Information Needs for the Healthcare

Professional of the 21st Century

Carl Roucel T. Animos

 Key terms

ü Clinical Guidelines
ü Fast Healthcare Interoperability Resources
(FHIR)
ü Continuing Education
ü Health Information Exchange (HIE)
ü Continuous Quality Improvement (CQI)
ü Interprofessional Collaboration
ü Procedures
ü Protocols
Accessibility to Guidelines, Protocols,
and Procedures
Handheld devices have become a craze in the new
millennium and it is difficult to find anyone today
without some or the other handheld gadget in his
or her hands. A handheld device is a pocket-sized
computing device with a display screen and
input/output interface like an external or touch
screen keyboard.
Various popular handheld devices include:

ØMobile computers
Notebook PC

A laptop (also laptop

computer), often
called a notebook, is a
small,
portable personal
computer(PC) with a
clamshell form factor,
typically having a
thin LCD (LED compute
r screen mounted on
the inside of the upper
lid of the clamshell and
an alphanumeric
keyboard on the inside
of the lower lid.
Ultra-Mobile PC
An ultra-mobile
PC (ultra-
mobile personal comp
uter or UMPC) is a
miniature version of a
pen computer, a class
of laptop whose
specifications were
launched by Microsoft
and Intel in spring
2006.
Handheld PC

A handheld PC,
or H/PC , is
a computer built
around a form
factor which is
significantly
smaller than any
standard
laptop computer.
It is sometimes
referred to as a
palmtop
computer.
Personal digital
assistant/Enterprise
digital assistant
Also known as
a handheld PC, is a
variety mobile
device which functions as
a personal information
manager. PDAs have been
mostly displaced by the
widespread adoption of
highly capable
smartphones, in
particular those based
on iOS and Android.
Graphing calculator

A graphing calculator
is a handheld
computer that is
capable of plotting
graphs, solving
simultaneous
equations, and
performing other
tasks with variables.
Pocket computer

A pocket
computer was a
1980s-era user
programmable
calculator-
sized computer that
had fewer screen
lines, and often
fewer characters per
line, than the Pocket-
sized computers intro
duced beginning in
1989.
Tablet Computer
A type of computer that
can be carried easily.
Unlike a laptop it has no
physical keyboard or
trackpad, though users
sometimes add those
things.
Users control a tablet
mostly by using its touch
screen with multi-
touch technology similar
to a smartphone.
Ø Handheld game consoles
Nintendo DS
Game Boy,
Game Boy Color
Game Boy Advance
Sega Game Gear
PC Engine GT
Pokémon Mini
NeoGeo Pocket, NeoGeo Color
Atari Lynx
Pandora
GP2X/GP32
Gizmondo
PlayStation
Portable
N-Gage
ØMedia recorders
Digital still camera(DSC)
Digital video camera (DVC or digital Camcorder)
Digital audio recorders

In digital recording, audio

signals picked up by
a microphone or
other transducer or video
signals picked up by a camera or
similar device are converted into
a stream of discrete numbers,
representing the changes over
time in air pressure for audio,
luminance values for video, then
recorded to a storage device.
Media players/displayers
Portable media player
e-book reader
An electronic book,
also known as an e-
book or eBook, is
a book publication
made available
in digital form,
consisting of text,
images, or both,
readable on the flat-
panel display of
computers or other
electronic devices.
ØCommunication devices
Mobile Phones
Cordless telephone
Pager
Benefits of Handheld Devices and Gadgets:
Office on the go:
High Convenience:
New Entertainment forms:
Breaking the Communication Barrier:
Guidelines, primarily evidence-based recommendations, are usually
generated from an authority group consisting of experts in the field and are
publish regularly. A well-known example is the set of guidelines published
annually by the American Diabetes Association. A council of expert assesses,
critiques, and updates the clinician guidelines for care of the patient with
diabetes. In years past, clinicians who regularly care for patients with
diabetes would carry these guidelines in their lab coat for easy reference.
Today, these guidelines are updated with the new
recommendations to safeguard patients with regard
to the physical and psychological health of people
with diabetes. Clinicians now have the ability to
access these updated guidelines because of the
work in the field of informatics.
Other common clinical guidelines are the National
Heart, Lung and Blood Institute (NHBLI) for the
management of asthma and hypertension published
by the Joint National Committee (JNC) and
colorectal screening guidelines released periodically
by the US Preventive Service Task Force.
 Examples of Commonly Used Clinical Resources
Topic Release URL Reference
Date
Colorectal http://jamanetwork.com/jou
rnals/jama/fullarticle/252948
U.S. Preventive
Service Task Force
Cancer 2016 6 et.al (2016)
Screening
https://professional.diabetes. American Diabetes
org/sites/professional.diabet Association (2017)
Diabetes 2017 es.org/files/media/dc_40_s1_
final.pdf

