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For this discussion I evaluated two different sites as required and used the evaluation methods discussed in the tutorial. The web sites I looked at were, The American Cancer Society @ cancer.org and Live Strong @ live strong.org. The way in which they were reviewed was by using authority, accuracy, currency, and objectivity.
The American Cancer Society (cancer.org) website was very good and the better of the two I evaluated. I actually recomend this site to my patients and patients family members if and only if I see a need for them to search for information. Usually when one of my patients has been given a new diagnosis I tell them to stay off the web for fear of becoming overloaded with information. However, I would and do recommend the ACS website as it is "tried and true."
ACS and Authority; The website gives full account of who writes, edits, and publishes the content on the site. Contact information is also included via e-mail, addresses, phone numbers, and live chatting. ACS and Accuracy; Information is seemingly accurate and verifiable. Sources are listed and links to sources are provided. ACS and Currency; All links work and several outside sources are provided. Many outside resources listed aid in the logistical side of caring for cancer and other treatments thereof. Information is updated with regularity and dates are provided. There are also web reviews whereby the site content is trimmed, updated, or removed. Dates are also provided with regard to site revisions. ACS and Objectivity; Since the information is focused on cancer and treatment thereof the site could seem biased. However, the site is not "selling" anything and is only providing information therefore no bias or agenda is felt while viewing it.
I believe that this site is an important site as related to its consumers and provides very important and useful information. I think that anyone who is effected by cancer would benefit by incorporating this site as a tool to navigate the rather complex world of cancer. As for its use in my practice I will continue to recommend it with a higher regard than others. I think that consumers can understand what is given on the site and have access to helpful resources should they have further questions.
Live Strong (livestrong.org) was the other site I reviewed. It also revolves around cancer, cancer types, treatments, and other logistics with regard to care. I found this site to be useful but I felt that the site was almost trying to brand a cancer as a happy type lifestyle. I may be wrong, but when it comes to cancer, there is no place in any stile of life for it. LS and Authority; The site lists board members and contributing staff. Addresses and contact info are provided along with links to outside resources. LS and Accuracy; Accuracy of information is seemingly correct however there are not many links to references nor are there many outside links to credible sources of information. LS and Currency; This site provides few links which is strange and there are very little dates with regard to revisions. LS and Objectivity; Seemingly this site is objective towards its target audience but it has a link to a gift shop. I could not find out if proceeds go to fund the site or if they go towards patients. Overall the site was nice but since it seemed to push a lifestyle rather than just useful information therefore I could not validate if it was fair and balanced. I would not recommend this site for my patients due to the potential platform of "cancer as a lifestyle" it portrays. I think that it could use help in it authority and provide more useful links as well. I think that if i were to this site recommend this site my patients may become overwhelmed and confused in an already complex process.

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Telehealth Discussion Nursing Informatics (Andrew Skipper)

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Telehealth Discussion Nursing Informatics (Andrew Skipper)

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Working on an oncology unit I see many different types of people affected by a very serious and oftentimes confusing and complicated disease. More often than not family members and caregivers alike miss the doctor when her/she rounds and have several questions when they come back regarding treatment, care plan, labs, etc. Usually the patient is unable to relay this information as the complexity surpasses his/her understanding. Therefor the family and/or caregivers become frustrated as they are in the dark related to the information they were wishing to receive. As a dedicated RN to my patients I will dig through the notes left by the MD, text the MD or their PA, and attempt to compose a picture of care for the patient and their family to help them understand what is going on. To aliveiate this problem we try and give the best times as to when the doctors will round but with no real schedule it becomes a virtual crap shoot for the family as to when to stay in the room for the doctors visit. Telehealth as described by Alexander et. Al. (2015), is the "use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration." Given this expanding and seemingly unlimited technology several complications within healthcare including the one described could be rectified.
If a system of facetiming  could be facilitated for all in-patients and their families/caregivers information disseminated during rounds could be properly communicated thus aiding the process of keeping everyone on the preverbial same page. Many patients and their families have personal communication devices that could be used, however, not all families are so monetary inclined. Health systems could adopt a form of facetiming  and provide the patients family with a small, cheap, and effective portable device that would allow for them to "be in the room" when the doctor is there given the advances in tele health. When the doctor enters the room the patient would have the option of turning on the device and connect with loved ones that might not be able to be there at a given time. Buy in for the system could be evaluated by providing indepeth education and training to doctors, staff, and patients needing this service. Also, tracking the success of this system using quantifiable and trackable metrics would display the so called bottom-line in terms of cost effectiveness. And finally, setting up clear quality standards that establish the structure in which the system is used will help those using it to actually see its effectiveness. Currently our hospital has a system called MARTY that allows for non-English speaking patients to have a realtime interpreter in the room via a FaceTime system. This system is effective but it is not cost effective, reliable, or easily set-up. Often times healthcare workers use family members to interpret but this method requires said member to stay in the hospital as well. This area of telehealth within the hospital surly needs a systems review and could use a few improvements to say the least.
References: Alexander, S., Frith, K., Hoy, H. (2015). Applied Clinical Informatics for Nurses. Burlington, MA: Jones & Bartlett Learning.

