Discussion: NR 599 EHRs Benefits and Drawbacks

Discussion: NR 599 EHRs Benefits and Drawbacks

Discussion: NR 599 EHRs Benefits and Drawbacks

Week 3: EHRs Benefits and Drawbacks

The National Institutes of Health defined an electronic health record (EHR) as a digital version of the patient’s medical chart. It is maintained by the health provider and may contain all the crucial administrative and clinical data pertinent to the patient’s care under a specific provider. EHRs are associated with various advantages and disadvantages. The table below outlines the pros and cons of EHRs.

Pros	Cons
Improves quality of healthcare delivery.The EHR enables providers to more effectively diagnose patients, decrease medical errors, and provide safer care (Kataria & Ravindran, 2020).	Potential privacy and cybersecurity issues compromise the privacy and confidentiality of patients’ data (Kataria & Ravindran, 2020).EHR systems are vulnerable to attacks by hackers, which could lead to dire consequences when patients’ data get into the wrong hands.
Promotes quick access to patients’ health records, facilitating more coordinated and efficient care.	EHRs can give inaccurate patient data if they are not updated as soon as new patient information is gleaned.Failing to update patient information in the EHR could result in providers accessing and using incorrect or incomplete patient information (Kataria & Ravindran, 2020).
Provides accurate, up-to-date, and comprehensive information about a patient at the point of care (Kataria & Ravindran, 2020).	High costs are involved in setting up and switching over to a new EHR system in an organization and regularly maintaining the system.
Improves communication and collaboration among providers, thus facilitating care coordination.	Increases the likelihood of malpractice liability concerns for healthcare providers.Liability concerns include how the hospital will ensure crucial medical data is not destroyed or lost when being transferred from paper to electronic records (Kataria & Ravindran, 2020).

Stage 3 Objectives for Meaningful Use

The Stage 3 proposed rule is built upon the framework developed in previous meaningful use stages and continues to foster EHR interoperability. The stage 3 meaningful use objectives selected for further research are: Generate and transmit prescriptions electronically and Actively engage in public health. With respect to electronic prescribing, CMS suggests increasing the upper limit for a menu set objective among eligible hospitals and clinics. Eligible providers should transmit more than 80% of their drug/treatment prescriptions electronically through certified EHR systems (Lite et al., 2020). In addition, more than 25% of hospital discharge medication orders will need to be electronically prescribed. The objective may impact my APN clinical practice since I will be expected to electronically send drug prescriptions to pharmacies to prevent fraudulent prescribing and ensure patient data is secure (Lite et al., 2020). Besides, I will embrace E-prescribing since it is crucial in preventing medical errors and illegal, fabricated prescriptions connected to drug abuse behaviors.

The objective of active engagement in public health builds on the requirements laid down in Stage 2 Meaningful Use regulations. It integrates some flexibilities, improvements, and innovations. In essence, the objective stresses the communication channels between providers, clinical data registries, and public health agencies (Lite et al., 2020). The objective may impact my future APN role in clinical practice since I will be required to engage with public health agencies and clinical data registries actively. Active engagement means that the APN is moving toward submitting production data” to a public health agency and clinical data registry (Lite et al., 2020). As an APN, I will demonstrate active engagement by completing registration to submit data, testing and validation, or production. Furthermore, I will be expected to send electronic public health data meaningfully using certified EHR systems.

References

Kataria, S., & Ravindran, V. (2020). Electronic health records: a critical appraisal of strengths and limitations. The journal of the Royal College of Physicians of Edinburgh, 50(3), 262–268. https://doi.org/10.4997/JRCPE.2020.309

Lite, S., Gordon, W. J., & Stern, A. D. (2020). Association of the Meaningful Use Electronic Health Record Incentive Program With Health Information Technology Venture Capital Funding. JAMA network open, 3(3), e201402. https://doi.org/10.1001/jamanetworkopen.2020.1402

1. As discussed in the lesson and assigned reading for this week, EHRs provide both benefits and drawbacks. Create a “Pros” versus “Cons” table and include at least 3 items for each list. Next to each item, provide a brief rationale as to why you selected to include it on the respective list.

