NUR 514 Benchmark Electronic Health Record Implementation Paper

NUR 514 Benchmark Electronic Health Record Implementation Paper

An electronic health record (EHR) refers to an electronic form of the traditional patient’s medical file kept by the health provider over time. It contains information from administrative and clinical encounters between patients and their health providers during patient care. The EHR also supports other patient care-related activities through interfaces, such as evidence-based decision support, outcomes reporting, and quality management (Schopf et al., 2019). This paper aims to discuss components of designing and implementing the EHR, the professional, ethical, and regulatory standards that should be incorporated, and leadership skills needed for collaboration of the interprofessional teams.

Key Information Needed in the Database to Track Opportunities for Care Improvement

The EHR support providers make better decisions and improve patient care quality. It achieves this by improving the accuracy and clarity of medical information, which reduces the occurrence of medical errors (Schopf et al., 2019). The EHR also makes health data available and easily accessible, reduces duplication of services, reduces treatment delays, and empowers patients to make better health decisions. Patient information is needed in the EHR database to help identify opportunities for patient

NUR 514 Benchmark Electronic Health Record Implementation Paper Online

improvement. The key patient information includes demographics, current medical problems, past medical and surgical history, medications, vital signs, immunization history, progress notes, laboratory results, and imaging reports (Schopf et al., 2019). The information can predict a patient outcome which helps to provide appropriate interventions to achieve the best possible outcomes (Schopf et al., 2019). It can also identify risk factors for a disease or complications and guide providers to take prior preventive interventions.

Role Informatics Plays in the Ability to Capture This Data

Informatics deals with computational systems, particularly with systems that involve data storage and retrieval. The role of informatics in facilitating the capturing of the data in EHR databases includes providing tools with clinical and operational applications that help health organizations capture health information in EHRs to advance medical care (Aguirre et al., 2019). Informatics help organize patient data collected from a myriad of devices and systems such as electronic medical records, patient portals, health tracking devices, and diagnostic systems (Aguirre et al., 2019). Informatics captures the data from all these devices, which is usually in different formats, and converts it to a single format stored in the database. For instance, database management systems have programming interface applications that transmit connections between databases and are used to process complex health information across various platforms.

The Systems and Staff Members that Would Need to Be Involved in the Design and Implementation Process and Team

Implementation of the EHR will entail handling a wide range of medical information across various medical settings. Therefore, it will be important to incorporate a range of systems that will convert the information in real-time and upon request. Systems that will be required in the EHR include Documentation system, Billing and reimbursement system, E-prescribing, and Report generation systems. The documentation system will facilitate electronic charting and enable information to be well-structured and easily accessible to practitioners and patients (Aguirre et al., 2019). The billing and reimbursement system will facilitate easy payment of health services and ease reimbursement with insurance companies. The E-prescribing system will help track prescribed medications, evaluate medications for allergies, side effects, and interactions, and enable clinicians to make quick decisions regarding patients’ medication (Aguirre et al., 2019). Furthermore, the report generation system will enable providers to develop reports using specific information like demographics, medication, and procedures.

The EHR team will be sourced from key internal stakeholders and external consultants. The team will be composed of a project manager, application analyst, application developer, QA Test Engineer, physician, nurse, billing advocate, and super-users. The project manager will be the team leader and will be responsible for keeping the team focused on the project and timelines and will address user issues (Aguirre et al., 2019). The application analyst will be responsible for data migration and cleansing, while the application developer will be tasked with system customization. The QA Test Engineer will be responsible for system testing and performance. The physician, nurse, and billing advocates will represent physicians, nurses, and billing departments, respectively, and advise on training, data, and testing (Aguirre et al., 2019). Lastly, the super-users will be the early adopters for the EHR implementation training programs.

Professional, Ethical, and Regulatory Standards That Must Be Incorporated Into the Design and Implementation of the System

Professional standards that must be incorporated in the EHR design and implementation include completing a risk analysis of the system, encrypting electronic health information, and obtaining a HIPAA-compliant business associate agreement. According to Lee (2017), system users must be advised to report when data breaches occur immediately. Ethical standards must be incorporated by ensuring that patient health information is protected, including billing information, claims processing, enrollment status, diagnostic notes, and clinic visit notes (Lee, 2017). Ethical standards that must be incorporated in the implementation include adhering to patient confidentiality laws such as the Directory information rule, Treating physician rule. Social media rule and Business Associate Agreement rule. Regulatory standards must be integrated by complying with the HIPAA and HITECH regulations (Lee, 2017). The design and implementation team will ensure that HIPAA and HITECH regulations are followed during EHR software development, including its design, programming, and distribution.

