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You are required to write a literatuture review on the given topic:

Should the digital health record be implemented for all patients?

Advantages of the Digital Health Record Technology

Digital Health Technology is defined as a process of electronically documenting the comprehensive health information of the patients and thereby generating patient-centred digital records (Levine, Lipsitz and Linder, 2016). According to the reports published by Jensen, Jensen and Brunak (2012) at present the efforts are being undertaken in order to increase the application of the electronic health records and thereby increasing the overall process of clinical care. However, application of the digital health technology or electronic health records might provide or extract different results under different demographics (Mandl et al., 2012). The following essay is based on the argument that whether digital health record can be effectively implemented for all the patients. In executing this argument, the essay will mainly analyse peer-reviewed research papers published centring digital health technology or electronic health record. Via analysing the journal articles, the essay will try to fetch advantages and disadvantages of digital health information technology and subsequently come up with a conclusion to clarify the argument. The elucidation of the conclusion based on the topic will further help to personalise the implementation of the digital health information technology across diverse population.

There are several advantages of the digital health record technology. They study conducted by Burke et al. (2014), highlighted that application of electronic health record (EHR) or digital health record helped to improve the overall quality of the outpatient clinical note along with overall reduction in the manual error during rush hours of the outpatient department. In order to elucidate the objectives of their research, Burke et al. (2014) conducted a five and half year longitudinal quantitative study. They compared the handwritten and electronic outpatient clinical visit note of 100 outpatients with type 2 diabetes mellitus (T2DM). Large sample, size and large tenure of data comparison might be proved to be very helpful but concentrating over single disease type, T2DM might lead to the generation of biased results. 

In the domain of clinical benefits of EHR, Murphy et al. (2014) mined the retrospective data in relation to cancer diagnosis from two large integrated healthcare systems operating through comprehensive electronic health record. The results obtained through the data mining algorithm highlighted that the EHR-based triggers can be successfully used to flag the records of the patients who are lacking follow-up of the abnormal clinical findings suspicious for cancer. Thus as a whole they concluded that the proper documentation of the patient data in the digitalised way through the EHR help to detect the potential delays in cancer diagnosis. This delay in cancer diagnosis is common both among the rural and the urban communities and thus the implementation of the EHR gains it importance under the clinical significance of the cancer treatment. However, the research is mainly concentrated over the delays in colorectal cancer and prostate cancer. Observation over other wide array of cancer like breast cancer, lung or liver cancer might have helped the researchers to analyse the effect on EHR on cancer treatment in a comprehensive way.

In relation to the clinical benefits of the EHR, King et al. (2014) conducted a cross-sectional study. The main objective of their study was to access the clinical benefits of the EHR on the basis of the physicians experience and report. 78% of US office-based physicians reported enhanced patient care through remote access of the patient record and at least 65% reported decrease in the medication error and documentation of the critical lab value. 30 % of physician reported clinical benefits over diverse group of patient communication and recommendation for future care. Overall, King et al. (2014) concluded that EHR help to enhance the overall quality of clinical care. The result is extremely significant because, King et al. (2014) conducted the research via taking US physicians where the concept of EHR was first defined and implemented. However, the study is mainly based on the personal opinion with no reference to any official documentation of the numerals and hence can be opinionated.

Clinical Benefits of EHR in Detecting Potential Delays in Cancer Diagnosis

In order to access the importance of the EHR in patient care, Woods et al. (2013) conducted a study in order to record the perspective of the patients. The qualitative study conducted by Woods et al. (2013) was designed to examine the experience of the patients in accessing their health records based on clinical notes. The theme based study based on patient’s experience highlighted that visualization of the own health records help to positively affected their communication with the healthcare providers and also help to increase their knowledge about their overall health. The five focus group study conducted over patients also highlighted that the increase in the knowledge about their own health helped to increase the participation of the therapy plan and thereby increasing their decision making process. The main strength of this study is it included both the patients and their family members however; the low sample size that is 30 might be regarded as its limitation.

Druss, Ji, Glick and von Esenwein (2014), conducted a randomized control trial in order to evaluate the effect of electronic personal health record in the overall quality of the care in community mental health setting. The study revealed that having personal health record help in significant improvement in the overall quality of medical care along with increase in the use of the medical service among the patients. The study also highlighted personal health record as a cost-effective care medium for the patients with co-morbid and serious mental illness. The main strength of the study is its study approach that is randomized control trail with 170-sample size. However, the main drawback of the study is, the participants were not blinded and hence the outcome can be biased.

