Electronic Health Record A digital version of a patients’ paper chart 1 Electronic Health Record A digital version of a patients’ paper chart Jacksonville University October 5th, 2013 by Shay Woodall, Lauren Wiktorek, Connie Williamson and Nathalie Wilson

2 Basic Functions Contain a patients’ medical history, diagnoses, medications, treatment plans, immunization dates, allergies, radiology images, and laboratory and test results Allow access to evidence-based tools that providers can use to make decisions about a patient’s care Automate and streamline provider workflow

What are some of the benefits? 3 What are some of the benefits? Improve quality and convenience of patient care Increase patient participation in their care Improve accuracy of diagnoses and health outcomes Improve care coordination Increase practice efficiencies and cost savings

Advantages Provide accurate, up to date information about patients 4 Advantages Provide accurate, up to date information about patients Provide quick access to a patients’ record for more coordinated care Enable safer, more reliable prescribing Helps promote legible, complete documentation Securely share electronic information with patients and other health care providers

Parts of EHR Administrative and billing Patient demographics 5 Parts of EHR Administrative and billing Patient demographics Progress noted Vital signs Medical History Medications Allergies Test results

Electronic Medication Administration Record and Pharmacy

Electronic Medication Administration Record Definitions: eMAR - an electronic medication administration record Bar-Code Administration - a system which uses a bar-code on both the unit-dose medication package and the patients’ wrist band identification Medication error - an unintended act that does not achieve its intended outcome (Wideman, Whittler, & Anderson, 2010) which can lead to patient harm

Overview It is critical to create a culture of safety for patients. Electronic medication administration record system (eMARS) is a first step in creating patient safety (Hebda & Czar, 2013, p. 124). Information technology has been shown to decrease the number of medication errors. Combining eMARS with Bar-Code Medication Administration reduces and prevents medication errors.

Statistics There is an estimated 400,000 preventable medication related injuries each year to patients hospitalized in the US (Thomas, 2013). According to the Institute of Medicine, there are more than 7,000 deaths annually in the US attributed to medication errors (Thomas, 2013). One dose of delivered medication involves up to 10-15 steps in which an error could occur at any step in the process (Wideman, Whittler, & Anderson, 2010).

Statistics 26-38 % of errors occur at point of administration (LaDuke, 2009). Decrease in medication errors using bar-code technology ranges from 65-86% (Thomas, 2013). Processing medication orders using CPOE further decreases errors. Adoption of CPOE results in a reduction of estimated 17.4 million medication errors in the US in one year (Radley, et al., 2013).

Benefits of Computerized Medication Administration Nursing benefits Improved patient identification and safety Maintains five rights of patient (right patient, right medication, right dose, right time, and right route). Alerts for allergies, dose warnings, lab results, vital signs, missed medications and PRN follow-up A more accurate medication administration record New medication orders or discontinued orders are instantly available No problems with illegible handwriting Reduced medication errors Computerized drug references readily available

Patient benefits Improved safety. Decrease in potential for medication error. Decreased potential for pain, increased length of stay, disability, injury, or death (Galusha, Brown, & Kelly, 2003).

Pharmacy Benefits New orders entered into record can be instantly sent to unit to prevent administering a discontinued medication. Interfaces with laboratory to show relevant lab results prior to dispensing medications. Alerted to look alike/sound alike medications. Alerted to patient allergies. Alerted to adverse reactions between medications.

Hospital benefits May be costly to implement the system but medication errors are more costly (Galusha, Brown & Kelly, 2003). Hospitals pay for increased length of stays, treatment costs, and litigation related to the injury or death of a patient from these errors. Medication errors result in $3.5 billion yearly in additional hospitalization costs (Thomas, 2013). Avoid litigation and reduced malpractice insurance rates

Conclusions Human error leads to medication error Fatigue, understaffing, higher patient workloads, and distractions can all contribute to medication errors. Human error while administering medications can lead to patient injury or death. Human error is unavoidable even in the best circumstances. Nurses, pharmacists, and physicians need to be provided with the best technology to decrease medication errors and improve patient safety. Bar-code technology and eMARS both are proven technologies to reduce drug-related injuries and deaths from medication errors.

EHR for Nursing Systems 1616 EHR for Nursing Systems Defining nursing information systems: supports the use and documentation of nursing processes and activities (Hebda & Czar, 2013, p. 115-116) Goals: 1) support nurse functions 2) improve nurse access to information and tools

The Nursing Process Approach EHR allows nurses to (Hebda & Czar, 2013, p. 116-117): Document! Nursing Admissions and Discharges Vitals Signs, Weight, I&O Routine Care Nursing Care Medication Administration Standardize! Nursing Language Care Plans Generate! Nursing Worklists

The Advantages are Endless! 1818 The Advantages are Endless! Better Access to Information Enhanced Quality of Documentation Improved Quality of Client Care Increased Productivity Improved Communications Reduced Errors Reduced Hospital Costs Increased Employee Satisfaction Compliance with Agency Regulations Common Clinical Database Improved Client Perception Enhanced Ability to Track Records Improved Hospital Image Improved Mandatory Reporting Capability (Hebda & Czar, 2013, p. 116) With all these advantages, why wouldn't you use EHR?!?

