Benchmark – Electronic Health Record Implementation Paper NUR 514
Benchmark – Electronic Health Record Implementation Paper NUR 514
A core aspect of health information system and technology is the use of electronic health records which entails an electronic form of patient’s medical information stored by providers and healthcare systems. Electronic health record (EHR) contains data from administrative and clinical encounters between patients and their providers (Tyllinen et al., 2018). EHR supports core patient-associated activities based on its interfaces like clinical support decision making based on evidence, reporting of outcomes and quality management. The purpose of this paper is to discuss elements of designing and implementing an EHR system, the professional, ethical and regulatory requirements to be incorporates and the leadership attributes needed for inter-professional teams’ collaboration.
Opportunity for Tracking Care Improvement & Key Information in the Database
Electronic health records (EHRs) database contains a unique feature that allows users to track opportunities for healthcare improvement, and which has made the model to attract attention from many stakeholders in the industry. EHRs support providers in making better decision and enhancing patient quality care by improving both accuracy and clarity of medical information leading to a reduction in the occurrence of medical errors. The registries contain information on all interactions between the patients and their providers, including the care facility. The database should contain certain routine components that allow for maximum usage of the benefits in keeping track of the chances to promote care.
The database requires record keeping, an important feature in tracking all the trends in the population and demographics of patients in a facility. The information is essential in improving care and informing the most appropriate research (Cresswell et al., 2017). Other data of the records should comprise of patient response to different treatment approaches and if the treatment satisfied the set objectives. The database should have a correct association between care intervention and patient outcomes and using health informatics to support decision making by taking notes of what is required to attain the desired healthcare objectives. The other feature that should be considered in the EHRs database is the availability of detailed indices that can collate all data at one point and ensure it is accessible by only authorized individuals in supporting interdisciplinary teamwork and healthcare models for better patient results.
Role of Informatics in Data Capturing & Project Management Strategies and Methodologies
Informatics play a critical role in analyzing the healthcare data with a keen focus on extraction of important aspects and attaching meaningful logic to the information. Further, informatics advances that all interactions in healthcare result to big data, and necessary
measures should be deployed to create meaning out of it through effective interpretation to support clinical decisions. In this case, informatics will make sense out of the collected or captured data by assigning value and extracting more insight to allow the health care system to reduce chances of error leading to better and increased opportunities for the realization of the expected outcomes (McCrorie et al., 2019). The implication is that those dealing with the data must incorporate critical strategies and approaches used in project management like establishing logical correlations to illustrate the relationships that can support intentional improvements of care and efforts to lower costs. Informatics will impact the data capturing process through identification of contextual factors and determinants that are fundamental in attaining the care goals and considering them as critical variables in the implementation of the project. Therefore, it will impact the collection of data and ability to identify the most important and useful information in designing the EHR system.
Informatics will capture all data from difference devices that include electronic medical records, patient portals, health tracking devices and diagnostic systems and convert them into a single format to be stored in the database. This implies that database management systems should have programming interfaces applications that transmit the relationships between the various database and require the team to understand critical aspects of project deliverables across the different healthcare platforms (Penrod, 2017). These strategies and methodologies are essential in supporting the implementation of the electronic health record system to enhance quality within the clinical setting.
Systems and Staff Members involved in Designing and Implementing the Process
The implementation of the HER will entail handling of a host of medical information across the different medical settings. Imperatively, the incorporation of a broad range of system that will convert information in real-time based on request cannot be overemphasized. The implementation will require documentation system, E-prescribing system, billing and reimbursement system and a system to generate periodical or on-demand reports. The EHR implementation will also require a clinical decision support system that provides support through disease diagnosis, prevention and treatment. The clinical decision support system will also have electronic tools, reminders, and prediction algorithms. The next system would be the health record system containing information collated during clinician-patient encounters and interactions. The fourth component would be telemedicine and telehealth system that will support self-care efforts without unwarranted health risks (Tyllinen et al., 2018). These systems will support the implementation of the HER stored information and ascertain access by only authorized personnel. The E-prescribing system will track prescribed medications and evaluate any drug reactions while the report generation system will allow providers to develop reports based on certain information like medication and procedures.
