, nursing exam 1

TSUNAMI OF CHRONIC ILLNESS

"Frequent Flyers" 5-10 percent of admissions, 1 percent of users 22 percent of costs Primary chronic conditions: cardiac/COPD/mental health/diabetes COST OF CHRONIC CONDITIONS - POPULATION >60 YEARS PHYSICIAN SHORTAGE

TELEMEDICINE

-Focused on patient care -Telehealth -Mobile Health (mHealth) -Remote Monitoring -Outsourced Specialty Services

This health professional is a knowledge worker who gathers and inputs correct data and uses the CBIS to find pertinent information to assist in the care of patients

A Nurse

Worldwide Drivers for Telemedicine

Accelerating demands and costs Shortages of health professionals Global public health concerns

Home Telehealth Software

Allows creation of a digital health record (DHR): - Information to be recorded over time. - Trend information can also be developed for groups of patients or populations, allowing for population based analyses of interventions. - set an acceptable range of values for an individual patient when he or she is enrolled in the monitoring program. Advanced telemonitoring software has sophisticated electronic notification protocols: - readings from multiple pieces of equipment on a single patient calculate risk of an acute episode - protocols can be developed related to both routine and alert information organizing communications with physicians, nurses and care givers

The conception, development, and implementation of informatics tools based on intelligent technologies.

Artificial intelligence (AI)

Boston Logan Airport to Massachusetts General Hospital 1967

Boston Logan Airport to Massachusetts General Hospital 1967 Collaboration between Logan International Airport and Massachusetts General Hospital (MGH) resulted in the establishment of the Logan International Airport Medical Aid Station. At the aid station employees in the airport and airline travelers could receive medical care from MGH physicians via a two-way audiovisual microwave circuit. The aid station was staffed with nurses with physicians present during the 4 hours of the day that were "peak" times. Nurses triaged each patient. NASA also played part in the development of telehealth in the 1960s with the intention of space exploration. Physiological data from the astronauts were collected by space suits and spacecraft, and transmitted to the medical staff on the ground for monitoring during missions STARPAHC - On the Papago Indian Reservation- 1975 HCPS relied on two way voice and video technologies transmitted remote care for residents

This system uses data acquisition, processing, dissemination, and feedback of information and assists nurses in the continuous cycle of knowledge generation and transmission

CBIS or Computer based information system

Tools for Home Telehealth

Central station/web server Peripheral biometric devices, vital signs, blood glucose meters. Telephones are already the most familiar household communications tool used in telehealthcare, can be augmented Video cameras, videophones Personal Emergency Response Systems (PERS) In home -portable Sensor and activity monitoring systems can track activities of daily living Medication management devices - 32 million people are taking 3 or more medications daily, with even more medications typically being taken by those 65 years of age or older.

A person involved with the information technology infrastructure of an organization. This role is sometimes called chief knowledge officer.

Chief information officer (CIO)

Person focused on organizational-based scientific and technical issues; responsible for technological research and development as part of the organization's products and services.

Chief technology/Technical officer (CTO)

Name an Information systems that is used to document patient care.

Clinical information system (CIS)

Name some Information systems that might be found in a healthcare setting:

Clinical information system (CIS), Decision support system (DSS), Executive support system, Geographic information system (GIS) Management information system (MIS), Office system, Transaction processing system (TPS), Hospital information system (HIS)

the science of understanding what information is housed in and processed by the brain.

Cognitive informatics (CI)

A field that involves both cognitive informatics and artificial intelligence

Cognitive science

These systems contain equipment, hardware, software, storage, and networks that work together for a specific purpose like healthcare information management

Computer based information systems

Input such as using the keyboard to place information in the search engine describes the term

Data

Raw facts are often called:

Data

the process by which collected data is processed to identify trends and relationship patterns.

Data analysis

any information entered into a computer system is called

Data input

What concepts form the basis of the nursing informatics framework?

Data, information, knowledge, and wisdom are all concepts that form the basis of the conceptual framework for nursing informatics.

RESISTANCE TO CHANGE

Discovery to implementation in medicine = 15 years

Viability of Knowledge, for knowledge to be viable it must be:

Easily accessed, Accurate, Timely, Presented in a way that is understandable and organized so that new knowledge can be generated.

Patient Use Considerations

Elders may have sensory, cognitive, and motor disabilities. Usability testing need to be sure system works for patien

True or false Storage is never considered part of processing,

False

Hit and Informatics

Focused on support systems Electronic Records E-Prescribing Management Information Systems Electronic Payments

HRSA

HRSA works to increase and improve the use of telehealth to meet the needs of underserved by: -Fostering partnerships within HRSA, and with other Federal agencies, states and private sector -Administering telehealth grant programs. -Providing technical assistance. -Evaluating the use of telehealth technologies -Developing telehealth policy initiatives to improve access to quality health services. -Promoting knowledge exchange about "best telehealth practices."

