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Examples of Autonomy, Beneficence, Nonmaleficence, and Justice - Ethical Principles

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I found the readings really interesting. It was stuff that I did not know and had not really thought about. When we came to the case studies I felt like maybe they just hit a little to close to home. I know we are busy, but people put so much faith in us and then sometimes bc we get busy and sometimes bc we get lazy..... we let them down.... and I think this week was just a really important reminder of that. Those two case studies. I just think of how long my mom hurt and they just kept saying "oh its this" "oh its probably that" until we finally got a CT that showed cancer..... I have a friend that her mom's chest xray showed a small spot but the NP didn't follow up and by the time they found it, it had spread and she didn't have long to live. We aren't in this to hurt people. We would never miss something if we thought it would hurt someone... it's scary how much people rely on providers.....

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14 Infographic Do's and Don'ts to Design Beautiful and Effective Infographics

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Take the 60-second quiz to find out if you're at risk for kidney disease.

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This week's topic was data visualization and health infographics. I have seen them but never really knew what the name was before. I looked them up on pinterest just out of interest after watching the lecture and there are literally thousands of different health infographics on every topic you could imagine from allergies to the benefits of apple cider vinegar. I do really like them though. I will admit I am drawn to them because they are like a good advertisement. It is small amounts of data that are easy to read and digest quickly instead of having to read an entire study. It can peak someone's interest in something but giving them quick facts about something and then information on where to get more information. I was watching a CEU presentation on CKD and DM and the National Kidney Foundation and the American Society of Nephrology have launched a new "take a minute for your kidney" program with infographics and information because 33% of americans are at risk of CKD and do not know.

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This week we discussed data use. We talked about big data again and the 6 Vs which are volume (amount created in a day), variety (types), veracity (how true/clean), value (clinically relevant), velocity (how data, how quickly and where it is gathered), and variability (extent and speed that it is changing). An important part of the medical field is where this data is being kept. The two TED talks talked about the generation of public forums of shared data and how we can use that shared data to find problems and then find solutions. Without data we cannot find knowledge or wisdom. I feel like as nurses we are taught to watch data trends on patients. We are taught to process data in this way (trend BP, temps, etc) this is just at a much bigger level. This seeing of the big picture to help more patients is something I think is really interesting.

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UK numbers but talks about how we use mobile technology that can easily be seen by people passing by. The cost and number of security breaches just in that way

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It seems strange to me in a country where everyone is so willing to put their credit card number in every app coming and going for convivence that health care portals are not more utilized. The book quotes that while 90% of providers have portals only 33% are using them. Are we so much more willing to trust GrubHub and Target than the doctor we see? Or is it more about the fact that portals are not advertised and we do not know how to use the data. With the HITECH act data is more secure because the government is watching the data, requiring reporting data breaches, and requiring certified EHRs. Those that have not been compliant with certification do still have the highest risk. The amount of data we place in a patients chart though, when breached, think about all the personal information and what can be stolen or done with that!! Sometimes we ignore the little warnings given to us on data security things thinking it is just us, but the big picture is ours AND our patients private information.

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Office of the National Coordinator for Health IT

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Your Medical Records: What you need to know

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Why Big Tech Wants Access to Your Medical Records

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Medical records are important no matter how you keep them. I feel like EHRs are so much easier because you do not have to keep up with the paperwork and keep it organized but before the introduction of EHR and before everything became digital my dad was sick and I got all his medical records printed and I have basically a printed two binder 2inch a piece stack of his PHR. It was super useful during the points when he was fighting for his disability for his back and I had everything organized and in one place. I have been able to keep everything in order and look through and find some things out and help get him better health care through all of this. Now, because of going through all of that I have a google document where I have listed all of his radiology and his surgeries so that if there is a question it can be looked up and accessed easier. I have started one for everyone else in my family trying to keep organized but it is hard where there are so many EHRs and ways to access information.

