Running head: evaluation tool 1 evaluation tool 6Evaluation Tool Name University Class Date Evaluation Tool Conducting the literature review and the evaluation methodology provided an insight into PICO question (Does implementing a new unified acute and ambulatory EHR (Electronic Health Record) system in the hospital, compared to when they are not used, improve the health care quality for the patients through documentation), and obtaining important information about what needs to be considered in a research project, particularly regarding research tool. The research should consider a tool that proves to be reliable and valid. The researcher should want to know if the tool is accurate and measuring what it is intended to measure (Penfold et al., 2011). Picking the wrong tool for research would result in an incomplete result, hence problem with the evidence. Thus, subsequent researchers may not want to use the flawed methodology to conduct their research. The purpose of this paper is to describe the selected evaluation tool for the project with a rationale, to summarize the criteria used in defining evaluation success, and to develop the assessment plan.Describing the Evaluation Tool Selected for the Evaluation Project The chosen tool for evaluation is the “Electronic Health Record End User Survey” (AHRQ, n.d.). The tool is a questionnaire that focuses on the usability of an EHR. The questionnaire is designed for the clinical staff in the ambulatory setting to evaluate the usability of an electronic health record in ambulatory care. The aim of the assessment tool is to measure the appropriateness of ambulatory care after the implementation of clinical documentation. The device involves various types of a survey that incorporate many stakeholders who ensure that the hospital adopts new technology relating to the improvement of health care within the hospital. The tool is associated with a survey tool for assessing the EHR implementation based on development initiatives guide. The EHR End User Survey measures the effectiveness realized in the hospital setup through documentation as compared to using the old system of documentation. Based on the developed PICO question that aims at evaluating the benefits that subsume the overtaken documentation. The evaluation tool captures various hospital domains including the end users feedback regarding training and competency, usefulness, usability, infrastructure, and the user support. The tool involves the validation efforts based on needs assessment, the pilot study and the analysis of the nurse respondents. The End User Survey tool based on the EHR provides questionnaire type of review where the clinical staff answer the asked questions focusing on the current state assessment and usability within the hospital. The remote documentation applicable to the new unified ambulatory system makes it easier and efficient since it increases the number o ...

1. Running head: evaluation tool 1
evaluation tool 6Evaluation Tool
Name
University
Class
Date
Evaluation Tool
Conducting the literature review and the evaluation
methodology provided an insight into PICO question (Does
implementing a new unified acute and ambulatory EHR
(Electronic Health Record) system in the hospital, compared to
when they are not used, improve the health care quality for the
patients through documentation), and obtaining important
information about what needs to be considered in a research
project, particularly regarding research tool. The research
should consider a tool that proves to be reliable and valid. The
researcher should want to know if the tool is accurate and
measuring what it is intended to measure (Penfold et al., 2011).
Picking the wrong tool for research would result in an
incomplete result, hence problem with the evidence. Thus,
subsequent researchers may not want to use the flawed
methodology to conduct their research. The purpose of this
paper is to describe the selected evaluation tool for the project
with a rationale, to summarize the criteria used in defining
evaluation success, and to develop the assessment
plan.Describing the Evaluation Tool Selected for the Evaluation
Project
The chosen tool for evaluation is the “Electronic Health Record
End User Survey” (AHRQ, n.d.). The tool is a questionnaire that
focuses on the usability of an EHR. The questionnaire is
designed for the clinical staff in the ambulatory setting to
evaluate the usability of an electronic health record in
ambulatory care. The aim of the assessment tool is to measure

