Running head: SCHOLARLY PROJECT

Scholarly Project Synthesis Care Transitions Jennifer R. Williams Ferris State University

SCHOLARLY PROJECT Abstract This paper provides a thorough synthesis of a care transition project that was initiated to improve hospital to extended care facility (ECF) transfers. A description of the scholarly project itself is provided and the goals to improve care transitions through increased quality and decreased cost are discussed. There is an evaluation of the project identifying the five objectives and whether each objective was met. Personal and professional accountability is described related to both the student and project management role. An analysis of the initial concerns is provided along with a discussion regarding project size, scope creep, and resistance to change. The project outcomes are discussed regarding the support of legal, ethical, nursing, and organizational standards. Recommendations for future project endeavors including project schedule and resource availability are further provided. A conclusion identifies the key points of this project synthesis. Keywords: scholarly project, informatics nurse specialist, care transitions, electronic information transfer

SCHOLARLY PROJECT Scholarly Project Synthesis Care Transitions Information is the essence of patient care delivery and medical practice. Efficient information management and timely clinical information exchange directly influences quality of care across the continuum. Health information exchange addresses a critical need to provide the best care possible during care transitions. The demand for information exchange is expected to continue to grow with payment reforms providing a strong incentive to improve quality of care (Williams et al., 2011). Coordination of care for hospital discharge requires patient information from multiple resources in the electronic health record (EHR). Care managers can face many challenges and barriers in regard to technology design, IT infrastructure, and organizational barriers when it comes to receiving adequate support for care coordination and transitions of care. Paper documents are often utilized to provide adequate information for patient care transitions; this can be challenging on transfer time constraints and departmental costs within an organization (Carayon et al., 2012). A portion of the patient and nursing experience includes the care transition process from an acute care hospitalization to an external setting. Memorial Medical Center of West Michigan (MMCWM) continued to practice a patient transition process that contained multiple barriers and constraints regarding time management and cost efficiency. This project allowed me to engage in the identification of appropriate solutions to these challenges within the INS role. This purpose of this paper is to provide a synthesis of the care transition project that was carried out to provide experience in the utilization of information technology solutions to improve the patient transition process within the chosen acute care hospital environment.

SCHOLARLY PROJECT This paper will include a description of the scholarly project itself along with the aligned goals and objectives. An evaluation of the project will be provided. Both personal and professional accountability related to the implementation of the project will be shared. There will be an analysis of any issues, concerns, and challenges associated with the project. Project outcomes will be reviewed followed by a full analysis of the project. Recommendations for future project endeavors will then be suggested. A conclusion will identify the key points of this project synthesis. Project Description During this project, a process was created to transfer appropriate electronic patient information to extended care facilities (ECFs) in order to improve the patient transition process and decrease any associated excessive cost with the current paper system. This project was completed at Memorial Medical Center of West Michigan under the guidance of my preceptor Ms. Saxton (see Appendix E). This hospital was chosen as they continued to hand complete a four page transfer form and manually fax a large amount of patient information to acute care hospitals, physicians offices, and rehab facilities etc. In order to complete this process, a large amount of information had to be printed off and then faxed to the receiving discipline. Process improvement is just one significant aspect of the INS role (ANA, 2008). This project was a perfect example of process improvement through the use of information technology. This project was held within the clinical quality department. The clinical quality department was originally created to monitor quality and efficiency throughout this organization. In recent years, quality departments within many organizations have become an intense forefront in healthcare related to the requirements of the Patient Protection and

SCHOLARLY PROJECT Accountable Care Act (PPACA) of 2010. The overall quality objective for organizations now consists of finding a way to improve care quality while reducing cost and expanding health access (Marjoua & Bozic, 2012). The project consisted of finding a way to electronically compile patient information to other disciplines for continuation of care. After a thorough consideration, it was determined that this project would be limited to extended care facility (ECF) transfers only. The project was split into multiple phases and will be completed over a longer period than originally expected. Related to time and resource constraints, transfers to other disciplines and the desktop faxing portions will now be reviewed at a later date. The purpose of this project was to improve the patient transition process while reducing cost and improving employee utilization. The goal was to develop an electronic process for the exchange of data between disciplines during patient care handoffs at transfer or discharge. The end result (project deliverable) is now expected to simplify the discharge process whilst decreasing cost through conservation of employee time and paper stock (see Appendix C; see Appendix D). Evaluation of Project Exchanging quality data during times of patient care transitions is key to improving continuity and quality of care. Many organizations are focused on defining an appropriate care transitions program to meet the new quality standards put forth by the government. One identified component of this process is the successful transfer of patient data and information to the receiving discipline that will resume patient care after discharge from an acute care hospital (Goroski & Clark, 2011).

SCHOLARLY PROJECT The first objective of this project was to complete a review of the literature and other data sources related to health data information transfers and transitions of care for acute care discharges. This process was utilized to define the appropriate steps needed to provide a successful care transition with the sharing of electronic patient information. A multiple database search including Cinhal, PubMed, Google Scholar, and Ferris Library sources were utilized to disseminate information for the project. A resource library was then created (see Appendix F). Once all needed information was obtained and sorted appropriately, the second objective was to meet with the IT and quality departments to identify information transfer options. Ready to access information is imperative to the transition process. Information technology integration leads to better information sharing. Utilization of IT and IT-enable learning mechanisms can provide improved communication across organizations (Pinsonneault et al., 2012). Objective two included meeting with IT and having an in depth discussion on how data can be captured and transferred in an electronic to external disciplines. This objective was slightly changed from its original format. IT was able to assist in building an electronic platform to successfully meet this objective. The value of the IT department during this change was imperative to stimulate the integration of information technology into the discharge transition process (Pinsonneault et al., 2012). The third objective was to develop a process to pull appropriate documentation from the current electronic medical record into transferable data files. Information transfer should include relevant and integrated information that will enhance patient care and