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College using gamification and research to better reward and offer staff incentives and reward options for move points from fitness trackers

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I never really thought of how many things we gamify just to get people to participate, but it is literally all around us. Health care not taking advantage of gamification is just loss of money. Studies have shown that attention span of most people have been reduced to that of the average tv show (30 mins), that data is old and its probably even shorter now that TikToks and "reels" average 5 mins or less. Healthcare would probably be better off to find a way to use gamification for attendance to appointments and reminders for pills, etc. The research idea with Sea Hero is amazing. Even some of these online surveys that you see on facebook it makes me wonder if they store and hold some of that data. Can you imagine the big data they have one what someone's favorite color is? ;)

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Hopelab’s founding project came to life when co-founder Pam Omidyar was inspired to create a video game that might help young cancer patients with treatment compliance.

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Medtronic carelink allows data to be sent quickly to offices.

Our EP offices get calls from Medtronic and messages when specific factors are out of range for patients so they can be called and the doctor/NP can review their data and increase medication or see them/send them to the ER.

Things like:
time spent sleeping upright
amount of activity
etc.

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Tools to keep you and your patients connected

Once a patient receives an implanted cardiac device, the care doesn't stop there. It's only the beginning of a long-term relationship that the patient establishes with you. Staying connected to your cardiac device patients is critical. However, we know that's difficult - given the demands you face every day. At Medtronic our goal is to provide you with tools that simplify how cardiac device patients are managed and help give you the insight you need to make better, faster decisions - so your patients' health can be restored.

We're always looking for new ways to work together with you, so we can improve the patient management tools you use every day. For example, we're now providing options for you and your patients that are app-based and work on mobile devices.

Our offerings connect you with your patients and their cardiac device data at every point of care:

Remote monitoring for the home and acute settings - such as the ER and OR

Programmers for implants and in-clinic device follow-up

Information Systems that integrate cardiac device data into your practice

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This page describes how Medtronic helps keep clinicians informed for better, faster decisions for their cardiac device patients. Our portfolio of solutions are for the home, clinic, and acute care settings. We also have Information Systems that help data flow seamlessly.

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I had no clue how early the begins of telehealth began in the 1920s or even 1878 with heart sounds. Even when talking telemedicine I think of things more current I forget things like the neuroDoc machines our ER/hospital sometimes uses for outreach facilities. With the surge of this new ability of seeing physicians by appointment and telehealth we have forgotten the steps that it has taken us to get there. We have been using steps in telemedicine for a long time. Using the teleDoc to assess stroke and neuro patients at facilities that do not have neurologists, using transmission of sound, checking up on patients and sending vital signs all these small things. The COVID pandemic did more to push telemedicine than we ever realized but it has always been in the background of our field.

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In today’s consumer-driven and regulation-heavy environment, there are financial, regulatory, and competitive imperatives for health organizations to promote patient engagement through user-friendly patient portal applications.  In fact, the utilization of patient portals is a key exercise for satisfying meaningful use (MU) criteria in 2014.

But patient portals are more than just a requirement for MU attestation – they are an excellent tool for providers to attract, retain, and communicate with patients and their families.  According to a recent survey, 84% of patients believe they should have full access to their medical records online, and 41% would consider switching providers if not given that opportunity.    Portals allow patients to take a proactive role in managing their healthcare, potentially reducing costs from repeat or unnecessary visits.  They also give patients a level of access to their information that they have enjoyed for years in other industries, such as banking and insurance.

For healthcare organizations, the return on investment from patient portals is evident in the reduction of phone calls and related paperwork, not to mention postage savings related to mailing lab results, bills, patient summaries, and other paper-based communication. These benefits are in addition to the harder-to-measure but very tangible returns, such as cost savings in the form of reduced hospital readmission rates.

But the key to successfully operating a patient portal is patient engagement.  To meet MU requirements, 50% of unique patients in both the ambulatory and acute settings must be given access to view their health information through a secure application.  Furthermore, a portion of these patients have to actually log in and view their information. On the ambulatory side, patients must communicate with their provider through integrated, secure messaging functionality.   This means that in addition to having the infrastructure and patient portal application in place, physicians, staff, and administrative personnel are tasked with encouraging their patients to log in and use the tool.

