Transcript File - Respiratory Therapy Files

Chapter 7
Computer Applications in
Respiratory Care
Copyright © 2013, 2009, 2003, 1999, 1995,
1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
Learning Objectives
• Describe computer applications in clinical
care, education, and research.
• Retrieve evidence-based information.
• Outline steps to maintain security and
confidentiality.
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1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
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Computer Applications
• Relied upon by healthcare team in clinical
care, diagnostics, management, education, &
research
• Hospital information systems
– Support hospitals’ administrative & clinical
missions
– Permit virtual chart review of clinical data at both
central & remote locations
– Allow clinicians access to blood gas reports, chest
radiographs, blood test results, etc… from all parts
of health care system
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1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
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Copyright © 2013, 2009, 2003, 1999, 1995,
1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
4
Computer Applications (cont.)
Copyright © 2013, 2009, 2003, 1999, 1995,
1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
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Computer Applications (cont.)
• Respiratory care management information
systems include:
– Charting & billing
– Assign respiratory care orders
– Manage staff productivity
– Report clinical results
– Execute respiratory care protocols
Copyright © 2013, 2009, 2003, 1999, 1995,
1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
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Computer Applications (cont.)
• Respiratory Care Practitioners
– Must know how to efficiently retrieve electronic
information
• From evidence-based resources
– Implement best practices & improve patient
outcomes
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1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
7
All of the following are functions of a respiratory
care management information system, except?
A.
B.
C.
D.
Charting and billing
Manage staff productivity
Blood gas results
Assign respiratory care orders
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1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
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Applications in Clinical Care
• Mechanical Ventilators—use of microprocessors
–
–
–
–
–
Control flow and pressure for triggering, limiting, & cycling breaths
Equilibrate measured values w/ target values
Control ventilator alarms
Archive history of set & measured values
Aim to enhance patient-ventilator synchrony via automation that is
highly responsive to patient
• Mode examples:
– Proportional assist ventilation
– Neutrally adjusted ventilatory assist
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1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
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Applications in Clinical Care (cont.)
• Automation of patient-driven protocols
– Accurate & consistent documentation of ventilator
settings
– Automated protocols can assist with spontaneous
breathing trials. (e.g., for ventilator weaning &
management of acute respiratory distress
syndrome (ARDS)
– Computerized ventilator charting applications
• Improve quality & consistency of ventilator
charting
• Improve patient outcomes (evidence based)
Copyright © 2013, 2009, 2003, 1999, 1995,
1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
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How does the use of microprocessors benefit the
use of mechanical ventilation ?
A. They equilibrate measured values with target
values
B. They help extubate patients
C. They alarm when the patient is due for a
treatment
D. They can do a timed ventilator check on their
own
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1990, 1982, 1977, 1973, 1969 by Mosby, an
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Applications in Diagnostics
• Hemodynamic Monitoring
– Thermodilution technique used in pulmonary
artery catheters; computers calculate cardiac
output
– Thermistor is linked to computer
– Reads subsequent change in temperature of
solution & deduces amount of blood flow or
cardiac output
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1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
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Applications in Diagnostics (cont.)
• Blood Gas Laboratories
– Computerized blood gas analyzers
– Allow for immediate results
– Computer assisted quality assurance
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1990, 1982, 1977, 1973, 1969 by Mosby, an
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Applications in Diagnostics (cont)
• Pulmonary Function Laboratories

