Fluent Essays

Requirements: As discussed in the lesson and assigned reading for this week, EHRs provide both benefits and drawbacks. Create a “Pros” versus “Cons” table and include at least 3 items for each list. Next to each item, provide a brief rationale as to why you selected to include it on the respective list. Refer to the Stage 3 objectives for Meaningful Use located in this week’s lesson under the heading Meaningful Use and the HITECH Act. Select two objectives to research further. In your own words, provide a brief discussion as to how the objective may impact your role as an APN in clinical practice.   Adhere to the following guidelines regarding quality for the threaded discussions in Canvas: Application of Course Knowledge: Demonstrate the ability to analyze, synthesize, and/or apply principles and concepts learned in the course lesson and outside readings. Scholarliness and Scholarly Sources: Demonstrates achievement of scholarly inquiry for professional and academic decisions using valid, relevant, and reliable outside scholarly source to contribute to the discussion thread.  Writing Mechanics: Grammar, spelling, syntax, and punctuation are accurate. In-text and reference citations should be formatted using correct APA guidelines. Direct Quotes: Good writing calls for the limited use of direct quotes. Direct quotes in discussions are to be limited to one short quotation (not to exceed 15 words). The quote must add substantively to the discussion. Points will be deducted under the grammar, syntax, APA category.  For each threaded discussion per week, the student will select no less than TWO scholarly sources to support the initial discussion post. Scholarly Sources: Only scholarly sources are acceptable for citation and reference in this course. These include peer-reviewed publications, government reports, or sources written by a professional or scholar in the field. The textbooks and lessons are NOT considered to be outside scholarly sources. For the threaded discussions and reflection posts, reputable internet sources such as websites by government agencies (URL ends in .gov) and respected organizations (often ends in .org) can be counted as scholarly sources. The best outside scholarly source to use is a peer-reviewed nursing journal.  You are encouraged to use the Chamberlain library and search one of the available databases for a peer-reviewed journal article.  The following sources should not be used: Wikipedia, Wikis, or blogs.  These websites are not considered scholarly as anyone can add to these. Please be aware that .com websites can vary in scholarship and quality.  For example, the American Heart Association is a .com site with scholarship and quality.  It is the responsibility of the student to determine the scholarship and quality of any .com site.  Ask your instructor before using any site if you are unsure. Points will be deducted from the rubric if the site does not demonstrate scholarship or quality. Current outside scholarly sources must be published with the last 5 years.  Instructor permission must be obtained BEFORE the assignment is due if using a source that is older than 5 years. readings: McGonigle, D. & Mastrian, K. (2018). Nursing informatics and the foundation of knowledge (4th ed.). Jones and Bartlett. Chapter 11 The Human-Technology Interface Chapter 14 The Electronic Health Record and Clinical Informatics (pages 266-269) McBride, S., & Tietze, M. (2018). Nursing Informatics for the Advanced Practice Nurse (2nd ed.). Springer Publishing. Chapter 1 Introduction to Health Information Technology in a Policy and Regulatory Environment Chapter 8 Systems Development Life Cycle for Achieving Meaningful Use Chapter 11 Electronic Health Records and Health Information Exchanges Providing Value and Results for Patients, Providers, and Healthcare Systems Articles Gold, M., & McLaughlin, C. (2016). Assessing HITECH implementation and lessons: 5 years later. (Links to an external site.) Milbank Quarterly, 94(3), 654-687.  Hydari, M. Z., Telang, R., & Marella, W. M. (2015). Electronic health records and patient safety (Links to an external site.). Communications of the ACM, 58(11), 30-32. Payne, T. H. (2016). The electronic health record as a catalyst for quality improvement in patient care (Links to an external site.). Heart, 102(22), 1782. doi: http://dx.doi.org.proxy.chamberlain.edu:8080/10.1136/heartjnl-2015-308724 Resnick, C. M., Meara, J. G., Peltzman, M., & Gilley, M. (2016). Meaningful use: A program in transition. (Links to an external site.) Bulletin of the American College of Surgeons, 101(3), 10-16. Waldren, S. E., & Solis, E. (2016). The Evolution of meaningful use: Today, stage 3, and beyond (Links to an external site.). Family Practice Management, 23(1), 17-22.The electronic health record as a catalyst for quality improvement in patient care Thomas