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.
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
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
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 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
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
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.
Clinical Area: Acute care, community-based care, long term care, educational institutions, outpatient clinics, pharmacies, etc.
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 Science, 34(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