Information Systems and E-Mail Electronic Medical Records and Electronic Health Records
Communication through the use of computer tech- nology is the norm today in nursing practice and health-care institutions. Electronic medical records (EMR) and documentation are used through- out health care. The Health Information Technol- ogy for Economic and Clinical Health (HITECH) Act mandated the use of the electronic health record (EHR) by the year 2015 (CMS, 2013). This organization developed Medicare and Medicaid incentive payment programs to help physicians and health-care institutions transition from traditional
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record-keeping to EHR. According to the Depart- ment of Health and Human Services (DHHS),
“EHR adoption has tripled since 2010, increasing to 44 percent in 2012 and computerized physician order entry has more than doubled (increased 168 percent) since 2008” (CMS, 2013).
Although the terms electronic medical record (EMR) and electronic health record (EHR) are used interchangeably, they differ in the types of informa- tion they contain. EMRs are the computerized clinical records produced in the health-care institu- tion and health-care provider offices. They are con- sidered legal documents regarding patient care within these settings. The EHR includes summa- ries of the EMR. EMRs are digital versions of the paper charts in the health-care provider’s office.
They contain the medical and treatment history of the patients within that specific health-care pro- vider’s practice. Some advantages of the EMR over paper charts include the ability of the health-care provider to:
■ Track data over time
■ Identify which patients need preventive screenings or checkups
■ Monitor patients status regarding health maintenance and prevention, such as blood pressure readings or vaccinations
■ Evaluate and improve overall quality of care within the specific practice
A disadvantage of the EMR is that it does not easily move out of the specific practice. Often the pati ent record needs to be printed and delivered by mail to specialists and other members of the care team.
EHR documents are shared among varying institutions/individuals such as insurance compa- nies, the government, and the patients themselves
(CMS, 2013). EHRs focus on the total health of a patient extending beyond the data collected in the health-care provider’s office. They provide a more inclusive view of a patient’s care and are designed to share information with other health-care provid- ers, such as laboratories and specialists, so they contain information from all the clinicians involved in the patient’s care.
The use of electronic patient records allows health-care providers to retrieve and distribute patient information precisely and quickly. Deci- sions regarding patient care can be made more effi- ciently with less waiting time. Errors are reduced, patient safety is increased, and quality is improved.
Information systems in many organizations also provide opportunities to access current, high- quality clinical and research data to support evi- dence-based practice (Gartee & Beal, 2012).
Because security safeguards are in place, EHRs also assist in maintaining patient confidentiality when compared to traditional paper systems.
Health-care providers and institutions need to enforce processes to protect patient information through the use of passwords, limited accessibility, and compliance with laws, regulations, and accept- able standards. If a nurse attempts to obtain infor- mation on a patient not under his or her care, the institution may consider this a breach of security and patient confidentiality. Many institutions have strict policies in place that may result in a nurse losing his or her position if an electronic record is accessed when it is not necessary for the nurse’s job.
It is important to remember to always log off when using a computerized system. This helps to prevent security breaches.
The goal of computerized record-keeping is to provide safe, quality care to patients. It allows for tracking of quality controls. The use of BAR scan- ning prior to administering medications or obtain-
table 6-1
Barriers to Effective Communication in Health Care
Low health literacy Lack of the skills needed to access and use health information
Cultural diversity Impedes the ability to access, understand, and utilize services and information.
Cultural competency of health-care providers
Lack of the ability of health-care providers to identify and consider cultural practices Communication skills of health-care
providers
Health-care providers lack the training needed for communicating with each other (interprofessional communication)
Source: Adapted from Schwartz, Lowe, & Sinclair (2010). Communication in health care: Consideration and strategies for successful consumer and team dialogue. Hypothesis, 8(1), 1–8.
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ing blood samples for laboratory testing maintains quality and assists in ensuring patient safety.
Additional benefits of computerized systems for health-care applications are listed in Box 6-1.
