Module 6: Policy and Ethical Issues Related to IT

I have learned in this module about important implications of electronic health records (EHR). EHR sounds simple and highly desirable because of its implied benefits of lowering costs, reducing medical errors and saving lives (Swartz, 2004). However it is more complicated than it seems. This is because of factors such as initial cost to purchase the product, training and education, user acceptance, and the issues associated with privacy and confidentiality.  User acceptance will not only come from healthcare workers but also from the patients. Most of my patients are worried about their personal and private information out in the open and accessed by anyone. This is of course not entirely correct because we do know that only specific users can access the information such as those who are involved with patient care including direct healthcare workers, doctors, labs, and insurance companies. The biggest role of the government is to make sure that sites are secure and impossible to access by hackers and those who are not authorized to access these information. Foreseeable problems that we can anticipate will happen might be our failure to input complete and accurate data such as diagnostic tests and results, medications and changes, allergies, new diagnoses, and any other changes and updates to patient’s medical condition. However I also see wonderful benefits of EHR in my clinical practice in home health care. Nurse case managers always have to "stay on top" of patient’s medication changes or any lab reports that are done during clinic or hospital visits. Most patients would say “I don’t know”. With EHR, the home health company may be given access to patient’s electronic records for patients who are under home health care. A desirable consequence is a reduction in the amount of time spent making phone calls to capture an updated medical record. 

As nurses, we definitely have an impact in steering healthcare in the direction that will benefit mankind. We need to be involved, not only in direct patient care but also in the processes and technological advancements that will improve quality of health care.

MODULE 5: Decision Support for Care Delivery

Something new I learned in this module is the word "heuristics". Listening to Kahneman on YouTube and reading his article about heuristics, gave me a good dose of realization that most people like myself have unknowingly used heuristics and biases with decision making. There have been times where my decisions were based on my previous experiences, common practices and intuition.  Oftentimes, the outcomes are desirable. At other times, the outcomes are less than desirable.

Information technology has been instrumental in the collection of expert knowledge and information at our fingertips. Nursing and medicine have been some of the recipients of such positive contribution of informatics with one in particular, the clinical decision support system. Studies about the effectiveness in clinical decision support systems in cost-effectiveness and improve patient outcomes have all been positive (Anderson & Willson, 2008).  Patient safety has been impacted because of its portability at the point of care and the quality of information and knowledge that are easily accessed by the clinician. With so much information and knowledge it is impossible to remember them all. Clinical decision support systems are wonderful tools when utilized at the point of care (Hebda, 2009).

Unfortunately widespread use is still in its infancy. There are costs involved with having the system and training the staff to utilizing the system. With the incredibly expensive cost of medical errors (both monetarily and in human lives), the cost of CDS's should never even be given second thought. I have worked in a nursing home the first several years of my nursing career and saw firsthand how devastating pressure ulcers are on the quality of life of the residents. With the availability of pressure relief surfaces and more evidence-based knowledge in wound healing, in addition to CDS, there will hopefully be less incidence of pressure ulcer occurence in bedbound patients. Decision making in my clinical practice would truly be patient-centered and quality-based care if CDS system is used in addition to my clinical knowledge and training.

MODULE 4: Teaching with Technology

I have held different positions in my nursing career both in long term care, occupational health and home health care setting where I was always teaching. Some positions may have involved less teaching than others and to varied audiences from patients, families, caregivers, colleagues, and so forth. As a case manager I was teaching patients and caregivers, or teaching clinical staff in my role as clinical education and staff development. Currently in my role as a new director of nursing in a home health agency, I am constantly teaching clinicians about documentation, best practices in patient care, and so forth.  

Health care providers who are not involved in direct patient care might not be actively teaching patients but most likely are involved in brief, informal teaching moments with colleagues or clients.I have also learned that in order to be credible in what you teach (especially healthy lifestyle/habits) you have to be an example of what you are teaching. 

Technology plays a significant role in information dissemination in this century and the future and is therefore an important tool to incorporate in our teaching and learning. I can teach a cousin living in the Philippines that same day she asked my help on how to care for her newborn baby just by sending her an email and attaching a link to a website with this information. 

