Healthcare Informatics, Essay Example

Part One: Data Integrity

1. The hospital that I work in allows for patient-specific information to be transmitted by email and is often contained on reports.  We have technical policies in place for the use of encryption software, and all information is password protected.  However, the bigger problem that I’ve noticed is the tendency amongst some employees to ‘shoulder-surf’ when coworkers are using computers to write reports/update patient files/etc.  Sometimes these employees have legitimate reasons for their behaviour (such as consulting on a specific case), but oftentimes they seem to be driven by boredom or curiosity and thus violate the confidentiality of patient records.
2. In developing a research database it’s important to take into account the aims and desire outcomes of the projects that will utilize the database so as to avoid capturing data that is irrelevant or unnecessary.  At the same time, a high level of granularity will allow users to access detailed information that could prove crucial for the research aims.  High granularity with multiple fields will ensure that references and other information are easily accessible through specified search functions (McGonigle & Mastrian, 2009).
3. Profession-neutral coding schemes may be simpler to implement and cheaper (at least initially) to bring into the hospital or clinic setting because it can use a more general coding scheme that doesn’t need to take into account the unique specifications of the health care field. However, profession-specific coding schemes allow for the sharing of information between individuals, departments, and practice settings. For example, my work in cardiac care is dependent on the accurate tracking of medications and procedures that are implemented while a patient is under our unit’s care.  Profession-specific coding schemes enable me to quickly and efficiently find out what treatments have occurred for a patient when I begin my shift, and leave a similar level of detailed information for my colleagues and other health care professionals when I go home for the day (McGonigle & Mastrian, 2009).
4. National Unique Identifiers (NUI) will assist in developing a comprehensive national EHR by standardizing data across the country and within a variety of provider-settings.  This will increase confidence in the EHR program, especially once developers are able to demonstrate the high level of security involved.  NUIs will assist in authenticating health care providers to ensure that security breaches remain at a minimum.  The accurate identification of health care providers within the EHR will help to ensure that only authorized individuals are given access to patient EHRs.  Although I believe that the NUI will help to facilitate collaboration between health care professionals across the country (and eventually internationally), I have already seen how difficult it has been to start the process of nationalizing the EHR; I expect that the NUI will encounter similar logistical difficulties, especially when it comes to achieving cooperation between multiple agencies and organizations to implement the NUI successfully (Canadian Institute for Health Information, 2006).

References

Canadian Institute for Health Information. (2006 Apr). Updated background paper on national unique identifiers (NUI) for health providers. Ottawa, ON: Author. Retrieved from http://www.cihi.ca/CIHI-ext-portal/pdf/internet/2005_cihi_nui_paper_EN

McGonigle, D. & Mastrian, K. (2009). Nursing informatics and the foundation of knowledge. Boston: Jones and Bartlett Publishers.

Part Two: Telehealth

1. The hospital that I work at uses telehealth primarily as a means to communicate with off-site practitioners and other institutions and agencies.  For example, my unit uses video conferencing to discuss aftercare for cardiac patients with their primary physicians.  This is especially helpful with patients who live quite far from the hospital and do not necessarily have the means or ability to return to our location for follow-up care.  This also includes the transmission of digital images/records for consultation purposes with physicians/patients who live several hours away. I believe that we could also utilize telehealth as a means of intervening with cardiac patients to check their risk-factors and symptoms before they come to the hospital as well as for conducting conferences with patients and their physicians to prepare them for upcoming surgical procedures (McGonigle & Mastrian, 2009).
2. I’m of two minds when it comes to telehealth:  I believe that it has the potential to improve patient care, especially in the case of patients who live in remote areas; however, when it is used by individuals who haven’t received proper training or aren’t ‘on board’ about using new technologies.  I worry that client health might be compromised in situations where health care providers don’t have the traditional ‘face-to-face’ contact in which they can use their intuition, experience, and skills to assess the patient.  However, an awareness of the potential risks of this system will assist health care practitioners in ensuring that they take extra caution when delivering health care information through telehealth and will help keep them within the ethical parameters established by their field (Canadian Nurses Association, 2006).
3. Some of the best solutions to dealing with privacy in relation to telehealth are also the simplest ones.  A common sense approach to confidentiality would suggest that health care practitioners take special care when dealing with patient files and treatment plans relating to sensitive issues such as substance abuse or mental illness by ensuring that only those members of the treatment team are present during video conferencing sessions.  This could involve having a specific room with a door that locks to ensure that no one ‘accidentally’ intrudes on a conference.  This would also involve making sure that discussions about patient care always takes place in a private setting rather than in public areas such as nurses’ stations, elevators, and  hallways.  As in other discussions of privacy and informatics, telehealth applications need to be part of a secure system which utilizes passwords and other security features to make sure that access to patient files and EHRs are limited only to those with a specific and necessary interest in the patient (Canadian Nurses Association, 2006).

