Introduction
A health information system (HIS) supports integrated functions such as patient data collection, compilation, management, and transmission. Hospitals use HIS to ensure patient-centered care and improve quality and safety (Sittig & Singh, 2017). This paper discusses a HIS project implemented in a satellite facility in compliance with current HITECH and HIPAA Security and Privacy regulatory requirements. The advantages and disadvantages of the system, its benefits to the organization, relevant stakeholder roles, and an evaluation plan are explained.
Advantages and Disadvantages of a System
HIS is a pillar of optimal healthcare practice. An advantage of a system with good usability lies in its simplicity, effectiveness, and accuracy, which streamline workflows and result in increased provider productivity (Kleib, Simpson, & Rhodes, 2016). It includes a user-friendly interface and supports integration that makes HIS efficient and patient-centric. A disadvantage of a system with low usability is that it is not learnable nor robust enough to enable providers to meet their goals.
Another critical feature of a good HIS is interoperability. Interoperable systems or interfaces can work or communicate with other products both within a facility and across settings to support data exchange (Kleib et al., 2016). Thus, an advantage of a HIS with high interoperability is that it allows timely provider access and retrieval of information needed to offer optimal care. A disadvantage of a low-interoperability system is that extracting and sharing accurate patient data can be a challenge, compromising care coordination, timeliness, and quality.
Scalability denotes the capability of the system to expand and adapt to higher user demands, thus, eliminating the need for replacement. A scalable HIS has the advantage is that it allows for changing priorities. For example, the electronic medical record (EMR) reporting needs may change with new regulations on reimbursement-related clinical outcomes (Mastrian & McGonigle, 2016). Therefore, a dynamic system can help meet evolving regulatory demands. The disadvantages of scalability relate to the high initial cost and training required to prepare staff on how to use the new HIS functions.
Compatibility is the ability of two systems or devices to integrate. Cross-compatibility HISs confers organizations significant advantages, including cost-effectiveness, synchronized access to EMRs, web view of data, and improved information flow within a facility. A disadvantage of systems with low levels of compatibility are manual entry or transfer of information from one HIS to another.
Patient Care and Documentation
Digitization of prescribing, dispensing, and medication administration in HIS can improve nursing care and patient outcomes. The proposed system will implement bar code-enabled point-of-care synchronized with other functions to minimize errors associated with patient misidentification during documentation and wrong drug dose and route (Pagulayan & Faber, 2018). Real-time monitoring of patient progress, lab values, and adverse drug events, including allergic reactions that require a nursing response, will be possible with HIS due to synchronization of health information. Thus, the system will ensure more efficient access to data by nurses to support quality and safe patient care.
Quality and Delivery of Nursing Care and Patient Outcomes
A health information system can lead to improved diagnostics, safety, and quality. Nurses will be able to retrieve and use comprehensive and accurate health data to offer optimal routine care. EMRs accessed through such systems lead to timely disease diagnosis, as the records can be readily accessed at the point of care (Mastrian & McGonigle, 2016). The utilization of a HIS in nursing practice will lower medical errors and enhance patient safety.
It will also support automatic checks for drug reactions, contraindications, or allergies and alerts the clinician. Addressing potential safety issues will avert sentinel events, resulting in improved patient outcomes. According to Mastrian and McGonigle (2016), programming of medication administration procedures will reduce the risk of medical errors. The system will improve the identification and management of risk factors related to chronic conditions, such as hypertension and diabetes.
Ways QI Data Can Lead to Measurable Improvement
Continuous quality improvement is critical for achieving appropriate standards of care. One way QI data can be used to improve clinical outcomes is through practice guidelines. These tools support healthcare decisions and patient involvement in the care process (Mastrian & McGonigle, 2016). For example, data collected through the charting system can be used to update clinical guidelines accessed by a clinician. Thus, a nurse can quickly gather specific standards to improve his or her practice. A second QI tool is a root-cause analysis (RCA). Data collected through RCA will be useful in investigating the cause of a problem and develop interventions to control it (Mastrian & McGonigle, 2016). Nurses will utilize QI data gathered using this tool to implement preventive measures to enhance patient care in line with meaningful use principles.
Cost containment is a measurable outcome of QI. The two variables of clinical guidelines and RCA will improve the efficiency of the healthcare process. Measurable improvements in preventable conditions, such as patient falls and hospital-acquired infections, are tied to higher Medicare reimbursements (Lavin, Harper, & Barr, 2015). Thus, clinical guidelines and RCA can be viewed as a cost-containment tool for chronic illnesses since they will improve the quality of care delivered and status of diabetic and in-dwelling catheter patients as indicated by better glycemic control and lower catheter-associated urinary tract infections, respectively. The key metrics that will be monitored are the length of stay and re-hospitalization rates that increase the overall cost of care.
HITECH and HIPAA Security Standards and Regulations
Compliance with health information privacy rules will require secure data storage and retrieval. To comply with HITECH and HIPAA requirements, and ensure the integrity of stored data, staff training on the system features will be a priority. Workers will receive email notifications on how to adhere to security standards and to avoid accidental deleting or altering of EMRs. Additional physical safeguards, such as policies on use and disposal of electronic media containing patient data and access controls using encryption will protect the integrity of stored information (Lavin et al., 2015). Routine system audits will be used to detect security threats to data accuracy and completeness.
