Module 5: Agency for Healthcare Research and Quality

The U.S. Department of Health & Human Services Agency for Healthcare Research and Quality website provides links to various grant projects currently in progress, under review, and completed. I spent most of my time looking over the reports under the “Health IT” menu. There were four recent reports I browsed over: barcode medication administration, chronic disease management, computerized provider order entry, and telehealth. I also read the abstract of Mixed Patient Use of Electronic Messaging to Communicate with Doctors.

Is there any relationship between the information available on this webpage and regulatory, accreditation, and reimbursement issues and health care information system use and design?

All the methods provide insightful information on how implementation can improve the quality, safety, efficiency, and effectiveness of health care. Some considerations to keep in mind are the regulation of such IT systems, how staff will be reimbursed for their time, and if their design will truly be the most effective.

Barcode Administration was launched a few months before I left IHC to move to Salt Lake. The training was straight forward, and because the system was new, we had opportunities to participate in improving the “bugs.” I found that there were always ways to override barcode scans, whether it was because the barcode did not work or because the “do not give reason” was incorrect. The intent was good, all overrides were compiled and reviewed by the pharmacy department, and I’m positive there were less med errors after implementation of the barcode system. With the option to override, there is abuse potential. Our manager publically posted how many “overrides” were performed by each nurse each month and also stated a goal in which the department would not exceed. I don’t think we ever reached that goal.

Chronic Disease Management is always tough because there are so many factors to consider. The website states 4 technologies that may better support and manage chronic disease: clinical decision support systems, health information exchange, telehealth, and hospital information systems. All of these systems are great tools to provide information about patients and manage the course of their disease. Many labs, meds, and results can be easily accessible. The article also emphasized the need for various team members to facilitate the success of the program including nurse educators, nurse case managers, case managers, and nonclinical assistants. The problem with the various systems is that there are multiple to choose from. The one decision support system I researched, DiagnosisPro, was updated by physicians and a devoted team; however, can we stop IT programs from information overload? This may be a growing problem, as others want to contribute to the body of knowledge without having any research background.

Computerized provider order entry has been talked about since I was in nursing school. It is still being discussed today because of illegible handwriting. We double chart all the time in first net, our written charting, and through the other departments we work with. If we could all get under one system, reimbursement would not be a big issue since providers can make orders and initiate referrals. Things do not have to be put in the system more than once.

Telehealth connects people and providers from a distance and although convenience is an advantage, there is question on losing the patient-provider interaction. Body language, tone of voice, and overall presence is lacking when telehealth is the only source of communication. Three other challenges presented on the website include security, image resolution, and technical support.

In a NEJM Reader’s Forum from October 30, 2003, the author states, “In the end, medicine will always be about one patient and one physician together in one room connecting through the most basic of communication systems: touch.” For me, this is the most important ethical consideration when looking at implementation of IT in healthcare.