NURS 8210 Information Architecture

Information Architecture

Health information systems (HIS) facilitate patient safety in the organization through improved communication between health care professionals, improved tracking and reporting, quality care through clinical decision support systems, and improved medication safety (Ball et al., 2011). At my organization, the HIT system collects data for QI, outcome reporting, and surveillance purposes.

Information Workflow

When the patient enters the facility, the patient details are captured through the patient registration point. The next step in the flow of information is the triage nurse, who inputs the patient history and patient values into the Electronic Health Records (EHR). Next, providers record the patient’s diagnosis, notes, medications, and care plans. The data on medicines flow towards the laboratory and scans for evaluation of diagnostic tests. Afterward, the provider has a chance to integrate changes to care plans based on lab data. The information then flows to the pharmacy department as the patient awaits medications. The information flow represents a multidisciplinary facility. The communication between providers is collaborative and efficient, and gears towards patient-centered care (El-Said & El-Sol, 2018). Information continuity is a feature in the Women’s hospital, and the flow is efficient and contributes to quality care.

HIT Systems and Evidence-Based Practice

The health information system facilitates evidence-based practice through data collection to assess the efficacy of interventions and clinical decision support systems and alerts that optimize best practices. There is record uniformity to reduce variations in care. The HIS can also be utilized for a QI audit to assess compliance with (Evidence Based Practice) EBP. Patients can access medical records and are empowered to take an active role in managing their conditions. HIS can facilitate diagnostic tests and follow-ups for appointments/consultations. However, computerized order entry compromises EBP despite its benefits of decreased processing time and lower risk for adverse events. Clinical expertise is an integral domain of EBP, and automated entry disrupts workflow with incompatibilities that prevent full assessment of the patient’s needs (Oach & Watter, 2016). Improvements in design and integration between platforms and robust interoperability will facilitate evidence-based care. However, the exchange of data across all settings and providers within the organization improves safety.

References

Ball, M. J., Douglas, J. V., Hinton Walker, P., DuLong, D., Gugerty, B., Hannah, K. J., & Troseth, M. R. (Eds.) (2011). Nursing informatics: Where technology and caring meet (4th ed.). London, England: Springer-Verlag.

El-Said, A., & El-Sol, H. (2018). Technology into nursing practices: Enhance patient’s outcomes. Mansoura Nursing Journal, 5(1), 191-195. https://dx.doi.org/10.21608/mnj.2018.150637

Oach, P., & Watter, A. (2016). Health information management: Concepts, principles, and practice (Fifth ed.). Chicago: AHIMA.

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Differing Information Needs and The Impact on the Organization The healthcare system includes six hospitals and multiple physician practice organizations. EPIC is used by physicians, nursing therapy, etc. for inpatient and EPIC Ambulatory for outpatient and physician practice. The laboratory uses a system called SoftLab and radiation oncology uses Aria. For each of these systems to share patient data, an HL7 interface passes the information between the systems. Health Level Seven International (HL7) is the standard used to map data fields between systems and allow for the communication of the data (Nursing Informatics: Scope and standards of practice, 2015). The EHR has been configured with evidence-based order sets and documentation templates to guide patient care. In February 2016, an international task force was convened to define sepsis and septic shock (Singer, Deutschman, Seymour, & et al., 2016). Which is impacting several areas of the healthcare system technology, including the EBP order sets and the 3M 360 application.

Information Flow Across HIT and Evidence-Based Practice

Interfaces have been developed across 3M 360 and EPIC, but they are not complete. For example, all documentation from EPIC is interfaced into 3M 360 to all the clinical documentation improvement (CDI) nurse to review the record for completeness of the documentation to support the diagnosis and to meet quality measures. The CDI nurse if they find a lack of documentation or need for clarification, for example sepsis as a diagnosis, the nurse creates a query in EPIC. Because there is no interface for query information, the nurse must copy and paste the information back into 3M 360 for tracking. 3M 360 is supported by multiple EBP references by mapping information through Natural Language Processing (NLP) and through buttons. For example, the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) is built into the system. The NLP will suggest diagnoses or needs to query based on the documentation from EPIC and if it meets certain EBP data within the documentation. EPIC and 3M 360 have the old definitions of sepsis and the EBP built into the systems to document and care for patients with sepsis. The issue now, is that the EBP has changed with SEPSIS 3 to include organ dysfunction based on Sequential [Sepsis-Related] Organ Failure Assessment Score (SOFA) (Singer et al., 2016). Recommendations to use codes R65.20 and R65.21 have also been made on the ICD-CM-10 codes to use, because the current codes do not match the new definitions (Singer et al., 2016). Even when a healthcare organization is trying to support EBP within HIT, when changes are made to the EBP it has clinical and billing impacts on the organization.

References

Hanson, D. (2011). Evidence-Based clinical decision support. In M. J. Ball, J. V. Douglas, & P. H. Walker (Eds.),

Nursing informatics: Where technology and caring meet (Fourth ed., pp. 243-258). London New York:

Springer. Nursing Informatics: Scope and standards of practice. (2015). (Second ed.). Silver Spring,

MD: American Nursing Association.

