Introduction.
Persons with intellectual and developmental disabilities (IDD) frequently require long-term healthcare screenings, including annual nursing evaluations, test workups, immunizations, drug management history reviews, and screening for prevention. Due to their interpreting nature and the fact that these are services delivered by multiple service providers the same year, the manual tracking process may lead to missed visits, delayed assessments, and documentation. Nursing informatics is a potential tool to improve these processes through EHR reminder systems, automation, and documentation that mirrors the medical record.
In this paper, I outline supporting evidence for its application in enhancing annual healthcare surveillance for the IDD population, highlight legal and ethical issues, describe process improvements, critique technology, and present an evidence-based policy based on nursing informatics.
Current Process.
Community nurses facilitate yearly examinations, laboratory testing, immunizations, specialist appointments alongside other preventive healthcare resources for IDD patients. Most institutions manage in a spreadsheet or in the form of a calendar or by reviewing their own records on a manual basis to track these needs.
This is labor-intensive and leaves the potential for missed healthcare interventions. Consequently, nurses spend more time tracking healthcare deadlines and compliance requirements than providing direct patient care to the individuals they serve.
Evidence Base for Nursing Information.
There is research to show how nursing infrastructures play a role in the practice of nursing. McGonigle and Mastrian (2022) state that electronic reminder systems and clinical decision support have improved workflow efficiency with decreased documentation errors.
Kruse et al. (2022), which established that EHR reminder systems enhance the completion of preventive health care services, enhance communication, and decrease the levels of paperwork that is not needed. Ratwani et al. (2019) also found EHR systems that are well designed also increase patient safety regarding standardized documentation and usability.
Collectively, these findings show that electronic reminder systems support evidence-based practice and serve to enhance preventive care and coordination of care.
Legal and Ethical aspects for Legal and Ethical Approval.
Electronic reminder systems must comply with HIPAA regulations to protect patient privacy and confidentiality. Access should be limited to authorized individuals, and all patient information must be securely stored and maintained within the electronic health record system.
The American Nurses Association (2015) Code of Ethics also makes clear that nurses should prevent the disclosure of patient information with efforts to ensure the provision of safe, equitable, and quality care. The potential of the use of automated reminders is that it will contribute to preventative work on individuals with IDD.
An issue is alert fatigue when there are too many triggers. In short, organizations must carefully set up reminder systems for meaningful alerts to be displayed only.
Workflow Analysis.
Currently, the workflow consists of nurses reading the records and identifying future healthcare needs manually. Once provided services have been identified, nurses can schedule an appointment, talk to providers, fill out paperwork, and initiate manual follow-up if indicated.
The workflow presented, in its proposal, incorporates automated alerts from the EHR to alert patients to overdue assessments, laboratory tests, and immunizations, as well as time-limited preventive screenings prior to the due date. Electronic notices for nurses, EHR documentation of completed service, and electronic dashboards to monitor compliance by supervisors.
Below is the current workflow illustrating the manual process used to identify, schedule, monitor, and document annual healthcare requirements for individuals with intellectual and developmental disabilities.
┌───────────────┐
│ START │
└───────┬───────┘
│
▼
┌──────────────────────────────────┐
│ Nurse reviews individual record │
│ for upcoming healthcare needs │
└───────────────┬──────────────────┘
│
▼
┌──────────────────────────────────┐
│ Identify due assessments, labs, │
│ immunizations, appointments │
└───────────────┬──────────────────┘
│
▼
┌──────────────────────────────────┐
│ Manually schedule appointments │
│ and notify providers/staff │
└───────────────┬──────────────────┘
│
▼
┌───────────────────────┐
│ Services Completed? │
└───────┬───────────────┘
No │ Yes
│
┌────────────────┘
▼
┌─────────────────────────────┐
│ Continue manual follow-up │
│ phone calls/emails │
└───────────────┬─────────────┘
│
▼
(Return to scheduling)
Yes
▼
┌──────────────────────────────────┐
│ Document completion manually in │
│ EHR and tracking spreadsheet │
└───────────────┬──────────────────┘
│
▼
┌───────────────┐
│ END │
└───────────────┘
Below is the proposed workflow demonstrating the implementation of automated EHR reminders, centralized tracking, and real-time compliance monitoring to improve annual healthcare coordination.
