How Specific Uses of ICT May Be Applied Nursing Information System - Essay Example

INTRODUCTION Health is an important social objective , which requires government intervention, hence providing quality health care services has remained primary concern for UK government. With the increased emphasis on patient centered care, the need and importance of improving the quality of care was realized. In order to increase patient satisfaction, provide better health outcomes and cost effective care, strategies were planned and measures suggested to improve quality of care. The quest for improving quality of care motivated organizational learning and the concept of learning organizations evolved in heath care. With the escalating demands of patients information was recognized as the foundation of efforts to cause improvement in the quality of care. Information and Communication Technology (ICT) was employed to increase efficiency, effectiveness and appropriateness of health care. Introduction of ICT caused positive impact on health care organizations and health care professionals. In Health Information : a National Strategy (2004) it was stated that, ICT offers many ways to make the health service more people-centered, improve the quality and safety of care, help staff to make better use of their time and expertise and promote greater efficiency. Today, electronic patient record system has led to fast and easy access to patient information. The current trend of using internet facility for communication between the practitioner and patient has contributed to better patient satisfaction and improved outcomes. Recording the patient initial assessment and response to treatment, recording the plan of care with multi media has helped nurses immensely. BACKGROUND : In 1990’s, government decided to change its policies and increase its expenditure on health care to provide optimum health care to its citizens. The importance of improving the quality of care was recognized and appropriate measures were suggested. In the Quality and Fairness : a health system for you (2001) the Department of health and children proposed to implement a structured set of planned and systematic activities such as documentation, training and review to improve performance and prevent problems. Further, it was decided to employ evidence based practice where, all decisions would be based on research findings, statistical qualitative or quantitative data and other documented trends and behaviors. The UK government came up with a framework termed clinical governance through which NHS organizations became accountable for continually improving the quality of their services, safeguarding high standards by creating an environment in which excellence in clinical care will flourish. ( Campbell, Stephan Roland, Martin Wilkin, David 2001 ) Alder, Millard, Crombie, Johnston, Davies (2000) propose clinical audit was introduced throughout the UK NHS in 1990, as an approach to improve the quality of patient care. Audit is the process of reviewing the delivery of care to identify deficiencies so that they may be remedied which is perceived as significant for clinical governance to achieve the aims of continuous quality improvement. The research conducted revealed that improvement in quality of care required embedding information and communication technology in health care system. The key recommendations of Audit of the Irish health system for value for money (2001) included development of a national Information Technology (IT) strategy in health, besides development of a strategic framework for information in health and a new health care policy with explicit target clear framework for implementation in order to improve the health care services. Since then, ICT has played a major part in improving health care. LEARNING ORGANIZATIONS AND ICT : Kelley, Mark A and Tucci ,James M (2001) believe that to improve quality of care provided health organizations and health professionals should ensure safe, effective, patient centered, timely, efficient and equitable care for all patients.They propose ten rules for this purpose- care based on continuous healing relationships, customisation based on patient needs and values, the patient as the source of control, shared knowledge and the free flow of information, evidence based decision making, evidence as a system property, the need for transparency, anticipation of needs, continuous decrease in waste and cooperation among clinicians. Improvement in quality of health care needed keeping up with technological advancements. Garside (1998) states, ‘all improvement requires change, and improving quality in health care involves changing the way that things are done, changes in processes and in the behavior of people and teams of people.’ Koeck, Christian (1998) states higher quality of care requires improvements in organizational structures and processes. It must integrate its organizational functions, professional groups, and specialist workers into one coherent effort. Sutherland, K and Leatherman, S (2004) assert, the quality agenda comprises a multitude of new organizations and initiatives concerned with such diverse functions as regulation, inspection, standard setting, change management, patient advocacy, assessment of clinician competency, "pay for performance" contracts, and routine performance monitoring. The quest for improvement in quality of care motivated organizational learning. Carroll and Edmondson (2002) believe, for the health care organizations seeking to enhance quality, organizational learning practices can help to improve existing skills and knowledge and provide opportunities to discover better ways of working together. Koeck (1998) states, the goal for any organization in a complex environment is to become a learning organization, able to adapt to the changing demands of the environment. Davies and Nutley (2000) feel learning organizations play a central role for enhancing personal capabilities and then mobilizing these within the organization. Learning organizations manage to accumulate competence and capacity despite the turnover of staff; hence individual learning can be retained and deployed in the organization. Carroll and Edmondson (2002) suggest organizations learn by creating opportunities for information flow and knowledge creation using a wide range of learning mechanisms such as after action reviews, audits, problem investigations, performance appraisals, simulation, and benchmarking. Some of these learning mechanisms are embedded in the work routines as staff give each other verbal and non-verbal feedback. The health organizations are employing the concept of learning organization for enhancing ICT usage. Health Organisations are developing information infrastructure to produce better health outcomes. Most of the health care institutions are being equipped with latest technologies to assist practitioners in their work, and health professionals made aware of new inventions in medical field through surveys, seminars and conferences. The awareness about usage of new equipments is spread through training provided by health institutions. Organizations are increasingly involving the health professionals in planning ICT implementations. The curriculum of training institution has undergone changes to include ICT in its course structure enabling the health care providers to make optimum use of technology available for patient care. Health organizations are encouraging its care providers to be innovative in application of skills and technology, but keep in mind patient health and safety. The use of internet has facilitated communication between patient and health care provider. It has led to increased awareness of latest inventions in medical field, besides enabling professionals all over the world share information and knowledge. The electronic patient record system has helped in easy access to the patient information system. Nursing information system helps in gaining information related to nurses. Computer monitoring of the patient has enabled practitioners to provide better health care. USE OF ICT IN HEALTH CARE : The use of ICT in health care has led to cost effective enhanced quality of care with increased patient satisfaction. It has also reduced clinical errors by assisting in decision making, improving communication and providing fast as well as easy access to information. Barber (2004) says, computerized decision support has been around in medicine for over 30 years, commonly used in the area of diagnosis and dose calculations. The "computerized prescribing" method, in which practitioner prescribes using a computer has improved patient safety. Bates, D and Gawande, A (2003) feel that computerized coverage systems for signing out, hand-held personal digital assistants, and wireless access to electronic medical records, may improve the exchange of information between clinicians. The exchange of emails between the patients and practitioner has strengthened their relationship. Certain problems require immediate attention, using ICT they can be communicated to clinicians. Computerized regular monitoring of the patient helps the clinicians in assessing progress made by the patient. Barnett, Denise (1997) states Information technology has now developed to the stage where small hand-held devices are available that would allow data to be collected at the bedside and stored. Acute general hospitals have been a focus for computer system development but these are not the only locations where treatments are delivered: in mental health and learning disabilities staff practice in a wide variety of settings, as well as in clinics. Laptops can store data for downloading into larger capacity machines for storage and data distribution. The use of internet has enabled clinicians to exchange thoughts, knowledge and information all over the world. The computerized databases maintain patient records and access to this information is at click of button for the care provider. Strachen H (1994) considers, other benefits of ICT include preventing the duplication of collection and recording of demographic details; and linking treatments and procedures with orders to suppliers, pharmacy or catering services. Linking nursing problems to research references, producing discharge plans for patients or summaries of care and treatment for other health care professionals and so on. Bates and Gawande (2003) state that computerized tools can also be used with electronic medical records to identify, intervene early in, and track the frequency of adverse events. Classen et al. pioneered an approach for combing clinical data bases to detect signals that suggest the presence of an adverse drug event in hospitalized patients, such as the use of an antidote. Finch, Gask, May, Mair, Mort (2003) believes that, telehealthcare might revolutionise the practice of medicine by enabling remote interaction between clinicians and patients, through the use of information and communications technologies such as interactive video, digital imaging, and electronic datatransmission. Electronic patient record system has led to fast and easy access to patient information system. The implementation