Ch 14 Information Technology in the Clinical Setting – Flashcards

Clinical information systems (CIS) offers nurses and other clinicians information when, where, and how they need it. CIS facilitates reporting of results, management of orders, and documentation of clinical care. CIS integrates with other systems to provide clinical information for patient care. CIS can be patient focused or departmental. In patient-focused systems, automation supports patient care processes. Applications found in a patient-focused system include order entry, results reporting, clinical documentation, care planning, and clinical pathways. Departmental systems evolved to meet the operational needs of a particular department, such as the laboratory, radiology, pharmacy, medical records, or billing.

A CIS is not the same as an EHR. The EHR includes all information about an individual's lifetime health status and health care maintained electronically. The EHR is a replacement for the paper medical record as the primary source of information for health care, meeting all clinical, legal, and administrative requirements. Information technology permits much more data to be captured, processed, and integrated, which results in information that is broader than that found in a linear paper record. Electronic medical record (EMR), electronic patient record (EPR), and computerized patient record (CPR). Term traditionally has suggested that the sole purpose for maintaining health data is to document events. Health care delivery system is dramatically changing, with a strong emphasis on improving outcomes of care and maintaining health. The EHR needs to be considered in a broader context and is not applicable only to patients (i.e. individuals with the presence of an illness or disease). Health data also include wellness information, such as immunization history, behavioral data, environmental information, demographics, health insurance, administrative data for care delivery processes, and legal data, such as informed consents. The who, what, when, and where of the data capture are also identified. Ideally within the EHR an individual's health data should be maintained and distributed over different systems in different locations, such as a hospital, clinic, physicians office, and pharmacy. EHR is maintained in a system that captures, processes, communicates, secures, and presents the data about the patient. EHR system include clinical rules, literature for patient education, expert opinions, and payer rules related to reimbursement. Data Capture: Data capture refers to the collection and entry of data into a computer system. The origin of the data may be local or remote from patient-monitoring devices, from telehealth applications, directly from the individual recipient of health care, and even from others who have information about the recipient's health or environment, such as relatives, friends, and public health agencies. Storage: Storage refers to the physical location of data. Access protocols permit only authorized users obtain data for legitimate uses. Systems must have backup and recovery mechanisms in the event of failure. A person's identity can be determined by many types of data in addition to common identifiers, such as name and number. Information processing: Application functions provide for effective retrieval and processing of data into useful information. Reminders can be provided for appointments, criteria path actions, medication administration, and other activities. The nurse could integrate standard guidelines, protocol, or critical as a basis for managing and documenting care. Data may also be downloaded into statistical software programs for more sophisticated analysis for research purposes.

Information Communication: Information communication refers to the interoperability of systems and linkages for exchange of data across disparate systems. To integrate health data across multiple systems at different sites, identifier systems for health care recipients, caregivers, providers, payers, and sites are essential. Vocabulary and code systems must permit the exchange and processing of data into meaningful information. EHR systems must provide access to point-of-care information databases and knowledge sources, such as pharmaceutical formularies, referral databases, and reference literature. Security: Computer-based patient record systems provide better protection of confidential health information than paper-based systems because such systems incorporate controls designed to ensure that only authorized users with legitimate users have access to health information. Security functions must be designed to ensure compliance with applicable laws, regulations, and standards. Security functions must be designed to ensure compliance with applicable laws, regulations, and standards. Security systems must ensure that access to data is provided only to those who are authorized and have a legitimate purpose for its use. Security functions also must provide a means to audit for inappropriate access. -Privacy: refers to the right of an individual to keep information about himself or herself from being disclosed to anyone else. -Confidentiality: refers to the act of limiting disclosure of private matters. Once a patient has disclosed private information to a health care provider, that provider has a responsibility to maintain confidentiality. -Security: refers to the means to control access and protect information from accidental or intentional disclosure to unauthorized persons and from alterations, destruction, or loss. Information Presentation: The wealth of information available through EHR systems must be managed to ensure that authorized caregivers (including nurses) and others with legitimate uses have the information they need in their preferred presentation form. Data can be presented in detail or summary form.

Two specific functionalities recommend by the IOM- clinical decision support and computerized provider order entry (CPOE)- are frequently mentioned in the literature as essential to improve the quality and safety of health care. CPOE is defined as the "process by which physician's assistant, or physical or occupational therapist, directly enters orders for a client care into a hospital information system" CPOE contributors to safety and quality by eliminating lost orders and illegible handwriting generating related orders automatically. Monitoring for duplicate or contradictory orders; and reducing time to fill orders. CPOE functions also contribute to medical error prevention through 1) improved communication 2)more readily accessible knowledge 3) requirements for key pieces of information (such as the dose of a drug) 4) assistance with calculations 5) checks performed in real time, 6) assistance with monitoring 7) decision support 8) rapid response to, tracking of adverse events.

