NU Exam #2.ppt - Introduction to Health Informatics NU234 1 Objectives Define healthcare informatics Explain the relevance of healthcare informatics and

NU Exam #2.ppt - Introduction to Health Informatics NU234 1...

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Unformatted text preview: Introduction to Health Informatics NU234 1 Objectives Define healthcare informatics Explain the relevance of healthcare informatics and techno devices for patients, healthcare and the nursing profession Describe nursing informatics competencies Describe the 3 sources of online health information Define a data warehouse. Use government sponsored large data warehouses to locate health related information. Discuss data mining as a tool to improve health 2 Nursing and Informatics Nurses have always played an important part in information systems. Nurses make up the largest group of healthcare workers using informatics. Informatics helps the nurse collect, record, and retrieve patient data. Some nurses have degrees in healthcare informatics. Electronic Health Records There are many benefits associated with EHRs. Benefits to patients: improved safety and quality of care, electronic accessibility Benefits to nurses: fewer medical errors, less time spent charting, electronic decision-making prompts, ability to monitor compliance Patient- and population-level data can be monitored. Health Insurance Portability and Accountability Act HIPAA requires that patient information remains private and secure. Government involvement in implementing EHRs is accelerating. Incentives are offered for meaningful use of EHR technology. Nurses need to enhance their knowledge of informatics. Telehealth and Medical Homes Telemedicine or telehealth involves exchange of medical information from between sites electronically. Aim is to improve patient care and cut costs Nurses can monitor chronic health conditions. Medical homes are designed to offer the lion’s share of preventative care. Aim is to improve population health and cut costs Simulation and Virtual Patients Simulating is increasingly being used in nursing education. Mannequins are programmed to talk and have vital signs. Nurses can practice skills without risking making an error on a human patien.t Lack of transfer of skills from simulation to clinical practice has been reported. Interactive Games and Health Promotion Internet- and computer-based health games can help users: Evaluate health risks and their consequences Obtain needed health education Engage in an enjoyable activity Example: Dr. Health’nstein’s Body Fun software (for schools) E-Health and Health Promotion Electronic health (e-health) uses cell phones, mobile computers, text messaging, email, Internet postings, and Internet support groups. Goal is to motivate patients to engage actively in their health care Older people are more likely to use cell phones than the Internet. Information sent by cell phone is less secure. Electronic Self-Care Education Materials About 50% of Americans use the Internet to access health-related information. The Internet includes biased, incomplete, and inaccurate information. Nurses can empower patients by providing lists of reputable Internet sites. Interactive Internet discussion boards and support groups have become popular. Use of Technological Devices to Promote Health Mobile electronic devices have been woven into clothing or attached as an accessory. Monitor health and possible emergency situations Microprocessors are being placed in the caps of medication containers. Unobtrusive health sensors are being developed. Such as a device worn by children that measures ozone while recording activity data Advantages and Disadvantages of Technology in Health Promotion Advantages More opportunities to tailor information to needs of individuals of groups Improved capability to match user learning style User anonymity while seeking information or support Increased access to information and support on demand Enhanced ability for users to update and maintain current scientific knowledge Disadvantages Costly to develop, update, and maintain Often rely on the user being able to afford fast Internet access Ability to select and use search terms is necessary Possible information overload Internet acceptability varies with age, literacy level, and learning style Socioeconomic, geographic, gender, age, and ethnic/racial access issues remain Nurses Nurses make up the largest group of healthcare workers using informatics. Informatics helps the nurse collect, record, and retrieve patient data. There are many benefits associated with EHRs. New developments include telehealth, medical homes, virtual reality, and e-health. Beginning Nurse Competencies Computer literacy (CL) Information literacy (IL) Nursing (Overall or Health) Informatics (NI) Each competency builds on the previous level. 14 Computer literacy (CL) Competencies Is a set of skills that allows individuals to use computer technology to accomplish tasks (ANA, 2008, p.125). Focuses on computer basics The use of applications such as word processing, databases, spreadsheets, email, and presentation software. 