A. Identify a current nursing practice within your healthcare setting that requires change.

HIS in Nursing practice

1. Describe the current nursing practice.

HMISs (Health Management Information Systems) are included among the building blocks vital to strengthening the nation’s health and healthcare system. They may be defined as data collection systems targeted specially at supporting planning, decision-making and management within hospitals smaller healthcare centers and health and healthcare related agencies.

Health information constitutes a central component of an operational health system. An HIS (health information system) offers evidence that supports program- and policy- level decision-making to improve individual and societal health outcomes. But the word “HIS” lacks a well-defined or explicit definition.

The position of nurse informatics (NI) specialist came into being when the health sector recognized the need to have interactions between healthcare professionals and IT experts for the purpose of dealing with patient care issues (Bickford, 2009). NI specialists have a pivotal role to play in the process of care delivery, and constitute a determining factor when selecting, implementing and evaluating healthcare; their efforts foster safe, patient-focused, superior-quality healthcare (Elkind, 2009). According to the ANA (American Nurses Association) (2008), nursing informatics denotes a field which incorporates computer science and nursing science to facilitate information and skills communication and management into nursing practice (p. 1). Another way of defining it is: nursing informatics represents any information technology usage by nursing professionals to improve patient outcomes, facilitate nursing research and education, and manage healthcare centers (Bickford, 2009).

According to several authors, the nurse informatics discipline incorporates two kinds of roles: 1) The specialist responsible for creating, facilitating, testing and implementing novel IT tools and 2) The clinician responsible for utilizing these IT tools. Current healthcare centers integrate the features of mobile labs, electronic prescriptions, tele-health, and e-scheduling of physician appointment, necessitating informatics nurses who help ensure interfacing of computerized solutions with one another (HIMSS, 2011). For completing information-related tasks, informatics nursing staff needs to synchronize and engage in significant technical and clinical data interchange to foster and coordinate safe, efficient care and assure efficient workflow.

Nursing documentation makes up a key healthcare information aspect. Nursing information systems have been devised for ideally using documentation to expand nurses’ care quality-related knowledge. Knowledge has exponentially evolved during the last four decades because of the discovery of novel means of learning. The nursing profession, particularly, has profited from such novel concepts, continually coming up with improved and newer means of achieving patient care improvements. Nursing skills and expertise have an element of personal history which influences their performance of nursing care. Nursing practice standards, nursing theory, and ethical and legal obligations need to be grasped and applied for enhancing nursing care quality.

The EHR (electronic health record) concept has grown to become a key facet of information workflow. IT usage will lead to improvements in care efficiency and quality, thereby bringing about patient outcome improvements. Patient documentation proves crucial when it comes to communication of patient condition and care organization based on individual patients’ unique needs. The profession of nursing has chiefly been guided by patient needs. Based on these needs and relevant environments, a number of theories may be applied to aid personalized care. Individual nurse practice application is founded on medical, nursing, psychological, philosophical, and other theories combined.

2. Discuss why the current nursing practice needs to be changed.

According to a recent report, nearly fifty percent of medical professionals who use Electronic Health Record Systems (EHRS) fail to acquire the necessary patient information to effectively coordinate patient care. Quinn (2015) observes that a DHHS (Department of Health and Human Services)-sponsored research headed by Professor Chun-Ju Hsiao indicated that a mere one-third of healthcare professionals employ EHRs to electronically share patient data. While four in ten professionals do make use of EHRs, they don’t share patient data using these systems (Quinn, 2015).

The entire idea comes down to CCD or continuing care document, with meaningful use being the key. The CCD should stay uniform all through the course of the EHR process (Quinn, 2015). Though compatibility ought to be demonstrated, this rarely happens.

B. Identify the key stakeholders within your healthcare setting who are part of the current nursing practice.

· Nurse informatics (NI) specialists

· The specialist responsible for creating, facilitating, testing and implementing novel IT tools and

· The clinician responsible for utilizing these IT tools

1. Describe the role each identified key stakeholder will play to support the proposed practice change.

· NI specialists

An NI specialist heads evolving technology within the medical domain. Hence, superior communication skills are a must. In an NI work environment, the professional will need to handle and communicate information to customers (i.e., patients), nursing staff, and healthcare providers. They are the link between IT personnel and nursing staff. One objective of information dissemination is enabling individuals to make more sound decisions on the basis of more accurate information.

What are NI specialists expected to do?

An HIMSS (Healthcare Information and Management Systems Society) survey reveals that 57% of participants reported that their chief responsibility was the provision of systems preparation, ongoing user support, and user training; further, 53% dedicated the majority of their efforts towards systems development, involving systems customization or updating, or the creation of a novel homegrown system (HIMSS, 2011). A second area of NI specialist focus is quality control.

