Archive for the ‘Information Systems’ Category

Healthcare Information Systems and Project Management

April 29, 2013

Healthcare information systems refer to any technology that meets the needs of clinical management. These computer applications include databases, spreadsheets, statistical applications, decision support systems, and automated systems for research. These sites show the diversity of applications that are designed to support the delivery of care and are utilized in a variety of settings.

As the technology increases, the complexity of integrating these systems into a usable tool for the end user is extremely challenging. Successful implementation of the product is dependent on support from the application specialists and the implementation team and buy-in from the end users.

Project management is complex and critical in the implementation of an information system. Project management provides the guideline and communication for the project from the initial scope to the evaluation of the implementation and ongoing support. Listed below are some sites to support the project manager. We use Gantt charts to help document a project and its progress through the timeline.

http://www.evolt.org/article/A_Project_Management_Glossary/20/15355/

http://www.allpm.com/index.php

http://www.mindtools.com/pages/article/newPPM_03.htm

http://www.planonthenet.com/screens.html

Healthcare informatics is a developing specialty. For nurses, certification provides validation of a nurse’s knowledge base in their field of specialty. Usually these certifications are identified as initials after the person’s name. These initials can be important in helping to define the abilities of that person. Certifications include:

1. Board Certification in Nursing Informatics by the American Nurses Credentialing Center http://www.nursecredentialing.org/Certification/NurseSpecialties/Informatics

2. HIMSS – Certified Professional in Healthcare Information and Management Systems (CPHIMS) http://himss.org/ASP/certification_cphims.asp

3. Health IT certification – Certified Professional in Health Information Technology (CPHIT) http://www.healthitcertification.com/about.html

In addition to certifications, there are different educational tracks in Healthcare Informatics. Post-degree certificates, Masters, PhD, DNP, and DNSc degrees are available depending on the route that the Informatics professional chooses to take; research, practice leader, etc.

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Lessons Learned: The Completion of a New Installation

March 1, 2010

In August our hospital implemented the e-mar – electronic medication administration record – documentation system. It was decided by the powers to be that a "Big Bang" roll-out would work much more efficiently than trialing the system on one unit first. This decision was made despite the months of "team" meetings where numerous members of lower Leadership expressed their concern and apprehension. Part of the package purchased with the software contract included on-site program developers and support. It was with this promise of guidance and support, that we were urged forward – pressured into meeting our initial launch date. It was said that we were facing a change in "thought process" among the older staff members – we were told that once the product was on the units that "buy in" would be quick – that the system was here to stay and the staff would have no choice but to adapt and accept. It has been and absolute nightmare to say the least. We have literally two nurses assigned to our computerized programming department. Neither one has had actual computer training other than what the emar company has provided. The provided program developers are nonclinical based professionals trying to create in a clinical field. Input from participating departments is often dismissed. Instruction to the staff has been inconsistent with unit based nurse clinicians being forced to teach computer classes with minimal orientation and little to zero resources. Feedback to staff over system errors, challenges and restrictions is inconsistent and varies depending on who is delivering the message. The list could go on for pages and has created dismay and distrust, a sense of failure within the Nursing department. Pharmacy has had an even more difficult struggle – expressing their concern over the timing and method of implementation during a period that their department had several vacant positions, including that of a department director – but we had a deadline to meet after all. In addition we have since discovered that there are several different software systems being utilized throughout the organization, L&D, ASU, Endo, OR, IRU, Dialysis, offsite, Dental and ER – to name a few. Not only do these systems not communicate with each other but they are for the most part not able to effectively incorporate the e-mar system. This has created an environment of half paper half electronic documentation, inconsistent between departments. Errors are being made, system failures and limitations are not being addressed within a timely fashion – if at all. With that said, the e-mar system may be more time efficient, cost effective, and allow for increased patient safety…but without expertly trained program developers, consistent clinical based instructors, adequate and around the clock implementation support staff, consistent and accurate communication between all departments of the organization – including frontline staff, realistic goals and time lines and the ability to make corrective and adaptive changes – the transition for the staff can become difficult, frustrating and unsafe for both patients and healthcare professionals alike.

