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HEALTH INFORMATION TECHNOLOGY PROJECT

Health Information Technology Project


Anthony Failano Gomez, PT, RN, BSN, MSN, LEU, LSS, DNPs, CPHQc
Walden University
Transforming Nursing and Healthcare Through Technology
February 10, 2013

HEALTH INFORMATION TECHNOLOGY PROJECT

Health Information Technology Project


Technology over the years has evolved from simply coding numbers and letters for processing
to applications reaching the medical and healthcare fields. Merriam-Webster (2013) defined
technology as the practical application of knowledge especially in a particular area.
Informatics as defined by Saba & McCormick (2006) is a science that combines a domain
science, computer science, information science, and cognitive science. (p.266). The use of these
applications in the healthcare industry was termed as Health Informatics which according to Dr.
John Glaser refers to the use of information technology to improve peoples health, but also the
ability of physicians and nurses and others to take care of someone.
In the Nursing profession, the practice of such technology is termed as Nursing Informatics
(NI). The American Nurses Association (2008) clearly defines NI as a specialty that integrates
nursing science, computer science, and information science to manage and communicate data,
information, knowledge, and wisdom in nursing practice (p.1) with a goal of improving the
health of populations, communities, families, and individuals by optimizing information
management and communication (p.1). Utilization of such technology revolutionized the
Nursing profession, transforming it to meet the ever-changing demands of healthcare.
Zaccagnini & White (2011) indicated that the target date for national implementation of
competence in computer literacy, information technology (IT), and healthcare informatics is
2014 (p.139). Consequently, the International Council of Nurses (2013) emphasized the
importance of healthcare informatics by incorporating eHealth Programmes such as ICNP
(International Classification for Nursing Practice), ICN Telenursing Network, and Connecting
Nurses as part of their significant projects that aims to advance nurses' knowledge of and

HEALTH INFORMATION TECHNOLOGY PROJECT

involvement in eHealth worldwide. Whether locally, regionally, or internationally, the effect of


technology in the nursing profession is inevitable.
As DNP prepared nurses that maximize the advantage of technology, Health Informatics could
be used as a major tool to transform the current healthcare industry for the benefit of the
humanity. This is evident in the Essentials of Doctoral Education for Advanced Nursing Practice
by the American Association of Colleges of Nursing (2006), particularly Essential IV Information Systems/Technology and Patient Care Technology for the Improvement and
Transformation of Health Care. AACN (2006) stated DNP graduates are distinguished by their
abilities to use information systems/technology to support and improve patient care and
healthcare systems, and provide leadership within healthcare systems and/or academic settings
(p. 12).
This project will validate the use of Health Information Technology in a healthcare setting and
eventually demonstrates its utilization not only by medical professionals but also by the whole
organization. This paper will present the organization information, information system
application design and development, and innovative aspects of the system.
Organization Information
Gharyan University Teaching Hospital, formerly known as Gharyan Hospital is the only
medical hospital in the city of Gharyan. Gharyan is a village located in the Nafousa Mountains in
the Northwest part of Libya with a population of 85,219. One of the defining characteristics of
the hospital is that, it has been considered as the training institution for medical, nursing, and
paramedical students of Al Jabal Al Gharbi University. Mr. Abdulla Mohammed, the Director for
Foreign Staff, mentioned that the original building of the hospital was built in 1970 and it was in

HEALTH INFORMATION TECHNOLOGY PROJECT

1975 when Colonel Muammar Gaddafi took office that the new Gharyan Hospital was
constructed (Figure 1 and Figure 2).

Figure 1. Front gate of Gharyan University Teaching Hospital, Libya

Figure 2. Main Building of Gharyan University Teaching Hospital, Libya


Gharyan Hospital was established when the city of Gharyan needed a facility to deal with the
health care needs of the community. The hospital has a 300-bed capacity, capable of admitting
and managing medical, surgical, gynecologic, pediatric, critical care, communicable/infectious,
and trauma cases. This institution is entirely government owned and all of the services provided
including medications and treatments are free for the citizens of Gharyan.
It was in 2009, when the hospital planned to adapt a system for clinical use. In order to
address this challenge the administration opened the Technology and Communications
Department, which is under the office of Administrative and Medical Services. It was Mr. Ali
Abdullah Abubakar who first chaired the department and was eventually replaced by Engr. Ali

HEALTH INFORMATION TECHNOLOGY PROJECT

Mohamed Diab. Engr. Diab was a graduate of Electronics and Communications Engineer of Al
Jabal Al Gharbi University and was part of the hospitals administration since 2006 (Figure 3).

