Electronic health records, EHRs, are one of the cornerstones of digital health and have the ability to transform healthcare and healthcare systems globally. An important tool to improve healthcare quality, efficiency, and safety. EHR provide important information and data that can be used to assess healthcare performance, and the health status of the population. It is thought that the rising demands of healthcare records can only be met by the development and use of electronic health records. EHRs are often called electronic medical records, and the terms are use interchangeably. There was a lack of consensus and clarity on the terms. It is important to distinguish that the two are different. Here we will focus on the EHRs. EHRs are real-time, patient-centered records available instantly to all authorized users and enable health information to be exchanged electronically with the benefit of providing higher quality and safer patient care. EHRs contain all data and facts associated to the person's health including administrative and clinical data. EHRs have been implemented across the world and are a systematic collection of a patient and population health record in a digital format conducted a single point in time or over a longer time period. This allows data to be collected over longitudinal time period. The social and economic benefits can outweigh their cost. For example, the cost of hardware, software, maintenance and training. A survey by the WHO and eHealth identified 57 out for 125 countries, that's 46 percent, to have some form of a national EHR system. So far you've been introduced to digital health, its definitions, and a brief history of the sector. Here the focus would be on understanding the importance of data, what electronic health records are, and how they can be used in the context of digital health, and opportunities and challenges in using them. Estonia is a good example of a high income country that has successfully use EHRs. The health system has been revolutionized using EHRs. Electronic health record, eHealth record, is a nationwide system integrating data from Estonia's different healthcare providers to create a common record every patient can access online. Each person has visited a doctor has an online eHealth record and can be tracked. Currently, 99 percent of healthcare data has been digitalized and the same percentage of prescriptions. For low and middle income countries, the adoption and usage of EHRs in integrating EHRs of a national healthcare systems is vital to improving healthcare systems, in improving health. However, EHR adoption and usage remains low. EHRs offer a range of benefits, including the ability to exchange health information electronically. This has the benefit of providing accurate, up-to-date, and complete information about an individual. Other benefits include the ability to be able to access information quickly and share information with healthcare providers. EHRs enable patients to be more effectively managed and this has been found to reduce errors, for example medical errors. Enhance privacy and security of patient data compared with paper based system is also a benefit. As is, improved efficiency and reduced costs, improved communication, better clinical decision making, improved coordination of patient care and patient care outcomes, improved quality of care and safety have also been reported as benefits. The data obtained from EHRs is also of great benefit, is invaluable in improving performance, quality assurance, and for research. The disadvantages and potential barriers to EHRs include security concerns, particularly around privacy and security issues. For example information that is confidential such as the patient's health, is susceptible to data leakages and breaches. Implementation issues have also been commonly reported to include workflow and time, particularly in setting up and maintaining these records, which often is a high cost and usability issues. Interoperability may also be an issue, as well as reduced medical interaction. While these issues in implementing EHRs in high income countries is well documented, the challenges faced in low and middle income countries is not, but the evidence is growing. A number of challenges in low and middle income countries have been identified. In 2016, Sikhondze and Erasmus post 10 challenges facing EHRs in low and middle income settings. These include poverty, poor healthcare and general infrastructure, language barriers, limited basic education, shortage of a skilled workforce and lack of medical expertise, availability of training facilities, organization and policy issues, a lack of funds, a lack of skilled healthcare informatics, and political challenges due to instability of governments. Study suggest that while there is a high cost to implementing EHRs initially, for example infrastructure and staff training, the return on this investment may be substantial in the long term. You've now been introduced to EHRs and understand the key benefits and disadvantages today usage and adoption. You've also learned there's great potential for usage in high as well as low and middle income settings. Next you will learn about learning health systems, and a case study on the importance of data in assessing healthcare quality and patient safety.
