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.