Electronic Health Records: Still-Evolving Tools to Help or Hinder Nurses

By Betsy Todd, MPH, RN, CIC, AJN clinical editor

Photo by Marilynn K. Yee/New York Times/Redux 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. […]

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

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. […]

April 16th, 2015|digital health, Nursing, Technology|3 Comments

Health information Technology, EHRs, Meaningful Use, and Nursing

By Maureen Shawn Kennedy, MA, RN, AJN editor-in-chief

If you’re like most nurses working in a health care organization, you’ve been involved in a migration to electronic health records, computerized physician order entry (CPOE), or bar code medication administration.

If you’re lucky, nursing input was considered during the planning stages of all this health information technology (HIT). We’ve heard from many nurses (and have had a few submissions from nurses about their experiences—see for example the Reflections essay “Paper Chart Nurse”) who have had “issues” with the systems or who wonder, why the big push?

In the August issue of AJN, which is available online and on the iPad (download the app here), Susan McBride and colleagues John Delaney and Mari Tietze debut their three-part series on HIT. The first article, “Health Information Technology and Nursing,” examines the federal policies behind efforts to expand the use of this technology, the importance of meaningful use, and the implications for nurses. Subsequent articles upcoming in the fall will take a closer look at the use of HIT to improve patient safety and quality of care, and the important role nurses are playing—and could play—in this system-wide initiative.

It’s crucial for nurses to understand HIT. As the authors note,

“If HIT systems are going to truly improve care, nurses need a voice in their planning and development to ensure patient safety and system usability. The success of this technology depends on nurses informing the […]

August 15th, 2012|digital health, nursing perspective|3 Comments

Top 10 (New) AJN Posts of 2011

Some of our posts, like this one from 2009 (“New Nurses Face Reality Shock in Hospitals–So What Else Is New?”) keep getting found and read. They remain as relevant today as they were when we posted them. Our top 20 posts for the year (according to reader hits, that is) include several others like this: “What Is Meaningful Use? One Savvy Nurse’s Take”; “Is the Florence Nightingale Pledge in Need of a Makeover?”; “Do Male Nurses Face Reverse Sexism?”; “Are Nursing Strikes Ethical? New Research Raises the Stakes”; and “Workplace Violence Against Nurses: Neither Inevitable or Acceptable.”

But putting aside these contenders (why do so many of them have questions in their titles?), here are the top 10 (again, according to our readers) new posts of 2011, in case you missed them along the way. Which doesn’t mean that these are (necessarily) our best posts, or a representative sample, or that many others didn’t hit home for various subgroups of readers.

While we all get a little tired of lists by this time in the year, we don’t really use them an awful lot here at Off the Charts. So please indulge us this once, and thanks to everyone who wrote, read, and commented on this blog in 2011.—Jacob Molyneux, AJN senior editor/blog editor

1. “Notes of a Student Nurse: A Dose of Reality,” by Jennifer-Clare Williams

2. “Placenta Facebook Photos: Nurse and […]

December 20th, 2011|healthcare social media|5 Comments

Today’s Notes from the Nursosphere

Image of Japanese Attack - Pearl Harbor, Hawai...

As noted today by Joni Watson at Nursetopia, it’s Pearl Harbor Day, and nurses were (surprise) key players in that day’s awful events. Here’s how the post begins:

My heart was racing, the telephone was ringing, the chief nurse, Gertrude Arnest, was saying, “Girls, get into your uniforms at once, This is the real thing!”

Speaking of safety, “Top 10 Health Technology Hazards for 2011” (pdf), from the ECRI Institute, gives us a list of hospital patient safety risks that, according to the authors, “reflects our judgment about which risks should receive priority now, a judgment that is based on our review of recent recalls and other actions . . . , our analysis of information found in the literature and in the medical device reporting databases of ECRI Institute and other organizations, and our experience in investigating and consulting on device-related incidents.” These include “radiation overdose and other dose errors during radiation therapy,” “alarm hazards,” and eight others.

And now to electronic charting vs. doing it the old-fashioned way: we have a comment thread going on at AJN‘s Facebook page about whether or not EHRs save nurses time or not. Go there to comment, or leave a comment here.

Also noted: Stephen Ferrara at A Nurse Practitioner’s View wonders whether the preceptorship model is still adequate for training NPs. Or is it time for a residency model instead?

I’m not necessarily referring to the […]

December 7th, 2010|nursing perspective|0 Comments