Application: Evaluation Project Part 1: Evaluation Plan Focus

Technology increases human effectiveness. Using a lever, you can move an object several times your size. In an airplane, you can move exponentially faster than on foot. Using the Internet, you can access information much more quickly than at a library. What possibilities like this exist in the nursing field? What health information technologies can amplify your impact as a nurse far more than ever before? In this Evaluation Project, you will have the opportunity to answer these questions.

Because of the great differences between HIT systems and different goals of an evaluation, there is no one-size-fits-all evaluation plan. Different technologies require different evaluation methods. Consequently, in this part of your Evaluation Project, you will conduct research on how system implementations similar to the one you select have been previously evaluated. After exploring similar system implementations, you will select one research goal and viewpoint to use in the evaluation.

Read the following three scenarios, and select the one that is of most interest to you:

Scenario 1:

Your hospital is implementing a new unified acute and ambulatory Electronic Health Record (EHR) system through which patient care documentation will occur. Interdisciplinary assessment forms (including nursing), clinical decision support, and medical notes will be documented in this system. The implementation of the system is anticipated to improve the hospital’s performance in a multitude of areas. In particular, it is hoped that the use of the EHR system will reduce the rate of patient safety events, improve the quality of care, deter sentinel events, reduce patient readmissions, and impact spending. The implementation of the EHR system is also intended to fulfill the “Meaningful Use” requirements stipulated in the Health Information Technology for Economic and Clinical Health (HITECH) Act. As the hospital’s lead nurse informaticist, you have been tasked with planning the evaluation of the EHR implementation.

Scenario 2:

As the lead nurse informaticist in your hospital, you have been given the task of planning an evaluation for a soon-to-be launched computerized provider order entry (CPOE) system. The CPOE system is designed to replace conventional methods of placing medication, laboratory, admission, referral, and radiology orders. CPOE systems enable health care providers to electronically specify orders, rather than rely on paper prescriptions, telephone calls, and faxes. The intended goal of a CPOE system is to improve safety by ensuring that orders are easily comprehensible through the use of evidence-based order sets. In addition, the CPOE system has the potential for improving workflow by avoiding duplicate orders and reducing the steps between those who place medical orders and their recipients.

Scenario 3:

You are the lead nurse informaticist in a large urban hospital that has recently implemented a new Electronic Medication Administration Record (eMAR) and Bar Code Medication Administration (BCMA) system. The BCMA system uses bar coding technology to facilitate the correct identification of patients at the point of administration of medications. BCMA will be used for all medications—tables, injections, and intravenous treatment. You have been selected to conduct an evaluation of the new system. The eMAR is designed to utilize the medication order entry process in order to expedite the creation of the 24-hour medication administration record, whereas the BCMA will automate administration documentation. In addition, the system is intended to reduce medication administration errors by tracking and alerting health care providers about dosages, proper administration times, medication allergies, or medication incompatibilities.

To prepare:

• Select one scenario to use for the Evaluation Project.
• Consider what viewpoint and research goal you would use to guide your evaluation plan. Although many potential research goals or viewpoints could be selected for each scenario, you are only required to choose one goal and one viewpoint. The scenario you select will be used for the Evaluation Project throughout this course. To maximize your benefit from this project, consider selecting a scenario that is relevant to a health care organization with which you are involved.
• Research published evaluations that have been conducted on HIT system implementations similar to the one in the scenario you selected.

To complete Part 1 of this Evaluation Project:

By Friday 12/23/2016

1)      In a  3-page paper, identify which of the three hypothetical health information technology systems you will be evaluating in this project, and explain why you selected this system.

2)      Summarize your research findings on similar HIT implementations.

3)      Describe the evaluation goal and viewpoint that will guide your own evaluation plan. Provide your rationale.

 

 

Required Readings

 

    Friedman, C. P., & Wyatt, J. C. (2010). Evaluation methods in biomedical informatics (2nd ed.). New York, NY: Springer Science+Business Media, Inc.

Chapter 2, “Evaluation as a Field” (pp. 21–47)

This chapter defines evaluation and shows how it differs from research. The chapter also includes a discussion the philosophy behind evaluation and the multiple approaches to evaluation.

