Adekunle Oyeyemi Adeniyi 1, *, Jeremiah Olawumi Arowoogun 2, Rawlings Chidi 3, Chioma Anthonia Okolo 4 and Oloruntoba Babawarun 5
1 United Nations Population Fund, Sri Lanka.
2 Bharat Serums and Vaccines Limited Lagos, Nigeria.
3 Parkville MO & North Kansas City Hospital, United states.
4 Federal Medical Centre, Asaba, Delta State, Nigeria.
5 Global Future Redemption Empowerment Foundation, Nigeria.
World Journal of Advanced Research and Reviews, 2024, 21(02), 1446–1455
Publication history: Received on 13 January 2024; revised on 20 February 2024; accepted on 22 February 2024 Article DOI: https://doi.org/10.30574/wjarr.2024.21.2.0592
Abstract
Electronic Health Records (EHRs) have revolutionized healthcare delivery, offering numerous benefits for patient care and outcomes. This comprehensive review examines the impact of EHRs on patient care and outcomes, highlighting key findings from existing literature. EHRs have significantly improved patient care by enhancing accessibility and accuracy of patient information. With EHRs, healthcare providers can easily access patient records, including medical history, medications, and lab results, leading to more informed decision-making and improved coordination of care. EHRs also facilitate communication among healthcare providers, enabling better care coordination and reducing medical errors.
Moreover, EHRs have been shown to improve patient outcomes by supporting evidence-based practices and clinical decision-making. EHRs can provide alerts and reminders for preventive care and screenings, helping healthcare providers adhere to best practices and guidelines. Additionally, EHRs enable real-time monitoring of patient data, allowing for early detection of potential health issues and timely interventions. Despite these benefits, challenges remain in the implementation and use of EHRs. Issues such as interoperability, data security, and provider burnout need to be addressed to fully realize the potential of EHRs in improving patient care and outcomes. In conclusion, EHRs have had a transformative impact on patient care and outcomes, improving accessibility, accuracy, and coordination of care.
However, ongoing efforts are needed to address challenges and ensure the effective use of EHRs in healthcare delivery.
Keywords: Impact; Electronic; Health Records; Patient; Care and Outcomes
1. Introduction
Electronic Health Records (EHRs) have transformed the landscape of healthcare delivery, offering a digital solution to store, manage, and share patient information. EHRs encompass a wide range of patient data, including medical history, medications, allergies, lab results, and treatment plans, among others. This comprehensive review explores the impact of EHRs on patient care and outcomes, highlighting the key findings and implications for healthcare practice (Cerchione, et. al., 2023, Gopal, et. al., 2019, Kumar, M., & Mostafa, 2020).
The purpose of this review is to provide a comprehensive overview of the role of EHRs in modern healthcare and their impact on patient care and outcomes. By examining existing literature and research studies, this review aims to identify the benefits and challenges associated with EHRs and provide insights into how they can be effectively integrated into clinical practice.
The significance of this review lies in its potential to inform healthcare providers, policymakers, and researchers about the impact of EHRs on patient care and outcomes. By understanding the benefits and challenges of EHRs, healthcare stakeholders can make informed decisions about the implementation and use of EHRs in their practice, ultimately leading to improved patient care and outcomes.
2. The history of Electronic Health Records
The history of Electronic Health Records (EHRs) is a tale of technological advancement, policy changes, and evolving healthcare practices that have collectively transformed patient care and outcomes (Cogan, et. al., 2023, Darlington, 2022, Robichaux, et. al., 2019). This comprehensive review explores the key milestones and developments in the history of EHRs, highlighting their impact on patient care and outcomes. The concept of electronic health records can be traced back to the 1960s when researchers and healthcare providers began exploring ways to digitize patient information.
Early attempts at electronic health records were limited by the technology of the time, with most systems relying on mainframe computers and punch card systems. These early systems were cumbersome and expensive, making widespread adoption challenging.
In the 1970s and 1980s, advancements in computer technology led to the development of more sophisticated electronic health record systems. The introduction of personal computers and networking technologies allowed for the creation of electronic databases that could store and retrieve patient information more efficiently. Despite these advancements, the adoption of EHRs remained limited, with many healthcare providers continuing to rely on paper-based records (Kim, et. al., 2019, Sadoughi, Khodaveisi & Ahmadi, 2019, Sutton, et. al., 2020). The 1990s marked a turning point in the development of EHRs, with the introduction of the Health Insurance Portability and Accountability Act (HIPAA) in 1996.
