KEY WORDS

Informatics: derived from the

French word, “informatique,” which
means “computer science.”Health
Information Technology: It involves
the processing, storage, and
exchange of health information in
an electronic environment.
BRIEF HISTORY
March 23, 2010
 President Barack Obama signed into law the landmark Patient Protection
and Aftordable Care both affordable and driven by quality standards. For the
Obama administration and the nation.
November 2013
 The participation in the meaningful-use has accounted for well more than
$17.8 billion in Medicare and Medicaid incentives payments to nearly
310,000 hospitals and physicians.
 More than half of all doctors and all other eligible providers have received
incentive payments for meaningful use.
May 2013
 Health and Human Services (HHS) had exceeded its goal of 50% of doctors
and 80 of eligible hospitals using EHRs by the end of 2013. The President's
Information Technology.
FORCES OF CHANGE IN TODAY'S NATIONAL HEALTHCARE
SYSTEM

• In 1991, the IOM concluded that computerization could help improve

patient records and information management, leading to higher
quality of care in its landmark report.

• lOM followed up on these reports in 2012 with Best Care at Lower

Cost: The Path to Continuous Learning Health Care in America.

• Further, the early report on the Computer Based Patient Record called
for an urgent across-the-board commitment to continuous
improvement; incremental upgrades by individual hospitals and other
providers would no longer suffice

• One of the earliest and most influential was PITAC: The President's
Information Technology Advisory Committee.
THE PRESIDENT’S INFORMATION TECHNOLOGY ADVISORY
COMMITTEE
 In 1997, an Executive Order of the President established the
visionary, 24-member President's Information Technology Advisory
Committee (PIIAC).

 In 1999, PITAC established a panel to provide guidance on now it

could be leveraged to transform healthcare and increase access to
care for all citizens

 A few years later, in a report entitled Transforming Health Care

through Information Technology, the PITAC panel decided to broaden
the dissemination for information technology in healthcare by
appointing a senior IT person to provide a strategic leadership.
PRESIDENT’S COUNCIL OF ADVISORS FOR SCIENCE AND
TECHNOLOGY
 George W. Bush announced that the President's Council of Advisors
for Science and Technology (PCAST) would assume PITAC's
responsibilities.

 Over next few years, PCAST studied and produced reports on issues
ranging from energy and technology to nanotechnology to
personalized medicine.

 They also tackled the necessity of using health technology to increase

access to patient information, streamline patient diagnoses and care,
improve monitoring of public health trends, and enhance the ability
to conduct clinical trials.
On January 20, 2004, President George W. Bush in his State of the
Union address called for “… an Electronic Health Record for every
American by the year 2014 … By computerizing health records, we
can avoid dangerous medical mistakes, reduce costs, and improve
care”
● establish a national health information technology coordinator position
● develop a nationwide interoperable health IT infrastructure
● develop, maintain, and direct implementation of a strategic plan to guide
implementation of interoperable health IT in both public and private sectors.
The Health Insurance Portability and Accountability Act
(HIPAA), which passed in 1996, required HHS to develop
regulations protecting the privacy and security of
electronic health information as well as facilitate its
efficient transmission. HIPAA’s goals are to
allow the flow of health information needed to provide
and promote high quality healthcare while protecting the
public’s health and well-being.
With the passage of ARRA and HITECH, ONC has become
the driving force behind the definition of meaningful use
of EHRs and the certification of EHR systems. This new
reality changed the operating environment for the
Certification Commission for Healthcare Information
Technology (CCHIT), which until 2009 had been the sole
organization to certify EHR systems
Interoperability is the ability of health information systems to work
together within and across organizational boundaries to advance the
effective delivery of healthcare for individuals and communities by
sharing data between EHRs. It is not simply the exchange of data
between two organizations, but rather the ability of the two
organizations to exchange and consume data to and from each other’s
EHRs
The majority of the HITECH funding will be used to reward hospitals
and eligible providers for “meaningful use” of certified EHRs by
“meaningful users” with increased Medicare and Medicaid payments.
As discussed in this chapter’s introduction, the rapid
advancement toward a more technologically enabled
healthcare system is driving a growing demand for health IT
professionals—highly skilled health IT experts who can
support the provider community in the adoption and
meaningful use of electronic health records
“Patient-centered care is considered one pillar of a high performing, high-quality
health care system. It is a key component of many efforts to transform care and
achieve better population health. Expansion of health information technology and
consumer e-health tools—electronic tools and services such as secure email
messaging between patients and providers, or mobile health apps—have created
new opportunities for individuals to participate actively in monitoring and directing
their health and health care
Today’s informatics nurse combines clinical knowledge with IT to improve the ways
nurses diagnose, treat, care for, and manage patients. Essentially, informatics nurses
support, change, expand, and transform nursing practice through the design and
implementation of information technology.
1. Technical Competency
2. Utility Competency
3. Leadership Competency
Informatics nurses are poised to play pivotal leadership roles in defining new
policies that help make the goals of ARRA and HITECH a reality over coming
years. To make such a profound difference in today’s constantly changing
healthcare environment, informatics professionals must be aware of existing
and proposed healthcare policy on an ongoing basis.
 N U R S I N G

T E C H N O L O G Y
 The Role of Technology in the Medication-Use Process

These industries not only acknowledge and accept the notion that individuals will make
errors from normal mental slips and lapses in memory, but recognize that enhancing
safety system design through the use of technology is an invaluable tool in the
prevention of potentially life-threatening mistakes.

