Electronic Health Records in Medical Facilities


The ever-changing technology has transformed several sectors of humanity that include education, business, and health. Notably, the wise implementation of technological advancements introduces beneficial outcomes for consumers and service providers in various entities. One of the sectors that have enjoyed the benefits accrued from technology is healthcare. Calvillo, Román, and Roa (2015) as well as Ginter, Duncan, and Swayne (2018) explain that the advancements in technology have introduced numerous components into the medical segment and helped medical practitioners to deliver services that match patient expectations. One of the factors that have been increasingly significant in the delivery of efficient and satisfactory services to patients is the electronic health records (EHRs). The introduction of an electronic system of storing, sharing, and outsourcing information is a far-reaching advantage attributed to the advances in technology.

The review undertakes a further analysis of the relevance of various theories such as Lewin’s theory of planned change and complex adaptive systems theory. An examination of the benefits of EHR and its barriers, as well as an analysis of the requisite approaches, is instrumental in unearthing the various literature highlighted by past scholars and identifying areas that need more research. Mainly, the review owes its focus to the primary objective that guides the entire project. The essence of reviewing the benefits and barriers as well as studying the stated theories emanates from the purpose of the aim that revolves around understanding the weaknesses and strengths of EHR and its use in medical centers. Therefore, the review examines the role of EHR in the health sector, especially in acute care departments, its benefits, and barriers that hinder its effective implementation.

Theoretical Framework

Although complex adaptive systems theory and Lewin’s theory have been discussed earlier, further evaluation is still necessary. The relevance of these theories in facilitating organizational adaptability to the trendy dynamics posited by modern lifestyles compels researchers to continue delving into the concepts outlined in their contents. Fundamentally, an analysis of the models is integral to understanding the process of implementing EHR systems in medical facilities. These approaches also augment knowledge concerning how nurses, doctors, and other practitioners perceive their introduction. Besides changing the attitudes held by practitioners, the theories are also significant in understanding the reasons behind the reactions witnessed from patients upon the utility of electronic records in hospitals. The various stages presented by the models enable studies to establish systematic practices that can be useful in introducing change. Additionally, the models facilitate a strong motivation of employees to embrace change and its components in the desired manner, a phenomenon that eventually becomes satisfactory to the consumers.

Complex Adaptive Systems (CAS) Theory

The CAS theory revolves around the fact that change is unplanned but is an occurrence triggered by other events. In the words of Akgün, Keskin, and Byrne (2014), a single happening in the external environment can generate various changes in an organization. The assertion justifies the transformations introduced by technology and its disruptions in the operations executed in medical centers globally. Due to the developments, EHRs emerged and changed how nurses manage information concerning patients. The theory notes that change takes place in a nonlinear fashion, a phenomenon that resonates well with the cornerstones of technology, which comprise unpredictability and absence of prior planning. In the contemporary world, hi-tech developments have become difficult to cope with because they occur chaotically leading to an imbalance in several sectors that include healthcare. One of the factors that stakeholders in the medical facilities need to understand is the shift in patient attention towards these volatile trends.

Furthermore, stakeholders in the health sector should carefully check how patients relate the kind of treatment received in a facility to the level of technology prevalent in their respective societies. The CAS theory plays a pivotal role in elevating the understanding that medical practitioners have of the process of change in organizations as well as perceiving the emergence and application of EHRs in the health sector. According to McEvoy, Brady, and Munck (2016), training employees on various components of the CAS theory is a useful milestone in motivating them to embrace it in their operations. As such, when stakeholders empower human resources in medical facilities with the right knowledge of the theory, they will implement the systems in the facilities successfully. It is vital to note that the useful utility of EHR technology takes effect only when employees have the right training regarding its essence. With the proper training, barriers such as limited skills, employee unwillingness, and privacy issues diminish. Therefore, CAS theory is significant in augmenting the knowledge on the problems presented by new developments such asEHRs in the health sector.

Lewin’s Theory of Planned Change

Another theory that is instrumental in the context of EHRs is Lewin’s theory of planned change. The approach has stages that enable practitioners in medical enterprises to adopt and utilize any new technologies that are beneficial to the department. In its three steps that comprise unfreezing, change, and refreezing, the approach captures the challenges that stakeholders in the field of healthcare experience in the face of new technologies. Through the three stages, Lewin’s model encourages service providers in organizations to prepare for new technologies and tackle any hindrances that may prevent their application (Cummings, Bridgman, & Brown, 2016). These impediments linked to Lewin’s theory, according to Batras, Duff, and Smith (2016), can be psychological or technical. Notably, human beings are resistant to change and prefer retaining a particular status quo. Opposition to change is a scenario that hampers the utility of new developments in the absence of training and proper unfreezing strategies.

