Archive for March, 2009

Medical information on the web

March 16, 2009

In this day and age with computer technology what it is, patients have more and more access to medical information on the web.  Unfortunately, not all the information they access is reliable.  Many patient reference materials state “facts” that are unfounded.  Sometimes the website is sponsored by a vendor with biased information.  At times, the availability of medical information on the internet can help a patient make educated decisions but at other times it can just confuse the issues and sometimes can result in interference in the patient’s medical care.  Part of our patient education needs to be to provide the patient with reliable resources to educate themselves.  One way of doing this is for physician’s websites to have links to reliable medical information. For example, a physician who sees patients with diabetes could include a link to the American Diabetes Association, a well-known, reliable source of diabetes information.  In this way, the patient is still able to access additional information and research about their condition without having to sift through misinformation.

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Roles of the Healthcare Informatics Professional

March 10, 2009

I found the information on the history of health care informatics and future roles of informatics professionals very interesting.

We have become so immersed in technology in such a short time. My husband and I were discussing last evening how when he decided to replace his computer 4 years ago we were keeping the old computer for the sole purpose of using it for games since that was pretty much the only reason I used the computer. He used his only to track his business on a very basic spreadsheet. We have since that time expanded to 2 PC’s, 2 laptops, a notebook and computer access on our cell phones. We use computers daily for business, communication, computation, finances and bill paying and of course computer games.
In reading the history of the evolution of computers it was surprising in many ways. We often forget that computer technology has been used for several decades, crude and massive as those first computers were. Few of the general public was even aware of their existence or use. We have since evolved to smaller, faster and more sophisticated computers. It is rare to talk with people who do not use computers in some capacity in their daily life. My father first began using email at 60 years old and enjoyed using the Internet until his death 6 years later. My mother refused to learn and at 77 years old is still fighting use of computers. She is constantly amazed at how common place the use of computers is in everyday life and does on occasion use them in the grocery store and doctors offices.  Computers are not only used in all aspects of my job but I use them continuously in my daily life. I can no longer imagine a life without them.

I found it interesting in reading these chapters how they talked about the eventual realization of Internet access on cell phones. In the 7 years since this book (Health Care Informatics, An Interdisciplinary Approach, 2002) was published Internet access on cell phones has become common place. As noted in Moore’s law the processing power of the transistor chip doubles every 18 months. Computer technology is advancing at an alarming rate making it difficult at times to keep up with these advances.

Of course all of this advancement has greatly changed to roles of the healthcare informatics professional. I have been at my hospital for 27 years. When I first came to the hospital we had an IS staff of 2, one for hardware and one for software. We now have an IS staff of over 50 with analyst, programmers, hardware implementation and maintenance and software developers as well as integration specialist.  Not only have the number of roles increased but the responsibilities included in each of these roles have greatly expanded.

In reading the information on standards as well as educational changes it is evident how these roles have expanded. The healthcare informatics professional must understand the needs of clinicians, patients and support staff. They must also be aware of the standards affecting all of the aspects of healthcare and keep up to date on these standards. There has been a great shift in the education of all healthcare professionals to incorporate the use of computers in the delivery of healthcare. In working on implementations not only with clinicians but with support staff I am often surprised at the capacity for staff to adapt and learn new systems. Even those who are resistant to change are able to adapt and make these changes.
The role of the healthcare informatics professional is constantly changing. This can be daunting at times however I find it also exciting. We are in the midst of a revolution of change and I enjoy being in the thick of things.

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Lessons Learned: The completion of a new installation

March 10, 2009

It is said that life imitates art. I have found that for me recently life has paralleled my studies. I have recently completed a project that I followed from inception to completion. It has been an interesting journey.

I began this journey in October of 2006. I was new to healthcare informatics and project management having just taken a new position a month earlier. I was asked by the CNO who I report to directly, to coordinate the demos of three companies who were to show us their vital sign solutions for a system that would integrate with our Meditech EMR. This was a bit of a challenge at first as I had not done anything like this in my nursing career; however my family owned several retail stores so I was familiar with salesmen and felt confident in my ability to deal with them.

