Capstone Project on "Human Machine Interface E-Iatrogenesis"

Capstone Project 30 pages (10355 words) Sources: 30 Style: APA

[EXCERPT] . . . .

E-iatrogenesis: Human-Machine Interface

e-Iatrogenesis: Chapters 1 and 2

Rationale, Issues, and Hypothesis

Rationale for Topic Selection

With the publication of the Institute of Medicine's (IOM) 2000 landmark report, to Err is Human, the public, their representatives, and the medical profession woke up to the fact that seeking medical care increases the risk of injury and death. At the time, best estimates suggested that between 44,000 and 98,000 Americans died each year from medical errors. These care-related mistakes are believed to cost the U.S. healthcare system about $2 billion each year. The prevalence of medication errors can vary greatly depending on the setting. For example, the medication error rate for hospitals was found to vary from about 0.3% overall to over 10% in a pediatric ICU setting. In addition, one estimate suggested that less than 10% of medication errors are ever reported.

One of the solutions discussed in the IOM report is the implementation of electronic safeguards in the form of computerized medical records, barcoding, and electronic medication administration records (IOM, 2000). The conversion of patient medical information into a digital format was projected to not only reduce the cost of healthcare, but increase the opportunities for automated surveillance strategies that protect the health of patients.

To promote the adoption of electronic health record (EHR) by individual providers and hospitals, the Centers for Medicare and Medicaid Services (CMS) has been given a mandate by Congress via the HITECH Act of 2009 to provide funds to help defray the costs o

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f implementation (CMS, 2013). Eligible providers under Medicare can receive up to $44,000, while providers under the state-run Medicaid programs can receive up to $63,750. Participation is not required, nor is EHR implementation, but by 2015 providers who have not implemented an EHR system will have their Medicare and Medicaid payments adjusted downward by 1% for the first year. Over the subsequent years, this penalty will eventually reach a maximum of 5% of Medicare and Medicaid payments.

This carrot and stick approach would be toothless if the number of patients covered by Medicare and Medicaid were small. However, spending on Medicare, Medicaid, and the Children's Health Insurance Program (CHIP) in 2010 approached a trillion dollars and represented close to one third of America's health care spending (Klees, Wolfe, and Curtis, 2012). EHR implementation on a national scale is therefore official government policy at the federal level, but one with teeth capable of chewing away at providers' profit margins if they fail to implement an EHR system and utilize it in a meaningful way.

The above policy is based on the assumption that EHR implementation will provide cost savings and improve patient safety (IOM, 2011). At the time, however, the empirical evidence to support these claims was absent. In the aftermath of the publication of several research articles revealing that implementation can increase the harm to patients, the IOM formed a committee to study this issue (IOM, 2011). The committee members concluded that the patient safety benefits of EHR implementation have yet to be substantiated empirically in a consistent manner. Of the different EHR software modules that exist, the most promising for reducing medical errors was found to be computerized physician order entry (CPOE) and clinical decision support (CDS).

The IOM Committee on Patient Safety and Health Information Technology noted that adapting EHR tools to meet clinician's needs is probably the best approach for ensuring patient safety (IOM, 2011). However, alterations in clinical workflow due to EHR implementation can impede efforts to effectively communicate patient information, increase workloads, cause alert fatigue and information overload, and precipitate EHR system avoidance behaviors, including the use of shortcuts. These problems can erode attempts to improve patient safety.

The need to better understand the information needs of clinicians has not gone unnoticed by researchers. From a theoretical perspective, there exists a clinical communications space within which clinicians share information (reviewed by Collins, Bakken, Vawdrey, Coiera, and Currie, 2011). To the extent that clinicians can communicate easily, whether verbally, by phone, or email, a shared understanding exists that allow the concepts exchanged to be understood by the parties involved. This shared knowledge and skills is called the 'common ground.'

Common ground, however, is not always sufficient for high quality care. Effective care teams are typically composed of individuals with unique knowledge and skills, but for these members to contribute in a meaningful way common ground must still be established. Therefore, common ground allows care team members to both communicate effectively and to make unique contributions to patient care. The overall effect is to expand the knowledge and skills of the care team and increase the quality of care. This phenomenon is called 'distributed cognition' and it is responsible for increasing the quality of care beyond the capabilities of a single clinician.

