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1975 when Colonel Muammar Gaddafi took office that the new Gharyan Hospital was
constructed (Figure 1 and Figure 2).
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).
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.
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)
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
10
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
11
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.
12
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
13
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
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,
14
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.
15
References
About EPIC - EPIC. (n.d.). Stanford Hospital & Clinics - Stanford Medicine.
Retrieved February 8, 2013, from http://stanfordhospital.org/epic/about_epic/
American Association of Colleges of Nursing (2006, September). The Essentials of Doctoral
Educatipon for Advanced Nursing Practice. Retrieved January 29, 2013, from
http://www.aacn.nche.edu
American Nurses Association. (2008). Nursing informatics: Scope and standards of practice.
Silver Spring, Md: American Nurses Association.
About Clinisys | Clinisys. (n.d.). Clinisys. Retrieved January 18, 2013, from
http://www.clinisys.ca/about
EHR Products Lack Usability Standards, Best Practices, Report Finds - iHealthBeat. (2010,
January 6). iHealthBeat Reporting Technologys Impact on Health Care.
Retrieved January 16, 2013, from http://www.ihealthbeat.org/articles/2010/6/1/ehrproducts-lack-usability-standards-best-practices-report-finds.aspx
Epic: Software. (n.d.). Epic. Retrieved February 8, 2013, from http://www.epic.com/softwareindex.php
Glasher, J. (2011). "What is health Informatics?" [Video File]. Retrieved
fromhttps://class.waldenu.edu/webapps/portal/frameset.jsp?
tab_tab_group_id=_2_1&url=%2Fwebapps%2Fblackboard%2Fexecute%2Flauncher
%3Ftype%3DCourse%26id%3D_1984843_1%26url%3D
16
Gruber, D., Cummings, G. G., LeBlanc, L., & Smith, D. L. (2009). Factors influencing outcomes
of clinical information systems implementation: A systematic review. CIN: Computers,
Informatics, Nursing, 27(3), 151163.
Hannah, K. J., & Ball, M. J. (2011). Nursing Informatics Where Technology and Caring Meet
(4th ed.). New York: Springer-Verlag London.
International Medical Informatics Association. (2011). The IMIA Code of Ethics for Health
Information Professionals.Retrieved from http://www.imiamedinfo.org/new2/pubdocs/Ethics_Eng.pdf< /span>
International Classification for Nursing Practice ( ICNP). (n.d.). ICN - International Council of
Nurses. Retrieved from http://www.icn.ch/pillarsprograms/international-classificationfor-nursing-practice-icnpr/
International Medical Informatics Association. (2011). The IMIA Code of Ethics for Health
Information Professionals.Retrieved from http://www.imiamedinfo.org/new2/pubdocs/Ethics_Eng.pdf< /span>
Lewis, D. (2007). Evolution of consumer health informatics [Editorial]. CIN: Computers,
Informatics, Nursing, 25(6), 316.
Nurses' Involvement With IT Systems Increasing - iHealthBeat. (2007, April 30). iHealthBeat
Reporting Technologys Impact on Health Care. Retrieved February 8, 2013, from
http://www.ihealthbeat.org/articles/2007/4/30/nurses-involvement-with-it-systemsincreasing.aspx
17
OHSU Launches $21M EHR System - iHealthBeat. (2005, November 1). iHealthBeat
Reporting Technologys Impact on Health Care. Retrieved February 8, 2013, from
http://www.ihealthbeat.org/Articles/2005/11/1/OHSU-Launches-21M-EHR-System.aspx
Philip, A., Afolabi, B., Adeniran, O., Oluwatolani, O., & Ishaya, G. (2010). Towards an efficient
information systems development process and management: A review of challenges and
proposed strategies. Journal of Software Engineering and Applications, 3(10), 983-989.
Promoting Health/Protecting Privacy: A Primer - CHCF.org. (n.d.). California HealthCare
Foundation -- Supporting Ideas and Innovations to Improve Health Care for All
Californians. Retrieved January 18, 2013, from
http://www.chcf.org/publications/1999/01/promoting-healthprotecting-privacy-a-primer
Retrieved January 28, 2013, from http://Enter www.merriam-webster.com/dictionary/technology
Saba, V. K., & McCormick, K. A. (2006). Essentials of Nursing informatics (4 th ed.).
Singapore:McGraw-Hill Education (Asia).
Schlotzer, A., & Madsen, M. (2010). Health information systems: Requirements and
characteristics. Studies in Health Technology and Informatics, 151, 156166.
Szydlowski, S., & Smith, C. (2009). Perspectives from nurse leaders and chief information
officers on health information technology implementation. Hospital Topics, 87(1), 3-9.
Withrow, S. C. (2010). How to avoid a HIPAA horror story. Healthcare Financial Management,
64(8), 82-88.
Zaccagnini, M. E. & White, K. W. (2011). The doctor of nursing practice essentials: A new
model for advanced practice nursing. Sudbury, MA: Jones & Bartlett Publishers.