• Electronic Prescribing. Computerized Physician Order Entry’(CPOE)

• Pharmacy Automation Automated Dispensing Cabinets

• Remote Monitoring Data Analytics and Machine Learning

 INFLUENCES ON THE ADOPTION OF TECHNOLOGY

Consumers have become increasingly concerned that hospitals are less than safe
following the numerous mass media reporting of medical mistakes, which have resulted
in patient harm and deaths. In 1995, there were television and newspaper accounts that
reported the tragic death of a patient from a preventable ADE due to an inadvertent
administration of a massive overdose of a chemotherapy agent over four days. This
particular error became a watershed event for patients, practitioners, and healthcare
organizations alike, not only because it occurred at the world renowned Dana Farber
Cancer Institute, but also because it happened to the prestigious Boston Globe
healthcare reporter, Betsy Lehman
 Computerized Prescriber Order Entry (CPOE)

Many factors demonstrate the need for a shift from a traditional paper-based system
that relies on the practitioners’ vigilance to automated order entry, record keeping, and
clinical care. These factors include accessing patient information spread across multiple
organizations that may be unavailable, especially in large organizations and, therefore,
medical care would be provided without pertinent patient information
 For more than 20 years, barcode technology has clearly demonstrated its power to
greatly improve productivity and accuracy in the identification of products in a variety of
business settings, such as supermarkets and department stores. Proven to be an
Barcode-Assisted Medication effective technology, it quickly spread to virtually all other industries. Yet, many
Administration (BCMA) organizations in the healthcare industry have not fully embraced this valuable technology
as a method to enhance patient safety. Although few medication errors have been
reported with these systems, it can be hypothesized that some of the following types of
errors could occur, especially if the system includes only the most basic of functionality:

• Wrong dosage form: Certain drug shortages may force a pharmacy to
dispense a different strength or concentration (mg/mL) other than
what is entered in the BCMA software.
• Omissions: After the patient’s barcode armband and medication have
been scanned, the dose is inadvertently dropped onto the floor. This
results in a time lapse between the documentation that the
medication was supposedly administered and the actual
administration after obtaining the new dose.
• Extra dose: An extra dose may be given when there are orders for the
same drug to be administered by a different route. For example, if
one nurse gives an oral dose and is called away and the covering
nurse administers the dose intravenously (IV). The problem arises
when there is no alert between profiled routes of administration
indicating that the medication was previously administered by one
route that is different than the second route.
• Wrong drug: In situations when the nurse received an alert indicating
that the wrong medication was selected, but the alert is overridden
and the medication is administered. - Wrong dose: These systems are
limited in their capability to verify the correct volume (e.g., 1mL) of
oral or parenteral solutions to administer. Most systems prompt a
nurse to manually enter the volume that was administered.
• Unauthorized drug: An order to hold a medication unless a lab value
is at a certain level such as an aminoglycoside (i.e., elevated
gentamicin drug level).
• Charting errors: Distinguish the indication for the administration of
the medication (Tylenol 650mg every four hours as needed for pain
or fever).
Automated Dispensing Cabinets (ADCs)

The ADC is a computerized point-of-use medication-management system that is

designed to replace or support the traditional unit-dose drug delivery system. The
devices require staff to enter a unique logon and password to access the system using a
touch screen monitor or by using fingerprint identification.
Smart Infusion Pump Delivery Systems

The introduction of smart infusion technology has changed the paradigm of infusion
therapy by removing the reliance on memory and human input of calculated values to a
software-enabled filter to prevent keystroke errors in programming infusion devices for
delivery of parenteral medications. Smart pumps can include comprehensive libraries of
drugs, usual concentrations, dosing units (e.g., mcg/kg/min, units/hour) and dose limits
as well as software that incorporate institution-established dosage limits, warnings to the
practitioner when dosage limits are exceeded, and configurable settings by patient type
or location in the organization (i.e., ICU, pediatric ICU [PICU]).
IMPLEMENTATION OF TECHNOLOGY
Implementing any form of technology in a healthcare organization can be an imposing
task. Many organizations have purchased various forms of automation, with little or
inadequate planning and/or preparation, which can lead to errors as well as the
development of serious problems. Therefore, it is vitally important to thoroughly plan for
necessary workflow changes and to remember your goal is to improve clinical
processes, which can be facilitated by technology. Foremost, the process will require
total commitment from the organization’s executive and medical leadership as well as all
staff members who will be affected by the implementation.
ards
healthcare so that its meaning is
nalysis and finding, and in
oposed standards and many
Health data standards
to the clinical domain health
ommunications stack, and on
 Health data standards
are used to store and communicate information related to healthcare so that its meaning is
Health data standards
unambiguous. They are used in clinical practice, in activity analysis and finding, and in
research and development. There are many existing and proposed standards and many
bodies working in this field. In addition to standards specific to the clinical domain health
informatics relies on other standards that are lower in the communications stack, and on
many standards from metrology
 Health data standards
are used to store and communicate information related to healthcare so that its meaning is
Health data standards
unambiguous. They are used in clinical practice, in activity analysis and finding, and in
research and development. There are many existing and proposed standards and many
bodies working in this field. In addition to standards specific to the clinical domain health
Barriers
informatics reliesto
onthe widespread
other standards that are lower in the communications stack, and on
adoptionfrom
many standards of effective
metrologydata
standards include:
Inconsistency in and poor understanding of the concepts and language used in clinical
practice, for example compared to those in chemistry or accounting
Rival systems
of standards
The cost of implementation
or change to better
standards
Avoidance of commercial
competition.
 3A4

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