Roberta Heale, Associate Editor EBN @robertaheale, @EBNursingBMJ

I spent a good part of last week receiving training for how to use a new, updated electronic medical record (EMR) system that will go live today at the community health centre where I work.  When I began working as a nurse practitioner in family practice in 1999 the only charting systems were paper-based.  Since then, all the community organizations I’ve worked at, and all in my area, have transitioned to electronic-based charting systems.  Although there are issues, I can still remember how excited I was to work with an EMR…no more searching for missing charts, or trying to read sloppy handwriting!

EMRs have potential to provide so much more than just efficiency.  They can also help to track and monitor patient care both within and from outside of the organization. Legible records help to reduce errors (Menachemi & Collum, 2011). EMRs can be used as evaluation tools to improve care and to fill in gaps where it is found that care is lacking.  For example, the use of EMRs can be used to demonstrate compliance with clinical guidelines, especially with the use of templates for chronic disease management (Lau et al., 2012).  A good example of this is in the care of patients with diabetes. Templates with all the care required each year help providers to note when such things as foot care or eye exams are needed.  Ultimately, there is huge potential for EMRs to be a helpful resource in improving the quality of care provided.

Despite the possibilities, EMRs are only effective tools to assist with better patient outcomes if used to their full potential.  Use of such things as templates, messaging and tracking can improve quality of care of patients. However, these tools don’t ensure that providers will make appropriate clinical decisions such taking patients’ blood pressure reading at each visit or monitoring that a patient has completed screening lab work at recommended intervals.  Although EMRs help to alert providers about processes such as best practice, factors that rely on practice and not documentation (eg. taking BP at patient visits) are not as consistently improved (Hsiao, Marsteller, & Simon, 2014).

A systematic review of 43 studies concluded that that quality of care related to EMR use was dependent upon many factors. These included such things as staff’s level of training, previous experience with EMRs, expectations, level of ambiguity of roles and responsibilities for adding to the chart and, importantly, time to chart all details. (Lau et al., 2012) Unfortunately, clinical documentation showed the least improvement over paper charting. However, care is improved when advanced features such as templates for chronic disease management and reminders are consistently implemented by the clinical staff (Gill, 2009; Menachemi, Ford, Beitsch, & Brooks, 2007; Schriefer, Landis, Turbow, & Patch, 2009).

Someone once told me that we us 10% of our smartphone capabilities.  The same may be true of the use of EMRs.  Even with training, we quickly forget all the features and resort to those that we are comfortable with or use most often.  Since better patient care can be achieved with better use of EMRs, it’s important for organizations to include ongoing training of EMRs and monitoring of (Ryan, Bishop, Shih, & Casalino, 2013).

I’ll try to keep this in mind as my clinic transitions to the new EMR.  It’s a time of possibility and excitement as well as apprehension.  However, we all have the opportunity to use this technology to improve our own practices and, ultimately influence more positive patient outcomes.

Gill, J. M. (2009). EMRs for improving quality of care: promise and pitfalls. Family Medicine, 41(7), 513–515.

Hsiao, C. J., Marsteller, J. A., & Simon, A. E. (2014). Electronic Medical Record Features and Seven Quality of Care Measures in Physician Offices. American Journal of Medical Quality, 29(1), 44–52. doi:10.1177/1062860613483870

Lau, F., Lau, F., Price, M., Price, M., Boyd, J., Boyd, J., et al. (2012). Impact of electronic medical record on physician practice in office settings: a systematic review. Management Science, 36(2), 123–139. doi:10.1186/1472-6947-12-10

Menachemi, N., & Collum. (2011). Benefits and drawbacks of electronic health record systems. Risk Management and Healthcare Policy, 47. doi:10.2147/RMHP.S12985

Menachemi, N., Ford, E. W., Beitsch, L. M., & Brooks, R. G. (2007). Incomplete EHR Adoption: Late Uptake of Patient Safety and Cost Control Functions. American Journal of Medical Quality, 22(5), 319–326. doi:10.1177/1062860607304990

Ryan, A. M., Bishop, T. F., Shih, S., & Casalino, L. P. (2013). Small Physician Practices In New York Needed Sustained Help To Realize Gains In Quality From Use Of Electronic Health Records. Health Affairs, 32(1), 53–62. doi:10.1377/hlthaff.2012.0742