EHR systems – electronic health records explained

EHR systems meaning electronic health record (EHR) systems are solutions that combine electronic patient records (EPR) about a person’s medical history and treatment with other patient details, such as demographics and psychographics but also associated medical history for things such as vaccinations, allergies, and – for private healthcare – billing information.

These records are kept digitally; on a local server within the healthcare setting, by the solution provider, or in a cloud-based database that is accessible remotely. The intention is that the maintenance of and access to these patient records is much easier for clinicians and other staff.

In this article I’ll explore the EHR management system, its role in healthcare, the benefits, disadvantages, and the implementation process within the hospital setting, before wrapping up with a cost analysis of the onboarding of electronic health records. After reading the article you will better appreciate the importance of choosing the right solution for the best care.

EHR software systems are important to healthcare. A key administrative function of EHR systems is to provide much needed oversight; compiling information from other solutions to see a bigger picture of hospital care management.

EHR systems examples include the most common – an acute care EHR system – as well as EHR systems for behavioural health and EHR systems for mental health providers.

Evaluating EHR systems leads us to categorise them into three groups:

1. Contract
2. Data location
3. Operational quality

The first point is whether or not an EHR system is based on the care provider’s premises or is SaaS – software as a service. The former is typically an upfront purchase with no subscription, while the alternative is a cheaper purchase on a subscription model with varying degrees of live support from the software provider’s own developers. Custom options are also available in niche cases but software integration and APIs typically negate the need for these explicitly bespoke options.

This brings us onto data location. Do the healthcare providers want their data stored on-site for their EHR, do they want it held remotely on dedicated servers, or do they want it to be cloud-based. Physically on their own site brings it under their own security and control, but poses a risk should anything happen to the location.

Remote holdings elsewhere negate this but lack the physical security and require reliable internet connection, and cloud-based removes the need for a physical holding and allows greater access by staff – but is also subject to reliable internet connection for both data transmission and the hosting itself, with data in virtual folders and not on a hard drive.

Finally is the operational quality or capability of a system. Certified EHRs – as approved by NHS Digital and others – are the best placed to meet the official expectations set out for modern healthcare in the UK. Similar expectations will be held in other nations no doubt, but to what degree is important.

Healthcare is expensive, and a smaller, cheaper standalone option with less integration but more multipurpose functionality could be a better fit for a new or small provider. Multipurpose can go further, combining electronic patient records (EPR) and electronic patient management (EPM) with the electronic health records (EHR) for a unified, easier to adopt system.

There are plenty of EHR system benefits, else why would hospitals and other healthcare providers utilise them. There are three main areas that benefit from EHRs:

• Communication
• Error reduction
• Security and Data Protection

Communication is easy enough to expand upon: EHR systems can integrate with other healthcare management tools, such as electronic patient management tools, patient flow tools, medication management… and so on. This integration and cooperation means quicker transmission of information, and that communication is saving vital time for clinicians and patients.

That then leads into the error reduction benefit. By having cloud-based EHR systems you are storing patient data externally. This remote storage enables a greater range of access from staff, meaning there’s less duplication of records because everyone can operate from one core file pertaining to the individual receiving care.

Cloud-based EHR systems also help with security and data protection. Paper records are vulnerable as physical items; to theft and to environmental damage (water, fire, tearing). Digitising records keeps them out of sight and out of mind in that sense, but also allows for things such as password protection, Role Based Access, and access monitoring to ensure access to information is being done so appropriately at all times.

Given the common usage of EHR systems, there aren’t that many disadvantages of onboarding such software solutions. A better phrasing would perhaps be that these are the challenges or drawbacks faced when implementing an EHR management system.

There are four challenges facing EHR systems being established:

• Finance
• Productivity and Workflow
• Privacy
• Knock-on effect

Finance

It costs to buy software and to maintain data. Hospital management will have to budget in the cost of a solution, which might make the decision for them about whether to buy outright or pay subscription. Maintenance costs also fall into this bracket (which is why SaaS/subscription is most popular) and issues with productivity reducing efficiency for providers and earnings for private providers specifically.

