The upside and downside of EHRs

John Santangelo, director of IT at Cleveland Clinic Florida, recently discussed the benefits and drawbacks of implementing electronic health records with Healthcare Finance News Editor René Letourneau.

Q: What are the primary benefits of moving to electronic health records versus using a paper system?

A: The primary benefits of moving to an electronic health record (EHR) system are to improve four areas in healthcare: quality, safety, efficiency and research. This is the role of medical informatics - to fix the gap in a currently fragmented delivery system but most importantly to improve quality and efficiency.

Quality is enhanced because physicians, nurses, patients and their families have the right information to make the right decision at the right time. Patients who have access to their health record through an EHR become more educated and more active in their healthcare plan.

The EHR improves safety because it reduces errors, medication errors and drug interaction errors. In the United States, between 40,000 to 100,000 patients die from medication errors each year. The EHR has the ability to crunch a patients’ medication information much faster than a human brain so that these mistakes can be avoided.

Efficiencies are enhanced because the EHR is potentially one single data source. The clinician has all their data in front of them, whereas before, they were dealing with four different data systems as well as paper files.

Having data in electronic format allows you to do more from a research perspective. Analytics is a very powerful tool for the research community.

Q: How do you manage data security?

A: We certainly use the highest levels of data encryption that are out there. We have a very detailed, extensive audit system with EHR. We can track that the right person is viewing the right information. We use all the latest internal security technology to make sure the network is safe, and auditing protects us from breeches internally. We use SSL connectivity to provide secure connection for the user.

How secure was the paper or fax that sat on a fax machine all afternoon, which had a name, medical record number and date of birth? In a paper world, that could have been compromised. Having it in a secure environment - its apples and oranges comparing EHR to the paper world.

Q: Are there any drawbacks or challenges to using an EHR?

A: Absolutely. You are completely changing a culture when you go from paper records to an EHR. That is a huge challenge.

The best way to overcome the challenges is to directly engage the end users and make them a part of the implementation. Build technology around their workflow, not workflow around the technology.

It takes a large amount of financial resources to implement an EHR system. You have to consider everything from the technical resources to physical bodies to build, train and optimize the system along the way. It’s not an easy endeavor, however, the benefits far outweigh the challenges.


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