Advanced Information Management in Healthcare

Health Information Systems: Discussion and Analysis

Advantages and Disadvantages of a System

Health information systems (HISs) are tools designed for enhanced management of healthcare data. Processes incorporated in HISs include the collection of patients’ healthcare information, its storage, management, and dissemination. Thus, HISs involve electronic health records (EHRs) and healthcare facilities’ operational management strategies. With the help of HISs, it is more convenient to arrange patient care and documentation, enhance the quality of nursing care, and increase patient satisfaction. Still, some healthcare organizations may feel opposed to applying technology due to the lack of training or trust. Hence, it is necessary to analyze the advantages and disadvantages of HISs and evaluate the benefits and challenges associated with their introduction.

HISs may be viewed from different angles, such as usability, interoperability, scalability, and compatibility. Each of these aspects has benefits and limitations when applied to HISs. Usability may be defined as the ability of a user to determine the system’s usefulness, understand its applicability, and perceive its operability. With this definition in mind, healthcare facilities should provide their employees with sufficient knowledge and resources for the successful implementation of HISs.

The advantage of HISs in terms of usability is that they enable healthcare providers to locate and manage patient data easily and timely. However, scholars also acknowledge some limitations of HISs’ usability (Asan & Yang, 2015). Examples of disadvantages due to usability issues include the interruption of workflow and the emergence of medical errors because of the need to adapt to new technologies.

The next factor is interoperability, which is defined as a factor indicating whether the selected HIS can work in accord with other systems required for the attainment of healthcare goals. When interoperability is provided, healthcare workers can promote their patients’ well-being and gain the highest results. Interoperability can be of three types: technical, semantic, and process (Bouamrane, Tao, & Sarkar, 2015).

The major advantage of HISs in terms of interoperability is the possibility of different systems working together successfully. However, as Bouamrane et al. (2015) note, there are some limitations related to interoperability. The main disadvantage is that interoperability, or, rather, its lack, is an obstacle to the establishment of a “mass-market” in well-being technologies and patients’ health (Bouamrane et al., 2015, p. 2).

Scalability is the element defined as the opportunities and possibilities for the HISs’ evolution and growth in relation to the changing demand. Any scalable system allows for easy accommodation of processes to the emerging alterations and new requirements. The advantages of HISs with scalability include competitiveness, stability, and efficiency. Meanwhile, the lack of scalability poses certain threats to HISs. The major disadvantage is that unscalable systems eliminate the mobility of devices and individuals involved in the process (Prasad, 2015). Other barriers involve broken communication, insecure connection, and deficient integrity.

Finally, the domain of compatibility should be discussed in relation to HISs. Compatibility may be defined as the level of coherence between the new system and established values, past experience, and present requirements (Sittig & Singh, 2015). With regard to compatibility, the main advantage of HISs is that they enable the establishment of a reliable link between the different practices, leading to a common beneficial outcome for the hospital and patients. A disadvantage refers to the unlikelihood of predicting all the difficulties that may occur due to the presence of many variables (Sittig & Singh, 2015). Thus, if HISs are employed in a merger, both organizations’ factors will have to be considered, and both of them will be able to affect the progress of the system’s implementation.

Patient Care and Documentation

The primary goal of introducing technology in the healthcare system is increasing patient care and satisfaction. Along with this, HISs help to improve the process of documentation, making it faster and simpler. It is possible to single out the following examples of how a HIS will impact patient care and documentation. First of all, many healthcare employees admit that the use of electronic health records (EHRs) has a beneficial effect on their workload.

According to research, medical employees spend from one-fourth to one-half of their working time on documentation (Clynch & Kellett, 2015). The use of HISs can decrease the amount of time wasted on taking and arranging notes concerning patients’ data. As Sockolow, Bowles, and Rogers (2015) remark, the use of HISs has the potential to improve healthcare organizations’ structural quality. Furthermore, the functionality of tools employed by healthcare providers can also improve with the use of HISs, such as EHRs.

