Electronic Health Records: Establishing New Practice Approaches
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Electronic Health Records: Establishing New Practice Approaches
Electronic health records (EHRs) are an emerging practice in healthcare that entails using information technology (IT) systems to acquire, store, manage, and manipulating healthcare data. EHRs enhance communication within care settings, thereby promoting care coordination. The practice is still evolving in most healthcare institutions as researchers develop newer approaches. Therefore, it is necessary to understand the current scientific principles, research, and deviations in expected outcomes related to EHRs.
Currency of Science Underlying EHRs
EHRs utilize information technology infrastructure. Hence, the science that dictates the use of the systems is as current as the IT advancements. For instance, when facilities began using EHRs, the main purpose was data storage. Hospitals, clinics, and nursing homes replace their paper-based documentation with computers. The systems allowed better data management, as it was easier to store and retrieve patient information. Consequently, EHRs evolved as IT revolutionized. Currently, EHRs can perform intricate functions such as remote data transfer and diagnosis. Self-care patients use devices to record their medical data, sending them to their care provider for interpretation and diagnosis. Remote data transfer is possible since various technologies, including mobile phone applications, Bluetooth connectivity, and wireless communication, support the EHR functions. Similarly, caregivers can exploit video teleconferencing to interact with patients, reducing travel costs and saving patients’ time. EHRs will continue to change as IT-related science grows even more. For example, there is a claim that ultra-fast internet connectivity could allow surgeons to perform operations on patients on different continents (Comeau, 2020). Such a development will require a solid IT framework based on modern scientific approaches and data. Therefore, EHRs utilize the most current and stable scientific concepts to enhance healthcare outcomes.
Electronic Health Records: Establishing New Practice Approaches
Causes of Deviations from Expected Outcomes
On paper, it seems as if EHRs enhance every healthcare aspect. However, the literature suggests otherwise. EHRs often cause new challenges that impede their effectiveness. For instance, Cheney (2020) notes that modern technological systems in healthcare could cause more fatigue among caregivers, reducing job satisfaction and lowering the care quality. The effect occurs due to a rift between manufacturers and users. Most EHR manufacturers adopt external technologies and do not modify them to suit the healthcare sector. Therefore, a nurse has to navigate the same data entry steps as a clerk working in a library. Hence, the manufacturers fail to consider that nurses have other functions and that the EHR system should complement their work, not create a new one. Cybersecurity also poses a major challenge to EHRs’ acceptability and effectiveness. All IT platforms are subject to cyber-attacks. However, the consequences would be severe in healthcare settings. Patients using IT-based life-support systems could die, while caregivers could administer the wrong medications to patients. Therefore, the fear of cyber-attacks makes many caregivers and patients reluctant to use EHRs. Thus, EHR developers should improve the systems’ usability and safety features to allow users to benefit from the technological inventions fully.
Effect of EHRs on Healthcare Practices
Despite the challenges, EHRs are providing significant impacts in improving healthcare practices. First, the systems are enhancing clinical risk management. EHRs address some of the common shortcomings of human-based care, such as medical errors and forgetfulness. The systems utilize internal checks to ascertain that caregivers administer the appropriate care for each patient. They also have reminder features that ensure that patients do not miss care accidentally. Therefore, patients face fewer erroneous risks by utilizing EHRs.
EHRs have also enhanced healthcare affordability. Frequent visits to physicians are expensive due to traveling costs, rigid consultation fees, and lost productive time. EHRs make it easy for clinicians to attend to their patients remotely. Therefore, patients do not travel. They can also schedule the interaction session at their convenience to avoid losing their productive hours. Finally, clinicians can offer more flexible payment plans than during physical visits. The increased affordability has created a higher demand for healthcare services, which has worsened the clinician shortage problem. Caregivers must now attend to more people than before, leading to burnouts and low-quality care.
Current Research
Two relevant articles addressing EHRs are:
Ford, E. W., Silvera, G. A., Kazley, A. S., Diana, M. L., & Huerta, T. R. (2016). Assessing the relationship between patient safety culture and EHR strategy. International journal of health care quality assurance, 29(6), 614–627. https://doi.org/10.1108/IJHCQA-10-2015-0125
Schooley, B., Walczak, S., Hikmet, N., & Patel, N. (2016). Impacts of mobile tablet computing on provider productivity, communications, and the process of care. International journal of medical informatics, 88, 62–70. https://doi.org/10.1016/j.ijmedinf.2016.01.010
GRADE Model
Article 1: Ford et al.
