Paper 2: Summarize, Quote, Critique, 750-1000 words) · Choose one of the readings we discuss during the next several weeks. In the first part of your paper, write an extended summary of this reading (300-400 words) Then, in the same paper, follow up your summary with your critique of her arguments. Your critique should focus on the essay’s strengths or weakness as an argument (rather than on whether or not the author agrees with you.) In other words, simply pointing out that you agree with her (or disagree with her) is not a critique unless you also indicate WHY you agree or disagree with her. What in her argument is flawed or what is particularly well argued and why? In your summary section, you should not quote at all. You should be able to state her argument in your own words. In the critique section, however, make sure you include at least two quotations, and make sure you “sandwich” them properly, as described in Chapter 3 of They Say, I Say. Whether you are summarizing or critiquing, make sure you use synonyms for “say.” Use at least five different verbs listed in pages 38-39. Be sure you know what they mean so you can use them correctly! In addition to the general writing criteria that is applicable to all of the papers in this course (introduction and conclusions, focus, audience, thesis, organization, development, language, grammar and mechanics, proper citation of outside sources ), this paper will be graded on the following criteria: For the summary portion · Accuracy of your summary. In other words, did you understand the main points the author was trying to make? This is the most important criterion. · The objectivity of your summary. Make sure you give the writer a fair hearing, even if you disagree with her. · Ability to distinguish between the main points and supporting or minor points of the text. Your summary should include ALL of the main points and ONLY the main points. · The ability to summarize the contents in your own words. For the critique portion: · Clear statement of argument’s strength and weaknesses · Clearly stated support for why you consider the argument strong or weak . · Evidence that you have read and considered the argument carefully (rather than skimming and making assumptions This assignment connects to these University Outcomes of Writing: Relate content to an audience, to develop and organize material, to construct fluent sentences using standard grammar, mechanics and references. For a more detailed assignment description and the grading rubric, please see Blackboard. SAMPLE PAPER FROM A CLASSMATE. Week 7 Discussion System Design and Workflow As I completed the assignment this past week, I am learning and finding more interest in the topic of Health Information Technology (HIT).  According to the Agency for Healthcare Research and Quality (AHRQ) a successful implementation of HIT balances both the clinical and administrative workflow (U.S. Department of Health & Human S.

1. Paper 2: Summarize, Quote, Critique, 750-1000 words)
· Choose one of the readings we discuss during the next several
weeks. In the first part of your paper, write an extended
summary of this reading (300-400 words)
Then, in the same paper, follow up your summary with your
critique of her arguments. Your critique should focus on the
essay’s strengths or weakness as an argument (rather than on
whether or not the author agrees with you.) In other words,
simply pointing out that you agree with her (or disagree with
her) is not a critique unless you also indicate WHY you agree or
disagree with her. What in her argument is flawed or what is
particularly well argued and why?
In your summary section, you should not quote at all. You
should be able to state her argument in your own words. In the
critique section, however, make sure you include at least two
quotations, and make sure you “sandwich” them properly, as
described in Chapter 3 of They Say, I Say.
Whether you are summarizing or critiquing, make sure you use
synonyms for “say.” Use at least five different verbs listed in
pages 38-39. Be sure you know what they mean so you can use
them correctly!
In addition to the general writing criteria that is applicable to
all of the papers in this course (introduction and conclusions,
focus, audience, thesis, organization, development, language,
grammar and mechanics, proper citation of outside sources ),
this paper will be graded on the following criteria:
For the summary portion

2. · Accuracy of your summary. In other words, did you
understand the main points the author was trying to make? This
is the most important criterion.
· The objectivity of your summary. Make sure you give the
writer a fair hearing, even if you disagree with her.
· Ability to distinguish between the main points and supporting
or minor points of the text. Your summary should include ALL
of the main points and ONLY the main points.
· The ability to summarize the contents in your own words.
For the critique portion:
· Clear statement of argument’s strength and weaknesses
· Clearly stated support for why you consider the argument
strong or weak
.
· Evidence that you have read and considered the argument
carefully (rather than skimming and making assumptions
This assignment connects to these University Outcomes of
Writing: Relate content to an audience, to develop and organize
material, to construct fluent sentences using standard grammar,
mechanics and references.
For a more detailed assignment description and the grading
rubric, please see Blackboard.
SAMPLE PAPER FROM A CLASSMATE.
Week 7 Discussion System Design and Workflow
As I completed the assignment this past week, I am learning and
finding more interest in the topic of Health Information

