Question

1. have carefully crafted paragraphs,
2. be at least 250 words,
3. show connections to course concepts, and
4. demonstrate critical thinking.

Explain the role that policy has played to improve and expand electronic health records and explain why it is important for a student in this course to understand these issues.

Answer 1

In the current senario electronic health records play a vital role.The students have to learn about this during their study period itself, because while starting the clinical duty it will be more easy for them to manage critical situations and can avoid errors.Through this way they can provide a quality health care services for their customers.

Critical thinking is the ability to think clearly and rationally, understanding the logical connection between ideas. Critical thinking has been the subject of much debate and thought since the time of early Greek philosophers such as Plato and Socrates and has continued to be a subject of discussion into the modern age, for instance the ability to recognise fake news.

Critical thinking might be described as the ability to engage in reflective and independent thinking.

In essence, critical thinking requires you to use your ability to reason. It is about being an active learner rather than a passive recipient of information.

Critical thinkers rigorously question ideas and assumptions rather than accepting them at face value. They will always seek to determine whether the ideas, arguments and findings represent the entire picture and are open to finding that they do not.

Critical thinkers will identify, analyse and solve problems systematically rather than by intuition or instinct.

Someone with critical thinking skills can:

Understand the links between ideas.

Determine the importance and relevance of arguments and ideas.

Recognise, build and appraise arguments.

Identify inconsistencies and errors in reasoning.

Approach problems in a consistent and systematic way.

Reflect on the justification of their own assumptions, beliefs and values.

Critical thinking is thinking about things in certain ways so as to arrive at the best possible solution in the circumstances that the thinker is aware of. In more everyday language, it is a way of thinking about whatever is presently occupying your mind so that you come to the best possible conclusion.

The Skills We Need for Critical Thinking

The skills that we need in order to be able to think critically are varied and include observation, analysis, interpretation, reflection, evaluation, inference, explanation, problem solving, and decision making.

Specifically we need to be able to:

Think about a topic or issue in an objective and critical way.

Identify the different arguments there are in relation to a particular issue.

Evaluate a point of view to determine how strong or valid it is.

Recognise any weaknesses or negative points that there are in the evidence or argument.

Notice what implications there might be behind a statement or argument.

Provide structured reasoning and support for an argument that we wish to make.

The Critical Thinking Process

You should be aware that none of us think critically all the time.

Sometimes we think in almost any way but critically, for instance when our self-control is affected by anger, grief or joy or when we are feeling just plain ‘bloody minded’.

On the other hand, the good news is that, since our critical thinking ability varies according to our current mindset, most of the time we can learn to improve our critical thinking ability by developing certain routine activities and applying them to all problems that present themselves.

Once you understand the theory of critical thinking, improving your critical thinking skills takes persistence and practice.

Try this simple exercise to help you to start thinking critically.

Think of something that someone has recently told you. Then ask yourself the following questions:

Who said it?

Someone you know? Someone in a position of authority or power? Does it matter who told you this?

What did they say?

Did they give facts or opinions? Did they provide all the facts? Did they leave anything out?

Where did they say it?

Was it in public or in private? Did other people have a chance to respond an provide an alternative account?

When did they say it?

Was it before, during or after an important event? Is timing important?

Why did they say it?

Did they explain the reasoning behind their opinion? Were they trying to make someone look good or bad?

How did they say it?

Were they happy or sad, angry or indifferent? Did they write it or say it? Could you understand what was said?

Read more at: https://www.skillsyouneed.com/learn/critical-thinking.html

Introduction

Translation of ancient Egyptian hieroglyphic inscriptions and papyri from 1,600-3,000 BC indicate the use of medical records. However, paper medical records were not steadily used until 1900-1920. Medical record, medical chart, and health record are different terms used to describe the documentation of a patient’s medical history and care. In recent years, the term health record has received prominence based on the fact that a patient’s medical information should include health and lifestyle information beyond just episodic medical encounters. Traditionally, health records were written on paper, maintained in folders divided into sections based on the type of note, and only one copy was available. New computer technology developed in the 1960s and 1970s laid the foundation for the development of the Electronic Heath Record (EHR). The use of EHRs has not only made patients’ medical information easier to read and available from almost any location in the world, but also changed the format of health records, and thus changed health care.

Thousands of published studies report on EHRs increasing use, clinical decision support’s (CDS) ability to improve or not improve the healthcare process or clinical outcomes, evaluation methods, implementation/adoption, clinical trial patient identification, numerous new applications, and unintended consequences. Information on specific studies is beyond the scope of this paper and not included. For the 25th anniversary of the Yearbook of the International Medical Informatics Association (IMIA), this paper focuses on the overall state and use of EHRs in 1992 and how they have evolved by 2015. This paper also discusses the expectations for EHRs in 1992 and which of these were realized, what events accelerated or disrupted/derailed EHR evolution. Finally, we will discuss the expected state of EHRs in the 25 years.

