TN004 Assignment Technologies Supporting Applied Practice and Optimal Patient Outcomes

Annotated Bibliography

The need for integrating clinical systems into healthcare organizations is now more crucial than ever to improve the outcomes of the care and to support workflow and decision-making. Electronic Health Records (EHRs), patient portals, and clinical decision support systems can revolutionize the clinical processes as they can improve and organize the clinical processes, increase care integration, and decrease medical errors in clinical and outpatient management plans. These technologies, however, are not without their issues, including technology compatibility, user accommodation,n or, surprisingly, invasion of privacy.

Article 1

Introduction

To answer the research question, this article reviews the impacts of EHRs on various aspects, such as the quality and productivity of care and patient outcomes. It offers a comprehensive discussion and synthesis of the interdisciplinary public health and informatics literature about EHRs, as well as the public health and economics literature. Considering that EHR adoption is a rather recent phenomenon, the authors evaluate the impact of this technology on clinical work by contributing to data exchange, increasing safety, and promoting information availability in healthcare organizations. The article is particularly relevant for healthcare managers, regulators, and clinical supervisors who can use it to find out the intended and potential unintended consequences of the use of EHR systems and make informed decisions for the future and for possible changes in the political agenda.

Citation

Atasoy, H., Greenwood, B. N., & McCullough, J. S. (2019). The digitization of patient care: a review of the effects of electronic health records on health care quality and utilization. Annual Review of Public Health, 40(1), 487–500. https://doi.org/10.1146/annurev-publhealth-040218-044206

Summary

purpose of the article is to develop a multi-dimensional analysis of EHRs and to uncover the advantages and disadvantages of the technology. The authors first present an overview of EHRs as electronic technology that can be used to manage, retrieve, and share patients’ health information and that can assist clinicians with their decisions. Another area of the study involves policy actions about the Health Information Technology for Economic and Clinical Health (HITECH) Act. The law encouraged the use of EHRs via incentives, and as a result, EHRs were implemented in both large and small health care organizations.

The article focuses on three key areas of impact that EHRs affect: clinical quality and safety, efficiency, cost of care, and unintended consequences. Another advantage of EHRs is that they help to prevent medication or order mistakes, and alert the clinician to possible drug interactions or allergies with the prescribed medication. In addition, EHRs eliminate paperwork, improve billing,g s and may even lower duplicate testing costs, and their effectiveness will rely on the extent of the working system. However, the review also discusses issues, namely disruption of the workflow, provider resistance, and compatibility problems, which will stress the requirement for the enhancement of EHRs to be more conducive as an assistive instead of a hindrance instrument.

Analysis

The article was well written in its attempt to provide an information-rich overview of EHR-related research that would be valuable to anyone who would like to gain a better understanding of the role of EHRs in the current healthcare landscape. One of the biggest benefits is their inclusiveness – the authors talk about different technological, clinical, and economic aspects of the implementation of EHRs. This approach enhances the paper’s credibility since the reader acquires a multidimensional view of the generally advancing, yet not solely clinical, EHRs.

The article, however, does not provide enough patient-centred outcomes coverage directly, as there is a strong emphasis on research synthesis. Many of the works described here are socio-technical and thus not directly aimed at patient health or outcomes, and too few of the works consider clinicians engaging in rationales for the use of EHR. In addition, its scope is limited with respect to the other studies observed due to variation in the approaches and findings reported in those studies, and sometimes contradictory results regarding the benefits of EHRs. Nevertheless, the article is still valuable for the entire scope of ERA effects and might be useful for further enhancements in the future.

Improvements to Outcomes, Efficiencies, and Lessons Learned

This study demonstrates the clear evidence of the positive impact EHRs can have on the quality of health and clinical care, and organizational performance. For instance, the use of CDSS in EHRs for the identification and prevention of ADEs includes the identification of other undetected DDIs and the patient’s allergies when a query is made, which are good examples. These have significantly worsened patient safety by steering decisions to the right targets, particularly in critical care and emergency care, where many decisions are made. In addition, EHRs have improved care coordination by creating a record of the individual patient that is shared with all the caregivers who treat the specific patient, and eliminating information gaps where perhaps the patient has received repeat tests and therapy due to failures in information sharing between the caregivers involved in treatment.