HIPAA set standards for the electronic exchange of healthcare information, laying the foundation for the widespread adoption of EHRs. Around the same time, the Institute of Medicine (IOM) released a report highlighting the benefits of electronic health records, further driving interest in digital health records. The early 2000s saw a rapid increase in the adoption of EHRs, driven by government incentives and advancements in technology. In 2004, President George W.
Bush announced the goal of implementing EHRs for all Americans within 10 years, leading to the development of the Office of the National Coordinator for Health Information Technology (ONC) to oversee the implementation of EHRs.
In 2009, the Health Information Technology for Economic and Clinical Health (HITECH) Act was passed as part of the American Recovery and Reinvestment Act (ARRA) (Clark, et. al., 2022, Fabiano, et. al., 2021, Ruffin & Hawkins, 2019).
HITECH provided financial incentives for healthcare providers to adopt and meaningfully use EHRs, leading to a significant increase in adoption rates. By 2017, nearly 86% of office-based physicians in the United States were using some form of EHR system. The adoption of EHRs has had a profound impact on patient care and outcomes. EHRs have improved the accessibility and accuracy of patient information, leading to more informed decision-making and improved coordination of care. EHRs have also streamlined documentation and record-keeping, reducing the risk of errors and duplication of tests. Furthermore, EHRs have facilitated communication among healthcare providers, enabling better care coordination and reducing medical errors. EHRs have also supported evidence-based practices and clinical decision-making, leading to better treatment outcomes and patient safety. Overall, the adoption of EHRs has improved the quality, safety, and efficiency of patient care, leading to better outcomes for patients.
Looking ahead, the future of EHRs is promising, with advancements in technology driving further innovations. Future EHR systems are likely to be more interoperable, allowing for seamless exchange of information among healthcare providers. EHRs are also likely to integrate more closely with other healthcare technologies, such as telemedicine and remote monitoring, further enhancing their impact on patient care and outcomes. In conclusion, the history of Electronic Health Records is a story of innovation and transformation in healthcare delivery. From humble beginnings in the 1960s to widespread adoption in the 2000s, EHRs have revolutionized patient care and outcomes, improving the quality, safety, and efficiency of healthcare delivery. As we look to the future, EHRs will continue to play a central role in shaping the healthcare landscape, driving improvements in patient care and outcomes for years to come (Abernethy, et. al., 2022, Jeffery Daigrepont, 2020, Wang, et. al., 2022).
3. Evolution of EHRs
Electronic Health Records (EHRs) have transformed the healthcare industry, revolutionizing the way patient information is stored, accessed, and shared (Cerchione, et. al., 2023, Mourya, & Idrees, 2020, Rudin, et. al., 2020). This evolution has been a result of decades of advancements in technology, changes in healthcare policies, and a growing recognition of the benefits of digital health records. This article traces the historical background and development of EHRs, as well as their adoption and integration into healthcare systems. The concept of electronic health records can be
traced back to the 1960s when healthcare providers began exploring ways to digitize patient information. Early attempts at electronic health records were limited by the technology of the time, with most systems relying on mainframe computers and punch card systems. These early systems were cumbersome and expensive, making widespread adoption challenging.
In the 1970s and 1980s, advancements in computer technology led to the development of more sophisticated electronic health record systems. The introduction of personal computers and networking technologies allowed for the creation of electronic databases that could store and retrieve patient information more efficiently. Despite these advancements, the adoption of EHRs remained limited, with many healthcare providers continuing to rely on paper-based records. The 1990s marked a turning point in the development of EHRs, with the introduction of the Health Insurance Portability and Accountability Act (HIPAA) in 1996. HIPAA set standards for the electronic exchange of healthcare information, laying the foundation for the widespread adoption of EHRs. Around the same time, the Institute of Medicine (IOM) released a report highlighting the benefits of electronic health records, further driving interest in digital health records (Kim, et. al., 2019, Sadoughi, Khodaveisi & Ahmadi, 2019, Sutton, et. al., 2020).
