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Strategic leadership is the ability of a leader to persuade others to willingly make various decisions that improve the organization's prospects for long-term success while maintaining the organization's long-term financial stability. Various leadership styles influence the development's direction and vision, as well as the firm's potential success. To effectively cope with change, all leaders in an organization must have the necessary tools and abilities for strategy formulation and implementation. The healthcare industry has a more complicated information system, and most executives find it difficult to manage such complexities, necessitating health organizations to embrace strategic leadership for the improvement of health information systems. As the Hospital's Director of Health Information, I sit on different institution-wide committees which govern the hospital's policies. I have made various recommendations, in collaboration with interdepartmental committees, regarding the improvements of various policies, procedures, and operations across the organization. However, despite the approval of funding for several initiatives, the organization's CEO and the Board of Directors have asked me, as the Director of Health Information, to narrow the changes to just a few. This paper, therefore, presents my action plan for the hospital.
Recommendations for Improvements to various Elements Included in the Data Quality Programs and Design of Audit Trails within the Hospital
Some of the critical policies that cover data security within the hospital include data recovery planning, e-security, and audits.
Data Recovery Planning
Data recovery planning ensures the restoration of the organization's information systems to an operational state following an accident or a technical hitch. Additionally, the data recovery planning policy ensures that the hospital can easily recover lost, deleted, or corrupted information within the health information system (Callen, 2016). Data recovery planning policy within a health organization also provides defensive mechanisms against data loss (Wilder, 2010). Since the health information system contains vital information regarding the organization's operations and patients' data, it is essential for the hospital to have an effective data recovery planning policy.
Having an electronic security system within a health organization is of critical significance, considering hospitals are places with accessibility to drugs, high-valued equipment, and many entrances. Additionally, a healthcare institution requires basic precautions against fire, vandalism, and attacks like any other large facility (Li, 2015). However, heightened security in hospitals requires specific electronic solutions including the control against the abduction of infants from various maternity wards, as well as the threats against staff or patients, and opportunity crimes. Besides, hospitals are highly sophisticated institutions that require strongest security policies (Li, 2015). E-security experts have the necessary skills and experience to evaluate the hospital's infrastructure and identify various security threats and vulnerabilities so as to protect the organization's property, people, and reputation.
Clinical auditing relates to the measurement of the quality of provided care against the relevant standards. Auditing in hospitals is a powerful tool that provides evidence for the need for various specific resources to improve the organization's performance or quality standards. Auditing of the patients' data is helpful in identifying the trends in attendance for different services within the hospital. Additionally, auditing also makes it easy for the organization's leadership to understand the impacts of various changes at the hospital so as to make appropriate adjustments (Li, 2015).
The hospital should consider adopting the use of data backups as a data recovery planning policy within the organization. Data backup involves copying of information from the central information systems and making separate storage of such data to allow for restoration through a data recovery process in the case of destruction to the primary data storage. Regarding e-security policy, the hospital should consider designing an integrated electronic security system in the most appropriate way to meet the organization’s needs as well as protect the organization against potential threats. An integrated e-security system has both digital alarms and CCTV security systems that can help in creating customized e-security system within the organization. Dealing with the risk relating to the disappearance of patients would require the hospital to install the CCTVs at the entrances of the patient wards.
Regarding Auditing, the hospital should consider integrating the information necessary for auditing with the routine recording of clinical data for effective audit results. Data for auditing should also get collected from all patients, even those with impossible good outcomes due to pre-existing co-morbidity. Additionally, the hospital should consider adopting an audit program that also includes mechanisms for determining common errors and monitors patients’ safety.
Assessment of the System’s Capabilities to Meet Various Regulatory Requirements
The hospital's information system faces different challenges regarding its ability to meet regulatory requirements relating to its use of technology in matters concerning data correction, electronic signatures, as well as audit logs.
The use of electronic signatures in the hospital can be legally valid in the execution of documents that require the use written signatures. Additionally, electronic signatures can get valid legally when various applicable laws require written documents (Hansen, 2011). However, that seems not to be the practice at the Hospital since the hospital's healthcare providers consistently make basic errors when trying to implement various protocols of electronic signatures. Such errors usually occur within the context of the healthcare providers working to ensure complete and accurate medical records, medical staff offices attempting to manage provider credentialing, and the organization trying to streamline the patients' consent process. Such missteps can lead to material liability in the hospital if a disputes arise. The electronic signature processes should therefore clearly demonstrate the patient’s knowledge of his or her consent to the matter at issue.