PRO’s	Improved patient-provider communication	EHRs have become an important part of nurse-patient interactions which includes both face-to-face and remote consultations (Aveyard, et al., 2022). EHRs allow the patient to connect with their provider from anywhere. Being able to connect at any time for any issue facilitates better communication and promotes better patient outcomes.	CONs	Less patient interaction	The distraction that can be caused by the use of EHRs by providers has negative impacts on the patient-provider relationship (Bohsali, et al., 2018). Providers need to be cognoscente of time they are devoting to EHR documentation, especially in the presence of the patient, as not to distract of the patient-provider interaction (Bohsali, et al., 2018).
PRO’s	Reduced costs	Advantages of EHRs are the shortening of the time to make a new medical record, the reduction of working hours for employees in the records department and other departments, increase of billing accuracy and income, and improvement in the quality of provider documentation (Adebowale, et al., 2022).	CONs	Cost of operation/running	Long-term costs associated with running an HER includes software protection to protect against malware, system upgrades, and ransomware concerns (Adebowale, et al., 2022).
PRO’s	Legible and complete documentation	EHRs support documentation which improves clinical outcomes and streamlines communication between professionals to improve patient safety, assess quality of care and maximize efficiency (Eltair, et al., 2018).	CONs	Usability	“…poor EHR usability has been found to be a contributor to physician dissatisfaction, and many have hypothesized a direct relationship between EHR usability and physician burnout” (Dyrbye, et al., 2019, para. 6). Authors further point out that providers spend 1 to 2 hours time charting in the EHR for every 1 hour they spend with their patient on top of the 1 to 2 hours personal time they spend working in the EHR (Dyrbye, et al., 2019).

2. Refer to the Stage 3 objectives for Meaningful Use located in this week’s lesson under the heading Meaningful Use and the HITECH Act. Select two objectives to research further. In your own words, provide a brief discussion as to how the objective may impact your role as an APN in clinical practice.

Generate and transmit prescriptions electronically: this objective strives to ensure all eligible hospitals and critical access hospitals use electronic health record technology to transmit prescriptions to patients (CMS, 2018). Under stage 2 controlled substances were excluded but under stage 3 e-prescribing of controlled substances is included in states where allowable (CMS, 2018). As an Advanced Practice Provider, I will have to be knowledgeable about prescribing restrictions. For example, in my state of Wisconsin, there are restrictions on prescribing controlled substances (Board of Nursing, 2019). Regardless of eligibility under the objective, I will be unable to prescribe any schedule I controlled substance (Board of Nursing, 2019). One of the factors in my ability to meet this objective is the training I receive. Proper training to ensure correct utilization of the organization’s EHR to e-prescribe will be vital. Beykloo, et al. states that use of the EHR for prescribing increases patient safety by reducing risk of errors, but can add to workflow thereby increasing provider frustration (The impact of electronic prescribing, 2019). To decrease workload, reduce steps in the process, and decrease frustration, providers often use workarounds (Beykloo, et al., 2019). Although workarounds can save time, they are not best practice and can lead to adverse events or poor patient outcomes.

Actively engage in public health: this objective requires providers to show active engagement with public health agencies by meeting at least 2 of the 5 different public health measures (Forward Health, 2023). These measures are: immunization registry reporting, syndromic surveillance reporting, electronic case reporting, public health registry reporting, and clinical data registry reporting (Forward Health, 2023). Meeting these public health measures are vital in my future practice to promote the overall health of the community by focusing on the social, economic, and environmental factors that contribute to patient well-being (Bekemeier, et al., 2021). As Advanced Practice Providers, we have the capacity to work in diverse settings such as health departments, nonprofits, and complex care systems in our community. Being able and willing to engage the fore-mentioned public health measures will guide us to provide better care to the patients we serve in our future practice (Bekemeier, et al., 2021).

