NURS 5051/6051: Transforming Nursing and Healthcare Through Information Technology

• Introduction
• Resources
• Discussion
• Week in Review

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• Introduction
• Resources
• Discussion
• Week in Review

Week 1: Nursing Informatics and Patient Safety

In 2011, Mason General Hospital was named by Hospitals & Health Networks magazine as one of the “Most Wired” hospitals in the United States. What makes this particularly significant is that Mason General is a small, 25-bed, rural hospital in the state of Washington. It credits its success to nurse Eileen Branscome, director of clinical informatics. Under her leadership, the hospital adopted such innovations as visual smart boards where real-time patient information is always available. According to the magazine, those hospitals designated as “Most Wired” “show better outcomes in patient satisfaction, risk-adjusted mortality rates, and other key quality measures through the use of information technology (IT)” (Mason General Hospital and Family of Clinics, 2012).

Developments in information technology have enabled patients and health care providers to collaborate for quality improvement at an unprecedented level, and nurses have consistently been at the forefront of these efforts. This week you focus on the IOM report “To Err Is Human” and consider how health information technology has helped to address the issues of patient safety and quality health care.

References:

Weinstock, M., & Hoppszallern, S. (2011). Health care’s most wired 2011. Hospitals & Health Network Magazine, 85(7), 26–37.

Mason General Hospital and Family of Clinics. (2012). MGH&FC named most wired – Again! Retrieved from http://www.masongeneral.com/most_wired.html

Learning Objectives

Students will:

• Analyze the utilization of health information technology to address issues raised in the IOM report “To Err Is Human”
• Assess the role of informatics in improving health care safety

Photo Credit: Angela Schmidt/iStock/Getty Images

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

American Nurses Association. (2015). Nursing informatics: Scope & standards of practice (2nd ed.). Silver Springs, MD: Author.

• “Introduction”This portion of the text introduces nursing informatics and outlines the functions of the scope and standards.

McGonigle, D., & Mastrian, K. G. (2015). Nursing informatics and the foundation of knowledge (3rd ed.). Burlington, MA: Jones and Bartlett Learning.

• Chapter 1, “Nursing Science and the Foundation of Knowledge”This chapter defines nursing science and details its relation to nursing roles and nursing informatics. The chapter also serves as an introduction to the foundation of knowledge model used throughout the text.

• Chapter 2, “Introduction to Information, Information Science, and Information Systems”In this chapter, the authors highlight the importance of information systems. The authors specify the qualities that enable information systems to meet the needs of the health care industry.

Wakefield, M. K. (2008). The Quality Chasm series: Implications for nursing. In R. G. Hughes (Ed.), Patient safety and quality: An evidence-based handbook for nurses (Vol. 1, pp. 47–66). Rockville, MD: U. S. Department of Health and Human Services.

• Pages 1–12These 12 pages highlight the issues raised by the Quality Chasm Series and examine their long-term implications for nursing. The text reviews external drivers of safety and quality, design principles for safe systems, and guidelines for health care redesign.

Cipriano, P. F., & Murphy, J. (2011). Nursing informatics. The future of nursing and health IT: The quality elixir. Nursing Economic$, 29(5), 282, 286–289.

Retrieved from the Walden Library databases.

In this article, the authors focus on how nurses can use health information technology to help transform health care using the recommendations included in the 2010 Institute of Medicine report “The Future of Nursing, Leading Change, Advancing Health.” The author also discusses the 2011 National Strategy for Quality Improvement in Health Care.

Plawecki, L. H., & Amrhein, D. W. (2009). Clearing the err. Journal of Gerontological Nursing, 35(11), 26–29.

Retrieved from the Walden Library databases.

This article presents a summary of the Institute of Medicine report “To Err Is Human: Building a Safer Health System.” The authors provide an overview of what has been accomplished in the decade following the IOM report, focusing in particular on health information technology.

