Nursing Informatics Practice Applications: Care Delivery

Nursing Informatics Practice Applications: Care Delivery  Nursing Informatics Practice Applications: Care Delivery ❑ The Electronic Health Record and Clinical Informatics ❑ Informatics Tools to Promote Patient Safety, Quality Outcomes, and Interdisciplinary Collab...

Nursing Informatics Practice Applications: Care Delivery  Nursing Informatics Practice Applications: Care Delivery ❑ The Electronic Health Record and Clinical Informatics ❑ Informatics Tools to Promote Patient Safety, Quality Outcomes, and Interdisciplinary Collaboration ❑ Using Informatics to Promote Community and Population Health  OBJECTIVES ▪ Describe the common components of an electronic health record. ▪ Assess the benefits of implementing an electronic health record. ▪ Explore the ownership of an electronic health record. ▪ Evaluate the flexibility of the electronic health record in meeting the needs of clinicians and patients. ▪ Examine strategies for developing a safety culture  The Electronic Health Record and Clinical Informatics ❑ Electronic Health Records January 2004, the President Bush raised the profile of EHR in his State of the Union address by outlining a plan to ensure that most Americans would have an electronic health record by 2014.  The Electronic Health Record and Clinical Informatics ❑ American Recovery and Reinvestment Act of 2009 (ARRA), including the HITECH Act was reaffirmed by President Obama. To specifically incentivize health organizations and providers to become “meaningful users” of EHRs.  ARRA Requirements ▪ Providers and hospitals must use a certified EHR that meets a set of standard functional definitions to be eligible for the increased reimbursement incentive. ▪ Department of Health and Human Services (DHHS) has granted two organizations the authority to accredit EHRs: 1) The Drummond Group 2) The Certification Commission for Healthcare Information Technology.  ELECTRONIC HEALTH RECORDS Definition ▪ A data warehouse or repository of information regarding the health status of a client, replacing the former paper-based medical record ▪ It is the systematic documentation of a client’s health status and healthcare in a secured digital format meaning that it can be processed, stored, transmitted and accessed by authorized interdisciplinary professionals for the purpose of supporting efficient, high quality healthcare across the client’s healthcare continuum  ADVANTAGES Electronic Health Records Four most common benefits 1) increased delivery of guidelines-based care 2) enhanced capacity to perform surveillance and monitoring for disease conditions 3) reduction in medication errors 4) decreased use of care  OWNERSHIP Electronic Health Records ▪ First step - typically a vendor selection process for a commercially available EHR oEHR certification ensures that a quality product will be selected. ▪ Second step - choose a system based on the organization’s current and predicted needs oThe criteria should include both subjective and objective items that cover topics such as common clinical workflows, decision support, reporting, usability, technical build and maintenance of the system.  OWNERSHIP Electronic Health Records Implementation planning ✓ should occur concurrently with the selection process, particularly the assessment of the scope of the work, initial sequencing of the EHR components to be implemented, and resources required. ▪ End-user adoption of the EHR ▪ Training may be delivered in a variety of media. ▪ Long-term optimization of the EHR.  Flexibility and Expandability An EHR must be flexible and expandable to meet the needs of patients and caregivers in all these settings, despite the challenges. ▪ Financial and patient privacy hurdles must also be overcome to achieve an expansive EHR. ▪ Patient privacy is a pivotal issue to determining how far and how easy it will be to share data across healthcare organizations.  The Future ▪ The future of EHRs is an exciting one for patient and clinician alike. ▪ Benefits may be realized by stand-alone EHRs but the most significant transformation will come as interoperability ▪ There is a wealth of descriptive data available pointing to the benefits of an EHR. ▪ Nursing must stay engaged in this evolution and help shape its direction.  Informatics Tools Informatics Tools to Promote Patient Safety, Quality Outcomes, and Interdisciplinary Collaboration ▪ Nursing professionals have an ethical duty to ensure patient safety. ▪ Increasing demands on professionals in complex and fast paced health care environments ▪ These deviations are more often practiced in the interest of saving time or because the organizational culture is such that risky behaviors are common place. ▪ Occasionally these inappropriate actions or omissions of appropriate actions result in harm or significant risk of harm to patients.  