Lecture 7: Nursing Informatics

Nursing Informatics An integration of nursing information, knowledge and management with information and communication technologies to promote the health of people, families and communities worldwide can improve nurses’ decision-making capabilities. ***Terminology - Data: Raw, uninterrupted observations and measurements made about the world. Data alone is meaningless. • Descriptive/qualitative. Pain • Measurable/quantitative, e.g., Score: 10 -Information: Processed data that contain meaning, e.g., weight over time. -Knowledge: Results when data and information are identified and relationship between data and information becomes formalized. - Wisdom: Knowing when and how to use knowledge in the process of caring for people - Evidence –based/Evidence o Evidence-Based Practice (EBP): “the integration of best research evidence with clinical expertise and patient values”; INVOLVES GATHERING, ASSESSING AND USING INFORMATION KNOWLEDGE TO INFORM PRACTICE. Steps in Evidence-Based Practice: • Asking the relevant clinical question (PICO): patient, intervention, comparison, outcome • Searching for the best evidence • Critically appraising evidence • Applying the evidence • Assessing the outcome - Health literacy: The degree to which an individual has the capacity to obtain, communicate, process, and understand basic health information and services to make appropriate health decisions.” - Ehealth Literacy: The ability to seek, find, understand, and appraise health information from electronic sources and apply the knowledge gained to addressing or solving a health problem - Clinical D.M Clinical Data Management (CDM) is a critical phase in clinical research which results in collection of reliable, high-quality, and statistically sound data. Phases include: - Digital divide: Population gaps related to who has or ha s no access to ICTs (OECD, n.d.). - Custodians: Gatekeepers of the health information; include regulated members. - Affiliates: “Regulated members are affiliates of health information if they practice in an organization identified as a custodian - Duty to Report a Privacy Breach: a custodian must as soon as practicable give notice in accordance with the regulations… of any loss of… or any unauthorized access to or disclosure of individually identifying health information in the custody or control of the custodian if there is a risk of harm to an individual because of the loss or unauthorized access or disclosure ***Differing Types of Research Methods and Designs: • Qualitative versus quantitative Quantitative research deals with numbers and statistics, Qualitative research deals with words and meanings. • Cross-sectional versus longitudinal A cross-sectional study is conducted at a given point in time and is conducted with different samples. A longitudinal study requires a researcher to revisit participants of the study at proper intervals. and is conducted with the same sample over the years. • Descriptive versus experimental Descriptive research is a method that describes a study or a topic. It defines the characteristics of the variable under research and answers the questions related to it. Experimental research is a scientific approach to testing a theory or a hypothesis using experimental groups and control variables. • Retrospective versus prospective In retrospective studies, individuals are sampled, and information is collected about their past. In prospective studies, individuals are followed over time and data about them is collected as their characteristics or circumstances change. • Knowledge synthesis (e.g., systematic reviews) A systemic review is making sense of large bodies of already acquired information to contribute/ find answers to questions about what works and what doesn't. Competencies and Organizations ***Identify informatics competencies required of a Registered Nurse at a beginning level of practice according to the Canadian Association of Schools of Nursing (CASN 2012). o o Performs search and critical appraisal of on-line literature and resources (e.g., scholarly articles, websites, and other appropriate resources) to support clinical judgment, and evidence-informed decision making. PLEASED formula for Reviewing Websites P – Purpose for which the site was created L – Links and their accuracy and reliability E – Editorial or site content: accuracy, bias, comprehensiveness, currency A – Author: credentials, expertise S – Site: design, navigability, ease of use E – Ethics: disclosure of author, sponsor, site purpose D – Date: Is information current, updated regularly Critically evaluates data and information from a variety of sources (including experts, clinical applications, databases, practice guidelines, relevant websites, etc.) to inform the delivery of nursing care. o Analyses, interprets, and documents pertinent nursing data and patient data using standardized nursing and other clinical terminologies (e.g., ICNP, C-HOBIC, and SNOMEDCT, etc.) to support clinical decision making and nursing practice improvements. o Assists patients and their families to access, review and evaluate information they retrieve using ICTs (i.e., current, credible, and relevant) and with leveraging ICTs to manage their health (e.g., social media sites, smart phone applications, online support groups, etc.). Describes the processes of data gathering, recording and retrieval, in hybrid or homogenous health records (electronic or paper), and identifies informational risks, gaps, and inconsistencies across the healthcare system. Articulates the significance of information standards (i.e., messaging standards and standardized clinical