NURS 6051: Transforming Nursing and Healthcare Through Technology

NURS 6051: Transforming Nursing and Healthcare Through Technology

Module 4: Technologies Supporting Applied Practice and Optimal Patient Outcomes (Weeks 6-8)

Learning Objectives
Students will:
Evaluate healthcare technology trends for data and information in nursing practice and healthcare delivery
Analyze challenges and risks inherent in healthcare technology
Analyze healthcare technology benefits and risks for data safety, legislation, and patient care
Evaluate healthcare technology impact on patient outcomes, efficiencies, and data management
Analyze research on the application of clinical systems to improve outcomes and efficiencies
Due By
Assignment
Week 6, Days 1–2
Read/Watch/Listen to the Learning Resources.
Compose your initial Discussion post.
Week 6, Day 3
Post your initial Discussion post.
Begin to compose your Assignment.
Week 6, Days 4-5
Review peer Discussion posts.
Compose your peer Discussion responses.
Continue to compose your Assignment.
Week 6, Day 6
Post at least two peer Discussion responses on two different days (and not the same day as the initial post).
Week 6, Day 7
Wrap up Discussion.
Week 7, Days 1-7
Continue to compose your Assignment.
Week 8, Days 1-6
Continue to compose your Assignment.
Week 8, Day 7
Deadline to submit your Assignment.
Photo Credit: Westend61

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
McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning.
Chapter 14, “The Electronic Health Record and Clinical Informatics” (pp. 267–287)
Chapter 15, “Informatics Tools to Promote Patient Safety and Quality Outcomes” (pp. 293–317)
Chapter 16, “Patient Engagement and Connected Health” (pp. 323–338)
Chapter 17, “Using Informatics to Promote Community/Population Health” (pp. 341–355)
Chapter 18, “Telenursing and Remote Access Telehealth” (pp. 359–388)
Dykes, P. C., Rozenblum, R., Dalal, A., Massaro, A., Chang, F., Clements, M., Collins, S. …Bates, D. W. (2017). Prospective evaluation of a multifaceted intervention to improve outcomes in intensive care: The Promoting Respect and Ongoing Safety Through Patient Engagement Communication and Technology Study. Critical Care Medicine, 45(8), e806–e813. doi:10.1097/CCM.0000000000002449
HealthIT.gov. (2018c). What is an electronic health record (EHR)? Retrieved from https://www.healthit.gov/faq/what-electronic-health-record-ehr
Rao-Gupta, S., Kruger, D. Leak, L. D., Tieman, L. A., & Manworren, R. C. B. (2018). Leveraging interactive patient care technology to Improve pain management engagement. Pain Management Nursing, 19(3), 212–221. doi:10.1016/j.pmn.2017.11.002
Note: You will access this article from the Walden Library databases.
Skiba, D. (2017). Evaluation tools to appraise social media and mobile applications. Informatics, 4(3), 32–40. doi:10.3390/informatics4030032
Note: You will access this article from the Walden Library databases.
Required Media
Laureate Education (Producer). (2018). Public Health Informatics [Video file]. Baltimore, MD: Author.

Accessible player
Laureate Education (Producer). (2018). Electronic Records and Managing IT Change [Video file]. Baltimore, MD: Author.

Accessible player

Discussion: Healthcare Information Technology Trends
Throughout history, technological advancements have appeared for one purpose before finding applications elsewhere that lead to spikes in its usage and development. The internet, for example, was originally developed to share research before becoming a staple of work and entertainment. But technology new and repurposed will undoubtedly continue to be a driver of healthcare information. Informaticists often stay tuned to trends to monitor what the next new technology will be or how the next new idea for applying existing technology can benefit outcomes.
In this Discussion, you will reflect on your healthcare organization’s use of technology and offer a technology trend you observe in your environment.
To Prepare:
Reflect on the Resources related to digital information tools and technologies.
Consider your healthcare organization’s use of healthcare technologies to manage and distribute information.
Reflect on current and potential future trends, such as use of social media and mobile applications/telehealth, Internet of Things (IoT)-enabled asset tracking, or expert systems/artificial intelligence, and how they may impact nursing practice and healthcare delivery.
By Day 3 of Week 6
Post a brief description of general healthcare technology trends, particularly related to data/information you have observed in use in your healthcare organization or nursing practice. Describe any potential challenges or risks that may be inherent in the technologies associated with these trends you described. Then, describe at least one potential benefit and one potential risk associated with data safety, legislation, and patient care for the technologies you described. Next, explain which healthcare technology trends you believe are most promising for impacting healthcare technology in nursing practice and explain why. Describe whether this promise will contribute to improvements in patient care outcomes, efficiencies, or data management. Be specific and provide examples.
By Day 6 of Week 6
Respond to at least two of your colleagues* on two different days, offering additional/alternative ideas regarding opportunities and risks related to the observations shared.
*Note: Throughout this program, your fellow students are referred to as colleagues.
Submission and Grading Information
Grading Criteria
To access your rubric:
Week 6 Discussion Rubric
Post by Day 3 and Respond by Day 6 of Week 6
To participate in this Discussion:
Week 6 Discussion

