Information Technology

System Applicable In
Nursing Practice
 Hospital/Critical Emergency Preparedness and
Care Response
TABLE OF CONTENTS

Community Health Administrative Assistive

Applications Devices and Workplace
Technologies

Ambulatory Care Telehealth

Systems
Hospital/Critical Care
Applications
 CRITICAL CARE NURSING
Is the nursing specialty that with human responses to life-threatening problems.

CRITICAL CARE NURSE

Is responsible to ensure tat critically ill patients are seriously conditioned individuals,
ensure that families of the medically ill patients should receive optimal care.

CRITICAL CARE APPLICATIONS

Areas where patients require complex assessment, high intensity medication, continuous
therapy and interventions, and unrelenting nursing attention and continuous watchfulness.
 1986
Saba and McCornick estimated that the
volume of data collected by nurses in
critical care settings on a daily basis was
as high as 1,500 points

A data point is a discrete unit of information. In a general sense, any single facts is a data point. In
a statistical or analytic context, a data point is usually derived from a measurement or research and can
be represented numerically and/or graphically. The term data is roughly equivalent to datum, the
singular form of data.
INFORMATION TECHNOLOGY CAPABILITIES
AND APPLICATIONS IN CRITICAL CARE
SETTINGS

 Physiologic Monitors
 Arrythmia Monitor
 Hemodynamic Monitors
 CCISs
PHYSIOLOGIC MONITORS
BASIC COMPONENTS
1. Sensors (Pressure transducer , ECG electrode)
2. Signal conditioners to amplify or filter the display device (amplifier,
oscilloscope, paper recorder)
3. File to rank and order information (Storage file, alarm signal)
4. Computer processor to analyze data and direct reports (Paper
reports, storage for graphic files, summary reports)
5. Evaluation or controlling component to regulate the equipment or
alert the nurse (Notice on the display screen, alarm signal)
ARRYTHMIA MONITORS
Computerized monitoring and analysis of cardiac rhythm

BASIC COMPONENTS
1. Sensors
2. Signal conditioner
3. Cardiograph
4. Pattern recognition
5. Rhythm analysis
6. Diagnosis
7. Written report
HEMODYNAMIC
MONITORS
Can be used to:
1. Measure hemodynamic parameters
2. Closely examine cardiovascular functions
3. Evaluate cardiac pump output and volume status
4. Recognize patterns (arrhythmia analysis) and extract features
5. Assess vascular system integrity
6. Evaluate the patient’s physiologic response to stimuli
7. Continuously evaluate blood gases and electrolytes
8. Estimate cellular oxygenation
9. Continuously evaluate glucose levels
10. Store waveforms
11. Automatically transmit selected data to a computerized patient database
CRITICAL CARE INFORMATION SYSTEM (CCIS)
1. Provide real-time resources utilization data and management of
information and access critical care areas through the integration
of the medical facilities in the critical to an intelligent computer
system which is capable of processing all data.
2. Enable electronic collection of hospital and patient-specific critical
care data of the entire patient in the critical care areas which can
be processed to create a patient profile which generate real time
and historical report.
3. Automated collection and management of medical information will
become the important task of the critical care information system.
 ADVANTAGES OF CCIS
• Intelligently integrates and process physiologic and diagnostic
information and store it to secured clinical repository

• Creates trend analysis graphical representation of results

• Offline stimulation can be performed to test the condition of the patient

• Provide clinical decision support system

• Provide access to vital patient information

• Providing feedback and quick evaluation of the patient condition and

provide alert
COMPONENTS OF THE CCIS
1. Patient management
2. Vital sign monitoring
3. Diagnostic testing results
4. Clinical documentation to support the process of physical
assessment findings
5. Decision support
6. Medication management
7. Interdisciplinary plans of care
8. Provider order entry
DEVICE CONNECTIVICITY INFRASTRUCTURE
In concept, the term Medical Information Bus (MIB) is
used to classify the backbone of information exchange,
allowing data to be moved from one point another.

