Assignment: Literature Review: The Use of Clinical Systems to Improve Outcomes and Efficiencies

New technology—and the application of existing technology—only appears in healthcare settings after careful and significant research. The stakes are high, and new clinical systems need to offer evidence of positive impact on outcomes or efficiencies.
Nurse informaticists and healthcare leaders formulate clinical system strategies. As these strategies are often based on technology trends, informaticists and others have then benefited from consulting existing research to inform their thinking.
In this Assignment, you will review existing research focused on the application of clinical systems. After reviewing, you will summarize your findings.  Transforming Nursing and Healthcare Through Technology Essay Paper

To Prepare:
• Review the Resources and reflect on the impact of clinical systems on outcomes and efficiencies within the context of nursing practice and healthcare delivery.
• Conduct a search for recent (within the last 5 years) research focused on the application of clinical systems. The research should provide evidence to support the use of one type of clinical system to improve outcomes and/or efficiencies, such as “the use of personal health records or portals to support patients newly diagnosed with diabetes.”
• Identify and select 4 peer-reviewed research articles from your research.
• For information about annotated bibliographies, visit https://academicguides.waldenu.edu/writingcenter/assignments/annotatedbibliographies

The Assignment: (4-5 pages not including the title and reference page)
In a 4- to 5-page paper, synthesize the peer-reviewed research you reviewed. Format your Assignment as an Annotated Bibliography. Be sure to address the following:
• Identify the 4 peer-reviewed research articles you reviewed, citing each in APA format.
• Include an introduction explaining the purpose of the paper.
• Summarize each study, explaining the improvement to outcomes, efficiencies, and lessons learned from the application of the clinical system each peer-reviewed article described. Be specific and provide examples.
• In your conclusion, synthesize the findings from the 4 peer-reviewed research articles.
• Use APA format and include a title page.

The Use of Clinical Systems to Better Outcomes and Efficiencies: An Annotated Bibliography
The adoption of technology in healthcare was delayed compared to other sectors or industries that made the adoption earlier. It was however just a matter of time before the healthcare sector left its long-held traditions of doing things its own way and thinking that technology would adulterate the practice of medicine and nursing. One of the things that made the adoption of technology in healthcare desirable was the fact that there had been reports from studies of the effect of human error on patient outcomes. One of these reports and arguably the most influential was the 1999 Institute of Medicine (IOM) report with the apt title To Err Is Human. The IOM report for the first time acknowledged that healthcare personnel were actually responsible for the preventable deaths of thousands of patients every year by their omissions and commissions. To be specific, it stated that the medical and nursing errors by healthcare staff resulted in the deaths of 98,000 patients annually in the United States at that time. For this reason, the report proposed that technology would be one of the tools that would help solve this problem (Palatnik, 2016). Several years later, the federal government would move swiftly with legislative policy to make it mandatory for all healthcare settings to have electronic systems that ease work and improve human efficiency. These laws spelt how healthcare organizations were to go about the matter of health information management (HIM). It would be mandatory going forward to have electronic health record (EHR) systems with components that facilitated the work of nurses (such as the patient data management system or PDMS) and clinicians (such as the computerized provider order entry or CPOE) (Alotaibi & Federico, 2017). Notable legislation in this respect includes the American Recovery and Reinvestment Act (ARRA) and the Health Information and Technology for Economic Clinical Health Act (HITECH) (Sweeney, 2017). This paper presents an annotated bibliography that reviews and discusses four peer-reviewed articles related to technological clinical systems. The review states the improvement to outcomes, efficiencies, and some of the lessons learnt from the standpoint of the studies.
Annotated Bibliography
The search for these four peer-reviewed studies was conducted in four reputable research databases namely CINAHL, Embase, PubMed, and ProQuest. All the studies were published within the last five years and report how clinical systems have improved efficiencies and reduced errors, thereby resulting in better patient outcomes. The studies are:
1. Alotaibi and Federico (2017)
2. El-Sawy et al. (2018)
3. Fedele et al. (2017), and
4. Islam et al. (2017)

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Alotaibi, Y., & Federico, F. (2017). The impact of health information technology on patient safety. Saudi Medical Journal, 38(12), 1173–1180. https://doi.org/10.15537/smj.2017.12.20631
This study by Alotaibi and Federico (2017) is a classical example of a scholarly endeavor to determine the role of technology and clinical systems in particular in improving efficacy and facilitating better patient outcomes. To begin with, what they found out is that there are disparate clinical systems out there by many different vendors. They all serve the same purpose, but unfortunately not all of them are interoperable. This means that they cannot interface with other systems from a different vendor. This lack of interoperability is deliberate and is what the law is attempting to legislate against to prevent care fragmentation. For this reason, the researchers advice that each healthcare organization must choose very carefully the system that they settle for. As they do this, they must make sure that they have the question of interoperability at the back of their minds. Another finding that these researchers made was that not every clinical system sold by the vendors is effective and efficient. Some of them were found to have design and functionality problems that would transfer to the organization complicating its utility. Out of all the clinical systems studied, fourteen came out as the best with the best evidence supporting their efficacy in improving efficiency, performance, and patient outcomes. The specific clinical systems demonstrated by the study to be capable of improving patient outcomes and increasing human efficiency include computerized provider order entry systems (CPOE), patient data management systems (PDMS), electronic medical record (EMR), electronic medication administration record (eMAR), clinical decision support (CDS) systems, and bar code medication administration (BCMA) amongst others. The proper health information management (HIM), prevention of medication errors (by CPOE and BCMA) are examples of how these clinical systems are improving outcomes and promoting efficiency. The lesson learnt is that as much as technology is an enabler and facilitator, not all technological solutions sold by vendors are suitable. Care should therefore be taken when choosing a clinical system for the organization.
El-Sawy, H.S., Al-Abd, A., Ahmed, T., El-Say, K.M., & Torchilin, V.P. (2018). Stimuli-responsive nano-architectures drug delivery systems to solid tumor micromilieu: Past, present and future perspectives. ACS Nano, 12(11), 10636–10664. https://doi.org/10.1021/acsnano.8b06104  Transforming Nursing and Healthcare Through Technology Essay Paper

