Two general technology trends in my workplace are that EHRs and the use of technology are getting increasingly ingrained in the workflow, with increasingly complex technology. And also that my clients are utilizing apps and their smartphones as part of their care.
I recently changed agencies and went from an agency that used a pretty non-sophisticated Ehr called AURA to an agency that uses a complex EHR called EPIC. When I use the terms sophisticated vs complex to compare these EHRs, I am basing these terms on capabilities. AURA seemed able to run certain reports and get information about what was happening with caseloads. And that seemed to help management keep on top of remote workers, for instance, leadership could run a report about which Care Coordinator had a treatment plan due. But it did not seem to have capabilities for looking at overall trends for health in specific patients and caseloads.
Epic is awesome, however. I was initially troubled by my first training which followed me through an office visit that seemed guided by the system rather than the needs of the patient. I asked the informatics team for more personalized training that would involve using the system for patient care, as it would likely unfold during my workflow, and they said OK, and I got great training.
Epic is very customizable. Epic has great communication abilities (you can see notes on the patient from every provider in the system). Epic has CDS or clinical decision support (McGonigle and Mastrian, 2022) to give suggestions for treatment based on what is entered into the system. Epic can help organize your workflow so you, as a nurse, do not forget anything you are supposed to do for your patient.
So overall, the complexity and ability to communicate and provide more communication between different caregivers is the trend I see. In discussion with the informatics nurse trainer and my provider, what is intended next for our facility is communication between Smart devices and the EHr, so that when vital signs are taken, they will be automatically entered into the EHr at the point of care by the devices. So there will be more of a move in our agency to Smart devices and the greater integration of artificial intelligence into the Her and items that the EHr is connected to.
A danger inherent in an Internet of Things type approach to entering data into an EHr, such as having vital signs or telemetry hooked up to the EHr and bypassing nurse input is exemplified by a case scenario in our text McGonigle and Mastrian (2022). In this scenario, a young mother with cardiac issues is left to rest after what the nurse and resident decided were several false alarms, and her monitoring equipment was turned off to silence the alarm. In this scenario, the patient died because a relationship with the technology replaced sound nursing care and judgment, AND the technology was also silenced. We need to be aware that competency with our technology is there to support the care we give individuals and not make the mistake of relying on technology alone.
McGonigle and Mastrian (2022) discuss a culture of safety and how use of an EHr can do things to contribute to safety, such as by decreasing medication errors. One such way of doing this is by having medications packaged with RFID tags or bar codes to ensure the correct administration of meds. The text describes a scenario where a check system can be put in place to scan the nurse’s ID, the patient’s ID, and the patient’s medications to ensure everything is correct. However, the nurse is still responsible to use their judgment. I worked at a psych hospital a few years ago where the system had 20mg (pink) Zyprexa tablets bar coded and dispensed as 5 mg. Fortunately I was looking for yellow, and the pink pill color immediately had me calling the pharmacy to check. And in this particular case the pyxis was just loaded, so the potential adverse event never reached any patients.
So the danger with increased use of and reliance on technology is that nurses can forget their part and not use the technology as a tool, but rather rely on it to the detriment of a patient. And a nurse can overcome this detriment by being aware and remembering the technology is a tool, and not total care.
Another trend is increased patient use of the internet and health apps. I work in addiction medicine and several of my patients use a health app that can remind them of coping skills and strategies to avoid the use of substances. Skiba (2017) discusses how 40% of patients use these types of apps to help with chronic disease and to manage things like stress and weight. Skiba (2017) also discusses how many people use social media and/or apps to discuss their medical experiences and evaluate and find providers, and ask questions related to their medical problems. These writers state that since these types of apps are changing the way people get their healthcare information, that as caregivers, we should help guide and educate people to evaluate these apps for accuracy, reliability, privacy, security, and ease of use.
A danger in using and relying on Internet technology and apps is that people can rely on information from the internet that is fallible. A prime example of this is the anti-vax movement and the momentum that one discredited study about a relationship between a measles vaccine and autism continues to have due to its supporters talking about it online (Barrett, 2018). Per McGonigle and Mastrian (2022) google is taking steps to remedy this by fact-checking medical information and making sure that scientifically vetted information will appear first in search results.
Another danger described by McGonigle and Mastrian (2022) is the ”digital divide.” Many people cannot afford smartphones and/or do not have access to medical information online. McGonigle and Mastrian (2022) describe some initiatives to remedy this, such as the “Connect-ED” initiative designed to give more people access to the Internet. There is also the e-health initiative which is designed to help promote the use of technology for health information and help individual patients understand their health needs.
I think in the future, the most exciting move for technology and healthcare will be in the direction of the internet of things and wearable smart devices. I already have a smartwatch that monitors my BP, heart rate, and sleep patterns, it hooks up to my scale and allows me to see all this data. It is not something that hooks up to my EHR for my provider to see, but if it had that capability, I would gladly ignore the inherent privacy issues for my NP to be able to see the info, rather than me just reporting it to her. Li et al. (2021) describe a developing platform for the monitoring of women in pregnancy through wearable smart devices that can continually monitor the baby’s heart rate, and the expectant Mom’s blood sugar, vital signs, bloodwork, and other key readings. Per these writers, this will greatly increase outcomes in pregnancies and avoid complications.
This type of personalized monitoring can only have a good effect. Besides giving the provider real-time information, it will also give the patient individualized feedback that may help them take better care of themselves. Tharageswari et al. (2020) discuss the use of Smart devices for overall health monitoring and just ensuring that patients are taking good care of themselves (in general, and not just for a specific condition like pregnancy). These writers discuss a potential model for interventions if a person is not taking care of themselves. This type of monitoring can be helpful, and assist people in making wiser choices. I think as these devices get smarter and more sophisticated, and there is greater communicability between such devices and our EHrs the wealth of information about our individual health and our community’s health will be greatly increased.
Barrett, M. (2018). The malign rise of the anti-vaxxers. New Statesman, 147(5419), 17.
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