In an effort to improve clinician workflow and enhance patient safety, a healthcare facility has purchased and will soon be introducing a computerized provider order entry (CPOE) system for use within the electronic health record. A pre-deployment evaluation plan will permit the informatics team to appraise the usability of the CPOE and provide administrators with valuable data regarding its successful implementation. This paper describes the formation of this evaluation plan including the goals, methodology, and tools to be used. The final sections cover the ethical implications and dissemination of findings, along with the limitations and opportunities that the study provides.
Goals of Evaluation Plan and the PICO Question
The practice of evaluation is done to uncover empirical data that will guide decision-making and enhance the knowledge base on the topic of interest. The first, and arguably most important step in conducting an evaluation is determining the perspective from which data will be gathered. Several approaches exist and there is never a right or wrong method; however, predefining the evaluation objectives is crucial to discovering relevant conclusions (Friedman & Wyatt, 2006). Since this evaluation is occurring prior to implementation and is aimed at improving workflow, the desired goal is obtaining clinicians’ perceptions of usability of the most critical components of the CPOE.
Determining which components are most critical is accomplished by conducting a current literature search. Formulation of a “PICO [question] can make it easier to identify search concepts and appraise the results retrieved from database searches” (Polly Beam, n.d., para. 1). The PICO frameworks defines the population, intervention...
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...for Nursing Practice 9th Ed, Softcover, (9th ed.). Philadelphia: Lippincott Williams and Williams.
Polly Beam, J. S. (n.d.). Levy Library. Evidence Based Medicine Tutorial. 1.3 What’s Best: The Evidence Hierarchy. Retrieved April 9, 2014, from http://libguides.mssm.edu/hierarchy
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Van Doormaal, J. E., Mol, P. G., Zaal, R. J., Van Den Bemt, P. M., Kosterink, J. G., Vermeulen, K. M., & Haaijer-Ruskamp, F. M. (2010). Computerized physician order entry (CPOE) system: expectations and experiences of users. Journal of Evaluation in Clinical Practice, 16(4), 738–743. doi:10.1111/j.1365-2753.2009.01187.x
Computerized Physician Order Entry (CPOE), is also known as Computerized Provider Order Management (CPOM). CPOE is a process of automated or electronic entry record of health care physician on different types of instructions on how to treat patients, especially patients that are hospitalized under a physician’s care. CPOE is one of the most remarkable system that is being used in the healthcare system to effectively reduce the amount of medication errors. The University of Health Care System might be in the process of rolling out the CPOE portion out of the EMR project, however, they did not do a thorough investigation on what CPOE is and whether or not it would have a positive impact on the EMR project. They should have not taken the step to start the project without already knowing the basics of CPOE. They might have had thought that since it is a computerized system everything would turn out okay and there would not be any problems. However, they fall short to recognize that the user’s knowledge and experience with using the CPOE system would have a significant influence on the effectiveness and productivity of the actual system.
Recommend which system is the best choice to meet meaningful use requirements in this particular setting. Both Cerner and CPSI have helped hospitals meet CMS Stage 1 and Stage 2 requirements. However, Cerner provides a modular concept that larger hospitals are using more than complete inpatient systems to achieve MU (Zieger, 2013). In 2014, EHR vendors said eight hospitals had attested to MU Stage 2, and Cerner was used twice as much as CPSI (Gregg, 2014). Concerning Computerized Physician Order Entry (CPOE), CPSI System had the broadest reach in community hospitals; nevertheless, the software was missing functionality and usability (KLSA Enterprises, 2010, p. 6). Therefore, CPSI’s CPOE was significantly below the market-average due to low physician satisfaction (KLAS Enterprises, 2010, p. 6). KLAS Enterprises (2010, p. 2) reported Cerner clients were happier the more they adopted CPOE.
Springfield General Hospital (SGH) is committed to high quality healthcare for patients, and providing tools to support physicians, nurses and pharmacists. SGH leadership approved the computerized physician order entry (CPOE) system as a solution to reduce prescription errors, and the results of the CPOE project are disappointing. The data show increased prescribing errors after implementing the CPOE; resulting in increased costs for adverse drug events, rather than the planned cost reduction (Spector, 2013). This change management plan provides the SGH board of directors and executive management team pragmatic steps to increase quality for patients by assessing the root issue of hospital
Melnyk’s Hierarchy of Evidence is a system often use for assigning levels of evidence in nursing by integrates clinical expertise and patient choices with the best available research. It is represented by a pyramid that enumerates the levels of strength of the evidence from 1 to 7, of which level 1 is the higher level. The higher level on the pyramid, the more likelihood that the research is valid; therefore, answering a clinical or practice question. “The systematic review or meta-analysis of randomized controlled trials are at the top of the evidence pyramid and are typically assigned the highest level of evidence, due to the fact that the study design reduces the probability of bias” (Melnyk, 2011). The weakness of the system is that when
As the evolution of healthcare from paper documentation to electronic documentation and ordering, the security of patient information is becoming more difficult to maintain. Electronic healthcare records (EHR), telenursing, Computer Physician Order Entry (CPOE) are a major part of the future of medicine. Social media also plays a role in the security of patient formation. Compromising data in the information age is as easy as pressing a send button. New technology presents new challenges to maintaining patient privacy. The topic for this annotated bibliography is the Health Insurance Portability and Accountability Act (HIPAA). Nursing informatics role is imperative to assist in the creation and maintenance of the ease of the programs and maintain regulations compliant to HIPAA. As a nurse, most documentation and order entry is done electronically and is important to understand the core concepts of HIPAA regarding electronic healthcare records. Using keywords HIPAA and informatics, the author chose these resources from scholarly journals, peer reviewed articles, and print based articles and text books. These sources provide how and when to share patient information, guidelines and regulation d of HIPAA, and the implementation in relation to electronic future of nursing.
