Navigating Advantages and Challenges of Health Information Systems in Nursing Informatics

The use of technology in healthcare is not a new concept but its ever-growing need and use technology advancements have had a great impact on healthcare as a whole. Health Information Systems (HIS) have become a major component in using technology to improve quality care, increase satisfaction, and decrease cost. Although as with all new advancements and programs there are drawbacks. Since the goal of Nursing Informatics is improving patient care, ongoing monitoring of its advantages and disadvantages on the quality of patient-centered care should be performed.

Advantages and Disadvantages of a System

When choosing a new HIS system for a facility there are four prime areas that are necessary to consider: usability, interoperability, scalability, and compatibility. The connection between technology and human’s acceptance and ability to use it, Human-Computer Interaction (HCI), is usability (Acrobatiq, 2019). Simply put usability is the ease in which the staff can use it. Some advantages to this include the ability to complete real time charting, increasing personnel productivity, provide immediate patient education and answers to plan of care questions, and having all the patient’s information at your fingertips. Some disadvantages to usability are the ability for personnel to find workarounds, lack of training and confidence for users, and decreasing human to human interactions by nurses not looking up from computer during care and education causing decreased patient satisfaction.

Interoperability is the ability of different systems to work together and organizations ability to share information (Mastrian and McGonigle, 2017). In other words, the ability of the programs to speak the same language. Imagine visiting the emergency room for increasing symptoms of gastrointestinal distress. Treatment is received, you are then discharged and told to follow up with a Gastroenterologist the next day. At that visit the doctor can retrieve your treatment history, labs the ER performed, and the number of times you have visited the ER for the same symptoms. As the patient you did not have to try to remember what the ER doctor said, what medications you were given or what tests they performed. It was all in your record and reviewed at the beginning of your appointment which resulted in a speedier diagnosis. This is a major advantage of interoperability. As the patient you already do not feel well so being able to perform timelier patient centered care increases patient satisfaction, decreases costs, and a quicker diagnosis improves symptoms and overall health. The primary disadvantage to interoperability would be failures of the system. Failures can be caused by human error, viruses, or power outages causing medical equipment and devices to fail to transfer data (Mastrian and McGonigle, 2017).

The ability for a system, such as the Electronic Health Record (EHR), to grow with an organization and provide the resources to support that growth is scalability. The advantage to scalability is the ability for the program to stay current and effective. As new technologies arise such as diagnostics and medical devices patients and doctors alike follow these advancements and want them added for their use. These programs will need room for the anticipated growth. The addition of cloud servers is helpful and necessary to increase storage throughout the organization. HIS are very expensive systems that require mass amount of time and resources to implement. If the program is not scalable it could become superseded within a few years, which leads to the major disadvantage which is cost. The more upgrades and customizing done within a system the more the cost of investment. Finding a balance between current needs and projected growth is necessary which leads into the final area, compatibility.

Compatibility is the ability for devices and software to work with each other independently but in the same organization and platform (Acrobatiq, 2017). Physicians having access to patient files to review, add notes, upload images and documents, and place orders from their phones and tablets is a great advantage. In addition, allowing patients access to personal health information (PHI) with the same ease increases patient satisfaction and encourages patients to take a larger role in managing their own health. A system will fail in all areas of usability, interoperability and scalability if it is not compatible with multiple operating systems, networks, and platforms such as MAC and Windows and their various versions in use such as Microsoft and Linux. This is a system’s major disadvantage. When these programs are not compatible frustration increases and redundancy occurs which can lead to workarounds and human errors. Users must be comfortable with various programs, maintain training, login and passwords, and be sure not to overlook or miss inputting data from one program to another in charting.

Quality Patient Care and Documentation

When all the above outlined components (usability, interoperability, scalability, and compatibility) are addressed HISs, such as the EHR, can have an immense affect on patients’ health care and greatly improve patient outcomes. So far how physicians and patients can use HISs to improve care has been addressed, but little has been included on how essential the EHR is to the bedside nurse. To best illustrate this let us follow a bedside nurse through admission of a neonatal patient.

