NURS 6051 Assignment The Use of Clinical Systems to Improve Outcomes and Efficiencies

ByLeon Kiprotich Leon Updated on

NURS 6051 Assignment The Use of Clinical Systems to Improve Outcomes and Efficiencies Example

The application and implementation of new healthcare technology require support from current literature. The literature may shed light on the benefits of using different clinical systems and the challenges encountered before, thus helping avoid similar challenges. In addition, research informs the selection of the best types of clinical systems. It provides results of related efficiencies and outcomes, assisting informaticists and healthcare institutions in trying different clinical systems (Atasoy et al., 2019).

NURS 6051 Assignment The Use of Clinical Systems to Improve Outcomes and Efficiencies

One of the commonly used clinical systems is remote patient monitoring technology. There are different technologies and devices used in remote patient monitoring. Therefore, research literature can be used to identify the best, based on previous studies and outcomes or efficiencies. This essay presents the literature review in an annotated bibliography form, focusing on the role of patient monitoring systems in improving the outcomes of diabetes patients and improving the efficiency of diabetes care.

Annotated Bibliography

Su, D., Michaud, T. L., Estabrooks, P., Schwab, R. J., Eiland, L. A., Hansen, G., DeVany, M., Zhang, D., Li, Y., Pagán, J. A., & Siahpush, M. (2019). Diabetes Management Through Remote Patient Monitoring: The Importance of Patient Activation and Engagement with the Technology. Telemedicine Journal and E-health: the official journal of the American Telemedicine Association, 25(10), 952–959. https://doi.org/10.1089/tmj.2018.0205

The study focuses on assessing the importance of patient activation and engagement with remote patient monitoring technology in diabetes management among type 2 diabetes patients. Su et al. (2019) note that despite the research results on the effectiveness of telemedicine, and remote patient monitoring, a clear report is needed to identify the effectiveness in patient outcomes. Therefore, the study measured the improvement of care outcomes among type 2 diabetes patients using changes in HbA1c levels. A sample of 1354 type 2 diabetes patients used remote monitoring technology for three months. 

The study found that most patients embraced remote patient monitoring technology and devices and had improved their self-monitoring skills over time. At the end of the study, the patients showed reduced HbA1c levels, thus indicating proper glycemic control, which can be translated as desirable diabetes care outcomes. The lessons learned from applying remote patient monitoring systems in diabetes management are that it improves patient outcomes. According to Su et al. (2019), patients are more likely to take keen initiative when monitoring themselves remotely, thus promoting better health outcomes by preventing complications and unnecessary healthcare expenses.

Johnson, E. L., & Miller, E. (2022). Remote patient monitoring in diabetes: how to acquire, manage, and use all of the data. Diabetes Spectrum, 35(1), 43-56. https://doi.org/10.2337/dsi21-0015

The focus of this study is to identify the different factors facilitating the acquisition, management, and use of diabetes technology and telehealth in diabetes management. According to Johnson and Miller (2022), remote patient monitoring technology would be ineffective without being complemented by telehealth, which enables the patient to communicate with the care provider and upload their progress so that the care provider can access them and give feedback. Therefore, it is vital to identify the facilitating factors, to avoid missing out or making preventable mistakes. 

The diabetes care remote monitoring systems assessed in the study included insulin pumps, health apps and personal digital devices, smart insulin pens and pen caps, connected glucose meters, and continuous glucose monitoring systems. These devices led to improved diabetes care outcomes since lower HbA1c levels and self-monitoring behavior were noted among patients using them (Johnson & Miller, 2022). The lessons learned from applying these systems is that it is vital to consider other facilitating factors, such as patients’ knowledge and confidence in using remote patient monitoring technology to produce the desired patient outcomes.

Al-Badri, M., & Hamdy, O. (2021). Diabetes clinic reinvented: Will technology change the future of Diabetes care? Therapeutic advances in endocrinology and metabolism, 12, 2042018821995368. https://doi.org/10.1177/2042018821995368

This study aimed to evaluate a virtual diabetes clinic, comparing it with regular primary care clinics, to determine whether diabetes remote care technologies such as remote patient monitoring devices increase efficiency in diabetes care. Al-Badri and Hamdy (2021) state that diabetes is a condition that requires continuous management, so remote patient monitoring technologies would increase efficiency and thus improve patient care outcomes. To validate the notion, the study assessed a complete virtual diabetes clinic. The must-have technologies for patients getting care services in the clinic include remote patient monitoring devices, patient portals/online records and mobile phones/computers to facilitate telehealth (Al-Badri & Hamdy, 2021). 