Required Media

Laureate Education (Producer). (2012e). Introduction to nursing informatics. Baltimore, MD: Author.

Note: The approximate length of this media piece is 8 minutes.

In this video, Doris Fischer, Richard Rodriguez, Carina Perez, and Carmen Ferrell introduce the concept of nursing informatics. These individuals provide insight into how informatics is transforming the health care system by improving efficiency and quality of care.

Optional Resources

Hilts, M. E. (2010). Up from the basement. Health Management Technology, 31(9), 14–15.

Retrieved from the Walden Library databases.

Institute of Medicine. (1999). To err is human: Building a safer health system. Retrieved from http://iom.edu/~/media/Files/Report%20Files/1999/To-Err-is-Human/To%20Err%20is%20Human%201999%20%20report%20brief.pdf

Kohn, L. T., Corrigan, J. M., & Donaldson, M.S. (Eds.). (2000). To err is human: Building a safer health system. Washington, D. C.: Institute of Medicine. Retrieved from the National Academies Press website: https://download.nap.edu/catalog.php?record_id=9728

Discussion: The Effects of “To Err Is Human” in Nursing Practice

The 1999 landmark study titled “To Err Is Human: Building a Safer Health System” highlighted the unacceptably high incidence of U.S. medical errors and put forth recommendations to improve patient safety. Since its publication, the recommendations in “To Err Is Human’ have guided significant changes in nursing practice in the United States.

In this Discussion, you will review these recommendations and consider the role of health information technology in helping address concerns presented in the report.

To prepare:

• Review the summary of “To Err Is Human” presented in the Plawecki and Amrhein article found in this week’s Learning Resources.
• Consider the following statement:

“The most significant barrier to improving patient safety identified in “To Err Is Human” is a “lack of awareness of the extent to which errors occur daily in all health care settings and organizations (Wakefield, 2008).”

• Review “The Quality Chasm Series: Implications for Nursing” focusing on Table 3: “Simple Rules for the 21st Century Health Care System.” Consider your current organization or one with which you are familiar. Reflect on one of the rules where the “current rule” is still in operation in the organization and consider another instance in which the organization has effectively transitioned to the new rule.

AACN BSN Essentials and Your Future Practice (graded)

Select one of the AACN BSN Essentials and elaborate on its meaning and importance in your own future professional nursing practice. In your post intended to clearly and thoroughly address the topic of this TD, be sure to:

• Identify the AACN BSN Essential that you have selected by name and number.
• Clearly and thoroughly explain why you selected this Essential.
• Clearly and thoroughly explain how this Essential will be used in your future professional nursing career.

For your response to a classmate to further develop that person’s ideas, select at least one classmate who has written about a different AACN BSN Essential than the one that you selected.

NOTE: Week 8 Discussion closes on Wednesday of Week 8. All Week 8 posts are due by Wednesday. Any posts submitted after Wednesday of Week 8 will not count towards your grade.

Hood, L. J. (2014). Leddy & Pepper’s conceptual bases of professional nursing (8th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.

• Chapter 7: page 171
• Chapter 22: pp. 568–574
• Chapter 23: pp. 600–607

Other Required Readings (located in Webliography):

• Massachusetts Nurse of the Future Nursing Core Competencies: Review
• AACN Essentials of Baccalaureate Education: Review

Assignment 2:

Practicum Assignment 1: Self-Assessment of Clinical Skills

A self-assessment is an opportunity for you to review what you have learned in the program, evaluate your clinical skills, and develop goals before exiting the NP program. For this assignment, you will complete the Risk Control Self-Assessment Checklist for Nurse Practitioners and identify your areas of strength and weakness. You also will explain how you plan to improve on these weaknesses, as well as how you plan to master clinical skills you have not obtained prior to exiting NP program.