http://jamanetwork.com/jou 2014 Evidence-Based

rnals/jama/fullarticle/179149 Guideline for the
Hypertension 2014 7 Management of High
Blood Pressure in
Adults
http://www.nhlbi.nih.gov/gui National Heart, Lung,
delines/asthma/asthgdln.pdf and Blood Institute
Asthma 2007
Protocols are usually evidence-based but tend to be
beam-based approaches to practices in a locale or
region. Through shared drives and web-based
applications, teams of clinicians can share and
access protocols to improve uniformity and best
practices germane to a particular practice.
Procedures are commonly performed skills in
practice setting. These procedures can be accessed,
shared, and easily updated with the emergence of
new evidence with the use of clinical informatics.
The application of clinical informatics allows the
nurse to review procedures prior to performing
them and also adds to the uniformity of procedures
performed within a given practice.
Common medical applications, such as
Epocrates and UptoDate, offer a centralized
repository of many guidelines, protocols, and
procedures
Epocrates is a mobile medical reference app,
owned by Watertown, Massachusetts-based
athenahealth, that provides clinical reference
information on drugs, diseases, diagnostics
and patient management.
UpToDate, Inc. is a company in the Wolters
Kluwer Health division of Wolters Kluwer
whose main product is UpToDate, a software
system that is a point-of-care medical resource.
The UpToDate system is an evidence-based
clinical resource.
Quality Improvement Techniques &
Nursing Informatics
 Electronic Health Record (EHR)

An electronic health record (EHR)

is software that's used to securely
document, store, retrieve, share,
and analyze information about
individual patient care.
EHRs are hosted on computers
either locally (in the practice
office) or remotely. Remote EHR
systems are described as “cloud-
based” or “internet-based.”
An electronic health record (EHR) is a
digital version of a patient’s paper chart.
EHRs are real-time, patient-centered
records that make information available
instantly and securely to authorized users.
While an EHR does contain the medical
and treatment histories of patients, an
EHR system is built to go beyond
standard clinical data collected in a
provider’s office and can be inclusive of a
broader view of a patient’s care.
EHRs are a vital part of health IT and can:
ü C o n t a i n a p a t i e n t ’s m e d i c a l
history, diagnoses, medications,
treatment plans, immunization
dates, allergies, radiology images,
and laboratory and test results
ü Allow access to evidence-based
tools that providers can use to
make decisions about a patient’s
care
üAutomate and streamline
provider workflow
One of the key features of an is that
health information can be created and
managed by authorized providers in a
digital format capable of being shared
with other providers across more than
one health care organization.
EHRs are built to share information with
other health care providers and
organizations – such as laboratories,
specialists, medical imaging facilities,
pharmacies, emergency facilities, and
school and workplace clinics – so they
contain information from all clinicians
involved in a patient’s care.
Our world has been radically transformed by
digital technology – smart phones, tablets,
and web-enabled devices have transformed
our daily lives and the way we communicate.
Medicine is an information-rich enterprise.

