Week 7: Electronic Health Technologies within Clinical Practice Settings (Part 1)

Course Content and Class Discussion

            Nursing informatics can be described as the application of computer technology to all fields of nursing (Booth, R. & Donelle, L., 2013). And with this technology, Canadians and health care providers reap the benefits of having electronic access to critical health information (Canadian Health Infoway, 2013). But to understand the types of technology involved, you must first learn the terminology. EHRs, or electronic health records are comprehensive client records that require authorized access, (Booth, R. & Donelle, L., 2013). They may be considered the ideal. All of a client’s medical information would be located in one place. Physicians or health care providers would have immediate, electronic access to any and all health information which could speed up the process of care in certain situations. For example, your physiotherapist would have access to all of your health information such as previous diagnostic imaging, surgical history, previous medication therapies attempted, etc. This seems it would enhance the process by saving time and lost paperwork, and increase interprofessional collaboration amongst health professions. But will this really be the case? The idea seems as if it makes great sense to health care providers to make their jobs easier, and better for the client as they will receive personalized care. However, if an EHR is an entire accumulation of a client’s medical history then it’s possible that many health care providers will be aware of irrelevant and possibly embarrassing personal health information belonging to the client. For example, knowledge of a sexually transmitted infection (STI) diagnosis, or a previous history of drug abuse. This knowledge is not required during a regular visit with your dentist, for example and now he/she would have that information accessible to them. This may leave clients feeling more vulnerable during health care visits and possibly cause an inhibition in their will to share information.

Electronic medical records, or EMRs, have been around for longer than you may think. See the video: 1961 Electronic Medical Records. Within the Canadian literature, EMRs may also be called EPRs – Electronic patient record (Booth, R. & Donelle, L., 2013).  They are different than an EHR, as they are only a “partial health record” under the custodianship of a health care provider that contains relevant health information related to that particular provider or institution (Booth, R. & Donelle, L., 2013). For example, an electronic version of your paper records at your different health care providers facilities: family doctor, emergency department, dentist, chiropractor, etc. This information is not readily available for sharing between health care professionals as an EMR. Some drawbacks to the EMRs may be just that – a lack of accessibility of relevant health information between providers.

And then of course, there is PHR, also known as the personal health record. These are consumer-centric tools used by clients to communicate health information to their health care providers as well as help to manage their own care (Kim, K. & Nahm, E., 2012). These are used to encourage an increase in quality of care as well as help to reduce medical errors, (Kim, K. & Nahm, E., 2012). This would allow for clients to be actively involved in their own health care, and this involvement may lead to better long-term health results. But does this consider the population’s health literacy?

Videos/Learning Tools

1961 Electronic Medical Record:                          
  http://www.youtube.com/watch?v=t-aiKlIc6uk                

Project Health Design Webpage:
http://www.projecthealthdesign.org

What is EMR?
http://www.youtube.com/watch?v=MOwML1N3TpM

The Difference between EHR & EMR:
http://www.youtube.com/watch?v=y85HfTG4UpU

Blue Button Video
http://www.youtube.com/watch?v=B53HEWVDJLI

Health IT.gov Webpage:http://www.healthit.gov/

Nursing Implications

            As mentioned previously, there are many perspectives to consider when attempting to analyze the use of EMRs, EHRs, and PHRs. It is by considering these perspectives that we are able to identify several implications to nursing practice that may be relevant in my career. Like I said earlier, with regards to EHRs, by having this information readily available for ALL health care providers, clients may feel vulnerable. This is an implication to my practice, as I need to set the tone for a therapeutic nurse-client relationship. My job is more than just ‘fixing the problem’, I am required to set a healing environment where the patient feels safe. Unfortunately, I believe that EHRs may hinder that relationship as clients may feel embarrassed to open up due to their increased vulnerability within that interaction. Maybe it would be possible to have restrictions in place within the EHRs that would require authorized access to only the information relevant to that particular health care provider. For example, information regarding a client’s previous abortion would not be available to her physiotherapist, dentist, chiropractor, etc. unless otherwise ‘released’ to them with the client’s permission.

            With regards to EMRs, I am lucky enough to have already gained some real life experience. This experience came when working for a family physician during my first year of University. The office used an EMR program that allowed the doctor to input clinical visit information, record immunizations, store blood work results and file other documents received from other health care providers (i.e. diagnostic imaging reports). There were many things about that particular program that I believe to be positive. It allowed for more efficiency within the office by reducing a large amount of paper, therefore decreasing the number of misfiled documents. It also made locating patient health information much easier, rather than flipping through old charts.

