Nursing Informatics: Key Concepts, Applications, and Ethical Use PDF

CH 38: Nursing Informatics Nursing Fundamentals Presented by Kimberly Headden, RN, MSN, CMSRN  Objectives After completing this chapter, you should be able to: Define informatics and its four components. Describe the importance of computers...

CH 38: Nursing Informatics Nursing Fundamentals Presented by Kimberly Headden, RN, MSN, CMSRN  Objectives After completing this chapter, you should be able to: Define informatics and its four components. Describe the importance of computers in evidence-based nursing practice. Explain the role of interoperability and standardized languages within the electronic health record system for exchanging health information. Discuss the benefits of the electronic health record. Discuss the impact of legislative efforts to encourage electronic health record adoption. Describe the importance of protecting personal health information. Explain the relationship between computers and standardized nursing languages. Identify at least two ways that automation decreases error in healthcare. Explain how computers can reduce some of the barriers to evidence-based practice. Identify at least four online sources of nursing research. Describe the process of literature database searching.  Key Concepts ⮚ Informatics ⮚ Managing and processing information necessary to make decisions ⮚ Nursing informatics ⮚ Managing and processing information applying to nursing practice, education, and research Nursing Profession Has Been Transformed  What is Nursing Informatics? ⮚ Nursing informatics “is the specialty that integrates nursing science with multiple information and analytical sciences to identify, define, manage, and communicate data, information, knowledge, and wisdom in nursing practice”. ⮚ Examples of technologies that have been developed as a result of nursing informatics: Computerized provider order entry (CPOE) and electronic health records (EHRs) ⮚ Nursing informatics specialists (NIS) work with EHRs and data analysis systems to be sure the best possible care is provided. Functions of the NIS include data collection and analysis, information sharing, and research dissemination. ⮚ Elements of Nursing Informatics: ⮚ Data ⮚ Information ⮚ Knowledge ⮚ Wisdom  Four Elements of Nursing Informatics ⮚ Data ⮚ Unprocessed numbers, symbols, or words that have no meaning by themselves ⮚ In nursing, data are primary facts and observations acquired when providing services ⮚ Example: weight, blood pressure measurement, age, disease history ⮚ Information ⮚ Groupings of processed data that has been organized into a meaningful, structured form so that one can interpret the significance of the data ⮚ Information emerges from data when it is organized in a meaningful way ⮚ Example: the numerical value of 320 means little alone but paired with age (67), gender (male), and a unit of measurement such as blood sugar, information is formed and may indicate the development of diabetes mellitus type 2 ⮚ Example: the numerical value of 115 means little alone but paired with a unit of measurement (heart rate) and age (65)---indicates tachycardia  Four Elements of Nursing Informatics ⮚ Knowledge ⮚ Is formed when data are grouped, creating meaningful information and relationships , which are then added to other structured information ⮚ Consider the previous example of the patient with a heart rate of 115 bpm. Combine this with additional information: patient is an 80 year old female with a respiratory infection (ex. Pneumonia), has been running low grade temperatures, respiratory rate is 30 breaths per minute, urine output over 4 hours is totaled at 60 mls and is dark colored, skin has decreased skin turgor, and patient reports feeling thirsty and tired. What could all of this information mean? ⮚ Wisdom ⮚ The appropriate use of knowledge in managing or solving human problems ⮚ It is knowing when and how to apply knowledge to deal with complex problems or specific human needs ⮚ Develops as an outcome of clinical experience, theoretical knowledge, critical thinking, and intuition The relationship of data, information, knowledge, and wisdom. Each level increases in complexity.  