1

Assessment 1: Proposing Evidence-Based Change

Kathy Ergle

Capella University

NURS-FPX 6218: Leading the Future of Health Care

Prof. Donna Ryan

November 09, 2022

Proposing Evidence-Based Change

A healthcare system is crucial to improve health, enhance the quality of life, and prevent

diseases. A good health system ensures timely access to effective care delivery. It integrates

clarity in roles, better information transfer, and best care collaboration for better health outcomes

(Kruk et al., 2018). In this assessment, I will propose a change in the local healthcare system to

improve care quality for people struggling with mental health issues. Moreover, the change will

be compared with two non-U.S. healthcare systems.

Executive Summary

Proposed Change

After heart and cancer problems, medication errors are the most common cause of high

death rates in the United States. Most errors occur due to faulty or ineffective processes in a

healthcare system (Carver & Hipskind, 2019). For example, the local health facility where I

work depends on paper records for patient medical information, rising the chances of medical

errors. Two other challenges that the healthcare system is facing due to paper records are related

to the security of the medical records, poor decision-making, and ineffective information storage

(Honavar, 2020). All these challenges make up care process for patients unsafe. According to the

World Health Organization (WHO), unsafe care is one of the ten worldwide leading causes of

disability and mortality (World Health Organization, 2019). Therefore, the aspect of the local

healthcare system related to paper records should be changed. The focus for change in the local

and regional healthcare system is the utilization of an electronic medical record (EMR) system

instead of paper records.

The expectation from the EMR system is to reduce medication errors, reduce time spent

on data recording, and improve information storage, decision-making, and security of medical

records through effective methods of data management (Vaidotas et al., 2019). According to the

expectations, the EMR system will reduce medical errors occurring due to manual medical

records. Also, the system will help providers store information in one place, and access the

complete medical history of patients without dual tests and waste of time, leading to effective

information and decision-making (Honavar, 2020). Moreover, the EMR system is encrypted and

provides access to only authorized stakeholders like relevant health providers and patients which

results in a secure medical record (Hodgson et al., 2021). Study shows that the use of EMR

reduced data recording time by 24.5% and 23.5% with equipment at the bedside and central

location, respectively (Vaidotas et al., 2019).

Desired Outcomes

The desired outcomes of the EMR system will be:

1. Decline in medical errors

2. Lesser time spent on data recording

3. Effective information storage and decision-making

4. Secure medical records

These outcomes are defined as the desired consequences of using the EMR system in the

local healthcare system. The rationale behind this definition is the evidence-based results of the

EMR system that are associated with a reduction in medical errors, effective information storage,

decision-making, and security of the medical record. The reduction in medical errors by using

EMR is supported by a comparative study conducted by Vaidotas et al. (2019). They compared

the occurrence of medication errors in two emergency departments and two other units of a

health setting. Two were using electronic records while the other was dependent on handwritten

records. The results showed lesser medication errors and improved patient safety in the

departments using electronic records.

The evidence by Hodgson et al. (2021) supports the enhancement of clinical factors and

patient outcomes, including the integration of patient information in one place and improved

decision-making regarding patient health by using an EMR system. Likewise, the research by

Chen et al. (2020) supports the effective information storage and security of medical records with

the implementation of EMR. According to the authors, cloud computing technology used in

EMR can store a large amount of health data in one place which makes it easier for providers to

store and access the information effectively. Moreover, the research asserts that the system is

secured with certain encryptions; its software is HIPAA compliant, and avoids access to

unauthorized personnel, leading to the security of patient medical records.

To implement the EMR system, eligible providers and healthcare systems are provided

with incentives by Medicaid and Medicare Services. Moreover, the Office of the National

Coordinator for Health Information Technology (ONC) pays local and regional systems of the

country to use the EMR system (HealthIT, n.d.).

Limiting Factors

There can be some factors that can limit the achievement of the desired outcomes.

1. Training issues for the technological use of EMR exist in some health settings.

For instance, lack of adequate training hinders the proper use of EMR by

physicians. They do not know how to use the advanced features of EMR due to

poor vendor training. Thus, better outcomes are not achieved properly. (Rahal et

al., 2021).

