Chapter 21 - Informatics and documentation

module 9

Meaningful use of Electronic Health record

Quality and safety, patient engagement, care and cooridnation, privacy and security

results of meaningful use compliance 

better clinical outcomes, improved population health, increased transparency, empowered individuals, robust research data

ANA definition of nursing informatics

The specialty that integrates nursing science with multiple information management and analytical sciences to identify, define, manage, and communicate data, information, knowledge, and wisdom in nursing practice

System Development Lifecycle (SDLC)

analyze and plan, design and develop, test, train, implement, maintain, evaluate

Analyze and plan

Define project scope, identify requirements, and establish
implementation strategy

Design and develop

Create system architecture, user interfaces, and functional specifications

Test

Conduct comprehensive testing across multiple environments and scenarios

Train

Prepare end users through education, documentation, and hands-on practice

Implement 

Deploy system in live environment with careful monitoring and support

Maintain

Provide ongoing support, updates, and system optimization

Evaluate

Assess outcomes, measure success, and identify improvement opportunities

Analyze and plan

Define project scope, identify requirements, and establish implementation strategy

Analyze and Plan: foundation questions 

What is the purpose of this new tech or change? What specific problem do we hope to solve? What data indicates the current state and severity of the issue? How will the tech integrate into current nursing workflows? What are the potential impacts on daily nursing activities? How can we minimize workflow disruption during implementation?

Analyze and Plan: strategic considerations

Documentation Impact Assessment, EHR Usability Enhancement, and Technology Options Evaluation

Design and development: user centered approach

screen layout and consistency, workflow support integration, evidence based design, standard terminology integration

Comprehensive testing framework

• Unit testing: Individual components tested in isolation to verify basic functionality and identify coding defects early in development process.

• Function testing: Comprehensive feature validation ensuring all system functions perform as specified in requirements documentation

• Integration testing: System interfaces and data flow validation between different components, modules, and external systems

• Performance testing: Load, stress, and response time testing to ensure system handles expected user volumes and data processing requirements

• User acceptance testing: End-user validation in realistic clinical scenarios to confirm system meets workflow needs and usability expectations

Ongoing maintenance: operational excellence

• clinical content updates: Ongoing updates to orders and
  medication preference lists, Provider patient lists and clinical protocol, Evidence-based care pathways and
  guidelines

• Scheduling and resource management: Scheduling blocks for ambulatory, radiology, and procedure areas; Resource allocation and capacity planning; Appointment optimization and workflow
  coordination

• System data integrity: Monthly loads of new medications,
  pricing, and clinical alerts; Error work queue maintenance for billing and interface issue; Data validation and accuracy verification processes

Advanced maintenance operations

• Financial and pricing systems: Regular pricing updates for medications and procedures; Insurance and billing code maintenance; Cost-effectiveness analysis and reporting

• Clinical decision support: Quality measures updates and compliance tracking; Clinical decision support tools and rules refinement; Evidence-based alert optimization and customization

Vendor collaboration

Monthly updates from EHR vendors include security patches, feature enhancements, and regulatory compliance updates that require careful testing and implementation planning

technology evaluation methodology

1. define evaluation scope

2. formulate research question

3. conduct literature review

4. identify required data

5. design study methodology 

6. execute data collection

7. document outcomes 

Critical informatics concepts

system usability, system optimization, standard terminologies, interoperability, security & privacy, blockchain technology 

Emerging informatics technologies

patient portals, healthcare analytics, data visualization, predictive analytics, and big data

telehealth

The use of electronic information and telecommunications technologies to support and promote long-distance clinical health care, patient and professional health-related education,
public health, and health administration. This comprehensive
approach enables remote consultations, monitoring, and care
coordination

Telemedicine

The use of telecommunications technologies to support the delivery of all types of medical, diagnostic, and treatment-related services, usually by physicians or nurse practitioners. This focused approach emphasizes direct clinical care delivery through digital channels

Telecare

Technology that allows consumers to stay safe and independent in their own homes through remote monitoring, emergency response systems, and automated health status tracking. This approach supports aging in place and chronic
disease management

Patient portal capabilities: core functions

health information access, digital forms and documentation, secure provider communication, medication management, financial management, and laboratory results

Patient portal capabilities: advanced features 

• interactive health management: Schedule appointments online with real-time availability; Receive automated reminders for appropriate screenings; Access personalized educational materials based on diagnosis

• Patient generated health data: Enter clinical data: blood
  pressure, glucose levels, weight; Integrate Fitbit data and activity tracking information; Review progress notes and care plan updates

Patient portal impact and benefits

better health outcomes, chronic condition management, timely access to care, patient retention, and medical home recognition

Health care analytics categories

clinical analytics, population analytics, administrative analytics, financial analytics

Clinical analytics

Patient outcome analysis, treatment effectiveness evaluation, clinical decision support optimization, and quality measure tracking for evidence-based care delivery

Population analytics 

Community health assessment, disease surveillance, risk stratification, and public health intervention planning across diverse patient populations

Administrative analytics

Operational efficiency analysis, resource utilization optimization, workflow improvement identification, and performance benchmarking across organizational departments

Financial analytics

Revenue cycle analysis, cost-effectiveness evaluation, budget forecasting, and financial performance monitoring to ensure organizational sustainability and growth

Genetics and Genomics: The Future of Precision
Medicine

transformative potential, leading causes of death, informatics integration

Transformative potential 

The field of genomics has the potential to significantly change the way health care is delivered, moving from reactive treatment to predictive and preventive care models

Leading causes of death 

Genomics play a role in 9 of the 10 leading causes of death, including heart disease, cancer, stroke, diabetes, and Alzheimer's disease, according to WHO data

Informatics integration

Because genomic health care is heavily dependent on data storage and interpretation, no other area is better suited than informatics to support this evolving field