An EHR system could be framed as a contributing member of a clinical care team because it is capable of contributing unique knowledge and capabilities; however, the ability to make contributions would also be limited by the extent of common ground established between the EHR system and clinicians. A priori, the magnitude of EHR/clinician common ground would be a function of both clinician training and system usability. Based on the perspective of the IOM Committee on Patient Safety and Health Information Technology, system usability is a function of implementation strategies, system adaptability by end users, point of care use, and usability feedback loops (IOM, 2011). However, these are not the only factors believed to influence whether an EHR system can protect or improve patient safety. The IOM Committee acknowledged that much more research needs to be done to understand how best to design, implement, and maintain EHR systems in a manner that predictably reduces the prevalence of medical errors.

Justification for Choice of Topic

The above discussion reveals what could be an impending crisis in patient safety as more and more providers implement EHR systems in their clinics and hospitals without understanding the risks. As I began to read through the IOM report on Health it, the lack of empirical evidence supporting the safety of EHR implementation was surprising, if not unsettling. Years ago the experts proclaimed that converting paper medical records into a digital format would provide many benefits, including lower costs and increased patient safety. Yet, the same experts are now cautioning clinicians about the risk to patient safety that such systems pose and the need for more research to better understand this issue. From my perspective, this seemed like an important and contemporary issue that is not going to be resolved any time soon. For this reason, I thought it was important to try and understand what is and is not known about the human-machine interface issues that arise in clinical settings.

This topic is relevant across disciplines, but even more so in the technology-driven critical care setting. The imposition of a poorly designed and implemented EHR system can no longer be viewed as a benign artifact of modern medicine, but as a potential threat to patient health and provider profitability that must be dealt with decisively and without delay. As I progress in my career, there could be a moment when I'm given responsibility for such a system. By digging into the literature on this topic I will be better prepared for such an event and in a position to offer suggestions on what needs to be done to make the system more efficient and less error prone. In addition, there is no conceivable expiration date on this topic as more and more providers' transition from paper to electronic medical information systems, while continuing to encounter problems.

The Human-Machine Interface Issues

If it were true that converting from paper to electronic medical records improved patient safety and provided cost savings then there would be little controversy, but according to a number of publications, including a comprehensive IOM (2011) report on this topic, there is little empirical evidence to base these assertions upon. Instead, there is a growing body of empirical evidence suggesting that the cost benefits are elusive for many and that patient safety may be at risk. A significant chasm therefore exists between past recommendations, current official government policy, and the clinical evidence being generated.

EHR systems have been predicted to provide many benefits. These include increased patient safety, reduced operational costs associated with a paperless clinic, sharing of patient information among different providers, remote access to patient information in real-time, and searchable databases that can be used by researchers (IOM, 2011). While these projected benefits are enticing, the most critical is patient safety. EHR systems are believed capable of reducing medical errors because handwriting becomes legible as it is converted into digital text and medication orders can be transmitted instantly and legibly to pharmacists who then fill stat orders without delay. In addition, EHR systems have been designed to provide clinical decision support to help alert clinicians to risks associated with a treatment approach or medication mix.

These projected benefits are rarely realized, however, and instead clinicians find that they become… READ MORE

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Quoted Instructions for "Human Machine Interface E-Iatrogenesis" Assignment:

“

MSN Education CAPSTONE (0213)

based on order A2095673 and A2095677 already completed by *****

Overview

****************DJT Task 1*****************

Directions

SUBDOMAIN 981.1 - CAPSTONE

Competency 981.1.1: Capstone - The graduate integrates and synthesizes competencies from across the degree program and thereby demonstrates the ability to participate in and contribute value to the chosen professional field.

Introduction:

In this task, you will briefly outline the problem that you intend to investigate, describe the participants in your study, and state your research questions. You will then describe the data you intend to collect and the data analysis you propose to conduct once you have gathered the data. This task will need to be approved before you move forward with the remaining tasks found in the capstone project assessment.

