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Module 48 Informatics The Concept of Informatics Definitions Informatics ( the science of computer information systems Nursing informatics ( science of using computer information systems in the practice of nursing Nurses handle large amounts of data and information Informatics provides tools to process, manage, analyze information Purpose of documenting and improving client care Nursing informatics Biomedical informatics ( the interdisciplinary science that deals with biomedical information, its structure, acquisition, and use All nurses must have a basic level of computer literacy Computer skills Information literacy skills Overall informatics competencies Privacy, confidentiality, security of information Recording data Informatics and health policy Professional organizations and government entities recognize and support the care, purposeful implementation of informatics in healthcare environments Federal government has provided incentives to healthcare agencies to promote use of electronic medical records Meaningful use objectives Improving care coordination Reducing health disparities among U.S. citizens by improving safety and quality of health care Ensuring the security and privacy of protected medical information Engaging clients and their families in the clients care Informatics and service delivery Informatics has broad implications for service delivery Improved quality of care for clients See CONCEPTS RELATED TO INFORMATICS, p. 2633 Healthcare information systems Technology overview Hardware ( physical parts of the computer, associated equipment Input devices Feed data into computer Keyboard, mouse, touch-sensitive screen, stylus, microphone, Ethernet card Central processing unit (CPU) Brains of computer, inside the system cabinet Arithmetic logic unit (ALU) Memory ROM ( read only memory, permanent RAM ( random access memory, temporary Control unit ( manages instructions to other parts of the computer Secondary storage Provides space to retain data in area separate from computers memory Hard disk drives, USB flash drives, DVD, (high-density) HD-DVD Some portable Output devices Allow user to view or hear processed data Terminals or video monitor screens, projectors, printers, speakers Software ( instructions or programs Healthcare information systems Various parts focused on Care of clients Behind-the-scenes work that makes healthcare facility operate efficiently Clinical information systems May be designed for use within one department ( data used by other departments Goal to allow access to information quickly and safely Avoiding duplicate services May include Electronic health records Clinical decision support systems Bedside medication administration using positive client identification Computerized provider order entry (CPOE) Client surveillance Clinical data warehouse Administrative systems Support process of providing client care Financial systems Payroll and human resource systems Contract management systems Risk management systems Quality assurance systems Physician management systems Executive information systems Materials management systems Computerized medical records Purpose Unify a clients entire health history into one single source of information Clients medical and surgical history Diagnostic tests and treatments Medications and therapies Multidisciplinary and multispecialty Computerized medical records should contain the following functionality Client support Health information and data Administrative processes Results management Reporting Secure electronic communication and connectivity Order management Decision support Terminology Electronic medical records (EMRs) Similar to electronic chart used in a clinicians office Focus is on diagnosis and treatment Designed to stay within a clinical setting and not meant to travel beyond it Electronic health record (EHRs) Give a broader view of clients health Designed so that multiple clinicians from multiple disciplines can have simultaneous access to the clients health information Other terms currently used Computerized patient record (CPR) Computerized medical record (CMR) Patient medical records software (PMRS) Electronic health records system (EHRS) Personal health record (PHR) Components Nursing process should be carried into the electronic record Nurses should be given tools to record assessments, nursing diagnoses, plans, interventions, and evaluations Real-time documentation of client data can help clinicians Uniform language ( consistent use of the same terminology among providers, facilities, institutions, and organizations Health Level 7 (HL7) terminology Health Insurance and Portability and Accountability Act of 1996 (HIPAA) Protection of private health information Nurses use many of the same rules for protecting clients privacy that were practiced prior to electronic health records See Box 48-2 SOCIAL MEDIA AND THE WORKPLACE, p. 2638 Quality assurance Outcomes of care depend on how electronic records are used Accuracy Recording accurate information is vital Device integration Critical thinking Electronic records do not replace critical thinking Clinical decision support systems (type of artificial intelligence that analyzes data and provides information about EBP These systems can help improve client safety and quality of care, but they do not take the place of sound nursing judgment Uniform language Use uniform language in all documentation Case Study A ( Mary Wilson is a 19-year-old with a history of grand mal seizures, p. 2639 Telehealth Telehealth ( uses telecommunications technologies to allow clients to access care that they might not otherwise be able to obtain Benefits of telehealth Access to health care is increased Health care outcomes are improved Healthcare costs can be reduced Telehealth may help with shortages of healthcare providers Applications Consult with colleagues Conduct interviews Assess and monitor clients View diagnostic images Review slides and laboratory reports Extend scarce healthcare resources Decrease the number of hospital visits for clients with chronic conditions Decrease healthcare costs Tackle isolation and loneliness Provide health education Improve the coordination of care Improve the equity of access to services Improve the quality of client care Improve the overall quality of the clients record Barriers to implementation of telehealth services Reimbursement Licensure Concerns about record privacy Barriers to client participation in telehealth services Insurance may not cover it Older adults may lack technical knowledge Equipment needs Lack of internet access Case Study B ( Jack Anderson is an 85-year-old retired machinist, p. 2641 Geographic information systems GIS ( uses location to capture, manage, and analyze data Technology is used both inside and outside of health care Relies on satellite imaging and global positioning systems (GPS) to capture geographical data Data is managed and stored on a database Used to Analyze population- or location-based data such as disease transmission, cancer rates, trends in diseases, environmental data Lifestyle choices such as obesity rates, lack of proper nutrition, use of tobacco, etc Track where chronic diseases programs