Layman (2008) reported that EHRs can improve efficiency by making records more legible, complete, and accessible. Wynia and Dunn (2010) agreed, stating as long as EHRs are widely utilized, they may improve quality of care through monitoring, marketing, or tracking. However, as was seen in the animation, this is not always the case. It took the nurse time to reboot the frozen computer, to remember her log-in, and to search the right client; time that would not have lapsed with paper care records and time that could have been better spent providing care to the patient.

"It is not obvious that PHRs [personal health records] are the most efficient investment...at this time" (Wynia & Dunn, 2010, p. 71). Mercuri (2010) cautioned that outages of the EHR system would at best be an inconvenience to healthcare professionals, at worst, could contribute to morbidity and mortality rates. Worse yet, complete system failures could result in the loss of patient data.


  1. Like so many items designed to improve efficiency (e-mail and PDAs coming quickly to mind) -- they will not do so, or will not do so in a timely fashion, unless time and effort are invested in user education. If the user is expected to gain this education on her own time, you can expect a lag between the time the device is provided and its actual net gain to the service. In the story of Beatrice, actual harm takes place during the lag time, and I suppose we are intended to question the ethical justification for such a risk to harm, as well as efficiency.

    (Loved that animation -- fantastic, truly!)

    Best regards,

  2. Though fully integrated EMR are more technically executable then their first generation counterparts. It is definitely true that we are far from a point in its evolution where electronic documentation becomes intuitive.

    Trish is right about the lag time... being involved with conversion to electronic records, we see those staff who have difficulty learning the system. We do provide additional training but much of the comfort and expertise is gained on the job. Mistakes and process issues are common. We attempt to correct issues during our on-site support period (14 days)... mostly focusing on intake and output documentation as errors could lead to erroneous medical interventions.

    Truth is however, much of the errors corrected occur due to carelessness. It has become quite obvious that clinical documentation has been lacking in quality among many... That process has become lax. Electronic documentation has just made poor practice much more obvious/transparent.

  3. I do have to question the risk Mercuri (2010) presents with respect to full system failures. I see how there is certainly a risk of entire medical records being lost; however, the same could be said for a fire destroying paper records. Electronic records can have back-ups made quite easily and regularly (although this does open an even bigger can of security and privacy "worms"). Do paper records ever have back ups made? I really don't know the answer so welcome other's thoughts.


  4. Most paper records are scanned into a system of some type. At our facility paper records are scanned into Sovera which is also accessible remotely through our network platform. So it is no more or less secure than the electronic record we are converting to.
    As far as backups... I assume that there is a backup for Sovera but I do know our backup plan for electronic documentation.
    We will be installing a backup system that will allow read only access to the electronic medical record if the network or master system should go down.