The study further shows that incorporating these technologies and services in diabetes care is attributed to successful patient engagement in diabetes management, proper glycemic control, improved quality of life, and reduced diabetes complications and related healthcare costs. Remote patient monitoring also improves diabetes care efficiency since providers can provide services to more patients at a reduced cost (Al-Badri & Hamdy, 2021). The lessons learned from this study include the importance of shifting physical diabetes care to virtual care in reducing costs and thus improving care efficiencies. Additionally, remote patient monitoring improves self-management behavior, improving care outcomes.

Salehi, S., Olyaeemanesh, A., Mobinizadeh, M., Nasli-Esfahani, E., & Riazi, H. (2020). Assessment of remote patient monitoring (RPM) systems for patients with type 2 diabetes: a systematic review and meta-analysis. Journal of Diabetes & Metabolic Disorders, 19, 115-127. https://doi.org/10.1007/s40200-019-00482-3

This study aimed to assess the effectiveness of remote patient monitoring systems in controlling glycosylated hemoglobin in type 2 diabetes patients compared to usual care. The study searched and reviewed other published studies from the most important electronic databases, whereby the main outcome was HbA1c levels. The review results showed that studies that employed remote patient monitoring systems and technologies had controlled glycosylated hemoglobin (Salehi et al., 2020). In addition, Salehi et al. (2020) note that patients who used remote patient monitoring technologies had better HbA1c levels than those who used routine patient care. The lessons learned from this study include the importance of assessing the efficacy of clinical systems before implementing them. These assessments can also be done by reviewing related research.

Summary

The essence of using clinical information systems in care is mainly improving outcomes and increasing care efficiency. Diabetes care is one of the areas that have adopted the use of clinical systems, especially remote patient monitoring systems. The literature reviewed above has justified improving patient outcomes and care efficiencies in diabetes care while using remote patient monitoring systems. The future of diabetes care depends on technology (Al-Badiri & Hamdy, 2021); however, it is essential to educate patients on how to acquire, manage and use data from remote monitoring systems (Jonhson & Miller,2022; Su et al., 2019), to lead to improved patient outcomes and care efficiencies. Therefore, remote patient monitoring increases patient outcomes and efficiency in diabetes care.   

NURS 6051 Assignment The Use of Clinical Systems to Improve Outcomes and Efficiencies References

Al-Badri, M., & Hamdy, O. (2021). Diabetes clinic reinvented: will technology change the future of Diabetes care? Therapeutic Advances in Endocrinology and Metabolism, 12, 2042018821995368. https://doi.org/10.1177/2042018821995368

Atasoy, H., Greenwood, B. N., & McCullough, J. S. (2019). The Digitization of Patient Care: A Review of the Effects of Electronic Health Records on Health Care Quality and Utilization. Annual Review of Public Health, pp. 40, 487–500. https://doi.org/10.1146/annurev-publhealth-040218-044206

Johnson, E. L., & Miller, E. (2022). Remote patient monitoring in diabetes: how to acquire, manage, and use all of the data. Diabetes Spectrum, 35(1), 43-56. https://doi.org/10.2337/dsi21-0015

Salehi, S., Olyaeemanesh, A., Mobinizadeh, M., Nasli-Esfahani, E., & Riazi, H. (2020). Assessment of remote patient monitoring (RPM) systems for patients with type 2 diabetes: a systematic review and meta-analysis. Journal of Diabetes & Metabolic Disorders, 19, 115-127. https://doi.org/10.1007/s40200-019-00482-3

Su, D., Michaud, T. L., Estabrooks, P., Schwab, R. J., Eiland, L. A., Hansen, G., DeVany, M., Zhang, D., Li, Y., Pagán, J. A., & Siahpush, M. (2019). Diabetes Management Through Remote Patient Monitoring: The Importance of Patient Activation and Engagement with the Technology. Telemedicine Journal and E-health: The Official Journal of the American Telemedicine Association, 25(10), 952–959. https://doi.org/10.1089/tmj.2018.0205

NURS 6051 Assignment The Use of Clinical Systems to Improve Outcomes and Efficiencies

Literature Review: The Use of Clinical Systems to Improve Outcomes and Efficiencies Instructions

New technology—and the application of existing technology—only appears in healthcare settings after careful and significant research. The stakes are high, and new clinical systems need to offer evidence of positive impact on outcomes or efficiencies.

