I long to open a chart, read a narrative that is unique to the patient without autogenerated verbiage, and find valuable information. But I am not about to rant that we go back to pen and paper. Electronic medical records (EMRs) offer many advantages. They are readable, easy to access, and allow for quality assessment, research, coding, and billing. When well designed, they are useful to clinicians and the healthcare system alike. But to borrow lines from Shakespeare's Hamlet, Aye, there's the rub. The slings and arrows of outrageous fortune with EMRs often include designs that are more useful to organizations than to frontline care providers.
How did this situation arise? EMRs are expensive. It takes a large outlay of time and IT resources, along with key administrative and clinical leaders to launch them. Factor in staff training costs. When total dollars are calculated, they encompass a hefty chunk of the budget. Organizations need a significant return on investment (ROI) before they can launch a new system or make pricey upgrades to existing ones. That ROI is derived from the EMR design and capabilities. Codes embedded in key clinical fields can facilitate billing as well as report quality data that may be tied to reimbursement. Various fields can generate compliance monitoring and research data.
The design of these very features can impact-and potentially interrupt-patient care for the frontline nurse by turning it into a litany of incessant screen clicks and check boxes: hourly rounding-check; call bell within reach-check; fall precautions-check; bed in lowest position-check, and so on. Patient assessments, observations, and care are reduced to checks and time stamps, leaving less focus on the patient and more on the computer. Pages of autogenerated items result, with few free-text sentences and a nurse beholden to a computer as taskmaster.
It is time to take arms against a sea of troubles. EMRs that are neither patient- nor clinician-centered need an overhaul. Imposing new check boxes or forms is not the default solution to every issue. Frontline clinicians must inform the design work. EMRs need to tell the patient story in a meaningful, human way so that it can be an asset for all in healthcare. The critical human interface is the foundation of the healthcare system-it needs to be the foundation of the EMR as well.
Until next time,
LINDA LASKOWSKI-JONES, MS, APRN, ACNS-BC, CEN, NEA-BC, FAWM, FAAN
EDITOR-IN-CHIEF, NURSING2021