Part 6: Evaluation Plan
Running head: Revised pico question 0 Revised PICO Question Name University Class Date 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.
Part 6: Evaluation Plan
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 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. 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 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. 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 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/pdfviewer/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/pdfviewer/pdfviewer?sid=e19434f1-fcaa-48e1-b856-5cf6bb14cdd1%40sessionmgr104&vid=1&hid=130.
Part 6: Evaluation Plan
Literature Review Protocol Summary Table Name: 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. (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, 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. 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 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 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 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: 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. 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: 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. 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: Controlled Variable: © 2013 Laureate Education, Inc.
Part 6: Evaluation Plan
Running head: evaluation methodology 0 Evaluation 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 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 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 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. 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/evaluationplanning.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/Nursing-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
Part 6: Evaluation Plan
Running head: evaluation tool 0 Evaluation 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 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 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 & 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. 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.