Running head: ELECTRONIC HEALTH RECORDS IN NURSING 1

Electronic Health Records in Nursing

Mariah Mollman

University of Saint Mary

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Abstract

Electronic health records (EHRs) are being used more frequently in the medical setting in replace

of paper health records (PHRs). EHRs make it easier on health care providers (HCPs) to chart

patient information in a more organized way. Patient’s records are available for all authorized

HCPs at all times making it so patient information is easily accessible and can be update

regularly. There are many benefits to using EHRs but there are still certain disadvantages that

need to be worked out in order to give patients quality care. EHRs are beneficial to both the

HCPs and the patients involved.

Keywords: electronic health record, paper health records, health care provider
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Electronic Health Records in Nursing

When working in health care professions it is important to remember that the main goal is

to help the patient. Helping a patient can be done in many different ways. The patient should feel

safe, comfortable, and provided for while in the care of a health care professional. Some

techniques in accomplishing this safe, comfortable, provided for feeling can be as great as

finding a new treatment plan that works for the patient, or as simple as finding a pillow that takes

away even an ounce of pain. No matter how small of a benefit the technique is, it is still a benefit

and progressing in the right direction. If there is a new technique out there that can give a patient

better care than what was being given before then, health care providers (HCP) should be willing

to give it some consideration. One technique that is giving many people questionable thoughts is

the technique of implementing electronic health records (EHRs) in all medical settings. In this

paper the topic of EHRs and the benefits health providers and patients receive will be discussed

along with how EHRs can be improved to continue to give patients the best quality care.

According to Potter, Perry, Stockert, and Hall (2017) EHRs are beneficial because EHRs

are inexpensive and will improve the quality of patient care. Being both inexpensive and quality

care are two of the patient’s major concerns. Some patients may often feel as if the option is

between one or the other but that having both, inexpensive and quality care, is impossible or

wishful thinking. With EHRs patients can soon understand that a health provider’s main concern

is that the patient’s needs are being fulfilled. Along with focusing on a patient’s concerns, EHRs

can help bring forth the patient’s chief complaint and keeping it as a priority for the care of the

patient while also monitoring the patient’s information as a whole. That way the patient’s main

complaint can be focused on while lowing anxiety and keeping other complaints under control.

The purpose of EHRs is to combine all of the patient’s information into one file on a
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computer; this includes the patient’s health history, laboratory results, nursing care plans and

much more (Rose, Richter, & Kapustin, 2014). EHRs make it easier and quicker to access a

patient’s information than paper health records (PHRs), having all of the patient’s records in one

location. Whereas, with PHRs a health provider may need to search multiple locations to find

certain patient information or call another health provider to get information collected by that

provider in the past. Another way that PHRs lack convenience is that EHRs are able to take a

picture of a wound and show, overtime, the healing process (Potter et al., 2017). Being able to

take pictures instantly and uploading the image directly saves time and effort for the health

provider so that other tasks can be started even quicker. EHRs are also useful by alerting the

HCP of patient needs (Peacock-Johnson, 2016). By alerting a HCP it may help certain

responsibilities to be taken care of on time, for example, this patient needs a specific medication

at a specific time of day and if receiving the medication is offset then it can interfere with the

patients care. EHRs make it easier on health providers to remember responsibilities that may be a

necessity for the patient.

Another benefit of EHRs is that it makes it extremely difficult to misplace anything.

Charts cannot be out of order and client information should not be easy to lose due to saving the

information onto a database. The more accessible the information, the quicker and easier it will

be to have important knowledge of the patient and the situation in order to provide the best care

for the patient. A physical advantage to using EHRs would be the possibility of having the

patient’s records on a tablet or cellular phone (Vélez et al., 2014). Having a portable system can

help HCPs when the patients are spread out, enabling the HCP to move from one location to

another, using EHRs is much easier when moving around than PHR (Vélez, Okyere, Kanter, &

Bakken, 2014). This way the health provider has the option to go where the patient is at instead
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of having the patient move. Having the option to move is great for the health provider especially

in case of an emergency and the patient is incapable of moving, having PHRs makes it difficult

to bring the information that is needed to the site and can make emergency situations even more

problematic.

