The Electronic Health RecordPatricia Egenton

Thomas Edison State College

Emerging Trends in Healthcare Technology

Nur-501-NG

Dr. Elizabeth Elkind

September 3, 2008

The Electronic Health Record

• A record of health information of an individual generated by any encounter that occurs in any health care setting that is organized with the use of

electronic equipment.

(MDPointcms.com-

Retrieved September 2, 2008)

The EHR may include information such as:• Demographics

• Family contacts

• Advanced directives

• Insurance

• Hospitalizations

• Physician visits

• Medical history

• Allergies (and reactions)

• Medication (current and past)

• Local Pharmacy

• Medical device Information ( i.e.: AICDs, orthopedic parts)

• Photos from procedures (i.e.: colonoscopies, wounds)

• Lab and radiology reports (also with films)

• Home Health Agency

• Patient teaching

• Vital signs

• Immunizations

• Oversea travel

• Appointments (HIMSS.org-

Retrieved: September 2, 2008

MDPointcms.com -

Retrieved: September 2, 2008)

The Electronic Health Record:

• Can streamline the clinician’s plan of care

• Can aid in patient convenience (avoids contacting offices and picking up paper records)

• Encompasses a more complete record of the patient’s health information and status

• Can aid with:

a. data reporting

b. risk management

c. coordination of care

d. communication between disciplines

(HIMSS.org –

Retrieved: September 2, 2008

MDPointcms.com -

Retrieved: September 2, 2008)

The EHR and The Institute of

Medicine’s Five Core Competencies

1. Provide patient centered care

a. Decrease stress on patient

b. Communicate with patient and/or POA

c. Educate patient

d. Respect patient’s requests and needs

e. Share decision making

(Peterson, 2003)

2. Work in Interdisciplinary Teams

a. Collaborate and communicate

b. Coordinate care

c. Alert other disciplines to issues and problems for quick

resolution

(Peterson, 2003)

3. Employ Evidence Based Practice

a. Include research to support plan of care

b. Offer patients choices in care based on the evidence and

literature

c. Respect data from other disciplines

(Peterson, 2003)

4. Use Quality Improvement

a. Identify errors and act on them quickly

b. Standardize language and abbreviations

c. Continuously monitor and measure quality and identify root

causes

d. Design interventions collaboratively to change process and

improve systems

(Peterson, 2003)

5. Utilize Informatics

a. Communicate clearly

b. Manage and share knowledge and information

c. Decrease errors

d. Leadership in organizations must support IT

e. Shared decision making

(Peterson, 2003)

The EHR Will Transform Nursing Practice

– Incorporating the internet with the EHR will:

a. Allow for convenient access to all health care providers in one place

b. Solve storage issues and lost paperwork

c. Decrease cost to departments and organizations by using and wasting less paper

d. Alert clinicians automatically with alert screens

e. Decrease errors by standardizing language and abbreviations and allowing for clear legibility

f. Allow for quick turnaround on results

g. Be password protected to track users and aid in protecting personal health information

h. Allow accessibility 24/7

i. Provide recommendations for treatment from online resources

j. Allow several disciplines to access information simultaneously

k. Increase patient interaction by allowing them access

l. Patients can enter daily blood pressures, blood sugars etc via electronic means (i.e. register through organizations such as MyChart etc)

(Malloch, 2007)

Positive Aspects

• Collection and storage of information will occur in real time and only once

• Integration of information for all disciplines, both inpatient and outpatient:

Nursing

Medicine

Pharmacy

Billing

Radiology

Medical Records

Physical Therapy

Social Services

Home Health Care

Radiology

Laboratory

Positive Nursing Tributes

• Increased efficiency

• Decreased delays in treatment

• Decreased errors

• Increased accuracy

• Increased documentation and capturing of nursing interventions

• Increased accessibility

• Less time wasted redocumenting already established history and information

• Increase access to evidence based practice and how to apply it in the clinical setting

• Information will be more organized

• Alert screens for:

medication due/medication changes

critical lab and radiology results

(Koerner, 2003)

Negative Aspects

• Cost

• System crashes or failures

• Multiple screens – increased chance one is overlooked

• Lack of verbal communication between disciplines

• Incidental omissions

• Clinicians lack of keyboard/computer knowledge

• Stolen information

• Need for constant upgrades

(Thielst-Beach, 2007)

Negative Aspects for Nursing

• Many screens may be confusing

• Initial pull from patient bedside to the computer screen

• Will need to provide layers of education

• Pushback

• Weakened critical thinking skills if system does all the alerting causing the RN to become complacent