2. the appropriateness of ambulatory care after the implementation
of clinical documentation. The device involves various types of
a survey that incorporate many stakeholders who ensure that the
hospital adopts new technology relating to the improvement of
health care within the hospital. The tool is associated with a
survey tool for assessing the EHR implementation based on
development initiatives guide. The EHR End User Survey
measures the effectiveness realized in the hospital setup through
documentation as compared to using the old system of
documentation. Based on the developed PICO question that
aims at evaluating the benefits that subsume the overtaken
documentation. The evaluation tool captures various hospital
domains including the end users feedback regarding training and
competency, usefulness, usability, infrastructure, and the user
support. The tool involves the validation efforts based on needs
assessment, the pilot study and the analysis of the nurse
respondents. The End User Survey tool based on the EHR
provides questionnaire type of review where the clinical staff
answer the asked questions focusing on the current state
assessment and usability within the hospital. The remote
documentation applicable to the new unified ambulatory system
makes it easier and efficient since it increases the number of
patients handled at the same time. The tool when applied to
measure the comparison will provide information based on the
questions developed by the clinical team and given to selected
stakeholders who give independent information on the success
or failure realized (Agency for Healthcare Research and
Quality, n.d.). Additionally, the tool looks impressive due to
several reasons ranging from the clarity of questions to
simplicity of the questions. Such a structured questionnaire
permit respondents time to evaluate their responses carefully
without interference from the researcher. Moreover, the tool has
allowed for both subjective and objective questions. The
questionnaire is framed in with questions in such a way that it
can gather quantitative data which could have been difficult to
collect otherwise. Also, most of the questions are directly

3. related to my PICO question which guides the research.
Rationale and Criteria for Success
The structured questionnaire will be helpful in the evaluation
project since my PICO question involves measurement of
different constructs of the respondents’ feelings, suggestions,
opinions, and other related aspects. Most of these constructs are
perceived to be unobservable individual characteristics that
cause variation in behavior. The items in the questionnaire will
be phrased in such a way that they pose one evaluation
characteristic per item so that the respondents will take minimal
time while responding to the questions. The aim is to ascribe
quantitative value to qualitative data so that the items can be
amenable to statistical analysis. More so, the end user survey
tool promotes the use of advance technology (electronic health
records) hence becoming useful for the evaluation as it saves
time and related resources for the hospital (Timmins, 2013).
More so, the survey becomes the standard method relating to
the collection of data. The survey tool is flexible, comfortable
during implementation, and offering unlimited data range hence
providing reliable results for the new mode of documentation
within the hospital. Another reason for selecting the tool is
because it measures the change-over-time effects of the clinical
documentation. It helps in monitoring pre-system conditions
against the post-system conditions hence gathering extensive
feedback (Penfold et al., 2011).
The outcome goals formulated in the earlier stages of the
project will form the basis for determining the success of the
evaluation tool. The deliverables for the project are the
evaluation goals. Thus, they should match the goals of the end-
users which should in term match those of the EHR
implementation in acute and ambulatory care (Seto, Foisy,
Arkison, Klassen & Williams, 2012). Additionally, the
evaluation will be based on clinical outcome measures, clinical
processes, patient care quality, provider adoption of EHR,
formulate evaluation and attitude measures tool (Friedman &

4. Wyatt, 2010). These items will be factored in the matrix to
facilitate the success of the evaluation. Plan for Utilizing the
Tool.
The plan regarding the evaluation tool will be in the form of a
questionnaire outlining the questions relating to the PICO
question. The plan aims at providing feedback by the end users
(clinic staff) utilizing the new system that is particularly for
documentation within the hospital. The method is precise and
the responses obtained will help the management measure the
effectiveness of the new system as compared to the previous
one. The results achieved from the end user survey
questionnaires are analyzed, and positive outcomes should show
that the implemented system has improved quality of health care
via documentation within the hospital. The issues addressed by
the structured questionnaire include a discussion about
challenges and implementers of the evaluation. Study design
questions will be used to obtain data to support quantitative
evaluation. This questionnaire has an advantage since it does
not allow for simple answers such as yes or no. The tool will be
helpful in the evaluation methodology since it will provide data
with some degree of opinion. Thus, this will permit the
researcher to obtain quantitative data that can be analyzed with
relative ease. Also, the evaluation questionnaires will offer
anonymity on self-administered questionnaires to reduce
pressure and social desirability bias (Kaphingst et al.,
2012).Summary.
In conclusion, an evaluation tool forms part of the important
basis for a flawless research. The tool selected should be tested
for reliability and validity. In this evaluation project, the
questionnaire will be helpful in obtaining credible data for
quantitative analysis. As noted earlier, the identified tool
utilizes a questionnaire with structured questions meant to
measure respondents’ latent constructs. Additionally, during the
evaluation process, the questionnaires should be designed in a
manner that the questions eliminate possible bias.

