UTHSC Groups E and D

cwoodru5 · Apr 16, 2014

Our book by Sewell (2013) gives a great example of a scenario in which standards are needed. Think of the different time zones in our country. They are a standard. If we didn't have the time zones and every town just decided what time they wanted to observe, everything would be a mess! Without standards in our electronic medical records, it would be a huge headache for anyone to get the information out of the medical record that he or she needed. A standard is an agreement to use a protocol that has been approved by a nationally or internationally recognized association or a governmental body (Sewell, 2013). Standards are vital to communication and interoperability is the ability of two or more systems to communicate and exchange information (Sewell, 2013). Therefore, standards keep interoperability on track.

Bouhaddau et. al (2012) state that other reasons for using standards in interoperability are efficiency, cost saving, and risk avoidance. Standards also affect nursing through the equipment used and also how information is documented in the electronic medical record (Sewell, 2011). Nurses have to stay current on what data to record, how to record it, the terminology to use, and what data will be reported to other organizations (Sewell, 2013). Standards and interoperability affect us because we are in the EMR so much. We have to make sure we are following protocol. This helps in patient care because everything stays organized and more easily accessible.

Bouhaddao, O.,Cromwell, T., Davis, M., Maulden, S., Hsing, N., Carlson, D., . . . Fischetti, L. (2012). Translating standards into practice: Experience and lessons learned at the Department of Veterans Affairs. Journal of Biomedical Informatics, 45, 813-823.

Sewell, J., & Thede, L.Q. (2013) Informatics and nursing: Opportunities and challenges. (4th ed.). Philadelphia: Lippincott.

aedwar18 · Apr 16, 2014

As discussed in the previous post, interoperability is how systems share and exchange information (Sewell, 2013). The previous student mentioned the book’s example of establishing time zones to regulate train schedules in the early 1900s. This standard to change the time zones was necessary to promote effective communication involving travel. Now, the world of health care is faced with a similar issue yet the standards that must be created to provide the proper communication are extremely complex. This standard will effect all aspects of hospital data; it will interfere will how, what, when, and where the data is recorded in an Electronic Health Record (Sewell, 2013). The use of interoperability can help prevent errors and be cost effective.

This establishment of standards to promote interoperability in electronic medical records is vital. From personal experience as a nursing student, I deal with the issue of consistent medical terminology and this is only the beginning of the problems with unstandardized data. For example, many nurses that have been working for a long period of time use abbreviations that are out of date. For example, the use of “w b/s.” This abbreviation can be interpreted as with breakfast and supper or with bowel sounds. Misunderstanding of this can cause medication errors.

According to the article, “The Value of Health Care Information Exchange and Interoperability” interoperability not only can reduce errors, but is also cost effective (Walker, 2005). By using one common electronic medical record program across a variety of health care providers, the cost for the patient will be less. Standards are required to create an effective and cost efficient health care system.

Sewell, J., & Thede, L.Q. (2013) Informatics and nursing: Opportunities and challenges. (4th ed.). Philadelphia: Lippincott.

Walker, Jan, Eric Pan, and Douglas Johnston. "The Value Of Health Care Information Exchange And Interoperability." The Value Of Health

Care Information Exchange And Interoperability. Institution: Partners Community Healthcare, 19 Jan. 2005. Web. 16 Apr. 2014.

BigRed15 · Apr 17, 2014

In healthcare, communication is crucial. Interoperability is the ability to exchange and share information. In health care, interoperability helps to provide the best care across communities and populations. Standards allow all members of the healthcare team to be on the same page, thus you have to have standards to have interoperability (Sewell, 2013).

I do agree with Candice. If there were no standards, it would be chaos. Sewell’s example of the meaning “stroller” gives great insight to how different words can have completely different meanings. In a museum, a sign that says “no strollers” could be taken two ways – no baby carriages, or no slow walkers. The difference in the meaning of one word can create a huge gap in communication. This is just on example of why standards are needed. I did not realize how much I depend on standards every day in the hospital until reading this chapter. As nurses, we are constantly documenting on each patient’s electronic health record (EHR). Decisions in healthcare, specifically in the EHR, about what is recorded, how it is recorded, terminology used, and what data needs to be reported to other organizations is dependent upon standards (Sewell, 2013).

An article from the American Journal of Nursing states that the goal of interoperability is to reduce duplication of tests, improve cost-effectiveness or interventions, and help compile a comprehensive patient history. He also goes on to say that technological advances are not for the sake of technology alone, but to create a more efficient and safe system to allow nurses to spend more time at the patient’s bedside (Mcbride, 2012).

Mcbride, S., Delaney, J. M., & Tietze, M. (2012). Health Information Technology and Nursing. AJN, American Journal of Nursing, 112(8), 36-42.