Other features, such as automatic scheduling and billing, encourage EHRs to make functional enhancements. For instance, through a common set of billing codes, enhanced documentation integrity of EHRs helps organizations decrease administrative errors, enhance reimbursement processes, and perhaps decrease operational costs. These improvements, however, are not equally felt across all the institutions but rather present a challenge to the smaller healthcare centers, which do not have adequate capital investment and recurrent costs to undertake and maintain EHR systems as most large hospitals do.

To overcome these challenges, the authors suggest making policy changes encouraging interoperability, continuing education for healthcare professionals, and enhancing usability design for safer, less disruptive use. To policymakers and administrators, these lessons can be a helpful roadmap for improving how EHRs are used, ultimately improving patient outcomes and health system efficiency.

Article 2

Introduction

The article reviews the emergence of Wearable health technology data along with EHRs. The authors of the recent trends have been discussing the strategies for adopting data from wearable technologies, such as fitness trackers and health monitors, in recent years and integrating them into EHR platforms. The integration will transform patient care, providing efficient health monitoring, preventive care, and a more personalized patient experience. The study is highly important for healthcare organizations, developers of wearable technologies, and insurers, as it provides detailed information about the logistical, technological, and privacy-related concerns needed for effective communication between wearables and EHRs.

Citation

Dinh-Le, C., Chuang, R., Chokshi, S., & Mann, D. (2019). Wearable health technology and electronic health record integration: Scoping review and future directions. JMIR MHealth and UHealth, 7(9). https://doi.org/10.2196/12861

Summary

The authors review the efforts by health systems, start-ups, and insurance companies to link data gathered from wearable devices to EHR, particularly Epic, in this scoping review. It targets ten start-ups and 16 health systems that are already working on eHHR start-ups with wearables integration projects. Issues that may be important during implementation of the system, including patient privacy, data overload, and compatibility issues, are accounted for and discussed. Developing effective systems that combine the use of all functions and patient privacy is crucial. The review also features examples of unique partnerships for wearable EHR integration for better data capture, integration of EHR systems, and health monitoring and incentive programs. The Epic UserWeb platform is given a specific focus due to its ability to enable the sharing and incorporation of wearable data into EHRs across various clinical contexts.

Analysis

As this article has provided a systematized view of wearable technology and its interface with EHRs, it holds useful information on ongoing advancements. One of the most important strengths of this study is that the list of currently existing projects on wearable integration in hospitals, insurance companies, and the main technology vendors is exhaustive. Here, there is an overview of outcomes and approaches introduced by such companies as UnitedHealthcare and Humana to encourage patients to engage in health-tracking programs. This study was restricted to a single EHR (the Epic system) and thus cannot be generalised to other EHR systems that may function differently, or have other challenges, with respect to the use of wearable data. Finally, as health technology evolves, especially for wearables, some of these results may soon be outdated and need to be constantly researched and innovated for wearables to be integrated into EHRs.

Improvements to Outcomes, Efficiencies, and Lessons Learned

Combining wearable health technology with EHRs has brought significant positive results for chronic illness, preventive care, and patient involvement. For instance, certain health systems have been able to use real-time monitoring for infusions for chronic diseases, such as diabetes and hypertension, in which the patient information from the wearable would be sent directly to the EHR, to be reviewed instantly by the healthcare provider. Further, UnitedHealthcare and Humana have incorporated rewards-based health tracking programs through which patients are supposed to track their health behaviors to enhance a healthier lifestyle that shows improved health among patients. The article also highlights the need to prioritize enhancing interoperability for data exchange and data privacy to safeguard patients. Key issues from such efforts emphasize the importance of robust and flexible environments to store and process significant amounts of data and engaging interfaces convenient for patients and clinicians.

Article 3

Introduction

The article discusses the utilization of electronic medical records throughout the United States, especially in primary care facilities. This paper is an attempt to look at the benefits EMRs can provide in improving the delivery of healthcare and the impediments that the providers and institutions face when implementing EMRs. While acknowledging that there are challenges associated with their usage, the paper authors describe EMRs as innovative and discuss how they improve some parts of care, such as care coordination, communication between professionals and patients, and reliability of services, with many literature reviews and years of experience. The findings are important for healthcare administrative and policymaking bodies as well as for IT professionals who wish to maximize the use of EMRs in healthcare environments and try to mitigate the challenges of implementing EMRs.

