Question

What is the clinical informatics concepts, informatics in the 21st century, informatics and evidence-based practice, informatics and the law, social media and confidentiality, informatics and patient safety, technology and alarm fatigue, the electronic medical record, EMR, and the future, technology and the nursing role, impact for nursing practice and impact for nursing curricula?

Answer 1

Clinical informatics has been around for over forty years, though it remains a relatively new concept to most clinicians. But it touches nearly everything we do as medical providers each day.As a field, clinical informatics aims to harness the power of information technology for the betterment of patient care through innovative care delivery systems. And by nature a multi-disciplinary practice, it affects all areas of patient care. For instance, electronic health records (EHRs) allow providers to communicate patient information seamlessly between outpatient clinics, emergency departments, the peri-operative space and the inpatient floors.A clinical informaticist may serve in a multitude of roles, depending on the size of the healthcare setting. Typically, these professionals evaluate the existing information systems and recommend improvements to functionality. Clinical informaticists may study a data entry or visual image storage system or interact with those who need access to records. They may train staff on system use, build interfaces, troubleshoot software and hardware issues, and work across multiple departments to integrate the sharing of information. They document and report their findings and work to implement improvements. The ultimate goal is to manage the costs while improving patient outcomes.

The informatics in 21st century aims to build the competencies such as  the value proposition of health information technology and how medical informatics and other fields contribute to it, the role of various individuals in the health information technology workforce, the basic tenets of biomedical computing to enable optimal selection of hardware, software, and network connections for a given setting, the essential functions of the electronic health record (EHR) and the barriers to its use,the principles of implementing EHRs in ambulatory, hospital, and other settings,the role of clinical decision support in health care settings and within the EHR,computerised provider order entry and how it enhances clinical decision support, the basic principles of health care quality assessment, including pay for performance programs, and how the EHR enables them,the role of health information exchange and Regional Health Information Organisations,The personal health record, its interface with the EHR and its value in promoting personal health,The importance of standards and interoperability of clinical data and the major initiatives underway, Maintaining privacy, confidentiality and security.,The core principles of evidence-based medicine and their application in clinical practice,accessing medical knowledge resources and linking them to clinical practice, people and organisational issues in the use of health information technology , The unique aspects of nursing information and practice in relation to clinical information systems, The growing impact of genomics on medicine and its implications for health information systems,the management of images in clinical settings, including the use of PACS systems,the role of telemedicine and barriers to its use,the function of public health information systems and their interaction with clinical systems and the key issues in organisational, project, and business management in informatics.

The contention of the author is that an informatics infrastructure is essential for evidenced-based practice. Five building blocks of an informatics infrastructure for evidence-based practice are proposed: 1) standardized terminologies and structures, 2) digital sources of evidence, 3) standards that facilitate health care data exchange among heterogeneous systems, 4) informatics processes that support the acquisition and application of evidence to a specific clinical situation, and 5) informatics competencies. Selected examples illustrate how each of these building blocks supports the application of evidence to practice and the building of evidence from practice. Although a number of major challenges remain, medical informatics can provide solutions that have the potential to decrease unintended variation in practice and health care errors.

The digitalization of the world has led to the application of technology to every sphere of the human life and endeavor with law being no exception. Law and technology have quite a history embedded in subject areas such legal informatics, legal information, technology law and other similar nomenclature. The storage/processing of data has gained so much prominence for a host of reasons prominent among which is the right to privacy and data protection. Therefore law plays a paramount role in the processing/storage of data making it inevitable for lawyers to study same. Due to the dynamic nature of technology with which legal informatics is concerned, it is important that lawyers keep in tune with both legal and technological advancements to ensure growth in the field of legal informatics.

The principles of confidentiality apply whether you are communicating offline or online.Social media should not be used to discuss individual patients, living or dead. Posting details of a clinical case, however heavily anonymised, without patient consent would constitute a breach of confidentiality – as would sharing a photograph of a patient's condition.Professional sites (eg doctors.net) allow exchange of information between doctors. In discussing a case anonymously, it may be possible for someone to piece together details that identify the patient.Even a closed group may have hundreds, if not thousands, of members, which means there can be a risk of another member sharing your post outside of the group. Keep in mind also that, although some professional sites are intended solely for doctors, it is possible that not everyone on these sites is a medical professional.When you post personal comments on social media (say, about your working day), be aware of how your comments may be viewed by colleagues or patients, and whether you are revealing confidential information. Most breaches of confidentiality happen inadvertently.

