What Key Information Would be needed in the Database that Would Allow You to Track Opportunities for Care Improvement?
Patient Charts
The patient chart is vital information in the electronic health record (EHR) and a critical element at the point of patient care. The map offers all essential information in one concise view for quick healthcare decision-making. As Kruse et al., (2018) claim, critical data such as age, height and weight are entered in the database for reference purposes. Physicians consult the chart to view which treatments were previously used and the consequent patient outcomes.
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Lab Reports
All EHR databases contain laboratory reports and images that users can import for decision-making. For instance, the lab results of a client's most recent blood scan can be viewed in the electronic health records system alongside images such as X-rays. Kruse et al., (2018) affirm that this is useful for the end-users as it allows them to promptly view such details in an instance. Furthermore, historical data can also be viewed for comparative purposes to determine notable improvements.
Prescriptions and Medications
Information on prescriptions is entered on the electronic database to allow users to identify current and past medications used by individual patients. As Kruse et al., (2018) note, this helps in identifying redundancies and establishing whether recent drugs are contraindicated with remedies the physician is presently considering prescribing.
What Role Does Informatics Play in the Ability to Capture this Data?
During the execution phase, informatics enables the implementation team to integrate the most meaningful data sets for EHR systems providers. Additionally, informatics plays a central role in guiding the design, including how immunizations histories can be presented to retrieve information quickly. Palabindala et al., (2016) remark that informatics can also allow programmers to send the right signal promptly to promote efficient clinical workflow.
Which Systems and Staff Members would need to be involved in the Design and Implementation process and Team?
A functional EHR involves five basic systems: Health Information Management, Order Management, Communication Management, Results Management, and Revenue Cycle Management ( Gagnon et al., 2016) . Besides, the technical requirements include security certifications, performance reporting, and data management, among others. Establishing a high-level team for the project is vital to developing the policy framework and responsibilities and pinpoint to whom the project manager should update progress and modifications in the scope ( Gagnon et al., 2016) . Implementation team members should add value to the project by presenting varying viewpoints on how the EHR will be utilized. Therefore, the team will include a Physician representative, a Nursing champion, IT staff member, and a Revenue Collection Lead from the health facility.
What Professional, Ethical, and Regulatory Standards Must be Incorporated into the Design and Implementation of the System?
For an EHR system to be successfully implemented, all the professional, ethical, and legal standards should be adhered to. Before going live, the system owners should demonstrate an understanding of the Health Insurance Portability and Accountability Act (HIPPA) that obligates care providers to allow patients to freely access information in their records ( McBride et al., 2018) . In the digital era, patient records from one system should be able to move flawlessly to another. McBride et al., (2018) assert that this standardization promotes interoperability of the EHR systems and enhances seamless clinical decision-making. The healthcare providers adopting the approach should also make ethical considerations by meeting confidentiality and security standards. As McBride et al., (2018) offer, an EHR system should have data protection mechanisms to ensure that the clinical records' integrity is maintained. The Health Information Technology and for Economic and Clinical Health Act (HITECH) requires that physicians and other authorized users of the system should be sufficiently trained to ensure that they can maintain health records confidentially and securely ( McBride et al., 2018) .
How Would the EHR Team Ensure that all Order Sets are Part of the New Record
In most cases, order sets utilize clinical decision support (CDS) at the patients' care points while giving attention to a specific ailment. However, these components of an EHR system can be improved and used in multiple settings ( Busby et al., 2015) . The best approach that the EHR implementation team can adopt to ensure that every order set makes part of the new record is through comprehensive planning early enough before the system is built. According to Busby et al. (2015) , early planning aids in establishing the overall process flow, which allows the team to pinpoint an element that should be excluded. Hence, having a suitable infrastructure is essential. The other strategy the team can deploy is by ensuring expert opinions from relevant stakeholders are included in designing the different order sets. Nurses, physicians, and laboratory technicians should bring their unique skill sets into the process. Also, efforts should be made by the team to facilitate quick content review and maintenance. Busby et al. (2015) comment that the time and resources set aside for this process are central to the orders sets' success in their new versions. As the providers seek to enhance patient safety, the new record should be regularly updated in the implementation process.
