Archive for the ‘Healthcare Informatics Computers’ Category

Human-Computer Interaction (HCI)

April 29, 2013

HCI is the study of interaction between people and computers. Interaction between users and computers occurs at the user interface, which includes both software and hardware. According to the Association for Computer Machinery, HCI is concerned with the design, evaluation, and implementation of interactive computer systems for human use and with the study of major phenomena surrounding them. In the healthcare environment, and specifically implementing and electronic medical record (EMR), it is important to understand HCI to ensure the users and the computers interact successfully. The goals of HCI are to deploy usable, safe, and functional systems. Developers must try to understand how people use technology in order to produce computer systems used by their intended audience, which will improve the collection of accurate data. Consulting with the end users is important in gaining the understanding of their needs. Also, maintaining the involvement of the end user will often result in an increased acceptance of the new process or new system to be used. When evaluating the computer system, identifying the appropriate end user is important. Receiving feedback from someone who will interact with the interface on a daily basis is a good resource. Tasks the users will be performing and how often these tasks will be performed, need to also be defined. Measurements should be established, such as the number of users performing the tasks, the time it takes to complete the tasks, and the number of errors made. Once these evaluation procedures are in place, a system can be designed and tested. After the initial testing, the interface should be analyzed using the same established evaluation criteria. The developers should make changes where necessary as identified from the analysis of the testing, then, repeat the testing and evaluation process until an acceptable user interface is developed. Designing health care information systems utilizing HCI methodologies and usability resources is a critical aspect of increasing patient safety. Well designed computer interfaces and systems allow for correct data entry, understanding the display of information, and assisting with making skillful clinical decisions, which results in reduced errors. Additionally, using HCI concepts ultimately has a positive return on investment to the organization by identifying time needed to complete tasks, time needed to train staff, and the level of support staff involvement. Utilizing these concepts will result in reducing the end users frustration with the system and increases their productivity. Studies prove the benefits and the value of using HCI concepts in developing computer systems. As healthcare organizations implement EMRs, it is imperative to understand the need for human factors in developing computer systems to ensure their systems and their users work together effectively and efficiently.

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Seasonal Allergies

April 22, 2013

I have two children who suffer from seasonal allergies. Their symptoms are similar, usually characterized by rhinitis and frequent sinus infections. These recurrent problems often lead to frequent trips to the doctor’s office. In the past, I’ve been asked by the doctor to keep a hand written account of their symptoms to take back to the office. I believe that if the information could be sent to the doctor electronically, it would be more convenient for the pt, and the doctor could share the information with other clinicians. The data could also be organized to look for any patterns between patients.

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Nursing And The Electronic Invasion

November 15, 2010

I started my medical career as a Care Attendant, then a Licensed Practical Nurse, and finally a Registered Nurse. Over this time I have worked in two different states and seen many changes in the continuing evolution of the nursing profession.

The most recent changes have been primarily within the way we record our care. Over the past few years electronic charting has overtaken more and more aspects of our daily routines, not only do we record each patients vital signs within the electronic record, we record whatever they eat and drink, each use of the ladies and gentleman’s room, and most stressful for nurses, the exact times we medicate. We are given an hour, half our prior and half hour after the scheduled time of a medication to administer it. That doesn’t sound hard to do, but when staffing is short a nurse or a nurse assistant, more is expected to be done by each nurse on the floor. It is not always possible to adhere to this tight timeline, and all the time in the back of your mind you know that each day a printout is generated and sent to each nurse manager showing who was late with their medications, and each floor is sent a monthly record that is hung in the medication room showing each floor within the hospital and the percentage of times medications are administered on time, and when they are late.

We find that our computers on wheels are never more than a fingertip away, and the information that we put within the electronic record is growing with each passing day. It is an electronic strangle hold that has the floor nurse’s attention rather than the patient having the attention.

Patient Education Matters

May 5, 2010

In researching a request by our hospital staff for a new Coumadin video to be used for patient education, I came across and wonderful website.  It is Patient Education Matters and is found at http://patienteducationmatters.blogspot.com/  . This blog spot was developed to assist healthcare professionals in the development, sharing and use of patient education materials.  The format is a biweekly newsletter, to which I will now subscribe, is totally dedicated to matters of patient education.  Patient education topics and resources are featured with each publication with links to education materials.  In this week’s edition Warfarin or Coumadin is featured as a resource.

