NUR3164
Introduction to Nursing Research and Health Informatics
Unit 1
Discussion
The ultimate goal of health informatics is
to empower populations, communities, families, and individuals with the
opportunity to improve the quality and increase the quantity of their days by
maximizing the use of technology in healthcare.
Following your readings, viewing the PPt for this module and viewing a
TED talk by Karalee Close: Will healthcare
embrace digital or will we die waiting? Link
(Links to an external site.)Links to an external site.
Answer 3 of the following questions and
reply to at least one student's post. Internal citations and references are
required. Please make sure at least one student answers each question.
Based on your reading and the link below,
each of you are responsible for addressing 3 of the following questions ~ the
goal is that you all, as a group, answer all of the questions.
This first week is heavy on the reading;
Unit 1 is really the foundation of informatics and these 5 chapters will be
expanded on throughout this course.
There are a choice of 2 discussion questions from each chapter. YOU ARE
RESPONSIBLE FOR answering a total of three questions ~ these should be from
different chapters.
Agency for Healthcare Research and Quality
(Links to an external site.)Links to an external site. (links to an external
site) Explore the AHRQ Health Care Innovations Exchange. Automation and informatics-based tools could
be used to bring resources from this site to the point of care.
Identify an area that health informatics is
being integrated into hospital systems; describe the research being done, what
is known, what is unknown?
As nurses, we are constantly coming across
health informatics, explain how it is integrated into the nursing profession (choose
one example ~ feel free to use a personal experience here).
Describe ways in which miscommunications
occurs between healthcare providers in a clinical settings and suggest how
technology could be used to decrease this miscommunication.
Whenever change occurs, there can be
resistance. List and describe at least 2 responses of individuals as described
in chapter 2 and how both of these groups should be managed when planning for
implementing change into a healthcare institution.
How can health informatics influence and
improve evidence-based practice (EBP)?
Using sources, other than just your book, identify and explain how
EBP/practice-based evidence (PBE) can influence or possibly replace research
studies that develop evidence-based practice.
Most clinical settings now use computers
quite comfortably. Discuss why
computerization and health informatics is required if evidence-based practice
is to becomes reality in the clinical setting.
Describe the use of one theory (*** COULD
YOU GIVE AN EXAMPLE OF ONE THEORY FROM THE READING?) in evaluation studies, is this theory
appropriate for the evaluation of electronic medical records?
Why are program evaluations important in
the use of health informatics and electronic medical records? How is program evaluation different from
program research?
Find a source of research or article that
explores a technical models such as cloud computing or application service
providers. Give a synopsis of your
findings (Be sure to give the reference details for easy review)
How did/do incentive programs, such as
Meaningful Use, both positively and negatively impact technical infrastructures
in healthcare settings?
NUR3164
Introduction to Nursing Research and Health Informatics
Unit 2
Discussion 9-11
The drive to quantify how CDS can help
maximize desired healthcare outcomes. The “10 Commandments” of the CDS best
practices and the “CDS Five Rights” are both guide for best practice.
“10 Commandments” of CDS best practices
Speed is everything.
Anticipate needs and deliver in real time.
Fit into the user’s workflow.
Little things can make a big difference.
Recognize that physicians will strongly
resist stopping.
Changing direction is easier than stopping.
Simple interventions work best.
Ask for additional information only when
you really need it.
Monitor impact, get feedback, and respond.
Manage and maintain your knowledge-based
systems.
“CDS Five Rights” is referring to providing
the right information to the right person using the right CDS intervention
format, delivered through the right channel and at the right point in the
workflow. (pg. 178 of your textbook).
Taking these into consideration, answer the
following questions;
How do patient safety, quality of care, and
economic interests contribute to the need to identify CDS best practices and to
quantify effective CDS practice?
What do the authors mean when they talk
about the drive “to make CDS more of a science than an art”?
How can this drive help in the effort to
replicate and disseminate successful CDS systems?
Considering that it is important to
recognize the limits and potential drawbacks of certain elements of CDS.
Discuss the problem of “alert fatigue” and
how this must be a consideration in any effective CDS system.
Discuss how CDS can alleviate the problem
of information overload by highlighting relevant
NUR3164
Introduction to Nursing Research and Health Informatics
Unit 2
Discussion 6-8
After completing the reading and viewing
the PPT for chapters 6-8, please join in the discussion. This week's discussion is in two parts, and
will explore electronic health records, (EHRs), administrative and telehealth
methods for delivery healthcare. Please
answer one question from each section. Support your answers with 2 scholarly
resources as well as the textbook.
