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Contributions:

Courtney Timmins:

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Terms, Introduction, Defining a Culture of Safety, Informatics Technologies for Patient Safety, Technologies to Support the Medication Administration Cycle, Additional Technologies for Patient Safety

Unless otherwise noted, all images, articles, and videos

Submission of Padlet to DB

Juli Teselle:

Impact of Informatics

Group questions

Wanda Winfield:

Strategies for Developing a Culture of Safety with image

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This section focuses on the latest current events of COVID-19 and its impacts on nursing informatics.

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Cameras are set up in the patient's room and monitored at the nurse's station.

Placed on units and at rehabilitation units where fall risk is high

Used to monitor epilepsy patients for active seizures and immediate intervention, or for continuous EEG monitoring to diagnose seizures

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Allows nurses and doctors to communicate with each through calls, emails, and texts

Reduces overhead paging in the hospital setting which can disrupt the patient's sleep

Offers direct nurse calls to the patient's room and bathroom without the call getting blocked or dropped

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The greatest risk to patient safety with medication administration is an adverse event. Today there are several technologies available to reduce medication errors.

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RFID Labeling & Barcode Medication Administration (BCMA)

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RFID Labeling & Barcode Medication Administration (BCMA)

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Radio-frequency identification (RFID) and barcodes store information in a database. RFID is usually used in healthcare for badges where the individual is tracked and their access to restricted areas is controlled, but both RFID and barcodes can be used for patient wristbands. Barcodes can now be 2D with color so alerts can be color coded and additional bands eliminated.

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A smart pump is an electronic infusion device that has dose-error reduction software imbedded in it. The purpose of the smart pump is to improve patient safety by reducing medication errors through a medication library. The library, which can be tailored to  suit the needs of the facility, has dosing guidelines for standard concentrations, dosing limits, and alerts.

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Distribution, storage, and tracking of medications is controlled by a computer  instead of manual distribution systems

Reduces medication dispensing errors

Limits access to and amount of medications

Allows for waste documentaiton

Automatically documents number of controlled drugs in inventory, who removed them and when, and how many

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Computerized Provider Order Entry (CPOE)

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Computerized Provider Order Entry (CPOE)

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Treatment instructions are created by a provider and transmitted electronically

Creates orders that are standardized, complete, and legible

Built-in clinical decision support tools that check for drug interactions and medication allergies

Flags orders that require pre-approval from insurance plans

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What is Computerized Provider Order Entry? (2018, March 21). Retrieved July 29, 2020, from https://www.healthit.gov/faq/what-computerized-provider-order-entry

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The Tech That Could Be Our Best Hope for Fighting COVID-19-and Future Outbreaks

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Smartphone apps, data analytics and AI all make finding and treating people with an infectious disease far more efficient than ever before.

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Efforts to combat the novel coronavirus rely on broad adoption of a few behaviors: physical distancing, frequent hand washing, wearing face masks in public and staying home when ill.

Alongside these populationwide tactics, health care authorities employ a proven method of disease control called contact tracing. Professional contact tracers interview people with confirmed infections about their recent whereabouts and the names of anyone with whom they have had close contact.

Contact tracers then inform those named about their exposure to the disease - without identifying the diagnosed patients - and guide them to obtain medical testing and practice self-isolation for two weeks to prevent further spread of the contagion.

This technique is effective, but also slow relative to the expansion of COVID-19 cases in many areas. Consequently, information technology experts are offering their support to improve the effectiveness of contact tracing.

"Artificial intelligence and machine learning can address the speed and logistical limitations of in-person contact tracing and do so in a secure and private manner," said Lalitha Sankar, an associate professor in the Ira A. Fulton Schools of Engineering at Arizona State University.

Sankar has been awarded a $200,000 National Science Foundation Rapid Response Research (RAPID) grant to advance the utility of mobile devices for contact tracing and even for the prevention of new COVID-19 cases. She is working toward these goals with Fulton Schools faculty peers Ming Zhao, Ni Trieu and Visar Berisha.