Task 1:

A. Provide a brief introduction that explains your rationale for the proposed project by doing the following:

1. Present your topic.

2. Describe the participants in your proposed study. Include the following:

*****¢ Demographic information

*****¢ Additional relevant characteristics of your target population (e.g., cultural factors, learning styles, education levels, prior learning, motivation)

B. Explain the problem and your proposed solution by doing the following:

1. Outline the problem.

2. Describe possible causes of the problem.

3. Discuss your proposed solution to the problem.

C. Present your research question(s).

D. Describe how you intend to answer your research question(s) by doing the following:

1. Describe the data you will collect.

2. Describe the instruments and methods you will use to collect the data.

3. Describe the data analysis techniques you will use to analyze the collected data.

E. When you use sources, include all in-text citations and references in APA format.

Note: Please do not save word-processing documents as *.rtf (Rich Text Format) or *.pdf (Portable Document Format) files as they are often too large to download and/or cannot be edited.

Note: When bulleted points are present in the task prompt, the level of detail or support called for in the rubric refers to those bulleted points.

Note: For definitions of terms commonly used in the rubric, see the Rubric Terms web link included in the Evaluation Procedures section.

Note: When using sources to support ideas and elements in a paper or project, the submission MUST include APA formatted in-text citations with a corresponding reference list for any direct quotes or paraphrasing. It is not necessary to list sources that were consulted if they have not been quoted or paraphrased in the text of the paper or project.

Note: No more than a combined total of 30% of a submission can be directly quoted or closely paraphrased from sources, even if cited correctly. For tips on using APA style, please refer to the APA Handout web link included in the General Instructions section.

Evaluation Method

*******************DJT Task 2***************

Directions

SUBDOMAIN 981.1 - CAPSTONE

Competency 981.1.1: Capstone - The graduate integrates and synthesizes competencies from across the degree program and thereby demonstrates the ability to participate in and contribute value to the chosen professional field.

Introduction:

After your prospectus has been approved, you will address the issue of human subjects in research. This includes completing the *****Informed Consent Form***** found in the web links section, which explains how your research will deal with issues concerning human subjects. Depending on your degree program you may have additional requirements. Note this in the task directions below and see your capstone course of study for more specific details.

Once you have submitted all four documents to TaskStream, they will be reviewed to see if they meet expedited IRB criteria. If so, you will pass this task, meaning you have XXX IRB approval to conduct your study. However, you need to pass the Prospectus (first three chapters) before you can begin data collection.

Task 2:

A. Submit the following four required documents:

*****¢ Informed Consent

*****¢ IRB Worksheet

*****¢ Organizational Permission - upload photo copy with signature

*****¢ NIH Certificate - upload photo copy (or CITI training certificate)

B. When you use sources, include all in-text citations and references in APA format.

Note: Please do not save word-processing documents as *.rtf (Rich Text Format) or *.pdf (Portable Document Format) files as they are often too large to download and/or cannot be edited.

Note: When bulleted points are present in the task prompt, the level of detail or support called for in the rubric refers to those bulleted points.

Note: For definitions of terms commonly used in the rubric, see the Rubric Terms web link included in the Evaluation Procedures section.

Note: When using sources to support ideas and elements in a paper or project, the submission MUST include APA formatted in-text citations with a corresponding reference list for any direct quotes or paraphrasing. It is not necessary to list sources that were consulted if they have not been quoted or paraphrased in the text of the paper or project.

Note: No more than a combined total of 30% of a submission can be directly quoted or closely paraphrased from sources, even if cited correctly. For tips on using APA style, please refer to the APA Handout web link included in the General Instructions section.

Web Links:

1. Informed Consent Form

2. IRB Worksheet

Evaluation Method

*******************DJT Task 3****************

Directions

SUBDOMAIN 981.1 - CAPSTONE

Competency 981.1.1: Capstone - The graduate integrates and synthesizes competencies from across the degree program and thereby demonstrates the ability to participate in and contribute value to the chosen professional field.

Introduction:

In this task, you will provide an introduction to the problem that you have identified and that you intend to research during your capstone project. You will also state and provide the context for your research questions via a review of relevant literature.

