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Example research essay topic: Medical Records Family Physicians - 2,164 words

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The Internet Age Influence on Electronic Medical Records The Internet has affected many industries around the globe, and its effects are ever growing. Medicine is no exception from this paradigm; various aspects of medical practice have been affected by the World Wide Web. One of the most heated controversies in the medical field now is Electronic Medical Records; this issue has triggered an array of contradicting responses from various experts. Within the scope of this research, we will elaborate on the Electronic Medical records issue. The first attempts to establish the electronic health patient record (EPHR or EMR) were initiated in the 1960 s and continued into the 1970 s and 1980 s. In 1991, the Institute of Medicine published a paper titled "The Future Computer-Based Patient Record, " which declared the EPHR as an essential technological tool and also predicted the widespread use of computer-based patient records by 2002.

EPHR can be defined as a "unified, secure solution for a platform and institution independent longitudinal electronic health record. " (Clayton, p. 355) In other words, a record that would document all of the health care interventions in a person's life starting with neonatal events and ending with his or her post-mortem. There are five distinct stages toward the development of the true EPHR. The first stage is the Automated Medical Record, which only about 5 % of institutions and physicians' practices have in place. (Graham, G. , Nugent, L. , Strouse, K, p. 20) This initial stage uses computers, but continues to rely on paper records as well for documentation. This is the first step toward the ultimate goal and is a necessary developmental stage. The second stage is called the Computerized Medical Record (CMR) stage, which totally eliminates the need for paper. At this level, the data is scanned into the system which preserves data integrity features.

Some U. S. hospitals have entered this level with mixed success. The third stage is the Electronic Medical Record (EMR), which would be a true enterprise wide application and would allow accessing of all patient information available within the enterprise. The EMR would allow the computer to record the complaints of the patient and would help in the diagnostic process as well as developing a plan of care and the placement of orders. This stage is provider-oriented.

The fourth stage is called the Electronic Patient Record and would be all that the third stage is, but also offer multi-provider links (community based, regional, national and international). This stage of development requires a unique national and international patient, provider and payer identification system as well as the infrastructure and technology for this interchange of information. The fifth and ultimate stage is referred to as the Electronic Patient Health Record (EPHR) and is the goal of all of the other stages. The EPHR makes the patient the center of the process by involving him or her in all aspects of data entry, as well as through the inclusion of data which is not necessarily health-related (such as the person's banking information, etc. ). The creation of the electronic patient record or the electronic health record was a journey without a definite end and was not a question of finding the right vendor as much as it was catching sight of the vision. (Kara, p. 141) The overall message is that the physician -- or even the somewhat less-expensive but still costly nurse -- should not be the ones to enter a lot of the information. It was stated in numerous lectures that patients should enter much of their own data.

The patient was deemed capable of being the best source of his or her history and chief medical complaint, at the very least. It is clear that the industry will receive encouragement as needed to continue to develop the electronic patient record. Both EMR users and nonusers believe current Emr's are too costly. The data suggests that family physicians are willing to pay a relatively low set-up charge <$ 5000 would be accepted by more than 87 % of respondents) and a very low monthly fee (<$ 100 would be accepted by more than 81 % of respondents) for the use of an EMR. (Wickramasinghe, N. , Mills, Gail L, p. 67) Few current Emr's can be installed and operated within these price specifications. This supports the previously published view that physicians believe current Emr's are not cost effective. (Wickramasinghe, N. , Mills, Gail L, p. 69) Lower prices or greater perceived value is needed for physicians to consider Emr's a wise business choice. Data entry is a concern for both users and nonusers.

Practicing family medicine requires varied skills, a fast pace, treating patients from multiple age groups, diagnosing conditions from a myriad of potentially unrelated complaints, and keeping a comprehensive record from multiple sources. These factors make data entry the largest potential obstacle to the effective use of computers in family medicine. (Wickramasinghe, N. , Mills, Gail L, p. 84) Only 55 % of users and 13. 4 % of nonusers believe data entry is easy for current Emr's. (Wickramasinghe, N. , Mills, Gail L, p. 93) Perceived and actual ease of data entry must be improved before widespread adoption of Emr's by family physicians can be realized. Concerns about security and confidentiality generated the largest number of written comments. Despite evidence to the contrary, nonusers believe that there are more security and confidentiality risks involved with Emr's than paper records. A small group emphatically expressed dismay at the possibility of subjecting their office to a "Big Brother"-type system. (Wickramasinghe, N. , Mills, Gail L, p. 117) The Health Insurance Portability and Accountability Act (HIPAA) sets the standards for medical record (electronic and written) confidentiality and security, and the creation of an EMR that is HIPAA compliant may give providers greater confidence in its security and confidentiality. (Wickramasinghe, N. , Mills, Gail L, p. 144) Educating physicians about the security and confidentiality risks of paper records and the safeguards built into EMR programs may help alleviate these concerns. Despite the low penetration of Emr's, family physicians are interested in using Emr's.