I am so grateful to have taken this class for all the things I am learning including technology. I have attached a link to our N6004 Wiki page. You must register as a member to be able to add, edit or participate in discussions about this great technology we call personal digital assistants (PDAs). Wiki away..... my friends.
http://editthis.info/nurs_6004_mobile_devices/Main_Page

MODULE 3 INFORMATION RETRIEVAL

This is coming from my heart-I love this class! 
Being raised in a small Philippine village without water and electricity, I didn't imagine that I will have the opportunities I have now.
Today, I learned how to create a screen shot!

This module reinforces the importance of having the ability to retrieve relevant information and locating appropriate sources for evidence-based practice. I used CINAHL, PubMed, National Guideline Clearinghouse and Google.

I have more success with CINAHL than PubMed. With CINAHL I found more articles with available full text. It was easy to narrow down my results for relevance using Boolean phrases, English language, publication year, age of population, type of article, and linked full text. 

Using the guideline index that is, National Guideline Clearinghouse (NGC), I am actually very happy to have found this because of the wealth of information I can use for my current clinical practice in home health and my future faculty practice. I can browse by topics, organizations, complete index, which are topics under each organization. There are also guideline resources such as AHRQ’s evidence reports, hospital-acquired conditions, patient education materials and so forth. With my search topic “home care versus hospital AND cost”, it yielded irrelevant results despite using advance search such as keywords, age of population, guidelines category, intended users, year of publication. The reason behind my unsuccessful search result might be that NGC is an index for clinical practice guidelines and do not include topics covering financial cost between health care areas including my search topic. 

The first three pages of my Google search yielded a few highly relevant topics. The rest of the pages were published by special interest groups and solicitors. While Google provides a good resource for research articles, it is still wise to use recommended sources for evidence based-practice for health care through PubMed, CINAHL, Cochrane and University of Utah’s libraries. 


Search away friends... :)

Connecting for Care

If you have read the article included in our Module 2 called "Connecting for Care: Nursing and Health Information Exchange" by Judy Murphy, like me, you will recognize that we have a major role in the health care reform. This is in the area of standardization of nursing language in all health care settings as we continue our direction to the mandate of electronic health record by year 2014. Our role is beautifully written by Murphy (2010), "Now my message is this. Be the change you want to see in patient-centric care. Make sure you are embracing the challenges of interoperability and getting involved in solving them for your organization. Participate in the data exchange efforts in your state. Understand the standards involved in the meaningful use definitions. Get involved in the nursing efforts for standardizing clinical vocabularies and reference terminologies. Being able to share and compare data between health care organizations and across time is the right thing to do for our patients- both for the individual patient's quality of care and for the secondary use of analyzing data across patients to study the efficacy of our practice and how we contribute to patient outcomes".

Module 2: My Involvement in IS Implementation

What is one way I could become involved in designing, selecting, evaluating or implementing an information system in my workplace?

As a home health nurse I will choose to be involved in the design and selection process of a new EHR at my employment as the representative from the nursing department. This is a switch from paper to electronic charting.  Some of the criteria on the clinical dimension that I will focus on are the following: what tools will clinicians use to enter patient information and how accessible are these tools, are they easy to use, is the EHR accessible at the patient’s home or wherever the patient resides, how is privacy maintained in the home health setting where clinicians are more likely to keep patient records in their cars, does it save time in documentation, and does it improve quality of patient care and contribute to good patient outcomes?

Several years back, I was involved in our transition from paper to electronic OASIS and plans of care. I helped review an EHR program (Misys) that my employer was interested in purchasing. I was involved in evaluating and testing the program’s fit in the home health arena.  I reviewed ease of use, simplicity especially in navigating through all outcome-based assessment questions, and if the medical diagnoses, nursing diagnoses and clinical pathways were based on approved standards. I helped create our company’s standardized clinical pathways (including goals and interventions), yet allowing free-texting for better customization of care plans.  It was exciting when we finally were in the test and evaluation process if it met our expectations. There are always ongoing issues such as system maintenance, privacy, security, and confidentiality,  ongoing training, costs, system failure, and so forth that are all associated with IS and we have to see it as just part of what we do.

