Nursing, Technology, and Informatics

1. Chapter 13: Nursing, Technology, and Informatics “Understanding the Past and Embracing the Future” (McIntyre & McDonald, 2014)

2. Outline: • Nursing informatics • What is it? • What are the pro’s and con’s? • How did health informatics begin? - How does nursing play a role? 3. How does ICT affect nursing education?

3. Core Competency #35:Demonstrates knowledge of and utilizes nursing informatics and other information and communications technology in promoting and providing safe nursing care.

4. Nursing Informatics • Nursing informatics is understood as the integration of information technologies and communications into nursing practice (McIntyre & McDonald, 2014, p. 240) • Nurses are knowledge workers that perform evidence-based practice based on information systems • Nurses have to be comfortable with using information technology because patients are using technology to educate themselves

5. Telehealth Telephone Electronic Mail Web-based Information Types of Informatics

6. Telehealth • Telehealth: “encompasses a broad range of healthcare and service delivery systems provided through distance or electronic technology” (McIntyre & McDonald, 2014, p. 241) • Telehealth can be used in the nursing process when assessing, planning and implementing care through information, referral, education and support, evaluation, and documentation (p. 241) • Because Canada’s population is widespread, telehealth can reduce barriers related to access • Can provide borderless, seamless, and accessible healthcare, delivering fast, accurate diagnoses and treatments where it is difficult to meet face-to-face • However, it is only beneficial if nurses have access to the resources and knowledge on how to use it

8. Telephone • Videoconferencing can now be used to improve access to specialist care, health-related education, and visits with family members located in healthcare facilities elsewhere in the province (p.243) • However, the use of telehealth in Aboriginal communities can create ‘digital divide’ (McIntyre & McDonald, 2014)

9. Web-based Information For Patients and Providers: (McIntyre & McDonald, 2014)

10. Electronic Mail and the Internet (McIntyre & McDonald, 2014)

11. Synchronous Chat Rooms -Real time discussion Asynchronous Interaction -Anytime discussion Online Support (McIntyre & McDonald, 2014)

12. Found Support: Online Support Group Video

13. Online Support Groups • Allow for an opportunity to consult others independently. • Include discussions on a wide array of topics—personal experiences, alternative therapies, coping strategies etc. • Beneficial for patients that are not comfortable with face-to-face support groups and for those patients who are geographically isolated. (McIntyre & McDonald, 2014)

14. Electronic Health Records (EHRs) • a collection of all a patient’s health records from various practitioners which are accessible to any future providers online from many separate, interoperable systems within an electronic network • includes voice, video, images, and data related to a patient that are available electronically McIntyre & McDonald 2014, pgs. 244-245

15. Electronic Health Records (EHRs):Benefits • Provides better information for decision-making, promotes interdisciplinary collaboration and improves continuity of care • Core competency #51: coordinates the health care team to address clients’ health challenges and identify strategies for health care planning McIntyre & McDonald 2014, pgs. 244-245

16. Electronic Health Records (EHRs):Benefits • Improves efficiency by eliminating duplication • Improves portability by potentially eliminating geographical constraints on acquiring patient information across provincial borders McIntyre & McDonald 2014, pgs. 244-245

17. Electronic Health Records (EHRs):Benefits • Allowing patients to access their own records may enhance personal decision-making in health behaviours, informing them about their health status, and allowing them to be collaborators in their own care • Make data readily available to policymakers McIntyre & McDonald 2014, pgs. 244-245

18. Electronic Health Records (EHRs):Challenges • Financial and logistical difficulties of building and maintaining such large, interconnected networks • Privacy issues arising from sharing such a vast, detailed amount of information over such a large network McIntyre & McDonald 2014, pgs. 244-245

19. Electronic Health Records (EHRs):Challenges • Privacy issues arising from sharing such a vast, detailed amount of information over such a large network - Health Canada Infoway is: 1) working with jurisdictions and privacy commissioners to implement an EHR information governance structure 2) completing a conceptual EHR privacy impact assessment McIntyre & McDonald 2014, pgs. 244-245

20. Electronic Health Records (EHRs):Challenges • Privacy issues arising from sharing such a vast, detailed amount of information over such a large network - Health Canada Infoway is: 3) is planning to conduct a survey of public attitudes and concerns about privacy and electronic health in collaboration with the Office of the Privacy Commissioner of Canada and Health Canada McIntyre & McDonald 2014, pgs. 244-245

21. TELEHEALTHVIDEO

22. Telehealth and EHRs: The Development • Developed as an initiative by the Provincial and Federal Government to enhance the quality of health care and life • Federal and Provincial governments partnered with Canada Health Infoway, set goals to implement an electronic system that would provide secure and fast access to patient information to various health care providers. (Morris, 2005)

