DNP 805 Topic 2 DQ 1

DNP 805 Topic 2 DQ 1 Discuss the usefulness of the electronic health record (EHR) and its impact on patient safety and quality outcomes. Describe strengths and limitations that might apply to its usage. During the last decade, healthcare has witnessed the development and implementation of electronic health records (EHRs). The initial theory was that EHRs would improve patient safety and quality outcomes. Silverman (1998) stated that some of the obvious advantages to an EHR would have included and were not limited to the ease of access and immediate availability of patient information, history, and treatment plans in routine or emergency situations. He stated the potential to decrease adverse outcomes such as missed diagnoses, unnecessary or repeated treatments and procedures, international drug interactions and contraindicated treatments. If all EHRs were connected, one could also have a complete and up to date medical record always immediately available to caregivers. Reimbursement incentives to increase the use of EHRs were put into place by the Health Information Technology for Economic and Clinical Health Act in 2009. This Act allocated $27 billion of reimbursement for the demonstration of the meaningful use of EHRs. Clinical decision support rules that are specialty specific were expected to be implemented in the EHR to guide professional practice at the point of care with a purpose of improving overall patient safety and quality outcomes (Moja et al, 2014). The impact of the EHR on the mortality, morbidity and costs of healthcare has been examined by several researchers throughout the years. Moja et al. (2014), conducted a systematic review of computerized decision support systems (CDSSs) that provided guidance messages such as “diagnostic test ordering and interpretation, treatment planning, therapy recommendations, primary preventive care, therapeutic drug monitoring and dosing, drug prescribing, or chronic disease management” to identify the impact of CDSSs on patient safety and quality outcomes. The researchers compared systems with CDSSs to those without access to CDSSs, those that did not generate advice for care and those that did not have evidence based advice for care (Moja et al., 2014). The results of 28 randomized control trials was surprising as it indicated little evidence for a difference in mortality. The small differences were primarily identified in particular settings with specific diseases and circumstances only. However, most studies were considered too short to prove or exclude a mortality effect. Morbidity outcomes of the studies were found to be too diverse and limited to make inferences. However, there was a 10% to 18% decrease of morbidity due to CDSSs linked to EHRs. This indicates that some studies showed an improvement in the health outcomes and quality of patient care as it pertained to the overall morbidity of patients. Finally, the differences observed for cost and utilization of health services among the studies was found to be small between the study groups (Moja et al, 2014). While this study had several limitations such as not including the processes of different facilities or the level of compliance of practice professionals to guideline recommendations, the study indicates that there are several advantages to the use of CDSSs within an EHR to improve patient safety and quality of care. Although more research is needed to prove the benefits of CDSSs within EHRs, several advantages have been observed. However, disadvantages have also been observed in relation to EHRs. There is concern for the privacy of medical record information and the accuracy of information entered into permanent medical records (Thede, 2010). The implementation of information technology systems is expensive, time consuming and at times is perceived as disruptive to the care being delivered by healthcare professionals. The adoption of a universal electronic health record is still yet to be achieved and the use of the EHR by some practice professionals still seems daunting and time consuming (Kreidler, 2019). Kreidler, M. L. (2019). Health Care and Information Technology. Salem Press Encyclopedia. Retrieved from Moja, L., Kwag, K. H., Lytras, T., Bertizzolo, L., Ruggiero, F., Brandt, L., … Bonovas, S. (2014). Effectiveness of computerized decision support systems linked to electronic health records: A systematic review and meta-analysis. American Journal of Public Health, (12), e12. Silverman, D. D. (1998). The electronic medical record system: Health care marvel or morass? Physician Executive, 24(3), 26. Retrieved from Thede, L. (2010). Informatics: Electronic Health Records: A Boon or Privacy Nightmare? Online Journal of Issues in Nursing, 15(2), 8. RESPONSES TO: Shaulene Stanley 1 posts Re: Topic 2 DQ 1 Electronic health record (EHR) has been found to be quite useful in supporting medical professionals to record data related to each patient encounter. This software provides a very comprehensive, reliable and practical system to manage patients’ data resulting in sound clinical decision making and quality patient outcomes (King, Patel, Jamoom & Furukawa, 2014). Electronic health record has vey positive impact on patients’ safety and quality outcomes, with the use of this software there is electronic prescribing, drug to drug interactions, drug allergy checks, recording and reconciliation, there is significant reduction in duplication and health care associated costs; additionally, there is interdisciplinary communication and collaboration in real time to facilitate sound and critical patient care decisions (Manca, 2015 ; ‘Quality & Patient Safety, 2019’). Undoubtably, the EHR has several strengths to its credit, namely but not limited to physicians and other healthcare workers involved in direct care being able to access the records remotely, there are system alerts to critical results or lab values, electronic recording which eliminates mistakes arising from poor penmanship, eliminates loss or damage to paper records and password encryption to protect patients’ health information. Additionally, there is accurate up-to-date and complete patient records which shows evidence of organizational efficiency (King, Patel, Jamoom & Furukawa, 2014). Despite the literature being replete with the strengths and benefits of the EHR; conversely, there are limitations that can impact the full usage of such a system. Some of these limitations include financial issues, workflow changes, safety and security concerns and loss of productivity. The financial burden associated with the adoption, set up, implementation and maintenance of the HER system can be a significant disincentive to hospitals (Menachemi & Collum, 2011). The financial cost for hardware and software installation, paper conversion to electronic process and required training can run into several millions to billions depending on the size and services offered by the healthcare institution. Additionally, system down time and continued training for updates and upgrades can interrupt workflow resulting in loss of revenue; also, there is a growing concern regarding possible breach to protected health information is also a significant limitation. Law