Advanced Technology and Information Systems

Chapter 7

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Technological Advancements in Acute Care Clinical Practice

Information Technology (the use of computers to gather, organize, process and communicate information) is one of the highest priorities in health care today.

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Technological Advancements in Acute Care Clinical Practice

Computers will be involved in almost every area of direct client care, making it possible to accomplish work more effectively and efficiently.

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Technological Advancements in Acute Care Clinical Practice

The acute care setting (hospital) uses advanced technology and computerized equipment that is up-to-date and ever-changing.

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Hospital

IV and gastric infusion pumps Patient-controlled analgesia (PCA) Vital signs, oxygen blood saturation

levels Computer-assisted ventilators Pulmonary function, blood gas, cardiac

and intracranial pressure monitoring

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Technological Advancements in Acute Care Clinical Practice

Computers at the bedside facilitate more efficient recording of assessments and actions.

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Hospital

Wireless Communication• Paging systems allow nurses to be

contacted regardless of their location.• Electronic phone devices (cell phones) allow

two-way communication among nurses.

Handheld wireless computer devices or personal digital assistants (PDAs)

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Hospital

Electronic Health Record (EHR)• All information related to the client is

recorded electronically.• Information is recorded legibly and more

completely than in handwritten form.• Provides accessibility to all members of

health care team from any point of service.• Orders are conveyed to appropriate

departments from a computer terminal.

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Hospital

Electronic Health Record • Laboratory results are posted directly into

client’s record.• Appointments are scheduled.• Printed discharge summaries, referral

orders, teaching guides can be customized.• Home care nurses have access to the

hospital information system.

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Hospital

Decision-Making Support Systems (Expert Systems)• Alert the nurse to abnormal diagnostic

findings.• Warn the nurse regarding factors related to

medication administration.• Support use of the nursing process.• Additional programs provide procedural

guidelines.

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Legal and Ethical Issues: Privacy and Confidentiality

Methods to limit access to client information via computerized systems:• A firewall, passwords, codes provide limited

access.• Backup files should be stored separately.• Computers are placed in a secure area.• Closed-circuit television surveillance.• Automatic recording of any activity.

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Legal and Ethical Issues: Privacy and Confidentiality

When documenting with computers, the nurse must still remember the principles for legal documentation.• Identify the right client and the right record.• Record date and time of each entry.• Sign the entry with correct professional

credentials.

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Technological Advancements in Ambulatory Care Services

Ambulatory care services are client care services that are delivered within 24 hours.

Ambulatory care centers are usually satellites within a hospital network.

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Advanced Technology and Ambulatory Care

Provide many short-term services that require advanced technology:• Endoscopic Examinations• Elective Surgeries• Dialysis• Radiation• Chemotherapy

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Advanced Technology and Ambulatory Care

Free-standing birthing centers Day care Rehabilitation centers Community-based, nurse-managed

centers

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Advanced Technology and Ambulatory Care

This child is having an audiology test performed in a community-based, nurse-managed center.

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Advanced Technology and Ambulatory Care

Mammogram technology has become a common method for wellness promotion for women over the age of 40.

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Advanced Technology and Ambulatory Care

This bone density scan equipment is very expensive and requires adequate resource allocation for smaller health care agencies to afford its purchase.

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Technological Advancements in Ambulatory Care Services

Care Map• A plan of care based on standards that

reflect optimal timing of sequential steps in managing health problems.

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Technological Advancements in Ambulatory Care Services

Advanced Technology and Documentation • Provide access to a client’s hospital/clinic

records.• Used to order prescriptions, schedule tests

and future appointments.• Used to record information related to the

visit.

