I find myself spending large amounts of time in airports, arriving early to get through strict security, or passing time in terminals due to weather or mechanical delays. During those periods, I seek refuge at a quiet boarding gate that has a high concentration of power outlets or Internet access. Finding these spots is often a challenge, as I peer under seats, circle support columns and poke around vending machines. Occasionally, if I'm lucky, I run across a re-charging station to at least take care of my power needs.
These recharging stations are becoming more and more popular as business travelers flock to them to charge a plethora of devices. There you can find the latest "must have" or "cool" device / gadget on the market. But as I glance at the array of devices, I wonder, "Is cool always smart?" As a nurse, what really matters to me is the impact a device has on workflow or how I do my job, not necessarily its "coolness."
By many estimates, the typical nurse spends approximately 2 hours a shift simply keeping numbers current in patient medical records. By the time the doctors and multidisciplinary care team actually receive the information, it's often already outdated. To me, "smart" gadgets should help me decrease the time I spend inputting data and increase the time I spend directly caring for my patients.
Mobile devices, such as tablets and smart phones, may be the latest technology, and what many hospitals are considering incorporating into every part of nursing workflow. But I'm not so sure these devices will help a nurse achieve what he/she intends. In my experience, adding to nurses' tool belts (which can include as many as 15 other devices) can sometimes weigh us down rather than increase the time directly interacting with patients. We should be "hands on" with our patients, not with another device.
As nurses, our focus should always be on delivering safe, competent, and compassionate care. We should take caution with becoming the first to use an innovative new technology. So, before moving ahead with the introduction of the latest and greatest mobile technologies, perhaps a hospital should consider the following items:
- Is it easy to use? Has it been thoroughly tested in the care environment?
- How many steps must the nurse complete in order to get data to its end location? Is it intuitive? Simple? Fast?
- Does it need to be put down for best data input? Where do we put the device if the patient needs our immediate attention? Then what about the transmission of infectious properties as we go from room to room?
As with any technology purchase, good research and asking the right questions are musts to help assure the tools acquired are more than "cool," but actually useful. When it comes to nursing and patient care, that usefulness equates to quality care, so we must be aware of the shiny new gadget and be confident that we are implementing the right technology, for the right people, at the right point in time.
"Learning cultures" within hospitals, health systems, and other healthcare organizations across the care continuum are rooted in the practices and policies of schools, colleges and universities. This blog explores how nurse educators can use supportive learning environments created within schools and colleges as a foundation for creating positive learning environments in healthcare organizations (HCOs).
Nurse educators can build a learning culture where students, faculty and administrators develop lifelong, positive learning attitudes, beliefs, values and behaviors by taking these steps:
- Sharing: Create opportunities where students, faculty and administrators can pose questions and share information and insights. Encourage everyone to capture and tell stories about how individuals and teams have transformed patient care and the profession of nursing.
- Reflection: Offer everyone-students, faculty and administrators--the chance to reflect on lessons learned, predict consequences and explore underlying assumptions, values, beliefs, attitudes and expectations. Equally important, develop programs and activities that promote the value of sustained experimentation and innovation by RNs.
- Talent: HCOs should hire, retain and promote faculty and administrators based on their ability to learn and adapt to new processes, systems and situations, and nurse educators can help identify and foster these staff members. Anchor performance reviews in positive learning behaviors and demonstrated innovations-not just technical nursing expertise.
- Feedback: Solicit student, faculty and nursing community input on learning programs, processes and outcomes. Then incorporate the feedback into plans, programs and projects.
Engineering a positive learning culture within nurse education is the first step toward building pro-learning cultures within HCOs, including hospitals, health systems, and medical groups. Nurse executives and managers can maintain learning cultures through these actions:
- Set learning goals and objectives: Encourage the C-suite to turn the concept of a pro-learning culture into an organization-wide commitment and goal. In a second step, link learning culture to the organization's clinical, financial and operational objectives.
- Promote Individual/group accountability: Invite RNs to identify personal learning needs via analyses of performance appraisals and competency based assessments. Teamwork is just as important, so encourage RNs to join teams or networks to share information and knowledge throughout the learning process. Finally, use special events and awards to celebrate the power of individuals and teams to achieve desired learning outcomes.
- Create a low-barrier learning environment: Nurse executives can support RN learning if they design and implement learner-centric environments and remove typical obstacles to learning. Such barriers often include adequate time for learning, ongoing funding, access to learning content, tools and technologies, and integration with learning programs with nursing unit and organizational goals.
- Promote the significance of learning: Nurses executives and managers must help RNs understand why they must engage in lifelong learning, including how they will likely contribute to the development of learning cultures. One strategy is to appoint learning coaches and mentors-experienced nurses who can help RNs tweak learning plans, make program choices and solicit feedback on learning program quality, accessibility and effectiveness. This model is similar to what the Nurse Faculty Leadership Academy of Sigma Theta Tau Intl. tries to do. The NFLA is supported by a grant from The Elsevier Foundation.
- Encourage experimentation and innovation: Nurse executives can support RNs in their quest to investigate fresh ideas for nursing practice and assume calculated risks. For example, nurse executives might encourage RNs to explore the healthcare and nursing implications of innovations like 3-D printing, augmented reality, wearables and mobility. Or they might challenge RNs to analyze the evolution and impact of healthcare trends like accountable care, continuum of care, population health, care collaboration and primary care shortages on professional nursing practice.
Building positive learning environments within nursing education and HCOs means offering RNs the opportunity to simultaneously function as learners, teachers and trainers. When the C-suite commits to building a training- and learning-focused culture, it can create nurse leaders and champions at all levels of the organization. It can also attract "the best and the brightest" nurses, boost RN productivity and facilitate nurse succession planning and promotions based on results.
RNs can create pro-learning environments if they secure the commitment of top management, align the pro-learning environment with business and clinical goals and personalize and individualize learning opportunities. As RNs eliminate or minimize common learning barriers, they will create environments that support rather than constrain learning, experimentation and innovation.
"The Path to Continuously Learning Healthcare"
"Becoming a Learning Organization: The Role of Health IT"
"Continuous Learning Drives Healthcare Improvement"
"How Kaiser Permanente Become a Continuous Learning Organization"
Leadership for Learning Organizations
Advanced practice nurses (APNs) are in demand. From Q1 2012 to Q1 2013, job postings for nurse practitioners (NPs) rose 15 percent, while nurse management postings increased 8 percent. Family medicine NPs topped the list for most nurse practitioner job postings in the first quarter of 2013, according to the HealtheCareers Network and the U.S. Bureau of Labor Statistics.
The increasing numbers of family practice (FP) NPs now rely on health information technology (HIT) to deliver safe, quality care. Required HIT competencies outlined by the American Association of Colleges of Nursing (AACN) call for changes in both master's level programs and learning interventions offered through hospitals, health systems and medical groups.
