Slide 10: Within nursing practice, assessment, documentation, and communication are the most frequent activities, consuming 18.1%, 9.9%, and 11.8% of nurses ' time, but with EHR nurses have more time to analyze and deliver patient care. The selection of bedside or central station desktop EHRs will influence documentation time for the two main user groups, physicians and nurses (Vondrak, 2012).
Slide 11: Human errors, such as medication errors or allergy errors, are minimized with alerts on the electronic health record. The electronic health record has shown to reduce the number of missing charts (82%), and improves data accessibility to patient records and documentation remotely (75%) (Narisi, 2013). By eliminating paper charting, the EHR makes all patient’s data and information available at all times to all physicians. The EHR improves patient care delivery by reducing the error of hand-written orders and allows for other physicians to access the order. This is great for when the doctor orders a medication to start stat, and puts the order into the EHR, so the nurse can start the medication right away (Palma, 2013).
Slide 12: EHR can help detect possible errors in the system. For example, EHR alerts providers of possible conflict in medications that were prescribed to patients.
In a case of emergency when a patient is unconscious and not able to communicate, clinicians can pull the patient’s medical history from the EHR in order to better treat the patient.
With the EHR
Electronic health records (EHR) are health records that are generated by health care professionals when a patient is seen at a medical facility such as a hospital, mental health clinic, or pharmacy. The EHR contains the same information as paper based medical records like demographics, medical complaints and prescriptions. There are so many more benefits to the EHR than paper based medical records. Accuracy of diagnosis, quality and convenience of patient care, and patient participation are a few examples of the
An electronic health record (EHR) defines as the permissible patient record created in hospitals that serve as the data source for all health records. It is an electronic version of a paper chart that includes the patient’s medical history, maintained by the provider over time, and may include all of the key administrative clinical data relevant to that persons care. Information that is readily available includes information such as demographics, progress notes, allergies, medications, vital signs, past medical history, immunizations, laboratory data, & radiology reports. The intent of an EHR can be understood as a complete record of patient
Adoption of EHR can derive a great amount of benefits in clinical outcomes such as patient safety and quality of care. Qualtiy of care can be measured with different dimensions such as patient safety, effectiveness, and efficiency. Patient safety is defined as ‘avoiding injuries to patients from the care that is intended to help them’(Menachemi and Collum, 2011, p. 49). Often times, lack of time can contribute to omission of asking patients important questions such as drug allergy information and confirming important patient identifiers such as addresses/phone numbers. Improvement of medication error is a well-noted benefit of EHR as seen in numerous researches. According to a study, researchers found that a CPOE system was contributory in reducing serious medication errors by 55% in the hospital setting (Bates, 1998). Many other studies have reported similar findings in patient safety improvement. When e-prescribing is used, prescriptions can be checked for any drug interactions with
These systems will also help cut down on medication errors by comparing the patient’s to medications or interventions so that it is given to the correct patient. Also documents the care given so there would be no human error in the case of questioning whether care had been given as long as the caregiver documents in the record. These features of the electronic health record are in place to promote patient safety by reducing errors.
EHR was created to have a technical way to securely exchange private and personal medical health information in hopes to improve the quality of care, decrease medical errors, limiting paper use, reduction of health care cost, and increasing a person access to affordable health care. A mandate was created for EHR stating that health records can be accessible to all facilities with patients having the capability to access their own health records at any time. Ameliorating the quality and convenience of care given to a patient, allow for cost saving measures, engage the patient and family to participate in their care, improve accuracy of medical diagnosis, and enhance the efficiency of the overall outcome of the patients’ health.
EHR documentation varies from system to system, and can enhance the quality of nursing care. As written previously, the organization can customize the EHR, to include safeguards for documentation. For example, the triage screen cannot be passed without documenting a completed abuse screening; when administering a cardiac medication, a prompt appears to enter the heart rate; or the allergy screen appears for review before the nurse can acknowledge an ordered medication. Becoming familiar with the system the organization is using, and understanding that a heart rate must be checked before administering certain cardiac medications, and reviewing a list of allergies before administering medications assists the nurse in high quality, safe care delivery. Safeguards within the system increase the quality of care, and decrease undesirable events.
National health database mandate will improve the diagnostics and outcomes for patients. Patients receive optimal medical care when the person should be able to obtain inclusive data. The providers can access their patient’s records at the point of care. Electronic Health Records (EHRs) “not only keeps a record of a patient's medications or allergies, automatically checks for problems whenever a new medication is prescribed or alerts the clinician to potential conflicts” (Benefits of EHRs n.d.). Any information recorded in an EHR by the primary provider is obtainable if the patient is in an emergent situation. It allows the clinician in an emergency department access
An Electronic Health Record is a computerized form of a patient’s medical chart. These records allow information to be readily available to authorized providers during a patient’s encounter with the healthcare system. These systems do not only contain medical histories, current medications and insurance information, they also track patients’ diagnoses, treatment plans, immunization dates, allergies, radiology images and lab tests/results (source). The fundamental aspect of EHRs is that they are able to share a patient’s information quickly across service lines and even between different healthcare organizations. Information is at the fingertips of lab techs, primary care physicians, pharmacies, clinics, etc. The
A major motivation for widespread use of an EHR is both efficiency and financial savings. One obvious savings is the elimination of the paper-based chart, storage costs, and retrieval costs. One study cites “that a chart pull costs $20 at Scott and White Memorial Hospital, Clinic, and Health Systems in Temple, Texas. Their electronic chart solution reduced electronic chart pulls to less than $1 apiece.” Electronic messaging systems built into an EHR enable speedier communication among staff members. Communication to the health-care provider concerning diagnoses, drug refills, pre-authorizations for treatments, and general patient concerns is expedited and simplified. Electronic communication among the office staff regarding referral setup,
Have the potential to improve the quality, safety, and efficiency of clinical practice due to their ability to deliver legible and timely access to patient information to multiple users, as well as the ability to provide users with decision support. Unlike paper documentation, use of the EHR allows practitioners to aggregate data, and provides the opportunity to
Improved patient safety and quality of care through warning-and-alert systems in the EHR – the feature of e-prescribing tracks and records allergies and previously prescribed drugs. Moreover, it has an alert system that will notify if newly prescribed drug poses allergy threat to the patient. Thus it decreases an amount of medical errors.
The Electronic Health Record (EHR) is an extensive electronic record of patient health data created by one or more experiences in any prudence communication setting. Included in this data are the patient’s demographics, advancement notes,
Electronic medical records had a great impact in the ushering in of the age of Nursing Informatics. (Himss, 2010)EMRS present healthcare professionals with the ability to retrieve and organize data in a quick and efficient approach. With information so readily available, patient safety increases and we know that patient cost goes down. This happens because patient medications, allergies, history, demographic, and treatment information is more collectively available.
Another big plus of the EHRs is that studies have shown that it has helped providers improve accuracy of diagnoses and health outcomes (Couch, 2008). For example, nurses could have reliable access to patients complete health information and have pictures which would help with whatever problem they might encounter. EHR doesn’t just keep patients medications and allergies, it also check for problems whenever a new medication is prescribed and it also alerts the nurse of potential problems (Couch, 2008). EHRs can also tell the nurse if potential safety problems occur, which helps them avoid more serious consequences for patients, which can lead to better outcomes. The EHRs can also help nurses quickly identify and correct operational problems, which compared to the paper-based setting, those kinds of problems would be more difficult to correct. It can also help