SSSSSSS

CHAPTER 14

Election Health Record System: US: Federal Initiatives and Public/Private Partnerships

In April 2004 ,the president of the United States issued an executive order that called for action put HER’s in place for most Americans in 10 years.(White House 2004) This order gave new momentum to efforts across the health care community to use HIT to improve health care. For over a decade, the institute of Medicine (10) has been calling for the use of information technology (IT) to improve the efficiency, safety, and quality of the health care Americans receive in a series of groundbreaking report ( Disk, Steen, and Detiner , 1991, 1997;Kohn, ( arrigan, and Donaldson, 200;( arrigan, Donaldson, and Kohn,2001;

The involvement of nurses is critical to such effort. Responsible for care condition and promotion of wellness, nurses are often the patients primary contacts and the final point in health care delivery where medical errors and other unintended action can be caught and corrected . As the largest human resource in health care , nurses are delivery system in organizational planning and process reengineering to improve the health delivery system. Increasingly , nurses and nurse managers are turning to nurse informatics for leaderships as their profession works to bring IT application into the health care environment.

OVERVIEW:

An early adopter of EHR-S , the U.S government is currently advancing initiatives to accelerate the use4 of HIT in both the public and private sectors . Private groups have been instrumental in promoting awareness of the benefits of EHR-S architecture, messaging, functions.Federal initiatives continue to actively identify and target solution that lessen the barriers and accelerate use of EHR-S. Development AND implementation in conformance with the existing and future standards activities are crucial to achieving interoperable systems.

DEFINING ELECTRONICS HEALTH RECORD SYSTEM

The term HER-S is often used interchangeably with computerized patient record , and many others .Yet the choice of the words in the term EHR –S reflects the broader focus of the consumer or indicates that the HER-S may be by all particidiciplines of clinicians , family caregiver , and the patient.

The set of components that form the mechanism by which patient records are created , used , stored and retrieved. A patients record system is usually located within a healthcare provider wetting . It includes people , data ,rules and procedures processing and storage device (e.g. paper and pen , hardware and software) and communication and support facilities.

In its used of the word system . the IDM drew a visionary distinction between a dynamic system and a stratic record. Recently , the IDM modified this definition in its report , Key Capabilities of an electronic Health Record System (2003), reiterating the new definition in a report on patient safety (Asp0den et. al., 2004)

1. Longitudinal collection of election health information for and about persons where health information is defined as information pertaining to the health of an individual or healthcare provided to an individual;

2. Immediate electronics access to person – and population level information by authorized and only authorized , users;

3. Provision of knowledge and decision support that enchances the quality, safety and efficiency of patient care ; and

4. Support of efficient processes for healthcare delivery 5. GOVERNMENT AS PROVIDER AND EARL ADOPTER

GOVERNMENT AS PROVIDER AND EARL ADOPTER

Federal agencies that provide direct are have been early adopter of EHR-S .The veterans Affairs (VA) and the general institutes of health (HIN) in the department

DEPARTMENT OF VETERANS AFFAIRS

All aspects of a patient’s record are integrated, including active problems allergies , current medication , laboratory results ,vital sign , hospitalization, and out patient clinic history .All electronics record are password protected to quarantee patient privacy.

A checking system that alerts clinicians if an order they are entering could cause a problem.

A notification system that immediately alerts clinicians to clinical significant event

A visual posting system that alerts healthcare provider to issues specifically related to the opening of the patients electronics charts including crisis notes, adverse reaction and advance directives.

A template system that allows the healthcare provider to automatically create reports .

A clinical remainder system that electronically alerts clinicians when certain action , such as examination , immunizations, patient education , and laboratory test , need to be performed.

Remote data viewing to allow clinicians to see the patient’s medical history at all the VA facilities where the patient was seen.

OFFICE OF THE NATIONAL COORDINATOR FOR HEALTH INFORMATION TECHNOLOGY

The executes order of April 2004, mentioned earlier in the chapter , created for ONCHIT to coordinates HIT in the federal sector and to collaborate with the private sector in driving HIT adoption across the healthcare system , David Brailer , MD ,PHD was named to fill the sub cabinet – level.

