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Nursing Informatics: Electronic Medical Record System Add in library

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Using the same environment review the current state of the infrastructure and focus on a specific area: security, data management, connectivity, etc., and make suggestions for future improvements. Papers must address the following:

1. Clearly describe current infrastructure, workflow, and processes.

2. Identify the existing gaps and issues within the environment.

3. Provide solutions for improvement associated to the gaps identified – zero cost and unlimited budget.

4. Recognize current technology that can change health care infrastructure.



An overlooked aspect to implement an EMR (Electronic Medical record system) is the need for operational readiness and medical-graded solid technical infrastructure which contains gathered information in one office of provider. An EMR system has most value added implications for patient safety and as well as caring purpose. Additionally EHRs also give an option to move the patient’s health record to move with them- t specialist, nursing homes, health care providers, even across the states.  Though, these technologies need a lot of care and maintenance, to avoid the outage of requirements. For example, in 2009 a system failure shut down the Veterans Affairs North Texas clinical records system in their Healthcare System for 23 hours at eight outpatient clinics and two hospitals in the Dallas area. Hence, for six hours, clinicians had no access into the patient’s record due to two aging drives failing for the poor maintenance.

1. Current workflow, Infrastructure and process:

Although there is a basic understanding of how a particular task is accomplished in clinic, over the time staff members develop workarounds, shortcuts, or other deviations from this basic view. When the newly appointed staff members come on board, their training consists of shadowing a fellow member and hence learning on deviations. However, in the cases, where a shortcut may lead to the whole team of medical assistants, (MA), front desk, billing, leaders, finance (, 2015). The clinic made for the children also use the workflow analysis process to gain advantage. The goal is for the standardization of the process across the sites, Whole team work collaboratively in order to design processes which worked for the small and large sites alike (Freifeld et al., 2010).

A survey undertaken by the Forrester consulting identifies that the EMRs are the primary source of growing demand for storage. Beyond the images, health care organizations require the capability to store and quick access to the lab results, orders, patient vitals and medication details. Additionally the patient information, which is rarely accessed, will require secure storage, which is affordable and scalable too (Practice Fusion, 2014). 


The cause behind the key privacy and security purpose needed in the EMR system includes-

  • Hacking incidents
  • Misuse of health information
  • Private health care concerned Corporate or Government intrusion.

A Quick fix, role based access control (RBAC) mechanism needed to be installed that allows fine-grained permissions.

In the effort of maintaining security and remediation made for the large health care provider, a good mechanism over RBAC is identified. Assigning roles sometime appear as a tricky one to consider it across the various departments of hospital and personnel. For example- an unwanted right to view could cause a new doctor’s inability to handle the total system or to view complicated data in a soft copy, using the system. These kinds of situations can easily lead towards the tragedy and for the ease of use considerations. Monitoring security at the database and the application level also needs substantial improvement. All the physical storage Medias are needed to be handled carefully, if required, only by the authorized person.

2. Existing gaps and issues within the environment:

The existing gaps based on the concept that every newly invented technology, which is introduced into a practitioner’s office which will initially reduce efficiencies and cause the increment in the cost of running the office (Stern, 2015). As the staffs become familiar with the present advent of the EMR system and its corresponding technology they become able to work out with the bugs. Before the invention of the EMR systems, the technologies, which are introduced in a physician’s office, only affected the single computer and few people. Physicians were able to calculate the relatively small gaps between the taken time and technology, which made difference in their practice. EMR system brought drastic changes in issues related to the cost, as it require simultaneously integrated technologies and people (, 2015).


3. Solutions for improvement associated to the gaps identified – zero cost and unlimited budget:

 EMR system is needed as cost-effective if the implementation is perused by the physicians. Going through some recent paper researches including BCMA paper, where it is stated that the system establishment for the physician’s office is similar to Alberta’s POSP to support the computerized physician offices in BC. The BCMA give recommendation on an annual allocation of $8000 per physician, in doctor’s office to support the IT costs (, 2015).

An EMR is beneficial by providing the under-mentioned records:

  • Tracking data.
  • Identification of patients, who are due for screenings and preventive visits.
  • Monitoring patients’ physical reading (e.g. vaccinations, blood pressure) (Nextech Systems, 2015).

4. Current technologies that can change health care infrastructure:

The processes involved into the change or revolution from traditional system to the automated one, it seems difficult, though numbers of opportunities are available in the era of adaptation of EMR and HIE (Health Information Exchange) systems (, 2015). 

EMR and HIE systems collect and store information about the individual patients from different connected information system (e.g. clinical record, imaging, laboratory, registration of patient) and through the aggregation among different entities or through exchanging the information.

Environmental electronic real-time data (water quality data) and remote sensing systems being combined with the GPS (global positioning system) and GIS (geographic information system) revolution also facilitated the person-centric and environmental information by place and time (, 2015).


An EMR is a digital version of the paper chart containing patient’s medical history from one practice. EMR contains standard and gathered clinical and medical data in one provider’s office. EHRs (Electronic health records) go beyond the collected data and include more vital and comprehended patient history. To achieve desired vision, certain key points must be noted down. Stand-alone systems can be considered only when there is no available option. Existing systems (commercial off-the-shelf solutions) should be used or the modification should be done, wherever it is possible and existing data stream needed to be leveraged for various purposes.



Freifeld, C., Chunara, R., Mekaru, S., Chan, E., Kass-Hout, T., Ayala Iacucci, A., & Brownstein, J. (2010). Participatory Epidemiology: Use of Mobile Phones for Community-Based Health Reporting. Plos Med, 7(12), e1000376. doi:10.1371/journal.pmed.1000376,. (2015). Electronic Medical Record (EMR) | Healthcare IT News. Retrieved 24 February 2015, from,. (2015). Electronic Medical Record Systems | AHRQ National Resource Center; Health Information Technology: Best Practices Transforming Quality, Safety, and Efficiency. Retrieved 24 February 2015, from,. (2015). Selecting an EHR System or Upgrading an EHR System | Providers & Professionals | Retrieved 24 February 2015, from,. (2015). Electronic Health Records Standards | EMR | Health IT Topics | HIMSS. Retrieved 24 February 2015, from

Nextech Systems, L. (2015). EMR | Medical Practice Management Software | Nextech | Tampa. Retrieved 24 February 2015, from

Practice Fusion,. (2014). EHR - Electronic Health Records Features | Practice Fusion. Retrieved 24 February 2015, from

Stern, V. (2015). General Surgery News - Promise of EMR Systems Yet To Be Fulfilled for Many. Retrieved 24 February 2015, from,. (2015). Electronic Medical Records | Electronic Health Records | GE Healthcare IT - Retrieved 24 February 2015, from


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