Introduction
Due to a variety and number of errors caused by the human factor, medical personnel needs not only wised-developed policies but also reliable support related to advanced technology. Health Information System (HIS) is a tool specifically designed to provide staff, clinicians, or patients with person-specific information, clinical guidelines and summaries, and intelligently filtered diagnostic support to facilitate decision-making in the clinical workflow. Thus, this paper aims at discussing the role of HIS, its impact on the delivery of patient care and documentation, and its benefit for medical organizations. In addition, the paper will describe four essential stakeholder roles that are required to form an interdisciplinary team and introduce a plan for assessing the success of the implementation of a system.
Examination of Health Information System (HIS)
Advantages and Disadvantages of HIS
In the healthcare setting, every medical-related user recognizes a practical necessity to have adequate, up-to-date support systems that follow the latest software requirements, namely, usability, interoperability, compatibility, and scalability. When HIS does not meet the first requirement of usability, users may face a considerable disadvantage in understanding software design, which can cause significant setbacks in the workflow and errors occurring while processing information in the software system. In contrast, an advantage of HIS is the support system that has a satisfactory usability level; in this case, medical users can comprehend and, thus, efficiently utilize information obtained from HIS. For example, after the ‘think aloud’ method was employed to enhance the system’s usability, contemporary Clinical decision support system (CDSS) models have been developed as a user-friendly system with an understandable display and design (Sutton et al., 2020). Regarding interoperability, it should be indicated that when HIS is designed as a stand-alone system, it cannot entirely or partly display information gained from other software systems, which can be a disadvantage leading to disruption workflow. An advantage, when the system is interoperable, it can adequately exchange data, process the data, and represent it reasonably.
When the third requirement of compatibility is not fulfilled, and HIS works as an independent system, HIS will be at a disadvantage because it cannot run smoothly and seamlessly in case of being attached to other software systems. In this regard, CDSSs, for example, should be created on the basis of software well integrated into work with computerized provider order entry (CPOE), electronic health records (EHR), and other software, which results in an advantage in the decrease in the number of compatibility-allied errors. Finally, scalability, which can be described as the capability of the HIS to process an ever-increasing amount of incoming information regarding patients, recommendations, and research findings and observations as the facility expands. An advantage of scalability is that HISs can be specifically designed to process an ever-increasing amount of incoming information regarding patients, recommendations, and research findings and observations. HIS with poor scalability is at a disadvantage due to the cost of expanding within the institution or facility. Thus, when a critical usability evaluation and users’ computer literacy are provided, modern HISs can meet the latest requirements concerning usability, interoperability, compatibility, and scalability.
Impact on Patient Care and Documentation
In general, a clinical decision support system displays significant betterments in patient treatment since it improves clinicians’ adherence to clinical guidelines by delivering timely recommendations and instructions from electronic protocols, manuals, and guides. The reminders also urge clinicians to reach out to patients who do not follow the specific instructions of a treatment plan, which thereby enhances the interaction between doctors and their patients (Sutton et al., 2020). In addition, CDSS delivers better diagnostics as they are developed with a computerized consultation system that organizes and filters possible or probable diagnoses for a particular patient, ensuring time- and cost-saving (Sutton et al., 2020). Finally, HIS arranges and provides appropriate quality of clinical documentation by promoting documentation accuracy concerning the patient’s history.
Effect of Using a System to Access Information on the Quality and Delivery of Nursing Care and Patient Outcomes.
Primarily, direct access to patient information aids doctors in making the right conclusion based on existing patient data and choosing appropriate treatment. Furthermore, CDSS provides important and urgent alerts and reminders for both medical practitioners and patients regarding the order and time of medications and their portions, especially in critical situations (Sutton et al., 2020). Lastly, patients can monitor, track, and control any changes occurring in their medical history and, in the case of errors or questions, can inform their doctors and clarify this situation.
Benefits for the Organization
Two Ways of Quality Improvement (QI)
In the context of healthcare, quality improvement is the change in the system of continuous actions, which results in practical and useful advances in patients’ wellbeing and the organization’s healthcare service. To measure QI, many organizations use quality indicators, the primary of which, according to “Quality Improvement” (n.d.), are prevention quality indicators, inpatient quality indicators, patient safety indicators, and pediatric quality indicators. In this regard, to develop a comprehensive picture concerning potential problem areas and provide excellent service, the hospital monitors the incidence of falls, catheter-associated urinary tract infection (CAUTI), and central line-associated bloodstream infection (CLABSI). Moreover, to deliver high-quality information, HIS collects data related to the previous cases of patients’ hospitalization in the form of reports from reliable healthcare databases, the access to which can only be provided through HIS.
Specifically, regarding patient safety, HIS provides clinicians and staff with complete, available, and accurate information from the patient’s history. For example, when nurses are continuously aware of a patient’s set of allergies, they know which medications and food should be avoided for the patient and which medical adhesive plaster and gloves should be used. Besides, HIS equips nurses with guidelines and reminders, which promotes the right execution of clinical procedures and prompts about the appropriate preparation actions. Second, HIS is directed at improving pediatrics service by delivering information about what vaccines have already been given and what vaccines are planned to be provided. The system also protects pediatric patients from procedures and medicines that can cause allergic reactions.
HITECH and HIPAA Security Standards and Regulations and Protection of Patient Privacy
To provide confidentiality, integrity, and availability of all electronic health information, the management of an organization should introduce a policy that protects a patient’s data against any anticipated threats or hazards and its illegal dissemination. This policy must establish clear rules of access to the information and identify individuals who are permitted to access it. Besides, in case of violation of the regulations, strict penalties must be imposed (“HIPAA and HITECH data security requirements,” n.d.). Finally, an organization should provide backup data storage on reserve databases, as well as provide software that allows for recovering lost or encrypted information, for preventing irretrievable information loss.
