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Implementation of an Electronic Health Record (EHR) Program
Mia Graham
School of Nursing, NURS 521, Liberty University
Author Note
Mia Graham
I have no known conflict of interest to disclose.
Correspondence concerning this article should be addressed to Mia Graham
Email: mlgraham5@liberty.edu
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Implementation of an Electronic Health Record (EHR) Program
When implementing an Electronic Health Record (EHR) system it is beneficial
to use the Graduate-Level QSEN Competencies to help guide you implementing the new system.
The Quality and Safety Education in Nursing (QSEN) makes sure the knowledge and tools that are
needed to deliver safe and effective quality patient care are in order. There are seven competencies
that can help guide you to establish the implementation of an EHR system: Quality, Safety,
Teamwork and Collaboration, Patient-Centered Care, Evidence-Based Practice (EBP) and
Informatics (QSEN, 2012).
Quality Improvement metrics should be implemented and should have automated
methods to get results using the EHR system. A unify data platform should be created so data on
patients from multiple platforms can be accessed and monitored. Although standards and
incentive programs have improved the utility of EHR data for population health, substantial
disincentives to the creation of interoperable metrics remain but the incentives allow platforms to
import data and not export data to other systems (Curtis, Sathitratanacheewin, Starks, Lee, Kross,
Downey, Sibley, Lober, Loggers, Fausto, Lindvall, & Engelberg, 2018). Well designed,
comprehensive templates with natural language processing (NLP) can help facilitate quality
metrics. NLP can get reliable information right out the clinical notes that can be used to improve
the quality and safety of patients in the healthcare system. A vendor should be chosen that can help
implement all this data for quality metrics.
Safety is always an issue when it comes to patients in the healthcare system. EHR systems
help minimize harm to patients and improve patient outcomes. EHR should have built in
safeguards especially when prescribing treatments that could cause the patient to have an adverse
reaction. Clinical alerts and reminders such as allergies and potential conflicts that a patient may
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have with a new medication should pop up to prevent them from being given. Clinical reminders
for preventative care such as a colon cancer screening can help prolong a patient’s quality of care.
Having functions in the EHR system that help detect and manage certain risk factor patterns such
as high blood pressure or low blood glucose can quickly notify at risk patients.
Teamwork and collaboration are the only way to design and implement a successful and
fully functional electronic health record system. It is good to get together and find out what new
upgrades are beneficial to the new system and what may be needed to support the community.
Clinicians, researchers, interprofessional teams, regulatory agencies and even patients must first
understand and critically examine the origins of health disparities among marginalized and under
resourced communities (Brewer, Fortuna, Jones, Walker, Hayes, Patten, Cooper, 2020). Including
the perspectives of the community members can help develop a technology system that can benefit
their needs. Once data is collected about patient’s needs and their environment you can get a better
understanding of the patient’s quality of life. The team can collaborate and implement a system to
better care for them.
Patient-centered care (PCC) can be enhanced using the EHR system which can impact
patient health outcomes in a positive way. The goal of many healthcare systems is to provider
patient centered care. Healthcare providers should be able to use the EHR system effectively and
maintain a meaningful relationship with the patients and have good provider-patient
communication (Alkureishi, Lee, Webb, & Arora, 2018). Patient center care should be
implemented into health information technology and the EHR system should be able to support
that. Institutions are prioritizing PCC which requires designs that support patient centered care as
optimized communication, incorporate patient goals, and should allow clinicians to prioritize PCC
(Butler, Gibson, Lewis, Reiber, Kramer, Rupper, Herout, Long, Massaro, Nebeker, 2020) The new
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system should be able to process patient generated data such as their goals, values, and things that
they prefer. This information can let healthcare providers get an idea of the patient’s social history,
health behaviors and an idea of the type of environment are in.
Evidenced-Based Practice (EBP) information in an EHR system is a necessity these days.
Providing good patient care requires you to have up to date information available at that moment
especially if a patient’s life depends on it. A clinical decision (CDS) system that can be accessed
through the EHR system with just a clink of a link is very beneficial. Incorporating tools that can
educate clinical staff, patients and help consider all aspects of a patient’s condition at that
moment inside of trying to find a medical book can be lifesaving. EBP has begun to lessen the
burden on physician’s daily work, improve critical skills and reduce time looking through
patients’ health records (Robinson & Kersey,2018). EHR documentation can improve efficiency
of charting, make information more reliable and provide patient safety.
