Digital Disruption on Healthcare Business

Richard Hutasoit, Anisa Azizah, Cheryl Marlitta Stefia

The School of Business and Management, Institut Teknologi Bandung, Indonesia

Abstract

Keywords

Introduction

When it comes to innovation, healthcare has a paradox. It is both a rabbit and a tortoise. While life-altering
breakthroughs in medical treatments can come at a rapid pace, improvements to the way healthcare is actually
delivered often happen very slowly. The forces that have disrupted other service industries—from retail to travel to
media—have so far made only tentative inroads into healthcare. Anyone who has had to wrestle with the frustration
of deciphering a hospital bill knows how far healthcare has to go before it reaches the levels of customer experience
and user-friendly technology that we have come to expect in other areas of our lives.

The healthcare industry is at a tipping point. Digital transformation is happening rapidly with a focus on improving
efficiency, accessibility, and communication between healthcare providers and engaging patients. The driving force
behind poor patient engagement in healthcare is rising cost and poor quality of service. As one of the world's largest
industries, healthcare is expected to change our everyday lives for the better to decrease inefficient patient care.

1 Technology
Partly in response to the pressure from outsiders, healthcare companies are increasingly employing tools such as
advanced analytics, machine learning and smart devices. Investors can find choice assets among the medtech and
healthcare IT (HCIT) companies that supply the devices and systems that make digitalized care possible. There are
also consolidation opportunities. Small companies anxious to avoid missing out on digitalization can make attractive
acquisition targets.

2 Healthcare system/hospital
In this digitized world, everything is going to be modernized so why not healthcare industry. To
solve this purpose, EMR software came into existence, known as the digital version of a paper
chart that contains all of a patient medical history from one practice.

Electronic Medical Record System is known as a digital version of traditional paper charts in the
clinician’s office for an individual. EMRs allow clinicians to track their patient data over time &
identifies which patient is due for preventive check-ups & screenings. In the market, different
types of digitized health records are available that contains similar information.

Advantage
One of benefit associated with Electronic Medical Records is an improved ability to conduct
research. Having patient data stored electronically increases the availability of data, which may
lead to more quantitative analyses to identify evidence-based best practices more easily.
Researchers have also found an association between Electronic Medical Records use and
physician satisfaction with their current practice. Physician satisfaction should be a priority in
health care organizations, because it is associated with better quality of care, better prescribing
behaviors, and increased retention in medical practices.
Studies examining organizational outcomes have focused on EHR use in both the inpatient and
outpatient settings. Such outcomes have frequently included increased revenue, averted costs,
and other benefits that are less tangible, such as improved legal and regulatory compliance,
improved ability to conduct research, and increased job/career satisfaction among physicians.
Increased revenue comes from multiple sources, including improved charge capture/decrease
in billing errors, improved cash flow, and enhanced revenue. Several authors have asserted that
Electronic Medical Records assist providers in accurately capturing patient charges in a timely
manner. With an Electronic Medical Records system, many billing errors or inaccurate coding
may be eliminated, which will potentially increase a provider’s cash flow and enhance revenue.
Reductions to outstanding days in accounts receivable and lost or disallowable charges can
potentially lead to improved cash flow. In addition, Electronic Medical Records reminders to
providers and patients about routine health visits can increase patient visits and therefore
enhance revenue.
Disadvantage
This misalignment of incentives for health care organizations, along with the high upfront costs,
creates a barrier to adoption and implementation of an Electronic Medical Record, especially
for smaller practices.

Another disadvantage of an Electronic Medical Record is disruption of work-flows for medical

staff and providers, which result in temporary losses in productivity. This loss of productivity
stems from end-users learning the new system and may potentially lead to losses in revenue.

Other declines in revenue are possible following Electronic Medical Record implementation.
Because Electronic Medical Records are often associated with fewer redundancies, fewer
errors, and shorter lengths of stay, it is conceivable that a given provider may avert certain
billable transactions that, although superfluous, may have generated reimbursements from
third-party payers, especially in a fee-for-service payment system. Although reimbursement
rates may differ for each organization, these declines could be offset by increased revenue that
is generated as a result of efficiencies achieved with the help of an Electronic Medical Records
system.

