Information Technology (Nursing)

00:02 Hi, I'm Jessica Spellman. This is the review of information technology.

00:09 A couple objectives for this course are to be able to identify the connection between information technology and patient safety; recognize and utilize information technology in the clinical setting that promotes patient safety; educate consumers on technology that supports health education; and recognize the role Telehealth plays in improving access to healthcare. The Institute of Medicine reports kind of brought to our attention back in 1998 the fact that there were quite a few medication errors that were causing issues in hospitals.

00:47 So the IOM Quality of Healthcare in America Committee was formed in June of '98.

00:53 This committee analyzed errors in the healthcare system and in 1999 they released the report "To Err is Human." This report made recommendations for reducing errors in healthcare and improving patient safety.

01:07 Later in 2003, a set of core competencies for nurses was released in their report "Health Professions Education: A Bridge to Quality." Let's look at the "To Err is Human" report that was released in 1999.

01:23 This report had some significant findings for the time. They defined safety as the absence of injury and they defined error as the failure of a plan action to be completed or intended or use of a wrong plan to achieve an aim. Remember that all of the statistics that I'm going over are from 1999. In 1999, the report summarized that between 44,000 and 98,000 Americans die each year as a result of medical errors. They also reported that more people die in the given year as a result of medical errors than from motor vehicle accidents, breast cancer or AIDS at that time.

02:06 Medication errors alone were estimated to account for over 7,000 deaths annually.

02:12 They also found that about 2 every 100 admissions experienced a preventable adverse drug event. So after reviewing that report in 1999 and releasing those statistics, it took until 2003 for the IOM to develop the five core competencies that healthcare professionals need to possess. And they released that information in "Health Professions Education: A Bridge to Quality" report. So let's review those five competencies.

02:42 First, provide patient centered care. Two, work in interdisciplinary teams. Three, employ evidence based practice. Four, apply quality improvement and, fifth, to utilize informatics in order to communicate, manage knowledge, mitigate error, and support decision making using technology. So health information technology, or health IT involves the exchange of health information in electronic format. The benefits of doing this are to improve the quality of healthcare, prevent medical errors, reduce healthcare costs, decrease paperwork and expand access to affordable healthcare.

03:29 There's legislations and regulations on the use, maintenance, entrance, mission of electronic health information. The privacy and security of that information must be maintained and falls under HIPPA. And HIPPA stands for the Health Information Privacy and Portability Act.

03:46 It is absolutely imperative that nurses are aware of the importance of utilizing information technology in the clinic setting as well as maintaining confidentiality of patient information. So to answer the question of why we need health IT, is a very simple answer and that is for patient safety.

04:05 Let's review a few health IT examples. We're going to review what an electronic health record is, what smartpumps are, how we use IT for consumer education, and then we're gonna discuss Telehealth. So let's start with electronical medical health records.

04:27 Those are digital versions of paper charts that are used in clinician offices, clinics and hospitals. They are specific for that organization only.

04:38 The benefits of the electronic medical record are that it enables providers to track data over time, identify patients for preventative visits and screenings, monitor patients and improve healthcare quality.

04:55 Electronic health records allow all clinicians involved in a patient's care to access information to provide care to that patient. It gives them a broader view of patient information and includes all services within that health network.

05:11 So how does the electronic health record promote patient safety? There are two main components that allow it to promote patient safety. The first is computerized physician order entry, or CPOE.

05:24 And the second is electronic medication administration record and Bar coded medication administration, also known as the eMAR and the BCMA. In 2012, the New York Times reported that 37 errors for every 100 paper prescriptions versus seven per 100 for those using e-prescribing software.

05:48 So a significant reduction in transcribing errors was reported using e-prescribing software.

05:56 Computerized physician order entry replaces traditional handwritten orders in CPOE. The benefits of CPOE are that it allows for clear and legible orders.

06:07 It decreases misinterpretation of poor handwriting and includes decision support and alerts to guide physicians in creating orders.

06:18 So health IT is useful in improving patient safety by improving medication administration.

06:24 Electronic medication administration record, or eMAR, replaces printed medication administration records and electronic health record. The BCMA part of the medication administration is the Bar Code Medication Administration.

06:43 It is basically an inventory control system that uses bar codes to prevent human error, while distributing medications in the hospitals.

06:53 So the information encoded in the bar codes allows for the comparison of the medication being administered to what was ordered for the patient. When it comes time for the clinician to administer the medication, a handheld device scans the bar code on the nurse's badge, the patient's wristband and the drug itself. If the BCMA system cannot match the drug to be given with order in the system, it alerts the clinician with a visual warning. It's basically an automated double check system of the five rights: the right drug, the right route, the right dose to the right patient, at the right time. The New England Journal of Medicine has done a report that has eliminated all transcription errors.

