Key Topics in Health Care Technology Evaluation

The amount of new information and data, and the number of available technologies are growing at an ever-accelerating rate. Did you know that during any given 24 hours, humanity generates enough new information to fill the Library of Congress 70 times (Smolan & Erwitt, 2012)? As a nurse informaticist, it is important to keep current on new developments in the field, but with the rapid pace of change, that effort can be overwhelming. It is easier to keep current with key trends if nurse informaticists focus on selected issues.

In this Discussion, you consider key topics in the field of health care technology. You then consider the different approaches you could take when designing an evaluation in these areas. For example, if you are interested in usability, your goal could be to determine if a system is user friendly from the viewpoint of a nurse. A different goal might be to determine if the location of the system facilitates ease of use from the viewpoint of physicians.

Note: This Discussion serves as practice for the first part of your Evaluation Project. What you derive from your Discussion with colleagues will likely inform the work that you do in Part 1 of the Evaluation Project.

The Discussion focuses on the following major topics in the health care information field:

Implementing HIT Systems

• Consumer health information
• Computerized Physician Order Entry (CPOE)
• Decision support systems
• Electronic health records (EHR)
• Tele-medicine and eHealth
• Nursing documentation

Other Issues Related to the Use of HIT Systems

• Interoperability
• Unforeseen consequences
• Usability

To prepare:

• Select at least two topics from the lists above that are relevant to your current organization or that are of particular interest to you. Read the articles in this week's Learning Resources that relate to these topics. Consider why these topics are of interest to you, what relevance they have to health care organizations, and how they impact your professional responsibilities. Choose one topic to be the focus of your Evaluation Project, and consider potential evaluation goals.
• Determine the viewpoint from which you would approach the evaluation, and why.

Post a minimum of 550 words essay in APA format with a minimum of 3 references from the list of required resources below, that addresses the level one headings as numbered below:

1) Post the two topics you identified as most relevant to your organization or to you personally, and explain why you selected those topics.

2) Identify the topic you selected for your Evaluation Project, and propose three potential evaluation goals for this topic.

3) Identify the viewpoint you would use with each goal, and explain why.

Required Readings:

Friedman, C. P., & Wyatt, J. C. (2010). Evaluation methods in biomedical informatics (2nd ed.). New York, NY: Springer Science+Business Media, Inc. Chapter 2, "Evaluation as a Field" (pp. 21-47) This chapter defines evaluation and shows how it differs from research. The chapter also includes a discussion the philosophy behind evaluation and the multiple approaches to evaluation.

Board on Health Care Services. (2012). Health IT and patient safety: Building safer systems for better care. The National Academies Press: Washington DC. Retrieved from http://www.nap.edu/catalog.php?record_id=13269. Chapter 2, "Evaluating the Current State of Patient Safety and Health IT" (pp. 31-58) This chapter addresses the challenges of evaluation in health information technology due to the complex nature of technology and rapid changes in the field. The chapter also identifies barriers to evaluation and the threats posed to patient safety by a lack of evaluation.

Nursing Documentation

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. Retrieved from the Walden Library databases. "The design of nursing documentation systems to support quality management and research as well as practice is a complicated task as it requires understanding of nursing practice and informatics" (p. 1010). In an effort to design more user-friendly interface screens for electronic nursing documentation systems, the researchers explore the application of theory and user-centered methods to the design process.

Saranto, K., & Kinnunen. U. M. (2009). Evaluating nursing documentation-Research designs and methods: A systematic review. Journal of Advanced Nursing, 65(3), 464-476. Retrieved from the Walden Library databases.  In this research study, the authors examine the nursing documentation literature. One significant finding was the importance of using structured nursing terminology, as this supports more consistent documentation practices.

Public Health

Honoré, P. A., Wright, D., Berwick, D. M., Clancy, C. M., Lee, P., Nowinshi, J., & Koh, H. K. (2011). Creating a framework for getting quality into the public health system. Health Affairs, 30(4), 737-745. Retrieved from the Walden Library databases. In this article, the authors explore two Department of Health and Human Services (DHHS) reports on public health quality. The authors also posit how a framework of quality concepts can be applied in various programs to address the quality concerns presented in the two DHHS reports.

