CHAPTER TWO

LITERATURE REVIEW

2.1 Introduction - - - - - - - - 6

2.2 Concept of Electronic Health Records (EHRs) - - - 6

2.2.1 Comparison with Paper-based Records - - - - 7

2.2.2 Technical Features of Electronic Health Record - - - 7

2.2.3 Electronic Health Record (EHR) Implementation - - - 7

2.3 Evolution/History of Electronic Health record - - - 10

2.4 Importance of Electronic health Records on Quality

Improvement in Healthcare Services - - - - - 12

2.5 Advantages and Disadvantages of Electronic Health Records - 14

2.5.2 Disadvantages of Electronic Health - - - - - 16

2.5.2.1 Financial Issues - - - - - - - 16

2.5.2.2 Potential Privacy and Security Issues - - - - - 16

2.5.2.3 Inaccurate Information - - - - - - 16

2.5.2.4 Frightening Patients Needlessly - - - - - 17

2.5.2.5 Malpractice Liability Concerns - - - - - 17

2.6 The Impact of Electronic Health Record on Quality health Delivery 17

2.6.1 Application of Electronic Health Record (EHR) in Healthcare System 18

2.6.1.1 Clinical Application of Electronic Healthcare System - - 18

2.6.1.2 Clinical Research Application of Electronic - - - 19

2.6.1.3 Application of Electronic Health Record (EHR) in Reporting in

Healthcare System - - - - - - - 20
2.6.1.4 Administrative Application of Electronic Health Record in

Health System - - - - - - - 20

2.6.1.5 Application of Electronic Health Record in Healthcare Financing - 20

2.7 Adoption and Challenges faced in Adoption of Electronic

Health Record in Healthcare System - - - - 21

2.7.1 Challenges of barriers faced in HER Adoption - - - 23

CHAPTER TWO
2.1 Introduction

This chapter is focused on review of related literature on the impact of Electronic Health records
on physician performance. In University of Maiduguri Teaching Hospital, Borno State. under the
various sub-heading, concept of electronic health records importance of electronic health record
on quality improvement in health care services, disadvantages and advantages of Electronic
Health Records on Health delivery etc.

2.2 Concept of Electronic Health Records (EHRs)

An electronic health record (EHR), is the systematic collection of patients and population health
information in a digital format.

These records can be shared across different healthcare setting. Records shared through network
connected, enterprise-wide information networks and exchanges. Electronic health records
(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 biling information. This was stated by Terry, (2015).

Gunter T. D. (2014). Opined that electronic health record system are designed to store data of a
patient across time.

It eliminates the need to track down a patients previous paper medical records and assists in
ensuring data is accurate and legible. It can reduce risk of date replication as there is only one
modifiable file, which means the file is more likely up to date, and decreases risk of lost paper
work. Due to the digital information being searchable and in a single fite, electronic medical
records are more effective when extracting medical data for the examination of possible trends
and long term changes in a patient population based studies of medical records many also be
facilitated by the wides spread adoption of electronic health records (EHRs) and electronic
medical records (EMRs).

 Terminology

The terms electronic health records and electronic patient record (EPR) and electronic medical
record (EMR) have often been used Interchangeably, although differences between the models
are now being defined the electronic health records (EHRs) is a more longitudinal collection of
the electronic health information of individual patients or population.

The electronic medical records (EMRs) in contract is the patient record created by providers for
specific encounters in hospitals and ambulatory environments, and which can serve as a data
source for an electronic health record (EHR).

In contract, a patient or personal health record (PHR) is an electronic application for recording
personal medical data that the individual patient controls and may make available to health care
providers as stated by Habib JL, in (2010).

2.2.1 Comparison with Paper-based Records

Govindaraju, (2017) opined that the increase portability and accessibility of electronic medical
may increase the ease with which they can be accessed and stolen by unauthorized person or
unscrupulous users compare to paper based medical records as acknowledge by the increased
security requirements for electronic medical records in included in the health information and
accessibility act and by large-scale breaches in confidential records reported by electronic
medical record users.
Handwriting paper medical records may be poorly legible, which can contributes to medical
errors pre-printed forms standardization of abbreviations and standard for penmanship were
encouraged to improve reliability of paper medical records.

