October 27, 2008

Nursing and Computers: the Inevitable Move Towards Electronic Health Records (ehr)

Nursing and computers have not always been a perfect mix. Typically, nurses try to get away from new computer systems as much as possible. However, it is an inevitable workflow evolution in today's hospitals.

"It was so easy before when all I had to do was give it (orders) to the clerk."

"This new computer system is such a mess. Why can't we keep our old system?"

"It takes time away from my patient care."

"This is never going to work."

As an RN working on the informatics side of healthcare, such comments are commonplace when I travel on site to different facilities.

Why I wanted to do it

With billions of dollars allotted to deploy this project to multiple facilities nationwide, I wanted to be a part of it. "It's never been done before in this scale," stated Vicki Levario, the Director of System Solutions & Deployment at Kaiser Permanente Southern California Region. When I was offered this job, I didn't hesitate. Here was a marriage of two things I feel comfortable with - clinical content and computers.

The magnitude of this project can be appreciated when you take into consideration the 8 million Kaiser members it will affect. By 2007, all 12,000 physicians and 150,000 employees in the Kaiser organization are expected to be fully trained and use the software in their workflows. After a few weeks of involvement in this project, I began to see what a Herculean undertaking this will be.

Resistance

"Good luck with that job. They're just wasting their money. It's never going to happen, " a physician said to me one day.

Healthcare automation is an inevitable progression, but not met with resistance. There are those who are so defiant to the change that they would rather retire than work under these conditions.

This sentiment is not unique to this organization. Cedars-Sinai Medical Center in Los Angeles met with such resistance from physicians that the implementation phase failed despite the system being two-thirds online.

I can understand where the overtone of paranoia comes from. Working on the units to support the software, I observed some users who are obviously using the computer for the first time. I saw them having difficulty using the mouse and typing their user names and passwords with painfully slow pecking style.

I try to encourage users by showing them the positive side. With the nation's healthcare trend of medical record automation, this will make health care givers more marketable as electronic health record (EHR) experienced professionals. And, in time they will master the system, and their workflows will be more efficient.

Safer Practice

The issue of electronic system workflows in the healthcare setting adversely affecting patient care has also been a concern. However, the opposite is true. According to the Institute of Medicine (IOM) in a report called To Err Is Human: Building a Safer Health System (2000), "98,000 Americans die in hospitals each year as a result of medical errors. Even when using the lower estimate, deaths in hospitals due to preventable adverse events exceed the number attributable to the 8th-leading cause of death. Deaths due to preventable adverse events exceed the deaths attributable to motor vehicle accidents (43,458), breast cancer (42,297) or AIDS.

In her report, Key Capabilities of an Electronic Health Record System July 31, 2003, Dr. Carolyn Clancy, Director, Agency for Healthcare Research and Quality stated, "There is a great deal of interest within both the public and private sectors in encouraging all health care providers to migrate from paper-based health records to a system that stores health information electronically and employs computer-aided decision support systems. In part, this interest is due to a growing recognition that a stronger information technology (IT) infrastructure is integral to addressing such national concerns as the need to improve the safety and quality of health care."

National Mandate

Automation of records in healthcare is not only a step in modernization, but a national mandate. The following is excerpted from the United States Department of Health Services.

Mission statement:

"… to guide the nationwide implementation of interoperable health information technology in both the public and private health care sectors that will reduce medical errors, improve quality, and produce greater value for health care expenditures, and coordinates outreach and consultation by the relevant executive branch agencies with the public and private sectors."

Vision:

"…Clinicians will have a patient's complete medical history, computerized ordering systems, and electronic reminder."

The implementation of electronic health records (EHR) is integral to this national mandate and it's just a matter of time when all hospitals in the US will be fully electronic in their workflow systems.

With this daunting task ahead, I'm reminded of the words of the National Coordinator for Health Information Technology National Coordinator, David J. Brailer, MD, PhD when he addressed the System Solutions and Deployment personnel. "All eyes are on you." As an RN and healthcare provider, it's breathtaking to see through the telescope to look beyond the horizon and be part of the mission.

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