EHRS or Electronic Health Records System is a technology tool that simplifies the work of healthcare providers by allowing them to work with patient data electronically. EHRS gives an opportunity to work with patient data in real-time, maintain their medical records, and monitor the progress of their treatment. Healthcare professionals use this tool for automated work with medical orders as well.
However, there are significant risks to be considered when using EHRS in nursing. This paper aims to give a brief background of using EHRS in US healthcare, analyze the main risks and benefits of EHRS, and identify the role of the nurse leaders who are working with EHRS.
EHRS has fast become an inherent part of daily workflows in many medical institutions throughout the US. Such technologies, like the Clinical decision support system, Computerized physician order entry, and Picture archiving and communication system, are also used in US hospitals more and more widely nowadays. State and federal governments, insurance companies, and large medical institutions all actively promote the EHRS introduction.
These included the governmental system of significant fines and rewards for doctors. The Health Information Technology for Economic and Clinical Health (HITECH) Act enacted as part of the American Recovery and Reinvestment Act of 2009 is the main legislative document regarding the EHRS. The 21st Century Cures Act slowed the system’s operability by prohibiting the blocking of information, while the “My Health E-Data” initiative of 2018 allowed patients to view the information in their health records.
Working with electronic data is simpler and more efficient than working with paper medical records. However, not all US medical institutions have entirely switched to working with EHRS, as the adaptation requires further efforts of personnel and additional financial investments. Scientists recognize that the EHRS introduction process strongly depends on the willingness of the medical staff to change (Barrett & Stephens, 2017).
Although the medical team may initially resist the introduction of EHRS, after the end of the adaptation period, most health workers show satisfaction working with these systems (Barrett & Stephens, 2017). Interestingly, the unhindered implementation of EHRS takes place when implemented as if in a hidden way, when the nurse leaders do not bring the issue of its application for discussion at the round table.
The open access for patients to their data is a great advantage of EHRS. According to Mackert, Mabry-Flynn, Champlin, Donovan, and Pounders (2016), when patients have more access to information about their health, this positively affects their tendency to adhere to the prescribed treatment and have a healthier lifestyle. Scientists note that “Health information technology (HIT) makes health information available directly to patients through electronic tools including patient portals, wearable technology, and mobile apps” (Mackert et al., 2016, p. 1). The study examined patient use of fitness and nutrition applications, activity trackers, and patient portals.
EHR system also provides an opportunity for remote patient counseling. The UK has introduced remote patient counseling practice while also providing patients with the opportunity to open access to their EHRS data for remote counseling staff. Pregnant women and young mothers were most open to such an opportunity since, previously, they had to visit their healthcare assistants almost every day. Women were satisfied with the quality of remote consultations, which helped them cope with anxiety and conduct proper treatment for their children. They were glad to enter data remotely during the entire period of pregnancy and after childbirth.
One of the most significant risks when using EHRS is the lack of synchronization between EHR systems provided by various suppliers of medical technology tools. This issue became challenging for UK hospitals, which are currently using 21 separate electronic systems of record (“NHS e-health systems ‘risk patient safety,” 2019). This incompatibility led to the fact that in 2019 of 121 million patient interactions, there were 11 million where information from a previous visit was inaccessible.
Although EHRS was launched there in 2002, about 25% of the UK hospitals still use paper records, and about 10% use several ERM systems in one hospital (“NHS e-health systems ‘risk patient safety,” 2019). At the same time, the mutual exchange of information was never established, even between the three most common EHRS in the country. It is noteworthy that the German government decided to introduce a health apps system, an analog of EHRS, in 2020. It is because health apps can significantly increase the number of patients per health worker during the caregiving crisis Germany is facing due to the lack of qualified personnel.
Scientists also mention the risks to patient safety associated with using EHRS. According to Clarke et al. (2016), the results of the study held in northern England showed “poor system design and human error… resulted in an increased potential for missing information and inputting error” (p. 62). Other scientists support this view, noting that before introducing new technologies, successful testing should be conducted first (Barker, 2019).
He emphasizes that ‘trivia’ such as difficulties with working at EHRS endanger the health and lives of patients due to delays in diagnosis and a decrease in attention to symptoms that occur during treatment. He also notes that doctors spend more time filling out orders than directly communicating with the patients.
Besides, there are risks associated with the safety and security of the patient’s data. According to Roussel, Harris, and Thomas (2015), the processes of working with the personal data of patients are regulated by several US laws, and their disclosure is unacceptable. Health workers are also responsible for possible ERHS data leaks that may occur due to system malfunctions. At the same time, nurse leaders have to promote data safety among their colleagues.
The role of the nursing leader requires familiarization with EHRS for further work with patients, while direct contact with the patient is still essential. Aside from the EHRS and Clinical decision support system assistance, the nurse should pay individual attention to every patient when making a diagnosis and during the treatment process. Nurse leader also needs to remember that different EHR systems may be incompatible, and check the completeness of existing data if the patient was treated in the other hospital. Also, a nurse could encourage patients to be interested in their data, as this positively affects both their medical literacy and their health.
Thus, a brief background of using EHRS in US healthcare was given, the main risks and benefits of EHRS were analyzed, and the role of the nurse leaders who are working with EHRS was identified. Among the benefits of EHRS are opportunities for remote counseling, open access of patients to their data, and EHRS compatibility with health care apps. The main risks include incompatibility between EHRS of different vendors, bureaucracy, and data security issues.
References
Barker, S. J. (2019). When technology is a master. Web.
Barrett, A. K., & Stephens, K. K. (2017). The pivotal role of change appropriation in the implementation of health care technology. Management Communication Quarterly, 31(2), 163-193.
Clarke, A., Adamson, J., Watt, I., Sheard, L., Cairns, P., & Wright, J. (2016). The impact of electronic records on patient safety: A qualitative study. BMC Medical Informatics and Decision Making, 16(1), 62.
Mackert, M., Mabry-Flynn, A., Champlin, S., Donovan, E. E., & Pounders, K. (2016). Health literacy and health information technology adoption: The potential for a new digital divide. Journal of Medical Internet Research, 18(10), 1-10.
NHS e-health systems ‘risk patient safety’. (2019). Web.
Roussel, L. A., Harris, J. L., & Thomas, T. (2015). Management and leadership for nurse administrators (7th ed.). Burlington, MA: Jones & Bartlett Publishers.