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Electronic Health Record


The health care network will be composed of many systems ... Journal of Advanced Nursing, 60 (2), 209 219. Doyle, M. (2006) ... – PowerPoint PPT presentation

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Title: Electronic Health Record

Electronic Health Record
What is the EHR?
  • EHR Electronic Health Records
  • EMR Electronic Medical Records
  • Systems that keep track of medical information by
    using computer software
  • Store health records electronically on a server
    which is connected to a network
  • Allows the records to be accessed electronically
    by different machines
  • Provides easy access for people who need the

EMR software allows the computer user to
  • create new patient records
  • record information
  • find information easily
  • keep track of prescriptions
  • write prescriptions
  • reduce paperwork
  • see information in an easily read text form
  • share information easily with other health care

  • A survey was conducted in seven countries. Canada
    had the lowest number of physicians using EMR at
  • Health Canada would like to have half of all
    Canadian health records in electronic form by

Around the World
United States
  • 5 major companies are providing their employees
    with a program called Dossia
  • This is a web based framework that allows their
    employees to maintain lifelong personal health

  • The Australian health care system has begun
    introduction of electronic health record systems.
  • These systems are already operational in many
    general practice and pharmacy environments, and
    most states are introducing, or supporting the
    introduction of, these systems to public health
    care services in one form or another.

  • EUROREC Institute is an independent
    not-for-profit organization, promoting in Europe
    the use of high quality Electronic Health Record
    systems (EHRs).

Pros to EHR use4 Major Advantages
  • Improving efficiency and quality of health
  • Improving patient safety and security
  • Improving patient satisfaction
  • Organizational efficiency
  • Thereby potentially improving health outcomes for

Improving efficiency and quality of health care
  • Instant access to a patient's EHR saves the
    clinician's staff time and enhances efficient
  • Alleviates the need to sort through large amounts
    of paper charts, simple electronic searches can
    retrieve a patient's complete medical record from
    any office desktop.
  • Before seeing a patient, staff members are able
    to review the patient's medical history, current
    medications, problem list and more.
  • These time savings are invaluable and improve

Improve patient safety and security
  • Provides a secure and seamless transfer of
    identification and medical information to health
    and safety professionals 24 hours a day anywhere
    in the world.
  • Provides nurses with the decision-support tools
    they need by placing care models, protocols, and
    other information electronically at the point of
  • Cross-checks orders, assessments, and patient
    information stored in the EHR against rules and
    alerts developed to support specific care
    processes, allowing nurses to leverage real-time,
    best-practice advice triggered by specific
    patient findings.
  • All points supports increased patient safety, and
    decrease in errors made influenced by time and
    the accessibility to appropriate tools and
    information in time of care.

Improve patient satisfaction
  • In a study of 1,421 users of an EHR that provides
    Web messaging and online access to medical
    records found that attitudes about the use of
    these features were mostly positive. The majority
    of patients were satisfied that the medical
    information contained in their EHR was complete
    and accurate, and most patients were not
    concerned about the confidentiality/privacy of
    their medical information or about learning of
    test results before discussing them with their

Organizational efficiency
  • No transferring of charts between buildings or
  • Admissions time would be decreased, alleviating
    wait times and paper work for patients,
    physicians, administration staff and nurses.
  • Paper work decreased

Barriers and Issues7 Major barriers and issues
Merging Various Approaches and Models
  • Harder to obtain support from multitude of Health
    Care Professionals (HCP)
  • Varying governance structures of health care
    services poses the issue of integration or
    compatibility of all these programs and systems
    into the network

Management of the EHR
  • Question of the ownership and administration of
  • Health care being provided by private service
    providers or private insurance
  • May need to hire a third party company to manage
  • Growing need for a coordinated national approach

Lack of a Health Network Architecture
  • The health care network will be composed of many
  • Networked architecture will allow these systems
    to interact or talk to each other within a secure
  • Technical issues and barriers must be addressed
    before this can be developed

Lack of policies on key issues
  • Privacy and liability
  • Need for public support
  • Canadians are concerned about the loss of privacy
    in an electronic world
  • EHRs will add a dimension to the existing issue
    of liability for health care providers
  • Federal/provincial/territorial governments must
    develop compatible policies in the adoption of

Obtaining Stakeholder Support
  • Agreement from the public, health care providers
    and governments
  • Need to educate the public on EHR
  • Architecture that is implemented must be accepted
    by all health care providers and users.

