NUR 514 In what ways can informatics help health care providers overcome current or emerging barriers to care and increase access to safe, quality health care?
NUR 514 In what ways can informatics help health care providers overcome current or emerging barriers to care and increase access to safe, quality health care?
Informatics can help healthcare providers increase access to safe, quality care by providing strategies for more efficient and cost-effective treatments. Informatics tools like electronic health records (EHRs), telehealth systems, and decision support systems are helping healthcare providers share information quickly, coordinate care across settings, reduce errors, and monitor patient outcomes (Brown et al., 2022). Additionally, informatics can help to provide quality care in remote and underserved areas by enabling healthcare providers to use technology to access patient information more quickly. Informatics can also help healthcare providers overcome barriers related to cost by reducing duplication of services and helping develop strategies for improving workflow efficiency.
Informatics helps healthcare overcome emerging barriers to care by providing tools that efficiently deliver safe and quality patient care. One such tool is Clinical Provider Order Entry (CPOE). This system allows clinicians to electronically enter orders for medications, tests, procedures, and other forms of treatment directly into a patient’s medical record, eliminating potential errors from handwritten orders and improving the accuracy of patient records (Aldhoayan et al., 2022). Another tool that can help healthcare providers in clinical decision support systems (CDSS). This system uses data from the patient’s medical record, such as laboratory test results and vital signs, to generate recommendations for diagnosis and treatment (Aldhoayan et al., 2022). This helps clinicians make more informed decisions about the care of their patients, reducing medical errors and improving the quality of care.
Heuristic principles are essential for efficient clinical information systems such as CPOE and CDSS because they ensure that the interface is both intuitive and user-friendly, making it easier for clinicians to access the system’s information quickly and accurately. By integrating heuristic principles into the design of CPOE and CDSS, healthcare providers can reduce the amount of time spent navigating the system, reducing frustration (Aldhoayan et al., 2022). Additionally, heuristics help ensure that the system is designed with patient safety in mind by providing consistent visual cues such as layout and color scheme so that users immediately understand how the system works.
Brown, S.-A., Hudson, C., Hamid, A., Berman, G., Echefu, G., Lee, K., Lamberg, M., Olson, J., Program, C. H. I. R., & Network, C. O. I. (2022). The pursuit of health equity in digital transformation, health informatics, and the cardiovascular learning healthcare system. American Heart Journal Plus: Cardiology Research and Practice, 17, 100160.
Aldhoayan, M., Alem, H., & Alduraywish, W. (2022). The Impact of Computerized Physician Order Entry (CPOE) Combined with Clinical Decision Support System (CDSS) On Preventing Adverse Drug Reactions In Renal Insufficiency: Systematic Review. Journal of Health Informatics in Developing Countries, 16(2), 1-10.
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There are a few ways that informatics can help overcome barriers. The first is when patients are being checked in regardless of the location that it is seamless from start to finish. In other words, how patients’ information is taken, that information is kept safe and when that patient transitions from one area to the next the information is shared equally across the interprofessional team. The second is that technology is available to the interprofessional team that meets their needs such as laptops, tablets, phones etc. so that their care meets the needs of the patient for safe and quality care as well as connected to the overall main system. Clinical provider order entry (CPOE) and clinical decision support systems (CDSS) can help alert providers with things like drug-drug interaction but as n.d. (2019) states to many alerts can lead to user fatigue and choose to ignore the alerts, leave them unread. Heuristic principles are important because implementing new systems should be tailored to the user’s way of working. When it is tailored to the users there is increased efficiency and patient safety. Akhoulfi, H. et al. (2019) reviewed use of antibiotic treatment and implementation of CDSS and CPOE systems and concluded that it is also important to provide to the user’s information is to be clear, concise and specific to avoid as much confusion as possible.
Akhloufi, H. Verhaegh, S.J.C., Jaspers, M.W.M., Melles, D.C., Van Der Sijs, H., & Verbon, A. (2019). A usability study to improve a clinical support systems for the prescription of antibiotics drugs. PloS One, 14(9), e0223073. https://doi-org.lopes.idm.oclc.org/10.1371/journal.pone.0223073
n.d. (2019). Computerized provider order entry. Agency for Healthcare Research and Quality. Computerized Provider Order Entry | PSNet (ahrq.gov)
Clinical informatics can help health care providers in several ways, including using the technology to better communicate with the interprofessional team, prevent errors and improve care, measure the quality of care, enhance education and research, improve access to health information, and many more. Clinical provider order entry (CPOE) refers to the process of providers entering and sending treatment instructions, including medication, laboratory, and radiology, through a computer application instead of paper or fax (HealthIt.gov, 2018 a). CPOE helps reduce errors, improve patient safety, improve efficiency, and improve reimbursement claims. Clinical decision support system (CDSS) provides clinicians, staff, and patients the knowledge and specific information, filtered and presented to enhance health care. These include alerts and reminders, clinical guidelines, order sets, and documentation templates. CDSS significantly impacts health care quality, safety, efficiency, and effectiveness. CDSS is sophisticated as it requires biomedical knowledge and an inferencing mechanism to generate information and guidelines for clinicians to support the delivery of care (HealthIt.gov, 2018 b).
