Karen L. Courtney

Patient-centered applications: use of information technology to promote disease management and wellness. A white paper by the AMIA knowledge in motion working group

Advances in information technology (IT) enable a fundamental redesign of health care processes based on the use and integration of electronic communication at all levels. New communication technologies can support a transition from institution centric to patient-centric applications. This white paper defines key principles and challenges for designers, policy makers, and evaluators of patient-centered technologies for disease management and prevention. It reviews current and emerging trends; highlights challenges related to design, evaluation, reimbursement and usability; and reaches conclusions for next steps that will advance the domain.

Defining Obtrusiveness in Home Telehealth Technologies: A Conceptual Framework

The literature of home telehealth technology recommends that systems be designed to minimize their obtrusiveness to end users. However, this term is neither explicitly defined nor consistently used. This paper presents a definition of the concept of obtrusiveness. Within this definition, twenty-two categories of what may be perceived as obtrusive in home telehealth technology are proposed based on a review of the literature. These categories are grouped into eight dimensions. This effort represents an initial step toward developing measures of obtrusiveness associated with home telehealth technology. A validated and reliable instrument would allow for evaluation of individual applications as well as theory-building across applications.

Information technology: changing nursing processes at the point-of-care.

Changing societal demographics, increasing complexity in healthcare knowledge, and increasing nursing shortages have led healthcare strategists to call for a redesign of the healthcare system. Embedded within most redesign recommendations is the increased use of technology to make nursing practice more efficient. However, information technology (IT) has the potential to go beyond simple efficiency increases. If IT is perceived truly as a part of the redesign of healthcare delivery rather than simply the automation of existing processes, then it can change nursing processes within institutions and furthermore change the point-of-care between nurses and patients. Nursing adoption of technology within the workplace is a result of the interactions between technical skills, social acceptance, and workplace culture. Nursing needs for information not only influence their adoption of particular technologies but also shape their design. The objective of this article is to illustrate how IT can change not only nursing practice and processes but also the point-of-care. A case study of the use of IT by nurses in telehomecare is presented and administrative implications are discussed.

Ethical Considerations for the Utilization of Telehealth Technologies in Home and Hospice Care by the Nursing Profession

Home care, including hospice care, is a growing component of the current healthcare system and pertains to care services that are provided to individuals, their family members, and caregivers in their ownresidence. Both domains face funding limitations as life expectancy and the segment of the population older than 65 years increase. Telehealth, defined as the use of advanced telecommunication technologies to enable communication between patients and healthcare providers separated by geographic distance, is perceived as a concept that can enhance both home and hospice care and address some of the current challenges. This article discusses ethical challenges associated with the utilization of telehealth technologies by the nursing profession in the home setting. These factors form a framework for the ethical considerations that result from the introduction of these technologies in nursing practice. Specifically, the article discusses the issue of privacy and confidentiality of patient data, informed consent, equity of access, promoting dependency versus independence, the lack of human touch and the impact of technology on the nurse-patient relationship, and the medicalization of the home environment. These issues constitute a roadmap both for nursing practitioners who are aiming to provide an efficient delivery of services in the home and for nursing administrators who are asked to make judgments about the use of telehealth technology as a supplement to traditional care and as a cost-saving tool.

Information technology from novice to expert: implementation implications.

AIMS This paper explores how the Novice-to-Expert Nursing Practice framework can illuminate the challenges of and opportunities in implementing information technology (IT), such as clinical decision support systems (CDSS), in nursing practice. BACKGROUND IT implementation in health care is increasing; however, substantial costs and risks remain associated with these projects. EVALUATION The theoretical framework of Novice-to-Expert Nursing Practice was applied to current design and implementation literature for CDSS. KEY ISSUES Organizational policies and CDSS design affect implementation and user adoption. CONCLUSIONS Nursing CDSS can improve the overall quality of care when designed for the appropriate end-user group and based on a knowledge base reflecting nursing expertise. IMPLICATIONS FOR NURSING MANAGEMENT Nurse administrators can positively influence CDSS function and end-user acceptance by participating in and facilitating staff nurse involvement in IT design, planning and implementation. Specific steps for nurse administrators and managers are included in this paper.

