Future Direction…

What if we could understand health and complex diseases BEFORE they occurred using personalized genomics, informatics, and biology to create a healthcare system that focused on prevention (Snyderman, 2012)?  This outlook on health is the concept best described as “personalized medicine/healthcare”.  The understandings from science are leading the way in changing our thinking about diseases and providing a deeper understanding of the development of diseases overtime based on a person’s genetic background and their exposure to environmental factors (Snyderman, 2012). 

With this concept in mind, what would a clinical best-practice guideline look like? With such a specific and holistic view of patients, having a “one-size fits all” approach to clinical best-practice guidelines would be difficult to create. However, with the focus being more on preventative and personalized medicine, clinical best-practice could be changed to medical guidelines based on subsets of the population (Antonanzas, Juarez-Castello, & Rodriguez-Ibeas, 2015).  Genetic testing would allow for the stratification of the population subsets which would provide information on treatments to support decision making on personalized medicine (Antonanzas, Juarez-Castello, & Rodriguez-Ibeas, 2015).  To be able to understand a person’s disease susceptibility as well as the best course of treatment based on their genetic make-up, will allow for a more personalized, predictive, preventative, and person-centered approach to care (Snyderman, 2012). 

In the research process to develop these recommendations, specific research modalities will need to be incorporated in order to utilize personalized medicine.  To better understand disease risk, research will need to focus on the development of diseases based on a person’s health status and risk.  This could be tracked using a longitudinal research project that focuses on human traits and health with a focus on genomes (Lifescience BC, 2017).  There is a project in British Columbia that is looking to implement personalized medicine.  The recommendation from this study was to study major disease states from certain communities and cohorts (Lifescience BC, 2017).  From this, socioeconomic, age, sex, ethnicity, genomic analysis, proteomic, metabolomics, and microbiomic data would be collected and analyzed (Lifescience BC, 2017).  By combining this information, clinicians could identify biomarkers that are associated with disease and provide information on the best way to optimize health and utilize healthcare resources (Lifescience BC, 2017).

Using this approach to healthcare, there are legal and ethical considerations to be aware of…

  • Genetic discrimination – test results affecting a patients ability to receive health insurance
  • Psychological impact of understanding genetic risk factors
  • Ensuring proper consent is obtained prior to genetic testing (Callier, et al., 2016)

Personalized medicine is not an entirely new concept in our modern day healthcare system.  There are many examples of bio markers and evidence of the efficacy of these treatments.  Examples such as:

https://www.ctvnews.ca/video?clipId=588080

Using advancements in research, personalizing medicine is a concept that will continue to evolve in our everyday practice. Nurses will need to continue to integrate best practice and evidenced based knowledge into their everyday practice to support the advancements made in personalized medicine.

References

Antonanzas, F., Juarez-Castello, C. A., & Rodriguez-Ibeas, R. (2015). Some economics on personalized and predictive medicine. The European Journal of Health Economics, 16(9), 985-994.

Callier, S. L., Abudu, R., Mehlman, M. J., Singer, M. E., Neuhauser, D., Caga, A. C., & Wiesner, G. L. (2016). Ethical, Legal, and Social Implications of Personalized Genomic Medicine Research: Current Literature and Suggestions for the Future. Bioethics, 30(9), 698–705.

Cutter, G. R., & Liu, Y. (2012). Personalized medicine: The return of the house call?. Neurology. Clinical practice2(4), 343–351. doi:10.1212/CPJ.0b013e318278c328

Lifescience BC. (2017, June). The time is now for personalized medicine in british columbia. Retrieved from Lifescience BC: https://lifesciencesbc.ca/wp-content/uploads/2018/01/Roadmap-2.0-Time-is-Now-for-Personalized-Medicine-in-BC-Final.pdf

Snyderman, R. (2012). Personalized health care: from theory to practice. Biotechnology Journal, 7(8), 973-979.

