Health Informatics
Integrating Electronic Health Record (EHR) technology into the clinical care of diabetic patients would facilitate personalized care through guided clinical decisions on their health. However, the involvement of stakeholders is essential to the accomplishment of such implementation efforts. The first stakeholder relevant to adopting Electronic Health Record technologies in diabetic management is health informatics. Health informatics is the composition of health data, technology, and people who enhance the quality and safety of patients in a medical facility. Implementing novel health information technology such as Electronic Health Record technologies is the duty of biomedical informatics professionals, including content experts, trainers, vendors, software developers, information systems staff, information technologists, and researchers (Osheroff et al. 2007). These technology experts create multidisciplinary teams when choosing a health information technology to manage the entire adoption process. Therefore, clinical informaticians would help advise on Electronic Health Record (EHR) implementation decisions and advise on approaches that demand customization to a diabetic patient’s health status. Besides, the information systems staff that configure and offer support to Electronic Health Record (EHR) study the implications for constant maintenance of this technology.
Clinicians
Clinicians and other physicians are the principal users of Electronic Health Record (EHR) and, to a greater extent, encourage the application of telehealth in practice. Ideally, the demand for diabetes management information, clinical implications, and complexity of Electronic Health Record system makes the involvement of clinicians in the implementation phases of this technology important. According to Bates & Gawande (2013), besides offering concrete input in the adoption process, seasoned clinicians act as trusted professionals that endorse a shared vision for Electronic Health Record technologies implementation and inform other stakeholders on the anticipated resistance to change. Therefore, clinicians are essential stakeholders in adopting Electronic Health Record telehealth because they are involved in the pre-implementation, selection, and decision stages.
Patients
Thirdly, patients are critical partners in health information technology implementation and healthcare policy. Larson (2013) stated that the ethical and social issues that might potentially arise by integrating patient information into Electronic Health Record (EHR), such as confidentiality and privacy concerns, render patients’ input crucial. Engaging with diabetic patients whose data would be fed into Electronic Health Record should be the cornerstone of the adoption process. This helps other stakeholders involved adhere to ethical restrictions by ensuring that they have the consent of patients to access their information. Besides, in such projects, patients are vital stakeholders because they need to be educated on the implications of integrating their health information into the Electronic Health Record. Moreover, patients help determine whether the new health information technology provides feedback based on their health outcomes and satisfaction levels.
Other Stakeholders
Lastly, other stakeholders such as test developers, research institutions, and the government have the power to generate national guidelines and standards which would facilitate the adoption of Electronic Health Record technologies at the local level. Such stakeholders bring diverse proficiency from disciplines such as social science and bioethics, which are crucial when implementing a new health information technology. Additionally, the ethical and social issues often associated with Electronic Health Record technologies highlight the importance of involving local communities. For instance, a Community Advisory Board can be created to provide rational policies which protect patients’ information from being accessed without their consent.
Cost-benefit Analysis/Financial Considerations
In an Electronic Health Record adoption project, the objective of a cost-benefit analysis is to determine whether the organization would increase its profitability by adopting this technology. The costs associated with implementing Electronic Health Record include induced fees and system costs (Wang & Biedermann, 2010). Induced costs of using EHR in diabetes management include the costs to scan paper records into the EHR system and the cost of hiring medical transcriptionists to help type patients’ medical records into the system. On the other hand, system costs include purchasing office supplies, developing EHR applications, and building the EHR system infrastructure. The benefits include additional revenues and cost reductions. Cost reductions might consist of removing paper supplies and medical devices, reducing employees in paperwork management, and the disposal of medical storage facilities. Once these costs and benefits have been determined, the manager overseeing the implementation of Electronic Health Record would calculate the discount rate and present value to determine the expected interest in this technology. Besides, the cumulative NPV would be obtained to calculate this new technology’s time to reach the breakeven point. Once this has been established, the facility will decide whether they should adopt this technology or not.