Informatics in healthcare is evolving everyday with all the new technology being
developed. There are so many devices that is used to communicate healthcare information for
patients. Patient’s information should be able to be transmitted from devices such as heart rate
monitors, exercise trackers and healthcare apps right into their chart in the EHR system. Health
informatics and digital health is impact so many people and a platform should be implemented
that can support the growing technology. Electronic health record systems could be used as
knowledge hubs that help point out socially disadvantaged groups. Producing data from these
hubs could better detect, track, respond to, and predict sources of health disparities and poor
healthcare outcomes amongst minorities
(Brewer, Fortuna, Jones, Walker, Hayes, Patten, Cooper,2020). Being able to determine if a
patient-provider communication is stereotyping or being bias as well as determine any errors in
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clinical decision making is a great tool to incorporate into the EHR system.
As of July 1, 2021, there were two policies that took effect for IT policies when an EHR
system is being implemented which are CMS Interoperability and Patient Access final rule
(CMS-9115-F) and CMS Interoperability and Prior Authorization proposed rule (CMS-9123-P)
(CMS.gov, Dec 9, 2021). The Interoperability and Patient Access final rule put patients first and
gives them access to their health information whenever they need it. The CMS Interoperability
and Patient Access final rule breaks down barriers in the health systems and establishes policies
to improve interoperability and unleash innovation (CMS.gov, March 9,2020). CMS is taking
steps to protect patient’s data and about sharing their information with third parties. As of
January 1, 2022, a process should be implemented for data exchange of patient’s information.
Having patient’s health information in place can be very beneficial to making decisions, efficient
care and having better health outcomes. Having this policy for the EHR system is needed to
provide quality care.
The Interoperability and Prior Authorization proposed rule requires payers in certain
government programs such as Medicare, Medicaid, Children’s Health Insurance Program (CHIP)
and Qualified Health Plans (QHP) to build application programming interfaces (API) to support
data exchange and prior authorization (CMS, Dec 10, 2020). A Fast Healthcare Interoperability
Resources (FHIR) API is good policy to have for patients to get fast quality care and for
providers to get paid properly. This implementation will also alleviate some burdens that
healthcare providers may endure. By having this application program interface put into a policy
would allow providers to know what documentation they would need for each health insurance
carrier, they can streamline the documentation process quickly, providers can send pre-
authorization request electronically and receive a response that way as well (CMS, Dec 10,
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2020). Having these policies in place can improve communication amongst healthcare providers,
patients, insurance companies while resulting in fewer authorization denials and appeals
There are four ethical principles for the EHRS that present conflict and should be
considered for the implementation program: beneficence, autonomy, fidelity, and justice
(Layman, 2020). Autonomy is an example of a patients right to privacy and confidentiality and
by them having access to their records gives them control. Informed consent is another example
of autonomy and it is the patients right to refuse to not have their data shared with other people.
Sometimes data is shared across other health care data bases without the patient’s knowledge.
When you go to the hospital you give your information for that specific visit but with data
mining your basically creating new information about a patient without their knowledge just
because you have access to it. Creating new information about a patient violates their autonomy
and they still need to sign an informed consent for that.
Fidelity brings up ethical issues due to the chance of having security breaches with
patient’s information. People have the right to keep their personal information confidential and
can choose who they authorize to have access to it. There were more than 27 security breaches
that involved more than 900,000 people’s health data between January and November of 2006
(Layman, 2020). The frequency of patient’s data being breached has increased due to electronic
health records and most of the breaches comes from laptops or external drives being stolen and
hacked. The IT team should make sure that adequate security measures are put into place to
protect patient’s health information and confidentiality when the system is implemented.
Justice can be promoted by using the electronic health record system. EHR helps discern
discrimination and socioeconomic in the health system but can build a digital divide because not
everyone has access to the internet and computer systems (Layman, 2020). When you think of
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Beneficence you think of “good” and having an EHR is good because it can improve the quality
of medical care, but it has its flaws. There are data inaccuracies, and some content does not
support basic medical services and access is not available for everyone who needs it. These four
ethical principles are very beneficial and should be taken into consideration when implementing
the EHR program.
There are so many potential benefits of the EHR system that makes it worth
implementing into your organization. When used at its fullest potential, the EHR systems can
give you the ability to share information across multiple specialties. A fully functioning EHR
system should include patient charts, patient portal, a good, computerized communication system
for the physicians, and clinical decision-making support system (Heart, Ben-Assuli, Shabtai,
2017). You can cut down on paperwork, productivity and efficiency increases which cuts the
waiting time for patients. Billing insurance claims can get processed faster as well as improve
clinical decisions for patients care. Clinical staff has easy online access to evidence-based
practices and journal articles that can help improve quality of care and monitor health issues in a
preventive manner.
