March 2nd, 2012
By Jennifer Olin, BSN, RN
Just two weeks ago Health and Human Services (HHS) Secretary Kathleen Sebelius announced that the number of hospitals using health information technology (HIT) has more than doubled in the past two years. According to a survey by the American Hospital Association (AHA), from 2009 to 2011, the percentage of U.S. hospitals adopting electronic health records (EHRs) went from 16 to 35 percent.
EHRs and EMRs (electronic medical records) are slightly different in definition but are often used interchangeably. The National Alliance for Health Information Technology (NAHIT) says:
Both are patient records kept by a doctor's office, insurance company, or healthcare facility. Despite their being much ballyhooed for making a patient’s navigation through the healthcare system safer and more efficient, many in healthcare have been slow to implement them citing issues of security and privacy, the expense of putting them into play and a lack of standardization between EMR programs.
The federal government has defined a complete EHR system as containing four basic functions:
An individual doctor's practice, healthcare facility or insurance company's system determines on its own which of those records will be kept, making it more or less complete. Federal definition has not resulted in a standard.
Just as nurses are the largest population of the healthcare community, they are the largest group expected to learn to use EMRs on a daily basis. Like many, we can be resistant to change, and this transition to an electronic world has spawned a whole new area of nursing education requirements.
Dr. Marcus Pantalion is not a physician but he spends the bulk of his time with nurses. His title is Senior Clinical Analyst/Implementation Educator. Pantalion is a D.H.Ed. or doctor of health education and he teaches healthcare providers how to use EMRs and EHRs. And according to him, it is sometimes quite the task.
So I guess there is no way to avoid this EMR business, huh?
”EMR’s are definitely the wave of the future. When used properly they can help streamline a physician’s practice, enhance patient care and safety, provide easier exchanges of health information internally and externally, and can serve as a great tool for reporting. For example, clinicians can run queries of their entire patient database to locate individuals with a certain diagnosis. Additionally, an EMR can help reduce workloads; allowing more time for a provider or clinician to focus on patient care.”
Do you find nurses are pretty open to taking on this new task?
”Most nurses are receptive to EMRs, but this is somewhat dependent on where they are at in their career. Recent grads love EMRs and cannot wait to get started using them. However, the seasoned nurses that are familiar with paper charts aren’t as receptive in the beginning. With them, I think it’s a mix of breaking old habits and overcoming their fear of computers. This is also the case with seasoned physicians as well. They are kind of “scared” of computers and don’t want to learn how to use them. Eventually, after a few training sessions and showing them that a computer isn’t evil, they settle in comfortably and use the EMR efficiently.”
Are nurses harder or easier to train than other people in healthcare?
”Compared to other clinicians, nurses are harder to train. During training they are very perceptive, wanting to know the “how and why” of EMR features not just sitting back and “enjoying the show”. So, most training sessions are intense and a lot of discussion takes place about how we (the nurses and I) can get the EMR to work for them. Now, this isn’t a bad thing or complaint—nurses always tend to ask really good, thought provoking questions (surrounding patient care) that other clinicians wouldn’t think to ask. Also, some of the best feedback I’ve received about training content and the EMR program comes from the nurses.”
Why are nurses are important to the use of EMRs and why are EMRs important to nursing?
”To me, nurses are important to EMRs because they have a “patient first” mentality. Nurses ignore the benefits (from an EMR) of reduced workloads or streamlined practices; they focus on patients and how the EMR will help them better care for patients. Their compassion for patient care spills over into their learning of EMR programs; which is why, to me, they use EMR programs far better than other clinicians.
”From personal experiences, I feel EMR applications are definitely important to nursing. I’ve noticed in many of the practices and hospitals where I’ve trained, nurses wear many hats—from office managers to front desk clerks. EMR programs are designed to increase efficiency and above all else enhance patient care. When implementation of an EMR is properly planned out and workflows established—small, three person practices can be high performing, efficient practices. So, bringing an EMR into the mix can help reduce interference from responsibilities that take away from patient care.”
Is there anything you would like to tell nurses who are converting to an EMR system, what you think they should know, what they should accept or get used to?
”Three things all nurses (and clinicians) should know is: have patience with EMR systems, stay positive, and accept what cannot be changed in the beginning. Most EMR programs are regularly updated and with each update a lot of small enhancements are implemented. These small enhancements are based on feedback received from end users—like nurses. So never discount your questions or concerns (or gripes); one person’s feedback can help others with the same concerns and/or issues. Again, patience is key and when feedback is requested—participate!”