This week we will explore how electronic health records (EHRs) are being incorporated in health care settings, and how they influence the workload of nurses and health care professionals (HCPs).
Before we dive into how EHR applies to nurses, let's quickly over view just what it is and some positives and negatives that may impact patients.
Electronic Health Records are an electronic profile documenting your entire health history. The record includes lab and tests results, past treatments and procedures, allergies, and past medications prescribed. This private information is all stored in one area where it can be easily accessed and analyzed by health care professionals. By having all this information in one universally accessible spaces (EHR), HCP are quickly able to provide safe and effective interventions (Flipova, 2013).
Despite now having to worry about losing documents, how else will this impact patients?
Positives
- Empowers consumers (patient) as they have greater access to their personal health information
- Enhances continuity of care from your health care team
- Effective in emergency situations when unable to supply own information (e.g allergies, medications, medical conditions)
Negatives
- Data accuracy and missing subjective information
- May not understand medical terminology and results
- Data privacy and confidentiality may be breached
Discussions about EHRs mostly focus on the client perspective, but what will these changes mean in clinical care settings? Adjusting to a technology-centred health care environment may be difficult for many health institutes. Thede (2008) states that nurses play an integral role in making this transition as smooth as possible. Nurses are responsible for reducing these barriers to aid the patient experience.
For nurses EHRs present a range of possibilities that can improve the care they provide, and their workload. When nurses have access to electronic health records it reduces the time spent on gathering generic health history each interview and interactions. Often, patients are repeatedly asked the same questions about their health and family history, which can be time consuming for the nurse. Much of the interview process can be spent going over history rather than focusing on the main reason for seeking care. EHRs contain all of this information in one area that will not be lost, and can be accessed at any time.
In turn, this also reduces the amount of paper work that nurses have to complete. EHR have specific sections for each type of data that can be directly imputed and have areas for fruther data and nurse's comments. This limits the paper being used, and ensures that the files are kept in an organized manner. This also means that nurses are more accountable for their work.
Health records can only be accessed with a password and security codes that are different for each HCP. The computer keeps track of who is signed on, what they have accessed and what each member had added to the profile. This function addressed the confidentiality issues that are present. As well, tracking who is responsible for information allows for clarity, and ensures that nurses are thoroughly documenting.
In my opinion, perhaps one of the greatest functions of the electronic health record is that it allows HCP is follow trends in data and track changes in results more efficiently. For example, consider a hypertensive patient who regularly has their blood pressure taken. Before the electronic health record, the documentation could be irregular, and difficult to compare if there are multiple paper records. These former reports mostly look at when the readings are normal and when they are irregular, but do not consider the contributing factors, time of day, and lifestyle of the patient. With EHR, nurses are able to graph and extrapolate data and relate it to the context of the individual. The EHR provides online functions to track specific details and take that into consideration when analyzing the data (Agency for Healthcare Research and Quality, 2012).
This takes out the guess work that many nurses face. EHRs provide visual evidence of how a patient is progressing. For patients with eating problems and disorders who are overweight or underweight, these charts can be used to monitor changes. As well, a patient's personal chart can be compared directly with expected patterns. This will also be useful for infants and children, to track development and how they are researching certain developmental stages. The nurse should take an active role in fully using the functions available on EHRs to make the most of their assessments, and advocate for patients health and wellness. By noticing changes early, the nurse can work with the patient and health care team to adjust practices that best support the patient's needs.
Unfortunately, there are still many drawbacks of the EHR that can influence the nurse's workload, and provision of care.
Continuity of care between institutions and facilities is a large concern. Implementing EHRs can be extremely expensive, and many rural health centres and hospitals are choosing to stay with traditional documentation. As well, there is yet to be one standard program that is used for all facilities. This causes gaps in the system, and means that information can be difficult to access and not as easily shared from one place to the next.
As well, these programs are initially difficult to use and therefore nurses need adequate training. Unfortunately much of this training is expensive, and nurses are often not paid for their time (Thede, 2008). Budgets also mean that there is a restricted amount of time allotted to training, and many nurses only learn the basic function of the the electronic record. This can lead to data inaccuracy and technology problems that few understand how to resolve.
Most importantly, EHR do not capture the emotional aspect of nursing. As the focus of health care shifts to a more technological approach, less time is spent with face-to-face interactions. While, health information may be more accessible and time will be focused on noticing and tracking changes in health, there is the possibility that EHR will decrease the client's experience. This focus on monitoring health and trends unfortunately feels like a step backward to when health-care had a bio-medical approach. Data may be solely concerned with physiology and pathology of a patient rather than holistic wellness. When nurses spend less time with patients, the trans-personal moments that foster the therapeutic relationship are lost (Thede, 2008).
How can nurses maintain the therapeutic relationship despite the digital divide?
Last post, I discussed the role of educator and teacher or the nurse, but this week we expand the definition of nurse to include that of advocate.
Nurses must advocate for their clients in health care settings to ensure that they are being met with holistic care. The nurse must use both the EHR and the client's unique experiences to create individualized care plans. EHRs provide the medical history and present condition of a patient. When the EHR is combined with the client's perspective, and mental and spiritual health is considered nurses can re-establish the therapeutic bond with patients that are based on mutual respect and trust (Coiera, 2004).
As well, nurses should encourage patient involvement in imputing information that they believe is valid and significant. Patient gathered data allows the patient to feel like an integral member of their care, and be empowered by their health information. Moreover, nurses can educate their patients on their rights to access their health information, and help patients understand results.
Since the implementation of electronic health records impact and influence nursing practice, nurses need to take an active role in utilizing these technology in the workplace. Nurses act as the regulator in allowing for a smooth transition and advocating for the holistic well-being in technology-driven society (Vitera, 2013).
---Student Nurse Katie
References
Agency for Healthcare Research and Quality. (2012). Electronic health records improve nursing care, coordination and patient safety. Research Activities. 5(381). Retrieved from http://www.ahrq.gov/news/newsletters/research-activities/may12/0512RA11.html
Coiera, E. (2004). Four rules for the reinvention of health care. BMJ, 328(7449), 1197–9.
doi:10.1136/bmj.328.7449.1197
Flipova, A. (2013). Electronic health records use and barriers and benefits to use in skilled nursing facilities. CIN: Computers, Informatics, Nursing. 37, 305-319. doi:10.1097/NXN.0b013e318295e40e
Thede, L. (2008). Informatics: The electronic health record: Will nursing be on board when the ship leaves? The Online Journal of Issues in Nursing. 13(3), doi:10.3912/OJIN.Vol13No03InfoCol01
Vitera. (2013). Nurses' integral role in EHR adoption. SuccessEHS. Retrieved from http://www.successehs.com/item/nurses-integral-role-in-ehr-adoption.htm
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