There is no disputing the electronic health record (EHR) market is undergoing drastic changes and has been doing so for a while now. While these changes have brought on barriers to acceptance, there are continued signs that the use of EHR applications is catching on. However, the pace seems to have slowed and signs point to technology getting in the way instead of helping.
While the market for EHR vendors appears to be dominated by a handful of companies, there are apparently more than 1,000 vendors. These vendors provide a mix of application types. Today, the call to action is ensuring integration with cloud and mobile technologies. However, desktop use remains as dominant as ever. Moreover, the use of paper remains as strong as ever too. So, for the foreseeable future, vendors will need to balance application capabilities. This includes embracing new technologies alongside long-established procedures and workflows. It can be argued that a failure to embrace this need is why adoption is slowing.
To balance providing new technologies alongside legacy capability needs, the capture part of a solution must be comprehensive. In other words, it’s not enough to allow just keyboard-based data entry. Voice dictation and barcode use are growing in importance too. And, document scanning – processing paperwork – remains as critical as ever.
For paperwork, image capture solutions must be flexible to work with different platforms and imaging devices. This includes supporting standards like TWAIN, UVC and more. They also need to serve complementary technologies, such as optical character recognition (OCR) and barcodes. Almost all advanced electronic medical record (EMR – also known as EHR) solutions today should employ image capture, OCR and/or barcode capabilities. OCR is arguably the best method to leverage data from scanned paper documents. Barcodes remain essential to inventory and asset tracking. In a patient record, this could be to track prescriptions or completed insurance forms.
Scanning and inputting documents while sitting by a traditional scanner must be expanded upon. Image capture today must also include on smartphones, tablets, laptops and other such devices where built-in cameras can be leveraged. However, it also needs to happen securely and across cloud and local or remote server platforms.
Balancing Digital and Paper Captures
Medical documents today are often a mix of digital and paper-based documentation. For example, dictation, lab and x-ray results might be available electronically. But, progress notes, provider information, graphic sheets, and doctor’s order might be on paper. Thus, it’s important to have a document capture solution that can integrate both. There are common digital document formats that are must to cover. These include PDF, TIFF, and JPEG so users can seamlessly load image files or be able to view the images in standardized viewers, such as a browser.
When scanning documents, a distributed capture and scanner setup can accelerate capture. A common setup involves a client/server architecture. Users capture data from different terminals and save the data to a central database on a central server. On the client side a desktop-based EHR application can work. But, a web-based EHR application provides flexibility. Done correctly, common industry standards can ensure users can accomplish document captures from common web browsers that exist on almost any device.
Mobile Capture and Security
A web-based EHR approach can more easily allow for mobile captures from devices such as smartphones and tablets. It’s ideal for EHR application designers to start with support for at least iOS 9 and Android 4.4 as system requirements. This is primarily because, according to Apteligent DATA , 98.5 percent of devices are using iOS 9.3 or above. For Android, 95 percent of devices are using Android 4.4 and above. Thus, you stand to have the greatest support for most devices from this starting point.
Keeping data secure is especially important when accessing health information on a personal smartphone or using an EHR that stores all patient data in the cloud. Security protocols must be meticulously followed when implementing new EHR upgrades or features. Any risks should be documented and addressed in your hospital’s HIPAA risk assessment.
We recommend minimum security as indicated in research done by Universidad de Valladolid, in Spain. These security recommendations are applicable worldwide. For example, access control should be user-centric whereby the patient is in charge of allowing or disallowing who has access to their medical record. To protect user identification and password authentication procedures, keys that are 256-bit are ideal.
Other recommended security measures to consider should also be for data transfers. It’s ideal to use TLS with 256-bit encryption during transfers online. Check out the research for complete recommendations. Also, be sure your vendor contracts have clear language that states the vendor’s responsibility in case of a data breach. There should also be defined clear steps you both will take to resolve any problems.
OCR and Barcodes to the Rescue
A common barrier to acceptance of EHR applications is an inability to meaningfully use content in an image. For example, if an ID is scanned and captured as a JPEG, that’s great but, the information on it requires manual entry to use. Here’s where OCR and barcodes can help foster more acceptance of EHR applications.
A proper EHR solution should automatically generate PDF files that convert image content to text which is searchable and can be edited. With these capabilities, the system can also use meta data for PDF or TIFF files to enable auto indexing and other content management capabilities. These features save staff time from manual data entry and combing through physical files for information. It’s also proven to reduce errors.
Barcodes are already known to help streamline a patient’s admittance process, medication ordering and tracking, and to identify patients throughout a hospital stay. Barcode wristbands are typically created at the point of admission, and specific patient information is continually updated. Medical records, medications, specimen samples, and more are tagged with a barcode label. Barcode technology is commonly used because it helps makes sure the correct treatment is administered to the right patient at the right time, ultimately reducing errors and helping ensure patient safety.
There are mainly two types of barcodes, 1D and 2D barcodes, and many different types of 1D and 2D barcodes too. A 2D barcode can store much more data, generally thousands of characters compared to around a couple of dozen or fewer characters in 1D barcodes. If you want to identify a customer with their ID or name, a 1D barcode would suffice. If you’re looking to include more data, you’ll want to start looking into 2D barcodes. For example, a 2D barcode might also let you include prescription information such as the name, expiration dates, batch numbers, and more.
Getting Buy In
These key features are a foundation for getting patient and user acceptance. For patients, it helps administrators easily lay out key benefits, such as efficiency gains during routine visits and security and control the patient will have over their EMR. For staff, it becomes easier to demonstrate how it adds convenience and speed to their daily workflow procedures. But, educating patients and users about this, and gaining their acceptance, has to start with a solid EHR system that can deliver each time its used.