Electronic Health Record (EHR)Implementation Assignment
The emergency department (ED) faces crowding and prolonged boarding times. Delays in admitting patients in the emergency department to internal medicine units lead to congestion and worsen patient outcomes. Monitoring the boarding times is essential in improving care and patient experience. Boarding time refers to the time of admission decision to when a patient departs the ED to internal medicine wards. A quality improvement project for reducing boarding would require data on the median admit decision time to ED departure time recorded in the electronic health records (EHR) system for hospitalized patients (Imhoff et al., 2022). It is a clinical quality that was commissioned by the Centers for Medicare and Medicaid Services (CMS). It is a process measure that tracks ED practices, interprofessional collaboration, and the effect on boarding time (eCQI Resource Center, 2023). The rest of the paper discusses the informatics role in capturing the identified data and the system and staff involved in the implementation process. It also encompasses the strategies for implementing the proposed EHR, professional, ethical, and regulatory standards, evaluation methods, and team leadership skills. Electronic Health Record (EHR)Implementation Assignment
Role Informatics Plays in The Ability to Capture Data
Health informatics has been linked to improved patient care. Najjar and Shafie (2022) explained that health informatics involves the application of information technology in care practice, management, and education. The technology helps gather relevant data necessary to improve processes and outcomes. The collected information can help develop measures for improving patient outcomes or nursing practice. Also, informatics in healthcare enables interprofessional collaboration by bridging communication gaps. The data captured is shared between different care providers to support clinical decision-making. Patients and families can access information about their health conditions and become partners in care planning and management.
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In the emergency department, health informatics can be used to improve boarding times. The health informatics system can collect data regarding the admission decision time and the ED departure time. The decision to admit is determined using an order or ED evaluation. Depending on various hospitals’ admission procedures, different orders can be used. They include the admission order, disposition order, documented acceptance by admitting physician, and documented bed request. The data would be used to calculate the median admit decision time and ED departure in hospitalized patients (eCQI Resource Center (2023). As determined earlier, it is a process measure for reducing boarding times. The data can address delays in ED and associated crowding. It would also improve patient care, satisfaction, and staff well-being (Imhoff et al., 2022). To implement informatics in improving ED boarding, Tun and Madanian (2023) noted that dedicated health information technology is required. The authors also stated that the staff and other stakeholders should prepare for the implementation. The project team should also consider the ethical, legal, and professional guidelines related to health informatics applications. Effective team leadership is also essential in implementing a health information technology system. Electronic Health Record (EHR)Implementation Assignment
Systems and Staff Members Needed in the Design and Implementation Process
The quality improvement initiative proposed for reducing boarding time in the ED department would need an EHR and staff team for its design and implementation. Modi and Feldman (2022) observed that different EHR systems exist, therefore a vendor selection should be conducted to select the system with capabilities in collecting, analyzing, and reporting board time data. A typical EHR includes computerized physician order entry (CPOE), imaging and laboratory reporting, medical device interfaces, billing, and patient medical data registries. The ideal informatics system should capture data on the median admit decision time and ED departure time. The system should also enable interoperability and usability.
The team for designing and implementing the EHR successfully should include administrators (finance and operations officer), nurse leader, the physician lead, nurses, medical assistants, billing and laboratory staff representatives, informaticists, workflow redesign lead, meaningful use/compliance officers, and super users /training lead (Modi & Feldman, 2022). All these parties will affect or be affected by the EHR adoption. Electronic Health Record (EHR)Implementation Assignment
Each stakeholder group plays a significant role in the design and implementation of the proposed EHR. The team will identify the most suitable system for the ED department and champion its implementation. The informaticists will provide technical guidance on the system design and implementation. The nurse and physician representatives will lead the nurses and physicians in electronically recording the time when a patient’s order to admit is made and their physical departure from the ED. A registered advanced practice nurse would be the most appropriate to lead the project team because of their background in emergency nursing care and their training in healthcare leadership. Also, the nurse leaders are highly involved in handling patients that come into the ED and recording outcomes and process measures, including wait times and patient admission time. As the project leader, they will coordinate the implementation, manage change, and evaluate the outcomes (Modi & Feldman, 2022). The healthcare and technical team will be crucial in developing the appropriate informatics infrastructure and implementing the system to reduce ED boarding time.
Additionally, the compliance or meaningful use lead will inform strategies for complying with health technologies application regulations. The administrators will provide the resources required for designing and implementing the EHR system. The super users will train and support their colleagues (Modi & Feldman, 2022). The trainers and the compliance team will ensure proper use of the health information technology while the management will support the project with leadership and financial resources. Electronic Health Record (EHR)Implementation Assignment
Strategies for Implementing the New EHR Proposal
The strategies for implementing the new EHR include planning, change management, and transitioning to the new EHR technology. The project team should identify and outline the requirements for the system adoption. It should consider the financial resources for procuring the infrastructure, hiring the consultants, and financing the implementation process, including end-user training. Also, the team should develop a schedule and related activities, roles, and responsibilities for each activity. It should also determine how workflow design will be affected and create mitigation measures. The team should manage change by communicating the importance of tracking the median admission decision time against ED departure. It should describe the project’s significance to the department and the organization, and its impact on the stakeholders. Open and persistent communication will enable the project leaders to engage the stakeholders and maintain motivation in the long term. The other strategy is the transition from the usual practice to using EHR to track ED boarding time. The leading team should understand that the process requires a team and be ready to support the staff with necessary resources until they develop readiness. Conducting performance audits can indicate the staff’s EHR use (Vassell-Webb, 2019). The strategies reviewed will be crucial in implementing EHR in the ED.
