Electronic health records have brought a lot of revolution in the health industry (Jin et al., 2011). It has enhanced the care and safety of patients and in addition, it has enabled many heath care facilities to save millions of dollars. In as much as we celebrate the fact the electronic health records have improved service delivery, it is important to understand that the benefits have not been enjoyed fully as there are some loopholes that have prevented the maximization of the benefits (Jin et al., 2011). Apparently, the implementation of the electronic medical records has faced series or trials and challenges within the health sector. The greatest challenge regarding these products of technology concerns the protection of patient records and information, which is indicated by the law as a requirement. The need to protect patient information has posed serious challenges to the implementation of the EHR system because it has led to the denial of patients to access their medical records. Some opponents argue that if patients are allowed to access their medical records using the EHR systems, there are high chances that their confidential information will be exposed, which will impact their safety and efficiency of service delivery in the health care facilities (Jung et al., 2012).
The purpose of this research is to generate information on whether patients should have access to their electronic medical records. The research shall provide objective arguments with respect to the topic. Without taking any sides, the researcher shall objectively evaluate the pros and cons of allowing the patients to access their medical records.
TABLE OF CONTENTS
Definition of Terms …………………………………………………………………..…………4
1.0 CHAPTER ONE…………………………………………………………………………….5
1.1 Introduction …………………………………………………………………………………5
1.2 Background of the study ………………………………………………………………….…5
1.3 Secondary Research…………………………………………………………………….……5
1.4 Project Approach and Methodology………………………………….…….………….….. 6
1.5 Implications of Research………………………………………………………….…….…..7
1.6 Project Implications………………………………………………………………………….8
1.7 Implementation Plan…………………………………………………………………………8
2.0 CHAPTER TWO: Literature Review …………………………………………….…….…..9
2.1 Understanding Electronic Health Records…………………………………………….….…9
3.0 CHAPTER THREE: Research Design………………………………………………..…….12
4.0 CHAPTER FOUR: Results and Implementation Plan …………………………………..…14
4.1 Benefits of Patient Access to Electronic Health Records …………………………………..15
4.2Challenges to Access and Use of Electronic Health Records……………………………..…16
4.3 Implementation plan………………………………………………………………..….……16
4.4 Professional Guidance and Legal Background of Patient Access to EHRs …………….…16
4.5 Security, Registration and Authentication of Information……………………………….…17
4.6 Personal Reflection …………………………………………………………………..……..18
5.0 References …………………………………………………………………………………..21
Definition of Terms Used
EHRs: Electronic Health Records
PHRs: Personal Health Records
CDO: Care Delivery Organization
1.0 CHAPTER ONE
An electronic health record (EHR) is a longitudinal record of health data/information that is compiled from different encounters that a patient comes upon (Berry et al., 2014). The data enables the health care givers to improve the services that they give to the patients. Electronic health records are beneficial in the health sector because they reduce the time spent in gathering relevant information about a patient. This is because they are permanent and cannot be lost easily. When a health care facility gathers and incorporates the health data of a person in their systems, the facility will be able to provide the best service to the patient (McAlearney et al., 2015).
For a significant period of time, the use of clinical informatics and electronic medical records has been voted as the best ways of improving service delivery. Basically, the approaches support several care-related activities either directly or indirectly, which include evidence-based support, quality management, and the reporting of results (Berry et al., 2014).
1.2 Background of the Study
Problem statement: The use of Electronic Health Records eliminates the lengthy and complex procedures that patients go through in healthcare institutions.
The provision of effective patient-centered care demands the education of patients and their families about the use of electronic medical records (Berry et al., 2014). That is to say, the patients and their family members should be trained and supplied with relevant tools that will enable them initiate self-governing and informed decisions about their health. Previous research indicates that unless patients are allowed to access their own health information, they will not be able to make informed decisions about their healthcare. It is a fact that nurses and doctors play significant roles in the provision of health care but patients and their families should also be given chances to make contributions in the healthcare. Ultimately, nurses have always been instrumental in the implementation of HER systems but their efforts may not produce the best results if the patients are not allowed to play their roles (Jung et al., 2012).
