APA 500

Role& Strategies

What role do nurses have in selecting and evaluating information systems within your work environment? What strategies facilitated implementation of the information system and/or what were the barriers to implementation?

Submission Instructions:

·

Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.

·

Online Materials & Resources

· Visit the CINAHL Complete under the A-to-Z Databases on the

University Library’s

website and locate the articles below:

· Parker, C. D. (2014). Nursing informatics leadership: Helping craft the profession’s future. Nursing 2014, 44(12), 23–24.

· Doran, D., Haynes, B. R., Estabrooks, C., Kushniruk, A., Dubrowski, A., Bajnok, I., et al. (2012). The role of organizational context and individual nurse characteristics in explaining variation in use of information technologies in evidence-based practice. Implementation Science, 7, 122. DOI: 10.1186/1748-5908-7-122

· Explore/View the website(s) below:

· HRSA PRESS OFFICE. (2012, December). Affordable Care Act helps expand the use of health information technology | Official web site of the U.S. Health Resources & Services Administration. Retrieved from https://www.hrsa.gov/about/news/press-releases/2012-12-20-health-center-networks.html

· (Links to an external site.)

·

· Informationweek. (2014, February 10). 3 Ways Affordable Care Act Can Empower Health IT – InformationWeek. Retrieved from https://www.informationweek.com/healthcare/leadership/3-ways-affordable-care-act—can-empower-health-it/d/d-id/1113758

· (Links to an external site.)
·

· QSEN. (2019). Learning Module 4. Retrieved from http://qsen.org/faculty-resources/courses/learning-modules/module-four/

· (Links to an external site.)
·

· Master Recerca Salut. (2014, March 27). INFORMATION TECHNOLOGY TO SUPPORT NURSING DECISION-MAKING [Video file]. Retrieved from

· INFORMATION TECHNOLOGY TO SUPPORT NURSING DECISION-MAKING

· (Links to an external site.)
·

Chapter 7

Applications for Managing Institutions Delivering Healthcare

Copyright © 2014 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Introduction
Definition of health information systems
Marketplace for administrative information systems in healthcare
Chapter focus
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2

Health information systems are “complexes or systems of processing data, information and knowledge in health care environments” (Haux, 2006, p. 270).
 Vendors comprise a $12 B marketplace.
 This chapter focuses on the administrative applications within health information systems designed to facilitate the management of healthcare delivery. The chapter will consider in turn financial, practice management, material management, human resources, and business intelligence systems.
2

Basic Financial Systems
General ledger
Payroll system
Patient accounting system
Claims processing and management system
Denial management system
Contract management system
Fixed asset management system
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3

Discuss the systems listed and some of the challenges of FIS.
Challenges with FIS
Integration of Information Systems
Resource Allocation for Information Systems
3

Financial Information System Architecture
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4

Figure 7-1.
4

Financial Information System Architecture (Cont.)
Common Reports Used by Healthcare Organizations
Income statement
Balance sheet
Cash flow statement
Financial Information System (FIS)
“Bolt-ons”
Revenue cycle management
Efficiency Tools
Productivity tools
Reporting tools
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5

Discuss Figure 7-3, The revenue Cycle Function
5

Practice Management Systems
Patient Record
Master patient index
Electronic health record (EHR)
Patient Outreach System
Electronic registry
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6

The Master Patient Index serves as a unique patient identifier.
Discuss how the EHR facilitates the medical records function.
Patient Outreach system facilitates preventive care and the management of chronic illnesses
6

Practice Management Systems (Cont.)
Online Billing and Payment Tool
Billing at point of service
Follow-up billing
Hospital-Physician Connection
Provider expectations of information systems
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7

Discuss box 7-1
7

Material Management—Health Care Supply Chain
Definition of material management
Material management within the context of supply chain management
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8

Material Management in healthcare is the storage, inventory control, quality control and operational management of supplies, pharmaceuticals, equipment and other items used in the delivery of patient care or the management of the patient care system.
 