The early 2000s saw a rapid increase in the adoption of EHRs, driven by government incentives and advancements in technology. In 2004, President George W. Bush announced the goal of implementing EHRs for all Americans within 10 years, leading to the development of the Office of the National Coordinator for Health Information Technology (ONC) to oversee the implementation of EHRs. In 2009, the Health Information Technology for Economic and Clinical Health (HITECH) Act was passed as part of the American Recovery and Reinvestment Act (ARRA). HITECH provided financial incentives for healthcare providers to adopt and meaningfully use EHRs, leading to a significant increase in adoption rates. By 2017, nearly 86% of office-based physicians in the United States were using some form of EHR system (Esdar, et. al., 2019, Johnson, Neuss & Detmer, 2021, Rahurkar, et. al. 2023).
The integration of EHRs into healthcare systems has led to numerous benefits, including improved patient care, enhanced care coordination, and increased efficiency. EHRs allow healthcare providers to access patient information quickly and easily, leading to more informed decision-making and better outcomes for patients. EHRs also facilitate communication among healthcare providers, leading to improved care coordination and reduced medical errors.
Despite these benefits, the adoption and integration of EHRs have not been without challenges. Interoperability issues, data security concerns, and provider resistance have all posed challenges to the effective implementation of EHRs.
However, ongoing efforts to address these challenges and improve EHR systems are expected to further enhance the role of EHRs in healthcare delivery (Gill, et. al., 2020, Mullins, et. al., 2020, Watterson, et. al., 2020).
4. Accessibility and Efficiency
Electronic Health Records (EHRs) have significantly improved the accessibility and efficiency of patient information, leading to enhanced patient care and outcomes. This comprehensive review examines the impact of EHRs on accessibility and efficiency, focusing on the improved access to patient information, streamlined documentation and record-keeping, and reduction of medical errors and duplication of tests. One of the key benefits of EHRs is the improved access to patient information. EHRs allow healthcare providers to access patient records quickly and easily, regardless of their location. This accessibility is particularly beneficial in emergency situations, where quick access to critical patient information can be life-saving (Ayaad, et. al., 2019, Neves, et. al., 2020, Abdulkadir et al., 2022; Tapuria, et. al., 2021).
EHRs also improve access to patient information by providing a comprehensive view of a patient's medical history. This includes information such as past medical conditions, medications, allergies, and test results. Having this information readily available allows healthcare providers to make more informed decisions about patient care and treatment. EHRs have streamlined the documentation and record-keeping process, making it more efficient and less prone to errors.
With EHRs, healthcare providers can enter and update patient information electronically, eliminating the need for paper-based records (Tapuria, et. al., 2021, Victor and Great, 2021; Wass, Vimarlund & Ros, 2019). This electronic documentation is more legible and easier to read than handwritten notes, reducing the risk of errors.
EHRs also streamline the record-keeping process by providing a central repository for all patient information. This allows healthcare providers to access all relevant information from a single source, rather than having to search through multiple paper records. Additionally, EHRs can automate certain documentation processes, such as coding and billing, further improving efficiency. EHRs have contributed to a reduction in medical errors and duplication of tests. By providing access to comprehensive patient information (Melton, et. al., 2021, Johnson et al., 2023; Rozental & White, 2019), EHRs help healthcare providers make more accurate diagnoses and treatment decisions, reducing the risk of
errors. EHRs can also alert healthcare providers to potential drug interactions or allergies, further reducing the risk of adverse events.
EHRs also reduce duplication of tests by providing access to previous test results. This allows healthcare providers to review previous tests before ordering new ones, ensuring that tests are only repeated when necessary. This not only reduces costs but also reduces the risk of unnecessary procedures and potential harm to patients. The accessibility and efficiency of EHRs have significantly improved patient care and outcomes. By improving access to patient information, streamlining documentation and record-keeping, and reducing medical errors and duplication of tests, EHRs have transformed the way healthcare is delivered. Continued efforts to enhance EHR systems and address remaining challenges will further improve the impact of EHRs on patient care and outcomes (Adane, Gizachew & Kendie, 2019, Ezeigweneme et al., 2023; Mehta, Grant & Ackery, 2020).
