Fielder Medical Center Scenario:
You are the manager of Western View Hospital’s health information management (HIM) department at your local community hospital located in Boulder, Colorado. The director of HIM has asked you to research and write a report on HIM quality improvement projects at another hospital in preparation for developing HIM quality improvement projects at your hospital. You have chosen Fielder Medical Center located in New York. Listed below are their current quality improvement projects:
High Quality Reliable Care
To assess the quality of our care, we monitor both processes (the way we deliver your care) and outcomes (the results of your care). For instance, one CMS-endorsed process measure focuses on how well we equip heart failure patients to continue their own care once they’ve returned home. In light of this, we’ve paid keen attention to ensuring more thorough in-hospital education about the importance of consistently monitoring symptoms. Fielder Medical Center has access to a robust, real-time database that compares its quality outcomes with those of more than 100 academic medical center peers.
- Rescuing Patients with Severe Sepsis/Septic Shock
When a patient has an infection, sepsis may occur. Sepsis is an inflammatory response throughout the body caused by chemicals released into the bloodstream to fight the infection. Fielder Medical Center has joined state agencies in working to prevent mortality from severe sepsis and septic shock. In 2013, best practice “bundles” to identify and treat adults and children with sepsis were developed by our teams of doctors and nurses. These bundles were implemented in 2014 and, since then, we have been collecting data to measure compliance with the best practices for each of our patients. These efforts have shown a reduction in mortality related to severe sepsis and septic shock.
- Reducing Avoidable Readmissions: Striving for Safe Transitions
Readmissions place undue physical, emotional, and financial burden on our most vulnerable patients, but national data show that nearly one in five Medicare patients will wind up back in a hospital within just 30 days.
Eager to provide our patients with more effective care—and safer, more seamless transitions back to their home or a skilled nursing facility— Fielder Medical Center continues an ambitious effort to improve the discharge experience.
A key component of this effort involves identifying patients who are particularly at risk for readmission (for instance, patients who’ve been readmitted in the past, or who have certain conditions like congestive heart failure or pneumonia), and then taking extra measures to support their discharges. The program empowers patients and families, providing more robust patient education about medicines (their unique purposes, potential side effects to watch for, etc.).
Exceptionally Safe Care
Fielder Medical Center strives to provide exceptionally safe care by promoting a culture that emphasizes the role of all doctors, nurses, staff, patients, and families in being members of the care team who will speak up to address safety concerns. Teams throughout Fielder Medical Center are now working diligently to prevent three specific types of infections through consistently practiced “bundles” of preventive measures.
- Central Line-Associated Blood Stream Infections (CLABSI)
While central line catheters are life-saving lines that deliver medicine, hydration, and nutrition to patients, historically, they have also been a prime target for bacteria. These dangerous bloodstream infections affect hospitals nationwide, putting patients at risk for potentially avoidable pain, distress, and even death.
Because of our proven track record in creating best-practice care-bundles that dramatically reduced ventilator-associated pneumonias at Fielder Medical Center, another ICU team was tapped to help eliminate catheter-associated bloodstream infections. The team pored over research, working diligently to develop two simple, cost-effective best-practice checklists—one for catheter-insertion, and another for line maintenance. Called “Stop the Line,” this new push to retrain staff in a more careful, consistent approach to catheter insertion and care (the program also empowers every team member, from unit secretary to physician, to speak up if they think the sterile environment has been compromised) was rolled out to all staff via mandatory education sessions. The results were striking—in just 18 months, infections dropped nearly 50 percent, bringing Fielder’s rates below the national average.
- C0atheter-Associated Urinary Tract Infections (CAUTI)
Another type of indwelling catheter is often used to remove urine from the bladder when a patient undergoes surgery or is unable to move easily. These catheters may cause a urinary tract infection in the bladder or kidney if germs travel along the catheter. Preventing catheter-associated urinary tract infection is important to help our patients’ avoid unpleasant symptoms, excessive antibiotic use, more serious complications such as sepsis, and extended time in the hospital.
Building on the previous successes with other types of infections related to medical devices used in the hospital, we currently have a team of doctors, nurses, and other caregivers identifying and implementing best practices regarding prevention throughout the hospital. This team has worked in a collaborative with other hospitals to obtain as current information as possible regarding effective strategies to address this complication.
