Health InformaticsTask 1: Electronic Health Records to improve care delivery

Goal: Understand how Electronic Health Record (EHR) Systems contribute to
improved management of health information and efficient care delivery. Explain
opportunities of using EHR data to find patterns of care.

a. Below are three advantages of Electronic Patient Records over traditional paper records. First,
provide a brief explanation for each of these three advantages and then provide an example
from the hospital practice to demonstrate each of these advantages.
A1: Electronic Health Records provide flexible ways to present information to the user
EHRs allow access to charts and patient information for healthcare providers even when
they are not in the office. EHRs allow for efficient care coordination (Bowman, 2013). They
support real-life clinical practice and workflow patterns, and this makes it easy for healthcare
providers to provide quality care with much ease. For instance, during medical emergencies and
consultations, healthcare providers do not need to be in the office for them to be of help. A
physician can consult with a fellow physician who is at home or away from the hospital, and they
will get the necessary assistance to provide quality care to patients.
A2: Information is accessible from more than one place at a time
Online EHRs ensure that data and patient information are always accessible from anywhere as
long as the practitioner has access to an internet connection (Bowman, 2013). Further, EHRs allow
for interoperability. They can interface with other systems, and this allows for continuity of care.
When patients are referred to specialists due to chronic illnesses, they do not have to carry their

medical records with them. Through interoperability, the specialists will be able to access the
patient’s medical history from their own computers. Also, a hospital whose EHRs are managed by a
vendor is able to access information remotely, even when the vendor is located at a different place.
Also, healthcare providers can respond to patient concerns from anywhere. A patient may contact a
healthcare provider from home and still get the necessary assistance. EHRs facilitate the provision
of healthcare in a home environment as patient information can be accessed from any location.
A3: Clinical research becomes easier
When EHR has been fully implemented in a healthcare setting, the reuse of EHR data can be
very useful in supporting clinical research. It is easy to analyze the data and get a real understanding
of the medical needs of the patient population. It makes it easy to detect safety risks early enough
for accurate interventions (De Moor et al., 2015). Also, this data makes it possible for medical
researchers to conduct post-marketing monitoring and surveillance. In the hospital, data from EHRs
are used to assess the effectiveness of certain treatment procedures by evaluating the outcomes. If a
certain procedure is seen to affect a particular population negatively, then it can be changed to
achieve better outcomes. Also, providers are able to determine the medical needs of certain patient
populations and adjust accordingly. Therefore, EHRs make it easy for medical professionals to
conduct clinical research.
b. Via Electronic Health Records, data are stored into databases and stay there for long periods of
time, even for decades. How will all these data collected over the years help the hospital
administrators understand the problem of length of stay inconsistencies at your hospital?
The implementation of EHRs is aimed at enabling the hospital management to accumulate
data over a long time, and then use the data to conduct clinical research and make predictions of
conditions that affect a certain patient population (Nickerson et al., 2005). EHRs are aimed at

ensuring the provision of seamless care service and indicate whenever there are inconsistencies.
Thus, by analyzing data stored through EHRs, hospital management is able to understand the issue
of the length of stay at the hospital. Inconsistences in the length of stay should, on average, be
shortened with the increased use of EHRs and the implementation of telehealth services. However,
when the length of stay at a hospital does not shorten despite the implementation of equipment and
systems aimed at reducing them, then there is an inconsistency. At my hospital, where they have
already included effective means of communicating drug therapies to patients upon discharge and
consequently while they are still home without requiring them to re-visit the hospital or stay longer
at the hospital, the management expects that the length of stay will be shortened. When this is not
the case after analyzing data stored through EHRs, then the management is able to look deeper and
try to understand the exact root cause of the problem. Besides, although data is stored over the
years, the management can always sort it. This way, they will be able to only analyze information
recorded for a certain duration. It is then possible to know when there are inconsistencies and the
change, which could be leading to inconsistency.
Task 2: Telemedicine for organizational improvements

Goal: Understand how telemedicine provides a gold opportunity to connect the
patients and providers to improve therapy compliance and patient satisfaction.

a. “Telemedicine services should be avoided because they do not allow face to face interaction
between the patient and the clinician.”
In the modern world, convenience in how one accesses healthcare is critical. A global
survey by Cisco revealed that 74 percent of patients prefer having easy access to medical services