How the EHR Team Would Ensure That All Order Sets Are Part of the New Record

Order sets refer to a group of orders that standardize and accelerate the ordering process for a specific clinical case. Order sets that are standardized and up-to-date facilitate the application of clinical decision support (CDS) at the point of care (Yang, Kang & Lee, 2016). The EHR team can ensure that all order sets are part of the new record using small groups of clinicians with multidisciplinary representation to curate order sets based on clinical guidelines, organizational policies, and expert opinion (Yang et al., 2016). The group should be tasked with approving, reviewing, and maintaining Clinical Ordered Sets in the new EHR. The EHR team can also create a clinical content strategy containing the best clinical practices and the organization’s standards with data content sources (Yang et al., 2016). Furthermore, the EHR team can develop a process that identifies and replaces obsolete content in the order sets that have potential adverse effects on patient safety and patient care quality.

Communication of the Changes, Including Any Kind of Transition Plan

Communication to the rest of the staff about the new EHR would be made through super-users and internal memos. The super-users will be provided in-depth training on all aspects of the EHR system to enable them readily understand and answer questions from the staff about the EHR (Aguirre et al., 2019). They will communicate to the staff on a face-to-face basis in organization meetings and CME programs. They will train the staff on the EHR, including its components and benefits in healthcare delivery. Internal memos will communicate to the staff about any changes in the EHR system and outline the implementation process.

Measures and Steps to Evaluate the Success of the EHR Implementation

The success of the EHR implementation will be measured from the staff, setting, and patient perspective, which will help identify improvement areas. To evaluate EHR implementation success from the staff perspective, I will conduct a survey to measure health providers’ satisfaction with the EHR (Aguirre et al., 2019). In the survey, I will ask them to rate how the EHR implementation has eased healthcare delivery, such as access to patient information, evidence-based decisions, and documentation. The EHR’s success in the healthcare setting will be measured by analyzing data error rates to evaluate how the EHR has improved data input and quality (Aguirre et al., 2019). I will also conduct return on investment (ROI) calculations to measure the EHR’s profitability. Furthermore, the EHR’s success will be measured by surveying patients’ satisfaction with the quality of care. I will also measure patients’ wait times to assess if providers can process patients promptly.

One way informatics can be especially valuable is in capturing data to inspire improvements and quality change in practice. The Agency for Healthcare Research and Quality (AHRQ) collects data related to adverse events and safety concerns. If you are working within a practice setting to implement a new electronic health record (EHR) system, this is just one of the many considerations your team would need to plan for during the rollout process.

NUR 514 Benchmark – Electronic Health Record Implementation Paper INSTRUCTIONS

In a paper of 1,250-1,500 words, address the following questions related to the advanced registered nurse’s role during this type of scenario:

  • What key information would be needed in the database that would allow you to track opportunities for care improvement?
  • What role does informatics play in the ability to capture this data?
  • Which systems and staff members would need to be involved in the design and implementation process and team?
  • What professional, ethical, and regulatory standards must be incorporated into the design and implementation of the system?
  • How would the EHR team ensure that all order sets are part of the new record?
  • How would you communicate the changes, including any kind of transition plan?
  • What measures and steps would you take to evaluate the success of the EHR implementation from a staff, setting, and patient perspective?
  • What leadership skills and theories would facilitate collaboration with the interprofessional team and provide evidence-based, patient-centered care?

You are required to cite five to 10 sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

This benchmark assignment assesses the following programmatic competencies:

2.3:        Develop leadership skills to collaborate on interprofessional teams in the provision of evidence-based, patient-centered care.

5.2:     Apply professional, ethical, and regulatory standards of practice in the provision of safe, effective health care.

Course Code
Class Code
Assignment Title
Total Points
NUR-514
NUR-514-O502
Benchmark – Electronic Health Record Implementation Paper
210.0
Criteria
Percentage
Unsatisfactory (0.00%)
Less than Satisfactory (80.00%)
Satisfactory (88.00%)
Good (92.00%)
Excellent (100.00%)
Content
70.0%

Key Information Needed in the Database to Track Opportunities for Care Improvement
10.0%
A discussion of key information needed in the database to track opportunities for care improvement is not included.
A discussion of key information needed in the database to track opportunities for care improvement is present, but it lacks detail or is incomplete.
A discussion of key information needed in the database to track opportunities for care improvement is present.
A discussion of key information needed in the database to track opportunities for care improvement is clearly provided and well developed.
A comprehensive discussion of key information needed in the database to track opportunities for care improvement is thoroughly developed with supporting details.

