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Nursing Informatics Unit 6 Week 6 Implementation of Technology

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Nursing Informatics (NSG 421)

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Herzing University

Academic year: 2021/2022

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1 Final Project Amari Wiley Herzing University Nursing Informatics Jennifer Dremann 2 Opening Final Project Our entire world changed due to an unexpected pandemic that expected to be this dangerous and last this long. Healthcare systems have faced shortages for supplies needed to keep both themselves safe and patients alive. Despite all the lives lost, and the fear and uncertainty that came from this pandemic, many organizations and businesses found comfort in knowing they had ways to survive turning to online meeting rooms. As a result of the pandemic healthcare organizations were forced to begin using telehealth services like never before. Telehealth appointments were the only way to continue seeing patients in clinics and hospitals without possibly infecting them and ourselves in the process of maintaining their health. Explanation of the Technology Telehealth is use of telecommunications and information technology to provide access to health assessment, diagnosis, intervention, consultation, supervision, and information across (Medicaid, n.). Telehealth facilitates the communication and information between providers allowing interactive teleconferencing between members of the healthcare team (Neville, 2018). Telemedicine is a healthcare service that many patients and providers had no knowledge of until the pandemic. The COVID pandemic of 2020, forced all individuals except essential workers to put their lives on hold while health and government officials did their best to control the number of cases, hospitalizations, and deaths that were occurring daily around the world. During the pandemic, those who truly needed the care of health professionals refused to be seen as they feared contracting the illness and spreading it to their loved ones, especially those with underlying conditions that would make 4 Kichloo et al. (2020), it would reduce the spread of germs amongst individuals in health care facilities as most health care waiting rooms cleaned until the end of clinic hours instead of in between which means that every patient that comes into that waiting room will come into contact with the germs and illness someone else has. According to Kichloo et al. (2020), additional benefits include decreasing healthcare costs not to mention helping ensure social distancing rules are followed. Additionally, the use of telehealth services for appointments can reduce the amount of rescheduled and cancelled patients appointments 2020). Telehealth services have been used in intensive care units (ICU). The use of telehealth services in ICUs has potentially reduced the length of hospitalizations along with ICU and hospital morbidity and mortality rates (Canfield Galvin, 2018). Research has found that using telehealth services within ICUs it can reduce the time needed to give interventions to patients. Telehealth services can also provide continuous monitoring to ICU patients while staff members continue with other tasks and patients potentially freeing up time to complete other things they need to complete during their shifts. Review of the Literature A journal article called, Ethical aspects of digital health from a justice point of view, explained that as a result of all the risks, benefits and uncertainty telehealth brings it is important to ensure that all users are given truthful information to help them determine whether they truly want to use the services or continue to meet and see their providers in person. From the research conducted on telehealth usage, ethical, legal, safety and privacy aspects, we have learned that there are concerns over who should have access to patient data along with how the information should be stored. There have been debates on the type of 5 consent forms needed for the use of telehealth services. There are concerns regarding what information would be collected and how it would be used in the future. Organizations would have to ensure safety protocols are in place to protect and store all the patient information provided while ensuring that only those who require the information have access. A journal article called, Bedside Nurse Acceptance of Intensive Care Unit Telemedicine Presence, explains that telehealth services have already been used for continuous monitoring of patients included with EKGs and even in intensive care units. Using telehealth services within departments that require critical care helps to free staff members to attend to other matters while also being able to have issues noticed a computer faster than if a human was constantly monitoring the patient. using telehealth monitoring systems, we can reduce the time between emergency events being recognized and the time it takes for patients to receive the interventions they need. The use of telehealth services first in intensive care units gives organizations an idea as to how the technology can be implemented in other departments throughout the organization to improve outcomes and care for patients while potentially helping to reduce burnout amongst staff members. This technology can also face barriers not only to leadership but to staff members and important to determine how organizations can begin to build acceptance before they begin to attempt to implement telehealth services. A journal article called, Integration of Advanced Health Technology Within the Healthcare System to Fight the Global Pandemic: Current Challenges and Future Opportunities, explains as a result of the unexpected COVID pandemic, health care organizations were forced to find safe and effective ways to help reduce and prevent the spread of amongst staff and patients. Throughout the pandemic advice given national and local health officials and 7 use telehealth services are password protected to reduce the risk of someone else accessing patient information. Additionally nurses who still need to document as they