Nursing Informatics Task Two: Implementation of an EMR Jessica Johnson, RN Thursday, July 26, 2012 1 Implementation of the Electronic Medical Record (EMR) Thursday, July 26, 2012 2 How the EMR System Benefits Nurses • Patient? s entire record, potentially from birth, at your ? ngertips ” Nurses will no longer need to track down paper charting, allowing them to spend more time with the patient. A complete and accurate health history allows nurses to provide safer, more effective care. • Reduces the risk of medication errors Chances of giving a patient the wrong drug or dosage due to illegible handwriting are decreased. Barcoded medications and patient armbands also decrease the risk of administering at the wrong time or to the wrong patient. • Simpli? es access to documentation during emergencies ” Complete documentation from all care providers can be quickly and easily accessed at the bedside during an emergency. Records can be searched and sorted with a single click instead of spending time searching the unit for a lost paper chart. Thursday, July 26, 2012 3 •
Provides aggregated data for analysis and monitoring of trends ” High infection rates can be scrutinized for a common link, or increases in adverse events can be analyzed to improve patient safety and provide better care. Information is easily sorted and compiled to provide various reports that are user-speci? c. • Safe and secure ” Threat of loss or damage to an EMR is minimized due to secure storage and backup at an offsite location. Access to the EMR requires an approved user to submit their user name and password. It also tracks all the information accessed by that user.
This ensures information is accessed on a need-to-know basis only and patient con? dentiality is maintained. Thursday, July 26, 2012 4 • Better communication between specialties and facilities ” EMRs are easier and faster to review than paper-records, making them more cost-effective. Care providers can simply log into the secure server to view the patient? s history instead of waiting for the inter-of? ce manila folder to be assimilated, delivered, and reviewed. An EMR can be sent via a secure channel to a physician in a separate facility for consultation in seconds. Provides nursing data ” EMRs help to provide evidence-based practice for nurses. Retrieving information from paper records, which is where most nursing documentation is stored, is a labor-intensive, hence expensive, task (Thede & Sewell, p. 288). In the absence of nursing data, too often nursing is measured by negative qualities, such as adverse events (Ozbolt, 2000). Thursday, July 26, 2012 5 PHI is Vulnerable • • • • • • One computer stores virtually unlimited health records. Access by an unauthorized user would breach con? dentiality for countless patients.
Records can be accidentally sent to unintended recipients Patients can access their own records from computers that haven? t been logged off Computer screens can be easily seen by people standing behind the user Hackers could in? ltrate ? rewalls to gain access to EMRs User names and passwords that are written down can then found by someone seeking access to EMRs illegally. Thursday, July 26, 2012 6 Security Measures to Ensure that HIPAA Regulations are Met Access Control – Only authorized persons are allowed to access protected health information (PHI).
Audit Controls – Hardware, software, and/or procedural mechanisms to record and examine access and other activity in information systems that contain or use PHI (US Department of Health and Human Services, 2012). Integrity Controls – Electronic measures must be put in place to confirm that PHI has not been improperly altered or destroyed (US Department of Health and Human Services, 2012). Authentication – a login process that authenticates that the person using the system is permitted access. Case-sensitive, alphanumeric characters are recommended.
Firewalls – monitor all incoming and outgoing messages within a system and allows or blocks information. Security audits – performed by trained personnel to ensure security and discover gaps in coverage US Department of Health and Human Services. (2012). Health Information Privacy. Retrieved July 25, 2023, from http://www. hhs. gov/ocr/privacy/ hipaa/understanding/srsummary. html Thursday, July 26, 2012 7 Quality Improvement • Quality improvement is about looking at a set of circumstances and determining their connections, or looking at the current method of providing care and trying to improve upon it.
