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I.T. in Nursing

A Look at the Impact of IT in Nursing 58 099 58 9 26 26 26 s8 0g9 190596050 51905 9605 60 63206 506 3206 3 500305 64757155475 647575 46 54648 6 85 01858 8272 420350030 46 5464 1 5258s01858 8 8272 86527 18 272 65 65 0 13 23016 0211 3 03 53 2 053 2 52461355323 660 80884 19 0 618 048 0 23016 0211 0 13 3 03 53 2 0532 52461355323 660 Need for Health IT 80884 19 0 618 048 0 000195 0 895916 0690 67000 2 08 84 4 18 18 000195 0 895916 0690 67000 2 08 1.Reduction of Medical Errors 400,000 premature deaths each year 190,000 210,000 due to preventable harm due to diagnostic errors, errors of omission, and failure to follow guidelines 23016 1 3 03 3 5246136 80884 8 19 0 000195 0690 Medical errors can be prevented by technological innovations such as Electronic Health Records (EHR), Electronic Medical Records (EMR), and e-prescribing (eRx) Technological innovations in health care will help reduce Adverse Drug Effects (ADES) 800,000+ preventable ADES Occur each year in long-term care facilities 530,000 occur annually among outpatient Medicare patients Total ADES per year in the U.S. = 1.5 million not including omission Preventable drug injuries Adds $10,340 to the cost of the hospital stay 380,000 to 450,000 per year in the U.S. *adjusting for inflation from the 2006 estimate 2. Reducing Health Care Costs The estimated annual economic impact of preventable deaths is $100 billion $3 trillion spent annually on health care in the U.S. 2. Inadequacy of Paper Documentation As a result of outdated documentation practices, the U.S. health care system has become complicated and inefficient Patients are often treated by multiple doctors and nurses, involving multiple records at different locations Records must be physically transferred in order for each caregiver to provide holistic care, risking security concerns and loss of information Handwritten prescriptions are often illegible 23016 0211 3 03 53 52461355323 16 0211 3 2 053 51355323 Components of Health IT 18 19 0 618 000195 0 89 0690 67000 : 195 0 895 91 0 67000 2 0 Clinical Data Repository (CDR) Clinical Information System (CIS) A computer based system that is designed for collecting, storing, manipulating and making available clinical information important to the health care delivery process A database that collects patient information from various clinical sources and presents that information in a single document Clinical Decision Electronic Health Records (EHR) Support System (CDSS) Real-time, patient-centered records which make information available instantly and securely to authorized Active knowledge systems which use two or more items of patient data to generate case-specific advice users Electronic Medical Records (EMR) Computerized Physician Order Entry (CPOE) Contain the standard medical and clinical data gathered in one provider's office and are not easily shared with providers outside of a practice Enables a patient's care provider to enter an order for a medication, clinical laboratory or radiology test, or a procedure directly into the computer Electronic Medica- tion Administration Record (EMAR) Electronic Prescribing (eRx) Automatically documents the administration of medication into certified EHR technology using electronic tracking sensors Enables prescribers to electronically send accurate, error-free and under- standable prescriptions directly to a pharmacy from the point-of-care Mobile Devices Cloud Computing Smartphones have the potential to enhance productivity, lower fail- ure-to-respond rates and increase information access and communica- tion, among other benefits Enables providers to access lab results, imaging scans and other pertinent test results at any time and in any place Projected to become a $5.4 billion global industry by 2017, encompassing both clinicai and non-clinical applications Telemedicine Enables the pairing of specialists with physicians caring for patients to improve access to diagnostic tools and specific knowledge by using image capture and data transfer 0212 0E 23016 0211 0 3 03 53 2 05 Assessing the Progress of Health IT 23016 3 03 53 2 05 