Benefits of Using an Electronic-Medical-Record in the Emergency Department: A Systematic Review

AbstractLow quality of care is a problem for many United States (U.S.) emergency departments (E.D.). The use of electronic medical records (EMR) with quick embedded tools, treatment plans, and protocols decrease E.D. overcrowding, reduce boarding time, to approximate the 4- hour recommendation by the Joint Commission on Accreditation of Healthcare Organizations, and improve quality of care. The project question asked whether a systematic review of EMRs with quick embedded tools, treatment plans, and protocols decreased overcrowding and boarding time, and improved E.D. quality care. This systematic review used the Johns Hopkins Model to answer the project question by guiding selection, evaluation, and assessment of best evidence to answer the project question. The evidence guiding this project was obtained via the Walden University library databases and included 31 articles from CINAHL & MEDLINE, Cochrane Database of Systematic Reviews, as well as the Centers for Disease Control and Prevention Interactive Data Base Systems, EBSCOhost, Google Scholar, and Joanna Briggs Institute Evidence-Based Practice (EBP) Databases. Results supported usage of E.D. EMRs with quick embedded tools, treatment plans, and protocols to reduce E.D. patient overcrowding, and improve E.D. boarding time. Additionally, improved quality care was supported by EMRs, with embedded quick embedded tools, treatment plans, and protocols, through improved clinical decision making, increased quality of patient diagnosis, and increased timeliness of diagnosis. This enabled more effective decision-making in patient care, improved patient safety, and enhanced satisfaction. Using EMRs with embedded quick tools, treatment plans, and protocols can therefore contribute to social change by improving patient health through improved quality E.D. care

Successful Strategies for Implementing EMR Systems in Hospitals

Some hospital leaders are ineffective in implementing the electronic medical record (EMR) systems in the hospitals. The purpose of this multiple case study was to explore strategies hospital leaders use to successfully implement EMR systems. The target population consisted of hospital leaders and healthcare professionals from two hospitals who have successfully implemented EMR systems. The conceptual framework of this research study was Kotter\u27s 8-stage process for leading change, building on the model of an effective change management method. Data were collected from 5 interviewed participants and company documents related to strategies regarding the EMR system implementation. The results of reviewing open-ended interview questions and archived documents were analyzed using codes and themes to facilitate triangulation. Three primary themes were developed from the coded data: (a) strategies hospital leaders use to implement the EMR system, (b) strategies hospital leaders use to achieve quality and best practice, and (c) strategies hospital leaders use to manage change and resistance to change. Results revealed 4 steps for successful implementation: (1) creating a vision, (2) communicating the vision, (3) establishing strong leadership, and (4) consolidating gains. Utilizing the successful strategies hospital leaders use to implement the EMR systems could produce quality patient care, efficiencies in hospital operations, and reduced organizational operation cost. The findings could effect positive social change through delivery of quality health and patient care that results in community cost benefits and healthier patient lifestyles

Strategies Hospital Leaders Use in Implementing Electronic Medical Record Systems

Some hospital leaders lacked strategies for implementing electronic medical record (EMR) systems. The purpose of this case study was to explore successful strategies that hospital leaders used in implementing EMR systems. The target population consisted of hospital leaders who succeeded in implementing EMR systems in a single healthcare organization located in the Los Angeles, California region. The conceptual framework used was Kotter\u27s (1996) eight-step process for leading change, and data were collected from face-to-face recorded interviews with 5 participants and from company documents related to EMR design and development. Data were analyzed through methodological triangulation of data types, and exploring codes exhibiting high frequencies to identify principal themes and subthemes. The data coding revealed three primary themes. The first theme related to strategies addressing training, technology, and catalyzing team effort. The second theme related to strategies focusing on employees\u27 concerns, and the third theme related to strategies for designing, developing, and disseminating workflow. The findings affirmed the conceptual framework of Kotter (1996) inasmuch as they showed that participating hospital leaders used one or more steps in Kotter\u27s eight-stage process of creating, implementing, and sustaining significant change. The findings could effect social change by improving the quality of healthcare services provided to patients, which can subsequently benefit patients\u27 families and communities through reducing the costs of healthcare

Nursing Approaches for Use and Sustainability of Barcode Medication Administration Technology

