NURS 8210 Differentiate the information needs within your organization

Sample Answer 2 for NURS 8210 Differentiate the information needs within your organization

Thank you for your inquiry. CPOE (Computerized Provider Order Entry) uses the EHR/computer support to process and enter the

orders from physicians. They were initially developed to improve prescribing and enhance patient safety (Abraham et al., 2018). They are, however, used in modern systems to order tests, consultations, and procedures. In the facility, clinical decision support is also integrated into the EHR and serves error prevention. Physicians can confirm the proper doses, frequency, and route of administration of medications. Some features prompt providers for patient allergies, drug interactions, etc. The prompt alerts the providers to follow clinical guideline recommendations in patient assessments, lab requests, and prescription medicine. There is evidence of the efficacy of CPOE in error reduction particularly, medication errors.

CPOE uses hard stops and error prevention functions which limit the provider’s intended action. These hard stops delay clinical treatment. High-profile failures, safety hazards, and other unintended consequences of CPOE disrupt clinical workflow (McGraw Caren, 2021). CPOE implementation disrupts the clinical workflow and may lead to the abandonment of the system. For instance, the clinician is required to perform several tasks, which decreases efficiency due to increases in cognitive load. This can disrupt the clinical workflow and limit evidence-based practice that hinges on the provider’s clinical expertise. Nurses and other providers may have to bypass the safety features and rely on adaptations to navigate these limitations provided by the CPOE commands.

In summary, the challenges of CPOE implementation include confusing displays, lack of standardized warnings and alerts, unfavorable workflow issues, unfavorable changes in communication patterns/practices, overdependence on the technology, never-ending system demands, negative feelings toward the new technology, more or new work for clinicians and new types of errors (Kebede, S. (2016). Integration of CPOE requires careful planning, real-world usability testing, and integration within the CDSS. Maximizing safety and tailoring the system to real-world clinical workflow will achieve a good balance.

References

Abraham, J., Kannampallil, T. G., Jarman, A., Sharma, S., Rash, C., Schiff, G., & Galanter, W. (2018). Reasons for computerized provider order entry (CPOE)-based inpatient medication ordering errors: An observational study of voided orders. BMJ Quality & Safety, 27(4), 299-307.

Kebede, S. (2016). Challenges associated with the use of Computerized Physician Order Entry (CPOE): A physician’s perspective. Journal of Health & Medical Informatics, 7(3), 63. http://dx.doi.org/10.4172/2157-7420.C1.010

McGraw, C. (2021, September). Computerized Provider Order Entry (CPOE) System. Prognocis EHR. https://prognocis.com/cpoe-system/

Sample Answer 3 for NURS 8210 Differentiate the information needs within your organization

Differing Information Needs and The Impact on the Organization The healthcare system includes six hospitals and multiple physician practice organizations. EPIC is used by physicians, nursing therapy, etc. for inpatient and EPIC Ambulatory for outpatient and physician practice. The laboratory uses a system called SoftLab and radiation oncology uses Aria. For each of these systems to share patient data, an HL7 interface passes the information between the systems. Health Level Seven International (HL7) is the standard used to map data fields between systems and allow for the communication of the data (Nursing Informatics: Scope and standards of practice, 2015). The EHR has been configured with evidence-based order sets and documentation templates to guide patient care. In February 2016, an international task force was convened to define sepsis and septic shock (Singer, Deutschman, Seymour, & et al., 2016). Which is impacting several areas of the healthcare system technology, including the EBP order sets and the 3M 360 application.

