Evidence-based practice (EBP) utilizes the most current research available to improve patient care outcomes and patient safety while reducing overall costs and reducing variations in patient outcomes. EBP combines best practices from the latest medical literature with clinical experience. EBP empowers nurses to conduct research and find ways to integrate new findings into meaningful action regarding patient care (UMFK, 2022; Fitzpatrick, 2016).
· Clinical Information Systems (CIS) are computer-based, and their job is to gather, store and allow health care professionals to access patient information on demand through tools such as electronic health records (EHRs). The software that provides the framework for CIS must be able to integrate all of the data considered input accurately and fast.
· EBP guides the clinical practice of the nurse or provider; how they conduct a patient assessment, what they document, and patient priorities based on clinical information they can access, such as lab results. CIS creates a safe, reliable data system where clinical information can be stored, shared between providers, and accessed by patients through portals. The patient is at the center of both EBP and CIS.
· Promoting EBP and CIS between clinicians and developers is vital to patient care outcomes. These goals can be achieved through clear communication, establishing focused goals, and standardized language. Improved software and CIS tools translate into better patient outcomes by improving efficiency, accurate information, and real-time updates. The Plan, Do, Study, Act (PDSA) framework promotes the evaluation of progress and challenges (AHRQ, 2020). The ultimate goal of each High-Reliability Organization (HRO) should be to make CIS smarter, easier to use, and improve the quality and overall efficiency of patient care (Hackl and Hoerbst, 2020).
Agency for Healthcare Research and Quality. (2020, September). Plan-Do-Study-Act (PDSA) Directions and Examples. Retrieved April 24, 2022, from https://www.ahrq.gov/health-literacy/improve/precautions/tool2b.html
Fitzpatrick, J. J. (2016). Distinctions Between Research, Evidence-Based Practice, and Quality Improvement. Applied Nursing Research, 29, 261. https://doi.org/10.1016/j.apnr.2015.12.002
Hackl, W. O., & Hoerbst, A. (2020). Trends in Clinical Information Systems Research in 2019. Yearbook of Medical Informatics, 29(01), 121–128. https://doi.org/10.1055/s-0040-1702018
The University of Maine. (2022, April 21). What Is Evidence-Based Practice in Nursing? – UMFK. Umfk. Retrieved April 24, 2022, from https://online.umfk.edu/nursing/rn-to-bsn/evidence-based-practice-nursing/
The evidence-based practice incorporates clinical opinion and expertise with the patients to offer quality care that meets the clinical standards and aligns with the patients’ needs and wishes. The process utilizes the judgment, knowledge, and critical reasoning acquired by health care professionals through professional experiences and training. Collecting accurate information and completing the care templates offered by a facility’s electronic health records system allows healthcare professionals to diagnose patients correctly. This essay assesses the intersection of evidence-based practice with EHR and how to promote their application. With the realization of the benefits of big data analytics, many health care facilities are exploring the application of electronic health records to improve the quality of care they offer and the relevance of their clinical decisions. Professionals are increasingly using the EHR to communicate medical discoveries and treatment plans allowing professionals to coordinate care within and between different facilities (Chipps et al., 2020).
One of the benefits of incorporating EHR systems into evidence-based care is that it helps to ensure the professionals reach better clinical decisions. The approach facilitates the creation and sharing of the new practice guidelines, recommending practices and guidelines that improve care quality, and allows for shared decision-making in facilities (Chipps et al., 2020). These three ways ensure that staff can achieve coordinated care sustainably. The approach also improves adherence to clinical guidelines and practices that may lead to short-term increases in costs.
However, these costs accrue to benefits in the future by mitigating future needs that health care facilities may face while offering quality care. More importantly, the approach needs to be used with complementary interventions that account for real-life situations, including suggestions made on decisions and the effect of leadership and interdepartmental relations. Patients are the center of evidence-based practice in that the care, while in line with the clinical guidelines offered, should align with their needs. Recent studies show that EHR systems are continuously used to nudge clinicians to make clinical decisions.