3. Technology (HIT). According to the Agency for Healthcare
Research and Quality (AHRQ) a successful implementation of
HIT balances both the clinical and administrative workflow
(U.S. Department of Health & Human Services, n.d.b). The
three different concepts I would use to help in redesigning
workflow at my organization would be benchmarking, using a
flowchart, and usability evaluation.
At St. Joe’s, our Short Stay Unit(SSU) currently utilizes
paper for all post-procedural patients, specifically, post cardiac
catheterization patients. All documentation pre and intra-
procedure is completed in the Electronic Health Record (EHR).
Upon admission to SSU, the nurse takes report on the post-
procedure paper form and all charting from admission to
discharge from SSU is completed on paper. Beginning any new
process or redesign requires research on what are the best
practices used at other organizations and then looking at how to
apply them to our redesign (U.S. Department of Health &
Human Services, n.d.b). My first task would be to reach out to
our “sister” hospitals and find out what their current practice is.
I would also refer to iVantage Health Analytics, an online
company. Our organization uses this company for benchmarking
purposes. The company utilizes strategic data to provide
guidance to healthcare industries regarding policy, research and
leadership.
After completing benchmarking, a visual diagram or flowchart
would be created to map our current practice (U.S. Department
of Health & Human Services, n.d.b). The flowchart would
represent our current state and what we would like our future
state to look like. Clinical nursing involvement would be key as
a flowchart is created and would include both our procedural
and short stay nursing staff to ensure all steps are mapped out.
As Page (2011) identified, nursing involvement at all stages is
needed for redesign to be transformational and sustaining.
In preparation for this redesign, I used the research link on the
AHRQ workflow website and reviewed a study that was done to
determine how “ambulatory leaders differentiate

4. implementation approaches between practices that are currently
paper-based and those with a legacy EHR system (EHR-based)”
(Zandieh et al., 2008). The study compared and contrasted
implementing an EHR system in an ambulatory care setting,
with a system that had already implemented an EHR system.
The study found that priorities differed in both practices but
that both worried about workflow changes and efficiency. The
paper based system worried regarding the staff’s ability to learn
and change versus the EHR system’s expression of resistance
met by staff. Overall, moving toward implementation of an EHR
system for documentation was recognized as a must and the
researchers found the new EHR would improve patient care by
improving communication among practitioners (Zandieh et al.,
2008).
The importance of monitoring the effect of technology
on workflow cannot be overstated. Completion of
benchmarking and identification of a process by using a
flowchart are early phases of redesign, but a successful
implementation requires continual reassessment. A usability
evaluation will be conducted to determine the extent the system
is easy to use (U.S. Department of Health & Human Services,
n.d.b). As the researchers identified, ongoing technical support
and leader support via communication were needed for success
(Zandieh et al., 2008). The implementation of technology must
serve to enhance workflow and allow nursing to provide quality
care to patients. Nurses must feel that this change is beneficial
and not adding to their workflow. Staff feedback will be vital as
part of the evaluation phase.
References
Page, D. (2011). Turning nurses into health IT superusers.
H&HN:Hospitals & Health Networks
85(4), 27-28.
U.S Department of Health & Human Services. (n.d.b).
Workflow assessment for health IT toolkit. Retrieved October 4,
2016, from https://healthit.ahrq.gov/health-it-tools-and-
resources/workflow-assessment-health-it-toolkit/all-workflow-

5. tools/checklist
Zandieh, S. O., Yoon-Flannery, K., Kuperman, G. J., Langsam,
D. J., Hyman, D., & Kaushal, R. (2008, June). Challenges to
EHR Implementation in Electronic- Versus Paper-based Office
Practices. Journal of General Internal Medicine, 23(6), 755-761.
INSTRUCTOR’S RESPONSE BELOW.
I really enjoyed your discussion of benchmarking, flowcharts,
and usability evaluations. The Meaningful Use initiative has
escalated the adoption of Health IT systems in the last few
years. It concerns me that there is little research on the usability
of these systems and impact of these systems on workflow. I
read an alarming poll recently that I thought you may be
interested in.
"Black Book polled nearly 14,000 licensed registered nurses
from forty states, all utilizing implemented hospital EHRsover
the last six months. Survey respondents also ranked the vendor
performance of nineteen inpatient EHR systems from a nursing
satisfaction perspective. Although the inpatient EHR
replacement frenzy has calmed temporarily, the frustration from
nursing EHR users has increased exponentially,” said Doug
Brown, Managing Partner of the survey firm Black Book Market
Research. “The meaningful use financial incentives for
hospitals have many IT departments scurrying to implement
these EHR’s without consulting direct care nurses, according to
the majority of those polled by Black Book.”
· 90% of EHR nursing users attested that the use of the current
EHR system in their facility has negatively impacted
communications between nurses and their patients.
· 94% of nurses do not believe that the use of their current EHR
has improved the communication between the nurse and the care
team (physicians, respiratory therapists, physical therapists,
occupational therapists, pharmacists, etc.).
· Only 26% agree with the statement, “As a nurse, I believe the
current EHR at my organization improves the quality of patient

