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Essay Instructions: Hello,

I specified 4 pages above but want to clarify that the four pages does not include a bibliography or the outline that is required for the project. Please advise on how you want to handle this.

Please allow me to start with a little personal info that will help with the opinion part of this paper. I have spent the last 10 years implementing and administering relational databases. i have taken time off to pursue a degree in health systems. HIPAA has had a dramatic affect in health information management and medical informatics. i strongly support the push to digitize healthcare in America. i am not sure about HIPAA specifications but i hear they are aggressive. I totally support change and feel that while HIPAA may be a little zealous; healthcare should bite the bullet for they will emerge triumphant

I am including some url's that may be helpful:

http://www.informatics-review.com/thoughts/index.html
http://www.coiera.com/publica.htm
http://www.aahp.org/template.cfm?section=Our_Issues
http://www.jhita.org


PAPER REQUIREMENTS:

Identify an article from one of the following sources:
(1) A health services policy or management journal
(2) A policy or association newsletter
(3) A regional or national newspaper

The focus of the selected article should on a current or emerging issue of major importance for the health care industry.

It is acceptable to draw from several sources. However, please provide a critique of the information collected (from one or many sources) and a discussion of the important implications rather than simply review information. Your input is an important component of the assignment.

Prepare a 3-5 page type-written Synopsis that includes the following:
(a) A description of the current issue,
(b) Potential Impact of the Issue on the health care industry,
(c) Whether you agree or disagree with the perspective of the author,
(d) Why you agree or disagree with the author and
(e) Set of recommendations or solutions to key problems addressed in the article.


Balance paper into three dimensions:
Context = background of paper,
Technical = main point of paper,
Aesthetics = presentation

Provide an outline of your paper in text at the start of your paper.

Provide a road map and include landmarks.

Introduce headings and sections of your paper.

Be concise and keep it simple. Your readers are executives and don't have much time.

Use active voice / and first person

Use page numbers.

Use reference/footnotes (MLA or APA) when attaining information from outside source.

Use numbers to list more than three things.

Use plural form of writing.

Thank you,

Strider Lloyd

Essay Instructions: Case Assignment



Communications between healthcare professionals account for the major part of the information flow in clinical and healthcare settings. Accordingly, it is essential that healthcare professionals communicate and share information in a manner that is efficient, timely and accurate. However, various information needs and barriers to communications do indeed exist, which create unique challenges.

The following study examined the perceived information needs and communication difficulties among inpatient physicians and nurses at New York Presbyterian Hospital. Read through this study carefully, and in three to four (full) pages answer and explain the following:

1. In what ways are the information needs of physicians and nurses at Presbyterian Hospital similar? In what ways are they different?

2. From the study, select three to four specific information needs and identify key data inputs, processes and outputs necessary for the information to be accurate and useful.

3. For each of the information needs selected above, describe what systems and methods of communication you believe would be best for sharing and communicating the information and knowledge. Explain why.

Please submit your assignment to CourseNet by the end of this module.



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Article

Perceived Information Needs and Communication Difficulties of Inpatient Physicians and Nurses

Source:

Journal of the American Medical Informatics Association 9:S64-S69 (2002)
Lawrence K. McKnight, MD, Peter D. Stetson, MD, Suzanne Bakken, RN, DNSc, Christine Curran, RN, PhD and James J. Cimino, MD


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Abstract
In order to understand the differing perceptions of information needs and communication patterns of healthcare professionals as they relate to medical errors, we conducted a survey and 5 focus group sessions of inpatient physicians and nurses. Although nurses and physicians stated differing information needs, both groups expressed significant problems with obtaining patient, domain and institution-specific information in a timely manner. Identification of appropriate providers and establishing contact with those people was perceived as the most pressing communication need. All focus group participants felt that communication difficulties were common and could give examples in which such difficulties led to adverse events. Our studies suggest that information needs and communication difficulties are common and can lead to medical errors or near misses. Many of these problems may be amenable to information technology solutions.