Plan for Dissemination and Adoption
Adoption Theory
The Technology Acceptance Model (TAM) would be effective if applied to adopting Electronic Health Record technologies in a facility. According to Charness & Boot (2016), this model explains the intention of a user to accept a particular technology through variables like attitude toward use, perceived ease of use, and perceived usefulness. Even though the developer of a given technology thinks that it is user-friendly and valuable, potential users might not accept it unless they share the same beliefs. Therefore, the Technology Acceptance Model (TAM) could be utilized in adopting Electronic Health Records to explore the correlation between the intent to use, ease of technology use, and perceived usefulness among diabetic patients. The Technology Acceptance Model framework and subsidiary evidence would then indicate external variables which influence the perceived ease of Electronic Health Records to use among intended users. Once this has been established, the management behind the adoption of this new technology would address these external variables and promote perceived advantages to increase the intent of intended users to use Electronic Health Records.
Complexity Leadership Functions that would Facilitate the Adoption of Electronic Health Records
The ideal leadership function that would be beneficial in facilitating the adoption of Electronic Health Records is operational leadership. Operational leaders look at how other people in an institution fit to work together to bring more significant outcomes. Besides, when they think about problems, they pay attention to the processes and systems required to address these problems (American Society for Quality, 2022). Since operational leaders serve a significant role in making sure that a project is done efficiently and effectively, they would be ideal for championing or overseeing the adoption of Electronic Health Record technologies. This is because implementing such complex technology in a healthcare facility requires the collaboration and input of almost every person involved. Operational leadership would ensure that there is inclusivity by welcoming the ideas of everyone to facilitate a more straightforward implementation.
Barriers to Electronic Health Record Adoption
One of the critical barriers to adopting Electronic Health records is cost. As Ajami & Bagheri-Tadi (2013) stated, physicians need to determine the costs of maintaining and creating their IT applications and systems or hiring outside vendors to offer these technological services. The main costs involved in adopting Electronic Health Record technologies include governance costs, upgrade costs, negotiating costs, monitoring costs, coordination costs, and purchase prices. Such costs are often expensive compared to Electronic Health Record technologies’ benefits. Ajami & Bagheri-Tadi (2013) argued that for small to medium health institutions that do have not allocated a significant part of their budget to IT, the cost of implementing Electronic Health Record technologies is the most significant barrier to its adoption. Besides, high up-front financial costs of implementing Electronic Health Record technologies are compounded by ambiguity on the magnitude of financial benefits that might accrue.
Secondly, the complexity of Electronic Health Record technologies is a barrier to their implementation. Problems with Electronic Health Record usability, particularly in documenting patients’ progress, have caused physicians to spend more financial resources and time learning how to use this health technology effectively. According to Ajami & Bagheri-Tadi (2013), such considerable initial time costs are critical barriers to achieving the benefits of using this technology. Ideally, as physicians spend more of their time learning about how to use Electronic Health Record technologies, their time with patients is interfered with, thus reducing their probability of attaining quality health improvement.
Thirdly, the absence of computer skills among relevant users of Electronic Health Record technologies is another significant barrier to adopting Electronic Health Record technologies. Ajami & Bagheri-Tadi (2013) claimed that the necessary skills to type notes, contemplate interventions, assess medical relevance, and listen to patients’ complaints demand a high level of familiarity with the user interface and typing skills and concentration. Unfortunately, these skills are absent in many proficient computer users. Besides, Electronic Health Record providers seem to underrate the computer skills demanded from medical professionals since these systems are generally very complex to use by essential physicians. Boonstra & Broekhuis (2010) argued that excellent typing skills are compulsory to feed patients’ medical prescriptions, patient health notes, and data into Electronic Health Record. However, many health professionals lack these skills, thus interfering with the smooth adoption of Electronic Health Record technologies.
The fourth barrier to adopting Electronic Health Record technologies is vendor trust. Ajami & Bagheri-Tadi (2013) stated that lack of technical support and training from vendors is a crucial barrier to Electronic Health Record technologies adoption by medical professionals. For this reason, the quality of vendors of Electronic Health Record systems is an essential factor to consider before accepting an Electronic Health Record technology. Ajami & Bagheri-Tadi (2013) added that since Electronic Health Record systems are comparably new in the market, many vendors cannot be trusted. The absence of appropriate vendors demonstrates an immature industry, which lacks adequate competitors and viable products to provide better services. Boonstra & Broekhuis (2010) stated that medical professionals are worried that many Electronic Health Record vendors might be adequately qualified to offer good services. Besides, there have been concerns that a lack of trustworthy vendors leads to significant financial losses and a lack of technical support; thus, the business might disappear in the future.
