Information Technology: Advancements in Healthcare
Felecia H. Rivers , MSN, RN, Constance Rotters Blake , MSN, RN, and
Katherine S. Lindgren , PhD, RN, CCRN
University of Tennessee at Chattanooga
School of Nursing
AbstractThe healthcare arena including education, research, administration and patient care has become inundated with advances in information technology over the last decade. We must view the changes in healthcare as a challenge rather than a risk to our profession and assist others through the transitions. Who knows what advancements will surface over the next few years?
Key Words: Nursing Informatics, Healthcare Information Technology, Information Systems, Change, Nursing Attitudes.
Nursing informatics applications have increased significantly within the past few years. Nurses must now face the vast challenge of learning and working within the age of technology. Information technology influences the manner in which nurses practice, how they are educated, and the methods of providing and documenting patient care. In addition, advances in information technology have also become an integral link to staff development and continuing education. Nursing administrators have begun to utilize informatics applications to assist with staffing, managing budgets and disseminating information.
The nursing profession, like many other professions, continues to function on a daily basis within the realm of technology. Nurse educators provide instruction through Web-based class es integrated with discussion boards and computerized testing. Nursing students search the Internet for information to complete assignments and submit their work via email attachment instead of submitting a hard copy to the instructor. Nurse researchers utilize the World Wide Web to gather information and to distribute the results of their findings.
Increasing Use of Technology
Nurses encounter the use of technology daily. Also, technology is the basis for changing the way patient care is being delivered. Clinical Information Systems have replaced paper and pencil charting. Duplicate charting and documentation are eliminated and error reduction allows more time for and flexibility in delivering patient care. Gone are the days of time spent trying to decipher illegible handwritten physician orders. The use of physician order entry systems allows orders to be entered at the point of care (POC) and provides alerts to possible contradictions or patient alerts eliminating errors. Standards of care are also tracked through computerized programs (Myles, 2000; Meadows, 2002, & Abrahamsen, 2003). Blood pressure, temperature, and other vital signs are now taken electronically, recorded and tracked for trends. Nurses are alerted to any abnormal results based on previously established parameters programmed into the systems (Myles, 2000).
Nurses are under constant stress and pressure to ensure medications are administered properly. POC bar coding helps the nurse ensure accurate medication administration through automated verification. The five rights are verified preventing medication errors before they can occur. Additional benefits derived from these programs include data capturing and reporting tools which meet quality-of-care for JCAHO, risk management and other quality assurance programs (Myles, 2000 & Meadows, 2002).
Handheld units are utilized to transmit patient information directly to electronic medical records (EMR) providing more efficient documentation with increased accuracy and consistency. Handwritten documentation was often inconsistent and pertinent patient information was frequently inadequate regarding nursing interventions. The resulting patient education or care plans compromised the validity and reliability of the data (Abrahamsen, 2003).
Another intervention is the use of a wireless phone system that enables a response to phone calls from any area within the unit through a wireless local network. The ability to reach the nurses instantly reduced delays caused by pagers. In turn, patient and family satisfaction increased assuring a better patient/care provider relationship (Abrahamsen, 2003).
The use of personal data assistants (PDAs) has moved from simply an appointment book and organizer to the use of comprehensive method programs for accessing healthcare databases and other patient information programs. Software companies have flooded the healthcare profession with applications that check for drug interactions, calculate dosages, analyze lab results, schedule procedures, order prescriptions, and automate other clinical tasks, thus reducing the probability of errors and increasing patient safety. This has eliminated the need to purchase drug and lab books for individual hospital units (Abrahamsen, 2003, Briggs, 2002). Physicians and nurses have information readily available at a moments notice to implement a change in the patient's plan of care. Practitioners are able to synchronize their PDAs with the hospitals electronic medical system when reporting to duty to gain updated information on patients prior to beginning rounds. Some software program includes automated updates to the programs while others offer updates via a free Internet download or as a subscription service (Abrahamsen, 2003, Briggs, 2002). Nursing and medical students are finding the PDA useful for collecting and transmitting information used in clinical research. Nursing students are also finding the PDA to be helpful with drugs, nursing diagnosis, and for procedural references. Another great resource for healthcare providers is the electronic Herbal/Alternative medication and over-the-counter medication references. OB nurses find the pregnancy calculator of great use, while the emergency room staff may utilize software relating to emergent situations (Hunt, 2002).