SCHOLARLY PROJECT improve continuity of care. Utilization of a systematic information exchange supports quality patient care (Thraen, Bair, Mullin, Weir, 2012). The third objective was not completed and was postponed to the second phase of this project. During the second phase of this project, the coordination of appropriate information technology channels and the patient transition process will assist in both cost reduction and the support of quality patient care (Williams, Mostashari, Mertz, Hogin, & Atwal, 2012). During this time, programmers will be utilized to identify how the required information can be compiled without having to print and re-scan the information back into a file. Until then, the current process of faxing to ECFs will continue with the utilization of the new electronically compiled format. It is imperative that there is also appropriate identification and application of the organizations privacy practice and regulations. Objective four addressed this concern. Organizations are accountable for integrating privacy-preservation during any data integration and sharing amongst other disciplines. In order to ensure the delivery of quality continuity of care outside of the original setting, an organization must utilize all available resources to protect the transfer of patient data (Grandison et al., 2012). During objective four, all privacy policy and procedures were reviewed to ensure that patient information is protected. Maintenance of privacy can often pose challenges when integrating data from multiple sources (Grandison et al., 2012). Careful thought was taken to protect patient information during data collection. All privacy measures were met during this process and will continue to be met prior to moving on with the remaining stages of this project.

SCHOLARLY PROJECT Working closely with the case management staff, the required steps for data transfer to ECFs were successfully reviewed in objective five. Managing care transitions includes obtaining the essential clinical information needed to create the appropriate process. Valuable information will be captured in the steps taken by the point of care decision makers and care management (Williams et al., 2012). Objective five included the review of multiple disciplines in the community along with the ECF transition process. It was determined that though implementation of other disciplines will not take place until the third phase of this project, that it was important to create the forms to meet all criteria. Implementing effective communication between community disciplines improves clinical handover needs (Johnson & Barach, 2009). The development of a single approach for all handovers is not always possible; therefore understanding each discipline will improve the understanding of patient needs (Johnson & Barach, 2009). Each discharge transition for external disciplines was defined during this phase. This will assist with maintaining personalization of the discharge process. During objective five, staff education regarding the importance of patient handoffs and the issues related to communication breakdowns was also stressed. Staff should be educated on the need to conduct the electronic transfer effectively in order to improve communication between disciplines. Appropriate tools (classroom, online learning, etc) and interventions should be utilized during the educational process to ensure adequate training (Wohlauer et al., 2012). All case management staff involved in the discharge or transition process was able to attend a class instruction on the new transition process during objective five. Information will be dispensed to Director of Nursing and Clinical Manager to provide at scheduled staff meetings when the forms are in the implementation phase.

SCHOLARLY PROJECT Due to project constraints and timeline issues, the implementation phase has not yet been initiated. As the project manager, I will continue to work with MMCWM until phase one of this project is complete. Once the appropriate education is complete, the new transition process will be implemented. Prior to implementation, a specified date of implementation will be communicated to all staff along with a step-by-step process sheet to be utilized as a staff resource during the change process. Troubleshooting and monitoring of the change will be managed by the project manager. Both preceptor and student evaluations of the project can be viewed in the attached appendix (see Appendix A; see Appendix B). Evaluations were also provided to the project stakeholders post project presentation. There were no concerns or negative comments provided through this communication process. All stakeholders agreed that the project was on target and appropriate. In addition, 100% agreed that the project outcomes would successfully improve patient care transitions. Overall, there was excellent feedback from all stakeholders and other disciplines involved in the project. Personal & Professional Accountability The Informatics Nurse Specialist (INS) role has multiple components attached to it. Many disciplines utilize the INS to incorporate nursing knowledge into department processes. It is within the scope of the Informatics Nurse Specialists (INS) practice to assist in resolving such issues as the need to improve care transitions through the use of alternate electronic solutions for current processes. The INS serves as a bridge between information technology and informatics solutions (Bowman-Hayes, 2009). Many early processes were built without the input of information technology or nursing opinion. Now,

SCHOLARLY PROJECT the INS spends a large amount of time ensuring the incorporation of information technology in an effective and manageable manor. This project management process ensures the improvement of both the nursing and patient experience (Bowman-Hayes, 2009). Both personal and professional accountability are essential components of any project. In this case, there was personal accountability in maintaining the preceptor/student relationship to provide a successful project in the organizational setting. The INS should utilize an evidenced-based systematic approach to identifying the problem and to obtain plan outcomes (ANA, 2008). Ongoing research was found to be an essential component of personal accountability throughout the project experience. It is essential to have a high level of empirical knowledge to apply to practice and gain understanding of the project management role. This process provides the ability to accurately predict the potential outcomes ones actions (ANA, 2008). I was blessed to have such a supportive preceptor to help guide my knowledge and insights regarding the outcome of this practicum. Throughout this project, I have found that I have learned to encompass and utilize applied wisdom to support change in nursing practice (ANA, 2008). In relation to professional accountability and the project management role, best practice should be integrated along with appropriate evaluation of performance and outcomes (Salmond, 2013). Project managers plan, budget, organize, control, monitor, and predict. Managers are also functional through coordination, maintenance of practical relationships. Leaders personalize approaches; build strong relationships, and question life through motivational change. Leaders further develop, communicate, motivate, inspire, and promote change (Shriberg, D., & Shriberg, A., 2011). I have found that professional

