Module 6, Question 3

This class had an easy to follow design, showing the 6 modules with their subsequent information and steps to complete each module. I thought this portion of the IT course was adequate. In completing the specific aspects listed in each module, the difficulty arose when expectations were not fully explained for the assignments. If I was the instructor for this course, I would prefer to design a curriculum that allowed for improved expectations and timely feedback. Feedback is a crucial component to learning and synthesizing the information taught in any course. Feedback given between each module would improve the understanding of expectations and improve the educational benefits, as well. I also believe that interaction with others improves the understanding of material. Improvements in teacher/student and student/student relationships would make the class more enjoyable and activities and communication between individuals would further cement the concepts taught.

Module 6, Question 2

The topic that I learned about the most in this class are the large variety of clinical decision support tools available. As a future practitioner, it is valuable to be well informed about the various assist tools and applications to aid practice. I look forward to implementing this technology in practice. My favorite topic, of course, has to do with these technological advances. Using these programs and devices in practice greatly aids in the efficiency and quality of practice. In the Emergency Department, I visualize technology used constantly to retrieve information useful in diagnosing and treating patients. Without these resources, providers would be much more limited to the accessibility of information.

Module 6, Question 1

As a student, I prefer to take online courses so that I may proceed at my own pace. I find this much easier for me than the traditional format and on-campus presentation. Without this technology, I would not be attending school currently. I feel very fortunate to have this opportunity and enjoy the advances in technology. The disadvantage of taking an online course is that it prevents students from interacting and getting to know the instructors. This, at times, makes communication and expectations difficult. A good course outline and clear grading criteria make this easier.

Module 5 Question

The Department of Health and Human Services (DHHS) website, Agency for Healthcare Research and Quality provides an extensive amount of information for consumers and professionals. Current reimbursement issues, clinical practice guidelines, and research findings are discussed as they pertain to current practice within the healthcare setting. I have noticed that present practices in the acute care setting is being designed around reimbursement issues imposed by Medicare/Medicaid. The Consumer Assessment of Healthcare Providers and Systems (CAHPS) is becoming a large consideration in care at Intermountain facilities. As this is to be the wave of the future with reimbursement, it bears consideration and is necessary to become informed to understand the criteria. Of concern is the role that patients play in determining reimbursement for providers. As a healthcare provider, it is beneficial to all to improve practice and utilize patient satisfaction to improve care. My concern lies in the fact that the patients, many uninformed consumers, are determining the amount of reimbursement to the facilities and providers. As this is placed in effect, I am sure there will be many kinks to be addressed and it will be beneficial to both parties.

The regulatory and accreditation information that is available to consumers and professionals is a great resource. It assures professionals that they are providing appropriate care based on current regulations to be compliant in practice. Making this information available to the public is important to improve education and awareness. Providing this information to the consumers assists to improve the information available; however, it is questionable how these people will utilize this information and if it will be consistent with the intention of the DHHS. It would be appropriate to measure the utilization and understanding of the content displayed but I don't think this would be possible. As providers of healthcare, the most pertinent contribution we can make would be to assure that our individual patients are well-educated.

The use of health information systems is addressed including the electronic medical record, telehealth, electronic prescribing, rural IT issues, and health information exchange. The DHHS website does an adequate job of explaining the pros and cons for these systems. It is evident that the DHHS is more supportive of some measures than others, but I believe that the with ongoing research and improvement of these technologies, the benefits will serve to outweigh the barriers. Providers, facilities, and reimbursement companies will embrace these changes as familiarity is increased. Considerations for these system's implementation include the awareness of the providers and the benefits to providing competent and appropriate care. Patient considerations include privacy factors as well as potential for decreased patient/provider interaction. Once again, the influence of education plays a very important role as these systems are introduced.

Module 4, Question 2

The quality of nursing data is extremely important in relation to decision support. To accurately utilize the tools available, accurate information needs to be obtained. The success and validity of the tool depends upon the accuracy of the objective information. Without this, the systems and tools are useless. As nurses and providers, we should strive to obtain accurate and objective information that will improve patient diagnosis, treatment, and outcomes. It is vital to focus on quality, objective data and realize the impact our own biases could have on healthcare.

