Health Information Technology in Hospitals

The Research Method Chosen

The research method that I have chosen is that of case studies under, the qualitative research method approach.  It is mostly used in sociology and anthropology, yet, has expanded to subjects such as medicine, social work, political sciences, sociology, education, psychology, and health sciences.  The case study is defined as a detailed and comprehensive exploration of an entity (the case) such that any person or persons, a social group, an event, a family, an organization or an institution. The case study is part of the daily context of the participants to build on their perspective. All phenomena include a number of aspects. The researcher chooses one or more aspects of the case concerned or on which he or which focuses for the collection and analysis of data. The data can be collected over a long period, during which a number of data collection methods are used. The study is event has the potential to reveal important results, which may lead to the design assumptions. The early steps of case studies are choosing and defining the problem, then furthering the elaboration of a description and a detailed analysis, the type of problem that is best is the one who can provide a thorough understanding of a case or cases come. Once any researcher has clarified a phenomenon of interest, it chooses a case and studies in depth the appropriate case, such a learning difficulty a high, rare or unique clinical condition. In the study of intrinsic cases, it essentially aims to allow a better understanding of the cases studied. take care researcher to identify important facts by abandoning the other aspects. Multiple data sources that are used (observations, interviews, audiovisual material, documents, reports, relatives, stakeholders) so a plate depth in describing the phenomenon under study. Like other methods of qualitative research, the researcher spends much time the ground to revise operations. From the collection of data, a detailed description emerges, in which the researcher describes aspects such as the history of the case, the chronology of events or the reporting of data, it can be holistic, covering cases whole, or be rooted in the precise case an aspect.

 

The Research Problem and Subject

The research subject matter is the question on the rise of technology within a hospital setting in the use of electronic documents and information systems such as e-patient health records. This will correlate to intrinsic case study research by looking at how the daily activity of the integrated electronic health record (EHR) and how it is affecting health care in the sense of the function as well as how it may affects patient care and the duties of the health professionals. whether it is a good thing or not.  This research will begin to look at how different health professionals feel as well as the amount of times they will use such e-health records such as nurses, physicians and health administrators. It will then the research will look at benefit and challenges that such technology brings for the patients and a global comparative analysis on how it affects different nations.

Three main Case Studies

A) Health ProfessionalsFor the health professional aspect, Dawn Dowding, Marianne Turley, and Terhilda Garrido’s “Nurses’ Use of an Integrated Electronic Health Record: Results of a Case Site Analysis” article studies how nurses use an integrated Electronic Health Record (EHR). Dowding and her peers that study such people, they use research observation and semi-structured interviews two hospitals – one that is new within rural area versus and a hospital within a city – and the interviews were conducted with 28 samples that are within the northern California region and they use the Kaiser Permanente. The in-depth analysis of how nurses feel in using the EHR practise to see if it bring better health care to their patients. Overall to study their perceptions of the KP Health Connect (EHR) and how it affected their practice.   3 Key Themes: Point of Care – Juggling competing demands (Prioritising information to be document; retrospective time – sampling; cut and paste); Limitations of System – Use of Paper (To link information between flow sheets; to provide cognitive and medication process) and functionality of system – accessibility of information (preventions of error and improved safety such as medication administration and legibility of records; monitor care quality such as audits of pain assessment; and communication processes with others such as physicians and patients). Additionally, the nurses saw improved communication, ease of access to information and the safety of medication administration processes; to support care documentation and initiatives to improve the quality of care provided by nurses.  Issues: Little is known of how technology and electronic records affect nurses daily function. Even though there is evidence that shows can bring benefits in the safety of outcomes and preventive care, but, the problem with how much technology being integrated into the work and which hospital/institutions/clinics would implement the technology or not. One issue is that the EHR and HIT will bring more of a burden for nurses which brings negative affects to safer care and threats to patient safety as well as overall efficiency and effectiveness. There is also concern what the individual use of the technology. Out of reviewing 11 studies, There is the problem of increasing amount of time documenting per patient across a range from 7% to 128.4%. There is some concern with the type of electronic system being used, the KP Health Connect that have spreadsheets that were not always easy to communicate patient health or the patient assesments are too long or extremely limited in what nurses are to look at when assessing patients. Time is important and if the assessment are very limited because the nurse may have to do it after their shift has ended or when they have their breaks or write on a piece of paper which is a regression to using the technology provided and how this affects the care that they must give to their patients or printed the summary handover sheets to write their notes. The papers would have notes on the patents behaviour to the medication that is needed to which patient. Furthermore, some of the sample participants 2 – 13 nurses have copied and pasted older assessment posts and just edited the needed sections of the patients actions or statements which can have a negative effect on the patients health. Due not being able to read properly the system and having too many patients, many times nurses may bring the wrong tests or medications to which patient. Also, placing the notes to the wrong patient health record.   Benefits: Using routine practice to work efficiently. A second benefit, is that once accustomed in using the system, it is easier and more immediate, Easier to get information from the past and easier to read physician scrawl that many times in the past can be difficult to read and a constant interaction with the doctors to understand which medicine or specific assessment/event. The e-cart that states which medication to which patient can state how much for which individual patient.  B) Patient – CareFor the patient care aspect, Christopher Harle’s “Overcoming barriers to implementing patient-reported outcomes in an electronic health record: a case report” article studies 6 health facilities in Florida and the use of EHR’s that have been implemented that affect patients by looking into the use of patient-reported outcomes as part of the EHR system to allow for health officials to assess their patients in a better manner. The purpose of this us to maximize the clinical decisions and care quality. Most of these facilities have a central IT system and uses a questionnaire Collaborative Health Outcomes Information Registry (CHOIR) – a web server that is an open source and looks at pain interference and behaviour, fatigue, physical function, sleep disruption, sleep -related impairment, anger, depression and anxiety.    Challenges: There is the concern of the case itself in the sense that it did not give any interview or observational response if this has worked for health officials; it was basic when giving information. Two stated major barriers:a) uncertain clinical benefit: uncertain if the users of the systems are doing their job well in giving the questionnaire and if the patients are being truthful in their answers, especially since many of the questions asked – according to some health officials asking the patients – look into psychological issues such as that many health officials who do assessments on a new patient arrives do not always want to do a new patient report.