State of EHRs in 1992

Initially, EHRs were developed and used at a number of academic inpatient and outpatient medical facilities, but none contained all the information in the paper chart and most EHRs today are still a hybrid collection of computerized and paper data Some EHRs developed between 1971 and 1992 were developed with hierarchical or relational databases, around or added to hospital billing and scheduling systems while others such as COSTAR, PROMIS, TMR, and HELP were developed as clinical systems to help improve medical care and for use in medical research. While some EHRs were developed on minicomputers, most were initially developed on large mainframe computers and in either case had limited storage, which required the use of removable disk packs and/or tape for extra data storage, nightly downtimes for database back-up, and dedicated/wired terminals. Only a few early EHRs allowed physician entry of orders, prescriptions, and notes and data entry was through keyboards focused mostly on laboratory and medication review While usually hospital-based, many of the early EHRs had features and functionalities that are still used and important today.

Capabilities and use of EHRs in 1992 and 2015

EHRs in1992-State of the Art

Mostly developed and used at academic centers
Hybrid of paper and electronic data
Hierarchical and relational databases
Based around billing and scheduling systems, some clinical systems
Large mainframe and minicomputers with limited data storage
Personal computers with graphics used as monitors
Data entry through keyboards and mouse
Used in inpatient & outpatient facilities
Local area networks & Internet, web-based
Admitting, pharmacy, laboratory, microbiology, surgery, radiology, respiratory therapy, infectious diseases, radiology, nurse charting, physician notes/orders/consults, patient measurements, patient care procedures, electrocardiogram, echocardiography
Image scanning
Paper printouts
Clinical Decision Support
Computerized Provider Order Entry
Drug references, clinical manuals, textbooks of medicine, literature searching
Physician documentation & electronic signatures
Health Level Seven/IEEE P1157
Universal Medical Language System
Medical device interfaces
Picture Archiving and Communication Systems (PACS)
Wide area networks
Ethical issues: data ownership, data liability, informed consent, security and privacy

EHRs in 2015-Differences

EHRs used in primary care rooms and by insurance companies, nursing homes, hospice, homeless population, departments of corrections
Mostly vendor EHRs
Personal Health Records interfaced to EHRs
Intra-facility data sharing with standards more common
Data mapping to SMOMED & LOINC
Digital pathology, mental health, external labs, e-prescribing, order-sets, family history, genetics, biobanks, biosurveillance, public health
Increased Clinical Decision Support
Natural Language Processing
Big Data
Mobil devices
Open-source EHRs
Digital identities
Enterprise Data Warehouses; birth to death data
Increased EHR education
Infobuttons
Cloud computing
Alerts via email, pagers/cell phones
Copy and paste; note bloat
Unintentional consequences
Interfaces to medical libraries
Medical scribes
Technical issues overshadowed by procedural, professional, political, social and especially ethical issues and the need for compliance with standards and information security
Significant increase in EHR related publications

Design and capabilities of EHRs in the next 25 years

Flexible component-based architectures
Not shaped by paper-chart thinking
Based on human-technology integration factors
Clinicians will have greater control of the EHR customization resulting in greater fit to their needs and preferences
Intuitive graphical user interfaces
Totally electronic and clinician approved
Based on internationally accepted standards
Built in Health Information Exchange capabilities with pluggable application programming interfaces and open services.
Pluggable, interchangeable and API based patient specific clinical decision support modules not dependent on EHR versions and updates.
Built-in infrastructure to monitor and learn from adverse events and errors and potential adverse events and error.
Complete access and use via mobile devices
Extensive use of voice recognition
Improved data entry applications
Improved recognition and reduction of alert fatigue
Improved computer diagnosis
No data duplication across all continuity of care
Measured reductions in clinician time
World-wide access with secure information across all platforms
Imbedded natural language processing
Imbedded foreign language translation with preservation of clinical meaning.
Birth to death data storage coupled with enterprise data warehouses
Complete genetic data storage with result interpretation
Ability to synthesize fragments of evidence documented in the entire record to understand the etiology of a disease and its clinical manifestation in individual patients.
Big data storage and analysis needed for precision medicine and forecasting, predictive modeling, and decision optimization.
Major contributor for a learning health system
Increased patient access and control
Interfaces for biosensors for improved patient monitoring
Extended capability for population health
Increased use for medical research and education
Increased use of cloud technology
Increased use, storage and access of social, economic, behavioral and environmental data
Designed by clinicians and developed by those with medical knowledge (Medical Informaticists)
Longitudinal based record; birth to death. Not encounter/billing based
Domain knowledge to identify relevant parts of the record to display
Increased development and use of “infobutton” like technology

While the goal of creating integrated EHRs is within our reach, its success will depend chiefly on the creation and especially adoption of standards by all international parties . HIE which will enable data integration, semantic interoperability, and CDS across multiple EHRs has been a desired but largely unattained aim of clinical informatics, especially in commercial EHR systems . The opportunity for enabling such scalable CDS will require vendor-supported, web-based CDS development platforms along with vendor-supported application programming interfaces (APIs) allowing the use of innovative, pluggable, interchangeable, and API-based CDS applications. This will probably require initially using custom EHR APIs and then moving towards standardized EHR APIs which are already starting to be supported by major commercial EHR vendors . Web applications that run on the Substitutable Medical Apps, Reusable Technologies (SMART) platform are starting to be used. The SMART platform is an example of an emerging framework that enables EHR systems to behave as “iPhone like platforms” by exhibiting an API for easy addition and deletion of third party applications .

