Over the course of my 11-year career as an inpatient and labor and delivery nurse, I became so accustomed to electronic documentation that I took the practice for granted. It was not until working as a traveling nurse at a paper-based hospital that I began to appreciate the many benefits that electronic medical records (EMRs) provide.

Many nurses across the country are on the verge of experiencing a similar epiphany as hospitals move quickly to qualify for $19 billion in economic stimulus funds designed to increase adoption of computerized medical records. Approximately 1.5 percent of hospitals and 4 percent of physicians in the United States have comprehensive EMRs, according to two recent surveys published in the New England Journal of Medicine.

What I love most about using an EMR is that its archived longitudinal patient information was readily accessible, visible, and transparent at all times. I also like that the EMR enabled multiple clinicians to document and access the same chart simultaneously.

In a paper-based world only one person can chart at any given time. If a physician or medical records employee had the paper chart I needed, I had to personally track down and retrieve it to document the care delivered.

Better and Safer Care

In addition to supporting faster and efficient charting, the EMR enhanced my ability to practice better medicine by providing easy access to medication histories, orders, laboratory test results, and other patient data.

Another way that the EMR assisted me in improving care was its connectivity to medical monitors and devices. As an example, I could better monitor mothers and their fetuses when using the Essentris® EMR™ from San Diego-based CliniComp International. Essentris includes a fetal monitoring recording device that sounds an alarm whenever a fetus’ heart rate accelerates or falls for a certain period during a contraction.

The alarm signals to nurses that the fetus is in distress or suffering from lack of oxygen from possible problems with the umbilical cord. The alarm cannot be turned off at the central nursing station. Nurses must walk to the patient’s room to address the problem and silence the alarm. This level of performance made Essentris the most patient-centered and safest EMR I’ve ever used; other systems easily allow anyone at or passing by the nursing station to shut off the alarm, posing a potential danger to the mother and her fetus.

Overall, Essentris helps provide better care to patients. The system flags potential drug-to-drug interactions. Unlike EMRs, paper records lack such built-in safety features that prevent easily avoidable medication errors from occurring. EMRs also decrease the risk of errors by generating legible electronic prescriptions, sparing me from deciphering physicians’ notoriously bad handwriting.

The technology also supported better and safer care by incorporating the latest standards of care practice. This feature is especially helpful to nurses in the neonatal intensive care unit (NICU) and labor and delivery (L&D) departments.

Every RN must keep up with and document a multitude of care standards, but the challenge is greater for NICU and L&D nurses because the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) routinely develops new standards in association with the National Institute of Child Health and Human Development (NICHD). As soon as AWHONN publishes a standard, paper charts instantly become outdated.

Some hospitals immediately buy revised charts. Others use the obsolete charts until they run out, putting nurses working at these hospitals in the odd position of having provided evidence-based care but being unable to document it in the preprinted paper chart. The inability of nurses to document their adherence to the latest standard of care from AWHOHN can potentially result in duplicate tests, rework, and even place a facility at risk of losing malpractice lawsuits.

Improving Patient Care, Efficiency, and Coordination

Although nurses may not believe it at first, the shift from paper to digital records will be a godsend. Today, nurses are busier and under greater pressure than ever before to deliver care on a timely basis. The national RN shortage, coupled with all the hours spent chasing paper charts and performing duplicate data entry and other non-clinical activities, are factors having a negative impact on their time. An EMR will ease that burden by improving the efficiency of nursing workflow in several ways:

