Wednesday, May 19, 2010

Nursing Informatics Final Exam

Basco, Sarah Elizabeth S. / BSN-2A / Submitted to Ma’am Luisa Uayan on or before 3pm, 05/20/10.


1. Describe the following nursing applications comprehensively according to purpose, rationale and nursing roles: (50 pts.)

OASIS (Outcome and Assessment Information Set):

A data set for patients/clients of the National Association of Home Care (NAHC) developed as an addition to the Uniform Data Set.

Purpose: The purpose of OASIS is to have a comprehensive assessment for an adult home health care patient and forms the basis for measuring patient outcomes for Outcome- Based Quality Improvement to be used to analyze and enhance the outcome of care.

Rationale: The data set is compromised of 79 health and functional status patient assessment items that are discipline- neutral and when measured at two or more points in time serve as outcome measures. They are not designed for maternity, pediatric, or hospice patients. OASIS maximizes the consistency of ratings among clinicians collecting the same information since the items included are clinically more precise than most existing HHA assessment items. As a result, this makes possible the benchmarking of data within and among HHAs. The data set also serves as a method to provide payment based on anticipated resource use for every 60-day episode of care. Answers to OASIS questions are weighed, compiled into a case mix adjuster which is mathematically formulated based on patient risk adjusted characteristics and combined with the wage index in the metropolitan statistical area where the patient resides.

Nursing Roles: Nurses are now using OASIS to integrate these particular assessment items into their existing assessment process. They collect them at defined time points during care delivery, minimally at admission to home health care and every 60 days.

HEDIS (Health Plan Employer Data and Information Set)

Purpose: HEDIS is a set of standardized performance measures designed to ensure that purchasers and consumers have the information for reliably comparing the performance of managed healthcare plans.

Rationale: These measures cross many community health applications as they evaluate care along the continuum of practice of inpatient care through community-based practice. Said measures become the basis to evaluate plan performance related to customer service, access to care, and claims processing.

Nursing Role: Nurses use HEDIS as a tool to document public health care by accomplishing a standardized survey of consumer’s experiences.

OMAHA system:

A research based, comprehensive taxonomy designed to generate meaningful data following usual or routing documentation of client care. It is now used in all clinical settings. It includes an assessment component (Problem Classification Scheme), an Intervention component (Intervention Scheme), and an outcomes component (Problem Rating Scale for Outcomes).

Purpose: The purpose of OMAHA system is to generate, meaningful data following usual or routine documentation of client care. The system provides a method for linking clinical data to demographic, financial, administrative, and staffing data.

Rationale: Enables collection, aggregation, and analysis of clinical data. It supports quality improvement, critical thinking, and communication. It fosters research involving best practices/evidence-based practice. It links clinical data to demographic, financial, administrative, and staffing data.

Nursing Roles: Nurses create an independent data baseline when establishing initial ratings for client problems. They are also responsible for capturing the condition and circumstances of a client at a given point in time. This admission baseline is used to compare and contrast the client’s condition and circumstances with ratings completed at later intervals and at client dismissal. The American Nurses Association has recognized the Omaha System as a standardized terminology to support nursing practice.

Hemodynamic Monitor:

A clinical care nursing monitoring system that allow for calculation of hemodynamic indices and limited data storage. It is usually used for critical care management.

Purpose: The Hemodynamic Monitor has many purposes:
o Measure hemodynamic parameters
o Closely examine cardiovascular function
o Evaluate cardiac pump output and volume status
o Recognize patterns and extract features
o Assess vascular system integrity
o Evaluate the patient’s physiological response to stimuli
o Continuously assess respiratory gases and electrolyte
o Continuously assess blood gases and electrolyte
o Estimate cellular oxygenation
o Continuously evaluate glucose level
o Store waveforms
o Automatically transmit selected data to a computerized patient database

Rationale: It allows calculation of hemodynamic indices and limited data storage. Hemodynamic monitoring can be invasive or noninvasive. Noninvasive monitoring methods are increasingly common.

