Open Medical Records: A Question of Safety

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 […]

2016-11-21T13:16:18-05:00August 3rd, 2010|nursing perspective, patient engagement|3 Comments
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Watch Out for Dengue Fever in Travelers

By Diana J. Mason, PhD, RN, FAAN, editor-in-chief emeritus

You may have heard that in late July the Centers for Disease Control and Prevention (CDC) issued an advisory on dengue infection, which can lead to dengue fever or dengue hemorrhagic fever, noting that dengue is becoming an epidemic in tropical and subtropical areas of the world, with recent or ongoing outbreaks occurring in Puerto Rico; in Key West, Florida; and the Caribbean. It’s particularly important for nurses to be alert for symptoms of dengue fever among people who have returned from travel to tropical areas. Symptoms may include fever, eye pain, joint pain, rash, and bleeding. The greatest danger is from dengue hemorrhagic fever, which can lead to death.

For more on dengue infection (including its detection, treatment, and prevention), see the April 2008 article on the topic in AJN. And as always, please let us know here if you’ve encountered it recently yourself as a clinician—or traveler.

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2016-11-21T13:16:19-05:00August 2nd, 2010|Nursing|0 Comments
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On Difficult Truths, Anger, and Compassion: Recent Poems in ‘Art of Nursing’

By Sylvia Foley, AJN senior editor

“Why couldn’t you leave cleanly?” asks the narrator of Ann Sihler’s poem, “Leavings,” featured in the June Art of Nursing. The poem, written in response to a suicide, speaks to the emotions of those left behind. Its central image, a pair of “oxblood loafers lying there / for all to see,” is somehow both mundane and horrifying. It’s a stark poem, suffused with the narrator’s anger; yet its lack of pretension also affords us  relief.

The married man with “schoolboy cheeks” in Nancey Kinlin’s poem, “Practicing at Post Office Square,” has just heard what no one wants to hear: “the result / is positive.” The poem, featured in July’s Art of Nursing, gives us the disclosure—from the nurse’s point of view. It’s a poem about mistakes and compassion, about what it feels like to be the one delivering bad news. Kinlin’s spare, clear writing doesn’t flinch from its difficult subject.

Both poems are free online (you’ll need to click through to the PDF files). We invite you to have a look, sit with them, and tell us what they evoke for you in the comments.

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2016-11-21T13:16:20-05:00July 30th, 2010|nursing perspective|0 Comments
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Supporting Nurse Practitioners as ‘Priority Primary Care Practitioners’

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 […]

2016-11-21T13:16:22-05:00July 29th, 2010|digital health, Nursing|1 Comment
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‘Meaningful Use’: What’s It All About, And Why Should Nurses Care?

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. 

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 […]

2016-11-21T13:16:23-05:00July 26th, 2010|digital health, Nursing|6 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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