Archive for April 20th, 2009

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

April 20, 2009

As a nurse who has worked in various settings,
I believe it would be beneficial for nurses to have access to the
actual film. Most hospitals and some smaller facilities are now able to
place these films online so that the physicians can review them from
anywhere. Agreeably most nurses do not know how to read xrays but some
are able to look at the xray and see a broken rib, a white out or such.
This would be helpful to the nurse to understand the patients problem
and to anticipate treatment. The other part of this is if the nurse has
access and it is in an area where she could show it to the family and
TEACH and INSTRUCT them as to what is wrong with their loved one it may
decrease anxiety and assist with the treatment of that patient. I don’t
believe nurses should be the first one to observe the xray and share it
with others because this would be above their scope of practice.
However, to be able to utilize these tools to learn and teach others
would be a great asset.

Original Post:
April 7, 2009
Digital images, such as X-rays and scans, will be stored on computer –
enabling them to be sent by email or stored in a USB device. This ends
the need to physically transfer X-rays or scans by hand from hospital
department to another. This is extremely important that the diagnosis
could be made faster and so as the treatment. Also, other health
professional could share the same information and of course we need the
patient’s consent.
This will also eventually see patient records
being stored electronically and all GPs making hospital appointments
for their patients from computers in their surgeries.
People in
rural areas will especially benefit because it will save many journeys
to hospital. The digital image will follow the patient wherever they go
and will be able to be recalled whenever and wherever they need to be
accessed by a patient’s healthcare professional. In addition to
patients not having to wait whilst their X-rays are processed and
delivered by hand from one department to another, clinicians will no
longer have to hold X-rays up to a light box in A and E to make a
diagnosis.
There will be improved staff and patient safety due to
reductions in radiation dosages from X-rays and avoiding the use of
hazardous chemicals for film processing.
Apart from that, health
professionals should learn to read the X-rays and scans so this would
be more beneficial to patients through different other therapies.
Although, protection of client’s private details would be another issue
to be considered.

Original Post:
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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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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Protection of Healthcare information, comment

April 20, 2009

Although we now have the magical HIPPA there are still medical facilities that do not follow or maintain this regulation. I realize that it is a benefit and convenience that physicians can now read their patients xrays, lab results, etc on email and by logging into a facility’s system, but how safe is this for the patient. If the physician can do it from his vacation spot, then what is to stop a hacker from doing it and placing it on the web or worse changing your information for his sick pleasure. I called for my personal records to a physician I had seen. I wanted to records sent to me to take for a second opinion. The medical records lady asked me what I wanted them for and when I explained I wanted so I could go elsewhere she stated no problem she would get them out to the address they had on file. I explained that I now had a POB and that I needed it sent to that address. She agreed. I signed nothing. I proved nothing. I was shocked. Having been in nursing for close to 20 yrs even “way back” we had to have a signature before we just sent out people’s information. When I got my records I reviewed them. Funny enough they had me listed on one xray report as a 77yr old wf. I am a 38 wf. The other part of the report was basically accurate, but the medication they had me on was inaccurate and the reason for the test was wrong. When I called the office to complain they laughed. Because of the problems I was having and the potential seriousness of the outcome, my new physician didn’t feel she could trust that report so I have had to pay to repeat the procedure and go through the procedure again. How scary is this? I was able to get my records without proving who I was and I received inaccurate reports. How many times does this happen? Now with the web involved it is even scarier to me. I wonder sometimes if my information is listed online. There are such websites that list individuals autopsy results. Now, most of these are famous people, but how upsetting would it be for you to google a loved one and read all about their autopsy and other medically sensitive information? I feel that we have an obligation to our patients to make sure their medical information is protected. We should treat our patients information as we would want ours treated. As an co-owner of a medical clinic I am very strict on my employees regarding patient confidentialty and I have even fired employees for discussing patients. This is wrong in my opinion. If it is not directly related to the patients care then it shouldn’t be discussed.

Original Post:
April 7, 2009
The differences among privacy, confidentiality and security The terms privacy, confidentiality and security are terms used to describe aspects of access that is the ability to obtain data and information for specific purposes any by specific users. Privacy, the individual’s right to limit the disclosure of personal information. The individual has the right to feel confident and trusting of the organization that their data and information will not be used inappropriately or released without their informed consent. Confidentiality is a condition in which that personal information is shared or released in a controlled manner. When information is released the individual should feel secure in the knowledge that the released information is complete and accurate, and is being released to the appropriate source for the correct reasons. Security refers to measures that organizations implement to protect information and systems, including efforts to ensure the integrity and availability of that information and the information system used to access it. With the ability to transmit information rapidly over the Internet and to large numbers of people, each institution should have policies and procedures in place to protect identifiable data and information, and to prevent inappropriate or accidental access to health care information and data. Some of these policies may meet the requirements of accreditation bodies. Violation of privacy, breaching of confidentiality or a failure to provide adequate security measures for health information can impose severe consequences.

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Medical information on the web, comment

April 20, 2009

Medical information on the web varies from useful to fraudulent. There are so many websites out there that offer inaccurate information to individuals that it is worrisome. How many times do our patients go home and google their medication, diagnosis and treatments? If you have individuals that can not separate real from fiction, this could be dangerous for your patient. My mom is a good example. She has only started using a computer within the last 2 yrs (she is in her 60’s) and she does not understand that the information on the web is placed there by “humans” and that the information is only as good or accurate as the person putting it on there. She lives several states away so we communicate a great deal by email. She sent me an email the other day with a website she found that discusses ADHD (which by daughter has). The information was WAY out there. She was convinced that we needed to look into this and change my daughters diet, clothes (yes clothes), shampoos, etc. It was a very weird site. I emailed her back and explained that this wasn’t a medical sanctioned website and it was some mother out there who was “out there.” This is a good example of how we, as professionals, need to be careful encouraging our patients to go online. If you have a patient who would benefit from more information than you have in your office, make sure that the information is medically sanctioned. Such as the American Academy of Pediatrics, Diabetes Association, etc. If you google weight loss you get information for everything from magical pills to the lapband surgery. If an individual is easily influenced or uneducated, the web could be a very dangerous place. Education is key for maintaining good patient relations. We should educate our patients not just push them towards the almighty internet.

Original Post:
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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