C791 Advanced Information Management and the Application of Technology Competencies

C791 Advanced Information Management and the Application of Technology Competencies

C791 Advanced Information Management and the Application of Technology Competencies

A1.  Summarizing advantages and disadvantages of the healthcare system:

With the advancement in healthcare, recent developments have led to the creation of electronic healthcare systems. The HIS or Health Information Systems have been used to collect, modify, analyze, and transmit the healthcare data through a wide myriad of disciplines within the system. This system also records the procedures and medications in the systems. It is very important to have this information to process it concerning better patient outcomes and process improvement. Like any other system, there are advantages and disadvantages to this system. This system collects personal and medical information of the patients and as a result, it should be kept very private. There is a large threat of invasion of privacy for these patients as their personal and financial data can be accessed.

The advantages and disadvantages of these systems center on usability, interoperability, scalability, and compatibility. According to the Healthcare information management systems society (HIMSS) usability is described as being effective, efficient, and satisfactory with which users can accomplish specific tasks in a set amount of time in a given environment. Good usability improves the quality and safety of a system and decreases burnout and errors on part of the users. If a system has good usability it will be easier to adopt for healthcare providers. On contrary, a system with a poor interface will not be very user-friendly and it will be difficult to adapt its facility-wide. (Boldt, 2020).

A lot of nurses were forced into retirement in my old workplace when we switched from paper charting to electronic Medical Records. They were hesitant to learn a new system and the stress of it all lead them to make this decision. It is very rare for usability errors to cause any patient harm, but some of them might lead to an IT issue and further lead to unfriendly usability. Interoperability is the ability of the Health Informatics system to draw on the information and utilize it for better patient outcomes, increasing patient satisfaction, and privacy and providing better and cost effective solutions for the facility.

Disadvantages of interoperability can lead to data sharing, invasion of privacy, and potential for cyber-attacks. Scalability is an important aspect if we want to expand the use of HIS throughout the hospital system. For a system to be scalable, it has to accommodate a large number of changes and updates with an ability to extract and process information to analyze it for the facility. It is also important for the system to be able to adapt to new technological changes and performance improvement.

The cost of updating the system and buying new software can be a part of the disadvantage of the scalability. It can also be disadvantageous if the system is not able to process data once a large amount of data is entered. It ultimately translates to the high cost of quality and worse patient care outcomes.

A2.  Describe how a system will affect patient care and documentation.

Implementing an EHR will streamline the documentation and care delivery notes of the patient in a uniform format, this will increase the compliance and continuity of care provided to the patients which will improve their clinical outcomes. All the departments can collaborate and view what other departments have done. Since all the notes are in the same place, it saves time for all providers. They can easily see the course of treatment and all the patient data and tests etc. in real-time. The ability of EHR to set off alarms for certain core measures and red flags for abnormal labs has proven to be very useful. The ease of obtaining data regarding the patient and thereby getting a complete medical picture which includes history, physical examination, labs, and imaging has been proven to be useful for the specialists so that they can provide better and fast care to the patient without compromising time.

A3.  Explain how using a system to access information will affect the quality and delivery of nursing care and patient outcomes.

            The implementation of EHR will improve patient care by improving the quality of care and delivery of healthcare services which will lead to better patient care outcomes. Another advantage of EHR is the ability to enter data in real-time. This can save valuable time in event of an emergency making the data easily accessible. Some of the EHR can also flag patients as fall risk or skin breakdown risk and appropriate for hospice or Palliative discussion. This can greatly influence healthcare providers to institute preventative measures and thereby improve patient care outcomes. Using the EHR can prevent many errors due to the use of bad handwriting and penmanship. It will make the documentation uniform and improve the quality of medical records. The information about allergies and code status that can get lost in a paper chart can be accessed easily through the EHR, preventing catastrophic outcomes.

B1.  Provide two ways that quality improvement (QI) data collected from a system can lead to measurable improvement in health care services and the health status of targeted patient groups.

Implementing successful QI projects can shed knowledge on key principles of success. Healthcare systems can benefit tremendously from applying these principles to workflow and operations. According to health resources and service administration, quality improvement is a systemic and continuous action that leads to measurable improvement in the healthcare services and health status of targeted groups (Healthcatalyst.com, 2019). The QI projects improve patient care outcomes and lower the cost of the services provided. Although it can appear to increase the workload of the participants in the long run it can give the healthcare facility the ability to improve the care of the patients, prevent medication errors, and decrease the cost of services and thereby improve patient experience and overall patient care outcomes.

I work as a Clinical Performance Nurse for a group of hospitalist physicians. My main job description is to monitor and improve the quality metrics for this group of physicians. When I joined the group, the two metrics that were not meeting targets were readmissions and Press Ganey HCAHPS scores. We started with 30-day readmissions at 12%.  We introduced a readmissions risk score and all patients were screened for potential risk of readmission. Any patients flagged on the score were given a pamphlet with all discharge information including the name of their discharging provider, discharging nurse, case manager, social worker, and their primary care provider.