 

    Board on Health Care Services. (2012). Health IT and patient safety: Building safer systems for better care. The National Academies Press: Washington DC. Retrieved from http://www.nap.edu/catalog.php?record_id=13269

Chapter 2, “Evaluating the Current State of Patient Safety and Health IT” (pp. 31–58)

This chapter addresses the challenges of evaluation in health information technology due to the complex nature of technology and rapid changes in the field. The chapter also identifies barriers to evaluation and the threats posed to patient safety by a lack of evaluation.

 

Nursing Documentation

 

Hyun, S., Johnson, S. B., Stetson, P. D., & Bakken, S. (2009). Development and evaluation of nursing user interface screens using multiple methods. Journal of Biomedical Informatics, 42(6), 1004–1012.

Retrieved from the Walden Library databases.

“The design of nursing documentation systems to support quality management and research as well as practice is a complicated task as it requires understanding of nursing practice and informatics” (p. 1010). In an effort to design more user-friendly interface screens for electronic nursing documentation systems, the researchers explore the application of theory and user-centered methods to the design process.

 

    Saranto, K., & Kinnunen. U. M. (2009). Evaluating nursing documentation—Research designs and methods: A systematic review. Journal of Advanced Nursing, 65(3), 464–476.

Retrieved from the Walden Library databases.

In this research study, the authors examine the nursing documentation literature. One significant finding was the importance of using structured nursing terminology, as this supports more consistent documentation practices.

 

Public Health

 

Honoré, P. A., Wright, D., Berwick, D. M., Clancy, C. M., Lee, P., Nowinshi, J., & Koh, H. K. (2011). Creating a framework for getting quality into the public health system. Health Affairs, 30(4), 737–745.

Retrieved from the Walden Library databases.

In this article, the authors explore two Department of Health and Human Services (DHHS) reports on public health quality. The authors also posit how a framework of quality concepts can be applied in various programs to address the quality concerns presented in the two DHHS reports.

 

Reeder, B., Hills, R. A., Demiris, G., Revere, D., & Pina, J. (2011) Reusable design: A proposed approach to public health informatics system design. BMC Public Health, 11, 116–118.

Retrieved from the Walden Library databases.

The authors of this article examine the current state of public health informatics in terms of design consistency and interoperability. They suggest a standard design framework be implemented to guide the development of public health informatics systems.

 

Consumer Health Information

 

Van Gemert-Pijnen, J., Nijland, N., van Limburg, M., Ossebarrd, H. C., Kelders, S. M., Eysenbach, G., & Seydel, E. R. (2011). A holistic framework to improve the uptake and impact of eHealth technologies. Journal of Medical Internet Research, 13(4), e111.

Retrieved from the Walden Library databases.

Many factors influence the successful adoption of eHealth technologies. As such, many integration efforts have not been successful or sustainable. In this article, the authors propose a more holistic approach for implementing eHealth technologies to overcome problems with adoption and sustainability.

 

    Black, A. D., Car, J., Pagliari, C., Anandan, C., Cresswell, K., Bokun, T., et al. (2011). The impact of eHealth on the quality and safety of health care: A systematic overview. PLoS Medicine, 8(1), e1000387. Retrieved from http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1000387

The authors of this article discuss eHealth technologies and reviews current literature on its impact. The authors argue that eHealth technologies have yet to demonstrate cost savings, improved patient outcomes, or improved quality of care.

 

Decision Support Systems

 

Levy, S., & Heyes, B. (2012). Information systems that support effective clinical decision making. Nursing Management, 19(7), 20–22.

Retrieved from the Walden Library databases.

The focus of this article is the importance of providing nurses with HIT tools to support them in using and managing information effectively to improve patient care. The nurses should use the clinical decision-making tools to have access to relevant and timely information that they can then relay to their patients.

 

 

Randell, R., & Dowding, D. (2010). Organisational influences on nurses’ use of clinical decision support systems. International Journal of Medical Informatics, 79(6), 412–421.

Retrieved from the Walden Library databases.

The article describes a study that examined nurses’ perceptions on which organizational features facilitate the introduction and use of clinical decision support systems. The authors rank the organizational features according to the findings of their study.

 

Tele-Medicine and Telehealth

 

Pelletier, A. C., Jethwani, K., Bello, H., Kvedar, J., & Grant, R. W. (2011). Implementing a web-based home monitoring system within an academic health care network: Barriers and facilitators to innovation diffusion. Journal of Diabetes Science and Technology, 5(1), 32–38.

