Advanced Nursing Informatics Information Management and the Application of Technology – C791

The impact of Health Information Systems (HIS) in the healthcare sector in the 21st century is one that has had a significant impact on healthcare outcomes. Undoubtedly, advancement in healthcare information technology has led to improved care delivery, access to healthcare services, and safety of patient information. Health information technology represents systems that are capable of recording, analyzing, and sharing patient health data to provide better care for patients. The use of these systems has demonstrated improved quality of patient care by decreasing medication errors and strengthening interaction between patients and providers. The increasing competition in the healthcare industry has seen organizations adopt different health information systems to improve service delivery. As much as these systems continue to dominate, there are various challenges like issues with data security that are experienced. The focus of this paper is on the implementation of HIS in an organization and discussion of major issues surrounding the adoption of the systems in healthcare.

Advantages and Disadvantages of a HIS

Health Information Systems (HIS) are complex and dynamic. It is essential to understand the advantages and disadvantages of some of the critical components of a HIS. Investigating the strengths and weaknesses of HIS’s usability, interoperability, scalability, and compatibility that affect the safety and effectiveness are essential to improving the systems (Wager, 2017). The benefits of using health information systems like EHR’s are to increase collaborative patient care delivery, enhanced capacity to perform monitoring for disease conditions, reduce medication errors, and decrease care (Mastriana & McGonigle, 2021).

Usability refers to the intended users’ ability to seamlessly achieve their tasks in the intended context that is useful, productive, and effective (Wager, 2017). An advantage of superior usability is that the user understands the software components to document efficiently (Wager, 2017). Poor usability of EHR systems contributes to clinician frustration and can lead to errors and patient safety concerns (Wager, 2017). Common frustrations include confusing displays, icons that lack consistency and intuitive meaning, and the feeling that systems do not support clinicians’ cognitive workflow or inhibit them from quickly drawing insights or conclusions from the data (Wager, 2017). Despite the proliferation in the acquisition of EHR systems, healthcare organizations still face critical issues and challenges related to interoperability, usability, and health IT safety (Wager, 2017).

Interoperability is the ability of multiple systems and health organizations to collaborate to exchange information (Mastrian & McGonigle, 2016). A health system’s vision is universal interoperability among all healthcare organizations to allow providers the advantage of quickly accessing and utilizing patients’ secure health information from all sources when the systems communicate with each other. (Wager, 2017). The health system aims to improve population health by generating knowledge from shared captured data, directly enabling individuals, clinicians, health agencies, and researchers to make informed decisions and rapidly learn, develop, and deliver innovative treatments (Wager, 2017). Patient safety is a primary concern of any healthcare provider. HIS provides essential data that can avoid adverse events or medication errors; for example, an electronic record can give information about a possible dangerous medication interaction or allergy that might not otherwise be immediately apparent (Electronic Health Reporter, 2018). By having interoperable data to review the documentation of a patient’s condition over time, interdisciplinary providers can make better decisions about providing care and when changes or adjustments need to be made (Electronic Health Reporter, 2018).

EHR interoperability is a vast, complex, and ongoing undertaking in health care delivery, involving a multitude of stakeholders both within and across care settings (Reisman, 2017). EHR systems need to have the ability to exchange information with standardized, secure data that the receiving system can interpret so that it is usable (Reisman, 2017). The complexity of successfully implementing a universal interoperable system has been a barrier due to different clinical terminologies, technical specifications, and functional capabilities (Reisman, 2017). The healthcare providers and organizations seem to support interoperability to improve patient care, reduce medical errors, and lower costs (Reisman, 2017). The future of EHR and its ability to be an essential tool in care coordination and team-based care will depend on the government and agencies involved to produce a systematic universal system for successful EHR interoperability (Reisman, 2017).

Scalability is the capacity for a health information system to grow with an expanding organization (Mastrian & McGonigle, 2021). If a hospital decides to merge with another hospital, it will be a scalable merge if their systems interface and are compatible with all users (Mastrian & McGonigle, 2021). Scalability is a prerequisite for designing and implementing an EHR system to support massive data exchange (Zhang & Zhang, 2013). A critical component for a system is the scalability when providing useful information while exchanging resources with other health-related information systems (Zhang & Zhang, 2013). When designing and implementing a new system, it can be a significant challenge to set up a structure that allows for a massive data exchange involving many concurrent users (Zhang & Zhang, 2013). The most significant thing is determining a method to ensure data security while maintaining high performance (Zhang & Zhang, 2013). A strategy should be designed and implemented to improve the scalability to ensure safety and simplify system performance (Zhang & Zhang, 2013).