While electronic records may help with the standardized forms, terminology and data input.
Ditization of forms facilitates the collection of data for epidemiology and clinical studies.
Electronic medical records can be continuously updated (within certain legal limitations)

If the ability to exchange records systems were perfected (interoperability). It would facilitate
health care facilities. In addition, data from an electronic system can be used anonymously for
statistical reporting in matters such as quality improvement, resource management and public
health, communicable diseases surveillance.

2.2.2 Technical Features of Electronic Health Record

 Digital formatting enables information to be used and shared over secure networks.
 Track care; example, prescriptions and outcomes blood pressure
 Trigger warnings and reminders
 Send and receive orders, reports and results
 Decrease billing processing time and create more accurate billing system, and health
information exchange.
 Technical and social framework that enables information to move electronically between
organization.
 Using an EMR to read and write a patients record is not only possible, through a
workstation but, depending on the type of system and healthcare setting, may also be
possible through mobile devices that are handwriting capable, tablets and smart phones.
Electronic medical records may include access to personal health records (PHRS) which
makes individual notes from an electronic medical record readily visible and accessible
for consumers as stated by Bergso, (2011).

2.2.3 Electronic Health Record (EHR) Implementation

Atima, (2014) opined that activating the electronic health record (EHR) involves a multi-
disciplinary approach to prepare the new system, ensure privacy and security compliance, design
practice workflows, train the care team and managed the adoption process. A thoughtful
electronic health record implementation can help the practice adapt more easily to the new
system which will benefit patients, physicians and staff.

The following nine steps to successful electronic health record implementation;

Create an implementation team; typically this team will include physicians, nurses, receptionist,
medical assistant. Compliance office staff and administrative staff clinical members play dual
roles by teaching electronic challenges back to the implementation team.

Step 2:

Confiqure the software; first, work with your health information technology vendor to configure
your electronic health record to meet appropriate security measures. This may require that you
conduct a HIPPA risk assessment.

Step 3:

Identify hardware needs: The right hardware can save an organization time and money. Further
more, some practices reduce the time spent logging into the system multiple times each day by
providing every workers with their own laptop or tablet to carry from room to room. System
hardware (i.e server and network) needs depend on the type of electronic health record (EHR)
purchased.

Step 4:

Transfer Data: determine the approach for migrating data from the former record keeping system
e.g paper based or other personal medical system modules to the new electronic health record. A
practice can assign existing staff to assist with this process prepare a checklist of items to be
entered into the electronic health record. This will ensure that no critical information is missed
during the transfer.

Step 5:
Optimize pre-launch workflows: It is best to optimize workflows before electronic health record
implementation. Some organization postpone workflow or insufficient support staff will be
exacerbated during the implementation of an electronic health record.

Step 6:

Consider the room layout: Placement of the computer in the exam room impacts patient care. If
the staff and physician must look over their computer it will bringout effective communication.

Step 7:

Decide on the Launch approach: Some practice convert all users to the electronic health record
for all functions and all patients on the same day.

Step 8:

Develop procedures for when your electronic health record is down; what will you do in the
event of a power outage or serve system malfunction. It is wise to develop procedures for periods
when the electronic health record is down so instructions about workflows when the electronic
health records (EHRs) is down so that physicians and staff have clear instructions about
workflows when the electronic health records is unavailable.

Step 9:

Initiate Training:Training staff and physicians is critical to ensuring electronic health record
implementation success create a training plan to make sure everyone has the necessary
knowledge and skills to use the electronic health record at the launch time.

In conclusion to this, the strategies and practices presented in this module as stated by AHIMA,
(2014) will aid in thoroughly understanding the practices specific needs relevant to the software
and hardware options, to the layout and to successfully implement an electronic health records
(EHRs).

