Running head: IMPORTANCE OF ELECTRONIC HEALTHCARE IMPLEMENTATION 1

The Importance of Electronic Health Record Implementation

Kenneth R. Williams
University of San Diego
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Abstract
As modern healthcare advances in the information age, it becomes evident that for a

practice to succeed, they must adopt an Electronic Health Record (EHR). Currently less than one

out of five medical clinics do not implement EHRs, and more than half do not have intentions of

adopting an EHR. As the health care industry adopts new technology, new challenges will

present themselves and prove what clinics will thrive or fail. Large breadths of data management,

improved health care accuracy and precision, reduced overall time and costs and market forces

are all strong factors that will push the industry into EHR adoption. Most importantly EHR

adoption will reduce human error and save lives.

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The Importance of Electronic Health Record Implementation

Electronic Health Records (EHR) are rapidly changing the health care industry, because

EHRs allow the health care industry to rapidly evolve. Deployment of EHRs allow for reductions

in patient deaths, health coverage for underserved communities, and the ability to report massive

amounts of data to patients; a plethora of new capabilities that will improve and extend the lives

of countless people.

Proper EHR implementation is vital to the efficacy and success of all medical practices,

and as a result the Health Care Industry is becoming more accurate and efficient. Each year there

is an estimated 44,000 to 98,000 patient deaths during hospitalizations that are not due to patient

condition, but rather due to mistakes occurring in the hospital (Balgrosky, 2015). A proper

implementation of an EHR will reduce this number by reducing mistakes, and thus preventable

deaths (Agrawal, 2009), yet there are still hurdles to overcome as improper data entry and other

unforeseen EHR limitations can lead to deaths.

Aside from aiding in preventing patient deaths due to human errors, EHR implementation

allows for Health Care to be provided for underserved or remote communities, as well as

demographic health data to be compiled. The Agency for Healthcare Research and Quality

(AHRQ) monitors case studies, one of such was documenting the proper implementation of an

EHR in Rural Iowa. This implantation allowed access to health care, and health care records in

an area that was previously underserved (O’Brien 2009). Compiling data for marginalized

communities allows for better treatment, and allows researchers to analyze data to better the lives

of people who may have otherwise been an afterthought.

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EHR adoption is vital in keeping up with the constantly changing health care industry,

and a prime example is the scientific breakthrough of sequencing the human genome. Large

quantities of valuable health care data can be found in a patient’s genetic code. As the health care

industry starts to capitalize on personalized treatment plans with insight from patient’s genetic

reports, EHR adoption will allow the industry to progress (Warner, 2016). Genomic data can be

used to analyze a patient’s possible reactions to pharmaceuticals but gathering that information

from a patient’s DNA sequence manually is cumbersome and time consuming. EHRs bridge the

gap between doctors and patient data, and allow quicker and more accurate access to

personalized treatment plans, and leaves room for researchers to develop more ways to crack our

genetic code.

As society advances in the information age, it is vital that the healthcare industry adapts

Electronic Health Records to keep up with large amounts of patient data. Aside from maintaining

large amounts of patient and clinical data, EHRs provide better health care by allowing patients

to access charts remotely (Levingston, 2012), allow medical professionals to be alerted to

pressing issues, and cross reference patient records from other providers. EHRs provide better

patient health, as patients require fewer tests, and compiling the health information from the

EHR paves the way for entire population health improvement. Lastly, adopting an EHR allows

for improved efficiencies and faster health care, as well as reduced costs for both patient and

provider (Bell, 2011).

Currently, less than one-fifth of physician practices have implemented an EHR, and more

than half of those have no plans on adopting an EHR. Most practices are content with the

outdated paper model. Overtime, it can be predicted that most of the practices using the

traditional methods will eventually fail, as the free market reduces the cost and time of the
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practices that adopt EHRs, traditional practices will not be able to compete (Abdolrasulnmia,

2008). Although the initial transition from paper to electronic health records can be a daunting

task, considering the initial training, continual support and overall costs, the product will always

be worth it in the end (AHRQ).

Implementing EHRs allows for large amounts of data to be stored electronically, and this

gives practices more patient information that is easily parsed and allows medical professionals to

give more accurate prognoses. One of the best cases for using an EHR is when referring to the

data that is generated though next-generation DNA Sequencing, a typical sequencing reaction

can generate hundreds of gigabytes of data that is stored as a bam file. A bam file has no use for

a clinical professional as it is a binary file consisting of only data, but if this data is stored and an

EHR implements software that reads the bam file appropriately, genetic data can become useful

(Tarczy-Hornoch). A patient’s somatic genome never changes during life, so a patient’s genome

will only need to be sequenced once. The bam file that is generated can be analyzed multiple

times, as new genetic information is release. The genetic data can be related to variant databases,

providing immediate information on potential drug metabolism and risks, as well as suggest

drugs (Wang, 2011).

