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3 EHR improvements nurses most want to see

HIMSS Analytics conducted a survey of nurses, uncovering what they like (and what they don’t like) about electronic health records (EHRs).

One of the results shocked me: about 15% nurses wanted to go back to paper-based medical records, and another 15% said they weren’t sure if they’d go back or not.

I flashed back to my experience as a pediatric oncology nurse on the night shift. For example, when a patient’s fluid intake and output didn’t match up, I had to figure out if it was a miscalculation. I could spend 90 minutes poring over a spreadsheet trying to find the math error.

It got me thinking. Where are EHRs coming up short? What makes nurses want to return to paper? Based on the top three reasons indicated in survey results, I have a few theories:

1) Easier to find information

Nurse survey respondents who want to return to paper charts said it was easier to find information that way. Ironically, the majority of nurses who would not return to paper say that it is easier to find information in EHRs.

It’s clear that nurses agree that access to information is vital for patient safety.

My guess is that nurses who find paper easier to navigate than EHRs likely have a workflow design problem. If an EHR view does not exist where nurses can see their top five or six things, then nurses need to speak up and change it.

2) More focus on the patients

Nurses would much rather spend time with their patients, not on documentation. The second most common reason they gave in the survey for wanting paper records is that EHRs detract from focus on patients. Again, this could be a workflow issue.

It could also be that people aren’t remembering the time-consuming aspects of paper-based records. For example, many of the pediatric units where I worked required us to keep patient charts at the nursing station. We spent lots of time going back and forth (taking time away from the patient). Hunting for missing charts also took time away from the patient.

3) Faster data entry

It might be easier to scribble a note in a paper chart rather than finding the right place to document in the EHR. But is paper documentation better for patients and the entire team of caregivers?

Nurses who would not go back to paper cite “handwriting issues” and “allows for complete entry” as two significant reasons why they prefer EHRs. The EHR forces a clearer, more complete form of communication. Yes, it might take more time up front, but it can save time in the long run.

Years ago, when paper dominated medical records, we managed new regulatory requirements by adding new forms. Need to do skin checks? Add a flow sheet. Need to start doing fall-risk assessments? Add another flow sheet. Given the increasing complexity and demands of today’s regulatory environment, I shudder to think about trying to manage it all with paper charts.

Maybe some of these nurses have never worked in a paper-based environment. Maybe they have forgotten. Maybe their EHR isn’t working as well as it should. But I remember very clearly the limitations of paper. I agree with the majority of survey respondents that EHRs are helping to improve patient safety.

To all my fellow nurses out there during Nurses Week, thanks for all you do. I’d love to hear your thoughts on this subject in the comments below.

Want more detail about the HIMSS Analytics Nurses Survey? Download a free white paper or check out this infographic.

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