Digital Health Technology in Nursing

• Nursing Informatics involves the integration of nursing, healthcare, and technology to promote health and wellness.
• Technology affects many aspects of life including how people access information, learn, socialize, commute, and how they approach health-seeking behaviors,.
• Digital Health Technology encompasses the use of technologies for health, health-related activities, and health behaviors.
• Digital health technology refers to any enabling technologies that are used for health-related applications.
• Digital Health Technology and Digital Health Systems can improve health outcomes, promote health, prevent disease, ensure surveillance, provide equitable and universal access to health services, increase efficiency and reliability, and reduce costs.
• They also improve patient and health worker safety, enhance the health workforce, and improve service delivery.
• Digital Health Technologies in Healthcare include Electronic medical records, computer Provider Order Entry Systems, patient Portals, telehealth, and point of Care Technology.
• DHT in Healthcare has benefits like improved access, efficiency, safety, and outcomes.
• DHT in Healthcare has drawbacks including reliability issues, disruption, workflow problems, and resource constraints.
• Nursing Informatics and Nursing Practice involves the current and future role of the nurse, knowledge and preparedness regarding HIT as well as the skills and competencies with using technology in nursing care and health services.
• Nursing informatics also covers readiness regarding nursing informatics as nursing students and new graduate nurses.
• Nursing Informatics and Practice roles and opportunities in clinical practice, education, administration, leadership, research, policy, and the private sector.

Nursing Informatics and Clinical Practice

• Focuses on using technology to support person and family-centered care.
• Assessment considerations for using technology in patient care include preferences and goals, capability and motivation, literacy, willingness, availability, and cost of technology, while focusing on client and family needs.

Patient Education Considerations

• Focuses on specific education for technology used, policies regarding privacy, security, and confidentiality, learning styles and the "Teach-back" method, with available resources and support.

Nursing Involvement Considerations

• Focuses on involvement in the Change Management Process, design, Adaptation, Adoption, and Implementation, as well as workflow and User Experience.

Nursing Informatics Education

Provision of fundamental and foundational knowledge regarding nursing informatics, nursing informatics entry to practice competencies and standards, digital health, and evidence-informed and best practices in nursing informatics

Nursing Informatics and Administration/Leadership

• Involves providing ongoing opportunities for staff education and training, leading change management processes and Innovation, championing Technology Implementation, needs assessments of staff, and interdisciplinary approaches and teams.

Nursing Informatics and Research

• Involves exploring design and evaluation strategies, technology, user, health outcomes, patient safety and quality of care, and supporting evidence-informed practice.

Nursing Informatics and Policy, Advocacy, Regulation

• Involves the use of technology in healthcare, current and emerging technologies including "normal" technology like social media and patient safety & quality of care.

Nursing Informatics and Private Sector/Consulting

• Involves emerging opportunities to drive, lead, or support change from a different and unique perspective/role, considering the intersection of healthcare, technology, and business, & innovative approaches and models.

Competency

• Combining and mobilizing knowledge and skills to apply appropriately to specific types of situations
• Opportunities to develop informatics competencies through education programs, mentorship from nursing professionals, courses, clinical placements, and experiential learning.
• Prior education preparation and experiences influences informatics competencies and nursing practice and experiences upon joining the workforce.
• Suggestions and gaps with transitioning to digital health practice involves nursing informatics in undergraduate education and exposure to DHT in education and clinical practice, hands-on learning and rationale behind DHT, and professional development opportunities.

Social Media

• Applications and websites that allow people to interact with other users, businesses, communities, and content
• Social networking is a form of communication on the Internet where users share information, ideas, personal messages, and other content
• Social Media and Health/Healthcare/Healthcare Behaviors refers to the access to educational resources and influence of social media on health.
• Formal Uses of Social Media includes course assignments, clarifying content, course-related sharing, patient education, studying for exams, and patient education.
• Informal Uses of Social Media refers to peer connections, skill review, following areas of interest, scaffolding knowledge, and accidental learning
• Concerns about accuracy, legitimacy, and professionalism must be taken into account with use of social media along with risks of distractions, breaches of confidentiality, and reputation issues
• Professionalism and Expectations are informed by Regulatory standards, professional ethics, and employer policies.
• Benefits and Risks of social media encompasses professional image, confidentiality, privacy, and boundaries.
• Expectations of social media includes integrity, accountability, & adherence to employer policies
• There are 6 Ps of social media: professional, positive, patient/person free, protect yourself, privacy, and pause before you post

