Key ways technology changes healthcare

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Patient safety is a subset of healthcare and is defined as the avoidance, prevention, and amelioration of adverse outcomes or injuries stemming from the processes of health care. Health information technology includes various technologies that span from simple charting, to more advanced decision support and integration with medical technology.

Health information technology presents numerous opportunities for improving and transforming healthcare which includes; reducing human errors, improving clinical outcomes, facilitating care coordination, improving practice efficiencies, and tracking data over time.

Since the original IOM report was published, there has been an accelerated development and adoption of health information technology with varying degrees of evidence about the impact of health information technology on patient safety. This review is intended to summarize the current available scientific evidence on the impact of different health information technologies on improving patient safety outcomes. This review might be useful for clinicians and healthcare policy makers when making evidence based decisions on procurement and implementation of such technology to improve patient safety.

Our primary outcomes of interest were patient safety, medical errors, adverse events, medication errors, adverse drug events, and mortality. The priority was given to systematic reviews, meta-analysis and randomized clinical trials.

If such studies were not identified then other types of experimental studies or epidemiological study designs including; non-randomized controlled trials, quasi-experimental, before and after studies, prospective and retrospective cohort studies and case control studies.

Studies were excluded if they met any of the following criteria: high risk of bias, studies that were conducted in non-clinical settings, cointerventions with non-health information technology interventions, not evaluating patient safety outcomes, qualitative or narrative studies. The search strategy was conducted to find both published and unpublished studies.

The search strategy included Medline, Embase, Cochrane Database. Studies published until January were considered for inclusion in this review. Studies were assessed for methodological validity and risk of bias using the Cochrane methodology prior to inclusion in the review. Computerized physician order entry entails the use of electronic or computer support to enter physician orders including medication orders using a computer or mobile device platform.

Computerized physician order entry systems are usually integrated with a clinical decision support system CDS , which acts as an error prevention tool through guiding the prescriber on the preferred drug doses, route, and frequency of administration. In addition, some CPOE systems may have the feature of prompting the prescriber to any patient allergies, drug-drug or drug-lab interactions or with sophisticated systems it might prompt the prescriber towards interventions that should be prescribed based on clinical guideline recommendation example venous thromboembolism prophylaxis.

A metaanalysis 6 evaluating the effectiveness of CPOE to reduce medication errors and adverse drug events in hospitals found that the implementation of a COPE with clinical decision support resulted in significant reduction in medication errors RR Similarly, studies conducted in community based outpatient services showed comparable results in reducing medication errors.

However, the use of hard-stops resulted in clinically important treatment delays. Studies that have evaluated the use of a basic CPOE system without a clinical decision support system showed that it did not improve overall patient safety or reduce medication errors.

Clinical decision support provides the health care professional with information and patient-specific information. This information is intended to enhance the decision of the healthcare provider and is rationally filtered and presented to the healthcare professional at appropriate times.

Clinical decision support includes a range of tools to enhance decision-making and the clinical workflow. These tools include notifications, alerts and reminders to care providers and patients, clinical guidelines, condition-specific order sets, patient specific clinical summaries, documentation templates, investigation and diagnostic support, among other tools.

Physicians tend to frequently ignore alerts from clinical decision support systems. A meta-analysis studied reasons for why some CDS systems succeed and improve patient outcomes and why others do not, and concluded that CDS systems which provided simple advice were less likely to succeed, while the odds of success were greater for CDS systems that demanded the healthcare provider to justify the reason when over-riding CDS advise.

The odds of success were also better for CDS systems that provided advice simultaneously to patients and practitioners. In addition, CDS systems that were evaluated by their developer rather than third party developers were more likely to be successful. Two systematic reviews 19 , 20 evaluating outcomes of electronic tools supporting physician shift-to-shift handoffs concluded that most studies supported using an electronic tool with an improvement in the process of handover, fewer omissions of critical patient information and reduced handover time when using the electronic tool with few low-quality studies assessing patient outcome measures.

