Discussions 1. Electronic Health Records Electronic health records (EHRs) are at the center stage of the effort to improve health care quality and control costs. In addition to allowing medical practitioners to access and record clinical documentation at much faster rates, EHRs are also positively influencing care delivery and nurse-patient interaction. Yet despite the potential benefits of EHRs, their implementation can be a formidable task that has broad-reaching implications for an entire health care organization. In this Discussion, you appraise strategies for obtaining the benefits and overcoming the challenges of implementing and using electronic health records. To prepare Review the implementation of EHRs in an organization. Reflect on the various approaches used. If applicable, consider your own experiences with implementing EHRs. What were some positive aspects of the implementation? What suggestions would you make to improve the process? Reflect on the reactions of others during the implementation process. Were concerns handled effectively? If you have not had any experiences with an EHR implementation, talk to someone who has and get his or her feedback on the experience. Search and indicate examples of effective and poor implementation of EHRs. RESOURCES Required Readings McGonigle, D., & Mastrian, K. G. (2015). Nursing informatics and the foundation of knowledge (3rd ed.). Burlington, MA: Jones and Bartlett Learning.  Chapter 15, “The Electronic Health Record and Clinical Informatics” This chapter describes the crucial parts of an electronic health record system and explores the benefits of implementing one. Bates, D. W. (2010). Getting in step: Electronic health records and their role in care coordination. Journal of General Internal Medicine, 25(3), 174–176. The author of this editorial critically analyzes current applications of electronic health records (EHRs) and their impact on cost, quality, and safety of health care delivery. The author describes a study on the use of vendor-developed EHRs in clinical practice settings, the results of which pinpointed the benefits and drawbacks of EHRs. Cresswell, K., & Sheikh, A. (2009). The NHS Care Record Service: Recommendations from the literature on successful implementation and adoption. Informatics in Primary Care, 17(3), 153–160.  This article defines the United Kingdom’s National Health Service’s Care Record Service (NHS CRS) as a standard electronic health record system. The article describes the challenges associated with implementing this new information technology and provides recommendations for overcoming those challenges. Fickenscher, K., & Bakerman, M. (2011). Change management in health care IT. Physician Executive, 37(2), 64–67. This article offers strategies for health care leaders to successfully implement change programs in their organizations, especially with regard to the new standards for electronic health records (EHRs). The article provide.

1. Discussions
1.
Electronic Health Records
Electronic health records (EHRs) are at the center stage of the
effort to improve health care quality and control costs. In
addition to allowing medical practitioners to access and record
clinical documentation at much faster rates, EHRs are also
positively influencing care delivery and nurse-patient
interaction. Yet despite the potential benefits of EHRs, their
implementation can be a formidable task that has broad-
reaching implications for an entire health care organization.
In this Discussion, you appraise strategies for obtaining the
benefits and overcoming the challenges of implementing and
using electronic health records.
To prepare
Review the implementation of EHRs in an organization. Reflect
on the various approaches used.
If applicable, consider your own experiences with implementing
EHRs. What were some positive aspects of the implementation?
What suggestions would you make to improve the process?
Reflect on the reactions of others during the implementation
process. Were concerns handled effectively?
If you have not had any experiences with an EHR
implementation, talk to someone who has and get his or her
feedback on the experience.

2. Search and indicate examples of effective and poor
implementation of EHRs.
RESOURCES
Required Readings
McGonigle, D., & Mastrian, K. G. (2015). Nursing informatics
and the foundation of knowledge (3rd ed.). Burlington, MA:
Jones and Bartlett Learning.
Chapter 15, “The Electronic Health Record and Clinical
Informatics”
This chapter describes the crucial parts of an electronic health
record system and explores the benefits of implementing one.
Bates, D. W. (2010). Getting in step: Electronic health records
and their role in care coordination. Journal of General Internal
Medicine, 25(3), 174–176.
The author of this editorial critically analyzes current
applications of electronic health records (EHRs) and their
impact on cost, quality, and safety of health care delivery. The
author describes a study on the use of vendor-developed EHRs
in clinical practice settings, the results of which pinpointed the
benefits and drawbacks of EHRs.
Cresswell, K., & Sheikh, A. (2009). The NHS Care Record
Service: Recommendations from the literature on successful
implementation and adoption. Informatics in Primary Care,
17(3), 153–160.
This article defines the United Kingdom’s National Health
Service’s Care Record Service (NHS CRS) as a standard