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SCHOLARLY PROJECT accountability in this role included the ability to apply both management and leadership techniques that would allow the project to be successful. However, it is evident that unforeseen circumstances can interfere with the original project and that it was important to adjust between these roles as needed. It is essential that even with change that every attempt is made to meet the original final deadline of the project (Tran, 2011). Through the project presentation requirement, I was able to identify multiple barriers to the project and arrive at adequate solutions regarding the creation of this new transfer process. Effective communication between the involved disciplines has been an essential component to the management of this project. The INS maintains adequate communications and relationships with other disciplines (ANA, 2008). Direct communication between all involved stakeholders was imperative to implement an effective process (Gardner et al., 2009). In order to successfully work in the informatics area, it will be essential to incorporate and understand the needs of other disciplines as resources. This has led to my improved knowledge in the informatics competency knowledge and skills in organization and human behavior (ANA, 2008, p. 35). I further found that setting reachable goals assisted greatly in the progress of this project. Personal and professional goals must be set in order to reach sustainable outcomes during task implementation. Setting reachable goals related to change and technology usability will assist in the persuasion of the need for technology to improve quality in the healthcare setting (Consolvo, McDonald, & Landay 2009). I believe that I have successfully applied the goal-setting theory. The Goal-Setting Theory relates to the individuals ability to set goals as an active participator and the ability to gauge his or her own progress (Consolvo, McDonald, & Landay 2009). I am constantly revamping my short

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SCHOLARLY PROJECT term goals during the project and identifying the need to change certain components in order to reach these goals. I feel as though I have created a good workflow that fulfills the project timeline. Challenges Initially, there were some challenges within the project that coincided with the student role. Difficulty encompassing the project manager role from the outside and attempting to maintain an IT/quality balance were identified as immediate obstacles. The INS is expected to perform successfully in multidisciplinary settings and in several functional areas (ANA, 2008). Attempting to become part of the organization as a visiting entity was a significant challenge. It was difficult to fully incorporate myself into the project management role initially. I had an initiative to perform within this role throughout the project; however, this was difficult when staff visualized me as an outsider. I was aware that I would need to develop an effective strategy to build relationships within the organization in order to fully meet my project goals. The purpose of this project was to obtain knowledge from both the information technology and clinical quality departments and to utilize this knowledge to improve upon patient care transitions to the local community. I became more aware of the need to promote success in binding technology and quality through the evaluation of information technology (Black et al, 2011). It was also apparent that ongoing review of current electronic processes in multiple department collaboration was an essential component to the role. During this process, I was able to learn something new every day while

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SCHOLARLY PROJECT maintaining the philosophy that converting my knowledge to wisdom will be an ongoing process throughout my career. Issues & Concerns In addition to the immediate challenges, there were also multiple issues and concerns that were recognized within this project. Project size, project timeline and scope creep, and resistance to change were three prominent areas that maintained significant relevance throughout this project experience. The ability to promote strong systematic interactions, in support of the implementation of the plan, is essential to the INS role (ANA, 2008). Meeting organizational needs is also considered an essential component of the INS role. In order to do this adequately, it is important to identify problems that may interfere with this process (Hamelin, 2007). Project Size From the beginning, it was obvious that this project was much larger than originally expected. Project plans must be continually adapted in changing circumstances (Turner, 2008). The original project was expected to be implemented across multiple disciplines. In addition, it was expected that the desktop faxing (electronic transfer) of the documents would be able to be completed during this project. It was determined through lengthy discussion with both the quality and IT departments that the project would need to be separated into multiple components. This portion of the project would be limited to transfer documentation to ECFs only and that the electronic transfer portion of the project would need to be delayed until after the initiation of the electronic format. As I worked in collaboration with other departments and disciplines on this project, daily decisions needed to be made to extend certain portions of the project and to shorten

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SCHOLARLY PROJECT others to meet project deadlines. Even then, it was not always feasible to maintain the initial project schedule or content. While trying to work with an already stressed and busy IT department, I was able to realize the challenges of managing a project. The INS tracks the progress of the plan while reporting and documenting any need to modify from the original strategy (ANA, 2008). Project Timeline-Scope Creep Estimation involvement was utilized to determine the activity timelines for this project. During this process, the estimation of each task was determined by assigned staff and department availability. Each involved department was included in the task estimation as that task or section of the project was being determined. However, it was evident that unforeseen circumstances could interfere with the original project timeline and that it would be important to adjust the timeline as needed. It was essential that even with changes that every attempt is made to meet the original final deadline of the project (Tran, 2011). This project has allowed for additional experience regarding the diversity of informatics and my ability to become familiar with other disciplines care processes. In order to successfully work in the informatics area, it was essential to incorporate and understand the needs of other disciplines as resources. This will also leads directly to my improved knowledge in the informatics competency knowledge and skills in organization and human behavior (ANA, 2008, p. 35). Project management, risk management, and intra-professional communication are also significant aspects of this competency (ANA, 2008). I had some concerns regarding the project timeline and the delays in relation to the IT department schedule. Ms. Saxton and I discussed future resolutions that could be put in

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SCHOLARLY PROJECT place when managing a project. She explained that each project is different and will have its own unique components and challenges. In this case, it is apparent that many other projects took precedence over this project. It was evident that in a real-time scenario that this project may have been delayed or pushed forward and not scheduled until the upcoming Meditech change was initiated. With clear guidance from my preceptor, I was able to move forward with less anxiety regarding the project timeline; however, it remained my goal to maintain the original timeline if possible. Resistance to Change It was apparent that resistance would be a barrier in the project. In healthcare, the adoption of change is often met with resistance (Morton & Wiedenbeck, 2010). Experience also told me that it is within some individuals nature to dislike change. This resistance can often time result in the failure to adopt the technological solutions to problems in healthcare quality (Morton & Wiedenbeck, 2010). The success of the implementation of new electronic procedures is reliant on acceptance of the change by staff members. Having an understanding of factors that influence staff perceptions and acceptance of change prior to the implementation of an EHRS can assist the INS in reducing or preventing staff resistance (Morton & Wiedenbeck, 2010). During meetings with the IT department, I often met resistance with this project. There were multiple concerns voiced by the by the IT director regarding the change related to current and upcoming projects. I was able to ensure that there would be ongoing consideration of these concerns during the project process. In this case, I was able to utilize the critical theory to assist in encouraging direct communication between the IT and clinical quality departments.