H Payne Department of Medicine, University of Washington, Seattle, Washington, USA Correspondence to Dr Thomas H Payne, Medicine IT Services, Box 359968, 325 Ninth Avenue, Seattle, WA 98105, USA; [email protected] washington.edu Received 4 April 2016 Revised 6 July 2016 Accepted 7 July 2016 Published Online First 8 August 2016 To cite: Payne TH. Heart 2016;102:1782–1787. ABSTRACT Electronic health records (EHRs) are now broadly used, following decades of development and incentive programmes for their use. EHRs have been shown through use of reminders, electronic order sets and other means to improve reliability of performance of many basic tasks in acute, preventive and chronic care. They assist with collecting, summarising and displaying the large volumes of information in patient records and support the implementation of guidelines and care pathways. Broad use of EHRs has brought into focus weaknesses of the current generation of EHRs: their user interface, implementation difficulties, time required to use them and others. Addressing these weaknesses and adopting new technologies, including use of voice, natural language processing and data analytic techniques, is necessary for EHRs to achieve their full potential: to gather information from routine care, to learn from it and to be an integral component of efforts to continuously improve and to transform care. INTRODUCTION Electronic health records (EHRs) have been regarded as an integral component of healthcare transformation1 and since large programmes in the UK2 and the US American Recovery and Reinvestment Act of 2009 financial incentives3 have become an important part of daily practice for physicians in many countries. The rapid transi- tion from paper to EHRs has resulted in substan- tial change in practice, with mixed reception among physicians.4 What evidence drove the vision that EHRs are the key to healthcare transformation? Should this vision be changed and if so in what ways? In this paper we provide an overview for the rationale of moving to EHRs and the ways they can be lever- aged to improve the quality of care we deliver. EHRs, sometimes referred to as electronic medical records, are computing systems that replace and expand functions previously provided by paper medical records: to document care, review patient data from the laboratory, imaging, clinical studies, patient experience and other sources and to enter and communicate orders. Beyond this, EHRs permit communication within the patient care team including the patient in ways paper could not and permit us to study and manage care of populations, to bill for care, potentially to learn from pooled EHR data and other functions (table 1). The term ‘system’ indicates that EHRs are usually not single applications but rather multiple applications and databases connected into a larger and more complex whole. They often using web poOriginal Investigation Assessing HITECH Implementation and Lessons: 5 Years Later M A R S H A G O L D a n d C AT H E R I N E McL A U G H L I N Mathematica Policy Research Policy Points: � The expansive goals of the Health Information Technology for Eco- nomic and Clinical Health (HITECH) Act required the simultaneous development of a complex and interdependent infrastructure and a wide range of relationships, generating points of vulnerability. � While federal legislation can be a powerful stimulus for change, its effectiveness also depends on its ability to accommodate state and local policies and private health care markets. � Ambitious goals require support over a long time horizon, which can be challenging to maintain. The future of health information technology (health IT) support nationally is likely to depend on the ability of the technology to satisfy its users that its functionalities address the interests policymakers and other stakeholders have in using technology to promote better care, improved outcomes, and reduced costs. Context: The Health Information Technology for Economic and Clinical Health (HITECH) Act set ambitious goals for developing electronic health information as one tool to reform health care delivery and improve health outcomes. With HITECH’s grant funding now mostly exhausted but statutory authority for standards remaining, this article looks back at HITECH’s experience in the first 5 years to assess its implementation, remaining challenges, and lessons learned. Methods: This review derives from a global assessment of the HITECH Act. Earlier, we examined the logic of HITECH and identified interdependencies critical to its ultimate success. In this article, we build on that framework to review what has and has not been accomplished in building the infrastructure authorized by HITECH since it was enacted. The review incorporates quan- titative and qualitative evidence of progress from the global assessment and The Milbank