Addressing EHR System Challenges: Nursing Informatics Paper

The radiologist at your hospital reports to the administrator that 30 patients have been diagnosed with brain tumors during the past 2 months. The administrator requests a report detailing the number of patients diagnosed with brain tumors during the past 6 months. However, the radiology department uses a free-text entry for their diagnoses, and their system does not communicate with the larger electronic health record (EHR) system installed at the hospital. You recognize an opportunity to address challenges with the EHR system in your hospital and decide to also write a proposal for a solution to improve your hospital’s EHR system.

Write a proposal for how the hospital in the scenario might overcome each of the following challenges related to the scenario:

Vocabulary standards

Interoperabiliy

Workarounds

Patient safety

Patient privacy and security when pulling reports

Recommend a change theory that might assist in your convincing the hospital administration to implement the EHR solution and improvements you propose. Be specific and provide examples.

Support your proposal by explaining how the EHR solution might benefit data analysis for the promotion of improved health outcomes.

Note: The title page, introduction, summary, and references are in addition to the required page count.

McBride, S., & Tietze, M. (2023). Nursing informatics for the advanced practice nurse: Patient safety, quality, outcomes, and interprofessionalism (3rd ed.). Springer Publishing.

Chapter 12, “National Standards for Health Information Technology”

Chapter 14, “Privacy and Security in a Ubiquitous Health Information Technology World”

Chapter 20, “Health Information Technology and Implications for Patient Safety”

Chapter 21, “Quality-Improvement Strategies and Essential Tools”

Note: Chapters 12, 14, and 20, which were assigned in the previous week, may be applicable to the Module Assignment and are listed here for review purposes.

Barrett, A. K., & Stephens, K. K. (2017). Making electronic health records (EHRs) work: Informal talk and workarounds in healthcare organizations

Links to an external site.. Health Communication, 32(8), 1004–1013.

Fry, E., & Shulte, F. (2019, March 18). Death by a thousand clicks

Links to an external site.: Where electronic health records went wrong. Fortune. Retrieved from http://fortune.com/longform/medical-records/

Kroning, M. (2017). 59 clicks in the EHR

Links to an external site.. Nursing, 47(12), 1–3.

Vazirani, A. A., O’Donoghue, O., Brindley, D., & Meinert, E. (2019). Implementing blockchains for efficient health care: Systematic review

Links to an external site.. Journal of Medical Internet Research, 21(2), e12439.

Proposal to Address EHR System Challenges – Addressing EHR System Challenges

Introduction

The recent report of 30 patients diagnosed with brain tumours within the past two months has highlighted significant challenges within our hospital’s EHR system. These challenges include vocabulary standards, interoperability, workarounds, patient safety, and patient privacy and security. To ensure accurate reporting and improve overall patient care, a comprehensive overhaul of our EHR system is necessary. This proposal outlines solutions to these challenges and recommends a change theory to guide the implementation process.

The first challenge to tackle is vocabulary standards. Currently, the use of free-text entry for diagnoses in the radiology department leads to inconsistent documentation, making it difficult to compile accurate reports and data analytics. Implementing a standardized vocabulary, such as SNOMED CT (Systematized Nomenclature of Medicine—Clinical Terms), would ensure that diagnoses are recorded uniformly across the hospital (Pankhurst et al., 2021). The system provides a comprehensive clinical terminology that enables consistent and accurate data entry, facilitating better communication among healthcare providers and more precise data analysis.

Interoperability is another significant challenge. The lack of communication between the radiology department’s system and the larger EHR system hampers effective information exchange. To overcome this, the hospital should adopt interoperable EHR systems that comply with Health Level Seven International (HL7) standards (Pedrera et al., 2023). These standards enable different healthcare information systems to share data seamlessly, ensuring that critical patient information, such as diagnoses and treatment plans, is readily available to all relevant departments.

Addressing workarounds is crucial to improving system reliability and efficiency. Staff often create workarounds when the EHR system does not meet their needs, leading to potential errors and inefficiencies (Bani et al., 2020). To mitigate this, the hospital should engage in regular training sessions and workshops to ensure all staff are proficient in using the EHR system. Additionally, involving healthcare providers in the design and update process of the EHR system can help tailor the system to better meet their needs, reducing the reliance on workarounds. Addressing EHR System Challenges

Patient safety is paramount and can be significantly enhanced with an improved EHR system. The current disjointed system can lead to missed or incorrect diagnoses and treatment plans. A robust EHR system that integrates all patient data, including radiology reports, can provide healthcare providers with a comprehensive view of a patient’s medical history, leading to more informed clinical decisions. Features such as clinical decision support systems (CDSS) can alert providers to potential issues, such as drug interactions or diagnostic discrepancies, thereby improving patient outcomes.