Material management is a subset of the larger function of supply chain management (SCM); the supply chain also includes the acquisition of materials of care and the logistics or movement of those materials to caregiving facilities and organizations
Why are information systems needed to manage medical materials?
8

Material Management— Key Files in the Supply Chain Information Management System
Supply item master file
Charge description master file
Vendor master file
Transaction history file
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9

The supply item master file is a list (hardcopy or electronic) of all items used in the delivery of care for a health organization that can be requested by healthcare services providers and managers. This file typically contains between 30,000 and 100,000 items.
 
The charge description master file is a list of all prices for services (DRGs, HCPCs, CPT-4s for example) or goods provided to patients and serve as the basis for billing.
The vendor master file is a list of all manufacturers or distributors (vendors) who provide the materials needed for the healthcare organization and contain the associated contract terms and prices for specific items. This file typically contains between 200 to 500 different vendors/suppliers. And
 
The transaction history file is a running log of all material transactions of the healthcare organization.
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Material Management—Supply Charge Capture
Integration with clinical point-of-care operations
Information systems that enable efficient charge-capture yield
Principles necessary for success
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10

Material Management—Supply Chain Principles
Strategic factors associated with supply success and enhancement
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11

Information system usefulness, electronic purchasing, and integration
Leadership supply chain expertise
Supply chain expenditures
Surgeon and physician level of collaboration
Nurse and clinical staff level of collaboration
Leadership team’s political and social capital
Capital funds availability
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Material Management Clinical—Considerations of Supply Chain Operations
Nursing unit needs and physician needs are addressed.
Physical layout variations may require modification to an accepted standard.
Business process must be efficient before a technological solution can be integrated into the process.
“One size” solution will not fit all.
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12

Human Resources Information Systems
Definition of human resources information systems
Human resources information systems vendors
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13

13

Human Resources Information System (Cont.)
Personnel Administration
Centralized and integrated management of employee data
Personnel records maintenance
Strategic and Operational Management
Technological infrastructure
Competitive advantage
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14

Human Resources Information System (Cont.)
Staffing and Scheduling
Definitions of staffing and scheduling
Features of enterprise staffing and scheduling software
Innovative scheduling solutions
Open-shift management
Incentive management
Predictive scheduling
Training and Development
Using technology to plan, manage, and deliver training
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15

Human Resources Information System (Cont.)
Compensation, Benefits and Pension
Administration, and Payroll Interface
Automation of financial services
Functions
Oversight of compensation history
Support of payroll and benefits administration
Reference to the budgeted salary pool
Online self-service
Performance Evaluation
“Talent Management” and “Performance Management”
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16

Human Resources Information System (Cont.)
Underrepresented Subsystems
Labor relations
Expense and travel
Health and safety
Competitive Advantage
Five dimensions of managing human resources capability

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17

Business Intelligence Systems
Definition of business intelligence
Business intelligence platform
Survey of business intelligence vendors
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18

Business Intelligence Platform
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19

Figure 7-6 from text
19

Conclusion and Future Directions
Information technology (IT) productivity paradox—lesson learned
Promises, promises—impact of information technology on:
Quality
Analysis of data
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. All rights reserved.
20

Chapter 6

Electronic Health Records and Applications for Managing Patient Care

Copyright © 2014 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Electronic Medical Record
versus Electronic Health Record
Electronic medical record (EMR)
Is an all-inclusive record that is institution specific.
Does not interact with outside systems.
Is provider controlled.
Electronic health record (EHR)
Is the favored term for a lifetime patient record.
Includes data from all specialties.
Patient can interact with the system.
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. All rights reserved.
2

2

Components of an Electronic Health Record
Administrative processes
Electronic communication and connectivity
Decision support
Health information and data
Order entry management
Patient support
Results management
Population health management
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3

Electronic Health Record Adoption
Interoperable EHR is mandated (2004).
EHR collaborative is formed to support rapid adoption.
Key capabilities of an EHR system are developed.
The Health Information Technology for Economic and Clinical Health (HITECH) Act was enacted (American Recovery and Reinvestment Act [ARRA], 2009).
Uses health information technology to improve healthcare quality, safety, and efficiency.
Stimulates EHR adoption and health information exchange networks.
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4

