Electronic Health Record and Nursing Education
What Are Electronic
Health Record
Traditionally,
patients’ health records were paper based, and nursing students learned
documentation skills by entering information under the supervision of the
clinical faculty (Baillie, Chadwick, Mann, & Brooke-Read, 2013). The move
to electronic-based health records was legislated in the United States in the
Health Information Technology for Economic and Clinical Health Act (2009).
According to this legislation, a qualified electronic health record (EHR)
includes patient demographic and clinical health information, such as medical
history and problem lists, and has the capacity to support clinical decisions;
support physician order entry; capture and query information relevant to health
care quality, and exchange electronic health information with, and integrate
such information from, other sources.
The goal of the federal legislation was
to have an EHR used for each person in the United States by 2014. Nursing
students need information about different EHR systems including their strengths
and limitations in accessing essential information at the point of care,
communicating across disciplines and settings , coordinating care, and guiding
patients through the many transitions that comprise the health care experience
(Mahon, Nickitas , & Nokes , 2010). Some nursing education programs are
purchasing academic EHRs that have the characteristics of a qualified EHR along
with an educational component that enables assessment of the student’s
documentation and feedback to the student through comments and grading in the
electronic format (Hanson, 2013).
Implementation of Electronic Health Records
There
are many EHRs being developed and sold in the health care marketplace. As
nursing students rotate through different clinical sites during their
educational program, they are exposed to different EHR systems; however, there
are a number of barriers that impact on whether students are able to document
using the clinical agency’s EHR. Rather than being given opportunities to
experience in simulated settings the mistakes and frustrations inherent in
using EHRs. health professional students often embark on a haphazard and
variable learning curve in patient care settings, where their EHR education is
directed by faculty with differing skill levels (Milano, Hardman, Plesiu, Rdesinski
, & Biagioli , 2014 )
have responded to the need for students to have electronic documentation skills
by using academic EHR during simulation experiences that encourage critical
thinking while allowing for errors. Vendors: supplying academic EHR include
SimChart by Elsevier, Neehr Perfect, and Cerner’s Academic Education Solution
(AES). Borycki , Joe, Armstrong, Bellwood, and Campbell (2011) described an
open-source system, the University of Victoria Interdisciplinary Electronic
Health Record Educational Portal, which allows access to a number of EHR
systems for health professional students.
Anest (2013) described how
pre-licensure nursing students were taught medication administration using
barcode technology, while interprofessional students (pharmacy, nursing,
physical therapy, and physician assistant) used the MEDITECH software package
(Medical Information Technology, Inc. Westwood, MA) to simulate the medication
administration and documentation ( Kirwin , DiVall , Guerra, & Brown, 2013).
Meyer. Sternberger , and Toscos (2011) described experiences with AES, while,
to avoid the costs associated with purchasing an EHR system, Rubbelke , Keenan,
and Haycraft (2014) used Google Drive, a cloud storage device that stores
documents and can be synced with a free Google account. Another strategy that
faculty have used is to partner with the EHR system used in the clinical
setting in order to have access to the same EHR system for student practice.
Electronic Record Versus Paper Record
The
transition from paper based record to EHRS is a worldwide phenomenon. Use of
EHR has been associated with better care coordination, continuous access to
evidence, information exchange between providers, and improved client
engagement in health and self-care processes (Topaz, Rao, Creber, & Bowles,
2013). The cost of using an academic EHR has been estimated to be at an expense
to each student of at least US$35 to US$49 per semester ( Rubbelke , Keenan,
& Haycraft , 2014). Not only do faculty need to learn skills associated
with using EHR, they need to communicate these skills to students who are
novices in clinical practice.
Role of Nursing Faculty and Education
Nursing
faculty and students must develop competence in EHR documentation skills and
establish clear systems for authorized access so that students can document
during clinical placements (Baillie et al, 2013).Health
professional educational programs should collaborate as they choose academic
EHR systems and develop curricula modules so that not only documentation skills
are taught but also the importance of communication between members of the
health care team.