The EHR: Good in Theory, however...

A medical team in Texas emergency room receives a call informing the unit that a critically injured patient will be transported to your center: the patient has been identified and is from another state. Because of the electronic health record, which is “designed to provide nationwide access to designated information compiled from data found in medical records” (Thede 16), the medical team is able to see the patient’s medical history, medications, and her blood type. The electronic health record has saved the healthcare team precious time and will be better prepared to care for her appropriately and quickly. This scenario is why the idea of the electronic health record (EHR) is so appealing: real-time information for healthcare providers that will save lives. President George W. Bush began promoting the EHR during his presidency, and to further it along, the Congress passed the stimulus bill in February that provided $19 billion to further develop the EHR. While addressing the Congress, President Barack Obama indicated that this “new technology…will reduce errors, bring down costs, ensure privacy, and save lives” (King). The admirable capabilities of the EHR are only theoretical, and not fact; from the modest research thus far, there is little proof that the electronic health record performs as promised and that only time, further research and development, and practical application will bring about efficacious results for patients, doctors and nurses, and hospitals.
According to Helen Figge of American Journal of Health-System Pharmacy, “studies indicate that between 1.5% and 4% of prescriptions are in error with potentially serious patient risk” (16). She also states that 3 million out of the 8.8 million adverse drug reactions are preventable due to “miscommunication caused by poor penmanship…and unclear or ambiguous abbreviations.” It is believed by many that the EHR and electronic prescribing would improve these statistics by eliminating “ambiguities” and integrating systems so that allergies and previous adverse drug reactions are on the patient’s profile. It makes sense that a legible prescription or physician’s order would decrease errors and save time because the order is clear and clarity saves time (making calls, finding the physician to correct or clarify an order). Legibility is an obvious aspect; doctors and nurses can read patient records without feeling like they are reading a foreign language, which is the case sometimes. However, there is no significant data, as yet, that supports the theory that the EHR does decrease errors; in six UK studies, it was discovered that although “a clear positive impact of [the EHR] on preventative care was noted,” the EHR did not show any benefits for better patient outcomes. The article goes on to say that the studies were limited but the data obtained up to this point “reflects deep assumptions” and believes the uptake of the EHR is “seemingly on a very weak evidence base” (Clamp, S. & J. Keene 9).
In addition to improved patient outcome and safety, the claim that the electronic health record will save money is another fallacy. These declarations (made by both Conservative and Liberal) are baseless; in fact, Harvard University just released a study in November 2009 that reveals the opposite. “A review of roughly 4,000 hospitals from 2003 to 2007 found that while many had moved away from the paper files that still dominate the U.S. healthcare system, administrative costs actually rose” (Heavey). Although the U.S. government has agreed to commit $19 billion to develop a nationwide EHR, individual hospitals and physicians must invest their own capital which is need to buy and implement this technology, an expensive endeavor. According to David Blumenthal, a professor at Harvard Medical School, “The [EHR] systems can cost between $20 million and $200 million, a significant investment at a time when hospitals are facing severe economic challenges.” The $19 billion set aside to digitize medical records includes some incentives: “Between $44,000 and $64,000 to doctors who computerize patient records and up to $11 million per hospital”—still there will be a significant investment for the private parties, as well as penalties if “physicians and hospitals…are not using electronic health records by 2014” (Bovard 9). The incentives would be distributed through Medicare and Medicaid payment, and if doctors want to care for these patients, they must comply (Heavey). While these incentives seem to be reasonable, doctors and hospitals are resistant to investing equity into a technology that is quite expensive and its benefits are based more on beliefs than “empirical evidence” (Clamp, S. & J. Keene).
