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.Your organization is a small critical access hospital (CAH), and you are the ch

.Your organization is a small critical access hospital (CAH), and you are the chief nursing officer (CNO) responsible for patient safety, quality, and HIT, in addition to your nursing leadership responsibilities. Your hospital is having significant financial difficulty with very tight profit margins. The EHR incentives from Centers for Medicare & Medicaid Services (CMS) that your organization has successfully attained have essentially kept your doors open. The implemented EHR has been considered a successful endeavor in achieving success with attaining meaningful use (MU) stage 1 and accessing the financial incentives associated with success. However, your organization adopted and implemented the EHR very rapidly, with what your vendor referred to as the “big bang” implementation, meaning one day your entire organization was on the paper-based record, and the following day the entire organization moved over to the EHR.
There are a number of issues with the use of the EHR, including overdependence on old paper-based ways, maintaining a dual documentation system with some information in the electronic format and the other in the paper-based record that nurses and physicians persist in using. In your patient safety reporting, your hospital has indicated several near misses with patient safety events related to missed orders on medications and labs that you suspect are related to this dual documentation practice.
Considering lessons learned in reviewing the chapter and the tools available to you as the CNO for your organization, respond to the following questions:
1.What is one of the first steps you will take to assess the unintended consequences of the EHR in critical access hospitals (CAHs)? 
2. What models are available to you to help you understand and document the problem and how will you go about using those tools? Please describe at one selected model. 

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