Introduction

The Institute of Medicine (IOM) report on medical errors1 has heightened awareness of the relationships between systematic processes and adverse events. The report argues both that medical errors are common2,3 and that many errors are preventable.4 Specifically, the report references the work of Leape5 and Reason,6 and calls for critical review of system processes to ensure that latent errors are prevented. Both Leape and Reason, in turn, argue that error reduction can be achieved by, among other things, reducing reliance on human memory and improving information access. Unfortunately there are few studies that characterize the types of information, the timeliness of their access, or the methods of delivery that are critical to prevent latent errors.

Information access may take many forms ranging from looking up information on a computer or in a textbook, to formal subspecialty consults, to the informal dialogs between health care professionals. The latter constitute the majority of the healthcare professionals information requests7 and time8. While the relationships between communication and medical errors remain poorly defined, retrospective reviews indicate that they contribute to a large percentage of adverse events.9

Coiera argues that information and communication needs are related and represent a continuum of activities, some of which are served best by communication dialogs and others that can be served by computable methods.10 He introduces the concept of "common ground" as the information that is shared by both participants and is relevant to the communication task. Common ground may be used to identify situations where computable information may be useful or where more effective communication channels are needed. Therefore, understanding the characteristic information types and communication patterns among health care professionals is necessary to effectively support system processes with informatics interventions. Appreciation of these concepts is particularly important if the intention is to have impact on latent errors.

In this light, we have proposed analysis of the impact of an informatics intervention on information need satisfaction, communication, collaboration, and selected quality indicators. As a preliminary study we sought to describe and compare the perceived information needs and communication difficulties among inpatient physicians and nurses at the Presbyterian Hospital (PH) campus of the New York Presbyterian Hospital. In order to triangulate the results, three qualitative methodologies were used: surveys, focus groups and observational studies. This paper reports on the survey and focus group findings. Observational studies are reported in a separate paper.11

Methods

Surveys
As a first step, we designed a semi-structured survey to gather information about the perceptions of information needs and communication difficulties at PH. The survey asked participants to list instances of information needs or communication difficulties and the surrounding circumstances including why the event occurred and the frequency of similar events. The survey questions were developed based upon the Krikelas model of supplemental information seeking behavior and revised based upon feedback from the members of the research team.12 General computer experience, functions used in the current clinical information system (WebCIS13), and discipline role were also recorded. Surveys were identical for the physician and nurse respondents except for discipline-specific role information and the method of completing the questionnaire. For the physician group, we developed a Web page for the survey, and e-mails were sent to all 125 medical interns and residents at PH, notifying them of the existence of the Web site and encouraging them to respond. We distributed 70 surveys in paper format to the nursing staff at PH through representatives of the Nursing Information Systems Committee.

Focus Groups
To flesh out information obtained in the surveys, we conducted three focus group meetings with physicians (interns, residents, and hospitalist physicians respectively) and two focus group meetings with nurses (nurse managers and staff nurses respectively) at PH. Studies were performed according to standard focus group principles as described by Kitzinger14 and Kruger.15 All groups consisted of 4-6 participants in addition to the facilitators with exception of the staff nurse group where two participants attended. Sessions were audio taped and transcribed. Common themes were identified and summarized from the transcriptions. Questions in the focus group session attempted to explore barriers to obtaining information or effective communication, to elicit examples of cases where such systematic processes lead to poor outcomes, and to suggest improvements.

Results

Survey Data

Twenty-six physicians and 17 nurses responded to the survey (response rates of 21% and 24% respectively).

Data related to general computer experience and WebCIS experience indicated a general level of computer literacy among both groups and greater use of WebCIS functions by physicians. All respondents to the survey reported having access to the Internet. All except one nurse reported having had experience with MS Windows. E-mail and Web browsing were the most frequently reported uses. WebCIS was used by all physician responders and by 76% of nurses. The most frequently used WebCIS function was laboratory results reporting by both nurses and physicians. While nearly all physicians (92%) reported using specialty reports (Endoscopy and Cardiac imaging), only 35% of nurses reported using these functions. Relatively fewer physicians reported using the diagnosis system (42%), alert system (23%) or infobuttons (15%). Only one nurse reported using these systems.

