Wait a second!
More handpicked essays just for you.
More handpicked essays just for you.
The importance of the electronic medical record
Application of electronic medical records
The importance of the electronic medical record
Don’t take our word for it - see why 10 million students trust us with their essay needs.
Recommended: The importance of the electronic medical record
Healthcare Information and Management Systems Society (HIMSS) states their vision on their website as achieving “better health through information technology”. They define their mission statement as an attempt to lead global actions towards optimizing healthcare by using informational technology (IT). When I explored theis website, I came across an explanation of Electronic Health Records (EHR), which I found useful for understanding this topic. It was described as an “electronic record of patient health information generated by one or more encounters in any care delivery setting”. According to HIMSS, EHR allows for sharing of information, such as patients’ demographics, health status, immunization record and past medical history. It can also include information regarding medications, vital signs and any other relevant reports concerning the patient. By having this information accessible to all the different health care providers who interact with a client, medical service can become more clients centered and efficient. EHR allows practitioners access to a broader narrative of the person’s life and it gathers outcomes of the health care they receive forming an up to date record of a client’s status while maintaining high quality of care. HIMSS website suggests that using EHR provides many benefits during daily tasks in a healthcare …show more content…
For example, if he or she happens to be traveling, it would assure better overall care for that person. During my clinical observation in a hospital in California, I got to see EHR in practice. One of the most interesting things I saw were computers placed on a cart with wheels, which the therapist could move around the room during the therapy session. This way, the therapist could document her observations right into the patient’s medical records, and also look up information she needed during
For years now, the healthcare system in the United States have managed patient’s health records through paper charting, this has since changed for the better with the introduction of an electronic medical record (EMR) system. This type of system has helped healthcare providers, hospitals and other ambulatory institutions extract data from a patient’s chart to help expedite clinical diagnosis and providing necessary care. Although this form of technology shows great promise, studies have shown that this system is just a foundation to the next evolution of health technology. The transformation of EMR to electronic heath record system (EHR) is the ultimate goal of the federal government.
Historically, physicians and nurses documented patients’ health information using paper and pencil. This documentation created numerous errors in patients’ medical records. Patient information became lost or destroyed, medication errors occur daily because of illegible handwriting, and patients had to wait long periods to have access to their medical records. Since then technology has changed the way nurses and health care providers care for their patients. Documentation of patient care has moved to an electronic heath care system in which facilities around the world implement electronic health care systems. Electronic health records (EHR) is defined as a longitudinal electronic record of
Meaningful Use and the EHR Many new technologies are being used in health organizations across the nation, which are being utilized to help improve the quality of health care. Electronic Health Records (EHRs) play a critical role in improving access, quality and efficiency of healthcare ("Electronic health records," 2014). In order to assist in expanding the use of EHR’s, in 2011 the Centers for Medicaid and Medicare Services (CMS), instituted an EHR incentive program called the Meaningful Use Program. This program was instituted to encourage and expand the use of the HER, by providing health professionals and health organizations yearly incentive payments when they demonstrate meaningful use of the EHR ("Medicare and Medicaid," 2014).
To begin, there are numerous advantages throughout the EHR system. Considering this, enhancing patient safety is priority in the healthcare industry. Reminders, alerts, and pop-ups are just a few of the safety features an EHR can provide. These items can prevent medication errors, by alerting a nurse or physician of a blood sugar that is out of range, or a medication with too high of a potency, such as a wrong dosage amount. Reminders can be as simple as an immunization reminder to get a flu shot. Another example could be a drug interaction between NSAIDS such as i...
Portability can improve patient care. Patients no longer have to “tote” their cumbersome medical records around anymore. EHR’s give physicians and clinicians access to critical healthcare information in the palm of their hand, which ultimately leads to improved patient care outcomes. EHR’s also provide security to vital medical and personal healthcare information. Organizations like HIPPA defines policies, procedures and guidelines for preserving the privacy and security of discrete distinguishable health information (HHS.gov,
Unfortunately, the quality of health care in America is flawed. Information technology (IT) offers the potential to address the industry’s most pressing dilemmas: care fragmentation, medical errors, and rising costs. The leading example of this is the electronic health record (EHR). An EHR, as explained by HealthIT.gov (n.d.), is a digital version of a patient’s paper chart. It includes, but is not limited to, medical history, diagnoses, medications, and treatment plans. The EHR, then, serves as a resource that aids clinicians in decision-making by providing comprehensive patient information.
