Electronic Health Record – EHR
The concept of electronic health record is constantly evolving and there is a multitude of definitions and interpretations. EHR is defined as “a comprehensive medical record or similar documentation of the past and present physical and mental state of health of an individual in electronic form, and providing for ready availability of these data for medical treatment and other closely related purposes”.
The focus of EHR systems is on the overall patient’s health and it is designed to extend beyond the reach of healthcare organizations originally collecting and compiling patient health data. EHR is developed to share patient data with different health care providers, including specialists and clinical laboratories. The intent is to have all the patient information from different clinicians involved in the care of the patient.
The patient data moves along across the healthcare organization, the patient, the specialist, even outside the country. All the people involved in the patient care can access the EHR system, including the patients themselves.
The potentials of the electronic health record
The EHR is an important instrument to improve safety, quality and access to health care. The ageing of the population and the consequent higher number of people affected by chronic diseases and multiple morbidities combined with rising costs, are challenging the sustainability of health care systems across Europe. In addition, the increase in mobility of the population and of health professionals, requires that health records should become available on an ‘as and when’ basis from more locations. These complex factors create an urgent need to increase collaboration notably between health professionals but also between health and social service providers.
This transformation will require more than technology: it will require organisational and social innovation and a shift to a more open, collaborative, and integrated system. In this context the possible benefits of EHR can be substantial.
EHRs have the potential to empower patients by providing them with easier access to their health information. That allows them to exert more control over their health records, thereby becoming more responsible and more active in their own care while facilitating communication with their health professionals.
Furthermore, storing and transferring patient information electronically can significantly reduce clinical errors and improve patient safety. For example, fast access to critical health data could be a matter of life or death especially during emergencies like allergy or medicines interactions.
EHRs allow health professionals to communicate more quickly and accurately by identifying relevant information more easily and to better plan complex treatment procedures. They can contribute to the avoidance of cases where, for example, the same examination is performed twice, a better understanding of the patient’s history and also ensure continuity of care. From a patient’s perspective this means a higher quality of care. From a health professional perspective this means a chance for a better patient-health professional relationship. From a policy perspective, it means more sustainable healthcare systems.
Finally, with patients prior consent, EHRs can be useful for health research purposes and for policy decisions: if managed appropriately, if the security data is assured and if the data can be fully anonymised, huge amount of health data could be easily collected and be used in various scientific studies, including epidemiological analysis, evaluation of health care procedures, pharmacovigilance etc.
It is recognized that the EHR system will be built incrementally utilizing clinical information systems and decision support tools as building blocks of the EHR. The goal is to identify reasonable steps that can be taken by health care providers to advance EHR to accomplishment of full maturity in the years ahead.
EHR systems must support the delivery of personal health care services, including care delivery, care management, care support processes, and administrative processes. As individuals engage more actively in management of their own health, they too become important users of electronic health information. There are also important secondary uses, including education, regulation, clinical and health services research, public health, and policy support.
Core EHR system functionalities are:
• Patient Care Delivery
• Patient Care Management
• Patient Care Support Processes
• Financial and Other Administrative Processes
• Patient Self-Management
and they fall into eight categories:
• Health information and data
• Results management
• Order entry/management
• Decision support
• Electronic communication and connectivity
• Patient support
• Administrative processes
• Reporting & population health management
and should address the following:
1. Improve patient safety.
Safety is the prevention of harm to patients. Each year tens of thousands of people die as a result of preventable adverse events due to health care.
2. Support the delivery of effective patient care.
Effectiveness is providing services based on scientific knowledge to those who could benefit and at the same time refraining from providing services to those not likely to benefit. Only about one-half of Americans receive recommended medical care that is consistent with evidence-based practice guidelines.
3. Facilitate management of chronic conditions.
Chronic conditions are now the leading cause of illness, disability, and death. Persons with chronic conditions account for over 75 percent of all health care spending, and more than half of that spending is on behalf of people with multiple such conditions. More than half of those with chronic conditions have three or more different providers and report that they often receive conflicting information from those providers; moreover, many undergo duplicate tests and procedures, but still do not receive recommended care. Physicians also report difficulty in coordinating care for their patients with chronic conditions, and believe that this lack of coordination produces poor outcomes.
4. Improve efficiency.
Efficiency is the avoidance of waste, in particular, waste of equipment, supplies, ideas, and energy. Methods must be found to enhance the efficiency of health care professionals and reduce the administrative and labor costs associated with health care delivery and financing. Staffing shortages have developed in multiple health care professions, placing added pressure on providers to continually improve care processes with current staffing. The cost of private health insurance is increasing at an annual rate of greater than 12 percent, while individuals are paying more out of pocket and receiving fewer benefits. Addressing these issues represents a major challenge.
5. Feasibility of implementation.
This criterion in determining the time frames within which it is reasonable to expect providers’ EHR systems will be capable of demonstrating the key functionalities. The time period necessary for vendors to develop, produce, and market new software to achieve certain functionalities and the willingness of users to purchase and implement such systems must be considered. It would be advisable to reassess periodically the feasibility of implementing certain EHR functionalities and modify expectations regarding timing, as appropriate.
Assuming that the migration from paper records to a comprehensive EHR system will take a significant amount of years for most providers, functional requirements can be divided in three time periods:
• In the immediate future,
it is assumed that providers will focus on (1) the capture of essential patient data already found frequently in electronic form, such as laboratory and radiology results; (2) the acquisition of limited decision support capabilities for which software is readily available in the marketplace (e.g., order entry, electronic prescribing); and (3) the generation of reports required by external organizations for quality and safety oversight and public health reporting.
• In the near term,
providers’ EHR systems should (1) allow for the capture of defined sets of health information, (2) incorporate a core set of decision support functions (e.g., clinical guideline support, care plan implementation), and (3) support the exchange of basic patient care data and communication (e.g., laboratory results, medication data, discharge summaries) among the care settings (e.g. pharmacies, hospitals, nursing homes, home health agencies, etc.) within a community.
• In the longer term,
fully functional, comprehensive EHR systems will be available and implemented by some health systems and regions. It may take considerably longer, however, for all providers to be using a comprehensive EHR system that provides for the longitudinal collection of complete health information for an individual; immediate access to patient information by all authorized users within a secure environment; extensive use of knowledge support and decision support systems; and extensive support for applications that fall outside immediate patient.