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Nursing Presentation Report

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ELECTRONIC HEALTH RECORD SYSTEMS: ELECTRONIC HEALTH RECORD SYSTEMS: Presentation Transcript

  •         In April 2004, the United States president called for action to put EHRs in place for most American in 10 years. Today, these systems can manage healthcare data and information in a way that is patient- centered and information in a way that is improved information and for the better patients care. The term EHR-S is often used interchangeably with computerized patients record, clinical information systems, electronic medical record, and etc. and this term was eventually used internationally. EHR’s also can be made up of one or more applications. The 10M’s 1991 definition of computer based patient record systems is currently the basic for domestic and international definitions of an EHR-S. The sets of component that form the mechanism by which patients records are created, used, stored and retrieved. A patient record system is usually located within a healthcare provider setting. It Includes people, data, rules and procedures, processing and storage devices and communication and support facilities (Dick, Steen and Derimer,1991). EHR-S includes the following; 1. Longitudinal collection of electronic health information for and about persons, where health information is defined as information pertaining to the health of an i9ndividual or health provided to an individual. 2. Immediate electronic access to a person and population level information by authorized, and only authorized users. 3. Provision of knowledge and decision support that enhance the quality safety, and efficiency of patient care: and 4. Support of efficient process for healthcare delivery.
  •             FEDERALO INITIATIVES An agencies providing direct healthcare offer evidence that the use of HER-Ss across a multifacility enterprise is a realistic goal with measurable, repeatable positive outcomes. GOERNMENT AS PROVIDER AND EARLY ADOPTER 1. The veterans health administration in the Department of Veterance Affairs 2. The National Institute of Health (NIH) in the department of Health and Human Services (HHS) are the two examples of the initiation of systems in the 1970’s that were actively used by clinicians. The Department of Defense (DOD) and the Indian Health Services (HIS) in the department of HHS both acquired the VA’s original clinical information systems years ago customizing it to meet their clinical and business needs (Kolodner, 1997). DEPATMENT OF VETERARS AFFAIRS The Veterans Health Information Systems and Technology Architecture (VISTA) supports day-to-day clinical and administrative operations at local VA health facilities. DEPARTMENT OD DEFENSE Within DOD, provides have a computerized physician order entry capability that enables them to order lab test and radiology examinations and issue prescriptions electronically for over 10 yrs. INDIAN HEALTH SERVICE The HIS has long been a pioneer in using computer technology to capture clinical and public health data. Many of its components are imported from the VA’s CPRS and adapted to fit the business needs of the HIS clinical environments of care. NURSING INFORMATICS
  •       GOVERNMENT AS LEADER Federal activities are focused on the development and adoption of terminologies and standards, grants for demonstrations of data exchange, and other pilot projects. The government is also pursuing the development of a public-private national health information network to facilitate HER-S deployment. OFFICE OF THE NATIONAL COORDINATOR FOR HEALTH INFORMATION TECHNOLOGY The national health information network is the technical infrastructure enabling national interoperability. Regional health information organizations are now being proposed at the community, regional or state level, as mentioned in the discussion of the Agency for Healthcare Research and Quality (AHRQ). THE NATIONAL COMMITTEE ON VITAL AND HEALTH STATISTICS NCVHS (2002) presented the concept of an infrastructure that emphasizes health-oriented interaction and information sharing among individuals and institutions, rather than simply the physical technical, and data defined the NHII as including the values, practices relationships, laws standards, systems, applications and technologies that support all facts of individual health, healthcare, and population health.