Sixty-four statements about information needs and 46 statements regarding communications difficulties were recorded. A summary of the survey themes is provided in the Table 1.


Table 1 Perceived Information Needs and Communication Difficulties (Survey Data)

Physicians
Nurses


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Information Needs

Patient Specific
? A list of current medications and time administered
? Patient diagnoses

? Laboratory and other test results

? Problem lists

? Outpatient notes (especially sub-specialty consultations.

? A central list of current providers for the patient (consultants, nurses)

? Laboratory and other test results

Institution Specific
? Current providers that are on-call and how to contact them.
? Policies and protocols (IV access device care policy, blood bank protocol)

? Census reports

Domain Specific
? Disease management information
? Drug information (dosage and side effects of specific drugs, patient/caregiver teaching information)

? Prescribing information

? Medical formulas linked to patient data
? Diagnostic definitions

? Educational materials (e.g. colostomy care educational materials)

Communication Difficulties
? Identifying and contacting other health care providers (especially consult services)
? Identifying and contacting other health care providers




Physician responses to the survey questions of information and communication needs focused on gaps in system function and often included recommendations on how they would want the gaps addressed. For example, one physician stated an information need of "Medication list for my signout" (a function that does not currently exist) with the comment "Integrate with pharmacy." In contrast nursing responses tended to focus on problems in using existing applications. For example, a typical information need was listed as "Blood bank protocol" with the comment "manual not up to date."

Physicians cited a majority of information needs related to patient specific data. Many comments about the need for improved availability of inpatient and outpatient consultation reports, needing patient problem and medication lists, improved drug-drug interaction alerts, and better recording of order status were mentioned. Domain-specific information, such as online textbooks guidelines and decision aids, formulas (linked to patient specific data), medication (and cost) prescribing information, and laboratory significance information were also mentioned by physicians but less frequently than by nurses.

Responses to questions about information sources fell into 3 categories: source characteristics (i.e., peer reviewed, up-to-date), source format (i.e., on-line, palm-device, paper), and specific content (i.e., NEJM, Harrison?s). Physicians often commented about source characteristics in generalities; for example, to include peer review and validation. In contrast, nurse?s comments tended to focus more on the source type (i.e., care plan, policy, protocols) but included a wider audience (i.e., patient teaching materials and continuing education). Physicians often made comments indicating that sources should be on-line or on a handheld device, whereas nurses often expressed concern over Web-based materials because some health care workers might not be able to access these materials.

Both groups stated a variety of difficulties in obtaining information including: 1) difficulty in finding information, 2) finding inaccurate or outdated information, and 3) limited time. Additionally, nurses reported that there was a lack of knowledge about how to get into the system.

Both physicians and nurses commented extensively on the difficulty in identifying and contacting other health care providers. Often these frustrations resulted from an inefficient paging system. Both physicians and nurses suggested information technology-based solutions for the rapid identification of people and common access to frequently referenced, but changing information. For example, one nurse asked for a Web page list of clean beds, a prerequisite for admitting patients and starting therapeutic regimens in a timely fashion. Physician respondents stated a very strong preference (93%) for e-mail as their primary method of communication despite currently using the telephone and paging system far more frequently. This may have been a result of selection bias since responding physicians answered using the Web-based survey, however 50% of responding nurses also stated that their preferred communication method was the Web or e-mail.

Thirty-six additional general comments about wishes for improvements to WebCIS functionality were made. These comments mirrored other comments about information and communication needs discussed above.

Focus Groups
Focus group discussions were lively and emotionally charged. Many themes from the survey data were reviewed and expanded upon.

