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Effects of electronic health records on transforming health

This article has been cited by other articles in PMC. Abstract The electronic effects of electronic health records on transforming health record represents a major change in healthcare delivery, either for health professionals and health institutions, either for patients. In this essay we will mainly focus on its consequences regarding patient safety and medical liability. In this particular domain the electronic health record has dual effects: This paper intends to underline the main human errors, technologic mistakes and medical faults that may occur while using the electronic health record and the ways to overcome them, also explaining how effects of electronic health records on transforming health electronic health record may be used in court during a judicial proceeding.

Conversely, the EHR allows an all new range of possibilities, such as to analyse and to compare the various results of exams and other data, resulting in a truly mechanism of information management, aimed to promote efficiency and speedy solutions. It also includes reminders, alarms and guidelines, transforming the content of healthcare decisions. In addition, the EHR makes possible computerized prescriptions and computerized healthcare instructions, as well as improves the communication within the medical team.

The improvement in communication effects of electronic health records on transforming health distant healthcare professionals, and even with patients, opens the door to telemonitoring and to other forms of telemedicine.

For the above-mentioned reasons, the implementation of the EHR in the majority of hospitals and clinics during the last decades caused a massive modification in the way healthcare is delivered. It would be very simplistic to say that it merely involves replacing sheets of paper by its electronic form. In fact, when analysed altogether with some other technological modifications that are connected with it, such as the communication between doctor and patient by e-mail, telemedicine, and medical apps, it translates in a truly Copernican revolution in healthcare.

In consequence, it changes the relationship between elements of the medical team, as well as the classic doctor-patient relationship. In the present paper we will analyse the following issues: The final aim is to evaluate how the introduction of EHRs is changing health care delivery. The speed in accessing the information and the amount of data accessible, especially in a very short period of time, are some of the main features of the EHR, allowing the medical team to have access to information that otherwise would go unnoticed, with the additional benefits of easily filtering that information according with the chosen criteria of research by episodes, by date, by drugs.

The simplicity and efficiency that result therefrom allow rapid methods to relate the recorded data in order to, e.

Differently, when using the traditional medical record, it is frequent to have a great pile of paper stored in different facilities and services, easy to get lost or destroyed, thus, leading to medical errors based on the lack of information in due time. To this extent, the EHR helps prevent medical errors.

For instance, it allows a more accurate calculation regarding the dose of the prescribed drug; it makes possible to predict the consequences of interaction with other medicines; and it guarantees more accuracy in data calculation, such as body mass index for anaesthetic effects.

Some systems even contain programs that warn about potential risks to the patient stroke, drug allergieswhich serve as reminders for cases in which the doctor could miss out an important clue.

It also presents benefits regarding the information that should be communicated to the patient, since it offers a substantial list of written information on his medical condition, effectively adapted to his situation, together with the necessary precautions to be taken, such as diet and drug dosage, which can simply be printed and delivered to the patient.

In addition, the EHR promotes and facilitates teamwork. On the one hand, because it allows more than one person to work simultaneously in the clinical file; on the other hand, because it allows interconnectivity with other agents, not only other members of the medical team, but also with laboratories, pharmaceuticals, and other hospitals, and even establishes the basis for telemedicine and patient monitoring from a distance.

It is so because the EHR ensures the mobility of data from one service to another, or — if allowed by the personal data protection schemes — from one institution to another.

The communication of information between several health agents also prevents the patient submission to repeated examinations, sometimes painful and dangerous, particularly in what concerns the unnecessary repetition of tests that the patient probably had recently been subjected to. Another advantage regards the fight against the waste of medical resources, an especially important target if we have in mind that medical exams are usually costly and, et pour cause, not immediately available to all that need them.

While computerization raises many problems in terms of privacy, on the other hand it solves some issues regarding private data protection. Note that when the medical record on paper is used for administrative purposes e.

It may carry so many benefits that authors such as Hoffman and Podgurski [ 4 ] proposed a project of financial support from governments in order to achieve the general adoption of EHR, which may be a good incentive to adopt it, especially because of the financial burdens involved in its implementation. Although technology in its current state is very reliable, it is still not without dangers, from computer bugs to cyber-attacks that can leave the system inoperative or cause functional errors, some with serious consequences.

The mere loss of a password is enough to involve problems in system operation, since it prevents the use of the EHR and its information, eventually precluding the provision of adequate medical care. Those mistakes are, in a way, to be expected. In fact, the EHR has become so complete and complex that the technology underneath is, likewise, quite complex. A small flaw can throw it all away, by messing with the records of many patients adding, dealing, or misplacing data.

