New Technologies In Healthcare: Telehealth Usage Sample College Essay


Emerging technologies in the healthcare industry have improved the provision of healthcare services to patients across the world. Most health care centers have focused on improving telecare services within their organizations. The global health research agenda has also focused on improving collaboration between countries on identifying and testing new technologies in health care. Some of the telehealth technologies include video conferencing, which has been adopted in most telecare services.

Moreover, the use of telephones in monitoring patients has been important in telehealth. New research studies have also been focused on improving telehealth services. Essentially, telehealth is useful across all units of caregiving facilities. This paper will perform a literature review on new technologies in healthcare. Specifically, the paper will examine the use of telehealth in healthcare (White, Krousel-Wood, & Mather, 2001).

Literature review

The health care sector is believed to be more than a decade behind other sectors in computing. However, this trend has changed. New computer and communication technologies are congregating to develop useful computing tools for the healthcare sector. According to White, computer and communications have enabled professionals to experiment using numerous applications that provide opportunities or achieving clinical demands.

Moreover, the authors posit that increasing demand for physician productivity has brought about the need to utilize technology in enhancing healthcare (White, Krousel-Wood, & Mather, 2001). Moreover, the authors believe that the use of telehealth has enabled health professionals to participate in crucial educational and research activities. According to the authors, telehealth can be defined as an inclusive term for describing support for long-distance clinical healthcare.

Moreover, they argue that telehealth is utilized for long-distance professional and patient health-related education. Additionally, they argue that telehealth also enhances health administration and public health. According to the authors, educational opportunities are increasing exponentially for individuals who have limited access to traditional courses. In this regard, telehealth has come in handy in improving opportunities for studies in medicine. Telehealth has enabled instant transmission of research and medical information across the globe. The authors argue that telehealth has narrowed the gap previously seen in data transmission (White, Krousel-Wood, & Mather, 2001).

Almost every federal agency has a website that provides health data. Moreover, healthcare facilities have integrated clinical management systems, which are aimed at assisting in the management of patient information. Additionally, integrated clinical management systems can also be utilized to monitor and manage patients with chronic illnesses. Moreover, telehealth can be utilized to provide professional ways of integrating patient education and monitoring.

Furthermore, telehealth can be utilized to provide capable ways of integrating consultations and follow-up with patients (White, Krousel-Wood, & Mather, 2001). Telehealth is also important in providing ways of integrating patient support during and after caregiving. Besides, the use of technology in health care can enable the interface of clinical management and administrative functions to provide healthcare practitioners with the opportunity to systematize their activities and services. The authors argue that increasing capacities and capabilities in information systems are the forefront of promoting telehealth (White, Krousel-Wood, & Mather, 2001).

Another article by Bashshur provides an evaluation of new technologies in the healthcare sector. The paper examines the status of evaluation research in telemedicine. Moreover, it examines the context of research in telemedicine. In the process, the author proposes two main strategies for meeting the significant policy in telemedicine. Also, the authors provide ways of dealing with programmatic issues in telemedicine (Bashshur, Shannon, & Sapci, 2005).

Moreover, the authors explain the evolution of evaluation research in the United States. Additionally, the authors describe an exclusive typology and the requirements for a successful evaluation. The authors also discuss the limitations of a successful evaluation. Furthermore, the authors give detailed information on major trends that exist in empirical studies. Importantly, the authors proposed two main strategies that could be utilized to come up with definitive findings.

The two strategies were found to be able to assess the existing empirical evidence. These were noted as large-scale experimental studies for assessing the evidence. Besides, it also consisted of empirical and theoretical triangulation for assessment purposes. The authors noted that the emergence of telemedicine came in to substitute in-person medical care. Moreover, telemedicine came in as an integrated system for providing medical care. The need for telemedicine was supported by many experimental data.

These were from different settings across the field. Moreover, clinical applications utilized proved that telemedicine was useful to society although it had not been accepted universally. The authors also argue that rigorous scientific studies in the health sector have shown the need for ultimate adoption as well as diffusion of telemedicine in medical care (Bashshur, Shannon, & Sapci, 2005). Telemedicine has been found to evolve at a fast pace to such an extent that it encompassed all clinical areas. Moreover, it has proliferated to include clinical areas in public health and medical education. Besides, telemedicine has made strides into health education.

Essentially, telemedicine has grown as an important component of telehealth. The authors evaluate telemedicine, its benefits, and its applicability. The authors also discuss the fundamental issues and requirements needed for a successful scientific valuation of telemedicine. They also argue that the evaluation of healthcare programs involves both political and scientific realities. While scientific modalities deal with the requirements, political realities deal with public policies (Bashshur, Shannon, & Sapci, 2005).

