Healthcare Informatics Reflection

Healthcare Informatics

Healthcare informatics is a term describing the acquiring, storing, retrieving and using of healthcare information to foster better collaboration among a patient’s various healthcare providers. Health Informatics plays a critical role in the push toward healthcare reform. Health informatics is an evolving specialization that links information technology, communications and healthcare to improve the quality and safety of patient care. Health informatics applies informatics concepts, theories, and practices to real-life situations to achieve better health outcomes. This includes collecting, storing, analyzing, and presenting data in a digital format.  The tremendous growth in the health informatics field was spurred in large part by the acceleration of electronic health record (EHR) adoption brought about by the Centers for Medicare and Medicaid Services' "meaningful use" incentive program.  As providers move quickly to embrace EHRs, which are designed to store and share information from all providers involved in a patient’s care, health informatics specialists will continue to be in high demand as healthcare facilities implement new systems, upgrade existing databases and work toward achieving the three stages of “meaningful use.”

For more information on healthcare informatics click here

Electronic Health Records and Meaningful Use

Today, technology seems to have a part in every aspect of life.  Everyone has a smart phone or a tablet.  People can’t seem to live without the internet.  This applies to health care as well.  This informatics class has taught me so much that I didn’t know about in regards to the importance of technology in the healthcare setting.  Electronic health records are a huge part of the healthcare world.  Electronic health records or EHRs in the United States is becoming more and more prevalent.  Adoption of EHRs has been increasing at about 3-6% per year (Jha, 2010).  EHRs are improving the way that patients are cared for and causing decision making to be easier for providers. There are 3 different stages of to implementing meaningful use.  In 2015 the Centers for Medicare and Medicaid Services issued a new rule for the EHR incentive program to align Stage 1 and Stage 2 objectives and measures with the long-term proposals for Stage 3, to build progress toward program milestones, to reduce complexity, and to simplify providers’ reporting.  These modifications would allow providers to focus more closely on the advanced use of certified EHR technology to support health information exchange and quality improvement (Center for Medicare and Medicaid Services, 2016). 

For more information, on meaningful use click here

Interoperability

Now that the clinicians are connected, the next step is to facilitate better care through technology. There are a great number of "interoperability solutions" available in the market today. Organizations have proposed a spread of solutions that can serve as a translator between two or three different types of patient records. But this approach is not enough. Instead, the industry needs to fully embrace a set of open standards to create the structure needed to drive innovation in healthcare technology, so that new tools and technologies can help clinicians provide better care for their patients (Mancuso, 2014). With broader standards, EHRs can be shared securely and enable clinicians to access and even analyze data more easily and more thoroughly.

Data Mining

In a typical work day, nurses use technology all the time.  A new type of technology is called data mining.  Data mining is a newer generation approach to data analysis and knowledge discovery that has grown out of the need to derive meaningful information from the massive amounts of high-dimensional data that have been produced and stored over the past decade (Berger & Berger, 2004).  Data mining is being used for research purposes but can be utilized for everyday practice as well. The technology is being used for analysis, modeling, and prediction in a variety of scientific disciplines.  It is also used for cataloging and classifying.  Data mining is defined as the semiautomatic exploration and analysis of large quantities of data in order to discover meaningful patterns and rules (Berger & Berger, 2004).

Databases

Technology is a huge part of the healthcare system and helps with the care of patients.  Databases, particularly, are a great resource for nurses and other health care professionals to utilize in order to keep our patients safe and to give them the best quality of care possible.  Databases are used by everyone, from doctors to care facilitators.  The use of health IT has long been recommended as a strategy to facilitate cost effective, high-quality, and safe patient care (Dykes & Collins, 2013).  According to Kuehnl-Cadwell (2010), databases are used to collect, manipulate, filter and report on various kinds of data.  Databases can help nurses find pertinent information fast and easy.

