Introduction
Health information technology (HIT) combines the use of informatics in healthcare to improve patient outcomes and care methodologies within hospitals today. This area in healthcare has seen increasing research, especially with the enactment of the HITECH Act in 2010 and various influential reports which have plotted the future of nursing in this direction. The HITECH Act requires the implementation of electronic health records and other information technology resources within the care environment, thus improving quality, safety and efficiency within the care environment (Blumenthal, 2010). As a result, professionals in this field have championed the development of various care technologies, including decision support, electronic health records and telehealth mechanisms. In this paper, a literature review of recent work in health information technology is explored with a wide scope of the application for patients. Nevertheless, specific focus will be narrowed down to the effect of the HIT systems on the efficiency, safety and quality of care for a gerontological nurse.
Literature Review
The HITECH Act has spurred the rapid growth being experienced in the development of electronic health record systems, as well as their implementation. Studies have already begun showing the effectiveness of HER in improving patient outcomes, especially for older patients who have experienced falls or ulcers. Dowding, Turley & Garrido (2011) evaluated an HER system for 29 hospitals and its effect on processes and outcomes for patient falls and ulcers. They noted that there was improved documentation systems and improvements in assessment documentation owed to the presence of the EHR systems. Moreover, usage of EHR systems was associated with a reduction of acquired pressure ulcers by up to 13 percent. In this study, it was noted that EHR systems worked together with other organizational factors, including collaboration and leadership to achieve the required positive outcomes. In effect, when these factors were in place, the implementation of electronic health records could bring about sustainable quality and safety improvements in the care environment.
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In the case of gerontological nurses, this presents an opportunity for sensitive measures such as patient falls and acquired ulcers. By modeling and adopting the use of EHR systems, there could be quality improvements both for nursing staff and the management (McFadden, Stock, & Gowen III, 2015). Applications such as NICHE organized for the improvement of health systems for the elderly, there is a chance for nursing management and staff members to partner and thus improve care for the elderly. Coupled with an electronic health record system, NICHE could capture data and systematically store it in a manner that provides decision support (Bowles, Dykes, & Demiris, 2015). In turn, patients can be assured of receiving personalized and evidence-based care, whereas the documentation available in the EHR system is used in future.
Further consideration of HER systems further reveal the advantages that they have in influencing patient outcomes. Experts can use the information input within these systems to standardize assessment methods and outcomes, thereby empowering decision-making through evidence-based evaluations. After all, the decision support tools are found within the systems themselves. For instance, a study in long-term elderly care resulted in the reduction of malnutrition cases following the evidence-based assessment present within the EHR was used. Data from nutrition and pressure ulcer risk assessment was taken to reach these findings (Fossum, Alexander, Ehnfors, & Ehrenberg, 2011).
The use of tools present within EHR systems provides caregivers with necessary data, which, over time, generates useful data that can improve outcomes and quality of care across a large number of similar patients. The system thus operates as a “learning” one, where the data obtained from electronic records generates knowledge applicable in evidence-based and personalized care by providing decision support (Friedman, Wong, & Blumenthal, 2010). An EHR system with the proper structures and data codes could provide the necessary infrastructure that will result in a learning healthcare system which modifies the operations of gerontological nurses. Simultaneously, data from one patient delivers personalized care for them while opening up news areas of discovery, research and innovation for future patients and their care (Greene, et al., 2009). As a result, gerontological nurses play an important role in developing these healthcare systems which will incorporate EHR systems.
Synthesizing the Literature
Evidence-based practice comprises three major components: patient values, research-based evidence and expertise (Haugham, 2017). At the helm of this practice is the need to reduce costs, improve quality and provide the patient with satisfactory care. When dealing with cancer patients, for instance, evidence-based practice will help a caregiver assess the benefit/risk of providing diagnostic tests. Considered in tandem with their expertise in the area, the caregiver can determine whether treatment is required or might just make things works. As a result, a systematic method of providing care for a large number of patients is thus developed.
The use of HIT systems has been brought onboard for a great many reasons, some of which are aligned to the goals of evidence-based practice. For instance, HIT systems have been found to improve quality and efficiency within the care environment (Bowles, Dykes, & Demiris, 2015). As a result, it becomes easier to assess patient records on a standardized system for as far back as treatment began for the patient, thus giving the caregiver an accurate understanding of what interventions have been staged before their encounter with the patient. In this manner, patients are now able to receive personalized care, as the information on EHR systems provide the caregiver with decision support on possible plans of action during that stage in their treatment.