The EHR team will consist of internal and external stakeholders and consultants. The team will comprise of a project manager, application analyst and developer, a quality assurance (QA) test engineer, an informatics nurse, a physician, a billing advocate and super-users. The project manager will lead the team and be responsible for keeping the project on course to attaining its deliverable. The application analyst will ensure effective data migration while the developer will customize the system to meet facility’s requirements. The QA test engineer will ensure effective testing and performance of the system. The nurse, the physician and billing personnel will represent different cadres of professionals that will be impacted by the new system. These individuals will also advise on training needs and requirements and integration of the system into their respective units or areas of specialization. The super-users will be the initial adopters of the implementation and training programs offered through the project.
The advanced registered nurse has a critical role in promoting use of evidence-base practice and leading quality and performance improvement initiative in clinical settings. In this case, the nurse will advocate for the implementation of the new system with a view of enhancing overall care interactions and decisions by different players. As specialized professional nurse, the registered nurse will be part of the team to offer advice on training needs and customization focused on patient preferences and unique situations. The registered nurse will play the role of a change agent and advocate increased use of electronic health records (EHRs) systems.
ALSO READ: NUR 514 The Evolution of Nursing Informatics Presentation
Strategies to Implement the New EHR proposal
The implementation of the new EHR proposal requires incorporation of effective strategies that include effective communication, the modalities for transitioning to the new system and efficient resource management approaches. Communication of the change and transition plan will require giving information to stakeholders and getting them ready for expected changes in the system. three aspects are important in ensuring effective change in communication. These include involving the relevant stakeholders and ensuring that they have a shared goal and vision about the need for the change and recognize that it is necessary in addressing the issue at hand.
Secondly, there should be effective leadership team that understand the significance of the system changes and its goals so that they can allocate enough and critical resources. The team will have different roles as change agents with a view of incorporating others for effective support in implementing the project. The final aspect in the transition is to ensure that dissatisfaction among stakeholders is tackled effective and they realize the importance of the project (Penrod, 2017). More fundamentally, effective implementation will hinge on effective management of resources, right from human to fiscal and healthcare resources. The team will ensure that its operations and expenditures are within the budget, project scope, and timelines.
Professional, Ethical and Regulatory Standards in Designing and Implementing the System
The EHR proposal implementation will require adherence to professional, ethical and regulatory standards. These include having a complete risk analysis of the system, encryption of electronic health data, and getting HIPAA-compliance approval and business associate agreement. HIPAA and HITECH rules mandate system users and implementers to report any data breach promptly for effective actions and protection of critical individual information. Ethical standards should be integrated by ensuring that patient health data is secured and protected from intrusion. The information includes billing data, processing of claims, diagnostic reports and visit note. The implementation should also consider other ethical issues like integrity, beneficence, justice and patient autonomy (Bani et al., 2020). The implementers of the system should ensure that there is confidentiality and privacy of patient records as required by existing laws.
The implementation should comply with regulatory standards by HIPAA and HITECH and other security laws as outlined in different frameworks at both state and federal levels. The team must ensure that these provisions are met in the software development, design, programming and distribution. The implication is that adherence to existing regulations and ethical and professional standards is essential in validating the use of this project to all stakeholders.
Successful Implementation Measures and Steps
The success of the EHR implementation will be based on staff, setting, and patient perspectives to help in recognizing areas that need improvements. From a staff perspective, the project’s success will depend on the results of surveys and feedback on the effectiveness of the new system. the system technical performance approach will be leveraged on set goals to ascertain if it meets the goals. The approach will compare the implementation cost against planned financial budget t and ascertain if it is efficient and effective. The second aspect would be engagement of staff and patients to get their opinions on the new model (Sherwood, 2020). The approach incorporates different stakeholders, the influence of the new system on their experience and work and evaluation of its performance, and incorporation of their change recommendations.
Leadership Skills and Theories to Facilitate Collaboration in the Inter-Professional Team
Effective leadership is a critical part of ensuring streamlined implementation that would lead to attainment of the project’s goals. A core leadership skill in the project’s performance and implementation will be self-governance and transparency as it will encourage different team players to express their concerns and expectations (Sherwood, 2020). The next leadership skill would need for transformational approach and effective interaction and collaboration with all employees and other stakeholders. The leader, especially the nurse leader, should be a change agent and ensure that all teams work to deliver quality project for better patient outcomes and inter-professional collaboration.
The implementation of the project would also require the leaders to use contingency approaches to leadership so as to address each challenge in the project based on the circumstances and enhance overall performance and delivery of the program. The situational leadership approach will ensure that leaders respect the unique nature of the implementation at each stage (Hannah et al., 2020). Again, the team leader should embrace ethical conduct and motivational approaches based on constant reports and meetings to ensure that the team performs based on set goals and objectives.
