NUR 752 Discussion 5.1: Enterprise Data Management and Analytics

This post will evaluate the readiness of my facility’s keenness to advance with a strategic information plan to use enterprise data being collected with the enterprise data management using the reporting and analytics program, E-DRAP (McBride & Tietze, 2019). The E-DRAP framework contains three main components. The first is the reporting and analytics sections which comprise the business intelligence (BI), the BI library, key performance indicator (KPI), and KPI data definition, also called the dictionary (McBride & Tietze, 2019). The second component is data stores which are comprised of enterprise data warehouse (EDW) and data marts (marts) (McBride & Tietze, 2019). The final component is data management which comprises the data model (DM), master data management (MDM), and terminology standards supporting interoperability (STDS) (McBride & Tietze, 2019).

In the post-anesthesia care unit (PACU), the five components of the nursing process are utilized (Dean, 2018). An example of this would be a patient who presents to the PACU after a shoulder arthroscopy. An initial assessment of the patient shows the patient to be moaning, wincing, as well as tachycardia and hypertensive; this is the first step in the nursing process. The second step would be to provide a diagnosis. What is the problem? The patient reports pain (as 8 on a scale of 0-10) as a result of surgery as seen by increased heart rate and blood pressure as well as pain score. The third step is planning/outcomes, what can the nurse implement as far as interventions and possible pharmacologic strategies to alleviate the patient’s pain and what could the outcomes of said implementations be? The fourth step is implementation. The nurse carries out the intervention that was previously evaluated, in this case the nurse decides to dim the lights, quiet the room, and provide the patient with pain medication per orders given by provider. The last step is evaluation. Did the intervention work? Is the patient’s pain alleviated? This step often requires another assessment to determine the effectiveness of the intervention. The Standards of Practice set forth by the BON guides this nurse process in that the nurse is able to evaluate the problem, consider options for implementing interventions then evaluating the outcomes, all based on the appropriate standards of care put in place.

The organization I am employed at seems to be ready and has had time to prepare for a move forward with a strategic plan. The preparation includes integration of data-gathering technology in position with the CMS standards and terminology. Asset implementation of these few strategies embraces the workers, primarily with core values such as encouraging positive distinction among the workers and upholding a competitive attitude with the nearby facilities. The facility I work at appears to be in several E-DRAP stages of development (McBride & Tietze, 2019). The organization is working by evidence-based conclusions that have been proven to keep focus and a competitive advantage in the nearby marketplace (RSM, 2019). Where I work also has procedures that encourage accuracy, reconciliation of data, and enhancement of all KPIs (McBride & Tietze, 2019).

The use of BI at the organization I work at is the use of technology like software tools and algorithms that use data analysis to monitor performance components consistently (McBride & Tietze, 2019). The organization where I am employed uses its people including experienced staff members and executive team leaders. Additional utilization of people is leveraged in training for bedside staff members that are implemented in a trickle-down attitude from the headquarters office out of state. Several of these training sessions are held throughout the year for appropriate staff. The BI library contains the KPI data utilized to enhance processes and business drivers (McBride & Tietze, 2019). Bedside staff use processes and technology that promote all KPI reporting and analysis of care drivers, core measures, and satisfaction. Much of the process that bedside staff use is worked into the electronic charting and existing workflow of direct bedside care. Data Pine has found eight vital KPI parts. Those parts are treatment costs, average hospital stay, 30-day readmission rates, safety, satisfaction, cost by insurers, and treatment and emergency care wait times (Data Pine, n.d.). Each KPI part is recorded and published by the Medicare Hospital Compare website linked by the hospital’s quality care tracking portal, which has public access (National Quality Program achieves…-LifePoint Health, n.d.).

In conclusion, E-DRAP appears to be vital to my organization’s quality of reports and data analysis (McBride & Tietze, 2019). The administration at my organization has a good relationship with clinical staff that can help safeguard the idea that processes and technologies will be used and remain an effective way to report, track, and drive care. I am confident that my organization empowers its employees to be strong participants in the overall enhancement of patient care and the healthcare experience on all sides of the bed.

