The Electronic Health Record ( EHR ) is a longitudinal electronic record of patient wellness information generated by one or more brushs in any attention bringing scene. This scene may include all the playing cardinal administrative clinical informations that are related to that patients care under a peculiar supplier, every bit good as patient demographics, advancement notes, jobs, medicines, critical marks, past medical history, immunisations, research lab informations and radiology studies. The HER potentiates the streamline of the clinician ‘s work flow and has the ability to promote other care-related activities in a direct or indirect manner through several interfaces, including evidence-based determination, support, quality direction every bit good as results describing.
In the developed states, the Electronic Health Record ( EHR ) is considered to be the nucleus of the health care substructure. The bringing of health care today is undergoing a major alteration throughout the universe in order to present schemes for national Electronic Health Record ( EHR ) systems. Accessibility of patients ‘ records between the health care professionals across the Earth will be of great attending and value in the close hereafter.
Electronic wellness records ( EHRs ) have been proposed as a sustainable solution for bettering the quality of medical attention. The successful national schemes taking to set up a proper EHR are assisted by assorted factors such as communications substructure, interoperable criterions and execution programs.
There is no uncertainty that in any lack of the indispensable information about the personal inside informations of the patient, different types of drugs prescribed, lab trials, radiological studies, and other therapies will take to misdiagnosis or mistreatment.
Bahrain and some of the GCC states has taken a important measure in supplying services online for the population to execute assorted undertakings with the aid e-government. Those services include paying measures, renew paperss, submit applications, book assignments for ID and some limited health care services. The great value of such on-line services opens doors for more desires as the being of such inaugural stairss put the present proposal in context.
In this paper, we propose that Bahrain needs an electronic wellness records ( EHR ) system with possible interoperability with other GCC provinces. In Bahrain, there are 3 chief governmental infirmaries ; largest is Salmaniya Medical composite ( SMC ) , 21 public wellness centres ( HCs ) , Bahrain Defense Hospital ( BDF Hosp ) and many other private wellness attention suppliers ( Hospitals and Clinics ) . We will besides discourse the demand to make full in the spread of EHR between the GCC provinces. Accessing the patient ‘s history and full medical informations can cut down the cost of patient direction while exchanged between those states. The characteristic of health-related information, particularly the medical history, is in discontinuity and lacking of coherence. This is a serious obstruction to accomplish optimum wellness attention services.
Presents, the status stands on the antique manual paper work and physical filing system. All files are shop in big shelves in the filing room of governmental infirmaries and HCs. Patients are normally assigned to their addressed HC where their files are kept. Everyday the files of the appointed patients are carried by from the filing room and back at the terminal of the twenty-four hours by the nurses who are seen forcing large supermarket-like streetcars full of files. Patients most of the clip spend hours upto whole waiting to see their physician. Absence of the concerned carrying nurse, loss or supplanting of the file will take to more waiting clip. Occasionally some of the documents of the advancement sheets can be torn or lost by transporting the files all over the infirmary or while exchanged between the wellness attention suppliers or infirmaries which can do tonss of incommodiousness for the patients and physicians and lead to negative deductions on the proficient facets of intervention.
Since many developed and developing states have already developed a good structured EHR, we propose a nation-wide, on-line EHR system costumed to the demand of the Kingdom of Bahrain with possible implementing similar system in other GCC states for future interoperability.
The execution of EHR and interoperability are faced by many challenges in footings in proficient and human resources. The package has to be really specifically designed for the organisation with easy handiness and use. There is no uncertainty that set uping a proper EHR with interoperable system has great advantages over the old paper record. Creating and pull offing such wellness engineering among the GCC states will be of great importance. Due to the fact of increasing nomadic society such as frequently single traveling or patient ‘s exchange between these states.
An electronic wellness record ( EHR ) is an official wellness record for an person that is shared among multiple installations and bureaus. Digitized wellness information systems are expected to better efficiency and quality of attention and, finally, cut down costs. Among other types of informations, an EHR typically includes: Contact information, Information about visits to wellness attention professionals, Allergies, Insurance information, Family history, Immunization position, Information about any conditions or diseases, A list of medicines, Records of hospitalization, and Information about any surgeries or processs performed. [ 1 ]
EHRs are the inevitable following measure in the continued advancement of health care that can beef up the relationship between patients and clinicians.A The information, and the seasonableness and handiness of it, will enable suppliers to do better determinations and supply better attention. A For illustration, the EHR can better patient attention by:
Reducing the incidence of medical mistake by bettering the truth and lucidity of medical records.
