definition, advantage of EHR, disadvantage of EHR, component, challenges of EHR, impact of EHR on care, EHR adoption model, stage of EHRAM framework, EHR system in clinical practice, use of EHR in nursing practice, future recommendation on EHR.

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HEALTH INFORMATIC AND TECHNOLOGY OF NURSING
UNIT – 4 (B) & SHARED CARE AND ELECTRONIC HEALTH RECORD
PREPARED BY DOLISHA WARBI

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m
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ELECTRONIC HEALTH RECORD
DEFINITION:
v Electronic health record, is the electronic version of the client data
found in the traditional paper record.
v EHRs are defined as “a longitudinal electronic record of patient health
information generated by one or more encounters in any care delivery
setting”.
EHRs contained wide range of patient information, including medical
history, diagnosis, allergies, medications, laboratory and emergencies
resolve treatments, planned, and other health related information. This is
required for improvements the health of the patients in the hospitals and
clinics.

3. ADVANTAGES OF EHRs:
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1. Better quality of patient care
2. Better emergency care
3. Security to patient data
4. Reduction in medical error
5. Increases efficiency and productivity
6. Cost saving.
7. Better communications and coordinations of care.
8. Improve patients engagement.
9. Better data management
10.Compliance with regulation.

4. DISADVANTAGES:
1. Required more time in data entry.
2. Reduce productivity
3. Need expensive software and computer purchase.
4. Software maintenance is required.
5. Depends upon reliable operation.
6. Needs education and training of the staff.
7. Governance, privacy and legal issues.
8. Records that are exchanged over the internet are subject to the same
security concerns as any other type of data transaction over the internet.
9. User resistance toward the EHRs.
10. Legal and regulatory challenges. Eg. Privacy, security, and reporting.
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5. COMPONENT:
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COMPONENT
Clinical
documentation
Patient portals
Patient
demographics
Health maintenance
reminders
Clinical decision
support

6. Cont..
PATIENT DEMOGRAPHICS:
Contains information about patient, including name, date of birth, address and
contact information.
CLINICAL DOCUMENTATION:
Include all the patients documentation such as medical history, diagnosis,
treatment plan, medication lease, test results, and imaging report, etc.
CLINICAL DECISION SUPPORT:
It provides real time information about patient health status, including alert and
notification related to medication, interaction, allergies and clinical guidelines.
ORDER ENTRY / MANAGEMENT:
It involved entry order for medication. And procedures, and track their progress in
real time.
RESULT MANAGEMENT:
It include assess and manage patient test result, including emerging studies,
laboratory results and other diagnostic tests.
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7. Cont..
CLINICAL MESSAGING:
It involves a secure messaging between health care provider and patient, allowing
for efficient communications and collaboration in the care process.
PATIENT PORTALS:
It allow a patient to assess their health information, schedule appointment,
request medication refills, and communicate with their healthcare provider.
REPORTING/ANALYTICS:
Give the health care provider the ability to generate report and analyze a patient
data to identify trends and opportunities for quality improvement.
CARE PLAN:
Include summary of patient care, medication, treatment, follow up appointment.
PATIENT – GENERATED DATA:
Included patient record data, Such as blood pressure recording, glucose level, or
exercise logs.
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8. Cont..
MEDICATION LIST:
Including all the medication list which patients is taking, dosage, frequency, and
route of administration.
ALLERGIES:
Including all the allergies reaction by the patient toward medications or any
allergies experiences by the patient.
IMMUNIZATION:
Including patient records for immunizations type of vaccine and date of
administration.
CLINICAL NOTES:
It includes progress notes, consultation notes, and discharge summaries.
HEALTH MAINTENANCE REMINDERS:
It includes reminders for routine health maintenance activities such as screening,
immunization, and preventive care.
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9. CHALLENGES OF EHR:
.
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CHALLENGES
TRAINING
USER
ADOPTION
INTEROPERABI
LITY
LEGAL AND
REGULATORY
ISSUES
COST
WORK FLOW
DISRUPTION
DATA
SECURITY AND
PRIVACY

