COVID-19’s effects have significantly had a massive impact on the technological sector. The COVID-19 pandemic, within a short period, has brought about a considerable change in how organizations in all regions and sectors conduct their businesses. One of these sectors that the crisis has impacted is the health sector. The pandemic has digitally transformed the health sector by bringing into the limelight the adoption of digital programs that help nurses and other medical practitioners expedite their work to battle the COVID-19 crisis. One such program is nursing informatics. This specialty field functions to digitally integrate multiple information with nursing science and analytical sciences to define, communicate, identify, and manage data, knowledge, wisdom, and information in the nursing field (Kleib et al., 2021). The paper discusses one such kind of nursing informatics program, the Electronic Medical Records (EMR) system, that can be useful to nurses and the nursing sector in combatting the COVID-19 crisis. Besides, it also analyzes some of the potential losses and risks that come with the program and possible mitigation measures for smooth and uninterrupted operations.
Development of the EMR Nursing Informatics Program
Electronic Medical Records (EMR) is a software that entails the digital recording of the paper patient’s health information that aids the nurses and other health providers in crucial decision-making concerning how to care for patients. It contains the patient’s diagnoses, treatment plans, medical history, immunization
dates, medications, laboratory test results, images of radiology, and allergies. They help improve the quality of patient care and facilitate their safety and overall workflow within a single healthcare facility (Kohli & Tan, 2016). There are two development phases of the EMR; the Early and Most Recent.
The Early Phase
The initial efforts to develop the EMR software system began during the 1960s and ’70s, with the academic medical institutions developing their own integrated systems. In the mid-1980s, leaders agreed to commercialize the system. This necessitated creating uniform governing standards to facilitate the global adoption and usage of the system. The initial EMR systems were referred to as clinical information systems. Lockheed Corporation developed one such product in the mid-1960s. It was then handed down to Vendor Technicon and later to TDS Healthcare and Eclipsys, which is today part of Allscripts. The product influenced subsequent systems due to its flexibility and processing speed, allowing multiple users in the system simultaneously (Kohli & Tan, 2016). During the same period, a collaboration between the University of Utah and 3M saw the development of the first clinical decision support system, the Health Evaluation through Logical Processing (HELP).
Later in 1968, in collaboration with Harvard, Massachusetts General Hospital began the Computer Stored Ambulatory Record (COSTAR), containing some novel designs. The modular design enabled the system to be divided into parts, for instance, the accounting portion and the vocabulary part. For example, the accounting parts of the system did not need to encompass clinical or any extra information. The feature helped increase the efficiency of the system. Besides, its vocabulary section exhibited flexibility as its database enabled multiple-term recognition of a similar disease (Kohli & Tan, 2016). That feature enabled system users to identify a specific condition across the system regardless of technological variations by different organizations. The adoption of the EMR by the federal government started in the 1970s with the Decentralized Hospital Computer Program (DHCP), currently known as the Department of Veteran Affairs’ Implementation of Vista. Most former medical students and resident physicians got used to the VA’s Computerized Patient Record System (CPRS).
More Recent Phase
Numerous concerted efforts have been put in place to enhance the usage of EMR since the 1980s.On recognizing the need for a thorough analysis of manual health records, the Institute of Medicine (IOM) embarked on a study in the mid-1980s that saw the publishment of the findings in 1991 and later revision in 1997. The report by IOM identified EMR among its seven top recommendations as the critical component to improving patient health records, thus posing the idea of changing paper to electronic records. It also highlighted the possible setbacks of adopting the system, such as security threats, lack of standards, and cost. In the report, IOM also suggested the need for public and private funding to develop the systems. On realization of the findings by the private industry, supporters developed the Computer-Based Patient Record Institute (CPRI) to break down the setbacks to the development of EMR (Kohli & Tan, 2016). This has since been combined with the Health Information and Management systems Society (HIMSS). Later in 2000, a study of medical errors, “To Err is Human,” was published by the IOM, insinuating that healthcare safety was laid within such systems. The IOM was also involved in the electronic standards organization, HL7 development.HL7, although not the only existing SDO, is a non-profit international standards-developing organization (SDO) initiated in 1987 and has been the most widely known.
Due to the variation of the EMR system components due to development by different vendors, there was a need for standards for the optimum functionality of the system. Thus, an oversight body, Certification Commission for Healthcare Information (CCHIT), was developed to certify the vendors since 2006 as HL7-compliance.In recent years, EMRs have been the subject of discussion in national political forums revealing the increased concerns about the effects of record keeping on public health. The issue was first mentioned in 2004 by President Bush in his State of the Union address. President Obama incorporated this into the system as part of the Health Information Technology for Economic and Clinical Health Act (HITECH) in the 2009 American Recovery and Reinvestment Act.