 

However, some flaws were noted almost immediately, and I can honestly admit I was quite reluctant to use the program. Right off the bat, the EMR was designed to be implemented on a ‘moving forward’ basis. This meant that all of the paper documentation had yet to be inputted into the electronic system and therefore any health information needing to be looked up prior to the implementation of EMR, would still have to be rifled out of the massive paper charts. This was time consuming and inefficient. Another flaw was noted as some of the clients’ information that had been entered into the system (i.e. name, health card number, and address) was entered incorrectly by the third party company involved. This made finding some patients within the system near impossible and often a second e-chart would be created unintentionally. Another concern I had with the EMR, is that given our out of town location, there were times when the Internet ‘server’ was down and we were unable to navigate through the program which essentially halted our production within the office.

Finally, I consider the implications of PHRs on nursing practice. Patients value easy access to their diagnostic tests and lab results and better communication with their health care provider and PHRs have the potential to be powerful tools for health management (Kim, K. & Nahm, E., 2012). The trouble I see with this otherwise innovative system, is that computer literacy and health literacy may play a large and important role in the success of the program.  This lack of computer competency and health literacy may lead to social exclusion of certain populations – defined as the “digital divide”, (Kim, K. & Nahm, E., 2012). A sub-population of the digital divide are those individuals aged 60 and over and may ‘suffer’ from technophobia. It is important that this population does not get left out from quality health care as they may experience greater and more abundant health concerns as they age. 

Watch the video above: Blue Button: The Timeline of Medical Records and/or visit Health IT’s webpage for more information regarding personal health records.  

Readings and Additional References

Booth, R., & Donelle, L. (2013). Nursing informatics and technology: Chapter 25. In B. Kozier, G. Erb, A. Berman, S. Snyder, M. Buck, L. Yiu, & L. Stamler. Fundamentals of Canadian Nursing: Concepts, process, and practice, 3^rd Edition, 532-550.

Canada Health Infoway. (2013). Opportunities for action: A pan-Canadian digital health strategic plan. Retrieved from: https://www.infoway-inforoute.ca/index.php/component/docman/doc_download/1843-opportunities-for-action-a-pan-canadian-digital-health-strategice-plan.

Kim, K. & Nahm, E. (2012). Benefits of and barriers to the use of personal health records (PHR) for health management among adults. Online Journal of Nursing Informatics. Retrieved from: http://ojni.org/issues/?p=1995.

iWedding #nursinginformatics

      

Although it's not specifically within the domain of nursing informatics, I couldn't help but blog about something interesting I noticed yesterday while attending a wedding.

         As I mentioned in a previous blog - I'm starting to notice the impact of technology in my own life. Things that affect me personally or things that I just happen to notice in the world that I may not have noticed prior to being involved in this course.
          With that being said, it took me about 2.5 seconds to notice that the officiant at the wedding was using an iPad!
          Seeing these types of changes makes me stop to contemplate what things will be like in a year? Five years? Ten?
          And with changes like this, I can only expect even more significant changes in the medical field. Will the technology I am learning about now, learning to use in my nursing education, even be relevant in my practice in a few years? Or will certain technologies just become moot in the grand scheme of things? And how will it affect the generation of nurses who are not the type to easily adapt to changes in technology?

          Will moving forward with technology actually cause set backs with regards to the care of patients and maintaining the therapeutic relationship...? Just something to consider.

Parks, Recreation and Twitter #nursinginformatics

 One of my favourite shows is back on the air this fall for its sixth season - Parks and Recreation! For those of you who aren't familiar with this program, this fictional show takes place in Pawnee, Indiana and is about the parks department of the Pawnee city government. More specifically it's about the characters that work in the department. But what does this have to do with the nature of my blog?

          One of my favourite characters on the show, Ron Swanson (pictured right) is the department manager. His character is very opinionated, and is very much against the idea of government in general.  But my favourite aspect of Ron's personality was indicated on last night's episode.

          It's in his character to want to remain 'off the map' so to speak; to remain anonymous. In this episode he recruits the help of two other employees in the parks department to help clear his name from everywhere in town. An example, they go to different restaurants in town where his picture is hanging on the wall to have them removed. He literally removes everything with his name on it - including his name plaque on his office! Near the end of the episode (SPOILER ALERT!) one of the employees that helped, Tom Haverford tells Ron that another employee in the department (who wasn't with them), Andy Dwyer, likes the sweater Ron is wearing. Of course Ron is confused - how the heck does Andy know what sweater he is wearing?! Tom replies that he has been Tweeting their entire day together with pictures!!!!

          I could NOT have found this more fitting to the course! Although Ron felt it was important that he remain off the grid ENTIRELY he was completely oblivious to Tom's picture-taking, tweeting, etc. And this got me thinking, not only do we need to be aware of what we're posting online, but we also need to be aware of what others are posting about us online too! It's kind of scary to think how easy stuff like this can happen, and it makes me wonder what information about myself I may find online that I didn't know was there....

