The Digital health care community

• Informatics provide health care with an opportunity to create a digital culture of interconnectedness that serves many clients
and team members

• Allows to be proactive response to wellness promotion, disease prevention, treatment of illness, and advancement of
knowledge

Computerized data risk manager perspective

• Helps improve client safety

• Evaluate evidence based practice intervention

Data regulation

• Health Insurance Portability and Accountability act 1996 (HIPAA)

• American Recovery and Reinvestment Act 2009 (ARRA)

The Health Insurance Portability and Accountability Act of 1996 (HIPAA)

• It is a federal law that requires the creation of national standards to protect sensitive patient health information from being
disclosed without the patient's consent or knowledge.

• Rules contain privacy, security, and breach notification requirements that apply to individually identifiable health information
created, received, maintained, or transmitted by health care providers who engage in certain electronic transactions, health
transactions, health plans, health care clearinghouses, and their business

• Five main components of HIPAA: (1) Privacy Rule, (2) Transactions and Code Sets Rule, (3) Security Rule. (4)

Unique Identifiers Rule, and (5) Enforcement Rule. Privacy rule.

• HIPAA examples

1. Automatic sign offs when leaving a computer screen

2. Alarms on mobile device to prevent theft

3. Hierarchical passwords

4. Unique passwords never shared with others

5. Shredding of documents

6. Placement of fax machines and computers in secure area

American Recovery and Reinvestment Act 2009 (ARRA)

• Part A - The Health Information Technology for Economic and Clinical Health Act (HITECH)

• Part B - provides financial incentives or health professionals, facilities to adapt, engage in use of electronic health

record technology
• Addresses the development, adoption, and implementation of health information technology policies and standards. and
provides privacy and security protection for client information.

Bar coding technology

medications

• A nurse at a client's bedside scans medication barcodes and the client's hospital ID band before giving the client's

Health Care Information and Management Systems Society (HIMSS)

• Provides guidelines for sharing electronic information through the development and integration of electronic interfaces.

ADMINISTRATIVE ASSISTIVE AND WORKPLACE TECHNOLOGIES

As technology advances, so does its influence in healthcare. Nurses must now be tech savyy to navigate online

charting systems, update health records, schedule care and more. In days past, patient information was kept in carefully filed,
handwritten charts. Now, technology in nursing has made it easier than ever to keep patient info efficiently recorded and
stored

"There can be temporary drawbacks when a technology is first implemented, but these are outweighed by the

long-term benefits of the technology." explains Anthony Sartor, registered nurse. *It's of vital importance that nurses are given
the necessary education to use new technologies that are being introduced in their workplaces."

Technological advances aren't likely to slow down any time soon. So what are the repercussions of integrating

tech into nursing? Is there a general consensus about its ability to help or hurt the system? Join us as we dig deeper.

What are some recent examples of technology changes in nursing?

• One of the biggest technological changes that's arisen in the field of nursing is electronic charting. Instead of filling out charts
with pen and paper, most nurses are now required to review information and fill out charts online. Many patients can now also
access their own medical records and test results through these online patient portals. This assists in closing the communication
gap and getting information to patients quickly and efficiently.

• Other updates include pagers or cell phones for enhanced communication between nurses, doctors and patients.

GPS tagging and tracking of medical equipment, enhanced diagnostic devices, smarter alarm systems and lifting devices that
allow nurses to lift patients without injuring themselves.

Stand out technologies transforming medical care, and as nurses are educated about new medical technologies and practices,
patients and providers benefit.

1. Automated IV pumps.

• Automated IV pumps control the dosages and drips given to patients. Software and medical tech allows nurses to change the
drip amounts and medication doses so patients aren't waiting for changes. • There are IV pumps for nutrition, which gives
needed meals at the right times. Additionally, there are self pumps which allow patients to increase a controlled amount of pain
medication for themselves.

• Automated IV pumps help speed up nursing processes, and can be crucial if there is a need for immediate adjustment.
Changing medication through an automated process also removes elements of human error that could present issues for
clinical patients and hospitals
• Automated IV kits give nurses opportunities to focus on other areas of work, instead of having to measure and give
medication or food.

• Hospitals all have different kinds of automated IV pumps, so training and education is often based en the specific hospital or
clinic where nurses work.

• • Additionally, many nursing schools give training and information on new software and technology, including how automated
IV pumps work and why they are valuable.