5. Communication and Coordination of Care
Electronic Health Records (EHRs) have revolutionized communication and coordination of care in healthcare settings, leading to improved patient care and outcomes (Janett & Yeracaris, 2020, Quinn, et. al., 2019, Vos, et. al., 2020). This comprehensive review examines the impact of EHRs on communication and coordination of care, focusing on enhanced communication among healthcare providers, improved care coordination and continuity, and the impact on patient engagement and involvement in care. One of the key benefits of EHRs is the enhanced communication among healthcare providers. EHRs allow healthcare providers to access patient information quickly and easily, facilitating more effective communication and collaboration. For example, EHRs can provide real-time updates on patient conditions, allowing healthcare providers to coordinate care more efficiently.
EHRs also improve communication by providing a central repository for patient information. This allows healthcare providers from different disciplines and locations to access the same information, leading to more coordinated care (Gatiti, et. al., 2021, Ibekwe et al., 2024; Hornik, et. al., 2019, Nordo, et. al., 2019). Additionally, EHRs can facilitate communication through features such as secure messaging and electronic referrals, further enhancing collaboration among healthcare providers. EHRs improve care coordination and continuity by providing a comprehensive view of a patient's medical history. This includes information such as past medical conditions, medications, allergies, and test results. Having this information readily available allows healthcare providers to coordinate care more effectively and ensure continuity of care across different settings and providers.
EHRs also improve care coordination by providing alerts and reminders for preventive care and screenings (Mallozzi, et. al., 2020, Schrembs, 2023, Etukudoh et al., 2024; Willis, et. al., 2022). For example, EHRs can alert healthcare providers when a patient is due for a screening or vaccination, ensuring that preventive care measures are implemented in a timely manner. EHRs have a positive impact on patient engagement and involvement in care. EHRs allow patients to access their own health records, empowering them to take an active role in managing their health. Patients can review their medical history, medications, and test results, and communicate with their healthcare providers through secure messaging systems. EHRs also improve patient engagement by providing access to educational resources and personalized health information. For example, EHRs can provide patients with information about their condition, treatment options, and self-care strategies, empowering them to make informed decisions about their health.
In conclusion, EHRs have significantly improved communication and coordination of care in healthcare settings, leading to improved patient care and outcomes. By enhancing communication among healthcare providers, improving care coordination and continuity, and empowering patients to take an active role in their care, EHRs have transformed the way healthcare is delivered. Continued efforts to enhance EHR systems and address remaining challenges will further improve the impact of EHRs on patient care and outcomes.
6. Clinical Decision-Making and Treatment Outcomes
Electronic Health Records (EHRs) have significantly impacted clinical decision-making and treatment outcomes in healthcare settings (Lee, et. al., 2020, Lewkowicz, Wohlbrandt & Boettinger, 2020, Patterson, et. al., 2019). This comprehensive review examines the impact of EHRs on clinical decision-making and treatment outcomes, focusing on the support for evidence-based practices, facilitation of clinical decision support tools, and influence on treatment outcomes and patient safety. One of the key benefits of EHRs is the support they provide for evidence-based practices.
EHRs can integrate clinical guidelines and protocols into the system, providing healthcare providers with access to up- to-date, evidence-based information at the point of care. This can help healthcare providers make more informed decisions about patient care, leading to better outcomes.
EHRs also support evidence-based practices by providing access to clinical decision support tools. These tools can help healthcare providers identify potential drug interactions, allergies, or other factors that may impact treatment decisions. By providing this information in real-time, EHRs can help healthcare providers make safer and more effective treatment decisions. EHRs facilitate the use of clinical decision support tools, which can improve clinical decision- making and treatment outcomes (Khalifa, Magrabi & Gallego, 2019, Ostropolets, Zhang & Hripcsak, 2020, Wasylewicz, et. al., 2019). These tools can range from simple alerts and reminders to more sophisticated algorithms that provide recommendations based on patient data. For example, EHRs can alert healthcare providers to potential drug interactions or provide recommendations for preventive care based on a patient's medical history. Clinical decision support tools in EHRs can also help healthcare providers manage chronic conditions more effectively. For example, EHRs can provide reminders for regular screenings or tests for patients with chronic conditions, helping to ensure that they receive appropriate care.
