ENHANCING CLINICAL CARE THROUGH NURSING INFORMATICS

1. ENHANCING CLINICAL CARE THROUGH NURSING INFORMATICS DECEMBER 14, 2009

2. QUOTE OF THE DAY "Computers are incredibly fast, accurate and stupid. Human beings are incredibly slow, inaccurate and brilliant. Together they are powerful beyond imagination." - Albert Einstein

3. DO YOU KNOW WHAT A TOILET BOWL CAN DO? • can redden faces • can measure sugar levels in urine • can measure blood pressure, heartbeat, body fat and weight • can do nearly everything

4. REDDEN FACE? An American diplomat was at a dinner party in a Japanese home when he excused himself to go to the bathroom. He did his business, stood up and realized he didn't have a clue about how to flush the toilet.

5. REDDEN FACE? The diplomat speaks Japanese, but he was still baffled by the colorful array of buttons on the complicated keypad on the toilet. So he just started pushing. He hit the noisemaker button that makes a flushing sound to mask any noise you might be making.

6. REDDEN FACE? He hit the button that starts the blowdryer for your bottom. Then he hit the bidet button and watched helplessly as a little plastic arm, sort of a squirt gun shaped like a toothbrush, appeared from the back of the bowl and began shooting a stream of warm water across the room and onto the mirror.

7. REDDEN FACE? And that's how one of America's promising young Foreign Service officers ended up frantically wiping down a Japanese bathroom with a wad of toilet paper. "It was one of my most embarrassing experiences in Japan," said the embassy employee who asked not to be identified.

8. NEOREST 600

9. NEOREST 600 The Neorest 600 from Japanese plumbing manufacturer Toto is a tankless toilet and personal cleansing unit. Its lid automatically opens when a person approaches it. When a person walks away from the Neorest 600, it automatically flushes and closes the seat and lid. There's a remote control for operating features including water spray temperature, pressure and direction; seat heater; air dryer; and deodorizer. List prices for the Neorest 600 start at US$5,200.

10. FRIENDLY RESTROOM

11. FRIENDLY RESTROOM Built-in assistance: The Friendly Rest Room combines a slew of high-tech features including a contactless smart card to store users' preferences, voice activation interface, and sensor systems for detecting falls and emergency situations. Users can control settings including seat height and tilt with a remote control or voice-activated commands. Researchers affiliated with Vienna University of Technology in Austria conceived the Friendly Rest Room as a way to provide greater independence to elderly and disabled people who might otherwise rely on assistance from a caregiver to use a toilet.

12. INTELLIGENT TOILET

13. INTELLIGENT TOILET Japanese homebuilder Daiwa House Industry collaborated with Toto to design the Intelligent Toilet, which doubles as an in-home health monitor. The design includes devices for measuring sugar levels in urine, blood pressure, body fat and weight.

14. WHO AMONG US ARE LIKE THIS FELLOW?

15. ARE YOU FRIENDLY OR “TOXIC” TO COMPUTERS? Let Computers Help You, Not Break You!

16. HOW? BY IMPROVING YOUR COMPUTER LITERACY…

17. COMPUTER LITERACY Computer literacy is commonly used today to denote some kind of basic knowledge and an understanding of computers combined with the ability to use them effectively.

18. COMPUTER LITERACY On the least specialized level, computer literacy involves knowing how to turn on a computer, start and stop simple application programs, and save and print information. It also refers to the attitude about computers and the actual ability to do some tasks or programs on the computer.

19. COMPUTER LITERACY The relationship between computer literacy, technological competence and a nurse's ability to care is congruent for quality care. Computer literacy represents a proactive response to technology which enhances caring in nursing (Delaney, 1990).

