Electronic patient records have the probability of improving communication efficiency, resulting in patient safety and quality, across NHS trusts in the UK. This requires, however, that they be fully implemented, which may explain why its adoption has been relatively slow. Various advantages of electronic patient records involve facilitation of improved communication among healthcare providers within the Ealing trust and promotion of patient care quality via optimized guideline compliance. In spite of the obstacles facing the widespread implementation and adoption of electronic patient records, their use as evidence based and real time support tools could aid busy healthcare providers, for example, those in acute settings, to improve documentation, communication and coordination. This will vastly improve patient care quality at no additional costs to the Ealing trust.
Electronic patient records have become increasingly important in the improvement of communication efficiency within the healthcare facility efficiency if fully implemented. If all goes well in the next three or so years, NHS boards and trusts across the UK, including London NHS Trust, will complete the implementation of EPRs to replace the earlier used medical records paper that has been a characteristic of most NHS trusts across the country (NIHR, 2011: 43). In London NHS trust, at least, implementing electronic health records has been problematic undertaking, especially since the National Programme for IT that has been tasked with provision of a central system has only delivered for a few trusts because of several delays. However, even given the difficulties that have plagued the implementation of EPRs in London NHS trust and other trusts across the UK, there is increasing need to incorporate them in healthcare delivery. With recent advances in IT, as well as its undeniable impact on in various sectors, healthcare included, the need to implement EPRs has been accelerated by the growing communication and coordination challenges facing London NHS trust today (Storey et al., 2012: 39).
Some of the challenges include improvement of communication among healthcare facilities and providers, reduction of preventable errors, and the control of medical care costs in the midst of austerity. It can even be argued that, the use of electronic health records could be the single solution that acts towards solving these three issues at London NHS trust. Armoni (2012: 34), in fact, concludes that electronic record keeping innovations have led to a dramatic improvement in communication sans increasing costs in various health institutions. Ealing NHS Trust could use this system for the recording of administrative and clinical patient data and information such as order entry, physician and nursing notes, electrocardiograms, medical and radiology graphs, pharmacy orders, and laboratory tests. For the Ealing NHS Trust, it has the ability to organise relevant data concerning patients and present it to clinicians across the trust in supporting clinical decisions at points of care. It could also involve the Bar Code Medication Administration System, which utilises wireless technology at points of care using a scanner (Dopson, 2012: 37). The use of electronic health systems would be an appreciated and successful tool if well implemented across the London NHS Trust.
To begin with, it could eliminate errors that mostly arise from the loss of physical, medical records that are paper based. In NHS trusts across the UK, at least one in seven hospital admissions have been found to result from loss or lack of medical records and, therefore, inadequate information at points of care (Newgard et al., 2012: 218). In addition, some twenty percent of laboratory tests have to be repeated because health care providers cannot access the results. By using the electronic health record system, the Ealing NHS Trust has the opportunity to set a national benchmark with regard to healthcare quality while also ensuring that healthcare costs per patient remain the same as they have been for years. However, this transformation of health record systems does not occur through the purchase of IT systems and their installation in points of care across the NHS trusts. It involves a cultural transformation that needs a solid foundation via the training and preparation of health care staff that will be required to utilise the systems (Star et al., 2011: 310).
This also requires the establishment of health information classes with accompanying diplomas and degrees. Moreover, a credentialing process is necessary: it has the objective of ensuring that the legitimacy and credibility of these training and education tools are widely acknowledged (Baker et al., 2009: 281). As a cultural change, the implementation of electronic health records system also requires regulation aimed at safeguarding the privacy of patients, as well as how the records are handled. This requisite cultural change will also emphasize the requirement to continue improving education with regards to delivery of healthcare at London NHS trust, as well as improvement in understanding the inner dynamics and complexity of the entire system. It is hoped and anticipated that the introduction of electronic health records fully will open doors for the tackling of these essential issues, while also incorporating the discussions below in the way the trust envisions healthcare systems in London (Donnelly, 2009: 20).
