¶ … Clinical Experience Sunrise Clinical System Version 6.1

The Emergency Room: Hybrid System

Meetings and Collaborative Care Councils

Workflow of the EMR

The KBC ( Knowledge Bas Charting) 3.4 Upgrade 6

The Role of the Nurse Informaticist

Comprehensive Analysis of my Clinical Experience

After completing 100 hours of practicum in informatics, the following will show the time at the site with my preceptor. The practicum took place at Franklin Hospital - North Shore Long Island. North Shore-LIJ which is an award-winning health system that consist of world-class tertiary hospitals, a nationally well-known children's hospital, a notorious mental facility and an assortment of community hospitals, in addition to a range of wellness and health programs. North Shore-LIJ Health System consist of 16 award-winning hospitals and approximately 400 physician practice locations all through New York, as well as Long Island, Manhattan, Queens and Staten Island. North Shore-LIJ Proudly serving an area of seven million people, North Shore-LIJ delivers world-class services designed for every step of your health and wellness journey. North Shore-LIJ Health System also comprises of 14 services and programs including: Bariatric Surgery, Cancer, Cardiovascular Services, Head and Neck, and Home Healthcare. Furthermore, their board-certified bariatric surgeons perform more than 60% of the weight-loss procedures in the region North Shore-LIJ serves -- about 1,300 surgeries every year -- with one of the finest records for long-term reclamation and operative weight loss ( North Shore-LIJ Health System, 2014).

Sunrise Clinical System Version 6.1

At North Shore-LIJ I was able to get familiar with the Sunrise Clinical System Version 6.1. This is an interesting piece of technology for informatics Sunrise Clinicals is an advanced clinical information solution that assimilates patient, emergency and ambulatory care through a sole, enterprise-wide electronic health record. This is a very powerful tool that I was introduced to and I learned that this method is utilized by many of the leading hospitals and health systems all over the world. After observing and working with this tool, it offers clinician-exact workflows that aid in driving adoption of clinical choice support that can lead to outcomes that are improved. I learned that the hospital adopted this tool because they heard that it was very promising and that it is very dependable. It was apparent that this technology be used because the lack of useful, obtainable data on emergency department services all over New York State has been significantly challenging physicians' abilities to develop strategies and plans for meeting the needs of patients who are really depending on the services. From observing it being used over and over, it was easy to understand that there was a strong need for a heightened data collection system for emergency department data.

The Emergency Room: Hybrid System

The ER at the North Shore-LIJ had a hybrid operating system. North Shore-LIJ hybrid operating room is like a surgical theatre that is prepared with radical medical imaging devices for instance fixed C-Arms, MRI scanners and CT scanners. After observing for a while, I was able to learn that these imaging devices allow minimally-invasive surgery that is less shocking for the patient. I learned that minimally invasive was just another way of saying that the surgeon does not need to cut the patient open all the way so as to access the body part he wants to perform surgery on, nonetheless can insert endoscopes or catheters through these little holes. (Seidl, 2012)

Meetings and Collaborative Care Councils

Going to all of the meetings were very informative throughout the practicum. I took a lot of notes and some of the material that actually comes to mind is the mention of Informatics / Big Data and how can we generate knowledge from our data and share it to make decision much better. Another point that was talked about was reducing the cost of care and this just talked about how IT investments & Care Coordination can be utilized in order to decrease the cost of care. Another interesting point at the conference was security / risk management and this went into making sure that the data integrity minimize breaches and also provide some kind of...

The way ACA has been affecting the reimbursements and how we move from volume-based to value-based strategies was another interesting point to mention. It was very informative to learn about Data & the Cloud and how we are able to store & structure data to enable information distribution and interoperability. The conference also hit on other topics such as Patient Engagement and how IT can be used in order to better engage the patients. Mobility was also brought up and they discussed how can we use health and TeleMedicine to make sure care is improved. They introduced the ACOs -- and explored the role IT plays in the move to ACOs and performance-based pay. The last interesting point that the conference hit on was what they called Population Management. Here they explored how IT can play a much better role in informatics.
Workflow of the EMR

North Shore-LIJ utilizes electronic medical records as an instrument to make their businesses flow much better. I was able to observe how they used this technology to basically make their life so much easier. I thought about the old day when everything was done by human hands but the EMR took care of all of that because I was able to observe how the EMR technology functioned as a system that was really efficient for record-keeping and client management. After observing the EMR for weeks, I was able to understand this was a cost-reducing prospective of a digital record system for North Shore-LIJ. One of the things I liked about this technology was that it could manages messages all by itself and I learned that the EMR was to schedules patients and also checks the patients into their rooms and then check them out. North Shore-LIJ also used the EMR to conducts exams on the patients as well as renews medications.

The KBC ( Knowledge Bas Charting) 3.4 Upgrade

I also observed how to use the KBC which is something that fans out from structured notes into flow sheets and works really well while doing it. The technology was not that hard to learn once I was able to understand that for each observation on a flow sheet, I was able to check if I want it to copy-forward, and identify how far back to look for charting on that observation. When I completed this configuration the copy-forward rapidly, or if I wanted to block any copy-forward, I was able to do that at the structured note/flow sheet level, and at the observation level within the structured note.

I understood that a new feature automatically copies earlier charting on stated observations, for instance earlier anesthesia and preceding functional level. A blue book icon shows near this information to show that documents are being referenced. When I would hover on the book, it showed the actual documents that were pulled into the chart. After a while, I learned that this is set up for the KBC Adult Patient Profile and the KBC Adult Social Work Assessment. I observed and later figured out that it is possible to identify if I want this auto-copy forward to take place at the level of observation. This is part of the new standard configuration within the notes that are structured.

The Role of the Nurse Informaticist

For the duration of the semester long practicum, there were numerous opportunities to learn and put on the role. Even though learning prospects were plenteous, there were as well some challenges. There were four main challenges during the application of the role and were recognized and consist of: (1) keeping fixed ideas about what is comprised in the role at bay, (2) having an mistaken perception of the way NISs work with or affect other restraints, (3) being capable of experiencing all features of the role the preceptor is accountable for, and (4) seeing influences the application of the role produced throughout an shortened era of time.

Challenges

To begin with, the vision of how regulatory compliance and quality improvement was comprised in the role of an NIS was uncertain. The vision comprised of looking at the quality improvement role remaining totally separate from the NIS part. As my present role consists of regulatory compliance and quality improvement, the anticipation was to isolate the NIS role from anything that had to do with quality and bring the focus entirely on the informatics role. Rapidly the understanding of how integral the work of an NIS is to improving quality started setting in. The challenge was obvious after going to Pine Rest's facility orientation and hearing footings for instance "mental health code" and "recipient rights." An assumption was made recognizing these positions as related to regulations and rules in behavioral health and led to the study of what the terms meant in addition to their function to the role.

Also, the ANA (2008) standards of professional practice include measuring for, recognizing issues, and being able to know the expected results, but how the standards could…