Paper medical records have been around forever. In more recent record-keeping history, clinicians and ancillary staff would document on the facility- based paper charts. Older nurses may remember the protocols of circling assessment findings, recording vital signs in a series of dots and arrows, and the ever-persistent challenge of finding a black ink-pen (other colors were forbidden!). Nursing care plans and shift notes had to be hand-written, and if an error is made in the documentation, some nurses may remember having to draw a single line through with initials.

Electronic medical records (EMRs) were developed to standardize documentation, prevent errors, promote concise charting, and have a way of storing medical records long-term while having a straightforward way to retrieve them. However, EMRs come with both pros and cons when utilized in an organization.

Some of the benefits of electronic medical records include:

  • Standardization: EMRs promote standard record-keeping to include staff and physician notes, assessment findings, and ordering processes.
  • Improved accessibility: EMRs allow members of the healthcare team to access pertinent parts of the medical record easily. Also, records can effortlessly be retrieved- sometimes between different healthcare organizations.
  • Reduction of errors: This is probably the most significant benefit of electronic medical records. Computerized physician ordering has helped reduce errors related to misinterpreted handwriting and transcription errors. EMRs often have flags or hard stops if an order is entered incorrectly (i.e., the wrong dose ordered, or a med ordered that is listed as an allergy). Electronic medication administration is developed to assist staff in the rights of medication administration. Barcode scanning, for example, helps correctly identify the right patient, right time, and the right med. Additionally, abnormal test results are flagged to prevent them from being overlooked. EMRs also help to avoid any significant component of healthcare delivery to be missed. For example, delivering a warning if a note or order is not complete.
  • Improved privacy and security for patients: The more hands that touch paper records, the more at risk private health information is. Paper charts sent to chart rooms or outside a facility is more at risk of a privacy breach. EMRs have safeguards in place to prevent violations. Access to certain parts of the medical record is given only to the appropriate employees. Flags are set up if a record is inappropriately accessed. Additionally, records are not usually physically sent from one department to another, or from another facility to another, reducing the risk of lost private health information or patient identification.
  • Improved efficiency: EMRs allow for quicker documentation, which can benefit patients needing rapid treatment. For example, an EKG can be performed and uploaded to a record in real-time, and a specialist can pull it up and advise within minutes. This leads to improved patient care outcomes as delays are shortened.

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While EMRs have many benefits, there are also drawbacks to electronic records. These may include:

  • Reduced oversight: Sometimes it's easy to click a button or enter shortcuts to reduce charting time. However, the mechanical nature of electronic charting can lead to an oversight of clinical findings. For example, assessment documentation shortcuts may default to "normal" findings, and the provider must alter based on an exam. If one component is overlooked, it's false documentation. Frequent, repetitive documentation places the provider at risk, especially if feeling rushed.
  • Cost: Electronic medical record programs are expensive-in the millions. Organizations must purchase the software and train hundreds of staff in its use.
  • Technical malfunctions: Any healthcare worker can attest to the crippling effect of technical difficulties with EMRs. When the system goes down, it's like the apocalypse. Backup paper records must be kept, and data inputted later when the system is back up and running. Confusion as to what to do when this occurs can lead to patient care delays and potential errors. Healthcare organizations should have clear guidelines as to what to do when this happens, and paper record-keeping available and accessible.
  • Over-standardization: Healthcare providers can attest to this fact as well. It's frustrating for providers when they need to order something that has not been inputted into the system. Lesser-used medications or treatments may not be part of the selection process, which leads to workarounds that can create frustration, confusion and potential errors.
  • Less patient interaction: This is a significant complaint among both patients and providers. Patients see their healthcare provider staring at a computer screen more than they lay eyes on them, which leads to a perception of de-personalization in care. Providers often feel that they spend more time documenting than caring for patients.
  • Increased virtual work: To piggyback on the point above, providers may argue that their workload has increased with the advent of EMRs. Completing charts, fielding test results that pour in throughout the day/ shift, and even handling patient emails can bog down providers immensely. While the ability to communicate with your provider is a huge benefit for patients, it creates an enormous amount of added work for providers.

Electronic medical records are the future of healthcare. The bottom line is that they were created for ease and patient safety, although it is not as black-and-white as initially thought.

Amanda Bucceri Androus RN, BSN

Amanda Bucceri Androus RN, BSN

Amanda Bucceri Androus is a Registered Nurse from Sacramento, California. She graduated from California State University, Sacramento in 2000 with a bachelor's degree in nursing. She began her career working night shifts on a pediatric/ med-surg unit for six years, later transferring to a telemetry unit where she worked for four more years. She currently works as a charge nurse in a busy outpatient primary care department. In her spare time she likes to read, travel, write, and spend time with her husband and two children.
Amanda Bucceri Androus RN, BSN

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