NUR 521 Module 1 National Informatics Initiatives Discussion Example

Discussion Board: National Initiatives and Health Informatics Legislation

Why Our Unit Scans Every Dose: Tracing a Medical Unit's Technology Back to National Initiatives and Law

Initial Post

Every scheduled dose on my medical unit is scanned at the bedside: the patient's wristband, then the medication, then the electronic record checks that the drug, dose, route and time match the order. Our nurses rarely ask why we work this way, but this week's readings answered that question for me.

The story starts with national quality reports. The quality chasm report (Institute of Medicine, 2001) argued that the American health care system needed redesign, including the use of information technology, to deliver safe, effective, patient-centered, timely, efficient and equitable care. Federal policy then supplied money and rules. The HITECH Act (Health Information Technology for Economic and Clinical Health Act, 2009) paid hospitals and clinicians incentives to adopt certified record systems and to use them in meaningful ways, such as computerized order entry and electronic medication records. Our hospital's switch from paper to an electronic record and barcode medication administration followed those incentives within a few years.

The benefits are real. Orders are legible, allergies are checked automatically, and barcode scanning catches wrong-patient and wrong-drug errors before they reach the patient. But technology also creates new problems. Researchers who observed barcode scanning in five hospitals documented 15 distinct workarounds, such as patient barcodes taped to carts or doorframes, with causes including unreadable labels, failing scanners and weak wireless connections; nurses overrode alerts for 10.3% of medications charted (Koppel et al., 2008). I have seen almost every one of those workarounds on my unit, which tells me that national initiatives succeed or fail at the level of a battery and a wristband.

HIPAA shapes daily practice too. Its privacy rule limits who can see patient information and requires minimum necessary access, and its security rule requires safeguards for electronic data. On our unit that means role-based access, automatic logouts on workstations and audits of who opened which record, which nurses sometimes find inconvenient but which protect patients.

For nurses, the lesson of these initiatives is that technology arrives with a policy purpose. Knowing that purpose helps us explain the technology to new staff and argue for fixing its weaknesses rather than working around them.

Knowing the policy history also helps when technology changes again. Each new requirement, from information blocking rules to new privacy protections, arrives with a purpose that nurses can learn and explain.

Reply to a Classmate

Gabriel, you described how your hospital joined a regional health information exchange and now sees outside lab results at admission. That is a benefit I wish we had; our nurses still call other hospitals for medication lists. Have you noticed whether nurses actually look at the exchange data, or does it sit in a tab no one opens? I suspect workflow decides whether exchange improves care, the same way scanner placement decides whether barcode scanning does.

References

Health Information Technology for Economic and Clinical Health Act, Pub. L. No. 111-5, div. A, tit. XIII, 123 Stat. 226 (2009).

Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. National Academies Press. https://doi.org/10.17226/10027

Koppel, R., Wetterneck, T., Telles, J. L., & Karsh, B.-T. (2008). Workarounds to barcode medication administration systems: Their occurrences, causes, and threats to patient safety. Journal of the American Medical Informatics Association, 15(4), 408-423. https://doi.org/10.1197/jamia.M2616