5. References
Las Agency for Healthcare Research and Quality. (n.d.). 2009
International Survey of Primary Care Doctors. Retrieved from:
https://healthit.ahrq.gov/health-it-tools-and-resources/health-it-
survey-compendium/2009-international-survey-primary-care.
Friedman, C. P., & Wyatt, J. (2010). Evaluation methods in
biomedical informatics. (2nd ed.). New York, NY: Springer
Science+Business Media, Inc.
Kaphingst, K. A., Kreuter, M. W., Casey, C., Leme, L.,
Thompson, T., Cheng, M. R., et al. (2012). Health literacy
INDEX: Development, reliability, and validity of a new tool for
evaluating the health literacy demands of health information
materials. Journal of Health Communication, 17(Supp 3), 203–
221. DOI: http://dx.doi.org/10.1080/10810730.2012.712612
Penfold, R. B., Kullgren, J. T., Miroshnik, I., Galbraith, A. A.,
Hinrichsen, V. L., & Lieu, T. A. (2011). Reliability of a patient
survey assessing cost-related changes in health care use among
high deductible health plan enrollees. BMC Health Services
Research, 11(1), 133–143. DOI: 10.1186/1472-6963-11-133
Seto, I., Foisy, M., Arkison, B., Klassen, T., & Williams, K.
(2012). The evaluation of an evidence-based clinical answer
format for pediatricians. BMC Pediatrics, 12, 34–41.
DOI: 10.1186/1471-2431-12-34
Timmins, F. (2013). Nursing Research Generating and
Assessing Evidence for Nursing Practice. Nurse Education in
Practice, 13(6), e29. DOI:
http://dx.doi.org/10.1016/j.nepr.2013.04.001.
Recycling Journal Template
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9. Page 1 of 1
Ecology and Environmental Sustainability
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Running head: evaluation methodology 1
evaluation methodology 6Evaluation Methodology
Name
University
Date
Evaluation Methodology
Evaluation methodology plan becomes the tool helping one to
understand various steps involved in performing a quality
assessment (Friedman & Wyatt, 2010). The project manager can
learn what he or she needs to know to determine the quality
level of performance within the hospital setup. The purpose of

10. the paper is to describe the evaluation methodology plan to
answer the PICO question: Does implementing a new unified
acute and ambulatory EHR (Electronic Health Record) system in
the hospital, compared to when they are not used, improve the
health care quality for the patients through documentation?
More so, there is specifying of the research design, the
information sources, and the data collection methods to be used.
There is a description of evidence around the PICO question
through the synthesis of what works, when, who, where, and
how regarding the evaluation. It also focuses on identifying the
analyses types performed on the data gathered. Eventually,
there is the discussion relating to the measure of success
relating to assessment and the summarizing of
results.Description of the Methodology Plan
The evaluation methodology to be used to answer the PICO
question is cognitively-based, which requires expertise in
medicine as well as the human-computer interaction.
Participants from both teams will collaborate on the pragmatic
and theoretical aspect of the evaluation process. The evaluation
process will be divided into four sections: profiling testers,
designing scenarios, creating an evaluation form and designing
questionnaire for the evaluator (Centers for Disease Control,
n.d.). The purpose of profiling testers is to identify and select
potential users of the EHR system. Four panels of users will be
designed based on several requirements from information
technology experts and health care professionals.
Additionally, A research design is an overall strategy chosen for
integration of various components of study in a logical and
coherent way, hence ensuring effectiveness in addressing the
PICO question. The design comprises the blueprint regarding
collecting, measurement as well as the data analysis. The design
involved is the peer-reviewed and the predetermined process
derived from the identification of research or PICO question,
the study protocol, analysis, and the interpretation of the
results. The sources of information are the peer review groups
that help in identifying research materials through electronic