A few other responsibilities of NI specialists include:

· Project management

· Systems user education, training and support

· Choosing of the right systems

· Policy writing

· Systems maintenance

· Optimizing systems

Outside of clinics, nursing homes and hospitals, NI specialists also engage in the activities of testing, sales, customer training, and system design.

For the integration and enhancement of EHR and Health Information System (HIS) application within the nursing profession, NI specialists ought to ensure NP (nurse practitioner) participation and determine extant HIS inefficiencies. The specialists ought to endeavor to ascertain areas for improvement for making make the system more practitioner-friendly.

· The specialist responsible for creating, facilitating, testing and implementing novel IT tools

HIT specialists are in charge of the protection and release of protected health-related data in adherence to every regulatory guideline and Libraries for Nursing (LFN) procedure and policy.

HIT specialists are also in charge of repairs and maintenance of IT systems in any healthcare center, including PCs, servers and networks.

What is the role of HIT specialists?

Health information technicians or HIT...

…process. Healthcare professionals, in the future, need to be provided specialized training to test the new system’s synchrony and practitioner capacity of achieving seamless system integration into everyday practice.

John Hopkins Hospital has successfully implemented novel integrated systems, with the following reported benefits:

· Patient transfer between hospitals: The hospital has witnessed a sixty percent growth in capacity to handle patients with complicated health conditions transferred from other healthcare facilities (GE Healthcare Partners, 2018).

· Operation theatre: A nearly-seventy-percent decline has been witnessed in transfer delays from operating rooms after the completion of a clinical procedure (GE Healthcare Partners, 2018)

· Emergency Room: A thirty-percent swifter patient bed allocation has been witnessed following admission decision. Moreover, patient transfer following bed allocation has become twenty-six percent swifter (GE Healthcare Partners, 2018)

· Patient discharges: Twenty-one percent more patients now get discharged prior to noon as compared to prior figures (GE Healthcare Partners, 2018)

G. Discuss possible barriers to successful implementation of the proposed practice change.

Key obstacles include: CAS, financial limitations (Penprase & Norris, 2005), resources and time required for program roll-out, opposition to change, and status quo disruption.

H. Discuss any possible ethical implications that may arise while planning or implementing the proposed practice change.

Maintaining patient data privacy and protecting the external intrusion system constitutes the major ethical challenge here. Information systems prove highly susceptible to attacks. Large organizations have even come close to absolute failure because of occasional system compromise on the part of internal or external players. The greatest ethical challenge is: development of a robust system which enables patients to authorize private data access, digitally. Another potential challenge is electronic document maintenance and synchronization of access, communication and retrieval from multiple electronic devices. Any likelihood of the system not being insulated from data leaks will serve to greatly impact security of patient information.

Usually, healthcare providers aren’t proficient in the area of digital information handling. For guaranteeing information security, there is a need for health institutions to constantly monitor systems and always synchronize information communication and storage. Healthcare organizations might need to establish Capacity Command Centers for achieving timely response to system issues, and maintaining, upgrading and ensuring security of organizational HIS and EHR systems (GE Healthcare Partners, 2018).

References

American Nurses Association (2008). Recognition of a nursing specialty, approval of a specialty nursing scope of practice statement, and acknowledgment of specialty nursing standards of practice. Silver Spring, MD. http://www.nursingworld.org/3SC-Booklet.pdf

Bickford, C. J. (2009). Nursing informatics: Scope and standards of practice. In Studies in Health Technology and Informatics (Vol. 146, p. 855). 

Elkind, E.C. (2009). Why information systems are helpful to nursing. The Pennsylvania Nurse, 64 (1), 24-25.

GE Healthcare Partners (2018). The Johns Hopkins Hospital Launches Capacity Command Center to Enhance Hospital Operations. Retrieved 23, February, 2018, from http://emea.gehealthcarepartners.com/insights/128-digital-and-advanced-analytics/information-management-and-analytics/73-the-johns-hopkins-hospital-launches-capacity-command-center-to-enhance- hospital-operations

HIMSS. (2011). HIMSS nursing informatics position statement. Retrieved 23, February, 2018 from: www.himss.org/files/HIMSSorg/handouts/HIMSSNIPositionStatementMonographReport.pdf

HIMSS (2011). Nursing Informatics Workplace Survey

Penprase, B., & Norris, D. (2005). What nurse leaders should know about complex adaptive systems theory. Nursing Leadership Forum, 9(3), 127–32.

Quinn, R. (2015). Compatibility Issues Make Physicians’ Use of Electronic Health Records Systems Tougher, The Rheumatologist. Retrieved 21, February, 2018, from http://www.the-rheumatologist.org/article/compatibility-issues-make-physicians-use-of-electronic-health-records-systems-tougher/

Shekelle, P. G., Morton, S. C., & Keeler, E. B. (2006). Costs and benefits of health information technology. Evid.Rep.Technol.Assess. (Full.Rep.), (1530–4396 (Print)), 1–71.…