Assignment: Literature Review: The Use of Clinical Systems to Improve Outcomes and Efficiencies
New technology—and the application of existing technology—only appears in healthcare settings after careful and significant research. The stakes are high, and new clinical systems need to offer evidence of positive impact on outcomes or efficiencies.
Nurse informaticists and healthcare leaders formulate clinical system strategies. As these strategies are often based on technology trends, informaticists and others have then benefited from consulting existing research to inform their thinking.
In this Assignment, you will review existing research focused on the application of clinical systems. After reviewing, you will summarize your findings.
To Prepare:
Review the Resources and reflect on the impact of clinical systems on outcomes and efficiencies within the context of nursing practice and healthcare delivery.
Conduct a search for recent (within the last 5 years) research focused on the application of clinical systems. The research should provide evidence to support the use of one type of clinical system to improve outcomes and/or efficiencies, such as “the use of personal health records or portals to support patients newly diagnosed with diabetes.”
Identify and select 5 peer-reviewed articles from your research.
The Assignment: (4-5 pages)
In a 4- to 5-page paper, synthesize the peer-reviewed research you reviewed. Be sure to address the following:
Identify the 5 peer-reviewed articles you reviewed, citing each in APA format.
Summarize each study, explaining the improvement to outcomes, efficiencies, and lessons learned from the application of the clinical system each peer-reviewed article described. Be specific and provide examples.

I need four references. Please and thank you.

References

McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning.
Chapter 14, The Electronic Health Record and Clinical Informatics” (pp. 267–287)
Chapter 15, Informatics Tools to Promote Patient Safety and Quality Outcomes” (pp. 293–317)
Chapter 16, Patient Engagement and Connected Health (pp. 323–338)
Chapter 17, “Using Informatics to Promote Community/Population Health” (pp. 341–355)
Chapter 18, “Telenursing and Remote Access Telehealth” (pp. 359–388)
Dykes, P. C., Rozenblum, R., Dalal, A., Massaro, A., Chang, F., Clements, M., Collins, S. …Bates, D. W. (2017). Prospective evaluation of a multifaceted intervention to improve outcomes in intensive care: The Promoting Respect and Ongoing Safety Through Patient Engagement Communication and Technology Study. Critical Care Medicine, 45(8), e806–e813. doi:10.1097/CCM.0000000000002449
HealthIT.gov. (2018c). What is an electronic health record (EHR)? Retrieved from https://www.healthit.gov/faq/what-electronic-health-record-ehr
Rao-Gupta, S., Kruger, D. Leak, L. D., Tieman, L. A., & Manworren, R. C. B. (2018). Leveraging interactive patient care technology to Improve pain management engagement. Pain Management Nursing, 19(3), 212–221. doi:10.1016/j.pmn.2017.11.002
Note: You will access this article from the Walden Library databases.
Skiba, D. (2017). Evaluation tools to appraise social media and mobile applications. Informatics, 4(3), 32–40. doi:10.3390/informatics4030032
Note: You will access this article from the Walden Library databases.

Solution

 

Assignment: Literature Review: The Use of Clinical Systems to Improve Outcomes and Efficiencies

 

Sun, R., Korytkowski, M. T., Sereika, S. M., Saul, M. I., Li, D., & Burke, L. E. (2018). Patient Portal Use in Diabetes Management: Literature Review. JMIR diabetes, 3(4), e11199. https://doi.org/10.2196/11199

Sun et al. (2018) examined the association of the patient portal use with diabetes outcomes and opportunities for the management of diabetes. The study utilized 30 articles 6 of which were randomized controlled trials, 16 observational studies, 4 qualitative studies, and 4 mixed studies. The features offered in the portals varied across systems with a majority of the portals visited allowing the patients to access visitation summary, medical history, lab results and physical examination results, general health education, communication with the healthcare providers, prescription refills. For patients with diabetes, the portals allowed the patients to upload their blood glucose readings accessed from their home-monitoring devices. The portals similarly provided patient-centered education based on the patient’s conditions. Some of the portals similarly allowed patients to key in their lifestyle information such as dietary habits and physical exercise habits.

