Health Information Systems HIS and Nursing Informatics

A1. Advantages and Disadvantages of a System
All health information systems (HIS) come with great advantages and some disadvantages that must be taken in account to keep patients safe. A HIS is a system that captures, retains information, and helps manage it. A HIS can be used to send health information within an organization and outside of the organization. Several items within a healthcare organization have interoperability with the HIS such but not limited to: x-rays, IV pumps, laboratory data, and vital machines can all be directly linked to the HIS. A big advantage of the HIS is that it makes patient information easy to find from several locations. Interoperability is having the various systems in the healthcare organization sharing information and working together. A patient can have their blood work results available inside the hospital to view and can also be viewed by another health care provider that is at home if needed. Another advantage of this HIS is that some of the documentation can be completed in real time depending on how the HIS is set up. A great benefit of the HIS is that you can view a patient’s medical records remotely rather than having to carry around a paper chart. Another advantage of the HIS is the ability to exchange patient information that will in turn increase patient safety. For example, a healthcare provider can view an abnormal x-ray from home and place orders to start the needed treatment. In addition, without the HIS, the healthcare provider would have to come into the hospital and physically find the x-ray. This would cause a delay in treatment.
Health information systems usability
There are primarily 6 categories that can be used to evaluate HIT usability and they are:
1. Satisfaction
2. Errors
3. Memorability
4. Utility
5. Efficiency
6. Learnability
Whenever the HIS system lacks in any of the 6 categories then the system will experience some form of disturbance in some area. In extreme instances the system could even get rejected. In order to comprehend usability more, it is indispensible to understand the working environment of the healthcare clinicians. Clinicians intermingle with HIS in ways that are fundamentally different from the way information workers interact with HIS.
HIS is designed to enhance safety and efficiency of the processes of healthcare. Systems like the pervasive devices for computing and electronic records have a record of improving safety in the healthcare environment. Research reveals that the design used in running such systems especially for user interface design may be linked to incidences of escalation of some other error types (Minshall, 2013).
The main disadvantage with usability is the time spent in training clinicians to handle the new system. Challenges of Complex Adaptive Systems may also contribute to the unwillingness to accept change.
Health information systems interoperability
HIMSS (Healthcare Information and Management Systems Society) defines interoperability as a description of the levels for which devices and systems can converse data and interpret the shared data (HIMSS, 2018; HIMSS, 2018b). In order for systems to become interoperable it must be possible for them to converse data and following that, present the data in such a manner that is understandable to the user.
Interoperability in the in healthcare industry means the capacity for computer systems and software to share and transmit data from essential sources such as the clinic, laboratory, medical practice, hospital and pharmacy.
Data exchange standards and schema should make it possible for data sharing among clinicians, pharmacy, hospital, patient and lab without respect to application vendor. The working together of HIS across and within organizational boundaries with an objective of advancing efficiency in healthcare delivery defines interoperability. HIS interoperability has three essential levels.
· Foundation level: Through interoperability of HIS the exchange of data from a particular IT system into another receiving IT system is made possible. It matters not whether the receiving system has ability to interpret the transmitted data.
· Semantic: Through interoperability it becomes possible for more than one system to transact information and apply such information that is already transacted. Semantic interoperability makes good use of data exchange structuring and data codification. This includes the vocabulary used so that IT system receiving such information can have capacity to interpret it. This interoperability level makes possible exchange of summarized patient information electronically among the clinicians and such like authorized parties through imminently HER systems as well as other systems which improve efficacy, efficiency, safety and quality of healthcare services.
· Structural: Interoperability helps define format or structure of exchanged data in instances where healthcare data takes uniform movement form a particular system to the other in such a manner that operational purpose or clinical purposes and data meaning is unaltered and preserved. Structural interoperability explains data exchange syntax. It makes sure that the exchange of data between IT systems becomes interpretable at the level of data field.
Importance of HIS interoperability
Safety in healthcare transitions: healthcare continuity is fundamental for patients notwithstanding whether chronic conditions are involved or whether the situation is acute with a number of health providers. Through interoperability there will be safety in healthcare transitions. This will contribute to enhanced patient outcomes for all.
