NURS 6431:Week 2: The Evolution of Health Informatics Part 2 Essay Assignment

In Week 1, you were introduced to some of the key pioneers who helped establish the field of health informatics, and you reflected on their achievements. This week, you continue the exploration of the evolution of the field by considering the next generation of HIT informaticists and how they have been able to build on earlier efforts.

Learning Objectives

Students will:

• Assess the evolution of the field of nursing informatics

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Joan Ash

Ash, J. S., Berg, M., & Coiera, E. (2004). Some unintended consequences of information technology in health care: The nature of patient care information system-related errors. Journal of the American Medical Informatics Association, 11(2), 104–112.

In this article, the authors highlight key areas where unintended consequences and errors are occurring as the result of health information technology use. These errors fall into two distinct categories: input and retrieval errors, and errors caused by poor communication of information.

Ash, J. S., Sittig, D. F., Poon, E. G., Guappone, K., Campbell, E., & Dykstra, R. H. (2007). The extent and importance of unintended consequences related to computerized provider order entry. Journal of the American Medical Informatics Association, 14(4), 415–423.

 

In this article, the authors discuss the unintended consequences of using computerized provider order entry systems. The article focuses in particular on the effects of human error.

Ash, J. (1997). Organizational factors that influence information technology diffusion in academic health sciences centers. Journal of the American Medical Informatics Association, 4(2), 102–111.

This article explores the discrepancies in the level of technology implementation and use that may exist between different clinics and hospitals. The author examines the organizational factors that may influence information technology diffusion in academic health sciences centers.

Nancy Lorenzi

Lorenzi, N. M., & Riley, R. T. (2000). Managing change: An overview. Journal of the American Medical Informatics Association, 7(2), 116–124.

The authors of this article explain various responses to change, especially with respect to medical technologies. In particular, the authors discuss how the medical field has dealt with the extreme changes in medical informatics.

Lorenzi, N. M., Riley, R. T., Blyth, A. J., Southon, G., & Dixon, B. J. (1997). Antecedents of the people and organizational aspects of medical informatics: Review of the literature. Journal of the American Medical Informatics Association, 4(2), 79–93.

In this article, the authors discuss the importance of the organizational and personal factors behind the implementation of medical informatics. They give an overview of research on complex health systems and how implementation occurs.

Stead, W. W., & Lorenzi, N. M. (1999). Health informatics: Linking investment to value. Journal of the American Medical Informatics Association, 6(5), 341–348.

The authors of this article discuss the need for increased emphasis on the value of health informatics. They highlight strategies for demonstrating this value and provide examples that help justify the need for health informatics to have an increased role in health field.

Ben Shneiderman

Shneiderman, B. (1982). The future of interactive systems and the emergence of direct manipulation. Behaviour & Information Technology, 1(3), 237–256.

Copyright 1982 by Taylor and Francis Informa UK Ltd.  Reprinted by permission of Taylor and Francis Informa UK Ltd. via the Copyright Clearance Center.

Interactive systems are a crucial part of medical informatics. In this piece, Schneiderman explores the future possibilities for increasing the capabilities of interactive systems and the emergence of direct manipulation.

Shneiderman, B. (1996). The eyes have it: A task by data type taxonomy for information visualizations. Visual Languages, Proceedings on Digital Object Identifier, 336–343.

The author of this article provides his perspective on the role visual languages play in medical informatics. The article explores how a task may be visualized according to its data type taxonomy.

Plaisant, C., Mushlin, R., Snyder, A., Li, J., Heller, D., & Shneiderman, B. (1998). LifeLines: Using visualization to enhance navigation and analysis of patient records. In Proceedings of the AMIA Symposium (p. 76). American Medical Informatics Association.

In this article, the authors explain how visualization may enhance the navigation and analysis of patient records. The authors elaborate on how visualization offers capabilities beyond those of simple text and tables.

