Wk4 Case Studies Assignment
Wk4 Case Studies Assignment
Prior to beginning work on this assignment review Chapters 21, 24, 25 and 27 of Health Informatics: An Interprofessional Approach.
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Select two of the case studies located in the course textbook at the end of Chapters 21, 24, 25, or 27, and answer the questions associated with those case studies in a cohesive, APA-formatted paper.
Chapter 21:
- Recommend where would you start to improve the user experience.
- Pharmacists are asking for your help due to struggles with non-integrated systems. What methods would you use to examine this issue?
- Describe how usability should be incorporated as part of the purchasing process for this institution.
Chapter 24:
- Assuming that you are the clinical content manager leading reporting efforts, recommend the approach you would take to address the reporting problem.
- Describe how the effort of changing preadmission testing data collection from paper to the Electronic Health Record System (EHR) can be approached.
- Using Patient Safety and Quality Research Design (PSQRD) methodology, identifying area of quality improvement in the hospital setting, recommend a process plan and identify the expected outcomes.
Chapter 25:
- Discuss whether the proposed course of action would be permissible under current fraud and abuse regulations.
- Explain common issues related to the use of EHR and healthcare fraud.
- Discuss how the proposed EHR could potentially facilitate healthcare fraud.
Chapter 27:
- Describe the timeline of the program and its potential financial impact on the individual healthcare providers who are involved in meaningful use.
- Explain the process that providers must complete to avoid payment penalties.
- Explain the timeframe for the provider to achieve modified stage two and stage three measures.
The Week 4 Case Studies Papers
- Must be three to four double-spaced pages in length (not including title and references pages) and formatted according to APA style as outlined in the Ashford Writing Center (Links to an external site.)’s APA Style (Links to an external site.) resource for each case study.
- Must include a separate title page for each case study with the following:
- Title of paper including the chapter number and case study title
- Student’s name
- Course name and number
- Instructor’s name
- Date submitted
For further assistance with the formatting and the title page, refer to APA Formatting for Word 2013 (Links to an external site.).
- Must utilize academic voice. See the Academic Voice (Links to an external site.) resource for additional guidance.
- Must include an introduction and conclusion paragraph. Your introduction paragraph needs to end with a clear thesis statement that indicates the purpose of your paper.
For assistance on writing Introductions & Conclusions (Links to an external site.) as well as Writing a Thesis Statement (Links to an external site.), refer to the Ashford Writing Center resources.
- Must use at least two scholarly or credible sources in addition to the course text.
- The Scholarly, Peer-Reviewed, and Other Credible Sources (Links to an external site.) table offers additional guidance on appropriate source types. If you have questions about whether a specific source is appropriate for this assignment, please contact your instructor. Your instructor has the final say about the appropriateness of a specific source for a particular assignment.
- To assist you in completing the research required for this assignment, view this Ashford University Library Quick ‘n’ Dirty (Links to an external site.) tutorial, which introduces the Ashford University Library and the research process, and provides some library search tips.
- Must document any information used from sources in APA style as outlined in the Ashford Writing Center’s Citing Within Your Paper (Links to an external site.)
- Must include a separate reference page that is formatted according to APA style as outlined in the Ashford Writing Center. See the Formatting Your References List (Links to an external site.) resource in the Ashford Writing Center for specifications.
Carefully review the Grading Rubric (Links to an external site.) for the criteria that will be used to evaluate your assignment.
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Chapter21CaseStudy.pdf95. Koch S, Westenskow D, Weir C, et al. ICU nurses’evaluations of integrated information integration in displays for ICU nurses on user satisfaction and perceived mental workload; 2012. Paper presented at the Medical Informatics Europe. Pisa, Italy.
96. Koch SH, Weir C, Westenskow D, et al. Evaluation of the effect of information integration in displays for ICU nurses on situation awareness and task completion time: a prospective randomized controlled study. Int J Med Inform. 2013; 82 (8):665–675.
97. Lowry SZ, Quinn MT, Ramaiah M, et al. Technical Evaluation, Testing and Validation of the Usability of Electronic Health Records. Rockville, MD: National Institute of Standards and Technology; 2012.
98. Tullis T, Albert B. Measuring the User Experience: Collecting, Analyzing and Presenting Usability Metrics. New York: Elsevier; 2008.
DISCUSSION QUESTIONS
1. Discuss critical user experience issues in your own organi- zation. Describe one example in more detail.
2. Outline how to apply the heuristic evaluation technique to analyze where the major violations exist for a selected health IT product.
3. Search the internet for current policies on the user experience in health IT by searching the Centers for Medicare and Med- icaid (CMS), the Office of the National Coordinator for Health Information Technology, and the National Institute of Standards and Technology websites. Analyze how one of these current policies will affect your organization.
