The Electornic Health Records

Published Date: 02 Nov 2017

The Vice president of the American Health Information Management Association Donald T. Mon, Ph.D. said " As the EHR matures and truly becomes the national standard to be developed and implemented in software products over the remainder of this decade. HER is merely a vision tool for change in the evolving healthcare system." Dr. Mon also, referred to the true forces behind the comprehensive changes, in health information systems as in healthcare service, and the sophisticated communications and computer technology that are beyond everyone’s direct control. The ultimate goal of everyone who creates, uses, and manages health information should be to provide the best health care possible (Amatayakul 1999, vii).

The vision of the electronic health record has been into existence for almost 20 years. Initially, it was called the computer- bases patient record (CPR); in the mid-1990s, it became known as the electronic medical record. This system became available in the united states, and then it was spread around the world, including Middle East. This system is now installed in hospitals in UAE (United Arab Emirates), Saudi Arabia, Egypt and Qatar. This system is being used in these countries and is starting to spread in the gulf area more and more.

Meanwhile in Lebanon, the EHR system is still used just in the big hospitals in Lebanon like St. George hospital and the AUB MC (AUH). While, the other hospitals in Lebanon are still using the old system which is based on paper and handwritten work. However these two big hospitals has introduced these systems 2 years ago in 2011 and started using it

The vision didn’t change through the years, and the various name changes. Attempts, were made to implement the HER, it became clear that it was not a single system but rather a collection of interlocking systems that were tied to a series of complex clinical and administrative work. In addition such interlocking systems can’t be accessible to all due to their high cost.

In his 2004 of the Union Address, President Bush noted: " By computerizing Health records, we can avoid dangerous medical mistakes, reduce costs, and improve care."

To make it simple, EHR is not a simple computer application, nor a Play Station game, rather it represents a carefully constructed set of systems that are highly integrated and required a significant investment of time, money, process change, and human factor reengineering.

Defining the Electronic Health Records is not simple. Actually there is no standard definition. The EHR is not an information system that is purchased and installed as world-processing pack like Microsoft Excel, or as a billing system or even laboratory information systems that may have been to be connected to other information systems and devices and customized to the specific environment. Actually EHR is more than an information-integrated system that accomplishes a set of functions.

The value of integrating, clinical, financial, and administrative data contributes significantly to improvements in quality, costs and access to healthcare. Furthermore, EHR is not limited to a certain location, but it should include remote access for providers and consumers. Potentially, it should be capable of integrating data across providers and personal health records. EHR is sectioned into 3 basic categories that integrate the functionality of EHR. Thus, the technical system components of HER include source systems that collect data to support EHR infrastructure. These source systems include all administrative, financial, clinical departmental systems that relate in any way to the health record. Another technical system component is the human-computer interface that helps capture data, knowledge where users can enter or receive data such as computer workstations, personnel computer, and notebooks. Also, The American Health Information Management Association’s (AHIMA’s) Health Information Vision 2010 states that "health information will be used concurrently for multiple and diverse purposes, including healthcare delivery and treatment, outcomes measurement, finance, and disease prevention and surveillance at the individual, community, national, and inter- national levels" (AHIMA 2003).

EHR, addresses many functions in this growing and sophisticated network ranging from simple operations to multi- complex. Patient care charting, clinical messaging systems, personal health records, clinical decision support systems and a computerized physician provider are the most common and significant functions. Also there are many other, detailed functions or at least sub functions that might other highlight. Another related example is the personal health records systems, which are designed to support patient entered data. If a provider associates them, they can serve as a means for patients to access their own health records. And in come cases PHR’S can be with the EHR, and access is usually provided through a specialized Internet website.

Designing, marketing, and implementing information systems that provide access to clinical data and process data into information that contributes to knowledge for improved quality of care has been challenging. A number of major awkward blocks are being addressed in clinical, cost and value, and technological areas. Those blocks are the most identifiable limitations that can cause severe effects.

Computers are very good at storing large volumes of data and performing mathematical complex formulas. However, they do not have the human capability of "thinking" or making links or expectations on their own. A lot of work is being done to program computers to perform more "reasoning" functions and to "learn" to offer decision-making support. But these functions are very sophisticated and still very much under development. A good example of clinical data limitations may be to consider how a computer can process a simple statement such as "the skin is red." Interpretation of "red skin" depends on the context to define what is meant by "red." Does red describe a burned area, a rash, or an increase in temperature? What is the cause—fever, embarrassment, allergy, burn, high blood pressure, or something else?

Another factor that has presented limitations to clinical use of information systems includes the volume of patients. It is not uncommon for a primary care physician to treat eighty patients per day during flu season. To quickly record data for this volume of patients, the way in which the caregiver enters or retrieves data from the computer (the human–computer interface) needs to be perfected. We are beginning to see many small, wireless input devices, including personal digital assistants (PDAs) and tablet computers.

On other hand, Technological limitations have made clinical information systems difficult to use. The care of patients requires direct interaction between patients and caregivers. Pen and paper that slip into a pocket are much easier to manage when a care- giver is making rounds and administering to patients. Another technological limitation is the extent to which disparate computer systems can be made to work together and exchange data. Standard laws or protocols have been industrialized to help, but vendors have developed highly proprietary systems to encourage age providers to buy all components from one vendor. Another major limitation, for any provider is the high cost of HER’s. Today, all healthcare providers are seeing reduced revenue and increased costs. The Healthcare Financial Management Association (HFMA 2003) reports that providers are often strapped for cash and many have very limited access to capital. The systems undoubtedly cost a significant amount of money in addition to the time required to tailor them to the environment and to manage the degree of change they create. May parties around American, have attempted to reduce the cost of EHR. For example, the Open Source EHR project spearheaded by the American Academy of Family Practice Physicians has attempted to significantly lower the cost of EHRs for physician offices by sharing the source code for development purposes.

EHR system is an important undertaking for any healthcare organization. Although the concept of the EHR is not new, the industry is now just beginning to fully appreciate the complexity of the integration required to achieve a comprehensive Major stumbling blocks in value of information, and technological limitations, and the content of information are just beginning to be addressed. Because of the rapid rate of change in information technology, putting off electronic health record implementation until it becomes more affordable, more proven, or more acceptable.

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