Balancing public health and personal privacy

Endorsement of the new ASU project reflects the limits of current digital technology for contact tracing - especially related to data security and individual privacy.

Apple and Google collaboratively released a software protocol in April enabling health care authorities to create mobile applications that leverage the vast number of smartphones in use to help monitor and mitigate the novel coronavirus.

Their model employs Bluetooth technology that exchanges anonymous codes, or "tokens," among mobile devices operating in close proximity for five minutes or more. If a smartphone user with one of these applications is subsequently diagnosed with COVID-19, the app enables health care authorities to electronically inform that user's recorded contacts of their exposure and direct them to testing and self-quarantine.

Advantages over traditional contact tracing include speed of outreach and the ability to advise relative strangers. In-person interviews can be effective for intervention among affected patients' friends and family, but not for those exposed by chance encounters.

At the same time, Bluetooth solutions generate concerns about data security and personal privacy. Some recently developed contact tracing apps contain coding links to social media platforms or permit targeted advertising.

Addressing these concerns, the new Apple and Google protocol does not use device location services, even though GPS would offer a significant means for identifying sources of infection. The companies prohibit this function because detailed records of where and when users are traveling also represent security and privacy risks that could undermine public participation.

While smartphone users are not required to use contact tracing software, broad adoption is vital to track and control disease spread. In order for smartphones to enhance COVID-19 mitigation efforts, large numbers of users need to download the apps offered by regional health authorities. If they do not, the data sets will be too small to be beneficial.

As a consequence, Sankar and her team are researching and developing a means to apply the capabilities of both Bluetooth and location services to support contact tracing and even to promote disease prevention, all while guaranteeing data security and personal privacy.

Distributing and aggregating on-device learning

"Federated learning is the key to these outcomes," Sankar said. "It's a method of machine learning that allows data residing on remote devices to be analyzed locally and to remain on the device."

A federated or distributed learning system uses a model that is sent to each participating mobile device and interacts with, or learns from, relevant personal data stored on the device.

The results of these data-and-model interactions are called parameters. In the case of the new ASU project, the parameters will reflect user mobility as well as phone sensor inputs related to personal health. Collectively, they can predict individual risk related to COVID-19 exposure.

With this model, each device will encrypt and return the parameters of what it has learned to a central server, which can help construct a detailed assessment of COVID-19 activity across the entire population of participating users. The results of on-device learning also can securely improve the performance of the entire system.

"The server aggregates those learned models and can thereby share an updated, richer model with all of the participating devices - and without sharing data from any one device," Sankar said.

She also says that similar techniques and well-studied applications from cryptography can be used by the server to expand the range of diagnostic capabilities.

"But the challenge here," Sankar said, "is to engineer a distributed system where devices can learn models in an energy-efficient manner."

Consequently, she will be working to develop such a system with Zhao, an associate professor in the School of Computing, Informatics, and Decision Systems Engineering, one of the six Fulton Schools. Zhao is an expert in developing methods to efficiently share locally learned models with servers, which are key to aggregating models from various devices in an effective manner.

Sankar believes that federated learning holds tremendous potential to make mobile devices a vital resource in COVID-19 mitigation. At one level, it can support existing contact tracing efforts, enabling authorities to more quickly reach people who have recently interacted with diagnosed patients.

"You go about your daily life and the app on your device builds graphs of your activity," Sankar said. "The data remain on your smartphone, but the model working on your phone periodically checks with the server to determine whether you have been near anyone for a sustained period who has just tested positive for COVID-19. If you have crossed paths, you are notified but they are not identified."

This will be possible because the activity graphs of people who test positive for the disease go to the server - anonymously - and can be used to inform others of exposure and recommend their testing and self-isolation. Consequently, server analysis of parameters aggregated from a large number of device users can foster disease prevention.

"There are locations where anyone is more likely to be exposed to COVID-19. Certainly hospitals, but also grocery stores and other places that many people frequent," Sankar said. "So, we are all more vigilant in those settings - or we should be. But the research we are beginning could develop a means to inform us about the current exposure risks of virtually everywhere we go."