A greater and more seamless flow of

information within a digital health care
infrastructure, created by electronic health
records (EHRs), encompasses and leverages
digital progress and can transform the way
care is delivered and compensated.
With EHRs, information is available
whenever and wherever it is needed.
ü Quick access to patient records from
inpatient and remote locations for more
coordinated, efficient care
ü Enhanced decision support, clinical alerts,
reminders, and medical information
ü Performance-improving tools, real-time
quality reporting
ü Legible, complete documentation that
facilitates accurate coding and billing
ü Interfaces with labs, registries, and other
EHRs
ü Safer, more reliable prescribing
ü Reduced need to fill out the same
forms at each office visit
ü Reliable point-of-care information
and reminders notifying providers of
important health interventions
ü Convenience of e-prescriptions
electronically sent to pharmacy
ü Patient portals with online interaction
for providers
ü Electronic referrals allowing easier
access to follow-up care with
specialists
Providers and patients who share
access to electronic health
information can collaborate in
informed decision making. Patient
participation is especially important
in managing and treating chronic
conditions such as asthma, diabetes,
and obesity.
Electronic health records (EHRs) can
help providers:

With EHRs,
providers can give patients full and
accurate information about all of
their medical evaluations. Providers
can also offer follow-up information
after an office visit or a hospital stay,
such as self-care instructions,
reminders for other follow-up care,
and links to web resources.
With EHRs, providers can manage
appointment schedules electronically
and exchange e-mail with their patients.
Quick and easy communication
between patients and providers may
help providers identify symptoms earlier.
And it can position providers to be more
proactive by reaching out to patients.
Providers can also provide information
to their patients through patient portals
tied into their EHR system.
As medical practices and technologies have
advanced, the delivery of sophisticated, high-
quality medical care has come to require teams of
health care providers—primary care physicians,
specialists, nurses, technicians, and other
clinicians.
Each member of the team tends to have specific,
limited interactions with the patient and,
depending on the team member's area of
expertise, a somewhat different view of the
patient. In effect, the health care team's view of
the patient can become fragmented into
disconnected facts and clusters of symptoms.
Health care providers need less fragmented views
of patients.
Electronic health record (EHR)
systems can decrease the
fragmentation of care by improving
care coordination. EHRs have the
potential to integrate and organize
patient health information and
facilitate its instant distribution
among all authorized providers
involved in a patient's care.
For example, EHR alerts can be used
to notify providers when a patient
has been in the hospital, allowing
them to proactively follow up with
the patient.
With EHRs, every provider can have the same
accurate and up-to-date information about a
patient. This is especially important with patients
who are:

ü Seeing multiple specialists

ü Receiving treatment in emergency settings
ü Making transitions between care settings
ü Better availability of patient information can
reduce medical errors and unnecessary tests.
ü Better availability of information can also
reduce the chance that one specialist will not
know about an unrelated (but relevant)
condition being managed by another specialist.
ü Better care coordination can lead to better
quality of care and improved patient outcomes.
When health care providers have access
to complete and accurate information,
patients receive better medical care.
can
improve the ability to diagnose diseases
and reduce—even prevent—medical
errors, improving patient outcomes.
• With EHRs, providers can have reliable
access to a patient's complete health
information. This comprehensive
picture can help providers diagnose
patients' problems sooner.
• A qualified EHR not only keeps a
record of a patient's medications
or allergies, it also automatically
checks for problems whenever a
new medication is prescribed and
alerts the clinician to potential
conflicts.
• Information gathered by a primary
care provider and recorded in an
EHR tells a clinician in the
emergency department about a
patient's life-threatening allergy,
and emergency staff can adjust
care appropriately, even if the
patient is unconscious.
• EHRs can expose potential safety
problems when they occur, helping
providers avoid more serious
consequences for patients and
leading to better patient outcomes.
• EHRs can help providers quickly
and systematically identify and
correct operational problems. In a
paper-based setting, identifying
such problems is much more
difficult, and correcting them can
take years.
Many health care providers have found that
help improve medical practice management
by increasing practice efficiencies and cost savings. EHRs
benefits medical practices in a variety of ways, including:

