Information Governance

Information Governance


Whilethe acceptance of Electronic Health Record (EHR) frameworks in thehealthcare sector guarantees various significant advantages,negatively impacting outcomes from the usage of these systems havedeveloped. Poorly designed EHR systems and inappropriate use canbring about EHR-related lapses that jeopardize the reliability ofdata in the EHR. As a result, it causes errors that imperil thesafety of patients or cause deterioration of the care quality. Thisinvoluntary outcome may further cause an increase in abuse and fraud,thus cause immense legal implications. Martin Health System inStuart, for instance, is an IT system failure that rendered EpicElectronic Medical Record system inaccessible. According to thehealthcare team, the outage lasted more than a day.

Indeed,the three-hospital Martin Health System underwent a systemmalfunction that resulted in unanticipated downtime for the Epic EMRas well as other entity applications. The system failure greatlyimpacted the healthcare facilities. A downtime of more than 24 hoursis never anticipated, and its occurrence caused numerous misfortunesfor the organization.

Keyfactors contributing to the failure in question

Improperand poor usability of the system is one of the major factorscontributing to the system failure at the MartinHealthcare organization. In addition to the design specifications ofthe EHR and the tasks contributing to the sub-standard quality ofhealthcare, errors may originate from unsuitable system utilization.The errors resulting from usability problem happen due to thecomplexity of the system, absence of functionality that isuser-friendly or even user limitations. Indeed, functionality that isfaulty may mislead medical practitioners in case of a confusingdisplay. Moreover, malfunctioning of the system may emanate fromprogramming bugs, which converts from one system measurement toanother incorrectly, for instance, kilograms to pounds. Another formof error that may occur is the adjacency error, where the clinicianselects an item adjacent to the intended item in a particular menu,including wrong medication or patient.

Additionally,inconsistencies between data field may result in errors, for example,when a structured data file free text area are uneven. An example ofthe structured data field is the indication that two tablets need tobe taken twice each day. However, free text area indicates one tabletshould be consumed in the morning and two of the same pills in theevening. Moreover, the inconsistent dosage of medication informationcontributes to the list of errors likely to be undertaken.

Regrettably,Sittig&amp Dean indicates that cliniciansshare complex processes control with computer systems such that insome instances, they make an assumption of a higher level omissionrole and permit computers to reach routine decisions and executenecessary actions. An example of such situation is an automaticgeneration of laboratory order when certain medications orders aremade. Indeed, this technology is so complex that clinicians are notable to comprehend computations made and thus are unable to carry outcompetent human intercession (Sittig,Dean F. &amp Hardeep Singh, 2011).

Incorrectrecords capture also contributes to the occurrence of the healthcaresystem in question. Vendors of EHR frequently make additionalfunctionalities aid in the documentation, including copy and paste,standard phrase use, templates and insertion of objectsautomatically. Such object insertion comprises of medical valuesimported from additional sections of the electronic record. Thesefeatures have numerous benefits, and they comprise of boosting theefficiency of capturing data, legibility and timelines, extensivenessand consistency of data documentation. Nonetheless, when thesefunctionalities are used inappropriately without sound control andeducation, these features may result in the wrong documentation andmay potentially lead to allegations of fraud and medical errors.

Leadershipteam’s reaction to the failure

Asmany healthcare organizations system migrates from paperwork todigital functionalities, the level of impact of unanticipated failureon patients cares systems is often highly complicated and pronounced.The 24 hour Martin Healthcare system in Stuart reported systemfailure as erratic and impacting to the organization’s operation.Furthermore, the recording of a two-day downtime worsened thesituation. According to the leadership team, the failure led to thesignificant compromise of patient’s care. Additionally, even thebackup framework went down, and this is attributed to the nurses’inability to use the system’s Pyxis management framework to printinformation about the patients. The data was reportedly registeringoutdated for the entire forty-eight hours.

Theteam also highlighted the fact that majority of the families becameconcerned and restless since patients did not receive theirprescribed medications for the better part of the day. Indeed, themajority of patients were not given medicine for the entire day owingto the failure of the EHR since the onset of the day.

