Information Technology:

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Information Technology:

Developing Tools for a Respiratory Care

Department

Christopher Teegardin RRT

Christopher Teegardin RRT Harborview Medical Center

Harborview Medical Center

Seattle, WA

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IT

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What is Information Technology?

Information technology

Information technology ((ITIT) is "the study, design, ) is "the study, design, development, implementation, support or

development, implementation, support or

management of computer

management of computer--based based information systemsinformation systems, , systems

systems, particularly software applications and , particularly software applications and computer hardware.

computer hardware.““

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What is Information Technology?

IT deals with the use of electronic

IT deals with the use of electronic computers computers and and computer software

computer software to to convertconvert, , storestore, , protectprotect, , process process, , process

process, , transmittransmit, and , and securely securely retrieve retrieve information information information

information

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What is Information Technology?

-- Operating systems_{Operating systems}

-- Spreadsheet applications_{Spreadsheet applications}

-- Database management systems_{Database management systems}

-- Presentation software_{Presentation software}

-- Email programsEmail programs

-- Web site development applications_{Web site development applications}

-- Content management systems (CMS)Content management systems (CMS)

-- Bulletin Board systems (BBS)Bulletin Board systems (BBS)

-- Audio and video equipment_{Audio and video equipment}

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What is Information Science?

Information science

Information science is an is an interdisciplinary interdisciplinary science science primarily concerned with the collection,

primarily concerned with the collection,

classification

classification, manipulation, storage, , manipulation, storage, retrieval retrieval and and and dissemination of

and dissemination of informationinformation

.

_.

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–

What information do we need?

–

How do we collect that information?

–

How do we organize that information?

–

How do we use that information?

–

How do we interpret that information?

–

How do we improve the way we do all of

these?

What is Information Science?

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Information Science and Informatics

Informatics is:

–

– information and knowledge specific to a field of information and knowledge specific to a field of expertise.

expertise.

–

– The management and processing of data linked The management and processing of data linked

directly to the concepts and theories that most impact

that field of expertise.

–

– The APPLICATION of information science and The APPLICATION of information science and

computer science to the management and processing

of data.

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What about Respiratory Care Informatics?

–

– Respiratory Care Informatics is not yet recognized as Respiratory Care Informatics is not yet recognized as an established discipline with a specialized focus.

an established discipline with a specialized focus.

–

– Little has been done by the respiratory care Little has been done by the respiratory care

community to integrate informatics as a discipline

within the respiratory care profession.

-- Constance C Mussa MSc RRT and Yedidyah Langsam PhD - Management and Processing of Respiratory Care Information in Respiratory Care Departments, RESPIRATORY CARE •

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Computer

Computer--aided instruction, problemaided instruction, problem--based learning, and based learning, and learning, and evidence

learning, and evidence--based practice demands that based practice demands that that health care professionals exercise increasingly

that health care professionals exercise increasingly

sophisticated information management skills.

-- Constance C Mussa MSc RRT and Yedidyah Langsam PhD -- Management and Processing of Respiratory Care Information in Respiratory Care Departments, RESPIRATORY CARE • JUNE 2007 VOL 52 NO 6

... so, why is all this important?

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•

• Staff management

_{Staff management}

•

• Patient management

_{Patient management}

•

• Department

_Department

’

_’

s mission

_{s mission}

Respiratory Care Informatics

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•

• Staff management_{Staff management} •

• Procedures and PoliciesProcedures and Policies •

• Work scheduleWork schedule •

• Shift assignmentsShift assignments •

• Work acuityWork acuity •

• Staff communicationStaff communication •

• Payroll Payroll •

• Staff educationStaff education •

• Staff evaluationStaff evaluation •

• Recruitment and retentionRecruitment and retention

Respiratory Care Informatics

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•

• Patient management

_{Patient management}

•

• Procedures and Policies

Procedures and Policies

•

• Medical Records

Medical Records

•

• Charting

Charting

•

• Therapist driven protocols

Therapist driven protocols

clinical decision making

•

• QI (Quality Improvement)

QI (Quality Improvement)

Respiratory Care Informatics

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•

• Department

_Department

’

_’

s mission

_{s mission}

•

• The goals set for your department that don

The goals set for your department that don

’

t fit

into the other two

•

• Ex: Part of our mission statement is community Ex: Part of our mission statement is community outreach

outreach

Respiratory Care Informatics

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•

Procedure Manual

_{Procedure Manual}

•

Shift Trade Request

_{Shift Trade Request}

•

Vacation Request

_{Vacation Request}

•

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Procedure Manual

Issues:

•

• Mandatory that a copy be at each nursing station_{Mandatory that a copy be at each nursing station}

•

• A LOT OF COPIES in big ringed notebooksA LOT OF COPIES in big ringed notebooks

•

• Difficult to update all copies_{Difficult to update all copies}

•

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Schedule Trade Requests

To trade a shift between two employees

Issues:

•

• Form required both employee_{Form required both employee}’_’s signatures_{s signatures}