Question Definition: The primary aim was to establish a relationship between patient safety culture and EHRs adoption.
Critical Appraisal: The research is recent and addresses a key aspect of EHRs’ integration.
Systematic Review Preparation: Reviewing the evidence required a general understanding of patient safety before EHRs’ integration began.
Assessing outcomes’ relevance: The results would provide information on whether EHRs can improve patient safety where it was previously lacking or if they are simply a newer safety maintenance tool.
Evidence profile: Quality Assessment: The research was comprehensive, valid, and reliable.
Summary of findings: The outcomes showed that facilities that previously had a positive patient safety culture were quick to embrace EHRs.
Article 2: Schooley et al.
Questions Description: The study’s objective was to assess EHRs’ acceptability by nurses and their effectiveness in promoting positive health outcomes.
Critical Appraisal: The research is relevant as it addresses one of the major challenges facing EHRs’ implementation.
Systematic Review Preparation: It was necessary to understand how EHRs can be an inconvenience to the care process before reviewing the evidence
Assessing outcomes’ relevance: The results are quantitative-based on several well-structured research queries.
Evidence profile: Quality Assessment: The research covered a significant sample to validate the outcomes.
Summary of findings: Most caregivers enjoy using EHR devices. They help them fulfil their care duties more efficiently. Only a small percentage are reluctant due to cybersecurity concerns.
Electronic Health Records: Establishing New Practice Approaches
References
Cheney, C. (2020). Physician Fatigue Linked To Electronic Health Record Use. https://www.healthleadersmedia.com/clinical-care/physician-fatigue-linked-electronic-health-record-use
Comeau, Z. (2020). Research: 5G Could Usher in Telesurgery and Remote Surgical Procedures. https://mytechdecisions.com/it-infrastructure/research-5g-could-usher-in-telesurgery-and-remote-surgical-procedures/#:~:text=A%205G%2Dconnected%20teleoperated%20surgical,the%20procedure%20possible%2C%20researchers%20said.
Ford, E. W., Silvera, G. A., Kazley, A. S., Diana, M. L., & Huerta, T. R. (2016). Assessing the relationship between patient safety culture and EHR strategy. International journal of health care quality assurance, 29(6), 614–627. https://doi.org/10.1108/IJHCQA-10-2015-0125
Schooley, B., Walczak, S., Hikmet, N., & Patel, N. (2016). Impacts of mobile tablet computing on provider productivity, communications, and the process of care. International journal of medical informatics, 88, 62–70. https://doi.org/10.1016/j.ijmedinf.2016.01.010
Question
Application 2: Laying the Foundation for New Approaches to Practice
In a 3- page paper, include the following:
• A brief summary of the currency of the science underlying the practices used to address your EBP Assignment issue
• Possible causes of the difference in outcomes from what would be expected according to the research literature
• The effect the EBP Assignment issue is having in practice
• Current research evidence on new practices for addressing the EBP Assignment issue
• A summary of the evidence-based practice model (including models from other disciplines as appropriate) and/or change theory or framework you will utilize to systematically integrate new approaches to practice to address the issue
New Practice Approaches, Part I
As underscored in Week 3, science provides a foundation for nursing practice and practice guidelines—yet, it can be surprising to realize that the latest research evidence is often not applied in practice, or that practice guidelines may not be updated based on new evidence.
The aim of evidence-based practice is to ensure that the most current science is used to promote the highest quality of health care. This is accomplished through the analysis, synthesis, and application of research, theory, and knowledge to nursing practice.
This week, you explore the interrelationships between theory, knowledge, research, and nursing practice and how this influences evidence-based practice. You also continue your EBP Assignment, as you initiate work on Application 2.
Learning Objectives
Students will:
• Analyze the interrelationships between theory, knowledge and research, and evidence-based practice
• Evaluate evidence-based approaches based on theories from non-nursing disciplines
• Evaluate research designs for addressing a specific issue in a specialty area
• Defend the selection of a research design
________________________________________
Learning Resources
Required Readings
Terry, A. J. (2018). Clinical research for the doctor of nursing practice (3rd ed.). Burlington, MA: Jones & Bartlett Learning.
