Question

C. ong1 d. personal health records. Short Answer: Briefly respond to each quest 0 16. Compare and contrast the advantages 17. Outline the steps that should be taken to 18. Discuss how health information professionals and disadvantages of paper and automated rec systems. ord prepare documents for scanning. can contribute to the transition to electronic record systems. mation exchange on the quality of patient care applications. 19. Summarize the impact of electronic health infor- 20. List and discuss three electronic clinical

Answer 1

Paper Records

Pros:

The biggest pro to using paper is that you can start with it practically for free. Create or purchase a paperwork packet, buy some paper and a few file folders and you're set to go. Very little ongoing cost... although you do need to ensure you have a cabinet to lock all files.

Another pro to using paper is that you can customize and change your forms at will, without worrying about requirements or limitations of an EHR. You can include a logo/branding to make them look nice and delete or add as many sections as you like.

The third pro with paper is that some people really do have more of a connection with writing something. Also, if you do a lot of worksheets, artwork, etc. with clients in session it is very easy to throw those papers in a file, rather than scanning and uploading everything you want in the client record.

Lastly, most people are familiar with paper. It is easy to set up and you don't have to learn anything new to get started.

Cons:

The biggest con with paper records is simply that you have to physically store them for so long! Most of us keep records for seven years (or longer, if you see children/teens) and it's really difficult to tell whether or not you plan to move at all in the next seven years. This can also make things difficult to track after multiple moves.

Related to storage is the fact that things can get lost. With paper records, you're really putting all your eggs in one basket and it's very easy to lose things once you start keeping multiple files.

Another harsh reality is that files can be destroyed or stolen. I know people whose offices have flooded from a leaky sink not caught over the weekend, people whose offices completely burned down in a fire and people whose computer and other equipment was stolen. These things really do happen and it's unfortunate to lose so much information so easily.

Lastly, many people simply write much more slowly than they type. Using paper records can be more time-consuming than using a computer to complete paperwork. This applies to both your clients as well as yourself and any employees/associates. In some ways, sharing documents can be easier with paper but it can also be more difficult if you need to fax or scan things that would've otherwise already been uploaded electronically.

The In Between

So... what if you want to type your notes on a computer, but not use a cloud-based system? Perhaps this seems like the easiest solution. The main benefits here are that you likely already have a computer for work, you won't have to lug around a bunch of files or have an ugly cabinet in your office, and you also won't have to pay for a monthly subscription to keep records.

However, most of the cons with paper still apply here. Your computer is probably the most likely item to ever be stolen and with this method you're likely putting all your eggs in that one basket. So, if anything happens to your computer (and even us Mac users have heard horror stories of people losing everything based on a glitch or a misplaced cup of coffee), well, you're screwed.

Electronic Records

Before we go over any pros and cons with electronic records, it's important to note that while there are some great EHR's out there, no system is perfect and no system will have everything set up exactly the way you want. With that in mind, let's look at what the general pros and cons include...

Pros:

Probably the biggest pro of using an EHR for your private practice is that all your records are easily housed in one place. You simply log in and voila, everything you need! If you have internet access, then you can access your full client records from any location. Many EHR systems even have apps so you can write a quick note from your phone.

Another huge pro is that having your records in an EHR will likely provide the safest records storage available. While we're all concerned about hackers, and that is certainly something to keep in mind, a good EHR will provide excellent security. This security will be far beyond what you could create for yourself, either using paper or keeping notes housed on your computer.

And because you have easy access to safe storage, many EHR's will safely store credit card numbers for your clients. Roy Huggins has a great article (click here to read) discussing the reasons you probably don't want to collect your client's credit card numbers yourself. Having them write their credit card information on a form you keep is very unsecure. But if you use an EHR that has this set up through a merchant account, they are ensuring the security is up to date and you can ensure you'll be paid.

If you contract with insurance companies, an EHR can save you tons of time because they typically include billing. While that doesn't mean they're going to call to check eligibility or follow up on rejected claims, they will often submit your claims electronically as soon as you enter the necessary data. Again, everything you need in one place. And if you provide clients with a super bill, most EHR's will print out a nice one for your clients based on the sessions you've entered.

Lastly, another benefit to using an EHR is that many offer client portals. This means your clients can log in to complete and upload paperwork before appointments, and even interact with you securely. This can save worry about email communication or clients forgetting to bring in needed paperwork.

Cons:

The most obvious con with using an EHR is the cost. While most are actually providing an exceptional service for the price, it can still be a stretch if you're just starting out and only have a few clients. This is where it's really important to think through all your expenses and also, your long-term goals. Using an EHR is probably one of the best investments you can make for a therapy practice... but if the money's not there, then it's just not there.

