The Electronic Medical Record System

In the medical field there have been a lot of technological advances and making health records electronic is one of them. The days of having a paper health record are almost obsolete. An electronic health record keeps a patient’s medical information and history on a computer which is accessible to more people in less time. I will explain how the continuity, communication, coordination and accountability of the electronic health record can help the medical office. I will explain what can be included in the electronic health record. As an advocate of the electronic health record I will also explain some disadvantages to the electronic system.

The EMR is a software program used to enter patients information into a computer, which organizes and stores the information. I believe most offices will keep the paper charts in a very safe location or shred it. But I think because of the confidentiality that any and all information or records relating to patients is considered privileged. basically saying keeping all information about the patient confidential.

The Inner City Clinic is experiencing problems with medication prescribing errors and seeks a resolution to this problem through use of electronic medical records and registration medication reconciliation. The Institute of Medicine reports in the work entitled "Preventing Medication Errors" that the "average hospitalized patient is subject to at least one medication per day. This is reported to confirm previous research findings that medication errors represent the "most common patient safety error." (Barnsteiner, nd, p.1) Medication reconciliation is described as follows:

Healthcare can be known for a complex industry. Every day is a new day facing complicated clinical administrative transactions with electronic medical records and safety? Health Information technology is suppose to realize errors using electronic medical records. Leaders must understand the complexity and safety issues in order to help mandate electronic medical records with design, development, implement and use. In the last decade, this article has informed executives, clinicians, and technology. Their main focus was on these three areas computerized physicians order entry. Their main focus was to work all three areas computer physician order entry, computer decision support system,

In the modern world technology is everywhere and it affects everyone’s daily life. People are constantly attached to cell phones, laptops, and other electronics, which all have affected how people live their lives. Technology is also a large part of the healthcare system today. There are many electronics and technologies that are used in health care, such as electronic health record, medication bar code scanning, electronic documentation, telenursing, and there are many more forms of technology that impact nursing. One technology that stands out is the electronic health record. The electronic health record, also referred to as EHR, is an electronic version of a patient’s chart, and it contains is a list of the patient’s current medications, allergies, laboratory results, diagnoses, immunization dates, images, treatments, and medical history (“Learn EHR Basics,” 2014). The purpose of the electronic health record is to have a patient’s health care record available to health care providers nationwide, but the patient can decide who has access to their record (Edwards, Chiweda, Oyinka, McKay, & Wiles, 2011). The electronic health record is a very important technology in health care and it impacts nurses, nursing care, and has a significant impact on patient outcomes.

We live in a world filled with technology. School teachers and college professors use technology to give lectures, health care professionals use technology to keep medical records, or monitor patient’s vital signs, we use technology such as social media, to connect with people and gain acceptance. In 2014, Gary Turk posted a video to Youtube titled Look Up, in which he argues that technology, such as smartphones, causes us to miss out on certain things in life, because we don’t use it in moderation. Technology benefits our lives by making us more efficient in our professional and personal activities.

For a nation to be technologically advanced, the United States (U.S.) is having a hard time overcoming the dark era of utilizing hand written scripts, progress notes, and paper records. In comparison to other countries, the U.S. is lagging behind in the health care system. Even with all the improvements that have been made recently, the U.S. ranked last in 2014 in areas such as access, efficiency and equity compared to Australia, Canada, France Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United Kingdom (Davis, Stremikis, Squires, & Schoen, 2014). Now, as our nation is trying to improve the quality, access, and proficiency of our health care, concerns have been raised whether the new policies are adequate enough for privacy amongst sharing and obtaining health information. This paper was put together to give background information on how the electronic medical record came about and whether privacy is a major concern amongst the American population.

Healthcare is a complex entity that encompasses a variety of specialties necessary toward meeting the needs of patient seeking clinical services. There are multiple communications necessary to efficiently meet patient needs. For many years detailed documentation, progress notes, specialty consults, and physician orders have been hand written. The legibility of this documentation was often illegible, and difficult to decipher, which resulted in clarification orders and often delays. The electronic medical record was introduced approximately 50 years ago with an ultimate goal of compiling healthcare information for immediate and future reference (Keller, 2016). Since the electronic medical records was initially implemented multiple versions have since been created. Successfully implementing the electronic medical record, requires a great deal of research to ensure that the specifications align with the organization’s short and long term goals.

I understand your concerns regarding the legality of the electronic signature. Electronic health record system have many policies and rules that must be followed in both state government and federal. In 2000 the U.S. Government passed a law that gave electronic signature the same legality as written signature. It doesn’t mean that its signed electronically that anyone can access it and sign it for you. Your signature authentication requires a password, biometric, and unique code this identifies that its you who is the signer in the system. If someone tries to access any documents to sigh them they will not be allowed because the system will not recognize it if it wasn’t you. To be save there are passwords that go along.

The electronic medical record (EMR) is the replacement of paper manual charts and is being used all across the country. As per Hebda and Czar (2013), the EMR is the “building block” of the electronic health record (EHR), which can be defined as “a longitudinal record that includes client data, demographics, clinician notes, medications, diagnostic findings, and other essential healthcare information” (p.293). The widespread use of EHR’s in America is foreseeable and inevitably unavoidable, but by no means a simple and undoubtedly an effortless task to achieve.

Consists of one to three bold sentences that present a specific focus, a point of view, an opinion, or an idea that is arguable. YES

Electronic Medical Records (EMS) is a digital version of the paper charts in the clinical office, the EMR contains the medical and history of the patient also allows us to track data over time, monitor and improve overall quality of care within the practice such as blood pressure and vaccinations, therefore the patients record may be printed out and delivered by mail to a specialist or members of the care team. Electronic Health Record (EHR) are designed to collect and compile all information to reach out beyond the health organization and to easily share the medical information of the patient to follow him or her through various modalities of healthcare, some benefits of EHRs are to gather information by the primary care which they advise

Not so in healthcare or public safety. Especially during emergencies, if a product fails to work as intended—or to work at all—it can mean lost productivity, mountainous legal fees, brain death, or loss of life, limb and property.

Robert Miller and Ida Sim found not only benefits but, also barriers that health care facilities and physician would encounter when adopting and using Electronic Medical Records. High initial cost and uncertain financial benefits was the highest rated barrier faced by Electronic Medical Record System adoption and implementation. Robert Miller and Ida Sim found that the cost of adopting an EMR for use by physicians ranged from $16,000 to $36,000 per physician (“Barriers to EMR Use,” Physicians’ Use of Electronic Medical Records: Barriers and Solutions, 2004). Since most health care institutions have more than one practicing physician and several other physicians with practicing rights. The initial cost to eliminate paper records and move to

Patton-Fuller Community Hospital is a nonprofit Healthcare organization in the city of Kelsey that has provided quality