Using your PICOT question as a guide and your starting point for this next project, you will conduct an efficient, thorough search for evidence to address the clinical question. The study types you seek will depend on the clinical question being asked. The best evidence to answer a question might be found in systematic reviews, randomized controlled trials, nonrandomized experimental studies, qualitative or descriptive studies, evidence-based practice guidelines, or expert opinion. Information should be searched for in all relevant sources, and the highest level of evidence should always be sought.

For this assignment, write an 8–10 page paper in which you describe search for evidence and evaluation using one of the rapid critical appraisal checklists in Appendix B of Evidence-Based Practice in Nursing and Health Care (keep this checklist in your portfolio for later use).

In this paper:

• Conduct a search for evidence that justifies the extent of the problem using:
  • Scientific literature and practice guidelines (if applicable).
  • Consensus documents (if applicable).
  • Quality improvement data (if available and applicable).
  • Expert opinion.
• List your search terms, databases used, and process by which you narrowed your search to find the best evidence.
• Use the rating of evidence to rank the strength of selected articles.
• Construct an evidence table summarizing at least five studies. Use the table in Appendix C of Evidence-Based Practice in Nursing and Health Care as a template.
• Synthesize the findings.
• Adhere to APA style and formatting throughout your paper and when citing your sources.

Write a 1,050- to 1,400-word paper that compares and contrasts a contemporary health care facility or physician’s office operation with a health care facility or physician’s office operation of 20 years ago.
Include an examination of information systems in your work place and an analysis of how data was used 20 years ago in comparison with how it is used today.
Identify at least two major events and technological advantages that influenced current HCIS practices.

Introduction

Healthcare facilities of today are both similar and different than what they were like two decades ago. Some of the similarities fall under organizational structure, who works in the offices, particular roles such as data record keeping, nurses, doctors, and assistants. Some of the differences include updated information systems, new laws which prohibit certain activities, more advanced degrees of the personnel, and the advancement in the medical equipment that is used in the facilities.

The similarities listed briefly above describe generalized static roles mainly which are common in any workplace. Generalized static roles are, of course, roles that do not change much throughout the years due to there being no need for change in those areas. Nurses will always be nurses, doctors will always be doctors, and these medical professionals will need other staff to run certain aspects of the healthcare facility. The organizational structure regarding these roles still has not changed much since 20 years ago in that it is still a top-down hierarchal structure where physicians tell nurses what to do and nurses direct assistants how to perform their daily or weekly duties.

The differences certainly outweigh the similarities in terms of how much has actually changed throughout the years. There are many legal issues that have been made public regarding healthcare practices which has spawned a large number of lawsuits that ultimately led to new laws in the healthcare industry. Another difference in healthcare facilities between today and twenty years ago is that the scholarly degrees of the personnel have changed from standardized licensures to a more advanced degree such as a four-year bachelors of Science in Nursing or to a specialty degree in medicine such as non-invasive thoracic surgery or pediatric psychology. Medical devices have also changed from twenty years ago and are now leaning toward a more comfort-based approach to the patient and to a more comprehensive approach to medical care.

The largest difference between healthcare facilities today and those twenty years ago, however, is that today facilities are much more dependent upon computer and information systems to run practically every aspect of the facility. Some of the important areas in healthcare facilities that use information systems are: billing, appointment scheduling, medicine dispenser units, hospital check-in and check-out, ultrasound machines in prenatal care, imaging (x-rays, upper GI’s, barium treatments, endoscopy, Electro Cardiograms, etc…), patient records, and record keeping just to name a few examples. The healthcare facilities of today would not be able to function without a comprehensive information system installed and constantly maintained. Twenty years ago much of the record keeping was done by hand. Even today there are many small facilities that still use only paper records. Currently, in the facility I work in, they are converting all paper records into digital copies and are storing all records in a large data warehouse (server) that can be accessed by authorized personnel only. Any healthcare facility that is still using older machines will ultimately have to adapt to the new information systems and to the new technology that is available in the healthcare industry, or patients will no longer continue to go to the outdated facilities for care. It is imperative that healthcare facilities keep up with technological trends for this very reason.

Information Systems in the Workplace

As previously mentioned, my workplace is converting to a new system which includes making digital copies (data entry) of all the old records into digital format (on a personal computer). This data is then stored into a data warehouse (server) where it can be mined by authorized personnel only, such as doctors or nurses for patient records or the billing department for financial records. The purpose of this transformation from the archaic pen and paper route as seen twenty years ago is to remove clutter in the facility but to also allow easier access to the facilities records / data. Twenty years ago nurses or office assistants would take a very long time just to pull a patient’s record from a large set of filing cabinet usually behind a main desk in a facility. Today with the use of information systems and personal computers (or workstations) it is much easier for a nurse to simply type in the last name of the patient and have all of their information readily accessible. With a simple click they can find the information needed in order to facilitate the process of getting the patient seen by the doctor and treated for their illness or situation as soon as possible.

Other than helping patients, nurses, and other facility staff with saving time and space, new information systems also help with the healthcare facility communication. For instance, when a doctor needs to know a question to an answer or needs information with a click of a mouse he or she can use office email programs which allow communication between employees in a secure manner. This information sharing prevents mistakes, loss of time, loss of money, and clears up a lot of confusion regarding what is going on in the facility at any given time. This type of email also allows managers (staff supervisors, HR managers, etc…) to easily contact all employees at the same time regarding news or updates for the healthcare facility or even the healthcare facility. Twenty years ago, much communication was left in the form of hand-written notes on patient files, via telephony, and by walking three floors up or down to directly communicate wasting much time in the process. The advances and progress in technology and information systems has certainly helped healthcare facilities within the last twenty years with many aspects of short as well as long term functions of the business.

Events and Technologies

In the last twenty years there have been major healthcare laws and policies which affect the overall practices in healthcare information systems. For instance, HIPAA (Health Insurance Portability and Accountability Act) was signed into effect on August 21, 1996 and this law directly deals with who is or is not allowed (authorized) to view a patient’s medical files. This law has such an influence on the practices in healthcare that even patients have a hard time getting their own medical records released directly to them. Other laws have been reforms to Medicare and Medicaid such as the age limits and income limits applied to families who receive the state benefits, but also to the income limits of the doctors who accept Medicare payments.

There have also been so many technologies that have advanced throughout the last twenty years which influence the healthcare information systems practices in facilities. The Internet is one major advancement in technology and due to the Internet facilities can hire easier, keep an eye on employees through social networking sites, contact employees 24/7 via email, face-chat with employees on off-time if needed through new iPhone and Android mobile apps, and doctors who were on-call twenty years ago had to sit by a phone or carry a beeper; today they can be anywhere within reason and still be able to come into work when expected. Some healthcare facilities are mobile in terms of home health care management facilities which technology has made it so much easier to communicate with nurses or other staff who are in the field, working.

———–à Please double-check and change to your liking. I did not include a conclusion to this paper and if you need references, you will need to add them from your reading because I did not have that available to me. If you ever need anything else, just ask for me: Tutor_23 J Thanks!