Task 3:

A. Using the Capstone template, develop Chapter 1 as you provide an introduction (suggested length of 4*****6 pages) that explains the rationale for the project by doing the following:

1. Present your topic.

2. Explain why you chose the topic.

3. Discuss why the project is important to your discipline.

B. Explain the problem (suggested length of 3*****5 pages) by doing the following:

1. Outline the problem.

2. Provide background information of the problem.

3. Discuss possible causes of the problem.

C. State your research questions and hypotheses, if applicable.

D. Create Chapter 2 by providing a thorough and well-organized literature review of professional sources by doing the following:

1. Outline research for best practices for your topic.

2. Summarize the professional literature relevant to the topic you have chosen.

3. Provide a conclusion that interprets how the literature applies to the problem being investigated.

Note: The required number of sources varies by program. Please refer to the course of study for your program*****s requirements.

E. Provide your preliminary reference list.

F. When you use sources, include all in-text citations and references in APA format.

Note: Please do not save word-processing documents as *.rtf (Rich Text Format) or *.pdf (Portable Document Format) files as they are often too large to download and/or they cannot be edited.

Note: When bulleted points are present in the task prompt, the level of detail or support called for in the rubric refers to those bulleted points.

Note: For definitions of terms commonly used in the rubric, see the Rubric Terms web link included in the Evaluation Procedures section.

Note: When using sources to support ideas and elements in a paper or project, the submission MUST include APA formatted in-text citations with a corresponding reference list for any direct quotes or paraphrasing. It is not necessary to list sources that were consulted if they have not been quoted or paraphrased in the text of the paper or project.

Note: No more than a combined total of 30% of a submission can be directly quoted or closely paraphrased from sources, even if cited correctly. For tips on using APA style, please refer to the APA Handout web link included in the General Instructions section.

Evaluation Method

*****************DJT Task 4*************

Directions

SUBDOMAIN 981.1 - CAPSTONE Competency 981.1.1: Capstone - The graduate integrates and synthesizes competencies from across the degree program and thereby demonstrates the ability to participate in and contribute value to the chosen professional field.

Introduction: In this task, you will provide the first two chapters of your capstone project, revised as directed. These chapters include the following: (1) an introduction to the problem that you have identified and that you intend to research during your capstone project; and (2) a statement of the context for your research questions via a review of relevant literature. Additionally, you will create a new chapter, Chapter 3, which will address the methodology that you plan to utilize to conduct your proposed study. Task 4:

A. Re-submit Chapters 1 and 2, revised as directed.

B. Create Chapter 3 by presenting the methodology you plan to use for your project and by addressing the following:

1. Discuss the evaluation methods and tools you will use.

a. Discuss the reliability and validity of the evaluation methods and tools you will use.

2. Discuss how the integrity of the data you collect will be maintained.

3. Discuss your research design.

4. Explain your research methods.

a. Explain why you are adopting these research methods.

5. Describe the participants in your proposed study. Note: Include demographic information and any additional relevant characteristics of your target population (e.g., cultural factors, learning styles, education levels, prior learning, motivation).

6. Describe how you obtained any needed permissions.

C. When you use sources, include all in-text citations and references in APA format.

Note: Please do not save word-processing documents as *.rtf (Rich Text Format) or *.pdf (Portable Document Format) files as they are often too large to download and/or they cannot be edited. Note: When bulleted points are present in the task prompt, the level of detail or support called for in the rubric refers to those bulleted points. Note: For definitions of terms commonly used in the rubric, see the Rubric Terms web link included in the Evaluation Procedures section. Note: When using sources to support ideas and elements in a paper or project, the submission MUST include APA formatted in-text citations with a corresponding reference list for any direct quotes or paraphrasing. It is not necessary to list sources that were consulted if they have not been quoted or paraphrased in the text of the paper or project. Note: No more than a combined total of 30% of a submission can be directly quoted or closely paraphrased from sources, even if cited correctly. For tips on using APA style, please refer to the APA Handout web link included in the General Instructions section.

Evaluation Method

**************DJT Task 5***************

Directions

SUBDOMAIN 981.1 - CAPSTONE

Competency 981.1.1: Capstone - The graduate integrates and synthesizes competencies from across the degree program and thereby demonstrates the ability to participate in and contribute value to the chosen professional field.

Introduction:

In this task, you will provide the first three chapters, revised as directed. These chapters include the following: (1) an introduction to the problem that you have identified and that you intend to research during your Capstone Project; (2) a statement of the context for your research questions via a review of relevant literature; and (3) a discussion of the methodology that you utilized to conduct your study. Additionally, you will now add your findings to this task submission as Chapter 4. This task requires the submission of completed Chapters 1-4 written in the past tense.

