Report to Board of Trustees: HIT Recommendation Comprehensive Nursing Paper Example


Like several other personal and social activities, healthcare has been revolutionized by the unfolding changes in information technology. People possess the same biological features that our forefathers lived tens of thousands of years ago, but modern people’s approach and their capacity to promote and restore health conditions have changed dramatically. Whether at the individual or population level, this change cannot solely be attributed to the information age as people also experience waves of change that emerged before the dawn of the information age, like the industrial revolution age. However, since health care is an information-intensive industry, the continuum of change from the time of the industrial revolution is assumed to have witnessed significant leaps resulting from disruptive information technologies. The penetration rates of information technology bypassed their critical mass thresholds as societies evolved towards the current state of the so-called information society.(HIT Recommendation Comprehensive Nursing Paper Example)

HIT Recommendation Comprehensive Nursing Paper Example

 The World Health Organization (2015) notes that evaluating how these information technologies impact human health is a very complex exercise. The same report acknowledges that health care is not the only determinant of the health condition but is one of the other determinants like genetics, gender, education, and the social-economic status or physical environment. As a way out, one can investigate the impact of health technology and systems in health care by evaluating how IT and systems interact with healthcare within the context of health information technology (HIT) and subsequent health information systems (HIS). Consequently, this essay purposes of presenting a report for the Board of Trustees of the selected healthcare organization that evaluates some HIS and recommends the best system for the healthcare organization that the author works for.(HIT Recommendation Comprehensive Nursing Paper Example)

Part I- Evaluation of at Least Evaluate at least Two HIS

          In modern times, health care organizations are continually looking for ways to improve patient outcomes and create efficient facilities. Ebnehoseini et al. (2019) note that since the hospital information system is one of the HIS that has been widely utilized, there is a need to evaluate the hospital information systems as serious concerns regarding these systems’ quality are raised. With the Health Information Technology and Clinical Health (HITECH) Act of 2009 stipulating that each hospital in the US receives about $10 million, the post-implementation evaluation of HIS success is of critical importance evaluation framework ISSM model can be utilized in the assessment process. ISSM was developed by Delone and Mclean in the 1990s and focuses on seven dimensions: system quality, information quality, service quality, system use, usefulness, satisfaction, and net benefits. The HIS evaluated in this report is a clinical information system (CIS), which is contextually defined as an information system used to collect, integrate and distribute information to the appropriate areas of responsibility. These areas include but are not limited to clinical, billing, inventory management, research schedule, and planning purposes. The CISs evaluated using the seven parameters above are electronic health/ medical records, clinical decision support tools, and CPOE systems. To evaluate the EHRs system, one should begin by setting the expectations so that the practice in context clearly understands and can define the reasons for implementing the EHRs system and the expected benefits. The next one has to factor in the standards compliance that revolves around patient data privacy and the interoperability and efficiency of the integrated systems. This implies that the EHRs system should be compliant with HIPAA Act. Meaningful usage and ICD new stand should be ICD-10 as mandated by HIPAA. Other evaluation components for this CIS touch on ease of use and the retrieval of the patient’s insurance details since the easier it is to retrieve the patient’s insurance records, the smoother the claims settlement process will be.(HIT Recommendation Comprehensive Nursing Paper Example)

          Most importantly, adopting a EHRs system should not be based on the national government’s monetary benefits but on the hospital’s need to improve efficiency and cost-effectiveness. As Gellert et al. (2015) quip, the EH/MRs replace the paper version of a patient’s medical and health history. The EHRs are designed to share data with other EHRs to enable the healthcare providers to access a patient’s healthcare data at the click of a button. On the other hand, Greenes et al. (2019) observe that to evaluate CDS’ success, one can use clinical and non-clinical domains like patient outcomes and workflow fit.  The successful CDS tool implemented in a hospital is the one that solves the issue it was developed to address and can be measured and monitored.(HIT Recommendation Comprehensive Nursing Paper Example)

