Electronic Health Record (EHR)

Respond to at least two of your colleagues* offering additional/alternative ideas regarding opportunities and risks related to the observations shared.

Eliverta

Discussion – Week 6

Top of Form

Electronic Health Record (EHR) is continuing to evolve in today’s medical facilities. The American Recovery and Reinvestment Act mandated health organizations to transition to Electronic Medical Records (EMR) by January 1, 2014 in order to maintain Medicaid and Medicare reimbursement (USF Health, 2019). For this week’s discussion I will reflect on the module resources on digital information tools and technologies. I will discuss the healthcare technologies used in the health organization I work for. Lastly, I will reflect on any possible health technologies and the impact it has on nursing practice and healthcare delivery.

The health organization I work for switched to EPIC software for EMR two years ago. EPIC is user friendly for nurses as well as patients. EPIC corresponds to MyChart giving patients access to on their medical records (MyChart, 2019). I work in outpatient Endoscopy clinic where part of patient After Visit Summary (AVS) we educate patients on the use of MyChart and provide them with a code so they can access MyChart from home. Patients can access their medical records, and view lab results, make appointments, communicate with their provider, and pay their medical bills with MyChart (2019). ProVation is another form of technology used in the facility I work for. ProVation is used by the physicians where they document the Endoscopy procedure outcomes and results noted by the physician (ProVation, 2019). The physicians can document their findings as well as list out orders or management solutions for the patients (ProVation, 2019).

EHR has made it possible for nurses to provide efficient patient care as it has given us the ability to share patient information with other providers and health care organization departments, such as pharmacy, laboratory, etc (HealthIT, 2018). Patient care and experiences are improving because patients are being included in their care and they can make decisions in the plan of care. Having quick access to medical records and information results in increased patient satisfactions. Also, by combining patient portals inpatient healthcare facilities has resulted in a decrease of medical errors and adverse events (Dyes et al, 2017).

EHR poses a list of challenges with the main one being security safety. Web-based technology does put us at increased risk of breach of information by hackers. It can also be challenging for individuals to navigate web-based health technology, resulting in decreased patient satisfaction. Our older population is reluctant when it comes to using technology, they prefer paper written information. Documentation errors are associated with improper utilization, due to insufficient training (David, 2017).

In conclusion, EHR comes with many benefits as well as challenges. It has improved quality, safety and efficiency in patient care. EHR has also shown to reduce health disparities (USF Health, 2019). It has also improved care coordination because patients are being involved into their care thus resoling in increased patient satisfaction. The use of EHR makes it easy to monitor community and public health. However, maintaining patient information privacy and security is crucial in order to not violate patient’s privacy.

References

Dykes, P. C., Rozenblum, R., Dalal, A., Massaro, A., Chang, F., Clements, M., Collins, S. …Bates, D. W. (2017). Prospective evaluation of a multifaceted intervention to improve outcomes in intensive care: The Promoting Respect and Ongoing Safety Through Patient Engagement Communication and Technology Study. Critical Care Medicine, 45(8), e806-e813.doi:10.1097/CCM.000000000002449

HealthIT.gov. (2018c). What is an electronic health record (EHR)? Retrieved from https://www.healthit.gov/faq/what-electronic-health-record-ehr

MyChart. (2019). Ohio Health Your Interactive Health Record. Retrieved from https://mychart.ohiohealth.com/mychart/Authentication/Login?