Chief information officers (CIOs), chief nursing officers (CNOs), chief nursing informatics officers (CNIOs) and other members of the C-suite must join forces to educate, train, coach and mentor FPNPs in how to integrate technologies to manage knowledge and improve healthcare. HCOs should measure competency by asking these questions:
- Education/coaching: Are FPNPs able to translate technical and scientific health information to meet patients' information and learning needs? Can they assess patient and caregiver educational needs? Are they able to coach patients and caregivers in positive behavioral change?
- Decision making: Can FPNPs demonstrate information literacy skills in situations that require complex decision making?
- Systems design: To what extent are FPNPs able to contribute to the design of clinical information systems?
- Evaluation: Are FPNPs able to use technology to evaluate the quality, safety and efficiency of nursing care?
By demonstrating these HIT competencies, FPNPs have already achieved impressive gains. The Office of the National Coordinator for Health Information Technology (ONC) labels NPs "crucial primary care providers on the path to meaningful use." NPs that enrolled in Regional Extension Center (REC) programs, which now work with half of the NPS and PAs in the U.S., have made even more dramatic progress. Four out of five NPs and PAs enrolled in a REC are now live with an electronic health record (EHR).
As more HCOs go paperless, FPNPs will rely even more on HIT, according to a January 2014 survey from TCS Health. Of the respondents to TCS' 2012 survey, 30 percent said their office had already moved to a paperless environment up from 17 percent in 2008 and 23 percent in 2010. That, in turn, will require intense, ongoing education and training.
Reliance on HIT is especially strong among FP physicians who outpace other office-based physicians in EHR adoption, according to a 2013 study in the Annals of Family Practice. That trend will continue as physicians adopt technologies to ease the transition to medical home, value-based accountable care and population health management.
But HIT doesn't end with EHRs. FPNPs must learn how to deliver care via technologies like iPads, mobile health apps, applications, smartphones, cloud-based computing and remote monitoring devices. Eighty percent of physicians now access online health and medical content via smartphones, according to a 2012 Physician Mobile Survey. FPNPs will do the same.
Equally important, FPNPs must master how to provide patients and families with relevant health education and information via links to specific pages within high quality Web sites or peer-reviewed patient education and discharge instructions available in print or video formats or integrated within the EHR.
FPNPs must also learn how to manage and monitor patients' use of personal health records (PHRs). Already associated with improved medication adherence, PHRs are on the upswing. More than four million people now manage their health via My Health Manager , a personal health record available through Kaiser Permanente. This trend will continue as more patients request PHR access via portals or mobile devices.
Remote patient monitoring will emerge as an essential component of FPNP education and training. Showcased at the Consumer Electronics Show in January 2014, options range from real-time devices that allow patients to receive care in any care setting to wearable devices that allow tracking of vital signs and health-promoting behaviors. Equally important in fulfilling Intel's vision to "make everything smart" is the "smart home" and other aging-in-place solutions that allow people to monitor variables that influence health.
The potential for FP NPs to transform healthcare via HIT is evident in the Health Information Management Systems Society's decision to bestow its 2013 HIMSS Davies Award for Excellence to White River Family Practice (WRFP), White River Junction, Vermont. With six family practice physicians, two NPs and a support staff of 14, WRFP relied on EHR technology to create a "collaborative environment" that improved care quality for patients with chronic conditions like asthma and diabetes while improving smoking and alcohol cessation. As a result, the National Committee for Quality Assurance (NCQA) granted WRFP certification as a Level III Patient Centered Medical Practice.
FPNPs have a bright future-especially if they continue to build on their EHR knowledge, skill and experience through planned learning interventions in areas like remote patient monitoring, mobile health and patient education and engagement. Doing so will help FPNPs prepare for new and emerging roles as educational content brokers, health information coaches and mentors, and integrators of data from wearable devices and smart phones.
Recently I observed several staff nurses using smartphones during their shift. They used them to scan medications, communicate with other staff members, receive calls from providers/ancillary departments and even look up drug-dosing information. What I witnessed is an ever-growing trend across hospitals: nurses in large numbers are adopting the use of smartphones - often their own personal devices - at the point of care. And, this happens whether their employer supports it or not.
This finding was highlighted in a white paper from the Menlo Park, Calif.-based Spyglass Consulting Group. The report is what Spyglass Managing Director Gregg Malkary called an outgrowth of a similar study performed in 2009. Malkary said the results demonstrate a definite change in attitude among nurses in the past five years. In fact, Malkary said most hospitals have rejected a BYOD approach for staff nurses out of hand; one factor, he said, is the potential for administrators and nurses' unions to get tripped up over simple affordability of smartphones. But more than half the hospitals in the report responded that they plan to either evaluate or invest in enterprise-class smartphone solutions over the next 18 months.
In the meantime, though, it appears nurses, dissatisfied with landlines and overhead paging, will increasingly use their personal devices. The study found that 67% of hospitals reported their nurses used them and 91% of hospitals said they were aware of this usage but did not have the time, tools or resources to monitor such usage.
"I suspected nurses were using their devices," Malkary said. "I just didn't realize how widespread it was. And it's not just nurses, it's doctors as well. Nobody wants to use a secure text messaging app. They don't want to have to use two apps, they want one, and the prevailing attitude is that unsecured SMS is just fine. They know it's a violation, but it's more fluid, they know everyone else's smartphone number, and they can coordinate care. They're leveraging consumer grade tools to facilitate closed loop communication, and to support multidisciplinary care. Unfortunately, it's outside the firewall."
The "look the other way" approach does not have long to live, though, according to Malkary. The HIPAA Omnibus ruling of 2013, he said, provides a strong incentive, such as million-dollar-plus fines per incident, to get mobile governance policies in order sooner rather than later. The good news, he said, is that both hardware and application vendors are stepping up to provide durable devices - he mentioned the Motorola MC40 and Spectralink Pivot as examples - and secure software from vendors such as Voalte and Extension Healthcare.
There are many challenges to nurses "bringing their own device." Often, a hospital's IT department may ban such devices outright, since it can be difficult to monitor and distinguish reasonable personal usage from HIPAA violations, network security issues, and inappropriate usage. Furthermore, most smartphones now incorporate cameras, which if misused could be another HIPAA violation.
However, in light of all the challenges and concerns, it is worth noting that most hospitals permit and support patients bringing and using personal wi-fi devices. Doctors would be outraged if they were told they couldn't employ the tools that they found most effective. Somehow, we in healthcare must devise the tools and policies that respect and support nurses while addressing the legitimate needs of security, privacy and efficiency.
More information about BYOD here:
Ten years ago seniors accounted for just 12% of the population, according to the U.S. Census Bureau. By 2050, that figure will grow to more than 20%. Americans are living longer lives, but not necessarily healthier lives. Old age continues to bring chronic disease.
So severe is the crisis that by 2030, 170 million Americans may have to cope with chronic disease, forecasts the CDC. Addressing the needs of this population will call for new approaches to education, learning and training for both nurses and patients.
Nurses can help fill gaps in chronic care management by preparing to become adult-geronotological nurse practitioners (GNPs)-professionals who work with older adults in multiple care settings, according to the Gerontological Advanced Practice Nurses Association.