This infrastructure is used to send the workload generated

by the patient care devices in the modern critical care setting.
MEDICAL INFORMATION BUS (MIB)
 Provides a generalized method of attaching patient monitoring devices
to a common interface
 it eliminate need for custom connector and software presently needed
to interface such device
 This interface converts the unique manufacturer data communications
protocol into a standardized hardware and software system.
 Has the ability to filter, store and select information sent for inclusion
into the clinical medical record on the clinical computer system
Community Health
Applications
Collective term for the methodical application of information science and
technology to community and public health process.

● Focuses on the health information system of the community, it is centered on the

majority part of the public.

● Emphasizes the prevention of the disease, medical intervention and public awareness.

● Fulfills a unique role in the community, promoting and protecting the health of the
community at the same time maintaining sustainability an integrity of health data and
information.
Effective and timely
COMMUNITY
assessment that
involves monitoring HEALTH
and tracking the health APPLICATION
status of populations SYSTEM
including identifying
and controlling disease
outbreaks and
epidemic Encourages optimal
application of
computer system,
computer programs
and communication
system for the benefit
GOAL OF
of majority of
COMMUNITY individuals families
HEALTH and community
INFORMATICS
 PRIMARY FOCUS OF COMMUNITY HEALTH
INFORMATION SYSTEM

1. Preventing, 1. Educating and 1. Effective

identifying, empowering transformation of
investigating, and individuals to adopt data into formation
eliminating health lifestyle
communicable 2. Effective
problems. 2. Facilitate the integration of
retrieval of data information to other
2. Accessibility of disciplined to
data and information concretized
through knowledge and
communication creates better
understanding
COMPUTER BASED SURVEY SYSTEM

HEALTH STATISTICAL SURVEYS

 Are used to collect quantitative information about items
in a population to establish certain information from the
obtained data.

 Focused on opinions or factual information depending

on its purpose and many surveys involves administering
questions to individuals
 Consistent
exchange of
response

Synchronization Disease
of the decisions tracking

ADVANTAGES OF
COMMUNITY
National
HEALTH SYSTEM
Building
alertness and
preparedness strategies

Control of
Building strong
spread of
communication
disease
Ambulatory Care Systems
 ● President George Bush April 27, 2004 E.O 2004
Announced a goal to establish electronic health records (EHRs) for all
citizens within a 10-year time frame. Created the position of a national
health information technology coordinator to develop a nationwide
interoperable health technology infrastructure.
● Tommy G. Thompson
Health and Human Services Secretary. Announced the "Decade of
Healthcare Information Technology" and announced the publication of a
report which reveals how vital it is to have automation in the physician's
and ambulatory offices.
 Goal 1: Inform Goal 3:
Clinical Practice. Personalize
4 MAJOR GOALS Care.
• Bringing • Using health
Goal 2:
information Interconnect information Goal 4: Improve
tools to the clinicians. technology to population
point of care, give health.
especially by • Building an consumers • Expanding
investing EHR interoperable more access capacity for
systems in health and public health
physician information involvement in monitoring,
offices and infrastructure, health quality of
hospitals so that records decisions. care
follow the measurement
patient and , and bringing
clinicians have research
access and advances
involvement in more quickly
health into medical
decisions. practice.
WHERE AMBULATORY CLIENTS ARE BEING TREATED:

 Ambulatory Clinics
 Surgery Centers
 Single and Multispecialty Group
 Diagnostics Laboratory
 Health Maintenance organizations
 Independent physician organizations
 Birthing Centers
 College and Universities health Services
 Applications Necessary in the Ambulatory Environment

Ambulatory Care Information System are designed to:

• Store
• Manipulate
• Retrieve information for planning, organizing directing, and controlling
administrative
• Clinical activities associated with the provision and use of ambulatory care
services and facilities
FINANCIAL BENEFITS

