e-Health: an emerging arena in the connection of public health, clinical informatics, and business

Digital health records, commonly known as electronic health records (EHR) are digital versions of paper-based patient charts and facilitate instant and secure availability of patient information to authorised users (Rajkomar et al., 2018). This reflection will elucidate my responsibilities in recording and assessing clinical care outcomes in such digitalised health setting and also focus on the necessity to adopt e-health.

Running head: REFLECTION
ASSESSMENT ONE: Written Assignment
Name of the Student
Name of the University
Author Note

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Introduction
e-health has been identified as an emerging arena in the connexion of public health,
clinical informatics, and business, and refers to the health information and services delivered
or improved through the usage of Internet and associated technologies (Ross, Stevenson, Lau
& Murray, 2016). It encompasses a way of thinking and state of mind for the improvement of
health care, with the usage of communication and information technology. Digital health
records, commonly known as electronic health records (EHR) are digital versions of paper-
based patient charts and facilitate instant and secure availability of patient information to
authorised users (Rajkomar et al., 2018). This reflection will elucidate my responsibilities in
recording and assessing clinical care outcomes in such digitalised health setting and also
focus on the necessity to adopt e-health.
Personal and Professional self-reflection
I believe that as new RNs, we have to constantly encounter countless challenges that
create an impact on successful transition to our practice. The healthcare environment is ever-
changing, nonetheless the demand for nursing professionals remains unchanged and the
requirement is more severe than before (Aberese-Ako, Agyepong & van Dijk, 2018). My
experience has helped me comprehend that hospitals are always under added pressure of
operating in an efficient and lean manner, owing to increased consumerism, increased patient
admissions and staff shortage. As a graduate nurse, my primary responsibility in a digitalised
health setting is to effectively use electronic health records (EHRs), predominantly
Computerized Physician Order Entry (CPOE), with the aim of decreasing rates of errors and
enhancing patient safety. The common challenges that are encountered following transition to
practice are namely, an increase in the number of patients suffering from multifaceted
conditions and numerous comorbidities, generational variety in the staff, non-existence of
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access to knowledgeable mentors and trainers, performance anxiety, and intimidation (Black,
2016).
To further worsen the scenario, workload and staff shortage result in errors in care
delivery, thus threatening the health and safety of patients. Not only are the RNs expected to
help patients gain access to personal health information, but also have the duty of decreasing
duplicate testing and saving time devoted to each patient, thus enhancing patient care
decisions (Bodenheimer & Mason, 2016). During transition to nursing practice, adoption of
digital health will not only prove beneficial to us nurses by providing us the occasion to
enhance patient lifestyle and maintain an optimal health, but will also help us in decreasing
healthcare costs and customise the care as per the requirements and demands of patients
(Mather & Cummings, 2019). The World Health Organisation proposes that e-health
encompasses the usage of digital technology for treating patients, conducting nursing
research, education, monitoring public health, and keeping a track on disease (WHO, 2020).
Considering the challenges that we have to encounter in practice, there often occurs
errors during care that commonly involve wrong dose, wrong route of drug administration or
incorrect drug preparation. Such incidents add to moral distress of nursing professionals, thus
forcing them to leave the practice. This calls for the need of utilising CPOE, the leading
feature of EHR, where the medical orders are electronically entered in a computer system,
with the aim of decreasing error rates, in comparison to paper-based patient records, and
enhancing effective communication with physicians, which in turn will allow complete
access to medical history of patients and facilitate keeping a track on patient health status
(Almond, Cummings & Turner, 2017). Therefore, as a graduate nurse, it is imperative to
record and document patient information and medication orders in computerised system, in
order to enhance patient outcomes, and increase job satisfaction.
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Evaluation
I believe that novel digital health technologies have the prospect of increasing care
efficiency, improving patient safety, and resulting in healthier outcomes. This is confirmed
by the fact that the fast pace of transformation in the digital world has made all domains
reconsider how to approach work, and the nursing profession is no exception (Gopal, Suter-
Crazzolara, Toldo & Eberhardt, 2019). My clinical expertise has helped me realise that
medical records are an assortment of clinical diagnostic notes and patient information that are
self-reported, conventionally stored on paper-based medium. Time and again it has been
found that paper-based records are easier to customise according to the health status and
requirements of each patient, without making any adjustments to any software (Foster et al.,
2018). However, I gained a sound understanding of the fact that paper-based medical records
need adequate physical space for their storage. I hold the notion that paper-based medical
records of patients once lost can never be retrieved or are difficult to recover.
However, digital health records such as CPOE involve communication of orders over
a computerised network across different departments like radiology, pharmacy, and
laboratory that decreases the time required for disseminating and completing the orders,
besides improving the efficacy by decreasing rates of errors (Were, Sinha & Catalani, 2019).
Our world has been drastically changed by digital technology such as, tablets, smart phones,
and web-enabled devices that have changed our day-to-day lives and the manner in which we
connect. Often I have encountered situations where lack of clear patient information or
transcription errors have resulted in duplicate order entries, thus adding to the time, billing
costs and other expenditure. According to Graboyes and Bryan (2018) more exhaustive and
complete information of medical history and ongoing care of patients available from digital
health records will enable physicians and nursing professionals to make care decisions, such
that there are no safety risks for the patients. It has been identified that e-health will not only
