Electronic Medical Records Essay
Electronic medical records are believed to be the way of the future. Hospitals and other healthcare settings are increasingly turning to electronic records over traditional paper records. However, many still have not made the leap and continue to use paper instead of electronic. Healthcare practices must weigh the pros and cons before deciding which records management system to use.
An electronic health record (EHR) is a representation of all a patients’ data; know as a digital version of a patient’s paper chart. Paper-based records are the most common method of recording patient information for most doctor’s offices and hospitals in the United States. The digital information is usually stored in a database and is accessible from everywhere via a network and EMRs contain mainstream data normally found on a patient’s medical records. It contains all information ranging anywhere from a patient’s medical history, diagnoses, medications, treatment plans, immunization dates, allergies, radiology images, and laboratory and test results that have been combined and structured in a digital form.
It allows for an entire patient history to be viewed without the need to track down the patient’s previous medical record volume and assist in ensuring data is accurate, appropriate and legible. It reduces the chances of data replication, as there is only one modifiable file, which means the file is constantly up to date when viewed at a later date and eliminates the issue of lost forms or paperwork. There have been many issues debating if this is a good system, and pros and cons that go hand in hand. Electronic records have many benefits, including accessibility. They are currently the preferred system because of how easily they make it for doctors to coordinate patient care. Accessing electronic records is a lot easier and faster than waiting to receive paper ones.
This can greatly speed up doctor collaborations in patient care and perhaps improve the quality of care that patients receive. There are many companies that sell these systems, so healthcare practices can choose a system with an EMR interface and features that best suit their needs. These interfaces can also be coordinated with billing systems for an extra degree of convenience and functionality. The case for medical records is compelling. They can make healthcare more efficient and less expensive. It can also improve the quality of our healthcare system by making patients medical history more easily accessible to all the people who treat them, being a hospital or doctor. The Government has given 6.5 million in incentives and hospitals and doctors have spent billions more.
Some complain that the electronic systems are time consuming and designed more for bureaucrats than physicians. Although the health care industry has been slower than many others to replace paper records with electronic ones, some of the advantages of computerized systems are becoming obvious. EMRs translate into better treatment for patient’s efficiency and speed of diagnosis translates into better health care service for patients. Similar to the previously discussed point, correct and timely information can significantly increase the quality of health care service rendered to patients. EMRs can save lives.
Improvements to patient safety are found throughout EHRs. For one, drug-drug and drug-allergy checks help prevent unintended reactions to medications. Secondly, photo-enabled EHRs help identify the patient. Thirdly, but definitely not the last one, barcode medication administration checks for the five rights to ensure the right patient receives the right medication at the right time.
Electronic health records provide an avenue for better care coordination between multiple health care providers and the patient. Information can easily be shared between the inpatient, outpatient and ED settings. Furthermore, patients are able to more easily access their information, either by receiving an electronic summary of care record or logging into a patient portal. Electronic health records provide the tools to help physicians and nurses make better care decisions. For example, clinical decision support tools, like making medication recommendations based on diagnosis, and built-in clinical pathways, which help guide a hospital through recommended procedures, help ensure patients receive the best, research-proven care.
EMRs give patients control over their health records. Based on the principle that since it’s the patient’s medical record, the patient should control it, decide what should be in it, and who gets access to it there are currently many online EMRs available. In spite of the many perks, electronic health records do come with some drawbacks. One major disadvantage is the significant start-up costs. From the technology, including hardware installations and software upgrades, to staff training, the start-up costs of migrating to electronic medical records are significant, especially for a small medical practice or for a large medical network of remote offices.
There is a lot of time and labor involved up-front to migrate paper files to a completely electronic platform. Another would be the lack of quality patient time. When doctors, nurses, and administrative staff are unfamiliar with the technology and how a new system works, they often spend more time on it. Or, they may be uncomfortable using it so it will take them longer to execute a task. All this lost time could be potentially spent servicing patients or tending to other mission critical matters. Since electronic medical records, as an industry, is still in its infancy, we have yet to see a standardization of EMR requirements and utilization across healthcare organizations, insurance companies, pharmacies, etc.