To prepare:

Complete the Risk Control Self-Assessment Checklist for Nurse Practitioners

Review preceptor and faculty evaluations in Meditrek for all completed clinical courses

Consider your strengths and weaknesses

Review types of patients treated and clinical procedures performed

By Day 7

Write a 2- to 3-page paper that addresses the following:

Identify at least three strengths

Explain why you consider these strengths and what you can do to maintain them in your practice

Identify at least three weaknesses

Explain how you plan to address each weakness

Examine at least three clinical skills you need to obtain prior to exiting the program

Explain how you plan to master the clinical skills before exiting NP program

Analyze the history of advanced practice nurses and the emerging role of your specialty area, and discuss what contributions you plan to make to advance the nursing profession

• Capstone Assignment Directions Capstone Assignment- HIM 305
  Thoroughly review capstone scenario to complete this assignment. 
  
  •  Submit an operating budget for HIM department.
  •  Respond to the questions for the capital budget scenario in a Word document.
  • Write a Request for Proposal (RFP) for the transcription and coding service referenced in the scenario conduct research for samples of request for proposals to assist with this task.
  • Complete the Excel budget spreadsheets. There will be three tabs- Tab One- lists employee salaries of department employees (yearly). Tab Two-departmental monthly expenses. Tab Three- annual budget for department.
  • Information for calculating the budget:
    
  • Use current dues for AHIMA (refer to AHIMA website for information).
  • Dues should be calculated for the Director and all credentialed employees in the department.
  • Director needs to budget to attend AHIMA National Convention. Find the budget information on the AHIMA website. Budget for transportation, registration and hotel. There is $45 a day allowed by organization for food.
  • Budget for luncheon for the HIP week- 12 employees at $10 per employee.
  • You must budget for employee education for CEU to maintain professional credentials. Calculate at least 10 CEU per year per coder to allow new information on coding updates to be obtained.
  • Refer to sample budget sheets for other information you may need.
  • Project a maximum 5% salary increase.
  • Project an increase in supplies of 7%.
  • Project a 5% increase in all other areas, except those discussed in the scenario.

• Capstone Case StudyCapstone Scenario- HIM 305
  Coppin State Regional Health Center is a 270-bed, not-for-profit community hospital.  Its largest percentage of patients consists of mothers and newborns, followed by a variety of cardiovascular-related admissions.  It has an emergency department staffed by hospital employees.  Coppin State Regional Health Center’s fiscal year follows the calendar year, ending December 31.  In August, Coppin State Regional Health Center began its year-end budget process by establishing its financial assumptions for the following two years.  Administration distributed operational and capital budget compilation packages to department managers for completion and return by September 30. 
  Financial Assumptions:
  Coppin State Regional Health Center Administration assumed that revenue would remain constant, that it would continue its existing contracts with payers, that its Medicare population percentage would not change, and that no major infrastructure maintenance would be required in the upcoming fiscal year.
  
  • No major capital projects were anticipated. 
  • In its operational budget, administration plans to include resources for a Joint Commission steering committee and related activities to prepare for the anticipated accreditation visit in the subsequent year. 
  • Coppin State Regional Health Center does not have a large marketing department.  It has one marketing professional on staff whose responsibilities include the development and publishing of brochures and coordination of patient satisfaction surveys, which are compiled and analyzed by an outside vendor.  In the past two years, there has been a slight, but continuing, decline in patient satisfaction among maternity patients.  Suggestions for improvement have varied, but common complaints center on the lack of soothing ambiance in labor and delivery and the hospital policy prohibiting overnight visitors.
    The maternity and newborn departments have been very concerned about declining patient satisfaction.  They are worried that the current year’s  slight decline in maternity admissions is the result of that dissatisfaction and that patients are traveling a little further to give birth at a neighboring medical center, at which some of their physicians also have privileges. 
    
