Healthcare Information Systems

Introduction

Today, the healthcare industry presents various challenges and burdens for professionals. It is crucial for organizations that deliver healthcare services to keep up with the emerging trends, provide excellent services, and meet the expectations of different stakeholder groups. According to Wager, Lee, and Glaser (2017), healthcare facilities highly depend on information technologies that “aids in managing population health effectively while reducing costs and improving quality patient care” (p. 4). Consequently, under the circumstances of a merger, the organization needs to introduce an efficient healthcare information system (HIS) that will benefit the facility at different levels. The purpose of this paper is to provide a description, thorough analysis, and evaluation of a new HIS implemented in the organization that exists as a result of a merger.

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Advantages and Disadvantages of a System

It is fundamental to look at the benefits and disadvantages of the HIS. The primary function of the HIS implementation is the use of electronic health records, which allows the professionals to have access to the patient’s medical history (Reisman, 2017). This aspect is crucial during the merger because it offers easier collaboration and transition. Impressive, that the Health Information Technology for Economic and Clinical Health (HITECH) Act provided the incentives of more than $30 billion to increase the use of the EHRs across the nation (Reisman, 2017).

The introduction of HITEC was directed at the simplification and improvement of the provided services and aimed to increase the satisfaction level of the parties involved in the healthcare industry. Nevertheless, the results have shown that the issues, such as insufficient cooperation among the stakeholders, regulations, or inability to employ the technologies properly, remain within the sector (Reisman, 2017). Therefore, it is beneficial to investigate HISs in terms of usability, interoperability, scalability, and compatibility.

The active integration of HIS with the organization implies the use of the application system messages (ASMs). This particular feature is directly connected to the usability dimension of HIS effectiveness. The study reveals that the software users reported that timely alerts and notifications’ availability could improve the work performance and help to avoid complications (Jones, Keane, Stawiarski, Fatus, & Kane, 2016).

Still, despite the positive sides, the usability of the HIS presents specific disadvantages. For instance, the study shows that the users identify the lack of system consistency and emphasize the need for the removal of the interruptions that can negatively affect the efficiency of the healthcare delivery (Jones et al., 2016). Hence, in terms of usability, it is crucial to integrate HIS gradually and perform continuous work on the system’s consistency and appropriateness to achieve the stakeholders’ satisfaction and increase usability benefits.

The principle of interoperability within the healthcare industry plays an integral role in the successful adoption of the HIS. According to Reisman (2017), interoperability is challenging, goes beyond the information exchange, and requires the further efficient use of the shared data. In the case of the two merging organizations, the semantic level of interoperability is essential to achieve the best results and present excellent performance. One of the HIS advantages in terms of this dimension is that with successful fulfillment of the criteria, the organization can have a smooth process of data exchange and interpretation.

Still, a significant obstacle to interoperability lies in the cultural aspect of the healthcare industry. In the US, the healthcare delivery culture “is defined by disparate stakeholders,” and “data is more of a commodity and competitive advantage than a basis for coordinated care” (Reisman, 2017, p. 573). In such a way, interoperability achievement has benefits for a successful collaboration, but the current culture presents burdens for its full implementation.

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Another significant aspect of the HIS implementation within the merging organization is the scalability of the system and technology. One of the benefits that the integration of an efficient information system offers is the ability to adapt to the changed volume of work and the scope of the procedures. Two organizations will have to unite their activities, understand the principles of each other’s professionals, and employ the best practices to be able to transform into the new process. It is integral to implement the HIS that will be scalable and will provide those advantages to the stakeholders. However, it might be very challenging and impose particular burdens on the organization.

It is crucial to conduct research that might require additional investments to provide a system that will help the professionals and will improve the quality of services and performance (Angraal, Krumholz, & Schulz, 2017). Consequently, there is a substantial benefit of the transformation help and specific disadvantages in terms of time, money, and human resources additional investments.

It is also crucial to look at the features of the integrated HIS in terms of compatibility. In the case of the merger, the principle of compatibility plays an integral role in the process, because the combination of the systems of two different organizations can impose numerous obstacles. A significant advantage of establishing strong compatibility is the creation of a system that works smoothly. It offers various possibilities for professionals to access the required data and exchange information. Thus, compatible HIS creates an algorithm of specific procedures with minimized interruptions and errors.