2. Resistance to the use of EMR at the providers’ level. Physicians sometimes find

the use of new technology complex and challenging which makes them avoid the

technology (Singh et al., 2020).

Healthcare System Comparative Analysis

The two non-U.S. systems selected for the comparative analysis are the Australian and

United Kingdom (UK) healthcare systems.

The Australian healthcare system (acute and primary health settings) uses an electronic

health record system to reduce medication errors, and improve information storage, decision-

making, and record security (Schofield et al., 2019). The usability of the system depends upon

the health sector and the features being used. For example, the positive experience of health

providers in decision-making is more positive in hospitals while in the primary care sector the

providers have positive EMR experience regarding easy storage of information and reduction in

errors (Lloyd et al., 2021). Studies show that medication errors after the implementation of the

EMR system in an Australian healthcare system rose to the highest level (44.6%) initially due to

lack of technology use. But after 1.5 years, the percentage of errors reduced below 7.3%. The

type of errors varies as per job role. The healthcare system can use the study to promote

providers’ training to effectively use the EHR system for the reduction in errors right after the

implementation of the system (Qian et al., 2020).

In the UK, the healthcare system uses the electronic patient record system to improve the

storage and access of patient information (McMillan et al., 2018). Study shows that the

information is securely gathered in a digital form by using the EHR system. Also, it reduces the

time for documentation. The healthcare system encourages the engagement of health providers in

improving usability processes to improve the system use (Tapuria et al., 2021). The use of

electronic medical records (known as NHS care records) in the healthcare system of the UK

reduces some types of medication errors. The study suggests system optimization to reduce

medication errors to a larger percentage (Slight et al., 2019).

Lessons from Both Systems

The lessons that I learned from studying both systems provide indicators for the US

healthcare system. First, the system should organize training of health providers and increase

their involvement in the usability of the EMR system to reduce difficulty in using the system.

Second, the system should be optimized according to departmental needs to reduce medication

errors of all kinds.

The Rationale for the Proposed Change

Proposed Change leading to Positive Outcomes

The use of the EMR system in the U.S. healthcare system will improve medication errors,

information storage, and security of records because it helps providers manage patient data using

online technology (Adane et al., 2019). The process of data management through EMR is much

easier than manual data recording (paperwork). In paper documentation, keeping patient records

in one place is difficult and can cause human errors. In the case of online data recording chances

of documentation errors are, reduce and providers can easily access the medical history of

patients to know about hisher allergies. Thus, the possible errors related to patient data and

health information can be reduced, improving outcomes (Vaidotas et al., 2019). Second, the use

of EMR reduces the time for paper documentation, gathers all patient medical history in one

place, and provides easy and timely access to health information. It makes the storage of

information effective and helps providers in decision-making regarding continuity of care

(Honavar, 2020). Moreover, the researchers showed that encryption methods in EMR make the

data of patients secure and safe from unauthorized access (Chen et al., 2020). The evidence

discussed above supports the rationale behind the proposed change and its contribution to

improved outcomes. The expectations related to the use of EMR in the existing healthcare

system are reasonable as they are supported by credible evidence. The associated benefits of

using EMR are also evidence-based which is why the change within the system will be

completely practical.

Financial and Health Implications

The use of EMR will reduce the financial burden on hospitals in certain areas such as

administrative, nursing, and documentation costs. One study also showed an increase in

reimbursement by using the EMR system (Tsai et al., 2020). Another study showed the short-

term and long-term effects of implementing EMR. The effects include an increase in the cost of

software updates and maintenance. But the cost related to paper documentation and staff in data

records decreased. Moreover, billing revenue increased with the use of the implementation of

EMR. According to the study, other health implications of using EMR were a reduction in

medication errors, increased confidentiality of data, better storage of information, increased

adherence to guidelines, and improved health outcomes (Gopidasan et al., 2022).

The implications of not making the proposed change may include the risk of medication

errors, lesser efficient decision-making regarding patient care, and risks associated with the

security of patient data. Poor care quality can increase readmissions and cost implications for

individuals and communities (Schopf et al., 2019). The United States government has to spend

more than $40 billion on patients affected by medication errors each year (Tariq et al., 2022).

