Critic and give constructive feedback. 1) Main issues: A. Care is provided across three services, with separate and largely paper-based patient records and ordering. This is associated with: Multiple registration processes Limited communication between providers Time and cost inefficiencies for staff and the patient Potential duplication, inconsistencies or gaps in information or care Garrido, Jamieson, Zhou, Wisenthal, and Liang (2005) and Smith et al. (2005) found that paper based, manual systems negatively impact care and outcomes. B. Appointment coordination is service focused, not patient centred. Taking time off work on two occasions for General Practitioner (GP) review and Cystic Fibrosis testing became a disincentive for care. C. The GP is functioning as a gateway to care, instead of actively managing care. GPs must lead patient-centred care coordination (Hall, 2015; Smith et al., 2005) to enhance the quality and safety of health services (Australian Commission on Safety and Quality in Health Care, 2011). D. The first birth center visit is largely wasted, with referral for tests and questionnaire completion. If assessments had already been completed with results available, appropriate care and care planning could be delivered at that appointment. 2) Proposed changes: Successful implementation of health information technology (HIT) relies in part on early consultation and problem identification (Zai et al., 2008), involvement of key people (Ash, Stavri, Dykstra, & Lara, 2003; Brown, Pasupathy, & Patrick, 2012), and detailed workflow mapping (Lee & Shartzer, 2005; Unertl, Weinger, Johnson, & Lorenzi, 2009). A team would therefore be formed with key service representatives, to undertake these tasks and propose changes from a systems perspective (Malhotra, Jordan, Shortliffe, & Patel, 2007). Preliminary thoughts on a new workflow, incorporating HIT solutions, are as follows: GP appointment made via smart phone scheduling application Attend GP in work hours Patient registration into common Electronic Health Record (EHR) Urine test confirms pregnancy EHR decision support module prompts GP to order routine blood tests including Cystic Fibrosis (via computerized physician order entry (CPOE)) GP refers to birth centre via CPOE GP provides patient an online link to questionnaire to be completed at home Patient attends for blood tests same day as GP appointment Patient completes questionnaire at home (smart phone option) Birth centre receives questionnaire and test results into EHR Birth centre contacts patient to attend for appointment Patient attends birth centre and receives results, education and care planning from midwife GP notified of results and patient attendance at birth centre via EHR * Flow chart attached 3. Redesign benefits: HIT has been demonstrated to enhance health service quality, efficiency and safety (Brown et al., 2012; Unertl et al., 2009). It is argued that adoption of an EHR across these providers is vital to facilitate information integration, communication and coordination, which is particularly relevant in community care environments such as this (Hovenga, Kidd, Garde, & Hullin Lucay Cossio, 2010). Hoyt, Yoshihashi, and Bailey (2012) argue that EHRs must have specific modules, including decision support, order and results management, and Westbrook and Gosling (2002) purport that these functions are priorities to improving patient safety. The introduction of a comprehensive EHR provides the opportunity for an improved workflow as above, the benefits of which include:

• Time and cost efficiencies for the patient, staff and services through reduced task duplication and fewer attendances (Hovenga et al., 2010)
• Consistent information availability across services (Bodenheimer & Grumbach, 2003)
• Patient centred care rather than service centred
• Enabling a community of practice around the patient (Brown et al., 2012)
• Optimal care provision through: o Proactive primary health care with GP coordination o Care able to be provided by midwife at first appointment o Point of care decision support that assists compliance with evidence-based guidelines (Westbrook & Gosling, 2002) 4. Potential obstacles / risks: Brown et al. (2012) states that implementation of HIT requires substantial organizational change and Ventres et al. (2006) argue that HIT produces negative results if poorly implemented. Key risks to implementation include: Cost. EHRs are expensive and responsibility for purchase would need to be negotiated and accepted by all parties (Bodenheimer & Grumbach, 2003; Poissant, Pereira, Tamblyn, & Kawasumi, 2005). Change resistance and slow uptake.