Another example of HISs’ influence on patient care and documentation is that by spending less time on documentation, doctors and nurses will be able to pay more attention to patients. Thus, the level of care will increase proportionally to the decrease in time required to arrange the paperwork. Patient documentation is one of the core competencies of healthcare employees. Without properly kept records, doctors would not be able to learn about patients’ history, make assumptions about the current situation, and predict future outcomes. The third example is that documentation helps to communicate crucial information from specialist to specialist. It is possible to draw a link between patient documentation and individualized care. By structuring the documentation process efficiently, nurses and physicians will be able to select the most suitable care methods for each client.

The features of documentation that make patient care better include the increased quality of information logistics, the enhanced level of customer satisfaction, efficiency, and the correctness and completeness of data (Sockolow et al., 2015). The quality of data logistics is enhanced due to the accumulation of information in one place and its arrangement in an accessible way. Additionally, electronic medical records typically contain much more information than their paper counterparts (Clynch & Kellett, 2015).

For instance, the use of tablet computers enables hospital staff to record patient data directly at the bedside and share it with all the specialists involved in this individual’s treatment (Clynch & Kellett, 2015). The quality of care and patient satisfaction are reported to increase with the use of EHRs (Rajkomar et al., 2018). Therefore, there is a variety of features of documentation that can make patient care better due to the possibility of collecting, storing, and sharing data efficiently.

Quality and Delivery of Nursing Care and Patient Outcomes

The use of HISs promotes the quality of nursing care and delivery, as well as improves patient outcomes. The most significant aspect of such an improvement is the possibility of nurses obtaining information from the HISs faster than they would do without HISs. The use of HISs, such as EHRs, requires less time and effort, so data access becomes a simple process in comparison to traditional methods.

An example of how the HISs help with the quality of nursing care is the use of electronic tools by bedside nurses. Research by Walker-Czyz (2016) indicates that the possibility to access patient data promptly allows nurses to make important decisions at the point of care, which leads to the enhanced quality of nursing care. Specifically, the application of electronic tools enables healthcare employees to make decisions faster and more accurately, which inevitably leads to an increased quality of care. Furthermore, research by Hessels, Flynn, Cimiotti, Bakken, and Gershon (2016) shows that the length of stay can be decreased due to the implementation of EHRs. Therefore, the quality of nursing care can improve significantly with the use of HISs.

The delivery of nursing care is a factor influencing patient outcomes and satisfaction to a great extent. The application of HISs can increase the delivery of nursing care due to their beneficial features. As Kalisch and Xie (2014) report, the delivery of care depends on such issues as staffing, material resources, and the level of communication across a healthcare institution. Therefore, it is viable to conclude that without appropriate time for arranging and accessing patient data, healthcare professionals are not able to deliver care at the required level. Hence, the use of HISs, including EHRs, can significantly enhance the documentation, which leads to better possibilities for the delivery of nursing care.

Finally, HISs are likely to improve patient outcomes due to the opportunities for improved quality and delivery of care. As Sockolow, Bowles, Adelsberger, Chittams, and Liao (2014) have found, the use of EHRs significantly decreases the number of days to Medicare claims. Such findings indicate that the application of HISs allows enhancing patient outcomes with the help of additional options offered by these systems.

For instance, not only healthcare providers but also patients and their families can collect data and record them on EHRs (Sockolow et al., 2014). As a result of a faster transmission of information, physicians and nurses will be able to create an effective care plan for each person, thus increasing patient outcomes. Another example of the beneficial effect of HISs on patient outcomes is the opportunity for doctors to see what medications their patients have been prescribed (Brummel et al., 2014). This way, the possibility of medical errors is limited, hence gaining a better result of treatment.