With your EBP project in mind, select and read the chapter that best fits your proposed methodologies:
• Chapter 6, “Designing a Clinically-Based Quantitative Capstone Research Project”
• Chapter 7, “Designing a Clinically-Based Qualitative Capstone Research Project”
• Chapter 8, “Designing a Clinically-Based Mixed Method Capstone Research Project”
Fawcett, J., & Garity, J. (2009). Chapter 1: Research and evidence-based nursing practice. In Evaluating Research for Evidence-Based Nursing, (pp. 3-20). Philadelphia, PA: F. A. Davis.
Adams, J. M., & Natarajan, S. (2016). Understanding influence within the context of nursing: Development of the Adams influence model using practice, research, and theory. Advances in Nursing Science, 39(3), E40-E56.
Djulbergovic, B. (2014). A framework to bridge the gaps between evidence-based medicine, health outcomes, and improvement and implementation science. Journal of Oncology Practice, 10(3), 200-202.
Hutchinson, A.M., Bioeth, M., Wilkinson, J.E., Kent, B., & Harrison, M.B. (2012). Using the promoting action on research implementation in health services framework to guide research use in the practice setting. Worldviews on Evidence-Based Nursing, First Quarter, 59-61.
Leung, K., Trevena, L., & Waters, D. (2014). Systematic review of instruments for measuring nurses’ knowledge, skills and attitudes for evidence-based practice. Journal of Advanced Nursing, 70(10), 2181–2195.
Leung, K., Trevena, L., & Waters, D. (2016). Development of a competency framework for evidence-based practice in nursing. Nurse Education Today, 39, 189-196.
these concepts based on your professional experiences and your experiences as a doctoral student embarking on your EBP Assignment.
Laying the Foundation for New Approaches to Practice
As frequently noted in the literature, there is often a gap between research evidence and practice. This is not a new phenomenon; however, with the rapid growth of knowledge, it is essential that nurses hone their ability to identify this gap, determine best practices based on the evidence, and then apply this evidence to practice through the development of new approaches. In order for that to transpire, nurses must be skilled in leading change efforts so that adoption of new practice approaches can be successful.
For your EBP Assignment in Week 2 (Application 1), you identified an issue in your practicum setting in which the outcome is different from what would be expected according to the research literature. This week, continue to explore current research literature looking for new evidence to address the problem. In addition, you build on the work you began in this week’s Discussion and select an evidence-based practice model and change theory or framework that will support your efforts.
To prepare for Application 2 address the following:
• How current is the science underlying the practices related to your EBP Assignment issue?
• Consider possible causes of the difference in outcomes from what would be expected according to the research literature.
• Evaluate the effect the EBP Assignment issue is having in practice.
• Using the Walden Library and other credible sources, locate current research evidence of new practices that are effective in addressing the issue.
• Use the GRADE model presented in the Guyatt et al. (2011) article to evaluate the research evidence.
Electronic Health Records: Establishing New Practice Approaches
Application 1
Practice Issue
According to research literature, electronic health records (EHRs) systems have many benefits in the delivery of quality care to patients. These benefits include improving accessibility and improving communication and engagement in care settings (Yanamadala et al., 2016). Because electronic health records will be stored electronically, they are accessible to different healthcare providers from different locations and at different times. Providers are able to view all the patient’s medical history and track the different treatment plans that such patients have been under, and efficiently draw up a plan for care for patients. The accessibility of electronic health records, therefore, helps improve the quality of care and increase the chances of positive outcomes among patients (Yanamadala et al., 2016). On the other hand, electronic health records help to improve communication between interdisciplinary teams in care settings, such as between physicians and nurses and between nurses and patients. EHRs have the potential to enhance communication and accurately track the treatment and care plans in care settings. This can help to improve the chances of positive outcomes among patients (Jetté & Kwon, 2019).