Diane Forsythe

Forsythe, D. E., & Buchanan, B. G. (1991). Broadening our approach to evaluating medical information systems. In Proceedings of the Annual Symposium on Computer Application in Medical Care (pp. 8–12). American Medical Informatics Association. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2247485/

The authors of this article provide a perspective on the conventional wisdom of using controlled clinical trials to conduct evaluations in medical informatics. The authors critique many of the underlying assumptions of this evaluation method and suggest a more expansive approach to evaluation.

Forsythe, D. E. (1992). Using ethnography to build a working system: Rethinking basic design assumptions. In Proceedings of the Annual Symposium on Computer Application in Medical Care (pp. 505–509). American Medical Informatics Association. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2247982/

This article examines a 3-year interdisciplinary project that focused on building a patient education system on migraine headaches. The author discusses the use of ethnography in the design of the system.

Rosenal, T. W., Forsythe, D. E., Musen, M. A., & Seiver, A. (1995). Support for information management in critical care: A new approach to identify needs. In Proceedings of the Annual Symposium on Computer Application in Medical Care (p. 2). American Medical Informatics Association. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2578881/

This article focuses on managing information in critical care. The authors explore a unique approach to identifying useful findings about clinical information management.

Chuck Friedman

Cork, R. D., Detmer, W. M., & Friedman, C. P. (1998). Development and initial validation of an instrument to measure physicians’ use of, knowledge about, and attitudes toward computers. Journal of the American Medical Informatics Association, 5(2), 164–176.

In this article, the authors discuss the results of a questionnaire given to physicians to measure their knowledge about and attitudes toward computer use in health care. The article describes how this information can be used to improve the relationship between health care providers and those in the field of medical informatics.

Friedman, C. P. (1995). Where’s the science in medical informatics? Journal of the American Medical Informatics Association, 2(1), 65–67.

The author of this article discusses the developing field of medical informatics and the need for science to be an integral part of the discipline. The author provides an example of a PhD student who faced issues in pursuing further education in medical informatics.

Friedman, C. P., Elstein, A. S., Wolf, F. M., Murphy, G. C., Franz, T. M., Heckerling, P. S., et al. (1999). Enhancement of clinicians’ diagnostic reasoning by computer-based consultation: A multisite study of two systems. JAMA: Journal of the American Medical Association, 282(19), 1851–1856.

The authors of this article examine how the diagnostic reasoning of clinicians may be enhanced by computer-based consultations. The article focuses on decision support systems

Kaplan, B., Brennan, P. F., Dowling, A. F., Friedman, C. P., & Peel, V. (2001). Toward an informatics research agenda: Key people and organizational issues. Journal of the American Medical Informatics Association, 8(3), 235–241.

Retrieved from the Walden Library databases.

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This article proposes methods for improving how information technology is developed and executed. The authors focus on how demographics and social and organizational issues can influence information technology.

Sue Bakken

Hyun, S., Johnson, S. B., Stetson, P. D., & Bakken, S. (2009). Development and evaluation of nursing user interface screens using multiple methods. Journal of Biomedical Informatics, 42(6), 1004–1012.

This article describes a study of nurses’ perceptions of a variety of Electronic Health Record (EHR) elements. These elements included the functional requirements for an electronic nursing documentation system, design user interface screens, and the usability of prototype user interface screens.

Newbold, S. K., Kuperman, G. J., Bakken, S., Brennan, P. F., Mendonca, E. A., Park, H. A., & Radenovic, A. (2004). Information technology as an infrastructure for patient safety: Nursing research needs. International Journal of Medical Informatics, 73(7), 657–662.

In this article, the authors describe the process of creating research questions to determine effective ways of promoting technology as an infrastructure for increasing patient safety in the nursing field. The article identifies information technology that can assist in improving safety.

Matney, S., Bakken, S., & Huff, S. M. (2003). Representing nursing assessments in clinical information systems using the logical observation identifiers, names, and codes database. Journal of Biomedical Informatics, 36(4–5), 287–293.

In this article, the authors explain the significance of the Logical Observation Identifiers, Names, and Code (LOINC) Database. The article describes how the LOINC database enables greater accuracy in determining how the nursing process contributes to diagnoses and interventions.