The implementation of electronic patient records at Ealing NHS Trust will be vital in the improvement of communication and coordination efficiency across the trust. Some of the aspects it will improve include tracking and reporting, office efficiency and healthcare delivery, and handling of workflow changes. However, there are also some key aspects of implementation that will be discussed, as well as the barriers to implementation, evaluation of its success, and recommendations to overcome the barriers.
Electronic Health Records in Tracking and Reporting
Electronic health records and their ability to store data and retrieve it make EHRs a logical tool for the Ealing NHS Trust in improving communication and coordination efficiency between all multidisciplinary team. Electronic health records come in handy in the process of consolidation of patient information, for example, test results, medications and diagnoses, enabling healthcare providers at the trust to deliver more effective and safer healthcare (Osborne & Brown, 2013: 47). Support in decision making, such as reminders and prompts when laboratory tests are due, as well as when NHS guidelines of care are not met, gives providers a tool for the provision of quality care. This improved ability for healthcare providers to document every aspect of their encounter with a patient using electronic health records in clear and easy to read way could also enhance coding and billing in the optimisation of reimbursements. After the appointment, the system could also improve follow up care by tracking patients, particularly in relation to missed appointments, and same reducing patient's waiting list. EHRs also have the capacity to flag abnormal lab results by synthesizing information regarding the symptoms of the patient and speed up treatment by efficient communication between multidisciplinary team to succeed patient's treatment in shorter time. Finally, electronic health records will enhance the ability of providers to examine particular patient populations in ensuring that quality measures like Pap tests and mammograms are up-to date (Slee et al., 2010: 99).
Using EHR to improve Office Efficiency and Delivery of Healthcare
Efficiency across the London NHS Trust offices, as well as the capability to streamline processes of workflow could also be improved through the use of EHRs. This is because it allows providers to access medical records in a timely manner, particularly when records are in multiple locations across the trust (Currie & Finnegan, 2011: 42). This frequency of cross-over happens between ambulatory and inpatient care settings, for example. By improving efficiency, it can translate to improvements in the direct care time for patients, completeness of EHR entered data, and its legibility and accuracy. Enhancement of efficiency in the offices, as well as the availability of legible health documents, could also enhance efficiency in billing and generate more referrals for needy patients. This is enabled by the system's ability to provide timely, clear, and legible health documents in support of expanded initiatives by various clinical teams across the trust (Baskaran, 2011: 51).
EHRs and Workflow Changes
One of the biggest impediments to HER adoption across NHS trusts in the UK has been the resulting alteration in workflow, as well as the redistribution of existing work. These processes, whether retrieval and viewing of information or order entry, are increasingly intricately related the physician's process of documentation (Shoniregun et al., 2010: 44). The design of the majority of vendor-provided electronic health records leads to added structure in this process that the user may not consider familiar. Nonetheless, it may be difficult to learn this system, which could result in the practice becoming less productive with the assimilation of the new technology, particularly in the beginning. Thus, until the EHR system has been fully implemented, it could be necessary to hire additional staff (Jones, 2014: 28). Another concern revolves around the change of focus by the clinicians across the trust from the patients. This has the possibility of detracting from the encounter with patients and a decrease in patients seen, albeit temporarily. It could also reduce the learning potential among students and residents as they become increasingly focused on the typing of notes or placement of orders, instead of performing sufficient examination of the patient and getting detailed histories (Papadopoulos, 2011: 214). Consequently, it is decisive for healthcare providers to comprehend the fact that EHRs do not make up for listening to a patient. The communication process with patients may be improved by placing computer screens appropriately during the encounter.
