Posts Tagged ‘EMR’

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Never Too Late: One Family Practice’s Shift to EHRs after 50 Years of Paper

April 16, 2015

Editor’s note: We hear a lot about the stress and lack of time for direct patient care that nurses (and physicians) have experienced with the movement to EMRs or EHRs. We’re in a transitional period, and in some instances the use and design of these systems has a long ways to go. But here’s a story with a positive slant, written by someone who might easily have responded very differently, given the circumstances. Change is inevitable; how we react to it throughout our lives, less so. 

By Marilyn Kiesling Howard, ARNP

Niklas Bildhauer/ Wikimedia Commons

Niklas Bildhauer/ Wikimedia Commons

I am a nurse practitioner and my husband of 60 years is a family practitioner. We still work full time in our Gulf Breeze, Florida, practice. About five years ago, we first learned that our paper records were becoming archaic and that Medicare was planning to penalize providers who didn’t switch to the use of electronic health records (EHRs) by a certain date.

It was terrible news—we had 50 years of work in the paper chart genre, and were unsure about how to make the transition. Some who were in our position took the pending requirements as an opportunity to retire, but we weren’t ready for that.

Embracing a predigital innovation. In the 1960s, we started a small family practice in Indiana. As we requested our patients’ records from the files of their most recent physicians, it was not unusual to receive an index card that had the date neatly stamped on the left edge, with a handwritten note on the same line. (Needless to say, we’d already gone upscale, with a folder for each patient and a piece of white note paper.)

We quickly found that the medical record was our link to the prospective health of our patients, so we explored how we might make our records more useful. Joe read about a clinic in Bangor, Maine, where physicians were implementing the problem-oriented medical record (POMR) developed by Dr. Larry Weed, so we flew there to learn about this innovation. Dr. Bjorn and Dr. Cross were still developing their application of the model; their favorite medical secretary was a ‘bored bright housewife,’ and the entire clinic had an aura of excitement and discovery.

When we returned home, we quickly converted our folders to a proper chart with the ‘problem list’ fastened on the left and the progress notes on the right, using the new methodology. As we treated our new patients, we dutifully produced the ‘subjective, objective, assessment, and plan’ (SOAP) model we’d also imported from Maine.

This method sufficed for all the years between the first enlightenment and our leap in May 2011 into the world of pixels. It’s a challenge to get up and running with an EHR system. It was as if we were starting a new office with 2,000 patients to enroll. We had to had to translate and enter all of their old information into the new charting system. Two of our staff did not have computer knowledge and could not type. We went to half production, and our lost revenue was felt for months afterwards. (‘Meaningful use’ rules reimbursed us for about one-half of what the transition cost us.)

We’d decided on a cloud-based system because it was easy to access and the records would be safely stored on a server in Maine, an extra plus due to our propensity for hurricanes in the Florida Panhandle. The program was extremely user friendly. Given our level of expertise, this was a necessity. We took lessons online; the training included a live operator who was willing to stay on the line until the information was understood and applied. The company that runs the system keeps us compliant with meaningful use requirements and lets us know of impending changes.

We have, since we started using it at our clinic, found the EHR so far superior to our handwritten method that it would be impossible for us to return to the scribbled messes, as we see our old charts now. We still refer to them to garner important items such as consults, colonoscopies, surgeries, etc. Those reports are then neatly bar-coded into the EHR. It is no longer necessary to weed, retire, or store the charts. We did not abstract the old charts, simply moved important reports from them. We keep them in our office for quick historical reference. Read the rest of this entry ?

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Finding a Job as a Nurse In a Digital Age — and Keeping It

October 26, 2010

Will at Drawing on Experience manages to post a new comic almost every day. A regular theme is the progress of his career—having finished his accelerated nursing program, he’s now looking for a job. To the left is a thumbnail of a recent drawing he did about one of the more annoying aspects of the process (click the image to visit his blog and see a larger version).

A nurse returns to work at age 68 and finds her biggest challenge is computers.Of course, this isn’t the first downturn we’ve had in the U.S. economy; as AJN clinical editor Christine Moffa wrote back in May, newly minted nurses have struggled to find work before. Once you actually do get a job as a nurse, there’s the small matter of doing it for the first time. Or for the second or third time—but as if it’s the first time, at least in some respects. The October Reflections essay, “Paper Chart Nurse,” gives another perspective on the ways computers have changed the lives of nurses. It’s by an oncology nurse who returned to practice two years ago, at age 66. Her struggles with adapting to using an electronic medical record system were at times profoundly discouraging; she just wasn’t as proficient as the younger nurses at computer use, despite all her skills and experience. Have a look and please, tell us what you think.—JM, senior editor

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Open Medical Records: A Question of Safety

August 3, 2010

By Christine Moffa, MS, RN, AJN clinical editor

We’ve all watched our health care provider writing or typing while we answered questions or described our symptoms. Before becoming a nurse I used to wonder what they were putting in my chart and if they got it right. And now that I am a nurse I can’t believe how often a medical assistant or nurse will take my vital signs and write them down without telling me what they are. How can it be possible that adults are kept from knowing their own or their children’s health information? Back when I worked on a pediatric floor my colleagues gasped in shock when I allowed a parent of one of my patients to look at his child’s chart. And I actually let them make me feel like I had done something wrong!

Last week this issue was the topic of a column by Dr. Pauline W. Chen in the New York Times, where two related blog posts (here and here) also received much reader commentary. The sudden flurry of interest in the subject was occasioned by an article published in the Annals of Internal Medicine detailing the preliminary findings of a study following a national project called OpenNotes, funded by the Robert Wood Johnson Foundation, in which “more than 100 primary care physicians and 25,000 of their patients will have access to personal medical records online for a 12-month period beginning in summer 2010.” Readers’ comments ranged from one extreme to the other, such as the following:

  • “The records are the doctor’s; the doctor creates the record. Just as I would create a file on a client, the intellectual property is mine, I can have control.”
  • “As a healthcare consumer, I pay a lot of money out-of-pocket to healthcare providers for the services they render me. I am fully entitled to the documentation produced as part of this business transaction.”

