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Respond to two peers offering additional/alternative ideas regarding opportunities and risks related to the observations shared.
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Discussion Post-Healthcare Technology Trends
The United States health care system faces many challenges as the need for technology increases, and costs continue to rise. In 2004, President Bush stated that all Americans would have an electronic health record (EHR) by 2014. He said, “by computerizing health records, we can avoid dangerous medical mistakes, reduce costs and improve care”(McGonigle & Mastrian, 2021, p. 294). In 2009, Congress passed the American Recovery and Reinvestment Act, which incentivized reimbursements for Medicare and Medicaid, penalizing healthcare organizations that did not adopt the EHR by 2015 ((McGonigle & Mastrian, 2021, p. 294). The EHR is a comprehensive electronic chart with a wide range of helpful information about patients, from demographics to primary care visits and radiology tests. Many advantages come with electronic charting and some challenges when implementing this system.
Implementing a new electronic charting system can be very expensive and challenging to learn in a small health care organization. As an emergency room nurse, when our hospital started out implementing the change from paper charting to electronic charting, it was a state of shock for most senior staff and physicians. Most physicians complained that electronic charting took too much time and took time away from seeing patients. Our hospital has since alleviated this complaint by allowing the physician group to pay for their scribes if utilized. Some of the senior staff resigned, stating that electronic charting was just too complex for them to learn, as most were not computer savvy, and the charting caused much anxiety. Our hospital has also changed its charting system three times in the last ten years, attempting to find one that extends a multidisciplinary effort.
Within the EHR, many new technology systems have drastically improved patient care and overall safety. From an ER standpoint, the mediation administration system (MAR) is one of the most effective systems. In a very busy ER, medication administration must be done correctly. This system has been proven to reduce medication errors, lower costs, and result in quicker administration of medications. However, this technology is not without setbacks when misused. Nurses find ways to work around the system. In a cardiac arrest in the department, the nurse may often select “emergency” instead of scanning the barcode; this is a high-stress time when many errors can happen. “Workarounds are performed to complete tasks, extend functionality, and evade designated limits in computer systems”(Yang et al., 2012). This can result in a very bad or life-threatening outcome.
The newest health care technology trend in the emergency department I work at is the use of the telehealth monitor. It has been an instrumental tool in working toward our stroke certification. It is impossible to always have a neurologist in the department. With the telehealth monitor, a neurologist is on the screen for a stroke assessment within minutes. Being able to decide on thrombolytics within minutes is life-changing for patients.
I feel that telehealth and electronic charts are both promising, along with many other new technologies that have been introduced. For a long time, patients and physicians longed for the traditional face-to-face interaction that personal interactions gave (McGonigle & Mastrian, 2021, p. 403). In 2020, telehealth increased drastically with the rise of Covid 19 and will continue to grow in its use. I think telemedicine will continue to emerge and evolve over the next several years. The advantages of telemedicine “include cost-effectiveness, ability to extend access to specialty services, and its potential to help mitigate the looming physician shortages” (Kichloo et al., 2020).
Kichloo, A., Albosta, M., Dettloff, K., Wani, F., El-Amir, Z., Singh, J., Aljadah, M., Chakinala, R., Kanugula, A., Solanki, S., & Chugh, S. (2020). Telemedicine, the current covid-19 pandemic and the future: A narrative review and perspectives moving forward in the USA. Family Medicine and Community Health, 8(3), e000530. https://doi.org/10.1136/fmch-2020-000530
McGonigle, D., & Mastrian, K. (2021). Nursing informatics and the foundation of knowledge (5th ed.). Jones & Bartlett Learning.
