WHAT IS A SMART CARD ELECTRONIC MEDICAL RECORDS NEWS
ADVANTAGES OF ELECTRONIC MEDICAL RECORDS
BARRIERS TO ELECTRONIC RECORDS
EMRs as a whole lack a standard. This has been a big barrier to implementation as providers don't want to implement one system and then have to buy another system for another standard. There are currently at least 25 major competing vendors of outpatient EHR systems alone, many selling software incompatible with competitors.It is only since 2007 that certification criteria for EMR developed by the Certification Commission for Healthcare Information Technology have been in use . The Veterans Administration health care system in the United States may provide the start of a standard. Its EHR system called VistA has been in use for years and serves 150 hospitals and 800 clinics and being expanded to integrate with Department of Defense healthcare facilities using the BHIE (Bidirectional Health Information Exchange) networking protocol to exchange data. This EHR and is publicly available and can be adapted for use in non-VA facilities.
Interoperability
Currently in the US there is currently no standard for different information technology systems and software applications to communicate, exchange data accurately, effectively, and consistently, and use the information that has been exchanged. The four levels of data structuring at which health care data exchange can take place. are: Level I: Non-electronic data : such Paper, mail, and phone call. Level II: Machine transportable data such Fax, email,for unindexed documents. Level III: Machine organizable data such as HL7 messages and indexed (labeled) documents, images, and objects. Level IV :Machine interpretable data of structured messages and standardized content so that no further interpretation or translation is required. eg Automated transfer from an external lab of coded results into a provider’s EHR.
Difficulty in adding older records to an EHR system
Paper must be scanned or digitally converted into an electronic format or data keyed into a database. The process involved in conversion of these physical records to EMR is an expensive, time-consuming process, which must be done to exacting standards to ensure exact and accurate capture of the content.
Hardware and technology limitations
Computer access is required to use
an electronic health record system.Until recently high speed internet was not
widely available and systems could not communicate with each other. New systems
must be able to read records on older media and operating systems.
Cost
The cumulative cost for 90
percent of hospitals to adopt an EHR system is an estimated $98 billion and an
estimate for all the 500,000 physicians in the US, $50 billion for physicians. A
full EMR for a one man practice typically costs $100,000. This does not include
time lost due to slowing of workload and the time, typically a week to train
each user to use a medical record.The current cost estimates for EHR do not
include reduced productivity as the technology was implemented, the cost of
staff training as well as the need to increase information technology staff to
maintain the system.
All EMRS because they do not conform to a provider workflow, require typing and usually coding, significantly increase providers' workloads and reduce productivity.Until an EMR these tasks were performed by typists and coders not providers. Most physician notes for completion require typing and coding of 24000 possible diagnoses (for insurance purposes and soon to be 240,000 diagnoses when ICD -10 becomes available). Current documentation does not easily capture the nuances of medical treatment and leads to less accurate documentation.Health information technology systems don't really understand the workflow needs of healthcare providers. Productivity would improve if an EMR sped up every day tasks such as writing notes, scripts,prescribing orders,incorporating test results into charts and communicating with patients.Currently they do not. Speech recognition will be helpful.Different medical environments have distinct requirements- a cancer care center has different needs to a heart surgery center. Customizing to workflow needs significantly increases cost and maintenance but should increase productivity. Healthcare technology needs to be flexible and able to accommodate non binary thinking and the exponential growth of medical knowledge .
Among others, until 2006 the Stark rule has prevented hospitals furnishing compatible software and training to community providers.
a. Ownership
Medical records, such as physician orders, exam and test reports are legal documents, which must be KEPT in UNALTERED form and AUTHENTICATED by the CREATOR. According to HIPAA the patient owns the information within the record and has a right to view the originals, and to obtain copies under law.a/ Ownership :This is a big barrier. Who takes responsibility for these records when they are no longer created by one person or group alone and they have no physical existence?
b. UNALTERABILITY of records:
Digital records such as EHR create difficulties ensuring that the content, context and structure are preserved when the records do not have a physical existence .
c. Long-term PRESERVATION and storage of records
Most medical records are legally required to be stored for 7 years,others longer.The rules depend on the state and country Records might also one day be used longitudinally and integrated across sites of care. Digital media will require upgrades and protections to make sure they remain usable. Backup copies of the data and protection must be provided in the event of damage to the original. It will also require the planned periodic migration of information to address concerns of media degradation from use. These are costly, time consuming processes that must be planned and budgeted for. An EHR archive might work through a co-operative trusted notary archive (TNA) which receives and stores health data from different EHR-systems.A TNA can store objects in XML-format and prove the integrity of stored data with the help of event records, timestamps and archive e-signatures. In Europe the basic XML-format has been found suitable for as the archive-format.
Privacy
Your medical record contains almost all your personal information,from your social security number, to copies of your drivers' license,credit card numbers , employer, family member details and personal information. Privacy concerns in healthcare apply to both paper and electronic records. According to the Los Angeles Times, roughly 150 people (from doctors and nurses to technicians and billing clerks) have access to at least part of a patient's records during a hospitalization, and 600,000 payers, providers and other entities that handle providers' billing data have some access also. In the United States, your medical record is Protected Health Information (PHI) and its management is addressed under the Health Insurance Portability and Accountability Act (HIPAA)passed in 1996, as well as many local laws. The organizations and individuals charged with the management of this information are required to ensure adequate protection is provided and that access to the information is only by authorized parties.This standards is more more stringent for electronic records than for paper records. HIPAA established the same rules used for years by the federal government for access, authentications, storage and auditing, and transmittal of electronic medical records,including standardized formatting of data electronically exchanged and federalization of security and privacy practices among the private sector. However, there are concerns as to the adequacy of implementation of these standards.Putting information at multiple access points over an open network like the Internet increases possible patient data interception.In fact it is almost guaranteed to happen. In 2007, the Government Accountability Office reported that there is a no overall strategy to ensure that privacy protections would be built into computer networks linking insurers, doctors, hospitals and other health care providers as the promotions of the electronic medical records expands throughout the United States.
ELECTRONIC HEALTH RECORD PERSONAL HEALTH RECORDS (PHR) & CONTINUITY OF CARE RECORD (CCR)
WHAT IS A SMART CARD ELECTRONIC MEDICAL RECORDS NEWS
ADVANTAGES OF ELECTRONIC MEDICAL RECORDS
BARRIERS TO ELECTRONIC RECORDS