Archive for May, 2009

The Impact of Informatics on the Sociocultural Environment of Health Care

May 29, 2009

This review pertains to Dr. Johnson’s Healthcare Informatics Program, Module Three, Unit One.

Organization theory and organizational behavior need to be incorporated concurrently when designing and implementing information systems. Organization theory has its focus on an entire ministry whereas organizational behavior focuses on end users. Interestingly enough, sometimes the ongoing improvements, updates, and implementations are more focused on the end goal and do not take into account the impact on the end user. This behavior is demonstrated in the timing of downtimes, the lack of ongoing education, and the lack of involvement of end users into the choice of the tools they will be expected to use.

Without the input of the end users, their can be conflict related to human factors, which is the relationship between humans, technology, and their environment. End user workflow needs to be studied, ergonomics addressed in relationship to the defined work flow and the technology used, and usability of the information systems and its related applications.

The axioms of usability have “stood the test of time”. It is a shame that these axioms are not always used. How do you understand the end users in depth if you do not speak with them, listen to their concerns, watch them in practice, or involve them in the choices and development of the end product? It is interesting to speak with non-clinical IS staff at my workplace. I have identified a lack of understanding of the impact the technology has on the clinical staff.

The concept of computer-supported cooperative work shifts the focus from an individual user to groups. This is important in the healthcare setting since work is done by teams of people, not just an individual.

This week was the first meeting of our Nursing Research Council. This is very exciting for the nursing staff and for increasing the nurses’ time and use of the PCs. The Research Council was established in order to support evidenced-based practices. CINAHL and MEDLINE are a couple of the databases that we will be using in order to locate research articles. The Internet has made a huge impact in the ability to share research results.

On the other side of this, is the ability to conduct research using the Internet; it is less expensive, there is greater access to subjects, and data collection is faster. The reliability and validity of the results are impacted by the population bias (internet users); the responders may answer multiple times, give misinformation, or ignore the criteria for participation. In any event, the ability to apply for grants, conduct research and share the results utilizing the Internet will continue to evolve over time.

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Brain Physiology

May 28, 2009

Chapter 1 of Montague: Physiology for Nursing Practice, 3rd Edition was a great review of cell structure and function as well as a basic review of the human body. In my day to day practice which is a critical care level post anesthesia care unit we utilize the computer for everything, medication administration, charting, diagnostic study results as well as communicating with our anesthesiologists for stat orders and updates on patient conditions. I noticed that I integrated the information in Chapter one when reviewing diagnostic data (i.e., labs, ABG’s, Chest X Rays etc). I was more cognizant of how the amounts of fluid given during the operative period impacts healing and recovery. I thought longer about the patient’s pre surgical state of health and where it was in comparison of homeostasis. I am a very visual learner and online learning allows me to quickly research different aspects of topics I am studying and find sites that put my topic in a visual format. For example, there is a site for kids called BrainPOP.com that, while it is for kids (through high school) it presents, for example, cell division so that I can see it step by step. There are several other sites I will also utilize for this course taught by Dr. Johnson. I don’t think a nurse can practice in a healthcare setting today without utilizing computer/electronic data systems.

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Patient education, computers, Internet

May 27, 2009

The Internet has made access to medical knowledge much easier for everyone to obtain. At one time the information was only available through books, available at the Dr.’s office, hospital library, or medical library. The information is now available to patients as well as anyone who wants to find more information on a medical subject.
At the click of the mouse, a nurse can find out if 2 medications are compatible in IV form. Before she would have to look it up in an IV handbook, if one was available, or call the pharmacy.
I find that some patients are more informed about their own health, and can participate in their own healthcare, especially when multiple disciplines are concerned. Patients can also look on the Internet and see if there are any natural treatments to assist in their care and then discuss them with their physician. When you pick up an RX, there is printed information about the drug with it.
The Internet has made it possible for many to obtain medical information to either help them as a patient or health care provider.

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Data, Information and Knowledge

May 26, 2009

Data, Information and Knowledge Data is a collection of facts from which conclusions can be drawn. Data is discrete entities objectively described, without interpretation or context. Raw data by itself means nothing. Information is data processed into a structured form. Data that are interpreted, organized, structured, and given meaning are referred to as information. To be useful, information must be the right information. It must be accurate, free from error, and meaningful. Information must be given to the right person – the person that will respond to it. Information must be given in a timely manner, at the correct time, not so late that it will be useless or detrimental to a treatment plan. Information must be delivered to the to the right place, a consult with a social worker is of no use if filed in the patients notes. Information must be given in the right amount. No one, (especially me), wants to wade through tons of paper for one piece if information. Knowledge is synthesized information derived from the interpretation of data, and it provides a logical basis for decision-making. Knowledge creates new questions and areas of research. To answer the questions, data are required that must be processes into information to create more knowledge. The purpose of this process is to provide the most up-to-date information to make decisions that guide practice.