2. Portable monitors.

• Portable monitor equipment allows nursing professionals to check up on patients even if they are on the move. or busy
helping someone else

• Portable devices monitor vital signs like ECG, respiratory rates, and oxygen saturations while transmitting the information
back to a central monitor. This means that nurses will get an alarm notification if there is any emergency.

• Most hospitals have nurses check on levels hourly. Portable monitoring technology allows nurses to track and note stats at
the right time, even if there are a lot of other things going on.

• This helps patients be constantly monitored from anywhere in the hospital, and the alerts and alarms sent to nurses through
the portable monitor can save lives.

• Nurses leam at their specific hospital how to utilize portable monitors, and nursing schools help teach students the value and
general use of many common pieces of equipment.

3. Smart beds.

• Smart bed technology can help nurses track movement, weight, and even vitals

• Smart beds also play a major role in keeping patients safe and comfortable during a long hospital stay. With the number of
falls and patient injuries inside hospitals, smart beds are very important for patient safety. • Smart bed technology gives nurses
a constant monitor in a room that provides them with regular updates and communications on a patient's activities. It can also
help them identify patterns, which can lead to a new diagnosis or a different understanding of a condition.

• Nurses also spend less time coming in and adjusting supplies and medical equipment for comfort or safety, because they can.
help control that with their smart bed. It allows providers to get back to other important work that needs to be done by
humans.

4. Wearable devices.

• Wearable devices and mobile apps are transforming the healthcare industry. Devices that help track heart rates, exercise,
sleep, respiration, and more, are helping people take their health into their own hands. • With increased accessibility to
iPhones, nurses also benefit from apps and devices that help them care for patients. For example. the Steth 10 smartphone
stethoscope is essentially a stethoscope app that allows nurses and doctors to simply use their smartphone to get breathing
sounds and see heart rates. Using a phone can be less intimidating, especially for younger patients, and gives providers a full
range of information and easy tracking of medical needs.

• Wearable devices from health tracking, to specific patient monitoring, are often called the future of healthcare.

With access to huge amounts of data, wearable devices can help the entire healthcare process; from diagnosis to recovery.

• Wearable devices help remove elements of human error for nurses, because the communication of data comes directly from
the device itself. It allows for faster record keeping, and helps patients and nurses maintain consistent monitoring of health.
5. Electronic health records.

• Electronic health records (EHR) are taking over older paper filing methods. Electronic health records allow nursing experts to
document care provided to patients, and retrieve information that can help prioritize care.

Additionally, information entered into computer systems, can then be accessed by the care team, including doctors and even
patients themselves when necessary.

• While security continues to be a concern for electronic health records HIPAA laws ensure security and privacy of electronic
records are maintained by healthcare organizations, and new technology like block chain and cryptography are easing privacy
concerns.

• • EHR's can tell registered nurses (RNs) whether steps still need to be taken for a patient, can monitor small condition
changes, and can give them information immediately as alerts or reminders.

• Real-time health updates impact the speed and accuracy of medical care. RNs learn how to use software systems on the job,
but their education and training will help them quickly understand what different indications on medical records mean, and
what their course of action should be; to ensure improved patient outcomes.

6. Centralized command centers.

• One of the newest ideas for hospitals, centralized command centers, promise improved patient experiences and better ways
for RNs and doctors to manage supplies, clinical technology, and capacity. This is done through software applications such as
dashboards that provide real-time updates for an organization.

• With shorter or non-existent delays between transitions of care, nurses and doctors can actively be aware of room
availability, OR schedules, and what individual patients still need in order to be discharged. This allows everyone to do their job
more efficiently, and help patients more effectively.

• Specifically designed for capacity management, command centers being piloted around the country are performing well.
Many hospitals report operating at higher capacity, and overall improved patient experiences.

7. Telehealth and applications.

• Telehealth is a new and valuable element in healthcare. Hospitals and clinics allow patients to virtually video chat with a
doctor or nurse. Patients are able to describe their symptoms, or show doctors things like rashes or bumps.

• This allows patients to quickly be diagnosed, without leaving the comfort of their own home. They can be told if they need to
come in for further testing or diagnosis, be prescribed medicine, or given medical advice. • Telehealth saves patients and
doctor's alike money and time. Similarly, it prevents sick patients from coming to public places. and exposing other patients.
This technology is changing the way clinics operate and how patients are cared for.

