Introduction
Healthcare
organizations and hospitals have been increasingly working on a data-rich and
information technology atmosphere that has not been integrated to ease care. In
today’s high-tech era, we are constantly gathering and storing data, only to
never use it because it is inaccessible, improperly formatted, or presented in
an inappropriate manner. Hospitals with auxiliary offices and other specialty
providers that are not in a physical proximity of their main hospitals have not
had a unified system for decades. It is often a system that may have multiple
charting software systems for every encounter with a provider. As a result,
fragmentation of care is the foremost delinquency in patient outcome. As an informatics
nurse responsible for the transition to electronic health records, it will be
prudent to study the problems and possible solutions.
Problem
Implementing Electronic Health Record
The implementation of organization-wide
electronic health record (HER) system is a complex matter involving a range of
organizational and technical factors including human skills, organizational
structure, culture, technical infrastructure, financial resources, and
coordination.
The
phenomenon of fragmentation of patient information is costing billions of
dollars and many lives. There are multi-factorial
reasons responsible for this situation. The first reason is that hospital like
organization has multiple objectives such as curing and caring for patients.
They play a role educating physicians, nurses and other allied health
care professionals. Second, hospitals have complex and highly varied structures
and processes.
Third, hospitals have a wide-ranging workforce including
medical professionals who possess high levels of expertise, power, and autonomy.(Boonstra,
Versluis & Vos, 2014).
These
distinct characteristics justify the complexity of implementing of an
electronic health record system. For example, organizations like Baptist Health
System in Jacksonville. Baptist health system
have multiple practice domains, pediatrics, adult acute care, mental
health care, cancer care, primary care offices and other specialty offices .
Solution
Every organization needs resources
to operate and function effectively in providing their consumers the benefit of
their services. Health care organizations in other to meet the expectations and
laws of the federal, states and other regulatory agencies they must meet certain
requirement established by these numerous agencies. Some of the solutions of
integrating electronic health record in a hospital system will discuss below.
Finance
A hospital system must have the
financial capability to pay a vendor to build and implement an electronic
health record system to meet the needs of their organization. The hospital must
be willing to pay vendors with credible reputations with mature products. The
vendor should be committed to a long term relationship with the hospital. The
hospital should not make the price as the overriding interest in a contract of
such. It should pay attention to the quality of the product and service
agreements as a core for purchasing a system. The initial price can be costly
and cause financial burden in some hospital systems. (Boonstra,
Versluis & Vos, 2014).
Organizational Culture
The culture of an organizational can
influence the success of organizational change as it relates to electronic
health records. As a recipe for change a strong culture with a history of
collaboration, teamwork, and trust between different stakeholders and groups
minimizes resistance to change. It is imperative an organization to have
history of collaboration to ease the transition to electronic health records
Organizational Bureaucracy
Highly bureaucratic
organizational structure impedes change: The success of a transition to
electronic health record will be daunting and slows. The process often leads to
inter-departmental conflict due to layers of managers and a complex
administrative structure. It will be necessary to specifically appoint a multidisciplinary
team to deal with EHR-related issues as a sequence conflicts will be prevented
and thus stimulate collaboration among departments and other specialties areas.
The multidisciplinary group should be empowered to make decisions quickly to
avoid the unnecessary delays.
Clinical staff
The users of the system must be
convinced to be part and parcel of the process of building, testing and
implementation. The users’ nurses, physicians and other allied health care
professionals should be recognized as the owners instead of customers of the
system. Often the users of this very new electronic health record system will be
discouraged because the system does not work for everyone as intended. However,
the participation of all users in
building the system will allow room for
improvement.
User-friendly
Software
It
is crucial that an electronic health record system should not just be available
and reliable; it should also be easy and efficient. It will allow for the
functionality required for medical staff to give high quality care. If a system
fails to do this, staff will not use the system and will stick to their old
ways of working and makes it difficult for the transition to take place
Implication for
Nursing and Others
Electronic health records
implication for nursing is fundamental to the success of the care nurses
provide to patients. Hospital payment system is tied to the use of electronic
heath records. Nurses will have to undergo training for the use of electronic health
records via simulations and live training at the job. As a result of electronic
health record use, nurses will be able to access evidenced based guidelines at
the point of care. Nurses, physicians and other allied health professionals
will be satisfied with the care they provide. Additional, data can be organized in a way where it is easy to
received and analyzed. More importantly, so patient outcome will be ideal. Although
EHR systems are anticipated as having positive effects on the performance of
hospitals, their implementation is a complex undertaking.The early involvement of nursing input and
gaining their trust is critical to success.