Although research literature highlights only the benefits of electronic health records to both the patients and healthcare providers, significant challenges emerge in the implementation of electronic health records systems in care facilities. These challenges mainly entail nursing burnout and interoperability. As a result of nursing shortages being experienced in the present times, nursing burnout is a common occurrence. In care settings, electronic health records contribute significantly to nursing burnout due to the detailed user interface. EHRs also demand a lot of time which affects the time the nurses will spend with their patients, which can contribute to increased stress, lower job satisfaction, and decreased quality of patient care. The lack of interoperability between different disparate systems also poses a huge challenge to the implementation of EHR systems in healthcare facilities.
References
Jetté N, & Kwon C. (2019). Electronic Health Records—A System Only as Beneficial as Its
Data. JAMA Netw Open.2(9):e1911679. doi:10.1001/jamanetworkopen.2019.11679.
Lee, J., Lee, Y., Bae, J., & Seo, M. (2016). Registered nurses clinical skills and reasoning process: A think-aloud study. Nurse Education Today, 46, 75-80
Simmons, B. (2010). Clinical reasoning: Concept analysis. Journal of Advanced Nursing, 66(5), 1151-1158
Yanamadala, S., Morrison, D., Curtin, C., McDonald, K., & Hernandez-Boussard, T. (2016).
Electronic Health Records and Quality of Care: An Observational Study Modeling Impact on Mortality, Readmissions, and Complications. Medicine, 95(19), e3332. https://doi.org/10.1097/MD.0000000000003332.
Application 2: Laying the Foundation for New Approaches to Practice
In a 3- page paper, include the following:
• A brief summary of the currency of the science underlying the practices used to address your EBP Assignment issue
• Possible causes of the difference in outcomes from what would be expected according to the research literature
• The effect the EBP Assignment issue is having in practice
• Current research evidence on new practices for addressing the EBP Assignment issue
• A summary of the evidence-based practice model (including models from other disciplines as appropriate) and/or change theory or framework you will utilize to systematically integrate new approaches to practice to address the issue
Electronic Health Records: Establishing New Practice Approaches
Electronic Health Records: Establishing New Practice Approaches
New Practice Approaches, Part I
As underscored in Week 3, science provides a foundation for nursing practice and practice guidelines—yet, it can be surprising to realize that the latest research evidence is often not applied in practice, or that practice guidelines may not be updated based on new evidence.
The aim of evidence-based practice is to ensure that the most current science is used to promote the highest quality of health care. This is accomplished through the analysis, synthesis, and application of research, theory, and knowledge to nursing practice.
This week, you explore the interrelationships between theory, knowledge, research, and nursing practice and how this influences evidence-based practice. You also continue your EBP Assignment, as you initiate work on Application 2.
Learning Objectives
Students will:
• Analyze the interrelationships between theory, knowledge and research, and evidence-based practice
• Evaluate evidence-based approaches based on theories from non-nursing disciplines
• Evaluate research designs for addressing a specific issue in a specialty area
• Defend the selection of a research design
________________________________________
Learning Resources
Required Readings
Terry, A. J. (2018). Clinical research for the doctor of nursing practice (3rd ed.). Burlington, MA: Jones & Bartlett Learning.
With your EBP project in mind, select and read the chapter that best fits your proposed methodologies:
• Chapter 6, “Designing a Clinically-Based Quantitative Capstone Research Project”
• Chapter 7, “Designing a Clinically-Based Qualitative Capstone Research Project”
• Chapter 8, “Designing a Clinically-Based Mixed Method Capstone Research Project”
Fawcett, J., & Garity, J. (2009). Chapter 1: Research and evidence-based nursing practice. In Evaluating Research for Evidence-Based Nursing, (pp. 3-20). Philadelphia, PA: F. A. Davis.
Adams, J. M., & Natarajan, S. (2016). Understanding influence within the context of nursing: Development of the Adams influence model using practice, research, and theory. Advances in Nursing Science, 39(3), E40-E56.
Djulbergovic, B. (2014). A framework to bridge the gaps between evidence-based medicine, health outcomes, and improvement and implementation science. Journal of Oncology Practice, 10(3), 200-202.
Hutchinson, A.M., Bioeth, M., Wilkinson, J.E., Kent, B., & Harrison, M.B. (2012). Using the promoting action on research implementation in health services framework to guide research use in the practice setting. Worldviews on Evidence-Based Nursing, First Quarter, 59-61.