How Do Nurses Use Informatics at Work? ⮚ Informatics is utilized in several ways in healthcare: ⮚ Through Computer Basics ⮚ Electronic Mail, Text Messaging, and Applications for Group Messaging ⮚ Social Networking ⮚ Online Forums ⮚ Web Conferencing and Webinars ⮚ Telehealth Computers ⮚ Are electronic means of processing information/data ⮚ Has 4 main functions: input, process, output, and store data and information ⮚ Consist of: ⮚ Hardware (machines and monitors) ⮚ Memory (data storage) ⮚ Processors (translators) ⮚ Software (coded programs or applications that support specific functions) ⮚ Networks: can exist as an individual device, or as part of a network of computers that share a common purpose which multiple computers are connected with each other ⮚ Connectivity: a term that refers to the ways in which computers and other hardware communicate and share information ⮚ Data Storage: data can be stored either internally (computer memory) or externally on some form of storage media (ex: flash drive, external hard drive, network drive, or the Cloud) Electronic Mail, Text Messaging, and Applications for Group Messaging ⮚ Electronic communication allows for rapid distribution of information to individuals. ⮚ Communicating Professionally: When transmitting messages by e-mail, text, or by messaging application, remember to communicate professionally at all times! Text messages should be concise, be aware of tone, and do not use abbreviations. ⮚ Protect Privacy: It is critical that all transmissions of patient information occur only on secure or encrypted sites ⮚ Transmitting Medical Orders, can be done via text messaging as long as the following requirements are met: ⮚ The device used is password protected and secure at all times. ⮚ The messaging is encrypted. ⮚ The phone number of the recipient is correct. ⮚ Messages show delivery and read receipts have a date and time stamp. ⮚ Messages are sent only to those who are authorized to receive the medical order. ⮚ The text message does not contain personal health information.  Social Networking ⮚ Allows people to connect and interact with others who have similar interests, regardless of physical location ⮚ Examples of social networking sites: Facebook, Twitter, YouTube, LinkedIn ⮚ This can be done through blogging (posting open messages that can be read by anyone with permissions to access the site), sharing pictures, videos, or instant messaging (real-time conversations with another person who is online). ⮚ Online sites generally require you to register for the site, create a profile, and be granted access privileges by the Web page administrator. ⮚ Sites are searchable by others: Never post anything on these sites that you would not want an employer to view. ⮚ Be aware of risks to patient privacy!  Online Forums & Web Conferencing and Webinars ⮚ Online Forums ⮚ Is a message board where information can be exchanged ⮚ Internet pages with online forums can be either public or limited to specific groups through user names and passwords ⮚ Examples: ⮚ Many schools have created interactive forums to support communication among student groups ⮚ Online forums have been created as support groups for patients with chronic health conditions ⮚ Web Conferencing & Webinars ⮚ Web conferencing is used to conduct or participate in live or synchronous (occurring at the same time) meetings or presentation via the Internet ⮚ Webinar is a specific type of Web conference that is conducted in a one-way manner, from the speaker to the audience. ⮚ These tools can be useful in helping staff obtain updated clinical information for patient care.  Telehealth ⮚ The use of telecommunication to send healthcare information between patients and professionals at different locations ⮚ Improves access to healthcare by providing remote clinical healthcare, patient and professional education, and health administration ⮚ Telehealth is beneficial in: ⮚ Rural Healthcare ⮚ Home Health Monitoring (see next slide for examples) ⮚ Shortage of Healthcare Providers ⮚ Emergency Care Triage ⮚ Remote Patient Care During a Pandemic—Allows patients to access healthcare providers without increasing the risk of transmitting infection to other patients or staff Examples of Home Health Monitoring Devices Example of Telehealth for MD Consults  Computer & Application-Based Tools for Providing and Managing Care ⮚ Tracking Patients and Equipment ⮚ Global Positioning Systems (GPS) allow real-time tracking of patients, and can be used in select clinical situations. Ex: Patient with dementia who wanders ⮚ Real-Time Locations Systems (RTLS) are being used by some agencies to assist in locating patient care equipment that may be dispersed throughout a building ⮚ Other examples of efficiency-enhancing devices include hands-free communication badges, cordless barcode scanners, and wireless smart phones ⮚ Managing Staffing and Workflow ⮚ Internet-based tools for staff scheduling, patient flow, access to evidence-based references, policy and procedures, and staff education are used for efficiency and convenience  Reducing Error with Automation ⮚ A hospital stay can be prolonged or injury and even death can result from a seemingly simple mistake such as administering incompatible medications or by inputting a medication order into the