Implementation Plan for EMR and Beyond

Change is never easy for anyone, but how we implement change can make the difference in how an innovation is accepted. Over the last two years, a small community hospital in California has introduced a new electronic medical record (EMR) to meet the requirements of meaningful use mandated by the Centers for Medicare and Medicaid (CMS) for all hospitals across the United States. EMRs are expected to improve quality in many areas, especially to improve outcomes, while safely reducing costs (U.S. Department of Health & Human Services, 2012). Adoption of EMR’s is not optional, if facilities want to avoid penalties and continue operating. As a result, EMR’s have been implemented in numerous healthcare facilities over the last decade. However, implementation does not guarantee acceptance. Many organizations have tried to implement something new and failed. Healthcare facilities need to build implementation plans into their development of any new innovations. In particular, end users need to buy in and accept new system usability in order to improve compliance and employee satisfaction. Our EMR is being developed in stages, so our processes are constantly changing with requires fast transitions in the end user learning. We have moved through the first two stages and are moving into the third stage in the next few months. This project describes an implementation plan for an electronic medical record development that we have used during our first two stages. The project plan has a strategic focus on end user acceptance of meaningful use guidelines that is sustainable for continued growth. The elements of this plan can be applied to other types of innovative change in healthcare

Health information technology (HIT) in small and medium sized physician practices: examination of impacts and HIT maturity

Small and medium sized physician practices (SMPP) are medical practices that consist of a staff of less than 10 physicians. Nearly 60% of the US physicians work in SMPP and face more barriers to HIT adoption and implementation than their larger counterparts. The dissertation is on the use and impact of Health Information Technology (HIT) on SMPP. The dissertation will also explore the effects of IT maturity on health care organizations’ abilities to impact outcomes. It will examine how SMPP have grown through the use of IT and how this has impacted the organization’s use of HIT. While previous work has observed some organizational impacts of HIT, they have only studied a single phenomenon that had been impacted and not how the organization as a whole is impacted. While researchers have found that organizations with higher IT maturity tend to show better operational and financial performance, very little prior studies have shown the impact of HIT maturity on SMPP. The dissertation’s goal is to answer the following questions: 1. How does HIT usage influence the organizational impacts on Small and Medium Sized Physician Practices? 2. How does the SMPP’s HIT maturity influence these impacts? To answer these questions, the dissertation used a framework derived from DeLone and McLean’s (1992, 2003) IS Success Model and the IT Value Hierarchy (Urwiler & Frolick, 2008). The dissertation employed a multiple case study approach by collecting and analyzing data from various members of five different SMPP. The dissertation found that the process of HIT documentation had a major influence on the SMPP. While it has a positive impact on the patient’s Quality of Care, it has a negative impact on Productivity and User Satisfaction. While prior HIT research found that communication was a final outcome of HIT use, this dissertation found that communication is a mitigating factor influencing organizational impacts

Emergency Physicians\u27 Perspectives on the Usability of Health Information Exchange

Emergency physicians are key users of health information exchanges (HIE). Understanding their perspectives on the usability of HIE is important if the full potential of the HIE is to be achieved. The literature identified that emergency physician experiences with HIEs are unexplored areas requiring further studies. The purpose of this study using grounded theory methods was to understand the perspectives of emergency physicians concerning the usability of HIEs. The fundamental question was how do emergency physicians use the HIE in making clinical decisions? Rich and thick data were collected from 15 emergency physicians in four urban hospitals in the mid-south using theoretical sampling and unstructured face-to face interviews. Concepts from the coded segments were developed into categories and an overarching theoretical scheme visualized in a conceptual framework. A substantive theory emerged that using the HIE among emergency physicians is the process of rationalizing non-use and reconciling challenges and benefits. The antecedent of usability was a typical day in the emergency department and why participants accessed the HIE and under what conditions. Six major themes emerged: using the HIE, influencing clinical decisions, struggling with challenges and barriers, recognizing benefits, current views, and rationalizing not using or reduced use of the HIE. Emergency physicians gave good reasons why the HIE is not being used for the majority of patients while reconciling the challenges and benefits of using the HIE to explain the role of HIEs in making clinical decisions. There was a disconnect in the necessity of using the HIE to make clinical decisions and any negative outcomes that may occur in patients from not using the HIE. Generally, emergency physicians viewed the HIE as not being user-friendly and that they probably do not use the HIE as much as they could for making clinical decisions. The perspective of the emergency physicians was the emergency environment is too busy and because the HIE is less than user-friendly as needed by physicians to practice emergency medicine, the HIE disrupts workflow and is a deterrent to consistent usage in making clinical decisions. A better understanding of how emergency physicians decided to use the HIE in making clinical decisions gives insights about how to achieve HIE usability. Satisfied end-users who view the HIE as effective and efficient should use the HIE more. However, this requires removing challenges and barriers while recognizing more benefits to using the HIE, and addressing the underlying reasons for not using the HIE. Understanding the complexities of using the HIE and providing solutions to increase usability of the HIE is necessary to influence greater use of the HIE in clinical decisions with demonstrated positive outcomes for patients

