Excerpt
Examining the Effectiveness of Electronic Health/Medical Records on Patients’ Waiting Time – Literature Review
The electronic medical/health records (EMR/EHR) systems are known to collect and store the patients’ information digitally. Evidence points out that both EMR and EHR can be used to improve patients outcomes and mitigating hospital expenditure through reduced expenses on drugs, minimizing the tests and procedures, decreasing the errors in billing, and improving the documentation of charges on a patient (Jabour, 2020). These benefits imply healthcare organizations can improve the quality of care accorded to patients, increase the productivity of the staff members, and enhance the communication outcomes between the medical practitioners and the patients.
The emergency departments (ED) play a crucial role in the healthcare system of any country serving numerous patients annually. Previous research shows that the number of patients visiting the EDs continues to increase while the inpatient beds have been noted to decrease (Furukawa, 2011). Consequently, the situation can lead to overcrowding, which can make some patients leave without being treated, an increased number of patients waiting for admission, and exceeding the time required to see a physician (Furukawa, 2011). To solve the issue of patients leaving without treatment, the management of the EDs have attempted to embrace health IT as a way of enhancing the timely and efficient provision of emergency medical care (Institute of Medicine, 2006). One such promising application of IT in the healthcare sector has been the use of EMRs/EHRs to automate the patient’s paperwork and enhance healthcare decisions.
Most of the medical practitioners have shown concerns regarding the amount of time required to capture patient’s data and going through the paperwork in case of a revisit (Jabour, 2020). According to physicians, the time spent entering data can be used to provide improved direct quality care to patients (Alkureishi et al., 2016). Further, evidence has shown that patients like to spend less time when they visit a health facility in terms of waiting for the medical expert, seeking admission, and going to the pharmacy, but they want more time when consulting a physician (Bielen & Demoulin, 2007; Xie & Or, 2017). As a result, this literature review aims to examine the effectiveness of EMR/EHR on patients’ waiting time using a PICOT question which states: When considering the increased number of a patient visiting the EDs (P), would the use of EMRs/EHRs (I) reduce the patients’ waiting time as compared to paperwork data collection (C) and lead to improved patient satisfaction (O) after a hospital’s visit (T) ?
Current Evidence-Based Research
Studies have reported a positive impact on patient waiting times after the healthcare organizations enforced EMR/EHR. In a systematic review by Liu et al. (2012), it is revealed that scholars have noted increased patient satisfaction with EMR/EHR, which can contribute to critical transformations in the healthcare sector. However, other findings by Jabour (2020) show that there might be no difference between the primary health centers using paper-based data collection or those that use EMR/EHR in terms of waiting time, reception time, time for consultation, and pharmacy time. The research outcomes of Jabour (2020) have been supported by previous scholars such as Mohan et al. (2013) who established that the implementation of EMR can lead to increased patient waiting times and a reduction in the performance of the ED. However, their study was based on the application of a particular type of EMR, which can lead to the inference that not all EMRs/EHRs systems can be effective in reducing the patient waiting time in ED.
Other scholars have reported improved patient satisfaction in waiting and treatment times. In a study conducted in Saudi Arabia, Wali et al. (2020) found that the implementation of EMR in primary healthcare centers leads to time increment in consultation, increased active listening, and heightened confidence among patients. These outcomes show that the time saved by medical practitioners after the enforcement of EMR/EHR is being used to improve the quality of care being offered to patients as supported by the research of Manca (2015). Therefore, with EMR, medical practitioners can capture point-of-care data required to inform and enhance practice through projects that improve quality and practice-level interventions.
Application of Evidence-Based Literature to the Project
Using an advanced EMR/EHR system can help to minimize patient waiting times in the EDs of various health centers. Projects seeking to improve the performance of healthcare organizations have been noted to embrace EHR/EMR at a particular point. In a project by Sayah et al. (2014) that was seeking to improve the arrival and departure times for patients visiting the ED of Cambridge Hospital, the researchers implemented EHR at some point for efficient data collection. The researchers then created a system that would employ the EHR information to place the patient in the ED immediately to avoid delays. With all the efforts, the project led to a time reduction of patients stay in the hospital to 132 minutes from 204 minutes (Sayah et al., 2014). The reduction of time facilitated the follow of more patients into the hospital.
On the contrary, the application of EHR/EMR in the healthcare setting has been reported to contribute to increased waiting time among patients which can only be solved when the volume of the patients is reduced. Vahdat et al. (2018) use a simulation model to evaluate the impact of heightening the encounter time between a medical provider and a patient. In their model, time is increased at particular intervals with the outcome demonstrating increased time length of booking appointment, heightened waiting time, and prolonged staying in the hospital (Vahdat et al., 2018). Nonetheless, these outcomes were only applicable to the dermatology clinic with missing evidence of how the result would be in an emergency department.
Currently, the use of the EHR/EMR system can be applied to the case of Chamberlain Hospital. The hospital has problems with increased waiting patient time that leads to more patients leaving without being seen (LWBS). This healthcare facility can emulate the Cambridge project reported by Sayah et al. (2014) where the EHR system can be incorporated into the registration process of a patient in the most expeditious way possible. The number of questions asked to a patient can be narrowed down to only capture the most crucial information which is then transferred to the bed registration process. Eventually, once the process of registration is completed it can be easy to make a follow-up on a patient in a coordinative, way with all the clinical teams.
However, there would be a need to ensure that Chamberlain applies the EHR/EMR appropriately and particularly in the segment of patient waiting time. This perception is attributed to the notion that when EHR/EMR is applied in the EDs without proper planning, then it might slow the operations of the medical practitioners as noted by Ward et al. (2014). In fact, in their study, Ward et al. (2014) report a lack of significant differences in length-of-stay in the interval marking the arrival of the medical provider. The researchers concluded that on average, the application of the EHR system in community emergency departments might not change based on the performance measure that an organization is seeking to improve.
Analysis of the Literature
The various findings from the literature review indicate that the problem of patient waiting time leading to LWBS can be mitigated effectively with the implementation of EHR/EMR. The benefits seem to outweigh the disadvantages particularly in terms of cost-saving. In addition, evidence points out that the use of EHR/EMR has the potential to improve the quality of care offered to patients through the mitigation of medical errors, heightened availability of real-time information, and effective clinical decision making (Bates & Gawande, 2003; Sequist et al., 2005). Critically, these are essential components in the emergency department where time is of the essence in handling patients while striving to ensure the quality of patient care. According to the literature, it is possible to establish a patient-centered approach using EHR although with proper management and implementation.
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