Electronic Health Records (EHR) aims to improve and streamline data entered into each patient’s permanent healthcare file. While the concept is sound, EHR implementation can be fraught with problems.
On the surface, the process is simple. Click, input data, click save, and your health chart is updated. Sounds easy, right? The reality is some healthcare providers haven’t completely boarded the EHR train, and two of the primary reasons are costs and ease of use.
For starters, healthcare providers in most specialties were slow to adopt EHR technology. Throughout the 1990s, hardware and software costs were high. When prices stabilized, and providers eventually installed systems, compatibility problems arose. End users grew frustrated with all of the problems with electronic health records and ultimately resorted to scribbling handwritten notes into a patient’s chart.
Others attempted to save a few pennies by using inferior service providers or products. Later on, we’ll highlight a civil lawsuit and judgment where a patient died of an accidental overdose. Why? Because the hospital contracted with a transcription company using foreign subcontractors who couldn’t understand the doctor’s orders, resulting in a deadly outcome. That is why using a reputable US based medical transcription company enhances the EHR process and should be a vital consideration for any provider with a large patient base.
EHR Implementation: A Brief History
Before we dive into the history of EHR implementation, it’s important to explain the differences between an EHR and EMR. The two acronyms are often used interchangeably, but the difference is important.
An EMR is an individual patient’s digital medical record that usually remains in the provider’s office. An EHR is the all-inclusive record of the patient’s medical records that are shared among healthcare providers.
A few decades ago, healthcare providers manually entered data in our medical records maintained by individual healthcare professionals. If a specialist such as a cardiologist needed to understand our previous medical issues, a family physician would need to mail or fax the information.
The advent of technology in the 1960s and 70s created opportunities for medical records to be made, maintained, and shared more expeditiously and securely. By the 1980s, many large academic medical facilities began implementing an EHR system. However, most physician practices still used a manual paper filing system, primarily because these practices were slow to adapt to modern office computer systems.
Throughout the 1990s, more healthcare providers implemented computer systems because the cost of technology became lower. Younger practitioners and staff had already begun using computers.
Technology changed rapidly over the next decade. By the 21st century, most innovative industries had been implementing the latest technological advancements—all except healthcare. By 2004, only 13 percent of America’s healthcare facilities had fully implemented EHR systems.
In 2009, Congress passed the Health Information Technology for Economic and Clinical Health Act (HITECH). The new law began the motivating factor for healthcare facilities and practitioners to finally take the plunge and take advantage of EHR systems.
By 2018, around 80 percent of hospitals used an EHR system. However, only about 70 percent of physician practices had adopted EHRs. Thankfully, those percentages are rapidly increasing, which are also exposing a lot of the problems with electronic health records.
Why Providers Were Slow to Adopt EHR
The one question industry insiders kept asking; why was it taking healthcare providers so long to implement an EHR system? The primary reason for slow EHR adoption is cost. Purchasing the necessary hardware and software, combined with entering HIPAA compliant data, takes time and is expensive. Most EHR systems require maintenance and updating, so you’ll need to hire an IT staff or retain an outside firm.
Twelve years ago, in 2009, the Harvard School of Public Health published a study on why hospitals in the U.S. were slow to adopt EHR technology. The study concluded that less than two percent of surveyed hospitals had implemented a comprehensive EHR system. You didn’t misread the last statistic. Only twelve short years ago, 98 percent of the hospitals that responded did not have a fully functioning EHR platform in place. The reasons given were:
According to The Office of the National Coordinator for Health Information Technology, in 2017, approximately 95% of hospitals used a certified EHR system. Almost all large and medium-sized hospitals used an EHR, with small, rural hospitals lagging at 93%.
For physician practices, EHR adoption lags even more. According to a 2017 study posted on the Centers for Disease Control website, slightly less than 80% of office-based physician practices used a certified EHR system.
Interestingly, one of the leading causes of physician burnout involves the implementation and use of EHR systems.
A 2018 study conducted by Stanford Medicine found that 74% of surveyed physicians say that using an EHR system has increased daily hours worked. A staggering 69% claim using an EHR platform takes valuable time away from seeing patients.
Patient Privacy and EHRs
Two of the many promoted benefits of EHRs are improved quality of healthcare and privacy. In 1996, Congress passed the Health Insurance Portability and Accountability Act (HIPAA). Portions this law required healthcare providers to impose certain security measures to protect confidential patient information.
Healthcare facilities and physician practices are required by law to implement security features to protect patient information. For example, only authorized individuals can view patient data. Most computer hardware and software programs have built-in security functions to protect patient records from unauthorized use. Nonetheless, hackers often stay one step ahead of cybersecurity professionals and constantly develop techniques to infiltrate software and computer systems.
If ransomware attackers can access patient records, they can demand financial payment from hospital systems or providers before relinquishing access. That’s why it’s important to have stringent cybersecurity protocols to protect patient information and guard access to sensitive data, so patient records don’t get indexed by Google.
