Healthcare Technology and Nursing Leadership

Reforming Healthcare Through Technology Initiatives

 

The implementation of the electronic medical record has brought with it several advantages for the heath care system. Along with providing access to a patient's medical record from anywhere, patient safety sets are preprogrammed into technology to guide the nurses clinical behavior. These sets are used to improve quality care and improve patient outcomes. The EHR is collecting data every day to be used in improving processes and trending diagnosis to be used in population health management. Many organizations are turning to big data warehouses to utilize data about demographics, diagnosis and interventions from other organizations that are close to their size and operations to influence the quality of care being provided. it will also help to focus on patient engagement initiatives. Big data can be accessed in real time and will play a part as health care switches to a value based model. The relationship between quality and cost will play a huge role in the years to come.


Standardized Quality Care

Nurses as a profession need to play a part in the implementation of these technology initiatives so that the workflow of the nurses is cohesive with the technology. Having nurses at the table from the beginning will help with the role out and buy in from the end users. If the nurses are familiar with the technology and understand the purpose and the goal, the impact of the implementation will not be as great. Technology is being used as a means to reduce errors and improve quality care. Nurses need to understand meaningful use of the EHR and the incentives behind the implementation. Organizations that are not on board with an EHR or technology to reduce errors are going to find themselves left behind.

Patient Safety and Quality Care

 

 

 

Identifying and using a standardized language for documentation will also help improve outcomes and safety for patients. Data mining is time consuming because of the different coding systems used by different organizations. The EHR's need to have a way for the clinical care to be documented and utilized by all of the interdisciplinary team while treating the patient. There are EHR's now that can be linked to each other across the country to look up a patient's medical record while treating that patient in a different location. Trying to sort through codes and documentation is a waste of valuable time while the patient is being cared for.

 

 

 

Health care organizations are feeling the pressure to improve the quality of care and safety, while decreasing costs and increasing revenue. Providers and organizations are being asked to do more with less. The advent of technology is being used as a way to increase efficiency, and improve productivity across the organizations. As a team, technology can be used as an improvement tool and not as a requirement.

 

References

Glaser, J., & Hess, R. (2011). leveraging healthcare IT to improve operational performance. Healthcare Financial Management, 82-85.

Huryk, L. (2010). Factors influencing nurses attitudes toward healthcare information technology. Journal of Nursing Management, 18, 606-612.

Moore, K., Eyestone, K., & Coddington, D. C. (2013, August). The big deal about big data. Healthcare Financial Management, 61-68.

Piscotty, R. J., Kalisch, B., & Gracey-Thomas, A. (2015). Impact of healthcare information technology on nursing practice. Journal of nursing scholarship, 47(4), 287-293.

 

 

 

 

 

 

 

 



A Workflow Solution

Improve Workflow

and

Remove the Waste!

Workflow can be described as the movement of documents and tasks through a business process. It can be a sequential progression of activities or complex processes taking place concurrently. As organizations rush to implement EHR's for incentive payments, they are not realizing that this is only one tool available to transform health care. Transformation of health care includes enhancing quality care, improving patient safety, expanding access to care and reducing the cost of care. Introduction of new technology often distracts us from our primary tasks.

In the transfer center there is a process that needs to be redesigned to improve quality care, decrease costs and improve patient outcomes. The process in which an accepting physician is contacted for a possible transfer of a patient from a referring facility that does not have the ability to care for the patient. This may be because they need a higher level of care than what is available at that facility or they need a specialty service that is available at our facility. Currently, the process is not efficient and there is a tremendous amount of wasted time that the patient, referring facility and transfer center nurses do not have a surplus of.




Workflow                                                                       Remove the Waste









 One barrier to the new design would be, " this is how we have always done it." Workflow and process redesign must consider the exiting patterns of care delivery and the ways to make them better along with the way human being process their environment. Human being make quick assumptions based on experiences.

