DNP 805 A Usefulness of the Electronic Health Record
Discuss the usefulness of the electronic health record (EHR) and its impact on patient safety and quality outcomes. Describe strengths and limitations that might apply to its usage.
Since the passage of the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009, advancements in technology for electronic health records (EHRs) have dramatically increased.1 HITECH includes incentives that provide reimbursements to hospitals and healthcare provider practices for adopting certified EHR technology and meeting meaningful use requirements.2
Despite these incentives, nurses, healthcare providers, and hospitals have been slow to adopt any comprehensive EHR. Potential barriers include a lack of computer skills, high cost, security concerns, workflow issues, and time.3 However, as this article will show, adopting EHRs has many more benefits than drawbacks, and implementation is worth the upfront time and cost commitment.
Clear benefits for clinicians
One major—and obvious—benefit is legibility. Historically, illegible handwriting has been a prime source of medication errors; in one source, more than 60% of medication errors in hospitals were attributed to poor handwriting.4
Further, managing medications through an EHR improves patient outcomes over time. In fact, EHRs reduce adverse drug events by 52%.5 Some are designed to integrate with bar code scanning technology; if a nurse scans the wrong medication, an alert pops up alerting him or her to a problem.
Critical lab values have to be reported to the healthcare provider in a timely manner. The EHR flags each critical value for clinical staff, making notifications simpler for nurses. The EHR also helps clinicians determine when to repeat a lab test.6
Another way an EHR improves treatment and clinical outcomes is by reducing the number of duplicate tests and improving overall efficiency.7 The EHR also stores radiology results, which can be accessed from within the application if clinicians need to view the actual X-ray or the report from the radiologist.8 All reports are accessible to all clinicians involved in the patient’s healthcare and can be viewed at any time.
It is important to note that not all EHRs provide the same features. Some features, such as the ability to view X-rays in the EHR, represent an additional design and development cost for the facility.
Involving the patient
The Health Insurance Portability and Accountability Act of 1996 requires that all protected health information be secure.9 Keeping this information safe is a major challenge for all members of the healthcare team. EHRs make this easier and improve accountability with audit trails and security that detail who has accessed the medical records and when, and what the individuals did while accessing each record. EHRs also keep information safe from anyone who does not have permission to see patient data.
Patients have access to their own EHRs through patient portals and can read, print, and send their health information to providers. This empowers patients to be their own advocate.10
Finally, EHRs help patients and clinicians with medication reconciliation. A medication list compiled from the EHR can be easily retrieved and updated at each patient visit. This makes maintaining a current medication list relatively easy for patients and providers.11
Harnessing the power of data
Because EHRs store massive amounts of data that are readily available, they are invaluable for performance improvement projects and quality assurance. Facilities can also use these data in more expansive ways. For example, clinical researchers, working with EHR vendors, have established standards and processes to use EHR data to improve the speed of the research cycle and “rapidly inform clinical decisions.”12
Electronic health information exchanges are currently available as directed exchanges, query-based exchanges, and consumer-mediated exchanges (see Definitions).13 This gives providers vital information regarding a patient’s health history, previous and current medications, allergies, family history, and any other pertinent information that may be necessary to properly diagnose and treat a patient. Ultimately, the EHR gives providers comprehensive data that can guide them to more accurate, reliable diagnoses.14
Nurses and the EHR
Despite all these potential benefits to clinicians and patients, many nurses are unhappy with their EHR. In one survey of nearly 14,000 nurses, 69% stated that their “IT department is incompetent” and 92% were unhappy with their EHR. They believe that using the EHR is time-consuming and takes time away from their patients.15
Nurses are on the front lines of patient care, but when administrators choose an EHR, nurses are often left out of the discussion.15 If nurses are not given a voice early in the process, they have to deal with the consequences of an EHR that does not meet their needs or structure a proper workflow to provide patient care in a timely manner.