After having arranged the demonstrations and gone through the process of narrowing it down to 2 vendors we had many discussions between IS and nursing about which vendor we would choose.  The CIO moved ahead and approved purchase from a vendor who would also supply us carts on wheels. After receiving the carts it was found that the vital signs equipment they had shown us in the demo was not what was on the carts. The equipment did not work and there was not a previous interface with Meditech as they had told us.

First lesson, communication is of utmost importance in selecting a vendor and implementing a new system. The CIO had made this decision without the approval of the CNO and had not talked with me about this also. Therefore the system did not meet the needs of the clinical staff though the IS staff felt it was the best choice. This was the second lesson which has been discussed in these chapters of Health Care Informatics, An Interdisciplinary Approach, the need for the healthcare informatics professional to understand the needs of the clinicians.

After more discussion and deliberation another vendor was chosen and we began the task of assessing and deciding how much equipment to buy, getting board approval and going through with the purchasing process.  At this time the CNO officially appointed me as the project manager.

I began setting up the acceptance of the products and working with the implementation team to coordinate not only training of the end users but working with the IS staff on the integration with Meditech. This provides the 3rd lesson which is also discussed in this module of my educational program. Never underestimate how many different entities are involved in a project. Not only were IS and the nursing staff effected but so were the bioengineering, purchasing, physicians, of course patients as well as safety and quality assurance departments.

One of the issues that are discussed in this module is the need to meet standards set by many agencies that the hospital answers to from JCAHO and OSHA to IEEE and AHRQ. It was interesting to see how this project required attention to many of these standards.

We came across many “bumps in the road” on this project. There was a previously unplanned upgrade to Meditech which delayed implementation. There then was a problem with Meditech not accepting messages from the PDA’s used to download vitals into the Meditech module which required a “special build” from Meditech. There were wireless assessments, training to both the IS and the bioengineering staff for support and maintenance of the system. There were builds needed both in Meditech and in the software on the PDA’s for the integration and then there was the issue of a lost shipment of PDA’s.
 At times I doubted the project would ever come to fruition. However, with much communication, organization and attention to detail we were able to complete implementation of the project with the final go live on March 4th. We are live on 5 inpatient units and are now looking to expand this to the outpatient arena. The staff loves the new processes and feels it has improved safety with positive patient ID and real time documentation of the vital signs. The team worked together, IS, bioengineering, and nursing as well as the other involved entities as well as the implementation team from our vendor, making the actual go live was a very smooth and positive process for all involved.

The final lessons learned, timing is everything, expect the unexpected, communication is essential and there are no small projects!

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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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Computer Assisted Communication

March 8, 2009

Computer assisted Communication. Communication is the process of sending and receiving information by a variety of means. Email is a common form of communication used in the health care systems. It can be sent to one person or a group of people. The person types a message, and instead of printing the message and sending it via the postal system, the sender click a send button on the email program and the mail arrives at its destinations within seconds. Internet conferencing is another method of communication for the health care systems. This happens when one of more persons interact in real time, receiving almost immediate replies depending on the speed of the connections. This can involve text, audio and or video. There is a leader who sets up the conference and sends out invites for others to join. This can be used as a meeting to vehicle to get people from around the work together in on forum to discuss the same topic together in real time. Video Conferencing involves a computer video camera microphone and speakers. Along with hearing the audio whatever images appear in front of the video camera are delivered to the participants monitor. Video conferencing can involve just 2 participants or multiple participants in conferences. My facility uses video conferencing to link the two hospitals for management meeting or to deliver other important information to the staff from our 2 hospitals simultaneously. We also use video conferencing for in-service training; getting expert speakers from different countries to do talks related to their fields in health-care the doctors, nurses, and other hospital staff. In computer assisted communication both the receiver and the sender of the message must have the appropriate hardware, software and connection to the network in order to communicate. Hospitals are networked. The network consists of the computers and related devices that are connected together for the purpose of sharing devices, programs, and data. There is the main Server, which runs user and computer software programs, stores data and controls network traffic. The Internet links the computer network using Transmission Control Protocol/Internet Protocol communication standards.