Immediate access to the Internet and its many resources eliminates the need for the healthcare provider to cart around numerous and burdensome paper reference materials (Abrahamsen, 2003). Through the use of the Internet, the patient now is more informed about his/her condition, medications, and alternatives to treatments. Patients are provided the addresses of informative Web sites prior to discharge from the hospital or leaving the physician's office. In some instances patients are able to use information technology to contact their primary care provider's office staff with questions via the Internet (Simpson, 2003, & Abrahamsen, 2003). Caregivers at the University of Texas M.D. Anderson Cancer Center in Houston have developed personalized Web pages for individuals in the Brain and Spine Center . The Web pages are customized with specific information regarding the disease process and thorough descriptions of pertinent clinical and administrative processes in the center. Once the patient has accepted their cancer diagnosis, many questions still arise from treatment to billing processes. The Web pages are designed to allow the individual patient to obtain information or pose questions at any given time. Nurses within each of the specialized treatment centers select educational information to place on the patient's site (Briggs, 2003).
The Veterans Administration (VA) has three specially designed interface systems that allow healthcare providers to access patient information nationwide once the individual has been placed in the system. All documentation of the patient visits is “real time.” All of the healthcare providers who see patients enter the information regarding their interactions in the computer while they are with the patient. Very little dictation is utilized in the VA facilities except for special cases. Physician orders, lab results, x-ray results, appointments, history and physicals, medications and immunizations are all available at a single touch through buttons on the bottom of the screen. The pharmacy is also automated into the system. The physician may order the medication dispensed the day of the visit or ask for it to be mailed from the pharmacy to the patient's home (R. Finger & J. Boyette, personal communication, March 21, 2002 ). A unique, futuristic use of technology was noted at Tripler Army Medical Center , in Honolulu , HI . As early as 1997 Tripler began using robots to assist with deliveries within the inpatient wards. The robots delivered medications and nutritional trays at specific intervals during the different shifts. They were programmed to operate though a wireless system within the hospital. Each ward was equipped with antennas similar to the antennas of cardiac telemetry enabling the pharmacy and nutrition departments to track the robots throughout the hospital. Each nursing ward had a security code with which to open the robot door and remove medications or trays. The nurses could also place medications from discharged patients, discontinued medications and food trays for return to the appropriate department. The use of this technology eliminated many trips to the pharmacy and dietary thus saving precious time that could be devoted to patient care. The robot also emitted warning statements as it began to move or change directions providing safety for staff members and patients.
Another area influenced by technology is staff development and continuing education. The Education Branch at Darnall Army Community Hospital , Ft Hood, TX, utilized the Health Education System (HES), a healthcare software program designed especially for staff development. The HES came with several standard JACHO mandated programs that could be adapted to meet the standards of the individual facilities for annual training. It had both audio and video capability. At any given time the sound could be turned off if the participants wished to only read the information. The individual could sign into the HES at anytime to acquire training and it could be paused it as necessary to allow the patient toreturn later to complete a lesson. Each lesson contained class information and a written test. Once the individual completed the required class es, their individual education files were updated automatically in a specially designed database. A courtesy message was also sent to individuals within 90 days of their annual update period to remind them of the required training. Reports needed for monthly meetings could be run at a specific time period. The program eliminated the need to attend annual training on days off and allowed healthcare providers to remain on the individual wards to provide patient care. Continuing education programs could be developed in a PowerPoint format and added to the HES for viewing. When the individual completed the educational program and test, a certificate of completion could be printed.One downfall to the use of technology in healthcare is the potential breech of confidentiality and security pertaining to patient information. At all times, the healthcare provider must be cognizant of federal guidelines regarding patient privacy, security and confidentiality. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) guidelines address the issues of privacy and security and have established electronic code sets that must be utilized when electrically documenting interactions regarding diagnosis, procedures and test. In consideration of purchasing any new software programs in the healthcare arena, management should ensure they adequately meet the federal guidelines implemented in early 2003 (HIPPA, 2003 & HIPPA Codes, 2003, Abrahamsen, 2003).
Response to Change
As with any new process, one will witness many varying attitudes regarding the change. Some individuals view change with excitement and anticipation of gaining a new skill or as an opportunity to grow. Others view it as a disruption or threat to their practice. Many nurses often resist the change to advancements in technology because they feel it is an intrusion into their routine of providing patient care. It is also noted that nurses question the security of their jobs and feel quite powerless with the unbridled, extensive and quickened process of the overall change in the healthcare arena due to informatics technology (Bozak, 2003).
One of the greatest fears is that advancing technology will make the nursing profession obsolete. However, information technology (IT) should be viewed as an assistant to their nursing responsibilities, one that will decrease time spent with administrative duties thus providing more time for hands-on care. IT has also demonstrated decreased medical errors relating to automated orders (Simpson, 2003).
