NURS 6401 week 8 Assignment Paper
Patient Centered Technologies
Patient-Centered Medical Home (PCMH) is an innovative model for delivering healthcare to patients with an objective of achieving maximum outcomes for health. The model is aimed at tracking down patients over time while providing coordination to health professionals to work in teams thus strengthen health care delivery. Consequently, there are many challenges in Patient-Centered Medical Home. Firstly, it is a tremendous challenge to establish health care agreements with clinicians and other referral physicians. This means that there is no guarantee of patient follow-up with the model. Coordinating patients with high-risk infections is also a challenge. This is because there are no established communication platforms that increased coordination from one patient to another. Thirdly, with the program it is difficult to integrate healthcare providers with health IT. Financial projections show that it is difficult to implement IT infrastructure due to their high costs. Scientific evidence shows that many healthcare organizations have found it difficult financing a change to PCMH.NURS 6401 week 8 Assignment Paper
In order to solve the challenges in PCMH it is essential to understand the root causes that lead to failure of the model. The government should give incentive payments to all physicians with an aim of improving their coordination with patients. Good payments will act as motivational factor to improve health care delivery. Moreover, all the stakeholders should unite to form a common code of conduct for physicians to in improving care. Patient management systems should be developed to monitor and supervise the conduct of physicians and clinicians in hospitals. Since quality and affordability of in Patient-Centered Medical Home is a challenge, effective healthcare legislation should be enacted to help improve care deliverance for many people in the society. Moreover, the government should also provide IT infrastructure to all Patient-Centered Medical Homes. This integration of information technology systems in PCMH will help to improve overall health care delivery.
The healthcare industry recognizing the need for communication between information technology personnel and healthcare practitioners in order to address the issues of patient care, created nurse informatics specialist positions. Nurse informatics specialists are an integral part of the healthcare delivery process and a deciding factor in the selection, implementation and evaluation of healthcare, which supports safe, high-quality and patient-centered care (Elkind, 2009). The American Nurses Association (2008) defined Nursing informatics as “A specialty that integrates nursing science and computer science to manage and communicate data, information and knowledge in nursing practice (p. 1). Nursing informatics can also be defined as any use of information technology by nurses for the purpose of enhanced patient outcomes, the management of healthcare facilities, nurse education and nursing research.NURS 6401 week 8 Assignment Paper
Many healthcare individuals associate the field of nurse informatics as having two types of roles, the clinician who uses the health information technology and the specialist, who creates, facilitates, tests, and implements new information technology. Healthcare settings now integrate electronic medication prescribing, tele-health, online appointment scheduling and mobile laboratories where informatics nurses are essential in guaranteeing that the computerized solutions interface with each other (HIMSS, 2011). In order to accomplish information related activities, informatics nurses must synchronize and exchange significant clinical and technical information with the goal of supporting and coordinating safe, effective patient care and assuring an efficient workflow.
A vital element of healthcare information is nursing documentation. Information systems are designed for nurses where documentation can be best utilized to expand their knowledge of quality of care. The evolution of knowing has been exponential in the past forty years due to the new ways of learning that have been discovered. Nursing in particular has benefitted from these new concepts and continues to find newer and better methods to improve patient care. Nurses bring to their practice a personal history that develops the way their nursing care is performed. Nursing theory, standards of practice, legal and ethical obligations must be understood and utilized to enhance the quality of nursing care.
The electronic patient record has become an important aspect in the information workflow, and using information technology will result in improving patient outcome quality and efficiency. Patient documentation is a vital skill in communicating the patient’s condition and organizing their care according to the patient’s needs. Nursing practice is primarily guided by patients’ needs and depending on those needs and their environments, different theories can be applied for individualized care. The application of individual nursing practice is based on an combination of medical, philosophical, psychological and other nursing theories.