Lack of leadership
  • Lack of National leadership
  • Could result in the development of incompatible
  • Many EHR systems are being developed at the
    institutional level by hospitals that feel they
    can no longer wait for provincial direction

Privacy Issues
  • Even though we know that EHRs have the potential
    to improve health care significantly, it also
    causes concern regarding privacy, confidentiality
    and security of personal information.
  • Confidentiality is assured by limiting subsequent
    sharing of personal information and by
    establishing appropriate security mechanisms to
    protect information from unauthorized access.

Personal Information Protection and Electronic
Documents Act
  • As of Jan 1, 2004 applies to all health sectors
    that do not have any other similar laws
  • Incorporates CSA code
  • If a province has a private sector privacy
    legislation that is similar to the PIPEDA then
    the provincial legislation will be followed

Personal Health Information Protection Act
  • Currently in Ontario, the personal health
    information protection act (PHIPA) is in
    existence, but until a exemption of the PIPEDA is
    completed, all agencies must comply with both

PHIPA Objectives
  • To establish rules for the collection, use and
    disclosure of personal health information about
    individuals that protect the confidentiality of
    that information and the privacy of individuals
    with respect to that information while
    facilitating the effective provision of health
  • To provide individuals with a right to access
    and to require the correction or amendment of,
    personal health information (PHI) about
    themselves, subject to limited and specific
    exceptions set out in PHIPA
  • To provide for independent review and resolution
    of complaints with respect to PHI to provide
    effective remedies for contraventions of PHIPA

Areas of Debate
  • Is patient consent being obtained before
    information is included in the EHR and being
    disclosed thought the device?
  • Patients have the right to say which information
    they want in the EHR and what they do not want.
    This typically includes psychiatric disorders,
    abortions or STDs.
  • Concern around subsequent uses such as research.

Adaption to Change
  • Nurses are known for their ability to adapt to
    change it is a requirement as their working
    environment is constantly shifting. One area of
    nursing that is continually changing is the
    technology. It is imperative for nurses, and all
    people in health care, to keep up on the

  • In a study conducted on Air Force nurses, it was
    found that the nurses preferred working with
    advanced technology however, they were capable
    of adapting to using very minimal technology
    while out in the field.
  • In the hospital setting, it was found that
    success was achieved when nurses thought outside
    of traditional nursing roles and focused on
    effective ways to deliver care (Mancher, 2001,

Rogers Diffusion of Change Theory
  • 5 categories for those experiencing change
  • 1)Innovators (2.5)- these individuals will
    readily adopt the EHR.
  • 2)Early Adopters (13.5)- these individuals will
    be able to persuade others to accept the EHR.
  • 3)Early Majority (34)- these individuals are
    reluctant to take risks, but if given the
    opportunity to weigh the Pros and Cons of the
    EHR and find the Pros outweigh the Cons they
    will accept the use of the EHR because it is

  • 4)Late Majority (34)- These individuals need to
    be thoroughly convinced that the change is
  • 5)Laggards (16)- these individuals will not want
    the induction of the EHR and be extremely
    suspicious and will think that something may go
    wrong with it. They most likely will not follow
    suit until the EHR has been implemented and
    proves to be useful and efficient in the
    provision of care.

  • Change with a new computer system will be
    difficult enough without the added disapproval
    from the nurses.
  • With the knowledge from this Theory,
    administration needs to apply this knowledge when
    introduction of the EHR occurs. 
  • Administration must be prepared to deal with each
    group of people.  They should develop strategies
    to help each group further accept the EHR.
  • Thus if each group is up to speed by the time of
    initiation the induction will flow a lot smoother.

Affecting Change
  • To be successful in affecting change, you must
    deliver it in a systematic manner. Providing
    proper training for new technology, ensuring
    fluent communication between the staff and
    teacher, and implementing the new technology
    efficiently and resourcefully is imperative in
    completing a smooth transition.