Here, it is critical to analyze the disadvantages of the new HIS implementation. Today, many healthcare organizations experience a lack of compatibility among the EHR systems, which creates obstacles for professionals (Quinn, 2015). Besides, the two merging facilities have an established system of their own, and it is essential to investigate how the professionals treat the use of the electronic system. The studies reveal that only more than 30% of physicians actively share information about the patients electronically (Quinn, 2015). This factor implies that the new organization can face issues with the implementation of the new information system and will have to employ new strategies to create a compatible system.

Patient Care and Documentation

The merger implies the changes in the workload and the challenges in the job satisfaction and performance levels. One should note that analyzing the influence of the HIS on patient care and documentation is critical. The integration of information technologies in the working process in healthcare has affected various aspects. For instance, the active use of IT leads to a higher time spent with the patient, which implies sufficient communication, education, and evaluation (Rouleau et al., 2017). In such a way, patient care is improved through the use of HIS and enhances patients’ experiences.

Besides, efficient HIS leads to the lower time spent on documentation, and the professionals can allocate this time to the patients, providing more exceptional care (Rouleau et al., 2017). The quality of documentation has also increased with the use of IT tools (Rouleau et al., 2017). Therefore, IT within the healthcare industry positively influences the level of patient care and documentation issues.

The introduction of effective HIS implies not only the reduced time spent on documentation but also more explicit documentation guidelines for professionals. Documenting necessary information is a process that needs to be precise and accurate. Active integration of information systems can provide the templates and thorough regulations for the employees to follow while filling out the required forms. Moreover, the digitalized registration process with the HIS significantly simplifies documentation procedures.

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This section mentions that with the integration of the information system, medical workers spend more time on patient care. Also, the quality of patient care is improved because professionals have an opportunity to transform knowledge and skills from HIS into proper practices (Rouleau et al., 2017). Increased learning, enhanced collaboration among professionals, and easy access to the information bring patient care to a higher level within the organization.

Quality and Delivery of Nursing Care and Patient Outcomes

The paragraph above mentions the advantages the HIS has on patient care and documentation. IT implementation influences other areas within the healthcare organization as well. Among them, there are time management, communication and coordination, nurse-patient relationship, the teaching of patients and family, knowledge utilization, care planning, and patient comfort (Rouleau et al., 2017). Consequently, the ability to access information using the system improves the overall performance of the nurses in terms of quality. For instance, patients receive more explicit instructions about the medication intake, and the ability to provide videoconference consultations leads to the trust establishment (Rouleau et al., 2017). Those factors significantly improve the patients’ experiences and the outcomes of medical care. Also, the nurses’ satisfaction with their performance is growing because they can see the results of their work and the positive influence that their attention has on patients.

Benefits to the Organization

Ways QI Data Can Lead to Measurable Improvement

The HIS allows the professionals to retrieve data about specific issues that can contribute to the provision of services. One of the ways that the healthcare organization can withdraw measurable improvements is through the access of the data about the clinical trials. For instance, the information about the cancer clinical trial results and participated patients’ experiences can measure “symptom assessment, evaluation of function and health-related quality of life” (Gilbert, Sebag-Montefiore, Davidson, & Velikova, 2015, p. 429). The information about the possible symptoms and what influence they might have on daily activities can be relevant to the patients who have cancer at the initial stages, and, consequently, to the professionals providing treatment for them.

Thus, one of the ways that QI data collected through the system can enhance the general performance is through the information collected with the help of the questionnaires and surveys. The results of the trials and after-trials patients surveys will be integrated into the system. The questions constructed in a specific way can provide measurable results, and offer suggestions to the professionals in their future practice, positively influence the image and the quality of the organization.

Besides the ability to actively use questionnaires, HIS offers the possibility to have access to the EHRs and the story of various diseases. Information technology with a high capacity of data storage can provide an option to measure the data about the conditions and analyze the causes of those illnesses more effectively. Hence, this is another way how the data withdrawn from the system can improve the organization’s performance and the quality of the services that it provides. The information system can divide the information about the patients with common diseases into groups according to age, prior medical conditions, and results.

