Common Errors In Ehr

Electronic health records (EHR) are health records that are generated by health care professionals when a patient is seen at a medical facility such as a hospital, mental health clinic, or pharmacy. The EHR contains the same information as paper based medical records like demographics, medical complaints and prescriptions. There are so many more benefits to the EHR than paper based medical records. Accuracy of diagnosis, quality and convenience of patient care, and patient participation are a few examples of the

After decades of paper based medical records, a new type of record keeping has surfaced - the Electronic Health Record (EHR). EHR is an electronic or digital format concept of an individual’s past and present medical history. It is the principle storage place for data and information about the health care services provided to an individual patient. It is maintained by a provider over time and capable of being shared across different healthcare settings by network-connected information systems. Such records may include key administrative and clinical data relevant to that persons care under a particular provider. Examples of such records may include: demographics, physician notes, problems or injuries, medications and allergies, vital

Implementation of EHR shows improvement of quality of care by the nurses ability to access the patient chart at the bedside, decreasing the risk of wrong patient errors.

Electronic Health Records (EHRs) are an important component in health care reform, but do they really bring efficiency to the practice? The extent to which practices use EHRs vary from the very basic (entering clinical notes and viewing results) to the intermediate (using e-Prescribing to indicate adverse drug prevention and provide suggestions for alternative drugs) to the advanced use (including lab and radiology order entry with testing guidance, capture of electronic charge, and evidence-based guidelines).

“… longitudinal electronic record of patient health information generated by one or more encounters in any care delivery setting”. Included in this information are patient demographics… reports. The EHR automates and streamlines the clinician 's workflow. The EHR has the ability to generate a complete record of a clinical patient encounter, and related activities directly or indirectly via interface—including evidence-based decision support, quality management, and outcomes reporting.”(GAO, 2010)

A lengthy list of EHR benefits supports the evolution from paper to electronic medical record keeping. One such benefit, the significant reduction of needed storage space. Bulky paper charts require a lot of space and misplaced charts waste time and effort to locate. Since EHR data remains on the computer, medical practices no longer require secure on-site storage, and electronic files eliminate misplacing files. Another benefit to data remaining on the computer rather than a medical chart, electronic records allow immediate access from several locations. EHRs provide emergency room personnel access to allergies and other pertinent information of unconscious patients. The on-call physician accesses patient information from their home computer, rather than driving to the medical

The cons of an EHR are part of the driving force behind the model restricted from the need to integrate EHRs throughout the health system and share information with network of referring hospitals. However, this sharing of information is often not possible (EHR,2013). Finding a hospital partner that is willing to open the lines of communication is critical to the success. The cost associated with EHRs is often a deterrent. Not only must the provider pay for the physical hardware and/or software, the organization must also put forth a considerable dollar amount for setup, maintenance, training, IT support and system updates (EHR,2013). With EHRs, much more documentation is required of physicians before, during and after a patient visit. This has its pros and cons. For example, a benefit of more strong documentation is that it provides additional information for the coders that may justify a higher level of service being billed(EHR,2013).

An Electronic Health Record is a computerized form of a patient’s medical chart. These records allow information to be readily available to authorized providers during a patient’s encounter with the healthcare system. These systems do not only contain medical histories, current medications and insurance information, they also track patients’ diagnoses, treatment plans, immunization dates, allergies, radiology images and lab tests/results (source). The fundamental aspect of EHRs is that they are able to share a patient’s information quickly across service lines and even between different healthcare organizations. Information is at the fingertips of lab techs, primary care physicians, pharmacies, clinics, etc. The

We live in a digital age where everything from photos to important documents is saved or stored online. This includes the use of electronic medical records. The electronic medical record (EMR) is useful in assisting physicians to have a complete and thorough health history of the patient. The EMR serves as a continuity of care from one hospital to another within the same organization (Hsieh, 2014). Consulting physicians also have quick access to recent diagnostic imaging, progress notes, and lab results. EMRs can help manage patients with chronic disease states, aid in data collection for use in research, and prevent adverse drug events (Hsieh, 2014).