Information Flow Across HIT and Evidence-Based Practice

Interfaces have been developed across 3M 360 and EPIC, but they are not complete. For example, all documentation from EPIC is interfaced into 3M 360 to all the clinical documentation improvement (CDI) nurse to review the record for completeness of the documentation to support the diagnosis and to meet quality measures. The CDI nurse if they find a lack of documentation or need for clarification, for example sepsis as a diagnosis, the nurse creates a query in EPIC. Because there is no interface for query information, the nurse must copy and paste the information back into 3M 360 for tracking. 3M 360 is supported by multiple EBP references by mapping information through Natural Language Processing (NLP) and through buttons. For example, the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) is built into the system. The NLP will suggest diagnoses or needs to query based on the documentation from EPIC and if it meets certain EBP data within the documentation. EPIC and 3M 360 have the old definitions of sepsis and the EBP built into the systems to document and care for patients with sepsis. The issue now, is that the EBP has changed with SEPSIS 3 to include organ dysfunction based on Sequential [Sepsis-Related] Organ Failure Assessment Score (SOFA) (Singer et al., 2016). Recommendations to use codes R65.20 and R65.21 have also been made on the ICD-CM-10 codes to use, because the current codes do not match the new definitions (Singer et al., 2016). Even when a healthcare organization is trying to support EBP within HIT, when changes are made to the EBP it has clinical and billing impacts on the organization.:

References

Hanson, D. (2011). Evidence-Based clinical decision support. In M. J. Ball, J. V. Douglas, & P. H. Walker (Eds.),

Nursing informatics: Where technology and caring meet (Fourth ed., pp. 243-258). London New York:

Springer. Nursing Informatics: Scope and standards of practice. (2015). (Second ed.). Silver Spring,

MD: American Nursing Association.

Piedmont Now. (2016). Retrieved from http://www.piedmont.org/patienttools/piedmont-now

Singer, M., Deutschman, C. S., Seymour, C., & et al. (2016). THe third international consensus definitions

for sepsis and septic shock (sepsis-3). JAMA, 315(8), 801-810. doi:10.1001/jama.2016.0287

Sample Answer 4 for NURS 8210 Differentiate the information needs within your organization

Each area of practice lends itself to some common information requirements which can be utilized amongst health care professionals, but there are also areas such as administration that has differing information needs. While watching the VA video, the discussion around the Vista CPRS fully integrated system looked very extensive. They incorporated concepts that were derived from Blum’s and later Graves and Corcoran, which include data (objective), information (subjectively reviewed), and knowledge (formally completed content) (ANA, 2014). Although the Vista CPRS has a bountiful amount of content to support best practice, there are other areas of health needs that are specific and therefore require a unique set of system requirements. In the video, we see that a system was implemented that focused on the needs of the veterans to allow them prescription refills and other personal health needs (United Stats department of Veterans Affairs, 2011).  In our area we have three major hospitals networks.  The difficulty is that each of these networks have chosen different interfaces as their HIT systems.  So a patient can go to two different hospitals in the same day and there is no communication or dialogue around the patients needs.  This can become a dangerous situation if this patient was prescribed narcotics from two different health care prescriber and was planning on taking these together.  In the hospital network I worked in, we used meditech as our HIT.  This HIT system supports some evidence based practice and is great from a lab testing and sharing of patients personal data such as medical history, specific medical orders currently active and previous tests and diagnostics.  Where we see it lacking is in the knowledge section.  We are using another format of HIT for continuing education, looking up medication knowledge and skills. We would like to click on a patients prescribed medication and then that drug be linked to knowledge that would be applicable to the understanding and administration of it.  We now must leave meditech and go into another application for this knowledge. Overall the needs of HIT continue to grow as our knowledge is being transmitted faster than ever before, and our patients’ health complexities also increase with an ageing population. Preparing for current and future trends such as seeing more integration between electronic health records, improved research, artificial intelligence (AI) and the use of robotics will be facilitated by partnerships and education amongst private and public institutions to develop an advancing approach to HIT (Sheikh et al., 2021).

References

ANA. (2014). Nursing Informatics (2nd Edition). American Nurses

Association. https://mbsdirect.vitalsource.com/books/9781558105812

Sheikh, A., Anderson, M., Albala, S., Casadei, B., Franklin, B. D., Richards, M., Taylor, D.,

Tibble, H., & Mossialos, E. (2021). Health information technology and digital innovation for national learning health and care systems. The Lancet. Digital Health, 3(6), e383–e396. https://doi-org.ezp.waldenulibrary.org/10.1016/S2589-7500(21)00005-4

United States Department of Veterans Affairs. (Producer). (2011). Innovation in VA, the Story

of VistA [Video]. Washington, DC: Author.