Benchmark – Electronic Health Record Implementation Paper

Assessment Description

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.

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).
  5. Discuss what professional, ethical, and regulatory standards must be incorporated into the design and implementation of the system.
  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?

You are required to cite five to 10 sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.

Electronic Health Record Implementation Paper

Nursing is an evolving practice that readily embraces opportunities for care quality and patient safety improvement. In this evolving practice, the role of science, data, and technology is critical; thus, organizational management and nurse leaders should continually integrate innovation into patient care (Lunden et al., 2021). Opportunities for tracking care improvement involve data collection, analysis, and evaluation. Accordingly, health care organizations should invest in robust systems that capture real-time data using electronic health records (EHRs) and protect sensitive information from unauthorized access and other risks. The purpose of this paper is to describe the processes and key considerations for implementing a new EHR system in a practice setting.

Opportunity for Tracking Care Improvement and Key Information in the Database

Advanced registered nurses should play a central role in improving care quality. They should be involved in developing initiatives for reducing service delays, improving teamwork, and promoting technology use in health care delivery. A perfect opportunity for tracking care improvement is the time lapse from when a patient’s visit to the emergency room is recorded in the EHR to when the patient receives medical attention. From a health dimension, long waiting time characterizes delays and increases patient dissatisfaction and discomfort (Biya et al., 2022). Long waiting time also reduces health care utilization, increases the chances of health complications, and discourages patients from returning to the health care facility.

Data helps health care practitioners to make timely, accurate decisions. Key information that would be needed in the database includes patient demographics, type of health conditions, and time-lapse before medical attention. Information on time-lapse is critical to improving care outcomes since it would help health care practitioners to identify potential delays and their causes. Common causes of delays in the emergency room include extended waiting lists, shortage of hospital beds, and inadequate testing equipment (Caesar et al., 2018). Such data can help the organization’s management and advanced registered nurses to collaborate and develop evidence-based interventions for delay prevention.

Role of Informatics and Project Management Strategies

Role of Informatics

The role of informatics is integral in advancing nursing practice since it encourages innovation and promotes efficiency. Alexander et al. (2019) described informatics as integrating science and technology for better patient outcomes. In data capturing, informatics helps health care practitioners to collect timely and accurate data. In this case, data on patient demographics, illnesses, and the time spent before receiving medical assistance would be collected timely and accurately. Informatics would also help to capture data in multiple formats. For instance, data for patients who have visited the emergency room before can be collected via demographics. Informatics can also help to capture data into categories. A suitable example is a graphical representation of waiting time to facilitate a detailed analysis of the severity of the situation.

Project Management Strategies and Methodologies

Effective patient care combines nursing and other concepts outside the health practice. Project management strategies to support informatics initiatives to help improve quality within the clinical care settings include planning, risk management, and goal-setting. Typically, informatics initiatives are complex, time-consuming, and resource-intensive hence the need for adequate planning. Risk management entails developing adequate measures for assessing risk potential, measurement, and mitigation measures (NEJM Catalyst, 2018). Goal-setting is also crucial to ensure that the purpose and deliverables of an initiative are clear and measurable. Suitable project management methodologies include the application of work breakdown structure (WBS) and Gantt charts. WBS and Gantt charts help in planning and scheduling tasks for easy implementation (Vaagaasar et al., 2020). A similar approach is necessary for EHR implementation to ensure that deliverables are clear and resources channeled towards supporting informatics initiatives are used prudently.

Systems and Staff Members and the Role of the Advanced Registered Nurse

Systems and Staff Members for Design and Implementation Process

New EHR systems and other technology-driven initiatives can only thrive with proper designs and implementation. Regarding systems, technology implementers should pay attention to hardware, software, and operating systems for new initiatives. It is crucial to ensure that the design will promote safe and effective use. Staff members that should be involved in the design and implementation process include system analysts, risk managers, project managers, and end users. The system analysts and risk managers would provide technical knowledge regarding the new system, while the project manager would facilitate a smooth implementation. As Dopp et al. (2020) suggested, EHRs should have user-centered designs to encourage their use. Hence, end users should be involved in the design and implementation process to give views on the type of system they would like to use and its features. They can also be involved in its piloting to assess efficiency, performance gaps, and opportunities for further improvement.