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References

Data Pine. (n.d.). Start finding the right KPIs for your business. https://www.datapine.com/kpi-examples-and-templates/

McBride, S., Tietze, M. (2019). Nursing Informatics for the advanced practice nurse: Patient safety, quality, outcomes, and… interprofessionalism. Springer publishing.

National Quality Program achieves … – lifepointhealth.net. (n.d.). Retrieved March 19, 2022, from https://www.lifepointhealth.net/docs/default-source/default-document-library/joint-commission-journal-lifepoint-nqp-july-2018.pdf?sfvrsn=e87adaf0_2

Discussion 5.1: Enterprise Data Management and Analytics

One of the main goals of utilizing enterprise data is accurate and consistent content throughout an organization. My organization’s readiness to move forward on a strategic information plan to utilize enterprise data includes analyzing key components of the readiness assessment which includes the people, processes, and technology of the organization. According to McBride and Tietze (2018), in order to properly incorporate enterprise data management and analytics throughout an organization, executive leaders have to make informatics and analytics a core priority of the organization. Leaders should practice clear communication of messages with supportive data to their staff to influence and set a standard for the “culture” of the information shared and practiced within the organization (McBride & Tietze, 2018, p. 410). According to Campion et al., (2020), culture plays a large influence in an organization on engagement factors, communication approaches, and successfulness of enterprise data engagement for staff members (Campion et al., 2020). Leaders should also keep the organization’s goals for enterprise data in mind and align their actions, processes, protocols, etc. accordingly. According to Brossard et al., (2022), a “…challenge for hospital managers is to define a context in which knowledge generation meet the objectives of the organization” (Brossard et al., 2022). They recommend hospitals recognizing and developing knowledge generation opportunities. In regard to the processes of the organization in implementing and practicing using enterprise data, effective reporting of analytics is important. The processes require constant evaluation and to be evolved for effectiveness. It is important that the processes support best practice use. McBride and Tietze describe a road map to managing, planning, and developing the E-DRAP. This road map can include a readiness assessment cycle, design document and build cycle, and a release and training cycle. It is important that the organization includes technology that is capable of using and developing these processes for the staff that works in the organization. “Data integrity and governance to ensure high-quality data are critical for organizations to consider with clinicians important to all aspects of HDO’s enterprise use of data” (McBride & Tietze, 2019, p. 422).

In regard to my organization’s readiness to move forward on a strategic information plan and utilization of enterprise data, I deem my organization ready to move forward and actively embracing new technology, enterprise data, and analytics in everyday practice. I formed this decision of readiness through a review of the people, processes and technology of the organization that I am currently employed with. In regard to the people of the organization, our leaders embrace new data and technology in practice. They always back their decisions or announcements in accordance with evidence-based practice. In regard to the processes of the organization, evidence-based practice and research implemented interventions are implemented throughout the organization on individual units and throughout the entire health system. Councils are developed for research and implementation of data on the units across the hospital. A good example includes a council that I am involved in which does research and evidence based practice on treatment and seclusion of mental health patients in the emergency department setting to try to improve their care while in our department. In regard to the technology of the organization, we have access to state of the art technology in our everyday practice. We also have access to a database of new literature on the hospital intranet which all affiliates and departments have access to. Overall, the organization shows readiness for enterprise data management through E-DRAP. As a DNP practicing nurse, having access and utilizing evidence-based evidence in my future practice is very important. Having access to databases with evidence based literature and best practice information from an organization is an important consideration when choosing which organization to work with in my future career.

References

Brossard, P. Y., Minivielle, E., & Sicotte, C. (2022). The path from big data analytics capabilities to value in hospitals: A scoping review. BMC Health Services Research, 22(134), 1-16. https://doi.org/10.1186/s12913-021-07332-0 (Links to an external site.).