Making the wellness information available, cut downing duplicate of trials, cut downing holds in intervention, and patients good informed to take better determinations.
Reducing medical mistake by bettering the truth and lucidity of medical records. [ 2 ]
Many people in the US health care industry and the imperativeness use the footings electronic medical record ( EMR ) and electronic wellness record ( EHR ) interchangeably. However, these footings describe wholly different constructs, both of which are important to the success of local, regional, and national ends to better patient safety, better the quality and efficiency of patient attention, and cut down health care bringing costs. EHRs are reliant on EMRs being in topographic point, and EMRs will ne’er make their full potency without interoperable EHRs in topographic point. [ 6 ]
The electronic medical record ( EMR ) is the tool that promises to supply the platform from which new functionality and new services can be provided for patients. Physicians are expected to document brushs they have with patients to guarantee important information for decision-making is recorded and actions taken are besides recorded. Documentation is besides required as an archival record of what happened in instances of difference. To a great extent, physicians resent the undertaking of certification, as it detracts from their primary undertaking: taking attention of patients. Doctors besides resent the duplicate of attempt required with certification, as every medicine that is written on a prescription tablet, every lab trial ordered, every X ray ordered has to be re-written in the chart to keep a good record. Communication between practicians is hard as in many instances the information collected is fragmented, often excess and voluminous. Finally, doctors are invariably inundated with new information and have no tools to assist them integrate new techniques and interventions into their daily activities, other than utilizing their memories or holding to tote around big text editions. [ 5 ]
Clearly, the EMR ( used by doctors in their offices ) and the EHR ( used by wellness systems to convey and pull off wellness attention informations ) are complementary engineerings. One without the other does n’t supply much benefit. The faculties required by an EMR include: programming, patient enrollment, documenting patient brushs, composing prescriptions, managing paperss, requisitioning and having lab and diagnostic imagination studies, pull offing interoffice communications, clinical determination support and charge. The faculties required by an EHR are: Authentication of patients and suppliers, research lab consequences describing, drug claims adjudication, diagnostic imagination coverage, hospital discharge sum-ups, secure messaging and clinical determination support. [ 5 ]
Historically, the first known medical record was developed in the fifth century B.C. by the early Grecian doctor Hippocrates, besides known for the Hippocratic Oath ( 400 B.C.E ) ( The Leapfrog Group,2004 ) . Hippocrates prescribed two chief features for the medical record: ( 1 ) it should accurately reflect the class of disease, every bit good as ( 2 ) it has to bespeak the likely cause of disease. Although these ends are still pertinent, modern EHR systems at the top of that can besides supply the clinician with extra maps that flow from the benefits of efficient and rapid cybernation [ 3 ]
The thought of entering patient information electronically alternatively of on paper – the Electronic Medical Record ( EMR ) – has been around since the late 1960 ‘s, when Larry Weed and his group, at the University of Vermont, a collaborative attempt between doctors and information engineering experts, introduced the construct of the Problem Oriented Medical Record ( POMR ) into medical pattern. Larry Weed is considered to be the first who presented and described the construct of computerized/ electronic medical records. Weed described a system to automatize and reorganise patient medical records to heighten their use and thereby take to improved patient attention. Besides, in the 1960s, the Mayo Clinic began developing electronic medical record systems. [ 4+5 ]
In 1970, the POMR was used for the first clip in a medical ward of the Medical Center Hospital of Vermont where a touch-screen engineering had been incorporated into informations entry processs. Over the following few old ages, all drug related information were added to the nucleus plan in order to let the doctors to look into for drug actions, doses, inauspicious effects, allergic reactions and interactions. At the same clip, diagnostic elements and intervention programs for over 600 common medical jobs were devised.
During the 1970s and 1980s, several EMR systems were developed and further refined by many different academic and research centres. The hospital-based system “ Technicon ” and Harvard ‘s COSTAR ( the Computer Stored ambulatory Record ) system had records for ambulatory attention. The HELP system and Duke ‘s ‘The Medical Record ‘ are illustrations of early in-patient attention systems. Indiana ‘s Regenstrief record was considered to be one of the earliest combined in-patient and outpatient systems.