The Role of the Advanced Registered Nurse

The advanced registered nurse plays a leading role in promoting evidence-based practice (EBP) and leading performance improvement initiatives. In this setting, the advanced registered nurse is centrally involved in identifying opportunities for change and responding by developing evidence-based interventions. Evidence-based interventions are supported by scientific research and guide nurses in implementing positive change to improve health outcomes (Lunden et al., 2021). The other role of the advanced registered nurse is leading change through EBP models. Such models provide a systematic, procedural approach to quality improvement. Above all, the advanced registered nurse promotes a culture of innovation in the setting. Commonly, organizations that encourage innovation are ready for change and support it. As a result, EBP and quality improvement projects face minimal resistance in such settings since the organizational staff is ready for change.

Strategies for Implementing the New EHR Proposal

Implementing a new EHR system typifies engagement in practice change. As a result, resistance to change is possible hence the need for change implementers to be prepared and outline potential interventions. Communication is essential when introducing a new EHR. In change initiatives, communication allows the nursing staff to understand the importance of change from staff and patient care perspectives. Milella et al. (2021) underlined the importance of communication in change projects since it prepares people for the change. Preparation for the new EHR would make the transition easier. The transitioning process should include user training to equip nurses with the skills necessary to use the EHR competently. Competence would also ensure that organizational resources are effectively managed by minimizing errors. The implementers also need to implement sustainability strategies to promote continuous and comfortable use of the new EHR. Such strategies include continuous performance assessment, progressive user training, and proper orientation of new users.

Professional, Ethical, and Regulatory Standards

Technology systems present significant risks to health care organizations, users, and patients that can be controlled if they meet some standards. The most important professional standards that should be incorporated into the system’s design and implementation are meaningful use and user-friendliness. Meaningful use implies that the system is designed to facilitate the easy exchange of health information between users to improve clinical quality and other measures (Alexander et al., 2019). Ethical standards include beneficence and non-maleficence. The implication is that the new system should be designed and implemented to benefit patient care and should be free from harm. Patients and users should be protected from all possible risks. Regulatory standards include developing secure systems and protecting private health information as outlined under the Health Insurance Portability and Accountability Act (HIPAA) security rule (Alexander et al., 2019). Adherence to the rule’s requirements implies that the new system must have adequate security measures to protect private patient data from unauthorized access and malicious use.

Measures and Steps for Evaluating the Success of the EHR Implementation

Successful EHR implementation should improve outcomes from a staff, setting, and patient care perspective. Process and outcome measures can be used to determine the effectiveness of EHR implementation. From a staff perspective, the new EHR system should improve efficiency, minimize errors, and allow nurses to respond to patient issues timely and more effectively. From a setting perspective, successful EHR implementation should be characterized by high efficiency to optimize resource utilization. It should enable nurses to detect and categorize patient care concerns in terms of severity and facilitate interprofessional collaboration for better responses to patient problems and holistic care. From a patient perspective, timely care increases patient satisfaction (Biya et al., 2022). As a result, reducing delays would be instrumental in improving patient satisfaction. To ensure quality improvement in practice, the advanced registered nurse should engage in continuous process and outcome assessment. Similarly, I should be involved in performance assessment and lead change by implementing appropriate evidence-based interventions.

Leadership Skills and Theories to Facilitate Collaboration and Provide Evidence-Based, Patient-Centered Care

Effective patient care is multidimensional, and the role of leadership for better outcomes cannot be underestimated. One of the best strategies for facilitating collaboration with the interprofessional team is clear communication. Leaders who communicate clearly allow nursing staff to work together without conflicting roles. Besides communication, health care leaders should also be emotionally intelligent. Prezerakos (2018) described emotional intelligence as a leader’s ability to understand and interpret personal and others’ feelings and emotions. It is a crucial skill when leading diverse teams and helping them to work for a common goal.

The most appropriate theory for promoting interprofessional collaboration is the transformational leadership theory. A transformational approach to leadership entails inspiring teams to work toward achieving a shared vision (Chu et al., 2021). Collaboration, engagement, and individual brilliance are highly encouraged in transformational leadership. The element of collaboration enables diverse health care practitioners to blend their skills to tailor patient care according to patient needs. Transformational leaders also support team members’ creativity, provided that it translates to the best possible patient outcomes. A similar approach would be needed when implementing new systems to improve patient care.

Conclusion

Health care organizations should be continually committed to improving patient outcomes. EHR systems offer a massive opportunity for integrating patient care with data, technology, and science. As discussed in this paper, the advanced registered nurse should lead change in EHR implementation by ensuring that such systems are risk-free and adhere to the established ethical, professional, and regulatory standards. They should also be actively involved in promoting a culture of change in health care to ensure leaders and other practitioners are ready for innovation and practice change for better patient outcomes.

References

Alexander, S., Frith, K. H., & Hoy, H. (Eds.). (2019). Applied clinical informatics for nurses (2nd ed.). Jones & Bartlett Learning.

