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Eastern Florida NUR3164 2019 March All Units Discussions Latest

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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?

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