Information Technology Information technology applications

described in this module are:

Applicable in the Physiologic monitors, including:
Nursing Practice arrhythmia and hemodynamic monitors
mechanical ventilators critical care
A. Hospital and Critical Care information systems (CCIS)
Applications Physiological Monitoring Systems
There are a lot of information technology Physiological monitors were developed
applications applicable in the hospital. It to oversee the vital signs of the
can be branched out based on the major astronauts. By the 1970's these
functional departments in the hospital monitors found their way into the
such as in the Administration, Clinical, hospital setting. Physiologic systems
and Nursing. In the administration consist of 5 basic parts
department, lets say for instance, the 1. Sensors
admission of the patient and retrieval of 2. Signal conditioners
clinical records uses computer 3. File to rank and order information
applications to make the work effective 4. Computer processor to analyze data
and efficient. In this discussion, we and direct reports
focus on the critical care aspects and 5. Evaluation or controlling component
how the nursing division benefits from to regulate the equipment or alert the
the information technology. nurse
Below is the list to sum up the various Microprocessors. Physiologic signals
applications of information technology in are typically of very small amplitude and
this setting particularly focusing on must be amplified, conditioned and
patient care: digitized by the device in in preparation
• Process store and integrate for processing by its embedded
physiological and diagnostic information microprocessors. It analyzes information
from various sources store pertinent information in specific
• Present deviations from pre-set ranges places, and controls the direction in
by an alarm or an alert reporting. It also alerts nursing
• Accept and store patient care personnel through a report, an alarm or
documentation in a lifetime’s clinical a visual notice.
repository
• Trend data in a graphical presentation Monitoring systems also store various
• Provide clinical decision support data elements with a time stamp derived
through alerts alarms and protocols from the monitoring system's internal
• Provide access to vital patient clock
information from any location both inside Physiologic monitoring systems typically
and outside of the critical care setting have modern platform allowing the
• Comparatively evaluate patients for selection of various monitoring
outcomes analysis Present clinical data capabilities to match the needs of a
based on concept-oriented views variety of clinical settings
More specialized monitoring capabilities
such as intracranial pressure or
bispectral index monitoring are also in neck and thorax Monitoring these
modular format. changes permits measurement of stroke
Physiologic monitors are usually built to volume: indices of contractility such as
incorporate both arrhythmia and velocity and acceleration of blood flow,
hemodynamic monitoring capabilities supraventricular rhythm and index.
Using bioimpedance as a factor
Hemodynamic Monitors integrated with analysis of the finger
Machines under the human machine blood pressure waveform has also been
interface used specifically for the demonstrated as a method of cardiac
following: output measurement.
1. Measure hemodynamic parameters Pulse Oximetry
closely examine cardiovascular function A critical piece of hemodynamic
2. Evaluate cardiac pump output and information involves the availability of
volume status oxygen to bodily tissues. The standard
3. Recognize patterns (arrhythmia for measurement of blood's oxygen
analysis) and extract features saturation is co-oximetry Pulse oximetry
4. Assess vascular system integrity is a noninvasive method of measuring
Evaluate the patient's physiologic oxygen saturation that also uses
response to stimuli spectrophotometry. Light is emitted
5. Continuously assess respiratory through a pulsatile arteriolar bed and
gases (capnography) then detected by photosensor.
6. Continuously evaluate glucose levels
7. Store waveforms Anticipated Problems
8. Automatically transmit selected data Largest contributor to alarms in the ICU
to a computerized patient database caused by:
1. blood pressure cuff
Thermodilution Technique 2. tourniquet
• The bolus must be injected within 4 3. air splint that may cause venous
seconds Amount of solution must be pulsations
accurate Temperature of the injective 4. limits the sensors ability to distinguish
must be measured and accurately between arterial or venous blood
maintained Catheter must be properly pressure while pulse oximetry provides
placed a measure of oxygen delivered to the
• Computer must have the appropriate tissue, mixed venous oxygen saturation
computation constant Bolus must be provides a measure of the amount of
injected at the appropriate time in the oxygen used by the patient.
respiratory cycle.