Poor handwriting is one of many downfalls to PHRs (Rose et al., 2014). Poor

handwriting can be the difference between the abbreviations mg (milligrams) and mcg

(micrograms), when the handwriting is unclear it could cause many problems for the future or

even cause a patient his/her life. EHRs make it easier so that others can clearly read what the

order is asking and most programs will have a Spellcheck program in order to detect any human

errors, another reason to double and triple check before submitting a report on the patien

Charting and giving orders using EHRs can result in better outcomes than when using PHRs.

Many nurses and physicians tend to have multiple responsibilities to take care of all at once;

causing HCPs to chart quickly and move to the next task. In the Rose et al. (2014) study patients

thought when providers had to re-ask questions with PHRs it showed that the provider was

incompetent. Having to re-ask the same question on multiple occasions due to not being able to

find the answer from the past showed that the health provider was not organized and lacked

information that would give the patient the best care. There are many different ways to chart and

some health care locations have guidelines on how to chart. Charting errors can be detrimental to

a patient’s care and/or health.

Using EHR benefit HCPs by making charting easier, and also making it so patient

information is more accessible. Searching for information is made easy on electronics; all that

needs to be done is to use a search function and input key words of the information that is needed

(Rose et al., 2014). By making the job easier on the HCP, the outcome will be to help the
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patients to feel that the best care is being given. Another benefit of EHRs is that it is consistent

and convenient. In EHRs all of the patient’s information is in one location and, depending on the

computer program, the templates are the same throughout the system (Rose et al., 2014). This is

a positive attribute for when a HCP needs to acquire about the patient. Having everything in one

location includes the patient’s health records from the past and present (Potter et al., 2017). This

gives the health provider background information on the patient and also helps the patient

receive ongoing management on past problems. The templates are convenient because it makes it

more difficult for a nurse, or any HCP, to forget important information while charting. EHRs

lessen the complexity of tasks because of the organization of the electronic format, which leads

to a better-guided interaction between the patient and the health provider (Rose et al., 2014). The

templates should have sections to complete, and some programs may even make it so that the

program cannot be exited without completing necessary material, for an example, vital signs.

EHRs give nurses the ability to communicate with other health providers more easily and

efficiently (Gomes, Hash, Orsolini, Watkins, & Mazzoccoli, 2016). According to Peacock-

Johnson (2016) EHRs help with being able to upload the information quickly so all HCPs

involved can see it instantly. Having everything in an electronic format makes it so the patient’s

file can be sent and received in a matter of seconds. Meaning that one HCP can give access to all

who are involved giving authorized HCPs access to records at all times when information on the

patient is required (Potter et al., 2017). Getting ahold of patient information and getting referrals

have never been easier. A health provider can send a patient’s information to another doctor,

with patient permission, to get a second opinion without ever having an encounter with the

second HCP. Although, receiving information instantly is convenient it is not always to best

option for many patients.

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Some may say EHRs give HCPs more time with patients and others may say the

opposite. In a study done by Gomes et al. (2016) surveys were given to nurses before

implementing the EHRs so that statistics of time spent with patients before the use of EHRs

could be compared to the statistics of time spent after using EHRs for six months. The nurses in

the study done by Gomes et al. (2016) went from spending 27% to 42% more time in patients’

room after the six months of using EHR. These results show that EHRs help nurses spend less

time at the nurses’ station documenting and more time in the patient’s room.

Even though technology seems to be the better option than no technology there are times

when PHRs excel more than EHRs. For example, PHRs do not rely on another source to work

properly unlike EHRs. EHRs need Wi-Fi in order to function; without Wi-Fi HCPs will not be

able to log or obtain information about the patient (Gomes et al., 2016). Having to rely on Wi-Fi

can cause many issues with giving the patient quality care; HCPs should not be dependent on

technology. A patient wants the HCP to be in control of the care not an inanimate object. EHRs

make the patient’s information easily accessible for all the care providers involved, and this

could also make it easily disposable, whether that is disposing of it on purpose or as a mistake.

