Impact of Electronic Health Record System on Nursing Practice and Patient Outcomes

The use of EHR has positively impacted the nursing profession by improving nurse-physician relationships, promoting positive practice culture, and providing holistic care to the vulnerable population set. However, the implementation of EHR has also been associated with ethical, legal, and security concerns that need to be addressed.

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Name of the Student:
Name of the University:
Author Note:

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Introduction:
The information management technology that has been chosen by me for
implementation within the hospital setting in order to promote positive patient outcome is the
electronic healthcare record system. The electronic healthcare system also known as the
EHR, has revolutionised the process of maintain patient record and documentation in the
healthcare sector. According to Ajmani and Bagheri-Tadi (2013), an electronic medical
record can be defined as an organized and systematic collection of the patients medical health
information in the form of a digital format. The digital records can be shared across various
healthcare settings. The healthcare records are shared online and the exchange of information
is maintained through information networking. As stated by Tanner et al. (2015), EHRs
include a wide range of data that includes demographics, medical history, detailed
explanation about medication and allergies, status of immunization, laboratory test results
and detailed description about the vital signs. In addition to this, it should further be noted
that the electronic health records also contain information about the personal statistics of the
patients such as the age, height and weight of the patient. Also, it comprises details of billing
information and radiology images of the patient. Electronic Health Record maintenance has
positively contributed to promote positive patient outcomes. In accordance with current trend,
the EHR system is being widely used by the healthcare organizations across the globe.
Healthcare providers are proactively making use of the patient data retrieved from the patient
records in order to deliver effective care and promote quality outcomes.
The combination of multiple clinical data from the electronic health record system has
equipped the care providers to ideally identify and manage chronic illness patients. In
addition to this, it should further be noted that EHR has been found useful in improving the
quality of care with the use of patient data and analytics to effectively reduce the rate of

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hospitalization in high-risk patients. As mentioned by Rind et al. (2013), EHR systems have
been designed with the purpose of storing data in an accurate manner and critically document
the physical as well as mental state of a person across time. The maintenance of EHR
eliminates the need to track down the previous records of the patient (Moja et al., 2014). This
helps in saving time and also ensures that the patient’s medical records are appropriately
organized and is accessible at any instant of time. A number of advantages have been
associated with the use of the technology. Firstly, the system reduces the possibility of data
replication as the system is based upon a single editable file. This effectively helps in
avoiding recording errors and at the same time the file is updated continuously. In addition to
this, the digital format of the file saves the risk of losing the hardcopy of a file. Also, EMRs
are easily accessible and efficiently extract medical data facilitates convenient extraction of
medical data prior to a diagnostic test. At the same time, EHRs also help in convenient
maintenance of population-based medical health data.
Quality healthcare refers to the provision of patient safety practices in order to ensure
protection of the patients from potentially preventable harm related with the healthcare
services (Ajami & Bagheri-Tadi, 2013). Electronic medical records ensure quality and safety
of the healthcare facilities provided with respect to traditional paper records (Middleton et al.,
2013). It serves as an informative analytical tool for the patients as well as the clinicians to
access patient history. It should further be noted in this regard, that EHRs offer an integrated
best-practice support system for the maintenance of electronic clinical decision support. The
clinical decision support offers general as well as person-specific information to the
concerned care teams (Meeks et al.,2014). The information provided is organized and can be
appropriately filtered. This improvises the care outcomes by making the information timely
accessible and facilitates strong decision making framework.

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Analysis:
The use of electronic health record system to record and document patient data has
been associated with a multitude of advantages within the healthcare context. According to
Meeks et al. (2014), it has been mentioned that the implementation of EHR within a
healthcare organization facilitates clinicians to record information about the patients in an
easier and effortless manner. At the same time, the clinicians are also equipped with the
facility to follow the patients stringently from one point of the care to another point of care.
Also, studies reveal that the application of EHR facilitates functions that are automated and
does not require manual operation. This increasingly helps in acquiring positive patient
outcomes and ensure assed patient security. EHR implementation thus promotes electronic
prescription for the patients, perform stringent checks on Drug-Drug interactions and Drug-
allergy interactions (Ajami & Bagheri-Tadi, 2013). As stated by McCoy et al. (2013), the
advantages associated with the implementation of electronic health record technology within
a healthcare system can be enumerated as follows:
 It provides organized, appropriate, updated and complete information about the
patients at different points of care
 It provides an easy access to the patient records and positively promotes in the
delivery of an efficient and coordinated care
 It ensures patient privacy and secures the sharing of the patient related information
between the patient and other related healthcare professionals
 It helps in effectively diagnosing a patient and reduce medical errors to render safer
care
 It improves the quality of interaction between the patients and the concerned
healthcare professionals
 It helps in the maintenance of accurate patient billing