          Additionally, the end-user should feel transparent, accessible, useful, and non-interruptive. Clinical decision support systems analyze data from various clinics and administrative systems to facilitate healthcare providers’ clinical decisions. The data derived can help prepare diagnoses or predict medical events like drug interactions as they help filter data and subsequent information to help the care team offer the appropriate services to individual patients (Sutton et al., 2020). However, despite the positive impact the two CISs can have on the community hospital where I work, I believe that CPOE is the best CIS to implement.(HIT Recommendation Comprehensive Nursing Paper Example)

CPOE as the Best CIS for the Community Hospital

CPOE was selected for this community hospital because it purports to enhance patient safety by eliminating transcribing errors as the provider enters the orders directly into the hospital information system. Patient safety is a pertinent healthcare issue to both patients and care providers, yet preventable medical errors continue to claim hundreds of thousands of lives of patients annually. By 2015, more than 800 000 injuries and deaths were attributed to adverse drug events like wrong medications, dosing errors, harmful medical interactions, and allergic reactions (Charles et al., 2014).(HIT Recommendation Comprehensive Nursing Paper Example)

Summary of the Value of CPOE in Terms of Improvements in Healthcare Service Delivery

Ensuring providers produce standardized, legible, and complete orders means CPOEs improve patient safety by avoiding medication errors and improving the quality of care since they get the correct prescription (Rabiei et al., 2018). Preventing medication errors triggers better patient outcomes as adverse drug events are avoided. A hospital that successfully uses the CPOE system becomes more efficient because of decreased healthcare costs. Freedman (2015) posits that as good patient outcomes attract more clients to the community hospital, the facility’s productivity would increase while adequate revenue would translate to improved service ‘through the use of best available evidence-based medicine more patients express better satisfaction with the care services offered.(HIT Recommendation Comprehensive Nursing Paper Example)

Summary of specific attributes of The CPOE System

Like other hospitals, the implementation of CPOE in the community hospital will improve the quality of care where patient safety has greatly been enhanced and improved efficiency and reimbursement. The CPOE system to be implemented has functionalities on patient attributes where amongst other things, patient medications are displayed when prescribing, ask for a prescription signature, and indicate any disturbance in the electronic prescription service. The system also has prescription support attributes where all medications can be renewed with one key tap, display generic drugs at the time of prescription, display all orders including current, stopped, and interrupted. In contrast, the decision support attributes are designed to generate alerts about interactions, allergies, contraindications, and laboratory results (Rabiei et al., 2018). The CPOE system can also link with other hospital information systems’ subsystems. At this point, it is essential to acknowledge that CPOE can be implemented either with or without a full EHRs. However, it is a prerequisite for any hospital implementing CPOE to implement a clinical data repository within a patient setting. The selected facility should be implemented before full electronic charting as doing so would mean a higher value in returns on investment.(HIT Recommendation Comprehensive Nursing Paper Example)

Analysis of Key Areas of Concern the Community Hospital Will Need to Address in the Implementation and Evaluation of the CPOE as the Recommended HIS

Although CPOE technology has been around since the 1970s, successful implementation of CPOE in a hospital largely relies on provider compliance, meaning that the organization must address some critical areas before implementing and evaluating the proposed project. The critical areas of concern for this medium-sized community hospital with a 120 –bed capacity located in suburban central California were high initial implementation cost, staff resistance, and productivity loss. Be that as it may, CPOE capability has been there since 2016. With high implementation and maintenance costs, small and medium-sized hospitals like the selected hospital have been unable to afford implementation costs, leading to lower CPOE adoption rates than large hospitals. Stevens et al. (2015)(HIT Recommendation Comprehensive Nursing Paper Example) also remarked that adequate healthcare professionals’ adequate training has proven costly for hospitals. For providers who are not computer literate, their resistance to learning the new technology would need to be resolved first. Lastly, workflow interruption leads to a loss of about 0.8 hours every day due to CPOE use (Nuckols et al., 2015).(HIT Recommendation Comprehensive Nursing Paper Example)

In a nutshell, through HIT, electronic records continue to transform the way healthcare operates by storing all patient records and tests in a central place where the medical staff can instantly access them, thus improving physician-patient interactions. In any facility, the hospital executive is committed to using HIS that utilizes the latest technology to retrofit the selected hospital’s fleet of clinical information to comply with the current HIS.  (HIT Recommendation Comprehensive Nursing Paper Example)