Sewell, J. P., & Thede, L. Q. (2013). Informatics and nursing: opportunities and challenges (4th ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

- Mary Jane

Mhunt17 · Apr 17, 2014

UTGE1-MH

As Sewell and Thede state, “Interoperability can be thought of as the ability to share data” (p. 323). Unless the shared data can be interpreted, it is useless; therefore, it is imperative that standards exist. We live in a world where everything is documented. This is especially true regarding healthcare. As we know, doctors are not a “one-stop shop”. There are many different specialties, and a person’s ailment determines what type of physician he or she consults. People often have comorbid diseases; therefore, it is very common for a person to consult many different physicians. As Kalra’s paper points out, “Patient care increasingly requires clinical practitioners to access detailed and complete health records in order to manage the safe and effective delivery of complex and knowledge-intensive health care, and to share this information within and between care teams” (p. 136). If there were not standards within EHR’s, it would be impossible for various care teams to share and correctly interpret data. Thus, without standards patient care could be jeopardized.

Standards are ultimately criteria or protocols that have been formally approved or recognized that ensure data can be interpreted in the same manner by various parties (Sewell & Thede, 2013). Standards must not only exist within the electronic healthcare world, but they must exist in the casual, “real” world as well. I really liked the example Sewell and Thede used for describing standards. It is quite common for people to have a misinterpretation due to a difference in language or culture. As Sewell and Thede demonstrate, “For example, the word “stroller” has several meanings depending on one’s cultural background. Two meanings that it can have are a type of baby carriage or walking slowly. Hence, a sign reading “No strollers” in a museum could be understood by some that one should not meander through the museum and by others that baby carriages are not allowed” (p. 266). While this misinterpretation does not pose a significant threat in real life, simple misinterpretations could be life-threatening in the healthcare setting. With this being said, shared information within inoperable systems cannot be accurately interpreted or efficiently used without standards being in place.

Kalra, D. (2006). Electronic health record standards. IMIA Yearbook 2006: Assessing Information-Technologies for Health, 1. Retrieved from IMIA Yearbook 2006: Schattauer GmbH Verlag für Medizin und Naturwissenschaften

Sewell, J., & Thede, L.Q. (2013). Informatics and nursing: Opportunities and challenges. (4^th ed.). Philadelphia: Lippincott.

UTDKS · Apr 17, 2014

As stated in previous posts, standards are needed to organize communication between medical disciplines a.k.a interoperability. By using EMR in clinicals, we have seen how interoperability is an abstract idea, but fine-tuned in practice because of standards. The most note worthy standard used in the EMRs at clinicals is the use of wb/s. Nurses on the floor did not know what it meant until the floor director stated it means "with breakfast and supper." Supper is a geographical term used in the south, but not so much in other areas of U.S.A. Policies need to be clearly defined to clear up the areas of miscommunication. If medical personnel do not know what a simple, "wb/s" means, then how are we holding them responsible to other standards that may or may not be clearly explained?

Furthermore, interoperability would be chaos without standards in this growing and ever-changing healthcare system we have. People doctor shop, travel, or move to different states.

EHRs have been seen as a solution to this problem. Policies guide this solution from spiraling out of control. "Health system usability, computer skills and the system's fit within the organizational culture and processes are significant factors in implementation success" (Ludwick, D. & Doucette, J., 2009).

In Italy, the Lombardy Region underwent standardization to enhance interoperability of their own electronic health records. The region had two options: completely change the current hospital information system to a new "Regional system" or maintain the current information system at the department/hospital level with the addition of a middleware software that would integrate standard requirements (Barbarito et al., 2012). The region chose the second option and it is still in use. Without standards in place, the Lombardy Region would not be able to organize "4,700,000 pharmacological e-prescriptions, 1,700,000 e-prescriptions for laboratory exams per month...490,000 laboratory medical reports, 180,000 radiology medical reports, 180,000 first aid medical reports, and 58,000 discharge summaries [per month]" (Barbarito et al., 2012).

References

Barbarito, F., Pinciroli, F., Mason, J., Marceglia, S., Mazzola, L., & Bonacina, S. (2012). "Implementing standards for the interoperability among healthcare providers in the public regionalized Healthcare Information System of the Lombardy Region." Journal of Biomedical Informatics, 45(4), 736-745. Retrieved , from http://0-www.sciencedirect.com.opac.uthsc.edu/science/article/pii/S153204641200007X

Ludwick, D. and Doucette, J. (2009) "Adopting electronic medical records in primary care: Lessons learned from health information systems implementation experience in seven countries." International Journal of Medical Informatics. 78(1), 22-31. Retrieved from http://0-www.sciencedirect.com.opac.uthsc.edu/science/article/pii/S1386505608000920>.

aedwar18 · Apr 17, 2014

UTDKS makes a great point when she stated that policies are not clearly defined for abbreviations. Supper is a geographical term used primarily in the south and some one working in California may not understand this order. But what or who creates the rules and standards to what is accepted and what is not? The book lists about 35 groups involved in establishing a standard (Sewell,2013). Each of these companies may support a different computer program that they believe is the best to use and attempt to introduce it as the standard for electronic medical records. How do they come to an agreement on which is best? I cannot help but to hypothesize that these companies are promoting computer programs that would promote their own monetary gain. The use of the electronic health records works as a way to keep tract of what a health care provider or hospital charges to a patient and works as a record for insurance reimbursement. The use of interoperability is key to the success in the health care system but I believe it would be more effective if a single governing body established the standards that all health care workers must follow. This would ensure an unbiased and fair standard that truly promoted the best outcome for the patient. The real goal of interoperability is for the nurse to be able to spend more time at the bedside of the patient and provide the best care possible (Mcbride, 2012).