10. CONT..
COST:
System can be expensive, ongoing maintenance and upgraded can also added to
the cost.
TRAINING:
The system need to be trained by the staff so it can also required a professional
trainer, to initiate the training.
USER ADOPTION:
Healthcare provider and staff may be resistant to use an EHR system as they are
on the paper based systems or other technology. It may be difficult for them to
adopt the new system.
INTEROPERABILITY:
EHR system from different vendors may not be able to communicate or share data
effectively, which can leads to information silos and limit the usefulness of the
EHR system.
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11. CONT..
DATA SECURITY AND PRIVACY:
EHRS contains sensitive patient information, healthcare organization must take
step to ensure the security and privacy of the data. This can be challenging.
WORKFLOW DISRUPTION:
Implementing an EHR system can disrupt clinical workflow, which can be difficult
to manage and be negatively impact patient care.
LEGAL AND REGULATORY ISSUES:
Healthcare organization must comply with various legal and regulatory
requirements related to EHRS, which can be complex and time consuming.
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12. IMPACT OF EHRS ON CARE:
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Improve quality and safety of
care.
Improve public health monitoring.
Increase efficiency and
productivity.
Better communication and
coordination of care.
Improve patient engagement.
Better data management.
Improve compliance with
regulation.

13. ELECTRONIC HEALTH RECORD ADOPTION MODEL (EHRAM):
The Electronic Health Record Adoption Model is a framework developed by HIMSS
analytic measure. The levels of adoption and implementation of electric health
record by health care organization.
The EHRAM framework has eight stages with stage ‘0’ being the lowest level of
EHR implementations on stage “7” being the highest level of EHR implementation.
The EHRAM framework is used by healthcare organization to assess their current
level of EHR implementation and to identify area for improvement.
The EHRAM framework is has been widely adopted by healthcare organization
around the world as a standard for measuring EHR implementation progress.
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14. Cont..
STAGES OF THE EHRAM FRAMEWORK –
There were 8 stages of the EHRAM framework;
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1. Stage 0. No EHR implementation.
2. Stage 1. Ad hoc EHR implementation.
3. Stage 2. Structure EHR implementation.
4. Stage 3. Clinical decision support.
5. Stage 4. Clinician documentation.
6. Stage 5. Closed- loop medication administration.
7. Stage 6. Electronic clinical quality.
8. Stage 7. Complete electronic patient record.

15. EHR SYSTEM IN CLINICAL PRACTICE:
EHRs Provide a location for storing and retrieving patient health information.
EHRS are designed to improve the quality safety, and efficiency of patient care by
providing health care with immediate access to patient information including medical
history, diagnosis, lab result, medication, and treatment plans.
Some example involved;
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Assessing patient
information;
qIt is uses to assess and review patient information
such as medical history, allergies, and medication for
accurate diagnosis and treatment planning.
Documenting patient
encounter;
qProvider Use EHRS to document patient encounters,
including diagnosis, treatment, and follow-up care also
documenting in real times, and estimate the needs for
the paper chart.

16. Cont..
.
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Ordering tests and
medication;
qOrder test and medication for their patient is provided,
also can alert provider to potential drug interaction, or
other contraindication that may impact patient safety.
Sharing patient
information;
Analyzing patient
data;
qProvider use EHRS to share patient information with
other providers such as specialist or primary care
physicians It facilitates communication and
collaborations between healthcare provider, improving
patient outcome and reducing medical error.
Providers can assess to a large amount of patient data.
Allowing them to analyze trend and pattern in patient
health. This is used to improve patient care and identify
areas for quality improvement.

17. USES OF ELECTRONIC HEALTH RECORDS IN NURSING PRACTICE:
.
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USES
Facilitation of
research &
quality
improvement
Increased
efficiency
Enhanced
communication
and collaboration
Improved
patient safety
Improved
access to
patient
information

18. Cont..
1) Improve assess to patient information: It provide nurses with an instant access
to comprehensive patient information, including medical history, medication list,
test results, and care plan. That will help the nurse to make informed decision
about patient care and ensure that they have the most up to date information
available.
2) Increase efficiency: EHRS can help in the workflow of the nurses by eliminating
the needs of the paper based documentation and reducing duplications of effort.
This is more efficient and productivity allowing them to spend more time with
patient and providing higher quality care.
3) Enhance communication and collaboration: It provides a centralized location for
patient information by making it easier for the nurses to communicate and
collaborate with other member of the healthcare team. This can help to improve
coordination of care and enhance the patient outcome.
4) Improve patient safety: Its help to improve patient safety by reducing the risk of
identification potential drugs interaction, and providing alerts for potential
adverse event.
5) Facilitation of research and quality improvement: It uses to collect and analyze
the data on patients outcomes, which can be used to improve the quality of care
and support research effort. This helps to bring the improvement in nursing
practice and patient care.
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19. FUTURE RECOMMENDATION ON EHR:
Some of the future recommendation on EHRs system involves;
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FUTURE
RECOMMENDATION
ON EHRs
Enhances
interoperability
Improved data
analytics
Enhance patient
engagement
Standardized data
Improve
cybersecurity
developed
artificial
intelligence
capabilities