Home telehealth has also been found to reduce healthcare costs. Essentially, the use of telehealth in remote settings can greatly reduce costs incurred in healthcare (Noel, Vogel, Erdos, Cornwall, & Levin, 2004). This is according to Noel et al., who conducted a study on the effectiveness of telehealth at home. This study was conducted to determine if home telehealth could reduce the cost of healthcare as well as improve the quality of life.

This study was conducted by integrating telehealth with the health facility’s electronic medical records system. Moreover, the study was done in comparison with the usual home healthcare services done for elderly people with complex co-morbidities. During the study, patients enrolled as participants in the study were identified through the medical center’s information database. Patients enrolled in telehealth received home telehealth units, which were integrated with standard phone lines for communications with the medical center. Moreover, peripheral devices for monitoring crucial signs as well as valid questionnaires were utilized in evaluating the quality of life during the study.

Essentially, these peripheral devices were FDA approved for quality purposes (Noel, Vogel, Erdos, Cornwall, & Levin, 2004). In the process, data that was found to be out of range triggered alert responses to nurse case managers. It should be noted that live video or audio was not incorporated in the study. However, templated progress notes were utilized to enable seamless data entry of patient records electronically (Noel, Vogel, Erdos, Cornwall, & Levin, 2004).

104 participants were involved in the study. These participants had complex heart failure, diabetes mellitus, or a chronic lung infection. These participants were assigned randomly to the control group or intervention group for between 6 and 12 months. Additionally, both parametric and non-parametric analysis was done on the results of the study. The outcomes were costs, health resource use, and subjective/objective quality of life.

As expected, the intervention group recorded significant improvements as compared to the control group. For instance, there was a reduced number of days in bed-care for the intervention group. Moreover, there were reduced emergency room visits. Moreover, patient satisfaction levels improved. Eventually, it was concluded that integrating home telehealth with the medical center’s electronic database considerably reduced the cost of healthcare (Noel, Vogel, Erdos, Cornwall, & Levin, 2004).

The next article compares patient outcomes and costs for home healthcare provided through telemedicine and traditional means (Finkelstein, Speedie, & Potthoff, 2006). The authors utilized patients receiving skilled nursing care from home. The study utilized a randomized control trial for three groups of participants. The first group was named control group C. this group received traditional skilled nursing care from home. In contrast, the second group was named video intervention group V. this group received traditional skilled nursing care from home through virtual visits which utilized videoconferencing technology (Finkelstein, Speedie, & Potthoff, 2006).

The third group was named the monitoring intervention group M. this group received skilled nursing care from home through virtual visits which utilized videoconferencing technology. For the third group, physiological monitoring was also done to observe patients’ underlying chronic state (Finkelstein, Speedie, & Potthoff, 2006). The outcome of the study showed that discharge to a higher level of caregiving in about six months showed 42% for group 1, 21% for group 2, and 15% for group 3. Besides, the resting outcome showed little or no difference in mortality between the groups in the study.

In this case, morbidity was evaluated in terms of changes in knowledge, status sales, and behavior as provided for in the Omaha Assessment Tool (Finkelstein, Speedie, & Potthoff, 2006). This assessment also showed no significant difference between the groups. However, there were increased scores for daily living activities among the second and third groups. The average cost for traditional home visits was $48.27 while that for video conferencing group was $22.11. Additionally, the average cost for monitoring group visits was $32.06, for congestive heart failure patients (Finkelstein, Speedie, & Potthoff, 2006).

Moreover, the average cost for monitoring group visits was $38.62, for chronic pulmonary disease patients. From the results observed, it was clear that groups 2 and 3 utilized fewer resources as compared to the first group (Finkelstein, Speedie, & Potthoff, 2006). In essence, the study confirmed that virtual visits that occurred between home healthcare nurses and chronically ill patients from home were important in improving patient outcomes. Also, this was done at a lower cost than that of traditional skilled nursing care that required face-to-face visits (Finkelstein, Speedie, & Potthoff, 2006).

On the other hand, Postema et al. argue that the introduction of home telecare has the propensity of bringing mixed results in practice. The authors investigate crucial factors that influence the success of implementing telecare. Consequently, the investigation finds that financial and technical stability is crucial to achieving success (Postema, Peeters, & Friele, 2012). Moreover, the investigation also finds that implementation strategy as well as the alignment of goals is essential to the success of telecare. Moreover, the authors emphasize a comprehensive rollout for initial implementation.

This research was conducted to establish the key factors that would influence se of video communication in healthcare (Postema, Peeters, & Friele, 2012). The authors argue that crucial factors for implementation success of telecare are found in three main organizational climates namely technology available, the strategy of implementation, and telecare implementation at home. This research was conducted through interviews in 3 caregiving organizations in which 27 respondents were interviewed (Postema, Peeters, & Friele, 2012). The respondents were from different levels inside and outside the caregiving organizations.