For a clinical information system to achieve it’s potential benefits, the human factor, user and usability need to be considered. The technology should fit well with human and user characteristics. This is referred to as the human-technology interface. The technology must match the user and the intended context of care. It should also be user-friendly and not complicated nor require multiple steps which then becomes time-consuming for users instead of promoting efficiency (McGonigle & Mastrian, 2018).
HealthIT.gov (2018). Computerized provider order entry: The basics. https://www.healthit.gov/faq/what-computerized-provider-order-entry
HealthIt.gov (2018). Clinical decision support. https://www.healthit.gov/topic/safety/clinical-decision-support
McGonigle, D., & Mastrian, K. (2018). Nursing informatics and the foundation of knowledge (4th ed.). Jones & Bartlett Learning
It is true that clinical informatics is useful in healthcare environment. Healthcare providers have prevented several medication errors as a result of using clinical informatics. Also, using informatics have improved care and accessibility to health information. Healthcare facilities have intensified their efforts to implement technology and clinical informatics (Dang et al., 2019). However, incompetence among some healthcare workers have troubled the implementation process. Clinical provider order entry (CPOE) and Clinical decision support system (CDSS) have transformed healthcare services delivery in most healthcare facilities. CPOE helps reduce errors, improve patient safety, improve efficiency, and improve reimbursement claims (Mutlag et al., 2019). CDSS provides clinicians, staff, and patients the knowledge and specific information, filtered and presented to enhance health care. The implementation of CPOE and CDSS systems have been a problem to other healthcare organizations due to financial constraints.
Dang, L. M., Piran, M. J., Han, D., Min, K., & Moon, H. (2019). A survey on internet of things and cloud computing for healthcare. Electronics, 8(7), 768. https://doi.org/10.3390/electronics8070768
Mutlag, A. A., Abd Ghani, M. K., Arunkumar, N. A., Mohammed, M. A., & Mohd, O. (2019). Enabling technologies for fog computing in healthcare IoT systems. Future Generation Computer Systems, 90, 62-78. https://doi.org/10.1016/j.future.2018.07.049
Informatics is intertwined in healthcare institutions and is part of nursing daily duties, and will continue to be embedded in core processes. Informatics has provided opportunities for healthcare innovation and improved patient outcomes. Informatics provides opportunities to implement safety measures and provide more efficient care. Two key resources are Clinical provider order entry (CPOE). McGonigle and Mastrian (2018) define CPOE as an “electronic process or system that automates the way that orders have traditionally been initiated for patients. It allows a healthcare provider to enter orders electronically and to also manage the results of those orders” (p 778). The second resource is clinical decision support systems (CDSS). CDSS is defined by McGonigle and Mastrian (2018), as “a computer-based program designed to assist clinicians in making clinical decisions by filtering or integrating vast amounts of information and providing suggestions for clinical intervention” (p 773).
These two programs help provides efficiency by gathering information and guiding clinical decisions that provide best-practice interventions. They provide a way to keep mass amounts of patient-specific information organized per patient. Essentially, these programs provide safety measures to flag orders or interventions that are counter-indicated for the patient and their plan of care. The programs combined offer automated safety checks to help mitigate errors and provide efficient ordering processes. A downside to these programs is relying on the safety checks of the system and skipping additional safety steps. Each patient requires customized care and consideration of the many variables that affect their overall care. The programs such as CPOE and CDSS are protocols and algorithms that provide little customizations. These factors can lead to errors and being too reliant on the system to make clinical decisions. It is important to not still take the time to consider all variables and not skip the five rights to administering patient care.