Unfortunately, not many health systems know how to maximize their electronic health record (EHR) and patient portal capabilities, let alone get patients to utilize the portal tools. Today, all of the major EHR vendors are in a position to provide integrated technology along with their applications; however, most, if not all, fail to deliver some of the basic support needed to help organizations encourage high levels of patient engagement.  The burden, then, falls on providers and care teams to see the requirements through.  As the primary contacts at hospitals and physician practices, these are the players who need to encourage patients to take ownership in the management of their healthcare online.

Organizational leadership must have a plan in place to educate providers and staff on how to promote and facilitate online patient/provider interactions and optimize the tools and technology that are available.

What are you doing to encourage portal adoption and patient engagement at your hospitals and physician practices?  If your answer is “not enough,” it’s time for us to have a conversation.

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"Despite the promotion of informatics and health IT competency, many nursing schools struggle with the inclusion of informatics and health IT content in their program of study and all levels since many faculty members are unfamiliar with informatics content. "  (Saba & McCormick, 2021, p. 771)

Informatics in other industries took off far quicker than in the medical industry partly because of the types of work and I believe partly because of the type of system we run. There are still a lot of nurses that want to do things "the way they always have" not the way proven by EBP just because of the "if it ain't broke don't fix it" thought. The thing is, it is broken or we wouldn't be here trying to fix it and advocating for the patient. As someone in rural WV I feel like I'm in a constant fight between I swear technology and the new way won't hurt you and EBP.

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Saba, V. K., & McCormick, K. A. (2021). Essentials of nursing informatics, 7th edition (7th ed.). McGraw-Hill Education / Medical.

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If you would have told me before this week WV participated in health exchange, outside of the pharmacy information traded I would have thought you were crazy. According to the WVHIN we are supposed to be sharing more than that but as an acute care nurse I don't see it. We get patients from facilities even those that according to the WVHIN website should be able to electronically send us records with printed records, no records, disks. Missing pieces and it hurts the patients. We are required to repeat tests at the expense of the patients and the insurance and it causes longer than necessary hospital stays. I had a patient a few months ago from Raleigh General who it says can fully share and they said they could send us nothing, we had to repeat everything so the patient was at our facility over a month. That is over 2.5hours from his family just because of inability to share information.

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The main push of not only informatics, the TIGER initiative, the BlueButton all of this is the patients ability and the systems ability to work and see the patient as a whole. I feel like that is the important thing that I got out of this weeks material. (Well the really simplified version.) The goal here is for all of our health information to be able to "speak" to each other so we aren't repeating tests so we aren't duplicating things and so we are taking care of the patient as a whole patient. We should have one seamless healthcare system where a person can go from a hospital in West Virginia and get diagnosis with cancer to a specialty facility in Norfolk, VA without carrying thousands of pages and disks with their life's records on it just to be seen for an appointment. Currently, I can't even go across town to a specialist without disks and films and pages of records. We have to much technology for that. Duplicating charges that patients end up having to pay because of wasted services, duplicating visits or tests, there is no need for that sort of thing in todays world. That is what the informatics and interoperability of data sharing is about.
As patients learn how to access their data they will become more educated and more able to advocate for themselves and their healthcare. As patient portals have become more and more popular I have seen an increase in patients who know their numbers, know their results and are interested in their care!

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Speaking the same language (Interoperability) Week 3

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Speaking the same language (Interoperability) Week 3

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Still through all the triumphs of technology and pushing there are many faults in "speaking the same language". Even in early education we have begun with trying to teach metric system to everyone to have a same language system for measurement. The health care system is the same. So many techniques and procedures could be improved if we all spoke the same language. Last week the TIGER initiative talked about CAUTI's and using same language techniques to find a common ground to solve issues. This week it was other issues. This week alone at my hospital we had a patient with Hidradenitis suppurativa and GYN was consulted, gyn saw the patient but said that MU Surgery had seen them prior for the problem, MU refused to see the patient bc it is a GYN problem without asking why GYN had consulted. All time money and run-around not only for the patient but for the nursing staff just trying to get the patient taken care of.

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What Is the Solution for Interoperability?