Moreover, the study utilized implementation determinants from previous research (Postema, Peeters, & Friele, 2012). These were used to categorize and organize a framework for interviews. The resulting outcomes conveyed the fact that successful implementation of telecare relied on the stability of both external and technical environments. Moreover, it was found that the implementation strategy was crucial to the success of telecare.

Furthermore, it was found that the methods of aligning the organization concerning its goals were also important in helping achieve success (Postema, Peeters, & Friele, 2012). Essentially, it was realized that video communication was becoming increasingly important in telecare. Moreover, the fact that experimenting with video communication was giving mixed results did not stop further scrutiny on its viability.

Organizing telecare was found to be imperative especially when key factors that influence its implementation are considered. The authors suggested that workable strategies be utilized in helping the implementation process for successful telecare service. The article showed that home telecare is increasingly becoming important in helping nurses discharge their duties. Moreover, the successful implementation of home telecare through video conferencing was found to improve the quality of life for patients under telecare intervention (Postema, Peeters, & Friele, 2012).

In another study conducted in Florida and Puerto Rico, Use of technology and care coordination was experimented to show the usefulness of telehealth (Kobb, Hoffman, Lodge, & Kline, 2004). On e of the chosen initiative for this study was the rural care project, which involved clinical demonstrations pilots. This was an initiative of the Veteran health Administration through its Sunshine network in Puerto Rico and Florida.

This project involved three care coordinators namely one social worker and two nursing practitioners (Kobb, Hoffman, Lodge, & Kline, 2004). The three healthcare practitioners collaborated with primary health care providers to manage high risk as well as high-cost veterans who had multiple chronic illnesses. Some of the illnesses covered in the study included heart failure and diabetes, among others (Kobb, Hoffman, Lodge, & Kline, 2004).

During the study, health care practitioners utilized telehealth devices to monitor patients to prevent possibilities of health crises. Moreover, the health practitioners utilized telehealth devices to educate patients on ways of improving their quality of life (Kobb, Hoffman, Lodge, & Kline, 2004). This research was conducted using the quasi-experimental design, which utilized the nonequivalent control group.

The control group was composed of usual care veterans. Information for the study was got through interviews with the subjects as well as providers. The outcome was analyzed statistically using a series of repeated-measure of covariance modeling (Kobb, Hoffman, Lodge, & Kline, 2004). The University of Maryland’s research team had designed the statistical analysis utilized in the study. The resulting outcome showed that care coordination using technology was significant in reducing hospital admissions. Also, it was found that telehealth is important in reducing the number of bed days of care patients take in hospitals (Kobb, Hoffman, Lodge, & Kline, 2004).

Besides, the study also found that care coordination using technology helps reduce emergency room visits (Kobb, Hoffman, Lodge, & Kline, 2004). Besides, care coordination utilizing technology was found to reduce prescriptions for patients. Furthermore, care coordination using technology was found to offer high provider and patient satisfaction. In essence, veterans were found to have improved perception of physical health because of care coordination using technology (Kobb, Hoffman, Lodge, & Kline, 2004).

According to one of the latest global research agenda on healthcare, personalized telehealth is one of the most important issues seriously considered in current and future health plans (Dinesen, Nonnecke, Lindeman, Toft, Kidholm, Jethwani, Young, Spindler, Oestergaard, Southard, Gutierrez, Anderson, Albert, Han, & Nesbitt, 2016). Telehealth plays a significant role in global healthcare service (Dinesen et al., 2016).

Moreover, the authors argue that it will be increasingly significant for the development of a strong evidence base of practicable telehealth solutions. Moreover, these solutions should be successful and innovative telehealth solutions. In essence, the study wanted a sustainable and scalable telehealth program. The research was aimed at two main tasks (Dinesen et al., 2016). The first task was to describe the challenges that hindered the promotion of telehealth implementation. This task was aimed at enabling advanced adoption of effective telehealth programs. The second task was to present a global investigative agenda for tailored telehealth (Dinesen et al., 2016).

Specifically, this task was aimed at managing chronic illnesses. This study utilized evidence from the European Union and the United States. In essence, the study provided a global overview of the existing state of telehealth services as well as its benefits to patients and society (Dinesen et al., 2016). Also, the study provided fundamental principles that need to be addressed to proceed with the status quo. Furthermore, the study provided the framework for existing and future research programs in telehealth that focuses on personalized care.