Genetic testing has had limited impact on routine clinical care. Widespread adoption of future EHRs will provide the needed methods of disseminating genetic testing into diverse care settings . However, the successful integration of genomic data will require significant redesign of existing EHRs. The future EHRs will be able to manage the size and complexity of genetic test results, use standards for combining clinical and genetic data, and eliminate the current limitations in the capacity to store and analyze genetic data. Related challenges of the uncertainty in the interpretation of results and privacy concerns specific to genetic testing will be resolved and EHRs will provide the genetic, environmental, and lifestyle data needed for precision medicine and the improvement of patient care .

The capabilities of NLP will continue to advance and its use will be needed to code the increasing dictated free-text produced by the concomitant advances and use of voice recognition. Data storage capabilities to handle the massive amount of patient information will increase as storage capacities will increase and the related costs decrease. Transforming clinical data into knowledge to improve patient care has been the goal of biomedical informatics professionals . With the increase in the amount of electronic healthcare data, the potential for knowledge discovery will be substantial if data are managed in innovative and effective ways . Some data sets will be so large or complex that traditional data processing applications will be inadequate. This will require the creation of new big data applications especially for data sharing. Analyses of this “big data” will provide the next step to transform healthcare data into actionable knowledge.

Displaying large amounts of irrelevant patient information can lead to information overload and user error. Next-generation interfaces for EHRs will use CDS to synthesize fragments of evidence documented throughout the entire record to understand the etiology of a disease and of its clinical manifestation in individual patients. Context-based EHRs will employ biomedical ontologies and disease models as sources of domain knowledge to identify relevant parts of the record to display . Usability, the ultimate goal of recording and managing patient data, will require improved technical considerations in addition to appropriate methodologies for medical data management . Since EHRs will continue to have the potential to increase medical errors, built-in EHR applications that detect physician-level usage of EHR features, and clinical simulations will be needed to analyze human-computer interaction in real healthcare settings . As EHRs continue to change and improve, engineering and reengineering will still be needed in order to increase their beneficial potential while at the same time improve their safety.

The fundamental role and purpose of the EHR in the future will be a data repository based on international standard APIs for the retrieval and storage of data. It will be coupled with facility and vendor provided, and user selected applications for data review and entry and especially CDS. In addition to health data, social, economic, behavioral, and environmental data will play a vital role in providing and especially improving healthcare. The applications will be interchangeable, not dependent on EHR versions and updates, and will facilitate innovation like the current Smart Phone applications .

EHR safety concerns involving both unsafe technology and unsafe use will persist in the future. Mounting pressure will require EHR implementations to build a robust infrastructure to monitor and learn from adverse events, errors, and potential adverse events and errors . These errors will be electronically and securely reported to a centralized, nonpartisan body (like a patient safety organization) whose purpose will be to find ways for future prevention rather than punishment .

Tourism as well as international business travel creates health risks for individuals and populations . International HIE standards like those proposed by the International Medical Informatics Association will provide travelers with their complete personal medical information interfaced with their primary EHR . This information will be available on mobile phones and other future mobile devices. Applications will allow that information to be securely uploaded to any standards-based EHR using state of the art cloud-like technologies to provide current medical care. New information, including patient entered, will be stored in the primary EHR . This will be coupled with tele-health which will allow the patients’ primary care physicians to directly see and communicate with other healthcare providers in urban as well as rural areas worldwide through computerized language translation and the preservation of clinical meaning . Thus, it will be necessary to develop specifications for privacy and trust agreements between international partners .

Use of mobile devices with high-resolution cameras by clinicians to capture images from the bedside and incorporate them into the EHR will increase. However, secure and efficient ways to manage and share digital images are lacking to date. Future clinical image applications should more closely link clinical images and documentation and should consider enabling secure transmission over public WiFi or cellular networks. The capability to share data and harness their potential to generate knowledge rapidly and inform decisions will have transformative effects improving health. The infrastructure to achieve this goal at scale --marrying technology, process, and policy-- is commonly referred to as the Learning Health System . We have been extremely fortunate to have the foresight and perseverance of a number of early biomedical informatics pioneers. While, we hope for a totally electronic and clinician accepted EHR within the next 25 years, we’ll have to wait and see. However, based on the current growth in education and training of numerous talented and innovative people, the future looks bright.