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The most important pickup for me out of this week was the DIKW framework. Data is just raw. It is numbers or something with no context. As you gain context you gain understanding of the data until you finally gain knowledge and wisdom. The second step is information. It is when you add the context to the data so information would be 100/70 and knowing it was a blood pressure instead of a number. Then you further gain context and realize it is a patient or a group of patients BPs until you find wisdom in the set of data. I think this is true of how nurses solve issues every day. We take the raw data we see and we take our knowledge and we put it to use to find some amount of wisdom in it. In informatics sometimes a computer can be programed to automatically do this or sometimes a person still has to see the context and bring the information together for the computer to interpret the data.

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What is Meaningful Use of an EHR? (Week 5)

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What is Meaningful Use of an EHR? (Week 5)

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Meaningful Use of an EHR: What Meaningful Use Is & How It Can Save You Money

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Meaningful use is about the providers ability to show they are actually using the technology in a meaningful way. It proves that they did not just buy the certified EHR that was required by the government for the money and stick it in the corner, but they are actually trying to use it and use it to its ability. The have Core and Menu items that they have to or choose to accomplish to prove that they are accomplishing their use to get their incentives from the HITECH act. I think this is important follow-through for this program. I know at our hospital we are still using paper charts and electronic charts and scanning and it is a mess because they do not pay to flip over completely to EHR. It is slowly getting better but it is so much duplicate work. I know they have to be paying fines but we print charts for new patients every day.

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Week 7

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West Virginia Health Information Network

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Transforming health care in West Virginia through secure electronic exchange of patient health information among health care providers.

Learn more about WVHIN

Access to the ULP web portal has ended. You will now be directed to the WVHIN Portal at portal.wvhin.org.

If you have not signed into the new portal yet, and your role still requires use of the WVHIN services, please contact our WVHIN Customer Support Team to have your credentials resent at 844-468-5755.

Access WVHIN Tools

Log In To Your WVHIN account here.

WVHIN is closely engaged in the COVID-19 outbreak. Guidance for providers is available through the West Virignia Department of Health and Human Resources and the CDC.

What we do

Increasing efficiency, reducing expense and supporting better care

Patients

The WVHIN enables your doctors to have more complete, up-to-date information about you

Providers

WVHIN is now scheduling providers for HIE onboarding in 2021.

Participating Providers

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Home - West Virginia Health Information Network

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Transforming health care in West Virginia through secure electronic exchange of patient health information among health care providers.

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Please include the standard citation for PhysioNet:(show more options)
Goldberger, A., Amaral, L., Glass, L., Hausdorff, J., Ivanov, P. C., Mark, R., ... & Stanley, H. E. (2000). PhysioBank, PhysioToolkit, and PhysioNet: Components of a new research resource for complex physiologic signals. Circulation [Online]. 101 (23), pp. e215-e220.

Data Description

This database includes beat annotation files for 29 long-term ECG recordings of subjects aged 34 to 79, with congestive heart failure (NYHA classes I, II, and III). Subjects included 8 men and 2 women; gender is not known for the remaining 21 subjects. The original ECG recordings (not available) were digitized at 128 samples per second, and the beat annotations were obtained by automated analysis with manual review and correction.

For additional data of this type, including digitized ECG signals, see the BIDMC Congestive Heart Failure Database.

We thank Rochelle Goldsmith, of Columbia-Presbyterian Medical Center, New York, for her generous contribution of these data to PhysioNet.

References

The following studies have made use of these data:

1. Krum H, Bigger JT Jr, Goldsmith RL, Packer M. Effect of long-term digoxin therapy on autonomic function in patients with chronic heart failure. J Am Coll Cardiol 1995; 25:289-294.

2. Goldsmith RL, Bigger JT, Bloomfield DM, Krum H, Steinman RC, Sackner-Bernstein J, Packer M. Long-term carvedilol therapy increases parasympathetic nervous system activity in chronic congestive heart failure. Am J Cardiol 1997; 80:1101-1104.

3. Mietus JE, Peng C-K, Henry I, Goldsmith RL, Goldberger AL. The pNNx files: re-examining a widely used heart rate variability measure. Heart 2002; 88:378-380.

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Congestive Heart Failure RR Interval Database

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Please include the standard citation for PhysioNet: (show more options) Goldberger, A., Amaral, L., Glass, L., Hausdorff, J., Ivanov, P. C., Mark, R., ... & Stanley, H. E. (2000). PhysioBank, PhysioToolkit, and PhysioNet: Components of a new research resource for complex physiologic signals. Circulation [Online]. 101 (23), pp. e215-e220.