The study also emphasized the need for a framework that initiates research on telehealth for personalized treatment and prevention of chronic illnesses. In this regard, the authors agreed that a broad, global research agenda is necessary to provide a standardized framework for recognizing and speedily reproducing best practices (Dinesen et al., 2016). Moreover, the broad research agenda is required to foster global collaboration in the development of new telehealth technologies.

Additionally, global collaboration is required to help in the thorough testing of new telehealth technologies to improve the quality of healthcare delivery (Dinesen et al., 2016). In conclusion, members of the Transatlantic Telehealth Research Network (TTRN) provided a twelve-point research agenda for future telehealth use when dealing with the management of chronic ailments (Dinesen et al., 2016).

This research study gives evidence of past research on telehealth in the 1970s. The study examines early telemedicine project, which involved NASA, the Space company, the Indian health services, and the Papago. Other stakeholders involved in this study were the department of health and welfare (Freiburger, Holcomb, & Piper, 2007). It is worth noting that the Papago tribe is the one currently known as the Tohono O’odham Indian Nation.

These groups collaborated in the study to explore the possibilities of using technology to provide enhanced health care to a remote population, which was located in Southern Arizona. This project was known as STARPAHC referring to Space Technology Applied to Rural Papago Advanced Health Care. The project occurred in the late 20th century (Freiburger, Holcomb, & Piper, 2007). The study was conducted in the 1970s. This study tried to show the viability of initiating collaboration between groups of consortiums from both public and private sectors in providing enhanced health care to people in remote areas of Arizona using telecommunication technology.

This program was a success and its activities were archived in Arizona Health Science Library. Materials from the university’s library showed important progress in telehealth practices. These materials were acquired and archived at the Arizona Archive of Telemedicine (Freiburger, Holcomb, & Piper, 2007). These materials contained crucial facts on the STARPAHC project, which was done in collaboration with the Arizona Telemedicine Program.

This study gives evidence of past attempts aimed at utilizing technology to improve health care in various remote areas throughout the United States and the world. The study also clarifies the fact that research on telehealth is relatively new in the health sector as compared to other sectors of the economy. In essence, the study also shows that despite late attempts to use technology in improving health care, the field has taken use of telehealth seriously (Freiburger, Holcomb, & Piper, 2007).

Numerous researches have been conducted to help improve health care through technology. Delivering health care at a distance as undergone various transformations since its initiation in the 20th century. This research is of great interest to individuals studying early attempts to use telehealth in delivering health care in remote areas. Moreover, it has been utilized in studying the sociological consequences of scientific and technical projects among indigenous populations (Freiburger, Holcomb, & Piper, 2007).

Care coordination utilizing technology is effective in improving the quality of life for patients. Another research was conducted to evaluate a care-coordinated project, which was assisted by technology in the form of a screen phone (Dang, Remon, Harris, Malphurs, Sandals, Cabrera, & Nedd, 2008). This evaluation was done mainly to support caregivers as well as educate them. From the study, 113 caregivers were recruited for evaluation.

These caregivers were from home-dwelling veterans with dementia. Among the caregivers recruited for the study, 72 were White while 9 were Hispanic. Additionally, the remaining 32 were African American. During the study, each caregiver underwent assessment for depression, burden, and quality of life (Dang et al., 2008). Moreover, the caregivers were also assessed on knowledge, coping, and satisfaction.

However, it is worth noting that none of the outcome measures changed significantly even after 12 months of monitoring. Nonetheless, it should also be noted that 40 care-recipient and caregivers dyads gave a response within the 12-month telephone satisfaction survey (Dang et al., 2008). In this regard, it was found that over 90% of respondents were satisfied by the quality of care coordination part of the program. Besides, results from the respondents also showed that 77% were satisfied with the education part of the program. On the other hand, 50% of the respondents were satisfied with the monitoring part of the program (Dang et al., 2008).

This evaluation showed that more respondents were satisfied with coordination than education or monitoring parts of the program. Even though a systematic study was not done at the time, the study showed that care coordination helped improve the quality of services provided by caregivers. Moreover, it was quite evident from the results of the pilot research project that care coordination in combination with screen phones would be vital for supporting caregiving in controlled care settings (Dang et al., 2008). This study also showed the importance of telehealth in improving caregiving in managed care settings.

Moreover, it also showed that telehealth was essential in caregiving because its benefits traversed across the various departmental units of caregiving centers (Dang et al., 2008).

This research conducted a literature review to get an inclusive view of the benefits of telemedicine in the management of five common chronic illnesses (Wootton, 2012). The illnesses considered in the research included hypertension, diabetes, and asthma. Also, the research included COPD and heart failure (Wootton, 2012). During this study, randomized controlled trials (RCTs) were done. The study identified 141 RCTs. The study also tested 148 different telemedicine interventions for 37,695 patients. In the process of testing, the value of outcome from each intervention was classified by the outcomes detailed by the individuals conducting the trial (Wootton, 2012).