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It is without question that databases are a valuable and integral part of the health care community at every level and every discipline from house keeping to the ICU. Recording data such as patient information, medications, procedures, orders, times, dates, instructions, and the like has proven to be valuable in many ways. As a clinician the advantages of being able to look up a disease process, medication interactions, orders, and even phone numbers has greatly improved the way I am able to deliver care to the patient. Information is key, information is power, and information is health. Being able to use a data base to deliver an explanation of a disease process to a patient or patients family in terms they can understand and process is a great gift. Information, and being informed properly assist in improved patient outcomes. When a patient understands exactly what is happening they are able to release a part of their anxiety and use that energy to facilitate a healing of self or soul. That's important in my practice as a nurse and that is something that I will pass on to future students. Informed practice conversations that take place on the patients level will produce positive outcomes to the overall situation the patient is facing and information systems when used properly facilitate that unequivocally.
Having said all of that I believe that informations systems have become a juggernaut in and of themselves. Learning the nursing process and learning health information systems (HIT) together can be overwhelming to the average college student not to mention the nontraditional  nursing student. So far in this program I have spent more time learning the apps and programs than I have the actual content of our classes and I'm sure I'm not the only one. Right?  Nevertheless when one gets past the learning curve a dawn of understanding is revealed and a practicality to what we do is realized.
I was actually excited by this discussion and the ability to evaluate a website. I am usually a cynic when it comes to technology but I appreciate the benefits of it as well. I am a walking hypocrite in the field of technology but at least I know it and accept it. After spending a while navigating the AHRQ website I found it both helpful and frustrating. I find a definite advantage to my practice in the way of information alone, and I feel that it could be useful in my current practice as an Oncology RN but way of informing my patients to rather complicated disease processes and treatment modalities. On the other hand I found it to be convoluted at best. Navigation and quick access to resources I am actually looking for seem to be lacking and I spend valuable time dissemination vast amounts of information, a needle in  a stack of needles if you will. As stated in Alexander et al (2015), "Increasing amounts of healthcare data that are collected will influence the needs for new types of applications and analyses of such data. To support these new applications and analyses, systems that complement relational databases will need to be developed." Well said by the author I'd say. I believe that the information needs to be organized or a program that can find what I want faster and with more accuracy will only help us in the long run.
As far as the usability of the website, I found it to be average at best but I may be overly judgemental in my analysis based on what I said in the prior paragraph. The website was easy to use at first but as I increased the focus of my searches my results became more skewed and less related to what it is I was actually looking for. The efficiency met the same review as learnability in that increased detail only brought more frustration. Memorability didn't seem to be much of a problem as the process itself of finding information was not difficult. Over all I was seemingly satisfied with the website and would even recomend it to others. However on a day to day use or for a very detailed search I may stick to other sites.