Most users (85. 4 %) and nonusers (76. 2 %) expressed interest in a system that would securely connect all physician practices, laboratories, radiography facilities, and hospitals in their area for exchanging patient data. Many family physicians are currently using the Internet (67 %), e-mail (53 %), computers (93 %), and PDAs (30 %) in their practice. (Wickramasinghe, N. , Mills, Gail L, p. 169) Despite this expressed interest, only two thirds of nonusers believe that physicians should computerize their medical records. This may be related to the fact that only half of the responding nonusers perceive that current Emr's are useful for physicians. There was also a considerable lack of belief that Emr's will improve quality or reduce medical errors. Replies to the open-ended question indicated that 5 % to 10 % of respondents, for a variety of reasons, have strong feelings about computerizing their offices. (Wickramasinghe, N. , Mills, Gail L, p. 212) A targeted, educational effort to show the advantages of Emr's may be useful for improving physician perceptions of Emr's. The demographic profile of the nonusers may indicate that current Emr's are not perceived as being well adapted for use in rural, solo, or small-group practice.

Emr's may be thought of as more feasible for larger organizations with larger capital budgets and robust information technology support systems. The differences in the volume of patients treated between users and nonusers suggest that productivity concerns may also be important. It is encouraging that both users and nonusers seem to understand the potential usefulness of Emr's. Over half of the nonusers believe an EMR is a useful way to provide patient education materials, participate in clinical and health services research, launch a literature search, or obtain up-to-date treatment guidelines. To increase the number of physicians using Emr's, vendors should maximize and promote the use of EMR features. The vendors and medical community are expected to progress along the continuum, but it also is certain that HIPAA will do much to move the effort of the EPHR forward.

Vendors that already are moving with the direction offered by HIPAA are ahead of the game, while those that have waited to respond until the legislation is in place will be playing catch-up. In spite of the emphasis of the HIPAA legislation, it is clear that the aspects that HIPAA addresses are necessary to the goal of the electronic patient and health records. Even at present stages of development, the electronic patient record could offer substantial benefits to all participants: On-line eligibility of patients. Co-pay determination.

Pre-authorizations. Pre-edit of transactions. Easy re-submission. Prompt payments. Electronic fund transfers. Reduction of retrospective denials. (Huff, p. 114) One of the most interesting of the free-form, capture, transcribe, scan and store approaches towards electronic health patient record system was exhibited by Advanced Imaging Concepts (AIC; Louisville, Kentucky) in its Impact MD product.

Its approach to automating patient care is to transparently automate the back office records storage of the physician's practice, whether the doctors change their front-end practice method or not. AIC and the companies that embed its products in theirs have done this quite well. The approach is simple: Give doctors what they want. As one doctor / user put it, "We don't have to file papers; we don't have to spend money on space to store paper charts anymore.

We just scan it into the system and it's there. It's at our fingertips when we want it. " (Van Ginneken, p. 121) The scanning approach to medical records storage and management, when well done, overcomes the fears of many doctors about Ephr's. It is cost-effective. It is controllable. It doesn't require a lot of training and can be done with existing office staff. It does provide rapid access to patient records, and it can allow physicians to continue to work in the manner they are accustomed to (with paper) as they gradually adopt a direct, electronic methodology to collecting patient information.

The AIC approach accommodates early adopters of electronic records, as well as the late and reluctant adopters, who hold onto the paper record until they die, retire or feel uncomfortable being among the last adopters of a new paradigm. (Graham, G. , Nugent, L. , Strouse, K, p. 22) As such, AIC is a nearly perfect solution to half of the medical records problem in physician offices -- it fixes the back-office records storage and retrieval problems. But it ignores the other important part -- mining the rich data content of patient medical records and using it to modify the paradigm of care delivered at the point of care. Yet it is these front office point-of-care encounters where medication errors are caught, where charting to support billing is needed, and generally where changes are needed to raise the bar, so that treating sickness can be transformed into "health" care. (Huff, p. 129) To make this transformation the data resident in the patient's chart, no matter how it is stored, managed and retrieved, is required, and that is the next challenge for systems like AIC's and others that embrace the scanning approach. What remains for AIC and others is how to mine data contained in its optical images. This will involve at least two steps: First, converting these images into a character-based, codifiable format, and second, indexing and cataloging such free-form data into medical concepts and frameworks that are unambiguously searchable.

Neither of these tasks will be easy to solve. AIC seems poised to bite off the optical character recognition step next. This step will add a step into the medical records back-office process, however, requiring more time that will in turn reduce the cost-effectiveness of the solution somewhat. Even when this has been successfully accomplished, the matter of resolving essentially free-form information into viable medical concepts will remain. Scanning also has a place as an adjunct to the optimization of the physician practice front office.

Card Scanning Solutions (Las Vegas, Nevada) makes a contribution with its Medic Scan products. This is a scanner and companion software that allows the practice to scan a patient's insurance card and optimizes the process of getting it into the chart and making it accessible. (Van Ginneken, p. 140) Once attached to the USB port of any Windows-compatible PC, the scanner senses the insertion of an insurance card, capturing the front and back sides of the card in a few seconds and converting it into a predefined, compressed image that is automatically routed to the windows desktop or to a patient's record (optional software) for inclusion in the chart. Additional data can be annotated to this record to facilitate retrieval. This optimizes the initial capture of insurance information and facilitates expedited validation of that information on each subsequent patient visit. Finally, to automate the completion of the patient form for each encounter, there are a variety of mechanisms, ranging from patient-carried, ...


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Research essay sample on Medical Records Family Physicians

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