Organizational Problem
Provide
The problems associated with charting and order entry in healthcare organizations increase the risks to patient health and lead to a violation of regulatory and quality requirements. Order entry and charting are electronic health records (EHR) elements of healthcare information systems. They serve different purposes but are interconnected in the process of work.
Charting involves managing patients’ EHR information by entering and updating data, including assessments, notes, and similar documents. Computerized provider order entry (CPOE) is an electronic system whose functions allow specialists to make orders necessary during the patient’s treatment, such as a drug order, laboratory test, or consultation with another specialist (Weiand et al., 2023). Challenges associated with collecting, recording, and storing data in electronic systems, for example, copying incorrect data, failing technology, or system inconvenience, can lead to problems in the healthcare institution.
CPOE and charting problems can cause medical errors and lead to a violation of healthcare standards. For instance, specialists should maintain four principles of clinical practice – beneficence, nonmaleficence, autonomy, and justice (Varkey, 2021). However, medical errors, disclosure of patients’ information, and other problems lead to principles violation.
The safety of patient data must be guaranteed under The Health Insurance Portability and Accountability Act (HIPAA). Moreover, information safety standards are supported by the Health Information Technology for Economic and Clinical Health (HITECH) Act. At the same time, this act emphasizes the importance of promoting and using technologies in healthcare (The Office of the National Coordinator for Health Information Technology [ONC], 2019). Thus, charting and CPOE problems can lead to risks of violating healthcare quality standards.
State
CPOE and charting issues suggest negative implications for the healthcare institute’s operation. Implementing these systems requires changing the usual workflows and starting employee training. Moreover, providers report that due to EHR usage and their slow speed, there are delays in operation and efficiency problems (Tutty et al., 2019). Records in systems often need to be more accurate and comprehensible and may contain errors due to workers copying documents to save time (Tutty et al., 2019). An influential problem is a technical malfunction, which leads to the fact that orders will not be received in the required department, or patient data will need to be clarified (Schulte & Fry, 2019). Such circumstances not only threaten patients’ health but can also cause conflicts between staff.
Evidence-Based Support
Provide
Organizations’ data and the testimonies of their employees confirm the seriousness of the problems associated with CPOE and charting. Following Honavar’s (2020) study, employees experience difficulties using these systems and report increased fatigue and a significant slowdown. Studies also register that about 40% of patient problems and diagnoses may go unnoticed by providers, distorting the assessment and reducing the effectiveness of treatment (Poulos et al., 2021). The reasons for missing such important information are the inaccuracy of records, lack of standardization, and copying of erroneous data.
Case-specific research also confirms how significant the consequences of CPOE and charting problems may be. In 2012, Annette Monachelli’s death received publicity due to a failure in the CPOE system (Schulte & Fry, 2019). The aneurysm leading to the woman’s death was not diagnosed as, despite creating the order for the test, it was not transferred to the laboratory, and the investigation of the patient’s condition was suspended (Schulte & Fry, 2019). Such evidence highlights the importance of improving the charting and CPOE processes.
Addressed
The development of information technology and its widespread use in the medical field is pushing specialists to look for solutions to the problems of CPOE and charting, for example, through improving systems and training personnel. A study by Weiand et al. (2023) demonstrates that standardizing forms in such systems can simplify information management and reduce the risk of problems.
Moreover, developers of information systems used in healthcare are constantly working to improve charting and CPOE, increasing their compatibility and efficiency (Tutty et al., 2019). Organizations, in turn, when implementing such systems, must provide support to employees and provide them with training for using information systems. Thus, it is possible to use various measures to reduce the likelihood of charting and CPOE problems.
Discuss
Safely using information systems and CPOE and charting processes supports a safety culture in healthcare organizations. Several regulations and established standards are associated with the operation of these systems and their functions to keep the quality of medical services. Specifically, the use of EHR for the process of health institutions has also been developed as an initiative to enhance the quality of medical services under the HITECH Act (ONC, 2019). This law establishes security standards for patient information used in systems and regulates privacy issues (ONC, 2019). HITECH also facilitated the establishment of a particular body that specializes in introducing technology into health care and develops further practice improvement programs – ONC. Organizations improve their work and patient care to meet established standards, promoting a safety culture.
Performance Improvement Initiative
Propose
Evidence from research and its introduction into organizational practice can improve the charting and order entry processes and avoid problems that may have negative consequences for patients. It is essential to consider that the patients’ records’ accuracy and ongoing contributions to safety culture are critical standards in medical practice (Young & Smith, 2021). As a result, efforts to improve charting and CPOE and reduce errors in these processes contribute to compliance with standards.
