Monica Informatics Plan Implementation.pdf

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Informatics Plan Implementation

Monica D. Sleboda

School of Nursing, Liberty University

Author Note

Monica D. Sleboda

I have no known conflict of interest to disclose.

Correspondence concerning this article should be addressed to Monica D. Sleboda

Email: mdsleboda@liberty.edu

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Informatics Plan Implementation

includes the right team in place to make go-live smooth, a proper budget to support

organization decides on the type of EHR program they want to install, whether purchased,

leased, or built in-house, they will need to devise an implementation plan. This paper will look at

implementation.

Quality and Safety Education for Nurses

The quality and safety education for nurses (QSEN) is a program that helps to guide

nurses in the “what” and “how” they deliver nursing care as well as helps nurses understand the

difference between the “what is” and “what should be” (Flavin, 2018). There are six main QSEN

competencies: quality improvement (QI), safety, teamwork and collaboration, patient-centered

care, evidence-based practice (EBP), and informatics. All six of these competencies need to be

considered when implementing a new EHR system.

Quality Improvement

The basis of any EHR implementation project should be the quality improvement of care

provided by an institution. EHR systems should be able to monitor data in relation to care

outcomes as well as meet reporting requirements as defined by the Centers for Medicare and

Medicaid Services (CMS). Some reporting guidelines required by CMS include central line

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associated blood stream infections (CLABSI), catheter associated urinary tract infections

Safety

computerized provider order entry (CPOE). Requiring physicians to enter their own orders will

reduce errors by ensuring that the physicians orders are standardized, legible, and complete;

2018). CPOE is a core meaningful use objective in both stage 1 and stage 2: stage 1 requires

CPOE for medication orders and stage 2 requires CPOE for medication, laboratory, and

radiology orders (HealthIT, 2018).

Clinical decision support systems (CDS) are another advantage to EHR implementation

in providing safe care for patients. Wiegel et al., (2020), insists that the use of CDS will improve

patient safety and workflow as well as increase efficiency and advance standardization of clinical

processes. The purpose of CDS is to “analyze data within EHRs and to provide prompts and

reminders to assist health-care providers in implementing evidence-based clinical guidelines at

the point of care” (CDC, 2020, para. 1). When applied properly, this can assist physicians in the

proper ordering of tests for any given problem. Many hospitals have implemented CDS when

ordering lab tests for CAUTI’s and CDI screening. When a physician enters an order for the lab

test, the physician must answer a series of qualifying questions to determine if the patient meets

the standards for testing. If the patient does not meet the standards, then the test will be rejected.

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Teamwork and Collaboration

setting which will ultimately improve the coordination of care. Bosch and Mansell (2015), write

(p. 176).

Another aspect of teamwork and collaboration is during the rollout of an EHR system. By

transition to a new EHR system. Proper leadership and support prior to and during the rollout

process can help facilitate buy-in from all other team members. Providing leadership will also

ensure that implementation teams function in a cohesive manner and provide the proper support

to clinical staff (Nelson & Staggers, 2018).

Patient-Centered Care

Patient-centered care should be at the forefront of any EHR rollout. When transitioning to

a new system it is imperative that patient care continue uninterrupted. Therefore, many facilities

will do a phased rollout, which means that certain features will open in a stepwise approach or

certain sectors of the hospital, such as emergency room (ER), new patients, operating room, etc.,

will go-live first. A phased rollout, also known as an incremental approach, has been proven to

improve physician and staff satisfaction while also allowing for the identification and correction

of any system glitches or gaps (Aguirre et al., 2019). Once these glitches and gaps in care have

been corrected the rollout will continue slowly to other units. There are many advantages and

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disadvantages to the incremental rollout, as well as the immediate rollout, that facilities need to

implementation phases on track, close attention to hybrid processes, and awareness of the

Evidence-Based Practice

EHR systems can support EBP in several ways, including identifying patients who are at

the hospital, the system should be able to flag whether they are at risk for any of the above listed

issues. If a patient is on any of the fall causing medications the system should automatically flag

the nurse and physician of this as well as trigger a care plan item and teaching opportunity for the

patient. Another goal for EHR implementation is to allow for “information technologies to

translate scientific evidence-based care into interface representations that make the practical

implications of this evidence for clinical decisions salient to or more accessible for practitioners”

(Flach et al., 2018, p. 30). The ultimate goal of any EHR system is to support evidence-based

clinical practice and research.