Part II: In-depth Research Supporting the CPOE Implementation Recommendation

CPOE implementation at this 120-bed community hospital would permit the providers to order medications and laboratory tests, and radiology studies electronically within the EHRs. Furthermore, the CDS can be annexed to the CPOE system, thereby alerting the provider to patient allergies and drug interactions. The hospital’s mission is to improve the community’s health and the world by setting the standard of excellence in clinical care, research, and health education. Its goals are to push the limits of discovery to transform healthcare and inspire hope for humanity. (HIT Recommendation Comprehensive Nursing Paper Example)The hospital’s core values are to be the best, be a role model, embrace and value all aspects of diversity and listen to understand and embrace other people’s distinct skills. The implementation of CPOE is compatible with and through its functionalities reinforces the organization’s mission to be the leading hospital of choice for patients in central California by excelling in healthcare. CPOE also reinforces the organizational goals’ achievement since the system would facilitate prescribing the best- evidence-based medicine in line with its four core values.(HIT Recommendation Comprehensive Nursing Paper Example)

Core Functions Of the Recommended CPOE and the Specific Impact These Capabilities Will Have on the Community Hospital

Healthcare delivery in the 2020s and beyond rely heavily on HIT utilization, where EHRs and CPOEs form the bedrock of critical transformation in the healthcare industry (Saluvan & Ozonoff, 2018). (HIT Recommendation Comprehensive Nursing Paper Example)The core functions of CPOE systems are to replace the paper-based ordering system in a hospital as they allow the end-users to electronically write the full range of orders, keep an online medication administration record, and review any changes made to order by successive personnel. All these capabilities will positively impact the community hospital by reducing medical errors resulting from poor handwriting, ambiguous abbreviations, or inadequate knowledge on ordering by the provider. Ensuring that the orders are standardized, legible, and complete, the implemented CPOE system would prevent medical errors during the ordering and transcribing stages.(HIT Recommendation Comprehensive Nursing Paper Example)

Evaluation of the Usability Factors You Addressed With the Healthcare Information Vendor and the Recommended Strategy to Evaluate the Usability Factor

Before evaluating usability factors of the CPOE system, the term usability in this context refers to the quality of a user’s experience when interacting with a product or a system like a website, software, device, or application. To evaluate the CPOE systems’ usability, the exercise will focus on 5Es, namely effectiveness, efficiency, engagement, error tolerance, and ease of learning. Under effectiveness evaluation, functionality testing is carried out to determine that the end-user will achieve the set goal or reduce medication errors. (HIT Recommendation Comprehensive Nursing Paper Example)To test effectiveness, one should test the CPOE features, functionality, and content. Secondly, efficiency will evaluate the speed at which the goal is achieved. An ideal assessment strategy for this factor in determining the number of strokes required to perform a specific task- the lesser the number of keystrokes, the higher the efficiency. The third usability evaluation factor is an engagement where one assesses the CPOE system’s capacity to tending the user to stay on the product at the optimal time by having attractive design elements like good visuals and micro-interactions and better graphics. Here, the evaluating strategy is to keep an eye on average session time, bounce rate, and the total number of sessions. The fourth factor is error tolerance. The CPOE system will have the functionality to minimize errors occurring on the product through inclusions like undo or redo, among others with functionalities that enable the user to correct an error or repair it being the evaluating strategy. The fifth and last usability evaluation factors are the ease of learning, which assesses how easily the CPOE system users will use the new product and feature updates. Likewise, the recommended evaluation strategy for ease of learning is to perform thorough testing from an end user’s perspective.(HIT Recommendation Comprehensive Nursing Paper Example)

The reason why the 5Es were used to evaluate the usability factors are that doing so will help the implementer to ascertain if the product meets the user expectations, identify the flaws in the product before the users find them while getting a candid picture of how successful the users are in executing their tasks.(HIT Recommendation Comprehensive Nursing Paper Example)

HIT Recommendation Comprehensive Nursing Paper Example

How the CPOE System Will Integrate With Other Products and How CPOE Products Ensure Absolute Privacy and Security

