1 Professional Issues in Nursing Paper: Nurses and the EHR Roentgen Fajardo Angeles College NSG 300 Professional Issues In nursing Kathleen Pecora May, 6, 2023 2 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 3 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 4 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 5 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). 6 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).... 7 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. 8 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/ 9 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/
