Policy Issues and Health Informatics

This week focuses on the policies that come into play when technology is incorporated into healthcare settings.

Consider the barriers that have been discussed in previous posts that can occur from when computers, iPhones, iPads, and EHRs are implemented into hospitals and health facilities.

• Personal health information being shared--> confidentiality and privacy breached
• Organization and data accuracy
• Nurse accountability and advocacy issues

Theses concerns can be addressed by implementing policies in institutions to create secure, safe, and educative environments.  

Policies provide standards and guidelines that help to address issues the are present that take action for effective change. These policies include plans and decisions that provide guiding principles that nurses, physicians and members of institutions are responsible for upholding. Policies are established for a specific goal that enhances a facility and workplace. In the transition in a more technology focused workplace, policies are vital in meeting the needs of consumers and bridging these barriers. 

The World Health Organization (WHO) defines an operational and successful policy has having the following characteristics:

                    1) Defines a vision for the future

                             -  Must have specific, clear goals that address explicit concerns or issues. 

                    2) Outlines priorities and expected roles of different groups/ parties

                              -  Labels what each person is responsbile for, relates to patients, HCPs, institutional                                         officials

                    3) Builds consensus and informs people

                               -  The public and workers have a common goal and must be informed

At every level there are different types of policies that govern nursing practice. 

                   Institutional --> Policies that apply specific institutions (hospital level)

                   Municipal-->Policies enforced by a municipality, city or community

                   Federal--> Applied at federal, provincial level (CNO, RNAO)

                   National--> Policies enforced by the nation governing body ( CNA)

                   International--> Global policies that set guidelines (WHO)

There are many policies that are currently present that apply to some of the concerns regarding eHealth, but nurses may have to take a significant role in implementing new change. Creating new policies is a dynamic and cyclical process that depends on on involvement from both the consumer (patient) and the institution (Rochon, 2010). 

Nurses must take an active role in recognizing where policies and guidelines are lacking. To formulate policy, specific common goals that unify the community are needed to be addressed. A clear and concise plan must be formed (Lomas, 2007). 

The nurses responsibilities to recognize where barriers exist. This involves having a thorough understanding of how technology is working to meet the needs of the health care provider and the patient. When inadequacies arise, nurses need to take initiative to reduce the barrier. For example, when patients find that their perception of illness is missing and being omitted from the EHR, nurses need to work with their eTools and the patient to fill the gaps. Patient-gathered data is an effective way to help address the patient perspective to understand inadequacies (Koliner & Flatley Brennan, 2013). 

The next step in policy construction is policy realization, and putting ideas into action. Many nurses are apprehensive in taking charge in their workplace and bringing concerns to the attention of their workplace (Perna, 2013). While this can be overwhelming, nurses should feel empowered to take a stance in their community to advocate for health rights. Nurses should partner with the inter-professional team and work with their patients to find the root of problems and make them known to the appropriate policy level. 

For instance, nurses and HCPs should advocate for policies that ensure adequate training regarding technology at the institutional level. By ensuring that technologies are properly used nurses are able to promote health privacy and security, and able to work efficiently. As well, this ensure that there is continuity of care, and that the health care team can work more cohesively via practice permissive policies (Koliner & Flatley Brennan, 2013). . Thus creating a properly trained network of health care providers who all understand the history of the patient. This policy will help meet and reduce barriers before they occur.

Policy learning requires the nurse to evaluate the effectiveness of policies and monitor changes. Once policies have been formulated and introduced to the workplace they need to be evaluated to see if they are meeting the desired goal. The nurse acts as educator by working closely with the patient to evaluate is they understand their rights and access to their personal health information (CNA, 2011). 

A policy that may apply is that nurses are responsible in keeping patients updated about their current health status and progress. This may involve showing patients trends and charts about their health that may help the patient recognize own trends in their lifestyle. A diabetic patient who is wanting a better understanding about how their blood glucose fluctuates throughout the day should be given access to this information to increase patient learning. Through policy learning and evaluation, nurses are able to enhance patient learning (Lomas, 2007). 

Since nurses work front-line, behind the scenes, and in every governing body level, they need to take action in recognizing inadequacies and potential barriers that exist. As technology becomes ingrained in hospitals, health units and community care, nurses are still the health care professional who works closest with patients. Nurses need to discuss with patients and evaluate their understanding about eHealth and advocate for their learning. 