A health information system that lacks scalability could mean an excessive amount of costs for an organization that wants to expand (Zhang & Zhang, 2013). Another disadvantage may be staff confusion when a hospital is growing and must continually learn new systems (Zhang & Zhang, 2013). The modern health system, driven by individual patient needs and history collected and organized in an EHR sharing the information electronically, providers can more effectively manage and improve the quality of that care (Electronic Health Reporter, 2018).

Compatibility is the ability for software to be interchangeable with other devices, such as versions of software that work with a MAC, Windows-based computer, and both IOS and Android mobile devices (Mastrian & McGonigle, 2016). A system is considered compatible if all devices can be in sync with each other on the same platform independently (Mastrian & McGonigle, 2016). Users can access patients’ information from a laptop in the hospital room while the lab person inputs the lab results for that patient visible on the computer. It also interfaces to send a text to alert flagged lab results. The goal is to distribute these information-related elements efficiently, effectively, and appropriately throughout the organization to enrich learning among organizational users and enhance care services across different providers (Mastrian & McGonigle, 2016). Critical and pertinent health information can be continuously gathered, compiled, securely stored, and analyzed from multiple device types such as device-linked mobile apps, medical image scanning, lab reporting systems, personal health records (PHRs), electronic medical records (EMRs), portable heart monitors, fitness trackers, smartwatches, blood glucose monitors, and other connected health consumer products and gadgets (Mastrian & McGonigle, 2016).

Compatibility of software over multi-devices will benefit subscribing patients to allow for easy and secure access to their health and clinical information anytime, anywhere, empowering them to monitor their status of health and well-being (Mastrian & McGonigle, 2016). Providers will now have real-time, digital information when attending to their subscribing patients supporting timely and effective clinical decision-making (Mastrian & McGonigle, 2016). An enormous amount of documentation auto-populates automatically through connected devices, which collect specific information in real-time and transmit it to patient records (Electronic Health Reporter, 2018).

Patient Care and Documentation

The EHR can positively impact patient care and documentation by allowing all areas of the patients’ health records to be documented in the system, promoting continuity of care throughout all organizational units of the health system. EHR makes chart review by the medical care team much more straightforward on any issue since all data parts are in the same location. Patient data from each department is documented in the same charting system making it transparent for the medical team to collaborate effectively. Nurses can document at the bedside allowing for real-time documentation. Real-time documentation is critical when factors such as out of range vitals and labs can alert the care team of any red flags. Sepsis alerts will automatically alert the nurse immediately after entering the patient’s data. The alert notifies the nurse to update the provider immediately to make immediate decisions on adjusting their fluids or starting an IV antibiotic. It also allows for the continuity of care when an on-call night provider comes on to see the patient’s full medical history to make improved decisions in their care.

Quality and Delivery of Nursing Care and Patient Outcomes

EHR will improve patient outcomes, quality, and nursing care delivery by having data integrity, accuracy, and consistency of the database’s information (Mastrian & McGonigle, 2016). The EHR system’s information allows for retrieving data from the database whenever it is requested (Mastrian & McGonigle, 2016). The EHR can provide data on a patient that could trigger preventive care fluid overload, sepsis, or respiratory depression, thereby improving patient outcomes. It can also provide data that support the decision-making mechanism, such as drug interactions, contraindications, or allergy alerts, which can prevent adverse outcomes. The replacement of EHR documentation vs. paper documentation will remove the risk of errors due to poor penmanship, allows the facilitation of data retrieval, and quality reviews across the healthcare organization. The use of EHR in the clinical setting will enhance patient outcomes and quality of care.

Health information systems have greatly improved the quality of patient care which represents the extent to which services provided meet the expected standards. For example, retrieving medical records from the EHR will help the healthcare provider understand the previous condition of the patient and plan appropriately. Through planning, the provider is able to minimize incidences of medication errors that could otherwise lead to adverse patient outcomes. Regarding decision making, the EHR systems can now be integrated with clinical decision support systems (CDS) to enable the physician to make the right choice of treatment. Since the adoption of the information technology systems, there has been a massive reduction in mortality and morbidity rates due to improved quality of service delivery (Krick et al., 2019).

Relationship-based care (RBC) in nursing is a concept that relates the interaction between nurses, patients, families, other healthcare team members, and the individual (Krick et al., 2019). To work towards building these relationships, the nurse assumes different responsibilities, accomplishes tasks, and responds appropriately to patient needs. The introduction of HIT has greatly improved the delivery of nursing care through the promotion of RBC. For example, the information systems allow for communication between healthcare providers during shift handover. The transition of care is made easy due to the availability of patient information from different units. The doctors get to document their care and recommend treatment using the EHRs. The nurses get to refer to the doctor’s notes and plan for patient care appropriately. When this kind of relationship exists, delivery of patient care becomes easy courtesy of HIT.