The need to improve documentation processes and the use of EHR is also dictated by regulatory requirements – laws that protect patient privacy and support the spread of technology for medical purposes in healthcare organizations (ONC, 2019). The organization’s quality improvement plan aims to improve CPOE and charting by addressing process-related challenges and issues in line with standards and requirements. The project proposes the following steps.
Evaluation of Current Processes
The improvement of documentation processes begins with analyzing the current situation in the organization and identifying problems and obstacles that interfere with efficiency and quality. At this stage, it is crucial to use root-cause analysis methods to understand the issues affecting the charting and CPOE processes accurately. This measure will strengthen the improvement plan as it will be aimed at the exact causes of the problems.
Planning and Introduction of Improvement Measures
In case of problems with CPOE and charting, using evidence from the scientific literature, the following steps can be introduced.
Personnel Training
Technologies and information systems used in health care are constantly developing, so it is essential to maintain staff skills in using EHR and its functions, update their knowledge, and share best practices.
Standardization of Processes
Variability in health care can be a barrier to service quality and workflow efficiency, but standardization can contribute to solving the problem (“Reduce variability,” 2019). Uniform methods and standards for charting and order entry can speed up filling out and reading documents thanks to familiarity.
Use of Auxiliary Tools
Even simple tools can significantly reduce the likelihood of errors and improve CPOE and charting. In a study by Rebello et al. (2016), bar codes and checklists have been proven to help avoid opening the wrong patient card. Decision support systems built into the EHR also make it easier to document and order, giving hints and additional information, such as the recommended dose.
Streamlining
Implementing changes requires getting employees used to new responsibilities or processes. At this stage, leaders need to support teams to simplify the transition. Support can be provided with additional information, clarifications, feedback, and other methods.
Monitoring and Evaluation
After implementing the changes, it is essential to ensure that the goals have been achieved. Managers should track the impact of transformations on the organization. This measure is also crucial for the continuity of improvement processes since leaders can introduce additional amendments and improvements when identifying new problems during the assessment.
Describe
The improvement in quality in the charting and CPOE processes will affect the organization’s performance and, therefore, will be noticeable when collecting data. In particular, it is essential to pay attention to administrative data, which contains details about patients and their appeals to the hospital (Healthcare Research and Quality, n.d.). In the current project, such data can be used to assess the impact of the transformations on patients and their safety, including information on medical errors or readmissions. Moreover, data that reflects the details of the use of EHR is also helpful for tracking project progress. Notably, information systems will help collect information about whether the speed of working with charting and CPOE has increased.
Finally, after implementing improvement measures, it is crucial to determine the employees’ opinions of the use of EHR systems. They often report problems with systems, which helps to understand the challenges associated with charting and CPOE (Tutty et al., 2019). Therefore, they will be valuable sources of information for assessing the impact of the improvement project and can draw attention to additional problems and factors.
Implementation of the Plan in the Organization
Communication
Communication between departments supports the implementation of the improvement plan, as it establishes roles for employees, gives information necessary for the change process, and provides support during transformations. Several steps can be distinguished to establish communication between departments during the project. In the first phase, a change plan, its objectives, and expectations for specialists must be presented to staff (Cunningham, 2019). These measures should convince personnel of the need for improvement and clarify what the teams involved in the change should do.
At the next stage, it is crucial to appoint leaders who will support communication and manage employees’ actions during the project’s implementation (Cunningham, 2019). Another important aspect of communication is the involvement of staff in change. Communication through regular meetings, providing feedback, or messaging encourages employees to work (Cunningham, 2019). Information systems will support communication efforts when implementing the project and help strengthen channels for communication.
Data
Implementing the project, its justification, communication, and subsequent assessment of its impact require collecting significant data. It should be comprehensible and available to teams involved in changes to improve perceptions (Khasnabish et al., 2020). In this case, the data will be a tool that will support the implementation of the project.
For example, information systems will be helpful for the current project as they allow for sharing information and presenting it in a convenient form. The data shown in graphs and infographics will be more understandable to employees studying it. The data shall be presented in the project reports and distributed among the parties involved.
Initiative
The initiative to improve the charting processes and CPOE should positively affect patient outcomes. For example, such measures as the introduction of barcodes and checklists are recommended to reduce errors in drug administration (Food and Drug Administration, 2019). Accurate records and orders support this effect, reducing patient health risks and developing a safety culture. Another potential implication is the increase in the effectiveness of patient treatment. With accurate and complete health records available thanks to standardized charting, specialists can precisely assess the patient’s condition.
