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Healthcare Informatics

 Health Care Informatics

Maria Schiaratura, Jody Bush, Rolanda Canty, Daneshea Crews, and Julie Sykora

In the following paper, Learning team A will describe the informatics influence and necessary steps for improving and providing safer and better health care delivery, which is the focus and mission of the health care industry in the United States.  Serious medication errors are common in hospitals and most likely these errors occur because of physician-ordered transcription.  To help avoid these types of errors, health care informatics has developed upgraded systems to support all health care providers in the care and safety of medication orders and transcriptions.

Key Concepts

The Computerized Physician Order Entry (CPOE) system is the informatics system that assists physicians and health care providers in decreasing medication errors.  According to Kuperman and Gibson (2003), CPOE is a promising technology that allows physicians and health care providers, directly involved in the care of patients, to enter orders into a computer instead of handwriting them (p. 31).  The advantage of CPOE allows transmission of real-time orders to satellite pharmacies, which improves standardization of care and provides a more comprehensive medication order with fewer medication errors (Hebda & Czar, 2009).  According to Detmer and Gillings (2003) in many hospital settings, standards are the backbone of technological progress because, “they enable parts to fit together, ensure consistency over time, and facilitate communication” (p. 1484).  Detmer and Gillings (2003) express standards as “prerequisites to the joining of information from many separate computer sources to produce a whole that is greater than the sum of its parts” (p. 1472).

 Roles, Activities, and Responsibilities of the Informatics Specialist

The informatics specialist roles, activities, and responsibilities vary throughout health care organizations.  An informatics specialist should possess a working knowledge of the system life cycle. The main roles of the informatics specialist involve designing, planning, researching, training, and continuing education (Cooper, 2009).  Designing systems and planning for the implementation of new systems and maintenance are processes that require collaboration with informatics committees.  The informatics specialist integrates nursing, computer, and information science when conducting research.  Training and continuing education are necessary for the informatics specialist to maintain current knowledge of trends and issues in health care, which supplements facilitation of initial and ongoing staff training.  Additional activities and responsibilities of the informatics specialist include data collection, reporting of outcomes, management of clinical databases, creating quality surveys and participating in surveys and questionnaires, creating and managing communications via designing forms and using desktop publishing (Newbold, 2010). 

American Medical Informatics Association

Basic roles, activities, and responsibilities of the informatics specialist differ among health care organizations; however, the informatics specialist is championed by the American Medical Informatics Association (AMIA).  By promoting effective use of data collection and organizational leadership, the AMIA supports patient care through education, research, community services, organizational leadership, and policies.  The AMIA is used as a guideline for creating adequate standards of patient care (American Medical Informatics Association, n.d.).  AMIA’s 4,000 members advance the use of health information and communications technology in clinical care and clinical research, personal health management, public health/population, and translational science with the ultimate objective of improving health (American Medical Informatics Association, n.d.).  The informatics specialist possesses a sophisticated level of understanding and skills in information management and computer technology (Hebda & Czar, 2009).  Equipped with this knowledge, the informatics specialist develops and uses the organization’s health informatics systems for quality assurance and improvement, clinical care, research, and other health care related functions.  The AMIA influences the role of the informatics specialist by providing an environment for informatics specialists to network and share information.  A well-trained informatics workforce and the utilization of electronic medical records are supported by the AMIA.  AMIA’s endorsement of electronic medical records permits health informatics specialists to promote the use of electronic medical records to their health care organizations.  Informatics specialists are bound by the ethics of the AMIA on the use of patient data.  Patients are informed that their information will be used safely and confidentially with respect to the law.  The AMIA provides the combination of a formal education and a professional environment, which results in informatics specialists who are technically proficient and supported in their job functions. 

The Effect of Driving and Restraining Forces on Informatics

Many underlying factors are propelling health informatics to the forefront of the health care industry in the 21st century.  The Recovery Act of 2009, offering monetary incentives to health care providers qualified as meaningful users of certified EHR’s (electronic health records), is motivating organizations to implement EHR systems (U.S. Department of Health and Human Services, 2010).  This requires a system that provides automated information, retrievable in a timely manner by various users in different places and ensures patient confidentiality.  At the same time, health care consumers are more proactive than ever about the quality and cost of their health care and demand information at their fingertips.  Malpractice suits are a tremendous cost to physicians, who realize that information technology lowers this cost by reducing errors, improving quality of care, and optimizing processes and patient safety (Hayes, 2008). 

Though driving forces to implement health informatics are compelling, resistance to change, inadequate planning skills, and lack of resources inhibit incorporation of health informatics.  Organizations with limited funds and seasoned staff resist changing and updating technology.  Finding experienced informatics specialist and adequate funds are necessary to defeat restraining forces.  Some say, “If it is not broken, then don’t fix it.”  The fear of the unknown prevents organizations from moving forward with electronic records; therefore, plans to overcome resistance of new systems must be executed.

