Use of Clinical Systems to Improve Outcomes and Efficiencies – Annotated Bibliography

Overview

The recent wide scale adoption of Clinical information systems (CIS) is considered a ground-breaking development in healthcare with far-reaching long-term implications. CIS technology was originally intended for use in critical care environments and based on the collection, recording, and analysis patient’s electronic healthcare data within a dedicated computer system According to Islam et al., (2018), CIS is routinely linked to improved patient-physician communication, quality improvement, ability to support the decision-making process, and also functions as a foundation for further clinical research. Furthermore, the need for CIS technology in critical care environments is a result of a high number of medical devices in use within this particular environment and the need for comprehensive decision-making mechanisms. Each of the measurements stemming from medical devices in critical care environments is recorded electronically to promote accuracy and to further enhance the care delivery process. Among the clinical systems are associated with improved access to healthcare data, higher levels of productivity, better clinical management, improved patient outcomes and an overall reduction in medical errors (Thanos et al., 2021).Therefore, clinical systems are generally linked to improved outcomes and efficiencies within a standard healthcare setting.

Annotated Bibliography

Bodí, M., Claverias, L., Esteban, F., Sirgo, G., De Haro, L., Guardiola, J. J., Gracia, R., Rodríguez, A., & Gómez, J. (2021). Automatic generation of minimum dataset and quality indicators from data collected routinely by the clinical information system in an intensive care unit. International Journal of Medical Informatics145, 104327. https://doi.org/10.1016/j.ijmedinf.2020.104327

Bodi et al., (2021) conducted an in-depth evaluation of the impact of clinical systems using a minimum dataset (MDS) and quality indicators (QI) in the Coronary Unit of the Spanish Society of Critical Care Medicine. The main objective was to determine the exact extent of the application of information technology in the facility’s intensive care units (ICU) and its overall impact on healthcare providers’ efficiency. Furthermore, the researchers also sought to determine whether the impact of clinical information systems (CIS) also extended to patients within the critical care unit and subsequent impact on outcomes.  Inferences made from this initial assessment would then guide the researchers in identifying important CIS prerequisites to improve care outcomes and quality of health services on offer. The researchers, thus, developed minimum datasets (MDS) and quality indicators (QI) from electronic healthcare data collected from patients within the Coronary Unit. This would serve as an ideal tool for the automatic generation of data and metrics to assess the actual quality of care and the potential present in the manipulation of CIS data. Electronic data from patient’s healthcare data was then extracted using Python and stoned in an associative database created for this specific purpose. The new set of associative data was then tested using records from a 30-bed capacity polyvalent ICU unit providing care to intensive care patients. An initial evaluation of 4546 admissions within a 6-year period revealed that higher levels of productivity and improved patient outcomes were crucial metrics associated with the adoption of CIS (Bodi et al., 2021). The researchers also proposed that, based on results from their QI and MDS dataset, the productivity of healthcare providers and patient outcomes could be used as a standard for gauging the efficiency of CIS. Furthermore, the researchers also encouraged the national scientific society to promote the application of the proposed metrics in critical care to enhance timely recording of high-quality data for analysis to meet patients’ goals.

Pachchigar, R., Blackwell, N., Webb, L., Francis, K., Pahor, K., Thompson, A., Cornmell, G., Anstey, C., Ziegenfuss, M., & Shekar, K. (2021). Development and implementation of a clinical information system–based protocol to improve nurse satisfaction of end-of-life care in a single intensive care unit. Australian Critical Care6(4), 142-153. https://doi.org/10.1016/j.aucc.2021.05.003