The review indicates that the percentage of the patients that registered for the portal was 29 to 46 percent. 27 to 76 percent of the patients with portal accounts logged onto their portals. The patient’s usage of the portals mostly was to view laboratory results, followed by requests for medication refills, sending and reading of messages, and making appointments. The study indicates that the patients who had access to the web-based portals recorded lower glycemic levels as well as better control of their LDL. Other portal uses like the request of prescription refills were associated with the decline of LDL and BP levels. The study, therefore, indicates that the use of the patient portals resulted in better management of diabetes among the patients and control of their patient’s health care outcomes.

Reed M.E., Huang J., Brand RJ, Neugebauer R., Graetz I., Hsu J., et al. (2019) Patients with complex chronic conditions: Health care use and clinical events associated with access to a patient portal. PLoS ONE 14(6): e0217636. https://doi.org/10.1371/journal.pone.0217636

Reed et al. (2019) aimed at examining the impact of portal access on the number of outpatient visits, preventable hospitalizations, and emergency visits among the patients. The observational study compared the visit rates with and without portal access. The setting was a large integrated delivery system, which implemented the patient portal between 2006 and 2007. The study utilized the clinical patient history information captured in the electronic health record on outpatient office visits emergency department visits and preventable hospitalizations.

The study findings indicate that patients that had more access to the portal experienced fewer emergency department visits at a rate of 3.5 per 1000 patients and preventable hospital stays at the rate of 0.8 per 1000 patients. The study indicates that patients with diabetes had more office visits after accessing the portal, which facilitated the self-management of the disease. The study also found out that ore office visits resulted in fewer admissions to the emergency departments as the patients would monitor and regulate their healthcare outcomes lowering their chance of suffering adverse events and health complications.

Diabetes being a multi-factorial disease requires the adoption of a multifaceted approach for its management and overall prevention of healthcare complications. The article, therefore, indicates the use of the patient portals results in better management of diabetes symptoms and self-management skills among the patents. The portals, therefore, facilitate the patients to access patient education, prescription refills, and consultations with the physicians resulting in better management of their healthcare outcomes.

Graetz, I., Huang, J., Muelly, E. R., Fireman, B., Hsu, J., & Reed, M. E. (2020). Association of mobile patient portal access with diabetes medication adherence and glycemic levels among adults with diabetes. JAMA Network Open, 3(2), e1921429-e1921429. doi: 10.1001/jamanetworkopen.2019.21429

Graetz et al. (2020) aimed at investigating if the mobile access to the patient portal is associated with improved outcomes among patients with diabetes. The retrospective cohort study included patients diagnosed with diabetes and treated in the Kaiser Permanente Northern California between April 2015 and December 2017. The study subjects are 18-year old individuals with the presence of diabetes being defined by the 2015 clinical diabetes chronic conditions registry.

The study used the portals to capture the use and access to devices as well as the EHR data such as prescription refills for oral diabetes drugs, laboratory test results, glycemic levels, demographics, and control variables. The study findings indicate that patients with mobile and computer access to the portal experienced 95 percent CI, 1.10 to 2.23) adherence to at least one diabetic medication. Similarly, the HbAIc levels among the patients with mobile and computer access to the portal experienced a change of (-0.07 (95%) CI, -0.09 to 0.06) percentage points in the HbAIc level (P<0.001).

The study by Graetz et al. (2020) shows that for patients who were previously using portals from the computers and added mobile access,  there was a significant increase in the adherence to drugs as well as a reduction in glycemic levels. The study findings show that the improvement that was associated with the mobile portal access was prevalent among patients with higher clinical needs with a baseline of HbA1c level >8 percent). The study similarly demonstrates that the addition of mobile portal access to patients with baseline glycemic levels below 8 percent also resulted in significant improvements in the administration of the oral diabetes drugs as well as the HbA1c levels.

