Balancing Advancements and Challenges in Healthcare Informatics

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" (Aspen University, 2020). Today, I’m diving deep into electronic medical records and comparing them to paper charting in healthcare.

Navigating Progress and Obstacles in Healthcare Informatics

Electronic health records (EHRs) are essentially digital versions of traditional paper charts, first introduced by Lockheed in the 1960s. These records encompass a comprehensive range of information, including patient history, immunizations, medications, treatment plans, allergies, diagnoses, lab tests, and results (Elation Health, n.d.). With EHRs, healthcare providers can employ evidence-based practices to enhance clinical decision-making, while also automating and streamlining workflows.

EHRs offer numerous advantages. In the U.S., it became mandatory in 2014 for all healthcare providers to adopt EHRs (HealthIT.gov, n.d.). They facilitate superior patient care, encourage patient engagement in their care plans, and improve care coordination among various providers. Moreover, they are immune to being misplaced like paper charts and contribute to better diagnostics and patient outcomes.

Challenges and Ethical Concerns

Despite these benefits, EHRs present certain challenges. Employers and healthcare providers may overly focus on maximizing Medicare and Medicaid reimbursements, prioritizing documentation over bedside patient care. On a typical day, whether I'm supervising or administering medications, I find myself spending less time with patients and more time interacting with the computer. Even when supervising, a significant portion of my time is devoted to clearing User Defined Assessments (UDAs) and updating patient care plans, reducing actual patient interaction.

Nursing shortages and burnout often result in insufficient training for new employees on EHR usage. At my workplace, new hires receive only about three days of training, with perhaps an hour dedicated to EHRs. Consequently, new nurses frequently have to navigate the system independently or learn from their peers.

Interestingly, many veteran nurses express nostalgia for paper charting, citing it as simpler and less time-consuming than EHRs. However, I do not miss the hours spent deciphering a doctor's illegible handwriting.

Remote Monitoring and Data Privacy

Hebda, Hunter, and Czar (2019) highlighted various data that organizations monitor to manage patient care. At my facility, owned by Accordius Health, specific data is monitored remotely and communicated with the director of nursing or a clinical liaison. For instance, User Defined Assessments (UDAs) are computer-generated prompts for evaluating risks such as weight loss, dehydration, dietary needs, and pain. Nurses must complete these assessments daily; failure to do so results in alerts and follow-up calls from a representative.

Another monitored aspect is the MDS and Resource Utilization Group (RUG) score, which indicates patient care levels and expected reimbursements if certain criteria are met. These assessments are monitored daily and communicated with the director of nurses or the MDS coordinator. Additionally, web surfing and private emailing on facility computers are scrutinized, prohibiting personal use to ensure patient safety and privacy.

However, ethical concerns arise with organizations tracking data. Bonnie Kaplan, PhD, from Yale, noted that medical record and prescription data might be used or sold for various purposes, often without patients' awareness (Relias Media, 2017). Devices, wearables, and smartphone apps can also generate data not always protected by HIPAA.

Remote monitoring can impact patient care. The individual monitoring might be unaware of on-ground situations, like a patient needing assistance with daily activities or facing a clinical emergency. Nurses might prioritize immediate patient needs over documentation, but the system often values documentation more due to reimbursement implications.

Transition to Electronic Health Records

This week, I’ve been contemplating electronic medical records for my project. At my workplace, we’re still transitioning to EHRs. Six months ago, we eliminated paper charts from the nursing station. Hence, EHRs are relatively new here, and many facilities in the deep South are only beginning to adopt them. We utilize a cloud-based system called Point Click Care for electronic medication administration. It’s cost-effective and user-friendly, facilitating quick medication administration and reducing errors (PointClickCare, 2018). However, it has drawbacks. Nurses spend considerable time navigating the system, and it can prompt unnecessary assessments, which can be frustrating.

The Role of Nurse Informaticists and Management Science

According to HIMSS, nurse informaticists play a crucial role in developing and optimizing clinical applications like nursing documentation, computerized practitioner order entry (CPOE), and EHRs (HIMSS, 2014). Our textbook suggests that the theory of management science aligns closely with EHRs. This theory employs mathematics, analysis, and evidence-based practice to enhance clinical decision-making and patient outcomes (Hebda et al., 2018).

As healthcare delivery evolves in the U.S., informatics is becoming essential for improving care and streamlining information for better decisions. Informatics is burgeoning as a profession, with more nurses becoming informaticians. Despite the challenges, EHRs are advancing patient care and fostering greater patient involvement in their care.

Conclusion

In conclusion, the text examines the evolution of EHRs and their impact on healthcare. It underscores the benefits and challenges, sharing personal experiences about the shift from patient interaction to increased documentation. Ethical concerns regarding data privacy and misuse persist, yet EHRs remain indispensable for enhancing patient care and decision-making. The author is keen on exploring health informatics further to contribute to healthcare advancements.

References

• Aspen University. (2020, September 14). What is nursing informatics? https://www.aspen.edu/altitude/what-is-nursing-informatics/
• 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
• Big data in healthcare: Privacy is a major ethical concern. (2017, April 1). Relias Media. https://www.reliasmedia.com/articles/140405-big-data-in-healthcare-privacy-is-major-ethical-concern
• EMAR. (2018, July 3). PointClickCare. https://pointclickcare.com/products/emar/
• Hebda, T. L., Hunter, K., & Czar, P. (2018). Handbook of informatics for nurses and healthcare professionals.
• The history of electronic health records. (n.d.). Clinical First Electronic Health Records | Elation Health. https://www.elationhealth.com/clinical-ehr-blog/history-ehrs/
• 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