The System’s Benefits for the Organization

Ways Quality Improvement Data Can Lead to Measurable Improvement

It is possible to discuss the impact of HISs on the improvement of healthcare outcome measures. Firstly, it is necessary to mention that the use of information technology helps to enhance healthcare services in general. For instance, such a measure as readmission rate can be bolstered by the application of HISs. Oh, Zheng and Bardhan (2017) have found that the implementation of HISs can decrease the readmission risk. Scholars note that the effective application of HISs leads to a reduction in the deviation between the length of stay and the geometric mean length of stay (Oh et al., 2017). The risk of readmission exists almost in every sphere of healthcare service provision, so the decrease in this rate is crucial.

The metrics utilized by the hospital to define compliance with quality improvement requirements include the rate of readmissions checked every three weeks and every six weeks. The HIS collects this information from EHRs and nurse managers’ reports. The data are used in reports every month. Therefore, the utilization of HISs promotes such a quality improvement measure as the rate of readmission and has the potential for further enhancement.

Secondly, it is possible to discuss the potential of HISs in regard to specific patient populations’ health care. Specifically, researchers emphasize the growing potential of HISs’ application when working with elderly patients. HISs are analyzed both as a singular approach and in combination with other interventions. Stoeckle, Iseler, Havey, and Aebersold (2018) note that the use of EHRs as a component of multifactorial approaches in adult emergency units leads to a reduction of patient falls and injuries. The authors state that such programs can increase the awareness of fall risks, which leads to better prevention measures (Stoeckle et al., 2018).

Bowles, Dykes, and Demiris (2015) emphasize the potential of HISs, in particular, EHRs, to improve older adults’ outcomes and care. According to Bowles et al. (2015), the utilization of EHRs in older adult departments promotes the increased safety and quality of care.

Quality indicator metrics used by the hospital, in this case, include the rate of patient falls and injuries checked every month. The HIS collects this information from EHRs, which allows generating reports about the indicator monthly. The usability of HISs in this health indicator is rather significant since falls constitute one of the major risks for patients and can result in longer stays or more expensive treatment. For the selected population group – older adults – the danger of falling is much greater than for younger populations because of a longer recovery process and other complications. Thus, HISs can lead to measurable improvements in the patient fall rate.

HITECH and HIPAA Security Standards and Regulations

The Health Insurance Portability and Accountability Act (HIPAA) establishes the standard for protecting patients’ personal data. Organizations, the work of which presupposes handling protected health information (PHI), should arrange security of data at the physical, process, and network levels (De Groot, 2019). Meanwhile, the Health Information Technology for Economic and Clinical Health (HITECH) Act focuses on the “meaningful” use of EHRs by healthcare facilities and employees (Lord, 2018, para. 1). HITECH, thus, demands that HISs should be employed in a measurable way in what concerns both quality and quantity (Lord, 2018).

HIPAA and HITECH can be achieved through HISs by ensuring the storage integrity of data. This means that EHRs should provide healthcare organizations with meaningful and valid information. Furthermore, the data must be complete so that hospitals could develop ways to enhance and optimize their strategies. The integrity of data storage is the “driving force” in HISs (Vimalachandran, Wang, Zhang, Heyward, & Whittaker, 2016, p. 1).

Storage integrity is a crucial factor in the delivery of healthcare services at different phases of hospital-client collaboration. In order to gain data storage integrity, the hospital needs to ensure that all patient data are recorded accurately and kept safely. Additionally, all the information related to patients should be reliable and consistent (Vimalachandran et al., 2016). When all of these measures are taken by the hospital, it will achieve HIPAA and HITECH.

Another important factor to consider in regard to safety requirements is data backup and recovery. In order to comply with HITECH and HIPAA regulations, hospitals need to create and adhere to the data contingency plan. Such a plan should include the following parts: a data backup plan, a disaster recovery plan, an emergency-mode operations plan, and evaluation and revision measures (Levinson, 2016).

To comply with these expectations, the hospital has to keep backup copies of patient data and paper medical forms that can be utilized when EHRs cannot be used. Because the work of EHRs can be disrupted due to technological or environmental factors, there is a risk of patient care deterioration if no effective data backup and recovery plans are in use (Levinson, 2016). Therefore, the organization needs to copy information and keep it safely offsite and onsite so that it could be accessed promptly in case of an emergency.