The growing use of mobile electronic devices has resulted in the smarter technologies for operating systems. IPhone and Ipad have 500,000 app available for them as of 2012. These devices are being used by providers on a daily basis, and would not result in an additional cost to the organization. If we switched from pagers to cell phones for transfer requests the triple aim of the Institute of Medicine (2010) would be met. Improved patient outcomes, decrease waste which reduces costs, improved patient and staff satisfaction would be some of the benefits that this process change could result in. Those pagers that are still in use can be returned to the vendor and many departments provide a cell phone for services when they are on call. A sound understanding by the providers of the benefits of switching to cell phone notifications of transfer requests would be required for a successful implementation. Many providers are resistance to change because they do not see the big picture of the benefits for the patients and the organization as a whole.

Reference:

Chaiken, B. P. (2011, April). Transforming health care through improved clinicican workflows. iHealthbeat. Retrieved from http://www.ihealthbeat.org/perspectives/2011/transforming-health-care-through-improved-clinician-workflows

Nelson, R., & Staggers, N. (2014). Health Informatics, An Interprofessional Approach. St. Louis: Elsevier

Retrieved on February 22, 2016 from https://www.google.com/search?q=workflow+in+healthcare&biw=2477&bih=1365&source=lnms&tbm=isch&sa=X&sqi=2&ved=0ahUKEwia_76284vLAhXE7CYKHdg4AoAQ_AUICCgD&dpr=0.75


Retrieved on February 22, 2016 fromhttps://www.google.com/search?q=workflow+in+healthcare&biw=2477&bih=1365&source=lnms&tbm=isch&sa=X&sqi=2&ved=0ahUKEwia_76284vLAhXE7CYKHdg4AoAQ_AUICCgD&dpr=0.75#tbm=isch&tbs=rimg%3ACQfxCoaqHBbXIjj9kLWGpGsGGrzY5iOk5GsUCKhV27vY_1ljiF0SDC7MJCr1Yn8AGeWWTaYDE46SFYuMUi1yipGSwpioSCf2QtYakawYaEfHZvtzP-CUBKhIJvNjmI6TkaxQRYjBpN-gv88wqEgkIqFXbu9j-WBFf0mSb0vCIjioSCeIXRIMLswkKEQNYnisgtA6PKhIJvVifwAZ5ZZMR1d2rhiqca7AqEglpgMTjpIVi4xEE7_1vy1pmj4SoSCRSLXKKkZLCmEZZypWWWAJWs&q=workflow%20&imgrc=g9OGlIjqftXyeM%3A

Nursing Leadership+Technology = Improved Quality Care, Safety of Patients, Improved Outcomes and Work Settings

Nursing Leadership + Technology = Improvement of Quality Care, safety of patients, improved outcomes and work settings.

Nursing Excellence
Nurse Leaders                                                                                  

Technology is the way of the future and the health care field needs to embrace technology and use it to improve the quality of care that is given, increase the safety of patients, improve patient outcomes and work settings.  There are many technologies that will change the practice of nursing in the near future. A couple of examples of those are robotics, 3-D printing, biometrics, electronic health records.
Provider order entry and clinical decision support. In general, technology improves efficiency and reduces errors. There has to be a fine balance between what can be done and what should be done. As nurse leaders, we can influence the implementation of technology as a profession. Technology is being introduced as a way to decrease errors and costs and maintaining quality, safe care.

Nurse leaders need to create an environment that engages the staff through shared decision making and implementation of technology. Staff buy in helps in the implementation stage and compliance. The nurse leader needs to have an understanding of the technology to be able to put the right equipment in the hands of the nurses that need it to provide quality safe care.


In the nursing profession, nurses can no longer be the keeper of the knowledge. They must learn to become the collectors of data, analyze the data and share it with others to improve care. In 2010, the Institute of Medicine suggested that the way nurses were educated in the 20th century is not adequate for the every changing and complexity of health care in the 21st century. Nurses need the skills to deliver high quality care including leadership, health policy, system improvement, research and evidence based practice, team work and collaboration.

As leaders, we need to make sure that the human connection is not lost with the patients. We need to  be involved in the implementation of technology to make sure that the innovation does not exclude the human element.

A second way that nurse leaders need to forge ahead with technology implementation is assuring that technical use is ethical. Just because something can be done doesn't mean that it should. We as a profession need to remain advocates for the patients and keep their best interests in mind. Nurse leaders need to ask how and why an innovation is going to be implemented and help to set parameters for its use.

