The Benefits of Integrating Health Information Technology in Doctor of Nursing Practice

Answer

The Benefits of Integrating Health Information Technology in Doctor of Nursing Practice

Integration of established technologies and informatics tools is essential in the 21 century healthcare environment, which has become increasingly complex and dynamic (Schoville, Shever, Calarco & Tschannen, 2014).  Informatics and technology have the potential to bring significant changes in nursing care through reduced errors and costs, enhanced quality access to care, speedy and accurate decision making and data exchange, diffusion of knowledge, among myriads of other benefits (Cashin, 2010).  Given the dynamic nursing environment, nurses can no longer rely on traditional or habitual ways of handling patients’ records and information in the new age (Cashin, 2010). There is need, therefore, for professionals in the healthcare, especially nurses, administrators and other practitioners not just to enhance their understanding or nursing informatics and technology, but rather translate research evidence regarding nursing informatics into daily clinical practice for quality service delivery (McGonigle, Kirkwood, Mastrian, & Rich, 2014). To improve overall quality in health care service delivery, integration of informatics and information technology in the healthcare system presents a multitude of opportunities to address clinical care problems more timely and at a reduced cost, hence the rationale for synthesizing research in this area and the evidence thereof into daily clinical practice (McGonigle et al, 2014).

A plethora of research evidence and published journals on electronic health records (Schoville et al, 2014), but regardless of the number of research and discoveries made on the field or the quality of evidence generated, this remains unhelpful to patients if it just remains on published journals (White & Dudley-Brown, 2011). Synthesis and uptake of such evidence and translating them in the nursing practice for the benefit of the patients and the entire healthcare system remains just as vital as the evidence itself if not more (White & Dudley-Brown, 2011). The aim of this project is thus to translate the evidence regarding the application and integration of EHRs in nursing practice for enhanced management of diseases, particularly chronic ones, reducing costs, enabling access to quality care, reduction in medical errors, enhanced care, patient safety, among other myriads of benefits. The evidence presented in this project shows the myriads of benefits that can be accrued through the integration of EHRs in nursing practice. Various researchers have reiterated and conducted studies that indicate the benefits of integrating electronic health records in nursing practice. For example, in a study that was conducted in the United States in Acute care hospitals by Appari, Eric and Anthony (2013), it was discovered that EHRs significantly improved the quality of care and services extended to patients, as well as overall costs of healthcare. Through incremental transitions into using EHRs, Appari et al (2013) the quality of processes and services were greatly enhanced because the system enabled hospitals to manage health information more effectively and efficiently. The study was conducted in eight hospitals of different levels and sizes.

The quality of services provided was measured using a 100 point scale in assessing changes in quality in service delivery and care for chronic diseases including heat failures and heart attacks, pneumonia, and in surgical procedures. Evidence was generated through collection of data from acute care hospitals in the US for a period of eight years (2006 to 2013). The paragraphs that follow shall provide a description the evidence behind the multiple of benefits derived from implementing and integrating electronic health records in the health care system, particularly in the management of chronic diseases. Next shall be a presentation of the selected evidence backing the need for integrating EHRs in the care system for quality outcomes.