The federal government has taken a stance to standardized care by creating incentive programs that are mandated under the Health Information Technology for Economic and Clinical Health Act (HITECH) of 2009. This act encourages healthcare providers and healthcare institutions to adopt Meaningful use in order to receive incentives from Medicare and Medicaid. Meaningful use is the adoption of a certified health record system that acquires or obtains specified objectives about a patient. The objectives or measures are considered gold standard practices with the EHR system. Examples of the measures include data entry of vital signs, demographics, allergies, entering medical orders, providing patients with electronic copies of their records, and many more pertinent information regarding the patient (Friedman et al, 2013, p.1560).
Evidence hierarchy pyramid is used to determine which research method produces the strongest evidence at the highest level (Level I)
Niemei, K., Geary, S., Quinn, B., Larrabee, M., & Brown, K. (2009). Implementation and evaluation of electronic clinical decision support for compliance with pneumonia and heart failure quality indicators. American Journal of Health-System Pharmacy, 389-397.
West, S. L., & O'Neal, K. K. (2004). Project D.A.R.E. outcome effectiveness revisited. American Journal of Public Health. doi:10.2105/AJPH.94.6.1027
230) in EBP. Clinical opinion, together with the best relevant research evidence, provides the framework to for the best patient outcome. The nurse’s clinical opinion is acquired through knowledge and skills developed from undergraduate, graduate, or continuing education, clinical experience, and clinical practice (Melnyk & Fineout-Overholt, 2010). Clinical opinion also includes internal evidence, which is generated within a clinical setting from quality improvement outcomes, management initiatives or EBP implementation projects (Melnyk & Fineout-Overholt, 2010). Nurses use their clinical opinion when they identify each patient’s condition, individual risks, personal values and expectations, benefits of possible interventions, and gather evidence for EBP. When searching for the best available evidence, there is a hierarchy in the strength of evidence. The highest level of evidence usually comes from a systematic review or an evidence-based clinical practice guideline based on a systematic review. Systematic reviews provide the strongest evidence through a summary combining the results from many relevant, unbiased studies, to answer a particular clinical question. Nurses critically assess the individual studies, to gather the best evidence available for patient care. Systematic
This paper will identify the use of Electronic Health Records and how nursing plays an important role. Emerging in the early 2000’s, utilizing Electronic Health Records have quickly become a part of normal practice. An EHR could help prevent dangerous medical mistakes, decrease in medical costs, and an overall improvement in medical care. Patients are often taking multiple medications, forget to mention important procedures/diagnoses to providers, and at times fail to follow up with providers. Maintaining an EHR could help tack data, identify patients who are due for preventative screenings and visits, monitor VS, & improve overall quality of care in a practice. Nurse informaticists play an important role in the adaptation, utilization, and functionality of an EHR. The impact the EHR could have on a general population is invaluable; therefore, it needs special attention from a trained professional.
The first professional organizational standard chosen is the ANA Position Statement on electronic health record. Statement of ANA Position: The ANA believes that the public has a right to expect that health data and healthcare information will be centered on patient safety and improved outcomes throughout all segments of the healthcare system and the data and information will be accurately and efficiently collected, recorded, protected, stored, utilized, analyzed, and reported. Principles of privacy, confidentiality, and security cannot be compromised as the industry creates and implements interoperable and integrated healthcare information technology systems and solutions to convert from paper-based media for documentation and healthcare
Walshe,K. & Rundall,T. 2001, Evidence based management:From theory to practice in health care ,Milbank Quarterly, Vol.79, PP.429-457
Adams A, Adams R, Thorogood M, Buckingham C. Barriers to the use of e-health technology in nurse practitioner-patient consultations.Informatics In Primary Care [serial online]. June 2007;15(2):103-109. Available from: Academic Search Premier, Ipswich, MA. Accessed November 29, 2013.
William Goossen’s theory can be applied in nursing practice to develop nursing informatics skills and knowledge, as well as develop technological system competencies among nurses to collect, process, retrieve and communicate pertinent information across health care organizations (Goossen, 2000). This theory is highly applicable in addressing matters related to electronic health records, which are currently characterized with issues of privacy and confidentiality in relation to storage, retrieval and reproduction of patient health information. The model also provides broad applicability in guiding research at any clinical setting and contributes to the discipline of nursing by simplifying and enhancing documentation and storage of patient’s health information and by allowing better utilization of nursing resources (Elkind, 2009).