Health Record in Ambulatory Care

By: Danielle Smith

Switching to EHRs:
Many health care systems are making the switch from paper health
records to electronic medical records. Electronic medical records (EHRs) are
rapidly increasing use in many types of health care facilities. There is
evidence to support the switch to EHRs in Ambulatory care centers. EHRs
Making the switch could allow more frequent, rapid communication
about patient care and treatment. There is proof that the use of EHRs assist
to improve quality and efficiency in the care provided to patients. As with
any new type of program there are also drawbacks to the switch. Studies
have found these drawbacks are limited and support the switch to electronic
record keeping.
Benefits:
Documenting patient information electronically can provide many
benefits to physicians in ambulatory care programs. It allows for ease in
patient care by allowing prescribing of medications, viewing imaging and
laboratory results, tracking clinical notes, and reviewing patient history and
physical information. For patients, having this information readily available
when visiting patients helps to shorten the amount of time documenting
details and allowing more physician-patient face time. Physicians are able to
view previous diagnosis and treatment plans and make informed decisions
about current and future care for their patients.

The result of data and information regarding patient health not being
readily available is poor clinical decision making. Poor clinical decision
making is what leads to lawsuits for malpractice. One study examined the
ambulatory care services before and after introduction of EHRs and found
significant improvements in patient care. They found a decreased use of
primary services and decreases in the amount of visits per patient during the
year. The ultimate finding from this study was increase in efficiency of
outpatient care in ambulatory settings after implementing the use of EHRs.
Studies have also found the implementation of EHRs has increased the
workflow of physicians. Physicians spend less time writing things down which
allows for increased amounts of face time with patients, also allowing more
time for more patients visits daily. With the increase in the amount of face
time spent with patients, physicians are able to do the work they became
physicians for, to provide healthcare to patients.
Other studies have found that making the switch lead to a decrease in
the amount of documentation errors. Errors with health records can happen
when the person transcribing the doctors notes is unable to read the doctors
writing or misses something that is of significant importance. With electronic
records a great deal of paperwork is scanned into the system, this benefit
allows transcribers to look at the paperwork and check the information in the
system with the actual information, such as insurance cards. One number
entered incorrectly can lead to the practice not being paid for services. With

the information scanned into the system billers can easily look at the
scanned document and correct the error.
Incentives:
The United States government is investing billions of dollars to offer as
incentives to providers to switch to EHRs. One program that has come about
as an incentive is the meaningful use program. This program was started in
2009 as a standard for which EHRs must meet in order to be useful to health
care practices. Meaningful use program is a program that provides incentives
to ambulatory care facilities to adapt EHRs into their programs. Meaningful
use programs also allow for tracking and reporting of health data to improve
patient outcomes. Studies have found that the reason many practices dont
want to make the change to EHRs is because it is costly. As with any new
program implemented in health care there is a financial aspect that must be
met, the meaningful use program will help with financing in return of high
quality health reporting.
After making the switch it was found that providers made the most of
their EHR program and used many of the functions provided in the early
stages. In 2012 only about 40% of ambulatory care centers used full
functionality of the EHRs. It is a requirement by the federal government that
when providers receive incentives from the meaningful program that they
must report on the use and functions of their system. This could be the
reason for decrease after prolonged use EHRs in some practices.

Drawbacks:
One of the problems with EHRs in the ambulatory care system is that
in most facilities they do not incorporate all the functions provided. Many
practices are still in the beginning stages of EHRs and still learning all the
functions. This could be a reason not all practices are making full use.
Another downfall to using the EHRs is that many practices have had to make
other changes to incorporate the use. They have had to make adjustments to
their schedules because of the decrease in the amount of time spent
documenting they are able to see more patients. This leads to having a
busier more structured day than some may have been use to, so many
providers feel they are rushing patients and not providing the best care
possible.
Many providers feel that the younger generations of doctors are not as
medically trained as doctors once were. They feel that these younger doctors
rely more on computers than their own health knowledge and that they lack
the education that patients have come to expect.
Conclusion:
As with any new program introduced to the healthcare system there
are going to be positives and negatives. The important part is to find what
works best for each practice. EHRs are still new and rapidly changing along
with other technology and medicine in general. There are researchers
everywhere putting this new technology and new medications and new forms

of treatment to the test. Eventually all these improvements will not only
provide benefits to the medical practices but also to the patients they serve.

References:
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Kaushal, R. (2015). Associations between healthcare quality and use of
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MHS, Volk, L. A., MHS, Burdick, E., MS, Tripahti, M., PhD, & Simon, S. R.,
MD MSH. (2009). Imminent adopters of electronic health records in
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Kern. L. M., MD MPH, Barron, Y., MS, Dhopeshwarker, R. V., MPH, Edwards, A.,
MStat, & Kaushal, R., MD MPH. (2012) Electronic Health Records and
Ambulatory Quality of Care. JGIM, 28, 496-503.

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