terminologies) necessary for interoperable electronic health records across the healthcare system. Articulates the importance of standardized nursing data to reflect nursing practice, to advance nursing knowledge, and to contribute to the value and understanding of nursing. o o o ***Explore key nursing and other organizations supporting informatics development in Canada. Nurses can embrace technology to improve nursing practice by: o o o Partnering with information technology (IT) staff to help drive EHR system initiatives. Being involved in decisions about process, design, and workflow in system integration EHR system professional development Leveraging opportunities to use IT to enable quality improvement. Digital Literacy and Responsibilities ***Explore benefits and challenges associated with using mobile devices and social media tools and associated professional responsibilities. Digital Health Compassion o Communication barriers and digitalization of care result in poor development of therapeutic relationships Patient Safety o Work arounds instead of reporting errors leads to continued poor health outcomes and mistakes. Clinical judgement o o We need to ensure that technology becomes a tool to support clinical judgment rather than a crutch. Technologies can support clinical judgement by: 1. Providing point-of-care patient/client data for decision-making 2. Trending data to highlight positive or negative trends (e.g. fluid status in renal patient/client) 3. Allowing comparison of current assessment data with older data such as the assessment data collected in the ER upon first presentation. Advocacy Health information and communication technologies present ways for nurses to act as advocates: 1. Supporting individualized care 2. Facilitating integration of these technologies 3. Ensuring equitable use and access to healthcare technologies Research Nurses can act as researchers on personal, organizational, and broader levels through: 1. 2. 3. participating in research (e.g., collecting data, participating in focus groups, etc.), exploring the evidence to guide their care, and designing and conducting studies. Nursing Education ***Understand policy and legislation related to health information protection. o Privacy Act Regulates personal information-handling practices by the federal government department and agencies. o Access to Information Act regulates use of information stored in government records. o Personal Information Protection and Electronic Documents Act (PIPEDA) regulates the use of information by the private sector. o Health information act • Applies to custodians and their affiliates. • Outlines expectations for the collection, use, disclosure, and security of health information that protects the privacy and confidentiality of individuals and their health information. • applies to all health information collected, used, and disclosed by custodians in relation to that health service. • diagnostic, treatment, and care information • registration information • health service provider information • Provide individuals with a right to request correction or amendment of health information about themselves. • Provide individuals with a right of access to health information. Circumstances where a custodian may refuse to disclose health information to an applicant: • if the health information is about an individual other than the applicant, unless the applicant originally provided the health information in the context of a health service being provided to the applicant. if the health information sets out procedures or contains results of an investigation, a discipline proceeding, a practice visits or an inspection relating to a health service provider. • if the health information would reveal the substance of deliberations of the Executive Council or - any of its committees or of the Treasury Board or any of its committees. • if the disclosure is prohibited by another enactment of Alberta. Enable health information to be shared and accessed for the provision of healthcare services. • • o Freedom of Information and Protection of Privacy Act (FOIP) • Applies to public bodies and their employees. • allows any person a right of access to the records in the custody or under the control of a public body subject to limited and specific exceptions as set out in this Act. • controls the manner in which a public body may collect personal information from individuals, to control the use that a public body may make of that information and to control the disclosure by a public body of that information. • allows individuals, subject to limited and specific exceptions as set out in this Act, a right of access to personal information about themselves that is held by a public body. • name, address, contact numbers. • ace, ethnic origin, religious or political beliefs. • age, sex, marital status • education, financial, employment history • allows individuals a right to request corrections to personal information about themselves that is held by a public body, and • provides for independent reviews of decisions made by public bodies under this Act and the resolution of complaints under this Act. o PIPA: • • o Applies to private sector. Examples: A physician directly hiring an employee - the employee information would be governed by PIPA. Private Physician clinics, Medi-Centre clinics CRNA Privacy and security policies for custodians • Policy 1: Roles and Responsibilities Role and Responsibility of Privacy Officer • Identify the individual in the practice setting who is the Privacy Officer for HIA matters. • Indicate who acts as Privacy Officer when the Privacy Officer is