┌───────────────┐
│ START │
└───────┬───────┘
│
▼
┌──────────────────────────────────────┐
│ EHR automatically monitors due dates │
│ for assessments and preventive care │
└───────────────┬──────────────────────┘
│
▼
┌──────────────────────────────────────┐
│ Automatic reminder generated 60 days │
│ before due date │
└───────────────┬──────────────────────┘
│
▼
┌──────────────────────────────────────┐
│ Nurse reviews dashboard and contacts │
│ providers/individual │
└───────────────┬──────────────────────┘
│
▼
┌────────────────────────────┐
│ Appointment Completed? │
└──────────┬─────────────────┘
No │ Yes
│
┌─────────────┘
▼
┌──────────────────────────────────────┐
│ Automatic reminder continues until │
│ healthcare service is completed │
└───────────────┬──────────────────────┘
│
▼
(Returns to reminder cycle)
Yes
▼
┌──────────────────────────────────────┐
│ Documentation entered into EHR │
│ Reminder automatically cleared │
└───────────────┬──────────────────────┘
│
▼
┌──────────────────────────────────────┐
│ Supervisor monitors compliance using │
│ dashboard reports │
└───────────────┬──────────────────────┘
│
▼
┌───────────────┐
│ END │
└───────────────┘
Automated workflows lessen manual logging, improve communication among patients, and improve documentation accuracy. They also allow nurses to spend a great deal more time caring directly for them on the spot.
Critique of Technological Systems:
Electronic Reminders: Systematically applying EHRs increases efficiency and communication and documentation while at the same time supporting evidence-based nursing. Automated tracking ensures that preventive health care requirements are met on time and preventive healthcare requirements are completed precisely on a regular basis, while minimizing records searching time.
Technology should augment clinical judgment instead of supplanting it. Nurses need to be trained to assess each individual and coordinate care with the healthcare team and keep their needs of each patient. Implementation will require staff education and continued assessment.
In general, automation of reminder systems is more beneficial than the negative impact.
Evidence-Based Policy.
Policy Title: Electronic Health Record Reminder System for Annual Monitoring of Health Care
Purpose.
To facilitate completion of the annual healthcare assessments, laboratory testing, immunizations, and preventive services via automated EHR reminders.
Policy.
The organization will use EHR reminder features to monitor annual health care activities to which individuals requiring nursing services will be entitled.
Procedure.
Automated reminders will be created 60 days before healthcare needs are scheduled. Nurses will review the weekly reminder reports.
Completed healthcare activities will be logged within 48 hours. Monthly compliance reports will be reviewed by supervisors.
All staff will undergo annual training on electronic documentation and compliance with HIPAA.
Expected Outcomes.
The objective of this policy is to better aid completion of annual assessments, enhance documentation, increase interdisciplinary communication, decrease manual tracking and thus influence patient outcomes.
Benefits to the Organization.
Automated reminders decrease the time nurses spend tracking healthcare needs manually for patients while also maximizing the delivery of preventive services. An enhanced documentation mechanism aids the regulatory compliance, quality improvement, and organizational reporting and improvement activities.
Individuals who have IDD get higher-quality, more seamless preventive care that is timely, coordinated and preventive, improving health outcomes significantly.
Conclusion.
Nursing informatics is an effective approach to enhance annual health care surveillance of persons with intellectual and developmental disabilities. Automated EHR reminder systems minimize manual tracking, better documenting, improve communication, as well as preventive care.
This is the evidence-driven workflow and policy that will lead to better operational, regulatory, and patient outcomes and ensure that nurses are able to spend more time on patients.
References
American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. American Nurses Association.
Kruse, C. S., Stein, A., Thomas, H., & Kaur, H. (2022). The use of electronic health records to support population health: A systematic review of the literature. Journal of Medical Systems, 46(2), 1–14.
McGonigle, D., & Mastrian, K. G. (2022). Nursing informatics and the foundation of knowledge (5th ed.). Jones & Bartlett Learning.
Ratwani, R. M., Savage, E., Will, A., Fong, A., Karavite, D., Muthu, N., Rivera, A., Gibson, C., & Hettinger, A. Z. (2019). Identifying electronic health record usability and safety challenges in pediatric settings. Health Affairs, 38(11), 169–176.