McGonigle, D., Mastrian, K. G. (Eds.). (2018). Nursing informatics and the foundation of
knowledge (4th ed.). Jones & Bartlett Learning. ISBN-13: 9781284121247
I concur with you that informatics is intertwined in healthcare institutions and is part of nursing daily duties. Healthcare organizations are embracing technology as they seek to improve healthcare services (Qadri et al., 2020). Clinical informatics is part of technology advancements in healthcare environment that has transformed service delivery. The reduction of medication errors and improvement of healthcare services are among the benefits of clinical information. Similarly, clinical informatics have increased accessibility to health information. Informatics provides opportunities to implement safety measures and provide more efficient care (Orji & Moffatt, 2018). Unfortunately, less techno-savvy healthcare workers have failed to benefit from clinical informatics. Other healthcare institutions have introduced training programs to improve their staff’s competence levels. CPOE is an “electronic system that automates the way that orders have traditionally been initiated for patients. The system reduces possibility of medication errors.
Orji, R., & Moffatt, K. (2018). Persuasive technology for health and wellness: State-of-the-art and emerging trends. Health Informatics Journal, 24(1), 66-91. https://doi.org/10.1177/1460458216650979
Qadri, Y. A., Nauman, A., Zikria, Y. B., Vasilakos, A. V., & Kim, S. W. (2020). The future of healthcare internet of things: A survey of emerging technologies. IEEE Communications Surveys & Tutorials, 22(2), 1121-1167. DOI: 10.1109/COMST.2020.2973314
The field of informatics has developed in response to the need to make health care more accessible and useful to its consumers as well as its providers. With a wide-spread shortage of primary care providers, especially in rural areas, telehealth has allowed for people in these areas to access care. Another way that informatics can help provide safe, quality healthcare is through the use of nursing sensitive indicators. By collecting and analyzing data that quantifies the effect that nurses have on health outcomes, nurses can use convincing evidence regarding their impact in patient outcomes to advocate for lower patient: nurse ratios. More nurses per patient load have been shown to result in better outcomes (DeNisco, 2021).
Clinical provider order entry (CPOE) and clinical decision support systems (CDSS) are two aspects of the electronic health record (EHR). The Leapfrog Group recommends measures to promote organizational quality. The first of these is implementing CPOE with the intent to reduce errors in the ordering process. CPOE takes one or more people out of the ordering and transcribing process that was used before CPOE which can reduce errors. Difficulty in reading a physician’s hand-written orders and incorrect abbreviation usage are two problems that should be eliminated with CPOE. Despite the projected reduction in ordering errors, DeNisco (2021) cites the Wetterneck et al. (2011) report which showed an increase in duplicate medication order errors with CPOE. Despite the efficiency that CPOE offers, the human attributes of critical thinking and attention to detail are necessary to use along with the electronic system.
CDSS can be helpful in many ways to flag or notify providers to patient allergies when ordering medication, routine screening that is due and recommended isolation precautions based on ordered lab tests, to name a few. These also require engaged, critical thinking by the provider to evaluate the appropriateness of the recommendations, rather than blindly acknowledging recommendations. A potential pitfall with CDSS is the “alert fatigue” that providers can experience with too many best-practice advisories. This can lead providers to quickly dismiss all alerts that pop up on their screen in order to get through their ordering process in a timely fashion.
DeNisco, S. M. (2021). Advanced practice nursing: Essential knowledge for the profession (4th ed.). Jones & Bartlett Learning.
Health informatics technology (HIT) has vastly evolved in recent years. Utilizing HIT allows healthcare providers to overcome barriers to care. Overcoming these barriers has the potential to prevent errors and improve patient care (DeNisco, 2021). Examples include barcode scanning, patient-provider communication, and provider-provider communication. Barcode scanning acts as a safety net and an additional check prior to administration of medications or vaccinations. Increased communication between patients and providers allows patients to have more control over the care they receive. This allows easy access to communication regarding medical questions, laboratory and imaging results, and scheduling. Improving communication between providers ensures coordinated care and consistency.
Clinical provider order-entry system (CPOES) and clinical decision support system (CDSS) have clear advantages along with challenges. CPOES improves safety by increasing legibility (DeNisco, 2021). Handwritten orders are often very difficult to read, leading to errors and possible harm to patients. Challenges of CPOES includes typos and inflexible ordering. CDSS improves safety by providing immediate feedback and often intervening prior to errors being made. An example of this is when a medication is being ordered and the system indicates that the patient is allergic. However, a challenge seen with this is that staff may be overly reliant on the technology. Some staff may assume that CDSS will detect all potential errors and may not perform their own independent checks.
It is crucial for clinical information systems, such as CPOES and CDSS, to have heuristic principles for functionality purposes. Technology is great, but human factors must be enabled for great success. Without these factors, HIT would be very inflexible and not user-friendly (DeNisco, 2021). When providers are unable to enter the exact information, functionality must be available to customize the order within comment sections.
DeNisco, S.M. (2021). Advanced practice nursing: Essential knowledge for the profession (4th ed.). Jones & Bartlett Learning.