Rebecca Joostens, RN The learner will be able to discuss endorsements for the use of EMR such as meaningful use. The learner will be able to discuss.

High Tech vs High Touch

High Tech vs High TouchRebecca Joostens, RN

ObjectivesThe 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 nursingThe learner will be able to discuss worrisome impacts of technology on the role of nursingThe learner will be able to discuss how the trained nurse can be an important leader in the development and use of electronic medical records.

IntroductionDocumentation 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 patients history and allows the nurse to compare and use their critical thinking skills to act in the patients interest.3Introduction ContinuedUntil 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, 20114AssumptionsEMRs 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 paper-based chartingA good EMR system automatically means quality careTime spent entering data into an EMR is wasted timeNurses 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 documentIf we refuse to use the EMR, we will eventually discover it is not working and it will go away.5Root Cause AnalysisIncreasing demands of HealthcarePreventive Service- reporting and tracking requirementsUncontrolled chronic disease statesIncreasing medication errorsNeed for transparency of patient information (referrals, transitions of care)Meaningful Use MetricsNeed for Population ManagementElectronic Medical Record6Policies: Why Electronic Medical Records?The Joint Commission The Accreditation Association for Ambulatory Healthcare Meaningful Use- ARRA, 2009PrioritiesPatient engagementReduction of racial disparitiesImproved safety and efficiencyCoordination 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).

7ImplicationsIf an electronic medical record is not developed appropriately and lacks nursing influence, it may not be the source of improved quality and efficiency healthcare needs8Nursing TheoryTheory of Interpersonal Relations by Hildegard PeplauThe nurse is:A strangerA teacherA resourceA counselorA Serrogate (Advocate)LeaderSupporting roles(Peplau, 2012)

9Diffusion of Innovation Theory by E.M. RogersSocial science theory from 1962Over time an idea gains momentum and spreads through a social systemThe end result: people in the social system adopt new ideas/behaviorsAdopter Categories (5) based on speed with which adopters accept the change (innovators, early adopters, early majority, late majority, laggards)(Diffusion, 2013)

10Quality and Safety: The Benefits of EMR use in NursingHealth Care SavingsDecreasing length of stayDecreasing nurse administration timeReducing Medication Errors (2/3 of preventable adverse drug event avoided based on EMR warning regarding potential interactionsManagement of preventive medicineManagement of chronic diseases Reduction in Medical ErrorsAid in Clinical ResearchSupport decision analysisPredict nursing care trends(Edwards, 2012)(Kelley et.al, 2011)

11Quality and Safety: The Benefits of EMR use in Nursing- continuedEfficiencyDrop down menusCopy and paste previous dataAccuracyLess error when copying down dataElectronic interfaces between monitors (vitals, heart monitors)Standardized templates allow easy assessment of adherence to standardsIncrease visibility and access to informationBetter organization because of toolsKelley, et.al 2011

Quality and Safety: The Disadvantages of EMR use in NursingNurses fears of EMR charting increasing documentation time: studies are inconclusive in comparison studies. (Kelley et.al, 2011),Greater than 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)

13Quality and Safety: The Disadvantages of EMR use in Nursing- continuedQuick tools in the EMR system can create problems:Copy forward/ automatic download of information can detract from the nurses critical thinking processMisrepresentation of patients current statusTemplated/structured documentation may feel restrictive and not allow for full description of the patients status(Kelley, et al, 2011)

14ConsequencesPatient SatisfactionPatients feel providers and nurses stare at the computer and dont look at themPatients may be worried about information sharingNurse Job Satisfaction:Nurses believe that EMRs will interfere with individualized patient careStudies 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.15Recommendations for Quality and Safety ImprovementsNurses as leadersBe proactiveA committed interdisciplinary Team

16ANA StandardsStandard: AssessmentThe EMR is used to collect data that is meaningful Information that is stored in the EMR is used to analyze the patients statusDocumentation is done in a manner that is retrievable Standard: Outcomes IdentificationDocumentation of patient goals Standard: Evidence-Based PracticeThe EMR uses evidence-based practices The EMR implements these into its tools17QSENPatient-Centered CareTeamwork & CollaborationEvidence Based PracticeQuality ImprovementSafetyInformatics

18Questions for DiscussionHow 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?

ReferencesBrooks, 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

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