1.0 Name of the system
Electronic Medical Record (Clinic)
2.0 Summary
Although the technology is kept on advancing from day to day, there are some clinics that are still using old method in handling their records. Piles of files in registry counter sometimes make the place looks messy and it takes a large space to store all the records of their patients. Sometimes, they cannot find a record due to misplace and the records might be lost. Each time they want to retrieve the records, they have to find based on the series number which sometimes the file is placed not according to the series number. This process will take more time than it should be. There are some clinics that are already implementing an electronic medical record and it gives positive impacts to their record management. Other than reduce time in retrieval the records of patients, the system also help to manage all the records efficiently. Besides that, by using this kind of system, the use of large space can be reduced. Same goes to the cost, the organization (clinic) can save more in terms of stationary and they do not have to hire many workers to manage their records.
Electronic Medical Record (EMR) provides convenient access to the staff of the clinic. It also provides quick access to patients’ information each time staff wants to retrieve the data. Other than that, the system could help in solving record movement problems and at the same time improve the quality of the process. In terms of security, using the EMR is more secured compared to manual system as it can be restricted to certain user for example to medical officer and receptionist. The user needs to login into the system so that it can be easily monitored and identified who uses the system. As for the b...
... middle of paper ...
...This is necessary to help record a medical workers to work more effectively and efficiently for better service and also to improved results management and patient care with a reduction in errors within your medical practice.
It also can improve their accuracy of diagnoses and health outcomes and improve care coordination through the efficiencies of practices.
7.0 Flowchart of the process
Works Cited
Ragavan, V. (2012, August 27). Medical Records Pals Malaysia : 17 Posibble Reasons How Electronic Medical Records (EMR) Might Support Day-to-Day Patient Care. Retrieved from Medical Records Pals Malaysia: http://mrpalsmy.wordpress.com/category/emr/
Systematic Conglomerate Sdn. Bhd. (2013, June). Malaysia Hospital Information System: MYHIS. Retrieved from Malaysia Hospital Information System: http://www.sc.net.my/v2/sc/downloads/myhis_pamplet.pdf
Also, these studies question those who are effected; in this case, those who are most effected, is everyone. Doctors and nurses spend the most time working within these systems, but the information that is put into these systems effects every individual in America, because it is their information. Because nurses are often considered “both coordinators and providers of patient care” and they “attend to the whole patient,” their opinion is highly regarded (Otieno, Toyama, Asonuma, Kanai-Pak, & Naitoh, 2007, p. 210). It is clear that the use of these new systems is much debated, and many people have their own, individualized opinion. This information suggests that when there is a problem in the medical field, those who address it attempt to gather opinions from everyone who is involved before proceeding. It has been proven by multiple studies that this system of record keeping does in fact have potential to significantly improve patient health through efficiency, and it is because of this that the majority of hospitals have already completed, or begun the transfer from paperless to electronic (Otieno, Toyama, Asonuma, Kanai-Pak, & Naitoh,
For years now, the healthcare system in the United States have managed patient’s health records through paper charting, this has since changed for the better with the introduction of an electronic medical record (EMR) system. This type of system has helped healthcare providers, hospitals and other ambulatory institutions extract data from a patient’s chart to help expedite clinical diagnosis and providing necessary care. Although this form of technology shows great promise, studies have shown that this system is just a foundation to the next evolution of health technology. The transformation of EMR to electronic heath record system (EHR) is the ultimate goal of the federal government.
The purpose of this paper is to discuss how Electronic Medical Records (EMR), affects healthcare delivery. I will discuss the positives and negatives this issue has on healthcare and how it effects the cost and quality for healthcare services. In addition, I will identify any potential trade-offs to cost or quality. Lastly, I will discuss how the EMR affects my job as well as any challenges or opportunities this issue presents.
...nce an incident that may not be seen as such by staff working in the same environment but, if the staffs have frequently witness that the same incident occur; they may stop reporting the incident. However, database application system can save charting time which could be utilized to provide care to residents. Administration function like medical records, risk assessments, daily reports and coding requires documentations from the service users` electronic medical record database to enhance the EHR, which link the EHR data with databases containing standardized assessment information from external healthcare systems. If the database is not similar as to what other healthcare systems use, it is impossible to share information from EHR database with other clinical application systems.
This article addresses major aspects such as clinical trial, integrated decision support and guidance, inadequacy of paper record, and data entry. The reason that paper records are not a match for modern medicine is that they are not accessible buy multiple health professionals causing a delay in response to health care, confidentiality and security is a risk granted that anyone could physically change the record and it would become official. The author of this article predicted the basic electronic medical record features that are available today, back in 1999 and the features include integrated clinical workstations with the computational power that can assist with clinical matters, financial and administrative topics, research, and scholarly information. This report indicates that having electronic records can provide efficiency throughout the system of health care for instance the example presented in this article was the process of admission, discharge and transfer of a patient can be changed drastically due to it initially taking hours to going from in and out in minutes. This article will provide the foundation of EMR’s and how time for reform had come more than a decade ago and it’s time for reform once again. With the examples and strategic tactics provided, it is fairly simple to display the evolution of Electronic medical records from
An electronic health record (EHR), or electronic medical record (EMR), refers to the systematized collection of patient and population electronically-stored health information in a digital format. It details medical problems, medications, vital signs, patient history, immunizations, laboratory data and radiology reports, progress notes .These records can be shared across different health care settings. It resides on an enterprise information systems and is exchanged via electronic networks.EHRs may include a range of data, including demographics, medical history, medication and allergies, immunization status, laboratory test results, radiology images, vital signs, personal statistics like age and weight, and billing information.why is it needed? It seeks to be a complete record of a patient that can follow him/her from setting to setting increasing knowledge and consistency. It allows providers to obtain a complete picture of a patient and allows firms to automate and streamline workflows. It could improve patient and financial outcomes via evidence-based decisions, quality management, data mining, tracking, and reporting.
