DNP 805 Discuss the usefulness of the electronic health record (EHR) and its impact on patient safety and quality outcomes
DNP 805 Discuss the usefulness of the electronic health record (EHR) and its impact on patient safety and quality outcomes
A variety of electronic methods have been used to integrate health information technology into the health system and into primary care for individuals and patients as a group to continue to improve and provide quality care to patients (Agency for Healthcare and Research Quality (AHRQ), 2019). The Electronic Health record (EHR) is defined as a ‘longitudinal’ electronic record of patient’s health information which is generated during several episodes of care in a care delivery setting. It has a robust database of information that has a capacity for customization to the needs of the patients and the healthcare providers (HCP) that could be endless. EHRs have been designed to collect and store so many different types of information on patients such as patient demographics, order entries, laboratory values, radiologic images and documentations by HCPs (Alexander, Hoy, & Frith, 2019).
Some of the strengths and limitations of EHR. In 2017, hospitals growth in the use of EHR is about 96 percent in non-Federal acute acer hospitals. The EHR has been used to redesign and benefit the healthcare system. EHR supports evidence-based practice that helps to improve the outcomes of patient care. With EHR, volumes of data can be stored for years and obtained quickly and easily to evaluate patient populations, manage acute and chronic diseases that will help to ensure adequate preventive care individually, collectively and simultaneously more than would have been possible with paper charts. It has become a clinical for all future clinical practices and is potentially life-saving, efficient and cost-effective (Thurston, 2014). EHR has led to the decrease in the number of errors with medical care in terms of clinical orders. HER has improved the ability to read orders and avoid errors, it has prevented the duplication of all health care orders. It has also led to the sharing of the same information by all HCP and has improved the outcome and quality of care for patients. EHR has improved the privacy of patient information (Thurston, 2014). AHRQ’s EvidenceNOW initiative was established in 2015 to support the delivery of evidence-based care and improve the heart health of patients more than 1000 primary care practices nationwide by supporting ongoing health information technology evaluation of practices and quality improvement efforts. But with small and medium sized practices HER has grown about 93% while some are using programs not designed to improve quality care or research. New practices still need support to navigate through the learning curve to improve their efficiency and adjust their workflows. Some practices do not report clinical quality measures to the outside group like the Centers for Medicare & Medicaid Services (CMS) and private insurers, like most practices do which helps to improve practice. Some practices are not aware of where to go for technical assistance but there are services available such as Hospital data networks, Health information exchanges, and clinical data warehouses though some resources are not available to all practices (AHRQ, 2019).
Agency for Healthcare and Research Quality (AHRQ). (2019). The promise of electronic health records: Are we there yet? Agency for Healthcare Research and Quality. https://www.ahrq.gov/news/blog/ahrqviews/promise-of-electronic-health-records.html
Agency for Healthcare and Research Quality (AHRQ). (2019). Health information technology integration. Agency for Healthcare Research and Quality. Rockville, MD. https://www.ahrq.gov/ncepcr/tools/health-it/index.html
Alexander, S., Hoy, H., & Frith, K. (2019). Applied clinical informatics for nurses (2nd ed.). Jones & Bartlett Learning.
Thurston, J. (2014). Meaningful use of electronic health records. The Journal for Nurse Practitioners, 10(7), 510-513. https://doi-org.lopes.idm.oclc.org/10.1016/j.nurpra.2014.05.012
In the United States, EHRs implementation is a major requirement for healthcare organizations, a transition that was led by the Centers for Medicare and Medicaid Services (CMS) through financial incentives supported by policies such as the 2009 HITECH (Health Information Technology for Economic and Clinical Health) Act (Aguirre et al., 2019). In supporting clinical tasks, EHRs have a legacy in visit documentations, ordering drugs, laboratory, and diagnostic tests, reviewing test outcomes, and tracking/following up patients.
The most important usefulness of EHRs is in its application to promote population health through monitoring and surveillance of both infectious and non-infectious diseases, improved patient management, particularly patients with chronic illnesses and identification of populations at high risk of specific diseases. In ensuring the continuity of care, EHRs have proven to be beneficial in managing chronically ill patients by preventing fragmented care, and promoting coordination. Honavar (2020) highlights that, in the Emergency department, EHRs use improve evidence-based therapeutic and diagnostic decision-making through the CDSS (Clinical Decision Support) embedded in its system.
