Chapter 2: Blockchain Technology and Electronic Health Records Overview
2.2 Electronic Health Record (EHR)
Since the beginning of healthcare, medical records have been around, though not in the same form as they do today. They were used to record patients' gender, age,
symptoms, etc. for purposes of study. The present and future care of a patient depends heavily on the patient's medical data. These data are significant for the patient’s life and health; they can also be utilized in the management and planning of healthcare facilities and services and for medical research. These records are written by healthcare
professionals so that the information may be utilized repeatedly when the patient visits the health facility. The medical record begins with the patient's first admission to the healthcare facility. Healthcare professionals are responsible for providing patients with high-quality treatment, and all information should be recorded into the patient's medical
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or health record accurately and completely. The record must have enough information to identify the patient, explain the current and past diagnosis, justify the treatment, and fairly describe the results of that treatment. The fundamental goal of a medical or health record is to preserve information about a patient's medical history, with a focus on the events that directly affected the patient, in case further medical attention is ever needed.
A medical/health record must be accessible by the healthcare professionals when the patient returns to the healthcare facility. If the record is unavailable, the patient may receive an incorrect diagnosis since previously recorded vital details are missing [14].
In previous years, the heavy reliance on paper was directly linked to the concept of possession: if one person holds a piece of paper, another cannot own it at the same time, and if that paper document changes hands, ownership changes. With electronic documents or records, health practitioners can properly diagnose a patient's illness;
however, healthcare practitioners must be able to transfer or exchange patient records in a secure and appropriate way. With electronic documents, data is transmitted either through real-time clinical monitoring or a "store-and-forward" method that can be duplicated easily, so keeping track of who possesses the genuine document can become particularly complicated. Data security, reliability, and privacy are the most crucial aspects because of the significant necessity of patient records. Over the years, a number of terms have been used to describe the transition from paper-based records to those generated electronically. Some of the popular terms include: Automated Health Records (AHR), Electronic Medical Record (EMR), and Electronic Health Record (EHR) [15].
a. Automated Health Records (AHR)
A collection of digital images of conventional health record documents has been referred to as "Automated Health Records." The images of these papers are often kept on optical disks after being scanned into a computer. It received the majority of the
attention, especially in the early 1990s. However, it did not address data input/output at the patient care level. Instead, it addressed access, space, and control issues related to paper-based records [15].
b. Electronic Medical Record (EMR)
19 Is the first electronic source used to digitize patient’s data. The term "Electronic Medical Record" (EMR), as with AHR, describes an organization-centric automated system based on document imaging or systems created within a medical practice or community health center. These have been used by general practitioners and include information on patient identification, medications and prescriptions, laboratory results, and occasionally all medical information recorded by the doctor during the patient visit [15].
c. Electronic Health Record (EHR)
The definition and scope of the "Electronic Health Record" (EHR) vary across different countries where it is in use, but it is mainly intended for information exchange between healthcare professionals and patients. Many people use the term "EMR" when defining EHR; whereas an EHR system is inter-organizational, connecting several
EMRs, EMR is part of EHR. An EHR is an electronic version of a patient's health record that was historically created, used, stored in a paper chart, and held by a healthcare organization, where only healthcare professionals who are involved in a patient's care can access and use an EHR [16].
It is widely recognized as a persistent health record with entries made by healthcare professionals at different locations where care is offered. It encompasses all information contained in a traditional health record, including a patient's health profile, behavioral, and environmental information. In addition to content, the EHR generated by one or more healthcare facilities. Included in this information are patient demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data, and radiology reports [16]. In more simplistic words, this type of
persistent electronic health record could be expressed as:
1. Contains all of an individual's personal health information.
2. Electronically entered and accessible by healthcare professionals during the individual’s lifetime.
3. All ambulatory care locations are included where the patient receives care in addition to acute inpatient facilities.
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In order to make sure that the deployment of an EHR includes healthcare delivery services throughout a broad spectrum of healthcare services, it has become necessary to change the focus in many sectors of healthcare.
The EHR automates and streamlines the clinician’s workflow. The EHR has the ability to generate a complete record of a clinical patient encounter and enables the healthcare providers to share the EHR with other healthcare providers electronically. The EHR is created and used by physicians in their clinics and by hospitals and other
healthcare facilities where the requirements include quality data reporting, computerized physician order entry, and electronic pharmacy orders [16]. This approach enabled the creation of an EHR that is persistent in order to enhance healthcare delivery and
guarantee that all treatment provided to a patient over the span of their life is retained in a single record and easily accessible. A computer program is needed that records data at the time and location of healthcare, whether it is at the hospital or primary care level, over an extended period of time. All levels of healthcare would be able to make
decisions about diagnoses, treatments, and medications with the use of readily available healthcare information. The EHR contains enormous amounts of a wide variety of clinical notes, patient records, laboratory reports, results from imaging tests, and other examination. Ideally, it should reflect the whole health history of each individual throughout their lifetime, including data from multiple health providers in a range of healthcare facilities [15]. The following are some of the well-known EHR-connected applications [16]:
• Administrative Applications: include patient registration, in which patient
demographics such as name, age, gender, address, contact information, insurance information, employer, patient's chief complaint, and a unique patient ID number are recorded on the health record.
• Computerized Physician Order Entry: An application used by physicians to order laboratory, pharmacy, radiology, and other physician orders. which ensures the accuracy of the orders and notifies the appropriate area that the patient will be arriving. It also lets healthcare professionals know what tests need to be performed.
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• Laboratory Systems: Lab information systems are interfaced into the EHR for patient data and testing results exchange. Lab information systems also contain lab orders, lab results, schedules, and other administrative functions.
• Radiology Systems: interfaced with the EHR, which contains patient information, radiology orders, test results, schedules, and image tracking. Radiology information systems are also used with picture archiving communications systems; the picture archiving communications system manages and stores the digital radiography image.
• Clinical Documentation: Physicians, nurses, and other healthcare professionals document an immense amount of information on a patient. This information ranges from clinical notes, clinical reports, assessments, medication administration records, vital signs, discharge summaries, transcription documents, and utilization
management.
• Pharmacy Systems: The standalone automated pharmacy systems are linked to an EHR, where pharmacies utilize bar coding on medications and patients to ensure the right dose, the right patient, and the right time for drug administration. That helps with reducing the drug errors that cause patient harm.
Challenges:
The following list includes some significant obstacles with using the EHR:
Hospitals utilize several EHR programs, which limits interoperability. Another drawback is that patients' inability to quickly access their whole EHR of the existing system. In addition, when a patient is transferred, healthcare professionals are not required to get the patient's consent before disclosing information for that patient's general care. When it comes to privileges, access, accountability, and recording between hospital systems, there are still obstacles to be addressed. A patient may not always be aware of who is gaining access to their medical/health records if consent is not required. Quick access to a comprehensive health record would help patients stay informed and ease their concerns about who is viewing and altering their EHRs [12].
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