In essence, each intervention tested was viewed and classified independently. That is, the investigators did not explore a common outcome for all the trials. Essentially, the practice in the conventional meta-analysis was not utilized in this research study. In summary, the resulting outcomes were found to convey positive effects. Specifically, 108 interventions brought a positive effect while just 2 interventions brought a negative effect (Wootton, 2012).

Wootton suggested possible publication bias in this case. Moreover, he claimed that there was no significant difference between chronic illnesses. That is, telemedicine conveyed equal results in all the illnesses without differentiating each case. Essentially, telemedicine was effective in the 108 interventions equally and was ineffective in the two interventions equally. Additionally, the author argued that most studies were relatively short term. Essentially, the author believed that the median duration of the study was six months (Wootton, 2012). Therefore, he argued that interventions couldn’t be realized on a short-term basis, especially for chronic illnesses.

Wootton believed that the interventions would be more effective when applied over a long period. Wootton also blamed inconsistent results on a few studies emphasizing cost-effectiveness. The author concluded that the evidence base that tried to evaluate the value of telemedicine was generally weak and contradictory (Wootton, 2012). Moreover, he believed that more research studies should be done to establish the cost-effectiveness of telemedicine. However, Wooton was quite specific that the duration of the study was short for the study of the use of telehealth in the management of chronic illnesses (Wootton, 2012).


Attempts to utilize technology in healthcare began in the 20th century. Since then, many benefits have been derived from telehealth and telemedicine. Patients can now receive remote assistance from home using telehealth and telemedicine devices. Moreover, the literature review above has shown that incorporating technology in health care can save time and resources. The review has also shown that telehealth and telemedicine are increasingly becoming important in the healthcare industry.

Moreover, several literature materials reviewed have proved that coordinated caregiving and support for patients using technology can improve the quality of care. Moreover, it has been shown that telehealth improves the quality of care for patients from remote areas. It has also been proved that telehealth provides educational benefits to patients and caregivers alike. Further revelations from the literature review have shown that telehealth is essential to the growth of the healthcare industry.

Moreover, it has also been established in the literature that telehealth devices are crucial in the management of chronic illnesses in a controlled healthcare setting. The use of video conferencing and screen phones are some of the new technologies that have been adopted for utilization in telehealth and telemedicine. Moreover, the use of the telephone has also been listed as helpful in telecare. Health care providers and patients have been found to show satisfaction with coordinated care, which utilizes technology. In this regard, telecare has become an integral part of caregiving. Furthermore, remote telecare has flourished because of improved technology in video conferencing.

This has resulted in the building of smart homes for caregiving when patients receive personalized telecare. However, it should also be noted that some authors have also proposed further studies in the field of telehealth and telemedicine. In particular, Wooton was not convinced that the current studies are adequate for establishing the benefits of telecare. However, most authors concluded that telehealth and telemedicine are cost-effective. Moreover, the authors agreed that telehealth is educative and it improves service delivery to patients.

Reference List

Bashshur, R., Shannon, G., & Sapci, H. (2005). Telemedicine Evaluation. Telemedicine and e-Health, 11(3), 296-315. Web.

Dang, S., Remon, N., Harris, J., Malphurs, J., Sandals, L., Cabrera, A., & Nedd, N. (2008). Care coordination assisted by technology for multiethnic caregivers of persons with dementia: a pilot clinical demonstration project on caregiver burden and depression. Journal of Telemedicine & Telecare, 14(8), 443-447. Web.

Dinesen, B., Nonnecke, B., Lindeman, D., Toft, E., Kidholm, K., Jethwani, K., Young, H., Spindler, H., Oestergaard, C., Southard, J., Gutierrez, M., Anderson, N., Albert, N., Han, J., & Nesbitt, T. (2016). Personalized telehealth in the future: A global research agenda. Journal of Medical internet Research, 18(3), 53. Web.

Finkelstein, S., Speedie, S., & Potthoff, S. (2006). Home telehealth improves clinical outcomes at lower cost for home healthcare. Telemedicine and e-Health 12(2), 128-146. Web.

Freiburger, G., Holcomb, M., & Piper, D. (2007). The STARPAHC collection: part of an archive of the history of telemedicine. Journal of Telemedicine & Telecare. 13(5), 221-223. Web.

Kobb, R., Hoffman, N., Lodge, R., & Kline, S. (2004). Enhancing elder chronic care through technology and care coordination: Report from a pilot. Telemedicine Journal and e-Health, 9(2), 189-195.

Noel, C., Vogel, D., Erdos, J., Cornwall, D., & Levin, F. (2004). Home telehealth reduces healthcare costs. Telemedicine Journal and e-Health, 10(2), 170-183.

