Clinical Journal:
1. Define the role of
the nurse informaticist at the selected health care setting.
The nurse informaticist at NYM has at least 4-5 years of
progressive managerial experience. This clinician is responsible for managing
the collaborative process between hospital departments, identifying the
different technological needs and requirements for the department of nursing,
coordinates and manages systems implementations, able to identify clinical data
to create reports for the department of nursing.
2. Discuss the role of
the nurse informaticist from the perspective of the interviewed preceptor.
Ms. Kathleen Mazza, MSN, RN is the nurse informaticist at New
York Methodist hospital. She has been the lead manager in the implementation of
the new information system Cerner Millennium at NYM. Ms. Mazza is not certified
in the field of informatics, but she carries a wealth of clinical experience in
the rise of computers. Her job is very complex and diversified. Some of the
characteristics that are expected from Mazza are that of being self-directed,
analytical and organized. She works closely and collaboratively with clinical
programs, management and staff to ensure that the new document system supports
clinical care and practices. Mazza states that one of the most challenging
aspects of her job is that of establishing and maintaining liaison with
managers in all the other health discipline to permit effective communication
between nursing and all other departments. In addition, she must keep abreast
of technology changes and the impact it will have on regulatory and accredited
bodies.
3. Discuss the
emergence of Telehealth, Telenursing, and Telemedicine at the selected health
care setting, identifying the benefits to patient care and management since the
implementation.
Cerner Millennium was implemented 1 ½ years ago. This system
includes client monitoring, diagnoses, evaluations, decision support systems,
research, and education. Some of the first stand-alone computer systems prior
to implementation of Cerner were in the critical care area, assisted in cardiac
monitoring, and the labor delivery area. Some other Telehealth applications at
Methodist hospital are in Radiology. The Radiologists are able to take calls
from all the networks and view films without ever leaving the site. The
following systems are now interfaced with the Cerner Millennium: Emergency
care, Labor and Delivery and Pathology units. Some high risk ante-partum
clients are monitored from home with greater comfort and decreased cost. The pathologists
are able to transmit slides, and tissue samples to other sites at a faster and
an easier pace for experts’ second opinion on biopsy findings.
1. Explain at least 3
observed practices of Telenursing used at the selected site to meet the
holistic needs of the patient, families, communities, and health care
providers.
Nurses at NYM use telephones, faxes, and computers in the
practice of Telenursing. The mother baby unit uses an interactive camcorder and
a computer application called Baby.com (that allows the new mother and her baby
to verbally communicate with any family member in any part of the world). The
case managers use a web-based system Cerner Millennium that facilitates the
administrative and insurance functions between payers and providers. The system
links case managers to other providers, which allow them to communicate and
advocate on their patients’ behalf.
2. Describe the codes
and measurements used in managed care at the selected facility.
The Diagnosis Related groups (DRG) classify hospital stages in
terms of admitting diagnosis and interventions provided to patients admitting
hospital staff in relation to that admitting diagnosis. Current Procedural
Terminology (CPT), as well as the international classification of Diseases
(ICD-9-CM) are used by managed care for reimbursement and utilization review
purposes.
3. Identify words
(nomenclature) in the health information system reflective of the commonalities
among the varied health care disciplines.
Product----Cerner
Millenium
Hardware-operating
system/language database---Open VMS, UNIX, Aix, Language-C, C++, SQL, Oracle
Web enabled/based
Product---Eagle/Siemens
Hardware-operating
system/language database--- Windows NT, Intel based. Language-Cobol, VB,
Visual Compaq, IBM, HP, Windows UNIX.
Language-VB, C++,
Web enabled/based
Product---McKesson-Robot
Hardware-operating
system/language database--- Java, Oracle, SQL
Web enabled
4. Explain the
difference between the therapeutic application of technology and the
information application of technology.
The application focus of therapeutic technology is to promote
health and wellness. An example of this type of application would be the use of
medical equipment used for detection and physiological changes like cardiac
monitors and EKG machines. Pharmacology used the technology to provide the best
therapeutic drugs. Radiology, CT scans, and MRI are some other therapeutic
modalities being used at NYM. The
automation of data to support patient’s care on the other hand is used as the
information application of technology.
Examples of such systems are clinical CPOE (Clinical Physician Order
Entry), results reporting, access of clinical reports and clinical
documentation.
5. Identify advantages
and disadvantages of the Computer Patient Record (CPR). If they are not using the CPR, what are their
plans for incorporation of CPRs.
Electronic Medical Record (EMR) is maintained by a physician’s
office or health care facility of a patient and contains all the information
about demographics, lab data and medication (Orlovsky, 2005). It is an electronic version of the client
data found in the traditional paper medical record. (Andrew & Dick,
1996). The general benefits of the EMR
are the level of improvement and consistency of patient care, improved data
integrity, increased productivity, increased satisfaction for caregivers, easy
and organized access, less storage space, data interface with other
systems. Some of the drawbacks of the
EMR are issues of privacy of confidentiality, data tampering, failure, and
incorrect data entry.
Andrew, W., & Dick.
(1998). Where we’ve been and we’re headed. Health
Care Informatics, 14(2), 52-56.
Orlovsky, C. (2005). The Endless Nursing Benefits of Electronic Medical Records. Retrieved
October 4, 2005 from http://www.nursezone.com/job/devices and
technology. asp? article ID=14271
9. Discuss legislation designed to address privacy and
confidentiality issues related to CPRs used at the selected facility.
The information system,
and the design of automated documentation at NYM incorporates safeguards for
information privacy imposed by accrediting agencies such as JCAHO, DOH,
Medicare and Medicaid regulations, and third party payers. The Health Insurance Portability and
Accountability Act (HIPAA) includes provisions designed to encourage electronic
transactions and also required new safeguards to protect the security and
confidentiality of health information.
Department of Health and
Human Services. Protecting the patient’s health information. (2003).
Retrieved October 9, 2005 from http://www.hhs.gov/news/facts/Privacy html.
Department of Health and
Human Services-National Standards to protect the Privacy of Personal Health
information. (2003). Retrieved October 9, 2005 from http://www.hhs.gov/OCR/hipaa/
12.
Reflect
on the clinical experience and the learning that has occurred as a result of
this experience.
I had an enjoyable, and informative clinical experience working
alongside a very knowledgeable preceptor, Mrs. Esther Mercado. I had the
opportunity to be part of different classes taught by my preceptor, and was
given a thorough orientation to the Cerner system. I was involved with staff
education regarding the system. I had the opportunity to meet with staff on
different levels, all of whom are involved in the day to day operations at NY
Methodist hospital. I feel very honored, and privileged to be involved in such
an evolving, and promising field such as nursing informatics.
Cost Analysis
The Cerner system at Methodist hospital costs about $6 million
dollars excluding the extra cost set aside for updates and maintenance of the
system. Ongoing staff education and
training of super users have added to the cost. Administration at NY Methodist
hospital has been committed to the implementation of the Cerner system. The
hospital purchased new interfaces for the emergency room and labor and delivery
for an undisclosed amount. Yearly
maintenance of the system is currently evaluated at about 1.2 million dollars.