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To improve nursing satisfaction with EHRs, facilities must involve clinical and informatics nurses early in the process, fully preparing them for the change without overloading them with information. Staff should be trained in advance of implementation and provided with continuous support after the EHR is in place.16
When a facility chooses an EHR that works for all stakeholders, these systems can improve patient care, nursing documentation, and patient outcomes, and will continue to revolutionize the healthcare industry with advancements in technology.17 EHRs are rapidly becoming the norm for medical records throughout the country, and patients and nurses alike stand to benefit.
Electronic health information exchange: allows physicians, nurses, pharmacists, other healthcare providers, and patients to appropriately access and securely share a patient’s vital medical information electronically.
Directed exchange: the ability to send and receive secure information electronically between care providers to support coordinated care.
Query-based exchange: the ability for providers to find and/or request information on a patient from other providers, often used for unplanned care.
Consumer-mediated exchange: the ability for patients to aggregate and control the use of their health information among providers.
1. Tripathi M. EHR evolution: policy and legislation forces changing the EHR. J AHIMA. 2012;83(10):24–29.
2. EHR incentives & certification: meaningful use definition and objectives. HealthIT.gov. 2015. www.healthit.gov/providers-professionals/meaningful-use-definition-objectives.
3. Ajami S, Bagheri-Tadi T. Barriers for adopting electronic health records (EHRs) by physicians. Acta Inform Med. 2013;21(2):129–134.
4. Center for the Advancement of Health. Computerized doctors’ orders reduce medication errors. Science Daily. 2007. www.sciencedaily.com/releases/2007/06/070627084702.htm.
5. Hydari Z, Williams T, Zimmer KP. HIT safety: progress made and challenges ahead. Office of the National Coordinator for Health Information Technology. 2014. www.healthit.gov/sites/default/files/ONC_HIT_SafetyHealthITWeekWebinar_2014_09_12.pdf.
6. How can electronic lab results help me improve patient care? HealthIT.gov. 2013. www.healthit.gov/providers-professionals/faqs/how-can-electronic-lab-results-help-me-improve-patient-care.
7. Heath S. Physician EHR use benefits quality performance, productivity. EHR Intelligence. 2016. https://ehrintelligence.com/news/physician-ehr-use-benefits-quality-performance-productivity.
8. HealthIT.gov. Imaging Results. 2013. www.healthit.gov/providers-professionals/achieve-meaningful-use/menu-measures-2/imaging-results.
9. U.S. Department of Health & Human Services. HIPAA for Professionals. www.hhs.gov/hipaa/for-professionals.
10. Ricciardi L. Making patient access to their health information a reality. Health IT Buzz. 2012. www.healthit.gov/buzz-blog/consumer/making-patient-access-health-information-reality.
11. Active Medication List. HealthIT.gov. 2014. www.healthit.gov/providers-professionals/achieve-meaningful-use/core-measures/active-medication-list.
12. Kush RD. Interoperability review: EHRs for clinical research. AMIA. 2012:2(2).
13. HealthIT.gov. What is HIE? 2014. www.healthit.gov/providers-professionals/health-information-exchange/what-hie.
14. HealthIT.gov. Improved diagnostics and patient outcomes. 2014. www.healthit.gov/providers-professionals/improved-diagnostics-patient-outcomes.
15. Perna G. Nurses dissatisfied with EHRs, report finds. Healthcare Informatics. 2014. www.healthcare-informatics.com/news-item/nurses-dissatisfied-ehrs-report-finds.
16. Schwartz A. Nurses adopt electronic health records. Science of Caring: University of California San Francisco School of Nursing. 2012. http://scienceofcaring.ucsf.edu/future-nursing/nurses-adopt-electronic-health-records.
17. Kutney-Lee A. Electronic Health Records Improve Nursing Care, Coordination, and Patient Safety. Rockville, MD: Agency for Healthcare Research and Quality; 2012.