NURS FPX 8012 Assessment 5 Quality Improvement Project Plan

Name

Capella university

NURS-FPX 8012 Nursing Technology and Health Care Information Systems

Prof. Name

Date

Quality Improvement Project Plan Using Informatics/Technology

Understanding the standard of care and its components is critical for correctly assessing the requirement for advancement in a medical facility. The Cleveland Clinic in Ohio uses an Electronic Health Record (EHR) system to boost coordinated care and operational efficiency. However, it was determined that the Cleveland Clinic’s EHR system needed to be improved. EHRs offer a digital version, real-time, personalized records available to authorized persons (Uslu & Stausberg, 2021). The acute care setting of Cleveland Clinic was explored in this study. The highlighted concern is a delay in patient treatment or care delivery. The assessment addresses the issue and presents a quality improvement strategy to offer prompt care and operational stability by reducing errors at Cleveland Clinic.

Problem

The Cleveland Clinic struggled to provide patients of Ohio with immediate and extensive coordinated care in the acute care unit. It is due to an inefficient workflow. The complexity of acute care necessitates a robust, effective, and extensive framework for handling patient information. These challenges lead to more extended waiting periods for individuals needing immediate assistance and an inability to deliver prompt care.

These difficulties are crucial as they affect patients’ standard of care and the Cleveland Clinic’s credibility as a renowned medical facility. Prolonged emergency room waiting times and a lack of coordination due to inefficient workflow can result in delayed evaluations and therapies, potentially leading to suboptimal patient outcomes. Moreover, quick holistic therapy reduces the likelihood of lasting repercussions and mistakes during acute care (Pierce et al., 2020). 

NURS FPX 8012 Assessment 5 Quality Improvement Project Plan

Stakeholders are concerned about the Cleveland Clinic’s issue because the inability to provide immediate and intensive treatment in the emergency unit can result in insufficient patient care and inferior patient outcomes. These problems at the Cleveland Clinic can impact stakeholders, especially doctors, nurses, patients, and hospital leadership. It creates patient mistrust and jeopardizes their safety. The issue is significant for medical personnel as it affects their workload and drives lower-quality care (Avendano et al., 2022). The executive leadership of Cleveland Clinic supports its reputation as a top medical center.

Addressing these concerns is critical to the Clinic’s commitment to prompt and efficient care. The IT staff must examine and execute actions to streamline operations, minimize acute patient care delays, and improve the performance of acute care units (Uslu & Stausberg, 2021). This problem led to significant economic implications for Cleveland Clinic, including increasing healthcare costs and financial strain. Resolving the problem of providing timely and effective care indicates the Clinic’s dedication to individualized care. By addressing these concerns, Cleveland Clinic can boost patient trust and establish an improved reputation.

Data to Support the Problem and Trigger a Need for Change in Practice

The Leapfrog Group has given Cleveland Clinic outstanding scores, awarding an ‘A’ in every survey. Leapfrog Group’s ranking is satisfactory (Leapfrog, 2023). Medicare awarded the Cleveland Clinic a 5-star rating for patient security and efficient care. This demonstrates the Cleveland Clinic’s incredibly rigorous standards of medical care. However, the Medicare score reveals Cleveland Clinic’s issues, showing an effective treatment score of 10 out of 12.

Another rating via patient survey shows 4 out of 5 with a 25% response rate. The average rate of timely and effective care is 56%, lower than the national average of 60%. Based on Medicare’s prompt and efficient care, the Clinic has a high emergency unit volume of 60,000+ patients per year and an average duration of 179 minutes in acute care. Clinic readmission is more significant for patients with cardiac issues, with 12.9 days per 100 discharges (Medicare, 2024).

Proposed Solution

Implementing informatics and technologies contributes to the medical system’s efficiency in providing high-quality, prompt treatment to patients. Thus, establishing an improved EHR system is a successful option for resolving concerns with care service delivery at the Cleveland Clinic (Pierce et al., 2020). The proposed solution and plan are discussed below. 