patient’s electronic chart incorrectly There are two types of errors: ⮚ Errors of commission—when the wrong action occurs (ex: giving an incorrect drug) ⮚ Errors of omission—when the correct action does not occur (ex: overlooking a serious medication allergy or failing to put up the bed rails for a confused patient) ⮚ Errors in omission can lead to errors in commission ⮚ Another way to look at errors is by asking whether the error was in planning or execution: ⮚ An error in planning---occurs when the original intended action or plan was not correct ⮚ An error in execution—occurs when the correct action is taken but does not proceeds as intended  Reducing Error with Automation..cont.. ⮚ Automation through technologies or informatics provides a Never Override error- prevention secure way to integrate all patient information (ex: health history, allergy history, lab values, and prescriptions). technologies! If these technologies alert you ⮚ Once all patient information has been placed into the electronic to a possible error---do record, it will be automatically checked for potential dangerous not overlook this alert interactions among prescribed care (Ex. New medication will be but address it! For checked for compatibly against other ordered medications) example, what would ⮚ The following are three examples of error-prevention you do if you are technologies: scanning a medication and the patient’s EMAR ⮚ Computerized physician order entry (CPOE) helps prevent alerts you to the fact errors in reading and transcribing orders. that the patient is ⮚ Barcoding medications, medication administration allergic to this systems reduce medication errors by electronically verifying the 5 medication??? DO NOT rights of medication administration—right patient, right dose, right GIVE IT, Call the drug, right time, right route—at the patient’s bedside Provider, Confirm the ⮚ Use of smart technologies (e.g., infusion devices) at the point allergy!!! of care helps to ensure that the correct dose is delivered to the patient.  Aiding Patients in Self-Care ⮚ As the nurse, you need to guide your patients on how to research credible information online ⮚ Internet-based programs and applications (apps) for mobile devices provide patients with patient education, patient-specific medication dose reminders, and appointment and medical bill-paying reminders.  Supporting Healthcare Professionals ⮚ Supporting healthcare professionals: A few of the many ways that computers assist nurses in learning include: ⮚ Communicating with colleagues and patients through text messaging, synchronous and asynchronous text-based discussions, Web logs (blogs), social media, and web conferencing, for example. ⮚ Time management for scheduling appointments and meetings, including reminders ⮚ Searching online databases and the Internet for evidence-based support of clinical practice and other sources of health information. ⮚ Performing and documenting patient care, and clinical tasks using electronic health record and hospital-based interfaces. ⮚ Supporting patient management using Internet- or app-based, diagnostic aids, decision support tools, and medical calculators ⮚ Using computer- or cloud-based simulation and high-fidelity manikins to emulate an authentic clinical environment prior to performing skills using live patients. Using Simulation for Skills Training & Clinical Judgment ⮚ Computer-Based Simulation is an active, individualized learning approach that uses patient situations to elicit competence and promotes learner confidence by: ⮚ Providing supplementary readings before the simulation experience or testing ⮚ Providing an overview of patient scenario ⮚ Offering options for patient interactions ⮚ Including the patient record ⮚ Showing provider orders that require action ⮚ Providing immediate feedback to learners. ⮚ Using guided discussion and reflection. ⮚ Assessing mastery of clinical skills. ⮚ High-Fidelity Manikins are life-like, patient simulators that emulate an authentic, clinical environment for learners prior to performing skills with live patients. ⮚ The manikins demonstrate physiologic symptoms (e. g., light sensitive pupils, bodily fluid excretion, changing vital signs) that help learners to improve clinical judgment and prioritization for patient care Electronic Health Records (EHR)  Electronic Health Records: Interoperability and Standardized Nursing Languages ⮚ Standardized Languages Facilitate Interoperability ⮚ Interoperability refers to the ability of a computer system or software to exchange, interpret, and share data, without losing the meaning of that shared data ⮚ For this to happen, consistent and standardized languages are needed so all computers understand ⮚ Example: if information about