  •                  Three dimensions of the National Health Information Infrastructure and examples of their content. HEALTHCARE PROVIDER DIMENSION -provider note -clinical orders -practice guidelines -decision- support programs PERSONAL HEALTH DIMENTION -non-shared personal information -self-care -audit logs -personal library POPULATION HEALTH DIMENSION -infrastructure data -planning and policy document -surveilance systems -health disparities data SOURCE; National Committee on Vital and Health Statistics
  •       CENTERS FOR MEDICARE AND MEDICAL SERVICES Within HHS, the CMS has initiates several pilot projects to promote health IT. In May 2004, CMS awarded as $ 100,000 grant to the American Academy of Family Physicians (AAFP) for a pilot project to improved comprehensive, standardized HER software to small and medium sized ambulatory care practices. Although the use of health IT is not mandatory, CMS views CCIF as a significant opportunity to demonstrate innovative, integrative information infrastructures and communication technologies. PUBLICT-PRIVATE PARTNERSHIPS Are those formed specifically to address issues of connectivity, HIT, and standards of organizations. CONNECTIVITY FOR HEALTH A large private collaborative with federal participants supported by the Marlke and Robet Wood Johnson Foundations, connecting for Health is addressing the barriers to development of an interconnected health information infrastructure.
  •       CENTERS FOR MEDICARE AND MEDICAL SERVICES Within HHS, the CMS has initiates several pilot projects to promote health IT. In May 2004, CMS awarded as $ 100,000 grant to the American Academy of Family Physicians (AAFP) for a pilot project to improved comprehensive, standardized HER software to small and medium sized ambulatory care practices. Although the use of health IT is not mandatory, CMS views CCIF as a significant opportunity to demonstrate innovative, integrative information infrastructures and communication technologies. PUBLICT-PRIVATE PARTNERSHIPS       Are those formed specifically to address issues of connectivity, HIT, and standards of organizations.  CONNECTIVITY FOR HEALTH  A large private collaborative with federal participants supported by the Marlke and Robet Wood Johnson Foundations, connecting for Health is addressing the barriers to development of an interconnected health information infrastructure.  EHEALTH INITIATIVE Is an independent, nonprofit affiliated organizations established to faster improvement in the quality, safety and efficient of health care through information and IT. Its membership brings together hospitals and other providers, practicing clinicians, community organizations, payers, employers, community-based organizations, HIT suppliers manufacturers, and academic organizations. INSTIUTE OF MEDICINE The 10M has championed the advantage of use of IT to improved healthcare since its 1991 foundational work. The 10M continues to illuminate the importance for the use of IT in healthcare. CERTIFICATION COMMISSION FOR THE HEALTH INFORMATION TECHNOLOGY The goal of this group is to support goal1, strategy2, “Reduce risk of HER investments,” of the strategic framework shown in representing the federal government. HEALTH LEVEL SEVEN An non-for-profit volunteer standards organizations, Health Level Seven (HL7) is known for its large body of work in the production of technical specification for the transfer of healthcare data. This time of great change brings grand opportunities for nursing informatics and the entire nursing profession.
  •              DEPENDABLE SYSTEM FOR QUALITY CARE Dexie B. Barker The transformation of the healthcare industry is undergoing manually intensive, crisis-driver model of care delivery to a more efficient, consumercentric, science-based model that proactively focuses on health management. DEPENDABILITY Are thus ethical obligations drive requirements for system reliability, availability, confidentiality , data integrity, responsiveness, and safety attributes collectively. Dependability is also a measure of the extent to which a system can justifiably be relied to delver the services expected from it. DEPENDABILITY SIX ATTRIBUTES System reliability Service Availability Confidentiality Data integrity Responsiveness Safety     Safety WHEM THINGS GO WRONG? Even we would like to be able to assume that computers, networks and software are as dependable as our toaster and telephones, unfortunately that is not the case, and stories that have appeared in trade journals have documents this fact. The bottom line is that systems, networks, and software applications are highly complex and the only safe assumption is that failures will occurs.      GUIDELINES FOR DEPENDABLE SYSTEMS A more practical approach to attaining dependability is to build tolerant systems- systems that anticipate problems, that detect faults, software glitches, and intrusions, and that take action so that services can continue and data are protected from corruption, destruction and unauthorized disclosure. GUIDELINE 1: ARCHITECT FOR DEPENDABILITY At the bottom of the architecture are the physical and logical networks that support the enterprise and provide the “pipes” that carry data from systems to system. The simplest design and integration strategy will be the easiest to understand to maintain, and to recover in the case o a failure or disaster.