of the nursing information has improved the nursing practice. This article further explores electronic patient record system and nursing information system as means to improve the quality in health care. ELECTRONIC PATIENT RECORD : With impressive efficiency gains and quick financial returns, the use of electronic patient records has gained momentum in the last few years. Electronic patient record is the electronic version of the paper based patient record. Haux, Winter, Ammenwerth, Brigl (2004) consider electronic patient record as a complete or partial paper record stored on an electronic medium. It is similar to the computer based patient record. Robertson (2004) asserts that electronic patient record is a medical document in which data is entered using document imaging and computer. The record includes electronic documentation of information regarding a specific patient. EPR is a significant development in the field of health care, which has increased the efficiency of health professionals and improved the quality of care with its easily accessible and accurate information. But earlier questions were raised on its reliabity and validity. Hippisley-Cox et al (2003) consider that the studies conducted have shown that paperless electronic records compare favourably with records using paper-based systems. Paperless electronic records contain significantly more words and abbreviations. They are more legible and easier to understand. They contain more diagnoses and details of referrals and of medication. Use of electronic records does not change the doctors recall of patients or their consultations. The EPR not only assists the practitioners by providing them with easily accessible patient information but also help in strengthening practitioner patient relationship. It enables the practitioner to take knowledge based decisions, based on patient’s complete health care picture. Hippisley-Cox et al (2003) states, the NHS information strategy, the national service frameworks, and the NHS plan, all promote the use of electronic patient records. Good quality electronic records can be used to prompt better care improve coordination of care between primary and secondary care, monitor the health of populations, and undertake primary care based research. Ball (2005) feels systematic data collection involved by EPR reduces paperwork redundancy and improves quality of care and fiscal efficiency. Rogerson, Simon (2000) proposes that, EPR offers new methods of storing, manipulating and communicating medical information of all kinds, including text, images, sound, video and tactile senses, which are more powerful and flexible than paper based systems. The data recorded in EPR may be put to multiple usage like drawing progress charts, generating summaries. The EPR may assist health professional in administering prescriptions by providing complete information about patient, that patient may fail to communicate. The easily accessible data of EPR gives the clinician more time to interact with patient, increasing patient satisfaction. Takeda et al (2003) state, an EPR system is a potent tool for directly identifying sources of health care incidents, error and accidents. Moreover, it is important to recognize that the EPR database provides a quantitative basis for risk and quality management, since the medical record should represent whole process and outcome of the health care provided. As an EPR is a combination of the contents of a (paper-based) medical record, physicians’ direct order entry (POE) and professional audits such as pharmacist order review, the EPR as a whole is a quantitative tool to manage the quality of health care. Robertson (2004) suggests that EPR designs should allow investigators to evaluate groups of diseases and conditions with their various characteristics and treatments. EPR should provide an integrated view of information needed regarding a specific patient’s care. NURSING INFORMATION SYSTEM : Nursing information system includes the facilities provided by ICT that aid nurses in providing quality care and improve nursing practice. Liaskos and Mantas (2002) consider Nursing Information system as a part of health care information system that deals with nursing subjects, particularly the maintenance of the nursing record. Hughes, Shirley (1997) proposed that nursing information systems involves identifying and implementing technology and information systems solutions that provide more breadth, depth, flexibility and standardization than ever before, and at a faster pace. Nursing informatics deals with collecting, manipulating, analyzing and interpreting several levels of data, information and knowledge. Although NIS has been in health care for sometime but still this field has not been fully explored and there is wide scope for its application in health care, particularly nursing. Swansburg, Lussell C (2002) suggests that clinical nurses can use their NIS to replace manual systems of data recording, which may reduce costs while permitting improved quality of work life. Clinical nurses can use the data collected to analyse and formulate treatment plans on computer. Computerized decision support system may be used in preparation of correct dosage. Bates and Gawande (2003) state that computerized tools can also be used with electronic medical records to identify, intervene early in, and track the frequency of adverse events. Liaskos and Mantas (2002) feel the several objectives of NIS should cover the user’s needs and offer an integrated view of patient data accessible from any location. Control of correctness, validity, safety