EHRs improve healthcare quality and outcomes by improving management, decreasing unnecessary investigations, improving interactions among healthcare staff, patients, and healthcare providers from other institutions involved in the care of patients (Kataria & Ravindran, 2020). From physician’s perspective, EHRs improve efficiency and workflow by decreasing the time needed to retrieve data, improve patient appointment scheduling, and allow remote access to patient data.
The limitations of using EHRs are associated with medical information errors, interoperability, and the financial resources needed to implement health information technology. Despite the increased efficiency in gathering and storing information using EHRs, medical errors still happen. According to Kataria & Ravindran (2020), medical errors are particularly associated with wrongly matching patients to their records or creation of duplicate records. Such errors do not only compromise the quality of care but also compromise the safety of patients.
Aguirre, R. R., Suarez, O., Fuentes, M., & Sanchez-Gonzalez, M. A. (2019). Electronic health record implementation: a review of resources and tools. Cureus, 11(9). doi:10.7759/cureus.5649
Honavar, S. G. (2020). Electronic medical records–The good, the bad and the ugly. Indian Journal of Ophthalmology, 68(3), 417. https://dx.doi.org/10.4103%2Fijo.IJO_278_20
Kataria, S., & Ravindran, V. (2020). Electronic health records: a critical appraisal of strengths and limitations. JR Coll Physicians Edinb, 50(3), 262-8. doi: 10.4997/JRCPE.2020.309
Electronic Health Records (EHR) have made a significant impact on health care today. The EHR has contributed to improving patient safety and patient services and has ultimately reduced costs in many organizations (Boonstra et al., 2021). One of the benefits of the EHR is accessing patient information such as history, treatments, and vital information pertinent to the patient’s health (Anderson, 2022). In addition, the EHR provides an updated version of the patient information compared to paper charting, which may require additional time spent verifying the most recent data. Another benefit of the EHR is efficiently gathering data essential to evidence-based research studies, quality improvement projects, and overall research findings. Data from the EHR has been a game-changer in healthcare because it enables the potential for research that can ultimately improve quality outcomes and patient safety (Boonstra et al., 2021). The EHR has also made a significant change to the workflow of providers such as physicians, nurses, case managers, and other staff members. The EHR has helped providers improve productivity and enable more time to spend with patients (Anderson, 2022). One of the disadvantages of the EHR is the ability for patient information to be compromised. Organizations are making great efforts to avoid this by establishing network protections and encryptions.
Anderson, R. (2022). Effects of an electronic health record tool on team communication and patient mobility: A 2-year follow-up study. Critical Care Nurse, 42(2), 23–31.
Boonstra, A., Jonker, T. L., van Offenbeek, M. A. G., & Vos, J. F. J. (2021). Persisting workarounds in
Electronic Health Record System use: Types, risks and benefits. BMC Medical Informatics and Decision Making, 21(1), 183.
In my current position I support seven inpatient psychiatric hospitals across the country. We are currently in the process of full electronic record implementation working with our largest hospital right now starting to use the EHR in the hospital tomorrow morning. The feedback directly from staff members is that the system is very easy to use and has saved them a large amount of time they were spending manually completing forms especially with the admission and discharge process. The major benefits we are seeing is that staff are engaged and happy, staff have more time to provide direct care and the record is available to everyone at anytime. This was one benefit that we did not necessarily see but has impacted patient safety. Having the record available at everyone’s fingertips has improved quality care and prevent safety events from occurring allowing staff to modify treatment quickly having all the information available. “The adoption of useful and usable EHR will lead to safer and higher quality care, and a better return on investment for institutions that adopt them”, (Middleton, 2013).
One process we are working on that is a downfall of having an electronic record would be downtime procedures. When the system goes down or an upgrade is needed we must have a backup process to continue our documentation and assessment process. Although a strong policy and procedure should help alleviate any issues it is always hard for staff to transition back to paper when needed without necessary documents being missed.
Journal of the American Medical Informatics Association, Volume 20, Issue e1, June 2013, Pages e2–e8, https://doi.org/10.1136/amiajnl-2012-001458
The usefulness of the electronic health record (EHR):
Electronic Health Records (EHRs) fulfill a multitude of roles for both clinicians and patients such as electronic billing and prescription of medications. In the past when medications are handwritten on prescription pads, it was noted that the orders were changed by some patients. Electronic prescribing makes it easy for providers to coordinate complex care plans between different healthcare providers and organizations. Electronic Health records assist Healthcare organizations to communicate electronically with other departments such as Pharmacy, Radiology, and hospitals. It assists in the documentation and retrieval of patient records (Li et al., 2021).
