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Electronic health records: a diamond in qualitative primary health care
24. June 2018 at 19:52
by Evbodaghe Omo-imafidon
Health records are the most important database of health treatment of the patient. Consistent recording by doctors, nurses and other staff is proof of proper monitoring of the health, planning and treatment. Initial health records were used to describe individual processes. Today, health records are a much broader concept than in the past because in the past, it was the doctors and nurses alone who recorded data.
Health records and documents serve as the basis for the realizing of individual rights, both in civil and legal transactions, as well as the exercise of rights relating to privacy and the retrograde determining health status (MilenaMrinič, 2015).

In healthcare, the use of information technology has developed considerably all over the world, especially in developed countries. On the other side, developing countries are working on sustainable use of technologies, especially in primary healthcare systems. In support of health and healthcare services, the use of information and communication technology (ICT) in such areas as healthcare services, health surveillance, health literature and health education, and knowledge and research is fast developing (WHO, 2005).

Use of health information technology, especially at the point of care, is often considered as a way to improve care coordination and quality (Blumenthal, 2010.) Mobile technology, such as tablet computers and personal digital assistants, represents an opportunity to gather information at the point of care. Collection of information at the care site would be especially important in home health and hospice care, where care is provided predominantly at the patient’s home rather than in an institutional (Sanchez, 2009).

Electronic health record (EHR) systems have the potential to transform the health care system from a mostly paper-based industry to one that utilizes clinical and other pieces of information to assist providers in delivering higher quality of care to their patients(NirMenachemi and Taleah , 2011). EHRs are defined as “a longitudinal electronic record of patient health information generated by one or more encounters in any care delivery setting. Included in this information are patient demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data, and radiology reports.

Electronic Health Records and Primary Health Care
Primary healthcare (PHC) refers to essential health care that is based on scientifically sound and socially acceptable methods and technology which make universal health care accessible to all individuals and families in a community, through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination (WHO, 1978). This definition as an Alma Ata declaration pointing out socially acceptable technology, which is a perfect match for electronic health records.

Electronic health records provide real time communication of care provided in one chart. Electronic health records provide report to better understand the population served by a team and the health outcomes of that population (Electronic Health, n.d). It provides the opportunity for health care organizations to improve the quality of patient care and safety, and also has the potential to reduce cost and improve efficiency of the workplace (Jha,,2009) simultaneous access to patient records by multiple users and the ability to perform data queries to inform decision making. These potential benefits of the EHR have enabled its wide acceptability in industrialized nations (Black et al, 2011).

Benefits of electronic Health Records
Patient`s Participation
Providers and patients who share access to electronic health information can collaborate in informed decision making. Patient participation is especially important in managing and treating chronic conditions such as asthma, diabetes, and obesity (Health IT, 2014).How Electronic health records (EHRs) can help providers:
i) Ensure high-quality care: With EHRs, providers can give patients full
and accurate information about all of their medical evaluations. Providers can also offer follow-up information after an office visit or a hospital stay, such as self-care instructions, reminders for other follow-up care, and links to web resources.
ii) Create an avenue for communication with their patients: With EHRs, providers can manage appointment schedules electronically and exchange email with their patients. Quick and easy communication between patients and providers may help providers identify symptoms earlier. And it can position providers to be more proactive by reaching out to patients.(HealthIT, 2014)

Information technology is at the heart of modern life. It touches different people in different ways. Some are comfortable with new technologies; others may be intimidated, at least at first. EHRs, PHRs, and other health IT developments tend to make many patients more active participants in their own health care. As providers adopt new technologies such as EHRs, it's important to keep the patient's perspective in mind.

Medical practice efficiencies and cost savings
Many health care providers have found that electronic health records (EHRs) help improve medical practice management by increasing practice efficiencies and cost savings. A national survey of doctors reported by Jamoom, 2012 revealed that:
79% of providers report that with an EHR, their practice functions more efficiently,
82% report that sending prescriptions electronically (e-prescribing) saves time,
68% of providers see their EHR as an asset with recruiting physicians,
75% receive lab results faster,
70% report enhances in data confidentiality.