Aside from large amounts of genetic data, if a clinic does not possess next-generation

sequencing capabilities, it will still have large amounts of data to manage, simply due to the

number of patients. Health clinics without EHRs would have cabinets filled with folders

maintaining information from patients that have ever been serviced the practice. This abundance

of paper can be digitized and become big data, removing the need for large file cabinets and the

need for a worker to navigate the human error prone sorting systems. Putting patient documents
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into an EHR database will allow parts of the data to be categorized as structured data, which is

hard coded and easily retrieved. However, when data cannot be simply categorized as structured

data, it realizes limitations in retrieval. It is currently very difficult to search for the results in a

doctor note, as opposed to a patient’s digital file that contains immunization schedules, vitals,

and current medications.

Big Data Analytics are diminishing the limitations of EHRs. Common complaints of

EHRs are the limitations of unstructured data, where data is manually written into a field by a

professional, and thus ‘unreadable’ by a computer. Big data advancements will allow this

Natural Language Process to be partially read, making the unstructured data fields potentially

become semi-structured (Ross 2014). Overtime we can predict that the software that is being

developed to improve EHRs will become smarter and will eventually use machine learning and

artificial intelligence to make sense of a humans note.

Not only are EHRs being implemented to manage large amounts of data that are beyond

the scope of human process capabilities, they also allow for information to be accessed off site,

either by the practitioner or the patient. Patients are now able to visit any medical provider, and

so long as the provider has an Internet connection and an EHR system, the patient can access

their information. Patients no longer need to fear a health emergency while on vacation.

Developers can create mobile applications that easily allow patients to access their information

that is provided in an EHR (Ventola, 2014). Instead of having to call their doctors office and

check back to receive their cholesterol readings from their last visit, a patient can immediately

reference their phone and manage their diet accordingly.

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EHRs are also relatively easy to implement in underserved areas, such as rural native

American tribal lands outside of Sacramento, California. Eight of twelve Native American sites

were able to successfully implement an EHR system, much higher than the twenty percent that is

the national average (Aranaydo, 2007). This also allows for underserved communities to receive

coverage, whereas before patients may have never seen a doctor.

EHR developers can prioritize pressing issues within the health data; this information can

then be presented on a dashboard, so health care providers can attend to the most pressing issues

without wasting time navigating the breadth of information from past visits. Reminders can be

set for vaccination notifications, a study showed that computerized reminders were able to

increase pneumococcal vaccinations from 19-45% of all patients (McDonald, 1992). These

computer alerts improve the overall error rate in a hospital setting by up to 55% (Bates, 1998).

Because of reducing hospital error rates, malpractice lawsuits decrease, thus saving money in the

long run for the hospital.

Access to such a large amount of clinical information gives a means of improving the

health of a given population. If the data being used follows HIPAA standards, researchers can

pool the information contained in the EHR for population health analysis. This includes but is

not limited to: aggregated clinical data, over the counter medication purchases, and school

absentee rates. Thus, researchers will be able to use this information to monitor localized disease

outbreaks and biological threats (Menachemi, 2011).

Currently only about twenty percent of all health care facilities have implemented an

EHR, however there is abundant documentation that proves proper EHR implementation has a

great return of investment as well as a multitude of patient and population benefits. If closer to
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ninety percent of all health care facilities were to adopt an EHR, we could expect to see overall

lower healthcare costs, more efficient and accurate personal care, and a healthier populace.

For any healthcare facility to be viable and have long-term ambitions, it is vital that the

facility adopt an Electronic Health Record. An EHR is less expensive in the long run, quicker,

more accurate and is becoming the industry standard. Most importantly EHRs are preventing

human deaths due to reducing the variable of human error.

It is shown that EHRs can successfully be used to manage large amounts of data, thus

removing previous data management limitations and allowing the future of healthcare to become

more specialized as genetic information can also be included. Allowing large swaths of data to

be stored digitally removes the need for full time folder management positions, helping larger

clinics. As time progresses EHRs are only expected to improve and the benefits of having a

paper-based health record diminishes. Digital implementation that follows HIPAA guidelines

will also help research institutes by compiling large amounts of data for future advancement.