Effective supervision and monitoring of health care programs significantly depend on the accurate, complete, and timely flow of information between one department of the medical facility to the other. The first step towards ensuring efficient delivery of intervention within the hospital's system is enabling the health care system managers and clinic staff to have access to reliable data that reflects the various care processes as well as the clinical outcomes (Gordon, 2012). However, that is not the situation at the hospital since the data collected at the health care facility gets commonly stated as unreliable when it moves from one department to another due to various unauthorized alterations. The collected data undergoes collation at the clinics before submission to other relevant departments within the hospital, a practice that forms a major breakdown that compromises the integrity of the data. There is, therefore, a need for the hospital to ensure consistency of data from the points of collection to the time the data reaches other relevant departments by eliminating the avenues of unauthorized data alterations.
The use of access controls alone would not ensure the security and privacy of electronic protected health information in a perfect world (Callen, 2016). However, the today's healthcare environment's complexities make it very challenging to limit the access to the necessary minimum data that employees need to perform their tasks. Without having access to certain portions of each patient's health records, the effectiveness of the medical staff could significantly get inhibited. As a result, patient safety and care could get compromised. The hospital needs to develop security audits and other related procedures and policies aimed at holding the employees accountable for their actions when accessing electronic protected health information through the electronic health record. Additionally, the hospital needs to perform security audits using audit logs and audit trails that provide a back-end view of the use of health care systems. The audit logs are helpful in recording primary activities, as well as showing the system’s access threads, transactions, and modifications. There is also a need for the hospital to perform periodic reviews of the audit logs so as to detect unauthorized access to patients’ data as well as establish a culture of accountability and responsibility.
Recommendations for Device Selection Based on Ergonomics, Workflow, and Human Factors
While health information technology appears to enhance the quality, efficiency, and safety of patient care, significant concerns regarding its unintended consequences have been on the rise. The lack of consideration of ergonomics and human factors is the design of a health information systems forms a critical barrier to the success of health information technology (Li, 2015). As a result, there is a need for a more effective integration of human factors and ergonomics approaches in the design, evaluation, and implementation of health information technology in the hospital.
Usability is one of the human factors and ergonomics that the hospital has to consider in device selection. Usability relates to the extent to which the device can be used by the designed users towards achieving specific goals with efficiency, effectiveness, and satisfaction in a given context of use. Usability is more than the device interface features as it addresses the compatibility of the system's behavior with the needs of the users (Li, 2015). Usability approach considers human-machine mismatches as one cause of human errors. Additionally, it emphasizes the significance of user-centric design as an assurance of the system’s overall safety and performance (Li, 2015). The hospital should, therefore, consider identifying key usability functions and features when selecting devices. However, such functions and features should relate to the users’ limitations, capabilities, and needs.
Another human factor and ergonomics that the hospital needs to consider in the user interface design of health information technology relate to understanding the nature of human error, as well as the identification of various mechanisms of human errors involved in patient safety. As described by the Swiss Cheese model of Reasons, there exist an alignment of hazards that can lead to interference with patient safety is a health care setup (Callen, 2016). Additionally, the model describes various management decisions, as well as latent failures that can lead to errors and create conditions that violate patient safety (Callen, 2016). Such conditions can, in turn, pose care delivery problems and even result in unsafe acts. The hospital, therefore, needs to adopt the use of Swiss Cheese model of reasons when selecting devices to allow them to investigate various incidents of patient safety efficiently.
Despite the increasing awareness of the importance of human factors and ergonomics (HFE) in the design of health information technology systems, the use of HFE in hospitals remains to be minimal (Callen, 2016). In fact, the use of HFE-based interventions as still far from achieving systematic performance and their adoption are incomplete. The hospital should, therefore, consider resilience in the selection of devices as a means of enhancing the use of HFE in user interface design of health information technologies. The consideration of resilience in the selection of devices would health the system users to easily understand how to detect, correct, mitigate, and deal with various errors within the health information technology system.
Evaluation of the System’s Architecture Based on Database Design and Data Warehousing
Database design technology is an essential tool in the operations of the health information system in the hospital. Additionally, a basic understanding of database design technology in the hospital has been adequate to enable the health information management professionals to work in close collaboration with the information services staff (Wilder, 2010). The database design technology in the hospital tends to move from the task of supporting paper systems to becoming the center of digitized health information system. However, the basic understanding relating to its implementation is still inadequate.