The pioneer CPOEs were marketed as standalone systems, but today many of these modules are integrated into many EHRs products. When integrated into EHRs, the CPOEs allow the physician to enter patient data electronically into text boxes and drop–down menus instead of handwritten notes. Although some physicians have demonstrated some reluctance to adopt CPOE citing high implementation costs, the CPOE modules offer several benefits like meaningful use stage one and stage two requirements. Kruse et al. (2017) (HIT Recommendation Comprehensive Nursing Paper Example)opine that confidentiality and security of protected health information matter as low privacy and security practices are likely to compromise the patient information stored in the HIS, exposing them to cyber-attack. Therefore CPOE modules have to adhere to HIPAA.(HIT Recommendation Comprehensive Nursing Paper Example)

Vendor Support That Will Be Supplied If the CPOE System Is Adopted and Evaluation of Vendor Reliability and Stability

Some vendors disappear as soon as the CPOE system is adopted. However, the CPOE vendor selected is expected to have an account manager-type individual allocated to the community hospital for questions that arise and insight into upcoming upgrades and enhancements. The selected vendor will have high quality and (HIT Recommendation Comprehensive Nursing Paper Example)reliable products, meaning deliveries are prompt, and the supplies are constant as the vendor is financially stable.

Cost Estimate of the CPOE System

The proposed CPOE system implementation led to developing a cost estimate model, which ended with the CPOE implementation costs. The Board of Trustees is reminded that capital software costs include CPOE application, medication administration, and upgrade to the pharmacy application if required. The costs included in the budget include capita costs for the hardware, software, and computer networking equipment, while the second part estimates the annual operating costs associated with maintaining the hardware, software, network equipment, and computer interface, among other devices.(HIT Recommendation Comprehensive Nursing Paper Example)

CPOE Implementation costs Estimates

Cost ItemCost in thousandsBudgeted Yes(Y) or No(N)
Hardware/ software  
Servers and OS400Y
Application License costs for CPOE Application License costs for BCMA160 50Y Y
Workstations MD150N
Business continuity plans /tools350Y
Single sign-on and integration200N
Network Install Wireless LAN Network monitoring equipment  350 100  Y N
MD Champion100N
Implementation Vendor costs  50  Y
Training Nurse training Pharmacy training  32 2  N N
Other Construction150N
                        Total2 099 

 A cost estimate of the CPOE Cost Estimate Maintenance for the Community Hospital

Cost itemCost in ‘000of dollars $Budgeted Yes(Y) or No(N) Y/N
Application software maintenance50N
Third-party software maintenance140N
Workstation Maintenance and spares70N
Single sign-on maintenance40N
LAN Maintenance70N
Staffing Required to support CPOE  
Clinical analyst/ informaticists Pharmacy analyst CPOE Project Manager Additional help desk support Liaison150 75 200 150 150N N N N            

The Selection and Acquisition Process by Developing a Timeline Noting the Major Milestones of the Process

One must acknowledge that the number of variables will either increase or decrease the time needed to implement the CPOE project. However, the six main steps are plan, design and build, test, train and go live. Step 1 called the planning stage depending on the CPOE demonstration and evaluation of the auditioned vendors. This ends when a final vendor is selected. The second step is designing and incorporates the user group of representatives, namely the project manager, technical members like the application analyst and application developer, application test engineer and consultant, and the user group comprising end-users, mainly nurses. (HIT Recommendation Comprehensive Nursing Paper Example)Thirdly the step involves building change management, which ends with fine-tuning the CPOE implementation budget by going through the vendor implementation fees, employee overtime, and extra administration staff. Step for follows with CPOE data audit and migration test and software testing. The fifth step is marked by training and preparation for the end-users through e-learning modules and seminars depending on the chosen training method. The sixth and last step involves going live with specific activities, including patient communication, staff scheduling, and the like. After going live, the CPOE system performance evaluation concludes the section and acquisition process of the CPOE health information system.(HIT Recommendation Comprehensive Nursing Paper Example)