By using digital networks EHRs can collect and maintain data for individuals who would

otherwise be unable to have their health monitored. Using an EHR allows healthcare facilities to

upload data instantly to the network, removing the possibility of data becoming lost in transition

or unrecorded for remote communities. It is also vital for remote/small medical practices to adopt

EHRs fiscally, due to potential competitiveness in the market, the overhead costs of not adapting

an EHR can quickly become greater than the implementation costs of EHRs.

When looking at the future, we can clearly say yes, EHR adoption will improve quality of

care (Manca, 2015). However how exactly will the implementation of EHRs look in the next 20
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years? The same as the topics discussed in this paper (Phillips, 2015). Nonetheless, it is vital for

patients and healthcare professionals, that as many facilities implement EHRs as possible.
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References

Abdolrasulnia, M., Menachemi, N., Shewchuk, R. M., Ginter, P. M., Duncan, W. J., & Brooks,

R. G. (2008). Market effects on electronic health record adoption by physicians. Health

Care Management Review, 33(3), 243-252. doi:10.1097/01.hmr.0000324904.19272.c2

Abdolrasulnia and company take an in depth look at EHR implementation in a variety of

different markets. It appears that most small market areas are typically those that are the

slowest to implement EHRs. The findings concluded that the more physicians there were

in an area correlated strongly with EHR adoption rates. The main finding was that for

every one more physician per 10k in a county correlated with a 2% increase in EHR

adoption. The researchers used graphical models to correlate this information to conclude

that although there previously wasn’t market research on this topic, it is to say that the

market is suggesting EHR adoption.

Agrawal, A. (2009). Medication errors: prevention using information technology systems. British

Journal of Clinical Pharmacology, 67(6), 681-686. doi:10.1111/j.1365-2125.2009.03427

Agrawal goes into detail about the benefits in terms of reducing error rates from EHR

implementation. Using barcoding systems and computerized order entry were proven to

prevent medication errors. The were conflicting arguments in this paper, as physician

groups always have issues with dealing with cost vs benefit analysis with EHR

deployment.
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Aranaydo L. M.D., Dahl S. MHA, (2007). Information technology systems for rural indian

health care: implementation and use of a commercial ambulatory care electronic health

record. Rockville, MD: The Agency for Healthcare Research and Quality (AHRQ).

A grant paper written by Aranaydo that discusses the benefits and troubles their team had

in implementing an EHR for a Rural Indian community. They were able to show that the

successful implementation of an EHR did result in improved health records and overall

health for native communities. This paper showed the feasibility of implementing a

relatively resource heavy system, in a remote resource scarce community.

Bates, D. W. (1998). Effect of computerized physician order entry and a team intervention on

prevention of serious medication errors. Jama, 280(15), 1311.

doi:10.1001/jama.280.15.1311

Bates compared the drug delivery methods amongst computerized physician order entry

and team order entry. The results were that there was a large amount of non-intercepted

errors in the team order entry group. It was found that using a physician order entry

system reduced the error rate by 55%.

Balgrosky, J. A. (2015). Essentials of health information systems and technology. Burlington,

MA: Jones & Bartlett Learning.

This section of the textbook provided information of death rates that were purely due to

human errors.

Bell, B, Thornton, K. (2011). From promise to reality achieving the value of an EHR. Healthcare

Financial Management, 65(2),51-56

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Bell and team discuss the benefits of EHR and how it can transform patient outcome. The

paper delves into a comparison of the difficulties of EHR development and the benefits

that fruit after EHR deployment.

Electronic Health Records. (AHRQ). Retrieved February 11, 2018, from

https://healthit.ahrq.gov/ahrq-funded-projects/emerging-lessons/electronic-health-records

Agency for Health Research and Quality, provides a robust description of what an EHR

is, what it entails and what it can provide. As well as what it takes to deploy one, the cost

benefits etc.

Jamoom E, Beatty P, Bercovitz A, et al. (2012) Physician adoption of electronic health record

systems: United States, 2011. NCHS data brief, no 98. Hyattsville, MD: National Center

for Health Statistics.

Jamoom provides a breakdown of the EHR adoption. The team shows that around half of

the target physicians have adopted an EHR and went on to show that at least eighty five

percent of them were satisfied with the EHR. One half of those who have not already

adopted an EHR, planned on doing so after being provided the information that Jamoom

and team provided.

Levingston, S. A. (2012). Opportunities in physician electronic health records: A road map for

vendors. Bloomberg Government.

Levingston provides a financial breakdown on the cost and savings from EHR adoption.

