When is an authorization to use or disclose personally idenfiable health information required by HIPPA?

Respond by offering additional thoughts regarding the examples shared, Systems Development Life Cycle SDLC-related issues, and ideas on how the inclusion of nurses might have impacted the example described by your colleagues.

                                              Main Post

                         Systems Development Life Cycle

           The systems development life cycle (SDLC) is a process whereby a company or entity determines the need for the implementation of new technology.  SDLC provides information systems that are effective at incorporating the company’s business plan (McGonigle & Garver Mastrian, 2018).  It is essential that a working knowledge of the problems or issues are understood.  In the case of healthcare organizations, this means establishing an assessment that discovers the needs of each department (McGonigle & Garver Mastrian, 2018).  Most of the time when analyzing these needs an outside company is brought in to assess, interview, and determine the type of system that would benefit the company.

Consequences of Lack of Inclusion of Nurses

In the application of any new technology or policy, it is essential to trial it with the individuals that will be using it.  When considering an update or new system in the healthcare setting, it is beneficial to involve nurses in the decision-making process.  The Agency for Healthcare and Research (n.d.a) report that it is important to consult with nurses in the preliminary period of development.  By incorporating nurses into the initial design, the researchers learn nursing processes, possible new tasks, effect the technology will have on patient care, staffing needs, and usability of the design.  This analysis of workflow is used to determine the best use of technology (McGonigle & Garver Mastrian, 2018).  Including nurses in this process opens routes for discussion and collaboration that will benefit the designers and users.  

            Failure to include nurses in the planning stages of technology design is detrimental to the intended use of the new system.  A researcher or computer designer could miss critical elements of the nursing process due to their lack of knowledge regarding nursing procedures.  McGonigle & Mastrian (2018) state, “nursing informatics professionals should always be included in these activities to represent the needs of clinicians and to serve as a liaison for technological solutions to process problems” (p. 250).  The role of the informatics nurse and a nurse, in general, can play in designing technology is critical.  Their contribution to the analysis of workflow and clinical implications is invaluable information needed for the formation of a system that will be used to its potential.

An Example of Collaboration

            A study was done in Canada to determine the impact of the initiation of computerized order entries for medications on nursing workflow and reduction of medication errors.  Registered nurses participated in a study where interviews and observations were used to study the effects of digital technology on the nursing process (Vito, Borycki, Kushniruk, & Schneider, 2017).  The researchers spent considerable time observing and recording how the technology affected nurses and the influence it made on time spent with patients.  This study is one example of the impact that nurses can have on the design and implementation of technology in the healthcare setting.

Current Healthcare Facility

             When our facility transitioned to electronic health records (EHR) as an ER nurse, I was not involved in the planning.  The nurse informaticist I assume worked with the company to create templates that are in use today.  Within the ER portion of the EHR, there have been changes made because of nursing input.  As a unit, we have asked for an ED narrator to be developed with our order sets, documentation narrators, and medication administration policies.  Recently we asked for changes to our trauma narrator to include additional documentation options for different trauma levels.  As a group we have also discussed missing pieces of data that is beneficial for everyday use and discussed this with our leaders.  The leaders take this information to the information technology (IT) individuals that work directly with the EHR company and changes are then made.  There are times when the nurse’s input is not embraced due to financial constraints or leadership ability to see the need.  The size of the healthcare organization plays a significant role in the inclusion of nurses in decision-making practices.  Many variables exist to modification of technology in healthcare.  In an ideal setting, it would be ideal to include nurses throughout the design process.

References

Agency for Healthcare Research and Quality (n.d.a). Health IT evaluation toolkit and evaluation measures quick reference guide.  Retrieved April 17, 2019, from https://healthit.ahrq.gov/sites/default/files/docs/page/impact-of-hit-on-nurses-quick-reference-guide.pdf

McGonigle, D., & Garver Mastrian, K. (2018). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning, LLC.

Vito, R., Borycki, E., Kushniruk, A., & Schneider, T. (2017). The impact of computerized provider order entries on nursing practice. Studies in Health Technology and Informatics, 234, 364-369. doi:/10.3233/978-1-61499-742-9-364

 1- The professor ask me also this question.Are you developing a survey or using one that is available? What would be some of the problems with using your own survey related to measurement? 

2-Please make me a response to this peer post. Has to be no less than 150 words. 

 Rainel Leon posted Apr 5, 2019 12:09 PMSubscribe

Professor and class

Researchers use instruments as a measurement device and they can be categorized as researcher-completed and subject completed depending on who administered or completed respectively. Based on the research question, researchers select what instrument they are going to use.

Some researcher-completed instruments are rating scales, interviews, flowcharts, checklists, time and-motion logs, observation forms, etc. Some of the subject-completed instruments are questionnaires, attitude scales, personality inventories, achievement tests, sociometric devices, etc.

In my proposed research project I am going to use a the Readmission Rate , based on a relation between the total number of patients discharged home with the diagnosis of Congestive Heart Failure and an inpatient admission for decompensating Cardiac Heart Failure within 30 days of the discharge .This number is going to be the numerator of the fraction. The denominator is going to be those all patients discharge from the hospital with the diagnosis of Cardiac Heart Failure and the number is going in the last three months. The denominator is going to be common for the two groups the experimental group and the control group.

All patients included in the investigation will be applied the LACE Index. The LACE Index is a tool to evaluate the Risk of readmission of a patient admitted in the hospital, and it is used as a predictor of readmissions. It consists of 4 parameters as described below:

Length of stay It will score 0,1,2,3,4,5,7 according to the days of stay: less than 1, 1, 2,3,4-6, 7-13, >=14 respectively.

Acuity if it was emergent admission it will score 3.

Comorbidities will be assessed by Charlson score .No comorbidities will score 0, 1 Comorbidity scores 1, 2 Comorbidities scores 2, 3 comorbidities scores 3, and more than 4 scores 5.

Emergency department visits on the last six months No visits 0, 1 visit scores 1, 2 visits scores 2, 3 visits scores 3, and 4 or more scores 4.According to the classification of the measurement tools this level of measurement is considered as ordinal.

The interpretation of the LACE Index is that if the Index scores is 0-3 there is a low risk of readmissions, if it is between 4 and 9 the risk is moderate , and if it is more than 9 the risk is high.

References 

Gray, J., Grove, S., & Sutherland, S. (2017). Burns & Grove’s the practice of nursing 

research: Appraisal, synthesis, and generation of evidence. St. Louis, Missouri: Elsevier. Retrieved from https://digitalbookshelf.southuniversity.edu/#/books/9780323377584/cfi/6/10!/4/2/6/[email protected]:0.00

Types of data & measurements scales: Nominal, ordinal, interval and ration. (2018). 

Retrieved from https://www.mymarketresearchmethods.com/types-of-data-

nominal-ordinal-interval-ratio/

Choose a sensitive indicator from the following websites

Agency for Healthcare Research and Quality https://www.ahrq.gov 

Write a 3 page paper describing a design for a process to collect and present data to a hospital unit to at least one nurse sensitive indicator using Six Sigma as a design process. Use a design model such as: Fishbone, PDSA, Swiss cheese or HFEMA models and include the model in the paper. 

APA format with citations and references.