In the case of Coumadin education, Patient Education Matters have linked to the Agency for Healthcare Research and Quality (AHRQ) where I found many Coumadin resources for patients and families.  “Your Guide to Coumadin/Warfarin Therapy” is a video available in both English and Spanish.  There were other education resources for patients available including a comprehensive patient handout.  These resources can be downloaded at no cost or in the case of the handout ordered as single copies free of cost. 

In addition to Coumadin education, Patient Education Matters has a topic index for a host of patient education topics.  Links are provided to the actual education source.  If the education topic needed is not listed they also have a Google search engine that searches across multiple patient education websites at once. 

Our organization is fortunate to have a video on demand education system for our patients.  However patient education such as is available from Patient Education Matters could be utilized in some of the outlying clinic areas or by patients once discharged to refresh knowledge. 

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Asthma Patient Education

May 5, 2010

In researching the Internet for asthma education, I came across an excellent patient education website located at http://www.asthmacure.com  that I wish to review.  I feel that it serves as a good example of what patient education can be.  A patient would need to have the ability to read and basic computer skills to utilize this education site independently.  Alternately portions of the material such as the movie could be used for children and non reading adults. 

The education begins with an overview of asthma; discussing what it is and the fundamental information one would need to understand the disease.  The next section contains a movie.  The graphics are colorful and the language easy to understand.  The movie would be suitable for children age 8 or older as well as adults.  The movie is a wonderful option for those patients who learn best visually or have limited reading skills.

The third section deals with understanding asthma’s warning signals.  To teach the concepts they use a colorful picture and concepts of a traffic light.

 The green light is described as Congrats! Stable Asthma zone; symptom free with PEFR > 80% of personal best.  There is a link explaining what PEFR is and how to measure it using a peak flow meter if the patient needs this information.

 The yellow light called the “caution zone”, discusses the signals and symptoms of asthma that indicate varying degrees of airway obstruction with a PEFR of 50-80.  The advice is to avoid triggers and to add medicines in effort to come back again in the green zone. 

The red light is the “crisis zone”.  Patients are encouraged not to delay medications and to seek medical care.  They discuss emergency signals that indicate urgent care needs.

The colorful pictures and analogy using a traffic signal, something most can relate to, as well easy to read language catch the learner’s attention while providing very valuable information.  This is an excellent example of patient education, useful to many.

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Dehumanized provider relationships

May 3, 2010

Taking a full head to toe assessment is vital in the care and treatment of patients. Sometimes having someone listen to your problems, make eye contact, touch your hand during conversation, smile, or even make a joke can make patients feel better. I use all of the above when it comes to assessing patients. When providers or nurses are harsh and have poor interpersonal skills, patients sense this. Even if you resolve the patients problems and give them the best medication, the patient will forever remember that healthcare worker as "not nice". When an interaction is formed between the provider and patient that is positive, it may make the patient feel better instantly. Countless times I have cared for an anxious, worried, or even angry patient and was able to turn the situation into a positive one by listening and providing care tailored to each individual patient. What if that interaction is taken away? When a provider enters a patients room and only makes eye contact at the start then directly looks at a laptop for the whole assessment, the interpersonal connection with the patient significantly changes. I would even say there is no connection at all. I have seen this take place at the hospital I currently work at. The younger, more savvy doctor walks in with his cool laptop and begins his interview. Business transactions are sometimes warmer than this technique in the hospital. Then I have seen the older providers grab a seat, cross their legs, lean in and listen to the patients. What a difference it makes! The patients feel special, listened to, and this may even help the provider obtain more information from the patients. Although there are many reasons electronic charting is beneficial, the way of going about obtaining the information is crucial. Maintaining eye contact, smiling, therapeutic touch are all vital during an interview, even when the laptop is the focus of attention.

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Computer based education programs

May 3, 2010

Computer based education for patients is a unique way to try and bridge the gap on health disparities.  Many patients are seen in a diverse population that are not understanding their medical care.  For example, the doctor enters the room quickly bolts out the diagnosis and a prescription for a new medication and leaves the room.  Often I have seen this happen and the patients are left confused.  I have even had a patient say, “I didn’t understand one word the doctor said”.  I inquired why he didn’t ask the doctor to repeat himself or explain in a different manner, but he didn’t have an answer.  Often times, nurses are incorporated in the education of a patient and discharge instructions.

When a patient comes from a different cultural background than the doctor or nurse, it may be more challenging to teach them.  Some cultures have a tremendous amount of respect towards doctors: to not interrupt, argue, say no, or challenge them.  Others simply nod and say yes to everything, come to learn they speak not one word of English.  There are many more challenges when it comes to varying cultures, but to be able to provide education in a language that suits the patient, with a representative from their country on the computer, taking into account their cultural needs would be an excellent tool.  If the patients are not ready to learn in the hospital setting, providing access  to the information online when they are home and feeling better would be another benefit to computer based education.