Figure 3. Engr. Ali Mohamed Diab


Manager - Technology and Communications Department
According to Engr. Diab, the decision was made to adapt a system for the hospital after a
foreign company demonstrated a clinical program. There was neither further assessment done
nor any research or feasibility studies conducted prior to the adaptation of the system. Engr. Diab
added that since telecommunication companies started to establish business in Libya, it was the
perfect timing for the hospital to use one.
Finally in 2010, the hospital acquired a health system program called CliniSys. According to
their official website CliniSys (2013), CliniSys is a dedicated team of professionals from
various disciplines including healthcare, IT, and business united with one goal to develop a
secure, scalable and user-friendly EMR solution for healthcare practitioners. CliniSys caters to
the healthcare sector including single or multi-physician clinics, specialization clinics, health
clinics, nursing homes and government health setups. CliniSys can be implemented in a variety
of environments that caters to patients and provides features such as patient management,
practice management, schedule management, billing, and patient relationship management. In

HEALTH INFORMATION TECHNOLOGY PROJECT

terms of its interoperability, the program meets the HL7 healthcare standards and therefore
capable of interfacing with other medical devices.
Although this HIT system is well designed and has promising benefits to the organization,
adaptability is the issue. CliniSys was designed for an English-user environment, which makes
use of international and standard terminologies. The main language in my organization is Arabic
and 90% of its employees does not even understand or speak the English language. Engr. Diab
also pointed that only 15% of the hospitals employees have the knowledge of using a computer.
Szydlowski and Smith (2008) stated that as the health industry becomes more competitive, and
the need for operational efficiency is critical for success in times of continued reimbursement
cuts and costs increases, hospital executives are assessing and using HIT as an instrument to
achieve these goals. The successful implementation of HIT systems is complex (p.5). The
authors added that hospitals often invest in HIT but have not appropriately assessed the basic
computer and software skill set necessary for nurses and HIT users (p.8).
Information System Application Design and Development
New information system development typically starts with a temporary organizational
structure called project team. Typically, a project team consists of a project manager, system
analyst, programmers, etc. A project manager, usually a senior system analyst in the organization
has the responsibility of the entire project. The project members must intensively interact with
users (Philip, Afolabi, Adeniran, Oluwatolani, and Ishaya, 2010).
CliniSys was chosen because of its user-friendly interface and easy navigation. CliniSys
interface was in the English language, although some of the basic terms/words in the program
was translated in Arabic, still the whole program was in English. The program lasted for only 3
months. There were a lot of problems and challenges brought about by the use of this program.

HEALTH INFORMATION TECHNOLOGY PROJECT

The main flaw was not on the program itself but on the planning and implementation of the
project. Although some of the foreign staff has the ability to use the program, the local nurses,
doctors, and paramedical staff who have no computer skills cannot utilize the program. It was a
huge disappointment and a waste of viable resources. (Figure 4 and Figure 5)

Figure 4. Hardware used for the program

Figure 5. Unused hardware resources in the ICU Department


Nursing participation in any design and implementation of a clinical information system is
crucial. Being the most number of medical professionals in an institution or organization, the role
of a nurse in the planning stage, implementation, utilization, and maintenance of CIS is

HEALTH INFORMATION TECHNOLOGY PROJECT

unparalleled (Saba and McCormick, 2006). However, Schlotzer & Madsen (2010) emphasized,
Health Information Systems (HIS) have some unique requirements and problematic
implementation issues. The implementation and adoption of electronic health records is both a
unique requirement and a problem area (p.156).
Usability as defined by Hannah & Ball (2011) is the extent to which a product can be used
by specific users in a specific context to achieve specific goals with effectiveness, efficiency, and
satisfaction (p.222). The usability of any HIT is achieved when the system had served its
purpose and that is to improve the efficiency and effectiveness of healthcare services (Gruber,
Cummings, Leblanc, & Smith, 2009). In order to attain this, any HIT should be adjusted to meet
health care-specific needs (IHB, 2010).
The identified challenge was due to a flaw in the design. A clinical application design should
have interdisciplinary collaboration (Hannah & Ball, 2011), gain end-user acceptance and
anticipated benefits realized (Saba & McCormick, 2006). The only strategy to prevent or even
overcome the challenges is proper planning. As Saba & McCormick stated Planning phase of
the project begins once an organization has determined that an existing need or problem may be
filled or solved by the development or implementation of a CIS or application (p.293). The
same authors also added that building or formulating a committee framework to research and
produce recommendations for the project is the first crucial step.
As a Health Informatics Professional, one is expected to ensure records are stored, accessed,
used, manipulated or communicated only for legitimate proposes (IMIA, 2011, p.7) and ensure
that appropriate measures are in place that may reasonably be expected to safeguard the security,
integrity, material quality, usability, and accessibility of electronic records (IMIA, 2011, p.7). In
the case of Gharyan Hospital, there were no policies and protocols on how to address if breach in