EHRs have a significant influence on treatment outcomes and patient safety. By providing access to comprehensive patient information, EHRs help healthcare providers make more accurate diagnoses and treatment decisions. This can lead to improved treatment outcomes and reduced healthcare costs. EHRs also improve patient safety by reducing the risk of medication errors. EHRs can provide alerts for potential drug interactions, allergies, or other factors that may impact medication safety. By alerting healthcare providers to these issues, EHRs can help prevent adverse drug events and improve patient safety (Hydari, Telang & Marella, 2019, Tubaishat, 2019).
In conclusion, EHRs have had a significant impact on clinical decision-making and treatment outcomes in healthcare settings. By supporting evidence-based practices, facilitating clinical decision support tools, and improving treatment outcomes and patient safety, EHRs have transformed the way healthcare is delivered. Continued efforts to enhance EHR systems and integrate new technologies will further improve the impact of EHRs on clinical decision-making and treatment outcomes.
7. Challenges and Barriers
Electronic Health Records (EHRs) have transformed healthcare delivery, offering numerous benefits for patient care and outcomes. However, their implementation and use have been accompanied by various challenges and barriers. This comprehensive review examines the challenges and barriers of EHRs in impacting patient care and outcomes, focusing on interoperability issues, privacy and security concerns, and provider resistance and adoption challenges. One of the major challenges of EHRs is interoperability, or the ability of different EHR systems to exchange and use patient information. Lack of interoperability can lead to fragmented care, as healthcare providers may not have access to complete patient information. This can result in duplicate tests, medication errors, and gaps in care (Rudin, et. al., 2020, Wyatt, Lampon & McKevitt, 2020).
Interoperability issues are often the result of differences in data standards and systems among healthcare providers.
Different EHR systems may use different formats for storing and transmitting data, making it difficult to exchange information seamlessly. Additionally, EHR vendors may have proprietary systems that are not easily compatible with other systems. Privacy and security concerns are another major barrier to the impact of EHRs on patient care and outcomes. EHRs contain sensitive patient information, including medical history, medications, and test results, making them a target for cyberattacks. Data breaches can lead to unauthorized access to patient information, compromising patient privacy and safety (Benson, et. al., 2021, Lehne, et. al., 2019, Schulz, Stegwee & Chronaki, 2019).
To address these concerns, healthcare providers must implement robust security measures, such as encryption, access controls, and regular audits. However, implementing these measures can be costly and time-consuming, posing a challenge for healthcare providers, particularly smaller practices with limited resources. Provider resistance and adoption challenges are also significant barriers to the impact of EHRs on patient care and outcomes (Niazkhani, et. al., 2020, Tsai, et. al., 2020). Healthcare providers may be resistant to using EHRs due to concerns about workflow disruptions, increased documentation burden, and perceived lack of usefulness. Additionally, older providers may be less comfortable with technology, making adoption more challenging.
To address these challenges, healthcare organizations must provide adequate training and support to healthcare providers. This may include training on how to use EHR systems effectively, as well as providing ongoing support to address any issues or concerns that arise. Additionally, healthcare organizations must ensure that EHR systems are user-friendly and integrate seamlessly into existing workflows to minimize disruption.
In conclusion, while EHRs offer numerous benefits for patient care and outcomes, their implementation and use are not without challenges and barriers. Interoperability issues, privacy and security concerns, and provider resistance and
adoption challenges all pose significant challenges to the impact of EHRs on patient care and outcomes. Addressing these challenges will require collaboration among healthcare providers, policymakers, and EHR vendors to develop standardized data standards, enhance security measures, and provide adequate support and training to healthcare providers. By addressing these challenges, we can maximize the impact of EHRs on patient care and outcomes, ultimately improving the quality and safety of healthcare delivery.
8. Future Directions and Opportunities
Electronic Health Records (EHRs) have already made a significant impact on healthcare delivery, but their full potential is yet to be realized. This comprehensive review explores the future directions and opportunities of EHRs in impacting patient care and outcomes, focusing on advances in technology and interoperability, potential for integration with telemedicine and remote monitoring, and their role in population health management and research.