Implications of CPOE

CPOE systems provide health care organizations with tools to enhance the efficiency and delivery of patient care.  The aim of CPOE is to help authorized users order patient medications, tests, referrals, and treatments with accuracy and completeness without the possibility of errors.  According to one study (Ohsfeldt et al., 2005, p. 20), the implementation of CPOE will help organizations prevent medication and transcription errors, alert physicians of potential order errors, and improve the efficiency of patient care.  The CPOE design assists the medical user in entering appropriate and cost-effective patient health care orders without the possibility of order duplication and wrong order entries (Doolan & Bates, 2002, p. 181).  The use of CPOE also raises concerns and implications with users when used in the health care setting.

The Physician Order Entry Team (POET) at the Oregon Health & Sciences University (2009, para. 4) have conducted research studies on CPOE implementation and have concluded that although CPOE has benefits, the system also has unintended consequences.  The study results reflect user concerns with organizational implications that could affect the efficiency and delivery of health care if organizations do not take the precautions and learn to adapt the system to future change.  Implications can increase the workload and overwhelm the user with system alerts.   The use of CPOE also affects the dependency users have toward technology.  POET (2007, para. 9) describes that CPOE and technology dependency could cripple the user’s organization when systems are down for an extended period.  Users become dependent on technology to complete work and forget how to do the basic tasks.  Additional implications or consequences that could affect organizational work (Physician Order Entry Team, 2007, para. 3) include:

  1. More/New Work for Clinicians
  2. Workflow Issues
  3. Never-Ending System Demands
  4. Problems Related to Paper Persistence
  5. Changes in Communication Patterns and Practices
  6. Negative Emotions
  7. Generation of New Kinds of Errors
  8. Unexpected and Unintended Changes in Institutional Power Structure
  9. Overdependence on Technology (Physician Order Entry Team, 2007, para. 3)

Conclusion

As with the CPOE, the incorporation of health informatics industry-wide is not a flawless process, albeit a necessary one.  The United States health care industry is transforming to answer demands for cost savings, improved efficiencies, automated information accessible to provider and consumer, and enhanced patient safety and confidentiality.  Implementation of informatics to existing health care systems is a complex process requiring time, input, and a willingness to change.  The informatics specialist plays a vital role in executing this transformation and serves as a liaison to gap the bridge between the medical and information technology sectors to help bring the health care industry closer to achieving optimal health care delivery. 

             References

American Medical Informatics Association. (n.d.). Retrieved from http://www.amia.org

Cooper, H. (2009).  Changing roles of Health Information Managers:  an education

            perspective.  Health Information Management Journal, 38(3), pp. 38-42.

Detmer, D., E. & Gillings, D. (2003). BMC Medical Informatics and Decision Making 2003. 3(1). Retrieved May 29, 2010 from BioMed Central. http://www.biomedcental.com

Doolan, D. F., & Bates, D. W. (2002). Computerized physician order entry systems in hospitals:

Mandates and incentives. Technology & Medicine, 21(4), 180-186.  Retrieved June 3, 2010, from http://www.mihealthandsafety.org/pdfs/DoolanBates.pdf

Hayes, J. (2008). IT informatics. Engineering & Technology. Retrieved from http://www.theiet.org/engtechmag

Hebda, T., Czar, P., & Mascara, C. (2009).  Handbook of informatics for nurses and health care professionals (4th ed.) upper Saddle River, NJ: Pearson Prentice Hall.

Kuperman, G., J. and Gibson, R., F. (2003, July). Computer Physician Order Entry:

Benefits, Costs, and Issues. Annals of Internal Medicine, 139(1). Retrieved May 31, 2010 from Columbia University database.

Newbold, S.K., (2010).  A New Definition for Nursing Informatics.  Advance for

            Nurses. Retrieved from   http://nursing.advanceweb.com/Editorial/Content/PrintFriendly.aspx?CC=7428

Ohsfeldt, R., Ward, M., Schneider, J., Jaana, M., Miller, T., Lei, Y., et al. (2005).

Implementation of hospital computerized physician order entry systems in a rural state: Feasibility and financial impact. Journal of the American Medical Informatics Association, 12(1), 20-27. doi: 10.1197/jamia.M1553.

Physician Order Entry Team (2009). POET research. Retrieved June 4, 2010, from Oregon

Health & Science University Web site:

http://www.ohsu.edu/academic/dmice/research/cpoe/research.php

Physician Order Entry Team (2007). Types of unintended consequences of cpoe.

Retrieved June 4, 2010, from Oregon Health & Science University Web site: http://www.ohsu.edu.academic/dmice/research/cpoe/unintended_consequences.php

U.S. Department of Health and Human Services. (2010). Health information  technology. Retrieved from http://www.healthit.hhs.gov

Note:  This paper was written as a group project during my graduate studies.

                                                         

 

 

 

 

 

 

 

 

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