Nursing Role: Nurses collect and monitor data from the hemodynamic system. They integrate data from hemodynamic devices, mechanical ventilators, bedside testing devices, and observations from direct patient assessments to form a comprehensive picture of patient’s status and the effect of care. Nurses must keep in mind that although it the system offers a wealth of information, it does not replace the clinical judgment or necessarily imply quality patient care. The critical care nurse must learn to recognize the limitations of manual estimation to diagnose a monitor malfunction. It can be very helpful in performing various interventions such as pulmonary artery catheter, measuring cardiac output, pressure measurement and telemetry monitoring.

Critical Care Information Systems:

It is a system designed to collect, store, organize, retrieve and manipulate all data related to are of the critically ill patient.

PURPOSE: The primary purpose of the Critical Care Information System is the organization of a patient’s current and historical data for use by all care providers in patient care.

RATIONALE: The CCIS has the ability to integrate information from a variety of sources and to manipulate that information in meaningful ways. Integration of these data results in a more complete representation of the patient’s status and can promote safety, quality, and efficiency in patient care. It also allows free flow of data between the critical care unit and other departments. This provides a rich repository of patient information that can be integrated for use in outcomes management.

Nursing role: Nurses collect and record data which includes patient management, vital sign monitoring, diagnostic testing results, clinical documentation, decision support, medication management, interdisciplinary plans of care, and provider order entry.

2. Explain the different issues of an Ambulatory Care System: (20 pts)

Issues surrounding those who work in ambulatory care are similar across the health care enterprise including increased accountability, the need for continuous and documented service improvements, pressures to control utilization, and the protection of confidential information. Effective reimbursement of services is paramount for continued operation.

The applications needed are the same with those required in the in-patient area. There is great emphasis on financial and administrative applications. A lot of benefits could be achieved by using electronic records.

It’s Financial Benefits includes gainful and timely bill compliance process resulting in low number of days in accounts receivable. Large organizations utilize electronic data interchange for computerization.

It’s Clinical benefits uses of ambulatory care environment can be further developed by electronic information technology for data collection and management. Instant transportation of requests will help in patient care and payment of the bill.

3. Describe the eClinicalog. (20 pts)

The eCLINICALOG is part of an educational strategy, initially designed to build data entry, analysis and synthesis skills in nurse practitioner students. It becomes relevant to undergraduate education as well. Like other logs, eClinicalog started out as a paper and pencil format. Nurse practitioner students used logs to track the number of patients seen in clinical practical and record basis demographic data, medical diagnoses, and medications prescribed.

It is also a useful pedagogic tool. It guides students through an informatics skill building and refinement process and assists professional development. Its successful use indicates that Internet applications are not just adjuvant educational tools but an integral part of the clinical learning process.

It is currently an electronic data base which addresses issues of retrievability, familiarity, availability, student acceptance, curricular congruence and contribution to the discipline. It also includes HIPAA principles as well. Even content thought to be clinically oriented was updated as the clinical log evolved to be more encompassing.

The eClinicalog is a necessary tool with the inclusion of electronic and Web-based tools to facilitate student learning and curricular development.

4. Enumerate and explain the importance of nursing informatics. (50 pts)

Nursing informatics is very important since it is the specialty that integrates nursing science, computer science and information science in identifying, collecting, processing and managing data and information to support nursing practice, administration, education, research and the expansion of nursing knowledge. (Based on the definition of ANA Scope and Standards of Nursing Informatics)

The use of computers is vital in the work of nurses within the twenty-first century practice environment. Nursing informatics addresses the changes in the practice environment-with its technologic advances, regulatory constraints, changing patient needs, and shortage of nurses. There are new standards for practice in nursing informatics; a vast array of new, improved systems for nursing documentation systems, care planning, decision-making, and outcomes management and emerging technology that address these problems. This will drastically alter the digital landscape of hospitals in the future.

Computer systems are indispensable for community health nursing practice. Computer systems and/or applications for CHN have been developed to support clinical practice because of the broad scope of services and the wide variance in applications. Applications for home health care involve integrating various functions of service delivery into a MIS, integrating the clinical, financial, operational, and administrative functions.

