Archive for the ‘Standardization’ Category

Progress, Change, Future

January 22, 2012

The future of healthcare information systems and a career in healthcare informatics holds exciting opportunities for healthcare organizations. Many improvements will be made in current technologies available. Although the concept of the electronic medical record (EMR) has been around for quite some time, we are just starting to see some advances in the actual implementation of automating portions of the patient medical record. To get to a fully automated health record, where all aspects of the legal medical record communicate to all systems, seems like a daunting task and yet so exciting to be a part of during these times. A career as a healthcare informatics professional will continue to be a desired profession and will gain momentum in the value these professionals will bring to an organization. Identifying their roles and responsibilities will become unique to each organization’s needs. Because of the many abilities and knowledge of healthcare informatics professionals, one healthcare facility may utilize these professionals in a different way and environment than another facility. Perhaps if there is not a developed informatics department, these professionals may even have different reporting structures based on where the organization sees them contributing and fitting into the organizational chart for that particular facility. The healthcare informatics field of study will be fundamental to bridging the gap between Information Technology Departments, Administration, clinical staff, physicians, vendors, and end-users. These positions are knowledgeable in a vast amount of areas, such as: information literacy, human computer interaction, human factors, usability testing, project management, working as change agents, standardizing language, evidence-based healthcare, numerous types of computer software such as database systems and spreadsheets. One cannot argue the fact that these knowledgeable individuals have developed skills, which bring much value to an organization. If these positions are utilized, directed, and supported, they will be extremely beneficial within a healthcare facility. Implementing, supporting, and maintaining an EMR is progress for any organization. The power of progress is amazing and builds upon each generation’s knowledge. Suppose each new generation had to rediscover numerals or language or medicine. The world would see no progress. Each generation stands on the shoulders of the previous generation to reach higher. Therefore, change is the price we pay for progress, and the EMR will bring about change for healthcare organizations. Change itself is not progress; it is the price we pay for progress. We will see some of the most advanced technology and the quest for a fully developed electronic health record will begin to take hold. As generations replace older generations an environment of automation will be expected and accepted by healthcare consumers and healthcare providers.

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Standardized Language in Healthcare

November 18, 2011

As the electronic health record (EHR) becomes increasingly utilized across the nation, a standardized language will need to be implemented and followed. This will improve more accurate billing, informed patient management, increased precision of documentation, and improve knowledge. Functioning without standards would be chaotic, out of control, and confusing to all individuals. Standardization proves to enhance any process. With the strategic organizational initiatives of many physician offices, clinics, medical centers, and hospitals to implement an automated electronic environment for documenting a patient’s health history, which then automate other processes, the need increases for the uniformity of a language. The downside of the uncontrolled terminology of medicine has been accentuated by the computer age, because without standard vocabulary the ability to acquire knowledge about healing professions through information technology is limited. Many clinical applications available today have restricted utility because they cannot understand each other. It seems with the urgency of healthcare facilities implementing EMRs, the development of a standard language is critical and needs to be on a fast track to develop solutions. Healthcare information system developers are not waiting for the standards bodies, in existence today, to make these determinations. These developers know that precise medical words are needed to analyze the information from automated medical records, which will improve quality and service in healthcare. Rather than use any existing clinical vocabulary standard, they are creating their own dictionaries or vocabulary sets. Although this represents a slight improvement over un-encoded or free text documentation, each vendor working in isolation, are creating a terminology which cannot be read or understood by other systems. This makes the potential of data exchange and comparing impossible. It is imperative that healthcare organizations, vendors, and government agencies work collaboratively to implement measures to effectively localize, update, and disseminate healthcare terminologies, mappings, and other terminology-related content currently issued by national and international standards bodies. A standardized language in healthcare is something of a monumental task, but one that needs dedicated professionals in establishing these standards. Although some standard languages exist, developed by various standards organizations, the need is paramount of unifying a standardized language. Controlled medical terminology is essential to maximize the true benefits of implementing a fully operational EMR. Additionally, if all physicians, nurses, patients, hospitals, clinics, payers, and government agencies would commit to the same healthcare language, the one who unquestionably benefits from this is the patient who can be any one of us.

