Module 6 Group project: EHR
The Components of an EHR and the protection of that information.
The EHR (Electronic Health Record) is a replacement and enhancement on the former paper charting used in medical care settings. They can contain information such as; Administrative and billing data, patient demographics, Progress notes, vital signs, medical history, diagnoses, medication record, patient data, test results and many more possibilities (Fragidis, 2016). In the modern age of technology they allow different departments to center the cares around the patient with speed and ease (Fragidis, 2016). The new EHR system allow for centralized and evenly distributed architecture for the patients information (Fragidis, 2016).
With ease of access, comes the ongoing challenge of making sure the information is not accessed from people who would intend to use the info for harm. Many Businesses’ that manufacture EHRs do not advertise the specifics because they do not want people to know the specifics of their defenses (Martinez, 2015). Computer security is defined as “the process of protecting applications, information, and computer resources.” (Martinez, pg 2, 2015). Most EHRs use various level of computer encryptions and differing levels of password and authentications in order to secure the information (Martinez, 2015). These techniques can present in the way of an RN having different level of access than their manager or their subordinate. Security is only as good as your employees (Martinez, 2015). The missing link remains to be the user. The user must always secure their station when not in use. It is an ongoing struggle as we move farther into this technological age.
Advantages and Disadvantages of Implementing EHR Systems in Nursing Education
According to Borycki et all, nursing is one of the highest users of EHRs, making competency with the system critical for their daily practice. While this technology is quickly becoming an integral part of nursing practice, integration of EHRs in undergraduate nursing programs lags behind (Borycki et al, 2015). There appears to be a large gap in the demand for nurses competent in utilizing EHRs and the ability to teach them in an academic setting
Advantages of implementing ERH systems in nursing education are many. One huge advantage, patient safety and evidence-based practice, are greatly enhanced when students are competent in informatics, according to Darvesh et al. Using technology in the classroom and clinical setting can teach nursing students to utilize this technology as a tool to integral to their nursing practice (Darvesh et all, 2014). According to Mastrian & McGonigle, another advantage of EHRs in the educational setting is the fact that they can be designed as a simulation (Mastrain & McGonigle, 2018). Nurses with more knowledge and tools at their fingertips will provide better care, improving patient safety, which leads to better patient outcomes.
There are many disadvantages to implementing EHR systems in nursing education. Not all clinical facilities use EHRs and Borycki et all noted that it is quite expensive to acquire and maintain EHR systems. Many schools do not have the financial resources available to them, nor do they have enough informatics experts available to set up and maintain an EHR system in an educational setting. Lastly, there are not enough nurse educators competent in nursing informatics to teach students how to use these systems (Borycki et all, 2015). The most common disadvantages to integrating EHR are lack of educators and lack of money. Even in the clinical setting, not all the hospitals and clinics are fully utilizing EHRs. This also leads to a gap in the student’s knowledge of EHRs.
Clinical Support Decision Tools and Impact of EHR
Borycki et all noted that EHRs are an important and powerful technology due to the fact that they are the interface between decision making and patient care. These systems allow nurses to enter and retrieve electronic data (Borycki et all, 2015). Clinical support decision tools are software applications, such as computerized alerts and reminders, clinical guidelines, or diagnostic support that work with the EHR to combine data, knowledge, and reasoning to generate helpful information to healthcare providers in real time (Clinical decision support, 2013). The clinical support decision tools are often times built into the EHR.
According to Healthit.gov, using EHRs enhanced with clinical support tools increases quality of care and improves patient outcomes. Together, these tools help caregivers avoid adverse events and minimize errors. EHRs have been shown to improve patient satisfaction with their care and providers have improved efficiency (Clinical decision support, 2013). It appears that EHR along with clinical support tools have had a positive impact on patient care, patient safety and decreased adverse events and errors.