Advancements in technology, such as artificial intelligence (AI), machine learning, and blockchain, are poised to revolutionize EHRs and their impact on patient care and outcomes. AI and machine learning can analyze vast amounts of patient data to identify patterns and trends, helping healthcare providers make more informed decisions and improve treatment outcomes. Blockchain technology, with its ability to securely store and share data, can enhance the interoperability of EHR systems, enabling seamless exchange of information among healthcare providers (Chattu, 2021, Kumar, et. al., 2022, Tagde, et. al., 2021).
Furthermore, the development of standardized data formats and protocols can improve interoperability among EHR systems. This will allow for better coordination of care and improved continuity of care for patients across different healthcare settings. EHRs have the potential to integrate seamlessly with telemedicine and remote monitoring technologies, expanding access to care and improving patient outcomes. Telemedicine allows healthcare providers to deliver care remotely, which can be particularly beneficial for patients in rural or underserved areas. EHRs can facilitate telemedicine by providing access to patient information and enabling secure communication between patients and providers (Ahmad, et. al., 2021, Dinh-Le, et. al., 2019, Jat & Grønli, 2023).
Similarly, EHRs can support remote monitoring of patients with chronic conditions, allowing healthcare providers to track patient data in real-time and intervene proactively when necessary. This can lead to better management of chronic conditions and improved outcomes for patients. EHRs play a crucial role in population health management and research by providing access to large amounts of patient data. This data can be used to identify trends and patterns in disease prevalence, track outcomes of interventions, and identify areas for improvement in healthcare delivery. EHRs also enable personalized medicine by providing access to genetic and other patient-specific information. This allows healthcare providers to tailor treatment plans to individual patients, leading to more effective and efficient care (Bardhan, Chen & Karahanna, 2020, Barrett, et. al., 2019, El-Rashidy, et. al., 2021).
Furthermore, EHRs can support population health management efforts by providing tools for tracking and managing population health indicators, such as immunization rates, chronic disease prevalence, and health disparities (Braunstein, 2022, Hatef, Weiner & Kharrazi, 2019, Hohman, et. al., 2023). This can help healthcare organizations identify areas where interventions are needed and allocate resources accordingly. In conclusion, the future of EHRs in impacting patient care and outcomes is promising, with advances in technology, interoperability, and integration with telemedicine and remote monitoring. EHRs have the potential to revolutionize healthcare delivery by providing access to timely and accurate patient information, enabling personalized medicine, and supporting population health management efforts. Continued investment in EHR technology and infrastructure will be key to realizing these opportunities and improving patient care and outcomes.
9. Conclusion
Electronic Health Records (EHRs) have had a profound impact on patient care and outcomes, transforming the way healthcare is delivered and improving the quality and safety of patient care. This comprehensive review has highlighted several key findings regarding the impact of EHRs on patient care and outcomes, including improved access to patient information, streamlined documentation and record-keeping, enhanced communication and coordination of care, support for evidence-based practices, and potential for integration with telemedicine and remote monitoring.
The implications of these findings for healthcare delivery and patient care are significant. EHRs have the potential to improve the efficiency and effectiveness of healthcare delivery by providing healthcare providers with access to timely and accurate patient information, enabling them to make more informed decisions about patient care. EHRs also have
the potential to improve patient outcomes by facilitating communication and coordination of care among healthcare providers, reducing medical errors and duplication of tests, and supporting evidence-based practices.
To realize the full potential of EHRs in improving patient care and outcomes, several recommendations for future research and practice are proposed. First, continued efforts are needed to address interoperability issues and improve the integration of EHR systems with other healthcare technologies. Second, healthcare organizations should focus on enhancing privacy and security measures to protect patient information. Third, healthcare providers should receive adequate training and support to effectively use EHRs in their practice. Finally, further research is needed to evaluate the long-term impact of EHRs on patient outcomes and to identify best practices for implementing and using EHRs in healthcare delivery.
In conclusion, EHRs have revolutionized healthcare delivery and have the potential to significantly improve patient care and outcomes. By addressing the challenges and barriers to EHR implementation and use, and by leveraging the opportunities presented by EHRs, healthcare organizations can continue to improve the quality, safety, and efficiency of patient care.
Compliance with ethical standards
Disclosure of conflict of interest No conflict of interest to be disclosed.
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