The authors in both reviews also noted that a significant number of the included studies were not well designed and further evaluation using rigorous study designs is needed. Bar code medication administration systems are electronic systems that integrate electronic medication administration records with bar code technology. These systems are intended to prevent medication error by ensuring that the right patient receives the right medication at the right time.

Furthermore, there are varying levels of sophistication among existing barcode systems. For example, some software produces alerts when sound-alike or look-alike medications may be confused.

Others provide clinical advisories for specific medications when scanned, and others may assist with documentation namely, recording drug administration in the eMAR and other relevant clinical details. Our literature search did not find any randomized controlled clinical trials on the use of barcode medication administration or closed loop medication administration.

The highest level of clinical evidence on this technology is based on observational or quasi-experimental studies. However, the systematic review did not elaborate on whether the included studies were evaluated for the quality of their methodology. The review also noted that there is a limited data on the use of barcode technology on pediatric and outpatient setting as most studies have been conducted in an inpatient adult setting.

However, this result should be interpreted with caution as studies involved in the meta-analysis had a high degree of heterogeneity. Although BCMA automates and improves documentation of medication administration, there is a moderate to weak clinical evidence on its efficacy in reducing medication errors.

Further robust studies are needed to make a conclusion. Healthcare organizations also need to consider the impact of implementing BCMA on their workflows. Smart pumps are intravenous infusion pumps that are equipped with medication error-prevention software.

This software alerts the operator when the infusion setting is set outside of pre-configured safety limits. The authors had explained that this was likely in part due to poor compliance of healthcare providers to infusion practices. A systematic review of quasi-experimental studies 25 concluded that smart pumps may reduce programing errors but they do not eliminate such errors. The review also found that hard limits were more effective than soft limits in preventing medication errors. This was explained by the high override rate of soft limits.

Automated dispensing cabinets ADC are electronic drug cabinets that store medication at the point of care with controlled dispensing and tracking of medication distribution. Automated dispensing cabinets were fist used in hospitals in the s, but have evolved over time to include more sophisticated software and digital interfaces to synthesize high-risk steps in the medication dispensing process. Automated medication dispensing cabinets have been successfully used as a medication inventory management tool that help in automating the medication dispensing process by minimizing the workload on the central pharmacy and keeping better track of medication dispensing and patient billing.

Detailed analysis revealed that most reduced errors were preparation errors. The automated dispensing system did not reduce errors causing harm. Automated dispensing cabinets seem to reduce medication preparation errors in critical care setting. Although the level of evidence is high, it is however only limited to critical care setting.

Further controlled studies are needed to make a conclusion on the impact of ADC on medication safety in other settings. There are various technologies that are used to enhance the prevention of retained surgical items which include: bar coding and radiofrequency RFID tagging of surgical items. A systematic review 27 identified 3 studies that evaluated technologies preventing retained surgical items. One study was a randomized control trial on the use of barcode assisted sponge count technology which found that there was no difference between the intervention group and the control group, but the time to conduct the count was significantly longer in the intervention.

Another study evaluated the RFID tagging of surgical items and found statistically insignificant results. Currently, there is insufficient clinical evidence to recommend for or against the use of such technology.

The use of such technologies must not be considered as a stand-alone procedure and must be supplementary to manual counts due to many reasons which include cost, confusion with older non-tagged devices, and wand technique with RF and RFID systems. A patient portal is a secure online application that provides patients access to their personal health information and 2-way electronic communication with their care provider using a computer or a mobile device.

However, there is no evidence that they improve patient safety outcomes. Telemedicine is defined as the use of telecommunication technologies to facilitate patient to provider or provider to provider communication. Communication maybe synchronous with real-time 2-way video communication or asynchronous transmission of patient clinical information.

