NURS 8210 Week 4 HIT Projects and Decision Makers ANSWER

                Within the past 4 years, the organization the writer is employed with has undergone many technology changes. These include implementation of an upgraded EMR platform, Meditech, which provided the ability of electronic documentation for staff. With the upgrade of the EMR platform, it was necessary to upgrade technology and install additional computers to ensure nurses and other registered staff had the ability to document at the bedside. The additional computers also included an upgrade to swipe access for staff to enter their individual EMR platform. This access provides a sense of security and privacy within the organization. With health information technology privacy, confidentiality, and security is a standard which is necessary to meet and uphold (College of Nurses of Ontario, 2019). Thus, the organization was able to identify the need and justify the rationale for this improvement.

Prior to implementation, privacy would be met by completing randomized audits of nurse’s access to ensure they were entering only their assigned patients. Furthermore, multiple reminders were posted for staff to ensure they logged off their computer when they left the nursing station. These reminders and prompting provided by management were minimally effective. With the option to move towards a secure platform, staff were involved and questioned whether they would engage in this change (American Nurses Association, 2015). The project team consisted of a project manager, programmers, and other staff from the information technology (IT) department (Philip et al., 2010). Unit staff were also involved within this initiative and were prompted to provide input on where computers should be installed based upon what would be most beneficial. With change, comes resistance, staff were provided with the benefits of the

NURS 8210 Week 4 HIT Projects and Decision Makers ANSWER

swipe access which included a time-out feature that automatically signed out a nurse when they were away from the compute. It is important to involve and engage staff with change so that they are positive during rollout as identified in American Nurses Association (2015).

References

American Nurses Association. (2008). Nursing informatics: Scope and standards of practice.

Silver Spring, MD: Author.

College of Nurses of Ontario. (2019). Confidentiality and Privacy – Personal Health Information.

Retrieved from https://www.cno.org/globalassets/docs/prac/41069_privacy.pdf

Philip, A., Afolabi, B., Adeniran, O., Oluwatolani, O., & Ishaya, G. (2010). Towards an efficient

information systems development process and management: A review of challenges and

proposed strategies. Journal of Software Engineering and Applications, 3(10), 983-989.

In order to have more affordable and quality healthcare, disruptive innovations need to take place.  It involves using technologies to become more efficient (Townsend, 2013).  For healthcare systems to implement new health information technology (HIT) the use of the systems development life cycle is used.  The system development life cycle includes five stages, planning, design, implementation, maintenance, and evaluation (Laureate Education, 2011).

The healthcare system had five regional cancer centers all using the same electronic health record (EHR).  The system had been implemented in 2005, and had undergone two upgrades to the system. The maintenance phase in the system development life cycle includes be aware of the new business needs, and refining the system to meet those needs (Dennis, Wixom, & Roth, 2012).  The physicians were proficient in CPOE and all orders were entered electronically.  The cancer center had an outpatient clinic, surgery, infusion center, and inpatient settings all using the EHR. Patients moved between levels of care frequently between levels of care, and the need became apparent that electronic reconciliation of medications needed to be implemented.  In the Institute of Medicine’s Report, To Err is Human, recommendations were made for organizations to use CPOE, bar code medication administration and medication reconciliation to increase patient safety and reduce medication errors (To Err Is Human: Building a Safer Health System, 2000).  The healthcare system had also implemented bar coded medication administration, but had never moved on to medication reconciliation using the EHR.  The project was identified by the physicians within the cancer center. Patient due to their changes of condition were moving from the outpatient to inpatient units.  The manual reconciliation for a patient at discharge from inpatient status was taking a physician at least two hours and mistakes were being made due to the manual process. I was director of clinical informatics for the hospital, and the chief hospitalist brought it to my attention.  Together we coordinated a meeting with the chief hospitalists and informatics directors at the other four hospitals to gain consensus.  The group created an enhancement request to take to the governance committee for information systems. The request was initially denied due to other projects currently prioritized.

In this situation, the physician and nursing leaders brought the new business need to the information systems (IS) department were willing to support the HIT project, but the IS department felt there was a shortage of resources to implement the medication reconciliation project (Szydlowski & Smith, 2009).  To make change in an environment it is necessary to have support of by stakeholders who can influence the project outcome.  It can be done through formal influence such at the executive team, and by informal influence of key stakeholders who may have influence conferred by their peers (Coplan & Masuda, 2011).  The physicians supported their chief hospitalist and as a part of the medical leadership committee voted for the implementation of medication reconciliation.  The chief hospitalist, the chief medical officer, and the chief surgeon aligned with the directors of clinical informatics to address the executive team at each hospital.  Statistics had been gathered to show the waste of physician hours to manually reconcile the medications and the potential safety errors.  The chief operating officer at each hospital sits on the IS governance board.  Each hospital executive team agreed and voted that the medication reconciliation module needed to be the top priority for the organization, and trumped other projects.  There was a meeting of the IS governance committee the next month, and the medication reconciliation was prioritized to be the next implementation. It then took six months to go through the system development life cycle to get to the go-love of the HIT.

Before implementing new HIT, the need for the new technology must be recognized.  HIT that is in the maintenance phase should be evaluated to see if there are new business needs and is it meeting those needs (Laureate Education, 2011).  The hospitalist recognized they were not using the HIT efficiently, when the patients were moving to different levels of care.  And in this instance, it was the influence and perseverance of the key stakeholders, the physicians, that impacted the implementation of the medication reconciliation module.

References

Coplan, S., & Masuda, D. (2011). Change mangement Project management for healthcare information technology (pp. 193-237). New York, NY: McGrawHill Companies.

Dennis, A., Wixom, B. H., & Roth, R. M. (2012). Transition to the new system Systems Analysis & Design (5th ed., pp. 471-501). Hoboken, NJ: John Wiley& Sons, Inc.

Laureate Education, I. (Producer). (2011). Transforming nursing and healthcare through technology: Systems analysis.

Szydlowski, S., & Smith, C. (2009). Perspectives From Nurse Leaders and Chief Information Officers on Health Information Technology Implementation.Hospital Topics, 87(1), 3-9. doi:10.3200/HTPS.87.1.3-9

To Err Is Human: Building a Safer Health System. (2000). Washington, DC: The National Academies Press.

Townsend, J. C. (2013). Disruptive innovation: A prescription for better healthcare. Forbes, 5. Retrieved from Forbes website: http://www.forbes.com/