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The Electronic Health Record

(EHR) & Nursing

An International Agenda

Margaret Lunney, PhD, RN

Professor College of Staten Island, CUNY

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What is the EHR?

� Electronic patient/health record

� Multiple Linkages� Integrated� Universal

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History of the Patient Record

Paper records since 1800s

1918- Required Proliferation of paper records

±Millions in each institution

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Strengths of Paper Record

Familiar 

Portable No downtime

Flexibility in recording data

Variety of ways to organize or seepatterns/trends of individual records

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Weaknesses Outweigh

theS

trengths

Content

Missing Excessive

Redundant

Illegible

Inaccurate

Lack of standardization

Incomprehensible

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Weaknesses of Paper Record

Format

Fragmented

Data cannot be found

Access & retrieval

Lack of access

Time to retrieve

Cost to enter data

Errors in data entry

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Weaknesses of Paper Record

� NOT integrated

Inpatient & outpatient

One type of service with others

Administrative, financial, quality indicators

Knowledge bases, e.g., guidelines

Other patients

Institutions & locations

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Weaknesses of Paper Record

Outpatient records

High number  Scattered

Poorly organized

Inaccurate

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Goals of EHR

Totally integrated patient record systems

Linkages to resources & databases

Purposes1.  Support patient care and improve quality

2. Enhance productivity and reduce costs

3.  Support clinical and health services research

4.  Accommodate future developments intechnology, policy, management and finance

5.  Maintain patient confidentiality

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Why?

Data   Information   Knowledge

Graves & Corcoran, 1989

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How? Standardization

File names, Definitions, Descriptions

Unified languages in meta-thesaurus Mapping of languages with one another 

Technological: Standards Associations International Standards Organization (ISO)

European Committee for Standardization (CEN)

American National Standards Institute (ANSI)

HL7 (see www.hl7.org)

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Advantages of EHR

Data abstracted, summarized,

aggregated; Local, regional, national,

international

Ease of entry, organization, & retrieval

Longitudinal records

Linkages to standards, guidelines, other 

internet sources, recent research

Decision support systems

Other 

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State of the Science in U.S.

DHHS--National Committee on Vital &

Health Statistics

Core Data Elements

National e Health Collaborative (NEHC)

� www.nationalehealth.org

� Purpose- Facilitate interoperability

Research

Being conducted by numerous agencies, e.g.,

AHRQ, NIH, NLM, VA, IOM, ANA, AHA, AMIA

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Standardization:

Nursing in the U.S

. NANDA (1973-present)

Nursing Minimum Data Set (1985)

Other classifications (1980¶s-present)

Omaha, Saba, Grobe, Ozbolt, NIC, NOC

ANA

1989, 1998: Committee on Nursing PracticeInformation Infrastructure

Unified Nursing Language System (UNLS),mapping of terms among nursing languages

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Standardization:

International Nursing

Countries involved worldwide, e.g.,

ACE

NDIO (E

uropean group), Japan, Korea,Australia, South American Countries, Africa

International Council of Nursing (ICN) International Classification of Nursing Practice

International Medical Informatics Assn.(IMIA); Working Group-Nursing Informatics

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Nursing Minimum Data Set

(NMDS

) : International Frame

Nursing Care Elements (4)

1.  Nursing Diagnoses2.  Nursing Interventions

3.  Nursing-Sensitive Patient Outcomes

4.  Intensity of Nursing Care

Patient Demographic Elements (5)

Service Elements (7)

12. Unique RN Provider Number 

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SNLs: Ongoing

Development U.S.= systematic approval process (Coenen

et al, 2001, Computers in Nursing, 19, 240-246)

7 SNVs approved for EHR (met criteria) NANDA-International

Omaha System

Home Health Care Classification (Saba)

NIC NOC

Patient Care Data Set (Ozbolt)

Perioperative Dataset (AORN)

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The EHR, SNVs, & You

Use SNVs

Become familiar with computers

Provide feedback to SNL developers

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The EHR, SNVs, and YOU

Explain rationale to others

Create a spirit of support Discuss with nurse leaders

Teach others