Consumer-Centered Computer-Supported Care for Healthy People.
Proceedings of NI2006
Volume 122 Studies in Health Technology and Informatics
Edited by: H.-A. Park, P. Murray and C. Delaney
Amsterdam, Netherlands: IOS Press
June 2006, 1104 pp., hardcover
Price: US$200 / 160 [euro] / 110 [pounds sterling]
It is also possible to order separate chapters or articles of this book on: www.booksonline.iospress.nl
A book from a conference, especially the Nursing Informatics 2006 conference in Seoul, Korea, can be a wonderful resource, and this is. Many CARING members attended this conference, and 56 of the 158 papers were presented or co-presented by CARING members. Trying to summarize a 1000 + page book that presents so many topics is an impossible task. In this review, I will briefly describe just a few of the many excellent articles it contains, leaving it to you the reader, to seek out the book to investigate the others. The job of selecting the papers to review is akin to a hungry person looking at hundreds of goodies all of which he/she wants (3 key note speeches, 158 papers, and 169 posters) when he/she can only select five.
The book is divided into four overall sections: keynote speeches, papers, posters, and demonstrations. The paper and poster sections are further subdivided into many different categories such as consumer informatics, decision support systems, and electronic health records. One of the strengths of the book is that, unlike many conference books, which usually contain only an abstract for presentations, this one includes both an abstract and the full paper for the three keynote speeches and the papers. Poster sessions are represented with an abstract and a brief description, but like all the other papers, contain references, keywords for further searching, and contact information for the authors.
Simpson, R.L. (Coherent Heterogeneity: Redefining Nursing in a Consumer-Smart World, p. 3-8)
Simpson discusses the need for nursing to move beyond the status quo. He writes that some factors creating this mandate are the increased communication that has made personal computers user friendly, the Netscape[R] Web browser that has led to digitization of much of the world's knowledge, and applications that allowed people to access and manipulate this digitized content. This has led to two things. First, the extension of the global economic world and an increase in travel have created the threat of diseases that heretofore were contained in one geographical area being seen anywhere. Second, the availability of knowledge that once was a purview of only professionals has been extended to anyone who has both an Internet connection and the ability to search, allowing patients to be knowledgeable about disease and health conditions. Another factor demanding attention is the nursing shortage resulting from efforts to reduce costs by cutting staff to create profits for managed care. Despite these evolutionary changes, Simpson writes that nursing has not yet evolved as a profession to the extent needed to be proactive within this environment. He believes that to adapt to this consumer-centric world, nursing needs a mission statement that includes the task (adapt to this world), purpose (to survive and flourish in this world), and actions to implement the mission (improve practice, care, and the profession).
Wong, T.K.S. (Feeling the Digital Pulse: Consumer-Centered Approach to Individual Health Profiling, p. 9-17)
Wong introduces the idea of a "consumer-centered approach to individual health profiling." This philosophy is implemented by the School of Nursing at the Hong Kong Polytechnic University using a telehealth system which has three components: a telehealth clinic; a Web-based information center; and a health statistics center. The telehealth clinic generates data from patients using user-friendly self-diagnostic tools such as a telestethoscope, a teleauroscope, a dermacam, and a non-mydriatic retinal imaging system that generate and transmit data to the center. This data is used by nurses to tailor interventions based on need. Wong reports that there is a large gap between consumers and health care providers in the use of convenient, cost effective technologies for home care such as non-invasive blood glucose meters, pulse diagnostic systems, and a smart device for sleep apnea. He envisions the use of data from such self-monitoring to be used in a proactive role in preventative health rather than as a status quo recording.
Patel, V.L. and Currie, L.M. (Clinical Cognition and Biomedical Informatics: Issues of Patient Safety, p. 18-22)
Patel and Currie address the problem of patient safety in information management when the role of cognition is ignored. They examine how nurses process information both from a theoretical and practical viewpoint. Their research has led them to believe that instead of Benner's linear progression in clinical decision making from novice to expert there is actually a U shaped progression. Novices generate few ideas because of their lack of stored knowledge and make few searches for more information. Intermediate level nurses, who have more knowledge, but have not yet structured that knowledge in an organized, usable manner, will generate many hypotheses and chase many irrelevant bits of knowledge. Gradually, the expert organizes his or her information and generates fewer, but more relevant, hypotheses hence need less information. The paper concludes that because of a lack of adequate knowledge about usability, we still have to train people to adapt to poorly designed systems, rather than design automated systems that fit people's characteristics.