Its impact on patient safety and quality outcomes:
Electronic Health Records (EHRs) provide graphical summaries of important patient information to minimize screen space, maximize comprehensibility of relevant information together on the screen, and use minimalism to highlight important areas for documentation. EHRs can pre-populate templates with data entered elsewhere such as initial visit notes, vital signs, and triage notes making it easy for use. EHR uses smart data entry where the computer would automatically add or remove additional data entry fields on the screen thereby increasing information quality (Romana, et al, 2017).
EHR provides interactive tables to allow the user to sort and filter information according to search needs, provide flexibility regarding slight misspellings, allow the user to begin to type desired item names, and suggest options as the user types thereby increasing performance (Li et al., 2021).
Strengths that might apply to EHR usage:
Privacy and Security: The benefits of interoperable Electronic health records (EHRs) include prominent display of patient identifiers such as name, date of birth, and address making them reliable to be used. EHR limits the number of patient records that can be open at the same time. It has the capability of making patient records to be Read Only, unable to be printed, or shared. EHRs provides privacy and uses Password and User ID to monitor who is accessing a patient’s medical record in compliance with HIPPA rules and regulations (Romana, L., C., Anckera, J., S., Johnsona, S., B., Senathirajah. Y., 2017).
Limitations that might apply to EHR usage:
Electronic Health Records (EHRs) create new opportunities for errors. Some patients answer the same name and share the same birthdate. EHR may have fragmented displays presenting a coherent view of patients’ health conditions, and inflexible ordering formats generating wrong orders. Again, the introduction of workarounds such as copy-and-paste may generate outdated or wrong patient information leading to diagnosis and medication errors. It can also lead to increased ordering time if the orders were sent to the wrong email address or fax number (Li, et al., 2021).
Li, E., Clarke, J., Luisa, A., Neves., Ashrafian1, H., & Darzi, A. (2021). Electronic Health Records, Interoperability and Patient Safety in Health Systems of High-income Countries: A Systematic Review Protocol. Vol 11, Iss 7 (2021). DOI https://doi.org/10.1136/bmjopen-2020-04494. Retrieved from https://bmjopen.bmj.com/content/11/7/e044941
Romana, L., C., Anckera, J., S., Johnsona, S., B., Senathirajah. Y. (2017). Navigation in the electronic health record: a review of the safety and usability literature. Journal of Biomedical Informatics. 67:69–79.doi:10.1016/j.jbi.2017.01.005. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/28088527
Thanks for your post, Margaret. It appears that as much as interoperability is efficient in healthcare facilities within the same healthcare system, it is still a big problem with the exchange of healthcare information with a different system. Research has noted that there are several hundreds of certified HER products by the government across the country and all of them using different terminologies, functional capabilities and technical specifications which is making it difficult for all them to synchronize and to have one standard interoperability format for sharing data for our healthcare systems almost as difficult as having one type of Medicare for federal or Medicaid among states. Most EHR’s are customized to an organization’s unique workflow and preferences (Reisman, 2017).
The 21st Century Cures Act of section 4003 defines the term ‘interoperability,’ related to health information technology, as a means of technology that— “(A) enables the secure exchange of electronic health information with, and use of electronic health information from, other health information technology without special effort on the part of the user; “(B) allows for complete access, exchange, and use of all electronically accessible health information for authorized use under applicable State or Federal law; and “(C) does not constitute information blocking as defined in section 3022(a).” (HealthIT.gov., 2021).
For two EHR systems to be interoperable, they must be able to exchange and use the same data system, the message that will be transmitted must contain the same standardized coded data so that the receiving system can interpret it. So, the lack of standardized data has plagued the U.S. health care system for years and has continued to limit the ability to share data electronically for patient care. One of the biggest obstacles with EHR interoperability is not necessarily technological but cultural. As in other industries, interoperability in health care requires the close coordination and collaboration of various stakeholders, including patients, providers, software vendors, legislators, and health information technology (IT) professionals, but the U.S. health care delivery system continues to have a culture defined by, fragmented processes, silos, and disparate stakeholders, where data has become more of a commodity and competitive advantage than a basis for coordinated care (Reisman, 2017).