College of Nurses of Ontario (2023) Code of Conduct

• Requires nurses to demonstrate professionalism and treat all healthcare team members with respect in all contexts, including on social media plus maintain public confidence in the nursing profession, and be accountable for their own decisions, actions, omissions, and related outcomes.
• College of Nurses of Ontario (2024) Professional Conduct/Misconduct encompasses Standards of Practice, disgraceful, dishonorable, and unprofessional Conduct
• National Council of State Boards of Nursing provides guidelines for the use of social media
• 2009/2010 social literature related to social media
• 2010/2011 social media lacks non-clarity surrounding social media and nursing
• Since 2011 social media provides policy and guideline development related to professionalism and social media by nurses/nursing profession
• "Healthy" Social Media provides access to information, health promotion, disease management, health behavior, mobile apps, and online communities.
• A policy is a set of statements of principles, rules, or guidelines that outlines expectations and provides a basis for consistent decision-making and resource allocation regarding a specific issue
• Health policy refers to decisions, plans, and actions that are undertaken to achieve specific healthcare goals within a society.

What a health policy can achieve

• Define a vision for the future
• Establish targets in points of reference for the short and medium term
• Outlines priorities and the expected roles of different groups
• Builds consensus and informs people
• Canadian Health Care Policy's primary objective is to protect, promote, and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers.
• The People's Health Care Act is committed to a sustainable, integrated, publicly funded healthcare system built to last.
• Ontario Health manages health service needs across Ontario to ensure the quality and sustainability of the Ontario health system through digital health, information technology, and data management services
• Personal Health Information Protection Act governs the collection, use, and disclosure of personal health information in Ontario outlines the client's rights regarding their personal health information and requires that personal health information be kept confidential and secure.
• Information Privacy is the client's right to control how their personal health information is collected, used, and disclosed.
• The Personal Health Information Protection Act permits the sharing of personal health information among healthcare team members to facilitate efficient and effective care.
• Security refers to processes and tools ensuring confidentiality.
• Personal Health Information is any identifying information about clients.
• The legislation recognizes that personal health information belongs to the client and is simply housed in healthcare facilities and clients have the right to give, refuse, or withdraw consent
• Nursing practice, education, and leadership are some nursing implications.
• Commercial Health Technology are Commercial, Private-Sector Organizations, and Federally-Regulated Businesses
• Personal Information Protection and Electronic Documents Act covers the collection, use, and disclosure of personal information, security and safeguard procedures, obtaining consent and data collection
• Digital Determinants of Health includes access to digital technologies, digital literacy, affordability of digital tools and internet services, data privacy and security, and availability of reliable health information online.
• Health Equity is the fair distribution of resources and opportunities that enable all individuals to achieve their highest level of health and refers to health disparities that are unfair, unjust, and modifiable.
• Digital Health Equity is an equal opportunity for individuals to benefit from the knowledge and practices related to the development and use of digital health technologies.
• Social Justice Considerations: Digital Health Technology involves providing the same level of access for patients, offering a more personalized and inclusive experience for patients, helping clinicians uncover and address health disparities, solving problems in new and creative ways, and bringing members of marginalized communities to the table.

Digital health literacy

• The ability to manage and understand information safely and appropriately through digital technologies
• The ability to seek, find, understand, and appraise health information from electronic sources.
• The ability to apply gained knowledge to addressing or solving a health problem.
• 60% of Canadian Adults and 88% of Canadian Seniors are NOT health literate so they are not able to understand and act upon health information and make informed decisions on their own
• 37% of Canadians seek health information online
• 23% of Canadians report they have had a negative health outcome from following online health advice
• 43% of Canadians experienced health anxiety or distress due to misinformation
• 43% of Canadians are highly vulnerable to believing misinformation
• There is concern that algorithmic mechanisms designed to drive engagement end up pushing misleading or harmful health information into people's feeds
• Misinformation refers to news or information that is verifiably false, inaccurate, or misleading.
• 59% of Canadians said they were concerned about any type of misinformation online
• 43% felt it was getting harder to distinguish fact from fiction compared with three years earlier.
• One way to determine the credibility of online information, many Canadians do NOT know how to fact-check information however people interested in separating fact from fiction were more likely to verify the accuracy of news stories
• Confirmation bias is a tendency to seek secondary sources that support their original thinking or beliefs

Searching Online To Evaluate News

• Refers to search engines and evaluating online (Health) Information
• Influence/Contributors of Online Health Information and Social Media include search engine optimization, preferences and cookies, algorithms, virality and trends, and echo chamber
• Echo Chamber is information that reinforces current beliefs as it presents you with information you already believe and can cause misinformation or misconceptions.
• Infodemic means accelerated flow of inaccurate information during disease outbreaks which causes panic and risk-taking behaviors
• Nurses need to collaborate with other health-care stakeholders to facilitate evidence-based decision-making, and sources of evidence need to be credible and reliable before their findings are incorporated into decision-making and practice.
• Nursing Support encompasses health literacy and digital health literacy, understanding consumers' health information-seeking behavior, consumers support their evaluation of online health information, and opportunities to further support patients/consumers.

