Electronic Health Record

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Electronic Health Record
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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
  information

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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
  professionals

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• A survey was conducted in seven countries. Canada
  had the lowest number of physicians using EMR at
  23.
• Health Canada would like to have half of all
  Canadian health records in electronic form by
  2009.

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Around the World
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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
  records

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Australia

• 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.

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Europe

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

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

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Improving efficiency and quality of health care

• Instant access to a patient's EHR saves the
  clinician's staff time and enhances efficient
  workflow.
• 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
  patient

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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
  care.
• 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.

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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
  providers.

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Organizational efficiency

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

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Barriers and Issues7 Major barriers and issues
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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

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Management of the EHR

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

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Lack of a Health Network Architecture

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

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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
  EHR

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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.

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Lack of leadership

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

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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.

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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

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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
  acts.

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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
  care
• 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

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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.

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Adaption to Change
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• 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
  advances.

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Evidence

• 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,
  p.45).

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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
  safe.

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• 4)Late Majority (34)- These individuals need to
  be thoroughly convinced that the change is
  beneficial.
• 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.

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• 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.

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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.

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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.

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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
  avoided.
• 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.

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

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• 44 felt that system currently used is optimally
  functional
• 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

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• 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.

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References

• 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
  s/ehealth-esante/2001-towards-vers-ehr-dse/index_e
  .htmlBarriers
• (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
  Database.
• 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),
  209219
• 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
  pgs