THE USE OF CLINICAL SYSTEMS TO IMPROVE OUTCOMES AND EFFICIENCIES

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Literature Review: The Use of Clinical Systems to Improve Outcomes and Efficiencies

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Walden University

NURS 6051: Transforming Nursing and Healthcare through Technology

July 26, 2020

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Introduction

Electronic health records and patient outcomes are very convenient for nurses and billing

departments in hospitals with inpatients, but how do the providers feel about electronic health

records (EHR)? The following research will explore whether providers believe that the EHR is

just as efficient for the provider, does it improve patient outcomes and if they support the

advancement of healthcare technology.

Article 1

How doctors feel about electronic health records. (2018, March 27). Stanford medicine; The

Harris Poll. https://med.standford.edu/content/dam/sm/ehr/documents/EHR-Poll-

Presentation

Researchers from Stanford medicine, along with The Harris Poll, conducted a study

regarding providers and how they feel about the implementation of the EHR system. The 500

Primary Care Physicians (PCP) who dedicated themselves to the study noted value in the

implementation but wanted major improvements. Six out of ten agreed that it did improve patient

care by the end of the study.

Two thirds of the providers stated improved care and 60% were satisfied with the new

program while the other 40% believed that the challenges outweighed the benefits causing most

of their time to be spent documenting or navigating versus actual time spent with their patients.

Only 8% of the provider’s participating stated that the EHR was a valuable tool to be

implemented in their clinic.

The research study also noted that 7/10 agreed that having the EHR increased the number

of hours that they had to be at work and they could see the EHR contributing largely to provider

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burnout. Nearly all of the physicians reported that they considered the EHR to be more of a

storage tool instead of a clinical one, and that they felt having to use the EHR distracted them

from their patients. The participating PCP’s commented that for the next improvement phase

they would like to see greater interoperability, more improved predictive analytics and better

integrated financial choices so that patient cold understand better the care option costs.

At the conclusion of the study, 99% of the participants reported that even though they

requested increased improvements, that, over time, they maintained a higher quality of records in

the EHR. A lesson learned with this study is to make sure you utilize the physician chief of staff

as well as the emergency room physician chief of staff when building a new program. By getting

their input from the beginning would not only allow them to customize their section but would

avoid any need for great improvements and only require mild amendments during the

implementation phase.

Article 2

Entzeridou, E., Markopoulou, E., & Mollaki, V. (2018). Public and physician’s expectations and

ethical concerns about electronic health record: Benefits outweigh risks except for

information security. International Journal of Medical Informatics, 110, 98-107.

https://doi.org/10.1016/j.ijmedinf.2017.12.0

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An evaluation was conducted by researchers regarding the awareness of electronic health

records with providers and the public. The purpose was to see the number of expectations and

knowledge and ethical concerns about using it. The public survey was made available in print

and an online service, and the physicians were made aware of an online survey. The survey asked

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for demographic area followed by specific questions regarding EHR and patient and physician’s

awareness and perceived ethical issues, impacts, and risks.

The public awareness results were 46%, and the provider results were 91%. These

comparable opinions were based on faster and more effective patient health decisions and greater

coordination between health clinics and hospitals when it came to healthcare quality and cost

reduction. It was noted that providers thought it would be a financial concern due to the cost of

getting it implemented and training, while the public’s main interest was that someone else would

gain access to their information. Both parties surveyed felt that the benefits of the EHR

outweighed the risks. Researchers found that 90.9% of the public believed that nurses and

ancillary staff should have restricted access, and only the provider should have full access to

their records. The result was that both parties were in support of EHR’s if given sufficient

security. A lesson to learn is to make sure public awareness is addressed so they feel comfortable

and understand the benefits along with the added security involved in technology advancement.

Article 3

Ham, P., Anderton, T., Gallaher, R., Hyrman, M., Simmerman, E., Ramanathan, A., Fallaw, D.,

Holsten, S., & Howell, C. (2016). Development of electronic medical record-based

“rounds report” results in improved resident efficiency, more time for direct patient care

and education, and less resident duty hour violations. The American Surgeon, 82, 853-

859.

Georgia providers reported increased frustration and a lack of productivity when using

the EHR. In a study put together at Agusta University, a team devised rounds reports (RR) that

would summarize a series of vital signs, patient intake as well as output, laboratory values, and

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other tests for individuals were results were input by hand. The subjects for this study were

surgical residents of Agusta hospital whose patient outcomes were considered during direct care

time, time spent on rounds, educational period, and times on incorrect or incomplete data from

rounds documentation. It also tracked duty hour rate violations over one month and 23 surgical

residents.