The discipline of nursing informatics

March 8, 2009

RE: Health Care Informatics An Interdisciplinary Approach, 2002 by Sheila Englebardt and Ramona Nelson


In reading Part One, The Foundations of Healthcare Informatics I was struck by how amazing the interaction of the systems actually are in the process of informatics. The sum of the parts to become the whole is deceiving on the surface when you are looking at an information system such as the EMR. Our hospital uses Meditech Magic for the majority of our medical patients. In looking at the EMR of a patient on the Meditech system it at first seems like a very simple record of the patient’s care. However, when you break it down and realize what has gone into making this record it is incredible that it happened at all. Not only are there several modules involved in building this seemingly simple record but when you look at the queries for each module and the process of data gathering that comes together to form this record it is truly amazing. I help build the dictionaries for the nursing and physician modules. I am very aware of how involved it is to build a simple assessment in these modules. You must first build the dictionary and the interventions. Then you have to build the queries and the group responses and bring these together in your customer-defined screen. This, in itself, is a complex process. However, reading these chapters reminded me of everything else that is involved in the actual completion of these assessments. There are auto responses that are pulled from the admissions module. I did not define these and yet I expect, or maybe a better term is, take for granted, that these responses will be available for my assessment. The complexity of these systems also made me appreciate how difficult implementation of these systems can be. I found the information on learning styles and adult learning very informative. I have done 2 implementations since I started this position 2 years ago. I have assisted on 2 other implementations as well. As a nurse, my largest role in go live is to teach and support the end users. I will in my next implementation be aware of these learning styles. One of the suggestions I liked was to highlight important details in my education manuals so that the student will not have to write it and be more attentive to the information they are hearing. My hope for the next lesson is some assistance on how to engage clinicians in accepting and using clinical decision support systems. The last chapter acknowledged clinicians could see these systems as a threat. Hopefully the next lesson will give tips on how to lessen this threat and allow the clinicians to see this as a useful tool.

Computers and Patient Education

March 8, 2009

Computers have become an amazing resource for patient teaching.  They provide wonderful resources for printed patient education as well as become a source of learning for the patients themselves.  When we can reach our patients in more than one aspect of learning we increase the amount of teaching that they will retain. 

Many hospitals and doctors offices subscribe to patient education programs.  This allows the nurse to provide exactly what the patient needs to know regarding their diagnosis.  The advantage to these types of programs is that they are from professionals who ensure correct patient information.  Getting patient information randomly off the Internet can result in unreliable information.  These programs are also updated so the healthcare professional can ensure the patient is getting the latest information.

Patients can also access electronic learning.  This can include learning from videos or DVDs or listening to a podcast.  Not all patients are proficient with these technologies while others prefer to learn this way.  Patients can also receive e-mails from their healthcare providers and access patient support groups through blogs and chat rooms.

Limiting our patient education to printed material only is limiting the many ways our patients can learn.  A careful assessment of patient learning needs, access and knowledge of technology and preferred methods of learning can enhance the patient’s learning experience.