Task 5:

A. Re-submit chapters 1 through 3 revised as directed and written in the past tense.

B. Create Chapter 4 (Data Analysis) by doing the following:

1. Organize and present your results.

2. Provide a data-driven general summary statement of the results.

3. Analyze each set of data.

a. reate visual aids (e.g., tables, charts, graphics) to display results.

4. Discuss the answers to your research questions based on your data analysis.

C. When you use sources, include all in-text citations and references in APA format.

Note: Please do not save word-processing documents as *.rtf (Rich Text Format) or *.pdf (Portable Document Format) files as they are often too large to download and/or they cannot be edited.

Note: When bulleted points are present in the task prompt, the level of detail or support called for in the rubric refers to those bulleted points.

Note: For definitions of terms commonly used in the rubric, see the Rubric Terms web link included in the Evaluation Procedures section.

Note: When using sources to support ideas and elements in a paper or project, the submission MUST include APA formatted in-text citations with a corresponding reference list for any direct quotes or paraphrasing. It is not necessary to list sources that were consulted if they have not been quoted or paraphrased in the text of the paper or project.

Note: No more than a combined total of 30% of a submission can be directly quoted or closely paraphrased from sources, even if cited correctly. For tips on using APA style, please refer to the APA Handout web link included in the General Instructions section.

Evaluation Method

***************DJT Task 6**************

Directions

SUBDOMAIN 981.1 - CAPSTONE

Competency 981.1.1: Capstone - The graduate integrates and synthesizes competencies from across the degree program and thereby demonstrates the ability to participate in and contribute value to the chosen professional field.

Introduction:

In this task, you will resubmit the revised first four chapters written earlier including:

1. An introduction to the problem that you have identified and that you intend to research during your Capstone Project

2. The context for your research questions via a review of relevant literature

3. The methodology that you utilized to conduct your study

4. A presentation of your findings

Additionally, you will now add chapter 5 to include discussion of the findings, implications, limitations, recommendations, and conclusions. This task will include submission of completed chapters 1*****5 written in the past tense.

Task:

A. Submit chapters 1*****4 revised as directed and written in the past tense.

B. Create chapter 5 (*****Results and Conclusions*****), addressing the results of your research project by doing the following:

1. Provide an overview of the project that restates the general purpose of your research.

2. Summarize your findings.

a. Explain how the results of your research were obtained.

3. Recommend possible solutions to your research problem based on your results.

4. Discuss implications and limitations of the project by doing the following:

a. Discuss strengths of the project.

b. Discuss weaknesses of the project.

c. Discuss problems you noted with the project.

d. Discuss any factors that may have skewed your findings.

5. Discuss how the study could be improved.

a. Recommend areas of your topic that could be further investigated.

b. Explain what you would do differently if you were to conduct the study again in the future.

i. Justify these differences.

6. Critique your master*****s degree experience by doing the following:

a. Reflect on your master*****s degree experience.

b. Reflect on how the experience and skills you have gained can apply in your work environment.

C. Develop a reference list of all the references you cited in your capstone report.

D. Create an appendix for your project that includes the following:

1. Appendices and exhibits important to the project that are referenced in the report, including your entire curriculum unit or instructional product

2. Data-gathering instruments (e.g., surveys, questionnaires)

3. The *****Informed Consent Form***** you used to obtain permission for the participants to take part in your project

E. When you use sources, include all in-text citations and references in APA format.

Note: Please do not save word-processing documents as *.rtf (Rich Text Format) or *.pdf (Portable Document Format) files as they are often too large to download and/or they cannot be edited.

Note: When bulleted points are present in the task prompt, the level of detail or support called for in the rubric refers to those bulleted points.

Note: For definitions of terms commonly used in the rubric, see the Rubric Terms web link included in the Evaluation Procedures section.

Note: When using sources to support ideas and elements in a paper or project, the submission MUST include APA formatted in-text citations with a corresponding reference list for any direct quotes or paraphrasing. It is not necessary to list sources that were consulted if they have not been quoted or paraphrased in the text of the paper or project.