Discussion Topics:
There are safety-related impacts of
applications such as the eMAR and BCMA. For example there has been an increased
emphasis on evidence-based care in the design and intended use of various
systems of the Centers for Disease Control and Prevention (CDC). Though despite
the goal of improved safety, software such as the CPOE can have unintended
negative consequences that actually result in medical errors.
Section 1
Is there need for improvement in the areas
of user error, lack of communication or coordination, and overuse of alerts, if
so what are they and what are possible solutions?
How does the introduction of a CPOE system
affect communication between healthcare providers, particularly the nurse and
the physician or pharmacist?
From chapter 7, Do you agree with Khatri’s
argument that an effective HRIS can give a healthcare organization a
competitive advantage. Why? On what specific aspects of an HRIS and premises
was Khatri basing this assertion?
The factors that will continue to drive the
expansion of telehealth are rising costs, increase in chronic conditions, aging
population, demands for improved access, and global shortages of healthcare
workers. There is an enormous potential for growth in telehealth in both the US
as well as other areas of the world (particularly in Asia, where cellular phone
use is increasing at a dramatic rate).
Section 2
Oxford’s telemedicine definition is “the
remote diagnosis and treatment of patients by means of telecommunications
technology.” The terms telehealth and telemedicine are often used
interchangeably, but telehealth has evolved to encapsulate a broader array of
digital healthcare activities and services~ it is not a specific service, but a
collection of means to enhance care and education delivery through virtual medical,
health, and education services.
Introduce the 4 primary modalities
associated with telehealth: Live video,
store & forward, remote patient monitoring (RPM) and mobile health
(mhealth). Discuss what one of the most
creative/most interesting ways each of these is being used. Is telehealth covered by insurance and how is
it's effectiveness being measured?
How has the rise of telehealth broadened
the possibilities of what it means to be a nurse? Could you see yourself in a telehealth role?
If so, which one most appeals to you?
What new settings and job descriptions have
opened up and will continue to expand in the field of nursing? What about these
seem exciting, challenging, or possibly daunting about these new opportunities
for nurses?
In what way can nursing be recognized as
“ahead” of other healthcare provider groups in terms of addressing many of the
legal and licensure challenges posed by the adoption of telehealth? (Hint:
Think about programs or models already adopted by nursing more than a decade
ago.)
NUR3164
Introduction to Nursing Research and Health Informatics
Unit 3
Discussion
Participatory Healthcare Informatics
Follow the instructions under DISCUSSION
BOARD RUBRIC and Discussion Guidelines and APA Tips to create your post and
respond to at least one other student. Internal citations and references are
required.
Along with your reading from the text book,
review the following links about Health 3.0 and ePatients, then answer the
questions that follow and answer ONE of the question prompts below:
1.
2.
This is an older source but it does a
wonderful job with explaining both a positive and negative aspect of ePatients.
3:
Through your library access, Read
article: E-patients hold key to the
future of healthcare BMJ 2018; 360 doi: https://doi.org/10.1136/bmj.k846
(Published 26 February 2018)
Discussion Topics
Answer ONE of the following questions :
As we move into Health 3.0, how will the
role of the nurse change in ensuring access and delivery of quality healthcare
to all patients—the active ePatients, as well as those who do not have access
to or do not want to participate in this brave new healthcare system?
Considering the changing patient
population, the future of ePatients with a focus on the impact of a growing
population of technology savvy patients, how will this affect the areas of
healthcare in which social media offers the most benefit ~ do you see it as in
research, patient-to-patient social support, and/or sharing of information?
How might mHealth change the
patient-provider collaboration and communication? mHealth technologies can be used to support
patient care. With this in mind, what
are the risks involved in using mHealth?
NUR3164
Introduction to Nursing Research and Health Informatics
Unit 4
Discussion
Follow the instructions under DISCUSSION
BOARD RUBRIC and Discussion Guidelines and APA Tips to create your post and
respond to at least one other student.
Along with your textbook reading, review
the following sources and answer the corresponding questions for either Part 1
or Part 2 below. Do not limit yourselves
to the resources I have listed here!
Part 1
1. TED talk by Talithia Williams: Own your
own body's data: (17 min) Link (Links to an external site.)Links to an
external site.
2. Ten key considerations for the
successful implementation and adoption of large-scale health information
technology. (Links to an external site.)Links to an external site.
Integrated health IT breaks down barriers
for a free flow of health information (Links to an external site.)Links to an
external site.
