The National EHR System & Who It Will Belong To

I am now 6 weeks into a Nursing Informatics class.  I realize every day how little I truly know about informatics in health care.  I am anxious for the National Electronic Health Record (EHR) system to become a reality.  Although there are some huge issues to be dealt with, patients could get faster, safer, better and more comprehensive care because their record could be accessed from anywhere.  Patient transfers would be made more efficiently.  The receiving institution could get a preview of the patient.  The sending institution would not have to worry about giving a good enough verbal and written report.  The patients would have the peace of mind that  everyone would have the same information.  I don’t think it was truly realized in 2004 how many good things could come from a National EHR system.  Everything could operate more efficiently.  Increased efficiency means less cost to all involved parties.  The downside of the National EHR system is it is creating a considerable strain, financially and psychologically, on health care institutions, staff, patients, and third-party payers.  To get the benefits of the system, vast amounts of information technology infrastructure has to be put down.  Infrastructure costs billions of dollars and this is taking place as the United States is trying to dig out of a financial meltdown.  That is why the United States Congress approved $27 billion in incentive payments to healthcare providers that proved they used EHR’s in a meaningful way (   When the National EHR is finally on-line, just think, everyone will be singing from the same sheet of music.   This is great for patient safety.  Many times safety issues arise as a result of a breakdown in communication.  The National EHR will help with the communication aspect of patient care and safety.

Face it, all health care providers want to do is to provide good care in an efficient manner with minimal obstacles.   The National EHR could be the answer if it is employed in the proper manner.  When health care providers get frustrated with the obstacles during care delivery, they start employing short cuts.  This is when mistakes occur and patient safety suffers.  The possibilities look great for the National EHR, we just have to continue to be patient advocates and make sure it is used to its potential.

Now, who will have ownership of each EHR?  The patient still owns it and should have access to it at their discretion.  The health care providers and  third-party payers should have access to the EHR when the patients use the health care system.  The Federal government should provide the rules and regulations for the EHR.  Not only does the patient’s EHR contain medical data, but it also contains personal information that belongs to the patient and only the patient.  Only when the patient allows, should anyone have access to the EHR.  The patient should be thought of as the CEO of their Electronic Health Record.  As healthcare providers, being allowed to have access to the record does not give one the right to claim ownership.  The same is true for third-party payers.  Possession does not equal ownership in this case.  With the new EHR coming, there will be more people with a vested interest in the patient’s chart.  We have to remember as healthcare providers we are there to serve the patient in a safe and efficient manner and document the service we provide.

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Who Wants To Be A Nurse Leader?

It is cliché, but being a leader can be challenging.  Many people depend on their leader and the leader depends on many people to achieve goals for the organization.  Motivating people is an interesting process.  It is challenging to motivate staff to participate in activities that are difficult, not interesting, or do not directly affect patient care. I feel that being a nursing leader is more challenging than many other leadership positions.  You ask why that is?  A nursing leader is not only responsible for their own staff and departmental issues, but they are also responsible for coordinating interactions with other departments (professional and non-professional) within the organization.  Nursing leaders are also responsible for all of the patient care direct and indirect.  According to Donna Cardillo, “Manager is a title and leader is an attribute” (Nursing Spectrum 2004).  Warren Bennis was quoted by Donna Hewett as saying, “A manager does things right and a leader does the right things”  (Modern Medicine 2007).  A manager is behind the staff pushing and a leader is in front of the staff setting an example.  A leader cannot be afraid of change, confrontation or failure.  A good leader knows how to “fail forward”.  This means that if you fail, make adjustments to where you are still moving forward and making progress.  The number one attribute for a good leader is respect.  Earn respect (don’t demand) and be respectful of others.  You can disagree and be respectful.  Tim Porter O’Grady was quoted by Susan O. Valentine in a University of Arizona article, “Motivate leadership from the bottom up…develop staff self direction rather than giving direction” (Nursing Leadership and The New Nurse).  He also wrote that “10% of unit-level decisions should belong to management” (O’Grady 2006).  A majority of the time if the front line staff is presented with a challenge or issue, the staff will brainstorm and solve the problem.  This helps the staff to become more engaged in the departmental challenges and goals.  Now the department has a multifaceted leadership structure.  Face it, a vast majority of the employees in healthcare want to do what is best.  We as leaders just have to communicate to the staff what the goals are.  The staff will make the goal a reality by incorporating  decisions into their daily work processes.

Dr. Stephen Covey, John Maxwell, and Tim Porter O’Grady are considered to be authorities on leadership.  All are internationally known for their leadership knowledge and ability to pass on useful information to leaders.  All three of them have written many books on leadership and have simplified the steps to becoming a good leader.  Covey wrote the book Seven Habits of Highly Effective People and John Maxwell wrote The 21 Irrefutable Laws of Leadership.  O’Grady wrote Interdisciplinary Shared Governance: Integrating Practice, Transforming Healthcare.  Many organizations’ (healthcare and non-healthcare) leaders hang on every word these men write.  Are the writings evidence based?  These organizations take to heart what these men write, apply the teachings and are very successful.  So, I would say the evidence shows strongly these men are correct in their teachings.  All three teach that a goal can be achieved when everyone works together (O’Grady, shared governance),  “the sum is greater than its parts” (Covey, #6 of the 7 Habits), and “secure leaders give power to others” (Maxwell, Law of Empowerment).  In short, all three of these men are teaching and encouraging leaders to build a team, set a goal and let the team work together to make the goal become a success.