  •         GUIDELINE 2: ANTICIOATE FAILURES  In anticipation of failures at the infrastructure level, features that are transparent to software applications should be implemented to defects faults, to fail over the redundant components when faults are detected. And to recover from failures before they become worst.  GUIDELINE 3: ANTICIPATE SUCCESS  The systems planning process should anticipate business, success and the consequential need for larger networks, more systems, applications, and additional integration. GUIDELINE 4: HIRE METICULOUS MANAGERS These managers use middle ware to manage the work load access the network. They take emergency and disaster planning seriously. GUIDELINE 5: DON’T BE ADVENTUROUS The products brochure urges the consumers to be adventurous and states that the company guarantees satisfaction or the purchaser’s money will be cheerfully refunded.     ASSESSING THE HEALTHCARE INDUSTRY For adherence to the first guideline “architect for dependability” the clinical care provider community gets a barely passion grade of “D”. Healthcare organizations build or perhaps ”compose” – their systems from the top down rather than from the bottom up. THE HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA) The following eight required administrative safeguards represent important operational practices that clearly will contribute to system dependability. Security management, including security analysis and risk management. Assigned security responsibility. Information access management, including the isolation of clearing house functions from other clinical functions.
  •      Security awareness and training. Security incident procedures, including response and reporting Contingency planning including data backup planning, disaster recovery planning, and planning for emergencies mode operations. Evaluation Business associate contracts that lock in the obligations of business partners in protecting health information to which they may have access.       Five specified physical safeguards also contribute to systems dependability by requiring that facilities, workstations, devi ces and media be protected. Access control, including unique user identification and on emergency access procedure Audit controls Data integrity protection Person or entity authentication Transmission security.
  •        ANTICIPATING FAILURES For adherence to the second guideline “expect failure” the clinical care provider community gets another grade of “D”. Medical technology and prescription drugs, as well as clinical treatment protocols, are required to undergo extensive validation before they can be used in clinical practice. ANTICIPATION SUCCESS Healthcare organizations definitely expect their software applications computer systems, and network to work. IT MANAGEMENT Organizations have hired IT managers who appreciate the important role of IT in a healthcare environment and who recognized the need for dependable systems that can anticipate and recover from failures.       ADVENTUROUS TECHNOOGIES IN HEALTHCARE On the one hand, healthcare givers typically are not early adopters. But on the other hand, they seem to cast fate to the wind for technologies that catch their collective fancy. NATIONAL NURSING MINIMUM DATA SETS The early NMDS work in the United States spurred development of NMDS on numerous other countries. EMGRENT NMDSS Most continents beyond North America are developing of NMDS systems. In summary, it is clear that there is major work being accomplished across the globe to ensure the nursing essential data will be more comprehensively available in the future.
  •    CALL FOR STANDARDIZED CONTEXTUAL DATA Ample studies have demonstrated the significance of nurse staffing, patient/staff ratios, professional autonomy and control, organizational characteristics, unit internal environment, work delivery patterns, work group characteristics, external environment, staff work satisfaction education of staff, multidisciplinary coordination/collaboration, and educational level on the quality and outcomes of patient care. The development within the United Sates of the NMMDS addresses this void.
  •                  The 18 NMMDS elements are organized into three categories: ENVIRONMENT Unit / cost center identification Organizational decision making power Type Environmental complexity Patient/ client population Patient/ Client accessibly Volume Method of care delivery Accreditation Clinical decision making complexity NURSING CARE Management demographic profile Staffing Staff demographic profile Staff satisfaction FINANCIAL RESOURCES Payer type Reimbursement Budget Expense
  •              NURSING MINIMUM DATA SETS SYSTEMS Connie White Delaney The NMDS historical Summary It is a standardized approach that facilitates the abstraction of these minimum, common, essential core data elements to describe nursing practice (Werly and Lang,1988) from both paper and electronic records. Eight benefits of NMDS Access to comparable, minimum nursing care and resources data on local, regional, national and international levels. Enhanced documentation of nursing care provided Identification of trends a related to patient or client problems and nursing care provided. Impetus to improved costing of nursing services Improved data for quality assurance evaluation Impetus to further development and requirement of NISs Comparative research on nursing outcomes, intensity of nursing care3, and referral for further nursing services. Contributions toward advancing nursing as a research-based discipline.
