Should the digital health record be implemented for all patients?

This essay analyzes the advantages and disadvantages of implementing digital health records for all patients. It explores peer-reviewed research papers to come up with a conclusion. The advantages include improved clinical performance, increased patient participation, and remote access to data. The disadvantages include privacy and confidentiality issues, information overload, and lack of proper exposure in rural areas.

Running head: DIGITAL HEALTH RECORD
Should the digital health record be implemented for all patients?
Name of the Student
Name of the University
Author Note

DIGITAL HEALTH RECORD
Digital Health Technology is defined as a process of electronically documenting the
comprehensive health information of the patients and thereby generating patient-centred
digital records (Levine, Lipsitz and Linder, 2016). According to the reports published by
Jensen, Jensen and Brunak (2012) at present the efforts are being undertaken in order to
increase the application of the electronic health records and thereby increasing the overall
process of clinical care. However, application of the digital health technology or electronic
health records might provide or extract different results under different demographics (Mandl
et al., 2012). The following essay is based on the argument that whether digital health record
can be effectively implemented for all the patients. In executing this argument, the essay will
mainly analyse peer-reviewed research papers published centring digital health technology or
electronic health record. Via analysing the journal articles, the essay will try to fetch
advantages and disadvantages of digital health information technology and subsequently
come up with a conclusion to clarify the argument. The elucidation of the conclusion based
on the topic will further help to personalise the implementation of the digital health
information technology across diverse population.
There are several advantages of the digital health record technology. They study
conducted by Burke et al. (2014), highlighted that application of electronic health record
(EHR) or digital health record helped to improve the overall quality of the outpatient clinical
note along with overall reduction in the manual error during rush hours of the outpatient
department. In order to elucidate the objectives of their research, Burke et al. (2014)
conducted a five and half year longitudinal quantitative study. They compared the
handwritten and electronic outpatient clinical visit note of 100 outpatients with type 2
diabetes mellitus (T2DM). Large sample, size and large tenure of data comparison might be
proved to be very helpful but concentrating over single disease type, T2DM might lead to the
generation of biased results.

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In the domain of clinical benefits of EHR, Murphy et al. (2014) mined the
retrospective data in relation to cancer diagnosis from two large integrated healthcare systems
operating through comprehensive electronic health record. The results obtained through the
data mining algorithm highlighted that the EHR-based triggers can be successfully used to
flag the records of the patients who are lacking follow-up of the abnormal clinical findings
suspicious for cancer. Thus as a whole they concluded that the proper documentation of the
patient data in the digitalised way through the EHR help to detect the potential delays in
cancer diagnosis. This delay in cancer diagnosis is common both among the rural and the
urban communities and thus the implementation of the EHR gains it importance under the
clinical significance of the cancer treatment. However, the research is mainly concentrated
over the delays in colorectal cancer and prostate cancer. Observation over other wide array of
cancer like breast cancer, lung or liver cancer might have helped the researchers to analyse
the effect on EHR on cancer treatment in a comprehensive way.
In relation to the clinical benefits of the EHR, King et al. (2014) conducted a cross-
sectional study. The main objective of their study was to access the clinical benefits of the
EHR on the basis of the physicians experience and report. 78% of US office-based physicians
reported enhanced patient care through remote access of the patient record and at least 65%
reported decrease in the medication error and documentation of the critical lab value. 30 % of
physician reported clinical benefits over diverse group of patient communication and
recommendation for future care. Overall, King et al. (2014) concluded that EHR help to
enhance the overall quality of clinical care. The result is extremely significant because, King
et al. (2014) conducted the research via taking US physicians where the concept of EHR was
first defined and implemented. However, the study is mainly based on the personal opinion
with no reference to any official documentation of the numerals and hence can be
opinionated.

