Making the case for electronic health records

By
Pam Brainerd
Carla Brown
Kelly Bustos
Jonathan Butler
Camille Herrmann

2005: George Bush calls for Electronic Medical
Records for every American.

2009: Barak Obama states every American
should have an EMR by 2014.

The thought was that EMR’s would improve healthcare, cut costs, and
promote efficiency, revolutionizing the industry.

What is an EMR?

“An electronic medical record (EMR) is
a digital version of the traditional
paper-based medical record for an
individual”
(http://whatis.techtarget.com/definitions/electronic-medical-
record.emr.html)

EMR’s can be the electronic record at one facility, or can be shared by facilities.

Some EMR’s are owned by the individual, so no matter where he or she goes,
the record goes too.

EMR’s can include all of the health information pertaining to a person or a visit.
This can include vital signs, age, height, weight, lab results, testing results, MD
Orders, and pharmacological information.

Why the big push for electronic records?
What’s wrong with the paper version?

-paper records no longer meet the needs of the industry
or it’s consumers.
-only one person can access paper records at any given time.
-paper records cannot include diagnostic studies.

Positives of EMR’s:
-can integrate patient information into one record
-can improve the quality of health information
-contains cost
-decreases wait time
-increases productivity
-improves patient satisfaction
-multiple disciplines can access
the same information at the same
time.

With paper records no longer satisfying the needs, and the push by politicians
to create an electronic record for every person, funding has been dispersed,
vendors have created programs, and more and more facilities are making the
transition from paper to electronic records.

To emphasize the difference that an electronic record can make for a patient,
we will follow an individual in an emergency room visit in two scenarios:
1. paper-based emergency room visit
2. electronic records-based emergency room visit

Emergency Room Visit Using non-EMR


Patient comes to ER with complaints of:
• Nausea
• Vomiting
• Headache
• Diarrhea

Once the patient is called to the
triage area, the nurse will
complete:

•Patients demographic info
•Vital signs
•Allergies
•Home medication list
•Advance directive/emergency contact
info
•Patient’s signs and symptoms

All information will be charted on a paper
flow sheet and passed on to the physician
to see the patient in the exam room


• Once all information has been entered and
the physician has seen the patient, the
physician will then make a diagnosis and
make orders for labs and meds to have the
nurse carry out.

Emergency room visit using non EMR

•After Physician and RN make initial
assessments the Physician will now write
orders.
•The RN must interpret the hand written
order by the physicians and any other
RNs involved in the care.
•The assessments and orders must be
legible


• Physician will hand write
orders for each department in
which tests are needed.
• RN will then call each
department informing of new
orders and new patient.
• Laboratory
• Imaging
• Pharmacy
• Bed openings if necessary.
• Dietary if admitted


• Laboratory
• Phlebotomist will hand write labels or
type with patients name and room
number.
• Phlebotomist will have RN sign that blood
draw occurred and receive a copy.
• CMP, CBC, PT, PTT, vial will be drawn
with type and screen and copy of order.


• Imaging
• X-ray, CT, Ultrasound,
MRI have been notified by
RN as needed per order.
• BUN, Creatinine clearance
entered by RN in nursing
notes per order.
• IV site, size and location
per order and put in note.

Emergency visit using non EMR

• Pharmacy
• Home medications listed on
medication sheet.
• Allergies are listed.
• Pharmacist is given patients weight
for correct dosing.
• Dosage, route and time per order
called or faxed to pharmacy.


• Nursing Orders are placed in nursing
notes per physicians orders.
• Foley Catheter and NG tube placement
entered into nursing notes.
• I&O entered in nursing notes and written
on I&O sheet.
• D5NS @125cc/hour stared per MD order
and written in nursing notes.

From the patients point of view:
• Time from triage to testing was two hours.
• Time from testing to MD telling diagnosis: 1 ½
hr.
• Time from diagnosis to interventions: one hour.


• Bed Placement.
• RN notifies supervisor of need
for bed.
• Acuity level, Isolation status and
if male or female is all written
down in nursing notes as being
performed per MD orders.