So far the electronic health record has not produced evidence that it will reduce errors or reduce costs, and studies, as recent as November 2009, have proven the EHR to be inefficient as well. The premise that the EHR would, overall, provide an efficient healthcare delivery—one that would save time, provide efficient scheduling, and better record keeping (paper versus electronic); real-time medical record retrieval is a benefit and thought to be vital in critical circumstances. InformationWeek discussed the medical record mayhem during Hurricane Katrina: “The storm had destroyed medical records that were needed to give victims medical attention” and the electronic record could have been utilized to care for Katrina patients properly and in a timely manner. In this article, Dr. Daniel Martich believed that the hurricane is a lesson, “We’ve learned a lot about what we lack as a nation with the Katrina disaster—we lack the essentials.” There is much confidence in the theories of the EHR, as noted by Dr. Martich, but the evidence base is proving that that it requires further discussion, science, and studies prior to a nationwide implementation. Dr. David Himmelstein, lead author of the Harvard study, says that utilization of the EHR has not shown any savings at all, and in fact, the “study finds that hospital computerization hasn’t saved a dime, nor has it improved administrative efficiency” (Heavey). In the UK study, signs of inefficiency and in fact, an increase in inefficiency was found: although the authors found that bedside nurses saved almost 25% of “overall time spent documenting during a shift,” conversely physicians increased their time by 17.5% when using computerized order entry (Clamp, S. and J. Keene).
Of course, everyone has an opinion about the privacy aspect of the electronic health record and how safeguarded our health information may be. The concern over the privacy of our health records is a valid and significant concern. The risk and the benefit of the EHR is the ease of access of records; to obtain paper records takes effort—they are in a room behind locked doors; one must fill out a document and show identity in order to obtain it; it then takes a day or two to obtain copies. Electronically, the health record can be obtained in an instant…and possibly in the wrong hands. Some “groups want to make it more difficult for pharmacists, hospitals [etc] to share information that can help patients…they propose requiring that individuals give explicit authorization each time their information is used” (Grealy). Grealy goes on to say that it would be chaos if a patient had to be contacted every time some entity shared information. How are they sharing information now? Is it chaotic? Electronic health records are just as vulnerable credit card data and in fact, there have been widely known breeches of patient information just this year; the state of Virginia had a possible security breach in which “a half-million people whose social security numbers may have been obtained in a prescription database…the criminal was demanding $10 million ransom for the information” (Commins). Breaches in confidential information, especially the most sensitive information is of utmost importance. Our employers, the police officer who pulls us over, the government, even our spouse has no right to our private health information without our explicit consent.
There is little information on how the electronic health record might affect nursing. There are theories and potential concerns from the nursing aspect. Nursing notes, “unless used institutionally in infection control reports, quality improvement projects, or for legal issues,” are usually ignored. There are some nursing groups that believe with the advent of the EHR, nursing notes and interventions will play a part in “identifying patterns of health care provided and subsequent outcomes among large groups” (Thede). It is imperative that nursing takes part in the development of the technology and development of the EHR, but so far, the importance of nursing interventions and individualized care is not recognized. According to the Journal of Clinical Nursing, the EHR “needs to be developed in parallel, to become more useful and to support both documentation and quality assurances. All professionals in health care must make a contribution to [its] development…with the safety of the patient as their common goal” (Tornvall 2124).
In conclusion, what has been uncovered by my research is that the electronic health record is a good thing, in theory, but so far has fallen short of “ideal.” I must admit that the EHR may be in its early years of development, and with further research and practical application (including doctors, nurses, and hospitals in its development), the EHR would inevitably improve. The research has proven that the EHR is not as expected: its deficiencies far outweigh its benefits at present time; it does not save money, time, and patient privacy is concerned. Meanwhile, the concern is that Congress and the President have established policies that are based on “beliefs about the positive value of the EHR rather than on the available empirical evidence [which are] full of aspirational statements rather than detailed and realistic expectations” (Clamp, S. & J. Keene).

