NR 599 Week 3 Discussion EHRs Benefits and Drawbacks

NR 599 Week 3 Discussion EHRs Benefits and Drawbacks

NR 599 Week 3 Discussion EHRs Benefits and Drawbacks

Part of the stage one requirements for meaningful use criteria is increasing compliance with medication reconciliation (Resnick, et al., 2016). Medication reconciliation can be such an important part of our care as an APRN. Until I worked in home health and sat down with each patient to not only go over each and every medication they are taking including vitamins and supplement but also have them show me how they were taking them each day, I found that almost none of the patients were doing so correctly. Since this experience I make sure to do a full medication reconciliation with each patient and make sure they known the importance of telling their providers of all vitamins and supplement as well. With a proper medication reconciliation we can help to avoid those drug-to-drug interactions.

Resnick, C. M., Meara, J. G., Peltzman, M., & Gilley, M. (2016). Meaningful use: A program in transition.Links to an external site.Links to an external site. Bulletin of the American College of Surgeons, 101(3), 10-16.

The National Institutes of Health defined an electronic health record (EHR) as a digital version of the patient’s medical chart. It is maintained by the health provider and may contain all the crucial administrative and clinical data pertinent to the patient’s care under a specific provider. EHRs are associated with various advantages and disadvantages. The table below outlines the pros and cons of EHRs.

Pros	Cons
Improves quality of healthcare delivery.The EHR enables providers to more effectively diagnose patients, decrease medical errors, and provide safer care (Kataria & Ravindran, 2020).	Potential privacy and cybersecurity issues compromise the privacy and confidentiality of patients’ data (Kataria & Ravindran, 2020).EHR systems are vulnerable to attacks by hackers, which could lead to dire consequences when patients’ data get into the wrong hands.
Promotes quick access to patients’ health records, facilitating more coordinated and efficient care.	EHRs can give inaccurate patient data if they are not updated as soon as new patient information is gleaned.Failing to update patient information in the EHR could result in providers accessing and using incorrect or incomplete patient information (Kataria & Ravindran, 2020).
Provides accurate, up-to-date, and comprehensive information about a patient at the point of care (Kataria & Ravindran, 2020).	High costs are involved in setting up and switching over to a new EHR system in an organization and regularly maintaining the system.
Improves communication and collaboration among providers, thus facilitating care coordination.	Increases the likelihood of malpractice liability concerns for healthcare providers.Liability concerns include how the hospital will ensure crucial medical data is not destroyed or lost when being transferred from paper to electronic records (Kataria & Ravindran, 2020).

Stage 3 Objectives for Meaningful Use

The Stage 3 proposed rule is built upon the framework developed in previous meaningful use stages and continues to foster EHR interoperability. The stage 3 meaningful use objectives selected for further research are: Generate and transmit prescriptions electronically and Actively engage in public health. With respect to electronic prescribing, CMS suggests increasing the upper limit for a menu set objective among eligible hospitals and clinics. Eligible providers should transmit more than 80% of their drug/treatment prescriptions electronically through certified EHR systems (Lite et al., 2020). In addition, more than 25% of hospital discharge medication orders will need to be electronically prescribed. The objective may impact my APN clinical practice since I will be expected to electronically send drug prescriptions to pharmacies to prevent fraudulent prescribing and ensure patient data is secure (Lite et al., 2020). Besides, I will embrace E-prescribing since it is crucial in preventing medical errors and illegal, fabricated prescriptions connected to drug abuse behaviors.

The objective of active engagement in public health builds on the requirements laid down in Stage 2 Meaningful Use regulations. It integrates some flexibilities, improvements, and innovations. In essence, the objective stresses the communication channels between providers, clinical data registries, and public health agencies (Lite et al., 2020). The objective may impact my future APN role in clinical practice since I will be required to engage with public health agencies and clinical data registries actively. Active engagement means that the APN is moving toward submitting production data” to a public health agency and clinical data registry (Lite et al., 2020). As an APN, I will demonstrate active engagement by completing registration to submit data, testing and validation, or production. Furthermore, I will be expected to send electronic public health data meaningfully using certified EHR systems.