Aveyard, H., Butcher, D. & Forde-Johnston, C. (2022). An integrative review exploring the impact of electronic health records (HER) on the quality of nurse-patient interactions and communication. JAN, 79(1), 48-67. Retrieved on 03/19/2023 from: https://onlinelibrary.wiley.com/doi/full/10.1111/jan.15484Links to an external site.

Adebowale, A., Amanullah, S. & Gopidasan, B. (2022). Electronic medical records – a review of cost-effectiveness, efficiency, quality of care, and usability. Journal of Psychiatry Spectrum, 1(2), 76-79. DOI: 10.4103/jopsys.jopsys_17_22. Retrieved on 03/19/2023 from: https://journals.lww.com/jops/Fulltext/2022/07000/Electronic_Medical_Records___A_Review_of.2.aspxLinks to an external site.

Bekemeier, B., Johnson, K., Kaneshiro, J., Kuehnert, P., Swider, S. & Zahner, S. (2021). A critical gap: advanced practice nurses focused on the public’s health. Elsevier Public Health Emergency Collection, 69(5), 865-874. doi:10.1016/j.outlook.2021.03.023. Retrieved on 03/19/2023 from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8092811/Links to an external site.

Beykloo, M., Blandford, A., Franklin, B., Furniss, D., Ma, T., McLeod, M. & Mohsin-Shaikh, S. (2019). The impact of electronic prescribing systems on healthcare professionals’ working practices in the hospital setting: a systematic review and narrative synthesis. BMC Health Services Research, 19. Retrieved on 03/19/2023 from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6806498/Links to an external site.

Board of Nursing (2019). Chapter N8. Wisconsin Legislature. Retrieved on 03/18/2023 from: https://docs.legis.wisconsin.gov/code/admin_code/n/8.pdfLinks to an external site.

Bohsali, F., Chisolm, M. & Wolfe, L. (2018). Clinically excellent use of the electronic health record: review. JMIR Human Factors, 5(4). doi: 10.2196/10426. Retrieved on 03/18/2023 from: https://humanfactors.jmir.org/2018/4/e10426/Links to an external site.

CMS (2018). Medicare promoting interoperability program stage 3 eligible hospitals, critical access hospitals, and dual-eligible hospitals attesting to CMS objectives and measures for 2018. Department of Health and Human Services. Retrieved on 03/18/2023 from: https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/MedicareEHStage3_Obj2.pdfLinks to an external site.

Dyrbye, L., Melnick, E., Nedelec, L., Shanafelt, T., Sinsky, C., Trockel, M., Tutty, M. & West, C. (2019). The association between perceived electronic health record usability and professional burnout among US physicians. Mayo Clinic Proceedings, 95(3), 476-487. Retrieved on 03/18/2023 from: https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S0025619619308365?returnurl=https:%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0025619619308365%3Fshowall%3Dtrue&referrerLinks to an external site.=

Eltair, S., Faber, K. & Pagulayan, J. (2018). Use the nursing process to take advantage of EHR’s capabilities and optimize patient care. The American Nurse Journal. Retrieved on 03/18/2023 from: https://www.myamericannurse.com/documentation-electronic-health-record/Links to an external site.

Forward Health (2023). Promoting interoperability program: meaningful use of certified EHR technology. Department of Health Services. Retrieved on 03/19/2023 from: https://www.forwardhealth.wi.gov/WIPortal/Subsystem/KW/Print.aspx?ia=1&p=1&sa=15&s=11&c=637&ntLinks to an external site.=

NR599 Nursing Informatics for Advanced Practice

Week 3 Discussion

EHRs Benefits and Drawbacks

Purpose

The ideas and beliefs underpinning the discussions guide students through engaging dialogues as they achieve the desired learning outcomes/competencies associated with their course in a manner that empowers them to organize, integrate, apply and critically appraise their knowledge to their selected field of practice. The ebb and flow of a discussion is based upon the composition of student and faculty interaction in the quest for relevant scholarship.