3. electronic health record system. The article describes the
challenges associated with implementing this new information
technology and provides recommendations for overcoming those
challenges.
Fickenscher, K., & Bakerman, M. (2011). Change management
in health care IT. Physician Executive, 37(2), 64–67.
This article offers strategies for health care leaders to
successfully implement change programs in their organizations,
especially with regard to the new standards for electronic health
records (EHRs). The article provides insights on change
management, the reasons people resist change, and the ways to
establish a culture that is more open to change initiatives.
Gruber, N., Darragh, J., Puccia, P. H., Kadric, D. S., & Bruce,
S. (2010). Embracing change to improve performance. Long-
Term Living: For the Continuing Care Professional, 59(1), 28–
31.
This text describes the implementation of a new electronic
health record system at a 105-bed hospital related-facility. The
authors highlight five key elements that were deemed necessary
for a successful EHR implementation.
Hyrkäs, K., & Harvey, K. (2010). Leading innovation and
change. Journal of Nursing Management, 18(1), 1–3.
According to the authors, the health care field is in need of
more effective leaders who understand innovation, who
appreciate diversity and change, and who can foster and
implement innovation and creativity. The authors describe how
nurse leaders can be instrumental in embracing and
disseminating innovation throughout the health care system and
provide scaffolding for subsequent articles in this issue of the
journal.

4. Mooney, B. L., & Boyle, A. M. (2011). 10 steps to successful
EHR implementation. Medical Economics, 88(9), S4–6, S8–S11.
The authors of this article describe the incentives and
requirements for electronic health records (EHRs) outlined in
the Health Information Technology for Economic and Clinical
Health (HITECH) Act. The authors then provide 10 steps for
health care leaders and organizations to follow when
implementing EHRs.
Murphy, J. (2011). Leading from the future: Leadership makes a
difference during electronic health record implementation.
Frontiers of Health Services Management, 28(1), 25–30.
In this article, the author examines the causes behind the
increasing complication of EHR implementations. In addition,
the author explores the role of leadership in guiding successful
EHR implementations.
Required Media
Laureate Education (Producer). (2012b). Electronic health
records. Baltimore, MD: Author.
In this video, Katie Skelton, Richard Rodriguez, Carina Perez,
Shannon Mori, and Carmen Ferrell describe how their hospital
implemented an electronic health record. They also outline the
general considerations, benefits, and support measures related
to electronic health records.
2.
Successful Implementation of Electronic Health Information
Technology

5. Since the inception of the HITECH Act, health organizations
have faced increased pressure to update their health information
technology (HIT) resources. As discussed last week, many
believe that the increased use of electronic health records and
the quick and efficient communication afforded by HIT can lead
to improved quality of patient care. Yet there are significant
costs associated with implementing such systems. What can
organizations do to ensure that the correct system is selected
and that the system will be appropriate for those required to use
it? Who should be involved in those decisions?
This week introduces the systems development life cycle and
discusses how it can guide an organization through the
complexities of adopting a new HIT system.
In this Discussion, you are asked to consider the role of nurses
in the SDLC process.
To prepare:
Review the steps of the systems development life cycle.
Think about your own organization, or one with which you are
familiar, and the steps the organization goes through when
purchasing and implementing a new HIT system.
Consider what a nurse could contribute to decisions made at
each stage when planning for new health information
technology. What might be the consequences of not involving
nurses?
Reflect on your own experiences with your organization
selecting and implementing new technology. As an end user, do
you feel you had any input in the selection or and planning of
the new HIT system?

6. RESOURCES
Required Readings
McGonigle, D., & Mastrian, K. G. (2015). Nursing informatics
and the foundation of knowledge (3rd ed.). Burlington, MA:
Jones and Bartlett Learning.
Chapter 10, “Systems Development Life Cycle: Nursing
Informatics and Organizational Decision Making”
This chapter explains the systems development life cycle and
explores various methods of applying it. The chapter also
examines the importance of interoperability in implementing
HITECH.
Chapter 11, “Administrative Information Systems”
This chapter provides an overview of agency-based health
information systems. The text also details how administrators
can use core business systems in their practice.
Boswell, R. A. (2011). A physician group’s movement toward
electronic health records: A case study using the
transtheoretical model for organizational change. Consulting
Psychology Journal: Practice and Research, 63(2), 138–148.
The authors of this article present a case study on an EHR
implementation in a multispecialty physician group. The case
study attempts to determine actions that promote successful
EHR implementation and the pros and cons of implementation.
Hsiao, J., Chang, H., & Chen, R. (2011).A study of factors
affecting acceptance of hospital information systems: A nursing
perspective. Journal of Nursing Research, 19(2), 150–160.

