Computerized management systems or electronic medical records (EMR) are computerized medical records generated in an organization that delivers care, such as in a physician’s office or a hospital. The EMR stores the patient’s protected health information, such as patient history, test results, current medications, and demographics in a centralized database. There are many EMR systems available on the market today, but the two most popular systems are EpicCare and NexGen. A. Increase in Quality of Care
Computer management systems facilitate “patient safety and quality improvement through use of checklists, alerts, and predictive tools; embedded clinical guidelines that promote standardized, evidence-based practices; electronic prescribing and test-ordering that reduces errors and redundancy; and discrete data fields that foster use of performance dashboards and compliance reports” (Silow-Carroll, et al, 2012). The EMR has shown to improve communication within the interdisciplinary team, reduce medication errors and other clinical errors, such as ordering duplicate tests, and improve documentation.
Clinical information is easier to access with an EMR. And it has the ability to collect quality improvement data from the system to identify the occurrence of problems and errors. B. Active Nursing Involvement Nurses should be involved in the planning, choice, and implementation of the system because they are the ones that are on the frontline of patient care and will be using the system the most. By overlooking the nurses within the organization during the implementation process, it will adversely impact the universal goal of the planning, choice, and implementation of the system.
Nurses may not cooperate and this may compromise the quality of service provided to patients, when they are not consulted and communicated with. Involving nurses in the implementation process will have a final outcome that is prone to be more accessible, wholly embraced, and thus have a larger positive influence on patient care. C. Handheld Devices The use of handheld devices such as personal digital assistants (PDAs) in nursing would enable an access to a range of evidence-based resources, however, research has shown that PDAs are not commonly used by nurses (Johnson, 2008).
Nonetheless, handheld devices used by nurses could be successfully integrated into management systems for better quality of care. The benefits of integrating a handheld device into nursing practice encompass “point of care access to electronic resources, which increases efficiency and productivity, facilitates time savings, and reduces errors” (Johnson, 2008). A handheld device, like a PDA or a smart phone, offers the nurse an ample assortment of resources that are configured specifically for the device. Nurses will not have to search for manuals, paper sources, or textbooks, wasting time, as it can be delivered in an electronic format.
They can look up electronic resources immediately at the bedside using a PDA, instead of waiting around for a computer. Clinical reference guides for nurses are also available and are a valuable resource for nurses who may encounter a patient with an unfamiliar medical condition. Clinical calculators to assist in the calculation of IV drip rates or weight-based dosing for medication administration are invaluable to a busy nurse. Other resources include drug reference databases, medical dictionaries, diagnostic tools, and clinical guidelines. D. Security Standards
Due to the necessity to maintain confidentiality for electronic protected health information (e-PHI), the U. S. Department of Health and Human Services has sanctioned the Security Rule under the Health Insurance Portability and Accountability Act (HIPAA). The Security Rule outlines several technical safeguards required by organizations to use to shield e-PHI from security breaches. The first technical safeguard is access control. Access control provides “users with rights and/or privileges to access and perform functions using information systems, applications, programs, or files.
It will enable authorized users to access the minimum necessary information needed to perform job functions” (Department of Health and Human Services, 2007). The access controls that required by entities to implement are each user possessing a unique user identification, and establishing an emergency access procedure or a “down-time” policy during times of emergency or electrical shut-off. Other examples of access control that are recommended, but not required, comprise of an automatic logoff if the workstation is left unattended for a period of time and a method to encrypt and decrypt e-PHI (Department of Health and Human Services, 2007).
Another technical safeguard is the person or entity authentication. This requires the organization to “implement procedures to verify that a person or entity seeking access to electronic protected health information is the one claimed” (Department of Health and Human Services, 2007). Organizations are required to execute at least one of these safeguards: utilizing a password or PIN to log on the system, inserting a key or smart card to access the system, or employing a biometric, such as a fingerprint or facial pattern recognition (Department of Health and Human Services, 2007).
Other technical safeguards include audit controls, integrity protection, and transmission security. Audit controls require the entity to “implement… procedural mechanisms that record and examine activity in information systems that contain or use electronic protected health information,” such as audit reports (Department of Health and Human Services, 2007). Integrity protection obliges the organization to “implement policies…to protect electronic protected health information from improper alteration or destruction” (Department of Health and Human Services, 2007), for example, digital signatures.
Lastly, transmission security requires the entity to “implement technical security measures to guard against unauthorized access to electronic protected health information that is being transmitted over an electronic communications network” (Department of Health and Human Services, 2007), this includes integrity controls and encryption. Along with technical safeguards, the Security Rule addresses the need for data storage integrity and data backup and recovery, or a contingency plan.
The aim of a contingency plan is to “establish strategies for recovering access to ePHI should the organization experience an emergency or other occurrence, such as a power outage and/or disruption of critical business operations” (Department of Health and Human Services, 2007). The objective is to make certain that entities have their protected health information accessible at all times. Organizations are required to have strategies in place for a data backup plan, a disaster recovery plan, and an emergency ode operation plan. E. Cost The cost of implementing a new computer management system in a hospital varies by size of the organization and the features of the EMR system. According to an article in Forbes, it will cost Duke University Health System $700 million to implement EPIC, an EMR system (Moukheiber, 2012). It cost the University of California in San Francisco[->0] $150 million and the Dartmouth-Hitchcock Medical Center in New Hampshire spent $80 million when they implemented EPIC in 2011 (Moukheiber, 2012).