Another difficulty to be considered relates with the possible simultaneous existence of two medical records for the same patient, a computerized one and another in paper format, a frequent situation in the beginning of the EHR implementation, so that a patient will have a record on paper referring to past events, and another one in electronic form for future events.

  1. Framing and reframing critical incidents in hospitals.
  2. Of course that they turn record much easier, since it is all about crosses and checks. The same increase in the level of demanding is a consequence of the technological development represented by the EHR.
  3. In order to perform this task the system must provide reports on the various accesses, dates and registration of any alteration of information or unauthorized access attempts. While computerization raises many problems in terms of privacy, on the other hand it solves some issues regarding private data protection.
  4. Potential health benefits, savings, and costs. So, it is recommended the choice of software that does not use extensive alarm lists.

However, this duality weakens many of the advantages aimed by the EHR in terms of efficiency and error prevention and may even cause confusions and malfunctions.

In court, the claimant, Mrs. Johnson, wife of the deceased, alleged that the doctors and the hospital failed in storing the results of the exams, which were placed in the wrong chart, so that the doctor did not find them.

However, the doctor could have traced them in the system, what he did not, since probably he was used to solely verify the paper chart. Though the doctor settled the case, the hospital did not, so, the court had the chance to analyse the behaviour of health institutions that allowed the parallel existence of a medical file in paper, and another one computerized.

The court stated that, in this case, the applicable standard of care demanded the hospital to include all patient information not only in the computer, but also in the paper chart.

On the other hand, technology may exacerbate the error. But the simple fact of copying information from one record to another multiplies mistakes, because an eventual error in one record turns into dozens of errors in dozens of records. The demand for too much information, and the actual possibility of inserting too much of it, leads to another problem: Privacy breaches are another relevant concern. Health and genetic data are very attractive for many industries, so, hackers may intrude in the system in order to get those data.

Another negative aspect is the cost involved in the implementation of the EHR, not only with what regards to the software purchase, but also its installation, maintenance and proper training of its users. These costs continue even after the initial phase, since software update, breakdown arrangements and knowledge apprises will systematically be requested. Finally, the risk of a medicine more concentrated in the computer than in the patient is a very real one.

Doctor-patient relationship may become impersonal, since the doctor will spend most of the consultation typing on a keyboard, without even looking at the patient, a behaviour that, in turn, will seriously affect doctor-patient relationship, especially in terms of informed consent.

1 Introduction

The risks involved may become so stringent that they led some authors to claim that litigation might rise for doctors using EHRs and, as a result, insurance companies will increase the awards, specifically for higher risk specialities. However, other studies defend otherwise. For instance, Mangalmurti, Murtagh and Mello [ 10 ] argue that the trend is for insurers to lower their premiums for policyholders who use EHR, precisely because it is considered more reliable than the paper one.

Eventually, the consequence will be dictated by the outcome of lawsuits involving EHRs, all depending if courts will find them a good support for healthcare delivery or, on the opposite, a dangerous instrument regarding the standard of care, which, in turn, will depend on the way how institutions and healthcare professionals deal with the EHR.

In our opinion, and as it will be further developed, EHR can actually become a very useful instrument to promote patient safety and to avoid medical faults, but, in order to do so, its proper use is absolutely required. But, in fact, some of those studies refer to the first years after the implementation of the EHR — see the study of Weir [ 14 ] about the experience of the Veterans Health Administration's computerized patient record system —, when the lack of experience in its handling and its technological degree of development was still in its very beginning, and it is a well known fact that novelties usually foster litigation.

The fact is that nowadays almost every study [ 15 ] underlines the fact that the danger does not lay in the EHR itself, but on the misuse made by unprepared users.

Actually, we believe that litigation surrounding the medical activity increased because of the new perceptions on the role of healthcare professionals and medicine, firming the erroneous perception in society that scientific and effects of electronic health records on transforming health developments can solve and heal everything and, thus, turning much stricter the standard of care. Therefore, it is unfair to attack the EHR for increasing the number of medical liability cases, a circumstance due to multiple factors, under which the EHR plays a minor role.

As stated above, the EHR is not, de per se, a new source of medical faults and lawsuits, placing doctors in an higher risk of getting sued. Quite the opposite, it is likely that the generalization of the EHR will turn its use in the best medical practice for healthcare professionals, effects of electronic health records on transforming health such a way that it would be precisely the maintenance of the old paper medical file that would force the doctor to justify why he has not already adopted the EHR.

