Information technology, nurse staffing, and patient needs

As health care organizations increasingly adopt health information technology, time-sensitive data that track patients' requirements for nursing care and nurses' responsiveness to these needs might be available to support evidence-based nurse staffing decisions. care information technologies available in hospitals and on nursing units may provide valuable sources of information that can be translated into usable data. In this study, the usefulness of electronic data obtained from a nurse tracking call light system as a source of information for quality measurement was explored. The findings point to what might be under-utilization of existing health information technology to track patients' needs and nurses' responsiveness, patient census, and patient movements. The authors recommend health information technology be used less as support for other organizational systems and more as an administrative resource that can allow nurse executives to be more actively engaged within and across nursing environments.     

Patient as center of the health care universe: a closer look at patient-centered care

We need to consider how the health care system should revolve around the patient, rather than the patient rotating around the hospital. Considering a patient-centric point of view when implementing and optimizing the use of health information technology (HIT) provides new perspectives on the meaning of "integrated" health care. ot only do we need to give patients the opportunities to participate as true partners in their health care, we must convince them why this partnership makes sense. We should not be naive and believe all patients want this involvement in their care today and are ready to do all their health care transactions electronically. But considering and using these practices are important steps in the health care reform journey to improve quality and decrease cost. Many patients will benefit by our working with them to demystify the health care experience through patient-centric practices and the use of HIT.     

Nursing informatics: an evolving specialty

Health care organizations will continue to invest heavily in clinical information systems to help improve patient safety, reduce variability of care, and increase the efficiency of their staff. These clinical information systems can assist in reducing medication errors through sophisticated medication management solutions and provide clinical decision support to aid in the decision making of all clinicians. They can also help offset the effects of a growing worker shortage, especially hard-felt in nursing, by reducing redundant tasks, improving communication, and streamlining clinical data collection. As these clinical systems are implemented, there is an increased need for information management of all of this complex data. By bringing both clinical and information systems expertise to bear, the informatics nurse plays a crucial role in ensuring that these goals are met to help the organization maximize its use of clinical information technology.$     

The effect of patient's asymmetric information problem on elderly use of medical care

It has been proposed that the patient's relative ignorance about medicine, ‘asymmetry of information between doctor and patient’, should place a patient in a disadvantaged position when purchasing medical care. Even if rapidly developing information technologies can enhance the patient's access to health information, a patient doesn’t have enough ability to understand, interpret and evaluate it. So, the doctor's effort at sincerely helping patient understand and utilize health information by effective communication with patient might improve the patient's asymmetric information problem and affect the patient's use of medical care by way of its being a source of patient's solid trust on doctor. This research seeks to determine whether a doctor's effort, mentioned earlier can affect the elderly use of medical care. This study used data from a survey sample of people aged more than 65 living in Seoul and Chuncheon, Korea. The results suggest the doctor's effort level has a statistically significant positive effect on the elderly use of medical care, which suggest a doctor's effort of effectively communicating with patient would ameliorate patient's information problem and it could be a source of patient's trust on doctor, so this trust would lead a patient to consume more medical care.     

Technicity in nursing and the dispensation of thinking

While technology and health care delivery are inextricably and increasingly intertwined and technology has driven major advances in quality and efficiency in health care, technology does not replace the need for a thinking human being in care delivery. The term "technicity" refers to the tension created by the ability of humans to think versus their risk of being exploited as objects subservient to technologies. Drawing upon the philosophical works of Thoreau, Heidegger, and others, the authors pause on the conundrum created by expanding technology with the assumption that technological "improvements" should be evaluated with caution. Health care information systems are an example of tools that have improved our ability to collect and store information, but when systems "go down," staff can be rendered helpless. Similarly, technology can impose personal distance between the patient and provider in instances where staff are positioned as a mechanism for collecting data rather than a person interacting with another person. In some cases, health care providers function as navigators helping patients reach the correct pharmaceutical, rather than as teachers helping patients seek better health. Lastly, the tendency toward systems analysis in the context of the complex hospital environment leads solely toward uniform solutions rather than instances where a customized solution is warranted.     

Nursing and technology: a love/hate relationship

The fundamental value of information technology in clinical settings is no longer in question, as clinicians enter and retrieve information in order to deliver care and the benefit of ubiquitous availability to clinical data using computers cannot be overplayed. The question now is how to increase adoption, improve productivity, and support transformational changes in health care delivery. It is important to get the interplay between people, process, and technology right for successful implementations which support care transformation. We must lead projects with the clinical practice changes being enabled by the technology, and then ensure the technology supports the practice change. Nurse leaders must consider letting the quality improvement process drive and define when and how technology is used, running our projects as practice changes and not IT implementations, with nursing sponsors owning the projects and leading the charge.     