Reeder, B., Hills, R. A., Demiris, G., Revere, D., & Pina, J. (2011) Reusable design: A proposed approach to public health informatics system design. BMC Public Health, 11, 116-118. Retrieved from the Walden Library databases.  The authors of this article examine the current state of public health informatics in terms of design consistency and interoperability. They suggest a standard design framework be implemented to guide the development of public health informatics systems.

Consumer Health Information

Van Gemert-Pijnen, J., Nijland, N., van Limburg, M., Ossebarrd, H. C., Kelders, S. M., Eysenbach, G., & Seydel, E. R. (2011). A holistic framework to improve the uptake and impact of eHealth technologies. Journal of Medical Internet Research, 13(4), e111. Retrieved from the Walden Library databases. Many factors influence the successful adoption of eHealth technologies. As such, many integration efforts have not been successful or sustainable. In this article, the authors propose a more holistic approach for implementing eHealth technologies to overcome problems with adoption and sustainability.

Black, A. D., Car, J., Pagliari, C., Anandan, C., Cresswell, K., Bokun, T., et al. (2011). The impact of eHealth on the quality and safety of health care: A systematic overview. PLoS Medicine, 8(1), e1000387. Retrieved from http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1000387. The authors of this article discuss eHealth technologies and reviews current literature on its impact. The authors argue that eHealth technologies have yet to demonstrate cost savings, improved patient outcomes, or improved quality of care.

Decision Support Systems

Levy, S., & Heyes, B. (2012). Information systems that support effective clinical decision making. Nursing Management, 19(7), 20-22. Retrieved from the Walden Library databases. The focus of this article is the importance of providing nurses with HIT tools to support them in using and managing information effectively to improve patient care. The nurses should use the clinical decision-making tools to have access to relevant and timely information that they can then relay to their patients.

Randell, R., & Dowding, D. (2010). Organisational influences on nurses' use of clinical decision support systems. International Journal of Medical Informatics, 79(6), 412-421. Retrieved from the Walden Library databases. The article describes a study that examined nurses' perceptions on which organizational features facilitate the introduction and use of clinical decision support systems. The authors rank the organizational features according to the findings of their study.

Tele-Medicine and Telehealth

Pelletier, A. C., Jethwani, K., Bello, H., Kvedar, J., & Grant, R. W. (2011). Implementing a web-based home monitoring system within an academic health care network: Barriers and facilitators to innovation diffusion. Journal of Diabetes Science and Technology, 5(1), 32-38. Retrieved from the Walden Library databases. In this article, the authors use the framework of the diffusion of innovation theory to examine the implementation of a new information communication technology intervention at the Center for Connected Health. The article provides details on the intervention in question, which focuses on non-visit-based diabetes care.

Boulos, M. N. K., Wheeler, S., Tavares, C., & Jones, R. (2011). How smartphones are changing the face of mobile and participatory healthcare: An overview, with example from eCAALYX.Biomedical Engineering Online, 10(1), 24[RAR1]. Retrieved from http://www.biomedical-engineering-online.com/content/10/1/24. This article explores the use of smartphones in health care by patients and health care professionals. The authors review a variety of apps available for smartphones and discuss the application of these apps in different health care settings. They also explore barriers to the adoption of this technology and provide strategies for addressing those barriers.

Unintended Consequences

Sockolow, P., Crawford, P., & Lehmann, H. (2012). Broadening a general framework for evaluating health information technology. Methods of Information in Medicine, 51(2), 122-130.

Copyright 2012 by Verwertungsgesellschaft Wort. Reprinted by permission of Verwertungsgesellschaft Wort via the Copyright Clearance Center.

This article describes the authors' attempts to create an informatics evaluation framework for health information technology (HIT). In particular, the authors focus on developing a framework that utilizes portions of pre-existing health services research evaluation and informatics evaluation to remedy issues in currently available HIT evaluation frameworks.

Sockolow, P. S., Weiner, J. P., Bowles, K. H., & Lehmann, H. P. (2011). A new instrument for measuring clinician satisfaction with electronic health records. CIN: Computers, Informatics, Nursing, 29(10), 574-585. Retrieved from the Walden Library databases. The authors of this article explore the creation of a new survey instrument designed to determine nurse satisfaction with an electronic health record's impact on clinical processes. The authors describe the influences that guided the selection of the survey's features.

