Chapter 25 Electronic Health Records and Other Health Care Technologies

connectivity, monitoring, and apps, as well as more advanced computers, have provided older adults with greater independence and family members’ reassurance that they can safely live on their own (15). Monitoring could include medication tracking, physiological sensors, and the study of movement patterns to note any changes in routine that might suggest the onset of illness. In addition, movement during sleep can be measured, which might help prevent development of decubitus ulcers. An obvious benefit of smart homes is peace of mind for the resident’s adult children. Smart homes can also include refrigerator sensors so that a family member will know if a parent has consumed too much or not enough for a meal. Wireless and digital technologies in health care and public health delivery of care is here and will become how health care and nutrition care are deliv- ered. Bluetooth capability enables medical devices— such as glucose monitors, electrocardiogram (ECG) monitors, pulse oximeters, and blood pressure moni- tors—to be worn by older adults, tracking movements and relaying health measurements back to caregivers. Collecting data with these technologies allows older adults to modify their behaviors and self-manage chronic conditions (eg, losing weight or managing dia- betes and congestive heart disease). ECG data can be collected day to day for several weeks, which is an advantage over the one-minute recording made at a weekly clinic visit. Any aberrations could be detected earlier and more easily, potentially leading to early diagnosis in conditions like depression or cognition. Technology can also be used to improve health care service delivery processes by targeting health care pro- viders or communication between these providers and the older adult client. In rural health care, telemedicine platforms for emergency response are already available.

Some applications collect information about the

individual’s lifestyle and activities (such as food habits and diet details, location tracks, physical activity, or social interactions). Other applications enable a broad range of health-related applications: sharing data with the health provider as in a traditional doctor relation- ship, but also sharing data with an insurance company (eg, to confirm compliance with a medication or health care regimen), with lifestyle coaches (eg, diet advis- ers), or with family (eg, to support a relative’s recovery from surgery).

MALPRACTICE AND THE

ELECTRONIC HEALTH RECORD Always remember that any documented record may be used in malpractice litigation: “Every aspect of EHR

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selection, implementation, and use may be examined in the course of medical malpractice discovery to uncover the source of the incident, or undermine the records that are being presented in defense of the malpractice claim” (16). Copying and pasting information from one elec- tronic record to another or large blocks of text repeat- edly copied in the EHR are easily revealed by a plaintiff attorney in the discovery phase of a malpractice suit. It suggests that you were not really engaged in patient care and may cast doubt on anything else you may say in your defense.

Passwords should never be shared. Forcing every- one to use a separate password, and changing pass- words at regular intervals, is a requirement. Input errors can easily be made if sufficient time is not taken when information is entered into an EHR. Unfortu- nately, studies show that entering information into an EHR may take longer than it did with paper charts, but not doing the due diligence required can be costly in the end.

SUMMARY

The benefits of technology and informatics-related solu- tions to the quality of life and safety of the older adult are limitless. With many of the mobile health devices, older adults will be able to stay in their own homes. Just as many assisted-living and residential care facilities are moving to a room-service meal style that includes a lib- eralized diet, so technology can help enhance a person’s overall sense of well-being and his or her feeling of independence. This technology does not come without threats; therefore, the RDN and NDTR must follow evi- dence-based practice standards and documentation poli- cies and procedures to ensure that nutrition care of the older adult is optimal.

REFERENCES 1. HealthIT.gov. Long-term & post-acute care. www .healthit.gov/policy-researchers-implementers/ long-term-post-acute-care. Accessed December 31, 2015.

2. Institute of Medicine. To Err Is Human: Building a Safer Health System. Committee on Quality of Health- care in America. Washington, DC: National Academies Press; 2000.

3. Institute of Medicine. Crossing the Quality Chasm: a New Health System for the 21st Century. Committee on Quality of Healthcare in America. Washington, DC: National Academies Press; 2001.

4. HealthIT.gov. Standards & Certifications Criteria Final Rule. www.healthit.gov/policy-researchers-implement- ers/standards-certifications-criteria-final-rule. Accessed December 31, 2015.