more than in-person interactions (Cisco, 2020). Having virtual care allows patients access to simple,
timely, and on-demand care. The cost of in-person visits is saved. Telemedicine services make it
possible for patients who live in remote locations, or those who are busy at work and cannot take
time off and patients who are homebound to have access to healthcare virtually. Patients are
connected to healthcare providers, trough online management systems, smartphone apps, and video
conferencing. Evidently, most patients do not value face to face interaction, as long as they have
access to quality care. Therefore, although there are some patients who feel that face to face
interactions are part of quality care, a majority do not hold that opinion. Therefore, telemedicine
services have driven efficiency up and made healthcare more accessible. They should not be
avoided because they are a “lifesaver.”
b. “Telemedicine services require a substantial investment to set up, without important
returns.”
Healthcare service costs are significantly reduced by substituting traditional healthcare
services with telemedicine services. First, the cost of monitoring services, remote analysis, and
storage of electronic data is reduced. Telemedicine reduces non-urgent visits to the hospital and
eliminates transport costs incurred by patients as they go to the doctor’s office. Although it saves on
these costs, the costs incurred to restructure information technology staff and purchase equipment
that facilitate the provision of services remotely are high. Also, physicians, practice managers, and
other healthcare personnel require to be trained on how to provide services through the new
systems. This kind of training is important when coming up with an effective telemedicine
healthcare program. However, the costs incurred in staffing is reduced. For instance, one nurse can
provide care to more than thirty patients at once suing telemedicine services and from a single
location. Thus, staffing costs are reduced. Evidently, telemedicine services require substantial

capital to start. However, maintaining is easy, thus ensuring that the returns are profitable to the
investor.
c. “Tele-diagnosis is today the best telemedicine application because the doctors can literally
diagnose any condition from a remote location”
Tele-diagnosis is only possible for a few selected health conditions, which do not require
heavy cross-examination and equipment to reach a specific and accurate diagnosis. In in-person
healthcare, misdiagnosis often occurs. However, the risks for misdiagnosis increase with telehealth
(Hooper et al., 2001). The notion that doctors have the ability to diagnose any condition from a
remote location is a misconception. The provision of healthcare remotely limits one-on-one
interaction between a doctor and a patient, which is sometimes necessary when making a diagnosis
for certain conditions. Besides, where samples, such as blood samples, are required for tests to be
conducted, telediagnosis may be limited.
Task 3: Interoperability for connected systems

Goal: Understand why interoperable systems are not possible without complete
electronic medical records and how interoperability improves the performance of
systems. Why is a national healthcare interoperability a hard feat?

Watch the short video https://www.youtube.com/watch?v=PaWcU7rqqyA about interoperability
and answer the three questions providing ~150-word responses for each.

1. Why are standardized Electronic Health Records required for interoperable health
   systems?

Electronic health records are standardized so that they can be used by doctors, pharmacies,
hospitals, health plans, and the patients as well. Standardization ensures that all these pieces of
information fit together so that it is possible to share them across different healthcare settings.
Standardized records ensure that anyone from anywhere across the health care system can
understand information that is being shared. It comes in handy when doing research or when a
patent is referred to a specialist. The specialist understands the records as they appear in the
previous hospital’s records, without the need to directly consult the physician who ordered the
referral for an explanation. Also explain why the transition from paper based to electronic
health records is a prerequisite for interoperability. When data is stored electronically, it is
easier and possible to share any piece of information across different healthcare settings. Electronic
health records ensure that patient information is available whenever and wherever it is needed. All
the parties involved, nurses, physicians, laboratory technicians, and even patients can have access to
information without the need to go to the hospital. Paper-based records are hectic to store, and they
are a barrier to interoperability.

2. Why is a National Healthcare Interoperability a very hard feat?
   First, national healthcare interoperability can only be achieved if clear standards are
   established to ensure that all systems across all different healthcare facilities use a common
   language that everyone can understand. This can be a hard feat because there are technology and
   business obstacles that must be eliminated to achieve interoperability. Also, interoperability raises
   the issue of confidentiality of patient data. National interoperability means that a patient’s
   information can be accessed by different people from different locations, and this can be a breach of
   patient privacy. Therefore, the interoperability of national healthcare requires new methods through
   which a patient’s electronic records will be protected and be accessed by only the right people.
   Establishing National healthcare interoperability should not put patients in tricky positions where

they have to make the hard choice between convenience and privacy. Thus, it is a hard feat that
requires detailed planning and research to ensure that obstacles are eliminated.

3. Explain how interoperability contributes positively to financial savings in hospitals.
   Interoperability allows two or more health systems to exchange information which they can
   then use. In saves hospital costs incurred in the delivery of healthcare while at the same improving
   healthcare outcomes for patients. Physicians have the opportunity to get the right data at the right
   time every time when delivering care. Consequently, this saves time spent on taking care of each
   patient, and this increases the number of patients that each physician is able to handle. Hospitals
   serve more patients within the same period of time. Also, healthcare providers have access to the
   right information, and this minimizes the occurrence of errors. Medical errors are costly to both the
   patient and the hospital involved. Accurate and faster data save finances for the hospital.
   Interoperability also facilitates a seamless exchange of vital information among physicians, nurses,
   laboratory technicians, thus reducing the cost that would have been incurred had the hospital been
   using paper-based records.
   Task 4: Health informatics applications to improve health outcomes

Goal: Understand how health informatics applications contribute to the improved
patient follow-up and the continuum of care.

a. Explain how the existence of homecare telemedicine services would help a patient self-manage
her/his condition after the discharge from the hospital after his recovery from a cardiac
infarction.

