A. Analyze the capabilities of the following decision support systems as they are
used in the electronic health record:
� Computerized physician order entry
� Medication reconciliation
� Computerized prescribing
� Clinical decision support
- Explain one benefit of one of the given decision support systems.
- Explain one challenge of implementing the selected decision support system.
a. Explain how this challenge could be resolved.
B. Present how a needs assessment could be performed for the practice in the
scenario below. - Identify one clinical area needing assessment.
- Outline the functional needs that staff members may have in the clinical area you
have selected. - Outline one concern staff may have from the selected area.
- Compare how the use of an electronic health record can affect privacy, security,
and legal aspects in ways that differ from the use of the paper medical record.
C. Develop a project proposal for adopting an electronic record for the practice in
the scenario below by doing the following: - Present the elements that might be included in a project plan for adopting an
electronic health record. - Explain how to form a project team.
a. Explain how each team member would bring value to the process. - Identify one benefit the practice might gain from adopting the electronic health
record. - Provide one example of an electronic health record functional application that
may be implemented in each of the following healthcare settings:
� Hospital
� Nursing home
� Dental office
D. When you use sources, include all in-text citations and references in APA format.
Electronic record adoption project
A. Analyze the capabilities of the following decision support systems as they are used in the
electronic health record:
Computerized physician order entry
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Computerized physician order entry (CPOE) is an application that permits input of
patients’ health orders and treatment instruction. The application has the capability of ensuring
that health orders are transmitted via a computer system to medical practitioners or various other
departments particularly those involved in fulfilling these orders, such as radiology, labs and
pharmacy (Kuperman & Gibson 2003). In addition, when effectively used, CPOE reduces the
issues of delay in the completion of health orders; decreases inaccuracies associated with
transcriptions; permit order input in on-site as well as off-site locations; presents fault inspection
for duplicate or inaccurate doses and makes inventory and transfer of charges effective. Due to
the aspect of increased efficiency it permits appropriate and delivery of services, improving
regulatory compliance. It also improves patient safety; its ability to provide several clinical
signals helps in the prevention of adverse incidences ensuring that appropriate practices are used
in the proviso of care. CPOE increase communication; it has the ability to allow computerized
information sharing in a synchronized manner of all health orders and tests. Moreover, CPOE
has the ability to decrease health errors and abolishes duplication of processes, reducing the time
of stay and decreasing the liability of the provider (Kuperman & Gibson 2003).
Medication reconciliation
A detailed list of all medication should be comprises of prescriptions, vaccines,
diagnostic agents, vitamin supplement and so forth. Since interaction can between prescribed
drugs, it is important all drugs as well as supplements should be included in the health history
and be part of reconciliation. The capabilities of medication reconciliation are direct helping
physicians to provide efficient services (Spooner, 2007). For instance for newly in-patients the
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steps will involve assessing patients health history, recording the patient health history write
orders for regimen purposes and develop a prescription management record. During discharge
the procedure will be assessing post-discharge prescriptions regimen, creating discharge
prescription, training the patient and sending the prescription to follow-up practitioner. In
ambulatory case, the main procedure is basically creating a complete prescription of current
drugs, and then the list is updated in scenarios where the prescription is changed or added
(Jamoom, et al. 2012).
Computerized prescribing
Computerized prescribing is a type of CPOE that comprises of electronic orders of results
and other forms of health interventions. Computerized prescribing has the ability to increase
patient safety, cost-effectiveness and efficiency in care. In addition, electronic prescribing has
improved set of interventions as well as knowledge that support database aspects, it operational
characteristics enhances usability and improves performance. Also it has centralized platforms
that decrease modification by suppliers and health providers, increases exchange of intervention
and dissemination of health knowledge (Kuperman & Gibson 2003).
Clinical decision support
Clinical decision support (CDS) is a stand lone network incorporated with computerized
physician order system that helps in effective decision making. This kind of incorporation
permits proactive, information based platform that considerably increase efficiency (Spooner,
2007).
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In addition, clinical decision notifies the physicians, inform him of the patient’s situation and
provide remedial options like reducing medication and so forth. CDS capabilities are based on
the classification that presents health information on different features including:
Trigger functionality that makes CDS to invoke. Some of these triggers include
prescribing medication, ordering lab tests, or inputting a new issue on the list
Input information feature that is used to develop references such lab results, demography
of patients, or patient issues.
