Electronic Health Record: Building Consensus Through EducationAndrea Oleary, Erina Nhundu, & Sarah NewmanNUR 353 Information Management in Health CareJacksonville University

What is EHR?

An electronic record that contains the health-related information on an individual (Hebda & Czar, 2013)

Should conform to nationally recognized interoperability standards & be accessible to authorized clinicians & staff across more than one healthcare organization

Computerized version of patient’s paper chart

Providers are able to record information electronically, eliminating need for paper charting

Why EHR is essential to healthcare

Provides complete & accurate patient information to providers throughout different organizations, facilities, & practices

Provides continuity of care across continuum

Promotes improved clinical decisions through increased knowledge

How To Build Consensus for EHR in Workplace

Address questions & educate potential user in order to promote consensus & implement use

Topics that will be covered include:

• Benefits of EHR: increased quality, safety, & efficiency

• Costs associated with EHR

• Facilitating successful transition to electronic records

Seamless Exchange & Availability of Health Info.

Leads to improved patient care coordination

• Comprehensive patient information is easily accessible by multiple healthcare providers

• Reduces delays in patient care related to unknown patient history

• Consolidation of patient’s record which includes past medical history, demographics, vital signs, assessment history, current & past medications, laboratory results, radiology results, & current diagnosis

Enables providers to make care decisions based on complete health profile of patient

Saves time by reducing amount of redundant information to be collected during patient encounter

Increased Quality of Care

Quality of care- doing the right thing at the right time in the right way to the right person & having the best possible result (Menachemi & Collum, 2011)

EHR helps support concept of wellness management & initiates preventative health measures by alerting providers when preventative health screening is due

Supports data collection & public health reporting

• Public health reporting supports research efforts & identifies trends

• Data collection can be analyzed to determine impact of care & interventions

Increased Quality of Care continued

Can also contribute to health of community by prompting for administration of vaccines such as influenza vaccine

Increased Safety & Efficiency Via Components

Clinical Decision Support

• May include clinical practice guidelines, alerts & reminders, order sets, patient data reports & dashboards, diagnostic support, workflow tools, & financial applications

• Use of decision clinical support has been linked to increased adherence to evidence-based practices (Menachemi & Collum, 2011)

Increased Safety & Efficiency continued

Mount Sinai Hospital, 2013 http://www.mountsinai.org/about-us/newsroom/press-releases/electronic-medical-records-at-the-mount-sinai-medical-center-shown-to-greatly-improve-quality-of-care

Increased Safety & Efficiency continued

Electronic Medication Administration• EMAR is capable of incorporating patient identifiers

(wristbands with barcodes or RFID technology) with use of barcodes on medications

• Scanning device is used to capture barcode data & automatically chart medication administration

• Facilitates 5 rights of medication administration: right patient, right drug, right time, right dose, & right route

• Can automatically generate user message when medications are past due, warn user if medication has black box warning or is considered high-alert, & can require 2nd

sign-off on high alert drugs such as insulin & heparin• Time required to administer medication can be decreased

through automation while safeguards in place during process can eliminate errors

Increased Safety & Efficiency continued

Computerized Physician Order Entry Systems• Medications, tests, & consults from other departments can

be ordered directly through EHR & sent to appropriate department automatically

• Saves time & eliminates potential for indecipherable handwriting

• Assists providers with clinical decisions by offering suggested dosages, notifying of potential drug interactions, & providing allergy alerts

• 55% decrease in errors when computerized order entry is utilized (Bates, et al., 1999)

• 83% reduction in errors when computerized order entry is combined with use of clinical decision support (Bates, et al., 1999)

Increased Safety & Efficiency continued

http://www.athenahealth.com/whitepapers/ehr-adoption/img/fig1-chart.gif

Increased Safety & Efficiency continued

http://ehrintelligence.com/wp-content/uploads/Area-of-exchange-impact.jpg

Decreasing Costs of Implementation

Upfront Cost Minimization

• HITECH act has established provision of incentive payments for eligible professionals & hospitals if meaningful use of EHR technology is demonstrated

Decreasing Cost of Implementation continued

Long-term Offsetting of Costs

• Elimination of costs associated with maintenance, storage, & retrieval of paper records

• Easier reimbursement from both Medicare & Medicaid

• Improved ability to capture correct charges for client through automation

• Capturing correct charges first time decreases number of billing errors which can delay payment

• Increased productivity

Decreasing Cost of Implementation continued

http://blog.capterra.com/wp-content/uploads/2013/09/risks-of-emr-graph.jpg

Ensuring Successful Transition

Support from Key Individuals within Organization• Engage support by appointing key staff throughout organization to

act as advocates & proponents for utilization of EHRs

Proper Training & Expectations• Adequate time & resources must be invested into training process to

avoid staff becoming frustrated with new technology & attempting to work around technology instead of working with technology

• Focus training on EMR features that speed up documentation process

• Staff needs to be capable of navigating system efficiently to maintain productivity levels during conversion process

• Staff must know where to quickly find essential patient data & be able to properly input pertinent data into system

• A setting-in period of 6-8 weeks after implementation is not uncommon; during this time, users are becoming acquainted with how they can best document patient encounter (LMR, n.d.)

Conclusion

EHRs provide means to access patient information across different healthcare settings in order to provide optimum client care

EHRs contribute to & enable safe, efficient, & high quality personalized care

Implementation costs can be reduced by utilizing meaningful use incentives

Training of staff & staff support are crucial for successful implementation

Conclusion continued

Educating individuals throughout organization about key points covered in presentation can lead to consensus for adoption of EHRs by showcasing value EHRs bring to healthcare process, helping to minimize concerns about cost, and explaining how to successfully implement EHRs in workplace

References

Bates,D.,Leape,L.,Cullen,D.,Laird,N.,Peterson,L.,Teich,J.,Burdick,E.,et al. (1998).Effect of computerized physician order entry and a team intervention on prevention of serious medication errors. JAMA,280(15);1311-1316

Bates,D.,Teich,J.,Lee,J.,Seger,D.,Kupperman,G.,Ma’Luf,N.,Boyle,D.,et al. (1999).The impact of computerized physician order entry on medication error prevention.J Am Med Inform Assoc.,6(4);313-321

Hebda,T.,Czar,P. (2013). Handbook of Informatics for Nurses and Healthcare Professionals (5th ed.). Boston,MA: Pearson Vue

LMR Partners Healthcare Organization. (n.d.) Electronic medical records implementation frequently asked questions.Retrieved from https://lmr.partners.org/lmr/securelogin//AboutMR%5CLMRFAQ.htm

Menachemi,N.,Collum,T. (2011).Benefits and drawbacks of electronic health record systems. Risk Management and Healthcare Policy,4;47-55