15 Information literacy (IL) Competencies A set of abilities allowing individuals to “recognize when information is needed and how to locate, evaluate, and use effectively the needed information. (Association of Colleges and Research Libraries, 2000). The focus is on information access and evaluation. An example is retrieving and evaluating information from the Internet. This is the focus of today’s class. 16 Nursing Informatics (NI) Competencies Is defined as “combining nursing science, information management science, and computer science to manage and process nursing data, information, and knowledge to deliver quality care to the public." (HRSA, 2008). 17 Examples of Nursing Informatics Competencies Should include (but is not limited to) identifying, collecting, and recording data relevant to patient care. Using informatics applications designed for nursing. Implementing policies related to confidentiality and security of information. ANA (2008) 18 Sources of Information 1. Primary – original research reports in journals 2. Secondary – indexes the primary literature. i.e. Medline 3. Tertiary – summarizes the primary literature i.e. text books. 4. Gray Information – web based information 19 Pros/Cons of the 3 “Traditional” Sources of Information Pro: Primary, secondary and tertiary are accessible to varying degrees (2° and 3° most accessible) Pro: Secondary and tertiary information summarizes key information thus is user friendly in decision making. Con: Searching primary information is time consuming and the yield may not be directly usable in decision making. 20 Our 4th Source: Gray Information Cons: Not indexed; not organized Searches can be time consuming Need computer expertise Sources/information can be of varied quality May be difficult to evaluate its quality Need good hardware Pros: Very accessible Interactive Cutting edge information 21 How is the Complex Gray Data Organized? Web based data is organized in two main ways: 1. Web Portals- Also called a “links page” ernational.html#internet Yahoo , AOL are web portals 2. Data warehouse- a repository of an organization's electronically stored data. Data warehouses are designed to facilitate reporting and analysis. Goal is data centralization Inmon, W.H. Tech Topic: What is a Data Warehouse? Prism Solutions. Volume 1. 1995. 22 Data Warehousing in Health Care Collection of data/databases gathered and organized so that it can easily by analyzed, extracted, synthesized, and otherwise be used for the purposes of further understanding the data. Databases: Usually within a data warehouse: An application that manages, updates data for quick and easy retrieval . It is data that is usually related in some way. 23 Who collects health data? US government State governments (varied levels of detail) County or local governments (varied levels of detail) UN International governments (varied reliability) Non Profit or NGO Special interest groups: DM, Spina Bifida, MS, (more common to make data sources available to the public) 24 3 Government Data Warehouses CDC National Center for Health Statistics BRFSS (Behavioral Risk Factor Surveillance System) CDC WONDER which is the Wide-ranging Online Data for Epidemiologic Research • •CDC: Makes health & behavioral info available to health professionals, researchers, academics & public • Menu driven: Composed of reported statistics, fixed data sets/tables • You can develop tables/charts from data based on variables you input & customize reports you create. 25 Practice Using CDC WONDER Group 1 Go into WONDER Go to Topics Go to Leading Causes of Death Go to 1999-2007 Find the top 3 leading causes of death in DC 26 Practice Using CDC WONDER Group 2 Go into WONDER Topics to On Line TB Information System (under Communicable Diseases) Data Request Current TB Case Reports Produce a chart that will tell us something about the status of TB in DC. (bi-variable: age groups standard, select location (DC), Alive, then most current year SEND -then CHART Which age group has the highest rate of TB in DC? 27 Vital Statistics on the WONDER Web Site: Group 3 Vital statistics tables Go to Infant Deaths, go to 2007 Variable: Choose Cause of death What is the first and second most common causes of death in babies for the US? What does “suppressed” mean? 28 Behavioral Risk Factor Surveillance System : Group 4 Largest on going telephone health survey Adults Go to Prevalence/Trends What percent of the adult population are current smokers in VA? In DC? Youth Risk Behavior Surveillance System (YRBSS) . htm 29 US Data and Maps : Group 5 What areas of the country should the US focus most of its efforts in disease prevention and education related to the West Nile Virus? 