Adoption of technology in the health sector is slow and disparate. The National Health Service is responsible for adopting technology but it has proven to be very slow (Healthcare Industries Task Force, 2004). The world is experiencing a data revolution whereby data information is becoming more useful. Opening it or making it accessible to a wide pool of people can result in an even more important outcome. Verhulst et al., (2014) provide an evidence that suggest an increase in the healthy behaviour and an improvement of decision making process in patients that are able to access their personal medical records. Healthcare systems become cost effective when providers can access comparative performance indicators in the different hospitals and for the physicians. Data on prescription and performances of different hospitals will empower the public to make better choices and be accountable. It is for this case that Britain has established initiatives that will technologically revolutionalise the health services (NHS) and in turn translate into a positive outcome for the inhabitants of South East England.
The project will investigate the government initiatives in regards to health care systems in the United Kingdom. It will also show how the National Health System has improved and give reasons why there are demands for a change.
The fundamental reasons for this study is to ensure that a lot of people embrace e-health, register with e-health record systems, and make the NHS quickly develop technology in the health sector.
The research towards revolutionising the health sector would educate the public about the benefits of e-health records, its efficiency and advantages. This research would like to build the people’s trust to the e-health initiatives and guarantee them security of their medical information. The paper would also reveal examples of e-health platforms in other nations and areas within the UK. The research would empower the public into making the best choices regarding their health.
EHR is a term utilized by NHS England to describe the “concept of longitudinal record of patient’s health and health care, from cradle to grave” (IM&T Programme Board). It collects and stores information about a patient which can be made widely available across relevant institutions, within a community or a specific department. The name is referred by many terms in regard to how it was first called. They include the Automated Health Records (AHR), Electronic Medical Record (EMR), Computer-based Patient Record (CPR) and the Electronic Health Record (EHR) which is used by many countries (World Health Organization, 2006).
Electronic Health Records in Other Countries
Implementation of the EHR has been achieved in some countries. Two hospitals, one with a capacity of 960 beds while the other with a capacity of 270 beds, have gone paperless. A teaching hospital used a form of electronic health record called Health Information Management Administration System (HIMAS) that used an IBM mainframe computer. The version was upgraded to INFORMED systems which cover patient admission, medical records tracing system, appointment scheduling, transfer, pharmacy ordering, laboratory ordering and reporting etc (World Health Organization, 2006).
Korea had 11 hospitals that used EMR system to record patient information. Australian tried to implement HealthConnect system which will collect, store and exchange information of patients through a secured network. Belgium created Behealth at the end of 2004 which coordinated and organized information among stakeholders in health care. Czech Republic used IZIP system which stored about 200 million records by the end of April 2012 from 100 million in December 2011. France has implemented the Dossier medical personnel (DMP) while many others have used the normal EHR system. England has been using the Summary Care Records (SCRs) in order to improve the quality and safety of patient care (eHealth Stakeholder Group, 2013). As of May 3, 2013, it had 27 million records across England.
Introduction of EHR are guided by policies established to ensure that the system becomes reliable and more effective. The information flow into EHR system follows the same procedures as the manual system with the difference being that data is entered at the nurses’ or doctor’s station ward by an electronic device. Downtime policy is responsible for backing up the system. A policy to determine when and why documents should be printed is also very important. For how long a data should be retained in the database falls under the retention policy and it either increases space or determine the amount of data that can be entered. They are usually not retained for more than thirty years. Individuals have a duty of care for the records that are subjected to the Public Records Act 1958 (Department of Health, 2009). Language and format should be simple so that the patient can understand and analyze his health progress or communicate with the medical professionals.
Before introduction of the EHR, patients’ records need to be in one medical record. Records of each patient should be uniquely stored using codes for easy accessibility and storage. Patient Master Index (PMI) has to be maintained and later be computerized or introduced if it had not been present.
With collection and sharing of information under the EHR system, the carers and health care institutions gain access to some information about patients for the purpose of continuity of care (Policy Engagement Network for the International Development Research Centre, 2010). Privacy is therefore dependant on the trust between the patients and the carers who make oaths not to disclose any information. In other cases, the patients are given more control over the information entered in EHR. They have a right to access their health records as stipulated in the Data Protection Act (DPA) 1998 (Royal College of General practitioners, 2010). Accessibility into the health information would require consent from the patient. Larger hospitals do not fully guarantee privacy in health records which may be due to low incentives that they get out of it (Miron-Shatz & Elwyn, 2011). A claim from the Consumers’ e-Health Alliance (2011) found that consumers (or patients) are able to manage their own medical information better that how healthcare providers can.