should be placed Monitor effectiveness of programs Plan new treatment facilities Track acute health problems Client education and e-health E-health ( utilizes electronic information that can be retrieved online or through a mobile device to improve a persons health or health care Online consumer medical information Individuals are using the internet for health information But the internet is not always an accurate source Accessing incorrect or outdated information can cause clients anxiety ( cyberchondria Nurses should evaluate web sites for themselves and their clients See Box 48-4 EVALUATING WEB-BASED HEALTH INFORMATION, p. 2642 Online client medical information Many facilities use internet to give clients access to and control over their own health records, often called patient portals Clients can schedule appointments, request prescription refills, communicate electronically with healthcare providers Online administrative tools Patient portals can also perform administrative functions Used to have clients complete questionnaires Price shopping Online information about insurance coverage Ergonomic considerations Ergonomics ( the science of fitting workplace conditions and job demands to the capabilities of the working population When working on a computer, goal of ergonomics is to set up a workstation that allows for neutral body position Repetitive strain injury( repetitive motion disorder that occurs when limbs are subjected to repetitive use, awkward positions, or forced positions Computer vision syndrome ( eyestrain that is most common sequel of computer use See Box 485 GOOD ERGONOMICS FOR COMPUTER USE, p. 2643 Review The Concept of Informatics Relate Link the Concepts Ready Go to Companion Skills Manual Refer Go to Student Resources Reflect Case Study Exemplar 48.1 Clinical Decision Support Systems Overview Clinical decision support (CDS) ( a system that provides healthcare providers with knowledge or specific information Is intelligently filtered, presented at appropriate times Enhances health and health care Software organizes information Tools may include clinical practice guidelines, alerts, workflow tools Computerized provider order entry (CPOE) with CDS shown to decrease medication errors up to 80 Program to assist nurses performing skin assessment Gives options Access facilitated through wireless devices Expert systems use artificial intelligence to model decision that expert in field would make Nurse enters data ( provided with list of nursing diagnoses Selects diagnosis (as) ( list of associated signs and symptoms Accept diagnoses based on actual data ( screen will show potential etiologies The role of uniform languages Standardized nursing languages facilitate data collection, communication Include NANDA Nursing Interventions Classification (NIC) Nursing Outcomes Classification (NOC) Clinical Care Classification (CCC) Home Health Care Classification (HHCC) Omaha System for capturing community health information Nursing Minimum Data Set (NMDS) Nursing Management Minimum Data Set (NMMDS) Patient Care Data Set (PCDS) PeriOperative Nursing Data Set (PNDS) ABC codes (Alternative Billing Concept codes) Logical Observation Identifiers Names and Codes (LOINC) Systematic Nomenclature of Medicine Clinical Terms (SNOMED CT) International Classification for Nursing Practice (INCP) Set the definition of key terms ( studies can be replicated Implementation requires Education of staff members who are unfamiliar with standardized terms Elimination of computer restraints Database coordination Utilizing research Gap between theory and practice ( diminished client care, inefficient practice, time lag Evidence-based practice (EBP) Approach to providing care that integrates Nursing experience and intuition Valid and current clinical research to achieve best outcomes Advances client health and safety Provision of quality care based on systematic examination of scientific literature Reported to increase job satisfaction and vitality Computers in nursing research Invaluable in quantitative and qualitative research Problem identification First step of research process Computers useful in locating current literature Literature review Online or CD-ROM bibliographic databases Computers in nursing administration Human resources All employers must maintain a database on each employee Medical records management Expensive to keep Must have access Facilities management Heating, ventilation, and air conditioning (HVAC), alarms systems Security devices Inventory, tracking Budget and finance Computerized billing Budget generally a spreadsheet program Quality assurance and utilization reviews Internal and external stakeholders need to know that services, activities have positive results Identification standards, pathways, key indicators ( computers facilitate data collection and analysis Quality a process, not an end point Accreditation Online mechanisms to monitor quality indicators mandated by Joint Commission (JC) Databases with policies, procedures, standards of care, employee accomplishment Review Clinical Decision Support Systems Relate Link the Concepts and Exemplars Ready Go to Companion Skills Manual Refer Go to Nursing Student Resources Reflect Case Study Exemplar 48.2 Individual Information at Point of Care Overview Several types of computerized bedside data entry systems Point-of-care may be near client Promote efficiency Computer-based client records EMR permits electronic client data retrieval by caregivers, administrators, and so on Four ways EMR can improve health care Constant availability of client health information across the life span Ability to monitor quality Access to warehoused data Ability for clients to share in knowledge and activities influencing their own health Client monitoring and computerized diagnostics Many external ( thermometers, digital scales, pulse oximetry, electrocardiogram (ECG)/telemetry/hemodynamic monitoring Implanted electronic monitors proving to have great value Transmit data Error alarms Diagnostic procedures use computers Computed tomography (CT) scans Magnetic resonance imaging (MRI) Positron emission tomography (PET) scans Blood gas analyzers Intracranial pressure (ICP) monitors Can be linked directly to store data in the EMR Community and home health Innovative ways in home settings Computer in home allows access to information on variety of topics Search internet E-mail provider Record data Preterm labor monitoring, acquired immunodeficiency syndrome (AIDS) clients, Alzheimer clients Case management Must be able to track a group of clients Caseload Must keep abreast of latest regulations Must be able to document quality Demonstrate client outcomes related to dollars spent Client education Consumers derive much of healthcare information from computers Client education materials can be generated by hospital information systems Integrate client education with the EMR through an intranet Allow clients to ask questions Web pages, video clips Review Individual Information at Point of Care Relate Link the Concepts and Exemplars Ready Go to Companion Skills Manual Refer Go to Nursing Student Resources Reflect Case Study 2015 by Education, Inc. 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