Their pharmacy and primary care provider appointments would be listed on that pamphlet. Each of these patients got a call from me within 2 days of their discharge. These steps helped us to prevent our avoidable readmissions. Our readmissions went from 12% to 4%. Our patients were happy with the extra attention and the nurses felt that they could contribute more to the care of the patient. The next metric that we focused on was the patient experience scores. We worked on the principles of AIDET and started doing mock patient encounters with our physicians. They watched the videos and scored themselves on the rubric. This allowed them to reflect on their style of interviewing the patients and their ability to see their body language.

Our physicians observed a lot of opportunities for improvement and came up with another idea for managing up other people involved in the care of the patients like the ER doctors, nurses, consultants, and even their colleagues. The data that we collected can also be used in case of any sentinel events or to implement companywide changes to the workflow. The ways that I used HIS system in my QI projects were (1) obtaining the name and demographic data of the patients and (2) the status of their HCAHPs survey, meaning if they were sent the survey or not also (3) the discharge information packet to reduce readmissions. Elaborating on the above information, I used the basic demographic information of the patients to contact the patients after discharge and reinforce some discharge teaching and make sure that these patients were filling out the Press-Ganey survey after being discharged.

I was also able to procure their pharmacy entered so that I could call the pharmacy and confirm if the patients had picked up their medication or if those medications were covered under the insurance or not. Then by using the status of whether they had filled out the survey or not, I was able to nudge the patients to fill out their surveys. Furthermore, By using the “Previous Visits” feature in the HIS, I was able to audit the number of readmissions and focus on brainstorming how to prevent these readmissions and whether our phone call and the survey was able to prevent these readmissions or not. There are several reports built in the system that enlightens us as to if the projects that we worked on are successful or not.

B2.  Explain how a system will meet HITECH and HIPAA security standards and regulations, including the following:

Adoption and meaningful use of the electronic health record by healthcare providers and their associates warranted the signing of the HITECH law in 2009. The EHR technology used should be qualitatively and quantitatively measurable. Mandatory security audits of the healthcare providers can provide strict enforcement of security and privacy rules for HIPPA. In the case of patients, it is easy for them to access their healthcare information. Even though the HITECH and HIPPA are different laws they allow for enforcement of each other (Lord, 2018).  The main objective of HIPPA is making it easier for patients to access their healthcare information. This access should not compromise the privacy of their healthcare information (CDC.gov, 2018).

The information should be secure and not accessible to anyone not authorized to access. The main utilization of electronic records is to make the flow of information easy and accessible to all the members of the healthcare team. The logging in of the information, tests, and procedures in real-time makes the use of EHR beneficial to the team and provides good quality of care and better outcomes for the patients. Where I work, you have to undergo a vigorous criminal, background, and medical check to even get access to the medical record software. Every person has a specific ID and password that logs them into the system. Even when you are in the system on a screen, if 5 minutes are inactive, the system logs you off automatically making it safe so that a passerby cannot glance at the records.

The unique password expires every 90 days and has to be changed, it cannot be the same as your past 10 passwords. All the healthcare providers can see all the patient names, but it is illegal to access a patient record that you are not caring for. We have a department specifically dedicated to monitoring the online EMR accessibility compliance. The corrective action starts from a disciplinary warning by the manager of the unit that is reflected on your permanent record and repeated violations lead to termination of employment and flagging of the candidate so that they will not be hired in the future.

Any violation in following the laws of HIPPA can result in severe disciplinary actions because it constitutes a breach in patient privacy. All our medical records are backed up on-site and off-site servers. Our hospital has a headquarters in Nashville, so all the records ultimately are backed up in the central server in case any emergency happens on the site.

B3 Protecting patient privacy

Various methods are used to protect patient privacy in an EMR (Electronic Medical Records). The site where I work, we use Medi-Tech. Firstly, it is very hard to get credentialed to get access to Medi-Tech. It takes a thorough employment review and background check to get access. Then each person accessing the patient records is closely monitored by the IT and compliance department for any outliers that “Peek” into other charts. Any chart left unattended for more than 5-10 minutes automatically locks the screen so that the user has to unlock with their password again. Every username and password is unique to the individual and expires after 90 days. Furthermore, the password cannot be the same as your past 10 passwords. This makes the system capable of protecting the patients’ privacy and valuable medical and financial information. Any violations in these policies can lead to disciplinary actions and termination by the management.  