Telemedicine services allow patients to monitor their heart rate, blood pressure, and body
weight. Although these are simple parameters, when monitored remotely through homecare, a
cardiac infarction patient is able to anticipate any signs of destabilization, which could be dangerous
if not noted early (Caldarola et al., 2017). Also, such a homecare check-up reduces the chances of
re-hospitalization. A patient knows when they have side effects from a certain drug, and this allows
for changes in the drug before any adverse effects are experienced. Homecare telemedicine services
allow a cardiac infarction patient to monitor their progress. Through the use of an
electrocardiogram, telemedicine services make monitoring of recovering patients easy, and
emergency situations are easily detectable, making it easier for such patients to get further
treatment. Pre-hospital triage, which is made possible by telemedicine services, facilitate recovery
even when patients are home.
b. Explain how an interoperable hospital environment facilitates a more effective clinical care (at a
hospital) services provision for a chronic patient with insulin dependent diabetes.
An interoperable hospital environment uses innovative devices in the management of
diabetes, thus making it easy for nurses and physicians to provide specified care to patients. Some
innovative devices such as insulin pumps and glucose meters generate a lot of patient data that can
be used to provide services to diabetic patients (Silk, 2016). in an interoperable environment, these
devices transfer data to several other devices that have software that then analyzes data. A hospital
that facilitates device interoperability uses devices that have the capacity to exchange information,
to correctly interpret that information, and to use it correctly. Although not all devices used in the
provision of care to diabetes patients facilitate interoperability, the ones that allow enhancing the
quality and timeliness of care provided to chronic patients with a diabetes type that is dependent on
insulin, for example, a patient may be issued with a smartwatch that monitors glucose levels and
alerts them in a timely manner when the body needs more insulin.

c. Explain how the Electronic Health Record would facilitate effective care to improve patient
outcomes in long term care facility.
EHR systems that have been integrated with a variety of alerts into clinical decision support
and clinical workflows. Alerts provide useful and lifesaving updates and reminders to nurses and
caregivers who are taking care of chronic patients (Kruse et al., 2017). EHR alerts such as
reminders for insulin administration for diabetes patients or monitoring of glucose levels and
checking of body weights for cardiac patients helps streamline efficiency and coordinate care when
nurses are taking care of many needy patients. Since some patients in these facilities are aging,
reminders help ensure that patients whose memory is affected get their daily dosages as required.
Besides, the implementation of EHRs in long term care facilities improves patient outcomes
through improved quality of care and saves the cost of delivering care in the long run. Errors in a
long-term care facility or any other healthcare facility are costly and can even lead to loss of lives.
The implementation of EHRs minimizes errors, consequently improving patient safety.

References

Bowman, S. (2013). Impact of electronic health record systems on information integrity: quality and
safety implications. Perspectives in health information management, 10(Fall).
Caldarola, P., Gulizia, M. M., Gabrielli, D., Sicuro, M., De Gennaro, L., Giammaria, M., … &
Menotti, A. (2017). ANMCO/SIT Consensus Document: telemedicine for cardiovascular
emergency networks. European Heart Journal Supplements, 19(suppl_D), D229-D243.
Cisco. (2020). Cisco Study Reveals 74 Percent of Consumers Open to Virtual Doctor Visit.
Retrieved 6 May 2020, from https://newsroom.cisco.com/press-release-
content?type=webcontent&articleId=1148539
De Moor, G., Sundgren, M., Kalra, D., Schmidt, A., Dugas, M., Claerhout, B., … & Kush, R.
(2015). Using electronic health records for clinical research: the case of the EHR4CR
project. Journal of biomedical informatics, 53, 162-173.
Hooper, G. S., Yellowlees, P., Marwick, T. H., Currie, P. J., & Bidstrup, B. P. (2001). Telehealth
and the diagnosis and management of cardiac disease. Journal of Telemedicine and
Telecare, 7(5), 249-256.
Kruse, C. S., Mileski, M., Vijaykumar, A. G., Viswanathan, S. V., Suskandla, U., & Chidambaram,
Y. (2017). Impact of electronic health records on long-term care facilities: systematic
review. JMIR medical informatics, 5(3), e35.
Nickerson, A., MacKinnon, N. J., Roberts, N., & Saulnier, L. (2005). Drug-therapy problems,
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care service. Healthc Q, 8(special issue)), 65-72.

Silk, A. D. (2016). Diabetes device interoperability for improved diabetes management. Journal of
diabetes science and technology, 10(1), 175-177.