Brian J. Armstrong
Eastern Michigan University
The Electronic Medical Record and Quality Patient Care: A Literature Review
The electronic medical record (EMR) has been used in the health care system for approximately 20 years. In its earliest form, EMRs took on the simplest of tasks such as recording the very basic types of patient data. Today, the EMR has advanced into a healthcare tool that has become essential to quality patient care. In 2004, President George Bush explained in his State of the Union Address, “. . . by computerizing health records, we can avoid dangerous medical mistakes, reduce cost, and improve care” (as cited in Yontz, Zinn, & Schumacher, 2015, p. 23). It was this push about ten years ago that has precipitated the current state of the EMR being a complex and integrated healthcare tool. There are positive effects that have materialized with the EMR. It has been used successfully to reduce patient morbidity and mortality. While it is an essential tool, there also have been many barriers to its implementation. Just like with any other computer system, there were concerns for security and privacy of information. The positive effects, barriers, and concerns of use and implementation of the EMR will be discussed supporting that while barriers exist due to its usage, quality patient care can be achieved by using it.
In searching for articles certain key words were used: Electronic health records, nursing, patient safety, quality patient care, electronic medical records, and EMR barriers. The database searches were performed in CINAL and PubMed. The search was narrowed to only publications that were scientific research studies. The articles reviewed were published in the last ten years with a focus on the most current ones. At least one article was used from a non-US research group in order to include a worldwide view. In researching quality patient care in these databases related to the EMR, it became apparent that it was a very broad topic. Many different themes became apparent. An exhaustive review of ten articles narrowed the focus to three. The three most common themes were using the EMR as a surveillance tool for patient safety, privacy and security of patient information, and barriers to implementation.
Review of the Literature
The issue of quality patient care is interlaced with many areas related to the usage of the EMR. There are many tools implemented in the medical field over the last few decades, but none as powerful in helping healthcare providers provide safe care as using the EMR as a surveillance tool.
EMR as Surveillance Tool
Patient safety with use of the EMR as a surveillance tool has been used to monitor patient specific data and alert clinicians. In a study conducted by McRee, Thannavaro, Moore, and Pasvogel (2014), the authors looked at sepsis in patients in the ICU. These authors’ study designed the EMR to be used to alert the clinician when a patient was showing signs and symptoms of pending sepsis. Prior to this EMR alert, some of the signs and symptoms would have been caught at a later state in the disease progression. A risk factor scoring system was used along with the patient data in determining the alert status. McRee, et al. (2014) conducted a retrospective chart review of 75 patients, 6 months prior to and then 96 patients after EMR surveillance, to see if there were any significant differences in outcomes. Both cohorts had about the same percentage of patients that were graded into the three different stages of sepsis: sepsis, severe sepsis, and septic shock. The mortality between the two groups showed a significant difference with the pre-group having 91% survival to discharge with seven deaths as compared to the post-group having 99% survival to discharge with only one death (McRee et al., 2014). McRee, et al. (2014) concluded that the “EMR surveillance in this study