20. COMPUTER LITERACY AM I COMPUTER LITERATE?

21. HOW FAR DO YOU KNOW? • ANIA • BCMA • CI • CPOE • CPU • CPRS • EHR • EMR • HIS • PC • PDA • RAM

22. HOW FAR DO YOU KNOW? • ANIA - American Nursing Informatics Association • BCMA - Bar Code Medical Administration • CI - Clinical Informatics/Informaticist • CPOE - Computerized Physician Order Entry • CPRS - Computerized Patient Record System • EHR - Electronic Health Record • EMR - Electronic Medical Record • HIS - Hospital Information System • PDA - Personal Digital Assistant

23. TOP BUSINESS ISSUES IMPACTING HEALTHCARE • Increasing Patient Safety/Reducing Medical Errors • Patient (Customer) Satisfaction • Nursing Shortage

24. CURRENT IT PRIORITIES • Reduce Medical Errors/Promote Patient Safety • Implement an EMR • Connecting IT at Hospital and Remote Locations Source: Healthcare Information and Management Systems Society (HIMSS)

25. CHALLENGES FOR NURSING • Fragmented, frequently interrupted, in chaotic work environment • Interrupted mid-activity 8 times per every 8 hours* • Switch patients every 11 minutes* • Average activity time – 3.1 min/care activity* • Average of 8.1 operational failures per 8 hours* • Missing med • Missing supplies • Missing order • Missing/ broken equipment

26. CHALLENGES FOR NURSING • 9% of time spent on resolving system failures or errors* • Most common was missing medications • Direct patient care tasks done in 2:43 minutes chunks • Average 44 minutes overtime • Only 30% of shift time is in direct patient care** • Medication administration errors • in 1999, ADE cost the U.S. $2 billion annually Sources: * Tucker and Spear. Operational Failures and Interruptions in Hospital Nursing. HSR 41:643-662, 2006 ** Hendrich A., George V. Random work sampling of Medical Surgical nurses using PDAs. Reported at Health Management Academy, May 20, 2004. Unpublished Data

27. CHALLENGES FOR CLINICIANS • We practice with incomplete information • We have alarming error rates • We spend 30-50% of time on administrative activities • Errors are associated with surveillance, change in venues, and patient handoffs • Fragmented, incomplete records can cause confusion, communication breakdown, and the opportunity for error. • We need to reduce burdens related to documentation

28. LEARNING OBJECTIVES • Define nursing informatics • Demonstrate how NI supports nursing process • Explain the value of NI to nursing practice and healthcare • Identify roles for NI practice • Identify practice areas and settings • Identify education paths and certifications

29. THE IMPORTANCE OF INFORMATION • The healthcare of your clients is largely dependant on information. • Every action taken depends on previous information and knowledge. • The delivery of health care requires information about: • Science of type of care (nursing) • Patient or client • Provider • Outcomes • Process and systems for delivery of care

30. THE IMPORTANCE OF INFORMATION • Information about each of these areas have an impact on the type and the amount of care given. • Information must be: • accurate • timely • accessible • understandable

31. WHAT IS INFORMATION? The structure of information • Delivered in conversation, handwritten notes, stored in a computer. • Regardless of the form, the same basic principles apply to the structure and the use of information. • Words are often used interchangeably to describe information.

32. WHAT IS INFORMATION? The structure of information • Data: discrete entities objectively described, without interpretation or context. • Example: 110 • Information: data processed into a structured form. Data that are interpreted, organized, structured and given meaning are referred to as information. • Example: When combining 110 with other data, it becomes information. Systolic blood pressure of 110 mmHg and diastolic blood pressure of 70 mm Hg. This information can be captured in a form, on a graph in a report.

33. WHAT IS INFORMATION? • Knowledge: synthesized information derived from the interpretation of data. It provides a logical basis for making decisions.Essential to decision-making and to new discoveries. • Example: When the blood pressure reading is combined with information about anatomy and physiology, pharmacology, pathophysiology, knowledge is used to decide about further care and treatment.

34. THE FIVE RIGHTS OF INFORMATION Information has five rights: • Right information • Right person • Right time • Right place • Right amount

35. USING INFORMATION “Up-to-date, accurate information of each step of the Nursing Process is the Power behind safe, high quality patient-centered care!”

36. USING INFORMATION • Evidence-based practice leads to: • Determining standards and guidelines • Guide for decision-making process • Determines best practice • Nursing informatics can enable dissemination of new knowledge. • Practitioners update themselves of new developments through journals, conferences, continuing education sessions. • The information is varied and copious. • There is a need to find the relevant evidence in a timely way.

