Clinical Information System Evaluation - Term Paper Example

?Synopsis: This is a ten page APA citation style research paper with sixteen works cited. The objectives of this research paper are the following To define the evaluation of clinical information systems. 2) To describe the reasons for performing the evaluation. 3) To describe who is involved in the evaluation and why. 4) To discuss the challenges in evaluating clinical information systems. 5) To propose measurement techniques/ tools for clinical evaluation systems. 6) Proposal and defense of a concrete and measurable evaluation matrix for electronic system implementation at the time of implementation, at six months after the implementation and at one year after the implementation. Abstract This is a clinical evaluation of information systems. There are sixteen works cited. The objectives of this clinical evaluation are: 1) To classify the assessment of clinical information systems. 2) To provide a description of the motivations for performing the evaluation. 3) To distinguish who is the interested party in the assessment and why. 4) To examine and explore the difficulties of assessing clinical information systems. 5) To recommend assessment strategies and implements for the clinical evaluation of information systems. 6) Propose and defend a measurable evaluation matrix for electronic record system implementation at the time of implementation, at six months after implementation and at one year after implementation. There has been a significant amount of research across many fields of study (i.e., communication sciences, behavioral sciences, sociology, administration and organizational psychology) which may be adapted to hospital information technology elements. The focus of the clinical evaluation is on the elements which would enable greater understanding of hospital internet technology motivations. This is due to the perceived under application and misapplication of hospital information technologies (HIT) and the patient safety outcomes which are a result. It is of tremendous significance to comprehend that deficient system planning, by means of its effect on motivation, is the focus of patient safety outcomes (IOM, 2000; IOM, 2004; IOM, 2005). Inadequately planned systems enable behaviors which may be detrimental to the hospital’s expectations, regulations or objectives. The scope of this critical evaluation is to synthesize a matrix which enables the comprehension of hospital and information technology motivations. This is in order to better understand the hypotheses which support the matrix and the matrix itself, and to provide clear insight into outsid3e elements which are system planning aspects. A few of the hypotheses are formulated in three classifications which are: 1) behavioral hypotheses, which explain what motivates personnel to apply or misapply hospital information technology (HIT); 2) theories of choices and options which examine and explore the reflexive and intentional processes which occur when health care decision makers are planning the implementation of hospital information technology (HIT); 3) hypotheses of the planning and implementation processes, which provide a hypothetical foundation in where the user community applies technology and the outcome of this application can justify future hospital information technology (HIT) motivations. Each of the classifications contain various hypotheses, notwithstanding, these classifications may be subdivided into fields of study. In this critical evaluation, all of these hypotheses must be considered a part of the greater whole. This is the discipline of hospital information technology (HIT) (Holden & Karsh, 2006). In reviewing the candidate’s objectives, it was demonstrated that information technology (IT) is a significant element because it is a means of minimizing errors. A description of the elements of error was examined; it is composed of all of the instances when an intended approach of the mental or physical endeavors does not yield the desired results. There are also instances when the error cannot be justified by the intervention of a third party. There is a requisite for greater comprehension and to conceptualize in greater clarity. The concept of error has no logical basis until the desired result is identified, the desired result being the objective of the endeavor. These reflections allow for the derivation of Norman and Zuboff’s concept of information technology as an enabling factor, a factor which should enable knowledge collection. Considering the user community at the health care facility, we reflected upon the primary aspects that information technology should convey: Herbert Simon offered some direction when he observed that the solution of a dilemma is in its representation, whereas it may be clearly and objectively examined. Objective focus is an important element in overcoming the problem, the clear and concise examination of the details of a circumstance which pertain to the inquiry. After this reflection, a matrix may be constructed which includes these aspects and excludes the non pertinent items (Schulman et al., 2007). An amended candidate objective and assessment standard was introduced. Our query became to which degree does this tool facilitate the creation of an inquiry matrix? The inquiry matrix required that the inquiry itself be divided into its components. These components were essential for the health care facility’s objectives and problems. These components are: 1) the administration of accounts receivable and accounts payable. 2) The conveyance of collected and processed data, 3) Conforming to the required regulations. 4) Revision and provision of client documentation. 5) Advisory support. 6) References. 7) Performance assessments. 8) Results oriented relationships. 