GNPs are registered nurses with master's degrees from academic NP programs. They specialize in caring for older adults, including diagnosing and managing acute and chronic diseases and, in some states, prescribing medications, notes the American Association of Colleges of Nursing (AACN).
To function as GNPs, nurses must build knowledge, skill and competence in nursing informatics. Only by learning how to design, implement and evaluate systems that allow for real-time information sharing among providers, government agencies and community groups can GNPs manage chronic disease and improve community based chronic care. Nurses must also master how to access real-time actionable information at the point of care to support the diagnosis and treatment of older patients, as well as patient education and health coaching.
Nurses who pursue specialized education and build the required repository of knowledge and skill to emerge as chronic care managers face bright career futures. Providers like Partners Healthcare have already initiated chronic care programs with technologies like telemonitoring and electronic health information exchange. Meanwhile, vendors like Alere have developed services like toll-free lines with nurse coaches, care alerts, biometric devices and chronic care reporting. GNPs and advanced practice nurses (APNs) could easily function in both not-for-profit and vendor environments.
But chronic care management involves more than the implementation of specific technologies. Nurses -specifically GNPs-must also pursue education that allows them to work throughout the continuum of care. Among the required competencies:
- Care coordination: To coordinate care, GNPs must learn how to use on cloud-based platforms that allow every member of the care team-nurses, physicians, patients and family members-to share healthcare information. Technology enabled communication and information sharing will emerge as key competencies.
- Care management: Caring for older adults demands that GNPs have the education and training to ensure the secure, immediate transmission of biometric and lab data. Doing so will free them to make timely, accurate, evidence-based decisions and then share these decisions with patients and families.
- Education and health promotion: The growth of Web-based portals for consumers, patients and clinicians requires that every member of the care team, including GNPs, have the knowledge and skill to access and ground decisions in evidence-based resources. Also needed is the knowledge and skill to work collaboratively with patients to promote better adherence to care plans.
Such developments come at a time when growing numbers of older chronic care patients rely on the Internet for health and medical research. Patients and consumers also tend to discuss conditions on social media and use mobile health apps to monitor data related to blood pressure, sleep behavior or glucose levels.
GNPs must engage in a lifelong learning process focused on older patients' use of the Internet, mobile devices and social media. Among the issues for GNPs:
- Internet: How do older patients use the Internet if they do? Where do they tend to get health information? Which sites should GNPs recommend to older and chronic disease patients and families? What's the GNP's role in training patients and family members on Internet use and Web site evaluation?
- Social media: How do older adults tend to use social media? What are the advantages and drawbacks? Should GNPs discourage social media use or point older patients and family members to specific social media resources? Should GNPs learn how they can make professional contributions to social media channels?
- Mobile devices: How do older adults use mobile devices? Which devices are specifically engineered to meet the needs of older adults? How can GNPs assist older patients and family members in mobile device selection and use? And what's the role of the GNP in providing coaching and advice to patients and family members?
- In the years ahead, GNPs will need education and training to advise patients and family members on how to track indicators and use the information to make more intelligent lifestyle decisions.
Supporting the trend toward patient-initiated tracking are a growing number of devices that call for involvement from GNPs, who will need to learn how to advise patients of available technologies and offer coaching on their use. For example, a wellness service from Alarm.com plants sensors throughout a senior resident's home, including living rooms and bathrooms. The service sounds an alarm if it detects that a senior is inactive for long periods of time or is away from the bed for an extended period at night.
Meanwhile, Zensorium has created Tinke which allows chronic care patients to measure heart and respiratory rates and blood oxygen levels through simple fingerprint scans. Independa's Angela Express creates an almost immediate connection between rehab residents with family members, opening up the world of video chat, photo sharing, Gmail Facebook and broadcast video.
Going forward, GNPs must pursue continuing education to monitor the impact of enhancements to electronic health records (EHRs), mobile devices and remote sensor technologies. GNPs will be in the vanguard technology enabled transformation, educating themselves, patients and family members on how to select, use and evaluate the best technologies available to improve care outcomes.
Conversations in Health Care: How Technology Is Advancing Senior Care http://www.westhealth.org/news/conversations-healthcare-how-technology-advancing-senior-care
Caregiving Goes Digital-and Lets Boomers Age in Place http://www.usatoday.com/story/news/nation/2013/11/24/technology-healthcare-boomers/3661007/
As Boomers Become Seniors, Health Technology Demand Grows http://www.informationweek.com/healthcare/patient-tools/as-boomers-become-seniors-healthcare-technology-demand-grows/d/d-id/1112786
Learning analytics is a powerful tool for nurse education and training. Students and practicing nurses can monitor their progress against other learners while monitoring timelines and benchmarks.
Learning analytics can also predict which learners need more support and attention from instructors and trainers, who increasingly rely on analytics technology to enhance or create courses and modules based on learner feedback.
Learning analytics varies from data mining, which uses data to perform assessments and personalize learning. However, both learning analytics and data mining are plagued by similar problems. Like other learners, nurses question the risks of sharing data with employers, colleagues and educators. Others wonder about overreliance on software rather than human judgment to make learning decisions. And still others question the merit of evaluations based exclusively on correct or incorrect answers and not the process of problem solving.
Despite these barriers, learning analytics has made inroads in creating highly personalized education opportunities for nurses and other professionals. Platforms like no-cost Always Prepped aggregate and analyze the most important aspects of a learner's performance on a single dashboard. Instructors can send learners real -time report cards with a single click, while integrating accounts from other sites.
Kno turns textbooks into interactive learning experiences by adding links, multimedia, flashcards and quizzes. Equally important, the textbook advises learners on how much they understand content and compares their performance to others. Kno already offers multiple learning texts on nursing. Learners can purchase Nursing Now for about $32 or rent it for a year for $16. Within the book, learners can engage in advanced search engage in advanced search of chapters and notes, create journal entries, generate flashcards of terms and definitions, and access 3-D images, and track study habits, engagement and progress in the textbook.
Billed as "an engagement, assessment and classroom intelligence system," Learning Catalytics allows faculty members and trainers to assess learners in real time through open-ended or critical thinking questions, which learners can address with numerical, textual or graphical responses. Faculty members and trainers can pinpoint areas that need further explanation and group learners for follow-up discussion and problem solving. They can also author questions on their own or collaborate with faculty who share question ratings and comments.
Technologies like Knewton deliver a platform that personalizes learning content developed by others. Faculty and trainers get feedback on what learners know at a specific percentile of proficiency. They can also pinpoint the source of an incorrect answer, including lack of proficiency, forgetfulness, distraction or a misworded question. Equally important, the technology sorts through multiple education goals and offers faculty and trainers feedback on what content the learner should focus next. Finally, faculty and trainers can calculate the probability that a learner will pass an upcoming test or quiz, as well as what the learner can do to enhance that probability.
Learning analytics will continue to influence nurse education and training as nursing benefits from a growing number of personalized and adaptive learning solutions. More learning management systems and learning platforms will integrate learning analytics features, advising trainers and faculty members on how to monitor and evaluate learner behavior. Over time, learning analytics will tap big data to present even more refined insights into learning outcomes and organizational performance.