Techno-illit

Like my friend (and classmate) Jean Doria, I grew up in a third world country without computers. Honestly I didn't even get to touch a typewriter. I told my sons the other day that I should have opted to become a secretary after high school. That would have given me an experience in typing (typing classes were only for those pursuing secretarial jobs). My ten year old planned to give me typing lessons soon. Anyway, my relationship with computers started when email became available and my husband allowed me to use his computer that he mostly use for his teaching job. Later on he bought me my own computer but the only thing I knew was to turn it on and send an email. Eventually it evolved into "googling" and finally a few months ago-Facebook.

I  realize the disadvantage I have over those who grew up or went to school having typewriters or computers but this does not mean that I can continue to make an excuse for not learning to use them. I have several nieces and nephews in the Philippines and one of the main thing I help them with is to have computers so that they will have a better chance with success. My goal in the next few years is to build a public library in my hometown and offer computer classes and other educational-related classes to help improve the lives of the youth as well as adults. Two years ago I donated a couple of computers at a small elementary school in Cebu and had my son teach the school principal and her assistant on how to use the computer. That was exciting to them.

In my most positive attitude, I can say that I will no longer be techno-illiterate by 2012 (when I finish my MSN)!!

Non-school related topic

My heart goes out to Doug Wright and his family. If you don't know who Doug Wright is- he has the Doug Wright Show on KSL. The first time you listen to him you'll get hooked and become a fan. But anyway, his son died on Aug 28 in Washington DC from a fall off the 7th floor of his apartment. He was there for an internship and was planning to be a history teacher after graduation from our beloved university (University of Utah).This is devastating and very sad for his family and to all of us even if we did not know him personally. Life is short. Let's enjoy every moment of it with our loved ones.

Web-based Learning

 At present, it is not uncommon for Nursing Schools to offer web-based classes and programs to meet the needs of students wherever they live to have access to basic and advanced degrees (Billings, 2000).
However, my opinion was that this may only  be attractive to those students who are computer literate. There was worry and hesitation on my part when I enrolled in the classes required for my program this semester. This is because I considered myself far from being computer proficient. What surprised me though, as classes started, how supportive my teachers are, including the university's technical support and library staff. My success this semester is going to be up to me and my motivation to learn new things, not just how to be an effective teacher but also how to become a facilitator of learning through web-based programs.

I WIll Survive...

I am feeling somewhat overwhelmed with all the new things I have to learn not just on the technology side of things but everything else. I am hopeful it will ease up a bit.Does it? I am taking a full-time load and this is my first semester in the MSN program.
 I am working very part-time at a home health agency mainly training newly-hired RNs on Medicare OASIS C documentation and creating POCs. I will also be doing monthly clinical staff inservice. I will survive...

Get To Know Me-Entry for Module 1

Hi Dr Sue and Dr Kathy and to all my fellow classmates.
My name is Emmie (short for Emelinda) Comer, in the Teaching Nursing Specialty program at the U. I finally have the courage to go back to school after being gone for 20 years. I graduated with my BSN at the University of Cebu in the Philippines in 1990. Married that same year and immigrated to the US in 1991. Hershey, Pennsylvania was my first home away from home. FYI, you never crave for chocolate in Hershey because you smell it in the air. In 1995 we moved to Utah due to my husband's teaching job at BYU. I have 2 boys (17 and 10). Most of my nursing career has been with the geriatric population (in SNF and Home Health) except for the 2 years I spent as a company nurse for Nestle USA.
I have a love/hate relationship with technology. My first exposure to computers was only a few short years ago. About 6 years prior,  the home health agency I worked for started having us use Palm Pilot for our daily visit charting and Misys (now Allscript) program for OASIS patient data collection. Last year we went paperless at the office and all patient data are stored in Allscript, HHGold and a couple of other programs. I think this class is going to finally convince me that there is no turning back and in order for me to succeed in school as a student and as a future faculty, I better learn all that there is to learn to survive in this day and age.
I hope to be a much learned woman at the end of this semester.