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Computer-based Patient-education Program

April 12, 2010

Given the enormous financial strains on the health care system, and the time constraints of health care providers institutions are seeking to find innovative and cost effective ways of reducing tasks like patient education.  Leading health care centers, many dealing with cancer patients such as Memorial Sloan-Kettering Cancer Center, have taken the first steps by using computer-based learning tools.  They have documented initial success in implementing an extensive computer-based education program. Their program consists of a CD-ROM education program, an internal interactive intranet site that contains education about cancer, has library resources, and Internet links, etc. for patients to access. 

The advantages are significant and health institutions everywhere are becoming involved with alternate methods of providing and reinforcing patient education.  Obvious advantages include the quality and consistency of the information provided to the patient, the ability to access education and information independently; provide training in the language of the patient, as well cost savings to the institution.  Disadvantages are the readiness and literacy of the learner, and the inability to interact with the patient at the time questions arise. Some would argue that the disadvantages are fewer than we currently experience, given the lack of caregiver time and consistency and quality of information imparted.

There is no doubt that we will continue to move forward with computer assisted patient education in much the same way as we have with our staff development and training.  Our institution is small compared to the major centers utilizing this resource for patient education.  However, we too, have embraced the practice of CD-ROM and computer based education at our Cancer Center.  Though manned by staff trained to educate patients, we have a resource center with CD’s, interactive patient education videos and an entire resource library for the patients to access.  The union of technology and patient education is upon us and, for the most part, appears to be a win-win situation.  Our challenge, moving forward, will be to find ways to reach and capture all patients, regardless of their status.

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Evaluation in Patient Education

April 12, 2010

Chapter 3 of the text, The Practice of Patient Education, A Case Study Approach discusses evaluation in patient education.  The text provides many excellent concepts and tools for the health educator to draw upon when evaluating the effectiveness of the education for the learner.  The importance of evaluating patient education programs cannot be underestimated.  The goals of improving patient outcomes must be evident for education programs to continue exist. 

Certified programs that provide patient education for management of diseases such as diabetes and COPD must collect and document extensive data on an ongoing basis.  The data is used to demonstrate the effectiveness of the program based on the outcomes of the patient over time.  Quality patient data is required for maintaining programs and recertification’s. If the objectives of the program are not met and demonstrated by improved outcomes, the program may not be re-certified.  Certified patient education programs, such as Outpatient Diabetes Education, are often required by Medicare and Insurances in order to be paid for the education.  The incentive for effective teaching is patient outcomes oriented, in part, so that the program can financially sustain itself.

The use of data collection tools and electronic tracking of outcomes is now the standard of practice.  There are many tools available to assist with data collection.  While browsing the intranet I came across the Stanford Patient Education Website, http://patienteducation.stanford.edu/research/.  It contains several patient evaluation tools that, due to a grant, are available for use by interested persons.  Tools for evaluating education regarding diabetes and COPD programs are available in English and in Spanish.  This resource could be very valuable to patient educators who are interested in either validating the tools they currently use or developing others to assess the effectiveness of their patient education.

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Choices that prepared me for my online nursing classes, comment

March 1, 2010

I think the biggest hurdle I’ve encountered with the decision to obtain an online degree, is the time management. I have never been a master of my time to begin with and trying to juggle the children, a full time job and school – amongst the hundreds of other commitments we all have, has been quite a struggle for me. I envisioned putting the children to bed with plenty of free time at night to study on line. I now realize that 1000 at night is not necessarily the optimal time to read and retain learning material. I also wished I had taken in account how stressful it can become when your taking a timed exam and the kids are running in and out of the room while the incoming calls are knocking offline! (yes I live in one of the few areas in New York that still uses dial-up service) If any, an important lesson I have learned throughout this experience is to impart time management unto my children – that it is an essential skill needed not just in healthcare but in life in general.

Original Post
February 1, 2010
Title: Choices that prepared me for my online nursing classes
We all made choices about the types of courses we wanted to take when we were in junior high school and high school. I went to high school long before the age of computers but know one course choice I made in 8th grade prepared me well for this class. No, it wasn’t a science class or a health class but instead it was a typing class. I cannot imagine doing the homework assignments if I couldn’t type fast. Thank you to my parents for encouraging me to take typing, I remember telling them, it was a waste of time and I wouldn’t need it as a nurse. I apologize to them both and thank them for guiding me well.

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