Module 4, Question 1

In contemplating my own clinical decision-making, these readings made me examine my decisions that I make on a daily basis at work. Many decisions I make about necessary treatments and evaluation are done based on past experiences. I found the information provided to be very interesting and informative. I can understand how overconfidence plays a large role in determining interventions. Perhaps those situations where overconfidence occurs is when a person has vast amounts of experience in any given situation. To combat overconfidence, I must constantly be thinking critically and support my decisions with evidence, not experience. Not to say that experience is not helpful, just that evidence and interventions change frequently with improved research.

Other considerations that must be taken when making clinical decisions include examining objective data to develop an accurate diagnosis while attempting to eliminate hindsight. Also, as important, is placing sufficient weight on prior probabilities associated with the condition. Reading this information will allow me to develop better decision making skills, provided I keep these concepts in mind.

Decision-making in clinical practice should not be based on bias or heuristics. They can be effective but can lead to errors in practice. Paying conscious attention to personal bias and heuristics will make us better practitioners.

Module 3, Questions

Based on the Multiple Intelligences Test, I discovered that my two areas highlighted were Musical and Spatial/Visual. Based on these results, I can understand avenues that could assist in my learning. My strength noted in the Musical area is not a surprise to me, as it is such a large part of my life. I know that Music holds strong connotations and memories. The Spatial/Visual category shows that I am able to better learn and understand when observing or visualizing the information. As I think about how I learn, I can see how I benefit from these areas. Technologies that I can utilize to augment my personal learning would include my Ipod and podcasts as well as videos. Information accessed online is also helpful to me as a visual learner, if there are diagrams and pictures involved. It provides an easier way for me to remember concepts and information.

Module 2, Question 3

Based on my subject for Critical Access Hospitals and Medicare reimbursement, I found that PubMed (the electronic index) to be the most beneficial. I was searching for specific information on the topic that was up-to-date. Unfortunately, frequently I was unable to access the text for the desired resource. Consulting the guideline index was not helpful for this subject. I can see how it could assist someone that was looking specifically for procedures based on evidence. The web-search provided the most information but it was difficult to sift through the irrelevant and unreliable data. It is also difficult to narrow the search as well as through PubMed.

At times, when I have discovered a reference that I cannot retrieve from PubMed, I am able to locate it on another website that I have discovered through Google. These three different sites each have their individual benefits, depending on what one is searching for. When results are obtained, depending on the source, validity must be determined by the reader.

Module 2, Question 2

The reference management software that I chose was EndNote. This software allows for importing of references for utilization in all future papers that I may write. It allows the user to categorize them based on subject, in multiple categories. I like the feature that allows for attaching the article to the reference within EndNote. An additional benefit of EndNote is the features for developing bibliographies in the format of your choice. It is unfortunate that many full text is unavailable, and if one is able to retrieve it, you must manually attach it. I haven't found the search feature through EndNote extremely beneficial. For citing references within a paper, though, it is a must have! Already, I have used the same references numerous times. Just a steep learning curve....

Module 2 Question 1

The clinical topic of my choice was obtaining information on Critical Access Hospitals and Medicare funding. The electronic index that I chose was PubMed. After completing the tutorial (in addition to the course taught by Jean LeBer), I was able to develop a decent search strategy to obtain oodles of information. Based upon the vast amount of information available, it was necessary to really narrow the search using several limits and dates. PubMed, once I used it a few times, has become easier; however, it is somewhat overwhelming initially. Even to narrow my subject and search information, I had to repeat sections of the tutorial. Now that I have utilized it several times, I feel that it is an easy index to search. One problem that I have found in obtaining information is that I am unable to obtain text articles on all of the references. Articles that are not available can be requested---which has been extremely helpful--but, to use in a daily practice one would need the information immediately. I have realized that I am able to obtain more articles using the University account than I can individually. So, to sum it up, it was somewhat difficult to learn but now that I know what a search entails and how to retrieve various articles, I feel that it is a necessary index to use.

Module 1, Question 2

In my current practice, information technology is used in almost all aspects of patient care. Recently, the facility in which I work changed to computer charting, which improves the documentation standards tremendously. It is also much easier to generate reports and information. In addition to current use, this allows providers to always have instant access to all medical records. No more searching for paper charts after hours! This allows for improved efficiency and improved care by the ability to access previous history and diagnostics.

In addition to computer charting, all laboratory, radiology, and clinical notes are available online. In the Emergency Room, this is very important. Many times patients are unable to communicate their history and it allows for pertinent treatment based on patient history. Medication lists and allergies are documented, as well, in one central location. Structured clinical data improves patient care by providing continuity, improved diagnosis, and more specific treatment.