Electronic Health Record Implementation

Electronic Health Record Implementation

Opportunity for Tracking Care Improvement

A key opportunity to track care improvement with the implementation of an electronic health record (EHR) system would be monitoring medication administration timeliness in the cardiology unit. Specifically, the time interval could be calculated from when the medication order is entered by the provider to when the nurse documents administration to the patient. This data could identify delays and areas for workflow improvement. The information needed in the database to determine this interval would include timestamp fields for the medication order entry and medication administration documentation events for each medication delivered to the cardiology unit. Additional context around reasons for delays could also be captured through a field where nurses enter notes on why medications were given late when applicable.

To expand on the rationale and importance of this metric, medication delays can significantly impact patient outcomes in acute scenarios like heart attacks or sepsis. For cardiology patients especially, late administration of life-saving drugs prescribed to stabilize heart rhythms, improve pumping efficiency, manage pain, or prevent clots could literally make the difference between living and dying. Beyond clinical impacts, late medication delivery also affects the patient experience—for example, in cases where patients anxiously wait for urgently needed medications. Finally, delays waste nursing time by chasing down orders, which is frustrating. So, from the perspectives of quality, safety, experience, and efficiency, improving medication administration timeliness should be a priority.

Role of Informatics in Capturing Quality Data

Informatics plays a central role in the ability to reliably capture medication administration timeliness data electronically through structured EHR documentation (McGonigle & Mastrian, 2022). Recording the medication order entry timestamp and matching the administration timestamp for each medication in discrete fields enables easy reporting on the time interval with precision down to the minute, which would be impossible with paper documentation. Manual data extraction from charts to calculate intervals is extremely labor intensive and prone to errors in matching orders to documentation. Beyond reporting, having structured medication data within the EHR also enables building decision support tools like alerts when medications are nearing late status based on frequency prescribed or analytics around patterns contributing to delays on certain units, during certain shifts or for specific drug classes.

From an implementation standpoint, the informatics team oversees the build of the necessary documentation forms, fields, reports, and, ideally, decision support tools within the platform to standardize timeliness data capture (Hebda et al., 2019; McGonigle & Mastrian, 2022). This requires coordinating with end-user committees to design intuitive workflows, working with developers on technical specifications, and iteratively testing functionality until ready for rollout. Effective project management throughout the execution is critical, including clearly articulated vision and goals, identifying both quantitative and qualitative key progress indicators, forming a collaborative implementation team with complementary skills, following a structured plan, and objectively evaluating outcomes at each milestone to guide the next steps.

Systems and Staff Members in Design and Implementation

Several stakeholder groups should be involved in the design process based on their expertise and, ultimately, role in using the EHR functionality (Hebda et al., 2019; McGonigle & Mastrian, 2022). The cardiology nurse manager is well-positioned to spearhead this optimization initiative overall, given the advanced registered nurse’s core responsibilities to promote evidence-based practice changes and care quality improvements in their unit. Bedside registered nurses in the cardiology unit should be closely engaged to provide invaluable insights on frontline medication administration workflow considerations and documentation needs, which will heavily impact adoption success. Clinical pharmacists are also key partners in sharing enhancements required in the pharmacy medication order entry process to enable capturing timeliness data, as well as domain expertise to inform decision support tools.

Nursing and general healthcare informatics specialists play crucial roles spanning project management, design sessions, technical writing, build and testing, end-user training, go-live support, and evaluation (Hebda et al., 2019; McGonigle & Mastrian, 2022). With expertise in bridging clinical environments and information systems, informaticists facilitate translating practice needs and work processes into technical system capabilities. On the technical side, the EHR development team oversees configuring the software architecture, database, interfaces, and configuration options to meet the outlined specifications and support tracking administration and efficiency. Representatives from hospital quality departments often round out teams to consult on reporting requirements.

Strategies for EHR Implementation

A structured, phased implementation approach with extensive preparation and end-user engagement well prior to going live is essential for EHR change management success. Early communication should focus on the rationale and vision for optimizing medication data capture, including timeliness tracking goals and their importance for the cardiology service, in particular, given the patient population’s vulnerability. As training materials and system demonstrations are developed, multi-modal education should be delivered, combining online learning modules, downloadable tip sheets, on-unit peer support, and dedicated super users to allow for varied learning styles. For such a central clinical workflow, hands-on practice time is invaluable prior to launch.