Cost-Benefit Analysis

The overall spent cost of the implementation of EMR was $31 billion till 2018. It is now

considered a necessity for better patient outcomes. In 2019, the cost went to $27 billion which

highlights the benefits of EMR usage in the settings (Nguyen et al., 2022). The cost-benefit

analysis in different health settings showed a positive impact of EMR implementation on hospital

revenue, positive net financial benefit after 3 years, and benefits for the pharmaceutical market.

Other advantages included improvement in population health and patient experience (Nguyen et

al., 2022).

Conclusion

The use of the EMR system in the U.S. healthcare systems can reduce medication errors

and improve information storage, decision-making, and security of medical records. The

comparative analysis of two non-U.S, healthcare systems provide lessons related to EMR use in

U.S. health settings. Also, the financial and health implications of making and not making the

proposed change are discussed in the research work.

Appendix

Table 1: Health Care System Comparative Analysis

Outcomes Health Care

System of Australia

Health Care

System of Norway

Health Care

System of U. S Reduction in medical errors

Long-term reduction

in medication errors

with the use of EMR

Reduced come kinds

of medical errors

Increased chances of

medical errors due to

paper documentation

Effective information storage and decision-making

Positive experience

with EMR regarding

easy storage of

information and

decision-making

Improved

information storage

and decision-making

with the use of EMR

Ineffective way of

information storage

and poor decision-

making while using

paper documentation

Secure medical records

The positive

experience of

keeping records safe

with EMR

Secure information

collection with EMR

Patient data on

papers is not secure

and anyone can

access the

information

10

References

Adane, K., Gizachew, M., & Kendie, S. (2019). The role of medical data in efficient patient care

delivery: A review. Risk Management and Healthcare Policy, Volume 12(12), 67–73.

https://doi.org/10.2147/rmhp. s179259

Carver, N., & Hipskind, J. E. (2019, April 28). Medical error. Nih.gov; StatPearls Publishing.

https://www.ncbi.nlm.nih.gov/books/NBK430763/

Chen, C.-L., Huang, P.-T., Deng, Y.-Y., Chen, H.-C., & Wang, Y.-C. (2020). A secure electronic

medical record authorization system for smart device application in cloud computing

environments. Human-Centric Computing and Information Sciences, 10(1).

https://doi.org/ 10.1186/s13673-020-00221-1

Gopidasan, B., Amanullah, S., & Adebowale, A. (2022). Electronic medical records – A review

of cost-effectiveness, efficiency, quality of care, and usability. Journal of Psychiatry

Spectrum, 1(2), 76. https://doi.org/ 10.4103/jopsys.jopsys_17_22

HealthIT. (n.d.). Is federal financial support available for implementing electronic health records

(EHRs)? | HealthIT.gov. Www.healthit.gov. Retrieved April 12, 2021, from

https://www.healthit.gov/faq/federal-financial-support-available-implementing-

electronic-health-records-ehrs

Hodgson, T., Burton-Jones, A., Donovan, R., & Sullivan, C. (2021). The role of electronic

medical records in reducing unwarranted clinical variation in acute health care:

Systematic review. JMIR Medical Informatics, 9(11), e30432.

https://doi.org/ 10.2196/30432

Honavar, S. G. (2020). Electronic medical records – The good, the bad and the ugly. Indian

Journal of Ophthalmology, 68(3), 417. https://doi.org/ 10.4103/ijo.ijo_278_20

11

Kruk, M. E., Gage, A. D., Arsenault, C., Jordan, K., Leslie, H. H., Roder-DeWan, S., Adeyi, O.,

Barker, P., Daelmans, B., Doubova, S. V., English, M., Elorrio, E. G., Guanais, F., Gureje,

O., Hirschhorn, L. R., Jiang, L., Kelley, E., Lemango, E. T., Liljestrand, J., & Malata, A.

(2018). High-quality health systems in the Sustainable Development Goals era: Time for

a revolution. The Lancet Global Health, 6(11), e1196–e1252.

https://doi.org/ 10.1016/s2214-109x(18)30386-3

Lloyd, S., Long, K., Oshni Alvandi, A., Di Donato, J., Probst, Y., Roach, J., & Bain, C. (2021). A

National Survey of EMR Usability: Comparisons between medical and nursing

professions in the hospital and primary care sectors in Australia and Finland.

