Computers and Nursing Practice
Science has bestowed health care delivery system with excellent technological innovations. One such innovation is the computerization of the entire health care delivery system. Computerization has contributed enormously towards the reduction of medical errors and the problems associated with such errors (Gan et.al, 2005). Computerization of health care delivery includes computerization of the medical records popularly known as the Electronic Medical Record System (EMR), Electronic Prescriptions, Personal Digital Assistants, Computer Automated Cancer Detection and Computerized Theatre Management Applications. The implementation of voice recognition technology in mobile healthcare settings is yet another recent innovation (Chang et.al, 2008).
A study to determine the attitudes of Registered Nurses towards the use of computers in the hospital setting as a predictor of their future behavior based on the theory of Planned Behavior with nine different indices namely, behavioural intention towards computer use, general attitudes toward computer use, nursing attitudes toward computer use, threat involved in computer use, challenge involved in computer use, organizational climate, departmental climate, attraction to technological innovations/innovativeness and self-efficacy has shown that the threat and challenge that are involved in computer use are mediating variables to the understanding of the process of predicting attitudes and intentions of nurses in using computers (Shoham and Gonen, 2008). A study to assess the community hospital nurses' use of electronic health records and views of the impact of such records on job performance and patient outcomes has shown that nurses prefer electronic records to paper charts and are comfortable with technology (Kossman and Scheidenhelm, 2008).
Instruments like Nurses' Computer Attitudes Inventory (NCATT), Revised NCATT, Dambrodt's scale for Computer Attitudes measure nurses' attitudes on computerization (Rohan and Peter, 1996). Success of computerization in nursing practice lies in utilization of features, functions, input and output modalities that nurse would find most useful (Mihailidis et.al, 2006).
Electronic Medical Records Systems
An Electronic Medical Record (EMR) is a medical record in digital format. Electronic Medical Record keeping facilitates access of patient data by nurses at any given location, building automated checks for drug and allergy interactions, clinical notes and laboratory reports. The term Electronic Medical Record can be expanded to include systems which keep track of other relevant medical information. Although an EMR system has the potential for invasion of a patient's medical privacy, EMRs can serve a great purpose when monitored effectively (Mandl et.al, 2001). Five levels of Electronic Health Care Record (EHCR) keeping has been classified .1.The Automated Medical Record, which is a paper-based record with some computer-generated documents. 2. The Computerized Medical Record (CMR), which makes the documents of level 1 electronically available. 3. The Electronic Medical Record (EMR) which restructures and optimizes the documents of the previous levels ensuring inter-operability of all documentation systems. 4.The Electronic Patient Record (EPR) which is a patient-centered record with information from multiple institutions and 5.The Electronic Health Record (EHR) that adds general health-related information to the EPR that is not necessarily related to a disease (Walker, 2005). The development of standards for EMR interoperability is vital because of the fact that without interoperable EMRs, practicing nurses, physicians, pharmacies and health care institutions cannot share patient information, which is necessary for timely patient-centered care. There are many standards relating to specific operation of EMRs in the USA and across the globe. These include ASTM International Continuity Of Care Record in which patient health summary is based upon XML; ANS1 X12, which is a set of protocols used for transmitting any data including billing information; CEN, which is the European Standard for EMR; DICOM, a popular standard in Radiology record keeping and HL7, which is commonly used in clinical document architecture applications (Laerum et.al, 2003). There are many software programs specially developed for Electronic Record Keeping with integrated appointment scheduling billing, prescription writer, transcription module, document management and workflow management (Ringold et.al, 2000).
Nurse Practioners have prescriptive authority in the United States (Galewitz, 1999) and prescription error is a problem in current nurse practice. Communication has been cited as the single biggest block in such prescription errors leading to wrong reading by the pharmacist. Errors seem to be more in the dose of the medicines prescribed. Electronic prescription systems have been designed as a total remedy to this problem (Laerum et.al, 2003).
Personal Digital Assistants
Personal Digital Assistants popularly known as PDA are literally handheld computers that help patient management. Using a PDA, a nurse can access a patient's laboratory reports and refer the latest information on relevant therapies, tests and treatments. The PDA can also be used for billing and updating patient visits. The PDA can also provide map and directions to the patient's homes. Using a PDA, a nurse can instantaneously transfer prescriptions to the patient's pharmacy, answer patient e-mail, refer to medical textbooks, drug databases, journals and updates (Laerum et.al. 2003). The utility of personal digital assistant resources in healthcare practice of course presents new challenges due to changing device capabilities and software availability (Kuiper, 2008).
Computer Automated Cancer Detection
A ThinPrep Processor Model 2000 has been recently approved by the FDA for the automatic preparation of PAP slides making it easier for screening atypical cells in female patients suspected with Cancer of the cervix (http://www.fda.gov). The ThinPrep System has been found to be especially effective for detecting low-grade squamous intraepithelial lesions known as SILs and severe lesions. The ThinPrep System provides for better detection of Cancer cells (Heuther et.al, 2004). PAPNET is another innovation that uses neural net computer technology, where, the computer provides guidelines for identifying abnormal cells from a series of digital images of PAP smears fed priori. AutoPap 300 QC is another Pap test re-screening system that uses image interproduction and pattern recognition techniques for identifying abnormal cells (Heuther et.al, 2004).
Computerized Theatre Management Application
Theatre Management Applications automatically record patient information like demographic and financial data, visit history with dates, procedures, performing and attending providers, care records with clinical highlights and patient status, surgical data including proposed, type, actual, severity and risks stored for reference in the event of future surgical procedures (Hillestad, 2005). The most important aspect of such applications is that they facilitate the management of patient supplies with associated refill lists. These systems help to monitor and track the use of implant and surgical items utilized during operative procedures. The applications allow the theatre nurses to create lists which give full information on the necessary equipments and surgical instruments required in the operating theatre for a surgery specific to a surgeon or specialty.
Computerization has contributed enormously towards the reduction of medical errors and the problems associated with such errors by providing timely access to client information and by assisting nurses with client monitoring, decision making and bedside documentation. But, the real challenge lies in utilization of features, functions, input and output modalities that nurse would find most useful.
Agency San Francisco
San Francisco, California
Charles L. Berman
Liz Di Bernardo