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Electronic Health Records in Nursing Homes

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This research paper was prepared to give insight on the issues surrounding the use of Electronic Health Records in nursing homes. The advantages and the disadvantages of resulting from the adoption of the Health Information Technology are critical with reference to nursing homes are analyzed. The study is based from previous studies that have been carried out on the topic. The study reveals that most of the previous studies advocated for the adoption of the technology as it was found to improve the efficiency and the quality of the and the delivery of the services in the nursing homes. Researches from the University of Colorado which were funded by the federal government through various agencies were used in the analysis. A critical analysis of the researches reveals that the adoption of the Electronic Health Records to be more favorable. This is in spite of the disadvantages they possess; as they were found to cut on the cost and improve efficiency in the long run.    This research paper aims to give insight on the relevance of the use of electronic health records (EHR) in nursing homes. Electronic Health Record can be said to be a data of the patients’ medical history that is stored in an electronic format. It automates the access thus streamlining the workflow of the clinicians and other health practitioners. This will be a very important step in that field of medicine as it will allow them to access data including the progress notes, problems, medications, past histories of medications, immunizations, reports on radiology and laboratory data amongst other information from one source (Center for Medicare & Medicaid services). This will breach the gap that exists between the patients and the clinicians. The advantages of using this technology are many: It will enhance the accuracy of the records thus reducing the incidences of errors in the treatment centers. The efficiency of the treatments will be enhanced as this will reduce the duplication of the tests that were previously carried out. The data corrected can be used for research activities and thus for the betterment of the treatment procedures. Action plan can be drawn from the information that has been obtained, performance can be evaluated, collaboration with other health care organizations and institutions located elsewhere (Evolution of Medical Informatics).

The use of information technology in the health sector is not without disadvantages. Some of the disadvantages include the initial costs of the implementation, transition difficulties and lack of qualified personnel. However, the advantages of adopting this new technology outdo the disadvantages. In North Carolina, more than $15 million is has been committed in the BCBSNC that seeks to link all health care centers and physicians (Campbell, 23011).  

In this research paper, we will wish to take a look at the development of the use of informatics on the field healthcare particularly the nursing homes, its historical development and its evolution, analyze its benefits and the setbacks, make recommendations for further study and give precise conclusion on the topic.

Background history

There have been various studies that have been carried out in order to ascertain the benefits of the use of information technology in nursing homes. The researches have pointed out to a potential for improvement of the patient safety, quality of the health care, satisfaction of the patient, and efficiency in the costs all this through management of the information. This will reduce the number of redundant procedures and reentering of the data which pave ways to mistakes. 

The use of informatics in the field of medicines has been necessitated by the rapid growth in the volume of the patients’ data in the hospitals which has grown to un-manageable levels. There have been various researches in this field in order to come up with new methods of data storage and management therefore enhancing research, teaching, and the betterment of the health care in a more efficient way. As a result, curriculums in this field have been developed to provide qualified personnel. The use of the information technology in the field of Medicare in the United States is estimated not to be fully developed as compared to other sectors in such as banking and manufacturing. This has seen the costs of rendering services remaining high unlike the costs in other sectors. The history of medical records dates back in the fifth century BC, when Hippocrates developed goals for the medical record asserting that it should reflect the course of the disease accurately and as well indicate the cause of the disease. This concept has been modified with the current information technology to yield more functionality such as interactive alerts and flow sheets, order sets which were not possible with the previous paper system (Electronic Health Overview).

The first EHR started in the 1960, the adoption of the IT continued and by the year 1965, 73 hospitals in the United States had already kicked off the implementation strategy. Since then many software programs have been developed for the data acquisition and storage (Electronic Health Overview). The growth accelerated and by the year 2004, in EU more than 50% of the hospitals had already adopted the system and more than 70% by the year 2009. In the U.S. the adoption rate was a bit slower, in the year 2005 only 12% had adopted the system and by the year 2009 the number had grown to 25%. There have been recent campaigns coupled with incentives that were launched to encourage the adoption of the system (Glaser & Salzberg, 2011).  According to the a report by Campbell in the EMR daily news, North Carolina has taken steps to make HER available to its physicians and in 2011 Blue cross and Blue shield announced a collaboration that could allow its physicians and more than 39 clinics to connect to the Statewide Health Information Exchange (HIE). This new initiative was called North Carolina Program to Advance for Health (NC PATH) (Campbell, 2011).

