NUR 514 Benchmark – Electronic Health Record Implementation Paper

One way informatics can be especially valuable is in capturing data to inspire improvements and quality change in practice. The Agency for Healthcare Research and Quality (AHRQ) collects data related to adverse events and safety concerns. If you are working within a practice setting to implement a new electronic health record (EHR) system, this is just one of the many considerations your team would need to plan for during the rollout process (NUR 514 Benchmark – Electronic Health Record Implementation Paper)

In a paper of 1,500-1,750 words, discuss the following:

1. Consider an opportunity for tracking care improvement. What key information would be needed in the database? Example: Time lapse from medication order documented in the EHR to delivery of medication to the patient for the cardiology service.
2. Describe the role informatics plays in the ability to capture this data. What type of project management strategies and methodologies can be implemented to support informatics initiatives to help improve quality within the clinical practice?
3. Discuss which systems and staff members would need to be involved in the design and implementation process. What is the role of the advanced registered nurse in promoting evidence-based practice and leading quality and performance improvement initiatives within this setting?
4. Outline strategies for implementing the new EHR proposal. Consider communication changes, transitioning to the new EHR, and managing resources (human, fiscal, and health care resources). (NUR 514 Benchmark – Electronic Health Record Implementation Paper)
5. Discuss what professional, ethical, and regulatory standards must be incorporated into the design and implementation of the system. (NUR 514 Benchmark – Electronic Health Record Implementation Paper)
6. Describe the measures and steps you would take to evaluate the success of the EHR implementation from a staff, setting, and patient perspective to measure effectiveness and ensure continuous quality improvement in practice?
7. Explain what leadership skills and theories would be needed to facilitate collaboration with the interprofessional team and provide evidence-based, patient-centered care? (NUR 514 Benchmark – Electronic Health Record Implementation Paper)

You are required to cite five to 10 sources to complete this assignment. (NUR 514 Benchmark – Electronic Health Record Implementation Paper) Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content. (NUR 514 Benchmark – Electronic Health Record Implementation Paper)

Electronic Health Record Implementation Paper-Solution

A crucial facet of health care transformation is the need to transform healthcare systems into a unified system that supports interprofessionalism and the interrelationships of Informatics and Information systems. EHR improves healthcare by aiding diseases diagnosis, preventing and reducing medical errors to enhance patient safety and support better outcomes. This paper discusses the role of EHR in care improvement, data capture, stakeholders in design and implementation of EHR, strategies for implementing EHR, professional, ethical, and regulatory standards incorporate in EHR design and implementation, measures and steps of evaluating EHR success,  and the leadership skills and theories that can facilitate collaboration between interprofessional teams. (NUR 514 Benchmark – Electronic Health Record Implementation Paper)

EHR provides an opportunity for clinical teams to track care improvement in a clinical setting. Traditionally, patient care is a nurse’s responsibility since the two spend significant time together, from admission to post-discharge. In this case, nurses need event-log and clinical datasets within EHR databases to facilitate effective care delivery.  As different nurses interact with the EHR systems, granular interactions are recorded (event log data), enlisting nurses’ activities to use the EHR systems (Adler-Milstein et al., 2020). Together with clinical data, event log data offer novel insights to support quality improvement initiatives in a clinical setting. Besides, EHR data can enhance nurses’ work-life by reducing factors that increase the burden and burnout associated with EHR use. (NUR 514 Benchmark – Electronic Health Record Implementation Paper)

Traditional clinical data include content related to the patient’s medical records, such as clinical state, care decisions, and clinical notes. Nurses often peruse these data as recorded by other practitioners to gain insight into the patients’ present state and medical history and medications and orders to ensure they offer consistent care (Aspevig & Singletary, 2020). Equally, even log data provides comprehensive information that offers the opportunity for a detailed evaluation of healthcare, focusing on consumption and creation of clinical information. Informatics facilitates electronic health records, diagnostics, and treatment plans that facilitate effective and efficient care delivery through data capture. Consequently, nurses interact with the medical team for additional insight on the patient’s care trajectory based on the event log and clinical data.