The problem is when these disparate systems do not synchronize; it results in errors, duplication of efforts, or a lag in time in service. Security concerns are still an issue. While many might think that migrating to an electronic system would be safer, another one of the disadvantages of electronic medical records is vulnerability those systems inherently create. There is still a real concern that no matter how many firewalls, password encryptions, and other security features added, there will be a hacker who can beat the system and potentially compromise and steal personal information.
All these concerns can be addressed by potentially partnering with an outsource company that specializes in electronic medical records as they have the technology and trained staff to handle large volumes of patient information. They have also invested the time and resources into the latest equipment and security measures. The irony is that while EMRs were designed to improve communication and increase time spent with patients, they actually have enabled some doctors to engage less with patients because they have much more information before actually seeing the patient. In addressing these concerns, there is one key way to circumvent these and other disadvantages of electronic medical records.
Working with a highly specialized electronic medical records solutions provider will assure that best-of-breed technologies, and the industry and operational expertise, is in place. By outsourcing the entire process, your staffs can also then focus on core business areas and foster the company’s service reputation. An electronic medical records partner also best ensures systems integrate with others in synergistic industries, and that the best and most current security mechanisms are deployed to keep patient information inaccessible to those unauthorized to view.
Electronic Medical Records Essay
When looking at Electronic Medical Records and how do we get our senior physicians to “buy in” for successful implementation of computer charting for the hospital there are several things to consider. First, most senior physicians are used to the paper patient charting system and are reluctant to convert to EMR because they feel it would take away from patient interaction and care. According to Griffith and White (2010) diagnostic excellence requires two kinds of knowledge which are rapid communication of patient’s current needs and an understanding of the clinically indicated responses.
With this in mind EMR makes recording patient information faster and more complete, includes safeguards to improve accuracy, and it speeds up patient related information. In 2004 president George W. Bush, set an ambitious goal that by 2014 all citizens would have access to their electronic medical record. President Barack Obama reinforced that commitment with nearly twenty billion in stimulus money for hospitals who convert to electronic medical records and a rather recent legislation called the American Recovery and Reinvestment Act further underlined the initiative to move towards the electronic medical record.
This legislation is aimed at creating more funding and a network of incentives for healthcare professionals and physicians who are ready to adopt EMR and abide by the concept of “meaningful use” of electronic medical records. The opportunity for improvement is to optimize the documentation of patient encounters, improve communication of information to physicians, improving access to patient medical information, reduction of errors, optimizing billing and improving reimbursement for services, forming a data repository for research and quality improvement, and reduction of paper costs within the HCO.
It is important to resolve this problem of EMR use now because it will considerably increase patient outcomes and patient safety within the hospital. Currently departments within the hospital have difficult time communicating with one another in a timely manner. EMR will enable departments to communicate effectively and cut down on treatment time for patients. This will result in better continuity of care for patients from the outpatient to inpatient and back to outpatient care.
HCOs must keep in mind there is a lot of federal pressure to have all patient’s access to their medical record thru EMR by 2014 and the penalties for not being in compliance are levied in reduced reimbursements of Medicare and Medicaid payments with financial penalties as well. The desired outcome from my MAP implementation is to have EMR fully operational within eighteen months and also have an inter workability with other healthcare systems for patients care.
I also want to accomplish the ability for all interdisciplinary services to have the ability to communicate with one another and the health team to have access to medical records for patient care in order to cut costs of visits and provide overall better patient care within the HCO. There are several realistic constraints to consider in the implementation of EMR which are the costs of implementing which is normally between one and three million dollars, federal and state compliance issues, and infrastructure for servers supporting EMR.
I also have to consider the constraint of time for the implementation process which is usually averages twelve to eighteen months for full system wide usage of EMR. There are several other constraints of EMR which are ensuring financial incentives for physicians, employee training, and sustainment training for updates and maintenance to EMR. The problem exists because senior physicians came thru medical school at a time where computers weren’t being used on a broad basis for patient care and they believe EMR will disrupt their traditional working style and require a greater constraint on them when dealing with EMR.
The physicians also are concerned with the complexity and usability of EMR which will require them to allocate additional time and effort which would take away from patient care. There are several actions that are needed to achieve my MAP goal. First, I must have C suite leadership buy in for the implementation of EMR. Next, I must ensure the financial plan is approved for EMR system. I also must ensure to have the physical space for the system within the clinics and facilities of my HCO.
