MC Gamboa [1]
Maria Corazon Gamboa
English 200
Professor Meredith Lee
The Implementation of Electronic Medical Record:
An Optimistic Solution for a better Health care System
Medical Informatics has become a major player in the advancement of medicine (Krishna Surti,
Robert Lin, 2002). This paper presents the major benefits of medical informatics with the example of an emerging system; Electronic Medical Record system. It will discuss the implementation of Electronic
Medical Record System and how the government did initiatively proposed for its immediate implementation nationwide and announced its full support to those physicians or institutions that will adopt the new system. Furthermore, this paper expatiate the benefits it has to offer in which will be generally to the health care providers. My researches about Electronic Medical Records System indicate more advantages with minimal risk than its predecessor. Most of the sources which were written previous years, however already noted that Electronic Medical Record System will be a great tool to shape our health care system, improve the patient-physicians relationship and promotes awareness about health issues which are major cause of death in the population. The success rate of this system was also proven by Hawaii Pacific Health, one of the major health institutions in state of Hawaii.
The information about the Electronic Medical Record is provided to better understand what will be the role of this emerging system in health care industry. In addition, the advantages of adopting the
EMR has been expected to increase the efficiency of our health care system. The purpose of this paper is to bring awareness to the readers about the great advantage of Electronic Medical Records and an attempt to liberate the physicians and health institutions from their ambiguous thoughts which concerns about securing the privacy of patient’s personal health data. With our strong standing in modernizing and advancing technology, nothing is impossible to change. As for us, a broadminded society is one of the key for successful leap forward.
We heard about EMR, it’s been a talk of the town. However, the information was first limited only to those involved and will be affected by the future modifications of the health care system. Slowly, the integration of information technology move their way in the health care system stealthily. Although the implementation have not yet place in, there were few physicians and health institution curios about the new system and adopt it even without confirmation of its efficiency. Since 1990, many countries have experienced the implementation of EMRs in primary health care such as Netherland (Marie-Pierre
Gagnon, Marie Desmartis, Michel Labrecque, France Legare, Lise Lamothe, Jean-Paul Fortin Jean-
Francois Rancourt Julie Duplantie, 2010). National use of EMRs may have reach 90% in primary care practices in Norway, Sweden and Denmark. However, those EMRs are only limited to administrative rather than clinical support (Open Clinical, 2010). We know very little about Electronic Medical Record.

MC Gamboa [2]
Sometimes we mistakenly identified EMR to be very similar with Electronic Health Record; however it’s not quite the same. EMR and EHR both of them are computer-based record to manage health care information. However, an EMR or Electronic Medical Records is an electronic health record under the ownership of a single entity, such as a private health care practitioner or health institution (Thede,
2010), while Electronic Health Record is a subset of each care delivery organization’s EMR. The understanding of these two is very crucial to the success of local, regional, and national goal to improve the quality and efficiency of patient care, and reduce health care delivery cost. It is important to understand the difference and to reduce confusion in the market (Dave Garet, Mike Davis, 2006). EMR in particular, is the new system that has been anticipated by the health care providers and institution; not just because of the promised benefits, but the infused feeling of moving forward. Electronic Medical
Records will initiate new ways to manage and improve the health care administration that will be as quick and easy as sending an email. As for the community, it will bring more awareness and people will be encourage to participate in decision making with their health issues while also exercising their rights.
The success of the new system does require more than just a current software update—it requires open-mindedness, leadership, and flexibility. In the book written by R. Busch, she adopted a quote originated from an Irish writer George B. Shaw which states, the reasonable man adapts himself to the world; the unreasonable man persists in trying to adapt the world to himself. Therefore, all progress
depends on the unreasonable man .It reflects our attitude toward changes, in which we must realize that there will be a glitch in every new system. However, we should also be willing to accept any flaw, so we can better work out the improvement the system.
Paper-Based Medical Records have been around for a long time and has demonstrated many flaws. Regardless of unknown starting point of our reliance in technology, it is surprising that it took us a little longer to realize about electronically managing health records. With the continuing population growth and the upcoming baby boomers entering their golden age, the need to Electronic Medical
Record is essential.
Even with the obvious benefits of Electronic Medical Record, the way of recording information by hand in a paper-based still remained in this “itouch” generation. If we take a closer look, there is a main reason for that. According to Dick and Steen (1991) (Hersh, 1995), some conventional doctors remained writing instead of typing their work due to its familiarity, portability, affordability and ease of recording for non-complex patients. Also psychologically, it provided them the feeling of ownership
(Hersh, 1995). However, we are probably aware of the disadvantages of using paper based record.
Inaccessibility is one of the major problems in paper-based records; because paper-based records can only be used in one place at a time. These also discourage patients to see other doctors due to the fact that their clinical data are only available in single institution, office, or network as well as their right to equity in access to appropriate care in a timely manner (Krishna Surti, Robert Lin, 2002). Doctor's in different fields were not able access the patient’s complex medical history (Hersh, 1995). Taking notes or photo copying a patient's records can lag treatment as it takes time, while also making their personal records unsecured as it is now more vulnerable to factors such as misplacements and inaccuracies. With higher workloads, it is more likely that a patient's record will have been outdated. Another issue with paper based record is security and confidentiality (Hersh, 1995). Mostly in the hospital setting, anyone