Citation

Janett, R. S., & Yeracaris, P. P. (2020). Electronic medical records in the American health system: challenges and lessons learned. Ciência & Saúde Coletiva, 25(4), 1293–1304. https://doi.org/10.1590/1413-81232020254.28922019

Summary

This article aims to identify what EMRs are and their strengths and weaknesses while stressing the importance of using them to create a well-integrated healthcare system. Through providing literature and examples from experience, the authors explain that EMRs enhance care coordination with examples, particularly in the primary care setting, where integrated, team-based models of care delivery are increasingly important. Features like checklists for preventive care, patient registries, and alerts for drug interactions can help enhance patient safety and continuity with EMRs. The article equally provides a detailed discussion of major hurdles in the implementation of EMRs, such as incompatibility of systems, high implementation cost, and continued maintenance of the EMRs,s and disruption of clinical practice that may occur during the integration process of the EMRs. In addition, it is noted that this aspect highlights the need for policy changes at the regional and national levels, which can enable the creation of functional requirements and interoperability standards for EMRs.

Analysis

The authors provide a balanced presentation of the material they are discussing and detail the potential problems and challenges that will occur with the use of this EMR in clinical practice. The authors’ strengths in this study are their hands-on experience with implementing EMRs in clinical practice and academic research in the private and public healthcare industries of the northeast USA. One drawback, however, is that the article cannot be replicated in other countries around the world due to the structure and resources of the American healthcare system. Additionally, the article extensively covers the characteristics of EMRs and the systemic problems, but the emphasis is not as strong on the patient-centered outcomes. The study appears to have greater value for health care administrators and policy makers than for direct care clinicians seeking evidence of the impact of EMRs on patient care.

Improvements to Outcomes, Efficiencies, and Lessons Learned

The article highlights the importance of EMRs in improving health outcomes because of their ability to reduce the disparate information silos between different providers, and also the health record for the patient as a whole. For instance, preventive care checklists and automated reminders establish that critical tests that are required for the patient’s continued well-being – including those for chronic patients – are performed when they ought to be performed, which helps to ensure patient care and continuity. Moreover, standardized care plans based on EMRs have also been shown to affect the delivery of other quality indicators, including immunizing with preventive vaccinations and timely health screening. The authors also note that policies need to be created to take into account System Interoperability to enable successful data sharing across the healthcare sector. Expected lessons, some of which include the impact of the clinical work processes on the architectures of EMR systems and the importance of having effective training programs to enhance user compliance. These changes are key to maximizing the value of EMs because they enable the EMR features to be fully used without intrusively interrupting patient care.

Article 4

Introduction

This article provides a summary of the effects of EHR Clinical Decision Support (CDS) applications on health outcomes for inpatients with diabetes. This section has a particular focus on diabetes order sets, glycemic management dashboards, and hypoglycemia protocols to maximize the efficiency of diabetes care by delivering protocol updates and patient information. This article is useful for healthcare consumers and hospital management planning to incorporate CDS technologies to improve the safety and care of patients suffering from diabetes.

Citation

Gerwer, J. E., Bacani, G., Juang, P. S., & Kulasa, K. (2022). Electronic health record-based decision-making support in inpatient diabetes management. Current Diabetes Reports, 22(9), 433–440. https://doi.org/10.1007/s11892-022-01481-0

Summary

The purpose of this paper is to gain insight into the use of comprehensive and integrated CDS tools in the EHR interface for inpatient diabetes management and improve interoperability. The authors discuss several CDS components, such as an electronic order set and glycemic management dashboard, which help the providers select the right insulin dose and set appropriate glycemic control goals. The study also discusses active notification capabilities, which alert the providers of emerging glycemic emergencies (e.g., hypoglycemia) for subsequent actions that can best be taken to prevent such emergencies. With real-time data, EHR CDS tools boost the efficiency of hyperglycemic management, reduce medication risk, and help preserve a proper blood glucose level within hospitals.

Analysis

The article provides a thorough literature review of the various CDS tools that have been incorporated in EHRs and demonstrates their use in diabetes care in hospital settings. Because of this, the study has a number of strengths, including detailed analysis of several different types of CDS functions (including order sets) and remote surveillance that allows hospitals to prevent hypoglycemia and other negative outcomes. However, the present study has certain limitations in that it focuses on inpatient care of diabetes, es and the findings are therefore not necessarily applicable to outpatient diabetes care. Further, the study does not give information on long-term outcomes on patients’ health, lth although it describes several capabilities of CDS. It provides a more administrative perspective of it, rather than a clinical one, which might be helpful for clinicians seeking patient outcome data.

