Tech Talk

Benefits of using an electronic health record

By Robin Hoover, MSN-HCI, RN

Since the passage of the Health Information duplicate tests and improving overall efficiency.7 Technology for Economic and Clinical Health The EHR also stores radiology results, which can (HITECH) Act in 2009, advancements in technology be accessed from within the application if clini- for electronic health records (EHRs) have dramati- cians need to view the actual X-ray or the report cally increased.1 HITECH includes incentives that from the radiologist.8 All reports are accessible to provide reimbursements to hospitals and health- all clinicians involved in the patient’s healthcare care provider practices for adopting certified and can be viewed at any time. EHR technology and meeting meaningful use It is important to note that not all EHRs provide requirements.2 the same features. Some features, such as the abil- Despite these incentives, nurses, healthcare ity to view X-rays in the EHR, represent an addi- providers, and hospitals have been slow to adopt tional design and development cost for the facility. any comprehensive EHR. Potential barriers include a lack of computer skills, high cost, Involving the patient security concerns, workflow issues, and time.3 The Health Insurance Portability and However, as this article will show, adopting EHRs Accountability Act of 1996 requires that all pro- has many more benefits than drawbacks, and tected health information be secure.9 Keeping this implementation is worth the upfront time and information safe is a major challenge for all mem- cost commitment. bers of the healthcare team. EHRs make this easier and improve accountability with audit trails and Clear benefits for clinicians security that detail who has accessed the medical One major—and obvious—benefit is legibility. records and when, and what the individuals did Historically, illegible handwriting has been a while accessing each record. EHRs also keep prime source of medication errors; in one source, information safe from anyone who does not have more than 60% of medication errors in hospitals permission to see patient data. were attributed to poor handwriting.4 Patients have access to their own EHRs through Further, managing medications through an patient portals and can read, print, and send their EHR improves patient outcomes over time. In health information to providers. This empowers fact, EHRs reduce adverse drug events by 52%.5 patients to be their own advocate.10 Some are designed to integrate with bar code Finally, EHRs help patients and clinicians with scanning technology; if a nurse scans the wrong medication reconciliation. A medication list com- medication, an alert pops up alerting him or her piled from the EHR can be easily retrieved and to a problem. updated at each patient visit. This makes main- Critical lab values have to be reported to the taining a current medication list relatively easy for healthcare provider in a timely manner. The EHR patients and providers.11 flags each critical value for clinical staff, making notifications simpler for nurses. The EHR also Harnessing the power of data helps clinicians determine when to repeat a lab Because EHRs store massive amounts of data that test.6 are readily available, they are invaluable for per- Another way an EHR improves treatment and formance improvement projects and quality assur- clinical outcomes is by reducing the number of ance. Facilities can also use these data in more www.nursingcriticalcare.com January l Nursing2017CriticalCare l 9

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved. expansive ways. For example, clinical researchers, Definitions13 working with EHR vendors, have established stan- dards and processes to use EHR data to improve Electronic health information exchange: allows the speed of the research cycle and “rapidly physicians, nurses, pharmacists, other healthcare providers, and patients to appropriately access and inform clinical decisions.”12 securely share a patient’s vital medical information Electronic health information exchanges electronically. are currently available as directed exchanges, Directed exchange: the ability to send and receive query-based exchanges, and consumer-mediated secure information electronically between care provid- exchanges (see Definitions).13 This gives providers ers to support coordinated care. vital information regarding a patient’s health histo- Query-based exchange: the ability for providers to find ry, previous and current medications, allergies, and/or request information on a patient from other family history, and any other pertinent informa- providers, often used for unplanned care. tion that may be necessary to properly diagnose Consumer-mediated exchange: the ability for patients and treat a patient. Ultimately, the EHR gives pro- to aggregate and control the use of their health infor- viders comprehensive data that can guide them to mation among providers. more accurate, reliable diagnoses.14