In transition planning, a staggered rollout beginning with the cardiology unit, while the old EHR remains available in other areas, prevents unsafe handoff gaps. This allows the project team to work through inevitable issues on one smaller scale unit before expanding to more staff and complexity (Porter-O’Grady & Malloch, 2019). No matter how strong the design and preparation efforts are, the launch stage still requires the allocation of extra staffing support and resources to respond to real-time needs. Pre-scheduling expanded information systems and super user shadowing during the stage of heavy initial system use prevents bottlenecks that could otherwise risk patient care quality or safety.

Standards for Design and Implementation

Several key professional standards guide the approach to optimization design and drive governance considerations. The American Nurses Association (ANA) nursing informatics competency framework emphasizes the importance of nurses being actively involved in designing, selecting, implementing, and evaluating information systems like EHRs, given their frontline workflow expertise, without which adoption suffers (ANA, 2021). The framework stresses understanding users and designing to match their cognitive needs and environments. Also, the American Health Information Management Association (AHIMA) sets best practices focused on maintaining health information integrity, confidentiality, availability, and security, which inform authentication methods, access controls, and auditing required to uphold patient privacy (AHIMA, 2019).

In addition, federal regulations specify optimization requirements. The consenting conditions of meaningful use demand that patients have the opportunity to get tools for patient engagement and to record particular quality metrics electronically by the EHR system to qualify for incentive funding (CMS, 2015). Furthermore, separate information-blocking rules involve tech know-how for the interface between the data across technologies to prevent siloed information from making it impossible to have coordinated care. Finally, the ethical principles of transparent communication, including both the progress of implementation and the arising challenges, will hold the trust, while the equity and opportunities for participating will be given to all staff roles, and finally, the decision-making will be collaborative, all over the optimization process. Without earnest reciprocal partnership, this interprofessional cardiology care team would be resentful if informatics specialists dictated workflow changes without earnest attempts to first understand the impacts on frontline providers.

Evaluation of EHR Implementation Success

Multifaceted evaluation assessing the EHR optimization from clinical, operational, and technical perspectives is vital for evidencing success both quantitatively through outcomes as well as qualitatively via stakeholder experience. In order to measure adoption, it is necessary to collect data on system use in addition to questionnaires that ask nurses and providers about the system’s intuitiveness, learnability, and efficiency (Aguirre et al., 2019). Medication administration timeliness rates and order correctness in the cardiology unit are two clinical indicators that should be monitored before, immediately after, and frequently after going live in order to measure the improvements in care.

The new functionality’s uptime and response times will remain stable even as the number of users rises, according to IT performance monitoring. According to Aguirre et al. (2019), patients may evaluate the impact of the update on staff workflow and communication by administering questionnaires before and after the update. Finally, ROI models should include measurable advantages, such as the time saved by providers due to automated documentation efficiency gains—the equivalent of wage expenses—when calculating expenditure payback over the next several years. However, real success comes from asking all levels of end users for honest qualitative input on the transition’s strengths and weaknesses rather than relying only on quantitative data.

Leadership and Collaboration with Interprofessional Team

Implementation of optimization initiatives of the EHR is a complex and cross-disciplinary practice, which raises the need for leadership; however, it is also challenging, as it lacks hierarchical authority. The transformational styles of leadership that are capable of spurring a team’s progress through the means of inspiration and not authority are of significant value. Stating a concise and cohesive message for the medicines administration project that encompasses strategic and interpersonal goals is meant to rationally align with stakeholder values while also appealing emotionally. Refreshing the accomplishment of the incremental milestones at intervals preserves the motivation (Porter-O’Grady & Malloch, 2019). However, imposing overly ambitious goals severely could spark a sense of resentment, and hence, there is an equal need for servant leadership principles emphasizing empathy, listening to concerns, and helping resolve barriers.

Furthermore, influencing without authority demands leading by example—the informatics team showing early adoption of learning the system themselves inspires clinician users more than issuing mandates (Porter-O’Grady & Malloch, 2019). Backing up professionally and building relationships interpersonally with the shared patients’ interests in mind, then just motivate change. When it is implemented, project management keeps the team working together to achieve goals. In a staged release model, lean principles become useful by highlighting error-proofing in each exercise until a full-scale initiative. As such, Six Sigma can be used to measure defect levels and find a way to reduce them. By using multiple-faceted leadership that encourages effective communication, empathy, and precise execution, the outcome of EHR can be adapted to practice.