The federated learning system behind the same mobile app that informs people whether they have been in close proximity with a recently diagnosed patient could also use data analysis to identify current viral "hotspots" in a given area. With such up-to-date information, users could make more informed choices about their movements. Imagine a smartphone display map with green, yellow and red zones of potential exposure based on recent diagnoses in those areas.

Trieu, who joins the School of Computing, Informatics, and Decision Systems Engineering as an assistant professor this fall, is an expert in aggregating data securely to learn such patterns. She will be leading the design of a GPS+Bluetooth-based token system for this new project.

Expanding the benefit of secure local data

Of course, identifying relative infection risks in our environment requires more than external data. The health conditions of users themselves are equally important, so Sankar and her peers seek to use federated learning to extend the value of secure, on-device personal data that users make available.

"Think about a health survey," Sankar said. "Do you have asthma or seasonal allergies? Or do you have diabetes or hypertension? All of these answers are data points that can stay on your device. But they offer a detailed assessment of your physical state, and that can be applied in conjunction with GPS tracing parameters for COVID-19 in your area to yield an effective way to help you monitor your own relative risks."

Expanding the range of on-device data for this customized purpose is also part of the project. Sankar and her team are working with Berisha, an associate professor in the School of Electrical, Computer and Energy Engineering, one of the six Fulton Schools, drawing upon his research in the diagnostic functionality of audible voice.

"Our phones capture acoustic measures," Sankar said. "So, for example, a user could phonate or utter sounds into their device microphone, and the data represented could signal preconditions of a respiratory ailment. In fact, phonation-based markers have already shown sound efficacy in identifying well-studied respiratory ailments. This information, in combination with your health history and the current state of infection in your surroundings, can build a powerful risk score to help guide behavior."

These remarkable possibilities lay in the wake of a great deal of forthcoming work. Sankar says there are three priorities for this project: building rich, mobile-device-level learning models; developing the server capabilities necessary to enact federated learning from the diverse aggregated parameters; and then testing the elements of the system at a meaningful scale to correct and improve them as necessary.

Adequate scale for testing is important to the ultimate value of any applications derived from this research. So, Sankar and her team are partnering with the ASU University Technology Office, which operates a vast array of information management resources, including the ASU mobile app.

"They already run a mobile app for tens of thousands of university students, which provides us a meaningful environment in which to test a prototype when we have one," Sankar said. "However, we have a lot to accomplish before getting to that scale of testing."

Sankar and her peers are hopeful that the outcomes of this federated learning research project will advance mobile technology in the battle against COVID-19. Results also could bolster work in other arenas where current concerns about data security and personal privacy hinder the potential for innovative solutions.

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ASU professor's research employs mobile devices to mitigate COVID-19

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Efforts to combat the novel coronavirus rely on broad adoption of a few behaviors: physical distancing, frequent hand washing, wearing face masks in public and staying home when ill. Alongside these populationwide tactics, health care authorities employ a proven method of disease control called contact tracing.

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Mount Sinai Data Science Discovery for COVID-19

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The Agency for Healthcare Research and Quality defines a culture of safety in healthcare as one in which

"healthcare professionals are held accountable for unprofessional conduct, yet not punished for human mistakes, errors are identified and mitigated before harm occurs, and systems are in place to enable staff to learn from errors and near-misses and prevent recurrence" (American College of Healthcare Exectuives, 2017).