Conclusion
The implementation of a new EHR system requires effective strategies, communication and collaboration among the different stakeholders and project manager and the team. While EHR adoption will offer improved benefits to users and practitioners, its implementation requires adherence to different aspects and requirements, right from ethical to professional and regulatory components for all those involved. The paper demonstrates the benefits of the EHR implementation and why all involved should focus on collaboration and team performance to effectively have a new system to meet their needs.
References
Bani, I.W., Al Akour, I., Ibrahim, A., Almarzouqi, A., Abbas, S., Hisham, F., & Griffiths, J.
(2020). Privacy, confidentiality, security and patient safety concerns about electronic health records. International Nursing Review, 67(2):218-230.
doi: 10.1111/inr.12585.
Cresswell, K. M., Bates, D. W. & Sheikh, A. (2017). Ten Key considerations for the successful
optimization of large-scale health information technology. Journal of the American Medical Informatics Association, 24(1): 182-187. https://doi.org/10.1093/jamia/ocw037
Hannah, S. T., Perez, A. L., Lester, P. B., & Quick, J. C. (2020). Bolstering workplace
psychological well-being through transactional and transformational leadership. Journal of Leadership & Organizational Studies, 27(3), 222-240. https://doi.org/10.1177/1548051820933623
McCrorie, C., Benn, J., Johnson, O. A. & Scantlebury, A. (2019). Staff Expectations for the
implementation of an electronic health record system: a qualitative study using normalization process theory. BMC medical informatics and decision making, 19(1):222.
doi: 10.1186/s12911-019-0952-3.
Tyllinen, M., Kaipio, J., & Lääveri, T. (2018). A Framework for Usability Evaluation in
EHR Procurement. In MIE (pp. 446-450). http://dx.doi.org/10.3233/978-1-61499-852-5-446
Penrod, L. E. (2017). Electronic health record transition considerations. PM&R, 9(5), S13-S18.
https://doi.org/10.1016/j.pmrj.2017.01.009
Sherwood, G. (2020). Commentary: Mediating role of the perceived benefits of using a
medication safety system in the relationship between transformational leadership and the medication-error management climate. Journal of Research in Nursing, 25(1), 35-36. https://doi.org/10.1177/1744987118824621
The current health practice has evolved in multiple dimensions, including better clinical systems, increased access, and more emphasis on patient-centered care. As these developments occur, technology has been instrumental in evolving critical patient care dimensions. As a result, nursing informaticists and other healthcare practitioners should embrace innovation and guide their organizations in tracking care improvement opportunities and intervening appropriately. For innovation to succeed, healthcare facilities should have the appropriate culture and resources to support and facilitate change (Sharplin et al., 2019). Advanced practice nurses should also play their role as change leaders effectively. The purpose of this paper is to discuss an opportunity for care improvement and the necessary considerations for implementing a new electronic health record (EHR) system.
An Opportunity for Tracking Care Improvement and Database Information
When visiting healthcare facilities, patients always look forward to a comprehensive analysis of their conditions. However, such care can only be achieved if the facilities have efficient and up-to-date EHR systems and other tools for clinical decision support. Effective EHR systems improve care efficiency and reduce inconveniences occasioned by medical errors (Kehsta & Odeh, 2021). A suitable opportunity for tracking care improvement is a system’s task completion rate. In everyday practice, systems’ inefficiencies hamper care outcomes by causing treatment delays or failing to facilitate quick information sharing between providers. An upgrade of the system’s operating system can produce better results in such instances. The other option is implementing a new EHR system to capture patient data easily, enable quick analysis, and ensure that practitioners can share crucial data in real time.
A database contains essential health information to guide practitioners in decision-making. In clinical settings, a database should allow clinicians to store information in a way that can be accessed and managed easily. Appropriate data updates should also be done conveniently. Key information in the database should be primarily about patients. Such information includes patients’ demographics, problems, and current medications (CMS.gov, 2023). The other crucial information relevant to clinicians and patients includes progress notes and time spent during the care process. Further analysis of the time spent during the care process can indicate whether the new EHR system requires improvements.
Role of Informatics in Data Capturing and Project Management Strategies
Informatics is at the center of healthcare evolution and plays an instrumental role in promoting data-driven care. According to Estiri et al. (2018), informatics allows clinicians to capture information rapidly to facilitate quick decision-making. Through informatics, patient information can also be captured in multiple formats, although organizations must have highly interoperable systems to use such data effectively. The implication is that the clinical setting embracing informatics would benefit from quick information capturing, further improving collation, analysis, storage, and retrieval.
