Introduction
Electronic
health records (EHR) systems are records of a patient’s medical detail (including
history, physical examination, investigation and treatment) in digital format (Ozair,
Jamshed, Sharma, & Aggawal, 2015). The
electronic health record technology was first introduced in 1972, by the
Department of Veteran’s Affairs, however, it was not until 2004, under the
Obama’s administration that EHRs came to the forefront of our health care
system (McGonigle & Mastrian, 2018). EHRs improve
the ability to diagnose illness, reduce medication errors and enhance safety patient
outcomes, while controlling cost. In addition, adverse drug reactions can be
reduced when EHRs are linked with drug banks and pharmacies. EHRs can be accessible from remote areas and
at the point of care. This coordination
of care results in a reduction of duplications tests, which is cost effective (Health
Technology, 2017). However, serious consequences have emerged
since the implementation of this technology. For example, breaches in patient’s
confidential health information is just one of several challenges faced by our
healthcare system since the arrival of this technology. Patient safety and quality of care can be
greatly compromised with flawed technological systems. Therefore, it is
imperative that attention to potential consequences of electronic health
records be seriously considered by our healthcare leadership. If these systems
are designed and used inappropriately, then systems failures will surely
compromise the integrity of the EHR. The current healthcare system is at risk
of the EHR spiraling out of control without governance, with specific concepts
and programs to control information assets. For instance, the emergence of
mobile devices have posed challenges to safeguarding the EHR. However, process of encryption is vital to
the success of mobile these mobile devices.
The
Impact in Healthcare & Nursing
The
emerging of the HER has resulted in a major impact on our healthcare
system. For example, the field of
nursing informatics has migrated into a specialty area since the implementation
of the EHR. Human – technology
interfacing has a definite linkage to patient safety and the delivery of
quality care. EHRs have made major contributions to our present healthcare
system by making big data banks accessible across the speculum of health care. This includes computerized physician orders
with patient – specific decision support that have powerful interventions for
improving patient safety. In addition,
recent data shows that many physicians believe EHR systems are beneficial to
patient care in a variety of ways. Faber,
N.,Lui, L., Chen, Y., Calvitti, A., Street, R., Zuest, D.,….Agha, Z. et. la. (2015), reports a greater than 50%
decrease in serious medication errors when physicians utilize EHR systems. EHR system have been estimated to save the
healthcare system approximately 81 billion dollars annually, in the reduction
of errors, adverse events, and improve preventive care and chronic disease management.
In addition, Hoyt, 2018, noted that EHR
systems were very expensive and can result in a financial burden for systems’
repairs. The study also revealed that EHRs can be time consuming, resulting in
providers and staff spending less time at the bedside.
The
EHR: Benefits & Barriers
EHRs have definite benefits over the
past use of hard copy paper records.
Production of legible records reduces the probability of erroneous
prescription, doses and procedures from occurring which have major adverse
impact on the patient population. However, challenges to the EHR system is that
this system cannot detect an error. For
example, the physician may omit prescribing Lasix 20 mg, by mouth, daily, for
Mr. Smith. On the 3rd day of his admission he
is transferred to ICU with acute exacerbation of CHF. McGonigle & Mastrian (2018), also
reports that applying EHRs with a stimulated learning environment is challenging
because they lack efficient feedback and are not design to work in real time.
Safety & Ethical Concerns
Prime examples of safety issues associated
with EHRs usage are such as the above mentioned scenario where the medication omission
went without detection until the patient was in an acute medical crisis. Copying and pasting is a compromising practice
that hinders proper diagnosis and treatments from being ordered. Recently, there have been many incidences
where unethical health care providers have breached the Health Insurance
Portability and Accountability Act (HIPPA) by stealing confidential health
record information such as the patient’s social security number and selling
them. This stolen data can contain the patient’s name, and addresses, which can
put the victims at even greater safety risks (Bowman, 2013). The patient holds ownership to the EHR,
therefore, it should be handled and maintained with a high level of protection
regarding privacy. This can occur by initiating authorized users capabilities.
Future
DNP Practice & the EHR
Nursing
practice is continuously evolving around the use of technology in the
healthcare system. Technology is used to
enhance and deliver quality care. The Advanced
Practice Nurse (APN) plays a pivotal role in the implementation of emerging
technology such as the use of EHRs.
According to Romeo (2017), it is imperative that the APN maintains
compliance, integrity, privacy and security when working with technology such
as EHRs. For example, incorporating
telemedicine in rural areas will allow providers to access electronic data that
in entered by the patient. This interoperable technology allows the patient to
access of care in difficult to reach areas. Another example of how the EHR will
impact the DNP practice is through interface terminology, whereas, documenting
patient’s diagnosis and procedures allows for concise medical decisions and
critical thinking to occur when taking care of patients. Improvements to the EHR system will depend on
information reform, which is vital for the DNP leader to have an active role.
In many healthcare areas, the APN will have the opportunity to engage in organizational
performance improvement goals to improve on the accuracy, reliability on the
instrument called the EHR.
References
Bowman,
S. (2013). Impact of electronic health
record systems on information integrity: Quality and safety
implications.
Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3797550.
Faber,
N., et.al (2015). EHR use and patient satisfaction: What we learned. Journal Family Practice, 64(11), 687 –
89, 693- 696.
Health
Technology (2017). Retrieved from: www.nextservices.com/healthcare-technology-articles-trends-and-insights-for-2018
McGonigle,
D., & Mastrain, K. (2018), Nursing
informatics and the foundation of knowledge. (4th ed). Burlington,
MA: Jones & Bartlett Learning.
Ozair,
F., Jamshed, N., Sharma, A., & Aggawal, P. (2015). Ethical issues in electronic health records: A general overview. Retrieved
from https//www.ncbi.nlm.nih.gov/pmc/articles/PMC4394583/
Romeo,
J. (2017). Healthcare data compliance:
Maintaining integrity, privacy, and security. Security solutions for enabling
and assuring business. Retrieved from Https//www.securitymagazine.com