Enhanced efficiency: healthcare interoperability is meant to help enhance efficiency. Whenever data gets presented consistently without regard to source it becomes much more easy for clinicians to quickly diagnose a matter through the decision making process with respect to treatment.
The disadvantage with interoperability of HIS systems in healthcare is the unwillingness by healthcare practitioners to apply the systems. Quinn (2015) references a research conducted in the U.S. According to the research, 33% healthcare practitioners recorded use for electronic health records in the sharing of patient information. 40% healthcare practitioners use electronic healthcare records although they do not transmit patient information through the EHR systems. IT would appear the HIS systems even though recommended healthcare practitioners are not ready to accept change.
Example
A patient who falls sick while on vacation may not have all their medical history details available with them. Through ICT and HIS it is possible to access patient information and provide healthcare to the patient amicably. ICT is an essential part of healthcare today. This is because HIS improve interoperability for clinicians through facilitation of meaningful and seamless information exchange across and within diverse institutions of healthcare at that point where care is given (Olaronke et al., 2014). As a consequence providers of healthcare get appropriate and prompt patient information access therefore enabling efficient management of patient health. Interoperability in electronic HIS has remained a challenge to date. Among the major hindrances to the acceptance and use of electronic HIS for successful exchange of information is systems’ user interface design (Olaronke et al., 2014). Poorly designed interfaces and missing fundamental functional qualities in the systems or inadequacies between features of user interface and tasks may propagate medical errors. It might as well lead to a decline in user satisfaction and system performance and inefficiencies in healthcare like in some missing fundamental details on patient diagnosis. This makes it harder for practitioners in healthcare to effectively use EHS for taking care of patients and for purposes of information exchange (Olaronke et al., 2014).
Health information systems usability compatibility
A report filed recently stated that close to half of medical practitioners using EHRS do not get the required patient information for patient care coordination. According to Quinn (2015) the department of human services and healthcare in the U.S. conducted a research study led by Professor Chun-Ju Hsiao. The research revealed that merely 33% of healthcare practitioners utilize HER for the purpose of electronically sharing patient information. Close to 40% of practitioners employ HER although they fail to share patients’ information (Quinn, 2015).
All this boils down to Continuing care Document (CCD). Meaningful use is the key thing. The CCD document must remain uniform in the entire HER process (Quinn, 2015). Compatibility should be demonstrated although most of the time this does not happen.
Health information systems scalability
A sizeable number of existing HIS have some heterogeneous systems and contend with the issue of scalability of the system.
In the HER interoperability context, why does usability and scalability appear challenging?
From the view point of scalability the issue of cost is quite pronounced, it is a big hindrance. Trying to bring many things together bit by bit or in dozens can result to multiple duplicating efforts. This might lead to higher costs and the meter might not move as first as required in arriving at a desired interoperability point for patients and healthcare providers. This is why the issue of scale and the ability to maneuver through the healthcare HIS crannies and nooks for seamless data exchange is still a big deal today.
There are many challenging issues on getting clinicians to accept and utilize the system. Incentive issues are still highly ranking when it comes to HIS implementation and use among physicians.
Wireless connections in hospital networks have become a fundamental part of the network environment. Leaders in IT in HIMSS intimate that the demands for HIS are manageable at the moment. This said though the coming years will have enhanced mobile devices as well as a growth in the size of healthcare organizations. It is quite difficult to manage and support environments that are not confined to the hospital compound. It is important to ensure that through the growth of mobility, hospitals become empowered also to manage physical structures in their environment as well as the community around that area.
The major drawback with HIS with respect to interoperability, scalability, compatibility, and usability is the unwillingness by practitioners to accept and actively employ the new HIS and EHR systems. For the systems to be fully integrated the healthcare practitioners must be willing to accept change and learn how to apply the CAS (complex adaptive systems) in their daily activities. Hospitals like John Hopkins have rolled out the HIS CCC (Capacity Command Center) and an evaluation of the new system is quite positive. The risk of technology and management errors may fundamentally cripple activities in the hospital.
