Electronic Medical Records, Care And Our Expertise

Administrators and insurance providers promote EMRs as a magic bullet for patient care. They say EMRs save money and advance care.

The truth is more complicated. EMRs:

1. Take time away from patient care.

2. Prioritize charting over care.

3. Fragment patient-care processes on menus.

4. Assume that patients' needs are routine and predictable.

5. Encourage charting by exception, putting words in a nurse's mouth for which she can be held responsible later.

6. Can bury crucial information in a sea of irrelevant questions and answers.

7. Can make it harder to catch errors because of their extensive, orderly and official appearance.

8. Replace clinical knowledge with technical knowledge.

9. Make care less personal and human.

10. Limit narrative charting, which is usually more concise, direct, personalized and holistic.

Hospital administrators and insurance providers promote EMRs as a magic bullet for healthcare. EMRs save money and advance quality care, so they say. But the truth is much more complicated than the propaganda.

Just ask a nurse.

Linette Davis, from National Nurses United’s Institute for Health and Socio-Economic Policy, presented a detailed analysis of EMRs at our 2013 convention. The fact is that EMRS eat away at the nursing practice and personalized, quality care.

Attack on Nursing Skill

Nurses, like all professionals, develop their skills over years of practice. But skills aren't just about time spent on the job or in class. They're about judgment and the ability to cope with the unexpected. If there’s one thing nurses learn quickly, it’s to expect the unexpected. No matter how common an illness, every patient is different.

EMRs fundamentally undermine nursing skills. They require nurses to mechanically follow menus as they check boxes to answer questions and move from screen to screen. Important information can easily get lost in long lists of irrelevant information. And a nurse’s insight into a patient’s condition, and the patient’s development over time, can have no place in a system that severely limits narrative charting.

Nursing skills develop in stages. A novice has no clinical knowledge to draw upon and follows procedures as learned in class. The competent nurse has extensive clinical experience and prioritizes based on consciously formulated long-term goals.

The expert’s skill is measured in their ability to exercise judgment, see beyond routine issues and responses and act on the basis of a patient’s particular circumstances. Hospital administrators promote EMRs as a way to standardize work processes under the pretense that standardizing means raising quality standards. That’s not true, though.

Standardizing really means making work processes uniform so that all nurses perform them in the same way. Routinizing nursing practice and following prescribed rules, as EMRs require, do not promote skill development beyond competence to the level of expert.

But patients deserve expert nursing, care from those who recognize a patient's particular individual needs and meet those needs. Expert nurses aren’t bound by rules, pre-determined routines, and so-called “best practices.” They assess a patient's unique needs and provide care accordingly. The truth is that the primary purpose behind the notion of best practices is controlling nurses and putting efficiency over care. To hospital administrators, the competent nurse — not the expert — is ideal.

Management Control

Routinized care turns nursing into something of an assembly line. It requires nurses to turn off their good judgment, thereby de-skilling the profession. In theory, IT systems are tools that help caregivers deliver quality care. In practice, they’re instruments that help hospital administrators put management control over nursing practice and expertise and profit before patient care.

Learn more

If you would like to learn more about the pros and cons of EMRs, come to NYSNA's "Charting with a Jury in Mind" educational program series for NYSNA members. Find upcoming continuing education programs here.