Data backup and recovery will be achieved by storing information in a private cloud. The goal is to limit unauthorized access and ensure that data loss or errors can be remedied. Additionally, technical policies will be implemented to support recovery after a threat. An offsite backup will be set up to help recover data after a security incident (Lavin et al., 2015). Network administration and security features will be implemented to ensure that the information retrieved or transmitted is intact.
Protection of Patient Privacy
Some features found in HIS offer protection of patient health information (PHI). While utilizing the system, measures involving extra layers of security will be taken to secure PHI. Access controls, including password protocols, will be used for authentication to restrict access to sensitive patient data. Authorized staff will only obtain information essential to performing their work, depending on variables such as patient location and user status (Moghaddasi, Rabiei, Asadi, & Ostvan, 2017). The differentiated access based on administration and support will mean that RNs will have different rights compared to physicians and other staff.
A second privacy measure will involve data encryption. Stored PHI will be encrypted so that only those users with a decrypting software and a key can read it (Moghaddasi et al., 2017). Thus, not all users will understand the sensitive components of the PHI. An audit trail will also be implemented in the HIS to capture details of individuals who access or modify PHI. This feature displays the time when a record is amended and the editor’s details. Thus, privacy breaches can be detected and corrected through audit trails.
Organizational Efficiency and Productivity
Standardizing Documentation
HIS standardized documents will include charting by exception (CBE). In this model, only significant discoveries are documented using direct notations to avoid lengthy and repeated notes that constitute a bottleneck during handovers (Mastrian & McGonigle, 2016). The components that will be included in the CBE are diagrams indicating records of daily care and handoff instructions at the bedside. Nursing standards will be used to avoid duplicating routine clinical activities. Expected outcomes of using a standardized CBE include a reduction in documentation time and improvement in workflow processes. The CBE system will also enhance the accuracy of reporting. The resulting efficiency gains will reduce the facility’s operating budget.
Reducing Waste
Paper-based documentation is more costly and time-consuming than HIS. Clerical functions such as creating a paper document, developing copies, and filing them is a lengthy process that wastes time. Transcription of handwritten records leads to additional costs. Thus, documentation using the HIS system will dramatically reduce waste as less paper and stages will be involved.
Increasing Productivity
EMRs can enhance organizational efficiency and output in many ways. Less time will be spent by nurses tracking paper charts or entering data manually. Through the new system, clinicians will quickly access PHIs electronically, and thus, will devote more hours providing care. Further, through integrated scheduling of patients with links to “progress notes, automated coding, and claims”, the employees will efficiently manage the facility (Lavin et al., 2015, p. 8). Additionally, less time spent on administrative tasks, including completing forms and billing, will result in productivity gains.
Human and Capital Resource
The implementation of HIS will affect the current workforce. Users will require new skills and expertise to access and use the system without compromising the security and integrity of patient data. Thus, the facility will invest in in-service staff training to build the requisite technical capacity to implement the project. Health informatics specialists will be hired to manage the system. Capital resource requirements will include information technology infrastructure, software, and hardware on which the system will run.
Interdisciplinary Team Identification
Team Member’s Title
A diverse skillset and expertise in the project team will be critical to the successful migration of the facility to the system. Therefore, the committee will be interdisciplinary, drawing its members from various departments. It will include the hospital manager, risk management expert, a nurse educator, and a health informatics specialist.
Team Member’s Role
The facility manager is a critical player in the organization’s leadership level. As a medical professional holding a management position, he or she will play an oversight role in the implementation of HIS. He will channel adequate resources for new staff, tools, and training to support the project. A risk management expert will be an administrator whose role will involve identifying threats to the satellite facility. He or she will review previous incidents and data and monitor staff activities to detect and prevent adverse events. The nurse educator’s primary role will be educating the staff on the new system. The goal is to reduce resistance to change. The facility’s health informatics expert’s function will entail system selection and installation based on the hospital’s needs.
Team Member’s Expertise
The facility manager will be a doctor who holds a leadership position in the organization. As a medical professional who understands the importance of HIS, he or she will be a physician champion and advocate for the project and ensure it proceeds according to plan. The risk manager will be an RN with a Master of Science in Nursing (MSN). His or her expertise in managing threats to patient safety will be critical in identifying problems inherent in the HIS project. The nurse educator will be MSN-prepared nurse experienced in training. The individual will share her expertise with colleagues and students to build staff capacity in HIS. The health informatics specialist will be a medical professional specializing in healthcare data management. This background will enable the individual to design and select a system tailored to the facility’s IT needs.
Plan for Evaluating Success of Implementing a System
The HIS must be tailored to the staff needs or size and the type of patients that the facility serves. The committee will evaluate the His using this criterion to ensure that the system is secure and scalable to deliver accurate datasets consistent with the American Nurses Association’s nomenclature recommendation (Lavin et al., 2015). Nurse skills will be evaluated to determine staff utilization of the HIS in line with the education HIMSS’s standard for creating competencies in health informatics (Healthcare Information and Management Systems Society, 2019). Employee feedback and workflow will also be used to evaluate the success of the project.
References
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