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 It promotes reliable medical prescribing
 It ensures improved productivity of the professionals and help in fostering work-life
balance
 It enables healthcare providers to efficiently meet business goals
 It facilitates reduction in costs fostered through decreased paper work and improved
health outcome
On the contrary, as mentioned by Lusignan et al. (2014), implementation of EHR has
also been associated with a number of disadvantaged that include the following:
Patient Privacy and security issues: Electronic health care data is sensitive to cyber-crimes
such as hacking and stealing of patient information. This proves that the patient data could
potentially be used in an inappropriate manner
Presentation of inaccurate information: On account of the dynamic nature of the EHR
professionals must update the information spontaneously after the patient visit. This is
important to ensure that allied health professionals do not rely upon inaccurate and un-
updated data to prescribe treatment intervention.
Unwanted anxiety in patients: As the electronic healthcare record is accessible to the patient,
there might be a possibility when the patient misinterprets a data file. This can lead to the
cause of stress and unwanted anxiety in the patients.
Malpractice and corresponding Liability Concerns: Electronic medical records often pose a
problem related to liability issues. It could lead to the dearth of a medical error during the
transition of patient data from appear to the system. Therefore, it can be said that the
implementation of the process should follow a standard protocol and should be monitored
stringently in order to avoid the possibility of committing a medical error.

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It should be stated in this regard that a number of ethical and legal implication issues
have been associated with the implementation of the EHR across healthcare organizations.
The ethical issue involved in the implementation process is ‘beneficence’ and it emphasises
on the fact that the patient raw data would constructively facilitate public health research to
improvise treatment strategy and promote positive patient outcome. The implication on the
other hand include, the development of a research data base to reinforce positive outcome.
The high cost of EHR systems to accumulate population data which would ensure benefit to
the society on a long term basis (Kwan et al., 2013). The legal issues on the other hand,
includes the consideration of ethical laws of data sharing. Also, the legal implications involve
the adverse consequences of cyber-criminal laws on infringing patient security and privacy
management. Care providers must comply with the legal framework of patient security that
includes (Improved diagnostics & Patient outcomes, 2017) ,
 The right information privacy
 The right to maintain confidentiality, and
 The right to information security
According to DesRoches et al. (2013), it has been stated that the implementation of
the healthcare record system helps in improving the health status of a vulnerable set of
population. A research study stated that the quality of care provided to patients with chronic
illness such as Diabetes had significantly improved after the successful implementation of the
electronic health record system. Research studies, further predicted that implementation of
the system saved the time of patient documentation and the care professionals could devote
more time to care for the needs of the patients who are dealing with long term illness. As
mentioned by Coorevits et al. (2013), EHR also helps in improving self-reporting of cases
dealing with abuse, neglect and other patient concerns that are aligned to human rights. This
equips healthcare professionals in prioritizing patient care and the designing of treatment

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routine to address the need of the patients. It should further be noted in this context, that the
implementation of health record system to manage old age patients facilitate awareness, self-
efficacy and empowerment about managing disease conditions independently (Chen et
al.,2013).
Patient Safety Outcomes:
Studies show that implementation of the electronic health record system has
effectively helped in improving service quality with respect to management of human
resources, workflow, medical health policies and work culture (Bowman, 2013); (Chen et al.,
2018). The inclusion of the information management system within the ambulatory and
emergency department of the hospital has significantly been associated with positive
outcomes. The major areas where the use of the electronic health care record system has
proved to be beneficial include, reduction in medication error, diagnosis error, administrative
management errors and communication errors. Primary issues such as documentation of
incorrect dosages, inappropriate handling of patient sample for laboratory tests, misdiagnosis,
delayed communication and intimidation, failure to preserve patient information and
improper handling of patient information have been accounted as major faulty concerns in an
emergency department. It should be critically noted, in this context that within emergency
and ambulatory settings, the positioning of different departments such as diagnostic and
administrative unit is widely spaced from the primary care unit. This leads to commotion
within the health care setting. It also, includes a possibility of communication error or
delayed intimidation to the multidisciplinary health care units that might be working together
to provide care to the patient (Moja et al., 2014). Research studies state that successful
implementation of electronic medical records help in the maintenance of effective
communication (Middleton et al., 2014). It also helps in ensuring patient safety by detecting