Campion, T. R., Craven, C. K., Dorr, D. A., & Knosp, B. M. (2020). Understanding enterprise data warehouses to support clinical and translational research. Journal of American Medical Informatics Association, 0(0), 1-8. https://doi.org/10.1093/jamia/ocaa089 (Links to an external site.).

McBride, S., & Tietze, M. (2018). Nursing informatics for the advanced practice nurse (2nd ed.). New York: Springer Publishing Company. ISBN: 9780826140456.

The strategic information plan that needs to be implemented within my organization is having one standard Electronic Medical Record (EMR) for the whole health care organization (HCO). I currently work for an HCO that has some hospitals using Cerner some using Epic. Outpatient practices use AthenaHealth, and home health uses an entirely different EMR. This can lead to potential errors in patient care by not having the EMR in one cohesive place for all to access within their relevant scope of practice.

Evaluate your organization’s readiness to move forward on a strategic information plan to utilize enterprise data best.

1. 1. People: For people, there would need to be a lot of training regardless of the single EMR that the HCO chooses. (e.g., Cerner vs. Epic). There needs to be one single EMR in place, so the HCO will have to employ the EMR company and have specialized training for all eligible employees. This could present possible learning barriers for staff and even have potential delays in care as there is a learning curve. The HCO is not ready to train staff until EMR experts are put on staff or contracted to help with the transition.
  2. Processes: The processes involve obtaining a contract with an EMR for purchase and adapting it to each clinical area, such as inpatient, outpatient, and home health. There would have to be possible hiring of IT staff with expertise in the chosen EMR. Mass training would take place.
  3. Technology: The HCO has the technology to make the change. The HCO has been using EMR, and there are sufficient computers; however, having a standardized EMR is key.

Assess the key components of reporting and analytics content, specifically addressing the people, technology, and processes.

1. People: While there are prime examples of key performance indicators (KPI) for an organization’s goal, people are human, so they can be missed without proper education and training. For example, a KPI that my hospital has is stroke care. I once missed a dose of aspirin (Pt was NPO) on a patient after a thrombotic stroke. That same evening I received an email from the stroke coordinator educating me on the importance of aspirin after a stroke.
2. Technology: Open access to the Business Intelligence (BI) library and employee databases. Having the BI library will help implement standard procedures and provide analytical data.
3. Processes: BI would help the HCO make and implement policies and procedures with evidence-based practice (EBP).

Smith, T. & McBride, S. (2018). Data, reporting, and analytics. In. S. McBride & M. Tietze (Eds.), Nursing informatics for the advanced practice nurse (2nd ed., pp 400-423). Springer Publishing Company.

The best way to ensure an organization can serve its patient population is to invest in the use of a strategic plan. An encompassing strategic plan should include specific information about budget planning, goals for the organization that are measurable, data management, and patient-centered care. This should utilize the Enterprise Data Management, Reporting, and Analytics Program (E-DRAP) framework and have input from a variety of disciplines within the organization (McBride & Tietze 2018). Building a secure, easy-to-use, system that is capable of reporting data is essential to creating a foundation for integrating business and clinical tools with patient care.

Currently, my organization is a federally qualified health center, that serves as a patient-centered medical home throughout many low-income areas of Chicago. We are fortunate enough to use EPIC which has a large portfolio of analytic capabilities and is a great clinical tool. EPIC can run reports, track outcomes, encourage meaningful use, and pull data in from our partners (with consent) to ensure we are able to deliver the best care possible. Companies that utilize analytic programs capable of sorting large data can improve the quality of care (Kamble et al., 2018). This coincides with our strategic plan of meeting patients where they are and trying to reach as many of our members as possible. We currently have a limited view of EPIC since we are outpatient and do not have access to the entire analytic capabilities EPIC offers.