The Growth of Learning Analytics http://www.trainingmag.com/content/growth-learning-analytics
Enhancing Teaching and Learning through Educational Data Mining and Learning Analytics: An Issue Brief http://www.ed.gov/edblogs/technology/files/2012/03/edm-la-brief.pdf
Society for Learning Analytics Research http://www.solaresearch.org/resources/
Digital health dominated the 2014 Consumer Electronics Show (CES) (http://www.cesweb.org/home). While curved TVs, 3-D television and Ultra HD were the talk of the show, the real happening at CES was the growth in the connected space and digital health. The Consumer Electronics Association (CEA), the organization behind CES, has reported a 40% growth in digital health exhibitors over past year with over 300 exhibitors in the medtech space. Now that health and wellness are becoming increasingly consumer-oriented, a younger more health-conscious population enters the market. In addition, the Baby Boomer generation looks for better ways of managing their health.
Where medical equipment manufacturers have traditionally thought of the healthcare provider as their consumer, a new, secondary business model is opening up, one that goes directly from the manufacturer to the patient. There is an overall trend toward digital technology across multiple industries. Perhaps, this can be linked to an overarching trend, which is that every business is a digital business and every consumer, or patient, is a digital consumer.
Here are three key trends that dominated the consumer digital health space at CES this year:
#1 - Self Tracking and Wearables
It should be no surprise to anyone that wearable devices and fitness trackers would have been a big presence at CES. According to the 2014 Accenture Digital Consumer Tech Survey, 52% of consumers are interested in buying wearable health trackers. A July 2013 survey done by CEA found that one-third of mobile smartphone or tablet users have tracked some aspect of their health in the past 12 months.
Wearables are gaining popularity, as they will be more discrete and will blend into people's daily lives by being embedded in clothes and everyday products. Wearables will provide a more user-friendly experience that offers more ease when it comes to analyzing data, sharing it across the Internet and social media, and data protection. New wearable products from major companies like Sony and LG have released the Sony Core and LG Lifeband Touch - both targeted at tackling the next-gen fitness tracking market.
#2 - Aging in Place Solutions
This year the first generation of Baby Boomers will be turning 68. Most people can tell you a funny story about trying to teach your parents or grandparents how to use the Internet. Yet AARP reports that eight in 10 of its members own a computer, tablet, or e-reader. And a 2012 AARP survey of seniors over the age of 50 found that 36% of those surveyed reported being "extremely or very comfortable" with technology.
Seniors and retirees are looking for options to receive assisted care they need in a way that they don't have to overly sacrifice their independence or standard of living. And electronics companies are seeing the potential in capturing a market that is tech savvy, but also increasingly in need of healthcare solutions. CES 2014 marked the unveiling of healthcare products for supporting increased social engagement, injury prevention, even early detection and treatment of chronic diseases among seniors.
MobileHelp is introducing the Celluar DUO, a personal emergency response system targeted at seniors and is capable of automatic fall detection. The DUO operates on AT&T's cellular network, ensuring patient safety in the absence of a land line. It will also work in conjunction with MobileHelp's just-announced MobileHelp Connect online portal, which provides patients and their families and caregivers with the ability to virtually track patient activity levels, medication adherence, and trends over time. A&D Medical, a manufacturer of biometric monitoring solutions, has unveiled its Connected Wellness platform which connects A&D devices, including weight scales and blood pressure monitors, via Bluetooth Smart - enabling patients to monitor their health across multiple devices on an Android or iOS smartphone. Siemens Healthcare won an Innovations Design and Engineering Awards Honor at CES this year with its miniTek, a device that can remotely connect a patient's hearing aid to phones, TV, music players, and other audio devices via Bluetooth. An accompanying Android-based app allows users to control their hearing aid's volume
#3 - Real Time Remote Monitoring
According to a Brookings Institute analysis, remote monitoring technologies could save the U.S. healthcare system $197 billion between 2010 and 2035. Industry experts believe the combination of Internet, video, and wireless technology for inbound patients and those with chronic conditions will create an explosion of consumer products with evolving patient monitoring capabilities. They also believe we will see further evolution including implanted bioelectric sensors and options to detect a deeper range of physiological information along with sensors that can track nonlinear data like bathroom visits, coughs, and erratic behaviors. Packaged behind these more powerful sensors will be systems such as monitoring apps for smartphones and tablets, that provide two-way communication to remote healthcare consultants.
SMK Electronics demonstrated a video game for remote rehabilitation (telehabilitation). The company's platform, which was developed in coordination with the University of Manitoba, uses the Gyration Air Mouse - a motion-tracking computer mouse that can be used while held in the air - to rehab patients with arthritis and balance and gait disorders.
Vancive Medical Technologies, a division of Avery Dennison, showcased its Metria Informed Health Technology Platform - a series of disposable, adhesive, sensor-based products for health monitoring and clinical applications. Vancive's first consumer level product, the Metria IH1, is intended for "lifestyle management applications" and measures activity, sleep, calories via a sensor that sticks directly onto the body - something that could be a welcome change for consumers whose wrists are already occupied with smartwatches and fitness bands.
Growing numbers of nursing educators and trainers have come to rely on a learning model known as the "flipped classroom." Simply stated, the flipped classroom restructures how nursing students and practitioners invest their time both within and outside the traditional classroom. Even more important, the flipped classroom represents a shift in learning accountability from the nurse faculty member or trainer to the nursing student or practitioner.
Once nursing students and practitioners exit the formal classroom, they take on new responsibilities and tasks. First, they must manage the content they decide to access and use. They also must select a learning style, set a pace for learning, and identify strategies and tactics to demonstrate or verify learning.
The shift in roles goes both ways. The nurse faculty member or trainer takes on the role of learning navigator, guide or broker. Rather than dispensing nursing content from a lectern or podium, the educator or trainer adapts varied learning approaches to the needs of students and practitioners and, as much as possible, brings learners along on a personalized learning journey.
Learners who once took copious notes within the confines of the classroom now rely on multiple technologies to master nursing competencies, knowledge, skills and procedures. They watch presentation videos, listen to podcasts, review enhanced e-book content and collaborate with faculty and fellow learners within online communities. For example, a nursing student or practitioner might access nursing content through these channels:
- Participate in a webinar on implementing health assessments in primary care sponsored by the Agency for Healthcare Quality and Research;
- Listen to a series of three podcast lectures on nursing ethics;
- Consult chapters of e-books focused on evidence-based nursing care guidelines and pain management;
- Attend virtual conferences sponsored by the National Hospice and Palliative Care Association and the Oncology Nursing Society.
- Use adaptive learning systems to individually learn specific content and evaluate the ability to apply that knowledge
The flipped classroom remains a powerful learning channel. However, instead of listening to lectures punctuated by questions, nursing students and practitioners use classroom time to engage in interactive, project-based learning. For example, learners might solve real world problems related to the management of chronic disease like obesity, diabetes or congestive heart failure.