Nurse's Experiences With EHR Liong (2008), through phenomenological study, gathered the following nurse opinions related to EHR: “gives a bit more time to spend with patients” (p. 46) “helps to streamline patient care” (p. 56) “cuts back on a lot of mistakes” (p. 46) “consistent safer care to patients” (p. 56) “more direct, we can look a and see the same thing” (p. 46)- communication “follows the workflow” (p. 46) “helps focus more on care” (p. 46)

EHR for Physicians In order to gain acceptance 2020 EHR for Physicians In order to gain acceptance from physicians, engagement and ownership are required.

Benefits for the Physicians 2121 Benefits for the Physicians Improved eligibility for reimbursement and reimbursement rates Previous encounter may be accessed easily Faster chart access waiting for old paper records to be located and delivered from medical records department Improved efficiency of billing inclusive of automated charge capture Better reporting tools

More Benefits for the Physicians 2222 More Benefits for the Physicians Simultaneous record access by multiple users More comprehensive information is available Reduced liability through better decision making and documentation Supports pay-for-performance bonuses Early warnings of changes in patients status Improved population health Increased efficiencies in workflow

2323 Physician Consensus The researchers found that in order to increase EHR adoption in practices, vendors need to include specific features and functionality, including: A flexible, customizable virtual workspace Workflows that closely mimic the paper-based processes and communications of clinicians Intuitive, easy-to-use interfaces and functionality; something anyone could pick-up, figure out, and start using right away at a basic level with little or no training The ability to work on tablets, laptops, and desktops Mobile capabilities to support an “on the go” work style Butterfield, Blair. "What Physicians Want in an EHR: Physician Practices have been Ignored by Health IT Vendors—Until Now." Journal of AHIMA 83, no.11 (November 2012): 44-46.

2424 The future of EHR As more organizations adopt electronic health records, physicians will have greater access to patient information, allowing faster and more accurate diagnoses. Complete patient data helps ensure the best possible care.

In Conclusion Why is EHR so important? 2525 In Conclusion Why is EHR so important? Safety: Access to patients records become much easier and safer when records can be shared easily Cost: Money is saved by the use of paper and labor Reduce errors in patient care: such as medication prescribed and past medical history

Better Information Means Improved and Safer Healthcare 2626 Better Information Means Improved and Safer Healthcare

References Anderson, P. & Townsend, T. (2010). Medication errors: Don’t let them happen to you. American Nurse Today, 5(3). Retrieved from http://www.americannursetoday.com/article.aspx?id=6356 Galusha, C., Brown, M. & Kelly, J. (2003). Bedside bar codes: Protecting patients and nurses. Online Journal of Nursing Informatics 7(3). Retrieved from http://ojni.org/7_3/galusha.htm Hebda, & Czar, (2013). Handbook of informatics for nurses and healthcare professionals (5th ed.). Upper Saddle River, NJ: Pearson. LaDuke, S. (2009). Playing it safe with bar code medication administration. Nursing 2009 39(5), 32-34.. doi:10.1097/01.NURSE.0000350754.49282.23 Liong, A.S. (2008). Descriptions of nurses' experiences with electronic health records (EHR). A phenomenological study. (Order No. 3360539, The University of Texas Medical Branch Graduate School of Biomedical Sciences). ProQuest Dissertations and Theses, 162. Retrieved from http://ezproxy.ju.edu:2048/login?url=http://search.proquest.com/docview/304356562? accountid=28468. (304356562).

References Continued Radley, D., Wasserman, M., Olsho, L., Shoemaker, S., Spranca, M., & Bradshaw, B. (2013). Reduction in medication errors in hospitals due to adoption of computerized provider order entry systems. Journal Of The American Medical Informatics Association, 20(3), 470-476. doi:10.1136/amiajnl-2012-001241 Thomas, M. (2013). Evaluation of the personalized bar-code identification card to verify high- risk, high alert medications. Computers, Informatics, Nursing 31(9), 412-421. doi:10.1097/01.NCN.0000432120.94699.64 Wideman, M., Whittler, M., & Anderson, T. (2010). Barcode medication administration: Lessons learned from an intensive care unit implementation. Advances in Patient Safety 3, 437-451. Retrieved from http://www.ahrq.gov/downloads/pub/advances/vol3/Wideman.pdf