The Advantages and Disadvantages of Electronic Health Records (EHRs)

Following the institution of federal and state laws to adopt “meaningful use” EHRs (Electronic Health Records), health information technologies have become a fundamental requirement in the assurance of safe and quality care (Choi et al., 2013). EPIC has since emerged as one of the most popular off-the-shelf software solutions for the management of electronic health records. EPIC makes the ideal choice for evaluation due to its extensive use in the healthcare context that has seen it acquire a market share of 47% in the healthcare informatics industry.  According to the website of its proprietor, Epic Software Systems, EPIC is tailored to streamline workflows, complement physicians as a decision support system, conduct predictive analytics, and to improve staff productivity (”Epic - With the Patient at Heart”, 2018). Based on their selling point and drawing upon personal experiences, the systems benefits and shortcomings are apparent.

Design Features and their Roles in Facilitating Safe and Quality Care

            EPIC consists of a set of modules each serving a unique role to enhance the delivery of safe and quality care. The popular modules comprise of ASAP ER, EpicCare Ambulatory, and Epic Cadence.  ASAP ER’s application is in the hospitals (ER) where physicians and nurse use it to track the availability of emergency rooms and related facilities. The EpicCare Ambulatory module maintains a digital record of patient visits, order placements, prescription dispatches, and primary care test results for outpatients. Medical administrative staff use Cadence to make schedules for outpatient clinics and track admitted patients within the healthcare facility (Pulcinella, 2017). Other modules of the EPIC system include Radiant, Caboodle, Cupid, Clarity, and Home.

Types of Data Tracked, Monitored, Stored, and Trended in the System

            EPIC is capable of collating various types of data for tracking, monitoring, and analysis purposes. Like the Typical HER system, EPIC captures data about the health status of patients which nurses then use to monitor their progress. Nurses may also use EPIC to store information about patient behavior in response to various treatment regiments as well as their personal preferences towards care. On the other hand, public health administrators may use EPIC to examine trends for inpatient admissions, demand for drugs, and perceptions about the reputation of a healthcare institution as well (Groves et al., 2013).

Effectiveness in Accomplishing in Intended Purpose at the New Hanover Regional Medical Center

            So far, healthcare institutions have reported significant benefits associated with the adoption of EPIC, giving particular credit to its ”ability to connect information and retrieve standardized data for comparative analysis” (Johnson, 2016, p. 3). EPIC’s Clarity module realizes this purpose by identifying instances of poor compliance with established standards of medical practice. During a volunteer practice session, it was noted that the module could analyze records of patients’ symptoms alongside records of the accompanying medication to determine cases of misdiagnosis. The system would issue a sound and visuals alert whenever such incidences occurred. More importantly, EPIC could then generate automatic suggestions for the appropriate diagnostic procedures to help the end user realize and learn from their mistakes.

            EPIC also demonstrated its ability to enhance the quality of and reliability of documentation. The system’s inbuilt decision support system facilitates such enhancements through the application of algorithms that assess the accuracy of data entries (Chiang et al., 2013). For instance, physicians and nurse collaborating from remote locations within the New Hanover Regional Medical Center would consult EPIC’s double graphical interface to confirm the accuracy of digital records of patient visits, order placements, prescription dispatches, and primary care test results for outpatients.

            Despite EPIC’s ability to limit the potential occurrence of misdiagnoses, Johnson (2016) acknowledges that EMR systems have indeed not entirely isolated from the occasional medical error. The presence of such errors often arises as the result of the improper execution and adoption of EMR technologies. For instance, Johnson (2016) cites poor initial training regarding the technical aspects of EMR systems have rendered end users prone to the making errors during data entry misplacing records. This challenge has been prevalent at the New Hanover Regional Medical Center with severe implications on the institution’s ability to guarantee safe and quality care. For instance, a resident nurse who had just reported to the hospital once entered information into the data entry module under the name of another patient other than the one for which they had conducted an initial assessment. Since the system had no mechanisms of identifying errors of data misplacement, the former patient was diagnosed wrongfully with pneumonia whereas they were suffering from bronchitis. The consequences of the misdiagnosis were manageable. However, the situation alerted the hospital management of the potential for fatal outcomes.