Emergency visit using non EMR
• Dietary
• Nurse instructs food service if patient
is admitted. Pt is NPO; no tray.
• Any food allergies.
• Religious dietary food restrictions if
any.
• What type of diet, regular,
mechanical soft, pureed, thickened
or non thickened liquids.
• If tray needs to be sent up. All
information is written in nurses notes
and on dietary request.
Jones, J. (2012). Personal Communication.


• Nurse will complete
assessment and information
she/he gathered from patient.
• MD will finish any information
or further orders in chart.
• All information is handwritten
in chart.
• Time from interventions to
admission: two hours.

Patient transferred to inpatient
bed.
Total patient care time in Emergency
Room: 6 ½ hours.
Now we follow this patient in a facility
that uses Electronic Records.

Emergency room visit using EMR


Patient presents to ER with the following
complaints:
• Nausea
• Vomiting
• Headache
• Diarrhea

In triage, the RN would document in EHR:

• Patient’s demographic information
• Allergies
• Home medication list
• Advance directive/emergency contact
information
• Patient’s sign and symptoms
• Patient identification wristband printed

• After RN completes
the triage
assessment, patient
will be taken to the
examination room
where MD will
visualize the
patient’s EMR

• MD would examine the patient and enter the
appropriate Computerized Physician Order Entry
(CPOE).

Orders would be generated in each
department’s task list such as
• Laboratory
• Imaging
• Pharmacy
• Nursing
• Bed placement (if necessary)
• Dietary (if admitted)

Laboratory

• CBC, CMP, PT, PTT, type
& screen. Labels printed
automatically in lab.

• Phlebotomist notified
immediately to draw
specimen via pager.

Imaging

• X-ray, Ultrasound, CT, MRI notified depending on MD
orders. Mandatory input fields for IV size & location,
allergy information, lab values for BUN, Creatinine
clearance.

Pharmacy

• Home medications listed on the medication
reconciliation screen.
• Allergies shown
• Safe dosage according to weight assured by
pharmacist.
• Timed doses of medication prompted by EHR.

Nursing Orders

• Nursing orders appear on the task list
as they are entered by the MD.
• Strict I &O
• Foley catheter
• Insert NG tube
• NPO except medications
• Start D5NS @ 125cc/hr

From the Patient’s Point of View:
• Time from triage to testing: 45 minutes
• Time from testing to MD telling diagnosis: 30
minutes.
• Time from Diagnosis to Interventions: 20
minutes.

Bed Placement

• Notifies nursing supervisor of need for bed.
• Acuity level
• Isolation status
• Male or female patient

Dietary

• Instructs food services to
not send a tray (if admitted)
• Food allergies and
sensitivities displayed
• Religious dietary restrictions
observed
• Food consistency orders
depending upon swallowing
ability followed.

MD would complete patient’s H&P on his or desk while
orders are being carried.
Time from interventions to admission: 1 hour, making total
time in the ER 2 hours and 35 minutes.

Conclusion
It is evident that electronic records
improve many aspects of patient care.
1. The patient is seen and examined more
quickly.
2. Diagnostic studies are completed in a timely
manner.
3. Results are uploaded, and diagnosis made.

Conclusion
The patient in this scenario experienced relief
much more quickly in the electronic version of
the visit than in the paper version.

Conclusion

The plan mandated by politicians for every
American to have an EMR by 2014 is a lofty goal,
but very much worth the effort.
• EMR’s will improve patient satisfaction
• EMR’s will cut costs
• EMR’s will improve work flow and efficiency

Conclusion
• If you were the patient in this scenario, which
visit would you have preferred to encounter?
The paper visit? Or the Electronic Record
Visit?

References
Bernd, D. L., Fine, P. S. (2012). Electronic Medical Records: A Path Forward. Frontiers of Health Service
Management, 28 (1), 3-13.

Eisenberg, S. (2010). Electronic Medical Records-Life in the Paperless World. ONS Connect, 8-11.

http://whatis.techtarget.com/definitions/electronic-medical-record-erm.html.

http://www.emrandhipaa.com/emr-and-hipaa/2009/1/14/obama-wants-full-ehr-by-2014.

Nicholson, S. (2011). Electronic Medical Records and You. Risk Management, 46-49.

Making the case for electronic health records

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