Going digital can increase practice efficiency, cut administrative cost, and decrease cost
of care. The biggest benefit of having an EHR system is reducing errors. Medication errors are a
big issue in the clinical setting. The EHR system can be programed to flag indicators that may be
a potential harm to patients such as drug interactions. The electronic health record (EHR) system
can provide data for research or monitor diseases such as potential outbreaks such as the flu or
COVID-19. You can monitor patient communication and satisfaction via mobile devices, iPad,
laptops, etc. You may also be able to increase staff recruitment and productivity. The EHR
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system allows providers more time to spend with their patients, clinical staff can share
information and detect patterns that can lead to a faster and more effective cure for patients.
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References
Alkureishi, M. A., Lee, W. W., Webb, S., & Arora, V. (2018). Integrating Patient-Centered
Electronic Health Record Communication Training into Resident Onboarding:
Curriculum Development and Post-Implementation Survey Among Housestaff. JMIR
medical education, 4(1), e1. https://doi.org/10.2196/mededu.8976
Bezemer T, de Groot MCH, Blasse E, ten Berg MJ, Kappen TH, Bredenoord AL, van Solinge
WW, Hoefer IE, Haitjema S A Human(e) Factor in Clinical Decision Support Systems J
Med Internet Res 2019;21(3): e11732 doi: 10.2196/11732
Brewer LC, Fortuna KL, Jones C, Walker R, Hayes SN, Patten CA, Cooper LA Back to the
Future: Achieving Health Equity Through Health Informatics and Digital Health JMIR
Mhealth Uhealth 2020;8(1): e14512 doi: 10.2196/14512
CMS Proposes New Rules to Address Prior Authorization and Reduce Burden on Patients and
Providers Dec 10, 2020 CMS.gov https://www.cms.gov/newsroom/press-releases/cms
proposes-new-rules-address-prior-authorization-and-reduce-burden-patients-and
providers
Curtis, J. R., Sathitratanacheewin, S., Starks, H., Lee, R. Y., Kross, E. K., Downey, L., Sibley, J.,
Lober, W., Loggers, E. T., Fausto, J. A., Lindvall, C., & Engelberg, R. A. (2018). Using
Electronic Health Records for Quality Measurement and Accountability in Care of the
Seriously Ill: Opportunities and Challenges. Journal of palliative medicine, 21(S2), S52
S60. https://doi.org/10.1089/jpm.2017.0542
Heart T, Ben-Assuli O, Shabtai I; A review of PHR, EMR and EHR integration: A more
personalized healthcare and public health policy, 2017
https://doi.org/10.1016/j.hlpt.2016.08.002
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Interoperability and Patient Access Fact Sheet (March 09, 2020) CMS.gov
https://www.cms.gov/newsroom/fact-sheets/ interoperability-and-patient-access-fact-sheet
Jorie M Butler, Bryan Gibson, Lacey Lewis, Gayle Reiber, Heidi Kramer, Rand
Rupper, Jennifer Herout, Brenna Long, David Massaro, Jonathan Nebeker,
Patient-centered care and the electronic health record: exploring functionality
and gaps, JAMIA Open, Volume 3, Issue 3, October 2020, Pages 360–
368, https://doi.org/10.1093/jamiaopen/ooaa044
Layman, Elizabeth J. PhD, RHIA, CCS, FAHIMA Ethical Issues and the Electronic Health
Record, The Health Care Manager: 10/12 2020 - Volume 39 - Issue 4 - p 150-161 doi:
10.1097/HCM.0000000000000302
Ethical Issues and the Electronic Health Record - PubMed (nih.gov)
McBride, S., Tietze, M., Robichaux, C., Stokes, L., Weber, E., (January 31, 2018) "Identifying
and Addressing Ethical Issues with Use of Electronic Health Records" OJIN: The Online
Journal of Issues in Nursing Vol. 23, No. 1, Manuscript 5. Identifying and Addressing
Ethical Issues with Use of Electronic Health Records (nursingworld.org)
Policies and Technology for Interoperability and Burden Reduction (Dec 9, 2021) CMS.gov
https://www.cms.gov/Regulations-and-Guidance/Guidance/Interoperability/index
Robinson, K. E., & Kersey, J. A. (2018). Novel electronic health record (EHR) education
intervention in large healthcare organization improves quality, efficiency, time, and
impact on burnout. Medicine, 97(38), e12319.
https://doi.org/10.1097/MD.0000000000012319
QSEN_Grad_Competencies_031213.pdf (aacnnursing.org)
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