Nurse informaticists and healthcare leaders formulate clinical system strategies. As these strategies are often based on technology trends, informaticists and others have then benefited from consulting existing research to inform their thinking.

In this Assignment, you will review existing research focused on the application of clinical systems. After reviewing, you will summarize your findings.

To Prepare this NURS 6051 Assignment The Use of Clinical Systems to Improve Outcomes and Efficiencies:

  • 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 4 peer-reviewed research articles from your research.
  • For information about annotated bibliographies, visit https://academicguides.waldenu.edu/writingcenter/assignments/annotatedbibliographies

The Assignment: (4-5 pages not including the title and reference page)

In a 4- to 5-page paper, synthesize the peer-reviewed research you reviewed. Format your Assignment as an Annotated Bibliography. Be sure to address the following:

  • Identify the 4 peer-reviewed research articles you reviewed, citing each in APA format.
  • Include an introduction explaining the purpose of the paper.
  • 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.
  • In your conclusion, synthesize the findings from the 4 peer-reviewed research articles.
  • Use APA format and include a title page.
  • Use the Safe Assign Drafts to check your match percentage before submitting your work.

By Day 7 of Week 8

Submit your completed Assignment.

Also read:

Discussion: Big Data Risks and Rewards NURS 6051

NURS 6051 Assignment The Use of Clinical Systems to Improve Outcomes and Efficiencies Sample Paper

The use of technology in healthcare delivery cannot be underestimated. Healthcare system is keen to use a new or implement an existing technology. Before technology is embraced, adequate research must have been conducted to prove its feasibility. There is associated improved patient safety, outcomes and work process with the use of technology in healthcare delivery (McGonigle & Mastrian, 2017). However, technology is not always an answer to improve patient safety and outcomes.

Therefore, nurses are required to gain knowledge in basic technology and health informatics as an entry level nursing competency (McGonigle & Mastrian, 2017). The purpose of this annotated bibliography is to review and synthesize credible resources that examine the application of technology-based clinical systems in the improvement of patient outcomes and care efficiencies.

In this article, Su et al. (2019) conducted a quantitative research to determine how effective remote patient monitoring (RPM) is on diabetic patients. The objective was to determine how patients’ levels of engagement with RPM devices impact post program hemoglobin A1C (HbA1C). In their study, the dependent variables include the patients’ level of participation and engagement, and the post program hemoglobin A1C. The primary outcome variable which is HbA1C was measured at two points, baseline and post program.

Further patients were divided into two groups depending on Hb levels, >9% and <9%. The findings from the research show lower HbA1C levels with increased use or engagement with RPM (Su et al., 2019). The findings imply a negative correlation between participation and post program HbA1C. Patients who engaged maximally with the RPM devices had lower HbA1C levels and the vice versa is true.

According to Eyth and Naik (2019), HbA1C serves as an indicator of glycemic control. Therefore, the higher the HbA1C, the poorer the glycemic control and therefore higher risks for diabetes and its complications. This is a case where technology is used to improve patient outcomes. Su et al. (2019) conclude that both the patient and the care givers’ efforts are crucial for the success of the RPM, and recommend an increased use of such technologies in the future care delivery.

The last demi decade has experienced massive research in the role of electronic health records (EHR) in healthcare. Tubaishat (2017) conducted a quantitative exploratory study to determine the effect of EHR on patient safety. The author, Tubaishat is a specialist and a professor in health information systems. The general purpose of the study was to explore nurses’ perception of EHR on patient safety. Semi-structured interviews were administered to the nurses from ten hospitals which had used EHR in the past between 1 and 5 years.

The findings from the research reveal that EHR is either directly or indirectly associated with decreased medical errors, improved data documentation and enhanced sustainability of data. According to Tubaishat (2017), e-prescriptions provide clear and precise medication doses as compared to paper-based prescription. Further, documentation is easier and less time consuming as compared to paper documentation (Tubaishat, 2017).