MartinHealthcare system should develop a custom application

Importantly,no single vendor can meet the entire needs of all customers in theapplication field. The implementation of a surrounding of standardprotocols and API will permit continuous integration of the bestthird-party hardware and software solutions. The healthcare systemwill liberate and thus they will have the freedom of choosing thebest application that meets her exclusive needs, regardless of thevendor. Evidently, the organization will not be locked into aparticular vendor who makes used of proprietary protocols and APIs,holding them hostage and might charge them a huge sum of money.

Moreover,use of custom application facilitates ease of internal and externalsystem integration. According to Sullivan, June M. (2007), making useof standard APIs and protocols will ensure the organization’s easeof integrating applications, both with external as well as internalapplications. The ease is owed to the standard API and protocols usedin all application. The organization will also enjoy a minimal totalcost of proprietorship. Regardless of the vendor, when organizationshave the freedom of choosing a certain application that suit theirneeds, the cost of both development and integration will particularlyreduce. Extensive integrations services, for example, will be of noessence. Also, for vendors running custom applications, they will betasked to maintain clients to participate in an open fieldcompetition. Evidently, the vendor will not have the freedom ofholding the organization hostage for the services they offer(Sullivan, June M., 2007).

Whenusing custom applications, migrating from one vendor to another iseasier and seamless. In case of integration services, they will bekept at minimal. Using custom applications will further createsuperior solution resiliency. Use of standard protocols and APIensures that quality assurance and testing have been undertaken toascertain compliance with the standards. This quality check meansapplication resiliency and stability have been certified. In additionto the advantages of using custom applications as discussed above,non-proprietor applications encourage innovation. Innovation isarticulated to the completion that increases with enactment ofinternationally accepted standards of APIs and protocols.

Bestpractices that any organization could adopt to avoid such a failurein the future

Anyhealth organization that does not desire failure of their systemsought to improve the usability of the system and articulate properuse of the same. Eradication and prevention of medical errors are notonly the design of EHR system that is significant but its executionas well. Furthermore, how the system is amalgamated into medicalprocesses and the manner end users make use of it in their routinebasis is equally important. Moreover, there is a need to assesssystematically patient harm risks associated with particularapplications as well as safety and quality procedures that arecomparative to the recognized clinical perils (Instituteof Medicine, Committee on Patient Safety and Health InformationTechnology, 2011).

Thepresent approach towards EHR certification and standardization dominimal to address usability, implementation or information integrityby the clinicians, which comprise of full integration with workflows.To begin with, there is a need for EHR certification to define whatvendor applications are not permitted to do in addition to theintended mandate. Moreover, healthcare organizations, as well asother providers, need to be tasked with developing and implementingprocedures and policies referring to the proper use of EHR.Healthcare organizations should further certify all intended usersundergo proper, and thorough training on the use of the systemdeveloped. Training also needs to include the provider’santicipations with regards to the use of the framework.

Forevery application developed, quality, as well as safety processesthat are steady with the level of safety peril related withparticular application and frameworks, should be embraced. Inaddition to establishing safety processes, an internal system toidentify problems internally using EHR and related errors should bedeveloped in healthcare organizations and other healthcare providers.

Accordingto the AmericanHealth Information Management Association (2012), Healthcareorganizations should further work towards minimizing errors emanatingfrom clinical and medical decision support frameworks. While risksmay not be eliminated, the target should be to enact procedures thatminimize the patient harm that are avoidable as well as manageunavoidable hazards that are known. Organizational safety culturesand practices should also be developed. These includes propertraining of users, developing working surroundings that are favorableto safety practices, as well as ascertaining that decision supportsystem is relevant for the medical and clinical chores, for which itis being utilized (AmericanHealth Information Management Association (AHIMA), 2012).