Compare the advantages and disadvantages of
“best of breed” (or a modular system) and integrated system approaches in
selecting healthcare information system architecture.
Having examined both a modular system and
an integrated system approach, which do you feel is the better option?
How do you think about which you
"pick" is going to change the future of EHRs?
Part 2
Anticipating future directions of some of
the technologies available, what does the research show as to the effectiveness
of mobile health technology that has now been around for a few years~ We now
have data. Things like fitbit-like apps,
exercise, apps, I-phone's health app, pregnancy apps (Link (Links to an
external site.)Links to an external site.), weight management apps (Link (Links
to an external site.)Links to an external site.), Fooducate, Gluco (diabetic
apps Link (Links to an external site.)Links to an external site.), mental
health apps (Link (Links to an external site.)Links to an external site.) etc. ~
are these apps being utilized effectively?
Are we actually using the data provided to make health related decisions
to improve our health?
How Smartphone Technology is Changing
Healthcare in Developing Countries (Links to an external site.)Links to an external
site.
Smartphones becoming primary devices for
physician and patient communication (Links to an external site.)Links to an
external site.
Two parts: (a) Review the research on ONE app and
present the scholarly research on the effectiveness of the app (not just the
"cool" aspect). Who uses it (
population of people: diabetics, people
struggling with depression, etc.) and how is effectiveness being evaluated? Discuss
ongoing evaluation, implementation, and integration of healthcare
technologies. (b) Have you personally
used (or know someone who has used) a smartphone either to monitor their own health or to access their
health records?
Since this is the wave of the future—but
still not the norm—how can using a smartphone to access health information be
taken into consideration as facilities plan to upgrade or implement a new HIS?
NUR3164
Introduction to Nursing Research and Health Informatics
Unit 5
Discussion
Follow the instructions under DISCUSSION
BOARD RUBRIC and Discussion Guidelines and APA Tips to create your post and
respond to at least one other student. Internal citations and references are
required.
As you are new to all of this, being
introduced to the many terminologies and systems of standards, you are bound to
feel overwhelmed. You all will not be
expected to become experts in each system. Rather, you should recognize the
unique purpose and goal of the various terminologies and understand the goals
of the systems, and the importance of achieving harmonization among systems of
terminology. One basic & practical
concept in striving for standardization.
This is similar to using the “right” key words when conducting an online
search. Nurses can only receive or communicate the “right” data about a patient
if they are using the “right” terminology.
Although it is more complicated than this, you will benefit by drawing
on your own success when communicating online through standard, consistent
terminology.
Choose ONE question from this week's four
chapters as your discussion post, then please respond to a post on a topic
other than the one you chose for your initial post:
Chapter 21:
(three options to choose from)
Discuss the importance of establishing
& using frameworks in designing and using health informatics. Introduce one
of the currently existing health IT frameworks, and discuss areas where it is
inadequate/needs further improvement. ( One option would be to discuss how the
Health Human–Computer Interaction (HCI) Framework addresses the missing
elements of previously existing frameworks).
User experience: Identify the elements critical to an improved
user experience: user(s) characteristics, interactions, tasks, information,
product(s) and their characteristics, context, and developmental timeline. Which
would you identify as most needing to be addressed base on an IT framework of
your choice (possibly make a quick phone call to your IT department and ask
them which framework is currently used at your hospital. Research this framework and add your
perspective based on personal experience.)
Define what cognitive systems engineering
is and the focus of this discipline ~ Discuss the implications of a
socio-technical system are and how they apply to the healthcare setting. What issues do joint cognitive systems
address?
Chapter 22:
4.
Discuss how standardized terminology enhances the monitoring of
healthcare quality and outcomes. Review
ways in which standardization of terminology will advance healthcare
research. Give examples/support with
data.
Chapter 23:
5. Lets look at the idea of data
mining (KDDM) compared with randomized control trials (RCT): In a randomized control trial, inclusion
criteria is very strict to limit errors in methodology. Compared to KDDM, RCT
can be quite lengthy and time consuming as well as costly.
When is the traditional gold-standard
research method of RCT not “enough”?
What are the drawbacks and limitations of
RCT?
Discuss areas of needed improvement in the
use of KDDM, what are the potential future benefits in cost-effectiveness of
KDDM.
In your opinion, will KDDM eventually
replace more traditional research methods such as RCT? Why or why not?
Chapter 24:
6. Patient safety and quality of
care are not improved simply by the implementation of an HIS, but by ongoing
evaluation to identify needed interventions and incentives to increase the
fidelity of use. Ultimately, health IT
is just a tool to improve patient outcomes.