07:40 So no transcription errors when these two systems are used together. It's also provided a 41% reduction in medication administration errors that are not related to the timing of the medication and a 51% reduction in potential adverse effects, along with a 27% reduction in timing errors.

08:02 This is very significant. Another way that we're trying to make medication administration safe is by using smartpumps.

08:14 There are many hazardous medications that must be delivered with infusion pumps.

08:18 Smart infusion pumps with dose checking technology are available to help avert potential errors in the administration of those medications. The role of the smartpump is to remember the large amount of rules, defined by the hospital and other clinical advisory committees. They enter the information into the drug library and apply those rules during the pump programming to warn the clinician about potential unsafe drug therapies. But in order for this technology to be effective, it has to be used. If we choose not to use that on our pump and manually enter the rate that the medication should be running at, that bypasses or overwrites the functions of the pump and then those alerts are no longer in place.

09:09 So, so far I've reviewed some of the technology that assists healthcare professionals maintain safety for patients, now I wanna spend a few minutes reviewing some of the information technology available to assist consumers in understanding their illnesses and treatment plans.

09:28 The first item I wanna discuss is health literacy. And that's defined as the cognitive and social skills which determine the motivation and ability of ability of individuals to gain access to, understand and use information in ways that promote and maintain good health.

09:45 Patients with access to the Internet are more likely to be white, have higher income levels and more education, be under 65 years of age, and have higher health literacy. Those vulnerable populations with no access to the Internet, low income, less educated, many minorities, and those with communication barriers, have lower levels of health literacy.

10:16 So health literacy is actually believe to be a stronger predictor of health outcomes than social and economic status, education, gender and age by themselves.

10:26 So how can health professional, especially nurses, help improve health literacy of their patients? Well, first we can be knowledgeable of the benefits of increased health literacy; be able to identify at risk populations for having low health literacy; and work with those populations to increase education regarding diagnosis, treatment, medications and other education that will benefit those populations. We should also use interpreters, print off information, spend extra time educating those vulnerable populations.

11:02 And we need to address the issue within our places of employment to see what resources can be dedicated to patients with low levels of health literacy. Another consumer information technology that is becoming much more popular is Telehealth.

11:21 Telehealth is where health services are provided by using telecommunication methods such as telephone, video conferencing, downloading medical devices and sending information to providers.

11:33 Here's some examples of how Telehealth is being used. Patients can download pacemaker information over the phone for their cardiologists to interpret.

11:42 They don't have to go into an office, they don't have to make an appointment; they can just download the information for the provider to review.

11:51 The e-ICU, or electronic ICU, is when ICU nurses work with off-site physicians and specialists by using web cameras in the rooms.

12:01 It's beneficial for evaluation of changes in patient condition, when waiting for a consult to come evaluate the patient might take too long. So they have people who are located within the e-ICU location and multiple locations, rural, city, prisons.

12:25 Other people can tap into those resources and use all of the same referrals. So it's really beneficial to the patients to get expedient care as well as it being cost effective. Also, using web conferencing in prisons to evaluate patients or manage chronic conditions, so that appointments and transporting inmates does not have to occur.

12:50 They can stay within the facility and on short notice be seen by a physician.

12:56 So the benefits of Telehealth are improved patient outcomes; a decrease in admissions and readmissions; improved continuity of care, physicians do not have to transfer patients out of their network to receive care; they receive more efficient use of physicians and specialist recourses resulting in reduced cost; an increase in number of patients with healthcare needs can access the decreasing supply of clinicians; and patients not close to services can benefit without travelling and decrease cost.

13:30 Telehealth also improves patient outcomes. So nursing services provided may also reduce healthcare cost.

13:39 Telephone triage, patient education, and case management.

13:42 Follow-up on patients decreases missed appointments due to inconvenience or inability to travel.

13:50 So let's summarize information technology. The IOM reported "To Err is Human," which made recommendations to improve patient safety.

14:01 Information technology has been integrated into the healthcare system over the past decade with the hope of decreasing those errors. Technology that has been implemented so far is the electronic health record, computerized physician order entry systems, electronic medication administration records with bar coded medication administration.

14:26 With all these health IT, it is important that nurses are familiar with the proper use of it.

14:33 However, consumers also need some assistance understanding and utilizing health IT to improve their health literacy.

14:42 Telehealth has become a valuable tool for bringing healthcare to areas that are not easily accessible to medical care.

14:50 Nursing is important for both of these areas in order to make them successful. Health IT is only going to increase for healthcare providers and consumers, and nurses are gonna be on the front line of that.

15:06 This has been information technology and I'm Jessica Spellman.