The fifth barrier interfering with Electronic Health Record technologies adoption is the associated privacy and security concerns. Many non-users believe that Electronic Health Records bring more confidentiality and security than paper records. One of the main disadvantages of health information systems is the risk of privacy violations when authorized users hack the system. Therefore, this has affected the adoption of Electronic Health Record technologies since many people are skeptical about having their health records stored electronically.
Solutions to the Barriers to Electronic Health Record Adoption
High up-front financial costs of implementing Electronic Health Record technologies can be mitigated by minimizing the ambiguity on the magnitude of the technology’s financial benefits in the future. Health institutions can hire IT and financial experts to analyze an Electronic Health Record Technology to determine its costs and benefits before deciding which one to adopt in their organization. Having these figures will increase the confidence of hospitals and other medical institutions to implement Electronic Health Record in storing their patient’s data. Besides, these financial experts will guide the institutions on which technologies fit their budget to ensure that they do not select a technology that would cost not benefit them in the long run.
Secondly, to address the lack of computer skills and the complexity of the Electronic Health Record systems, healthcare institutions can provide initial training to physicians before adopting this technology. Moreover, hospitals can ensure that the time spent on training clinicians and other medical professionals on using Electronic Health Record does not interfere with their interaction with patients by allocating time for training clinicians in batches. For instance, the hospital can hire technologies experts from the Electronic Health Record systems vendors to train their staff over some time. This would facilitate balanced training and providing services to patients since a particular batch of clinicians can be trained one day as the other one attends to patients. Ultimately, they will gain the required computer skills to manage the Electronic Health Record system before adopting it.
Thirdly, hospitals can ensure that they work with trusted Electronic Health Record vendors by selecting highly rated vendors. This will ensure that they work with knowledgeable and experienced vendors whose guidance and training can be trusted and effective in facilitating a more straightforward use of the new system. As mentioned above, the quality of Electronic Health Record systems vendors is an essential factor to consider before accepting an Electronic Health Record technology. Therefore, to increase a user’s confidence in the safety and benefits of using a particular’s vendors Electronic Health Record system, hospitals should choose vendors that would provide technical support in implementing and managing the system.
Societal Implications Relevant to the Adoption of Electronic Health Record Telehealth
Many issues, notably legal, ethical and safety concerns, emerge from the increasing trend in telehealth since patients’ health information is stored in servers that cloud service providers manage. The common issues include confidentiality, security, and privacy. Even though privacy and security are closely related, they are different. Keshta & Odeh (2021) stated that security is the degree to which access to an individual’s information is allowed or restricted for authorized parties only. In contrast, privacy is defined as an individual’s right to decide if third parties can share their personal information. Therefore, sharing or transferring sensitive health information can cause a data breach when not authorised. Sittig & Singh (2015) argued that privacy could also be abused through inevitable systemic identification in Electronic Health Record systems. Besides, privacy can be violated when major parties and technologies monitor the actions of medical professionals and patients. Moreover, laboratories, pharmaceutical companies, the government, and researchers might have concrete reasons to access a patient’s medical records. However, in the process, a medical professional might cause privacy violations by accessing the medical records of a patient both intentionally or accidentally.
Fundamental information technology security necessities such as availability, integrity, and confidentiality are associated with the legal, ethical and safety issues of Electronic Health Record systems. Keshta & Odeh (2021) defined confidentiality as constraining information to unauthorised parties to access data during the transmission and storage of patient information. Essentially, confidentiality could be obtained through technical approaches like data encryption or moral dispositions like professional silence. Nevertheless, Dehling & Sunyaev (2014) claimed that even though data encryption mainly applies to patient data transmitted within exposed networks, it does not apply to information stored in other storage media such as mobile devices. Therefore, since Electronic Health Record systems carry sensitive clients and patient data, confidentiality is a primary privacy concern that should be adhered to when adopting such technologies.
