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1. Discuss the role of the nurse informaticist from the perspective of the interviewed preceptor.

This paper will present a personal interview with my preceptor at Flushing Medical Center (D. Mangubat personal communication, April 1, 2007). She has a PhD in Nursing but no nursing informatics background. Although this was the case, she demonstrated a high knowledge of nursing informatics. She stated that her role as a nurse informaticist includes planning, implementing electronic health records, training others how to access and use the implemented systems, troubleshooting when there is a problem, maintaining and updating the system. Furthermore, according to Gunn Jody (2007), the role of a nurse informaticist can be summed up as the point where “high tech” truly meets: “high touch” (p.3).The nurse takes on two roles: The clinician and the technician. The American Nurses Association (ANA) defines the role of the Nursing Informatics Specialist (NIS), as one that facilitates the integration of data, information and knowledge to support patients, nurses and other providers in their decision-making in all roles and settings. They serve as the interface.

2. Identify the concepts of Nursing Informatics applied by the nurse informaticist at the selected health setting.

Dr. M directs and oversees the nursing implementation of various systems. As stated earlier, she is not a nurse informaticist and also there is no nurse in her staff. She makes sure that the nurses and other healthcare professionals are well trained in the system which the hospital is planning to implement. This includes managing, maintaining and entering data into the system. She enters information into the system on a daily basis and retrieves the data in the form of a report when needed. She is aware that the wave of the future in all healthcare facilities is information technology. She attends meetings that talk about selection of different systems for the hospital.

3. Discuss the emergence of Telehealth, Telenursing, and Telemedicine at the selected health care setting to capture a historical understanding. Compare and contrast the outcomes to data learned in prior IN courses as related to patient care and health care management.

According to Greenberg, (2000), Teleservices use telecommunication technology to transmit information from one site to another. Applications in clinical practice, research, and administration include telephone consultation, triage, follow up, email inquiries and advice, video conferencing, video monitoring and digital photography. Telehealth is the delivery of health services over distances. This has replaced telemedicine as the inclusive term used to describe the wide range of services delivered by all health-related disciplines. The term telecare is comparable to telehealth, referring to the delivering of care over distance. Specialty applications of telemedicine include teleradiology, telepathology, telepsychiatry, teledermatology, and teleoncology (Greenberg, 2000). Telenursing is the delivering of nursing care and services using telecommunications. This continues to increase access to nursing care interventions for clients in remote or distant locations. Although it is typically associated with the telephone, it also incorporates telecommunications technologies, for example, interactive video, video monitoring and digital camera. Telephone nursing is the use of the nursing process to provide care to patients over the telephone. The role of telephone nursing has become increasingly central to the delivering of cost-effective, quality care for disease management populations. The Matria is the only electronic device used in the home that is provided by Flushing Hospital. It was implemented about seven years ago and it is used to monitor women who have high risk pregnancies. IDX image cast is a system used in the radiology department. It interprets radiology imageries after working hours. It was implemented about five years ago. PICIS health record system is used in the operating room to document, to promote patient safety, and to make rapid decisions. This system was implemented five years ago. The Extended Care Information Network (ECIN) system is another system in Flushing Hospital that helps to connect patients with extended care providers on the outside.
In Flushing Hospital there are many systems that serve different purposes in various departments. These systems are not working to their full capabilities because they do not interface with each other. They stand on their own in the different departments. The systems include MediServe Respiratory Care, SCC laboratory, Hemocare Blood Bank, and Pharmacy Management System. The hospital is currently trying to interface these systems with the Order Communication system (OC). This will enable nurses and doctors to do their job more effectively by reducing time spent in making phone calls to order medications, laboratory services, and dietary services and will also reduce paper work. Nurses will also have more time with the patients by not leaving the unit to go and pick up medications from the pharmacy.
The electronic health record that exists in Flushing hospital is in the OB/GYN department. This system is the IPRob system. The other parts of the hospital still use paper for their health records and this slows down the progress of the delivery of care. In the previous Informatics class, telehealth, telemedicine, and telenursing have taught that this is the way of the future in delivering efficient and effective care. Paperless systems are also the way of the future because they promote better patient outcome and lessen patients’ stay in the hospital. The future is all about taking care of the patient from a distance. Some methods of healthcare management come in the form of medical software and telemedicine. Patients’ medical information is being delivered through the use of video, web, laptops, and telephone. The health care industry is going technical and all medical institutions should go with the trend. Flushing Hospital has a long way to go with regards to having a paperless system in the entire institution. They need to carefully plan this in order to have a smooth transition from a paper to paperless system.