Lastly, nurse leaders are going to help to bridge the clinical nurse and technology. Nurses are going to have to be trained in new technologies and remain competent in the skills. Nurses cannot provide care without information. As leaders, we must provide educational models and leadership training programs to ensure that nurses have the skills needed to address the emerging technology. Nurses as a profession need to take the lead on this and use foreshadowing, and evidence based practice to use across the continuum of care and across the interdisciplinary team.

 

Nurse leaders need to have a working relationship with the IT department and other administrators of the organization so that they understand the influence that nursing care has on patient outcomes. By connecting these dots and with the role out of pay for performance programs,  if nurse leaders can help effect patient outcomes, goals of the organization can also be met.

References:

Huston, C. (2013). The impact of emerging technology on nursing care: warp speed ahead. Journal of Issues in Nursing, 18(2).

Nurse leaders discuss the nurse's role in driving technology decisions. (2010, February, March, April). Virginian Nurses Today, 8-9.

Retrieved February 14, 2016 from https://www.google.com/search?q=nursing+leadership+and+technology&biw=2477&bih=1365&source=lnms&tbm=isch&sa=X&ved=0ahUKEwjnh8a5x_bKAhVJPD4KHVATDWAQ_AUICSgE&dpr=0.75#imgrc=K5rMEjiSXfWD7M%3A

 

Nursing ExcellenceNursing Excellence

Human/Technology Interface

 





 

 

 

 Technology is the foundation of healthcare in the future. Patient care has become the focus of innovative technological developments and concepts that help to reduce costs, increase patient outcomes and satisfaction and improve clinical processes. This is a result of the realignment of the reimbursement schedule revolving around patient outcomes, patient satisfaction and reduction of costs. The healthcare industry understands that there needs to be communication between information technology and practitioners for this to be effective in the implementation throughout the organization. The balancing act comes into play for nurses between hands on patient care and technology advancements. We do not want to lose the caring aspect of the profession of nursing by being focused on the technology task. Hence the development of the specialized nursing practice of informatics. An equal amount of information science and nursing science. Patients still feel they are getting the best quality, safe care and the providers are using cutting edge technology to improve outcomes and reduce costs.

 Some examples of human-technology interfacing are:

• Mobile Health Strategies- apps on the electronic devices that are useful for managing symptoms, preventative care, health restoration or a monitoring regime.
• Tele-health Strategies- monitoring in the home , consultation, and disease management are all examples of ways that providers can interact with the patients at home
• Personally Delivered Health Messages- behavior changing messages are sent using a patient portal as text messages, emails or automated phone calls. Providers are aware of the messages sent to the patient and can reinforce the message at appointments. It is shown that patients that receive these messages have a better chance of changing negative behavior than those that do not receive them.
•  Electronic Health Records (EHR) - an electronic documentation tool that allows all medical records to be in one location to ensure the best quality care is available for the patient. An EHR is a database of clinical information about the patient. It allows for information to be shared throughout the continuum of care with all treating providers.

Exemplar Scenario:

                  One examples of a way that the nurses are giving medications in a safe way, is with a new system that identifies who the patient is prior to handing the medication to the patient. There is a wand hooked up to the computer on the cart with wheels. When it is the patient's turn for medication, the nurse touches the patient's name bracelet with the wand to identify who the patient is. The computer reads the patient's name and makes sure that it is the same patient that is supposed to be receiving the medication. The computer also verifies that it is time for that patient to receive their medication and makes sure that the patient does not have any negative reactions to the medication they are about to receive. This new system is a great example of how technology is making nursing practice safer and more efficient. This new system will decrease medication mistakes and improve the process of handing out medications. This system allows the nurse to communicate with the patient, explain what they are giving them and educate them about possible side effects. A nurse still has to hand the medication to the patient and is able to interact while decreasing mistakes and improving efficiency.





Nursing Informatics                                                         Healthcare Information Technology 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 



References:

 Cassano, C. (2014, October). The right balance- technology and patient care. Online Journal of Nursing Informatics, 18(3).

     Gephart, S., & Effken, J. A. (2013, October). Issues, impacts and insights column. Online Journal of Nursing Informatics, 17(3).