The team has focused on encouraging the use of alternatives to urinary catheters and educating doctors and nurses about the importance of removing the catheter as quickly as possible during the patient’s stay in the hospital. Improvements have been made to ensure that sterile technique is consistently adhered to in the placement and maintenance of the catheters. These efforts are beginning to show success as the number of catheter-associated urinary tract infections at Fielder Medical Center has been decreasing.
- Surgical Site Infections (SSI)
Infections that follow surgery, in the part of the body where the surgery took place, can sometimes be superficial, involving the skin only. Other times, these surgical site infections (SSI) are more serious, harming tissues under the skin, organs, or even implanted materials.
At Fielder Medical Center, the initial focus was on preventing surgical site infections among our cardiac surgery patients. Cardiac care leaders at Fielder have been successfully reducing rates of SSI after coronary artery bypass graft surgery (CABG) since 2008 through a comprehensive program to root out all potential infection sources.
Health Information Management in Projects
Health Information Management (HIM) is currently among the most important aspects in the healthcare sector. HIM, which is described as the acquisition, analysis, and protection of both the digital and conventional information in a medical facility, is aimed at enhancing the quality of care provided by the organization. HIM is identified as the combination of science, business, and information technology which are the current trends across various sectors indented to achieve organizational goals and objectives (Cresswell & Sheikh, 2013). For Fielder Medical Center, despite the introduction of various quality improvement strategies, there is need to integrate HIM which will in turn further enhance the quality of patient care. This is through assisting in accessing records, promoting safety of patient data and analyzing records for accuracy. This report entails enhancement of this center with regards to the current quality improvement projects.
High-Quality Reliable Care
Across all approaches, computerized care should be implemented. With the center’s accessibility to a robust and real time database that compares quality outcomes with those of more than 100 academic medical centers peers, it will be important to have patients’ information integrated into this system. One of the main approaches for heart patients is consistent monitoring. In this regard, patients, regardless of their location, should have a connection to the center’s database. This brings to the fore the need to have a system that all patients have an account on the organizational website. As a result, they can register information regarding their recovery to this site which can further be used to track their progress. Similarly to eHealth, these patients will have a 24-hour connection with Fielder’s healthcare professionals where they can interact while making queries regarding their health (Price et al., 2014). This approach is applicable to all other conditions including patients with severe sepsis. The information collected to measure compliance with profound approaches for every sepsis patient should be stored in their accounts and related to other medical records. At this point, this report assumes that Fielder center has implemented the electronic health recording (EHR) system where the patient’s health records including their demographics are stored for easy retrieval. The data collected from various setups should be analyzed effectively and provide reports for future development of effective intervention strategies. One of the major recommendations in this regard is installation of data analysis tools that evaluate the collected information.
Safety concern has been mentioned in several situations including readmissions. One of the main challenges identified on patient’s safety which transcends their outcome is readmission. The winding up of these patients within 30 days after admission can be attributed to less information analysis about their conditions. There is need to implement data analysis tools in the admission process which will analyze probability of readmission (Mi et al., 2017). In addition, even after discharge, it will be important for the Center to keep in touch with patients and monitor their progress. This will also involve providing information regarding their health and how they can self-manage different emergency situations. This brings to the fore the issue of patient education. eHealth, in this regard, comprises integration of patient education in the program whose implementation should be fostered (Kontos et al., 2014). This report, therefore, proposes web based application on patient self-management. In this approach, it is centered on integrating vital information about the patient’s care and approaches through which they can enhance their health. Such include reduction of risk factors.
Patient education is considered an effective strategy in preventing health related complications through equipping them with vital knowledge on how they can contribute to their recovery. In this case, the web based application incorporates educational programs where patients are provided with relevant information regarding their health (Murdoch & Detsky, 2013). The web based approach is characterized by availability of technologically advanced devices and the internet entail patients having access to the Center’s website and database, and conducting the recommended approaches that enhance their health. Patients also have the flexibility of making queries to the website about anything including medication, prescription, and emergency approaches. Further, there is an option to interact with medical practitioners which is further aimed at increasing their knowledge on different health aspects.