Reflection

All of these areas of technology are extremely important to nursing and nursing leadership.  These topics should be taken seriously and fully understood by leadership.  Technology is not going away; it’s only going to get more prevalent.  It’s crucial for the application in the healthcare setting to be understood and implemented.  These past five weeks have shown me the importance of healthcare informatics and that it is so much more than just "computer stuff."  I enjoyed working with the different programs to create presentations.  I enjoyed Prezi the most and found it most helpful.  I am glad that I have been exposed to such programs and plan on using them in the future.  Healthcare informatics is a growing field, and it is essential that we as nurse leaders embrace it and utilize it to our full potential.

References

Berger, A.M. & Berger, C.R. (2004). Data mining as a tool for research and knowledge development in nursing. Computers, Informatics, Nursing, May/June, 123-131.

Dykes, P. & Collins, S., (2013). Building linkages between nursing care and improved patient outcomes: The role of health information technology. The Online Journal of Issues in Nursing, 18, (3).

Jha, A.K. (2010). Meaningful use of electronic health records: The road ahead. Journal of American Medical Association, 304, (15). 1709-1710.

Kuehnl-Cadwell, J. (2010). Use the right tool for the right job.  Retrieved from www.datawisesolutions.com/database-vs-spreadsheet.shtml

Mancuso, M. (2014). Collaborating our way into interoperability. Health Management Technology, 35, (6), 24.

Workflow Management

Workflow

 

 

 

 

 Workflow can be described simply as the movement of documents and tasks through a business process.  Workflow can be a sequential progression of work activities or a complex set of processes each taking place concurrently, eventually impacting each other according to a set of rules, routes, and roles.  

 

 

Workflow Management Systems

 

Workflow management systems allow organizations to define and control the various activities associated with a business process.  In addition, many management systems also allow a business the opportunity to measure and analyze the execution of the process so that continuous improvements can be made.  Such improvements may be short-term or long-term.  Most workflow systems also integrate with other systems used by the organization: document management systems, databases, e-mail, office automation products, Geographic Information Systems, production applications, ect.  This integration provides structure to a process which employs a number of otherwise independent systems.  It can also provide a method for organizing documents from diverse sources.

 

Benefits to Workflow Management

 

The introduction of workflow management tools should be seen as an opportunity to improve both the underlying business process and the existing organizational structure.  Many benefits can be accrued in the workflow management system is implemented as part of a broader business solution.

 

 

 

Unity Hospital's Information Management

 

At Unity Hospital, most of the information management is done through the electronic health record.  Any health care provider can go into a patients chart.  Depending on what your role is, what you can see might be a little different.  For example, a care assistant won't be able to see as much as the nurse or the doctors.  The use of the EHR is a great tool for communication between different providers.  The doctors, physician assistants, and residents can see what was recommended by their colleagues and can then put in orders accordingly.  The nurses can, in turn, see what the doctors recommended and provide the proper care.  Also, social work, physical and occupational therapy, psych, and other services can also access the patient's chart.  I believe that Unity has a very productive information management system.  However, not everything is perfect and there is always room for improvement on different aspects. 

 

 

Informational Management Concern

 

One of the problems that I see at Unity with informational management is the nurse to nurse report from the emergency department to the units.  There can sometimes be a lack of communication.  The emergency department is a busy place and nurses see patients go in and out all shift.  There is no telling how many patients a ED nurse will see during a shift.  Because of this, there can be some confusion and lack of information being told when the ED nurse is calling up report to the floors.  Important pieces of information are not being passed along and this can be detrimental to the patients.  Also, sometimes patients are coming up to the floors but there are no orders written in the EHR.  This can also be confusing for the accepting nurses on the floors.

 

 

Solution

 

I propose that there should be a form that the nurse can fill out that will be a part of the EHR.  This form will address the pertinent information that the ED nurse wants the floor nurse to know.  The nurse will still call report, however, this form will be filled out and in the EHR for the floor nurse to look back to.  The information on the form will include reason for admission, orientation, if they are able to eat, how they transfer/ambulate, the code status, and if they are on telemetry, what their rhythm has been.  Between this form and the nurse to nurse report, the accepting nurse will be able to anticipate what orders will written and provide the best quality of care they can.