Patient outcomes refer to the results of nursing care delivery in the hospital including restored health patterns, maintenance of safety, and patient satisfaction. The change in the health status of individuals is measured using metrics such as mortality rates, hospital readmissions, and the use of patient experience surveys (Brenner et al., 2016). The use of health information technology has had a huge impact on patient outcomes through the reduction of hospital readmissions and mortality rates. For example, the systems are used to design discharge plans for patients including communication of instructions and follow-up to reduce hospital readmissions. The healthcare provider can use the EHR to formulate health education information that is based on the health patterns of the patient. Additionally, the use of EHRs has improved communication among healthcare providers leading to improved patient satisfaction.

Ways QI Data Can Lead to Measurable Improvement

Quality improvement represents systematic and continuous actions that lead to measurable improvement in healthcare services and the health status of populations. Various measures are used to determine the extent of quality in nursing care including mortality rates, patient satisfaction, and hospital readmission rates (Lackey & Tesh, 2016). The incorporation of health information technology into healthcare has affected how institutions perform in relation to the mentioned quality metrics. For example, many institutions use mortality rate data to determine if the quality of services has improved over time. Data from the health information systems like the EHRs can be used to improve the quality of hospital mortality rates.

Increased mortality rates in healthcare are attributed to medication errors, lack of safety measures, and healthcare issues like understaffing. Electronic health records data can be used to improve the area of mortality through analysis of medication errors. For example, the EHR will provide information on the number of patients who died due to over-sedation or inappropriate use of narcotics especially for the elderly. This data is then used to plan for process improvement in the facility through the implementation of evidence-based practices. Eventually, the health information helps in reducing mortality rates in the facility. Another example is the issue of sepsis which is a significant cause of mortality in many hospitals. With the advancement in technology, monitoring of patients with sepsis is made easy. The EHR provides alerts that enable the nurses and other healthcare practitioners to make timely interventions. The end result is reduced mortality rates due to effective management of sepsis and other deadly diseases.

The second metric that can be improved through the use of health information technology is hospital readmission rates. There is substantial evidence suggesting that technology may be yielding notable improvements in patient health outcomes evidenced by reduced readmissions. For example, recent data from over 269 hospitals in the US indicate an average of 3% reduction in readmission rates attributes to the use of technology (Lackey & Tesh, 2016). Meaningful use of EHRs which includes capturing patient’s information systematically and using it to make clinical decisions has ensured that patients spend less time in the hospital. Data collected from the EHR especially on hospital-acquired infections is used to help in designing interventions that reduce readmissions. The EHR system also provides the healthcare provider with information that is used to formulate individualized discharge plans for patients which minimizes the likelihood of readmission.

HITECH and HIPAA Security Standards and Regulations

Before the introduction of the Health Insurance Portability and Accountability Act (HIPAA), there was no generally accepted set of security standards protecting health information. In 1996, the HIPAA privacy and security rules were made to ensure that health information was protected as more technological advancements continued. The HIPAA privacy rule establishes national standards for the protection of patient information while the security rule establishes a national set of security standards for protecting certain health information that is held or transferred electronically (HHS.gov, 2013). After the establishment of these rules, there was a need to reinforce the adoption of electronic health records uses in healthcare. In 2009, the Health Information Technology for Economic and Clinical Health Act (HITECH Act) was signed into law to drive the adoption and meaningful use of EHRs in healthcare. These two acts, HITECH and HIPAA, are used to govern the use of health information technology including the protection of patient information today.

The HITECH act contains information that guides the meaningful use of EHRs by healthcare providers and their business associates. Under this act, healthcare providers must demonstrate the use of certified EHR technology in a way that can measure quality and quantity. Using the HITECH rule has seen many organizations improve efficiency, safety, and quality of services provided to patients. The rules have also ensured that EHRs are used effectively during care coordination, improvement of public health, and ensuring sufficient privacy and security of protected health information (PHI) (HHS.gov, 2013). The HITECH and HIPAA are separate laws but are used mutually to reinforce the use of EHRs and protection of information when using health information systems.