This paper will identify the use of Electronic Health Records and how nursing plays an important role. Emerging in the early 2000’s, utilizing Electronic Health Records have quickly become a part of normal practice. An EHR could help prevent dangerous medical mistakes, decrease in medical costs, and an overall improvement in medical care. Patients are often taking multiple medications, forget to mention important procedures/diagnoses to providers, and at times fail to follow up with providers. Maintaining an EHR could help tack data, identify patients who are due for preventative screenings and visits, monitor VS, & improve overall quality of care in a practice. Nurse informaticists play an important role in the adaptation, utilization, and functionality of an EHR. The impact the EHR could have on a general population is invaluable; therefore, it needs special attention from a trained professional.
...will benefit the patient as well as the treating organization of care. The patients benefit with the confidence, comfort and security of competent, continuous care. The treating organization will benefit by not having to worry about missing information to the puzzle of person and their healthcare. Therefore the choice of electronic medical records versus paper medical records becomes evident: electronic medical records make health care more efficient and less expensive while improving the quality of care by making patients’ medical history easily accessible to all who treat them. Electronic medical records ensures patients that they are receiving competent care while establishing and maintaining optimal health and best possible quality of life, living with a medical condition, illness and/or diagnosis, with everyone involved informed of any and all changes in care.
Scott, T., Implementing an Electronic Medical Record System: Successes, Failures, Lessons, Oxon, Radcliffe Publishing, 2007.
The main objective of EMR is to improve quality, safety, and efficiency as well as reduces costs. Through EMR systems, physician and health practitioner will be able to provide and improve care coordination. Moreover, by having patient information available to both patients and patients’ health care team, patient result is not only accessible quickly and easily. However, EMR will eliminate duplicated tests and exam, this will save money and times. Furthermore, by using EMR systems will provide meaningful use to both the organization and patients, as it will meet the goals and objectives for our organization (healthit, n.d):
Our clinical knowledge is expanding. The researcher has first proposed the concept of electronic health record (EHR) to gather and analyze every clinical outcome. By late 1990s computer-based patient record (CPR) replaced with the term EHR (Wager et al., 2009). The process of implementing EHR occurs over a number of years. An electronic record of health-related information on individual conforms interoperability standards can create, manage and consult with the authorized health professionals (Wager et al., 2009). This information technology system electronically gather and store patient data, and supply that information as needed to the healthcare professionals, as well as a caregiver can also access, edit or input new information; this system function as a decision support tools to the health professionals. Every healthcare organization is increasingly aware of the importance of adopting EHR to improve the patient satisfaction, safety, and lowering the medical costs.
The purpose of the Electronic Health Record is to provide a comprehensive, standardized and universal digital version of a patient 's health records. The availability of a patient 's digital health record provides health information and data for critical thinking and evidence based decision-making, aggregates patient data for quality assurance and research. The Electronic Health Record has been, "identified as a strategy for effectively and efficiently coordinating and maintaining documentation of patients health histories and as a secure method of providing more informed clinical decision making" (MNA, 2006).
The patients are attended to much faster and conveniently as compared to the case of traditional paper or face-to-face communication with the attendants. The patents no longer have to wait in long queues to acquire medical services. The electronic medical records enable quick data transfer and processing alongside provision of the most appropriate diagnosis for the conditions of the patients attended to.
Firstly using advanced technology allows easier access to patient records like electronic medical records which continue to evolve as a result of advanced technology. It implementation allowed accurate and complete health records of patient including all diagnostic test and treatment history for instance blood tests, drug dosage history and radiological test which stored electronically in an accessible database. It improves several aspects of current health care systems which increase the ability to better co-ordinate the care given. Moreover it access helped to diagnose patient’s health problem more readily, lessens medical errors and provides safer care. According to Menachemi and Collum (2011) computerization helps to reduces errors and staff do not need to get clarification from the illegible written orders which can ultimately results in effectiveness of care. However this is an open database which can potentially allow health care professionals to get access to patient’s information. The ethical...
The use of computers and information systems in healthcare industry is quite a good move in the right direction. Vast amounts of information are stored, data is sorted according to categories and can easily be retrieved, and patients are diagnosed effectively and accurately. Uniform codes and standards are created which makes the system universally acceptable. Most hospitals and healthcare facilities are focused on treating their clients and saving their lives and in the process forget about adhering to Health Insurance Portability and Accountability Act which mandates protection of electronic health information since its implementation in 1996.