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Do yo u more ti spen d at a cme looking screeomputer looking n than patienatt you r s? Why is it to n impor taotthe lis ten t escribe d patient n dition in their co wn way? their o H o w h ave you seen des killing in you r hospital? Have any u r o of y o e r tw atients ev p been the sa me? Managers often claim that HIT will free RNs to spend more time with their patients, but the opposite is true. EMRs enforce cumbersome documentation requirements that take time away from patient care, often without benefiting patients. Menu Hazards EMRs may or may not allow substantial narrative charting. Narrative charting is important because it allows an RN to describe a patient's condition and care precisely and efficiently. But even when EMRs allow narrative charting, they subordinate it to a long series of menu selections. Imposing menus on patient assessment and care gives management more control over nursing practice by routinizing it, with many negative consequences. • Reviewing the menus and making selections often takes so long that • little time is left for patient care, let alone narrative charting. • Like other aspects of HIT, imposition of menus depersonalizes the relationship between RN and patient. • Crucial information in a record can go unnoticed because it's buried in a lot of irrelevant information. • Menus suggest charting by exception. If a symptom listed in a menu isn't selected, someone reviewing the record later is likely to assume that the patient was normal in that respect, when this may not be the case. • It's easier to make an incorrect selection with a single mouse click than to write something incorrectly. Errors are easily overlooked because EMRs are more extensive than paper charts, include irrelevant information, and appear orderly and official. Errors also can have a wider impact because they proliferate electronically, appearing everywhere records are accessed and impacting other HIT programs. • Too much reliance on electronic menus in patient assessment and care deskills RNs. Over time, knowledge of how to use EMRs supplants knowledge of patient care. RN professionals are, in effect, displaced by technicians when EMRs usurp their power to make choices based on their professional judgment. • The assumption underlying menus is that all patients are more or less the same, so their needs are routine and predictable. But because every patient is different, a patient's condition or care may not be accurately reflected in any of the choices included in a menu. In this situation, the RN is often forced to make a selection, misrepresenting the patient's circumstances, in order to advance to the next screen. Menus obscure the individuality of every patient, and thus his or her humanity. Although making documentation more burdensome may seem inefficient, EMRs promise to increase technical efficiency as the hospital or HMO grows, in part by increasing management's control of RNs. Employers expect longterm financial benefits from increased control. Surveillance Electronic medical records are a powerful surveillance technology, a rich data © Copyright IHSP 2009. All rights reserved.