According Mastrian & McGonigle, in 2009, the government realized health information technology was critical for positive patient outcomes and implemented as a part of the American Recovery and Reinvestment Act (ARRA), the financial incentive for what they called Meaningful Use. Healthcare organizations qualify for these incentives based on the level of meaningful use they achieved. This was broken into three levels: data capturing and sharing, advanced clinical process, and improved outcomes. In 2015, the Medicare Access and CHIP Reauthorization Act (MACRA) added a new hurdle of paying for value and better care (Mastrian and McGonigle, 2018). All of these changes in short period of time added a great deal of pressure to an already stressed system.
Mastrian and McGonigle state that MACRA requirements are to streamline and simplify the system by creating a quality payment program to replace the Medicare reporting programs. This would entail multi-payer applicability, coordination and share across measure developers, clinical practice guidelines, the evidence base for non-endorsed measures, gap analysis, quality domains and priorities, the applicability of measures across healthcare settings, clinical practice improvement activities, considerations for electronic specifications, and Qualified Clinical Data Registries. Ultimately, this would allow physicians to choose the measures that reflect how technology best suits their day-to-day practice and simplify the process for achieving meaningful use goals. Also, this would emphasize information exchange with patients and maintain security. The last thing MACRA accomplished was to reduce the reportable measures from 18 to 11 and eliminated the need to report on clinical decision support and computerized physician order entry measures (Mastrian and McGonigle, 2018). Healthcare providers are still required to gather and report a large amount of data electronically to meet the requirements of both ARRA and the modifications enacted by MACRA.
Technology Evolving to improve
Advances in technology have changed the way all health care providers practice. Electronic Health Records have made it so all providers can access their patients with ease, convenience, and accuracy. With continuing advances in technology, EHRs are expected to progress as well. EHRs may progress in ways such as, connected medical devices, , on-the-go medical records, and on-call providers via telehealth.. Connected medical devices include insulin pumps and pacemakers. Companies are creating insulin pumps and pacemakers that are capable of picking up any changes and signals, then automatically transmitting data to any networked computers. As security for technology continues to be improved, more EHRs will be capable of being accessed on cloud-based and web-based platforms, making it easier for providers to access medical records on-the-go. The use of telehealth allows for providers to treat and see their patients remotely. Over the next decade, telehealth will continue to advance by incorporating the use of other healthcare technology being used to monitor patients’ vital signs from afar. Telehealth may even make it possible to eliminate visits to the ED for any unnecessary, non life-threatening illnesses. As technology continues to advance, EHRs will continue to do the same (White, 2015).
Benefit of EHR to students
It is critical to the safety of patients, for nurses to be capable of using Electronic Health Records In order for nurses to effectively use EHRs, they must have obtained any necessary knowledge and skills which may be associated with it. “If it isn’t charted, it wasn’t done” is something every nursing student hears their professors stress during the course of their program. The use of EHRs makes it easier for nurses to chart what they did, as well as allowing for other healthcare providers to see that it was completed. It is important for nursing programs to begin utilizing EHRs for therir students, for a multitude of reasons. The majority of healthcare organizations now operate under the use of EHRs. By incorporating the use of EHRs, nursing student are then capable of obtaining the necessary knowledge and skill sets they need for when they begin practicing as Registered Nurses. Nursing students should be educated and begin practicing what EHRs can be utilized for; such as, completing complex clinical calculations, the identification of potential drug interactions, and the use of scanning large amounts of information at ease and accuracy. By incorporating EHRs into nursing programs, nursing students are then prepared to enter their careers prepared for the use of EHRs (HIMSS, 2014).
Types of EHR products
During nursing programs, students are exposed to various EHR products and systems depending the individual nursing programs and various clinical assignments throughout the program. During this time, it is important for these nurses to practice and understand both the positive benefits of using EHR technology as well as the impact, issues, and limitations this important technology can have (Kushniruk & Borycki, 2014). EHR’s are transforming the practice of healthcare and each new nurse needs to be knowledgeable on what types of EHR’s are available and utilize this time to become comfortable with this technology. Along with simulations and evidence-based practice literature reviews, nursing programs incorporate EHR’s into their coursework to stimulate critical thinking and decision making in new nurses based on the data at hand. Various products used in current nursing programs to introduce EHR’s include courses such as a Nursing Fundamentals course, which introduces clinical skills and health information technology throughout the curriculum with opportunities for laboratory sessions with EHR exposure. During the laboratory sessions nursing students can document things such as completion of wound care and medication administration check-off requirements. Integrations of EHR products into nursing programs better prepares graduates to have the knowledge and skills to use this technology. This new knowledge can allow these graduates to be prepared to identify, find, use, and evaluate information to successfully apply evidence-based principles for delivery of culturally competent and safe care upon graduation (Meyer, Sternberger, & Toscos, n.d.).