The large amounts of data getting collected by electronic medical records provide additional value when combined and stored in the hospital's data warehouse. Data Warehousing allows the hospital to integrate all the information relating to both the outpatients and inpatients for easy and efficient analysis (Li, 2015). Data Warehousing is an essential tool not only for the hospital's management and strategic decision-making but also specific clinical decision support for the patients. One of the ways that the hospital can make use of the collected data to improve its performance is through the creation of a data warehouse as a means of getting all the relevant clinical data on patients and forwarding such data to doctors and nurses using alerts.
The Hospital’s system testing seems to be a complex task, and the health information professionals face several challenges relating to database testing. A successful performance of system testing requires the health information professionals to collect the technical and functional requirements from all the sources. Besides, there is a need to breakdown such requirements into smaller parts to reduce complexity. The hospital should also consider following all the testing processes to optimize the system’s performance.
The successful application of information communication and technology system in the hospital significantly relies on the resolution of the challenges concerning the management of the system’s interface. The use of electronic health records (EHRs) within the organization has a problem of host (hospital) acceptance. There is, therefore, a need for the health information system to get appropriately interfaced according to the hospital's objectives, environment, and staff since the failure to make such accomplishments could complicate the system's interface management process.
Data relationships within the hospital relate to the extent of the system's adoption of the health information exchange (HIE) as a means of improving healthcare by addressing matters related to the fragmentation of patients' health information. Despite the efforts by the hospital to facilitate its HIE, it continues to experience a recurrence of challenges and barriers beyond those relating to technology. There is, therefore, a need for the hospital to review its system's data relationships and develop new technology-based strategies aimed at improving its health information exchanges.
Participation in the Development of Information Management Plans that Support the Organization’s Current and Future Goals and Strategy
Some of the information management plans that support the hospital’s present and future strategy and goals include corporate strategic plan, operation improvement planning, information management plans, as well as disaster and recovery planning.
Corporate Strategic Plan
The organization’s strategic plans are most effective when they exist in the form of working, dynamic documents that provide the structure, organization, and reporting for organizational planning as well as its business implementation processes (Callen, 2016). Additionally, there are various internal benefits that the hospital can realize from the processes of its strategic planning. Some of such benefits include organizational collaboration, clarity amongst the chaos, employee engagement and motivation, operation in vision, and transformational leadership and accountability. A properly developed and implemented strategic plan should reflect the hospital's critical strategic issues, as well as provide a roadmap for its future vision.
Operation Improvement Planning
For the hospital to meet the challenges of its permanently changed healthcare environment, it has to improve its operational structures and efficiencies to address both short-term financial management and long-term quality and service requirements. One of the ways through which the hospital can achieve sustained operational improvements in its changing healthcare environment is by first strategically focusing on high-return improvements (Li, 2015). That would involve the identification of various efficiency and cost reduction opportunities that have a high likelihood of yielding the greatest results and the pursuing such initiatives in a way that supports quality, service, and patient satisfaction. The hospital can also attain sustained improvements by balancing its short-term and long-term goals, as well as improving its organizational capabilities and knowledge as a means of ensuring sustainable operational improvements.
Information Management Plans
The hospital's information management plans involve the management of information, application systems, as well as information and communication technology systems. Additionally, the hospital's information management plan processes need to be conducted systematically to allow for orderly information processing according to the organization’s goals. The hospital’s information management plans can either be strategic or tactical (Wilder, 2010). The strategic plans encompass the hospital's information processing and take the form of a business strategy. On the other hand, the tactical management plans relate to specific components of the hospital's information system such as the allocation of staff to various departments and budget decisions.
Disaster and Recovery Planning
The hospital needs to maintain a high degree of network and system availability since the lives of the patients depend on the systems' ability to remain active and operational. Additionally, the hospital's disaster recovery planning has to consider the clinical workflows' impact, particularly in the case of a patient surge. The infrastructure resiliency and disaster preparedness in the hospital become apparent as clinicians and physicians become more reliant on various clinical applications in delivering patient care. The hospital's first step in the development of an effective disaster recovery planning should involve conducting a business impact analysis aimed at identifying all the applications and systems with subsequent determination of their impacts on the patients and delivery of care (Callen, 2016).
