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The Use of Electronic Health RecordsResearch Proposal

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Electronic health records (EHR) have been a project in the works since HIPAA was passed in the 1990s. There are several issues surrounding the implementation of electronic health records, but several advantages as well. Twenty years after HIPAA set out EHR as official government policy, there has been ample opportunity to gather evidence about both the pros and cons, such that nursing views of electronic health records as a matter of informatics policy can be determined on the basis of evidence gather from practice over time. This paper will outline the evidence on both the pros and cons of implementing electronic health records, with an emphasis on the nursing perspective.

Pros and Cons With Evidence from the Literature

Comparing electronic health records to paper ones, there are several advantages that have been identified over the course of the past couple of decades. The first advantage is that health records are easier to manage -- stored in databases, they are easier to retrieve, and much easier to move (Jerant & Hill, 2000). This has advantages for the patient in particular when the patient sees multiple physicians in different locations, because the patient's entire medical history is easier to access. This ease of access of information -- and the ease of documenting items -- should also result in efficiency improvements. A meta-analysis of studies on the impact of electronic health records on nursing efficiency found time savings over 20% for nurses in terms of retrieving and documenting patient information (Poissant et al., 2005).

A study of nurses found that they preferred EHRs over paper record-keeping. They expressed that it was difficult to implement electronic record-keeping at bedside, but it was a significant advantage to have this. Three-quarters of nurses surveyed found that electronic health records resulted in improved quality of documentation, and that both safety and patient care improved with EHRs (Moody et al., 2004).

There are, however, some drawbacks with respect to the implementation of EHRs. A common one is that the cost of such systems is often prohibitive for small practices. A concern for many nurses, particularly when the idea of EHRs was first introduced, was that comfort level with the systems has always been correlated to the level of general comfort with computing that nurses have. Moody et al. (2004) found that nurses with a higher general comfort level with computers had a strong preference for electronic health records, not shared with colleagues less comfortable with computers in general. While of course this would reasonably have been an issue in the 1990s, in 2016 the percentage of nurses in the workforce not comfortable with computers is much smaller, and in just about any line of work a familiarity with computing is expected, nursing no exception.

Another issue with EHRs that has emerged, however, is that EHRs, and nursing informatics in general, reflect a number of different systems for charting, medication administration, assessment, admissions and other aspects. Many of the information systems are not compatible with each other, or can differ from one company to another, much less from one country to another. It is common that information silos are a result of this, to the detriment of both nurses and patients (Hayrinen, Saranto & Nykanen, 2008).

The other major concern that many have with electronic health records is with respect to privacy. No system is 100% safe, but that is true of paper records as well. Electronic health records are typically secured via password, and access to the system on which they are stored. Security is arguably better than with paper records, but of course the perception of security matters as well, and for many electronic records represent an unknown risk. Evidence shows that when proper, reasonable procedures are followed, electronic health records are more secure than paper records, because some level of knowledge of the information system, and access to it, is required, a barrier that does not normally exist for paper records (Thede, 2010).

Overall, EHRs are found to improve patient care. They make patient care and shift documentation easier for nurses, which improves nurse efficiency, reduces workloads, and allows nurses more time for direct patient care. There remain key drawbacks to the use of EHRs, but their advantages outweigh the disadvantages. Over time, as the different issues constraining their implementation are addressed, EHRs will become even more common, and will work even better than they do at present. It is recommended, then, that health care facilities utilize EHRs, and that all nurses receive training on their use. Training for EHRs for nurses should be conducted from the basis that this technology is standard in the industry, and that mastery of the technology is an essential component of the job in the 21st century.

How this Affects Practice

Electronic health records have been shown to improve nursing efficiency, and this increase to the extent that EHRs are implemented. That is to say, if bedside data entry is possible, efficiency is increased. Modern technology -- tablets, smartphones and other devices -- can serve as access points. This can increase access to records for nurses, while maintaining a consistent level of security. Patient care is also improved through the use of EHRs. Nurses surveyed have felt that EHRs increase the safety of patient care, though there were concerns about the quality of care (Kossman & Scheidenhelm, 2008), as substantial time is taken in working with records, possibly because there is more information that needs to be processed.

Overall, nursing practice has been transformed by the use of electronic health records, in particular with respect to the emphasis on software and computers. Over the past couple of decades, the profession has become more oriented to working with computers and technology, such that it is no longer a viable option to perform the nurse's role without some working knowledge of these technologies. Ideally, a nurse today will obtain a high level of functionality, in order to work more quickly and accurately with the technology. The use of electronic health records is much more efficient when a high level of skill is developed in making queries, and processing the substantial amount of relevant information that is available at the fingertips of the nurse about any given patient.

There have been concerns from some nurses that the quality of patient care has been reduced by this emphasis on electronics, however, and that is worth taking into account. While it is more accurate to learn about a patient based on facts as recorded in the records, the emphasis on doing so can remove some of the knowledge and care that comes from direct personal interaction with patients. It is important for nurses to remember that direct interaction with the patient still holds a lot of value, and that EHRs are not a substitute for patient interaction. It is important for nurse managers not to see the improved efficiency as an excuse to make the nursing function more robotic, and to work nurses harder with more patients, as this can also contribute to decreased patient interaction, again to the detriment of overall quality of care. I think that working in a facility that employs this strategy would be perfectly normal. I would be kind of concerned about working in a facility that had not entered to digital age. I am not sure, as someone who is quite comfortable working with computers, that I would actually function well in such an environment. Like a lot of people, I use computers all the time and it is easier for me to do things with them than without them, and that includes the performance of my nursing duties.

Personal Impressions

I would seek out employment at a facility where electronic health records are in use. One of the ways in which they have improved the nursing role is that the information needed to perform at a high level and to guarantee patient safety is readily available. Anybody coming through nursing school today, or entering the field today, should have a strong working knowledge of electronics. I would personally be wary of working somewhere that was hesitant to enter the 21st century -- there are many reasons why facilities are hesitant but I prefer a modern environment that aligns with my view of evidence-based practice, ease of access to critical information, and a reduction in barriers to performing the nursing role at the highest level.

Thus, overall, I support the use of electronic health records. It is certainly important to keep in mind that there are limitations to their use -- they are not a substitute for patient contact by any means, and many systems are imperfect. But for the most part, system design issues are not the responsibility of the nurse working in the health care facility. What is important is that patient outcomes are improved, and that the systems used for the management of electronic health records continue to improve in order to transform the nursing role in the future.

Informatics is an important element of all… [END OF PREVIEW]

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