After the study, it was determined that rounds report time decreased for both floor

patients and acute care patients while their workdays patient care productivity went from 45% to

54%. The most impressive was that duty hour resident violations decreased a shocking 58%, and

the American Board of Surgery in Training test scores increased as the department showed a

budgetary saving range of $67,000 to just over $273,000 that year. It’s always good to have a

physician as part of the team when implementing any new program, especially an electronic

health records program. With these types of results, any facility with inpatients should have

standardized EHRs as they help with efficiency and positive patient outcomes. A positive lesson

was learned using the EHR system with the astounding decrease in resident violations as well as

the incredible amount in budgetary savings.

Article 4

Reid, S., Naidu, C., Kantor, G., & Seebregts, CJ. (2020). Do electronic patient information

systems improve efficiency and quality of care? South African Medical Journal, 110(3),

210-216. https://doi.org/10.7196/SAMJ.2020.v110i3.14111

This journal article explored why physicians hesitate using EHR’s even though they have

many benefits and make a difference with efficiency. The survey had a qualitative part for

individual interviews, followed by a quantitative phase of random providers and specialists who

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were signed system users. After resulting in the qualitative part, it was reported that they

believed it to be easy to maneuver through the applications. Their motivation for use, benefits

and functions, efficiency impact, and quality of care, were also noted. They did report some

challenges and made a few improvement suggestions regarding training and support. When it

came to the quantitative survey, the results stated that there was patient care improvement while

using electronic systems, and it was easier to access patient records. They also concluded that it

had a more significant impact on maintaining the confidentiality of patients and enhancing

teamwork and efficiency.

A lesson learned following this study is that EHR systems do improve medical efficiency

by increasing medical access to health information storage without having data entry by

clinicians. By having this benefit, they have great potential to improve the quality of care

indirectly.

Article 5

Pyron, L., & Carter-Templeton, H. (2019). Improved patient flow and provider efficiency after

the implementation of an electronic health record. Comput Inform Nurs, 37(10), 513-521.

https:doi.org/10.1097/CIN.0000000000000553

A study was done evaluating Urgent Care physician efficiency and the flow of patient

care and if any improvement was noted after EHR implementation. Prior physician efficiency

was tracked from collected data in billing and through manual paper charting, which proved

inconsistent. Because the workflow program will assist in the physician efficiency evaluations, it

will represent an accurate systematic report because it will note assumptions and evidence. This

study is unique in that it hadn’t previously been done in an urgent care setting.

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An urgent care wait time is generally an hour to an hour and a half long, with 71-160

million visits per year. With fewer providers and more patients, this will cause overcrowding.

The EHR was implemented to improve the following: patient care, participation, care

coordination, diagnostic and patient outcomes, and efficiencies with practice, workflow, and

cost. Because it’s been long noted that paper charting is illegible and often has missing data, if

EHR implementation occurred due to the American Recovery and Reinvestment Act of 2009,

they were provided with incentives in addition to EHR. Urgent care expectations on wait time

and now with the addition of EHR, they are expected to experience efficiency improvement as

well as workflow processes. When this occurs, so will increase in a positive outcome and cost

reductions with an estimated savings of $3.9 million to $9.8 million in revenue loss.

After evaluating the physician efficiency program with information on the average visit

length collected, the learned lesson is that the EHR did help in all areas, especially with

consultation efficiency going from 109 minutes to 73 minutes which leads to better patient

satisfaction scores.

Conclusion

After researching and reviewing five articles, I believe that, overall, physicians do report

increased patient outcomes and greater efficiency when using electronic health records versus

paper charting and handwritten notes. While many, if not all, showed hesitation to do so, with

training and patience, it improved their practice with faster visit times allowing more patients to

see and better cost-efficiency. The greatest challenge was getting used to the program and after

they received proper training in navigation, they learned what it could be utilized for. When the

providers managed to accomplish this, they saw greater productivity, increased patient outcomes

and better patient visit efficiency.

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References

Entzeridou, E., Markopoulou, E., & Mollaki, V. (2018). Public and physician’s expectations and

ethical concerns about electronic health record: Benefits outweigh risks except for

information security. International Journal of Medical Informatics, 110, 98-107.

https://doi.org/10.1016/j.ijmedinf.2017.12.04

Ham, P., Anderton, T., Gallaher, R., Hyrman, M., Simmerman, E., Ramanathan, A., Fallaw, D.,

Holsten, S., & Howell, C. (2016). Development of electronic medical record-based

“rounds report” results in improved resident efficiency, more time for direct patient care

and education, and less resident duty hour violations. The American Surgeon, 82, 853-

859.

How doctors feel about electronic health records. (2018, March 27). Stanford medicine; The

Harris Poll. https://med.standford.edu/content/dam/sm/ehr/documents/EHR-Poll-

Presentation

Pyron, L., & Carter-Templeton, H. (2019). Improved patient flow and provider efficiency after

the implementation of an electronic health record. Comput Inform Nurs, 37(10), 513-521.

https:doi.org/10.1097/CIN.0000000000000553

Reid, S., Naidu, C., Kantor, G., & Seebregts, CJ. (2020). Do electronic patient information

systems improve efficiency and quality of care? South African Medical Journal, 110(3),

210-216. https://doi.org/10.7196/SAMJ.2020.v110i3.14111

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TOPIC: LITERATURE REVIEW: THE USE OF CLINICAL SYSTEMS TO IMPROVE OUTCOMES AND EFFICIENCIES

To Prepare:

· Review the Resources and reflect on the impact of clinical systems on outcomes and efficiencies within the context of nursing practice and healthcare delivery.

