DiversityNursing Blog

Electronic Health Records: Love It or Leave It?

Posted by Erica Bettencourt

Wed, Oct 07, 2015 @ 12:13 PM

It is clear that digital technology has a firm grasp on our lives and is advancing daily. We walk around with a computer in our pocket (cellphones) full of endless amounts of information. This technology has changed the way we provide healthcare and with this change there are pros and cons. Specifically, Electronic Health Records (EHRs) or Electronic Medical Records (EMRs). 

An Electronic Health Record according to CMS.gov, is an electronic version of a patient's medical history. It is maintained by the provider over time, and may include all of the key administrative clinical data relevant to that person's care under a particular provider, including demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports. The EHR automates access to information and has the potential to streamline the clinician's workflow. The EHR also has the ability to support other care-related activities directly or indirectly through various interfaces, including evidence-based decision support, quality management, and outcomes reporting.

Pros

EHRs will save you space and paper. Administrative duties in health systems represent a significant amount of time and costs. Staff can spend a good portion of the workday filling out and processing forms. Because they are paperless, EHRs streamline a number of routine tasks. With less paperwork taking up space there will be less clutter and more room to be efficient.

Patient’s medical files will all be consistent. The medical staff can interact easily with affiliated hospitals, clinics, labs and pharmacies about the patient’s medical history. All of the patient’s files are updated when something is entered or changed in the system. This way the patient’s information is always up to date, leaving less room for errors or miscommunication.

Easy access to all clinical data. Staff can quickly transfer patient data to other departments or providers, while also reducing errors, which yield improved results management. Patients and employees often respond positively to this because it helps keep a health system’s schedule on track.

Cons

Privacy is a major concern when it comes to electronic health records. Using EHR software could put your organization at risk if you don’t follow privacy settings correctly. Paper records also make it easy to violate a patient’s privacy but, electronic records are convenient and timely which makes it easier to violate the patient’s privacy. A common privacy concern is identity theft.

Another disadvantage is data loss. A computer crash could wipe out vital data that you’ve been accumulating over the years. Always have a backup plan. This is imperative.  Many systems backup their data through a cloud program. So if there is an unfortunate event and your system crashes, you will still be able to access the data from the cloud.”

There are high costs involved with implementing an EHR to your system and many smaller health systems might not be able to afford it. The American Action Forum says, “Implementing an EMR system could cost a single physician approximately $163,765. As of May 2015, the Centers for Medicare and Medicaid Services (CMS) had paid more than $30 billion in financial incentives to more than 468,000 Medicare and Medicaid providers for implementing EMR systems. With a majority of Americans now having at least one if not multiple EMRs generated on their behalf, data breaches and security threats are becoming more common and are estimated by the American Action Forum (AAF) to have cost the healthcare industry as much as $50.6 billion since 2009.”

Do you work in a health system that uses Electronic Health Records? If so, how do you feel about them? We want your honest opinion, the good, the bad and the ugly.

Topics: electronic health records

Med/Surg Nurses Use Informatics To Save Time, Enhance Patient Safety

Posted by Erica Bettencourt

Mon, Apr 20, 2015 @ 11:08 AM

By Tracey Boyd

http://news.nurse.com

describe the imageInformatics programs that allow med/surg nurses to cut down on documentation and increase patient safety at the touch of a button are becoming more essential in today’s fast-paced healthcare environment.

“Most all nurses use the electronic health record in their daily practice,” said Jill Arzouman, MSN, RN, ACNS-BC, CMSRN, president of the Academy of Medical-Surgical Nurses and clinical nurse specialist in surgical oncology at the University of Arizona Medical Center, Tucson. The university has computer stations inside each patient room for access to charting, she said, and some hospitals are investing in iPads to facilitate charting. Arzouman is a DNP candidate.

Med/surg nurses at New York’s Montefiore Health System in the Bronx use informatics throughout the day to document patients’ electronic medical records and provide direct care to patients, said Maureen Scanlan, MSN, RN-BC, vice president, nursing and patient care services and former director of informatics for the health system. “Electronic documentation has provided us the ability to track and trend patient outcomes data in a more efficient manner. We have the added benefit of decision support alerts to guide practice and documentation. We then can leverage information collected from the records to streamline workflows and improve patient safety.” 

According to a HealthIt.gov study “Benefits of EHRs,” (www.healthit.gov/providers-professionals/improved-diagnostics-patient-outcomes), having quick, up-to-date access to patients’ information can also reduce errors and support better patient outcomes by keeping a record of a patient’s medications or allergies, checking for problems whenever a new medication is prescribed and alerting the clinician to potential conflicts. 