Howhealthcare leaders can use project metrics and portfolio managementto ensure operational efficiency and effectiveness

Indeed,many successful organizations make use of portfolio managementpractices to establish the kind of business they intend to pursue orIT plan venture to make. Project portfolio management integratesadditional dimensions through the utilization of disciplines ofmanagement as well as present governance to ascertain that the EHRproject investment is attaining its set objectives. Projectmanagement portfolio can be used by healthcare leaders to establishviews, analysis and management of EHR projects to maximize positiveoutcome within the organizations’ electronic resource constraints.Project portfolio management will also enable healthcare leaders toeither include in or exclude from, the performance and strategyagainst the organization’s business objectives.

Alternatively,project metrics is identified as the standard of the dimensionthrough which healthcare leaders can assess efficiency, performance,quality, progress and productivity of EHR project to be developed.Furthermore, metric will help the health care team in developingpredictability, laying out what is working, and refiningdecision-making process of the healthcare organization. Projectmetric will also guide the team on focusing on EHR project in theright and appropriate direction. Project metrics enables thehealthcare leaders to assess the status of the procured EHR projectconcerning cost, schedule, and profitability. The project metric willalso enable the leadership team to foresee any prospective risks andthus develop preventive measures. Moreover, healthcare leadershipwill be able to check on the profitability of the laid down projectand assess the degree of team’s profitability in correlation withwork product quality to be delivered.

Governmentintervention into healthcare businesses

Theadvancements anticipated in the healthcare sector with EHR systems ishighly dependent on high levels of information quality to improve themanner in which healthcare services are provided. Improved safety,engagement of patients in their healthcare and the costs ofhealthcare are compensated. Indeed, there is the necessity of thegovernment to ensure accurate accountability, compliance,availability and reliability, and protection of information ofhealthcare organization. According toDavid C. Classen, &amp Dean F. (2011), healthcareorganizations require well-defined information regarding patients tofacilitate sound decision making, minimize limitations on value forhealthcare entities in the EHR investments and projects. Whilehealthcare organizations have identified the necessity for highdegree of protection and quality of information for huge data as wellas analytics that boost decision making and safety, the government istasked to identify and address the encounters to information safety,integrity, and system failures (Singh,Hardeep, David C. Classen, and Dean F. Sittig., 2011).

Thegovernment should set up information control programs and concepts tosecure and manage healthcare information assets as well as ensuringsuitable decision making and level of integrity. With an efficientand effective control program, healthcare providers can shift fromresponsive position to one is based on information assets andoptimizing the utilization of EHR. Indeed, the combination ofindustry action and central government oversight is appropriate toprevent unintentional consequences resulting from EHR use.

Centralgovernment leadership is appropriate to facilitate the building,enactment as well as enforcement of all-inclusive state standards forperformance, design and the use of EHR systems which minimizes severeerrors related to EHR systems. Nonetheless, sole government oversightis not sufficient to eradicate medical system related adversarialevents. The systems vendors need to adopt usability and designstandards that work towards optimizing information integrity andsystem safety. The government should mandate healthcare organizationsto enact procedures and policies that incorporate suitable EHRtraining and its use. All these will work towards preventing systemrelated errors, as opposed to the design of the system, and ascertainEHR errors before the care of the patients are adversely affected.


AmericanHealth Information Management Association (AHIMA).(2012). DataQuality Management Model.Chicago, IL: AHIMA.

Instituteof Medicine, Committee on Patient Safety and Health InformationTechnology.(2011) Health IT and Patient Safety: Building Safer Systems for Better Care.Washington, DC: National Academies Press.

Sullivan,June M. (2007). RecentDevelopments and Future Trends in Electronic Medical and PersonalHealth Records.”TheHealth Law19: 16.

Sittig,Dean F., and Hardeep Singh. (2011). DefiningHealth Information Technology-Related Errors.Archivesof Internal Medicine171(2011): 1281.

Singh,Hardeep, David C. Classen, and Dean F. Sittig. (2011). Creatingan Oversight Infrastructure for Electronic Health Record-RelatedPatient Safety Hazards.Journalof Patient Safety7:172.