General

Bélanger, E., Bartlett, G., Dawes, M., Rodríguez, G., & Hasson-Gidoni, I. (2012). Examining the evidence of the impact of health information technology in primary care: An argument for participatory research with health professionals and patients. International Journal of Medical Informatics, 81(10), 654-661. Retrieved from the Walden Library databases. This article examines the findings of numerous literature reviews concerning the impact of information systems on health outcomes in primary care settings. In particular, the article focuses on the findings' implications for developing personal health records.

Coiera, E., Aarts, J., & Kulikowski, C. (2012). The dangerous decade. Journal of the American Medical Informatics Association, 19(1), 2-5. Retrieved from the Walden Library databases. This article provides an overview of changes resulting from information and communication technology (ICT) that are anticipated to occur in the decade following 2012. Specifically, the article has a large emphasis on how these potential changes could impact patient safety.

Lanham, H. J., Leykum, L. K., & McDaniel, R. R. Jr. (2012). Same organization, same electronic health records (EHRs) system, different use: Exploring the linkage between practice member communication patterns and EHR use patterns in an ambulatory care setting. Journal of the American Medical Informatics Association, 19(3), 382-391. Retrieved from the Walden Library databases. The authors of this article describe a study that examines the link between communication patterns "within-practice" and the use patterns of practice-level electronic health records (EHR). The authors explain how the link between these patterns may provide additional opportunities for standardizing the use of EHRs.

Looking toward the future: 2012: Industry insiders weigh in on the year ahead in healthcare technology. (2012). Health Management Technology, 33(1), 8, 10-12, 14-15. Retrieved from the Walden Library databases. This article provides the perspectives of numerous "industry insiders" on how technological changes shape health care. In particular, the insiders focus on cloud computing, real-time location systems, business intelligence, patient engagement, the ICD-10 standard, high-performing health care organizations, the information technology market, electronic medical record adoption, and much more.

Looking toward the future: 2012 part II: Industry insiders weigh in on the year ahead in healthcare technology. Health Management Technology, 33(2), 30, 32-34. Retrieved from the Walden Library databases. This article continues the examination of health care technology in 2012 begun in Part I. The "insiders" in this article expound on their predictions for the individual network-exchange model, revenue cycle management, and health care cuts, as well as on implementing HIPAA Version 5010 and more.

Wu, I.-L., Li, J.-Y., & Fu, C.-Y. (2011). The adoption of mobile healthcare by hospital's professionals: An integrative perspective. Decision Support Systems, 51(3), 587-596. Retrieved from the Walden Library databases.  This article explores the integration of technology adoption frameworks to predict the adoption of mobile technology by health care providers in a hospital setting: the Technology Acceptance Model (TAM), the Theory of Planned Behavior (TPB), the perceived service availability (PSA), and the personal innovativeness in IT (PIIT).

Jensen, P. B., Jensen, L. J., & Brunak, S. (2012). Mining electronic health records: Towards better research applications and clinical care. Nature Reviews: Genetics, 13(6), 395-405. Copyright 2012 by Nature Publishing Group. Reprinted by permission of Nature Publishing Group via the Copyright Clearance Center.  In this article, the authors discuss the wealth of information and data provided by electronic health records (EHR) and how these data could provide valuable information for medical research. The authors also address the ethical and legal barriers to using EHR data in this manner, and they examine methods for addressing these barriers.

Required Media

Laureate Education (Producer). (n.d.g). Telehealth and public health. Retrieved from https://class.waldenu.edu. Note:  The approximate length of this media piece is 21 minutes. This video revolves around a presentation discussing telehealth. The video also provides a general overview of different technologies being applied to improve the health of individuals and populations.

Laureate Education (Producer). (n.d.c). Interoperability and standards. Retrieved from https://class.waldenu.edu.  Note: The approximate length of this media piece is 16 minutes. In this video, presenters discuss the need for standards to facilitate the availability of health information. In addition, the video elaborates on challenges commonly faced with health information exchange.

Laureate Education (Producer). (n.d.a). Clinical and administrative systems. Retrieved from https://class.waldenu.edu. Note: The approximate length of this media piece is 19 minutes. This video provides a general overview on clinical information systems. The video focuses in particular on clinical and administrative systems in the United States.