normally would. Telehealth services unfortunately as confidential as meeting in person as there are no doors to prevent others from overhearing the conversations going on between patients and their health team as these meetings can occur anywhere with an internet connection despite wearing headphones. Although wearing headphones means that those surrounding them would only hear one side of the conversation it mean that others hear private, patient sensitive information. As a result, it is important to ensure that before officially starting the that patients are instructed to move to a private area away from strangers or anyone they want to know their health issues and concerns. The journal article called, access for rural, regional and remote communities, within this article we learned that due to the COVID pandemic the Australian government changed their policy for who could use telehealth services. Before COVID, the Australian government was only training pharmacists and general practitioners to access health services. As a result of the Australian government allowing more health professionals to use telehealth services to treat patients, those living in remote and rural areas were able to receive the care they needed in a convenient and easy way. An Overview of Ethical When using telehealth services, healthcare and government officials need to determine if the same healthcare providers who had access to patient records and charts still received access. Organizations need to determine how the information healthcare providers need to perform their jobs should be accessed and stored. Organizations need a universal informed 8 consent form to give patients and families that clearly explains the benefits and risks of using telehealth services to allow patients and their families to make informed decisions on whether or not they wish to receive care using telehealth services. It is important to note that the responsibilities of healthcare professionals change slightly when using telehealth services compared to sessions as privacy becomes harder to guarantee. When using telehealth services, nurses are faced with new responsibilities including informing patients that the sessions are recorded, gaining informed consent and informing them of risks around using telehealth services. Nurses must still confirm patient identity. Nurses like any other health professional must ensure they use devices that are password protected. Documentation must still be performed as normal (Lambe, 2020). Additionally, these records should be stored in the record to ensure they also have access to review it at any point after the session. There are four most important ethical principles in healthcare. The four principles are: nonmaleficence, do no harm, beneficence, act for the benefit of the patient, autonomy, respecting wishes, and justice (Varkey, 2020). Before COVID telehealth visits using Zoom was impossible because the company ensure the safety of health information. In order to be able to protect health information and privacy, healthcare leaders need to create rules and regulations. Governments and healthcare officials need to find ways to make video conferencing complaint with the Health Insurance Portability and Accountability Act (HIPAA). Providers need to ensure that each company making the video conferencing software, is able to ensure the information is protected from hackers and is still accessible both healthcare providers and patients. All healthcare individuals who will provide care or assist in making appointments should have the proper training on how the technology should be used 10 patients not only within the state in which they currently practice but even in other states (Panter, 2021). Telehealth would challenge that licensing requirement as the healthcare professionals seeing patients using outside the state of practice and licensings have a license to practice or treat patients in other states which becomes a legal issue if something goes potentially wrong. Allowing healthcare professionals in any role to not have a license to practice in other states, puts the healthcare provider at risk for lawsuits and losing their license to practice because they protected. Another legal issue telehealth poses is telehealth providers prescribing medications without ever meeting the patient in person first (Panter, 2021). Prescribing medications without knowing an medical history is dangerous and potentially life threatening. Another big risk with using telehealth services includes the meetings with patients and providers are confidential if they are occurring in public places or using public internet that have security in place. Unprotected networks increase the risk of hacking and allowing meetings to occur in public places means that anything a patient or provider says kept being patients unless headphones are worn, but it hide what the speaker is saying to the other individual on the screen. In the world of technology, we have smartphones, tablets, computers (laptops and desktops) that allow video calls to occur. These technology devices are constantly being attacked resulting in software updates being released often to keep users protected. We have seen classroom zoom calls get taken over those without the zoom link, kicking the teacher out while young students are trying to attend class and learn. We have seen ba monitors connected to the internet get hacked and strangers are watching and talking with young children. An Overview Safety 11 With the use of telehealth services during the 2020 COVID pandemic, patients and healthcare providers were able to do their part in reducing the spread of COVID. using telehealth services as much as possible when appropriate to keep emergency rooms, hospitals, urgent cares and clinics visit to a minimum allowed for decreased patient contact. Telehealth services have allowed individuals in underserved areas, individuals and those concerned about friends and family members to get the necessary care they deserve without increasing their chance of contracting COVID entering healthcare settings unless it was absolutely necessary. Telehealth services allowed healthcare providers to still see patients