  • The departments would like to renovate the maternity and newborn wing, forming a women’s center with increased emphasis on wellness and ancillary services.  This would be a two-year capital project that would require marketing support and some minor disruption of services during construction.
  • The cardiology department staff is very excited. They have just learned that a well-respected cardiologist has retired to the area and is exploring the idea of opening a small consulting practice.  The cardiologist has not yet applied for privileges at any area hospitals, but it is known that she is used to working in a facility with its own cardiac catheterization lab.  Because the current chief of the medical staff at Coppin State Regional Health Center is a personal friend of the cardiologist, the cardiology department believes that she could be lured on staff if the hospital had its own lab.
    
  • Based on the volume of patients that Coppin State Regional Health Center currently sends out to another facility for cardiac catheterization, the cardiology department believes that patient care would be facilitated by the expansion and that the increased revenue would help justify the cost.
  • The HIM department has recently lost several employees to retirement and promotions with the facility.  It is currently down two coders and a file clerk, and has reduced its weekend coverage to one person, day shift only.  Transcription is handled largely by the department, with an outside service processing any overflow. 
    
  • The HIM department would like to outsource all of its transcription and move to a Web-based coding system that would allow the coders to telecommute.
  •  These changes would also require the implementation of an Electronic Record System (EHR). 
• Capstone Case StudyCapstone Scenario- HIM 305
  Coppin State Regional Health Center is a 270-bed, not-for-profit community hospital.  Its largest percentage of patients consists of mothers and newborns, followed by a variety of cardiovascular-related admissions.  It has an emergency department staffed by hospital employees.  Coppin State Regional Health Center’s fiscal year follows the calendar year, ending December 31.  In August, Coppin State Regional Health Center began its year-end budget process by establishing its financial assumptions for the following two years.  Administration distributed operational and capital budget compilation packages to department managers for completion and return by September 30. 
  Financial Assumptions:
  Coppin State Regional Health Center Administration assumed that revenue would remain constant, that it would continue its existing contracts with payers, that its Medicare population percentage would not change, and that no major infrastructure maintenance would be required in the upcoming fiscal year.
  
  • No major capital projects were anticipated. 
  • In its operational budget, administration plans to include resources for a Joint Commission steering committee and related activities to prepare for the anticipated accreditation visit in the subsequent year. 
  • Coppin State Regional Health Center does not have a large marketing department.  It has one marketing professional on staff whose responsibilities include the development and publishing of brochures and coordination of patient satisfaction surveys, which are compiled and analyzed by an outside vendor.  In the past two years, there has been a slight, but continuing, decline in patient satisfaction among maternity patients.  Suggestions for improvement have varied, but common complaints center on the lack of soothing ambiance in labor and delivery and the hospital policy prohibiting overnight visitors.
    The maternity and newborn departments have been very concerned about declining patient satisfaction.  They are worried that the current year’s  slight decline in maternity admissions is the result of that dissatisfaction and that patients are traveling a little further to give birth at a neighboring medical center, at which some of their physicians also have privileges. 
    
  • The departments would like to renovate the maternity and newborn wing, forming a women’s center with increased emphasis on wellness and ancillary services.  This would be a two-year capital project that would require marketing support and some minor disruption of services during construction.
  • The cardiology department staff is very excited. They have just learned that a well-respected cardiologist has retired to the area and is exploring the idea of opening a small consulting practice.  The cardiologist has not yet applied for privileges at any area hospitals, but it is known that she is used to working in a facility with its own cardiac catheterization lab.  Because the current chief of the medical staff at Coppin State Regional Health Center is a personal friend of the cardiologist, the cardiology department believes that she could be lured on staff if the hospital had its own lab.
    
  • Based on the volume of patients that Coppin State Regional Health Center currently sends out to another facility for cardiac catheterization, the cardiology department believes that patient care would be facilitated by the expansion and that the increased revenue would help justify the cost.
  • The HIM department has recently lost several employees to retirement and promotions with the facility.  It is currently down two coders and a file clerk, and has reduced its weekend coverage to one person, day shift only.  Transcription is handled largely by the department, with an outside service processing any overflow. 
    