Li et al. (2013) used attribute based encryption (ABE) techniques in order to encrypt patient's file and scalable data of personal health record in the digital health system. The analysis of the data highlighted that digital health record helps in scalable and secured sharing of the personal health records through cloud computing. Sharing of patient's data, through cloud computing, promotes equitable access of the patient's information. The main strength of the study it is approach. It used attribute encryption based scanning of the patient's data. This helped to ensure the privacy and confidentiality of the patient’s information. The main drawback of the study is, it does not high the total number of patient's whose data was analyzed via attribute-based encryption.

Thus analysis of the advantages of the digital health record through review of primary literature have highlighted that Application of digital health record or ELH help to increase the overall clinical outcome via reducing the chances of medication error. It also showed that apart from improving the clinical performance the application of EHR also helped to increased the cancer follow up thereby helping in proper handling of complex disease. Physicians also reported that use of EHR helped in the remote access of the patient's data and thereby helping in providing quality care via reducing the time for communication and hospital visit. From the patient perspective it can be said that access their own health-related notes helped to increase their indulgence in the overall healthcare plan and thereby helping to facilitate in the informed decision making process. Thus from the access of the advantages it can be said that remote access of the data, improved clinical performance and increase in patient participation in the care plan are the main driving force behind the recruitment of the digital health record across the diverse section of patient care. However, analysis of the literature also highlighted several disadvantages of this digital technology in healthcare.

EHR Enhancing Overall Quality of Clinical Care

In 2013, Chiang et al. (2013) conducted a population based study in order to access the result of implementation of EHR in the ophthalmologic department. Analysing the 120,490 clinical encounters via 23 faculty members during the tenure of 3-year study period, Chiang et al. (2013) highlighted that implementation of EHR was associated with increase in the overall documentation time along with the increase in the clinical volume and change in the nature of the ophthalmic documentation. However, change in the documentation process cannot be highlighted as one of the principal disadvantage of EHR or digital health record. Five month long follow up study is the main strength of this research however the study is concentrated over the ophthalmic healthcare professionals and hence the elucidated results might not be applicable in other sphere of health care domain.

In relation to the application of the digital health record to all the patients, DesRoches et al. (2012) are of the opinion that the application digital health record might not be suitable in the rural areas as the staffs working in rural healthcare shows decrease in the rate of adoption of the electronic health record. Via analysing the US national survey data in health record keeping information of patient in rural health, DesRoches et al. (2012) elucidated gaps in the rate of adoption of the basic record keeping through digital technology in rural areas. Thus lack of proper exposure of the rural health care staffs, especially the nursing professionals, towards EHR might make the entire digital process unsuitable for the rural population.

Estabrooks et al. (2012) conducted quantitative study in order to study the effectiveness of EHR from patients’ perspective who resides in the underdeveloped regions or who are the victims of health inequality. The study of Estabrooks et al. (2012) highlighted that EHR have potential to improve patient care however, this potential might not reach its zenith among the population who suffers from poor social determinant of health. Moreover, demographics, patient centred factor and psychological distress hamper the overall application of the EHR. Thus this study highlighted that in order to comprehensively implement EHR in areas where poor social determinants of health exist, proper interplay among the stakeholders like patients, service providers and policy makers are mandatory. The study of Estabrooks et al. (2012) is extremely significant because it recruited 93 experts to analyse the effect of EHR among people residing under social determinants in health. However, the study did not indicate that whether the reviewers were blinded about the desired outcome of the study.

In the domain of providing care to patients residing in the rural regions or in the under developed community it can be said that the application of the EHRs lead to overall decrease in the effective communication among the patients and the care givers. This is because the healthcare providers are more engaged in documentation. The analysis of the 125 consultation of the primary care providers indicated that they spent more time in gazing over the computer rather than consulting with the patients (Street et al., 2014). This has lead to decrease in the patient satisfaction. One of the main strength of this study is its high sample size which helped in the generation of less biased results. However, the results are only concentrated over the primary health care providers and thus can be regarded to be unidirectional.