Word-Processing in Health Care

March 6, 2009

Word-Processing in Health Care. The use of the computer to create, edit, format and print text is word-processing. When using the computer to create documents you should save the information on a regular basis to prevent accidental loss of valuable information, and frustration at having to try and recreate that lost info. (As I’m know to have to done on occasions to numerous to mention). Some of the nice features in word processing is the spell check feature, but you have to be care full when using it, because the word maybe spelt correctly, but is not the correct word for that part of the document. So Proof reading is essential when creating documents. There are 2 ways to prepare the formatting for a document. One is to prepare the format first. The other is to type the text and format the document after. Creating merged documents is a nice way of creating personalized form letters for individual persons. Word can print a personalized copy for each person on that merged list. This saves time and having to type or write in individual names separately. It will also merge the name with a personalized envelope when the information is entered in the correct data source fields. Presentation graphics software programs are growing fast. Microsoft PowerPoint is one of the most common used. PowerPoint provides the user the ability to design, create and edit presentations; to create a professional looking presentation. These presentations can be presented to the target audience in a number of ways, as a slide show, as transparencies using computer screens, as a web page, as handouts or notes or even a work book. These presentation and be simple or very involved using animation. Word processing packages include a wide variety of fonts, and can create documents with limited graphics that can be used for presentation purposes. Spreadsheets can be very helpful with tracking inventory such as medical and stationery supplies, and equipment. This will give an indication on the usage and ordering habits of the different areas. This can also show the most popular or least used products and adjustment can be made to the stock supply and bulk ordering from suppliers. Spreadsheet can be used to make things such as budgeting, and task involving numeric calculations easier and more accurate. Word processing is used in the healthcare in online documentation. Patient clinical information and progress notes is typed and entered into the computer. A chart can be made from data collected on a patient’s weight to show his/her weight gain/loss activity over a period of time. Staff can use word-processing for patient/client summaries. These summary documents can be in the form of a power point presentation. Showing improvement or decline in the patient physical and or mental health using information collected, collated and evaluated in a slide and or handout presentation.

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Would it be helpful for nurses to have actual X-rays on the computer?

March 6, 2009

Currently physicians can pull up the actual x rays and ct scans on the computer but nurses can only pull up the report. Now I agree not all nurses can read X rays but in the ER, ICU and Recovery Room seasoned nurses can read basic films (chest x ray, bones for fractures, etc). I was taught this skill when I first trained in critical care. As a nurse I always appreciate the ability to look at a film and be able to see if my patient has fractured ribs, which would prepare me to understand the complications for this type of fracture. Or to see a pneumo following central line placement and have a chest tube set up at the bedside when the physician arrives. In the ER I can set up for a closed reduction if I have access to the films. Most of the time a nurse has more time to keep checking for results than do physicians. Additionally, printed reports are, in most cases, not downloaded into the computer system until long after the patient receives treatment. I am an advocate for electronic documentation and medical records however nursing education and the level of knowledge we have these days is under estimated. Yes, the radiologist reads the results and the physician orders the treatment but most nurses can anticipate what the treatment will be which in turn decreases both patient and physician wait time and decreases the risks associated with those wait times.

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Access to Healthcare Information From the Internet

March 6, 2009

If one of the goals of Health Informatics is to get information to the end user, than the Internet has to be the single most influential factor of the past decade. Most Americans now have easy access to the Internet. If not from a home based computer, many public agencies such as community libraries provide free computer and Internet access. With the exception of our very young and older citizens, most people in our country have basic computer skills awareness and can obtain information either directly or with minimal assistance. Internet based health information is extensive and includes topics such as basic first aid, illness prevention, health promotion, nutrition and specific information about most medical procedures. Physicians and other healthcare providers must now be willing to discuss what their patients have read in journals or on the Internet as well as what they see and hear on public broadcasts such as radio and television. This notion still does not bode well with some of the older physicians that I know. Yet, most of us have become well accustomed to such discussions and find them to be beneficial for both the patient and the healthcare professional. I frequently search the Internet regarding management of health issues for my family. Most recently, I searched the Centers for Disease Control (CDC) web site for the Community Associated Methicillin Resistant Staph Aureus (CA-MRSA) treatment algorithm. I emailed it for my sister to take to her physician who was treating her for shingles. Though resistant to do so, the physician did culture the lesion which ultimately came back with CA-MRSA and her treatment was changed. With the healthcare system being overburdened as it is today, we will all have to take more responsibility to research and educate ourselves regarding aspects of our own health. This is not a bad thing. Information can be empowering and promote positive change in healthy behavior. The Internet can also provide a source of networking and support for many chronic conditions. I personally use the Weight Watchers Internet site for assistance with healthy eating and weight management and find it very helpful. In the future, I am certain we will see more interactive health information functions such as remotely accessed physician visits. It will be exciting to witness the evolution of healthcare in relation to informatics and technology in the upcoming years.

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