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Reduce our national debt by reducing the federal electronic medical records mandate, comment

July 21, 2011

Your post Reduce our national debt by reducing the federal electronic medical records mandate is right on target. The federal government and President Obama should not be mandating electronic medical records in the way they propose. The medical/nursing community and hospitals know what is best for themselves and their budgets.

I will add that hospitals should pull the reigns on electronic medical records. What I see is fierce competition between hospitals to draw patients. This competition occurred with CAT scans, MRIs, helicopter ports, etc. Just because one hospital in town has the latest item, does not mean the other hospitals in town should follow suit. Sure, time and saving lives are critical things to consider. The money spent could be used in providing some basic and needed items for rural hospitals. This includes providing the personnel needed for some of the rural hospitals. Our rural hospitals have a greater need than our city hospitals.

Original Post
July 11, 2011

Reduce our national debt by reducing the federal electronic medical records mandate

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Reduce our national debt by reducing the federal electronic medical records mandate

July 11, 2011

I agree that electronic medical records (EMR) that help to save lives, reduce paperwork, reduce expenses, and secure healthcare information. Larger vehicles like SUVs can also save lives and secure passengers. But, this does not mean that every family or business needs to trade in their fuel efficient smaller cars for larger SUVs. This is more true when these families and businesses are struggling during this economic recession (or depression).

Our government can save money by not currently dealing with the EMR mandate, by not tying up our court system with this mandate and letting our hospitals spend this money within their communities (meaning the government does not have to put extra money into these communities).

President Obama, this is one way of reducing your stress, the legislators’ stress, the courts’ stress, and the stress of the American people. Relieve our nation of the current EMR mandate. Consider a revised and later mandate.

Thank you.

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The Need for Standardization. Is it necessary?

October 19, 2009

I have had the opportunity to listen to Steve Shaha twice now in my career. He is able to place standards of care in a completely different perspective. He uses charts and slides and math and statistics. He makes his information usable and understandable. He assists hospitals with the information that he gleans from charts and is able to make correlations. He was able to work with a NICU out west and decrease there infant mortality by 75% in one year after discovering through patient chart reviews and collection of data that there was a cycle associated with the mortality rate at this institution. The cycle, he found, happened to correlate with feeding, and his discovery led to a change in how lipids were administered. This small change in care brought about the 75% decrease in mortality. Steve is also able to put his numbers into useful categories for us non-math people. The change that was instituted at this facility saved the lives of 21 premature infants in one year. Numbers of a different kind for me. His work has brought care standards to the forefront to people who will listen. Hopefully the right people are listening.

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Indicators, comment

September 14, 2009

I just finished reading a post on Monitoring of indicators, our facility received accreditation on the first round as well and I was shocked! The amount of work and prep that lead up to the survey was overwhelming and added to our already great time constraints. Not only were we trying to run our departments but now the added stress of putting together information and evidence  binders was astronomical. However I learned so much from the process and how valuable indicators were for improved patient outcomes I have added, modified or implemented new programs and made changes to the way I run my department. I even won a recognition award for Quality Insurance this past year.

Original Post
September 2, 2009
Title: Monitoring indicators
My current place of employment gained full accreditation in 2007; it was our first attempt. I understand it is rare to get full accreditation the first time. I did not realize how important the monitoring of health indicators and tracking progress was at that time. We (the staff) only saw it as time consuming; and is it really necessary to the outcomes of our patients? Tracking of data allows us to monitor our progress of goal achievement and the ability to improve programs to meet the needs of our patients. As a result we have added new programs based on the needs and requests of our patients. It has also enabled us to acquire more funding to increase staff. I guess what I am really trying to say, healthcare tracking, indicators and data collection provide much needed information to improve services, allocation of funds etc… It’s interesting how my views of unnecessary and time consuming work have changed.