With progresss in computing machine engineering and diagnostic applications during the 1990s, EMR systems became progressively incorporate and more widely used among clinicians. In the twenty-first century, more and more patterns are implementing electronic medical records. [ 4 ]
By and large, electronic wellness records are the most common Fieldss that are remaining at the top of the states ‘ precedence lists around the universe to develop an indispensable substructure for national wellness information, such as, Canada, Australia, England, and USA [ 7 ] .
As of 2005, the National Health Service ( NHS Executive, 1998 ) in the United Kingdom is holding one of the largest countrywide EMR undertakings. The NHS is tageting to hold 60,000,000 patients with a centralized EMR by 2010 ( illustrated in Figure 1 ) . In the Canadian ( Healthcare Infoway, 2007 ) state of Alberta, the Alberta Netcare undertaking is a large-scale operation, an EHR system. [ 8 ]
Many research workers have published documents in the country of EHR and the positive impact on wellness attention systems. Hayrinen et Al. ( 2008 ) explored a reappraisal of the research literature on EHR systems. The chief end of this paper was to happen out how EHRs were defined and structured every bit good as their content and use with their impact. In order to that they studied four electronic databases: Pubmed/Medline, Cinalh, Eval and Cochrane. The writers coming from Finland, found that despite the construct of EHR comprised a broad scope of information systems, really few researches offered clear descriptions of nomenclatures used for EHR or the system construction. EHRs were implemented in primary, secondary and third attention, and informations were generated in EHRs by different groups of wellness attention professionals. This paper besides studied the quality of the information and found that in several surveies the usage of an information system was contributing to more accurate certification by wellness attention professionals. The quality of information is an of import component in patient attention, but EHRs add value to the patient attention by supplying of import information for secondary intents, such as wellness policy planning. [ 8 ]
Catherine M. et Al. ( 2008 ) studied a national study on EHR in ambulatory attention ( published at www.nejm.org on June 18, 2008 ) . The survey was conducted in USA in order to measure doctors ‘ acceptance of outpatient electronic wellness records, their satisfaction with such systems, the sensed consequence of the systems on the quality of attention, and the sensed barriers to acceptance. This national study was conducted in late 2007 and early 2008 included 2758 doctors which represented a response rate of 62 % . In refer to a definition for EHR which was based on adept consensus, the writers determined the proportion of doctors who were utilizing such records in an office scene and the relationship between acceptance and the features of single doctors and their patterns. This paper came with a decision that doctors who use electronic wellness records are really happy and satisfied with such systems as they believe that those systems improve the quality of attention. However, as of early 2008, electronic systems had been adopted by merely a little minority of U.S. doctors, who may differ from ulterior adoptive parents of these systems. [ 9 ]
Daniel Deutscher et Al. ( 2008 ) studied 21,523 grownup patients ( average age_50.6 old ages, SD_16.3, range_18-99 ; 58.9 % adult females, 41.1 % work forces ) who were referred for physical healer direction of neuromusculoskeletal upsets. This paper had 2 ends, foremost to depict execution and integrating of electronic functional position outcomes into an electronic wellness record ( EHR ) for the publicity of clinical pattern betterment procedures and 2nd to analyze the consequence of ongoing results informations aggregation in a big physical therapy service in relation to patient and clinic load. The decision indicated that everyday aggregation of result informations is realistic in a big public physical therapy service and can be successfully integrated with EHR informations to bring forth a valuable clinical pattern betterment platform for service rating and results research. Engagement and completion rate ends of 90 % and 65 % , severally, look to be executable. [ 10 ]
William Ventres et Al ( 2006 ) believed that merely small is known about the effects of EHR specifically on physician-patient brushs. Based on that position they did an ethnographic analysis survey with aim in order to place the factors that influence the mode by which doctors use the EHR with patients. The writers came up with decision showed that presenting EHRs into pattern influences multiple cognitive and societal dimensions of the clinical brush. It besides brings into focal point of import inquiries that through farther enquiry can find how can EHR optimally used to heighten curative relationships. [ 11 ]
A.Jalal-Karim et Al. presented many surveies in the field of EHR and health care system. In one survey in