I have to make sure a training plan is developed for my IT staff, physicians, nurses, and associates. I have to develop a plan for embedding IT staff within each clinic to provide assistance and troubleshoot any glitches within the EMR system. I must ensure my EMR system talks with the networks of other facilities to ensure the patient information flow is adequate for patient processing time and internal consulting. I also have to ensure protection for HIPPA and the safeguarding of patient information when it is sent to outside servers.
Finally, I must ensure my EMR system is in compliance with all federal, state, and local requirements. When looking at the key actions steps and there sequencing the first step I would do is ensure I have C suite buy in for the implementation of EMR. Before I meet with them I would have my total implementation plan completed and ready to present to them and ensure that all key steps are covered. Next, I would ensure with the HCOs building manager that the necessary space is available for the EMR system and all spaces are compliant with fire barriers with in the hospital.
The next key action step would be the implementation of the training plan on EMR for my IT personnel to ensure they are fully ready for the launch. I would also have to ensure the training plan for the physicians, nurses, and staff is fully implemented and resourced. This would lead me to ensure I have my IT staff embedded in each clinic for the first month to make sure the implementation goes smoothly as possible.
Electronic Medical Records Essay
Electronic Medical Records (EMR) are becoming more widely used across the healthcare spectrum. One of the reasons for their popularity is the potential that is presented for increasing the quality of care delivered to patients by decreasing handwriting interpretation errors, reducing medication administration errors and eliminating lost charts. Time management is a crucial skill to have as a nurse. It allows for a smooth workflow which translates into quality patient care. Much time can be wasted not only by the nurse signing off illegible handwritten orders, but also by the other nurses that have to help interpret the handwriting.
The EMR requires the physician to enter orders electronically, thereby eliminating handwritten orders. Electronic orders are more precise and more accurately followed (Sokol, 2006). Fewer errors make it to the patient, reducing unnecessary tests and increasing the quality of care that patients are receiving. Electronic medication administration records (MAR) are useful in displaying medications due at specific times. Not only is it possible to sort the medications due at one time, the MAR will also alert the nurse to potential drug interactions. Late medications will be displayed in red to be easily seen.
If bar coding is implemented, medication errors can be reduced by a range of 60%-97% (Hunter, 2011). A lost chart can be very frustrating while trying to deliver seamless care to a patient. Paper charts are easily misplaced. Since there is only one, if a single provider is using it, no one else of the medical team can view the chart. The EMR can be viewed from any computer with secure internet access or on a handheld device. When the internet is down, a downtime view only access is available. Nursing Involvement Nurses are known as patient advocates.
In advocating for their patients, nurses strive for what is best in their patient’s care. Since nurses will be using the EMR most frequently, it is imperative that they are part of the selection and implementation on an EMR. A nurse, on the EMR team, will represent all nursing. Nurses will be accessing the EMR through their shift several times and will become familiar with the layout and workflow and will be able to provide insight into what would work best to ensure quality of care. There is a saying that you don’t know what you don’t know. A nurse knows what she will need and is the best to supply this information.
While researching which EMR would be the best for a facility, a nurse can provide information on time saving workflows between systems. Nurses must also be trained as super users to provide a seamless change from paper charting to electronic charting and provide support to fellow nursing staff. A nurse on the EMR team will be able to deliver new information in a way that other nurses are more receptive to. Handheld Devices If nurses were to use handheld devices in delivery of patient care, there would be a noticeable savings of time as well as more accurate charting.
Nursing personnel carrying a handheld device would have immediate access to their patients chart to notice new orders, lab results, or medication admission records. The need to review the paper chart repeatedly throughout the day would be eliminated along with the long search that commences every time you have to look for the paper chart. This could add several minutes to a nurse’s time at the bedside, improving patient satisfaction. When vital signs are taken, written on a slip of paper and then transcribed into the paper chart, there are many opportunities for error and delay.