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Lessons learned:The completion of a new installation, comment

February 22, 2010

The small community hospital where I work is currently coordinating the install of our second electronic charting system. The initial install with the first company was a complete disaster as communication between project managers and management was lacking. It is vital for all departments to communicate in order to best meet the needs of all involved. After training our entire staff, it was discovered that the different departments of the hospital had different goals and needs for their EC and the departments were unable to communicate with each other via the charting system chosen. The entire project was scrapped and a new company chosen that could meet everyone’s needs. It was unfortunate that the time and money was wasted due to each Department manager having separate discussions with the IS department and the IS department not coordinating their discussions amongst everyone. We are two years later, no electronic charting as of yet, still need to train the staff again on the new system, and a lot of money wasted that healthcare just doesn’t have to absorb right now.

Original Post
March 9, 2009
Title: Lessons learned: The completion of a new installation
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!

Online Education Health Care Informatics Certificate Program

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Health care Informatics: data, information, knowledge, and wisdom

January 29, 2010

Health care informatics, as defined by Englebardt and Nelson, 2002, is the study of how health care data, information, knowledge, and wisdom are collected, stored, processed, communicated, and used to support the process of health care delivery to clients, providers, administrators, and organizations involved in health care delivery. There are many variations of this definition, all with ultimately the same meaning. The statement that effectively explains the importance of this field is by Hannah, Ball, and Edwards, 1999, that stated, health care informatics, is truly interdisciplinary. In its truest form it focuses on the care of the patient, not a specific discipline. Therefore, even though there are specific bodies of knowledge for each health care profession, they all interface at the patient. The increasing awareness health care organizations are developing towards the informatics discipline is proving its value. I realize it is an evolving discipline and will continue to progress and grow in correlation with technology and the electronic medical record. Information systems, information technology, information literacy, information management-information is all around us every day. Understanding how to evaluate the information available is critical to deciphering the true unbiased detail of the data. Although there is no control of the validity of data available on the Internet and the fact that there is an abundance of information, doesn’t necessarily mean the information on the subject is valid. Following criteria designed to evaluate information, will help an individual find and use quality information. Some criteria to use: is the source or authority reliable; is the data current; is it organized logically and easy to navigate; is it objective and free of bias; and is the data accurate and error-free. Developing a checklist and a form to assist with data collecting and decision making will serve as tools to enhance the evaluation of on-line material. In this age, information is plentiful. Understanding how to collect and process information is vitally important. One simply must be information literate.

Online Education Health Care Informatics Certificate Program

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Information Technology: A Mandatory Part of Nursing Curriculum

January 29, 2010

I feel that most nursing programs do focus on the bedside care of the patients. As a clinical nursing instructor teaching disease process, nursing assessment, medications, clinical skills and patient education are a priority in our program. Our program has integrated technology however. The students that we have are very techno savvy. They have the ability to text page, while taking notes during lecture and respond to IM. These students will have no problem with the new computer charting that many of us “mature” nurses have. Our program gives the students PDA’s with dictionaries, drug books, and lab manuals loaded on them to use as references. Lectures are placed on Blackboard for students to download and study from. We have the ability to interact with our students online for preclinical assignments. This allows the students and instructors to be at home with family and friends rather than back out in the classroom. Nursing schools don’t necessarily have to teach computer skills as part of the curriculum, but can have the students take a class as a prerequisite. Each hospital has their own system and the types of equipment changes as newer and better one arrive. The new nurses will get the training on the equipment and system that is used by that hospital as part of the orientation process. I believe that we are doing a good job of using some of this technology in my program to help better prepare our students.

