The Electroinc Health Record and Ethical Concerns

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 3^rd 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. (4^th 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