THE NATIONAL COMMITTEE ON VITAL AND HEALTH STATISTICS

In the resulting report, information for health , NCVHS (2002) presented the concept of an infrastructure that emphasizes health oriented interaction and information sharing among individuals and institutions rather simply the physical , technical and data system that mage those interaction possible.

GOAL 1

Inform Clinical practice: Informing clinical practice is fundamental to improving care and making healthcare delivery more efficiency.

Three strategies for realizing this goal are :

Strategy 1: Incentive EHR adoption Strategy 2: Reduce risk of HER

investment Strategy 3:Promote HER diffusion I rural

and under nergued areas.

GOAL 2

Interconnect Clinicians : Interconnecting clinicians will allow information to be portable and to move with consumer from one point of care to another.This will required an interoperable infracture to help clinicians get access to critical healthcare information when their clinical and / or treatment decisions are being made.

Strategy 1: Foster regional collaboration Strategy 2: Develop a national health information

network Strategy 3: Coordinate federal health information

systems

GOAL 3

Personalized Care: Consumer – centric information helps individuals manage thiers own wellness and assists with their personal health decision:

Strategy 1: Encourage use of personal health record

Strategy 2: Enhance informed consumer choice

Strategy 3: Promote use of teleheath systems

GOAL 4

A number of collaborative efforts are focused on the use of EGR-S and HIT to improve care .Among these private sector organizations are those formed specifically to address issues of connection ,HIT , and standards development.

CONNECTING FOR HEALTH

More recently in July 2004 , connecting for health organized several an incremental “raodmap” that laid out nearterm action necessary to achieving electronictivity.

CERTIFICATION COMMISION FOR HEALTH INFORMATION TECHNOLOGY

The health information and management system Americans Health Information Management Association and National Alliance for health information technology have joined together to establish the certification commission of health information.

HEALTH LEVEL SEVEN

Supported by public and private groups, the HLf’s HER technical committee developed draft standard for trial use , known as a DSTU, for HER and made it available for public comment prior to being as a standard.

Table 14.2 developing a use profile with the draft standard for trial use:

STEP 1

With help of a nurse informaticist , a small group of clinical subject matter experts generates a definition of the environment in which the HER-S is to be used.

STEP 2

The clinical experts review the list of function and prioritize each function as essential now. Essential future, optional, or Non applicable to each function.

STEP 3

Using the list , the nurse informaticist prepares a “story board” that shows the work flows and clinical function to be performed within the work flow and marks the clinical function with the function identifier from the eHr-S DSTU

STEP 4

The nurse informaticist present the story board to a larger group of clinicians who validate that it is comprehensive and accurately portrays the activities of the clinical environment.

STEP 5

The final validated story board is used as a tool to communicate the work clinical work flow integrated with EHR-S function needed to support the clinical environment or compare to a product profile for the selection of a product that is able to support the clinical environment.

CHAPTER 15DEPENDABLE SYSTEMS FOR QUALITY CARE

Introduction:*the healthcare industry is undergoing a dramatic

transformation from todays inefficient, castly,manually intensive, crisi-driven model of care delivery to a more efficient , consumer-centric, science-based model that proactively focuses on health management. This transformation is driven by several factors , most prominently the skyrocketing cost of healthcare delivery, the exposure of patient safety problems, and an aging “babyboom” population that recognizes the potential for information technology (IT) to dramatically reduce the cost and improve the quality of care. Some of the key technologies that will enable this transformation yo occur are identified in.

*The electronic health record (HER) will form the foundation for pervasive personalized, and science base care. Other key applications are clinical information system (CIS) with integrated, outcomes-based decision support, clinical knowledge-based computerized physician order entry (CPOE),electronic prescribing, consumer knowledge bases and decision support and supply chain automation. The technologies that enable to transformation are largely state of the art and include enterprize application integration (EAI) wireless communications: handheld and tablet computers, continuous speech recognition; new interpretation;electronic;sensor technology;radio frequently identification (RFID) tagging, and robotics.

* the internatonal council of nurses (icn) code of ethies for nurses affirms that the nurse ”holds in confidence personal information and ensures that use of technology..compatible with the safety ,dignity and rights of the people’ (ICN), 2000. Fulfilling these ethical obligations is the individual responsibility of the nurse, who presumably that has ability and authority to ensure that personal information is protected and that technology is safe.