Disbelief that EHRs will impact positively (O'Malley, Grossman, Cohen, Kemper, & Pham, 2010), time taken to learn and use new technology (Hoyt et al., 2012), concerns about privacy (Bodenheimer & Grumbach, 2003) and provider – patient relationship impact (Ventres et al., 2006) are some of the reasons that staff may resist use of EHRs. Failure of GPs to embrace case management role. Lack of acceptance of standards, classification and coding systems to enable interoperability between sites. This would profoundly hinder system functionality (O'Malley et al., 2010) Lack of agreement on data storage location. Brown et al. (2012) outlines that a critical consideration in EHR implementation is the location of data storage. Negotiation regarding institution versus cloud-based storage will need to be agreed between services. Incorrect alignment between EHR and workflows. Importantly, HIT only impacts positively if it is aligned with workflows (Unertl et al., 2009; Westbrook & Gosling, 2002). Dinh et al. (2010) argues that failure to assess workflows properly and plan change risks success. References: Ash, J., Stavri, Z., Dykstra, R., & Lara, F. (2003). Implementing computerized physician order entry: the importance of special people. International Journal of Medical Informatics, 69, 235-250. doi:10.1016/S1386-5056(02)00107-7 Australian Commission on Safety and Quality in Health Care. (2011). Windows into safety and quality in health care 2011. Retrieved from http://www.safetyandquality.gov.au/wp-content/uploads/2011/11/Windows-into-Safety-and-Quality-in-Health-Care-2011.pdf. Bodenheimer, T., & Grumbach, K. (2003). Electronic technology. A spark to revitalise primary care? Journal of the American Medical Association, 290(2), 259-264. Brown, G., Pasupathy, K., & Patrick, T. (2012). Health informatics: A systems perspective. Chicago, Illinois: Health Administration Press. Dinh, A., Kennedy, M., Perkins, S., Peterson, L., Warner, D., & Washington, L. (2010). MIgrating from papers to EHRs in physician practices. Journal of AHIMA, 81(11), 60-64. Garrido, T., Jamieson, L., Zhou, Y., Wisenthal, A., & Liang, L. (2005). Effect of electronic health records in ambulatory care: retrospective, serial, cross sectional study. BMJ, 330, 1-5. Hall, J. (2015). The challenge of reform in a fragmented system. The New England Journal of Medicine, 373(6), 493-497. Hovenga, E., Kidd, M., Garde, S., & Hullin Lucay Cossio, C. (2010). Health informatics: An introduction. In E. Hovenga, M. Kidd, S. Garde, & C. Hullin Lucay Cossio (Eds.), Health informatics: An overview. Amsterdam, Netherlands: IOS Press. Hoyt, R., Yoshihashi, A., & Bailey, N. (2012). Health informatics: Practical guide for healthcare and information technology professionalism. Raleigh, North Carolina: Lulu.com. Lee, J., & Shartzer, A. (2005). Health IT and workflow in small physicians' practices. Retrieved from http://www.nihcm.org/pdf/AHRQ-QandA.pdf Malhotra, S., Jordan, D., Shortliffe, E., & Patel, V. (2007). Workflow modeling in critical care: piecing together your own puzzle. J Biomed Inform, 40(2), 81-92. doi:10.1016/j.jbi.2006.06.002 O'Malley, A. S., Grossman, J. M., Cohen, G. R., Kemper, N. M., & Pham, H. H. (2010). Are electronic medical records helpful for care coordination? Experiences of physician practices. J Gen Intern Med, 25(3), 177-185. doi:10.1007/s11606-009-1195-2 Poissant, L., Pereira, J., Tamblyn, R., & Kawasumi, Y. (2005). The impact of electronic health records on time efficiency of physicians and nurses: a systematic review. J Am Med Inform Assoc, 12(5), 505-516. doi:10.1197/jamia.M1700 Smith, P., Araya-Guerra, R., Bublitz, C., Parnes, B., Dickinson, M., Van Vorst, R., . . . Pace, W. (2005). Missing clinical information during primary care visits. Journal of the American Medical Association, 293(5), 565-571. Unertl, K. M., Weinger, M. B., Johnson, K. B., & Lorenzi, N. M. (2009). Describing and modeling workflow and information flow in chronic disease care. J Am Med Inform Assoc, 16(6), 826-836. doi:10.1197/jamia.M3000 Ventres, W., Kooienga, S., Vuckovic, N., Marlin, R., Nygren, P., & Stewart, V. (2006). Physicians, patients, and the electronic health record: an ethnographic analysis. Ann Fam Med, 4(2), 124-131. doi:10.1370/afm.425 Westbrook, J., & Gosling, S. (2002). The impact of point of care clinical systems on health care; a review of the evidence and a framework for evaluation. New South Wales: Centre for Health Informatics. Zai, A., Grant, R., Estey, G., Lester, W., Andrews, C., Yee, R., . . . Chueh, H. (2008). Lessons from implementing a combined workflow-informatics system for diabetes management. J Am Med Inform Assoc, 15(4), 524-533. doi:10.1197/jamia.M2598

ANSWER. PAPER DETAILS
Academic Level	College
Subject Area	Nursing
Paper Type	Essay
Number of Pages	1 Page(s)/275 words
Sources	5
Format
Spacing	Double Spacing

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