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Introduction
In the past ten or more years, rapid technological advancements have been witnessed in almost every aspect of life. The field of medicine has not been spared by such developments. Electronic health records implementation is among the technologies that make integral contributions to the evolution of health care. However, Electronic Health Records (EHRs) also come with a few setbacks that should worry about their users.
The consumers of EHRs might have embraced their heterogeneity across various systems of health care provision, including their relationship with other health care providers. However, they did not consider the implications of EHRs for patient safety. Hence, this paper gives an in-depth review of the heterogeneity of Electronic Health Records in relation to patient safety.
Literature Review
The Heterogeneity of Electronic Health Records
According to Clarke et al. (2016), the design of most software and devices of electronic medical records has a profound impact on their users. The best way to move in line with the increasing complexity that is emanating from the health care activities in the Neonatal Intensive Care Units is to use state-of-art Electronic Medical Records (EMRs). With such a technology, health care providers get access to the latest information about their patients, as well as the diagnostics generated by the machines and/or from clinical records. Such EMRs also enable caregivers to have access to and learn how to use the digitized program of information entry referred to as the Computerized Physician Order Entry (CPOE).
With the help of technological innovations such as the EHRs, new forums open for the systems of health and care provisions to the extent of boosting the relevance and accuracy of the information that the health care providers can access on the wellbeing of patients and the society. These technologies not only introduce changes in terms of the mechanisms that are deployed in delivering care but also provide new ways of predicting, detecting, preventing, and treating diseases.
The diffusion and integration of the innovations and advancements of technology in the cases of critical care come with unexpected consequences. Examples include changes in the roles of staff, workflow, and the outcomes of patients (Clarke et al., 2016).
From a broad perspective, Hydari, Telang, and Marella (2015) assert that the heterogeneity of Electronic Health Records encompasses the benefits derived from using them. The first beneficiary of these technologies is the patient. Using EHR improves communication between health care providers while at the same time allowing each of them to have access to the full medical background of the patient. This development is in contrast to the traditional methods in which physicians viewed the latest information about their patients. With these records, they can give a detailed analysis of patients who are in need of medical attention. EHRs enable doctors to provide an accurate and quick diagnosis to their clients.
Another benefit of the EHRs is that they lessen the burden of following up on the health needs of a patient and/or giving a record of accomplishment (Hydari et al., 2015). In the case of the traditional methods, physicians could only monitor the patients under their care. However, this rigidity is currently not a problem anymore since the EHR enables general practitioners to extend their services to the patients of other doctors. With these technological innovations, doctors can derive test results and/or appraise them with their patients. The aim is to help them in not only understanding issues that can harm their lives but also verifying past medical procedures and examinations.
Besides flexibility and reducing the workload, Electronic Health Records also save time during the physicians office visits (Hydari et al., 2015). For example, they can provide life-saving and other vital information in the case of an emergency. In addition, it is helpful for those who become victims of mass casualties. Unlike traditional systems, doctors can use EHRs in risky situations such as the cases of natural calamities to access the past medical information of the patient involved in the accident.
Such catastrophic situations leave the victims confused and having no memory of themselves, past events, or medical information. Some of them cannot even speak for themselves. However, with the help of Electronic Health Records, health care providers can still access patients health history and blood type. The EHR technologies make access to patients information scalable (Hydari et al., 2015). However, it is crucial to examine EHR heterogeneity poses any problem. The subsequent section examines this subject.
The Problems of Heterogeneity
According to Pan and Cimino (2014), the unfortunate case of the heterogeneous nature of Electronic Health Records is that such reports pose various challenges, including data retrieval. While many health care providers advocate the use of these records in hospitals, they lack the mechanisms and strategies for ensuring that the consumer market gets universal access to them. Most of their attempts to ensure that these technologies do not provide substandard services or fall short of reaching some users fail to attain fruition.
In addition, health care providers also struggle in their attempts to campaign for the uptake of new models and methods for health care provision in line with the Electronic Health Records. One of the factors that lure medics into using these technologies is the fact that they can handle, as well as store large volumes of information. However, this factor is a challenge in itself since it leaves the physicians with the trouble of having to deal with an extensive database.