Key features of a safety culture identified by the AHRQ Agency for Healthcare Research and Quality (AHRQ) ▪ Acknowledgment of the high-risk nature of an organization's activities and the determination to achieve consistently safe operations ▪ A blame-free environment where individuals are able to report errors or near misses without fear of reprimand or punishment ▪ Encouragement of collaboration across ranks and disciplines to seek solutions to patient safety problems ▪ Organizational commitment of resources to address safety concerns Key features of a safety culture identified by the AHRQ Failure Modes and Effects Analysis (FMEA) is a systematic, proactive method for evaluating a process to identify where and how it might fail, and to assess the relative impact of different failures in order to identify the parts of the process that are most in need of change” -(IHI, n.d.1 para. 1). This powerful tool can be viewed at http://www.ihi.org/knowledge/Pages/Tools/FailureModesandEffectsAnalysisTool  Strategies for Developing a Safety Culture ▪ Just culture: People are encouraged, even rewarded, for providing essential safety-related information, but clear lines are drawn between human error and at-risk or reckless behaviors. ▪ Reporting culture: People report their errors and near misses. ▪ Learning culture: People are willing and competent to draw the right conclusions from safety information systems and willing to implement major reform when their need is indicated  Just Culture ▪ Blame free environment to encourage error reporting ▪ System or process issues that lead to unsafe behaviors and errors are addressed by changing practices or work-flows processes ▪ Clear message is communicated that reckless behaviors are not tolerated  Just Culture Error Types Three types of behaviors that lead to patient safety compromises: ▪ Human Error unintentional mistakes ✓ perform FMEA to understand error ▪ Risky Behaviors work arounds or cutting corners ✓ examine workflow ✓ educate ▪ Reckless Behavior total disregard for established policies and procedures ✓ Enact zero tolerance policy ✓ disciplinary measures  Human Factors and Systems Engineering Its application to system design improves ✓ease of use ✓system performance and reliability ✓user satisfaction, while reducing operational errors ▪ operator stress ▪ training requirements ▪ user fatigue ▪ product liability (Ebben, Gieras, and Gosbee 2008, p 327).  Human Factors and Systems Engineering “The overall human factors philosophy is that the system should be designed to support the work of people, rather than designing systems to which people must adapt” Publication cautions that issues with information and information chaos contribute to safety incidents because clinicians are overwhelmed with information.  Information Chaos Definition ▪ Information overload too much unnecessary information ▪ Information underload missing or not enough information ▪ Information scatter information located in many different places and difficult to find ▪ Erroneous or conflicting information  Informatics Technologies for Patient Safety ▪Health IT has the “potential to improve patient safety ▪Technology that’s designed to improve patient safety  Informatics Technologies for Patient Safety ▪ Medication errors are the most frequent and visible errors because the medication administration cycle has many poorly designed with processes with several opportunities for human error. Reduces the potential for human errors by: ▪ performing electronic checks ▪ providing alerts to draw attention to potential errors ▪ Tracks performance  Technologies to Support Medication Administration Cycle ▪ Computerized provider order entry (CPOE) is an electronic prescribing system designed to support physicians and nurse practitioners in writing complete and appropriate medication and care orders for patients. ▪ Barcode Medication Administration (BCMA) Systems help to ensure adherence to the five rights of medication administration ▪ Smart Pump Technology are designed for safe administration of high-hazard drugs and reducing adverse drug events during IV medication administration  Technologies to Support Medication Administration Cycle ▪ Clinical Decision Support (CDS) can enhance the medication administration cycle by promoting safety and improving patient outcomes ▪ Applications (apps) or mobile apps are being used by and prescribed for patients. ▪ Radio-frequency identification (RFID) is rapidly gaining a foothold in healthcare technology and may soon be used in the medication administration cycle  Additional Technologies for Patient Safety ▪ EMedonline collects patient medication compliance data by scanning package barcodes or RFID medication tags and using PDA or smart phone technology to send compliance data to the server ▪ Smart Room Technology Smart rooms are also being used in healthcare facilities as a way to better engage patients and families in the hospital experience.  