Week 7: Electronic Health Technologies within Clinical Practice Settings (Part 1)

Course Content and Class Discussion

            Nursing informatics can be described as the application of computer technology to all fields of nursing (Booth, R. & Donelle, L., 2013). And with this technology, Canadians and health care providers reap the benefits of having electronic access to critical health information (Canadian Health Infoway, 2013). But to understand the types of technology involved, you must first learn the terminology. EHRs, or electronic health records are comprehensive client records that require authorized access, (Booth, R. & Donelle, L., 2013). They may be considered the ideal. All of a client’s medical information would be located in one place. Physicians or health care providers would have immediate, electronic access to any and all health information which could speed up the process of care in certain situations. For example, your physiotherapist would have access to all of your health information such as previous diagnostic imaging, surgical history, previous medication therapies attempted, etc. This seems it would enhance the process by saving time and lost paperwork, and increase interprofessional collaboration amongst health professions. But will this really be the case? The idea seems as if it makes great sense to health care providers to make their jobs easier, and better for the client as they will receive personalized care. However, if an EHR is an entire accumulation of a client’s medical history then it’s possible that many health care providers will be aware of irrelevant and possibly embarrassing personal health information belonging to the client. For example, knowledge of a sexually transmitted infection (STI) diagnosis, or a previous history of drug abuse. This knowledge is not required during a regular visit with your dentist, for example and now he/she would have that information accessible to them. This may leave clients feeling more vulnerable during health care visits and possibly cause an inhibition in their will to share information.

Electronic medical records, or EMRs, have been around for longer than you may think. See the video: 1961 Electronic Medical Records. Within the Canadian literature, EMRs may also be called EPRs – Electronic patient record (Booth, R. & Donelle, L., 2013).  They are different than an EHR, as they are only a “partial health record” under the custodianship of a health care provider that contains relevant health information related to that particular provider or institution (Booth, R. & Donelle, L., 2013). For example, an electronic version of your paper records at your different health care providers facilities: family doctor, emergency department, dentist, chiropractor, etc. This information is not readily available for sharing between health care professionals as an EMR. Some drawbacks to the EMRs may be just that – a lack of accessibility of relevant health information between providers.

And then of course, there is PHR, also known as the personal health record. These are consumer-centric tools used by clients to communicate health information to their health care providers as well as help to manage their own care (Kim, K. & Nahm, E., 2012). These are used to encourage an increase in quality of care as well as help to reduce medical errors, (Kim, K. & Nahm, E., 2012). This would allow for clients to be actively involved in their own health care, and this involvement may lead to better long-term health results. But does this consider the population’s health literacy?

Videos/Learning Tools

1961 Electronic Medical Record:                          
  http://www.youtube.com/watch?v=t-aiKlIc6uk                

Project Health Design Webpage:
http://www.projecthealthdesign.org

What is EMR?
http://www.youtube.com/watch?v=MOwML1N3TpM

The Difference between EHR & EMR:
http://www.youtube.com/watch?v=y85HfTG4UpU

Blue Button Video
http://www.youtube.com/watch?v=B53HEWVDJLI

Health IT.gov Webpage:http://www.healthit.gov/

Nursing Implications

            As mentioned previously, there are many perspectives to consider when attempting to analyze the use of EMRs, EHRs, and PHRs. It is by considering these perspectives that we are able to identify several implications to nursing practice that may be relevant in my career. Like I said earlier, with regards to EHRs, by having this information readily available for ALL health care providers, clients may feel vulnerable. This is an implication to my practice, as I need to set the tone for a therapeutic nurse-client relationship. My job is more than just ‘fixing the problem’, I am required to set a healing environment where the patient feels safe. Unfortunately, I believe that EHRs may hinder that relationship as clients may feel embarrassed to open up due to their increased vulnerability within that interaction. Maybe it would be possible to have restrictions in place within the EHRs that would require authorized access to only the information relevant to that particular health care provider. For example, information regarding a client’s previous abortion would not be available to her physiotherapist, dentist, chiropractor, etc. unless otherwise ‘released’ to them with the client’s permission.

            With regards to EMRs, I am lucky enough to have already gained some real life experience. This experience came when working for a family physician during my first year of University. The office used an EMR program that allowed the doctor to input clinical visit information, record immunizations, store blood work results and file other documents received from other health care providers (i.e. diagnostic imaging reports). There were many things about that particular program that I believe to be positive. It allowed for more efficiency within the office by reducing a large amount of paper, therefore decreasing the number of misfiled documents. It also made locating patient health information much easier, rather than flipping through old charts.

 

However, some flaws were noted almost immediately, and I can honestly admit I was quite reluctant to use the program. Right off the bat, the EMR was designed to be implemented on a ‘moving forward’ basis. This meant that all of the paper documentation had yet to be inputted into the electronic system and therefore any health information needing to be looked up prior to the implementation of EMR, would still have to be rifled out of the massive paper charts. This was time consuming and inefficient. Another flaw was noted as some of the clients’ information that had been entered into the system (i.e. name, health card number, and address) was entered incorrectly by the third party company involved. This made finding some patients within the system near impossible and often a second e-chart would be created unintentionally. Another concern I had with the EMR, is that given our out of town location, there were times when the Internet ‘server’ was down and we were unable to navigate through the program which essentially halted our production within the office.

Finally, I consider the implications of PHRs on nursing practice. Patients value easy access to their diagnostic tests and lab results and better communication with their health care provider and PHRs have the potential to be powerful tools for health management (Kim, K. & Nahm, E., 2012). The trouble I see with this otherwise innovative system, is that computer literacy and health literacy may play a large and important role in the success of the program.  This lack of computer competency and health literacy may lead to social exclusion of certain populations – defined as the “digital divide”, (Kim, K. & Nahm, E., 2012). A sub-population of the digital divide are those individuals aged 60 and over and may ‘suffer’ from technophobia. It is important that this population does not get left out from quality health care as they may experience greater and more abundant health concerns as they age. 

Watch the video above: Blue Button: The Timeline of Medical Records and/or visit Health IT’s webpage for more information regarding personal health records.  

Readings and Additional References

Booth, R., & Donelle, L. (2013). Nursing informatics and technology: Chapter 25. In B. Kozier, G. Erb, A. Berman, S. Snyder, M. Buck, L. Yiu, & L. Stamler. Fundamentals of Canadian Nursing: Concepts, process, and practice, 3^rd Edition, 532-550.

Canada Health Infoway. (2013). Opportunities for action: A pan-Canadian digital health strategic plan. Retrieved from: https://www.infoway-inforoute.ca/index.php/component/docman/doc_download/1843-opportunities-for-action-a-pan-canadian-digital-health-strategice-plan.

Kim, K. & Nahm, E. (2012). Benefits of and barriers to the use of personal health records (PHR) for health management among adults. Online Journal of Nursing Informatics. Retrieved from: http://ojni.org/issues/?p=1995.