Health Literacy and EHealth Initiatives

Healthy people 2010 defines health literacy as, "The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions" The eHealth Initiative (eHI) was developed to address the growing need for managing health information and to promote technology as a means of improving health information exchange, health literacy and health care delivery.

ADOPTION ISSUES

Historic resistance to change Lack of consistent adoption and integration pathways Changing service delivery models and payment coverage

Home Telehealth Practice and Protocols

Home telehealth programs will differ depending on the type of technology used and the focus of the telehealth programs. Informed written consent must be obtained from the client or designee before beginning the use of telehealth consultations.

Telehealth Patient Populations

Homebound Limited access to transportation Lack of primary care and emergency resources in rural or remote populations Acute care - strategy to reduce hospital length of stay Managing patients in a major disaster, large scale nuclear/bio-chemical attack or in the case of an outbreak of highly infectious disease.

Challenge: How to keep care patient-centered

How do we conceptualize patient-centered How is telehealth patient-centered? How is it not patient centered? Technology - 1950s moved care from home to hospital care not patient centered Technology 2012 - moved care from hospital to home Is physical presence necessary for patient- centered care?

Ethical Concerns

How provider or patient-centric is the technology? Does the shift to remote services promote rationality and efficiency at the expense of values traditionally at the heart of caregiving? How does the design affect home life and family dynamics? To what extent should technology usage involve attempts to manipulate users into different behaviors? How might the replacement of human contact by new technologies be ameliorated? To what extent is the deployment of technology an end in itself, aimed not toward the improvement of health or well-being, but to create market needs? How do we identify the boundaries between genuine solutions and futility in light of technologies that may shift them?

Elder Care Telehealth

In assisted living facilities or subacute care centers a kiosk can be used to obtain vital signs for large groups of people. Vital sign reports can then be forwarded on a regularly established schedule to physicians and other involved in the patient's care.

Processed data that that has meaning is

Information

Confidentiality and Privacy

Information systems must ensure a high level of data security Patients and families should have the opportunity to revise consent after they fully understand the intrusiveness of home monitoring All involved parties, including the technical staff assistants, must have appropriate training in privacy and confidentiality issues.

Why do we need information systems in health care?

Information systems shape healthcare organizations as they affect communication, speed, and storage and access of information and data.

Promoting Health Literacy

Internet is a source of health information for patient education and health literacy. Provides 'instant' information about health maladies.

The nurse is interested in researching a topic of interest in clinical nursing practice. What options are most suitable for researching existing information?

Interviewing a specialist, Online websites Professional databases

The Foundation of Knowledge Model and Home Telehealth

Knowledge acquisition, processing, generation, dissemination -Knowledge acquisition involves the nurse's receiving the information from the telehealth devices via a variety communication modes. -Knowledge processing is understanding a set of information and ways it can be useful to a specific task -After processing information, the nurse is able to target the appropriate next steps involving knowledge generation and knowledge dissemination. -The nurse considers all of the data as it applies to this patient, and decides which is the best course of action to be taken and acts on the data

Students build their knowledge through interactions with the course content.

Learner-Content Interactions

Students build their knowledge by finding, retrieving and using information that they need.

Learner-Learner Interactions

Employers/Wellness Programs

Monitor workers and offer telehealth options as a wellness program to: - reduce absenteeism and increase productivity. - lower healthcare costs and associated insurance premiums. - create financial incentives for achieving healthcare objectives such as appropriate weight, reduced blood pressure, and levels of exercise.

Web Sites of Organizations

Most offer physician search capabilities, e- newsletters, and call-center tie-ins. Must be a sincere commitment to keeping information current and easily accessible. Web designers must pay particular attention to the aesthetics, the ease of use, and the literacy level of those in the intended audience.

A nurse who specializes in nursing informatics and who works with the CIO, CTO, nurses, and other staff to integrate, improve, and use the CBIS.

Nurse informaticist

facilitates the integration of knowledge, data, and information to support nurses and other providers in the various roles they play; enhances The Foundation of Knowledge model by supporting nurses in their quest for information and knowledge.

