A patient – an elderly man – is stereotypically traditional in terms of his “fear of technology.”
He’s more comfortable with pen and paper than using a computer, particularly when it comes to tracking his doctor’s appointments, medical history and protecting his privacy. The thought of having his patient records released on the Internet, in secure fashion or not, is essentially horrifying.
To think that a printer could process his current laundry list of medications without omitting one in error is blasphemous at best. He’d rather everything related to his healthcare remain as it has been for years.
Until he takes a moment to realize how much more convenient and safe his life can be once his healthcare provider thoroughly engages him in his electronic health record (EHR).
“I have this 75-year-old patient who was very frustrated that I was putting things on the computer,” explained Laura Nevill, RN-C, APRN, senior director for nursing informatics at Cambridge Health Alliance in Massachusetts. “And then the light dawned on him that he couldn’t wait for his specialists to get online, too.”
Ensuring Quality Care
EHRs are one of the more significant waves of technology to impact the medical world over the past several years.
Having such data as, diagnoses, prescriptions and appointment schedule bundled at one’s fingertips for the patient and provider’s perusal continues to prove increasingly invaluable, particularly for those patients living with chronic health conditions such as diabetes, cancer or HIV/AIDS..
In regards to her patients with diabetes, Nevill said the role of EHRs is most evident in tracking the effectiveness or ineffectiveness of someone’s disease management.
“It will pull up for this patient his or her weight, blood pressure, hemoglobin A1C and other significant labs,” she explained. “I can immediately get a feel for where we are – what tests I need to run, how well the diabetes is being managed and what I need to help them focus on.”
In the home health setting, nurses are also utilizing EHRs by taking photos of ulcerations on patients’ skin so physicians can review them without the patient having to travel into the office.
For those with long-term cardiac issues, for example, internal pacemakers can also be tracked remotely.
Other disease processes that are better managed through the use of EHRs include COPD and neurological disorders, especially in regards to possible medication changes and side effects that can occur.
When hospital admissions are unavoidable and more healthcare providers become involved with a case,
EHRs can help simplify that process, said Karen Fuller, RN, ES, PMP, a critical care nurse with 35 years of experience in healthcare and information technology (IT) who’s on staff with CSC Health Services, an IT and professional services provider.
“In the moment, data doesn’t just go to the practitioner at hand or into the online database for physicians and nurses to access later – other people of the healthcare team receive real-time info and alerts as well,” Fuller said.
“There are alerts and reminders that can be targeted to care providers and alerts that can be sent to the pharmacist. [The EHR] provides everyone involved availability of critical information at the point of care, whether its entry, dispensing or administration.”
Use of EHRs is also alleviating readmissions in some cases.
“Now, when patients follow up [after hospital discharge], EHRs create a continuum of care,” Fuller said.
Providing Self-Care
In order for that continuum to be complete, providers must attempt to ensure that they are not alone in the responsibility to update and review EHRs for accuracy.
Patients have a role, too. Sometimes, that assignment is fairly simple for the patient: talk to the provider so data can be input regularly.
“I’ll oftentimes have patients who will call me and say ‘I weigh 3 more pounds today than yesterday,’ or ‘I’m noticing that my blood pressure is very high and I’ve had to take an extra dose of my medication’,” said Betsy Boyle, RN, case manager at Greenspring Medical Center, Springfield, VA, one of 16 full-service retirement communities managed by Erickson Living.
Boyle inputs information that she receives from patients into the system and sends alerts to any other parties involved.
“Our EHRs have a flag system,” she explained. “I can send a doctor a flag saying ‘Mrs. Smith is coming to see you today for evaluation of her wound; however, she has been coughing for 4 days, as well.'”
While Boyle’s job gives the patient a relatively passive role in HER management, other systems and facilities call for more active participation.
“We have a patient portal that allows me, when I get labs, to write a note immediately to the patient and forward it to them,” said Nevill. “When they get a message in their email, they can go onto the system to see those labs and my comments. They then print the lab results and take them to their appointments. I think a lot of places are moving toward this.”
EHRs also allow patients the opportunity to update personal information between visits or send messages to appropriate practitioners, alerting them of specific concerns. Additionally, information remains available throughout the patient’s life, which can be an amazing aid, Nevill said.
“You can see everything that I’ve given the patient since 2004 in my health center,” she added. “If you [as the practitioner] want to try a new medication but I discontinued its use for this patient in 2005, the EHR system will flash up a warning to let you know that. You don’t lose pieces of information that, quite frankly, we as humans can forget. It’s in the system.”
Barriers to Care
Of course, there are cons to EHRs that providers have to be wary of. The primary concern is interfacing.
Right now, most hospital EHR systems are not compatible with private systems. Outside practitioners and those on staff within out-of-state hospitals, for example, cannot always simply log on and access a patient’s information online uniformly.
Mail and fax are still the primary modes of communication among out-of-network providers, though steps are being taken to change that.
Then, there are those who, despite their providers’ best efforts, succumb to the “fear.” There are also those working in the healthcare community who need a little convincing and a lot of training in regards to electronic communication.
“When you work with residents and newer healthcare practitioners coming out of school, they’ve all been trained on computers; but for the nurses and physicians who have grown up using paper, it’s a big change,” Fuller related. “In support of nurses, sometimes the change impact has been underestimated. Having said that, once they get through that painful learning curve, they don’t want you to take that computer system away from them.”
Sue Coyle is a freelance writer in Bucks County, PA.