Barbara Carper, a professor at the College of Nursing at Texas Woman’s University, wrote an essay in 1978 titled the “Fundamental Patterns of Knowing in Nursing,” that has identified four ways of knowing that nurses apply to meet patients’ needs. Today many universities and nursing colleges are using her fundamental patterns to help nursing students gain a more universal approach to assessing, understanding and treating patients. One of Carper’s patterns is the empirical knowing that is based on the result of the most relevant and supported evidence derived from research. This includes research related to nursing informatics and the use of technology in healthcare.NURS 6401 week 8 Assignment Paper
Before the digital age, nurses were utilizing paper forms to document important patient information. A significant factor in the nursing profession and healthcare systems is the transition to electronic documentation. Electronic documentation contains flow sheets that help in assembling information about the patient’s needs, improve the patient’s information accuracy, and enhance the quality of patient care. A well designed information system can facilitate and provide an easier and faster information flow that is needed for efficient documentation processing. Nurses play an essential role in patient’s safety where the quality of the nursing environment and electronic documentation has a positive influence on patients. The electronic documentation method has evolved to provide a plan of care for patients, efficient communication between clinicians, and direct patient care processes. Nurses are very diligent in coordinating, monitoring and delivering patient care to guarantee effective documentation flow. Nursing computer based software allows nurses to collect, store, recover data and integrate clinical data with nursing management resources.
Among multiple healthcare organizations, nurses represent the largest technology user group. In the beginning nurses believed that electronic documentation and information systems were an interruption to their daily workflow and a disruption from bedside care (Lee, 2004). Over the years however, nurses have become more accustomed to the technology, which is positive since their acceptance of it is imperative to successful system implementation. Today, nurses are more proficient in all aspects of information technology while maintaining superior levels of patient care.
Most nurses now have a positive attitude related to the improved quality of electronic documentation and a new appreciation of the decreased workload afforded when using a well- designed system. However, despite the benefits of electronic documentation for nursing workflow, there are barriers that can obstruct the utilization of computerized documentation systems. Some of these barriers can result from behavioral issues in regards to perception and satisfaction toward information technology and the time spent documenting the patient information. The challenge comes when some nurses (i.e. older nurses) have doubts about working in a nursing environment filled with technology. Even though they are provided with reference guides, screen shots, and cheat sheets that are helpful, some nurses still have a hard time adjusting to electronic charting. Some of them have a fear of clicking in the wrong place as they work with computerized charts and they become aggravated when they cannot perform their electronic tasks.NURS 6401 week 8 Assignment Paper
With electronic charting, nurses have the capability of accessing information quickly and efficiently and are able to use information to improve the quality of nursing workflow. In most of these situations, nurse informatics specialists play a pivotal role in assisting nurses in identifying and addressing these challenges. Many nursing theories have been developed to promote nursing practice efficiency. For an informatics nurse, change theory is the most integrated theory in their practice. Nurse informatics specialists apply theories in directing patient care, while providing guidance and technical assistance for staff nurse workflow as well as providing leadership for system change.
Kurt Lewin’s theory of change offers a tactical approach that can help informatics nurses in implementing and evaluating the projected changes in the system processes. An interesting article was written by Polly Ryan in 2009 where she stated that: “the integrated theory of health behavior change suggests that health behavior change can be enhanced by fostering knowledge and beliefs, increasing self-regulation skills and abilities, and enhancing social facilitation” (p. 161). Informatics nurses motivate and encourage nurses to use innovative problem-solving methods by providing them with support.
The informatics nurse is part of the delivery of care, the building of knowledge, skills, and the experience in the use of information technology. They often lead clinical informatics committee meetings that have a major influence for nurses in assisting them to coordinate all the multifaceted technology activities in regards to patient care, documentation and safety. Informatics committees provide continuing guidance in the development and implementation of information technology and digital solutions for nursing practice and patient care. The significance of developing and maintaining positive attitudes and computer-use acceptance among nursing staff have been discovered in multiple literature reviews. For a successful implementation of an electronic documentation system, it is important to understand the various levels of computer familiarity, and acknowledge nurses’ computer use needs, attitudes, skills, beliefs and readiness to learn. An informatics committee also provides structure, support and staff development to nurses from different departments who interface with or are impacted by information technology.