Improvements to Outcomes, Efficiencies, and Lessons Learned

The study demonstrates that EHR-based CDS functions have the potential to significantly improve inpatient diabetes management and reinforce better results, coupled with the efficient utilization of resources. A series of CDS tools, such as order sets for insulin dosing, glycemic management order sets,s and glycemic management dashboard, ds has reduced the occurrence of hypo- and hyperglycemia episodes by ensuring the appropriate use of insulin doses and maintenance of target blood glucose. With the help of real-time alerts, there is the possibility to quickly respond to changes in glycemic levels and avoid dangerous outcomes for patients. Furthermore, the CDS improvements in the organization of the care processes achieved by means of the CDS tools help to reduce the variability in the treatment process and limit the number of errors involved in manual insulin administration.

Concerning the lessons identified, the article highlights the fact that CDS tools have to vary from patient to patient, as every patient has a different condition of diabetes. Furthermore, the importance of frequent updating of the CDS algorithms and educating the healthcare staff on the use of these tools comes from the need to optimise their use. It also helps the providers to be comfortable with the CDS functionalities and make the right decision within the stipulated time with a high degree of confidence, thus enhancing patient care and clinical productivity.

Article 5

Introduction

This article discusses the link between multifunctional EHRs and burnout among NPs in primary care practices. Burnout is an important issue for clinicians, and this study aims to identify whether the capabilities of the EHR and the computer and electronic reminders worsen or ease clinician burnout, specifically for NPs. Healthcare managers and policymakers will benefit from the findings in this article to better understand the impact multipurpose EHRs have on NP health and how to minimize burnout.

Citation

Abraham, C. M., Zheng, K., Norful, A. A., Ghaffari, A., Liu, J., Topaz, M., & Poghosyan, L. (2021). Use of multifunctional electronic health records and burnout among primary care nurse practitioners. Journal of the American Association of Nurse Practitioners, Publish Ahead of Print. https://doi.org/10.1097/jxx.0000000000000533

Summary

The sample consists of 396 NPs from New Jersey and Pennsylvania, and by exploring the impact of multifunctional EHRs on the burnout process, the study helps to address the understanding of the issue at hand. The burden of burnout was measured with cross-sectional questionnaires, while the EHR functionality was rated on scales, including patient data entry, prescription/ordering, and electronic alert/reminder for clinical protocol. The authors also found that neither type of EHR (multifunctional EHRs) was related to the burnout of NPS; in fact, NPS using multifunctional EHRs were found to have a lower risk of burnout. This research suggests that some EHR functions can benefit NPs by better organizing workflow and enhancing clinical decision-making skills.

Analysis

The article provides an important perspective into the correlation where functionalities in EHR are beneficial for decreasing NP burnout, which differs from prior research, which pointed to EHRs as a cause of physician burnout. One advantage of this study is that it examined the population of NPs, which is growing quickly as part of the primary care workforce in the United States, and conducted an exploratory analysis of the EHR functions and primary care. It has, however, a few limitations, such as the study being done in only two states, which could possibly not be relevant to other states. In addition, the results of this research do not account for the amount of time that the NPs spend on EHR tasks that could lead to burnout.

Improvements to Outcomes, Efficiencies, and Lessons Learned

The research suggests that the work productivity of PCP NPs can be boosted and even reduce burnout if optimized EHRs are developed to perform multiple functions. One of the key benefits is that EHR takes the lead in optimizing workflows, consolidating data, and setting up essential clinical alerts and notifications regarding the need for medication renewal or other key prevention measures. These features enable NPs to handle numerous patients and make decisions in real time for better care for patients and the safety/efficiency of care.

From an effectiveness standpoint, using automated prompts and ease of data entry helps decrease the workload and leaves it primarily to engage in direct patient care. These EHR capabilities can help save time and effort for the practitioner by preventing them from repeating the same work and effort to recall the preventive care requirements for their patients, or the coming schedule of meds, a nd reminding them if there are any gaps. This could lead to more efficient use of time for NPs to see more patients without the tracking system.

The study’s findings underscore the importance of certain EHR features like electronic reminders and easy data entry if the satisfaction of NPs is to be achieved, and thus reduce their levels of burnout. The results of the study show that some aspects of EHR can be adapted to capitalize on the strengths of wellness in clinical practice, allowing for the practice of the NP to the full extent of their training. The authors recommend further studies to determine other EHR capabilities that promote NP resilience. Finally, the authors emphasize the need to move forward in EHR designs to include more features that can help alleviate information loads for health care providers.