2.3 Evolution/History of Electronic Health Record

Health records have undergone many changes over the last thirty years or so. In the 1980s, all
patient health records, from vital signs to medication lists, were on paper. These documents
would be bound and sent to a medical records department or storage.

When a healthcare provider would need to review these medical records, a request would be sent
to find the records and deliver them to the requesting provider. This would take hours to day to
retrieve and would cause delays in treatment. Documentation on paper would be challenging in
that sometimes handwriting was difficult to read, leading to in accurate data and misinformation.
This would also lead to delays in treatment. As advances in computers came, so did advances in
health records. The 1990s brought about scanning of documents, so health records could be
recorded on paper than scanned into computer system. This helped healthcare providers access
health record without waiting on a request for a paper chart. They could more expediently
analyse what medications a patients was taking, what a previous diagnosis was, how up to date.

Immunization were, and what surgeries or procedures a patient had undergone. There would be
some documentations in a computer, but most of what was entered would be orders for labs and
radiology test result from those tests.

In the 1990s, if you have received treatment at a different facility than your usual medical
practice, your records would need to be retrieved from the other facilities which would have to
be done by fax or courier. Retrieving these records was still challenging and could delay
treatment.

The early 2000s were when electronic health record (EHRs) came to the forefront healthcare
providers and nurse could document vital sign, patient assessments, and lab results directly into a
computer for easy storage and later for healthcare providers at hospitals and medical offices to
access past records for patient as well as identify medication interactions, immunization records,
previous diagnoses and patient histories.

This would be especially important for those patients with several different healthcare providers
and specialist caring for them and various prescribed medications. The use of electronic health
records (EHRs) would also identify when duplicate orders were entered, saving time and money.
The ability to send and receive records from other facilities was also becoming easier,
eliminating the need for faxing or waiting on documentation.
In the 2010s, the electronic health records has advance to paperless systems. When you last
visited your health care provider did the nurse or healthcare providers did the nurse or healthcare
provider use an electronic tablet when they asked you why you were visiting? If so, all of your
information as well as all vital signs, lab reports, and radiology result can be entered into an
electronic tablet, which communicates with the computer system using an encrypted system to
record your information into your health record. Therefore use of electronic tablets allows
healthcare providers to access your health information and enter data while they’re at your side,
this is research and stated by Jennifer Mitchell (2015).

2.4 Importance of Electronic health Records on Quality Improvement in Healthcare

Services

According to 10m (institute of medicine) one of the most revolutionizing changes that have taken
place in the medical industry during the last decade is the switch to electronic health record
(EHR). These digital versions of paper records have greatly impacted the quality of patients care
as well as the ability to better manage patient information.

Infact, 94 percent of medical providers state that their HER system make it much simpler to
access vital records at the points of care. And 78 percent of these providers testify that their
electronic health record (EHR) systems have enabled them to provide better patient care.

Jessica, (2017). Opined that health industry collects and relies on a considerable amount of data,
which needs to be stored and retrieved on a constant basis. The advent of electronic health
records (EHRs) brought about the opportunity to change the way these records were handed.
HER software has significantly changed not only patient record documentation, storage and
retrieved but its ultimately changed the level of care provided.

Jeff, (2017). Opined electronic health records, improves the quality of healthcare services
improves the quality of healthcare services through increase patient safety decrease in medical
errors and strengthens the interaction between patients and healthcare providers. In low and
middle income countries (LMIC) the need for reliable and affordable medical records software is
paramount. The open medical record system (MRS) community helps meet this specific need by
developing and supporting the open medical record system an open source electronic health
record (EHR) platform, specificallydesigned for low resource environments and is complete free.

Brain, (2016). Stated that the use of electronic health record in medical clinics improves the
quality of healthcare that is delivered by providing accurate patient records and allow doctors to
better understand the patients medical history.

Having a comprehensive patient history empowers doctors to more accurately treat ailments and
prevent over prescribing medication which can be fatal. Without medical records, physicians
could need to depend on the patient’s memory, which can load to inaccurate medical history due
to forgetfulness, complex drug names, and ailments affecting the patients recollection. Patient
that suffer from disease and ailments directly benefit from health IT because of the improved
level of care.