– Computer algorithms aid in interpretation of
pulmonary function tests (PFTs)
– Include spirometry, lung volume, diffusing
capacity, & bronchodilator response
Most cardiopulmonary exercise & metabolic
measurement systems use desktop or notebook
computers
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1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
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Clinical Decision Support
• Information technology Applications
– Assist clinicians w/ preventive measures, diagnosis, & drug dosing
– Useful in preventive care, vaccination & screening reminders,
counseling & adherence to medications
– Response to critical laboratory values
– Evidence-based care
– Clinical practice guidelines
– Chronic disease management
– Communicates recommendations to clinicians via hospital information
systems, email, pagers, mobile phones, or printouts
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1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
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Clinical Decision Support (cont.)
• Decreases unnecessary hospital admissions
– By decreasing inappropriately diagnosed diseases
• Improves respiratory disease care—(e.g. decreased tidal
volume & more consistent monitoring of plateau pressures)
• Improves patient clinical outcomes by determining optimal
drug dosages
–
–
–
–
Faster time to achieve therapeutic drug levels
Reduced toxic drug levels
Decreased adverse drug reactions
Decreased hospital length of stay
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1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
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Clinical decision support has helped decrease
unnecessary hospital admissions for which of the
following inappropriately diagnosed diseases?
A.
B.
C.
D.
CHF
Myocardial infarctions
Cardiac ischemia
Asthma
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1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
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Clinical Decision Support (cont.)
• Telemedicine
– Use of computers & telecommunications to
provide patient care in remote sites
– Access to diagnosis, monitoring, & treatment for
medically underserved who are geographically far
away
– Used in home care, emergency departments, &
intensive care units (ICU)
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1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
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Copyright © 2013, 2009, 2003, 1999, 1995,
1990, 1982, 1977, 1973, 1969 by Mosby, an
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Clinical Decision Support (cont.)
• Treatment of Tobacco Use & Dependence
– “eHealth” applications
– Online, individually tailored treatment
– Support via e-mail, texting, adjunct to quitline counseling

Management of Chronic Respiratory Diseases



7 out 10 deaths in U.S. from chronic disease
As “baby boomers” age, population of 65 or older is
expected to double
Computers & “Ehealth” applications can help provide
cost-effective care of patients with chronic pulmonary
disease
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1990, 1982, 1977, 1973, 1969 by Mosby, an
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Clinical Decision Support (cont.)
• Asthma
– Monitor patient data to tailor plan of care
– Improvement in knowledge, self-management skills, peak flow rates,
adherence to inhaled corticosteroid controller medications
– Fewer symptoms, missed school days, nighttime awakenings,
emergency department visits, hospitalizations; improved level of
control over time
• Chronic Obstructive Pulmonary Disease (COPD)
– Education, self-management, & health care provider feedback
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Clinical Decision Support (cont.)
• Improved outcomes include:
– Earlier identification of deteriorating symptoms
– Better response to exacerbations
– Increased rate of sustained exercise after
pulmonary rehabilitation
– Decreased emergency departments visits &
hospitalizations
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1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
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“E-Health” applications for COPD patients have
facilitated all of the following, except?
A.
B.
C.
D.
education
self-management
feedback from health care providers
assisting with a diagnosis
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Information Retrieval
• Enhances clinical expertise by providing
information
• Vital to development of evidence-based
patient protocols
– Aids in clinical decisions for individual patients
• World Wide Web
– Google Scholar—search engine for scholarly
publications
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1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
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Copyright © 2013, 2009, 2003, 1999, 1995,
1990, 1982, 1977, 1973, 1969 by Mosby, an
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Information Retrieval (cont.)
• PubMed (includes MEDLINE)
– National Library of Medicine’s free search engine
for health information
– Uses Boolean Logic
– Users can combine search words or phrases with
connectors such “AND” or “OR” (narrows or
broadens searches)
Copyright © 2013, 2009, 2003, 1999, 1995,
1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
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Information Retrieval (cont.)
Copyright © 2013, 2009, 2003, 1999, 1995,
1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
28
Information Retrieval (cont.)
Copyright © 2013, 2009, 2003, 1999, 1995,
1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
29
Information Retrieval (cont.)

