Medical Records: Electronic Health Records

Introduction
The institution of effective health care practice in the digital revolution age calls for timely, authoritative and accurate information from a wide number of sources. Most institutions have encouraged the professionals to adopt computers and other information technologies so as to ensure efficient delivery of health care practice (Lau et al., 2010). The implementation of Health Informatics in the health systems has been the center of most policy makers with the proponents arguing that the implementation will go a long way in ensuring that the health care
practice is boosted to higher levels. The major advantages cited are the increased collaboration, informed decision making, and the filling of the information gap that exists with the current traditional stand-alone systems (Lau et al., 2010). The proponents have also backed up their arguments with the benefits that accrue from the implementation of health informatics. The opponents on the other hand have leveraged on the barriers and associated disadvantages of health informatics and Electronic Health Records in the provision of adequate health care (Lau et al., 2010). This paper evaluates the concept of HER looking into the proposed benefits, barriers and their solutions for Canada, as well as the implications of EHR implementation to different stakeholders.
The Concept of Health Informatics and Electronic Health Records
Health informatics also known as healthcare informatics refers to an umbrella term that is used to describe the involvement of computers, communication technology and other myriad of electronic based applications in the provision as well as documentation of healthcare (Lau et al., 2010). In this definition it is lucid that health informatics uses computers and information communication technology to support variety of processes within the jurisdiction of health care practice.  Electronic health records abbreviated as EHR while also referred as electronic patient records or computerized patient records is a relatively new and evolving concept (Menachemi & Collum, 2011). EHR can be defined as the systematic collection, storage and management of electronic health information about a general population or patients. Essentially EHR comprises of progress notes, complications, past medical history, laboratory data, patient information or credentials, patient demographics, radiology reports and medications among others (Menachemi & Collum, 2011). Electronic health Records was coined in the 1960’s after the realization by doctors that full health history of the patients were not accessible. This called for innovation that would see the storage, management and use of comprehensive medical information in electronic form. Some of the first clinics to integrate this were the Mayo Clinic in Minnesota and Medical Center Hospital in Vermont. Electronic health records is an issue based on the fact that it is generated and maintained within an institution that could be a hospital, a clinic, physician’s office, and or integrated delivery networks. Meaning that there are some legal implications that surrounds its adoption and implementation because it is not longitudinal records reflecting all the care that has been given to the patient in all the available venues. The key stakeholders of EHRs are the nurses, general practitioners, patients, physicians, EHR vendors, policy makers, and safety advocates health care organizations such as hospitals, laboratories, clinics and pharmacies.
Proposed Benefits of Electronic Health Records
EHRs have a plethora of benefits that are reflected through their advantages and competencies. First off, EHRs enable informed decision making for the physicians based on the knowledge that is collaboratively shared among the practitioners and various institutions that interact with the patient at any one given time (Menachemi & Collum, 2011).  Based on the information available the practitioner is able to define better the disease their patient is ailing from and make the best decisions on the dosage to give and may be the need to refer them to particular specialists. It also guards against particular adverse events through increased aggregation, analysis and at the same time dissemination of patient’s information. The other benefit is improved patient care. The physicians are likely to access the patients’ records from remote locations, in patient records that enables more coordinated and efficient care to the patient in question.  The EHRs have also been linked with most research to increased adherence to the evidence based clinical effective care and guidelines (Menachemi & Collum, 2011). This has reduced the less common but adverse errors that are rampant in the health care setting.
Thirdly, the institution of HER offers convenience in health care provision especially when the patient stored records have been altered or lost. In this case, the practitioners will be more reliant on the available information in the networks to provide adequate health care to the patients. The providers are also able to coordinate some activities within their offices such as filing of insurance claims as well as e-prescriptions (Menachemi & Collum, 2011). Additionally, when in remote areas, the practitioners are still able to access and aptly respond to situations. EHRs are also a basis of quality improvement since the whole process of health care response is well documented and thus coordinated as well. With this the practitioners are better placed in ensuring that the diseases are well managed.
For the practitioners, EHRs provide a work-life balance that improves their productivity. EHRs reduce the costs and time involved in the paperwork thus improving safety, reduced redundancy of records, and thus efficient health care provision (Menachemi & Collum, 2011). The ultimate benefit of HER is that they allow the enhancement of security as well as privacy in the patient data since only the relevant practitioners are able to access and interact with the data.
In terms of organizational setting. Most physicians and practitioners who use EHRs affirm to have increased job satisfaction based on the ease of work. Secondly, there is increase in revenue since there is improved billing, cash flow, and optimized revenue (Menachemi & Collum, 2011). The reminders to patients also increase their frequency to the health care organizations thus increased revenue. Research in health care organization is also made easier by the mere fact that the information required is available. Lastly, EHRs ensure that there is compliance with the regulatory and legal compliance within the health care organizations. These benefits of EHRs make health care practitioners better placed in ensuring that there is adequate and improved as well as quality health care (Menachemi & Collum, 2011).  Based on these, the public and policy makers should be in a position to embrace EHRs. The public will benefit more when it allows the exchange of information in different health care providers’ databases. The policy makers should be in the forefront in setting standards and policies to ensure proper funding, adoption and implementation of EHR (Menachemi & Collum, 2011).