Yang, Z., Ng, B.-Y., Kankanhalli, A., & Luen Yip, J. (2012). Workarounds in the use of is in healthcare: A case study of an electronic medication administration system. International Journal of Human-Computer Studies, 70(1), 43–65. https://doi.org/10.1016/j.ijhcs.2011.08.002
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I work in a psychiatric/Mental health facility, when I started working in 2005 as a Licensed Practical Nurse (LPN) nurses were documenting all nursing care and interventions in papers and stored in individual charts of the patients. These charts were in a room called the chart room and every employee had access to the room. Anyone could come in and get a chart and that chart could be gone for the day. Also, nurses passed out medications using the paper version of the Medication Administration Record (MAR). Images, laboratory records, vital signs and blood sugars were recorded manually in papers and kept in the charts. In any employee wants to look up information about the individual, they will have to do so in the chart. There were times were certain information could not be recorded because the charts were not available. Some employees took charts and forget them in their offices and go home, and the chart will be missing for 2 days or more. Sometimes more than one person may needed a chart, and one has to wait until the other person gets through with the chart before they can use it, This may cause delay in documentation and sometimes, some information may be forgotten and not documented, Medication errors and omissions were frequent because orders were not taken off the chart on time, or forgotten.
About 2010, computers were introduced at my hospital for the good. It was not easy for some nurses to transition from paper documentation to electronic documentation. Now all health-related documentations are stored in computer as their Electronic Health Record (EHR). According to HealthIT.gov. (2018c), an electronic health record (EHR) is a digital version of a patient’s paper chart. EHRs are real-time, patient-centered records that make information available instantly and securely to authorized user. The EHR have brought so much ease in nursing care as every health information of the patient can be accessed easily for easy and fast intervention. Our nurses are able to use the computer system to administer medications faster and its safer because dosages can be calculated by the machines with less errors, the nurse can administer medications that want checking parameters like labs, vital signs, blood sugars by just looking the numbers up without flipping through different pages. With the electronic systems communications between the medical team is quite easy and fast.
Another electronic innovation witnessed at my job site is the use of cameras. Being in a psychiatric/mental health environment, abuse may be common since a lot of the patients have behavior challenges. So, the use of cameras was introduced as a safety measure for both the staff and the patients. In an article from Nursing Standard questionnaires (2017), a response of 61% said the cameras prevented confrontational situations because staff behaved more professionally while wearing body cameras, and 90% said they prevented confrontational situations because patients improved their behavior if being filmed. Since the introduction of cameras at my jobsite, the number of incidents between the individuals and the staff heave dramatically reduced because both everyone in the facility is aware that the cameras are rolling 24/7. This has greatly improved the patient-staff relationship and a safe place to work.
Also, another technological advancement introduced at my workplace is the electronic clock, with the recruitment of timekeepers and schedulers. Clocking in to work using the biometric fingerprints and having a scheduler to make the work schedule has taken away a lot of work from the Nurse managers. Employees are very satisfied with this system because each person can see their schedule on their smartphone using the app. It is so easy to use the app to change your schedule, ask for time off, and accept open shifts for over time without physically present at work or calling the nurse managers who may not be available to take calls at times.
Biometric technology has provided security to health information and reduce fraud because no one employee can use another’s fingerprint, facial or voice recognition to access health information. Curtin & Simpson (2000) reported that biometrics are much more difficult to violate than password and personal identity numbers and pins. Biometric technology is used to monitor vital signs of the patients to prevent cross contamination of virus especially with COVID-19. Manta et al (2020) state that as the healthcare system faces an unprecedented need for remote monitoring due to the COVID-19 pandemic, Biometric Monitoring Technologies (BioMeTs) offer solutions for collecting disease-related measurements from patients at home. BioMeTs offer convenient opportunities to collect frequent and objective data and disease-related measurements, which facilitates assessing trends and detecting changes in vital signs not traceable by conventional spot check data collection protocols.
Manta, C., Jain, S. S., Coravos, A., Mendelsohn, D., & Izmailova, E. S. (2020). An Evaluation of Biometric Monitoring Technologies for Vital Signs in the Era of COVID-19. Clinical and Translational Science, 13(6), 1034–1044. https://doi.org/10.1111/cts.12874
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