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SCHOLARLY PROJECT The critical theory focuses on the perspective that the full participation of all individuals involved in a new process will support quality outcomes. This theory acknowledges the social needs of human beings and their need to voice an opinion regarding change. Therefore, utilization of the Critical Theory through analysis encourages direct communication between stakeholders, organizations, and information systems. The connection between technology and healthcare can sustain improved information quality to support change (Shaw & Stahl, 2011). Project Outcomes This project has allowed me the additional experience regarding the diversity of informatics and my ability to become familiar with other disciplines care processes. In order to successfully work in the informatics area, it will be essential to incorporate and understand the needs of other disciplines as resources. This will also leads directly to my improved knowledge in the informatics competency knowledge and skills in organization and human behavior (ANA, 2008, p. 35). Project management, risk management, and intra-professional communication are also significant aspects of this competency (ANA, 2008). Through experience I have learned that external factors play a larger part in a persons personality, integrity, and character. Leaders are tested through their followers reactions and responses. A true leader must instill confidence in his/her followers through trust, integrity, and respect (Shriberg, D., & Shriberg, A., 2011). Organization culture should provide a vision to explore adequate communication, create successful relationship, and to establish a structured and successful hierarchical culture (Paroby, & White, 2010). I have found from this experience that organizations that focus on these areas also expect

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SCHOLARLY PROJECT ethical leaders. Trust and understanding amongst organizational culture is an essential component for leadership. It is identified that the recognition of leader-member relationships is significant to outcomes, satisfaction, and performance is not a new concept. A focus on organization values can impact positive employee relationships, attitudes, and behaviors (Nahrgang, Morgenson, & Ilies, 2009). Throughout the project, significant relationships were maintained to make the final outcome a success. This could imply that this organization may already have a strong culture, thus supporting a smooth transition for new leadership. I believe that I was able to maintain a stable culture throughout this project by successfully creating trusting relationships and maintaining adequate communication with the appropriate stakeholders. Culturally responsive practices encourage and empower employees to be productive and satisfied (Shriberg, D., & Shriberg, A., 2011). This project was also highly focused on technology. The need to transition the transfer process to an electronic one was long overdue. I find that technology has a huge impact on the future of leadership. The leader of the future will work to serve the followers through encouragement and empowerment (Shriberg, A., & Shriberg, D., 2011). With the upcoming technological changes in organizational structure and environment, I believe that leaders will be utilized very differently than they are today. Technology will assist in the evolution of leadership theories and culture change within organization (Avolio, Walumbwa, Weber, 2009). As the manager of this project, I was able to successfully implement change through the use of technology. It has been proven that organizations that encompass new technology are often more culturally sound than those that do not (Avolio, Walumbwa, Weber, 2009). This

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SCHOLARLY PROJECT project was highly accepted amongst all stakeholders and was found to be a new asset to the quality and medical records departments. In addition, this project created a significant improvement in the care continuity of patients. Overall, it was demonstrated that this project was a success and that the ongoing portions of this project will continue to only improve upon the completion of this stage of the changes in the patient transition process. Analysis of Project This project focused on the finding a way to electronically transfer documentation to disciplines for continuation of care. The addition of this process allowed for the improvement of the current transition process by decreasing data/patient information transfer time. In addition, there is expected to be a reduction in cost through the elimination of paper and the reduction of employee hours during the transition process. This project proved to be a significant challenge as a project manager. As I worked in collaboration with other departments and disciplines on the project, I identified with the idea that a plan must be continually adapted in changing circumstances (Turner, 2008). The goal of this project was to create a successful electronic process to capture restraint and seclusion data. Daily decisions often needed to be made to extend certain portions of the project and possibly shorten others to meet project deadlines. Even then, it was not always feasible to maintain the initial project schedule. While trying to work with an already stressed and busy IT department, I was able to realize the challenges of managing a project. Throughout the project process, I was able to increase my knowledge of and feel more comfortable as a change manager. It was further realized that keeping an open mind regarding the planning and build process, assisted in creating significant relationships

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SCHOLARLY PROJECT within the project team and with those involved in the change. It was also evident that the change manager should be fully informed of the project components as well as the requirements for the final product in order to fulfill the expectations of all stakeholders. Teamwork is an essential component when leading a group or team (Shriberg, D., & Shriberg, A., 2011). Leaders must focus on building team relationships and identifying trust issues when they arise. In addition, leaders should deal with individual team members that do not pull their wait or that are not participating appropriately with the team. I was further able to recognize that trial and error is a good way to adapt a project successfully and that communication is key to isolating the appropriate approach to successfully implement a change (Shriberg, D., & Shriberg, A., 2011). Throughout the project, I began to become more comfortable with the project management process. A good rapport was established with the quality and IT department staff and decreased the resistance associated with the planned change. The INS tracks the progress of the plan while reporting and documenting any need to modify from the original strategy (ANA, 2008). Changes in a project plan can sometimes increase resistance; therefore, it is essential that these changes are handled with appropriate education for the need to adapt the project timeline. The INS must be able to identify with the fears associated with the change and understand the barriers associated with this fear of change (Reid & Gallagher, 2011). Understanding resistance can aid in strengthening organization and individuals during change (Reid & Gallagher, 2011). I was able to sense that I had been able to assist with the understanding of the need for this change and assist in reflecting the resistance that

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SCHOLARLY PROJECT I have received from staff. It was then obvious that most staff members were on board with the change and effectively participated in the process to make the change a success. During the project, I was a little intimidated by the build process. This was new to me and it has been challenging trying to understand all of the ins and outs of this process. It was invaluable to have the IT department to consult with during multiple objectives. It became evident that in order to build an appropriate electronic transfer document; I would need to utilize all of my available resources. Effective communication between the involved disciplines has been an essential component to the management of this project. The INS maintains adequate communications and relationships with other disciplines (ANA, 2008). It was further realized that direct communication between all involved stakeholders would be imperative to implement an effective process (Gardner et al., 2009). I eventually began to find my way in the development of processes in informatics. Though many of these tasks were new to me, I was able to obtain a great deal of knowledge regarding creating, maintaining, and obtaining data to improve care transitions. The INS continues to engage in the development, implementation, and evaluation of procedures that improve quality practice (ANA, 2008, p. 79). During this process the INS will also identify factors that will be efficient in improving quality care and safety (ANA, 2008). The project has thus far been successful and the new electronic transfer document will be implemented in August, 2013. Future Project Recommendations In my experience, this individualized wisdom allows a great leader to see the big picture and to be able to view their environment from multiple aspects. Wisdom is a social practice derived through ideational, subjective, and ethical knowledge. A wise individual