 

 

 

Here are some resources that address the information management concern:

Nurse to nurse report
Hand-off report
ED to floor report




 



Technology and Nursing Leadership

 

 

Technology is a huge part of a nurses career.  It is used all the time to help keep our patients safe and increase the quality of care.  It can be something as simple as taking a temperature to something more advanced such as a ventilator that is keeping a patient alive.  Everyday, nurses come into contact with some of the most advanced technology in the world.  It is important that they know how to use that technology and understand what it does. 

 

 

How much an employee knows about a certain technology, depends on the leadership.  It is important that nursing leadership understands this technology as well.  Staff nurses should be able to come to the nurse leader and ask questions; and that leader should know the answer or know where to find the answer.  It is imperative to the success of the staff nurse utilizing the technology.  If the staff nurses feel they are supported and are able to come to their nurse leader with questions, the more inclined they will be to use the technology and learn about it.  It is important for the nurse leader to be patient and open minded when approached about the technology being used.  The nurse leader needs to understand that some people are just more technologically advanced than others, and that's ok!  Being a support and allowing the staff to know that you are available is key to the success of the staff nurses. 

 

 

 

The nurse leader needs to step up to the plate with understanding and incorporating technology in their own administrative platform as well as the clinical setting.  The nurse leader can set up in-services on how to use the technology and have hand-outs available to explain how it works.  Also, it is important for the nurse leader to have some evidence based practice information to show why that technology is being used, in case there is push back from the staff nurses.  This will explain the benefits of it's use and it is coming from a credible study/article. 

 

 

 

Here is an editorial on why nurse leaders need to stay informed

 

 

Here is a reflection from a nurse leader on why technology is a gift to nursing

 

 

 

 

 





Human-technology Interface

Human-Technology Interface

 

 

 

 

 

Technology is all around us and is a huge part of every day life.  This applies to our lives in the hospital as well.  There are technological advances happening everyday.  Technology helps us, as nurses, keep our patients safe and save lives when necessary.  Human technology interface or human-computer interface (HCI) is the means of communication between a human user and a computer system. Devices are becoming available to mediate the human-computer interaction. These include graphics devices, touch-sensitive devices, and voice-input devices. HCI is a branch of the science of ergonomics, and is concerned especially with the relationship between workstations and their operators.  This interface is incredibly important in a health care setting.  With all the technological advances, it is our duty to take full advantage of them in order to benefit our patients. 

 

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Nursing Practice

 



Nurses have a vast selection of technology at their fingertips.  We use it everyday in our professional lives.  It makes life easier.  In the hospital, there are many machines that we utilize to help us care for our patients.  From machines that take vital signs like Dynamaps to heart monitoring machines like telemetry monitors, we use this technology without thinking twice.  It has become a part of our everyday life.  Nurses sometimes take for granted the amount of technology that they can use.  In the past, vital signs were taken manually.  There is a dependence on the technology that we have.  My thought always is, what if that machine breaks, will I know how to safely monitor my patient and care for them without it.  They say that pretty soon there will be technology the listens to breath and heart sounds for you.  Yes, the technological advances in medicine have been beneficial, but I think we need to remember our basics and practice our hands-on nursing skills sometimes. 

 

 

 

 

 

Patient Care

 



The use of technology as it pertains to direct patient care is vast.  We, as nurses, use different technology to care for our patients every day.  From things as simple as the call bell system, to things as complicated as a ventilator.  Technology is all around us.  The use of this technology by nurses is important, but it is also important to think about how the patients can use the technology available to them as well.  Patients have access to much more technology more than ever now.  They are able to see parts of their charts online through the "patient portal" and they can connect with their physician's offices easier.  Some healthcare systems are utilizing telemedicine where they can talk and see a provider through video chat, so the patient doesn't have to leave their home.  Being able to use technology to benefit, advocate and have a say in their own care allows patients to be more involved, therefore taking better care of themselves. 