Retrieved from the Walden Library databases.

In this article, the authors use the framework of the diffusion of innovation theory to examine the implementation of a new information communication technology intervention at the Center for Connected Health. The article provides details on the intervention in question, which focuses on non-visit-based diabetes care.

 

Boulos, M. N. K., Wheeler, S., Tavares, C., & Jones, R. (2011). How smartphones are changing the face of mobile and participatory healthcare: An overview, with example from eCAALYX.Biomedical Engineering Online, 10(1), 24[RAR1]. Retrieved from http://www.biomedical-engineering-online.com/content/10/1/24

This article explores the use of smartphones in health care by patients and health care professionals. The authors review a variety of apps available for smartphones and discuss the application of these apps in different health care settings. They also explore barriers to the adoption of this technology and provide strategies for addressing those barriers.

 

Unintended Consequences

 

Sockolow, P., Crawford, P., & Lehmann, H. (2012). Broadening a general framework for evaluating health information technology. Methods of Information in Medicine, 51(2), 122–130.

Copyright 2012 by Verwertungsgesellschaft Wort. Reprinted by permission of Verwertungsgesellschaft Wort via the Copyright Clearance Center.

This article describes the authors’ attempts to create an informatics evaluation framework for health information technology (HIT). In particular, the authors focus on developing a framework that utilizes portions of pre-existing health services research evaluation and informatics evaluation to remedy issues in currently available HIT evaluation frameworks.

 

 

    Sockolow, P. S., Weiner, J. P., Bowles, K. H., & Lehmann, H. P. (2011). A new instrument for measuring clinician satisfaction with electronic health records. CIN: Computers, Informatics, Nursing, 29(10), 574–585.

Retrieved from the Walden Library databases.

The authors of this article explore the creation of a new survey instrument designed to determine nurse satisfaction with an electronic health record’s impact on clinical processes. The authors describe the influences that guided the selection of the survey’s features.

 

General

 

    Bélanger, E., Bartlett, G., Dawes, M., Rodríguez, G., & Hasson-Gidoni, I. (2012). Examining the evidence of the impact of health information technology in primary care: An argument for participatory research with health professionals and patients. International Journal of Medical Informatics, 81(10), 654–661.

Retrieved from the Walden Library databases.

This article examines the findings of numerous literature reviews concerning the impact of information systems on health outcomes in primary care settings. In particular, the article focuses on the findings’ implications for developing personal health records.

 

 

Coiera, E., Aarts, J., & Kulikowski, C. (2012). The dangerous decade. Journal of the American Medical Informatics Association, 19(1), 2–5.

Retrieved from the Walden Library databases.

This article provides an overview of changes resulting from information and communication technology (ICT) that are anticipated to occur in the decade following 2012. Specifically, the article has a large emphasis on how these potential changes could impact patient safety.

 

 

Lanham, H. J., Leykum, L. K., & McDaniel, R. R. Jr. (2012). Same organization, same electronic health records (EHRs) system, different use: Exploring the linkage between practice member communication patterns and EHR use patterns in an ambulatory care setting. Journal of the American Medical Informatics Association, 19(3), 382–391.

Retrieved from the Walden Library databases.

The authors of this article describe a study that examines the link between communication patterns “within-practice” and the use patterns of practice-level electronic health records (EHR). The authors explain how the link between these patterns may provide additional opportunities for standardizing the use of EHRs.

 

 

    Looking toward the future: 2012: Industry insiders weigh in on the year ahead in healthcare technology. (2012). Health Management Technology, 33(1), 8, 10–12, 14–15.

Retrieved from the Walden Library databases.

This article provides the perspectives of numerous “industry insiders” on how technological changes shape health care. In particular, the insiders focus on cloud computing, real-time location systems, business intelligence, patient engagement, the ICD-10 standard, high-performing health care organizations, the information technology market, electronic medical record adoption, and much more.

 

Looking toward the future: 2012 part II: Industry insiders weigh in on the year ahead in healthcare technology. Health Management Technology, 33(2), 30, 32–34.

Retrieved from the Walden Library databases.