At the same time, an improved order entry process will support the prescribed treatment and help prevent deterioration due to a missed order. Eliminating the problem of the speed of work with documentation in the EHR will reduce the fatigue reported by employees and, therefore, will positively affect performance. As a result, a project to improve quality can bring significant benefits to the healthcare institution.
Since the plan focuses on processes within the EHR information system, this system plays a crucial role in patient care. It includes tools and subsystems that support the charting and CPOE processes. Therefore, improved work with them positively affects the operation of the entire EHR. For example, information systems support analytics in healthcare, and accuracy of documentation means the accuracy of analysis results, better forecasts, and high quality of services. Thus, the contribution of efforts to charting and CPOE is necessary to provide high-quality care to patients.
Effect
Contributing to the organization’s safety culture is another benefit of the improvement project aimed at charting and CPOE. The changes proposed within the plan contribute to reducing errors in documentation, drug administration, and treatment prescription. As a result, the safety of patients is improved, and the risk of threats is reduced.
Moreover, the accuracy of documentation supported by CPOE and charting means better quality of treatment and fewer readmissions, also maintaining safety. The project includes educating employees, which draws their attention to the importance of accurate records in EHR. Subsequently, employees are more attentive to these processes, motivated to keep accuracy in documents, and their actions support a safety culture.
Finally, the culture also depends on the ability of employees to communicate and collaborate. Communication measures proposed as part of the improvement plan contribute to more open dialogues and discussions of problems and concerns. Employees who understand the benefits of such communication can continue the necessary discussions and cooperation on other issues, developing a safety culture.
The Success of the Performance Improvement Plan
Financial
If the implementation of the project is successful, positive financial changes in the company are possible, and they can be tracked using performance indicators and special tools to assess the effect of improvement projects. Managers and leaders of organizations need to consider that any measures within the project’s implementation will require investments of resources, including financial ones, which can bring difficulties. However, if practice improves, such plans subsequently lead to financial benefits.
According to Powell et al. (2019), an economic evaluation of implementation is necessary before projects are executed as it compares the potential investments and benefits of change. Such an assessment may imply using various methods, such as the Cost of Implementing New Strategies, which aims to determine whether the expected results justify the required resources (Powell et al., 2019). Using the results of such an assessment, the administration can decide to change the project, implement it, or terminate it.
An additional measure that can be used to monitor financial changes is Key Performance Indicators. For example, the return on investment ratio may indicate whether the change brings more financial benefits or expenses (“ROA vs. ROI,” n.d.). Increased profits or cost savings can also be essential ratios indicating the positive effect on organizations’ funds due to the improvement project. Managers need to compare financial data gathered before and after transformations to notice patterns of change.
Information
Information management systems are necessary to implement a plan to improve CPOE and charting processes, as they help to collect and analyze the data needed for the project. While the project aims to improve the work with the EHR information system, the system itself is one of the tools for introducing the project. For example, the system ensures data sharing, which can be used for employees’ education and communication, providing feedback, and generating reports (Tolf et al., 2020).
Moreover, information systems collect and analyze data that will be difficult for employees to manage, such as time of work with patient records or error counts. Based on the patterns highlighted by the analysis, the change team can make decisions on changes in the project. Therefore, when developing a detailed improvement plan, it is necessary to consider the options provided by information management systems.
Processes
The practical implementation of the CPOE and charting improvement plan depends on the number of interconnected organizational processes, including change management, strategic planning, leadership, personnel education, and robust communication. Change management and strategic planning can enhance the positive effect expected from the implemented transformations (Powell et al., 2019). These processes help to better prepare for changes and foresee potential obstacles.
Moreover, change management ensures that the organization’s employees will be equipped with the necessary guidance and support through the transition. The involvement of leaders is necessary, as they manage the change process and influence which resources employees use. Lastly, comprehensive training and effective communication strategies are critical, as they provide personnel with the essential knowledge and skills to integrate novel processes. Since these processes are interlinked, their consistency is a serious factor that can impact the project’s success.
Communication
Communication is critical in implementing the plan, as it contributes to its dissemination to departments and helps clarify measures to be taken. In the current project, communication can include a variety of forms – team and in-person meetings, training sessions, communication on digital platforms, or reporting. The exchange of messages and feedback with the help of information technology is an advantage as it saves time and allows for the transmission of urgent messages. Communication helps implement the improvement plan as it provides its details and supports employees.
Conclusion
In particular, managers need to communicate with specialists to inform them about the changes being implemented, their role, and the consistency of actions. Moreover, transformations require adaptation to new conditions and often raise questions and concerns, which can be solved through communication. Thus, communication is one of the critical factors that influence the introduction of an improvement plan.
References
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