Digital Tools: EHR Simulation, Telehealth, and Professional Databases

Digital Tools in Respiratory Therapy Practice

Modern respiratory therapists (RTs) work in environments shaped by three interconnected digital systems: electronic health records (EHRs), professional clinical databases, and telehealth platforms. Competence with each is required for safe, legal, and effective practice—and is tested in both the NBRC credentialing exams and by state licensing boards.

Electronic Health Records (EHR) in Respiratory Care

An EHR is the legally binding, patient-centered digital record of all clinical encounters. For an RT, the EHR is where you document every assessment finding, every treatment given, every ventilator change, and every patient response. Incomplete or inaccurate documentation is not just a paperwork problem—it is a patient safety hazard and a legal risk.

When entering a respiratory therapy assessment and treatment record, you must populate all required fields without exception. For a ventilator patient, this typically includes:

• Patient identification — name, date of birth, medical record number
• Date, time, and location of the encounter
• Assessment findings — breath sounds, work of breathing, level of consciousness, oxygen saturation, capnography values if applicable
• Ventilator settings — mode, tidal volume, rate, FiO₂, PEEP, and any alarms
• Patient response — tolerance of current settings, any adverse events
• Plan and follow-up — recommended changes or next scheduled assessment
• Clinician signature and credentials

EHR systems flag errors or missing data automatically. You must resolve every system-flagged error before submitting a record. Submitting a record with unresolved errors can mask critical clinical information from the next provider. In a real clinical setting, an unsigned or incomplete record may be treated as if the care never occurred.

Safety point: Never document a treatment you have not yet performed. Never back-date or alter an entry without using the EHR's official amendment process, which creates a transparent audit trail. Both practices violate federal and state law and professional ethics.

Professional Clinical Databases

Evidence-based practice (EBP) is the standard of care in respiratory therapy. Professional clinical databases—such as ClinicalKey, DynaMed, PubMed, and the AARC Clinical Practice Guidelines available at aarc.org—give RTs access to current, peer-reviewed evidence at the point of care.

The American Association for Respiratory Care (AARC) publishes Clinical Practice Guidelines (CPGs) that synthesize research into specific recommendations for interventions such as oxygen therapy, incentive spirometry, airway suctioning, and mechanical ventilation management. These guidelines are widely used as benchmarks by hospitals and accreditation bodies.

When using a clinical database, follow this process:

1. Frame a clear clinical question (for example: What is the recommended frequency of suctioning for an intubated adult patient on mechanical ventilation?).

2. Search the database using relevant terms.

3. Evaluate the source — prefer systematic reviews, clinical practice guidelines, and peer-reviewed studies over opinion pieces.

4. Extract the key recommendation and note the strength of evidence.

5. Cite the source correctly. The NBRC and most programs require APA format.

A correctly formatted APA citation for a guideline includes the authoring organization, publication year, title, and URL or DOI. Accurate citation protects intellectual honesty and allows other clinicians to verify the source.

Safety point: Clinical guidelines are updated as new evidence emerges. Always verify you are reading the most current version before applying a recommendation to patient care.

Telehealth Monitoring in Respiratory Care

Telehealth allows an RT or supervising physician to monitor patients and review data remotely using secure audio-video connections and digital data transmission. This is increasingly common in intensive care settings (tele-ICU), home ventilator monitoring, and sleep therapy management.

In a telehealth respiratory encounter, the remote RT may:

• Review real-time ventilator waveforms and alarm data transmitted from the bedside
• Communicate assessment findings and recommendations to bedside nurses or therapists via secure video or messaging
• Document the encounter in the EHR exactly as they would for an in-person assessment, including the remote nature of the visit

Three key workflow differences from in-person care:

1. Physical assessment is limited. The remote RT cannot directly auscultate breath sounds or assess work of breathing by touch; they rely on bedside staff reports, transmitted waveform data, and camera views.

2. Communication is mediated. Instructions to adjust settings must be clearly relayed to and confirmed by a credentialed bedside clinician who physically makes the change.

3. Documentation must specify the telehealth modality. The EHR entry must note that the encounter was conducted remotely, identifying the platform used and who was present at the bedside.

Safety point: Scope of practice applies equally in telehealth. An RT operating remotely must stay within their state license and employer policy. Any urgent finding must trigger an immediate, documented escalation to the bedside team.

Connecting to Your Credentials

The NBRC CRT and RRT exams test your understanding of documentation standards, evidence-based practice, and technology-assisted care. Your state RT license requires that all your clinical activities—including telehealth and EHR documentation—comply with state practice act regulations. Maintaining accurate, complete records and using current evidence are foundational to passing your boards and keeping your license.