Implications and Challenges of Cost, Quality, and External Forces on Electronic Health Record

The Future of Health Information Systems

The adoption and implementation of electronic health record (EHR) systems is normally associated to a number of significant benefits that include decreased costs of healthcare and better care, due to increase of efficiency, accuracy and speed among other things. However this is not the only thing that comes with EHR implementation. EHR implementation also comes with a number of unanticipated consequences that may make it hard to use. Poor design and improper utilization of EHR system can results to EHR-associated errors which jeopardize the information integrity in the EHR, resulting to errors which threaten the safety of patients or that lower the care quality. Some of these errors occur due to lack of enough money to finance effective implementation of the EHR system and to train the personnel in a manner that enhance effective utilization of this technology in their organization (Bowman, 2013). This paper analyzes external threats, challenges and implications of quality, cost, and external forces on electronic medical record (EMR) no electronic health record (EHR) implementation and selection in health care information department

Implications and Challenges of Cost, Quality, and External Forces on EHR

One of the major challenges facing the implementation and maintenance of EHR is the cost. According to Boonstra, Vesluis and Vos(2014), financial issues that include implementation and adoption costs, continuous maintenance, loss of income related to temporal loss of productivity, and revenue decline act as discouragement for physicians and hospitals to implement and adopt an EHR. Costs of EHR implementation and adoption include buying and installing software and hardware, changing paper works to electronic work, and end-users training. The initial installation cost has been the main challenge in the past, though the extensive use of EHR technology is resulting to decrease in this cost. Maintenance cost is also a great challenge as software has to be upgraded and hardware replaced regularly. Without enough money to enhance the process of implementation, adoption and maintenance, EHR may be poorly installed or implemented resulting to bugs or security loopholes. This can also results to poor workers training, resulting to a lot of human errors in system utilization. Lack of proper maintenance may results to system failures that can yield to loss of productivity among other issues (Boonstra, Vesluis& Vos, 2014).

The effectiveness of the EHR system in its operation is highly determined by its level of accuracy, reliability and integrity. EHR system thus needs to be safe, efficient, and consistent in delivering high quality of care. The EHR adoption has failed to attain the projected cost savings and benefits due to shortcoming in system implementation and design, influencing effective and safe use of these systems. Irrespective of the EHR promise to improve care quality and safety of patients, an extensive range of evidence demonstrates possible safety threats related with EHR use, sometimes regarded as e-iatrogenesis. The occurrence of EHR-associated errors yields to data incorrectly entered, data loss, and/or incorrect datatransmission or display, resulting to loss of information integrity. According to Bowman (2013), increase in EHR use in provision of care has been associated with increase in healthcare risks, including possible EHR-induces medical harm, error, or death. Despite this, there is no set standard on the EHR to be developed in an organization or in the level of safety and efficiency it must satisfy before the system commissioning. This means, errors can easily occur without being recognize as there is no body focusing on ensuring that only the safest and effectively implemented EHR should be commissioned for operation. In addition to this, there is no sense of accountability on some of the errors and risks that the system causes to the patient. Some systems are created with high level of errors and bugs, some designs are incomplete, and some use unreliable software platforms or hardware. These aspects highly impact the care quality and in most cases incasing the risks and disadvantages of the EHR implementation than the enjoyed benefits (Bowman, 2013). Some of the external forces influencing the EHR cost and quality is the change of technology, and competition in healthcare facilities, where each organization focuses on being the best to lead in the market. High competition results to increase in price of quality system to create differentiation in the market.

External Threat Facing
Electronic Health Record Systems

The effective operation of EHR is also influenced by external factors. One of the main possible external factors that can highly influence the EHR system performance is the security issue. The basic to the EHR adoption is the privacy and security of the highly sensitive, digitalized medical data. Thus, privacy and security becomes a popular and significant topic in research of health informatics. EHR system protection from abuse by permitted users and from unauthorized access or from being re-identified from the published health data for secondary use is one of the most important practices in the EHR system development. Security can be an internal and external factor since it can be compromised from inside and/or outside. Systems attempts to compromise the system security can be very costly since they can highly interfere with data integrity through alteration, data privacy and confidentiality through access, or compromise data availability. External security attacks can play a great role in compromising the system quality and efficiency. It can also be very costly to handle security related issues, especially major attacks that influence system availability or integrity (Ajami& Bagheri-Tadi,  2013). It is thus important to pay a great attention to enhancing EHR system security to prevent hacking, snooping, man-in-the-middle attacks, virus attacks and spyware among other security breaches.


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