Health services research in nursing: current status and future directions

To assess the current status of health services research in nursing, 113 studies reported between 1980 and 1989 were reviewed. Identified gaps in this research included comprehensive cost-benefit and cost-effectiveness analyses, effects of technology on patient care, evaluations of information systems, evaluations of innovative care delivery approaches, and studies of ethical issues related to the use of scarce resources.     

Streamlining regulatory compliance through clinical systems

The Joint Commission states that its mission is "to continuously improve the safety and quality of care provided to the public through the provision of healthcare accreditation and related services that support performance improvement in healthcare organizations.... Accreditation is a risk-reduction activity; compliance with standards is intended to reduce the risk of adverse outcomes" (JCAHO, 2003). The focus of JCAHO is not much different from that of every health care organization. Clinical information systems should be employed to help deliver safer, more efficient patient care, and at the same time ensure that health care organizations achieve regulatory compliance.     

The role of e-Health in the changng health care environment

In 2005 health care organizations spent 2.3% of total operating expenses on information technology and are slowly developing the infrastructure necessary to expand e-Health capabilities. E-Health is being recognized as a method to improve the overall health status of the population. It is important to build partnerships among health care providers, local community organizations, and national health care associations to ensure the continued development of e-Health initiatives. This study has managerial implications associated with the strategic application of e-Health systems and policy implications on future resource allocation.     

Capacity planning in hospital nursing: a model for minimum staff calculation

An aging population, emerging technology, heightening patient expectations, rising health care costs, shorter patient stays, and growing pressure to improve quality have made the management of nursing resources even more critical today. While approaching a model for staffing levels, the authors considered factors such as patient acuity, work redesign, and minimum quality standards. The methodology for analysis included estimating the time needed to complete nursing tasks and calculating the average number of tasks per patient. With respect to nursing quality measures, the study examined the adequacy of nursing documentation including admission history, assessments, nursing procedures, and discharge report as well as nursing-driven outcomes such as fall and phlebitis rates. Lastly, the authors determined the theoretical number of staff needed to provide nursing care according to quality standards.     

A model for testing the relationship of nursing care and patient outcomes

Studying patient outcomes alone may not provide enough information to determine the associated factors that must be improved when the desired patient outcomes are not achieved. The purpose of this correlational study was to investigate the effects of perceived quality of nursing care and coordination of care on patients' comfort, satisfaction, and length of hospital stay. The overall model-data fit was good according to four indices: the chi-square value, goodness of fit index, adjusted goodness of fit index, and the Steigers root square error of approximation. The proposed model, effects of care quality on patient outcomes, was tested. The relationship between quality of nursing care and the proposed outcomes was tested. The results provide important information to the nursing profession and policymakers in meeting patient care needs.     

TIQ (Technical IQ)--a survival skill for the new millennium

Managing in the new technocracy of the new millennium will be challenging but also much more exciting than the work we do now. Twenty years ago, nurse managers weren't held accountable for the level of knowledge about financial outcomes that is expected now. The same will be true for technology. With electronic medical records, innovations in medical treatments, and the impact of the information and technologic revolution on the entire world, the interface between technology assessment, operationalizing technology, and continually upgrading staff to know what the implications of the technology revolution are will be imperative for success. That means that we must influence schools of nursing to include technology in their content now, and to help us prepare this generation of health care leaders to take a full seat at the leadership table to manage these complexities in the future. The success of the leader of the future will be measured by that person's ability to integrate the very complex issues of patient care and technology in a way that makes sense for patients, the organization, and the staff who will be working in a very complex environment. The leader's TIQ will be as important as other intelligences in the next 20 years.     

Crossing the quality chasm: creating the ideal patient care experience

To create a health system that better meets patients' needs requires a fundamental redesign of our care delivery system and a new framework. Without a payment mechanism to reflect the value of care provided other than the face-to-face visit, adoption of advanced medical home principles will be challenging. The hand-off of the patient between providers and settings of care is a critical time for the patient and its effectiveness impacts patient care outcomes. The appropriate utilization of hospital and other health system resources is crucial, especially as hospitals, emergency departments, and other health care venues increasingly face capacity constraints and throughput challenges. It becomes the responsibility of the multidisciplinary team of providers to ensure that patients being discharged have an identified personal physician or team who will provide a medical home, and that the handoff to this medical home is thorough and well coordinated. An ideal patient care experience is one in which all systems and processes are geared to meet the needs of the patient: a safety-oriented system that provides standardized, evidence-based care supported by technology, but that recognizes and responds to individual needs.     