Some of the features that are considered as data integrity involve data reliability, the internal quality of information, and the accuracy of data. The integration of these aspects allows maintaining the quality of information, thus leading to better patient outcomes (Vimalachandran et al., 2016). Accuracy, reliability, and quality of data are closely related to the ways information is gathered and kept. The hospital should avoid programming errors, copying and pasting data, and using default settings in order to minimize the risks that can affect the integration of the mentioned features.

Protection of Patient Privacy

The essential features of HISs that are designed to protect patient privacy include security and confidentiality. Security of patient data with the use of EHRs can be gained by the elimination of persons who can access these data. Confidentiality presupposes that the information is shared only among those directly involved in the situation, excluding third parties that can harm patients psychologically or emotionally or undermine the hospital’s reputation by sharing personal data. Kruse, Smith, Vanderlinden, and Nealand (2017) note that confidentiality and security are ingrained in the HITECH and HIPAA regulations. Thus, HISs help to conform to these requirements and provide the protection of data.

There are several steps to be taken while using the system to protect patient information. Firstly, in order to gain PHI, a healthcare employee needs to consider the possibilities of data breaches and eliminate them. Not only physicians and nurses have access to EHRs, patient information is thus being exposed to front desk managers, laboratory technicians, insurance providers, and many other actors. Millions of patients can suffer if confidential information is stolen (“HIPAA data breach report,” 2015). Therefore, to protect patient data, it is necessary to create a profile for those accessing data and to check their activities once logged into the system.

Another measure one can take to increase protection is promoting the value of the security mindset in the hospital. Healthcare providers should bear in mind that any kind of sharing patient data can be harmful. Not only access to EHRs but also speaking with a colleague who is not the patient’s physician, sharing some facts with one’s friends casually, or mentioning some data to any third party can be dangerous. Thus, every staff member should realize the significance of information security and do everything possible to avoid sharing patients’ data with those who are not supposed to know it.

One more step to protect data is to share it with the patient. More and more physicians allow patients to access their EHRs, which increases data security (“Office-based,” 2015). Patients can download data or share it with third parties if they choose. Storing information in one database and letting different stakeholders view it is better than keeping data in different places. Finally, healthcare specialists can utilize an extra level of protection when they treat HIPAA and HITECH as helpful strategies rather than the requirement they have to comply with strictly. PHI is beneficial both for patients and hospitals, so it is crucial to resort to the mentioned steps in order to gain the highest data security.

Organizational Efficiency and Productivity

A HIS can help the organization to achieve and impact the process of standardizing documentation due to offering unique possibilities for data collection, storage, and classification. The process of gathering information by means of EHRs allows keeping patients’ data on electronic means, which allows healthcare providers to classify it by different measures. For instance, one can create markers for patients depending on the disease or unit at which they are staying. As a result, such standardization of data will make it possible to locate the necessary information promptly and effectively.

What is more, the utilization of HISs helps to reduce waste. Some of the factors contributing to waste in healthcare settings include the lack of coordination and overtreatment. Frequently, patients are treated for a longer time than needed due to inconsistent information about previous decision-making on a concrete patient’s health issue. The use of EHRs eliminates this complication, and healthcare providers will be able to make decisions faster and more efficiently. Another approach to reducing waste by means of HISs is that with the help of them, nurses and doctors will be able to get access to the same amount of data. Thus, the coordination between different levels will be improved, and waste will be decreased.

Also, HISs can help to increase the level of productivity within the organization. First of all, with EHRs, there will be no need to spend much time on creating paper charts and filling out numerous paper forms. Secondly, healthcare providers will not have to share one patient history record and will not waste time taking the patient’s data from one specialist to another. Every staff member involved in the treatment of a concrete patient will have equal access to EHR and will be able to use it whenever necessary. Also, productivity will be improved to a great extent due to the lack of the need to decipher someone’s handwriting or do excessive paperwork.