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Personal Experience:
I have been a nurse for 10 years and have seen the systematic implementation of health information systems a multiple times and in multiple healthcare environments. While working in an emergency department early in my career the hospital launched EPIC. The staff of the hospital had to be educated for several weeks and log several hours of practice within a virtual environment. The training was fast but effective, nevertheless an overwhelming anxiety was very much present on the actual launch week. Being that I worked in the ER where time is of the essence, we all felt that launch day one would be a catastrophe and patient care was going to be greatly affected. Our hospital system provided super users at a ratio of 2 nurses for every 1 super user. They would be available for two weeks on a decreasing availability as the staff became more and more comfortable thus facilitating a smooth transition. In the end time would be saved within the overall care of the patient, assessments and procedures would become safer, charting accuracy increased and became more efficient, and the level of efficiency would greatly improve.
Again, I would see the implementation of another computerized charting system while I worked in the home care setting. The company would transition to an iPad charting system that used another type of software. There would be more training associated with this transition, however, total and reliable crossover from paper to computer was less efficient and not as effective. I believe that problems would be due to the lack of education on the software and that the connectivity of the iPads at the time was lacking which lead to frustration and noncompliance by several staff. Other problems were also due to the fact that in a home care setting it is very hard to organize staff around a typical training schedule making education difficult. The overall transition to an effective and reliable charting system that the employees could comprehend and effectively use took around one year. 
Currently I work at Kettering Medical Center on an oncology unit. We use EPIC there for all charting and a system called BEACON for all chemotherapy administration. After a few years of experience and practice i have come to appreciate EPIC very much. The BEACON programming was a learning curve but in the end has proven to be extreamily effective in the organization and administration of chemo therapy. Both programs aid in proper management, assessment, and overall care for the patient by not only a time factor but security and safety factors as well.

Successes/Obstacles:
As discussed in question one, I feel a great sense of security by using EPIC. I find that the access of information has increased my productivity and effectiveness to to deliver better health care to my patients. I have found myself becoming more and more organized in my routine and have been able to pass on the little things within nursing to younger nurses hopefully making them more efficient. I think that assessments have also imporoved with the ability of a comparison directly at your fingertips. Seeing how a patient was on a prior shift is extreamly valuable given a sudden change of patient condition. I also appreciate the ability to see all disciplines and their assessment notes as well. I am able to use that information to better inform the patient and their family members of the plan of care, condition changes, and any prognoses as well.
The problem I have with EPIC is the convolution of its platform. Several times a day I am asked how to do something, how to chart something, or where to find something on the computer. I also find the fact that a patients chart is not readily availability when of if that patient is being treated at another healthcare system or in another state. This is a suggestion that I would love to take to the state and even national level. I believe that in the interest of the patient some sort of decoding or deciphering program should be constructed/invented that would allow for all different types of HIT systems to seamlessly communicate. Think about the time, money, and even lives that could be saved if you could have your records immediately accessed if you were in another part of the country and an unfortunate event took place. I believe that at times technology can and does get the better of us and that that simple fact could play a large role in a very large catastrophe. 
Importance in end user testing:
End user testing should be imperative to any organization thatwants  to be successful. If an organization doesn't value the feedback of their employees they are setting the system up for potential failure. At Kettering representatives from the IT department are constantly rounding to make sure there are no issues with the program. They even ask for suggestions and host open meetings in a town hall format to discuss the system, any changes, and suggestions of the nurses, who use the system the most. This feed back is a key element in the satisfaction of the employees which in-turn is a benefit to the patient.
Point end user testing is important:
I personally believe that end user testing is important from the beginning of development all the way through the role out, implementation, and continued use of a given product. I think that this statement holds up for any product regardless. We are in the business of caring for the lives of human beings and ideally there should be no limitations thereof. I know business rules may dictate differently, however, if my grandma, mother, or wife, had a complication due to a malfunction of a software system that was not checked and rechecked I would not be happy. If we must go through the school and keep ourselves educated across the continuum of care so must our HIT systems. No exception, not even cost. In the end if we spend the money now to develop the right tools for the job, so to speak, then our future and the future of our patients will become much more secure.

