Assessment 1: Policy and Guideline for the Informatics Staff: Making Decisions to Use Informatics System
Capella University
Course Name
Professor’s Name
July, 2024
Policy and Guidelines for the Informatics Staff: Making Decisions to Use Informatics System
In the evolving environment of contemporary healthcare, an electronic health record (EHR) system is a necessity to provide the best care to patients and to manage one’s practice. This paper designs a policy and guidelines within a clinical practice setting on the use of the Cerner EHR system in supporting evidence-based practice.
Functions
- Cerner EHR system provides very extensive documentation capabilities to healthcare providers for documenting encounters, medical histories, and treatment plans of patients accurately (Ritchie & Welch, 2020).
- The clinical decision support tools within the system provide evidence-based recommendations to aid clinicians in making appropriate treatment decisions.
- Besides, it also facilitates electronic ordering for tests, medicines, and other forms of treatment. The business Cerner facilitates this process and hence streamlines it with reduced errors.
- Cerner also provides for the interchange of information from all healthcare systems for easy communication in promoting the continuity of care (Overhage & McCallie, 2020).
- It also allows access to a patient portal for the patients to check their manifests, make appointments, and communicate with health providers.
- Cerner provides real-time analytics and reporting for healthcare organizations to track their performance with compliance and outcomes.
Evaluation of Function of Tool Related to Evidence-Based Practice
The EHR of Cerner enhances the basis for evidence-based practice by initiating clinical decision support tools. These tools provide healthcare professionals at the frontlines with real-time access to the best current research findings and nationally accepted clinical guidelines to inform decisions (Asmar et al., 2021). This functionality makes sure that clinical decisions are based on the best currently known practices to ensure the optimization of outcomes for the patient. It has the advanced feature of documentation, which allows users to record and maintain accurate and comprehensive patient records. This is very important for monitoring the progress of patients and conducting clinical research. Interoperability features in the system ensure smooth sharing of data across different care settings, thus ensuring coordinated and efficient care (Miandoab et al., 2023). Besides, Cerner’s automated workflow reduces manual errors and streamlines operations, hence the high safety and efficiency of clinical practice. This means that Cerner EHR facilitates evidence-based practice with the necessary tools and functionalities that improve areas such as clinical decision-making, operational efficiency, and quality of care for patients.
Guidelines Reflecting Analysis of Work Setting
For any care setting, unique policies and guidelines concerning the Cerner EHR system should outline its features that support evidence-based practice. The guidelines address proper data entry procedures that ensure up-to-date patient records and promote the accuracy of documentation (Cordasco et al., 2023). This is very important to be certain of the data inequality and accuracy needed for clinical decision-making. The policies would also go to the extent of explaining the process permitted for ongoing staff training and evaluation for their proficiencies in the use of the EHR system; therefore, any provider should be able to work within the system (Lytle et al., 2021). The implication is that flawless compliance to the workflows in the Cerner EHR can do a lot in enhancing efficiency, guaranteeing patient safety, and delivering quality care and better patient outcomes by relying on the prioritized, accurate, and reliable data practice.
Cerner Supporting Strategic Plan
The Cerner EHR system helps support the strategic plan of a health organization related to the use of evidence-based information (Cogan et al., 2023). This is through enhancing the accessibility and accuracy of rigorous patient data by integrating health information system components into its strategic planning. In this way, healthcare providers can deliver quality patient care since their operations become efficient enough to put into practice evidence-based policies supporting effective patient care. The system reduces hassles in continuous quality improvement initiatives through analytics and detailed reports required to monitor performance and areas for improvement. In addition, the Cerner EHR system promotes interprofessional collaboration through the provision of a unique platform where all the members involved in health can access patients’ information for updating in real-time, thus improving communication and patient satisfaction (Sipanoun et al., 2022).
Assessment of Workflow to Maximize Efficiency
The Cerner EHR system improves operational efficiency and safety within healthcare settings by optimizing both clinical and administrative workflows. It facilitates smooth data entry and retrieval, reducing the time used in documenting and giving more time to attend to patients (Zheng et al., 2020). All data about a patient are made very accessible to all health providers through the integrating capacity of this system, thereby developing the communication and coordination of care among the care team. It provides an evidence-based practice environment where clinical decisions are supported by current patient data and research evidence (Hodgson et al., 2021). Furthermore, Cerner’s advanced features in the mitigation of potential mistakes by way of automated alerts and reminders ensure safe practice. Optimizing these workflows, Cerner EHR can increase operational efficiency and raise the level of patient satisfaction, which leads to better health results.
Cerner’s Contribution to Inter-Professional Care
Implementing the Cerner EHR system in health institutions provides interprofessional care within the health teams. The tool in this digital health record easily helps to facilitate communication and sharing across disciplines, ensuring that all team members have fully detailed information about their patients. The Cerner EHR enhances coordinated efforts among nurses, physicians, specialists, and all other healthcare practitioners in the course of treatment through the consolidation of patient records, treatment plans, and care protocols in one system (Cordasco et al., 2023). Such an integrated approach is not only instrumental in enhancing the efficiency of treatment dispensation; it also improves the safety of patients by way of reducing communication errors and ensuring that all members of the treatment team are on the same platform concerning treatment options. Moreover, patient outcome and preference tracking lead to very high patient satisfaction because treatment plans can be more readily tailored to the needs of each individual. Cerner EHR offers robust functionality for interprofessional care, as it facilitates cohesive work among healthcare teams toward the achievement of optimal patient outcomes.