11. databases, pursuing references, experts’ advice, and hand-
searching journals. The selected literature is based on medical
history information and predictions. The data is mainly
collected from the experimental data, by using the data
extraction forms. Any qualitative data is usually coded based on
medical documentation reviews for validity, and robustness.
Detailing the “Who,” “What,” “When,” “Where,” and “How” of
the Evaluation
Studies reveal that usability and acceptability of a system can
be tested using a group of five testers to obtain meaningful
results (Viitanen, Kuusisto & Nykänen, 2011). With the help of
a small questionnaire, I will define the panels regarding
computer systems' experience and understanding of auto-
medication. Based on my PICO question, the improvement of
the quality of health care for patients through documentation
can only be realized if the users understand the system and
accept it in their environment. Past experience of the users
regarding similar technology can also determine whether the
system will improve the quality of health care in the hospital.
Experienced system users will be assumed to be those with at
least six months’ experience of interaction with related
technology and at least three hours of browsing weekly. A user
ready for electronic health record is someone who knows how to
use the internet and can at times prescribe medication to himself
or interpret medication information with minimal or no
consultation with a general physician.
Moreover, the evaluation process should take place in the real
working environment. I will also design evaluator forms to take
notes during the evaluation process. The scenario here will be
an examination of usability of EHR and accuracy of
documentation, the efficiency of documentation using the new
system and exploitation of the documented information
(Viitanen et al., 2011).Analysis of Result.
The results obtained from the evaluator forms, as well as the
questionnaires, form a valuable source of data. Formal data will

12. be summarized in table forms. The results will be emphasized
that all scenarios were conducted successfully. Quantitative
analysis will be used to analyze the data. The decision to use
quantitative analysis is informed by the fact that the data collect
is in quantitative form. This means that the data was collected
through participant observation and questionnaires while
assuming fixed and measurable reality (Centers for Disease
Control, n.d.). Thus, the analysis will involve numerical
comparisons and statistical inferences. Inferential statistics will
enable me to examine the difference and relationships different
samples of the population under study. Although it is complex
analyses, it provides significant differences between variables.
Inferential statistics will allow me to evaluate my PICO
question and generalize the results. The correction will be used
to describe the relationship between outcomes obtained
regarding the usability of EHR (Friedman & Wyatt, 2010).How
to Measure Success in the Evaluation and Summarizing Results.
To ensure the success of the evaluation, the survey will be
conducted in the real working environment. The focus will be
on the usability of EHR and its five attributes; memorability,
learnability, errors, efficiency, and satisfaction (Viitanen et al.,
2011). These attributes will be measured on a percentage scale.
A higher percentage means success in the given attribute. The
results will also be presented in a tabular form. Summary.
To sum it up, a cognitive-based evaluation methodology will be
valuable for EHR evaluation. The analysis of the data obtained
will help in redesigning some aspects of the system. Moreover,
the evaluation information will also be helpful to communicate
with users of the system. The evaluation methodology focuses
on usability, and it only tests with the potential users of the
system. A cognitive approach is important when designing the
panel of users, evaluation forms, scenarios, and questionnaires.
Regarding the EHR, it will be necessary to study patients and
other users exposed to such technological tool as well as
studying patient-doctor relation over a period (Stroud &
Gansauer, n.d.). This will ensure credibility and reliable results.

13. References
Centers for Disease Control. (n.d.). Evaluation Planning: What
is it and how do you do it? Retrieved from:
http://www.cdc.gov/healthcommunication/research/evaluationpl
anning.pdf
Friedman, C. P., & Wyatt, J. C. (2010). Evaluation methods in
biomedical informatics (2nd ed.). New York, NY: Springer
Science+Business Media, Inc.
Stroud, S., & Gansauer, L. (n.d.). Nursing evidence-based
nursing practice tool kit: Practice, evidence, and translation
process. Spartanburg Regional Health Care System. Retrieved
from:
https://www.spartanburgregional.com/app/files/public/537/Nursi
ng-evidence-based-practice-tool-kit.pdf
Viitanen, J., Kuusisto, A., & Nykänen, P. (2011). Usability of
electronic nursing record systems: definition and results from
an evaluation study in Finland. In ITCH (pp. 333-338).
doi/abs/10.1177/0018720815576827
Literature Review Protocol Summary Table
Name:
Literature Review Summary Table
NURS 6431
Citation
Study
Design Type
Framework/Theory
Setting
Key Concepts/Variables
Findings
Hierarchy of Evidence Level
Narcisse, M. R., Kippenbrock, T. A., Odell, E., & Buron, B.

