Policy Effect Reflection and Case Analysis

Badaki Peter Ilesanmi

Walden University

IF005: Policy-Driven Nursing Informatics

Dr. Vannesia Morgan-Smith

June 12th, 2022

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Policies to Effect Meaningful Use: Current Policy Implications on Nurse Informatics

Practices

The Health Information Technology for Economic and Clinical Health (HITECH) Act

is a policy mandate established to promote the adoption of health information technology,

such as electronic health records (EHRs) by healthcare providers, enhancing their respective

healthcare providers. The Act contains two sets of standards established as regulatory

requirements to help providers meet the meaningful use (MU) of electronic health records

(EHRs). (McBride & Tietze, 2019). This involves optimizing information and technology to

integrate the best current evidence with clinical expertise and what patients prefer to support

decision making, manage knowledge, mitigate error, and communicate outcomes for delivery

of optimal health care. (AACNEC, 2012, P.5). The prepared nurse informatics utilizes

clinical decision support systems such as EHRs to gather and integrate the best current

solutions to facilitate healthcare outcomes.

The Cure Act is another policy mandate that integrates electronic health records

(EHRs) and electronic health data across the continuum of care, with health information

technology (health IT) provisions focusing on data availability, usability, and patient access.

However, the Act aimed to promote interoperability by prohibiting and penalizing developers

and healthcare providers who engage in information blocking. (HITECH Act, 2009; Lye,

Forman, Daniel, & Krumholz, 2018). First, the HITECH Act enhances the capability of nurse

informatics in the development, implementation, optimization, and sustainability of new

systems. For example, the clinical nurse informatics specialist would require more funding to

utilize appropriate resources to build and implement new integrated and standardized systems

to reduce medical errors and costs and increase patient care or satisfaction. Furthermore,

nurse informatics would need to acquire more training/skills necessary for adapting to the

new systems. Also, the Cure Act makes data sharing during nursing electronic clinical
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documentation and point-of-care clinical decision support less stressful. For instance, nurse

informatics could create electronic charting to allow nurses to carry out early and qualitative

charting at the bedside. Thus, enhancing care delivery.

Effect of Evolving Policies on Future Nurse Informatics Practices

First, the final rule of the 21st Century Cures Act, as an evolving policy, contains

information that would advance interoperability and support the access, exchange, and use of

electronic health information without contributing to information blocking when

implemented. (Federal Register: The Daily Journal of the United States Government, 2020).

Therefore, to maximize the full benefits of this policy, future nurse informatics might

consider developing, implementing, and optimizing cloud-oriented EHR systems or

applications. This will enable the seamless exchange of secure information in a coordinated

way to enhance patient care, including time spent with patients, safety, usability, and security

and at a minimal cost. The Medicare Access and CHIP Reauthorization Act of 2015

(MACRA) is another evolving policy that established the Quality Payment Program to

reward eligible clinicians who provide higher-value care in the Merit-based Incentive

Payment System (MIPS). The future nurse informatics would be committed to advancing

value-centered care or care information instead of Meaningful Use to promote

interoperability, information exchange, patient safety and security.

Policy and Ethics: Ethical Decision Making and Policies for Nursing Practice

Fowler & American Nurses Association (2015) recommend using the nursing process

to accommodate a preferred ethical theory to guide data collection and ethical analysis in

ethical-clinical situations.

Assessment/ Data collection: A cardiac patient missed his/her appointment wait time while

the manager asked the nurse informatics in the ER department how to adjust/falsify the report
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to make the time look better before the following review. In this scenario, ethical, moral,

clinical, and professional issues relating to caring, and integrity are raised.

Assessment/Analysis: The Ethical Principles decision-making approach, which emphasizes

respect for autonomy, beneficence, non-maleficence, justice, fidelity, and integrity, would be

integrated and adopted to analyze the data. (Corey, G., Corey, M.S., & Callahan, 2011 &

Beauchamp & Childress, 2013; Fowler, M. D. M., & ANA, 2015). First, the healthcare team

must inform and provide the patient with detailed and truthful information about the situation

and ensure genuine and honest interactions with the patient. The healthcare team must allow

a fair and impartial decision to resolve possible conflicts of interest and reduce risks for the

patient, healthcare team, and organization. Third, the manager and the nurse informatics in

the ER department would be accountable for their actions if they both agreed to adjust the

report.

Diagnosis: The following ethical codes are a violation. One, failure to participate in

Promoting a Culture of Safety is a violation of ANA Code of Ethics Provision 3.4. For

instance, nurses are to promote a culture of safety by reporting errors or near misses in

clinical practice per the chain of authority within the institution. (Fowler, M. D. M., & ANA,

2015, p.50). Two, avoiding Action against Questionable Practices violates ANA Code of

Ethics Provision 3.5. Nurses are to uncover questionable practices to promote patient safety,

the integrity of the nursing profession, and the social institution of health care. (Fowler, M. D.