30 Local Statistics: Group 6 DC Dept of Health Look at the BRFSS – What percent of the DC population is covered by health insurance compared to national data ? What ward has the highest percent of the population covered? Arlington Dept of Health ealth/HumanServicesServicesHealthPublicHealth.aspx Virginia Dept of Health 31 The Challenges in Finding Maps: Group 7 The CDC web sites are all different formats Usually look for Data and Statistics For example – Go to CDC Home Go to diabetes; Go to Data and Trends See US and State Maps. Now try to find a map for HIV/AIDS Others are very easy – Heart Disease and Stroke maps 32 Census Data: Group 8 US Census – Zipcodes ex.xhtml Enter a zip code ( MU= 22207) and find: • Renters vs own house • Age of house • How large is house, how many bedrooms and baths • Average income 33 Not All Data Are Created Equal Data Collection: Are not surveillance systems because are not directly linked to disease control activities; are useful in other ways National Vital Statistics records (birth and death) Disease registries Surveillance Systems: Data analysis that is always linked to efforts to control disease. BRFSS (Behavioral Risk Surveillance System) (NNDSS) National Notifiable Data Surveillance System 34 United Nations on the WWW World Health Organization - UN Affiliate - is the directing organization for health in UN system 35 Others i.e. NGOs Kaiser Family Foundation The Urban Institute 36 Challenges with US Data Searches Categorization/indexing non-existent Decentralized- causes variation in how data is collected Historical data “iffy” Costly Time intensive so real time data are not available 37 Challenges with International Data Even more difficult Limited sources of data Often not collected due to lack of resources in developing countries UN and WHO are the main resources 38 Data Mining Explore data for hidden trends/patterns Analyze data from different perspectives and summarize it into useful information Information can be used to increase revenue, cuts costs, or both. Data mining software is one of a number of analytical tools for analyzing data. 39 Data Mining Example: A grocery chain used the data mining capacity of Oracle software to analyze local buying patterns. They discovered that when men bought diapers on Thursdays and Saturdays, they also tended to buy beer. Further analysis showed that these shoppers typically did their weekly grocery shopping on Saturdays. On Thursdays, however, they only bought a few items. The retailer concluded that they purchased the beer to have it available for the upcoming weekend. To increase revenue the beer display moved closer to the diaper display. And, they made sure beer & diapers were sold at full price on Thursdays. Sourcehttp:// nologies/palace/datamining.htm 40 Chapter 4 Genetic and Social Determinants of Health: An Ecological Perspective Objectives (1 of 2) Identify the major determinants of health. Explain the ecological model and its application in health promotion. Apply the ecological model to a health promotion program. Explain the stress–diathesis model and how it affects health outcomes. Objectives (2 of 2) Define epigenetics and its mechanisms. Explain the significance of both genetics and environmental factors on health. Develop health promotion strategies using the ecological framework. Introduction Advances in nutrition, vaccines, sanitation , and infant survival have improved quality of life and increased life spans. The complex interactions between biological and social elements, and their influence on health, are called the determinants of health. The Ecological Framework Determinants of health Biological Social Cultural Environmental A departure from past nature-nurture dichotomies. Genes and environment are intricately linked. The Stress–Diathesis Model Examines how social circumstances and individual responses to stressful events affect health At the cellular and physiological level One’s current health status reflects physiological responses to past experiences. Diseases linked to stress include depression, ulcers, colitis, heart disease, and adult-onset diabetes. Genetic Determinants of Health (1 of 2) Gene regulation and mutations Gene regulation turns genes “on” or “off”—critical to maintaining life. Mutations can change gene regulation. Mutations can be harmless or can cause disease. Gene–environment interaction Occurs at cellular level Risk behaviors illustrate such interaction Genetic Determinants of Health (2 of 2) Epigenetic mechanisms “Epigenetics” refers to inheritance that is not explained by changes in the DNA. Highly influenced by the internal and external cellular environment Two main mechanisms: DNA methylation and histone modification The Nurse’s Role Nurses need to be educated about genetics and understand genetic influences on disease in order to: Convey genetic information and disease risks to patients Effectively participate in disease management Assess patients for familial patterns of disease Social Determinants of Health WHO definition: The circumstances in which people are born, grow up, live, work and age, as well as the systems put in place to deal with illness These circumstances are in turn shaped by a wider set of forces: economics, social policies, and politics Health promotion strategies can result in meaningful interventions. The Social