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advance information handling for health care personnel, patients, and decision-makers in
health and social care services, but will also encompass a range of communication
technologies (Usher, 2017).
I believe that the healthcare service is intensely reliant on information and evidence.
Documenting and evaluating care outcomes of patients in form of CPOE will enhance
communication with organisations and stakeholders and will also help in quality
improvement of care. Therefore, while using CPOE, I am expected to remain alert about the
potential contraindications or drug interactions related to particular patient orders.
Analysis
There is a growing body of evidence that a lone cloud server has the capacity to stock
countless patient medical records, nonetheless physical files to accommodate to that volume
necessitate excess space (French-Baidoo, Asamoah & Oppong, 2018). Therefore, a better and
seamless sharing of data within the digital health care infrastructure, generated by CPOE,
incorporates and controls digital development and can modify the process by which care is
provided and compensated. I have often encountered that illegible handwritings in paper-
based patient records makes it difficult for us to comprehend the medications and/or
interventions that have been prescribed to patients in the challenging work environment, thus
increasing our risk of making errors in care delivery. With CPOE, illegible handwriting of
physicians and problems in transcription of the prescriptions are no longer recognised as an
issue and the process of billing or coding becomes easier (Gellert, Webster, Gillean, Melnick
& Kanzaria, 2017).
Not only will computerised entry of patient orders prevent such avoidable errors, but
will also allow nursing professionals to reduce the overall expenditures that are sustained by
patients in healthcare settings, thereby decreasing expenditure for both providers and patients
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alike. It will help me to prevent misplacement or misfiling of patient charts and will also
decrease miscommunication errors with other professionals. According to Hoover (2017) it is
imperative for nursing professionals to strive for utilising digital patient-centred records that
helps in keeping close surveillance over the care continuum of the patient, in health and
sickness. Adopting digital health records in practice has also been associated with an
enhanced and holistic view of the complete patient health for improved diagnosis and
lifespan treatment.
Often it has been found that digital records increase the capability of sharing
information across a range of specialties, hospitals, disciplines, pharmacies, and emergency
response teams, in addition to improved and more opportune decision making, predominantly
in critical care situations (Jathanna, 2017). Another key outcome is that rapid access of
nursing professionals to accumulations of scientific information is significantly correlated to
the expansion of knowledge- and evidence-based practice. Additionally, appropriate access to
sufficient patient information brings about an increased participation by patients, together
with their family members (Ryu et al., 2017).
Considering the challenges encountered during transition to practice, recording and
documenting patient information through CPOE will help me to deliver enhanced patient care
with the help of clinical decision support systems. Additionally, my communication will
different departments like specialists, doctors, and laboratory assistants will also get
improved. Nurses and patients have lesser forms to fill out, thus increasing the time devoted
to care. Prescriptions and referrals can also be sent rapidly, thus decreasing waiting time for
patient appointments and admissions (Hribar et al., 2018). Not only does continuous
collection of patient data in a digital format facilitate personalisation of care, but also creates
the opportunity of addressing health problems in a precautionary manner.
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Strategies for practice
Taking into consideration the fact that as nursing professionals, we are expected to
accomplish myriad milestones, we need to adopt several strategies that will enable our
seamless transition to practice and also help us adopt digital health records. In relation to
information management, efforts need to be taken to have sufficient access to decision
support and information, at the time of providing care to patients. It is imperative to directly
contribute to the development of the terminologies and structure used in the digital patient
records, while structuring nursing documentation in an accurate manner (Kahn et al., 2016).
Employing standardised terms that represent the wider domain of nursing, in relation
to the care process will also help in easy transition. While learning the use of electronic
health records, it is essential to use effective verbal and written communication skills that will
prevent miscommunication and misinterpretation. Mentors have been found to play an
important role in the personal and professional lives of all individuals (Saunders &
Vehviläinen‐Julkunen, 2017). Thus, efforts will be taken to establish contact with mentors
such as, senior RNs who will offer guidance and support with the use of these records. Apart
from enrolling at workshops and certificate programs for use of e-health facilities, their
implementation will be successful on learning how to enhance organisational skills and time
management (Lee, Alkureishi, Wroblewski, Farnan & Arora, 2017). This can be
accomplished by avoiding multitasking, delegating duties, establishing deadline, and
rewarding oneself.
With the presence of digital health records, efforts will be taken to easily organise and
track care of patient across facilities and practices. Therefore, the records will help in delivery
of services required by patients in a complex health environment such as, testing, office
visits, hospital appointments, surgery, and follow-up visits, under one roof, such that the care
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services will remain synchronised and programmed over the duration of distinct visits, in
place of time-consuming numerous visits.
Conclusion
Thus, the reflection using Gibb’s cycle helped me to realise that it is no secret that we
feel fatigue and stress while caring for numerous patients under such stressful work
circumstances. Not only are we entitled with the responsibility of delivering care to patients,
but also have to manage the associations with families and providers, while leading
interprofessional team. Digital healthcare is an emerging phenomena and it has
overwhelming possibilities of transforming the delivery of healthcare services. To conclude,
the reflection helped me to review my nursing practice and knowledge, besides allowing me
to enhance my personal and professional skills and awareness.
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