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The Use of Clinical Systems to Improve Outcomes and Efficiencies

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The Use of Clinical Systems to Improve Outcomes and Efficiencies

Electronic health records, or EHRs, are now the cornerstone of each healthcare system to improve patients’ health and provide more effective and coordinated care. Electronic medical records transmit patient information electronically, eliminating paper charts and providing up-to-date information to all departments and caregivers (Li et al., 2022). Thus, while much can be achieved through the most effective use of EHRs, their results will depend on the quality of implementation, the users involved and the integration of the program into clinical practices. In practice, both benefits and challenges have been realized in most healthcare institutions. This paper reviews four peer-reviewed articles highlighting the impact of EHRs on clinical outcomes, factors affecting efficiency and the lessons that can be learned when implemented in different institutions.

Provenzano, M., Cillara, N., Curcio, F., Pisu, M. O., González, C. I. A., & Jiménez-Herrera, M. F. (2024). Electronic health record adoption and its effects on healthcare staff: A qualitative study of well-being and workplace stress. International Journal of Environmental Research and Public Health, 21(11), 1430. https://doi.org/10.3390/ijerph21111430

Provenzano et al. (2024) employed a qualitative research study in an Italian hospital to analyze the impact of EHR on the clinical staff regarding psychological and operational aspects. There were 16 observational interviews with physicians and nurses in a general surgery unit. The study employed Interpretative Phenomenological Analysis (IPA), and the two key themes were EHRs as “a two-edged sword” and the effects of EHRs on professional relationships. The findings presented a positive approach concerning the availability and safety of data on one hand, while on the other hand, included stress, workload, and questions regarding professional affinities.

According to participants, EHRs would improve patient safety, reduce the time required to access the necessary data and reduce or eliminate transcription mistakes. Electronic records of individual patient records were anticipated to enhance sound decision-making and eliminate time wastage. Similarly, these refinements may improve patient care since this approach enhances diagnoses and coordination of health care delivery. Nurses and physicians noted that EHRs could help improve prescribing safety and promote the continuity of care in complex hospital settings.

However, there was concern over the augmentation of the workload for the administrative units and technostress. One of the concerns expressed by participants during the study was that using the system was likely to decrease direct interaction with the patient. Nonetheless, EHRs were credited with enhancing organizational and interdisciplinary teamwork and avoiding repeat activities, specifically identifying test results and patient histories. This centralization of data was conceived as capable of saving time, thus enabling more effective teamwork even when disruptions to the workflow were still occurring.

The study highlighted the relevance of readiness for organizational change, training of clinicians, and psychological support for clinical employees. Emphasis was placed on the interviews conducted with healthcare workers regarding the fact that system design should be more consistent with actual clinical practice. If there is no proper preparation and inclusion, EHRs are likely to demoralize and lower the standards of professionalism in healthcare givers. The authors also emphasized the need to use human-centered interventions to counteract the burnout effects and the best optimization of the system.

Trout, K. E., Chen, L., Wilson, F. A., Tak, H. J., & Palm, D. (2022). The impact of meaningful use and electronic health records on hospital patient safety. International Journal of Environmental Research and Public Health, 19(19), 12525. https://doi.org/10.3390/ijerph191912525

Trout et al. (2022) conducted a quantitative study on the trend analysis of EHR implementation and patient safety in 349 hospitals across four states in the USA. The article contrasted hospitals that had a full EHR system, hospitals that had attained Meaningful Use, and those that did not. The PSI-90 score and several other patient safety indicators were also examined, for which the researchers employed generalized linear modeling to determine the correlation between EHR use and these indicators.

Hospitals with fully implemented EHRS, regardless of their status on MU, showed a positive trend on many of the PSIs that had problems with surgical complications and hospital-acquired conditions. The patients with MU attestation exhibited slight enhancement in two safety measures. The composite score of the PSI-90 did not change across any of the groups, suggesting that mere implementation leads to a lack of broad safety improvement. This means that certification is not as important as functionality and integration of the systems.

The study shows a slight improvement in efficiency. The hospitals that implemented EHRs reported improved monitoring, tracking, alert, and order entry systems, which led to decreased errors. However, the results indicated that efficiency improvements depended on the type of hospital and the level of integration. The authors also asserted that the efficiency of EHRs in clinical practice depends on ownership and the extent to which the systems are integrated into the work setting and clinical practice.

The study found that patient safety cannot be assumed by just compliance with the MU measures. Thus, institutions need to shift efforts toward more clinically relevant uses of EHRs. While certifying professionals, policymakers were encouraged to move from direct incentives to outcomes-based strategies. Hospitals should emphasize the objective of functional integration and utilization of the system to achieve specific quality objectives rather than merely complete checklists.

Tsai, C. H., Eghdam, A., Davoody, N., Wright, G., Flowerday, S., & Koch, S. (2020). Effects of electronic health record implementation and barriers to adoption and use: A scoping review and qualitative analysis of the content. Life, 10(12), 327. https://doi.org/10.3390/life10120327

Tsai et al. (2020) conducted a scoping review of 141 articles published between 2005 and 2020 to assess the impact of EHR system implementation. The review was conducted regarding the clinical work, data, care quality, and economic aspects. The purpose was to systematically review all the data available and extract general themes concerning the advantages and drawbacks of implementing EHR systems.

The review established that EHRs decreased medication mistakes, improved the control of chronic illnesses, and improved patient care continuity. Clinical decision support and historical data were associated with more accurate interventions and nursing practice routines frequently used in EHRS. However, fragmentations and improper usage rather constrained outcome enhancements in some cases.