absent. • Outlines the responsibilities of the Privacy Officer • Policy 2: Right of Access to Health Information • Formal and informal requests • Authorized Representatives • Policy 3: Information Handling and Security • Administrative Safeguards • Technical Safeguards • Physical Safeguards • Security Breaches • Policy 4: Collection, Use and Disclosure of Health Information • • • • • • Collection of Health Information • Use of Health Information • Disclosure of Health Information Policy 5: Information Privacy and Security in Contracting • An HIA specific agreement or contract is completed and signed by all service providers who have access to the health information. • The service provider must ensure that the service provider’s information security and privacy policies are available upon request, including any updates or revisions that occur after the execution of the contract, Policy 6: Research • Research access to personal health data requires a written request with proof of ethics board approval. • A decision is made after receiving the request. • The researcher signs an agreement. Policy 7: Transitory Records (Temporary Information, Duplicates, Draft Documents and Working Materials) • Transitory records are identified and destroyed after the actions to which they relate, or immediate purposes are completed. • All confidential transitory records are kept secure and disposed of using containers or shredders designated for confidential records disposal. • Before destroying documents be sure that the documents are in no way needed for future accountability, liability, or documentation purposes. Policy 8: Alberta Electronic Health Record (Alberta Netcare) • The CRNA registrant, may access and use the information available in Alberta Netcare for authorized purposes such as providing a health service, determining/verifying a person’s eligibility to receive a health service, and carrying out any purpose set out in the Information Exchange Protocol (IEP). • The CRNA registrant in the practice setting accessing Alberta Netcare must use their unique user credentials for each access. • Each user of Alberta Netcare must log out and close the browser before leaving the system. Policy 9: Penalties/Sanctions • If a policy is willfully or accidentally breached, penalties/sanctions may include disciplinary action, up to and including dismissal. Information Management and Literacies ***Understand professional responsibility accountability and policies related to working with technology. Code of ethics for registered nurses CASN Competency: Information and Knowledge Management • Uses information and communication technologies to support information synthesis in accordance with professional and regulatory standards in the delivery of patient/client care. • Uses relevant information and knowledge to support the delivery of evidence informed patient care. Competency: Professional and Regulatory Accountability • Uses ICTs in accordance with professional and regulatory standards and workplace policies. Competency: Information and Communication Technologies • Uses information and communication technologies in the delivery of patient/ client care. CRNA o o o o o o o o o o Guideline 1: Nurses understand their professional and ethical obligation to protect the public and maintain conduct that reflects trustworthiness and that does not harm the integrity of a client, person, employer, another health professional, colleague, or organization, including their online presence. Guideline 2: Nurses follow relevant legislation, standards, policy, and employer requirements when using social media and other electronic forms of communication. Guideline 3: Nurses maintain professional boundaries in the use of electronic communication and social media. Guideline 4: Nurses maintain professionalism when using social media. Guideline 5: Nurses follow employer requirements regarding the use of social media in their practice setting. Guideline 6: Nurses ensure any posts and comments they make regarding health information is evidence informed. Guideline 7: Nurses protect the privacy and confidentiality of their clients when using social media and electronic communication. Guideline 8: Nurses provide evidence-informed health information to clients through professional social media accounts or an employer approved platform and only to those with whom they have a nurse-client therapeutic relationship. Guideline 9: Nurses are responsible to use their professional judgment with respect to their online presence and avoid posts or comments that could be considered negative, disparaging, or demeaning. Guideline 10: Nurses are competent in the use of social media and understand the risks and benefits of its use. ***Explore different types of health records / systems and their implications. o o o Electronic medical record (e.g., EMR) • allow entry and viewing of data within an organization. • used for documenting clinical care and obtaining relevant information to support clinical decision making. Electronic Health Records (EHR) • allow data entry and viewing across multiple services and across a lifetime. • Ei Connect care. Personal health Recor (e.g., PHR) • enables the patient/client to enter, review, and share personal health information. ***Factors Influencing Access to Health Information • Quality of health information available online–highly variable and the public is challenged to determine the quality and credibility of information. • Misinformation: False or inaccurate information—getting the facts wrong. • Disinformation: False information which is deliberately intended to mislead—intentionally misstating the facts.