Healthcare information technology (HIT) has been defined as “the application of information processing involving both computer hardware and software that deals with the storage, retrieval, sharing, and use of health care information, data, and knowledge for communication and decision making”.Health information technology includes various technologies that span from simple charting, to more advanced decision support and integration with medical technology. Health information technology presents numerous opportunities for improving and transforming healthcare which includes; reducing human errors, improving clinical outcomes, facilitating care coordination, improving practice efficiencies, and tracking data over time. Since the original IOM report was published, there has been an accelerated development and adoption of health information technology with varying degrees of evidence about the impact of health information technology on patient safety.

As the healthcare sector adopts more and more technologies, the increased number of tech-aided devices from ventilators through feeding pumps to vital sign machines will bring along their own alerts for warnings, but the truth is, most don’t require clinical intervention and are due to improper readings resulting from devices and alarms not set up for individual patients.For example, patients with a low ECG voltage will trigger unnecessary alarms if the monitor is not adjusted properly. But among the endless bells and chimes from the innumerable devices.

By implementing EMR, patient data can be tracked over an extended period of time by multiple healthcare providers. It can help identify those who are due for preventive checkups and screenings and monitor how each patient measures up to certain requirements like vaccinations and blood pressure readings. EMRs are designed to help organizations provide efficient and precise care.Perhaps the most significant difference is that EMR records are universal, meaning that instead of having different charts at different healthcare facilities, a patient will have one electronic chart that can be accessed from any healthcare facility using EMR software.

The Healthcare Information and Management Systems Society defines nursing informatics as “a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, knowledge, and wisdom in nursing practice.” Informatics is becoming increasingly present in our profession due to rapidly changing technologic advances. Healthcare systems are assimilating technology into daily practice at a quick pace. Security and patient privacy must be upheld while achieving the goal of transforming data into useful knowledge. Integrating informatics with evidence-based practice (EBP) can only help improve the care we provide to our patients.Applying technology to knowledge may help identify potential problems earlier. For example, with the use of electronic documentation, identifying changes in patient status can occur quickly because the information is readily available. Trending of patient vital signs is always accessible and the data are interpreted, systematized, and arranged. The nurse is able to use this knowledge to formalize an appropriate plan of action.Standardizing nursing language will facilitate acceptance of new methods of documentation in the electronic health record. A template for nursing notes is one method of assisting with our daily workload. The use of a template can remind you of important information required in the documentation of patient care.

The American Nurses Association’s Scope and Standards of Nursing Informatics Practice provides a description of informatics competencies for nurses ranging from “beginning” to “specialist”. Beginning nursing informatics competency includes information management and computer literacy skills (e.g., using a word processor, database, or spreadsheet program). Experienced nursing informatics competency focuses on proficiency in information management and communication directly related to one’s major area of practice. Specialist nursing informatics competency relates to standards of practice and professional performance.Online education in nursing increases accessibility for students in rural areas and those who work or have family responsibilities prohibiting them from attending traditional classes. The number of online programs is growing. The College of Nursing at East Carolina University (2006) offers a transfer program for associate degree nurses who return to school to earn a bachelor of science in nursing that is completely online. The College of Nursing also offers several master’s degree programs online. Online educational settings offer nursing students the ability to collaborate with colleagues in other geographic areas through participation in online group activities, thus increasing opportunities for social professionalism. Participating in online courses, videoconferencing, group discussion threads, and group chats gives nursing students the opportunity to gain experience working in interdisciplinary teams. Using online databases to search current literature offers nursing students the opportunity to understand the value of research and literature to evidence-based nursing practice. Online collaboration regarding search results also provides nursing students with the opportunity to develop the skills necessary to identify valid sources through peer reinforcement.