June 17, 2017
Evaluation of Health Care Technology
The technology previously explored by this author was the use of the computerized provider order entry (CPOE) and clinical decision support (CDSS) systems within the electronic health record (EHR). Some of the information contained in the paper is from a previously submitted paper in week three. Computerized order entry is a new technology that permits the physician to electronically enter the order into the system instead of handwriting an order. In the United States (U.S) every year approximately 200,000 people die due to preventable medical errors (Andel, Davidow, Hollander, & Moreno, 2012). Most medical errors start with the physicians at the point of ordering medications or specific services such as an x-ray. Many errors occur due to poor handwriting skills and some have had adverse outcomes for the patient including death. The results from Adverse Drug Events (ADEs) are patients experiencing negative reactions to drugs which can result in extended hospital stays, increased medical costs, permanent disability, and possibly death (Du, Goldsmith, Aikin, Encinosa, and Nardinelli, 2012). According to Junqueira, (2017), using a computer system when writing a prescription can help ensure the prescription is complete and legible; that the medication dose, route and frequency are appropriate; that, if a dosing calculation must be made, it will be correct; that allergic reactions are avoided; that interactions with other drugs the patient is taking are avoided; and that patients don’t receive more drug than they should. Insurances are concerned with the pricing of drugs and costs. The computer can also ensure the medication being prescribed is on the formulary for that specific patient’s insurance.
According to Eysenbach, Gunther (2013), the clinical decision support system (CDSS) helps improve health care outcomes and reduce preventable medical adverse effect. The CDSS relies on the implementation context and how effective the use of the system is in a complex setting. One important aspect of the CDSS is the development of the product to meet the needs of the facility. If the product increases workload for the nurse and/or physician the information may not be entered correctly and the proper follow-up may be ignored.
The assessment revealed the success and effectiveness of the of both systems depend on the human-computer interaction. The main area was initial training and follow-up as needed with each nurse due to different learning patterns. Many nurses learned to work around certain areas of the CDSS which decreased the effectiveness. The CDSS uses many reminders and alerts based upon the user interactions to help notify the nurse of potential violations. When the nurse learns to work around those alerts the system becomes ineffective.
Elements used to Evaluate
The elements used to the evaluate the user interface products would be usability inspection, heuristic evaluation and scenarios. Usability inspection is where an evaluator looks at the user interface system and determines if there are any problems with the usability of the design. Many different types of inspections fall under usability inspection such as: heuristic evaluation, heuristic estimation, cognitive walkthrough, pluralistic walkthrough, feature inspection, consistency inspection, standards inspection and formal usability inspection. The best options for the CDSS and CPOE would be pluralist walkthrough, feature inspection and formal usability inspection.
Pluralist walkthrough would involve meetings where the actual developers and users go through a scenario and practice inputting the data into the system. This process gives the nurse time to give feedback on each screen, assessment and alert they may receive in real time. Permitting the nurse to have a live meeting with the developer empowers the nurses and gives them buy in with the product.
Feature inspection provides the nurse with a list of procedures to perform in order to accomplish a task. The nurse can walk through the procedures and check for errors in the program. The goal would be for this process to occur prior to the implementation of the product so the nurse could give feedback regarding errors.
Formal usability inspection involves both group and individual inspections. This inspection is a specific six-step process with defined roles. This method is similar to the feature inspection in that the participants area given distinct instructions with a list of procedures. The nurse can provide specific feedback to each step of the data entry process.
The elements that would need to be evaluated with these systems would be ease of data entry, ability to see screen size, productive alerts. The ease of data entry is important for nurse’s due to short staffing and time constraints. Simple copying and pasting from text within the medical record make more accurate documentation than requiring the nurse to type the same information over and over. The ability for the nurse to easily see the screen and the checklists is a must for effective use of the program. The screen needs to be large enough to have two columns on the screen to look at both systems and pull information from both when looking at the total picture of the patient. The CDSS can provide checklists which are known to reduce medical errors. The screen could have a checklist on one side of what needs to be observed for a particular problem and on the other side of the screen a checklist for potential causes for the change in the patient’s condition. The productive alerts need to alert the nurse and require the issue to be addressed prior to moving on to another patient. The alert may be something simple or complex but the system cannot permit the nurse to advance prior to addressing the issue.
The nurse’s environment can be interrupted often and the ability copy and paste would ensure accuracy and decrease time. The amount of education with nurses using the systems discussed in the paper must be long enough to ensure the nurse can demonstrate competency. This will not be the same for each nurse and management must realize that everyone does not learn at the same level nor the same way. The deployment of human user interface technology should be evaluated initially three months after the implementation and additional education provided if needed.
In conclusion, use of the CPOE and CDSS would ensure safer practice for the administration of heparin. Most leaders advocate for the implementation of CPOE in their facilities to help improve the quality of health care. The electronic medical record can cause alerts but they must be addressed before the nurse can continue further into the patient’s record. The use of technology has advanced over the past 10 years at a fast past and that pace continues to get faster with each year. As nurses on the front lines we must keep up to date with technology and be willing to learning new technology as it is introduced.
Andel, C., Davidow, S. L., Hollander, M., and Moreno, D. A. (2012) The economics of health care quality and medical errors. Journal of Health Care Finance, 39(1), 39-50. Baron, J. M., and Dighe, A. S. (2011). Computerized provider order entry in the clinical laboratory. Journal of Pathology Informatics, 2(35).
Du, D. T., Goldsmith, J., Aikin, K. J., Encinosa, W. E., and Nardinelli C. (2012) Despite 2007 law requiring FDA hotline to be included in print drug ads, reporting on adverse drug events by consumers still low. Health Affairs, 31(5), 1022-1029.
Kuperman GJ, Gibson RF. Computer Physician Order Entry: Benefits, Costs, and Issues. Ann Intern Med. 2003;139:31-39. doi: 10.7326/0003-4819-139-1-200307010-00010
I, Michelle Mayhew, verify that I have completed 10 clock hours in association with the goals and objectives for this assignment. I have also tracked said practice hours in the Typhon Student Tracking System for verification purposes and will be sure that all approvals are in place from my faculty and practice mentor.