Informatics

EHR systems should be able to communicate with other interfaces and technology,

reduce errors, and support decision making among staff. The Public Health Informatics Institute

(2020) insists that in order to be informatics-savvy, a facility must have an overall vision and

strategy got how they use their information and information technology, a skilled workforce, and

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a well-designed and effectively used EHR system. With the proper use of the EHR system, a

professionals, to ensure a smooth rollout of the new EHR system. Using guiding principles will

development of an installation roadmap that will meet the needs of the facility, develop effective

governance and accountability, and improve the efficiency of workflow (PHII, 2019). The rollout

system, and develop a plan to for entering information into the system as the need arises. An

EHR Implementation checklist would be a valuable tool to have in place prior to go-live.

Health IT Policies

When implementing a new EHR system it is important to understand the rules and

regulations which drive the use as written by the government and other entities. Patient privacy is

of utmost importance when considering the use of any EHR system. Therefore, it is important for

strict IT policies to be put in place that will protect the unintended release of protected health

information. The IT department must establish rules within the system that determine which staff

can access certain information. For example, if a high-profile patient is admitted to the hospital,

there needs to be regulations and policies written to protect that individual from others accessing

their health information who have no business accessing said information. Some systems require

the use of 2-person authentication for access to verify the need is there. Many systems will also

allow for reports to be run to identify individuals who have accessed medical records to

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determine if the individual had the right to do so. The Health Insurance Portability and

activities. Policy should also be written to prevent the use of unauthorized electronic resources

such as universal serial buses (USB). Security should be at the forefront of any EHR

development and implementation in order to protect patient privacy and work controls.

implementing an EHR system. One such ethical consideration is the use of collected health

information for research purposes. When gathering patient data for research from any EHR

system it is important to ensure proper removal of any protected health information and

personally identifiable information. With the implementation of electronic medical records, this

has allowed for beneficial studies to be performed with the use of large, complex data sets from

multiple entities (U.S. Department of Health and Human Services, 2015). In order to protect

individuals from identification in a research study, it is important for proper deidentification to

be performed. There are two methods in which organizations may deidentify personal data in

accordance with the HIPAA Privacy rule: expert determination and safe harbor. The U.S.

Department of Health and Human Services (HHS) define expert determination as a process in

which health information that does not identify an individual is removed to the point where a

covered entity, the expert, is not able to identify the individual involved. The second method,

safe harbor, requires the removal of 18 types of identifiers including name, geographic

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information, telephone numbers, device identifiers, email addresses, medical record numbers,

Potential Benefits

patient medical information, more coordinated, efficient care, better safeguards in medication

prescribing, improved efficiency and reduced costs through reduced test duplication and

their own care. By implementing services such as mobile health, wearable technologies, and

telehealth systems within the EHR, information can be shared even faster.

Another benefit of implementing an EHR is meeting meaningful use guidelines

implemented by the Medicare Access and CHIP Reauthorization Act (MACRA). The term

“meaningful use” came into play when the Health Information Technology for Economic and

Clinical Health (HITECH) act was signed into law. The purpose behind this act was to ensure

that healthcare providers integrated EHRs into their practice in a meaningful way and by doing

so the providers were reimbursed with an incentive program for care provided to their patients

(Nelson & Staggers, 2018). HealthIT.gov (2013) reports that for eligible providers and hospitals

to demonstrate meaningful use they must be able to demonstrate electronic data capture and

sharing, advanced clinical processes, and improved outcomes.

Conclusion

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Electronic Health Record implementation can be a long and tedious project for any

much smoother by giving direction on important issues to consider such as quality improvement,

informatics. The goal of any EHR should be quality of care improvements as demonstrated

through meeting meaningful use guidelines. Prevention of hospital acquired conditions such as

care. Once implemented they can also assist in research while protecting patient privacy. There

are numerous ethical issues that need to be considered though before using EHR information in

research. Patient health information protection is most important when using data collected from

an EHR for research. There are laws in place, such as HIPAA, that dictate how and when patient

data may be used. Therefore, it is important to understand and follows these regulations to

protect the organization from lawsuits. Finally, it is of utmost importance to have strong security

policies in place to prevent unintended downtime from malicious malware that has been

introduced to the system by unknowing employees who are accessing unapproved websites.