Importance of Digital Health Records in Patient Care

According to Harman, Flite and Bond (2012), one of the important barriers in the equitable access of EHR in the healthcare system is its privacy and confidentiality issue which restricts is comprehensive application. Caine and Hanania (2012) conducted a research in order to access patient’s desire for granular level of privacy control on the basis of which personal health information should be shared. Caine and Hanania (2012) also analysed the preferences of patient based on sensitivity of the health information. Caine and Hanania (2012) recruited 30 patients whose health information are stored in EHR and contained certain sensitive information. The analysis of the interview on the basis of questionnaire highlighted none of the patients are willing to share all the information stored in their EHR with all the potential recipients. Patients wanted to share data via granular privacy control. The main strength of this research helped to highlight the patient perspective in the domain of privacy control and however, selection of the poor sample size of 30 might be regarded as its limitations.

In the domain of analysing privacy and confidentiality, Agaku et al. (2013) conducted a quantitative survey. The survey revealed respondents raising concerns about the breach in data privacy and confidentiality in their protected health care information. The multi-variative logistic regression was used to analyse the data and this can be regarded as the main strength of the research conducted by Agaku et al. (2013). The research highlighted that breaching of the privacy is the main concern in comprehensive implementation of EHR or digital health record across several sectors of patient’s care. However, the study is mainly based on the US perspective and hence may lead to the generation of insignificant results in other demographic location.

The study conducted by Singh et al. (2013) highlighted that the primary care professionals who are using comprehensive EHRs have a tendency to suffer from information overload. This leads to the miss-interpretation of information. The comprehensive set of information displayed in the module of the electronic health record creates a problem for the healthcare professionals to scan or highlight the actual patient’s data and this in turns leads to gap in the information. In order to analyze the effectiveness of EHR, Singh et al. (2013) conducted cross-sectional survey of primary care practitioners. The main strength of the study is its cross-sectional study design. However, in sampling, the author’s have excluded trainees and subspecialists. However, at times trainees or sub-specialists are asked to review and summarize the information and due to their lack of proper exposure they tend to commit more mistakes in comparison to the registered professionals (Ajami & Bagheri-Tadi, 2013). Hence, it can be said that the sampling is biased.

Baillie et al. (2013) conducted a survey among the nurse and the midwives in order to investigate their experience of learning the implementation process of digital health record. The survey highlighted two themes. First is the preparing skills for understanding EHRs and increase in the involvement in the system process of EHRs. The study mainly highlighted that before earning to implement digital health technology, proper computer skill is mandate. Thus, digital health record cannot be implemented globally the nursing professionals practicing in remote areas lack basic computer skills. The main strength of the study is its unique approach. The limitation of the study is its poor sample size.

Personal Health Record for Patients with Co-occurring Mental Illness

Thus the main disadvantage include privacy and confidentiality issues, time consuming digital documentation, lack of effective communication with the patients and lack of proper knowledge behind the adoption of the digital technology among the rural healthcare professionals. Moreover, it also highlighted that application of digital health information in patients of rural or under-developed areas might not provide suitable results due to the poor social determinants in health.

Thus from the perspective of the contemporary nursing, it can be said that application of the digital health record is proved to extremely helpful in streamlining the patient information. This digitalization of data will help in remote access of the patient’s information and thereby helping to doctors to indulge under immediate decision making process during emergency time irrespective of their location. Thus from this perspective it can be said that application of digital health information can be helped for all the patients with a special mention to the patients residing in the rural areas or underdeveloped regions. However, gaps in regulating the privacy and confidentiality and increase in the clerical work load (data documentation) time might results in ineffective application of digital health information over a comprehensive patient’s population. However, proper patient education about the concept of EHR and bridging gaps in privacy and confidentiality concerns associated with digital health information technology will promote overall clinical significance in the healthcare research.


Agaku, I. T., Adisa, A. O., Ayo-Yusuf, O. A., & Connolly, G. N. (2013). Concern about security and privacy, and perceived control over collection and use of health information are related to withholding of health information from healthcare providers. Journal of the American Medical Informatics Association, 21(2), 374-378.

Ajami, S., & Bagheri-Tadi, T. (2013). Barriers for adopting electronic health records (EHRs) by physicians. Acta Informatica Medica, 21(2), 129.