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SCHOLARLY PROJECT uses a blend of intelligence, creativity, experience, and virtue in their actions. A great leader is able to incorporate their wisdom into their leadership approach (McKenna, Rooney, & Boal, 2009). Those with wisdom are thought to make sound judgments regarding the betterment of their environment (Shriberg, D., & Shriberg, A., 2011). Wisdom can only be gained and applied through education, experience, and the ability to apply learned knowledge in the appropriate situation. It is obvious that the craft of project management is one that cannot be perfected in the beginning stages of the INS role. I have learned many lessons through the project management process that can be applied to future projects as I move on with this career. Two significant changes that come to mind include improved project planning and resource availability. The project manager is highly involved in creation, troubleshooting, implementation and integration of the health technology programs. Project management and the art of employing new programs into the acute care environment can be complex (Shriberg, D., & Shriberg, A., 2011). In future projects, it will be essential to identify the appropriate project plan prior to the initiation of the project. It was obvious that the student role prevented this ability. I was unable to identify in advance the size of this project and the need to break it up into multiple stages. The lack of foresight into this issue was significantly related to lack of knowledge related to the project process. In addition, it was difficult to determine the availability of resources so far in advance. The project guidelines were created via estimation and prepared multiple months in advance to adhere to my student requirements. Future projects will entail an improved analysis of available resources that are needed during the project timeline.

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SCHOLARLY PROJECT The competencies required for the INS continue to be an ongoing progression in nursing, although continued research identifies that integral incorporation of informatics into nursing programs, adequate clinical experience coupled with computer literacy, proficient staff development and a confident leadership style are basic needs of the informatics nurse role (ANA, 2008). In the INS role 15% percent of informatics nurse specialists gain their knowledge from on the job experience, only 56% have reported having an advanced degree of masters in nursing or higher, and 44% gain their clinical experience in the CCU setting (Anderson & Sensmeier, 2011). It is obvious that ongoing experience can only improve upon my future project endeavors. Conclusion This project entailed finding a successful electronic format for hospital to community patient transfers. The project was initiated by identifying adequate stakeholders including clinical quality, case management, and local ECFs. The project progressed in an efficient manor and was continuously reviewed by myself and Ms. Saxton for any issues/concerns. Multiple issues were identified throughout the project including project size, project timeline and scope creep, and resistance to change. Each concern was defined in a timely manner with the implementation of successful solutions. The project size was decreased by creating multiple phases that will be completed at different times. Scope creep was addressed through the ongoing review of project deadlines and consistent communication with other disciplines. Finally, resistance was addressed through anticipation and ongoing communication with the stakeholders.

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SCHOLARLY PROJECT Overall, the project was evaluated and considered a success. The electronic transfer form platform was presented to the stakeholders and approved by all involved. Recommendations to improve future projects include additional research regarding project size/timeline and resource availability. This project was an essential component to my education and served as a significant learning experience.

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SCHOLARLY PROJECT References American Nurses Association (ANA). Nursing Informatics: Scope & Standards of Practice. Silver Spring, MD: Nursebooks.org Avolio, B.M., Walumbwa, F., & Weber, T. J. (2009). Leadership: Current theories, research, and future directions. Annual Review of Psychology, 60, 421-449. doi:10.1146/annurev.psych.60.110707.163621 Black, A. D., Car, J., Pagliari, C., Anandan, C., Cresswell, K., Bokun, T., . . . Sheikh, A. (2011). The impact of eHealth on the quality of safety of health care: A systemic overview. PLOS Medicine, 8(1), 1-16. doi:10.1371/journal.pmed.1000387 Bowman-Hayes, J. (2009). The role of the informatics nurse specialist. AORN Journal, 90(6), 922-924. doi:org.libcat.ferris.edu/10.1016/j.aorn.2009.11.042 Carayon, P., Alyousef, B., Hoonakker, P., Hundt, A. S., Cartmill, R., Tomcavage, J., . . . Walker, J. (2012). Challenges to care coordination posed by the use of multiple health IT applications. Journal of Prevention, Assessment, & Rehabilitation, 41(1), 4468-4473. doi:10.3233/WOR-2012-0746-4468 Consolvo, S., Mcdonald, D. W., & Landay, J. A. (2009). Theory-driven design strategies for technologies that support behavior change in everyday life. CHI, Online, 405414. Retrieved from http://homepage.psy.utexas.edu/ Gardner, J. Dowd, A.M., Mason, C., Ashworth, P. (2009). A framework for stakeholder engagement on climate adaption. CSIRO Climate Adaption Flagship Working paper No.3. Retrieved from http://www.csiro.au/resources/CAF-working-papers.html Goroski, A. D. & Clarke, J. L. (2011). Engaging communities in improving care transitions

