Running head: INFORMATICS: ERRORS IN EHR UTILIZATION 1

Informatics: Errors in EHR Utilization

Delaware Technical Community College

NUR 410 Nursing Informatics

Veronica Franco

April 9, 2018
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Abstract

Today, most institutions across the nation have implemented a form of electronic health records.

This has in turn provided with multiple resources that can aid healthcare professionals in

establishing better care to the patients. It is essential for healthcare professionals to be

knowledgeable on how these systems are utilized and be able to understand how to properly

document information. There are many errors that could result due to the use of electronic health

records. Some of the errors are a result of human error; others are as a result of improper

implementation or design flaws of the system. It is always essential to maintain the safety of the

patient and work toward considering the ethical implications of care. It is important to maintain

awareness of the different errors that can result while in practice and find measures to solve

them.
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Informatics: Errors in EHR implementation

Nursing is a profession that has evolved throughout the years. There have been numerous

technological advancements that have shaped and improved the health of the population. The use

of informatics has helped enhance the nursing profession in numerous ways. It provides many

useful resources that healthcare professionals can utilize when providing care for patients. We

are able to locate and implement evidence based practice guidelines immediately and can aid in

providing timely implementation of treatments. Today, with the establishment of Electronic

Health Records (EHR), we have been able to experience a great evolution in the documentation

and research of patient data. The healthcare professional that provides care can immediately

document and make available the results of the patient. Multiple healthcare professionals can

have access to the same patient chart and allow for a faster plan of action. While the use of this

system can aid the healthcare professionals tremendously, there are human errors that could

contribute to potential drawbacks in patient health. This article will examine errors in Electronic

Health Records and potential measures of improving it.

With use of informatics, particularly the use of electronic health records, we must

consider the ethical implications that take place during patient care. It is essential to follow and

be knowledgeable of the Nurses code of ethics when caring and using informatics. Today, almost

all of the hospitals throughout the nation have implemented the use of Electronic Health Records

as a mean of storing patient information. According to McBride, Tietze, Robichaux, Stokes, &

weber, after the approval of the Health Information Technology for Economic and Clinical

Health (HITECH) of 2009, 95% of hospitals have established EHRs (2018). Some outpatient

facilities are still relying in the use of paper records for storing information. It is estimated that

60% of outpatient facilities particularly office visits, have an EHR system (McBride et al., 2018).
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With the aid of computerized records, we are able to access a numerous amount of resources that

can enhance patient care. There are several instances when nurses have trouble with EHR

utilization. Due to improper training, some nurses can have trouble accessing or locating

information (McBride, 2018). In some instances, nurses are unable to view the notes entered by

other staff, and when scanning patient responses, they are not enough options available

(McBride, 2018). Sometimes, personnel can copy and paste past responses without adjusting or

creating new ones, and in some cases, computers are frozen and can slow down the care of

healthcare personnel (McBride, 2018). While all of this drawbacks could contribute to patient

delay of treatment or could potentially lead to errors, we must be aware of the ethical

implications. It is the duty of the nurse to provide safe and effective care to the patient and

ensure that all their rights are respected. We have to always consider the ethical principles of

non-maleficence, justice, self-determination, and strive towards maintaining patient beneficence.

According to the ANA Code of Ethic’s provision one and two, the nurses role is maintain

compassion, ensure that the dignity of the patient is maintained, and ensure that their primary

commitment is to the patient (Slate, 2018).

The use of Electronic Health Records can provide many resources to the healthcare

professionals. There are several forms of EHR that can be accessed by the nurse or other

professional. They consist of patient storing of information in the form of Clinical Data

Repository (CDR), guidance of care in the form of Clinical Decision Support Systems (CDSS), a

form of establishing orders in the form of Computerized Provider Order Entry (CPOE), and

Physician Documentation (PD). These can all provide directions of care and alert the healthcare

professional during certain situations arise such as when prescribing medication or when

determining steps to follow during patient conditions (Muhammad, Telang & Marella, 2015).
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These tools can aid in a more efficient and timely care of the patient. According to Mihammad,

Telang, & Marella, “Errors in modern medicine occur because of work complexity, knowledge

intensiveness, and the variety and volatility of circumstances” (2015, pg. 32). These factors, can

contribute to the development of inappropriate care of the patient. According to the authors, a

properly established EHR system can aid in enhancing patient safety through improvement in

healthcare professional’s communication, providing knowledgeable tools that support decision-

making, can aid in establishing proper medication conversions or calculations and enable timely

monitoring of patient’s condition (Muhammad, Teland & Marella, 2015). These types of tools

should be properly utilized in order to prevent errors.

Electronic Health Record’s misuse can cause patient harm and lead to malpractice risks.