HEALTH INFORMATION TECHNOLOGY PROJECT

the security of the program occurs.


Engr. Diab directly stated that there was no prior bidding for the project and there was only
one company who submitted the proposal. Since the administration wanted to apply the system,
it was implemented immediately without consultation and knowledge of the hospital staff. All
the funds came from the government of Libya and Engr. Diab indicated that the allotted budget
for the program was close to one million Libyan Dinars. The budget was used to purchase the
program, acquisition of the hardware resources, and installation of the system.
The manager of the Technology and Communications Department admitted that the whole
project failed. They were in a very critical situation and the same time the Libyan revolution
started which makes everything worst. When the revolution happened most of the hardware
resources were gone because Gharyan Hospital was looted since no security was available in the
hospital premises. Currently, everything is in chaos, form the administration down to the
personnel. Every month the medical director changes due to charges of corruption and misuse of
funds. Still no government is formed, no constitution in act, no laws to follow, and no court to
rule. Engr. Ali Mohamed Diab concluded with the words Insha Allah which means God
willing.
Health information technology application changed dramatically in the advent of legislation
supporting and regulating it. Ethical use and safeguarding the system became one of the pivotal
points in its design. With the advent of these applications, California Healthcare Foundation and
Consumer Union (1999) observed the dramatic increase of healthcare organizations utilizing
patient data, which eventually sparked the expansion of, numerous, integrated databases of
personal health information. This situation places both parties legally, ethically, and financially at
risk.

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The International Medical Informatics Association stated, A Code of Ethics for Health
Informatics Professionals (HIPs) should be clear, unambiguous, and easily applied in practice.
Moreover, since the field of informatics is in a state of constant flux, it should be flexible so as to
accommodate ongoing changes without sacrificing the applicability of its basic principles. It is
therefore inappropriate for a Coed of Ethics for HIPs to deal with the specifics of every possible
situation that might arise (p.1).
The major ethical issue concerning the use of informatics in the healthcare industry is privacy
and security of personal health information. According to Withrow (2010), privacy refers to
obligations of authorized persons using personal health information to keep such information
secret (p.83) and security refers to procedures designed to prevent unauthorized persons
accessing personal health information (p.83). The California Healthcare Foundation and
Consumer Union (1999) were clear on stating the benefits of technology but cautioned on the
privacy risks as well. The foundation recognized the people vulnerable to Breaches of Privacy,
which includes the adolescents, immigrants, mental health patients, and people who have
HIV/AIDS.
Although health privacy is not yet the primary focus of health reform agenda, legislation to
address the concern is emerging. The California Healthcare Foundation and Consumer Union
(1999) identified HIPAA (Health Insurance Portability and Accountability Act) and Managed
Care Reform as initiatives. The foundation also included NCQA (National Committee for
Quality Assurance) and KCAHO (Joint Commission on Accreditation of Healthcare
Organizations) as the two major accreditation organizations to address the increasing demands
for health information (p.21). Federal proposals for privacy bills were also introduced like H.R.
1815, H.R. 3900, and S. 1921, which serves to uphold privacy and security personal health

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information.
One important strategy to safeguard privacy and security of information is a strict provision
of the law. A perfect example is the HIPAA security provisions on information access
management and access control. Another is the Health Information Technology for Economic
and Clinical Health Act of 2009 (HITECH). These laws safeguards the flow and sharing of
information in a technologically advanced healthcare system. Violations of such provisions
would lead to potential civil and monetary penalties. This strategy guarantees that everyones
rights are respected appropriately.
Innovative Aspects of the System
Technology will continue to transform the healthcare delivery and industry. The
transformation includes the use of innovative informatics tools such as Telehealth, Genomics,
and Robotics that directly affects the delivery of care. As the American Nurses Association
(2008) stated Care is no longer limited to traditional healthcare settings, even when it is
delivered locally. Clinicians are now available in retail stores, work settings, and other nontraditional places. These new settings will require new design, deployment, and support models
that will challenge the NI specialist(p.60).
With the mentioned failure of the project in Gharyan University Teaching Hospital and the
challenges realized during the whole process of planning through implementation, a new,
innovative, and applicable technology should be introduced. The involvement of the healthcare
provider as end users and patients as consumers should be emphasized. As Lewis (2007) stated
As healthcare providers, we need to continually evaluate our role in the new delivery system
and utilize interventions to improve the provider-patient interaction and facilitate access to
resources that will support patient decision making.