The study by El-Sawy et al. (2018) was groundbreaking research on the use of technological clinical systems in the delivery of pharmacotherapeutic interventions to cancer patients. They studied systems that would increase efficiency of drug bioavailability to specific cancer cells, thereby improving therapeutic outcomes tremendously. The systems enable the medications to be delivered through nanotechnology at the molecular level with hitherto unseen specificity to cancerous tissues. Through nanoparticles, the particular medication is sent with precision to only target cancer cells. This spares the unaffected tissues in a way that traditional pharmacotherapeutic methods have not managed so far. Indiscriminate chemotherapy is known to affect even those cells that are not affected by cancer, causing a lot of suffering to cancer patients through side-effects. This study proves that indeed there are clinical systems buoyed by technology that can improve the efficacy and efficiency of the medications used to treat cancer. Improved quality of life and better survival rates for cancer patients are some of the indicators of improved patient outcomes and efficiency by the clinical systems in thus study. The lesson learnt with this study is that medical therapeutics can be improved by harnessing innovative technologies through novel clinical systems.
Fedele, D.A., Cushing, C.C., Fritz, A., Amaro, C.M., & Ortega, A. (2017). Mobile health interventions for improving health outcomes in youth. JAMA Pediatrics, 171(5), 461. https://doi.org/10.1001/jamapediatrics.2017.0042
As for Fedele et al. (2017), they concentrated on the clinical systems that employ mobile telephony to deliver clinical solutions to patients. The aim of their study was to find out if clinical systems that are based on the concept of the mobile smartphone can be efficacious in delivering health promotion and health education. In other words, they set out to assess the efficacy of these systems in disease prevention and improvement of outcomes. The meta-analysis provided the highest level of evidence on the pyramid of evidence for the effectiveness and efficiency of mobile phone-based clinical systems. The researchers found that clinical systems that use mobile phone technology to reach large masses through text messaging are fast, efficient, effective, timely, and appropriate for delivering disease prevention information to many. The systems demonstrated improved outcomes and efficiency through the effective behavioral changes observed in the target populations. The lesson learnt here is that the mobile phone is a gadget that can find a place in healthcare to facilitate the delivery of quality care.
Islam, M.M., Poly, T.N., & Li, Y.-C. (2018). Recent advancement of clinical information systems: Opportunities and challenges. Yearbook of Medical Informatics, 27(01), 083–090. https://doi.org/10.1055/s-0038-1667075
Lastly but not least, Islam et al. (2018) studied the efficiency and efficacy of clinical information systems in preventing medical errors committed by healthcare staff. They found that these systems indeed played a big role in preventing adverse patient outcomes as a result of mistakes made by healthcare personnel. The improvement in patient outcomes and facilitation of efficiency is therefore by way of prevention of errors that place patient safety at risk. The lesson learnt is that the IOM report of 1999 was revolutionary with the report correctly predicting the important role of technology in preventing unnecessary deaths from human mistakes.

Conclusion
These four studies show that technological clinical systems that make use of novel innovative ideas have a great future in quality improvement in healthcare. From systems that support clinical decisions such as CPOE and PDMS, to nanotechnology and mobile telephony; these innovative clinical systems are invaluable in improving patient outcomes and increasing efficiency and efficacy. There are many lessons learnt from these studies. However, the greatest of them all is that technology is here to stay in healthcare. Clinicians and nurses must therefore acquire technological competencies or perish occupationally.

References
Alotaibi, Y., & Federico, F. (2017). The impact of health information technology on patient safety. Saudi Medical Journal, 38(12), 1173–1180. https://doi.org/10.15537/smj.2017.12.20631
El-Sawy, H.S., Al-Abd, A., Ahmed, T., El-Say, K.M., & Torchilin, V.P. (2018). Stimuli-responsive nano-architectures drug delivery systems to solid tumor micromilieu: Past, present and future perspectives. ACS Nano, 12(11), 10636–10664. https://doi.org/10.1021/acsnano.8b06104
Fedele, D.A., Cushing, C.C., Fritz, A., Amaro, C.M., & Ortega, A. (2017). Mobile health interventions for improving health outcomes in youth. JAMA Pediatrics, 171(5), 461. https://doi.org/10.1001/jamapediatrics.2017.0042
Islam, M.M., Poly, T.N., & Li, Y.-C. (2018). Recent advancement of clinical information systems: Opportunities and challenges. Yearbook of Medical Informatics, 27(01), 083–090. https://doi.org/10.1055/s-0038-1667075
McGonigle, D., & Mastrian, K.G. (2017). Nursing informatics and the foundation of knowledge, 4th ed. Jones & Bartlett Learning.
Palatnik, A. (2016). To err is human. Nursing Critical Care, 11(5), 4. https://doi.org/10.1097/01.CCN.0000490961.44977.8d
Sweeney, J. (2017). Healthcare informatics. Online Journal of Nursing Informatics (OJNI), 21(1). https://www.himss.org/library/healthcare-informatics    Transforming Nursing and Healthcare Through Technology Essay Paper