Issues in Informatics

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NI and healthcare policy Role of technology in the medication-use process Healthcare data standards Electronic health record systems Dependable systems for quality care Nursing minimum data set systems

ISSUES IN INFORMATICS
Prepared by: Prof. Donna Lou E. Neri, RN, MHSS, PhD

Policy is defined as a course of action that guides present and future decisions based on existing conditions and emerging trends.

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Nursing shortage Concern for patient safety National information initiatives Delivery of services through telehealth

Bradley (2003)
Technology solutions should:
improve existing care processes and outcomes Increase access through the use of portable and handheld

devices Incorporate internet capability to overcome distance barriers of care Improve access to knowledge acquisition

Surveys confirmed that concern for patient safety is the biggest factor driving IT (Anderson, 2004).

Telehealth and NI
Telehealth is the use of electronic information and telecomunications technologies to support long distance clinical healthcare, patient and professional health-related education, public health, and health administration

Summary
NI needs to broaden its educational and practice

perspectives to include a more interdisciplinary focus

A specialist level of certification in NI is needed to

acknowledge more advanced informatics skills

Summary
there is a tremendous need to improve the general

informatics skills of nursing faculty, students, and clinicians

collaborative efforts are needed to link schools so that

informatics resources can be shared

The role of technology in the medication-use process ...

Computerized physician order entry (CPOE) systems

allow physicians to enter orders for patient medications into a

computer rather than write them by hand

goals of CPOE are to reduce medication errors by having a

computer program alert the prescribing physician if there is a harmful medication interaction and also identify other potential problem with the order be granted authority to use CPOE systems

other medical staff members, such as nurse practitioners, can also

Prior to medication administration, each bar coded package of medication to be administered at the bedside is scanned

The system can then verify the dispensing authority of the nurse

Confirm the patients identity

Match the drug identity with their medication profile in the pharmacy information system

Electronically record the administration of the medication in an online MAR

ADCs

 Automated dispensing cabinets (ADCs) are computerized

drug storage devices or cabinets that allow medications to be stored and dispensed near the point of care, while controlling and tracking drug distribution
Also called unit based cabinets (UBCs), automated

dispensing devices (ADDs), automated distribution cabinets or automated dispensing machines (ADMs)

 Adoption of this technology in healthcare started slowly--only about

50% of hospitals were using ADCs in 1999, but by 2007 more than 80% had implemented them

They are now used in the majority of hospitals, and have become

more prevalent in the outpatient setting as well

Many healthcare organizations have moved beyond storing only

narcotics and floor stock in ADCs and are using ADCs as their primary method of drug delivery

this change in the pharmacy distribution model has had broad

implications for pharmacist and nurse workflow and the safety of associated practice

Benefits of automated dispensing cabinets (ADC):

Improving pharmacy productivity Improving nursing productivity Reducing costs Improving charge capture Enhancing patient care quality and safety

Limitations of ADC:
Lack of pharmacy screening of medication order prior to

administration
Choosing of the wrong medication from an alphabet pick list

High-alert medications placed, stored, and returned to ADCs

Storage of medications with look-alike names and/or packaging

next to each other in the same drawer or bin

Smart Infusion Pump Delivery Systems

Healthcare Data Standards

Core Concepts of Standard Development Process for a secured, patient-centered EHR

(Presidents Information Technology Advisory Committee, 2004)

Safeguards personal privacy Uses standardized medical terminologies which can be read by any

care provider to support clinical decision making Eliminates danger of illegible handwriting and missing patient information Can be transferred as a patients care requires over a secure communications infrastructure for electronic information exchange

Electronic Health Record Systems

EHR-S
computerized patient record clinical information system Electronic medical record

May be used by all participants in the process of

achieving health, including all disciplines of clinicians, family caregivers, and the patient

EHR
Physical or logical

EHR-S
Made up of one or

(virtual) repository of data Foundation for pervasive, personalized, and science-based care

more applications Provides the components that supports clinical and healthcare functions

KEY CAPABILITIES OF AN EHR-S (IOM, 2003)

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Longitudinal collection of electronic health information for and about persons, where health information is defined as information pertaining to the health of an individual or healthcare provided to an individual Immediate electronic access to person- and population-level information by authorized, and only authorized, users Provision of knowledge and decision support that enhances the quality, safety, and efficiency of patient care Support of efficient processes for healthcare delivery

Dependable Systems for Quality Care

Key applications of systems that improve healthcare:

CIS CPOE E-prescribing Wireless communications

Handheld and tablet

BPOC
ADCs

computers Continuous speech recognition Radio frequency identification (RFID) robotics

The nurse (ICN Code of Ethics):

holds in confidence personal information and ensures that use of technology is compatible with the safety, dignity and rights of people
Thus, ethical obligations drive requirements for system reliability,

availability, confidentiality, data integrity, responsiveness, and safety attributes, collectively referred to as DEPENDABILITY

6 Attributes of DEPENDABILITY
1.

SYSTEM RELIABILITY: the system consistently behaves in the same way SERVICE AVAILABILITY: required services are present and usable when they are needed CONFIDENTIALITY: sensitive information is disclosed only to those authorized to see it

4.

DATA INTEGRITY: data are not corrupted or destroyed

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2.

RESPONSIVENESS: the system responds to the user input within an expected and acceptable time period
SAFETY: the system does not cause harm

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3.

5 GUIDELINES FOR DEPENDABLE SYSTEMS

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Architect for dependability Anticipate failures Anticipate success Hire meticulous managers Dont be adventurous