  • The HIM department would like to outsource all of its transcription and move to a Web-based coding system that would allow the coders to telecommute.
  •  These changes would also require the implementation of an Electronic Record System (EHR).

• All three departments submitted capital budget requests for the projects described.
  
  Budget Considerations (to be submitted in a Word document with spreadsheets):
  
  1. What things should be considered in conducting a cost-benefit analysis on each project?
  2. At this point in your decision making which request is most appropriate?  Request for Information, Request for Proposal or Request for a Quote?  Explain your answer.  Develop a request for proposal to send to the transcription and coding services.
  3. If the hospital can only approve one of the proposed projects, which do you think has the best chance of being approved?  Why?
  4. If you were the director of the HIM department, how would you justify your department’s project so that it is presented most favorably?  What are the benefits to selecting this project?

• Cost Benefit Analysis InformationCost-Benefit Analysis
  Deciding, Quantitatively, Whether to go Ahead
  (Also known as CBA and Benefit-Cost Analysis)
  http://www.mindtools.com/pages/article/newTED_08.htm
  Imagine that you’ve recently taken on a new project, and your people are struggling to keep up with the increased workload.
  You are therefore considering whether to hire a new team member. Clearly, the benefits of hiring a new person need to significantly outweigh the associated costs.
  This is where Cost-Benefit Analysis is useful.
  Note:
  Cost-Benefit Analysis is a quick and simple technique that you can use for non-critical financial decisions. Where decisions are mission-critical or large sums of money are involved, other approaches – such as use of Net Present Values and Internal Rates of Return – are often more appropriate.
  About the Tool
  Jules Dupuit, a French engineer, first introduced the concept of Cost-Benefit Analysis in the 1930s. It became popular in the 1950s as a simple way of weighing up project costs and benefits, to determine whether to go ahead with a project.
  As its name suggests, Cost-Benefit Analysis involves adding up the benefits of a course of action, and then comparing these with the costs associated with it.
  The results of the analysis are often expressed as a payback period – this is the time it takes for benefits to repay costs. Many people who use it look for payback in less than a specific period – for example, three years.
  You can use the technique in a wide variety of situations. For example, when you are:
  
  • Deciding whether to hire new team members.
  • Evaluating a new project or change initiative.
  • Determining the feasibility of a capital purchase.
  • However, bear in mind that it is best for making quick and simple financial decisions. More robust approaches are commonly used for more complex, business-critical or high cost decisions.
    How to Use the Tool
    Follow these steps to do a Cost-Benefit Analysis.
    Step One: Brainstorm Costs and Benefits
    First, take time to brainstorm all of the costs associated with the project, and make a list of these. Then, do the same for all of the benefits of the project. Can you think of any unexpected costs? And are there benefits that you may not initially have anticipated?
    When you come up with the costs and benefits, think about the lifetime of the project. What are the costs and benefits likely to be over time?
    Step Two: Assign a Monetary Value to the Costs
    Costs include the costs of physical resources needed, as well as the cost of the human effort involved in all phases of a project. Costs are often relatively easy to estimate (compared with revenues).
    It’s important that you think about as many related costs as you can. For example, what will any training cost? Will there be a decrease in productivity while people are learning a new system or technology, and how much will this cost?
    Remember to think about costs that will continue to be incurred once the project is finished. For example, consider whether you will need additional staff, if your team will need ongoing training, or if you’ll have increased overheads.
    Step Three: Assign a Monetary Value to the Benefits
    This step is less straightforward than step two! Firstly, it’s often very difficult to predict revenues accurately, especially for new products. Secondly, along with the financial benefits that you anticipate, there are often intangible, or soft, benefits that are important outcomes of the project.
    For instance, what is the impact on the environment, employee satisfaction, or health and safety? What is the monetary value of that impact?
    As an example, is preserving an ancient monument worth $500,000, or is it worth $5,000,000 because of its historical importance? Or, what is the value of stress-free travel to work in the morning? Here, it’s important to consult with other stakeholders and decide how you’ll value these intangible items.
    Step Four: Compare Costs and Benefits
    Finally, compare the value of your costs to the value of your benefits, and use this analysis to decide your course of action.
    To do this, calculate your total costs and your total benefits, and compare the two values to determine whether your benefits outweigh your costs. At this stage it’s important to consider the payback time, to find out how long it will take for you to reach the break even point – the point in time at which the benefits have just repaid the costs.
    For simple examples, where the same benefits are received each period, you can calculate the payback period by dividing the projected total cost of the project by the projected total revenues:
    Total cost / total revenue (or benefits) = length of time (payback period).
    Example
    Custom Graphic Works has been operating for just over a year, and sales are exceeding targets. Currently, two designers are working full-time, and the owner is considering increasing capacity to meet demand. (This would involve leasing more space and hiring two new designers.)
    He decides to complete a Cost-Benefit Analysis to explore his choices.
    Assumptions
    