An organization's culture of safety is largely dependent on their values, beliefs, and norms as it pertains to patient safety. A culture of safety can have a profound effect on healthcare workers in many ways:

It affects their attitudes, cognitions, and behaviors;

Reinforces behavior that is considered "normal" for patient safety;

Determines what actions are punishable and what actions are praiseworthy;

Aides them in prioritizing patient safety in relation to other goals (Weaver et al., 2013)

There are a few elements which have been identified with a culture of safety:

Acknowledging that healthcare is hazardous

Being responsible for reducing risk

Encouraging blame-free error reporting

Willingness to discuss errors without punishment

Willingness to learn from mistakes

Establishing structures to hold staff accountable for patient safety

Promoting effective interdisciplinary teamwork

Providing open communication among staff and management

Implementing a systems approach to understand errors (Kilbridge, 2008)

A group of authors published the results of their analysis of 34 global studies that reported issues with healthcare informatics and their effects on patient safety. The study found that 53% of those studies found a direct link to informatics problems and patient harm and death, and 29% found a direct link to near-miss events (Kim et al., 2017). It is possible that problems arise between informatics and users more often than previously thought, and this highlights the importance of promoting a culture of safety.

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The Healthcare Executive's Role in Ensuring Quality and Patient Safety. (2017, November). Retrieved from https://www.ache.org/about-ache/our-story/our-commitments/policy-statements/healthcare-executives-role-in-ensuring-quality-and-safety
Weaver, S. J., Lubomksi, L. H., Wilson, R. F., Pfoh, E. R., Martinez, K. A., & Dy, S. M. (2013, March 05). Promoting a culture of safety as a patient safety strategy: A systematic review. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4710092/
Kilbridge, P. M., & Classen, D. C. (2008). The Informatics Opportunities at the Intersection of Patient Safety and Clinical Informatics. Journal of the American Medical Informatics Association, 15(4), 397-407. doi:10.1197/jamia.m2735

Kim, M. O., Coiera, E., & Magrabi, F. (2017). Problems with Health Information Technology and Their Effects on Care Delivery and Patient Outcomes: A Systematic Review. Journal of the American Medical Informatics Association, 24(2), 246-250. doi:10.1093/jamia/ocw154

Fostering a Culture of Safety. (n.d.). Retrieved July 29, 2020, from https://www.ahrq.gov/patient-safety/settings/esrd/resource/fostersafety.html

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Find our Summary Video in the Week 6 discussion post.

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Patient Safety Leadership WalkRounds TM: Management rounds with patient care departments to discuss safety issues
Safety Briefs: Daily updates on safety concerns, near-misses, and adverse events

Patient Safety Officer: designated individual on the floor that ensures patient safety is prioritized
Voice Over Internet Protocol (VoIP): telephone system is connected to Cloud server instead of a landline
Clinical decision support tools: built-in tools in the EMR that alert staff to possible errors and adverse events; also called 'hard stops'

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Medicine is becoming as "high-tech" as it is "high-touch"

Informatics plays an integral role in medicine, especially nursing. It combines the latest technological advancements with medical practice to reduce errors and improve patient safety.

However beneficial informatics is in medicine, there is a downside. Many clinicians report frustration with informatics, especially when there is a lack of education or a malfunction in the software. At times, these issues lead to errors that reach the patient.

Consequently, medicine has looked to other high hazardous industries like aviation to reduce errors. It was then that a medical culture of safety was born.

Fast-forward to today and you will find informatics and safety top the list of the most beneficial, productive, and important additions to medicine today.

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There's a difference between health informatics and health information management:
Health information management focuses on the storage and retrieval of health data whereas health informatics focuses on data analysis and utilization. The former is also dedicated to managing people and processes, the latter on improving patient care.

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Bresnick, J. (2017, April 21). Patient Safety Errors are Common with Electronic Health Record Use. Retrieved from https://healthitanalytics.com/news/patient-safety-errors-are-common-with-electronic-health-record-use
Rush, T. (2017, July 22). ‎Your Career In Healthcare: Improving Patient Care Through Health & Nursing Informatics on Apple Podcasts. Retrieved from https://podcasts.apple.com/us/podcast/improving-patient-care-through-health-nursing-informatics/id881601915?i=1000390219113

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Informatics is continually changing in nursing and has benefited nursing outcomes for years. One of the largest benefits is documentation; having an accessible electronic health record has reduced the errors of paper charting, saved the amount of time spent on charting, and effectively increased the communication between the health care team. Having electronic records allows access to patient information for pharmacies, primary care providers, nursing assistants, and imaging technicians. This allows communication to flow smoothly, provide and reduce data errors, and improve patient centered care.