Informatics and nurses support for ongoing professional development that implements the work knowledge of nurses leads to high quality care and patient satisfaction. Research reveals the importance of nurse’s involvement in informatics committee meetings where they can participate in system design, redesigning workflow, and improving interdisciplinary communication (Lee, 2007). Many nurses are professionally and ethically motivated to contribute to new knowledge, high quality improvement, and innovation through evidence based decision making.NURS 6401 week 8 Assignment Paper
Evidence-based practice and decision-making began with Florence Nightingale in the 1850s during the Crimean War. She realized a correlation between poor sanitary situations in the hospitals and rising death rates among wounded soldiers. Her consequent efforts to keep the hospitals disinfected in order to save soldiers resulted in a remarkable drop in patient mortality (Alligood, 2014). Since Nightingale’s work in improving healthcare conditions, the progress of evidence based practice has evolved over time. Effective nursing care relies on the gathering and use of nursing evidence. The pattern of empirical knowledge is founded in evidence-based research and objective experience, and has been identified as the most prevalent in nursing practice. Evidence based practice functions as the key standard for quality in nursing practice by enhancing patient satisfaction. Evidence-based quality improvement was redesigned to transform healthcare into an environment of care that is effective, safe, and efficient. Research is being used progressively as the basis for clinical decisions in many organizations. The stream of information through the increase of technology, has transformed the decision-making process for clinicians. Research authenticates, enhances and creates a scientific base for nursing practice and is facilitated and disseminated through the use of information technology and nursing informatics. The nurse’s ultimate goal through the use of information technology is patient education, while providing high quality care and most importantly patient safety.
It has been observed that patient education has slowly become a major concern and that hospitals want to get involved in implementing better education for patients and their families. The importance of patient education is an example of critical study and evidence based practice by nurses that has shown that knowledge, on the part of patients and their families, can reduce re-admission rates, decrease healing time, improve mental discomfort, and produce better patient results. Today, patients are educated with the help of technology including modern televisions, I-pads and other sophisticated electronic devices where the patient can watch, learn and explore their illnesses and care. Partnership with team members and families is essential to optimal treatment. The application of individual nursing practice is based on an arrangement of the clinician and the patient. Traditional patient education relied on written material about disease processes, medication, medical management, and self-care instruction guidelines. Today, patients benefit from many forms of education and with all these forms of education nurses can provide patients with knowledge that enables them to understand the disease process and make important decisions about their health. Nursing interventions in proper patient education improves patient self-care, satisfaction, moral support, coping skills and mental stability. Addressing improvement in nursing workflow is essential to the improvement of patient stability and safety.NURS 6401 week 8 Assignment Paper
Healthcare outcomes including quality of life measures are the result of a multifaceted relationship between the patient, the nurse, the treatment and the information healthcare system. A strong foundation for addressing the challenges of electronic documentation is the informatics nurse’s capability to understand and direct the balance of patient care with the technology systems and organizational structure that supports this balance. In order to guarantee a successful implementation of a computer system while managing patient care it is important to integrate nurses’ perceptions, beliefs, and knowledge in the use of new technology and how nurses implement this technology into their daily nursing practice. Finding the right balance of information science in conjunction with nursing science is a continuing process that will rely on the forward thinking and perseverance of today’s modern nurse and the support of nursing informatics specialists.