Such as that the federal government has already paid out 7.1 billion dollars to

professionals who have already adopted an EHR. It is expected that if current adoption

rates are to continue, this number will triple over the next five years.
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Manca, D. P. (2015). Do electronic medical records improve quality of care?: Yes. Canadian

Family Physician, 61(10), 846–847.

Manca goes into detail about the benefits of EHR adoption with regards to the patient and

to the physician and shows that there are not any pressing issues that can arise from

adopting an EHR aside from initial cost. Manca shows that patient-physician relations

increase, as well as terms of overall care.

Menachemi, N., & Collum, T. H. (2011). Benefits and drawbacks of electronic health record

systems. Risk Management and Healthcare Policy, 4, 47–55.

http://doi.org/10.2147/RMHP.S12985

Menachemi and team provide a detailed comparison of the risk management for EHR

adoption. The result is that is ever important for medical clinics to adopt EHRs do to a

variety of reasons, such as improved health care, improved overall costs and reduced

error rates.

McDonald, C. J., Hui, S. L., & Tierney, W. M. (1992). Effects of computer reminders for

influenza vaccination on morbidity during influenza epidemics. M.D. Computing.

Retrieved February 12, 2018.

McDonald showed that when a patient/physician has a reminder for an upcoming

influenza vaccination. It was shown that in a control group over three years influenza

rates increased, whereas they did not with the experimental EHR group.

O'Brien, J. (2009). Collaborative EHR Implementation to Bridge the Continuum of Care in Rural

Iowa. Rockville, MD: The Agency for Healthcare Research and Quality (AHRQ).
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O’Brien showed that in remote yet critical Hospital locations it was possible to

successfully implement an EHR.

Phillips, L. (2015, April 21). What will health care look like in 5-15 Years? Retrieved February

18, 2018, from http://www.hfma.org/Leadership/E-

Bulletins/2015/April/What_Will_Health_Care_Look_Like_in_5-15_Years_/

Phillips and team provide an in depth speculation on how they expect health care records

to change within the next 5-15 years. They assume that mobile health records will

become readily available. Such that users will have the medical reminders sent to their

phone as opposed to having to rely on their physician. Also patients will be able to view

the record on their own without having to get into contact with the medical offices.

Ross, M. K., Wei, W., & Ohno-Machado, L. (2014). “Big data” and the electronic health

record. Yearbook of Medical Informatics, 9(1), 97–104. http://doi.org/10.15265/IY-2014-

0003

Ross and team provide an in depth look at the issues that are related to mass amounts of

data storage. As more health information is being generated, it becomes ever pressing on

how to manage such data. Ross and team suggest a variety of physical data storage

solutions as well as a multitude of algorithms that can be used to successfully store data.

Tarczy-Hornoch, P., Amendola, L., Aronson, S. J., Garraway, L., Gray, S., Grundmeier, R. W.,

Yang, Y. (2013). A survey of informatics approaches to whole-exome and whole-genome

clinical reporting in the electronic health record. Genetics in Medicine, 15(10), 824-832.

doi:10.1038/gim.2013.120
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Tarczy-Hornoch and discuss how Next Generation Sequencing will play a role in

upcoming EHRs. They discuss how there is a lack currently of genome-medication

algorithms and how there must be careful decisions based on genetic information and

how it should be stored in an EHR.

Ventola, C. L. (2014). Mobile devices and apps for health care professionals: uses and

benefits. Pharmacy and Therapeutics, 39(5), 356–364.

Ventola discusses the promise of adapting Mobile Devices and Apps to include health

care information. Ventola goes into detail about the challenges that are included when

using a mobile device such as data integrity and storage. As well as a simplistic view

about how medical information can be stored on an app.

Wang, L., M.D., McLeod, H. L., Pharm.D., & Weinshilboum, R. M., M.D. (2011). Genomics

and drug response. Genomic Medicine. Retrieved February 12, 2018.

Wang goes into detail about how using genetic information and seeing how it relates to

drug responses can be used when using EHRs. This is the developing field of

pharmacogenomics, where referring to a patients genotype can influence which drugs

should be used.

Warner, J. L., Jain, S. K., & Levy, M. A. (2016). Integrating cancer genomic data into electronic

health records. Genome Medicine, 8(1). doi:10.1186/s13073-016-0371-3.

Warner delves into details about how far EHRs have come. What used to be a means of

storing patient information as well as billing details has become a full blown means of

relating medical data to the patient. Warner also discusses how EHRs will be a successful

means to storing genetic data when it refers to oncology.

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