Quarterly, Vol. 94, No. 3, 2016 (pp. 654-687) c© 2016 Milbank Memorial Fund. Published by Wiley Periodicals Inc. 654 Assessing HITECH Implementation and Lessons 655 from the evaluations funded by the Office of the National Coordinator for Health Information Technology (ONC) of individual programs authorized by the HITECH Act. Findings: Our review of the evidence provides a mixed picture. Despite HITECH’s challenging demands, its complex programs were implemented, and important changes sought by the act are now in place. Electronic health records (EHRs) now exist in some form in most professional practices and hospitals eligible for HITECH incentive payments, more information is being shared electronically, and the focus of attention has shifted from adoption of EHRs toward more fundamental issues associated with using health informa- tion technology (health IT) to improve health care delivery and outcomes. In some areas, HITECH’s achievements to date have fallen short of the hopes of30 C O M M U N I C AT I O N S O F T H E A C M | N O V E M B E R 2 0 1 5 | V O L . 5 8 | N O . 1 1 V viewpoints Economic and Business Dimensions Electronic Health Records and Patient Safety Examining the effects of electronic health records on the safety of patients in medical facilities. U . S . H E A L T H C A R E H A S made huge investments in health information technologies (IT). The U.S. Health Infor- mation Technology for Eco- nomic and Clinical Health (HITECH) Act of 2009 earmarked more than $20 billion to foster electronic health records (EHRs) at U.S. hospitals and other medical facilities, and facilities have spent billions of their own to digi- tize patient records and clinical work- flows. What benefits have accrued? Have EHRs lowered the cost and im- proved the quality of healthcare? In particular, what has been the effect of EHRs on patient safety? There is some evidence that EHRs reduce costs over the long term and under the right conditions.2,a But evi- dence is scant on the effect of EHRs on patient safety. An Institute of Medi- cine (IOM) 2012 study, Health IT and a EMR detractors have asserted EMR implemen- tations also impose high cost to hospitals and physicians—both direct financial costs of imple- mentation and maintenance and for the medi- cal providers, the indirect costs of increased doc- umentation imposed by EMRs. For a polemical example of such an argument, see Charles Krau- thammer, “Why Doctors Quit.” The Washington Post (May 28, 2015); http://wapo.st/1FdVEX4. DOI:10.1145/2822515 Muhammad Zia Hydari, Rahul Telang, and William M. Marella I M A G E F R O M S H U T T E R S T O C K .C O M http://dx.doi.org/10.1145/2822515 N O V E M B E R 2 0 1 5 | V O L . 5 8 | N O . 1 1 | C O M M U N I C AT I O N S O F T H E A C M 31 viewpoints V viewpoints Patient Safety, concluded, “current literature is inconclusive about the overall impact of health IT on patient safety.” This lack of evidence prompt- ed an econometric study of patient safety at Pennsylvania (PA) hospitals. Patient safety improved for Pennsyl- vania hospitals that adopted EHRs: a 27\% decline in overall patient safety events and a 30\% decline in medica- tion errors.b What Is Patient Safety? Patient safety can be described as “free- dom, as far as possible, from harm, or risk of harm, caused by medical man- agement (as opposed to harm caused by the natural course of the patient’s original illness or condition).”4 A pa- tient safety event (PSE) occurs if a pa- tient is harmed or unnecessarily placed at risk of harm. Every year PSEs affect hundreds of thousands of patients in the U.S. and cost billions of dollars. Medical errors and the harm they cause have been seen as unavoidable side effects of modern medicine or the result of incompetence. Lucian Leape says, “many errors are preventable and many are evidence of system flaws not character flawThe electronic health record as a catalyst for quality improvement in patient care Thomas H Payne Department of Medicine, University of Washington, Seattle, Washington, USA Correspondence to Dr Thomas H Payne, Medicine IT Services, Box 359968, 325 Ninth Avenue, Seattle, WA 98105, USA; [email protected] washington.edu Received 4 April 2016 Revised 6 July 2016 Accepted 7 July 2016 Published Online First 8 August 2016 To cite: Payne TH. Heart 2016;102:1782–1787. ABSTRACT Electronic health records (EHRs) are now broadly used, following decades of development and incentive programmes for their use. EHRs have been shown through use of reminders, electronic order sets and other means to improve reliability of performance of many basic tasks in acute, preventive and chronic care. They assist with collecting, summarising and displaying the large volumes of information in patient records and support the implementation of guidelines and care pathways. Broad use of EHRs has brought into focus weaknesses of