Many authors have endorsed the idea of allowing patients to access their own medical records. For instance, Nancy Berlinger of Hastings Center argues that patients should be granted the right to information about themselves (Fleisher & Dechene, 2004). Consequently, they should always be provided with truthful information about their health. From Nancy’s arguments, it is evident that denying the patient any information that concerns his/her life is punishable. She concludes by explaining that patient’s access to their health information is beneficial because it may ease the confusion and worry, which will reduce the workload for nurses and doctors (Fleisher & Dechene, 2004; Furht & Agarwal, 2013).
Stephen E. Ross and Chen-Tan Lin in their article “The Effects of Promoting Patient Access to Medical Records”, explain that while the promotion of patient access to medical records brings lot of benefits, there are also some drawbacks that may result. However, the benefits outshine the drawbacks and therefore, patient access to medical records should be encouraged in the health sector. The results and arguments that have been raised about Electronic Health Records form the topic of this research. The study seeks to discern the myth that surrounds patient access to their health records. Specifically, the study will weigh the benefits and drawbacks while at the same time suggesting the ways in which the drawbacks can be eliminated (Furht & Agarwal, 2013).
1.3 Secondary Research
The use of technology in the health sector is not a new development. As such, the use of electronic health records is not new as it has been embraced in various healthcare institutions in different parts of the world. In that case, the findings of this study shall be based on the rich information that is contained in online journals, books, health reports and health magazines. Similarly, much of the information shall be collected from reviews and tutorials that have been prepared by health experts. Here is a list of resources that will be considered during the completion of the thesis:
- Online libraries, which include Ebscohost and Emerald
- Google books
- Reputable websites such as the World health Organization
- Health journals
- Reports compiled by healthcare practitioners.
The process of collecting information shall be carried out in an objective manner because the findings of this study are intended for use by future medical practitioners and researchers. Hence, all sources that will be used are reputable and relevant.
1.4 Project Approach and Methodology
The project approach and methodology that will be used during the preparation of this thesis shall comply with the standards and requirements that have been defined by the University. The project shall feature all essential components of a thesis, which include chapters 1 to 4. Similarly all essential components of the chapters shall be included. The researcher shall commence by introducing the topic, where he will discuss the background and the reasons for the study. This is intended to equip those who will read the thesis with prior knowledge of what the entire project talks about. Thereafter, a review of related literature shall be carried out. Review of literature is an important component of the researcher because it is where background information about the study is provided. Finally, the findings of the study shall be discussed to facilitate the generation of conclusions and making recommendations.
1.5 Implications of the Research
The procedure and process that is involved in the access of patient information is lengthy and tiresome. Hence, it calls for the need to put in place measures that will improve their access. Ease in access not only improves service delivery but it also brings and encourages the contribution of patients in their service delivery. The findings of this study are intended not only to improve the care of patients but also to troubleshoot some of issues that have impaired service delivery to specific groups of persons. Additionally, the findings shall be used to verify whether service providers can help build confidence in their patients. The implications and results of allowing patients to access their health records electronically have been witnessed in different parts of the world. Hence, the findings act as a sensitization to states and countries that have been reluctant to adopt this product of technology.
1.6 Project Limitations
This is a lengthy research that considers all sectors in health care provision. As such, the findings are general and may not fully fulfill the needs of specific sectors. For instance, the impact of access to health records among the old may not be necessarily similar to those of youths. Consequent, this study was not carried out on a specific institution and therefore the findings need to be verified by relating them with what really happens in health care institutions.
The limitations, however, sets the ground for further research, which makes the research relevant and multidirectional in the sense that other researchers can used it as reference in their research.
1.7 Implementation Plan
|Selection of Topic||2 weeks|
|Literature review||2 months|
|Collection of data||1 month|
|Analysis of data||1 month|
|Making conclusions and recommendations||2 weeks|
2.0 CHAPTER TWO: LITERATURE REVIEW
2.1 Understanding Electronic Health Records
Normally, patient health information is scattered across the desks of many service providers and health care facilities. When a patient visits a new doctor or member of health care team, he/she will be taken through a lengthy process of filling personal and health information in a system, especially where the system has no links to other databases where patient information of contained (Fleisher & Dechene, 2004). For instance, in a new hospital, patients are taken through repeated tests and repetitive discussions and cross examinations, which may be irritating. The repetitive processes can be ignored if there is a central repository of information. In cases where there are no central repositions of data, patients are bound to incur high costs. The costs also spill over to the government and the health insurance firms.