-Abi Edwards

Sewell, J. P., & Thede, L. Q. (2013). Informatics and nursing: opportunities and challenges (4th ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

Mcbride, S., Delaney, J. M., & Tietze, M. (2012). Health Information Technology and Nursing. AJN, American Journal of Nursing, 112(8), 36-42.

aedwar18 · Apr 17, 2014

Mary Jane,

I agree with the idea that technological advances are not jut for the sake of technology but instead to create an efficient health care system (Sewell, 2013). But that raises another question. How is the health care system expected to stay up to date in the technology that they use, if the technology continues to improve daily? Mrs. Putman mentioned in class the price of our laptops are several hundred dollars and this price excludes the programs like “Microsoft Word” that we then pay to have access to. What if an entire hospital bought new computers and a new program every time a “better” electronic medical record program became available? This would be wasteful and impossible. As I alluded to in a previous post, our society is fueled by money. If a hospital organization can save dollars by using an out date but still functioning computer system then I believe that they will do so. I noticed at Le Bonheur hospital that nothing is complimentary. If a patient needs a new pair of socks, that patient’s room number must be inserted into the Omni-cell and charged for that pair of socks. I do not mean to say that hospitals are cheap, but instead present this example to support my point that the hospitals will try to save money anywhere that they see the opportunity.

- Abi Edwards

Sewell, J. P., & Thede, L. Q. (2013). Informatics and nursing: opportunities and challenges (4th ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

UTDKS · Apr 17, 2014

Aedward18 brings up a good point. As the saying goes, there are too many hands in the cookie jar. It would be easier to have one organization set the standards than 30+ organizations.

There are multiple vendors available for hospitals to purchase their EMR from. Sewel and Thede (2013) state how "purchasing from a single vendor does not insure the buyer that the system is seamlessly interoperable; large well-known vendors commonly purchase smaller popular applications then design interfaces with other vender applications" (pg. 357).

As a result, medical personnel are documenting the information in multiple areas, which leaves the opportunity for mistakes and more time finding what is actually going on with patients.

Resources

Sewell, J. P., & Thede, L. Q. (2013). Electronic healthcare system issues. In Informatics and nursing: Opportunities and challenges (4th ed., p. 357). Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins.

sawells · Apr 17, 2014

The ability of different systems and devices to exchange and interpret data is known as interoperability (HIMSS, 2014). In the healthcare setting the ultimate goal of interoperability is for clinicians, labs, hospitals, pharmacies, and patients to share data related to the patient regardless of application or application vendor (HIMSS, 2014). There are several different types of healthcare information technology interoperability, but the focus of this discussion will be on structural interoperability.

Structural interoperability pertains to how the data is formatted. In order for data to be shared among all the different healthcare providers, it must be able to move from one system to another so that its purpose and meaning is preserved and unaltered (HIMSS, 2014). In simple terms the concept of standards driving interoperability is exemplified by what took place when videotape technology first got its start.

There were two different types of recording formats (standards). Some video recorder manufacturers used the Beta Max format, and some used the VHS format. The VHS format eventually became the most popular, and movie distributors knew it was in their best interest to use the VHS format when recording their movies. Even though there were numerous manufacturers, as long as the machine played the VHS format, the VHS tape would work in it.

In much this same way, structural interoperability of healthcare information can be accomplished once a standard (format) is agreed upon. If a hospital is running one kind of system, and the pharmacy is running another kind of system, and a physician is running yet another kind of system, the exchange of data won't take place unless the data is formatted using the same standard.

References

Healthcare and Information Managements Systems Society. 2014. What is

interoperability?Retrieved April 17, 2014 from

https://www.himss.org/library/interoperability-standards/what-is

Posted by UTGE1-SW

BigRed15 · Apr 17, 2014

I agree with UTDKS. Multiple vendors seem to be a challenge. Sewell (2013) states the health care, specifically the electronic information standards, is still in its infancy. The problem is that all systems are not interoperable with each other. The lack of interoperability between certain systems prevents early detection of errors, such as serious drug side effects. This may not be possible, but it seems to me if there were a single set of standards, information could be easily accessed, and documentation would not be in so many different areas.

Sewell, J. P., & Thede, L. Q. (2013). Informatics and nursing: opportunities and challenges (4th ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

utnursejdm2014 · Apr 18, 2014

Mhunt I really like the example you used when you mentioned how many people go to different practitioners and doctors when they have been diagnosed with life threatening diseases. Interoperability would definitely a play a part in this process. I think it is a easy and convenient way of accessing a person's healthcare information. I like when stated that standards are needed not only in healthcare ,but in the "real world." I could only imagine a world without standards. The world we live in wouldn't have structure or order. As we all know, mistakes happen, but it good to know they have these systems to help with misinterpretations to help keep our patients and their healthcare information safe.

Sewell, J. P., & Thede, L. Q. (2013). Informatics and nursing: opportunities and challenges (4th ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.