A Neonatal Intensive Care Unit (NICU) nurse is notified a neonate will be admitted shortly. There is a lot of data that needs to be gathered for this admission to run smoothly and offer the best care and outcome for the patient and the family. The neonate does not have a history to review, but the mother does so the nurse is able to access her PHI in the EHR. These records will include mom’s blood type, level of prenatal care, vaccine record, medications administered and prescribed at home, labs values, related diagnoses, and the neonate’s gestation and tolerance of labor based on decelerations on the fetal monitor. All this information is vital to know when preparing for delivery and anticipation of care that will be needed. The nurse learns the mother was admitted initially to rule out HELLP Syndrome and she is 34 2/7 weeks gestation. Additionally, she is advanced maternal age and has been compliant with all of her prenatal care, her only home medications were prenatal vitamins and calcium carbonate, she is up to date on her vaccines, and she is blood type O+ so the RhoGAM injection is not necessary and the neonate is not at risk of ABO incompatibility. Upon reviewing the mother’s vital signs and labs the nurse notices an upward trend in her blood pressure and liver enzymes which is expected related to the HELLP Syndrome diagnosis. Next the nurse looks up the mother’s Medication Administration Record (MAR) to assess what medications she is currently taking. As expected, the mother is on a Magnesium drip to reduce her blood pressure, Lactated Ringer since she is NPO, and received betamethasone 3 hours prior. Based on this data the nurse can anticipate the neonatologists order sets, some of the neonate’s signs and symptoms and needs upon arrival to the unit. Due to the neonate’s size an incubator is set up and the warmer is set, resuscitation equipment and ventilator is gathered and set up based on gestational age, blood tubes are gathered for blood work, supplies are gathered for a central line placement, fluids and an IV pole are also gathered knowing the infant will be NPO based upon the order set. With the maternal administration of the magnesium, late decelerations on the fetal monitor, and gestational age the nurse anticipates the neonate to have decreased muscle tone and decreased breathing effort which is why the ventilator is gathered. Without the EHR the nurse would not have had enough time to prepare for arrival to the unit as timely and accurately. The nurse would have spent most of this time on the phone in attempt to gather as much accurate data as possible from the delivery room nurse whom is additionally caring for the mother. Information would have been delayed and not very detailed. When caring for the neonatal population timeliness and efficiency of care is of the upmost importance. Neonates have very little reserve in relation to blood glucose available and brown fat to maintain their little body’s vital functions. Wasted time dramatically affects their outcome and quality of life.

After the infant is delivered via cesarean section admitting is called and the infant is activated in the EHR. This now allows the various systems to transfer data such as vitals upon arrival and as ordered, medication scanning, ventilator settings, intravenous fluids administered via the pump, and blood glucose readings. It also allows the care team to activate order sets for the infant. Following the hustle of the initial admission process and stabilization the nurse can now review orders within the EHR to verify they are all completed, chart assessments, add notes, activate the nursing plan of care, and review diagnostic testing. Upon shift change the nurse can review all the infant and mother’s history, orders, and results with the oncoming nurse quickly and efficiently since all the data is at their fingertips on a summary page, which also is utilized to help prioritize patient care.

This example illustrates many of the advantages of the HIS. The ability to review the complete history allowed the nurse to anticipate care needs and prepare reducing stress to the infant and care team improving the infant’s overall health status. This also reduces waste by only gathering supplies that will be anticipated for use. Having systems that seamlessly transfers data such as lab values, vital signs, and equipment settings into the charting system saves time, reduces errors and eliminates redundancy which all reduces the overall cost of care. Real time charting promotes accuracy of assessments and family education. Additionally, the use of a HIS standardizes used terminology which bridges the gap in communication between care providers (Hawkins, 2014).

Using Quality Improvement Data Leads to Measurable Improvement

Quality Improvement (QI) includes a combination of quality indicators produced by two major organizations: the Agency for Healthcare Research and Quality (AHRQ) and the National Database of Nursing Quality Indicators (NDNQI). The focus of these initiatives is on research for patient safety after the report “Crossing the Quality Chasm” was released in 2001 by the Institute of Medicine highlighting issues in safe, quality patient care (Acrobatiq, 2019). These two organizations primary focus is their main difference. NDNQI’s primary focus is more on the quality and outcomes of nursing care while AHRQ focuses more on hospital and area specific indicators in prevention, inpatient, patient safety, and pediatric. In the wake of the focus on healthcare reform many projects have been underway across the USA as the aim is to improve patient care experience, improve the population’s health and reduce the cost of healthcare (Weston & Roberts, 2013).