Another potential drawback of Electronic Medical Records is the risk of patient privacy
violations, which is an increasing concern for patients due to the increasing amount of health
information exchanged electronically.
Electronic Medical Records may cause several unintended consequences, such as increased
medical errors, negative emotions, changes in power structure, and overdependence on
technology. Additionally, end-users of an Electronic Medical Record may experience strong
emotional responses as they struggle to adapt to new technology and disruptions in their
workflow. Changes in the power structure of an organization may also occur due to the
implementation of an Electronic Medical Record. For example, a physician may lose his or her
autonomy in making patient decisions because an Electronic Medical Records blocks the
ordering of certain tests or medications. Overdependence on technology may also become an
issue for providers as they become more reliant upon it. Organizations should ensure that basic
medical care can still be provided in the absence of technology, especially in times when the
downtime of the system may be critical. Although there are many unintended consequences of
Electronic Medical Records, when balancing the advantages and disadvantages of these
systems, they are beneficial, especially at the society level.

3 Patient

Eighty percent of Internet users seek online health information, 66 percent of Internet users
look online for information about a specific disease or medical problem, and one in 20 Google
searches is for health-related information. The statistics represent that in this digital era,
patients are becoming more empowered — thus making it imperative for healthcare companies
to engage them across the drug life cycle. Patient engagement in recent years has become a
key focus for healthcare companies. Healthcare professionals have realized that in order to
grow in a competitive marketplace, patients need more in the way of information, quality,
access and accountability.

The advances in information technology bring forth changes in nursing care and the healthcare
system. One of the prominent changes is the utilization of medical record, aiming at increasing
the quality of medical service. Medical provider found it very useful since it allows timely issues,
quick and accurate data retrieving. Electronic medical records are expected to improve the
quality of care which is provided to hospitalized patients. The objectives of the Electronic
Medical Record system are access to patient
information, document patient progress, assist in chronic disease management, facilitate
disease coding for billing and disease demographics, provide health‑care staff with decision
support tools, create educational patient handouts, and help track health maintenance and
preventive medical interventions. This technological change the way to secure and improve
communication between the nurses and the health care team.

Patients are increasingly shifting to the online sphere as they start to discuss about their
conditions, to manage their healthcare appointments, or to get medical advice from doctors.
However, these trends not only lead to completely new forms of health services, but also
enable new business models for creating, delivering, and capturing value.
A question that is frequently asked by the health‑care systems about to employ an Electronic
Medical Record is “How do patients react to this new form of medical record keeping?” Pyper
et al. in the United Kingdom questioned 606 patients in the UK who responded to a
questionnaire about the use of the EMR in their healthcare. The responses to the questions
were as follows: “I want to have access to my health record:” 83% said yes. “I think it is a good
idea to make health records electronic:” 79% said yes.
However, 50% of patients were concerned about the security of their health information.
Nevertheless, the overall response was quite positive. In general, there are a number of aspects
of Electronic Medical Records that make them a positive intervention for patients. The
Electronic Medical Record gives the patient a larger role in their care through increased patient
knowledge and self‑management. There is the potential for greater health‑care provider–
patient interaction, and this can potentially increase patient safety because of the improved
communication between the physician, the patient, and other members of the health‑care
team.

The implementation of electronic medical record is essential to enhance the provision of safe,
ethical, and effective health care. Another benefit of electronic documentation are a health
care providers no longer have to waste time consulting with one another in person, trying to
decipher someone’s dreadful handwriting, and fewer errors related to misinterpreted orders.

Most of medical records in Indonesia is still paper-based. Paper-based documentation usually

makes frustrated because many activities must document. Another barrier of paper
documentation was its lacking function to take analysis from big data and time-consuming to
get an old data.