A.Jalal-Karim et Al. ( aˆ¦aˆ¦aˆ¦ . ) focused on the influence of following elaborate health care record on bettering the quality of healthcare diagnosing and determination devising procedures. The writers believed on how greater sharing of more elaborate wellness attention information has the potency to better the quality of patient attention instead than minimising the current system into Drumhead Patient Record merely. This paper came to a decision that sharing more elaborate wellness information between health care professionals has got a positive possible impact to significantly better the attention provided to patients. The questionnaires study every bit good as the literature reviews used in this research showed that sharing of detailed health care records through integrated health care system can heighten clinicians to supply more efficient attention to the patients who can have health care services from different suppliers. Healthcare organisations require a well construction system which provides more efficient and accessible method of a complete health care in order to assist clinicians to entree to the needed critical sections of electronic patient records at different degrees, increase analyst productiveness, and derive more visibleness and control over the costs and quality of health care system operations. Besides that, an advanced storage and informations direction environment is an of import component required for clinicians in order to acquire an efficient and dependable entree to detailed patient record. [ 12 ]
Another survey by A. Jalal-Karim et Al. ( 2009 ) proposed an EHR system in the Kingdom of Bahrain through concentrating on the challenges and chances. The questionnaire resulted in that EHRs can hold a immense positive impact on the wellness attention system in Bahrain. IT can do information faithfully available and accessible to wellness attention suppliers, gettable at anytime and at every phase of the wellness attention proviso concatenation. That could be easy achieved in a potentially well-integrated system in a little state such as Bahrain. Besides the smooth flow of patient information will reenforce and back up determination doing on the portion of all clinicians, contribute to a civilization good wellness attention pattern every bit good as cut downing clip and costs. [ 13 ]
Healthcare professionals and clinical research workers are seemingly struggle in sharing electronic patient records among assorted health care system locations. The interoperability criterions are considered to be the chief challenge faces healthcare suppliers in order to portion patient ‘s records. A.Jalal-Karim et Al. ( 2008 ) presented an overview of the significance evolved Electronic Health Record ‘s with chief concentrating on the interoperability criterions which are being developed. The writers concentrated on chiefly four criterions that are taking the leading: HL7, DICOM, ISO/TC 215, and CEN TC 251 criterions. This paper came up with a decision that the important Electronic Health Records are extremely turning and adopted by many states to be shared among the bulk of health care professionals. That will hold a good impact in every turning networked environment to accomplish complete, fast and particularly easy entree treating with demoing high consideration for the confidentiality of patients information. Interoperability subjects often become highly a proficient issue as it is concentrating on how clinical information is created, stored, and shared between assorted systems. To show a complete electronic wellness record, these systems must be connected, therefore easing authorized health care suppliers to entree required healthcare information. Due to this enlargement and requirement for successful deployment of appropriate EHR, relevant criterions are basically desired to enable EHR information to be shared whenever and wheresoever needed. However, due to the increased planetary patient mobility, interoperability criterions based on and supported by planetary understandings on sharing EHR can play a important measure towards bettering health care safety, quality, efficiency and cost provided to consumers. [ 14 ]
In a white paper entitled Health Informatics – Requirements for an Electronic Health Record Architecture ( 2005 ) published by the Australian Standards Bureau, a complete architecture and methodological analysis for EHRs in Australia is outlined. Organizations such as the Department of Health ( South Australia ) , Engineers Australia, Health Information Management Association of Australia and the Health Insurance Commission were represented in the cooperation commission who wrote the study. The study starts with an interesting note: ‘Standards are populating paperss which reflect advancement in scientific discipline, engineering and systems. To keep their currency, all criterions are sporadically reviewed, and new editions are published. Between editions, amendments may be issued. Standards may besides be withdrawn. It is of import that bargainers assure themselves they are utilizing a current criterion, which should include any amendments which may hold been published since the criterion was purchased ‘ .
The ISO ( International Organization for Standardization ) has guidelines for EHR criterions. The ISO, which is considered as a world-wide federation of national criterions organic structures, has the end of puting all sorts of criterions for international application. The ISO approaches the definition of EHR in two facets, the signifier and construction. The ISO emphasiss on the issue of interoperability which is the individual most of import feature of the EHR in the signifier of ability to portion EHR information between different authorised users. Harmonizing to the ISO, there are two chief degrees of interoperability of information: functional interoperability ( ability of exchange of information ) and semantic interoperability ( consistence of defined constructs ) . The ‘Integrate Care EHR ‘ harmonizing to the ISO is defined as ‘a depository of information sing the wellness position of a topic of attention in computing machine processable signifier, stored and transmitted firmly, and accessible by multiple authorised users. It has a standardised logical information theoretical account that is independent of the EHR systems. Its primary intent is to back up go oning, efficient and quality integrated wellness attention, every bit good as incorporating information which is retrospective, coincident and prospective ‘ .