Health care providers store the Electronic Health Records they use to give descriptions for the diseases and methods for treating patients in specific sections or regions of the hospital where they design or create them. However, they may treat their patients in a different health facility. This situation forces them to integrate health reports from different locations. Unless they adopt such a strategy, any network of hospitals may not find it easy to give a detailed evaluation of the health background of the patient in question.
Integrating the proceedings is a heterogeneous process that presents various problems that the health care providers must solve to have a seamless blend of Electronic Health Records from different health units. Such a move may also help them to use the records on a regular basis.
One of the problems of integrating information about patients is that rarely do two separate health centers use the same DBMS. Hence, they lack the properties of the traditional atomicity, constancy, segregation, and robustness (ACSR). As a result, the issues of consistency or autonomy arise. Fortunately, this problem is solvable if health care providers use the properties of relaxed ACSR in the different regions where the hospitals are located.
Another problem that emanates from the heterogeneity of Electronic Health Records is the incompatibility of different standards for registering the EHRs. The most startling issue about this shortcoming is the fact that it has no solution if the process of registering one location is not well-matched with that of another region.
Patient Safety
The most intriguing factor about the adoption of Electronic Health Records and the central focus of this paper is its implications on the safety of patients. According to Ventura et al. (2011), introducing these technologies helps their users to migrate from the use of the traditional methods to the digital concepts of providing health care. However, the adoption of these technologies fails to unravel the weaknesses in them. Examples of the shortcomings that come with the EHRs include the complications of their usability, workflow interruption, and the difficulties in their ability to interact with the patients. Hence, they compromise patient safety.
Analysts such as Pan and Cimino (2014) assert that replacing paper with electronic records is a daunting task that requires much effort, time, and resources. Health care providers and facilities seem to focus on the benefits of EHRs while overlooking the shortcomings associated with such records. These technologies need further improvement since the past efforts to upgrade them failed to register significant changes concerning the safety of patients as the world had expected.
The only problem with the EHR approach to patient management is the fact the medics seem not to know how to go about the process of handling or enhancing the records. The first school of thought argues that the best way to improve the EHRs is to collect relevant data to be studied. According to earlier studies, various scholars have identified several errors in different facilities. For example, the database of the Pharmacopeia MEDMARX of the United States compiled a list of about 10,000 mistakes in which the CPOE contributed to over a million medical mishaps recorded in the country (Ventura et al., 2011).
According to the database, these errors related to the CPOE underwent meticulous analysis and categorization as the researchers designed other platforms for testing whether similar mistakes could emanate from compiling a list of orders with the help of the current Computerized Physician Order Entry (Ventura et al., 2011). According to this study, the modern systems of Computerized Physician Order Entry can effortlessly accommodate a significant percentage of the same errors.
For example, a health care provider using these technologies can give a prescription of pioglitazone for a patient suffering from heart failure with the hope that the other doctors will flag it down for review. Unfortunately, the mistake in such medication is that pioglitazone also hastens the withholding of body fluids, a situation that can exacerbate the condition of the heart malfunction.
Relying on the programs that promote self-reporting such as the MEDMARX is a challenge because they contain a subset of the entire population. This case presents a bias. A significant percentage of the errors in the data files do not emanate from order entry. Hence, it has second-hand data that lack sufficient information. For this reason, efforts of past researches do not present a perfect view of the issues that arise from the Computerized Physician Order Entry, including how the medics can find appropriate solutions to them. An average-sized public health facility in the United States can record as many as 10,000 reports.
However, since the country has over 5,000 health amenities, the researchers have many places to conduct further research on the use of EHRs. The most stimulating issue about the use of the modern Computerized Physician Order Entry system is that it fails to capture most of the errors associated with it. One of the factors that attract such an error is the complex nature of Electronic Health Records. Some of the mistakes in the medical reports that modern technologies fail to capture are the same ones the earlier devices registered.
The same complexity leads to the fact that the errors in the EHRs span in almost all aspects of the systems functionality, including allowing speedy and perfect entry of notes, prescription reconciliation, result display, and the opening of forums for ordering a range of services. Besides medications, these problems also extend to the laboratory tests and imaging systems.