Retrieved on February 8, 2016 from http://ojni.org/issues/?p=2870
 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Retrieved on February 6, 2016 from http://www.himss.org/ResourceLibrary/GenResourceDetail.aspx?ItemNumber=33541



Week 1 Blog Assignment/STANDARDIZED NURSING LANGUAGE and INFORMATICS, THE LANGUAGE OF NURSING.

 SNOMED-CT

In an effort to promote the uptake of electronic health records, (EHR) as a way to promote patient safety and the delivery of quality care, the clinical terminology SNOMED CT or the systematized Nomenclature of Medicine Clinical Terminology has been deployed.  SNOMED was created by the College of American Pathologists and later transferred ownership to the International Health Terminology Standards Development Organization (IHTSDO) (Lusignan, 2011). The SNOMED CT describes clinical entities such as diseases, substances and organisms through clinical terminology. It facilities what the provider inputs into the EHR. With the use of SNOMED CT, used as the national standard clinical  terminology in Australia, there should be a significant change in the predictability of the clinical records and data reliability adding consistency to documentation. This will help to reduce miscommunication and inefficiencies that effect throughput and timeliness (Truran, 2010) . The EHR will contain standardized terminology describing the clinical information. This language or clinical reporting is acknowledged internationally and is now an NHS standard in England.

           INFORMATION MANAGEMENT                                       DATA STANDARD

SNOMED CT is comprehensive and makes searching for codes difficult and time consuming. One way to make this more efficient is to have a certain number of codes available for each specialty so that there is a smaller list to go through. practitioners are rewarded for reaching indicator targets, in the UK through the pay for performance  system that is in place. Using a smaller list may tinge the data, but if providers want to get paid they have to stay within the list of codes assigned. The training of non clinical staff in this system is overwhelming and not realistic. There needs to be new cost analysis' done and the pros and the cons of implementation need to be compared (Lusignan,  2011).
                                              

LOINC

Semantic interoperability is the ability for one IT system to receive information from another and then make it compatible to its business principles and make the information compatible and usable The Center for IT Leadership believes that introducing semantic inoperability and implementing it would produce the greatest economic benefit to the US health system ( Dixon, 2015). The Logical Observation Identifiers Names and Codes (LOINC), which has been in development for 20 years, provides universal identifiers for laboratory tests.

For an EHR to be certified as meaningful use, the LOINC and SNOMED CT are required for communicating tests. The translation process or mapping  is a set of terminology mediation strategies used among health enterprises ( Dixon, 2015). Identifying the correct concept from standard vocabulary is difficult for even the personnel with a good understanding of the tests when they lack the specific knowledge of their local concepts to standard vocabularies.

National policies in the US that require the use of LOINC contribute to the pressure on organizations to map quickly and efficiently. To do this there is software out now that shows how many times a LOINC has been mapped to local codes of other organizations and use it as a comparison as a match. Mapping to standard vocabulary is important to semantic inoperability. It is also time consuming and costly to an organization. The goal is to enable semantic inoperability through the promotion of the software tool as a sourced repository of mappings for use by organizations (Dixon, 2015).

                                                                     

                                                                                






Resources:

de Lusignan, S., Chan, T., & Jones, S. (2011). Large complex terminologies: more coding choice, but harder to find data- reflections on introduction of SNOMED CT (Systemized Nomenclature of Medicine- Clinical Terms) as an NHS standard. Informatics in Primary Care, 19, pp. 3-5.

Dixon, B. E., Hook, J., & Vreeman, D. J. (2015, Spring). Learning from the crowd in terminology mapping: the LOINC experience. Lab Medicine, 46(2), pp. 168-174.

Retrieved on February 1, 2016 from https://www.google.com/search?q=LOINC&biw=2477&bih=1365&tbm=isch&source=lnms&sa=X&ved=0ahUKEwiFxIjgldjKAhWDOhoKHUXxBpIQ_AUICCgD&dpr=0.75#imgrc=KD16KcXqGyeN2M%3A

Truran, D., Saad, P., Zhang, M., & Innes, K. (2010). SNOMED CT and its place in health information management practice. Health Information Management Journal, 39(2).