Improving Early Sepsis Identification on Inpatient Units

Sepsis is a life threatening medical emergency that if left untreated could ultimately lead to death. It is defined as the body’s extreme response to infection which can rapidly worsen if not identified and managed quickly. As sepsis worsens, it leads to extended hospital stays, poor patient prognoses and increased hospital costs. In an effort to combat these negative outcomes, efficient protocols must be implemented hospital wide. A 5 P’s microsystem assessment was preformed to assess the purpose, patients, professionals, processes and patterns. Additionally, assessments were conducted to collect baseline nursing knowledge regarding sepsis criteria, treatment, and hospital protocol. A root cause analysis was used to identify any discrepancies in compliance with completing the sepsis screening in a timely manner, expose contributing factors in sepsis treatment delays, and ensure the sepsis process map is reflective of hospital policy and easy to follow. To confirm nurses were correctly documenting the sepsis screening within the correct timeframe, the surveyors, under the direction of the Sepsis Committee Director, developed a Sepsis Screening Observation Checklist to observe the nurses on the unit and determine if it was completed. A chart audit was conducted as well and looked at 100 patient’s sepsis screenings in five different units for both morning and evening shift. Finally, a nursing questionnaire was handed out to assess their baseline knowledge of sepsis and the hospital protocol regarding sepsis treatment. Results demonstrated vital signs are reported to the nurse only 50% of the time, the greatest contributor to delays in treatment of sepsis are the labs, and only 38% of nurses feel adequate educational resources regarding sepsis are provided for them. This provided an arena for development with both clinical nursing knowledge, and overall process improvement

A Study of Problems Preventing the Implementation of Programs for the Educable Mentally Retarded in Utah

The purposes of the study were to determine the level of priority of importance of administrative problem areas and specific problem items preventing the implementation of special programs for the educable mentally retarded in Utah. The study was conducted using a survey of twenty-seven school districts in the state of Utah lacking a sequential program for the educable mentally retarded in grades one through six. A questionnaire was sent to 184 selected respondents, including school board chairmen, superintendents, and elementary principals. Responses were received from 92 percent of the original selection. The respondent was asked to rank each of the problem items according to one of five choices, major, moderate, average, minor, or no problem to implementation. Results were evaluated on the basis of agreement among the rankings of the respondents, the relationship of the rankings, priority of the administrative areas, priority of the problem items, and individual group rankings. Statistical treatment revealed significance at the .01 level for the level of agreement and relationship among the rankings of the administrative problem areas. Further treatment revealed the priority of administrative problem categories in order of major importance to be: (1) professional personnel, (2) pupil personnel; (3) supervision , (4) communications, (5) research, (6) finance, and (7) policy. Individual problem items used in the questionnaire were ranked by priority of importance as perceived by the respondents as a combined group as well as by individual groups. There were sixty-two problem items ranked in order of priority. The conclusions arrived at as a result of the analysis of the data included: (1) there was a high level of agreement among the perceptions of the administrators in ranking the importance of the problem areas and specific items , (2) the respondents as individual and combined groups perceived the category of obtaining and retaining qualified professional personnel as the major problem to implementation of the special program, (3) the individual problem of greatest concern was the obtaining of a qualified classroom teacher for the educable mentally retarded, (4) communications are needed to inform the parents, public, and school faculty to gain support for t he educational needs of the educable mentally retarded, (5) administrators recognize the need for early identification of the potential retardate, accurate diagnosis and educational placement as important to program implementation, and (6) it appeared that present school policies are adequate in meeting the needs of program implementation of the educable mentally retarded