Therefore, several authors share some of the same ideas as to what some of the barriers faced during the transition to Electronic Health Records (EHRs) and if these barriers still exist once the transition to a full EHR system is complete. Herrick, et al., 2010, states that currently, there is no hard-core evidence to support the argument that Electronic Health Record (EHRs) and Health Information Technology is the best route for health organizations to prevent errors. In fact, the use of such technology could potentially lead to errors if information incorrectly entered in the system and Haupt, 2011, statement that smart software could help to prevent life-threatening errors better when administering medicines. Whereas, Boonstra & Broekhuis, 2010, states from a physician point a view need the understanding of the possible barriers that faced during implementation of EHRs because there a tremendous amount of literature on the obstacles but no suggestion on how to resolve these barriers have not been viewed. Barriers such as, financial on great startup and ongoing cost, technical and time to train staff and how much knowledge do they have with computer skills and psychological when support needed from vendors, etc. It suggests that once those barriers have been ironed out and a plan has set in place, then the transition from paper documentation to Electronic Health Records (EHRs) may go a lot easier for the healthcare arena physician, nurses and administrative

According to The Healthcare Information and Management Systems EHR is considered a longitudinal electronic record of patient health information generated by one or more encounters in any care delivery setting( Kohli & Tan, 2016). The Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) describes EHR as an electronic version of a patient’s medical history, that is maintained by the provider over time, and may include all of the key administrative clinical data relevant to that person’s care under a particular provider, including demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports (CMS.gov). The International

The utilization of electronic health records (EHR) has become increasingly common in the inpatient hospital setting and outpatient care. EHRs benefit the physician, patient, and healthcare facility. Historically, electronic records were not in place for healthcare organizations, and currently, it helps the organization in several ways instead of using paper. Patients have access to their medical records and history, which gives them readily available information about their health. Proper implementation of an EHR system results in higher patient satisfaction. The benefits of EHRs significantly improve the care experience for patients physically and mentally. Additionally, patient care is improved because the patient can leave their doctor’s office with a complete copy of their medical record. While inpatient and outpatient care has several similarities, there are also many differences, as well as challenges with both healthcare setting with implementing the EHR.

EHR has been proposed for a solution to increase the quality of health care. Patients in the United States are receiving recommended medical care, and there have been calls to improve health care quality. Electronic health records (EHRs) has been touted as cost-effective and sustainable solutions for improving quality in medical care. EHR is still controversial and very important topic in health informatics. There is no universally accepted definition for electronic health records. In 2008 National Alliance for Health Information Technology released definition for EHR “An electronic record of health-related information on an individual that can be created, gathered, managed and consulted by authorized clinicians and staff within one healthcare

Electronic health records (EHR’s) have many advantages, but there are plenty of disadvantages. EHR’s were created to manage the many aspects of healthcare information. Medical professionals use them daily and most would feel lost without it. Healthcare organizations were encouraged to adopt EHR’s in 2009 due to the fact that a bill passed known as The Health Information Technology for Economic and Clinical Health Act (HITECH Act). “The HITECH Act outlines criteria to achieve “meaningful use” of certified electronic records. These criteria must be met in order for providers to receive financial incentives to promote adoption of EHRs as an integral part of their daily practice”, (Conrad, Hanson, Hasenau & Stocker-Schneider, 2012).

Many studies conducted in different health care settings have indicated that EHR will assist health professionals to reduce medical errors, achieve better effective care coordination, improve safety and quality, and also, it can reduce health care costs [2, 4, 6, 7, 12, 13]. Healthcare systems, like all business entities, are information-intensive enterprises [14]. Healthcare workers require adequate data and information management tools to make accurate decisions, both while caring for patients and while managing and running the enterprise, to document and communicate plans and activities, and to meet the requirement of the regulatory and accrediting organization [14]. Currently, the use of an EHR includes clinical care application/functions, clinical research function, and administrative function. The Institute of Medicine (IOM) highlights that a more immediate access to computer-based clinical information, such as laboratory and radiology results, can reduce redundancy and improve quality [15]. Similarly, the availability of complete patient health information at the point of care delivery,