Note: No more than a combined total of 30% of a submission can be directly quoted or closely paraphrased from sources, even if cited correctly. For tips on using APA style, please refer to the APA Handout web link included in the General Instructions section.

Evaluation Method

*****************DJT Task 7**************

Directions

SUBDOMAIN 981.1 - CAPSTONE

Competency 981.1.1: Capstone - The graduate integrates and synthesizes competencies from across the degree program and thereby demonstrates the ability to participate in and contribute value to the chosen professional field.

Introduction:

In this task you will create a single document that contains your entire Written Capstone Report.

Task:

A. Provide an abstract. (Maximum length 120 words.)

B. Provide an introduction (suggested length of 4*****6 pages) that explains the rationale for the project by doing the following:

1. Present your topic.

2. Explain why you chose the topic.

3. Discuss why the project is important to your discipline.

C. Explain the problem (suggested length of 3*****5 pages) by doing the following:

1. Outline the problem.

2. Provide background information of the problem.

3. Discuss possible causes of the problem.

D. Create a well-organized literature review of 15*****20 professional sources by doing the following:

1. Outline research for best practices for your topic.

2. Summarize the professional literature relevant to the topic you have chosen.

3. Provide a conclusion that interprets how the literature applies to the problem being investigated.

E. Provide your preliminary reference list.

F. State your research questions.

G. Discuss the methodology you used for your project by doing the following:

1. Discuss the evaluation methods and tools you used.

a. Discuss the reliability and validity of the evaluation methods and tools you used.

2. Discuss how the integrity of the data you collected will be maintained.

3. Discuss your research design.

4. Explain your research methods.

a. Explain why you adopted these research methods.

b. Discuss what caused any differences between what you had planned to do and what you actually did.

5. Describe the participants in your proposed study.

Note: Include demographic information and any additional relevant characteristics of your target population (e.g., cultural factors, learning styles, education levels, prior learning, motivation).

6. Describe how you obtained any needed permissions.

H. Present the results of your project by doing the following:

1. Outline how your results will be organized and presented.

2. Provide a data-driven general summary statement of the results.

3. Analyze each set of data.

a. Create visual aids (e.g., tables, charts, graphics) to display results.

4. Discuss the answers to your research questions based on your data analysis.

I. Discuss the results of your research project by doing the following:

1. Provide an overview of the project that restates the general purpose of your research.

2. Summarize your findings.

a. Explain how the results of your research were obtained.

3. Recommend possible solutions to your research problem based on your results.

4. Discuss implications and limitations of the project by doing the following:

a. Discuss strengths of the project.

b. Discuss weaknesses of the project.

c. Discuss problems you noted with the project.

d. Discuss any factors that may have skewed your findings.

5. Discuss how the study could be improved.

a. Recommend areas of your topic that could be further investigated.

b. Explain what you would do differently if you were to conduct the study again in the future.

i. Justify these differences.

6. Critique your master*****s degree experience by doing the following:

a. Reflect on your master*****s degree experience.

b. Reflect on how the experience and skills you have gained can apply in your work environment.

J. Develop a reference list of all the references you cited in your capstone report.

K. Create an appendix for your project that includes the following:

1. Appendices and exhibits important to the project that are referenced in the report, including your entire curriculum unit or instructional product

2. Data-gathering instruments (e.g., surveys, questionnaires)

3. The *****Informed Consent Form***** you used to obtain permission for the participants to take part in your project

L. When you use sources, include all in-text citations and references in APA format.

Note: Please save word-processing documents as *.rtf (Rich Text Format) or *.pdf (Portable Document Format) files.

Note: When bulleted points are present in the task prompt, the level of detail or support called for in the rubric refers to those bulleted points.

Note: For definitions of terms commonly used in the rubric, see the Rubric Terms web link included in the Evaluation Procedures section.

Note: When using sources to support ideas and elements in a paper or project, the submission MUST include APA formatted in-text citations with a corresponding reference list for any direct quotes or paraphrasing. It is not necessary to list sources that were consulted if they have not been quoted or paraphrased in the text of the paper or project.

Note: No more than a combined total of 30% of a submission can be directly quoted or closely paraphrased from sources, even if cited correctly. For tips on using APA style, please refer to the APA Handout web link included in the General Instructions section.

*****

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