Gimme my Damn Data! #nursinginformatics

       

 This weeks topic: Consumer Health Informatics and eHealth

          Have you met e-patient Dave? Today we watched a video where Dave shared an amazing story of how his ability to access the right information about his health care allowed him to beat his odds against cancer and dance with his daughter on her wedding day. A real tear jerker at moments I might warn:

http://www.youtube.com/watch?v=2vejkD0Rl3o

          The point that Dave is trying to make is that it's important for patients to be a part of their own care. If he had not taken his care into his own hands, he may not have been around to tell his story today, and certainly wouldn't have been able to share in an important moment in his daughter's life.

          Having worked in a doctor's office myself, I've often heard the doctor say, "We'll call you if anything comes up" or "We will only contact you in the case of abnormal results". I've also seen, many times, things get missed, or overlooked due to high patient volumes. Often times, practices are so large that patients can no longer be viewed on an individual level and instead just become a part of the system. But what implications does this have?

           I think in order to understand the importance of Dave's concept, you need to put yourself in his shoes. How many of you would have done what Dave did? And how many of you would have the knowledge to do what Dave did? I can honestly say, that prior to starting the nursing program, I likely would not have questioned a doctor's diagnosis or prognosis. Mainly because I just assumed that because they are the doctor, they would know best. But it's amazing how having access to knowledge and resources about your diagnosis/condition can allow you to make your own informed decisions about health care treatments and options, rather than sitting idly by awaiting the worst case scenario.

          Dave's talk raised some interesting ideas as well, suggesting a 'Google Earth' for our bodies to allow us to explore our own health concerns. He also pointed out that having the medical information listed on our charts similar to a 'nutritional label' would allow all health care providers to have access to the same information helping to prevent errors.  Gladwin (2012), agrees with Dave in her article, Patients welcome access to online health records, when she states, "There are many benefits to patients being able to access their records" (p.10). In addition, Gladwin (2012),  informs us that, "Those who have evaluated the service in our practice have said that they have reduced the number of visits or calls to the practice by accessing results or referrals online" (p.10). By this logic, wouldn't  we also be helping to reduce health care expenses as well as give patients a sense of self in their own care?

          I personally have not experienced a situation like Dave has but having listened to what he has to say about it, I can see how valuable it would be to have all patients participating in their care in some form or another. I believe that as we evolve more and more into a technologically advanced world as health care providers, our patients should be evolving with us.

References

 

Gladwin, Jacqui. 2012. Patients welcome access to online health records. Primary Health Care 22, (5) (06): 10

A 'MUCH' Needed PSA! #nursinginformatics

 It's funny how you start to become more aware of things as they become more relevant in your own life...

          Last night while watching the MUCHMUSIC channel, a commercial came on and immediately grabbed my attention. The commercial opened with a girl sharing ALL of her information with a group of guys on the street. She shared information about her personal life, her address, and plans for vacation. Turns out that the guys on the street were strangers, and without sounding judgmental, the men were.... questionable. The message of the commercial was essentially that you wouldn't share your information with three, strange men on the street and so you should be careful of what you post online as well as the information becomes public and can be accessed by almost anyone.

          Although I was unable to find the commercial online for you to view, the commercial did offer a great website to get extra information on how to be safe online:

 

http://www.muchmusic.com/contests/igotu/

          The website is comprised of silly little videos of the dos and donts of being safe online. The videos seem to be directed at the teenage population but offer some very important and relevant information when it comes to social media and personal information!

The Bubble #nursinginformatics

          Today's class discussion was surrounding evidence informed practice in a technology enhanced workplace, and after viewing the following video in class, I'm still unsure how it makes me feel:

 http://www.youtube.com/watch?v=EsjQLB_jTBA
 

 

          The video informs viewers that the internet is more complex than some of us may have known. The internet is essentially keeping track of your usage - what sites you visit, your previous searches, etc. and uses that information to help pre-populate your next search!  I personally was oblivious to this information prior to today's class, but now, as I continue to use search engines, I can see that it's quite apparent. 

 

          Although I've become more aware of this now, I still don't know how I feel about it. On one hand, it allows you to narrow down your searches making things easier to find - but how much stuff is being left behind? What information am I missing out on because 'Google' assumes it knows what's best for me? Are reputable websites being filtered out when I'm looking for important searches because of my previous online shopping searches? I may continue to struggle with how this affects me specifically but what implications does this have on my practice as a nurse?

 

          It's not unheard of for patients to 'Google' their symptoms for themselves or others. And now I wonder, what information will these people be seeing? Is it relevant? Is it credible? Is it accurate? And whether it is or it isn't - will people take the advice as if it were? How many clients may be missing something important when caring for their health because of this 'filter bubble'?

          I consider myself quite lucky as I currently have access to hundreds of thousands of online scholarly journals and documents allowing me to understand questions I have. Many people don't have access like this, and if they wished to, it may come at a monthly fee in order to subscribe to this valuable information. Are we actually harming clients by having this filter bubble in place?

          Should there not be a way to 'disable' the filter when we choose?