Regarding information needs, both nurses and physicians emphasized that the time to look up information was limited, and that quick, relevant information sources were most useful. Interns in particular liked MD Consult for its "One-Stop-Shopping" approach with the ability to look up information at many levels of detail and then choose the appropriate source for their particular situation. Hospitalists preferred Up-to-Date because it was more focused and relevant than MD Consult.

Nurses commented that, when they have information needs, they often turn to someone with expertise in that area as a first source. Physicians did not mention this.

All groups felt that Medline searches were useful in limited situations, but generally were not useful for day-to-day clinical activities. Most of the physician participants used palm-based organizers and commented on their practicality, particularly for looking up drug information.

In contrast to physicians, nurses identified the need for patient education materials. Current patient education materials were felt to be difficult to access, and often inappropriate for the literacy level of patients. They also expressed the need for materials in foreign languages, particularly Spanish.

Communication difficulties identified by physicians focused around four main problems: 1) a slow and inefficient paging system, 2) inconsistent communication at transfer of patient care, 3) the need for feedback on order status, and 4) the need for face-to-face communication where mistrust or disagreement in care plans existed.

Several cases where the lack of communication led to medical errors or near misses were identified. Patient transfers were particularly problematic. One physician reported:

[just] last night there was a patient who left the CCU . . . in the morning?was assigned to me at 11 PM?and the patient was on heparin . . . and was on the floor for 12 hours without a physician aware or covering this patient.

Others in the group agreed that similar problems were not infrequent. Multiple cases were described where physicians were unaware of medicines being given to the patient because they were omitted from medicine lists in sign out sheets.

Communication between consult services was also highlighted as a problem area. As one intern describes:

We had a patient who . . . had a lot of [consult teams] and all . . . of them were remarkably opinionated and all disagreed with each other. And so they used me for the last two weeks as a mode of communication. I was the conduit. . . . But I think it did affect the patient?s care.

The nurses also identified quality of care issues related to ineffective or delayed communication. For example, one nurse in talking about how communication affected patient satisfaction with care stated:

It?s really a dissatisfier when a patient is in pain and you can?t find the right person to give you an updated order. . . . you?re flipping the kardex and you?re calling 11 people, and it just [gives] the image that . . . the nurse-patient relationship is now fractured because you can?t even get the right doctor. . . . It implies that you don?t even know what you?re doing. That message is given very strongly . . . like you know, "can?t you find me a doctor?" It?s not that you don?t want to, it?s just that you don?t have the right information easily accessible to you.

Another nurse pointed out how this relates to adverse outcomes.

It does specifically affect our patients who we know could code at any time. And we are trying to be able to get in touch with an intern.

A significant tension between nurses and physicians was identified when analyzing the focus group data. For example, some nurses felt that telephone and verbal orders should be eliminated, and that physicians were flagging all orders as "stat" inappropriately. Physicians on the other hand felt that telephone orders were essential in order to get work done in a timely fashion, and felt the need to seek nurses out face to face or mark orders as stat in order to ensure that orders were actually carried out. Regarding finding the physician for a patient, one nurse pointed out:

I?ve never been able to figure out why that?s so complicated. The nurses have an assignment?whether it?s written on paper or computer-generated or what ever ? we have an assignment. At any given moment you can just look at it and see what nurse is assigned to what patient. But it?s much more complicated with the doctors. You have to go through hoops to find out.

In contrast, a physician trying to find a nurse for a patient stated:

I think the nurses should have their pictures on the floors, saying ?this is my face?, ?this is who I am?, ?I?m taking care of these rooms?. [Instead] they tell me??S____ is taking care of this patient.? Like, who is S____? Until I figure that out, basically I have to ask nurse to nurse until some nurse can say ?I?m taking care of this patient.?

All groups felt that the current paging system needed to be changed, and that a common "whiteboard" area with patient problems, responsibilities, and tasks with check off to identify completion was considered to be a potential solution to less urgent communication issues regarding patients.