Postema, T., Peeters, J., & Friele, R. (2012). Key factor influencing the implementation success of a home telecare application. International Journal of Medical Informatics, 81(6), 415-423. Web.

White, A., Krousel-Wood, M., & Mather, F. (2001). Technology meets healthcare: Distance learning and telehealth. Ochsner Journal, 3(1), 22-29. Web.

Wootton, R. (2012). Twenty years of telemedicine in chronic disease management-an evidence synthesis. Journal of Telemedicine & Telecare, 18(4), 211-220. Web.

Electronic Health Records In Urinary Infections Control


There is an enhanced need for healthcare coupled with nurse staff shortages leads to poor documentation and maintenance of patient health records. In recent years, several hospitals have implemented electronic health records (EHRs) as a part of quality improvement efforts to enhance care quality (Rojas & Seckman, 2014). The US, for instance, has witnessed increased adoption of EHRs because of regulations and financial resources invested in quality improvement. These facilities have implemented EHR based on the promise of improved efficiency attained through integration and quick access to patient data, cost-cutting, improved relationships, and/or the need to adapt to evolving healthcare settings.

One must, however, appreciate that the implementation of an EHR system is a complicated initiative that accounts for multiple factors, including organizational culture, structure, technical skills, financial resources, IT infrastructure, and support from multiple sources (Boonstra, Versluis, & Vos, 2014). It is observed that information system implementation in healthcare facilities is usually complex and more puzzling due to numerous medical data involved, data capture and entry constraints, data security and confidentiality issues, and low awareness among end-users on benefits of the system (Boonstra et al., 2014).

Moreover, healthcare facilities differ from other organizations because of multiple factors. First, they focus on curing, caring, and nurse, physician, and patient education. Second, organizational structure and procedures are intricate. Finally, there is multiple personnel in healthcare facilities with different levels of experience, expertise, autonomy, and roles. As such, it is imperative to understand how EHR implementation, as a part of quality improvement efforts, is conducted in hospitals.

Problem Statement

Catheter-associated urinary tract infection (UTI) is a rampant device-related infection in the US and other regions globally. Nearly 60% of catheter-associated UTIs are seen as preventable if the recommended infection control measures are implemented (Saint et al., 2016). It is also noted that about 50% of the catheter of patients who receive an indwelling catheter does not have any documentation based on evidence-based care (Welden, 2013).

Available guidelines insist on the effective application, aseptic insertion, care, well-timed withdrawal of indwelling urinary catheters, and prevention strategies, such as hand washing. Effective prevention strategies tend to focus on bacterial infection controls and restrict the use of an indwelling catheter and discontinue the use when clinically sound. Amidst all these efforts, infection control efforts require the implementation of EHR systems to monitor and capture data to control catheter-related UTIs.

Consequently, there would be surveillance of use, effective use, and complication monitoring (Nicolle, 2014). However, challenges associated with EHR implementation are numerous and could hinder intended outcomes. Besides, most inpatients do not have sufficient documentation (Welden, 2013). Based on the PICOT question (can the implementation of EHR help in reducing catheter-associated UTIs among patients?), this research paper investigates if EHR implementation can improve quality outcomes among patients with indwelling urinary catheters by capturing appropriate data for decision-making.

The objective of this quality improvement research was to reduce cases of catheter-associated urinary tract infections by using EHR implementation to aid in promoting evidence-based quality care. The major focus was on the prevention of unwarranted insertion and well-timed removal of the urinary catheter when it was no longer clinically necessary (Parry, Grant, & Sestovic, 2013).

Review of Relevant Literature

The evolving healthcare landscape is characterized by a heightened need to enhance patient safety and improve outcomes. Data from hospitals gathered by the Centers for Disease Control and Prevention (CDC) on catheter-associated UTIs in patients with urinary catheters have shown high rates of infections with adverse outcomes (Gudino, 2015).

Notably, increased bacterial colonization is known to facilitate the spread of hospital-related infections. Such infections occur within the hospital but are usually preventable if effective care is taken. Catheter-associated UTIs are considered as hospital-acquired infections. When they occur, in most instances, there is no record to support the use of the catheter or its timing. As such, it is difficult to claim that effective care was administered in the absence of documentation for decision-making (Welden, 2013).

It was observed that clinical nurse specialists noted some drawbacks in current practices, which required multiple interventions, including evidence-based use of indwelling urinary catheters supported with EHR (Purvis, Gion, Weber, & Kennedy, 2014). Purvis et al. (2014) also established that effective implementation of intervention strategies led to declines in infection rates and catheter days. According to Gould et al. (2010), most hospital records have shown that about 50% of patients who receive an indwelling catheter do not have any documentation based on evidence-based care (cited in Welden, 2013).