Nurses and the EHR 4. Center for the Advancement of Health. Computerized doctors’ orders reduce medication errors. Science Daily. 2007. www.science Despite all these potential benefits to clinicians daily.com/releases/2007/06/070627084702.htm. and patients, many nurses are unhappy with their 5. Hydari Z, Williams T, Zimmer KP. HIT safety: progress made and challenges ahead. Office of the National Coordinator for Health EHR. In one survey of nearly 14,000 nurses, 69% Information Technology. 2014. www.healthit.gov/sites/default/files/ stated that their “IT department is incompetent” ONC_HIT_SafetyHealthITWeekWebinar_2014_09_12.pdf. and 92% were unhappy with their EHR. They 6. How can electronic lab results help me improve patient care? HealthIT.gov. 2013. www.healthit.gov/providers-professionals/faqs/ believe that using the EHR is time-consuming and how-can-electronic-lab-results-help-me-improve-patient-care. 15 takes time away from their patients. 7. Heath S. Physician EHR use benefits quality performance, pro- Nurses are on the front lines of patient care, but ductivity. EHR Intelligence. 2016. https://ehrintelligence.com/news/ physician-ehr-use-benefits-quality-performance-productivity. when administrators choose an EHR, nurses are 8. HealthIT.gov. Imaging Results. 2013. www.healthit.gov/providers- 15 often left out of the discussion. If nurses are not professionals/achieve-meaningful-use/menu-measures-2/imaging- given a voice early in the process, they have to results. 9. U.S. Department of Health & Human Services. HIPAA for Profes- deal with the consequences of an EHR that does sionals. www.hhs.gov/hipaa/for-professionals. not meet their needs or structure a proper work- 10. Ricciardi L. Making patient access to their health information flow to provide patient care in a timely manner. a reality. Health IT Buzz. 2012. www.healthit.gov/buzz-blog/ To improve nursing satisfaction with EHRs, consumer/making-patient-access-health-information-reality. 11. Active Medication List. HealthIT.gov. 2014. www.healthit.gov/ facilities must involve clinical and informatics providers-professionals/achieve-meaningful-use/core-measures/active- nurses early in the process, fully preparing them medication-list. for the change without overloading them with 12. Kush RD. Interoperability review: EHRs for clinical research. AMIA. 2012:2(2). information. Staff should be trained in advance of 13. HealthIT.gov. What is HIE? 2014. www.healthit.gov/providers- implementation and provided with continuous professionals/health-information-exchange/what-hie. support after the EHR is in place.16 14. HealthIT.gov. Improved diagnostics and patient outcomes. 2014. www.healthit.gov/providers-professionals/improved-diagnostics- When a facility chooses an EHR that works patient-outcomes. for all stakeholders, these systems can improve 15. Perna G. Nurses dissatisfied with EHRs, report finds. Health- patient care, nursing documentation, and patient care Informatics. 2014. www.healthcare-informatics.com/news-item/ nurses-dissatisfied-ehrs-report-finds. outcomes, and will continue to revolutionize the 16. Schwartz A. Nurses adopt electronic health records. Science of healthcare industry with advancements in technol- Caring: University of California San Francisco School of Nursing. ogy.17 EHRs are rapidly becoming the norm for 2012. http://scienceofcaring.ucsf.edu/future-nursing/nurses-adopt- electronic-health-records. medical records throughout the country, and 17. Kutney-Lee A. Electronic Health Records Improve Nursing Care, patients and nurses alike stand to benefit. ❖ Coordination, and Patient Safety. Rockville, MD: Agency for Health- care Research and Quality; 2012.

REFERENCES Robin Hoover is a clinical informaticist, Vicksburg, Miss. 1. Tripathi M. EHR evolution: policy and legislation forces changing the EHR. J AHIMA. 2012;83(10):24-29. Adapted from Hoover R. Benefits of using an electronic health record. Nursing. 2016;46(7):21-22. 2. EHR incentives & certification: meaningful use definition and objectives. HealthIT.gov. 2015. www.healthit.gov/providers- The author has disclosed that she has no financial relationships related to professionals/meaningful-use-definition-objectives. this article. 3. Ajami S, Bagheri-Tadi T. Barriers for adopting electronic health records (EHRs) by physicians. Acta Inform Med. 2013;21(2):129-134. DOI-10.1097/01.CCN.0000508631.93151.8d

10 l Nursing2017CriticalCare l Volume 12, Number 1 www.nursingcriticalcare.com

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.