524613553 23 6 80884 84 4 1 19 0 618 048 000195 0 8959 0690 67000 2 5 52 51 8653 2 06 742 9 64 524613553 23 6 80884 19 0 618 048 000195 0 8959 84 4 1 0690 67000 2 5 52 51 8653 2 06 742 9 64 1. HIMSS Analytics EMR Adoption Model (EMRAM) The EMRAM scores hospitals in the HIMSS Analytics Database on their progress in completing the 7 stages to create a paperless patient record environment 7 STAGES O All three ancillaries not installed 1 All three major ancillary clinical systems are installed 2 Major ancillary clinical systems feed data to a CDR Required nursing/clinical documentation is implemented and 3 integrated with the CDR for at least one inpatient service in the hospital CPOE for use by any clinician licensed to create orders is added to the nursing and CDR environment along with the second-level of clinical decision support capabilities related to evidence based medicine protocols 5 The closed loop medication administration with bar coded unit dose medications environment is fully implemented Full physician documentation with structured templates and 6 discrete data is implemented for at least one inpatient care service area for progress notes, consult notes, discharge summaries or problem list & diagnosis list maintenance The hospital no longer uses paper charts to deliver and manage patient care and has a mixture of discrete data, document images and medical images within its EMR environment Q1 2014 Q2 5.6% 4.9% 3.2% 2.8% 7.2% 5.9% 27.7% 25.4% 15.7% 15.3% 24.2% 27.5% 13.3% 15% 3.1% 3.2% 2. EHR Adoption According to the Office of the National Coordinator (ONC) for Health Information Technology 56% 44% 16% 17% 12% 3% 2009 2012 more than Hospital adoption of at least a basic EHR system tripled increased six-fold Hospital adoption of comprehensive EHR systems Hospital adoption of at least a basic EHR without clinician notes more than tripled 3. Nurse Assessment of EHR A 2010 study of 16,352 nurses working in 316 hospitals in 4 states found the following: EHR Only 21 (7%) of the 316 hospitals in the sample had a basic EHR system implemented on all patient care units Nurses working in hospitals with a fully implemented basic EHR had a 14% decrease in the odds of reporting that "things fell between the cracks" when transferring patients between units 25% decrease in the odds of reporting that actions of hospital management show that patient safety is a low priority decrease in the odds of a unit receiving a poor grade on patient safety 18% 17% decrease in the odds of reporting a lack of confidence in patients' readiness for discharge The American Federation of Teachers (AFT) conducted a survey in 2010 of 604 hospital nurses They found 23% -49% of nurses said new computerized systems have had a negative effect on patient care of nurses said new computerized systems have had a positive effect on patient care 23% said they have not had any effect While 73% said implementation of the systems went smoothly, many problems were identified, including 52% who said physicians are refusing to use the new systems 23016 021 3 03 52461355323 6 23016 021 5 3 The Advancing Field of Nursing Informatics 3 03 5 2461355 3 80884 0 61 000195 0 0690 670 52 51 4 1 0 61 000195 0 0690 670 52 51 959 2 Based on several surveys conducted by the Healthcare Information and Management Systems Society (HIMSS) 1. Definition 2. Average Nurses' Salary $100,7 The American Nurses Association (2008) defines nursing informatics as $98,7 $83,7 a specialty that integrates $69,5 nursing science, computer science and information science to manage and communicate data, information, knowledge and wisdom in nursing practice 2004 2007 2011 2014 3. Size of Workforce 4. Education 3 million nurses nationwide 9,000 specialize'in informatics 2013 Post-graduate education Nearly two-thirds of nurse informaticists have a post-graduate degree in some field 5. Workplace Nurse Informaticist Titles have a master's degree or Ph.D. in either nursing informatics or other informatics (an increase from 21% in 2011) 23% are Nursing Informatics Specialists 7% are Clinical Analysts 6% are Application Analysts 5% are Directors of Nursing Informatics 4% are Consultants 