37. WHAT IS HEALTHCARE INFORMATICS? • With the knowledge of the importance of information in healthcare, healthcare informatics has become a specialty. • Healthcare informatics is a combination of computer science, healthcare science, information science and cognitive science.

38. WHAT IS HEALTHCARE INFORMATICS? • Computer science: development, configuration, architecture of computer hardware and software. • Healthcare science: body of knowledge on which healthcare profession bases their practice. The sciences of anatomy, physiology and knowledge specific to each profession. • Information science: also includes information technology which involves the process of sending and receiving information. • Cognitive science: the process of human thinking, understanding and remembering.

39. HOW FAR HAVE WE COME? • 1992 – First Scope of Practice for Informatics Nurse • 1992 – Informatics Nursing recognized as a specialty by ANA • 1994 – First Informatics Nursing Certification exam offered by ANCC • 2007 – 3rd Version of Informatics Nursing Scope of Practice • 2007: AONE identifies Information Management and Technology as a core competency for Nurse Executives

40. WHAT IS NURSING INFORMATICS (NI)? “Nursing Informatics is a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, and knowledge in nursing practice.  Nursing informatics facilitates the integration of data, information, knowledge, and wisdom to support patients, nurses and other providers in their decision-making in all roles and settings.  This support is accomplished through the use of information structures, information processes, and information technology.”  (ANA Scope & Standards of Nursing Informatics Practice, 2008)

41. WHAT IS NURSING INFORMATICS (NI)? • Like any knowledge-intensive field these days, nursing is greatly impacted by the explosive growth of computer technology. Nursing informatics is a new and exciting specialty that combines nursing skills with computer expertise. Nurse informatics specialists manage and communicate nursing data and information to improve decision making by consumers, patients, nurses and other health care providers.

42. SCOPE & STANDARDS OF PRACTICE • System Lifecycle • Human Factors • Information Technology • Information Management • Professional Practice • Models and Theories

43. IN vs. INS • IN – Informatics Nurse: • RN who works in the area of informatics • This RN is not formally prepared in informatics but has an interest and/or experience working in the area. • INS – Informatics Nurse Specialist: • RN with advanced, graduate education in nursing informatics or information management

44. NURSING INFORMATICS JOB TITLES • 14% “clinical analysts” • 14% “informatics nurse specialist” or “nursing informatics specialist” • 9% “consultant” • 40% identified “other” • Director of Clinical Informatics, Clinical Informatics Coordinator, Clinical Systems Analyst, Clinical Informatics Specialist

45. NI SPECIALIST SALARY • In 2007, the Healthcare Information and Management Systems Society (HIMSS) conducted a major survey of nurse informatics specialists. The average salary earned by respondents to this survey was $83,675, compared to $69,500 in the 2004 survey. This is strong evidence of the increasing maturity and value of the specialty.

46. NURSE INFORMATICS CAREER OUTLOOK • The demand for all types of nurses is expected to increase significantly over the next ten years. In general, the more training, certifications and experience a nurse has, the more demand there will be for his or her skill set.

47. HEALTHCARE INFORMATION AND MANAGEMENT SYSTEMS SOCIETY (HIMSS) LEVEL 7

48. Nurses need to develop competencies in informatics. Informatics enables nurses to use information and communications technologies in the: collection of data, use of information generation of knowledge to support nursing practice WHY IT IS IMPORTANT? Technology Nursing

49. WHY IT IS IMPORTANT? • the trend in hospitals are computerizing nursing documentations • for effective and efficient data management such as workload statistics, performance monitoring, etc. • promotes and improves evidence-based nursing practice and patient outcomes.

50. WHY IT IS IMPORTANT? • Nursing informatics enables nurses to quickly move to the synthesis of nursing knowledge and the development of nursing wisdom. Gone were the days of manual documentation that consumes most of your time, now, more time are used in applying nursing knowledge and wisdom to everyday care because of informatics.