Emerging Role of Electronic Health Record in Nursing Profession
Dr. Dey below writes about the rise of electronic health records in nursing and nursing informatics. Dr. Dey is currently one of our instructors at the American Institute of Health Care Professionals and is the instructor for Health Information Technology Certification Program.
AbstractIn this article the author points out the essential and emerging role of Electronic Health Record in nursing practices. While nursing is about direct caregiving, the medical and nursing community is acutely aware of the monumentally increasing demand in patient care that we are experiencing. Information Technology, Mobile Health, Electronic Health Record and Bedside Technologies are expanding in use within all health settings to automate and clinically document patient conditions at admissions, progress and discharge stages. Not only these technologies are proven to be effective in allowing direct caregivers such as nurses and doctors to get to mission critical information quickly, but through “interoperability”, share patient information in a real-time manner for better outcome and holistic care. Electronic communication could help put an end to the perennial physician shortage problem in the U.S., according to new analysis published this month in the journal Health Affairs. EHRs are the primary technology emerging to be the most important and secured channel of communication between physicians and nurses.
Electronic Health Record, Nursing, Nursing Informatics, Healthcare Reform
Electronic Health Record and Nurses
Nursing is about taking care of a patient either in an ambulatory or in a non-ambulatory healthcare setting such as in a Hospital or a Physician Practice. However, nursing responsibilities changed in the 90s when efficiency was measured on interpersonal communication and clinical skills. Then came the issues related to documentation, paperwork, HIPAA Privacy along with evidenced-based practices. Times have changed, and we are in the era of an Electronic Culture. I am not suggesting or ignoring the traditional traits, but emphasizing on the need to train nurses in Health Information Technology and Electronic Health Record to make their “Compassion” faster, effective and secure. With all traditional research, “Patient Satisfaction” is still a function of kind and caring nurse practices along with their ability to explain “episodes, events and conditions” to a patient. The nurse patient relationship, according to research by Press Ganey Associates Inc., sets the tone of patient’s experience and satisfaction predominantly with interpersonal care. Higher satisfaction with care might have some degree of correlation with better compliances with instructions, hence better outcome.
Unfortunately, with patient privacy issues, documentation and paperwork, nurses these days get to be with patients less than 50% of their scheduled time. With proper Electronic Health Record training nurses are more probable to utilize their time more efficiently, organize paperwork and documentation faster and accurately. This in turn is expected to allow nurses to have more time with patients. That increases satisfaction, post discharge compliances and ultimately patient outcome. Experts however seem to have been concerned for some time stating that “To date nursing has failed to acknowledge that the day in which patient data will be stored electronically is fast approaching and that this electronic data will be used for secondary analysis, resulting in decisions that affect all of healthcare.”
What are the specific benefits of Electronic Health Record use in today’s Nursing Practices?
- Most important, preserving patient safety by using electronic documentation of patients reaction to drugs, events, chemicals, history of physical and psychological reactions and quickly consulting with physicians;
- Preserving patient privacy and confidentiality through secured e-records;
- Electronically documenting and instantly accessing patient data such as vitals, electronic medications, charts and consent form;
- Electronic messaging and patient reminders through patient portals and PHRs;
- Most recently, Electronic Health Record has been frequently referenced as a valuable tool for closed loop medication administration, bedside care and information required in other nursing related service areas.
- The trend of Health IT adoption and new technologies in healthcare / hospitals are increasing at a rapid rate. Because of widespread cuts in Medicare, Medicaid and similar programs hospitals are looking at technology solutions much more seriously. As one hospital CFO points out, “New technologies can play an important role in reducing the incidence of such infections and thus lowering hospital costs.” Most of these devices, monitors and systems create entries and logs for a patient record in an Electronic Health Record system. This practice definitely will increase the need and frequency to use EHR systems by direct caregivers such as the nurses.
- 7. In low-income and rural communities, public health nurses also provide critical health care services. They immunize school children, provide pre-natal and well-baby care, and teach the elderly how to stay safe and healthy at home. They also must be able to recognize and respond to potential health crises. A significant aspect of Public Health is moving rapidly towards Health Information Technology and Electronic Health Record framework. Those who are planning for a Public or Community Health Nursing profession, training in Electronic Health Record should be a mandatory requirement.