Traditionally, health information is stored in chapter files that cannot be organized to facilitate sharing with others (Standing, & Cripps, 2015). Similarly, such data is not standardized, a scenario that may lead to misplacement and loss of information. In an attempt to reduce the problems associated with the traditional storage of information, the adoption of modern technology as led to the electronic storage of health records. The goals of the integration and use of EHRs is to reduce the cost of service delivery, which is normally directed towards the patient, the government and the health insurance firms (Fleisher & Dechene, 2004). Electronic Health Records, also Known as Electronic Medical Records, are computerized charts that allow medical facilities to compile patient information in to a common system. The goal of EHR is to improve patient flow in the medical setting.
The use of modern technology in the health sector has grown over the years (Fleisher & Dechene, 2004). This has strengthened the delivery of services. Research has shown that allowing patients to access their own medical records is paramount for the improvement of service delivery. It encourages patients to be involved in their healthcare management. Health care institutions should therefore put in place measures that will improve patient access to medical records. In order to understand the importance of EHRs, it is vital to get an idea of what PHRs are so that confusion between the two terms can be eliminated (Fleisher & Dechene, 2004).
Personal Health Records (PHR) systems are developments that have been created to assist in tracking the EHRs from different encounters. These systems have been singled out as the most effective options for empowering patients in their own health care. The principle behind the promotion of the systems is that patients tend to understand and adhere to the rules and instructions that are given by caregivers when they are given a chance to access their health information. From this information, PHRs can be defined as electronic applications that allow patients to access manage and share their health data in a secure platform. The systems allow the patients to access and coordinate their health information thus making it available to those who need it. EHRs are different from PHRs because data in EHR care are controlled by medical providers while in PHR; the data is managed and controlled by the patient (Furht & Agarwal, 2013).
Nowadays, the term “electronic health record” is common in the healthcare setting (Standing & Cripps, 2015). It is used to describe the comprehensive and longitudinal collection of patients’ healthcare and health information. It is composed of data that is not only relevant to a patient’s treatment but also that relates to the patient’s health in general. According to the proponents of this modern development, the patient should always be considered an active partner in healthcare. As such, he/she should be considered in the assessment, addition and management of his/her health data. In that way, effective healthcare services will be achieved (Furht & Agarwal, 2013).
As a way of improving quality and effectiveness of healthcare, giving the patient a chance to contribute in the treatment process is paramount. Modern challenges in the healthcare provision can only be eliminated if patients are allowed to access their electronic health records. Specifically, the allowance of access to EHRs is vital in the reduction of the costs incurred by patients. The cost issue has played significant roles in the development of EHRs. Another reason for the use of EHRs is the need to achieve cross-border interoperations on both the semantic and technical levels. From the arguments, it can be deduced that if EHRs are implemented fully, the quality of healthcare and provision of support to all stakeholders in the healthcare shall be achieved (Staroselsky et al., 2006).
Apparently, sharing of medical records through EHR systems, especially radiology imaging databases with the CDOs will reduce medical redundancies, exposure to harmful radiations and reduction of medical costs to patients (Castellani et al., 2015). Additionally, the systems will empower the patients. Another instance that explains the importance of allowing the patients to access the medical records is that it will enable them to develop good relationships with the health care service providers. As such, they will develop an idea of where they want to be referred to during treatment.
3.0 CHAPTER THREE: RESEARCH DESIGN
Summary of the Thesis Statement and Purpose of the Research
There is plenty of literature review on the topic and the study shall rely on secondary sources are the main source of information. As such, the research design involves the review of published research. The published researches that will be analyzed include clinical notes, surveys of patients and health care givers and studies that have been conducted previously. In the end, the researcher shall give a justified recommendation on the research topic. The findings of this research are intended to provide an insight to the subject matter. Policy developers, health care practitioners and investors shall obtain a lot of help from this research.
Similarly, by gaining access to their health information through the EHR systems, the patients can plug data from the electronic health records into the increasing number of e-health tools and apps, which will further enhance their personal wellness even when outside the context of normal healthcare (Standing & Cripps, 2015). For instance, tools such as digital scales and pedometers will enable them to tract their health info. On the other hand, a health application on smartphones will provide information that will boost the courage and knowledge about the health conditions. It is also important to understand that gaining access to health information is paramount when finding emotional support and definition of health goals. This is because the patient will get to understand how to improve his/her health condition irrespective of whether the healthcare givers are present or not. Research studies confirm that more than 80% of Americans who have access to their EHRs use it and they have always given positive reviews about the impacts that the records bring in their lives. In summary, more than 75% of Americans who do not have access to their electronic health records are optimistic that they will gain access in good time. This is a clear indicator that many people in the United States are aware of the benefits of accessing the Electronic Health Records (Castellani et al., 2015).