4. Outline a usability test for one module of your current EHR. Include the elements discussed in the chapter in your proposed usability test. Describe why you chose the methods you did.
5. Your organization is planning to purchase new physiologic monitors for the adult ICUs. You are the clinical/informat- ics person assigned to this project. Describe how you would include usability in the purchase process. Outline participants, methods, and tasks to be tested.
CASE STUDY
A tertiary care center in the western United States has an installed base of EHRs supported by Cerner Corporation for inpatient areas and by Epic for outpatient areas. Other technol- ogy includes a suite of about 300 different applications sup- ported by the IT department. The current environment, while including robust capabilities such as computerized pro- vider order entry, is “siloed” with information. Healthcare pro- viders complain that they have difficulty obtaining the “big picture” of the patient across systems and they have to remem- ber information located in disparate systems. They are bur- dened with integrating information themselves. Not only is this time consuming; it is potentially prone to error. Providers have developed numerous workarounds to the different sys- tems in ambulatory and inpatient areas, including “ shadow” files for patients they see frequently. Nurses complain that they have to “jump around” the inpatient system to find information they need for activities such as patient handoffs. The organization responds by developing a vision for the future that centered on the concept of knowledge manage- ment (KM). This concept is defined as the systematic process
of identifying, capturing, and transferring information and knowledge that people can use to create, compete (with other organizations), and improve. A crucial aspect of KM is improving the user experience. As the leaders in the organi- zation begin to address KM and improve the user experience, they are employing the same tactics described in this chapter. Wk4 Case Studies Assignment
Discussion Questions 1. Assume that you are the leader for UX for your discipline
in your organization. Where would you start to improve the user experience?
2. Pharmacists supporting the ICUs are asking for your help to improve their situation (their user experience) because they are forced to use nonintegrated systems. What methods would you use to examine this issue?
3. The institution is in the process of purchasing new phys- iologic monitors for their step-down unit. Describe how usability should be incorporated as part of the purchasing process. Design a brief usability test to support the pur- chasing process. Wk4 Case Studies Assignment
369CHAPTER 21 Improving the User Experience for Health Information Technology
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Chapter27CaseStudy.pdf
Value-Based-Programs/MACRA-MIPS-and-APMs/MACRA- MIPS-and-APMs.html. Accessed April 16, 2016.
17. Cragun E. The Most Important Details in the SGR Repeal Law. The Advisory Board Company; 2015. https://www.advisory. com/research/health-care-advisory-board/blogs/at-the-helm/ 2015/04/sgr-repeal.
17a. Medicare Access and CHIP Reauthorization Act of 2015.[ Public Law No: 114-10]. https://www.congress.gov/114/plaws/publ10/ PLAW-114publ10.pdf. Accessed August 3, 2016.
18. American Hospital Association. Physician Payment Reform: What is MACRA. http://www.aha.org/advocacy-issues/ physician/index.shtml. Accessed April 16, 2016.
DISCUSSION QUESTIONS
1. Describe how the NwHIN is facilitated by the MU program.
2. List and describe the federal agencies and committees that are responsible for facilitating electronic exchange of health information in the United States.
3. What are the current time periods for the MU program under Medicare and Medicaid, respectively?
4. How do providers avoid payment penalties for failing to satisfy MU requirements?
CASE STUDY
A health system owns and operates a hospital and employs primary care physicians, general surgeons, and oncologists. The hospital purchased a surgical practice in 2012. Part of the purchase of the practice included the purchase of the elec- tronic medical record system that was a certified EHR. In Jan- uary 2014, the hospital transitioned the primary care physicians, surgeons, and the radiologists in the hospital to a new certified electronic health record, the implementation of which was completed 10 months later in October 2014. The physicians did not satisfy the MU criteria from January 1, 2014, to December 31, 2104, because of the transition to a new certified EHR system. In addition, in 2015 the hospital’s electronic medical record vendor informed the hospital that it would not be able to satisfy the Stage 3 interoperability and technology standards by January 2018. Wk4 Case Studies Assignment
Discussion Questions 1. Determine which (if any) of the following physicians will
be subject to a payment penalty in 2015: (a) primary care physicians, (b) surgeons, or (c) radiologists.
2. Describe the timeline of the program and its potential financial impact on the individual healthcare providers who are involved in MU.