Or they might devise real-world applications of findings from a 2014 AHRQ study that reported the most common diagnoses for hospitalization are live births, pneumonia, septicemia, congestive heart failure and osteoarthritis. Or students and practitioners might identify emerging trends, implications and action steps related to research conclusions like these:
- Post-menopausal women who followed the cancer-prevention guidelines developed by the American Cancer Society were 17 percent less likely to develop cancer and percent less likely to die from cancer. Question: How should nurses share cancer prevention strategies with patients?
- The number of states with widespread flu activity increased from 25 to 35, according to the Centers for Disease Control and Prevention (CDC). Patients between the ages 18 and 64 have accounted for about 61 percent if flu-related hospitalizations nationwide. Question: How is the local community responding to the flu crisis? What's the appropriate role for hospitals, physician practices and nurses?
- According to a 2014 study from researchers at Children's Hospital at Montefiore (CHAM), only 1 of 169 adults was able to demonstrate correct use of a metered-dose inhaler. Such inhalers are commonly used to treat asthma in children. Question: How can nurses provide parents with better guidance on the benefit and use of MDIs?
By shifting the focus from formal presentations to problem analysis and resolution, nursing students and practitioners can learn more by doing more. No longer tethered to the lectern, educators and trainers can lead learners through the processes of content interpretation, analysis, evaluation, and synthesis while devoting more time to interactions with individual learners.
The flipped classroom doesn't stand alone. Instead, it functions as one component of a cluster of solutions designed to making nurse education and training more active, fluid and engaging. Such concepts have won the approval of bodies as diverse at the President's Council of Advisors on Science and Technology, and the National Council of State Boards of Nursing.
In the years ahead, nursing educators and trainers will join forces with learners to aggregate lessons learned from a variety of models, including blended and inquiry based learning. Meanwhile, nursing students and practitioners will gain access to an ever-growing array of online and offline learning resources, driving the inevitable transition to more self-directed, lifelong learning.
As learners continue to access videos, podcasts, and online content at the time and place of their choosing, nurse educators and trainers will use classroom time for hands-on exercises in problem-solving, conflict resolution, decision making and collaboration.
Other educators and trainers will turn lectures into workshops where groups of nursing students or practitioners collaborate and compete to design care plans, deliver population-specific education and counseling, integrate patient information from a wide array of tools and devices and coordinate care with multiple healthcare professionals. Still others will experiment with one-on-one coaching and mentoring, independent learning projects and real world and virtual field trips.
The future of nursing education and training is as broad as our imagination. By partnering with educators learners, technology vendors, and government, we can extend the boundaries of learning with the nursing profession.
Despite the widespread adoption of electronic medical records (EMRs), nurses still spend a large part of their shift on patient charting. This time could be better spent delivering patient care and working toward outcome and quality goals. The first thought that comes to mind regarding the time spent working with the EMR is But I thought computers are supposed to save time.
Responding to that assertion, both to providers and healthcare consumers, is a tough task. Many people watch TV programs that showcase the marvels of science with regards to forensics, as it applies to criminal justice and medical issues. Most medical professionals know that existing tools actually pale in comparison to their fictional counterparts. The computer systems used in healthcare mimic this dichotomy between reality and television entertainment. The EMR provides a wonderful toolset for providers, particularly for nurses charged with patient documentation. However, EMR systems have not yet reached the perfect level of usability. And the main reason for this is a lack of interoperability standards.
So what does interoperability mean? The basic definition of interoperability is the ability of a system to interact with all its parts, thereby producing useful and meaningful results.
Nurses know that for quite awhile now blood laboratories have had the ability to share patient test results through an electronic system, speeding their delivery and helping to improve quality of care. Doctors and nurses can now view these test results in the central patient record nearly in real-time, as soon as the tests are completed. But the ability of the EMR to do more than simply display data is where the concept of interoperability comes into play.
For example, an interoperable EMR might integrate lab results with nursing workflows. Critical lab results, like a blood sugar value less than 60, would not only be highlighted in red, but would sound an audible alert and require nursing staff nurse to acknowledge the result and document the action that was taken. This can help ensure a fast, direct patient intervention – as well as provide an audit trail for accountability of care, since the intervention can be tracked electronically.
Even more advanced interoperability might take all of this information and send the data through the mobile phone system – securely encrypted, of course – so the physician on call is immediately alerted of the situation and the actions taken.
Nurses can play a role in attaining that level of interoperability. How? They can engage the EMR administrator and assist in integrating evidence-based practice into the overall system that’s used throughout the entire facility. This daunting task for nurses is one that could potentially lead to great rewards, including reducing the need for nurses to manually input data, which in turn could allow more time for bedside care – and thereby ensure a high level quality, safety, and transparency for the patient’s dynamic health condition. Only the diligence of nursing on the front lines and promoting the interoperability of systems can meet the needs of our patients in years to come.
Recently, the question of "what's the difference between HIM and Informatics" was posed to me. At first pass, I believed I could answer this succinctly and completely. However, upon thinking about this some more, I knew I needed to describe just how interrelated the two fields were. On the surface, health informatics (HI) and health information management (HIM) may seem very similar to most people. Both fields revolve around the use of technology in the healthcare field and share some common skill sets and job responsibilities, but there are many differences between these two fields.
The key factor that distinguishes HI from HIM is that HIM typically focuses on the information technology processes needed to store and retrieve patient data accurately and complying with regulations. HI, focuses on applied technology by using information management and information technology to improve patient care.
While HI and HIM complement each other, they differ on what each of these professionals do. Health informatics professionals design and develop information systems and processes that improve the quality, effectiveness and efficiency of care. They also assess emerging technologies for healthcare applications. HI is often described as the intersection of computer science, information science and healthcare. This means that HI professionals work with both the processes and the tools used to record, store and analyze healthcare information. They have a deep understanding of data, particularly electronic health records and how it can be used to support decisions and protocols. Health informatics professionals often interact directly with clinical staff and patients in order to evaluate the impact of information technology on clinical processes, outcomes and resources.
Health information management professionals generally work with organizing and managing patient data contained in the medical record. HIM professionals are often responsible for coding health information for proper reimbursement or research. They also ensure compliance with governmental regulations regarding patient data. They must make sure patient health records are complete and accurate. It is important for them to provide access to records to staff and others, while protecting the privacy and security of patient health information.
Required skills and knowledge often is another differentiator between the two professions. Health information management careers generally require education or experience with medical records management, coding and billing and regulatory requirements. Information technology knowledge, particularly involving electronic health records is also often required. HIM careers may also require familiarity with medical terminology, medications and basic anatomy and physiology.
Careers in healthcare informatics can benefit from some of the same core skills and knowledge needed for a HIM career. However, HI roles place less emphasis on coding, billing and regulations. There is a greater emphasis on information analysis and organization and knowledge of system infrastructure design, networking, and even programming skills. HI careers often require familiarity with clinical guidelines and applications within specialty areas such as nursing, clinical care, public health and biomedical research. Since, HI positions tend to require highly specialized knowledge and an advanced skill set, HI professionals often have a Master's of Science in Health Informatics or a Graduate Certificate in Health Informatics.