• Eliminating time wasted on inefficient documentation processes and rework. Essentris, for example, has comprehensive flowsheets covering nearly everything that can go wrong with a patient. This functionality saves considerable time because nurses no longer have to write the long narratives that were part-and-parcel of a paper chart. They simply check off options from pull-down menus. The only time they will compose lengthy notes in an EMR is when patients experience unusual problems or are in unstable condition.
• Decreasing physician requests for patient information. Because doctors can securely access data within the hospital or over the Web from any location at anytime, nurses have more “face time” and thus higher quality interactions with patients.
• Reducing rework. In a manual environment, nurses routinely write down the services completed for patients on paper. They constantly stuff pieces of paper in their pockets, and if paper is not available or within easy reach, they hurriedly write on hands and arms. Either method is problematic. Like everyone else, nurses may not be able to interpret their handwriting – it is always easier to read a note soon after it is written than hours afterward. Although nurses may have every intention of entering the information on the chart as their first availability, the reality is that they are likely unable to do so, given the unexpected distractions and variables to patient care that can and will happen. Nurses also will have a hard time remembering or recreating what had taken place earlier. Thanks to EMR charting being performed in realtime, nurses will never experience those problems.
• Improving accuracy, thoroughness and timeliness of documentation. When tending to the patient, it is not usual for nurses and doctors to make decisions based on incomplete information. Other clinical team members usually do not have time to record performed tasks. And, caregivers sometimes will complete the chart the next day instead of at the end of their shift. When this happens, a hospital has no method of accurately knowing when data was entered into the chart. All of this can hurt the organization’s ability to defend itself against a malpractice lawsuit. With an EMR, however, every caregiver’s footprint or action is readily visible through audit trails.

Nurses can benefit from EMRs when a hospital moves to minimize verbal orders by either requiring or making the automated process easy for physicians to enter the orders themselves. The results are fewer errors resulting from miscommunication between nurses and doctors and more time for patient care.

Another EMR benefit is the improved interdisciplinary collaboration. When a hospital connects electronic records between the high acuity and inpatient areas, it facilitates cross-department communication, coordination, and efficiency among nurses, physicians, occupational therapists, speech therapists, nutritionists, and other healthcare professionals involved in the patient’s treatment plan. For example, Essentris can be configured to automatically print out a physician order for a respiratory therapist to visit a patient, speeding up consultations, treatment, and blood gas readings. A respiratory therapist can document completing their assignment in the EMR, letting clinicians know the task was done.

Learning Curve

While an EMR offers multiple benefits, the technology requires nurses to make adjustments. Still, the learning curve is not as steep as nurses perceive.

As both a trainer for EMRs and former user of EMRs, I’ve noticed that the biggest misconception is the technology will radically change workflow and adversely affect patient care. In fact, the opposite is true: first, the software changes documentation practices, not the practice of nursing. Second, rather than stealing time away from patient care, an EMR helps RNs increase their time with patients and complete their job within regular work hours.

Some nurses blame their lack of desire to adopt an EMR on poor typing skills and computer experience. A colleague once declared she was retiring upon learning our hospital was replacing paper with electronic records. Well, she took typing and PC lessons to brush up her skills and did not encounter any major problems when the EMR was rolled out. My colleague epitomizes the fact that everyone is anxious about changing the way they’ve worked for years. Whenever an organization moves to install an EMR, the initial reaction runs the gamut from enthusiasm to fear.

After users gain experience and become comfortable with an EMR, the fear, which typically stems from poor computer skills, disappears. Nurses end up embracing the tool because they discover it is easy to use, does what they want it to do, and, more importantly, helps them improve patient care. They often tell me, “I love this system! It makes my job easier. I will never go back to paper again.”

My advice to nurses whose organizations are preparing to invest in EMRs is to be patient. If nurses can exchange e-mails, they can use an EMR. It will not be long before they look back and laugh about how worried they once were in making the switch.

I urge every nurse to take advantage of the opportunity to help their hospital evaluate, select, and implement EMRs. Every facility will solicit and gladly accept input from nurses, giving them a chance to help design and choose a system that meets their specific needs.

By enabling us to chart at the bedside in realtime, get easy access to data, and eliminate rework and administrative hassles, an EMR permits nurses to do what we love – take care of our patients.

— Cristina Womack, RN, is a clinical analyst at San Diego-based CliniComp International. In this role, she trains nurses to use CliniComp’s Essentris EMR. Over the course of her career, Womack has used several electronic medical records systems while working as a pediatric med-surgical, operating room, labor and delivery, and neonatal intensive care unit nurse. Other questions and comments can be directed to editorial@therapytimes.com.