The Impact of Use of Electronic Medical Records on The Quality Of Health Services and Patient Safety: Review

Diah Wijayanti Sutha; Christine Christine; Lilis Masyfufah; Eka Wilda Faida; Titin Wahyuni; Siti Novianti; Agustin Dwi Syalfina

doi:10.47134/ijhis.v3i1.62

Authors

Diah Wijayanti Sutha STIKES Yayasan Rumah Sakit Dr. Soetomo
Christine Poltekkes Kemenkes Palu
Lilis Masyfufah STIKES Yayasan RS Dr. Soetomo
Eka Wilda Faida STIKES Yayasan RS Dr. Soetomo
Titin Wahyuni STIKES Yayasan RS Dr. Soetomo
Siti Novianti Universitas Siliwangi
Agustin Dwi Syalfina Sekolah Tinggi Ilmu Kesehatan Majapahit

DOI:

https://doi.org/10.47134/ijhis.v3i1.62

Keywords:

Information technology, health information system, healthcare, digital tranformation

Abstract

Electronic Medical Records have been introduced to improve the efficiency and quality of healthcare services, as well as patient safety. This study aims to review the impact of the use of Electronic Medical Records on these aspects through a narrative review. The literature review was conducted using three databases, namely PubMed, MEDLINE, and CINAHL, with the addition of Google Scholar for wider coverage. The articles retrieved were limited to publications from January 2013 to October 2023. The implementation of Electronic Medical Records improves the efficiency of healthcare services by accelerating patient data access, reducing administrative costs, and strengthening coordination between healthcare workers. However, although the advantages of Electronic Medical Records are seen in increasing the accuracy and accessibility of medical information, there are risks to patient safety, such as data input errors and the threat of data leakage. Overall, Electronic Medical Records contribute positively to improving the quality of healthcare services, especially in chronic disease management, collaboration between medical professionals, and real-time monitoring of patient conditions, which have an impact on the continuity and effectiveness of care.

References

[1] D. Joos, Q. Chen, J. Jirjis, and K. B. Johnson, “An electronic medical record in primary care: impact on satisfaction, work efficiency and clinic processes.,” AMIA Annu. Symp. Proc., pp. 394–398, 2006.

[2] R. M. Jedwab, C. Chalmers, N. Dobroff, and B. Redley, “Measuring nursing benefits of an electronic medical record system: A scoping review,” Collegian, vol. 26, no. 5, pp. 562–582, 2019, doi: 10.1016/j.colegn.2019.01.003.

[3] F. Williams and S. A. Boren, “The role of electronic medical record in care delivery in developing countries,” Int. J. Inf. Manage., vol. 28, no. 6, pp. 503–507, 2008, doi: 10.1016/j.ijinfomgt.2008.01.016.

[4] R. Oluseun and O. B. Hospital, “Why Sub-Saharan Africa Lags in Electronic Health Record ( EHR ) Adoption and Possible Strategies to Increase EHR Adoption in ...,” no. January, pp. 59–64, 2017.

[5] C. Alemayehu, G. Mitchell, and J. Nikles, “Barriers for conducting clinical trials in developing countries- a systematic review,” Int. J. Equity Health, vol. 17, no. 1, pp. 1–11, 2018, doi: 10.1186/s12939-018-0748-6.

[6] R. Boyle, L. Solberg, and M. Fiore, “Use of electronic health records to support smoking cessation,” Cochrane Database Syst. Rev., vol. 2014, no. 12, 2014, doi: 10.1002/14651858.CD008743.pub3.

[7] Rokom, “Fasyankes Wajib Terapkan Rekam Medis Elektronik,” Kemenkes RI, 2023. [Online]. Available: https://sehatnegeriku.kemkes.go.id/baca/umum/20220909/0841042/fasyankes-wajib-terapkan-rekam-medis-elektronik/.

[8] A. P. Pandamsari, “Indonesia’s Journey Towards Electronic Medical Records,” Healthcare Asia Magazine, 2023. [Online]. Available: https://healthcareasiamagazine.com/exclusive/indonesias-journey-towards-electronic-medical-records.

[9] R. Mulyanto, “Indonesia Officially Requires Its Healthcare Facilities to Implement EMRs,” Healthcare IT News, Jakarta, Sep-2022.

