Bad Request (Invalid Hostname)

Christine Doerr	More NurseWeek Features   Smoke-Free Zone   Nurses and patients tackle nicotine addiction   Bloodless Survival     Surgical techniques to use when transfusion drops out of the equation
“Nurses are embracing the electronic health records technology and making it work,” says Charlotte Mitchell, RN, who helped launch and enhance the $154 million system that Sutter Health’s Northern California region is implementing throughout its provider network by the end of 2006.

Nurses at the Palo Alto Medical Foundation are test-driving a patient-accessible electronic health records (EHR) system about to be deployed to 5,000 physicians and 27 hospitals in Sutter Health’s Northern California region.

At Kaiser Permanente’s clinic-based Colorado provider network, nurses are being wired for wellness with an upgraded EHR platform that places a strong emphasis on promoting preventive care.

In an accelerating trend toward paperless, data-driven health care systems, nurses are taking key roles in the testing, tutoring, and tweaking of complex technology tools that will radically change the way they work and interact with patients. With the Veterans Health Administration (VHA) hospital network paving the way nationally, inpatient and ambulatory facilities throughout the country are getting onboard the digital express.

The VHA was an early pioneer in computerizing patient records in 1985. In the mid-1990s, the Mayo Clinic and some larger networks launched more modern-style EHRs. While a new generation of Web-based applications is speeding the trend, there’s still a long way to go. A government survey earlier this year showed only 13% of hospitals and 14% to 28% of physicians’ practices used EHRs in 2002, citing cost, technical compatibility problems, and privacy and confidentiality issues.

“Nurses are embracing the electronic health records technology and making it work,” says Charlotte Mitchell, RN, MPA, who helped launch and enhance the $154 million system that Sutter is implementing throughout its provider network by the end of 2006. “It raises the bar for quality and gives us more patient information. The medical records are more complete, the patient literature is more complete, and the problem lists are more complete.”

However, the technology can be daunting, and there was a “bell curve” learning experience for nurses — ranging from the computer-savvy to those who had never used a keyboard, Mitchell says. “They all got there. It isn’t hard to learn, but it’s a different way of processing when you’re dealing with a computer instead of paper.”

Mitchell says a unique feature for the 40,000 clinic patients is the ability to access portions of their medical records from home or work to view their health histories, request prescription renewals, schedule medical appointments, or even question their physicians about health concerns via e-mail and receive a prompt reply.

At your fingertips

Jeffrey Emrich, RN, assistant nurse manager of the ICU at the San Francisco VA Medical Center, recalls having to rush to a folder-filled chart room to pull a patient’s X-ray or health history. Now, the records room is gone, and instead of shuffling through a paper trail, Emrich can instantly access specific patient data without leaving his busy 18-bed unit.

Through the VHA’s advanced computerized patient record system (CPRS), nurses throughout the 120-bed hospital can go to any computer station and check on a patient’s medications, lab results, clinical reminders, or physician notes on a diagnosis. In intensive care, getting such information quickly can provide an edge in patient safety.

“With CPRS, we can scan through all kinds of documents related to a patient, and the faster we get information, the better care we can give,” Emrich says. For example, he can click an onscreen tab that pulls up a menu of a patient’s medical images, including X-rays, pathology slides, video views, scanned documents, cardiology exam results, wound photos, dental details, or endoscopies.

In Colorado, clinics serving thousands of Kaiser patients in the Denver, Boulder, and Colorado Springs areas were upgraded to an advanced EHR system called KP HealthConnect. It’s a $3 billion network that will eventually integrate 8.2 million patient records in nine states and the District of Columbia. While the Kaiser rollout is gradual in most regions, the Epic Systems-powered technology was implemented in four weeks in the Rocky Mountain state.

“We’ve been using an older clinical information system for years, but the new computerized medical chart is amazing,” says Sherrie Epperson, RN, MSN, NP, charge nurse at Kaiser’s Skyline Internal Medicine Clinic in Denver. “It really lets nurses navigate around health care information in a very timely manner and allows for accuracy and clarity that I don’t think ever existed in a paper chart.”

With the transition, nurses can access physician orders, track medications, and create graphs of a patient’s vital signs, such as blood pressure readings. The system also incorporates Kaiser’s strong emphasis on wellness and preventive care with alerts on patients who would benefit from disease management, weight control, or diet and fitness programs.

Also, patients in Colorado will be able to log in and view portions of their medical records from their home computers in mid-2005, an enhancement Epperson says would further engage patients in managing their own health.