Different perspectives can be given as to how to service delivery can be improved. For instance, the system will enable the patients to check the results of medical checkups, which leads to the elimination of inconveniences and costs of having to visit the service providers. For example, patients whose conditions are being monitored will not have to abandon their daily duties as they will be able to provide relevant records and information to various doctors (Castellani et al., 2015).
Access to Electronic Health Records facilitates sharing information with those that we wish to share the information with. For instance, patients can share relevant information with their relatives and this will speed up the provision of assistance. In light of this, it is evident that access to the information is convenient. For many people, especially the doctors, time is always a limited resource. Much time will be saved if repeats are used instead of starting the whole processes over and over. Blood results, x rays and medical letters never change and if such information is accessible by the patient, the service delivery will be fast and smooth (Thirukumaran et al., 2015).
3.1 Ethical consideration
Credit shall be given to everyone whose data and information has been used in this report. Appropriate referencing and the use of in text citation shall be considered at all times so that the problem of plagiarism is avoided. In case, individuals and organizations are used, their real names shall be withheld and the information that is sourced from them shall be used for research purposed only.
4.0 CHAPTER FOUR: RESULTS AND IMPLEMENTATION PLAN
Problem statement: The use of Electronic Health Records eliminates the lengthy and complex procedures that patients go through in healthcare institutions.
Hospitalized patients should be allowed to access their electronic medical records (Castellani et al., 2015). In many countries, everyone has a right to access information that is held by doctors and other health providers. Despite the fact that access to the records should be granted to any patient, it is surprising to learn that some health care providers do not grant this right to their patients. For instance, about 41% of Americans have been reported to find challenges in accessing the health care information (Castellani et al., 2015).
4.1 Benefits of Patient Access to Electronic Health Records
One of the most important benefits that accrue from patient access to health record is that it facilitates better communication with service providers and peers. In that case, the patients shall be able to understand their health as well as the treatment options. In addition, it enables the patient to understand and ensure that the health information about them is complete and accurate. Research studies confirm that when patients are engaged in healthcare, they are most likely to receive better health care. Engaging the patients is also paramount in the avoidance of medical errors.
Finally, it should be remembered that Electronic Health Records are designed to protect patient information. The system uses a security approach system, which enables the owner of information to control access of his/her information. Just like the banking system, passwords and pin numbers are used to control access of information and this means the information will never be assessed without the consent of the owner.
Through the use of Electronic Health Records, the healthcare team shall have access to accurate and complete data. In that case, an improvement in the diagnosis of ailments and reduced commission of medical errors will be achieved. According to the findings of a national survey that was carried out in the United States, 94% of the doctors confirm that EHRs improve the readability of records. Similarly, 88% agree that EHRs improve the clinical practice because it will allow the patients to participate in their healthcare. The participants also endorsed the allowance of patients to EHRs because it will improve the delivery of patient care (Thirukumaran et al., 2015). The participants based their reports on the functionality of EHRs. EHRs are not only designed to transmit information but they also aid in computation of data. In that case, EHRs carries out the manipulation of data, which makes a difference for the patients. As a result of this, healthcare givers can easily identify the operational errors. The identification of errors under the paper-based systems is not possible because it is not easy to identify the errors.
4.2 Challenges to Access and Use of Electronic Health Records
The accuracy of data that is provided for access by the patients has always been a concern. Persons who capture the data electronically should be knowledgeable and keen so that valid and accurate information can be entered into the system. Thus, it is important for institutions that are mandated to enter information to put in place measures that will facilitate recording of accurate data. For instance, data should be updated and checked regularly to ensure that they are truthful and up to date.
Another issue that has been raised with respect to access of information entails the privacy and security of information. Many people argue that allowing patients to access medical information is disastrous as it may lead to exposure of confidential information, especially where the patients are not informed and taught about what they share and what they should not. In most cases, the security issues may not result from the patients’ perspective but from the security issues of the internet. This issue has forced many to opt out of the EHRs. In a survey that was conducted in the UK, it was found out that 75% percent of adults without personal health records are concerned about their security.