23. How it Started • 1994: Information Highway Advisory Council (IHAC) to mandate use of emerging information and technologies for the benefit of economic and societal benefit • IHAC: need fast, easy way to access information that would: • improve quality of life, reduce costs and improve services • 1994: A National Forum of Health, advised federal government on innovative ways to improve the health care system • 1997: Advisory Counsel on Health Infostructure, addressed the issue of how ICT would support and promote, informed decision making for stakeholders such as health care providers, policy makers, planners (Morris, 2005)

24. How it Started Con’t • 1997: Office of Health and Information Highway (OHIH), assisted the federal government to coordinate, facilitate and manage the health infastructure • 1997 report suggested that federal government should invest in an electronic system • 2001: Federal investment of $500 million to Canada Health Infoway (CHI) was approved to begin research and development of information communication technologies (ICT) such as patient health records • Between 2003-2004 another $700 million was invested and given to CHI to initiate implementation of electronic patient records (Morris, 2005)

25. Canada Health Infoway • Non-profit organization working with the federal and provincial government to initiate an electronic health care system • Goal: implement EHRs in 50% of the Canadian population by 2010 • Still do not have 100% implementation of a fully interoperable EHR system in Canada due to the challenges associated with implementation, use and funding (Canada Health Infoway, 2012)

26. Nursing Teleheatlh • Nursing telehealth, as per the CNO “encompasses all types of nursing care and services delivered across distance”. • CNO Six Principles of Nursing telehealth: • The therapeutic nurse-client relationship • Providing and documenting care • Roles and responsibilities • Consent, privacy and confidentiality • Ethical and legal considerations • Competencies CNO. 2009. Telepractice. Practice Guidieline. http://www.cno.org/Global/docs/prac/41041_telephone.pdf

27. Telehealth Ontario • This is one way nursing is playing a crucial role in telehealth. • Telehealth is free access to a Registered Nurse; 24 hours a day, 7 days a week. ServiceOntario. 2015. Teleheath Ontario. Ontario Ministry of Health and Long-term Care. http://www.health.gov.on.ca/en/public/programs/telehealth/

28. Health Seeking Behaviour -Internet has provided the opportunity for health-seeking behavior by patients, often before contact with a health professional. -They amount and quality of information are often conflicting and cause confusion among patients and care providers.

29. Health Seeking Behaviours Nurse are a vital resource that can help patient verify information what they are looking up online. As nurses we can also incorporate the evaluation of Internet sites for their accuracy and credibility into patient teaching.

30. Online Support Group -Internet is also used for support groups through -Synchronous chatrooms -Asynchronous interactions (anytime discussions) How can nurses play a role in online support groups? (McIntyre & McDonald, 2014)

31. Ways Nurses Can Play a Role: • Utilize Client Centred Core Competencies through verbal communication. • Provide health teaching, that is clearly written, which patience can re-reference in the future. • Provide support for a patient who is at home alone and having a hard time coming to terms with their new way of life.

32. Nursing and EHR • NO ROLE in development of electronic systems • Role in the use and implementation of EHRs • front line workers, therefore need cooperation for implementation • Leadership Role • Need to be updated continuously to train other members of the team on use of EHR • Specialized nursing roles for ICT e.g. informatics nurse specialist (new programs) • Nurses act as a patient data custodian • Ensure privacy of patient information • Ensure patient safety via access to patient information • Allows for collaboration with other health care providers • Knowledge of EHR and use allow for nurses to gain the information needed to collaborate with doctors, dieticians, pharmacy etc… • Having access to patient EHR allows for nurses to advocate for patient • Know what the patient wants and does not want based on information accessed via EHR (CHI, 2012)

33. CNO Competency #44 • Uses existing health and nursing information systems to manage nursing and health care data during client care • Using different methods of nursing informatics, the three goals (Reduce costs, improve service and improve quality of life) the government aimed for are enacted. • Ensures privacy at the point of care and during documentation • Reduce medical errors and gain quick access to patient information • Important in emergency situations when information is critical to make the right decision • Alerts the doctors, nurses and other health care providers of allergies, DNRs, wills, next of kin etc…

34. Past to Present: Nursing Education Past: “tell ‘em and test ‘em” method • Lectures were designed with the professor teaching material in a lecture format Present: learner center paradigm • Constructivism principles: learning is a process in which learners integrate knew and old knowledge (McIntyre & McDonald, 2014)

35. What makes implementing technology hard? • Time: little time for adding more information into the undergrad degree, professors time to implement new technology • Rapid advances of technology: technology is changing so quickly it is hard to keep up with the latest technology used in the work place (especially since the work place is still changing to catch up to) • Loss of Critical thinking skills: with technology rapidly changing, such as the PDA in the work place, will students critically think or rely on the technology for answers (McIntyre & McDonald, 2014)

36. Technology is the future. It is expected that nurses will be drawn towards work places that have the most up to date technology to provide the best client care. Question becomes how does the educational system hone in on the raw skill students have to establish nurses that how know how to use the ICT? (McIntyre & McDonald, 2014)

37. How do we educate future eHealth nurses for future? 1ST Recommendation: • Information literacy: “an understanding and set of abilities enabling individuals to recognize when information is needed and have the capacity to locate, evaluate, and effectively use the needed information” (Booth, 2006) • A highly skilled nurse should be able to effectively utilized and manage technology in augmenting clinical practice.