Organizational support is vital in promoting informatics initiatives. Organizational leadership should assess multiple aspects of communication within and outside the EHR system, its integration with other technologies within the institution, clinical teams, processes, and culture. Consequently, communication and collaboration enhancement capability creates a platform that eases healthcare workflow management, improved coordination, and enhances patient outcomes (Lee, 2014). Moreover, there is a need to document clinical records to facilitate efficient monitoring of patients’ clinical status and access to clinical data. Through the systemized arrangement, nurses can apply available knowledge to establish an appropriate plan of action. (NUR 514 Benchmark – Electronic Health Record Implementation Paper)

Another strategy to improve the use of health informatics is by involving database analysts. Patient data analysis from EHR tends to be complex, yet analysts can provide more insights on the collated data. Moreover, standardizing nursing language can encourage acceptance of adopted EHR systems (Lee, 2014). Using nursing notes can help nurses with their workload, reminding them of crucial information to be documented or applied for patient care. (NUR 514 Benchmark – Electronic Health Record Implementation Paper)

The systems involved in the design and implementation of EHR include communication and administrative systems. Communication systems are involved in patient care collaboration, patient referrals, scripts issuance, accessing lab results, and payment processing. Communication systems also facilitate the establishment of appointment reminders and include telemedicine solutions. Administrative systems include support frameworks for managing nonclinical activities, client information, financial and demographic data, and reporting capabilities. Therefore, communication and administrative systems must be integrated into the HER to facilitate its effectiveness. (NUR 514 Benchmark – Electronic Health Record Implementation Paper)

Staff members involved in EHR design and implementation include team lead, implementation manager, nurse lead, physician, IT lead, Medical assistant, and laboratory staff lead. Other members of the design and implementation include billing, registration, and training lead. Significantly, nurses play a crucial role in EHR implementation since they work with IT professionals in integrating the technology with patient care to transform data into practice evidence-based practice knowledge (Daly, 2015). In this regard, APRNs assume responsibility and accountability for applying the EHR system in health promotion, assessment, diagnosis, and management of patients. (NUR 514 Benchmark – Electronic Health Record Implementation Paper)

EHR proposal implementation strategies involve a stepwise consideration of needs, adoption, system testing, education, implementation, ongoing maintenance, and optimization. First, it is vital to communicate the logic for EHR adoption, explaining to the clinical staff the benefits for each team member and improved quality of care for the patients (Aguirre et al., 2019). Equally, the team lead should communicate results by establishing a plan to measure the success of the EHR system. Such communication should be frequent at pre-defined intervals. Finally, always communicate to staff about the different phases throughout the adoption path of EHR implementation. (NUR 514 Benchmark – Electronic Health Record Implementation Paper)

Before transitioning to the new EHR system, testing is necessary to ensure that every system crucial to its implementation is put in place. This will ensure that the EHR system is appropriately integrated and synchronized to allow users to collect, process, and store clinical data (Aguirre et al., 2019). Moreover, testing ensures that the EHR system interface is working as intended, workflows adjusted appropriately, and current system security features are effective. Therefore, it is vital to ruminate each of these steps to safeguard an uneven transition from the traditional data collection to the EHR system and ensure staff is well acquainted with its application. (NUR 514 Benchmark – Electronic Health Record Implementation Paper)

Following the implementation, the institution management should consider training employees, optimizing, and maintaining the EHR system. This involves managing resources to ensure that users are well trained on effective and efficient use of the EHR system (Aguirre et al., 2019). In addition, factors such as unprecedented failure of the EHR system or power failure must be considered to facilitate the establishment of a recovery plan to ensure continuity of services. Finally, a training and assessment plan for users’ skills should be established to facilitate a successful EHR adoption. (NUR 514 Benchmark – Electronic Health Record Implementation Paper)

The professional, ethical, and regulatory issues that must be considered when adopting an EHR system include privacy and confidentiality of patient data, security concerns, data inaccuracies, and system implementation. Clinical data that pertains to patient treatment should not be shared without a patient’s consent or legal compulsion (Ozair, Jamshed, Sharma, & Aggarwal, 2015.). Therefore, security measures should be adopted, including robust privacy and confidentiality policies to secure patient information from access. (NUR 514 Benchmark – Electronic Health Record Implementation Paper)

Furthermore,  security breaches from hackers threaten the privacy of patient data stored in EHR systems. Hackers often make available patient data without authorization or consent. Therefore, certain policies and procedures need to be put in place to maintain the privacy and confidentiality of patient data (Ozair et al., 2015). For instance, users of the EHR system should be compelled not to share their IDs with anyone. Besides, installing security measures such as intrusion detection, antivirus software, and firewalls can help boost data integrity. Moreover, installing security officers designated to assist the IT experts and conducting routine audits can ensure compliance with regulations and policies that protect data integrity. (NUR 514 Benchmark – Electronic Health Record Implementation Paper)