Under- and Postgraduate Education in Health Economics for Australia's Medical Practitioners: Time for Change?

Directly or indirectly, medical practitioners influence health-care policy and spending through their clinical decision-making. As medical expertise and technology has grown, and patient choice has been empowered by the consumer movement, there are now many more medical interventions than can be accommodated in a finite national health-care budget. We reviewed the Australian Medical Council, Medical School and Medical Specialist curricula. In Australia, medical students, doctors and medical specialists do not appear to have specific health economics education that would improve skills to select beneficial and cost-effective care. We propose a framework for medical practitioner health economics education.     

Using patient-reported outcome assessments in clinical practice and their importance in risk management

Abstract

Patient-reported outcome (PRO) instruments are related to risk management programmes in that they are tools to measure the benefits and risks of exposure to pharmaceutical products from the patient's perspective. Clinical measures of improvement of certain conditions may not necessarily correlate with improvements in a patient's ability to perform daily activities. PRO data, when properly administered, collected, analysed and returned to physicians are a very useful source of information. This will ultimately address safety concerns, facilitate the physician–patient relationship and improve patients' compliance to treatment in routine patient care. In this article we stress the importance of PRO in risk management.     

Registered nurse-managed anticoagulation clinic: improving patient outcomes

Anticoagulation therapy is essential in the prevention of thromboembolic events in a variety of patient groups, but has a high risk/benefit profile. Patient adherence and careful control of therapeutic levels of medication require frequent monitoring and good communication. An emerging model of care is nurse-managed anticoagulation clinics, which provide a focused and organized approach. This institution found that registered nurses were successful in providing consistent patient education and relationship-based care, which appear to improve compliance and minimize complications. The patient group that received the care of the nurse-managed anticoagulation clinic had outcomes that were better than those of patients managed by the previous model. More randomized controlled studies are needed to validate and enhance improved patient outcomes.     

信息化能促进农户的市场参与吗?--来自中国苹果主产区的微观证据

在转型时期,信息化工具的引入对农户打破低水平均衡、改善信息困境、提高市场进入能力具有重要作用。文章基于比较静态分析和专业化苹果主产区微观调查数据的实证分析表明,手机和电脑这两种信息化工具的应用能够改善信息的流动性和共享程度,会对农户的销售市场选择和垂直协作参与产生正向的促进作用。此外,电脑和互联网的引入也有助于提高农户的信息可得性以及与收购商的博弈能力,进而对农产品销售价格产生积极影响。因此,进一步克服自然环境和社会经济条件的约束,提高信息化工具普及率,注重农产品生产、销售相关信息的搜集和发布等信息源建设仍是农村信息化工作的题中之意。     

TOWARDS REASONABLE PATIENT CARE UNDER UNCERTAINTY

This keynote address provides a foundation that incorporates decision‐theory methods for integrating uncertainty into the decision‐making process for patient care in the health care system. The article provides linkages between the medical economics literature, health care analysis, and quantitative methods to help improve the outcomes for patients in the health care system. (JEL I18, I14, I10)     

Presidential Address: Innovation in retrospect and prospect

Abstract This paper asks whether innovation has slowed in recent decades. While there has been dramatic progress in information and communications technology, the recent record of innovation in the crucially important agriculture, energy, transportation, and health care sectors is cause for concern. The paper also considers whether the pace of innovation is sufficient to improve or even maintain living standards in the face of still rapidly growing population, global warming, and other challenges. I review the major market failures that lead to under‐provision of innovation and question whether current innovation policy, particularly patent policy, is effective in promoting innovation.     

The implications of nurse staffing information: the real value of reporting nursing data

There is a dearth of information about the relationship between the patient care contributions of nursing and its financial contributions to an organization. As consumers and legislators are becoming more aware of the ramifications of nurse staffing issues, and as they endeavor to address them with legislative solutions, the decision on how best to develop optimal staffing strategies may soon be taken away from nursing leaders. To maintain control of this important issue and develop solutions that will help highlight the economic and patient care contributions of nurses, a thorough understanding of the problem, and a new commitment are needed from nursing leaders to take charge of the issue. To relate nursing care to patient outcomes, meaningful data on the nursing care provided is needed in addition to data on the nursing needs of patients. Staffing and performance monitoring tools should be used to effectively plan, implement, and control financial and operating resources as well as measure the economic value of the nursing profession's contribution to the cost and benefits of patient care.