ü Reduced transcription costs

ü Reduced chart pull, storage, and re-filing costs
ü Improved documentation and automated coding
capabilities
ü Reduced medical errors through better access to patient
data and error prevention alerts
ü Improved patient health/quality of care through better
disease management and patient education
EHR-enabled medical practices report:

oImproved medical practice management

through integrated scheduling systems
that link appointments directly to
progress notes, automate coding, and
managed claims
oTime savings with easier centralized chart
management, condition-specific queries,
and other shortcuts
oEnhanced communication with other
clinicians, labs, and health plans through:
ü Easy access to patient information from
anywhere
ü Tracking electronic messages to staff,
other clinicians, hospitals, labs, etc.
ü Automated formulary checks by health
plans
ü Order and receipt of lab tests and
diagnostic images
ü Links to public health systems such as
registries and communicable disease
databases
HRs and the ability to exchange health
information electronically can help you provide
higher quality and safer care for patients while
creating tangible enhancements for your
organization. EHRs help providers better manage
care for patients and provide better health care
by:

ü Providing accurate, up-to-date, and complete

information about patients at the point of care
ü Enabling quick access to patient records for
more coordinated, efficient care
ü Securely sharing electronic information with
patients and other clinicians
ü Helping providers more effectively diagnose
patients, reduce medical errors, and provide
safer care
ü Improving patient and provider interaction
and communication, as well as health care
convenience
ü Enabling safer, more reliable prescribing
ü Helping promote legible, complete
documentation and accurate, streamlined
coding and billing
ü Enhancing privacy and security of patient data
ü Helping providers improve productivity and
work-life balance
Other Advantages:

Transformed Health Care

Electronic Health Records (EHRs) are the first step to
transformed health care. The benefits of electronic
health records include:

by improving all aspects of patient

care, including safety, effectiveness, patient-
centeredness, communication, education, timeliness,
efficiency, and equity.
by encouraging healthier lifestyles in
the entire population, including increased physical
activity, better nutrition, avoidance of behavioral risks,
and wider use of preventative care.
 by promoting preventative
medicine and improved coordination of
health care services, as well as by reducing
waste and redundant tests.
by
integrating patient information from
multiple sources.
o Enabling providers to improve efficiency
and meet their business goals
o Reducing costs through decreased
paperwork, improved safety, reduced
duplication of testing, and improved health.
An contains patient
health information, such as:
An is more than just a
computerized version of a paper
chart in a provider’s office.
It’s a digital record that can
provide comprehensive health
information about your patients.
Some people use the terms
and
“ (or “EMR”
and “EHR”) interchangeably.
While it may seem a little picky at first,
the difference between the two terms
is actually quite significant.
The term came along first, and
indeed, early EMRs were “ ”
They were for use by clinicians mostly
for diagnosis and treatment.
In contrast, relates to “The
condition of being sound in body, mind,
or spirit; especially…freedom from
physical disease or pain…the general
condition of the body.”
The word “health” covers a lot more
territory than the word “medical.” And
EHRs go a lot further than EMRs.
Electronic Medical Records (EMRs)

are a digital version of the paper charts in the

clinician’s office. An EMR contains the medical and
treatment history of the patients in one practice.
EMRs have advantages over paper records. For
example, EMRs allow clinicians to:

ü Track data over time

ü Easily identify which patients are due for
preventive screenings or checkups
ü Check how their patients are doing on certain
parameters—such as blood pressure readings or
vaccinations
ü Monitor and improve overall
quality of care within the
practice
But the information in EMRs
doesn’t travel easily out of the
practice.
In fact, the patient’s record might
even have to be printed out and
delivered by mail to specialists
and other members of the care
team.
In that regard, EMRs are not
much better than a paper record.
The EHR is the future of healthcare because they
provide critical data that can help coordinate care
between everyone in the healthcare ecosystem. An
EHR has the following benefits over an EMR:

The system holds

what‘s normally in a paper chart – problem lists,
ICD-10 codes, medication lists, test results.
An EHR lets you receive lab
results, radiology reports, and even X-ray images
electronically while ensuring tests are not
duplicated.
No more prescription pads. All your
orders are automated using secure e-prescribing
technology.
 Offer access to evidence-
based tools to support clinical decisions. An
EHR is smart enough to warn you about drug
interactions, help you make a diagnosis, and
point you to evidence-based guidelines when
you’re evaluating treatment options.

