Running head: ELECTRONIC MEDICAL RECORDS 1

Utilization of Electronic Medication Records

Melissa H. Towe

Delaware Technical Community College

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Utilization of Electronic Medication Records

Electronic Medication Records (EMRs) are a valuable tool in patient care right now. The

process of medication administration is one of the riskier things that nurses do on a daily basis.

The medication administration process can be improved with use of EMRs as this technology has

the ability to improve patient safety, nurse efficiency, and patient/nursing satisfaction. EMRs can

also reduce wastefulness thus improving overall cost/resource efficiency. The following will

discuss the benefits as well as the risks of EMR technology, the logistics of implementing EMRs

into a facility, and a policy relating EMR usage to providing evidenced based patient care.

EMRs require programs, software, and of course internet connection to run properly. The

computerized program aspects of EMR technology offer the most impressive benefits. One of

these programs is known as computerized provider order entry (CPOE). “Computerized

provider order entry directly affects many facets of a health care facility and provides

communication among every member of the care team, including team members who are both

onsite and offsite” (Ghaemmaghami, 2014, p. 683). The most important benefit of CPOE is

that it eliminates the risk of medication errors related to illegible handwritten orders by

allowing physicians to physically enter their own orders electronically (Ghaemmaghami,

2014). CPOE also improves patient outcomes by diminishing delays in medication

administration and diagnostic testing, and allowing for actual-time documentation and chart

review (Ghaemmaghami, 2014). CPOE is now included as a government advocated patient

safety initiative that when utilized properly, will result in “improved quality of care, increased

patient safety, and streamlined patient care processes” (Ghaemmaghami, 2014, p. 685).

Another important program in EMR technology is a clinical decision support system

(CDSS). CDSS is a program that produces system alerts such as patient drug allergies or
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medication interactions (Oliveras et al., 2017). While it can be argued that this is a task nurses

are already responsible for doing, the alerts from a CDSS prove to be a guaranteed additional

security check.

EMRs may have several advantages but they do not come without risks. Maintaining the

security and confidentiality of patients’ medical records and health information is a huge risk

with EMRs. “Most of us are aware that the risk to privacy of any information increases

exponentially with each additional person whom we tell” (Thede, 2010, para.1). This is no

different in the case of EMRs and patients’ health records. One benefit to EMRs is the ease of

access; information can be made available and shared between various health care providers with

little difficulty. Health care providers utilize this to share information between themselves, other

providers, insurance companies, billing personnel, and many more. Benefits to sharing this

information include but are not limited to: continuity of care between providers, reduction of

duplicate testing, and more thorough/up to date care for patients. The risk however, is that the

information that is shared electronically will be “permanently engraved in cyber world,” which

means that you can never truly remove or erase it (Thede, 2010, para. 1).

In 2003, the Health Insurance Portability and Accountability Act (HIPPA) established

guidelines and tools to govern the sharing of patients’ health information (Thede, 2010). One of

the tools are electronic systems auditing trails, which record who has accessed the records and

what information was accessed (Thede, 2010). Auditing trails are effective when they are

implemented correctly. However, audit trails must be regularly monitored by someone who is

“independent of any administrative oversight” (Thede, 2010, para. 4). When audit logs are

monitored by someone who could benefit from hiding a violation, the process falls apart. An

example of this is when a patient is also an employee of the hospital… access to an employee’s
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medical records might contribute to hiring/firing decisions which is unethical but also possible if

auditing tools are not utilized properly (Thede, 2010).

President Obama’s American Recovery and Reinvestment Act, specifically the Health

Information Technology for Economic and Clinical Health Act (HITECH) of 2009 acted as an

extension of HIPPA laws in regards to electronic health records (Thede, 2010). The HITECH Act

states any “entity that maintains electronic health records has to account for disclosures for

purposes of treatment, payment, and business operations for three years prior to the date of the

request” (Thede, 2010, para.6). These laws forced the hands of all business associates with

access to health records to comply with HIPPA, and opened the doors for patients to view who

had accessed their health records and what they were accessed for. Information security can be

difficult to protect whether on paper charts or through electronic health records. To access a

paper chart a “white coat and a badge” will grant information access, but to access an EHR all of

that, plus a username, and a password is required (Thede, 2010, para. 3).

Nurses can contribute to protecting patients’ information by practicing good computer

etiquette. Leaving patient’s information up on computer screens when they step away, allowing

co-workers to use their login information, and looking at more information than is needed for

their duties are all violations of patient information security/privacy. Protecting patient

information protects the nurse as well; when nurses fail to protect patient information HIPPA

violations and legal consequences can and should occur. For nurses, simply being mindful of

surroundings, and using technology appropriately can truly make a difference in protecting

patient information. EHRs will never be 100% safe but the benefits do outweigh the risks when

the systems are utilized correctly (Thede, 2010).