MC Gamboa [3] who’s wearing a badge that looks like the identification of the staff can pick up a patients paper record
(chart) (Thede, 2010). The risk of handing the information to the wrong people is very high on this old system. Finally, paper-based medical records can also lead to over consuming space. With the world population continually growing and the rising of life expectancy, the demand will also increase in all areas of paper-based records. The need for a new method of record keeping will have to be answered.
2004 was the year for which George Bush asserted ambitiously aimed to improve the health care industry; targeted a 10 year deadline in implementing a new system of recording health care information. By 2014, all citizens will have access to electronic medical record (Hoffman, 2009).
Followed by Barack Obama’s term, he finally put the wishful thinking into action, reserving $20 billion of stimulus money to aid the health care providers in adopting the new electronic record system. EMR has been out and expanding in Europe, Australia, and other areas of the world. However, here in the US, in
2009, only 4% adopted the modernize recording (Hoffman, 2009). In a web site called Health Level
Seven, the blog author Jon Mertz included his finding from Dr. Blumenthal, the national coordinator for health information technology claimed that as of January of this year, 80% are intending to adopt the new system. 40 percent of physicians decided while the other 40 percent was still skeptic (Mertz, 2011).
That being said, the implementation of this system is just slowly moving stealthily. Part of this is the formulation of the standard and protocols for collection, exchange, and retrieval of electronic medical information, although it may vary widely system to system (Hoffman, 2009). Adopting the system is expected to be initially challenging for everybody, most especially the smaller clinic and private doctor’s offices. However, with the proper relay of information, education and training, the success of implementation will be guaranteed.
Moreover, the government is determined to reach their goal within that ten year contract.
Many have said that the new system will not be mandated, but will be given as an option. However, for those who will be stubborn and skeptic with the system that will remain conventional by 2015, the government particularly the Department of Health and Human Service will have the pleasure of decreasing the Medicare payments slowly, but surely. As for those who will truly adopt the system, the government is willing to grant up to $64,000 incentives for the eligible physician while hospital can have an astonishing $2 million or more (HIT, 2011). However, this grant is not a freebie without condition.
These incentives are tied to “meaningful use” of health care. Although, the solid definition for
“meaningful use” is still unclear, a preliminary description and summation from all of my readings provided that it basically means, any eligible office-based physicians will have to demonstrate the benefit of EMR in prescribing, information exchange with different doctors in different fields, improve coordination, better understanding with patient’s records and history, and ease access of the records
(HIT, 2011), and so forth.
Now, moving on, there are many important reasons why health care providers must put their faith with this electronic system. Previously, the beams of benefits of adopting the EMR were already forecasted by William Hersh in the year of 1995 in his article The Electronic Medical Record: promise and problem. At that year, he noted that the main benefit of Electronic Medical Records is the ease of accessibility. However, as we move forward every year, our demands get even greater as the benefits of
Electronic Medical Record also evolve to adapt in our growing needs. As stated earlier, EMR may vary

MC Gamboa [4] system to system, and so as their major functionalities. The benefits can be subdivided in categories; accessibility, clarity and security.
A patient’s complex health issue or medical history will be accessible to all the doctors involve in resolving the patient’s health issues. These information will be accessible, meaning, could be retrievable or accessible for important modification through any various electronic devices. Through fast moving technology, a physician can perform his/her assessment using a touchscreen, handheld tablet such as iPad. These devices are also categorized as “smart” devices, like smartphones. Through additional applications, these handheld and portable devices provide decision and support system which is programmed in the application. Auto spell, fill in the blank and built in medical dictionary or reference are the other impressive features that these portable devices or the electronic medical record system are the other important features that can reduce medical assessment errors. The straightforwardness of
EMR promotes a better administration. Charting management and scheduling patients became an easy task. Tracking the forgetful, always late, and the no call-no show patients became possible and an action can immediately take before the day ends. In addition to structured administration, EMR allows physicians to prescribe and order medication and laboratory test electronically is as easy at the charting management (Hawaii Independent Physicians Association, 2005). The online data base which is accessible only to authorized pharmacies within the institution or neighboring pharmacies provide an time-efficient pick up for the prescribed medicines. Aside from that, insurance may take advantage the benefits of its accessibility to identify patient’s insurance coverage.
Clarity is a paramount in the Electronic Medical Record (Krishna Surti, Robert Lin, 2002). The
Electronic Medical Records will allow physician to have a better outlook in their patient’s health status.
The EMR’s programmable software allows them to select the information(s) that is vital only in every situation. This prevents the unnecessary retrieval and disclosure of the patient’s personal information and medical history. Also with this feature, physicians can display information in the purpose of comparison such as progress of recovery by month to month or every doctor’s visit. In addition, a feature called Picture Archive and Communication System is another feature of EMR that allow the physician immediately view imaging results such as x-rays (Hawaii Independent Physicians Association,
2005). It supports better observation in comparing before and after procedures and patients were able to access the film in their visit.
The accessibility and clarity of EMR brings out the efficacy of this system which benefits both parties; the health care providers and the patient. It saves time and effort of every associate in the health care industry and promotes a good relationship between the doctor and their patients.
EMR is obviously an exceptional system. However, there are a number of major concerns in establishing an electronic medical records system. Privacy, security, increased technology requirements,
(Hersh, 1995) and lack of protocol and standards (Hoffman, 2009) are only a few of them to mention.
However, privacy and security of data are the most vulnerable in the system. As we know, privacy and security is very crucial in any electronically base communication and exchange of information. Especially, now that we have come to a period where sharing private information is more enjoyable and accessible far beyond what we can ever imagined. These trends raise concerns when information and medical