Since nurses spend a greater portion of their time documenting information, adapting to electronic documentation is a much more difficult process than for physicians. The age of the nurse, nursing experience and education level impactacceptance of the technology. Younger nurses acquire informatics skills while in nursing school and are more accepting of computer advancements. Those nurses who have been in the healthcare field for a number of years often find the change quite difficult. They must simultaneously learn new skills and new system programs which require additional time not always readily available. Patients are the priority and computer skills are squeezed in when time permits. (Bozak, 2003 & Gillespie, 2003).
If the facility utilizes many different information systems, multiple passwords are required which may cause difficulties and resentment. Some programs require an input in every field even when it is not applicable to the situation thereby hampering the individual's time. In addition, other healthcare providers have indicated the training was not sufficient to enable them to correctly use the programs (Gillespie, 2003).
Helping with the Transition
Many facilities now employ nurses who have specialized in Nursing Informatics to assist with technological transitions. These nurses are involved in the planning process since they are familiar with the nursing process and workflow. The informatics nurse is able to identify the correct software programs to enable the healthcare staff function more effectively while helping the nursing personnel to perceive the projected change as a challenge instead of a threat to their profession (Bozak, 2003 & Gillespie, 2003).
Information technology has integrated the healthcare arena. Administrators must ensure they have a well-structured plan to enhance the acceptance of the technology advancements. Involving healthcare providers in the planning process is imperative to facilitating the proposed change. Since it has been established that change due to advancements in information technology will continue in healthcare, providing information regarding the benefits gained by the new system will augment acceptance.
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Felecia Harrell Rivers , MSN, MSA, RN firstname.lastname@example.org
Felecia Harrell Rivers graduated from East Tennessee State University with a BSN in 1994. She completed a MS in Administration from Central Michigan University in 1997. Ms. Rivers returned to graduate school at the University of Tennessee at Chattanooga earning a MSN with a concentration in Nursing Education and a certificate in Nursing Informatics in 2003. Her graduate research concentrated on identifying competency skills needed for military nurses to function in a combat support hospital during deployments into areas of conflict. Ms. Rivers is a Captain in the Army Nurse Corps and has served in the military for 18 years. She held the position of an adjunct instructor in the OB/GYN course while stationed at Tripler Army Medical Center and served as the Nurse Manager of the Educational Branch at Darnall Army Community Hospital . Presently she is serving as the Chief Nurse in a U.S. Army Health Clinic, Katterbach , Germany . Professional memberships include Sigma Theta Tau - Zeta Alpha Chapter, Who's Who Among Students in American Universities & Colleges and AMSUS (Association of Military Surgeons United States). CPT Rivers professional interests include increasing the use of informatics technology within the military health care system and the educational arena. Grief management is another of her professional interests.
Constance Rotters Blake, MSN, RN email@example.com
Constance Rotters Blake graduated from Dalton (GA) Junior College with an AS in nursing in 1970. She completed the BSN at the University of Tennessee at Chattanooga in 1999 and the MSN in Administration/Informatics in 2001. Her graduate project focused on Parish Nursing as a Community Resource in an Information Technology Environment . Women's health issues were the primary focus of her clinical nursing practice. Ms. Blake has held adjunct faculty positions at the University of Tennessee at Chattanooga School of Nursing and Eastern Tennessee State University School of Nursing. Faculty responsibilities at UTC included Coordinator of the SON computer lab/students. Currently she is Coordinator of Parish Nursing at Memorial Health Care Systems in Chattanooga , TN. Professional memberships include AWHONN (Association of Women's Health, Obstetric and Neonatal Nursing), ANIA (American Nursing Informatics Association), HMA (Health Ministries Association) and Sigma Theta Tau – Zeta Alpha Chapter. Ms. Blake's professional interests include expanding the use of informatics in health ministry/faith-based settings as well as selected web design and technology applications in the synchronous/asynchronous learning environment.
Name: Katherine S. Lindgren, Ph.D., RN, CCRN Kay-Lindgren@utc.edu
Kay Lindgren has a BSN from Troy State University ; MS with a specialty in Adult Health from GA State University and PhD from the Medical College of GA. She has held various positions as a clinical nurse specialist, nurse manager, quality assurance, risk management, director of nursing and faculty at three universities. Currently, Dr. Lindgren serves as Director of the School of Nursing and UC Foundation Associate Professor in the School of Nursing at the University of Tennessee at Chattanooga . Currently she holds membership in ANA, AACN, Sigma Theta Tau, and others. Dr. Lindgren is a drilling reservist in the USNR holding the rank of CAPT in the Nurse Corp.