CHAPTER 1: INFORMATICS

• Handheld device


  Pocket-sized computing device with a display screen and input/output interface like an external or touch screen keyboard
• Handheld devices and gadgets

  • Mobile phone
  • PDA
  • Mobile PC
  • Handheld game consoles
• Notebook PC


  • Small, portable personal computer (PC) with a clamshell form factor, typically having a thin LCD (LED computer screen mounted on the inside of the upper lid of the clamshell and an alphanumeric keyboard on the inside of the lower lid
• Ultra-mobile PC


  • Miniature version of a pen computer, a class of laptop whose specifications were launched by Microsoft and Intel in spring 2006
• Handheld PC


  • Computer built around a form factor which is significantly smaller than any standard laptop computer
• Personal Digital Assistant/Enterprise Digital Assistant


  • Variety mobile device which functions as a personal information manager
• Graphing calculator


  • Handheld computer that is capable of plotting graphs, solving simultaneous equations, and performing other tasks with variables
• Pocket computer


  • 1980s-era user programmable calculator sized computer that had fewer screen lines, and often fewer characters per line, than the Pocket-sized computers intro duced beginning in 1989
• Tablet computer


  • Type of computer that can be carried easily, has no physical keyboard or trackpad, users control it mostly by using its touch screen with multi-touch technology similar to a smartphone
• Handheld game consoles


  • Nintendo DS
  • Game boy
  • Game boy color
  • Game boy advance
  • Sega game gear
  • PC Engine GT
  • Pokemon mini
  • NeoGeo pocket, NeoGeo color
  • Atari Lynx
  • Pandora
  • GP2X/GP32
  • Gizmondo
  • PlayStation Portable
  • N-Gage
• Media recorders


  • Digital still camera (DSC)
  • Digital video camera (DVC or digital Camcorder)
  • Digital audio recorders
  • Media players/displayers
  • Portable media player
  • e-book reader
• Digital recording


  Audio signals picked up by a microphone or other transducer or video signals picked up by a camera or similar device are converted into a stream of discrete numbers, representing the changes over time in air pressure for audio, luminance values for video, then recorded to a storage device
• Communication devices


  • Mobile Phones
  • Cordless telephone
  • Pager
• Benefits of handheld devices and gadgets

  • Office on the go
  • High convenience
  • New entertainment forms
  • Breaking the communication barrier
• Guidelines


  Evidence-based recommendations, usually generated from an authority group consisting of experts in the field and published regularly
• Common clinical guidelines


  • American Diabetes Association
  • National Heart, Lung and Blood Institute (NHBLI) for the management of asthma and hypertension
  • Joint National Committee (JNC) for hypertension
  • US Preventive Service Task Force for colorectal screening
• Protocols


  Evidence-based but tend to be beam-based approaches to practices in a locale or region
• Procedures


  Commonly performed skills in practice setting
• Application of clinical informatics

  • Allows the nurse to review procedures prior to performing them and also adds to the uniformity of procedures performed within a given practice
• Medical applications with guidelines, protocols, and procedures

  • Epocrates
  • UpToDate
• Epocrates


  Mobile medical reference app, owned by Watertown, Massachusetts-based athenahealth, provides clinical reference information on drugs, diseases, diagnostics and patient management
• UpToDate


  Software system that is a point-of-care medical resource, an evidence-based clinical resource
• Electronic Health Record (EHR)


  A software that's used to securely document, store, retrieve, share, and analyze information about individual patient care. EHRs are hosted on computers either locally (in the practice office) or remotely.
• EHRs


  • They are real-time, patient-centered records that make information available instantly and securely to authorized users
  • They contain a patient's medical history, diagnoses, medications, treatment plans, immunization dates, allergies, radiology images, and laboratory and test results
  • They allow access to evidence-based tools that providers can use to make decisions about a patient's care
  • They automate and stream line provider workflow
  • Health information can be created and managed by authorized providers in a digital format capable of being shared with other providers across more than one health care organization
• Cloud-based or internet-based EHR systems

  Remote EHR systems
• EHR


  A digital version of a patient's paper chart
• Medicine is an information-rich enterprise
• A greater and more seamless flow of information within a digital health care infrastructure, created by electronic health records (EHRs)

  Can transform the way care is delivered and compensated
• EHRs


  • Information is available whenever and wherever it is needed
• Improved patient care with EHRs