Baillie, L., Chadwick, S., Mann, R., & Brooke-Read, M. (2013). A survey of student nurses' and midwives' experiences of learning to use electronic health record systems in practice. Nurse Education in Practice, 13(5), 437-441.

Burke, H. B., Sessums, L. L., Hoang, A., Becher, D. A., Fontelo, P., Liu, F., ... & Bunt, C. W. (2014). Electronic health records improve clinical note quality. Journal of the American Medical Informatics Association, 22(1), 199-205.

Caine, K., & Hanania, R. (2012). Patients want granular privacy control over health information in electronic medical records. Journal of the American Medical Informatics Association, 20(1), 7-15.

Chiang, M. F., Read-Brown, S., Tu, D. C., Choi, D., Sanders, D. S., Hwang, T. S., ... & Wilson, D. J. (2013). Evaluation of electronic health record implementation in ophthalmology at an academic medical center (an American Ophthalmological Society thesis). Transactions of the American Ophthalmological Society, 111, 70.

DesRoches, C. M., Worzala, C., Joshi, M. S., Kralovec, P. D., & Jha, A. K. (2012). Small, nonteaching, and rural hospitals continue to be slow in adopting electronic health record systems. Health Affairs, 31(5), 1092-1099.

Druss, B. G., Ji, X., Glick, G., & von Esenwein, S. A. (2014). Randomized trial of an electronic personal health record for patients with serious mental illnesses. American Journal of Psychiatry, 171(3), 360-368.

Estabrooks, P. A., Boyle, M., Emmons, K. M., Glasgow, R. E., Hesse, B. W., Kaplan, R. M., ... & Taylor, M. V. (2012). Harmonized patient-reported data elements in the electronic health record: supporting meaningful use by primary care action on health behaviors and key psychosocial factors. Journal of the American Medical Informatics Association, 19(4), 575-582.

Harman, L. B., Flite, C. A., & Bond, K. (2012). Electronic health records: privacy, confidentiality, and security. Virtual Mentor, 14(9), 712.

Jensen, P. B., Jensen, L. J., & Brunak, S. (2012). Mining electronic health records: towards better research applications and clinical care. Nature Reviews Genetics, 13(6), 395.

King, J., Patel, V., Jamoom, E. W., & Furukawa, M. F. (2014). Clinical benefits of electronic health record use: national findings. Health services research, 49(1pt2), 392-404.

Levine, D. M., Lipsitz, S. R., & Linder, J. A. (2016). Trends in seniors’ use of digital health technology in the United States, 2011-2014. Jama, 316(5), 538-540.

Li, M., Yu, S., Zheng, Y., Ren, K., & Lou, W. (2013). Scalable and secure sharing of personal health records in cloud computing using attribute-based encryption. IEEE transactions on parallel and distributed systems, 24(1), 131-143.

Mandl, K. D., Mandel, J. C., Murphy, S. N., Bernstam, E. V., Ramoni, R. L., Kreda, D. A., ... & Kohane, I. S. (2012). The SMART Platform: early experience enabling substitutable applications for electronic health records. Journal of the American Medical Informatics Association, 19(4), 597-603.

Murphy, D. R., Laxmisan, A., Reis, B. A., Thomas, E. J., Esquivel, A., Forjuoh, S. N., ... & Singh, H. (2014). Electronic health record-based triggers to detect potential delays in cancer diagnosis. BMJ Qual Saf, 23(1), 8-16.

Singh, H., Spitzmueller, C., Petersen, N. J., Sawhney, M. K., & Sittig, D. F. (2013). Information overload and missed test results in electronic health record–based settings. JAMA internal medicine, 173(8), 702-704.

Street Jr, R. L., Liu, L., Farber, N. J., Chen, Y., Calvitti, A., Zuest, D., ... & Ashfaq, S. (2014). Provider interaction with the electronic health record: the effects on patient-centered communication in medical encounters. Patient Education and Counseling, 96(3), 315-319.

Woods, S. S., Schwartz, E., Tuepker, A., Press, N. A., Nazi, K. M., Turvey, C. L., & Nichol, W. P. (2013). Patient experiences with full electronic access to health records and clinical notes through the My HealtheVet Personal Health Record Pilot: qualitative study. Journal of medical Internet research, 15(3).

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