Thus, the decision to use the catheter is not supported by any data. When documentation is lacking, nurses cannot claim that appropriate, quality care was offered. Thus, EHR systems have been implemented to improve quality of care by providing evidence-based care practices, and they are usually associated with positive catheter care usages and documentation to support indwelling urinary catheter insertion and removal. Hence, there are benefits associated with the use of EHRs to control usages of the urinary catheter.


A comprehensive systematic literature review was conducted using relevant terms to the study. Various databases, including the Cochrane Library, PubMed, and Sigma Theta Tau International were chosen for the literature search.

Keywords for the search included EHR implementation in hospitals; EHR implementation and evidence-based catheter-associated urinary tract infections care practices; catheter-associated urinary tract prevention; and quality improvement (QI) and EHR implementation.

The inclusion and exclusion criteria were

  1. selected articles were peer-reviewed,
  2. focused on EHR implementation, quality improvement, and catheter-associated urinary tract prevention,
  3. demonstrated the relevance of EHR implementation, benefits, and challenges.

The abstract of the selected articles was reviewed to determine their aims to facilitate inclusion.

Data Analysis

After a systematic literature review, it was noted that studies focused on infection prevention by restricting the insertion of catheters and durations of use in order to control cases of hospital-acquired infections related to catheter usage. The quality improvement project that focused on EHR to help in the adoption of evidence-based practices to improve the quality of care was noted as a successful initiative. The EHR systems were used as platforms for capturing patient data for clinical decision-making. Consequently, they were used to drive evidence-based practices in care delivery among patients and ensure sustained usages.

The results generally showed improved outcomes when quality improvement project was implemented successfully. There were notable declines in infections, enhanced catheter usages, and documentation for evidence-based practices in care delivery.

Discussion and Findings

The major goal of EHR implementation was to control catheter-associated urinary tract infections by enhancing documentation to collect data for decision-making on the use and duration of an indwelling urinary catheter. Inappropriate use of a urinary catheter, including prolonged periods of usages, was directly linked to increased risks of catheter-associated UTIs. It was observed that EHR implementation was important for accelerating documentation of patient daily condition (Welden, 2013).

The collected data were used to drive evidence-based intervention in the use of an indwelling catheter to control UTIs. A notable decline was noted in patients with inserted catheters, durations of usages, and timing of removal. As such, the quality improvement effort was successful because of controlled insertion and/or continued usage (Gudino, 2015).

Based on these findings, a change project would focus on quality improvement by implementing EHR to drive evidence-based practices in the insertion and duration of catheter usage. It is important to recognize that there would be challenges during the implementation. As such, an implementation process was developed to eliminate numerous challenges, including staff learning. These barriers could negatively impact EHR implementation, documentation, and core measures.

Conducting a needs assessment Nurse and physicians would describe their needs and expectations from the system
Conducting a readiness assessment Both internal and external factors to facilitate the implementation process would be evaluated
Conducting a workflow analysis All care processes and procedures related to catheter insertion and usage would be analyzed
EHR system vendor selection and implementation The system would be configured to account for complex processes and structures in care facilities

The change process is a multistep process and, therefore, it would be done carefully to eliminate barriers (Gershengorn, Kocher, & Factor, 2014).

The evaluation would be conducted after six months after EHR implementation by analyzing data before and after implementation to determine changes in catheter insertion rates and durations of use (Chenoweth & Saint, 2013). It determines the effectiveness of the EHR system in enhancing quality care practices.

The implication would present an opportunity for quality improvement teams, nurses, and physicians to adopt EHR systems for improving the quality of care by facilitating documentation and decision-making associated with evidence-based patient care and best practices.


Quality of care improvement continues to pose challenges to hospitals. EHR systems have demonstrated enhanced safety, efficiency, and quality of care delivery. It was concluded that EHR implementation could significantly transform catheter practices based on documentation and decisions supported by patient data. Hence, the platform was suitable for supporting, facilitating, and sustaining evidence-based practices in catheter-associated urinary tract infection prevention and patient data capture.


Boonstra, A., Versluis, A., & Vos, J. F. (2014). Implementing Electronic Health Records in Hospitals: A Systematic Literature Review. BMC Health Services Research, 14, 370. Web.

Chenoweth, C., & Saint, S. (2013). Preventing Catheter-Associated Urinary Tract Infections in the Intensive Care Unit. Critical Care Clinics, 29(1), 19-32. Web.

Gershengorn, H. B., Kocher, R., & Factor, P. (2014). Management Strategies to Effect Change in Intensive Care Units: Lessons from the World of Business. Annals of the American Thoracic Society, 11(3), 444–453. Web.