Numbers can be transposed, written incorrectly or the wrong patient’s information could go into a chart. With the immediate availability of a handheld device, the information from the vital signs monitor would have the ability to interface into the patient’s chart virtually eliminating late charting and errors. Security Standards The Health Insurance Portability and Accountability Act (HIPAA) was initiated in 1996 as a standard for protecting individually identifiable health information (U. S. Department of Health and Human Services).
HIPAA requires that all information, either written or electronically, that falls under the criteria is protected from unauthorized viewers. An EMR carries more stringent HIPAA guidelines than a paper chart due to the risks associated with computer based files and there are a few key steps that must be taken to ensure compliance with this act. Access control: each user will have a unique user name and password that must not be shared. Firewall protection must be used on the internet server the hospital utilizes to prevent hackers from obtaining access to protected information.
If users are authorized to access patient information from home, there must be a secure server used (Arevalo, 2007). Storage: Data must be encrypted to enhance the security while information is being stored and while it is transferred. Encryption entails protection of files and data that is only viewable to authorized users. Compliance of these regulations should be audited on a regular basis with any violation being swiftly remedied (Medical Records, 2013). Healthcare Costs Purchasing an EMR can cost hundreds of thousands of dollars.
In order to justify such a large purchase, one must examine the potential ways that money can be saved while using an EMR. After spending hours training users and with a little practice, nurse’s workflows will improve and less time will be wasted. A chart will not have to be searched for, double or triple charting is eliminated by using handheld devices for immediate charting. The quality assurance team will be able to run reports on compliance of core measures and be able to recommend changes to nursing personnel to implement. Fewer medication errors will be made by using the electronic MAR.
Most importantly, these time and money saving factors will enhance patient safety. With fewer paper charts to store, valuable space can be remodeled into patient care areas that offer services not previously offered due to space issues (Power, 2013). This will increase revenue for the facility. Comparison Epic offers a computerized management system that is utilized by everyone in the healthcare setting including, nurses, nurse aids, physicians, dietary, radiology, emergency department and the business office. Each department will have a unique look and functionality to their program.
There is no need to use multiple systems to gather information on a patient. It can be used in medium size ambulatory settings such as a clinic as well as in a hospital setting for either inpatients or outpatients. With all departments having access to the same information on a patient, errors will be reduced in delivery of patient care. The chance for entering erroneous lab results or miss- documentation will also be reduced with department specific workflows. Not only will this result in better patient care, but also in a nurse’s ability to delivery effective, efficient, quality care without delay.
In addition, all physician order entry is electronic, every time. Order sets can be customized for each prescriber, saving time and hassle while maintaining meaningful use and following core measures. For added security, the system can be set to automatically sign a user out after a specified length of time of non-use. And while all of the patient’s information is available to each user, audit trails are left enhancing patient security. Epic has pre-loaded patient teaching materials available as well as the option to custom make information.
After visit summaries are easily printed upon discharge and an electronic copy is permanently attached to the chart. Patient would benefit from a facility the uses the Epic system by having access to MyChart. MyChart is a portal of access between a patient and their provider for communication as well as a portable computerized health record. IF a patient were to access care from a facility that does not utilize the Epic system, that patient would have access to MyChart and would then be able to provide critical information that would enhance their care. Another computerized management system available is one from Cerner.
This system can be used in all settings in a hospital including nursing. For medication administration, Cerner has available barcode identification of medication to help nursing staff complete their five rights verification prior to administration. It also allows charting at the bedside to enhance accuracy either through a handheld device or a stationary computer. All order entry by physicians is done on the computer allowing the providers to follow built in prompts for allergy information and adverse drug interactions as well as prompts that will aid in the order of care protocols to enhance patient care.
Cerner also has a portal designed for patient to have access to their records no matter where they are as well as tracking information for health goals a patient and their provider have established. The portal allows progress tracking and provides information on steps that can be used to help the patient reach their goals. This gives patients more responsibility for their health while providing the incentive needed. Nursing care will be escalated similarly to the way it would be in Epic.
Patient information is easily accessible through intuitive workflows allowing nursing staff to make responsible decisions regarding patient care. My recommendation for a computerized management system would be the one available from Cerner. It is the most user friendly for staff including nursing and offers intensive training and yearly upgrades. The different departments systems appear to work together seamlessly resulting in increased savings of time and money (Cerner, 2013).