Additional Technologies for Patient Safety ▪ Smart Bed which provide continuous rotation to prevent pressure ulcers, sense when a patient at risk for a fall leaves the bed, and continuously monitor vital signs ▪ Wearable technology technologies provide the ability to wear a small, unobtrusive monitor that collects and transmits physiologic data via a cell phone to a server for clinician review ▪ Robotics technologies are also being increasingly tested for safety and efficiency uses. Robotics has been used in minimally invasive surgery for some time; as with most technologies, there are risks and rewards ▪ Expanded RFID Uses  Technologies for Home Medication Compliance ❑ Patient Monitoring Technologies ▪ Body Area Networks or Patient Area Networks prov ▪ Wireless chip on a disposable band-aid ▪ Blood glucose, blood pH, and blood pressure ▪ wear a small unobtrusive monitor that collects and transmits physiologic data via a cell phone to a server for clinician review ▪ Caps of pill bottles may contain RFID tags ▪ Smart inhalers track asthma medication compliance using a microprocessor that records and stores medication compliance.  Role of the Nurse Informaticist ▪ Ensure that the technology systems are properly configured and maintained. ▪ Routinely monitor and check these systems, the users, are capable of using the systems accurately to avoid errors. ▪ Nurse informaticists must be involved in all stages of the system development life cycle (SDLC) with a focus on safety.  ▪ Surveillance “the collection, analysis and use of data to target public health prevention. It is Using Informatics to Promote the foundation of public health Community and Population Health practice” - CDC (2020) public health surveillance center ▪ Syndromic surveillance systems - use data that are not diagnostic of a disease but might indicate the early stages of an outbreak. Public Health Informatics ▪ Dr. John Snow can be designated as the “father” of public health informatics (PHI) ❖In 1854, he plotted information about cholera deaths and was able to determine that the deaths were clustered around the same water pump in London. ▪ Florence Nightingale should also be recognized as an early public health informaticist. ❖Her recommendations about medical reform and the need for improved sanitary conditions were based on data about morbidity and mortality that she had compiled from her experiences in the Crimea and England  Public Health Informatics ▪ This is focused on the promotion of health and disease prevention in populations and communities. ▪ When applied to public health, informatics can be used to: ― effective monitoring and surveillance ― support improved decision-making ― improve population health ▪ Core functions of public health: ― Assessment ― Policy ― assurance  Community Health Risk Assessment ❑Public Health Risk Assessment Tool (PHRAT) ▪ human health ▪ health care services ▪ inpatient health care infrastructure ▪ community health ▪ public health services ❑The PHRAT also measures preparedness based on a public health agency’s self-assessment of capability for emergency response and healthcare capacity. ❑The results of the assessment are used “to prioritize planning and plan exercises for specific hazards” , such as weather emergencies and outbreaks of infectious diseases. ❑A "threat" is a harmful act such as the deployment of a virus or illegal network penetration. ❑A "risk" is the expectation that a threat may succeed and the potential damage that can occur” (PCMAG, 2007). Four steps ascribed to human health risk assessment 1. Hazard identification examines whether a stressor has the potential to cause harm to humans and/or ecological systems and, if so, under what circumstances. 2. Dose-response assessment examines the numerical relationship between exposure and effects. 3. Exposure assessment examines what is known about the frequency, timing, and levels of contact with a stressor. 4. Risk characterization examines how well the data support conclusions about the nature and extent of the risk from exposure to environmental stressors.  Examples of Risk Assessment Tools ▪ Suicide Prevention Community Assessment Tool (SPRC) ▪ Youth Risk Behavior Surveillance System (YRBSS) ▪ The Behavorial Risk Factor Surveillance System (BRFSS) ▪ National Health and Nutrition Examination Survey (NHANES). Informatics Tools to Support Communication and Dissemination The Revolution in IT Two-Way Communication in Healthcare PH Information Systems Dissemination of Information IT solutions  Informatics Tools to Support Communication & Dissemination ❑Here are examples of some of the innovations reported during the pandemic: ▪ Artificial intelligence tools ▪ Predict outbreak hot spots and resurgence by analyzing HIE and social media data ▪ AI-based chatbots ▪ robots, facial thermal scan cameras, and no-contact infrared sensor systems ▪ Telehealth Reference: Thank you!