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Monitoring indicators

September 2, 2009

My current place of employment gained full accreditation in 2007; it was our first attempt. I understand it is rare to get full accreditation the first time. I did not realize how important the monitoring of health indicators and tracking progress was at that time. We (the staff) only saw it as time consuming; and is it really necessary to the outcomes of our patients? Tracking of data allows us to monitor our progress of goal achievement and the ability to improve programs to meet the needs of our patients. As a result we have added new programs based on the needs and requests of our patients. It has also enabled us to acquire more funding to increase staff. I guess what I am really trying to say, healthcare tracking, indicators and data collection provide much needed information to improve services, allocation of funds etc… It’s interesting how my views of unnecessary and time consuming work have changed.

Online Health Care Informatics Certificate Program

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National electronic health record

June 26, 2009

In 2004, President George W. Bush charged the medical community to develop a National electronic health record.

“By computerizing health records, we can avoid dangerous medical mistakes, reduce costs and improve care.”

The purpose of the EHR is to share pertinent patient information among healthcare providers and healthcare institutions. Sharing the information will save the patient money, increase patient safety, and improve the quality of care. The difficulty with this initiative is the variety of applications utilized to create and store the data.

As the need and ability to collect data has increased, so has the need to share the information, thus the development of technical health care standards. However, the lack of healthcare informatics standards to ensure the smooth transfer of data between systems is a major barrier to the national EHR initiative.

Another complicated area to deal with is the protection of patient information. Policies and Procedures are usually written at Healthcare Institutions that address patient confidentiality, electronic data access, integrity of electronic documentation, etc. Screen savers, privacy screens and short logout times are tools utilized on computers that are viewable by casual observers. Limiting access to the system based on job function is also used to secure patient data. The Health Insurance Portability and Accountability Act of 1996 mandates standards for developing unique patient identifiers that will provide privacy, security, and immaculate data transfer in order to link patient records.

The smooth joining of all this data is difficult to achieve. Institutions are currently challenged with trying to interface the different applications utilized in one hospital. It gets even more difficult when interfacing an entire Health System, let alone an entire nation of applications, patient identifiers unique, provider identifiers, etc.

In addition to the national EHR, hospitals continue to launch new applications to be used to support the care delivery. Over the years I have noted a lack of understanding regarding electronic signature, electronic documentation, access to patient records, etc. by nursing staff at all levels. The increase in electronic records has made information much more accessible to staff members but can also be deemed as too accessible if the staff members are not oriented to the confidentiality issues as they relate to electronic medical record access.

There is limited to no assessment of staff and their informatics knowledge on hire to healthcare organizations. Currently, the American Nurses Informatics Association is supporting a national initiative, Technology Informatics Guiding Education Reform (TIGER) aimed with writing competencies for nurses and nursing students to support the use of technology seamlessly in the delivery of safe and effective patient care. These competencies will incorporate theories, tools, and fundamentals of nursing informatics.

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The need for Standardization. Is it neccesary? (comment)

April 20, 2009

I agree that there should be “Standards of Care” to guide the healthcare providers, but patients are not textbook. We must be able to take these standards and mold them to our individual patients to ensure they are receiving the appropriate care. I haven’t worked in the hospital for many years, but I remember having to correlate the care of my patient with 4 or 5 other ancillary services. It was difficult because each area thought their treatment was more important than the other. I felt this really harmed the patient instead of helping them. We, as providers, spent more time arguing why our procedure or treatment was better for the patient than actually treating the patient. Patient care should be based on the patient and their needs not a standard of care so to speak. When you are treating a diabetic the standard for treatment is basically the same. Diet and medication. But what one patient takes for medication may not work on another. It seems that alot of physicians get into a standard mode and start all patients on the same medication then they change it accordingly. My husband is diabetic and this is the way his physician first started. We felt he didn’t listen to us with regard to symptoms nor did we feel he looked at the test results. The first medication didn’t work. When we went back to discuss this the comment was “we start all 1st time (?) diabetics on this medication and then change accordingly” What does this mean? So, we went home and we changed his medication and he has done wonderfully. We looked at his particular case and not the overall case of a diabetic. Basically, we should have a standard of care that we hold providers to, but we shouldn’t treat all patients the same. We should treat our patients not their disease. However, because you do have physicians out there who can’t seem to work within common sense guidelines there have to be protocols in place so we can say “You didn’t perform within the standard of care. You failed your patient.”