The usability of EHRs needs improvement to offer better workflow and swiftness in its use. While the responsiveness of usability leans towards the health care providers, most of these improvements need the input of the developers of this technological innovation. It is worth noting that some of the Computerized Physician Order Entry frameworks do not have hitches in their functionality. For example, they will not delay in alerting the prescriber if he or she orders drugs to which his or her patient is allergic provided the entries of the EHR registered an allergy.
Inciting the benefits of Computerized Physician Order Entry, many studies focus on the reduction of such errors (King, Patel, Jamoom, & Furukawa, 2014). However, the same research fails to consider mistakes such as placing an order for the prescription of pioglitazone in the case of a patient suffering from heart breakdown. Here, one question arises: how do the health care providers record in the EHR that a patient has such a problem? The quickest fix for such cases is to use the digitized problem lists. Although such lists were not commonplace in the past, they involve several inaccuracies. For this reason, any alert from the EHR to avoid the prescription of pioglitazone is likely to present many errors.
Even the simple rules of Computerized Decision Support still present some safety problems to the users. For example, the alerts for drug-drug interactions in most commercial Electronic Health Records do not consider the age of the patient, renal functions, and other primary checkups. Hence, physicians need to undertake mid-orders to receive the alerts during the time of prescription. As a result, the health care providers end up overriding these alerts to the extent of leading to missing an alert that can prove helpful to the overall treatment of the patient. In addition, even checking the limit errors for prescription dose orders seems a struggle with Electronic Health Records. One can deduce that the problems will only increase if no intervention takes place.
The shortcomings of these technologies will not disappear if those responsible such as the manufacturers and medics do not respond appropriately. Hence, they need to conduct further research on the Electronic Health Records, study the errors in the reports, and/or use the data collected from the studies to improve the usability of the systems. Vendors and designers of these technologies alone cannot handle all these tasks and need to improvise a comprehensive framework for handling the critical issues at first. One of the most pressing issues about the errors in the Electronic Health Records is that most of the previously done studies identified them long enough, although no medical unit has tried to leverage them to date. As a result, the modern systems of Computerized Practitioner Order Entry fail to detect some errors (King et al., 2014).
The Corrective Measures
The findings of the weaknesses in the modern versions of Electronic Health Records bring the feeling of pessimism. However, several reasons have been cited for optimism. One of the reasons is that these technological innovations will still make the provision of healthcare a safe practice. For example, quick response to these shortfalls by the researchers, manufacturers, and medics can improve safety in the use of these technologies for medical care. The use of Computerized Practitioner Order Entry systems took shape in the past five years. During this period, their consumers learned their weaknesses. My belief is that the same time also presented an opportunity for rectifying errors in these technologies.
With a five-year experience, medics can conduct research on practical measures that help them to make the Electronic Health Records safer to use for medical care compared to how they were more than ten years ago. For this reason, the errors highlighted in this paper open a forum for investigating the shortfalls of the EHRs and their safety for use in medical care.
The strategy for filling the loopholes in these technological innovations should begin by gathering as many problems as possible about the Computerized Practitioner Order Entry systems and learning from them with the sole focus on developing better strategies for using them for health care provision. Subsequently, they can refine both the EHRs and CPOE to attain their potential in handling issues of health care provision (Payne, 2016).
Standardized Electronic Health Records keep information about the allergies and medications of a patient. In addition, they also conduct automatic checkups for health issues whenever the physicians prescribe a new medication. Such records also send signals (alerts) to the health care providers about potential conflicts. The information collected by the physicians is entered into the CPOE. It can also be recorded in the Electronic Health database.
Electronic Health Records transmit the same information to the doctor in the hospitals emergency division. An example of information that medical practitioners can record in the EHR is one that involves a life-risking allergy that the patient could have developed in the past. In this case, the emergency staff can provide the appropriate medical care. With the help of standardized EHRs, doctors can administer the relevant medication even if the patients health status is critical (Payne, 2016).
If standardized, Electronic Health Records can uncover the potential issues of patient safety when they arise. Hence, they can help physicians, clinicians, and doctors to avoid other health problems that revolve around patient safety. The overall outcome is improved health care provision. In addition, the Electronic Health Records can also help them to identify and rectify the operational issues in a quick and systematic way. In the case of the traditional methods, the health care providers struggled to identify the same problems. In fact, rectifying any underlying issue would take them more than five years.