Here are some resources helpful in defining health information management and health informatics:
We are witnessing the emergence of a data-powered revolution of healthcare. The digital age has broken down barriers on access, distance, socioeconomic status and time zones. In addition, devices to access digital health are affordable, mobile and intelligent (i.e., smart). As noted by Todd Park, U.S. chief technology officer, "We are beginning to see what happens when you unleash the power of American innovators and data to transform health care for the better from the ground up. It's no surprise to the doctors, hospitals, patients and entrepreneurs who have been working so hard to improve health care. But it is, indeed, great news for the nation. "
A notable trend that has emerged is that patients are "co-pilots" in their care. Traditionally, patients have had "little access to information and knowledge that could help them participate in, let alone guide, their own care. However, the Institute of Medicine design rules propose that patients have shared knowledge and free flow of information. At a minimum, they need access to information from their providers' EHRs - their own diagnoses, medications, allergies, lab test results, visit summaries, and other findings over time. A continuous healing relationship is a two-way interaction (whether electronic or face-to-face) between patients and their providers."
A convergence or coming together has also occurred, which has allowed for the explosion of digital health. While technology and data have existed for decades, it is only when various elements converged and matured that consumers could achieve increased access to digital health information. For example, the Internet, applications, and devices (personal computers to tablets) all have evolved and are utilized in daily life. Computing has become more mobile, agile, powerful and affordable. Consumer mobile devices, such as tablets have become more affordable and cell phones have morphed into smartphones, which put powerful capacity at one's fingertips.
The future is now and consumers are looking for more healthcare solutions. According to the U.S. Food and Drug Administration, there were 17,288 health and fitness apps on the market in mid-2012 along with 14,558 medical apps. " Given society's embrace of mobile devices, consumers inevitably are turning to mobile apps to manage their well-being and health care. According to the latest industry data available, there are presently 31,000 health, fitness, and medical related apps on the market today. This rise in consumer use parallels increased traction among physicians and other health practitioners. Some of the best examples are:
Social Content or Information, which can be found from several sources:
- Websites (health specific), professional health organizations, physician practices or clinics, hospitals / health systems.
- Mobile apps: American Heart Association, American Diabetes Association.
- Hospitals and health systems reacted to the proliferation of health and medical content during the late to mid-‘90s. Examples are Mayo Clinic, Intermountain Healthcare, and your local health system's website.
- Various elements of information can be found on many provider websites: blogs, risk assessment tool, health library, and request for appointment.
Wellness and Health Management- An important aspect of consumer digital health are the many applications designed to manage and monitor your own health. Sensors are now available to attach to your Smartphone or tablet (applications are free but the sensor has a price tag). Examples are:
- iHealth Wireless Blood Pressure Wrist Monitor
- Jawbone Up (sleep tracking, 24/7 activity tracking, food/drink tracking).
Nutrition- There is an abundance of nutrition-focused applications (looking to loose weight, eat gluten-free, and manage your diabetes).
Chronic Disease Management- The management of chronic disease is one of the greatest challenges to our population's health and cost of medical care. (Example, www.patientslikeme.com)
Personal Health Records - Your physician or health system may offer access to an application for personal health records that may include communication to their practice.
All these solutions sound so wonderful, but what does this all mean? On the surface consumers may have found a way to engage in their health and wellness and they also have access to vast sources of information at their fingertips. However, what about:
- Privacy (HIPAA)
- Limited access or restricted access
- Security (HIPPA)
- Data-mining without your permission
We all understand some of the potential hazards in using current technology, the Internet, websites, and applications as we know them today. However, it is unclear what other challenges that may present themselves, in what has been termed the "Wild West" of the Internet. Theft of patient data and patient identify is on the rise so caution is required!
Going forward, the ongoing challenges for consumers are:
- With a universe of available health and medical information, it can be daunting as to what will work best for you as a consumer. You will have to find the application/tool that gives you the right amount and correct information you need.
- Can each consumer understand and place into the right context what the next appropriate action might be? A specific example is the posted quality information about hospitals. Can this be deciphered by the average consumer? How can you assess whether a treatment that is recommended is your best option?
- Consumer health literacy varies. How do we evaluate how well a person understands the information that is being supplied to them? Is an online video vignette better than textual information for a particular consumer or population?
- Security and privacy may remain an open and potential issue. It is important to understand what this means for you and your family when using online sources or mobile applications.
- Consumer expectations with unrestricted access to all health information may not be realistic today from all providers. Many physicians report being inundated with the many questions that their patients bring to them upon researching on the Internet.
- Patient identify fraud is on the rise. Since HIPAA was instituted, many data breaches are documented annually. We also know there is a link between breaches and potential fraud.
The new rise in digital health can be termed a ‘Pandora's Box' (a prolific set of troubles). But, it is here to stay, as patients are the biggest stakeholders in their health.
All things mobile is a hot trend right now for personal, business and academic purposes. About 40 percent of time spent online is though a mobile device, according to a 2013 comScore report. The worldwide market for mobile learning products and services will reach $9.1 billion by 2015, reports Ambient Insight Research.
The healthcare industry has a similar story to tell. Seventy-one percent of nurses already use smartphones on the job, surpassing physician use of digital technologies, reports Manhattan Research. HIMSS Analytics labeled 2013 a banner year for mobile health, with more clinicians relying on mobile options to collect data, read barcodes, monitor data from medical devices and obtain visual representations of data. The result: Mobile devices could be the key to saving billions of dollars in healthcare costs, claim speakers at HealthBeat 2013.
And yet, mobile learning comes with more than a few constraints. While many people now own mobile devices, device use is often limited to e-mail or Web-based search. People using mobile devices to access complete courses, tests, evaluation instruments or learning activities is limited. For education vendors, trying to make mobile learning content easy to view, read and use is difficult, given the wide variety of device platforms and challenging content. Others point to the absence of learning management systems for mobile devices. Additionally, concerns exist in some health care agencies surrounding students using mobile devices in the clinical area, and the standards for taking pictures or communicating with mobile devices to protect confidentiality.
Does this mean that mobile learning is doomed? Probably not, but it won't evolve and mainstream as fast as many predict. Mobile learning has generated exuberance so intense that organizations sometimes fail to evaluate factors like readiness or content and technology barriers. Nurse educators, managers and executives must acknowledge the possibilities of mobile learning while accepting the incremental nature of educational transformation. Among the trends the nursing industry must monitor and influence are these:
- Mobile-readiness of content: As more students and professionals rely on mobile devices, developers and educators will format content for easier access, viewing, reading and interaction.
- Point-of-learning nurse education: Nurse educators and managers will increasingly share brief bursts of information, insight and motivation with students and nurses. Nurses will consume data, information and content at any time, in any location, within minutes.
- Nurse expert access: Nurse educators and managers will be able to access the right expert at the right time to share opinions and advice and collaborate on problems and analyze issues. While some experts may reside within the local nursing community, others will come from across the country and around the world.
- Nurses as producers and videographers: "Everyone will become a publisher," said pundits of the first wave of Internet empowerment. The same observation applies to nursing. Nurse educators and managers will challenge nurses to create video vignettes of events, encounters and processes, embedding face-to face interviews that offer balance, objectivity and perspective.