3. Describe the process the physicians must complete to avoid the payment penalties.
4. Describe the time frame for the provider to achieve mod- ified Stage 2 and Stage 3 measures.
5. Discuss what the hospital must do to achieve the MU objectives for interoperability.
473CHAPTER 27 The Health Information Technology for Education and Clinical Health Act
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Chapter25CaseStudy.pdf
DISCUSSION QUESTIONS
1. How does the U.S. regulatory framework work to ensure patient safety?
2. Describe two express powers and one implied power given to the federal government in the Constitution that has implications for health-related technology.
3. Name two federal agencies and describe their role in the regulatory oversight of health IT.
4. What are the different types of healthcare fraud and abuse statutes?
5. What are three major issues with mHealth applications and wearable devices?
6. How are patient privacy rights impacted by labor and employment regulations?
CASE STUDY
A 50-member multispecialty medical practice has decided to implement a new EHR system. The practice chooses the new EHR system based on both clinical functionality and the prac- tice management and billing functionality that is demon- strated specifically because the EHR sales representative repeatedly states that the new EHR can reduce patient visit times (thus increasing the number of patients a provider can see in a day) and increase reimbursement to the practice by helping the practice “correctly code” to the highest E/M (evaluation and management) code available. While the healthcare providers and practice administrator are impressed with the new EHR, the new system will cost $2,000,000 for the EHR software and $250,000 for the asso- ciated hardware, plus yearly maintenance fees of $125,000. These costs exceed the practice’s budget. One day, while meet- ing with the vice president of a community hospital, the prac- tice administrator mentions this issue and how the practice will have to delay purchasing an EHR due to the budget con- straints. The VP states that the hospital will be happy to cover 85% costs for the new EHR system if the practice agrees to (1) consider their hospital first before sending a patient to any
other potential competitors including not just ER or inpatient admission but outpatient diagnostic services and hospital- owned specialty practices, (2) include the hospital’s logo on patient education materials printed from the system, (3) use the hospital’s template for designing data entry pages for practitioners, and (4) use the hospital’s template for the patient portal in the design of their patient portal. Wk4 Case Studies Assignment
Discussion Questions 1. Explain the basic requirements for a hospital to help
finance the purchase of an EHR system by a provider. 2. Discuss whether the proposed course of action would be
permissible under current fraud and abuse regulations. 3. If the structure of the proposed donation is not permitted
under current fraud and abuse regulations, explain what steps the parties would need to take to make the transac- tion compliant.
4. Explain common issues related to use of EHR and healthcare fraud.
5. Discuss how the proposed new EHR could potentially facilitate healthcare fraud.
435CHAPTER 25 Legal Issues, Federal Regulations, and Accreditation
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Chapter24CaseStudy.pdf
post-menopausal women with abdominal obesity. Int J Med Inform. Jan 20 2012.
61. Shade SB, Steward WT, Koester KA, Chakravarty D, Myers JJ. Health information technology interventions enhance care completion, engagement in HIV care and treatment, and viral suppression among HIV-infected patients in publicly funded settings. J Am Med Inform Assoc: JAMIA. 2015;22(e1):e104–e111. Wk4 Case Studies Assignment
62. Bowles KH, Dykes P, Demiris G. The use of health information technology to improve care and outcomes for older adults. Res Gerontol Nurs. 2015;8(1):5–10.
63. Dowding DW, Turley M, Garrido T. The impact of an electronic health record on nurse sensitive patient outcomes: an interrupted time series analysis. J Am Med Inform Assoc: JAMIA. Jul-Aug 2012;19(4):615–620.
64. Dykes PC, Carroll DL, Hurley A, et al. Fall prevention in acute care hospitals: a randomized trial. JAMA. 2010;304(17):1912–1918.
65. Fossum M, Alexander GL, Ehnfors M, Ehrenberg A. Effects of a computerized decision support system on pressure ulcers and malnutrition in nursing homes for the elderly. Int J Med Inform. 2011;80(9):607–617.
66. Fossum M, Ehnfors M, Svensson E, Hansen LM, Ehrenberg A. Effects of a computerized decision support system on care planning for pressure ulcers and malnutrition in nursing homes: an intervention study. Int J Med Inform. 2013;82(10):911–921.
67. Garrett J, Wheeler H, Goetz K, Majewski M, Langlois P, Payson C. Implementing an “always practice” to redefine skin care management. J Nurs Adm. 2009;39(9):382–387.
68. Riggio J, Sorokin R, Moxey E, Mather P, Gould S, Kane G. Effectiveness of a clinical-decision-support system in improving compliance with cardiac-care quality measures and supporting resident training. Acad Med. 2009;84(12):1719–1726.
69. Schnipper JL, Linder JA, Palchuk MB, et al. Effects of documentation-based decision support on chronic disease management. Am J Manag Care. 2010;16(12 Suppl HIT): SP72–SP81.