• Will still need paper back up on units in case of crash

• Increased visibility when others access record

• Relearning new abbreviations and languages

• New ergonomic issues

carpal tunnel

vision issues

new types of back problems from sitting

(Cohen, 2006)

Transformation in a clinical setting

58 year old male to ED with chest pain

BP=114/58 HR=48 Irregular RR=20 T=98.1

The EHR is accessed and shows:

• Medications

• Allergies

• Patient has a Medtronic biventricular pacemaker with ACD that was placed last month

• Last cardiac catheterization and images

• Patient is on beta blockers

DATA ENTRY EXAMPLES :

RN is able to:

-complete medication reconciliation easily

-find all past medical history for review

-find last flu/pneumonia immunizations

-review pacemaker settings (Ventricular setting is 60)

-review allergies

-enter present physical assessment and findings

-review past EKGs (3 degree heart block last month)

-evidence based chest pain protocol is generated and treatment

initiated

-gets an alert screen when entering low heart rate

-alert screen reminds RN of medications contraindicated

in bradycardia

-evidence based bradycardic protocol is generated and treatment initiated

-RN holds contraindicated medications i.e.: beta blockers

-RN compares EKG strips to PPM/ACD settings for correlation

-RN documents initiation of bradycardic protocol

Physician is able to:

-review triage and vitals immediately

-enter lab work orders that lab will receive directly

-considers alternate medications after seeing bradycardic alert screen

-enters medication orders that pharmacy will receive directly

-contact the patient’s cardiologist easily via text message through computer

-can send present findings to cardiologist via computer for his or her review

-enter additional evidence based orders/tests for chest pain and bradycardic protocol when prompted by screen

-review PPM/ACD settings, old EKGs for comparison

-enter present history and physical at the bedside

-retrieve information on patient’s PPM/ACD

With the EHR in place:

• The RN knows within minutes what kind of pacemaker the patient has and why and when it was put in

• The physician can text the cardiologist directly instead of putting out calls and waiting and forward his or her findings electronically within minutes

• The RN knows the patient received his pneumonia immunization last admission and will not over vaccinate

•Preparing RNs for the

transformation• Allow for learning curve

• Have nurses be involved in choosing and creating system

• Set up phases and set goal dates

• Create “buy in” by showing examples of improved easier practice with the EHR

• Expect and prepare for pushback

• Leadership must set the tone but be supportive of staff through process

• Allow staff input and decision making

• Create IT committee and unit subcommittees for feedback

• Provide basic computer, keyboard and mouse training before system is introduced

ensuring basic skills

• Provide ongoing classes from IT nurses

• Provide CD ROMs for take home practice

and offer rewards for completion

(Malloch, 2007)

During transformation provide clinical support

to staff by:

• Having IT nurses available live 24/7 for

initial phase

• Have additional staff on during initial phase to

provide adequate patient care

• Identify “SUPERUSER” from committees and allow

them to focus on learning needs of unit or subgroup

• Allow for feedback

• Maintaining supportive and positive attitude

• Allow for more education as needed

Summary

The EHR

BE AWARE AND PREPARE FOR

NEGATIVE AND UNINTENDED

CONSEQUENCES!

Einstein said:

“Technological change is like an axe in

the hands of a pathological criminal.”

AT THE SAME TIME, OUR PATIENTS

MUST BENEFIT FROM THE

TECHNOLOGY!

Lincoln said:

“As our case is new, so must we think

anew and act anew.”

NURSING LEADERSHIP NEEDS TO

SUPPORT RNs TO ENSURE THEIR

SUCCESS WITH INFORMATION

TECHNOLOGY!

Darwin said,

“It is not the strongest or the most

intelligent of the species that survives, but

the one most responsive to change.”

References

Cohen, M. (2006). Why I never had an Atari video game system. Family Practice Management, 13 (8), 90.

Healthcare Information Management and System and Society, (ND). Electronic health record. Retrieved September 2, 2008 from http://www.himss.org/ASP/topics_ehr.asp

Koerner, J. (2003). The virtual world. Enhancing the technology and knowledge professional interface for life-long learning. Nursing Administration Quarterly, 27 (1),

9 – 17.

Malloch, K. (2007).The electronic health record: An essential tool for advancing patient safety. Nursing Outlook, 55 (3), 159 -161.

MDPointscms.com, (2007) Electronic record. Retrieved September 2, 2008 from http://www.mdpointcms.com./index.php?x=19

Thielst- Beach, C. (2007). The future of healthcare technology. Journal of Healthcare Management, 52 (1), 7 – 10.