Electronic Record-Keeping for Healthcare Providers - Essay Example

?Research Proposal: Electronic Record Keeping for Health Care Providers in Relation to Patient Outcomes PROBLEM STATEMENT In the year 2004, President Bush announced a federal initiative for all healthcare systems to transition from the common paper-based data management to electronic-based data management (Brailer 2005). Furthermore the contemporary health care settings are driven by the need to get the most productivity out of the limited resources (Kellum & Gillmer 2000). These are trends that have influenced the transition from paper based systems to electronic based systems. However there is still uncertainty as to whether the healthcare providers feel comfortable using the electronic medical records (EMRs). Their perceptions and attitudes as concerns the use EMRs are unknown and therefore also difficult to know whether they are adapting to the transition or not. There are very few studies if any on these issues of perceptions and adoption. THEORETICAL FRAMEWORK LOSCIN’S TECHNOLOGICAL COMPETENCE MODEL Locsin’s model of technological competency as caring in nursing is a model that specifically integrates who nurses are as professional, with the modern technology they encounter at their work places. Locsin’s central premise is that the competent use of technology demonstrates caring in nursing. Since the contemporary nursing is believed to be a call to practice in a technologically mediated profession (Casterline 2006). The ultimate purpose of the technological competency in nursing is to acknowledge that wholeness of persons is a focus of nursing and that various technological means can and should be used in nursing in order for nursing to realize wholeness of person more fully (Locsin & Purnell 2009). In this theory Locsin does not address the nurses only but rather the healthcare professionals citing that the modern healthcare world is permeated with technology that healthcare professionals are supposed to use on a daily basis. Instead of viewing technology is a feature on its own and separate from patients, Locsin suggest that technology can be used to know the patients fully (Casterline 2006. The model recognizes caring in nursing, human beings as persons and technological competence as three spheres that interface and which nurses come to know their patient (Locsin & Purnell 2009). The theory is highly linked to the various statements of the research questions. The theory as applied to the use of EMR’s, health care providers can show they care about their clients or patients through the use of the EMRs to better synthesize the important health information about their patients. For example the nurse’s knowledge of the person as a whole human being improves the nursing process and ultimately patient care. Therefore through great organization and efficiency of the EMRs the nurse is able to use this t his or her advantage to know the patients more completely and thus provide quality care. The theory is linked to attitudes and perceptions such that if the health care providers perceive the EMR’s positively it will lead to “knowing” of the patient as a “whole” and this is important in improving health care delivery. If they know the patients and feel that the use of EMRs is good it means that they will easily adopt it for their continued use and in so doing improve patient health. RESEARCH QUESTIONS The research aims to answer the question: What are the attitudes and perceptions of health care providers as concerns the use of electronic record keeping in medical practice? A qualitative research is a kind of systematic empirical inquiry into meaning. This is because the research is ordered or planned, following specific rules that are defined by members of a given community. The research is grounded in the world of experiences that members of a given community have gone through. The research therefore intends to find out what people make sense of these experiences (Yin 2011). Therefore qualitative research involves a qualitative and naturalistic approach and this means that the researcher has to study things in their natural settings, attempt to look further into them and make sense of them, and interpret them in terms of the meanings people bring to them (Yin 2011). In this question the research will aim to find out what the health care providers think about the use of the electronic record keeping in medical practice. It attempts to find out the feelings that they have on whether electronic record keeping has led to improvements in their service delivery, if it has affected their delivery of care to their patients and generally what they think of electronic record keeping in relation to other methods of record keeping available for use by them. LITERATURE REVIEW The changing technology requires that professionals move with it. The transition from paper based techniques to electronic medical records was as a result of established policies and need to increase productivity and efficiency. However uncertainty is still being witnessed in the users of the system and whether they feel comfortable using it which affects the rate of adoption. Locsin’s model of technological competency informs this study by centering on the advantages that technology brings to the profession as it enables understanding of the person or individual as a whole (Locsin & Purnell, 2009). The study question aims to find out the attitudes and perceptions of healthcare providers as concerns the use of electronic record keeping in relation to knowing patients and the second is find out the rate of adoption of EMRs in U. S hospitals in its bid to improve patient knowledge and efficiency. Using Locsin’s theory of technological competency, it can be seen that the use of technology in healthcare leads to increased knowledge of the patient as a whole the various technologies enable the complete assessment of the patient in order to provide quality care. Therefore if the healthcare providers are positive about the whole idea of using EMRs then their attitudes and perceptions will be positive and this increases knowledge about the patient as a whole. The relationship here is a causal one and that is why a change in the independent variable leads to an automatic change in the