B4 Improving Organizational Efficiency and Productivity

Implementing an EHR helps to improve the productivity and efficiency of an organization. This is achieved by standardization of documentation and practices so that every member of the team is on the same page with the care of the patient. For physicians, it can help them to document uniformly without missing important aspects of the diagnoses and hence help with proper documentation of acuity of the patient. The use of EHR will ensure that all the protocols will be followed closely hence it will keep us on track with the core measures and competencies and eliminate any fallouts. The documentation and care plans for nursing will help keep the notes in a more standardized fashion to eliminate any guesswork or gap in the care.

The entry of the results, tests, vitals, and procedures done in real-time can eliminate the need for documenting anything on paper. This will eliminate a lot of double documenting and wastage of paper and time on part of the healthcare team. It will reduce the need for scanning documents in the chart and save some valuable time. The use of centralized charting and instant message feature on the Medi-Tech Software has eliminated the need for unit secretaries for our hospital. This has led to some huge savings on part of human and capital resources for the company. If some time is invested in training the staff to use the EHR properly, it can increase productivity and reduce the cost of care for the organization.

C Interdisciplinary stakeholders for system implementation.

Implementation of Electronic Health Records can be an extensive project for the site. It will need the involvement of a strong interdisciplinary leadership team to bring it to fruition. A physician champion needs to be identified, who can explain the importance of electronic health records to fellow physicians and hone in on the advantages of a standardized format of documentation. He will be also communicating with fellow clinicians about their needs and concerns about the new system. Collaborating with other members of the interdisciplinary teams and continued participation in the implementation efforts with an emphasis on process improvement in real-time should be his priorities. The next important member of the group should be an IT lead for electronic health records.

The IT Lead will be responsible for troubleshooting any analytical, IT issues that arise with the electronic health system. Streamlining the process of implementation of a new system as painless as possible. He/she should be able to be a good collaborator since he will be working with clinicians, nurses, and all of the ancillary departments. This person should also be in charge of making sure that the interface of the system looks and feels uniform for a better transition to several departments.  He/she will be responsible for vendor negotiations and making sure that each part of the implementation process has sufficient IT support to troubleshoot any analytical issues that arise during this phase. This person will make sure that there is all the support with regards to hardware, software, and analytics before going live with the new system.

The next important role is the role of a superuser. It can be a nurse or a healthcare informatics graduate. This person will be one receiving the initial training and will be responsible to educate the staff on the implementation of electronic health records. This member has to be very approachable, as people can come to him/her with their concerns or issues. They have to be able to communicate effectively with various departments when training them. They have to be familiar with the system to pinpoint the exact issue with precision for the IT department to improve compliance and use of the system. They will evaluate the system for proficiency and evaluate the capabilities of this system to meet the requirement of the staff. Another important member of this interdisciplinary team would be the Risk/compliance manager.

With all the implementation efforts done, we need to make sure that everyone is being compliant with electronic health records. With so much information available at your fingertips, it is easy to look around. The team needs to make sure that users are documenting in their charts and are not accessing other patient charts as this will be a violation of patient privacy. They also need to make sure that the information is populated appropriately, for example, the labs, vitals, test results, and imaging, so that the continuation of care is not disrupted. Any fallouts that happen due to the implementation of the new system should be investigated further. This member also reviews the incident reports and data statistics to study the liability and claims at the hospital and corporate level.

The main role of this position is to evaluate the risks and liabilities before they happen to prevent any sentinel event-form happening.  This interdisciplinary team should work well together and collaborate on timely intervals to make sure that the implementation is on track and troubleshoot any issues that arise at that time. Another important member of the group can be the administrative team who will deal with budgetary and regulatory issues relating to the implementation of this system (Green, 2019).
 

D. Plan for evaluating the success of the implementation of a system by incorporating two professional organization standards.

The necessity and methods for evaluating electronic health records have been backed by several professional organizations. American Nursing Informatics association happens to be one of them. They published a paper taking a position in 2015, about the necessity of the process to report EHR related safety issues from clinicians and nurses should have an easier interface with proper communication to the original reporter for easier follow-up. The ease of this process will enable the healthcare team to report these events more readily and thereby prevent any safety-related issues due to the electronic health record. (ania.org, 2015).

It will also help the facility to collect this data and analyze it to format any quality improvement outcomes for better care delivery in the organization. The American Nurses Association strongly supports the need for a stronger standardized EHR that is patient-centered and the supporting infrastructure to promote optimum communication between the interdisciplinary team and the patients. According to ANA, nurses are an important part of the healthcare team and as such should be involved in the development, design, implementation, and evaluation phases of the EHR.

ANA stresses on the documentation of the expected outcomes for the patient care to be part of the documentation. They can be a medical condition, ethical outcome, situational, and or organizational construct. These should be well communicated to the key stakeholders of the team, family, patient, and clinical providers.  While documenting these a nurse should be cognizant of risks, liability, benefits, costs, and evidence based outcomes (nursingworld.org, 2009).