This said though HIS are advantages in many aspects. They help reduce human error, increase hospital efficiency, alleviate fatalities related to inefficiencies, improved coordination, and enhanced capacity. John Hopkins Hospital has recorded incredible HIS results.
Some of the disadvantages of HIS are interoperability issues when different programs do not work well with each other. Connection issues within the organization can be an issue when Wi-Fi is weak in some of the patient care areas. Team members can become more focused on the technology than the patient’s well-being and this can lead to errors. Further, Medication issues can be caused by the HIS if the barcode scanner is not working properly. If the barcode scanner is working, then it can increase patient safety. Many of the advantages of a HIS can become disadvantages if the system is not working properly. In addition, a proper education plan is also important to keep the HIS advantages from becoming disadvantages.
A2. Patient Care and Documentation
All healthcare organizations have a goal to provide safe patient care with a high quality. With the HIS disadvantages, the HIS still greatly increase patient safety and quality of patient care. Error reductions are made by using a properly running HIS. An example of this is the scanning of patient and medication barcodes. The scanning of these barcodes keeps the patient safe by making sure the right medication, right medication dose, right medication route is used to the right patient, at the right time. The barcode also ensures the medication is on the patient care documentation. When working with any part of the HIS, the nurse must make sure to not become fixated on the technology. It may be easy to become fixated on the technology during patient care and not involve the patient in their own care.
A3. Quality and Delivery of Nursing Care and Patient Outcomes
A HIS can help ensure a high-quality nurse’s care by being a common place for easy access to patient information. Nurses working with a HIS can have a clearer view of the patient’s medical history rather than only being able to question the patient about past medical history. Most patients will be unsure of some of their history. For example, they may not know when they had an EKG and or what the accurate results were. If a nurse has access to a HIS, they can look on it to see the patient’s past EKG versus waiting for medical records to be sent from another organization. A HIS makes trending of blood sugar results and other lab values easy to trend the history of them. When the nurse has access to the HIS to see the patient’s past visits, the nurse will have a clearer and more in-depth patient history. If the nurse did not have access to a HIS, then they would have to wait for medical records to be found and sent to them. This step could cause patient care delays and decrease the quality of patient care.
B1. Ways QI Data Can Lead to Measurable Improvement
Quality improvement (QI) can be made by using the HIS QI data that is collected on each patient encounter. The QI data will help show which areas in the healthcare system have opportunities for improvement. Some areas that QI data can be used in are reducing central line infections, surgical site infections, and increasing patient satisfaction scores. Part of patient satisfaction is how prepared the patient and their family are ready for discharge. Another part of being ready for discharge is giving the patients education on how to best care for themselves at home. The nurses can find appropriate patient education videos and handouts to give to the patients about their condition. By using the HIS for patient education, patients are ensured that they are receiving hospital approved education and not having to educate themselves using YouTube. Hospital acquired infections such as central line infections and surgical site infections can be tracked using the QI date from the HIS. QI data helps to show which areas of the hospital are having issues with these infections and they can properly focus their education plans to be implemented where they are most needed.
B2. HITECH and HIPAA Security Standards and Regulations
The HIS stores its data security on a server and places it on cloud backup or a cloud storage provider. The HIS and all places that the data is stored at must take appropriate safeguards such as using pass words or biometric scanners to get access to the data. HIPAA standards were put into place in 1996 to protect patient privacy and patient information. Two rules that are a part of HIPAA is the privacy rule to protect patient’s privacy by creating standards for how patient information in handled. The other rule covers patient information security by creating standards to ensure patient information is protected, stored, and transferred in electronic form. Organizations can meet the HIPPA standards by creating policies, giving education to the health care team, and creating hard stops in the HIS to limit access to protected health information (Summary of the HIPAA Security Rule, 2013).