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Professionalism

This week’s module focuses on the topic of professionalism in nursing and how this relates to a nurses online representation.  An example of this comes from a case involving a nursing student in her final year, Doyle Byrnes, who took a photograph of a placenta during a lab at a medical centre and posted it on Facebook.  This situation involved seven other students who asked permission of a clinical instructor to take the photograph.  The clinical instructor did not instruct the nursing students not to take the photograph.  Doyle Byrnes and three other students were expelled from the program.  This case went to court and the three nursing students including Doyle Byrnes were reinstated to finish their nursing degrees. 

https://www.huffpost.com/entry/doyle-byrnes-student-expe_n_803839?guccounter=1

Using the College of Nurses Practice Document on Professional Standards (2002), there are breaches of this standard that are evident in this situation.  The nursing students did initially ask their clinical instructor if taking a photograph would be allowed.  They were not told not to and therefore, used the discretion of their instructor as a means of permission to go ahead.  In an educator role, the nurse is responsible for ensuring standards of practice are maintained for students, as well as, ensures that students are given the “appropriate education, support, and supervision when acquiring new knowledge and skills” (College of Nurses of Ontario, 2002, p. 4).  The educator should have instructed the nursing students not to take the photograph.  The other issue at hand was the perceived breach of confidentiality.  According to the judge in this scenario, there was no breach of confidentiality due to the fact that there was no identifying information.  According to the Director of Nursing at the College, Jeanne Walsh, there was a breach of confidentiality.  However, the judge dismissed this claim based on the evidence available.  Using the Practice Standard on Confidentiality, personal health information (PHI) is any identifying information about clients that is in verbal, written, or electronic form (College of Nurses of Ontario, 2019).  The donation of body parts is included in this definition (College of Nurses of Ontario, 2019).  The College of Nurses of Ontario also state that PHI does not always have to be named for it to be considered a breach of confidentiality; if the information can be combined with other information to identify the person, this can be considered PHI (College of Nurses of Ontario, 2019). 

The professional code of conduct at the College should include up to date and clear expectations of the nursing students.  This could include clear expectations of social media use.  There is a position statement available from the International Nurse Regulator Collaborative on social media use and the expectations for nurses.  The 6 ‘P’s of Social Media Use include:

This scenario is a great example of the importance of using critical thinking skills and ensuring that professional standards of practice are maintained online.  It is a nurses responsibility to maintain extreme vigilance in posting images, commentary, or recordings that intentionally or unintentionally breach patient confidentiality (Westrick, 2016).  This extends to nursing students, not only practicing nurses, that are held to the same standard professionally, legally, and ethically (Westrick, 2016).

This video includes social media guidelines for nurses with case scenarios:

References

College of Nurses of Ontario. (2016, December). Position Statement: Social Media Use. Retrieved from College of Nurses of Ontario: http://www.cno.org/globalassets/docs/prac/incr-social-media-use-common-expectations-for-nurses.pdf

College of Nurses of Ontario. (2002). Professional Standards, Revised 2002. Retrieved from College of Nurses of Ontario: https://www.cno.org/globalassets/docs/prac/41006_profstds.pdf

College of Nurses of Ontario. (2019, April). Confidentiality and Privacy – Personal Health Information. Retrieved from College of Nurses of Ontario: https://www.cno.org/globalassets/docs/prac/41069_privacy.pdf

NCSBNInteract. (2011, Dec 9). Social media guidelines for nurses [Video file]. Retrieved from https://www.youtube.com/watch?v=i9FBEiZRnmo

Westrick, S. J. (2016). Nursing Students’ Use of Electronic and Social Media: Law, Ethics, and E-Professionalism. Nursing Education Perspectives (National League for Nursing), 37(1), 16–22. https://doi-org.roxy.nipissingu.ca/10.5480/14-1358

Information Literacy

Protecting our patients personal health information (PHI) under the regulations of the Personal Health Information Protection Act (PHIPA) is a nursing responsibility.  Nurses have both the ethical and legal responsibility to maintain our patient’s confidentiality and privacy as we are health information custodians (College of Nurses of Ontario, 2019; Information and Privacy Commissioner of Ontario, 2015).  