Implementing system changes typifies engaging in a project designed to improve patient outcomes. Essential project management strategies and methodologies include teamwork, planning, design, and implementation. Teamwork is crucial in improving quality in clinical practice since it allows people to share perspectives and address a common issue creatively. Regarding system changes, Aguirre et al. (2019) underlined that EHR implementation could be challenging hence the need for effective planning to minimize errors. The planning phase is broad since it entails assessing the selection criteria of teams and intended system performance, including interoperability and confidentiality. Concerning design, maximum consideration of the infrastructure is crucial to ensure clinicians are provided with a robust system and tools to transform practice (Estiri et al., 2018). Implementation denotes putting the system into use. In the current context, it should be implemented after successful piloting and when users can use it comfortably and effectively.
Systems, Staff Members, and the Role of the Advanced Registered Nurse
System implementation should be a collaborative task. Such an approach is crucial since diverse leaders and healthcare teams have different skills and competencies, which are essential in informed decision-making. In clinical practice, shared perspectives improve decision-making since information can be analyzed and critiqued (Roodbeen et al., 2021). Systems necessary in the design and implementation process include communication and health information technology (IT) systems. Communication systems are crucial for enabling healthy interaction between team members, while IT systems are valuable for data collection, analysis, and other related functions. Staff members include the organization’s management, IT department members, system analysts and designers, nurse leaders, and nurses as the end users. Involving nurses as the end users is vital since they will be interacting with the system regularly. Hence, they should understand its basic features, functionality, and how to use it for optimal patient care.
Successful organizations should be open to change and support innovation. Consequently, they should promote evidence-based practice (EBP) and support quality improvement initiatives. As Sharplin et al. (2019) suggested, EBP thrives in a culture ready for change and in organizations that support and reward innovation. In this setting, advanced registered nurses are mandated to identify opportunities for quality improvement and propose interventions for enhancing outcomes. For instance, advanced practice nurses design education programs to reduce infections and improve health literacy. This implies that they are pivotal in practice transformation and ensuring progressive improvement in healthcare processes and outcomes.
Strategies for Implementing the New EHR Proposal
The new EHR system is expected to improve clinical outcomes and have new features, including design, themes, and layout. As a result, communication about the proposed changes is essential to ensure its targeted users are mentally ready for it. Readiness for change reduces possible resistance hence quick implementation (Sharplin et al., 2019). When everyone is ready, a transition to the new system can occur. Here, clinicians would start using the new EHR system to perform tasks quicker than the previous system. A crucial component of the transitioning process is user education to ensure nurses and other users can use the system competently and confidently. Teamwork should also be encouraged before everyone is conversant with the new system. Change leaders should also monitor nurses’ experience with the new system and intervene in areas where user challenges are witnessed. Doing so would allow leaders to design post-implementation support for the sustainable use of the new EHR system.
Professional, Ethical, and Regulatory Standards
EHRs are the foundation of health information exchange. They facilitate the exchange of protected health information (PHI) hence the need for compliance with the established standards. Professional standards that must be incorporated into the system’s design and implementation include user-centeredness and interoperability. User-centeredness can be achieved by an institutive design that is user-friendly to encourage healthcare professionals to use a system (Micheal et al., 2021). Interoperability entails a system’s capacity to share information among different users. It should also be a priority area since interoperable systems should be convenient and safe to use.
The most crucial ethical standards to consider are security, privacy, and confidentiality. The system should be secure from internal and external attacks that can hamper its efficiency. Effective system security is achieved by implementing appropriate safety measures. A secure EHR system is also able to protect patients’ private information (Kehsta & Odeh, 2021). Confidentiality is achieved by ensuring identifiable health information is inaccessible to unauthorized users. Regarding regulatory standards, the EHR system should adhere to the principles of meaningful use. In this case, all the design considerations should enable healthcare professionals to use the system to improve care outcomes such as quality and safety. For instance, quick information sharing would improve care quality and patient satisfaction due to timely care.
Success Evaluation
EHR system implementation can be tedious and time-consuming. Evaluating outcomes would help to determine whether the desired goals were achieved. From a staff perspective, the EHR system should improve communication and teamwork between clinicians. Effective communication and sustained teamwork are the foundation of interprofessional collaboration (Schot et al., 2020). Other outcome measures include improved efficiency (task completion speed) and patient care characterized by minimal errors and treatment delays. The setting would benefit from teamwork and efficiency to increase its productivity, leading to higher revenue. Efficient systems also enhance job satisfaction, reducing fatigue and other potential causes of staff burnout. From a patient perspective, the system’s success could be evaluated by increased satisfaction, reduced treatment delays, and better patient-provider interaction. The implication is that patient experience would improve, and failure to achieve these goals would necessitate further practice improvements.