These problems usually cause nurses to
The process of thermodilution: spend more time in troubleshooting and
The influence of these user-related can lead to less hours doing the
issues is negated by using heat of a necessary bedside care. To prevent
thermal filament embedded in the these from happening, it is important for
catheter to replace the injectate. An nurses to become familiar with the user
alternative means of measuring cardiac guide of the respective machines
output noninvasively if provided by specifically on the troubleshooting part.
thoracic electrical bioimpedance. Four Some pulse oximeters are more
sensor are positioned on the sides of the sensitive as compared to the others,
some need specific charging times, and critically ill patient. CCIS is the
some are more durable than the others. organization of a patient's current and
historical data. CCIS allows the free flow
Telemetry of data between the critical care unit and
Hemodynamic monitoring can take other departments. Provides a rich
place at the bedside of can be repository of patient information that can
conducted from a remote location via be integrated for use i our outcomes
telemetry. Telemetry allows for the management. Each patient's data can
continuous monitoring of patients be accessed from any terminal or
usually outside of the ICU. Telemetry workstation. This capability can extend
monitoring is susceptible to signal loss. across units and departments or be
Remember that computer-based restricted to a single unit.
hemodynamic monitoring offers the
critical care nurse a wealth of CCIS include: Patient management
information does not replace clinical service length of stay mortality readmit
judgment. rates. Prognostic scoring systems can
be integrated to facilitate assessing the
Arrhythmia Monitors severity of an illness. The CCIS can use
Computerized monitoring and analysis the healthcare organization’s system to
of cardiac rhythm have proved reliable schedule patient care activities,
and effective and in detecting potentially treatment, and diagnostic testing )
lethal heart rhythms. A key functional Vital Sign Monitoring Vital signs and
element is the system's ability to detect other physiologic data can be
ventricular fibrillation and respond with automatically acquired from bedside
an alarm. SYSTEM TYPES Detection instruments and incorporated into the
Surveillance Diagnostic or Interpretive. clinical database Data can be
What’s the difference? In a detection incorporated into flow sheets with other
system, the criteria for a normal ECG data elements such as laboratory results
are programmed into the computer. body system assessment findings
Interpretive systems search the ECG problem lists.
complex for five parameters Location of CIS also includes: Diagnostic Testing
QRS complex Time from the beginning Result Results can be displayed in flow
to the end of the QRS Comparison of sheets such as Laboratory Radiology
amplitude, duration, and rate of QRS Cardiology results Clinicians can also
complex with all limb leads P and T access picture archival information
waves Comparison of P and T waves
with all limb leads Clinical Documentation to support the
process of Physical assessment findings
Basic Components of arrhythmia As the critical care environment requires
Monitors sensor signal conditioner frequent assessments, these flowsheets
cardiograph Pattern recognition Rhythm may be configured to ease this
analysis Diagnosis Written report extensive data collection. Flowsheets
CRITICAL CARE INFORMATION may also be organized by body system.
SYSTEMS A CCIS is a system designed All disciples can document patient
to collect store, organize, retrieve, and assessment findings into the CCIS.
manipulate all data related to care of the
Automatic calculation of physiologic on the majority part of the public.
indices can be performed • Emphasizes the prevention of the
disease, medical intervention and public
Decision support The CCIS can awareness.
provide alerts and reminders to guide • Fulfils a unique role in the community,
care in accordance with evidence-based promoting and protecting the health of
guidelines. Point of care access to the community at the same time
knowledge bases that contain maintaining sustainability and integrity of
information on evidence-based guide- health data and information.
lines of care, drug information,
procedures and policies. Data can be Goal of Community Health
integrated with patient information. Informatics
• Effective and timely assessment that
Medication Management Can facilitate involves monitoring and tracking the
the medication administration process health status of populations including
Medication administration of flowsheets identifying and controlling disease
incorporate the use of bar code outbreaks and epidemics.
technology
Community Health Application
Interdisciplinary plans of care Special System
flowsheets incorporating required • Encourages optimal application of
treatments and interventions may be computer system, computer programs
provided Work flow management and communication system for the
solutions that help orchestrate all of the benefit of majority of individuals, families
numerous, simultaneous processes and community.