9) Task effectiveness and task expediency. This research allowed for the perspective that the accumulation and dissemination of data elements is the beginning of the required responsibility. The accumulation of data is supported by a format of direct questions which are designed to facilitate the hospital’s mission. These implementations must satisfy these questions by their ability to withstand inspection: Which aspect of IT application or client maintenance does this implementation facilitate our accumulation of knowledge? What is the objective of this implementation? What are the anticipated outcomes? How do we classify the outcome which may be demonstrated? What may be the change in procedure, once that this data is accumulated and disseminated? What is the proposed performance goal that is to be sought for the assessment variable? This foundation of inquiry is directly related to the clear perceptions as to directives and results (Schulman et al., 2007). As a complement to both back and CDS system capacities and front end implements, it is also necessary to distinguish between EHR system aspects as planned and the available resources as applied. A certain mode of clinical support is feasible within a system; whether the end user community has accessibility is greatly reliant upon the application of the system. A hospital may make the decision whether or not to purchase particular CDS from the EHR supplier if they may be procured otherwise, or what was procured may be limited in its application. Research has demonstrated that the identical industrial systems may be implemented with a variety of outcomes. Research performed by the Leapfrog Group demonstrated the examination of an electronic physician’s order entry systems (CPOE) as applied. It was discovered that each industrial system which was assessed failed to pass the examination as applied in at least one facility, and did pass the examination in another facility. This is evidence which attests to the range of possible outcomes of the procedures which involve configuration and implementation (Wright et al., 2011). An expanded comprehension of CDS systems on the back and front end, planning and application stages is of great importance to future investigation and application. The present systems have not been classified within these stages. The evaluation of back end capacities as applied inside of an internally applied EHR is performed to exercise the scientific categorization of back end capacities. These are requisites to the inception of practical front end tools. Research which followed on back end systems as planned, evaluated their accessibility by means of various industrially obtainable EHR systems. This area of scholarly investigation has not yet been conducted on the front end system. The objective of the current evaluation is to designate the fourth and final step front end tools as anticipated (Wright et al., 2011). Policy makers may be deviated into following the preconception that technology is without fault and should be completely incorporated into the health care system. The other side of the coin is that policy makers may agree with the premise that the acquisition of information technology should be founded upon its effectiveness, with regards to research or positive patient and economic outcomes (Heathfield et al., 1998). Clinical; information systems enable the medical and nursing personnel in their daily endeavors by means of facilitating the accumulation and dissemination of knowledge. They operate via the intranet in hospital facilities as well as through the communication systems. The evaluation of clinical data is of increasing significance as more data is applied in the daily endeavors of medical and nursing personnel. There are three points of inquiry which should be addressed: What should be measured? How to measure? How should the results be disseminated? ‘Clinicians would be unwise to use any system unless it has been shown to be safe and effective’ (Van Bemmel & Musen, 1997; Burkle et al., 2001). The objective of this research is to introduce a new foundation for hospital information systems (HIS) evaluation, which encompasses a strong impression and is a suitable quality for the technological, human and organizational perspectives. The foundation which is to be introduced (HOT – fit) would be of potential utility in providing a more comprehensive research opportunity. It is feasible that this foundation (HOT- fit) will enable researchers and clinicians in deciphering the intricacies of HIS evaluation. This new foundation is constructed upon the previous foundations of IS assessment, primarily the IS Success Model and the IT- Organization Fit Model. In constructing this foundation, the difficulties and systems of HIS assessment are illustrated. In addition, the models of IS success and IT organization are reflected upon in order to assess their potential utility in the modification of Health Information Technology (Maryati et al., 2006). Traditional outcome founded assessments encompass measurement of the economic influence, precision, safety and dependability of implemented information systems. In this type of research, contrasts and assessments are achieved between an experimental group of respondents with the application of technology and a control population. Traditionally, this research has led to an objective which was anticipated. The expected measures are compared to actual assessments after the system has been implemented in a setting (Kushniruk & Patel, 2004). In the comprehension of IT as a component of the data accumulation and data dissemination system of an organization, it is apparent that an assessment will not focus solely upon the hardware or the software, but on the relationship between the user community and the setting. It is an assessment of a concept. The assessment requirement is not limited to the comprehension of computer technology, it is also the social and psychological domains which influence and are influenced by the technology. The prevalence of IT relies upon how it is integrated with the clinical endeavors, the manner in which the technology was introduced into the organization and the quality of data accumulation and data dissemination. Other