Even though the shortcomings that have been discussed seem substantial, they can be eliminated by putting into consideration the recommendations that will be discussed in this paper. Dozens of academic journals and nursing books explain that healthcare providers hold the keys to the elimination of all challenges associated with access to healthcare records by patients. Once the healthcare professionals understand the benefits that accrue from appropriate use of EHRs, they will be in a position to devise measures that will streamline their use.
4.3 Implementation plan
Patients’ right to access of Electronic Health records should be granted. To achieve this, appropriate policies should be formulated not only in the health sector but also in sectors that have a relation with the welfare of the patient. This section will pioneer the actions that need to be taken in order to enable patients’ access their records. It is important that health professionals understand the implications of the recommendations that will be made in this sections since they are the ones who will spearhead the implementation process.
4.4 Professional Guidance and Legal Background of Patient Access to EHRs
In the literature review section of this thesis, it was explained that many countries have enacted laws to enable patients to access their health records. For instance, in the UK, the law of access to medical reports stipulates that patients and anyone who has been authorized by the patient are entitle to access a patient’s records and reports supplied by medical practitioners (Standing & Cripps, 2015). In addition, parents and individuals who are entitled to access a child’s health records should not be denied the opportunity to access the records. With respect to the information described and the scenario in the UK, the government plays significant roles in patient access to health records. Unless the government puts in place strict laws to regulate the access of medical reports and records, patients are yet to reap the rewards of accessing their health information (Diaz, & Bubalo, 2014).
Once the government enacts laws to govern the access of information, health professionals should provide the needed assistance during access so that no harm can be inflicted on the owner of information. That is to say, doctors and other health professionals should screen data such that data that is deemed to be damaging to the patient can be eliminated. According to experts in in records access, some patient information may have to be withheld because if allowed to be accessed, serious harm may be suffered by the patient.
4.5 Security, Registration and Authentication of Information
One of the main concerns of patient access to health records is security (Diaz, & Bubalo, 2014). It is very important to ensure security and privacy of information. As such, technical controls such as audit trails need to be put in place to control access by unauthorized persons. To achieve this, health care facilities should make use of data controllers who will take appropriate measures in securing and controlling access to the personal data and patient records. They should also be knowledgeable about how to deal with security breaches that may arise.
The responsibility of protecting information lies in the organization, the health care professionals and the owners of the information. During the provision of Record Access to patients, the organization should provide an environment that enables the patient to access the records privately. However, on accessing their information, the patients can share them (the information) as they wish. However, they should be notified that they are responsible for their actions.
It is necessary to ensure that the correct patient accesses the correct records (Diaz, & Bubalo, 2014). Hence, a robust verification of identity should be done. In fact, two-factor authentication is recommended to ensure the achievement of stringent security. In different countries, different systems of record access have been developed. Regardless of a system that is developed or adopted in a country, it is important to ensure that the systems are of high standards and not confusing. Consequently, the process of data access should be standardized in all systems.
Apart from putting in place necessary measures to ensure smooth access of information, sensitization programs should be arranged. The programs are meant to inform patients about the implications of record access. Patients should be informed in advance about the risks and benefits of accessing personal records. In that way, they will learn to be cautious and careful when sharing the information. They should be educated about their responsibilities as well as the consequences that arise from their decisions to share health information. Ultimately, the process of sharing records requires the acquisition of new knowledge and skills. It also requires culture change. With appropriate training, the risks associated with record access shall be reduced.
4.6 Personal Reflection
Incorporating technology in the health sector will aid in saving huge amounts of resources. EHRs are amazing options that can enhance patient care if used appropriately. They benefit both the patient and the healthcare providers in unique ways. For instance, while it reduced the costs of services that will be incurred by the patient, they reduce the amount of time that is spent by the physician in treating the patient. Consequently, the amount of time that is spent by a patient while waiting for the physician will be reduced significantly since with the EHR, the patient need not present himself/herself at the physician’s office since the health information shall be accessed by the patient electronically (Biruk et al., 2014).
The electronic health records get rid of miscommunication that is normally experienced in healthcare settings. The miscommunications are normally disastrous as patients may provide misleading information to their doctors, which lead to the provision of the wrong prescriptions. I have experienced severally in my volunteer work. On many occasions, dealing with old people is challenging as they are prone to provision of wrong medical information. Similarly, they find it challenging to adhere to the prescriptions that they are given. If the old people are allowed to access their health information and subsequently share with their relatives, they will definitely obtain the help that they need in any healthcare facility. From the encounters that I have had, I am hopeful that if appropriate measures are taken during their implementation, allowing patients to access their health records shall facilitate an improvement in patient safety and precision.