7. The focus of this article is to determine what factors are most
important in predicting the acceptance of new health
information technology. The results of the study indicated that
self-efficacy, top management support, and the quality of
information retrieved are the most important determinants of the
willingness of nurses to adopt and use a new technology.
Kelley, T. F., Brandon, D. H., & Docherty, S. L. (2011).
Electronic nursing documentation as a strategy to improve
quality of patient care. Journal of Nursing Scholarship, 43(2),
154–162.
This article summarizes a literature review of the relationship
between electronic health records (EHRs) and quality of patient
care. The article identifies deficiencies in existing research
regarding the daily interactions of nurses, patients, and
electronic documentation, and it provides a comparison between
electronic and paper-based documentation and its effect on
quality of care.
Nurse leaders discuss the nurse’s role in driving technology
decisions. (2010). Virginia Nurses Today, 18(1), 8–9.
This article summarizes a roundtable held with a number of
nursing executives to discuss the role nurses should take in the
selection and adoption of new technologies for health care. The
executives concluded that the nurses’ goals should be to select
technology that will further their ability to provide safe, quality
care to their patients.
Page, D. (2011). Turning nurses into health IT superusers.
Hospitals & Health Networks, 85(4), 27–28.
This article highlights the importance of involving nurses with
all phases of the decision and implementation process
surrounding new health information technology. The author

8. stresses the importance of communication in the process as well
as defining success.
Swab, J., & Ciotti, V. (2010). What to consider when
purchasing an EHR system. hfm(Healthcare Financial
Management), 64(5), 38–41.
In this article, recommendations are given for purchasing health
information technology. These include selecting the appropriate
vendor, carefully considering the cost of both new equipment
and personnel, and involving clinicians in decisions.
Required Media
Laureate Education (Producer). (2012g). Systems development
life cycle. Baltimore, MD: Author.
The systems development life cycle (SLDC) provides a
framework for all of the steps necessary to implementing a new
technology or process within an organization. This video
explains the SDLC and how it is used in the health care field.
Optional Resources
Agency for Healthcare Research and Quality. (2005). A toolkit
for redesign in health care. Retrieved from
http://www.ahrq.gov/legacy/qual/toolkit/index.html
This website supplies strategies for reconfiguring and
transforming a hospital’s care processes. The text breaks down
the redesign process into a series of steps.
3.
Understanding Workflow Design

9. As you explored last week, the implementation of a new
technology can dramatically affect the workflow of an
organization. Newly implemented technologies can initially
limit the productivity of users as they adjust to their new tools.
Such implementations tend to be so significant that they often
require workflows to be redesigned in order to achieve
improvements in safety and patient outcomes. However, before
workflows can be redesigned, they must first be analyzed. This
analysis includes each step in completing a certain process.
Some systems duplicate efforts or contain unnecessary steps
that waste time and money and could even jeopardize patient
health care. By reviewing and modifying the workflow, you
enable greater productivity. This drive to implement new
technologies has elevated the demand for nurses who can
perform workflow analysis.
In this Discussion, you explore resources that have been
designed to help guide you through the process of workflow
assessment.
To prepare:
· Take a few minutes and peruse the information found in the
article “Workflow Assessment for Health IT Toolkit”.
o As you check out the information located on the different
tabs, identify key concepts that you could use to improve a
workflow in your own organization and consider how you could
use them.
o Go the Research tab and identify and read one article that is
of interest to you and relates to your specialty area.
RESOURCES
Required Readings

10. McGonigle, D., & Mastrian, K. G. (2015).
Nursing informatics and the foundation of knowledge
(3rd ed.). Burlington, MA: Jones and Bartlett Learning.
Chapter 14, “Nursing Informatics: Improving Workflow and
Meaningful Use”
This chapter reviews the reasons for conducting workflow
analysis and design. The author explains specific workflow
analysis and redesign techniques.
Huser, V., Rasmussen, L. V., Oberg, R., & Starren, J. B. (2011).
Implementation of workflow engine technology to deliver basic
clinical decision support functionality.
BMC Medical Research Methodology, 11
(1), 43–61.
Retrieved from the Walden Library databases.
In this article, the authors describe an implementation of
workflow engine technology to support clinical decision
making. The article describes some of the pitfalls of
implementation, along with successful and future elements.
Koppel, R., & Kreda, D. A. (2010). Healthcare IT usability and
suitability for clinical needs: Challenges of design, workflow,
and contractual relations.
Studies in Health Technology and Informatics, 157
, 7–14.
Retrieved from the Walden Library databases.