In the white paper Toward Health Information Liquidity, Penfield et Al. ( 2009 ) studied the success of integrating in bing systems. The writers concluded that while HIT was indispensable for supplying high-quality wellness attention. Information engineering ( IT ) entirely was non plenty and that preparation every bit good as the information flow issues need to be tackled.
Hostgaard and Nohr ( 2004 ) who focused in their survey on the Danish wellness attention system, explored the spread of execution of the wellness information system in Denmark. They besides studied the importance of the construct of alteration readiness-research ( CRR ) . In a broad ranging survey including questionnaires and development of survey theoretical accounts, the research assessed employee inactiveness and deficiency of computing machine accomplishments in relation systems, with immediate deductions for work flow. They decision was that such hindrances have lead to the successful acceptance of merely few of the Danish governments ‘ recommendations sing EHR systems, and that employees ‘ fright of looking stupid left much to be desired.
Gans et Al. ( 2005 ) surveyed a nationally representative sample of medical group patterns to measure their current usage of IT. The writers concluded that acceptance of EHRs is come oning easy, at least in smaller patterns, though a figure of group patterns plan to implement an EHR within the following 2 old ages. However, the procedure of taking and implementing an EHR appears to be more complex and varied than the writers expected. This paper suggests a demand for greater support for patterns, peculiarly smaller 1s, in this pursuit if the benefits expected from EHRs are to be realized.
In an interesting survey entitled Paper Versus Computer: Feasibility of an Electronic Medical Record in General Pediatrics, by Roukema et Al. ( 2001 ) , the writers stated: ‘The execution of EMR systems promises important progresss in patient attention, because such systems enhance readability, handiness and informations quality. Structured informations entry ( SDE ) applications explained by Roukema et Al. ( 2001 ) can motivate for completeness, provide greater truth and better telling for seeking and retrieval and permit cogency cheques for informations quality monitoring, research and particularly determination support. A generic SDE application ( OpenSDE ) to back up papers of patient history and physical scrutiny findings was developed and tailored for the sphere of general pediatricss ‘ .
Burt and Sisk ( 2005 ) looked into the greater usage of EMRs, in which they believe it has the potency to better and advances the quality of medical attention. It besides has become a end of the U.S. disposal at the clip. They go on: ‘According to the National Ambulatory Medical Care Survey, merely an norm of 17.6 % of doctors reported usage of EMRs in their office-based patterns. The acceptance rate did non increase from 2001-2003.
Practices with more doctors and those owned by wellness care organisations ( HMOs ) were significantly more likely to utilize this engineering, but use varied small by the features of single doctors, the pattern ‘s range of services or the pattern ‘s beginnings of gross ‘ .
Many IT writers have commented on the issue of EHR systems and their execution. Walsh ( 2004 ) , mentioning to the UK health care system indicated, ‘the clinical serviceability of electronic records systems is peculiarly relevant with the recent assignment of service suppliers to implement the National Integrated Care Record Service for the NHS as serviceability besides affects patient attention ‘ . On the issue of serviceability, Zitner ( 2006 ) had this to state, ‘Usability concerns whether an information system is structured so that users can acquire an reply to suit their intent ‘ . Laerum et Al. ( 2003 ) remarks have direct application to the state of affairs in Bahrain: ‘The effects of presenting an EHR system and taking the paper-based EHR might depend on the size of the infirmary, nature of work at the section, functionality in the EHR system introduced and readiness, ability and willingness of the infirmary organisation to accommodate to the alterations introduced ‘ .
Development of electronically linked patient records or Electronic Health Record schemes ( EHRs ) is a precedence for authoritiess in many states, including Australia, as portion of a vision for future wellness attention services utilizing call centres, web-based patient information and telehealth. [ 15 ]
Questionnaires were distributed to doctors in SMC and assorted HCs in Bahrain. That was conducted by 2 ways ; by e-mailing the electronic nexus of the questionnaire to those doctors to be solved on-line on Google physician and besides by personal meeting and managing the difficult transcript for immediate response. The information analysis and reading was carried out on the footing of the information provided. The questionnaire addressed several issues, in the format of the closed-end in different types ; multiple pick, dichotomous, Likert graduated table every bit good as evaluation graduated table. by of both graduated graduated table inquiries and open-ended inquiries. Participants will be encouraged to talk freely about the thought and supply input about their attitude sing the possible execution of an EHR system and other specific countries like barriers to execution and their possible function in such a system.