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Professional Issues in Nursing Paper: Nurses and the EHR
Roentgen Fajardo
Angeles College
NSG 300 Professional Issues In nursing
Kathleen Pecora
May, 6, 2023
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Full Title of Your Paper
“It is not the strongest of the species that survive, nor the most intelligent, but the one
most responsive to change,” Charles Darwin… (continue later) In the medical field patient
results are vital documents for all healthcare workers and because of that keeping track of who
and what they are is necessary, however, the amount of work to maintain and keep the charts is
time consuming and a headache. However, thanks to the introduction of technology and the rapid
advancement of it, it has redefined charting and how it is done. It might seem like overpraise for
what’s been brought to the medical field but it’s no exaggeration to say it’s immensely helped
many healthcare workers sort out patient charts in a more effective manner while also keeping
that information relatively consistent. However, this does not necessarily translate to improved
accuracy of these records as it’s relatively common to have some mistakes or inaccuracies in
reports.
Method (Heading Level 1)
Participants (Heading Level 2)
(Topic sentence)... According to Sage Journals, a qualitative analysis was done on EHRs
in terms of healthcare quality and safety for roughly 8 months with participants from Nevada and
from California, however, only a few participants from their respective locations volunteered but
despite the amount expected, they are representatives of the clinician population meaning their
feedback is still important for this research and by the end of it results were given from all
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representatives (Hu, 2022). Based on the results provided by the participants, many of them have
found that data accuracy is a necessary component in delivering the highest quality of care
meaning the information and reports taken from patients should be as precise and detailed as
possible on EHRs to ensure no medical errors or mishaps happen while delivering care. Upon
further investigation participants of each field noted the pros and cons of the use of EHRs. The
main selling point according to each representative was the accessibility and the overall
efficiency of it in comparison to paper charting. Some other notable inputs were the overall time
reductions when documenting as well as the ability to take notes for future reviews for all
relative healthcare workers. Although the reviews are shown to be positive, every silver lining
has its clouds. The number of cons listed and mentioned by each representative was also made
apparent. The most prevalent concern is the inaccuracies given with each new documentation.
For nurses, it’s become a problem where previous information was just copy/pasted onto the next
documentation causing a variety of mishaps such as not only for the next nurse but also other
healthcare workers. Some complaints also come from the complexity of EHRs meaning there is
less time to focus on the quality of documentation and more so just filling in information as soon
as possible. As a result, while documentations may be quickly delivered and accessible to other
workers in a timely manner, the level of quality is a cause of concern that further emphasizes the
dissatisfaction and problems regarding EHRs now for workers who find it challenging.
EHRs have become commonplace in all, if not most hospitals and healthcare settings due
to… (continue later) According to Registered Nursing, EMRs were primarily developed to
standardize documentation, prevent errors, promote concise charting, and having ways to store
medical records for the long term, however, even with the benefits they provide for the
workforce there are pros and cons to it that should not be put aside but rather explained to
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establish the presence of EMRs and the effect it has in the medical field (Androus, 2023). In
order to understand where EMRs stand, explanation of what the pros and cons are is necessary.
According to the list provided by Registered Nursing, the pros listed are: Standardization,
Improved Accessibility, reduction of errors, improved privacy, and improved insurance; as for
the cons listed, they are: reduced oversight, cost, technical malfunctions, over-standardization,
less patient interactions, and increased virtual work. To summarize, the pros of EMRs ensure
orders, documentation, and notes from the provider are properly ordered and categorized to
allow for a quicker review of every report. Nurses aren't the only ones able to access the records
of patients as the healthcare team is able to meaning, the amount of time to retrieve the data and
share with the rest of the team is drastically reduced to a computer that the whole team is able to
access which in turn allows them to view the documents that have been categorized and sorted in
a timely manner and without wasting a single second. The most significant benefit to have
electronic records is that physicians and providers do not have to worry about illegible
handwriting and transcript errors as they are designed to identify such errors and hard stop the
whole order; not only that it assists in identifying the proper medications and patients as well as
ensuring a healthcare delivery is not missed or incomplete… (continue later). Although we’ve
listed what can make Electronic records problematic, it’s best to compare how it fares against
paper charts in terms of accuracy.
In the earliest days of healthcare, paper charting was the only method do document
finding and reports of patients but with the introduction of EHR and the continued advancement
of it, paper has been fading out; However, in spite of all these improvements in the medical field,
paper is still a reliable form of documentation in different ways. According to the National
Library of Medicine, findings suggest paper records hold more credibility as they were
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significantly more complete than Electronic records. Possible causes of inaccuracy include:
resistance to use of EHR because of lack of computer skill, no cross check reference in EHRs,
unable to correct mistakes, and inability to replace errors with a new revised record (Wu, 2018).
Despite the popularity of EHRs, paper records are a mainstay in hospitals as it allows for more
freedom in what could be written on it with precise detail, whereas EHRs are bounded by
standardizations that keep it very simple in documenting, however, this level of simplicity causes
an increase in carelessness which as a result ended up records achieving an 80% accuracy.