4

Meaningful Use
Provides incentives for providers who:
Implement and use certified EHR technology
Meet objectives of meaningful use
Stage 1 began in 2011 and will end in 2014.
Stage 2 starts in the fiscal year 2014.
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5

Health Practitioner Role in Electronic Medical Record Adoption
Provide care coordination and patient education.
Assist in designing clinical decision support systems.
Assist with developing data set standards.
Engage in local, regional, and national initiatives to improve care.
Collaborate with the patient and other providers to manage care.
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6

Providing care coordination and patient education are key objectives of the Meaningful Use requirements.
Health practitioners assist in designing clinical decision support systems that can be used to enhance patient adherence to disease management.
Other activities include developing data set standards to improve outcomes, increase patient safety, and evaluate quality of care.
Engage in local, regional, and national strategic initiatives to improve care coordination using EHRs and HIE.
6

Computerized Provider Order Entry
Allows providers and clinicians to enter orders via the computer.
Medications, laboratory and diagnostic tests, consultations
Interfaces with other EHR components to process orders.
Order management system allows orders to be:
Entered
Tracked
Processed
Updated
Completed
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7

Discuss the benefits and medical errors related to CPOE.
Benefits:
Reduce medication errors
Improved drug dosing
Decrease number of allergic reactions
Decrease transcription errors
Decrease medication turn-around time
Decrease length of stay
Lowered costs
Improved quality of care
Faster results reporting
Medical Errors:
Process of entering and retrieving information
Communication and coordination
Fragmented data and processes
Lack of integration among systems
Human-computer interaction issues
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Electronic Medication Administration Record
Electronic medication administration record (eMAR) is the medium to view and document medication use.
Orders are entered via computerized provider order entry (CPOE) and verified by the pharmacy.
eMAR includes the drug name, administration time, dose, and route.
Can be displayed in a variety of ways (e.g., scheduled, as needed, pending, past due, completed).
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8

Bar Code Medication Administration
Bar code medication administration (BCMA) is best combined with a CPOE, the pharmacy dispensing system, and an eMAR.
Is designed to prevent errors during medication administration.
Scanner verifies the five “rights.”
Right patient
Right drug
Right dose
Right time
Right route
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9

Discuss the benefits of BCMA:
Easy to use
Reduce medication errors
Save time
Improve medication documentation
9

Clinical Documentation
Records, manages, and reports patient care activities through software application.
Format may differ by application and organization.
Using standardized vocabularies and taxonomies has advantages.
Should support clinician workflow.
Offers functionality for plans of care, decision support, viewing, and trending data.
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10

Discuss the benefits of clinical documentation.
Better communication between providers
Promote profession accountability
Streamline workflow
Access to literature sources, guidelines, policies, procedures
Support EBP
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Specialty Applications
Are also referred to as “niche” systems
System is designed for specific departments or groups of users.
May stand alone or be integrated or interfaced with EHRs.
Examples include:
Perioperative or surgical services
Maternity care
Neonatal intensive care
Emergency department
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11

Clinical Decision Support
Provides tools and applications that assist with decision making.
CPOE may include alerts for duplicate orders, allergies, and dosing errors.
Reminders are related to the patient’s condition, follow-up, preventive care, and immunizations.
Internal and external links to resources are provided.
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12

Ancillary Systems
Software programs are used by support departments.
Common systems include:
Laboratory Information System (LIS)
Radiology Information System (RIS)
Pharmacy System
Are designed to address the specific needs of a department.
Collect, process, and report results, as well as manage resources and costs.
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13

Consumer Perspectives
Saves time.
Streamlines registration.
Tracks his or her own health record.
Improves quality of care.
Reduces duplicated services.
Increases engagement in healthcare decisions.
Provides safer emergency care.
Accesses online medical information.
Provides appointment reminders.
Offers educational resources.
Offers greater control over personal health outcomes.
Supports patient privacy and confidentiality.
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14