OVID search engine
– Extensive collection of Web-based resources:
•
•
•
•
–
–
–
–
–
–
Databases
Journals
Books
Searching software
Used by medical libraries & large hospitals
Medical research articles
Practical instructional handouts for patients
Medical Encyclopedia
Videos of various surgical procedures
Online interactive tutorials for users
Copyright © 2013, 2009, 2003, 1999, 1995,
1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
30
All of the following is a valuable aspect of
information retrieval in evidence-based respiratory
care?
A.
B.
C.
D.
Dictates patient interaction
Provides evidenced based patient protocols
Automates clinical decisions for whole groups
Uses cost effective techniques
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1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
31
Applications in Management &
Administration
• Respiratory care managers
– Use computer applications to plan, organize,
direct, evaluate
• Electronic health records
– Patient medical records available across
continuum of care & varying geographic
locations
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1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
32
Applications in Management &
Administration
• Respiratory Care Management Information
Systems
– Organize & assign orders, measure staff
productivity, report clinical results, & execute
respiratory care protocols
– Handheld computers facilitate organization &
assignment of workload, fulfillment of physician
orders, & improve documentation
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1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
33
Applications in Management &
Administration (cont.)
• Benchmarking
– American Association for respiratory Care (AARC)
provides an online benchmarking system
– Managers can compare performance of their
department with that of similar departments
– Valuable for planning, organizing, directing, &
evaluating
– Benchmarked incidence of ventilator associated
pneumonia (VAP) in their hospital to that reported to
the National Nosocomial Infections Surveillance
(NNIS) system
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1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
34
Applications in Management &
Administration (cont.)
Copyright © 2013, 2009, 2003, 1999, 1995,
1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
35
Applications in Management &
Administration (cont.)
• Hospital information system (HIS)
– Form of communication & information
processing.
– Includes networks, computer hardware &
software, & computerized patient records
– Patient billing, reimbursement, &
communication
– Means to report results
• Electronic Health Records
– Improves access to patients’ updated health
informationCopyright
for clinicians
& patients
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1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
36
Applications in Management &
Administration (cont.)
Copyright © 2013, 2009, 2003, 1999, 1995,
1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
37
Applications in Education
• Clinical simulators
– Computerized simulators: powerful learning
aids
– Software for clinical scenarios
– Simulated vital signs & physical examination
(e.g. complex airway management or advanced
life support situations)
– Help develop psychomotor, critical thinking,
decision making, & team building skills
Copyright © 2013, 2009, 2003, 1999, 1995,
1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
38
Applications in Education (cont.)
Copyright © 2013, 2009, 2003, 1999, 1995,
1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
39
Applications in Education (cont.)
Copyright © 2013, 2009, 2003, 1999, 1995,
1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
40
Applications in Education (cont.)
• DataARC—for documenting clinical
educational activities
– Secured, password-protected, Web-based data
management system
– Functions include time clock, daily log for
completed procedures & activities
– Instructors validate competency evaluations
– Includes surveys to accommodate questionnaires
for students, graduates, & clinical affiliates
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1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
41
Applications in Education (cont.)
Copyright © 2013, 2009, 2003, 1999, 1995,
1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
42
Applications in Education (cont.)
• Computerized testing for NBRC credentialing
of Respiratory Care Practitioners
• Distance Education
– Use interactive video networks & internet to
deliver courses
– Improves access to education for students in rural
areas
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1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
43
Applications in Education (cont.)
• Pulmonary Artery Catheter Education Project
(www.paep.org)
– Provides excellent online training in hemodynamic
monitoring
– Includes Web casts w/ audio & slides; pre- & posttesting for each module; case studies for many of
modules
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1990, 1982, 1977, 1973, 1969 by Mosby, an
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Applications in Research
• Data sources
– Data sources for outcomes research (e.g., birth
and death rates in certain populations)
– E.g. National Health & Nutrition Examination
Survey (NHANES)
• Data collection
– Handheld computers
– Web-based surveys
• Statistical tests
– SPSS, SAS, Statistical
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1990, 1982, 1977, 1973, 1969 by Mosby, an
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Applications in Research (cont.)
• Protection of human research subjects
– Research w/ human subjects must have ongoing
approval of institutional review board (IRB)
– Use information technology systems to help
regulate researcher’s compliance w/ regulatory
requirements
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Security & Confidentiality
• Prevention of infiltration by malicious software
– Use of firewalls to filter exchange of information
w/ internet
• Confidentiality
– HIPAA regulations concerning confidentiality are
pertinent to electronic medical records & research
data containing personal health information
– Patient data must be kept in password-protected
files
– Access to patient files should be on a need-toknow basis
– Thumb-print protected security
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1990, 1982, 1977, 1973, 1969 by Mosby, an
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