[10] KMS, “The Importance of Electronic Medical Records (EMR) in the Indonesia’s Healthcare Sector,” KSATRIA eHospital, 2023.

[11] E. Aromataris, R. Fernandez, C. Godfrey, C. Holly, H. Khalil, and P. Tungpunkom, “Methodology for JBI umbrella reviews,” Joanna Briggs Inst. Rev. Man., pp. 1–34, 2014.

[12] M. J. Page et al., “The PRISMA 2020 statement: An updated guideline for reporting systematic reviews,” Int. J. Surg., vol. 88, no. March, 2021, doi: 10.1016/j.ijsu.2021.105906.

[13] R. J. Mashoka et al., “Implementation of electronic medical records at an Emergency Medicine Department in Tanzania: The information technology perspective,” African J. Emerg. Med., vol. 9, no. 4, pp. 165–171, 2019, doi: 10.1016/j.afjem.2019.07.002.

[14] Y. H. Sidek and J. T. Martins, “Perceived critical success factors of electronic health record system implementation in a dental clinic context: An organisational management perspective,” Int. J. Med. Inform., vol. 107, no. August, pp. 88–100, 2017, doi: 10.1016/j.ijmedinf.2017.08.007.

[15] A. Essén et al., “Patient access to electronic health records: Differences across ten countries,” Heal. Policy Technol., vol. 7, no. 1, pp. 44–56, 2018, doi: 10.1016/j.hlpt.2017.11.003.

[16] S. Wass, V. Vimarlund, and A. Ros, “Exploring patients’ perceptions of accessing electronic health records: Innovation in healthcare,” Health Informatics J., vol. 25, no. 1, pp. 203–215, 2019, doi: 10.1177/1460458217704258.

[17] D. Blumenthal and D. Squires, “Giving Patients Control of Their EHR Data,” J. Gen. Intern. Med., vol. 30, no. 1, pp. 42–43, 2015, doi: 10.1007/s11606-014-3071-y.

[18] J. Adler-Milstein, A. J. Holmgren, P. Kralovec, C. Worzala, T. Searcy, and V. Patel, “Electronic health record adoption in US hospitals: The emergence of a digital ‘advanced use’ divide,” J. Am. Med. Informatics Assoc., vol. 24, no. 6, pp. 1142–1148, 2017, doi: 10.1093/jamia/ocx080.

[19] J. Adler-Milstein, C. Salzberg, C. Franz, E. J. Orav, J. P. Newhouse, and D. W. Bates, “Effect of electronic health records on health care costs: Longitudinal comparative evidence from community practices,” Ann. Intern. Med., vol. 159, no. 2, pp. 97–104, 2013, doi: 10.7326/0003-4819-159-2-201307160-00004.

[20] S. Bowman, “Impact of electronic health record systems on information integrity: quality and safety implications.,” Perspect. Health Inf. Manag., vol. 10, 2013.

[21] M. J. Howley, E. Y. Chou, N. Hansen, and P. W. Dalrymple, “The long-term financial impact of electronic health record implementation,” J. Am. Med. Informatics Assoc., vol. 22, no. 2, pp. 443–452, 2015, doi: 10.1136/amiajnl-2014-002686.

[22] D. A. Hanauer, R. Preib, K. Zheng, and S. W. Choi, “Patient-initiated electronic health record amendment requests,” J. Am. Med. Informatics Assoc., vol. 21, no. 6, pp. 992–1000, 2014, doi: 10.1136/amiajnl-2013-002574.

[23] J. M. Pell, M. Mancuso, S. Limon, K. Oman, and C. T. Lin, “Patient access to electronic health records during hospitalization,” JAMA Intern. Med., vol. 175, no. 5, pp. 856–858, 2015, doi: 10.1001/jamainternmed.2015.121.

[24] S. Wass and V. Vimarlund, “Same, same but different: Perceptions of patients’ online access to electronic health records among healthcare professionals,” Health Informatics J., vol. 25, no. 4, pp. 1538–1548, 2019, doi: 10.1177/1460458218779101.

[25] S. Yanamadala, D. Morrison, C. Curtin, K. McDonald, and T. Hernandez-Boussard, “Electronic health records and quality of care an observational study modeling impact on mortality, readmissions, and complications,” Med. (United States), vol. 95, no. 19, pp. 1–6, 2016, doi: 10.1097/MD.0000000000003332.