This article continues the examination of health care technology in 2012 begun in Part I. The “insiders” in this article expound on their predictions for the individual network-exchange model, revenue cycle management, and health care cuts, as well as on implementing HIPAA Version 5010 and more.

 

 

Wu, I.-L., Li, J.-Y., & Fu, C.-Y. (2011). The adoption of mobile healthcare by hospital’s professionals: An integrative perspective. Decision Support Systems, 51(3), 587–596.

Retrieved from the Walden Library databases.

This article explores the integration of technology adoption frameworks to predict the adoption of mobile technology by health care providers in a hospital setting: the Technology Acceptance Model (TAM), the Theory of Planned Behavior (TPB), the perceived service availability (PSA), and the personal innovativeness in IT (PIIT).

 

 

    Jensen, P. B., Jensen, L. J., & Brunak, S. (2012). Mining electronic health records: Towards better research applications and clinical care. Nature Reviews: Genetics, 13(6), 395–405.

Copyright 2012 by Nature Publishing Group. Reprinted by permission of Nature Publishing Group via the Copyright Clearance Center.

In this article, the authors discuss the wealth of information and data provided by electronic health records (EHR) and how these data could provide valuable information for medical research. The authors also address the ethical and legal barriers to using EHR data in this manner, and they examine methods for addressing these barriers.

 

 

Required Media

Laureate Education (Producer). (n.d.g). Telehealth and public health. Retrieved from https://class.waldenu.edu

Note:  The approximate length of this media piece is 21 minutes.

This video revolves around a presentation discussing telehealth. The video also provides a general overview of different technologies being applied to improve the health of individuals and populations.

 

 

 

Laureate Education (Producer). (n.d.c). Interoperability and standards. Retrieved from https://class.waldenu.edu

Note: The approximate length of this media piece is 16 minutes.

In this video, presenters discuss the need for standards to facilitate the availability of health information. In addition, the video elaborates on challenges commonly faced with health information exchange.

 

 

Laureate Education (Producer). (n.d.a). Clinical and administrative systems. Retrieved from https://class.waldenu.edu

Note: The approximate length of this media piece is 19 minutes.

This video provides a general overview on clinical information systems. The video focuses in particular on clinical and administrative systems in the United States.

Select one of the two questions from the discussion questions listed below.

Be sure to respond to the question using the lessons and vocabulary found in the reading. Justify your answers using examples and reasoning. Support your answers with examples and research and cite your research using APA format.

Start reviewing and responding to the postings of your classmates as early in the week as possible. Respond to at least two of your classmates’ posts. Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion.

Discussion Question 1

CF is a sixty-year-old African American male who presents as a new patient for initial evaluation and follow-up. He has been diagnosed with hypertension for the last twelve years and Type 2 diabetes for the same period of time. His current blood pressure is 162/90, with a pulse of 76. His body mass index (BMI) is 32. He is currently taking Maxzide 37.5/25 mg every morning. This is the only antihypertensive medication he has taken.

For this question, focus on the treatment of hypertension. Discuss the influences of his age, gender, and ethnicity on hypertensive medications. On the basis of an analysis of those factors, provide one option for improvement of his blood pressure and provide a clear and specific justification for that choice. Be sure to include dosage and scheduling. Include highlights of patient teaching and/or recommendations for any lifestyle changes. Support your decisions with at least one reference to a published clinical guideline and one peer-reviewed publication.

Discussion Question 2

MT is a fifty-six-year-old obese (BMI 31.5) Caucasian female with a significant family history of cardiovascular disease. She has uncontrolled hypertension and is currently taking metoprolol 50 mg twice daily. She has dyslipidemia and is taking exetimibe 10 mg daily and garlic. Her current cholesterol is 240 mg/dL, HDL is 41 mg/dL, LDL is 163 mg/dL, and triglycerides are 183 mg/dL. Her blood pressure today is 174/94, and her pulse is 90.

Review the medications she is taking for hypertension and dyslipidemia. Evaluate the efficacy of these medications. Review them in terms of her age, gender, and ethnicity. Suggest any changes you would recommend, with clear justification for those choices. For medications, include dosages and schedules. Include highlights of patient teaching and/or lifestyle alterations. Support your decisions with at least one reference to a published clinical guideline and one peer-reviewed publication.