To evaluate our readiness to advance to a more comprehensive system we need to look at the technology, people, analytic content, and processes involved (McBride & Tietze 2018). We currently use a closed system that allows partner data to be pulled in as long as that partner is with our EMR system. EPIC offers educators, IT solutions managers, and other team members who can be placed on our account to help meet our technology needs. Being able to pull data in from multiple sources, including those outside the EPIC family, to create ‘a single source of truth’ is crucial for our vulnerable population (McBride & Tietze 2018).

The people involved are stakeholders, end-users, patients, and the clinical team. The program needs to be able to segregate the clinical team from the operations team and protect patient information. We need to ensure customization for the addition of the reports with the providers being able to run and manage their own dashboards for quality (McBride & Tietze 2018). We need committees that include the clinical team and quality team to ensure the correct patient panel is accounted for. We should pilot these programs and new dashboards for feasibility, useability, and complete ‘stress tests’ to ensure the program makes sense for the entire organization (McBride & Tietze 2018). Once piloted successfully we should offer additional education to the clinicians or sites that have identified technological deficits.

Our organization is focused on quality metrics and moving away from a fee-for-service model. This has been a difficult transition, but EPIC has helped track what has been done within our organization regarding quality. Care gaps are one way to improve quality, these measures are things like cervical cancer screenings, mammograms, colorectal cancer screenings, etc. Allowing outside vendors to close care caps could be invaluable in our goal to decrease health inequities in Chicago. This can help reduce duplicate work, labs, orders, referrals and decrease the amount of time spent on prior authorizations, claims, and harmonize data (Attaran, 2020). Using analytic reports and content we can identify the areas with lower quality and focus our efforts on closing care gaps for those patients. I believe we are in the pre-action phase and can move on to this upgrade for our strategic plan for 2023.

Attaran, M. (2020). Blockchain technology in healthcare: Challenges and opportunities. International Journal of Healthcare Management, 1-14.

Kamble, S. S., Gunasekaran, A., Goswami, M., & Manda, J. (2018). A systematic perspective on the applications of big data analytics in healthcare management. International Journal of Healthcare Management.

McBride, S., & Tietze, M. (2018). Nursing informatics for the advanced practice nurse (2nd ed.). New York: Springer Publishing Company. ISBN: 9780826140456

Utilizing the E-DRAP framework from your assigned readings, Chapter 17 of your textbook, you are to:

Evaluate your own organization’s readiness to move forward on a strategic information plan to best utilize enterprise data.
Assess the key components of reporting and analytics content, specifically addressing the people, technology, and processes.

Enterprise Data Management, Reporting, Analytic Program (E-DRAP) is designed to connect clinical, financial, operational, and third-party data sources for reporting, analytics, and research purposes within an organization (McBride and Tietze, 2019). Using E-DRAP, I evaluated the readiness of the University of Utah Hospital to move forward on a strategic information plan to best utilize enterprise data.

E-DRAP is broken down into three main components which are people, technology, and processes. The people component is comprised of the CEO, Information Governance, Program Management, stakeholders, senior leaders, physicians, nurses, clinical operations, and finance (McBride and Tietze, 2019). For an organization to be ready to move forward on a strategic information plan, the people involved within the organization must have clear communication among all team members, use data and analytics to move towards reaching the goals and have transparency among all members (McBride and Tietze, 2019). The technology component includes the organization’s Data Architecture Foundation and Business Intelligence Library (McBride and Tietze, 2019. The goal of the Data Architecture Foundation is to provide trusted, reliable, and accessible data to meet the goals, while the Business Intelligence Library is an online collection of content that is shared with users that are convenient within their analytics workflow (McBride and Tietze, 2019). An organization must have these elements in place for it to move towards a strategic information plan. The processes component includes three pieces. The first piece is a road map that prioritizes program management (McBride and Tietze, 2019). The second piece includes key continuous and iterative process cycles that assess readiness, design, reporting, and analytics (McBride and Tietze, 2019). The last piece includes supporting best practice methods to be used (McBride and Tietze, 2019). Once all aspects of E-DRAP have been met, then the organization can move forward with its strategic information plan.