dependent variable (George, 2011). Through this study the research will contribute to filling the gap over the uncertainty that exists about health providers’ attitudes and perceptions as concerns the use of EMRs in understanding patients. If they have negative attitudes it means that implementation should be stopped and interventions sought to address the issue. This research is likely to find a greater number of people who are positive about the use of EMRs because of the impact it has had on patient outcomes. METHODOLOGY Background Earlier stated, this is a qualitative study. A qualitative research is a kind of systematic empirical inquiry into meaning. This is because the research is ordered or planned, following specific rules that are defined by members of a given community. The research is grounded in the world of experiences that members of a given community have gone through. The research therefore intends to find out what people make sense of these experiences (Yin 2011). Therefore qualitative research involves a qualitative and naturalistic approach and this means that the researcher has to study things in their natural settings, attempt to look further into them and make sense of them, and interpret them in terms of the meanings people bring to them (Yin 2011). The Focus Group Methodology A focus group is an informal discussion among a group of selected individuals about a particular topic. A focus group as a research methodology involves more than one participant per data collection session and thus it is sometimes called a focus group interview, a group interview or a group depth interview. Focus groups are collective conversations which may be small or large. They are arranged to examine a specific set of topics. The group is focused because it involves some kind of collective activity for example debating about a specific social or health issue (Babbie, 2010). The objective of a focus group is to describe and understand the meanings and interpretations of a select group of people to gain understanding of a specific issue from the perspective of the participants in the group. A successful focus group discussion relies on the development of a permissive, non-threatening environment within the group where all the participants can feel comfortable to discuss their opinions and experiences without the fear that they will be judged or ridiculed by others in the group (Creswell, 2003). Focus group studies are seen to be both descriptive and explanatory. Descriptive research is s type of research that is neither qualitative nor quantitative and is used to describe one or more characteristics of the population. The purpose of descriptive research is to make reality known and as a result of these conclusions may be reached and decisions made from them. The purpose of descriptive research is therefore to collect information that describes the existing phenomena, identify problems or justify conditions and practices and make comparisons and evaluations (Babbie, 2010). Explanatory research focuses on why things happen the way they do. They attempt to go beyond the descriptive researches by identifying the actual reasons as to why things occur the way they do. Explanatory researches aim to build and enrich the reasoning behind a theory by providing several explanations as to why a given issue occurs the way it does and then offer the best possible explanation as to why the phenomena occurs the way it does. In answering why questions these researches requires the development of causal explanations arguing that a given factor is affected by another and this may be either simple or complex (Gravetter & Forzano, 2010). Thus focus group studies are seen to be descriptive and explanatory because they describe thoughts and behavior and at the same time provide an explanation of why they happen the way they do. Variables An independent variable is one that the researcher has control over and these are the variables that the researcher is able to choose and manipulate. In most cases their manipulation may lead to a given effect on the dependent variable (Babbie, 2010). The independent variables in this study are attitudes and perceptions while in the second question the independent variable is the rate of adoption. A change in attitudes and perceptions affect the use of EMRs by health care providers while on the other hand an increase in the rate of adoption will lead to improved patient knowledge and efficiency. The dependent variables are those that the researcher has no control of and therefore he cannot manipulate (Babbie, 2010). The dependent variable in this study is patient knowledge. A change in the independent variables described above will affect these mentioned variables. For example increasing the use of EMRs may lead to increased efficiency and patient knowledge. Population and Sampling When conducting research it is not usually possible or it is not necessary to gather information from the entire population (Connaway & Powell, 2010). This means that the researcher has to come up with a small group that is part of the population that is representative of the total population which he/she then studies (Goddard & Melville, 2007). Sampling is thus a way of selecting that part of the entire population that will accurately represent the patterns of the entire population (Gravetter & Forzano, 2010). This study will use probability sampling and in this study the design that will be used is the systematic random sampling. In this type of sampling the population will be numbered and thus a person to participate in the research will be chosen after every given interval. The method is used because different healthcare providers are going to be considered and thus in each of those groups, a few people will be selected randomly for study (Sharp, Peters, & Howard, 2002). In this study any healthcare provider, be it nurses, doctors, health insurance providers will is eligible for participating in the study. An educational forum will be called from which the groups will be identified and a number of people selected from each group. A total of 5 people will be used for each group or category of healthcare providers who will be available. The seminar or workshop should bring together many people and this will make it