The Health Insurance Portability and Accountability Act of 1996 ensures the security of all health information data (Chipps et al., 2020). However, while access to patient information is limited to the management and the relevant professionals, patients are allowed to read, share or print their health information. Helping patients to understand the role of EHRs in improving the quality of care provided allows them to be part of the care process by increasing platforms to review care and journal their health conditions to improve the information available to their physicians (Hoover, 2017). Patients can use EHR systems to access telehealth services and conference with their physicians without visiting the facility in person when there is no need. Improving patient empowerment and engagement allows facilities to educate the patients on their role in improving care and the role of EHR in facilitating it. One of the benefits of electronic health records is that it presents legibility attributed to medical errors. Electronic health records systems further improve patient outcomes by identifying medication errors and alerting clinicians on missing patient information that can affect the quality of clinical decisions (Hoover, 2017). The systems also allow for the timely sharing of critical medical and laboratory reports in emergencies. Clinicians should be made aware of the benefits of electronic health records to their decisions and patient outcomes. Making them shareholders in the design of the health information systems allows them to apply their expertise and knowledge in creating a diagnosing tool. With the realization of the benefits of big data analytics, many health care facilities are exploring the application of electronic health records to improve the quality of care. Improving patient empowerment and engagement allows facilities to educate the patients on their role in improving care and the role of EHR in facilitating it. Making clinicians shareholders in the design of the health information systems allows them to apply their expertise and knowledge in creating a diagnosing tool. References Chipps, E., Tucker, S., Labardee, R., Thomas, B., Weber, M., Gallagher-Ford, L., & Melnyk, B. M. (2020). The impact of the electronic health record on moving new evidence-based nursing practices forward. Worldviews on evidence-based nursing, 17(2), 136–143. https://doi.org/10.1111/wvn.12435 Hoover, R. (2017). Benefits of using an electronic health record. Nursing2020 Critical Care, 12(1), 9-10.
Evidence-based practice is the idea that clinical practice (diagnostics, treatments, monitoring, etc), is grounded in scientifically-vetted methodologies; simply that practice should be based on evidence. Though this seems a given, the time it takes for research to reach practice can be significant, and this flow of information into practice often doesn’t happen automatically. Health IT systems can help bridge the gap between evidence-based practice by creating algorithms or other clinical decision support tools that utilize reliable information. Furthermore, they can serve as repositories for research and a place where this research is synthesized to produce clinical recommendations with more weight.
Health IT systems play an important role in facilitating evidence-based practice (EBP) for providers, especially through clinical decision support systems (CDSS). These systems can be knowledge-based, using literature or practice-based evidence to create “rules” using IF-THEN statements to help support decisions (Reisman, 2017). For example, a CDS tool could prompt a provider to order a set of tests or medications for a patient presenting with ACS symptoms according to an algorithm that is grounded in a reliable evidence base. These tools are a clear example of how technology can be leveraged to support the evidence-based practice by integrating a large body of research into practice recommendations at the provider’s fingertips, and their integration into EHRs is now incentivized by the federal government. Beyond CDSS, providers have access to numerous nationally and internationally renowned EBP databases, which they can consult in a variety of situations, perhaps when encountering a rare pathology for which there is not an established algorithm in their institution. Such databases include but are not limited to the Cochrane Library, Joanna Briggs EBP Institute, and the NNT (Queens University Library, 2022).
Policymakers, as well, can and should utilize evidence-based practice. When public health initiatives rely on misinformation or outdated assumptions to shape their policies, they will not achieve optimal results. Hunger et al (2020) discuss how national health strategies that focus on weight-loss may be operating from assumptions that are not only misguided but often harmful; the evidence does not support various tactics that remain the mainstays of public health policies. For example, the notion that weight loss in the short term results in long-term improvement of health is not supported by research, nor is the assumption that weight stigma will motivate individuals to lose weight (p75). Even the simple notion that BMIs that classify individuals as “overweight” is associated with higher mortality than “normal” BMIs is not supported by evidence. This is an example where prevailing public attitudes are not in line with medical research, and the consultation of evidence databases would be wise before shaping policy. To promote the use of clinical information to policymakers, I would again recommend the numerous reliable databases available to the public, which compile a wealth of research and synthesize it in a way that produces recommendations that are based solidly in evidence.