“An electronic health record (EHR) is a digital version of a patient’s paper chart. EHRs are real-time, patient-centered records that make information available instantly and securely to authorized users.” (healthit.gov) The EHR mandate was created “to share information with other health care providers and organizations – such as laboratories, specialists, medical imaging facilities, pharmacies, emergency facilities, and school and workplace clinics – so they contain information from all clinicians involved in a patient’s care.” ("Providers & Professionals | HealthIT.gov", n.d., p. 1) The process has proved to be quite challenging for providers. As an incentive, the government began issuing payments to those providers who “meaningfully use certified electronic health record (EHR) technology.” (hhs.gov) There are three stages that providers must progress through in order to receive theses financial incentives. Stage one is the initial stage and is met with the creation and implementation of the HER in the business. Stage two “increases health information exchange between providers.” ("United States Department of Health and Human Services | HHS.gov", n.d., p. 1) Stage three will be the continuation and expansion of the “meaningful use objectives.” ("United States Department of Health and Human Services | HHS.gov", n.d., p. 1) The hospital, where I work, initiated the HER mandate many years ago. In this paper, I will discuss the progression and the challenges that my hospital encountered while implementing the EHR mandate.
Electronic Health Record (EHR) is a digital collection of patient health information instead of paper chart that captures data at the point of collection, supports clinical decision-making and integrates data from multiple sources in any care delivery settings. The health record includes patient’s demographics, progress notes, past medical history, vital signs, medications, immunizations, laboratory data and radiology reports. National Alliance for the Health Information Technology defines EHR as, “ an electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be created, managed, and consulted by authorized clinicians and staff across more
This paper will identify the use of Electronic Health Records and how nursing plays an important role. Emerging in the early 2000’s, utilizing Electronic Health Records have quickly become a part of normal practice. An EHR could help prevent dangerous medical mistakes, decrease in medical costs, and an overall improvement in medical care. Patients are often taking multiple medications, forget to mention important procedures/diagnoses to providers, and at times fail to follow up with providers. Maintaining an EHR could help tack data, identify patients who are due for preventative screenings and visits, monitor VS, & improve overall quality of care in a practice. Nurse informaticists play an important role in the adaptation, utilization, and functionality of an EHR. The impact the EHR could have on a general population is invaluable; therefore, it needs special attention from a trained professional.
The EHR is a computerized health record that will take place of the paper chart. The health care information will be available to all health care providers at anytime, anywhere. The record will contain medical history, diagnosis, medications, immunization, allergies, diagnostics and lab results; from past doctors, emergency department visits, school, pharmacies, and out patient laboratories and facilities (Department of health and human services, 2014). Health care providers will be able to access evidence-based tools to aid in decision-making. EHR will also streamline workflow, and support changes in payer requirements and consumer expectations. In 2004, “the HHS secretary, Tommy Thompson appointed David Brailer as the national health information coordinator to provide: leadership for the development and nationwide implementation of a interoperable HIT infrastructure, with the goal of establishing electronic health records...
EMRs provide a common access point where clinicians and health care providers can review and document information about clients and their care. These records are essential to improving efficiency and increasing client safety (Electronic Medical Records, n.d.). Electronic reports are an enabling technology that allows medical practices to pursue more powerful quality improvement programs than is possible with paper-based records (Miller, Robert; Sim, Ida). Clinicians and clients do not have to worry about errors occurring due to the poor legibility of handwritten paper medical records. EMRs facilitate the continuity of care before, during and after hospitalization because all the data in one place. Think of the amount of time and money employees spend on phone calls, emails, and faxes ...
The purpose of the Electronic Health Record is to provide a comprehensive, standardized and universal digital version of a patient 's health records. The availability of a patient 's digital health record provides health information and data for critical thinking and evidence based decision-making, aggregates patient data for quality assurance and research. The Electronic Health Record has been, "identified as a strategy for effectively and efficiently coordinating and maintaining documentation of patients health histories and as a secure method of providing more informed clinical decision making" (MNA, 2006).
The process of implementing an EHR occurs over a number of years. An electronic record of health-related information on individuals conforming to interoperability standards can be created, managed and consulted with the authorized health professionals (Wager et al., 2009). This information technology system electronically gathers and stores patient data, and supplies that information as needed to the healthcare professionals, as well as a caregiver can also access, edit or input new information; this system functions as a decision support tool to the health professionals. Every healthcare organization is increasingly aware of the importance of adopting EHR to improve the patient satisfaction, safety, and lower the medical costs. Studies have implied that, healthcare professionals who practice clinical features through EHR were far more likely to provide better preventive care than were healthcare professionals who did not.
Medical records are already a huge part of the medical industry and pretty soon electronic medical records will be a standard in all doctors’ offices and hospitals. These records are still in the integration process so not all doctors and hospitals are using them yet. There needs to be a way to reassure patients that when they have their information entered into electronic records they are safe and that the people who work with those records are handling them properly. Electronic medical records also need to be protected from outside threats as well as any accident that could occur with software or hardware malfunctions. Medical entities need educating to ensure these records are going to be protected.
Ragavan, V. (2012, August 27). Medical Records Pals Malaysia : 17 Posibble Reasons How Electronic Medical Records (EMR) Might Support Day-to-Day Patient Care. Retrieved from Medical Records Pals Malaysia: http://mrpalsmy.wordpress.com/category/emr/