Literature Review: The Use Of Clinical Systems To Improve Outcomes And Efficiencies

  • Literature Review the Resources and reflect on the impact of clinical systems on outcomes and efficiencies within the context of nursing practice and healthcare delivery.
  • Conduct a search for recent (within the last 5 years) research focused on the application of clinical systems. The research should provide evidence to support the use of one type of clinical system to improve outcomes and/or efficiencies, such as “the use of personal health records or portals to support patients newly diagnosed with diabetes.”
  • Identify and select 5 peer-reviewed articles from your research.
Literature Review
Literature Review

In a 4- to 5-page paper, synthesize the peer-reviewed research you reviewed. Be sure to address the following:

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  • Identify the 5 peer-reviewed articles you reviewed, citing each in APA format.
  • Summarize each study, explaining the improvement to outcomes, efficiencies, and lessons learned from the application of the clinical system each peer-reviewed article described. Be specific and provide examples.

Sade Watson


Patient-Centered Portals Improving Primary Care

Sade Watson

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Patient-Centered Portals Improving Primary Care

The Use of Clinical Systems to Improve Outcomes and Efficiencies

Patient – Centered Portals Improving Primary Care

Walden University

NURS – 6051N

Transforming Nursing and Healthcare through Technology


DATE: 4/21/2019

Patient-Centered Portals Improving Primary Care, Literature Review

In our world today, technology is on the rise and improving more each day. With the explosive growth of information technology (IT), emerging infrastructures and devices, the provision of healthcare is increasingly taking place supported using these technologies (Solomon Negash, 2018). With the use of patient-centered portals, it has been effective in improving patient’s primary care. Patients can now have access to their health records, recent doctor visits, discharge summaries, plan of care, medications as well as scheduling their next appointment. These services and technologies provide patients, doctors and healthcare organizations immediate access to healthcare information for efficient decision-making as well as better treatment (Solomon Negash, 2018). The use of patient portals has been useful in providing more patient involvement in their care and improving their outcomes. Improvements in care have resulted in life expectancy increased dramatically and consequently resulting in higher demands for healthcare services accompanied by a dearth of medical professionals in parts of the world with the highest need (Solomon Negash, 2018). Patient Portals has provided improved patient care, decrease office visits, decrease cost and improve patient outcomes.

The Centers for Medicare and Medicaid Services defines a patient portal as “a secure online website that gives patients convenient 24-hour access to personal health information from anywhere with an internet connection. Using a secure username and password, patients can view basic health information” (Alfano, 2016). Patient portal has improved the relationship with the patient and provider by giving them direct access to communicate. Patients have found it convenient to email their provider with questions and or concerns through their portal to help improve patient outcomes. Along with emails patient can also schedule appointments, refill their medications, make payments, view insurance coverage and download education materials. The overall advantage that patient portals provide will need to be benchmarked to determine how to improve not only the flow of information but to also provide the patient with tools to take part in their care. To be fully utilized in the future, these applications should be implemented to allow for fewer time-consuming encounters between patients and providers as well as to enhance the accuracy of information being exchanged (Kruse, 2019).

Web-based patient portals are increasingly part of the outpatient experience and help patients engage in their care (Huerta, 2017). With patient portals, patients have been more involved in decision making in their primary care to help improve their outcomes. Doctors typically will give a patient a visit summary and or a discharge summary on paper and now it is also being uploaded online in the case a patient misplace their paperwork. At the Ohio State University (OSU) Wexner Medical Center, we observed substantial increases in patient engagement when we implemented an outpatient portal, especially for patients with chronic conditions, and we were impressed with findings from studies showing that the hospitalization period can be used to initiate long-term behavior change among patients (Huerta, 2017). Patients with chronic conditions can also download educational instructions on their disease process and start to adapt to new lifestyle changes. With patient is being more involved in their care and having immediate access to their plan of care has been effective with primary patient care.

As the patient portals continue to advance from only collecting the patient’s information to a wide spread of patient care, it has shown an impact on the clinical systems. At their outset, patient portals were nothing more than a way for a health care provider to collect information or to share information (mostly test results) with patients (Alfano, 2016). In a clinical setting, electronic records have become more convenient to pull up patient information rather than searching through the paperwork. Healthcare workers can also share patient information and office visits to other healthcare providers involved in their primary care. One of the critical features of an EHR is that health information can be created and managed by authorized providers in a digital format capable of being shared with other providers across more than one health care organization. EHRs are built on sharing information with other health care providers and organizations – such as laboratories, specialists, medical imaging facilities, pharmacies, emergency facilities, and school and workplace clinics – so they contain information from all clinicians involved in a patient’s care (, 2018). In the case that a primary care provider sees a patient and complete lab work and the patient may go see their cardiologist, they can then pull up the patient’s previous office visits to see changes and lab results needed to improve patient outcomes.