References     

Canadian Nurses Association. (2006). Telehealth: The role of the nurse. Retrieved from http://www.cna-aiic.ca/CNA/documents/pdf/publications/PS89_Telehealth_e.pdf

McGonigle, D. & Mastrian, K. (2009). Nursing informatics and the foundation of knowledge. Boston: Jones and Bartlett Publishers.

Part Three: The Future of Healthcare Informatics

1. I use a PDA in my work setting (hospital cardiac unit) and I’ve found it to be vastly superior to writing patient notes down just with a pen and pencil.  It is much less time consuming, I don’t have to worry about whether my penmanship is legible, and I tend to do more of my note taking ‘in the moment’ rather than back at the nurses’ station, which means that the information I input is much fresher and more accurate.  I’m fairly comfortable with a variety of new technologies (cellphones, Blackberries, laptop, etc.), so the learning curve wasn’t too steep when this device was first introduced, however I’ve seen the difficulty that some coworkers have operating their PDAs.  This provides a good opportunity to share knowledge and offer support.  One problem that I foresee is the future expense of updating from PDAs to Smartphones, which seem to be able to do what PDAs do already along with other capabilities such as telephone, video, and camera readiness.  Tooey and Mayo (2004) point out that change is inevitable when dealing with new technologies, and I hope that my colleagues who have had difficulty adapting to this new mode of record-keeping and information sharing will be more comfortable with digital tools when my hospital eventually updates our handheld devices.
2. In my role as a nurse educator in a cardiac surgical care unit, there are many opportunities to use a clinical decision support system.  One way in which I’ve used it has been to prepare detailed discharge instructions for patients with heart failure to make sure they’re aware of the medications they should be taking, and the behaviors that they should avoid.  My unit uses an electronic checklist which is filled out prior to discharge and printed out for the patient.  It also remains in the patient record as proof that the necessary steps were taken to inform the patient of what to expect in their recovery process.  It’s been my experience that recovering patients are often very focused on going home and resuming their normal activities in the hours before discharge.  Their excitement at the prospect of leaving the hospital often means that they aren’t listening with their full attention when nurses go over information about medications.  Thus, by having an electronic checklist and a hard copy for the patient (that can be accessed in the future should the patient misplace their copy), it becomes more likely that the patient will follow through on the steps necessary for recovery because they’ll have something tangible to read when they’re trying to remember what we told them (Tooey & Mayo, 2004).
3. I believe that the most significant change over the next decade will come from connecting provincial EHR and telehealth programs into one national system.  This will link patients with a variety of resources and ensure that their medical records will remain accessible to all health care professionals at every stage in their life.  Advances in information and communications technology are inevitable, and will become a welcome facet of health care in Canada.  There is likely to be some resistance from both patients and health care providers, especially in the area of security concerns and privacy issues, as well as logistical and bureaucratic issues.  However, especially given the large size of our nation and the number of patients currently without health care providers due to their remote locations, it is crucial that all health care providers take steps to educate themselves and their patients about the benefits of their EHR and telehealth programs. I also believe that the younger generation of health care professionals will help to expedite this process because they don’t tend to possess the fear or distrust of technology of some of their older counterparts.  The ease with which younger generations use technological devices and embrace new technologies will facilitate this process to the point where, a decade or two from now, we’ll wonder how we ever got along without EHRs and telehealth programs (Canadian Nurses Association, 2009).

References

Canadian Nurses Association. (2009). The next decade: Canada’s vision for nursing and health. Retrieved from http://www.cna-aiic.ca/cna/resources/next-decade/default_e.aspx

Tooey, M.J. & Mayo, A. (2004). Handheld technologies in a clinical setting: State of the technology and resources. Critical Care Nurse, Career Guide 2004, 28-30, 32, 34-36.