ASSIGNMENTIN NCM 112

Date: April 15 , 2021

Time: 4-6PM
Instructor: Mrs. Thaiza Mithel D. Cajigas

1. Research a case study/article/journal exploring the emerging issues and challenges of

telehealth. In 100 words, create a summary of the article.
2. Define public health informatics and the public health nurse informatician.
3. Describe the National Electronic Disease Surveillance System.
4. Describe two public health electronic information systems with implications for the public
health nurse.
5. Define the post-acute care delivery continuum and their contribution to the
Triple Aims of increased quality at reduced costs, improved patient experience, and
improved population health.
6. Identify the current state of standards needed for care coordination across post-acute care
delivery.
7. Describe how healthcare policy and regulations require participation of all care delivery
sites including post-acute care to accomplish full care coordination.
8. Explain the current functionality and adoption of electronic health record tools available to
and used by post-acute care providers.
ANSWER SHEET

1. There are “seven deadly barriers” for telemedicine: money, regulations, hype, adoption,
technology, evidence, and success. Some of these barriers are already present and
observable with health care in general but some are new that arose from the
transformation of health care by telemedicine. Money for example is a hindrance to the
development of telemedicine in a way that in order to establish a proper and working
system, you need money. The hype that we are putting on telemedicine also is a barrier to
itself. We tend to talk all about what telemedicine can do but not on the things it really
does. To move forward with telemedicine is to be realistic. So much more is needed to be
fixed in order to establish telemedicine as a regular in our health care system.

Source:
Board on Health Care Services; Institute of Medicine. The Role of Telehealth in an
Evolving Health Care Environment: Workshop Summary. Washington (DC): National
Academies Press (US); 2012 Nov 20. 4, Challenges in Telehealth. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK207146/

2. Public health informatics has been defined as “the systematic application of information
and computer science and technology to public health practice, research, and learning”.
Public health informatics, like public health, focuses on populations. In public health
informatics, population-level data and information are collected, analyzed, and
disseminated with the ultimate goal of supporting preventive, as opposed to curative,
interventions. On the other hand, the Public Health Informatician (PHI) is a “public
health professional who works either in practice, research, or academia and whose
primary work function is to use informatics to improve population health. The role
requires more expertise than the multi-highly functional public health professional that
assists with informatics related challenges or supports personal productivity with
information technology”.

3. The National Electronic Disease Surveillance System (NEDSS) provides guidance for the
technical architecture and standards for nationally reportable condition reporting. NETSS
 differs from NEDSS in several ways. NETSS was case based; NEDSS is person based. In
addition, NETSS used proprietary codes, but NEDSS is based on standards so it can
capture data already in electronic healthcare data streams. These differences precipitated
the need to transition to NEDSS.

4. Newer immunization registries are based on electronic Immunization Information

Systems (IIS). These IIS are confidential, computerized information systems that allow
for the collection of vaccination histories and provide immediate access by authorized
users to a child’s current immunization status. Benefits for healthcare providers include
consolidating immunization records from different sources; automatically calculating the
immunizations needed; easily providing official copies of immunization records;
reducing chart pulls for coverage assessments and Healthcare Effectiveness Data and
Information Set (HEDIS) reviews, automating vaccine inventory and ordering
procedures; allowing for vaccine tracking during vaccine shortages or manufacturer
recalls; flagging high-risk patients for timely vaccination recalls; and assisting with
vaccine safety and adverse event reporting. The National TB Surveillance System is an
electronic incidence surveillance system that collects 49 data items on newly diagnosed
verified cases of TB in the United States. The appropriate authority transmits the data
from the state or designated health jurisdiction to CDC at three intervals: initially at the
time of case verification, at receipt of initial test results for drug susceptibility, and at
treatment closure. Formats for reporting TB cases have evolved over decades from paper-
based reporting beginning in 1952, to electronic reporting introduced in the mid-1980s, to
an NEDSS-compatible, electronic surveillance system, using HL7 messaging, operational
in 2010 for verified TB cases reported in 2009.

5. National Quality Strategy (NQS), is based on a translated version of IHI’s triple aims of
“better care, healthy people/healthy community, and affordable care” and six priorities
that target making care safe, coordinated, based on evidence of clinical effectiveness,
development of new care delivery and reimbursement models, and community level
focus for healthier living. Significantly, for post-acute care providers, one of the six
national priorities targets care coordination with expectations for managed care
transitions and communication across care settings. Patients with chronic illness and
disability are to have a current and shared care plan used by all providers, coordinated
through primary care with extensions into community-based providers.

6. Standards for clinical information systems apply to the ways data are named, stored, and
shared as well as to promote accuracy and to work more efficiently. Ultimately,
standardized systems can improve patient safety and lower healthcare costs. When
aspects of care coordination are standardized, it is easier to collect data and share data
pertinent to care across multiple sites by various care providers. Nursing has been
 represented in all phases and environments of standards development for care
coordination. Each of the SDOs reviewed here embraces wide engagement from all
disciplines. The SDOs encourage clinicians and clinical informaticists to contribute in
leadership roles, and also as contributors, reviewers, testers, and/or implementers. Nurses
engaged in these development projects represent the full spectrum of nursing including
acute care, pediatric care, chronic care, care management, and post-acute care.

7. Just as these forces for change are making operational expertise within one sector
insufficient, clinicians and informaticists alike must be informed of the full care
continuum. This knowledge is fundamental to our ability to do effective and appropriate
care planning with coordination that includes the patient and family in decision-making
today and going forward. For those that design, build, test, implement, and support
clinical systems use in organizations, these broader understandings of integrated and
coordinated care are essential. Also, to deliver care and information systems that support
care that is coordinated, inclusive of patient, cost-effective and achieves highest
outcomes, we have to be able to work as a team that goes where the patient and family go
—out into community and mostly home. It could be easily argued that the majority of
healthcare that makes a difference in health levels happens where the patient lives.

8. From 2000 to 2013, there have been three national surveys conducted on the levels of
EHR adoption in the home health industry. Tracking across these surveys shows a shift
from only 32% of HHAs having clinical systems with the basic EHR functions in 2000 to
58% as reported in the 2013 survey. This means that a bit more than 40% of the agencies
sampled in 2013 are still in paper mode for clinical documentation, and of those, only
42% reported that they would be looking to buy a system in the next 12 months. Missing
from these benchmarks, however, is the degree to which the specific functionality that is
basic to HER standards today is in the systems being used. This functionality includes
clinical decision support; flexibility of views of patient care information; point-of-care
support for clinical documentation; telemedicine and standardized, structured
terminologies; and ability to send and receive patient information with other external
providers. Resnick and Alwan also found that sharing of health information data with
other providers was almost negligible in 2007 stemming from the lack of enabling
functionality, such as the Consolidated Clinical Document Architecture (C-CDA) tool in
the home health EHR systems at that time.