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Chapter 14 Information Technology in the Clinical Setting Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Information Technology in the Clinical Setting Clinical Information Systems Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. General Definition Collection of software programs and associated hardware that support the entry, retrieval, update, and analysis of patient care information and associated clinical information related to patient care Primarily a computer system used to provide clinical information for the care of a patient Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. General Definition Patient-focused systems support patient care processes Departmental systems meet the operational needs of a particular department and may be stand-alone systems A major challenge that is facing developers involves the integration of stand-alone systems to work with each other and with newer patient-focused systems Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Electronic Health Record (EHR) A variety of terms are used to refer to electronic health information management systems: Electronic medical record (EMR) Electronic patient record (EPR) Computerized patient record (CPR) Electronic health record (EHR), the term used in this chapter Ideally includes in an electronic format all information about an individual’s lifetime health status and health care Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Electronic Health Record (EHR) Replacement for the paper medical record as the primary source of information for health care, meeting all clinical, legal, and administrative requirements Allows an individual’s health data to be maintained and distributed over different systems in different locations (e.g., hospital, clinic, physician’s office, pharmacy) Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Electronic Health Record (EHR) The EHR is maintained in a system that captures, processes, communicates, secures, and presents data about the patient Data capture—collection and entry of data into a computer system Storage—the physical location of data Information processing—provides for effective retrieval and processing of data into useful information Information communication—interoperability of systems and linkages for exchange of data across disparate systems Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Electronic Health Record (EHR) Security—Only authorized users with legitimate uses have access to health information. Security—method of controlling access and protecting information from accidental or intentional disclosure to unauthorized persons and from alteration, destruction, or loss Privacy—the right of an individual to keep information about himself or herself from being disclosed to anyone else Confidentiality—the act of limiting disclosure of private matters Information presentation: Authorized caregivers, including nurses and others with legitimate uses, gather the information they need in their preferred presentation form Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Decision Support and CPOE The Institute of Medicine recommends that EHR systems offer eight functionalities Health information and data Results management Computerized provider order entry (CPOE) with or without decision support Clinical decision support Electronic communication and connectivity Patient support for patient education and home monitoring, where applicable Administrative processes Reporting and population health management Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Decision Support and CPOE Two specific functionalities recommended as essential for improving the quality and safety of health care Clinical decision support i. Automatic reminders about preventive practices ii. Drug alerts for dosing and interactions iii. Electronic resources for data interpretation and clinical decision making Computerized provider order entry (CPOE) i. Clinician with order writing authority sits at a computer to directly enter patient care orders. ii. Eliminates lost orders and illegible handwriting iii. Generates related orders automatically iv. Monitors for duplicate or contradictory orders v. Reduces time needed to fill orders Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Point of Care Technology Devices used at the point of care to perform tests (e.g., blood gas, clotting time, cardiac markers, rapid strep, bilirubin, breathalyzer, rapid influenza A/B, rapid HIV, salivary testing for drugs of abuse) Tablet personal computers (PCs) and personal digital assistants (PDAs) may be thought of as point of care technology (POCT) devices Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Point of Care Technology Improve patient safety. One study found that 85% of physicians believed the PDA helped them reduce errors POCT may influence common sources of error i. Misinterpretation of physician orders ii. Incorrect calculations iii. Inaccurate charting iv. Illegible writing v. Inappropriate anticoagulation parameter processes Bar coded patient identification bracelets or identity cards can be scanned to confirm correct administration of medications Ability to instantly receive lab test results will enhance safety Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Point of Care Technology Save time and money. When health care providers have these devices with them, they are much more apt to use them at the time needed Immediate documentation of data eliminates the need to wait for “down time” to chart Enable evidence-based practice. Improve access to evidence-based material Moves nursing practice from one that relies on human memory to one that emphasizes continuous use of resources as they are needed Computer-based alerts and reminders are helpful in detecting and preventing potential adverse drug events Standardized protocols and clinical practice guidelines can be more readily available Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. HIPAA (Health Insurance Portability and Accountability Act) In the early 1990s, the U.S. President called together health care industry leaders to determine how the administrative costs of health care could be decreased. Leaders determined that the use of electronic data interchange within the health care industry held the greatest promise for decreasing costs Recommended that national standards for electronic data interchange and information privacy and security be established—HIPAA HIPAA regulations focus on the privacy and security of patient data Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. HIPAA (Health Insurance Portability and Accountability Act) HIPAA and clinical information systems Any institution that collects/stores protected health information (PHI) is required to name a privacy officer, provide employee training, and implement HIPAA policies and procedures Access to PHI must be controlled so that only employees with a need to know specific information are able to access that information Individuals who knowingly use or disclose PHI in violation of HIPAA may be subject to criminal penalties and civil monetary penalties Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. HIPAA (Health Insurance Portability and Accountability Act) HIPAA and handheld computers (HHCs) Common patient information may be entered on an HHC Institutional policies may consider HHCs “at risk devices” in terms of HIPAA security issues HHCs are often individually owned; therefore, the individual