Several works mentioned improved efficiency owing to adopting an automated billing system, eliminating repeated tests, and enhancing access to records. Some participants claimed that they experienced higher workloads and more extended time to document because of the unfavorable interface design or lack of proper training. This variability means that EHRs are not always helpful, and their utility depends on the systemization as well as the competency of the users.

As it was evident, the participants often mentioned barriers like lack of digital literacy, absence of technical support, and a high degree of incompatibility. The authors underlined that sustainable implementation needs planning in the macrosystem, focusing on the user’s and the staff’s education. Overcoming the barriers involved ways such as cultural readiness and engagement of relevant stakeholders to minimize resistance towards using EHR in healthcare facilities.

Upadhyay, S., & Hu, H. (2022). A qualitative analysis of the impact of electronic health records (EHR) on healthcare quality and safety: Clinicians’ lived experiences. Health Services Insights, 15. https://doi.org/10.1177/11786329211070722

Upadhyay and Hu (2022) employed a qualitative interview approach with 20 clinicians obtained from Nevada and California to determine the impact of EHRs on healthcare quality and safety. The targeted participants were physicians, nurses, hospitalists, and safety officers in different health departments. A thematic analysis was conducted on how patient care providers and revenue cycle staff interfaced with EHR regarding aspects of usability, their perceived benefits, and the challenges faced while in practice.

Some of the benefits mentioned by clinicians included a decline in medical errors, medication alerts, real-time availability of test results, and prior patients’ clinical records. These features improved the functions of decision-making and enhanced protocol conformity. Nonetheless, the nurses raised a few limitations regarding data credibility and the ability to incorporate unstandardized data into structured formats, signifying a conflict between standardized practice and individualized practice care.

Efficiency perceptions differed across roles. Nurses said that EHRs help them process orders and communication faster and more effectively; however, some physicians complained that they consume a lot of their time and interrupt the workflow. Although documentation was described as being time-consuming in some situations, a common patient record made it easier to communicate with other team members and delegate responsibilities. Therefore, there is a general perception that EHRs enable the coordination of care while at the same time hindering individual care processes whenever they are not customized.

Some challenges include a lack of training, the system’s inability to accommodate new and probably more efficient changes and compatibility issues. According to clinicians, roles should be more specific and engaged in system design efforts. In this situation, a supportive environment and proper onboarding experiences were pertinent to the usage. The results imply that EHR depends on clinicians’ support and constant optimization of functions within the system.

Conclusion

From the four reviewed studies, EHR was found to enhance patient safety, decrease medical mistakes, and enhance the quality of care services. However, these benefits were not applicable in all contexts. They depend on the implementation approach, ease of use of the system, roles of clinicians in the implementation, as well as organizational commitment to the development of the system. Provenzano et al. (2024) and Upadhyay & Hu (2022) discussed EHR’s several human and emotional consequences, such as stress and technostress or workflow interruptions. Trout et al. (2022) also found that an emphasis on regulatory compliance cannot guarantee an increase in outcomes, while Tsai et al. (2020) described the interaction between the features of the system and the users globally. In combination, the results suggest that for EHRs to deliver on their potential, organizations must focus on improving the usability of education, compatibility, and leadership in ways that are mindful of clinician outcomes and staff welfare.

References

Li, E., Clarke, J., Ashrafian, H., Darzi, A., & Neves, A. L. (2022). The impact of electronic health record interoperability on safety and quality of care in high-income countries: Systematic review. Journal of Medical Internet Research, 24(9), e38144. https://doi.org/10.2196/38144

Provenzano, M., Cillara, N., Curcio, F., Pisu, M. O., González, C. I. A., & Jiménez-Herrera, M. F. (2024). Electronic health record adoption and its effects on healthcare staff: A qualitative study of well-being and workplace stress. International Journal of Environmental Research and Public Health, 21(11), 1430. https://doi.org/10.3390/ijerph21111430

Trout, K. E., Chen, L., Wilson, F. A., Tak, H. J., & Palm, D. (2022). The impact of meaningful use and electronic health records on hospital patient safety. International Journal of Environmental Research and Public Health, 19(19), 12525. https://doi.org/10.3390/ijerph191912525

Tsai, C. H., Eghdam, A., Davoody, N., Wright, G., Flowerday, S., & Koch, S. (2020). Effects of electronic health record implementation and barriers to adoption and use: A scoping review and qualitative analysis of the content. Life, 10(12), 327. https://doi.org/10.3390/life10120327

Upadhyay, S., & Hu, H. (2022). A qualitative analysis of the impact of electronic health records (EHR) on healthcare quality and safety: Clinicians’ lived experiences. Health Services Insights, 15. https://doi.org/10.1177/11786329211070722

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Question 

The Use of Clinical Systems to Improve Outcomes and Efficiencies

New technology—and the application of existing technology—only appears in healthcare settings after careful and significant research. The stakes are high, and new clinical systems need to offer evidence of positive impact on outcomes or efficiencies.

Improve Outcomes and Efficiencies

Improve Outcomes and Efficiencies

Nurse informaticists and healthcare leaders formulate clinical system strategies. As these strategies are often based on technology trends, informaticists and others have then benefited from consulting existing research to inform their thinking.

In this Assignment, you will review existing research focused on the application of clinical systems. After reviewing, you will summarize your findings.

Resources

To Prepare:

The Assignment: (4-5 pages not including the title and reference page)

In a 4- to 5-page paper, synthesize the peer-reviewed research you reviewed. Format your Assignment as an Annotated Bibliography. Be sure to address the following:

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