The University of Utah Hospital already has a strategic plan in place for the next several years and have it laid out on their hospital website. The overall strategic plan is to serve the community, lead education, discovery, and innovate care leading to positive outcomes (Good, 2020). The plan includes effective communication, inclusion, diversity, interdisciplinary collaboration, and the use of research and data among all team members (Good). The hospital is also using digital health systems and resources to coordinate care, develop successful health plans, have positive outcomes, align clinical practices (Good, 2020). The hospital uses the culture of data and analytics as a core asset to bring transparency and accountability into the organization (Good, 2020). Overall I feel that the University of Utah hospital is ready to move forward with its strategic plan, due to the effective utilization of the E-DRAP components.

References

Good, M. (2020, November 11). Our strategic roadmap to 2025. University of Utah Health Sciences – Research, Education, Clinical Care – Salt Lake City, Utah. https://uofuhealth.utah.edu/notes/postings/2020/11/strategic-roadmap.php#.YjtkZ5rMK3I (Links to an external site.)

McMcbride, S., & Tietze, M. (2019). Nursing Informatics for the Advanced Practice Nurse. (2^nd ed.). New York: Springer Publishing Company. ISBN: 9780826140456

Security threats can be alarming for any organization. For healthcare entities, this is especially true due to the nature of the information collected and stored. The advent of EMR/EHR systems is a double-edged sword. Data can be stored and accessed by medical professionals easier, and give patients more autonomy over their health data, but can also be vulnerable to hackers and data breaches (McBride & Tietze, 2018). These threats can often be mitigated by proper security training, procedures, and protocols. Significant security measures need to be in place to protect health information as well as to help prevent erroneous orders and fraud (Vinaykumar et al., 2019). The EMR system is not the only vulnerable technology within healthcare entities.

According to McBride and Tietze (2018) additional technologies can be targeted through things like trojans, malware, viruses, etc. These threats are typically sent via email from outside untrusted sources that might look like they come from within the company. Once access has been gained unauthorized users can take over the computer, gain access to protected information, and even steal passwords. Our company has an automatic scan of any email with an attachment that delays the recipient from opening a potentially harmful attachment. At times, this can be cumbersome, but a slight delay is better than a system-wide breach.

Factors that contribute to security threats are vast and evolving rapidly. Some are easy to troubleshoot and safeguard against, limiting access to computers with EMR accessibility, password protection, and two-factor authentication are some of the easier implements against security threats (Chen et al., 2020). These can be done at the organization level with input from shareholders, IT, and end-users. Other threats are harder to protect against and not as easy to find. Making sure only clinical personnel can access HIIT is an important and often late consideration (McBride & Tietze, 2018). This can separate the protected data from those who shouldn’t have it. This has been a growing concern in hospitals near and around LA due to the celebrities that might be brought in. We had to all sign additional NDA forms and be restricted to patients on our floors only during my clinical rotations in nursing school to combat the release of protected health information.

Our practice utilizes block-chain EMRs for ease of use. This is a universal practice for our EMR system and helps to pull data in from participating partners. Our organization helps to safeguard against some threats by adding layers to the data that can be accessed (Vinaykumar et al., 2019). One of these layers is consent, each patient needs to authorize us to view their outside health information, another is a read-only feature for outside reconciled information and a third is the safe storage of any consolidated health information.

Chen, C. L., Huang, P. T., Deng, Y. Y., Chen, H. C., & Wang, Y. C. (2020). A secure electronic medical record authorization system for smart device application in cloud computing environments. Human-centric Computing and Information Sciences, 10(1), 1-31.

McBride, S., & Tietze, M. (2018). Nursing informatics for the advanced practice nurse (2nd ed.). New York: Springer Publishing Company. ISBN: 9780826140456

Vinaykumar, S., Zhang, C., & Shahriar, H. (2019). Security and privacy of electronic medical records. SAIS 2019 Proceedings, 29, 1-6.