Adaptation to Change
  • Technology is celebrated by some and detested by
    others some nurses will find that it has made
    their jobs easier, while others will argue that
    it has only added more stress. One thing is
    certain, that technology is here to stay if it
    is used properly, it can be a very positive thing.

Ways To Encourage Use of EHR
  • 1. Making users comfortable with software
  • If staff are uncomfortable with a software,
    proper use of or use of it at all will be
  • Ex. In-services, orientations
  • 2. Creating an understanding among staff of why
    the electronic switch has been made and the
    benefits of the switch to patient care and health
    care in general. (ex. Seminars, lectures)
  • 3. A gradual implementation of EHR allows a
    comfort to build with the software and a lesser
    chance of resistance.

Impact on Nursing
  • Nurses attend to the whole patient.
  • Largest proportion of healthcare professionals to
    interact most with EMR systems due to the nature
    of their work.

  • 44 felt that system currently used is optimally
  • 61 frustrated with multiple EHR systems
  • 54 stated that were duplicating their work on
    paper then electronically
  • 81 stated that it they thought that the EHR is
    more a help than a hindrance
  • 96 said that it improved documentation and would
    have a positive effect on patient care

  • ER
  • Quicker access to patients information and
    medical histories. More efficient
  • Assessments with faster documentation methods.
  • LTC
  • More knowledge on patients full history,
    especially when transferring to different
    facilities. In North Bay, because of the switch
    to a different documentation method, the EHR is
    not viewed as conventional, as they have just
    switched their documentation methods.
  • Multidisciplinary (GPs, PT, OT, pharmacies)
  • quicker access to information, for ex.
    Pharmacies have access to knowing the patients
    medication history, and will be aware if the
    patient is a drug-seeker.

  • Dremsa, T. L., Ryan-Wenger, N. A., Reineck, C.
    (2006). Reliability and Validity
  • Testing of a Short Form of the Readiness Estimate
    and Deployability Index Revised for Air Force
    Nurses. Military Medicine, 171, 879-885.
    Retrieved from ProQuest Database on Oct.3, 2007.
  • Mancher, T. (2001). A better model by
    design.and it works! Nursing
  • Management, 32, 45-47. Retrieved from ProQuest
    Database on Oct.3, 2007
  • Health Canada. (2001) Toward Electronic Health
    Records. Office of Health and the
  • Information Highway, Health Canada. Retrived
    October 20 from http//www.hc-sc.gc.ca/hcs-sss/pub
  • (no authors)(2004) Electronic Medical Records
    MedicAlert to play key role in electronic health
    record standards collaboration. Obesity, Fitness
    and Wellness Week. Pg. 483. Retrieved Oct.
    20/2007 from Proquest Database.
  • Hagland, M.(2007). Performance Improvement EMR
    Nirvana Part I The Landscape. Healthcare
    Informatics. 5 (24) pg. 20 . Retrieved October,
    10/2007 from Proquest Database.
  • Hassol, A. Walker, J. Kidder, D. Rokita, K. et
    al.(2004). Patient Experiences and Attitudes
    about Access to a Patient Electronic Health Care
    Record and Linked Web Messaging. Journal of the
    American Medical Informatics Association. 6 (11)
    pg. 505. Retrieved Oct. 20/2007 from Proquest
  • Asonuma, M., Kanai-Pak, M., Naitoh, K., Otieno,
    O.G., Toyama, H. (2007). Nurses views on the
    use, quality and user satisfaction with
    electronic medical records questionnaire
    development. Journal of Advanced Nursing, 60 (2),
  • Doyle, M. (2006). Home study program Promoting
    standardized nursing language using an electronic
    medical record system. Association of Operating
    Room Nurses, 83 (6) 1336-1347.
  • Nelson, R. (2007). Electronic health records
    Useful tools or high-tech headache? American
    Journal of Nursing, 107 (3) 25-26.
  • Information systems in the new world an emerging
    national approach
  • Heather Grain. Australian Health Review. Sydney
    Aug 2005. Vol. 29, Iss. 3 pg. 292, 5 pgs
  • http//www.ehr-implement.eu/
  • 5 Large Companies Working to Provide Lifelong
    Personal Health Records for Employees
    ...Anonymous. Healthcare Financial Management.
    Westchester Feb 2007. Vol. 61, Iss. 2 pg. 11, 2
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