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Implementing EMRs is a process that requires a lot of prior planning and constant

ongoing evaluations. The process itself should have a mandatory implementation policy in

order to prevent it from failing. The first step in implementing computerized systems is

known as standardization or simplification, in which an to attempt is made to make the current

paper templates match a new electronic system’s layout (Shah, 2011). This would be a quality

first step in an implementation policy for EMRs as it can ease the eventual transition to the

computers. Nurses will be well familiarized with the forms and how to document on them.

The next step would be to assess employee computer literacy, and ensure that all staff are

prepared to make the change to technology systems (Shah, 2011). This can be done in simple

trainings and through the utilization of staff member “superusers” who have advanced

computer literacy skills and have demonstrated proficient understanding of the new system

(Celia & Rebelo, 2015, p.8). These superusers should be utilized to help on the floor before,

during, and after the implementation of EMRs to support staff during the change. Staff should

also be given appropriate time to practice with the new system in an environment that has no

risks/consequences.

The implementation of EMRs are backed by government initiatives because they support

and provide evidenced based patient care outcomes. Initially, EMR benefits include “better

patient care coordination and disease management, fewer medical errors, increased productivity,

and the reduced costs which could result if all of these objectives were achieved” (Hayes, 2015,

para. 4). In the long run, EMRs can yield even more benefits such as “more targeted public

health initiatives; more effective preventive health measures; personalized, predictive medicine;

significant reductions in national health expenditures… and ultimately a healthier society”

(Hayes, 2015, para. 4). Unfortunately, these benefits are not free, and while they may improve
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productivity/efficiency, ultimately they are costly. “Implementing an EMR system could cost a

single physician approximately $163,765” (Hayes, 2015, para. 2). The upside to these costs are

the potential for grants and incentives. The government is supportive of EMR usage and the

benefits directly associated with it. The Centers for Medicare and Medicaid Services (CMS) has

already paid over 30 billion dollars in incentives to support the implementation of EMRs (Hayes,

2015). While implementing the process may be expensive, there are ways for a facility to receive

financial assistance, grants, and incentives.

In conclusion, informatics has an important role in nursing as “hospitals are

increasingly turning to information technology solutions to address issues such as medication

errors and handwriting illegibility and to guide providers in using evidence-based practices

and improve the accuracy of patient care” (Ghaemmaghami, 2014, p. 683). While medication

errors will never be completely avoidable, EMRs with programs such as computerized

physician order entry (CPOE), and clinical decision support systems (CDSS) offer the best

chance at decreasing them. With use of EMR technology, evidenced based care is provided to

patients in a multitude of ways.

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References

Celia, A., & Rebelo, D. (2015). Sustaining the Human Experience in a High Tech

Environment: EMR Implementation. MEDSURG Nursing, 24(2), 8–9. Retrieved from

http://search.ebscohost.com.libproxy.dtcc.edu/login.aspx?direct=true&db=hch&AN=1

02472730&site=ehost-live

Ghaemmaghami, V. (2014). Computerized Provider Order Entry: Advancing Technology

Today, Saving Lives Tomorrow. AORN Journal, 100(6), 683–685. https://doi-

org.libproxy.dtcc.edu/ 10.1016/ j.aorn.2014.09.005

Hayes, T. (2015). Are Electronic Medical Records Worth the Costs of Implementation? Retrieved

from https://www.americanactionforum.org/research/are-electronic-medical-records-

worth-the-costs-of-implementation/

Shah, S. (2011). Prepare Your Practice for an EMR. Journal of Surgical Radiology, 2(2), 120–

121. Retrieved from

http://search.ebscohost.com.libproxy.dtcc.edu/login.aspx?direct=true&db=a9h&AN=6

0145142&site=ehost-live

Thede, L. (2010). Informatics: Electronic Health Records: A Boon or Privacy Nightmare? Online

Journal of Issues in Nursing, 15(2), 8. https://doiorg.libproxy.dtcc.edu/10.3912/OJIN.Vol

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Vicente Oliveros, N., Gramage Caro, T., Pérez Menendez, C. C., Álvarez, D. A. M., Martín,

A. Á. S., Bermejo Vicedo, T., & Delgado Silveira, E. (2017). Effect of an electronic

medication administration record application on patient safety. Journal of Evaluation

in Clinical Practice, 23(4), 888–894. https://doi-

org.libproxy.dtcc.edu/10.1111/jep.12753