The Office of the Information and Privacy Commissioner of Ontario (2015) outlined a document on circle of care and how health care custodians can share PHI for health-care related purposes.  Although the “circle of care” cannot be clearly defined, there are six conditions when implied consent can be used to disclose PHI (Information and Privacy Commissioner of Ontario, 2015).  It is important for the health care custodian to be aware that PHI can only be disclosed to certain other custodians for the “purpose of providing health care or assisting in the provision of health care to an individual” (Information and Privacy Commissioner of Ontario, 2015, p. 2).  The Ontario Agency for Health Protection and Promotion is considered a health information custodian due to their role in the provision of health for research and support as legislated by the Government of Ontario (Public Health Ontario, 2019).  This could include mandatory reporting for diseases such as HIV, Hepatitis A B C, and Influenza (Government of Canada, 2018).  Another condition that must be met is that PHI must have been received from the individual of the PHI, his/her substitute decision maker (SDM), or from another health care custodian (Information and Privacy Commissioner of Ontario, 2015).  Therefore, consent cannot be assumed if received from a third party such as an employer, insurer, or educational institution (Information and Privacy Commissioner of Ontario, 2015).  The PHI that will be used, collected, or disclosed must be used for providing health care or assisting in the provision of health care to the person that the PHI relates (Information and Privacy Commissioner of Ontario, 2015).  This is an important consideration when determining implied consent as there are a number of situations where this does not apply.  These situations can include research, fundraising, marketing, or providing health care to another individual or a group of individuals (Information and Privacy Commissioner of Ontario, 2015).  As well, implied consent cannot be provided to a person or organization that is not a health information custodian (Information and Privacy Commissioner of Ontario, 2015).  Patient’s always have the right to withhold or withdraw consent of their PHI, however, in some cases, PHIPA requires that information is shared (Information and Privacy Commissioner of Ontario, 2015).  An example of this would be the mandatory reporting to Public Health.  

There is a difference between implied consent and expressed consent.  Implied consent was discussed in the above paragraph, however, expressed consent is provided by the individual or SDM either verbally or written (Information and Privacy Commissioner of Ontario, 2015).  In expressed consent, there are still required elements that must be fulfilled in order for the consent to be valid.  These include:

  • Consent obtained from the individual of the PHI or SDM
  • Must be knowledgeable about the purpose, use, or disclosure and his/her rights to withdraw consent
  • Must relate to the information being collected, used, or disclosed; and
  • Cannot be obtained through deception or coercion (Information and Privacy Commissioner of Ontario, 2015)

Health Information on the Web

Personal health information and health information that is available on the internet continues to grow.  Personal health information contains any identifying information about a person’s physical or mental health including family health history, care that has been provided, a plan for services, payment or eligibility for health care, donation of body parts or substances, health number, and the name of a client’s SDM (College of Nurses of Ontario, 2019).  Health information can include information on a health related topic that can be found on the internet.  For example, a fact sheet on how to manage hypertension could be considered health information and could alter health behaviours in people seeking out that information.  In my role as a health care provider and a soon-to-be Registered Nurse (RN), it is important to hear the patients version of what they have learned from their own research in order to fully appreciate their level of understanding of the illness/symptoms/disease process.  Depending on the accuracy of their information, the RN can provide evidence based information and recommendations based on their health issue.  The RN can also promote the patients ability to participate in their own health care by recommending reputable websites such as The Heart and Stroke Society, if they want additional information on hypertension, for example. 

Patients can post information about their own PHI, however, PHIPA does not allow for the disclosure of PHI of family members or SDM.  So, if the person is sharing information about their own journey of hypertension and then states that their Father also has this condition, this would be a violation of PHIPA.  As a soon-to-be RN, my role in this would be to educate people on PHIPA. 

Health information is becoming more readily available for Canadians on the internet.  There is a variety of sites available for people to access information on diseases or illnesses, basic self-care strategies, and several other health related topics.  Depending on the person’s health literacy this can significantly impact the person’s ability to respond to the information provided on the internet or to critically examine information that is not reputable.  Using the health discussion board on the web called: http://www.reddit.com/r/Diagnosed, I will examine a message thread that was posted and deconstruct the responses provided to the original poster.