Nursing Perspectives
Increases productivity.
Improves performance.
Enhances effectiveness.
Supports clinical care.
Provides centralized access to patient information.
Improves clinical documentation.
Monitors patient status.
Provides resources for patient education.
Improves discharge follow-up with patients.
Supports compliance with regulatory requirements.
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15

Healthcare Provider Perspectives
Increases efficiencies related to billing and care coordination.
Accesses current and past medical records.
Stores patient information.
Facilitates a partnership between the physician and the patient.
Improves overall office operation.
Increases patient teaching by sharing online medical information.
Improves prescribing and medication safety.
Improves decision making, which can reduce liability.
Supports compliance with quality and regulatory requirements.
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16

Healthcare Organization Perspectives
Improves efficiency.
Strengthens communications.
Increases patient safety.
Supports compliance.
Improves record security and storage.
Improves care coordination.
Enhances the quality of care.
Offers faster turnaround.
Offers better disease management and reporting of services.
Supports pay for performance.
Can integrate with billing and coding structures.
Provides data to control costs and manage expensive procedures.
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17

State and National Government Perspectives
Improves the coordination of care.
Improves the quality of care.
Reduces medical errors.
Shares data across organizations.
Provides a dataset for public health and research.
Improves overall healthcare for all citizens.
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18

What improvements are needed?
Nationwide interoperable EHR
Health Information Exchange Networks
Communication Standards
Nomenclatures, Taxonomies, Vocabularies
Coding Structures
18

Key Issues
Cost
Ownership
Data integrity
Privacy and confidentiality
Standards
Organization culture
Human factors
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19

Cost
Providers may spend 54,000 – 100,000 for EHR
Hospitals may spend 100 million or more
Additional costs for maintenance, support, upgrades, training, etc.
Unclear who will pay for links to health information exchange
Ownership
Traditional records owned by service facility
Cross-institutional records will make ownership more complex
Consumer consent and critical elements of nationwide HER
How will this impact documentation and access?
Data Integrity
Refers to the accuracy and consistency of stored and transmitted data
Data can be compromised if:
information is entered incorrectly
deliberately altered
system protections are not working correctly
system suddenly fails mutual understanding of terms and improved communication among healthcare professionals along with a common way to collect and aggregate data. A universal language would allow us to consistently capture, represent, access, and communicate clinical data, information, and knowledge across all settings.
Privacy and Confidentiality
Major concern for healthcare
Patients must feel free to reveal personal information
Healthcare provider must treat patient information confidentially
Security of information is required
Increased risk for unauthorized use and disclosure of confidential patient information
Standards
EHR implementation hindered by
disagreement on which terminologies to use
lack of standards to harmonize multiple coding structures
cultural and language barriers
interpretation of meaning
threats to autonomy
user resistance
Organizational Culture
User Resistance major issue:
lack of computer skills
complexity of application
lack of available hardware
difficulty adjusting to change
interferes with routine workflow
takes time away from bedside
impact on clinician role
Human Factors
Problems with usability
Complex human-computer interfaces
Poorly designed systems
Lack of training
Increased cognitive workload
Unnecessary clerical tasks
Overly structured data entry requirements
Fragmented data retrieval designs
Address Issues
Early user involvement
Attention to system design and testing
Adequate technical support
Training
19

Future Directions
Personalized medicine
Genetic testing
Customized medications
Expansion of a national EHR
Global sharing of health information
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20

Chapter 3

Evidence-Based Practice and Informatics

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Evidence-Based Clinical
Decision Making
Choices are based on the idea that research-based care improves outcomes.
What intervention will most likely diminish the health problem?
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2

Quality of Care
Is the “degree to which health services to individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.”
(Institute of Medicine [IOM], 1990)
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3

Quality of Care (Cont.)
Quality of care lags behind knowledge.
Evidence-based practice (EBP) is considered as a solution.
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4

How is EBP a solution?
4

Agency for Healthcare Research
and Quality (AHRQ) Annual Report
Data are gathered from 36 databases.
Healthcare quality in America is suboptimal.
Gap between the best possible and routine care is substantial.
Small gains are being made.
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5