Original Post:
March 9, 2009
It is interesting in beginning to study this module within Dr. Johnson’s course the mixed feelings on the need for standardization in health care informatics. I have watched with only a fleeting interest the continual exchanges about this topic on the CARING list serve. It did not seem an important issue to me however in reading the information in this module I have begun to develop a different attitude regarding these issues.
It is a bit mind boggling when one looks at all of the disciplines involved in healthcare and how they enter into the process of healthcare informatics. This collaboration does muddy the waters in effect when looking at standards.
An example was given early on in the readings of the standard gauge for railroads as 4feet 8.5 inches, which was the standard width of the Roman chariot. It is easy to see how the standard was created out of an early necessity for the railroad rails to fit the rail cars, which were built at the same width as a chariot.
In looking at setting standards for healthcare informatics the process is complicated by the number of players on the field so to speak. You have standards for physicians, nurses, respiratory therapists, pharmacist and many more clinical disciplines. You then add into the mix the standards for the support staff such as health information staff, bioengineering, housekeeping, buildings and grounds, electricians, purchasing, information systems and communication services. Each of these disciplines has not only their own standards but also standards for the products they use or install as a part of their job in assisting directly or indirectly with patient care.
The health care informatics professional interacts with all of these disciplines in some capacity in order to provide computer technology to improve the delivery of patient care. When one considers the chaordic nature of this process it is easy to see that standards must be developed to attempt to communicate effectively with all disciplines involved as well as with outside entities nationally and internationally especially in the advent of electronic medical records. It is also easy to see what a difficult task this is in trying to bring together all of the existing standards to one unified standard for healthcare informatics.

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The Need for Standardization. Is it necessary?

March 9, 2009

It is interesting in beginning to study this module within Dr. Johnson’s course the mixed feelings on the need for standardization in health care informatics. I have watched with only a fleeting interest the continual exchanges about this topic on the CARING list serve. It did not seem an important issue to me however in reading the information in this module I have begun to develop a different attitude regarding these issues.
It is a bit mind boggling when one looks at all of the disciplines involved in healthcare and how they enter into the process of healthcare informatics. This collaboration does muddy the waters in effect when looking at standards.
An example was given early on in the readings of the standard gauge for railroads as 4feet 8.5 inches, which was the standard width of the Roman chariot. It is easy to see how the standard was created out of an early necessity for the railroad rails to fit the rail cars, which were built at the same width as a chariot.
In looking at setting standards for healthcare informatics the process is complicated by the number of players on the field so to speak. You have standards for physicians, nurses, respiratory therapists, pharmacist and many more clinical disciplines. You then add into the mix the standards for the support staff such as health information staff, bioengineering, housekeeping, buildings and grounds, electricians, purchasing, information systems and communication services. Each of these disciplines has not only their own standards but also standards for the products they use or install as a part of their job in assisting directly or indirectly with patient care.
The health care informatics professional interacts with all of these disciplines in some capacity in order to provide computer technology to improve the delivery of patient care. When one considers the chaordic nature of this process it is easy to see that standards must be developed to attempt to communicate effectively with all disciplines involved as well as with outside entities nationally and internationally especially in the advent of electronic medical records. It is also easy to see what a difficult task this is in trying to bring together all of the existing standards to one unified standard for healthcare informatics.

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