Interoperability is an important concept in the realm of EBP. The migration of information from research to practice can often be timely and cumbersome, but this reality can be improved by creating a digital environment where information flows as freely as possible. In order for this to happen, Health data exchange architectures need to be interoperable on multiple levels including foundational, structural, semantic, and organizational (HIMSS, 2020). While the adoption of EHRs in favor of paper charting by providers across the country is nearly complete, meaningful use measures such as interoperability have lagged (Adams et al., 2017). Prioritizing interoperability in the future will help not only in transitions of care but in the realm of evidence-based practice as a way to more easily share research and practice guidelines.
Adams, K. T., Howe, J. L., Fong, A., Puthumana, J. S., Kellogg, K. M., Gaunt, M., & Ratwani, R. M. (2017). An analysis of patient safety incident reports associated with electronic health record interoperability. Applied Clinical Informatics, 8(2), 593–602. https://doi.org/10.4338/ACI-2017-01-RA-0014
HIMSS.(2020). Interoperability in healthcare. HIMSS. https://www.himss.org/resources/interoperability-healthcare
Hunger, J. M., Smith, J. P., & Tomiyama, A. J. (2020). An Evidence‐Based Rationale for Adopting Weight‐Inclusive Health Policy. Social Issues and Policy Review, 14(1), 73–107. https://doi.org/10.1111/sipr.12062
Queens University Library. (2022). Evidence-based practice databases. https://guides.library.queensu.ca/evidence-based-practice/databases
Reisman M. (2017). EHRs: The Challenge of Making Electronic Data Usable and Interoperable. P & T : a peer-reviewed journal for formulary management, 42(9), 572–575.
One of the essential advantages of health information technology (IT) is to make it easier to communicate amongst health care providers at all levels, i.e., improving medication safety, tracking, and promoting quality of care through optimized access and adherence to guidelines (Committee opinion no. 621: Patient safety and health information technology, 2015). Healthcare delivery is possible by utilizing IT systems and collecting and sharing patient data. According to Dowding (2015), the use of IT to monitor health through personal devices and social media has immensely increased. The improvement in the availability of technology, both in healthcare settings and in the broader population, provides unique opportunities for supporting evidence-based practice (EBP) across healthcare settings. Interoperability additionally is key in achieving IT systems to work to their maximum potential. Interoperability is defined as the ability of health information systems to work together within and across organizational boundaries to advance the effective delivery of healthcare for individuals and communities (Reis et al., 2017, as cited in Li et al., 2021). To promote evidence-based practice and clinical information, policymakers must encourage the integration of IT systems to deliver effective, safe care. There are many ways to violate patients’ privacy through IT (Savage & Savage (2020). Health data may be collected from different sources, i.e., EHRs, insurance claims, social media posts, etc. In the process, the patient’s privacy can be violated.
Therefore, it is imperative to protect patient information by managing it effectively. When used effectively, health IT can facilitate healthcare data collection and directly improve patient care. Studies have determined that the use and configuration of health IT to collect HIV data, for example, can increase the availability of data to monitor HIV care (Institute of Medicine, 2012). References Committee opinion no. 621: Patient safety and health information technology. (2015). Obstetrics and Gynecology (New York. 1953), 125(1), 282-283. https://doi.org/10.1097/01.AOG.0000459867.14114.7a Dowding, D. (2015). Using health information technology to support evidence-based practice. Worldviews on Evidence-Based Nursing, 12(3), 129-130. https://doi.org/10.1111/wvn.12093 Institute of Medicine, Committee to Review Data Systems for Monitoring HIV Care, & Board on Population Health and Public Health Practice. (2012). The role of health information technology and data system integration in the collection of HIV care data. In Carol Mason Spicer, & Morgan A. Ford (Eds.), (pp. 273-298). National Academies Press. Li, E., Clarke, J., Neves, A. L., Ashrafian, H., & Darzi, A. (2021). Electronic health records, interoperability, and patient safety in health systems of high-income countries: A systematic review protocol. BMJ Open, 11(7). https://doi.org/10.1136/bmjopen-2020-044941 Savage, M., & Savage, L. C. (2020). Doctors routinely share health data electronically under HIPAA and sharing with patients and patients’ third-party health apps is consistent: Interoperability and privacy analysis. Journal of Medical Internet Research, 22(9), e19818-e19818. https://doi.org/10.2196/19818
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