NURSING INFORMATICS

Mobile Electronic Health Records

Recently, there has been a growing interest and demand to harness the power of electronic health records (EHR) beyond the delivery of care. In part, the demand has risen due to the consumerism of health care. A growing wave of patient expectation is mounting, and patients have expressed dissatisfaction with electronic health records being accessible to only the providers. Healthcare organizations have also realized the importance of patient accessible health records in improving patient experience, supporting chronic conditions, enhancing transparency, and ensuring the continuity of quality care beyond the health facilities. Consistently, many systems have enabled personal health records (PHRs) and made the records available in a mobile format. According to Bouri & Ravi (2014), mobile PHRs allow patients as well and health care providers to access health information through electronic devices such as mobile phones and tablet computers. In particular, mobile Patient Health Records have the potential to help patients and care providers identify medical conditions from different locations, minimize medical errors, and improve the overall health of the patient. However, despite their benefits, mobile electronic health records also pose several challenges especially in their adoption and integration into the existing healthcare systems. In light of this, we identify and discuss in details the benefits and the potential problems that mPHRs may pose to an advanced nurse practitioner.  

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Benefits of Mobile Electronic Health Records to Advanced Practice Nurse

The use of electronic records by health care professionals has been widely recognized as an efficient way to transform various aspects of the clinical practice in healthcare organizations. Mobile devices have become a common thing in healthcare facilities, something that has led to the tremendous development of medical applications. Currently, several mobile apps are now available to assist healthcare professionals in the management and delivery of quality care. According to Lee (2014), mobile devices and applications provide several benefits for health care providers, which have also significantly helped in better clinical decision-making and improved patient outcomes. In nursing, with the transition of care from being primarily acute care to being community-based, nurses may not have instant access to evidence-based information or patient health history. However, according to Airth-Kindree & Vandenbark (2014), mobile medical applications can fill this gap and nurses can now use mobile apps for clinical reference and other tools to help in the delivery of quality care.

Enable sharing of Information

Advanced practice nurse plays a critically important role in the delivery of care. The primary caregivers are usually at the forefront providing preventative care to patients. Arguably, one of the major benefits that mobile Patient health records provide nurses with is a feasible backup strategy for sharing critical medical information. According to Bouri and Ravi (2014), mPHRs provide care providers with a mechanism to share information with their patients including clinical summaries, drug prescriptions, appointment reminder, and educational resources. The functionality is more important in case patients are displaced and no longer have access to health care facilities that have access to their EHRs or when care facilities lose access to their EHRs. In such a case, mPHRs can be the only source of accurate medical information concerning the patient. Virtually, mPHRs helps providers determine important information such as medical history and allergies to better coordinate care.

Improved accuracy and Minimal Documentation Errors

Nurses are often overwhelmed with taking care of multiple patients while being expected to accomplish so much within a short duration. For instance, a nurse may be recording patient data, while assessing at the bedside. As Bouri and Ravi note, Mobile PHRs make it easy for nurses to access patient information such as clinical summaries, medicine prescription, and follow-up procedures without necessary having to liaise with the attending physician or accessing the EHR. Furthermore, mPHRs enables nurses to instantaneously record patient data on a mobile app, as they check vitals or assess the patient, which helps reduce documentation and medical errors. 

Drug Reference

Additionally, advanced practice nurses often require a wide variety of reference information including information on drugs, lab values, and pathophysiology among other vital data. From time to time, nurses are also likely to encounter patients who are unable to recall the names of their medications but can describe the medication appearance. In such cases, mPHRs can be used to access information about the patient drug prescriptions. Alternatively, nurses can use drug reference applications such as pill identifiers to understand the type of medication prescribed to the patient (Lee, 2014). Similarly, nurses can use drug reference applications to access information about drug indications, dosages, interactions, and even calculate dosage by weight calculators.

Enable Communication and Consulting

Usually, a healthcare system is highly dispersed and encompasses multiple locations including emergency department, inpatient wards, clinics, outpatient services, intensive care units, and operation theatres among others. In these settings, health care providers need to be able to communicate and collaborate with each other from different locations without necessarily being there physically. According to Lee (2014), mobile devices and applications satisfy this need by providing a channel for communication. In this case, advanced practice nurses can easily communicate with their colleagues and physicians among other care providers. Other tools such as social networking applications can help advanced practice nurse in consultations and collaborations with other APN’s even though they are not working in the same health facility. Along with that, mobile applications can also be a source of news acquisition about the latest medical news about drugs, disease management, and medical procedures. 

Problems Associated with Mobile Electronic Health Records to APNs

Despite the several benefits associated with integrating mobile electronic health records into mainstream advanced practice nurse practice, some challenges remain. According to Ozair, Jamshed, and Sharma (2015), some of the problems associated with mobile electronic health records are based on ethical priorities, which include privacy and confidentiality, security breach, data inaccuracy, and system implementation. Virtually, when patient data is collected, it should be protected from surveillance from other individuals. As Ozair et al., note, patient information should only be released to others with the permission of the patient or by law. For instance, when a patient is incapacitated to make decisions about sharing their information and in the absence of a legal guardian, the nurse may opt to access the information in an attempt to save the patient. Unfortunately, this is likely to bring up legal issues, which may pose a threat to the advanced practice nurse accessing patient information without permission. Security breach threatens the privacy of the patient when their health information is shared willing or unwillingly with other without the consent or authorization of the patient. The advanced practice nurse may not have intentions to share the patient information with others. However, having this data on their mobile device can lead to data theft unintentionally, landing this information into unsafe hands. The result may be endless legal battles between the nurse and patients, even though the information was leaked unwillingly. Integrity ensures that data is accurate and has not been tampered with. Mobile electronic health records help improve the patient’s safety by reducing medical errors. Nonetheless, as Ozair et al., note, the accuracy and reliability of data in the form of electronic record have been questioned. Inaccurate representation of data is likely to occur due to options that allow copying and pasting of data. Similarly, options such as drop-down menus may limit choices to the advanced practice nurse who in a hurry might choose the wrong entry leading to major medical errors. Depending on the mobile PHR in use, the nurse may be unable to verify the accuracy of patient data provided causing major problems for the patient and the nurse as well. Furthermore, in the event of electronic system failure, it may become hard for the nurse to access information especially if it is an emergency. 

Medical devices and mobile applications are indispensable tools for health care providers. Their features become more advanced, and it is expected that they will be more widely incorporated into almost every facet of clinical practice. Use of mobile devices and mobile patient health records has a wide range of benefits to health care providers. Some of these benefits range from the ability to share information, improve accuracy and minimize documentation errors, provide drug reference for the nurses, and enable communication and consulting. Alongside the benefits, the mobile electronic health records also have various potential risks based on ethical issues associated with patient data. Nonetheless, mobile electronic health records are the future, and health care providers cannot avoid embracing this technology. Consequently, such challenges can be averted by evaluating and understanding the risks and benefits to ensure a fundamental level of quality and safety when using the tools.

References

Airth-Kindree, N., & Vandenbark, R. T. (2014). Mobile Applications in Nursing Education and Practice. Nurse Educator, 39(4), 166-169.

Bouri, N., & Ravi, S. (2014). Going mobile: how mobile personal health records can improve health care during emergencies. Jmir Mhealth and Uhealth, 2(1), 1-25.

Lee, V. C. (2014). Mobile devices and apps for health care professionals: Uses and benefits. P and T, 39(5), 356-364. 

Ozair, F. F., Jamshed, N., Sharma, A., & Aggarwal, P. (2015). Ethical issues in electronic health records: A general overview. Perspectives in Clinical Research, 6 (2), 73-76.

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