EHRs facilitate interactions between patients and their healthcare and this result in the empowerment of patients (Biruk et al., 2014). Patients also get empowered by their access to electronic records because they will get the change to control and manage their health information by determining whom to share their information with. The access to information is also paramount for encouraging patients to contribute in clinical decision making. Electronic Health Record systems enable patients with little medical knowledge to understand the reports that are generate by healthcare professionals. On gaining an understanding about the reports, the patients will be able to participate actively in the making of decisions such as disease risks.
Effective communication is achieved when patients are allowed to access their health records (Biruk et al., 2014). Precisely, patients hate using communication methods such as phone calls and emails to contact their doctors. The electronic health records have made it possible to obtain health information without having to present oneself physically at the physician’s office. For the benefits of access to health information to be achieved, the recommendations that have been discussed should be implemented. Complete implementation of the recommendations will also lead to the elimination of the drawbacks of access to information, which have also been discussed in this thesis (Biruk et al., 2014).
Berry, L. L., Beckham, D., Dettman, A., & Mead, R. (2014). Toward a strategy of patient-centered access to primary care. Mayo Clinic Proceedings, (10), 1406.
Biruk, S., Yilma, T., Andualem, M., & Tilahun, B. (2014). Health Professionals’ readiness to implement electronic medical record system at three hospitals in Ethiopia: a cross sectional study. BMC Medical Informatics & Decision Making, 14(1), 1-14. doi:10.1186/s12911-014-0115-5
Castellani, W. J., Sinard, J. H., Wilkerson, M. L., Whitsitt, M. S., & Henricks, W. H. (2015). Accreditation and Regulatory Implications of Electronic Health Records for Laboratory Reporting. Archives Of Pathology & Laboratory Medicine, 139(3), 328-331. doi:10.5858/arpa.2013-0713-SO
Diaz, A. H., & Bubalo, J. S. (2014). Evaluation and implementation of chemotherapy regimen validation in an electronic health record. Journal Of Oncology Pharmacy Practice, 20(6), 461-468. doi:10.1177/1078155213520339
Fleisher, L. D., & Dechene, J. C. (2004). Telemedicine and e-health law. New York: Law Journal Press.
Furht, B., & Agarwal, A. (2013). Handbook of Medical and Healthcare Technologies. New York, NY: Imprint: Springer.
Jin, J., Ahn, G., Hu, H., Covington, M. J., & Zhang, X. (2011). Patient-centric authorization framework for electronic healthcare services. Computers & Security, 30(Special Issue on Access Control Methods and Technologies), 116-127. doi:10.1016/j.cose.2010.09.001
Jung, M., Riedmann, D., Hackl, W. O., Hoerbst, A., Jaspers, M. W., Ferret, L., & … Ammenwerth, E. (2012). Physicians’ Perceptions on the usefulness of contextual information for prioritizing and presenting alerts in computerized physician order entry systems. BMC Medical Informatics & Decision Making, 12(1), 111-120. doi:10.1186/1472-6947-12-111
McAlearney, A. S., Hefner, J. L., Sieck, C. J., & Huerta, T. R. (2015). The Journey through Grief: Insights from a Qualitative Study of Electronic Health Record Implementation. Health Services Research, 50(2), 462-488. doi:10.1111/1475-6773.12227
Standing, C., & Cripps, H. (2015). Critical Success Factors in the Implementation of Electronic Health Records: A Two-Case Comparison. Systems Research & Behavioral Science, 32(1), 75-85. doi:10.1002/sres.2209
Staroselsky, M., Volk, L. A., Tsurikova, R., Pizziferri, L., Lippincott, M., Wald, J., & Bates, D. W. (2006). Improving electronic health record (EHR) accuracy and increasing compliance with health maintenance clinical guidelines through patient access and input.International Journal Of Medical Informatics, 75693-700. doi:10.1016/j.ijmedinf.2005.10.004
Thirukumaran, C. P., Dolan, J. G., Webster, P. R., Panzer, R. J., & Friedman, B. (2015). The Impact of Electronic Health Record Implementation and Use on Performance of the Surgical Care Improvement Project Measures. Health Services Research, 50(1), 273-289. doi:10.1111/1475-6773.12191