CASE Study: Chapter 19..

Last month you were hired with the title Chief Health InformaticsSpecialist at an independent community care hospital with 350 beds. The hospital includes a comprehensive outpatient clinic, a rehabilitation center with both impatient and outpatient services a cardiac care center, and an emergency room. In addition, four family health centers are located throughout the community. More than 930 primary care and specialty physicians are associated with the hospital, which has a staff of just over 2000 employees. The hospital is moving ahead with installing an HER system following the Meaningful Use criteria.

The hospital has a working relationship with a major academic medical center located 23 miles aay. Acute care patients who need more extensive treatment are usually transferred to the medical center. These are often emergency situations and data are freely shared between institutions with the best interests of the patient in mind.

Located directly beside the hospital is a 194-bed skilled nursing home. While the nursing home has its own medical staff consisting of a physician and two nurse practitioners, patients needing consults or additional care are usually seen at the hospital with follow-up at physician's offices. While the nursing home, most of the physicians' offices, and the hospital are independent institutions there is a long history of sharing health relate data when treating patients who live at the nursing home and are seen at the hospital or in the physicians' offices. This coordination has been a general benefit for a number of patients. It appears that most patients have signed a form giving the hospital permission to send information to the nursing homes. However, these forms have been stored in individual offices so it is difficult to determine who has signed what forms and what permission has or has not been given to share information between the nursing home, hospital and independent medical practices.

Chapter 19

• Describe: What additional information is needed to clarify what problems may exist, and what changes may be needed in terms of shared data between the institutions?
• Examine: Can the EHR system currently being installed be used to share data between these institutions more effectively and securely? If yes, how would this be done?
• Compile: In your position as Chief Health Informatics Specialist, how would you go about determining whether there are other potential security issues that now need to be managed by the hospital?

Case Study Chapter 21

A tertiary care center in the western U.S. has an installed base of electronic health records supported by Cerner Corporation for inpatient areas and by EPIC for outpatient areas. Other technology includes a suite of about 300 different applications supported by the IT department. The current environment, while including robust capabilities such as computerized provider order entry, is siloed with information. Healthcare providers complain that they have difficulty obtaining the big picture of the patient across systems and they have to remember information located in disparatesystems. They are burdened with integrating information themselves. Not only is this time consuming, it is potentially prone to error. Providers have developed numerous work-arounds to the different systems 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 hand-offs.

The organization responds by developing a vision for the future that centered on the concept of knowledge management (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 organization begin to address KM and improve the user experience, they are employing the same tactics described in this chapter

Chapter 21

• Describe: Assume you are the leader of the KM effort. Where would you start to improve the user experience?
• Examine: 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 the issue?

• Compile: The institution is in the process of purchasing new physiologic 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 purchasing process.