Introduction
Paper-based records have been in existence for centuries, and their gradual replacement by computer-based records has been underway for the past 20 years. These forms of electronic records are known as Electronic Health Records (EHR) and are the future of medical records. An EHR can be defined as a record in a digital format with the ability to be shared across a number of healthcare settings by being attached to a wide network enterprise that can be accessed by authorized healthcare entities. Simply put, EHR is the systematic collection of electronic information belonging to individual persons of given populations (Nemeth et al., 2008). Electronic health records may constitute a whole range of data in a complete or abridged form, including demographics, medical history, diagnosis and prescriptions, immunization status, laboratory exam results, radiotherapy sessions, personal health information such as age, weight, and height, x-ray images, and so on (Thede, 2010). The whole purpose of implementing EMR systems can be assumed to be a need to have a comprehensive record of patient data in a single platform as this makes it possible for computerization and restructuring of processes in a healthcare facility, thereby increasing the precision of medical procedures through decision support based on an informed perspective, quality care delivery, and real-time reporting of results. Although it is an expensive form of record-keeping, EHR holds major advantages over paper records, as will be examined later.
The paper will explore the role of EMR in shaping the nursing practice, particularly how the nursing profession can benefit from the adoption of the system and its implications on the future of the profession.
Purpose of Paper
The purpose of the paper is to expound on electronic health records and how the system is useful in nursing practice. The paper will also present a literature review regarding the importance of EMR to nursing, its influence on the health care needs of clients and the practice of nursing, and the implications for future nursing practice.
The topic was chosen due to the increasing importance of EMR in the medical field, especially in the management of patient information due to their ability to avail a patient’s total health information together in one place. The ability of EMRs to make a patient’s health information available when and where it is needed gives a vast advantage over paper records that are normally locked away in strong rooms. This aspect of EMRs can improve collaborative efforts between different entities since the information is stored on a network server that can be accessed by authorized entities. These entities include primary care physicians, hospitals, insurance companies, and patients. Besides, this system allows for the integration of other modern technologies such as decision support systems into regular clinical procedures, thereby improving the provision of healthcare (Korst et al., 2003). Indeed, several countries around the world have already implemented EMR systems, most of which are still in the pilot stage. The US Department of Health Services has already set aside funds to enable it to switch to a complete EMR system within the next ten years. The paperless, interoperable, multi-provider, the multi-specialty, multi-discipline computerized medical record is currently a target for many health institutions, and its full adoption by any institution will definitely improve the quality of care given by providers (Nemeth et al., 2008).
How EMRs directly or indirectly impacts health care policy
Full adoption of the EMR system has several impacts on healthcare policies, both directly and indirectly. Firstly, it alters the way patient information is handled and improves the security of this information by reducing accessibility by unauthorized persons. Security and privacy of EMR data are ensured by the fact that patient information can only be accessed by authorized persons who have the right login details. Besides, most EMR systems implement a user access level system where information accessible by different users is limited by the access rights of the user, with managers and administrators having full rights in most systems. On a wider scale, the safety of patient information will be a matter of concern, particularly the access of such information by stakeholders, including primary care physicians, hospitals, and insurance companies. The question of whose authority should be sought in accessing such information (patient, healthcare provider, or even local or federal government) is still a matter of deliberation (Miller and Sim, 2004).
Secondly, the system will alter how long health records are stored. There are ideas to make health information accessible for a long period of time. Stakeholders are yet to agree on the length of time to store the electronic health records and methods to make sure that the information is accessible in the future and the compatibility of the archived data with yet-to-be-developed retrieval systems. Considerations about the long-term storage of EHRs are complicated by the fact that the information might, in the future, be used by different stakeholders across the health divide. Ownership of the records will definitely affect the accessibility and privacy of electronic health records. The appropriate length of storage will rely on federal and state laws, which can be altered over time. Traditionally, the preservation time of medical records varies between 20 and 100 years. However, the full adoption of EMRs will definitely impact this policy (Nemeth et al., 2008).
A final health policy that the adoption of an EMR system will impact is the synchronization of health records. When a patient visits two or more health facilities, there will be a requirement to merge this information so that an overall picture of the patient’s health can be determined. However, this effort may become difficult in cases where such authority is not accorded. This may be due to a patient’s reluctance to give such authority or the use of different systems. However, the latter may be solved by adopting a standardized EMR system that will allow the use of synchronization programs to merge the information.
Importance of EMRs to Nursing
As health institutions venture into the electronic age, the nursing field is beginning to recognize the advantages that EMRs provide both to the clients and to the profession. The use of an EMR system is critical to the success of the care providers and the nursing practice. Since the 1970s, healthcare information systems have been based upon the administrative and financial capabilities of a healthcare institution. Since the early 1990s, there have been great developmental strides in the capacity and power of personal computers and equal advancements in peripheral devices, leading to more reasonably priced workstations. These developments have resulted in a shift: healthcare personnel can now collect, record, and retrieve greater amounts of clinical information applicable to the nursing profession faster and more accurately (Korst et al., 2003).