After unfreezing and preparing an entity for takeoff, stakeholders in the medical sector then introduce change. Bakari, Hunjra, and Niazi (2017), as well as Burke (2017), assert that change is a process where the employees and managers of an organization gradually adopt new technology and begin using it in their operations. Remarkably, the shift starts in the mindset before translating into the activities undertaken by the respective employees. Fundamentally, when the right unfreezing procedures materialize, perceptions held by the members of staff that make them reluctant towards new technologies such as EHRs change from negative to positive. The shift in attitude is vital in realizing the benefits accrued by new developments. After that, the refreezing stage, which involves a systematic application of new technologies and a close follow-up on the milestones expected from the implementation, commences. During the follow-up stage, stakeholders assess the progress and make timely changes geared towards improving the quality of services that patients receive in medical centers.

Benefits of EHRS in Medical Facilities

Improved Service Quality and Employee Motivation

Electronic health records play an important role in amplifying the quality of services received by patients. Due to the increased ability to store and share information relating to patients, nurses and doctors are in a better position to give them the right prescriptions. Unlike in the past, when hospital executives and nurses had to juggle through several files to get information, the emergence of EHRs has made it easy to obtain patient details and administer the right treatment. Significantly, using EHRs enables staff in hospitals to store large amounts of information in secure and safe compartments without the fear of loss or damage (Nguyen, Bellucci, & Nguyen, 2014; Chang & Gupta, 2015). Disasters such as fires, floods, and earthquakes that could initially lead to loss of vital information no longer worry doctors and nurses in the therapeutic centers after the inception of electronic files.

Another benefit linked to the maximum utility of EHR is the motivation of human resources. Some of the factors that inspire members of staff to deliver their best in organizations comprise efficiency and ease of accessing information. Kohli and Tan (2016) elucidate that since nurses understand that they do not need to go through several difficulties before retrieving details concerning a patient, they are motivated to handle issues encountered in the course of duty. Previously, healthcare practitioners would be anxious whenever past patients arrived at a facility in need of medical attention. The worry stemmed from the understanding that they had to search through numerous records before getting the relevant file. Therefore, EHRs have helped medical service providers because they only enter the name or a few details of individuals into the system to retrieve the required data that contains their history and other necessary information.

Efficiency in Service Delivery and Consumer Satisfaction

Efficiency in service delivery is among the notable benefits brought about by EHRs in medical facilities. In the explanation of Ben-Assuli (2015), EHRs have made it easy to acquire patient details swiftly regardless of the period taken before the next visit. Therefore, nurses and doctors can handle several patients in a single instance. In the past, medical executives would look for files related to a patient for an extended period forcing others to wait. The process was long, and the number of people who received treatment was low. However, with the invention of electronic records, access to files is quick and timely, a factor that leads to high-end service delivery to a vast number of individuals. The increasing number of patients visiting various hospitals amplified the workload subjected to healthcare service providers tremendously. Conversely, the emergence of EHRs has reduced the workload because the practitioners in hospitals spend a substantial part of their time in addressing patient needs.

Consumer satisfaction is the focus of organizations delivering products all over the globe. In the same regard, the healthcare sector has made several strides with the intent of improving the quality of its services to match patient expectations and attain their satisfaction. Kahouei, Zadeh, and Roghani (2015) explain that client satisfaction translates to a positive attitude and employee motivation. The high intensity of pleasure derived from EHRs propels healthcare facilities to succeed. A combination of the various benefits generated from the use of EHRs leads to client satisfaction (Wang, Kung, & Byrd, 2018; Nelson & Staggers, 2016). Modern clients need swift, efficient, and high-end attention from medical centers. Therefore, when hospitals generate the aforementioned positive attributes associated with EHRs, they attain the much-desired satisfaction from their patients. It is important to note that recovery from an ailment begins with the kind of attention that a client receives upon entering a medical center. If the quality of service fails to match the expected standards, the process of treatment and recovery becomes complicated and long-drawn.

Barriers to Implementation

Skills and Facilities

While EHR has various benefits, its optimum implementation has not materialized owing to some internal and external obstacles. Remarkably, internal hindrances are those from within the hospitals and their management, whereas external impediments emanate from factors that the facilities cannot control. Skills, equipment, cost, and flexibility are among the internal hindrances that affect the successful execution of EHRs in hospitals. Fundamentally, expertise is one of the impediments that can cripple the process of introducing changes such as EHRs in a medical facility. Bayer, Santelli, and Klitzman (2015) note that at times, medical centers may have modern equipment but lack skilled members of staff to operate them. In such scenarios, the absence of the necessary expertise prevents the full implementation of the technology in a therapeutic center.

