Positive Impacts of EHRs on Patient Safety
Discuss about the Use Of Electronic Health Records.
Electronic Health Records or the EHRs had been in use over the past decade in both the outpatient as well as in the inpatient settings. These systems comprises of the electronic patient chart that is mainly seen to include functionality of a typical program called the computerized provider order entry (CPOE) (Nguyen et al., 2014). Moreover, it is also comprising of laboratory as well as imaging reporting and other medical devices interfaces. Researchers are of the opinion that this system is successful in creation of the seamless, legible, comprehensive as well as enduring records of the medical history and the treatment of the patient. Although, they had been helping the development of the quality and safety of the patient’s treatment and care, there had been also claims and reporting of other types. It had been stated that transition of this new form of recording and communicating of the medical information had also introduced a number of new type of opportunities for different types of errors and others types of unanticipated consequences which contribute in preventing safety risks (Mennemeyer et al., 2016). Therefore, this assignment will be focusing both on the positive as well as negative impacts that directly or indirectly affect the safety of the patient in the healthcare environment. A literature search would be conducted which will enlighten the findings of the impacts of HER on the health of patients in the modern day and will mainly try to find out the different causes that result in positive or negative impacts on the patients.
Sittig et al., had conducted a study in the year 2013 where they had found a number of different types of positive impacts on the health of the patients who were admitted in the wards and also those who came for check-ups in the hospital outpatient centre. They had stated that a qualified EHT helps in keeping a note of the allergies of the patient and automatically helps the nurse in finding out any problems that may arise when any new medication is prescribed. This helps in alerting the clinicians for any potential conflicts that may take place resulting in medication errors. Another important positive contribution of the electronic Health records is that the primary care provided who collects the necessary information and records in the EHR can easily tell the clinician working in the emergency department about the different life threatening situations, allergies and others. It can thereby help the emergency staffs to adjust the care of the patient accordingly especially in the situations when the patients become unconscious. Moreover, many of the other studies like the works of Gellert, Ramirez & Webster (2015) have also stated that EHRs have the capability for exposing the potential safety problems when they occur. This help the providers avoid any more serious consequences for the patients and thereby lead to better patient outcomes. Moreover, this system can also help the providers quickly as well as systematically identify and correct operational programs. Paper based settings are criticized nowadays as identification of such problems become difficult in the patients and therefore correcting them may take many years. Hence, in such situations, electronic health records can be considered to have positive influences of the patient’s health.
1. Improved Medication Management
Another paper was published by King et al. (2014). Authors have stated different types of risk management activities of the HER and how it helps in bringing various types of positive outcomes on the health of the patients. He had mainly conducted a qualitative study where interviews were conducted from 21 nurses where several themes emerged from answers of the nurses. It had stated that EHRs help in providing clinical alerts as well as reminders. It also helped in the improvement of aggregation, analysis as well as communication of the patient information. Moreover, it also helps the nursing professionals to make it easier to consider all the important aspects of the patient’s condition. Moreover, the effective supporting of the diagnostic as well as the therapeutic decision making also help the professionals to ensure that correct procedures are maintained and followed. Moreover, it also helps in the gathering of all the relevant information in one place only and helps in enabling evidence based decisions at the point of the care (Moja et al., 2014). It also helps in prevention of the adverse patients and thereby providing built-in safeguards against the different prescription of the treatments that have great potential for causing adverse events.
However, a number of negative aspects are also found that indirectly affect the health of the person by making the professionals go through a hard phase of time management. Effective time management helps professionals to provide more time to caring of patients and designing their care plan through effective interdisciplinary meetings that have positive impact on patient health. In the study conducted by Shanafelt et al. in the year 2016, it had been seen that professionals do not convey satisfaction about the utilization of the EHRs in the working environment. Here it was seen that physicians who had used EHRs and CPOE had lower satisfaction with the amount of time that they had spent on the different clerical tasks. They also reported higher levels of burnouts on the univariate analysis. Many of the professionals are of the opinion that higher the penetration of the EHRs in the different aspects of the healthcare (like electronic prescribing, electronic patient portals, and computerized physician order entry (CPOE) and others), higher will be levels of information overload as well as frequent interruptions and distractions and even change in the content of the professional works. EHRs have also been seen to increase the clerical burden of the physicians along with the alteration of the patient –physician interaction that ultimately result in the destruction of the more meaningful aspects of the medical practice.
