Literature Review: The Use of Clinical Systems to Improve Outcomes and Efficiencies

 Research Review
Feldman, S. S., Buchalter, S., & Hayes, L. W. (2018). Health information technology in healthcare quality and patient safety: a literature review. JMIR medical informatics, 6(2), e10264. https://medinform.jmir.org/2018/2/e10264
Feldman et al. (2018) carried out research to identify how health information technologies are used to improve patient outcomes. The study is focused on determining how health information technology influences the quality of care and patient safety.  The research has the primary objective of understanding where the focus should be put in health information technology and the influence that healthcare informatics might have on the quality and safety of care a patient receives.  The research carries out a literature review through studying per reviewed publications that report on healthcare information technology that can be used to improve safety and quality of care.  The research identified 41 studies identified through categorization. The research results showed that most studies used healthcare informatics to identify and prevent healthcare safety and quality issues.  Custom IT systems were implemented to create alerts in healthcare settings and support specific decisions. The research identified interface design, culture, and implementation of the IT systems in healthcare settings as significant challenges.

The research makes it easier for organizations to identify what kind of IT systems better work in the healthcare setting. The research acts as evidence of the benefits of using informatics to improve the quality and safety of care patients receive.  The research shows that clinical systems such as informatics help reduce instances of medical errors, omissions, and also help identify issues before they happen. Informatics is also vital to developing preventive strategies and improving the safety and quality of care that the patient receives.
Fuji, K. T., Abbott, A. A., & Galt, K. A. (2015). A qualitative study of how patients with type 2 diabetes use an electronic stand-alone personal health record. Telemedicine and e-Health, 21(4), 296-300. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4378613/
The research by Fuji, Abbott, and Galt (2015) is on how patients with diabetes (type 2) use electronic stand-alone personal health records to manage their conditions. The use of personal health records (PHR) is proposed to enhance the way patients view their healthcare, increase healthcare knowledge, and promote change in care behavior. Therefore, the qualitative study has the objective of exploring how patients with type 2 diabetes use health records to manage the condition and change self-care behaviors. The research used 59 patients, all of whom had type-2 diabetes.  The participants received training on the use of web-based personal health records. They were then interviewed 3-6 months after the training, and the interviews analyzed iteratively by using categorization, coding, and theme development.
The research shows how electronic health care records, such as PNR, could be used in clinical settings to improve patients’ outcomes. The results of the study show that the themes that emerged showed positive experiences. Such included participants citing that they had access to complete records, increased awareness on type-2 diabetes and increased behavioral change. The research also showed that electronic records could have challenges, especially if patients are computer illiterate. Patients’ access and use of electronic healthcare records also have shortcomings in that there is no one-on-one physical interaction with the physicians. Electronic health records like PHR are handy tools of passing information in the clinical setting. However, all barriers related to such systems must be eliminated by educating the systems on how they are used.
Mohsen, M. M., Riad, N. A., Badawy, A. E., Abd El Gafar, S. E., Abd El-Hammed, B. M., & Eltomy, E. M. (2020). Tele-nursing versus Routine Outpatient Teaching for Improving Arterial Blood Pressure and Body Mass Index for Hypertensive Patients. American Journal of Nursing, 8(1), 18-26. http://article.scinursingresearch.com/pdf/AJNR-8-1-3.pdf
The research is about how telehealth and telenursing have progressed in healthcare practice.  It discusses how telenursing can improve arterial blood pressure and body mass index for hypertensive patients. Telenursing is the use of conversations over the phone and other IT infrastructure to give care to patients, not in the same proximity. The research cites that the increasing shortage of nursing professionals has led to telehealth and telenursing. Tele-medicine or nursing is useful when it comes to hypertensive patients who have to travel long distances to get care or who have to wait for a long time to visit physicians.
The research aims to compare telenursing and routine outpatient teaching and see which one influences patients more or improves the level of body mass index and arterial blood pressure in hypertensive patients. The study used a quasi-experimental design with a group of 100 participants divided equally into a study group and a control group. The study was conducted on outpatients that had hypertension. The first group (study group) received care through telephone follow-ups while the control group would go through the traditional in-facility care. The research used structured interviews and bio-physiological measurements as instruments in the study. The study results showed a statistically significant difference between BMI and the arterial blood pressure in the study and control groups. The mean levels of BMI and arterial blood pressure were lower in the study group compared to the control group. The research shows the importance of telenursing to the outcome of a patient’s health.  Telenursing proved to be effective in improving the condition of patients with hypertension.
Woehrle, H., Arzt, M., Graml, A., Fietze, I., Young, P., Teschler, H., & Ficker, J. H. (2018). Effect of a patient engagement tool on positive airway pressure adherence: analysis of a German healthcare provider database. Sleep medicine, 41, 20-26. https://www.sciencedirect.com/science/article/pii/S1389945717303416
The research objective was to investigate the effect of patient engagement tool on positive airway pressure (PAP) adherence when added to other proactive telemedicine strategies. The methods for carrying out the research were through data analysis. Data were from ResMed Healthcare Germany was retrospectively analyzed. The participants were patients that were on PAP therapy between September 2009 and 30th April 2014. The participants were managed using telemedicine tools (AirView ) or telemedicine and patient engagement tools (AirView and MyAir). The metrics used in the research were therapy start dates, device usage hours, and sleeping disorder indices.
The research used 500 patients managed by telemedicine alone and another 500 guided by telemedicine and engagement tool. The rate of device use was higher in the latter group compared to the former. Therapy termination was also lower in the group with an engagement tool compared to the one with telemedicine only.  The research proves that patient engagement tools such as MyAir have better outcomes than patients who do not use a patient engagement approach in healthcare.
Panyo, K., Putthinoi, S., & Lersilp, S. (2018). Development of Health Informatics for Caring for Children in Occupational Therapy Service Communities. J. Comput. Sci., 14(7), 1029-1037. https://www.researchgate.net/profile/Supawadee_Putthinoi/publication/326989853_Development_of_Health_Informatics_for_Caring_for_Children_in_Occupational_Therapy_Service_Communities/links/5b7151ba92851ca650573846/Development-of-Health-Informatics-for-Caring-for-Children-in-Occupational-Therapy-Service-Communities.pdf
Healthcare informatics helps improve the way healthcare is delivered. The research discusses how informatics affects levels of efficiency in occupational therapy within the community setting.  The study has the objective of developing health informatics in the community to help care managers working with children from birth to 6 years. The study participants were fifteen individuals that work as occupational therapists in the community. The research used questionnaires with four major themes: security, usability, function, and requirement. The health informatics system used to log in, data summary and display, intervention, follow up, and assessment as the parts of analysis.
The study results showed that most participants thought the health informatics system set in the community increased efficiency as there was a high mean in usability, security, and functional requirements. The research shows the importance of health informatics in improving the outcome of patients. With efficiency comes quality and safe care, therefore, more patient satisfaction.

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