assumes responsibility for ensuring the security of the information Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. HIPAA (Health Insurance Portability and Accountability Act) Various measures required to protect PHI on HHCs • Password protecting the device with a programmed timeout • Using biometric fingerprint identification • Encrypting information • Implementing data self-destruct mechanisms if security is • • • breached Disabling infrared transmission capabilities (beaming) Avoiding wireless transmission of data Installing virus protection and firewall protection Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. HIPAA (Health Insurance Portability and Accountability Act) Centralized registration of HHC is recommended so that audits can be performed to ensure compliance with security measures Safest use of HHCs: reference materials, nonidentifiable data, clinical calculators Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Telehealth Telecommunications technology to assess, diagnose, and, in some cases, treat persons who are located some distance from the health care provider Home care arena is seeing significant changes as a result of telehealth Telehome care devices: automated blood pressure monitors, glucometers, peak flow meters, pulse oximeters, weight scales, and video monitors Potential to transcend state boundaries; this creates issues, given that nurses and most health care providers are licensed in specific states Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Information Technology in the Clinical Setting Trends in Computing: Past, Present, and Future Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Nurses as Knowledge Workers Information explosion requires nurses to be on the cutting edge of knowledge to practice ethically and safely Trends in computing will also affect the work of professional nurses Research advances New devices, monitoring equipment, sensors, and “smart body parts” Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Three Phases of Computing Phase I (past)—mainframe era, in which many people share one computer Phase II (current)—PC era, characterized by one person to one computer Phase III (future) Ubiquitous computing in which many computers will provide access to each person Computers will be everywhere—walls, chairs, clothing, light switches, cars, appliances—and will become so fundamental to our human experience that they will “disappear,” and we will cease to be aware of them Crossover with PC era will be between 2005 and 2020 Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Voice Systems Computer users talk to a computer • Becoming more commonplace Individual users train their personal computers to recognize their voices and are able to dictate documents and emails and direct their computers to perform specific activities upon voice command Provide an efficient mechanism for communication among health care providers Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Robot Technology Enables clinicians to interview and examine patients, even when 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 Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Biometric Technology Use human characteristics (e.g., fingerprints, retinas, irises, voices, facial patterns) to authenticate or grant access to data or information Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Web 2.0 Promises to make significant changes in the way people use the Web, most notably in enhancing people’s abilities to share, collaborate, and connect with each other and with ideas and information Specific Web 2.0 technologies: Web logs (blogs), social bookmarking sites, wikis, podcasts, shared databases, and collaborative writing spaces Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Information Technology in the Clinical Setting Information Literacy and Information Technology Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. General Definitions Information literacy is the ability to determine when information is needed and how one can locate, evaluate, and use the information appropriately Information technology is the hardware and software that facilitate the storage, retrieval, communication, and management of information Computer literacy is knowledge and understanding of computers, combined with the ability to use them effectively Rapid growth and turnover of information and enormous changes in the technologies make it imperative that nurses possess information literacy and fluency with information technology Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Information Competencies in Clinical Practice 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 Many nurses do not possess adequate information technology, information literacy, and computer literacy competencies Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Informatics Integrates nursing science, computer science, and information science in identifying, collecting, processing, and managing data, as well as information to support nursing practice, administration, education, research, and the expansion of nursing knowledge (ANA, 1994) 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 Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Informatics Current and future roles for nurses in informatics: • Liaising with users of computer and information science (CIS) • Installing CIS • Managing CIS products • Analyzing/programming systems Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Applied Information Literacy 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 critical thinking Expect to instantaneously find answers to their questions on the general 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 Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Applied Information Literacy • Research has demonstrated that students do the following: Regularly 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 understand how and when to use library databases for resources Enter their educational programs with varying degrees of experience and ability in computer skills and knowledge Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Finding Information on the Internet One study revealed that the best search engines found only approximately 33% of the information available on the Internet Search engines are good starting points, but you can augment their effectiveness by adding a few other strategies. Target your search by conducting a “purpose-focusapproach” (PFA) assessment. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Purpose-Focus-Approach (PFA) 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 accessed 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 Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Evaluating Information Found on the Internet Internet is open to anyone w/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 author’s credentials Author’s contact information Affiliation of the website is important: .edu=educational institutions .org=non-profit organization .com=commercial enterprise .net=Internet Service Provider .gov=governmental body .mil=military Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Evaluating Information Found on the Internet Objectivity Accuracy Look for documentation and referencing Compare information on the Website with other sources Currency 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? Look for 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 Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.
