By Betsy Todd, MPH, RN, CIC, AJN clinical editor
Photo by Marilynn K. Yee/New York Times/Redux
One of my earliest memories of electronic health records (EHRs) is the day I had to review a chart at another hospital in the city. As I headed over to medical records, I expected at worst a “big” chart—one of those 15-inch stacks of multiple folders from a long hospitalization. I wasn’t allowed access to their system to view the chart online, so I was escorted into a separate room, in which the printed-out chart was waiting for me.
But their electronic chart wasn’t “printer-friendly,” and the hard copy version now consisted of thousands of pages of documentation spread out over a nine-foot long table. Many of the pages included only a line or two of print. Making sense of this chart was a nightmare.
My own (large, well-resourced) hospital had been one of the early adopters of an extremely clinician-friendly system, and I was shocked over the next few years when I encountered the many unwieldy, maddening charting systems that have been rushed into use at many hospitals.
In this month’s AJN, nurse and technology expert Megen Duffy gives us a clear-eyed look at the state of electronic health records today in “Nurses and the Migration to Electronic Health Records.” She is realistic about the pros and cons of electronic charting, pointing out the limitations of (for example) drop-down menus and forced choices in lieu of narrative notes, while offering a glimpse of what a well-designed system can do for us.
For those of us who have been frustrated by workflow problems resulting from the poor design of many current systems, Duffy offers hope and support, along with practical tips for getting the most out of the systems we are working with. She emphasizes two keys to nurse-friendly EHR systems: more nursing involvement in system design, and adequate training and resources—including extra staff during go-live periods.
Practical and encouraging, this article doesn’t downplay ongoing challenges as it points us to a less painful and—dare we say?—more productive future in which EHRs will be fully integrated into nursing’s workflow. The author ends on a hopeful note: “This era is ushering in major changes to our profession, and in the end we will have systems that help us with our ultimate goal: good, timely patient care.”
EHR for nursing is in a state similar to the days of personal computing before the Mac operating system introduced the desktop metaphor. In the days of DOS the user had to conform to the needs of the computer for every desired command. The desktop metaphor made doing things like moving or deleting a file pretty much intuitive. That leap has yet to occur for nursing EHR. They are not designed around the workflow of a nurse, and do conform input to needs of the nurse–the nurse must conform to the EHR.
Physicians now use scribes in examining rooms to continuously record findings. Nurses will need an accurate voice recognition system, large touch screen by every patient, and a move to a graphical interface before EHRs become a help and not a hindrance to documentation.
Great comment. You make excellent points.