The Role of EPIC Regarding Future Research

EPIC’s data storage facilities are arguably the most robust assets that researchers may use to support clinical and medical studies.  The electronic health records management system provides a rich database of patient records, interventions, and healthcare outcomes which only expands with more patient visits. Public health management institutions may then use EPIC’s accurate electronic documents as a primary source to populate national health databases. For researchers, the pool of data is a starting point for data mining technologies that could support the identification of complex interrelationship among health data. Researchers may then discover aspects of healthcare that would otherwise be time and resource intensive. For example, data regarding patient outcomes could prove useful in the identification of populations that qualify for retrospective clinical trials whenever pharmacists develop new drugs (Groves et al., 2013).

Opportunities for the Involvement of Nurses in the Design and Testing of System

Since nurses comprise the end-users of the EPIC system, opportunities abound for their participation in the design and testing phases. Due to their hands-on interaction with information systems, Zahabi, Kaber, and Swangnetr (2015) recommend that healthcare system designers consult the user requirements of all healthcare professionals to achieve optimal use to realize the standard of meaningful use. For example, their input would be most useful regarding the design of the user interface to ensure that graphical simplicity and ease of navigation. Most importantly, nurses would guarantee that the system analyst captures the entire scope of the desired functionalities before the implementation of the software.

During the testing phase, the input of nurse is equally significant since it gives software designers the opportunity to verify the HER system’s conformance to requirements. Nurses who interact with the system, for instance, can inform the design team about modules that they might have failed to capture. Similarly, participating nurse get the opportunity to pinpoint such functionalities that may require polishing, or suggest the inclusion of even more that they may not have provided during the requirements gathering stage (Zahabi, Kaber, and Swangnetr, 2015).

Opportunities for Enhancing the System to Satisfy the Needs of Professionals End-users

            Given its relative demerits, EPIC faces numerous opportunities for enhancing its technical capabilities to serve the needs of the professional who apply it in the healthcare context. Identifying the areas of improvement indeed require an analysis of the experiences of the system’s end users. Foremost, system administrators ought to consider Johnson’s (2016) concerns about EPIC’s complicated workflow processes, ability to merge information from other data management systems, security of patient information, and system downtimes.

Conclusion

            The EPIC system has demonstrated both in theory and practice a significant capacity to improve patient outcomes. However, the achievement of ideal results depends on the ability of the end users to make to make optimal use of HER software. Nursing professions, therefore, ought to undertake training programs to improve their technological literacy regarding such systems. Having gained the necessary competence, nurses could leverage the benefits of EPIC and other similar systems to guarantee quality care and identify promising areas for advanced clinical research

References

Chiang, M. F., Read-Brown, S., Tu, D. C., Choi, D., Sanders, D. S., Hwang, T. S., ... & Wilson, D. J. (2013). Evaluation of electronic health record implementation in ophthalmology at an academic medical center (an American Ophthalmological Society thesis). Transactions of the American Ophthalmological Society, 111, 70.

Choi, J. S., Lee, W. B., & Rhee, P. L. (2013). Cost-benefit analysis of electronic medical record system at a tertiary care hospital. Healthcare informatics research, 19(3), 205-214.

Epic - With the Patient at Heart. (2018). Epic.com. Retrieved 5 February 2018, from https://www.epic.com/software#PatientEngagement

Groves, P., Kayyali, B., Knott, D., & Van Kuiken, S. (2013). The ‘big data’ revolution in healthcare. McKinsey Quarterly, 2, 3.

Johnson III, R. J. (2016). A Comprehensive Review of an Electronic Health Record System Soon to Assume Market Ascendancy: EPIC®. Journal of Healthcare Communications.

Pulcinella, A. (2017). Epic Specialty Modules Glossary. Hopkinsmedicine.org. Retrieved 5 February 2018, from https://www.hopkinsmedicine.org/epic/manager_toolkit/specialty_modules_glossary.html

Zahabi, M., Kaber, D. B., & Swangnetr, M. (2015). Usability and safety in electronic medical records interface design: a review of recent literature and guideline formulation. Human factors, 57(5), 805-834.