Evidence-based practice sees a lot of patient participation in their choice of treatment. The dialogue passing between the caregiver and patients provides a platform of value sharing that offers the caregiver ideas on more personalized care. For instance, patient sharing recorded on electronic records might indicate specifics that would influence decision-making on the part of the caregiver, thus improving care outcomes for the patient. As a result, the patient and caregiver can provide an appropriate course of action together. As explained above, EHR records provide the necessary decision support required by the caregiver to provide personalized care, thus meeting the thresholds of evidence-based practice. In addition, the collection of data on electronic systems can provide caregivers with areas of research, which result in the development of innovative endeavors in providing patient-centered care.
Challenges
Nurses are leaders in the use of electronic health records systems for the purpose of decision support and evidence-based practice. As a result, there has been improved quality, efficiency and safety within care. Nevertheless, specific challenges plague the undertaking of these studies, chief among them being the incapacity to conduct randomized trials for these outcomes. Because most studies of this nature are quasi-experimental, it is not possible to determine the outcomes with a control group because all systems are delivered to every patient (Bowles, Dykes, & Demiris, 2015). This, therefore, limits the study’s ability to determine the impact of confounding factors and other controls during the non-randomized test environment.
Again, it is not possible to consider the multiplicity of factors that surround the successful completion of these systems (Bowles, Dykes, & Demiris, 2015). For instance, telehealth monitoring technologies normally have different outcomes depending on the number of times a patient has used the equipment as well as the quality of staff communication. As a result, any of these factors could influence the impact observed in the course of the study, making it difficult to pinpoint with accuracy, the factor that was chiefly responsible. In cases where decision support is being evaluated, it is also critical to determine if any simultaneous interventions are in place and their effect on outcomes. Moreover, they are not generalizable outcomes; rather, they are decision support for the particular patient in question. Thus, it is critical to remain focused on the individual patient and suspend decision support where it is inapplicable.
Recommendations
With these challenges present in the implementation of EHR systems to support decision-making and evidence-based practice in the care environment, different areas of research could be suggested, thus making things easier in future for this area. It is important to conduct research to clarify how nurses use HIT systems within their practice, including factors of adoption and the effect of these systems on practice and outcomes. Moreover, one needs to understand the impact of organizational factors in improving safety, efficiency and quality outcomes after the implementation of HIT systems. Again, research to determine how patient data can be used for providing personalized decision support should be pursued, alongside HIT interventions which focus on target populations, thereby providing necessary decision support that is personalized to the patient in question.
Lastly, it is necessary to expand the operations of HIT systems within the healthcare environment. Research shows that only 3.75% of HIT systems were present in long-term care, whereas acute care had a penetration of up to 42 percent (Carrington & Tiase, 2013). Long-term care homes present prime areas for the required knowledge generation. This will provide the opportunity to have research done on the impact of HIT systems in other care settings.
Conclusion
Health information systems have changed the terrain of nursing care. Progressively, it is finding expression in various fields of care, necessitating research in these areas. Above, a discussion regarding the impact of HIT systems on long-term care environments is discussed. Specifically, the impact on caregivers’ decision support and evidence-based practice is explored. When cumulative data on patient history is accessible at one electronic location, outcomes have been found to improve. Specifically, patients were less likely to develop hospital-acquired ulcers. Again, the use of EHR systems in conjunction with other organizational factors was seen to have positive impact on quality, safety and efficiency of care. Nevertheless, the literature review noted the need to have randomized studies that could quantify the impact mentioned above, as well as other research areas. However, a challenge presented itself in this literature review: expanding the use of HIT systems to reduce concentration in acute care systems and diffuse to other areas, such as long-term care environments.
References
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Carrington, J. M., & Tiase, V. L. (2013). Nursing informatics year in review. Nursing administration quarterly, 37(2) , 136-143.
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Haugham, J. (2017). 5 Reasons the Practice of Evidence-Based Medicine Is a Hot Topic . Retrieved from Health Catalyst: https://www.healthcatalyst.com/5-reasons-practice-evidence-based-medicine-is-hot-topic
McFadden, K. L., Stock, G. N., & Gowen III, C. R. (2015). Leadership, safety climate, and continuous quality improvement: impact on process quality and patient safety. Health care management review, 40(1) , 24-34.