M., & ANA, 2015, p.51-52). Three, failure to preserve integrity violates ANA Code of Ethics

Provision 5.4. Nurses are to maintain their integrity in the face of a clinical activity or

situation in which they have moral objections to participation. (Fowler, M. D. M., & ANA,

2015, p.84-88). Lastly, failure to promote a Safe Healthcare Environment violates the ANA

Code of Ethics Provision 6.3. Nurses are to protect the dignity and autonomy of nurses in the
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workplace and have the right to query or dissociate themselves from unethical practices that

threaten patient or nursing safety. (Fowler, M. D. M., & ANA, 2015, p.104-108). 

Outcomes/Planning: First, adjusting the report suggests an unethical practice and a violation

of 'integrity' as specified in the Nursing Code of Ethics (Fowler, M. D. M., & ANA, 2015,

p.84-88). 24). Lastly, reflecting on an alternative action such as identifying possible Cath Lab

mistakes related to the facility (Jensen Kurt, 2020).

Implementation: Dissociating from such practice and insisting on adhering to established

policies and professional standards (American Nurses Association, 2021). Lastly,

recommending an alternative decision or solution reflecting the Cath Lab mistakes identified.

Recommended Solutions Related to Ethical Decision Making for Nurse Informatics

The recommended solution includes the creation of a Quality Management Team

in the Cath Lab. (Henien, Aronow, & Abbott, 2020) or the adoption of a collaborative

interdisciplinary and patient-centered approach involving the informatics nurse, manager,

other clinicians, the patient, and a Consensus decision making process to define and solve the

issue. (An interdisciplinary Approach to Caring, 2021& Path to Performance, 2022). This

would enable the Cath team to identify potential medical errors and operate efficiently.

However, the report that the duration from when a patient arrives in the ER reporting cardiac-

related symptoms to being seen in the cardiac catheterization lab is above the national time

implies that the trackable quality indicator in the cardiac Cath lab shows Missed door-to-

balloon time. (Henien, et al., 2020). Therefore, as a frontline nurse informaticist responsible

for processing and retrieving data for optimizing healthcare delivery and improving patient

outcomes in the facility, I would validate that the data is clean and accurate. Then, in bridging

the gap between data, technological processes and nursing practice I would recommend

among others, comprehensive documentation for quality improvement; having a written

protocol or standardized order set for patient undergoing cardiac catheterization procedure to
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prevent errors in high pressure situation that could lead to adverse effect on complication;

consistently adopting appropriate use criteria to enhance quality and effective care; and

including comprehensive indicators and assessments in the facility quality assurance protocol

to promote assurance and quality care. (Jensen Kurt, 2020).

For a patient who is directly visiting the Emergency Room, (ER) as in the

scenario, Dhungel, et al., (2018) argue that the delay experienced by the patient represent the

extra time spent for carrying out investigations, giving out consent and clearing financial bills

for interventions and this could assist the Cath Lab team determine among others the time to

electrocardiogram, (ECG), catheterization lab team activation and procedural time.

Furthermore, to cushion the attendant complications and morbidity associated with

the missed door -to- balloon time of 90 minutes or less target recommended for primary

percutaneous coronary intervention (PCI) in patients with ST elevation myocardial infarction

(STEMI), (Keeley, Boura & Grines, 2003 & O’ Gara, et al. & Steg, et al; Dhungel, et al.,

2018), I would recommend strategies enumerated by Bradly et al., (2006) which include

having the emergency department (ED) activate the Cath Lab, expecting Cath Lab staff to

arrive within 20 min of being paged, always having an attending cardiologist on site, and

having staff in the ED and Cath Lab use real-time feedback (Bradly et al., 2006; Lee et al.,

2019), to reduce the door-to-balloon time and patient morbidity.

In addition, the following reports recommended by could be developed to assist

the Cath Lab team in assessing the issue whenever the Cath Lab is used. First, Cardiac

Catheterization Report Root provides the overall clinical results of catheterization procedure

and interventions. Second, Cardiovascular Patient History, which contains information about

a cardiovascular patient's past medical history and relevant for the interpretation of the
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Structured Reports document. Lastly, Patient Presentation, Cath describes the patient-specific

aspects of this clinical presentation. (Cath Lab Clinical Report Templates, 2013).

Finally, I would emphasize the use of vetted standard vocabulary as defined in the

National Cardiovascular Data Registry, (NCDR) instead of free text to reduce errors and

achieve interoperability, reporting and reimbursement. (Henien, et al., 2020).

Justification of solutions Related to Ethical Decision Making for Nurse Informatics

First, the solution would enhance person-centered solution or practice (An

interdisciplinary Approach to Caring, 2021). The Cath lab team collaborative approach

would enable the patient to receive early or timely efficient therapy or intervention.

Second, mitigate patient induced decision delays associated with door-to-balloon

time. (Dhungel, et al., 2018). This implies that there would be a reduction in door-to-balloon

time for the patient less than the national recommended duration, eliminate potential

complications and patient mortality.

Lastly, it would facilitate quality improvement and patient safety. (Landman et al.,

2013). This shows that the collaborative effort of the interdisciplinary team could promote

system changes.
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