Based on the size of a health system and the scope of their implementation, benefits for large hospitals can range from $37M to $59M over a five-year period in addition to incentive payments (Kumar and Bauer 2011.). Savings are primarily attributed to automating several time-consuming paper driven and labor-intensive tasks (Bell and Thornton, 2011).
• Reduced transcription costs
• Reduced chart pull, storage, and re-filing costs
• Improved and more accurate reimbursement coding with improved documentation for highly compensated codes reduced medical errors through better access to patient data and error prevention alerts
• Improved patient health/quality of care through better disease management andpatient education

Electronic Health Records Create More Efficient Practices
Improved medical practice management through integrated scheduling systems that link appointments directly to progress notes, automate coding, and managed claims Time savings with easier centralized chart management, condition-specific queries, and other shortcuts. Enhanced communication with other clinicians, labs, and health plans through:
a) Easy access to patient information from anywhere
b) Tracking electronic messages to staff, other clinicians, hospitals, labs, etc.
c) Automated formulary checks by health plans
d) Order and receipt of lab tests and diagnostic images
e) Links to public health systems such as registries and communicable disease
databases (Bell and Thorton, 2011).
f) Enhanced ability to meet important regulation requirements such as Physician Quality Reporting Initiative (PQRI) through alerts that notify physicians to complete key regulatory data elements.
g) Reduction of time and resources needed for manual charge entry resulting in more accurate billing and reduction in lost charges.
h) Reduction in charge lag days and vendor/insurance denials associated with late filing. Charge review edits alerting physicians if a test can be performed only at a certain frequency, alerts that prompt providers to obtain Advance Beneficiary Notice, minimizing claim denials and lost charges related to Medicare procedures performed without Advance Beneficiary Notice (Bell and Thorton, 2011).

Electronic Health Records Reduce Paperwork
EHRs can reduce the amount of time providers spend doing paperwork. Administrative tasks, such as filling out forms and processing billing requests, represent a significant percentage of health care costs. EHRs can increase practice efficiencies by streamlining these tasks, significantly decreasing costs. In addition, EHRs can deliver more information in additional directions. EHRs can be programmed for easy or even automatic delivery of information that needs to be shared with public health agencies or for the purpose of quality measurement (HealtIT, 2014).

Electronic Prescribing (E-Prescribing)
Paper prescriptions can get lost or misread. With electronic prescribing (e-prescribing),doctors communicate directly with the pharmacy. An e-prescribing system can save lives (by reducing medication errors and checking for drug interactions), lower costs, and improve care. It is more convenient, cheaper for doctors and pharmacies, and safer for patients. In short, e-prescribing is an important, high-visibility component of progress in health information exchange (HealtIT, 2014).

Electronic Health Records Reduce Duplication of Testing
Because EHRs contain all of a patient's health information in one place, it is less likely that providers will have to spend time ordering and reviewing the results of
unnecessary or duplicate tests and medical procedures. Less utilization means fewer costs (HealtIT, 2014).

Improved care coordination
The Need for Better Improved Care Coordination
As medical practices and technologies have advanced, the delivery of sophisticated, high-quality medical care has come to require teams of health care providers—primary care physicians, specialists, nurses, technicians, and other clinicians.
Each member of the team tends to have specific, limited interactions with the patient and, depending on the team member's area of expertise, a somewhat different view of the patient. In effect, the health care team's view of the patient can become fragmented into disconnected facts and clusters of symptoms. Health care providers need less fragmented views of patients (HealtIT, 2014).

How can EHRs Improve Care Coordination?
Electronic health record (EHR) systems can decrease the fragmentation of care by improving care coordination. EHRs have the potential to integrate and organize patient health information and facilitate its instant distribution among all authorized providers involved in a patient's care. For example, EHR alerts can be used to notify providers when a patient has been in the hospital, allowing them to proactively follow-up with the patient. With EHRs, every provider can have the same accurate and up-to-date information
about a patient. This is especially important with patients who are:
• Seeing multiple specialists
• Making transitions between care settings
• Receiving treatment in emergency settings
Better availability of patient information can reduce medical errors and unnecessary tests. Better availability of information can also reduce the chance that one specialist will not know about an unrelated (but relevant) condition being managed by another specialist (HealtIT, 2014)

Improved diagnostics and Patient Outcomes
When health care providers have access to complete and accurate information, patients receive better medical care. Electronic health records (EHRs) can improve the ability to diagnose diseases and reduce even prevent medical errors, improving patient outcomes. A national survey of doctors (Jamoom et al, 2012), who are ready for meaningful use offers important evidence:
94% of providers report that their EHR makes records readily available at point
of care.
88% report that their EHR produces clinical benefits for the practice.
75% of providers report that their EHR allows them to deliver better patient care.

