Using Informatics in Your Clinical Area, Research Paper Example

Introduction

I work in the long term care branch of the nursing profession.  Our department is still making use of the conventional rolling medication charts and paper charting.  The larger Health System, of which we are an integral part, is using electronic information systems in such areas as bar-coding, e-medical records, and medical administration.  This paper looks at aspects of systems integration and where substantive improvements might be made in the technology and management information systems.  Specific examples will be examined together with three key areas of research :

• where paperwork might be streamlined or eliminated in favor of an electronic communications approach;
• the concept of decision support tools and how this might facilitate nurses in long term care;
• how informatics might contribute to patient safety and general improvements in this area;

Hence, if the technology is available, why is it not being deployed now and supporting more effective nursing care for the patients?

Use of Technology

The use of Information Technology undoubtedly has an important subordinate role to play in the nursing profession.  It is a vital assist in improving the accuracy and quality of information and the storage and retrieval of same.  A definition in this area might be ” nursing informatics is the use of technology and/or a computer system to collect, store, process, display, retrieve, and communicate timely data and information in and across health care facilities ”  (Spath).  One of the historic problems with the use of Information Technology is the way it has been deployed.  All too often we see pockets of automated concepts without realising the full benefits of systems and data integration.  The IT profession terms such structures as ” Islands of Automation” , by definition you can swim around the Islands but they are not interfacing  or communicating with one another.  This becomes compounded when you consider other vital service areas that are not brought into the shared information loop. With nursing in long term care this might mean access to social services records, access to local GP records and details of any family or personal records or information that may be beneficial to the general patients care or wellbeing.  Some of the key issues which have prevented more widespread use of technology are around patient confidentiality, shared access of information, computer security and communications i.e. the transmission of information around different regional geographical locations.

Within my own business area, we are still using rolling medication cards and paper charting. The elimination of paper might be dispensed with if we moved to the use of more “hand held devices” like computer tablets.  Specific document templates could be pre-loaded into the devices, together with any necessary programmable algorithms.  The nurses would then simply need to enter relevant data.  Wireless access to local print servers could produce any limited hard copy information.  The entered information could then update a central server relational database and the information would become immediately available to other interested parties.  This real-time system concept would save duplication of effort, streamline administrative and paper production, generally improve the accuracy and efficiency of data.  In addition to cost reduction it would free the nurses up to focus on core business i.e. the nursing and welfare of their patients.  The software applications could equally take submitted data and produce any charts or graphical statistical information required.

Decision Support

The Concept of decision support in nursing is equally supported by increased integration of technology.  Decision support in this context defined as “Clinical Decision Support Systems are “active knowledge systems which use two or more items of patient data to generate case-specific advice” (Spiegelhalter, 2009).  Decision support systems are an instrumental part of the clinical management technology facilitating clinical process from diagnosis through to long term care.  There are four key areas of decision support in the nursing arena:

1. Administration –  Use of clinical coding and authorization of procedures
2. Clinical Complexity  – Tracking orders, referrals, follow-ups, preventative care, maintaining drug records and chemotherapy protocols
3. Cost Control – Monitoring medication orders and avoiding duplicity of recording
4. Decision support – Clinical treatment planning and procedures, use of best practices, maintaining guideline records

Decision Support tools are most likely to be used by the patients when looking for the best types of long care nursing.  Information technology can be extremely useful in enabling research to be conducted over the range of options and inquiries that you might have ” It can be the starting point in the search for long term care. Geography more than the long term care offered is the normal point of search  inquiry.  ‘Was it available near where I ( or my parents or family members) live?’ Consumers also used decision support systems to find out about insurance cover options”  (California Health Care Foundation, 2009)

Decision support systems have been used with helping patients to decide on preferences in their support and care systems.  This helps the nurses to profile individual patients and put forward the most suitable nursing options “Information about patient preferences changed nurses’ care priorities to be more consistent with patient preferences and improved patients’ preference achievement and physical functioning. Further, higher consistency between patient preferences and nurses’ care priorities was associated with higher preference achievement, and higher preference achievement with greater patient satisfaction.”  (Rulland, 1999)

Urgent Need Assessment Nurses have been piloting a new Decision Support system in a North England Hospital.  The nurses have been trained to utilize their emergency accident experience and work with computers in order to make an early assessment of the emergency situation.  This is done in consultation with the patient by sharing information displayed on the computer screen and jointly agreeing on a first step procedure.   This has led to faster treatment and reduced waiting times in Accident and Emergency rooms.  This has in turn resulted in increased patient satisfaction and the ability of the hospital to concentrate resources on more serious and urgent cases.

Patient Safety

Computer Technology also has an important role to play with regard to patient safety.  “Information technology can reduce the rate of errors in three ways: by preventing errors and adverse events, by facilitating a more rapid response after an adverse event has occurred, and by tracking and providing feedback about adverse events”  (David W. Bates, 2003 p. 233).  The science behind medicine and nursing is increasing in technical complexity.  This is most significant in the area of clinical research focusing on diagnosis and treatment.  As to date not a great deal of attention has been placed on refinement of operating procedures applicable to medical safety.  The science needs to make significant gains in quality control and information technology will play a significant part here.

In 2009 the real verdict on IT and increased patient safety is still out.  Nobody would doubt the fact that technology makes and important contribution to the medical profession but more substantive evidence needs to be produced on the overall contribution to that of patient safety.  Further investment and research is required in this specific area “Using four years of Medicare inpatient data, we found that electronic medical records have a small, positive effect on patient safety. Although these results are encouraging, we suggest that investment in health IT should be accompanied by investment in the evidence base needed to evaluate it.”  (McCullough, 2009 p 182)

Concluding Remarks

During the last ten years the nursing profession, within the field of long term nursing cares, has moved towards development of more general individual level data collection systems. These forming the basis of measures for quality performance.  In 1986 it was considered that general home nursing quality was poor and the community providers invested little in terms of supporting the changes required to improve the quality of care.  Technology is vital for improving the information gathered for the quality of care provided and helping to develop strategies to improve same.  “Such information is of interest to many constituencies, including consumers, caregivers, provider organizations, managers, regulators, purchasers, and researchers. Consumers and their advocates want information to guide the selection of care providers, monitor current care, inform efforts to encourage and promote system-wide improvements in long-term care, and work with their providers to improve quality of care. Providers want such information to target their efforts toward improving care processes and outcomes”  (Kohler, 2009)

References

California health care foundation. (2009). California health care foundation. Retrieved January 30, 2010, from http://www.myccl.ca.gov/res/docs/RCFE/d1.pdf

David W. Bates, M. a. (2003). Improving Safety with Information Technology. New England Journal of Medicine .Vol :348 :252-62534

Kohler, G. S. (2009). Improving the quality of long term care. Institute of Medicine .

McCullough, S. T. (2009). Health Information Technology And Patient Safety: Evidence From Panel Data. Health Affairs , 357-360.

Rulland, C. M. (1999). Decision Support for Patient Preference-based Care Planning. Americal Medical Infomatics Association , 304-312.

Spath, P. L. (2003). Reducing health care errors; health informatics and nursing; using the Internet as a resource – Book Review. AORN , 284.

Spiegelhalter, W. J. (2009). Decision Support Systems. Open Clinical.