Liverpool Community Health NHS Trust has implemented eRedbook as an e-health record for children. The electronic platform uses internet-enabled devices such as laptops, smart phones and other mobile devices to retrieve information about the health status of patients. Parents, GPs, health visitors and health professionals are able to work together to ensure that babies and young children’s health are improved. The Trust has registered over 450 local families to the eRedbook. eRedbook keeps information of a child’s health and development. It has details of the tests and immunizations that have been done on the baby patients. Sitekit in conjunction with Harlow printing have developed the online version of Redbook and it hopes to have digital health records of children throughout their lives (Todd, 2013). The database is hosted by Microsoft’s HealthVault.
The Royal College of Paediatrics and Child Health, the NHS and other companies were involved in developing eRedbook hence it has been hugely endorsed. Sometimes referred to as a ‘personal child health record’ or PCHR, it has allowed parents and children to co-manage their health with the health providers. RiO2RiO is another electronic health record that has been very successful in North East London because it has made it possible to get instant and wide information on the children immunizations, bloodspots, and health checks. Accuracy has been improved as a result of immediate addition of information at a click of a button.
Internet use in the UK has increased over the past few years. It therefore makes a lot of sense for parents to keep records of their children online. In addition, the eRedbook has better security features than the paper version. This is because the eRedbook cannot be damaged thereby ensuring the safety of important child health records. The Microsoft HealthVault that is used to store the data is secure and has enhanced features that allow individuals to control their own health information.
The eRedbook has tools that allow individuals to manage and control their own healthcare. This includes the access that the eRedbook guarantees to a host of other medical information online. Furthermore, the eRedbook can be accessed anywhere and at anytime via devices including tablets, smartphones and laptops. Parents can choose to share this data with relatives or other caregivers. The eRedbook also has a calendar feature. This provides alerts and reminders on when immunization is due or other developments within the growth of the child. There is a feature that allows parents to upload photos of their children during their stages of development. The photos make the eRedbook very interactive allowing parents, relatives and caregivers to track the growth progress of the child.
Some countries have similar e-health records but there has been slow adoption of the technology. Canada has such kind of a child health record referred to as eCHN based in Ontario. The eCHN records has currently listed 2,587,922 children patients from 2,586, 414 in the previous week (www.echn.ca). Information about children health can be accessed through eCHN which is easily accessible and to check. Dr. Beth Gamulka has used the electronic health record to retrieve information about children before deciding on the type of diagnosis. eCHN has enabled her get relevant information and lead her into making quick and right decision pertaining the type of diagnostic procedures on the patients.
South East London has a population of 1.67 million but a high percentage is underprivileged making the region the fifth most disadvantaged in England (Lewishamccg, 2014). Digital exclusion affects the most underprivileged areas in England (Government Digital Service, 2014). A lot of people in England are embracing technology with more than fifty percent of people below 54 years having mobile phone internet connections. This means that South East of London is also recording high numbers of people with internet connections. With London having the largest number of youngest people (63%) than the rest of UK, ehealth initiatives will easily be implemented.
With ehealth technology, the poor will be able to afford medical services while at the same time save a lot of money. A 60 year old woman fell down the stairs and unfortunately broke her shoulder. The woman made eight visits to see a doctor in a fracture clinic. She had to write eight letters to the doctor and make eight GP appointments. Each appointment cost £25. After registering in an electronic health service, the woman got quick feedbacks from the letters she wrote to the doctor. If she would have registered earlier, the woman could have saved the NHS £ 200 from the eight visits (Mynors & Newsorn-Davis, 2012). In addition to being cheap, health enquiries, assistance, observations and information can either be added or accessed from home. Less serious cases can be handled from home and allow the hospitals concentrate on medical cases that need a lot of attention. The time and space that people will use to seek medical attention can be used to save a life.
The objective of this study is to explore the perceptions of eRedbook and the issues of privacy, protection policies and membership. An online questionnaire will be used to interview the participants on how they currently manage their children’s health records. The interview will integrate the aspects of ethnography to understand how the challenges that participants have in managing their children’s health data, how they resolve the issues and how the current system can be improved.