Professional, Ethical, and Regulatory Standards Implementation
The EHR to be implemented must incorporate some professional, regulatory, and ethical standards. The system should align with professional standards. It should reinforce the nurses’ and physicians’ practice mandates. For example, the technology should be easy to use and able to produce quality data to allow healthcare professionals to make conclusive clinical care decisions (Uslu & Stausberg, 2021). It should also comply with the existing laws governing the use of technology in healthcare. One relevant legislation the EHR should meet is the health insurance portability and accountability act (HIPAA) of 1996. HIPAA safeguards patient information. EHR collects diverse patient data to guide diagnosis and treatment, including social demographics and medical and family history information. The system should be designed to protect against unauthorized access to the data. Also, users should understand the limits of data sharing as per HIPAA law (Farhadi et al., 2019). Aside from the professional and legal standards, the EHR system design team, trainers, and users should consider the ethics of privacy and confidentiality, autonomy, fidelity, data quality, and security threats (Afzal & Arshad, 2021). Meeting these standards is essential to avoid negative professional, legal, and ethical consequences. Electronic Health Record (EHR)Implementation Assignment
Evaluation of the Success of EHR Implementation
Following the EHR go-live, an evaluation will be conducted to determine its effectiveness and assess continuous practice improvement. The Office of the National Coordinator for Health Information Technology (ONC) recommends the first evaluation be completed three to four weeks after the system’s initial operation. Different measures should be considered. They include the impact of adoption on culture, issues related to infrastructure and network, and EHR vendor support, product and service quality. The quantitative and qualitative data from these measures will indicate the effectiveness of the new EHR (ONC, 2023). To examine if the ED department has reduced the boarding time, the evaluators should focus on the median admit decision time and ED departure time as recorded in the EHR. By comparing the data before and after the implementation, the team can understand if there are improvements. Other secondary outcome measures include patients’ and staff’s satisfaction with ED care delivery and EHR use. Surveys can be used as data collection tools for patients and the staff, among other stakeholders, whereas focus-group discussions can gather additional information to improve the quality improvement project (Imhoff et al., 2022). Reduced boarding time in the ED and increased patient and staff satisfaction would indicate the EHR’s efficacy and the possibility of facilitating continuous practice change.
Leadership Skills and Project Management to Collaborate with Interprofessional Teams
Effective leadership is required to implement EHR successfully in the ED because it involves multidisciplinary teams. Laukka et al. (2020) identified team building, communication, and problem-solving skills as leadership skills needed to promote interprofessional collaboration. The project team leader should be able to encourage cooperation between and with the team members. Also, they should have excellent communication skills to enhance stakeholder engagement. Different stakeholders have varied interests and power. A good leader should know how to manage each stakeholder while remaining focused on the quality improvement project goals. They should also have conflict resolution skills to manage issues that might arise.
Some leadership theories can support effective project management. An example is transformative leadership, which emphasizes the value of leaders supporting, inspiring, motivating, and empowering their staff to perform beyond expectations. The project leader under this theory acts as a facilitator, decision maker, problem solver, change manager, advocate, and champion (Laukka et al., 2020). These leadership characteristics and capabilities are inherent in harnessing interprofessional collaboration in EHR implementation. Electronic Health Record (EHR)Implementation Assignment
Conclusion
The implementation of EHR for tracking boarding time in the ED requires several considerations. The project team should define the objective, such as monitoring the median admit decision time versus the ED departure time. Next, they should identify the requirements and the staff for the design and implementation. Other issues the project team should evaluate are the implementation strategies and professional, ethical, and legal implications. Lastly, the team should identify the evaluation process and outline strategies for promoting interprofessional collaboration to improve ED care delivery through an evidence-based approach.