Further Implications on Nursing Activities
The continuing expansion of functions, modules and mandates related to meaningful use of Electronic Health Record will place added emphasis in the nursing community for learning and using EHRs.
Following are some immediate areas that come to mind:
- Joint Commission and added responsibility of nurses on preventing Medical and Medication Errors
- Patient Collaborations
- Nursing in Behavioral Healthcare
- Nursing in Long Term care and Home Healthcare
- Nursing in Public Health
- Mobile Healthcare and Nursing Informatics
- Expanding role of Nurse Practitioners in all healthcare settings and their operational knowledge of Electronic Health Record Systems
With the recent Health Reform Act and Individual Mandate ruling we shall get approximately 45-50 million new patients in our health systems by 2018. Keeping in mind what I call the “Healthcare Episode Multiplier” phenomena, this will cause almost 200 million new episodes of Patient encounters required to be attended Physician, Nurse and direct caregivers. Are we ready for that Outbreak when there is already a serious shortage of Physicians, Clinicians, Nurses and allied health workforce? Just the demand for CNAs will grow 100% by 2018. The ER visits per year is approximately 130 million. This reform will increase these visits to some 180 – 200 million annually and one can linearly estimate the astronomical need for ER nurses; which I think is one of the most difficult, stressful yet skill oriented nursing specialization. Based on my knowledge of Electronic Health Record infrastructure, ER based EHRs require a very different framework, architecture; interface, interoperability mechanism and training which in most cases are grossly ignored by vendors.
Professional organizations and Health Systems are concerned about legislations allowing nurses to practice care to work to the fullest extent of their education. Recent study involving more than 16,000 nurses working at 316 hospitals in four states, found having a basic electronic health record system was associated with better outcomes independently of nurse staffing — indicating that both play an important and complimentary role in quality of care.
In ConclusionUnfortunately, Electronic Health Record practices are not as common and frequent as they should be in the Nursing World as well as most nursing curriculums as of yet. A recent report clearly points out “Information literacy, evidence-based practice (EBP), and informatics are fundamental to delivering culturally competent, safe patient care. Yet most nursing schools continue to educate students in traditional ways; only a minority integrates high-fidelity simulations, require evidence-based literature to support nursing interventions, identify the five core competencies for healthcare professions delineated by the Institute of Medicine (IOM), and incorporate the electronic health record (EHR) to stimulate critical thinking and decision making.” The astronomical increase in duties and responsibilities in care settings call for compulsory training in EHR systems in all aspects of nursing education. The ANA believes that the public has a right to expect that health data and healthcare information will be centered on patient safety and improved outcomes throughout all segments of the healthcare system and the data and information will be accurately and efficiently collected, recorded, protected, stored, utilized, analyzed, and reported. For nurses, systematic Electronic Health Record training both in the academic world and in the professional environment will produce a new breed of “Technology Savvy” nurses to have data and documents side by side with “compassion” to do what they want to do most – Be with patients as a compassionate caregiving friend.
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Sukhen Dey, PhD
Former, Associate Prof. Computing Science and Informatics
Former, Adjunct Faculty, Masters of Liberal Studies
Indiana University Southeast, New Albany, Indiana, USA
Former, Associate Faculty, Healthcare Information Technology, Park University, St. Louis, MO. USA
Founder, Deyta.com, Louisville Kentucky, USA
President’s Order of Merit, Republican Congressional Committee, 2008
Business Advisory Council-Kentucky-2008
International Advisory Board, International On-line Medical Conference
Editorial Board, International Journal of Collaborative Research on Internal Medicine & Public Health
Reviewer, Nursing Outlook Journal, Elsevier Publishing
Panel Member – Pharmacy Quality Alliance (PQA, DC)
Circle Member, International Journal for the Systemic Innovation of Education (JSIE)
Faculty, Quality Colloquium Symposiums at Harvard University Faculty Club; 2008
Invited Poster Presenter, Quality Colloquium Symposiums at Harvard University Faculty Club; 2011
Invited Poster Presenter, American Association of Public Health World Conference, Boston; 2013
Life Member, Cambridge Who’s Who International Directory
Author, Speaker, Consultant, Editor, Systems Engineer