Executive Summary
Patients can stand to benefit significantly from improved healthcare informatics systems. They can access reliable healthcare information and proper healthcare services. The use of informatics systems improves healthcare accessibility, effectiveness, and safety. Examples of informatics systems include electronic health records (EHRs), remote patient monitoring (RPM), and laboratory information systems (LIS). EHRs are increasingly used in the organization of patient care. However, it creates challenges in the protection of patient privacy and confidentiality. There are applicable laws for EHR users and healthcare organizations to protect patient privacy and confidentiality. The laws ensure that high professional standards are maintained within a healthcare organization. Healthcare organizations implementing informatics systems must train their employees in the appropriate techniques required when using the systems. It will ensure the protection of private and confidential information following institutional policies. The systems developed must meet the regulatory requirements. It should build flexible and robust privacy settings that protect patients’ information.
Introduction
Healthcare informatics integrates healthcare sciences, information science, computer science, and cognitive science to improve patient care’s safety and quality. Healthcare informatics blends practical concepts with technology (Hoyt & Yoshihashi, 2019). It provides a robust healthcare data infrastructure allowing easy access to patient records. Healthcare is one of the biggest digital industries embracing information technologies. Healthcare informatics has been around for the past three decades. It has experienced rapid growth while incorporating evolving technology within the medical field. There have been improvements in healthcare outcomes, patient education, and care delivery in health systems.
Christiana Care Hospital is the healthcare organization of choice. The hospital adopts healthcare informatics systems to acquire, store, and retrieve information in healthcare and biomedicine. The organization has shifted its focus to quality improvement, evidence-based medicine, and data accessibility and security for its patients (Cowie et al., 2017). The study aims to assess informatics currently used in Christiana Care Hospital. It will further provide recommendations on how the organization improves its informatics systems to increase the efficiency and effectiveness of healthcare. The study begins with an executive summary, followed by an introduction, then conducts an analysis of informatics systems and ends with a conclusion.
Informatics Systems
Healthcare informatics organizes theories, knowledge, and information from a computerized system. It focuses mainly on providing support to the well-being of the human population. Through this process, public health becomes highly protected from infectious diseases (Pramanik et al., 2020). The information works with advanced technologies in solving problems related to health system management. It means incorporating data through science and organizing the necessary knowledge appropriate for patient care. Public health interventions are effective just like the data supporting the information (Coiera, 2018). The quality and safety of patient care are offered through various forms of public health informatics intersecting between data, humans, and technology. The informatics systems in public health include electronic health records (EHRs), remote patient monitoring (RPM), or telehealth and laboratory information system (LIS).
Electronic Health Records (EHRs)
Electronic Health Records (EHRs) application at Christiana Care Hospital has replaced the patient paper records. Traditionally, patient information was documented on paper or in medical books. However, the introduction of EHRs in the organization has enabled the collection and storage of medical information on each patient electronically (Evans, 2021). The records include health information, doctor visits, test results, and healthcare treatments. EHRs make patient information secure and available instantly to authorize users. The system is real-time and patient-centered in storing their information. The information about the patient medical history can be shared with other healthcare facilities upon patient authorization. Christiana Care Hospital can share its information with the facility of choice if the patient wants to change to a different healthcare organization. The interlink built with other health facilities allows for easy transfer of patient information (Foxman & Kilcoyne, 2018). No paperwork is required to make information available to the authorized user from another end. Therefore, the organization has eliminated the traditional paperwork.
The radical transformation of the world by digital technology has not left the organization out. Web-enabled devices, tablets, and smartphones have transformed the lives of people and how they communicate (Aziz, 2019). Healthcare is an information-rich industry. It requires a specialist to obtain information from a patient before making laboratory test requests. The information is recorded in a manner that can be retrieved easily. The laboratory department also takes information like the name of the patient, age, sex, and tests requested. The test results are sent to the doctor electronically to minimize errors or loss. The patients will receive improved healthcare services when healthcare providers have access to full and accurate results (Pramanik et al., 2020). Electronic Health Records (EHRs) reduce medical errors, improving the ability to make diagnoses. The healthcare providers at Christiana Care Hospital agree that EHRs allow them to deliver quality services to patients. They can easily access patient information and make diagnostic changes if the patient does not respond well to previous treatments.