and confidentiality of information is a very important issue and one of the main objectives that NIS should meet. Nursing information system is continuously evolving as a result of development of fast processing computer equipments, advanced data transmission and increase in information system efficiency and data manipulation effectiveness. Ball, Marion (2005) suggests Information System (IS) proliferation will have important influences on the role of the nurse administrator, enabling them to organize, coordinate and develop IS management and support computer-based data collection. In financial management, linking patient classification data, staffing requirements, and evidence-based practice data to a budget methodology can help justify the nursing departments annual operating budget and expedite budget preparation. Strachan H. (1996) states, a UK study which used the Delphi method to collect opinions on current and future nursing information systems suggests that the benefit of existing hospital NIS were numerous. The advantages included: improved communication; improved availability and access to information; improved consistency and legibility of documentation; and saving time. So further development of NIS is needed to improve quality of care and provide better health outcomes. CONCLUSION : Information and Communication technology has brought significant changes to the field of health care. It has increased the efficiency of practitioner, reduced his workload and enabled him to provide better care. Electronic patient records, provides medical information about patient, which assists the care giver in diagnosis of ailment and prescribing medicine. Nursing Information System has brought significant changes in nursing practice, like the use of computer for collecting data, multi media sources to provide care, emails to communicate etc. REFERENCES : Audit of the Irish health system for value for money (2001). Department of health and children (Ireland). Retrieved from world wide web < http://www.dohc.ie/publications/pdf/vfmes.pdf?direct=1 > Ball, Marion (2005). Nursing Informatics of Tomorrow. Healthcare Informatics. Retrieved from world wide web Barber, N (2004). Designing information technology to support prescribing decision making. Qual Saf Health Care 13:450-454 Barnett, Denise (1997). Clinical applications. Information Technology in Nursing 1(9):7 Bates, D and Gawande, A (2003). Improving Safety with Information Technology. The New England Journal of Medicine 348:2526-2534 Carroll, J S and Edmondson, A C (2002). Leading organisational learning in health care. Qual Saf Health Care 11:51-56 Campbell, Stephan Roland, Martin Wilkin, David (2001). Improving the quality of care through clinical governance. BMJ 322:1580-1582 Carroll,J S and Edmondson, A C (2002). Leading organisational learning in health care. Qual Saf Health Care 11:51-56 Davies,Huw T O and Nutley, Sandra M (2000).Developing learning organizations in the new NHS. BMJ 320:998-1001 Finch,Tracy, Gask,Linda May,Carl Mair,Frances Mort,Maggie (2003). Integrating service development with evaluation in telehealthcare: an ethnographic study. BMJ 327:1205-1209 Garside (1998). Organizational context for quality: lessons from the fields of organizational development and change management. Quality in Health Care 7 (Suppl):S8-S15 Haux,Reinhod Winter,Alfred Ammenwerth,Elske Brigl,Birgit (2004). Strategic Information Management in Hospitals : An Introduction to Hospital Information Systems. New York : Springer-Verlag (2004) p105-106 Health Information : a National Strategy (2004). Department of health and children (Ireland). Retrieved from world wide web Hippisley-Cox, Pringle, Cater, Wynn, Hammersley, Coupland, Coupland, Hapgood, Horsfield, Teasdale, Johnson (2003). The electronic patient record in primary care—regression or progression? A cross sectional study. BMJ 326:1439-1443 Hughes, Shirley (1997). Time for New Thinking. Healthcare Informatics. Retrieved from world wide web Johnston,G, Crombie,I K, Alder,E M, Davies,H T O, Millard,A (2000). Reviewing audit: barriers and facilitating factors for effective clinical audit. Quality in Health Care 9: 23-36 Kelley, Mark A and Tucci, James M (2001). Bridging the quality chasm. BMJ 323:61-62 Koeck, Christian (1998). Time for organisational development in healthcare organisations. BMJ 1998;317:1267-1268 Liaskos, Joseph and Mantas, John (2002). Nursing Information System. Textbook in Health Informatics : A nursing perspective. Oxford : IOS Press p258 Quality and Fairness : a health system for you (2001). Department of health and children (Ireland). Retrieved from world wide web Robertson, Kenneth R. (2004). Electronic Patient Record. Stahl, Michael. Encyclopedia of Health Care Management. London : Sage Publication. p154 Rogerson, Simon (2000). Electronic Patient Records. IMIS Journal 10(5). Retrieved from world wide web Sutherland, K and Leatherman, S (2004). Quality of care in the NHS of England. BMJ 328:E288-E290 Strachan H. (1996). Issues for future nursing information systems: Delphi study results.(Part 2 of 3) Information Technology in Nursing 8.4; 6-8. Swansburg, Lussell C (2002). Introduction to Management and Leadership for Nurse Manager. London : Jones and Bartlett Publishers International. p476 Takeda,Hiroshi Matsumura,Yasushi Nakajima,Kazue Kuwata,Shigenori Zhenjun,Yang Shanmai,Ji Qiyan,Zhang Yufen,Chen Kusuoka,Hideo Inoue,Michitoshi (2003). Health care quality management by means of an incident report system and an electronic patient record system. International Journal of Medical Informatics 69 : 285-293 Read More