The importance of electronic health records include, better healthcare by improving the quality
safety, effectiveness, patient-centeredness, communication, education, timeliness, efficiency and
equity.

According to Paul, (2012). The importance of an electronic health records perform to help
physician and other healthcare professionals in health care delivery system, practice better
medicine and improve the bottom line. Some of these importance include;

1 To identify and maintain a patient records; identify and maintain a single patients record
for each patient.
2 Manage patient demographics: capture and maintain demographic information where
appropriate, the date should be clinically relevant, reported and tractable over time.
3 To manage problem lists: Create and manage patient specific problem lists.
4 To manage patient History: capture, review and manage medical procedure and surgical,
social and family history including the capture of pertinent positive and negative
histories, patient report or externally available patient clinical history
5 Manage Clinical Documents and Notes: Create, attend, correct, authenticate and close, as
needed transcribed or directly-entered clinical documentation and notes.
6 To manage consents and authorizations: Create, maintain, and veritypatient treatment
decisions in the form of consents and authorizations when required.
7 To present alerts for preventive services and wellness; sat the point of clinical decision
making identify patients specific suggestions/remainders screening tests/exams, and other
preventive services in routine preventive and wellness patient care standards.

According to Louis, (2012). Stressed out the importance of electronic health record in speech-
recognition has help him as one of the numbered tools that he use, most of the time he will put in
a few sentence after the patient leaves the room.

Sometimes a nurse is drawing blood or taking care of something else, he need to dictate a letter
or another note for the patient and he will just excuse himself and say “I am dictating this letter
for you” very few patients object to getting things done for them right now.

Ahima, (2012). Stated that handling medical records electronic ally, has many importance over
the older paper counterparts.Providers can be more easily track data over time.

2.5 Advantages and Disadvantages of Electronic Health Records

Mancuso, (2007). Bring out opinion that electronic health record (EHR) system have the
potential to transform the healthcare system from a mostly paper-based industry to one that
utilizes clinical and other pieces of information to assist providers in delivering higher quality of
care to their patients. The health information technology for economic and clinical.

Health (HITECH) Art of 2009, which is part of American recovery and Reinvestments Act
(ARFA) aka “stimulus pakage”, was signed into law with an explicit purpose of incentivizing
provers, e.g hospitals and physicians to adopt electronic health record being a computerized
records eliminate poor penmanship; which has historically plagued the medical chart. HER
systems an include many potential capabilities, but three particular functionalities hold great
promise in improving the quality of care and reducing cost at the healthcare system level.

Middleton B. (2003). Stated that the advantages of electronic health care by considering clinical,
organizational, and social outcomes clinical outcomes include improvement in the quality of
care, a reduction in medical errors and other improvements in patient level measures that
described the appropriateness of care, organizational outcomes, on the other hand, have include
such items as financial and operational performance, as well as satisfaction among patients and
clinicians who use electronics health records, lastly social outcomes include being better and able
to conduct research and achieving improved population health. Many clinical outcomes that have
been a focus of electronic health record studies relate to quality of care and patient safety.
Quality of care has been defined as “doing right thing at the right in the right way to the right
person and having the best possible result” and patient safety has been defined as “avoiding
injuries to patient from the care that is intended help them”

According to World Health Organization (WHO, 2015). Electronic health records and the ability
to exchange health information electronically can help you provides higher quality and
improvements for your organization. Electronic health record (EHR) help providers better to
manage care for patients and provides better health care by;

 Providing accurate, up-to-date and complete information about patients at the point of
care
 Enabling quick access to patient records for more co-ordinated efficient care to patients
 Securely sharing electronic information with patients and other clinicians
 Helping providers move effectively diagnose patients, reduce medical error, and provide
safe care.
 Helping providers improve productivity and work-life balance.
 Improving patient and provider interaction and communication as well as healthcare
convenience.
 Reducing costs through decrease paper-work, improved safety, reduces duplication of
testing and improved health of the patients.
 Better health care by improving all aspects of patient care, including safety, effectiveness,
patients centeredness and communication, education, time lines, efficiency and equity.