---Student Nurse Katie

References

Canadian Nurses Association. (2011). Nursing informatics: Best nursing. Retrieved from http://www.cna-aiic.ca/en/on-the-issues/best-nursing/nursing-informatics

Lomas, C. (2007). Policy: Nurses' input vital to guideline development. Nursing Times.net. Retrieved from http://www.nursingtimes.net/policy-nurses-input-is-vital-to-guideline-development/304488.article

Perna, G. (2013). HIT voices: The policy challenges facing health IT leaders. Healthcare Informatics. Retrieved from http://www.healthcare-informatics.com/article/hit-voices-policy-challenges-facing-healthcare-it-leaders-part-1

Koliner, S., & Flatley Brennan, P. (2013). Advancing healthcare information technology through policy. CIN: Computers, Informatics, Nursing, 31(5), 205–207. doi: 10.1097/NXN.0b013e318299dc34 

Rochon, P. (2010). Institutional financial conflicts of interest policies at Canadian academic health sciences centres: A national survey. Open Medicine. 4(3). Retrieved from http://www.openmedicine.ca/article/view/340/341

Weill Cornell Medical College. (2013). Center for Healthcare Informatics and Policy. Retireved from http://weill.cornell.edu/chip/about-us/

Electronic Health Record and Clinical Settings

What exactly is an Electronic Health Record? How does it affect patients? And how does it affect health care professionals?

This week we will explore how electronic health records (EHRs) are being incorporated in health care settings, and how they influence the workload of nurses and health care professionals (HCPs). 

Before we dive into how EHR applies to nurses, let's quickly over view just what it is and some positives and negatives that may impact patients.

Electronic Health Records are an electronic profile documenting your entire health history. The record includes lab and tests results, past treatments and procedures, allergies, and past medications prescribed. This private information is all stored in one area where it can be easily accessed and analyzed by health care professionals.  By having all this information in one universally accessible spaces (EHR), HCP are quickly able to provide safe and effective interventions (Flipova, 2013). 

Despite now having to worry about losing documents, how else will this impact patients?

Positives

• Empowers consumers (patient) as they have greater access to their personal health information
• Enhances continuity of care from your health care team
• Effective in emergency situations when unable to supply own information (e.g allergies, medications, medical conditions)

Negatives

• Data accuracy and missing subjective information
• May not understand medical terminology and results
• Data privacy and confidentiality may be breached

Discussions about EHRs mostly focus on the client perspective, but what will these changes mean in clinical care settings? Adjusting to a technology-centred health care environment may be difficult for many health institutes. Thede (2008) states that nurses play an integral role in making this transition as smooth as possible. Nurses are responsible for reducing these barriers to aid the patient experience. 

For nurses EHRs present  a range of possibilities that can improve the care they provide, and their workload. When nurses have access to electronic health records it reduces the time spent on gathering generic health history each interview and interactions. Often, patients are repeatedly asked the same questions about their health and family history, which can be time consuming for the nurse. Much of the interview process can be spent going over history rather than focusing on the main reason for seeking care. EHRs contain all of this information in one area that will not be lost, and can be accessed at any time.

In turn, this also reduces the amount of paper work that nurses have to complete. EHR have specific sections for each type of data that can be directly imputed and have areas for fruther data and nurse's comments. This limits the paper being used, and ensures that the files are kept in  an organized manner. This also means that nurses are more accountable for their work.

Health records can only be accessed with a password and security codes that are different for each HCP. The computer keeps track of who is signed on, what they have accessed and what each member had added to the profile. This function addressed the confidentiality issues that are present. As well, tracking who is responsible for information allows for clarity, and ensures that nurses are thoroughly documenting. 

In my opinion, perhaps one of the greatest functions of the electronic health record is that it allows HCP is follow trends in data and track changes in results more efficiently. For example, consider a hypertensive patient who regularly has their blood pressure taken. Before the electronic health record, the documentation could be irregular, and difficult to compare if there are multiple paper records. These former reports mostly look at when the readings are normal and when they are irregular, but do not consider the contributing factors, time of day, and lifestyle of the patient. With EHR, nurses are able to graph and extrapolate data and relate it to the context of the individual. The EHR provides online functions to track specific details and take that into consideration when analyzing the data (Agency for Healthcare Research and Quality, 2012). 

This takes out the guess work that many nurses face. EHRs provide visual evidence of how a patient is progressing. For patients with eating problems and disorders who are overweight or underweight, these charts can be used to monitor changes. As well, a patient's personal chart can be compared directly with expected patterns. This will also be useful for infants and children, to track development and how they are researching certain developmental stages. The nurse should take an active role in fully using the functions available on EHRs to make the most of their assessments, and advocate for patients health and wellness. By noticing changes early, the nurse can work with the patient and health care team to adjust practices that best support the patient's needs. 

Unfortunately, there are still many  drawbacks of the EHR that can influence the nurse's workload, and provision of care. 

Continuity of care between institutions and facilities is a large concern. Implementing EHRs can be extremely expensive, and many rural health centres and hospitals are choosing to stay with traditional documentation. As well, there is yet to be one standard program that is used for all facilities. This causes gaps in the system, and means that information can be difficult to access and not as easily shared from one place to the next. 