With any new technique there can be many complications. Time and experience is essential for

working out all of the kinks in order to use a technique properly. It is important to know if there

is potential in the technique to provide the best care for the patient and how the patient feels

about the care that is being received. EHRs can help this goal yet, at times, makes it more

difficult. In the study by Rose et al. (2014) some patients felt as if the HCPs were giving more

attention to the computer screen while assessing. One way to combat this would be to allowing

the patient to look at the screen along side the provider. Take time to alternate between typing

and listening, that way the patient feels acknowledged and important in the process.
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According to Rose et al. (2014) transition periods from PHRs to EHRs were bad for the

patients, causing frustrations and errors with the HCP causing the patients to be concerned. To

combat this shortcoming it would be a good idea to have classes for HCPs and nurses to take in

order to know how to work the EHR and to electronic format. Some HCPs found the EHRs to be

very tedious work at times, transferring data and/or adding a new patient to the database (Vélez

et al., 2014); making EHRs feel more like going through obstacles than helpful. Another

complication with EHRs is that the touch screens on cellular phones and tablet cause some

problems with misreading which key was pressed but this problem could be fixed by using

different hardware versus reevaluating the software (Vélez et al., 2014).

In the end it is the patient’s desires that matter the most. In the study by Rose et al. (2014)

it was found that participants preferred the use of EHRs but there was also concern for

communication issues, safety/security issues, and transitions. But despite the doubtful

encounters, patients and the HCPs experienced, both parties tend to be in favor of using the

EHRs. No matter how small of a benefit that comes from a technique, it is still worth the

consideration if that means the technique will help the patient progress in the right direction.

EHRs are progressing the medical setting in the right direction, but some minor corrections will

need to be implemented in order to get the best results.

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References

Gomes, M., Hash, P., Orsolini, L., Watkins, A., & Mazzoccoli, A. (2016). Connecting

professional practice and technology at the bedside: Nurses’ beliefs about using an

electronic health record and their ability to incorporate professional and patient-centered

nursing activities in patient care. Computers, Informatics, Nursing, 34(12), 578–586. doi:

10.1097/CIN.0000000000000280

Peacock-Johnson, Annette. (2016.) “News.” Quality and safety education for nurses, Retrieved

from http://www.qsen.org/heath-informatics-and-technology-professional-

responsibilities/.

Potter, P.A., Perry, A.G., Stockert, P.A., & Hall, A. M. (2017). Fundamentals of nursing (9th

ed.). St. Louis: Mosby Elsevier.

Rose, D., Richter, L. T., & Kapustin, J. (2014). Patient experiences with electronic medical

records: Lessons learned. Journal of the American Association of Nurse Practitioners,

26(12), 674–680. doi: 10.1002/2327-6924.12170

Vélez, O., Okyere, P. B., Kanter, A. S., & Bakken, S. (2014). A usability study of a mobile

health application for rural Ghanaian midwives. Journal of Midwifery & Women’s

Health, 59(2), 184–191. doi: 10.1111/jmwh.12071

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Appendix

I. Introduction

a. Goal of nursing

i. There are many techniques

ii. Progression is key

b. EHRs

II. What are EHRs?

a. How are EHR beneficial

b. Focus of EHR

III. How are EHRs better than PHRs

a. One location

i. Convenient

ii. Efficient

b. What can EHRs do that PHRs can never do?

i. Pictures

ii. Reminders

c. Physical benefit of EHR

i. Easily portable

ii. Reading handwriting is not an issue

IV. Charting made easy

a. Templates

b. Completion

V. Communicating between HCP

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a. Instant upload

b. Instant access

VI. More time with patient

VII. Downfalls of EHRs

a. Wi-Fi

b. Balance time between patient and screen

c. Physical difficulties

VIII. Conclusion

a. Pros and cons summarized

b. Patient main priorities