Table of Contents
- See Chai Carol Chan, academic clinical fellow in general practice1,
- Ana Luisa Neves, clinical senior lecturer in digital health1, director2,
- Azeem Majeed, head of the department of primary care & public health1
- Twitter: @carolchancarol @Azeem_Majeed @ana_luisa_neves
The introduction of electronic health records (EHRs) has been one of the most significant changes in how healthcare is delivered.1 While EHRs have brought many benefits to the NHS, for patients and clinicians, they have also created substantial challenges that require careful consideration and actions to tackle them.
EHRs have revolutionised medical records by making them more legible, accessible, and secure.2 Gone are the days when patients’ paper medical records were often missing, leading to difficulties in patient management and the need for multiple appointments. EHRs now enable clinicians to access patient records from anywhere at any time, streamlining the provision of care to patients in different locations; and enabling innovations such as remote consultations and sharing of records with clinicians working in different healthcare providers.
The societal impact is equally important, as the digitisation of healthcare data paved new avenues for research and secondary uses of healthcare data. Capitalising on big data analytics, routinely collected healthcare data are now used to generate new knowledge with implications for quality monitoring, care delivery, and health services research.3 Another key impact on society is in allowing patients to access their own medical records.4 This potentially allows patients to be better informed about their healthcare; facilitating shared decision making and improving health outcomes.4
However, the implementation of EHRs has also led to substantial challenges for clinicians and healthcare providers.5 EHRs have forced clinicians to modify their working patterns, which can be frustrating for them when it is perceived as them having to adapt to the EHR rather than the EHR supporting them to provide more efficient and better quality of care. Fragmentation of EHRs—with elements of the medical record being held on different IT systems—and suboptimal interoperability across multiple different systems impose an administrative burden; as well as increasing clinician workload and fatigue. This can ultimately result in risks to patient safety and increased healthcare costs.6 The increased use of technology in healthcare can also sometimes result in decreased interaction between clinicians and patients, as clinicians are often focused on reading data entries and entering new data into the EHR.
Cybersecurity is another substantial concern in the use of EHRs, as data breaches can compromise patient privacy and confidentiality. In 2017, the ransomware attack “WannaCry,” led to substantial disruption in the NHS, which included, among other negative impacts, reverting to manual processes to report blood test results and add entries to clinical notes, cancelling outpatient appointments and, for some affected acute NHS trusts, the diversion of emergency ambulances to other hospitals.7
Additionally, major IT failures, like those experienced during the heatwave in the summer of 2022, pose threats to the EHR system.89 Cyberattacks and data breaches can also erode patients’ trust in current EHR systems.10 They also create additional pressures on healthcare workers and can reduce the efficiency of healthcare delivery, for example by lengthening consultations. As we continue to rely on technology as an integral component of healthcare service delivery, it is important that healthcare providers take appropriate measures to protect patient data and prevent data breaches and disruption of health services delivery.
Despite these challenges, EHRs are here to stay. It is vital that these systems are designed to minimise the burden on clinicians while maximising the benefits to healthcare providers and patients.11 Research efforts should focus on understanding and tackling the current inefficiencies of EHRs, to pave ways for improved methods of entering and retrieving patient data. Ultimately, the ongoing development of EHRs and other technological advancements must always prioritise patient care and safety. This requires designing responsive IT systems that encourage input from staff and patients and iteratively incorporate their feedback. It is crucial that both healthcare professionals and patients are provided with time and resources to learn to use EHRs effectively and provide feedback when necessary to improve their design.
EHRs have great potential to enhance the quality and efficiency of healthcare delivery. To maximise their benefits and mitigate potential drawbacks, it is essential to prioritise implementation and staff training; foster collaboration between healthcare providers, EHR developers, and patients; and invest in research to overcome existing implementation challenges. This also includes adequate support and investment in areas such cybersecurity and resilient IT systems that minimise “downtime” when EHRs and key IT functions are unavailable. By focusing on these aspects, we can harness the full potential of EHRs to improve patient care in the era of digital healthcare.
Footnotes
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Conflict of interest: ALN and AM have received funding for research on EHRs. The authors declare no other conflicts.
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Acknowledgments: Imperial College London is grateful for support from the NW London NIHR Applied Research Collaboration. The views expressed in this publication are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.
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Provenance and peer review: not commissioned, not peer reviewed.
References
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Care D of H and S. The future of healthcare: our vision for digital, data and technology in health and care. Uk government policy paper. 2018.
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Smart W. Lessons learned review of the WannaCry ransomware cyber attack. Department of Health and Social Care: London, UK. 2018;1:10-1038.
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Leana Hosea. Guy’s and St Thomas’ systems hit by “ludicrous” heatwave. BBC. 2022 Jul 30;
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Campbell D. This article is more than 9 months old London NHS trust cancels operations as IT system fails in heatwave. The Guardian. 2022 Jul 22
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