Discussion

The survey data suggest that providers are having significant difficulty in obtaining certain types of information. Implied in the comments is the notion that information is available, however due to time constraints it is too difficult to obtain. The Information needs listed (ie. knowledge sources, provider lists, medication lists, etc.) appear predictable and have much common ground between providers, therefore computable information sources would be appropriate.

In contrast, comments in the focus group sessions highlight frustration with the interruptive nature of their work environment that is inevitable in clinical medicine. At the same time they illustrate personal goals to improve efficiency without consideration of systemic efficiency. Some of these processes may need to be addressed though non-informatics means, however others such as the feedback of task status may be targets for interventions such as improved asynchronous channels such as a virtual whiteboard.

There is significant work to be done to implement successful technologies, however. In analyzing the data collected from these studies, we identified several ambiguities in the problem terminology. For example, in response to the question "name a communication difficulty you have had" one respondent identified the source as "Pharmacy", the difficulty as "I couldn?t remember what meds the patient was on", and commented, "Need medication section like the demographics section [of WebCIS]." We had difficulty classifying this as an information need or communication problem. Future studies will benefit from an ontology for this domain16.

Conclusions

Although quite limited by design, the focus group and survey data outlined here confirm that health care professionals perceive significant gaps between information needs and timely access, and that communication difficulties are commonly linked to poor outcomes. While physicians and nurses have different needs, methods and goals, they share common problems in obtaining information and communicating effectively.

We believe that successful tools can be developed. Both groups had favorable responses to the idea of a common "virtual whiteboard" that would facilitate communication of low-priority tasks without interruption but with confirmation of task completion. Physicians in particular were receptive to the idea of a wireless handheld device for this. Our data indicate that exploring the use of such technology has potential for favorably impacting the process of care.

Acknowledgments

This work has been supported by National Library of Medicine Training Grant NO1-LM07079.

Reprinted from the Proceedings of the 2001 AMIA Annual Symposium, with permission.

References

Kohn, KT, Corrigan, JM, Donaldson, MS (editors for the Committee on Quality of Health Care in America). To Err is Human: Building a Safer Health System. Institute of Medicine. National Academy Press, 1999.
Brennen, TA, Leape, LL et al. Incidence of adverse events and negligence in hospitalized patients: Results of the Harvard Medical Practice Study I. NEJM. 1991. Vol. 324(6) pgs. 370-376.
Thomas, EJ et al. Incidence and types of adverse events and negligent care in Utah and Colorado. Medical Care . 2000 Vol. 38(3):261?271. [Medline]
Bates, DW. Et al. Incidence of Adverse Drug Events and Potential Adverse Drug Events: Implications for prevention. JAMA. 1995. Vol. 274(1):29 ? 34. [Abstract]
Leape, LL. Error in Medicine. JAMA 1995. Vol. 272(23):1851 ? 1857.
Reason, J. Human Error. Cambridge, Mass: Cambridge University Press; 1982.
Covell DG, Uman GC, Manning PR. Information needs in office practice: are they being met? Ann Intern Med. 1985;Vol. 103:596?9. [Medline]
Tang P, Jaworski MA Fellencer CA Kreider N, LaRosa MP Marquardt WC. Clinical information activities in diverse ambulatory care practices. Proc AMIA Fall Symposium . 1996; 12?6.
Wilson, RM, Runciman, WB, Gibberd, RW et al. The quality in Australian health care study. Med. J. Aust. 1998. Vol. 169: 458?471.
Coiera E. When Coversation Is Better Than Computation. JAMIA. 2000: Vol. 7(3) 277?286. [Abstract/Full Text]
Kubose TT, Cimino JJ, Patel VL. Assessment of information needs for informed, coordinated activities in the clinical environment. AMIA 2001 Fall Symposium (in press).
Krikelas, J. Information-seeking behavior: Patterns and concepts. Dexel Library Quarterly 1983; 19(2), 5?20.
Hripcsak G, Cimino JJ, Sengupta S. WebCIS: large scale deployment of a Web-based clinical information system. JAMIA. 1999; Vol. 6 (supl.):804?8.
Kitzinger J. "Qualitative Research: Introducing Focus Groups." BMJ. 1995; 299?302.
Kruger R. Focus Groups: a practical guide for applied research, 3rd Ed. London: Sage, 2000.
Stetson PD, McKnight LK, Bakken S, Curran C Kubose TT, Cimino JJ. Development of an Ontology to Model Medical Errors, Information Needs, and the Clinical Communication Space. AMIA 2001 Fall Symposium (in press).

