Rebecca Joostens, RN
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The learner will be able to discuss
endorsements for the use of EMR such as
meaningful use.
The learner will be able to discuss positive
impact of technology on the role of nursing
The learner will be able to discuss worrisome
impacts of technology on the role of nursing
The learner will be able to discuss how the
trained nurse can be an important leader in the
development and use of electronic medical
records.
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Documentation is an important part of nursing
care.
“Nurses use their clinical expertise, prior
knowledge, and critical thinking to
continuously assess, plan, intervene, and
evaluate their patients.” (Kelley, et al, 2011)
Documentation is a crucial piece that provides
the patient’s history and allows the nurse to
compare and use their critical thinking skills to
act in the patient’s interest.
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Until recent years, paper- based charting has been
used in nursing and other health care professions.
High Touch/ Quality Patient care was chosen
above patient information management
This year (2014) marked the cut-off for integration
of electronic documentation.
This effort is due to the expectation that better
patient information management will improve
patient care.
Can we Expect improved quality of care directly
related to the use of EMR systems?
Kelley et.al, 2011
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EMR’s are not user-friendly and make sense only to the
programmers who have no idea of what patient care is.
Electronic documentation takes longer than paperbased charting
A good EMR system automatically means quality care
Time spent entering data into an EMR is wasted time
Nurses cannot affect the implementation or
development of an EMR and we are stuck with what
we are given.
Quick tools within an EMR are the best way to
document
If we refuse to use the EMR, we will eventually
discover it is not working and it will go away.
Increasing
demands of
Healthcare
Need for
Population
Management
Uncontrolled
chronic disease
states
Electronic
Medical Record
Preventive
Service- reporting
and tracking
requirements
Meaningful
Use Metrics
Increasing
medication
errors
Need for transparency of
patient information
(referrals, transitions of care)
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The Joint Commission
The Accreditation Association for Ambulatory
Healthcare
Meaningful Use- ARRA, 2009
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Priorities
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Patient engagement
Reduction of racial disparities
Improved safety and efficiency
Coordination of Care
(Edwards, 2012)
Financial Incentives (Kelley et. al, 2011)
A comprehensive EMR tool is the most efficient way to
meet all the criteria set forth by Meaningful Use (Kelly
and Kutney-Lee, 2011).
If an electronic medical record is not developed
appropriately and lacks nursing influence, it may
not be the source of improved quality and
efficiency healthcare needs
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Theory of Interpersonal Relations by
Hildegard Peplau
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The nurse is:
 A stranger
 A teacher
 A resource
 A counselor
 A Serrogate (Advocate)
 Leader
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Supporting roles
(Peplau, 2012)
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Social science theory from 1962
Over time an idea gains momentum and spreads
through a social system
The end result: people in the social system adopt
new ideas/behaviors
Adopter Categories (5) based on speed with which
adopters accept the change (innovators, early
adopters, early majority, late majority, laggards)
(Diffusion, 2013)
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Health Care Savings
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Decreasing length of stay
Decreasing nurse administration time
Reducing Medication Errors (2/3 of preventable adverse drug
event avoided based on EMR warning regarding potential
interactions
Management of preventive medicine
Management of chronic diseases
Reduction in Medical Errors
Aid in Clinical Research
Support decision analysis
Predict nursing care trends
(Edwards, 2012)
(Kelley et.al, 2011)
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Efficiency
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Accuracy
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Drop down menus
Copy and paste previous data
Less error when copying down data
Electronic interfaces between monitors (vitals, heart
monitors)
Standardized templates allow easy assessment of
adherence to standards
Increase visibility and access to information
Better organization because of tools
Kelley, et.al 2011
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Nurse’s fears of EMR charting increasing
documentation time: studies are inconclusive
in comparison studies. (Kelley et.al, 2011),
Greater than ½ of nurses report they use paper
initially and transfer information to the EMR
later .
EMR use does not automatically improve
quality care. High-quality outcomes require
high-quality practices and structure. (Kelley
et.al, 2011)
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Quick tools in the EMR system can create
problems:
Copy forward/ automatic download of information
can detract from the nurses’ critical thinking process
 Misrepresentation of patient’s current status
 Templated/structured documentation may feel
restrictive and not allow for full description of the
patient’s status
 (Kelley, et al, 2011)
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Patient Satisfaction
Patients feel providers and nurses stare at the computer
and don’t look at them
 Patients may be worried about information sharing
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Nurse Job Satisfaction:
Nurses believe that EMRs will interfere with
individualized patient care
 Studies on attitudes towards EMR : inconclusive
differences between age, gender, and education level
(Kelley et.al, 2011)
 The only conclusive study (as reviewed by Kelley et.al,
2011) indicated that nurse attitudes were more favorable
if they had prior knowledge and experience with
computers.
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Nurses as leaders
Be proactive
A committed interdisciplinary Team
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Standard: Assessment
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Standard: Outcomes Identification
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The EMR is used to collect data that is meaningful
Information that is stored in the EMR is used to
analyze the patient’s status
Documentation is done in a manner that is
retrievable
Documentation of patient goals
Standard: Evidence-Based Practice
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The EMR uses evidence-based practices
The EMR implements these into its tools
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Patient-Centered Care
Teamwork & Collaboration
Evidence Based Practice
Quality Improvement
Safety
Informatics
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How and why might a nurse be an important and impactful
leader in the development of or implementation of an EMR
system?
How might patients perceive the use of EMR systems?
Do you believe that there is an improvement in quality of
patient care based on implementation of EMR systems in
your personal practice?
Do you think the use of EMR systems does or should impact
talent acquisition for hospital nurses? Out-patient nurses?
What generational differences may be present based on the
increased use of EMR?
Do you believe that your patient connection has suffered
based on the implementation of EMR systems?
Brooks, R. (2011.). Embracing EMR. on ADVANCE for Nurses. Retrieved June 24, 2014, from
http://nursing.advanceweb.com/Columns/Nursing-Informatics/Embracing-EMR.aspx
Diffusion of Innovation Theory. (2013, January 1). Diffusion of Innovation Theory. Retrieved June 24, 2014, from
http://sphweb.bumc.bu.edu/otlt/MPH-Modules/SB/SB721-Models/SB721-Models4.html
Edwards, C. Nursing Leaders Serving as a Foundation for the Electronic Medical Record. Journal of Trauma Nursing, 19, 111-114.
Jones, S., Adams, J., Schneider, E., Ringel, J., & McGlynn, E. (2010, January 1). Electronic Health Record Adoption and Quality
Improvement in US Hospitals. AJMC. Retrieved June 24, 2014, from
http://www.ajmc.com/publications/supplement/2010/AJMC_10dec_HIT/AJMC_10decHIT_Jones_SP64to71
Kelley, T. F., Brandon, D. H., & Docherty, S. L. Electronic Nursing Documentation as a Strategy to Improve Quality of Patient
Care. Journal of Nursing Scholarship, 43, 154-162.
Kutney-Lee, A., & Kelly, D. The Effect of Hospital Electronic Health Record Adoption on Nurse-Assessed quality of Care and
Patient Safety. The Journal of Nursing Administration, 41, 466-472.
Peplau's Theory of Interpersonal Relations: Hildegard. E. Peplau. (2012, January 1). Peplau's Theory of Interpersonal Relations:
Hildegard. E. Peplau. Retrieved June 24, 2014, from http://currentnursing.com/nursing_theory/interpersonal_theory.html
Sinclair, J. (2010, January 1). Why nurses need better EMR design to care for patients. KevinMD.com. Retrieved June 24, 2014, from
http://www.kevinmd.com/blog/2010/08/nurses-emr-design-care-patients.html