Week 4 Case Studies

post-menopausal women with abdominal obesity. Int J Med Inform. Jan 20 2012.

61. Shade SB, Steward WT, Koester KA, Chakravarty D, Myers JJ. Health information technology interventions enhance care completion, engagement in HIV care and treatment, and viral suppression among HIV-infected patients in publicly funded settings. J Am Med Inform Assoc: JAMIA. 2015;22(e1):e104–e111.

62. Bowles KH, Dykes P, Demiris G. The use of health information technology to improve care and outcomes for older adults. Res Gerontol Nurs. 2015;8(1):5–10.

63. Dowding DW, Turley M, Garrido T. The impact of an electronic health record on nurse sensitive patient outcomes: an interrupted time series analysis. J Am Med Inform Assoc: JAMIA. Jul-Aug 2012;19(4):615–620.

64. Dykes PC, Carroll DL, Hurley A, et al. Fall prevention in acute care hospitals: a randomized trial. JAMA. 2010;304(17):1912–1918.

65. Fossum M, Alexander GL, Ehnfors M, Ehrenberg A. Effects of a computerized decision support system on pressure ulcers and malnutrition in nursing homes for the elderly. Int J Med Inform. 2011;80(9):607–617.

66. Fossum M, Ehnfors M, Svensson E, Hansen LM, Ehrenberg A. Effects of a computerized decision support system on care planning for pressure ulcers and malnutrition in nursing homes: an intervention study. Int J Med Inform. 2013;82(10):911–921.

67. Garrett J, Wheeler H, Goetz K, Majewski M, Langlois P, Payson C. Implementing an “always practice” to redefine skin care management. J Nurs Adm. 2009;39(9):382–387.

68. Riggio J, Sorokin R, Moxey E, Mather P, Gould S, Kane G. Effectiveness of a clinical-decision-support system in improving compliance with cardiac-care quality measures and supporting resident training. Acad Med. 2009;84(12):1719–1726.

69. Schnipper JL, Linder JA, Palchuk MB, et al. Effects of documentation-based decision support on chronic disease management. Am J Manag Care. 2010;16(12 Suppl HIT): SP72–SP81.

70. Day R, Roffe D, Richardson K. Implementing electronic medication management at an Australian teaching hospital. Med J Aust. 2011;195(9):498–502.

71. Dykes P, Carroll DAH. Fall TIPS: strategies to promote adoption and use of a fall prevention toolkit. Paper presented at AMIA Annual Symposium. 2009.

72. Schnipper JL, McColgan KE, Linder JA, et al. Improving management of chronic diseases with documentation-based clinical decision support: results of a pilot study. AMIA Annu Symp Proc. 2008;1050.

73. Ingebrigtsen T, Georgiou A, Clay-Williams R, et al. The impact of clinical leadership on health information technology adoption: systematic review. Int J Med Inform. 2014;83 (6):393–405.

74. Office of the National Coordinator for Health Information Technology. Interoperability Standards Advisory, Draft for Comment; 2015. https://www.healthit.gov/standards-advisory/ 2016.

75. The Leapfrog Group; 2015. http://www.leapfroggroup.org/home.

DISCUSSION QUESTIONS

1. The U.S. Department of Health and Human Services Agency for Healthcare Research and Quality has identified seven Portfolios of Research. The full list can be viewed at http://www.ahrq.gov/cpi/portfolios/index.html. Two of the Portfolios of Research that are of key importance to this chapter are (1) Health Information Technology and (2) Patient Safety. Describe how these two Portfolios of Research relate to the ONC’s Health Information Technol- ogy Patient Safety Action and Surveillance Plan: June 2013 (Washington, DC: Office of the National Coordinator for Health Information Technology, 2013).

2. What is the utility of Donabedian’s structure-process- outcome model as the basis for evaluating quality of care and patient safety associated with a health IT application? Describe two limitations. Discuss how the framework for patient safety and research design can be used to overcome these limitations.

3. Use the framework for patient safety and quality research design to create a comprehensive plan to support success- ful implementation of Bar Code Medication Administration.

4. The Office of the National Coordinator (ONC) is taking actions on health IT and patient safety as described in their Health IT Patient Safety Action and Surveillance Plan by improving the safe use of health IT, learning more about the impact of health IT on patient safety, and leading to create a culture of shared responsibility among all users of health IT. A description of this initiative is located at https://www.healthit.gov/policy-researchers- implementers/health-it-and-safety. Describe the implica- tions of this initiative from an interprofessional prospec- tive for either your current work setting or that of the case study presented later.

CASE STUDY

Western Heights Hospital (WHH) is a 1125-bed, 5-hospital academic healthcare system servicing central and western Massachusetts. WHH is the only designated Level I Trauma Center for adults and children in the area and is home to New England’s first hospital-based air ambulance and the region’s only Level III Neonatal Intensive Care Center. WHH launched a 5-year strategic plan with a fundamental goal of a system-wide move from a predominately paper environment to an electronic one. Phase I included

implementation of an EHR system consisting of order entry for all laboratory, radiology, and patient care orders. Addi- tionally, clinical documentation was implemented, includ- ing admission assessments and all nursing flow sheets. The nursing informatics counsel, a 25-member group of nurses representing all disciplines, developed the clinical content. The clinical content was custom built using both free text and structured data entry fields within the application.

420 UNIT 5 User Experience, Standards, Safety, and Analytics in Health Informatics

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Three months after go-live, hospital leadership is reporting that it is unable to report on various state and federally man- dated quality measures. These measures track healthcare qual- ity based on national standards, are compared to nationally accepted benchmarks, and are used to plan ways to improve quality. Leadership has communicated that the reports gener- ated by the system are incomplete and are putting the hospital at financial risk due to lower reimbursement rates.

Clinicians are eager and excited to continue to develop content in the application. However, the project’s program manager is proposing a stabilization and optimization approach and does not want to go forward with content development until the issue of reporting has been assessed and addressed.

Discussion Questions 1. Assuming that you are the clinical content manager and

lead all reporting efforts, what approach would you take to address the reporting problem?

2. Preadmission testing data are currently collected on paper. The chief of surgery has identified an opportunity to have these data collected in the new EHR system by the preadmis- sion testing area in the outpatient setting. Many of the col- lected data elements are shared with the current admission assessment. Describe how this effort can be approached. What methods can be used to implement the process?

3. Using the PSQRD methodology, identify an area of quality improvement in the hospital setting, develop a process plan, and identify the expected outcomes.

421CHAPTER 24 Patient Safety and Quality Initiatives in Health Informatics

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