Information Technology is proving to be a vital element in the administration of the healthcare industry by providing a new way to store vast amounts of information without requiring a huge physical storage space. An electronic health records (eHR) system is a comprehensive database system used to store and access patients’ healthcare information. Performance improvement throughout the industry remains a primary focus to improve the quality of care and organisation performance. Soon as the industry advances, “no longer paper-based records systems will fulfill the needs of clinicians and related healthcare workers”. [1] Information Technology will continue to be an instrument to improve the industry as benefits of using electronic health records are achieved. However, several barriers, obstacles and disadvantages will be observed as costs to implement such technology. In this essay, three related case studies will be discussed to demonstrate the cost/benefit analysis of electronic health records. Thus, to determine this, determinants of cost/benefit analysis are defined beforehand as a general overview.
Criteria for Determining the Cost/Benefit Analysis of Electronic Health Records
Cost has always been a major factor in the evaluation of information retrieval systems, but it has assumed to have increasing important constraints and possible elimination of some services. In a related literature (as paraphrased from “Evaluating Information Retrieval System”, Eva Kiewitt, 1979),[2] Kiewitt defined that an information retrieval system can be evaluated from three viewpoints. Firstly, it is effectiveness of the system where how well it satisfies the demands placed upon it. Secondly, it is cost-effectiveness evaluation where the determination efficiency (in term of costs) that satisfies its objective. Lastly, it is the determination and evaluation whether the system justifies its existence (the system’s worth). [2] Hence, cost/benefit will be analysed by evaluating the system’s worth. Thus, the three viewpoints can be applicable for the implementation of electronic health records.
Apparently, the disadvantages are also contributing in the part of cost analysis in electronic health record. These include items such as the start up cost and the training cost, which can be excessive. There is a substantial learning curve, where practitioners have to have the literacy in using the system, performance data entry as well as information retrieval. [3] These were once a job of the clerks. Electronic health record designers have to consider the needs of the users. In other words, systems must be user-friendly. Another disadvantage is every error on the records can have a major impact since multiple users can access the record at one point of time. This can lead to further failures in hardware or software, which can cause loss of information. Lastly, the security measure has to be enforced strictly to protect privacy and confidentiality in the system. [4]
On the other hand, the benefits (also known as part of the advantages) of electronic health records, in terms of electronic storage, accessibility and availability [5] of information to authorised practitioners, are often combined with the benefits of an electronic healthcare system. These include enhanced access to medical information, greater efficiency, allowing continuous data processing and up to date information [5]. A huge potential for cost savings and centralised administration have proven to be some of the distinct benefits of using electronic health records over paper health records. [6] Furthermore, electronic health records allow completed and accurate documentation of all clinical details and variances in treatments by providing a single point of access.
In addition, information can be easily sorted or grouped according to certain priority and criteria, such as the treatment dates performed. Electronic health records also allow the users and practitioners to graph a set of results over time. For instance, a patient’s blood pressure can be graphed over a short time period, allowing the practitioners or nurses to notice the trends that might be vital for special attention or proper care.
According to Powsner and Wyatt (1998), there are a total of ten benefits in having an Electronic Health Record. One of the benefits mentioned before, that is, continuous data processing, is actually where the data are structured and coded in an unambiguous structure. Subsequently, programs can check and filter the data for errors, as well as summarise and interpret data continuously. The other seven benefits include assisted search, tailored paper output, incorporation of electronic data, patient data confidentiality, flexible data layout, and safer data and legibility of records.
Case Study 1 : Spartanburg Regional Medical Center
Herald Journal, March 22, 2000
By Scot Silverstein [7]
In the case of Spartanburg Regional Medical Center, in the States (reported on March 22, 2000 on Herald Journal, cited by Scot Silverstein), several staff members observed that malfunctions in the hospital computer system that stores patients' medical or health records are jeopardizing patients’ care. This incident had led to a cost of $2.7 million since nurses use the system for clinical reports, storing electronic medical records and a database used by doctors to track patients' clinical progress.
Furthermore, according to the hospital’s documents, the problems include difficulties in retrieving medical histories, frequent error messages and failure of the system to post lab and pathology reports in patients' files. Two of the possible reasons that caused the occurrence of errors within the system could either lie with the technical problem or security.
This is one of the cost analyses that Spartanburg Regional Medical Center has to face after implementing the electronic health records. Further, this will worsen the situation with such incident in their electronic health records system, as the cost of the start up for implementing the system, which includes training the healthcare staff, is high. Thus, this will add more problems to the current situation. This is also an example from the second view point by Kiewett.
Case Study 2 : St. Jude Children’s Research Hospital - Using Electronic Medical Records to Improve Patient Care
by Mark Frolick
The implementation of an electronic health records system at St. Jude Children’s Research Hospital, in Tennessee (USA) addresses the problems that existed with the paper based health record and explores the benefits of electronic health records system. It is vitally important for St. Jude Children’s Research Hospital to adopt such system, as it is dedicated to the treatment of children with catastrophic illnesses. The criteria for each protocol of treatment are carefully defined, which aid the maintenance of electronic health records to complete and store accurate documentation of all clinical details and variances in treatment. Thus, St. Jude has decided to invest in a project of building an electronic health record system. In addition, this electronic health record provides a single point of access for all employees seeking information both for clinical treatment of patients and research data collection. In a long process, St. Jude will benefit in a number of ways by implementing such system, which include the accessibility of retrieving information and an improved communication.
Now, all clinical laboratory and patient demographic information can be viewed at any terminal in the hospital, as long as the employee has security clearance. Data retrieval is more accurate and efficient due to automated clinical documentation and protocol information is electronically linked to clinical report. These include the following: medical-error reduction and time saving due to the electronic record’s availability and legibility; information sharing with patients; and support for clinical decision making.
From the case study, St Jude has fully benefited from the electronic health record system. St Jude has also observed a great improvement and efficiency in the working professionals.
Case Study 3 : EHR Net Strategy
By NSWHealth Council [8]
Another implementation project by NSW Health Council is to introduce electronic health records at different locations in Australia. The project has shown significant progress in at least two areas within the first three years. There have been a number of key developments, where benefits are extended from immediate consumer, provider and organisation benefits.
Consumers are better informed about their health status. They are able to access and control their health records and importantly, and they can be actively involved in the creation of their own health records. Providers can improve legibility and accountability as event summaries are electronically transmitted and there are few errors and duplication of treatment since episodes of care can be tracked across all health services. Lastly, the organisation will obtain better communication and access to information for audit and research purposes.
For this case study, the benefits do not only fall on one party since consumers, providers and organisations are at the advantages from this implementation. These benefits will improve efficiency, safety and quality of care over paper-based systems.
Conclusion
These case studies have shown that cost/benefits analysis can result in a vital role in the successful outcomes of the electronic health records. The benefits realized by the implementation of an electronic health records system include efficiency in managing clinical information, and an improved quality of care and cost through decision support and management of patient care. In contrast, the cost analysis has shown a number of disadvantages. Yet, it can be also a useful tool for evaluation processes in the implementation of such a system. In the first case study, the implementation of electronic health records was not properly planned and evaluated from the three viewpoints defined by Kiewett. One the other hand, the other two case studies have benefited from the implementation of electronic health records and this is a good point for further development.
In conclusion, the decision to implement electronic health records in any healthcare setting requires a clear understanding of the potential cost-benefit. Electronic health records have provided every sector in the health industry with extensive benefits and options for improving patient care. Information stored electronically now is more accurate as well as legible. Yet, keeping in mind about the benefits of using health electronic records, cost analysis must be taken note of, as it is a vital factor in implementing such systems.
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