. Pros and Cons List

EHR Benefits	EHR Drawbacks
1. Convenience for patient and providers Patient information and test results are readily available for the interdisciplinary team to review from anywhere within the hospital computer system (Chamberlain College of Nursing, 2023). Patients can also access their EHR information and results remotely via patient portals or other forms of access to the hospitals computer system electronically.	1. Dependency on internet and technology The EHR is dependent on the internet to function and allow providers to chart in the system and to upload results. When the internet is delayed or having an unexpected outage, it can cause delays in information being documented and uploaded. Technology malfunctions such as computers breaking down can also delay EHR documentation and uploads.
2. Access to faster data collection for research  Data can be easily accessed and sorted to improve the collection and analysis of data for research to create improvements in the system Chamberlain College of Nursing, 2023).	2. Not user friendly The EHR can be difficult to navigate and learn where and how to document patient assessments and other information (Ratwani et al, 2018). The efficiency of documentation and practice can be delayed due to additional time needed to learn how to navigate the EHR resulting in decreased provider satisfaction (DiAngi et al, 2019).
3. Faster completion of charting Using the EHR to document requires less time for charting compared to paper documentation and in turn allows additional time to be spent caring for patients directly.	3. High risk of documentation error Using the EHR to document is associated with a high probability of charting information/placing orders on incorrect patient (Ratwani et al 2018).

2. Meaningful Use Objectives- Impact on APN Role

Giving patients electronic access to their health information including test results and specified patient education can impact the role of an APRN in clinical practice by allowing the patients to become more aware and informed about their health and conditions as well as encourage participation in developing and implementing their plan of care along with the healthcare team. Patient’s having access to their results and health information can also lead to more questions being asked by the patient about their health which can give the APN an opportunity to not only educate the patient in person but use the Certified EHR Technology to provide the patient with more education and resources about specific areas of their health that they may have questions or concerns about (U.S. DHHS, 2014).

Using computerized provider orders can allow the interdisciplinary team to keep track of what tests, medications, or other orders related to the care of the patient have been placed and by which area of the interdisciplinary team. Computerized provider orders can impact the role of the APN by allowing the APN to see which consulting specialties, if any have ordered any additional testing or changed any patient medications and allows the APN and fellow consulting parties to stay up to date with the patient’s plan of care to prevent any delays as a result of a lack of communication between the interdisciplinary team. The EHR can also notify the APN by flagging any abnormal results or results that need immediate attention to ensure that no results go unaddressed. The computerized provider orders can also be tracked to determine if they have been initiated or completed to show the APN the progress on the orders placed to determine a time frame for the patient’s plan of care (U.S. DHHS, 2014).

                                                                               References

Chamberlain College of Nursing. (2023). NR599 Week 3: Health information technology and informatics tools [online lesson].

DiAngi, Y. T., Stevens, L. A., Halpern-Flesher, B., Pageler, N. M., Lee, T. C. (2019). Electronic health record (EHR) training program identifies a new tool to quantify the EHR time burden and improves providers’ perceived control over their workload in the EHR. Journal of American Medical Informatics Association (JAMIA) Open, 2(2), pp. 222-230. https://doi.org/10.1093/jamiaopen/ooz003

Ratwani R. M., Hodgkins, M., & Bates, D. W. (2018). Improving electronic health record usability and safety requires transparency. American Medical Association, 320 (24), pp. 2533-2534. https://doi.org/10.1001/jama.2018.14079

U.S. Department of Health and Human Services (DHHS). (2014). Work Product of the HITPC Meaningful Use Workgroup – Meaningful Use Stage 3 Recommendations. The Office of the National Coordinator for Health Information Technology (ONC). https://www.healthit.gov/sites/default/files/facas/hitpc_muwg_stage3_recs_2014_03_11.pdf