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There are faxes for this order.

Essay Instructions: (TITLE PAGE):
Addressing the Issue of Medical Errors: Mandatory Reporting Systems and Computer Technology

(MAIN TOPIC): (Introductory Paragraphs Listed Below)

Experts have known that medical errors are widespread for more than a decade. But the problem has received a new dose of attention from the public and Congress following a recent report from the prestigious Institute of Medicine (IOM) confirming the extent of the phenomenon and urging reforms. In fact, more people die each year from medical mistakes in American hospitals than are killed in car crashes or by breast cancer or AIDS.
To combat the current crisis of deaths due to preventable medical errors, the health care industry and lawmakers have taken two approaches. The first is to implement a system of mandatory reporting systems. The solution here is to create an atmosphere in hospitals that fosters less blame, not more, according to the IOM report. A blue-ribbon panel appointed by the IOM argues that the failure to acknowledge and analyze mistakes deprives hospitals of important information that could help prevent similar mistakes in the future. However, many in the health care industry argue that mandatory reporting of errors will foster an atmosphere of lawsuits and backlash by the public. The end result would be increased costs, higher insurance premiums, and an overall distrust of hospitals and other health care facilities.
On the other hand, current research evidence shows that when compared to paper-based systems, the optimal solutions for the prevention of medical errors are high-tech in nature. When implemented these solutions show markedly reduction in all types of medical errors. The success of any rollout involving new hardware and software hinges on the collaborative effort between IT managers, administrators, programmers and the end-users themselves. It is not sufficient to possess the high-end technology without the willingness of the end-users to undergo proper training followed by a sincere effort to properly use the newly installed computer information systems. Likewise, the IT management team must access end-user needs and incorporate their suggestions into the final decision making process. When both of these situations exist simultaneously, the end result is one of achievement.
Because we are in a computer/digital age coupled with the fact that healthcare organizations are trying to reduce or eliminate medical errors with alternative solutions, an in-depth discussion of high-tech options is highly relevant for hospital administrators and IT management to consider. This is especially the case when uses of these systems reduce error rates dramatically; thereby positively affecting the health care patients receive. In addition, a net effect of reduction in health care costs cannot be overlooked. Today, these pressing issues are of immense importance to all Americans as the health care system in the United States is poised to undergo significant changes in the near future. With the recent HIPPA legislation, possible privatization of Medicare, new innovations including Wi-Fi Internet access, mobile computing, remote access and a never ending quest to eliminate costs, hospital IT management must always be cognizant of new technology as it materializes.
When examining the successful introduction and final adoption of new, high-tech solutions into the health care system, one must review the whole picture before and after implementation. By studying the overall characteristics of an organization, assumptions can then be made as to why certain applications are readily accepted while others are not. Also, the same reasoning can be applied to the assessment of why particular departments within healthcare institutions welcome change while others resist at every step along the process of upgrading. Common area of interests include the following:
? Educational background of employees to be affected by the new computer systems
? Attitudes, perceptions, and biases toward computer technology
? Level of communications between different departments
? Relationship between upper management, IT personnel, and end users
? The extent of the problems leading to medical errors
? Employee training and evaluations
? The technologies (hardware & software)


(PRELIMINARY OUTLINE)