 

 

 

Nursing Leadership

 

 

As nurse leaders, it is important that we act as the link between nursing practice and patient care.  We need to be a support to the nurses and staff in using the technology that we have.  We need to understand how to use the technology so we are able to demonstrate and give reasoning as to why we are using it.  We also need to be an advocate to the patients and their use of the technology available to them.  We should be knowledgeable about technology such as the "patient portal" so that we can  use our experiences to promote it to our patients.  Technology is only going to have a more prominent role to the healthcare systems and to nurses.  Nursing leadership needs to be on board with it so that we can lead by example to the staff.

 

 

 

 

 

Exemplar

 

A 70 year old male patient, J. Hernandez came into the emergency department with the complaint of shortness of breathe and chest pain.  An EKG, blood work, and vital signs were done and showed that the patient had a suffered a myocardial infarction.  He was admitted to the cardiovascular telemetry unit.  During transport to his room, the patient was on the Zoll, which was monitoring his heart rhythm and rate.  Once in the elevator, the patient complains of worsening shortness of breath, and worsening chest pain.  He is diaphoretic and pale.  Suddenly the Zoll shows ventricular tachycardia.  The nurse immediately feels for a pulse.  It is weak and erratic.  The nurse pushed the code blue button in the elevator so once off, the appropriate staff can come help.  Once off the elevator, the provider comes and looks at the monitor.  He instructs the nurse to put on the defibrillator pads and charge the defibrillator to 150 jules.  The patient is shocked and his rhythm returns to normal sinus rhythm.  The patient is immediately transferred to the ICU where he can be monitored more closely. 

 

In this scenario, the use of technology is crucial is saving this patients life.  The first things used were the EKG machine and vital signs machine.  Blood work was also done and the lab tested it.  This technology assisted with the initial finding of the myocardial infarction.  The Zoll machine assisted in monitoring the heart rhythm and rate and also provided the defibrillator shock.  This allowed the patients heart to go back to normal sinus rhythm, therefore saving the patients life.  Once in the ICU, there is more advanced technology that can help the patient be monitored more closely.  It is important to debrief the patient, once stable, and the family as to what happened.  The patients electronic health record can be accessed to show test results and a recap of what had happened. 

 

 

For more information on the human-technology interface

click here and here

 

 

 





ICNP

 

The International Classification for Nursing Practice (ICNP),

classifies patient data and clinical activity in the domain of nursing and can be used for decision-making and policy development aimed at improving health status and health care delivery. ICNP can improve communication and statistical reporting practices across health services. ICNP, a product of the International Council of Nurses (ICN), is a formal terminology.  It provides a dictionary of terms and expressive relationships that nurses can use to describe and report their practice in a systematic way. The resulting information is used reliably to support care and effective decision-making, and inform nursing education, research and health policy. ICNP is intended for use by and for nurses. It is a rich and comprehensive resource that nurses can use to describe and report in detail the things that they assess and the things that they provide. The potential benefits of a consistent approach to capturing nursing data are far-reaching.

 

Classification structure

ICNP has a formal foundation that is used to compose and represent diagnoses, interventions, and outcomes. A number of subsets are available to provide pre-coordinated concepts for select health priorities, including nursing outcome indicators, pediatric pain management, palliative care, and partnering with patients and families to promote adherence to treatment.

 

 

Vision

ICNP is an integral part of the global information infrastructure informing health care practice and policy to improve patient care worldwide.

Goals

• Serve as a major force to articulate nursing’s contribution to health and health care globally.
• Promote harmonization with other widely used classifications and the work of standardization groups in health and nursing.

Benefits to nursing

• Establishes an international standard to facilitate description and comparison of nursing practice
• Serves as a unifying nursing language system for international nursing based on state-of-the-art terminology standards
• Represents nursing concepts used in local, regional, national and international practice, across specialties, languages and cultures
• Generates information about nursing practice that will influence decision-making, education and policy in the areas of patient needs, nursing interventions, health outcomes, and resource utilization
• Facilitates the development of nursing data sets used in research to direct policy by describing and comparing nursing care of individuals, families and communities world wide
• Improves communication within the discipline of nursing and across other disciplines
• Encourages nurses to reflect on their own practice and influence improvements in quality of care.

Resources

How do terms get picked?

Unifying nursing through the use of ICNP

Why ICNP?