Provider Order Entry Electronic entry Primary Focus of Community Health
and communication of patient orders Information System
can help clinicians improve • Preventing, identifying, investigating
communication, streamline processes, and eliminating communicable health
facilitate care, and can help clinicians all problems.
providers in managing quality. • Accessibility of data and information,
COORDINATION AND SCHEDULING through communication
OF PATIENT CARE • Educating and empowering individuals
ACTIVITIES Critical care flowsheet is a to adopt health lifestyle
predominant display format for CCIS the • Facilitate the retrieval of data
goal of CCIS is to have as much • Effective transformation of data into
information integrated into the system as information
possible to obtain a comprehensive • Effective integration of information to
picture of the patients. other disciplined to concretized
knowledge and creates better
  understanding.
• Creation of computerized patient
B. Community Health records, medical information system
Applications • Central repositions of all data such as
data warehouse
• Focuses on the health information • Simple Graphical User Interface (GUI)
system of the community, it is cantered for nurses and other healthcare
provider, patient ad consumer controlling disease outbreaks and
epidemics.
Computer Based Survey System
Health Statistical Surveys Advantages of using this system, the
• Are used to collect quantitative tracking and detection of the disease in
information about items in a population the community will be easy because we
to establish certain information from the can easily track the spread of it, and the
obtained data. communication among the nurses and
• Focused on opinions or factual other health care provider will be strong.
information depending on its purpose
and many surveys involve administering
The community health center should
question to individuals
really use this kind of system because i
Advantages experienced how the health centers
• Consistent exchange of response record and updates of information of the
• Disease tracking people in the community and believe it
• Data and information sharing Building or not it takes us to weeks to do it from
strategies letter A-Z.
• Early detection and monitoring of
disease and sickness Control of spread
A sample of informatics use in the
of disease
Philippines is the Philippine Integrated
• National alertness and preparedness
Disease Surveillance and
Building strong communication
Response (PIDSR). It is a multi-faceted
• Maintaining strong relation between
public health disease surveillance
nurses and other healthcare provider
system that provides public health
• Continuous coordination of the
officials the capabilities to monitor the
healthcare professionals
occurrence and spread of diseases.
Synchronization of the decisions
Goal
• Streamlining of the process
1. strengthen the surveillance and
• Effective management of data and
response capabilities at each level of the
information Optimal operation of hospital
health system by building local
and clinics
capacities and leveraging strengths and
Nursing Informatics: Community areas of expertise through partnership
Health Application and coordination
Support and improve collaboration Vision
among the doctors, community health 2. To improve the availability and use of
provider and patients. Informatics is very surveillance and laboratory data so that
useful in monitoring and tracking the public health managers and decision
health status of the community. The goal makers can plan for and carry out more
of community health informatics is to timely detection and response to the
attain an effective and timely leading causes of illness, death and
assessment that involves monitoring disability
and tracking the health status of Functions
populations including identifying and 3. Information from PIDSR is expected
to be used for the following purposes:
4. Facilitate collecting, managing,
analyzing, interpreting, and and improve workflow, reduce medical
disseminating health-related data for errors, and lastly the management and
diseases designated as nationally monitoring of the billing, doctors’ fees,
notifiable prescriptions and many more.
5. Develop and maintain national
standards, such as consistent case One of the most important responsibility
definitions for nationally notifiable of a nurse is to make sure that the
diseases applicable across all the patient receives the care that he/she
provinces and cities needed and with the use of this system i
6. Maintain the official national notifiable believe the quality of care can be given.
diseases statistics
7. Provide detailed data to control
D. Emergency Preparedness
programs to facilitate the identification of
specific disease trends and Response
8. Work with cities and provinces and Same with the objective in the
partners to implement and assess application of informatics in Community
prevention and control programs Health, the overall objective is public
health. The only difference is the focus
and level of prevention. In Community
C. Ambulatory Care Systems Health, the focus of the use of
informatics is on the promotive and
The ambulatory care nurse focuses on preventive side, while in emergency
patient safety and the quality of nursing preparedness and response focus on
care by applying appropriate nursing the mitigation and control of
interventions, such as identifying and emergencies. The use of informatics
clarifying patient needs, performing here is much wider and critical. The
procedures, conducting health need for information in real-time is very
education, promoting patient advocacy, crucial in saving the lives of many.
