DNP Essential VI focuses on the importance of inter-professional collaboration for patient safety and to provide optimal care. This assignment aligns with Essential VI because it requires the DNP student to take a deeper look at continued barriers preventing seamless inter-professional collaboration within EHR systems.

As the healthcare climate rapidly changes, providers must adapt. Over the years the introduction of EHR (electronic health record), has become a blessing and a torment. Technological advancement in healthcare has proven to be beneficial for all of us-patients and providers alike. It does, however, have its hinderances (Noblin, 2021). If the internet goes down, we no longer have anything from the patient’s chart to reference. This can be especially frustrating when needing to review labs and trends, previous treatments, specialists’ notes, etc. The goal of requiring EHR was to have one centralized database in which all patient records can be viewed-this has not yet been successful. There have been substantial benefits with having EHR. The records can be accessed somewhat easily, there are macros and templates that can be made to aid with documentation, notes are typed which can help with misinterpretation from handwritten notes, and quality metrics are within the EHR which increases compliance with completion (Janssen, 2021). The struggle to keep up with the documentation in an EHR can be overwhelming and some feel that attention is kept on the electronic device depersonalizing the visit (Janssen, 2021).

In 2016, the Center for Medicare Services (CMS) introduced two incentive programs for health care practices: Merit based incentive payment system (MIPS) and Alternative payment model (APM) (Moore, 2019). Both programs are part of the shift to value-based care reimbursement (Moore, 2019). Value based care reimbursement is under the premise that quality healthcare services should yield higher reimbursement rates. This, however, is a multifaceted issue. Many of the quality indicators rely on primary care services such as blood pressure control, A1C control, compliance with diabetic foot care, diabetic eye care, up to date vaccinations, preventative services such as colonoscopy and mammography, smoking cessation, obesity, and depression screening. These quality indicators also rely heavily on the compliance of the patient. In rural SC, there are several barriers preventing such quality indicators to show “control.” Barriers may include lack of adequate services in the area, cost of insurance and medications, inability to return for follow-up exams, inability to pay for necessary diagnostic testing, cultural beliefs, and lack of education for personal health. Quality healthcare which is equitable and efficient remains important for the ultimate success of any healthcare reform, however, barriers should be taken into consideration. Patients have equal responsibility for the success of any healthcare reform. The attitude of our nation must change from that of “sick” care to preventative well care. Insurers do provide reimbursement for some quality items such as normal weight, non-smoker, normal blood pressure, etc, but this unfortunately is not a mandate for all insurers to provide. Even with this “reward” system, it remains difficult to reach all quality indicators. The inability to reach quality indicators puts pressure on private practices who struggle to remain privately owned. In my practice, meetings have been held to discuss how noncompliance in patients can be reduced while still providing much needed care.

Attitudes for our nation’s healthcare system must change for both healthcare providers and the patients which we treat. We must transition from the attitude of “sick” care to that of preventative well care. Insurance companies could help with this transition by covering all preventative diagnostics and rewarding patients who are compliant with their health regime. Additional services must be expanded to rural areas to help support primary care practices. Continued work on EHR systems must be conducted to have one centralized database for all patient records which can be accessed by any provider in any state. As healthcare providers and DNP students, we must aid in the effort, leading by example, educating other providers and patients in transitioning to a healthier nation.

References

Janssen, A. ,. (2021). Electronic medical record implementation in tertiary care: factors influencing adoption of and electronic medical record in a cancer centre. BMC Health Services Research.

Moore, R. N.-T. (2019). Enhancing pharmacy services in a primary care. American Journal of Health-System Pharmacy, 1460-1461.

Noblin, A. H. (2021). Can caregivers trust information technology in the care of their patients? A systematic review. Informatics for Health and Social Care.