factors which should be considered are the extent of the application, the behavior of the user community and the user community’s application of the system. This type of assessment is more comprehensive than the assessment of a pharmaceutical or the introduction of a medical procedure (Ammenworth et al., 2003). The extent of the assessment has some significant outcomes. The presentation of ITY requires time. It is not sufficient to apply the technology and to assess the results. The user community and their endeavors require sufficient time in order to get acquainted with the new implements and to thoroughly maximize the opportunity. Hardware or software improvements which are performed in order to modify (i.e., IT accessibility or usage) may also be amended and so may their outcomes. Hence, assessment outcomes can be modified within the introductory application. For example, a research assessment of the extent of nursing paperwork after the presentation of IT discovered modifications of several measures of excellence after ninety and two hundred and seventy days of application. For a measurable assessment, the personnel may be required to expend more time than in clinical trials (Ammenworth et al., 2003). After the initiation of the IT, the subject is undergoing modification. The application of IT may be influenced by alteration in the organization or in the personnel of the organization. Requiring that the environment be static during the assessment period is not feasible. Hence, after concluding research, the setting may have been significantly altered in contrast to the initiation of the research. This would render the outcomes useless. It is very difficult to attain a stable circumstance in a dynamic hospital setting. This makes the assessment outcome reliant upon the period in time when the assessment occurred (Ammenworth et al., 2003). Every IT system is distinct. The information technology applied may be similar in some environments, the endeavors of the user community and the accessibility may be distinct. Consequently, the presentation of its initiation as well as the behavior of the user community must be considered. Hence, the identical information technology may be presented and the lout comes may differ. The influence of these aspects on the outcome of an assessment study is often difficult to separate. The aspects which affect the assessment can be partially controlled. This creates the problem of external validity; many research studies may only be applicable to certain institutions in conjunction with their data accumulation and dissemination system (Ammenworth et al., 2003). The assessment of information systems excellence or efficiency is important to the comprehension and importance of IS management’s endeavors and IS investments. The D&M IS Success Model is founded upon theoretical and evaluative research, the application of IS has been adapted and has evolved. By the same means, scholarly investigation into the assessment of the efficiency of IS has evolved as well (Delone & McLean, 2003). The research has been evaluated according to the perspective of DeLone & McLean. Following this perspective, the parameters of success which are categorized for administrative information systems are pertinent to patient care systems also. DeLone and McLean suggested that in order to distinguish the successful assessments of management information systems into six distinctions: 1) The state of excellence of the system 2) The state of excellence of the information 3) Application of the information system 4) User fulfillment 5) Individual influence 6) Organizational influence Inside of each distinction there are several characteristics which could be defined as successful (Van Der Meijen et al., 2003). The implementation of hospital information systems is of tremendous impact upon the well being of the patients who are clients of the hospital. The formatting of prescriptions is a task which serves as a core activity in clinical endeavors. The endeavor of the prescription of medications in a clinical treatment setting is realized under the constraints of time, pressure and usually with inadequate diagnostic data. Infection is a recurring difficulty and the most frequently prescribed remedies are antimicrobial medications. The ingestion of antibiotics has been perceived as a significant objective for the study of medical decision making processes. Research has demonstrated a measurable rate of antibiotic misprescription which is 41% to 66% at university medical centers (Sintchenko & Coiera, 2003). Adequate information resources are essential for the health care decision maker. There is a growing need for increased efficiency and productivity in this area. The endeavor of antibiotic prescription is a mentally challenging endeavor. The afflictions of ventilator associated pneumonia (VAP) sepsis and central venous line infection (CVL) require a formidable cognitive effort. Each of these infections requires a large dosage of antibiotics and special treatment perspectives. Each of these afflictions has a limited scope of diagnosis, which requires supplemental hospital information systems support (Sintchenko & Coiera, 2003). Prescription medication over dosages and adverse drug events are frequent, expensive and significant clinical difficulties. In any given year, it has been assessed that 770,000 patients are impaired or perish from adverse drug events (Kaushal et al., 2003). Pharmaceutical prescriptions are important in health care. These pharmaceutical expenses compose 13% of health care expenses and are being ingested by 65% of health care clients. Mistakes in the ingestion of pharmaceutical medications occur frequently, the outcome is that the patient suffers injury. These liabilities could be avoided with superior hospital information technology. E- Prescribing, which is the prescription of medications by electronic media; present the possibility of minimizing prescription medication errors and to modify health care efficiency. A large