The first medical record was not electronic. It was written on a clay tablet by the Sumerians more than 4,000 years ago. Followed by the Egyptian papyrus and, of course, the thick folders that we still find pilling up in so many hospitals and medical practices.
It was only in 1960 that Lockheed developed the first medical electronic information system. In the 1970s, the Decentralized Hospital Computer Program (DHCP) with the Computerized Patient Record System (CPRS) was introduced by the Department of Veteran Affairs’. In 2004, President Bush first mentioned the term Electronic Health Record (EHR).
In President Obama’s American Recovery and Reinvestment Act of 2009, which was part of the Health Information Technology for Economic and Clinical Health Act (HITECH), the use of the EHR system granted higher payments to physicians and hospitals. Today, EHR is an integral part of the Digital Health transition and includes numerous technologies, such as Blockchain, to keep the data secure and private.
But, what are the true advantages of electronic health records, especially in a post-COVID19 world where Telehealth is becoming the norm?
What is an Electronic Health Record?
According to the Center for Medicare & Medicaid Services (CMS), an Electronic Health Record is “an electronic version of a patient’s medical history.” The definition is simple and allows to include anything in it.
Are Electronic Medical Records and Electronic Health Records the same?
An Electronic Medical Record or EMR is not an EHR. They share common elements but have a different purpose. EMRs contain the patient’s medical history, immunization, diagnostics, and all of the data classically found on paper forms in medical practice. EHRs go on step further and include patient information such as demographics, insurance, and clinical decision support elements.
While an EMR is not easily sharable outside of the practice, the EHR is easily transferrable. Thanks to interoperability. In a nutshell, an EHR can be seen as an EMR 2.0. But, including so much private information can potentially pose a threat to privacy.
That is where the Blockchain technology comes into play.
Is Blockchain the key to a secure EHR?
Most will agree that Blockchain is the future technology that will change how healthcare is delivered and administered. We recommend you to read our article about the numerous benefits offered by blockchain in healthcare. Interoperability refers to the possibility for different systems to have access securely to various sources of information and to exchange data.
The main issue involves the information’s asymmetry, meaning that all parties do not share the same smooth access to the data. Blockchain has the potential to solve this issue.
By offering a secured distributed network, a shared ledger, and the possibility of adding independent blocks of medical transactions, blockchain and smart contracts secure the data, improve interoperability, and allow multiple entities to access the medical information that constitutes the EHR.
According to Abhinav Shashank, the CEO at Innovaccer, a startup based in California developing Blockchain and Artificial Intelligence IT solutions for healthcare, Blockchain will bring 5 major benefits to an EHR system.
- Longitudinal patient records: All of the data are assembled sequentially without any possibility for losses or alteration,
- Master patient indices: A single master patient file includes all of the various blocks of information hence lowering the possibility of medical errors or mismatches,
- Claims adjudication: Without the need for a central authority, the use of automated smart contracts can help process the claims faster and more efficiently,
- Supply chain management: the supply and demand cycle can be analyzed in real-time, offering better control and management,
- Interoperability: Only approved authorized providers have access and the ability to modify the data, allowing for better reconciliation and improvement of the quality of care.
Benefits of Electronic Health Records
The benefits of electronic health records go far beyond reducing costs. Improving the organization of care and the patient’s involvement ultimately benefit all parties: the carers, the payers, and the patients.
Improving the quality of care
For providers, EHRs allow access to patient healthcare history. In Estonia, 99% of the health data are digitized. First care responders and paramedics even have access to e-Health Records. It is beneficial for non-responsive patients when there is an urgent need to know more about their medical background and potential allergies. It ultimately helps save lives.
With an EHR, all the needed data are available in a single location at the right time. It is critical for establishing clinically relevant diagnostics.
There is no need anymore to fill up the same paperwork for patients at each visit to the doctor. E-prescriptions delivered directly to pharmacies improve convenience. Electronic referrals ease the patient journey. The use of a dashboard also helps the patients interact smoothly with their providers and streamline their care.
In a survey mandated by the CDC, 75% of the providers reported that the EHR system’s implementation allowed them to provide better care.
Improving patient’s involvement
By sharing the same platform, patients and doctors have a direct line of communication. It can be beneficial for treating chronic conditions and improving patient care.
Relevant information can be provided at the most appropriate time. The patients are not in limbo anymore. They feel more involved. They can regularly check their personal health records and do not have to wait for a doctor’s visit to be informed on their condition’s evolution.
Improving care coordination
Twenty-first-century medicine is multi-factorial and involved numerous providers. Long have gone the times of the family doctor who acted as a one-stop-shop. Paper trails were hard to follow and often lost between various providers.
With electronic health records, different specialists, hospitals, laboratories, and even pharmacists will share the same information. By being less fragmented, care providers will get a better picture for improving patients’ care.
Decreasing healthcare costs
Electronic health records’ obvious benefit is to reduce transcription cost, but it doesn’t stop there, far from it. Automatic claim management helps ensure smooth reimbursements. It also smoothens the hospitals or practices administrative costs.
Laboratory or imaging results being part of the standard file allows reducing the number of repeat diagnostics analyses. By automating administrative tasks and automatic clinical documentation, efficiency improves, and costs decrease. In a study conducted in 2005, the Return On Investment was reached in 2.5 years, meaning that a small primary care practice saved $15,000 in administrative costs reduction only.
Drawbacks of Electronic Health records
Electronic Health Records’ benefits are numerous, but they also carry a couple of drawbacks mostly linked to implementing EHR systems and learning how to use them. The risks related to the digital storage of information are also a potential limiting factor, even though blockchain technology is a way to mitigate them.
Implementation and maintenance costs
Implementing an EHR system is not free. The costs are estimated to $50,000 to $70,000 for a three physicians small practice. For 280 beds hospitals, the expenses rocket to more than $19 million.
EHR maintenance costs are also not trivial, with studies announcing $8412 per FTE provider per year. Most of these expenses are directly related to hardware and software implementation.
Storing the data has also been associated with high costs even though Amazon HealthLake provides a cost-competitive and HIPAA compliant solution.
Disruption of workflow
The workflow is inevitably disrupted when using new systems, leading to a temporary loss of productivity. In 2011, one could estimate the physicians’ time to learn how to use the system properly to $10,135. Ultimately these losses will only be temporary, and the revenues will increase. Thanks to the improvement in productivity and smoother claims reimbursements.
Risks for patient privacy
By increasing the amount of data transmitted electronically, the risks for patient privacy will also inevitably increase. Policymakers and organizations have taken many steps to ensure the confidentiality of the data. Some hospitals have even put in place a zero-tolerance policy to inappropriate access.
The patients’ whole medical history is readily available, which is helpful for diagnostics but potentially risky for keeping sensitive information private. Most EHR systems offer audit capabilities to ensure that the Health Insurance Portability and Accountability Act is strictly respected.