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“ Nursing informatics can also be defined as any use of information technology by nurses for the purpose of enhanced patient outcomes, the management of healthcare facilities, nurse education and nursing research (Cassano, 2014).”

Informatics in patient care has successfully increased the way patients perceive and react to their medical treatment and/or diagnosis. By providing telehealth, online appointment systems, and accessible charts and results patients are able to be more involved in their care.  Patient care is improved as a whole by the health care team having access to records electronically, communicating through the health record, safely prescribing medications, and providing information to patients to increase their knowledge on their diagnosis and/or treatment plan.

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Host: Tim Rush

Guest: Teresa MacGregor PhD, ARNP

Guest: Roberta Christopher, EdD, MSN, ARNP, NE-BC, CHTS-CP

Federal regulations requiring the implementation of electronic health records (EHRs) spurred the need for the healthcare industry to assess processes and employee skill sets relative to maintaining proper electronic records and improving patient care and safety outcomes. As a healthcare professional, it's likely that your job is affected every day by tasks or information related to health informatics. Because of the breadth of the health informatics industry and the depth of its impact on medical facilities throughout the country, we have interviewed some of the industry's thought leaders on the practice of health informatics and nursing informatics.
Dr. Christopher is an ANCC board certified nurse executive, and is board certified as a healthcare technology specialist clinician/practitioner consultant (CHTS-CP) through the American Health Information Management Association (AHIMA). She is also an active member of the AHIMA and the Healthcare Information and Management Systems Society (HIMSS). Dr. Christopher was credentialed by EPIC in electronic health record (EMR) report writing and inpatient clinical documentation. She had further training in EPIC hospital outpatient departments, Stork (maternal child module), ASAP (emergency department module), BEACON (oncology module), research, and business intelligence reporting during her tenure overseeing a nursing informatics department and co-facilitating an EPIC EMR go ...

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improving patient care through health & nursing informatics

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‎Your Career In Healthcare: Improving Patient Care Through Health & Nursing Informatics on Apple Podcasts

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‎Host: Tim Rush Guest: Teresa MacGregor PhD, ARNP Guest: Roberta Christopher, EdD, MSN, ARNP, NE-BC, CHTS-CP Federal regulations requiring the implementation of electronic health records (EHRs) spurred the need for the healthcare industry to assess processes and employee skill sets relative...

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With the use of informatics in nursing, patients have the ability to access their medical records. This could pose a risk of breaching a patients autonomy with too many people having access to records and causing unintentional harm if providers release information on the chart that the patient wanted only them to know. There is also a risk of hacking, identity theft, using information for personal use, and breaches that also conflict with the nursing code of ethics (Phillips, 2015).

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Shapland, M. (n.d.).

Impact of Informatics on Health Industry Challenges.

Retrieved July 30, 2020, from https://study.com/academy/lesson/impact-of-informatics-on-health-industry-challenges.html
Phillips W. (2015). Ethical Controversies About Proper Health Informatics Practices. Missouri medicine, 112(1), 53–57.
Cassano, C. (2014, October 1). “The Right Balance –Technology and Patient Care.” Retrieved from https://www.himss.org/resources/right-balance-technology-and-patient-care

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Conduct Patient Safety Leadership WalkRoundsTM

Create a reporting system

Designate a Patient Safety Officer

Appoint a Safety Champion for every unit

Create an Adverse Event Response Team

Relay safety reports at shift changes

Simulate possible adverse events and reenact real adverse events from your hospital

Conduct safety briefings

Involve patients in safety initiatives

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Helps provider promote patient safety

Algorithms that help select appropriate medication

Checks for drug-drug and drug-allergy reactions

Checks for duplicate and incomplete orders

Provides drug libraries with the latest information

Offers evidence-based clinical resources for nurses