Pachchigar et al., (2021) conducted a single-centered observational study to assess the impact of implementing a clinical information system (CIS) within intensive care units (ICUs) in Australia among end-of-life care nurses. The researchers sought to determine whether CIS-based protocols had any perceptible impact on nurses’ level of satisfaction, efficiency, and whether this had an impact on terminally-ill patients. The study was also conducted between 2015 and 2017 within the cardiothoracic unit of an unnamed healthcare facility offering end-of-life care to intensive care patients. Study participants comprised of 58 end-of-life ICU nurses; routinely monitored and reviewed by the researchers during scheduled stints at the 20-bed cardiothoracic unit. From the onset, each participant was informed of the study’s intention and routinely briefed on the scheduled introduction of CIS-based protocols in the cardiothoracic unit. The overall outcome, based on a survey administered by the researcher, was a higher level of satisfaction among end-of-life ICU nurses working situated in the hospital’s cardiothoracic unit and higher levels contentment with the services provided.  The initial number of participants also increased from 58 to 64 end-of-life ICU nurse. This change was attributed to an overall sense of satisfaction noted among the original pool of participants. Furthermore, the researchers recorded a median of 2 within the interquartile range of the curative treatment compared and an interquartile range of 0.049 with regard to the quality of end-of-life care provided (Pachchigar et al., 2021). This was attributed to the effortlessness associated with the new CIS-based protocol and the fact that ICU nurses were now allowed to incorporate patient’s cultural, spiritual, and ritual beliefs within their framework of end-of-life care. The researchers theorized that provisions in the new CIS-based protocols resulted in a higher rate of satisfaction among ICU nurses based on evidence of improved productivity and efficiency in the provision of end-of-life care. They, therefore, conclude that the application of electronic based protocols within an intensive care environment improved nurse’s satisfaction within their respective practice environment and a positive influence patient’s perceptions of the quality of care offered

Poba-Nzaou, P., Uwizeyemungu, S., & Liu, X. (2020). Adoption and performance of complementary clinical information technologies: Analysis of a survey of general practitioners. Journal of Medical Internet Research22(7), e16300. https://doi.org/10.2196/16300

Poba-Nzaou et al., (2020) participated in a pilot review of data from general practitioners (GPs) on the impact and performance of CIS technologies in care. Among its aims was to characterize GPs attitudes towards CIS technologies, identify commonly-used profiles, their application in predicting cluster membership and the subsequent performance of individual CIS technologies.  Data was collected from 5793 healthcare facilities across the European Union (EU). According to Poba-Nzaou et al., (2020) the assessment was based on the actual efficiency of combining  personal health records (PHRs), health information exchange (HIE), telehealth, and electronic health records (EHRs) as the main CIS-based technologies under review. Each of the 4 factors identified above were then used to identify the most popular factor among GPs and the results evaluated using analysis of variance (ANOVA). A multivariate multinomial statistical regression was also conducted and the performance of clinical staff and patient outcomes compared prior to the incorporation of CIS-based technologies. Results from the ANOVAS indicated a high level of performance and patient outcomes among practitioners working within a clinical environment embracing CIS-based technologies. This also translated to high-quality care, higher levels of satisfaction with the nurse practice environment and better practice performance outcomes 2-years after the integration of CIS-based technologies. Generally, GPs attributed the aforementioned improvements to the assimilation of personal health records (PHRs), health information exchange (HIE), telehealth, and electronic health records (EHRs) technologies within a healthcare setting. The researchers concluded that CIS technologies had a positive impact on the efficiency, productivity, and satisfaction among GPs and was associated with significantly high performance. Consequently, patients benefitted from GPs practice outcomes based on the provision of high-quality care which translated to better outcomes.

Stevenson, J. K., Campbell, Z. C., Webster, A. C., Chow, C. K., Campbell, K. L., & Lee, V. W. (2019). EHealth interventions for people with chronic kidney disease. Cochrane Database of Systematic Reviews8(6), 21-64. https://doi.org/10.1002/14651858.cd012379

Stevenson et al. (2019) conducted a systematic review of randomized controlled trials (RCTs) and quasi-RCTs to determine the impact of CIS-based technologies, such as eHealth interventions, on outcomes among patients with chronic kidney disease. The main purpose of the review was to determine the potential benefits and harms when attempting to initiate behavior change among patients with chronic kidney disease using CIS-based technologies.  Later, the researchers conducted a search of relevant peer-reviewed journal articles in the Cochrane Kidney and Transplant Register of Studies, using randomized controlled trials (RCTs) and quasi-RCTs published before 2019 as a criterion for inclusion. The search also included studies discussing strategies to promote behavior change among patients with CKD.  A total of 43 studies were eventually selected discussing the incorporation of eHealth modalities as a viable intervention among patients with CKD. Six eHealth modalities involving 6617 patients were identified to determine their impact on patient’s wellbeing. Out of the initial 43 studies, 39 identified CIS-based technologies such as telehealth, remote patient monitoring (RPM) and mobile applications were linked to positive behavior change among patients with chronic kidney disease. According to Stevenson et al. (2019) CIS-based technologies influenced behavioral counseling, self-monitoring, and served as a clinical decision-aid among patients with CKD.  The researchers concluded that CIS-based technologies were capable of improving control over fluid and sodium intake among patients with CKD, therefore leading to better outcomes and an overall reduced risk of death.

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