In addition to communication, telemedicine may provide health information that is collected remotely from medical devices or personal mobile devices. This information may be used to monitor patients, track or change their behavior. Numerous systematic reviews 34 - 37 have studied the impact of virtual visits on patient outcomes in critical care, chronic disease care, and psychiatric care.

All have showed that telemedicine is as effective as face to face care with regard to specific clinical outcomes but there is limited evidence regarding patient safety outcomes. This technology facilitates guidance from the specialist regarding the management of the patient without the need for referring the patient. There is limited evidence about the efficacy and safety of e-consults, but studies have shown that e-consults may reduce patient wait times for specialist appointments and opinions.

Studies evaluating community based Remote patient monitoring telemonitoring 40 - 44 have shown that it improves patient outcomes for certain chronic conditions including; heart failure, stroke, COPD, asthma and hypertension.

Patient data management system PDMS are systems that automatically retrieve data from bedside medical equipment namely patient monitor, ventilator, intravenous pump, and so forth. The data is subsequently summarized and restructured to aid healthcare providers in interpreting the data. A systematic review 45 studied the clinical impact of PDMS and found that such systems increased the time spent on direct patient care by reducing the time spent on charting. In addition, PDMS systems reduced the occurrence of errors medication errors, ventilator incidents, intravenous incidents, and other incidents.

The review also found that 2 articles reported an improvement in clinical outcomes when a PDMS was integrated with a clinical decision support system. Research shows that telemedicine technology seems to improve clinical outcomes for certain medical conditions and, seems to enhance accessibility to healthcare services and foster patient-physician collaboration. Apart from the limited evidence on PDMS, the impact of telemedicine on patient safety does not seem to be very clear.

Electronic incident reporting systems are web-based systems that allow healthcare providers who are involved in safety events to voluntarily report such incidents. Such systems can be integrated with the electronic health record EHR to enable abstraction of data and automated detection of adverse events through trigger tools. Electronic incident reporting systems potentially have the following advantages; standardize reporting structure, standardize incident action workflow, rapid identification of serious incidents and trigger events, while automating data entry and analysis.

Published research shows that healthcare organizations that have moved to an electronic reporting system have experienced a significant increase in reporting frequency. Numerous studies have considered the outcomes of implementing an electronic medical record on healthcare quality and patient safety, with a majority of studies showing favorable results. Although, some studies demonstrated negative outcomes which continues to evoke dispute.

Campanella et al 48 published perhaps the largest and most recent metaanalysis on the impact of electronic health records on healthcare quality and patient safety, which included 47 studies. The results favored the use of electronic medical records. The meta-analysis did not find any impact on overall mortality. Computerized physician order entry and CDS are probably one of the most beneficial health information technologies for improving patient safety.

Currently, there is insufficient evidence to reach a conclusion on patient safety outcomes for the following health information technologies; electronic sign-out and hand-off tools, smart pumps, bar-code medication administration, retained surgical items detectors, patient portals, telemedicine and electronic incident reporting. It is worth mentioning, that there is evidence that the aforementioned technologies seem to improve healthcare processes and non-safety outcomes Table 1 summarizes the evidence on various HIT technologies on patient safety.

Published studies on health information technology exhibit variation in outcomes between different organizations when using the same technology. This has been attributed in the literature to the operationalization of health information technology within the complex adaptive health care system. Sittig and Singh 49 suggested a conceptual socio-technical model that accounts for key factors which influence the success of health information technology interventions.

The 8 dimensions of their model are human-computer interface, workflow and communication, clinical content, internal organizational policies, people, hardware and software, external factors and system measurement and monitoring. The authors of this review recommend a comprehensive framework for organizations looking to improve patient safety outcomes when using health information technology which includes the following:.

Health Information Governance. Organizations must establish a health information oversight mechanism that includes leadership and relevant stakeholders. Safety Risk Identification. Organizations need to identify areas that health information technology might aid in improving patient safety namely, medication safety, guideline adherence, and so forth. Stake-Holder Involvement: Stakeholders need to be involved in all phases of health information projects from planning and implementation until continuous improvement.