2. Preventing Adverse Events and Exposure of Potential Safety Problems
In the works of the Gephart, Carrington and Finley (2015), nursing perceptions about the positive and negative aspects of the use of the HER has been stated. Some of the nurses had been seen to state important themes that were identified through the content analysis regarding the nurse’s perceptions of the benefits of the use of the system. This include in justifying their care for the legal purposes, simplification of the EHR use as well as ensuring the safety of the patients and improving the communication of the team. They have also stated times when they have found that the HER records were redundant and duplicative, nurses faced confusion and this add to their mental workload as they then had to find information that they needed. They are also of the opinion that complex systems of EHR often make it difficult for effective navigation and thereby results in missed information like unclear navigation changes. The situation made the nurses more prone to make mistakes like logging medication on the wrong day or the time. However they also stated of some of the benefits like the system help in presenting a collective record which could be easily accessible by all the healthcare providers at any time of the day and also help in supporting the data permanence (Boonstra, Verslius & Vos, 2014). It also helps in the increase of the legibility as well as readability and even helps in the reduction of the different types of paper shuffling issues. The paper was also seen to talk about the part of the HER called the Nursing Information System (NIS). It mainly helps the nurses for getting access to the different evidence based guidelines for effective planning and informing the patient care decisions. Thematic analysis also provided good amount of information about the positive as well as the negative aspects of the NIS usability. Three different types of reactions had been noted. They were found to be satisfied about the completeness of the documentation, access to quick medication as well as ability of the nurses to document at the bedside and about the availability of the reminders. However, they were also seen to be neutral in the aspect of the NIS charting functionality as well as the systems’ contribution to the concept of team communication. However, the nurses were seen to be dissatisfied about the frequency of the interruption that they face when documenting at the bedside as well as a lack of ability of providing effective feedback to the Nis system. They also were dissatisfied with poor flow in the sheet design as well as hindering their ability for constructing a clear clinical picture about what was going on with the patient. In the author’s language it was seen that “Design factors that could influence patient safety included poor usability, the need to copy patient information, time lags between orders, lack of physician assessment of documentation in the nursing information system, missing information, need for duplicative documentation, and inadequate training during implementation.”
3. Effective Supporting of Diagnostic and Therapeutic Decision Making
Tubaishat (2017) had conducted a qualitative study where his finding supports the already established facts in the above paragraphs. He had pointed out three to four important points that help to ensure positive impacts of the use of the EHR on the patients. One of the most important benefits that the author had stated is the minimization of the medication error thereby reducing the chances of potential threats from the life of the patient. E prescriptions are much clearer than the paper prescription that may contain illegible handwriting. This reduces the chance of occurrence of error. Moreover the filling if the EHR medication sheets asks the nurses to fill up details about the correct drug, dose, route, and frequency and therefore the chances of professionals forgetting about any of the information to be documented is reduced. The second point is that by the use of the HER, documentation procedure of all the important data is improved and the completeness of all the data is also ensured. The paper had also ensured about the sustainability of the data. However, the author remarked several aspects by regarding the impact of using the HER that expresses the potential concerns on the patient safety. Many of the nurses have expressed concerns that state that errors can be inputted in the system where nurses who are new can input error or may be also during the early stages of implementation of the system when everything is new for the nurses regarding the use of this technology. The reason stated here is that the nurses might be unaccustomed to the system or they might not have adequate training. They might also not have received adequate training or may find initial navigation of the system easier said than done. This inputting of errors has the capability of jeopardizing the safety of the patients. Another impact of the use of the EHRs is that it might also result situations where technical problems