I found an interesting thread that was posted almost 5 years ago from a nineteen year old female who had presented to the emergency room (E.R.) for tachycardia, hyperventilation, hypotension, and dizziness upon standing.  This patient was monitored in the E.R. with lab work, ECG, and monitoring of her vital signs.  She has had panic attacks in the past but had reported these episodes were different and not triggered by anxiety.  She was discharged home with no explanation for her symptoms and directed to follow up with her primary health care provider.  There was four responses to this woman about possible explanations for her symptoms and recommendations on further follow up.  The first response was surprisingly accurate in describing the common diagnostic tests that are performed in the E.R. such as an ECG and lab work.  However, this responder stated that having “black spots” or “dizziness” when standing or sitting up quickly is common.  This is not common in everyone and should be investigated further as there could be a number of reasons for this phenomena.  It is normal to have an increase of 5-20 bpm above resting, a slight increase to systolic pressure (up to 10 mm Hg), and a slight increase to diastolic (5 mm Hg) (Norris & Swiniarski, 2016).  Another responder encouraged this woman to ensure that she was consuming enough fluids of 1-2 L per day and to relieve stress.  This responder also directed the woman to check out a Wikipedia website on orthostatic hypotension.  Although the recommendation for fluid intake and relieving stress was appropriate, it is worrisome to direct this woman to a Wikipedia site for health information.  Another responder inquired about vertigo or hypothyroid.  Hypothyroid manifests as fatigue, hair loss, brittle nails, dry skin, paresthesia in fingers, menstrual disturbances, subnormal body temperature and pulse rate, and an increase in weight (Williams & Day, 2016). 

I enjoyed reading the posts on this website as it gave me a perspective I did not have before on health-related discussion boards.  People can use these sites for support and expertise that may support their journey in determining causative factors for their symptoms, however, it is important that the people using these sites seek the opinion of a regulated health professional.

References

College of Nurses of Ontario. (2019, April). Confidentiality and Privacy – Personal Health Information. Retrieved from College of Nurses of Ontario: https://www.cno.org/globalassets/docs/prac/41069_privacy.pdf

Government of Canada. (2018, November 25). List of nationally notifiable diseases. Retrieved from Government of Canada: https://diseases.canada.ca/notifiable/diseases-list

Information and Privacy Commissioner of Ontario. (2015, August). Circle of Care Sharing Personal Health Information for Health-Care Purposes. Retrieved from Information and Privacy Commissioner of Ontario: https://www.ipc.on.ca/wp-content/uploads/Resources/circle-of-care.pdf

Norris, C. & Swiniarski, G. V. (2016). Assessment of cardiovascular function.  In P. Paul, R.A. Day, & B. Williams (Eds.), Brunner & Suddarth’s Canadian textbook of medical-surgical nursing (3rd ed., pp. 716-753). Philadelphia, PA: Lippincott Williams & Wilkins.

Public Health Ontario. (2019, April 8). Privacy. Retrieved from Public Health Ontario: https://www.publichealthontario.ca/en/about/privacy

Unknown (Photographer). (Unknown). Privacy lock [digital image]. Retrieved from URL https://ryyacatjr.files.wordpress.com/2015/11/privacy_lock_300_jpg.jpg

Williams, B. & Day, R. A. (2016). Assessment and management of patients with endocrine disorders.  In P. Paul, R.A. Day, & B. Williams (Eds.), Brunner & Suddarth’s Canadian textbook of medical-surgical nursing (3rd ed., pp. 1334-1379). Philadelphia, PA: Lippincott Williams & Wilkins.

Computerized Patient Information System

The Darbyshire (2004) article described the nurses and midwives experience to computerized patient information systems being implemented across five Australian hospitals during their everyday practice.  There was a significant amount of negative responses to this implementation.  This was a qualitative study which allowed nurses and midwives to describe their experience in their own words and there were many themes that emerged such as difficulty in using the software, in clearly articulating the nurses’ practice, in retrieving information, and no identifiable change in clinical outcomes. 

Based on these responses, it would be important to address both the technical and social elements that are described by the participants.  First, it would be important for the organization to support the nurses by offering in-service education that addresses workflows specific to accessing information in a timely manner and using the software effectively in their everyday practice.  This could be achieved by using specific case examples.  A study by McGuire et al. (2013) identified a implementation strategy that employed self-study, one-to-one sessions with super users, and in class training to support the staff.  They also provided on-site support during the first two weeks of initiating the electronic medical record (McGuire et al., 2013).  These strategies could support the technical elements of the system.  To address the social aspects, the staff may benefit from having a working group to talk about the current challenges they are facing and communicate these challenges to a super user or senior manager.   

