Electronic Health Record: Adoption, Considerations and Future Direction

Introduction

Providing high-quality, safe, integrated, affordable, efficient and sustainable care should be the hallmark of healthcare organizations. This is a promise we have to make and keep to our patients, their families and other key stakeholders in the healthcare delivery process. A critical component in facilitating this kind of care and an overall excellent patient experience is an EHR. An EHR is defined as an electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be created, managed, and consulted by authorized clinicians and staff across more than one healthcare organization. An electronic medical record (EMR) is different in that the record is used by authorized clinicians within one healthcare organization. “The principal difference between an EHR and an EMR is the ability to exchange information interoperably,” National Alliance for Health Information Technology (NAHIT) says in its April 28, 2008 report, Defining Key Health Information Technology Terms.

The benefits of an EHR have been published and contested (Ludwick et al., 2009). Paperwork has been reported to take up to a third of a physician’s workday and a national survey of residents shows that they spend as much as six hours per day documenting (Chen, 2010). The ability to access information, leverage best practice, support individualized medicine, minimize inappropriate variation in health care and enable timely interventions are all perceived advantages of an EHR. The availability of patient data together with the expert knowledge of qualified clinicians helps to assure the best care for every patient, every day. The hope is that the EHR provides an infrastructure to support the best patient care and experience. Like most health care systems though, electronic health records are complex. The ability to collect and store data (e.g. textual, imaging, administrative) has led to a data explosion which if not properly managed can lead to difficulty finding and synthesizing pertinent information. To meet the needs of multispecialty and multidisciplinary healthcare providers, EHRs must balance application data granularity and the interoperability needed to integrate data and communicate across systems. Implementation of an EHR must be carefully planned and executed to leverage the benefits and avoid the risks introduced by immature, misaligned and poorly implemented technology.

In addition to effectively and efficiently supporting the clinical practice, the EHR must also facilitate research, education, and operational aspects of healthcare delivery. The EHR is critical for analyzing large amounts of patient information more efficiently, and for providing decision support and best practice guidance at the appropriate points in the care process. The EHR supports applying new research findings to continually enhance patient care, wellness and prevention, comply with ever increasing regulations, assist with revenue recognition opportunities and minimize the administrative healthcare overhead.

The EHR is very important in enabling patients and families to actively participate in the healthcare process, access and enter information online (e.g. review lab results and dismissal instructions, monitor vital signs, schedule appointments) in a patient friendly and safe manner and communicate with their care providers. In an increasingly knowledge and information centric service like healthcare, the intellectual assets and expertise embodied in people and contained in the EHR are central to global competitiveness, population health and economic growth.

The objectives of this chapter are to:

• 1.

  Discuss the value of an EHR and the role of management engineering.

• 2.

  Highlight key enablers and considerations for successful EHR adoption.

• 3.

  Recognize the potential of knowledge management and decision support.

• 4.

  Share EHR challenges and implications.

• 5.

  Suggest future opportunities to leverage management engineering and advances in technology.