Electronic documentation implementation requires much time and attention. The psychological
impact of change should be minimized. Technological changes, in general, may influence
nurses’ attitudes and perceptions. Health care provider which using the Electronic Medical
Record is still low and they are generally dissatisfied with the service of the implemented
system. The study show that this dissatisfaction is caused mainly and strongly by the poor
service quality, the current practice of double documentation (Electronic Medical Record and
paper-based), and partial departmental use of the system in the hospitals. Nurses regularly
resist new technological advancements based on the assumption that it will disrupt their
normal way of performing routine activities.

Electronic medical record systems have the potential to transform the health care system from
a mostly paper-based industry to one that utilizes clinical and other pieces of information to
assist providers in delivering higher quality of care to their patients. However, we need to
assess how exactly do electronic medical records improve care? What is the current situation
that electronic medical records functionalities will translate into benefits? Answering these
questions is the purpose of this paper. Impacts include both benefits and drawbacks, and, as
such, we discuss the advantages and disadvantages. Overall, we expect that any reader
interested in understanding the current state of the knowledge base with regard to electronic
medical records benefits will find this paper useful.

Advantages of Electronic Medical Records

What are the potential benefits that can be realized by using the Electronic Medical Record?
First, the use of an Electronic Medical Record helps to reduce medical errors by utilizing
computerized prescription entry, predicting drug interactions and displaying a warning for the
health‑care provider, assisting clinicians in reconciling patient medications, and most
important, maintaining a legible medical record.
Communication between physicians can be greatly improved with the use of Electronic Medical
Record, allowing each party full access to a patient’s medical history rather than a snapshot-
type overview from a current visit. This access allows for a more in-depth evaluation, and
enables doctors to reach an accurate diagnosis more quickly.

Electronic Medical Records can make it easier for doctors to follow up with patients and track
continuing care, both under their supervision and that of the patient’s other doctors. A major
plus for the Electronic Medical Record is that patients can be seen sequentially by different
providers with up‑to‑date information immediately available to all providers. This was often
difficult when paper charts were being utilized. At the very least, electronic health records can
save time during a doctor’s office visit. Theoretically, Electronic Medical Record ‑guided visits
should be shorter and better organized although increased time is required to write the
electronic clinical note than with handwritten notes.

In case of emergency, these records can provide critical, life-saving information to emergency
care providers. People who find themselves in mass casualty situations, such as natural
disasters, can benefit greatly from electronic medical records. Healthcare providers can use
Electronic Medical Record in an emergency situation to get a more accurate picture of a
patient’s medical history more quickly than with traditional means.

Catastrophic events have demonstrated that patients in these situations are often confused
and frightened, making it easy to forget personal medical details. Every second counts during
an emergency, so having access to a patient’s medical history, blood type and allergy
information, when the patient is unable to communicate can be the difference between life and
death. Also, the digital format can make quick access more scalable.
Researchers have also focused on other preventive services and on how Electronic Medical
Records can improve various outcomes and make care more effective. Efficiency refers to the
avoidance of wasting resources, including supplies, equipment, ideas, and energy. One such
form of waste involves redundant diagnostic testing. In a widely cited study, experts found that
an Electronic Medical Records system was associated with a 55% reduction in serious
medication errors in the hospital setting. Researchers found that computerized records and
order entry were associated with lower mortality rates, and Electronic Medical Records was
associated with fewer complications. Additionally, the same study found that computerized test
results, order entry, and Electronic Medical Records were all associated with lower costs.

In addition, the Electronic Medical Record gives clinicians immediate access to patient medical
information, as well as the ability to enter and store orders for prescriptions, tests, and other
services in a computer‑based system with orders and clinical notes easily stored. This saves a
lot of storage space that was needed when paper records were the norm.
Other advantages include the fact that the system allows the patient to access their own
medical information easily and from home. Moreover, Electronic Medical Records include
scheduling systems that can greatly improve hospital and clinic efficiency and provide more
timely service for patients.

Disadvantages of Electronic Medical Records

Despite the growing literature on benefits of various Electronic Medical Record functionalities,
some authors have identified potential disadvantages associated with this technology. These
include financial issues, changes in workflow, temporary loss of productivity associated with
Electronic Medical Records adoption, privacy and security concerns, and several unintended
consequences.

