Nurses: critical members of the IT team.
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Biomedical subjects
Publications and source records attributed to Marion J Ball.
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Consumer demand for personal health records (PHRs) and the capabilities provided by regional health information organizations (RHIOs) will change healthcare, just as automatic teller machines have changed banking. The PHR is predicated on the existence of electronic medical records (EMRs) and electronic health records (EHRs). Patient and consumer principles guiding the development of the PHR reflect issues of access, control, privacy, and security. Working models illustrate the variations of RHIOs and PHRs possible and suggest the benefits that electronic information exchange can accrue for healthcare and healthcare consumers. Today both the private and public sectors are working to define the issues involved in efforts that are now taking place and that will transform healthcare. Consumers are ready for the type of changes that will improve healthcare quality.
The Johns Hopkins Medical Institutions and the University of Pittsburgh Medical Center are both working to improve patient safety. Johns Hopkins is focused on creating a culture of safety--frontline interventions at its Children's Center include a focus on the "Culture of Safety" and three programs that use information technology to "fix the broken medication process." Quantitative data indicate these programs are making care safer. At UPMC, efforts launched under the Robert Wood Johnson Foundation and the Institute of Health Care Improvement, a program named Transforming Care at the Bedside, are redesigning care processes to support nurses and focus on patients. Interventions include family-initiated rapid response teams and other changes designed to streamline processes and use information technology to make care patient-centered. Simulation-based training targets critical procedures and performance for physicians and nurses, and a "smart room" is slated for development.
A hospital is a type of system, yet healthcare information technology (IT) has largely failed to view it as such. The failure to view the hospital as a system has contributed to the practice of inefficient and ineffective clinical documentation. This paper seeks to address how current clinical documentation practices reflect and reinforce inefficiency and poor patient care. It also addresses how rethinking clinical documentation and IT together may improve the entire healthcare process by promoting a more integrated and patient-centered healthcare information paradigm. Rethinking IT in support of clinical documentation from a system-oriented perspective may help improve patient care and provider communication.
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Ongoing government and healthcare industry initiatives clearly indicate that information technology will be the driver for change in healthcare. As systems proliferate, healthcare organizations grapple with issues of whether to choose best-of-breed systems or standardize around one vendor. For many years, HCA Inc. has been a major proponent of standardization to help meet its financial and patient safety objectives. This article examines HCA's experience and explores how standardization has been a major factor in the company's financial and clinical success, enabling faster implementation, greater quality control and significant cost-savings.
The application of information technology (IT) in health care has the potential to transform the delivery of care, as well as the health care work environment, by streamlining processes, making procedures more accurate and efficient, and reducing the risk of human error. For nurses, a major aspect of this transformation is the refocusing of their work on direct patient care and away from being a conduit of information and communication among departments. Several of the technologies discussed, such as physician order entry and bar code technology, have existed for years as standalone systems. Many others are just being developed and are being integrated into complex clinical information systems (CISs) with clinical decision support at their core. While early evaluation of these systems shows positive outcome measurements, financial, technical, and organizational hurdles to widespread implementation still remain. One major issue is defining the role nurses, themselves, will play in the selection and implementation of these systems as they become more steeped in the knowledge of nursing informatics. Other challenges revolve around issues of job satisfaction and the attraction and retention of nursing staff in the midst of a serious nursing shortage. Despite these concerns, it is expected that, in the long run, the creation of an electronic work environment with systems that integrate all functions of the health care team will positively impact cost-effectiveness, productivity, and patient safety while helping to revitalize nursing practice.
PURPOSE: To assess progress made in hospital information systems (HIS) since 1979, when the forerunner of the International Medical Informatics Association Working Group on HIS first met. METHODS: A review of the recommendations made in 1979 identified core concerns, which were analyzed in light of the state of the art in 2002. RESULTS: Despite significant changes over the years, the underlying concerns identified in 1979 are still valid today. In 2002 as in 1979, HIS must be integrated into the hospital's organizational structure; financial and economic benefits depend upon using technology as an enabler of improved clinical outcomes; and education and training remain critical to the successful use of technology solutions. The tools available for addressing these concerns have changed enormously. Where there were dumb terminals, there are the World Wide Web and handheld devices. As a result, we are raising our expectations and changing the terms of our discussions. Today the focus is shifting to patient safety, decision support, and evidence-based practice; the concerns voiced in 1979 have become medical informatics cornerstones. New tools and new approaches now available can improve the quality of care. Using them appropriately requires careful planning and education for patients as well as healthcare professionals.
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New knowledge from biotechnology and new capabilities provided by the evolving global information infrastructure are already transforming health care. Three clusters of technologies hold particular promise: grid computing, intimate computing, and micro laboratory computing. The confluence of these technologies will change clinical laboratory equipment into portable devices, easing the administrative details involved in delivering care and ushering in a new age of monitoring clinical states. Two vignettes, an office visit and a clinical trial, are offered as prognosis for clinical care in 2013. New capabilities hold the power to transform health care, making it truly patient centered as the Institute of Medicine (IOM) has urged.
The growing understanding of medical errors as systemic in nature underscores the importance of analyzing and redesigning systems. Best practices in medication safety that promise rapid payback include computerized physician order entry, ongoing tracking and benchmarking, and the creation by leadership of nonpunitive environments where this new culture of safety can thrive.