Moreover, HER are sustainable and protected using networks and passwords. The study is a typical example where technology is leveraged in improvement of patient care efficiencies, outcomes and safety. Even though the study affirms positive impacts of EHR on patient safety, it concludes that safety concerns such as technical problems and data entry errors should be addressed.

Polypharmacy is a common problem especially among the geriatric population due to the multiple health conditions they have. Rieckert et al. (2020) conducted a research to determine the effects of a computerized decision support tool in reduction of polypharmacy among the elderly population living with chronic diseases. A clustered randomized control study design, which is pragmatic and multi centered was used.

3904 patients aged 75 years and above, and on eight or more medications per day participated in the study. The participants were divided into two groups, the intervention group (1953) which was assigned to a computerized decision support tool and the control group (1951) which received treatment as usual. The findings of the study do not reveal a significant difference in the primary outcome (unplanned admissions or deaths) between the two groups; however, there is a subtle difference.

Among the intervention group, 44.6% of the participants experienced the primary outcomes while 48.4% (slightly higher) experienced the primary outcomes (Rieckert et al., 2020). Further, the secondary outcomes (number of drugs at final follow-up) were lower in the intervention group than the control group. The results indicate that the computerized decision support tool prompted the reduction in prescription and decreased the adverse consequences such as unplanned admissions and deaths. This publication is relevant to the current research as it espouses the fact that the use of computerized decision support tools should be extensive in healthcare as its efficacy in improving patients’ outcomes is proven.

Mobile technologies are increasingly used in the management of cardiovascular diseases. Of all the cardiac arrhythmias, atrial fibrillations are the most common (Guo et al., 2017). Guo and his colleagues conducted a research on the use of mobile health technologies in management of atrial fibrillation. A randomized control trial study was used on 113 patients with atrial fibrillations. The patients were divided into two groups, the intervention group which used the mobile application (mAF App) and the control group that did not use the app.

The mobile application incorporates the following details: patients’ personal health records, stroke and bleeding risk assessments, patient involvement self-score items and patient educational programs. The findings reveal that patients in the intervention group had better drug adherence, knowledge improvements and anticoagulant satisfaction as compared to the control group. In summary, quality of life significantly improved in patients who used the mAF App compared to the team that received usual care (Guo et al., 2017). The study had an upper hand being the first research in the use of mobile of mobile technologies in management of atrial fibrillation.

Synthesis of Findings and Conclusion

The use of technology in healthcare is expanding. Su et al. (2019) study found that use of a RPM in management of diabetes is effective in glycemic control. The findings of the research are as follows: patients’ participation and engagement with RPM devices causes lower post program HbA1C. Further, the study found that the frequency of use of the RPM also determine post program HbA1C levels; for instance, patients who used the RPM twice or more times a day had decreased HbA1C.

In a different study by Tubashat et al. (2017), use of EHR is associated with decreased medical errors, improved documentation of data and increased sustainability of data. According to the study, EHRs are a better alternative to traditional paper based documentation and prescription systems. Further, Rieckert et al. (2017) conducted a research on the use of electronic decision support tool to mitigate polypharmacy among elderly patients.

The findings indicated reduced adverse events such as unplanned admissions and deaths among the patients who use the tools. Further, there was a reduction in the prescribing among the patients in the intervention group. The final study about use of mobile applications in management of atrial fibrillation show positive correlation. The patients who used the mAF App showed improved educational levels and quality of life. Therefore, technology in healthcare in deed leads to improved patient outcomes, safety and care efficiencies.

NURS 6051 Assignment The Use of Clinical Systems to Improve Outcomes and Efficiencies References

Eyth, E., & Naik, R. (2019). Hemoglobin A1C. Ncbi.nlm.nih.gov. Retrieved 16 January 2021, from https://www.ncbi.nlm.nih.gov/books/NBK549816/#_NBK549816_pubdet.