The study, therefore, indicates that access to a mobile patient portal can enhance the convenience of the patient’s management of diabetes by access prescription refills and communication with healthcare professionals. Adherence to diabetes drugs has been associated with positive healthcare outcomes. Therefore, the continued use of the portal is likely to result in better healthcare outcomes such as the reduction of the glycemic levels while at the same time resulting in meaningful interactions between the patients and the healthcare practitioners

Marsh, K. K., Bush, R. A., & Connelly, C. D. (2020). Exploring perceptions and use of the patient portal by young adults with type 1 diabetes: A qualitative study. Health Informatics Journal, 1460458220911780. doi: https://doi.org/10.1177/1460458220911780

Marsh, Bush & Connelly (2020) aimed at exploring the emerging adults’ patient portal knowledge, perceived barriers, and successes with the ultimate goal of improving access and engagement in the management of chronic illnesses such as diabetes. The researchers used individual semi-structured interviews, which lasted between 35 and 55 minutes to gain an understanding of the merging adults’ familiarity and perceptions out the portal in the self-management of diabetes type 1. The study findings indicate that one of the themes that were identified from the study was that participants would like a more comprehensive and user-centered health portal. Twenty participants indicate that they are looking for a health portal that would provide a comprehensive picture of the health as well as one that would contain strategies that would help them manage their care rather than only relying on their doctors for health promotion activities about diabetes.

A second theme, which emerged from the study, is that the patient portal facilitates access to providers and medical history, which is likely to support diabetes self-management. The theme indicates that the patient portal supports access to healthcare providers as well as a patients’ past medical history, which supports diabetes self-management. Sixty-six of the participants claimed to have enjoyed messaging their providers rather than booking appointments especially among the newly diagnosed patients who can ask questions and receive accurate and timely responses.

Twenty-four patients note that they value the ability to view their laboratory results from the previous visits form providers. The participants appreciated the fact that they can easily track their tests results over time, monitor their health changes, and most importantly view their HbA1c levels before their next visit to the providers. Participants similarly acknowledge that their ability to view and monitor their glycemic levels enabled them to be more accountable for their health.

The study, therefore, indicates that the application of the patient portal among the emerging adults is likely to result in better diabetes management through self-monitoring and tracking of their healthcare outcomes. The tracking and monitoring of the glycemic levels are likely to result in individuals being more accountable for their health and subsequently engaging in healthier behaviors.

Jackson, S. L., DesRoches, C. M., Frosch, D. L., Peacock, S., Oster, N. V., & Elmore, J. G. (2018). Will use of patient portals help to educate and communicate with patients with diabetes?. Patient education and counseling, 101(5), 956-959. doi: https://doi.org/10.1016/j.pec.2017.11.004

Jackson et al. (2018) aimed at examining whether the patients diagnosed with diabetes perceived greater benefits to having electronic access to their doctors’ clinic notes via the patient portals as compared to patients without diabetes. The study hypothesizes that patients with access to the doctors’ notes are likely to experience higher rates of self-care facilitated improving their literacy and communication ability. The study utilized surveys of patients with and without diabetes in Massachusetts and Pennsylvania about the perceptions and the benefits and risks of reading their clinical notes on the patient portals.

The study results indicate that a majority of the patients both with and without diabetes have positive perceptions of the impact of the portals on their healthcare outcomes. Patients with diabetes believed that having access to their notes on the patient portals would result in better medication administration and self-care practices. The article indicates that individuals with chronic illnesses such as diabetes are likely to experience positive healthcare outcomes from accessing their doctors’ notes following proactive communication with their healthcare providers as well as enhanced disease self-management.

 

References

Graetz, I., Huang, J., Muelly, E. R., Fireman, B., Hsu, J., & Reed, M. E. (2020). Association of mobile patient portal access with diabetes medication adherence and glycemic levels among adults with diabetes. JAMA Network Open, 3(2), e1921429-e1921429. doi: 10.1001/jamanetworkopen.2019.21429

Jackson, S. L., DesRoches, C. M., Frosch, D. L., Peacock, S., Oster, N. V., & Elmore, J. G. (2018). Will use of patient portals help to educate and communicate with patients with diabetes?. Patient education and counseling, 101(5), 956-959. doi: https://doi.org/10.1016/j.pec.2017.11.004

Marsh, K. K., Bush, R. A., & Connelly, C. D. (2020). Exploring perceptions and use of the patient portal by young adults with type 1 diabetes: A qualitative study. Health Informatics Journal, 1460458220911780. doi: https://doi.org/10.1177/1460458220911780

Reed M.E., Huang J., Brand RJ, Neugebauer R., Graetz I., Hsu J., et al. (2019) Patients with complex chronic conditions: Health care use and clinical events associated with access to a patient portal. PLoS ONE 14(6): e0217636. https://doi.org/10.1371/journal.pone.0217636

Sun, R., Korytkowski, M. T., Sereika, S. M., Saul, M. I., Li, D., & Burke, L. E. (2018). Patient Portal Use in Diabetes Management: Literature Review. JMIR diabetes, 3(4), e11199. https://doi.org/10.2196/11199