Conclusion

This paper describes an implementation strategy of the meds administration efficiency plan around an electronic health record system upgrade. Compiling time intervals from the date of the medication order entry and administration was a way to trace and improve the quality of care and use informatics instruments. Structured documentation forms were presented in the EHR that gathered the timestamp fields of order and administration events to assist in the real-time monitoring of timeliness variances. The data is highly dependable and difficult to extract from routine nursing documents. This builds a strong case for nursing informatics specialists who are in charge of translating complex clinical workflows like medication delivery into easy-to-use systems.

The multistakeholder collaborative of HCPs like bedside nurses, pharmacists, quality leaders, and EHR developers should jointly participate in system development while giving their different views—patient-centric and software sound—seamless patient flow. Their involvement fosters buy-in, which is crucial for spurring acceptance of change. New tools may be successfully introduced in stages, with smaller rollouts initially, so that dependence can grow with further use. Active monitoring needs to incorporate not only quantitative but equally qualitative criteria across clinical data, workflow, and staff experience metrics so that continuous improvement based on best practices and new technologies can be achieved.

Leading without formal authority instead requires winning hearts and minds through vision inspiration, empathy, and leading by example rather than by issuing orders. Interprofessional projects risk collapsing due to a lack of organized project coordination. Integrative leadership styles that are good at bringing together specialists from different fields and thorough program management have the most influence on improving performance and results when it comes to implementing complicated EHR projects. The strategic relevance of informatics for practice innovation and transformation will only increase as healthcare becomes more digitalized. This is because informatics can uncover insights from data coalescence and provide actionable assistance. Investment in smarter delivery, as shown by benchmarks like the suggested drug timeliness monitoring, may be achieved by gathering structured inputs to improve decision-making.

References

Aguirre, R. R., Suarez, O., Fuentes, M., & Sanchez-Gonzalez, M. A. (2019). Electronic health record implementation: A review of resources and tools. Cureus, 11(9). https://doi.org/10.7759/cureus.5649

AHIMA. (2019). AHIMA Code of Ethics. AHIMA Body of knowledge. https://bok.ahima.org/topics/industry-resources/code-of-ethics/

ANA, A. N. A. (2021). Draft nursing informatics: Scope and standards of practice, Third Edition. Nursingworld.org. https://www.nursingworld.org/~48fe04/globalassets/get-involved/draft-ni-scope-and-standards-3ed–2021-01-20-for-public-comment.docx

CMS, C. for M. & M. S. (CMS), HHS. (2015, March 30). Medicare and Medicaid Programs; Electronic Health Record Incentive Program-Stage 3. Federal Register. https://www.federalregister.gov/documents/2015/03/30/2015-06685/medicare-and-medicaid-programs-electronic-health-record-incentive-program-stage-3

Hebda, T., Hunter, K., & Czar, P. (2019). Handbook of informatics for nurses and healthcare professionals. Pearson.

McGonigle, D., & Mastrian, K. (2022). Nursing informatics and the foundation of knowledge. Jones & Bartlett Publishers.

Porter-O’Grady, T., & Malloch, K. (2019). Leadership in nursing practice: Changing the landscape of health care. Jones & Bartlett Publishers.

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In a paper of 1,500-1,750 words, discuss the following:

Consider an opportunity for tracking care improvement. What key information would be needed in the database? Example: Time lapse from medication order documented in the EHR to delivery of medication to the patient for the cardiology service.
Describe the role informatics plays in the ability to capture this data. What type of project management strategies and methodologies can be implemented to support informatics initiatives to help improve quality within the clinical practice?

Electronic Health Record Implementation

Discuss which systems and staff members would need to be involved in the design and implementation process. What is the role of the advanced registered nurse in promoting evidence-based practice and leading quality and performance improvement initiatives within this setting?
Outline strategies for implementing the new EHR proposal. Consider communication changes, transitioning to the new EHR, and managing resources (human, fiscal, and health care resources).
Discuss what professional, ethical, and regulatory standards must be incorporated into the design and implementation of the system.
Describe the measures and steps you would take to evaluate the success of the EHR implementation from a staff, setting, and patient perspective to measure effectiveness and ensure continuous quality improvement in practice.
Explain what leadership skills and theories would be needed to facilitate collaboration with the interprofessional team and provide evidence-based, patient-centered care.
You are required to cite five to 10 sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.