Productivity and Workflow

It takes time to learn new software. A good provider will support the buyer and their staff in doing this – something we do here at The Access Group – but that is still time being spent on learning to use the tool and not using the tool for the purpose of care, thus hitting productivity. Workflow follows on from this impact, with changes to the workflow of information now that records are entirely digitised. It’s beneficial to go digital, but there will be little improvement in the speed of documentation and document processing at first whilst staff understand which channels to use to save or transfer data.

Privacy

Safeguards are present in practically all healthcare software solutions, in order to properly protect patient data and other information that has an expectation of privacy. The concern here tags on with the learning process though; that somebody might unintentionally share data through a channel, or to a destination, that they did not intend to or were not permitted to. Malicious intent isn’t the concern here, but an accidental data breach is still a data breach.

Knock-on effect

This is a somewhat loose fourth point, reminding people that there are consequences of implementing new solutions. Data errors are the obvious one, as clinicians and administrators come to terms with new software. There may also be other changes though. Staff satisfaction or confidence might be hit by a new solution meaning new strain upon them, even if it is a longer term benefit. There may then be a dependence or overdependence on technology, which can be problematic. Staff may see a change in the operational structure in terms of permissions for performing tasks, tests, making requests… all because the EHR has a say too. These may be small impacts, they may be major for a time, but they still need looking out for and tackling before they become a larger problem.

There is no such thing as the best EHR system, instead when doing research about the best EHR systems for hospitals it’s important to research thoroughly about what they offer and what it is you, the hospital or healthcare provider, need from them.

There are many big name EMR or EHR systems out there:

• EMIS Health
• Access Rio EPR
• SystmOne
• iSOFT
• Epic Systems Corporation
• Oracle Cerner
• INPS Vision

This is just to name a few operating in the UK and USA. The important thing when looking is to know in advance of the functional requirements for your EHR system; do you need interoperability? Do you need certified EHR systems? Is this for acute, community, or mental health services? Will you need to scale up for greater capacity in future? What solutions do you already have? EPRs are only slightly different from an EHR, so perhaps electronic patient records are more what you need than getting a solution with any extra functionality that might be wasted.

There are many different providers out there with excellent solutions available, and for those organisations in the UK you can browse the NHS England accredited supplier list – established in conjunction with NHS Digital.

The Access Group (and acquisition Servelec) are listed thanks to multiple accreditations. We are a Framework Agreement Supplier in the digital alarm and intelligent monitoring categories with our Access Assure solution. Access Care and Clinical (AC&C) is also accredited, as is our ACP for digital care records.

So, how much do EHR systems cost? According to HealthAffairs research, “the typical multi-physician practice will spend roughly $162,000 to implement an EHR, with $85,000 going toward first-year maintenance costs”. This equates to an estimate of £130,100 on implementation and £67,000 on maintenance. SoftwarePath also offers input, stating figures of $1,200 [£948] per user per year for running an EHR/EPR solution.

These aren’t definitive costs though. It is important to compare EHR systems and speak to solution providers to better understand a product, build relationships, and negotiate the best deal for your healthcare organisation.

With the NHS setting aside £2 billion to support electronic patient records or electronic health records being established within trusts, it’s important that trusts and hospitals get the best value for money possible to allow nationwide digitisation.

With this in mind, an EHR systems cost comparison is a wise exercise. By researching the market, speaking to providers, and building up a comprehensive list of who can offer what and how much for you can build up a clear picture of the market. This gives you as a healthcare organisation the best chance at getting value for money.

EHR system selection is a balancing act between cost and performance however; it may be worth paying more for extra functionality or interoperability, so the key is to compare EHR systems. Diligent research will instruct you whether you need a big solution or perhaps a more modular tool to fit existing products.