I. Medical Errors: Background information

II. Solution One: Mandatory Reporting Systems

A. Benefits
B. Drawbacks and Challenges
C. Stakeholders
D. Legislation
E. Conclusions

III. Solution Two: Computer Technology

A. Clinical Decision Support Systems
B. Computerized Physician Order Entry
C. Electronic Medical Record
D. E-prescribing
E. E-health
F. Advantages Disadvantages

IV. The Obstacles for Solutions Implementation

A. The Human Factor
B. Cost (Funding)
C. Lack of Standards (Protocols)
D. Limitations of Technologies

V. Conclusions


(REFERENCES LIST) (you may add other sources as needed)

(BOOKS):

--Kohn, L.T., Corrigan, J.M., & Donaldson, M.S. (2000). To Err Is Human: Building a Safer Health System. Washington, D.C., National Academy Press.


(JOURNALS):

--Bates, D.W., & Gawande, A.A., Improving Safety with Information Technology. (2003). New England Journal of Medicine, 348: 2526-2534.

--Bates, D.W. et al, Effect of computerized Physician Order Entry and a Team Intervention on Prevention of Serious Medication Errors. (1998). Journal of the American Medical Association, 280: 1311-1316

--Hagland, M., Reduced Errors Ahead. Health Care Informatics, August, 2003.

--Hersh, W.R., Medical Informatics: Improving Health Care Through Information. (2002). Journal of the American Medical Association, 288:1955-1958.

--Benjamin, M.D., Reducing Medication Errors and Increasing Patient Safety: Case Studies inClinical Pharmacology. (2003). Journal Of Clinical Pharmacology, 43: 768-783.

--Eskew, A., Geisler, M., O?Connor, L., Saunders, G., Vinci, R., Enhancing Patient Safety: Clinician Order Entry with a Pharmacy Interface. (1999). Journal of Health Care Information Management, 16: 52-57.

--Hayward, R.A., Hofer, T.P., Estimating Hospital Deaths Due to Medical Errors. (2001). Journal of the American Medical Association, 286: 415-420.

--Hunt, D.L., Haynes, R.B., Hanna, S.E., Smith, K, Effects of Computer-Based Clinical Decision Support Systems on Physician Performance and Patient Outcomes. (1998). Journal of the American Medical Association, 280: 1339-1346.

--John Wiley & Sons, Inc. Journals --Bates, D.W., & Gawande, A.A., Improving Safety with Information Technology. (2003). New England Journal of Medicine, 348: 2526-2534.

--Berner, E.S., Maisiak, R.S., Cobbs, C.G., Taunton, O.D., Effects of a Decision Support System on Physicians, Diagnostic Performance. (1999). Journal of the American Medical Informatics Association, 6 (5): 420-427.

--Persson, M., Mjorndal, T., Carlberg, B., Bohlin, J., Lindholm, L.H., Evaluation of a Computer-Based Support System for Treatment of Hypertension with Drugs: Retrospective, Nonintervention Testing of Cost and Guideline Adherence. (2000). Journal of Internal Medicine, 247: 87-93.

--Randolph, A.G., Haynes, R.B., Wyatt, J.C., Cook, D.J., Guyatt, G.H., How to use an Article Evaluating the Clinical Impact of a Computer-Based Clinical Decision Support System. (1999). Journal of the American Medical Association, 281:67-74.

--Friedman, C.P., Elstein, A.S., Wolf, F.M., Murphy, G.C., Franz, T.M., Heckerling, P.S., Fine, P.L., Miller, T.M., Abraham, V., Enhancement of Clinicians? Diagnostic Reasoning by Computer-Based Consultation. (1999). Journal of the American Medical Association, 282:1851-1856.

--Durieux, P., Nizard, R., Ravaud, P., Mounier, N., Lepage, E., A Clinical Decision Support System for Prevention of Venous Thromboembolism. (2000). Journal of the American Medical Association, 283:2816-2821.