WHEN THINGS GO WRONG

The computers, network, and software are as dependable as our toasters and telephones, unfortunately that is not the care, and stories that have appeared in trade journals have documented his fact a catastrophic failure in the network infrastructure that supported care group, one of the most prestigious healthcare organization in the United States , the failure resulted in a 4 hour closure of the emergency room, a complete shutdown of the network, and 2 days of paper based clinical operations a true ‘ retro experience for many of the physician who had never pracriced without computers.

GUIDELINES OF DEPENDABLE SYSTEM

All computer system are vulnerable to both human – created threate, such as malicious code attacks and software bugs

GUIDELINES 1: ANTICIPATE FOR DEPENDABILITY

Architecture is that an enterprise system – architecture should be developed from the bottom up so that no critical component is independent on component less trustworthy that itself. At the bottom of illustration are the physical and logical networks that support the enterprise and provides the “pipes” that data from system to system.

 

GUIDELINES 2: ANTICIPATE FAILURES

Unfortunately , mimizing complexity is more easily said than done. Consistent with Moure’s law (Moure,1965) the speed of processors is doubling every 18 months , while the cost for that computing power is halving within the same time period .

GUIDELINES 3: ANTICIPATE SUCCESS

The system planning process should anticipate business success and the consequential need for larger networks , more systems, new applications and addition integration. Modeling of use-case sensation that anticipate hospital and clinics mergers, acquitions, and a growing patients / costumer base will enable the system designer o visualize the data flows.

GUIDELINES 4: METICULOS MANAGER

Managing and keeping complex networks and integrated system available and responsive require meticulous over gees – individuals who know that failures will occur and accept that failure are most likely to occur when they are least expected.

GUIDELINES 5: DON’T BE ADVENTUROUS

Imagine that a small start-up company called cute chutes has announced the available of a new parachute unit that promises to revolutionize the sport of sky diving.

ASSESSING THE HEALTHCARE INDUSTRY Health care clearly has a need for dependable system

both now and after the transformation, as the industry becomes increasingly dependent on IT in the delivery of patient care.

Architect for dependability “ the clinical care provide community get a barely passing grade of “D” Healthcare organization build – or perhaps “compose” – their system from the top down rather than from bottom up. Creating further their complexity are the merger and consolidation of healthcare enterprises, each bringing into the merger its own software application.

Security management , including security analysis and risk management

Assigned awareness responsibility Information access management, including the isolation of

cleaning house functions from other clinical function Security awareness and training Security incident procedures , including response and reporting Contingency planning, including data backup panning

disaster , recovery planning for emergency mode operations. Evaluation Business associate controls that locks in the obligation of

business partners in protecting health information to which they may have access

The five specified physical safeguards also contribute to system dependability by requiring that facilities , work-station, devices, and media be protected.

Access control , including unique user identification and emergency access procedure

Audit controls Data integrity protection Person or entity authentication Transmission security

A security plays a critical role achieving system dependability. However , security within clinical environment is very different from environment that seek to tightly restrict access to information , system , and services

ANTICIPATING FAILURES

For adherence to the second guidelines “expect failures” the clinical care provider community gets another grade of “D” Medical technology and prescription drugs , as well a clinical treatments protocols , are required to undergo extensive validation before they can be used in clinical practice , application , computer system and networks .

The architectural complexity discussed above increased the opportunities for failures to occur. PC’s that connect to the enterprise network from outside , laptops with wireless modern , Smartphone’s, and PD’s that synchronize with enterprise system.

ANTICIPATING SUCCESS

The third guidelines “expert success” the clinical care provider community has earned a mediocre grade of “G” .Healthcare organization definitely expect their software application , computer system , and networks to work.

IT MANAGEMENT

For the fourth guidelines “hire meticulous manager ” the clinical care provider community has been designed a mediocre grade “C”.

ADVENTURE TECHNOLOGY IN HEALTHCARE

The fifth and final guidelines “ don’t be adventurous ” is the most definitely to access for healthcare.

Healthcare clinicians , including nurses , historically and typically are very resistant to change.

