Medical Computer Charting (EHR) — 6 Areas Needing Improvements
I was excited about computer charting at first, but that quickly faded. Computer charting made my work slower, tedious and overall more difficult. It is one more obstacle preventing doctors and nurses good patient care. Here are the critical trouble areas
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#1. Slow computing
Looking up information in a computer should be easy but that is not always the case. You are limited to your computer’s processing speed and internet speed. Information has to be downloaded from the system and sometimes it can be painfully slow.
If you go away for 5 minutes, and the system will log you out, creating constant log ins. If you are in a hurry, the system seem to slow down even further because it is not designed to accommodate fast and changing pace of a nursing floor. This can be frustrating and counter productive.
The system does not follow a nurse’s workflow — it wants you to follow the computer’s designed work flow. This workflow is unrealistic and does not conform to how real things are done on the floor. The program becomes the priority over the work at hand.
#2. Slow Internet
Most electronic charting systems are cloud based or internet based; the information resides in a remote server. The speed of your system will depend on the speed of your Internet connection or worse, your WiFi connection. Sometimes there are down times due to maintenance and nurses are not able to access the charts and files for hours. On weekends Internet traffic swells and access become sluggish.
#3. Way too many clicks
This is one of the biggest problem with EHR — it takes an excessive amount of clicking to perform any given task. For every piece of documentation there are too many windows to open and in each window there are several options to click. As the program is updated, more and more option clicks and windows are added, while the opposite should occur.
This is not only time-consuming but a health hazard as excessive clicking can cause carpal tunnel syndrome, specially if you are in a hurry which is often the case.
There is a disparity between how time is spent documenting and documentation priority. For example: you are required to chart 99% of something that only happens 1% of the time. It makes a nurse’s job hours longer than it should.
#4. Never ending charting
EHR charting should simplifying the work, but it does the opposite. Most information nurses need to enter are redundant, useless and add nothing to the patient’s well-being.
Instead of dedicating their time to patient care, nurses are forced to create complex and detailed spreadsheets for administrators to see. This is unfortunate.
I you have a busy shift and need to stay away from the computer things can get worse. When you finally have time to look at the screen there will be thousands or red flags you need to spend more time correcting. It is like the computer is punishing you for not doing things on time the computer’s time that is.
When you work with paper and pen you can be as fast as you want and you are in control. With EHR you are at the mercy of the computer, or the system your employer was sold.
#5. Making older nurses obsolete
Older nurses are being forced into obsolesce because of computer charting. These are older nurses who are not technically inclined; which is fine because nurses are not supposed to be computer geeks.
These are nurses with excellent patient care and people skills, but are barred from nursing because they can’t work with computer charting. They are ostracized by younger nurses and administrators. We are basically taking years of nurses experience and flushing it down the toilet.
#6. Too much information
Information is good to a point. If data entry takes time away from patient care, there is a problem. No one seems to be evaluating the cost and need for all this information.
The price is footed to the patient in the form of less time and attention. With electronic charting sometimes if feels like we are doing computer work rather than patient work. But nurses are not alone.
Doctors, administrators, therapists all suffer from the same data overload, and the time-consuming madness of entering information that might never be used. This is particularly noticeable in nursing skilled facilities (SNF).
Software companies sell packages to SNF’s promising they will look like hospitals. But most of the laborious data collection is useless to skilled facilities. They have limited staff and cannot address acute care issues.
It also prevent facilities from hiring replacement nurses from registries. On calls’ need to be software trained, something that never happens, leaving the burden of nursing replacements to the already small staff.
Changing the face of nursing
Nurses feel like their job today is more like data entry rather than patient care. The public too, feel like nurses are always in front of a computer.
It’s kind of like: one minute with the patient and 5 minutes in the computer. It is a loss for the patients that not only have to compete for the nurse’s time with other patients but now they have to compete with computers.
Out of sight, out of mind — computer filing do not provide visual markers. unlike paper work computer files are hidden from site so it is easy to forget about it
The Good
There are certainly good things in electronic charting. For once It eliminate the need to read doctors’ orders. Provided they know how to type because we know they don’t know how to write.
The other good thing is that all the information is in one spot and can be easily retrieved. Communications between facilities, labs, can provide comprehensive care as other health care worker’s data can be shared over a network. Not always possible presently, but will probably be possible in a near future.
Writing nurses notes can be more accurate and again, we don’t have read other people’s hand writing.
In the end of the day computer charting and EHR is in its infancy but is heard to stay. We have to remind ourselves that its implementation was only done about 5 years ago. As technology improves, computer charting will be more efficient. Right now we are just in a trial faze and having to iron out the kinks.
Final considerations
Computers are perfect at repeating tasks without any errors. But computers might be making us more dumb in the long run. But because computers create systems in which everyone relies, they give people the impression of security and safety, and that is not always the case.
The more information is stored an accessed by computer systems, less is the need for human intervention. Our reliance in computer database can make us more disconnected to knowing the whole process and understanding how the parts fit together.
It is fundamental for good and safe patient care that we evaluate if the data overload we spend so much energy gathering is of any real value and contribute to the well-being of our patients in the end.
Resources
- Electronic Health Records Documentation in Nursing: Nurses’ Perceptions, Attitudes, and Preferences
- Evaluating the Impact of Computerized Clinical Documentation
- Informatics: The Electronic Health Record: Will Nursing Be on Board When the Ship Leaves?
- ELECTRONIC MEDICAL RECORD IMPLEMENTATION IN NURSING PRACTICE: A LITERATURE REVIEW OF THE FACTORS OF SUCCESS