Photo by Christina Morillo on Pexels.com

In the past three years my workplace has changed from a paper based documentation system to a computerized system.  This included a new online documentation system (electronic medical record; eMH) and a medication administration system (electronic medication administration record; eMAR).  Similar to the responses from the staff in the article, many of the staff at my workplace described the eMH and eMAR being difficult to navigate and use, inability to capture the essence of nursing, and incompatibilities between systems.  However, the attitude shifted after about one year of implementation and all staff are using the systems on a regular basis more competently.  At my workplace we had a lot of support from super users and were provided with opportunities for feedback and extra education if needed.

Darbyshire, P. (2004). “Rage against the machine?”: nurses’ and midwives’ experiences of using Computerized Patient Information Systems for clinical information. Journal of Clinical Nursing, 13(1), 17-25.

McGuire, M., Noronha, G., Samal, L., Yeh, H., Crocetti, S., & Kravet, S. (2013). Patient safety perceptions of primary care providers after implementation of an electronic medical record system. Journal of General Internal Medicine, 28(2), 184-192. doi:10.1007/s11606-012-2153-y

Process of Administering Medications

The process of administering medications goes beyond the actual act of providing a patient with a medication. Nurses must implement the three principles that are outlined by the College of Nurses of Ontario that include: authority, competence, and safety (CNO, 2019). I have integrated these three principles in a word cloud that outlines the process of medication administration.

Workflow

At my work we use both the computerized physician order entry (CPOE) and an electronic medication administration record (eMAR).  I work on an inpatient addictions unit and my patients are often able to receive their medications at the medication window located in the nursing station.  The patients are responsible for receiving their medications at the specific structured times and must have a patient identification card that the nurse scans into the eMAR system.  This patient identification card has their full name, age, date of birth, day of admission, and any drug/food allergies.  Because the patients come to a medication window there is a limited amount of space for them to wait in the hallway for their turn and therefore, this creates a loud environment that can be distracting.  This medication system/process is not ideal for creating a confidential space for the patient to ask questions pertaining to their medication and it can also increase the risk of medication errors due to the noise. 

Reference

CNO. (2019, January). Practice Standard: Medication. Retrieved from College of Nurses of Ontario: http://www.cno.org/globalassets/docs/prac/41007_medication.pd

Defining Types of Data

For this week’s module, I will be exploring six different informatics/eHealth systems.  Depending on your level of understanding/exposure to these systems, you may feel unaware of the meanings behind the acronyms and what it means to nursing. I hope to provide you a deeper understanding of these systems and the data that can be captured or utilized in nursing practice.

PACS

Picture archiving and communication system (PACS) stores and transmits electronic images and clinical reports digitally that can be accessed on off-site servers using the PACS software (Rouse, 2018).  Types of data that can be stored include medical images (eg. MRI and X-ray images), clinical reports (ex. Radiology interpretation), and patient medical history (Rouse, 2018).  According to the framework identified by Matney et al., (2011), this type of information that is stored could be considered raw data (in the form of images captured by a radiology machine), information (reports written by the radiologist), and then clinical medical information on the patient can encompass the knowledge aspect.

Depending on the type of role the nurse is in, the information found in this system could be used for identification of certain fractures, tumors, placement of artificial implants, etc. This could be used to support assessment data, interventions, and outcomes for nursing-related care.

Clinical Area: Acute care (inpatient and outpatient clinics), surgery, family physician offices

EMR/EPR

The electronic medical record (EMR) is a computerized patient record (Canada Health Infoway, 2019).  The EMR can vary depending on the healthcare environment or clinical area (Canada Health Infoway, 2019).  It stores information such as lab results, medications, clinical reports, diagnostic images, and other relevant health-related information (Canada Health Infoway, 2019). 

The key difference between a personal health record (PHR) and an EMR is the custodianship belongs to a person (the patient, family member, or SDM/POA) in the PHR (Canada Health Infoway, 2019).  The EMR is controlled by a healthcare provider (Canada Health Infoway, 2019).  The PHR holds information about a specific person over their lifetime (Canada Health Infoway, 2019).

