NUR 621 What were the positives, and are there any negative issues with any aspects of EHR?
Present one function of the EHR that has impacted your work and improved patient care. What has been the impact? Present examples.
Last year my organization went live with an EPIC Advance Care Planning (ACP) Navigator. If upon admission the patient couldn’t express their wishes and preferences the clinicians could still access their documents or documentation quickly. These items would show on the initial page of the patient chart once opened which allowed for greater and quicker access to this vital information. If the patient had wishes expressed the medical team was able to access their records and act appropriately. Therefore, expansion of the EHR through the implementation of the ACP navigator had a major impact on improving patient care that is consistent with their wishes and preferences for those who engaged in an ACP conversation or had an advance directive (AD) on file (Moses et al., 2020).
Moses, A., Dharod, A., Williamson, J., Pajewski, N. M., Tuerff, D., Guo, J., & Gabbard, J. (2020). Considerations for integrating advance care planning into the electronic health record: A primer for clinicians. American Journal of Hospice and Palliative Medicine, 37(12), 1004–1008. https://doi.org/10.1177/1049909120909303
One function of the EHR that has impacted our work and our organization is the Best Practice Alert (BPA). There are many ways that BPA can help with patient outcomes and cost. Bejianki et al. (2018) noted that that under ordering, over ordering, and mis ordering of lab test can cost the healthcare system a large amount of money. That is one reason why BPA’s are nice because they can alert the provider if a test has recently been completed or if there are additional test needed for a particular treatment. An example is with Heparin drips. A PT/INR may have already been completed, but maybe a PTT was not. This is one test that is needed prior to beginning this drip. A BPA pop up can remind the provider that one needs to be ordered. The same thing goes if all lab test had recently been completed.
Bejjanki, H., Mramba, L. K., Beal, S. G., Radhakrishnan, N., Bishnoi, R., Shah, C., Agrawal, N., Harris, N., Leverence, R., & Rand, K. (2018). The role of a best practice alert in the electronic medical record in reducing repetitive lab tests. ClinicoEconomics and outcomes research : CEOR, 10, 611–618. https://doi.org/10.2147/CEOR.S167499
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Electronic health care records have a lot of benefits in healthcare. One of the main benefits of EHR is having security of data. By having most data in computer system that require the use of password to access, it is easy to track anyone who logs in any healthcare system and accesses patients’ private health data. EHR has made it easy for healthcare providers to share and access patients’ healthcare records in real-time without necessarily having patients carry paper documents physically whenever they go to see their providers. All what healthcare providers need to do is to access the health information online and find about their patients. EHR has helped in reducing medical error among patients. Different healthcare providers can access medical records of their patients online, that way they are able to see what type of medication they are on. By doing this they wouldn’t overprescribe or under prescribe their patients meds.
EHR has gone a long way in improving the environment, since a lot of documents are saved electronically which eliminates the use of paper documents thus saving a lot of trees in the process. EHR has also reduced the cost of doing business, since most records can be sent online without necessarily using postage or mail. Some of the downside of EHR is that when the system goes down, patient records are no longer accessible, which may result in delay of care. There is a risk that private healthcare information may end up in the wrong hands, especially if healthcare information system is breached. It may cost a lot of money for any healthcare institution to constantly update the security of software on their system. Some healthcare providers may find it difficult to adopt using EHR which may hinder use of IT in the highest capacity (Patterson,2004).
Patterson, K. D. (2004). Healing Health Care: Fixing a Broken System with Information Technology. Kansas Journal of Law & Public Policy, 14(1), 193–220.
Charles, great information!
Much has been interpreted about HIPPA and what the rules are. One thing that HIPPA does NOT do is impede care coordination. I cannot tell you how many times a patient moves between home, to hospital, to SNF, and back to a home care agency. Information is not shared because of “HIPPA”.
HIPPA was developed to safeguard protected patient information. “Covered entities”, which include physicians, health care organizations and health plans, must adhere to rules that are published to manage and secure patient data. In addition, patients also have rights under this law. Protected patient information includes: past, present and future health conditions, the provision of health care to individuals, and payment for care for this conditions. Any health information that may lead back to a specific patient is protected (US Department of Health and Human Services, n.d.).
Class – think about this. What processes are in place at your organizations to protect patient information?