The most important stakeholder must be the system end-user and process owner. Informed Decision: Organizations need to review the cost effectiveness of suggested technologies, which includes conducting an evidence based decision and an evaluation of the current information technology infrastructure including software and hardware.

Sufficient Training: Organizations need to ensure that all relevant line staff receive sufficient training on the use of the proposed health information technology. It allows for faster record keeping, and helps patients and nurses maintain consistent monitoring of health. Electronic Health Records allow nursing experts to document care provided to patients and retrieve information that can help prioritize care. Additionally, information entered into computer systems can then be accessed by the care team, including doctors and even patients themselves when necessary.

While security continues to be a concern for Electronic Health Records, HIPAA laws ensure security and privacy of electronic records are maintained by healthcare organizations, and new technology like blockchain and cryptography are easing privacy concerns. EHRs can tell registered nurses RNs whether there are further steps they need to take for a patient, monitor small condition changes, and give them information immediately as alerts or reminders.

Real-time health updates impact the speed and accuracy of medical care. RNs learn how to use software systems on the job, but their education and training will help them quickly understand what different indications on medical records mean and what their course of action should be to ensure improved patient outcomes.

One of the newest ideas for hospitals, centralized command centers promise improved patient experiences and better ways for RNs and doctors to manage supplies, clinical technology, and capacity. This is done through software applications such as dashboards that provide real-time updates. With shorter or non-existent delays between transitions of care, nurses and doctors can actively be aware of room availability, OR schedules, and what individual patients still need before being discharged.

This allows everyone to do their job more efficiently and help patients more effectively. Specifically designed for capacity management, command centers are performing well around the country.

Many hospitals report operating at higher capacity with overall improved patient experiences. Telehealth is a valuable, newer element in healthcare. Hospitals and clinics allow patients to virtually video chat with a doctor or nurse to describe their symptoms or show doctors things like rashes or bumps. This helps patients with a quick diagnosis without leaving the comfort of their own home. They can find out if they need to come in for further testing or diagnosis, get a prescription for medicine, or get medical advice.

Telehealth saves both patients and doctors money and time. Similarly, it prevents sick patients from coming to public places and exposing other patients. This technology is changing the way clinics operate and how patients are cared for. Similarly, medical apps and wearables help patients and doctors work to improve health. Doctors and nurses can monitor vital signs of patients without them being in the office.

They can be utilized for overall health and wellness, or for specific medical concerns such as seizures or diabetes. Apps can also help patients understand when they should call a doctor and when a simple over-the-counter medication could help. This again conserves resources in clinics and helps patients save time and frustration. Apps can also help address mental health issues. Mindfulness apps help individuals understand their mental health and energy and remind them to take time for these important aspects of wellness.

Increasing app and telehealth technology gives doctors, nurses, and patients themselves more control over their health. New clinical healthcare technology is exciting and transformative, with innovations launching every day that impact the industry.

This can present a challenge to nurses who are tasked with learning about this new technology and implementing it into their work lives—not to mention, how this can impact their career advancement. Education is key to navigating these new waters.

Not only can furthering your education help you become more comfortable in managing the technological needs of the advancing healthcare industry, but you can also learn to prepare yourself for future advancements and innovations that may impact your role as a nurse. As the healthcare industry continues to change with the support of new technology, nurses can change right along with it—and elevate patient care in the process. Our focus on your success starts with our focus on four high-demand fields: K—12 teaching and education, nursing and healthcare, information technology, and business.

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View all degrees. By submitting you will receive emails from WGU and can opt-out at any time. We're emailing you the app fee waiver code and other information about getting your degree from WGU. Ready to apply now? March 1, So, what nursing technologies are being used? Learn how vital public health nurses are in healthcare and how you can become one. Read more. Take closer look at the wide range of tasks and responsibilities healthcare careers involve.