11. This article points to many health information technology
designs and workflow decisions that limit their value and usage.
The authors also examine the structure of the conceptual
relationships between HIT vendors and the clinical facilities
that purchase HIT.
U.S. Department of Health & Human Services. (n.d.b).
Workflow assessment for health IT toolkit
. Retrieved, June 18, 2012, from
http://healthit.ahrq.gov/portal/server.pt/community/health_it_to
ols_and_resources/919/workflow_assessment_for_health_it_tool
kit/27865
This article supplies a toolkit on the planning, design,
implementation, and use of health information technology. The
sections of the website provide a definition of workflow,
examples of workflow tools, related anecdotes, and research.
Document: Sample Workflow of Answering a Telephone in an
Office (Word document)
Required Media
Laureate Education (Producer). (2012f).
System design and workflow
. Baltimore, MD: Author.
This video provides an overview of how workflow modeling can
be used in a health care setting to target areas for revising
current practices and procedures. The video also shows how
technology and informatics can be used to improve workflow
efficiency and increase the quality of care.
4.

12. Using Health Information Technology as a Source of Evidence-
Based Practice
Before the digital revolution, health information technology
supplied very limited support for evidence-based practice. If
nurses wanted to be informed about cutting-edge research, their
best bet was to either subscribe to leading journals or make
periodic trips to the library. With the establishment of research
databases, however, nurses became empowered to learn about
and facilitate interdisciplinary and translational research.
Databases are just one example of how health information
technology supports evidence-based practice.
To prepare:
· Read the following scenario from the text (McGonigle &
Mastrian, 2015, p. 445):
Twelve-hour shifts are problematic for patient and nurse safety,
and yet hospitals continue to keep the 12-hour shift schedule. In
2004, the Institute of Medicine (Board on Health Care Services
& Institute of Medicine, 2004) published a report that referred
to studies as early as 1988 that discussed the negative effects of
rotating shifts on intervention accuracy. Workers with 12-hour
shifts realized more fatigue than workers on 8-hour shifts. In
another study done in Turkey by Ilhan, Durukan, Aras,
Turkcuoglu, and Aygun (2006), factors relating to increased
risk for injury were age of 24 or less, less than 4 years of
nursing experience, working in the surgical intensive care units,
and working for more than 8 hours.
· Consider how the resources identified in the scenario above
could influence an organization’s practice.
· Select an issue in your practice that is of concern to you.
Using health information technology, locate at least three

13. evidence-based practice resources that address your concern and
that could possibly inform further action.
RESOURCES
Required Readings
McGonigle, D., & Mastrian, K. G. (2015).
Nursing informatics and the foundation of knowledge
(3rd ed.). Burlington, MA: Jones and Bartlett Learning.
Chapter 23, “Research: Data Collection, Processing, and
Analytics”
The authors of this chapter relate nursing research to the
foundation of knowledge model. The chapter assesses
informatics tools for collecting data, storing information, and
processing and analyzing data.
Chapter 25, “Translational Research: Generating Evidence
for Practice”
In this chapter, the authors differentiate evidence-based practice
and translation research. They also describe models used to
introduce research findings intro practice.
Hynes, D. M., Weddle, T., Smith, N., Whittier, E., Atkins, D.,
& Francis, J. (2010). Use of health information technology to
advance evidence-based care: Lessons from the VA QUERI
program.
Journal of General Internal Medicine, 25

14. (Suppl. 1), S44–S49.
This article presents a study that evaluated the role of health
information technology (HIT) in the Department of Veteran
Affairs’ Quality Enhancement Research Initiative. The authors
convey their findings on how HIT provided data and
information to aid implementation research, and how
implementation research helped further HIT development.
Additionally, the text details methods of overcoming common
HIT barriers to implementation research.
Jamal, A., McKenzie, K., & Clark, M. (2009). The impact of
health information technology on the quality of medical and
health care: A systematic review.
Health Information Management Journal, 38
(3), 26–37.
This text details a study that reviews the published evidence
concerning the impact of health information technology (HIT)
on the quality of health care. The study investigated the use of
HIT in medical care and allied health and preventive services.
The authors primarily focus on the impact of electronic health
records, computerized provider order-entry, and decision
support systems.
Umscheid, C. A., Williams, K., & Brennan, P. (2010). Hospital-
based comparative effectiveness centers: Translating research
into practice to improve the quality, safety and value of patient
care.
JGIM: Journal of General Internal Medicine, 25
(12), 1,352–1,355.
This article revolves around the usage of the hospital-based
comparative effectiveness (CE) center model. The authors
highlight the model’s benefits and the increasing usage of CE
evidence. The article also reviews solutions to overcoming