Nursing informatics is necessary for critical care nursing. Critical care nursing is conducted in a technologically intense environment geared to the monitoring and supporting the needs of critically ill patients. Embedded in much of that technology are microprocessors, which permits gathering, processing, and storage of large volumes of clinical and financial data. Much of the data originate from the point of care medical devices found in the critical care environment. Technology help nurses deliver care to life threatening problems.

Nursing informatics benefits client care in various ambulatory care settings. Ambulatory care systems usually computerized are designed to store, manipulate, and retrieve information for planning, organizing, directing, and controlling the administrative and clinical activities associated with the provision and use of ambulatory care services and facilities.

Additional importance of nursing informatics if used:

  • Educating patients on how to use certain types of equipment or technology. For example, if a patient needs to use a talking pillbox the nursing informatics professional may need to educate them on how this technology works.
  • Training nurses and other healthcare professionals on how to use certain software and other technology. This is especially important during implementations or upgrades.
  • Working in a project management capacity for implementation of clinical product processes. This involves an analysis of the process at the current state, working with the clinician or nurse to identify an appropriate future state, and developing and implementing a design with the electronic system.
  • Ensuring that proper patient documentation systems are utilized which improves accuracy and diminishes the chance for error.
  • Conducting consistent, regular data analysis to determine how to cut costs so the hospital facility has a more optimized bottom line.
  • Cost Saving Analysis of surgical or hospital billing to identify items or areas of lost charges and develop processes to help eliminate revenue loss.
  • Analysis of quality and safety initiatives in a facility or system.

5. How will you utilize your learning in the nursing informatics course in your chosen profession? (60 pts.)

Computer and telecommunication systems have proven to be effective management tools for health care data. Communication of this information to other healthcare professionals and their use will become the way of the future. The knowledge I have gained from this course is the first step in preparing me to work in a technology-rich environment anywhere in the world. For example, the federal government plans for the United States to have electronic health records by 2014. The National League for Nurses (NLN) (2008) has found that the next generation of nurses will not be prepared to work in such a technology-rich environment. Hence, as a nursing student who aims to be globally competitive, I am greatly helped in getting a basic knowledge of informatics from this course. This course has also widened my horizon in the sense that I am made aware that there is a wealth of information that has still to be learned in terms of equipping myself in achieving competency in informatics.

I learned that the science of nursing informatics has evolved to aid in the management of nursing data. I am now aware that my future profession which is nursing, is a discipline which is information intensive and thus requires the careful investigation into the use of computers to process nursing information. The course has taught me that as a future nurse, I need to feel comfortable working with computerized data. I now know from this informatics course that becoming an informatics nurse specialist is an option for specialization after graduation.

As the movement towards evidence-based practice drives the direction of health care, it is perceivable that it will become necessary for nurses to have key information for decision making at the point of care. I have discovered in this course that there is such a thing as point-of-care technology, which is a computerized patient record that includes all the patient data in one place and is accessible to caregivers at different locations. I have experienced through a hands on group project that with this technology, software programs can be designed to assist health care providers in making decisions for individual patients, as data are entered for analysis by the computer software, and recommendations are made so decisions can be made quickly, with minimal errors. I have been given awareness that in developed countries and in high technology hospitals in the country there is now in existence systems where evidence-based practice is coded to an appropriate taxonomy system, the computerized nursing documentation will allow nurses to track their care and improve patient outcomes by implementing appropriate interventions for identified problems.

Nursing documentation is a dynamic and complex process. As a result of this course, I know that we nursing students have to learn nursing documentation using the electronic recording system. I can imagine that there will be efforts at standardization of charting methods, as well as what data is to be included in the electronic record and what terminology is used to record the data. Educators must work to establish consistent documentation guidelines for students.

With this course in Nursing Informatics I can already see into the not so far future when nurses would look back in awe at how nurses documented with paper and pen to present a complete picture of the patient’s condition. By then, needed data will be available anytime, anywhere at click of a button.

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