References
Afzal, S., & Arshad, A. (2021). Ethical issues among healthcare workers using electronic medical records: A systematic review. Computer Methods and Programs in Biomedicine Update, 1(100030), 1-7. https://doi.org/10.1016/j.cmpbup.2021.100030
eCQI Resource Center (2023). Median admit-decision time to ED departure time for admitted patients. eCQI Resource Center. https://ecqi.healthit.gov/ecqm/eh/2023/cms111v11
Farhadi, M., Haddad, H., & Shahriar, H. (2019). Compliance of open source EHR applications with HIPAA and ONC security and privacy requirements. Kennesaw State University, Master of Science in Computer Science Theses. https://www.researchgate.net/publication/332849252
Imhoff, B., Marshall, K., Nazir, N., Pal, A., & Parkhurst, M. (2022). Reducing time to admission in emergency department patients: A cross-functional quality improvement project. BMJ Open Quality, 11(3), e001987. doi:10.1136/bmjoq-2022-001987
Laukka, E., Huhtakangas, M., Heponiemi, T., & Kanste, O. (2020). Identifying the roles of healthcare leaders in HIT implementation: A scoping review of the quantitative and qualitative evidence. International Journal of Environmental Research and Public Health, 17(2865), 1-15. http://dx.doi.org/10.3390/ijerph17082865
Modi, S., & Feldman, S. S. (2022). The value of electronic health records since the health information technology for Economic and Clinical Health Act: Systematic review. JMIR Medical Informatics,10(9), e37283. https://doi.org/10.2196/37283 Electronic Health Record (EHR)Implementation Assignment
Najjar, R. I., & Shafie, Z. M. (2022). Impact of nursing informatics on the quality of patient care. International Journal of Medical Science and Clinical Research Studies, 2(5), 418-425. https://doi.org/10.47191/ijmscrs/v2-i5-19
ONC (2023). EHR implementation evaluation. HealthIT.gov. https://www.healthit.gov/faq/how-do-i-conduct-post-implementation-evaluation
Tun, S. Y., & Madanian, S. (2023). Clinical information system (CIS) implementation in developing countries: Requirements, success factors, and recommendations. Journal of the American Medical Informatics Association, 30(4), 761-774. https://doi.org/10.1093/jamia/ocad011
Uslu, A., & Stausberg, J. (2021). Value of the electronic medical record for hospital care: Update from the literature. Journal of Medical Internet Research, 23(12), e26323. https://doi.org/10.2196/26323
Vassell-Webb, C. (2019). Strategies for implementation of electronic health records. Walden Dissertations and Doctoral Studies Collection. https://scholarworks.waldenu.edu/cgi/viewcontent.cgi?article=8537&context=dissertations
Assessment Traits
Benchmark
Requires Lopeswrite
Assessment Description
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. Electronic Health Record (EHR)Implementation Assignment
In a paper of 1,500-1,750 words, discuss the following:
Consider an opportunity for tracking care improvement. What key information would be needed in the database? Example: Time lapse from medication order documented in the EHR to delivery of medication to the patient for the cardiology service.
Describe the role informatics plays in the ability to capture this data. What type of project management strategies and methodologies can be implemented to support informatics initiatives to help improve quality within the clinical practice?
Discuss which systems and staff members would need to be involved in the design and implementation process. What is the role of the advanced registered nurse in promoting evidence-based practice and leading quality and performance improvement initiatives within this setting?
Outline strategies for implementing the new EHR proposal. Consider communication changes, transitioning to the new EHR, and managing resources (human, fiscal, and health care resources).
Discuss what professional, ethical, and regulatory standards must be incorporated into the design and implementation of the system.
Describe the measures and steps you would take to evaluate the success of the EHR implementation from a staff, setting, and patient perspective to measure effectiveness and ensure continuous quality improvement in practice?
Explain what leadership skills and theories would be needed to 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.
Complete the “APA Writing Checklist” to ensure that your paper adheres to APA style and formatting criteria and general guidelines for academic writing. Include the completed checklist as an appendix at the end of your paper. Electronic Health Record (EHR)Implementation Assignment
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.
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. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.
Benchmark Information
This benchmark assignment assesses the following programmatic competencies:
MBA-MSN; MSN-Nursing Education; MSN Acute Care Nurse Practitioner-Adult-Gerontology; MSN Family Nurse Practitioner; MSN-Health Informatics; MSN-Health Care Quality and Patient Safety; MSN-Leadership in Health Care Systems; MSN-Public Health Nursing
2.3: Develop leadership skills to collaborate on interprofessional teams in the provision of evidence-based, patient-centered care. Electronic Health Record (EHR)Implementation Assignment
5.2: Apply professional, ethical, and regulatory standards of practice in the provision of safe, effective health care.
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Attachments
MSN-APA Writing Checklist-Student.docx
Rubric Criteria
Opportunity for Tracking Care Improvement
21 points
Role Informatics Plays in Ability to Capture Data
14.7 points
Systems and Staff Members Needed in Design and Implementation Process
16.8 points
Outline Strategies for Implementing EHR Proposal Electronic Health Record (EHR)Implementation Assignment
21 points
Professional, Ethical, and Regulatory Standards Implementation (B)
21 points
Evaluation of the Success of EHR Implementation
21 points
Leadership Skills and Project Management to Collaborate With Interprofessional Teams (C2.3)
21 points
Required Sources
6.3 points
Appendix
4.2 points
Thesis, Position, or Purpose
14.7 points
Development, Structure, and Conclusion
16.8 points
Evidence
10.5 points
Mechanics of Writing
10.5 points
Format/Documentation
10.5 points Electronic Health Record (EHR)Implementation Assignment