b) time, work flow, and effort constraints: cuts across all of the stakeholders feedback on the concerns about implementing the system. In other words, there may be less work in areas such as patient wait times or reduce health professionals and patient time and effort.     Benefits: The patient reported outcomes documents within EHR can be a useful clinical tool in the sense that it reduces burden from patients by 71%.

C) Global PerspectiveOne global example is with Ben-Assuli, Shabtai, and Leshno’s article “Using Electronic Health Record Systems to Optimize Admission Decisions: The Creatinine Case Study” that looks at how medical organizations are implementing (EHR) and (HIE) networks to improve medical decision-making through the investigation of how such technology is trying to reduce redundant admissions, especially in emergencies by studying how 7 Israeli hospitals are contributing to EHR to reduce any avoidable admissions, such as track log-file analysis. Within Israel, its citizens are legally required to be a member of one of four health maintenance organizations (HMO) – looks at the largest one with 3.8 million – and it is sort of like an insurance company. The sample participant size is narrowed to patients who are within a Creatinine program – the breakdown of creatine phosphate in muscles and is usually produced at a fairly constant rate by the body and can usually be seen within going through the kidneys and goes through the blood. The study focuses on two groups within the Creatinine programs patients: those whose information is looked at and those whose information isn’t.  Challenges: one of the major challenges that this study tries to tackle is the lack of information and use of the technology implemented can lead to lesser quality of care and unnecessary costs. The increase of information given from EHR is viewed as making decisions more complex. Also, the information given to health professionals can be exploited because they will only retrieved limited amount of relevant information to make such decisions even without time constraints. There is rising concern that IT will be poorly adapted within the social setting of the healthcare environment and will lead to health officials making it flexible to their needs when working. 62.9% or all referrals didn’t involve the EHR (37.1% of hospitals did referrals the EHR). Saw increase admissions rate by 6.11%, but, there was a decrease in 7-day readmission by 3.51%. Huge concern is with privacy of patient information and that different hospitals will jvae different policies and practives regarding the use of EHR.  Benefits: teaching health officials how to use the technology given, and properly, can lead to a reduce in unnecessary costs and increase quality of care. IT is seen as helping in the achievement of safer, more effective, patient – centred, timely, efficient and equitable health care. HIT can decrease costs of healthcare while maintaining or improving quality. Electronic records allow to view the medical history and are deemed as allowing for better decision making and outcomes.               

References

Ben-Assuli, O., Shabtai, I., & M. Leshno (2015). Using Electronic Health Record Systems to Optimize Admission Decisions: The Creatinine Case Study. Health Informatics Journal,           Vol. 21(1) 73 –88. DOI: 10.1177/1460458213503646

Bouma, G.D., Ling, R. and L. Wilkinson (2012). The Research Process. Don Mills, ON: Oxford University Press.

Dowding, D.W., Turley, M., & Garrido, T. (2014). Nurses’ Use of an Integrated Electronic        Health Record: Results of a Case Site Analysis. Informatics for Health and Social Care,         Vol. 40(4) 345-361. DOI: 10.3109/17538157.2014.948169

Fortin, M.F. (2010). Fondaments et Étapes du Processus du Recherche: Méthodes Quantative et Qualitative. 2 éd. Montréal: Chernelière Éducation.

Harle, C.A., Listhaus, A., Covarrubias, C.M., de Schmidt, S., Mackey, S., Carek, P.J., Fillingim, R.B., & R.W. Hurley (2016). Overcoming Barriers to Implementing Patient-Reported         Outcomes in an Electronic Health Record: a Case Report. Journal of the American Medical Informatics Association, Vol. 23, 74–79. DOI:10.1093/jamia/ocv085

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