1. Cost Effective
2. Accurate insurance information obtain
3. Timely bill submission processed resulting decreased days in
account payable
4. Reduction of rejected claims
ADMINISTRATIVE BENEFITS
1. Reduction in size of the record room
2. Reduce time spent finding and delivering chart
3. Increase privacy of data
4. Formats that are legible
5. Comply with legal regulations
6. Promotions of quality assurance
7. Improve patient satisfaction
8. Ability for home access by the physician and nurse practitioners
9. Alerts for incomplete data
10. Integration of clinical data
CLINICAL BENEFITS
1. Medical record 8. Medication allergies
2. Vital signs 9. Profiles
3. Progress notes 10. Alerts
4. Results from laboratory 11. Reminders
5. Radiology departments 12. Follow-up system
6. Flow sheets 13. E-prescribing
7. Growth Charts 14. Evidence-based medicine
8. Immunization records
REGULATORY REQUIREMENTS
• Resource Based Relative Value Scale (RBRVS)
is a model designed by the Department of Health and Human Services (DDHS).
• Current Procedural Terminology (CPT)
codes describe medical procedure performed by physicians and other health
providers.
• Ninth Revision of the International Classification of Diseases

it is designed for the classification of morbidity and mortality information for

statistical purposes, for the indexing of hospital records by diseases and operation,
and for data storage and retrieval.
 • HCFA HPCS (2004)
Is a collection of codes that represent procedures, supplies, products, and
services which may be provided to Medicare beneficiaries and to individuals
enrolled in private health insurance programs.
• National Drug Code
Identifies pharmaceutical in detail including packaging.Its use is required by
the FDA for reporting and it is used in many healthcare information systems to aid
reimbursement.
• NDC directory
Is limited to prescription drugs and few selected over-the-counter products.
• Medicare's ambulatory payment classification (APC) system
Is a prospective payment system for hospital outpatient services.
 • APCs
were mandated by Congress as part of Balanced Budget Act of 1997
• Software
is available to help ambulatory care organizations determine outpatient
payment and verify payment received.

• Centers for Medicare and Medicaid Services

formerly known as the Health Care Financing Administration

• Health Plan Employer Data and Information Set (HEDIS)

is a standardize, comprehensive set of indicators to measure the performance
of a health plan
 Outcome and Assessment Information Set
A data set for use in home health agencies and is an initiative from the Health
Care Financing Administration the purpose is to provide a comprehensive
assessment for an adult home care patient and measure patients outcomes for
purpose of outcome-based quality improvement
Emergency Preparedness and
Response
Early informatics contributions to the emergency planning and response agenda
have focused largely on surveillance of threat detection.
 A broader assessment of possible informatics contributions unveils that
informatics can also contribute to increasing the efficiency in disaster
response as well as providing a tele-presence for remote medical caregivers.
Special challenges for data management occur every emergency or disaster.
 Tracking of victims, electronic health records and supply inventory are a
few of the contributions that informatics can play during disasters.
 Early Response

 Earlier response by the informatics community focused on contributions

toward:

 Surveillance of threat detection

 Biosurveillance and biogent detection
 Increasing the efficiency in disaster response
 Providing a telepresence for remote medical care givers
 Consistent Challenge

 A challenge for emergency and disaster response continues to be

communication and information management.

EFFECTIVE RESPONSE
Requires:
 a moment to moment “situational analysis”
 real time information to assess needs and available resources that can
change suddenly and unexpectedly.
 New Technologies

 These technologies are being used and evaluated to improve patient care and
tracking, foster greater safety for patients and providers, enhance incident
management at the scene, coordinate response efforts, and enhance
informatics support at both the scene of the disaster and at the community
resource levels.
 Technologies such as:
 Smart devices
 Wireless connectivity
 Positioning technologies
Interagency Standing Committee (IASC) of the UN
Office of Humanitarian Affairs (UN-OCHA)

 Initiated changes called the “humanitarian reform”

 Organized clusters whose principal mission was to assist the
impacted government with coordination of all responses and with
evaluation of the impact of intervention.
 World Health Organization (WHO)

 Appointed as the lead agency for health.

