Some interesting considerations about the Electronic Medical Record

ERMurse brings up some good points about Electronic Medical Records and how they interfere with patient care, although not all his criticisms are justified.

Most importantly, he highlights how EMRs often restrict access based on roles. My hospital is transitioning (slowly) to EMRs, and in my role as a ward clerk, I have access to very little beyond order entry. However, this is a recent change. Previously, ward clerks, doctors, and nurses in my hospital all had essentially the same access.

I am constantly being asked to do things now that I used to do without problem. Most commonly, I am asked to enter a patient's height and weight in the computer while the nurse is in the process of getting the patient settled in bed. (This is necessary because the way our systems are arranged, the pharmacy can't get started on a patient's meds until they have a height and weight entered by the floor.) I used to it all the time. Now, I have to remind nurses that I can't, which means they have to do the nursing admission immediately if they need a med. Crazy? Yes.

Frankly, restricting my access has done nothing to improve patient care or confidentiality (the nurses tell me anything I ask--maybe not right, but reality...) and added heretofore unknown difficulties.

However, ERMurse is not right on all counts:
(1) We also have charting by exception, and this works just fine. I can't imagine how any nurse could advocate excessive charting in the face of the trade-off between care and charting.

(2) Care planning is essentially a waste of time, and a care-planning module is as well. On my PCU unit we use primarily clinical pathways and some generic care plans, and these are completely adequate. I thought care plans were a waste when they were introduced in my Nursing Fundamentals course, and I have seen nothing since then to change my mind. This and the so-called "nursing process" (which Virginia Henderson correctly criticized as having no unique professional qualities) are historical anachronisms. Time to go! Sorry, ERMurse.