How Would You Communicate the Changes, including any Transition Plan?
Staff members, including nurses and physicians, report differing reactions to organizational change as some would adjust promptly while others may resist the EHR implementation (Meeks et al., 2018). Because of such reasons, timely and effective communication of these imminent process changes is necessary so that all employees feel that they have direct input in the project. The first step in communicating the changes is explaining to the staff the project's justification and how its implementation would affect their routine approaches to care. The aim would be to eliminate any fears, encourage active participation, generate and sustain enthusiasm for the project, and alleviate potential obstacles. Meeks et al., (2018) suggest that this should be followed up with assigning different roles and responsibilities in simplifying the transition process. Therefore, by providing details on the changes' benefits, all staff members would acquire a sense of ownership in the process.
What Measures and Steps Would you take to Evaluate the EHR Implementation's Success from a Staff, Setting, and Patient Perspective?
Conducting a post-implementation assessment of the EHR would allow the providers to improve processes and realize the system's benefits. As Fritz et al. (2015) claim, it will be critical to identify the individual groups' process change responses. The next step would be to determine how the different groups perceive the success of the EHR system. For the staff, the evaluation will determine the degree of awareness of the change, their aspirations for growth, and lessons learned during the transition period ( Fritz et al., 2015). For the setting, the measure of success would entail the impact of this change on organizational culture. Aspects such as healthcare safety would be critical indicators of the system's impact at the facility level. From a patient perspective, success will comprise reduced wait times and how quickly patients can access their health records.
What Leadership Skills and Theories Would Facilitate Collaboration with the Interprofessional Team and Provide Evidence-Based, Patient-Centered Care?
Leadership often makes a significant difference in a project's success, especially when leading a team with individuals from different disciplines. One of the essential skills that would foster collaboration is effective communication and relationship management. Morgan et al., (2015) allege that conflicts are bound to emerge in an interprofessional team, which will require good communicators to neutralize such issues. Flexibility is another skill that would enable healthcare leadership teams to incorporate divergent views in offering safe and patient-centric care. Through this competency, individuals and communities' opinions would be considered in decision-making while acknowledging cultural disparities and expectations ( Morgan et al., 2015).
References
Busby, L. T., Sheth, S., Garey, J., Ginsburg, A., Flynn, T., Willen, M. A., & Palmer, E. S. (2015). Creating a process to standardize regimen order sets within an electronic health record. Journal of Oncology Practice , 7 (4), e8-e14.
Fritz, F., Tilahun, B., & Dugas, M. (2015). Success criteria for electronic medical record implementations in low-resource settings: a systematic review. Journal of the American Medical Informatics Association , 22 (2), 479-488.
Gagnon, M. P., Payne-Gagnon, J., Breton, E., Fortin, J. P., Khoury, L., Dolovich, L., & Archer, N. (2016). Adoption of electronic personal health records in Canada: perceptions of stakeholders. International Journal of Health Policy and Management , 5 (7), 425.
Kruse, C. S., Stein, A., Thomas, H., & Kaur, H. (2018). The use of electronic health records to support population health: a systematic review of the literature. Journal of medical systems , 42 (11), 214.
McBride, S., Tietze, M., Robichaux, C., Stokes, L., & Weber, E. (2018). Identifying and addressing ethical issues with use of electronic health records. OJIN: The Online Journal of Issues in Nursing , 23 (1).
Meeks, D. W., Takian, A., Sittig, D. F., Singh, H., & Barber, N. (2018). Exploring the sociotechnical intersection of patient safety and electronic health record implementation. Journal of the American Medical Informatics Association , 21 (e1), e28-e34.
Morgan, S., Pullon, S., & McKinlay, E. (2015). Observation of interprofessional collaborative practice in primary care teams: an integrative literature review. International journal of nursing studies , 52 (7), 1217-1230.
Palabindala, V., Pamarthy, A., & Jonnalagadda, N. R. (2016). Adoption of electronic health records and barriers. Journal of Community Hospital Internal Medicine Perspectives , 6 (5), 32643.