Participation in the Planning, Design, Selection, Implementation, Testing, Integration, Evaluation, and Support of Health Information Technologies
System planning involves the preparation of a system proposal which contains the objectives, problem definition, constraints, terms of reference, and the expected benefits of the new system (Hanson, 2011). One of the planning challenges is that the management may reject the proposal or suggest various modifications to the proposed electronic health record (EHR) system. Another challenge of the planning phase involves the determination of whether the proposed system is consistent with the hospital's strategic objectives. Ensuring the development of the new health information system without causing any social issue within the hospital in the process of health information exchanges (HIE), also forms a challenge during the planning phase.
System design is the most critical phase of system development (Callen, 2016). One of the challenges in the design phase relates to turning the logical design into a physical design since it involves a detailed description of what is required to solve the original problem. Another challenge involves drawing up the details of forms, input, output, processing specifications, and codification schemes to enhance HIEs, which require maximum accuracy. The decision regarding the software, hardware and programming language in which the new system will run is also a challenge since it there has to be a consensus.
System selection involves a detailed investigation of the system based on the objectives of the proposed system (Wilder, 2010). One of the challenges of system selection relates to the requirement of a detailed study of various operations performed by the system at different regional extension centers (RECs), as well as determining how such operations relate within and outside the system. Conducting on-site data collection is also a challenge since it requires one to keep in view the new requirements and problems of the system.
The evaluation phase involves the collection of factual data, understanding the involved processes, identification of the problems, and making various recommendations on how to improve the system’s functionality (Gorgon, 2012). The primary evaluation challenges relate to the collection of operational data, determination of the system's weaknesses and their respective solutions, as well as understanding the system's information flow. The accomplishment of such evaluation activities requires more time and costs.
The testing phase involves the removal of all the bugs before the implementation of the new information system (Hanson, 2011). One of the testing challenges involves the development of a test plan which the professionals have to run on a particular set of test data. Another challenge is ensuring that the results of the test match the expected output. That means the testing process must ensure that the health information exchanges (HIEs) within the system are error-free.
The implementation phase involves turning the theory into practice, and the biggest challenges relate to the acquisition and installation of software and hardware, conversion and user training (Hanson, 2011). Some software or hardware may fail in providing proper electronic health records (EHRs). At the same time, the conversion process may take a longer time that expected, and the same may happen to the users' training process.
The integration phase involves incorporating the new system into the old one, and one of the challenges involves the identification of the best suitable approach that can cause minimal interference with the system's operation regarding the provision of accurate EHRs. Some integration strategies are risky and may lead to the loss of data within the system. Additionally, errors may occur during the integration process, thereby reducing the confidence of the users.
Support of Health Information Technologies
Supporting the new health information technology involves the maintenance of the system (Callen, 2016). One of the challenges involved is the elimination of the errors within the system which requires accurate system monitoring. Another challenge relates to tuning the system to any changes within its working environment. Additionally, the maintenance process must meet the scope of the health information system's future functionality and improvement.
Effective use of Health Information Technology in the hospital can play an essential role in enhancing patient safety by use of the data contained in the organization's electronic health record (EHR), as well as the notification and error-checking features utilized by the system in ensuring high-quality care. Additionally, efficient use of EHRs in the hospital can provide a better and more complete picture of the patients' health conditions to the doctors than the manual records. Such information can enable physicians to get the required information for effective evaluation of the patient's condition in the context his or her health history.
Callen, J. (2016). Evaluation research studies essential to ensuring health information systems meet the needs of users, including patients. Health Information Management Journal, 45(1), 3-4. http://dx.doi.org/10.1177/1833358316639457
Gordon, L. (2012). Electronic Health Records And Improved Care. Health Affairs, 31(6), 1366-1366. http://dx.doi.org/10.1377/hlthaff.2012.0474
Hanson, R. (2011). Good health information – an asset not a burden!. Australian Health Review, 35(1), 9. http://dx.doi.org/10.1071/ah09865
Li, J. (2015). Ensuring Privacy in a Personal Health Record System. Computer, 48(2), 24-31. http://dx.doi.org/10.1109/mc.2015.43
Wilder, B. (2010). Need For Open-Source Electronic Health Records. Health Affairs, 29(2), 332-334. http://dx.doi.org/10.1377/hlthaff.2010.0061
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