Consequently, this data can be measured and analyzed, producing the outcomes that can generate a description of the risk group. In such a way, the patients that fall under the risk category represent a target group that will benefit from this information. They can receive proper care, and medical professionals can reduce the likelihood or prevent the disease. Moreover, the measurability of this data implies the possibility to prevent potential diseases among specific patients, which can significantly improve the overall health quality.

HITECH and HIPAA Security Standards and Regulations

Every healthcare organization needs to follow the standards and regulations proposed by HITECH and HIPAA because breaches in data security can lead to severe problems. HITECH and HIPAA represent the “laws which are to be operationalized into an organization’s standard operating procedures,” including those that are the parts of the information system (Kiel, Ciamacco, & Steines, 2016, p. 437). Consequently, the HIS must meet the requirements imposed by those acts, including data storage integrity and data backup and recovery.

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After the merger, the issue of integrity of the stored data is critical, because the combination of the information from the two organizations can create chaos. The information technology department will carefully work on the active protection of the data and will implement cloud-based health IT. According to the researchers, this type of data storage offers additional security layers that are related to the “extraction, transformation, and loading of patient-related data” (Kruse, Goswamy, Raval, & Marawi, 2016, par. 25). Therefore, the IT department of the merged organizations will collect and manage the data used by the cloud-based storage system to ensure the security and integrity of the information.

Data backup and recovery also represent essential points in information system management. Proper implementation of specific data recovery guidelines and strategies can help to eliminate potential information breaches and losses. One of the possible solutions to ensure the safety of those aspects is to implement a particular application, such as Healthcare Data Gateway (HDG). The essence of this app is to manage electronic medical data with the help of the blockchain system (Yue, Wang, Jin, Li, & Jiang, 2016).

The IT department will introduce the application for the professionals and the patients that will help them to manage and control the information. At the same time, all the information will be transmitted to the cloud storage with additional layers of security, which will enable the stakeholder to restore lost records or other relevant information.

Protection of Patient Privacy

Another crucial issue in the implementation of HIS is patient privacy protection. It is critical for the information technology team to ensure the confidentiality of the patients’ EHRs and to control access to the data. The researchers claim that “given the vulnerability of patient privacy, security should be paramount when considering using technology in the healthcare setting” (Al-Janabi, Al-Shourbaji, Shojafar, & Shamshirband, 2017, p. 115). The most significant activities directed at the patient privacy protection will be the increased specialized access system, in which the patients can grant the availability of their information to the professionals in the required cases.

Adequate security measures should include group management, integrity, privacy, and procedures of authorization and authentication (Al-Janabi, Al-Shourbaji, Shojafar, & Shamshirband, 2017). In such a way, HIS, within the organization after the merger, will employ strict security regulations to ensure the safety and privacy of the individuals’ information.

Organizational Efficiency and Productivity

Above, it was mentioned how the implementation of HIS influences the level of patient care, simplifies the documentation process and improves the outcomes for the patients. Besides those areas within the healthcare organization, active integration of the information system has an impact on the productivity of the professionals in different departments of the facility. According to Rouleau et al. (2017), HIS helps to enhance the time management of employees and efficiency because of the changed workflow with the use of information technology.

Consequently, when the nurses, doctors, and other employees within the healthcare organization spend less time for documentation purposes, they can dedicate more time to the activities related to patient care. As a result, productivity increases, and the process of documentation becomes more accessible and precise, positively influencing the organization’s performance and structure. Besides, HIS produces unspoken incentives for the professionals, and, in combination with the increased productivity and job satisfaction, the employees’ turnover will be lowered, which keeps human resources within the organization.

It is also crucial to mention that HIS implementation has an impact on the capital resources of the organization. In the case of the merger, the finances of the establishment will be increased, but so will be the needs. HIS implies a less complicated strategy to manage the resources, which results in a more precise structure of financial management for the company. Structured resource allocation with the help of HIS can reduce the stress for the commercial department employees and have a positive effect on the organizational culture. Besides, proper capital resources management can lead to higher financial incentives and rewards, which will reduce employee turnover and increase productivity.

