Anda di halaman 1dari 36
Issues in Informatics 1. NI and healthcare policy 2. Role of technology in the medication-use process
Issues in Informatics
1.
NI and healthcare policy
2.
Role of technology in the medication-use process
3.
Healthcare data standards
4.
Electronic health record systems
5.
Dependable systems for quality care
6.
Nursing minimum data set systems
ISSUES IN INFORMATICS Prepared by: Prof. Donna Lou E. Neri, RN, MHSS, PhD
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
Policy is defined as a course of action that
guides present and future decisions based on
existing conditions and emerging trends.
1. Nursing shortage 2. Concern for patient safety 3. National information initiatives 4. Delivery of services
1.
Nursing shortage
2.
Concern for patient safety
3.
National information initiatives
4.
Delivery of services through telehealth
Bradley (2003) Technology solutions should: • improve existing care processes and outcomes • Increase access through
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).
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
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
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,
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 ...
The role of technology
in the medication-use process ...
Computerized physician order entry (CPOE) systems  allow physicians to enter orders for patient medications into
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
other medical staff members, such as nurse practitioners, can also
be granted authority to use CPOE systems
Prior to medication administration, each bar coded package of medication to be administered at the bedside
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 patient’s 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
ADCs
 Automated dispensing cabinets (ADCs) are computerized drug storage devices or cabinets that allow medications to
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
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
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
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
“Smart” Infusion Pump Delivery Systems
Healthcare Data Standards
Healthcare Data Standards
Core Concepts of Standard Development Process for a secured, patient-centered EHR (President’s Information Technology Advisory Committee,
Core Concepts of Standard Development Process
for a secured, patient-centered EHR
(President’s 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 patient’s care requires over a secure
communications infrastructure for electronic information exchange
Electronic Health Record Systems
Electronic Health Record Systems
EHR-S  computerized patient record  clinical information system  Electronic medical record  May be
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 EHR-S  Physical or logical (virtual) repository of data  Made up of one or
EHR
EHR-S
Physical or logical
(virtual) repository of
data
Made up of one or
more applications
Provides the
Foundation for
components that
pervasive,
personalized, and
supports clinical and
healthcare functions
science-based care
KEY CAPABILITIES OF AN EHR-S (IOM, 2003) 1. Longitudinal collection of electronic health information for and
KEY CAPABILITIES OF AN EHR-S (IOM, 2003)
1.
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
2.
Immediate electronic access to person- and population-level information by
authorized, and only authorized, users
3.
Provision of knowledge and decision support that enhances the quality, safety,
and efficiency of patient care
4.
Support of efficient processes for healthcare delivery
Dependable Systems for Quality Care
Dependable Systems for Quality Care
Key applications of systems that improve healthcare:  Wireless communications  CIS  Handheld and tablet
Key applications of systems that improve
healthcare:
Wireless communications
CIS
Handheld and tablet
CPOE
computers
E-prescribing
BPOC
Continuous speech
recognition
ADCs
Radio frequency
identification (RFID)
robotics
The nurse (ICN Code of Ethics): “holds in confidence personal information” and “ensures that use of
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 4.
6 Attributes of DEPENDABILITY
1.
SYSTEM RELIABILITY: the
system consistently behaves
in the same way
4.
DATA INTEGRITY: data are not
corrupted or destroyed
5.
RESPONSIVENESS: the
2.
SERVICE AVAILABILITY:
required services are present
and usable when they are
needed
system responds to the user
input within an expected and
acceptable time period
6.
3.
CONFIDENTIALITY: sensitive
SAFETY: the system does not
cause harm
information is disclosed only
to those authorized to see it
5 GUIDELINES FOR DEPENDABLE SYSTEMS 1. Architect for dependability 2. Anticipate failures 3. Anticipate success 4.
5 GUIDELINES FOR DEPENDABLE SYSTEMS
1.
Architect for dependability
2.
Anticipate failures
3.
Anticipate success
4.
Hire meticulous managers
5.
Don’t be adventurous