HITECH act started in 2009 to offer an incentive to healthcare organizations to use electronic health records across their system. This act was aimed to increase patient care and improve quality of the healthcare system by encouraging healthcare organizations to adopt EHR. The organization will need to place system safeguards making sure that the data storage integrity is always secure. This will be accomplished by using firewalls, anti-spyware, and backing up main frames on a regular basis. The backup data will need to be stored in a safe and secure place and can be stored on a disc. The organization should plan with their HIS vendor on the process for if a disaster takes place so they will know how to efficiently recover the data in a timely manner.
B3. Protection of Patient Privacy
With all the benefits of the HIS that improve patient care, protection of patient information must be ensured. The Healthcare team is responsible for keeping all patient information secure. This is done by the HIS using passwords that only allow authorized personnel into the HIS. The passwords can also limit where appropriate team members can go inside the HIS. The Healthcare team should never share their passwords or any healthcare information with anyone that does not have proper authorization. Audits should be implemented to ensure that no one is viewing patient information that should not be doing so. HIS uses encrypting of the information when sending it to keep the information protected.
B4. Organizational Efficiency and Productivity
Adopting a HIS will improve patient care, organizational efficiency, and productivity by reducing waste. The HIS makes patient information readily available and reduces paper clutter in the nurse’s station. The reduction of paper will reduce the health care team’s time on paperwork which will allow more time for the patient’s care as well as less paper will be wasted. Reducing waste will also be done by decreasing the time looking for medical records. Furthermore, by decreasing the amount of time looking for records, there will be an increase productivity of the health care team. The HIS will improve organizational efficiency and productivity by creating a standard patient chart layout. The HIS will reduce the amount of time the healthcare team waits for medical records to find and send past patient medical information. The HIS makes charting more organized and reduces the amount of time a health care professional spends charting. The adopting of the HIS will decrease the team member turnover rate by improving the work environment by having a standard documentation template that is easy to use and share with the rest of the health care team.
Impact of the HIS on capital resources
To have an inclusive method of approaching patient safety it is important to have capacity to foresee and safeguard against the circumstances which result to adversities otherwise choosing to implement actions correctively. Adverse circumstances and situations that border failure need standard process for collection and reporting, analytics and definition approaches which could be realized only through integration of patient safety systems of reporting into HIS context. This happens both in the large facilities and the normal office practice. The systems utilize a number of methods for detection and many channels for reporting. The systems also involve a wide data elements array. It is necessary to establish HIS infrastructure nationally so as to create a foundation for healthcare systems.
Organizational leaders and legislators in State and federal governments have laid emphasis on the necessity of the healthcare industry to take queue from other industries where computer IT implementation has become a critical element of enhanced accessibility of fundamental information, reduced human error and automated process and labor intensive processes (Shekelle, Morton & Keeler, 2006).
HIS technology has its fundamental use in reduction of medical errors as earlier alluded to. The strategy that is founded on technology has over time proven its effectiveness in the reduction of human errors in aviation and banking industries among others. HIS may help enhance safety and medical quality through integration of knowledge and decision making tools into medical practice. Subsequently this will reduce omission errors which often leave failure or gaps in knowledge therefore effecting application and synthesis of knowledge in medical care (Shekelle, Morton & Keeler, 2006). Integration of HIS within expansive systems can assist in the improvement of decision making processes in healthcare and the efficient application of therapeutic agents and diagnostic tests.
The capital resources required include:
Human resources
· Nursing informatics specialists
· clinicians responsible for using the HIS and
· The specialists who are responsible for the creation, facilitation, testing and implementation of new IT systems.
Financial resources
Implementing the system is an expensive undertaking that may not be possible for smaller health facilities. Institutions like John Hopkins hospital have managed the CCC facility due to their financial strength. Hospitals might have to seek assistance from State and federal governments as earlier alluded to.
Computing resources
A progressive and actionable HIS must be supported by highly integrated computer systems. The integration of actionable systems requires a lot of financial commitment. This may derail the hospital institution fundamentally.
