I N F O R M AT I O N

A N D C O M M U N I C AT I O N
TECHNOLOGIES

IN CRITICAL CARE

Acute Biological Crisis

Concept
 designed for use in the critical care environment (ICU).

can integrate diagnostic test review, test ordering, prescription or

administration of drugs, and storage or retrieval of imaging studies.

draws information from all these systems into an electronic patient

CLINICAL record, which physicians can see at the patient’s bedside.

INFORMATION enhance patient care by:

•Improving access to clinical data

SYSTEM (CIS) •Reducing errors

•Tracking compliance with high quality standards
•Providing decision support

Improved communication
between the many health
professionals caring for each
patient
May integrate with
pathology results database
ADVANTAGES OF CIS
Automation and increased
accuracy of repetitive tasks
Provides all the information Increased legibility and
Allows better clinical such as recording of
clinicians need to make improved searchability of
research observations and ventilator
good decisions records
settings
Electronic record of Built in spell checker and
prescriptions offers Built-in error checking, arithmetic function prevents
Records are simultaneously knowledge database and
improved and security with medication dose calculation
available from multiple alert systems ensure
electronic signatures and errors and spelling mistakes
points of access prescribing is legal and
password-protected which lead to
accurate.
ordering. misinterpretation of orders.
Makes it easier for patients
to have x-rays and scans
when needed

Expensive to install and
maintain
There are concerns that
electronically signed
prescriptions are legally invalid
DISADVANTAGES OF CIS
Difficult to integrate with other
existing electronic systems
There are concerns regarding
the security of passwords, and
the potential of untraceable
"doctoring" of the records
Steep learning curve
Built in spell checker is hardly
protective from errors and may
malfunction disastrously.
Computer literacy among staff
influences the degree to which
the CIS changes workload
patterns (many things previously
easy may suddenly become
more difficult)
The system will try to record
everything. For example, the
patient coughs or strains on the
bed pan, and the system records
a peak blood pressure of
300mmHg.
May degrade the quality of
handover and ICU ward rounds
(consultants focus their
attention on surfing the CIS
rather than on what the staff are
telling them)
Susceptibility to attack - the
CIS can be compromised by
accident or through malice, as
any other database can.
 Computerized
Provider/Physician/Practitioner Order
Entry (CPOE)

a medical professional entering and sending medication orders and treatment instructions
electronically through a computer application instead of paper charts.

Benefits:

reduces errors r/t the ambiguity of handwriting or transcription of medication

orders.

Improve efficiency when submitting medication, laboratory and radiology

orders to their respective departments or facilities by enabling healthcare providers to
quickly transmit orders electronically

Streamline reimbursements by flagging orders that may require preapproval

from insurance plans, reducing a return on initially denied insurance claims.

safeguards that are available to check for potential adverse drug events
 Features of CPOE

Ordering: Physician orders can be entered by the clinician into a

workstation, laptop, or secure mobile device versus writing orders on a
paper chart.

Patient-centered decision support: When integrated with CDS systems and

EHRs, clinicians have up-to-date patient information, and a more complete
medical history on the patient, enabling better care decisions.

Patient safety features: CPOE enables doctors and nurses to make real-time
patient identification, review medication dosage recommendations and
screen for potentially adverse drug-to-drug or drug-to-disease interactions.
This software can also check for patient allergies and treatment conflicts.
Intuitive user interface: The order entry workflow is like that of traditional,
paper-based order forms, enabling efficiency even among those who are new
or infrequent users.
 Features of CPOE

Regulatory compliance and security:Access and

information are secure and in compliance with state and
federal guidelines.
Portability: CPOE systems can accept and manage orders
from all departments at the point of care through various
devices, including wireless mobile laptops and tablets.
Management: Reports are generated so they can be
analyzed and evaluated, which helps determine if changes
need to be made in staffing, productivity, and inventory.
Billing: Documentation is improved, referral and treatment
preapprovals can be flagged, and orders can be linked to
diagnoses at the time of order entry.
 Errors that are previously associated with poorly
written clinical notes
a bane of paper-based charting can now
manifest themselves if clinicians incorrectly enter
information in a CPOE system.

Challenges of example: A potential user could assign

inaccurate dosages or enter orders for the wrong

CPOE patient. Multitasking can

amplify these entry risks.

With new systems come a learning curve for users.