I have been in the nursing leadership role for over 3 years.  It is exciting and challenging, but it is very rewarding when one has a great group of people to work with.  I want to be able to motivate people and get the most production out of a strong working relationship with my staff.  The only way to motivate people is to also be self-motivated.  If the leader is not motivated the staff will follow suit.  Leaders and staff must take ownership in the department and the department’s goals.  The leadership authorities mentioned above know how to motivate leaders.  Once we become motivated and enthusiastic, the tasks at hand become less troublesome and more exciting.  Excitement and enthusiasm is contagious and more people jump in and work toward the goal. TEAM = Together Everyone Achieves More.

Nursing Spectrum:

This article was written by Donna Cardillo to let all nurses know that they are leaders.  It encouraged nurses to pursue becoming formal leaders.  It is intended for new nurses and new nursing leaders.

Nursing Leadership and the New Nurse:

This site’s article contained different nursing theories.  It gave examples for each theory.  Intended for new nursing leaders and for nursing leaders wanting to improve their leadership skills.

Modern Medicine: Donna Hewitt RN, BSN:

This is an RN’s reflection on what it takes to be a leader.  Written during Nurses’ Week in 2007.  Written to let nurses know they can be leaders.  You do not have to be a manager or charge nurse to be a leader in your respective department.

Presentation of the 21 Irrefutable Laws of Leadership.  Power Point presentation.  This presentation allowed the reader to get the main points of the book and the ideas John Maxwell was trying to make.  Intended for all people wanting to be better leaders.

This article contained the “7 habits” that Stephen Covey wrote about.  It was a walk through the 7 steps with explanations of each.  Each step is very applicable to nursing leadership as well as outside of nursing.  The steps can also easily be applied to everyday life.

The Concept Behind Shared Governance 2006.

Shared Governance is a theory taught by Tim Porter O’Grady.  Application of the theory allows larger groups of people be involved in the decision making processes.   It applies mostly to the nursing profession, but many of the theories can be applied outside the nursing profession.  Shared Governance is a foundation to achieving Magnet Status for hospital organizations.

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Healthcare and Informatics: These Are the Days of Our Lives

Computers (informatics) entered the healthcare forum many years ago.  I don’t think that anyone at that time was aware of the great impact informatics would have.  Informatics started out as a quick way to log in lab tests and get results.  Informatics have helped remove human error from many human processes.  This helps increase patient safety and decreases the risk of patient injury or death.  Since the introduction, every facet of healthcare is greatly influenced by informatics and the patients’ electronic healthcare record (EHR).

So why is there such a push to make the patients’ charts electronic?  It was quickly  realized that the possibility of gaining access to a patient’s chart from anywhere in the world was a possibility.  In 2004 President Bush signed a mandate that this possibility become a reality.  The push for a national EHR has been gaining great momentum, especially in the last 3 years.   The EHR is as close to real-time documentation as one can currently get.  There are hardware and software programs that automatically adjust IV drip rates and then automatically document it in the EHR.  These “tasks” can be viewed by the care giver and the physician at the same time from different places in the world simultaneously.  Patient treatment can happen in a faster and more efficient manner as well as being safer because of the decreased risk of human error.

All of this is helpful for many reasons.  The information can be exchanged at a faster rate with fewer mistakes and decreased risk to the patients.  Handwriting legibility issues are greatly decreased, thus making mistakes decrease.  Patients could have easier access to their own health record if it is electronic.  Safety alerts can make the healthcare provider aware of possible patient safety issues.  Evidence and data can be collected faster and easier when the information is in an electronic format.  This can help expedite the development and approval of new medications and treatments.  The downside of the EHR is keeping the end-users engaged in the EHR process.  The technology is moving so fast, it is hard for the care givers to keep up.  They feel as if they are being pulled away from their patients in order to enter information in a computer.  The data entry is frequently made even more frustrating and more cumbersome by computer “down time” or networking or interface issues.  It is soon going to be the end of the line for any paper charting.  The care givers have to learn to embrace the thought of working with the EHR because it is here.

So now we have an EHR.  Who does it belong to and where does it reside?  It is a current debate taking place between all involved parties.  The patient has the greatest vested interest in the EHR, but many other parties have an investment in the EHR.  Because the patient’s private information is in the chart, the patient has the greatest amount of ownership.  I think the patient has 51% ownership of the EHR and the other involved parties make decisions based on the maintenance of the EHR while having a 49% share.  No final decisions about the patient should be made without consulting with the controlling shareholder, the patient.  As far as where the EHR resides, when the national EHR is functioning it will reside everywhere.

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Healthcare informatics

Well, here we are.

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