Biya, M., Gezahagn, M., Birhanu, B., Yitbarek, K., Getachew, N., & Beyene, W. (2022). Waiting time and its associated factors in patients presenting to outpatient departments at public hospitals of Jimma Zone, Southwest Ethiopia. BMC Health Services Research22(1), 1-8. https://doi.org/10.1186/s12913-022-07502-8

Caesar, U., Karlsson, J., & Hansson, E. (2018). Incidence and root causes of delays in emergency orthopaedic procedures: a single-centre experience of 36,017 consecutive cases over seven years. Patient Safety in Surgery12, 2. https://doi.org/10.1186/s13037-018-0149-1

Chu, H., Qiang, B., Zhou, J., Qiu, X., Yang, X., Qiao, Z., … & Yang, Y. (2021). The impact of transformational leadership on physicians’ performance in China: a cross-level mediation model. Frontiers in psychology12, 586475. https://doi.org/10.3389/fpsyg.2021.586475

Dopp, A. R., Parisi, K. E., Munson, S. A., & Lyon, A. R. (2020). Aligning implementation and user-centered design strategies to enhance the impact of health services: Results from a concept mapping study. Implementation Science Communications1(1), 1-13. https://doi.org/10.1186/s43058-020-00020-w

Lunden, A., Kvist, T., Teräs, M., & Häggman-Laitila, A. (2021). Readiness and leadership in evidence-based practice and knowledge management: a cross-sectional survey of nurses’ perceptions. Nordic Journal of Nursing Research41(4), 187-196. https://doi.org/10.1177/2057158520980687

Milella, F., Minelli, E. A., Strozzi, F., & Croce, D. (2021). Change and innovation in healthcare: Findings from literature. ClinicoEconomics and Outcomes Research: CEOR13, 395–408. https://doi.org/10.2147/CEOR.S301169

NEJM Catalyst. (2018). What is risk management in healthcare? https://catalyst.nejm.org/doi/full/10.1056/CAT.18.0197

Prezerakos, P. E. (2018). Nurse managers’ emotional intelligence and effective leadership: a review of the current evidence. The Open Nursing Journal12, 86–92. https://doi.org/10.2174/1874434601812010086

Vaagaasar, A. L., Skyttermoen, T., & Clegg, S. R. (2020). Project management: a value creation approach. SAGE.

Communication technologies have significantly increased the ability of health care providers to collaborate with peers across disciplines and locations.  Two specific examples, electronic health records (EHRs) and telehealth, provide clear examples of how communication modalities have increased collaboration between providers which facilitates greater assess and faster delivery of health care.  This in turn leads to improved patient outcomes and increased quality of care.   

The electronic health record (EHR) is a unique communication modality that facilitates collaboration among health care providers across different disciplines.  One benefit is that the EHR allow providers to coordinate and discuss care at any time or location which prevents care delivery delays (Vos et al., 2020).  Further, because the health care data is comprehensive and is provided in real time, EHR communication increases joint clinical decision making which facilitates faster care delivery (Vos et al., 2020).  It further saves time by removing the necessity of face-to-face communication. While there are some challenges to navigate, when providers utilize this modality with a sense of commitment to the process, it can increase enhance the coordination of care and improve care delivery.   

During the Covid-19 pandemic rural hospitals faced the unique challenge of limited access to specialists for consultations and treatment guidelines. The advent of telemedicine allowed for increased knowledge sharing and collaboration between providers.  Patients benefited from access to timely critical care input from specialists that otherwise would have taken more days thus delaying care.  In addition to increased access, Yonkai et al., (2021) stated that telehealth facilitated open collaboration with other key stakeholders such as government authorities, research institutions and laboratories. The increased collaboration created by telehealth during the pandemic provided great insights that will guide public health institutions as they battle future epidemic outbreaks (Yonkai et al., 2021). 

Vos, J. F., Boonstra, A., Kooistra, A., Seelen, M., & Offenbeek, M. V. (2020). The influence of electronic health record use on collaboration among medical specialties. https://doi.org/10.21203/rs.3.rs-27832/v1

Yunkai Zhai, Yichuan Wang, Minhao Zhang, Jody Hoffer Gittell, Shuai Jiang, Baozhan Chen, Fangfang Cui, Xianying He, Jie Zhao, Xiaojun Wang. (2021). From isolation to coordination: How can telemedicine help combat the COVID-19 outbreak? Digital Health and Medical Analytics. Vol, 1412.  ISBN : 978-981-16-3630-1