Discussion: Integrating PHRs Into EHR Platforms

When electronic health records (EHRs) first entered the market, their primary focus was to collect and analyze patient information within health care settings. As technological capabilities grew, so did the interest in making these records available to patients. In addition, many health care professionals saw benefits in allowing the patient to enter his or her own health data into EHR platforms. Though many patients are already utilizing personal health records (PHRs) to manage and track their own health, some believe that an integrated system would provide a better, more comprehensive picture of a patient’s health history.

As a result, many EHR platforms are now equipped with a PHR tool. This PHR tool allows patients to enter health information as they would in a stand-alone PHR system. In addition, web-based portals within the EHR allow patients to access information entered by their physicians and health care providers.

Like many emerging trends and technologies, there is much discussion about the potential benefits and challenges of this type of integrated system. While many health care professionals are excited about the empowerment provided to patients, others express significant concerns about access, security, ethics, and other implications.

In this Discussion, you explore how integrating PHRs into EHR platforms could impact you and your patients.

To prepare:

• Review the media Patient-Centered Technologies, and reflect upon Dr. Simpson’s statements about the ownership of patient data.
• Review the article, “Dreams and Nightmares: Practice and Ethical Issues for Patients and Physicians Using Personal Health Records” found in this week’s Learning Resources. Consider how PHR capabilities can be integrated into EHR platforms.
• Examine the “dreams” and the “nightmares” the authors associate with this type of integrated health record. Select one benefit or one challenge of integrating PHRs into EHR platforms. Then, consider its potential impact on health care providers and patients. Why is this considered to be a benefit or challenge for health care professionals and patients?

By Day 3

Post a brief description of your selected benefit (I choose Promoting data use or Promoting responsibility) or challenge and support your selection. Explain the potential impact on health care professionals and patients.

APA Style, 600 characters minimum (not including the reference on this 600 words count)

 

As I write above, I choose Promoting data use or Promoting responsibility one of those. 

Required Readings

Saba, V. K., & McCormick, K. A. (2015). Essentials of nursing informatics (6th ed.). New York, NY: McGraw-Hill.
Review Chapter 1, “Historical Perspectives of Nursing Informatics”
In this chapter, the authors explain the transition from paper-based records to electronic records. The chapter provides an overview of the historical events that contributed to the rise of electronic health records. 

Chapter 25, “Care Delivery Across the Care Continuum: Hospital-Community-Home”
Chapter 25 analyzes the impact of home health on the health care system. The chapter explains the current level of home health technology and how the Patient Protection and Affordable Care Act (PPACA) changes this aspect of health care. 

Chapter 44, “Initiation and Management of Accessible, Effective Online Learning”
This chapter explores the past and present perspectives of distance education, important teractive electronic tools and essential strategies for the online learner. 

Chapter 45, “Social Media in the Connected Age: Impact on Healthcare Education and Practice”
The focus of this chapter is on the evolution of the Internet, mobile tools and the use of social media in healthcare education. 

Chapter 35, “Consumer/Patient Engagement and eHealth Resources”
As access to health care information increases, patients are becoming more informed about and engaged in their health. This chapter discusses current trends in health care, including patient empowerment, consumerism, and widespread use of computers and technologies for health.

Crilly, J. F., Keefe, R. H., & Volpe, F. (2011). Use of electronic technologies to promote community and personal health for individuals unconnected to health care systems. American Journal of Public Health, 101(7), 1163–1167.
Retrieved from the Walden Library databases.

The authors of this article describe technologies that have been used to increase access to health care for underserved populations. The authors present strategies, benefits, and challenges of addressing this issue, and they provide examples of successful programs.

Walker, J., Leveille, S. G., Ngo, L., Vodicka, E., Darer, J. D, Dhanireddy, S., … Delbanco, T. (2011). Inviting patients to read their doctors’ notes: Patients and doctors look ahead: Patient and physician surveys. Annals of Internal Medicine, 155(12), 811–819.
Retrieved from the Walden Library databases.

In this article, the authors discuss the results of their study on the outcomes of allowing patients to read their doctors’ notes. The study highlights the benefits of sharing notes with patients and how doing so can promote better outcomes.

Wynia, M., & Dunn, K. (2010). Dreams and nightmares: Practical and ethical issues for patients and physicians using personal health records. Journal of Law, Medicine & Ethics, 38(1), 64–73.
Retrieved from the Walden Library databases.

The authors of this article highlight the primary uses and benefits of personal health records (PHRs) as an electronic health record (EHR) tool. In addition, the article presents an overview of practical and ethical issues that may emerge from integrating PHR components into EHR systems. 

 

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Across health care settings, many different terms are used to describe the same or similar conditions. For example, a bed sore may alternatively be called a pressure sore, a pressure ulcer, or a decubitus ulcer. While it may be fairly manageable for a nurse to make the connection among these terms, the same cannot be said for a computer system. Nurses have the ability to reason and reflect upon their clinical knowledge. Computer systems are linear, relying on user input to output information. When diverse terms are used, systems are unable to make the connections between the data. For this reason, the health care industry is vigorously moving towards the standardization of terminologies.

Learning Resources

Saba, V. K., & McCormick, K. A. (2015). Essentials of nursing informatics (6th ed.). New York, NY: McGraw-Hill.

· Chapter 8, “Standardized Nursing Terminology”

This chapter introduces the problems related to terminology and vocabulary standardization across the broader health care field. Nursing-specific.