Guo, Y., Chen, Y., Lane, D., Liu, L., Wang, Y., & Lip, G. (2017). Mobile Health Technology for Atrial Fibrillation Management Integrating Decision Support, Education, and Patient Involvement: mAF App Trial. The American Journal Of Medicine, 130(12), 1388-1396.e6. https://doi.org/10.1016/j.amjmed.2017.07.003

McGonigle, D., & Mastrian, K. (2017). Nursing Informatics and the Foundation of Knowledge (4th ed.). Jones and Batrlett Learning. https://samples.jbpub.com/9781284121247/9781284122688_FMxx_Pass01(1).pdf

Rieckert, A., Reeves, D., Altiner, A., Drewelow, E., Esmail, A., Flamm, M., Hann, M., Johanson, T., Klaassen-Mielke, R., Kunnamo, I., Loffler, C., Piccoliori, G., Sommerauer, C., Trampisch, U., Vogele, A., Woodham, A., & Sonnichsen, A. (2020). Use of an electronic decision support tool to reduce polypharmacy in elderly people with chronic diseases: cluster randomized controlled trial. BMJ, m1822. https://doi.org/10.1136/bmj.m1822

Su, D., Michaud, T., Estabrooks, P., Schwab, R., Eiland, L., Hansen, G., DeVany, M., Zhang, D., Li, Y., Pagan, J., & Siahpush, M. (2019). Diabetes Management Through Remote Patient Monitoring: The Importance of Patient Activation and Engagement with the Technology. Telemedicine And E-Health, 25(10), 952-959. https://doi.org/10.1089/tmj.2018.0205

Tubaishat, A. (2017). The effect of electronic health records on patient safety: A qualitative exploratory study. Informatics For Health And Social Care, 44(1), 79-91. https://doi.org/10.1080/17538157.2017.1398753

NURS 6051 Assignment The Use of Clinical Systems to Improve Outcomes and Efficiencies Sample 2

Information technology has had a significant impact on the development and implementation of healthcare services. Through information technology, service providers can easily and efficiently deliver quality healthcare. Existing research evidence has proven that health information technology improves healthcare delivery in different ways, including improving compliance to regulatory standards, minimizing medical errors, and minimizing adverse reactions. However, health organizations should select the best information technology to minimize waste and increase effectiveness. This review summarizes the currently available evidence about the impact of health information technology on improving patients’ quality of care and safety.

Kruse, C. S., & Beane, A. (2018). Health information technology continues to affect medical outcomes positively: a systematic review. Journal of medical Internet research, 20(2), e8793. https://preprints.jmir.org/preprint/8793,

This article seeks to evaluate the impact of health information technology on health outcomes. It explores various elements of health information technology, such as health records management and health information systems. The study is based on the background that various adverse outcomes within the hospital’s information system can lead to patients’ morbidity or mortality, increasing the cost of healthcare.

The study relied on a systematic literature review methodology to identify and review evidence on health information technology, retrieving journal articles from CINAHL and MEDLINE. The review was structured as Primary Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) and completed using the Assessment for Multiple Systematic Reviews (AMSTAR).

The search yielded 37 studies for final review, 81% of the reviewed journals revealing that health information technology had at least one improved medical impact. This supports the study’s hypothesis that there is a positive association between the adoption of health information systems and medical outcomes.

Menachemi, N., Rahurkar, S., Harle, C. A., & Vest, J. R. (2018). The benefits of health information exchange: an updated systematic review. Journal of the American Medical Informatics Association, 25(9), 1259-1265.https://doi.org/10.1093/jamia/ocy035

Health information exchange through health information technology has contributed to reduced costs and improved quality of care. This study aimed to rigorously evaluate the evidence that health information exchange has positive effects and benefits on the delivery of healthcare services. The study took the form of a systematic literature review and meta-analysis, retrieving peer-reviewed journal articles from Scopus and PubMed databases.

All the 24 reviewed studies reported beneficial effects of health information exchange through health information technology. Some of the benefits found by the survey include reduced imaging, lower costs, reduced duplicated procedures, and improved patient safety. This article is helpful in providing evidence about how healthcare providers can utilize health information technology to facilitate health information exchange for purposes of interprofessional teamwork.

Young, R., Burge, S., Kumar, K., Wilson, J., & Ortiz, D. (2018). A time-motion study of primary care physicians’ work in the electronic health record era. Family medicine, 50(2), 91-99. DOI: 10.22454/FamMed.2018.184803

While electronic health records have been appreciated for improving efficiency in the healthcare system, other critics claim electronic health records negatively impact the time providers take to care for patients. This study sought to update previous research on the time taken by providers to care for patients in the clinic using electronic health records.