2.5.2 Disadvantages of Electronic Health

According to Zurit L. (2004) opined that despite the growing review on the advantages of
various electronic health record (EHR) functionalities, some authors have identified potential
disadvantages associated with this electronic health record adoption, privacy and security
concerns, and several unintended consequences.

2.5.2.1 Financial Issues

This includes adoption and implementation cost, ongoing maintenance costs, loss of revenue
associated with temporary loss of productivity, and decline in revenue present a disincentive for
hospitals, and physicians to adopt and implementation cost include purchasing and installing
hardware and software, converting paper charts to electronic ones, and training end-users many
studies have documented these costs in both the inpatient and outpatient settings.

2.5.2.2 Potential Privacy and Security Issues

As with just about ever computer network these days, electronic health records (EHRs) systems
are vulnerable to hacking, which means sensitive patients data could fall into the wrong hands.

2.5.2.3 Inaccurate Information

Because of the instances nature of electronic health records, they must be updated immediately
after each patient visit or when ever there is a change to the information. Failure to do so could
mean other healthcare providers will rely on inaccurate date when deterring appropriate
treatment protocols.

2.5.2.4 Frightening Patients Needlessly

Because an electronic health record system enables patients to access their medical data, it can
create a situation where they misinterpret a file entry.
This cause undue alarm or even panic.

2.5.2.5 Malpractice Liability Concerns

There are several potential liability issues associated with electronic health record (EHR)
implementing for example, medical data could get lost or destroyed during the transition from a
paper-based to a computerized electronic health record (EHR) system which could lead to
treatment errors since doctors have greater access to medical data via electronic health record
(EHR), they can be held responsible if they don’t access all the information at their disposal, as
stated by Gallagher, (2015).

2.6 The Impact of Electronic Health Record on Quality health Delivery

Walter Riccardi, (2016). Brought out the opinion that our world has been radically transformed
through digital innovation. Information technologies play a growing role in healthcare delivery
and help address the health problems and challenges faced by clinicians and other health
professionals. An electronic health record (EHR) is a systematic electronic collection of health
information about patients such as medical history, medication orders, vital signs laboratory
results, radiology reports, and physicians and nurse notes.

In healthcare institutions, it automates the medication, as well as examination, ordering process

ensuring. Standardized, readable and complete orders. An electronic health record (EHR) may
also include a decision support system (DSS) that provides up-to-date medical knowledge
reminders or other actions that aid health professionals in decision making.

Mojica, (2006) stated that electronic health record as an impact on quality healthcare delivery in
that, it has been applied in various ways in the health care delivery system by health care
professionals to assist them to reduce medical errors, achieve better effect care coordination,
improve patient safety and care quality and decrease health care cost by making a significant
patients information available electronically health care information system can help to prevent
ordering of duplication of tests and procedures, thereby reduce patients information in digital
form will decrease by making a significant patients information available electronically, health
care information system can help to prevent ordering of duplication of test and procedures,
thereby reduce patients expenditures, on health care services, additionally, availability of patient
information in digital from will decrease the expenditures on storage, retrieval and transportation
of patient chart in the health record department.

Luiz, (2013). Stressed that health care delivery systems, similar to other business entities, are
information intensive enterprises.

Health care workers or provider need adequate data as well as tools to manage information to
make accurate decisions, both while managing and running the enterprise and while caring for
the patient to document and communication plans and activities, and to meet the regulatory
requirements of the accrediting organization. Electronic health record has been very useful in
various ways in health care delivery system ranging from clinical care application to
administrative function, to clinical research function, to financial application, and reporting in
the health care system.

2.6.1 Application of Electronic Health Record (EHR) in Healthcare System

According to Safdari, (2014). Currently the roles and application of the electronic health record
application in the health care system include clinical care application/functions, financial
function, clinical research, reporting and administrative function. The following section presents
the details of electronic health record applications/function.