In a paper-charting world, certain circumstances may not make themselves apparent quickly or easily, such as a few seemingly random visits to a local ER for food poisoning. Adopting an EMR could help link those events to a chain restaurant and prevent further illness in the community. Examining current methods of providing care for improvement made evident by an EMR reduces patient morbidity and mortality. Monitoring nosocomial infections to determine causes and reduce their occurrence (Birz, 2005). Information previously hidden in paper charting that was time-intensive to ? d can now be retrieved in seconds, resulting in lower costs, fewer infections, and shorter hospital stays. Monitor data on fall rates to pinpoint causes and reduce risks for falls (Weber, Wright, & McIlvried, 2008). The ability to combine data in new ways and screen for risks directly affects patient outcomes. Barcoding medications reduces medication errors (Goth, 2006). Additional safety checks are available to overworked nurses to help ensure right drug, right dose, right time, right patient, and right route. Reducing medication dispensing errors improves patient safety and decreases cost. • • Birz, S. (2005). Electronic surveillance provides hospital infection control. Retrieved July 15, 2012 from http://www. nursezone. com/NursingNews-Events/devices-and-technology/Electronic-Surveillance-Provides-Hospital-Infection-Control_23980. aspx Weber, V. , Wright, A. , & McIlvried, R. (2008). An electronic medical record (EMR)-based intervention to reduce polypharmacy and falls in an ambulatory rural elderly population. Journal of General Internal Medicine, 23(4): 399–404. Retrieved July 25, 2012 from http:// www. ncbi. nlm. nih. ov/pmc/articles/PMC2359523/ Goth,G. (2006). Raising the Bar. Barcoding has the potential to dramatically reduce medication errors. Healthcare Informatics. Retrieved July 25, 2012 from http://www. healthcare-informatics. com/ME2/dirmod. asp? sid=9B6FFC446FF7486981EA3C0C3CCE4943&nm=Articles %2FNews&type=Publishing&mod=Publications%3A %3AArticle&mid=8F3A7027421841978F18BE895F87F791&tier=4&id=E4E1FB00EF4C4434A7081D01BFDE42C5 Thursday, July 26, 2012 8 Role of the Implementation Team Preparing to implement an EMR requires an extensive team.
A project team should include a physician champion, a project manager who leads the team and a broad representation of the office staff and clinicians (Digitalized Medicine, 2009). Knowledge is needed for all of the processes used in the practice on a daily basis such as telephone answering, message taking, appointment scheduling, check-in processing, weight and vital signs recording, history-taking, encounter documentation, medication administration, referral management, discharge instructing, billing and check-out processing (Digitalized Medicine, 2009).
The physician champion’s role in an EMR implementation is to keenly focus on strategic implementation decisions, education of colleagues on the EMR, process/work flow redesign and on the design, configuration, build and testing of the EMR (Digitalized Medicine, 2009). A project manager coordinates the selection of EMR properties and the implementation process. Super users from each unit should be selected to test their respective EMR sections, and eventually train staff within their unit. Digitalized Medicine. (2009). EMR Selection: Roles of Project Team, Project Manager and Decision Making Process.
Retrieved July 26, 2012 from http:// www. digitizedmedicine. com/2009/08/emr-selection-roles-of-project-team-project-manager-and-decisionmaking-process. html Thursday, July 26, 2012 9 Role of the Super User A super user provides feedback to the company implementing the EMR. They help the computer programers understand the way the system will be used, the issues with the current formatting and ways to improve it. Once the EMR is ready to be adopted within the unit, the super user trains the staff. The super user helps staff members with basic questions, troubleshooting, and navigation.
A super user must possess good communication and computer skills. Thursday, July 26, 2012 10 Discussion Guide Question #1: What is the nurse’s role in information management? To protect PHI by logging off computers, ensuring privacy when accessing PHI, and ensuring PHI is only sent to intended recipients on a need-to-know basis. Nurses should never write down their user name and password, and be careful when speaking on the telephone or conversing in a public setting. Thursday, July 26, 2012 11 Question #2: How can caring and technology coexist in nursing care delivery?
Nurses pride themselves on knowing their patient inside and out, and being able to predict any turns for the worse. Patients experience continuous, unpredictable change, and tools are needed to assist the nurse in recognizing the change and intervening when necessary. Recognizing that technology helps, not hinders, the nurse to know more about the patient demonstrates that technology and caring can coexist. Thursday, July 26, 2012 12 Question #3: Why are we implementing an EMR? EMRs allow patients to have a single secure medical record across the entire hospital.