Description of Evidence

One of the core competencies required of the a nurse and any other healthcare professional for that matter is the use of informatics for knowledge management, provision of quality care, patience safety, decision making, among many other uses that enhances service delivery to patients in terms of efficiency, accuracy and reduced costs (White & Dudley-Brown, 2011). Nursing informatics involve the management of data, information, and knowledge by integrating nursing science and information technology (White & Dudley-Brown, 2011). Through nursing informatics, nurses and other health care professionals are able provide timely, accurate, and cost effective quality service and care to patients. To add on to this, informatics and application of information technology assists data and knowledge generation, storage and analysis and even facilitate the implementation of knowledge translation through effective knowledge management (White & Dudley-Brown, 2011). Informatics and information technology therefore are crucial in as far as closing the gap between knowledge and discoveries, and evidence based practice where new knowledge, research or evidence is translated in nursing practice to provide a care system that is not just high in quality, but also conscious to the patient’s values and best interest. Electronic health records in particular, which shall be the main concern of this project, through various research publications, have been found by a number of scholars in studies to have the potentials of changing the quality of care that patients receive (reduced errors, speedy decisions) (White & Dudley-Brown, 2011).  The study that was conducted by Appari et al in 2013 evidences that the use of electronic health records systems in nursing practice has a positive bearing on the quality care that the healthcare system extends to patients, particularly in the caring and management of chronic diseases and acute health conditions such as heart failure. The evidence was generated from a panel data analysis, in which the data was obtained from three main sources: Hospital Compare, Health Information and Management Systems Society Analytics, and also from the In-patient Prospective Payment system for the year 2006 to 20110 (Appari et al, 2013). The sample that was used in the study for generation of evidence was draw from 3,921 hospitals in the US that dealt with patients in need of acute care. The information regarding the EHRs system comprised of data within the years 2006 to 2010, a period of five years. Data that was collected from these hospitals was on quality process care and general performance of the hospitals based on the use of EHRs system. The sampled hospital’s HER levels, process quality, and market characteristics were some of the measurements that were taken on the 100 point scale. The obtained data were then subjected to a statistical analysis to ascertain the effects of HER system on the quality process of acute care patients. Results provided evidence that hospitals that increased their level of transition of EHRs recorded higher quality process outcome indicating that the EHRs had positive impacts by improving the quality of services extended to patients. This was seen through faster decision making, reduced errors, diminishing costs, speedy information retrieval and enhanced exchange of in among other benefits (Appari et al, 2013). The findings in this study have been replicated in other studies by other scholars as well. For example, Adler-Milstein, Salzberg, Orav, Newhaouse, and Bates (2013) conducted a longitudinal study involving the effects of electronic health records and the study revealed that indeed electronic health records have benefits especially significant reduction in healthcare costs.  Their study was conducted between the years 2005 to 2009 in 806 ambulatory clinics around the US and its was found that HER actually slowed down the ambulatory costs in the healthcare system (Adler-Milsten et al, 2013). Additionally, in a systematic review from the United Kingdom Biobank by Woodfield, Grant, and Sudlow in 2014, aimed at finding out the accuracy of EHRs in the identification of stroke cases, found out that EHRs improved efficiency in the diagnosis of diseases, especially for stroke case b more than 90%. The study examined publications from the year 1990 up to 2013. This systematic review added on to the evidence that indeed EHRs stem in a hospital has multifaceted benefits and improvement of quality of care given to patients. Rezaibagha, Khin, Susilo (2015) also did a systematic review regarding the security of EHRs systems in the healthcare system through examining published articles between 1998 up to 2013. Their review illuminated the importance of integrating EHRs systems in health care for overall improvement in the security and safety of patient’s records (Rezaibagha et al, 2015). In a cost benefit literature review conducted by Schoville, Shever, Calarco, and Tschannen in 2014, it was found out that EHRs among other benefits had a costs befit advantage by reducing on costs of healthcare. Integrating EHRs, therefore, according to Schoville and company are essential in as far as not just reducing costs, but also additional benefits such as increased standardization, and speedy decision making (Schoville et al, 2014). There are other areas of disagreements among some other scholar about the benefits of integrating EHRs system in nursing practice. For example, in a study conducted by Muhammad-Zia, Telang and Marella in 2014 to find out the relationship between electric health records and patient’s safety, it was found out that while EHRs have the benefits of reducing costs, EHRs were highly susceptible to management errors and other risks that could compromise patient’s safety and confidentiality, particularly in cases of mismanagement (Muhammad-Zia et al, 2014).