Remote Patient Monitoring (RPM)
The organization uses Remote Patient Monitoring (RPM) to provide medical sensors for transmitting patient information to healthcare providers. The system is also called telehealth. It uses communication technologies and digital information to manage healthcare remotely (Otokiti, 2019). The commonly used technologies are computers and mobile devices such as smartphones and tablets. Telehealth may be the technologies being used by healthcare providers or those used by patients at home. Telehealth in the organization aims to make healthcare delivery easier for people living in remote areas. The introduction of the telehealth system has proven that technology meets healthcare. Patients in remote areas have access to healthcare like those in the health facility. Sometimes the patient may find it difficult to travel to the health facility (Cowie et al., 2017). Healthcare providers may also find it difficult to balance their schedules and travel to remote areas. Telehealth will remain one of the best technologies ever in healthcare during an epidemic.
The healthcare providers at Christiana Care Hospital are using RPM for remote monitoring of patients with blood pressure and blood sugar levels. The system benefits patients with hypertension and diabetes. Patients with these chronic conditions may not require moving from home to the health facility (Cowie et al., 2017). Diabetes could be accompanied by swelling of the lower limbs, and such patients only need home care. The data collected by RPM are transmitted to the doctors to make clinical interventions. It helps make quick diagnoses when the pressure is high, or there is an increased sugar level. These dietary conditions must be constantly monitored because the patients can easily go into shock. To easily monitor these patients, the doctors at Christiana Care Hospital have connected their electronic gadgets with the patient (Pramanik et al., 2020). The doctors confirmed that this informatics system has allowed them to monitor chronic conditions from remote areas. The implementation of telehealth has helped the organization during the Covid-19 pandemic as people were forced to work from home.
Laboratory Information System (LIS)
The Laboratory Information System (LIS) allows coordination between doctors and laboratory officers. It helps manage outpatient and inpatient tests for hematology, microbiology, chemistry, immunology, and parasitology (Foxman & Kilcoyne, 2018). The doctor enters the patient information into the software, which reflects in the laboratory. The patient is then sent to the laboratory, where laboratory investigations are conducted. LIS links the laboratory departments apart from the clinical department. The results from different departments are easily merged into the system before they are released to the doctor. For example, the doctor may request a full blood count and malaria tests conducted in the hematology and parasitology departments, respectively (Aziz, 2017). These are independent departments carrying out specified tests. However, once all the results are out, they are merged, and the final copy is sent to the doctor. It makes it easier for the doctor to have a complete copy of the results from the laboratory without logging into the departments independently.
The doctors and laboratory officers at Christiana Care Hospital use the Laboratory Information System (LIS) to coordinate between the clinical and laboratory departments. It is confirmed that the system is making work easier for patient management. The patients do not have to wait for the results in the laboratory after sample collection (Otokiti, 2019). They wait for the results at the clinical department. The results are sent to the doctor directly and cannot be manipulated. A copy of the result remains in the laboratory, where it can be retrieved when needed. The results are available even during the subsequent visits for easy patient follow-ups. The hospital uses a standard information system for the laboratory (Aziz, 2017). The system manages patient demographics, specimen entry and processing, and final results release. Therefore, patient data is protected from loss in the facility and can be accessed by authorized individuals. LIS has promoted effective coordination of doctors and laboratory officers in patient management.
Findings and Recommendations for EHR
Christiana Care Hospital has implemented Electronic Health Records (EHRs) software faster. The hospital has registered for EHR Incentive Programs since its initial implementation. The organization is among the eligible healthcare providers implementing EHRs in the United States (Evans, 2021). The program accounts for over 388,000 practices to which the organization must adhere. However, although the organization has successfully implemented the initial stages, the initial usage is never easy. The resources, time, and cooperation from the entire process have not been easy. Some barriers have been faced in the usage of this informatics system. They have posed a serious threat to the organization in the continued implementation of the system (Pramanik et al., 2020). Also, Christiana Care Hospital does not have to stop its continued implementation since it is one of the outstanding healthcare organizations. Barriers are common in implementing any strategic plan, and EHRs are no exception.