Bovard, James "Health of the State." American Conservative 8.5 (2009): 9-11.
Academic Search Complete. EBSCO. 11 Oct. 2009. Web.

Clamp, S., and J. Keen "Electronic health records: Is the evidence base any use?"
Medical Informatics & the Internet in Medicine 32.1 (2007): 5-10.
Science & Technology Collection. EBSCO. 11 Oct. 2009. Web.

Commins, John. “Virginia Warns More Than 500,000 of Possible Records
Breach.” HealthLeaders Media. N.p. 4 June 2009. 11 Oct. 2009. Web.

Figge, Helen "Electronic prescribing in the ambulatory care setting."
American Journal of Health-System Pharmacy 66.1 (2009): 16-18.
Science & Technology Collection. EBSCO. 11 Oct. 2009. Web.

Grealey, Mary R. "Balance privacy with benefits." USA Today n.d.
Academic Search Complete. EBSCO. 11 Oct. 2009. Web.

Heavey, Susan. “No Hospital Savings with Electronic Records: Study.
Reuters. N.p. 18 Nov. 2009. 28 Nov. 2009. Web.

"Hurricane Katrina Highlights Need For Electronic Medical Record-Keeping;
The storm destroyed medical records that were needed to give victims
medical attention." InformationWeek. N.p. Sept 19, 2005.
11 Oct. 2009. Web.

King, Rachael "Putting Patient Privacy in Peril?" BusinessWeek Online (2009): 6.
Academic Search Complete. EBSCO. 11 Oct. 2009. Web.


Thede, Linda "Informatics: The Electronic Health Record: Will Nursing Be on
Board When the Ship Leaves?." Online Journal of Issues in Nursing 13.3
(2008): 16-24. Academic Search Complete. EBSCO. Web. 11 Oct. 2009.

Tornvall, Eva and Susan Wilhelmsson. “Nursing Documentation for Communicating
and Evaluating Care. Journal of Clinical Nursing. 17. (2008): 2116-2124.
Academic Search Complete. 6 Oct. 2009. Web.

Wollersheim, Dennis, Anny Sari, and Wenny Rahayu "Archetype-based electronic
health records: a literature review and evaluation of their applicability to
health data interoperability and access." Health Information Management
Journal 38.2 (2009): 7-17. Academic Search Complete. EBSCO.
6 Oct. 2009. Web.

"My Precious".....Medical Record

A main concern of mine, and probably millions of other patients, is the question of security and privacy of our electronic health record (EHR). Although some medical records can be three feet thick, at least they are not zipping around in cyberspace. The risk and the benefit of the EHR is the ease of access to records—key word “ease.” In order to get someone’s paper health record (even one’s own), it takes a bit of work: one must go to the hospital’s health records department, fill out a form, show your identification, have it photocopied, and a fee might be incurred in order to retrieve one’s records…it might even take a number of days prior to the copied record to be ready. With the EHR, Snap! It’s right there on the screen for perusing. Minimal standards (which should be quite strict) for client’s records must be followed. Some employees at my hospital have been fired for looking at a health record they had no business looking at. Usually it is a “high profile” patient (something in the news or a famous person’s child) that is the main focus, but knowing that fact keeps those who have “no business knowing” away from someone’s electronic chart. As we have been learning in our technology class, it is important to anticipate consequences of technology, and one of the main concerns for the EHR is having them accessible on a “need to know basis.” Earlier this year, the state of Virginia had a possible security breach in which “a half-million people whose Social Security numbers may have been contained in a prescription…database was hacked into…the criminal was demanding a $10 million ransom” for the information (Commins). Let’s face it, the creators of technology have to be smarter than the criminal! Is our personal data secure? I think the answer is a resounding “maybe.” This endeavor of the EHR sounds perfect but there are some challenging hurdles to keep our most precious information safe.


Commins, John. “Virginia Warns More Than 500,000 of Possible Records
Breach.” HealthLeaders Media. 4 June 2009. Web.

The Jury is Still Out...

It seems like the jury is still out on the electronic health record (EHR). There is not enough “evidence base” to discern whether the EHR is effective in the areas expected:

• Decreased medical errors
• Decreased preventable adverse drug events
• Standardization of care
• Efficiency in care delivery (legibility, automation, efficient scheduling)
• Improved quality of care
• Cost savings (reduction of hospital length of stay)

According to S. Clamp and J. Keen, authors of “Electronic health records: Is the evidence base any use?” there isn’t enough evidence to prove the EHR’s viability or cost effectiveness. In research studies, the authors found improvements in one area, but in another area, a decrease in efficacy. For instance, for nurses, the bedside terminal (a computer terminal just outside a patient’s room—many are mobile and can be wheeled down the hall) saved nurses almost 25% of “overall time spent documenting during a shift.” Conversely, for physicians, the bedside terminal increased their time by 17.5%, and 328% when using the “central station” for computerized order entry, which is extraordinarily inefficient. Thus far, the data obtained has not proven the EHR to perform as it was expected; the areas that show most weakness are (1) improved patient outcomes, (2) reduction of healthcare costs, and (3) reduction in preventable adverse drug events. Some areas show reasonable improved efficiency: (1) order turn around time, (2) standardization of care, and (3) some improved work patterns. According to the article, the research that has been done so far on the EHR “reflect[s] deep assumptions;” many of the studies were done in one setting (a hospital or clinic) but the data collected is being used as overall data—assuming that every clinical setting is the same. My impression of this article is that it may have been wiser to establish the EHR within a large community or one state; this would have allowed a system to be studied closely and have problems resolved before allowing the system to go nation wide. The idea and hopes for the EHR is a good, but perhaps we have jumped the gun on this one. Something as big as this requires deliberate, educated discussion, science, research, and proper implementation and troubleshooting. Oh yes, the jury is still out…