Role Informatics Plays in the Ability to Capture This Data
10.0%
A discussion of the role informatics plays in the ability to capture this data is not included.
A discussion of the role informatics plays in the ability to capture this data is present, but it lacks detail or is incomplete.
A discussion of the role informatics plays in the ability to capture this data is present.
A discussion of the role informatics plays in the ability to capture this data is clearly provided and well developed.
A comprehensive discussion of the role informatics plays in the ability to capture this data is thoroughly developed with supporting details.

The Systems and Staff Members that Would Need to Be Involved in the Design and Implementation Process and Team
10.0%
A discussion of the systems and staff members that would need to be involved in the design and implementation process and team is not included.
A discussion of the systems and staff members that would need to be involved in the design and implementation process and team is present, but it lacks detail or is incomplete.
A discussion of the systems and staff members that would need to be involved in the design and implementation process and team is present.
A discussion of the systems and staff members that would need to be involved in the design and implementation process and team is clearly provided and well developed.
A comprehensive discussion of the systems and staff members that would need to be involved in the design and implementation process and team is thoroughly developed with supporting details.

Professional, Ethical, and Regulatory Standards That Must Be Incorporated Into the Design and Implementation of the System (5.2)
10.0%
A discussion of professional, ethical, and regulatory standards that must be incorporated into the design and implementation of the system is not included.
A discussion of professional, ethical, and regulatory standards that must be incorporated into the design and implementation of the system is present, but it lacks detail or is incomplete.
A discussion of professional, ethical, and regulatory standards that must be incorporated into the design and implementation of the system is present.
A discussion of professional, ethical, and regulatory standards that must be incorporated into the design and implementation of the system is clearly provided and well developed.
A comprehensive discussion of professional, ethical, and regulatory standards that must be incorporated into the design and implementation of the system is thoroughly developed with supporting details.

How the EHR Team Would Ensure That All Order Sets Are Part of the New Record
5.0%
A discussion of how the EHR team would ensure that all order sets are part of the new record is not included.
A discussion of how the EHR team would ensure that all order sets are part of the new record is present, but it lacks detail or is incomplete.
A discussion of how the EHR team would ensure that all order sets are part of the new record is present.
A discussion of how the EHR team would ensure that all order sets are part of the new record is clearly provided and well developed.
A comprehensive discussion of how the EHR team would ensure that all order sets are part of the new record is thoroughly developed with supporting details.

Communication of the Changes, Including Any Kind of Transition Plan
5.0%
A discussion of how to communicate the changes, including any kind of transition plan, is not included.
A discussion of how to communicate the changes, including any kind of transition plan, is present, but it lacks detail or is incomplete.
A discussion of how to communicate the changes, including any kind of transition plan, is present.
A discussion of how to communicate the changes, including any kind of transition plan, is clearly provided and well developed.
A comprehensive discussion of how to communicate the changes, including any kind of transition plan, is thoroughly developed with supporting details.

Measures and Steps to Evaluate the Success of the EHR Implementation
5.0%
A discussion of measures and steps to evaluate the success of the EHR implementation is not included.
A discussion of measures and steps to evaluate the success of the EHR implementation is present, but it lacks detail or is incomplete.
A discussion of measures and steps to evaluate the success of the EHR implementation is present.
A discussion of measures and steps to evaluate the success of the EHR implementation is clearly provided and well developed.
A comprehensive discussion of measures and steps to evaluate the success of the EHR implementation is thoroughly developed with supporting details.

