Healthcare professionals encounter numerous challenges and frequently experience enormous physical and psychological load in their daily workflow. In this regard, many medical organizations widely introduce various health information systems (HIS), such as CDSS, EHR, and CPOE, to support clinical staff in complicated conditions, avert potential errors, and alleviate the overall burden. Moreover, hospitals and clinics need the elaborated arrangement of patient care activities, namely, care coordination, to promote safe and efficient patient care. Therefore, this paper aims at exploring the HIS’s effect on nosocomial infections and explaining the beneficial impact of care coordination, community resources, state and governmental policies on mitigating this severe issue.
Health Information Technology (HIT)
Due to the diversity and number of faults stemming from the human factor, advanced technology support is of a real necessity for healthcare providers. In this context, Health Information System (HIS) is an innovative documentation instrument specifically designed to collect, store, transmit, and manage healthcare data to facilitate clinical workflow and boost individual and population health outcomes. Currently, the term “HIS” is polysemantic and, depending on purposes and functions, includes electronic medical record (EMR), clinical decision support (CDS), computerized provider order entry (CPOE), among others.
For example, EMR contains and displays persons’ test results performed previously and other patient-related information in digital form, thereby replacing the conventional paper-based documentation of a patient’s medical history. CDSS is a specifically developed tool that provides staff, clinicians, or patients with health information, clinical guidelines and summaries, and intelligently filtered diagnostic support to foster decision-making. Thus, HIS allows for recording and exchanging useful healthcare data to assist health providers in evaluating patients’ conditions.
The variety of HIS can bring many benefits for the population, healthcare personnel, and overall industry. First, medical providers possess straight-forward and quick access to complete and reliable information about patients’ histories, including specific symptoms, tests, and allergies, contributing to a more accurate and faster diagnosis and therapeutic decision-making process. CDS, for instance, allows medical professionals to obtain relevant and necessary information from various databases, supplying them with practical reminders about allergies, drug interactions, and other critical points.
A literature review by Feldman et al. (2018) indicates that immunization alerts provided by HIS resulted in 12 percent growth in children’s well-being during the immunization procedure. This is particularly valuable in preventing or eliminating healthcare-acquired infections (HCAIs). Besides, the study states that drug alerts caused a 22 percent decrease in medication receipt mistakes, including antibiotics use (Feldman et al., 2018). HIS also facilitates close cooperation between clinicians and patients and, in the case of need, allows doctors or nurses to connect with patients and clarify emerging issues. Finally, these systems also aid in researching by providing scholars with an immense amount of diverse, valuable data.
Nevertheless, medical organizations can face some significant issues while using HIS, which is primarily connected with its usability and interoperability. When HIS does not meet the first requirement, users may experience considerable difficulties in understanding software design and display, which can cause significant setbacks in the workflow.
In particular, the overview by Ratwani et al. (2019) of HIT’s decade utilization has identified that its usability remains suboptimal, which leads to different errors, patients’ harms, spending extra time, and clinician frustration. In this regard, Alotaibi and Federico (2017) recommend that medical providers should be highly selective when selecting technology and attentive during HIS’s implementation. In addition, sometimes, HIS has poor interoperability; that is, it cannot exchange, process, and represent the data gained from other software systems appropriately.
The HIS’s implementation can be accompanied by several barriers. The first considerable is connected with staff’s attitudes toward HIS, which can be prejudiced and adverse. In other words, the adoption of any technology usually requires personnel training and entails radical changes in the work routine, which may discourage nurses from using HIS. Another widespread obstacle arises from the substantial cost of HIS. However, Wang et al. (2018) specify that a proper implementation process can reduce cost and result in better financial performance and productivity. Finally, excessive reliance on information technologies can impede the cultivation of critical-thinking and decision-making skills, which may be met by some managers with hostility.
Care coordination (CC) is an elaborate healthcare strategy providing the purposive organization of patient care activities and ceaseless information exchange among all stakeholders to deliver safe and productive care. Due to such plans, medical providers can ensure that the right people are familiar with the patient’s needs and preferences beforehand, reducing medical costs and staff errors. In brief, CC aims at synchronizing the delivery of patients’ care and treatment from various health providers and specialists.