Online Education Health Care Informatics Certificate Program

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Information Literacy and Information Systems

January 29, 2010

Information Literacy There is a phenomenal amount of information available to us every day, which is generally not difficult to acquire: although time-consuming in some instances. We now live in an era where information is all around us, available in various forms and from various sources and relatively inexpensive, and, often at no cost. When an issue requires researching one can gain the knowledge from resources such as: text books, journals, local and national newspapers, television, radio, and the never-ending World Wide Web. To be most effective in utilizing these areas of information gathering, it is important to know how to locate, search, obtain, access, and evaluate the information. This allows for an efficient use of resources. I am pleased to learn of the Information Literacy Competency Standards for Higher Education, which provides a framework for assessing the information by a literate individual. Developing information literacy within an individual is critical to their journey throughout their life. I find it extremely beneficial these standards extend the opportunity to articulate its information literacy competencies within K-12 grades, in order for a continuum of expectations to develop for students at all levels. How fabulous it is to see that information literacy is becoming more of a requirement than a nice-to-know subject in many areas. Additionally, I applaud the regulatory agencies for identifying the need for information literacy to be part of their criteria, this proves how valuable information literacy truly is in the world we live in today. Information Systems is yet another fascinating topic to understand the depths of its function. Basically, this is the “heart beat” of many organizations today. Information systems provide information to the users, which will facilitate the work of the organization. Many times it seems as though Information Systems departments drive an organization and until they say “yes,” to a particular project affecting the company’s infrastructure, it doesn’t happen. This tends to be frustrating for most individuals within an organization. However, understanding the needs, analysis, infrastructure, and resources involved is a critical factor in determining the necessity of implementation of a project request. Unfortunately, moving an organization to another level of automation can be very time-consuming and expensive; however, many times the outcomes can improve workflow processes, increase productivity, and improve data integrity. As I learned, the basic information system consists of 4 elements: people, procedures, communication, and data. As I reflected on these elements, I realized it is an awesome way to identify any “information system” whether manual or automated. For an organization to be successful each element plays a vital role in handling information.

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The 6 rights of medication administration, comment

October 26, 2009

Medication administration is going to be a difficult task with all the new and different types of computer documentation systems available. Medication administration will always be the responsibility of many parties, not just nursing. One of the post mentions nurses as the last line of defense, and there are many steps where errors can occur. The physician writes the order, hopefully correctly and legibly. It is then the responsibility of the pharmacy to ensure the medication is available and that it has been profiled against all current medications and allergies. The nurse must need to teach the patient the effects of the meds, the reason for the med and side effects. Last line of defense in an era where too many people rely on computers for correct information, but we must remember that information within the computer is only as good as the people inputting that information. So every one should think of themselves as the last line of defense against med errors. That, and only that, will lead to a decrease in med errors. As long as excess meds are stocked on units and physicians are allowed to write illegibly, and pharmacists don’t verify everything that comes out of the pharmacy, errors will always be there.

Original Post
July 17, 2009
Title: The 6 rights of medication administration, comment
Coming across this post, l recognised the device (scanner) which the writer says her facility uses. On the face value, JAHCO will applaud this device because it acted as if the cases of med errors have been eliminated. Yet as the writer said, it still goes back to knowing your patients and knowing your medications. Nurses are the final check point in the health team providers list. We are in between the ordering physicians and the releasing pharmacists. Nurses have to see that the parameters for which the drug is being administered is not in violation. For instance, nurses know by common sense that once the med is due, the scanner will scan and does not tell if the parameter for using a betablocker is checked for not. It is up to the nurse to make sure that the blood pressure is stable and the heart rate is within normal range. Despite these technologies, we are still required to do our checks before trusting the device.

Original Post:
June 30, 2009
Title: The 6 rights of drug administration
The 6 rights of drug administration did not prevent the cause of death in one particular case. The problem lies with the incorrect labeling of medication. The key is to trace what happened, review for any outlying causes or "what happened" and correct that as soon as possible. While the nurse I am sure will have to live with that the rest of her life, and that’s not easy, I feel that she has comfort in knowing she did not cause this. Many hospitals are using the computerized medical dispenser where you scan the patients ID bracelets then you scan the drug that is being administered which is on a time schedule also. The thinking is this will correct and help make sure the 6 rights of drug administration are followed, while this looks good for JACHO, the bottom line is a human is still keying in the information and we all make mistakes. I am not so sure the technology we have today in practice is as good as the old fashion, "know your patient and the medications being administered".

