National electronic health record


In 2004, President George W. Bush charged the medical community to develop a National electronic health record.

“By computerizing health records, we can avoid dangerous medical mistakes, reduce costs and improve care.”

The purpose of the EHR is to share pertinent patient information among healthcare providers and healthcare institutions. Sharing the information will save the patient money, increase patient safety, and improve the quality of care. The difficulty with this initiative is the variety of applications utilized to create and store the data.

As the need and ability to collect data has increased, so has the need to share the information, thus the development of technical health care standards. However, the lack of healthcare informatics standards to ensure the smooth transfer of data between systems is a major barrier to the national EHR initiative.

Another complicated area to deal with is the protection of patient information. Policies and Procedures are usually written at Healthcare Institutions that address patient confidentiality, electronic data access, integrity of electronic documentation, etc. Screen savers, privacy screens and short logout times are tools utilized on computers that are viewable by casual observers. Limiting access to the system based on job function is also used to secure patient data. The Health Insurance Portability and Accountability Act of 1996 mandates standards for developing unique patient identifiers that will provide privacy, security, and immaculate data transfer in order to link patient records.

The smooth joining of all this data is difficult to achieve. Institutions are currently challenged with trying to interface the different applications utilized in one hospital. It gets even more difficult when interfacing an entire Health System, let alone an entire nation of applications, patient identifiers unique, provider identifiers, etc.

In addition to the national EHR, hospitals continue to launch new applications to be used to support the care delivery. Over the years I have noted a lack of understanding regarding electronic signature, electronic documentation, access to patient records, etc. by nursing staff at all levels. The increase in electronic records has made information much more accessible to staff members but can also be deemed as too accessible if the staff members are not oriented to the confidentiality issues as they relate to electronic medical record access.

There is limited to no assessment of staff and their informatics knowledge on hire to healthcare organizations. Currently, the American Nurses Informatics Association is supporting a national initiative, Technology Informatics Guiding Education Reform (TIGER) aimed with writing competencies for nurses and nursing students to support the use of technology seamlessly in the delivery of safe and effective patient care. These competencies will incorporate theories, tools, and fundamentals of nursing informatics.

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