Information Technology is revolutionizing the healthcare industry. Digital records provide exciting opportunities to speed patient care, improve the quality of care, increase patient safety, enrich research, and enhance public health efforts. But there is concern in the medical community that increasing reliance on information technology will weaken the human connection that is the cornerstone of U.S. patient care, and particularly nursing care.
The tenth annual survey of America’s 100 Most Wired Hospitals and Health Systems published in the July 2008 issue of Hospitals & Health Networks found a direct relationship between information technology (IT) and, not only the quality of patient care, but, surprisingly, patient perception of that care. Medical facilities that employed IT techniques such as patient portals and personal health records to promote strong customer relationships were rewarded with higher-than-anticipated overall patient satisfaction ratings.
“Any action that an organization takes to improve communication, such as IT, is going to have an effect on patient perspectives,” said Dennis Kaldenberg, senior vice president of research, knowledge management, and strategic planning for Press Ganey Associates, Inc., which performed the satisfaction analysis for the Most Wired survey.
“Patients perceive this as technology protecting them,” affirmed R.N. Merrie Wallace, vice president and solution line manager of McKesson Corp.
Whether Health Information Technology (HIT) raises the quality of care or the pursuit of greater quality drives the investment in technology is like asking, “Which came first, the chicken or the egg?”
“Facilities that are more progressive with regard to IT are also those that are more progressive with regard to changes that improve the processes of care,” noted Kaldenberg.
Despite increased use of HIT in certain areas – admissions, testing, patient-centric care – the Most Wired survey concluded: “Industry-wide progress in adopting clinical IT remains elusive. Overall gains in the use of information technology appear remarkably slow.”
The medical community, particularly at the Physician level, has been reluctant to replace paper records with electronic records. “Despite its potential to improve quality and reduce errors, use of information technology in the health sector lags behind other sectors of the economy in the U.S.,” concluded the 2001-03 National Ambulatory Medical Care Survey (NAMCS) conducted by the Centers for Disease Control and Prevention (CDC) and National Center for Health Statistics (NCHS).
Hospital emergency rooms were the first to embrace computerized patient records. According to the 2003 NAMCS, from 2001 to 2003, 31 percent of hospital emergency rooms and 29 percent of outpatient departments used electronic medical records (EMRs), compared to only 17 percent of Physicians participating in the survey. However, 73 percent of Physicians did use computerized billing systems.
By 2005 (the latest data currently available), NAMCS results showed a 31 percent increase in the use of EMRs by Physicians with nearly one-quarter (23.9 percent) of those surveyed reporting at least partial use. However, only 1-in-10 Physicians surveyed satisfied the survey’s minimum requirements for full EMRs: computerization of prescription orders, test orders, test results reporting and Physician notes.
The 2005 survey found that use of EMRs was more likely in multi-Physician practices in large metropolitan areas. Solo practitioners were the least likely to use EMRs. Neither specialty, age, gender of the Physician, nor ethnic makeup of the patient population had any statistical bearing on EMR use. While progress has been made toward universal electronic health records, the medical community is still years away from realizing the enrollment of every U.S. citizen in a nationwide EMR system.
Experts agree on the potential value of implementing a comprehensive nationwide EMR system that would store patient medical history, patient demographics, nurse and doctor notes, prescription information, diagnostic test orders and results, and other clinical and medical support tools, such as nutritional and genetic data, in a universal data base. The ability to access a patient’s complete and accurate medical record 24-hours a day, 7 days a week from anywhere in the country or the world would revolutionize patient care. There would be significant advantages to both patients and the medical community, including:
• ability to instantly update a patient’s medical record
• records viewable by multiple Physicians concurrently
• improved communication between primary and specialty care providers
• improved Physician communication during referrals
• improved communication between doctors, nurses and other staff
• legibility of orders, notes and prescriptions
• reduction of medical errors, duplicate testing and redundant treatments
• reduced cost of dictation and chart pulls
• improved test scheduling and results reporting
• automatic transfer of patient information captured from discrete systems, decreasing documentation time and handoff errors
• reduction of pharmaceutical errors through electronic Physician order entry and bedside medication matching
• improved efficiency in identifying the least expensive drugs and those covered by the patient’s insurance
• identification of allergies and drug interactions
• automated reminders and alerts
• prevention guidelines for chronic conditions
• billing efficiency
• expansion of medical research and faster disclosure of results
• public health disease surveillance
• homeland security surveillance
So why all the foot-dragging? The cost of implementation, record transfer and staff training is a major prohibitive, especially for sole practitioners. A 2005 study by the non-profit Rand Corporation estimated that implementation of a national EMR system could cost $8 billion per year over 15 years, but would save $81 billion over the same period – a net cost of $39 billion. In 2007, the U.S. Department of Health & Human Services projected that wide-scale adoption of EMRs could reduce health spending by 7.5 percent to 30 percent, with additional cuts in administrative costs which comprise one-third of total healthcare expenses.
The other major stumbling block is security. Maintaining patient privacy and confidentiality, authorizing access, and preventing identity theft are just some of the legal liability issues to be solved. The fear is not merely that hackers could gain access to patients’ personal information, but that they might tamper with medical information or co-opt electronic signatures. If allergy, drug interaction, or blood type data was changed, the consequences could be deadly.
Some hospitals and health systems have already implemented EMR measures of their own. A consortium of drug companies and care providers has launched the Health Information Trust Alliance (HITRUST) in an attempt to create universal security measures for the creation, access, storage and exchange of personal health information.
Implementation of HITRUST is expected to improve workflow efficiency and free more nursing time for direct patient care.
“Nurses should care, generally, about information technology in hospitals, because it drives quality, it drives efficiency and it drives safety,” said Aldeh Solovy, executive editor of Hospitals & Health Networks.
Nurses now spend only 30 percent of their time on direct patient care, according to Linda Burnes Bolton, vice president of nursing at Cedars-Sinai Medical Center in Los Angeles. By freeing nurses from manual record keeping and other time-consuming chores, HIT can increase nurse-patient interaction, improve the quality of care and increase patient safety.
The following appeared in an issue of Maxim’s nursing eNewsletter, Nursing Now. To receive news in your e-mail inbox each month, sign up today.