- Special connections: Nurse educators and managers will use mobile devices' global positioning systems (GPS) to send nurses content based on location, task, encounter, responsibilities or schedules. In the same way, educators and managers will be able to offer nurse learners audio coaching and mentoring.
- Nurse e-books expanded: As nurses benefit from highly personalized, just-in-time information and content delivered at the right location, e-books will evolve from digital versions of print publications to complex resources that blend content, collaboration, testing and evaluation.
- Aggregation of online and online learning: Look for innovations like Tin Can or Experience API which can integrate a learner's offline and online experiences, including social, collaborative and experiential learning, with games and real-world activities.
For now, nurse educators and professionals would do well to follow Clark Quinn's four Cs of mobile learning:
- Content: Invite students and professionals to read and review documents, watch videos and listen to media in a portable format
- Compute: Create opportunities to process data from student and professional users, deliver answers to queries and perform calculations
- Capture: Use devices to record sound, video and images, along with other information, for storage and sharing
- Communicate: Connect student and professional learners with others-fellow students, educators, and experts-via text, audio and video
Through trend tracking and integration of Quinn's four Cs of mobile learning into lesson, module or curriculum planning, nurse educators and managers can help nurses make the most of their mobile devices. Mobile, after all, offers something for everyone. While visual learners can benefit from photo and video applications, auditory learners can master concepts by listening to instructors, coaches, experts and fellow students.
Mobile also offers flexibility. Nurse students and managers might collaborate on a video on patient safety, followed by a recognition or memory game via images communicated on cell phones. Others might complete a text communication exercise where students and managers share, repeat and confirm data and information about a patient, issue, situation or event.
The future of mobile is bright. Educators, students and managers appreciate mobile learning's potential benefits. They are ready for incremental change and the opportunity to collaborate on fresh solutions. The best course is to monitor mobile usage by clinical and healthcare business professionals while tracking new and emerging trends in mobile learning solutions.
Blended learning is now used within the training plans of clinical information systems (CIS) implementations at countless healthcare organizations, from 700+ bed medical centers, to critical access hospitals, to outpatient surgical centers, to physician offices and home health agencies across the United States. The blended way of learning has to be a collaborative effort with clinical interdisciplinary leadership, education and clinical informatics staff to develop, deliver and achieve your organization's learning plan goals and measureable targets.
Blended learning has also proven to be among the most popular choice for learners at institutions of higher education. The majority of colleges and universities have at least one, if not more, well-established online degree programs composed of blended learning curriculum.
Research has proven that online learning alone is not enough. The evidence shows that blended learning - combining in-class, facilitated training with e-learning - is much more effective than either alone. As cited in the U.S. Department of Education's "Evaluation of Evidence-Based Practices in Online Learning: A Meta-Analysis and Review of Online Learning Studies" (Revised September 2010), "Students in online conditions performed modestly better, on average, than those learning the same material through traditional face-to-face instruction" (p. xiv) and, notably, "Instruction combining online and face-to-face elements had a larger advantage relative to purely face-to-face instruction than did purely online instruction" (p. xv). Learners perform better in blended courses.
In healthcare information systems implementations the use of the blended learning approach combines a variety of learning delivery methodologies. Additional benefits to be attained using blended learning include: allows organizations to compensate for limited classroom space; provides a transitional opportunity between online instruction and face-to-face classes and minimizes the time required for end users to train. End users report blended learning provides the convenience of online learning along with the social instructional interactions of facilitated in-person classroom courses. Later, more about facilitated courses.
A blended learning approach typically includes some (if not all) of the following components:
- 1) In-person, facilitated, just-in-time classroom training
- 2) E-learning (computer based training (CBT)
- 3) Educational materials/media
- 4) The train the trainer (TTT) model
- 5) Open labs
Facilitated classroom training is not the same as traditional instructor-led training, which puts the onus of knowledge "transfer" primary on the instructor. In order for clinical end users to become optimal users of the new information system they must be held accountable for learning, be engaged and take a proactive role in their knowledge acquisition. Learning is the responsibility of the adult student/clinical end user. During clinical information systems implementations it is imperative for clinical end users to take the initiative to perform hands on practice, practice, and practice some more in the Test system prior to go-live.
Additionally the staff development/education and clinical informatics/IT departments, in collaboration with system subject matter experts and champions are responsible for organizing and providing clinical end users with in-person, instructor facilitated classes.
In-person facilitated classes should be a combination of: 1) basic course content delivered classes; and 2) hands-on, self-paced, role-based scenario guided sessions. The role based scenarios should simulate future state workflows and performance of system tasks such as: accessing a patient census; associating yourself to a patient per your clinical role; using MAR; creating hand-off documentation; how to change a specimen collection order from lab to collect- to nurse to collect; viewing department tracking boards; trending vitals and I&O, etc. Both types of in-person training sessions should be guided by your organization's policies and procedures and focused on patient care delivery activities that support learning being implemented into practice.
Just- In - Time Training
Adult learners are particularly receptive to learning new information when it is delivered to them right when they need it. "Just-in-time" training refers to a method of providing training right when it is needed, not weeks or months too earlier or too late. Just-in-time training eliminates the need for refresher training due to knowledge loss experienced if training proceeds, over an extended period of time. Just-in-time training prevents knowledge loss because staff are soon able to put the material learned into actual use upon returning to the clinical setting.
E-Learning and Other Educational Media
In addition to in-person, facilitated classroom training, the project's education developers should not overlook creating learning materials especially for e-learning/online use. The e-learning modules should ideally be packaged into bite-sized chunks of no less than 15 minutes and no more than 40 minutes in length. E-learnings such as those developed in Captivate allow clinical end users to take full advantage of interactive features such as video, audio, animation and illustrations. Utilizing e-learning allows your clinicians the convenience of choosing where and when to undertake their learning and provides end user staff with more scheduling flexibility. Incorporating e-learning into the training plan also means clinical informatics and education staff can update online materials rapidly so clinical end users can access the most up to date course content. Unlike traditional paper based courses which become outdated quickly as system upgrades are rolled out and new clinical practice evidence emerges.
Educational materials/media should not be limited to online media or e-learnings. The original system manuals provided by the vendor are often dry, voluminous and written in non-clinical speak. The original vendor's manual(s) should be edit and revises thus customizing them into smaller versions that correlate system functionality with future state work flows, and unique organization policy and procedure. Customized your end user manuals in such a way will definitely improve their usability and value for your clinical staff.
Additionally, ensure hard copy, laminated and pocket size job aides, quick tips and cheat sheets are created and provided to staff end users prior to go-live. These types of hand outs will help to further reinforce information provide from both the e-learnings and the in-person facilitated training classes.
Train the Trainer (TTT) Model
The TTT model reflects proven research that people who train others recall 90% of what they teach and that people learn new information through trusted social networks. The train the trainer model is the standard in clinical information systems implementation and is also recommended as such by many vendors. The TTT model will also help create a team of your organization's system subject matter experts and champions who are capable of transferring solution knowledge to their peers.