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Time Traveler. See more words from the same century. Phrases Containing key. Dictionary Entries Near key. Cite this Entry. Copy Citation. Post the Definition of key to Facebook Facebook. Share the Definition of key on Twitter Twitter. Kids Definition. Legal Definition. Biographical Definition. Key 1 of 2 biographical name 1. Key 2 of 2 biographical name 2. More from Merriam-Webster on key. Love words? Need even more definitions? Word of the Day. Get Word of the Day daily email!

Test Your Vocabulary. You know what it looks like… but what is it called? Can you make 12 words with 7 letters? One L or two? When Were Words First Used? Look up any year to find out. Ask the Editors Literally How to use a word that literally drives some pe A notched and grooved, usually metal implement that is turned to open or close a lock.

A similar implement or an electronic device used for opening, winding, or starting something: the key of a wind-up alarm clock; the new car's electronic key. A device, such as a wedge or pin, inserted to lock together mechanical or structural parts. A determining factor in accomplishing or achieving something: One key to the store's success has been consistent customer service.

Something that provides access to or understanding of something else: The key to the mystery was a drug store receipt. A table, gloss, or cipher containing correspondences, as for decoding or interpreting something. Computers A number used by a cryptographic algorithm to encrypt or decrypt data. A button or lever that is depressed to operate a machine. A button that is depressed to cause a corresponding character or function to be typed or executed by a typewriter or to be accepted as input by a computer.

Music A button or lever that is depressed with the finger to produce or modulate the sound of an instrument, such as a clarinet or piano. Music a. A tonal system consisting of seven tones in fixed relationship to a tonic, having a characteristic key signature and being the structural foundation of the bulk of Western music; tonality. The principal tonality of a work: an etude in the key of E. A characteristic tone or level of intensity, as of a speech or sales campaign.

Often used in combination: high-key; low-key. An outline of the distinguishing characteristics of a group of organisms, used as a guide in taxonomic identification.

Basketball An area at each end of the court between the baseline and the foul line and including the jump-ball circle at the foul line: a jump shot from the top of the key. The act of replacing portions of a video or photograph containing a preselected color with material from a separate image, as by chroma key.

Of crucial importance; significant: key decisions; the key element of the thesis. To be the determining or crucial factor in: a double that keyed a three-run rally in the fifth inning.

To bring into harmony; adjust or adapt: "achievement tests that are more clearly keyed to what students are held responsible for in high school" New York Times. To cause to pay attention to: school officials who were keyed into the dietary needs of students. To supply with a key of correspondences or with corresponding references: keyed the pages in the edited book to illustrations in the manuscript. To operate a device , as for typesetting, by means of a keyboard.

To vandalize or mar by scratching with a key: Vandals keyed the cars left in the parking garage. To pay close attention; focus: improved service by keying on customer complaints; keyed into the main points of the lecture.

Sports To watch or cover an opposing player closely in an effort to limit the player's effectiveness. Used with on: " [She] still carries the burden of scoring To replace portions of a video or photograph containing a preselected color with material from a separate image, as by chroma key.

All rights reserved. Mechanical Engineering a metal instrument, usually of a specifically contoured shape, that is made to fit a lock and, when rotated, operates the lock's mechanism. Mechanical Engineering any instrument that is rotated to operate a valve, clock winding mechanism, etc.

Mechanical Engineering a small metal peg or wedge inserted into keyways. Mechanical Engineering any of a set of levers operating a typewriter, computer, etc. Instruments any of the visible parts of the lever mechanism of a musical keyboard instrument that when depressed set in motion the action that causes the instrument to sound.

Classical Music a. Also called: tonality any of the 24 major and minor diatonic scales considered as a corpus of notes upon which a piece of music draws for its tonal framework. Also called: key move the correct initial move in the solution of a set problem.

Biology biology a systematic list of taxonomic characteristics, used to identify animals or plants. Photography photog painting the dominant tonal value and colour intensity of a picture.

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