Nursing Informatics (NI)

The Foundation of Knowledge Model provides a framework for the four building blocks of Nursing Informatics; the four building blocks are:

Nursing Science, information science, computer science and cognitive science

Includes anything that returns information back to a user, multiple printed or electronic formats, often associated with printed documents

Output

The retrieval, analysis, or synthesis of data is called

Processing

Promoting Health Literacy in School Aged Children

Promoting health literacy in school aged children presents special challenges to health educators. e-health programs need to be developed specifically to appeal to the generational (highly connected and computer literate) and cultural needs of this group.

data focused on number and frequency analysis, which matches perfectly to technology use.

Qualitative data

data that focuses on words, experiences, scenarios, value, and meaning.

Qualitative data Qualitative data is not measurable in terms of tangible variables, such as numbers

ADVANCED TECHNOLOGIES

Robotics Remote Surgery Live Monitoring via Cell Phones

Telehealth Services

Service contracts - prisons, oil rigs, ships, international Outsourced services - teleradiology, neurology, mental health

Transmission Formats

Store and Forward - Digital information is stored on client computer or device; then, at a convenient time, the data are transmitted securely (forwarded) to a specialist or clinician at another location for interpretation Real Time - real-time or live interaction Remote Monitoring - devices are used to capture and transmit biometric data Telephony - monitoring via telephone

Social and Cultural structures affecting Telehelath

Technical Religious/Philosophical Economic Educational Kinship/social Cultural values/Beliefs Political/Legal factors

What is Telehealth?

Tele (operating at a distance) Health Telehealth is the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration. Health services that are delivered by telecommunications-ready tools, such as the internet; telephone, videoconferencing; streaming video and wireless communicaiton. Tele health will allow us to improve care delivery services even more of the population. broader definition of remote healthcare that does not always involve clinical services. • Videoconferencing • transmission of still images • remote monitoring of vital signs, • continuing education • nursing call centers

Name Games

Telemedicine m-Health Telehealth Remote Medicine E-Health Telecare

Real-Time Clinical Telehealth

Telemental health Telerehabilitation Telehomecare Teleconsultations Telehospice/ telepalliative care

Telenursing

Telenursing refers to the use of telecommunications and information technology for providing nursing services in health care to enhance care whenever a physical distance exists between patient and nurse, or between any number of nurses The most developing area of telenursing today is in home tele healthcare. More than 90% of seniors want to remain independent at home and age in place. Sicker patients being discharged Home care telenursing can also involve other activities such as providing customized patient education in dietary or exercise needs nursing teleconsultations review of results of medical tests and exams and assistance to primary care providers in the implementation of medical treatment protocols.

Trusted Websites

The Health on the Net (HON) Foundation Survey (2005) describes the certifications and accreditation symbols that identify trusted health sites. The HONcode and Trust-e were identified as the two most common symbols that power users look for.

Internet information

The challenge for consumers and health care professionals alike is the proliferation of information on the Internet and the need to learn how to recognize when information is accurate and useful for the situation at hand.

In regards to Demands of Health-Related Information, what are some demands or requirements for standardized technologies?

The demands on standardized nursing terminologies include accessibility, ubiquity, longevity, and reusability

Hospital Hub-and-Spoke Benefits

The hub and spoke telemedicine model connects several smaller spoke hospitals to one or more hub hospitals via formal agreements to engage in telemedicine consultation. Hub hospitals are typically academic medical centers, with specialty and subspecialty expertise available 24 hours a day, 7 days a week. Spoke hospitals are typically smaller and do not have extensive specialty support. They may be community hospitals located in underserved rural or suburban areas. Hub Benefits: Transfer of appropriate patients arriving in better condition Increased reimbursement for downstream treatment Reduced transfers of inappropriate patients Increased relationships with community hospitals in surrounding areas Service to network community Spoke Benefits Increased admissions Reimbursement ie:tpa Achieve Primary Stroke Center status On demand access to specialists Enhanced reputation Service to community

Acquiring knowledge from one situation and applying it to a similar situation. It moves thoughts and ideas from one area to another for the generation and dissemination of knowledge.

Translational research

True or False Computer based information systems includes patient care equipment.

True

True or False Healthcare information systems are Computer based information systems, or CBIS

True

True or False Nurses use all of the aspects of the Foundation of Knowledge Model, regardless of their area of practice.

True

Using fingerprints for administration of medications, and kicking a form back because a mandatory area wasn't completed are both types of:

Verification of data by the IS

Examples of quantitative data include

a patient's height, weight, and vital signs.

The American Nationals Standards institute (ANSI)

aims to reduce patient risk from harm, decrease healthcare costs, and improve patient outcomes through promoting research and technology applications focused on evidence-based practice (EBP).