14. (2013). Advanced Practice Nurses' Meaningful use of electronic
health records. Applied Nursing Research, 26(3), 127-132.
Type of Study:
Quantitative,
Design Type:
Non-experimental research
Framework/Theory:
Exploratory Study using survey
Convenience sampling was used to select subjects for the survey
and these were selected from the Arkansas, Louisiana,
Mississippi and Tennessee state nursing boards
Concepts:
The study was done using 6986 postcards, to which 526
individuals responded
Independent Variable:
The survey consisted of self-administered multi choice
questions aimed at getting different views
Dependent Variable:
Chi-Square Test
Controlled Variable:
Mann-Whitney U Test
Two thirds of the APNs were EHR-user. Statistically significant
differences between EHR-users and
non-users were found in age categories, practice setting,

15. practice size, and in tasks related to imagery report
review and care coordination. EHR
Level III
Kirkendall, E. S., Goldenhar, L. M., Simon, J. L., Wheeler, D.
S., & Spooner, S. A. (2013). Transitioning from a computerized
provider order entry and paper documentation system to an
electronic health record: Expectations and experiences of
hospital staff. International journal of medical informatics,
82(11), 1037-1045.
Type of Study:
. Qualitative
Design Type:
I-SEE Survey
Framework/Theory
Examining perceptions of healthcare workers towards the use
of systematic Electronic Health Records
The study was conducted in Cincinatti Children’s Hospital
Medical Centre
Concepts:
The study was done using 731 sets of response data that was
attained from the inpatient staff.
Hospital Training, Electronic records.
Independent Variable:
The survey was conducted online via survey monkey application
and the data gathered from all participating respondents
Dependent Variable:
Cronbach coefficient was used in the survey
Controlled Variable:
Wakefields Support and Resources Scale
Most respondents agreed that the use of EHR had improved
their performance in the field.

16. Survey results demonstrated that the organizational expectations
for transitioning from a hybrid
paper/electronic HIT system to a fully functional EHR were
positive and that the organization met and even staff exceeded
expectations (for the items surveyed) 1 year post-
implementation.
Level IV
Citation
Study
Design Type
Framework/Theory
Setting
Key Concepts/Variables
Findings
Hierarchy of Evidence Level
Penoyer, D. A., Cortelyou-Ward, K. H., Noblin, A. M., Bullard,
T., Talbert, S., Wilson, J., ... & Briscoe, J. G. (2014). Use of
electronic health record documentation by healthcare workers in
an acute care hospital system. Journal of healthcare
management, 59(2), 130-146.
Type of Study:
Qualitative
Design Type:
Methodical research and survey
Framework/Theory:
Reviewing the effectiveness of EHR systems in the healthcare
setting
A study was carried out in a large six facility healthcare center
in the southeastern part of the USA.
Concepts:
Vaccines, caregivers, patient assessment.
A survey was done on 839 healthcare professionals in various

17. centers
Independent Variable:
The survey was an online survey aimed at gathering information
on ETR usage
Dependent Variable:
The use of systematic survey methods for the assessment of the
efficiency of EHR
Controlled Variable:
The evaluation of clinical summary tabs
Many participants preferred the usage of EHR compared to
traditional methods of storing patient information
Level III
McAlearney, A. S., Hefner, J. L., Sieck, C., Rizer, M., &
Huerta, T. R. (2014). Evidence-based management of
ambulatory electronic health record system implementation: an
assessment of conceptual support and qualitative
evidence. International journal of medical informatics, 83(7),
484-494.
Type of Study:
Qualitative study
Design Type:
Research survey
Framework/Theory
:
Studying the success of EHR system implementation in health
Interviews and focus groups were designed to explore
perspectives of organizations and healthcare givers on the use
of ambulatory EHR in the line of duty
Concepts:
Interviews were done in 6 healthcare facilities to determine the
effectiveness of ambulatory EHR in hospitals

