The Implications of Maintaining a Nationwide Healthcare Record System

A Review of the Literature

Since the 1980s, healthcare providers and the United States government have worked towards implementing and maintaining electronic health records (EHR). The implementation of this type of system should improve many areas of healthcare. The implications of maintaining a nationwide healthcare record database are both positive and negative. Some of the positive aspects include improved care coordination, a decrease in medical errors, and improved population health due to tracking and research. The negatives with maintaining a nationwide health care record database include the cost of the system and the risk of privacy violations.

In the present paper, the implications of the implementation of EHR is investigated. The following 12 literature reviews attempt to discuss both the positive and negative implications with a specific focus on 1) patient outcomes, 2) care coordination, and 3) privacy of EHRs in private practice and nationwide.

Patient Outcomes

In a research article by Menachemi and Collum (2011), the benefits and drawbacks of EHRs are examined through a review of the literature. Of the benefits, the authors note that electronic health records might be a potential benefit for patients (Menachemi & Collum, 2011). The EHRs could help with care coordination, decrease medical errors due to penmanship, and even help improve research programs. Even with these benefits, the potential drawbacks are privacy concerns and the cost of implementing an EHR system. The capabilities are improved quality of care and computerized physician entry. This is important due to frequent penmanship errors with charts and prescriptions. It was found that a computerized EHR and computerized physician entry was associated with a 55% reduction in medication errors. The cost was another factor that showed the negative implications of a nationwide EHR. In a 2002 study of a 280-bed acute care hospital, the estimated cost for a seven-year-long EHR project was projected at $19 million (Menachemi & Collum, 2011). This included the cost of training staff, converting documents, and software installation of programs such as Lytec and MedEnt. Despite the cost to physicians, the U.S. government wants to transition as many providers as possible to this technology. So much so that the U.S. government enacted the Health Information Technology for Economic and Clinical Health Act of 2009 (HITECH) that provides about $560 million to states to create the infrastructure needed to implement a nationwide EHRs. One of the many reasons for this act was to improve patient outcomes through advancements in health information technology.

In an article by Schenarts, Goettler, White, Brett, and Waibel (2013), the concern was that implementation of EHRs would not improve patient outcomes and not make a difference in long-term care. The study focused on patients in a traumatic center. There was not a notable decrease in medical errors. Instead, it was revealed that the accuracy of charting decreased over time. This was due to providers using fillable forms and copying previous notes. This shows the negative impact and how medical errors can actually increase with the use of EHRs. These errors put the patient at risk for unnecessary tests. There was also an increase in billable encounters. This finding disputes what Menachemi and Collum (2011) reported.

In another article on patient outcomes, Bellazzi (2003) raised the issues of integrated disease management and EHRs. While diabetes was the focus of this article, the results can be applied to managing any disease. The limitations of EHRs speak to the organization of healthcare as a whole and the need for nationwide interventions to implement technologies that will help communication between providers to manage diseases more effectively. In a study of the One Health Plan in Denver, Colorado, patient outcomes were greatly improved and patients had fewer visits to the provider due to access to the internet, the ability to email providers, and an interactive voice responder service. There was also a significant cost saving for the health plan. Organizing the technology allowed for better patient care. Lastly, if the government used models like the one used by the One Health Plan, implementing a nationwide health record database would be more manageable and improve care coordination.

Care Coordination

In an article by Robinson (2010), it was noted that care coordination allowed healthcare providers to provide optimal care. The use of technology can benefit medical providers when helping patients with many health concerns and issues. The use of EHRs would ensure the accurate delivery of test results, lab finding, and other physician and nursing reports. As noted by Menachemi & Collum, 2011, increased use of technology and EHRs would also decrease medical and medication errors. Additionally, with the implementation of HITECH, more facilities can improve care coordination by developing EHR infrastructure.

Escobedo, Kirtane, and Berman (2012) reported that due to the increasing use of healthcare technology, care coordination has improved patient outcomes. The use of healthcare technology and EHRs specifically addresses having the right information at the right time. With the funds from the HITECH Act, there have been significant improvements in care coordination due to computerization and digital networks (Escobedo, Kirtan,e & Berman, 2012). Information in medical care is crucial to care coordination and establishing proper infrastructure allows for patients to receive the specific care needed, no matter they are treated. The promise of real-time data provides for support not only for the patient and family but also for medical staff. This decreased medical errors and redundant medical and laboratory tests. As noted in Bellazzi (2003), this also improved the relationship between patient and provider through increased information exchange.

Young, et al. (2007), found that the integration of care coordination models that use healthcare technology improved chronic illness in patients. The use of EHRs was a critical piece of care coordination that improved follow-up care and allowed information access for healthcare providers. This benefited the patients, especially in situations where the patients were unable to articulate the current problem or concern to the healthcare provider. Information flow was greatly improved due to the use of EHRs. But, due to significant cost and learning new systems, “electronic medical records can be limited in their scope, or become complex and unwieldy” (Young et al., 2007). The cost of implementing an EHR system is a barrier for small medical practices or even solo practitioners. Yet, this system can reduce medical errors.

Another benefit of implementing a nationwide healthcare record database system, as noted previously, is a reduction in medical errors. Pharmacies who utilize healthcare technology have also seen a decrease in medication errors. Siska and Tribble (2011), reported that due to increases in regulatory practices, the use of healthcare technology optimized the role of pharmacists while improving patient outcomes. The use of an EHR along with computerized physician entry for medications reduced the need to rely on memory, increased use of standard terminology, and ensured that patients received proper medications.