Cyber Security Tools

Employing multifactor authentication, verification, and encryption guarantees that patient information is accessed and communicated anonymously in Cleveland Clinic. These tools aid in preserving patient confidentiality and trust, which is critical for security and compliance standards. Protected EHR data increases quality treatment by reducing medical mistakes, facilitating collaboration and communication, and providing real-time health data. Only authorized professionals can access the data, maintaining the standard of care (Basil et al., 2022).

Speech Recognition System

Speech Recognition (SR) can help healthcare workers document patient information rapidly and precisely, especially in emergency departments with significant patient wait times. Incorporating SR in EHRs enables real-time voice-to-text translation into health documents, offering quick proofreading. It eliminates the need for medical staff to enter data, allowing them to spend more time providing effective patient care. It minimizes time spent on administrative activities and boosts care service delivery at Cleveland Clinic (Avendano et al., 2022).

User-Friendly Interface

A user-friendly interface can help staff and patients use it more quickly and intuitively, resulting in more efficient care delivery. Designing user-friendly interfaces assists medical personnel in increasing their efficiency. Such an interface decreases cognitive burden and improves clinical process efficiency. It has an organized framework and helps the user complete work without disruptions and errors, improving the workflow in patient care (Pierce et al., 2020).

Optimized Alert System

Implementing an improved alert system in EHR offers clinical decision-support tools while enhancing patient safety at Cleveland Clinic. This alert mechanism ensures clinicians have the information they need to make informed recommendations. It also prevents pharmaceutical errors by delivering medication warnings and reminders to medical professionals and facilitating automated drug management (McGreevey et al., 2020).

Relevancy to the Solutions

The suggested actions of deploying an improved EHR tool is significantly pertinent to the difficulty of longer waits and delays in providing care at the Cleveland Clinic’s emergency unit. The suggested strategy intends to improve workflow, reduce mistakes, assure correct information exchange, and encourage coordinated treatment by giving immediate and real-time medical data (McGreevey et al., 2020). These strategies can mitigate care delays while retaining high standards of care and positive outcomes. It also supports improving the scores identified by Medicare at Cleveland Clinic, resulting in favorable patient outcomes (Pierce et al., 2020).

Potential Implementation, Challenges, and Solutions

Installing an improved EHR at the Cleveland Clinic can present several issues. A leader must identify issues and propose potential ways to address them. The most significant problems related to using updated EHR technology are:

Data Privacy and Security 

An updated EHR system in healthcare necessitates managing sensitive patient information and raising data confidentiality, privacy, and safety issues. To solve this difficulty, the Cleveland Clinic should establish robust data protection mechanisms, such as encryption, verification, authentication, and safe retention of information (Basil et al., 2022).

Integration with Existing Systems

Incorporating improved EHR technologies like SR, optimized alert systems, and user-friendly interfaces with the Cleveland Clinic’s current systems can be challenging. Implementing an improved EHR system also raises technological concerns. System adaptability and interaction with present systems must be meticulously assessed to guarantee an effortless change. Technical difficulties develop, necessitating rapid resolution and communication between the IT department and medical personnel. To solve these technical obstacles, the system should be piloted on a small scale before complete adoption, and regular communication networks must be established (Janett & Yeracaris, 2020).

Resistance to Change

 Medical staff can hesitate to adopt an updated EHR system, considering these tools modify their responsibilities. Staff who rely on the present system can be reluctant to incorporate new technologies into their workflow due to a lack of technical abilities (Jimma & Enyew, 2022). Appropriate change management measures must be implemented to overcome opposition, such as proactive stakeholder engagement, conveying the benefits of the updated system, and integrating medical staff in the decision-making process.

To combat reluctance, the Cleveland Clinic should create extensive training sessions encompassing the improved EHR system’s capabilities and functionalities. Hands-on experience and case-based studies should be provided to medical staff to become competent in using the updated EHR (Olley & Hozynka, 2023).