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SCHOLARLY PROJECT and reducing utilization. Prescriptions for Excellence in Healthcare, 13(1), 1-3. Retrieved from jdc.jefferson.edu Grandison, T., Lan, C., Hsiao, I., Chang, H., & Pai, H. (2012). Privacy protection for personal data integration and sharing in care coordination services: A case study on wellness cloud. Service Operations and Logistics, and Informatics, 111-116. doi:10.1109/SOLI.2012.6273514 Johnson, J. K. & Barach, P. (2009). Patient care handovers: what will it take to ensure quality and safety during times of transition? MJA, 190 (11), 110-112. Kalshoven K., Den Hartog, D. N. (2009). Ethical leader behavior and leader effectiveness: The role of prototypicality and trust. International Journal of Leadership Studies, 5(2), 102-119. Retrieved from dare.uva.nl Lechuga, V.M., Clerc, L. N., & Howell, A. K. (2009). Power, privilege, and learning: Facilitating encountered situations to promote social Justice. Journal of college Student Development, 50(2), 229-244. Doi:101353/csd.0.0064 Lee, E. S., McDonald, D. W., Anderson, N., & Tarczy-Hornoch, P. (2009). Incorporating collaborator concepts into informatics in support of translational interdisciplinary biomedical research. International Journal of Medical Informatics, 78(1), 10-21. doi:10.1016/j.ijmedinf.2008.06.011 Marjoua, Y., & Bozic, K. (2012). Brief history of quality improvement in U.S. healthcare. Current Relevant Musculoskeletal Medicine, in press. doi:10.1007/s12178-0129137-8 McKenna, B., Rooney, D., & Boal, K. B. (2009). Wisdom principles as a meta-theoretical basis for evaluating leadership. The Leadership Quarterly, 20, 177-190.

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SCHOLARLY PROJECT Morton, M. E. & Wiedenbeck, S. (2010). EHR acceptance factors in ambulatory care: A survey of physician perceptions. Perspectives in Health Information Management, 7(1), 1-17. Mujtaba, B. G., & Sungkhawan, J. (2009). Situational leadership and diversity management coaching skills. Journal of Diversity management, 4(1), 1-11. Nahrgang, J. D., Morgeson, F. P., Ilies, R. (2009). The development of leader-member exchanges: Exploring how personality and performance influence leader and member relationships over time. Organizational Behavior and Human Decision Processes, 108, 256-266. doi:10.1016/j.obhdp.2008.09.002 Paroby, D., & White, D. W. (2010). The role of shared vision and ethics in building and effective learning organizations. Southern Journal of Business & Ethics, 2, 133142. Pinsonneault, A., Dakshinamoorthy, V., Reidel, K., & Tamblyn, R. (2012). The impact of IT on quality of care: Evaluation of an integrated chronic disease management system. 45th Hawaii International Conference on System Sciences, 2947-2956. doi:10.1109/HICSS.2012.569 Reed, J. & Gallagher, M. (2011). Resistance to change: Friend or foe. Health Progress, 92(4), 14-19. Retrieved from http://www.chausa.org/2011_Annual_Index.aspx Shaw, M.C., & Stahl, B.C. (2011). On quality and communication: The relevance of critical theory to health informatics. Journal of the Association for Information Systems, 12(3), 255-273. Shriberg, D., & Shriberg, A. (2011). Practicing leadership: principles and applications (4th ed.). Hoboken, NJ: John Wiley and Sons, Inc.

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SCHOLARLY PROJECT Threan, I., Bair, B., Mullin, S., & Weir, C. R. (2012). Characterizing information transfer by using a joint cognitive systems model to improve continuity of care in the aged. International Journal of Medical Informatics, 81(7), 435-441. doi:10.1016/j.ijmedinf.2011.11.006 Tran, C. (2011). Project Management: The Delphi Technique. Retrieved from www.helium.com Turner, J. R. (2008). The Handbook of Project-based Management (3 ed.). New York: McGraw-Hill Professional. Williams, C., Mostashari, F., Mertz, K. Hogin, E., & Atwal, P. (2011). From the office of the national coordinator: The strategy for advancing the exchange of health information. Health Affairs, 31(3), 527-536. doi:10.1377/hlthaff.2011.1314 Wohlauer, M. V., Arora, V. M., Horwitz, L. I., Bass, E. J., Mahar, S. E., & Philibert, I. (2012). The patient handoff: A comprehensive curricular blueprint for resident education to improve continuity of care. Academic Medicine, 87(4), 1-8. doi:10.1097/ACM.0b013e18248e766

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SCHOLARLY PROJECT Appendix A Completed Evaluation Tool Preceptor

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SCHOLARLY PROJECT Appendix B Completed Evaluation Tool - Student Objectives/Standard/Competency I. Standard VIIII: Enhances quality of practice and quality of care through effective informatics practice. (Rating 3)

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Comments: I feel as though I have become proficient in the ANA standard VIII of informatics practice through my participation in this project. Though this project, I have learned a great deal regarding the practice of a project manager and the use of informatics to enhance nursing practice. Though I may have a great deal more to learn regarding this practice, I genuinely feel that have met the goals of completing this competency. II. Utilizes appropriate technology techniques to improve nursing practice. (Rating 2)

Comments: It is evident that I have learned to apply informatics practice to improve nursing practice through this project. On the other hand, with the abundance of innovative practice in informatics and the continued growth in this practice area, U feel that I have just touched on the true capability of informatics It is my goal to continue to obtain knowledge in the area of technology and apply new informatics techniques to the nursing process. III. Understands process of recommendations to improve practice. (Rating 3)

Comments: Practicing implementation in the realm of informatics can be a challenge; however, I feel that I was able to overcome any barriers or challenges in this area during the project. Through the course of the project I fell that I was able to effectively improve nursing practice through adequate recommendations. It is my goal to continue to utilize this same practice to crate many more successful informatics methods. IV. Collaborates with Information Technology and Quality Department to identify appropriate Technology needs. (Rating 3)

Comments: I have worked I many positions that require interdisciplinary teams. Therefore, it was not difficult for me to incorporate this practice into the project. I feel as though I am proficient in this area and that adequate relationships were obtained even with certain barriers. I was able to fully engage the needed entities to make this project successful. V. Builds relationships with the disciplines Involved in the project. (Rating 3)

Comments: As previously stated, adequate relationships were formed throughout the project process. In addition, adequate communication was maintained with all stakeholders.

VI.

Information technology knowledge and competency; Understands build process

SCHOLARLY PROJECT for new technology. (Rating 2)

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Comments: It is evident that I have learned a great deal about the technology process. On the other hand, with the abundance of innovative practice in informatics and the continued growth in this practice area, I feel that I have a ton of knowledge to continue to gain in the information technology build portion of this realm. It is my goal to continue to work towards proficiency in this area. VII. Project Management Skill: Project safety, Project timeline, Project success. (Rating 3).