 Includes coordination and production of health information
 At global level, it aims at discouraging individual and
organizational response efforts that were not part of this
coordinated response.
 The Centers for Disease Control and Prevention
(CDC)

 Monitors influenza activity and trends virus characteristics through

a nationwide surveillance system
 Estimates the burden of flu illness using statistical modelling
 National Retail Data

 Monitoring system tracked the real time purchase of over the

counter medication, such as fever, reducers and influenza
treatments, in over 29,000 retail pharmacies, groceries and mass
merchandise stores.
 Provides early detection of naturally occurring outbreaks as well as
bioterrorism
 Electronic Surveillance System for Early
Notification of Community Based Epidemics
(ESSENCE)
 Is a Department of Defense (USA) tool that fuses syndromic
information from multiple data resources that differ in their
medical specificity, spatial organization, scale and time series
behaviours to provide early warning at the community level.
 Real time Outbreak Disease Surveillance (RODS)

 Took chief complaint information from clinical encounters

hospitals and classified it into one of seven syndrome categories
using Bayesian classifiers.
 Data is stored in relational databes, used univariate and
multivariate statistical detection.
 Alerted users of when algorithms identify anomalous patterns in
the syndrome count
 Healthcare Consumers Contribute to Surveillance
Activities
 Now more than ever before consumers have opportunity to
contribute to surveillance activities.
 Some cases, the participation is a conscious decision, but in others
consumers may be unknowingly contributing to this information
process.
 Advantage

 Shorten the typical lag time to publication for CDC’s publicly

reported data which can be from 10 to 14 days.
 Telephone Triage Data

 Is being used to track influenza in specified geographic location

with the added advantage that the data is real time in nature.
 Google Flu Trends

 Assumption that there was a relationship between how many

people search the internet for flu related topics and how many
people flu-like symptoms.
 Comparing to CDC published data, they found the search based flu
estimates had a consistently strong correlation.
Competency Based Learning and Informatics Needs

 Nurses must be appropriately and consistently educated to provide the

right response

Competency based Education:

 Provides an international infrastructure for nurses to learn about
emergency preparedness and response.
 However, there are no accepted, standardized requirements for disaster
nursing training or continuing education.
 International Nursing Coalition for Mass Casualty
Education
 Later renamed the Nursing Emergency Preparedness Coalition.
 Generated a list of 104 competency statements for all nurses
responding to disasters using domains developed by the American
Association of Colleges of Nursing.
 Detection of and Response to the Threat of
Bioterrorism
 Requires:
 Continuous monitoring of a variety of data
 Standards for combining data from different sources and
coordinaton of such efforts
 Computes based processing and analysis that help detect unusual
and statistical significant patterns.
 Communication technologies
 Informatics and Incident Management

 Incident management systems (IMS) was first used by firefighters

to control disaster scenes in a multijurisdictional and
interdepartmental manner.
 Calls for a hierarchical chain command led by the incident
manager or commander.
 Each job assignment is consistently followed by assigned
personnel who refer to a specific job action sheet.
 Benefits

 Improves communication through a common language

 Allow staff to move between management location
 Facilities all responders to understand the established chain of
commands.
 Emergency Operations Center (EOC)

 Is a physical location where the Incident Management Team

convenes to:
• Make decisions
• Communicate
• Coordinate the various activities in response to an incidents

 Accurate, real time data acquisition regarding:

• Patient needs
• Rescue personnel
• Resources available
 Technology and Informatics Contributions to
Incident Management
 Technology can be used to capture and represent data for purposes
of increasing situational awareness in the Emergency Operations
Center (EOC) for making the most informed and efficient
decisions.
 Informatics and Volunteerism

 Healthcare volunteers are a necessary components of mass casualty

events but can also create challenges.
 Questions to think about:
 How are liability issue dealt with?
 How do you educate them so that they can perform effectively
when needed?
 Disaster Medical Assistance Teams

 Federal government system for organizing teams that are willing to

travel to other regions if the country in the event of an emergency.
 When activated, members of the teams are federalized or made
temporary workers of the federal government.
 Medical Reserve Cops

 National network of community based volunteer units that focused

on improving the health, safety, and resiliency on their local
communities.
 Include medical and public health professionals such as:
 Physicians
 Nurses
 Pharmacists
 Dentists
 Veterinarians
 Epideminologist
 Volunteers

 Require education prior to responding to an event.