POCT devices were used to test for occult blood, dipstick urinalysis, urine pregnancy, and blood glucose. Today these devices are being used at the point of care to test blood gas, clotting time, cardiac markers, rapid strep, bilirubin, Breathalyzer, rapid influenza A and B, rapid human immunodeficiency virus (HIV), and salivary testing for drugs of abuse. The patients identification badge can also be scanned, thereby allowing the test report to be uploaded directly to the patients healthcare record. once the test is done the POCT device can be docked to a computer and the data uploaded to a central database for recording in a patients electronic record, accessible by other nurses, physicians, and laboratory personnel. Improving Patient Safety: Another advantage in using POCT devices is a reduction in errors and in increase in patient safety. Another systematic review of PDAs showed evidence that PDA use in a healthcare setting improved decision making, enhances learning of students and health care providers, and reduces the number of medical errors. Some of the most common sources of error in patient care environments include misinterpretation of physician orders, incorrect calculations, inaccurate charting, illegible writing, and inappropriate anticoagulation parameters. Technology can capture and display data to show important trends and provide mechanism to quickly screen. Bar-coded bracelets or identity cards can be scanned to confirm correct administration of medications. Saving time and money: POCT devices are time savers because of their portability and documentation features. Small enough, whether an HHC or a tablet personal computer (PC), to be carried by health care providers. Much more apt to use them at the time they need them. Immediate documentation of data eliminates the need to wait for "down time" Enabling Evidence-based Practice: POCT devices facilitate evidence-based decisions making and quality of care. Promoting patient safety and enabling evidence-based practice are two cornerstones for ensuring health care quality. Access is reliable, trustworthy information needs to be as close to the bedside as possible. Many facilities, the Internet is inaccessible from patient care areas, in a belief that Internet access would be abused. Means that nurses must make special efforts to acquire material that ought to be readily available - via desktop or HHC. It is important that nursing practice goes from practice that relies on memory to one that emphasizes continuous use of resources as they are needed. Standardized protocols and clinical practice guidelines are other important materials that need to be more readily available than the oft-disappearing and outdated protocol and procedure books on shelves.

Telecommunications technology to assess, diagnose, and in some cases treat persons who are located some distance from the health care provider. Home care arena seeing significant changes as a result of telehealth. Nurses, physicians, radiologists, psychiatrists, and other use this technology via telephones, computers, and interactive video or teleconferencing. Telehealth interventions that have demonstrated cost-effectiveness include enhanced self care management, early detection of health deterioration, and symptom management. Not all of the telehealth networks offer secure communications, which may limit the acceptability of this intervention for some persons. The process of referrals, a need for technical support personnel, and a lack of standard for interoperability of equipment are significant issues facing telehealth providers. *Telehome care devices:* Automated blood pressure monitors, glucometers, peak flowmeters, pulse oximeters, weight scales, and video monitors (Can do video instruction Ex. peritoneal dialysis). Potential to be transcended state boundaries: licensed in specific states.

Information explosion requires nurses to be on the cutting edge of knowledge to practice ethically and safely. Trends in computing also affect the work of professional nurses- research advances, new devices, monitoring equipment, sensors, and "smart body parts"

Nurses are knowledge workers who require accurate and up-to-date information for the professional work. Explosion in information some estimate that all information is replaced every 9-12 months- requires nurses to be on the cutting edge of knowledge to practice ethically and safely. Weiser and brown have characterized the history and future of computing in three phases, first phase is known as the "mainframe era" in which many people shared one computer. Computers during this phase were found behind closed doors and run by experts with specialized knowledge and skills. Phase II in modern computing is the era of personal computers (PC), which is characterized by one person (linked) to one computer. In this era the computing relationship is personal and intimate. Phase III has been dubbed the era of ubiquitous computing (UC), in which there will be many computers to each person. Weiser and brown estimate that the crossover of the UC era with the PC era will occur between 2005 and 2015. In this phase computers will be everywhere in walls, chairs, clothing, light switches, cars, appliances and so on. Internet can also be considered an integral component of UC. A person truly does become one person linked to hundreds of computers. Ironically the interference to the UC world of internet is still through the PC. Network wireless technologies are becoming more prevalent and enable the following: Instant access via HHCs to prescription writing, charge capture, research, patient education, daily schedules, memo writing, voice dictation, photography, drug calculations, and lab orders, telehealth for sending and receiving data, voice communication, once we become wireless and mobile UC will become a reality.