Comments: I feel that throughout the project I was able to maintain a successful timeline. Though there were some delays, the project went on to be completed timely and successfully. VIII. Project risk assessment skills. (Rating 2)

Comments: I definitely feel that I could improve in this area. The size of the project as well as the availability of resources was a huge project risk. It was identified after the initiation of the project that there would need to be multiple phases. In addition, resources for this project were limited. Even though some of these issues were student status related, I would still like to take full responsibility for this project; therefore, I see room for improvement in this area. IX. Collaborates with disciplines involved in the project. (Rating 3).

Comments: As previously stated, this is an area of strength for me. I do not feel that there were any concerns regarding collaboration. Many of the IS and CQ staff had multiple complements in regards to the end product of this project. X. Able to implement new transition process successfully. (Rating 3).

Comments: The new process was initiated and has been a success. I feel that even with the challenges of this project, that it was a success. XI. Utilized adequate education techniques for staff on new transitions process. (Rating 3).

Comments: During the education process, I was able to provide one-on-one education as well as online education related to the small group of end users. Both of these education techniques were successful and the case management staff felt comfortable using the form by the implementation portion of the project. Self Evaluation by: Jennifer R. Williams Date: August 3rd, 2013

SCHOLARLY PROJECT Appendix C Project Deliverable Platform

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This page is the starting platform for the transfer form in the Electronic Medical Record (EMR). Case managers will have the long term care transfer choice within their favorites; this way they will not have to search for the form. The form appears on this screen when the document button to the right is chosen. Once the long term care transfer module is chosen, the form will appear as seen on the next screen.

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This page is the admission/transfer section of the long term care transfer from. This section contains the patient demographic information, contact information, and nursing assessment of patients current performance status. Once this section is complete, the case manager can select the orders page at the top of this screen (see next slide).

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This section of the long term care transfer form contains the patient/data and orders required for a transfer to ECF. Many of these areas can be automatically populated from the EMR. The remainder of the form has a point and click selection format with the option to add any comments as needed. Once this section is complete, it can be saved as a draft until the patient is on discharge. Once the physician is ready to transfer the patient, the case manager will need to add the final sections to the form to initiate retrieval of current vitals, I&O, and physical assessment information.

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When a add a section button is selected the following favorites list will appear on the screen. The case manager will then be able to add these selections.

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Once the exam and meds/IV/IO sections are added, they will appear at the top of the screen for completion. The exam screen contains the physicians most recent documented physical assessment. This assessment can be altered but this is not typically necessary unless there have been recent changes with the patient. Once completed, the case manager may then select the meds/IV/IO choice at the top of the screen.

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This screen pulls the patients hospital medications, most recent date given, and whether the medications have been discontinued. In addition, the most recent vital signs are obtained from the EMR along with the last 72 hours of recorded vital signs and I&Os. Once this section is complete, the case manager will save the form and then move on to the ISIGN process.

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When saved, there will be an opportunity to add a provider to the left. The case manger will then need to add the discharge physician; this will allow the physician to review and sign the form once the case manger has signed off. The case manger will then select signed to the right and then select save one more time.

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The appearance of this screen identified that the long term care transfer form has been saved and signed by me. The case manger will then need to notify the discharge physician that he may view, input changes, save, and sign the form for the transfer.

SCHOLARLY PROJECT Appendix D Project Deliverable Long Term Care Transfer Form

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SCHOLARLY PROJECT Appendix E Preceptor/Organization Agreement

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SCHOLARLY PROJECT Appendix F Literature Resource List Alder-Milstein, J. & Jha, A. K. (2012). Sharing clinical data electronically: A critical challenge for fixing the health care system. The Journal of the American Medical Association, 307(16), 1695-1696. doi:10.1001/jama.2012.525 American Nurses Association (ANA). Nursing Informatics: Scope & Standards of Practice. Silver Spring, MD: Nursebooks.org Bello, J., Quinn, P., Horrell, L., & Thede, L. Q. (2011). Maintaining patient safety through innovation: an electronic SBAR communication tool. Computers, Informatics, Nursing, 29(9), 481-483. doi:10.1097/NCN.0b013e31822ea44d Bourgeois, F., Olson, K. L., & Mandi, K. D. (2010). Patients treated at multiple acute health care facilities: Quantifying information fragmentation. Archives of Internal Medicine, 170(22), 1989-1995. Doi:10.1001/archinternmed.2010.439 Bowman-Hayes, J. (2009). The role of the informatics nurse specialist. AORN Journal, 90(6), 922-924. doi:org.libcat.ferris.edu/10.1016/j.aorn.2009.11.042 Carayon, P., Alyousef, B., Hoonakker, P., Hundt, A. S., Cartmill, R., Tomcavage, J., . . . & Walker, J. (2012). Challenges to care coordination posed by the use of multiple health IT applications. Journal of Prevention, Assessment, & Rehabilitation, 41(1), 4468-4473. doi:10.3233/WOR-2012-0746-4468 Chen, X., Berry, D., & Grimson, W. (2009). Identity management to support access control in e-health systems. Dublin Institute of Technology. Retrieved form http://arrow.dit.ie/teapotcon/20 Cortelyou-Ward, K., Swain, A., & Yeung, T. (2012). Mitigating error vulnerability at the