easier to get the participants. The study as already explained is going to find out the attitudes and perceptions of the health care providers as it relates to the use of electronic medical record keeping and how it contributes to their knowledge about their patients or clients. The study is going to be carried out on healthcare providers and these will include physicians, nurses, insurance providers, government healthcare institutions among others. Human participants will thus be involved in the study and whose details or whose contributions to the study could affect their work or relationship with their clients (Babbie, 2010: Kathi, 2003). Several people will be studied here and this necessitates that they be protected for the sole purpose of ensuring ethics in research. Analysis and Justification of the methodology Focus group discussions have emerged as a more preferred way of understanding people’s behaviors, attitudes and perceptions about a given issue (Lane, Mckenna, Assumpta, & Fleming, 2001). They are organized to explore a specific set of issues that affect people. The group is focused in that it involves some kind of collective activity such as viewing of a film or debating on a particular set of questions (Sladjana, 2005). Scholars view the difference between focus groups and other forms of group interviews by the way the focus group makes use of explicit group interaction as research data (Sharts-Hopko, 2001). For focus groups to work researchers agree that there needs to be a common culture in terms of what the people or the participants in this case do and also there needs to be a point of difference that causes the necessary argument to take place in order that data is gathered from the participants (Lucasey, 2000). A shared culture is this study may be something to do with the medical practice and the use of technology in general. The point of difference could come from the use of electronic record keeping in improving patient outcomes. A discussion will ensure as these participants are arguing from the same profession and they argue based on their interaction with the said issue. The appropriateness of this study methodology in this research is linked to the advantages that the focus group study brings to qualitative research. Its use in this study is appropriate because of the fact that a number of people need to be interviewed not necessary through an interview session but through a session in which they can freely interact so that a number of issues can be identified from their interaction. Some of the advantages that the focus group methodology will bring to this study include: (1) the ability to highlight the respondents attitudes, priorities, language and framework of understanding; (2) encouraging a greater variety of communication from participants thus tapping into a wide range and form of understanding; (3) helps provides an insight into the operation of group/social processes in the articulation of knowledge and lastly (4) focus groups can encourage open conversations about an embarrassing subject and facilitate the expression of ideas and experiences that might be left underdeveloped in such approaches as interviews (Stokes & Bergin, 2006). There researcher will benefit from the focus group because he/she will be able to explore difference between group participants in situ with them and also benefit from interconnectedness of the data because participants reflect upon each other’s ideas. Secondly the researcher will use the conflict between the participants in order to clarify why people believe what they do. He will be able to examine the questions that people ask one another in order to reveal their underlying assumptions and theoretical frameworks. Third is that the researcher will be able to explore the arguments people use against each other, identify the factors which influence individuals to change their minds and document how the facts and stories operate in practice and fourth he will be able to analyze how particular forms of speech facilitate or inhibit peer communication, clarify or confuse the issue (Parker & Tritter, 2006). Thus in this study the case study approach is quite appropriate given the participants and the kind of information that the research aims to elicit from the participants. Building on the above mentioned advantages and benefits it is possible to come to a conclusion that focus group study methodology is most appropriate for this study and will elicit a lot of information that will be very helpful in the study. References Babbie, E. R. (2010). The practice of Social Research. Belmont, CA: Cengage Learning. Brailer, D. (2005, July 1). Remarks by David Brailer, MD PhD. Retrieved April 21, 2012, from http://www.hhs.gov/healthit/BrailerSpch05.html Brailer, D., & Augustino, N. (2003, July). Moving Toward Electronic Health Information Exchange. Retrieved October 11, 2011, from California Healthcare Foundation: http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/S/PDF%20SBCCDEInterimReport.pdf Casterline, G. L. (2006). Book Review: Technological Competency as Caring in Nursing: A Model for Practice. Nursing Science Quarterly, 19(3):273-274. Connaway, L. S., & Powell, R. R. (2010). Basic Research Methods for Librarians (5 Ed.). California: Greenwood Publishing Group. Creswell, J. W. (2003). Research design: qualitative, quantitative and mixed method approaches. London: Sage publications. George, J. B. (2011). Nursing Theories: the basis for professional nursing practice. London: Pearson Education. Goddard, W., & Melville, S. (2007). Research Methodology: An Introduction. Lansdowne: Juta & Company. Gravetter, F. J., & Forzano, L.-A. B. (2010). Research Methods for the Behavioral Sciences. Belmont, CA: Cengage Learning. Kathi, H. E. (2003). Responsible Research: A systematic Approach to Protecting Participants. New York: National Academies Press. Kellum, S., & Gillmer, B. (2000). (2000). The benefits of an electronic patient record. Tar Heel Nurse, 62(4):26-27. Lane, P., Mckenna, H., Assumpta, A. R., & Fleming, P. (2001). Focus group methodology. Nurse Researcher, 8(3), 45. Locsin, R. C., & Purnell, M. J. (2009). A contemporary Nursing process: The (Un) Bearable Weight of Knowing in Nursing. 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