Another essential point for the healthcare facility is waste management, and each establishment aims to reduce waste. Waste sorting and management in the healthcare industry represents a challenging process due to the presence of possibly infectious items and a high amount of waste, and efficient ways to dispose of it are critical. One of the strategies that the organization after the merger will integrate is “standardized medical waste streams” (Windfeld & Brooks, 2015, p. 106). In such a way, with the use of information systems, the professionals will have easier access to the disposal equipment around the facility. Moreover, with the data about the procedures and required disposal equipment being in the system, it will be easier to manage the tools and reduce the amount of produced waste.

Interdisciplinary Team Identification

The implementation of HIS will require a strong interdisciplinary team, in which the professionals from different areas will collaborate and produce the most excellent outcomes for the organization. The team members should have a broad spectrum of knowledge and skills, various perspectives on the implementation process, and the ability to contribute time (“Who Are the Key Stakeholders,” 2019). The interdisciplinary group, which is responsible for the implementation of HIS, plays the most significant role in the process. The points below identify four essential stakeholder roles:

  1. Team leader (the head of the IT department). The primary role of this professional would be to make the final decisions concerning the HIS system and its functioning, taking into consideration the opinions and suggestions of other team members. Immense expertise and experience in the field of information technologies will help the professional to choose the alternatives that offer the most effective ways of managing specific data and procedures.
  2. Nursing department leader. The integration of HIS will influence the working process for the nurses, which implies that they should be able to use the system efficiently. Consequently, the primary role of the nurse leader is to encourage nursing professionals to adapt to the changes and make recommendations about the most convenient ways of the system’s use. As the leader of the nurses within the organization, the nurse lead will bring expertise in the clinical flow of the facility and will help to make the implementation smooth and positively acceptable.
  3. Physician professional. The primary role of this professional is to provide the clinical perspective of the working process, which will help to design all the aspects of the system designed specifically for the medical environment. The physician professional would be responsible for consulting with the other doctors within the organization, gather their opinions and preferences, and deliver the information to the team. The expertise of the physicians is fundamental for effective and high-quality HIS because the change will influence this stakeholder group directly.
  4. Registration staff leader. As far as the registration process employees will actively use the system, the primary role of this professional will be to deliver the change effectively and increase the awareness about new HIS among the subordinates. High expertise in the registration workflow and communication will have a significant contribution to communicating the transition to the personnel and bringing new insights to the system use.

Plan for Evaluating Success of Implementing a System

Various methods for the evaluation of HIS implementation exist within the industry. Some of the most common evaluation processes include the checklist and measuring how the system follows the predetermined principles (Khajouei, Hajesmaeel Gohari, & Mirzaee, 2018). The discussed organization will use the checklist to check the effectiveness of the measurable evaluation plan. It is critical to design a checklist that will cover all the principles and expectations of the system’s implementation. After the merger and the implementation of the HIS, the healthcare facility will carefully comply with the standards offered by the American Medical Informatics Association.

The two primary AMIA standards the compliance with which needs to be evaluated are health IT data standards and interoperability (“AMIA Public Policy,” 2017). This association helps to enhance the transformation of the healthcare sector to the use of information technology. If to follow the rules and suggestions, it can contribute to the increase in effectiveness, decrease in the costs, and improvement of safety (“The Science of Informatics,” 2020).

Another professional organization, the standards of which play a crucial role in the evaluation of the integrated HIS, is the American Nurses Association. The organization offers the Nursing Scope and the Standards of Practice that provide a clear description of the aspects involved in the practice (“Scope of Practice,” 2020). Some of the ANA professional standards to comply with are the standards of professional performance, including resource utilization, and the standards of practice, such as health teaching and health promotion (“Scope of Practice,” 2020).

Consequently, it is crucial to evaluate the system continuously according to those standards to meet the changing needs and requirements. The organization must follow the professional guidelines after HIS implementation, and the evaluation process will help to determine how the proposed system manages to do it.

The organization must integrate a measurable evaluation plan to track the success of the implemented HIS and to measure the outcomes of the advancement. The sections above describe the primary aspects of the new information system for the healthcare facility after the merger, which provides the points for the development of a practical evaluation. The list below will detail the evaluation plan of the two chosen ANA standards. The standards are the assessment when the IT nurse collects data and evidence related to the situation and the outcomes’ identification when the nurse identifies the outcomes expected within a specific case (Bickford, 2017). The organization will use the evaluation questions proposed by the National Network of Libraries of Medicine (“Booklet 2,” n.d.).