38. How do we educate future eHealth nurses for future? • 2nd Recommendation: • Increase interdisciplinary colloboration: • “By learning in interdisciplinary teams, students would be exposed to specific skills required in their disciplines’ unique curricula” (Booth, 2006) • Nursing curricula should not only encompass informatics specific to nursing but open up to learn other health profession informatics equally to be an expert of future collaborative eHealth system.

39. How do we educate future eHealth nurses for future? • 3rd Recommendation: • Patient focused systems should be developed. • “ At the heart of the eHealth movement is the notion of empowerment and encouragement of the patient to achieve a higher level of health” (Booth, 2006) • One of the main goal of developing future technologies is to make patients guardian of their own health as much as possible.

40. How to improve nursing Curricula to educate future eHealth nurses? • Nursing curricula should be flexible to changes in informatics and focused on eHealth paradigm of client centered care. • McNeil and Odom (2000) define nine nursing informatics concepts need to be included in all entry level program: • General information on informatics • Computer technology • Information processing • Informatics theory • Telehealth • Future careers • Current informatics issues • Information systems • Life cycles of information system. (Booth, 2006)

41. Why will nursing students not be prepared to use ICT? • According to Button, Harrington and Belan (2014) review of information communication technology educators found that their ICT skills were not up to par • It was time inefficient to make online courses or online aspects to course material for some professors • It was cost inefficient for some universities to train staff in ICT • Not all students had appropriate ICT skills and fell behind when classes had online components • Students did not understand how using technology in school related to wok place technology • A large portion of students and teachers enjoyed mixed learning- classroom and online learning

42. CNO Competency 86. Demonstrates ethical responsibilities and legal obligations related to maintaining client privacy, confidentiality and security in all forms of communication, including social media - Nursing instructors may find it difficult to teach ways to prevent breaches in confidentiality with technology they may have not experienced themselves. On the other hand it may be hard for nursing students to demonstrate confidentiality because social media is second nature to most.

43. Social media defined as: ‘‘primarily Internet- and mobile-based tools for sharing and discussing information about human beings.’’ (Schmitt, & Lilly, 2012) 43

44. Social Media Among Nurses • More than 60% of Canadian nurses are now using social media • Four ways to apply social media in nursing: • communication/networking • gain the latest healthcare and scientific research information • rapid dissemination of sound health information • increased efficiency in job performance (Schmitt, & Lilly, 2012) 44

45. ‘‘Risks are minimal if nurses use basic good judgment, like they should with any aspect of nursing practice. Confidentiality and protection of privacy must always be observed, no matter the medium. Good manners, simple politeness, respect for others, and observing the rules of professionalism and courtesy will prevent almost any difficulty. People create their own problems in SM [social media], and in many other venues, by saying things they should not say in any circumstance’’ Dr. Carole Eldridge (Dean of Nursing, Dallas Campus, West Coast University) (Schmitt, & Lilly, 2012) 45

46. Evidence shows that even though nursing students had access to computers in primary and secondary school they didn't use them for tasks other than word processing and social interaction. • Today’s students: • Generation X (young adults in late 20s to early 30s) • Generation Y (early to mid-20s) • Generation that wants quick access to information, little tolerance for delays and, prefers interactive and collaborative learning styles • These students have different learning needs and they come from diverse backgrounds • They want learning activities that are structured, involve teamwork, and include the use of technology (McIntyre & McDonald, 2014) 46

47. Technology being used to address issues of… • increasing student numbers • multiple site/distant campuses • declining numbers of faculty • limited financial resources • reduced access to clinical sites • There is the “..temptation of substituting quality of instruction for increased student access and financial gain” (McIntyre & McDonald, 2014) 47

48. Early studies showed critical thinking, clinical judgment, and confidence levels can increase when nursing students use computer-based simulations in their postsecondary programs • However, the effectiveness of these simulations are still being questioned (McIntyre & McDonald, 2014) 48

49. Some students believe • They are substituting clinical days for simulating learning experience • Concerned this reduces exposure to “real” patient situations • Thus, reduces students ability to think critically and develop competency as a practicing nurse (McIntyre & McDonald, 2014) 49

50. Educational institutions are trying to find alternative approaches to teaching which include distance-learning options • These alternative methods of teaching can also be used by practicing nurses who are looking to build on the skill set they already have (McIntyre & McDonald, 2014) 50