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electronic health record

electronic health record (EHR) (and electronic patient records (EPR) or computerized patient record ) is an evolving concept defined as the systematic collection of electronic health information about individual patients or populations. This is a record in digital form that is capable of splitting into different health care settings, which are embedded in a network connected to the entire enterprise information systems. Such records must include the full range of data in a comprehensive or summary form, including demographics, medical history, medications and allergies, immunization status, laboratory test results, radiology images, vital signs, personal statistics such as age and weight, and billing information.

The purpose can be understood as a complete record of patient encounters that enables the automation and rationalization of health care settings, and increasing safety through evidence-based decision support, quality management and performance reports

Terminology

Terms of EHR, EPR and EMR (electronic medical record) are often used interchangeably, although the difference between them can be definirati.EMZ can be defined as a legal patient records created in hospitals and ambulatory environments, which is the source of data for the EHR. [3] It is important to note that the EHR is created and maintained within an institution, such as hospitals, integrated delivery networks, medical clinic, doctor or office, to patients, physicians and other health care providers, employers and payers or insurers access to patient medical records by objects. [4]

personal health record, in modern speech, generally defined as an EHR that individual patient control.

philosophical view of EHR

In the meta-narratives systematic review of research in the field, Professor Trish Greenhalgh and colleagues defined a number of different philosophical approach to EHR [5]. Health information systems literature has seen the EHR as a container holding the patient records, and a tool for aggregating clinical data for secondary uses (billing, auditing and Dr. ). However, other research traditions see the EHR as an artifact in the context of socio-technical system. For example, actor network theory to see the EHR as an actant in the network (, eg [6]), while research in computer supported cooperative work (CSCW) see the EHR as a tool supporting a particular job . Prof. Barry Robson and OK Baek also examined these aspects and see the EHR as a key to human history.

History

History

Advantages

several potential advantages over paper records EHRs have been proposed, but the debate about the extent to which they are achieved in practice (, eg [9]).

Cost reduction

In the U.S., large amounts of funds are allocated to the health care industry more than $ 1.7 trillion annually. [10] If the savings allocated by using the current level of spending from the National Health Accounts, Medicare would receive about $ 23 billion in potential savings per year, while private payers will receive a $ 31 billion annually.

to improve the quality of care

implementation of electronic health records (EHR) can help reduce patient pain due to medical errors and the inability of analysts to assess quality. [10] Information technology is now used to automate the day-to-day processes, so helping to reduce administrative costs, which then in turn can free up time and money for health care. [11]

EHR systems can help reduce medical errors by providing health professionals with decision support. [12] Fast access to medical literature and current best practices in medicine are assumed to allow for expansion of ongoing improvements in health. [13] Increased use of EHR achieves what appears on screen or on paper is not only longitudinally, but hierarchically arranged and layered. During development, while hospitalization or walked serving patients, ease to get access to the details of the enhanced browser capabilities applied to the screen presentation and cross referring to certain concepts of ICD coding, DRG and medical information, procedures <[EM> citation needed ].

Computerized physician order entry (CPOE)-a component-EHR enhances patient safety by listing instructions for doctors to follow when prescribing medication to patients. Of course, tremendously CPOE can reduce medical errors:. CPOE could eliminate 200,000 adverse drug events and save about $ 1 billion annually if installed in all hospitals

promotion-based medicine

EHRs provide access to unprecedented amounts of clinical data for research that can accelerate the level of knowledge of effective medical practice.

Realistically, these benefits can be realized only if systems are interoperable EHR and the wide spread (eg, national or regional level), so that different systems can easily share information. Also, to avoid mistakes that can cause injury to the patient and violations of privacy best practices in software engineering and medical informatics should be deployed.

records and mobility

EHR systems have the advantage of being able to connect to many electronic medical record system. In the current global medical environment, patients are shopping for their actions. Many international patients travel to U.S. cities with academic research centers for specialty treatment or to participate in clinical trials. Coordination of these appointments via paper records the time the proceedings.

Disadvantages

Critics point out that, although EHRs could save the "health system", money, doctors, those who buy the system, they can not benefit financially. EHR price tags range widely, depending on what is included, as a robust system, and how providers can use it. When asked what they paid for the on-line survey, about a third of respondents paid between $ 500 and $ 3,000 per liječniku.Treći paid between $ 3,001 and $ 6,000, and 33 percent paid more than $ 6,000 per physician for the EHR. [16] Physicians tend to see at least temporarily reduced productivity, as implemented EHR. They spend more time entering data into an empty EHR but have to spend updating the paper chart with a simple dictation. Such obstacles can be overcome by a software has some data, as well as doctors learn to use templates for data entry, and work practice changes, but do not get any practice so far.

Studies have also called into question whether, in real life, EHRs improve quality. [17] [18] 2009 is the number of articles raising doubts EHR benefits. [19] [20] [21]

costs

the steep price of EHR and provider uncertainty about the values ​​that will result from adoption in the form of return on investment is a significant influence on the adoption of EHR. [22] In a project initiated by the Office of National Coordinator for Health Information (ONC), the inspectors found that hospital administrators and physicians who have adopted EHR noted that any gains in efficiency was offset by reduced productivity as the technology is implemented, and the need for increasing the information technology staff to maintain the system. [22]

U.S. Congressional Budget Office has concluded that the savings could only happen in a large integrated institutions such as Kaiser Permanente, and not in small physician offices. They challenge Rand Corp. estimates savings. "Office based physicians in particular may see no benefit if they buy such a product and May even suffer financial harm. Although the use of health care that could generate savings for the health system in general to offset the cost of EHR, many doctors may not be able to to reduce your office costs or increase their income enough to pay for it. for example. the use of health care that could reduce the number of duplicate diagnostic tests. However, that improvement in efficiency is likely to increase the income of many physicians. "If the doctor carries out tests in the office, this could reduce his or her income. "Given the ease at which information can be exchanged between healthcare information systems, patients use the doctors they may feel that their privacy is more at risk than securities, if the records were used.

during

Often, doctors do not want to spend time to learn the new system. Some doctors believe that the adoption of a system with EHRs could reduce clinical productivity. [25]

management, privacy and legal issues

privacy concerns

In the United States, Britain and Germany, the concept of a national centralized service model of health care information is poorly received. Privacy and security in this model are of interest.

policy applies to health applies to paper and electronic records. According to Los Angeles Times , about 150 people (from doctors and nurses to technicians and billing staff) have access to at least part of the patient records during a hospitalization, and 600,000 payers, providers and other entities dealing with providers billing some access too. [28] recently published a "safe" data breach in a centralized data repositories in the banking and other financial institutions, retail industry and from government databases, have caused concern about the preservation of electronic medical records in a central location. [29] data which are exchanged over the internet subject to the same safety reasons as well as any other type of data transactions over the Internet.

Health Insurance Portability and Accountability Act (HIPAA) was passed in the U.S. in 1996 to establish rules for access, authentications, storage and review, and forwarding of electronic medical records. This is the standard limit for electronic records more stringent than those for paper records. However, there is concern that the adequacy of these standards. [30]

In the European Union (EU), several directives of the European Parliament and the Council protect the processing and free movement of personal data, including the health care needs. [31]

Data Protection and Electronic Documents Act (PIPEDA) was given Royal assent in Canada 13th April 2000 to establish rules on the use, disclosure and collection of personal data podataka.Osobne includes a non-digital and electronic form. In 2002, PIPEDA extended to the health sector in Phase 2 of law in the implementation [32] There are four provinces where the law does not apply because the Privacy Act is considered similar to PIPEDA: .. Alberta, British Columbia, Ontario and Quebec