Along with improved patient outcomes, EHRs can also help improve outcomes for specific populations. In an article by Baldwin (2013), it was discussed that the fundamental building block of population health management is the EHR. Translating paper charts into digital information allows for greater preventative care as alerts can notify the physician of missing exams and other preventative measures. One example was that by using the EHR, a patient can be tracked via vital signs and lab results. Then a risk assessment can be performed to determine if a patient is at risk for a heart attack. This can be applied to many patients at once and help improve outcomes in population health management. This is another benefit to using a nationwide EHR database because these numbers can also help agencies like the Centers for Disease Control to use demographics to generate top health concerns in the population.

Privacy and Ethics

With increasing reliance on EHRs, doctor’s offices have moved from closed systems where information was stored within the organization to the “cloud”. “The cloud, servers, network, and storage are designed to be abstracted, which means you do not know where things physically reside” (Witt, 2011). In Witt’s (2011), article, privacy concerns and potential Health Insurance Portability and Accounting Act (HIPPA) violations were raised. With the use of the internet and storing EHRs, this benefits patients nationwide when they see a provider as the medical record is available. But, the pitfalls are that almost anyone associated with maintaining the server has access to confidential information. Organizations need to maintain contracts with vendors that ensure information is encrypted and protected. The contract should also have steep penalties associated with a breach of information.

And breaches are possible. Under HIPPA, patients can request information, with the exception of certain psychiatric records. There is a small measure of control over the patient’s information. But, with EHRs patients can simply have information sent electronically to a doctor, hospital, pharmacy, or another person. With a nationwide network of doctors, hospitals, pharmacies, and other healthcare organizations, the potential for HIPPA violations are enormous. The HITECH Act also mandated that healthcare organizations maintain the privacy of patient records, but how is this possible with an electronic, nationwide database of EHRs? As mentioned in Witt (2011), cloud computing puts EHRs at risk for access by unauthorized people. Despite this challenge, the U.S. government still wants to work with the private sector to develop a nationwide health network.

In an article by Samy, Ahmad, and Ismail (2010), the issue of threats to privacy within such a network is raised. For example, Samy, Ahmad, and Ismail (2010) noted that from 2006 to 2007, over 1.5 million names were exposed during data breaches that occurred in hospitals alone. This was attributed to several causes that range from power outages to human error or other technological errors. The power failure was one of the top reasons for security breaches. A power outage causes significant dangers for patients as providers are unable to access vital information.

The HITECH Act placed additional demands on healthcare providers by forcing providers to relook at HIPPA practices. Vines (2010), raised the issue of the cost of enforcing HIPPA requirements. The federal government mandated that through the HITECH Act that state attorneys prosecute for HIPPA violations. The act also created a federal requirement to report security breaches. A nationwide healthcare record system creates many opportunities for information breaches as more individuals will have access to the database. The government fully expected healthcare organizations to implement the use of EHRs within a certain timeframe or the organizations face penalties ranging from $25,000 to $1.5 million. This pressure reflects the view of Postman (2011).

In effect, the government is putting pressure on small private practices across the United States. This pressure works as an invisible technology and “works subversively but powerfully to create a new way of doing things” (Postman, 2011). Hence the HITECH Act and resulting stimulus package that provides funding and rewards for implementing healthcare technology.

References

Baldwin, G. (2013). Tracking population health. Health Data Management, 21(8).

Bellazzi, R. (2003). Electronic management systems in diabetes mellitus. Disease Management Health Outcomes, 11(3), 159-171.

Escobedo, M., Kirtane, J., & Berman, A. Health information technology: A path to improved care transitions and proactive patient care. Journal of the American Society on Aging, 36(4).

Menchemi, N. & Coolum, T. (2011). Benefits and drawbacks of electronic health record systems. Risk Management and Health Care Policy, 4, 47-55.

Postman, N. (2011). Technopoly: The surrender of culture to technology. Random House.

Robinson, K. (2010). Care coordination: A priority for health reform. Policy, Politics, and Nursing Practices, 11(4), 266-274.

Samy, G., Ahmad, R., & Ismail, Z. (2010). Security threats in healthcare information systems. Health Information Journal, 16(201).

Schnerts, P., Goettler, C., White, M., & Waibel, B. (2013). An objective study of the impact of electronic medical records on outcomes in trauma patients. Division of Trauma Surgery & Surgical Critical Care, Department of Surgery, Brody School of Medicine.

Siska, M. & Tribble, D. (2011). Opportunities and challenges related to technology in supporting optimal pharmacy practice models in hospitals and health systems, American Journal of Health-Systems Pharmacy, 68, 1116-1126.

Young, A., Chaney, E., Shoai, R., Bonner, L., Cohen, A., Doebbeling, B., Dorr, D., Goldstein, M., Kerr, E., Nichol, P., & Perrin, R. (2006). Information technology for chronic illness. Presented at the Department of Veteran Affairs Research and Development: State of the art conference.

Vines, J. (2010). HITECH Act brings more aggressive HIPAA enforcement. Receivables Report for America's Health Care Financial Managers, 25(6), 3-5.

Witt, C. (2011). HIPPA versus the cloud. Journal of Healthcare Compliance, September-October, 2011.