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Legal And Ethical Implications Of An Electronic Health Record

Decent Essays

Needs Assessment As an organization that pride itself on continuous improvement it is time to move away from an electronic medical record (EMR) to an electronic health record (EHR). The organization currently utilizes three different EMR, each for different reasons. This has and will continue to make accessing patient information difficult and inefficient as access to each database is dependent on individuals role within the organization. Overall, this will continue to influence patient care negatively. Currently, only nurses have the ability to enter and change orders, therefore, all orders must be given verbally to the nurse or be written down. Further, the system only contains information of each clinics patients and not across the …show more content…

This is to ensure that staffs are compliant with organizational policy.
EMR or EHR, Selection Process EMR or EHR, which is better? An EMR is an electronic medical record containing patient health information that is created within a clinical setting during the delivery of patient care (Heart et al., 2017). An effective EMR will include a patient health history, immunizations, laboratory data, vitals, diagnostic images, clinical documentations, computerized physician order entry, and clinical decision support. An EHR contains all of the above, unlike the EMR that is only accessible within a specific clinic, EHR can be access through different healthcare networks. Therefore, enhancing patient care. Ghazisaeidi, Ahmadi, Sadoughi, and Safdari (2014) proposed taking into considerations the following components prior to selecting a system. Components to considers include: a thorough assessment of the organizations need, the organizations readiness for change, determining a timeframe for the implementation process, estimate of total costs, defining roles and responsibilities in the change process, researching different systems and vendors, identifying key elements that are needed in the system, and having a strategic plan and support system in place for the implementation process.
A Culture of Quality and Safety Strong leadership is needed during times of change. For the proposed change to be successful, a clear vision of the proposed change needs to be

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