18. Independent Variable:
45 interviews were conducted on the participants to determine
the effectiveness of these processes
Dependent Variable:
PDSA model
Controlled Variable:
Preliminary coding
The participants agreed that it was necessary to introduce
sufficient structures for the use of EHR in the medical
perspective
Level III
Level V
Hessels, A., Flynn, L., Cimiotti, J. P., Bakken, S., & Gershon,
R. (2015). Impact of Heath Information Technology on the
Quality of Patient Care. On-line journal of nursing
informatics, 19.
Type of Study:
Quantitative
Design Type:
Research study and survey
Framework/Theory:
Examining the relationship between successful EHR adoption
and patient satisfaction
New Jersey nurse survey data was analyzed to explore the use
of EHR in health facilities in the region
Ranging from schools, home, mail, college, summer camps
Concepts:
Analysis of cross sectional data from 4 main sources

19. Independent Variable:
Data from the New Jersey State Inpatient Database was
analyzed
Dependent Variable:
Practical Environment Scale of the Nursing Work Index
Controlled Variable:
Cronbach Alphas
The findings revealed that there was a connection between high
patient satisfaction in hospitals and the use of Electronic Health
Records
Level V
Level IV
Citation
Study
Design Type
Framework/Theory
Setting
Key Concepts/Variables
Findings
Hierarchy of Evidence Level
Dolezel, D., & Moczygemba, J. (2015). Implementing EHRs: An
exploratory study to examine current practices in migrating
physician practice. Perspectives in Health Information
Management, 12(Winter).
Type of Study:

20. Mixed methods of quantitative analysis Design Type:
Descriptive co- relative research study analysis was used which
included the use of open ended questionnaires
Framework/Theory:
the study aims at assessing the effectiveness of EHR practices
in the modern healthcare settings
Interviews took place in several locations, including
participants’ homes, and public places.
Concepts:
A web based survey was conducted on physicians, office
managers and a nurse to gain a response
Independent Variable:
A survey was conducted on data from the Healthcare
Information and Management Systems Society
Dependent Variable:
Descriptive Statistics were used
Controlled Variable:
Use of research methodologies to assess the targets
The finding revealed that most healthcare practitioners chose to
migrate patient records to the EHR systems
Level IV
Type of Study:
Choose an item.
Design Type:
Choose an item.

21. Framework/The-ory:
Concepts:
Independent Variable:
Dependent Variable:
Controlled Variable:
Type of Study:
Choose an item.
Design Type:
Choose an item.
Framework/Theory:
Concepts:
Independent Variable:
Dependent Variable:
Controlled Variable:

22. Citation
Study
Design Type
Framework/Theory
Setting
Key Concepts/Variables
Findings
Type of Study:
Choose an item.
Design Type:
Choose an item.
Framework/Theory:
Concepts:
Independent Variable:
Dependent Variable:
Controlled Variable:
Type of Study:
Choose an item.

23. Design Type:
Choose an item.
Framework/Theory:
Concepts:
Independent Variable:
Dependent Variable:
Controlled Variable:
Type of Study:
Choose an item.
Design Type:
Choose an item.
Framework/Theory:
Concepts:
Independent Variable:
Dependent Variable:

24. Controlled Variable:
1
© 2013 Laureate Education, Inc.
Running head: LITERATURE REVIEW
1
7
LITERATURE REVIEW
Literature Review
Name:
University
Class
Date
Literature Review
The paper is an analysis of articles reviewing the efficiency of
Electronic Health Records (EHR) in the medical practice. The
paper studies several related articles from various authors who
established issues affecting the use of EHRs in the medical
field. The information gained from these articles gives insight