The HIPAA act contains different sections that explain information protected by the laws, who is covered by the security rule, and the general rules for health information protection. For example, the HIPAA security rule applies to health plans, health care clearinghouses, and to any health care provider who transmits health information in electronic form in connection with a transaction for which the Secretary of HHS has adopted standards under HIPAA (HHS.gov, 2013). Generally, health organizations should ensure confidentiality, integrity, and availability of PHI. These systems must create, receive and transmit health information while ensuring compliance by their workforce. The use of EHRs also mandates the organization to identify and protect against reasonably anticipated threats to the security and integrity of information. Lastly, the security standards require the protection of health information against reasonably anticipated, impermissible uses or disclosures (HHS.gov, 2013).

Data storage integrity in healthcare means that information should be complete, accurate, consistent, and updated during its storage period. The goal of HIPAA regarding the storage of information is to protect the confidentiality, integrity, and availability of PHI. For example, cloud data storage is a common and convenient option to store information by healthcare organizations. This system provides a convenient, decentralized, and reliable platform to store unlimited health information. Healthcare organizations should therefore ensure they have a system that supports cloud storage of information and that their cloud storage provider is reliable. Cloud storage of information ensures that only the business entity has the mandate to retrieve information when required.

The second measure to ensure data storage integrity is through the restriction of data access in the computers. The most basic protection available is the use of passwords, especially for the EHRs. The passwords ensure that only authorized individuals access the patient’s information. Policies and procedures are also available to govern the sharing of patient information in healthcare to prevent a breach of data. The advancement of technology has also brought other tougher security measures like two-factor authentication for external access to information to ensure only authorized computers and personnel gets access to information. Other data integrity management options for EHRs include the use of antivirus software, network firewalls to prevent unauthorized access, and the use of encryption mechanisms to prevent the unauthorized exchange of data between computers.

Data backup is not optional according to the HIPAA rules. All entities should securely backup retrievable exact copies of electronically protected health information (HHS.gov, 2013). Under the technical safeguards rule, policies and procedures must be implemented to guide proper storage of information and retrieval when necessary. The HIPAA regulations recommend that service providers should implement a full backup plan schedule of the system and the entire healthcare infrastructure containing patient information. For instance, data backup should offer redundancy through storage in at least two locations. The information should be encrypted and have a managed restoration platform that must be regularly tested. The backup services should be regularly monitored and reports against backup failure generated.

Off-site data storage is one of the mechanisms to ensure the availability of patient information when required. All backup stations should be placed in a secure environment with CCTV, water sensors, and added physical security. While these layers of security exist, the data backup and recovery should be contained in a contingency plan that is written and documented (HHS.gov, 2013). A contingency plan or program is a list of protocols, policies, and procedures that an organization follows in case of events such as disasters or emergency crises that can disrupt the operation. The last step to ensure backup and retrieval of information is regular testing and auditing of the plan. Trusted third parties should be involved in the testing of the backup and retrieval plan.

Protection of Patient Privacy

Protection of patient privacy is one of the primary considerations during the implementation of HIS. The first way the systems protect privacy is through the use of passwords. Passwords ensure that only authorized personnel access patient information when required. Secondly, the exchange of patient information ensures encryption to avoid data sharing to third parties. Sometimes data sharing will only be allowed on certain browsers or computer systems. Additionally, the use of additional security measures such as two-factor authentication ensures secure access to information from different locations.

 Organizational Efficiency and Productivity

Standardizing documentation. Health information systems provide an easy way to document patient information including organized sections for different data. For example, the EHR has organized sections for nursing notes to ensure that information is not mixed. The EHRs have also ensured that recorded information is easily understood through the use of medical terms and surpassing the manual handwritten instructions. Healthcare providers are able to give clear instructions that can be understood by every member of the care team.

Reducing Waste. Health information systems have improved efficiency and productivity through waste reduction. For example, EHRs have minimized the use of paperwork system that is wasteful in terms of resources use and time. The availability of the backup and retrieval system ensures that information is easily available minimizing time to go through manual records. The use of HIS has ensured a reduction in extra costs for diagnosis and treatment through the use of CDS and EHRs. Repeat tests and unnecessary procedures can now be avoided through the use of these systems.

Increasing Productivity. Health information systems have increased productivity by making work easier for healthcare workers. Aspects such as standardized documentation, retrieval of patient information, and easy communication of patient care have led to more positive health outcomes. Many patients can be served at a time due to the availability of EHRs which increases revenue in the organization.

Human and Capital Resource. The introduction of HIS has led to a shift in the human and capital resource requirements in healthcare organizations. The introduction of the HIS requires new personnel to operate and monitor data. The organization has to hire IT team members to ensure electronic information is transmitted and stored well. Extra costs will be required to purchase computer hardware and install software for the smooth running of operations. Training for employees is necessary during the implementation phase to equip staff with the knowledge and expertise to use the new technology.

