Week 7
CDC National Center for Health Statistics survey (2011)
1) 85% of physicians with EHRs = satisfied 2) 74% reported EHRs enhanced overall patient care 3) 29% ordered fewer laboratory tests Since the implementation, hospitals have received $1 billion more in Medicare reimbursement in 2010 vs. 2005
Point of Care device
1) Glucose 2) Medication 3) Specimen Collection 4) Mother's milk
Taxonomy of Workarounds
1) Omission of a process step 2) Steps performed out of sequence 3) Unauthorized process steps
Healthcare Apps
1) Pocket Anatomy 2) HR Monitor 3) Free Medscape 4) Real Bodywork 5) Micromedex - medications FDA Approved: 1) Mobile MIM - Share images 2) AliveCor - Electrocardiograms 3) Diabetes Manaber by Well Doc 4) AirStrip - Cardiology
Before HITECH Act:
2% of hospitals with comprehensive systems and less than 8% with basic systems
Workaround stats
89% of 3.1million RN's =2.75 million RN's admit to creating workarounds and utilizing them on a regular basis 67% of 3.1 million RN's =2.07 million RN's - have been taught workarounds from their coworkers
What is a workaround?
A workaround can be understood as a situation in which an individual finds an alternative work process to bypass a problem in the system/process
Bedside Documentation
Advantages: 1) Workflow 2) Patient Safety 3) Nurse - Patient Time 4) Communications Disadvantages: 1) Complexities - disruptions 2) Privacy and Security concerns
What is Clinical Decision Support System (CDSS)?
Any type of computer software that provides clinicians, staff, patients, and other individuals with information to improve health and health care Source for healthcare providers to find information about PT. DIAGNOSIS Helps with quality through advancements in technology Ex. Electronic medical records (EMRs) Aid in improvement of care NOT care ending at the systems suggestions Still a need to implement all degrees of optimal care Ex. EMRs help with versatile accessibility and legibility but still need correct use Thorough notes
Conclusion to CDSS
Clinical decision support systems are a necessary in all computer system. Example in Medication Administration: 1) CDSS are used to flag allergies, suggest other medications if the Physicians orders a medication that is contradicted with other medications already scheduled. 2) CDSS are used as an alert if the dose or route is questionable. 3) CDSS are used when Pharmacy pulls and scans the medication 4) CDSS are used if the wrong dose is pulled from Pyxis and scanned for patient Critical thinking skill should still be used!
Knowledge-based (broad approach) CDSS
Contains the rules and associations of data Form of IF-THEN rules Edit to keep it up to date with new drugs and patient data Show results to the user
ANA Nursing Informatics Scope and Standards
Defines nursing informatics as the integration of nursing science, computer and information science, and cognitive science to manage communication and expand the data, information, knowledge, and wisdom of nursing practice. Nurses certified in Nursing Informatics are: 1) skilled in the analysis, design, and implementation of information systems that support 2) nursing in a variety of healthcare settings 3) function as translators between nurse clinicians and information technology personnel 4) insure that information systems capture critical nursing information
Vocera
Designed to empower mobile workers by instantly connecting them to the people and the information they need right now, the Vocera Communication System is a software-based solution that can run on any smart device or the Vocera badge, inside and outside the facility.
HITECH and Meaningful Use
HITECH's incentive program lays the groundwork for delivery system reform by linking an estimated $30 billion in incentive payments for demonstrating meaningful use to a host of quality-related applications of health IT
Conclusion of HEITECH
Health Information and Technology for Economic and Clinical Health Act of 2009 Provides incentives as well as penalties regarding the use of electronic health records Increases patient safety, accessibility of information, and in hopes of decreasing long term costs Physicians and facilities still in progress in adapting to the Act
Money = Movement
In 2014, 3 out of 4 (76%) hospitals had adopted at least a Basic EHR system. This represents an increase of 27% from 2013 and an eight-fold increase since 2008. Nearly all reported hospitals (97%) possessed a certified EHR technology in 2014, increasing by 35% since 2011. MN - 85% Basic EHR
When a problem in the system arises
Many health care professionals work around the problem Working around a problem is first-order problem solving Consequence of first-order problem solving is that nothing is changed
Non-knowledge based (Narrow approach) CDSS
Means computers learn from past patterns of data input Two types are artificial neural networks and genetic algorithms Artificial neural networks use connections to find patterns of pt. data to help determine a association between symptoms and a diagnosis Genetic Algorithms look at solutions and determine the best result
FDA
Mobile apps for which the FDA intends to exercise enforcement discretion For many mobile apps that meet the regulatory definition of a "device" but pose minimal risk to patients and consumers, the FDA will exercise enforcement discretions and will not expect manufacturers to submit premarket review applications or to register and list their apps with the FDA. This includes mobile medical apps that: 1) Help patients/users self-manage their disease or condition without providing specific treatment suggestions; 2) Provide patients with simple tools to organize and track their health information; 3) Provide easy access to information related to health conditions or treatments; 4) Help patients document, show or communicate potential medical conditions to health care providers; 5) Automate simple tasks for health care providers; or 6) Enable patients or providers to interact with Personal Health Records (PHR) or Electronic Health Record (EHR) systems.