  • Currently, the owner of the company has more work than he can cope with, and he is outsourcing to other design firms at a cost of $50 an hour. The company outsources an average of 100 hours of work each month.
  • He estimates that revenue will increase by 50 percent with increased capacity.
  • Per-person production will increase by 10 percent with more working space.
  • The analysis horizon is one year: that is, he expects benefits to accrue within the year.
  • Costs
    CategoryDetailsCost in First YearLease750 square feet available next door at $18 per square foot$13,500Leasehold improvementsKnock out walls and reconfigure office space$15,000Hire two more designersSalary, including benefits
    Recruitment costs
    Orientation and training$75,000
    $11,250
    $3,000Two additional workstationsFurniture and hardware
    Software licenses$6,000
    $1,000Construction downtimeTwo weeks at approximately $7,500 revenue per week$15,000Total$139,750Benefits
    BenefitBenefit Within
    12 Months50 percent revenue increase$195,000Paying in-house designers $15 an hour, versus $50 an hour outsourcing (100 hours per month, on average: savings equals $3,500 a month)$42,00010 percent improved productivity per designer ($7,500 + $3,750 = $11,250 revenue per week with a 10 percent increase = $1,125/week)$58,500Improved customer service and retention as a result of 100 percent in-house design$10,000Total$305,500He calculates the payback time as shown below:
    $139,750 / $305,500 = 0.46 of a year, or approximately 5.5 months.
    Inevitably, the estimates of the benefit are subjective, and there is a degree of uncertainty associated with the anticipated revenue increase. Despite this, the owner of Custom Graphic Works decides to go ahead with the expansion and hiring, given the extent to which the benefits outweigh the costs within the first year.
    Flaws of Cost-Benefit Analysis
    Cost-Benefit Analysis struggles as an approach where a project has cash flows that come in over a number of periods of time, particularly where returns vary from period to period. In these cases, use Net Present Value (NPV) and Internal Rate of Return (IRR) calculations together to evaluate the project, rather than using Cost-Benefit Analysis. (These also have the advantage of bringing “time value of money” into the calculation.)
    Also, the revenue that will be generated by a project can be very hard to predict, and the value that people place on intangible benefits can be very subjective. This can often make the assessment of possible revenues unreliable (this is a flaw in many approaches to financial evaluation). So, how realistic and objective are the benefit values used?
    Key Points
    Cost-benefit analysis is a relatively straightforward tool for deciding whether to pursue a project.
    To use the tool, first list all the anticipated costs associated with the project, and then estimate the benefits that you’ll receive from it.
    Where benefits are received over time, work out the time it will take for the benefits to repay the costs.
    You can carry out an analysis using only financial costs and benefits. However, you may decide to include intangible items within the analysis. As you must estimate a value for these items, this inevitably brings more subjectivity into the process.