Discussion: Hypothetical database

DNP 805 Topic 5 Discussion: Hypothetical database

Using the clinical question you identified from above, determine the individual components to that question and pinpoint the location in the hypothetical database where the information you require will be extracted.

Example Solution – DNP805 Topic 2 DQ 1

Discuss the usefulness of the electronic health record (EHR) and its impact on patient safety and quality outcomes. Describe strengths and limitations that might apply to its usage.

 

During the last decade, healthcare has witnessed the development and implementation of electronic health records (EHRs). The initial theory was that EHRs would improve patient safety and quality outcomes.  Silverman (1998) stated that some of the obvious advantages to an EHR would have included and were not limited to the ease of access and immediate availability of patient information, history, and treatment plans in routine or emergency situations.  He stated the potential to decrease adverse outcomes such as missed diagnoses, unnecessary or repeated treatments and procedures, international drug interactions and contraindicated treatments.  If all EHRs were connected, one could also have a complete and up to date medical record always immediately available to caregivers.

 

Reimbursement incentives to increase the use of EHRs were put into place by the Health Information Technology for Economic and Clinical Health Act in 2009.  This Act allocated $27 billion of reimbursement for the demonstration of the meaningful use of EHRs.  Clinical decision support rules that are specialty specific were expected to be implemented in the EHR to guide professional practice at the point of care with a purpose of improving overall patient safety and quality outcomes (Moja et al, 2014).

 

The impact of the EHR on the mortality, morbidity and costs of healthcare has been examined by several researchers throughout the years. Moja et al. (2014), conducted a systematic review of computerized decision support systems (CDSSs) that provided guidance messages such as “diagnostic test ordering and interpretation, treatment planning, therapy recommendations, primary preventive care, therapeutic drug monitoring and dosing, drug prescribing, or chronic disease management” to identify the impact of CDSSs on patient safety and quality outcomes.   The researchers compared systems with CDSSs to those without access to CDSSs, those that did not generate advice for care and those that did not have evidence based advice for care (Moja et al., 2014).

 

The results of 28 randomized control trials was surprising as it  indicated little evidence for a difference in mortality.  The small differences were primarily identified in particular settings with specific diseases and circumstances only. However, most studies were considered too short to prove or exclude a mortality effect.  Morbidity outcomes of the studies were found to be too diverse and limited to make inferences.  However, there was a 10% to 18% decrease of morbidity due to CDSSs linked to EHRs.  This indicates that some studies showed an improvement in the health outcomes and quality of patient care as it pertained to the overall morbidity of patients. Finally, the differences observed for cost and utilization of health services among the studies was found to be small between the study groups (Moja et al, 2014).

 

While this study had several limitations such as not including the processes of different facilities or the level of compliance of practice professionals to guideline recommendations, the study indicates that there are several advantages to the use of CDSSs within an EHR to improve patient safety and quality of care.  Although more research is needed to prove the benefits of CDSSs within EHRs, several advantages have been observed.

 

However, disadvantages have also been observed in relation to EHRs.  There is concern for the privacy of medical record information and the accuracy of information entered into permanent medical records (Thede, 2010). The implementation of information technology systems is expensive, time consuming and at times is perceived as disruptive to the care being delivered by healthcare professionals. The adoption of a universal electronic health record is still yet to be achieved and the use of the EHR by some practice professionals still seems daunting and time consuming (Kreidler, 2019).

 

References

 

Kreidler, M. L. (2019). Health Care and Information Technology. Salem Press Encyclopedia. Retrieved from https://search-ebscohost-com.lopes.idm.oclc.org/login.aspx?direct=true&db=ers&AN=89163746&site=eds-live&scope=site

 

Moja, L., Kwag, K. H., Lytras, T., Bertizzolo, L., Ruggiero, F., Brandt, L., … Bonovas, S. (2014). Effectiveness of computerized decision support systems linked to electronic health records: A systematic review and meta-analysis. American Journal of Public Health, (12), e12. https://doi-org.lopes.idm.oclc.org/10.2105/AJPH.2014.302164

 

Silverman, D. D. (1998). The electronic medical record system: Health care marvel or morass? Physician Executive, 24(3), 26. Retrieved from

 

Thede, L. (2010). Informatics: Electronic Health Records: A Boon or Privacy Nightmare? Online Journal of Issues in Nursing, 15(2), 8. Discussion: Hypothetical database