Health IT plays a very important role in the Accountable Care Organizations and the Patient-Centered Medical Homes. In most cases, little attention is given to the delivery-system that is required to improve the coordination and quality of the health care and lower the spending rates. Accountable Care Organization and the Patient-Centered Medical Home are two models that are mainly discussed for delivery system reform. They also offer opportunity to enlarge the efficiency of the care coordination. Care coordination helps to improve the appropriateness, efficiency, timeline and the quality of clinical decisions and care, in that way, the quality and efficiency of the health care is improved. The main goals involved in care coordination include: the transfer of medical information such as medication lists, medical history and test results properly from one participant to another in patient care. These can only be efficient when the health information technology is involved and very well utilized.
According to some physicians, PCMH is the model of care that gives the patient’s needs the first priority. Gerlach (2010) says that it provides the most efficient and effective care to the patients by including the use of health information technology, behavioral health services, health maintenance, patient education, and providing preventive services through health promotion. Medical homes are responsible for providing the patient’s health care needs or it takes the responsibility of arranging care with other professionals who are well qualified (Shortell & Gillies 2010). Provider members of ACOs work collectively across the specialties in order to develop delivery of care programs that focus on coordinating care and outcomes. The ACOs encourage most hospitals and physicians to incorporate care by holding them responsible for both cost and quality.NURS 6401 week 8 Assignment Paper
PCMH and ACO models play a role in improving the quality of health care and reduce the costs. For instance, one of their major objectives is to deliver high value products and good quality services. These can be achieved by coordinating care, consolidating multiple level of care to the patients, being accountable for the quality of care, efficient delivery and having a brawny primary care foundation. Health information technology therefore, helps to ensure that all these are well achieved.
PCMC’s and ACO’s try to provide a solution to control the costs of Medicare by ensuring that the country avoids spending or paying for wasteful procedures, and authorizing nurses and doctors to offer more efficient and high quality care. Some of the rules that are used in the models include; providing equal care among populations, providing care in the right setting, supporting the well being of all individuals, providing timely, convenient, responsive services, efficient services, and should easily access to appropriate care and information when required. Other principles include identifying measurable outcomes and availability of information that helps in providing and planning for the patients effectively. In order to make the two models, PCMH and ACOs successful, it is very necessary to use the HIT (Health Information Technology). HIT should integrate across the health care system from one care site to the other (Gerlach 2010). The modern information technology commonly used includes computers, servers, and database management systems. Technology is capable of supporting the rural access to health care which is very critical when it comes to caring for all the patients.
The implementation of the ACOs and PCMH has various challenges that mainly concern the direct control of the primary care practice. First, the model, PCMH, doesn’t provide direct incentives to the other providers collaboratively with the primary care providers in order to optimize health outcomes even though it calls for practices of primary care to take the task for coordinating and providing care across the health care continuum (Shortell & Gillies 2010). Another challenge is that most primary care practices have no financial arrangements that enable them to share the savings.
The information technology helps in the implementation, processing and even the storage of some important data on health care. Meaningful use of IT is actually intended to enable the significant improvements in the health of the population via a transformed health care delivery system. Currently, in the year 2011, NCQA instituted more stringent certification standards. NCQA has also built on various standards with increased accent on patient-contentedness that actually includes a stronger focus on the integration of behavioral health. In addition, it helps in the management of chronic disease and therefore improving the quality of patients with the use of patient surveys. All the activities in improving the patient’s conditions are more efficient with the use of IT. It is therefore important to note that IT also plays a major role in the two model’s well performance.NURS 6401 week 8 Assignment Paper
The two models of the delivery-system reform tend to redirect the delivery system towards the improved quality and the reduced cost mainly with the use of health IT. ACOs need a stable primary care core in order to succeed and provide the effective delivery-system infrastructure beyond the primary care practice to enable the realization of the PCMH model. The combination of both the models and the use of HIT are all essential for the implementation and success. Due to the information above, it is clear that health information is very much involved in the current rules related to the ACOs and the PCMH. It is therefore necessary for you to incorporate it in the planning in order to improve the quality and accessibility of healthcare information and facilities.NURS 6401 week 8 Assignment Paper