Evaluating Online Health Information

• DARTS, QUEST, AACODS, and 5 W's
• DARTS: Date, Author, References, Type, Sponsor
• QUEST is Quality Evaluation Scoring Tool; 28-point system
• AACODS: Authority, Accuracy, Coverage, Objectivity, Date
• Theory refers to assertions, descriptions, or predictions of relationships

Good characteristics of theory

• Is logical and coherent
• Has a clear definition of terms, variables, and conditions
• Has domain/area of application
• Consists of clearly described relationships among variables
• Includes concepts, themes, principles, and constructs based on empirical data Includes substantive concepts and principles for prediction
• Framework provides a structured approach informed by pre-existing theories or theoretical ideas and can be used to guide or inform nursing practice and more.
• Good characteristics of a framework are developed from literature and evidence and different parts of the theoretical framework explained.
• Peplau's Theory of Interpersonal Relations, Leininger's Theory of Transcultural Nursing, and Watson's Theory of Transpersonal Caring are examples of nursing theories
• CNO Therapeutic Nurse-Client Relationship is based on trust, respect, professional intimacy, empathy, and power

Sociotechnical Model

• Ongoing challenges inherent within health information technology interventions within complex adaptive healthcare systems
• Focuses on the need for safe and effective implementation and use of HIT interventions within real-world clinical contexts
• Results in an eight-dimension approach to study HIT
• The eight dimensions: hardware and software, clinical content, human-computer interface, people, workflow and communication, internal policies, procedures, and culture, external rules and regulation, and system measurement and monitoring
• Hardware and software covers hardware and software required to run the applications
• Clinical content encompasses all sources of information stored in the system and clinical content assist in configuring software requirements and it may assist in developing other clinical tools.
• People refers to all human participants involved in all aspects of HIT and focuses on the importance of user training and possession of knowledge and skills
• Human-computer interface allows for the interaction between users and the system including interaction based on seeing, touching, and hearing and considers how technology is integrated and its intended use.
• Workflow and communication is a "complex" component of the model which recognizes the collaborative nature of healthcare and dynamics of clinical practice and often results in proposed changes
• Internal/Organizational Policies affect every other dimension in the model and includes roles and responsibilities, budget and procurement, IT policies and procedures, and clinical workflow
• External Rules, Regulations, and Pressures refer to the broader external forces that facilitate or constrain the design, development, implementation, use, and evaluation of HIT in clinical settings
• System Measurement and Monitoring entails the need for HIT to be regularly measured, monitored, and evaluated and measurements and objectives including availability, usage of features and functions, effectiveness on healthcare delivery and patient health, and unintended consequences

Sociotechnical Model implications

• Hardware and software
• Encompasses clinical content, human-computer interface
• Involves people, workflow and communication
• Encompasses internal policies, procedures, and culture
• Includes external rules and regulation and system measurement and monitoring
• Workaround is a method or action used to bypass a perceived block or limitation in the workflow and it is an informal problem-solving behavior to minimize workflow disruption.
• Factors that contribute include: HIT delaying or blocking workflow, poor work design and time constraints, override of organizational and administrative policies, and unfamiliarity with technology/cognitive overload
• Interoperability refers to secure and timely exchange of health information across systems and the common interpretation of that information and it enables connection, collaboration, and communication between health systems, clinicians, and care providers.

Interoperability benefits

• For patients, encompasses improved access, management, and sharing of health information and reduced time to diagnosis/treatment and medication errors, and better transitions of care
• For clinicians, encompasses time savings, improved communication, and comprehensive information and improved confidence in decision-making and time on direct care
• For health systems, encompasses increased system capacity and productivity and effective system planning and evaluation, Research; Health Data
• For researchers, involves marketing, time and expense savings, and more resources for innovation

Interoperability: Current Gaps

• Includes care coordination and provider burnout, poor patient access and experience, risks to patient safety, inefficient, costly, and disconnected care, and health equity and Indigenous data sovereignty
• Achieving interoperability barriers include data blocking and lack of data portability, the inability for providers to access patient data at the point of care, and a lack of care coordination and collaboration