Activity Learning Outcomes

Through this discussion, the student will demonstrate the ability to:

Contribute level-appropriate knowledge and experience to the topic in a discussion environment that models professional and social interaction (CO4)

Actively engage in the written ideas of others by carefully reading, researching, reflecting, and responding to the contributions of their peers and course faculty (CO5)

Due Date:

Students must post a minimum of two times in each graded discussion. The two posts in each individual discussion must be on separate days. Posting twice on two different days meets the minimum requirement however for full credit, the student must post at least three substantive posts on three different days. The student must provide an initial post to each graded discussion topic posted by the course instructor, by Wednesday, 11:59 p.m. MT of Week 3. Subsequent posts, including essential responses to peers, must occur no later than the Sunday, 11:59 p.m. MT at the end of Week 3. Students are expected to submit assignments by the time they are due. Threaded discussions are not considered assignments and are not part of the late assignment policy.

A 10% late penalty will be imposed for discussions posted after the deadline on Wednesday regardless of the number of days late. NOTHING will be accepted after 11:59pm MT on Sunday (i.e. student will receive an automatic 0).

Requirements:

Post a written response in the discussion forum to EACH threaded discussion topic:

ORDER NOW FOR AN ORIGINAL PAPER ASSIGNMENT: Discussion: NR 599 EHRs Benefits and Drawbacks

As discussed in the lesson and assigned reading for this week, EHRs provide both benefits and drawbacks. Create a “Pros” versus “Cons” table and include at least 3 items for each list. Next to each item, provide a brief rationale as to why you selected to include it on the respective list.

Refer to the Stage 3 objectives for Meaningful Use located in this week’s lesson under the heading Meaningful Use and the HITECH Act. Select two objectives to research further. In your own words, provide a brief discussion as to how the objective may impact your role as an APN in clinical practice.

Adhere to the following guidelines regarding quality for the threaded discussions in Canvas:

Application of Course Knowledge: Demonstrate the ability to analyze, synthesize, and/or apply principles and concepts learned in the course lesson and outside readings.

Discussion: NR 599 EHRs Benefits and Drawbacks

Scholarliness and Scholarly Sources: Demonstrates achievement of scholarly inquiry for professional and academic decisions using valid, relevant, and reliable outside scholarly source to contribute to the discussion thread.

Writing Mechanics: Grammar, spelling, syntax, and punctuation are accurate. In-text and reference citations should be formatted using correct APA guidelines.

Direct Quotes: Good writing calls for the limited use of direct quotes. Direct quotes in discussions are to be limited to one short quotation (not to exceed 15 words). The quote must add substantively to the discussion. Points will be deducted under the grammar, syntax, APA category.

For each threaded discussion per week, the student will select no less than TWO scholarly sources to support the initial discussion post.

Scholarly Sources: Only scholarly sources are acceptable for citation and reference in this course. These include peer-reviewed publications, government reports, or sources written by a professional or scholar in the field. The textbooks and lessons are NOT considered to be outside scholarly sources. For the threaded discussions and reflection posts, reputable internet sources such as websites by government agencies (URL ends in .gov) and respected organizations (often ends in .org) can be counted as scholarly sources. The best outside scholarly source to use is a peer-reviewed nursing journal. You are encouraged to use the Chamberlain library and search one of the available databases for a peer-reviewed journal article. The following sources should not be used: Wikipedia, Wikis, or blogs. These websites are not considered scholarly as anyone can add to these. Please be aware that .com websites can vary in scholarship and quality. For example, the American Heart Association is a .com site with scholarship and quality. It is the responsibility of the student to determine the scholarship and quality of any .com site. Ask your instructor before using any site if you are unsure. Points will be deducted from the rubric if the site does not demonstrate scholarship or quality. Current outside scholarly sources must be published with the last 5 years. Instructor permission must be obtained BEFORE the assignment is due if using a source that is older than 5 years.