EHRs can aid in diagnosis
With EHRs, providers can have reliable access to a patient's complete health information. This comprehensive picture can help providers diagnose patients' problems sooner. EHRs can reduce errors, improve patient safety, and support better patient Outcomes. How? EHRs don't just contain or transmit information; they "compute" it. That means that EHRs manipulate the information in ways that make a difference for patients. A qualified EHR not only keeps a record of a patient's medications or allergies, it also automatically checks for problems whenever a new medication is prescribed and alerts the clinician to potential conflicts. Information gathered by a primary care provider and recorded in an EHR tells a clinician in the emergency department about a patient's life-threatening allergy, and emergency staff can adjust care appropriately, even if the patient is unconscious.

EHRs can expose potential safety problems when they occur, helping providers avoid more serious consequences for patients and leading to better patient outcomes.
EHRs can help providers quickly and systematically identify and correct operational problems. In a paper-based setting, identifying such problems is much more difficult, and correcting them can take years (HealtIT, 2014)

EHRs can improve public health outcomes
EHRs can also have beneficial effects on the health of groups of patients. Chute and Koo, 2002 expressed that Surveillance research using EHR’s with a public health extended data model could be used to enhance the public health surveillance function. Pressing further they emphasized that it could also clarify the connections between changes in risk factors and early detection behaviors and disease outcomes. Emaimo and Anametemfiok (2014), stated that EHR influences of the quality of health services and clinical treatment on disease survival, quality of life and mortality.

Providers who have electronic health information about the entire population of patients they serve can look more meaningfully at the needs of patients who:
a) Suffer from a specific condition
b) Are eligible for specific preventive measures
c) Are currently taking specific medications
This EHR function helps providers identify and work with patients to manage specific
risk factors or combinations of risk factors to improve patient outcomes.
For example, providers might wish to identify:
How many patients with hypertension have their blood pressure under control, how many patients with diabetes have their blood sugar measurements in the target range and have had appropriate screening tests. This EHR function also can detect patterns of potentially related adverse events and enable at-risk patients to be notified quickly (HealtIT, 2014).

Challenges of EHR implementation in Nigeria`s PHC System
Inspite of the numerous benefits of EMR, it is painful to observe that its implementation in Nigeria is still very slow and low (Emaimo and Anametemfiok 2014). Maxwell, (2014) stated that the major documented challenge to the establishment of EHR was the high cost of set-up and maintenance. This was attributable to poor existing infrastructure, frequent power outages and network failure. Furthermore they stated that in facilities with EHRs, use was sub-optimal because of the need for parallel entry of data to paper and computer which increased the workload of over stretched staff.

The challenges can be summarized under three broad categories namely: technical, institutional and human capital factors. Technically, the absence of consensus on data standard in terminology, messaging, data structures and data recording remains a primary barrier to an inter-operable infrastructure. The resulting differences in the message format can make it difficult to transmit messages across institutions. (Chute and Koo, 2002, Emaimo and Anametemfiok 2014).

Fuller, 2007 emphasized that resistance to change to electronic recording poses a serous barrier. Electronic health recording involves some complex challenges with regards to record integrity, skill and high level of commitment because of integrated linkage of information systems across a continuum of care. Many health workers view ICT as a project that is too demanding and time wasting (Emaimo and Anametemfiok, 2014).

As the world matches on with development in technology, Primary Health Care; especially in Nigeria must adopt the scientifically sound and socially acceptable Electronic Health Record System to meet up with the ever expanding demands of healthcare, to improve quality care delivery, enhance job satisfaction for health care providers and invariably promote the health of all members of the community. EHR remains a precious diadem though expensive to acquire but possesses the potential of providing utility that is far greater than its cost if well harnessed.

Recommendations for primary health care in Nigeria
• Primary health care in Nigeria should intensify its moves in driving electronic health records to ease congestion of paper work.
• Implementation of the National Health Act, 2016 (components that emphasizes the use of EHR) to enhance the quality of care.
• Health care providers should be trained, re-trained, encouraged to use electronic health records managements.
• Alternative to power supply in resolving challenges in power supply and to ensure prompt data accessibility should be considered.
• Increased funding for researches targeted at electronic health records to bring about ground breaking discoveries that would enhance its utilization in Nigeria
• Enhanced health financing to cover for cost of procurement and maintenance of EHR facilities
Cite This Article As: Evbodaghe Omo-imafidon. "Electronic health records: a diamond in qualitative primary health care." International Youth Journal, 24. June 2018.

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