EHR Accuracy and Reliability

Updated EHR system configurations present challenges, leading to accuracy and reliability difficulties. The improved EHR system algorithm and configuration must be precise and robust to enable effective decision-making and patient treatment. To address reliability and accuracy issues, the Cleveland Clinic should invest in extensive validation and testing procedures and regularly upgrade EHR features based on actual utilization and feedback from medical personnel (Shaikh et al., 2021).

Regulatory and Ethical Considerations

 Implementing updated EHRs in a medical setting raises regulatory and ethical concerns, including configuration bias, transparency, and data privacy. The Cleveland Clinic must proactively engage and collaborate with medical staff, technological vendors, and legislative bodies to guarantee seamless integration and adherence to the Health Insurance Portability and Accountability Act (HIPAA) (Basil et al., 2022).

Financial and Resource Constraints

 Upgrading EHR technology necessitates significant economic strain and resource commitment. To solve this difficulty, the Cleveland Clinic can look into various funding sources, including grants or collaborations with technology firms, and emphasize EHR solutions that provide the best return on investment in care service and productivity. Additionally, forming a capable system redesign team is critical for successfully transitioning to the improved EHR system (Uslu & Stausberg, 2021). Successfully addressing these concerns and challenges will be crucial in achieving the benefits of Cleveland Clinic’s enhanced EHR system.

Role of Leaders in Change Management

Change management is an intricate procedure that must be recognized and conveyed effectively within the medical setting. Leaders are vital in change management while installing updated EHR systems to address healthcare delivery difficulties at the Cleveland Clinic. Clinic leaders can evaluate the organization’s preparation for transition by acknowledging the health environment, infrastructure, and employee capacity. Recognizing the organization’s situation enables leaders to adjust their change approach and identify solutions to overcome opposition.

When implementing the change plan for updated EHR, leaders adopt the Transformational Leadership (TL) style to utilize the organization’s strengths, including an attitude of innovation, a committed workforce, and a practical governance framework. Leveraging these characteristics, leaders develop an encouraging atmosphere for change and build confidence in stakeholders regarding adopting updated EHR in their practices (Mohammed & Al-Abrrow, 2023).

NURS FPX 8012 Assessment 5 Quality Improvement Project Plan

Cleveland Clinic administrators have implemented Lewin’s change management approach. Lewin’s paradigm has three stages: unfreeze (preparation), change (management), and refreeze (sustainability). The model’s simplicity and methodical approach justify its selection (Arabi et al., 2022). It offers an organized, step-by-step approach to regulating change, guaranteeing all relevant elements are handled, enhancing patient care, and reducing wait time. In the unfreeze stage, leaders raise knowledge about the urgency of transition and the flaws of the exciting EHR. Leaders instill an atmosphere of urgency and an ambition to improve.

A leader can tackle shift obstacles during the unfreeze stage and equip the Cleveland Clinic for a novel transition. During the transformation stage, leaders oversee the implementation of the improved EHR technology. Leaders give the tools and training and encourage employees to adopt the updated EHR successfully. Lastly, in the refreeze step, leaders reinforce the new procedures and practices connected with the improved EHR system (Arabi et al., 2022).

Proposed Communication Plan

To successfully obtain encouragement for introducing advanced EHR tools, a Cleveland Clinic executive and leaders can promote an innovative culture through communication. Leaders should highlight the significance of innovation in patient care and the role of updated EHR in driving advancement. Promoting an innovative culture can contribute to a receptive atmosphere for introducing an updated EHR system and stimulating interest and enthusiasm regarding its benefits, including prompt and efficient patient care and effective use of resources. The communication plan concentrates on the effective timing of interaction and knowledge supplied to stakeholders (Parthasarathy et al., 2021). Initially, the plan entails communicating with clinicians, nurses, technical staff, and other non-medical personnel.