70. Day R, Roffe D, Richardson K. Implementing electronic medication management at an Australian teaching hospital. Med J Aust. 2011;195(9):498–502.
71. Dykes P, Carroll DAH. Fall TIPS: strategies to promote adoption and use of a fall prevention toolkit. Paper presented at AMIA Annual Symposium. 2009.
72. Schnipper JL, McColgan KE, Linder JA, et al. Improving management of chronic diseases with documentation-based clinical decision support: results of a pilot study. AMIA Annu Symp Proc. 2008;1050.
73. Ingebrigtsen T, Georgiou A, Clay-Williams R, et al. The impact of clinical leadership on health information technology adoption: systematic review. Int J Med Inform. 2014;83 (6):393–405.
74. Office of the National Coordinator for Health Information Technology. Interoperability Standards Advisory, Draft for Comment; 2015. https://www.healthit.gov/standards-advisory/ 2016.
75. The Leapfrog Group; 2015. http://www.leapfroggroup.org/home.
DISCUSSION QUESTIONS
1. The U.S. Department of Health and Human Services Agency for Healthcare Research and Quality has identified seven Portfolios of Research. The full list can be viewed at http://www.ahrq.gov/cpi/portfolios/index.html. Two of the Portfolios of Research that are of key importance to this chapter are (1) Health Information Technology and (2) Patient Safety. Describe how these two Portfolios of Research relate to the ONC’s Health Information Technol- ogy Patient Safety Action and Surveillance Plan: June 2013 (Washington, DC: Office of the National Coordinator for Health Information Technology, 2013). Wk4 Case Studies Assignment
2. What is the utility of Donabedian’s structure-process- outcome model as the basis for evaluating quality of care and patient safety associated with a health IT application? Describe two limitations. Discuss how the framework for patient safety and research design can be used to overcome these limitations.
3. Use the framework for patient safety and quality research design to create a comprehensive plan to support success- ful implementation of Bar Code Medication Administration. Wk4 Case Studies Assignment
4. The Office of the National Coordinator (ONC) is taking actions on health IT and patient safety as described in their Health IT Patient Safety Action and Surveillance Plan by improving the safe use of health IT, learning more about the impact of health IT on patient safety, and leading to create a culture of shared responsibility among all users of health IT. A description of this initiative is located at https://www.healthit.gov/policy-researchers- implementers/health-it-and-safety. Describe the implica- tions of this initiative from an interprofessional prospec- tive for either your current work setting or that of the case study presented later.
CASE STUDY
Western Heights Hospital (WHH) is a 1125-bed, 5-hospital academic healthcare system servicing central and western Massachusetts. WHH is the only designated Level I Trauma Center for adults and children in the area and is home to New England’s first hospital-based air ambulance and the region’s only Level III Neonatal Intensive Care Center. WHH launched a 5-year strategic plan with a fundamental goal of a system-wide move from a predominately paper environment to an electronic one. Phase I included
implementation of an EHR system consisting of order entry for all laboratory, radiology, and patient care orders. Addi- tionally, clinical documentation was implemented, includ- ing admission assessments and all nursing flow sheets. The nursing informatics counsel, a 25-member group of nurses representing all disciplines, developed the clinical content. The clinical content was custom built using both free text and structured data entry fields within the application. Wk4 Case Studies Assignment
420 UNIT 5 User Experience, Standards, Safety, and Analytics in Health Informatics
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Three months after go-live, hospital leadership is reporting that it is unable to report on various state and federally man- dated quality measures. These measures track healthcare qual- ity based on national standards, are compared to nationally accepted benchmarks, and are used to plan ways to improve quality. Leadership has communicated that the reports gener- ated by the system are incomplete and are putting the hospital at financial risk due to lower reimbursement rates. Wk4 Case Studies Assignment
Clinicians are eager and excited to continue to develop content in the application. However, the project’s program manager is proposing a stabilization and optimization approach and does not want to go forward with content development until the issue of reporting has been assessed and addressed.
Discussion Questions 1. Assuming that you are the clinical content manager and
lead all reporting efforts, what approach would you take to address the reporting problem?
2. Preadmission testing data are currently collected on paper. The chief of surgery has identified an opportunity to have these data collected in the new EHR system by the preadmis- sion testing area in the outpatient setting. Many of the col- lected data elements are shared with the current admission assessment. Describe how this effort can be approached. What methods can be used to implement the process?
3. Using the PSQRD methodology, identify an area of quality improvement in the hospital setting, develop a process plan, and identify the expected outcomes. Wk4 Case Studies Assignment
421CHAPTER 24 Patient Safety and Quality Initiatives in Health Informatics
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