2.6.1.1 Clinical Application of Electronic Healthcare System

Glaser (2005). Stated that one key area of the electronic health record (EHRs) application in
healthcare system is in the use of clinical patient care. Electronic health record (EHR) provide
clinical functions which are health information and data, results management, order entry and
support, and decision making supports. The main objective of the electronic health record in the
healthcaresystem is to manage the information that health personnel require to do their work
efficiently and effectively. Electronic health record (HER) assist in the organization of patients
medical information and records keeping. It provides timely access to patients clinical
information, for example, radiology results, and laboratory test result thereby reducing
redundancy and improving health care service quality. Similarly, the availability of significant
medical information at the point of healthcare service delivery with clinical decision support
systems like those for drug order entry will reduce drug adverse effectively and medical errors.

Electronic health record, facilitate communication, integration of information and patient care
co-ordination action among many healthcare personnel such as doctor, nurses, pharmacist,
laboratory scientist, health information managers, just to mention a few.

2.6.1.2 Clinical Research Application of Electronic

Electronic Health Record (EHR) in healthcare system; Ahmadi, (2013). Ahmadi stressed that
another important area where biomedical informatics has played a significant role in health care
system is in the aspect of clinical research using the surveillance and query facilities in the digital
stored records.

The query system may be used to identify patient who meet appropriate criteria for prospective
clinical trails. Surveillance facility supports the execution of clinical trail by tracking patients via
their visits and by way of following the research protocols. And besides, data required for a
clinical trial research could be derived directly from the electronic health record (EHR), thereby
making research data collection a by product of regular medical records keeping. Thus assists in
the elimination of system, adapted from cost accounting applications in other industries have
been adopted widely.

2.6.1.3 Application of Electronic Health Record (EHR) in Reporting in Healthcare

System

Cimino, (2014). Stated that electronic health record (EHR) has also been very useful in reporting
and population health management. Many health care institution; both private and public
presently have many reporting requirement at the local, state, and national levels for patient
safety and quality as well as for public health.
The internal quality improvement efforts of various health care systems involve routine reporting
of vital health quality indicators. Therefore, having clinical data and information represented in a
standardized format and in an electronic readable from will decrease the burden of data
collection substantially at different levels of reporting. Furthermore, this will not only reduce the
costs of data collection and organization but also increase the data reporting accuracy and
completeness.

2.6.1.4 Administrative Application of Electronic Health Record in Health System

Shahi, (2013). Opined that administratively, electronic health record (EHR) can be used to
schedule hospital admissions, in patient and out-patient procedures, and visit, therefore,
improves the efficiency of healthcare systems and also offer better more timely services to
patients.

In addition, system of patient information in the healthcare system provides speedy and accurate
patients insurance eligibility validation, consequently access to health care services, more timely
payments, and reduced paper work. Hence query system is an important tool for an
administration who wishes to make informed decisions in the increasing healthcare costs.

2.6.1.5 Application of Electronic Health Record in Healthcare Financing

Maryam, (2013). Stated that application of electronic health record in health care financing is an
important area to disease especially during this period of federal healthcare reform with the goals
of maintaining. Some balance among access, cost accounting applications in other industries,
health care cost-accounting is often automated.

The ability to track or retrieved this information is important in many situations, including if a
doctor want to identity how a patient is responding to a particular type of treatment.

Electronic health record can also help identify patient who might be due for preventive assist and
screening. Additional healthcare delivery system is that it allow physician to enter orders for test
automatically and write prescriptions without prescription pads.
2.7 Adoption and Challenges faced in Adoption of Electronic Health Record in
Healthcare System

Adebesin, (2013). Stated that the use of electronic health records (EHRS) is not new, but the
adoption and provision of their services are challenging. Despite the positive aspect and
promising features of electronic health records (EHRs) use medical and healthcare practices,
there are many issues that need to be identified and addressed to expected the adoption rate of
electronic health record (EHR).

Terry (2005). Opined that recent technologies and advancement are enabling more efficient ways
to access medical information.

