Optimizing Merged Health Information Systems
Although the merger of two comparably sized companies competing in the same industry is a relatively commonplace business strategy, the process is fraught with obstacles and challenges and a significant percentage of merged entities fail outright because of these problems (Murphy, 2019). These types of problems are further compounded when there are sophisticated information systems involved that must also be merged successfully. The purpose of this paper is to explicate the responsibilities involved in implementing a health information system (HIS) that meets current Health Information Technology for Economic and Clinical Health (HITECH) Act and the Health Insurance Portability and Accountability Act (HIPAA) Security and Privacy regulatory requirements. To this end, a discussion and analysis of health information systems, a description concerning how a system will affect patient care and documentation and an explanation concerning how using a system to access information will affect the quality and delivery of nursing care and patient outcomes are followed by a discuss about how a system will benefit the merged organization. Finally, a description of four essential stakeholder roles needed to form an interdisciplinary team to work on a system implementation is followed by a discussion concerning the plan for evaluating the success of the implementation of a system by incorporating two professional organization standards are followed by a summary of the research and important findings about the challenges and issues involved are presented in the paper’s conclusion..

A. Discussion and analysis of health information systems

1. Summary of advantages and disadvantages of a system.

A health information system is defined by Abouzhar (2009) as an "integrated effort to collect, process, report and use health information and knowledge to influence policy-making, program action and research" (p. 578). Although health information systems may differ significantly in terms of configurations and capabilities, they typically share some common features that are related to improving the ability of health care organizations to more effectively manage patient-related data to identify problem areas and opportunities for improvement. For instance, according to Shahmoradi and Habibi-Koolaee (2016), the primary advantages of health information systems relate to their ability to “provide assembly, analysis, and dissemination of data necessary to guide, promote and evaluate the disease prevention and health promotion programs” (p. 1096).

Conversely, the main disadvantages of health information system include their complexity and the piecemeal fashion in which they are frequently developed (Creswell & Aziz, 2013). Moreover, there is no conceptual framework available for the implementation of health information systems and the process can be extremely difficult as a result of a broad array of technical, social, and organizational factors that tend to be inter-related (Cresswell & Aziz, 2013). In this regard, Cresswell and Azis (2013) emphasize that, “The evidence indicates that there are a range of technical, social and organizational considerations that need to be deliberated when attempting to ensure that technological innovations are useful for both individuals and organizational processes” (p. 73). Because these factors are typically inter-related, though, the decision-making process for implementing health information systems must apply a holistic approach so that there are no unintended outcomes or adverse effects on patient care (Cresswell & Aziz, 2013)

The full range of the advantages that accrue to the use of health information systems can only be achieved by ensuring they are usable, scalable, interoperable and compatible. For example, effective health information systems are characterized by a high degree of usability. In this context, “usability” refers to the effectiveness, efficiency and satisfaction with which specific users can achieve a specific set of tasks in a particular environment” (Usability, 2019). Moreover, it requires a significant amount of time to realize these advantages and organizational leaders should be prepared for some setbacks and mistakes.

At present, the usability of many health information systems remains suboptimal due to the manner in which data is stored and the difficulties that are frequency experienced in attempting to access it (Abouzhar, 2009). Likewise, the term “interoperability” refers to “the ability of different information systems, devices or applications to connect, in a coordinated manner, within and across organizational boundaries to access, exchange and cooperatively use data amongst stakeholders, with the goal of optimizing the health of individuals and populations” (What is interoperability?, 2019, para. 2).

Effective health information systems are also characterized by a high level of scalability so that they can accommodate ongoing increases in data and user demand (Zhou & Watzlaf, 2017). In addition, it will be vitally important to ensure the compatibility of the two merged health information systems in order to optimize their operations. In the past, compatibility between disparate health information systems was somewhat easier to achieve because the data typically consisted of alpha-numeric data only; however, in recent years, the transition from paper-based documentation to digital storage has also be marked by the addition of graphic images and other types of data that may not be easily shared between these systems (Reichertz, 2009), making the need for compatibility a fundamental requirement for success.

One strategy that can be used to help ensure the interoperability and compatibility of disparate health information systems is the use of middleware. For example, Shahmoradi and Habibi-Koolaee (2016) report that:

Standards on terminology, security and data exchange play a critical role to integrate health information systems and provide interoperability across heterogeneous systems. Middleware is a tool to facilitate the integration of health information systems, so that, in the interaction between the systems there is no need to reproduce the same component of them. (p. 1098)

Taken together, it is clear that there are a number of advantages and corresponding disadvantages related to health information systems, and these systems also have a profound effect of patient care and documentation as discussed further below.

2. Description concerning how a system will affect patient care and documentation

Properly implemented and administered, health information systems affect patient care in a number of positive ways. For instance, according to Shahmoradi and Habibi-Koolaee (2016), “[Health information systems] have been developed in order to integrate health information to meet...…background

Ensure that schedules and timelines are followed and collaboration between team members.

IT specialist

? Ensuring data quality; information assurance constructs of confidentiality, integrity, and data availability

? Design of mobile app, database, and web portal

Data integration and analysis

? Customization of the open-source electronic health record

Health information system design, development and management

Provides effective management of the health information system

Advanced practice nurses (two)

? Designing of well-being assessments

? Personalized interventions

? Providing feedback on electronic health records, mobile app, and web portal

Specialty expertise in various areas of clinical medicine

Provides clinical information and feedback needed by the IT specialist to optimize the health information system

Source: Adapted from Kruse & Smith, 2017

D. Discussion of plan for evaluating the success of the implementation of a system by incorporating two professional organization standards

Besides using aggregated data concerning the effectiveness of the interventions that are developed for the health information system , two relevant professional organization standards published by the National Association of Healthcare Quality (NAHQ) that can be used to evaluate the success of the implementation of a health information system are as follows:

1. Healthcare quality professionals understand that recipients of healthcare services are the most vulnerable stakeholders in the system. They treat recipients with empathy and respect, honoring their autonomy and privacy. They support positive health outcomes for healthcare recipients.

2. Healthcare quality professionals advocate for quality and safety regardless of healthcare setting. They facilitate seamless transitions of care among providers and provider groups. They support approaches to care that promote the right intervention to the right person at the right time and in the right setting (NAHQ code of ethics for healthcare quality, 2019).

In order to apply these professional organization standards in ways that can accurately evaluate the effectiveness of the health information system, it will be necessary to develop appropriate quantifiable metrics concerning the extent to which these standards are followed. Weights can be assigned along a range from 1 to 10 for any identified violations, with 1 representing the least serious and 10 the most serious violations. This data will be analyzed to determine where problems areas exist and what steps need to be taken in response.

Conclusion

The research was consistent in showing that mergers between two comparably sized organizations frequently fail to a lack of planning and follow-up oversight. Moreover, these challenges are exacerbated when there are disparate information systems involved. Further, organizations that maintain health information systems have a legal responsibility to comply with the provisions of the Health Information Technology for Economic and Clinical Health Act and the Health Insurance Portability and Accountability Act. Compliance with these laws and professional organization standards can be achieved by ensuring that there are appropriate and adequate administrative, physical and technical safeguards are in place. Finally, the research was also consistent in emphasizing that the improved delivery of nursing services and achieving optimal patient outcomes does not just happen when health information systems are used, but are rather…