heartrate is to be exchanged, shared terminology is needed. One EHR system may use the term “heart rate” and another EHR system may use the term “pulse rate”. This can interfere with clear communication. ⮚ Standardized Languages Support Evidenced-Based Practice ⮚ Using the same terms to describe a clinical condition in all electronic health records (EHRs) allows comparisons (e.g., of interventions and outcomes), which is necessary for evidence- based practice. ⮚ Review Standardized Language, American Nurses Association Recognized Languages for Nursing on page 1642  Benefits of an Electronic Health Record ⮚ Improves efficiency, productivity, and continuity of care ⮚ Increases communication ⮚ Reduces redundancy ⮚ Improves accessibility ⮚ Serves as a clinical support tool  Benefits of an Electronic Health Record…cont… ⮚ Reduces physician order entry errors through CPOE ⮚ Privacy ⮚ Public health benefits  Barriers to EHR Adoption ⮚ Reasons for objecting use of an EHR: ⮚ Fear of loss of personalization of the record to the individual patient ⮚ Belief that moving to an EHR will cause disruption in workflow, lead to errors, or add to the already taxed workload ⮚ Purchase and installation costs ⮚ Unintended consequences of EHR implementation: ⮚ Less face-to-face communication among the healthcare team. ⮚ Software upgrade and periodic new releases are essential, some of which may require more robust hardware than previous versions. ⮚ New, expensive equipment to replace perfectly serviceable hardware that has been made obsolete by the EHR is a factor when considering the cost of an EHR.  Ethical Use of Electronic Health Records Patient Privacy and Security Safeguards ⮚ Although privacy is often used interchangeably with the terms confidentiality and security, they have distinct meanings. ⮚ Privacy addresses the question of who has access to personal information and under what conditions. ⮚ Confidentiality is the right of an individual to have personal, identifiable medical information kept private. ⮚ Security refers the procedural, technical, and physical safeguards for patient information. ⮚ Common measures to provide security (i.e., prevent unauthorized access, modification, use, and dissemination of electronic health records) include: ⮚ Passwords and PIN numbers for all users are probably the most obvious safeguard. For example, the business office does not see day-to-day clinical information, and nurses do not see any special arrangements a patient has made to pay a bill. ⮚ Encrypting means health information cannot be read or understood except by someone who can decipher it using a special code made available only to authorized individuals. ⮚ Workstation privacy filters at each workstation help to block the view of unauthorized people. ⮚ Designated workstation computers can be assigned for specific functions (e.g., accessing laboratory results) to reduce high-volume use at select terminals. What would you do first if you see an unauthorized user in the hospital’s electronic record? Turn off the monitor so the user looses immediate access!!!  Some Simple Tips For Password Management ⮚ Never share passwords with others. ⮚ Make sure your device is secure. The best password in the world might not do you any good if someone is looking over your shoulder while you type. ⮚ Use a password manager app or software to create and store strong, unique passwords for various accounts. ⮚ The more complex the password is, the harder it is for hackers to break it. Use combinations of letters, numbers, and symbols for maximum protection. ⮚ Don’t use words or numbers that are easy to guess (e.g., pet names, birthdays). ⮚ Change passwords frequently. ⮚ Do not record passwords in easily accessible places. ⮚ Do not use the same login information (username and password) for all accounts.  Ethical Use of Electronic Health Records…cont… ⮚ Audit Trails ⮚ Organizations are required to have software that tracks each person who accesses information. ⮚ HIPAA (Health Insurance Portability and Accountability Act) Regulations ⮚ Privacy Rule that was mandated in 1996 ⮚ Two important requirements are that health plans and providers must: ⮚ Obtain consent before disclosing health information used for treatment or payment options ⮚ Limit disclosure of information to the minimum necessary to accomplish intended purposes ⮚ HIPAA rules apply fines to organization for each reported breach of personal health information ⮚ HIPAA rules give authority to individual states to monitor compliance with the rules  Using Informatics to Support Evidence-Based Practice (EBP) ⮚ EBP is an approach that blends firm scientific data, clinical judgement and expertise, and patient characteristics and preferences to make decisions