Patty Brennan

Brennan, P. F., Moore, S. M., Bjornsdottir, G., Jones, J., Visovsky, C., & Rogers, M. (2001). HeartCare: An Internet‐based information and support system for patient home recovery after coronary artery bypass graft (CABG) surgery. Journal of Advanced Nursing, 35(5), 699–708.

The authors of this article discuss the use of a tool called “HeartCare,” an Internet-based support and information system for patients recovering from coronary artery bypass graft surgery. The article describes a randomized controlled study to evaluate the outcomes of patients who used the HeartCare system.

Brennan, P., Ripich, S., & Moore, S. (1991). The use of home-based computers to support persons living with AIDS/ARC. Journal of Community Health Nursing, 8(1), 3–14.

The authors of this article elaborate on their development of a computer network (ComputerLink) that provides home-care support to AIDS and AIDS-related complex patients. The article describes a study that examines the feasibility of using such home-based computer networks to inform patients.

Diane Skiba

Hardin, R. C., & Skiba, D. J. (1982). A comparative analysis of computer literacy education for nurses. In Proceedings of the Annual Symposium on Computer Application in Medical Care (p. 525). American Medical Informatics Association.

Copyright 1982 by IEEE. Reprinted by permission of IEEE via the Copyright Clearance Center.

 

This article provides insight on the learning curve for nurses in becoming computer literate. The article analyzes how different approaches can affect the development of computer literacy in nurses.

Billings, D., Connors, H., & Skiba, D. (2001). Benchmarking best practices in Web-based nursing courses. Advances In Nursing Science, 23(3), 41–52.

 

The authors of this article explore a framework and processes used to decipher the best practices in online learning communities for nursing courses. The article explains how benchmarks were developed and the results of a survey using the benchmarks.

Skiba, D. J., & Cohen, E. (2000). Case management and technology: A necessary fit for the future. Nursing Administration Quarterly, 25(1), 132–141.

This article examines how case management is more difficult without the support of technology. The authors stress the need for case management to be digitized to promote a more efficient means of tracking patients.

Danny Sands

Rodriguez, N. J., Borges, J. A., Soler, Y., Murillo, V., & Sands, D. Z. (2004, June). A usability study of physicians’ interaction with PDA and laptop applications to access an electronic patient record system. In Computer-Based Medical Systems, 2004. CBMS 2004. Proceedings. 17th IEEE Symposium on Computer-Based Medical Systems (pp. 153–160). IEEE.

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This article highlights a study of physicians’ use of PDAs and laptop applications to access an electronic patient record system. The article compares the benefits of PDAs and laptops.

Sands, D. Z. (1999). Electronic patient-centered communication: Managing risks, managing opportunities, managing care. American Journal of Managed Care, 5(12), 1569–1571.

Copyright 1999 by Intellisphere, LLC. Reprinted by permission of Intellisphere, LLC via the Copyright Clearance Center.

This article provides a perspective on the risks, opportunities, and changes in care management associated with electronic patient-centered communication. The article supplies an extensive literature review of this area.

McCrossan, B. A., Grant, B., Morgan, G. J., Sands, A. J., Craig, B., & Casey, F. A. (2008). Diagnosis of congenital heart disease in neonates by videoconferencing: An eight-year experience.Journal of Telemedicine and Telecare, 14(3), 137–140

This article describes an 8-year study performed to test the viability of performing diagnoses of congenital heart disease using videoconferencing. The authors debate the effectiveness of echocardiograms, hands-on tests, telemedicine, and telecare.

Safran, C., Rind, D. M., Davis, R. B., Ives, D., Sands, D. Z., Currier, J., et al. (1995). Guidelines for management of HIV infection with computer-based patient’s record. The Lancet, 346(8971), 341–346.

This article describes an early trial of the use of electronic messages to promote adherence to clinical practice guidelines related to HIV infections. The authors discuss the structure and guidelines behind the computer-based patient records and their role in managing HIV infection.