Critical Analysis

The use of EHR has evolved to some great extent since its inception. In nursing homes the use of EHR is relatively scarce despite the potential it holds for improved medical services. The estimates are inconsistent owing to the different definitions of the term EHR. There has been massive progress in tools that are used in the adoption of the concept but the challenges lies in the fact that the tools are not directly applicable for the use in nursing homes. In the year 2007, the federal government in collaboration with the University of Colorado carried out a research on the use and the need for the adoption of the Health Information technology in nursing homes. The survey identified the need for the enhancement of the use of HIT in nursing homes (Taxonomy of Health Information Technology in Nursing Homes and Home Health Agencies)  

In the year 2010, a survey by The University of Colorado Denver which was funded by the United States government was carried out. The aim of the project was to develop a survey that is sensitive and capable of capturing time change of automation in nursing home and means of enhancing the adoption of Health Information Technology and provide a way to evaluate future growth. This has seen the adoption of the Health Information Technology becoming a national policy. The most conspicuous issues that arose were the fact that the term EHR lacked a clear definition thus making it difficult to carry out the survey. The survey laid down the strategies that were to be used for the evaluation and thus the implementation process was made more efficient (Survey Questions for EHR Adoption and Use in Nursing Homes).  

A report by the Texas Tech University health Sciences Center also pointed out on the advantages of the adoption of the EHR systems. The report pointed out to the cost based advantages as well as the quality of the services delivered and the enhancement of the employees’ satisfaction. The research recommended the continuation of the use of technology and also pointed out that the fact that the adoption could actually save the state a lot of money. However, there is a slight hindrance in the initial costs pertaining to the installation and the training of the staffs (Nursing home).

This implementation is not without challenges. Some critics argue that the virtual interaction of the patients and the physicians will cripple the passion for the medics in their line work. The advantages far much outdo the disadvantages thus the initiative was adopted. The government, on realizing the importance of the program has been offering incentives with the aim of encouraging the use of medical informatics by various health institutions. The underlying matter is that the IT is just a tool and therefore the impacts will only depend on the implementation. Various studies have been carried out to determine the outcomes of the use of the IT in the health care sector; the use of Computerized Physicians Order Entry (CPOE) has shown contradicting results with some indicating a decrease in errors while others indicated an increase in errors in the prescription. Campbell (2011) cites the initial startup costs as one of the hindrances in starting and running the project.

Strassman (1997) carried out a study to determine the relationship between the organizational effectiveness and the IT expenditures and found out that there was no significance correlation between the two. However, some organizations showed a positive impact thus leading to a conclusion that the effectiveness of the use IT depends on the implementation, leadership and the general efficiency in the implementation. The nursing homes are not exemptions, for them to realize the maximum benefits that are accrued with automation, proper administration and leadership ought to be employed. The success of the implementation depends on the governing concept of the physicians, if they view the concept as a way of improving the health care, then it might translate to the success. Otherwise, the implementation as well as the support may not be possible. Once the foundation for the implementation has been laid down, efforts should continue so as to avoid the slump that might reverse the progress already accomplished (Glaser & Salzberg 2011). According to Campbell (2011), BCBSNC have invested $15 million into the NC PATH program and this will help cover for about 85 percent of software costs but be able to cover for 600 physicians. He says that this will eliminate the largest barrier of entry for HER technology for most clinics.  

Recommendation for Future Work

Future studies should be carried out to evaluate how EHR can be extended beyond an organization; that is to the patients. A good example is the adoption of personal health records, and the implementation of remote monitoring of the patient. Another field that ought to be developed is the integration with other institutions thus data can be centralized thus enabling access and collaboration. Another conspicuous mistake is the lack of a standardized definition for the notation EHR. The stock holders should come together and come up with a precise definition that will harmonize the evaluation and the implementation of the use of EHR.  Campbell (2011) sys that the HER technology in North Carolina will   

Learning Experience Summary

From the above discussion, it is clear that the use of Electronic Health Records has undergone a great deal of transformation since its inception. The advantages of adopting this technology outdo the disadvantages by far. The health sector adoption is a bit lower as compared to the other sectors such as manufacturing and communication. Also within the health sector, the adoption in the nursing homes is a bit lower than other departments. This is due to the inhibiting costs and the nursing homes are not profit oriented institutions. However efforts have been put in place in order to harmonize the adoption of the technology in the nursing homes to line with the other health departments.

Support from the literature

All the above highlighted literature, preview from various researches and publication indicates the benefits of the use of Electronic Health Records.

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