Assessing the Nature and Process of Hospice Interdisciplinary Team Meetings

In response to federal law, which requires hospices to provide end-of-life care in an interdisciplinary team format, most hospices conduct team meetings to coordinate holistic plans of care for patients. The goal of this study was to uncover the structural characteristics of hospice interdisciplinary team meetings and learn more about common practices among hospice organizations. A total of 191 hospice agencies participated in a semi-structured phone survey regarding interdisciplinary team practices. The study found that not all hospices are fulfilling federally regulated requirements. Although the average hospice interdisciplinary team meeting is held once a week, lasts 1 to 2 hours, and consists of 10 to 20 people, this study reveals variation within the number and types of disciplines participating in interdisciplinary team meetings. Suggestions for future action are provided.

Visualizing nursing workforce distribution: Policy evaluation using geographic information systems

Health services literature suggests that geographic information systems (GIS) are useful policy evaluation tools when policy success is dependent on location. Nursing workforce distribution is an inherently local issue and nursing shortages present serious concerns for local, state and national governments. In 1991, Missouri enacted a nurse recruitment and retention policy targeting underserved (HPSA-designated) counties. Following Institutional Review Board approval, policy effectiveness was explored using a combination of GIS data visualization, spatial and classic statistics. Results of both data visualization and statistical methods do not demonstrate an expected trend of decreasing group differences between HPSA and non-HPSA-designated counties over time. Only two of the five time periods studied had significant group differences. Between 1993 and 1995, the loss in nurse to population ratios in HPSA counties was significant (U=1020, p<0.001); however, between 1999 and 2001, the growth in nurse to population ratio changes in HPSA counties was significant (U=1032, p=0.001). The GIS data visualization and statistical techniques performed suggest that current policy definitions of underserved areas may not be effective in defining areas of nursing shortages and the existing policy implementation may not be achieving the stated goals.

Telehospice Tools for Caregivers: A Pilot Study

Abstract This pilot study introduces videophones into the homes of elderly caregivers of dying patients, evaluating their usefulness as a communication tool. A total of 12 senior caregivers from two hospice agencies were recruited into the study. Portable videophones were installed allowing caregivers to conduct video-calls with hospice staff. Findings indicate that the anxiety scores significantly decreased (p < 0.05) for participants over time. Differences in quality-of-life scores (including individual dimensions as well as overall score) were not statistically significant. Staff members at one of the participating hospice agencies were originally reluctant to recruit caregivers to the study. Videophones were perceived as easy to use by caregivers who overall saw benefit in the visual feedback during their communication with hospice staff.

Designing and Evaluating Quality of Life Technologies: An Interdisciplinary Approach

Developing quality of life technologies (QoLT) poses unique challenges to engineers and computer scientists. This paper provides a roadmap for design, development, and evaluation. We begin with a definition of quality of life and identify key attributes of QoLT. This is followed by a discussion of methods for identifying target populations and needs. Next, we describe the process of user-centered iterative design and development and conclude with evaluation strategies to assess the impact of QoLT. A central theme of the paper is that successful technology development in this arena is highly dependent on collaborative interdisciplinary teams involving social scientists, clinicians, engineers, and computer scientists.

DEVELOPMENT AND USE OF A TOOL TO GUIDE JUNIOR FACULTY IN THEIR PROGRESSION TOWARD PROMOTION AND TENURE

Junior faculty have multiple roles and need to participate in a variety of activities that increase their likelihood of achieving promotion and tenure. Yet, these faculty often struggle when deciding how and when to expend effort along their career trajectory. In response to the need for structured guidance when setting priorities and making decisions about time management, faculty from a school of nursing at a research university have developed and begun to use a faculty progression tool. Introduced during orientation, this tool helps junior faculty weigh the relative importance of engaging in specific activities by offering a time frame and suggestions for prioritizing and pacing efforts to accomplish critical milestones. Although primarily aimed at tenure stream faculty in a research-intensive environment, this faculty progression tool serves as a model that may be modified for environments with less focus on research. Likewise, it may provide a foundation for development of a similar tool for nontenure stream faculty.