KAREN ZIKOSKY LAURIE NARDOZZI

OBJECTIVES OBJECTIVES Describe paperless hospitals Describe and evaluate the hardware and software utilized in Paperless Hospitals Describe and evaluate the information systems used in Paperless Hospitals

OBJECTIVES OBJECTIVES Assess the role and function of the nurse of paperless hospitals List the advantage/disadvantages of paperless hospitals Examine legal/ethical issues

INTRODUCTION INTRODUCTION Paperless hospitals are the wave of the future. The key concept is to minimize the amount of paper and convert all forms of documentation to digital form. It will be the integration of all disciplines to one system. Patient images and information are readily available from parts of the hospital and thru a secured network.

INTRODUCTION INTRODUCTION Paperitis is becoming an epidemic (Omtool 2007) 5% of hospitals are computerized Electronic prescriptions to be mandated by 2010 (Schlesinger 2003)

INTRODUCTION INTRODUCTION Incentive programs for successful electronic prescribers (AHA 2008) Medicare payments increase for paperless physicians (MSNBC 2008)

Computer based records may include: Computer based records may include: EHR (Electronic Health Record) Prescriptions Test order & result retrieval Physician orders & progress notes Messaging & reporting Documentation & VS Billing & Scheduling

HARDWARE USED IN PAPERLESS HOSPITALS WebcamsMonitorsMouse Wireless networks Bluetooth

WEBCAMS WEBCAMS Video cameras Images can be accessed through WWW, instant messaging or video conferencing. Images upload to a web server, continuously or timed intervals. Wikipedia (2008)

WEBCAMS WEBCAMS Monitors traffic, weather, volcanic activity Tracks weather Educators use for virtual classes Interpretation service (Gately 2008)

(Dunbar, 2008) WEBCAMS WEBCAMS Rooms at Sloan Kettering ICU are equipped with web cameras that allow staff to monitor patients from locations outside the ICU, and physicians now enter orders on a computer system that produces an electronic medication administration record that calculates dosages and sends reminders to the nurse when medications are due, or are late.

Sloan Kettering ICU

SOFTWARE IN PAPERLESS HOSPITALS SOFTWARE IN PAPERLESS HOSPITALS Microsoft Office, Excel Spreadsheets Visualization & Imaging software Anti-virus software Billing software Scheduling software

SOFTWARE SOFTWARE Adobe reader Health & wellness Discharge planning Bed management Patient tracking Medicare coding

STATCOM SOFTWARE Facilitates workflow and escalates task completion Provides staff with real-time logistical information Focus remains on patient care Acquires data from: hospital information systems phones and wireless devices phones and wireless devices touch-screen input panels voice over IP badges barcodes RFID scanners (StatCom 2008)

STATCOM Emergency Department Bed Management Patient-Stay Management Discharge Planning Hospital Support Services Business Activity Monitoring Perioperative Services (StatCom 2008)

USABILITY EVALUATION USABILITY EVALUATION Training minimal Implementation months not years User friendly displays Cost effective Information easily entered through touch pads (Staggers 2003)

USABILITY EVALUATION USABILITY EVALUATION Proven to increase patient & staff satisfaction Automatic time-stamp for patient safety & security Real-time communication No written documentation on HIPPA (Staggers 2003)

3M HEALTH INFORMATION SYSTEMS 3M HEALTH INFORMATION SYSTEMS Used by all healthcare professionals Functions: Health information management Documentation Creation Documentation management & imaging Case management Revenue cycle management Performance improvement Health information exchange (3M 2008)

3M Workstation configuration Healthlevel 7 data standard ICD-10 LOINC and SNOMED CT LOINC and SNOMED CT

3M 3M From the research that has been done, this system would be recommended because it has been around since M has over 55,000 products ranging from post-it notes, bandages, stethoscopes, to computer technology.Their products and ideas are simple to use, enhance and improve lives. From the research that has been done, this system would be recommended because it has been around since M has over 55,000 products ranging from post-it notes, bandages, stethoscopes, to computer technology. Their products and ideas are simple to use, enhance and improve lives. (3M 2008)

ADVANTAGES OF PAPERLESS HOSPITALS Reduces medical errors Prevents deaths by mistakes Alerts nurses to allergies Eliminates hard to read handwriting Eliminates transcription errors 24 hour access

