Information and communication technologies in nursing
Even though the tasks performed in the course of nursing work remain the same, it is impossible to ignore the importance of introducing health informatics achievements into their daily work. Health care organizations should continuously monitor patient health data so that they will not receive inadequate care. They must be fully equipped with the appropriate infrastructure for systematically creating and analyzing big data (Dash et al., 2019). Nurses are required to know not only basic computer skills but also advanced skills with medical devices (Alexander et al., 2019). Information and communication technologies help to monitor patients remotely using mobile medical devices.
History
Cerner electronic health record (EHR) helps organize and document clinical patient data from a health care organization. Its primary goal is to improve the coordination and identification of patients. Cerner Corporation is the vendor of this electronic health record system. Cerner is a U.S. provider of services for transmitting and storing data in the healthcare sector. This company is also engaged in developing devices and equipment suitable for hospitals and community-based outpatient clinics. Indeed, the use of the analyzed product is planned to be implemented in these two kinds of places. Cerner is praised for its innovative methods of improving communication between healthcare professionals and patients. The analyzed system was developed back in 2008, but research confirming the product’s effectiveness has become available only recently. The seller provides recommendations for the implementation and use of the product, which makes it easier for employees to familiarize themselves with the system.
This product was created to replace the existing paper-based system. When all data about the patient’s condition is correct and stored in reliable sources, it helps that doctors do not make mistakes when diagnosing clients. In addition, the use of electronic medical records makes it possible to achieve great success in terms of identifying subsets of clients based on their classification according to the necessary criteria (Van Batavia et al., 2018). From the point of view of nurses, storing patient data in electronic format will facilitate patient care. At any time, the information on the electronic device is available and can be used for treatment. EHR improves treatment and clinical outcomes by reducing repetitive tests and increasing overall efficacy (Hoover, 2017). The introduction of this system also helps speed up the decision-making process.
Many employees of medical organizations understand the need to switch to electronic form since paper workflow reduces the effectiveness of the organization’s activities. Moreover, in the modern world, not only document flow but also the very communication with current and potential clients occur using electronic resources (Kruse et al., 2017). Such a replacement is vital to keep up with changes in the provision of health services. However, it should be noted that most modern physicians often suffer from information overload when they view patient information in health information technology systems (Fan et., 2020). This issue should be taken into account by the leaders of the organization when implementing the EHR.
EHR committee, clinical I.T. resources, and hospital executives decided to purchase this system. Since financial losses accompany the purchase of software, the acquisition benefits must match the money spent. Even though several categories of employees managed project implementation, their impact on the final decision regarding whether to acquire the system was different. The main coordinators of the startup were representatives of the I.T. department. The role of I.T. experts in this project was not only to decide whether to use the program but also to make it easier for nurses and other staff to familiarize themselves with it. Accordingly, the process of project implementation was preceded by teaching employees the basics of working with the system. The user manual provided to customers in an accessible form sets out the essence of the system, which ensures quick adaptation of employees.
Companies such as Truman Medical Centers, Northern Arizona Healthcare, and Intermountain Healthcare have already appreciated the performance of the electronic medical record system. For example, Truman Medical Center workers noted that Cerner’s product allowed their medical staff to have a device on hand to scan the patient during medication administration (Cerner Corporation, 2017). According to Lacey Alvarez, a Population Health Strategist, the system makes possible earlier intervention with patients (Cerner Corporation, 2017, 4:48-4:51). In addition, the interview was conducted with the I.T. director at Birmingham Veterans Administration Medical Center in Birmingham, Alabama (M.C., personal communication). Clients note that the work with Cerner Corporation has yielded highly positive results, both in improving the performance of services provided and financial performance.
Hardware
The remote hosting option is the “heart” of the system: it ensures high levels of system availability. It stays with the vendor; this allows the health care organization to pay only for a specific service, thus reducing costs. Also, when using the system, the company will need some peripheral devices, including computers, laptops, iPods, barcode scanners, printers, and workstations on wheels. However, the expenses of buying the newest and most powerful computers are likely to be avoided because EHR is supported on older computers as well.
The management of the implemented product requires the participation of highly specialized I.T. specialists. A bachelor’s degree in computer science is enough to tackle the challenges that arise during product use. In addition to the staff located within the organization, there must be a supportive care team outside the clinic; this support team will analyze emerging operational problems. Employees must are officially employed in the organization; they are not affiliated with the vendor; however, they must have vendor education and certifications in each aspect of each system being built.
