Health care providers are facing various challenges, especially in recording and managing health information with the ever-increasing number of patients. Manual recording of patient health information on paper has proven tiresome, erroneous, time consuming, and highly unreliable. Therefore, many health care providers have adopted Electronic Health Care (EHR) systems for easy accessibility and accuracy of their patients’ health information. In relation to this, this paper aims to present the various challenges associated with paper recording of health information and hence develop a plan for changing health facilities from paper records to electronic health records. The research used case study of two health care facilities in Appalachia, one of the poorest regions in the United States, which cater for health needs for vulnerable and poor populations. Observations and questionnaire were used in collecting data. The results collected indicate that paper records are inefficient and unreliable in recording patients’ health information. EMRs are accurate, allow easy and quick access to patients’ health information, and hence improve the efficiency and reliability of health care providers. However, careful considerations such as involving all clinic employees and educating them on the usability and importance of EMRs are of high importance in ensuring the EMRs are successfully implemented.
Empirical research shows that the clinical field is facing various challenges, especially in the area of Health Information and Information Management (HIIM). Paperwork has proven tedious and erroneous. Therefore, this research addresses the various issues facing health providers especially those located in vulnerable populations in the US and hence present how paperwork can be converted into an “Electronic Health Record (EHR).” In relation to this, the US federal government has embraced the idea of EHR in all health care providers’ centers and it aims at making health care a paperless institution by 2014. The research will use case study of two health care centers in Appalachia, an area populated with poor and vulnerable people. A case study was chosen because of time limit and for enhancing the gathering of detailed information that can be generalized to cover all health care centers in all parts of America occupied with such populations. Questionnaires and observation will be used to collect primary data because they are liable, and easy to conduct.
Statement of the Problem
According to Amatayakul (2007), accessing accurate and up-to-date health information in many health care centers has become a challenge. As the author points out, this problem has existed since time in memorial. This is because health care centers have been reported to be among the institutions that serve thousands of people on daily basis because people fall sick any time. Therefore, manual collection, exchange, recording, and storing of health information of all these people have become slow, fragmented, and highly prone to errors. According to Smith et al. (2005), there are many incidents where clinicians have reported the loss of key information from patient’s paper, health records. There have been errors of medical records covering transactions from inpatient to outpatient care mainly because primary care providers are not updated of the patient’s discharge or recent hospitalization promptly (Moore et al., 2003). Therefore, this project will be of high importance in the field of HIIM, in several ways. First, it will increase the liability of the health information by eliminating manual errors. Second, it will enhance easy and quick access to health information. Third, patient information can be securely accessed from multiple locations. Fourth, significant clinical or public health can be reported promptly. Fifth, patients’ information can be transmitted across various health care facilities and hence improve the effectiveness and efficiency of health care providers in general.
According to the “US Department of Health and Human Services (2011),” an Electronic Health record can be described as a computerized record containing a patient’s health information, such as progress notes, medical problems and their medications as well as laboratory results among others. This information is electronically recorded in each visit that a patient pays in a health care center that uses this form of recording. As Collen (1995) points out, the development of EHR started in 1960s and 70s a period when medical centers had started creating their information systems. However, researchers argue that many of the primary health providers who have designed and implemented them have not achieved the goal of EHR, which is to compile patients’ health information for easy and quick accessibility.
It was not until 1980s when public and private health institutions realized the benefits associated with EHR. Following this realization, many public and private health care providers started adopting this form of recording. According to Briggs (2000), the initial EHR were called “Clinical Information Systems.” Since then, various EHRs have been developed and constituently reviewed to minimize errors and promote the competence and efficacy of health care providers, especially in the area of HIIM. Kohn, Corrigan, and Donaldson (1999), argue that nowadays EHRs perform important multiple functions, especially in Health information management. EHR have changed all the manual recording of health information and made it automatic. They are extensively used in various clinical practices, such as appointment, scheduling, admission, and discharge of patients, collection of patients’ health information, patients’ visits and procedural notes and coding, and submission of patients’ claims among others.
According to “Health Information and Management Systems Society (2011),” EHRs also provide various clinical tools, such as prescription through the internet, ordering, and viewing of laboratory and radiology results via the net, provision of information to patients while at home via the net for proper adherence to clinical guidelines. As De Wet, McDonald, and Pistorius (1998) argue, EHRs have been improved to enable health care providers perform practices, such as accessing patients’ information remotely and from various practice locations. This has greatly enhanced the efficiency of health care providers, as they do not have to travel from a medical center to another to access a patient’s health information. EHRs have made it possible for various significant, clinical events to be reported in time and quickly. It is now possible to transfer patients’ health information from one health care facility to another in different parts of the country.
According to Wang, Middleton, and Prosser (2003), despite their various best practices, EMRs have various disadvantages. EMRs are computerized and this means they are highly susceptible to system crash downs. If a system crashes down, the entire health center as an institution is paralyzed. Therefore, health care providers should have back-up systems, such as paper records to take care of such catastrophes. Another challenge facing the EHRs is occasional poor system response, which may lead to many users losing patience. To enhance security, many EHRs have encouraged users to create passwords to secure their health information. As a result, EMRs have become flooded with thousands of passwords making them congested and hence slow. According to Centre for Disease Control and Prevention (2005), some researchers also argue that overreliance on EMRs can impair face to face communication between health care workers and patients, which is of high importance in ensuring effective health care.