[26] J. Bae, E. W. Ford, H. H. K. Kharrazi, and T. R. Huerta, “Electronic medical record reminders and smoking cessation activities in primary care,” Addict. Behav., vol. 77, no. September 2017, pp. 203–209, 2018, doi: 10.1016/j.addbeh.2017.10.009.

[27] S. Upadhyay, R. Weech-Maldonado, C. H. Lemak, A. Stephenson, T. Mehta, and D. G. Smith, “Resource-based view on safety culture’s influence on hospital performance: The moderating role of electronic health record implementation,” Health Care Manage. Rev., vol. 45, no. 3, pp. 207–216, 2020, doi: 10.1097/HMR.0000000000000217.

[28] C. T. Lye, H. P. Forman, J. G. Daniel, and H. M. Krumholz, “The 21st Century Cures Act and electronic health records one year later: Will patients see the benefits?,” J. Am. Med. Informatics Assoc., vol. 25, no. 9, pp. 1218–1220, 2018, doi: 10.1093/jamia/ocy065.

[29] T. Toscos et al., “Impact of electronic personal health record use on engagement and intermediate health outcomes among cardiac patients: A quasi-experimental study,” J. Am. Med. Informatics Assoc., vol. 23, no. 1, pp. 119–128, 2016, doi: 10.1093/jamia/ocv164.

[30] S. Upadhyay and H. F. Hu, “A Qualitative Analysis of the Impact of Electronic Health Records (EHR) on Healthcare Quality and Safety: Clinicians’ Lived Experiences,” Heal. Serv. Insights, vol. 15, 2022, doi: 10.1177/11786329211070722.

[31] S. Nijor, G. Rallis, N. Lad, and E. Gokcen, “Patient Safety Issues From Information Overload in Electronic Medical Records Background and Objective: Electronic health records (EHRs) have,” vol. 18, no. 6, pp. 999–1003, 2022.

[32] C. Imison, S. Castle-Clarke, R. Watson, and Edwards, Delivering the benefits of digital health care. London: Nuffield Trust, 2016.

[33] N. A. Mohd Nor et al., “Development of electronic medical records for clinical and research purposes: The breast cancer module using an implementation framework in a middle income country- Malaysia,” BMC Bioinformatics, vol. 19, no. Suppl 13, 2019, doi: 10.1186/s12859-018-2406-9.

[34] E. A. Chrischilles et al., “Personal health records: A randomized trial of effects on elder medication safety,” J. Am. Med. Informatics Assoc., vol. 21, no. 4, pp. 679–686, 2014, doi: 10.1136/amiajnl-2013-002284.

[35] W. Broughton, “Health Information Technology: A New World of Nursing Homes,” J. Gerontol. Geriatr. Res., vol. 02, no. 02, 2013, doi: 10.4172/2167-7182.1000122.

[36] A. Pinsonneault, S. Addas, C. Qian, V. Dakshinamoorthy, and R. Tamblyn, “Integrated Health Information Technology and the Quality of Patient Care: A Natural Experiment,” J. Manag. Inf. Syst., vol. 34, no. 2, pp. 457–486, Apr. 2017, doi: 10.1080/07421222.2017.1334477.

[37] E. Munyisia, P. Yu, and D. Hailey, “The effect of an electronic health record system on nursing staff time in a nursing home: A longitudinal cohort study,” Australas. Med. J., vol. 7, no. 7, pp. 285–293, 2014, doi: 10.4066/AMJ.2014.2072.

[38] N. Wang, P. Yu, and D. Hailey, “Description and comparison of quality of electronic versus paper-based resident admission forms in Australian aged care facilities,” Int. J. Med. Inform., vol. 82, no. 5, pp. 313–324, 2013, doi: 10.1016/j.ijmedinf.2012.11.011.

[39] A. Clarke, J. Adamson, I. Watt, L. Sheard, P. Cairns, and J. Wright, “The impact of electronic records on patient safety: A qualitative study,” BMC Med. Inform. Decis. Mak., vol. 16, no. 1, pp. 1–7, 2016, doi: 10.1186/s12911-016-0299-y.