ProVation. (2019). Putting clinical productivity into practice. Retrieved from https://www.provationmedical.com/

Taylor, D. N. (2017). A literature review of electronic health records in chiropractic practice: Common challenges and solutions. Journal of Chiropractic Humanities, 24(1), 31–40. https://doi-org.ezp.waldenulibrary.org/10.1016/j.echu.2016.12.001

USF Health. (2019). Federal mandates for healthcare: Digital record-keeping requirements for public and private healthcare providers. Retrieved from https://www.usfhealthonline.com/resources/healthcare/electronic-medical-records-mandate/

7 hours ago

Heidi

Discussion – Week Top of FormMost of my nursing career has been in the surgical setting where there was numerous patient information to collect and analyze.  We used an electronic health record that stored all the patients’ past health information, lab results, CT results, current or past medication, and any information from other providers. The providers and nurses could access any of that information within the system.  Surgery is no stranger to technology as there are numerous pieces of equipment utilized to have a successful surgery.  One piece of technology used is called Navigation.  It is used as an aid for total knee arthroplasty surgery by using a computer system that sits bedside during the procedure communicating to the physician.  The purpose of navigation systems is to correct axial misalignment, reduce rate of revisions, and achieve better patient outcomes (Brainlab, 2019).  This technology is used for sinus procedures as well.  Also, in surgery we there are certain patient criteria that we are required to measure for optimal patient outcomes.  These are part of the Surgical Care Improvement Project (SCIP).  Some of these measures are surgical site infection prevention, appropriate hair removal, continuation of beta-blockers post- surgery, venous thromboembolism prevention, and correct antibiotic administration (Institute for Healthcare Improvement, 2009).  These measures were built into our electronic system as “hard stops” meaning that they had to be charted and addressed before proceeding to the next section or finalizing your chart.  The outcomes are measured by our quality control staff.

Some of the risks associated with the navigation systems is that it is a computer and could always malfunction or shut off.  I worked at a small, rural hospital and we only had one. The staff has to enter patient information before the program starts and you must fill in the laterality.  I have been in surgical cases where the wrong knee was selected and therefore the precision of cutting was a little off.  Also, the surgeon gets accustomed to using this equipment and there have been times that the machine was not working which meant we could not use it for the case.  For us that meant doing things the “old fashion” way which was time consuming and usually left us behind in our surgery schedule and made for patient delays.  The challenge for using the SCIP measures is that if it wasn’t documented properly then it wasn’t accurate.  Since the results were evaluated by our quality control team, we relied on them to audit the charts accurately.

Some benefits to the navigation system are that it does not store personal health information unless you manually save it, the law does not require you to use it, and it improves patient care by enhancing the surgeons performance and capabilities.  Some potential risks are that there could be a personal health information breach if the patients’ information is stored on the device, there could be a potential HIPAA violation, and if used incorrectly could end up hurting patient more than helping.  Potential benefits to the SCIP measures is that we can use data to pinpoint our strong points and what needs improvement and patient outcomes can be better.  Also, the Centers for Disease Control and Prevention (CDC) oversee the SCIP project (Rosenberger, Politano, & Sawyer, 2011).  A few risks associated with this is that there could be a data breach and HIPAA violation, failure to comply with the CDC guidelines, and that we do not follow the guidelines and put the patient at risk.

I feel that healthcare trends we will see more of is TeleHealth and wearable devices.  We know there is a lack of primary care providers and in rural areas it may be beneficial to utilize TeleHealth in order to serve that population who are unable to make it to an office for a visit.  Wearable devices are already popular for personal use and it would make sense that we could use this technology to assist with medical care.  There is already an ECG monitor on the apple watch.  I foresee that more technology like this will be available in the future to use in medicine. Both of these technologies would benefit patient outcomes.

References

Brainlab. (2019, March 5). Continued evidence for improved outcomes in navigated total knee arthroplasty. Retrieved from https://www.brainlab.com/news/continued-evidence-for-improved-outcome-in-navigated-total-knee-arthroplasty/

Institute for Healthcare Improvement. (2009). Surgical complications core processess. Retrieved from http://app.ihi.org/imap/tool/processpdf.aspx?processGUID=9102c77f-e32e-4677-be9f-a5dbf8329940

Rosenberger, L. H., Politano, A. D., & Sawyer, R. G. (2011). The surgical care improvement project and prevention of post-operative infection, including surgical site infection. Surgical Infections, 12(3), 163-168. doi:10.1089/sur.2010.083

 
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