There are some disadvantages to patients interacting with Electronic Medical Records including
potential confusion when patients do not understand medical terms or reports. Moreover, the
Electronic Medical Record has the ability to make the patient–doctor relationship more
impersonal. In addition, as noted above, patients are often concerned about the confidentiality
of their personal health information.

Electronic Medical Record adoption and implementation costs include purchasing and installing
hardware and software, converting paper charts to electronic ones, and training end-users.
The introduction of electronic medical record in practice settings will inevitably create changes
that may cause health care provider to experience a variety of feelings including fear, anxiety,
anger, resentment, confusion, exhaustion, and irritability. These feeling and behaviors can
cause healthcare provider to resist the transition to computerized documentation. Meanwhile,
a person’s attitude about the usefulness of technology and satisfaction in the new system can
affect to the success of a system implementation.
 The maintenance cost of an Electronic Medical Records can also be costly. Hardware must be
replaced and software must be upgraded on a regular basis. In addition, providers must have
ongoing training and support for the end-users of an Electronic Medical Record. From the
physician’s point of view, the Electronic Medical Records can be useful but also presents some
challenges. Benefits include legible orders, the volume of transcription material is reduced, and
orders are rapidly routed. One large challenge involves getting a large medical staff trained in
the use of the Electronic Medical Records. This is particularly a problem with older physicians
who may not be very “computer savvy.” The high cost of these systems is another challenge for
hospitals and practices. It is often difficult to measure any financial benefit given the high cost
of these systems. .

Conclusions

There is no question that the Electronic Medical Records will continue to evolve and bring even
more information to the clinician caring for a specific patient. Undoubtedly, in the near future,
genetic information will also become a routine part of the patient’s record. This will be
extremely useful since it will provide the health‑care provider with specific information
concerning possible diagnoses, as well as important aspects of drug metabolism and
sensitivities. Moreover, as noted above, the potential for “big data” clinical research using
collected patient clinical data is huge and exciting because of its potential to improve patient
care.

Reference

Works Cited

How Digital Health Will Disrupt the Healthcare Industry, www.stantive.com/How-Digital-Health-Will-Disrupt-the-

Healthcare-Industry.

Hariyati, Rr. Tutik Sri, et al. “The Effectiveness and Efficiency of Nursing Care Documentation Using the SIMPRO

Model.” International Journal of Nursing Knowledge, vol. 27, no. 3, 2015, pp. 136–142., doi:10.1111/2047-

3095.12086.

Insights, Bain. “Riding The Disruption Wave In Healthcare.” Forbes, Forbes Magazine, 9 May 2018,

www.forbes.com/sites/baininsights/2018/05/01/riding-the-disruption-wave-in-healthcare/#486192732846.
Lee, Kenneth, et al. “Consumer Use of ‘Dr Google’: A Survey on Health Information-Seeking Behaviors and Navigational

Needs.” Journal of Medical Internet Research, JMIR Publications Inc., 29 Dec. 2015,

www.ncbi.nlm.nih.gov/pmc/articles/PMC4710847/.

Lee, Kenneth, et al. “Consumer Use of ‘Dr Google’: A Survey on Health Information-Seeking Behaviors and Navigational

Needs.” Journal of Medical Internet Research, JMIR Publications Inc., 29 Dec. 2015,

www.ncbi.nlm.nih.gov/pmc/articles/PMC4710847/.

Menachemi, Nir, and Taleah H Collum. “Benefits and Drawbacks of Electronic Health Record Systems.” Risk Management

and Healthcare Policy, Dove Medical Press, www.ncbi.nlm.nih.gov/pmc/articles/PMC3270933/.

“Patterns.” Model-Driven Design Using Business Patterns, pp. 159–234., doi:10.1007/3-540-30327-2_5.

“Usability and Satisfaction of Using Electronic Nursing Documentation, Lesson-Learned from New System Implementation

at a Hospital in Indonesia.” Taylor & Francis,

www.tandfonline.com/doi/full/10.1080/20479700.2018.1504387.