Also, the America Medical Association (AMA) points to poorly designed EHRs as part of the problem. Among the capabilities that vendors need to improve or develop, the AMA says, are reducing cognitive workload, facilitating digital and mobile patient engagement, and expediting user input into product design and post-implementation feedback. According to Dr. Gurman, “The AMA is focused on reducing and reimagining EHR use and design regulation,” until this issue is resolved, EHR vendors will continue to develop and produce products that only meet federal requirements rather than those that meet patient and physician needs (Reisman, 2017).
The Healthcare Information and Management Systems Society (HIMSS) previously outlined three types of Interoperability data exchange in 2017: foundational, structural, and semantic, then they redefined it in 2019 by adding organizational interoperability.
· Foundational is when one EHR system can send and receive data from another system but does not need to or have the ability to interpret it.
· Structural is when data can be exchanged between information technology systems and interpreted at the data field level only.
· Semantic is the highest level of interoperability, where two or more systems can exchange information, they will recognize the terminology, medication symbols, coding value sets, and coding vocabularies used and provide meaning to the system users (Reisman, 2017) (DEMIGOS, 2021).
· Organizational is the new level which covers the non-technical parts of EHR Interoperability, like the social and administrative considerations, exchange of policies, and legal processes. This part is necessary for the seamless and secure exchange of data between different healthcare system providers and businesses (DEMIGOS, 2021).
According to HIMSS research in 2019 about 75% of healthcare organizations have progressed beyond foundational interoperability. However, only 36% have reached semantic interoperability, which is the desired level for the effective exchange of patient information between systems. Notwithstanding, healthcare providers are encouraged to achieve organizational interoperability to ensure faster communication with partner organizations (DEMIGOS, 2021).
DEMIGOS. (2021). EHR/EMR interoperability: Benefits, challenges, and use cases. Demigos. https://demigos.com/blog-post/ehr-emr-interoperability/
HealthIT.gov. (2021). Interoperability. ONC | Office of the National Coordinator for Health Information Technology. https://www.healthit.gov/topic/interoperability
Reisman, M. (2017). EHRs: The challenge of making electronic data usable and interoperable. PubMed Central (PMC). 42(9): 572–575 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5565131/
Health Care system has had an ongoing focus on improving access to and quality of care, and more recently on cost reduction. The primary mean to achieve these goals has been to change health care policy, as exemplified by the adoption of health information technology in particular the adoption of patient centered information, characterized by the ability to manage comprehensive patience information. These are some of the benefits of EHR
Improved quality: EHR systems have the potential to improve quality of care, particularly when they are coupled with imbedded features such as computerized physicians order entry (CPOE) and d clinical decision support systems (CDSS). Research indicates that EHR is linked to improved outcomes including better infection control, improved prescribing practices and improved disease management in hospitals. In the outpatient setting, improvements in quality are also possible.
Improved patient safety: Like improvements in quality, EHR can specifically result in improved patient safety. For example, an EHR that utilizes CPOE can achieve a reduction in medication errors in hospitals and help clinicians identify root causes of adverse events in hospitals and outpatient settings after they occur.
Improved patient education: Certain features of an EHR can simplify patient education. For example, EHR products can be used as tools for the provider to illustrate or explain procedures or conditions to patients, and handouts can be printed directly from the system (Lakbala P, Dindarloo K. 2014).
Improved coordination of care: The EHR allows all clinicians on a healthcare team to document their care and to access relevant and timely information about their patients. This fosters an improved level of communication and can facilitate improved coordination of care overall, and specifically for chronic care management
Improved ability to conduct research: Electronically available data for EHR systems will allow for improved ability to quantitatively analyze trends and identify evidence based best practices more easily (Nir Menachemi · Robert G. Brooks, 2005).
Some of the limitations of EHR are entering data into an EHR requires Clinicians to spend a lot of time doing so. As a result, Clinicians are putting too much time into this cumbersome process rather than helping more patients. Most of the time, electronic records are not shared across EHRs. This means the heavy process of inputting data is usually repeated whenever a patient is transfers to a different facility. EHRs are at risk of cyber-attacks which may have exposed patient names and personal details, such as their address and medical history.
Lakbala P, Dindarloo K. Physicians’ perception and attitude toward electronic medical record. Springerplus. 2014;3:63. Nir Menachemi · Robert G. Brooks, (2005): Reviewing the Benefits and Costs of Electronic Health Records and Associated Patient Safety Technologies. http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.1058.9135&rep=rep1&type=pdf