Another con is that despite your best efforts and our tech society, there is still a lot of paper going around. This means you are likely to end up scanning documents every once in a while. For some, this may be just a couple pages a year but for others (and depending on your particular EHR set up) it could mean LOTS of scanning. Consider your clientele- do you tend to work with people who often have reports or require lots of communication with other providers? If so, you'll want to consider a more robust system that allows clients to upload documents. Also, if you have an assistant, this may not be such a big deal.

Lastly, another con with EHR's is that some offer limited ability to customize your documentation. You know this is a big one for me because I believe that you should personalize your paperwork to your client's needs as much as possible. Some EHR's do allow you to create your own templates, some don't, and some charge extra for this feature. This is where shopping around and trying things out ahead of time is crucial. The last thing you want is to get everything set up and then realize the notes or treatment plans are a total pain to work with!

Some Cons to All Methods

One mistake I've seen over and over applies to all records, paper or electronic. That's putting something in the wrong client file. I've seen people physically put the wrong note, release form, etc. in a paper file and I've also seen people accidentally type a note in the wrong client's file within an EHR. Some people have never made this mistake, some people have done it multiple times. Obviously, the key here is to make sure you're taking time to be mindful of what you're doing when writing notes.

An EHR can save you lots of time and headache, but it can't think for you. So regardless of which method you use, make sure that documentation isn't an afterthought. Instead, let's make it a meaningful part of your practice.

Electronic medical records (EMRs) have had a positive effect on patient care and the work lives of family physicians.

Over the past few decades our medical knowledge has increased. More investigative and treatment options are available; as a result our patients are living longer and we are dealing with more chronic conditions. Family physicians cannot “know all things” nor can we be “all things to all patients.” To adequately address our patients’ complex needs, we need good sources of information and good relationships, including access to a multidisciplinary team of professionals and other specialists. We need tools that improve access to information and relationships. We have had to transform how we practise, and the EMR, with its associated information technology, has facilitated that transformation. It is no longer the early adopters or innovators who are using the EMR, as 75% of physicians responding to the 2014 National Physician Survey were using EMRs.¹ Of those, 65% indicated that patient care improved and less than 5% indicated a negative effect on the quality of care they provided.¹ However, there are still a few laggards who will argue against using EMRs. They will argue that there is no evidence EMRs have a positive effect on the health of their patients, or that implementing EMRs in their practices will reduce efficiency and negatively affect their patient flow.

Public health depends on a robust information base to carry out its primary tasks of assessment, policy development and assurance.1 Reliable, timely data are needed perhaps most evidently in response to infectious disease and other acute events. Historically, public health surveillance has relied on telephone and mail, and more recently online, completion of notifiable disease reports and access to electronic laboratory reporting (ELR). However, several new types of health information technology (HIT) may play an important role in support of public health in the near future, including: electronic health records (EHRs), personal health records (PHR), health information exchange (HIE), clinical decision support (CDS), and Big Data analytics. Each technology has potential benefits, as well as significant barriers to use.

This HIT is seen as central to achieving the “Triple Aim” of health-care reform: “improving the individual experience of care; improving the health of populations; and reducing the per capita costs of care for populations.”2 Ready access to data at the point of care supports clinical decision making that benefits the individual patient, and that same access to data is required to support agencies making decisions that have an impact on the health of populations. For example, public health could quickly assess the completeness of immunizations, understand which populations remain underimmunized, initiate action to understand the reasons, and take action targeted at clinical care systems, physicians, or patients as the need requires.3

Similarly, the availability of electronic clinical information on cases and their management will greatly enhance the ability to improve the quality of traditional public health services. While most communicable disease services are currently provided outside of public health clinics, public health remains responsible for investigation, contact tracing and management, relying on laboratory and passive physician reporting to assure cases are referred. More efficient and more rapid transmission of medical data can lead to more rapid identification of patients, simplify identification of clusters, facilitate contact tracing and patient or professional education and other initiatives. The data can be used to identify gaps in quality of care, such as failure to follow recommended guidelines or inadequate follow up and treatment.

The advent of widely available electronic health information and Big Data, the massive amount of data produced each day, also provides new opportunities to understand social interactions, environmental and social determinants of health and the impact of those environments on individuals. The powerful analytic tools that have been applied to marketing and other fields are not commonly present in public health departments, but implementing them has the potential to fundamentally change surveillance and other systems. By the same token, technology puts information into the hands of users who can use it to drive community change. Making data readily available – with appropriate protections, of course – can empower stakeholders in ways that one can now only imagine.