EMR/EHR – Electronic Medical/Health Records
Electronic medical or health records are an online digital version of your typical paper chart. It contains the standard medical and clinical data from a physician’s office or health care system. (Quatris Healthco, n.d.). This includes things like your medical history, diagnoses, medications, immunization dates, allergies, lab results, tests, treatments and doctor’s notes (Quatris Healthco, n.d.). EMRs ensure appropriate care throughout the healthcare system by effectively allowing communication and coordination among members of a health care team (Quatris Healthco, n.d.). Hospital systems, physician clinics, and long term care homes would benefit from EMRs.
EMR and EHR are very similar. The difference being EMR contains information and records of the patient from one provider, while EHR contains all of this and can be shared amongst all providers to help coordinate care for the patient (Quatris Healthco, n.d.).
PACS – Picture Archiving and Communication System
PACS is an electronic system for acquiring, sorting, sharing, storing, and electronically displaying medical images (Jorwekar, Dandekar & Baviskar, 2015). It is filmless and doctors can now access these images via a secure computer system from any location. It is used for things such as x-rays, ultrasounds, CTs, and MRIs. It is found in both the hospital systems and in outpatient clinics (Jorwekar et al, 2015). It is especially useful for physicians who depend heavily on radiology images, such as orthopedic surgeons (Jorwekar et al, 2015).
CPOE – Computerized Physician Order Entry
CPOE is a computerized system which allows physicians to directly enter their orders digitally (Khanna & Yen, 2014). This ensures that the orders are standardized, legible and complete (Khanna & Yen, 2014. There is no handwriting involved. The orders are then automatically transcribed onto the eEMAR. CPOE has been promoted as an important component of patient safety, quality improvement, and modernization of medical practice (Khanna & Yen, 2014). This system helps support those delivering acute care for patients in the hospital as well as in long term care.
eMAR – Electronic Medication Administration Record
EMAR, which I use at Niagara Health, is an Electronic Medication Administration Record technology that automatically documents the administration of medication into certified and monitored technology using radio frequency identification and other electronic tracking sensors (Covetus, 2020). EMAR reduces medication errors by improving mediation order legibility and by providing nurses with easier access to the patient’s current medication profiles and potential drug interactions (McComas & Riingen, 2014). We may see this technology in auto care and long term care.
Telehealth is the delivery of health care, health education, and health information services via telecommunications and digital communications (NEJM Catalyst , 2018). It can be used to speak to a doctor remotely over the phone or video chat or by messaging back and forth using chat messaging, e-mail, and secure file exchange (Health Resources & Services Administration [HRSA], 2021). Telehealth is very beneficial in particular right now during the pandemic because it allows us to socially distance but still communicate with our physicians
OTN – Ontario Telemedicine Network
Part of Ontario Health, the “Ontario Telemedicine Network” (OTN) allows patients and clinicians to meet virtually via a secure two-way network (OTN, 2021). It is a form of Telehealth. OTN is one of the largest telemedicine networks in the world. It uses two-way videoconferencing to provide access to care for patients in every hospital and hundreds of other health care locations across the province (OTN, 2021). My health system utilizes this system for non-schedule 1 psychiatric facility assessments. For instance, when an individual struggling with mental health arrives in Niagara Falls, Welland, or Fort Erie they will be seen, via OTN, by a psychiatrist in St. Catharines. This system is great for outpatient, community, and family health care teams.
Patient portals have the potential to enhance patient engagement by enabling patients to access their electronic medical records (EMRs) and facilitating secure patient-provider communication and treatment. Patient portals also support patients in the delivery of health care and has the potential to improve health outcomes and patient satisfaction (Dendere, Slade, Burton-Jones, Sullivan, Staib & Janda, 2019). For example, my health system, Niagara Health, utilizes a patient portal called “MyChart” which provides patients access to lab results, medical imaging reports, and clinical notes (including progress reports, discharge summaries, operative reports, etc.) (MyChart, 2021). This system is great for patients experiencing outpatient treatment and community care.