International Journal of Medical Informatics, 154(104535), 104535.

https://doi.org/ 10.1016/j.ijmedinf.2021.104535

McMillan, B., Eastham, R., Brown, B., Fitton, R., & Dickinson, D. (2018). Primary care patient

records in the United Kingdom: Past, present, and future research priorities. Journal of

Medical Internet Research, 20(12), e11293. https://doi.org/10.2196/11293

Nguyen, K.-H., Wright, C., Simpson, D., Woods, L., Comans, T., & Sullivan, C. (2022).

Economic evaluation and analyses of hospital-based electronic medical records (EMRs):

A scoping review of international literature. Npj Digital Medicine, 5(1).

https://doi.org/10.1038/s41746-022-00565-1

Qian, S., Munyisia, E., Reid, D., Hailey, D., Pados, J., & Yu, P. (2020). Trend in data errors after

the implementation of an electronic medical record system: A longitudinal study in an

Australian regional drug and alcohol service. International Journal of Medical

Informatics, 144(104292), 104292. https://doi.org/ 10.1016/j.ijmedinf.2020.104292

Rahal, R. M., Mercer, J., Kuziemsky, C., & Yaya, S. (2021). Factors affecting the mature use of

12

electronic medical records by primary care physicians: a systematic review. BMC

Medical Informatics and Decision Making, 21(1). https://doi.org/ 10.1186/s12911-021-

01434-9

Schofield, P., Shaw, T., & Pascoe, M. (2019). Toward comprehensive patient-centric care by

integrating digital health technology with direct clinical contact in Australia. Journal of

Medical Internet Research, 21(6), e12382. https://doi.org/10.2196/12382

Schopf, T. R., Nedrebø, B., Hufthammer, K. O., Daphu, I. K., & Lærum, H. (2019). How well is

the electronic health record supporting the clinical tasks of hospital physicians? A survey

of physicians at three Norwegian hospitals. BMC Health Services Research, 19(1).

https://doi.org/ 10.1186/s12913-019-4763-0

Singh, A., Jadhav, S., & Roopashree, M. (2020). Factors to overcoming barriers affecting

electronic medical record usage by physicians. Indian Journal of Community Medicine,

45(2), 168. https://doi.org/ 10.4103/ijcm.ijcm_478_19

Slight, S. P., Tolley, C. L., Bates, D. W., Fraser, R., Bigirumurame, T., Kasim, A., Balaskonis, K.,

Narrie, S., Heed, A., Orav, E. J., & Watson, N. W. (2019). Medication errors and adverse

drug events in a UK hospital during the optimisation of electronic prescriptions: A

prospective observational study. The Lancet Digital Health, 1(8), e403–e412.

https://doi.org/ 10.1016/s2589-7500(19)30158-x

Tapuria, A., Porat, T., Kalra, D., Dsouza, G., Xiaohui, S., & Curcin, V. (2021). Impact of patient

access to their electronic health record: Systematic review. Informatics for Health and

Social Care, 46(2), 194–206. https://doi.org/ 10.1080/17538157.2021.1879810

Tariq, R. A., Vashisht, R., Sinha, A., & Scherbak, Y. (2022). Medication dispensing errors and

prevention. PubMed; StatPearls Publishing.

13

https://www.ncbi.nlm.nih.gov/books/NBK519065/#:~:text=The%20total%20cost%20of

%20looking

Tsai, C. H., Eghdam, A., Davoody, N., Wright, G., Flowerday, S., & Koch, S. (2020). Effects of

electronic health record implementation and barriers to adoption and use: A scoping

review and qualitative analysis of the content. Life, 10(12), 327.

https://doi.org/ 10.3390/life10120327

Vaidotas, M., Yokota, P. K. O., Negrini, N. M. M., Leiderman, D. B. D., Souza, V. P. de, Santos,

O. F. P. dos, & Wolosker, N. (2019). Medication errors in emergency departments: Is

electronic medical record an effective barrier? Einstein (São Paulo), 17(4).

https://doi.org/ 10.31744/einstein_journal/2019gs4282

World Health Organization. (2019). Patient safety. Who.int; World Health Organization: WHO.

https://www.who.int/news-room/fact-sheets/detail/patient-safety