Computer users talk to a computer, becoming more commonplace. Individual users train their PCs to recognize their voices; can dictate documents and emails and direct their PCs to perform specific activities on voice command. Provide an efficient mechanism for communication among health care providers. Voice communication systems are being integrated into some clinical institutions. Vocera communication system is an example that allows you to initiate internal and external calls and designate the party to be called by name, title, function, or group, thereby eliminating the need to know phone numbers or who is on duty. Vocera saves a great amount of time.

Enables clinicians to interview and examine patients, even with the health care providers are located in their offices or at home. Connects to language translators for patients who need translation services. Delivers additional sensorimotor activity to disabled persons. Serves as a courier within institutional settings.

Use human characteristics (e.g. *Fingerprints*, retinas, irises, voices, facial patterns) to authenticate or grant access to data or information.

Information Literacy:Ability to determine when information is needed and how one can locate, evaluate, and use the information appropriately. Information technology: Hardware and software that facilitate the storage, retrieval, communication, and management of information. Computer literacy: knowledge and understanding of computers, and ability to use them effectively. Rapid growth and turnover of information and enormous changes in the technologies make it imperative that nurses possesses information literacy and fluency with information technology. Every nurse needs to be computer literate. Computer-literate nurse is able to use these systems effectively and can address issues discussed earlier, such as confidentiality, security, and privacy. Nurse must be able to effectively use applications typically found on PCs such as word, spreadsheets, presentation graphics, and statistics for research. Access information from a variety of electronic sources and how to evaluate the appropriateness of the information at the professional and patient levels alike.

Information technology and the ability to access reliable electronic resources are crucial to ensure that health care delivery is based on current knowledge and best practices. Ability to access up-to-date evidence-based practice information results in the following: improved quality of patient care, improved patient safety, increased confidence, improved nursing productivity and efficiency. Nurses receive less education related to information literacy, and computer literacy than do most health care workers. As a result of inadequate competencies, nurses are twice as likely to seek out general and less credible information instead of targeted information relevant to practice. Nurses have a low awareness of available internet sources. Two important initiatives designed to address nursing students and nurses limited competencies in information technology, information literacy, and computer literacy are technology informatics guiding educational reform.

Integrates nursing science, computer science, and information sciences in identifying, collecting, processing, and managing data, as well as information to support nursing practice, administration, education, research, and the expansion of nursing knowledge. Relatively new specialty within the profession of nursing. More than just computers- includes all aspects of technology and science. Involves using new tools and building on capabilities provided by computers and related information technologies.

Students born after 1980 are members of the Net generation: favor multimedia, Known for multitasking, multiprocessing, and connecting to people and ideas, think and process information fundamentally differently than persons who are older, spend less time on reflection and and critical thinking , expected to instantaneously find answers to their questions on the internet, concern is that although they may know how to get answers quickly, they are not able to evaluate the accuracy and integrity of their results. Research has demonstrated that students do the following: regualry overrate themselves on their ability to find information on the internet, recognize that they struggle and waste time when attempting to find useful materials for class, have not been taught how to evaluate whether the information they locate is reliable and trustworthy, do not underestimate how and when to use library databases for resources, enter their educational programs with verifying degrees of experience and ability in computer skills and knowledge.

One study reveals that best search engines found only approximately 33% of the information available on the internet. Search engines good starting points, but you can augment their effectiveness by adding a few other strategies, target your search by conducting a "purpose-focus-approach" (PFA) assessment.

Determine your purpose: Why are you doing the search? Why do you need the information? Focus: Broad and general (basic information for yourself), lay-oriented (to give information to a patient), professionally oriented (for colleagues), narrow and technical with a research orientation. Purpose combined with focus determines approach: broad and general can be found with brute force methods or quick and dirty searching, lay information can be quickly assessed at a few key sites, professional associations and societies are good starting points for professionally oriented information, scientific and research information requires literature resources in scholarly databases such as *MEDLINE* or CINAHL.

Internet is open to anyone with access to a computer. Material that looks official may actually be posted by persons without formal education in an area. Specific criteria useful in evaluating a website: authority with regard to the topic, author and authors credentials, author's contact information, affiliation of the website is important: *.edu= educational institutions*, .org= nonprofit organization, .com=commertial enterprise, .net=internet service provider, .gov= governmental body, .mil= millitary. Objectivity: is the purpose of the website clear? is the information factual or opinion? is the information primary or secondary in origin? Who is sponsoring the site? Accuracy: look for documentation and referencing, compare information on the website with sources. Currency:Look for the dates, Compare the last update with current literature. Usability: is the site well designed, stable, and easy to use? Content should be error-free and readable by the intended audience.