Nurses and Technology
Nurses are expected to provide safe, competent, and compassionate care in an increasingly technical and digital environment. A major theme in this new healthcare environment is the use of information systems and technologies to improve the quality and safety of patient care. Nurses are directly engaged with information systems and technologies as the foundation for evidence-based practice, clinical-decision support tools, and the electronic health record (EHR). Unfortunately, not all nurses are fully prepared to use these tools to support patient care.
Problem in the system with workarounds
Nurses have mastered the art of workarounds. With this the organization sees that things are going smoothly when actuality the nurses are working harder then they need to get the job done Workarounds are a temporary solution to an immediate problem. With many workarounds yes it is the nurse who acts the workaround out but the real problem comes from a system that needs improvements.
Nursing Informatics
Nursing Informatics, has emerged over the past 20 years to help nurses fully use information technology to improve the delivery of care.
The TIGER Initiative
Our Vision: Advancing the integration of health informatics to transform education, practice and engagement. Our Mission: To enable clinicians to use informatics and emerging technologies to make healthcare safer, more effective, efficient, patient-centered, timely and equitable by interweaving evidence and technology seamlessly into practice, education and research fostering a learning healthcare system.
Patient Technology
Patient Portals: 1) Schedule Appointments 2) Have discussion with caregivers 3) Blogs with others with similar diagnosis 4) Gather information (controlled by facility) Self Tracking: 1) Weight - CHF 2) Vital Signs - Hypertension 3) Asthma - Children Support Groups Communications: 1) Ask MD 2) Ask a nurse
Workaround examples
Printing out the patients barcode to bypass scanning the patients Overriding the Pyxis to obtain drugs Not having high alert medications double checked by a second nurse Not putting personal protective equipment on when entering a patients room Not performing three checks on medications Silencing alarms without investigating
Health Information and Technology for Economic and Clinical Health Act (HITECH) of 2009
Promotion of health informatics and technology to improve healthcare quality, safety, and efficiency through financial incentive or penalties. Provided billions of dollars of incentives to clinicians and hospitals for the use of: 1) Certified health information technology 2) Comparative effectiveness research 3) Privacy protections for medical records. Penalties for physicians and hospitals that do not use certified products.
The TIGER Informatics Competencies Collaborative...
Sought to evaluate the current preparedness of the nursing workforce and propose a set of minimum informatics competencies that all nurses need to practice in today's digital era.
Smart Phones/PDA's
Stay Fit: 1) Monitor weight 2) Running 3) Yoga Save Lives: 1) Monitor glucose FaceTime: 1) Patient and family communication Educational Videos TeleHealth
What does TIGER stand for?
Technology Informatics Guiding Education Reform
Solution to workarounds
The real solution is second-order problem solving. Find where the problem is arising and fix it Prevents further workarounds from occurring
Internet Resources
There are an estimated 95,000 healthcare apps in the world today. 40,000 Health and Wellness apps Over 200 million people have downloaded a healthcare app to their smartphone
TIGER
Was formed in 2004 to bring together nursing stakeholders to develop a shared vision, strategies, and specific actions for improving nursing practice, education, and the delivery of patient care through the use of health information technology (IT).
The Institute For Safe Medication Practice (ISMP)
noted 71 at risk behaviors which can be classified as a workaround or that can lead to a workaround.