Leadership Skills and Theories for Collaboration and Evidence-Based, Patient-Centered Care
An interprofessional team comprises members with diverse skills and roles. Keeping such a team motivated and glued to accomplishing its role is a critical success factor. Leadership skills crucial in facilitating collaboration with the interprofessional team include open communication, dialogue, and respect. It is crucial for all team members to be respected, irrespective of their ranks and roles. Open communication and dialogue encourage sharing information and ensure all perspectives are incorporated in decision-making (Albert et al., 2020). The transformational leadership theory would facilitate collaboration with the team and provide evidence-based, patient-centered care. According to Collins et al. (2020), transformational leadership focuses on empowering and motivating the team by utilizing a leader’s influential attributes and behaviors. In a transformative approach, the leader carries the team’s vision and inspires the team to work together for a shared purpose. A similar approach would be required in the EHR system implementation due to the diverse nature of team members.
Conclusion
Healthcare organizations require efficient systems for the continuous delivery of high patient outcomes. As a result, appropriate system changes should be encouraged to ensure clinical settings benefit from technology and informatics as they strive to optimize patient outcomes. When designing and implementing a new EHR system, nurses and other change leaders should be guided by professional, ethical, and regulatory standards. Adherence to these standards would ensure the system complies with the foundation principles of standard practice. Since system design and implementation require teamwork, transformational leadership should be highly recommended. A transformational approach encourages shared decision-making as the team work together to achieve a shared vision.
References
Aguirre, R. R., Suarez, O., Fuentes, M., & Sanchez-Gonzalez, M. A. (2019). Electronic health record implementation: a review of resources and tools. Cureus, 11(9), e5649. https://doi.org/10.7759/cureus.5649
Albert, N. M., Pappas, S., Porter-O’Grady, T., & Malloch, K. (2020). Quantum leadership: Creating sustainable value in health care. Jones & Bartlett Learning.
CMS.gov. (2023). Electronic health records. https://www.cms.gov/Medicare/E-Health/EHealthRecords#:~:text=An%20Electronic%20Health%20Record%20(EHR,progress%20notes%2C%20problems%2C%20medications%2C
Collins, E., Owen, P., Digan, J., & Dunn, F. (2020). Applying transformational leadership in nursing practice. Nursing Standard (Royal College of Nursing (Great Britain): 1987), 35(5), 59–66. https://doi.org/10.7748/ns.2019.e11408
Estiri, H., Patel, C. J., & Murphy, S. N. (2018). Informatics can help providers incorporate context into care. Jamia Open, 1(1), 3-6. https://doi.org/10.1093/jamiaopen/ooy025
Keshta, I., & Odeh, A. (2021). Security and privacy of electronic health records: Concerns and challenges. Egyptian Informatics Journal, 22(2), 177-183. https://doi.org/10.1016/j.eij.2020.07.003
Michael, C. L., Mittelstaedt, H., Chen, Y., Desai, A. V., & Kuperman, G. J. (2021). Applying user-centered design in the electronic health record (EHR) to facilitate patient-centered care in oncology. AMIA … Annual Symposium Proceedings. AMIA Symposium, 2020, 833–839. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8075506/
Schot, E., Tummers, L., & Noordegraaf, M. (2020). Working on working together. A systematic review on how healthcare professionals contribute to interprofessional collaboration. Journal of Interprofessional Care, 34(3), 332-342.
Roodbeen, R. T. J., Noordman, J., Boland, G., & van Dulmen, S. (2021). Shared decision making in practice and the perspectives of health care professionals on video-recorded consultations with patients with low health literacy in the palliative phase of their disease. MDM Policy & Practice, 6(1), 23814683211023472. https://doi.org/10.1177/23814683211023472
Sharplin, G., Adelson, P., Kennedy, K., Williams, N., Hewlett, R., Wood, J., Bonner, R., Dabars, E., & Eckert, M. (2019). Establishing and sustaining a culture of evidence-based practice: an evaluation of barriers and facilitators to implementing the best practice spotlight organization program in the Australian healthcare context. Healthcare (Basel, Switzerland), 7(4), 142. https://doi.org/10.3390/healthcare7040142