Clinical Decision Support and Electronic Health Records
Introduction

Information technology has revolutionized nearly every aspect of life, from how people recreate to how they work. This is no less true in the field of health care, where clinical informatics is reshaping the nursing workplace environment, how patient data is recorded and shared, and how health care is delivered. This paper will discuss clinical informatics concepts emerging in the 21st century, what evidence-based practice (EBP) shows with respect to clinical informatics, how the law figures into this issue with respect to HIPAA, privacy/confidentiality and security issues; and how patient safety, the nursing role and electronic medical records are impacted.

Clinical Informatics Concepts in the 21st Century

Controlling the flow of information to promote efficiency, security, and safety is the number one priority of clinical informatics. 21st century concepts for how this can be accomplished include training in how to find information, how to appraise information, and how to apply information. One common mistaken assumption among nurses is that having clinical informatics skills simply means to have computer literacy (Khezri & Abdekhoda, 2019). While computer literacy is a necessary component, it is by no means the full concept of informatics. In the 21st century, nurses need to know how to engage in information retrieval, the way librarians do. They need to be able to plug information into databases, pull up information from other databases, search for information manage knowledge effectively. Additionally, they have to be able to appraise information. When conducting an information search in a database, they may get a return of a thousand different references or sources of information. If they cannot process that information and appraise it well, their ability to conduct a search will be meaningless. Thus, informatics is more than just about knowing how to use a computer or how to obtain information; it is also about how to appraise information and assess its value. Keeping complete records for the purpose of electronic medical records (EMR) databases is also part of the concept because of need for continuity of care, which necessarily depends upon continuity of information (Kleib & Nagle, 2018).

Database Systems and Analytics and Their Impact on Nursing Research

Database systems require that nurses understand the concept of analytics as well. Nursing research is no different from any other kind of research in which analysis is involved. Nurses must be able to search data, appraise it, compile the relevant data, and utilize it for research purposes. Sousa, Reeder, Bondy, Ozkaynak and Weiss (2017) note that even today nurse leaders do not have adequate access to EMR. Without adequate access to EMR, nurse leader cannot engage in effective or timely decision-making (Sousa et al., 2017). Nursing research has to focus more on how to positive integrate EMR systems into nurse workplaces. One of the big questions going forward, however, is whether nurse PHDs, researchers or leaders are being prepared in the classroom to handle big data or data science (Westra et al., 2017). It appears to be the case that as technological advances are made, the need to be able to handle, process, interact with, command, and drive informational technology resources has grown—and nowhere is that seen more than in health care.

Informatics, EBP and the Law

Nursing informatics can be useful when it comes to implementing EBP for quality care (Elsayed, Hussein & Othman, 2017). However, as Effken, Weaver, Cochran, Androwich and O’Brien (2016) point out, nurses tend to be data-rich yet information-poor—meaning they have as much data as they could want at their fingertips yet they do not have the skills to retrieve or make sense of that data. One EBP to consider is the practice of mapping clinical terms to terminologies that have been standardized to help nurses better understand how to use information (Effken et al., 2016). Elsayed et al. (2017) posit that an informatics competency should be made part of the standard nursing curriculum in order to help promote the use of more EBP in the nursing field.

Nursing informatics can also be used to promote health literacy among at-risk patients (Haupeltshofer, Egerer & Seeling, 2020). By teaching older patients how to use technology to retrieve health information, nurses can increase their access to health literature and foster their health literacy. Technology thus has advantages that can be used to encourage the EBP of promoting health literacy as a means of preventive medicine. Still, this requires an informatics competency that is not as of yet being standardized in nurse education.

Nurses using clinical informatics still have to be careful, however, with respect to how information is shared. The Privacy Act of 1974 regulates how information is collected by the federal government, which means that nurses working in Veterans Affairs have to follow these regulations. Then there is also the Conditions for Coverage of Specialized Services by Suppliers, which is part of Medicare laws and requires that patient health information be confidential and private. Patients must give their written authorization before their information can be shared or forwarded. Health care facilities must protect patient information, which is why EMR must be securely maintained—and that can be a challenge, as numerous data breaches over the years have shown.

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 was implemented to regulate health care facilities with respect to how they handle health information, and HIPAA violations can lead to big fines for health care facilities. The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 likewise gives the Department of Health and Human Services the ability to regulate the use of Health IT and clinical informatics. Safety, security and quality issues are all overseen by the federal government under HITECH.

Privacy, Confidentiality and Security Issues

One of the challenges facing the field of nursing is how to keep information private in a world that has largely blurred the line between private and public. Social media has become a platform for people to take their private lives and make them public. Confusion persists as to how “public” social media really is, and some believe that because they have their own profile pages and determine which friends get to see it that the forum is somehow still private. They believe they have a right to air private grievances on these formats even though the information may be obtained in a semi-public manner. Sharing patient information on social media is prohibited...…diagnosis of symptoms. Treatment decisions can likewise be facilitated in this regard. EMR can also come with clinical parameters that provide clinicians with a way to be notified when a patient’s critical health levels are reached. For instance, if a patient has a history of hypertension, the clinical decision support system can be engaged to notify care providers when parameters in the patient’s records are reached, suggesting that the patient is at risk (Kharbanda et al., 2018).

EMR-linked clinical decision support can also facilitate the decision process for ordering diagnostic testing for patients. Too much testing can be a waste of time, energy and resources and it can cause strain on the patient’s health. It is far better to order the right diagnostic tests from the start rather than try a wide range of tests. To that end, EMR can help in the process of determining what tests should be conducted based on the information within the EMR. As software can be programmed to check for parameters that will then indicate which tests should be run, there is little need for clinicians to be able to sift through the data. Instead, they can rely on the system to search the data and indicate what the evidence suggests.

This will help in the future of nursing as more and more time can be freed from having to try various diagnostic tests. The EMR software will facilitate the decision making process and allow nurses to engage in a more one-to-one interactive manner with patients. It is often the case that nurses have to spend more time engaging with data and technology, which places time constraints on their ability to engage with patients. When that time is freed up due to streamlining technology that does a lot of the work of data analysis for the clinicians, nurses can then dedicate more of their time to interacting with patients, providing them with information and helping them to understand their health issues. They can address patient concerns in this manner and provide the kind of quality support and care that patients need.

Conclusion

Technology is changing the way that health care is provided in the 21st century. Information technology, EMR, telehealth, and communications systems are just some of the ways in which nursing is adapting. Collaborative care, continuity of care, and reduction of nursing errors are some of the ways in which technology can help improve the nursing field. Telehealth allows time and space obstacles to be overcome and patient quality care can be improved by way of clinicians using EMR for clinical decision support. Patient data and patient safety must be concerns, however, as patients have a right to know that their health information is being protected at all times. Facilities that do not take care to protect patient data can be fined under HIPAA. Nurses play a big role in this regard as they are end users of the technology and must safeguard passwords and beware of phishing schemes, which are used to steal access into systems. Technology thus offers a great deal of support for nurses in today’s industry, but it also comes with risks, from patient data being stolen to nurses’ own health being burdened via…