The discussions with healthcare providers have realized some challenges with the system. Firstly, the computer’s technical ability (Coiera, 2015). The ability of computers to retrieve and send information depends on their age and location. The software requires an internet connection to transfer information from one point to another. Sending information to rural areas is stressful due to poor network coverage compared to urban centers. Secondly, some people on board may not know about using EHRs (Cowie et al., 2017). The patients and healthcare providers easily give up on the system when there are technical malfunctions. The patients would even think of visiting the doctor rather than waiting for information to be sent. Thirdly, the cost of use may be expensive (Aziz, 2017). The technological advancements in healthcare information can require additional costs. Investing in training and the physical infrastructure at the initial stages is expensive. Therefore, the following recommendations have been made to the organization’s Electronic Health Records (EHRs) system.
Firstly, Christiana Care Hospital should consider security concerns while implementing electronic health record systems. The security measures should target both the internal environment as well as the external environment. A security officer must be designated to work with a team of experts on health information technology (Iyenga et al., 2018). The team should identify possible threats and weaknesses of the system and address them appropriately. Security, privacy, and confidentiality responsibilities should be assigned to a nurse manager or nursing staff member. Patient information should never leave the healthcare informatics systems without patient authorization. The hospital is tasked with storing data, but full ownership remains with the patient.
Secondly, the organization should use safety experts to advise on the customization, implementation, and use of electronic health records. A customized EHRs system meets the practice’s needs and responds to the practice’s problems more than the generic system (Hoyt & Yoshihashi, 2019). The templates and specialty-specific tools provide an intuitive experience in the system. An organization that prefers dealing without professionals is likely to perform much better. A team of professionals on the same subject has a pool of ideas that can be used in implementing a system. They are experts in a particular area and understand what should be done to achieve desired objectives. They advise on the integrity levels of the system at the initial stages.
Thirdly, the system users should avoid documentation errors at all costs. It would ensure proper data integrity during collection and use. The users of healthcare information systems should be provided with adequate training on its operations (Otokiti, 2019). They have to get equipped with the necessary troubleshooting mechanisms to avoid system failure. The system management must address the gaps that could lead to data manipulation, intentionally or unintentionally. It would ensure that data integrity within the system does not become compromised. An alert has to be created to inform the system manager if an unauthorized person tries to access the patient information.
Fourthly, the organization should be keen on healthcare informatics systems users who misuse their privileges. Some healthcare providers perform unauthorized actions such as browsing through patients’ records. The system should develop mechanisms to protect patient information (Iyenga et al., 2018). Expansion of the healthcare system exposes it to more vulnerable attacks. Thus, the systems have to be continuously updated to prevent easy access. Also, lay-off employees may leave with crucial information on the functionality of the hospital’s systems. Appropriate measures are required to kill individuals with malicious acts in the systems’ operations. It is an area of interest since experts can interfere with the healthcare system information unnoticed. It will need another team of experts to identify such illegalities.
Fifthly, the organization should perform a formal usability assessment of the system. Standard test cases are necessary to understand the systems’ functionality (Evans, 2021). It then provides measures for adverse events. The EHR system can be appraised based on the usability references cataloged and perceived by usability evaluators. There are defined expectations that need to be reached by the system. Standard compliance is valid for the system and users. A manual guide provides the standards of compliance for operating the system. There should be ease of use by the system to show that it meets the usability assessment. It can only be demonstrated when the users are not struggling with the system.
Lastly, it would be more appropriate for the organization to look into the future. Even though electronic health record is a current trend in the healthcare management system, it would be more important to focus on working as a leader with healthcare agencies (Evans, 2021). It calls for the need to lead in improving the quality of care by upholding the professional code of ethics. The healthcare providers will display both technological and healthcare competence while handling patients. The electronic health record systems have full information about the patient. The organization has the sole responsibility of protecting this information from a breach. The organization’s system must guarantee future protection of patient data.