Regarding patient privacy, it should be indicated that the entrance to private data must be provided only via using personal passwords that only relevant individuals know, including patients, clinicians, operators, and trustees. It should be indicated that when one of the password owners divulges confidential information, they should incur administrative or even criminal responsibility, depending on specifically publicized information. Furthermore, webpages must be tied to patients’ devices, and any login must be notified to the patient through the mobile app and permitted only through affirmative confirmations given by patients on their mobile phones. Another example of patient privacy is an automatic log-off after a short period of inactivity by the user. Last, to provide privacy to patients’ health information, computers and databases can be located in specially designated offices or departments that can be accessed only by authorized persons.
Impact on the Productivity of an Organization
First of all, since HIS aggregates data from various sources and allows for avoiding and correcting errors in patient’s data, it promotes documentation accuracy. Second, the system selects necessary tests for diagnosis, which reduces the waste of time and improves efficiency and productivity in the healthcare service and the treatment overall. Third, HIS facilitates clinical workflow by providing better retrieval, collection, and presentation of information. Last, it can have a valuable contribution to the staff’s computer literacy and knowledge and expertise via continuously providing access to clinical guidelines.
Nevertheless, HIS can cut the facility’s workforce since it reduces and, sometimes, cancel the need to use registry and management staff because the conventional paper form is replaced by electronic form. Besides, the setup of hardware and software for HIS can be expensive and time-consuming because it belongs to advanced technologies. Finally, the amount of capital required for the implementation of HIS may be increased due to operator resistance to change. However, a profound cost analysis conducted by the management can guarantee cost-savings and long-term cost-effectiveness in the prospect. Additionally, since the workforce is reduced, the expenditures provided for staff training are also decreased.
Four Essential Stakeholder Roles
The first group of critical stakeholders includes nurses, physicians, pediatricians, and clinical pharmacists since the success of HIS implementation significantly depends on input information obtained from clinicians during the planning process. In this regard, healthcare providers should provide the right information referring to patients’ histories, guidelines, protocols, and clinical requirements. To ensure this, they should possess a broad array of skills and knowledge about HIS, including computer literacy and professional medical education, to provide quality healthcare service. Another stakeholder is office staff and managers, including financial specialists, secretaries, project managers, and attorneys, because they are accountable for collecting billing, contact, monetary and demographic information of all the patients and providing it to vendors. Moreover, they deliver information about potential threats and improvements that relate to the system. Office staff can obtain, gather, and categorize information received from other disciplines, namely, clinicians and nurses. In this regard, office managers should possess skills, primarily in accounting, financial planning, logistics, and record keeping.
The third stakeholder is the administration or board members, consisting of a chief financial officer, CEO, president, chief engineer, since they may perform a role in both promoting and hindering the implementation of HIS and in developing a valid strategy of the application. Besides, they make financial and operational decisions concerning the HIS project. Thus, to ensure the successful setup of the system, the broad managers should hold a comprehensive vision about the needs of an organization and potential challenges and be experts in planning and organizing. The last stakeholder is a vendor, such as a vendor on-premises, programmers and related assistants, and quality assurance (QA) test engineer who install the system because they provide a smooth and seamless work and integration of the system with the rest software. They should be highly aware of software and hardware planned to be installed and specialize in IT technologies.
Two Professional Organization Standards for Evaluation of the Success of the Implementation of a System
The first standard that will be implemented in the evaluation plan is resource utilization, the primary role of which is described by the American Nurses Association. The standard explains that informatics nurses should be competent for monitoring the healthcare demands of specific consumers, determining opportunities, potential risk, best practices, and evidence for safety and care outcomes while considering resource allocation (American Nurses Association, 2015). The second standard, supported by the American Nurses Association, is ethics. The standard indicates that nurses should follow the Code of Ethics for Nurses with Interpretive Statements to direct workflow. Besides, according to the Association, nurses should apply nursing and informatics principles in a way that is useful and safe for consumers and communities and assume relevant actions regarding cases of unethical, illegal, or inappropriate behavior.
To evaluate the effectiveness of the HIS implementation plan, it is recommended to compare the results of hospital activity before and after the application of HIS. To meet the first standard, the committee can consist of a project manager, QA test engineer, nurse, and billing representatives. For example, a project manager in charge of scheduling and organizing, QA test engineer is accountable for the performance and system testing, and nurse and billing advocates are responsible for consultation on data, training, and testing.
In the second case, the committee can involve a programmer, an attorney or lawyer, a physician, and a project manager. The lawyer would offer consultation regarding legal issues, rules, and norms that protect patients’ privacy; the programmer would focus on developing or installing software that follows technical and lawful requirements. The physician would consult regarding the methodologies and guidelines to maintain healthcare consumer confidentiality and report about illegal and impaired practices. Finally, to assess the HIS implementation plan, two standards should be evaluated and reviewed after three or four weeks of HIS installation, and, in case of need, relevant amendments should be introduced. Finally, it is worth noting that the discussions about the plan of implementation and evaluation of HIS should be held in specifically designated office rooms or cabinets and at the appointed time.
References
- American Nurses Association. (2015). Nursing informatics: Scope and standards of practice. American Nurses Association.
- HIPAA and HITECH Data Security Requirements. (n.d.). Henry Schein MicroMD. Web.
- Sutton, R. T., Pincock, D., Baumgart, D. C., Sadowski, D. C., Fedorak, R. N., & Kroeker, K. I. (2020). An overview of clinical decision support systems: Benefits, risks, and strategies for success. NPJ Digital Medicine, 3(1), 1-10.
- Quality Improvement and monitoring at your fingertips (n.d.). AHRQ.