coordinating nursing and other health
services, assisting the patient to Based on Weiner and Slepski (2012)
navigate the health care system, and The modern movement toward HIE
evaluating patient outcomes. could go a long way to expanding
The ambulatory care covers a wide information outreach to victims of
range of services that can be offered to disasters and humanitarian crises.
patients that needs medical attention. by Although not the primary reason for the
integrating the ambulatory care legislation that has provided such
information system in the nursing sanctioned growth in electronic health
practice will really help in making the care records, for once an unintended
work easy like the processing of data consequence has a possible positive
and information and the billing & effect. Other efforts to expand and
charges and etc. upgrade communications to all
There are advantages of the ambulatory populations have benefits for the
care information system like first, the disaster community as well. As an
access of medical records of patients to example, radiofrequency identification
health care providers, second, the (RFID) technology holds such promise
nurses will be able to give quality care with early prototypes tagging victims
with treatment and other information.
Longer range RFID tags and readers will communicate early warning and critical
make it possible to continuously track updates and foster electronic
victims as they move through the information exchange worldwide. Rapid
system from evacuation to treatment detection is critical to save lives and
facilities (National Research Council, improve incident outcomes, and the
Committee on Using Information United States serves in a key role as
Technology to Enhance Disaster part of a global surveillance network.
Management, 2007)
E. Telehealth
Improved decision support and resource
tracking/allocation tools bring added According to Mayo Clinic (2020)
intelligence to the disaster situation. For Telehealth is the use of digital
example, better available collaboration information and communication
software and fi le sharing have benefited technologies, such as computers and
the recent business world and can serve mobile devices, to access health care
to better reduce duplication of effort services remotely and manage your
during times of disaster. At the same health care. These may be technologies
time, distributed emergency operation you use from home or that your doctor
centers provide resources in a less uses to improve or support health care
centralized manner that aids in the services.
distribution of planning, coordination, Consider, for example, the ways
and scheduling. Computer-assisted telehealth could help you if you have
decision-making tools and intelligent diabetes. You could do some or all of
adaptive planning provide alternatives to the following:
decisions that are typically made in a • Use a mobile phone or other device to
vacuum. upload food logs, medications, dosing
and blood sugar levels for review by a
Biosurveillance is a key capability of nurse who responds electronically.
obtaining and maintaining situational • Watch a video on carbohydrate
awareness before and during a health counting and download an app for it to
emergency. Early recognition and your phone.
under-standing of departures from • Use an app to estimate, based on your
human, animal, plant and environmental diet and exercise level, how much
baselines, including detection of novel insulin you need.
occurrences, is necessary to give early • Use an online patient portal to see
warning and save lives; however, your test results, schedule
detecting deviations from the norm is appointments, request prescription refills
complicated because of the complexities or email your doctor.
of systems and variables and the • Order testing supplies and medications
multiple stovepipes that exist. Many online.
efforts are underway to improve data • Get a mobile retinal photo screening at
collection, sharing, and analysis. your doctor's office rather than
Informatics and technology solutions scheduling an appointment with a
such as smartphones, tablets, and other specialist.
wireless devices may help to gather • Get email, text or phone reminders
signals to detect potential incidents when you need a flu shot, foot exam or
earlier, regardless of the cause, and other preventive care.
• The goals of telehealth, also called e-
health or m-health (mobile health),
include the following:
• Make health care accessible to people
who live in rural or isolated communities.
• Make services more readily available
or convenient for people with limited
mobility, time or transportation options.
• Provide access to medical specialists.
• Improve communication and
coordination of care among members of
a health care team and a patient.
• Provide support for self-management
of health care.
In the Philippines, we have also adopted
telehealth and have become an
increasing necessity with the emergence
of the pandemic and implementing the
community quarantine measures. To
promote safety among the public,
telehealth has been adopted by private
and government hospitals. The
University of the Philippines – Manila
(UPM) is one of the earliest in the
Philippines who adopted the telehealth
in 1998. They established the UP
National Telehealth Center with the
commitment is to engage people to use
available technologies to improve health
care albeit distance barriers. Since its
conception, it continues to develop
telehealth applications derived from
people’s own problem-solving
contributions. Through research-cum-
service activities, the center helps both
patients and health care providers
maximize widely available and cost-
effective ICT tools to improve delivery of
healthcare.