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Change is an integral component of progress in every sphere of life. It is particularly true about fields that use technology and its advances. Currently, health care is one of the areas that actively introduce change projects implying the implementation of health information technologies. One of the most popular technologies that provide evident benefits for health care is Electronic Health Record (EHR). It is widely applied in diverse settings including clinical, long-term care, and even home care. Still, despite its active adoption, EHR implementation is lower in small and rural hospitals (Henry, Pylypchuk, Searcy, & Patel, 2016).
This project is aimed at the development of change interventions that support the implementation of EHR in a clinical setting. The focus of this change project is on acute care units where the increased quality of care, patient safety, and efficiency of care are the benefits of EHR that are most significant. The change project includes stages such as planning, selection of resources including project team, staff education, implementation, and efficiency assessment. After the assessment stage, strategies should be reviewed and changed in case of necessity to increase the effectiveness of the EHR application. Also, educational interventions can be altered or organized after the project start to provide staff with more recent knowledge or in case the software is updated.
Acute care hospitals and units frequently suffer from nurse understaffing. These units are characterized by high work intensity and exhaustive conditions that can lead to nurse fatigue and burnout. The problem of understaffing can be partially compensated by the implementation of a technology that has the potential for reducing the time spent on routine activities of nurses and an increase in the quality of care. EHR is a technology that can be used to meet the needs of understaffed units and contribute to the overall improvement of care quality and improved patient outcomes.
The project of EHR implementation in acute care units is expected to be beneficial for two major parties. First of all, the patient in acute conditions will benefit. They will get high-quality care that is well-organized and delivered timely. Also, EHR can positively influence the reduction of medical errors that are a risk factor in acute care settings due to heavy workload and the related human factor. Consequently, patient outcomes will improve as well as patient satisfaction. The second party that will benefit from EHR implementation is the nursing staff. Due to unfavorable work conditions and the necessity of high attention concentration, fatigue and burnout are frequent among acute care units’ staff. Therefore, the utilization of EHR technology is expected to reduce time spent on routine paperwork as well as empower information exchange among the staff members who work different shifts. The evident benefits for nursing staff will include the shortened burnout and fatigue that results in higher job satisfaction.
The project is significant for nursing practice because it contributes both to nursing science and nursing practice. First of all, it has the potential to advance nursing science providing evidence of EHR effectiveness, summarising its possible applications, and accumulating data about its use in different contexts. As for nursing practice, the project is expected to provide evidence of EHR implementation peculiarities in a given acute care unit.
Personal and Professional Expectations
I have both personal and professional expectations for this project. The personal aspect includes the development of certain skills. For example, I hope to improve my analytical and critical thinking skills due to the necessity to critically analyze data that provide a background for the project. Moreover, I expect to gain more research experience while selecting scholarly literature to support the project. Finally, I believe I can enhance my leadership skills and abilities that are necessary for project development and implementation.
As for professional gains, they are expected to be as follows. Firstly, I will study the research-based evidence of EHR implementation, which is a benefit for my future practice. Secondly, I will learn how to implement evidence and theoretical knowledge in practice. Finally, I expect to obtain the useful experience of being a member of a change team that contributes to an increase in the quality of patient care.
The project of EHR implementation in acute care settings has both long- and short-term goals. One of the most global long-term goals is an increase in the quality of care and the related improvement of patient outcomes. The second long-term goal is the growth of job satisfaction among the acute care unit staff and a contribution to the solution of the understaffing problem. Short-term goals include the reduction of time spent on paperwork in the unit and improvement of information circulation around a healthcare facility.
Analysis of the Literature
EHR has been the issue for many studies related to diverse aspects of healthcare. For example, Meeks et al. (2014) present research on EHR-related patient safety outcomes. The analysis of incidents reported to the Informatics Patient Safety Officer of the Veterans Health Administration revealed the following findings. Thus, the majority of the reported cases involved unsafe technology, and one-quarter happened due to unsafe use of technology (Meeks et al., 2014). Some of the reported problems appeared due to non-technical aspects such as workflow or facility policies. Also, there were technical aspects related to the interaction of personnel with hardware, software, interface, and content. Therefore, it can be concluded that both technical and non-technical aspects are significant in choosing EHR to be implemented in a unit or a facility.
Clinical benefits of EHR implementation were investigated by King, Patel, Jamoom, and Furukawa (2013). Their cross-sectional study revealed that EHR implementation enhanced patient care, assisted the remote access to a patient’s chart, alerted physicians to a potential medication, and reflected critical lab values (King et al., 2013). Moreover, EHR contributed to the provision of recommended care, the request for appropriate tests, and the facilitation of communication.
EHR includes some useful tools that empower clinical practice. Thus, Litvin, Ornstein, Wessell, Nemeth, and Nietert (2013) investigated the clinical decision support (CDSS) tool that is a component of EHR, to reveal inappropriate use of antibiotics and stimulate appropriate prescription of broad-spectrum antibiotics. The study findings prove that the utilization of CDSS has a sustained influence on the shortening of broad-spectrum antibiotic prescription for acute respiratory infections and thus can contribute to judicious antibiotic application in conditions of primary care.