Ethical Issues and Policies
The main ethical issues in healthcare informatics systems are privacy and confidentiality. Ethical issues occur when choices have to be made in healthcare informatics systems (Mason, 2017). The answers may be unclear, and the available options may not be ideal. The result could be reduced quality of care for the patients. Thus, it could also result in challenges in clinical relationships between healthcare providers and patients. Moral distress could also result, defined as knowing the right thing to do without being allowed to do it. Informatics systems’ handlers are more susceptible to legal and ethical issues in information access and moral distress (Foxman & Kilcoyne, 2018). It is because they are entitled to mentoring and leadership roles in healthcare. The information systems experts look to the system managers for reliable, ethical decision-making.
Privacy and confidentiality are fundamental rights that exist in healthcare management. Research showed that it is the responsibility of healthcare providers to safeguard such rights concerning the personal health information of the patients (Mason, 2017). Every informatics systems handler should have the understanding and respect necessary for patient privacy and confidentiality. The connection between medical practitioners and patients relies on the confidence established. Privacy refers to the right of patients to keep their personal health information from being disclosed (Iyenga et al., 2018). They play full control over how other individuals get access to themselves. Confidentiality refers to how the system users treat the private information about the patients once it has been disclosed to them. The patients disclose their personal health information to healthcare providers due to trust. They believe the information disclosed to doctors would remain confidential. The following healthcare policies have been put in place to ensure the privacy and confidentiality of patient information.
Firstly, the Health Insurance Portability and Accountability Act (HIPAA) should conform. The policy was implemented to improve communication between healthcare providers and their patients. It also improved communication between healthcare providers and patients’ relatives (Mason, 2017). The effect of this law has been felt in the whole healthcare informatics system. The law provides rights for every patient and safeguards the rights of every employee. Christiana Care Hospital has stressed the significance of ensuring privacy and confidentiality for all patient information since the writing of the Nightingale Pledge took place. Effective communication allows for transparency in providing patient information (Cowie et al., 2017). The patient is also assured that the information provided is protected. All the information is within the hospital’s reach and can only be issued once authorized. The data are stored electronically and are not prone to loss. They are available for future reference during healthcare visits designed by doctors.
Secondly, there should be adherence to Personal Health Information Protection Act (PHIPA) formed in 2004 by the government. The policy was passed due to the sensitive nature of privacy information (Iyengar et al., 2018). It was to provide general guidance to healthcare professionals. It also ensured that the patients had peace of mind while seeking healthcare services. In the recent years following its enactment, it has become a personal health information laws model in the United States. The informatics systems users in the healthcare organization should remain cognizant of the law moving forward (Aziz, 2017). It includes adhering to its requirements and application in this increasingly interconnected digital age. The Personal Health Information Protection Act, 2004, has set rules for collecting, disclosing, and using personal health information. It has been defined as “health information custodians,” encompassing broad categories of individuals and organizations (Mason, 2017). The healthcare providers fall under the custodian and are subject to the Health Information Protection Act.
Thirdly, compliance with the fundamental guiding principles identified by the Information and Privacy Commissioner on patient information collection and use should be compliant. The policy directs the custodian to collect, use and disclose the patient’s personal health information upon being issued with full consent by the patient or unless the Act permits to do so (Iyengar et al., 2018). The custodian should not collect, use, or disclose personal health information if the current information provides the same solution of interest. The custodian must not proceed with collecting, using, and disclosing personal health information if the information does not meet the intended purpose. Besides, there should be express consent before collecting, using, and disclosing personal health information. These refer to personal health information that may be used for fundraising purposes. The Act provides a mechanism for complaints about persons who believe someone else has contravened the Act.
Conclusion
Healthcare informatics is experiencing rapid growth due to technological advancements in healthcare systems. The growth touches every aspect of healthcare organization in modern health systems. Several factors have shaped healthcare informatics, including healthcare reforms, computerized data storage and records, and the urge to improve patient care and safety. The definition and delineation of informatics scope into subspecialties. A focus on Christiana Care Hospital has revealed the use of informatics systems like electronic health records (EHRs), remote patient monitoring (RPM), and laboratory information systems (LIS). An investigation of electronic health record systems (EHRs) has revealed challenges experienced with the system. Privacy and confidentiality are the main ethical issues in informatics systems. It is the responsibility of every healthcare organization to ensure the protection of patient information. Sharing of patient information between users and other healthcare organizations will increase in the future. Thus, the patient demand for transparency and accountability will grow with national benchmarks.
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