Canon, M.A. Smith, K. and Bickford, C.J. (Case study: A View of Informatics Nursing from a Clinical Nurse's Perspective, p. 284-287)
These authors reported on the difficulties incurred in a transition to a new unit that were created by not including an informatics nurse in the planning for a major redesign and renovation of a surgical ambulatory care unit. Specifically they encountered five problems: an inadequate number of computers resulting in additional waits for clinic patients; improper installation of needed software on the installed computers requiring one month of reprogramming; the cutting of the connection to the wireless system during construction creating an extra expenditure of $4680; the mandated use of new programs with insufficient training; and the inability to record information about patient education required by the Joint Commission. The paper closes with suggestions for preventing these problems.
Welton, J.M. Halloran, E.J. & Zone-Smith, L. (Nursing Intensity in the Footsteps of John Thompson, p. 367-371)
Despite indications that nursing care is related to outcomes, and findings that the Diagnosis Related Groups (DRG) do not adequately represent actual nursing care, billing for nursing care today is still generally billed as a fixed cost, often part of room and board with no concern for any data other than length of stay and the type of unit. A study reported in 2000 by Welton and Halloran found that adding nursing diagnoses to DRGs provided a better explanation for length of stay, hospital charges, and mortality. The study reported here by the same authors plus Zone-Smith compared adding either nursing diagnoses or data from a nursing intensity database in which nurses enter direct time spent with each patient to DRGs. They found that this process more fully explained costs, strengthening the case for adding a measure of nursing intensity to reimbursement for hospital costs.
Mills, M.E. (Linkage of Patient Records to Support Continuity of Care: Issues and Future Directions, p. 320-324)
The call for full electronic health records that span institutions requires the linkages of patient records. Mills presents the benefits and examines some of the technical, regulatory, and practical issues associated with this endeavor. Americans have multiple healthcare records, scattered in many places, and unfortunately, 1 out of every 20 patients has duplicate records from the same provider, each with different identification numbers. One suggestion that she makes to ensure accurate identification of records is to use biometric identification such as fingerprinting, although this too presents difficulties. Another large issue is standardization in spellings and codings, plus an agreement about what data to collect. All of these decisions need to be made at a level beyond an individual agency; a situation that is proving difficult even with providers under the same ownership. Confidentiality is also addressed.
Gugerty, B., Maranda, M. & Rook, D. (The Clinical Information System Implementation Evaluation Scale, p.621-625)
Much money has been spent on clinical information systems with varied success. In this paper the authors describe the process they used to develop a generic form that could be used for both formative and summative evaluation of clinical system implementations. Starting with an earlier evaluation questionnaire that was developed to evaluate the implementation of a critical care system, they used focus groups and expert panels to further refine the form to be more generic. This form was then used to evaluate user satisfaction with the implementation of a critical care implementation system at a Florida hospital. The questionnaire, which focuses on user satisfaction with the implementation, not how the system functions, was administered to staff nurses three to five months post "go-live." Results demonstrated that users generally agreed that they had a strong commitment to the successful use of the system, a high satisfaction with the impact on the functioning of their team as well as the department's role in the introduction of the system and their training. They also believed that patient information was more confidential and secure. Users, however, felt that they did not have enough say in the development of the system, that the system added to their workload, that it did not allow them to spend more time on other aspects of patient care, and that it did not improve the quality of their practice. The authors believe that this questionnaire is still a work in progress. It should, however, be usable with any clinical system to quickly design and implement needed changes that shorten the post-implementation period.
The poster categories, although containing all the categories contained in the papers, include two additional areas: clinical informatics and confidentiality and security issues. The first category contains information from posters about a pressure ulcer nursing information system and a venous thromboembolism safety toolkit. The posters in the confidentiality and security category address data integrity and completeness.
Some of the software included in the demonstration section contain interactive program that provides interventions for managing depression in patients living with HIV; a Web-based suicide prevention source; and the use of evidence-based knowledge in a nursing documentation system. You will also find descriptions of two programs that pertain to nurse practitioner students as well as two systems facilitating the use of standardized nursing terminologies.
The papers in this book come from all over the world and represent many different aspects of nursing informatics, including reflections on the past and cutting edge uses of informatics, as well as everything in between. Because it includes so many different topics and perspectives on each topic, if you only want one book about informatics to use as a reference for generating ideas and practices, this is it.
Reviewer: Linda Q. Thede, PhD, RN-BC
Dr. Thede is a Professor Emeritus from the College of Nursing at Kent State University. She is the current editor of CIN Plus, which is part of CIN: Computers, Informatics, Nursing. She is the author of Informatics and Nursing: Opportunities and Challenges, whose third edition will be published in January 2009. She also writes an Informatics column in The Online Journal of Issues in Nursing (OJIN) http://www.nursingworld.org/ojin/.
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|Author:||Thede, Linda Q.|
|Article Type:||Book review|
|Date:||Jun 22, 2008|
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