E-mail has become a communication standard.
Organizations use e-mail to communicate both within (intranet) and outside (Internet) of their systems. The same communication principles that apply to traditional letter writing pertain to e-mail.
Using e-mail competently and effectively requires good writing skills. Remember, when communicat- ing by e-mail, you are not only making an impres- sion but also leaving a written record (Shea, 2000).
The rules for using e-mail in the workplace are somewhat different than for using e-mail among friends. Much of the humor and wit found in per- sonal e-mail is not appropriate for the work setting.
Emoticons are cute but not necessarily appropriate in the work setting.
Professional e-mail may remain informal.
However, the message must be clear, concise, and courteous. Avoid common text abbreviations such as “LOL” or “BZ.” Think about what you need to say before you write it. Then write it, read it, and reread it. Once you are satisfied that the message is appropriate, clear, and concise, send it.
Many executives read personal e-mail sent to them, which means that it is often possible to contact them directly. Many systems make it easy to send e-mail to everyone at the health-care institution. For this reason, it is important to keep e-mail professional. Remember the “chain of command”: always go through the proper channels.
The fact that you have the capability to send e-mail instantly to large groups of people does not necessarily make sending it a good idea. Be careful if you have access to an all-company mailing list. It is easy to unintentionally send e-mail throughout the system. Consider the following example:
A respiratory therapist and a department admin- istrator at a large health-care institution were engaged in a relationship. They started sending each other personal notes through the company e-mail system. One day, one of them acciden- tally sent one of these notes to all the employees at the health-care institution. Both employees were terminated. The moral of this story is simple: do not send anything by e-mail that you would not want published on the front page of a national newspaper or broadcasted on your favorite radio station.
Although voice tone cannot be “heard” in e-mail, the use of certain words and writing styles indicates emotion. A rude tone in an e-mail message may provoke extreme reactions. Follow the “rules of netiquette” (Shea, 2000) when communicating through e-mail. Some of these rules are listed in Box 6-2.
Text Messaging
Text messaging has evolved as a non-voice cell phone function among individuals. What started as a simple informal method of communication has evolved far beyond its initial intent. The average number of texts sent and received daily per cell phone user is growing rapidly. Texting as a brief, informal method of electronic communication between friends, close acquaintances, or automated systems has become the rule more than the exception.
• Increased hours for direct patient care
• Patient data accessible at bedside
• Improved accuracy and legibility of data
• Immediate availability of all data to all members of the team
• Increased safety related to positive patient identification, improved standardization, and improved quality
• Decreased medical errors
• Increased staff satisfaction
Adapted from Arnold, J., & Pearson, G. (eds.). (1992). Computer applications in nursing education and practice. New York: National League for Nursing.
box 6-1
Potential Benefits of Computer- Based Patient Information Systems
1. If you were face-to-face, would you say this?
2. Follow the same rules of behavior online that you follow when dealing with individuals personally.
3. Send information only to those individuals who need it.
4. Avoid flaming; that is, sending remarks intended to cause a negative reaction.
5. Do not write in all capital letters; this suggests anger.
6. Respect other people’s privacy.
7. Do not abuse the power of your position.
8. Proofread your e-mail before sending it.
Adapted from Shea, V. (2000). Netiquette. San Rafael, CA: Albion.
box 6-2
Rules of Netiquette
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Presently, there are not any texting “rules.” This permits mobile phone users to express themselves however they see fit. “Texters” frequently use short- hand abbreviations during such exchanges to replace longer, more commonly used phrases.
Although texting has evolved as a widely accepted, even preferred, form of “talking,” messages may be misinterpreted with the absence of voiced emotion and body language.
Business consultants predict that texting will evolve as an accepted form of electronic communi- cation for certain occasions that require only simple questions and answers. When texting colleagues or departments, follow the same guidelines as you would for e-mail (Ruggieri, 2012). Confidential information should never be sent in a text message.