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In order to access the importance of the EHR in patient care, Woods et al. (2013)
conducted a study in order to record the perspective of the patients. The qualitative study
conducted by Woods et al. (2013) was designed to examine the experience of the patients in
accessing their health records based on clinical notes. The theme based study based on
patient’s experience highlighted that visualization of the own health records help to positively
affected their communication with the healthcare providers and also help to increase their
knowledge about their overall health. The five focus group study conducted over patients also
highlighted that the increase in the knowledge about their own health helped to increase the
participation of the therapy plan and thereby increasing their decision making process. The
main strength of this study is it included both the patients and their family members however;
the low sample size that is 30 might be regarded as its limitation.
Druss, Ji, Glick and von Esenwein (2014), conducted a randomized control trial in
order to evaluate the effect of electronic personal health record in the overall quality of the
care in community mental health setting. The study revealed that having personal health
record help in significant improvement in the overall quality of medical care along with
increase in the use of the medical service among the patients. The study also highlighted
personal health record as a cost-effective care medium for the patients with co-morbid and
serious mental illness. The main strength of the study is its study approach that is randomized
control trail with 170-sample size. However, the main drawback of the study is, the
participants were not blinded and hence the outcome can be biased.
Li et al. (2013) used attribute based encryption (ABE) techniques in order to encrypt
patient's file and scalable data of personal health record in the digital health system. The
analysis of the data highlighted that digital health record helps in scalable and secured sharing
of the personal health records through cloud computing. Sharing of patient's data, through
cloud computing, promotes equitable access of the patient's information. The main strength

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of the study it is approach. It used attribute encryption based scanning of the patient's data.
This helped to ensure the privacy and confidentiality of the patient’s information. The main
drawback of the study is, it does not high the total number of patient's whose data was
analyzed via attribute-based encryption.
Thus analysis of the advantages of the digital health record through review of primary
literature have highlighted that Application of digital health record or ELH help to increase
the overall clinical outcome via reducing the chances of medication error. It also showed that
apart from improving the clinical performance the application of EHR also helped to
increased the cancer follow up thereby helping in proper handling of complex disease.
Physicians also reported that use of EHR helped in the remote access of the patient's data and
thereby helping in providing quality care via reducing the time for communication and
hospital visit. From the patient perspective it can be said that access their own health-related
notes helped to increase their indulgence in the overall healthcare plan and thereby helping to
facilitate in the informed decision making process. Thus from the access of the advantages it
can be said that remote access of the data, improved clinical performance and increase in
patient participation in the care plan are the main driving force behind the recruitment of the
digital health record across the diverse section of patient care. However, analysis of the
literature also highlighted several disadvantages of this digital technology in healthcare.
In 2013, Chiang et al. (2013) conducted a population based study in order to access
the result of implementation of EHR in the ophthalmologic department. Analysing the
120,490 clinical encounters via 23 faculty members during the tenure of 3-year study period,
Chiang et al. (2013) highlighted that implementation of EHR was associated with increase in
the overall documentation time along with the increase in the clinical volume and change in
the nature of the ophthalmic documentation. However, change in the documentation process
cannot be highlighted as one of the principal disadvantage of EHR or digital health record.

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Five month long follow up study is the main strength of this research however the study is
concentrated over the ophthalmic healthcare professionals and hence the elucidated results
might not be applicable in other sphere of health care domain.
In relation to the application of the digital health record to all the patients, DesRoches
et al. (2012) are of the opinion that the application digital health record might not be suitable
in the rural areas as the staffs working in rural healthcare shows decrease in the rate of
adoption of the electronic health record. Via analysing the US national survey data in health
record keeping information of patient in rural health, DesRoches et al. (2012) elucidated gaps
in the rate of adoption of the basic record keeping through digital technology in rural areas.
Thus lack of proper exposure of the rural health care staffs, especially the nursing
professionals, towards EHR might make the entire digital process unsuitable for the rural
population.
Estabrooks et al. (2012) conducted quantitative study in order to study the
effectiveness of EHR from patients’ perspective who resides in the underdeveloped regions
or who are the victims of health inequality. The study of Estabrooks et al. (2012) highlighted
that EHR have potential to improve patient care however, this potential might not reach its
zenith among the population who suffers from poor social determinant of health. Moreover,
demographics, patient centred factor and psychological distress hamper the overall
application of the EHR. Thus this study highlighted that in order to comprehensively
implement EHR in areas where poor social determinants of health exist, proper interplay
among the stakeholders like patients, service providers and policy makers are mandatory. The
study of Estabrooks et al. (2012) is extremely significant because it recruited 93 experts to
analyse the effect of EHR among people residing under social determinants in health.
However, the study did not indicate that whether the reviewers were blinded about the
desired outcome of the study.