6. information.”
· 51% of nurses working in hospitals with greater than 100 beds
report that all care team members at their organization access
and document on the same EHR screens.
“Technology can help nurses do their jobs more effectively or it
can be a highly intrusive burden on the hospital nurse delivering
patient care,” said Brown. “Many compounding nurse
productivity problems of can be sourced to the failure of those
selecting and implementing an EHR to involve direct care
nurses in the process.”
· 30% of nurses believe their hospitals’ IT departments and
administrations respond quickly to making changes in the EHR
that the nurses recognize as vulnerabilities in documentation.
Alarmingly, 69% of nurses in for-profit inpatient settings report
their IT department as “incompetent” when describing the level
of expertise their organization’s in-house staff has working with
the selected EHR software.
· Nurses working in for-profit, chain facilities are the most
exasperated. 98% are dissatisfied with the time allowed to be
spent with patients versus the time allowed to document on the
myriad of electronic medical record and departmental programs
with no connectivity that their hospitals have accumulated.
“Add to that the unique software interfaces from medical
equipment and the multiple EMRs each individual physician’s
office, it’s no surprise that hospital nurses are getting
discouraged and seeking employment in less complex
organizations,” said Brown. “EHRs have become an advantage
for some hospitals in attracting top nursing talent, but in many
cases a poorly implemented EHR with chaotic processes and
bungling IT support is becoming a detriment to hospital nurse
retention and recruitment.
· 79% of job seeking registered nurses reported that the
reputation of the hospital’s EHR system is a top three
consideration in their choice of where they will work.
· Nurses in the 22 largest metropolitan statistical areas are most
satisfied with the usability of Cerner, McKesson,NextGen and

7. Epic Systems. Those EHRs receiving the lowest satisfaction
scores by nurses
include Meditech,Allscripts, eClinicalWorks and HCare.
A lack of IT resources is also impacting nursing productivity.
· 93% of nurses in for-profit facilities stated they do not have
computers in each room or hand-held/mobile devices to aid in
the EHR requirements. 91% state they have difficulty even
locating an available EHR workstation on wheels at their for-
profit hospital job which, in turn, takes time away from patient
care. 35% of nurses in not-for-profit hospitals have a similar
situation of not enough devices.
· Within for-profit hospital facilities, just 15% of the surveyed
nurse respondents believed the IT department that supports the
EHR are knowledgeable and receptive to nurses’ suggestions in
improving electronic documentation.
· Among those hospitals outsourcing the EHR help desk, 88% of
nurses reported that their experiences with EHR’s call center do
not meet their expectations of communication skills and
knowledge of product. 98% of those directed to offshore help
desks report their EHR problems being typically unresolved and
that suggestions for improvement were never given
consideration.
"Nurses will drive a new wave of inpatient EHR replacements
and advances to outdated hybrid systems as it becomes harder to
retain and recruit staff,” said Brown. “Hospitals, particularly in
competitive markets, will experience an exodus of nurses who
will change employers for those with flexible, highly
usable EHRs, where nurses feel they can get more real time to
care of patients.”
· Current users ranked Cerner as the most nurse user-friendly
inpatient EHR vendor, particularly in interoperability with
ancillary and physician EHRs. Other vendors in the study
included: Siemens, McKesson, Epic Systems,Allscripts, CPSI,
GE Healthcare, NextGen, Meditech, Quadramed, HMS,
HCS, RazorInsights, 3M, HCare,
Vista,Healthland, Prognocis and eClinicalWorks.

8. · 67% of nurses reported they have been taught workarounds to
allow other health team members to view pertinent information
related to a patient, as to not lower the quality of care, yet
avoiding the EHR systems’ unresolved flaws.
· Among the EHR vendors ranked lowest in nursing satisfaction,
89% of nurses report developing creative workarounds to deal
with shortcomings and system deficiencies that are not
addressed or corrected after reporting issues to IT and nursing
supervisors".
Frankly I was shocked and discouraged to read these statistics.
It really raises some critical concerns on the effect of these
systems on the workflow of nurses. The workflow tools
discussed in the AHRQ are really important to use for
addressing these critical issues. I think Brown's earlier
statement speaks to the root of the problem. “The meaningful
use financial incentives for hospitals have many IT departments
scurrying to implement these EHR’s without consulting direct
care nurses, according to the majority of those polled by Black
Book.” As we discussed earlier in the course, the involvement
of nurses is essential in all phases of the SDLC. It seems to me
that the lack of involvement of nurses not only contributes to
implementation and acceptance issues, their non-involvement
may be comprising the nurse-patient relationship and the quality
and safety of care. I hope organizational leaders recognize very
quickly the need to involve nurses and exploring and addressing
their concerns is essential. Clearly the effect of Health IT
systems on the workflow of nurses and patient care need to
be addressed.
Thanks for your thoughtful post, Dr. Reilly
PRWeb (2014). Hospital nurses forced to develop creative
workarounds to deal with EHR system flaws; outdated
technologies and lack of interoperability, reveals Black
Book. http://www.prweb.com/releases/2014/09/prweb12182208.
htm