NURS FPX 6614 Assessment 3 Disseminating the Evidence Scholarly Video Media Submission

Name

Capella university

NURS-FPX 6614 Structure and Process in Care Coordination

Prof. Name

Date

Disseminating the Evidence Scholarly Video Media Submission

Hello everyone, my name is [Name], and in this presentation, I will explore improving care coordination for adult patients managing chronic diseases through an evidence-based intervention. The focus will be on addressing care coordination challenges tied to a specifically designed PICOT question. Additionally, I will outline services and resources that promote interprofessional collaboration to improve health outcomes for chronic conditions. The discussion will also highlight strategies employed to foster stakeholder engagement and conclude with future recommendations to optimize thoughtful resource utilization and maintain a safe, coordinated care environment.

Analysis of Care Coordination Efforts Related to PICOT Question

The analyzed PICOT question is: “In adult patients with chronic diseases (P) in local healthcare organizations, does implementing a centralized Electronic Health Record system (I) compared to no technology-oriented coordination (C) result in improved care coordination (O) within two years (T)?”

Effective management of chronic conditions requires seamless communication and coordination among healthcare professionals. Disruptions in the information exchange between interprofessional teams have been identified as a barrier to delivering patient-centered care, often resulting in treatment delays and errors (Schot et al., 2019). One of the primary solutions identified is the implementation of centralized Electronic Health Record (EHR) systems. These systems can significantly enhance interprofessional communication by enabling simultaneous, real-time access to patient health data (Martyn et al., 2022). Through EHR systems, healthcare providers are promptly notified about changes in patient status, enabling rapid adjustments to treatment plans and reducing the risk of adverse events.

The integration of a centralized EHR fosters a collaborative care environment where providers can access unified care plans and treatment goals. It also supports data-driven decision-making by offering comprehensive patient data that quality assurance teams can use to analyze trends and track outcomes. This process enhances the prioritization of clinical interventions and promotes evidence-based care delivery (Classen et al., 2020). The benefits of EHR implementation extend to improved efficiency, as it streamlines communication processes that traditionally relied on phone calls and paper-based records, thereby reducing operational bottlenecks (Mullins et al., 2020).

NURS FPX 6614 Assessment 3 Disseminating the Evidence Scholarly Video Media Submission

Table 1 illustrates the comparison between traditional coordination methods and EHR-integrated systems in chronic care management:

Aspect	Traditional Coordination	EHR-Integrated Coordination
Data Access	Paper-based, delayed	Real-time, electronic
Communication	Phone, in-person, fragmented	Centralized, instant
Care Plan Consistency	Variable, often inconsistent	Unified, easily accessible
Decision-Making	Isolated, delayed	Collaborative, data-driven
Risk of Errors	High	Reduced through alerts
Outcome Tracking	Manual, retrospective	Automated, real-time

Key Implications and Conclusions

Adopting a centralized EHR system can notably improve care coordination for adults with chronic conditions. Technology-enabled coordination facilitates the seamless sharing of patient information, resulting in timely, patient-centered care. EHR use also enhances operational efficiency, as providers can respond promptly to any changes in a patient’s health status, thus improving treatment outcomes (Mullins et al., 2020). Beyond immediate care improvements, EHR systems support strategic healthcare management through resource optimization and the continuous evaluation of clinical practices. These factors collectively contribute to better chronic disease management and sustainable healthcare delivery models.

Change in Practice Related to Services and Resources Available for Interprofessional Care Coordination Team

The implementation of an EHR system transforms how interprofessional care teams access and manage patient information. This change in practice allows multiple healthcare providers—such as physicians, nurses, pharmacists, behavioral specialists, and nutritionists—to simultaneously access updated patient records through a centralized platform (Renoux et al., 2020). This digital shift reduces the dependency on physical meetings and manual data sharing, thereby enhancing productivity and minimizing treatment delays.

Additionally, the adoption of EHR systems eliminates communication barriers associated with traditional tools like phone calls and handwritten notes. Real-time alerts and collaborative tools integrated within EHR systems support immediate decision-making and unified care planning (Lourie et al., 2020). Evidence-based research has consistently demonstrated that healthcare organizations utilizing EHR systems report better chronic disease outcomes, improved team coordination, and reduced communication errors (Mullins et al., 2020). These operational efficiencies strengthen care coordination by ensuring that all team members work toward common treatment goals using accurate, up-to-date information.

Efforts to Build Stakeholder Engagement within Interprofessional Team

Stakeholder engagement plays a crucial role in the successful implementation of EHR systems. Effective leadership, combined with structured interprofessional collaboration, facilitates smoother transitions to technology-driven care coordination (Robertson et al., 2022). Key stakeholders include clinicians, nursing staff, administrators, IT experts, and support personnel. To encourage active involvement, regular interdisciplinary meetings were organized to clarify the roles of each team member and explain the benefits of collaborative EHR use for managing chronic diseases.

This inclusive approach improved buy-in from all stakeholders and led to the development of shared care plans within the EHR system (Robertson et al., 2022). During implementation, ongoing support and troubleshooting services addressed operational concerns, reinforcing the commitment to a smooth transition (Vos et al., 2020). Potential challenges were proactively managed using a comprehensive risk assessment strategy. This involved identifying areas prone to issues—such as data security, system adoption resistance, and workflow disruptions—and prioritizing them based on severity and likelihood.

For high-priority risks, targeted mitigation strategies were developed in collaboration with internal and external experts. This approach promoted transparency and minimized unexpected disruptions associated with EHR implementation (Sittig et al., 2022).