One of the example of this is the use of electronic health records (EHRs). Electronic health
records are collection are collection of electronic health records information about one individual
patient. Electronic health records, electronic patient records, and electronic medical records are
term often used interchangeably and in relation to each other. Recording these data in electronic
form is supported by low like health insurance portability and accountability Act (HIPAA) and
the health information technology for economic and clinical to health (HITECH) Act. HITECH
was created to stimulate in the adoption of electronic health record in the healthcare delivery
system.

Williams, (2008). Stressed that in the past, the traditional method of storing medical records in
paper form. However, paper form storage posses certain Limitations when it comes to accessing
medical record data. Patient and hospital staff have limited access to these paper-based medical
records, some medical facilities operate under limited hours, thus restricting hours where in data
can be accessed.

In the case of an emergency situation late at night, accessing medical records from medical
facilities that do not run for 24 hours a day would take a lot of time and effort. Furthermore,
managing medical records is not easy in paper form. Sorting and searching through medical
records can be time consuming and inconvenient given how essential time is in medical field. It
is important that electronic health record (EHR) are adopted into hospital system in order to save
times.
Lactman, (2014). Opined that many countries have switched to electronic health records (EHR)
or have adopted various other health information technologies. Korea, known as one of the most
wired country in the world, is one the countries where electronic health record has been adapted
or implemented. Their network infrastructure is to advanced that various remote medical services
using high-speed networks are already available.

Remote consultation uses tele-communication for the purpose of diagnosis or treatment of a

patient at a site away from a physician remote patient monitoring uses devices to collect and send
data to a remote diagnostic testing facility.

Carpathia, (2005). Said that the four major benefits of adopting electronic health record over
paper-based medical records are cost, storage, security and access. The first managing electronic
health record requires fewer staff members, and physical storage taking up large spaces for
record keeping will not be needed, anymore, therefore, it costs less to manage and maintain
records with this method. Secondly, as the number of patients grow, preservation of records
becomes an issues. Paper medical records need to be physically printed on papers and often take
up large physical spaces. Thirdly, electronic health records can be stored in a more secure place
such as cloned and can be monitored for any suspicious access, while paper records are mainly
stored in file cabinets with less security. The files can be stolen or damaged by natural disasters,
such as fire and flood. To be prepared for any loss, we need to have backups. Electronic health
records, we can easily make copies while paper records require photocopy backups, and sorting
and binding the copies together.

Yoo & Kim, (2010). Stated that with advanced network and mobile technology, we can access
our electronic health records and other medical services anywhere. Today’s networks allow us to
view high quality images of lab results and other health information, as well as give access to our
medical records anytime, anywhere.

2.7.1 Challenges of barriers faced in HER Adoption

Gagnon et al; (2016). Opined that challenges or barrier to electronic health records adoption
includes maintenance costs, lack of financial incentives and suboptimal technology;
Ferranti et al; (2006). Stressed that sharing electronic health records among organizations is
highly describable. However, several standards are required to create compatible or common
terminology and common data structures. In addition, security is big concern for a remote access
system. For example, while we can access medical records at home, that also means that
someone can remotely steal our medical records. Containing sensitive information doctors note
or our financial information. The cloud computing paradign negatively and distrust for
electronics widering the digital divide.

Walter et al, (2005). Emphasize and show the effectiveness of searching and sharing electronics
health records. Lack of interoperability standards and solution has been a major obstacle in the
exchange of healthcare data between different stakeholders.

Anderson, (2010). Wikipedia. Opined that security is another challenges or barrier in adoption of
electronic health records. He also defined information security as well. Informed sense of
assurance that the information risks and controls are in balance. electronic health records systems
may have many security vulnerabilities and one of the threats for electronic for electronic health
records systems is malicious code. Weaknesses in software and hardware must be removed to
minimize vulnerability; so that risk and controls are balanced to protect the system and to
continue business. It dangerous for electronic health record to have security. Issues since medical
record usually require patients to fill out sensitive and accurate personal information and for
doctor’s