Proposed Management Structure

The evidence for multi-benefits that can be obtained from integrating and implementing electronic health records in the healthcare system have been highlighted by in numerous studies by a number of scholars. The evidence by itself is, however, not beneficial or of use to patients and the entire healthcare system unless it is implemented and put into the nursing practice (White & Dudley-Brown, 2011). While several healthcare centers have implemented EHRs in their system, the idea is yet to be implemented in many other health facilities globally. Incremental transitioning, integration and implementation of EHRs system require a change management plan and management strategies effective in the integration of EHRs system into nursing practice. A proposed management change for the integration of EHRs system in an organization for this project would employs the Donabedian framework of structure-process-outcome

Structural changes

Implementation and integration of electronic health records in a health organization requires a change in the existing structure of an organization. The first step to achieve this is selection of an implementation team that is designated with various functions for smooth implementation and integration of EHRs system (Fowler, Yaeger, Yu, Doerhoff, Schoening & Kelly, 2014). Transferring the EHRs evidence into practice would require structural changes, where work flow is analyzed and redesigned. The old system of paper based records would need to be changed and replaced with the EHRs system. This would require data entry, scanning, and other procedures so as to transfer the record from paper based form to Electronic records. The physical structure and old facilities that were previously in use would need to be replaced to reflect the current uptake. The culture of the organization would also need to be changed for quality improvement using the EHRs to take place. Management especially the leadership would have to play a leading role in encouraging the new practice to be adopted throughout the organization. Others changes such as organizational redesigning and provision of incentives for those who apply the new system in their practice would help speed up the integration process. The nurses and other healthcare workers would need undergo training on the use of the new implementation of EHRs to build skill on adoption and usage.

Process

The implementation process would be successful following successful structural changes in a healthcare organization adopting the EHRs. Upon translation or implementation of the EHRs in an organization, certainly there would be changes in the process of the hospital regarding the health records of the patients. The process of how records are handled would thus also change and this is facilitated by changes in organization’s practices. For example, nurses and other staffs in the organization would need to be involved in the implementation, assessment of polices and how work generally flows. Training of staff upon would also need to be undertaken so as to ensure that there is no resistance to changes due to a feeling of incompetency in the change of processes within the health institution. Informatics, particularly EHRs have the potential to not just to change diagnosis processes and treatment of patients (Alexander, 2007). Diagnostic process would be made more accurate with reduced errors hence improving on diagnosis accuracies (Alexander, 2007). For example, electronic health records have been found to dramatically enhance the accuracy of which hospitals are able to identify stroke cases as well as the pathological types of the disease because of accurate evaluation of data made possible with the use of EHRs system (Woodfield et al, 2015). Since the change in process would also involve a transition from paper based to computerized documentation, DNP have a role to ensure that they increase their skills and knowledge of the use and application of the since this would make them implement the new move for a more sustainable EHRs system in their respective institution of practice (Sheridan, Williams, Wyatt, Krauskopf, Gardner, Jones & Design, 2012). There would also be increased reduction in the costs of healthcare, better coordination of care process, increased privacy, safety, efficiency and overall quality of health care services (Sheridan et al. 2012). For sustainability, advanced practice nurses (APN) have a vital role to play when it comes to managing the EHRs.

Outcome

As evidenced by various scholars in different research publications, putting EHRs into practice or their implementation and integration in a healthcare institution has positive outcomes for the entire health fraternity, but importantly to the quality of services extended to patients. For example, implementation of EHRs would come along with positive outcomes such as increased accuracy in the diagnosis of disease, minimizing chances of errors and misdiagnosis (Fowler et al, 2014). Some of other positive outcome would include improved care to patients, reduced medical errors, and easier exchange of information among the nursing staff (Sheridan et al. 2012). Current evidence on EHRs emphasizes the importance of their implementation for speedy and more accurate clinical decision making (Fowler et al, 2014). 

In conclusion, the healthcare organization is keen on implementing and integrating EHRs in the daily practices and numerous studies and evidence generated emphasize the benefits accrued by this move. However, the uptake of such evidence and their translation has been slow among APN and this projects reiterated the benefits that would be derived by their adoption into daily nursing practice. While numerous evidence exists regarding the benefits of EHRs implementation, this does not automatically translate such findings into practice and so conscious plan need to be put in place to evaluate the evidences weight them and translate then into nursing practice to realize their full benefits. Change management is essential when introducing such new technologies and as plan for structural and process changes has to be addressed, as well as the expected outcomes.