Carelessness in handling EHR document was not the only cause for errors to happen as there
were various other obstacles that made it difficult to get the proper results. Some of the cases
indicate it has to do with how technologically challenged the workers are. Learning and
understanding a new piece of equipment requires time and patience to grasp the basic idea of it,
however, due to the fast-paced environment of the hospital, not enough time is given in order to
properly learn it which resulted in some areas of inaccuracies in electronic reports. Another
intervention to quality reports on the EHR is due to the limitations the EHR offers and how strict
the coding is. Based on reports and observation, studies show that a number of workers had no
possible way…(Explain)
EHR vs paper records based on data quality and data reuse. Studies indicate EHRs are
able to effectively reuse data as well as share documents with other workers with more ease
whereas a physical copy of the data requires more menial tasks to deliver and copy. Legacy EHR
vs paper-based were observed and research finds that when transitioning to the new EHR
version, it proved to be more effective to formerly-paper based hospitals rather than Legacy EHR
hospitals. A large factor comes from the expectation of the pre implementation that the Legacy
EHR had for it (Joukes, 2019).
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Two samples, M1(EHR) and M2(paper) observe documentation and effectiveness over a
whole shift as well as preferences on when to document. Findings indicate M1 prefers to
document after meeting the patient, whereas M2 varies between during the shift or after as the
time to document all findings takes longer. Despite the difference in time, M2 has shown to
provide higher accuracy data as they’re more detailed and specific. M1 has more difficulty with
providing detail as most EHRs are standardized (Slyngstad, 2022).
As we’ve established, EHR errors are mainly comprised of human errors resulting in
inaccuracies in documentation which ends up changing the perspective of how the use of EHR is
used; However technology continues to advance thus so should the policies and process for
operating an EHR. In a recent study, there have been some tests on the installment if speech
recognition software and a generated tool for EHRs can improve the overall accuracy of reports
close to as detailed as paper reports. According to the National Institute of Medicine, the main
point is on patient handoffs and the inaccuracies shown when handwritten. A generated tool for
EHRs were created to increase information accuracy by 80%, reduce handoff time, and reduce
frequency of incorrectly listed medications. After implementation, a notable increase in accuracy,
up to 97% was mentioned and a 0% in frequency of incorrect listed medications (Koo, 2020)...
(explain)... In another study by BMC medical, Speech recognition EHRs are increasing in usage
and are methods to reduce document workloads to efficiently focus on the patient rather than the
documents. However, studies find that speech recognition EHRs resulted in lower accuracy
reports by about 3-4% (Peivandi, 2022). (Explain)....
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Despite all the major improvements technology had on the medical field, it’s nearly
impossible to perfectly cover for human errors, hence why inaccuracies are fairly common when
making reports in hospitals. Although we’ve established methods that allow for a simpler
streamlining process, it can not beat paper charts in accuracy.
Upon careful analysis that have spanned in a course of a month at the least, many reports
and findings suggest the process has become significantly easier meaning a speedy process in
inputting information into an EHR than on paper, however, there are limitations to it that cause it
to fall short. For an EHR, there are presets, otherwise known as standardizations that enable
nurses, physicians, and other healthcare workers to input information at a quicker rate; As for
paper charts, there is a lot more freedom in the type of information you’re allowed to add in
resulting in more detailed explanation rather than predetermined sets; The downside, however, is
the amount of time needed to include such information. However, in spite of the steep hill in
accuracy, technology aims to improve and come as close as possible.
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References
Amanda Bucceri Androus, R. N. (2023, February 1). What are some pros and cons of using
electronic charting (EMR)? RN Programs - Start Your Journey as a Registered
Nurse. Retrieved April 29, 2023, from
https://www.registerednursing.org/articles/pros-cons-using-electronic-charting/
Line Slyngstad & Berit Irene Helgheim. (2022). How do different health record systems
affect home health care? A cross-sectional study of electronic- versus Manual
Documentation System. Taylor & Francis. Retrieved April 29, 2023, from
https://www.tandfonline.com/doi/full/10.2147/IJGM.S346366
Hu, H.-fen. (2022). A qualitative analysis of the impact of electronic health records (EHR
... Sage Journals. Retrieved April 30, 2023, from
https://journals.sagepub.com/doi/full/10.1177/11786329211070722
Joukes, E., de Keizer, N. F., de Bruijne, M. C., Abu-Hanna, A., & Cornet, R. (2019,
March). Impact of electronic versus paper-based recording before EHR
implementation on health care professionals' perceptions of EHR use, data quality,
and Data Reuse. Applied clinical informatics. Retrieved April 29, 2023, from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6426723/
Koo, J. K., Moyer, L., Castello, M. A., & Arain, Y. (2020, July 10). Improving accuracy of
handoff by implementing an electronic health record-generated tool: An
improvement project in an academic Neonatal Intensive Care Unit. Pediatric quality
& safety. Retrieved April 29, 2023, from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7360222/
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Peivandi, S., Ahmadian, L., Farokhzadian, J., & Jahani, Y. (2022, April 8). Evaluation and
comparison of errors on nursing notes created by online and offline speech
recognition technology and handwritten: An interventional study - BMC Medical
Informatics and decision making. BioMed Central. Retrieved April 29, 2023, from
https://bmcmedinformdecismak.biomedcentral.com/articles/10.1186/s12911-022-01
835-4
Wu, C. H. K., Luk, S. M. H., Holder, R. L., Rodrigues, Z., Ahmed, F., & Murdoch, I.
(2018, July). How do paper and electronic records compare for completeness? A
three centre study. Eye (London, England). Retrieved April 29, 2023, from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6043594/
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