Barriers to Instituting Electronic Heath Records in Canada
The adoption and implementation of EHRs in Canada will be a major milestone in the Canadian Health Care Systems. However, despite the accruing benefits (identified above), the adoption implementation of electronic health records has been slower than it should be in Canada due to some barriers. The Key barriers can be grouped into financial, technological, human, security, and political barriers. At the center of adoption and implementation of EHRs is the financial concerns (Terry et al., 2008).  Much of the funding for the rollout of HER is through a non-profit organization; Canada Health Infoway, by the federal government. The organization encountered high startup and maintenance costs as well as lack of proper funding being that the territories it covers and the funds do not match. The funding problem has also become an issue with reference to the rural clinics that do not have access to funds to institute and manage the EHR systems (Terry et al., 2008). The government should increase its funding since funds are essential in the adoption an implementation of EHR systems.
Secondly, there exists widespread dissatisfaction in terms of political support and inaction with reference to the development, institution and implementation of EHR systems in Canada. Most health care professionals and political figures are convinced beyond measure that Infoway is unsuccessful in implementing the health information technologies has attracted various political debates. Most of the opponents to Infoway, believe that the government is funding a white elephant in the health care domain. This has hampered the ability of Infoway itself to implement EHR (McGinn et al., 2011). Most of the stakeholders have also pulled out basing their actions on lack of a federal watchdog to oversee the expenditure and initiatives meant to institute EHRs into the Canadian health care systems.
Still on the political barriers, there lacks local, provincial and federal policies that guide the funding of all the HER initiatives. There are thus technical standards and interoperability of the systems are all based on the lack of policies (Terry et al., 2008). This has exacerbated lack of information sharing among health care givers. There should be clear cut strategies that will institute sound policies that will set lucid goals and expectations that allow the sharing of patients’ information, defines technical standards and the frameworks to enable the proper functionality of EHRs, and guides the federal, local and provincial funding initiatives (Miller & Sim, 2004). This will ensure proper roll out of EHRs in Canada.
Most practitioners in Canada at one point in time have to be trained on how to use the systems. Most practitioners register their dissatisfaction with the unpaid training schedules as well as steep learning curves that consume most of their time (McGinn et al., 2011). The health care professionals in Canada most of which have little technical knowhow on technology are resistant to the adoption of EHR systems. As such most of them are more inclined in attending to their patients and daily schedules rather than engaging in the unrewarding training sessions (Terry et al., 2008). There is also lack of proper leadership in the implementation of EHR. Lack of champions who are familiar with the system has been cited in most studies as the major barrier to the adoption of EHR in Canada. Most of the health care practitioners who have served for a long time see this as a method of kicking them out and are thus resistant to adopting it (McGinn et al., 2011). The practitioners should be given financial incentives so that they are participative in the process of implementation (Canadian Health Infoway, 2010). They should also be educated on the importance of the adoption.
Thirdly, despite the laws and regulations in place to ensure safety and privacy concerns are addressed. Most stakeholders mainly patients and the care givers feel that the records are getting into too many providers raising some questions on the possible infringement of the privacy rights. Being that most of the information may find their way into the internet platforms and thus access by multitude of practitioners, the patients are uncomfortable with the information’s use for good or malicious purposes (Canadian Health Infoway, 2010).
Lastly, just like any other normal EHR implementation, Canada has also experienced technological barriers that hinder the implementation of EHR technologies.  Most of the health care settings especially those in the rural areas lack the necessary infrastructure. However, even in the case when they are present most of the systems are slow due to lack of high speed networks (Terry et al., 2008). The practitioners also lack technical training and knowledge to use the systems. At the clinical level, most of the practitioners have pointed out that the systems are too complex that they are unwilling to spend most of their valuable time in implementing the EHR systems. Lastly, most of the systems and software become obsolete and thus the practitioners and policy makers are more likely to resist the buy-in HER technologies (Canadian Health Infoway, 2010). To completely eliminate this barrier, the practitioners should receive paid training schedules so as to be able to upgrade to the level of technological knowhow that is required (Miller & Sim, 2004). Additionally, the health care organizations should evaluate the systems prior to investing in them including the ability to upgrade instead of facing out the whole systems (Miller & Sim, 2004).
Conclusion
As have been seen in the paper, the concept of HER has evolved over the past few decades and is now widely practiced in the health care domain. The public and policy makers should be able to accept HER based on the proposed benefits discussed. The proposed benefits are many and thus the plausibility of the implementation of EHRs. Canada has been slow in the adoption of EHRs as owing to the barriers that have been grouped into political, financial, security and human factors. However, based on the discussed solutions, these barriers can be eliminated for the success of EHRs. the government of Canada and the rest of the world alike should capitalize on the benefits and solutions for effective implementation of EHRs in the health care systems.






References
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Terry, A. L., Thorpe, C. F., Giles, G., Brown, J. B., Harris, S. B., Reid, G. J., Stewart, M. (2008). Implementing electronic health records: Key factors in primary care. Canadian Family Physician, 54(5), 730–736.