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The use of the technology does not only changes the healthcare delivery system but also the
recipients of care. Individuals, families, communities and societies become more involved in
their health, searching for information that will assist or challenge clinicians. As Saba &
McCormick (2006) stated Today, patients and families expect to be partners in care, evaluating
with their caregivers the implications of diagnostic tests and ramifications of treatment
modalities, including cost and effectiveness (p.481).
The EpiCenter of Stanford Hospitals and Clinic (2013) defines EPIC as a state-of-the-art
clinical information system. Built on the widely-used Epic software application, the system
encompasses all aspects of a patients care - clinical and business-related and connects those
involved in the patients care with a click of a computer mouse. The Epic Systems Corporation
(2013) added that the system is Known for being fast and physician-friendly. Integrated access
and revenue systems simplify administration. The "one patient, one record" approach improves
care in the physician group, hospital, and both.
The Epic system provides patients access to their records using MyChart that is also being
used by their healthcare providers. Patients can plan their healthcare agendas including their own
use of personal health record with an interoperable health diary (Epic Systems Corporation,
2013). Stanford Hospital and Clinics (2013) adopted the Epic system, which includes the
following:

A computerized physician order entry (CPOE) system allowing providers to manage and
communicate orders and results

A clinical documentation tool that enhances workflow for all caregivers and makes
information accessible to those who need it

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An electronic medication administration record (eMAR) and closed-loop medication


administration system that ensures patient safety and reduces errors

An integrated set of tools that allows data to move with patients across all areas such as
clinics, the emergency department, and inpatient units

An electronic system for patient registration, appointment scheduling, billing and other
business related functions

An online communication tool which connects our referring providers with us

A patient portal which empowers our patients to become directly involved in the
management of their own health information and the services they receive from us.

In terms of its meaningful use, Epic can greatly assist HITECH portion of the ARRA

stimulus package allocates funding for per-hospital and per-physician incentives for those
who demonstrate "Meaningful Use" of EHRs and the system installs quickly, letting
patients do more, and help the organization be more profitable. (ESC, 2013). In 2005,
Oregon Health & Science University approved the implementation of Epic electronic
health record system that is expected to To improve quickly patient safety, quality and
outcomes, but financial returns are expected to take longer. (iHealthBeat, 2005).
The mentioned characteristics of the Epic system make it suitable for an organization such as
Gharyan University Teaching Hospital. The interoperability, usability, and applicability of this
application may meet the challenges and issues of the institution. However, the involvement of
professional nurses in the planning and implementation stages of the project is crucial. Since
there is no available qualified healthcare professional in the organization to assist in the creation
of the project, a nurse with an informatics background will be critical. iHealthBeat (2007) stated,

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At least 75% of nurse informaticists are developing or helping their health care facilities adopt
clinical information or documentation systems, according to an industry survey.
Conclusion
Health information technology will continuously evolve and together with this phenomenon is
the ever-changing healthcare industry. HITs adaptability will be constantly challenge depending
on the healthcare needs and demands of our patients. With these transformations, the Nursing
profession should always be prepared to meet its expectations. Thus, the Tiger Informatics
Guiding Education Reform (TIGER) Initiative started with the mission To bring together
leaders from various nursing specialty organizations to coalesce and create a vision plus an
informatics agenda for the next 3 years and 10 years. This mission involved bringing together the
intellectual and social capital of these specialty organizations with the informatics community to
create an informatics agenda (Hannah & Ball, 2011, p. 35).
Gharyan University Teaching Hospital did failed in implementing its HIT project. However,
the administration is very much aware of what happened and was able to identify the challenges
and issues encountered during the application of the first system. This experience will eventually
assist them in planning for a new project, which will take a tremendous amount of time, will
power, and determination. Libya is in a transition that has no definite end and this great transition
requires time.

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