15. many of the challenges to operating hospital-based CE centers.
Optional Resources
Chlan, L., Tracy, M. F., & Grossbach, I. (2011). Pulmonary
care. Achieving quality patient-ventilator management:
Advancing evidence-based nursing care.
Critical Care Nurse, 31
(6), 46–50.
5.
HITECH Legislation
In order for organizations to receive the incentives offered
through the HITECH legislation, they must be able to
demonstrate that they are using the technology in meaningful
ways. The following criteria for meaningful use must be evident
to qualify for EHR incentives (U.S. Department of Health &
Human Services, 2012). The technology must:
· Improve quality, safety, and efficiency, and reduce health
disparities
· Engage patients and families
· Improve care coordination
· Improve population and public health
· Ensure adequate privacy and security protections for personal
health information
For this Discussion, you consider the impact of the meaningful
use criteria of the HITECH legislation on the adoption of health
information technology.

16. To prepare:
· Review the Learning Resources on the HITECH legislation
and its primary goals.
· Reflect on the positive and negative impact this legislation has
had on your organization or one with which you are familiar.
· Consider the incentives to encourage the use of EHRs. Focus
on the definition of meaningful use and how it is measured.
· Reflect on how the incentives and meaningful use impact the
quality of patient care.
· Find an article dealing with one of the criteria to qualify for
meaningful use and how it has been successfully met.
RESOURCES
Required Readings
McGonigle, D., & Mastrian, K. G. (2015).
Nursing informatics and the foundation of knowledge
(3rd ed.). Burlington, MA: Jones and Bartlett Learning.
Chapter 9, “Legislative Aspects of Nursing Informatics:
HITECH and HIPAA”
This chapter explores two pieces of legislation that
dramatically impact nursing informatics: the Health
Information Technology for Economic and Clinical Health
Act of 2009 and the Health Insurance Portability and

17. Accountability Act of 1996.
Arlotto, P. (2010). 7 strategies for improving HITECH
readiness.
hfm(Healthcare Financial Management)
,
64
(11), 90–96.
This article reviews seven strategies to help prepare for the
implementation of the Health Information Technology for
Economic and Clinical Health Act (HITECH). The central point
of the article focuses on demonstrating meaningful use of
electronic health records.
Begum, R., Smith Ryan, M., Winther, C. H., Wang, J. J.,
Bardach, N. S., Parsons, A. H., & … Adams Dudley, R. (2013).
Small Practices’ Experience With EHR, Quality Measurement,
and Incentives.
American Journal Of Managed Care, 19e
SP12–8.
This article presents a study of clinician’s attitudes toward the
use of financial incentives for the implementation of electronic
health records in small practices.
Brown, B. (2010). The final rules for meaningful use of EHRs.
Journal of Health Care Compliance, 12
(5), 49–50.
In this article, the author poses four questions pertaining to the
EHR system in the United States. In particular, the article
examines Medicare and Medicaid incentive payments and the
ways the meaningful use of certified EHRs will be verified.

18. Classen, D. C., & Bates, D. W. (2011). Finding the meaning in
meaningful use.
New England Journal of Medicine, 365
(9), 855–858.
This article details the challenges of meeting the meaningful use
standards in order to receive the benefits legislated under the
HITECH Act. The authors specify the requisites for achieving
benefits with EHRs, the relationship between meaningful use
and commercial EHRs, and the tools needed to evaluate EHRs
after implementation.
Kempfert, A. E., & Reed, B. D. (2011). Health care reform in
the United States: HITECH Act and HIPAA privacy, security,
and enforcement Issues.
FDCC Quarterly, 61
(3), 240–273.
The authors of this article examine HITECH, in addition to the
impact of the privacy rules under the Health Insurance
Portability and Accountability Act (HIPAA). The article details
the potential negative repercussions of failing to comply with
HIPAA and HITECH.
Murphy, J. (2010b). Nursing informatics. The journey to
meaningful use of electronic health records.
Nursing Economic$, 28
(4), 283–286.
This article reviews HITECH and the background leading up to
its passage. The author also details the financial incentives
intended to assist health care providers in purchasing and
implementing HIT and EHR systems.
Optional Resources

19. U.S. Department of Health & Human Services. (2011).
Health IT home
. Retrieved from http://www.healthit.gov/
U.S. Department of Health & Human Services. (2012).
Regulations and guidance
. Retrieved from http://www.healthit.gov/policy-researchers-
implementers/health-it-rules-regulations