To ensure effective CC, medical professionals should set four main priorities: patient support, accountability, relationships, and connectivity. Patient support implies organizing a specific team to help patients and their caregivers during referral and transition. Accountability assumes determining a primary care clinic responsible for care coordination and designing a tracking system that manages referrals or transitions. Relationship priority means developing agreements with leading hospitals, specialist groups, and community agencies based on shared goals and the best intentions for the patients’ care. Connectivity requires introducing HIS that contains shared electronic health records and a standardized information flow process.
Over recent decades, scholars have conducted numerous studies on evaluating CC plans and defining their benefits. For instance, a study by Hoyer et al. (2018) concluded that CC interventions reduced the 30-day readmission rates and emphasized the importance of the relevant interventions for difficult-to-reach patients. Moreover, a systematic review by Conway et al. (2019) revealed that CC plans were frequently associated with much better patient and health service outcomes, especially when nurses were engaged in active, in-person interactions with patients. Khullar and Choksh (2018) indicate that CC interventions can notably curtail local healthcare costs. Concerning nosocomial infections, CC plans decrease the risk of contamination by reducing patients’ hospital stay and unnecessary contact with other people.
State Board Nursing Practice Standards and Governmental Policies
In the USA, all states and distinct territories own specific licensing and regulatory bodies known as Boards of Nursing (BONs) forming the National Council of State Boards of Nursing (NCSBN). The NCSBN gathers governmental agencies to address the issues of patients’ safety and welfare, public health, and nursing licensure examinations jointly, regulating nursing practice and education.
According to the Nursing Practice Act (NPA), BONs guarantee the quality of care delivered by licensed nurses, thereby protecting public health (Huynh and Haddad, 2020). NCSBN also incorporates telehealth regulations in its strategic plan and promotes telehealth nursing practice by providing recommendations and statistics and determining safety and quality standards (National Council of State Boards of Nursing, 2021). Besides, the HAI Action Plans contribute to federal and state coordination care attempts to prevent HAIs by sharing resources, best practices, and lessons retrieved from collective clinical experience.
It is also worth mentioning the significant roles of the Health Insurance Portability and Accountability Act (HIPAA) and Health Information Technology for Economic and Clinical Health (HITECH) Act. The acts establish compulsory confidentiality, integrity, availability requirements for all electronic health information that medical organizations should comply with (“HIPAA and HITECH data security requirements,” n.d.). For example, access to healthcare-related information should be executed through personal passwords and advanced encryption of data. Additionally, organizations should have reserve databases to provide backup data storage and prevent information loss. Finally, these policies require nurses to behave with patients’ and organizations’ data carefully and responsibly to avert information leakage.
Ethical principles acquire critical importance since trust in healthcare programs, technologies, and the medical profession directly depends on them. The prime ethical decision while delivering health intervention is beneficence, that is, the absence of deliberate harm or malignity. Benevolence also means that healthcare providers choose medical practices that favor patients’ best interests and well-being (DeCamp et al., 2018).
The second essential ethical principle is respect for patients’ values, privacy, and needs, requiring professionals to involve patients in decision-making and give a clear, evidence-based presentation of benefits and risks of care choices. Finally, the third integral ethical imperative is equity and justice towards all people irrespective of their racial, social, and sex affiliations in terms of medical resources distribution.
In summary, the paper has examined the HIS’s effect on nosocomial infections and explained the beneficial impact of care coordination, community resources, state and governmental policies on mitigating this severe issue. HIS replaces the traditional paper-based documentation of a patient’s medical history and provides medical providers with health information, clinical guidelines, and diagnostic support to foster decision-making. The most serious issue connected with HIS is its usability that requires comprehensible design and display. CC is typically associated with better patient and health service outcomes, especially when nurses maintain active, in-person interactions with patients. BONs, HIPAA, and HITECH define and regulate nursing practice scope regarding patient privacy and teleservice.
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