Balancing Advancements and Challenges in Healthcare Informatics

So, according to the Healthcare Information and Management Systems Society (HIMSS) and the American Nurses Association, Nursing Informatics is "the specialty that integrates nursing science with multiple information and analytical sciences to identify, define, manage and communicate data, information, knowledge, and wisdom in nursing practice" ('What is nursing informatics?,' 2020). Today, I'm diving deep into electronic medical records and comparing it to paper charting in healthcare.

Electronic health records (EHRs) are basically digital versions of old-school paper charts. Lockheed came up with them in the 1960s. These records hold a ton of info like patient's history, immunizations, meds, treatment plans, allergies, diagnoses, lab tests, and results. With EHRs, healthcare providers can use evidence-based practices to make better clinical decisions. Plus, it automates and streamlines the workflow. EHRs have a lot of pros. In the U.S., it's actually a law that all healthcare providers had to start using EHRs by 2014. They help provide better patient care, get patients more involved in their own care plans, and improve care coordination among different providers. Also, they can’t be lost like paper charts, and they improve diagnostics and patient outcomes.

But, even with all these benefits, EHRs have their downsides. Employers and healthcare providers can get a bit too focused on maximizing their Medicare and Medicaid reimbursements. This means more emphasis on documentation over bedside patient care. On a typical day, whether I'm supervising or giving meds, I end up spending less time with patients and more time clicking away on the computer. Even when I'm supervising, I spend most of my time clearing User Defined Assessments (UDAs) and updating patient care plans, leaving less time for actual patient interaction.

Nursing shortages and burnout mean that employers sometimes cut corners on training new employees to use EHRs properly. At my workplace, new hires get only about three days of training, and maybe an hour on EHRs. New nurses often have to figure things out by themselves or learn from their peers.

It’s funny, but a lot of older nurses miss paper charting. They say it was easier and less time-consuming than EHRs. But honestly, I don’t miss spending an hour trying to decipher a doctor's messy handwriting.

Hebda, Hunter, and Czar (2019) talked about some data that organizations monitor to manage patient care. At my facility, which is owned by Accordius Health, they monitor certain data remotely and communicate with the director of nursing or a clinical liaison. One example is User Defined Assessments (UDAs), which are computer-generated prompts for things like weight loss risk, dehydration risk, dietary needs, and pain assessments. Nurses have to complete these daily. If an assessment isn’t done, it turns red the next day, and we get a call from a representative.

Another thing they monitor is the MDS and Resource Utilization Group (RUG) score, which indicates the level of patient care and the expected reimbursement if certain criteria are met. These assessments are monitored daily and communicated with the director of nurses or the MDS coordinator.

They also keep an eye on web surfing and private emailing on the facility's computers. Nurses aren’t allowed to use these computers for personal stuff, which makes sense for patient safety and privacy.

But there are ethical concerns with organizations tracking data. Bonnie Kaplan, PhD, from Yale, mentioned that medical record and prescription data are sometimes used or even sold for different purposes (‘Big data in healthcare: Privacy is major ethical concern,’ 2017). Patients might not know what’s happening with their data. Devices, wearables, and smartphone apps can also generate data that isn't always covered by HIPAA.

Remote monitoring can also impact patient care. The person monitoring might not know what’s happening on the ground, like a patient needing help with daily activities or a clinical emergency. Nurses might prioritize immediate patient needs over documentation, but the system often values documentation more because of reimbursement.

This week, I’ve been thinking about electronic medical records for my project. At my workplace, we’re still transitioning to EHRs. Six months ago, we removed paper charts from the nursing station. So, EHRs are pretty new here, and many facilities in the deep South are just starting to use them. We use a cloud-based system called Point Click Care for electronic medication administration. It’s cost-effective and easy to navigate, helping nurses pass meds quickly and reducing errors. But it has downsides. Nurses spend a lot of time clicking, and the system can prompt unnecessary assessments, which can be frustrating.

According to HIMSS, nurse informaticists are key in developing and optimizing clinical applications like nursing documentation, computerized practitioner order entry (CPOE), and EHRs (HIMSS, 2014, p.2).

Our textbook mentions that the theory of management science aligns closely with EHRs. This theory uses math, analysis, and evidence-based practice to improve clinical decision-making and patient outcomes (Hebda et al., 2018, p. 30).

With healthcare delivery changing in the U.S., informatics is becoming crucial for improving care and streamlining information for better decisions. Informatics is growing as a profession, with more nurses becoming informaticians. Despite the challenges, EHRs are improving patient care and getting patients more involved in their care.

In conclusion, the text discusses how EHRs have evolved and their impact on healthcare. It highlights the benefits and challenges, sharing personal experiences about the shift from patient interaction to more documentation. There are ethical concerns about data privacy and misuse, but EHRs are essential for better patient care and decision-making. The author is interested in learning more about health informatics to contribute to healthcare advancements.

References:

1. Benefits of EHRs | HealthIT.gov. (n.d.). ONC | Office of the National Coordinator for Health Information Technology. https://www.healthit.gov/topic/health-it-basics/benefits-ehrs
2. Big data in healthcare: Privacy is major ethical concern. (2017, April 1). Relias Media | Online Continuing Medical Education. https://www.reliasmedia.com/articles/140405-big-data-in-healthcare-privacy-is-major-ethical-concern
3. EMAR. (2018, July 3). PointClickCare. https://pointclickcare.com/products/emar/
4. Hebda, T. L., Hunter, K., & Czar, P. (2018). Handbook of informatics for nurses and healthcare professionals.
5. The history of electronic health records. (n.d.). Clinical First Electronic Health Records | Elation Health. https://www.elationhealth.com/clinical-ehr-blog/history-ehrs/
6. User-defined assessments. (n.d.). Long Term Care Provider .com: Digital Marketplace for the healthcare industry. https://www.longtermcareprovider.com/doc/user-defined-assessments-0001
7. What is nursing informatics? (2020, September 14). Aspen University. https://www.aspen.edu/altitude/what-is-nursing-informatics/