Lastly if your organization has the space and equipment budget, plan for having an open lab - a space with desktops or laptops (and earphones) located away from the clinical units and departments that staff can come to for additional practice time. Remembering that some units/high volume areas in your healthcare organizations are less conducive to staff learning than are others. Think about staffing your open lab with subject matter experts and champions to give support to end users who show up to practice in the test system.
Many large hospital systems offer behavioral health services as part of their continuum of care, so, it is important to fill in the gaps that behavioral health has when it comes implementation of an EMR. Some examples of why it is important to offer behavioral care services that are supported by a robust EMR include:
- One in eight or nearly 12 million ER visits in the U.S. are due to mental health and/or substance use problems in adults. This is the most costly venue for care delivery. Mental Disorders and/or Substance Abuse Related to One of Every Eight Emergency Department Cases. AHRQ News and Numbers, July 8, 2010. Agency for Healthcare Research and Quality, Rockville, MD. h p://www.ahrq.gov/news/nn/nn070810.htm
- Major depression is considered equivalent (in terms of its burden on society) to blindness or paraplegia. Schizophrenia is equivalent to quadriplegia. Disability Adjusted Life Year, DALY, Daly 2004
The gaps that are often identified in a behavioral health EMR include:
1. Providers: Most behavioral health providers are not MDs. In fact, primary care physicians spend limited time with patients and are often hesitant to diagnose and treat behavioral concerns. Most behavioral health providers are clinicians with masters or doctorate degrees who have been licensed by their state(s) to diagnose and treat behavioral health disorders.
2. The diagnostic process and tools: Behavioral health disorders are the only serious, chronic illnesses that are diagnosed based solely on self-report. The tools used to assess the behavioral health patient's mental status and substance abuse patterns are very different than the traditional medical diagnostic tools of imaging and lab work. Behavioral health diagnostic tools are most often elaborate question and answer tools that can be both clinician-administered and self-administered. Behavioral health clinicians use tools such as the Beck Depression Inventory (BDI), Generalized Anxiety Disorder scale (GAD 7), and the Diagnostic and Statistical Manual (DSM IV). These tools need to be incorporated into the data capture and workflow built into an EMR. Additionally, behavioral health providers are required to develop elaborate treatment plans with the patient's participation. Non-behaviorally focused EMRs typically don't have tools built in for this and must be built (or ignored). If ignored, the EMR becomes nothing more than a word processor.
3. Customization will always be required: While there are multiple behavioral health specific EMR vendors in the marketplace and enterprise-wide EMRs that can be configured to cover behavioral health, customization will be required to meet multiple state specific mandates, practitoner specialty requirements and federal privacy rules that apply to behavioral health. Although there are challenges when implementing an EMR in behavioral health, the successes are growing. For example, the state of New Jersey has been successful in bridging the gap between behavioral health and EMRs.
The following recommendations help to ensure a positive implementation outcome:
- Create a small but specific implementation team that aligns with behavioral health leadership during the build and test period, so all build and testing work is completed in a collaborative manner.
- Build using the most commonly used diagnoses and their DSM IV criteria into the EMR to make it easy for providers and therapists to use drop-down lists to create the diagnostic picture of the patient.
- Build using ASAM criteria, so chemical dependency staff s can more easily complete treatment planning.
- Design within the ‘tighter than HIPAA' federal constraints that govern confidentiality of patient information for patients receiving chemical dependency treatment (i.e., CFR 42).
- Involve trainers and testers in the workflow discussions.
To avoid putting a round peg in a square hole, it's essential to understand the variances in the behavioral health setting and address them in workflow, data capture, information exchange, provider engagement, and administrative requirements and incorporate them into the EMR project plan, design, and implementation.
Nurse educators, managers and executives have turned to learning analytics in the same way healthcare has turned to data or predictive analytics. Learning analytics provides a way to evaluate the responses of nursing students and professionals, deliver rapid feedback, and tweak content and formats to meet learners' needs and industry requirements. Learning analytics has the potential to create highly personalized learning environments that complement the learning styles and behaviors of nurse students and professionals. For that reason, nursing professionals should consider how they can champion learning analytics in the years ahead.
Nursing schools, colleges and universities have turned to blended or hybrid learning that combines face-to-face classroom instruction with online learning environments and platforms where tracking tools document student behaviors, identify numbers of clicks or specify time spent on a single page. Within nurse education and training, effective learning analytics systems create practice sessions through scenarios and case studies.
Exams evaluate learners' readiness for follow-up testing, along with their ability to apply concepts. Learners can review concepts as they move through modules or courses or immediately prior to an exam. If learners fail to perform well on an exam, they can take advantage of personalized online remediation activities. Finally, a solid learning analytics system creates reports for learners, educators and managers. Learners discover how well they performed on tests, while educators and managers gain insight into individual learner and program performance.
How should educators respond to the learning analytics revolution?
Promote the value of learning analytics: By blending data analysis with how learners interact with online tools and content, learning analytics helps to create more integrated, customized learning experiences. Learners are better able to learn and apply nursing concepts. That, in turn, means a more skilled, competent and prepared nursing workforce-one capable of addressing challenges like care coordination, meaningful use, quality improvement and patient engagement.
Focus on features, functions and opportunity: Learning analytics has the capacity to predict learner performance, deliver feedback to struggling learners, personalize the learning process, offer motivation and encouragement, build on individual learners' strengths, and identify learning barriers by tracking data like time spent on a site, log-in frequency or lack of attention and understanding.
View learning analytics as a component of healthcare transformation: Just as the healthcare industry is moving away from the assumption that patients are the same, nursing professionals have abandoned the assumption that all learners start at the same point and progress at the same speed. Learning analytics bases learners' future performance on their past performance. It views learners as distinct, unique, special and deserving of full engagement via customized, personalized content and regular feedback and reinforcement.
Work with vendors that grasp learning analytics: Learning analytics demands content management, delivery and evaluation, a learner information system or data repository and a mechanism to track and store learners' completed work. Equally important are integrated predictive models that record learners' progress and forecast learning outcomes based on demographic and learning data. Systems should allow nurse educators and managers to assist and support learners while customizing content to meet learners' needs, preferences and learning styles. A dashboard or control panel should track learning trends and deliver summaries of learner and program performance to nurse educators, managers, executives and researchers.
Prepare for roadblocks and barriers: Developers of learning analytics systems still need to resolve issues related to privacy and confidentiality, ethics, access, cost, misinterpretation of data, metrics and standardization. Equally important, nurse educators and managers will require training and coaching on how their can expand and balance their roles as teachers, content developers, information brokers, coaches and mentors, group facilitators and data analysts.
Learning analytics within nurse education and training faces a bright future. Educators and managers will be better able to identify slower learners who, with specific interventions, can evolve into learning superstars. Data-driven learning will expand nurses' critical thinking skills by compelling each learner to address each question, case or scenario. Learners will receive close to real-time feedback on performance, offering them the push they need to pursue remediation. Finally, learning analytics will build learner engagement through features like self and peer evaluation and grading and collaboration. While learning analytics poses multiple challenges, nurses can help to achieve its promise and potential.