Facilities or equipment can also hinder the successful execution of electronic recording in hospitals. Scholars such as Agarwal, Perry, Long, and Labrique (2015) as well as Busse, Aboneh, and Tefera (2014), link the challenge of limited facilities to developing countries, a misguided notion. It is notable to understand that the dynamic technological shifts prevalent in modern times can introduce redundancy even among the latest and hi-tech devices used in developed countries. Therefore, stakeholders in the medical sector need to understand that the absence of proper machinery can affect their progress towards the delivery of high-quality therapeutic attention to patients. Without the right equipment, medical centers may not deliver the required services to patients, a factor that lowers their reputation.

Cost and Flexibility

Cost and flexibility are among the obstacles that can prevent healthcare centers from enjoying the full benefits of EHRs. Training employees and purchasing the right set of equipment are some of the activities that need resources. Some of the devices and training may be costly and can exceed the purchasing power of medical facilities. Campanella et al. (2015) assert that when a hospital fails to purchase the necessary devices or train its workforce, the overall quality of services rendered to patients diminishes. Some hospitals in various parts of the world have not fully optimized electronic recording owing to their limited ability to purchase the necessary equipment and train their workforce with the skills regarding the operations linked to the EHR technology.

Flexibility is another internal barrier that has affected several hospitals in the face of new technology. Unlike the first three challenges centered on the hospital’s financial ability and expertise, flexibly lies in the management and human resources. Concisely, flexibility implies employee or management’s unwillingness to embrace change and adopt the associated technologies. Presently, diverse organizations have exited the market because they delayed in utilizing modern techniques when a shift occurred. A similar scenario can materialize if a medical facility fails to embrace new technology such as EHR. Remarkably, when hospitals delay in adopting new technologies, they force patients to look for services elsewhere (Lakbala & Dindarloo, 2014; Cifuentes et al., 2015). Unlike in the past, contemporary consumers have the liberty to choose a facility to visit and obtain their desired medical attention. The wide array of health-care insurances present in countries such as the United States is among the factors that increase the patient’s ability to choose facilities that deliver the best services. Therefore, failing to adopt new technologies is an impediment that has affected the full realization of EHR benefits in different hospitals globally.

External Barriers

Poor International Relationship and Cyber Security

Some barriers that are beyond the control of healthcare enterprises include poor international relationships and cybercrime. Fundamentally, a good international relation is critical to the achievement of the best medical services in a country. When nations have favorable diplomatic ties, they can exchange expertise and share knowledge with the view of improving the quality of services enjoyed by their citizens (Kim, 2017; Zaidan et al., 2015; McMurray, Zhu, McKillop, & Chen, 2015). Some of the areas that make up the knowledgebase exchanged by these countries comprise the effective use of EHR and the realization of its full benefits. In a context where a particular nation does not have positive relations with others, the distribution of knowledge becomes limited. Partial exchange of expertise leads to an inadequacy of skills and equipment that is useful in experiencing the full benefits of technologies such as EHR.

Another external threat that has affected the implementation of EHRs in medical facilities is cybersecurity. The threat borders on the issue of confidentiality that exists between a patient and a medical practitioner. Zhang, Qiu, Tsai, Hassan, and Alamri (2017) and McLeod and Dolezel (2018) explain that several hospitals are resorting to cloud storage of data to ensure safety from loss, a factor that increases the chances of hacking. It is notable to explain that even in the face of modern protective strategies advanced by skilled internet scholars, cases of piracy are gradually increasing. In recent times, various organizations have become victims of hacking and online theft of information, which is believed to be stored safely in online platforms. Therefore, while EHRs may appear to be the best in the storage of data concerning patient’s health, more research needs to be undertaken to ascertain if the technology is indeed the best option regarding the vital nature of information kept in hospitals.


The use of EHR is fast gaining popularity in various parts of the world. Due to the numerous benefits associated with the technology, several practitioners are adopting it in their operations. Information stored using EHRs is easy to access and safe from loss or damage. The ease in access helps nurses and doctors to retrieve patient details on and when required, a phenomenon that reduces the time spent in service delivery. While EHR benefits make its adoption significant, some challenges affect its implementation. Problems such as hacking have reduced the willingness of some facilities to adopt the technology. Remarkably, access to vital information by cybercriminals affects the credibility of the hospital and makes the patients vulnerable. The high scale of susceptibility associated with patient information stems from their private nature. An analysis of the present literature reveals that cybercrime is high, a factor that calls for further research with the view of addressing the vice so that the safety of data improves.


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