Electronic Health Records for Clinical Decision-Making

Introduction

The emergence of health information technology has revolutionized the way patients’ data is collected, documented, stored, retrieved, viewed, managed, shared, and utilized. Consequently, healthcare providers can select from the many available applications to enhance the way they deliver care to patients. One such application, electronic health records (EHR), is being used extensively to ensure that patients get quality and timely services. The EHR system allows providers to capture and store patients’ important administrative clinical data for reference when making care decisions. Data within this system could be shared and accessed remotely by other care providers, thus streamlining workflow and improving patient outcomes. The system can also synchronize with other care-related activities through various interfaces to support evidence-based decision-making. This paper discusses EHR’s impact on the quality of decision-making, its selection, implementation process, and the associated costs. Nurses’ role in this process is also addressed in the paper.

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The Application’s Impact on the Quality of Decision Making

EHR has influenced clinical decision-making in ways that could not have been realized in the absence of technology. The first characteristic of this system is the ability to store and share patients’ data. As such, the involved care providers can access and retrieve all the necessary information that aids in making the right decision. The system does not simply store information – it computes data, thus manipulating it to generate the best possible action points for the involved care providers (Davis, Roudsari, Raworth, Courtney, & MacKay, 2017). For instance, on top of keeping records on a patient’s prescribed medications and known allergies, it also scans the system for potential problems whenever a new medication is given. If potential adverse reactions are noted, the involved clinician is alerted of the same. Ultimately, the right decisions are made to avoid medication errors, thus improving patient safety and outcomes.

Additionally, EHR information gathered by primary care providers could be used in cases of emergency and when the patient is unconscious. For example, the emergency staff could rely on EHR patient data to adjust care appropriately to avoid allergies and adverse drug interactions (Castaneda et al., 2015). In this case, the patient’s safety would be ensured by avoiding medication errors, which could have negative health implications. In the absence of such a system, a patient may not receive quality and timely care. EHRs could also be used to expose possible safety problems at the point of occurrence to avoid escalation of the same into serious cases. Finally, EHRs play a central role in identifying and correcting operational problems, which would have taken years to adjust in a paper-based setup. Therefore, care providers using EHRs, make the right decision for improved patient safety and outcomes.

The Process for Selecting and Implementing EHRs

Selection

The first step in selecting the EHR system involves building a team to steer the process. The team members may include a project manager, physician advocate, nurse advocate, and representatives from billing, administration, marketing, and other relevant departments (Boonstra, Versluis, & Vos, 2014). The second step is for the team to gather critical information based on practice requirements. This section should include identifying features that should be in the application. In the third step, the team forecasts the budget required to acquire an application with the specified features. The fourth step is shortlisting vendors offering the selected application at the projected budget. The criterion used here should focus on affordability, suitability, vendor culture, and efficacy. The last step is identifying the appropriate EHR vendor through a request for proposal (RFPs) or demos. At this point, the team should interact with all potential vendors and select the final one for service provision.

Implementation

After settling on one vendor, the implementation process starts with training and system preparation. Users should get adequate on-site or online training from the vendor to familiarize themselves with the system and identify areas that may need clarification or improvement. The final step is the launching part, whereby the vendor should be present to initiate the process and handle all arising issues. Users should give constant feedback to the vendor to make the necessary adjustments.

The Associated Costs

The cost for implementing EHR varies depending on several aspects, including the vendor, features of the application, adds-on to the system, the nature of deployment, hardware requirements, and the scale of the installation, among other elements. The following table shows some of the variables and costs involved in securing a SaaS EHR system. However, the total cost of ownership (TCO) will vary greatly based on specific practice needs that are being addressed.

Upfront cost Yearly cost 5 year TCO
Cloud EHR $26,000 $8,000 $58,000
On-premise EHR $33,000 $4,000 $48,000

Table 1: Estimated TCO for SaaS EHR (Green, 2019).

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Nurses’ Role in Selecting and Evaluating the Application

Nurses play a central role in the selection, evaluation, and implementation of the appropriate EHR applications because they are the link that keeps the patient care spectrum functional. Given that nurses are in constant contact with patients at all levels of care provision, they know the specifics of what needs to be done where and in which manner (Strudwick, Booth, Bjarnadottir, Collins, & Srivastava, 2017). For instance, nurses are the major player’s inpatient data entry, and thus their insights would be invaluable in deciding which application to select. With the involvement of nurses, the selected application will have high compatibility scores with practice needs being addressed.

Another role of nurses in the selection and evaluation of this system is to reduce barriers to adoption by ensuring that they embrace the change process. A study by Kruse, Kristof, Jones, Mitchell, and Martinez (2016) showed that the failure or success of EHR implementation depends largely on nurses’ attitude towards the process. As such, if nurses are involved, the process is likely to succeed. After embracing the change process, nurses become champions of the same by educating other staff members for improved utilization. It thus suffices to say that nurses play the most important role in the selection and evaluation of EHR applications for higher adoption rates and success of the entire process.

Conclusion

EHR applications have replaced the traditional paper-based systems used to capture and store patient information. This innovative system has changed the way clinical decisions are made in the process of delivering care services to patients. Clinicians can now make informed decisions based on patient data captured at different levels of care provision. Consequently, making the right decisions has reduced medication errors and other related issues for improved patient outcomes and safety. The selection and implementation process should be spearheaded by a carefully selected team to ensure that the application addresses the relevant practice needs. The costs of such systems vary depending on different factors, including the vendor of choice, features, and support services. The role of nurses in the selection process is central as they determine whether the change process succeeds or fails.

References

Boonstra, A., Versluis, A., & Vos, J. F. (2014). Implementing electronic health records in hospitals: A systematic literature review. BMC Health Services Research, 14(370), 1-24. Web.

Castaneda, C., Nalley, K., Mannion, C., Bhattacharyya, P., Blake, P., Pecora, A., … Suh, K. S. (2015). Clinical decision support systems for improving diagnostic accuracy and achieving precision medicine. Journal of Clinical Bioinformatics, 5(4), 1-16. Web.

Davis, S., Roudsari, A., Raworth, R., Courtney, K. L., & MacKay, L. (2017). Shared decision-making using personal health record technology: A scoping review at the crossroads. Journal of the American Medical Informatics Association, 24(4), 857–866.

Green, J. (2019). How much EHR costs and how to set your budget. Web.

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Kruse, C. S., Kristof, C., Jones, B., Mitchell, E., & Martinez, A. (2016). Barriers to electronic health record adoption: A systematic literature review. Journal of Medical Systems, 40(12), 252-265. Web.

Strudwick, G., Booth, R. G., Bjarnadottir, R. I., Collins, S., & Srivastava, R. (2017). Exploring the role of the nurse manager in supporting point-of-care nurses’ adoption of electronic health records: Protocol for a qualitative research study. BMJ Open, 7(10), 1-6. Web.

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