Meaningful use of EHR
According to Lin et al. (2019), although adopting EHRs had no significant effect on quality, achieving meaningful use of these systems results in a 0.19–0.43 percentage point improvement in process quality of care–with substantial societal benefits right behind the scenes therein! The results indicate a positive relationship between successful implementation of EHRs and an increase in the quality of care, especially process information.
Lin et al. (2019) state that although merely installing an EHR did not greatly improve the quality of care, meaningful use compliance brought a noticeable improvement in process-quality indicators for health facilities that successfully completed these stages. These results indicate a direct relationship between making effective use of EHRs and the level of care, in particular process quality. At the same time it is also important not to overlook how much post-adoption EHR usage can vary, and points out that we must develop strategies for dealing with clinicians which get them more effectively engaged in using these technologies. The implications of the study by Lin et al. (2019) are important for healthcare managers: doubts about EHR’s value must be cleared up while stimulating clinicians to use them, and clinical workflows should be redesigned to encourage their usage. These implications provide concrete guidance to healthcare organizations looking for ways in which they can put their IT investment behind them and improve the quality of care being given.
Limitation of EHR
Kroth et al.’s (2019) point to some ubiquitous worries about EHR design and use–like the enormity of data entry burden, long cut-and-pasted notes copied from elsewhere and difficulty in information accessibility or note structure. Composition of EHR design and use played a role in stressing geriatricians out, but other conditions in the workplace–office atmospheres, workload control, physical symptoms resulting from using an EHR system–usually had more to do with burnout.
Kroth et al. (2019) summarize that while such EHR design/use factors are associated with clinician stress and burnout, it is important to also address other work-related problems, particularly those related to the atmosphere in seaside clinic rooms as well as overwork control challenges. Their conclusions imply that placing sole emphasis on the design of EHRs does not include some major contributors to doctor stress and burnout. This points to the fact that EHR design improvement isn’t enough, and we also need to look at broader work conditions in order for changes concerning clinician well-being during clinical encounters to take place.
Barriers
Fragidis and Chatzoglou (2018) state that one of the major failure factors in implementing EHR systems is lacking support from both medical and nursing communities, as well as resistance to change among administrative personnel. The inability of healthcare professionals to accommodate themselves to new systems not only makes them difficult for users, it also affects the level and quality of patient care during clinical interactions.
Fragidis and Chatzoglou (2018) point out that lack of support, coupled with resistance to any kind of change from the medical, nursing and administrative arms are a major shortcoming in the implementation by organizations for EHR systems. This lack of involvement by users reflects the barriers to effectively integrating EHRs systems with clinical workflows which directly impinges on patients ‘care experiences. Furthermore, the results point up the importance of integrating it systems with workflow. This is what the systematic review’s goal of evaluating health technology in terms of its impact on healthcare delivery efficiency was geared to. If technology is not catching up to workflow processes, an EHR system cannot be optimally utilized. This misalignment of technology and workflow processes keeps the EHR from being utilized as well as it could be, which may negatively impact patients. Moreover, that the study points out that user confidence and support are very important for being able to use EHR system chimes well with parts of our systematic review which explore provider perspectives and their effect on patient satisfaction.
Advantages of EHR
Krousel-Woodet al., (2018) data showed that the switch to complete EHR greatly improved accessibility of patient information during inpatient transfers, providing better interoperability between different levels and types. In addition, providers noted that they felt the EHR system was better at promoting appropriate preventive care and generating prompts related to laboratory tests, which made both monitoring of patients as well as timely reminders for such tasks. A rise in positive perceptions about being able to communicate with patients identified a possible improvement by the EHR system of channels for communications between providers and patents. Likewise, providers’ satisfaction with sharing medical information rose as well. Provider reports indicate that the comprehensive EHR system could simplify transmission of healthcare data among professionals. Lastly, satisfaction with system reliability increased. This suggests that the shift made the system more stable and consistent.
In fact, a transition to the whole EHR engendered better access to patient information during transitions between hospitals which improved communication among different settings in healthcare. Krousel-Wood et al. (2018). Further, report authors found that providers reported improvements in preventive care quality and prompts for lab tests, reflecting that the EHR supported better monitoring of health status as well as timely reminders to perform selected healthcare measures. These conclusions highlight the need to continue research on whether EHR systems are usable and effective in actual practice, as well as how they can be optimized within each healthcare setting. However, one way of addressing these concerns may be refining EHR systems to match local workflow processes and care teams. In addition, the study highlights a need for studies of longer duration in various real-world settings to better understand how EHR use is related to physician perception and clinical outcomes. Implementing this comprehensive approach could reveal ways to optimize the benefits of EHRs while helping healthcare providers overcome dilemmas in their actual use.
References
Fragidis, L. L., & Chatzoglou, P. D. (2018). Implementation of a nationwide electronic health record (EHR): The international experience in 13 countries. International journal of health care quality assurance, 31(2), 116-130. https://doi.org/10.1108/IJHCQA-09-2016-0136
Kroth, P. J., Morioka-Douglas, N., Veres, S., Babbott, S., Poplau, S., Qeadan, F., … & Linzer, M. (2019). Association of electronic health record design and use factors with clinician stress and burnout. JAMA network open, 2(8), e199609-e199609. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2748054
Krousel-Wood, M., McCoy, A. B., Ahia, C., Holt, E. W., Trapani, D. N., Luo, Q., … & Milani, R. V. (2018). Implementing electronic health records (EHRs): health care provider perceptions before and after transition from a local basic EHR to a commercial comprehensive EHR. Journal of the American Medical Informatics Association, 25(6), 618-626. https://academic.oup.com/jamia/article/25/6/618/4176276
Lin, Y. K., Lin, M., & Chen, H. (2019). Do electronic health records affect quality of care? Evidence from the HITECH Act. Information Systems Research, 30(1), 306-318. https://doi.org/10.1287/isre.2018.0813
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