Data, such as keyboard input data, is known as

alpha data, which includes all text and numeric outputs of digital monitors

Types of data include:

alpha, numeric, audio, image, and video data. Alphanumeric data that nurses encounter might be patients' names and identification numbers. Audio data might be monitor alerts, alarms, or dictated notes.

Consumer Demand for Information

consumer empowerment, trend of people interested in taking control of their health, not satisfied being dependent on a health care provider to supply them with information. 8 in 10 of Americans who are online have searched for health information.

Information is:

data that has been processed and has meaning because it is organized in a way that people find meaningful and useful

Computer based information systems, or CBIS must have two key elements to function well:

decision making/problem-solving ability AND the quality of data/information inputted.

Driving Forces For Telehealth

demographics nursing/health care worker shortages chronic conditions the new, educated consumers excessive costs of health care services that are increasing in need and kind. The American health care system spends $1.4 trillion/year on conventional medical care. Much more should be expected to be spent in the coming decades. A solution is to develop a new clinical model for American healthcare that includes technology. Telehealth technology should be included to fill the gap resulting from an overabundance of patients and a scarcity of health care providers.

A system that grades evidential research based on various categories of importance

evidence hierarchy

Data integrity refers to

how complete and correct data is

Nurses interact with technology in all aspects of their practice. When using any technology, the goal of the interaction should be:

improved patient outcomes.

Qualitative data is not measurable in terms of tangible variables, such as numbers, examples of qualitative data include:

information obtained from interviews and direct observations.

Name 3 things crucial things required when more than one information system is used within a healthcare setting:

interaction, security, and functionality of systems are crucial.

Thurmond described four types of web-based learning interactions:

learner-learner, learner-content, learner-instructor and learner-interface interactions.

Patient Education for internet use

nearly 75% of online searchers do not check the date or the source of information they are accessing on the web 3% of online health seekers report knowing someone who was harmed by following health information found on the web. US National Library of Medicine and National Institutes of Health sponsor MedlinePlus a web site that has a tutorial for learning how to evaluate health information as well as an electronic guide to web surfing that is available in both English and Spanish.

Legal and Ethical Aspects

nurses must be licensed to practice in all of the states in which they provide telehealth services. scope of practice and accountability for practice must be defined nurses must be vigilant about keeping extensive documentation of their visits on and off site.

The ISO (International Standard for Organization) created the standard ISO 18104:2003 "Health informatics—Integration of a reference terminology model for nursing." At the heart of this ISO standard are two models, what are they:

one model for assessing nursing diagnoses, and another for assessing nursing actions.

Information systems are also used to manage the following:

personnel data, monitor paid hours, and how/when staff is paid for work; types of equipment, availability, clinical materials, and financing of both.

Two types of data exist, what are they:

quantitative and qualitative

Knowledge

refers to the synthesis of information and data that is always evolving. A paper is an example of sharing __________________.

The Center for Evidence-Based Practices (CEBP) focuses on:

research-to-practice initiatives related to early intervention, early childhood education, parent and family support, and family-centered practices.

Chronic Disease Patients

significant risk of having an acute episode when subtle but significant changes in their medical condition occur. - congestive heart failure (CHF), - chronic obstructive pulmonary disease (COPD), - diabetes, - those who require long- term wound care.

The agency for healthcare research and quality (AHRQ)

supports health services research initiatives. Their website has a wealth of information regarding health care quality.

Knowledge is:

the awareness and understanding of a set of information and ways that information can be made useful to support a specific task or arrive at a decision.

The Foundation of Knowledge Model illustrates:

the dynamic, evolving nature of knowledge. We learn by continually acquiring, processing, generating, and disseminating knowledge. As we share our knowledge, we also receive feedback, leading us to rethink and reshape our own knowledge base in a continual cycle., core level of knowledge

Nursing science is:

the ethical application of knowledge acquired through education, research and practice to provide services and interventions to patients in order to maintain, enhance or restore their health.

Digital Divide

the gap between those who have and those who do not have access to online information. Grey Gap - A term used to reflect the age disparities in computer connectivity; there are fewer persons over age 65 who use computer technology than those in younger age groups. Developing countries

Information science is

the science of information studying the application and usage of information and knowledge in organizations and the interfacing or interaction between people organizations and information systems. Integrates features from cognitive science, communication science, computer science, library science and social sciences

Nursing informatics is:

the study and application of technology, information, and computer science to the practice of nursing

Healthcare workers rely on _______________research because medical, biomedical, informatics, and nursing research can be translated from the original source and applied directly to bedside and clinical interventions

translational research