[40] E. R. Melnick et al., “The Association Between Perceived Electronic Health Record Usability and Professional Burnout Among US Physicians,” Mayo Clin. Proc., vol. 95, no. 3, pp. 476–487, 2020, doi: 10.1016/j.mayocp.2019.09.024.

[41] E. R. Melnick et al., “The association between perceived electronic health record usability and professional burnout among US nurses,” J. Am. Med. Informatics Assoc., vol. 28, no. 8, pp. 1632–1641, 2021, doi: 10.1093/jamia/ocab059.

[42] R. M. Jedwab, E. Manias, A. M. Hutchinson, N. Dobroff, and B. Redley, “Nurses’ Experiences After Implementation of an Organization-Wide Electronic Medical Record: Qualitative Descriptive Study,” JMIR Nurs., vol. 5, no. 1, 2022, doi: 10.2196/39596.

[43] D. W. Bates, S. Saria, L. Ohno-Machado, A. Shah, and G. Escobar, “Big data in health care: Using analytics to identify and manage high-risk and high-cost patients,” Health Aff., vol. 33, no. 7, pp. 1123–1131, 2014, doi: 10.1377/hlthaff.2014.0041.

[44] G. Roesems-Kerremans, “Big Data in Healthcare,” J. Healthc. Commun., vol. 01, no. 04, pp. 1–3, 2016, doi: 10.4172/2472-1654.100033.

[45] S. Goriah, “Advanced Electronic Health Records (EHR) and Their Impact on Medication Errors,” Medical University of South Carolina, 2016.

[46] M. Crane, “Who caused this tragic medication mistake?,” Medical Economics, 2001. [Online]. Available: https://www.medicaleconomics.com/view/who-caused-tragic-medication-mistake.

[47] S. N. Weingart, L. Zang, M. Sweeney, and M. Hassett, “Chemotherapy medication errors,” Lancet, vol. 19, no. 4, pp. 191–199, 2018.

[48] J. Westbrook, M. Rob, A. Woods, and D. Parry, “Errors in the administration of intravenous medications in hospital and the role of correct procedures and nurse experience,” BMJ Qual. Saf., vol. 20, no. 12, pp. 1027–1034, 2011, doi: https://doi.org/10.1136/bmjqs-2011-000089.

[49] H. Singh et al., “Electronic health record-based surveillance of diagnostic errors in primary care,” BMJ Qual. Saf., vol. 21, no. 2, pp. 93–100, 2012, doi: https://doi.org/10.1136/bmjqs-2011-000304.

[50] K. Hercich, “Universal Health Services faces $67 million loss after cyberattack,” Healthcare IT News, 2021. [Online]. Available: https://www.healthcareitnews.com/news/universal-health-services-faces-67-million-loss-after-cyberattack.

[51] J. Berlinger, “Singapore hack affects 1.5 million – including Prime Minister,” CNN, 2018. [Online]. Available: https://edition.cnn.com/2018/07/20/asia/singapore-hack-intl/index.html.

[52] I. Tham, “Personal info of 1.5m SingHealth patients, including PM Lee, stolen in Singapore’s worst cyber attack,” The Straits Times, 2018. [Online]. Available: https://www.straitstimes.com/singapore/personal-info-of-15m-singhealth-patients-including-pm-lee-stolen-in-singapores-most?

[53] S. James, “Medical Records and Confidentiality: Evolving Liability Issues Inherent in the Electronic Health Record, HIPAA, and Cybersecurity.” pp. 315–342, 2021.

[54] D. McGlade and S. Scott-Hayward, “ML-based cyber incident detection for Electronic Medical Record (EMR) systems,” Smart Heal., vol. 12, pp. 3–23, 2019, doi: 10.1016/j.smhl.2018.05.001.

[55] D. E. Burgner, L. A. Wahsheh, J. M. Graham, and G. Hsieh, “Cyber Security and Portability of Electronic Medical Records,” Rev. Inf. ..., vol. 7, pp. 355–365, 2012.

[56] D. W. Sutha, B. Nudji, E. W. Faida, and C. Christine, “Electronic Medical Record and Smoking Cessation Activities: Literature Review,” Int. J. Heal. Inf. Syst., vol. 1, no. 3, pp. 95–105, 2024, doi: 10.47134/ijhis.v1i3.24.