data design and relational databases workflow and gap analysis in clinical informatics

data design and relational databases workflow and gap analysis in clinical informatics

Respond to 2 classmates post at least 150 – 200 words (can be more if needed). APA citations with retrieved from url and doi if online references.

Discussion Response 1

This week for the discussion post I struggled between Scenario #1 and Scenario # 3, as I could definitely see myself performing a gap analysis on either of these situations. However, I went ahead and chose scenario #1 as I am currently in the mindset of medication delivery and safe administration. So after reviewing this scenario the most prominent workflow gap is that the medication ordering is not done directly as other orders are being completed through CPOE (Comptuerized Physician Order Entry). The responsibility of this I believe is twofold to include the IT department but also the executive leadership of the organization. IT projects should have a vision that is directed by the executive leadership and the organization’s strategic plan. I often run into this within my own workforce where at times IT is not aware of the strategic plan or goals as they operate in a different “lane” or “cilo” which proves to be difficult with project management.

Meaningful use has different stages and with the CPOE aspect within stage 2, this aspect of medication orders was a prominent miss on the IT design/build. In order to have this particular facility operate with their EHR being certified they have missed out on a variety of key pieces, some of which we will describe. According to Meaningful Use, the providers are to utilize CPOE for at least 80% of all orders (Brown, 2010). As part of the gap analysis which will be discussed later, it would be important to note how many orders are truly done by CPOE and does the organization obtain their 80% without the medication orders. Another aspect is the safety aspect of checking allergies and drug to drug interactions and this is not being performed by either the provider or even the pharmacist when profiling the orders (Brown, 2010). Another aspect of meaningful use and safe medication delivery is accurate medication lists as well as their allergy list (Brown, 2010). This process is a very manual process and allows the potential for human error to increase as well as not utilizing the technology to the fullest of its scope or ability.

It is important to note that a gap analysis can “assess existing personnel and nonpersonnel resources within a health system, identify areas for integration of health care delivery, and uncover areas of potential safety a liability risk for a single overarching topic (Golden, et. al, 2017). In order to perform a Gap Analysis, I feel it would be important to leverage the various LEAN methodologies that I have learned through my personal experience as a Nurse Manager. I would follow a systematic approach with determining the specific problem area. The first step after identifying the problem would be to describe and obtain the ideal state that one would desire and then start looking at the present state of the workflow. From here it is important to utilize other tools I’ve learned through LEAN, such as SWOT and fishbone diagrams (Athuraliya, 2019). I would utilize this tools to shadow Stephanie and determine the present gaps within our current state and then determine and brainstorm with her and other frontline staff ways that we could improve this workflow. The end goal should be to deliver safe and effective patient care in a timely manner and therefore it is imperative to have the involvement of the right stakeholders from the very beginning of the gap analysis.


Athuraliya , Amanda (2019, July 4). 5 Gap Analysis Tools to Analyze and Bridge the Gaps in Your

Business. Retrieved December 11, 2019, from

Brown, B. (2010). 25 steps to meaningful use. Journal of Health Care Compliance, 12(3), 33034, 68-69.

Golden, S., Hager, D., Gould, L.J., Mathioudakis, N., & Pronovost, P.J. (2016). A gap analysis needs

assessment tool to drive a care delivery and research agenda for integration of care and sharing of best practices across a health system. Joint Commission Journal on Quality and Patient Safety, 43(1), 18-26. Retrieved from…

Respond to 2 classmates post at least 150 – 200 words (can be more if needed). APA citations with retrieved from url and doi if online references.

Discussion Response #2 Post

In scenario two, the nurse leader needs to contact patients with specific diagnoses that could benefit from outpatient educational clinics. The current electronic health record (EHR) does not contain up-dated patient demographic information and the appointment desk is also lacking in proficiency.

Workflow Gap

Workflow is a series of tasks or progression of steps (McGongigle & Mastrian, 2018) and a gap is an error, inconsistency or slowing of the flow of productive movement. A gap analysis investigates and identifies the gap and then fixes the issue to ensure better patient safety.

Meaningful-use, as defined by Centers of Disease Control and Prevention (CDC), is “ensuring that the certified EHR technology connects in a manner that provides for the electronic exchange of health information to improve the quality of care” (para 2, n.d.).

Within this scenario the primary gap in demonstrating meaningful-use is the inability for the EHR to manage patient demographics. According to Brown (2010) within phase one of EHR adoption, patient demographics must be recorded in a structured and formatted way. The EHR must also be able to generate lists based on “specific conditions to use for quality improvement, reduction of disparities, research, and outreach, as well as send reminders for preventative and follow-up care” (Brown, 2010, p. 33).

Conducting Gap Analysis

In this scenario, a gap analysis has already been conducted by acknowledging that the current system is unable to perform tasks like setting reminders, generating lists based on patient correct demographics, and diagnosis.

I imagine that the organization is buying an EHR package from a vendor with established components. A V-model methodology would be best suited for this scenario V-model pays more attention to testing individual components linked to analysis and design and is considered reliable (Dennis, Wixom & Roth, 2015).


Brown, B. (2010). 25 steps to meaningful use. Journal of Health Care Compliance, 12(3), 33-34, 68-69.

Dennis, A., Wixom, B. H., & Roth, R. M. (2015). Systems analysis and design (6th ed.). Hoboken, NJ: Wiley.

Center for Disease Control and Prevention. Meaningful use: Introduction. Retrieved from….

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

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