ADVANTAGES OF PAPERLESS HOSPITALS ADVANTAGES OF PAPERLESS HOSPITALS Avoids duplicate ordering Time efficient Accurate billing Automatic inventory replacement Patient satisfaction improvement Prior treatment instantly available

DISADVANTAGES OF PAPERLESS HOSPITALS DISADVANTAGES OF PAPERLESS HOSPITALS Initial cost $500,000-$1,500,000 Ongoing costs Continuous need for upgrades Reduced hospital revenue Difficult transition

DISADVANTAGES OF PAPERLESS HOSPITALS DISADVANTAGES OF PAPERLESS HOSPITALS System failures Resistance to change Violation of HIPPA Still generates paper

(McCracken 2008)

ETHICAL/LEGAL ISSUES ETHICAL/LEGAL ISSUES Access only to employees with need Time and signature stamped Biometric devices Voice recognition Retinal patterns Fingerprints Computer hackers Legal rights

INFORMATICS COMPETENCIES OF THE PROFESSIONAL NURSE INFORMATICS COMPETENCIES OF THE PROFESSIONAL NURSE E-learning based competencies CEU’s On job training MAGNET Recognition

FUNCTIONS AND RESPONSIBILITES OF THE PROFESSIONAL NURSE FUNCTIONS AND RESPONSIBILITES OF THE PROFESSIONAL NURSE Restrict to relevant information Keep passwords safe and to self Patient confidentiality

FUNCTIONS OF THE INFORMATICS NURSE IN THE PAPERLESS HOSPITAL SELECTS AND EVALUATES SOFTWARE TROUBLESHOOTS SELECTS NURSING TERMINOLOGY TRAINS YEARLY COMPETENCIES

SUMMARY The paperless system improves patient care and saves billions of dollars, yet less than 20% of hospitals have gone paperless. The ultimate goal is a nationwide network. Benefits could reduce medical errors, redundant tests, and shorten length of stays. Advanced computerized records can signal dangerous drug combinations and potentially save a life.

SUMMARY SUMMARY Files will be stored electronically, reducing the storage space needed. Paperless hospitals goals are for all health care workers to have access to all patient records from anywhere in the hospital. Physicians also may have access to records away from the hospital setting. President Bush has set a goal for all hospitals to be paperless by 2014.

REFERENCES REFERENCES OmtoolLTD. (2007). YouTube. The cure for paperitis-Creating the paperless hospital. Retrieved September 05, 2008, from youtube video Web site: Schlesinger, A. (2003). Paperless hospitals' popularity grows. Retrieved September 05,2008, from CBS News Web site: 7.shtml 7.shtml Conway, M. (2004). MSNBC. Retrieved September 06,2008, from Health officials back paperless prescriptions Web site:

REFERENCES REFERENCES King, J. (2005). AHA News. Retrieved September 05, 2008, from The Paperless Hospital -- Really ! Web site: 00.html 00.html McGonigle, D, & Mastrian, K. (2008). Nursing Informatics and the Foundation of Knowledge. Sudbury, MA: Jones and Bartlett Publishers. Gately,(2008) iHealthBeat. Retrieved September 16, 2008, from Arizona hospitals use webcams to overcome language barriers Website: To-Overcome-Language-Barriers.aspx?topicID=89 To-Overcome-Language-Barriers.aspx?topicID=89

REFERENCES REFERENCES SNOMED. (2008). In Wikipedia Free Encyclopedia [Web]. Retrieved October 2, 2008, from SNOMED. (2008). In Wikipedia Free Encyclopedia [Web]. Retrieved October 2, 2008, from 3M.(2008). Retrieved October 4, 2008, from The spirit of innovation. Web site: McCracken, T. (2008). Retrieved September 19, 2008, from Cartoons by T.McCracken. Web site:

REFERENCES StatCom. (2008).Retrieved September 10, 2008, from Patient flow logistics & tracking software Web site: ANCC., (2008). MAGNET program overview. Retrieved October 09, 2008, from American Nurses Credentialing Center Web site: Associated Press. (2005, September 14). Promises, challenges of digital medical records. Retrieved October 10, 2008, from MSNBC Web site: Staggers, N. ( 2003). Human factors: Imperative concepts for critical care. AACN Clinical Issues14 (3),