Attitudes towards the use of computers by registered nurses

The purpose of this study was to describe the attitudes of a group of nurses towards the use of computers in a Southern California Veterans Affairs hospital

Factors associated with the incidence and severity of neonatal abstinence syndrome in infants born to opioid dependent mothers

Indiana University-Purdue University Indianapolis (IUPUI)Neonatal abstinence syndrome (NAS), the constellation of withdrawal symptoms experienced by neonates exposed to opioids prenatally, is an epidemic affecting an estimated 23,580 infants each year with an annual cost of $720 million. The purpose of this study was to examine factors associated with the incidence and severity of NAS as measured by the need for initiation of neonatal medication, peak medication dose, hospital length of stay (LOS), and hospital costs among newborns born to opioiddependent mothers. A retrospective review of medical records was conducted with two convenience samples: 204 infants born to mothers who used opioids during pregnancy; and 121 of these infants who required treatment with morphine to control symptoms of NAS. Data from April 2011 to September 2017 were collected from medical records of a large Midwestern hospital. Exploratory analysis and descriptive statistics were performed. Associations between independent variables and outcomes were examined using correlations, chi-square, t-tests, analyses of variance, and linear regression. Of the 204 neonates who were exposed to opioids prenatally, 121 (59%) developed symptoms of NAS requiring treatment with morphine. Neonates requiring morphine had significantly higher gestational ages than those who did not (37.7 vs 36.4 weeks; p = < .001) and their mothers were present at the neonates’ bedside a lower proportion of their total hospital stay (mean = 0.5684 of days vs 0.7384 of days; p = < .001). Compared to maternal use of buprenorphine, maternal methadone use was associated with higher peak morphine doses needed to control the neonate’s withdrawal symptoms (0.089 mg/kg versus 0.054 mg/kg; p = .023), and with longer hospital length of stay when compared to maternal use of buprenorphine and other opioid analgesics (34.2 vs. 20.8 vs. 22.5 days, respectively; p=0.02). Higher visitation time from the primary caregiver was correlated with lower hospital LOS (r = -0.421; p = < .001). Future research is needed to examine these relationships prospectively in a larger and more diverse sample. An effective response to the epidemics of opioid use during pregnancy and the incidence of NAS requires ongoing coordinated research and intervention in clinical care, public health, and health policy.2019-11-0

Readiness for Insulin Pump Use in Pediatric Type I Diabetes: A Quality Improvement Project

Background: Insulin pumps are essential in the management of type 1 diabetic pediatric patients because of their versatility in meeting the developmental needs of childhood and adolescence. Summary of the Evidence: There is lack of evidence for standardized pump initiation program in pediatric patients (ADA, 2019). Moreover, adverse events from insulin pump misuse, such as diabetic ketoacidosis, arise from lack of anticipatory guidance of pump management and troubleshooting (Evert et al., 2016; Grunberger et al., 2014, Wheeler et al, 2014). Project Purpose: The purpose of this quality improvement (QI) project was to reduce and prevent adverse outcomes of insulin pumps secondary to an inefficient initiation process, management, and patient/family understanding. Project Objectives: Objectives of this QI were: the implementation of a streamlined initiation process, assessment of patient knowledge through an additional education session including a pre-and post-test patient skills questionnaire, and to decrease adverse effects related to new insulin pump use. Results: 100% staff education was achieved, 67.5% of patients/families attended the new education session achieving an average score of 80% or higher on the skills questionnaire, and adverse effects related to new insulin pump usage decreased from a rate of 66% to 50% after implementation. Implications for Practice: Use of practice guidelines to implement a structured process for insulin pump initiation is a cost-effective strategy to promote patient ownership, improve patient knowledge, lower potential costs of clinic or hospital visits for adverse effects, and guide provider oversight in effective use of technology to improve patient outcomes and decrease barriers to care