For nursing to understand the potential capabilities of the new
technology to support their work and potential beneļ¬t of delivering safe and
effective patient care will be a dream come true for nurses(Kent,Redley,Wickramasinghe,Nguyen, Taylor,Moghimi
& Botti,2015) Recognizing and
addressing these aspects can increase the likelihood of getting an EHR system
successfully implemented.
References
Chang,
C. P., Lee, T. T., Liu, C. H., & Mills, M. E. (2016). Nurses’ Experiences
of an Initial and Reimplemented Electronic Health Record Use. CIN:
Computers, Informatics, Nursing, 34(4), 183-190.
Boonstra,
A., Versluis, A., & Vos, J. F. (2014). Implementing electronic health
records in hospitals: systematic literature review. BMC Health Services Research, 14(1), 370.
Kent, B., Redley,
B., Wickramasinghe, N., Nguyen, L., Taylor, N. J., Moghimi, H., & Botti, M.
(2015). Exploring nurses' reactions to a novel technology to support acute
health care delivery. Journal Of Clinical Nursing, 24(15/16),
2340-2351. doi:10.1111/jocn.12881
You had mentioned that users turn away from embracing EHR due to collaboration between users. However, problems cited by users is the continual learning and training for using the system (Bujold, 2015). Having to continually update the knowledge of using the EHR is cited as getting in the way of caring for patients. Many providers do not having to stop to chart while caring for patients. Like used, we are able to capture trends and patterns by analyzing EHRs. Therefore, we must figure out where the happy medium lies so that we can easily chart while providing quality care to our patients.
ReplyDeleteBujold, E. (2015). When practice transformation impedes practice improvement. Annals Of Family Medicine, 13(3), 273-275. doi:10.1370/afm.1789
You said on your blog "Electronic health records implication for nursing is fundamental to the success of the care nurses provide to patients".
ReplyDeleteThe federal government, is encouraging widespread implementation of health information technology (HIT) to improve healthcare quality and patient safety (Derek W Meeks 2014). These efforts should improve and encourage coordination of care, improved follow-up, and increased efficiency throughout the continuum of care. Research suggests that technology may lead to new uncertainties and risks for patient safety through disrupting established work patterns, creating new risks in practice, and encouraging workarounds. Many providers resisted for a long time to jump to EMR, due to I believe, typing issues and computer knowledge, they got behind in charting and some times patient information was not completed. Notes were partial. I thing in those cases trained prescribers that understand physicions and all the levels of healthcare personnel to reduce the medical errors and for the patients safety should be hired.
Derek W Meeks, Amirhossein Takian, Dean F Sittig, Hardeep Singh, Nick Barber; Exploring the sociotechnical intersection of patient safety and electronic health record implementation. J Am Med Inform Assoc 2014; 21 (e1): e28-e34. doi: 10.1136/amiajnl-2013-001762
I agree with you Angjeline, training personnel's is imperative for proper use of electronic records
ReplyDeleteAccording to Sewell, there are several barriers to the adaptation of the electronic health record in many healthcare facilities. In fact, there is a growing need for standardization in many areas of the EMR. Some problems listed by Sewell, are a lack of standardized terminology for all disciplines, which would make documentation and communication more effective between providers, nursing staff, and other members of the healthcare team. Another problem with the EMR, is linking. Not all EMR systems can communicate, even within the same healthcare facility. Since all of the systems are not purchased at the same time, older systems cannot communicate with newer systems, causing a breakdown.
DeleteUpgrading the EMR systems can also be expensive, however, certain systems provide many upgrades, free of charge. It just depends on the contract a provider or facility has with the vendor.
Without standardization, nurses will constantly be met with challenges, when utilizing the EMR.
Reference
Sewell, J. (2016). Informatics and Nursing: opportunities and challenges (5th ed.). Philadelphia, PA: Wolters Kluwer.