Secondly, to secure acceptance, the plan will be disclosed before execution. The strategy includes crucial elements, such as concise and unified messaging regarding the positive effects of the change and the implementation processes (North et al., 2020). Moreover, verbal communication via stakeholder discussions and presentations will be utilized to communicate the change. Applying alternate methods of delivering the planned communication, including social media forums and specific group communication radio channels, is crucial to communicating for effective change implementation (Omaghomi et al., 2024). Thirdly, the communication strategy highlights the achievements of other medical centers that effectively implemented improved EHR, showcasing beneficial effects and reducing resistance. Lastly, addressing the economic implications of installing an updated EHR system entails discussing the adoption expenses and possible revenue. Highlighting lower costs, improved efficiency, and future earnings from upgraded EHR can assist in rationalizing the investment (Modi & Feldman, 2022).

Workflow Analysis

Before incorporating an upgraded EHR system, the Cleveland Clinic’s workflow was inefficient because of alert fatigue, privacy issues, increased documentation time, delayed treatment delivery, EHR system complexity, and inadequate resource allocation. Clinicians frequently reported that entering specific information into EHRs was time-consuming. Manual data entry into the EHR is a non-value-added step that significantly impacts the care process (Avendano et al., 2022). Excessive notifications cause alert fatigue, in which practitioners become desensitized and miss vital signals, affecting patient safety (McGreevey et al., 2020).

The workflow has significantly improved after the adoption of the modern EHR system. By implementing upgraded EHR, clinicians can have accessibility to a robust and extensive digital system. An updated EHR with SR provides for more streamlined and efficient documentation. SR allows clinicians to enter clinical data and follow-up directions into the EHR system (Avendano et al., 2022). By avoiding manual entry procedures, the EHR with SR feature significantly decreases the possibility of inaccuracies and ensures that accurate and complete patient data is entered quickly. An improved EHR system with an enhanced interface significantly minimizes documentation time and accessibility while increasing cost-effectiveness with a maintenance approach that includes robust encryption and authentication to safeguard records and adhere to HIPAA rules.

NURS FPX 8012 Assessment 5 Quality Improvement Project Plan

Cleveland’s whole care team has access to the EHR, which allows immediate information, communication, and integrated care. Optimized automated notifications are an added step that has minimized alert fatigue by rapidly resolving essential information (McGreevey et al., 2020). Clinicians can input and monitor orders online, and immediate notifications are available to all pertinent employees in the emergency unit, ensuring performance and reducing redundancies.

Ongoing tracking of health indicators and crucial parameters of emergency patients is constantly updated in the EHR. It provides quick access to their information and directions for discharge, increasing involvement and transparency (Pierce et al., 2020). By tackling the inefficiencies of the prior workflow, the upgraded EHR has improved the provision of care at Cleveland Clinic. The Cleveland Clinic workflow before and after implementing the updated EHR is shown in Fig. 1.

Final Recommendations and Conclusions

The Cleveland Clinic can benefit from an upgraded EHR system in providing timely, effective patient care through collaborative efforts with IT specialists, trial deployment, employee education and training, and managing change. Installing the upgraded EHR is recommended for all relevant units of Cleveland Clinic. Cleveland Clinic has reduced and streamlined its documentation and other operations. The Cleveland Clinic can employ an updated EHR system to strengthen its reputation as a leading medical facility and ensure extraordinary patient care through ongoing performance surveillance, proactive difficulty resolution, and effect evaluation on patient outcomes.

References

Arabi, Y. M., Al, A., Al-Moamary, M., Abdullah Al Mutrafy, AlHazme, R. H., & Knawy, A. (2022). Electronic medical record implementation in a large healthcare system from a leadership perspective. BioMed Central Medical Informatics and Decision Making, 22(1). https://doi.org/10.1186/s12911-022-01801-0

Avendano, J. P., Gallagher, D. O., Hawes, J. D., Boyle, J., Glasser, L., Aryee, J., & Katt, B. M. (2022). Interfacing with the Electronic Health Record (EHR): A comparative review of modes of documentation. Curēus, 14(6), e26330. https://doi.org/10.7759/cureus.26330