• Similarly, medical apps and wearables help patients and doctors work to improve health. Doctors and nurses can monitor vital
signs of patients without them being in the office. They can be utilized for overall health and weliness, or for specific medical
concerns such as seizures or diabetes

• Similarly, apps can help patients understand when they should call a doctor, and when a simple over-the counter medication
could help. This again conserves resources in clinics, and helps patients save time and frustration.

• Mental health issues can also be addressed with the help of apps. Mindfulness apps help individuals understand their mental
health and energy, and remind them to take time for these important aspects of wellness.

• Increasing app and telehealth technology gives doctors, nurses, and patients themselves, more control over their health.
Computerized nursing systems on administrative application can help nursing manage and use information to fulfil its unique
data and requirements:

• Clinical needs (patient care, documentation etc.)

• Strategic needs (organizational performance support processes etc.)

• Quality management need (outcome measurement and regulation compliance)

• Resource and personnel management needs (scheduling, continuing education, staff development)

Examples of Computer applications for Administrative information management:

• Nursing intensity

• Error reports

• Patient Classification System • Staffing and • Incidental reports • Infection control

Scheduling System • Unit activity reports

• Training and education

•• Financial planning

• Hospital expansion

• • Improved documentation

• Improved communication

• Improved planning

• Increased standardization of nursing practice • Ability to define nursing practice and associated issues

• Personnel files • Quality assurance

Benefits of using Information technology for Nurse Administrators • Expanded use of nursing staff resources

• Improved quality of patient care monitoring

Schedule:

• Ability to define methods to track patient care delivered, outcomes achieved and revenue generated

• Enhanced recruitment and retention

• Improved evaluation of care provided

• Support dynamic organization, capable of change

What are some potential drawbacks?

While technology certainly helps with communication and spurs other efficiencies, there can be a learning curve when new
technology is implemented

• is a lack of ability to communicate effectively?

TELEHEALTH

• The use of telecommunication technologies and computers to exchange healthcare information and to provide services to
clients at another location, previously known as telemedicine

• is defined as the use of electronic information and telecommunications technology to support long-distance clinical
healthcare

• GOAL: to expand provision of healthcare services to locations/populations in need of those services

• Some examples include:

• video conferencing

• sharing images online

Telehealth

• streaming media and wireless communication

• Examples of how telehealth is used:

ROLLASCERTIOR

• Patient portals

• Virtual appointments

• Wearable devices allowing for remote monitoring

• Tracking health information in a personal health app

• Telehealth supports and promotes health care from a distance, connecting patients with healthcare providers and the
resources they need to control their own health. It also supports

continuity of care and allows healthcare professionals to better serve their patients.

Licensure issue

• Confidentiality issue

• Lack of standards

Terms Related

• Collaboration among healthcare professional • Improved decision making

• Education

• May lower cost of healthcare

• Increase access to care and to specialist • Increase quality of care (home, time. continuous)
• Extend the care services

• Centralized health record

Legal and Privacy Issues

• Reimbursement and licensure issues e

Referral and Payment

• Support Personnel

• Liability

• Need for technical support

• Lack of available infrastructure

• Accreditation and regulatory requirements • Limitations

• Lack of funding

• Quality of service rendered

• Teleconferencing: Implies that people at different locations have audio and possibly vide contact which is used to carry out
telehealth applications.

• Video Conferencing: Implies that people meet face to face and view the same images through the use of telecommunications
and computers even though they are not in the same location.

• Desktop Videoconferencing: Synchronous or real time encounter that uses specially equipped personal computers with
telephone line hook up. DSL or cable connections to allow people to meet face to face and/or view papers and images
simultaneously.

Types of Applications

• Store and Forward: digital images, video, audio, and clinical data are captured and stored on the client computer or device,
then, at a convenient time, the data are transmitted securely (forwarded) to a specialist or clinician at another location for
interpretation

• Real-time Telehealth: This service offers concurrent interactions between patient and doctor. This service includes phone
conversations, online communication and home visits. Real-time or live interaction • Remote Patient Monitoring: This type is
also called 'self-monitoring/testing'. It facilitates the nurse to check a patient remotely using different technological equipment.
Devices are used to capture and transmit biometric data

Applications of Telehealth Nursing

• Practice: Clinical applications comprise early patient assessments, diagnosis (tele-diagnosis), and consultation (tele-
consultation). Supervision of physicians and observation of patient status are likely.