Leung, K., Trevena, L., & Waters, D. (2014). Systematic review of instruments for measuring nurses’ knowledge, skills and attitudes for evidence-based practice. Journal of Advanced Nursing, 70(10), 2181–2195.
Leung, K., Trevena, L., & Waters, D. (2016). Development of a competency framework for evidence-based practice in nursing. Nurse Education Today, 39, 189-196.
these concepts based on your professional experiences and your experiences as a doctoral student embarking on your EBP Assignment.
Laying the Foundation for New Approaches to Practice
As frequently noted in the literature, there is often a gap between research evidence and practice. This is not a new phenomenon; however, with the rapid growth of knowledge, it is essential that nurses hone their ability to identify this gap, determine best practices based on the evidence, and then apply this evidence to practice through the development of new approaches. In order for that to transpire, nurses must be skilled in leading change efforts so that adoption of new practice approaches can be successful.
For your EBP Assignment in Week 2 (Application 1), you identified an issue in your practicum setting in which the outcome is different from what would be expected according to the research literature. This week, continue to explore current research literature looking for new evidence to address the problem. In addition, you build on the work you began in this week’s Discussion and select an evidence-based practice model and change theory or framework that will support your efforts.
To prepare for Application 2 address the following:
• How current is the science underlying the practices related to your EBP Assignment issue?
• Consider possible causes of the difference in outcomes from what would be expected according to the research literature.
• Evaluate the effect the EBP Assignment issue is having in practice.
• Using the Walden Library and other credible sources, locate current research evidence of new practices that are effective in addressing the issue.
• Use the GRADE model presented in the Guyatt et al. (2011) article to evaluate the research evidence.
Application 1
Practice Issue
According to research literature, electronic health records (EHRs) systems have many benefits in the delivery of quality care to patients. These benefits include improving accessibility and improving communication and engagement in care settings (Yanamadala et al., 2016). Because electronic health records will be stored electronically, they are accessible to different healthcare providers from different locations and at different times. Providers are able to view all the patient’s medical history and track the different treatment plans that such patients have been under, and efficiently draw up a plan for care for patients. The accessibility of electronic health records, therefore, helps improve the quality of care and increase the chances of positive outcomes among patients (Yanamadala et al., 2016). On the other hand, electronic health records help to improve communication between interdisciplinary teams in care settings, such as between physicians and nurses and between nurses and patients. EHRs have the potential to enhance communication and accurately track the treatment and care plans in care settings. This can help to improve the chances of positive outcomes among patients (Jetté & Kwon, 2019).
Although research literature highlights only the benefits of electronic health records to both the patients and healthcare providers, significant challenges emerge in the implementation of electronic health records systems in care facilities. These challenges mainly entail nursing burnout and interoperability. As a result of nursing shortages being experienced in the present times, nursing burnout is a common occurrence. In care settings, electronic health records contribute significantly to nursing burnout due to the detailed user interface. EHRs also demand a lot of time which affects the time the nurses will spend with their patients, which can contribute to increased stress, lower job satisfaction, and decreased quality of patient care. The lack of interoperability between different disparate systems also poses a huge challenge to the implementation of EHR systems in healthcare facilities.
References
Jetté N, & Kwon C. (2019). Electronic Health Records—A System Only as Beneficial as Its
Data. JAMA Netw Open.2(9):e1911679. doi:10.1001/jamanetworkopen.2019.11679.
Lee, J., Lee, Y., Bae, J., & Seo, M. (2016). Registered nurses clinical skills and reasoning process: A think-aloud study. Nurse Education Today, 46, 75-80
Simmons, B. (2010). Clinical reasoning: Concept analysis. Journal of Advanced Nursing, 66(5), 1151-1158
Yanamadala, S., Morrison, D., Curtin, C., McDonald, K., & Hernandez-Boussard, T. (2016).
Electronic Health Records and Quality of Care: An Observational Study Modeling Impact on Mortality, Readmissions, and Complications. Medicine, 95(19), e3332. https://doi.org/10.1097/MD.0000000000003332.
Electronic Health Records: Establishing New Practice Approaches
Electronic Health Records: Establishing New Practice Approaches