about medical and nursing practice. EBP involves: 1. Identifying a clinical question or need for change 2. Searching the literature for best evidence that can change quickly and continuously 3. Evaluating evidence 4. Applying the results to practice ⮚ How do informatics facilitate EBP? ⮚ Affords rapid access to most current health information ⮚ Enables healthcare staff to locate the best evidence supporting nursing practice  Using Informatics to Support Evidence-Based Practice (EBP) cont… ⮚ Nurses need to use computer and hospital informatics available resources to research most current evidence-based practices. ⮚ Computers at the workplace help overcome the barrier to evidence-based practice by providing fast, easy access to current practice information from around the world. ⮚ Nurses often fail to computer search the literature for EBP due to a lack of literature- searching skills. There are several steps nurses can use to conduct a computer search of the literature: ⮚ Identify the information. When you clearly define the topic you want to investigate and how it will be used, it is easier and more efficient to search, locate, evaluate, retrieve, organize, and manage the resources required to answer your question. ⮚ Formulate a precise definition of the problem. This is usually in the form of a question, for example, “What are the leading causes of falls in older adults?” This question guides your search for information. ⮚ Conduct a search of the most recent literature and most relevant studies.  Using Informatics to Support Evidence-Based Practice (EBP) cont… ⮚ Sources of Nursing Research Literature ⮚ Textbooks (ex. E-books, printed books) ⮚ Journal Articles ⮚ The World Wide Web ⮚ Provide the most current information available from professional organizations (ex. American Heart Association), government sources (ex. Centers for Disease Control & Prevention), sites publishing clinical guidelines (ex. National Guideline Clearinghouse), and various online nursing journals (ex. American Journal of Nursing, Online Journal of Issues of Nursing, and Nursing Standard Online) ⮚ Literature Databases (see next slide for examples) ⮚ Review and Read Sources of Nursing Research Literature Section on Pages 1645-1646  How Do I Evaluate Evidence & Determine A Solution??? ⮚ Evaluating the evidence may be as simple as reading a descriptive study and applying the results to the clinical situation ⮚ For example, when searching information about safety measures to prevent falls in the hospital setting. ⮚ At other times, evaluating evidence can be complex, requiring an understanding of statistics and research methodologies. ⮚ Many sites are created by individuals with uncertain credentials or by commercial sources attempting to promote their products or services ⮚ Remember! Although an article you find on the Internet may be current, it is not necessarily complete, accurate, valid, or reliable! ⮚ Review Box 38-3 on page 1647 for suggestions on evaluating materials obtained from an Internet Site.  Question Time!!! Take a few minutes and answer the questions on the next few slides!!! The rationales are included under the slides!!! Don’t forget to email Mrs. Headden if you have questions or concerns about this content!!!! Go Study!!!  Audience Response Question #1 The nurse sits at the unit computer to begin her shift documentation for her client. She notes the previous user of the computer, the physical therapist, did not log off appropriately. The nurse should A. Report the physical therapist to the unit manager. B. Complete the log off for the physical therapist before beginning her documentation. C. Proceed with her documentation because it will be in a different screen. D. Call the physical therapist and have her come back and log off. Audience Response Question #2 Which of the following health information is protected in the electronic health record? (SELECT ALL THAT APPY). A. Social Security Number B. Insurance Information C. Physician’s Name D. Laboratory Results E. Patient’s Gender Audience Response Question #3 The nurse is conducting a literature search. In which instance might the nurse question the reliability of the health information? (SELECT ALL THAT APPLY). A.The author has a DNP degree. B.The article has a list of references. C.The Web address ends in.net. D.The Publication date is 3 years old.  Audience Response Question #4 You are a Facebook friend with a nurse colleague and note that the colleague posted a picture of a client’s wound along with a description of the client’s health history and current problems. ▪ Which action should you take? ▪ What are the consequences of this posting to the nurse colleague? ▪ What would happen if you “do nothing?” The END!!! Now GO STUDY!!!!