One of the longstanding targets of the health information system is to come up with an interface between administrative/financial systems, electronic information pertaining to patients, and all other facts pertaining to the patient’s personal health, including current treatments, diagnostic information, radiology results, allergies, etc. Such an interface would allow persons with appropriate security clearance to access updated and precise health information easily (Miller and Sim, 2004). Upon full adoption, nurses and other healthcare personnel will interact with the system for a number of medical procedures. Even in areas where the system has been fully adopted, it has had a significant impact on nursing practice. Studies have also proved the vast benefits of adopting EMRs.For instance, studies have shown that nurses spend a considerable amount of time assessing and documenting patient health information. The studies found out that nurses using paper spend almost 1.5 hours per shift documenting their observations while those using EMR systems spend around 0.5 hours (Korst et al., 2003). An immediate benefit of the EMR would be to cut the documenting time significantly (Korst et al., 2003). Besides, EMRs can improve patient care by lessening preventable medical faults.
Another importance of EMR to nursing would be the ability to deliver quality care while reducing the costs associated with such procedures. Some EMR systems are fitted with programmed instructions that suggest the use of generic or affordable medication brands. A medical facility using this kind of EMR reported savings of roughly $750,000 due to the use of generic medication options (Miller and Sim, 2004). Yet another EMR system suggested the replacement of expensive intravenous medications with oral medications whenever possible. Consequently, the medical facility reported that it had saved $1 million in one year (Miller and Sim, 2004).
EMRs have also been known to improve patient-clinician communication, thereby improving the quality of care. Since electronic records can be accessed by both the patient and provider, the system can support better follow-up information for patients – for example, after a clinical visit or hospital stay, instructions and information for the patient can be effortlessly provided without the patient having to travel to the provider. Besides, reminders and follow-up care can be sent easily or even automatically to the patient (Wang et al., 2003).
An improvement over Paper Records
EMR differs from other communication methods in the way information is sent and accessed by both the patient and the care provider. In using paper records, a patient has to go to the institution to access health information. However, EMRs can be accessed anywhere, and information interchange can take place seamlessly. Besides, medical personnel can use various methods to check for trends such as re-infections or an error in previous treatments patient’s medical records (Wang et al., 2003). These methods include graphs, curves, and analytic tools that incorporate parameters such as BMI and age (Wang et al., 2003). The system can also predict when a medical condition will recur next and even the most effective treatment alternatives. Paper records cannot provide this additional information.
EMRs are vulnerable to security breaches, similar to all forms of electronic data. Anyone with appropriate login can access EMRs. Besides, a person can ‘steal’ login details over an unprotected network and have access to health records (Wang et al., 2003). One point that should be stressed is that even though EMRs may not be 100% secure, neither is paper. Patient privacy is still important, nonetheless, since privacy is a constitutional right of every citizen. Security of patient health records can be improved by integrating several security features such as using secure logins, biometric systems, and securing network connections. These features can make EMRs more secure than paper records (Thede, 2010).
Implications for Future Nursing Practice
Once the full adoption of EMRs takes place, nursing practitioners will observe changes in many aspects of their work. These include the rate at which they record patient information, ease of access of patient information from any location, provided that the appropriate software and hardware requirements are available, communication with patients, and undertaking collaborative efforts with other stakeholders in the health industry (Miller and Sim, 2004). However, these benefits will not be realized immediately but will require meticulous processes that begin from training to the full adoption of the system. This system would mark a huge shift from traditional methods of collecting, recording, documenting, storing, and retrieving patient information. Hence, nurses must prepare adequately before full adoption of an EMR system is effected (Nemeth et al., 2008).
Conclusion
Although it is still in its early stages in a number of health facilities around the world, electronic medical records have been generating a lot of interest for the past two decades. These interests arise due to the vast advantages that the new system holds over conventional paper records and the effects it will have on the nursing profession. Some of these benefits include improvement of documentation, access, retrieval of patient information, improvement of the security of patient information, reduction of overall costs associated with medical procedures, synchronization of health records from different providers, availability of patient information in one single platform, ability to integrate other technological tools to improve healthcare delivery, among others. However, the system will alter some healthcare policies such as access to patient information, sharing of patient information with other stakeholders in the healthcare industry, and how long the records are stored. Areas for future research include the following: how to facilitate the adoption of EMR, evaluation of the nurses’ perception towards the adoption of EMR, and a comparison of how patient IT literacy impacts the outcomes of an EMR adoption.
References
Korst, L. M., et al. (2003). Nursing documentation time during implementation of an electronic medical record. The Journal of Nursing Administration, 33(1): 24-30.
Miller, R. H., and Sim, I. (2004). Physicians’ Use Of Electronic Medical Records: Barriers And Solutions. Health Affairs, 23(2): 116-126
Nemeth, L. S., et al (2008). Implementing change in primary care practices using electronic medical records: a conceptual framework. Implementation Science, 3(3).
Thede, L. (2010). Informatics: Electronic Health Records: A Boon or Privacy Nightmare?The Online Journal of Issues in Nursing, 15(2).
Wang, S. J., et al. (2003). A cost-benefit analysis of electronic medical records in primary care. The American Journal of Medicine, 114(5): 397-403