Besides, health professionals are often worried that unauthorized parties might access patient’s data when stored in Electronic Health Record systems leading to legal issues following privacy and confidentiality breaches. Ideally, health professionals tend to pay more attention to confidentiality and security issues than patients themselves because they want to avoid facing heavy fines and legal charges once sensitive health information is leaked to other parties. Additionally, many healthcare professionals that have used Electronic Health Record systems have shown a preference for using paper records since they believe that they are more confidential and secure. This indicates that security and privacy are taken seriously when it comes to adopting Electronic Health Record systems.
Enhancing Electronic Health Record systems to eradicate problems which can cause harm to patients can be attained through several policies which enable sharing of patient information between developers, researchers, and end-users. One of the main barricades to improving the safety and usability of Electronic Health Record systems is that the contracts between healthcare systems and EHR vendors comprise gag clauses that restrict providers from openly and freely sharing solutions and discussing challenges. For instance, providers are limited from sharing videos or screenshots of the safety or usability issues that they face without permission from an Electronic Health Record vendor (MedStar Health,2022). Vendors claim that such contract provisions are to protect intellectual property. However, safety experts and end-users state that clinician needs and patient safety should be prioritized.
Future Applications
The future of Electronic Health Record systems will transform into a communication tool between medical professionals. There are many crucial reasons that Electronic Health Records have the potential to bring unprecedented changes in the healthcare sector. First, there is interoperability which enables providers and patients to access medical records wherever they are. Essentially, Electronic Health Records can be transferred from one hospital to another with the aid of relevant medical data and communication. This enables healthcare professionals to communicate with those in emergency facilities, medical imaging facilities, pharmacies, and laboratories. Therefore, patients would confidently provide healthcare providers’ health information, trusting that it will travel with them. Secondly, the future of Electronic Health Records will increase value for everyone. Electronic Health Record systems can significantly improve the quality of healthcare patients receive. Ideally, when a healthcare provider has access to a patient’s medical records in real-time, it enables them to make more informed treatment decisions, improving patient outcomes.
References
American Society for Quality (2022). What is Leadership?https://asq.org/quality-resources/leadership
Bates, D. W., & Gawande, A. A. (2013). Improving safety with information technology. New England journal of medicine, 348(25), 2526-2534.
Boonstra, A., & Broekhuis, M. (2010). Barriers to the acceptance of electronic medical records by physicians from systematic review to taxonomy and interventions. BMC health services research, 10(1), 1-17.
Charness, N., & Boot, W. R. (2016). Technology, gaming, and social networking. In Handbook of the Psychology of Aging (pp. 389-407). Academic Press.
Dehling, T., & Sunyaev, A. (2014). Secure provision of patient-centred health information technology services in public networks—leveraging security and privacy features provided by the German nationwide health information technology infrastructure. Electronic Markets, 24(2), 89-99.
Keshta, I., & Odeh, A. (2021). Security and privacy of electronic health records: Concerns and challenges. Egyptian Informatics Journal, 22(2), 177-183.
Larson, E. B. (2013). Building trust in the power of “big data” research to serve the public good. Jama, 309(23), 2443-2444.
MedStar Health (2022). 3 Policy Changes That Could Make Electronic Health Record Systems Safer and Easier to Use. https://www.medstarhealth.org/news-and-publications/news/3-policy-changes-that-could-make-electronic-health-record-systems-safer-and-easier-to-use
Osheroff, J. A., Teich, J. M., Middleton, B., Steen, E. B., Wright, A., & Detmer, D. E. (2007). A roadmap for national action on clinical decision support. Journal of the American medical informatics association, 14(2), 141-145.
Sittig, D. F., & Singh, H. (2015). A new socio-technical model for studying health information technology in complex adaptive healthcare systems. In Cognitive informatics for biomedicine (pp. 59-80). Springer, Cham.
Wang, T., & Biedermann, S. E. (2010). Running the numbers on an EHR: Applying cost-benefit analysis in EHR adoption. Journal of AHIMA, 81(8), 32-36.
write