may create potential threat to the treatment of the students. Although many of the nurses had stated this problem to be infrequent however they could give rise to potential problems. Some of the technical problems that are cited in the article are the system crashes, poor internet connections as well as the problems of system freezing. All these result in increasing downtime. The different types of safety concerns that remain associate with this type of downtime is “inaccessibility to patient data, which in turn could endanger patients, especially in emergency cases when prompt actions are required which should be based on patient data in the system.” Another important point is that it also helps in the minimizing the clinical alerts. Many of them also criticized the system due to the poor use of the system communication channel. However, they had stated that communication channels existed on the system helping the users to send each other through the clinical messages about the care of the patient, still there had been a negative point associated with it. The feature is only used by the mangers and the directors exchanging messages and memo and is used for only managerial purpose. This is actually a short coming by the ways with which the nurse deal with the system and is not a fault of the system itself. This could be proved with the help of an excerpt of a participant “… when a medication is not available, the pharmacist will inform the nurse by phone, and then the nurse will inform the physician by phone. If all staff used the communication feature available on the system, the matter would be made easier, since messages could be sent directly from the pharmacist to the physician, who would be able to order an alternative drug in a timely manner…”
4. Gathering of Relevant Information in One Place
From the above discussion, it is quite clear that the electronic health records have both positive and negative impacts on the health of the patients. Many of the researchers have stated that it helps in reducing medical errors and helps in documenting important information like allergy and others that help in proper decision making during care planning for the patients. The information that is gathered also helps in emergency when ready information yield additional benefits. It also involved completion of documentation and in communication purposes among different healthcare providers about the present condition of the patient. However, there are many negative aspects also like inputting error, wrong information, no scope of communication through the system among important members, technical issues and many others. Moreover, many of the papers also state excess time is required for its completing of documentation that delays entire procedure which also crate burnout for the professionals. Therefore, professionals should practice and develop knowledge and take training so that they can handle EHR successfully and accordingly ensure patient safety.
References
Boonstra, A., Versluis, A., & Vos, J. F. (2014). Implementing electronic health records in hospitals: a systematic literature review. BMC health services research, 14(1), 370.
Gellert, G. A., Ramirez, R., & Webster, S. L. (2015). The rise of the medical scribe industry: implications for the advancement of electronic health records. Jama, 313(13), 1315-1316.
Gephart, S., Carrington, J. M., & Finley, B. (2015). A systematic review of nurses’ experiences with unintended consequences when using the electronic health record. Nursing administration quarterly, 39(4), 345-356.
King, J., Patel, V., Jamoom, E. W., & Furukawa, M. F. (2014). Clinical benefits of electronic health record use: national findings. Health services research, 49(1pt2), 392-404.
Mennemeyer, S. T., Menachemi, N., Rahurkar, S., & Ford, E. W. (2016). Impact of the HITECH act on physicians’ adoption of electronic health records. Journal of the American Medical Informatics Association, 23(2), 375-379.
Moja, L., Kwag, K. H., Lytras, T., Bertizzolo, L., Brandt, L., Pecoraro, V., … & Iorio, A. (2014). Effectiveness of computerized decision support systems linked to electronic health records: a systematic review and meta-analysis. American journal of public health, 104(12), e12-e22.
Nguyen, L., Bellucci, E., & Nguyen, L. T. (2014). Electronic health records implementation: an evaluation of information system impact and contingency factors. International journal of medical informatics, 83(11), 779-796.
Shanafelt, T. D., Dyrbye, L. N., Sinsky, C., Hasan, O., Satele, D., Sloan, J., & West, C. P. (2016, July). Relationship between clerical burden and characteristics of the electronic environment with physician burnout and professional satisfaction. In Mayo Clinic Proceedings (Vol. 91, No. 7, pp. 836-848). Elsevier.
Sittig, D. F., & Singh, H. (2012). Electronic health records and national patient-safety goals.
Tubaishat, A. (2017). The effect of electronic health records on patient safety: A qualitative exploratory study. Informatics for Health and Social Care, 1-13.
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