Inaccurate data entry also compromises its accuracy and reliability, limiting its ability to improve patient safety. Because of the challenges faced in EHR implementation, organizations should provide adequate funds and involvement of employees to avoid wastage of resources, negative attitudes, and patient safety concerns (Ozair et al., 2015). Other inherent features such as cut and paste and the drop-down menu also contribute to inaccurate data representation, risking patient lives and clinician liability (Ozair et al., 2015). In this sense, EHR experts and experienced clinicians should train other clinicians to understand their contribution to EHR implementation and quality improvement and prevent software problems. (NUR 514 Benchmark – Electronic Health Record Implementation Paper)

Evaluating the EHR system is centered on its reliability, performance, interoperability, standards, usability, usefulness, and customizability. Therefore, I would first determine whether the vendor of the EHR system incorporated the institutional needs (McBride & Tietze, 2016). Then, I would consider aspects such as throughput, operations, and synchronization. These aspects are crucial for effective EHR function. In this regard, I would collect information related to quality improvements, such as the EHR system integration with the existing culture, employees’ competence with the system, and the level of migration of different departments and partners to the new EHR system. (NUR 514 Benchmark – Electronic Health Record Implementation Paper)

Additionally, I would determine whether the EHR network and infrastructure are appropriate, whether the EHR captures the required data elements, and whether there are unanticipated consequences (McBride & Tietze, 2016). I would also evaluate bottlenecks, downtimes, reliability of technology tools, and security incidences of patient data. Furthermore, I would establish a communication plan to ensure employees understand the EHR system (McBride & Tietze, 2016). Consequently, providing employee provider training, change control, and revies would contribute to continuous quality improvement. (NUR 514 Benchmark – Electronic Health Record Implementation Paper)

Appropriate leadership skills are necessary for a successful EHR system implementation. The leadership must have a working knowledge of technology, prioritize quality and safety and cope with changes in a clinical setting. These skills would allow the leadership to establish training opportunities and support frameworks for nurses with limited knowledge of EHR system operation and data analysis. Besides, the leadership will foster multidisciplinary relationships to facilitate appropriate and accurate clinical data and information sharing. This would allow the nursing team to synthesize and share evidence-based information to inform safety practices. (NUR 514 Benchmark – Electronic Health Record Implementation Paper)

Lewin’s theory of change could be vital in implementing the EHR attributed changes.  Lewin’s theory facilitates behavioral changes, particularly among employees and institutional factors limiting a proposed change (Mitchell, 2013). The theory would alter exiting behavior (unfreezing phase), guide initiation of changes (movement phase), and establishing equilibrium between employee behavior with the adopted EHR system (refreezing). Therefore, Lewin’s theory can play a significant role in adopting, evaluating, and maintaining the EHR system. (NUR 514 Benchmark – Electronic Health Record Implementation Paper)

References

Adler-Milstein, J., Adelman, J. S., Tai-Seale, M., Patel, V. L., & Dymek, C. (2020). EHR audit logs: a new goldmine for health services research?. Journal of biomedical informatics, 101, 103343. https://doi.org/10.1016/j.jbi.2019.103343

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). https://dx.doi.org/10.7759%2Fcureus.5649

Aspevig, J., & Singletary, V. (2020). Project Management and Public Health Informatics. In Public Health Informatics and Information Systems (pp. 221-236). Springer, Cham. https://doi.org/10.1007/978-1-4471-4237-9_12

Daly, P. (2015). Clinical nurses lead the charge with EHR. Nursing2020, 45(10), 25-26. https://doi.org/10.1097/01.nurse.0000471426.47075.d2

Lee, A. (2014). The role of informatics in nursing. Nursing Made Incredibly Easy, 12(4), 55. 10.1097/01.NME.0000450294.60987.00

McBride, S., & Tietze, M. (2016). Nursing informatics for the advanced practice Nurse. Patient Safety, Quality, Outcomes, and Inter professionalism, 2015. McBride, S., & Tietze, M. (2016). Nursing informatics for the advanced practice Nurse. Patient Safety, Quality, Outcomes, and Inter professionalism, 2015.

Mitchell, G. (2013). Selecting the best theory to implement planned change. Nursing Management, 20(1), 32-37.

Ozair, F. F., Jamshed, N., Sharma, A., & Aggarwal, P. (2015). Ethical issues in electronic health records: A general overview. Perspectives in clinical research, 6(2), 73. https://dx.doi.org/10.4103%2F2229-3485.153997

Rouleau, G., Gagnon, M. P., Côté, J., Payne-Gagnon, J., Hudson, E., & Dubois, C. A. (2017). Impact of information and communication technologies on nursing care: results of an overview of systematic reviews. Journal of Medical Internet Research, 19(4), e122. https://doi.org/10.2196/jmir.6686