MC Gamboa [5] record is involved (Thede, 2010). Medical identity theft is one of the cyber-criminal offense that is most feared of. Like internet hackers, these thieves steal personal medical information and health insurance information to get medical treatment, prescription drugs or surgery (FTC Facts for Consumers: Medical
Identity Theft, 2010). Although many websites and software programs are now design to secure the privacy of the main user of the system, it never gives us a peace of mind and guarantee 100% safe.
However, in implementing Electronic Medical Records, the government deliberated preventive measure to ensure the privacy and security of the system.
Last year (2010), Kathleen Sebelius, the HHS secretary, announced important new rules and resources to strengthen the privacy of health information. These is to provide peace of mind to all and provide more information to promote better understanding to our rights and the resources that will be available to protect our personal health information (News Release: HHS Strengthens Health
Information and Privacy and Security through new rules, 2010). She states that the key to the success of the implementation is that health information will be accessible to anyone in the health care industry that makes influential choices and risky decisions. That being said, she also assures that protecting the privacy and health information will remain as their constant goal.
In addition, the Health Information Technology for Economic and Clinical Health (HITECH )Act was enacted and are specifically designed to work together to provide the necessary assistance and technical support to providers (vendors and users), enable coordination and alignment within and among states, establish connectivity to the public health community in case of emergencies, and assure the workforce is properly trained and equipped to be meaningful users of EMRs (HIT, 2011).
Moreover, HIPAA shares a role of protecting personal health information. Although their primary purpose was to insure the portability of health care information, they are aware that data in electronic format can be easily shared. To protect these data, rules were promulgated to set a national standard for the privacy of health information (Thede, 2010). Besides HITECH and HIPAA,
(Department of Health and Human Services, 2011).
Learning the opportunities and benefits of adopting the Electronic Medical Records convinced me as individual that this system is not just an ordinary make over in our health care system; because it’s not. The integration of information technology in health care and medicine is another break through.
It seems to me that all the wild cards were all laid out. If there will be a “joker” that was not revealed, we all American (with the government) will surely find out about it. As government relies on our feedback as well as other case studies were made even before the formal implementation of EMR. The flaws were identified yet immediately justified with all the security measure the government enacted; it should give us peace of mind and trust. Resistance is an understandable reaction through process changes. However, if resistance will only delay the modernization of our health care system, then we

MC Gamboa [6] will never know when we’ll have another chance. The government can’t stand alone with this implementation. They (the government) need us, the people, to expand our horizon in understanding that successful nation cannot be made in first take; it might take two or more. Also, remember, health is wealth; a paradigm in which we have faith in. Without healthy citizens the success of one nation is not guarantee.
Hawaii Independent Physicians Association. (2005, August ). Retrieved from Hawaii Independent
Physicians Association: http://hawaiiipa.com/media/Document_1.pdf
FTC Facts for Consumers: Medical Identity Theft. (2010, January). Retrieved from Federal Trade
Commission: http://www.ftc.gov
News Release: HHS Strengthens Health Information and Privacy and Security through new rules. (2010,
July 28). Retrieved from Department of Health and Human Services: http://www.hhs.gov/news/press/2010pres/07/20100708c.html
Open Clinical. (2010, February). Retrieved from Open Clinical: http://www.openclinical.org/emr.html
Department of Health and Human Services. (2011, January 19). Retrieved August 3, 2011, from http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__privacy_and_security/1
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HIT. (2011, February 24). The Office of the National Coordination for Health Information Technology.
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Hoffman, L. (2009). Implementing Electronic Medical Record. Communications of ACM, 18-20.

MC Gamboa [7]
Krishna Surti, Robert Lin. (2002). Electronic Medical Records and the Allergist. Internet Journal of
Asthma, Allergy and Immunology.
Marie-Pierre Gagnon, Marie Desmartis, Michel Labrecque, France Legare, Lise Lamothe, Jean-Paul Fortin
Jean-Francois Rancourt Julie Duplantie. (2010). Implementation of an Electronic Medical Record in family practice: case study. Informatics in Primary Care.
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Mertz, J. (2011, February 17). HL7 Standard. Retrieved August 3, 2011, from http://www.hl7standards.com/blog/2011/02/17/the-state-of-the-ehr-recent-studies-and-stats/
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of Issues in Nursin, 8-8.