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In the domain of providing care to patients residing in the rural regions or in the under
developed community it can be said that the application of the EHRs lead to overall decrease
in the effective communication among the patients and the care givers. This is because the
healthcare providers are more engaged in documentation. The analysis of the 125
consultation of the primary care providers indicated that they spent more time in gazing over
the computer rather than consulting with the patients (Street et al., 2014). This has lead to
decrease in the patient satisfaction. One of the main strength of this study is its high sample
size which helped in the generation of less biased results. However, the results are only
concentrated over the primary health care providers and thus can be regarded to be
unidirectional.
According to Harman, Flite and Bond (2012), one of the important barriers in the
equitable access of EHR in the healthcare system is its privacy and confidentiality issue
which restricts is comprehensive application. Caine and Hanania (2012) conducted a research
in order to access patient’s desire for granular level of privacy control on the basis of which
personal health information should be shared. Caine and Hanania (2012) also analysed the
preferences of patient based on sensitivity of the health information. Caine and Hanania
(2012) recruited 30 patients whose health information are stored in EHR and contained
certain sensitive information. The analysis of the interview on the basis of questionnaire
highlighted none of the patients are willing to share all the information stored in their EHR
with all the potential recipients. Patients wanted to share data via granular privacy control.
The main strength of this research helped to highlight the patient perspective in the domain of
privacy control and however, selection of the poor sample size of 30 might be regarded as its
limitations.
In the domain of analysing privacy and confidentiality, Agaku et al. (2013) conducted
a quantitative survey. The survey revealed respondents raising concerns about the breach in

DIGITAL HEALTH RECORD
data privacy and confidentiality in their protected health care information. The multi-variative
logistic regression was used to analyse the data and this can be regarded as the main strength
of the research conducted by Agaku et al. (2013). The research highlighted that breaching of
the privacy is the main concern in comprehensive implementation of EHR or digital health
record across several sectors of patient’s care. However, the study is mainly based on the US
perspective and hence may lead to the generation of insignificant results in other
demographic location.
The study conducted by Singh et al. (2013) highlighted that the primary care
professionals who are using comprehensive EHRs have a tendency to suffer from information
overload. This leads to the miss-interpretation of information. The comprehensive set of
information displayed in the module of the electronic health record creates a problem for the
healthcare professionals to scan or highlight the actual patient’s data and this in turns leads to
gap in the information. In order to analyze the effectiveness of EHR, Singh et al. (2013)
conducted cross-sectional survey of primary care practitioners. The main strength of the
study is its cross-sectional study design. However, in sampling, the author’s have excluded
trainees and subspecialists. However, at times trainees or sub-specialists are asked to review
and summarize the information and due to their lack of proper exposure they tend to commit
more mistakes in comparison to the registered professionals (Ajami & Bagheri-Tadi, 2013).
Hence, it can be said that the sampling is biased.
Baillie et al. (2013) conducted a survey among the nurse and the midwives in order to
investigate their experience of learning the implementation process of digital health record.
The survey highlighted two themes. First is the preparing skills for understanding EHRs and
increase in the involvement in the system process of EHRs. The study mainly highlighted that
before earning to implement digital health technology, proper computer skill is mandate.
Thus, digital health record cannot be implemented globally the nursing professionals

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practicing in remote areas lack basic computer skills. The main strength of the study is its
unique approach. The limitation of the study is its poor sample size.
Thus the main disadvantage include privacy and confidentiality issues, time
consuming digital documentation, lack of effective communication with the patients and lack
of proper knowledge behind the adoption of the digital technology among the rural healthcare
professionals. Moreover, it also highlighted that application of digital health information in
patients of rural or under-developed areas might not provide suitable results due to the poor
social determinants in health.
Thus from the perspective of the contemporary nursing, it can be said that application
of the digital health record is proved to extremely helpful in streamlining the patient
information. This digitalization of data will help in remote access of the patient’s information
and thereby helping to doctors to indulge under immediate decision making process during
emergency time irrespective of their location. Thus from this perspective it can be said that
application of digital health information can be helped for all the patients with a special
mention to the patients residing in the rural areas or underdeveloped regions. However, gaps
in regulating the privacy and confidentiality and increase in the clerical work load (data
documentation) time might results in ineffective application of digital health information over
a comprehensive patient’s population. However, proper patient education about the concept
of EHR and bridging gaps in privacy and confidentiality concerns associated with digital
health information technology will promote overall clinical significance in the healthcare
research.