Finally, HISs have the potential to affect human and capital resources in the organization positively. Human resources, including knowledge, manpower, expertise, and talent, can benefit from the implementation of HISs due to new opportunities for development. During the implementation process, there might be some difficulties with the human resource since employees will be subject to training and maybe will have to spend additional time at work.

Capital resource utilization will also be affected at this phase in that additional expenses will be needed to cover the employee training sessions and the purchasing of new equipment and software. However, after the implementation, both human and financial resources will be changed effectively. On the part of healthcare providers, their knowledge and expertise will improve, and talent management will rise. On the part of capital resources, the enhanced accuracy and standardized documentation will lead to a lower operating budget, and the hospital will be able to spend the money saved on some essential purchases.

Interdisciplinary Team Identification

To implement a HIS successfully, the organization’s manager’s support is not enough. It is necessary to collect a team of skilled professionals who will arrange the process of implementation and control it. For the current project, a nurse informatics specialist needs to create an interdisciplinary mix of individuals who will help the leader to make the HIS as beneficial for the merger as possible. The first member of the “dream team” will be a project manager.

It is of utmost importance to pick a person with relevant experience for this position. The role of the project manager will be concerned with planning every stage of the project, predicting their positive sequence, and taking into account the possible barriers to implementation. The expertise of the project manager will be associated with the team member’s experience in the field of HISs and his or her ability to come up with effective solutions in case of unpredicted challenges.

The second team member will be the analyst, whose role is to create valid connections between the required concepts and the organization’s possibilities. The expertise of the analyst will be in his or her ability to build connections between the team members, the system, and the hospital’s management. The third team member will be the designer of the application. The designer’s role will be to develop the EHR system needed for the hospital and customize it to healthcare providers’ needs. The expertise of the designer will be in his or her ability to adapt quickly and make the alterations necessary for different units promptly.

Finally, the fourth team member will be the functional manager. The role of this team member will be in testing the HIS and reporting on the drawbacks and benefits, as well as suggesting optimal improvements. The expertise of the functional manager will be his or her experience in the nursing sector, including taking patient records, communicating with patients, and collecting feedback on patient satisfaction.

The Plan for Evaluating Success of Implementing a System

The American Nurses Association (ANA) has developed several standards relevant to the implementation of HISs. The adherence to some of these regulations will be used as an evaluation marker of the success or failure of the project. The first ANA standard that will be utilized is “Standard 1. Assessment” (ANA, 2015, p. 53). This standard deals with the competence of nurses in performing a valid evaluation of patient data. The HIS implementation will be deemed successful if healthcare personnel will be able to collect data and acknowledge the effect of their personal beliefs on patients’ in the process or treatment (ANA, 2015).

The functional manager will check nurses’ adherence to the standard with a survey a month after the implementation. The survey will be distributed at the workplace, and the functional manager will evaluate it with the help of Likert scale responses.

The second standard is “Standard 14. Quality of Practice” (ANA, 2015, p. 79). This regulation involves correspondence with policies and initiatives put forward by the administration. The HIS might involve the introduction of the new EHR design. In this case, the analyst will check the skillfulness of healthcare employees when utilizing the new system. The evaluation will be performed four weeks after the implementation. The assessment will be performed on-site, and the analyst will observe the personnel’s level of mastery. It will be possible to say that the implementation was successful if healthcare providers demonstrate a high level of professionalism in adherence to both standards.

References

ANA: American Nurses Association. (2015). Nursing: Scope and standards of practice (3rd ed.). Silver Spring, MD: ANA.

Asan, O., & Yang, Y. (2015). Using eye trackers for usability evaluation of health information technology: A systematic literature review. JMIR Human Factors, 2(1), e5.

Bouamrane, M.-M., Tao, C., & Sarkar, I. N. (2015). Managing interoperability and complexity in health systems. Methods of Information in Medicine, 54(1), 1-4.

Bowles, K. H., Dykes, P., & Demiris, G. (2015). The use of health information technology to improve care and outcomes for older adults. Research in Gerontological Nursing, 8(1), 5-10.