Nationwide adoption of EHRs is one of the healthcare system priorities. The study by Adler-Milstein et al. (2015) revealed that as of 2014, 75.2% of hospitals were using at least a basic EHR system compared to 58.9% in 2013. There was a connection between the hospital size and the type of EHR adopted. Thus, bigger hospitals were using comprehensive systems while smaller ones had adopted basic EHR systems. The challenges revealed in this study included financial costs, achieving physician cooperation, and the complexity of implementing the system effectively within the required time frame. Thus, despite many efforts to implement EHR in healthcare facilities, there are some barriers to the efficient use of this technology. Khalifa (2013) discovered barriers to health information systems as a whole and electronic medical records (EMR) in particular by the example of Saudi Arabian hospitals. The study revealed six types of barriers that need to be addressed to implement EMR successfully. They include human, professional, technical, organizational, financial, and legal barriers (Khalifa, 2013). The most important barriers to consider when implementing EHR are human and financial ones.
The suggested project is expected to meet the gap in the aspect of EHR implementation in acute care settings. Although there are many studies that discover EHR peculiarities, outcomes, and barriers, the project will contribute to the evidence base and allow tracing all stages of change interventions. The reviewed investigations create a basis for the project providing data about the variety of EHR aspects and the possible barriers that have to be met.
The procedure of this change project consists of planning, search for resources and team selection, staff education, implementation, and efficiency assessment stages. Thus, during the planning stage, the setting will be selected. It will be an acute care unit, possibly in a small or rural hospital, because these healthcare facilities have lower rates of EHR adoption compared to big hospitals (Henry et al., 2016). Search for resources includes a financial aspect, which is traditionally considered one of the barriers to EHR implementation. Funding for the project can be obtained from local authorities, community, or private companies. Another aspect of finding resources is team selection. It is a responsible step because human resources are frequently decisive for project success.
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The team will include a project leader, head of the unit, a responsible physician, a nurse manager, two staff nurses, and an IT specialist to deal with hardware and software during the initial stage. Staff education is the following step. It implies teaching all the staff nurses to use EHR. After these three stages, project implementation will start. It includes the installation of an EHR system on all devices used in a unit and its application in daily procedures. The whole project is expected to last for six months. Two weeks are given to the planning stage, a month for finding the necessary resources, both technical and human, and the staff education will last for two weeks. An estimated timeline for implementation is three months. The final month will be used to evaluate the project and make the necessary changes.
Evaluation is a significant component of project implementation. The current project will be evaluated by team members with the involvement of a representative from the hospital administration. For this project, a specially developed survey tool will be implemented. The survey will include such blocks as demographics, current use of the EHR system, feedback from nurses and their satisfaction, and opportunities for further improvement. Apart from demographic information, the survey is based on questions that need a scaled answer to choose among five options (from “strongly agree” to “strongly disagree”). For example, the block of the current EHR use is expected to discover the extent of its implementation and rate of acceptance by the nursing staff. The feedback and satisfaction section is aimed to measure nurses’ satisfaction with EHR. Finally, data obtained from the improvement block will allow researchers to modify the system and enhance its qualities. This project is expected to succeed due to careful organization and thoughtful preparation that includes planning as well as research and development of the evaluation survey tool.
Adler-Milstein, J., DesRoches, C., Kralovec, P., Foster, G., Worzala, C., Charles, D., … Jha, A. K. (2015). Electronic health record adoption in US hospitals: Progress continues, but challenges persist. Health Affairs, 34(12), 2174-2180. Web.
Henry, J., Pylypchuk, Y., Searcy, T., & Patel, V. (2016). Adoption of electronic health record systems among U.S. non-federal acute care hospitals: 2008-2015. ONC Data Brief, 35, 1-11. Web.
Khalifa, M. (2013). Barriers to health information systems and electronic medical records implementation. A field study of Saudi Arabian hospitals. Procedia Computer Science, 21, 335-342. Web.
King, J., Patel, V., Jamoom, E., & Furukawa, M. (2013). Clinical benefits of electronic eealth record use: National findings. Health Services Research, 49(1pt2), 392-404. Web.
Litvin, C., Ornstein, S., Wessell, A., Nemeth, L., & Nietert, P. (2013). Use of an electronic health record clinical decision support tool to improve antibiotic prescribing for acute respiratory infections: The ABX-TRIP study. Journal of General Internal Medicine, 28(6), 810-816. Web.
Meeks, D., Smith, M., Taylor, L., Sittig, D., Scott, J., & Singh, H. (2014). An analysis of electronic health record-related patient safety concerns. Journal of the American Medical Informatics Association, 21(6), 1053-1059. Web.