References

Kataria, S., & Ravindran, V. (2020). Electronic health records: a critical appraisal of strengths and limitations. The journal of the Royal College of Physicians of Edinburgh, 50(3), 262–268. https://doi.org/10.4997/JRCPE.2020.309

Lite, S., Gordon, W. J., & Stern, A. D. (2020). Association of the Meaningful Use Electronic Health Record Incentive Program With Health Information Technology Venture Capital Funding. JAMA network open, 3(3), e201402. https://doi.org/10.1001/jamanetworkopen.2020.1402

Purpose

The ideas and beliefs underpinning the discussions guide students through engaging dialogues as they achieve the desired learning outcomes/competencies associated with their course in a manner that empowers them to organize, integrate, apply and critically appraise their knowledge to their selected field of practice. The ebb and flow of a discussion is based upon the composition of student and faculty interaction in the quest for relevant scholarship.

Activity Learning Outcomes

Through this discussion, the student will demonstrate the ability to:

Contribute level-appropriate knowledge and experience to the topic in a discussion environment that models professional and social interaction (CO4)

Actively engage in the written ideas of others by carefully reading, researching, reflecting, and responding to the contributions of their peers and course faculty (CO5)

Requirements:

Post a written response in the discussion forum to EACH threaded discussion topic:

As discussed in the lesson and assigned reading for this week, EHRs provide both benefits and drawbacks. Create a “Pros” versus “Cons” table and include at least 3 items for each list. Next to each item, provide a brief rationale as to why you selected to include it on the respective list.

Refer to the Stage 3 objectives for Meaningful Use located in this week’s lesson under the heading Meaningful Use and the HITECH Act. Select two objectives to research further. In your own words, provide a brief discussion as to how the objective may impact your role as an APN in clinical practice.

Adhere to the following guidelines regarding quality for the threaded discussions in Canvas:

Application of Course Knowledge: Demonstrate the ability to analyze, synthesize, and/or apply principles and concepts learned in the course lesson and outside readings.

Scholarliness and Scholarly Sources: Demonstrates achievement of scholarly inquiry for professional and academic decisions using valid, relevant, and reliable outside scholarly source to contribute to the discussion thread.

Writing Mechanics: Grammar, spelling, syntax, and punctuation are accurate. In-text and reference citations should be formatted using correct APA guidelines.

Direct Quotes: Good writing calls for the limited use of direct quotes. Direct quotes in discussions are to be limited to one short quotation (not to exceed 15 words). The quote must add substantively to the discussion. Points will be deducted under the grammar, syntax, APA category.

For each threaded discussion per week, the student will select no less than TWO scholarly sources to support the initial discussion post.

Scholarly Sources: Only scholarly sources are acceptable for citation and reference in this course. These include peer-reviewed publications, government reports, or sources written by a professional or scholar in the field. The textbooks and lessons are NOT considered to be outside scholarly sources. For the threaded discussions and reflection posts, reputable internet sources such as websites by government agencies (URL ends in .gov) and respected organizations (often ends in .org) can be counted as scholarly sources. The best outside scholarly source to use is a peer-reviewed nursing journal.  You are encouraged to use the Chamberlain library and search one of the available databases for a peer-reviewed journal article.  The following sources should not be used: Wikipedia, Wikis, or blogs.  These websites are not considered scholarly as anyone can add to these. Please be aware that .com websites can vary in scholarship and quality.  For example, the American Heart Association is a .com site with scholarship and quality.  It is the responsibility of the student to determine the scholarship and quality of any .com site.  Ask your instructor before using any site if you are unsure. Points will be deducted from the rubric if the site does not demonstrate scholarship or quality. Current outside scholarly sources must be published with the last 5 years.  Instructor permission must be obtained BEFORE the assignment is due if using a source that is older than 5 years.