You can talk in cyberspace with patients, your

medical assistant, referring doctors, hospitals,
and insurers—securely. Interoperability is the
key word as you streamline your workflow by
interfacing with other providers, labs, imaging
centers, and payers.
 Engage your patients by
allowing to them to receive educational
material via the EHR and enter data
themselves through online
questionnaires and home monitoring
devices.
. The system
lends a hand with practice management
and helps avoid delays in treatments.
Patients can schedule their own
appointments and staffers can check on
insurance eligibility.
While there are many advantages to having
an EMR or EHR system, there are some
disadvantages as well.

o They are typically much more expensive to

implement initially, as providers must
invest in the proper hardware, training and
support on top of the software.
o Unless properly built, there’s also the
chance the system will malfunction,
destroy all data.
All computer systems are prone to attacks
by hackers, and EHR systems are not
immune. Patient healthcare information is
one of the most targeted areas of data, so
healthcare providers need to integrate an
advanced data security strategy for their
EHR systems. Thus, it is essential to opt for
an EHR that is HIPAA Compliant, ONC-ACB,
and HL-7 interfacing.
If an EHR is not updated immediately,
once new information is collected,
such as after an exam or after the
entry of test results, anyone who sees
that EHR may receive incorrect or
incomplete information. This could
lead to subsequent errors in diagnosis,
treatment, and health outcomes, not
only by the issuing practitioner but
also by specialists, pharmacists, and
physiotherapists.
When implementing an EHR system, you
must prepare for the costs and time. It is
important to choose the right
functionality to estimate the scope of
the budget and how long it will take to
implement the system. There’s
something else to consider when
planning time frames for project design
and implementation. You will need time
for your staff training to teach them how
to use the EHR’s functionality.
EHR-related burnout is a real and
serious concern among clinicians. EHR-
related burnout among doctors stems
from increased demands for data entry
into an EHR system. As a result, studies
show that decreases in job satisfaction
and burnout can be linked to increased
EHR-related data entry requirements.
 The National
Academy of Medicine,
highlights six main
aims of HCPs:
(Agency for
Healthcare Research
and Quality)
üEffectiveness- it
is the ability of an
intervention to
have a
meaningful effect
on patients in
normal clinical
conditions.
üSafety- In AHRQ, ü Efficiency- effective
avoiding harm to operation as measured
patients from the care by comparison of
that is intended to help production with cost (as
them. in energy, time, and
money)
ü Patient- centeredness-
In AHRQ, providing care
that is respectful of and
responsive to individual
patient preferences,
needs, and values and
ensuring that patient
values guide all clinical
decisions.
üTimeliness- According ü Equitability- In AHRQ,
to the Agency for all individuals have
Healthcare Research access to affordable,
and Quality, it refers to high quality, culturally
a practice’s ability to and linguistically
quickly provide care appropriate care in a
after recognizing a need. timely manner.
Several groups have attempted to address
this issue by researching, vetting, and
endorsing measures of quality that are
valid and reliable and more proximal to the
actual care provided rather than a long-
term measurement.