CHAPTER 16 NURSING MINIMUM SET SYSTEM

INTRODUCTION: -Clinical nursing visibility from National to

International Context -The empetus to access to and use of nursing data

and information has never been stronger. The identification of NMDS visionary works begun in the United States in 1980s by werley and long (1988), has indeed spurred activity extended national develop similar data sets around the world. This chapter provides a synthesis of historical, current and future NMDS system with can increase nursing data and information capacity to drive knowledge building for the decipline and profession to contribute to the standard supportive of the electronic health record.

NMDS HISTORICAL SUMMARY

-The NMDS identifies essential, common, and core data elements to be collected for all patients/clients receiving nursing care. The NMDS is standardized approach that facilities the abstract of this minimum, common, essential core data elements to describe nursing practice (Werley and Lang) from both paper and electronic records. The NMDS was conceptualize though a small group work at the nursing information system. The University of Illinois Colledge of Nursing. Werley and collegues took the NMDS In 1985 held at the University of WINCONSON – mIlwaukee school of nursing 64 conference participants and formalized. The NMDS includes three board categories of elements ,nursing care patient or client demography service elements . The aim of the NMDS to be redundant of other data sets , but rather to identify what are the minimal data to be collected from records of patients receiving nursing care.

1.Access to comfortable, minimum nursing care, and resources data on local, regional, national and international levels.

2.Enchance documentation of nursing care provide.

3.Identification of trends related to patients or clients problems and nursing care provided.

4.Impetus to improve costing of nursing service. 5.Improved data for quality assurance

evaluation.

NATIONAL NURSING MINIMUM DATA SETS

-The seven countries have identify NMDS system , including Australia ,Canada, Belgium, Iceland, the Netherlands, Switzerland, and Thailand.

EMERGENT NMDSS

-General countries across most continents beyong north American are exploring development of NMDS system World Health Organization has been concern variables including nursing care, personal data, medical diagnosis, and service data.

CHAPTER 17 THEORIES , MODELS, AND FRAMEWORKS

INTRODUCTION: -Lifelong learning is base on the

recognition of patterns and variance, build on previos experience and knowledge, and involves the use of analogies . Recognition of principles proves invaluable for those exploring or already engaged in nursing informatics practice because the nurse in this specialty role is always learning and always teaching.

FOUNDATIONAL DOCUMENTS GUIDE NURSING INFORMATICS PRATICES

The nursing process a delinated pathway and process for decision-making. First , assessment or data collection begins the nursing process. Outcome identifying is third step, followed by planning as the fourth step. The collection of data bout a client or about a management, education or research situation is guided by a nurse’s knowledge built on formal or informal educational preparation, research and previous expectance.

NURSING INFORMATICS

The ANA modified the Graves of Corcoran definition with the development of the first scope of practices as the specialty that integrates nursing information science, computer, science and information science in identifying, collecting, processing and managing data and information support nursing practices, administration, education and research.

MODELS FOR NURSING INFORMATIONS

Models are presentation of some aspects of the real world. Models involve as knowledge about selected aspect changes and are dependent on the world view of those developing the models.

DATA INFORMATION AND KNOWLEDGE

Are “describe objectively without interpretation” and would include value assigned to variable.

REGITERED NURSES AS KNOWLEDGE WORKERS

Knowledge work is the exercises of specialist knowledge and competencies a nation of knowledge workers. Registered are nurse are consummate twenty-first century knowledge worker. Their skill in assessment, planning critical thinking, and evaluation are transferable to many different setting but are most exquisite employed in nursing practice.

ELECTRONIC HEALTH RECORD

American Society for Testing and Material (ASTM) standard E defines the HER as “any information related to the past, present, or future physical health/mental health or condition of an individual.

There are many reasons for health data and information documentation. These include compliance with law and regulation, communication with other providing healthcare to the client, conduct of research and clinical trials.

TERMINOLOGIES

To convey important data and information to others the communication must be understood by the listener and be interpreted as having meaning.

Most of these data elements, except for the nursing care elements in the unique identifier for the primary registered nurse, have along been captured in the health care information system.

Nursing terminologies offer systematic, standard ways of describing nursing practices and include data sets taxonomies, nomelatures, and classification system.

NANDA

NANDA- I has evolved from an alphabetical listing in the 1980’s to a conceptual system that guide the classification of nursing diagnoses in a taxonomy and includes definitions and defining characteristics.