Ethics and AHRQ, accreditation/reimbursement, and regulatory accreditation

With respect to healthcare system information use and design there are numerous links to healthcare data involving nearly every facet within the healthcare arena, some of which includes: accessibility, ambulatory, emergency, healthcare spending, health care disparities, healthcare use, HIV, Hospitalizations by payer and by state. All of these links provide a wealth of knowledge and information specific to those universal topics.
With respect to regulatory and accreditation the entire section under quality and patient safety addresses specific components meeting those compliance requirements. They provide data which was obtained from AHRQ funded reports specific to the usability of Electronic Health Record (EHR) systems. These studies were conducted to identify and promote standards specific to usability and design of such systems. The development of frameworks to evaluated existing system designs was a priority in establishing a baseline for those standards. A focus on User-Interface design was also identified as this is an important factor for integration throughout departments, professions, organizations, reimbursement and regulatory bodies. It is easy to recognize the regulatory emphasis through the use of “government-supported efforts like Practice-Based Research Networks, which are designed to improve the ability to track and evaluate actual HER use through expanded use of captured audit trail data and structured analysis of navigation patterns.” (Ahrq.gov, 2010).
The apparent potential expansiveness of these systems is almost unimaginable and therefore undoubtedly possessing many concerns involving ethics. Confidentiality being one of the central ethical concerns due to the potential limitless accessibility. Despite advances in privacy promotion through policy development, HIPAA, encryption, hardware and software firewalls and the like, there always seems to be a potential weakness or gap in any and all of such preventative measures. Personally, I believe that the benefits outweigh the negatives of such development simply because logic indicates that this has the potential to benefit the greater good with faster, comprehensive, universal access to necessary medical information in an instant. To me, when a critical situation or upcoming event is highly dependent on these factors (timeliness, completeness, and accuracy), the debate is really a non issue. To me the focus needs to be directed towards security.
Medical Informatics is a new up and coming specialization which will likely continue to take on a life of its own as it is molded and shaped through the advent of technology and its subsequent use and misuse. I feel that we as Professional practitioners need to keep abreast of these advancing technologies to promote the best interest of our patients and profession. Unfortunately this will not be an easy task anytime soon due to the rapid technological advances, rapid adoption, opportunistic individuals and apparent policy vacuums that continue to exist.
Fortunately organizations such as the AHRQ will assist with our agenda through continued services such as those identified on the website that involve technology assessment tools, Preventative services and taskforces, practice guidelines as well as grant and funding opportunities among countless other services and information are available to assist in development.




Reference:

AHRQ (2010). http://www.ahrq.gov/

Question 2

2. How does nursing data quality relate to decision support?
I readily recognize that many barriers exist which may limit nurses’ ability to consistently implement knowledge from evidence based practice in the actual setting. Lack of technology and related support systems, lack of administration support, lack of co-worker knowledge and support, knowledge gaps among co workers as a result inconsistencies of educational background and specializations, resistance to technology and subsequent adoption into practice and inaccurate data entry. Therefore to promote data quality it is important to recognize the potential barriers and address each of them to reduce potential negative impact. Employee education specific to data entry and retrieval should be continually provided. Conducting a system check and establishing fail safes to ensure accurate and timely data input is maintained is important. Developing and maintaining data verification practices assists in ensuring data accuracy. The skill of the employees along with the actual data usage is important to consider when determining an organization’s decision support system. Off-the-shelf software may be appropriate for some organizations, however due to the various sub specialties in healthcare , homegrown software often needs to be developed completely or adapted to scalable off-the-shelf versions. Therefore depending on the skill level and needs of the organization will direct the use of particular decision support systems. Nursing data quality and decision support are interdependent on one another in order to achieve the most benefit which results in quality care. An efficient, user friendly, decision support system will complement the provision of quality care and vice versa as with the required input of quality data into the system.

Module 4

1. How did the readings influence your perception of your own clinical decision-making? How do we reconcile the value of nursing experience with known heuristics and biases used in human decision making?
The use of heuristics is innate and with this comes innate misperceptions involving judgment and probability. Personally, I do incorporate previous experience of probabilities when making judgments about situations. Understanding the existence of such biases is important if one is to offset their potential erroneous influence as it relates to making clinical decisions. When considering insensitivity to sample size, despite a perceived decent understanding of statistics, I too rationalized what the majority assumed, however after reading on remembered that larger sample sizes are less likely to experience significant deviations from a known average. From this it is apparent that I need to consciously evaluate each individual situation and possibly even conduct some basic research prior to making a decision which could help to reduce the occurrence of such biases. To me, after rationalizing each of the individual topics specific to known heuristics and biases, the correct assumption is always understandable which I attribute to my experience and education, however despite this background, it is easy to see how such mistakes can be made. It is clear why using Evidence Based Practice is so important as its use can obviously reduce the occurrence of making judgment errors if one is closely adhering to the highly supported practices it promotes.