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The Role Nurse Informaticist

The role of the nurse informaticist, Nursing Informatics Specialist (NIS), at Winthrop University Hospital (WUH), as described in the 2002 position description, is as system manager of the SMS or Envision hospital information system. The Nurse Informatics Specialist is responsible for the development, implementation and training within the Nursing Department. In collaboration with the Nursing Department, including the unit secretaries and the Medical Information System (MIS) staff, the Nurse Informatics Specialist is responsible for the clinical informational needs of the nursing department. The NIS conducts orientation programs for the nurses, ancillaries, and the physicians and serves as a resource person for all other departments regarding the SMS hospital information system. Application implementation, enhancements and conversions of the system are coordinated and directed by the NIS. Policies and procedures regarding the information system are written, implemented and maintained. The NIS is also responsible to update the staff on the design of the SMS system and the use of the order entry, results reporting and new program functions on the system. Additionally, the NIS is involved in CQI activities and serves on the CQI committee.

The Role of Lois Basile RN

The Nurse Informatics Specialist at Winthrop University Hospital (WUH) is Lois Basile RN, a “resource person” for any system that interfaces with Envision, the hospital information system (HIS). She addresses any technological issue that is clinically related to patient care. She is the clinical nurse manager of the HIS and is a liaison between the clinicians and network designers. During the interview, she referred to herself as a “problem solver” and an “investigator.” Her roots are in education. She enjoys teaching nurses, physicians and the ancillary staff how to access and utilize the many functions of the HIS, as well as any new technology introduced at WUH. Ms. Basile serves on many committees including the documentation, medical records and the forms committee. She assists in creating, implementing and computerizing patient care records. She participates in CQI, the Clinical Guidelines Executive CQI Steering Committee and in the Clinical Trial Workgroup by aggregating necessary data for performance, patient quality, outcome measurement and research. She also worked to develop and implement standardized order sets, following the Long Island Network Guidelines (LIHN). As a supported of provider order entry and computerized patient records, she looks forward to the future of technology at WUH.

Telehealth, Telenursing, and Telemedicine

Teleconferencing with other Long Island Health Network (LIHN) facilities enables communication during the American Heart Association’s Get with the Guideline Program meetings ways to identify patients at risk for heart disease. Data collected by each facility is entered into a database and transmitted via internet to the International Professional Review Organization (IPRO) who is responsible for strategies quality improvement. Telenursing is evident throughout Winthrop University Hospital. Through the use of technology nurses are able to monitor patient care, document and archive vital patient health information. A system like Quantitative Sentinel by GE Medical, utilized in the antipartum and intrapartun areas, is only one example of telenursing; nursing science, computer science and information science at work to benefit patient care. Telemedicine has emerged in the radiology and pathology departments through the use of Talktech, which enables the physician to generate patient reports with verbal input. Physicians also have system keys which allow for internet access to Invision by Siemans. Laboratory and other patient test results such as EEG, EKG and surgical reports can be accessed from home or office. Results can then be reported to patients in a timelier manner.

Observed Practices of Telenursing

WUH installed EmergisoftED™, a comprehensive electronic medical record system, to their newly renovated emergency room in 2003. It includes Triage, Tracking, Lab Results, Discharge, Prescription Writing Modules as well as the capability for electronic patient recording. The CBORD computer software system for food and nutrition services is another example of a system utilized at WUH. This dietary system focuses on the individual nutritional needs and requirements of the patients. QS Perinatal Clinical Information System by GE Medical, is a practical system used in the entire maternal/fetal care continuum. It displays fetal heart waveforms, allows for surveillance, archiving of fetal heart tracings and provides for electronic recording of patient data.

Codes and Measurements

The WUH medical records department utilizes 3M Grouper Software which interfaces with Invision , for coding and billing . It provides tools and services to “capture, classify and operationalize healthcare data”. It allows for an organization's “ability to manage revenue and resources, comply with regulations, and ultimately, to improve the quality of patient care” (3M-Grouper Software). Winthrop uses NDC codes as a common procedural coding system. J codes are drug codes. DRG’s are used for in-patient billing. CPT codes are used for out-patient billing. ICD’s are procedure and diagnostic codes.

Nomenclature

Pathway: A collection of wires through which is transmitted from one part of a to another
Run Charts: To execute a program
HTML: HTML defines the structure and layout of a Web document by using a variety of tags and attributes
Access: access often means to read data from or write data to a mass storage device
Interface: A boundary across which two independent systems meet and act on or communicate with each other
Vaporware: A sarcastic term used to designate software and hardware products that have been announced and advertised but are not yet available
HL-7: Health Level Seven, a messaging standard in the healthcare arena
Standardized order sets: guidelines required by the Long Island Health Network
PDF: Portable Document Format, PDF captures formatting information making it possible to send formatted documents and have them appear on the recipient's monitor or printer as they were intended
CPOE: computerized practitioner order entry
Database: a collection of related data
Data: facts and figures from which conclusions can be drawn
(Webopedia.com)
The same standards exist between healthcare departments with regard to patient care. However, there is a separation and lack of understanding with regard to the use of technology.

Theraputic and Information Applications

Examples of therapeutic applications of technology are seen through the use of radiology, nuclear medicine, magnetic resonance imaging, and the use of ultrasounds. This is technology is diagnostic in nature. The application of information technology can be seen through the use of computerized order entry, electronic patient records, computerized medical administration records, and any medical equipment that records wave forms such as heart rate, blood pressure, or pulse.

The Computer Patient Record:Advantages and Disadvantages

At present, computerized patient records are utilized in part in the labor and delivery room only. WUH has been slow to adopt clinical documentation due to the cost. A cost benefit analysis was done in 2003. Software that met the needs of the organization was at that time immature.

Advantages Disadvantages
Complete and accurate patient data

More easily archived

Standardized and customized reporting

Legible

More accurate patient data, less chance of error

Document set maintained

Increased costs to startup, maintain, train, and upgrade

Computer literacy required-fear of computers

Confidentiality, privacy and security difficult to guarantee

Privacy and Confidentiality

Winthrop is in compliance with HIPAA through the use of user ID and password, which is changed every 6 months. Access is limited by administration and the MIS department. Patient names and information are protected and not viewable by the general public. Policies and procedures regarding privacy and safety of patient information are available and upheld. WUH hired a consultant to see if they were in compliance with HIPAA regulations with regards to paper and computerized documentation. The Congress recognized challenges in standardizing healthcare information on-line; standardizing the format of healthcare data so that it can be used by different electronically based systems and protecting the confidentiality and privacy of healthcare information as it moves across public and private networks and stored in computer databases. The hospital data center is located in a fire-safe environment to protect archived information.

Health Promotion Program

Easy How-To Breastfeeding

Reflection

I thoroughly enjoyed working with Lois Basile at Winthrop University Hospital. I had no idea of the amount of technology involved in the hospital setting. I was able to participate in the training and education of information system users and felt very comfortable with Invision medical information system. I became very involved with Get With The Guidelines, and would like to continue in support of the American Heart Association's goal of identifying patients at risk and influencing them in making healthy lifestyle changes.