The adoption and use of the electronic health registers (EHR) system by healthcare organizations are aimed at improving the patients’ outcomes, promote effective health management, aid in the coordination of care, improve accountability, and align incentives with impressive patient and population outcomes. To promote greater adoption of the EHR in the delivery of care, the system must be used in a meaningful manner, implying that providers should not just have an IT system. There are, however, some issues that arise while using the EHR. This paper addresses these issues and how they act as barriers to effective adoption of EHR as per the meaningful use requirements. It also addresses means through which providers can use EHR in line with the meaningful use, and how an organization implements the system.
Legal, Financial, and Ethical Issues that May Arise As A Result of Meaningful Use Legislation
The legal system is characterized by its dependency on precedents, which makes it delay the adoption of new technology such as the HER, and offer little, if any, guidance on how navigation from the manual-based to electronic records will be executed. The adoption and use of EHRs calls for the development of local, state, and national wide health information exchanges (Sittig & Singh, 2011). This implies that the caregivers will have rapid computer access and to several organizations’ paper based chart. Even, though these initiatives will help in addressing the longstanding issues of missing clinical data, there lacks statutes to address the extent to which healthcare providers are responsible for reviewing the information in an integrated EHR that holds data from several sources. It is becoming difficult for many clinicians to review all information within a reasonable timeframe. Besides, the use of the HER comes with liabilities since it is able to store unlimited amount of legible and instantly accessible records that have all particulars regarding the care given and all of which are discoverable (Sittig & Singh, 2011). EHR also increases the legal responsibility and accountability of clinicians. They are also legally responsible for retrieving and electronically signing finding not within their purview.
The ethical issues related to the ownership of the protected health information. It also relates to the care giver’s responsibility of informing patients of the likelihood of privacy breach since EHRs facilitates the unauthorized disclosure of protected health information (Beverly & Ellen, 2011; Hanrahan, 2013). There are also ethical concerns from the breaches of computer-based personal health information (Sittig & Singh, 2011). Compared to the paper-based records, EHR has a wider scope for privacy breaches. The privacy and control of electronic information also present many ethical issues.
The financial issues surrounding the implementation and maintenance of the EHR relate to who should pay for the costs involved, which is estimated to be $40 000 to $100 000 (Beverly & Ellen, 2011; Sittig & Singh, 2011). Currently, the monetary benefits from the use of the EHR are enjoyed by the health care player instead of those financing its implementation. There are also financial issues because of the longer period that records for obstetrics patients and infants must be maintained. There are also huge financial losses associated with the EHR and health information exchanges’ use.
How These Issues Might Present Barriers to the Implementation of EHR
Some of the legal issues such as the complexity of the EHR system because of the multiplicity of options, navigation aids, and screens stand to be a challenge for most physicians. Such complexities require more time from clinicians and where they lack the necessary skills; they abandon it, arguing that the EHR is extremely complicated (Boonstra & Broekhuis, 2010). Also the problems regarding the quality, usability and reliability of the EHR system make physicians concerned that there could be loss of patients’ data, and thus impede its implementation.
The ethical dilemmas associated with the enhanced accessibility and portability of HER makes physicians feel that they may lose the professional autonomy. The adoption of EHR denies them the control over processes, conditions, procedures as well as content of their work. However, this is not the case under the EHR system which is accessed by many clinicians. They may, therefore, be slow to support EHR since its implementation means that they lose control over patients’’ data and other information.
The high costs of adopting the system are barriers to the successful implementation of the HER (Snyder & Oliver, 2014). After a cost-benefit analysis by the physicians, they get concerned whether they will benefit from running EHR. The high startup costs that incorporate all the expenditure required to have the EHR system in place and include the purchase costs of hardware and software, installation costs, and selecting and contracting costs (Boonstra & Broekhuis, 2010). Besides the startup costs, there are the high ongoing costs incurred in the course of EHR’s administration, maintenance, control and support. The uncertainties over return on EHR investment also hinder clinicians from implementing the EHR. They are not aware if they will get financial benefits from its use. Above all, there could be lack of funds to finance all these expenses, thereby hindering implementation of the EHR.
“Ways through which Health Care Organizations Can Make the Most of Their Electronic Health Record Investments in Light of Meaningful Use”
To unlock the tens of millions of dollar funding of Fed healthcare IT subsidies, the providers must do it in line with the ‘meaningful use’. They must, therefore, follow the three stages of a meaningful use. In Stage 1, health care organizations need to transfer the health data to the EHRs for information sharing (Agency for Healthcare Research and Quality, 2013). This will involve electronic extensions of charting and involve recording of patients’ demographics, maintaining problem lists, listing medication allergies, recording smoking status of patients, recording vital signs, maintaining medication lists, and adding laboratory results into the EHRs (Miller & MacGregor, 2011). In addition, they must meet other 24 measures, where 19 of them are met through structure data entry and include medication reconciliation, patient-specific education resources, and patient electronic access. The providers will must also have a patient-centered rules such as implementing security and safety measures for patients’ privacy, identifying patient-specific educational needs, offering patients access to their health records and clinical summaries (Miller & MacGregor, 2011), and childhood immunization status, and preventive care and screening measures (Agency for Healthcare Research and Quality, 2013).
The providers must also embrace Stage 2 standards such as online sharing and access of health information between them and patients. Their measures should emphasis on the use of clinical decision support that assist them in adhering to the evidence-based guidelines and improve their performance on high-priority health situations. In Stage 3, the provider must focus on improving safety, efficiency and quality, to improve health outcomes. They must also adopt infrastructure that supports patient access to self-management tools, and improve the population health (Health IT, 2013).
How Electronic Health Record -Related Meaningful Use Legislation is Being Implemented in Your Organization
My organization, through its strong and able leadership appreciates the need to implement the EHR in accordance with the meaningful use requirements. It is committing a significant amount of financial resources towards the equipment purchases, contracting, and training of the IT staff and physicians (Silow-Carroll, Edwards, & Rodin, 2012). The training programs for physicians are those encouraging an active learning, positive role models and active information technology contributions (Snyder & Oliver, 2014). To enhance good performance, the organization is redesigning and standardizing the care protocols, and nesting them in the EHR system as guidelines. To enhance a closer monitoring of the patients’ care, the provider has developed checklists functionality in the EHR system. Above all, it has created a patient portal as required by Stage 2 of the meaningful use, to educate and allow patients to have access to their health records.
A proper use of EHRs will help in improving the health condition and patients and population because it offers a broad range of information, especially where it is captured in a usable format. Several standards have been developed to guide a ‘meaningful use’ of the system. However, there are a myriad of challenges that inhibiting the implementation of the EHRs. Therefore, the concerned stakeholders must come in and address these issues for the EHR to achieve the intended goals meaningfully.