As well, these programs are initially difficult to use and therefore nurses need adequate training. Unfortunately much of this training is expensive, and nurses are often not paid for their time (Thede, 2008). Budgets also mean that there is a restricted amount of time allotted to training, and many nurses only learn the basic function of the the electronic record. This can lead to data inaccuracy and technology problems that few understand how to resolve.

Most importantly, EHR do not capture the emotional aspect of nursing. As the focus of health care shifts to a more technological approach, less time is spent with face-to-face interactions. While, health information may be more accessible and time will be focused on noticing and tracking changes in health, there is the possibility that EHR will decrease the client's experience. This focus on monitoring health and trends unfortunately feels like a step  backward to when health-care had a bio-medical approach. Data may be solely concerned with physiology and pathology of a patient rather than holistic wellness. When nurses spend less time with patients, the trans-personal moments that foster the therapeutic relationship are lost (Thede, 2008). 

How can nurses maintain the therapeutic relationship despite the digital divide?

Last post, I discussed the role of educator and teacher or the nurse, but this week we expand the definition of nurse to include that of advocate. 

Nurses must advocate for their clients in health care settings to ensure that they are being met with holistic care. The nurse must use both the EHR and the client's unique experiences to create individualized care plans. EHRs provide the medical history and present condition of a patient. When the EHR is combined with the client's perspective, and mental and spiritual health is considered nurses can re-establish the therapeutic bond with patients that are based on mutual respect and trust (Coiera, 2004). 

As well, nurses should encourage patient involvement in imputing information that they believe is valid and significant. Patient gathered data allows the patient to feel like an integral member of their care, and be empowered by their health information. Moreover, nurses can educate their patients on their rights to access their health information, and help patients understand results. 

Since the implementation of electronic health records impact and influence nursing practice, nurses need to take an active role in utilizing these technology in the workplace. Nurses act as the regulator in allowing for a smooth transition and advocating for the holistic well-being in  technology-driven society (Vitera, 2013).

---Student Nurse Katie 

References 

Agency for Healthcare Research and Quality. (2012). Electronic health records improve nursing care, coordination and patient safety. Research Activities. 5(381). Retrieved from http://www.ahrq.gov/news/newsletters/research-activities/may12/0512RA11.html

Coiera, E. (2004). Four rules for the reinvention of health care. BMJ, 328(7449), 1197–9. 

doi:10.1136/bmj.328.7449.1197 

Flipova, A. (2013). Electronic health records use and barriers and benefits to use in skilled nursing facilities. CIN: Computers, Informatics, Nursing. 37, 305-319. doi:10.1097/NXN.0b013e318295e40e

Thede, L. (2008). Informatics: The electronic health record: Will nursing be on board when the ship leaves? The Online Journal of Issues in Nursing. 13(3), doi:10.3912/OJIN.Vol13No03InfoCol01

Vitera. (2013). Nurses' integral role in EHR adoption. SuccessEHS. Retrieved from http://www.successehs.com/item/nurses-integral-role-in-ehr-adoption.htm

Consumer Health and eHealth

Quick Review:
... If you recall, last post we discussed how patients are more likely to turn to their computers to access health information, rather than primarily speaking to a health care professional (HCP). Information that was once only privileged to HCPs is now openly broadcast. Because of this, patients are becoming constant consumers of information related to their health, and it is the responsibility of nurses to ensure that this information is reliable and is being appropriately used.


Now that we have an understanding about how patients and clients are consumers of health information, how is social media and technology being applied to support  these consumers?

This week I will examine online communities of sharing, and the role the nurse has to contribute to these communities.

In the past, people accessed information through word of mouth, textbooks, radio, and television. However, as technology has become more prevalent in our everyday lives, people are more likely to access a newspaper article on their phone or computer rather than in print. Instead social media has became our greatest supplier or knowledge and information that allows for open discussion, posts and forums that can facilitate discussion (Gruzd & Haythornthwaite, 2013).

Online communities of sharing are internet groups that provide support to specific groups, raise public awareness, increase policy discussion and promote involvement, and provide medical education. These groups have a common goal and passion of how to improve and increase awareness about an issue or concern (Gruzd & Haythornthwaite). These sources can range from an online support forum, to Pinterest groups, Facebook communities to newspaper apps for phones. This week, I will explore how communities have utilized the different streams of social media to share information and create discussion, critique the benefits and barriers to these portals, and analyze how the nurse can contribute to these online communities.

To begin, let's address some of the organizations and communities that have utilized social media to broadcast their message.

Information transmission primarily takes place through social networking sites and phone applications. When news is released about world issues, political disputes, and natural disaster, information is typically spread through these outlets. Information is quickly distributed by simply pressing the 'share' button. As well, these sites allow for increased information transmission as they are constantly updated and globally accessed, thus information is extremely recent and relevant (Eysenbach, 2008).

