From The Floor
Electronic Health Records Are Here to Stay
To make the process better, get involved!
Are electronic health records (EHRs) the bane of your existence? Like ‘em or loathe ‘em, you’d better get used to them: Due to a provision in the Affordable Care Act (ACA), these systems will become almost universal in the very near future. Unfortunately, as many of us know all too well, there are still a few bugs in the system.
Many of us think of EHRs as a very modern concept, but in fact the idea dates back to 1969 with the Regenstrief Institute at the Indiana University School of Medicine. Other systems soon followed, including Technicon, COSTAR and HELP, to name a few.
Although the Institute of Medicine recommended back in 1991 that all doctors computerize their practices by 2000, the adoption of EHRs has been slow. Many providers balked at the systems’ cost and complexity, so for a long time, few hospitals and even fewer clinics had EHR systems.
Carrots and Sticks
The ACA includes two provisions intended to drag reluctant healthcare providers kicking and screaming into the 21st century. The first is Medicare and Medicaid incentive payments for doctors and hospitals demonstrating “meaningful use of certified EHR technology.” More than 300,000 providers have already received a total of $15.5 billion in incentive payments, which help facilities cover the costs of purchasing and implementing these systems.
That’s the carrot — next comes the stick. Starting in fiscal year 2015, critical access hospitals (CAHs) that do not successfully demonstrate meaningful use of certified EHR technology will face Medicare reimbursement rate penalties, which will increase each year through 2019. Since so many facilities rely on Medicare dollars, hospitals and clinics are scrambling to adopt EHR systems before the deadline.
These measures have provided the proverbial kick in the derrière for providers. According to a report published in June by the Centers for Medicare and Medicaid Services, 4,024 hospitals and clinics — 80.3 percent of Medicare-eligible facilities — now have or are rolling out certified EHR systems.
In principle, EHR systems are great. Who among us wouldn’t love to be able to spend less time charting, reduce medical errors and never have to make another phone call to figure out a doctor’s unintelligible handwritten notes?
Unfortunately, in the real world, these electronic wonders often create as many problems as they solve. Some EHRs work better than others, but even with the best systems, the learning curve can be steep. Worse, it sometimes seems like the people who program and set up these systems know very little about how nurses work. A particular peeve is systems that force nurses to choose from a dropdown menu rather than allowing them to record what they actually see, potentially a very dangerous limitation.
It’s no surprise that many providers are very resistant to EHR systems. At one local L.A. hospital, the EHR system provoked a full-scale rebellion: Doctors and nurses became so frustrated with the system’s cumbersome and redundant procedures for prescribing medication — and so annoyed at the hospital administration’s lack of response to their complaints — that they declared they would no longer use the computerized system until the issue was addressed.
So, your facility has just rolled out an EHR system and it falls well short of expectations. What’s a nurse to do? The short answer is, “Don’t just get mad, get involved.”
Technical Feedback. With many hospitals scurrying to adopt EHR systems ahead of the ACA deadline, it’s inevitable that there will be bugs. However, before they can be fixed, the IT department has to know they exist. If you find a glitch, find out who’s responsible for implementing and improving the system and tell them what’s going on. Take the time to document whatever issues you have. The more you can tell the development team about the problem, the quicker they can deal with it.
More Training. If the problem is insufficient training, don’t be shy about asking for more. These systems can be extremely complicated and not everybody learns at the same rate. Many hospitals offer remedial classes or training sessions and can set up such classes if the staff asks for them.
Form a Committee. If your facility holds meetings to solicit feedback about the EHR system, make sure you attend them and make your voice heard. If there’s a steering committee of nurses that makes recommendations for improving the system, see if you can join the committee or at least send your representative a note explaining your concerns or suggestions. If your facility doesn’t have such a committee, consider organizing one. Talk to other nurses and physicians and see if there’s a consensus about what needs to be done. The administration is more likely to listen if most of the staff is saying the same thing.
Remember, while facilities don’t want to be penalized for not having an EHR system, no hospital administration wants their staff to waste time struggling with a cumbersome or confusing system, especially if it affects patient care. Even if a system isn’t perfect, improvements can be made and most flaws can be patched over if they can’t be eliminated completely.
Electronic records systems are here to stay, but as nurses, we can help to make a bad system better or a good one great. EHRs can be powerful tools to help us practice our art and it’s up to us to help them get there.
Note: While many people use the terms EMR and EHR interchangeably, there is a difference. According to the American Medical Association, an electronic medical record is a digital recordkeeping system that replaces paper charts. An electronic health record is an EMR that can be transmitted digitally; for example, to share patient data between a primary care physician and a specialist. For the sake of brevity in this article, we use the term “EHR” to include both systems.
Geneviève M. Clavreul, RN, Ph.D., is a healthcare management consultant who has experience as a DON and as a lecturer on hospital and nursing management.
This article is from workingnurse.com.