the current generation of EHRs: their user interface, implementation difficulties, time required to use them and others. Addressing these weaknesses and adopting new technologies, including use of voice, natural language processing and data analytic techniques, is necessary for EHRs to achieve their full potential: to gather information from routine care, to learn from it and to be an integral component of efforts to continuously improve and to transform care. INTRODUCTION Electronic health records (EHRs) have been regarded as an integral component of healthcare transformation1 and since large programmes in the UK2 and the US American Recovery and Reinvestment Act of 2009 financial incentives3 have become an important part of daily practice for physicians in many countries. The rapid transi- tion from paper to EHRs has resulted in substan- tial change in practice, with mixed reception among physicians.4 What evidence drove the vision that EHRs are the key to healthcare transformation? Should this vision be changed and if so in what ways? In this paper we provide an overview for the rationale of moving to EHRs and the ways they can be lever- aged to improve the quality of care we deliver. EHRs, sometimes referred to as electronic medical records, are computing systems that replace and expand functions previously provided by paper medical records: to document care, review patient data from the laboratory, imaging, clinical studies, patient experience and other sources and to enter and communicate orders. Beyond this, EHRs permit communication within the patient care team including the patient in ways paper could not and permit us to study and manage care of populations, to bill for care, potentially to learn from pooled EHR data and other functions (table 1). The term ‘system’ indicates that EHRs are usually not single applications but rather multiple applications and databases connected into a larger and more complex whole. They often using web poAs discussed in the lesson and assigned reading for this week, EHRs provide both benefits and drawbacks. Create a “Pros” versus “Cons” table and include at least 3 items for each list. Next to each item, provide a brief rationale as to why you selected to include it on the respective list. Pros Rationale Cons Rationale Decrease medical errors Patient safety is the number one priority of all healthcare works and facilities. Possible privacy violations Exposing patient data and can make it unavailable for a particular time (Alghamdi, Alomari, Althubaiti & Aziz, 2017). Makes patient lose trust and can be costly to facility. Increased adherence to evidence-based clinical guidelines and effective care Provides best practice to patients and promotes better patient outcomes. Cost of maintenance of EHR Cost of maintaining ERH as well as the cost of training for the employee to learn system may be too much for some smaller facilities. Faster results and treatment of patients Labs and other tests are more readily available to providers and therefore reduces the delay of medical treatment and enhancing the quality of care (Alghamdi, Alomari, Althubaiti & Aziz, 2017). National interoperability Unable to cross patient data from one database to another, which may cause delay in care or missed information of the patient. Refer to the Stage 3 objectives for Meaningful Use located in this week’s lesson under the heading Meaningful Use and the HITECH Act. Select two objectives to research further. In your own words, provide a brief discussion as to how the objective may impact your role as an APN in clinical practice. One objective that I found relevant in the stage 3 objectives for Meaningful Use was the ability of the patient to view, download and transmit their personal health information including labs and other information within a four-day window of their visit. One benefit of the direct release of healthcare information is it leads to better-informed patients who are more involved in their care. Another benefit is it improves patient safety by allowing patients to see results and avoiding missed follow-ups of critical findings. According to Walker, Meltsner, and Delbanco (2015) 8– 26\% of abnormal test results are not followed up in a timely manner and therefore, can lead to https://www.coursehero.com/file/53029510/Week-3-Discussiondocx/ Th is stu dy re so ur ce w as sh ar ed v ia C ou rs eH er o. co m https://www.coursehero.com/file/53029510/Week-3-Discussiondocx/ delay in care for the patient. This can lead to unwanted outcomes and failed or missed treatment of the patient. By allowing the patient access to their record impacts the APN in many ways. For example, it allows the patient to be more involved in their care as well as answering some of the questions the patient may have regarding their visit. Another objective that I see significant is the use of the