Intervention functionalities that show a course of action CDS takes like alerting the
clinician, providing guidelines, and reporting that an incidence occurred.
Offered choices that helps in decision making regarding prescriptions or go for a safer
medication.
- Explain one benefit of one of the given decision support systems.
Computerized physician order entry is beneficial in medical institutions since it has
shown to be a vital tool in lowering health errors, increase service quality and increases
efficiency (Levingston, 2012). - Explain one challenge of implementing the selected decision support system.
One of the challenges affecting the adoption of CPOE is the complexity and costs
involved. Nevertheless, cost issues and safety of patients provides an evident challenge to
implement CPOE: technological development, together with high industry experience and
complex CPOE applications (Kuperman & Gibson 2003). Generally, this system is not
unconnected rather a module of health information network. Medical centers in position to
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implement this system are those with health networks from suppliers that offer computerized
physician order entry capabilities. As such any institution replacing its health system should
cautiously assess CPOE characteristics. Due to the complexity and cost involved in the
implementation of CPOE, few institutions are likely to adopt it (Spooner, 2007).
a. Explain how this challenge could be resolved.
Medical institutions should learn from the pioneers of CPOE to increase understanding of
how to ensure successive adoption. Therefore, these institutions should; develop a schedule to
train its staff and universal understanding of the system. They should also integrate CPOE it
overall safety of patients and also a detailed decision support of CPOE application (Levingston,
2012).
B. Present how a needs assessment could be performed for the practice in the scenario
below.
- Identify one clinical area needing assessment.
Neuropsychological assessment will be carried out. For accurate results, neuroimaging
will be employed to asses the cognitive, behavior and also the degree of brain harm and
neurological infirmity that a patient suffers from. As such neuropsychological experiments will
be conducted to evaluate the mental status in determining dementia and Alzheimer’s. Elements
that are crucial in assessing the mental aspects include; acumen, speech, learning remembrance
and so forth (Jamoom, et al. 2012). This assessment will also touch on things to do with
emotional, personal, interpersonal and broader contextual circumstances.
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- Outline the functional needs that staff members may have in the clinical area you have
selected.
Assessment will be executed for many reasons that include; medical review, to comprehend the
trend of mental strengths and any intricacies an individual might have, and to help decision
making in a medical or therapy environment. Scientific exploration for reviewing a proposition
regarding the structure and function of mental assessment, or to avail information that permeates
experimental testing to be viewed in context of a broader mental profile (Levingston, 2012).
- Outline one concern staff may have from the selected area.
Neuropsychological assessments are normally executed by PHD psychologists trained in
cognitive screening. These postdoctoral pundits must be licensed and practicing psychologists in
their various disciplines. Modern developments in this discipline warrant only those with high
qualifications like psychometrics which may be a limiting factor (Kuperman & Gibson 2003).
- Compare how the use of an electronic health record can affect privacy, security, and
legal aspects in ways that differ from the use of the paper medical record
Privacy and security aspects
Privacy and security aspects apply to ERH as well as paper medical records. In paper
medical records risks emerge from gaining access to information left on counters or copy
machines. The access can either be unintentional or intentional. With ERH, inappropriate
entrance can be in form of unauthorized person access health information or authorized person
breaks terms of use. ERH can as well encounter the issue of system security that permits hackers
to gain entrance to patients’ information (Kuperman & Gibson 2003).
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The problem of record tempering; with regards to paper records anyone with access to the
records can remove some pages, add data or delete while with ERH changing details basically
relies on the users rights.
Record loss due to natural calamities; risks such as fire or floods can lead to loss of paper
and EHR. There is also the issue of incorrect filing or lost records; paper records can easily be
misfiled while ERH can rarely get lost since they are not removed from the system.
Information degradation; paper records deteriorates slowly and it need be they can be
copied to develop new ones. On the other hand, EHR degrade catastrophically, hence making it
difficult to retrieve affected information.
System becoming obsolete; paper medical records are not affected by changes in
technology. Even in cases where recorded are kept on film, the technology cycle is adequate to
prevent issues of obsolesce. ERH relies on the electronic technology which has shorter cycle
(Spooner, 2007).