01 03 46 88 2301 3 03 5246 3553 2 84 0211 0 32301 23 03 05246 8088 53 2 05 ADVENTIST UNIVERSITY OF I IEALTH SCIENCES SOURCES 8088 01 90 618 0001 5 0 8 019 60001 80690 59 0690 67000 2 Florida iHospital's University http://ehrintelligence.com/glossary/what-is-certi- fied-ehr-technology/ http://www.healthit.gov/providers-professionals/electronic-me- dical-records-emr http://www.healthit.gov/providers-professionals/leam-ehr-ba- sics http://www.eclinicalworks.com/knowledge-center-meaning- futuse-what-is-meaningful-use.htm http://www.himssanalytics.org/hc_providers/emr_adoption.asp http://www.aft.org/newspubs/news/2010/041610healthcare.cfm http://www.himssanalytics.org/docs/HA_EMRAM_Over- view ENG.pdf http://www.iom.edu/-/media/Files/Report%20Files/2006/Pre- http://www.cms.gov/Regulations-and-Guidance/Legislation/EH- RincentivePrograms/downloads/Stage2_HospitalCore_16_Electr onicMedicationAdminRec_EMAR.pdf http://ehrintelligence.com/glossary/clinical-data-repository-cdr/ http://www.openclinical.org/dss.html http://www.healthit.gov/sites/default/files/oncdatabrief9fi- nal.pdf http://www.ncbi.nim.nih.gov/pmc/articles/PMC3236066/ http://www.ncbi.nim.nih.gov/pmc/articles/PMC3197984/ http://www.amia.org/programs/working-groups/nursing-infor- matics http://www.amia.org/sites/amia.org/files/NI- WG-NOA-March-31-2014.pdf http://online.wsj.com/article/PR-CO-20140812-906773.html http://explorehealthcareers.org/en/Career/91/Nursing_Infor- matics http://www.amia.org/working-groups/nursing-informatics/histo- ry-project http://himss.files.cms-plus.com/FileDownloads/2014-Nursing-in- formatics-Survey-Full-Results.pdf http://journals.lww.com/journalpatientsafety/Fulltex- /2013/09000/A_New,_Evidence_based_Estimate_of_Patient_Ha ms.2.aspx https://www.premierinc.com/safety/topics/patient_safety/in- dex 1jsp#Responses%2010M-1%20government http://www.forbes.com/sites/danmunro/2014/02/02/annu- al-u-s-healthcare-spending-hits-3-8-trillion/ http://www.wolterskluwerlb.com/health/resource-center/arti- cles/2012/10/economics-health-care-quality-and-medical-errors http://www.m.com/getpdfphp/1860.pdf http://www.himss.org/files/HIMSSorg/handouts/NI101.pdf http://www.nursingworld.org/Nursing-Care-and-Improved-Out- comes.html#Role http://www.ncbi.nim.nih.gov/pmc/articles/PMC3384108/ http://www.amnhealthcare.com/uploadedFiles/Mainsite/Con- tent/Healthcare_Industry_Insights/Industry_Research/2013_RN Survey.pdf http://news.nurse.com/arti- de/20130916/NY01/130916001#.U_Vpvldwsp http://www.himssanalytics.org/data/annualstudy.aspx http://www.theamericannurse.org/index.php/2012/10/05/be- vent- ing-Medication-Errors-Quality-Chasm-Series/medicationerrorsn ewashx https://himssopoewiki.pb- works.com/w/page/20831139/Def%20CPOE http://www.cms.gov/Medicare/Quality-Initiatives-Patient-As- sessment-Instruments/ERxIncentive/index.html http://www.cms.gov/Regulations-and-Guidance/Legislation/EH- RincentivePrograms/ClinicalQualityMeasures.html http://www.hi7stan- dards.com/blog/2009/09/17/what-is-hqmf-health-quality-meas ures-format/ http://public.qualityforum.org/hitknowledgebase/Pages/eMea- sures.aspx http://www.biohealthmatics.com/technologies/his/cis.aspx http://www.aana.com/newsandjournal/News/Pag- es/022613-Bene- fits-and-Risks-of-Mobile-Device-Use-during-Patient-Care.aspx http://mobihealthnews.com/28694/wireless-ehr-mar- ket-to-hit-23b-in-2018/ http://www.americansentinel.edu/about-american-senti- neluniv- ersity/newsroom/american-sentinel-university-details-how-clou d-computing-has-the-potential-to-revolutionize-health-care http://www.federalnewsradio.com/538/3693879/VA-build- ing-on-My-Healthevet-successes-with-mobile-apps http://www.nursezone.com/nursing-news-events/devic- es-and-technology/The-Rise-in-Telemedicine_24030.aspx http://www.cms.gov/Research-Statistics-Data-and-Systems/- Com- puter-Data-and-Systems/Minimum-Data-Set-3-0-Public-Reports/ hind-the-technology/ index.html DDDE 28% 60%

I.T. in Nursing

shared by andrewdeen on Apr 13
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An in depth look into how internet technology can be used by nurses to optimize hospital operations.

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