C. Interdisciplinary Team Identification
The HIS project team must be set up properly in order to be successful. The project team needs to be an interdisciplinary team. This team will have four essential members; Chief Nursing Officer, Chief Operating Officer, Senior Informatics Officer, and Chief of Education. These four team members will help identify others to join the interdisciplinary team when needed. This group of four senior leaders will need to identify what the goals are of their HIS and create a timeline for implantation. The Chief Nursing Officer’s role will look at this project from a nursing stand point to assure that there will be no workflow issues. The Chief Nursing Officer has expertise in the nursing workflow and is responsible for this workflow. The Chief Operating Officer’s role will be to work on the project team to be able to keep the team aligned with the Chief Executive Officer and the rest of the executive team. Having this person on the team will also be able to help with maintaining a budget and timeline for the project. The Chief Operating Officer has expertise and a skill set in running large projects and keeping to a budget. The Senior Informatics Officer’s role will be to develop the action item list for the project and giving updates on the progress of these action items to the organization. The Senior Informatics Officer has expertise in data management, interoperability, and compatibility of the system. The Chief of Education’s role will be to publish education training plans for the organization and develop the training schedule for the project. Further, The Chief of Education will have expertise in adult learning techniques and ensuring that all training is on schedule.
D. Plan for Evaluating Success of Implementing a System
When planning for a new HIS, the project team will need to identify what the return of investment will be and how it will be measured. Two professional organization standards that will need to be met are giving education to the patients and nurses about the HIS. The American Nurses Association position statement on EHR includes the importance of education to the patients and nurses about the HIS that can make a system successful or fail (Privacy and Confidentiality, 2015). The second professional organization Healthcare Information and Management Systems Society recommends creating a standard charting layout and language. Making sure the healthcare team uses a standard layout and language will improve communication between the team members. The HIS must also maintain and protect patient information. (Privacy and Confidentiality, 2015). In conclusion, all of the above items will be tracked and audited to ensure the success of the HIS.
John Hopkins Hospital HIS Evaluation plan
John Hopkins Hospital just launched an advanced control center for the hospital. The command center for capacity command is known as Judy Reitz. It is built and designed with partnership from GE Healthcare Partners (GE). The command center uses the most advanced methods in predictive analytics, innovative solution to problems and predictive analytics for the better management of volume, experience and patient safety alongside management of patient movement into and outside the hospital. This enables better access to life saving practices in john Hopkins (GE Healthcare Partners, 2018). The CCC (Capacity Command Center) details the engineering systems principles commonly seen within many complex industries like in aviation, aerospace and power generation. It is surprising that the healthcare industry with highly critical patient information has yet to integrate the HIS tools (GE Healthcare Partners, 2018).
The CCC technology helps staff members remain informed around the clock on issues such as patient influx, the hospital units that require more members, the number of patients undergoing treatment, the necessity and availability of in-patient beds in the entire hospital, priority discharge and admissions, and such like essential information. This will help guarantee quality of healthcare for all visiting patients (GE Healthcare Partners, 2018).
From the start of the CCC for John Hopkins there has been a number of visits from different countries and from across the entire country. Preliminary results show that patient operational outcomes and patient experience has essentially improved in areas such as:
· Transfer of patients from different hospitals: John Hopkins has seen a 60% increase in its capacity to receive and manage patients undergoing complicated conditions from different hospitals in the region.
· Operation room: the delays in transfer from operation rooms following a medical procedure has gone down by close to 70%
· Emergency Department: Patients get bed allocation 30% quicker following a decision to admit them from an emergency department. The transfer of patients after bed allocation is also 26% faster.
· Patient discharges: There are 21% more patients who get discharged before 12PM in comparison to previous statistics (GE Healthcare Partners, 2018)
System Evaluation plan
As referenced in the John Hopkins hospital case the success of any HIS will be evaluated by answering the following questions:
· Has the HIS system improved hospital capacity?
· Has the system alleviated delays in patient admission?
· Has the system enhanced activities at the emergency department?
· Has the system improved the rate of patient discharge
· Has the system reduced the number of hospital fatalities related to inefficiencies?
· Has the level of satisfaction among patients improved?
