Although there are many advantages to using electronic health records for documentation, there are also many disadvantages. Many researchers concur that more research needs to be performed before hospitals can confidently say that switching from paper documentation to computerized documentation has had an overall positive impact within the healthcare field for nurses.
POSITIVE: EPIC IMPROVES COMMUNICATION BETWEEN HEALTHCARE PROVIDERS
Epic "significantly enhances teamwork among clinical professionals" (Meadows & Chaiken 34). These professionals can include
One particular example of how EPIC helps to improve communication is that it "allows a physician to convey a treatment plan, represented by a set of orders, in a clear, concise way, with a distribution of those orders to each professional involved in the patient's care" (Meadow and Chaiken 34).
In order to help improve communication and to educate healthcare providers on how to navigate through EPIC, Gabr suggests that hospitals develop "training for all health care workers about using the computerized patient record" (108).
- physicians
- nurses
- patients
- other healthcare providers (physical therapy, occupational therapy, radiology, dieticians, etc.)
One particular example of how EPIC helps to improve communication is that it "allows a physician to convey a treatment plan, represented by a set of orders, in a clear, concise way, with a distribution of those orders to each professional involved in the patient's care" (Meadow and Chaiken 34).
In order to help improve communication and to educate healthcare providers on how to navigate through EPIC, Gabr suggests that hospitals develop "training for all health care workers about using the computerized patient record" (108).
NEGATIVE: EPIC INCREASES THE AMOUNT OF TIME NURSES MUST SPEND DOCUMENTING
There are two reasons why nurses may spend more time documenting if they document electronically.
Firstly, EPIC is a very detailed spreadsheet that involves many boxes that the nurses/nurses aide/physician can choose. One example involves vitals. A nurse may write down a patient's vitals on a piece of paper. From there, the nurse must document the vitals into the computer. With this method, nurses almost double the amount of time that they spend doing vitals. A second example involves incontinence. With paper charting, nurses simply had to tally if a patient urinated or had a bowel movement. However, EPIC is more detailed. Robin Lochtefeld, a hospital nurse of seven years, articulated her feelings about the conversion of paper documentation to computerized documentation. Anna stated that when a patient urinates, she must document the amount (measured or unmeasured), consistency, color, appearance, odor, and method of elimination. She stated that the same goes for bowel eliminations. Although charting a patient's toileting becomes much more detailed with EPIC, it takes a little more time.
Secondly, EPIC often has downtimes in the late hours of the night. Anna Gehret, a veteran hospital nurse of twenty-seven years, stated that downtimes are when the IT servicemen work to improve EPIC during the night hours. Their goal is to fix any glitches that occured throughout the day. Anna stated that during a downtime, the nurse must write down on paper everything that happens to her patients during the downtime. When the computer system comes back on, the nurse must document the activities into the computer system. Therefore, it takes extra time documenting a patient's activities on both paper and the computer.
Firstly, EPIC is a very detailed spreadsheet that involves many boxes that the nurses/nurses aide/physician can choose. One example involves vitals. A nurse may write down a patient's vitals on a piece of paper. From there, the nurse must document the vitals into the computer. With this method, nurses almost double the amount of time that they spend doing vitals. A second example involves incontinence. With paper charting, nurses simply had to tally if a patient urinated or had a bowel movement. However, EPIC is more detailed. Robin Lochtefeld, a hospital nurse of seven years, articulated her feelings about the conversion of paper documentation to computerized documentation. Anna stated that when a patient urinates, she must document the amount (measured or unmeasured), consistency, color, appearance, odor, and method of elimination. She stated that the same goes for bowel eliminations. Although charting a patient's toileting becomes much more detailed with EPIC, it takes a little more time.
Secondly, EPIC often has downtimes in the late hours of the night. Anna Gehret, a veteran hospital nurse of twenty-seven years, stated that downtimes are when the IT servicemen work to improve EPIC during the night hours. Their goal is to fix any glitches that occured throughout the day. Anna stated that during a downtime, the nurse must write down on paper everything that happens to her patients during the downtime. When the computer system comes back on, the nurse must document the activities into the computer system. Therefore, it takes extra time documenting a patient's activities on both paper and the computer.
POSITIVE: EPIC SAVES TIME AND POSSIBLY LIVES
Epic "allows physicians to have access to patient health information and data to facilitate timely clinical decisions (Li and Korniewicz 17).
For example, if a patient's heart rate skyrockets into the 180's around four in the morning, a doctor can simply look on the computer to see a patient's electronic health record on EPIC instead of driving to the hospital to view the patient's written chart, thus allowing the doctor and nurses to bring this patient's heart rate down in a timely manner. This could potentially save a patient's life.
For example, if a patient's heart rate skyrockets into the 180's around four in the morning, a doctor can simply look on the computer to see a patient's electronic health record on EPIC instead of driving to the hospital to view the patient's written chart, thus allowing the doctor and nurses to bring this patient's heart rate down in a timely manner. This could potentially save a patient's life.
NEGATIVE: WITH EPIC, CARE PLANS MAY NOT BE CREATED AND USED PROPERLY
Ting-Ting Lee's article "Nurses' Perception of Their Documentation Experiences of Computerized Nursing Care Planning System" discusses a few problems that nurses have had while doing their patients' care plans via an electronic system. Her study found that "on some occasions nurses could not find the diagnosis they wanted so they used 'knowledge deficit' as a common nursing diagnosis" (Lee 1380). By this, Lee is stating that by using computerized care plans opposed to paper care plans, nurses may give patients the wrong diagnosis since the correct diagnosis is not available in the computer's drop down box. Her article also
concluded that some nurses do not
even use the care plans in the patient’s electronic health record. Instead,
“nurses applied their judgment or experience to revise and even correct
unsatisfactory content” (Lee 1380). Since some drop boxes did not have the
right diagnosis for each patient, nurses simply used their own judgment to take
care of their patients opposed to using a care plan system to take care of
their patients. Lee’s study introduced a major problem with electronic medical
records. Since patient’s care plans may be incorrect and are not looked at very
often, a patient may not be getting the best care he/she deserves. Perhaps
after enough research on this topic, nurses will go back to using paper care
plans opposed to electronic care plans so that they can create and follow
through with an appropriate care plan for each individual. The study concludes
by stating that further studies need to be done concerning care plans via
electronic health records.
EXTRA POSITIVES
Other positives of EPIC is that it:
- enhances patient privacy
- improves the quality of nursing records
- allows healthcare providers to see a comprehensive overview of multiple patients
- promotes safety within the workplace
- reduces costs in regards to transportation and supplies
- helps healthcare workers to facilitate evidence-based practice
- assists nurses in organizing their day