Electronic Health Records Provide a Link Between Patient Data and Care Outcomes

Christina Boord, BSN, RN, OCN^®, clinical practice and education specialist at the University of Maryland Greenebaum Comprehensive Cancer Center, and Cori Kopecky, MSN, RN, OCN^®, clinical development specialist at the University of Texas MD Anderson Cancer Center in Houston, discussed electronic health records, patient data, and outcomes during a session at the 43rd Annual Congress in Washington, DC (https://ons.confex.com/ons/2018/meetingapp.cgi/Session/1591).

Nurses are intimately familiar with ERHs’ ability to organize data. Patient health records, pharmacy systems, research and registry databases, billing and scheduling, and medical devices are often kept in EHR.

Boord and Kopecky said that EHRs increase a patient’s visibility across the continuum of care and that they are more than just a “digital version” of a patient’s paper chart—EHRs link providers, patients, research, and health databases.

EHRs inform patients of their own health care, measure patient outcomes, evaluate the healthcare process, and evaluate structure of providers, organizations, and facilities.

The three main components to EHRs are:

• Results Reporting Information System (laboratory results)
• Computerized Physician Order Entry System (a medical professional entering medication orders)
• Clinical Decision Support System (best practice advisories and alerts to enable healthcare providers to make clinical decisions)

The speakers noted that from a nurse’s perspective, EHRs can be helpful because they provide greater access to information and real-time documentation.

In the instance of hybrid systems (e.g., the laboratory uses a different data system), institutions will need to ensure a way to bridge the systems, providing all disciplines with the most complete and updated information.

Flowsheets specifically for oncology can be done through EHR, which helps to prevent anecdotal variation in practice and inconsistent information.

MD Anderson Cancer Center started its transition to fully using its EHR in 2012 and went live in March 2016. To achieve success, the system needed to be a collaboration between providers and interdisciplinary team members, including nursing informatics and EHR analysts, direct patient care representatives, and patients and caregivers.

Staff included graduate nurses, rotating medical staff (e.g., residents), current employees, and new hires who can learn the functionality of the system and use it immediately, the speakers said.

MD Anderson’s EHR contains reports and compliance for:

• Chlorhexidine gluconate (CHG): For CHG bathing, a daily report was kept for hospital-wide central line­–associated blood stream infection reduction efforts to verify compliance and to provide documentation of CHG and alcohol swab use around the central line.
• Pressure injury surveillance: This was a collaboration with the Wound, Ostomy and Continence Nurses Society and the nurses to provide prophylactic or treatment regimens and well-rounded approaches to patient care.
• Pain assessment and reassessment: Compliance with this report decreased following conversion to the new EHR. To combat this, the group used the ERH’s reminders and weekly emails to improve compliance and worked to simplify the pain documentation.
• Blood administration: Education increased regarding documentation for blood bank accreditation, and changes were implemented to the flowsheet for better support of workflow.

Although EHRs are beneficial for linking patient data to care outcomes, cost could be a barrier in having a system-wide EHR program, as well as the lack of commitment in using the system. A willingness to change clinical and business processes is integral to an EHR's success, Boord and Kopecky said.