25. into the PICO question that indicates whether the
implementation of the new unified acute and the Ambulatory
EHR (Electronic Health Record) system in the hospital
improves the healthcare quality regarding the patients via
documentation when compared to when the system is not in use.
The purpose of the paper is to explain and explore issues that
affect the adoption of Electronic health records in the medical
practice. Additionally, the paper is describing, summarizing,
and synthesizing the findings in the literature relating to the
stated PICO question.
Review of Literature
The first peer-reviewed article titled Advanced Practice Nurses’
Meaningful Use of Electronic Health Records focuses on the
increasing role of EHRs in the US healthcare system. It analyses
the processes and mechanisms in place to assess the use of
EHRs in modern healthcare procedures (Narcisse, Kippenbrock,
Odell, & Buron, 2013). It includes systematic analysis
reviewing the effectiveness of procedures using Electronic
Health Records (Rozas, & Klein, 2010). The article concludes
by recognizing the fact that the implementation of Electronic
Health Records is an important step in ensuring that disease
management occurs.
Penoyer et al., (2014), looked at the use of EHR systems in the
hospital system, as well as issues that may affect its adoption in
healthcare institutions. The article concludes that it is necessary
for organizations to review EHR processes and ensure that
structures are put in place for better functioning in healthcare
processes. It furthermore interprets a survey carried out by
healthcare professionals to assess the effectiveness of the study.
Dolezel and Moczygemba (2015), analyzed the implementation
of EHR systems in physician practices. It incorporates
analytical data to assess the efficiency of the adaptation of these
systems. The article concludes by explaining the fact that
though the transition to EHR may be challenging, it is a
necessary process in the current healthcare setting.

26. McAlearney, Hefner, Sieck, Rizer and Huerta (2014), assessed
the implementation of Electronic Health Record with interviews
carried out on several participants. It includes research into the
successful management of ambulatory EHR implementation. It
uses evidence from surveys carried out, and it gives more
insight into practices that can improve the use of these systems
in healthcare centers.
Hessels et al., (2015) through their article, analyzed the
relationship between the adoption of Electronic Health Records
and the rate of satisfied patients. Their analysis highlights the
success of the implementation of this technology on improving
healthcare practices. It concludes that the adoption of Electronic
Health Records in hospitals was associated with a shortened
length of stay in the various hospitals.
Kirkendall, Goldenhar, Simon, Wheeler and Andrew Spooner
(2013), analyzed the effectiveness of the transformation from
traditional data recording methods to the use of EHR in medical
practices, through detailed research. The study revealed the
importance of a smooth transition to the use of modern
technology, especially through practices such as training. It
reveals that though many healthcare professionals embrace the
use of EHR, not many are knowledgeable concerning its
application in healthcare.
How the Literature Demonstrates the Significance of the PICO
Question Topic.
The research clearly shows that adopting the new system within
the hospital will help in improving the healthcare quality as
compared to using the old paperwork system of documentation.
According to McAlearney et al., (2014), It’s much more
important to implement while facilitating the successful
ambulatory EHR. It should apply the QI (Quality Improvement)
model that work towards the success of the system. The patients
manage to receive the results instantly upon being well-
documented from the point of admission to the point of

27. discharge. According to Hessels et al., (2012), there are several
sources of data when it comes to the changeover in technology
within the hospital setup. For instance, nurses are asked to
provide technical skills and challenges being encountered while
introduced to the new ambulatory system and any adjustments
are made accordingly. The patients also have their contributions
to the unified system in ensuring there is the integration of the
documentation process. The administration of the information
systems including the experiences and expectations survey
became much critical in the hospital evaluation. It contributed
to the adoption of the new system with positive expectations
and hence provided perceptions relating to the handling of the
new system within the hospital. It helped in realizing improved
quality of health care (Kirkendall et al., 2013).
Describing Original Conclusions Derived from the Evidence
Gathered.
There was evidence as by Hessels et al. (2012) that EHR
adoption level has a statistical relationship with the patient
satisfaction. It is mostly in the acute care clinics when analysis
regarding the patient satisfaction results is done. The hospitals
with the new ambulatory system have demonstrated positive
feedback when it comes to medical documentation as compared
to those using the paperwork system. The system helps in
recording much information at the same time hence serving
many customers per day. It has helped improved the level of
health care within the hospital since there is also a module
regarding patients’ critiques. However, the research by Penoyer
et al. (2014), is seen to focus on more than one purpose of
medical documentation. More so, the nurses are viewed to have
the perception of time-consuming of the new system hence the
need for further research to realize the overall effectiveness and
the purposes of the system.
Summary
The literature review answers the PICO question concerning the
efficiency of Electronic Health Record systems as compared to
manual methods of recording health information of patients.