In other words, in the near future, the adoption of the EHR will probably be the standard of care expected from health institutions and healthcare professionals, therefore, helthcare providers risk a conviction whenever a patient suffers any injury while being treated using the paper file as resource [ 10 ], [ 13 ]. But it is a fact that the EHR has some risks, which may generate new kinds of medical faults.

Curiously enough, some of those risks result precisely from its benefits. To overcome this difficulty Hoffman and Podgurski [ 2 ] suggest that the doctor could require a nurse to summarize the most relevant notes from the wide range of information about the patient. However, this solution would allow the nurse to access information that probably he or she is not authorized to, since privacy laws in this matter tend to be very restrictive.

Their excessive repetition will lead the physician to disregard serious risks for the patient, risks that perhaps he would have noticed by the traditional methods of human evaluation of information [ 16 ]. The coded language used by the system, which was just qualified as a benefit, also raises problems.

First, it is necessary to know and understand it. Furthermore, that language may prove too standardized to describe accurately the clinical status of a particular patient, with all its intricacies and peculiarities, which may be decisive in the outcome of the case. Another difficulty to have in mind relates with the fact that the choice of any code presupposes a previous diagnosis, which often cannot even be done.

In addition, it can be difficult to choose the correct code, especially in more complex cases or when some of the codes are similar in what regards the situation they describe. Likewise, we also cannot set aside the hypothesis of human error in choosing the effects of electronic health records on transforming health, which will often be the case, as data appears many times as mere strings of numbers or letters aligned together in a small computer screen.

The very way in which the record is done — rectius, can be done — promotes medical error. The reason is that the system asks for very detailed information, that often is not available to the clinician. The problem is that information that was valid for a prior date may not be adequate for any other time, and it is a well-known fact that the quality of healthcare largely depends on the integrity, reliability and accuracy of health information. The fact that the same data the same answers, the same values are carried over from week to week, fosters errors, since the medical team does not realize that the clinical condition of the patient has changed and instead, continues to reason based on outdated information.

Another peril comes from the templates offered by the EHR. Of course that they turn record much easier, since it is all about crosses and checks. But the fact is that many records can end up having the same content, disregarding the particularities of each patient, sometimes unable to fit a standardized template.

Moreover, some systems automatically fill the empty spaces without the doctor noticing it, once again discounting the specificities of the patient [ 6 ]. Besides, the speed at which everything happens, when it takes simply a click to change completely the information on the computer screen, decreases attention in data visualization. It is a fact that the EHR promotes easy access to the result of those tests, whereas in another situation the physician would tend to duplicate them.

Nonetheless, the clinical condition of the patient may have changed in the meantime, so, decisions based on previous results may become a present hazard.

Another dimension of the problems raised by easy access to previous exams occurs when the first examination is carried out by a certain doctor, who wrongly recorded the results, and another doctor came to make decisions and take actions based on those erroneous results. When this scenario occurs we can have a litigation snowball: It is true that incidents of this nature may also occur with paper-based medical files, however, in this last scenario those incidents are rarer and with limited effects, precisely because one of the disadvantages of paper records is the difficulty in gaining access to previous patient information; while within the EHR any existing error propagates its harmful effects very quickly, given the easy access to information.

Electronic health records: Is it a risk worth taking in healthcare delivery?

Some medical faults may be generated by the way EHR systems make information available to the doctor. Usually the screen presents a list of small letters and numbers displayed in a column, thus, the doctor may easily select the wrong patient name or the incorrect medication among the long list of small letters. It is also conceivable that the information will eventually be recorded on the wrong patient record, which, besides providing incorrect clinical decisions, or even death, can cause serious and unnecessary distress to a patient who was been reported of suffering from a disease that, after all, does not affect him.

Some errors can be generated by programs that the doctor, on its own initiative, and often without authorization, installs on the computer, and that may conflict with the normal operation of the software. Therefore, this type of conduct shall be forbidden to users, otherwise it may distort the whole mechanism. As already noted, sometimes are the apparent EHR advantages that become its greatest enemies. Surely this additional service greatly facilitates medical treatments.

But sometimes it may be an inadequate instruction, since those guidelines are laid down for the majority of cases, reasoning in the abstract, without taking into account the patient particularities. However, the doctor may be tempted to follow what the system recommends, without considering whether, in the particular case, this is the most appropriate conduct. In fact, the spread of technology in healthcare is reaching decision-making itself and actually doctors are allowing machines to make some routine decisions, either because of lack of time, or because they believe the machine is a better decision-maker.

For instance, it is common to have a prescription based solely in the registered symptoms and its informatic evaluation, which, of course, can originate wrongful decisions, because human factors and specific particularities are not considered.