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 2 for NURS 8210 Information Architecture
This is insightful. Health information system is an important resource in the healthcare system. With the increase in the demand for quality healthcare services, health information system has been used in the various department to enhance the quality of healthcare services delivered to patients. Both EPIC and EPIC Ambulatory are examples of technological products that can be applied to enhance the quality of healthcare delivery systems (Brundage et al., 2019). SoftLab and Aria are technologies commonly applied in healthcare systems to facilitate the quality of diagnosis and direct the treatment processes. SoftLab is often applied in the provision of quantifiable improvements in workflow efficiencies and clinical outcomes. The system was mainly developed after a careful analysis of some of the problems associated with the delivery of healthcare systems. SoftLab enables clients to achieve high productivity with full multisite consolidation, specimen tracking, as well as management reporting. Both SoftLab and Aria can be used together with the EHR systems to enhance the management of information and measure patient outcomes (Johnson & Ehrenfeld, 2018).
The EHR system is always applied in capturing and managing patient information and facilitating the development of other technological systems such as SoftLab and Aria (Hellems et al., 2021). In my organization, there is always the use of telehealth to enhance communication and the management of digital information. Telehealth often involves a network of computers and mobile devices. These devices can be used by patients to access healthcare services from remote locations. The devices should be carefully configured to reduce technology breaches and enhance efficiency in healthcare delivery processes. The development of technologies to be applied in the healthcare processes all depends on the data that have been collected in the course of healthcare processes; this explains the importance of EHR systems.
References
Brundage, M. D., Barbera, L., McCallum, F., & Howell, D. M. (2019). A pilot evaluation of the expanded prostate cancer index composite for clinical practice (EPIC-CP) tool in Ontario. Quality of Life Research, 28(3), 771-782. https://link.springer.com/article/10.1007/s11136-018-2034-x
Hellems, M. A. (2021). Ambulatory physicians’ electronic health record self-efficacy. JAMIA Open. https://academic.oup.com/jamiaopen/article/4/3/ooaa071/6062732?login=true
Johnson, K. B., & Ehrenfeld, J. M. (2018). An EPIC switch: preparing for an electronic health record transition at Vanderbilt University Medical Center. Journal of medical systems, 42(1), 6. https://link.springer.com/article/10.1007%2Fs10916-017-0865-6
Sample Answer 3 for NURS 8210 Information Architecture
Health information systems (HIS) facilitate patient safety in the organization through improved communication between health care professionals, improved tracking and reporting, quality care through clinical decision support systems, and improved medication safety (Ball et al., 2011). At my organization, the HIT system collects data for QI, outcome reporting, and surveillance purposes.
Information Workflow
When the patient enters the facility, the patient details are captured through the patient registration point. The next step in the flow of information is the triage nurse, who inputs the patient history and patient values into the Electronic Health Records (EHR). Next, providers record the patient’s diagnosis, notes, medications, and care plans. The data on medicines flow towards the laboratory and scans for evaluation of diagnostic tests. Afterward, the provider has a chance to integrate changes to care plans based on lab data. The information then flows to the pharmacy department as the patient awaits medications. The information flow represents a multidisciplinary facility. The communication between providers is collaborative and efficient, and gears towards patient-centered care (El-Said & El-Sol, 2018). Information continuity is a feature in the Women’s hospital, and the flow is efficient and contributes to quality care.
HIT Systems and Evidence-Based Practice
The health information system facilitates evidence-based practice through data collection to assess the efficacy of interventions and clinical decision support systems and alerts that optimize best practices. There is record uniformity to reduce variations in care. The HIS can also be utilized for a QI audit to assess compliance with (Evidence Based Practice) EBP. Patients can access medical records and are empowered to take an active role in managing their conditions. HIS can facilitate diagnostic tests and follow-ups for appointments/consultations. However, computerized order entry compromises EBP despite its benefits of decreased processing time and lower risk for adverse events. Clinical expertise is an integral domain of EBP, and automated entry disrupts workflow with incompatibilities that prevent full assessment of the patient’s needs (Oach & Watter, 2016). Improvements in design and integration between platforms and robust interoperability will facilitate evidence-based care. However, the exchange of data across all settings and providers within the organization improves safety.
References
Ball, M. J., Douglas, J. V., Hinton Walker, P., DuLong, D., Gugerty, B., Hannah, K. J., & Troseth, M. R. (Eds.) (2011). Nursing informatics: Where technology and caring meet (4th ed.). London, England: Springer-Verlag.
El-Said, A., & El-Sol, H. (2018). Technology into nursing practices: Enhance patient’s outcomes. Mansoura Nursing Journal, 5(1), 191-195. https://dx.doi.org/10.21608/mnj.2018.150637
Oach, P., & Watter, A. (2016). Health information management: Concepts, principles, and practice (Fifth ed.). Chicago: AHIMA.
Sample Answer 4 for NURS 8210 Information Architecture
This is insightful, the application of technology in the healthcare system is critical in enhancing patient safety and facilitating workflow. Health information system has been widely used in various healthcare institutions to facilitate the delivery of quality care through the improvement of approaches and general healthcare delivery systems (El-Said & El-Sol, 2018). With the health information systems, organizations have been able to improve communication among the healthcare professional and the entire organizational stakeholders. Communication in the healthcare system is key to success in the diagnosis and treatments. Through the health information systems, it is easier to achieve or improve clinical decision support systems.
The EHR system is one of the technologies used in most healthcare systems to manage patients’ information and generally enhance the quality of healthcare services delivered to patients. With EHR systems, it is easier to develop workflows that can be used to guide healthcare professionals in achieving the best treatment outcomes. The EHR system should be integrated with other systems to ensure a continuous flow of information and data management (Johnson & Ehrenfeld, 2018). Today, quality improvement processes are always based on the healthcare data that have been collected over time through the EHR system and other technological systems.
In my healthcare organization, the health information system facilitates evidence-based practice through data collection to assess the efficacy of interventions and clinical decision support systems and alerts that optimize best practices. Besides, the health information system has been used to develop different technologies such as telemedicine to enhance communication between patients and healthcare providers (Hossain et al., 2019). Telemedicine has been widely used to provide remote healthcare services to patients from different locations. Also, the system has been applied in delivering evidence-based practices.
References
El-Said, A., & El-Sol, H. (2018). Technology into nursing practices: Enhance patient’s outcomes. Mansoura Nursing Journal, 5(1), 191-195. https://dx.doi.org/10.21608/mnj.2018.150637
Hossain, A., Quaresma, R., & Rahman, H. (2019). Investigating factors influencing the physicians’ adoption of electronic health record (EHR) in healthcare system of Bangladesh: An empirical study. International Journal of Information Management, 44, 76-87. https://www.sciencedirect.com/science/article/abs/pii/S0268401218304432
Johnson, K. B., & Ehrenfeld, J. M. (2018). An EPIC switch: preparing for an electronic health record transition at Vanderbilt University Medical Center. Journal of medical systems, 42(1), 6. https://link.springer.com/article/10.1007%2Fs10916-017-0865-6
Sample Answer 5 for NURS 8210 Information Architecture
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.
