Laurie A. Huryk RN, BSN - New Jersey Primary Care Association
Laurie A. Huryk RN, BSN - New Jersey Primary Care Association
Laurie A. Huryk RN, BSN
VNACJ Community Health Center
Family Medicine Residency Program at CentraState
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Questions: Please reserve your
questions until the end of the
Determine the level of involvement end
users should have in an IT project.
Determine an acceptable level of decreased
productivity throughout the development
and implementation process.
Provide appropriate support for end users
Modernize our nation’s infrastructure
Enhance energy independence
Expand educational opportunities
Provide tax relief
Preserve and improve affordable health
Goal: Improve quality and value of
American health care
Method: Expanded use of health
information technology (HIT)
*2008 only 4% physician offices and 2% hospitals
fully utilize Electronic Health Records (EHR)
Plan: Accelerate the adoption of HIT
Eligible Providers and Hospitals who
are Meaningful Users of certified HIT.
Beginning with financial year 2011 and
ending with financial year 2015.
Penalties of reduced payments will
begin in financial year 2015.
Must use certified EHR technology in a
Must be able to electronically exchange
information from the certified EHR.
Must submit clinical quality measures
to the Secretary of the US Department
of Health and Human Services.
Systems that are fully functional but
inadequate for meeting meaningful use
Systems that are not being used to their
Upgrades and core functionality
modifications from the vendor
Perceive problem with current process and
believe that an improved process exists.
The individual or group must be willing to
learn the new process, and must feel safe in
the learning environment.
New process must be congruent with
individual’s other tasks and responsibilities.
User must be aware that an innovation
exists and persuaded that the idea is
A conscious decision must be made to use
The user must be provided with feedback to
verify that the new innovation is beneficial
in order to sustain change.
Retrieved from http://en.wikipedia.org/wiki/File:Diffusionofideas.PNG
Reduction in medical errors
Expert support for clinical decisions
Reduction in re-hospitalization
Ability to reach rural patients
Access to experts around the clock
Consistency in documentation
Portability and redundancy of medical records
Ability to create and maintain a complete patient centered
Enhanced reporting capabilities
Improved patient follow-up
Where is the evidence?
Longhurst, C. A., Parast, L., Sandborg, C. I., Widen, E., Sullivan,
J., Hahn, J. S., … Sharek, P. J. (2010). Decrease in hospital-wide
mortality rate after implementation of a commercially sold
computerized physician order entry system. Pediatrics. Advance
online publication. doi: 10.1542/peds.2009-3271
Poon, E. G., Keohane, C. A., Yoon, C. E., Ditmore, M., Bane, A.,
Levtzion-Korach, O., … Gandhi, T. K. (2010). Effect of bar-coded
technology on the safety of medication administration. New
England Journal of Medicine, 362(18), 1698-1707.
Chumbler, N. R., Haggstrom, D. A., & Saleem, J. (2010).
Implementation of health information technology in veterans
health administration to support transformational change:
Telehealth and personal health records. Medical Care 48(12),
Advance online publication.
Diligent healthcare providers
Improved quality through focusing on
chronic conditions and other factors
The potential is unimaginable with
Designate specific meeting times
Develop timeline for project
Purpose: Allow IT staff the opportunity to
understand the workflow requirements of clinical
Methods: Individual key IT personnel observe
patient encounter through entire visit cycle
current documentation processes of clinical
current system report usage
Purpose: To familiarize IT staff with current forms so
that new system may be analyzed for congruency with
documentation requirements and formatting may be
customized to be similar to current forms whenever
Method: IT staff members will analyze
clinical documentation forms
external forms (i.e. referral forms for particular
reports compiled under current system
Purpose: Allow clinical staff the opportunity to
further explain and clarify workflow and
documentation needs and to offer suggestions for
process improvement that may be incorporated into
the new system.
Method: IT Analyst will interview
clinical staff members
Thorough testing done in stages
Involve all staff, not just committee
Be prepared to rework some
components of system
Encourage constructive criticism
Onsite vendor support
Onsite super–user support
Method depends upon comfort level of
Plan on decreased productivity
Six month rule
Utilize the IT Committee
Thoroughly test all changes
Train all users on changes
Required changes to system
Standards of care
Patient education documents
ENHANCEMENT REQUEST FORM
DETAILED DESCRIPTION OF ENHANCEMENT REQUEST
Implementing an EHR is a big
investment. Including your staff and
physicians throughout the planning,
development, and implementation
processes and providing adequate
support post “go-live” enhances the
probability of success.
Leiber, H. S. (2009). Overview of the American Recovery and Reinvestment Act of 2009.
Powerpoint presentation from a virtual conference of the Health Information
Management Systems Society. Retrieved May 1, 2009 from http://www.himss.org/.
Lewin, Kurt (1997). Resolving social conflict/ Field theory in social science. Washington,
D.C.: American Psychological Association.
McGonigle, D., & Mastrian, K. (2009). Nursing Informatics and the Foundation of
Knowledge. Sudbury, MA: Jones and Bartlett Publishers.
Medicare and Medicaid Programs; Electronic Health Record Incentive Program;
Proposed Rule, 75 Fed. Reg . (proposed Jan. 13, 2010) (to be codified at 45 C.F.R. pt. 412,
413, 422, and 495).
Rogers, E. M. (2003). Diffusion of innovations (5th ed.). New York: Simon & Schuster.
Schein, E. H. (1996). Kurt Lewin’s change theory in the field and in the classroom:
Notes toward a model of managed learning. Systemic Practice and Action Research 9(1),
Shelly, G. B., & Rosenblatt, H. J. (2010). Systems analysis and Design (8th Ed.). Boston,
MA: Course Technology, Cengage Learning.
U.S. Department of Health and Human Services. Health IT Adoption Initiative.
Retrieved June 11, 2009
To be published in the Journal of Nursing Management
within the next 6 months.