                                                                                    For example, the Canadian Medical Association

Journal (CMAJ) has an active twitter profile that supplies knowledge if you're looking to stay updated in medical research and new discoveries. Not only does the CMAJ account post their recent editorials and direct links to their articles, they also provide their followers with medical research projects, social support groups, and fun facts in science. As well, they weigh-in on current events and encourage followers to provide their opinions and tweet questions. This is effective as it allows for
information exchange, and creates a supportive                                                                                             community where curiousity is welcome.

Communities are using social media as a way to raise awareness for causes and issues, and to provide an online community of support. Many people make not have adequate social support networks or coping mechanisms, or may live in an isolated area. These portals allow patients and consumers to share their experiences living with a disease or illness, provide support to those who are struggling, and to communicate and share resources. Social media presents a great opportunity for these communities as it is estimated that over 60% of all people use some form of social media (Statistic Brain, 2013). Connecting with others through these outlets is convenient and allows for quick alliances to be made regardless of location.


Facebook is the most commonly used social
networking site, with over 1.4 billion users worldwide (Statistic Brain, 2013) . Due to this, many of these communities use Facebook to reach a large audience. For instance the Mental Health Foundation uses a Facebook page to reach out to those suffering with illness related to mental health, and to reduce the negative stereotypes associated with mental health. They provide their members with sources on managing stress and anxiety, awareness events, and secure discussion forums. These forums create a safe online environment as they can be submitted anonymously, only members can access the information and it cannot be shared to other Facebook groups or pages. This site creates an effective online community as they provide their members with external resources that may apply to their specific illness.

Additionally, communities use social media as an educative tool. As stated last post, most people use the internet as their primary and first means of gathering information. Often people are looking for a fast and simple way to understand concepts that are sometimes difficult to understand. Patients and health consumers feel empowered by self-educating, and these communities provide them with adequate support for health teaching (Donelle & Booth, 2012).

An effective social media outlet for education is YouTube. These short videos are accessible without an account, and provide consumers with a multi-dimensional environment for learning. Educational YouTube videos are great as they meet the learning needs of many through visual, written and audio teaching. Since these videos are easily shared, and comments are responded to quickly, viewers are able to be engaged and active in this community. AsapSCIENCE is an online science community that answer viewers health and medical questions in videos that are easy to understand and humorous. The videos are available in categories to help navigate the site and find exactly what is needed. As well, the site encourages viewers to post more                                                                                               questions that are on their mind, and advocate for                                                                                          increasing knowledge (Gruzd & Haythornthwaite,                                                                                        2013).

Despite, the overwhelming positives that erupt from these resources, there are still barriers and areas that need thorough consideration from a nursing standpoint. With any form of online interaction there is always the implication of privacy and confidentiality. This becomes more critical when you consider the sensitivity of the issues discussed, and the personal health information that can be posted and accessed by millions.

Consider how consumers use social media as an educative tool. Over-use can lead to self-diagnosing that relates back to cyberchondria discussed previously (White & Horvitz, 2009). Additionally, people must be aware of the credibility of the sources they use, and how they use the information provided. As well, consumers need to understand the policies present on these sites and how they use the information that is posted to forums and discussion panels.

This is where nurses can become involved. Nurses are educators and take a directive role in health teaching. Nurses should discuss with their patients where they primarily obtain their health information and knowledge about disease. When patients bring online data forward, nurses should not criticize patients but encourage and support that they are taking an active role in their health. As well, the nurse should offer to work with their patients to appropriately use this information and discuss the effectiveness of online communities in their patients health experience.

Consider your role in online health communities. How do you most benefit from these resources, and what sites do you find particularly effective?

Until next post,
---Student Nurse Katie


References
AsapSCIENCE. (2012). Your daily dose of science. Retrieved from http://www.youtube.com/watch?      v=N3DWtVhEnbE

Donelle, L., & Booth, R. G. (2012). Health Tweets : An exploration of health promotion on Twitter. Online Journal of Issues in Nursing, 17(3). doi:10.3912/OJIN.Vol17No03Man04

Eysenbach, G. (2008). Medicine 2.0: Social networking, collaboration, participation, apomediation, and openness. Journal of Medical Internet Research, 10(3), e22. doi:10.2196/jmir.1030

Gruzd & Haythornthwaite. (2013). Knowledge translation of evidence-based medical information in the age of social media. Social Media Lab. Retrieved from http://socialmedialab.ca/?p=8921

Statistic Brain. (2013). Social networking statisitcs. Statistic Brain. Retrieved from http://www.statisticbrain.com/social-networking-statistics/

White, R. & Horvitz, E. (2009). Cyberchondria: Studies of the escalation of medical concerns in web search. ACM Transactions on Information Systems. 27(4). doi:10.1145/1629096.1629101