This report has established that the modern healthcare industry faces the challenge of balancing computerized technology and offering safe patient care efficiently, which is also cost-effective. The report has been outlined in two main parts. Part I evaluated two HISs (with particular reference to clinical information system like the electronic health/ medical records(EH/MRs), clinical decision support system(CDSSs)(HIT Recommendation Comprehensive Nursing Paper Example), and computerized provider order entries(CPOEs) before selecting  CPOE as the one which in the author’s considered opinion would work best for the selected organization. The report then summarized the value of the chosen HIS within the context of improved quality, efficiency, and satisfaction together with its specific attributes. Next, a brief analysis of key areas of concern the hospital will need to be prepared to address during the implementation and evaluation of the selected HIS. After exploring information needed for a foundational understanding of the capabilities and the need for the proposed HIS, Part II delved into supporting literature that supports the CPOE implementation at this community hospital by, amongst other aspects, identifying the recommended HIS, evaluates the compatibility of the system to the organization’s mission, goals and values all the way to estimate a cost estimate of the HIS before describing the selection and acquisition process with a timeline denoting the significant milestones of the process.(HIT Recommendation Comprehensive Nursing Paper Example)


Charles, K., Cannon, M., Hall, R., & Coustasse, A. (2014). Can a computerized provider order entry (CPOE) system prevent hospital medical errors and adverse drug events? Perspectives in Health Information Management, 11(Fall).(HIT Recommendation Comprehensive Nursing Paper Example)

Dey, P. K., Bhattacharya, A., Ho, W., & Clegg, B. (2015). Strategic supplier performance evaluation: A case-based action research of a UK manufacturing organization. International Journal of Production Economics166, 192-214.(HIT Recommendation Comprehensive Nursing Paper Example)

Ebnehoseini, Z., Tabesh, H., Deldar, K., Mostafavi, S. M., & Tara, M. (2019). Determining the hospital information system (His) success rate: Developing a new instrument and case study. Open access Macedonian journal of medical sciences7(9), 1407.(HIT Recommendation Comprehensive Nursing Paper Example)

Fischer, S. H., Rudin, R. S., Shi, Y., Shekelle, P., Amill-Rosario, A., Scanlon, D., & Damberg, C. L. (2020). Trends in computerized physician order entry by health-system affiliated ambulatory clinics in the United States, 2014–2016. BMC health services research20(1), 1-6.(HIT Recommendation Comprehensive Nursing Paper Example)

Freedman, D. B. (2015). Towards better test utilization–strategies to improve physician ordering and their impact on patient outcomes. Journal of the International Federation of Clinical Chemistry and Laboratory Medicine, 26, 15-30.

Greenes, R. A., Bates, D. W., Kawamoto, K., Middleton, B., Osheroff, J., & Shahar, Y. (2018). Clinical decision support models and frameworks: seeking to address research issues underlying implementation successes and failures. Journal of biomedical informatics78, 134-143.(HIT Recommendation Comprehensive Nursing Paper Example)

Kruse, C. S., Smith, B., Vanderlinden, H., & Nealand, A. (2017). Security techniques for electronic health records. Journal of medical systems41(8), 1-9.(HIT Recommendation Comprehensive Nursing Paper Example)

Rabiei, R., Moghaddasi, H., Asadi, F., & Heydari, M. (2018). Evaluation of computerized provider order entry systems: assessing the usability of electronic prescription systems. Electronic physician10(8), 7196.(HIT Recommendation Comprehensive Nursing Paper Example)

Russ, A. L., & Saleem, J. J. (2018). Ten factors to consider when developing usability scenarios and tasks for health information technology. Journal of biomedical informatics78, 123-133.(HIT Recommendation Comprehensive Nursing Paper Example)

Saluvan, M., & Ozonoff, A. (2018). The functionality of hospital information systems: results from a survey of quality directors at Turkish hospitals. BMC medical informatics and decision making18(1), 1-12.(HIT Recommendation Comprehensive Nursing Paper Example)

Sutton, R. T., Pincock, D., Baumgart, D. C., Sadowski, D. C., Fedorak, R. N., & Kroeker, K. I. (2020). An overview of clinical decision support systems: benefits, risks, and success strategies. NPJ digital medicine3(1), 1-10.(HIT Recommendation Comprehensive Nursing Paper Example)

WHO (2015). Determinants of health.

HIT Recommendation Comprehensive Nursing Paper Example

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