· Review Chapter 7, “Health Data Standards: Development, Harmonization, and Interoperability”

Health standards, rules, and definitions are requirements for effective and efficient electronic health records (EHRs). This chapter explains various options for these areas and discusses how they can be incorporated into EHRs.

· Appendix A, “Overview of the Clinical Care Classification System”

In this chapter, the authors describe challenges in health care related to clinical care classification and terminology standards. These issues are analyzed and possible solutions are overviewed.

Scherb, C. A., & Weydt, A. P. (2009). Work complexity assessment, nursing interventions classification, and nursing outcomes classification: Making connections. Creative Nursing, 15(1), 16–22. 

Retrieved from the Walden Library databases.

The authors of this article discuss the Work Complexity Assessment (WCA), a process that allows nurses to better understand interventions for patient care. The connection between the WCA, the Nursing Interventions Classification (NIC), and the Nursing Outcomes Classification (NOC) are also discussed.

Truran, D., Saad, P., Zhang, M., & Innes, K. (2010). SNOMED CT and its place in health information management practice. Health Information Management Journal, 39(2), 37–39. 

Retrieved from the Walden Library databases.

This article focuses on the Systemized Nomenclature of Medicine – Clinical Terminology (SNOMED CT) and how it can be used to support electronic health records (EHRs). The authors describe how SNOMED CT can contribute to EHR improvement with regard to patient safety, quality care delivery, and decision support functionality.

Cimino, J. J. (1998). Desiderata for controlled medical vocabularies in the twenty-first century. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3415631/ 

Discussion: James Cimino’s Desiderata

Desiderata is a Latin word that translates to “something that is wanted or needed.” It is obvious that James Cimino had this translation in mind when he created his “Desiderata for Controlled Medical Vocabularies.” In his work, Cimino outlines 12 desiderata he believes the health care community should consider when constructing medical vocabularies. He also highlights the need to control the vocabulary used within terminology sets, as well as the requirements for doing so.

For electronic health records (EHR) and clinical decision support systems (CDS) to truly be successful, Cimino, along with many other health care professionals, expresses the vital need to standardize and control the terminology being used in health care settings.

For this Discussion, you will use one of Cimino’s desiderata (or themes) to critically appraise a nursing terminology set:

Cimino’s 12 themes for the 21st century:

· Vocabulary content

· Concept orientation

· Concept permanence

· Nonsemantic concept identifiers

· Polyhierarchy

· Formal definitions

· Reject NEC “Not Elsewhere Classified”

· Multiple granularities

· Multiple consistent views

· Representing context

· Graceful evolution

· Recognize redundancy

To prepare:

· Review the article “Desiderata for Controlled Medical Vocabularies in the Twenty-First Century” in this week’s Learning Resources. Consider how each theme aims to control the vocabulary used by nursing terminologies.

· Reflect on prominent standardized nursing terminologies sets, such as NIC, SNOMED, SABA, NANDA, and NOC. How might these terminologies compare to the requirements outlined in Cimino’s 12 themes?

· Select one nursing terminology set and one of Cimino’s themes to further examine. Does the terminology align with the requirements of this theme? Why or why not?

By Day 3

Post a brief description of the nursing terminology set and theme you selected. Explain whether this terminology aligns with the requirements and why. Provide terminology and vocabulary examples to support your answer. 

· For this discussion I choose NANDA and Formal definitions. (If it difficult, you can choose NANDA and another one of the 12 Cimino’s Theme’s.

· APA Style, 500-600 words minimum, Master Degree Quality Discussion/assignment work. 

· Please follow the instructions and read the part that say “to prepare” before do the paper. 

. Deadline: 4/18/18 at 8:00pm ET.

· For this discussion I choose NANDA and Formal definitions. (If it difficult, you can choose NANDA and another one of the 12 Cimino’s Theme’s.

· APA Style, 500-600 words minimum, Master Degree Quality Discussion/assignment work. 

· Please follow the instructions and read the part that say “to prepare” before do the paper.   

 

 

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 Case Study #5 NURS 6541: Trina is a 9-year-old female who weighs 110 pounds. Vital signs are as follows: BP 122/79, P 98, R 20. Her mother reports she is a picky eater and refuses to eat fruits and vegetables. Her physical activity includes soccer practice for 1 hour a week with one game each weekend from September through November. Family history is negative for myocardial infarction, but both parents take medication for dyslipidemia. 

 Post an explanation of the differential diagnosis for the patient in the case study you selected. Explain which is the most likely diagnosis for the patient and why. Include an explanation of unique characteristics of the disorder you identified as the primary diagnosis. Then, explain a treatment and management plan for the patient, including appropriate dosages for any recommended treatments. Finally, explain strategies for educating patients and families on the treatment and management of the respiratory, cardiovascular, and/or genetic disorder. 

Due: 7/9/18 at 6am

 

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Select a patient that you examined during the last three weeks. With this patient in mind, address the following in a SOAP Note:

• Subjective: What details did the patient provide regarding her personal and medical history?
• Objective: What observations did you make during the physical assessment?
• Assessment: What were your differential diagnoses? Provide a minimum of three possible diagnoses. List them from highest priority to lowest priority. What was your primary diagnosis and why?
• Plan: What was your plan for diagnostics and primary diagnosis? What was your plan for treatment and management, including alternative therapies? Include pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters, as well as a rationale for this treatment and management plan.
• Reflection notes: What would you do differently in a similar patient evaluation?

 

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