 MRC unities have competency based education requirements.
 American Red Cross has a long history of volunteerism
 Regardless the group, nurses are urged to be a part of an organized
group rather than just showing up to the disaster.
 Future Advances

 Health information technology investments are a necessary

foundation in healthcare reform, linking potentially valuable
information such as vaccination records and subsequent use of
healthcare services to provide information about adverse events as
well as vaccine effectiveness.
 Grids

 Using “grids” to connect multiple computers across the country

will allow data sources to share and view large amounts of health
information
 Grid participants will be able to analyse data in other jurisdiction
with out moving the actual data.
 Electronic Health Records

 Expanding the use of electronic health records should help both

patients and their healthcare providers during times of emergencies
and disasters.
 Improve clinical data and sharing of clinical information for
displaced patients.
Administrative
Assistive Devices and
Workplace
Technologies
 Assistive Devices

● facilitate the clients' communication abilities, their performance

of the activities of daily living, their highest possible level of
independence, the prevention of the complications associated
with immobility, and it also enhances the patient's feelings of
self-esteem and self-worth. Nurses must assess and reassess the
client's safe and appropriate use of all assistive devices.
 Canes
● Typically used to facilitate the client's
balance and to facilitate ambulation when
the client is physically and cognitively able
to use it rather than a walker. There are a
variety of different canes including a
standard one foot cane, a tripod cane with
three feet, and the quad cane which has four
feet. Some canes like a wooden cane are not
adjustable to the client's height and others
can be adjusted to meet the height needs of
the client.
 Walkers
● are indicated when the patient needs more support
with ambulation than a cane can safely offer them.
Walkers can be with or without wheels, with or
without brakes, and with or without a seat that the
client can use when they need to rest during a long
walk.
 Hearing Aid
● a device designed to improve hearing
by making sound audible to a person
with hearing loss.
 Word boards
● It is designed as communications board
available for those patients who are
unable to communicate verbally, the
patient is able to indicate his or her
status or needs by pointing to words in
real time. Improved patient-provider
communication enhances the patients
hospital stay and wellness.
 Evaluation of using Assistive Devices

● The client's correct use of assistive devices is evaluated and monitored by

observing the client using these devices and evaluating whether or not the
client has remained without injury secondary to the improper use of these
devices.
 Workplace technologies

● The nursing profession finds many of these new medical technologies help
them with routine processes, and can decrease human mistakes and errors
that can come from too few nurses, working long hours, with too many
patients. While technological advancements aren’t a cure-all as healthcare
solutions, new technology is changing the way nurses work in positive ways.
 Automated IV Pumps

● Automated IV pumps control the dosages and drips given to patients.

Software and medical tech allows nurses to change the drip amounts and
medication doses so patients aren’t waiting for changes. It help speed up
nursing processes, and can be crucial if there is a need for immediate
adjustment. Changing medication through an automated process also
removes elements of human error that could present issues for clinical
patients and hospitals.
 Portable Monitors

● Portable monitor equipment allows nursing

professionals to check up on patients even
if they are on the move, or busy helping
someone else. This helps patients be
constantly monitored from anywhere in the
hospital, and the alerts and alarms  sent to
nurses through the portable monitor can
save lives.
 Smart Beds

● Smart bed technology can help nurses track movement, weight, and even
vitals. It also play a major role in keeping patients safe and comfortable
during a long hospital stay. With the number of falls and patient injuries
inside hospitals, smart beds are very important for patient safety. Smart bed
technology gives nurses a constant monitor in a room that provides them
with regular updates and communications on a patient’s activities. It can also
help them identify patterns, which can lead to a new diagnosis or a different
understanding of a condition.
 Electronic health records

● Electronic health records (EHR) are taking over older paper filing methods.
Electronic health records allow nursing experts to document care provided to
patients, and retrieve information that can help prioritize care. Additionally
information entered into computer systems, can then be accessed by the care
team, including doctors and even patients themselves when necessary.
 Evaluation

● New clinical healthcare technology is exciting and transformative for

healthcare. With new innovations impacting the industry every day, now is
the perfect time to advance your nursing career. As new technology changes
the field, you need to change with it. Earning a degree will help you be
prepared to take on new roles and be qualified for the responsibilities that
are coming your way.
TELEHEALT
H
Telehealth is the use of digital information and communication technologies,
such as computers and mobile devices, to access health care services remotely
and manage your health care. These may be technologies you use from home or
that your doctor uses to improve or support health care services.
 Use a mobile phone or other device to upload food logs, medications, dosing
and blood sugar levels for review by a nurse who responds electronically.
 Watch a video on carbohydrate counting and download an app to your phone.
The goals of telehealth, also called e-health or m-health
(mobile health), include the following:

 Make health care accessible to people who live in rural or

isolated communities.
 Make services more readily available or convenient for
people with limited mobility, time or transportation options.
 Provide access to medical specialists.
 Improve communication and coordination of care among
members of a health care team and a patient.
 Provide support for self-management of health care.
The following examples of telehealth services may be
beneficial for your health care.
Patient portal
Your primary care clinic may have an online patient portal. These
portals offer an alternative to email, which is a generally insecure
means to communicate about private medical information. A portal
provides a more secure online tool to do the following:
 Communicate with your doctor or a nurse.
 Request prescription refills.
 Review test results and summaries of previous visits.
 Schedule appointments or request appointment reminders.
Virtual appointments
● Some clinics may provide virtual appointments that enable you to see your doctor or a
nurse via online videoconferencing. These appointments enable you to receive ongoing
care from your regular doctor when an in-person visit isn't required or possible.
● Other virtual appointments include web-based "visits" with a doctor or nurse
practitioner. These services are generally for minor illnesses, similar to the services
available at a drop-in clinic.
● When you log into a web-based service, you are guided through a series of questions.
The doctor or nurse practitioner can prescribe medications, suggest home care
strategies or recommend additional medical care.
● Similarly, a nursing call center is staffed with nurses who use a question-and-answer
format to provide advice for care at home. A nursing call center doesn't diagnose an
illness or prescribe medications.
While these services are convenient, they have drawbacks:
 Treatment may not be coordinated with your regular doctor.
 Essential information from your medical history may not be considered.
 The computer-driven decision-making model may not be optimal if you
have a complex medical history.
 The virtual visit lacks an in-person evaluation, which may hamper accurate
diagnosis.
 The service doesn't easily allow for shared doctor-patient decision-making
about treatments or making a plan B if an initial treatment doesn't work.
Remote monitoring
A variety of technologies enable your doctor or health care team to monitor your
health remotely. These technologies include:
 Web-based or mobile apps for uploading information, such as blood glucose
readings, to your doctor or health care team
 Devices that measure and wirelessly transmit information, such as blood
pressure, blood glucose or lung function
 Wearable devices that automatically record and transmit information, such as
heart rate, blood glucose, gait, posture control, tremors, physical activity or
sleep patterns
 Home monitoring devices for older people or people with dementia that
detect changes in normal activities such as falls
Personal health records
An electronic personal health record system — often called a
PHR system — is a collection of information about your health
that you control and maintain.
● A PHR app is accessible to you anytime via a web-enabled
device, such as your computer, laptop, tablet or smartphone. In
an emergency, a personal health record can quickly give
emergency personnel vital information, such as current
diagnoses, medications, drug allergies and your doctor's contact
information.
Personal health apps
A multitude of apps have been created to help consumers better organize their
medical information in one secure place. These digital tools may help you:

 Store personal health information.

 Record vital signs.
 Calculate and track caloric intake.
 Schedule reminders for taking medicine.
 Record physical activity, such as your daily step count.
 The Potential Of Telehealth
● Technology has the potential to improve the quality of health care and to make
it accessible to more people. Telehealth may provide opportunities to make
health care more efficient, better coordinated and closer to home.
● Research about telehealth is still relatively new, but it's growing. For example,
a 2016 review of studies found that both telephone-based support and
telemonitoring of vital signs of people with heart failure reduced the risk of
death and hospitalization for heart failure and improved quality of life.
The Limitations Of Telehealth
● While telehealth has potential for better coordinated care, it also runs the risk
of fragmenting health care. Fragmented care may lead to gaps in care,
overuse of medical care, inappropriate use of medications, or unnecessary or
overlapping care.
● The potential benefits of telehealth services may be limited by other factors,
such as the ability to pay for them. Insurance reimbursement for telehealth
still varies by state and type of insurance. Also, some people who would
benefit most from improved access to care may be limited because of
regional internet availability or the cost of mobile devices