who needed to be seen in clinic to get the care they needed in a timely manner, as those who seriously ill or could be treated and seen using telehealth services taking up much needed limited in person appointments. Using telehealth services healthcare providers need to remember to verify patient information at the start of appointments and when checking patients in to ensure they are speaking with the correct patient. Providers need to still ensure that those who are also on or in the conference call have permission to hear the information they will be discussing prior to starting. Patients must also be informed their sessions are recording and they can access the recording whenever they ask. An Overview of Privacy Issues The biggest challenge to using telehealth services is being able to protect information. Providers need to ensure they are using password protected video conferencing software or sites and a secure internet network especially if the patients themselves have access. Healthcare organizations should create or find secure video conferencing software that complies with HIPAA and allows them to send secure links to patients. Another challenge is 13 without interruptions. Telehealth services with the help of internet providers would be able to reach every individual in the world, even remote communities. Telehealth services would be used to treat communities that normally be able to get medical treatment because of where they live and the distance it would take to receive. Many individuals in these communities have the necessary equipment needed to treat all individuals which results in them having to be transferred away from their homes and families in order to get the treatment they require. Telehealth services would ensure individuals are able to get the preventative treatment needed that so many individuals are missing until too late. Telehealth services means health professionals would be able to serve all individuals who wish to receive medical help. This year healthcare systems around the world have been pushed to their limits. Hospitals have run out of beds due to the number of individuals infected with COVID to the point where they accept any other patients who are in need of hospital care. We have seen stories over this last year of hospitals with patients laying in hallways because they have open rooms. With the increased use of telehealth services, facilities would be able to treat and determine which patients truly require medical attention immediately without having to see the individuals in person using up more equipment than they can afford to waste on noncritical patients. Additionally, expanding telehealth services would allow healthcare professionals to reach missed populations that are usually forgotten. Telehealth services are more convenient for busy families which can reduce the amount of canceled or rescheduled appointments. Results from the Royal Australian College of Physicians taken during the COVID19 pandemic found that of the participants wanted to continue telehealth services after 14 the pandemic. This survey found that of physicians felt their patients would be more likely to keep these appointments vs keeping appointments 2020). Telehealth services mean that healthcare professionals are still about to attend to patients while keeping other patients and themselves safe from future contagious and deadly illnesses. Overview of Plan I would begin introducing this technology meeting with heads of the organization and departments and educating them on the additional services they could be offering to patients that could both save time and money. I would interview employees including physicians and nurses along with patients to get their thoughts on offering additional telehealth services after the COVID pandemic. Additionally, I would inform them about the success other organizations have had with the implementation of telehealth services in reaching underserved areas. I would begin working with technology departments and businesses to work on building a secure system that allows for storage and access along with creating a firewall in all telehealth links sent to patients as we guarantee that the internet connection patients are using is secure. The practice environment we hope to implement telehealth services would be in our biggest clinic as they would have the most patients to use for this testing process. We would implement the telehealth services in the primary care departments, pediatrics, family medicine, and internal medicine starting out. Eventually, we would incorporate specialty departments such as psychiatry, and cardiology in addition to other departments. The primary care departments together see patients of various ages and backgrounds which can help give insight into how telehealth services would potentially be used in other departments. Each department that uses telehealth services to meet with patients and their families would start out with only 16 pandemic when you can never be sure that the person next to you carrying a dangerous deadly illness. Telehealth services would give patients the satisfaction to know they have to take time off from work, or miss class to attend appointments. Additionally, telehealth services can be used to monitor health from the comfort of their own home with their providers being updated constantly on any changes. Telehealth does bring uncertainty when it comes to patient information security. Patient security will be a huge challenge that will need to be answered to ensure that telehealth services can be used regularly outside of health pandemics. Unfortunately constantly using telehealth services will make some individuals miss the interactions with their health provider. Additionally, healthcare professionals will have more tasks to complete to ensure they are meeting with the correct individual and making sure all information is kept confidential which is harder using internet devices instead of having security rooms to communicate privately as surrounding individuals are able to hear one side of the conversation. Stakeholders The stakeholders would be nurses, physicians, appointment staff, unit clerks, clinic managers, departmental