Gudino, C. (2015). Eliminating Catheter-Associated Urinary Tract Infections: Implementing a Quality Improvement Project. Web.

Nicolle, L. E. (2014). Catheter Associated Urinary Tract Infections. Antimicrobial Resistance and Infection Control, 3, 23. Web.

Parry, M. F., Grant, B., & Sestovic, M. (2013). Successful Reduction in Catheter-Associated Urinary Tract Infections: Focus on Nurse-directed Catheter Removal. American Journal of Infection Control, 41(12), 1178-81. Web.

Purvis, S., Gion, T., Weber, J., & Kennedy, G. (2014). Catheter-Associated Urinary Tract Infection A Successful Prevention Effort Employing a Multipronged Initiative at an Academic Medical Center. Journal of nursing care quality, 29(2), 141-8. Web.

Rojas, C. L., & Seckman, C. A. (2014). The Informatics Nurse Specialist Role in Electronic Health Record Usability Evaluation. Computers, Informatics Nursing, 32(5), 214-20. Web.

Saint, S., Greene, T., Krein, S. L., Rogers, M. A., Ratz, D., Fowler, K. E.,… Fakih, M. G. (2016). A Program to Prevent Catheter-Associated Urinary Tract Infection in Acute Care. New England Journal of Medicine, 374, 2111-2119. Web.

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Research-Based Practice: JHNEBP Model And Iowa Model


The process of integrating scientific evidence into nursing practice is critical for ensuring efficient performance. Thus, there is a wide scope of different models developed in order to assist nurses in implementing the relevant knowledge in their work. The paper at hand provides a brief overview of the two models: John’s Hopkins Nursing Evidence-Based Practice Model and Iowa Model of Research-Based Practice. The analysis is aimed at pointing out the common traits that these approaches share as well as the key differences that need to be considered.

Comparing and Contrasting

On the face of it, the models under discussion have few differences – they share a common aim and base on the similar principles. Meanwhile, there are some distinguishing features that need to be considered in order to select the model relevant to the specificity of the targeted outcomes.

According to White and Dudley-Brown (2011), John’s Hopkins Nursing Evidence-Based Practice (JHNEBP) Model is a scientific approach that implies integrating valid theoretical knowledge into working experience (13). Iowa Model of Research-Based Practice is based on the similar core principles – thus, it is aimed at allowing nurses implementing research findings in their everyday practice (White & Dudley-Brown, 2011).

Therefore, the key target of both models resides in incorporating the available evidence for the benefit of the quality of the Evidence-Based Practice (EBP). Hence, it might be assumed that both models were initially designed to solve one and the same problem. However, their structures are still different.

First and foremost, Iowa Model of Research-Based Practice is more complicated in terms of the stages that it suggests. While JHNEBP’s process is relatively simple – practice evidence, question, translation, – the algorithm developed in the framework of Iowa Model is much more complicated. Thus, Chiappelli (2010) points out eight main stages: the identification of triggers, the generation of the pivot questions, the formation of a team, the analysis of the collected data, the preparation of the change strategy, the implementation of this change, the outcomes’ monitoring, and the evaluation of the results (63).

It is essential to note that the triggers component is the one that distinguishes Iowa Model from JHNEBP Model and all the other models of a similar character. White and Duddle-Brown (2011) explain that there are two types of triggers: problem-focused and knowledge-focused (15). These triggers help a nurse stick to a certain algorithm and address each problem complexly.

In addition, Iowa Model concept suggests that the implemented evidence-based knowledge should be necessarily relevant to the particular organizational context (Gawlinski & Rutledge, 2008). Otherwise stated, it is considered critical to ensure the selected scientific theory can be applied to the environment. JHNEBP concept, in its turn, suggests that the scientific evidence should be, first and foremost, relevant to the targeted problem. On the whole, however, both models are supposed to assist nurses in carrying out effective decision-making with the use of the latest research findings and valid theories.


The analysis of the two models has shown that in spite of the fact that they generally target a common aim, their structures are slightly different. Moreover, the key focus of Iowa model is placed on implementing the evidence into a particular environment, whereas JHNEBP Model puts a particular emphasis on selecting the relevant theoretical evidence to address a specific problem.

Reference List

Chiappelli, C. (2010). Evidence-Based Practice: Toward Optimizing Clinical Outcomes. Los Angeles, California: Springer Science & Business Media.

Gawlinski, A., & Rutledge, D. (2008). Selecting a Model for Evidence-Based Practice Changes. Advanced Critical Care, 19(3), 291-300.

White, K.M., & Dudley-Brown, B. (2011). Translation of Evidence into Nursing and Health Care Practice. New York, New York: Springer Publishing.

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