Ef? ciency for nurses, physicians, and other clinical staff will be improved, and medication errors will be decreased. The medical records will be safer and more secure. Data will become available to study and improve patient outcomes. Thursday, July 26, 2012 13 Question #4: What kinds of clinical decisions can be enhanced by the EMR? Nurses can document patient care as well as access reference materials and databases. They can monitor their patient outcomes by using automated clinical pathways (Newbold, 2011). Nurses can use personal digital ssistants with reference and charting information, and can use the EMR to place nursing orders and plan care (Newbold, 2011). Patients with complicated medical histories, such as those with more than one chronic disease, are often difficult to screen for contraindicated therapies. An EMR can cross-check therapies, medications, treatments, and even diets with the click of the mouse. Newbold, S. (2011). A New De? nition for Nursing Informatics. Advance for Nurses. Acces July 26, 2012 from http://nursing. advanceweb. com/article/a-newde? nition-for-nursing-informatics. aspx Thursday, July 26, 2012 14
Question #5: How can the EMR decrease medication errors? The EMR decreases the probability of medication errors by cross-checking prescribed drugs with other medications the patient is taking. It also ? ags drugs that the patient is allergic to, and highlights common side effects. In combination with barcoding, the ? ve rights of medication administration are double-checked, making medication errors less likely. Thursday, July 26, 2012 15 Question #6: How can the EMR help protect a patient’s privacy? Electronic safeguards within the EMR are more reliable than physical safeguards formerly used to guard paper charting.
Loss of records are no longer an issue with data backup at a secure off-site location. Any records physically taken from the hospital are encrypted, ensuring the information doesn’t fall into the hands of unauthorized individuals. Thursday, July 26, 2012 16 Question #7: What is HIPAA and what is it’s purpose? HIPAA was enacted to promote patient privacy and to ensure the portability of health insurance. It protects all “individually identi? able health information” held or transmitted by a covered entity or its business associate, in any form or media, whether electronic, paper, or oral (US Department of Health and Human Services, 2012).
US Department of Health and Human Services. (2012). Health Information Privacy. Retrieved July 25, 2023, from http://www. hhs. gov/ocr/privacy/hipaa/ understanding/srsummary. html Thursday, July 26, 2012 17 Question #8: What is the impact of the EMR on patients and their families? While most of the aspects of the system will be transparent to the patient, the EMR will provide a higher quality of care by assisting the clinician with decisions and providing easy access to labs, xrays, and tests. The EMR will identify risk-factors, improve safety in medication administration, and help deliver evidence-based practice.
Better charting leads to better care and better outcomes. Thursday, July 26, 2012 18 Question #9: How will the EMR enhance communication between nurses and other clinical staff? Because the EMR is available throughout the hospital, there is free exchange of information between inter-department personnel involved in the patient’s care. Access to and utilization of information is one of the key elements in providing excellence in patient care. Thursday, July 26, 2012 19 Question #10: How a nurse can utilize technology while retaining the caring aspects of nursing?
Because the EMR is an electronic record, nurses can spend less time handwriting their charting and more time at the bedside providing direct patient care. Technology creates an environment in which nurses can support their patients and their recovery. Nurses can look up reliable information to help answer patient’s questions at the bedside. They can then be immediately available to provide support, reinforce teaching, and assist in the healing process. Thursday, July 26, 2012 20 The EMR will bene? t nurses by streamlining charting, providing decision support, and safeguarding against errors.
Patient care will be enhanced, and outcomes will be improved. Data will be easier to obtain and trends will become apparent. The EMR will make the hospital and staff more ef? cient, cost-effective, and allow more time for direct patient care. Thank you Thursday, July 26, 2012 21 References Birz, S. (2005). Electronic surveillance provides hospital infection control. Retrieved July 15, 2012 from http://www. nursezone. com/NursingNews-Events/devices-and-technology/Electronic-Surveillance-Provides-Hospital-Infection-Control_23980. aspx Digitalized Medicine. (2009).
EMR Selection: Roles of Project Team, Project Manager and Decision Making Process. Retrieved July 26, 2012 from http://www. digitizedmedicine. com/2009/08/emr-selection-roles-of-project-team-project-manager-and-decisionmaking-process. html Goth,G. (2006). Raising the Bar. Barcoding has the potential to dramatically reduce medication errors. Healthcare Informatics. Retrieved July 25, 2012 from http://www. healthcare-informatics. com/ME2/dirmod. asp? sid=9B6FFC446FF7486981EA3C0C3CCE4943&nm=Articles %2FNews&type=Publishing&mod=Publications%3A %3AArticle&mid=8F3A7027421841978F18BE895F87F791&tier=4&id=E4E1FB0