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Personal Experience:
I have been a nurse for 10 years and have seen the systematic implementation of health information systems a multiple times and in multiple healthcare environments. While working in an emergency department early in my career the hospital launched EPIC. The staff of the hospital had to be educated for several weeks and log several hours of practice within a virtual environment. The training was fast but effective, nevertheless an overwhelming anxiety was very much present on the actual launch week. Being that I worked in the ER where time is of the essence, we all felt that launch day one would be a catastrophe and patient care was going to be greatly affected. Our hospital system provided super users at a ratio of 2 nurses for every 1 super user. They would be available for two weeks on a decreasing availability as the staff became more and more comfortable thus facilitating a smooth transition. In the end time would be saved within the overall care of the patient, assessments and procedures would become safer, charting accuracy increased and became more efficient, and the level of efficiency would greatly improve.
Again, I would see the implementation of another computerized charting system while I worked in the home care setting. The company would transition to an iPad charting system that used another type of software. There would be more training associated with this transition, however, total and reliable crossover from paper to computer was less efficient and not as effective. I believe that problems would be due to the lack of education on the software and that the connectivity of the iPads at the time was lacking which lead to frustration and noncompliance by several staff. Other problems were also due to the fact that in a home care setting it is very hard to organize staff around a typical training schedule making education difficult. The overall transition to an effective and reliable charting system that the employees could comprehend and effectively use took around one year. 
Currently I work at Kettering Medical Center on an oncology unit. We use EPIC there for all charting and a system called BEACON for all chemotherapy administration. After a few years of experience and practice i have come to appreciate EPIC very much. The BEACON programming was a learning curve but in the end has proven to be extreamily effective in the organization and administration of chemo therapy. Both programs aid in proper management, assessment, and overall care for the patient by not only a time factor but security and safety factors as well.

Successes/Obstacles:
As discussed in question one, I feel a great sense of security by using EPIC. I find that the access of information has increased my productivity and effectiveness to to deliver better health care to my patients. I have found myself becoming more and more organized in my routine and have been able to pass on the little things within nursing to younger nurses hopefully making them more efficient. I think that assessments have also imporoved with the ability of a comparison directly at your fingertips. Seeing how a patient was on a prior shift is extreamly valuable given a sudden change of patient condition. I also appreciate the ability to see all disciplines and their assessment notes as well. I am able to use that information to better inform the patient and their family members of the plan of care, condition changes, and any prognoses as well.
The problem I have with EPIC is the convolution of its platform. Several times a day I am asked how to do something, how to chart something, or where to find something on the computer. I also find the fact that a patients chart is not readily availability when of if that patient is being treated at another healthcare system or in another state. This is a suggestion that I would love to take to the state and even national level. I believe that in the interest of the patient some sort of decoding or deciphering program should be constructed/invented that would allow for all different types of HIT systems to seamlessly communicate. Think about the time, money, and even lives that could be saved if you could have your records immediately accessed if you were in another part of the country and an unfortunate event took place. I believe that at times technology can and does get the better of us and that that simple fact could play a large role in a very large catastrophe. 
Importance in end user testing:
End user testing should be imperative to any organization thatwants  to be successful. If an organization doesn't value the feedback of their employees they are setting the system up for potential failure. At Kettering representatives from the IT department are constantly rounding to make sure there are no issues with the program. They even ask for suggestions and host open meetings in a town hall format to discuss the system, any changes, and suggestions of the nurses, who use the system the most. This feed back is a key element in the satisfaction of the employees which in-turn is a benefit to the patient.
Point end user testing is important:
I personally believe that end user testing is important from the beginning of development all the way through the role out, implementation, and continued use of a given product. I think that this statement holds up for any product regardless. We are in the business of caring for the lives of human beings and ideally there should be no limitations thereof. I know business rules may dictate differently, however, if my grandma, mother, or wife, had a complication due to a malfunction of a software system that was not checked and rechecked I would not be happy. If we must go through the school and keep ourselves educated across the continuum of care so must our HIT systems. No exception, not even cost. In the end if we spend the money now to develop the right tools for the job, so to speak, then our future and the future of our patients will become much more secure.