The impact of technology on education programs
With EHRs now incorporated in to nursing programs it is found that in many ways this advanced technology can impact nursing education programs. Educational institutions are now recognizing the need for meaningful and quality learning opportunities related to EHR use (Miller, Stimely, & Matheny, 2014). This advanced technology allows graduate nurses to be able to walk in their workplace with the ability to access and use an EHR system quickly and efficiently which overall, supports reimbursement to the healthcare facility for the overall cost of implementing the EHR. These nursing education programs are training the largest numbers of employees that will be working in an acute care setting and this EHR training improves clinical accuracy and outcomes overall.
Future of health care
EHR products impact this nurses’ thoughts about the future of health care because the ability of nurses to use an EHR effectively is critical to patient safety, decreasing facility expenditures for training, and reducing healthcare costs. Documenting skills are essential for any nurse and go hand in hand with bedside care and to use EHRs effectively, nurses must have the required knowledge and skills to enter, retrieve, and update individual patient records (Miller et al., 2014). EHRs are the future of health care and incorporating EHRs into nursing curriculum allows new nurses to be competent and have the skills needed to excel in the current practice environment.
Borycki, E. M., Frisch, N., Moreau, J., & Kushniruk, A. W. (2015). Integration of electronic health records into nursing education: issues, challenges and limitations. Studies In Health Technology And Informatics, 20888-92
Clinical decision support. (2013, January 15). Retrieved February 7, 2018, from https://www.healthit.gov/policy-researchers-implementers/ clinical-decision-support-cds
Darvish, A., Bahramnezhad, F., Keyhanian, S., & Navidhamidi, M. (2014). The Role of Nursing Informatics on Promoting Quality of Health Care and the Need for Appropriate Education. Global Journal of Health Science, 6(6), 11–18. http://doi.org/10.5539/gjhs.v6n6p11
Fragidis, L. L., Chatzoglou, P. D., & Aggelidis, V. P. (2016). Integrated Nationwide Electronic Health Records system: Semi-distributed architecture approach. Technology & Health Care, 24(6), 827-842. doi:10.3233/THC-161231
HIMSS. (2014, June 1). Novice Nurse Preparedness to Effectively Use Electronic Health Records in Acute Care Settings: Critical Informatics Knowledge and Skill Gaps. Retrieved from http://www.himss.org/novice-nurse-preparedness-effectively-use electronic-health-records-acute-care-settings-critical
Kushniruk, A., & Borycki, E. (2014). A virtual platform for electronic health record (EHR) education for nursing students: Moving from in-house solutions to the cloud. Nursing Informatics, 48-54.
Martínez Monterrubio, S. M., Frausto Solis, J., & Monroy Borja, R. (2015). EMRlog Method for Computer Security for Electronic Medical Records with Logic and Data Mining. Biomed Research International, 20151-12. doi:10.1155/2015/542016
Mastrian, K. G., & McGonigle, D. (2018). Nursing informatics and the foundation of knowledge (4th ed.). [VitalBook file]. Retrieved from http://online.vitalsource.com
Meyer, L., Sternberger, C., & Toscos, T. (n.d.). How to implement electronic health records in undergraduates. American Nurse Today.
Miller, L., Stimely, M., & Matheny, P. (2014). Novice nurse preparedness to effectively use electronic health records in acute care settings: Critical informatics knowledge and skill gaps. Online Journal of Nursing Informatics, 18(2).
White, J. (2015, August 6). 5 technology trends that will affect hospital care. Retrieved from http://www.healthcarebuisnesstech.com/technology-future-hospitals/
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