Meaningful use initiatives laid a great foundation, but have proven to
be somewhat lacking. Why are these
initiatives not enough to advance best practices in all settings? What else is needed?
NUR3164
Introduction to Nursing Research and Health Informatics
Unit 6
Discussion
Link
(Links to an external site.)Links to an external site.Follow the
instructions under DISCUSSION BOARD RUBRIC and Discussion Guidelines and APA
Tips to create your post and respond to at least one other student. Internal
citations and references are required.
This week, choose ONE chapter from this
week's five chapters as your primary discussion post, then please respond to a
post on a topic other than the one you chose for your initial post:
Chapter 25: Legal Issues, Federal
Regulations, and Accreditation
There are three key fraud & abuse laws:
the Stark Law, the Federal Anti-Kickback Statute, and the Federal False Claims
Act.
Define one of the fraud and abuse laws and
expand on the purpose of this law in healthcare and identify a case in which
one of these laws were violated. What are the penalties for violating this law?
(For example: Review this violation in a case using the Anti-Kickback
Statute: Link to Case) (Links to an
external site.)Links to an external site.
Explain the safe harbor protections against
criminal and civil prosecution for Stark and Anti-Kickback violations.
Chapter 26:
Privacy & Security
As healthcare providers, earning and
keeping patients’ trust & ensuring privacy is paramount ~ ethically,
morally & legally. Legally, there
are a range of penalties and fines that can be assessed to healthcare
organizations for security breaches.
Research sources of new and increasing
threats to health data security.
Investigate and explain what federal and
state collaboration efforts (if any) exist for the state in which you live or
practice. Does your state currently participate in Health Information Security
and Privacy Collaboration (HISPC)? If not, are there plans to become involved
in this partnership? (This information should be available through the state’s
Department of Health or at the HealthIT.gov page on HISPC). (Links to an external
site.)Links to an external site.
Chapter 27: HITECH, MU & MACRA
Describe the Medicare Access and CHIP
Reauthorization Act of 2015 (MACRA) and how it came about. How did the Medicare
Access and CHIP Reauthorization Act of 2015 change how Medicare pays
physicians?
What is its potential impact in value-based
payment models?
Chapter 28: Health Policy
We are still in the early stages of
implementing health IT and as this are of technology grows, the nurse’s role in advocacy, leadership,
collaboration, and policy making will continue to grow with it. Explore at least 2-3 of the links below and
answer the following questions:
Informatics and the Future of Nursing
Practice (Links to an external site.)Links to an external site.
IOM’s “The Future of Nursing: Leading
Change, Advancing Health” (Links to an external site.)Links to an external
site. – Link to IOM PowerPointPreview the document
Alliance for Nursing Informatics (ANI)
(Links to an external site.)Links to an external site.
HIMSS Nursing Informatics Workforce Survey
(Links to an external site.)Links to an external site.
HIMSS Nursing Informatics Position
Statement, “Transforming Nursing Practice Through Technology and Informatics”
(Links to an external site.)Links to an external site. - or if that doesn’t work, here is a PDF link
TIGER Initiative, TIGER Action Plan, and
TIGER Standards and Interoperability Collaborative Center to Champion Nursing
in America (CCNA) (Links to an external site.)Links to an external site.
Discussion prompt:
What qualities and characteristics are
necessary to be an effective informatics nurse in the public policy arena?
How are these skills unique or somewhat
different from the characteristics that make a good nurse in general? How are
they the same? That is, what required traits are shared to perform these roles?
Chapter 29:
HIT Governance
Considering that there has been increasing
and competing demands on health IT resources, very little has been published
and studied about the topic of health IT governance. Although health IT
governance is a relatively “new” concept, the demands for this expertise are
vast and the needs are immediate.
Healthcare reform is one example. Explore
the links below and answer the following questions: Link to article: Nine best practices in heathcare IT
governance (Links to an external site.)Links to an external site.
Explore and discuss what health IT
governance encompasses.
What's the relationship between IT
governance and GRC (governance, risk and compliance)?
Why do healthcare organizations implement
IT governance infrastructures?
What challenges and opportunities lie ahead
for those choosing to enter this healthcare industry?
NUR3164
Introduction to Nursing Research and Health Informatics
Unit 7
Discussion Part 1
Ethics & Health Informatics: Part I
According to the federal regulations for
human subjects research, children, prisoners, and pregnant women are considered
the “vulnerable” population. However,
there are actually other sub-populations that are often considered vulnerable
due to the nature of terms of their participation ~ that would include
students, employees, impoverished, elders, ethnic groups, disenfranchised
populations and cognitively impaired individuals (with cognitively impaired, it
is primarily related to the capacity to give informed consent).