Exceptionally Safe Care
As mentioned in the improvement projects, another major requirement in enhancing the quality of care provided to the patients is having an all-inclusive decision making approach. This is centered on the different health care providers convening either physically or virtually to deliberate on the presented situation. In this case, implementing technology would involve virtual decision making approach that considers different healthcare providers’ ideas. The merits of this approach is that vast information regarding a patient’s condition will be presented upon which the involved healthcare providers will deliberate on the subject and make the best decision (Price et al., 2014). While acknowledging the patient centered model, a major aspect of delivering quality health care is incorporating families in decision making process and management of conditions, particularly if the patient is discharged and other management strategies are to be conducted at home. Fielder Medical Center identifies three major infections that require effective prevention strategies. These include the central line-associated blood stream infections (CLABSI), catheter associated urinary tract infections (CAUTI) and surgical site infection (SSI). While enhancing the safety of patients fitted with these elements, a HIM that needs to be put in place one that records different situations of a patient, analyzing and consideration findings while developing further medical intervention strategies. In addition, recording information associated with these approaches is critical for evaluating the trends and considering new management approaches.
Coordination of the various healthcare providers at Fielder Medical Center from the experienced physicians to students also requires enhancing the HIM. Various evidence based practices have recommended the use of mentoring and sharing of patient’s information on a single platform. Mentoring, in this regard, involves experienced medical practitioners sharing their information and knowledge with others and in particular young individuals in terms of practical experience. Web based mentoring approach is, therefore, recommended where various health care providers will have access to the Center’s website and learn from it. While still considering the issue of quality, it is important for health care providers to have knowledge of the current practices and guidelines governing health care sector in the country. Web based application that has all this information will be essential for enhancing these professionals’ knowledge and ideas on practice guidelines (Murdoch & Detsky, 2013). The issue of medical practitioner education is also essential as well as how the uptake of EBPs can be improved. As a result, telehealth is essential since it is centered on educating healthcare providers on various issues important for Fielder Medical Center. Another recommendation for this Center is the need to integrate all systems into one. This ensures various data entries are accessed from multiple points. For instance, the EHR should be linked to the web based applications on different aspects such as patient monitoring and education. This provides an easy time for medical practitioners to access patient’s information in case of an emergency. In addition, this is critical in the development of multiple reports that can be used to analyze the progress of the Center while developing profound intervention strategies
In conclusion, the importance of HIM in health care is noted in various applications from improving the quality of care through coordination of health care professionals to enhancing healthcare literacy. It is, therefore, imperative for organizations to implement HIM among other quality improvement approaches. With communication and patient’s data being the major aspects in HIM, it is important for health care organizations to consider education and enhancing patient based approach in the intervention strategies which further improves the quality of care provided. The above discussion entails how Fielder Medical Center can enhance its activities through integrating enhanced HIM approaches in quality improvement projects. As recommended in the report, the Center should adopt various HIM strategies from the web based applications to telehealth and data analysis tools. This will aid in consolidating vast information, enhance both the patient and healthcare providers’ education strategies and effectively analyze data to provide reports that can be used to develop effective intervention approaches.
Cresswell, K., & Sheikh, A. (2013). Organizational issues in the implementation and adoption of health information technology innovations: an interpretative review. International journal of medical informatics, 82(5), e73-e86.
Kontos, E., Blake, K. D., Chou, W. Y. S., & Prestin, A. (2014). Predictors of eHealth usage: insights on the digital divide from the Health Information National Trends Survey 2012. Journal of medical Internet research, 16(7).
Mi, H., Huang, X., Muruganujan, A., Tang, H., Mills, C., Kang, D., & Thomas, P. D. (2017). PANTHER version 11: expanded annotation data from Gene Ontology and Reactome pathways, and data analysis tool enhancements. Nucleic acids research, 45(D1), D183-D189.
Murdoch, T. B., & Detsky, A. S. (2013). The inevitable application of big data to health care. Jama, 309(13), 1351-1352.
Price, M., Yuen, E. K., Goetter, E. M., Herbert, J. D., Forman, E. M., Acierno, R., & Ruggiero, K. J. (2014). mHealth: a mechanism to deliver more accessible, more effective mental health care. Clinical psychology & psychotherapy, 21(5), 427-436.