Gradient of Health Evidence has shown that mortality increases with decreasing socioeconomic position. Not just between low and high socioeconomic positions, but within those levels A suggested factor is difference in social status. The assumption is that there is less stress as one goes up the social gradient. Cultural Perspectives Understanding cultural diversity and the complex nature of culture is the cornerstone of health promotion. Culture is linked to perceptions about health. Leininger’s theory of culture care diversity and universality gives a framework to understand cultural dimensions. Culture and the Social Gradient In addition to cultural values of individuals and social groups, the nurse needs to consider: Demographic factors such as income and education How these factors interact with other influences in the ecological environment to contribute to the determinants of health Summary Determinants of health are biological, social, cultural, and environmental. Genes and the environment are intricately linked. Nurses need to be educated about genetics and understand genetic influences on disease. Important factors are cultural perspectives and the social gradient. Chapter 5 Health Disparities Objectives (1 of 2) Define a health disparity. Describe how quality of care and access to care affect health disparities. Discuss how health disparities are determined and monitored. Identify various health disparities that impact diverse populations. Articulate which factors and policies contribute to health disparities. Objectives (2 of 2) Discuss effective ways to intervene to decrease health disparities. Discuss the role of governmental organizations in decreasing health disparities. Describe why it is crucial to increase the involvement of diverse populations in health promotion research. Evaluate policy recommendations for reducing health disparities and identify policies that are most likely to have substantial benefit. Introduction Not all individuals have enjoyed the same degree of increased life span and quality of life. Select populations experience a disproportionate disease burden. Health disparities exist based on factors such as race, ethnic group, geographic area, gender, age, income, education, disability, and culture. Definitions of Health Disparities A population is a health disparity population if there is significant disparity in rates of: Disease incidence and prevalence Morbidity and mortality Survival Included are populations with considerable disparity in the quality, outcomes, cost, use, access to, or satisfaction with healthcare services. How Disparities Are Determined Three health statistics are used. Incidence (number of new cases) Mortality (number of deaths) Survival rates (length of survival following diagnosis) Types of Health Disparities Asthma, cancer, cardiovascular disease Diabetes, obesity Low birth weight, infant mortality HIV/AIDS Mental Health Violence Quality of care measures Disparities in access to, use of, and cost of care Language fluency and health literacy Gender, age, and disability Rural populations Factors Contributing to Health Disparities (1 of 2) Examples of factors within the healthcare delivery system Lack of insurance coverage Quality of insurance Availability of providers and facilities Ineffective provider–patient communication Fragmentation and lack of follow-up care Language and cultural barriers Factors Contributing to Health Disparities (2 of 2) Examples of factors outside the healthcare delivery system Age, gender, education level Socioeconomic status, race and ethnicity Transportation barriers Taking time off from work, childcare issues Lack of knowledge of appropriate health care Cultural beliefs, lack of trust of healthcare providers and systems Interventions for Minimizing Health Disparities Rely on the cultural expertise of members of the target group in designing educational materials Increase access to online services and to screening and prevention Tailor approaches to the needs of specific cultural groups Increase diversity of the workforce Follow culturally and linguistically appropriate standards for health care Role of Government and Other Entities in Decreasing Health Disparities The government has taken the lead in decreasing health disparities. Not researchers, professional organizations, private foundations, or community advocates CLAs- Culturally and linguistically appropriate The NIH identified health disparities as a research priority in 1999. In 2000 the National Center on Minority Health and Health Disparities was established. Research and Epidemiology Reliable data are necessary to understand and take steps to minimize health disparities. Having an accurate baseline from which to gauge progress is vital. Several methods of monitoring and evaluating health disparities are also ways of minimizing disparities. Future Trends and Associated Costs Reducing disparities is necessary to: Contain healthcare costs Provide equitable care to the entire U.S. p...
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