Behind the widespread adoption of Electronic Health Records is the belief that they can prevent some harm risks for patients if used in an appropriate manner. For example, besides standardizing and facilitating the transmission of information from one health care provider to another, they can bridge the communication gaps by providing prompt notifications in case of abnormalities in the test outcomes. Here, the assumption is that those who use the records will do so in the correct manner with the intention of observing the provisions of the routine practice (Gheorghiu & Hagens, 2016).
Electronic Health Records are crucial in providing medical care to patients on more than one level. For instance, they help in attaining the targets of the various national programs that aim at improving patient safety using electronic data, especially when detecting, managing, and learning from upcoming safety activities. The problem with the current systems that are used in measuring the safety events is that their users over-depend on the incident reports, although they only detect a small set of the same safety issues.
On the contrary, other automatable programs can give quick alerts about patient issues, although they do not get the same attention. To restore patient safety with the use of these technologies, medical practitioners can undergo upgrading to detect the underreported and omitted errors such as those that relate to patients who need medication monitoring. Another school of thought holds that Electronic Health Records can also cover patients who do not receive proper surveillance, especially after medication, including those who do not get appropriate follow-up care after hospitalization. Such records also help patients who have received radiologic tests or abnormal laboratory results
. EHR-related trigger programs can also assist healthcare providers to detect commission shortfalls that are associated with preventable adverse cases of drug prescription, postoperative problems, and patient misidentification.
Medical institutions and manufacturers need to leverage Electronic Health Records to promote the rapid detection of health-related problems, including those that are linked to the EHRs. The goal is to improve the surveillance of high-priority cases of patient safety. In addition, standardized EHRs can help physicians to keep track of trends over a long period. These technological advancements can also facilitate the upgrading of the existing systems that health facilities use in reporting patient issues to the organizations concerned with their safety. Consequently, they improve the development of data concerning various safety events.
An example includes using an e-PSG in conjunction with Electronic Health Records to detect, report, and monitor the potential events and issues that can compromise patient safety. Such a combination can improve the process of detecting and reporting health-related issues while at the same time allowing the providers to use the resources in areas of significant needs such as patient safety (Sittig & Singh, 2012).
Conclusion
As revealed in this paper, Electronic Health Records have several benefits to health care providers and patients. However, they also jeopardize their safety because of their complex nature, which encompasses almost every aspect of their usability. For example, their shortfalls include errors that are associated with the systems quick entry of notes, medication reconciliation, result display, and their capacity to open forums for ordering a range of services, laboratory testing, and imaging therapies. On the bright side, these errors are fixable. Once rectified, the Electronic Health Records can guarantee patient safety by providing various measures for improving the provision of health care.
Reference List
Clarke, A., Adamson, J., Ian, W., Sheard, L., Cairns, P., & Wright, J. (2016). The impact of electronic records on patient safety: A qualitative study. BMC Medical Informatics & Decision Making, 16(1), 1-7.
Gheorghiu, B., & Hagens, S. (2016). Measuring interoperable EHR adoption and maturity: A Canadian example. BMC Medical Informatics & Decision Making, 16(8), 1-7.
Hydari, M. Z., Telang, R., & Marella, W. M. (2015). Electronic health records and patient safety. Communications of the ACM, 58(11), 30-32.
King, J., Patel, V., Jamoom, E. W., & Furukawa, M. F. (2014). Clinical benefits of electronic health record use: National findings. Health Services Research, 12(1), 392-404.
Pan, X., & Cimino, J. (2014). Locating relevant patient information in electronic health record data using representations of clinical concepts and database structures. AMIA Annual Symposium Proceedings, 1(1), 969-975.
Payne, T. H. (2016). Electronic health records and patient safety: Should we be discouraged? BMJ Quality and Safety, 24(4), 239-240.
Sittig, D. F., & Singh, H. (2012). Electronic Health Records and National Patient-Safety Goals. The New England Journal of Medicine, 367(19), 1854-1860.
Ventura, M., Battan, A., Zorloni, C., Abbiati, L., Colombo, M., Farina, S., & Tagliabue, P. (2011). The electronic medical record: pros and cons. The Journal Of Maternal-Fetal & Neonatal Medicine, 1(1), 163-166.
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