Summary
It can be ascertained from a careful interrogation of Jon Hopkins Hospital CCC that HIS are beneficial in many ways. They can help increase the efficiency levels of a hospital facility tremendously and within a limited period of time. While it may be surprising why the hospital industry has not fully embraced information technology in their system it is also understandable that healthcare professionals have been more inclined towards healthcare research. Experts in Information technology may not have done enough to exploit the healthcare industry perhaps because the industry is not as lucrative as the e-commerce or mobile technology industry.
Recently there has been a growing desire to increase information efficiency amidst the issues with ethics in patient information handling. The ultimate goal of an efficient HIS is to enhance safety, increase efficiency and eliminate errors in healthcare provision. The HIS systems under use in hospitals may be blamed for a poor acceptability rate among physicians due to their inept user interface. For a HIS system to function seamlessly it must embrace the following:
1. Satisfaction
2. Errors
3. Memorability
4. Utility
5. Efficiency
6. Learnability
John Hopkins has capitalized on developing a system that embraces all the six aspects. Capital resources may also be a big challenge. The cost of implementing an efficient HIS system may be unmanageable for most hospital organizations. The proposal to have the State and federal governments participate in the development of hospital efficient HIS systems may help mitigate the numerous costs that go into having an efficient system. Efficient systems may help reduce scalability costs and improve system interoperability. Just as different companies like the information industries such as Google, Apple, Amazon, Facebook, Twitter etc. have attracted a lot of financing interests the Hospital industry should be rebranded to attract financing for better efficiency. The debate around having a national HIS that allows for integration of various hospitals must not be abandoned. It may be the easiest way to increased hospital efficiency, safety and effectiveness.
References
American Nurses Association Center for Ethics and Human Rights (2015, June). Privacy and Confidentiality Retrieved February 14, 2018, from http://www.nursingworld.org/MainMenuCategories/Policy-Advocacy/Positions-and-Resolutions/ANAPositionStatements/Position-Statements-Alphabetically/PrivacyandConfidentiality.html
GE Healthcare Partners (2018).The Johns Hopkins Hospital Launches Capacity Command Center to Enhance Hospital Operations. Retrieved 21, February, 2018, from http://emea.gehealthcarepartners.com/insights/128-digital-and-advanced-analytics/information-management-and-analytics/73-the-johns-hopkins-hospital-launches-capacity-command-center-to-enhance-hospital-operations
HIMSS (2018). What is Interoperability? Retrieved 27, February, 2018, from http://www.himss.org/library/interoperability-standards/what-is-interoperability
HIMSS (2018b). Healthcare Information and Management Systems Society. Retrieved 27, February, 2018, from http://www.himss.org/
Minshall, S. (2013). A review of healthcare information system usability & safety. Stud Health Technol Inform, 183, 151–156.
Olaronke, I., Rhoda, I., Ishaya, G., & Abimbola, S. (2014). Impacts of Usability on the Interoperability of Electronic Healthcare Systems - ProQuest. International Journal of Innovation and Applied Studies, 8(2), 827–832.
Quinn, R. (2015). Compatibility Issues Make Physicians’ Use of Electronic Health Records Systems Tougher, The Rheumatologist. Retrieved 21, February, 2018, from http://www.the-rheumatologist.org/article/compatibility-issues-make-physicians-use-of-electronic-health-records-systems-tougher/
Quinn, R. (2015). Compatibility Issues Make Physicians’ Use of Electronic Health Records Systems TougEHR, The Rheumatologist. Retrieved 27, February, 2018, from http://www.the-rheumatologist.org/article/compatibility-issues-make-physicians-use-of-electronic-health-records-systems-tougEHR/
Shekelle, P. G., Morton, S. C., & Keeler, E. B. (2006). Costs and benefits of health information technology. Evid.Rep.Technol.Assess. (Full.Rep.), (1530–4396 (Print)), 1–71.
U.S. Department of Health & Human Services (2013, July 26). Summary of the HIPAA Security Rule Retrieved February 13, 2018, from https://www.hhs.gov/hipaa/for-professionals/security/laws-regulations