Electronic health records have continually been on the rise showing multiple advantages in patient care. Electronic health records and the ability to exchange health information electronically can help you provide higher quality and safer care for patients while creating tangible enhancements for your organization (, 2018). Patient portals have shown results in helping healthcare providers to better manage patient care. Patient portals have been able to show up to date and accurate information regarding primary patient care. Patients and healthcare workers can have access to their electronic records providing quick access to the patients’ data to provide effective care. Securely sharing electronic information with patients and other clinicians helping providers more effectively diagnose patients, reduce medical errors, and provide safer care (, 2018). A patient can also talk directly to their provider through email in which helps improve patient/provider relationship, prompt treatment, and medical advice. Patients have been able to manage their medications, refill as needed and educate themselves on proper medication administration and medication teaching.

Other advantages in patient portal electronic records to help improved efficiencies include improved documentation, streamlined coding, and billing, enhancing privacy and security of patient data, enable patient/provider goals and reducing costs through decreased paperwork, improved safety, reduced duplication of testing, and improved health (, 2018). Although most patients are elderly and may not understand technology healthcare workers have started to include patient portal teachings in their discharge instructions. It is vital for patients to understand the benefits of using the patient portal and having direct access to their primary care. Once patients can understand the use of their portal, it could in turn help improve patients’ outcomes. Evidence has demonstrated that portals contribute to improved health outcomes, in one study, 43% of patients believed that apps, such as portals, could improve relationships with doctors, 48% would feel more in control of their health, and 40% would be would encourage to ask physicians more questions (Alpert, 2016).

The majority of portal functionality is about access to information and convenience. The patient is looking for test results, appointment times and prescription information. The clinic wants patients to update demographic and insurance information or make a payment by sharing their credit card number (Alfano, 2016). Patients and healthcare providers have shown improvement in all aspects of patient care. Healthcare workers have started to encourage more patients to take advantage of their patient portal and access their electronic record. Health care organizations are increasingly offering patients access to their electronic medical record and the ability to communicate with their providers through Web-based patient portals, thus playing a prominent role within the patient-centered medical home (Fix, 2016). Although patient portals have a lot of advantages in improving patient outcomes and being effective in involving in their care the use of patient portals remains low. A few reasons why patient usage to patient portals remain low include limited awareness, lack of familiarity with computers and the Internet, low levels of health literacy, and lack of provider endorsement (Fix, 2016). As healthcare workers it is our duty to educate the patient and or the patient primary caregiver on the benefits of using patient portals and having access to their electronic health records as it could play a vital role in improving patient outcomes if accessed correctly.

In conclusion, technology continues to improve, and the use of patient portals and electronic health records will continue to evolve. Healthcare workers will continue to complete studies and experiments to test the effectiveness of patient portal and patient outcomes to continue to show improvement and get more patients to take advantage of patient portals. Additional technologies are being implemented, such as text messaging systems and wearable device, both of which will take the time of someone (providers, techs, clerks) to explain to patients what they are, how to use them, and to help them enroll. Similarly, it will be important to bring providers on board for these other technologies because they are likely to be at least partially affected either by the data they provide or patients asking about them (Fix, 2016). These additional technologies will take place once technology continues to improve. Studies have shown that technology will have a big impact on patient portals and patient involvement in their care to help improve patient outcomes.

References Alfano, S. (2016). Patient-Centered Portals Improving Primary Care. Physician Leadership Journal, 3(4), 10-13. Alpert, J. M. (2016). Applying Multiple Methods to Comprehensively Evaluate a Patient Portal’s Effectiveness to Convey Information to Patients. Journal Of Medical Internet Research, 18(5), e112. Fix, G. M. (2016). Encouraging Patient Portal Use in the Patient-Centered Medical Home: Three Stakeholder Perspectives. Journal Of Medical Internet Research, 18(11), e308. (2018). What is an electronic health record (EHR)? Retrieved from . Huerta, T. R. (2017). Introducing a Patient Portal and Electronic Tablets to Inpatient Care. Annals Of Internal Medicine, 167(11), 816–817. Kruse, C. S. (2019). The Effect of Patient Portals on Quality Outcomes and Its Implications to Meaningful Use: A Systematic Review. JOURNAL OF MEDICAL INTERNET RESEARCH, 17(2), 70–77. Solomon Negash, P. M. (2018). Healthcare information technology for development: improvements in people’s lives through innovations in the uses of technologies. Information Technology for Development, 24:2, 189-197, DOI: 10.1080/02681102.2018.1422477 .

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The Use of Clinical Systems to Improve Outcomes and Efficiencies

Tami Frazier

Walden University

NURS 5031 – Informatics

April 19, 2019

The Use of Clinical Systems to Improve Outcomes and Efficiencies

The healthcare system of today is rapidly changing to include technology that combines both communication and exchange of information between providers.  Technology use in everyday healthcare practice is just the beginning of the integration of communication tools with existing clinical applications (McGonigle & Garver Mastrian, 2018).  The exchange of information encourages better patient care, safety, and satisfaction.  McGonigle & Mastrian, 2018 state “by integrating communication and clinical applications a real-time approach facilitates interactions and a flow of communication among the entire healthcare team, patient, and their families to enhance care (p. 191).  This paper will present five peer-reviewed research articles that incorporate technology into clinical applications within the healthcare realm.