According to Aziz & Alsharabasi “EHR is a powerful tool that improves patient safety, reduces

cost, and increases healthcare quality by promoting the practice of evidence-based medicine and

consequently minimizing medical errors and malpractice incidents” but, can be hindered by

human errors, technology malfunction, or system imperfections (2015, pg. 251). The use of EHR

has brought many benefits that have improved the speed of patient care but they are also tools

that can contribute to adverse effects. According to the article, malpractice risks related to

Electronic Records can be summarized in three categories.

The first errors are those that occur during implementation of patient care which include

entry errors, opening the wrong patient chart and ordering procedures, lack of communication

among systems such as electronic versus paper records, distraction of the healthcare staff when

interacting with the patient, and transitioning from health systems can slow down the

implementation of care (Aziz & Alsharabasi, 2015). When nurses or other healthcare

professionals are focused on the use of the computer when storing patient information, that
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distraction could result in missing of patient signs and symptoms or can jeopardize the

relationship with that patient. The patient could feel that the staff is not willing to interact with

the patient and doesn’t concern themselves with their condition.

A second set of errors occurs when the EHR is in place. One of the most frequent errors

is that of copying and pasting healthcare information (Aziz & Alsharabasi, 2015). Due to

potential procrastination or a lack of time, some providers are relying on copying and pasting

notes that should be entered as new patient histories. Another factor that could lead to EHR

errors is that of medical alert fatigue. According to the authors, an improperly established alert

system can overwhelm the staff and result in improper action of the staff (Aziz & Alsharabasi,

2015). Finally, an overdependence on technology can lead to a delay in treatment if the systems

are malfunctioning or are down (Aziz & Alsharabasi, 2015). The healthcare staff can forget how

to properly calculate medication dosages or are unable to maintain an organization on proper

documentation.

The third type of issues that could lead to potential errors within the institutions that have

implemented Electronic Health Records is design related malfunctions. The first type of

malfunction can be a flaw in the design of the system. When an electronic system is

implemented, it is essential to consider factors such as how it should be integrated into the

workplace, the training provided to the healthcare staff, and the ability to access and work

through the system (Aziz & Alsharabasi, 2015). Other examples include the creation of improper

CPOE that could potentially lead to a wrong dose of a medication and overdependence in CDSS

which could lead providers to avoid ordering certain tests that aid in understanding the patient’s

condition but are not supported them (Aziz & Alsharabasi, 2015).
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In order to prevent or reduce the amount of errors are occurring as a result of the

implementation of an EHR system, it is essential to find possible options during its utilization.

First, it is to provide proper training to the healthcare staff that is utilizing these types of system.

There should be sessions that provide an orientation that guides them on where to access certain

information. If the staff are not confident or forget where to access certain information, they

should offer course refreshments that would allow for strengthening of the materials already

learned. They should educate the staff on how to correctly locate and identify the patient’s chart

and properly document information. It is essential to encourage nurses and other professionals to

open one chart at a time in order to avoid confusion and prevent entering information in the

wrong patient’s chart (Aziz & Alsharabasi, 2015). Even though copying and pasting information

can reduce the time of documentation, it is always essential to reinforce the creation of new

entries that can prevent missing information that could be essential to understanding the

treatment of the patient’s condition. When EHR systems are initially installed, there should be

tests that can verify its usability (Aziz & Alsharabasi, 2015). It is important for providers to be

knowledgeable of the different alerts that are available through the system. Many of the features

that are connected with the EHR system such as when scanning medications, can aid in

preventing the administration at the wrong time or wrong dose.

Today, we are held accountable for what occurs to our patients. We must be careful an

always double-check our work especially when identifying patients and providing medications.

The establishment of electronic health records has brought a great advantage to the nursing

practice and it is important to utilize these resources with care. It is important to not rely solely

on technology but always utilize our critical skills especially when we have lives that depend on
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us. The use technology is a great tool that can aid in properly treating our patients and we must

be able to take that into our advantage.

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References

Aziz, H. A., & Alsharabasi, O. A. (2015). Electronic Health Records Uses and Malpractice

Risks. Clinical Laboratory Science, 28(4), 250-255. Retrieved from EBSCOhost

McBride, S., Tietze, M., Robichaux, C., Stokes, L., & Weber, E. (2018). Identifying and

addressing ethical issues with use of electronic health records. Online Journal Of Issues

In Nursing, 23(1), 6. doi:10.3912/OJIN.Vol23No01Man05. Retrieved from EBSCOhost

Muhammad Zia, H., Telang, R., & Marella, W. M. (2015). Electronic Health Records and Patient

Safety. Communications Of The ACM, 58(11), 30-32. doi:10.1145/2822515. Retrieved

from EBSCOhost

Slate, M (2018). Nurses code of ethics. Retrieved from

http://www.rn.org/courses/coursematerial-177.pdf