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Technological Advancements in the Home and the Community

Use of mechanical ventilators, infusion pumps modified for home use

Computer access to client records and diagnostic information

Communication with others on health care team

Electronic mail to transmit progress reports

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Technological Advancements in the Home and the Community

Home Care Monitoring Devices• Identify changes in a client’s condition.• Assist client and non-professional care

provider to follow prescribed plan of care.- Maintaining medication routines- Monitoring blood sugar levels- Recording vital signs

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Home Care Monitoring Devices

Cardiovascular Monitoring Devices• Holter cardiac monitor and diagnostic tool• Cardiac pacemaker monitoring and

regulating

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Home Care Monitoring Devices

Home Monitoring of High Risk Pregnancy • Evaluation of uterine activity and fetal heart

rate via television and telephone hookup

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Home Care Monitoring Devices

Automated Telephone Monitoring System “Home Talk”• Clients with chronic health problems• Menu of “problem specific” questions • Scores tallied and rated according to a

predetermined standard• Phone contact made for any negative

changes or client’s failure to answer a call

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Emergency Response Monitoring Systems

Particularly helpful to elderly persons living at home in the event of a:• Fall, heart attack, stroke

Linked directly to a monitoring agency.

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Telehealth, Telemedicine, and Telenursing

Home-based technology providing telecommunication services in health care delivery.

These services are conducted through video, audio, and computer systems.

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Telehealth, Telemedicine, and Telenursing

Allows “virtual office visits” via audio-video monitors.

Clients test their blood pressure, oxygen levels, and blood sugar levels.

Health care providers respond with instructions.

Access to on-line courses for clients. Additional communication by e-mail.

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Telehealth, Telemedicine, and Telenursing

The Government’s Role• Support for emergency care for combat

casualties, diagnostic studies, computerized client records, and links for aeromedical evacuation

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Telehealth, Telemedicine, and Telenursing

Telehealth Distribution• Worldwide connections between health

professionals and clients• Transmission of client information from

inside ambulances during transport

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Telehealth, Telemedicine, and Telenursing

Finances and Telehealth Issues• High costs of equipment and installation too

costly for many agencies.• Reluctance of some physicians, other health

care providers, and clients.• Reimbursement and interstate licensure

restrictions have limited widespread acceptance.

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Advances in Biotechnology

Magnetic Resonance Imaging (MRI) Computed Tomography (CT) Electromyography Fiber Optics Computerized Microscope Digital Cameras

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Cost of Biotechnology

Research and development costs overshadow need for funds for illness/disease prevention and health promotion measures.

Cost control strategy:• Managed care is major reimbursement

system at present.

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Nursing Roles and the Use of Advanced Technology

Nurse Administrators/Managers • Some nurses become certified in Nursing

Informatics.

Nurse Educators

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Advanced Technology Use by Nurse Administrators/Managers

Computer Information Systems• Community Health Information Networks

(CHINs)• Smart Card (computer disk for carrying

information)

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Advanced Technology Use by Nurse Educators

Computer-Assisted Instructional (CAI) Programs

Audio-Visual Presentations Distance Learning “Virtual Learning Labs”

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Nursing Research and Advanced Technology

National and international computer databases enhance literature searches.

Theses and dissertations to be submitted electronically to their universities and made available through digital libraries.

The Washington, DC Area Nursing Research Resources (WANRR) website.

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Classification Systems for Nursing Language

Computers have contributed greatly to the development of a standardized language for documenting nurse-sensitive outcomes and client outcomes.

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Classification Systems for Nursing Language

The Unified Nursing Language System (UNLS)• Developed by the American Nurses

Association (ANA) in 1991.• Encompasses common nursing terms from a

variety of vocabularies that can be used interchangeably.

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Classification Systems for Nursing Language

Advanced technology has allowed for an easier use of four classifications systems recognized by the ANA:• The North American Nursing Diagnosis

Association (NANDA)• The Omaha Classification System (OCS)• The Home Healthcare Classification (HHC)• The Nursing Interventions Classification

(NIC)

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High-Tech, High-Touch Nursing

It is imperative that the nurse balance “high-tech” (advanced technology) care with the caring aspect of nursing.

Personal contact is still a very important part of nursing that technology cannot replace.