Approximately 43.4% of medication errors occur at the time of administration despite the use of bar code medication administration (BCMA) System. This trend has prompted a national effort to mitigate this problem in the United States. Implementing BCMA in health care settings is one of those efforts. Studies focusing on the approaches employed by nurses when using this system are scant. The purpose of this qualitative case study was to investigate strategies nurses and their leaders use to ensure BCMA is implemented, maximized, and sustained. The technology acceptance model was used to guide the study. The 2 research questions addressed nurses\u27 perceptions regarding the use and optimization of BCMA, and approaches of clinical nurses and their leaders to ensure that BCMA technology is properly used, optimized, and sustained in acute care units. Data collection included semistructured interviews with 8 participants. Thematic data analysis generated themes including ease of use, reduce errors, time saving, old technology, overreliance on technology, paper backups, and hope for future development. Common barriers to system effectiveness were system errors and inadequate training; intragroup and self-monitoring were important strategies to sustain use of the system. Study results may be used by health care leadership to reduce medication errors by adopting easy to use technology, change policies regarding training of BCMA end users in hospitals, increase the culture of patient safety among nurses, and prompt technology redesign within health care settings that meets the national patient safety goals

Identifying Physicians’ User Experience (UX) Pain Points in Using Electronic Health Record (EHR) Systems

Healthcare institutions have migrated to online electronic documentation through the means of Electronic Health Record (EHR) systems. Physicians rely on these systems to support their various clinical work processes, such as entering clinical orders, reviewing essential clinical data, and making important medical decisions using reporting analytics. Although EHR systems appear to be useful and have known advantages over paper records, studies suggest there are persistent user interface design problems that may hinder physician productivity. The study focused on the research problem that EHR system designs create productivity problems for physician users who frequently report that system workflows are inefficient and do not map to their clinical process needs. Although researchers have examined EHR system adaptation and user interface design with various stakeholders, research is limited on the lived experiences of physicians who use the system. A few studies have focused on quantifying the factors that describe the phenomena of “meaningful use” of EHR systems. A qualitative approach to studying the phenomenon of physicians\u27 use of EHR systems is understudied and is relevant to investigate given EHR systems have become commonplace tools in clinical settings. An interpretive phenomenological analysis (IPA) study was conducted with the goal to discover what emergency room physicians describe as the pain points of their user experiences with EHR systems, which may include many different experiences to be uncovered, and their perspectives about how they manage the difficulty of system tasks and demands. Eight participants who represented a purposeful sample were recruited from one hospital in the Southeast region of the United States and participated in semi-structured interviews with open-ended questions. The data derived from the personal lived experiences of the participants were reviewed and analyzed through a step-by-step analytical process to develop five super-ordinate themes: Historical Chart Review, Inadequate Note Documentation, Difficult Order Entry, Patient Throughput Barriers, and Poor System Performance. The findings reveal consistencies with previous research that suggests physicians experience mental burden and burnout using EHR systems due to task complexity, task demand, and inefficiencies of system design. The findings have multiple implications for information technology (IT) system designers, healthcare administrators, and physician end users. This study provides future research opportunities to investigate the experiences of individuals who work in a different specialized area of the hospital, such as the intensive care unit (ICU)

A qualitative study of workflow and information systems within Emergency Departments in the UK

Background: Health Information Technology (HIT) has the potential to improve the quality and efficiency of healthcare delivery and reduce costs. However, the integration of HIT into healthcare workflows has experienced a range of issues during its implementation. It can adversely impact healthcare workflows, therefore reducing efficiency and safety in healthcare delivery. As healthcare settings are characterised by its own workflow, an in-depth understanding of the workflows of where the HIT to be implemented is crucial in order to avoid complexities that can arise. As there is a lack of research investigating an overall ED workflow, both clinical and non-clinical processes and practices, this research aims to gain an in-depth understanding of emergency care workflow which includes the work processes and practices of its clinicians and non-clinicians and its information artefacts. Methodology: This research employed a fieldwork case study approach analysing the work processes and practices of clinicians and non-clinicians in the delivery of emergency care. The approach was used in order to capture the situated nature of the ED workflow. The study was conducted in two emergency care settings located in the UK. Data were collected using semi-structured interviews, non-participant observations and documents. A multiple triangulation technique: data triangulation and within-methods triangulation were employed in order to gain an in-depth understanding of the topic. The data were analysed using thematic analysis. Findings: The emergency care workflow consisted of multidisciplinary ED team members’ work processes. These work processes were comprised of collaborative clinical and non-clinical tasks and activities in delivering care treatment governed and defined by time-related activities, organisational rules, exceptions and variability. The workflow was supported by both computerised systems and non-computerised information artefacts, such as non-electronic whiteboards and paper-based records and forms, which needed to be used in conjunction with each other. Additionally, the hybrid implementation had also been utilised to support collaborative work of the clinicians and non-clinicians, hence giving the implication that HIT systems should not be designed as purely technical system focusing on single users, but also as a collaborative work system. Conclusion: An ED workflow consists of interrelated care processes, clinical and non-clinical processes. These processes are executed semi-autonomously by clinicians and non-clinicians and governed by time-related organisational constraints, variable and exception-filled, relying on hybrid information architecture. The architecture presented workflow with a number of integration issues. However, its implementation does not only support the functionalities for the delivery of emergency care processes but also the collaborative practices of the clinicians and non-clinicians