Module 6

What did you like or dislike about taking an online course?

Online courses are convenient and I enjoyed being able to do the course work at my own pace. The problem I have with online course work is that I'm more of an auditory learner and I have an easier time remembering things if I've heard them rather then read them. The use of activities in this course have help to mediate this perference.

What topic did you learn the most about and what was your favority topic?

I learned the most from Module 2, Information Retreival and also enojoyed this the most. This module enhanced my ability perform literature search with data basis. As a graduate student and in clinical practice the ability to locate appropitate and informative information is vital and an every day occurance. The skills I learned from Module 2 helped me to do this faster and more efficiently.

If you were the instructor, and this being the first course for all DNP and Master student, what would you fo the same or different?

I'm not sure what I would do differently. My least favorite assignment was the paper evaluating the computer clinical decision support system. I'm not sure that a paper is the best means of learning about CDSS; there wasn't a lot of literature on the CDSS that choice to evaluate and that was frusterating. I do think that CDSS are an important tool, especially in EBP, so I do think that it valuable to learn about them. Maybe a matrix comparing different CDSSs would be a better reenforcement activity.

Module 5

Visit the U.S. Department of Health & Human Services Agency for Healthcare Research and Quality at http://www.ahrq.gov/.What, if any relationship do you see between the information available on this webpage and regulatory, accreditation, and reimbursement issues and healthcare information system use and design?

This website contains a lot of information and links that make it a little overwhelming to a first time user. Information about regulatory issues was not easy to locate at first glance. There is information on quality indicators and patient safety measures that could be utilized by regulatory and accreditation bodies like The Joint Commission, National Committee for Quality Assurance, and American Medical Accreditation Program. The reports that are generated by the Agency for Healthcare Research and Quality (AHRQ) about National Healthcare Quality could be used by legislative bodies in making decisions about healthcare legislation and public policy. AHRQ creates yearly reports on healthcare quality national and by state that the public or healthcare entities have access to via their website.

Reimbursement issues, specifically pay for performance, can be impacted by the information contained on the AHRQ website. They compile research and create reports on evidence based practice on a variety of topics that healthcare professionals can access and apply to practice, with the goal of increasing performance and subsequently pay. This seems an important means of furthering evidence based practice because the site is free and readily available. There is also a link to the National Guideline Clearinghouse, which contains guidelines for caring for patients with a many different healthcare issues. The National Guideline Clearinghouse provides a means of comparing guidelines from different organizations side by side.

The AHRQ website has a large about of useful information on use of technology in healthcare information. If as a healthcare provider I was interested in integrating a new technology related to healthcare information into my practice I would utilize this site. There is information about liability issues, which is important to most healthcare providers. They worry about malpractice suits, insurance, and other liability issues as well as providing the best care to their clients. The AHRQ also created a report on clinical decision support systems, which would be beneficial prior to investing in such a system.

 

Ethical considerations about this website may include issues related to were AHRQ gets the information for their reports. While it is beneficial for the healthcare community and patients to have these reports on healthcare quality, the patients who provide the information aren't usually aware that it is being used in such a way. Because currently healthcare entities own patient data, if they remove patient identifiers, they can share this information with other healthcare organization including AHRQ (Hebda & Czar, 2009). Maybe we should be informing patients of this, or maybe current legislation is appropriate because the data can't be connected to the original patient due to lack of identifiers.   

Hebda, T., Czar, P. (2009).  Handbook of Informatics for Nurses & Healthcare Professionals (4th ed).  Upper SAddle River, NJ:  Pearson-Prentice Hall

Module 4 Question 2

How does nursing data quality relate to decision support?

Quality data is an important aspect of decision support in that if you aren't able to trust that the information provided by the decision support system is accurate and reliable then you aren't going to utilize it. Hebda and Czar (2009) state that "data integrity is one of the most important issues related to computing and information handling in healthcare because treatment decision are based on information derived from data" (p 79). With all of the information available via the internet and other sources it is important to be able to determine the integrity of the information before making a decision based on it. Hebda and Czar (2009) also point out that poor quality data can result in harm to patients. For this reason it is important to have measures and checks in place that help maintain data integrity and quality (Hebda & Czar, 2009). 

Hebda, T., & Czar, P. (2009). Handbook of Informatics for Nurses and Healthcare Professionals (4th Edition ed.). Upper Saddle River, New Jersey: Pearson.

Module 4 Question 1

How did the readings influence your perception of your own clinical decision-making?  How do we reconcile the value of nursing experience with known heuristics and biases used in human decision making?

The readings help me reflect on how I make decisions in make clinical practice. I would like to believe that all my decision are based on EBP and the lowest cost and greatest benefit. But I wonder how often I am guilty of the three common heuristics and biases in clinical decision-making that Thompson (2003) discusses: a) overconfidence, b) hindsight, and c) base rate neglect. While nursing experience is valuable it is important for those making clinical decisions to realize that there is a potential for heuristics and biases. This potential needs to be weighted against the value of nursing experience. Nursing experience can provide confidence but this need to be tempered by "adjusting your own personal confidence estimates downwards" (Thompson, 2003, p 233). The bias of hindsight can be combated by attempting to ignore hindsight and focusing on alternative possibilities (Thompson, 2003). Finally, effects of base rate neglect bias can be mediated by learning about base rates and using them in decision-making process (Thompson, 2003). It seems that clinical decision support systems would be one methods of helping to reduce biases. "Decision support system aid in and strengthen the selection of viable options using the information of an organization or a field to facilitate decision making and overall efficiency" (Hebda & Czar, 2009, p 158).

Hebda, T., & Czar, P. (2009). Handbook of Informatics for Nurses and Healthcare Professionals (4th Edition ed.). Upper Saddle River, New Jersey: Pearson.

Thompson, C. (2003). Clinical experience as evidence in evidence-based practice. Journal of Advanced Nursing, 43(3), 230-7.