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Increase in Quality of Care

Until the second part of the last century, all medical records were on paper. This system worked fine in an age of family doctors making house calls and patients never travelling far from their local hospital. Our modern society has changed and our healthcare record management has changed as well. Computerized record management (CRM) and Electronic Medical Records (EMR) are poised to increase the quality of healthcare. According to the US Department of Health and Human Services, there are numerous ways that CRM’s are improving quality of patient care.

Their web site lists problems with paper records. These include, illegible handwriting, multiple healthcare providers for one patient not communicating, and increased amounts of medical and new drug information. “Patients with chronic diseases such as diabetes or congestive heart failure often have to monitor their blood glucose level, weight, blood pressure, and medication regimens in their homes” (AHRQ, 2012). CMR will allow health care providers to track any abnormal values recorded from patient’s home, eliminating the need to wait until the next appointment which may be a month away.

With CMR, patients will be able to go to different specialists who can all plug in to the same medical record. Also, the medical record will follow the patient if he is travelling and needs to receive care far from his primary care provider. The switch to computer records will eliminate time trying to decipher a physician’s handwriting. EMR’s will also be updated continuously with updated medical and drug information. This resource will allow the healthcare provider to keep up to date on all the latest research which will increase quality of care as well.

Another aspect of increased quality of care is the patient id band being linked to the electronic record. “The system of linking hospital ID bracelets to patients’ EHRs has curbed medication errors”. Active Nursing Involvement While developing and implementing a CMR, it is very important to get input and direction from professional nurses. Nurses are a critical element in the management of health care records. They are the ones charting, administering drugs, identifying patients, and writing plans of care. According to the Hospital and Health Networks website, anyone who is uilding a CRM system, needs “to spend time on the nursing units and see how nurses work” (hhnmag. com, 2012). Nurses are the professionals who care for patients. The input they can offer will be useful since they are the ones using the system. Nurses have firsthand knowledge about what really works on the floor and will simplify their jobs while increasing quality of care for the patient. The first step will be for the nurse to give input into exactly what they would use in an EMR. Then, nurses could guide the developers in the actual flow of their duties and charting.

Without involvement of nurses, programmers may include items not used by nurses or put charts out of logical order for the nursing process. Handheld Devices The current trend in computerized healthcare management is handheld devices or PDAs. “The functionality provided by PDAs has expanded exponentially from simple personal organizer to include healthcare databases and applications that check for drug interactions, aid in IV calculations, analyze lab results, provide charge capture information, scheduling functions, prescription refilling and other practice management tasks” (Online Journal of Nursing Informatics, 2001).

Using a handheld device, nurses are able to keep current on research, standards of care, and drugs. The nurse will be able to access patient records from the bedside, drug room, or during change of shift report. A PDA will cut down on the spread of germs since each nurse carries her own device instead of sharing a computer keyboard with the entire hospital staff. The handheld device will be able to offer real time updates if there is a change in a patients status, perhaps to “transmit telemetry waveforms from monitors at the nurses’ station directly to the bedside nurse” (OJNI, 2012).

At change of shift, a nurse can handoff to the next nurse syncing the two handheld devices improving continuity of care and assuring that tasks are not inadvertently left off. Security Standards The Health Insurance Portability and Accountability Act (HIPPA) is federal law in place to protect a patient’s privacy. Any computerized medical records must be in compliance with HIPPA as well as protect the computer records from being breeched in anyway. How to keep medical records safe and away from non-authorized eyes is a major concern for healthcare providers. The technical part of security includes firewalls, protected servers, ncryption, and secure networks. Storage and back up of all information will be integral in protecting the electronic medical records. At Epic Systems, “’we have all sorts of firewalls and security systems in effect to prevent data breaches,’ Ms. Faulkner says. On laptops used by doctors, files can be viewed but not stored. The same is true for smartphones and tablets. We do not store patient data on them, she says, so it cannot be misused if these devices are stolen” (Freudenheim, M, 2012). Hospitals also need role based access. This will “limit access to a patient’s record to only those individuals who need the information for treatment.

Audit trails can automatically record who viewed the health record and can be used after the fact to identify any unauthorized access, leading to improvements in training or, if warranted, corrective action (HHS. org, 2012). As with paper charting, nurses will need to carefully guard who has access to the patient’s chart and who is allowed to view it. Computer monitors need to go blank when not in use to prevent unauthorized viewing of patient records. Cost The savings to health care systems is not only in time, convenience and increased patient safety; CMRs can also save hospitals money.

The Department of Health and Human Services published a white paper outlining cost benefits of transitioning to electronic records. “The all cost-benefit analyses predicted substantial savings from EHR (and health care information exchange and interoperability) implementation. The quantifiable benefits are projected to outweigh the investment costs. However, the predicted time needed to break even varied from three to as many as 13 years” (AHRQ, 2006). The cost to implement electronic medical records vary tremendously. PracticeFusion is a company that offers an on line free EMR program.

This company offers “a comprehensive practice management software platform includes charting, scheduling, billing, e-Prescribing, lab integrations and secure messaging” (PracticeFusion. com). There are no charges to use the technology. If the user prefers to use PracticeFusion without seeing the ads, they can pay a nominal $100 per month fee. On the other end of the cost spectrum, Epic Systems provides electronic medical records for large hospitals like Cedars-Sinai and Kaiser. “Kaiser estimates it will eventually spend a total of $4 billion on the software and related osts like those for equipment and training employees,” (Freudenheim, M. , 2012).

For large, multi-campus hospital systems, the costs are enormous. There are extra costs associated with CMRs. Training time, upkeep, new hardware, and IT employees all go in to the continuing ?

Benefits to Care

The benefits of electronic medical records to the patient can be many. Patient safety can be increased, health care providers receive the absolute most current research and evidence based best practices, and timeliness of care can go up as well. Communication between members of the health care team is improved.

Medication errors decrease. Time savings from transcription to reading illegible handwriting leads to more time the nurse is able to spend caring for the patient. Even the US government wants to support CRMs. “The federal government is contributing to the recent growth of Epic and similar firms by offering financial incentives to health providers who switch to electronic records. It sees these records as a way to improve patient care and reduce inappropriate costs like those for duplicated tests,” (Freudenheim, M. , 2012). Recommendation The two providers I looked at are PracticeFusion and Epic Systems.

Comparing these two companies is a little like comparing apples to oranges. Epic has been in business developing electronic medical record systems since 1979 and has an excellent reputation in the industry. Epic claims to have the medical records of 127 million patients and is used by 250,000 doctors. In an industry where cross platform communication can be difficult to say the least, it is reassuring to go with a company that has such widespread market share. Epic is relatively easy to learn and use. It is the system I learned while working at Cedars-Sinai in Los Angeles and the system I recommend.

PracticeFusion is not in the same league as Epic Systems. It may be a good choice for a small, detached practice to use for internal EMRs ?


The cost of using Epic Systems for medical records can be prohibitive. Once the decision to go electronic has been made, Epic works closely with the staff at the hospital to design a user friendly, safe, and effective program. The government is supporting the transition to EMRs. Other hospitals have made the move, private practices are involved. Quality of patient care can be increased and that is really the best reason to make the change.

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