Institute of Medicine (IOM)
2001 Report
STEEEP redesign:
Safe
Timely
Effective (EBP)
Efficient
Equitable
Patient-centered
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6

Evidence Hurdles
VOLUME of literature:
No unaided human being can read, recall, and act effectively on the volume of clinically relevant scientific literature. (IOM, 2001, 25)
FORM of knowledge:
Not every knowledge source is suitable for informing clinical decisions. (ACE Star Model, 2004)
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7

ACE Star Model of Knowledge Transformation
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8

Figure 3-1.
8

Knowledge Transformation
Is the conversion of research findings from a single research study through a series of stages to impact health outcomes.
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9

Premises of the Star Model
Knowledge transformation is necessary before research results are usable in clinical decision making.
Knowledge is derived from a variety of sources. In healthcare, the sources of knowledge include research evidence, experience, authority, trial and error, and theoretical principles.
The most stable and generalizable knowledge is discovered through systematic processes that control bias, namely, the research process.
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10

Premises of the Star
Model (Cont.)
Evidence can be classified into a hierarchy of strength of evidence. The relative strength of evidence is largely dependent on the rigor of the scientific design that produced the evidence. The value of rigor is that it strengthens cause-and-effect relationships.
Knowledge exists in a variety of forms. As research evidence is converted through systematic steps, knowledge from other sources (e.g., expertise, patient preference) is added, creating yet another form of knowledge.
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11

Premises of the Star
Model (Cont.)
The form (i.e., package) in which knowledge exists can be referenced to its use; in the case of EBP, the ultimate use is its application in healthcare.
The form of knowledge determines its usability in clinical decision making. For example, research results from a primary investigation are less useful to decision making than a clinical EBP guideline.
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12

Premises of the Star
Model (Cont.)
Knowledge is transformed through the following processes:
Summarization into a single statement about the state of the science
Translation of the state of the science into clinical recommendations, with the addition of clinical expertise, the application of theoretical principles, and client preferences
Integration of recommendations through organizational and individual actions
Evaluation of the impact of actions on targeted outcomes
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13

Point 1: Discovery Research
Knowledge produced through primary discovery
Knowledge is in the form of results from a single research study.
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14

Point 2: Evidence Summary
Includes:
Evidence synthesis
Systematic reviews
Integrative reviews
Reviews of literature
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15

Point 3: Translation to Guidelines
Experts are called on to consider the evidence summary, fill in gaps with consensus expert opinion, and merge research knowledge with expertise to produce clinical practice guidelines (CPGs).
For example, research becomes clinical recommendations.
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16

Strength-of-Evidence
Rating Hierarchy
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17

Figure 3-2.
17

Point 4: Practice Integration
Integrate clinical findings into practice.
Can involve change at varying levels.
Individual
Organization
Policy
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18

Point 5: Evaluation
Evaluate the impact of the change:
Redesign of care
Effectiveness of the care in producing desired patient outcomes
Patient outcomes
Population outcomes
Efficiency and cost factors in the care (short- and long-term)
Satisfaction of both providers and patients
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19

Conclusion and Future Directions
The EBP frameworks provide a foundation upon which informatics solutions can be constructed to move evidence into practice.
Information exchange, integrating interoperability standards into vendor products, and data linkage are critical for advancement.
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20

Chapter 1

Introduction: The Evolution
of Health Informatics

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Introduction
Health informatics incorporates processes, procedures, theories, and concepts from:
Computer and informatics sciences
Health sciences (e.g., nursing or medical science)
Social sciences (e.g., cognitive and organizational theories)
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2

Informatics Roots
Nurses and other healthcare professionals apply computer and information sciences to healthcare problems.
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3

Computer Science
Uses mathematics and engineering to study methods for representing and transforming data.
Evolution of computers:
Human “computers” – prone to error
Babbage approach – input and output
Electronic numerical integrator and computer (ENIAC) – moved from mechanical to electronic power
Personal computer (PC) – increased use and computer literacy
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4

