Electronic Healthcare Record EHR\'s

Healthcare Costs

Electronic Records Healthcare

As a member of the committee charged with designing an EHR at the facility, it is important to note that the new EHR process must not interfere with the nursing staff's ability to deliver safe, cost-effective care for their patients. The system would have to offer a method of comparing a patient's data from previous, current and past events. The system would also have to be able to adapt and support a continuous ongoing record of the patient's education and learning response from this facility and other encounters or visits. The system should be able to eliminate the need to constantly acquire baseline demographics data every time the patient visits this or any other facility. Access to the patient's data should be universal and seamless for the nursing staff that need access and who also have the proper credentials. The nurses also need the EHR system to offer access and quality for research purposes.

The EHR system will have to meet the nursing staff's needs to maintain and control the basic bureaucratic needs of the facility. In other words, the system will have to ensure administrative and documentation processes of all medications and treatments and in certain cases track cost of care without the nurses having to intervene. For example, when a Band-Aid is used on a patient and the nurse properly documents its use in the EHR, the system should be able to note the cost of the physical Band-Aid and seamlessly incorporate it into the patient's administrative record.

There is no doubt that the new EHRs have to be able to ease and even if possible improve the nursing team's documentation and quality of care processes. The system will have to be efficient for the nursing team. "The nursing process provides a way to identify the health, strengths, and needs of clients." (Lindberg, Hunter, Kruszewski, 247) The EHRs should offer access to the patient's historical records and all pertinent assessments, operative notes, allergies and drug reactions, medications, specific lab data such as blood type, and some diagnostic tests needed but it cannot be so cluttered with minute by minute temperature results. Also, one of the more important needs on the system by nursing is the requirement that the EHRs supports a database that ensures research, offers useful data to the administration and any clinicians while at the same time providing evidence and recognition of the nursing team's efforts and work in viable and measurable way that is structured in a language that nurses can understand and appreciate.

12.4 -- New and effective EHRs will be utilized by more than just one facility and even within a given facility many departments. The entire healthcare system made up of health insurance plans, governmental agencies like Medicare and Medicaid, hospitals, public health programs, clinics and clinicians, physicians, nurses, laboratories and radiologists and of course, the consumers themselves will be directly affected. Because of this, EHRs will have large amounts of a patient's information that other areas of the patient care process will not need access to at some point or many cases, ever. For example, the information need of an administrative aspect like billing will not require the same information by a trauma nurse in an emergency room setting.

Nurses will always require the clinical information regarding a patient's past, present and future medical needs. It is rare that the general nursing process requires access to a patient's current or past billing or payment information. The majority of interactions nurses have with EHRs will entail certain, but not all of the available client history.

Consider an emergency department client that is having a heart attack. Obviously, in this situation, the team dealing with this scenario requires some patient history in regard to the immediate problem, the number of related incidents and previous episodes or history of heart problems. At the same time, they do not need childhood problems that may also be in the patient record such as falling off a bike and breaking an arm thirty years before, or that a physical therapist appointment four years ago was not paid for. The key is that the information will have to be presented in a way that is useful at the time of need. The system has to literally improve and facilitate the automation of all critical and clinical pathways data.

Question 1 - It is important to understand that even though the requirements of healthcare information have evolved, "no country has implemented an operational national EHR to date." (Hebda & Czar, 302) This means that standardization on a national level is a global problem for this type of information process. With this in mind, it is important to note that there are several key issues to consider when implementing a complete EHR system. Systems like this at one time were considered to be a luxury: Today, they are a necessity.

The first key then is to understand current and future trends of the overall process. The facility may need to be fully aware of future trends in many areas such as vocabulary and record standardization because if the facility's EHRs cannot communicate with Medicare for example, it may not be usable. Medicare entails many potential future changes in input and is a critical key to consider prior to implementing any new system. The future of e-prescribing and the Medicare Prescription drug program will be the driver of many new systems.

A second key will be verifying that the facility has up-to-date computerized processes and an electronic infrastructure needed as a foundation for EHRs. "While most hospitals have some level of automation, few have attained a fully electronic environment, and many physician offices, ambulatory care areas, and long-term care settings still maintain manual processes." (Hebda & Czar, 294) Included in this infrastructure will be costs of a new system. If a facility is currently at stage 0 where they have little to no electronic systems in place, cost could be staggering where as a fully automated system may only need some system adjustments to be fully operational.