The articles reviewed for this paper represent the merging of technology with clinical applications with the goal of creating a merging of information that is accessible to individuals and providers.  The five papers are:

1. Deep Patient: An Unsupervised Representation to Predict the Future of Patients from Electronic Health Records (Miotto, Kidd, & Dudley, 2016).

2. Role of Telehealth in Pre-anesthetic Evaluations (Schoen & Prater, 2019).

3. The Benefit of the Smartphone in Oral and Maxillofacial Surgery: Smartphone Use Among Maxillofacial Surgery Trainees and iPhone Apps for the Maxillofacial Surgeon (Carey, Frederick Brakkan Payne, Ahmed, & Goodson, 2015)

4. Healthcare Information Technology, Work Organization, and Nursing Home Performance (Hitt & Tambe, 2016).

5. Conceptualizing smartphone use in outpatient wound assessment: patients’ and caregivers’ willingness to use technology (Wiseman et al., 2015).

In the first study, the researcher’s goals are to create quantitative models that predict the health status of patients with the intention of finding ways to put an end to preventable diseases and disabilities (Miotto et al., 2016).  By using the data collected from the electronic health record (EHR) computerized technology can initiate algorithms to discover which patients are at risk for disease.  The authors presented a concept of a “deep patient”.  Essentially the “deep patient” concept is used to “represent patients by a set of general features, which are inferred automatically from a large-scale EHR database through a deep learning approach”(Miotto et al., 2016, p. 2).  Essentially, this article found that deep learning applied to EHR’s offer enhanced clinical predictions resulting in improved clinical systems and outcomes.

The second study, utilized telehealth to assess patients prior to elective surgical procedures.  Telehealth can be defined as a method to distribute medical information and treatment to individuals and other healthcare professionals over a distance using technology (Schoen & Prater, 2019).  By accessing patient’s medical records and merging it with telehealth visual technology physicians are able to assess airway, review history, lab data and prior tests with the goal of determining the patient;’s readiness for the surgical procedure (Schoen & Prater, 2019).  Utilizing telehealth medicine provides an alternative for traditional brick-and-mortar facilities while providing care that is efficient and cost-effective.

The third study, combines smartphone technology and clinical learning for surgeons.  A study was done to examine the use of medical apps and smartphones and the benefits for students training to be oral surgeons (Cary et al., 2015). With the introduction of medical applications and the trend toward smartphones, students and providers are able to be prepared for interactions with clients.  Smartphone use among healthcare providers is said to be over 80% (Carey et al., 2015).  Benefits of this for clinical practice include access to health information, teleradiology, photo documentation, telecommunication, and internet accessibility for reference material (Carey et al., 2015).  The use of smartphones for medical convenience and cost will continue to rise in the next few years.

For the fourth study, the authors sought to show that the use of information technology increases the performance and productivity of nursing home services over a time period.  The article sought to prove initiating healthcare information technology (HIT) in nursing homes was beneficial for costs, quality, efficiency, and productivity (Hitt & Tamble, 2016).  When health information technology is assimilated into existing practices in nursing homes improvements can be seen for patients and staff.

Lastly, information technology and smartphones are making a difference in wound assessment and care.  The older patient population who are willing to adopt smartphone practices show increased health related to proper documentation of wound healing and instant access to providers (Wiseman et al., 2015).   Accessibility and convenience for this population increase compliance. Wiseman et al., (2015) state, “using smartphones to remotely monitor incisional wounds via digital photos as well as collect postoperative symptom information has the potential to improve patient outcomes and transitional care (Wiseman et al., 2015, p. 245). The possibility of this type of technology in the future is remarkable.



Carey, E., Frederick Brakkan Payne, K., Ahmed, N., & Goodson, A. (2015). The benefit of the smartphone in oral and maxillofacial surgery: Smartphone use among maxillofacial surgery trainees and iPhone apps for the maxillofacial surgeon. Journal of Maxillofacial Oral Surgery14(2), 131-137. doi:/10.1007/s12663-013-0550-3

Hitt, L., & Tambe, P. (2016). Health care information technology, work organization, and nursing home performance. ILR Review69(4), 834-859. doi:/10.1177/0019793916640493

McGonigle, D., & Garver Mastrian, K. (2018). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning, LLC.

Miotto, R., Kidd, B. A., & Dudley, J. T. (2016). Deep patient: An unsupervised representation to predict the future of patients from the electronic health records. Scientific Reports6, 26094, 1-10. doi:/10.1038/srep26094

Schoen, D. C., & Prater, K. (2019). Role of telehealth in pre-anesthetic evaluations. AANA Journal87(1), 43-49. Retrieved from

Wiseman, J. T., Fernandes-Taylor, S., Barnes, M. L., Tomsejova, A., Saunders, S., & Kent, K. C. (2015). Conceptualizing smartphone use in outpatient would assessment: patients’ and caregivers’ willingness to use technology. Journal of Surgical Research, 245-251. doi:/10.1016/j.jss.2015.05.011

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