Patient privacy and security are critical concerns when pulling reports. The hospital must ensure that the EHR system complies with the Health Insurance Portability and Accountability Act (HIPAA) regulations (Kiel., 2022). Regular security assessments and updates are necessary to safeguard against emerging threats and ensure that patient information remains confidential and secure.

To convince hospital administration to implement these EHR improvements, I recommend using the Kotter’s 8-Step Change Model. The change theory involves creating a sense of urgency around the need for improvement, forming a powerful coalition to lead the change, developing a clear vision and strategy, communicating the vision, empowering employees to act on the vision, generating short-term wins to build momentum, consolidating gains, and anchoring the changes in the organizational culture (Miles et al.,2023). For example, by presenting data on the current inefficiencies and potential risks associated with the existing system, the administration can see the immediate need for change. Involving key stakeholders from various departments in the planning process ensures buy-in and collaboration.

The proposed EHR solution will significantly benefit data analysis, leading to improved health outcomes. Standardized and interoperable data allows for comprehensive data collection and analysis, enabling the hospital to identify trends, measure performance, and implement evidence-based practices. By leveraging advanced analytics, the hospital can proactively identify areas for improvement and implement targeted interventions, resulting in better patient outcomes and overall hospital performance.

Summary

In a nutshell, addressing the challenges of vocabulary standards, interoperability, workarounds, patient safety, and patient privacy and security through a comprehensive EHR improvement plan will enhance the hospital’s ability to deliver high-quality care. Implementing these changes using Kotter’s 8-Step Change Model ensures a structured and effective approach to organizational transformation, ultimately benefiting patients, healthcare providers, and the hospital Addressing EHR System Challenges.

References

Bani Issa, W., Al Akour, I., Ibrahim, A., Almarzouqi, A., Abbas, S., Hisham, F., & Griffiths, J. (2020). Privacy, confidentiality, security and patient safety concerns about electronic health records. International nursing review, 67(2), 218–230. https://doi.org/10.1111/inr.12585

Chishtie, J., Sapiro, N., Wiebe, N., Rabatach, L., Lorenzetti, D., Leung, A. A., Rabi, D., Quan, H., & Eastwood, C. A. (2023). Use of Epic Electronic Health Record System for Health Care Research: Scoping Review. Journal of medical Internet research, 25, e51003. https://doi.org/10.2196/51003

Miles, M. C., Richardson, K. M., Wolfe, R., Hairston, K., Cleveland, M., Kelly, C., Lippert, J., Mastandrea, N., & Pruitt, Z. (2023). Using Kotter’s Change Management Framework to Redesign Departmental GME Recruitment. Journal of graduate medical education, 15(1), 98–104. https://doi.org/10.4300/JGME-D-22-00191.1

Kiel, J. M. (2022). Data privacy and security in the US: HIPAA, hitech and beyond. In Nursing Informatics: A Health Informatics, Interprofessional and Global Perspective (pp. 427-435). Cham: Springer International Publishing.

Pankhurst, T., Evison, F., Atia, J., Gallier, S., Coleman, J., Ball, S., McKee, D., Ryan, S., & Black, R. (2021). Introduction of Systematized Nomenclature of Medicine-Clinical Terms Coding into an Electronic Health Record and Evaluation of its Impact: Qualitative and Quantitative Study. JMIR medical informatics, 9(11), e29532. https://doi.org/10.2196/29532

Pedrera-Jiménez, M., García-Barrio, N., Frid, S., Moner, D., Boscá-Tomás, D., Lozano-Rubí, R., Kalra, D., Beale, T., Muñoz-Carrero, A., & Serrano-Balazote, P. (2023). Can OpenEHR, ISO 13606, and HL7 FHIR Work Together? An Agnostic Approach for the Selection and Application of Electronic Health Record Standards to the Next-Generation Health Data Spaces. Journal of medical Internet research, 25, e48702. https://doi.org/10.2196/48702 Addressing EHR System Challenges