Relevant issues of electronic health record usage within the U.S. health care sysytem

Relevant Issues of EHR Usage within the U.S Health Care System
A decade ago, only 48.3% of physicians were using an EHR system. Today, the number has nearly doubled. About 85.9% of office-based physicians are using EHRs, with only 79.7% using a certified EHR system (CDC, 2017). Substantial evidence further shows that the adoption and use of these systems only accelerated in recent years among providers. As a result, several of these providers now report the benefits of using EHRs. They confirm that electronic health records have improved the quality of care, efficiency, overall health outcomes, reduced errors, and costs. These benefits extend to patient safety, decreased delays, and better care coordination (Gellert, Webster & Gillean, 2017). Some of these reported benefits are in line with the five “meaningful use” objectives, which was a mandate under the HITECH Act of 2009.
In contrast, some clinicians have voiced their concerns about EHR’s usability and interoperability. Other scholars are not convinced that electronic health records can maintain privacy and confidentiality. Therefore, providers remain divided whether they should embrace EHRs or not. These controversies necessitate a critical examination of the fundamental aspects of this new technology. Thus, this paper examines the relevant issues of EHR’s usage within the U.S healthcare system by drawing from recent evidence. The author argues that although EHRs promise to improve care through the “meaningful use” objectives, it also needs substantial improvements in usability, interoperability, and confidentiality.
Relevant Issues
Interoperability across healthcare systems
Evidence asserts that achieving an interoperable EHR system has long been a significant concern in the U.S healthcare system. By 2015, only 12% of physicians could seamlessly share records of their patients with other providers. Half the number (6%) could easily transmit patient records to another provider using a different system (American Medical Association, 2015). Why is it challenging to have a certified interoperable system for electronic health records? Reisman (2017) attributes this to the lack of standard medical terminologies, functional capabilities, and technical specifications. These factors, coupled with a health organization’s unique preferences and workflows, cause a lack of standardized data. Standardization is the primary reason why providers in the U.S healthcare system are limited in sharing EHRs.
Conversely, Holmgren, Patel, and Alder-Milsten (2017) found that the government is making some progress towards interoperability. However, their 2015 data shows that the progress was slow and did not engage some providers. More recent evidence suggests that the government is making strides to speed up the process. To promote interoperability, the CMS, in early 2018, renamed the EHR Incentive Program. The focus was to expand the vision of the meaningful use objectives by improving access to patient data. Today, the initiative is named “Promoting Interoperability Programs” (PIP). This change does not overrule the requirements of meaningful use. Instead, it increases the focus on the issue of interoperability (CMS, 2019). Such slow progress to interoperable systems and the issue of standardization indicates the need for further improvements in the PIP initiative. Researchers have already made recommendations on how the CMS can guide providers and patients towards interoperability.
Privacy and Confidentiality
Though EHRs offer several benefits that improve patient care, significant ethical concerns about patient privacy and confidentiality remain. Shenoy and Appel (2017) assert that the legal protections that the government has implemented through laws such as HIPAA of 1996 are not enough. In practice, EHRs are still susceptible to breaches that compromise the privacy of the patient’s data. Kaplan (2016) confirms that sensitive data such as sexual health, mental health, or substance use data are at a higher risk of a breach. They further argue that data security and privacy are the keys to the successful integration of personal health records (PHRs) and EHRs. Thus, healthcare organizations and professionals are obligated to ensure the privacy and security of EHRs
Several physical, administrative, and technical safeguards are necessary to ensure the patient’s privacy and confidentiality. As a result, healthcare providers have already adopted different precautions to guarantee the security of EHRs. There is no consensus about the success of these safeguards. Some scholars view them as satisfactory, while others see them as inadequate. Kelley (2016) offers a starting point. She emphasizes the need for healthcare organizations to carry out risk assessments to identify the strengths and weaknesses of EHR systems. Evidence reveals that several organizations are already assessing their systems for security risks. Nonetheless, one thing remains clear. EHR benefits are only achievable if the patient is confident that their electronic health records are safe and accurate.
Presence of Usage Mandates
The presence of mandate programs and incentives for “meaningful use,” such as the PIP and the HITECH Act, encouraged widespread adoption of electronic health records. Through its three stages, the EHR Incentives Program (now PIP) has provided incentive payments to providers who met its requirements. As a result, more physicians and hospitals are now adopting this new technology. Adler-Milstein et al. (2017) found that as of 2017, 80.5% of U.S hospitals had adopted a basic EHR system. Though there is no evidence whether these mandates delivered the expected transformation on healthcare, increased EHR adoption is one indicator of this change.
Equally, the existence of these usage mandates did not encourage the widespread use of the EHR system’s advanced features. Adler-Milstein and colleagues confirm this divide in the use of advanced functions of EHR systems. Only 41.7% of the above hospitals were using patient engagement functions. Also, only 37.5% of these facilities used EHR data for performance measurement functions. These findings indicate a lag in using functions that are vital to the improvement of a health facility’s performance. The current mandates need strengthening. They should encourage not only the adoption of EHRs but also the use of the systems to their full potential.
Cost
The purchase and maintenance of EHR systems is a prevalent barrier to their adoption and use among hospitals. However, not all hospitals consider it as a significant issue. Evidence suggests that these costs vary by the health facility’s type, size, and location. Adler-Milstein et al. (2017) established that hospitals in the rural areas of the U.S report high up-front and ongoing costs as a significant barrier compared to urban health facilities. Also, small hospitals (100 beds or less) are more likely to cite two or more costs as barriers to using EHRs as compared to large hospitals. Though this data clarifies what type of costs are supreme, other factors contribute to this variation. Excellent examples include levels of required staff training and labor costs for system operat...