Leadership Skills, Theories, and Styles to Employ for Collaboration on Interprofessional Teams Participating in the Legislative Process and Providing Evidence-Based, Patient-Centered Care (2.3)
10.0%
A discussion of leadership skills, theories, and styles to employ for collaboration on interprofessional teams participating in the legislative process and providing evidence-based, patient-centered care is not included.
A discussion of leadership skills, theories, and styles to employ for collaboration on interprofessional teams participating in the legislative process and providing evidence-based, patient-centered care is present, but it lacks detail or is incomplete.
A discussion of leadership skills, theories, and styles to employ for collaboration on interprofessional teams participating in the legislative process and providing evidence-based, patient-centered care is present.
A discussion of leadership skills, theories, and styles to employ for collaboration on interprofessional teams participating in the legislative process and providing evidence-based, patient-centered care is clearly provided and well developed.
A comprehensive discussion of leadership skills, theories, and styles to employ for collaboration on interprofessional teams participating in the legislative process and providing evidence-based, patient-centered care is thoroughly developed with supporting details.
Required Sources
5.0%
Sources are not included.
Number of required sources is only partially met.
Number of required sources is met, but sources are outdated or inappropriate.
Number of required sources is met. Sources are current, but not all sources are appropriate for the assignment criteria and nursing content.
Number of required resources is met. Sources are current, and appropriate for the assignment criteria and nursing content.
Organization and Effectiveness
20.0%
Thesis Development and Purpose
7.0%
Paper lacks any discernible overall purpose or organizing claim.
Thesis is insufficiently developed or vague. Purpose is not clear.
Thesis is apparent and appropriate to purpose.
Thesis is clear and forecasts the development of the paper. Thesis is descriptive and reflective of the arguments and appropriate to the purpose.
Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear.
Argument Logic and Construction
8.0%
Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources.
Sufficient justification of claims is lacking. Argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility.
Argument is orderly, but may have a few inconsistencies. The argument presents minimal justification of claims. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis.
Argument shows logical progressions. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative.
Clear and convincing argument that presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.

Mechanics of Writing (includes spelling, punctuation, grammar, language use)
5.0%
Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is used.
Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register) or word choice are present. Sentence structure is correct but not varied.
Some mechanical errors or typos are present, but they are not overly distracting to the reader. Correct and varied sentence structure and audience-appropriate language are employed.
Prose is largely free of mechanical errors, although a few may be present. The writer uses a variety of effective sentence structures and figures of speech.
Writer is clearly in command of standard, written, academic English.

Format
10.0%
Paper Format (Use of appropriate style for the major and assignment)
5.0%
Template is not used appropriately or documentation format is rarely followed correctly.
Template is used, but some elements are missing or mistaken; lack of control with formatting is apparent.
Template is used, and formatting is correct, although some minor errors may be present.
Template is fully used; There are virtually no errors in formatting style.
All format elements are correct.

Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style)
5.0%
Sources are not documented.
Documentation of sources is inconsistent or incorrect, as appropriate to assignment and style, with numerous formatting errors.
Sources are documented, as appropriate to assignment and style, although some formatting errors may be present.
Sources are documented, as appropriate to assignment and style, and format is mostly correct.
Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.

Topic 8 DQ 1

Open and clear communication is critical for the effective functioning of the interprofessional team and the delivery of safe patient care. Discuss the way communication technologies can enhance coordination of care by interprofessional teams. Be sure to discuss a specific communication technology in your response.

Re: Topic 8 DQ 1
Medicine is a team sport, and communication is the foundation of collaboration. Communication technologies enable members of the care team to coordinate with one another, making collaboration easier and care delivery more effective. One communication technology that can be effective is Spectralink phones with nurse call. We use these at my facility, and while we don’t have the latest and greatest models of phones—still using those old brick Nokias!—the system is efficient and promotes quick and easy communication for enhanced patient care. Every member of the patient care team carries a phone with a unique intra-hospital number. As the nurse, I am easily able to call anybody from my respiratory therapist to my provider to my charge nurse and everybody in between. At the same time, our phones are equipped with Nurse Call which wirelessly connects them not only to our patient rooms but to our patient monitors. This way we can not only communicate with other team members, but we can easily get alarm alerts to our phones when our babies are having apnea-bradycardia-desaturation events, or when a parent calls from the room.

Not only does this spectralink system foster increased communication, it also works to fulfil The Joint Commission’s patient safety goal from 2016 to use alarms safely, including ensuring that alarms are heard and responded to on time (McGonigle & Mastrian, 2018). With the alarms wirelessly transmitted to our phones, we are able to receive our alarms anywhere on the unit with our phone on our hip. We do not need to be continuously watching a centralized monitor or sit at the bedside. This solves one problem but potentially creates another—alarm fatigue—but any technology brings with it a host of implications.

McGonigle, D., & Mastrian, K. G. (2018). Nursing informatic and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning.

Topic 8 DQ 2

Virtual care and telehealth technologies have the capability to greatly expand access to quality health care. Discuss some benefits and drawbacks of virtual care/telehealth particularly related to the collaboration and coordination of care and the role of the advanced registered nurse.

