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Recently we asked nurses if they think electronic medical records (EMRs) improve patient safety. Their response: 58% said they make care safer, but 42% felt they increase risks. (See , November 2012.) That's very concerning because the federal government is currently incentivizing healthcare organizations to achieve "meaningful use" through the utilization of certified EMRs. EMRs are now being launched in complex healthcare environments, often before anyone fully appreciates the impact these systems will have on work flow and patient care.
The problems with EMRs can be significant if they're not designed well. For example, one electronic system may not interface with another in the same institution, making critical patient information difficult to retrieve or even invisible to healthcare providers. Poor graphic design may make selecting the wrong patient or intervention from similar-looking lists all too easy. Then there's productivity loss from too many mouse clicks, navigation issues, screen freezing, and use of nonvalue-added language, fields and tasks. Just trying to piece together a coherent clinical summary or discerning a patient's unique story can prove challenging. I could go on.
Despite the problems, EMRs have real value but we need a more intelligent approach. We need the talent of the software gurus who developed the easy functionality we enjoy in our mobile devices to work their magic in the healthcare IT industry-partnered with frontline staff, facility IT experts, and other stakeholders who must use these systems in the real world. We need design flexibility that enables the EMR to complement patient care, not drive dysfunctional work flow. This is a paradigm shift-many EMR platforms and vendors are quite rigid. When we permit vendors to dictate design rules in isolation, we're letting the tail wag the dog.
Nurses, this is a wake-up call. We need to be active participants in EMR design so that the final product facilitates a safe, efficient, and patient-centered work flow instead of hindering it. Consider joining committees charged with selecting, designing, and implementing EMRs. Question problematic EMR structures. Complete event reports when an EMR is the root cause of an error or near-miss. Finally, be ever vigilant to prevent patient care from becoming a casualty of "progress."
Until next time-
Linda Laskowski-Jones, MS, RN, ACNS-BC, CEN, FAWM
Editor-in-Chief, Nursing2012 Vice President: Emergency and Trauma Services Christiana Care Health System, Wilmington, Del.
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