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SCHOLARLY PROJECT transition of care through the use of health IT applications. Journal of Medical Systems, 36(6), 3825-3831. doi:10.1007/s10916-012-9855-x Dalal, A. K., Schnipper, J. L., Poon, E. G., Williams, D. H., Rossi-Roh, K., . . . & Roy, C. L. (2012). Design and implementation of an automated email notification system for results of tests pending at discharge. Journal of the American Medical Informatics Association, 19(4), 523-528. doi:10.1136/amiajnl-2011-000615 Freitag, M. & Carroll, V. S. (2011). Handoff communication: Using failure modes and effects analysis to improve the transition in care process. Quality Management in Health Care, 20(2), 103-109. doi:10.1097/QMH.0b013e3182136f58 Gibbons, M. C. & Casale, C. R. (2010). Reducing disparities in health care quality: The role of health IT in under resourced settings. Medical Care Research and Review, 67(5), 155S-162S. doi:10.1117/1077558710376202 Goroski, A. D. & Clarke, J. L. (2011). Engaging communities in improving care transitions and reducing utilization. Prescriptions for Excellence in Healthcare, 13(1), 1-3. Retrieved from jdc.jefferson.edu Grandison, T., Lan, C., Hsiao, I., Chang, H., & Pai, H. (2012). Privacy protection for personal data integration and sharing in care coordination services: A case study on wellness cloud. Service Operations and Logistics, and Informatics, 111-116. doi:10.1109/SOLI.2012.6273514 Haddad, M. & Chetty, G. (2012). Development of a smart e-health portal for chronic disease management. Computer Science, 7440, 284-291. doi:10.1007/978-3-64233065-0_30 Hustey, F. M. & Palmer, R. M. (2010). An internet-based communication network for

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SCHOLARLY PROJECT information transfer during patient transitions from skilled nursing facility to the emergency department. Journal of the American Geriatrics Society, 58(6), 11481152. doi:10.1111/j.1532-5415.2010.02864.x Johnson, J. K. & Barach, P. (2009). Patient care handovers: what will it take to ensure quality and safety during times of transition? MJA, 190 (11), 110-112. Kelly, N. A., Mahoney, D. F., Bonner, A., & OMalley, T. (2012). Use of a transitional minimum data set (TMDS) to improve communication between nursing home and emergency department providers. Journal of American Medical Directors Association, 13(1), 85.e9-85.e15. doi:10.1016/j.jamda.2011.02.007 Lopez-Cantor, M. T. (2012). Comparative effectiveness and efficacy research and analysis for practice. Transitional Care, 3, 165-180. doi:10.1007/978-3-642-23144-5_10 Marjoua, Y. & Bozic, K. (2012). Brief history of quality improvement in U.S. healthcare. Current Relevant Musculoskeletal Medicine, in press. doi:10.1007/s12178-0129137-8 McLeod, S. A. (2008). Simply Psychology; Likert Scale. Retrieved from http://www.simplypsychology.org/likert-scale.html Murphy, D. R., Reis, B., Kadiyala, H., Hirani, K., Sittig, D. F., . . .& Singh, H. (2012). Electronic health record-based messages to primary care providers: Valuable information or just noise? Archives of Internal Medicine, 172(3),283-285. doi:10.1001/archinternmed.2011.740. Pinsonneault, A., Dakshinamoorthy, V., Reidel, K., & Tamblyn, R. (2012). The impact of

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SCHOLARLY PROJECT IT on quality of care: Evaluation of an integrated chronic disease management system. 45th Hawaii International Conference on System Sciences, 2947-2956. doi:10.1109/HICSS.2012.569 Polit, D.F., & Beck, C.T. (2012). Nursing Research: Generating and Assessing Evidence for Nursing Practice (9th Ed.). Philadelphia, PA: Wolters Kluwer Health. Rudin, R. S., Simon, S. R., Volk, L. A., Tripathi, M, Bates, D. (2009). Understanding the

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decisions and values of stakeholders in health information exchanges: Experiences from Massachusetts. American Journal of Public Health, 99(5), 950-955. Doi:10.2105/AJPH.2008.144873Rudin, R., Volk, L., & Simon, S., D. (2011). What affects clinicians usage of health information exchange? Applied Clinical Informatics, 2(3), 250-262. doi:10.4338/ACI-2011-03-RA-0021 Rudin, R. S., Salzberg, C. A., Szolovits, P., Volk, L., & Simon, S. R. (2011). Care transitions as opportunities for clinicians to use data exchange services: how often do they occur? Journal of American Medical Informatics Association, 18, 853-858. doi:10.1136/amiajnl-2010-000072 Ruj, S., Nayak, A., & Stojmenovic, I. (2011). DACC: Distributed access control in clouds. 2011 International Joint Conference of IEEE. doi:10.1109/TrustCom.2011.15 Threan, I., Bair, B., Mullin, S., & Weir, C. R. (2012). Characterizing information transfer by using a joint cognitive systems model to improve continuity of care in the aged. International Journal of Medical Informatics, 81(7), 435-441. doi:10.1016/j.ijmedinf.2011.11.006 van Walraven, C., Taljaard, M., Bell, C. M., Etchells, E., Zarnke, K. B., Stiell, I. G.,

SCHOLARLY PROJECT & Forster, A. J. (2008). Information exchange among physicians caring for the same patient in the community. CMAJ, 179(10), 10131018. doi:10.1503/cmaj.080430 Weissman, J. S. & Hasnain-Wynia, R. (2012). Advancing health care equity through improved data collection. The New England Journal of Medicine, 364(24), 22762277. Williams, C., Mostashari, F., Mertz, K. Hogin, E., & Atwal, P. (2011). From the office of the national coordinator: The strategy for advancing the exchange of health information. Health Affairs, 31(3), 527-536. doi:10.1377/hlthaff.2011.1314 Wohlauer, M. V., Arora, V. M., Horwitz, L. I., Bass, E. J., Mahar, S. E., & Philibert, I. (2012). The patient handoff: A comprehensive curricular blueprint for resident education to improve continuity of care. Academic Medicine, 87(4), 1-8. doi:10.1097/ACM.0b013e18248e766 Zamora, Z., McCall, B., Patel, L., Biese, K., LaMantia, M., . . . & Kizer, J. (2012). Implementation of a web-based system to improve the transitional care of older adults. Journal of Nursing Care Quality, 27(2), 182-189. doi:10.1097/NCQ.obo13e318237af71

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