• Education: Affords opportunities to educate healthcare consumers and professionals through increased information
accessibility via online resources (world wide web, distance leaming, and clinical instruction). • Administrative: Administrative
uses, for instance, conferences, preparation, utilization and quality appraisal may be offered.

• Research: Improved by aggregation of data from numerous sources and harmonization.

Uses: • Telephone triage

• Follow-up calls

• Obtaining test result & physiologic parameter

• Education & consultation

• Patient assessment

• Telepresent

• • Use of telecommunications and information technology for providing nursing services in health care whenever a large
physical distance exists between patient and nurse, or between any number of nurses.

• This is a subset of telehealth in which techpology is used to deliver nursing care and conduct nursing practice. It is specific to
nursing as a profession.

• Telenursing is not a new mode of health care delivery rather it is an evolving model of health care delivery that begun from
the advent of telephone use in 1876

• Telenursing is one of the various innovative and improved methods of providing nursing care that directly affects registered
nurses and expands their capacity to practice nursing in a relatively new arena as well as directly affecting clients

Objectives of Telenursing

1. To deliver care and expertise

2. For curative, preventive and rehabilitation

3. For training and information

Types of telenursing

1. Remote monitoring.

• The nurse monitors the patient remotely from his/her house

• Patients collect and transmit data to nurses; the nurse plans the intervention.

• Used for handling chronic diseases like heart disease, diabetes, asthma etc.

2. Interactive telenursing services

• It involves a series of interactive sessions with clients via phone conversations and online communication.

Used to obtain history, physical tests, psychiatric assessments, ophthalmology evaluation

3. Store and forward telenursing

* Used to obtain medical images, audio or video data that can be forwarded to a nurse at a suitable time for evaluation offline.

• Areas utilized are dermatology, radiology and pathology

• Patient sees a nurse over a live video connection or using diagnostic images/video along with patient data to a specialist for
viewing later

5. Imaging services

• Used in radiology, pathology and in cardiology

Methods of delivering telenursing

1. Point-to- point connections using private network

2. Web-based e- health patient service sites

3. Networked programs

4. Connections to monitoring Centre from home

5. Primary or specialty care to the home connections

Applications of telenursing

1. Home care

2. Patient consultations

• Saves time

Nurses benefits

• Saves time

• More efficient seeing distant patients

• Rural providers can receive continuing education

• Available as a specialty program

Hospital benefit

• Administrators save travel time and funds by attending meetings via telenursing • Addresses shortage of nurses

• Service available to more clients

Disadvantages of Telenursing

Class number:

Date:

Benefits of utilizing telenursing

Patient benefits

• Increase acoess to health care

• No therapeutic touch. Conferences/ videos can't replace valuable time between nurse and patient. • Laws and a set code of
rules and ethics will first need to be applied before telenursing can be used regularly in various capacities

• Equipment malfunction

• Inability for patients to use equipment/ device.

Challenges in telenursing utilization

• Non acceptance by nurses: Older nurses who are not computer literate. Feeling of being replaced with computers

• Reimbursement issues Patient confidentiality and security to private information may be difficult to safe guard.

Financial issues: cost of establishment, coat of transferring videos, audio, files

Ethical and legal issues surrounding telenursing

• Confidentiality and the law: involvement of non -clinical personnel, hackers and cyber theft, vulnerability of transmission lines
to security breaches

• Patient-nurse relationship: it is difficult to establish when a nurse- patient relationship has been established. To know when a
duty of care is owed to a patient

• Patient consent to disclosure of information

• Consent to treatment

• Role of nurses in telenursing

• Ensure proper and accurate documentation in electronic or paper format

• Carry out only the activities you are competent and authorized to perform

• Ensure the privacy, security of patient information

• Establish client-nurse relationship so as to establish a duty of care

• Take into account client's spiritual and psychosocial needs and preferences as everybody is unique

Nurses have a key role to play in the application and implementation of telenursing services. It is therefore expected of them to
understand their role so as not to go beyond their locus of duty.

• Nurses should support the expanded role of telenursing

• Seminars and workshops should be put in place so as to increase the level of awareness among nurses

• Government should support the establishment of telenursing services in the country