According to Bodenheimer and Grumbach (2003), converting an organization from using electronic paper records to using electronic ones is not a simple task. Implementing EHR can be challenging, especially for the minor practices. Initial financial costs and adoption are the main barriers to implementation of an EHR. As Stello and Charlton (1999) explain, currently, there are various EHRs products and hence one can easily choose the wrong EMR for a health provider facility. The other challenge experienced in implementation of an EHR is resistance from clinic staff as some fear technology and others fear to lose their jobs, especially those in charge of record keeping. The time and labor needed to transfer data from existing paper records into a new EHR also discourages some health workers. In small-scale and the developing health care facilities, the main challenge is lack of enough training for the staff, and hence difficulties in using and adopting a new EHR system. However, research shows that these barriers are being overcome through various solutions, such as adequate staff training, careful selection of an EHR system from the many options and educating clinic staff on the importance of EHR to win over their support.
Two urban primary care settings in Appalachia were chosen as the case studies for the research. From each of the two health care centers, five health care providers were issued with questionnaires. The questionnaire was designed to collect data mainly on health information recording and the challenges faced. The questionnaire also aimed at finding if there were any efforts made in implementing an EHR system in any of these institutions, and the challenges faced in the implementation process. Issues such as awareness of the staff with EHR and their fears on its implementation were also scrutinized through the questionnaire. In addition to questionnaires, in-depth observation of patient-provider encounters was conducted to investigate further the challenges faced with paper recording of health information. The observations were carried in a period of three weeks. The filled questionnaires were collected and information gathered was analyzed.
Results and Discussion
From the observation made and the data collected using the questionnaires, there was enough evidence that manual paper recording of patients’ health information was tedious, erroneous, and unreliable. From observations, many patients were attended by each provider per day leading to erroneous recording of health information because of exhaustion. According to the answers provided in many questionnaires, the information gathered and recorded manually is limited, because health providers want to lessen their duties. It was also evident that the existing tools of collecting data were not up to standard.
According to the data collected, one of the health care centers selected for this research had attempted implementing an EHR system in the past, but was not successful. The main reason that made it fail was that the health care providers resisted it because they had not been taught about its importance and had received no training concerning its adoption and usability. As Isham, Austin, and Berman (2003) point out, it is very important that mangers of health care facilities do not force implementation of EMRs in their organizations without involving their employees, as their support is of high importance in determining the success of the EMR system implemented. It is important that health care centers’ mangers should make it a priority to educate their staff on the usability and importance of EMRs to win over their support.
Application of the Research Findings to the Clinical Area
According to recent empirical research done in the field of health information management, it is argued that manual recoding of health information has proven inefficient in meeting the ever-increasing needs of health care providers in terms of information recording and management. The research findings are highly usable, as they have highlighted the various challenges faced by health care providers in manual recording of patients’ health information. It is clear from the findings that paper recording of health information is tedious, time consuming, highly erroneous, and unreliable. Information gathered through paper records is limited and substandard. Health care providers are spending much time and energy in manually recording health information of the many patients they attend to per day. Many times important information has been reported missing in patients’ records making the work of health care providers more tiresome and inefficient.
According to Tang, Coye, and Bakken (2003), all these challenges can be overcome by properly converting health care institutions from paper records to EHRs. The research findings are useful as they emphasize the various considerations that must be made in implementing an EHR system for it to become a success. However, as noted earlier in implementing an HER system, health care providers must be very careful to avoid various pitfalls that can make the system ineffective. Such considerations include, involving the employees in the implementation process, educating them on the importance and usability of the system and financial considerations. If an EHR system is implemented effectively, it makes the collection, recoding, and overall management of patient health information easy and fast. The information can also be accessed easily, remotely, and from multiple locations hence enhancing the overall performance, efficiency, and effectiveness of health care providers.
Recommendations for Future Research
The research conducted has various limitations. First, the time was not enough for gathering adequate data for generalization. The study sample was also very small. The literature review is not extensive because the topic is broad. Therefore, future extensive researches should be conducted on this topic. The researches should take a longer period and investigate the actual implementation of an EHR system to come up with the challenges faced and how they can be overcome. The researchers should use larger samples to make generalization of their findings more viable.
From the paper, it is clear that paper records have become unreliable in health information recording and management. Manual recording of patient health information is tiresome, time consuming, and highly erroneous. Therefore, many health care providers have developed and implemented EMRs to overcome these challenges. EMRs have proved useful in recording correct and up-to-date health information. Accessing patients’ health information through an EMR system is easy and can be done from various locations. Transmission of patients’ health information from one health care facility to another is possible using EMRs. Therefore, EMRs have made health care providers more efficient, effective, and hence reliable.