  • Quick access to patient records from inpatient and remote locations for more coordinated, efficient care
  • Enhanced decision support, clinical alerts, reminders, and medical information
  • Performance-improving tools, real-time quality reporting
  • Legible, complete documentation that facilitates accurate coding and billing
  • Interfaces with labs, registries, and other EHRs
  • Safer, more reliable prescribing
  • Reduced need to fill out the same forms at each office visit
  • Reliable point-of-care information and reminders notifying providers of important health interventions
  • Convenience of e-prescriptions electronically sent to pharmacy
  • Patient portals with online interaction for providers
  • Electronic referrals allowing easier access to follow-up care with specialists
• Patient participation


  Providers and patients who share access to electronic health information can collaborate in informed decision making
• EHRs help providers


  • Give patients full and accurate information about all of their medical evaluations
  • Offer follow-up information after an office visit or a hospital stay, such as self-care instructions, reminders for other follow-up care, and links to web resources
  • Manage appointment schedules electronically and exchange e-mail with their patients
  • Identify symptoms earlier and be more proactive by reaching out to patients
  • Provide information to their patients through patient portals tied into their EHR system
• EHRs


  • Can decrease the fragmentation of care by improving care coordination
  • Integrate and organize patient health information and facilitate its instant distribution among all authorized providers involved in a patient's care
  • Allow every provider to have the same accurate and up-to-date information about a patient
  • Reduce medical errors and unnecessary tests
  • Reduce the chance that one specialist will not know about an unrelated (but relevant) condition being managed by another specialist
• Better care coordination with EHRs

  Can lead to better quality of care and improved patient outcomes
• EHRs


  • Can improve the ability to diagnose diseases and reduce—even prevent—medical errors, improving patient outcomes
  • Keep a record of a patient's medications or allergies and automatically check for problems whenever a new medication is prescribed and alert the clinician to potential conflicts
  • Expose potential safety problems when they occur, helping providers avoid more serious consequences for patients and leading to better patient outcomes
  • Can help providers quickly and systematically identify and correct operational problems
• Ways EHRs improve medical practice efficiencies and cost savings

  • Reduced transcription costs
  • Reduced chart pull, storage, and re-filing costs
  • Improved documentation and automated coding capabilities
  • Reduced medical errors through better access to patient data and error prevention alerts
  • Improved patient health/quality of care through better disease management and patient education
  • Improved medical practice management through integrated scheduling systems that link appointments directly to progress notes, automate coding, and managed claims
  • Time savings with easier centralized chart management, condition-specific queries, and other shortcuts
  • Enhanced communication with other clinicians, labs, and health plans
• Advantages of EHRs

  • Providing accurate, up-to-date, and complete information about patients at the point of care
  • Enabling quick access to patient records for more coordinated, efficient care
  • Securely sharing electronic information with patients and other clinicians
  • Helping providers more effectively diagnose patients, reduce medical errors, and provide safer care
  • Improving patient and provider interaction and communication, as well as health care convenience
  • Enabling safer, more reliable prescribing
  • Helping promote legible, complete documentation and accurate, streamlined coding and billing
  • Enhancing privacy and security of patient data
  • Helping providers improve productivity and work-life balance
• Transformed health care benefits of EHRs


  • Better health care by improving all aspects of patient care, including safety, effectiveness, patient-centeredness, communication, education, timeliness, efficiency, and equity
  • Better health by encouraging healthier lifestyles in the entire population, including increased physical activity, better nutrition, avoidance of behavioral risks, and wider use of preventative care
  • Improved efficiencies and lower health care costs by promoting preventative medicine and improved coordination of health care services, as well as by reducing waste and redundant tests
  • Better clinical decision making by integrating patient information from multiple sources
  • Enabling providers
• Electronic Health Records (EHRs)


  The first step to transformed health care
• Benefits of electronic health records

  • Improving all aspects of patient care, including safety, effectiveness, patient-centeredness, communication, education, timeliness, efficiency, and equity
  • Encouraging healthier lifestyles in the entire population, including increased physical activity, better nutrition, avoidance of behavioral risks, and wider use of preventative care
  • Promoting preventative medicine and improved coordination of health care services, as well as by reducing waste and redundant tests
  • Integrating patient information from multiple sources