Clamp, S., and J. Keen "Electronic health records: Is the evidence base any use?" Medical Informatics & the Internet in Medicine 32.1 (2007): 5-10. Science & Technology Collection. EBSCO. Web. 11 Oct. 2009.

Politics, Healthcare, and Bills...oh my!

President Obama promised that all personal healthcare records would be digitized within the next five years—an admirable goal; the downside to this same promise is that government and politics could be involved in the management and access of American’s medical records. Should there be a “separation of medical records and state” as there is a “separation of church and state?” It is interesting to point out that within the stimulus bill, passed earlier this year, “computerization of healthcare records is one of the showpieces” with a $19 billion budget (Bovard). Because the bill was passed so quickly, with the details undebated, there is some concern that some of the particulars—the devil is in the details—may do more harm than good. Privacy continues to be a significant concern; the electronic record would “require only a push of a button [and] in a matter of seconds, a person’s most profoundly private information [could] be shared with…millions” (Bovard). Another concern is that this leaked information could be used against an individual; do people want the government, employers, law enforcement, or neighbors to know the most intimate details of their medical and psychological history? The answer would probably be a unanimous “NO” on either side of “the aisle.”

The article “Health of the State” points out that doctors and hospitals would receive credits or funding for digitizing medical records and would be penalized if they did not comply by 2014. The article goes on to say that the software that exists does not do a great job at “sharing” information among providers; if doctors and hospitals were rushed into installing sub-optimal software, “it would only dramatically intensify the Babel that already exists.” As I originally thought, privacy is a huge concern when considering the electronic health record. So far, the benefits of the electronic health record outweigh the drawbacks, but these weighty concerns should, however, prompt lawmakers, medical providers, insurance companies, and patients to demand policies that require scrupulous safeguarding of private information.


Bovard, James "Health of the State." American Conservative 8.5 (2009): 9-11.
Academic Search Complete. EBSCO. Web. 11 Oct. 2009.

It's a Good Thing

First of all, I believe that the “e-record” or the “EHR” is, in more ways than not, a good thing. In some ways, I feel that the e-record has the potential for getting in the wrong hands, or, if something is incorrect on a patient’s record—it may be hard to get rid of (just like identity theft). I think some things are private and should stay so, if the patient wants it that way. This week, I read an article about Hurricane Katrina and its victims. In the immediate aftermath of the hurricane, our hospital received critically ill patients from Louisiana coming with whatever record they had at hand. For those, who weren’t ill at the time, they left their homes without prescription and allergy information, documented medical history, or immunization records. Many children had to start all over with their immunizations. This is a great example of how useful an e-record could be. Dr. Daniel Martich says, “We’ve learned a lot about what we lack as a nation with the Katrina disaster—we lack the essentials” (1). New York city mayor Michael Bloomberg touts the advancement of the electronic health record in his city saying that NYC doesn’t just talk about the e-health record…”we are actually doing it.” From the article in InformationWeek, it appears they are just putting the program together, utilizing a software company called eClinicalWorks. Their goal is to equip more than a thousand healthcare providers and create the “country’s largest community-based e-health records network” (2). This project has an emphasis on prevention of disease; doctors will obtain up to date information and have “the tools to better manage” (2) chronic diseases. New York City’s goals for this program are praiseworthy and plan for a healthier patient by providing additional software tools that will provide “charts and graphs for tracking blood pressures and cholesterol…provide instant referrals”(2); send prescriptions electronically to pharmacy; provide better follow up care by sending automatic appointment reminders to patients. They have plans to monitor and evaluate the effectiveness of the preventative care. As far as cost, the state of NY and the CDC are providing some funds for this program; primary care physicians “must pay for hardware and network infrastructure” (2)…and $4000 for the Fund for Public Health of New York. A hefty cost; I’m wondering if the benefits outweigh the costs for the physician.