The shortcoming of the EMR system: Potential Loss of Privacy and Hacking
Privacy of patient issues is one of the primary concerns with electronic health and medical records due to their potentiality of access by unauthorized users. This is one of the areas for improvement of this proposed nursing informatics program. Some confidential information landing into unscrupulous individuals may pose massive mental damage to a patient. Improper usage and reckless design of the EMR system interface have a high potential of causing errors in the EMR that may jeopardize the integrity of the system data. This may lead to declining healthcare quality and endanger the patient’s safety. Such unexpected consequences may also escalate abuse and fraud cases, resulting in harsh legal implications (Bani Issa et al., 2020). For instance, a malicious individual may hack into the system due to poor security design and manipulate the data, such as the patient’s Covid-19 vaccination data. A healthcare provider then uses the same data unknowingly to make a critical healthcare decision, for example, the type of medication or treatment a patient requires. This will automatically result in a misinformed decision which may put the patient in great danger.
Additionally, data may need to be correctly transmitted, entered, lost, or displayed, resulting in a loss of integrity with the system information. For instance, the patient’s previous COVID-19 vaccination records may be accidentally lost in the system. This will make it difficult for the nurses and other health service providers to know whether the patients had received vaccination earlier and how often they received it. Healthcare quality hugely depends on the health information’s reliability, credibility, and verifiability. Thus cases such as these, if not looked into with care, affect the credibility of the EMR system.
Mitigation Measures of the Potential Loss of Privacy and Hacking of the EMR
Cybersecurity attacks have significantly increased in recent years, becoming one of the primary healthcare information breaches. This, in many cases, has caught several healthcare institutions by surprise as they have been unprepared to secure patients’ data with the ever-changing dynamics of security threats (Wang et al., 2021). Hence, this section details some possible practices that may be critical in mitigating the security risks in healthcare Electronic Medical Records. First, proper education of the healthcare service providers team will be essential. Slight human negligence and unprecedented errors can pose a huge disaster and regrettable losses for healthcare institutions. Thus, creating security awareness and organizing cybersecurity training will be crucial. This helps equip nurses and other healthcare service providers with the essential knowledge to enhance intelligent decision-making when handling patient information.
Secondly, strict restrictions on data access and applications will bolster healthcare organizations’ patient data privacy. This will ensure that only authenticated users can access the system (Wang et al., 2021). Additionally, the implementation of protective data application controls will be essential. This ensures that malicious or risky data activities that target sensitive data in the system are blocked or flagged off on time. Also, data encryption in transit and rest will be critical. This makes it difficult for a hacker to decipher patients’ data even if they manage to access the system.
Key Stakeholders Needed to Ensure Successful Implementation of the System
For the successful implementation of the EMR system, various stakeholders will need to be involved. First are the clinicians the system has primarily designed to assist as they discharge their duties. Being in the frontline position of offering clinical services, they suggest the possible inputs required by the system during the selection and planning phases. Secondly, the front office staff/manager will be critical as they are responsible for the billing, contact, and demographic input information of the patients served by the health organization. Besides, this group of stakeholders will help with crucial feedback on the system’s performance, which can help improve the system. For instance, the wait time taken to serve one patient to another, especially with the high number of visiting Covid-19 patients.
Another group of stakeholders is the marketing team. They are essential because they help create a thorough review of the practice requirements. Through extensive promotion, patients get complete information about the system that can best serve them well and get to choose. For example, some EMR systems have online portals. These can help patients gain access to book and schedule appointments, especially during the Covid-19 period when the health facilities were packed and excessively busy. Also the board members and management will also be crucial in successfully implementing the proposed nursing informatics program. This is because they are the final decision-makers and controllers of the finances required to purchase the system.
Conclusion
The technology field is developing at first-rate, becoming the core of many business organizations’ success and the health sector. Due to the ever-changing technology landscape, the health sector, in particular, has seen the development of the nursing informatics specialty that deals with the automation of the health industry. One such kind is the Electronic Medical Records (EMRs) that facilitate the digital storage of patients’ health data. The software has dramatically improved the health sector but only came with shortcomings. One of those has been the risk of hacking and potential loss of privacy, which has questioned the system’s credibility and reliability. Although if possible measures are put in place, as discussed in the paper, the system will remain a game changer in the health sector. In conclusion, successful system implementation requires concerted effort and cooperation among various stakeholders, such as the clinicians, front office staff, the board members /management, and the market team.
References
Kleib, M., Chauvette, A., Furlong, K., Nagle, L., Slater, L., & McCloskey, R. (2021). Approaches for defining and assessing nursing informatics competencies: a scoping review. JBI evidence synthesis, 19(4), 794–841. https://journals.lww.com/jbisrir/Abstract/2021/04000/Approaches_for_defining_and_assessing_nursing.6.aspx
Kohli, R., & Tan, S. S. L. (2016). Electronic Health Records. Mis Quarterly, 40(3), 553–574. https://www.jstor.org/stable/26629027
Bani Issa, W., Al Akour, I., Ibrahim, A., Almarzouqi, A., Abbas, S., Hisham, F., & Griffiths, J. (2020). Privacy, confidentiality, security, and patient safety concerns about electronic health records. International nursing review, 67(2), 218–230. https://doi.org/10.1111/inr.12585
Wang, Q., Davis, P. B., Gurney, M. E., & Xu, R. (2021). COVID‐19 and dementia: Analyses of risk, disparity, and outcomes from electronic health records in the US. Alzheimer’s & Dementia, 17(8), 1297-1306. https://doi.org/10.1002/alz.12296
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