One study has shown that with a 90 percent adoption of an EMR system among health care settings, “the potential HIT-enabled efficiency savings for both inpatient and outpatient care could average more than $77 billion per year (an average annual savings of $42 billion during the adoption period)” (Hillestad, et al, 2005). The average annual costs for a fifteen-year adoption period are $6. 5 billion, which is approximately one-fifth of the estimate of potential efficiency savings in hospitals (Hillestad, et al, 2005).
Over fifteen years, “the cumulative potential net efficiency and safety savings from hospital systems could be nearly $371 billion; potential cumulative savings from physician practice EMR systems could be $142 billion” (Hillestad, et al, 2005). It is the hope of those who are pro-EMR that the money saved will trickle down to the consumer to help lower health care costs. If instituted in all hospitals, computerized physician order entry (CPOE) could eradicate 200,000 adverse drug events and save about $1 billion annually (Hillestad, et al, 2005). Organizations will save money alone in paper usage.
The reduced amount of transcription and medication errors will also save money. The time saved in utilizing the EMR by the nurse will allow her to focus her energies elsewhere, like on patient teaching or care coordination, which may reduce readmissions. Even though the initial start-up costs are extremely high, an EMR system will save money and lower health care costs in the future. F. Benefits to Care EMR systems, such as EpicCare and NexGen can help improve patient care and nursing care delivery. Both systems are very similar, however NexGen is web-based, EpicCare is not.
EpicCare is used in medium to large practices and hospitals systems. NexGen is used in small to large practices and local hospitals. Both prevent transcription and order entry errors by reducing the need to decipher illegible handwriting through CPOE. EpicCare and NexGen provides a centralized location for all patient information. The nurse will no longer waste valuable time hunting down the patient’s paper chart to find the last set of vital signs or searching for the contact number for the patient’s next of kin. Both systems use a barcode medication administration system.
NexGen is tailored to alert staff of the five rights of medication administration to prevent medication errors. EpicCare can help to reduce infection rates by alerting nursing staff to follow national infection prevention parameters. For example, EpicCare triggers the users to select a justification when an order for a Foley catheter is entered and then, at the applicable time, sends a prompt to ensure it is removed. NexGen has automatic back up and encrypted data transfer for stronger security measures, EpicCare does not. F1. Recommendation
As a member of the EMR implementation team, the nurse recommends the team should purchase the NexGen EMR system. F1a. Justification When compared to EpicCare, NexGen is more affordable and is utilized in smaller settings, which makes it more practical for the small community hospital in the scenario. It is an easy to use and offers more technical support than EpicCare. NexGen has automatic back up and encrypted data transfer, EpicCare does not. NexGen features CPOE, a barcode medication administration system, a centralized clinical data repository, and 24/7 support and proactive monitoring of the system.
It also includes ePrescribing which automatically checks prescriptions against a patient’s medications and allergies. NexGen features Joint Commission approved care plans that are added to the patient’s plan of care automatically upon assessment criteria. It has secure remote access for providers via Smartphone. NexGen provides automation in ancillary departments, robust reporting, core measures, and results trending for quality patient care. NexGen has a better training program than EpicCare, such as end-user training and on-site training.
It can be used in all areas of the hospital, including financial, scheduling, surgical, and emergency department. Because of its flexibility, interoperability, and prestigious customer service awards, the nurse recommends the NexGen system. As our society travels further into the electronic age, an EMR system is recommended for all hospitals and health care systems to adopt in the upcoming years. It has been proven to decrease healthcare costs, decrease medical errors, and increase workflow. An EMR can be valuable tool for today’s nursing care.
Department of Health and Human Services. (2007). Security standards: technical safeguards. HIPPA Security Series, 2. Retrieved from http://www.hhs.gov/ocr/privacy/hipaa/administrative/securityrule/techsafeguards.PDF[->1]. Hillestad, R., Bigelow, J., Bower, A., Girosi, F., Meili, R., Scoville, R., & Taylor, R. (2005). Can electronic medical record systems transform health care? potential health benefits, savings, and costs. Health Affairs, 24:5. Retrieved from http://content.healthaffairs.org/content/24/5/1103.full. Johnson, C. (2008). Nurses and the use of personal digital assistants at the point of care. Scroll: Essays on the Design of Electronic Text, 1. Retrieved from http://fdt.library.utoronto.ca/index.php/fdt/article/view/4906/1766. Moukheiber, Z. (2012). The staggering cost of an epic electronic health record might not be worth it. Forbes. Retrieved from http://www.forbes.com/sites/zinamoukheiber /2012/06/18/the-staggering-cost-of-an-epic-electronic-health-record-might-not-be-worth-it/. Silow-Carroll, S., Edwards, J.N., & Rodin, D. (2012). Using electronic health records to improve quality and efficiency: the experiences of leading hospitals. The Commonwealth Fund,17. Retrieved from http://www.commonwealthfund.org/ ~/media/Files/Publications/Issue%20Brief/2012/Jul/1608_ SilowCarroll_ using_EHRs_ improve_quality.PDF. [->0] – http://www.forbes.com/places/ca/san-francisco/