Training on how to properly use CPOE
systems, as well as eliciting feedback from users a
nd emphasizing the benefits of the
system, are among the ways to lessen these errors.
 Challenges of CPOE

Alert fatigue
- occurs when the user is exposed to an inordinate
number of frequent alerts, such as visual messages or
audible warnings, and consequently becomes desensitized to
them.
- Ignoring routine alert messages embedded in the
software applications and automatically clicking on
prompts can result in unintended consequences associated
with potential medication errors or serious adverse
advents.
 Hand-Held Technologies

small, special function computers that brings the benefit of computers to the
bedside.

versatile and inexpensive.

Even though of smaller size than the laptop and notebook microcomputers,
some have claimed to have almost the same functionality and processing
capabilities.
PERSONAL DIGITAL ASSISTANTS (PDA) - smallest of the handheld
computers
-provides calendar, contacts, and note-taking functions, and may
provide word processing, spread sheet, and a variety of other functions
- originally sold as isolated devices, but today they are already
combined with telephone functionality and sold as smartphones.
 ADVANTAGES of handheld
computers in the clinical setting:

§ allows the nurse to obtain assessments such as electrocardiograms,

heart and respiratory rate, hearing acuity, oxygenation, and blood
pressure using a smartphone.
§ helps nurses compute drugs safely using drug dose calculators.
§ Nurses can use programs that can help identify drug facts such as
actions and dosages, and drug interactions, and remind the nurse of
potential complications to watch for as well as special nursing actions
to take with various medications.
§ Nurse can make use of reminders to avoid forgetting to perform a
treatment or give a medication on time.
DISADVANTAGES of Handheld
computers in the clinical setting:

They come with both still photo and video capabilities.

It can be very easy to forget the legal requirement for
permission to photograph anything on a patient, much less
take a photo of a patient’s face when the technology is so
available.

Few nurses have been in serious trouble when they forgot

that social media such as Facebook, Twitter, and LinkedIn are
not private spaces and they uploaded photographs of patients
or confidential patient information on social media.
 Tele-Health Initiatives

Telemedicine - is the use of information exchanged from one site to another via
electronic communications to improve patients’ health status.

Telehealth - often used to encompass a broader definition of remote healthcare

that does not always Involve clinical services (ATA, 2010).
- considered as another component of the eHealth concept, with
the difference being around the delivery mechanisms,
which can include live video conferencing; store-and-
forward systems, such as those used to store digital images; telephone
conferencing; and remote patient monitoring and e-visits via a
secure Web Portal.
Teleconferencing and digital networking systems are now merging, giving rise to
“group consultation” opportunities.
 Telehealth in three ways:

Synchronous:
when the doctor communicates with the patient in real time via
computer or telephone

Asynchronous:
when data, images, or messages are recorded to share with the doctor
later
Remote patient monitoring:
when measurements such as weight or blood pressure are sent to the
health care provider
Features of telehealth:

Recording measurements: weight, food intake, blood pressure, heart rate,

and blood sugar levels either manually, or through a wearable device,
and sending them to the doctor.
Virtual visit with a doctor or a nurse
Online portal to check test results
Reporting information: informing doctors of test results, diagnoses,
medications, and drug allergies.
Coordination of care between healthcare members involved in the
patient’s care
-sharing of exam notes and test results between medical
offices in different locations.
Schedule of appointments are sent through email
Monitoring: older adults at home are monitored to make sure they are
eating, sleeping, and taking their medications on schedule.
TELEHEALTH:

A DVA N TA G E S D I S A DVA N TA G E S
Cost effectiveness patients still has to go to health facilities for
things like imaging tests and blood works, as
Convenience
well as for diagnoses that require a more
Ability to provide care to people with hands-on approach.
mobility limitations, or those in rural areas
who do not have any access to a local doctor The security of personal health data
transmitted electronically is a concern.
or clinic.
Some services are not fully covered by
insurance companies, leading to out-of-pocket
costs.
ICU TELEMEDICINE

§ a specialty subset of the overall field of telemedicine.

§ involves physician intensivist, critical care nurses, nurse practitioners, and other
members of the multidisciplinary team such as pharmacists, respiratory therapists,
and administrative staff.

§ Implementing ICU telemedicine technology is often touted as a means to

optimize labor costs.

§ affect costs secondary to improving patient outcomes, decreasing complications,

and lowering resource utilization.

§ it lowers treatment cost and allows more efficient use of ICU areas with bed
shortages via higher patient throughput.

§ reduce medical errors through increased physician availability and improved

communication between caregivers.