DIGITAL HEALTH RECORD
References
Agaku, I. T., Adisa, A. O., Ayo-Yusuf, O. A., & Connolly, G. N. (2013). Concern about
security and privacy, and perceived control over collection and use of health
information are related to withholding of health information from healthcare
providers. Journal of the American Medical Informatics Association, 21(2), 374-378.
Ajami, S., & Bagheri-Tadi, T. (2013). Barriers for adopting electronic health records (EHRs)
by physicians. Acta Informatica Medica, 21(2), 129.
Baillie, L., Chadwick, S., Mann, R., & Brooke-Read, M. (2013). A survey of student nurses'
and midwives' experiences of learning to use electronic health record systems in
practice. Nurse Education in Practice, 13(5), 437-441.
Burke, H. B., Sessums, L. L., Hoang, A., Becher, D. A., Fontelo, P., Liu, F., ... & Bunt, C. W.
(2014). Electronic health records improve clinical note quality. Journal of the
American Medical Informatics Association, 22(1), 199-205.
Caine, K., & Hanania, R. (2012). Patients want granular privacy control over health
information in electronic medical records. Journal of the American Medical
Informatics Association, 20(1), 7-15.
Chiang, M. F., Read-Brown, S., Tu, D. C., Choi, D., Sanders, D. S., Hwang, T. S., ... &
Wilson, D. J. (2013). Evaluation of electronic health record implementation in
ophthalmology at an academic medical center (an American Ophthalmological
Society thesis). Transactions of the American Ophthalmological Society, 111, 70.

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DesRoches, C. M., Worzala, C., Joshi, M. S., Kralovec, P. D., & Jha, A. K. (2012). Small,
nonteaching, and rural hospitals continue to be slow in adopting electronic health
record systems. Health Affairs, 31(5), 1092-1099.
Druss, B. G., Ji, X., Glick, G., & von Esenwein, S. A. (2014). Randomized trial of an
electronic personal health record for patients with serious mental illnesses. American
Journal of Psychiatry, 171(3), 360-368.
Estabrooks, P. A., Boyle, M., Emmons, K. M., Glasgow, R. E., Hesse, B. W., Kaplan, R.
M., ... & Taylor, M. V. (2012). Harmonized patient-reported data elements in the
electronic health record: supporting meaningful use by primary care action on health
behaviors and key psychosocial factors. Journal of the American Medical Informatics
Association, 19(4), 575-582.
Harman, L. B., Flite, C. A., & Bond, K. (2012). Electronic health records: privacy,
confidentiality, and security. Virtual Mentor, 14(9), 712.
Jensen, P. B., Jensen, L. J., & Brunak, S. (2012). Mining electronic health records: towards
better research applications and clinical care. Nature Reviews Genetics, 13(6), 395.
King, J., Patel, V., Jamoom, E. W., & Furukawa, M. F. (2014). Clinical benefits of electronic
health record use: national findings. Health services research, 49(1pt2), 392-404.
Levine, D. M., Lipsitz, S. R., & Linder, J. A. (2016). Trends in seniors’ use of digital health
technology in the United States, 2011-2014. Jama, 316(5), 538-540.
Li, M., Yu, S., Zheng, Y., Ren, K., & Lou, W. (2013). Scalable and secure sharing of
personal health records in cloud computing using attribute-based encryption. IEEE
transactions on parallel and distributed systems, 24(1), 131-143.

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Mandl, K. D., Mandel, J. C., Murphy, S. N., Bernstam, E. V., Ramoni, R. L., Kreda, D. A., ...
& Kohane, I. S. (2012). The SMART Platform: early experience enabling
substitutable applications for electronic health records. Journal of the American
Medical Informatics Association, 19(4), 597-603.
Murphy, D. R., Laxmisan, A., Reis, B. A., Thomas, E. J., Esquivel, A., Forjuoh, S. N., ... &
Singh, H. (2014). Electronic health record-based triggers to detect potential delays in
cancer diagnosis. BMJ Qual Saf, 23(1), 8-16.
Singh, H., Spitzmueller, C., Petersen, N. J., Sawhney, M. K., & Sittig, D. F. (2013).
Information overload and missed test results in electronic health record–based
settings. JAMA internal medicine, 173(8), 702-704.
Street Jr, R. L., Liu, L., Farber, N. J., Chen, Y., Calvitti, A., Zuest, D., ... & Ashfaq, S.
(2014). Provider interaction with the electronic health record: the effects on patient-
centered communication in medical encounters. Patient Education and
Counseling, 96(3), 315-319.
Woods, S. S., Schwartz, E., Tuepker, A., Press, N. A., Nazi, K. M., Turvey, C. L., & Nichol,
W. P. (2013). Patient experiences with full electronic access to health records and
clinical notes through the My HealtheVet Personal Health Record Pilot: qualitative
study. Journal of medical Internet research, 15(3).