Lucian Leape

Bates, D. W., Cohen, M., Leape, L. L., Overhage, J. M., Shabot, M. M., & Sheridan, T. (2001). Reducing the frequency of errors in medicine using information technology. Journal of the American Medical Informatics Association, 8(4), 299–308.

This white paper describes how using information technology in the provision of care can help reduce the frequency and consequences of errors in medical care. The authors provide specific recommendations for reducing medical errors through the use of information technology.

Hunt, D. L., Haynes, R. B., Hanna, S. E., & Smith, K. (1998). Effects of computer-based clinical decision support systems on physician performance and patient outcomes: A systematic review. JAMA: Journal of the American Medical Association, 280(15), 1339–1346.

In this article, the authors describe a systematic review of all the literature on the effects of computer-based clinical decision support systems (CDSSs). The authors explain their findings and how CDSSs can improve clinical performance in determining drug dosing, preventive care, and other areas of medical care.

Jha, A. K., Kuperman, G. J., Teich, J. M., Leape, L., Shea, B., Rittenberg, E., et al. (1998). Identifying adverse drug events: Development of a computer-based monitor and comparison with chart review and stimulated voluntary report. Journal of the American Medical Informatics Association, 5(3), 305–314.

This article describes the findings of a study that tested the effectiveness of a computer-based adverse drug event (ADE) monitor. The authors analyze how well the computer-based monitor identified ADEs when compared to traditional chart reviews and voluntary reports.

Leape, L. L., Berwick, D. M., & Bates, D. W. (2002). What practices will most improve safety? JAMA: Journal of the American Medical Association, 288(4), 501–507.

This article features three patient safety leaders discussing implementing evidence-based safety practices versus implementing those that are effective but that possess little published support. The authors point out the limitations of waiting for randomized controlled trials to implement obvious strategies for improving patient safety.

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Discussion: Second-Generation HIT Informaticists

Great discoveries can transform the world. In 400 BC, Hippocrates theorized that the body was composed of four “humors”—blood, phlegm, black bile, and yellow bile. Now think of the impact of the seminal work of William Harvey, who, in the 1600s, accurately described the circulation system and the role of the heart for the first time. It was not until the early 1900s that the Austrian biologist Karl Landsteiner identified four distinct blood groups. Today, knowledge about the nature and properties of blood is so complicated that the entire field of blood chemistry is devoted to its study.

This same type of expansion of knowledge within a scientific field is mirrored within the field of informatics. As new technologies develop, subsequent changes occur in the fiel that are, built upon the earlier work of others. In this Discussion, you examine the continuing evolution of the field of health informatics and assess how researchers built on the work of preceding scientists.

You will focus on the following individuals:

• Joan Ash
• Nancy Lorenzi
• Ben Shneiderman
• Diane Forsythe
• Chuck Friedman
• Sue Bakken
• Patty Brennan
• Diane Skiba
• Danny Sands
• Lucian Leape

To prepare:

• Select and read at least one article from this week’s Learning Resources for at least five individuals listed above.
• Consider how the work of each individual has built upon the work of earlier pioneers in the informatics field.
• Assess the areas of growth in informatics research from the informatics pioneers you researched last week to the individuals you read about this week, and the ways in which health informatics has continued to evolve.
• Select one individual from this week you found to be of particular interest, and read at least one additional article written by him or her from the list provided in the Learning Resources.
• Conduct further research to determine recent contributions or additions to the individual’s research.

By Day 3

Post a brief summary of key contributions of the individual you selected. Explain which ideas/accomplishments you found to be most compelling, and why. Assess the evolution of the field of nursing informatics from the first group of pioneers (Week 1 Discussion) to the second generation of HIT nurse informaticists. Provide specific examples of how this evolution is evident in the field.

By Day 6

Respond to at least two of your colleagues on two different days, using one or more of the following approaches:

• Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
• Validate an idea with your own experience and additional research.
• Expand on your colleagues’ postings by providing additional insights or contrasting perspectives based on readings and evidence.