Piedmont Now. (2016). Retrieved from http://www.piedmont.org/patienttools/piedmont-now

Singer, M., Deutschman, C. S., Seymour, C., & et al. (2016). THe third international consensus definitions

for sepsis and septic shock (sepsis-3). JAMA, 315(8), 801-810. doi:10.1001/jama.2016.0287

health information system is an important resource in the healthcare system. With the increase in the demand for quality healthcare services, health information system has been used in the various department to enhance the quality of healthcare services delivered to patients. Both EPIC and EPIC Ambulatory are examples of technological products that can be applied to enhance the quality of healthcare delivery systems (Brundage et al., 2019). SoftLab and Aria are technologies commonly applied in healthcare systems to facilitate the quality of diagnosis and direct the treatment processes. SoftLab is often applied in the provision of quantifiable improvements in workflow efficiencies and clinical outcomes. The system was mainly developed after a careful analysis of some of the problems associated with the delivery of healthcare systems. SoftLab enables clients to achieve high productivity with full multisite consolidation, specimen tracking, as well as management reporting. Both SoftLab and Aria can be used together with the EHR systems to enhance the management of information and measure patient outcomes (Johnson & Ehrenfeld, 2018).

The EHR system is always applied in capturing and managing patient information and facilitating the development of other technological systems such as SoftLab and Aria (Hellems et al., 2021). In my organization, there is always the use of telehealth to enhance communication and the management of digital information. Telehealth often involves a network of computers and mobile devices. These devices can be used by patients to access healthcare services from remote locations. The devices should be carefully configured to reduce technology breaches and enhance efficiency in healthcare delivery processes. The development of technologies to be applied in the healthcare processes all depends on the data that have been collected in the course of healthcare processes; this explains the importance of EHR systems.

References

Brundage, M. D., Barbera, L., McCallum, F., & Howell, D. M. (2019). A pilot evaluation of the expanded prostate cancer index composite for clinical practice (EPIC-CP) tool in Ontario. Quality of Life Research, 28(3), 771-782. https://link.springer.com/article/10.1007/s11136-018-2034-x

Hellems, M. A. (2021). Ambulatory physicians’ electronic health record self-efficacy. JAMIA Open. https://academic.oup.com/jamiaopen/article/4/3/ooaa071/6062732?login=true

Johnson, K. B., & Ehrenfeld, J. M. (2018). An EPIC switch: preparing for an electronic health record transition at Vanderbilt University Medical Center. Journal of medical systems, 42(1), 6. https://link.springer.com/article/10.1007%2Fs10916-017-0865-6

The application of technology in the healthcare system is critical in enhancing patient safety and facilitating workflow. Health information system has been widely used in various healthcare institutions to facilitate the delivery of quality care through the improvement of approaches and general healthcare delivery systems (El-Said & El-Sol, 2018). With the health information systems, organizations have been able to improve communication among the healthcare professional and the entire organizational stakeholders. Communication in the healthcare system is key to success in the diagnosis and treatments. Through the health information systems, it is easier to achieve or improve clinical decision support systems.

The EHR system is one of the technologies used in most healthcare systems to manage patients’ information and generally enhance the quality of healthcare services delivered to patients. With EHR systems, it is easier to develop workflows that can be used to guide healthcare professionals in achieving the best treatment outcomes. The EHR system should be integrated with other systems to ensure a continuous flow of information and data management (Johnson & Ehrenfeld, 2018). Today, quality improvement processes are always based on the healthcare data that have been collected over time through the EHR system and other technological systems.

In my healthcare organization, the health information system facilitates evidence-based practice through data collection to assess the efficacy of interventions and clinical decision support systems and alerts that optimize best practices. Besides, the health information system has been used to develop different technologies such as telemedicine to enhance communication between patients and healthcare providers (Hossain et al., 2019). Telemedicine has been widely used to provide remote healthcare services to patients from different locations. Also, the system has been applied in delivering evidence-based practices.

References

El-Said, A., & El-Sol, H. (2018). Technology into nursing practices: Enhance patient’s outcomes. Mansoura Nursing Journal, 5(1), 191-195. https://dx.doi.org/10.21608/mnj.2018.150637

Hossain, A., Quaresma, R., & Rahman, H. (2019). Investigating factors influencing the physicians’ adoption of electronic health record (EHR) in healthcare system of Bangladesh: An empirical study. International Journal of Information Management, 44, 76-87. https://www.sciencedirect.com/science/article/abs/pii/S0268401218304432 Johnson, K. B., & Ehrenfeld, J. M. (2018). An EPIC switch: preparing for an electronic health record transition at Vanderbilt University Medical Center. Journal of medical systems, 42(1), 6. https://link.springer.com/article/10.1007%2Fs10916-017-0865-6

NURS 8210 Information Architecture