Some of the essential security measures available on most EHR platforms are:
According to the U.S. Department of Health & Human Services, the top five HIPAA violations reported are:
EHRs Greatest Ethical Dilemma: Data Input
The issues of privacy and confidentiality always surface when the subject of EHR arises. Patients should naturally be concerned about how and when their personal medical records are shared. Healthcare providers, multiple assistants, executives, and IT personnel are just some of the individuals who have access to our individual medical records. The issue of how and who enters our data into an EHR is also an overriding issue.
As any physician or healthcare provider, most will tell you that inputting patient data into an EHR platform is a hassle. Not only does EHR data input take time away from patient interaction, but it also adds to the total time spent in the office.
Some physicians are hiring either in-office or virtual scribes to input patient data into their EHR system. In-office scribes follow the physicians and input patient data in real-time. Virtual scribes listen to patient-physician encounters through a secure HIPAA connection and documents all the information. After the exam, the physician is supposed to review the patient’s chart for accuracy.
Both physicians and patients say that when doctors spend more time during an exam entering data into a computer or portable device, neither are satisfied with the outcome. That’s why the idea of using Artificial Intelligence (AI) programs to record conversations and translate them into an EHR is an attractive option.
However, there are multiple issues with using AI voice recognition software programs. Think about it for a minute. The medical and healthcare professions use terminology that is complex and complicated. A 2018 report on the use of AI for inputting data into an EHR system resulted in an error rate of 7.4%. That figure might appear low unless the error was made in your medical record.
Here’s a perfect example. The medications “Xanax” and “Zantac” sound and even look similar. However, Xanax is often used to treat anxiety, while Zantac is used to treat gastrointestinal issues.
While using AI voice recognition is a novel idea until further enhancements are made to ensure near-perfect accuracy, this approach isn’t viable.
Transcription Services and EHR
One option for entering data into an EHR system is for practitioners to record conversations of their patient interaction and have the audio files converted to written format by a medical transcription company. This is a popular approach growing in demand around the US.
However, when healthcare providers choose to save money by using non-U.S.-based transcriptionists, significant problems can and usually do arise.
In 2008 a lifelong diabetic patient was admitted to a hospital to have her dialysis port cleared of a clot. After the procedure, the physician dictated her discharge summary. However, the doctors were unaware that the medical center where the procedure occurred had contracted with a transcription company that used overseas transcriptionists to save $.02 per line.
Two days later, a nurse working at the rehab center where the patient was recovering requested the patient’s transfer orders. When told that the information wasn’t yet available, the nurse decided to print the patient’s discharge summary instead of waiting on the final transcript.
The document contained several significant transcription errors undetected by the transcription company and the quality assurance specialists dedicated to reviewing the report. The doctor had ordered eight units of insulin. Unfortunately, the AI transcribing software recorded 80 units.
After being given the incorrect amount, the patient died two days later. The family filed a lawsuit against all parties, citing negligence. After a jury trial the treatment hospital and the three transcription companies were held responsible for the $140 million in punitive damages.
That’s one reason why U.S. healthcare providers should use U.S.-based transcription companies that employ or contract only with U.S.-based transcriptionists who have an excellent command of the English language and understand medical terminology.
In addition, it’s also very important that any medical transcription company that a healthcare provider uses understands and is HIPAA compliant. An important component of HIPAA compliance is restricting third-party access (including subcontractors and freelancers) from sensitive patient records.
How to Improve EHR and Eliminate The Problems with Electronic Health Records
The good news is more healthcare providers and facilities are using the latest technology today. With changes in the healthcare landscape, almost every provider is or will be using the technology soon. One reason for the increasing use of EHR systems is the advent of telehealth.
Implementing Clinical Documentation Improvement (CDI) is one method to help providers enhance the accuracy of an EHR system. CDI is a new healthcare administration specialty that focuses on improving how data is entered into patient medical records. Large hospitals and providers have begun using CDI with medium and smaller facilities following closely behind.
Another way to improve EHR data input is to stop using copy-paste functions when entering patient information.
While some providers may consider the copy-paste function a time-saving strategy, using this function can result in inaccurate information and inconsistent notes in a patient’s chart. The best practice for entering patient data into an EHR platform is only entering the exact information for that particular examination.
Not All Transcription Companies Are Alike
We’ve already seen the devastating adverse effects when a healthcare facility chooses a subpar medical transcription company to save two pennies per line. Let’s hope that today’s healthcare providers won’t sacrifice quality for our treatment and confidential, personal medical records.
At Transcription Outsourcing, we take pride in providing a quality medical transcription product at a competitive rate. All of our medical transcriptionists are experienced, full-time, and understand medical terminology. Plus, each medical transcriptionist we hire must have extensive industry experience, and pass our rigorous testing before we on-board them.
For medical transcription services, we offer:
Based in Denver, Colorado, Transcription Outsourcing is HIPAA compliant and offers a “don’t love, don’t pay” guarantee. You’ll have to look far and wide to find another transcription company with similar characteristics and our commitment to quality.