AHRQ is the primary provider of these

vetted quality measures, and a breakdown
of these measures can be found on its
National Quality Measures Clearinghouse
website
(http://www.qualitymeasures.ahrq.gov).
Continuous quality improvement,
or CQI, is a management philosophy
that organizations use to reduce
waste, increase efficiency, and
increase internal (meaning,
employees) and external (meaning,
customer) satisfaction.
It is an ongoing process that
evaluates how an organization
works and ways to improve its
processes.
CQI is a way of improving the processes
to enable to achieve strategic goals and
attain the vision of becoming The Model
of Service Excellence.
It begins with the customers, utilizes
proven methods and tools, is data-driven,
and implemented by individuals and
teams closest to the customer experience.
In ongoing, daily ways and through
longer-term initiatives, CQI helps to
transform ways in business.
A detailed list of QI strategies and tools can be
found at the AHRQ’s website:
(https://innovations.ahrq.gov/qualitytools/quality-
improvement-quality-toolbox)
Interprofessional Collaboration and
Practice Workflow
Clinical informatics impact the ability of professionals to
interact and build upon one another’s contribution to
patient care. In years past, inter-professional
collaboration was limited to verbal encounters, phone
calls, and facsimiles.
Fast Healthcare Interoperability
Resources (FHIR, pronounced "fire") is a
standard describing data formats and
elements (known as "resources") and
an application programming
interface (API) for exchanging electronic
health records.
The standard was created by the Health
Level Seven International (HL7) health-
care standards organization.
HIEs (health information
exchanges) are high level
systems that are designed to
promote rapid sharing of data
across facilities. Although
technological factors are
certainly essential in the success
of an HIE, understanding how
the HIE impacts users is also
important.
Nursing Curricula and Continuing
Education
The American Association of Colleges of Nursing,
summarizes the need for informatics content in curricula:”
Knowledge and skills in information management and
patient care technologies are critical in the delivery of
quality patient care.”
Essentials of Baccalaureate Education for professional
Nursing practice: Information Management and
Application of Patient Care Technology

ü Demonstrates skills in using patient-care

technologies, information systems, and
communication devices that support safe nursing
practice.
ü Use telecommunication technologies to assist in
effective communication in a variety of healthcare
settings.
ü Apply safeguards and decision-making support
tools embedded in patient-care technologies and
information systems to support a safe practice
environment for patients and healthcare workers.

ü Understand the use of clinical information system

to document interventions related to achieving
nurse-sensitive outcomes.

ü Use standardized terminology in a care

environment that reflects nursing’ unique
contribution to patient outcomes.
ü Evaluate data from all relevant sources, including
technology, to inform the delivery of care.

ü Recognize the role of the information technology in

improving patient-care outcomes and creating a safe
care environment.

ü Uphold ethical standards related to data security,

regulatory requirements, confidentiality, and
patients’ right to privacy.
ü Apply patient-care technologies as appropriate to
address the needs of a diverse patient population.

ü Recognize the redesign of workflow and care

processes should precede implementation of care
technology to facilitate nursing practice.

ü Participate in evaluation of information systems in

practice settings through policy and procedure
development.
Ongoing Education and Nursing
Information
Continuing education is required for all nurses to stay
current in practice,meet their state-mandated continuing
education units (CEUs), and fulfill requirements for
certifications/re certification in specialty practice.
As clinical evidence rapidly evolves,an efficient
means to gain access to education is available
through online programs offering CEUs.
 Resource Internet Address
Agency for Health care and Quality:Quality Measures http://www.qualitymeasures.ahrq.gov
Website

Agency for Health care and Quality:Patient Safety http://www.patientsafety.gov

Website

American Library Association Information Literacy http://www.ala.org./ala/mgrps/divs/acrl/standard

Competency Standards for higher Education s/informationliteracycompetency.cfm

American Nurses Association States Which Require http://nursingworld.org/MainMenuCategories/Pol

Continuing Education for RN Licensure icy-Advocacy/State/Legislative-Agenda-
Reports/NursingEducation/CE-Licensure-Chart.pdf

ECD Foundation, which is an international http://www.ecdl.org/programmes/ecdl_icdl

organization whose mission is to raise digital
competence in the workforce,education,and
society(European Computer Driving Licence
Qualifications,2013 )
Technology Informatics Guiding Education http://www.himss.org/professionaldevelopment/t
Reform(TIGER)Initiative (Health Information and iger-initiative
Management System Society,2017)