Interdisciplinary team Identification

Nursing Informatics Specialist. Nursing informatics specialists (NIS) incorporate nursing science, information technology, and analytical sciences in order to effectively process, manage and communicate important information among nurses, patients, and healthcare personnel. The role of the nurse informaticist will be to gather information about the new technology and advise appropriately on the course of action. Through his education and experience, the nurse informaticist will help in choosing the best HIS to use and also in educating other stakeholders on the importance of information technology use.

Nurse Educator. Adoption of the new technology will require education on the use of EHRs and their relevance to the healthcare environment. The nurse educator is in a good position to educate nurses and other healthcare team embers on the importance of technology use in improving quality care in the facility. The involvement of the nurse educator in this project will ensure adequate preparation of employees for new organizational change.

Chief Financial Officer. The CFO is the senior executive who has the overall responsibility of managing the financial side of the organization. The CFO will be involved during the implementation of the HIS to aid in allocating finances for purchasing hardware, software, and other accessories for the project. The CFO’s knowledge and expertise in project management will greatly contribute to proper financial management during the implementation of the technology.

Information Technology Specialist. An IT specialist is involved with the monitoring of a company’s computer systems, assessing and troubleshooting errors, and updating or upgrading the systems. This individual will ensure that a good HIS is selected from the market, properly installed, and organize for the training of employees to use the systems. The IT specialist has experience in computer systems and he will be a key player in the selection of the best technology to use in the organization.

Plan for Evaluating Success of Implementing a System

Education: Education is among the nursing informatics standards of professional performance with competencies which describes the importance of equipping healthcare providers with knowledge of HIS (ANA, 2014). Supported by the American Nurses Association (ANA), the education standard will be used to evaluate the success of implementing a HIS in the organization. The nurse educator and the nurse informaticist will work to educate nurses on the importance of HIS to the organization. To evaluate this practice, nurses will complete a survey on HIS use and describe areas that require further education. Each individual will practically demonstrate an understanding of EHR use including aspects of documentation and protection of patient information. The evaluation exercise will be done at the end of the year.

Collaboration. The American Nurses Association describes collaboration to be a practice that involves multiple healthcare team members working together to achieve a common goal (ANA, 2014). To evaluate this practice, the committee will analyze meetings held to ensure nurses, doctors, IT team members, and the key stakeholders participated. Secondly, each team should provide a list of their roles and contributions towards the implementation of the HIS. At the end of the year, all teams will describe their partnerships and any challenges experienced during the implementation phase.

References

American Nurses Association. (2014). Nursing Informatics: Scope and standards of practice, second edition. https://www.himss.org/sites/hde/files/FileDownloads/ANA%20NI%20Scope%20%26%20Standards%20of%20Practice.pdf

Brenner, S. K., Kaushal, R., Grinspan, Z., Joyce, C., Kim, I., Allard, R. J., Delgado, D., & Abramson, E. L. (2016). Effects of health information technology on patient outcomes: A systematic review. Journal of the American Medical Informatics Association : JAMIA, 23(5), 1016–1036. https://doi.org/10.1093/jamia/ocv138

HHS.gov. (2013). Health information privacy: Summary of the HIPAA security rule. https://www.hhs.gov/hipaa/for-professionals/security/laws-regulations/index.html

Krick, T., Huter, K., Domhoff, D., Schmidt, A., Rothgang, H., & Wolf-Ostermann, K. (2019). Digital technology and nursing care: A scoping review on acceptance, effectiveness and efficiency studies of informal and formal care technologies. BMC Health Services Research, 19(1), 400. https://doi.org/10.1186/s12913-019-4238-3

Lackey, S., & Tesh, P. (2016). Nursing quality measures (simplified). Nursing Made Incredibly Easy, 14(3), 20-24. https://journals.lww.com/nursingmadeincrediblyeasy/Abstract/2016/05000/Nursing_quality_measures__simplified_.5.aspx

Reisman, M. (2017). EHRs: The challenge of making electronic data usable and interoperable. P & T : A Peer-Reviewed Journal for Managed Care and Hospital Formulary Management, 42(9), 572–575. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5565131/

Wager, K. A., Lee, F. W., & Glaser, J. P. (2017). Health care information systems : A practical approach for health care management (4th ed.) [ProQuest Ebook Central]. John Wiley & Sons, Incorporated. https://doi.org/https://ebookcentral.proquest.com/lib/westerngovernors-ebooks/detail.action?docID=4815068.