EHRs Benefits and Drawbacks

Pro	Multiple medical personnel can participate in complex patient care coordination in a more timely manner (Rathert et al., 2019).	Rationale	Results can be communicated in real-time, which provides improved coordination (Rathert et al., 2019). This information is viewed by multiple disciplines of medical staff at the same time.
Pro	Test results and medical information is available through patient portals.  Patients are able to view their results as they become available.	Rationale	There is better patient involvement in the plan of care and better adherence to medical treatment (Rathert et al., 2019). Patients become a part of their treatment plan as they become more aware of what their test results mean.  Patients have the opportunity to have the results in front of them and ask questions to better understand what is going on.
Pro	Electronic health records allow for a more efficient transfer of data across multiple medical settings (Rathert et al., 2019).	Rationale	Being able to see the information from one setting to the next is helpful with continuity of care.  The information on the patient is carried over through the computer system.  If a patient is hospitalized and then has a follow-up at the clinic with their physician, the physician is able to view what occurred during that hospital stay.  The treatment is then carried on from that point.
Con	There can be inaccuracy in the EHR from clinicians not entering their own medical notes (Rathert et al., 2019).	Rationale	It is frequently seen in charting that one physician will copy the note from the previous physician.  Information is repeated and it is often hard to determine what is occurring at that present time.  The symptoms the patient was experiencing the previous day can be repeated the next day although they might not actually be occurring.  This leads to errors in the information.
Con	There can be disruption in direct communication while the clinician is scrolling through information on the computer (Rathert et al., 2019).	Rationale	The clinician is not looking at the patient and is instead looking at the computer.  Non-verbal expressions can be missed which prevents the clinician from experiencing the emotional expressions of the patient (Rathert et al., 2019).
Con	Learning a new computer system can be costly for the facility.	Rationale	The out-of-pocket costs for the hospital can initially have high costs.  The high levels of cost are seen in purchasing the computer program for electronic health records, training the staff and paying for someone to train and support the staff.   Often times ongoing support is needed after the initial training of a new computer system.

                                                               Visit Summary/Clinical Summary

As a nurse practitioner seeing a patient during an office visit, an after-visit summary is to be provided to the patient.  This is to outline what occurred during the visit, the diagnosis and the treatment plan.  The patient can look back to the after-visit summary and see what care was provided and what recommendations were made.  After an office visit, many patients do not understand their diagnosis and treatment, which leads to poor outcomes from not following medical treatment plans (Clarke et al., 2018).  One study by Calkins et al., found that patients forgot about 56% of their treatment plan after leaving an office visit (Clarke et al., 2018).  Therefore, as a nurse practitioner, it is important to provide a detailed after-visit summary for the patient.  Having an understanding of the treatment plan and something to look back to for guidance can lead to better adherence to the treatment plan resulting in better outcomes for the patient.

                                                              Summary of Care for Transfers of Care

As a nurse practitioner, providing a summary of care for patient transfers of care is important for continuity of care. When transferring care from one site to the next, it is necessary for the excepting facility to know what occurred during the previous medical stay.  A clinical picture needs to be made of exactly what the patient has been experiencing through their medical treatment. This helps to show what the patient may need or if they are making progress after the transfer.  There are risks to a patient’s safety when there is a lack of availability of critical results which often leads to unnecessary repetition of tests (Lin et al., 2018). Therefore, as a nurse practitioner, it is necessary to provide detailed information when providing a summary of care for transfers of care.

References

Clarke, Moore, J. L., Steege, L. M., Koopman, R. J., Belden, J. L., Canfield, S. M., & Kim, M. S. (2018). Toward a patient-centered ambulatory after-visit summary: Identifying primary care patients’ information needs. Informatics for Health & Social Care, 43(3), 248–263. https://doi.org/10.1080/17538157.2017.1297305

Lin, S. C., Everson, J., & Adler-Milstein, J. (2018). Technology, Incentives, or Both? Factors Related to Level of Hospital Health Information Exchange. Health services research, 53(5), 3285–3308. https://doi.org/10.1111/1475-6773.12838

Rathert, C., Porter, T. H., Mittler, J. N., & Fleig-Palmer, M. (2019). Seven years after meaningful use: Physicians’ and nurses’ experiences with electronic health records Lippincott Williams and Wilkins. doi:10.1097/HMR.0000000000000168