  • To what extent was the organization able to implement the new HIS as planned?
  • To what extent the organization conducted the planned specific activities related to the new HIS?
  • How many stakeholders’ interest did the new HIS generate?
  • To what extent did the organization reach the intended community?
  • How effective were the recruitment strategies?
  • What situational factors in the external environment or the organization itself affected the implementation of the project?

The organization will gather the information to answer those questions relevant to the two chosen ANA standards through the use of surveys, interviews, and focus groups among the employees and stakeholders. With this data, the healthcare facility will be able to identify the extent of the performance according to the standards of assessment and outcomes identification. This way, it will be possible to gather the information that is measurable and that provides the scope of the implemented HIS.

References

Al-Janabi, S., Al-Shourbaji, I., Shojafar, M., & Shamshirband, S. (2017). Survey of main challenges (security and privacy) in wireless body area networks for healthcare applications. Egyptian Informatics Journal, 18(2), 113-122.

AMIA public policy principles and policy positions. (2017). Web.

Angraal, S., Krumholz, H. M., & Schulz, W. L. (2017). Blockchain technology: Applications in health care. Circulation: Cardiovascular Quality and Outcomes, 10(9), 1-3.

Bickford, C. J. (2017). The professional association’s perspective on nursing informatics and competencies in the US. In J. Murphy, W. Goossen, & P. Weber (Eds.), Forecasting informatics competencies for nurses in the future of connected health (pp. 62–68). Clifton, VA: IOS Press.

Booklet 2 – Planning outcomes-based outreach projects. (n.d.). Web.

Gilbert, A., Sebag-Montefiore, D., Davidson, S., & Velikova, G. (2015). Use of patient-reported outcomes to measure symptoms and health-related quality of life in the clinic. Gynecologic Oncology, 136(3), 429-439.

Jones, S., Keane, A., Stawiarski, A., Fatus, R., & Kane, B. (2016). The impact of application system messages on the usability of healthcare software applications. In 2016 IEEE 29th International Symposium on Computer-Based Medical Systems (pp. 306-311). Dublin, Ireland: IEEE.

Khajouei, R., Gohari, S. H., & Mirzaee, M. (2018). Comparison of two heuristic evaluation methods for evaluating the usability of health information systems. Journal of Biomedical Informatics, 80, 37-42.

Kiel, J. M., Ciamacco, F. A., & Steines, B. T. (2016). Privacy and data security: HIPAA and HITECH. In Weaver C., Ball M., Kim G., Kiel J. (eds.), Healthcare information management systems (pp. 437-449). New York, NY: Springer.

Kruse, C. S., Goswamy, R., Raval, Y. J., & Marawi, S. (2016). Challenges and opportunities of big data in health care: a systematic review. JMIR Medical Informatics, 4(4). Web.

Quinn, R. (2015). Compatibility issues make physicians’ use of electronic health records systems tougher. Web.

Reisman, M. (2017). EHRs: The challenge of making electronic data usable and interoperable. Pharmacy and Therapeutics, 42(9), 572-575.

Rouleau, G., Gagnon, M. P., Côté, J., Payne-Gagnon, J., Hudson, E., & Dubois, C. A. (2017). Impact of information and communication technologies on nursing care: Results of an overview of systematic reviews. Journal of Medical Internet Research, 19(4). Web.

The Science of Informatics. (2020). Web.

Scope of Practice: American Nurses Association. (2020). Web.

Wager, K. A., Lee, F. W., & Glaser, J. P. (2017). Health care information systems: a practical approach for health care management (4th ed.). San Francisco, CA: John Wiley & Sons.

Who are the key stakeholders during electronic health record (EHR) implementation? (2019). Web.

Windfeld, E. S., & Brooks, M. S. L. (2015). Medical waste management–A review. Journal of Environmental Management, 163, 98-108.

Yue, X., Wang, H., Jin, D., Li, M., & Jiang, W. (2016). Healthcare data gateways: Found healthcare intelligence on blockchain with novel privacy risk control. Journal of Medical Systems, 40(10), 218-225.

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