So, what does this mean to the
student/employee as a vulnerable population?
(1) a potential subject can be influenced/induced to participate or (2)
a potential subject can find themselves in a situational/positional
vulnerability subjecting them to coercion.
The difference between these is that with unduly influencing a potential
subject, one is offering them an excessive or inappropriate reward for their
participation. When I received IRB
approval for my study, I had to offer support to show that the gift card I was
giving was a reasonable amount that would not cloud the potential subjects’
decision-making with the offered reward.
Coercion on the other hand, is when someone’s power/position is used to
negatively impact the potential subjects if they don’t participate, influencing
the “voluntary choice” aspect of the research.
(Teacher saying you get an A if you do participate and “a poor grade” if
you don’t ~ that type of thing.)
Institutional Review Boards (IRB) are
designed to safeguard against these issues, and all research involving human
subjects must have IRB approval.
So ~ Where did we come from and where are
we going in the area of ethics?
Discussion Board Topic:
Part I:
After reading the Belmont Report, Answer ONE of the following questions
~ the goal is that all of the questions get covered by the students in this
class for all of you to review.
Expand on the Nuremberg Code and its role
in the current ethical guidelines
Expand on the declaration of Helsinki and
its role in the current ethical guidelines
Many research studies that were identified
as “unethical” lead to the task force and other documents forming today’s
ethical guidelines. The majority of these experiments are horrific, but deserve
to be remembered, lest we forget where we came from. Choose ONE of the following studies to expand
upon, including their implications to the study subjects and to the development
of ethical guidelines.
Tuskegee Syphilis Study
Biomedical experiments on children: The
polio vaccine trials
The 1956–1971 Willowbrook hepatitis studies
(institutionalized children)
Clinical trials involving thalidomide
Experiments on twin children in German
concentration camps conducted by J. Mengele from 1943 to 1944 on approximately
1,500 sets of imprisoned twins at Auschwitz
What are the three ethical principles
identified by the Belmont Report? (expand on each)
Who are the vulnerable populations
protected by the Belmont Report? (how is "vulnerable" defined and how
are they protected?)
What happened in the U.S. AFTER the Belmont
Report in the U.S. in the area of ethical research practices?
What is an IRB, who does it protect, and
who offers it?
What must be included in informed consent?
NUR3164
Introduction to Nursing Research and Health Informatics
Unit 7
Discussion Part 2
Ethics & Health Informatics: Part II
Part II:
Health related journals and research articles: Identifying ethically conducted research
For a peer-reviewed journal, the
publication of articles plays an essential role in the development of the body
of knowledge. Therefore, it is essential that all publishers, editors, authors,
and reviewers, in the process of publishing the journals, conduct themselves in
accordance with the highest level of professional ethics and standards. Many
journals follow the recommendation of the Committee of Publication Ethics (Link
(Links to an external site.)Links to an external site.) but many journals state
their ethical practices where an author would submit an article for
publication. Two of the most prestigious
journals are the British Medical Journal (BMJ) and the Journal of American
Medical Assoc.(JAMA).
British Medical Journal Author Hub
discusses its ethical approval standards for conducting research on human
subjects, appraisal of ethical issues, and what happens if a submitted journal
for publication doesn't meet their stated standards: Link
(Links to an external site.)Links to an external site.
Journal of American Medical Assoc.
discusses it's requirements of the authors to conduct ethical research, obtain
appropriate IRB/ethics committee review or follow the principles outlined in
the Declaration of Helsinki: Link (Links to an external site.)Links to an
external site.
(hmmm...where have you seen this
before?! Hint: Part I)
Discussion Board Assignment:
Select a research article that involves a
vulnerable population as identified by the regulations for human subjects
research (
As expanded on in DB 1: children,
prisoners, pregnant women, students, employees, impoverished, elders, ethnic groups,
disenfranchised populations and cognitively impaired individuals (with
cognitively impaired, it is primarily related to the capacity to give informed
consent).
Summarize the article in 1-2
paragraphs: include the article’s
question/hypothesis
Introduce the vulnerable population of
interest & the social aspects of this group
Did they identify the Institutional Review
Board approval or ethics committee? If so, what was/were the reviewing
institution(s)?Give your professional opinion as to effectiveness of the
protection of the vulnerable population in the conducted the research ~ any
thoughts?