  •        STANDARDS AND RESEARCH ERATWENTY-FIRST CENTURY Although the full benefits of the NMDS are still being, the NMDS work has influenced a number of advances. The NMDs serves as a key component of the standards developed by the Nursing Information & Data Set Evaluation Center (NIDSEC). The tools and methods to facilitate comparability of nursing data continue to evolve, including the international for nursing practice. NMDSs relationships to International Nursing Minimum Data (i-NMDS) EVOLUTION OF CONCEPT Te i-NMDS includes the core, internationally relevant, essential minimum for providing nursing care (Clark and Delaney, 2000) These data can provide information to describe, compare, and examine nursing practice around the globe.      COSPONSORSHIP I-NMDS research center is lead by a steering committee of international representatives of countries with existing and emerging NMDS as well as professional co sponsorship and areas of informatics expertise. PORPOSES Contribution of nursing care and nurses is essential to healthcare globally The i-NMDS as a key data sets will support. -Describing the human phenomena, nursing interventions, care outcomes and resources consumption related to nursing services
  •       -Improving the performance of healthcare systems and the nurses working within these systems worldwide. -Enhancing the capacity of nursing and midwifery services -Addressing the nursing shortage, inadequate working conditions poor distribution and inappropriate utilization of nursing personnel and the challenges as well as opportunities of global technological innovations. DATA ELEMENTS The elements of i-NMDS are organized into three categories setting subjects of care and nursing elements (Delaney et al, 2003). Setting variable include country characteristics as well as descriptors of the location of the care, whether the setting is acute ambulatory, home and so on. Measures includes care personnel characteristics including numbers, fulltime equivalents, education, gender and so on.        ISSUES Normalization of data collection time periods is a difficult issue. FUTURE DIRECTIONS To describe the power of NMDS in nursing practice from international perspective is daunting, (Delaney, 1996, et al.) The human phenomena serve by nursing the interventions given and the outcomes realized are essential to improving outcomes assuring patient safety, and providing wise stewardship of ll resources, from human to financial. CASE SCENARIO The National Service in collaboration with the world health organization wishes to establish bench makers for case.
  •    You are ask to file a report addressing the following: What is the relationship between and among the number, education, certifica tion and experience of healthcare workers and the vacancy rate? What is the relationship between and among the number, education certification, and experience of health workers and turnovers rates?        What is the relationship between and among the number, education certification, and experience of healthcare workers and the following outcomes: Nosocomial infections Discharge effectiveness Patient/ Family satisfaction with care received Length of stay appropriate to diagnosis Morbidity/ Morality Nurse satisfaction
  •     THEORIES, MODELS AND FRAMEWORKS Carol BicFord Kathleen M. Hunter Based on the recognition of patterns and variances, builds on previous experiences and knowledge and involves the use of analogies. Recognition of such learning principles proves in valuables for those exploring or already engage in nursing informatics practices because the nurse in this specially roles is always learning and always teaching.    FOUNDATIONAL DOCUMENTS GUIDE NURSING INFORMATICS Nursing working in the informatics specialty are professionally bound to follow these provisions. Terms such as decisionmaking comprehension information, knowledge share goals, disclosure , outcomes, privacy, evaluation. Confidentiality, protocols and factual documentation abound throughout the explanatory language of the interpretative statements.
  •     IT IS A SCIENCE THAT COMBINES A DOMAIN SCIENCE, COMPUTER SCIENCE, INFORMATION SCIENCE AND COGNITIVE SCIENCE. NURSING INFORMATICS According to Kathryn Hanna who proposed a definition that NI is the use of information technologies in relation to any nursing functions and actions of nurses (Hanna, 1985)
  • NURSING INFORMATICS BSN 2