Quality data must be relevant, timely, thorough, objective, transparent, reproducible, and verifiable (Acrobatiq, 2019). HISs have become the standard tool used to gather and analyze data to monitor QI, but nurses need to be aware the information disseminated is only as good as the information entered so it is important to remember what quality data is when charting. Within the NICU there are numerous trends that are monitored, some of these QIs include: central line-associated bloodstream infection (CLASBI), urinary tract infections (UTI) related to catheter vs diaper care, neonatal abstinent syndrome (NAS) days of admission, ventilator-associated pneumonia (VAP), nosocomial infection rates, and breast feeding vs formula rates just to name a few. The abuse of opioids has become a major problem across America and the rate of NAS admissions has grown exponentially. Neonatologist, caregivers, and hospitals all closely monitor the length of stay (LOS) of these patients related to Medicaid limiting reimbursement to a specific LOS. The bedside nurse can monitor the Finnegan Scores of the infant, the LOS, medication weaning schedule and symptoms of the infant all through the EHR. Not only does this aid offering support and care to the infant such as volunteers to hold, swings, and sound limitations, but it also provides trends for the nurse anticipate when the infant will need these additional support measures.

CLASBIs can greatly affect the population within the hospital and monitoring of them is a major focus across all units of the hospital. Not only can a CLASBI have detrimental effects on the patients’ health by now limiting much needed venous access but fighting a bloodstream infection takes a large toll on the body it increases morbidity rates and LOS. When a unit has increasing number of CLASBIs the Quality Management team is quick to use the EHR to perform chart reviews to determine the root cause so they can offer timely support to correct these measures. Not only is it important to the hospital to protect the patient’s but these infections are often not covered through Medicaid and Medicare related to them being hospital acquired so the treatment and stay is now the financial responsibility of the hospital. The HIS also improves health care services by offering alerts and reminders of needed care for these central lines from order sets put in place when the line is placed. These alerts are clinical decision supports that remind bedside nurses to perform sterile dressing changes and line changes as indicated in addition to reminders of which medications are recommended or not to run through these lines which can help decrease medication errors, waste, cost, and undue harm to the patient. Looking at our example patient from above it is helpful for the bedside nurse to be able to see these reminders and orders from her EHR summary pages. Not only does this assist the nurse in planning the day and prioritizing the tasks of all the patients, but it also assists in time management and decreasing human error from giving report from one nurse to the next over the LOS.

HIPAA and HITECH Security Standards

Health Insurance Portability and Accountability Act (HIPAA) and Health Information Technology for Economic and Clinical Health (HITECH) are both forms of legislation enacted to protect PHI and ePHI. This includes the storage, backup and recovery of quality data, which is accurate, consistent, and available at all times. Quality data can be compromised through human error, viruses, hardware crashes, transmission errors, and hackers. The HIS needs to incorporate automatic file backups, transmission error detection and data entry alerts. When working with the IT developer of a HIS it is important to consider these needs and questions about how the HIS addresses such issues. Some questions to ask include details of ePHI encryption, auditing functioning, auto time-outs, user/role access controls, and backup/ recovery system (The Office of the National Coordinator for Health Information Technology, April 2015). The Security Rule of HIPAA “establishes national standards to protect individuals’ electronic personal health information that is created, received, used, or maintained by a covered entity. The Security Rule requires appropriate administrative, physical and technical safeguards to ensure the confidentiality, integrity, and security of electronic protected health information” (U.S. Department of Health and Human Services, 12 May 2017). Therefore, HITECH granted Health and Human Services (HHS) authority to audit and enforce penalties for violations. Clear and precise policies and procedures should be adapted by organizations that fulfill these regulations such as who can access, add, change, and audit data, for staff members to reference and follow.

Conclusion

In summary, the text highlights the impact of technology, particularly Health Information Systems (HIS), on healthcare. It discusses the advantages and disadvantages of HIS components such as usability, interoperability, scalability, and compatibility. The importance of HIS in improving patient outcomes, streamlining care, and reducing costs is illustrated through a scenario involving a Neonatal Intensive Care Unit (NICU) nurse. The text emphasizes the role of Quality Improvement (QI) data in monitoring and enhancing patient care, focusing on quality indicators and initiatives. Furthermore, it addresses the crucial aspects of security standards (HIPAA and HITECH) to protect electronic health information. Overall, the text underscores the ongoing need for Nursing Informatics to evaluate and optimize HIS for the continuous improvement of patient-centered care.