Defense Attorney Lawyer Medication Drug Error

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Web, Communication and Information Management, comment

October 26, 2009

Computer communication is here to stay and we must be cautious on not leaving behind the idea of human networking. Networking involves interaction, and when humans stop networking, the flow of communication and ideas slows to a trickle or just dams up altogether. My facility is currently undertaking the implementation of an Electronic Health Record (EHR) and the staff are beginning to see what a daunting project it really can be. We have three separate teams working under one administrator and it appears as if no one is coordinating the efforts of all 3 teams. Each team says one thing, then another happens and another team has to scramble. The implementation is costly, and not just in dollars. There is the "umbrella" or main team, a surgical services team and a pharmacy team. Just to show what is occurring, the pharmacy team has no idea of the workflow of the nursing team and vice versa. And we go live with eMAR in 2 weeks. And new issues crop up that no one can answer. And the conversations between the clinical people and the IT people can be interesting to say the least. Our teams are small and that may be one of the issues. For projects like this, all members of the teams should have an understanding of the projects each team is involved in. And one person should coordinate the team. In a perfect world……….

Original Post
October 7, 2009
Title: Web, Communication and Information Management
Review of Introduction to Computers for Healthcare Professionals, Fourth Edition, 2005/2006. Authors: Irene Joos, Nancy Whitman, Marjorie Smith, and Ramona Nelson. Within Dr. Johnson’s course.
I found a lot of the information in these chapters to be stuff that I already knew for the most part. Although I did learn the definition of the world wide web. I just thought that the web was the Internet. One of the activities at the end of chapter 9 did walk you through creating your own web page. I did not know how to do that. Chapter 12 did go over all the computer crimes and some of them I had never heard of either. The IT professionals at work only address the most common threats.

Health Care Informatics online certificate program

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The 6 rights of medication administration, comment

July 17, 2009

Coming across this post, l recognised the device (scanner) which the writer says her facility uses. On the face value, JAHCO will applaud this device because it acted as if the cases of med errors have been eliminated. Yet as the writer said, it still goes back to knowing your patients and knowing your medications. Nurses are the final check point in the health team providers list. We are in between the ordering physicians and the releasing pharmacists. Nurses have to see that the parameters for which the drug is being administered is not in violation. For instance, nurses know by common sense that once the med is due, the scanner will scan and does not tell if the parameter for using a betablocker is checked for not. It is up to the nurse to make sure that the blood pressure is stable and the heart rate is within normal range. Despite these technologies, we are still required to do our checks before trusting the device.

Original Post:
June 30, 2009
Title: The 6 rights of drug administration
The 6 rights of drug administration did not prevent the cause of death in one particular case. The problem lies with the incorrect labeling of medication. The key is to trace what happened, review for any outlying causes or "what happened" and correct that as soon as possible. While the nurse I am sure will have to live with that the rest of her life, and that’s not easy, I feel that she has comfort in knowing she did not cause this. Many hospitals are using the computerized medical dispenser where you scan the patients ID bracelets then you scan the drug that is being administered which is on a time schedule also. The thinking is this will correct and help make sure the 6 rights of drug administration are followed, while this looks good for JACHO, the bottom line is a human is still keying in the information and we all make mistakes. I am not so sure the technology we have today in practice is as good as the old fashion, "know your patient and the medications being administered".

Tags: , ,

The 6 rights of drug administration

June 30, 2009

The 6 rights of drug administration did not prevent the cause of death in one particular case. The problem lies with the incorrect labeling of medication. The key is to trace what happened, review for any outlying causes or "what happened" and correct that as soon as possible. While the nurse I am sure will have to live with that the rest of her life, and that’s not easy, I feel that she has comfort in knowing she did not cause this. Many hospitals are using the computerized medical dispenser where you scan the patients ID bracelets then you scan the drug that is being administered which is on a time schedule also. The thinking is this will correct and help make sure the 6 rights of drug administration are followed, while this looks good for JACHO, the bottom line is a human is still keying in the information and we all make mistakes. I am not so sure the technology we have today in practice is as good as the old fashion, "know your patient and the medications being administered".

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