What is the next step in this evolution?
4

Information Science
Key dates:
1937 – The American Documentation Institute was established.
1948 – Royal Society of Great Britain held a conference.
1963 – First information science textbook was published.
1964 – Medical Literature Analysis and Retrieval System (MEDLARS) database was established.
1971 – National online access to MEDLINE was provided.
1972 – Physicians and other health scientists were trained in the use of computer technology for the delivery of healthcare.
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5

Health Informatics
Dates to the 1950s
Informatics: The study and use of information technology to the arts, sciences, and professions; and its use in society as a whole
Medical informatics: Branch of informatics that focuses on disease diagnosis and management
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6

Establishing the Specialty
of Health Informatics
Health informatics, a new specialty, is evident in the:
Publishing of health informatics books
Development of new journals
Establishment of professional organizations
Number of informatics conferences that are now recurring events
Creation of university-level educational programs
Development of certification programs
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7

General Trends in the Development of Knowledge within a Discipline
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8

Figure 1-1.
8

Books
Books were first published in the 1960s.
The use of the word informatics in a book title did not appear until 1971.
Today, most, if not all, of the major publishers in the healthcare arena publish books related to health informatics.
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9

Journals
New journals began to be published in the 1960s.
The first peer-reviewed informatics journal, Computers in Biomedical Research, began publishing in 1967.
The first journal article using the term nursing informatics was indexed in MEDLINE and Cumulative Index to Nursing and Allied Health Literature (CINAHL) in 1986.
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10

Professional Organizations
American Medical Association (AMA)
International Medical Informatics Association (IMIA)
Symposium on Computer Applications in Medical Care (SCAMC)
American Association for Medical Systems and Informatics (AAMSI)
American College of Medical Informatics (ACMI)
American Medical Informatics Association (AMIA)
Healthcare Information and Management Systems Society (HIMSS)
Alliance for Nursing Informatics (ANI)
American Health Information Management Association (AHIMA)
Council on Computer Applications in Nursing
National Forum on Computers in Healthcare and Nursing
Capital Area Roundtable on Informatics in Nursing (CARING)
American Nursing Informatics Association (ANIA)
Association of Record Librarians of North America (ARLNA)  American Association of Medical Record Librarians (AAMRL)
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11

Educational Programs
1950s: Educational programs began.
1964: One of the earliest medical informatics departments was established.
1977: First computer-related nursing course was conducted.
1984: Integrated Advanced Information Management Systems (IAIMS) grant program was announced.
2009: The Health Information Technology for Economic and Clinical Health (HITECH) Act gave funding to programs.
2012: Medical informatics and nursing informatics were both established as subspecialties of health informatics.
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12

What did the IAIMS grant program do?
12

Certification
2011 breakdown of the Certified Professional in Healthcare Information and Management Systems (CPHIMS) certification:
68.5%—Registered nurse
18.3%—Medical physician
8.8%—Registered pharmacist
4.4%—Other
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13

Recognition of the Specialty
Health informatics is a specialty within:
Computer science
Information science
In each of the various healthcare disciplines or in:
An interdisciplinary healthcare specialty with students from different healthcare specialties combined; or
A new specialty distinct from its historical roots in the other disciplines
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14

Naming the Specialty
1950s—Bioengineering
2002—Health Informatics
2006—Biomedical Informatics
Led to health and biomedical informatics

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15

Umbrella Model of Health Informatics
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16

Figure 1-2.
16

Venn Diagram Model
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17

Figure 1-3.
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AMIA Position: Biomedical Informatics and its Areas of Application and Practice
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. All rights reserved.
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Figure 1-4.
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Hierarchy of Informatics
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. All rights reserved.
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Figure 1-5.
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Conclusion and Future Directions
Health informatics is influenced by:
Healthcare professionals
Healthcare organizations
Infrastructure
Advances in technology
Health informatics will evolve to shared, core competencies, knowledge, and skills, rather than emphasizing differences.
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. All rights reserved.
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