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incidences of missed diagnoses and generating diagnosis error alert notifications to make care
providers aware about the medical error.
Impact on Professional Nursing:
The Health Information Technology for Economic and Clinical Health Act has
revolutionised the health care sector with the introduction of electronic health records. The
implementation has rendered a positive implication on the nursing professional practice
(Chen et al., 2018). Studies reveal that, hospitals that implemented the system had nursing
professionals who were able to handle work pressure efficiently. The system also ensures the
protection of the healthcare workers during the instances of patient-nurse liability issues
(Tanner et al., 2015). Studies also mentioned that nursing professionals found it easier to
collect and record patient data. In addition to this, it has also been mentioned that hospital
settings that witnessed organizational change or problematic decision making, the
implementation of EHR promoted improved nurse-physician relationships, positive practice
culture and effective administrative support (Rind et al., 2013). The implication of the system
within the nursing professional practice would require nursing professionals to be on the
frontline while communicating with the patients and the family members of the patients. In
addition to this, it would require nurses to remain updated with the application of the
technology and accordingly educate the patients about the use of technology. Studies further
indicate that the use of electronic medical records help in the sequential maintenance of data
overview, medication safety, management of handoffs and transitions and improving
competency in order to foster effective care.
According to Tanner et al. (2015), it has been stated that the use of EHR helps in
providing positive and holistic care to the vulnerable population set. The findings of the
research study indicated that the implementation of the system yielded positive outcome on

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older patients. The Aged Care unit typically comprises of patients aged 60 and above who are
diagnosed with long-term illness that require critical care. Studies show that the healthcare
organizations that have implemented EHR can substantially address the physical as well as
the mental health needs of the target audience (Health Information, 2017). It can be
mentioned in this regard, that automated documentation and recording of patient facilitates
appropriate diagnosis that further helps in devising a satisfactory treatment routine. Also, it
saves time for making appropriate referrals and reduces the chances of medical errors. In
addition to this, the primary care physicians and nurses do not need to invest time on
recording patient history and tracking medication that could possibly elicit an allergic
reaction and negatively impact the health of the client. The medical record efficiently
presents the list of medications that the patient could be allergic to and this sufficiently
reduces risks related to misdiagnosis of disease conditions (Ajami & Bagheri-Tadi, 2013).
It has been estimated that almost 94% of the healthcare service providers have stated
that maintenance of electronic health record system has proved to be extremely beneficial to
promote quality patient outcomes (Kwan et al., 2013). According to Lusignan et al. (2014),
the implementation of EHR within the healthcare system effectively generated a 35%
reduction in the rate of medical error and misdiagnosis. At the same time, it should also be
noted that the implementation was tightly linked with increased satisfaction level of the
patients post treatment. At the same time, care professionals reported smoother
communication flow and positive patient outcomes within a hospital setting.
Concluding Reflection:
On the basis of the discussion above, it can be said that the inclusion of electronic
health record system would facilitate increased patient safety, better access to care and
positive patient outcome. However, it should be noted in this context that the use of the

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system must be stringently supervised or monitored so as to ensure quality outcome while
dealing with a set of vulnerable population. For instance, while dealing with elderly patients,
it is important to consider the background and the technological aptitude of the patients while
proceeding with the treatment regimen. On a general bases, elderly patients find it difficult to
manage electronic health records and often seek help from others to interpret and manage
data. This leads to cases of fraudulences where the patient data is used in an unethical
manner. Therefore, I believe that the system should be equipped with some form of feature to
make it feasible for the older people to use it. The feature could accessing the application
with the use of voice command or include a short term training to the patients about the use
of the application by a care professional.
As a nursing professional, I stringently believe that the use of electronic healthcare
record to store and maintain patient data has made the process of documentation extremely
convenient. It has effectively reduced the possibility of committing medical error and has
saved a major proportion of time. However, I feel the system should be constantly monitored
to upgrade the security so as to foster patient privacy and avoid mismanagement and
unethical use of the confidential data of the patients.