Re: Topic 8 DQ 2
The terms telehealth or telemedicine, encompass real-time, audio-video communication tools that connect providers and patients in different locations; store-and-forward technologies that collect images and data that can be transmitted and interpreted later, and remote patient monitoring tools such as home blood pressure monitors (Balestra, 2018). Rules that define and regulate telehealth are evolving and vary greatly across states, so much that health care groups are issuing different guidelines about the standard of care that applies in telehealth encounters.

Distance and travel time between patients and care providers can limit access to care. Telemedicine can overcome geographic barriers to healthcare, especially for specialized providers. Telemedicine can be particularly beneficial for patients in medically underserved communities and those in rural geographical locations where clinician shortages exist. Telemedicine can improve the quality of care for patients with both medical and mental health conditions. With telemedicine, patients had fewer hospital admissions and readmissions, spent fewer days in the hospital, and were more engaged in their healthcare (Care Innovations, n.d.). For nurse practitioners (NP) who deal with patients in a variety of settings, telehealth can help improve healthcare delivery to underserved communities.

Telemedicine can increase efficiency of care delivery, reduce expenses of caring for patients or transporting to another location, and can even keep patients out of the hospital. A strong doctor-patient relationship is the foundation for high-quality patient care and reducing health care costs. Telemedicine should support, not replace, traditional care delivery. With telemedicine care providers can continue to care for patients in-person while still providing the flexibility and convenience of seeing patients remotely for follow up visits, check-ups, and education when appropriate or necessary. Telemedicine makes it easier and more convenient for patient to stay healthy and engaged in their health care (Care Innovations, n.d.). Patients love the convenience, flexibility and real-time care with their providers. For providers, telemedicine can improve job satisfaction by making it easier to meet the patients. Providers can use telemedicine to make it easier to balance their work and family life.

While telemedicine promises to grow rapidly, there are still some technical and practical problems for healthcare providers. Restructuring IT staff responsibilities and purchasing equipment takes time and costs money. Training is crucial to build the effective telemedicine program. All-staff and physicians need to be trained on the new systems. In cases where patients are using an on-demand telemedicine service, they are connected with a random healthcare provider, care continuity suffers. A patient’s primary care provider may not have access to records from those other visits and end up with an incomplete history for the patient. This increases the risk that a doctor won’t know a patient’s history or have notes about care routines (Bull, Dewar, Malvey, & Szalma, 2016). Because reduced care continuity can decrease care quality, telemedicine providers must apply sound data solutions to maintain adequate and accessible patient records. As more healthcare providers adopt telehealth to use with their own patients, especially during the current pandemic, care continuity will increase. Many providers worry about technical problems associated with telemedicine. Poor broadband connections could lead to possible patient mismanagement. Healthcare laws, reimbursement policies, and privacy protection rules struggle to keep up with this fast-growing industry. As a healthcare provider, best practices should still be followed when approaching telemedicine.

The rules and regulations addressing NP requirements differ from state to state, and this variability creates confusion for NPs involved in the practice of telehealth. Some of the most critical issues include; Licenses and credentialing. Typically, a nurse practitioner is licenses only in the state in which he or she practices medicine (Balestra, 2018). Telemedicine technology allows NPs to assess patients remotely and in a variety of settings, and could include patients located across state borders. The NP providing collaborative care must be licensed in the state the patient is located and be in collaborative practice with a provider in that state.

Major developments have been made to telehealth reimbursement over the past couple years, and even more since the start of the pandemic it still remains a common stumbling block for providers interested in telemedicine. While telemedicine still has some limitations, many healthcare providers are innovating to solve these issues and improve their patients’ access to quality care.

References

Balestra, M. (2018). Telehealth and Legal Implications for Nurse Practitioners. Journal for Nurse Practitioners, 14 (1), 33-39. https://doi-org.lopes.idm.oclc.org/10.1016/j.nurpra.2017.10.003

Bull, T.P., Dewar, A.R., Malvey, D.M., & Szalm, J.L. (2016). Considerations for the Telehealth Systems of Tomorrow: An Analysis of Student Perceptions of Telehealth Technologies. JMIR medical education, 2(2), e11. https://doi.org/10.2196/mededu.5392

Care Innovations. (n.d.) How Virtual Care Benefits Patients, Clinicians & Healthcare Organizations. [Blog]. Retrieved from : https://news.careinnovations.com/blog/how-virtual-care-benefits-patients-clinicians-healthcare-organizations

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