managers, supervisors, directors, and board members. The nursing staff are the ones who interact with patients daily. Nurses will be the ones to learn about issues patients are having with their Mychart and other telehealth services along with concerns patients and their families have. From the information given to them patients, nurses are in a position to make suggestions for changes in the current telehealth process along with suggesting new telehealth services that patients are wanting. Supervisors are able to look at the data and watch staff to see if all members are doing their part to ensure it is being used as 17 intended. Much like nurses advocate for patients, supervisors advocate for the employees under their leadership. Additionally, employees need a leader who is willing to promote change and the use of practices. Supervisors can also be helpful in relaying suggestions and concerns to those in higher positions involved in the implementing process. Managers and directors work closely with supervisors to ensure the new process is being implemented successfully to reduce unwanted and unexpected problems for staff and patients. Board members will work to determine who much of the budget they can spare to run this testing process for the new system. Additionally, they work to determine how much money they could save with the use of telehealth services. Additionally, the community including patients and families. Ensuring the patients and the community are involved in the process would allow the organization to determine which services their patients want from them. Without fully implementing throughout their entire organization, the organization and developers are able to have individuals testing the system in the early stages of development give feedback on the system to help it run smoothly and better assist patients allowing them to get the most of our telehealth services. Change Theory Introduction The change theory that we are using as the framework for implementing this technology is change theory. According to Herzing University (2021), this theory expands on another change theory called Change change theory is based on the belief that behavior is a dynamic balance of forces working in opposition. The driving forces will facilitate change pushing employees in the desired direction while the preventing forces will stop change because they push employees in the other direction. 19 them the most. Everything in this world requires open and honest communication. Communication is the key to ensuring change can happen and that everyone feels comfortable with it. Projected Evaluation of the Implementation Process (NEW) In order to ensure that our process for implementing the telehealth services within primary care departments we would send out either physical or digital questionnaires depending on the preference. Before the testing process begins we will send out the first questionnaire, we will continue to send questionnaires out to participants as changes are made based on feedback to ensure we include what the majority is asking for in the technology to ensure it is beneficial for everyone using it. The questionnaires will serve as a way to allow the organization and creators a way to predict what the majority of the clients are looking for. Staff members and patients would be asked to answer the questionnaire regarding the technology ex. how they use it, do they think convenient and helpful, would they use it again, would they recommend the services to others, how the services can be improved, what would they like us to add or change. Additionally staff and patients would also be able to include their views and opinions on the technology. Once the technology has been implemented we will continue to meet or send out questionnaires either every 3 or every 6 months to determine who staff and patients are viewing the technology. Additionally, organizations will look at the number of appointments kept and cancelled compared to appointment data from the last three to twelve months to determine if there is any improvement. We will also look at patient and staff satisfaction, at the end of each telehealth session a questionnaire will on both sides to get their immediate feedback and if they 20 complete it immediately after their session one will be sent to the email to be completed. All staff members in the primary care department at the chosen clinic will have the new technology already set up on the systems through a mandatory update that will occur overnight once the clinics close. For ease of transition for staff the upgrade would occur after 5pm on a Friday and would begin at the start of the clinic day, the next Monday when they arrived. As questionnaires and data is collected it will be reviewed and tracked to determine the direction this new change is taking the primary care departments the department leaders and board members. Projected Evaluation of the Benefits to Patient Care (New) To evaluate the benefits to patient care, satisfaction surveys will be sent out to patients and families (younger or older patients who are unable to complete themselves). As a result of implementing telehealth services, we expect to see more appointments amongst our primary care departments as a result of the appointments not requiring parents or the patients themselves to take time off of work, school along with taking away the need to find basitters or a ride to the appointment. With the use of telehealth services for appointments, patients are able to reschedule at times and days convenient for them and would only need to click the emailed link or find the link in the mychart appointment We would need to ensure we maintain the same standard of care and professionalism we have when meeting patients in person is at the same level when meeting patients virtually. Doing so would help maintain and even improve patient satisfaction. It is also expected that staff find a way to communicate with patients waiting to start their appointments when they are having issues or if the provider is running late. It is expected that staff members are actively listening and giving

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