Future Steps to Thoughtful Resource Utilization and Safe Care Coordination

Future recommendations for advancing coordinated care include continuous professional training and tailored education programs for interprofessional teams. These initiatives will ensure that healthcare providers remain proficient in using EHR systems and are well-equipped to handle system updates (Samadbeik et al., 2020). Additionally, routine system audits are essential to maintain data accuracy and security while identifying and addressing any system vulnerabilities (Poulos et al., 2021).

Quality improvement programs will be sustained through regular performance audits and feedback sessions. This ongoing evaluation ensures that care coordination processes adapt to changing patient needs and healthcare standards (Yurkofsky et al., 2020). Benchmarking care outcomes against national or institutional standards will further support performance optimization (Mollica et al., 2021). Importantly, involving patients and their families in care coordination discussions will enhance adherence to care plans and foster a truly patient-centered care approach (Sauers-Ford et al., 2021).

Conclusion

In summary, this scholarly dissemination highlights a PICOT-driven intervention aimed at improving care coordination for chronic disease patients through EHR implementation. The analysis identified gaps in current care practices and proposed a centralized EHR system as an effective solution. Changes in service delivery, strengthened stakeholder engagement, and future-oriented strategies were discussed to promote safe, efficient, and coordinated chronic care. Moving forward, continuous training, regular system audits, and patient engagement initiatives are essential to sustain improvements in care coordination outcomes.

References

Classen, D. C., Holmgren, A. J., Co, Z., Newmark, L. P., Seger, D., Danforth, M., & Bates, D. W. (2020). National trends in the safety performance of electronic health record systems from 2009 to 2018. JAMA Network Open, 3(5), e205547. https://doi.org/10.1001/jamanetworkopen.2020.5547

Lourie, E. M., Utidjian, L. H., Ricci, M. F., Webster, L., Young, C., & Grenfell, S. M. (2020). Reducing electronic health record-related burnout in providers through a personalized efficiency improvement program. Journal of the American Medical Informatics Association. https://doi.org/10.1093/jamia/ocaa248

NURS FPX 6614 Assessment 3 Disseminating the Evidence Scholarly Video Media Submission

Martyn, T., Montgomery, R. A., & Estep, J. D. (2022). The use of multidisciplinary teams, electronic health records tools, and technology to optimize heart failure population health. Current Opinion in Cardiology, 37(3), 302–306. https://doi.org/10.1097/hco.0000000000000968

Mollica, M. A., Buckenmaier, S. S., Halpern, M. T., McNeel, T. S., Weaver, S. J., Doose, M., & Kent, E. E. (2021). Perceptions of care coordination among older adult cancer survivors: A SEER-CAHPS study. Journal of Geriatric Oncology, 12(3), 446–452. https://doi.org/10.1016/j.jgo.2020.09.003

Mullins, A., O’Donnell, R., Mousa, M., Rankin, D., Ben-Meir, M., Boyd-Skinner, C., & Skouteris, H. (2020). Health outcomes and healthcare efficiencies associated with the use of electronic health records in hospital emergency departments: A systematic review. Journal of Medical Systems, 44(12). https://doi.org/10.1007/s10916-020-01660-0

Poulos, J., Zhu, L., & Shah, A. D. (2021). Data gaps in Electronic Health Record (EHR) systems: An audit of problem list completeness during the COVID-19 pandemic. International Journal of Medical Informatics, 150, 104452. https://doi.org/10.1016/j.ijmedinf.2021.104452

Renoux, J., Veiga, T. S., Lima, P. U., & Spaan, J. (2020). A unified decision-theoretic model for information gathering and communication planning. Örebro University Library (Örebro University). https://doi.org/10.1109/ro-man47096.2020.9223597

Robertson, S. T., Rosbergen, I. C. M., Burton-Jones, A., Grimley, R. S., & Brauer, S. G. (2022). The effect of the electronic health record on interprofessional practice: A systematic review. Applied Clinical Informatics, 13(03), 541–559. https://doi.org/10.1055/s-0042-1748855

Samadbeik, M., Fatehi, F., Braunstein, M., Barry, B., Saremian, M., Kalhor, F., & Edirippulige, S. (2020). Education and training on Electronic Medical Records (EMRs) for health care professionals and students: A scoping review. International Journal of Medical Informatics, 142(1), 104238. https://doi.org/10.1016/j.ijmedinf.2020.104238

Sauers-Ford, H., Statile, A. M., Auger, K. A., Wade-Murphy, S., Gold, J. M., Simmons, J. M., & Shah, S. S. (2021). Short-term focused feedback. Medical Care, 59(8), S364–S369. https://doi.org/10.1097/MLR.0000000000001588

NURS FPX 6614 Assessment 3 Disseminating the Evidence Scholarly Video Media Submission

Schot, E., Tummers, L., & Noordegraaf, M. (2019). Working on working together: A systematic review on how healthcare professionals contribute to interprofessional collaboration. Journal of Interprofessional Care, 34(3), 1–11. https://doi.org/10.1080/13561820.2019.1636007

Sittig, D. F., Sengstack, P., & Singh, H. (2022). Guidelines for US hospitals and clinicians on assessment of electronic health record safety using SAFER guides. JAMA, 327(8), 719. https://doi.org/10.1001/jama.2022.0085

Vos, J. F. J., Boonstra, A., Kooistra, A., Seelen, M., & van Offenbeek, M. (2020). The influence of electronic health record use on collaboration among medical specialties. BMC Health Services Research, 20(1), 676. https://doi.org/10.1186/s12913-020-05542-6

Yurkofsky, M. M., Peterson, A. J., Mehta, J. D., Horwitz-Willis, R., & Frumin, K. M. (2020). Research on continuous improvement: Exploring the complexities of managing educational change. Review of Research in Education, 44(1), 403–433. https://doi.org/10.3102/0091732×20907363