As technology advances, handheld devices are becoming more and more common in healthcare. It allows members of the healthcare team to have instant access to vast amounts of information using the internet and healthcare applications (Mickan, Atherton, Roberts, Heneghan & Tilson, 2014). Physicians can use handheld devices to research drugs and clinical conditions, use clinical decision support systems, and access patient information including clinical and laboratory investigations (Mickan et al., 2014). These handheld devices can provide real time access to clinical information facilitating decision making at the point of care (Mickan et al., 2014). Handheld devices (i.e., phones) are so common you can find them in any area of care. I can’t tell you how many times I’ve whipped my phone out to quickly research something. I’ve seen physicians do the same. When I worked in the community, I was given a phone with a portal where I retrieved all my patient information and checked into and out of their house. It can also be used in education. A study from 2008 found that handheld devices improved leadership skills and professional confidence in BScN students (Farrell & Rose, 2008). It provided students with reinforcement of core knowledge and information in real time (Farrell & Rose, 2008).
How could information from these systems potentially be converted into nursing knowledge used for clinical practice?
Technology is continuously evolving, as are each of these eHealth systems we have just discussed. As nurses, it is our job to evolve with it and continue to learn and grow with these systems. Whether we like it or not, they play a large part in the care we provide our patients.
Covetus. (2020, July 24). The features &benefits of eMAR (electronic medication administration record). Retrieved from https://www.covetus.com/blog/the-features-benefits-of-emar-electronic-medication-administration-record#:~:text=eMAR%20is%20an%20Electronic%20Medication,and%20other%20electronic%20tracking%20sensors
Dendere, R., Slade, C., Burton-Jones, A., Sullivan, C., Staib, A., & Janda, M. (2019). Patient Portals Facilitating Engagement With Inpatient Electronic Medical Records: A Systematic Review. Journal of medical Internet research, 21(4), e12779. https://doi.org/10.2196/12779
Farrell, M., & Rose, L. (2008). Use of mobile handheld computers in clinical nursing education. The Journal of Nursing Education, 47(1), 13–19. https://doi.org/10.3928/01484834-20080101-03
Health Resources & Services Administartion. (2021). What is telehealth. Retrieved from https://telehealth.hhs.gov/patients/understanding-telehealth/?gclid=CjwKCAjw-qeFBhAsEiwA2G7NlxHcPVtLmOlQ6leZ3GNJidMfTmS8Sg4WnhAwj5w5Xhgh1_Xd7LntIBoCv-oQAvD_BwE
Jorwekar, G., Dandekar, K., & Baviskar, P. (2015). Picture Archiving and Communication System (PACS): Clinician’s Perspective About Filmless Imaging. Indian Journal of Surgery, 77(S3), 774–777. https://doi.org/10.1007/s12262-013-0998-x
Khanna, R., & Yen, T. (2014). Computerized physician order entry: promise, perils, and experience. The Neurohospitalist, 4(1), 26–33. https://doi.org/10.1177/1941874413495701
McComas, J., & Riingen, M. (2014, December). Impact of electronic medication administration record on medication administration efficiency and errors. CIN: Computers, Informatics, Nursing, 32(12). 589-595. doi: 10.1097/CIN.0000000000000116
Mickan, S., Atherton, H., Roberts, N., Heneghan, C., & Tilson, J. (2014). Use of handheld computers in clinical practice: a systematic review. BMC Medical Informatics and Decision Making, 14(1), 56–56. https://doi.org/10.1186/1472-6947-14-56
MyChart. (2021). Welcome to mychart. Retrieved from https://www.mychart.ca/
NEJM Catalyst. (2018). What is telehealth? Retrieved from https://catalyst.nejm.org/doi/full/10.1056/CAT.18.0268
OTN. (2021). Ontario Telemedicine Network. Retrieved from: https://otn.ca/
Quatris Healthco. (n.d.). Understanding EMRs & EMR systems. Retrieved from https://www.quatrishealthco.com/what-is-an-emr/