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Affiliation

¹ Margret and H.A. Rey Laboratory for Nonlinear Dynamics in Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA 02215, USA. ary@astro.bidmc.harvard.edu

Abstract

The newly inaugurated Research Resource for Complex Physiologic Signals, which was created under the auspices of the National Center for Research Resources of the National Institutes of Health, is intended to stimulate current research and new investigations in the study of cardiovascular and other complex biomedical signals. The resource has 3 interdependent components. PhysioBank is a large and growing archive of well-characterized digital recordings of physiological signals and related data for use by the biomedical research community. It currently includes databases of multiparameter cardiopulmonary, neural, and other biomedical signals from healthy subjects and from patients with a variety of conditions with major public health implications, including life-threatening arrhythmias, congestive heart failure, sleep apnea, neurological disorders, and aging. PhysioToolkit is a library of open-source software for physiological signal processing and analysis, the detection of physiologically significant events using both classic techniques and novel methods based on statistical physics and nonlinear dynamics, the interactive display and characterization of signals, the creation of new databases, the simulation of physiological and other signals, the quantitative evaluation and comparison of analysis methods, and the analysis of nonstationary processes. PhysioNet is an on-line forum for the dissemination and exchange of recorded biomedical signals and open-source software for analyzing them. It provides facilities for the cooperative analysis of data and the evaluation of proposed new algorithms. In addition to providing free electronic access to PhysioBank data and PhysioToolkit software via the World Wide Web (http://www.physionet. org), PhysioNet offers services and training via on-line tutorials to assist users with varying levels of expertise.

Similar articles

PhysioNet: an NIH research resource for complex signals.

Costa M, Moody GB, Henry I, Goldberger AL. Costa M, et al. J Electrocardiol. 2003;36 Suppl:139-44. doi: 10.1016/j.jelectrocard.2003.09.038. J Electrocardiol. 2003. PMID: 14716615

PhysioNet: a research resource for studies of complex physiologic and biomedical signals.

Moody GB, Mark RG, Goldberger AL. Moody GB, et al. Comput Cardiol. 2000;27:179-82. Comput Cardiol. 2000. PMID: 14632011

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Moody GB, Mark RG, Goldberger AL. Moody GB, et al. Annu Int Conf IEEE Eng Med Biol Soc. 2011;2011:8327-30. doi: 10.1109/IEMBS.2011.6092053. Annu Int Conf IEEE Eng Med Biol Soc. 2011. PMID: 22256277

Scaling Up Scientific Discovery in Sleep Medicine: The National Sleep Research Resource.

Dean DA 2nd, Goldberger AL, Mueller R, Kim M, Rueschman M, Mobley D, Sahoo SS, Jayapandian CP, Cui L, Morrical MG, Surovec S, Zhang GQ, Redline S. Dean DA 2nd, et al. Sleep. 2016 May 1;39(5):1151-64. doi: 10.5665/sleep.5774. Sleep. 2016. PMID: 27070134 Free PMC article. Review.

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national center for biotechnology information

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PhysioBank, PhysioToolkit, and PhysioNet: components of a new research resource for complex physiologic signals - PubMed

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The newly inaugurated Research Resource for Complex Physiologic Signals, which was created under the auspices of the National Center for Research Resources of the National Institutes of Health, is intended to stimulate current research and new investigations in the study of cardiovascular and other ...

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Patient access to their health record is important. I think there is a lot to be gained by patient access but there are also some dangers that I have seen along the way. I would love to have a national EHR because I think that would help a lot with some of the addiction issues (when the pharmacies started sharing information it cut down on a lot of multiple script fills here, but we still find some people that sneak by). I think it would allow for people who travel or go on vacations or go to see families to have an easier time with medical issues. Even within the same city (even though we are owned by the same company) there are a lot of places that don't have shared access to medical records and that is ridiculous and hard on people that don't have someone who is health care knowledgeable to help them. I have also see patients who have taken their results and turned into google doctors and made demands or seen results turn over before the staff has and it has become a problem so their have been some things that haven't been as great.