One night while working the night shift as a new nurse, a young medic said to me, “Sir, you nurses spend more time treating a computer than you do treating patients." He was absolutely correct. Before I became a nurse, I never could have imagined how much of my time would be spent hunched over a keyboard staring at a computer monitor, double and even triple-charting because the Electronic Health Record (EHR) programs we were using were poorly designed and not anywhere close to being user-friendly. If I could go back and add up the time spent waiting for a computer screen to change from one page to the next, or restarting the computer after it “froze-up” or "crashed", I honestly believe that number would be measured in weeks and not hours. These countless lost hours have made real impacts on patient care, but not the type to brag about.

It is no secret that the Department of Defense (DoD) has been slow to upgrade to a faster and more efficient EHR, and my current clinical site at Madigan Army Medical Center was one of the first to launch the new system in 2017. It is therefore fitting that I share assignments I completed prior to the launch of the new DoD EHR on how to improve the current system and a timeline for the process that goes into implementing a new EHR system. My project on Clinical System Analysis was based on the idea that all EHRs nationwide should be able to share patient information no matter where that information is stored. Treating patients at a Military Treatment Facility is often difficult as patients have records from many different hospitals and clinics. Though the majority of DoD medical facilities use the same EHR, which allows for portability of records as the patients move from duty station to duty station, I often have patients who are referred out to the civilian sector and I am unable to access that information. It was not until December 2015 that the DoD implemented a new computer system that allowed military providers access to Veteran's Administration (VA) records. It is still slow and difficult to use, but it is a start.

The project Maintaining Data Integrity seemed like obvious information when I wrote it, but the ability to keep electronic data and patient information private has been quite a challenge in recent years. My current facility has to remind providers every few months to not send patient information through the DoD email system, and we even had an issue with one employee checking her own health records within the EHR even though she is not a healthcare provider and should not have EHR access. It is these two issues I outlined in my paper, as the level of computer access employees are given is not always needed for the position they hold. Though we bemoan the yearly recertification training we complete for HIPAA and computer data security, I believe they are necessary reminders to keep providers from making mistakes that may violate the privacy of our patients.