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References:
Ajami, S., & Bagheri-Tadi, T. (2013). Barriers for adopting electronic health records (EHRs)
by physicians. Acta Informatica Medica, 21(2), 129.
Bowman, S. (2013). Impact of electronic health record systems on information integrity:
quality and safety implications. Perspectives in health information
management, 10(Fall).
Chen, J., Malani, P., & Kullgren, J. (2018). Patient portals: Improving the health of older
adults by increasing use and access. Health affair blogs. Retrieved
https://www.healthaffairs.org/do/10.1377/hblog20180830.888175/full/.
Coorevits, P., Sundgren, M., Klein, G. O., Bahr, A., Claerhout, B., Daniel, C., ... & De Moor,
G. (2013). Electronic health records: new opportunities for clinical research. Journal
of internal medicine, 274(6), 547-560.
DesRoches, C. M., Charles, D., Furukawa, M. F., Joshi, M. S., Kralovec, P., Mostashari,
F., ... & Jha, A. K. (2013). Adoption of electronic health records grows rapidly, but
fewer than half of US hospitals had at least a basic system in 2012. Health
Affairs, 32(8), 1478-1485.
Health Information. What can you do to protect your health information. (2017, September
5). Retreived https://www.healthit.gov/topic/privacy-security/what-you-can-do-
protect-your-health-information.
Improved-diagnostics & Patient outcomes. (2017, October 12). Retrieved
https://www.healthit.gov/topic/health-it-basics/improved-diagnostics-patient-
outcomes.

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Kwan, J. L., Lo, L., Sampson, M., & Shojania, K. G. (2013). Medication reconciliation
during transitions of care as a patient safety strategy: a systematic review. Annals of
internal medicine, 158(5_Part_2), 397-403.
Lusignan, S., Mold, F., Sheikh, A., et al. (2014). Patients’ online access to their electronic
health records and linked online services: a systematic interpretative review. BMJ
Open. Volume 4, issue 9. Retrieved
https://bmjopen.bmj.com/content/4/9/e006021.citation-tools.
McCoy, A. B., Wright, A., Kahn, M. G., Shapiro, J. S., Bernstam, E. V., & Sittig, D. F.
(2013). Matching identifiers in electronic health records: implications for duplicate
records and patient safety. BMJ Qual Saf, 22(3), 219-224.
Meeks, D. W., Smith, M. W., Taylor, L., Sittig, D. F., Scott, J. M., & Singh, H. (2014). An
analysis of electronic health record-related patient safety concerns. Journal of the
American Medical Informatics Association, 21(6), 1053-1059.
Middleton, B., Bloomrosen, M., Dente, M. A., Hashmat, B., Koppel, R., Overhage, J. M., ...
& Zhang, J. (2013). Enhancing patient safety and quality of care by improving the
usability of electronic health record systems: recommendations from AMIA. Journal
of the American Medical Informatics Association, 20(e1), e2-e8.
Moja, L., Kwag, K. H., Lytras, T., Bertizzolo, L., Brandt, L., Pecoraro, V., ... & Iorio, A.
(2014). Effectiveness of computerized decision support systems linked to electronic
health records: a systematic review and meta-analysis. American journal of public
health, 104(12), e12-e22.
Rind, A., Wang, T. D., Aigner, W., Miksch, S., Wongsuphasawat, K., Plaisant, C., &
Shneiderman, B. (2013). Interactive information visualization to explore and query

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electronic health records. Foundations and Trends® in Human–Computer
Interaction, 5(3), 207-298.
Tanner, C., Gans, D., White, J., Nath, R., & Pohl, J. (2015). Electronic Health Records and
Patient Safety. Applied clinical informatics, 6(01), 136-147.