“The ability to clearly read a medication order printed from a computer is vastly different than trying to decipher a handwritten order,” said Arzouman.

In addition, staff can revisit patient information at any time. 

“Many of the systems are very intuitive and allow the entire interdisciplinary team to document and communicate with precision and ease,” she said “A medical/surgical nurse may be busy with another patient but she or he can go back and read documentation from the dietitian who may have visited the patient at the same time.“

A reduction in medication errors was the catalyst for a project using computerized EHRs at Abington (Penn.) Health. When staff realized that patients with heart failure were being readmitted largely because of incorrect medication lists upon discharge, Diane Humbrecht, MSN, RN-BC, chief nursing informatics officer, devised a plan to evaluate the accuracy of such lists. 

Humbrecht, a DNP candidate who is also a chapter director for the American Nursing Informatics Association, has worked in both cardiac and home care during her career and said she had experienced heart failure patients going home with medication lists that were either incorrect or missing information. 

“It was very frustrating for both the patient and the nurse who is trying to follow up,” she said.

As part of her DNP program, Humbrecht decided to focus on transitions of care for this vulnerable population to help correct their discharge medication instructions and reduce their risk for readmission.

“As I began researching, I saw medication errors on medication discharge lists were the main reasons patients were readmitted to the hospital,” she said. •

Her findings were validated, she said, when the transition nurses who were involved in the postop discharge process informed her of problems with patients going home with incorrect medication lists. “Medication reconciliation and discharge instructions are done by the physician, but the nurses are the ones who review them and they were finding these errors after discharge,” she said. 

Humbrecht implemented three changes to remedy the situation. The first step was to bring the pharmacists in on the front end. Pharmacists already performed patient rounding on units, but they were not involved in medication reconciliation at all, she said. The new protocol called for pharmacists to come in within 24 hours of a patient’s admittance to review the co-medications. The input from the pharmacists on the front end was crucial. “The pharmacists had to change about 80% of the lists,” Humbrecht said.

Next, upon discharge, the nurses perform a thorough review of the co-medications list that was corrected by the pharmacist. “If anything needed to be corrected, the nurse then called the physician to tell them they need to change a medication,” Humbrecht said. “Once that was done, it caused the physician to perform medication reconciliation again, automatically updating the entire medication list.” 

The transition nurses were the final piece to the puzzle. Prior to the new protocol, upon calling the discharged patient and finding any errors, the nurse would make notations on paper. If the patient was readmitted, and the change was not transferred onto the patient’s EHR, the incorrect information was still in the system. Now, using the computerized medication list, any errors are updated immediately in the system. 

The changes worked. Since implementation last fall, the transition nurses have found one error on the medication list of a discharged patient, Humbrecht said. 

“We figured if we can get the home medication list correct on the front end by using the pharmacists and double-checked and changed as needed by the nurses on the back end, then the transition nurses should find less errors,” she said.

Besides documentation and patient safety, med/surg nurses are using informatics to enhance patient care. “Our staff nurses provide expert advice when we are defining a new process for delivering patient care,” said Scanlan, who holds board certification in nursing informatics. “A recent implementation of a new lab system that changed the way specimens are collected was successful due to workflow and hardware recommendations from the frontline staff.” 

Scanlan said staff nurses recently have contributed to revising the electronic skin assessment template as well. 

“Although not a clear time saver,” she said, “it has significantly improved the ability to track, trend and communicate hospital-acquired pressure ulcers [and] has supported performance improvement efforts that are led by the nursing staff.”

Arzouman also noted innovative uses. “For a postoperative patient who needs to continue to ambulate and exercise while at home, a medical/surgical nurse can teach the patient how to track his activity using a smart phone app,” she said. “I have had the opportunity to trial an app on my smart phone that translates basic medical information into many different languages without needing to use a translator. For something simple like ‘Hi, my name is Jill and I will be the nurse coordinating your care today,’ it is a very helpful tool.” 

Topics: EHR, nursing, health, healthcare, nurse, nurses, data, electronic health records, med/surg, informatics

Implementing Electronic Health Records at Healthcare Organizations

Posted by Erica Bettencourt

Mon, Apr 13, 2015 @ 11:26 AM

Ohio University's Master's of Health Administration Online Program

http://healthadmin.ohio.edu

OU MHA EHR resized 600

Topics: EHR, health, healthcare, medical, infographic, electronic health records

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