· Conduct a search for recent (within the last 5 years) research focused on the application of clinical systems. The research should provide evidence to support the use of one type of clinical system to improve outcomes and/or efficiencies, such as “the use of personal health records or portals to support patients newly diagnosed with diabetes.”

· Identify and select 4 peer-reviewed research articles from your research.

· For information about annotated bibliographies, visit 

https://academicguides.waldenu.edu/writingcenter/assignments/annotatedbibliographiesLinks to an external site.

The Assignment: (4-5 pages not including the title and reference page)

In a 4- to 5-page paper, synthesize the peer-reviewed research you reviewed. Format your Assignment as an Annotated Bibliography. Be sure to address the following:

· Identify the 4 peer-reviewed research articles you reviewed, citing each in APA format.

· Include an introduction explaining the purpose of the paper.

· Summarize each study, explaining the improvement to outcomes, efficiencies, and lessons learned from the application of the clinical system each peer-reviewed article described. Be specific and provide examples.

· In your conclusion, synthesize the findings from the 4 peer-reviewed research articles.

· Use APA format and include a title page.

· Use the Safe Assign Drafts to check your match percentage before submitting your work.

Rubrics for grading

This criterion is linked to a Learning Outcome In a 4- to 5-page paper, synthesize the peer-reviewed research you reviewed. Format your Assignment as an Annotated Bibliography. Be sure to address the following· Properly identify 4 peer-reviewed research articles you reviewed- The response identifies 4 peer-reviewed research articles for the Assignment.

Summarize each study, explaining the improvement to outcomes, efficiencies, and lessons learned from the application of the clinical system each peer-reviewed article described. Be specific and provide examples – The response accurately and thoroughly summarizes in detail each study reviewed, explaining in detail the improvement to outcomes, efficiencies, and lessons learned from the application of the clinical system each peer-reviewed article described.Specific, accurate, and detailed examples are provided which fully support the response.

Synthesize the findings from the 4 peer-reviewed research articles in a cohesive conclusion – Response includes a synthesis of the findings in an exceptionally well-written conclusion.

Written Expression and Formatting – Paragraph Development and Organization:Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance – Paragraphs and sentences follow writing standards for flow, continuity, and clarity.

This criterion is linked to a Learning OutcomeWritten Expression and Formatting – English writing standards:Correct grammar, mechanics, and proper punctuation – Uses correct grammar, spelling, and punctuation with no errors.

Written Expression and Formatting – APA:The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list- Uses correct APA format with no errors.

Reference/Resources

McGonigle, D., & Mastrian, K. G. (2022). 
Nursing informatics and the foundation of knowledge (5th ed.). Jones & Bartlett Learning.

· Chapter 14, “The Electronic Health Record and Clinical Informatics” (pp. 293–316)

· Chapter 15, “Informatics Tools to Promote Patient Safety, Quality Outcomes, and Interdisciplinary Collaboration” (pp. 323–349)

· Chapter 16, “Patient Engagement and Connected Health” (pp. 357–378)

· Chapter 17, “Using Informatics to Promote Community/Population Health” (pp. 383–397)

· Chapter 18, “Telenursing and Remote Access Telehealth” (pp. 403–432)

·  Dykes, P. C., Rozenblum, R., Dalal, A., Massaro, A., Chang, F., Clements, M., Collins, S. …Bates, D. W. (2017). 

Prospective evaluation of a multifaceted intervention to improve outcomes in intensive care: The Promoting Respect and Ongoing Safety Through Patient Engagement Communication and Technology Study

 Download Prospective evaluation of a multifaceted intervention to improve outcomes in intensive care: The Promoting Respect and Ongoing Safety Through Patient Engagement Communication and Technology Study

. 
Critical Care Medicine, 45(8), e806–e813. doi:10.1097/CCM.0000000000002449

· HealthIT.gov. (2018c). 

What is an electronic health record (EHR)

? Links to an external site.

Retrieved from 
https://www.healthit.gov/faq/what-electronic-health-record-ehr

· Rao-Gupta, S., Kruger, D. Leak, L. D., Tieman, L. A., & Manworren, R. C. B. (2018). 

Leveraging interactive patient care technology to Improve pain management engagement Links to an external site.

. 
Pain Management Nursing, 19(3), 212–221. 

· Skiba, D. (2017). 

Evaluation tools to appraise social media and mobile applications Links to an external site.

. 
Informatics, 4(3), 32–40.