The EMR system is used to input raw assessment/observation data, provide information pertaining to a patient’s condition/health history, and can contain laboratory results and other test results to support the identification of the clinical picture of the patient.  The EMR system can be used by all disciples and therefore can provide the nurse with a holistic view of the patient condition.  The information contained supports the rationales (wisdom) for nursing care.

Clinical Area: Acute care, community-based care, long term care, outpatient clinics

CPOE

Computerized provider order entry (CPOE) refers to the technology available for a medical professional to enter medication orders and treatment instructions electronically (Charles, DelVecchio, Eastwood, & Rouse, 2018).  This technology represents the entire DIKW (data, information, knowledge, wisdom) framework as it encompasses:

  • the collection of data (entering of an order or treatment),
  • the ability to input information (example: the physician entering an order for daily weights),
  • the ability to integrate knowledge to support clinical decision making (example: the nurse interpreting the order for a weight),
  • and using wisdom to critically think about the appropriateness of the CPOE orders and the clinical picture (Matney et al., 2011)

The information that is inputted in this system is important for nurses to critically analyze as it provides direction for medication administration and treatments ordered for the patient.  The nurse must use the EMR (if applicable)/patient record and the clinical picture/status of the patient in order to administer the correct treatment or medication.

Clinical Area: Acute care, community-based care, long term care, pharmacies

Telehealth

Telehealth is a free and confidential telephone service that a person can call to get health advice or information (Government of Ontario, 2019).  A Registered Nurse (RN) will assess the health problem and give advice on the most appropriate level of care the person should seek out (Government of Ontario, 2019). 

Clinical Area: Community-based care

Patient Portal

A patient portal is web based software that combines an electronic health record system and a patient ability to access their own medical record and results (Gheorghiu & Hagens, 2017).  These systems can also be used for making appointments, ordering medication refills, or exchanging messages with physicians (Gheorghiu & Hagens, 2017).  There are various providers that exist which include Google Health, Microsoft Vault, Revolution Health, Kaiser Permanente’s kp.org, and Sunnybrook Health Sciences’ MyChart (Gheorghiu & Hagens, 2017).

Clinical Area: N/A as this is patient-initiated and optional

Handheld

A handheld device could include a smartphone (iPhone or android), tablet, digital scheduler, etc.  Depending on the handheld device, the application to health is vast.  There is a publication that was completed by the World Health Organization 2011) that looked at global initiatives and the adaptation to mHealth (mobile technologies).  This publication identifies the many ways that mobile technologies can support health care initiatives such as the promotion of health, connecting people with physicians/healthcare providers, reminders for appointments, etc.  (World Health Organization, 2011). 

I found an interesting podcast called ‘Managing mHealth App Development under FDA Regulation’ that discusses the various types of apps available on smartphones or computer systems.  I felt this was a relevant piece of audio as medical applications can influence raw data input (example: testing urine samples VIA app software), influencing knowledge available to healthcare providers, and how these applications relate to clinical practice.

https://player.fm/series/conversations-on-health-care/managing-mhealth-app-development-under-fda-regulation

Clinical Area: Acute care, community-based care, long term care, educational institutions, outpatient clinics, pharmacies, etc.

References 

Canada Health Infoway. (2019). Understanding EHRs, EMRs and PHRs. Retrieved from Canada Health Infoway: https://www.infoway-inforoute.ca/en/solutions/digital-health-foundation/understanding-ehrs-emrs-and-phrs

Charles, M., DelVecchio, A., Eastwood, B., & Rouse, M. (2018). computerized physician order entry (CPOE). Retrieved from SearchHealthIT: https://searchhealthit.techtarget.com/definition/computerized-physician-order-entry-CPOE

Gheorghiu, B., & Hagens, S. (2017). Use and maturity of electronic patient portals. Studies in Health Technology and Informatics, 136-141.