One challenge of studying healthcare information management is the personal and private nature of healthcare information. From the eRedbook, each child’s health record is unique thereby making it difficult to determine the best strategy for studying health information. Giving participants fictitious non-personal examples of different scenarios may not help the participants because the participants may not be able to identify with the non-personal records. In addition, the participants may not be willing to divulge personal health information of their children.
One-hundred and twenty (120) participants will be selected for this study. The participants will be recruited from the local community. The participants will be informed on the purpose of the study and allowed to make a choice on whether they want to participate in the study or not. The study will involve the use of manual and online questionnaires that will ask participants their opinion on eRedbook. The questions will focus on their registration and membership on eRedbook, the user perceptions, security and privacy issues and whether the participants have embraced eRedbook. The questionnaire will be distributed to all the participants in the study.
One important area of the health sector that the government has identified for technological development is in the recording of health information. Health records have traditionally been put in patient books, health cards, discharge plan sheets and computer applications within the hospitals. The UK health secretary launched a “paperless NHS” project in January 2013 that ensured healthcare records were shared between social and health care services. The project was predicted to save £5bn in a year. It was aimed to make sure that hospitals and GPs were able to access and update GP records by the year 2014 while patients were able to access their records online. All parts of the NHS and social care were targeted to be connected by the year 2018 (eHealth Stakeholder Group, 2013). This led to the formation of an Electronic Health Records (EHR) computer-based application that mainly focused on the patients’ information.
SPSS will be used for analysing the data from questionnaires. First, the data collected will be evaluated for errors. A grid will be prepared to collate the data collected from the questionnaires. A simple coding system will be designed to evaluate the responses. The data will then be analysed and reports generated. SPSS has the ability of generating reports from complex data.
The benefits of EHRs outweigh the negatives. They ensure that admission and monitoring of patients is very fast and efficient. As a centralized system, different health information can be entered by any one but after a consent from the patients anywhere and any time. It will also allow health professionals to go through historical health information of a patient and resume treatment procedures. It is cost effective to both patients and hospitals. They will also increase health behaviour and improve decision making process of patients who are able to access their personal medical records.
Electronic health records (EHRs) have become an inevitable technology in the provision of health services (Luchenski, et al., 2012). Some of the benefits of storing and sharing healthcare information include improved access to medical records, improvement in the quality of medical services, reduced healthcare costs, reduction in medication errors, improved population-level health and improved health research (Majeed, 2004). However, there are some risks which must be eliminated for the successful deployment and implementation of electronic health records.
Some of the political and ethical challenges of implementation include right to ownership of medical information, this specifically means the terms and conditions under which personal or anonymised health records can be used in treatment and also in research. In addition, there are citizens’ concerns about the safety and security of healthcare records. These issues are very complex and if not solved, may present barriers to implementation of EHRs (Luchenski, et al., 2012).
In a bid to improve healthcare provision, the UK government has developed a policy dubbed Connecting for Health. This was to develop an information system that was to be used by clinicians in the provision of health services to the communities. This also includes a research service that ensures that research institutions have access to health records. However, this access must follow the legal and ethical standards. The issue of Connecting for Health has been considered in great detail. However, the issue of user perceptions has not received much attention among researchers (Luchenski, et al., 2012).
The different perceptions on EHRs can be based on fears over personal and private healthcare data and also on how EHRs may improve delivery of healthcare to the communities. In general, concerns are generally about privacy, security, access, use and misuse of EHRs data (Paterson & Grant, 2010). Different views about EHRs are likely to differ based on educational levels, income levels, age, medical status and previous healthcare experience (Luchenski, et al., 2012).
The UK media has reported conflict between hospital managers, government, healthcare professionals and patient groups. The conflicts are usually based on policy issues, security and performance issues of EHRs. There has also been a debate on whether implementation of the EHRs would significantly reduce healthcare costs especially bearing in mind that clinicians may resist the adoption of EHRs within healthcare institutions (Currie & Finnegan, 2010).
The UK public is constantly changing its relationship with EHRs and information technology. This is because service users are continuously gaining access to more information via the worldwide web, social networking sites and other forms of global media. The increased access to information has increased user expectation on the performance and delivery of health systems. This has brought about some internal and external challenges (Sara, 2013).
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