Depending on the type of connection to the vendor presented in the organization, a downtime plan is provided when there is a system failure. There are two separate models of reading access to data. The product is equipped with a backup plan program; multiple backups are placed in different locations to prevent data loss. A robust security system is provided that requires the supplier to comply with all federal security measures. In addition to this, the Department of V.A. also has a security team that looks for potential problems with EHR use. Both the vendor and Moffitt DVA security team are responsible for security.
Maintenance and Security
EHR interacts with the billing system and remote tracking of workflows; it uses an automatic patient scheduling tool. The system also interacts with in-house data storage. Accordingly, the exchange of data takes place in an organization that is internal to the product. The data is stored inside a data warehouse located in Birmingham, Alabama, and backed up in Atlanta. Thus, all clinical staff and medical institutions such as insurance companies and health registries can receive output data and information from the system.
Decision Making
The use of the system helps to avoid many mistakes, particularly the likelihood of re-ordering, taking medicine by a patient who is allergic to the components of the pills, or generally taking the wrong drug or at the wrong time. This electronic registry aims to minimize potential errors; a paper-based system still used in many healthcare organizations was remarkable in that it contained many such errors.
Inputs/Processing/Outputs
The diagram was created using the “Draw.io” site. Using the example of the algorithm of actions of a patient visiting a clinic without an appointment, it was possible to demonstrate how data collection and processing by the EHR system occurs (Figure 1). The presented diagram shows an action algorithm for nurses, PCPs, and front office staff when a client visits the clinic without making an appointment. The rectangle in the diagram represents any step in the process. The oval is used to represent the start and end of a process. The arrow is used to emphasize specific steps in the process. The diamond symbolizes that a decision is required to move forward.
The following categories of employees are directly involved in data entry. Specialists and nurses collect VS, patient assessments, and document medications. Providers place orders and document clinical assessments such as HPI, DC summary, progress notes, and procedure notes. Pharmacists verify orders and adjust dosage in patients with renal insufficiency. A registered dietitian provides nutritional assessment, documented findings, and records. Registration staff collects patients’ consent for data processing and insurance data. The chaplain should supply emotional and spiritual support for patients, family and friends, and hospital staff; they must provide a spiritual assessment and findings. Registered dietitians, physical therapists, and occupational therapists carry out document assessments. Radiology specialists verify the order and document the completion of the exam.
Among the possible data elements entered into the system are indicators of the patient’s health – body temperature, pulse rate, respiration rate, and blood pressure. The overall information is displayed on the screen; it is possible to create and view reports and dashboards. This system can be triggered on-demand or configured to generate a specific date or a specific metric. These functions of the system can be used, in particular, when creating a registry of colorectal cancer screening. In addition, it is possible to use the data filtering function for a specific custom query.
Note. During a coronavirus epidemic, if it turns out that the patient is potentially ill, the examination takes place when the client is inside his car outside the clinic.
References
Alexander, S., Frith, K. H., & Hoy, H. M. (2019). Applied clinical informatics for nurses. Jones & Bartlett Learning.
Cerner Corporation. (2017). Truman Medical Centers: We are here for our community [Video]. YouTube. Web.
Fan, Z., Burgun, E., Ren, Z., Schleyer, T., & Ning, Xia. (2020, November 21). Improving information retrieval from electronic health records using dynamic and multi-collaborative filtering. 2019 IEEE International Conference on Healthcare Informatics (ICHI), Xi’an, China, IEEE. Web.
Dash, S., Shakyawar, S.K., Sharma, M. et al. (2019). Big data in healthcare: management, analysis and future prospects. Journal of Big Data, 6, 54. Web.
Hoover, R. (2017). Benefits of using an electronic health record, Nursing Critical Care, 12(1), 9-10. Web.
Kruse, C. S., Smith, B., Vanderlinden, H., & Nealand, A. (2017). Security techniques for the electronic health records. Journal of medical systems, 41(8), 127. Web.
M.C. (n.d.). Personal interview containing information available for current users.
Van Batavia, J. P., Weiss, D. A., Long, C. J., Madison, J., McCarthy, G., Plachter, N., & Zderic, S. A. (2018). Using structured data entry systems in the electronic medical record to collect clinical data for quality and research: Can we efficiently serve multiple needs for complex patients with spina bifida? Journal of pediatric rehabilitation medicine, 11(4), 303–309. Web.