Evaluating Success of EPRs
Evaluating the success of electronic patient records implementation is an important step in integrating the system with the trust's operations. It will enable the health facilities across the trust to improve workflows, realize EPR benefits, and attain objectives and aims of the implementation (Jones et al., 2009: 43). During the evaluation, it is essential to check that the facility teams remain intact and that there is smooth running of workflows. It is also important to identify any interface issues, unresolved vendor issues, and staff training needs. The outcomes from this evaluation will then be used to target initiatives and implement them to enable the facilities to continually improve communication and coordination efficiency. The evaluation should be done at least 3 to 4 weeks after initial implementation. Information that should be collected involves culture and adoption, network and infrastructure, and what has been learned about the EPR vendor that was not available prior to the implementation (Rybynok et al., 2010: 4433). This latter point should help in knowing the concerns that should to be resolved prior to handing over the facilities' systems to the technical maintenance and support division
Barriers to Implementation
In spite of the numerous potential benefits that electronic patient records endow on healthcare facilities, implementation of the technology is still faced by various limitations and barriers. The most critical barrier to implementing electronic patient records has to do with resistance of the staff, to the changes involve (Gallego et al., 2013: 530). Other obstacles that limit the implementation of EPRs include the fact that they are expensive, and need a massive investment of funds from the facilities or, in this case, the government, which may not be a priority during a period of austerity. EPRs are also more difficult to use compared to paper-based records, while EPR applications are also not standardised for use across any facility and require customization that also adds to the expenses. In addition, the implementation of EPRs tends to reduce the productivity of the facilities, as well as disrupt the workflow during initial implementation. There is also a perception that implementing EPRs only benefits society and payers, stakeholders, rather than the provider (Brooke-Read et al., 2012: 443). Finally, issues with technical limitations of staff also act to limit the implementation and adoption of EPRs.
Keys to EPR Implementation: Inter-professional Collaboration
One of the most vital requirements in implementing EHR fully across the London NHS Trust is the identification of leaders or champions among the present providers who have the ability to bridge training programmes between the providers of healthcare and the EHR vendors (Berk et al., 2008: 105). These leaders or champions should be continuously involved in the improvement of workflow processes and systems; this is aimed at making them more efficient and effective. One great impediment to the implementation and assimilation of EHRs is the inability to take advantage of powerful and new healthcare advances in information systems or slow and unreliable systems. In order for EPRs to be accepted across the London NHS Trust, it must be facilitated by the installation of a specific programme across the entire trust's computer network, as well as the establishment of IT support by the NHS trust itself (Cea-Soriano et al., 2013: 980). This will enhance communication uniformity, allowing for a complete interface between practices of the healthcare providers and the Ealing NHS Trust.
In addition, it will also allow the trust to provide a department for IT support by partnering with a specific vendor. Staff of the IT department could also collaborate on a regular basis with clinicians in order to review navigation, usage and system updates. The IT support department, in addition, should also be available at all times to consult immediately in troubleshooting system issues (Sherwood, 2006: 36), including offering assistance to clinicians in efficient use of the EHR system, as well as how to retrieve lost data in case of system crashes or power outages. The department's effectiveness depends on its ability to train clinicians and assist them on top of upgrading the EHR system if there is discovery of inefficiencies or problems. The efficiency of EHR systems across the Ealing NHS Trust will be maximised when the IT department includes personnel from the vendor company that can adapt the system for the trust (Russell & Hellawell, 2013: 36).
While this discussion shows that health information technology has the probability to overpoweringly improve the quality of healthcare, it is clear that there is a need for more research in examining the exact benefits of electronic patient records, as well as its impact on enhancing healthcare outcomes and patient safety. Most of the literature used has been reviewed via national estimates and single site studies while also being based on extrapolations from the proposal. As more evidence regarding electronic patient record benefits become available with the increasing implementation of EHR across NHS trusts in the UK, the need for healthcare IT should gain more significance. Utilisation of electronic patient records as real time tools, for example, could aid all multidisciplinary team members as physicians, nurses and physiotherapists in improving care quality via improved communication, coordination and documentation in health care.
' Before implementing EPR, it is important to first assess the readiness of facilities involved by creating management and leadership teams for implementation.
' Selection of a certified EPR vendor is also crucial and requires contracting guidelines to be in place, as well as an evaluation matrix tool for the vendor.
' In addition, the practice should also conduct training prior and after implementation of the EPR system.
' In addition, it must be ensured that the EPR system achieves meaningful use.
' Finally, quality improvement is a vital part of implementation and adoption of EPRs, which can be aided through patient satisfaction surveys.
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