US Department of Health and Human Services. (n.d.). Summary of the HIPPA Privacy Rule. http://www.hhs.gov/ocr/privacy/hipaa/understanding/summary/index.html
Safeguarding patient data is of utmost importance in healthcare organizations. One aspect of patient safety has a lot to do with confidentiality and protection of patient data; the Health Insurance Portability and Accountability Act (HIPAA) helps achieve the same. The HIPAA of 1996 is a federal law that required the creation of national standards to protect sensitive patient health information from being disclosed without a patient’s consent or knowledge (CDC, n.d.). HIPAA helps to keep patient data secured and free from fraudulent activities. Patient data can be sensitive and poses liability risks if it gets in the hands of the wrong person or persons. When patients know that data is private and secured, it facilitates more trusted open communications and promotes better patient outcomes. Healthcare providers must safeguard patient information, and some ways to achieve this include securing passwords, securing mobile devices, and refraining from accessing unauthorized data or applications to avoid negative impacts. This writer’s network hospital uses practices and mechanisms such as user authentication, lock-out time, regular system updates, audits, and physical hardware security to help ensure data protection.
Centers for Disease Control and Prevention. (n.d.) Health insurance portability and accountability act of 1996 (HIPAA). https://www.cdc.gov/phlp/publications/topic/hipaa.html
Charles, I agree with you that EHR is associated with numerous benefits in the health care. Today, many health organizations are increasingly adopting EHR to help in streamlining the care given and also ease processes for health care professionals and patients. However, the implementation of EHR in the organization tends to encounter many challenges. One of the challenges includes lack of usability (Ratwani et al., 2018). Some EHR systems are dysfunctional. Instead of being user friendly and intuitive, they are poorly designed, prevents accurate data entry, challenging to navigate, and have poor alerting system, which can hamper their adoption in settings and practices. These issues can also result in frustrations, mistakes, and can obstruct productivity and workflows instead of increasing efficiency. Moreover, lack of usability can lead to compromised medical data, which is associated with serious consequences (Staggers et al., 2018). The other challenge is upholding data privacy (Chenthara et al., 2019). Health care providers may be reluctant to adopt EHR system for fear of being counterproductive. The systems need to be updated frequently. However, updating new systems that contains existing patient information is an extensive work for many providers.
Nurse leaders who perform the budgeting for their department(s) can, at the end of the year, experience a favorable or unfavorable variance. A budget variance is the difference between what is budgeted for and the actual amount spent. Nurse leaders create budgets with the hopes of predicting expenses for their department to be fewer than expected or to break even. When leaders underestimate their budget, it can result in an unfavorable variance or expenses for the unit exceeding the projected budgeted amount. If, at the end of the fiscal year, the nurse leader sees the department expenses to be lower than the predicted amount, this is a favorable variance (Leger, 2021).
Developing a department budget involves budgeting for unit staffing, equipment, supplies, and other department costs, such as expenses for patient supplies, based on the previous year’s performance. Commonly, new nurse leaders will review the previous three years of staffing financials and expenses of the department when creating a fiscal budget (Leger, 2021). There are two other variances nurse leaders should become familiar with, and they are quantity and price variance. A quantity variance means to purchase a higher or lower quantity of a specific item than budgeted. If the unit leader plans to purchase 50 items at $1.00 each as they are budgeted for $50.00 but purchase 100 items, the $50.00 variance becomes the quantity variance. A price variance is where the nurse leader budgets to pay one price; however, the price, when purchased, goes up or down than budgeted for, and that variance amount becomes the price variance (Leger, 2021).
An expense variance is also seen in budgeting when the number of patients to be seen is predicted and the actual number of patients seen is higher. Suppose the department was planning to see 100 patients in one month. In that case, 150 patients are seen, and the expense variance would occur because an additional 50 patients seen were not budgeted for, causing additional expenses not planned for (Leger, 2021). Planning for these changes is sometimes unavoidable during budget planning with the changes in the volume of patients being seen. When such events occur, other variances are identified, such as volume variance when there are more patients; more staff are needed, which can cause a volume variance with more staff, many of those being from a float pool or resource pool of staff to fill in the staffing gaps.
Negative cost variances are unfavorable, and nurse leaders do their best to control costs so this does not occur. According to Rundio, 2021, ways to prevent negative variances within the healthcare setting include sharing staffing from one unit that has a low census to a unit with a higher census and additional nursing staff, staffing a nursing assistant to help instead of calling in a nurse, creating a float pool for the facility, schedule staff differently during busier times of the day, and hire part-time nurses to fill in if more staff are needed as they do not acquire overtime. These ideas can reduce negative cost variances and keep nurse leaders from paying overtime, and outside contracted travel nursing staff, which all cost the department budget more money (Rundio, 2021).
Leger, M. (2021). Financial management for nurse managers: Merging the heart of the dollar (5th ed.). Jones and Bartlett. ISBN-13: 9781284230932
Rundio, A. (2021). The nurse manager’s guide to budgeting and finance, third edition. Sigma, PPHU, Banecki, J., Jasniewski, I. i wspolnicy, spolka jawna.