number of organizations are endorsing e- prescribing. There are currently preparations being made for outpatient prescribing by electronic media. The organizations which select e- prescribing may choose from a wide selection of e- prescribing possibilities. However, there is no established foundation to support their elections (Bell et al., 2003) Conclusion There is a tremendous need in the clinical setting for improved hospital information systems. The medical decision makers are responsible for patient outcomes and may be held responsible for misprescribing medications. The hospital environment is a system which is composed of interdependent components. The hospital information system is of tremendous significance to the health care decision makers. The outcome of the patients and the economic well being of the hospital depend on the effectiveness of the hospital information system. Proposition and Defense of a Measurable Evaluation Matrix for Electronic Record Systems Implementation A new candidate objective and assessment standard was introduced. Our query became to which degree does the tool facilitate the creation of an inquiry matrix? The inquiry matrix required that the inquiry itself be divided into several components. These components were essential to the health care facility’s objectives and problems: Administration of accounts receivable and accounts payable Conforming to the required regulations The conveyance of collected and processed data Provision and revision of client documentation Advisory support References Performance assessments Results oriented relationships Task effectiveness and task expediency The foundation of inquiry is directly related to the clear perception of as to directives and results (Schulman et al., 2003). As a complement to both back and CDs system capacities and front end implements, it is also necessary to distinguish between EHR system aspects as planned and the available resources as applied. Research performed by the Leapfrog Group demonstrated the examination of a computerized physician’s order entry system (CPOE) as applied. It was discovered that each industrial system which was assessed failed to pass the examination as applied in at least one facility and did pass the examination in another facility (Wright et al., 2011). At the time of implementation, the user community in a hospital setting would be the first to notice any measurable results. What would be proposed at the time of implementation of the electronic record system is a survey to be taken at the time of implementation. This survey would be conducted at random with a sample population initially. At six months, another survey would be taken, using a larger population than the initial sample group. At one year of implementation of the electronic records system, a third survey would be conducted and the original sample group would be surveyed (statpac.com). This survey would ask questions one a Likert scale with 0 being the rating if no significant improvements were noticed and 5 being the rating if there were a significant amount of improvements. Any other improvements in the electronic record system implementation would be assessed between 0 and 5 on the survey (socialresearchmethods.net). For example, a research assessment of the extent of nursing paper work after the implementation of an electronic records system discovered modifications of several measures of excellence after ninety days and two hundred and seventy days of implementation. For a quantitative assessment, the assessment personnel may be required to expend more time than the normal reaction periods at clinical trials in order to assess the improvement of an electronic records implementation (Ammenwerth et al., 2003). Works Cited Ammenwerth, E.(2003)”Evaluation of health information systems- problems and challenges International Journal of Medical Informatics Bell, D. (2004) “A Conceptual Framework for Evaluating Outpatient Electronic Prescribing Systems Based on Their Functional Capabilities J Am Inform Assoc: M1374 Burklej, T. (2001) “Evaluation of Clinical Information Systems What Can Be Evaluated and What Cannot”? Journal of Evaluation in Clinical Practice 7(4): 373-385 Delone, W. (2003) The Delone & McLean Model of Information Systems Success: A Ten Year Update Journal of Management Information Systems, Vol. 19(4): 9- 30 Heathfield, H. (1998) Evaluating information technology in health care: barriers and challenges BMJ 316(7149): 1959- 1961. June 27, 1998 PMC1113407 Holden, R. (2009) A theoretical model of health information technology usage behavior with implications for patient safety Behav. Inf. Tecnol., 28(1): 21-38 Kauchal, R. (2003) Effects of Computerized Physician Order Entry and Clinical Decision Support Systems on Medication Safety Arch Intern Med. 2003; 163: 1409-1416 Retrieved from: Kushniruk, A. (2003) Cognitive and usability engineering methods for the evaluation of Clinical information systems Journal of Biomedical Informatics 37(2004): 56- 76 Retrieved from: Likert Scaling Retrieved from: Maryati, M. (2006) Toward a Framework for Health Information Systems Evaluation Proceedings of the 39th Annual Hawaii International Conference on System Sciences, Hawaii Schulman, J. (2007) Discovering How to Think About a Hospital Information System by Struggling to Evaluate It: A Committee’s Journal J Am Med Inform Assoc 14(5): 537- 541 Sintchenko, A. (2003) “Which clinical decisions benefit from automation? A task complexity Approach. International Journal of Medical Informatics 70: 309- 316 Survey Sampling Methods Retrieved from: Van Der Meijden, M. (2003) “Determinants of Success of Inpatient Clinical Information Systems: A Literature Review” J Am Med Inform Assoc 10(3): 235- 243 Wright, A. (2011) Development and evaluation of a comprehensive clinical decision support taxonomy; comparison of front end tools in commercial and internally developed electronic health record systems Journal of the American Medical Informatics Association 18(3): 232- 242 Read More