28. The articles’ review findings as well as data that proves the
efficiency of modern technology in managing health records in
health facilities. The articles further reveal the advantages of
Electronic Health Records in health institutions by explaining
how they have influenced modern medical practices in the
healthcare setting. It gives a well-detailed analysis of these
efficiencies and exposes new information concerning the
changing medical technologies. These articles conclusively
agree to the fact that EHRs improve outcomes in healthcare
institutions and furthermore improve the quality of care that
patients receive (Scutt, 2008). It is also mentioned that it is
important to improve ambulatory EHR, to ensure efficient
practices. Therefore, it is necessary to ensure proactive
implementation in healthcare facilities for improved healthcare
processes.
References
Dolezel, D. & Moczygemba, J. (2015). Implementing EHRs: An
Exploratory Study to Examine Current Practices in Migrating
Physician Practice. Perspectives in Health Information
Management. Retrieved from:
http://perspectives.ahima.org/implementing-ehrs-an-
exploratory-study-to-examine-current-practices-in-migrating-
physician-practice/
Hessels, A., Flynn, L., Cimiotti, J. P., Bakken, S., & Gershon,
R. (2015). Impact of Heath Information Technology on the
Quality of Patient Care. On-line journal of nursing
informatics, 19. Retrieved from:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5001503/
Kirkendall, E., Goldenhar, L., Simon, J., Wheeler, D., &
Andrew Spooner, S. (2013). Transitioning from a computerized
provider order entry and paper documentation system to an
electronic health record: Expectations and experiences of
hospital staff. International Journal of Medical Informatics,
82(11), 1037-1045. Doi:
http://dx.doi.org/10.1016/j.ijmedinf.2013.08.005

29. McAlearney, A., Hefner, J., Sieck, C., Rizer, M., & Huerta, T.
(2014). Evidence-based management of ambulatory electronic
health record system implementation: An assessment of
conceptual support and qualitative evidence. International
Journal of Medical Informatics, 83(7), 484-494. DOI:
http://dx.doi.org/10.1016/j.ijmedinf.2014.04.002
Narcisse, M., Kippenbrock, T., Odell, E., & Buron, B. (2013).
Advanced Practice Nurses' Meaningful use of electronic health
records. Applied Nursing Research, 26(3), 127-132. DOI:
http://dx.doi.org/10.1016/j.apnr.2013.02.003
Penoyer, D., Cortelyou-Ward, K., Noblin, A., Bullard, T.,
Talbert, S., & Wilson, J. et al. (2014). Use of Electronic Health
Record Documentation by Healthcare Workers in an Acute Care
Hospital System. Journal of Healthcare Management, 59(2),
130-144. Retrieved from:
http://web.b.ebscohost.com.ezp.waldenulibrary.org/ehost/pdfvie
wer/pdfviewer?sid=157cf576-cbb4-4db3-926d-
30a76f07b39c%40sessionmgr104&vid=1&hid=128
Rozas, L. W., & Klein, W. C. (2010). The value and purpose of
the traditional qualitative literature review. Journal of
Evidence-Based Social Work, 7(5), 387–399. DOI:
http://dx.doi.org/10.1080/15433710903344116
Scutt, D. (2008). How to review literature. Radiologic
Technology, 79(4), 306–308. Retrieved from:
http://web.b.ebscohost.com.ezp.waldenulibrary.org/ehost/pdfvie
wer/pdfviewer?sid=e19434f1-fcaa-48e1-b856-
5cf6bb14cdd1%40sessionmgr104&vid=1&hid=130.
Running head: Revised pico question 1
Revised pico question 2
Revised PICO Question
Name
University
Class
Date

30. Revised PICO Question
My revised PICO question is as followed: Does implementing a
new unified acute and ambulatory Electronic Health Record
(EHR) system within the hospital, compared to when they are
not used improve the quality of healthcare for the patients
through documentation?
P (problem) is the quality of patient care through
documentation,
I (intervention or indicator) is implementing the new EHR
system,
C (comparison) is no implementation of the new system having
other consequences,
O (outcome) is the improved quality of patient care.