Legal aspect
In paper record the issues of incomplete or indecipherable data is not usual while EHR
can keep decipherable as well as instantly easily reached information covering all phases of care
not considering of time and place. In addition, electronic health records increase physicians’
legal accountability. Synchronized electronic auditing processes, compared to paper records log-
ins can easily identify people who assess or never review EHR data. Documentation-based issues
lead to liabilities in both electronic and paper-based records. Many records contain
documentation templates that permit automatic importation of lab results. The physicians will
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incur liabilities in scenario where they import results not in their medical purview. Likewise,
written records which are copied and pasted may have extraordinary volume of data and appear
remarkably analogous, showing data that is incorrect (Jamoom, et al. 2012).
C. Develop a project proposal for adopting an electronic record for the practice in the
scenario below by doing the following:
- Present the elements that might be included in a project plan for adopting an electronic health
record.
Some of the key elements that will be included in this project include;
Assessment that will in turn include several tasks including selection team; development
group; completing a needs assessment; developing a preliminary budget; recording workflows;
health records; filing system for health records; sharing project charter with the entire institution,
assessing patient check-in; assessing nursing stations and assessing office space.
Planning will include; developing a general project timeframe; developing
communication plan; preliminary selection of suppliers, training supplier selection group on
electronic health record; outlining main deliverables and milestones; researching potential
suppliers; assessing hardware and office configuration; creating and exchanging supplier
assessment tool; contacting suppliers to set-up demonstrations; creating preliminary
implementation and chart abstraction strategies.
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Selection stage will include elements such as assessing practice workflows; demo
products with supplier selection group; carrying out reference checks (visiting the site of making
telephone calls); meeting with the supplier selection group to choose the best supplier; selecting
hardware supply; re-evaluating hardware based on the chosen supplier; negotiating the
agreement with the software and hardware supplier; developing project management process and
signing the agreement (Jamoom, et al. 2012)
Implementation of the electronic health record will comprise of updating project plan based on
supplier deliverables and date; creating pre-education plan with supplier options; updating
implementation and chart abstraction strategies; creating a go-live schedule; creating new office
workflows; updating key practices; hardware and software installation; installation of peripherals
and network; transferring information from old to new system; testing and implementing the
application; and training (Levingston, 2012).
- Explain how to form a project team.
Forming a project team is a vital implementation procedure whose key goal is developing
the team in concert with promoting their performance.
Basically, forming a project team should been early immediately since it is a fact that team
members perform effectively than a group of people. In the formation process, there is the need
to;
Creating tasks for project team; these are developed based on the project requirements are used
as a basis of inputs since the assignments includes a list of all members for the project.
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Developing resource calendars’; they show unspecified features that in the event a team member
is ready to perform their roles related to the project, essentially in this case is when they are
available to participate in team building exercises.
Create management plan; this plan presents important information in developing a team as it
describes how to train every individual team member and how to conduct project team
development. The management plan comprises of dynamics as well as environment in which the
team will conduct its activities for instance, the location of the project, information of members’
compensation and working condition while involved in the project.
a. Explain how each team member would bring value to the process.
Sam will be a key play in the adoption of EHR by convincing other staff concerning the
efficiency and the patient safety aspect.
Dr Travis; will help in the adoption of the EHR system
Board of directors: will support the adoption of EHR after viewing cost benefit analysis
New nurse will train ancillary staff about EHR efficiency compared to paper-based records.
Coders and transcriptionists: support the adoption of the system because it would improve their
work flow
Nurse practitioner is also supportive of the technology and will assist in convincing other staff
about the benefits of EHR.
- Identify one benefit the practice might gain from adopting the electronic health record.
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Implementing electronic health record will be important because increase quality and
safety of patients. Additionally, the system will improve coordination of care and generally cost-
effective (Spooner, 2007).
- Provide one example of an electronic health record functional application that may be
implemented in each of the following healthcare settings:
• Hospital- CPOE applications
• Nursing home- health information technology (HIT)
• Dental office-electronic dental record (EDR)
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Reference
Jamoom E, Beatty P, Bercovitz A, et al. (2012) Physician adoption of electronic health
record systems: United States, 2011. NCHS data brief, no 98. Hyattsville, MD: National
Center for Health Statistics.