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Problems with the electronic health record.

Hans-Peter de Ruiter1, Joan Liaschenko2, Jan Angus3

  • 1College of Allied Health and Nursing, Minnesota State University, Mankato, MN, USA.

Nursing Philosophy : an International Journal for Healthcare Professionals
|November 26, 2015
PubMed
Summary

The shift from paper records to electronic health records (EHR) has redirected documentation focus from patient progress to institutional priorities like finance and quality improvement, impacting clinician work and patient relationships.

Keywords:
careelectronic health recordembodimentethics of carenursingtechnology

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Area of Science:

  • Healthcare Informatics
  • Sociology of Health & Illness

Background:

  • The transition from paper-based to electronic health records (EHR) represents a major shift in healthcare delivery.
  • This evolution has fundamentally altered documentation practices within healthcare settings.

Purpose of the Study:

  • To analyze the shift in documentation focus from individual patient progress to Institutional Priorities (IPs) with the adoption of EHRs.
  • To explore the unintended consequences of EHR implementation on clinician work, patient relationships, and administrative functions.

Main Methods:

  • The study employed an institutional ethnography approach in a large urban US hospital.
  • Analysis was informed by theoretical frameworks from scholars like Jacques Ellul, Don Idhe, and Langdon Winner.

Main Results:

  • EHR documentation has shifted focus towards Institutional Priorities such as finance, risk management, quality improvement, regulatory compliance, and evidence-based practice.
  • This shift has led to significant changes in the organization and volume of clinician work.
  • Clinician-patient relationships have been notably affected by the implementation of EHR systems.

Conclusions:

  • The adoption of EHRs has reoriented healthcare documentation towards institutional needs rather than solely individual patient monitoring.
  • Understanding the impact of EHRs on workflow and relationships is crucial for optimizing healthcare delivery and technology integration.