NURS FPX 6412 Assessment 1 Policy and Guideline for the Informatics Staff: Making Decisions to Use Informatics System Conclusion
In conclusion, comprehensive policies and guidelines on implementation developed for Cerner EHR will ensure evidence-based practice, workflow efficiency, patient safety, and interprofessional collaboration in healthcare organizations. Developed into practice, this enables the health care organization to fully tap the potential of electronic health records in delivering quality care and attainment of strategic objectives related to information use and patient satisfaction issues.
NURS FPX 6412 Assessment 1 Policy and Guideline for the Informatics Staff: Making Decisions to Use Informatics System References
Asmar, M., Dharmayat, K. I., Vallejo, A. J., Irwin, R., & Mastellos, N. (2021). Effect of computerized, knowledge-based, clinical decision support systems on patient-reported and clinical outcomes of patients with chronic disease managed in primary care settings. BMJ Open, 11(12), e054659. https://doi.org/10.1136/bmjopen-2021-054659
Cogan, A. M., Rinne, S. T., Weiner, M., Simon, S. R., Davila, J. A., & Yano, E. M. (2023). Using research to transform electronic health record modernization: Advancing a VApartnered research agenda to increase research impacts. Journal of General Internal Medicine, 38(S4), 965–973. https://doi.org/10.1007/s11606-023-08289-y
Cordasco, K. M., Gable, A. R., Ganz, D. A., Brunner, J. W., Smith, A. J., Hertz, B., Post, E. P., & Fix, G. M. (2023). Cerner millennium’s care pathways for specialty care referrals: Provider and nurse experiences, perceptions, and recommendations for improvements. Journal of General Internal Medicine, 38(Suppl 4), 1007–1014. https://doi.org/10.1007/s11606-023-08285-2
Hodgson, T., Burton, A., Donovan, R., & Sullivan, C. (2021). The role of electronic medical records in reducing unwarranted clinical variation in acute health care. JMIR Medical Informatics, 9(11), e30432. https://doi.org/10.2196/30432
Lytle, K. S., Westra, B. L., Whittenburg, L., Adams, M., Akre, M., Ali, S., Furukawa, M., Hartleben, S., Hook, M., Johnson, S. G., Settergren, T. (Tess), & Thibodeaux, M. (2021). Information models offer value to standardize electronic health record flowsheet data. Journal of Nursing Scholarship, 53(3), 306–314. https://doi.org/10.1111/jnu.12646
Miandoab, A. T., Samad, T., Jodati, A., & Rezaei, P. (2023). Interoperability of heterogeneous health information systems. BMC Medical Informatics and Decision Making, 23(1). https://doi.org/10.1186/s12911-023-02115-5
Overhage, J. M., & McCallie, D. (2020). Physician time spent using the electronic health record during outpatient encounters. Annals of Internal Medicine, 172(3), 169. https://doi.org/10.7326/M18-3684
Ritchie, J., & Welch, B. (2020). Categorization of third-party apps in electronic health record app marketplaces. JMIR Medical Informatics. https://doi.org/10.2196/16980
Sipanoun, P., Oulton, K., Gibson, F., & Wray, J. (2022). The experiences and perceptions of users of an electronic patient record system in a pediatric hospital setting. International Journal of Medical Informatics, 160, 104691. https://doi.org/10.1016/j.ijmedinf.2022.104691
Zheng, K., Ratwani, R. M., & Adler-Milstein, J. (2020). Studying workflow and workarounds in electronic health record–supported work to improve health system performance. Annals of Internal Medicine, 172(11), S116–S122. https://doi.org/10.7326/m19-0871
Appendix A
Policy
This policy is sufficient to define parameters for the implementation of the Cerner EHR System and how it would be used in our healthcare facility.
Overview
Cerner EHR System: A complete EHR solution designed to streamline clinical workflows from end to end in the best manner to coordinate patient care for improved health outcomes.
Purpose
This policy seeks to standardize the usage of the Cerner EHR System by all departments, ensuring efficiency in bother operations and accuracy to comply with the set regulation procedures. It seeks to ensure that there will be seamless integration of electronic health records in daily clinical practice, thereby putting it in a better position toward optimizations and safety enhancement in patient care delivery.
Responsibility
- The clinical staff shall accurately document all relevant patients’ information in the Cerner EHR System according to established protocols.
- It lies in the hands of the IT personnel to ensure that a Cerner EHR System is intact, secure, and accessible.
- This shall include ensuring appropriate training of all staff in the use of the Cerner EHR System and monitoring compliance with the policy for the same.
Guidelines
These guidelines are in place to outline best practices for the implementation and adherence of the policy governing the use of the Cerner EHR System. Guidelines are critical in ensuring consistency, efficiency, and compliance across a number of our various departments within our healthcare setting.
- All staff must be correctly oriented and educated about the functionality and protocols of the Cerner EHR System before accessing patient records or documenting any information.
- All entries must be checked for accuracy and completeness to minimize errors and present reliable clinical decisions with accurate information.
- The regulations of HIPAA and institutional policies related to the confidentiality of patients must be fully followed while accessing, sharing, or divulging patient information saved on the Cerner EHR System.
- All encounters of patients must be documented without any confusion, consistently, and coherently for assessment and intervention with the use of standardized templates and guidelines provided about the documentation by the Cerner EHR System.
- Periodically update and review the security measures on the Cerner EHR System to maintain a robust leading edge against unauthorized access, data breaches, and cyber-attacks.
- Provide professional collaboration using the Cerner EHR System for appropriate sharing of relevant patient information among the health care team members to support coordinated care. Re-developed clinical processes with constant review of workflows to ensure the greatest productivity and least duplication within the Cerner EHR.