Basil, N. N., Ambe, S., Chukwuyem Ekhator, & Ekokobe Fonkem. (2022). Health records database and inherent security concerns: A review of the literature. Curēus, 14(10), e30168. https://doi.org/10.7759/cureus.30168

Janett, R. S., & Yeracaris, P. P. (2020). Electronic medical records in the American health system: Challenges and lessons learned. Ciência & Saúde Coletiva, 25(4), 1293–1304. https://doi.org/10.1590/1413-81232020254.28922019

Jimma, B. L., & Enyew, D. B. (2022). Barriers to the acceptance of electronic medical records from the perspective of physicians and nurses: A scoping review. Informatics in Medicine Unlocked, 31, 100991. https://doi.org/10.1016/j.imu.2022.100991

NURS FPX 8012 Assessment 5 Quality Improvement Project Plan

Leapfrog. (2023). Cleveland Clinic Foundation. hospitalsafetygrade.org. https://www.hospitalsafetygrade.org/table-details/cleveland-clinic-foundation?findBy=state&state_prov=OH&rPos=613.5999755859375&rSort=grade

McGreevey, J. D., Mallozzi, C. P., Perkins, R. M., Shelov, E., & Schreiber, R. (2020). Reducing alert burden in electronic health records: Atate of the art recommendations from four health systems. Applied Clinical Informatics, 11(01), 001-012. https://doi.org/10.1055/s-0039-3402715

Medicare. (2024). Find healthcare providers: Compare care near you. medicare.gov. https://www.medicare.gov/care compare/details/hospital/360180?id=ed5b40c6-1de8-48d6-b1e4-d7853887adbc&state=OH#ProviderDetailsRatingsContainer

Modi, S., & Feldman, S. S. (2022). The value of electronic health records since the health information technology for economic and clinical health act: systematic review. Journal of Medical Internet Research Medical Informatics, 10(9), e37283. https://doi.org/10.2196/37283

Mohammed, A. A., & AL-Abrrow, H. (2023). The impact of empowering and transformational leadership on organizational performance and innovation: the mediating role of shared leadership and moderating role of organizational culture in the Iraqi healthcare sector. International Journal of Organizational Analysis, 31(7), 3532-3552. https://doi.org/10.1108/IJOA-08-2022-3380

Olley, R., & Hozynka, J. (2023). The effectiveness of scenario-based training of clinicians in the use of electronic health records-A systematic review. Asia Pacific Journal of Health Management, 18(1), 58-73. https://doi.org/10.3316/informit.008000823887209

Omaghomi, T. T., Akomolafe, O., Onwumere, C., Odilibe, I. P., & Elufioye, O. A. (2024). Patient experience and satisfaction in healthcare: a focus on managerial approaches-a review. International Medical Science Research Journal, 4(2), 194-209. https://doi.org/10.51594/imsrj.v4i2.812

Parthasarathy, R., Garfield, M., Rangarajan, A., & Kern, J. L. (2021). The case of organizational innovation capability and health information technology implementation success: As you sow, so you reap?. International Journal of Healthcare Information Systems and Informatics (IJHISI), 16(4), 1-27. https://doi.org/10.4018/IJHISI.20211001.oa21

NURS FPX 8012 Assessment 5 Quality Improvement Project Plan

Pierce, R. P., Eskridge, B. R., Rehard, L., Ross, B., Day, M. A., & Belden, J. L. (2020). The effect of electronic health record usability redesign on annual screening rates in an ambulatory setting. Applied Clinical Informatics, 11(04), 580–588. https://doi.org/10.1055/s-0040-1715828 

Shaikh, M., Vayani, A. H., Akram, S., & Qamar, N. (2022). Open-source electronic health record systems: A systematic review of most recent advances. Health Informatics Journal, 28(2). https://doi.org/10.1177/14604582221099828

Uslu, A., & Stausberg, J. (2021). Value of the electronic medical record for hospital care: Update from the literature. Journal of Medical Internet Research, 23(12), 26323. https://doi.org/10.2196/26323

 

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