The paper is about the benefits and costs of a computerized hospital management system from a nurse's perspective. The author is placed in the position of a nurse of a small 100 bed-community hospital who is the only nurse in a team of doctors to participate in the hospital management's decision on whether to buy such management system. In answering six specific questions related to the benefits and economic costs of computerized hospital management systems, the paper shows -- among others - that improved health care and increase in personnel and work efficiency will well outweigh the financial burden imposed on the hospital when buying two specific managements systems: ELECTRA and Microsoft Dynamics GP. In addition, the paper outlines the security standards of data and patient confidentiality, including the need for data storage integrity and data backup and recovery and how the Health Insurance Portability and Accountability Act (HIPAA) requirements impact the use of computerized hospital management systems.
A. Explain how using the computerized management systems could increase quality of care
The use of computerized management systems would lead to quality of care improvements in the following areas: Elimination of lost orders; Improved documentation consistency and thoroughness; reduced variation in care from standard order sets; automated outcomes analysis and reporting; reduction in dosing errors; drug-drug, drug-disease, drug-lab, and drug allergy checking and alerts prevent medication errors. Studies have shown that computerized hospital information systems can significantly reduce medication error rates, including rates of serious errors. One large east coast hospital saw a 55% reduction in serious adverse medication errors after the system was installed. However, on occasion errors can actually be introduced due to the computing process; in particular, errors can be introduced if the provider accidentally selects the wrong medication from the list or drop-down menu. Thus, a computerized hospital system should not be viewed as a replacement for the pharmacist in terms of checking for medication errors. In addition, proper user interface design such as highlighting every other line on the medication screen for better visibility and having the provider give a final check to the orders before sending are some ways of reducing this kind of error. Overall, error rates from incorrect order entry on the computer are much smaller than other medication errors prior to introduction of the system (Metfessel ibid). Furthermore, the system would lead to an elimination of illegible orders; verification of medication administration and immediate access to online knowledge bases (see Metfessel ibid).
B. Explain why active nursing involvement in the planning, choice, and implementation of the systems is important
An active nursing environment in the planning, choice, and implementation of the systems is important because it ensures that the managerial level of the systems see what the problems are. There is no substitute for first-hand report on the needs of a hospital as regards to improving quality of treatment, patient safety, and also employee satisfaction (see Berczuk, 2008, p. 2).
Nurses know exactly what they need to accomplish their professional duties in the best way possible. They are the ones who have the clear picture of the entire process for the patient. They have the overview. Recognizing what's wrong is the first step toward improving it (see Berczuk, 2008, p. 3 with references). In addition, an active nursing involvement would ensure that there is a steadfast commitment to the value of hospital employees, even in economically difficult times. Putting the power of improving a hospitals organization not only into the hands of the senior management but also the nurses means that staff directly involved with patient care is charged with developing process improvement (see Dunn, 2009, p. 2). I think that this will result in a strong identification of the nurses' personnel with and commitment to the computerized management system resulting in a high identification with their role in the implementation of the system making it even more efficient. Lean management promotes employee participation in process improvement. It is a staple of the lean process that the staff actually doing the work figures outs ways to improve it. It's not a management-driven process. It's a staff-driven one. (Dunn, 2009, p. 1 with further references).
C. Describe how handheld devices used by the nursing staff could be integrated into the management systems for better quality of care
Currently, in our hospital we waste a lot of precious time in the traditional three-step discharge process. First, the treating physicians have to write a discharge orders. Clerks have to prepare them. Finally, we nurses have to give the patients the discharge instructions. I am a discharge nurse at our hospital and I know from experience that one bottleneck in this manual serial process would delay the entire discharge process (see Berczuk, 2008, p. 2). One mistake made during the discharge process may lead to a later re-admission of the patient. It is crucial for my work to arrange follow-up appointments, reconcile medications and educate patients and their families about their conditions, their medications and self-care strategies. Due to the lack of a computerized management system I have to wait for a doctor to write discharge orders and a cerk to notify me about this. Very often I find myself running around for missing supplies. Time to completion of discharge letters is relevant for quality management and efficient resource utilization a in a hospital (see Dugas & Eckholt & Bunzemeier, 2008, p. 2). Computerized management systems would allow the nurses as well as the patients to save time and it would free-up personnel capacity by increasing parallel procedure by breaking processes down into parts and eliminating waste. Waste is an important concept in lean management thinking, especially as it relates to time and motion (see Berczuk ibid). One key principle of lean management via computerized hospital management systems is the elimination of any activity that does not add value to an organization's end product. For hospitals, this refers to any activity that is not necessary in providing excellent patient care (Dunn, 2009, p. 1). Computerized discharge letters would allow that highly complete discharge orders are timely available at the patient's bedside. Those forms would go directly to the clerks, who notify the nurses, who then begin their discharge instructions. In theory, no one is waiting for anyone else to finish one job before starting another. In practice, discharge time would significantly decrease. A computerized patient discharge system objective (PDS) would allow to register patient data quickly and qualitatively correct for general practitioners and/or other hospitals. Knowing early how many beds will become available each day would also help to ease the backlog of patients in the ER trying to get into beds and offloads workloads at those places (see Berczuk ibid).
D. Discuss security standards of data and patient confidentiality, including the need for data storage integrity and data backup and recovery and how the Health Insurance Portability and Accountability Act (HIPAA) requirements impact the use of the systems
Computerized hospital management systems need to include security standards to protect secure information electronically as compared to having a paper chart that can be lost or open in front of patients and visitors (see Metfessel, 2007, p. 7). Therefore, data storage integrity and data backup recovery is essential for any computerized hospital management system.
Secure password protection must be in place at multiple levels to ensure that access to Protected Health Information (PHI) is restricted to those who need the information at that time (Metfessel ibid). Appropriate encryption of data is essential for transmission between systems in order to prevent the interception of data (Metfessel ibid). A critical feature of any healthcare computer system is that it complies with regulatory requirements. One of the most important requirements is compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The key is to have computer systems, terminals, workstations, servers, and hand-held systems fully in communication with each other -- including the ability to send data outside the walls of the institution as needed -- while ensuring the confidentiality of protected health information (PHI), which is health information where the person to whom it belongs is identifiable. The federal government required compliance with HIPAA security regulations by April 2005 (Metfessel, 2007, p. 7).
E. Discuss how the [two] new systems [you have chosen]can affect healthcare cost
A significant initial cost outlay for an organization-wide computerized hospital information sys system is necessary, which for a large hospital may run into the tens of millions of dollars. Understandably, the majority of the hospitals that have installed a computerized management system are large urban hospitals. The up-front cost outlay may be prohibitive for smaller or rural hospitals unless there is an increase in outside revenue or third-party subsidies. However, although it may take a few years before a positive ROI becomes manifest, there can be a significant financial return from such systems (Metfessel, 2007, p. 14). Consequently, it is critical that such a system produce a positive return on investment (ROI) through patient care quality improvements,…