Brummel, A., Lustig, A., Westrich, K., Evans, M. A., Plank, G. S., Penso, J., & Dubois, R. W. (2014). Best practices: Improving patient outcomes and costs in an ACO through comprehensive medication therapy management. Journal of Managed Care & Specialty Pharmacy, 20(12), 1152-1158.

Clynch, N., & Kellett, J. (2015). Medical documentation: Part of the solution, or part of the problem? A narrative review of the literature on the time spent on and value of medical documentation. International Journal of Medical Informatics, 84(4), 221-228.

De Groot, J. (2019). What is HIPAA compliance? 2019 HIPAA requirements. Web.

Hessels, A., Flynn, L., Cimiotti, J. P., Bakken, S., & Gershon, R. (2016). Impact of heath information technology on the quality of patient care. Online Journal of Nursing Informatics, 19(3). Web.

HIPAA data breach report July 2015. (2015). Web.

Kalisch, B. J., & Xie, B. (2014). Errors of omission: Missed nursing care. Western Journal of Nursing Research, 36(7), 875-890.

Kruse, C. S., Smith, B., Vanderlinden, H., & Nealand, A. (2017). Security techniques for the electronic health records. Journal of Medical Systems, 41(8), 127.

Levinson, D. R. (2016). Hospitals largely reported addressing requirements for EHR contingency plans. Web.

Lord, N. (2018). What is HITECH compliance? Understanding and meeting HITECH requirements. Web.

Office-based physician electronic patient engagement capabilities. (2015). Web.

Oh, J. C., Zheng, Z. E., & Bardhan, I. R. (2017). Sooner or Later? Health information technology, length of stay, and readmission risk. Production and Operations Management, 27(11), 2038-2053.

Prasad, S. (2015). Designing for scalability and trustworthiness in mHealth systems. In R. Natarajan, G. Barua, & M. R. Patra (Eds.), Distributed computing and internet technology: 11th International Conference, ICDCIT 2015: Bhubaneswar, India, February 5-8, 2015: Proceedings (pp. 114-133). Cham, Switzerland: Springer.

Rajkomar, A., Oren, E., Chen, K., Dai, A. M., Hajaj, N., Hardt, M., … Dean, J. (2018). Scalable and accurate deep learning with electronic health records. NPJ Digital Medicine, 1(18), 1-8.

Sittig, D. F., & Singh, H. (2015). A new socio-technical model for studying health information technology in complex adaptive healthcare systems. In V. L. Patel, T. G. Kannampallil, & D. R. Kaufman (Eds.), Cognitive informatics for biomedicine: Human computer interaction in healthcare (pp. 59-80). Cham, Switzerland: Springer.

Sockolow, P. S., Bowles, K. H., & Rogers, M. (2015). Health information technology evaluation framework (HITREF) comprehensiveness as assessed in electronic point-of-care documentation systems evaluations. In I. N. Sarkar, A. Georgiou, & P. M. de A. Marquez (Eds.), MEDINFO 2015: eHealthenabled health: Proceedings of the 15th World Congress on health and biomedical informatics (pp. 406-409). Fairfax, VA: IOS Press.

Sockolow, P. S., Bowles, K. H., Adelsberger, M. C., Chittams, J. L., & Liao, C. (2014). Impact of homecare electronic health record on timeliness of clinical documentation, reimbursement, and patient outcomes. Applied Clinical Informatics, 5(2), 445-462.

Stoeckle, A., Iseler, J. I., Havey, R., & Aebersold, C. (2018). Catching quality before it falls: Preventing falls and injuries in the adult emergency department. Journal of Emergency Nursing, 45(3), 257-264.

Vimalachandran, P., Wang, H., Zhang, Y., Heyward, B., & Whittaker, F. (2016). Ensuring data integrity in electronic health records: A quality health care implication. Web.

Walker-Czyz, A.-M. (2016). The impact of an integrated electronic health record adoption on nursing care quality. JONA: The Journal of Nursing Administration, 46(7/8), 366-372.