The researchers used direct observations to observe family physician attendings, residents, and ambulatory patients in 982 visits. The researchers then measured total visit time, face-to-face time, pre-visit chart time, out-of-hours electronic health records time and total electronic health records work time.

The study results revealed that primary care physicians spent more time working with electronic health records than working face-to-face with patients. This study is helpful in deducing the impact of the electronic health records system on the average time physicians take to interact with patients physically and how that impacts the quality of care.

Gardner, R. L., Cooper, E., Haskell, J., Harris, D. A., Poplau, S., Kroth, P. J., & Linzer, M. (2019). Physician stress and burnout: the impact of health information technology. Journal of the American Medical Informatics Association, 26(2), 106-114.https://doi.org/10.1093/jamia/ocy145

Health information technology has mixed effects on the delivery of healthcare services to patients. The main aim of this study was to investigate the relationship between stress and the use of health information technology and how health information technology predicts burnout.  The study surveyed 4197 physicians on their health information technology use, with the primary outcome being self-reported physician burnout. The presence of burnout was denoted by excessive time spent on electronic health records at home, poor or marginal time for documentation, and the agreement that the use of electronic health records contributes to additional frustration. 

The results showed that health information technology produces measurable stress-related, common, and independently predictive of burnout. As such, this study is useful in identifying health information technology factors related to burnout, helping to guide healthcare organizations on how to measure and resolve burnout among their staff.

Sittig, D. F., Wright, A., Coiera, E., Magrabi, F., Ratwani, R., Bates, D. W., & Singh, H. (2020). Current challenges in health information technology–related patient safety. Health Informatics Journal, 26(1), 181-189.https://doi.org/10.1177/1460458218814893

The main aim of this study was to identify and describe the short-term challenges to help healthcare organizations, developers of health information technology, and policymakers address the challenges that health information technology presents to patient safety. The study identified some of the current challenges of health information technology to patient safety, including difficulty with developing appropriate information technology models, challenges designing effective user interface design functions and features, challenges with implementing unambiguous patient identification, challenges with creating network-enabled clinical environments, and challenges with developing safety-improving decision support systems.

This study highlights complaints about health information systems, claiming that whereas health information technology systems are effective tools for improving efficiency and low cost of care, they present many challenges and complexities that may complicate the delivery of care. Failure to address these challenges may contribute to different bottlenecks within the healthcare system, leading to poor quality, unsatisfactory and substandard care. Therefore, healthcare managers are responsible for ensuring that when implementing health information technology, they should address the challenges that come with it to minimize the adverse effects on quality of care.

NURS 6051 Assignment The Use of Clinical Systems to Improve Outcomes and Efficiencies References

Gardner, R. L., Cooper, E., Haskell, J., Harris, D. A., Poplau, S., Kroth, P. J., & Linzer, M.(2019). Physician stress and burnout: the impact of health information technology. Journal of the American Medical Informatics Association, 26(2), 106-114.https://doi.org/10.1093/jamia/ocy145

Kruse, C. S., & Beane, A. (2018). Health information technology continues to show positive effect on medical outcomes: systematic review. Journal of Medical Internet Research, 20(2), e8793. https://preprints.jmir.org/preprint/8793,

Menachemi, N., Rahurkar, S., Harle, C. A., & Vest, J. R. (2018). The benefits of health information exchange: an updated systematic review. Journal of the American Medical Informatics Association, 25(9), 1259-1265.https://doi.org/10.1093/jamia/ocy035

Sittig, D. F., Wright, A., Coiera, E., Magrabi, F., Ratwani, R., Bates, D. W., & Singh, H. (2020). Current challenges in health information technology–related patient safety. Health Informatics Journal, 26(1), 181-189.https://doi.org/10.1177/1460458218814893

Young, R., Burge, S., Kumar, K., Wilson, J., & Ortiz, D. (2018). A time-motion study of primary care physicians’ work in the electronic health record era. Family Medicine, 50(2), 91-99. 

Also Read: NURS 6050 Discussion: The Role of the RN/APRN in Policy Evaluation