Evaluating Websites for Stem Cell Research

Chapter 14
Information Technology in the
Clinical Setting
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

 Technology advancements have influenced all
sectors of civilization including health care, even
in developing countries that have limited access
to health care
 Advancements in the widespread use of health
information technology (HIT) first occurred in
European countries
 Germany initiated a universal HIT process in 1993
 Norway in 1997
 United Kingdom in 2002
Technology Across the Globe
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 2

 For electronic health record (EHR) systems to
have the greatest impact on cost and quality,
they must be interoperable with the ability to
exchange information across systems and
settings in a standardized manner
 Goal of both the Bush and Obama
administrations has been to have universal EHR
adoption in the United States by 2014
HIT in the United States

 An EHR is a system that captures, processes,
communicates, secures, and presents data
about a patient
 Integration of information from multiple sources
 Serves as a primary source of information for
patient care and quality
Electronic Health Records

 EHR System
 Data capture: collection and entry of data into an EHR
system
 Storage: the physical location of data
 Information processing: provides for effective retrieval
and processing of data into useful information
 Information communication: interoperability of
systems and linkages for exchange of data across
disparate systems
 Security: provide better protection of confidential
health information because of incorporated controls
Electronic Health Records (cont'd)
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
5

 Institute of Medicine recommends that EHR systems
offer eight functionalities
 Health information and data
 Results management
 Computerized provider order entry (CPOE) with or without
decision support
 Clinical decision support
 Electronic communication and connectivity
 Patient support for patient education and home monitoring, when
applicable
 Administrative processes
 Reporting and population health management
Electronic Health Records (cont'd)

 Two specific functionalities recommended as
essential for improving the quality and safety of
health care
 Clinical decision support
 i. Automatic reminders about preventive practices
 ii. Drug alerts for dosing and interactions
 iii. Electronic resources for data interpretation and clinical
decision making
Decision Support and CPOE

 CPOE
• Clinician with order writing authority sits at a computer to
directly enter patient care orders
• Eliminates lost orders and illegible handwriting
• Prevents medical error
 Improved communication and readily accessible knowledge
 Requires key information (e.g., drug dose)
 Calculation assistance
 Checks performed in real time
 Assistance with medication monitoring
 Decision support
 Rapid response and tracking of adverse events
Decision Support and CPOE
(cont'd)

 Information available through EHR systems
must ensure that authorized caregivers
(including nurses) have the information they
need in their preferred presentation form
 Examples:
 Data organized by source, caregiver, encounter,
problem, or date
 Data can be presented in detail or summary form
 Tables, graphs, narrative, and other forms of
information presentation must be accommodated
Information Presentation

 Defined as a complex set of capabilities and
standards to be met by EHR use in a series of
stages over several years
 Stage 1 (2011-2012)
• Quality, safety, and efficiency
• Engage patients and families in their health care
• Improved care coordination
• Improved population and public health
• Privacy and security protections for PHI
 Stage 2 (2014 - ): continuous quality improvement
 Stage 3 (~ 2015 ): decision support tools and quality
metrics
EHR and “Meaningful Use”

 Opportunities
 Financial Incentives
 Quality care, safety, efficiency
 Continuity of care
 Barriers
 Meeting guidelines is strenuous and costly
 Lack of interoperability
• Corporate competition
 EHR implementation cost
Opportunities and Barriers to EHR

 In the early 1990s, the U.S. President called together
health care industry leaders to determine how the
administrative costs of health care could be decreased
 Leaders determined that the use of an electronic data
interchange within the health care industry held the greatest
promise for decreasing costs
 Recommended that national standards for electronic data
interchange and information privacy and security be
established—HIPAA
 HIPAA regulations focus on the privacy and security of
patient data
Health Insurance Portability and
Accountability Act (HIPAA)

 HIPAA and clinical information systems
 Any institution that collects/stores protected health
information (PHI) is required to name a privacy
officer, provide employee training, and implement
HIPAA policies and procedures
 Access to PHI must be to only employees with a need
to know specific information
 Individuals who violate HIPAA may be subject to
criminal penalties and civil monetary penalties
Health Insurance Portability and
Accountability Act (HIPAA) (cont'd)

1. The Health Insurance Portability and Accountability
Act (HIPAA, 1996) provides:
A. Health insurance at a group rate in the event of
unemployment
B. Regulations to ensure privacy and security of patient
data
C. The ability for individuals within an organization to
choose between different types of health insurance,
such as health maintenance organizations or
preferred provider organizations
D. A method to ensure that providers are ordering only
necessary diagnostic testing to limit out-of-pocket
spending

 Paramount to deliver safe, efficient, quality
patient care
 Easy access to patient data (past and present),
references, policies, procedures, evidence-
based literature
 Hand-held computers, laptops, tablets, smart
phones, and PDAs
 Moves from practice that relies on memory to
continuous use of resources as they are needed
Point of Care Technologies

 Telecommunications technology to assess, diagnose,
and, in some cases, treat persons who are located some
distance from the health care provider
 Home care arena has seen significant changes as a
result of telehealth
 Telehome care devices: automated blood pressure
monitors, glucometers, peak flowmeters, pulse
oximeters, weight scales, video monitors
 Real time data capturing improves management of
chronic diseases
Telehealth

Consumer Health Information
Technology

 Has made significant changes in the way people use the
Web, most notably in enhancing people’s abilities to
share, collaborate, and connect with each other and with
ideas and information
 Specific Web 2.0 technologies: blogs, social networking
sites, wikis, podcasts, shared databases, and
collaborative writing spaces
 Has led to a more knowledgeable patient and requires
clinicians to teach patients to be good consumers of
health information
Web 2.0

 Effective and efficient Internet searching is a must in
today’s information overloaded society
 Search engine (“Google it”)
 Advance searching (Google Scholar)
 Brut Force (Specific web address)
 Links
 Professional association and societies are a good
starting point for professional information
 Scientific and research information usually requires
literature resources that can only be found in scholarly
databases such as CINAHL
Finding Information on the Internet

 Internet is open to anyone with access to a computer
 Material that looks official may actually be posted by persons
without formal education in an area
 Specific criteria useful in evaluating a website
 Authority
• Authority with regard to the topic, author, and author’s
credentials
• Affiliation of the website is important
 .edu = educational institutions
 .org = nonprofit organization
 .com = commercial enterprise
 .net = internet service provider
 .gov = governmental body
 .mil = military
Evaluating Information
Found on the Internet

 Objectivity
• Is the purpose of the website clear?
• Is the information factual or opinion?
• Is the information primary or secondary in origin?
• Who is sponsoring the site?
 Accuracy
• Look for documentation and referencing
• Compare information on the website with other sources
 Currency
• Look for dates
• Compare the last update with current literature
 Usability
• Is the site well designed, stable, and easy to use?
• Content should be error-free and readable by the intended audience
Evaluating Information
Found on the Internet (cont'd)

2. A nurse is preparing a presentation and is
reviewing websites to collect information on stem
cell research. One site does not contain headings
to direct the reader, and hyperlinks do not
connect to the stated information. Which criterion
to establish a reputable website is missing?
A. Authority
B. Objectivity
C. Usability
D. Currency

 Current technologies that offer insight to
possibilities
 IBM partnering with Memorial Sloan to build a decision support
tool
 Examining using GPS to track individuals that may require in-
home monitoring
 No-touch health physicals
 Voice recognition for dictation and note taking
 Biometric technologies
Trends

Evaluating Websites for Stem Cell Research

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Editor's Notes