 

Patients finding errors. Last year, as part of our ongoing “Putting Patients First” series, AJN published an article, by Susan Frampton of the Planetree organization, about Griffin Hospital in Derby, CT (there’s also a series of free Webinars, the next of which is on September 21). At this facility patients can view their records either alone or during conferences with their health care providers. In addition to increasing patient satisfaction, this openness about medical records may also improve safety. According to the article,

“At hospitals with open medical records policies, patients viewing their own medical records have identified numerous errors (for example, name, address, allergies, medications, and historical data); a recent study comparing data obtained from postdischarge patient interviews and medical records indicated that patients can help ensure their medical records’ accuracy regarding adverse events, and that the safety of the care provided may be improved when patients can view their records and correct mistakes and omissions.”

What happens at your facility when a patient asks to see their records?

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Supporting Nurse Practitioners as ‘Priority Primary Care Practitioners’

July 29, 2010

By Susan McBride, PhD, RN, professor at Texas Tech University Health Science Center School of Nursing 

It’s important for nurses to understand the Medicare and Medicaid incentives to implement electronic health records (EMRs) and to move to their “meaningful use,” as well as the purpose of the Regional Extension Centers created to support nurse practitioners and other “priority primary care providers” in the implementation process.

Dr. Mari Tietze, John Delaney, and I are fortunate to be involved in two of the Regional Extension Centers in Texas. We believe that nursing professionals have many contributions to make in the evolving electronic highway in the U.S. We will blog later about our roles as nursing informaticists in the Regional Extension Center program.

What are ‘Regional Extension Centers’? Under the Office of the National Coordinator (ONC) Health Information Technology Initiative to support getting providers to meaningful use on electronic health records, the ONC has established Regional Extension Centers. There are 60 Regional Extension Centers that will furnish assistance to providers in specific geographic services areas covering virtually all of the U.S. A total of $643 million is devoted to these centers.

The purpose of the Regional Extension Centers is to support priority primary care practitioners in priority settings to implement and use EMRs according to the meaningful use requirements outlined in our previous post (below is a screenshot illustrating one example of how an EMR might align with meaningful use requirements; click image to enlarge). The goal of the program is to provide federally subsidized outreach and support services to over 100,000 priority primary care practitioners within the next two years. 

© 2010 e-MDs, Inc. All rights reserved. Product and company names are trademarks or trade names of their respective corporations.

Regional Extension Centers will provide the following support services to providers:

  • EHR implementation
  • education and training
  • project management
  • incentives
  • meaningful use

NPs as “priority primary care practitioners.” A priority primary care practitioner is defined by the ONC as a primary care provider  that is any doctor of medicine or osteopathy, any nurse practitioner, nurse midwife, or physician assistant with prescriptive privileges in the locality where she or he practices, who is actively practicing in one of the following specialties: family, internal, pediatric, or obstetrics and gynecology.

Priority settings. Many NPs work within priority settings identified by the ONC, including small group practices of 10 or fewer, public and critical access hospitals, federally qualified health care clinics, rural healthcare clinics, and other settings serving uninsured, underinsured, and medically underserved populations.

NPs are eligible for support services of the Regional Extension Centers. For more information on what services might be available to you, contact the Regional Extension Center within your geographic region. A table and map covering the 60 centers is available here.

Incentives program for EMR implementation. February 17, 2009, President Obama signed the American Recovery and Reinvestment Act (ARRA) and along with that Act $33 billion dedicated to Medicare and Medicaid incentives for providers and hospitals who adopt, implement, or upgrade an EMR system and meaningfully use that system. As we blogged previously, meaningful use of EMRs has many parameters that providers must meet—but with that comes financial incentives that eligible providers can receive.

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For Those Interested In Learning More, See Below….

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‘Meaningful Use’: What’s It All About, And Why Should Nurses Care?

July 26, 2010

By Susan McBride, PhD, RN, professor at Texas Tech University Health Science Center School of Nursing. McBride and fellow nurse informaticists Mari Tietze and John Delaney will be blogging here on the intersection of nursing and informatics in the coming days. 

By DeclanTM, via Flickr.

Everyone knows by now that the Obama administration has made electronic health records (EHRs) a high priority and is providing financial incentives to health care providers (and yes, nurses are included in that group) to adopt them. But not everyone knows it’s not just about converting records from paper to digital—its much more than that.

On July 13, the Office of the National Coordinator (ONC) for Health Information Technology (HIT) released the final rules establishing definitions for the “meaningful use” of EHRs. The final rule is 864 pages and contains critical information for nurses to understand about how electronic records will change our lives. 

(No one expects every nurse to read the entire document. That’s why we’re going to be blogging about some important aspects of the topic. In the meantime, click here for a good overview of meaningful use and electronic medical records, as well as links to more exhaustive information. And for a short, useful table breaking down the rule by health outcomes policy priorities such as “improving care coordination,” have a look at this PDF: Stage 1. Meaningful Use Objectives and Associated Measures Sorted by Core and Menu Set.)

Ongoing concerns. The idea behind these rules is to establish EHRs within a National Health Information Network that will allow us to exchange health care information regardless of where we are in the nation. There are many concerns about privacy and security related to this network, and these concerns are likely to be the most difficult component to address in establishing it. But there are definite clinical advantages. Read the rest of this entry ?

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