--Raschhke, R.A., Gollihare, B., Wunderlich, T.A., Guidry, J.R., Leibowitz, A.I., Pierce, J.C., Lemelson, L., Heisler, M.A., Susong, C., A Computer Alert System to Prevent Injury from Adverse Drug Events. (1998). Journal of the American Medical Association, 280:1317-1320.

--Britto, J. & Ramnarayan, P., Paediatric Clinical Decision Support Systems. (2002). Arch.Dis.Child, 87: 361-362.

--Chan, W., Increasing the Success of Physician Order Entry Through Human Factors Engineering. Journal of Health Care Information Management, 16: 71-79.

--Leape, L.L., Berwick, D.M., bates, D.W., What Practices Will Most Improve Safety? (2002). Journal of the American Medical Association, 288: 501-507.

--Memel, D.S., McMillan, D.R., Donelson, S.M., Sheehan, M., Development and Implementation of an Information Management and Information Technology Strategy for Improving Health Care Services: A Case Study. (2001). Journal of Health Care Information Management, 15: 261-285.

--Noffsinger, R., Chin, S., Improving the Delivery of Care and Reducing Health Care Costs with the Digitization of Information. (2000). Journal of Health Care Information Management, 14: 23-30.

--Rose, E., Life After Go-Live, Part 4: Preventing Error with an EMR. (1999). Journal of Health Care Information Management, 17: 15-17.


(REQUIRED SECTIONS):


1. Title Page
2. Table of Contents (list every heading with page number)
3. Introduction
4. Literature Review
5. Methodology
6. Results and Findings
7. Discussion
8. References Pages

-Use APA Style according to the Publication Manual of the American Psychological Association


-Contact me as soon as possible if you have any questions regarding format, content, etc.

Essay Instructions: Consumer Health Informatics
Resources

Required Readings

Course Text: Nursing Informatics: Where Technology and Caring Meet

Chapter 16, "Personal Health Record: Managing Personal Health"

Articles:

Adams, S. A. (2010). Blog-based applications and health information: Two case studies that illustrate important questions for Consumer Health Informatics (CHI) research. International Journal of Medical Informatics, 79(6), e89-e96.

Keselman, A., Logan, R., Arnott Smith, C., Leroy, G., & Zeng-Treitler, Q. (2008). Developing informatics tools and strategies for consumer-centered health communication. Journal of the

American Medical Informatics Association, 15(4), 473-483.

Lewis, D. (2007). Evolution of consumer health informatics [Editorial]. CIN: Computers, Informatics, Nursing, 25(6), 316.

Misra, R., Mark, J. H., Khan, S., & Kukafka, R. (2010). Using design principles to foster understanding of complex health concepts in consumer informatics tools. AMIA 2010 Symposium Proceedings, 492-496.

Pak, R., Price, M. M., & Thatcher, J. (2009). Age-sensitive design of online health information: Comparative usability study. Journal of Medical Internet Research, 11(4), e45.

Powell, J., Inglis, N., Ronnie, J., & Large, S. (2011). The characteristics and motivations of online health information seekers: Cross-sectional survey and qualitative interview study. Journal of Medical Internet Research, 13(1), e20.

Websites:

Health on the Net Foundation. (2011). Retrieved from http://www.hon.ch/

The PEW Charitable Trusts. (2011). Health. Retrieved from http://www.pewtrusts.org/our_work_category.aspx?id=184

Robert Wood Johnson Foundation. (2011). Publications and research. Retrieved from http://www.rwjf.org/en/research-publications.html

TOPIC: CONSUMER HEALTH INFORMATION

Post a cohesive response that addresses the following:

1. Synthesize your previous experiences with consumer health literacy in your practice setting.

2. Formulate strategies that you could use to assist patients in interpreting and applying online health information going forward.

3. Include strategies for those patients that overuse medical websites or regularly misinterpret medical information found online.


I WANT researchpro KELVIN to WRITE the PAPER. THX