Government of Ontario. (2019, March 25). Get medical advice: Telehealth Ontario. Retrieved from Government of Ontario: https://www.ontario.ca/page/get-medical-advice-telehealth-ontario

Lippincott Nursing Education. (2018 , March 02). How an Educational EHR Improves Patient Outcomes on the Job. Retrieved from Lippincott Nursing Education Blog: http://nursingeducation.lww.com/blog.entry.html/2018/03/02/how_an_educationale-Kpcc.html

Matney, S., Brewster, P. J., Sward, K. A., Cloyes, K. G., & Staggers, N. (2011). Philosophical approaches to the nursing informatics data-information-knowledge-wisdom framework. Advances in Nursing Science34(1), 6–18. Retrieved from http://search.ebscohost.com.roxy.nipissingu.ca/login.aspx?direct=true&db=cin20&AN=108240207&site=ehost-live&scope=site

ReachMD. (2014, March). Managing mHealth App Development Under FDA Regulation. Retrieved from https://player.fm/series/conversations-on-health-care/managing-mhealth-app-development-under-fda-regulation

Rouse, M. (2018, August ). PACS (picture archiving and communication system). Retrieved from SearchHealthIT: https://searchhealthit.techtarget.com/definition/picture-archiving-and-communication-system-PACS

World Health Organization. (2011). mHealth. Retrieved from World Health Organization: https://www.who.int/goe/publications/goe_mhealth_web.pdf

Thesis Statement

For this week’s module, I have been tasked with creating a thesis statement to begin the process of writing a scholarly paper. I have had the privilege of being involved in the evolution of using technology at my workplace. I assisted in the roll-out of the new electronic medication administration record (eMAR) by educating nurses, creating a manual, and providing direct support during the initiation of this system. This experience led me to the development of my thesis statement as I have anecdotal evidence that eMARs reduce medication errors.

Photo by freestocks.org on Pexels.com

My thesis statement is: Electronic medication administration records reduce medication errors.

I look forward to your feedback on my thesis statement! Thank you

What Is Informatics?

After reading this week’s material that included the required readings from the Registered Nurses Association of Ontario (RNAO), I have a better understanding of what the word ‘informatics’ means.  Although there are various definitions of the word, it appears that informatics embodies the basic fact of technology and the connection technology has in the delivery of health care to consumers.   Considering the role of nursing, informatics is a combination of nursing, computer, and information science with the purpose of managing and communicating data, information, and knowledge in our daily nursing practice (RNAO).  When I reflect on my own daily nursing practice, I can identify many forms of nursing informatics that play a key role in the delivery of nursing care to my patients.  For instance, in order to communicate my nursing assessments I use a computer program to document which is interconnected with the interdisciplinary team.  Each health care discipline has their own ways of contributing to the patients electronic health record, but all members may access the information in order to provide holistic care to the patient.  Another example of nursing informatics at my workplace is the availability of ‘Up to Date’ to incorporate evidence based knowledge in our daily practice in order to provide competent and evidenced informed care to patients. 

I have been a nurse for five years and when I reflect on my experiences in these past years, it is surprising how rapidly eHealth has been integrated into the daily care of a patient regardless of the healthcare disciple that is treating them.  During my consolidation as a Registered Practical Nurse I was a part of the Assertive Community Treatment Team (ACTT) and each morning the interdisciplinary team would meet VIA Ontario Telemedicine Network (OTN) to update everyone on the status of their patients in the community.  This service was also used in the direct care of patients to see a psychiatrist so that patients who could not travel to their appointments could still be seen promptly.  As described above, this is an example of informatics being implemented to connect real patients to health care services VIA technology. 

Ontario Telemedicine Network has always sparked my curiosity as it appears to open up so many options for patients who might otherwise not be able to see specialists in the community.  At my workplace we are currently piloting an OTN consulting service for psychiatrists in the community.  As I researched this further, I found a news release from the OTN website from March 15, 2018 that spoke about this exact initiative.  The partnership is called OntarioMD that aims to engage family physicians and specialists with OTN to meet the needs of patients in the community.  There are two platforms that are being discussed that will assist physicians and patients in reducing wait times and ensuring access to healthcare services are more accessible.  This is a great example of informatics in practice currently.  Please see link below for further details!

https://otn.ca/wp-content/uploads/2018/05/otn-press-release-2018-03-15-ontariomd-partnership-en.pdf

RNAO. (n.d.). Health Informatics. Retrieved from Nursing and eHealth: https://elearning.rnao.ca/mod/page/view.php?id=489

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