(1) "Hurricane Katrina Highlights Need For Electronic Medical Record-Keeping; The storm destroyed medical records that were needed to give victims medical attention." InformationWeek (Sept 19, 2005)

(2) "New York City Puts E-Health Records Online For 200,000 Patients; City leaders say their initiative has created the largest community based e-health records network in the United States and can serve as a national model." InformationWeek (Feb 26, 2008)

Electronic Healthcare Record--Better care, Safety, Privacy

Before I started this project, I really didn’t know much about the electronic health record (EHR). According to Healthcare Policy Monitor, the EHR has a number of benefits: improved patient care--secondary to better communication between the hospital and the community healthcare team, reduced medication errors, and overall reduced cost. What I think is most important is that the healthcare providers will be able to see up-to-date information on their patients. Community doctors will be able to look and see information about a patient’s hospitalization, the medications the patient was placed on, and test results—and hospitals will be able to see the same. This will help to eliminate duplicate diagnostics and treatment; this will also allow providers to understand their patient and their medical history. A survey that was done by Healthcare Policy Monitor (HPM) explained that the EHR program surveyed was created to integrate already existing systems that would cut down on costs of purchasing compatible hardware. This seems like an economical way to go, because cost will be an issue for many healthcare providers. I don’t foresee smaller clinics, as one of my “followers” said, participating in the EHR because of the cost. As far as medication errors, the program “reduce[s] the frequency of dangerous medical mistakes, unknown sensitivity, etc” (HPM). As stated in my first blog, the concern for privacy of the medical record is a major concern. The program that was surveyed by HPM, stated that physicians were only able to view their own patients and no others. That’s only part of it. In Healthcare IT News, patient privacy is seen as “a controversial but key aspect of developing healthcare IT policy.” In the article “Privacy Experts Debate Patient Consent,” a number of experts don’t want the patient controlling their health record (and why not!?—Do we really want big brother in control of our health records?). On the contrary, Dr. Deborah Peel, founder of an organization Patient Privacy Rights, says: “A lack of safeguards poses risks to a person’s well-being, livelihood and financial stability.” I have to wholeheartedly agree that the patient needs to be in control of the record and that only those who have consent are allowed to see it—and that includes the U.S. government. Well, I am on my way to finding out more about the electronic health record and how it affects nursing and patient care. Until then, be safe and healthy this coming flu and viral season. It’s going to be a doozy

Welcome to Kathy's Blog

Hi, my name is Kathy. I have been working as a Registered Nurse for 16 years and have been a witness to many technological advances in the medical and nursing fields. I have been thinking about which direction to go in my technology research. I decided to look at the work I was doing at our hospital, how it has changed, and in which direction is our hospital going? At its forefront, our hospital is in the midst of establishing the electronic health record. Many of you will know what an electronic health record (EHR) is, and some will not. It has been a subject that has been discussed and supported by both President Bush and President Obama. An EHR is a patient’s record that is no longer on paper but in a computer storage system…but it is more than just storage. Apparently, it is supposed to improve both efficiency and quality of healthcare. I am going to find out how and why this is so. I wanted to research the EHR because I do not know much about it. How will it affect nursing? Is the EHR a better way? Will it save lives? Will it save money? Will it make my patients safer? Will it save me time? Is my patient’s (or my own) information safe? Is there a back-up system for this information? This is essential, personal information we are storing; will we honor it? Why is our government so interested in the electronic health record? These are all questions I want to know. Maybe you want to know. Maybe you do know. Perhaps some of you work in a hospital that has fully integrated into electronic charting. What do you think about it? I’m not exactly sure where my research will take me, but I think my goal will be to answer the following: (1) Technology as Knowledge- How will the EHR affects nurses’ methods, procedures, and routines? (2) Technology as a Process-What is the problem with the present health information storage and how was it (or will it be) solved? (3) Technology as a Socio-technical System- How will this system involve nurses and their patients? I welcome your input and your experience with the electronic health record.