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The use of computer aided equipment in the recovery room, comment

May 26, 2009

This seems like such an odd thing to me. To
have paid professionals (nurses) trained specifically in physical
assessment, in a sense deemed unable to perform what they are paid to
do. I understand the need for there to be accountability and to ensure
that patients are consistently safe as there will be some nurses who
may not be strong in their assessment skills. However, I find it rather
surprising that the answer is then to provide another form of
technology to in a sense do the job for them. I feel this is a good
example, as far as I understand the situation to be, of how far we can
take informatics and technology in healthcare, but may be
inappropriate, or at least unnecessary. I feel in this situation, that
we should not use technology to replace a trained professional’s
judgment. If the judgment is inconsistent, then better train those whom
judgment you need (i.e. nurses). It is always better in medicine to use
the acquired skills of a person in matters of judgment as not all
things in medicine are cut and dry. Some take the a sense of well
trained eye instead.

Original Post:
May 17, 2009
Title; The use of computer aided equipment in the recovery room
The hospital where I am currently working utilizes a computer system
that connects to monitors placed on the patient and determines the
level of the patient’s recovery and when they are deemed safe to
release from the recovery room. I call into question the dependence on
this type of equipment and believe that assessing what the patient is
doing physically is a better indicator of when a patient is ready to be
transferred out of the recovery room. The use of Cholinergic
Antagonists such as rocuronium and a Parasympathomimetic such as
Neostigmine as well as the use of Neophenylephrine an Alpha Adrenergic
Agonist all affect the patient’s ability to meet criteria. Chapter two
in Dr. Johnson’s course discusses the importance of a patient’s
underlying illnesses when assessing neurological function. The use of
an Alpha Adrenergic Agonist is going to increase blood pressure. In a
patient with poor lung compliance, recovery from rocuronium may take
longer despite the administration of Neostigmine. I have utilized the
enhanced knowledge I received in reading about Control and Coordination
out of “Physiology for Nursing Practice” in assessing patients. I find
that the computer’s indication that a patient meets discharge criteria
is significantly different than my hands on assessment. It is
concerning to me in this environment of moving patient’s in and out
faster that we are depending more on machines than we are on our senses
and assessments skills.

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Computerized Medication Reconciliation

May 26, 2009

I have recently seen a need for medication reconciliation to be computerized. In my current hospital, the patient’s meds are documented individually on paper at each floor they are admitted to. Problems arise in this system when papers get lost, each floor uses different charting, nurses do not complete the form, etc. In short, the patient ends up either answering the same question regarding their home meds repeatedly, the nurse at each floor must searches for the med list or the family must bring in the home med list more than once to appease the admission paperwork required of each floor and nurse. I see a much easier answer to be to computerize the medication reconciliation forms. The computerized form could then be checked at each floor if needed for completion. We could also solve the problem of incomplete forms through this means. The program could be designed to ensure that the form must be complete, for example, using a symbol such as a red exclamation mark to notify the nurse at each shift if it is not completed. I see this as using informatics to eliminate problems and ensure patient safety in home medication reconciliation.

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Cardiac Care from a Distance

May 25, 2009

There are several patients that live rural and live far from a hospital as well as many elderly that may lack transportation or it is difficult for them to get to the office. There are many patients that would benefit from the Vigilence 2 and the Vigileo monitoring systems. Monitoring a patient from a distance can also help with unnecessary visits to an ER. Sometimes the solution may be as simple such as a medication adjustment, and other times hospitalization may be required. This also can give some piece of mind to the individual as well as preserving their independence.

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“The Purpose, Structure, and Function of Health Care Information Departments”

May 21, 2009

A review of Health Care Informatics – An Interdisciplinary Approach
Englebardt/Nelson – Chapters 6

“The Purpose, Structure, and Function of Health Care Information Departments”
The Health Care System has many administrative departments that require IT services which may include: registration, materials management, general accounting.  In addition, many clinical departments such as, operating room, same day surgery, radiology, pharmacology, and laboratory necessitate assistance from their respective information services.  I found it interesting to read that tension often builds within the organization between the IS department and the respective end user.  I see this more as a lack of accountability from both the clinical manager and information system manger.  In addition, it was stated that most IS staff members believe it the responsibility of the user department staff.  I relished in the solution by integrating a health care informatics specialist to help bridge the technical and clinical worlds.  Likewise, I have located software that I have found imperative for my vocation, but the software has to be “approved” by the IS department.  Eventually the approval comes through and the end user is ultimately responsible.  I see the value of “niche software” because each department should have a valid input of what their needs are and not “corporate” mandates.

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Nursing Physiology; genes

May 21, 2009

I used our health care informatics system through our clinical library of our HMO to find this article published in Oncogene 2004. Authors: Jose Silva, Kenneth Chang, Gregory Hannon, and Fabiola Rivas. It discussed how sequencing of complete genomes has provided researchers with a wealth of information to genome organization, genetic instability, and knowledge about all potentially expressed genes. The identification of genes encoded in the human genome opens doors for gene silencing by using small interfacing RNAs (siRNA) and short hairpin RNA (shRNA). The application of RNA technology around cancer genes and to delineate molecular pathways in which theses genes affect normal and transformed cells will contribute to the knowledge necessary to develop new and also improve existing cancer therapy.

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Healthcare Informatics Education Consulting, comment

May 20, 2009

Yes, our company offers consulting in the subject area of Healthcare Informatics online education. Some of the areas include
1. Starting an online Healthcare Informatics course.
2. Advertising
3. Keeping students active
4. Preparing students for employment

Original Post:
May 18, 2009
Title: Healthcare Informatics Education Consulting
Does your company offer consulting in the area of healthcare informatics education?

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