The Benefits of the Electronic Health Record for Older Adults across the Continuum of Care: Is the Computer Friend or Foe?

Submitted by Catrin Brodie, RN, MN, GNC(C)

This article is based from a previous article written for publication in the Journal of Gerontological Nursing.

The patient electronic health record (EHR) is a computerized document that includes all of a person’s health information. In the past, this information, was held by many different health care workers in paper files and may not have included all of the necessary information or health details. The EHR provides great benefits to the complex care needs of the older adult who are either in the hospital, in residential care or living in the community, because it contains all of the necessary information the doctors and nurses need to make the best decisions for their patient.

The greying of the population will have an incredible impact on the health care system and their caregivers, especially on Vancouver Island where about 9.0% of people are 75 years old or older, compared to 6.9% for the province of British Columbia. Did you know that roughly 2.7% of the population is aged 85 and over, compared to 2.0% for the Province? In addition to a growing population of seniors, baby boomers, currently between the ages of 43 and 62, make up approximately 31% of the population. Did you know that by 2010, the first wave of baby boomers will be nearing 65, and as they age, this will put more pressure on nearly every area of our health care system?

Background
Currently on Vancouver Island the patient records, documentation and information are either in a paper format stored in different locations, such as hospitals, home care offices, residential care facilities, physician’s offices, or via the electronic heath record or both. This paper system being held by many different health care providers and in many different locations is not a good system. It increases the chance of risks for seniors, such as repeating the same test, and medication errors due to more than one doctor ordering different medications and because of their complex health needs. Therefore, in 2008, the Vancouver Island Health Authority (VIHA) started to use the EHR to decrease the amount of paper and to make the patient information accessible to the responsible health care providers. The most important reason to make this change is due to the aging population, the increasing need to provide care to the frail elderly, a rising burden of illness from chronic diseases, and advances in technology and pharmaceuticals that are enabling new procedures and treatments. The EHR can therefore improve patient safety by having as much up to date clinical information “at the fingertips” or “point of care” as possible to assist in care delivery decision making.

History of the EHR
The first reports of computers being used in nursing care began to appear in literature in the 1970s. The use of the personal computer in the 1980s would allow for the “capture” of the nurse’s notes and patient care plans. The introduction of the Internet and web-based applications in the 1990s, enabled communication across distances and made it possible to transfer health information. In some areas computers became smaller and nurses could take them to the bedside or homes as laptops or personal data assistants (PDAs). The nurse could begin to access the patient information at the bedside, rather than returning to the nurse’s station. In 2000, an increased importance was placed on computerized information to help with decision making, quality improvement and research. The EHR is a tool which will increase efficiency, information gathering and research, and improve patient safety and patient health outcomes.

The Health Authority has begun to create an EHR for every person on Vancouver Island providing 24/7, online access to patient records and information in the hospital and remotely at home or from the doctor’s office. This allows for the best care for patients because now their doctors, nurses, hospitals and community services can share information across the information highway.

Benefits
Using the EHR can improve population health in the following ways. It allows the caregivers access to xrays, laboratory results, and medication information right at the time they need it; therefore, assisting to speed up the time to make their decisions. Other benefits are the ability to write doctor’s orders, communication, care planning and clinical notes, faster referrals between doctors, fewer delays ordering tests and getting results, and fewer reporting errors. There are often many different people involved in their care and they need to have all the information and the ability to communicate this information between each other. Many older adults have long term care case managers, home care nursing, a general doctor or specialists that are all involved in their life and health care decisions. The increasing numbers of the aging population of Vancouver Island, their increased care needs and complexities, is a significant reason why the EHR should be used.

Consent and Confidentiality
A patient entering the health care system will be providing “presumed consent” for their information becoming part of the EHR. This means that they may not give their consent in writing but the health authority will presume that if they are in the hospital for treatment that they are aware all of the care team has access to their information. However, there are processes in place to protect the privacy and confidentiality of the patient. To protect data there are restricted login passwords, digital signatures and special coding. As well as policies, the staff are expected to follow that only the health care worker that is directly responsible for that patient can access their information. There is password protection and coded patient identifiers to help protect patient confidentiality, and the software automatically locks a device after a period of inactivity.

Conclusion
Simpson stated in 2001 that, “by 2011, computers will learn and reason better than humans. By 2012, they’ll memorize, recognize, and learn in a human fashion. By 2013, health care professionals will view them as colleagues rather than tools. Health care will finally grasp the gold ring of precision as computers eliminate the guesswork, eradicate the deadly errors, and usher in the age of accuracy” (Simpson, 2001, p.14). Do you agree that the prediction for 2011 has come true? Over time, every British Columbian will have a personal EHR, which will be a secure and private lifetime record of their key health history and care within the health system and this record will be available electronically to their health professionals to support high-quality care.