4. Explain at least 3 observed practices of Telenursing used at the selected site to meet the holistic needs of the patient, families, communities and health care providers.

As earlier stated, the only telenursing system used in Flushing Hospital is the Matria system. This system is hooked up to expectant mothers and it monitors the mother and the fetus. It monitors the contraction patterns and fetal heart rates. The results are monitored by the agency who in turn delivers the message to the health care provider for any abnormalities that exist. The nursing director of maternal and child health stated that mothers who are discharged from the hospital after giving birth are contacted two days to a week via phone to see how they and their babies are doing. The mothers are asked about how they are coping with the newborn and if the baby is being fed well. This program started about four years ago.
The nursing director of Operating Room mentioned that a day before surgery patients are called to be reminded of their pre-operational requirements, such as not eating the night before the surgery and the medicines to take on the morning of the surgery. After the surgery is completed and the patient is discharged, a nurse from the surgery department would call to check upon the patient to see how he/she is doing.

5. Identify the primary uses of administrative software at the selected health care setting.

The hospital utilizes both administrative and clinical software. The KRONOS is a fingerprint system used primarily for attendance. It is used in the entire hospital. This system interfaces with the LAWSON system, which is used by human resources and payroll for salary scale, tax rates for deduction, and printing of checks. The ANSOS-1 staff system is used solely by human resources for nursing scheduling and record keeping of personal information, such as name, address, and date of hire. I was able to use the ANSOS to generate report on the staff that worked on a specific day and to find out the nursing licenses that are expired.



The Infinite is a system used to retrieve radiology, dietary, admitting, and laboratory results. The Order Communicating system is also used to order dietary, radiology, and laboratory requests. This system interfaces with the Infinite.




6. Trace the progression of at least 20 words/terms phrases used to develop nomenclature among the multidiscipline healthcare providers at the facility designed to improve the quality of patient care.

Dr. M. my preceptor mentioned some of the nomenclatures used in Flushing Hospital Laboratory department. These include:
1. Hemoglobin 2. Hematocrit
3. Prostatic Specific Antigen 4. Prolactin Serum
5. Iron Serum 6. Glucose, Serum
7. Albumin, Serum 8. Hemoglobin A1C
9. Chloride, Serum 10. Cortisol, Serum
11. Amylase 12. Digoxin level
13. Phenytoin level 14. Coumadin level
15. Basic Metabolic Panel 16. Calcium, ionized serum
17. Fluid Calcium 18. Amylase, body fluid
19. Phenobarbital level serum 20. Glucose tolerance
According to Englebardt and Nelson (2002), nomenclature is the systematic listing of the proper names for concepts, items, actions, and other aspects of a particular knowledge domain or a particular area of interest. It is a standardized language. It is important that everyone speaks the same language. This is because one thing can have many names and can lead to confusion. For example, bedsores can also be called decubiti ulcers. The International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) is being used in Flushing Hospital to classify groups of related disease entities.

7. Analyze the measures used to maintain confidentiality of electronic records at the selected facility.

Maintaining confidentiality of electronic records in any institution is very important. Englebardt and Nelson (2002) stated that confidentiality describes a health care professional’s duty to protect the secrecy of information about a patient’s condition, regardless of its source. She further describes confidentiality as “condition information is shared or released in a controlled manner” (p.523). At Flushing Hospital, employees are assigned user names and passwords to access the electronic health records. The passwords are updated every three months. During training sessions employees are reminded of the Health Insurance Portability and Accountability Act (HIPAA). Also to maintain confidentiality, the electronic health record logs off if not attended to in three minutes. Another confidentiality issue discussed at the time of training is insider curiosity. Employees are advised not to access friends’ or neighbors’ medical records if they are not directly involved in their care. When an employee resigns, retired, or is fired, his or her access to the electronic health record is terminated.

The clinical experience was wonderful. I was privileged to be involved in training the employees on the Order Communication system which will go live soon. I also used ANSOS to recover data for administrative purposes. In general it was a fulfilling experience.












References
Department of Health and Human Services (CDC). (2006, June 30). Inactivated Influenza Vaccine.
Englebardt, S.P., & Nelson R. (2002). Health care informatics. St. Louis, Missouri: Mosby.
Greenberg, M. (2000). The domain of telenursing: Issues and prospects. Nursing Economics, 18, 220-224. Retrieved February 4, 2007, from http://library.molloy.edu.
Jody, G. (2007, February). HIMSS… A burgeoning partnership: The future of nursing informatics. Power point presentation to informatics group. New Orleans.