1. Culver, Cathi L. RN, MHA, FACHE


Merge the separate needs of nurses and physicians to preserve the processes of this relationship within the electronic healthcare record.


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Both nurses and physicians want an electronic healthcare record (EHR) system that matches the activities they're required to perform in the manner they're required to perform them. 1 An EHR must therefore reflect the activities of clinical practice and the process involved. 2 To not only preserve, but enhance, positive collaboration between physicians and nurses, first delineate separate actions for the two professions, then incorporate as many of those as possible into the EHR planning process. This process should serve to decrease work-related frustrations. The following six recommendations can help ease EHR implementation.


1. Heed the different frames of reference of nurses and physicians when implementing the EHR, taking care to incorporate clinical activities as they're performed, when possible. This may mean mapping workflow processes as you go, changing some while maintaining others. The incorporation of permanent processes into the EHR supports nurses' and physicians' activities, rather than forcing them to work differently or encouraging them to develop work-around or dual systems.


2. Be active in eliminating practices and processes that are no longer efficacious. This will increase morale and satisfaction among practicing professionals.


3. Don't underestimate the cost of managing change, which accompanies the implementation of an organization-wide EHR. It could be up to two or three times the cost of the EHR system, and will greatly affect both nurses and physicians as the two largest groups of participants.


4. Decrease isolationism by devoting time and effort to increasing methods of communication and role understanding between nurses and physicians. You can achieve this electronically, for example, with an e-mail system connected to physician orders for ease of clarification and questions, and also interpersonally, through team rounds, mixed professional boards, and teaching sessions.


5. Though it's required that you ensure the EHR system is tested for security and privacy regulation compliance on the federal, state, and local levels, also develop policies that identify and retain documentation that qualifies as a business event, including e-mail. Ensure the system has enough storage capacity to retain records in electronic form to the degree legally necessary. Users should be able to easily retrieve archives.


6. Stress to both nurses and physicians the positive organizational effects of increased clinical and managerial outcomes through electronic reporting. These professionals need to see that this innovation will help them not only accomplish their daily work and provide increased ease of response to accrediting and regulating agencies, but may hold other personal and collective benefits such as research and publication opportunities.



Consider taking an inventory of EHR elements reflective of the nurse/physican relationship and evaluating their value to the post-implementation relationship. Thus, you'll establish a foundation of successful collaborative EHR elements that can then be used in any EHR system to further enhance nurse/physician relations.




1. Berg, M.: "Medical Work and the Computer-Based Patient Record: A Sociological Perspective,"Methods of Information in Medicine. 37:294-301, 1998. [Context Link]


2. Maddock, E.: "The Benefits of Implementing an Electronic Patient Record System,"Nursing Times. 98(49):34-36, 2002. [Context Link]