makers and policy makers alike are endeavoring to enact safeguards amidst these growing concerns, to ensure privacy of clinical information (Menachemi & Collum, 2011). Hello Shaulene: I agree with you that the electronic health record (EHR) has made it possible for “medical professionals to record data related to each patient encounter.'' The ease of reading, locating and reviewing health records has become a much easier process over the last twenty years. Being a part of the implementation of several electronic health records from paper to the computer has been an amazing experience and the additional benefits that you mentioned in your post have been saliently obvious. While the intent of the implementation of the EHR has been for the purpose of improvement of patient safety and clinical outcomes, many practitioners 15 years ago were averse to the costs of implementation, found the use of these systems cumbersome and limited in the amount of help they offered to improve clinical decisions and overall care (Goldschmidt, 2005). Goldschmidt (2005) stated that the forecast for 2020 was the widespread use of computers in health care. We can agree that this is true as we have seen the implementation and use of EHRs in almost every healthcare institution with which we have interacted in recent years. The expectation was that decision support technology would help to improve health care decisions and overall health care. While this has proven to be true in many aspects, in my experience, some of the EHRs used in hospitals today are still limited in the usage of clinical decision support technology in the EHR to help drive best practice for patient care. While the use of clinical decision support systems has been impacted by the Health Information Technology for Economic and Clinical Health (HITECH) and by the Health and Human Services requirements for interoperability and patient empowerment, the integration of clinical decision support is lagging in the development of many EHRs. Menachemi and Collum (2011) stated that studies related to quality of care and patient safety only include 3 of 6 dimensions of quality and safety. They stated that the focus has been on patient safety, effectiveness and efficiency. However, they reinforce that research is needed to study the patient centeredness, timeliness and equitable access of EHRs in order to consider EHRs fully interoperable. So while the current advantages we have seen with the EHRs have been well received, there are many more benefits to be realized as it pertains to the use and implementation of clinical decision support technology to reach the maximum rewards for patient care and safety. Goldschmidt, P. G. (2005). HIT and MIS: Implications of Health Information Technology and Medical Information Systems. Communications of the ACM, 48(10), 68–74. Menachemi N, & Collum T. (2011). Benefits and drawbacks of electronic health record systems. Risk Management and Healthcare Policy, (default), 47. Retrieved from Sharon Gebelein 1 posts Re: Topic 2 DQ 2 The electronic health record provides clinical documentation, which allows for effective interprofessional communication. The electronic health record allows for better communication between different providers. Each provider can see the notes of other providers, which can help with treating patients consistently and without having to subject patients to the same tests multiple times. Unfortunately not all electronic health records communicate with each other. Providers within the same organization will have the same EHR but if a patient goes to a different organization their records won’t be found there. In a metropolitan area hospitals it is likely to be a facility with many specialties and overall a large hospital/clinic. Patients often see multiple providers on one day in larger hospitals/clinics. When notes are entered immediately other providers can view them and adjust their care for the patient. The larger facilities are more likely to have providers in many different specialties. Magnet hospitals due play a part in the adoption of the electronic health record. Part of the Meaningful Use strategy was to incorporate technology to improve the safety of patients. The implementation of Meaningful Use incorporates a lot of nursing responsibilities. In the stage I of Meaningful Use nursing is involved in 11 of the 13 Core Objectives (Lippincott, Foronda, Zdanowicz, McCabe, & Ambrosia (2017). One study done by Lippincott, Foronda, Zdanowicz, McCabe, & Ambrosia (2017) found there were no difference between Magnet hospitals and non-Magnet hospitals regarding adoption of an EHR. Of the hospitals that did adopt an EHR, Magnet hospitals scored higher on the HIMSS Analytics Electronic Medical Record Adoption Model (EMRAM). Rural regional clinic systems rely on telehealth and the use EHR for communication. I am familiar with rural regional clinics living in central Wisconsin. Marshfield Clinic is a large organization with many satellite centers in Northern Wisconsin. They have been using Telehealth for more than 20 years and have had a lot of success with it. It has allowed them to give more responsibilities to nurses in the satellite centers. Nurses staff the rural centers and take the patient into a room with a camera. The physician is at the Marshfield center but can see the patient. The nurse takes the vital signs, weight, and height. The nurse and physician are able to use a stethoscope connected to a computer to allow the physician to listen to heart and lung sounds. Lippincott, C., Foronda, C., Zdanowicz, M., McCabe, B., & Ambrosia, T. (2017). The relationship between magnet designation, electronic health record adoption, and Medicare meaningful use payments. Computer Informatics Nursing, 35(8), 385-391. doi: 10.1097/CIN. Hello Sharon: good post! The advantages of being able to use an electronic health record (EHR) is quite an innovation. You mentioned the ability for multiple providers having the ability to see each other’s notes and avoiding having unnecessary and duplicate tests ordered. From the personal experience of working in an environment of 100% paper charting and then transitioning to a completely electronic health record, I can definitely agree that these two features are certainly two important advantages that the EHR allows us to realize. There are many other advantages of EHRs. One of the progressive advantages of an EHR is the ability to develop programs to help guide clinical workflows that are considered best practice. Advice and best practice decisions are delivered to the practitioner at the point of care (Chopra & Bonello, 2019). I was very intrigued by your account of the use of telemedicine at the satellite centers in Northern Wisconsin. I had not envisioned the use of telemedicine with instruments as you described such as the stethescope connected to the computer. Telemedicine has made major advances in the last decade. There is still so much to be learned by all as we are not all exposed to the same experiences due to the capabilities of the institutions in which we work. Chopra, S. J., & Bonello, J. (2019). How to Achieve a Return on an EHR. Hfm (Healthcare Financial Management), 1–7. Retrieved from