•

• Required supervisor approvalRequired supervisor approval

•

• Forms misplaced between employees_{Forms misplaced between employees}

•

• Could not be performed in a timely mannerCould not be performed in a timely manner

•

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Schedule Trade Requests

To trade a shift between two employees

Issues:

•

• Form required both employeeForm required both employee’’s signaturess signatures

•

• Required supervisor approval_{Required supervisor approval}

•

• Forms misplaced between employeesForms misplaced between employees

•

• Could not be performed in a timely manner_{Could not be performed in a timely manner}

•

• Supervisor accused of misplacing forms_{Supervisor accused of misplacing forms} •

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Vacation Requests

Issues:

•

• Form required employee_{Form required employee}’_’s signatures_{s signatures}

•

• Required supervisor approvalRequired supervisor approval

•

• Forms were sometimes misplaced _{Forms were sometimes misplaced}

•

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Communication

Issues:

•

• Communication log was sometimes lost_{Communication log was sometimes lost}

•

• Staff did not diligently check their department Staff did not diligently check their department mailbox (or their email)

mailbox (or their email)

•

• Multiple copies of important memos were provided Multiple copies of important memos were provided provided

provided

•

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HTML

--

stands for

_{stands for}

Hyper Text Markup Language

_{Hyper Text Markup Language}

--

predominant

_predominant

markup language

_{markup language}

for

_for

web

_web

pages

. It defines:

-- how a page is structured how a page is structured

-- how and what text and images are displayedhow and what text and images are displayed

-- how parts of the page are labeledhow parts of the page are labeled

-- how additional instruction is embedded in the how additional instruction is embedded in the page

page

http://

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JavaScript

–

– code is embedded into the code is embedded into the HTML HTML source document source document –

– clientclient--side scripting language for web pages side scripting language for web pages

it enables little program snippets to be performed on your

computer by your computer

PHP

-- stands for stands for Hypertext PreprocessorHypertext Preprocessor

-- code is embedded into the code is embedded into the HTML HTML source document source document

-- is a generalis a general--purpose purpose scripting languagescripting language

-- interpreted by a interpreted by a web server web server with a PHP processor with a PHP processor module which generates the

module which generates the web page web page document document

http://

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SQL

–

– Stands for Stands for Structured Query LanguageStructured Query Language –

– the most widely used language for relational the most widely used language for relational databases

databases

–

– Its scope includes data query and update, Its scope includes data query and update, schema schema creation and modification, and data access control.

creation and modification, and data access control. MySQL

MySQL

–

– is a openis a open--source (free) source (free) relational database relational database management system

management system (RDBMS)(RDBMS) –

– Dominant RDBMS used for web applications Dominant RDBMS used for web applications –

– Hosted on a web serverHosted on a web server

http://

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Procedure Manual

Issues:

Issues: •

• Mandatory that a copy be at each nursing stationMandatory that a copy be at each nursing station

•

• A LOT OF COPIES in big ringed notebooksA LOT OF COPIES in big ringed notebooks

•

• Difficult to update all copiesDifficult to update all copies

Solution:

•

• Manual was electronically provided throughout the _{Manual was electronically provided throughout the}

the hospital

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Schedule Trade Requests

To trade a shift between two employees

Solution:

•

• On line request, agree, and approve formsOn line request, agree, and approve forms

•

• Email notifications are sent to employeesEmail notifications are sent to employees

•

• When trade is requestedWhen trade is requested •

• When it is agreed on or turned downWhen it is agreed on or turned down •

• When it is approved (denied) by the supervisorWhen it is approved (denied) by the supervisor

•

• Email notification is sent to the Supervisor only after the tradEmail notification is sent to the Supervisor only after the trade e is agreed on.

is agreed on.

•

• Trade status is provided on the staff pageTrade status is provided on the staff page

•

• Can be performed in a very timely manner, all you need is Can be performed in a very timely manner, all you need is access to a computer and the internet

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Vacation Requests

Solution:

•

• On line request and approve formsOn line request and approve forms

•

• Email notifications are sent to employeesEmail notifications are sent to employees

•

• When vacation request is submittedWhen vacation request is submitted •

• When it is approved (denied) by the supervisorWhen it is approved (denied) by the supervisor

•

• Email notification is sent to the Supervisor Email notification is sent to the Supervisor

•

• When vacation request is submittedWhen vacation request is submitted

•

• Vacation status is provided on the staff pageVacation status is provided on the staff page

•

• Data is readily available to the supervisor and staffData is readily available to the supervisor and staff

•

• Can be performed in a very timely manner, all you need is Can be performed in a very timely manner, all you need is access to a computer and the internet

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Microsoft Access

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Adobe Acrobat

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Communication

Solution:

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• Staff Meeting Minutes were put on the web siteStaff Meeting Minutes were put on the web site

•

• Important email and memos were put on the web site _{Important email and memos were put on the web site}

•

• Personal messages were put on the website_{Personal messages were put on the website} •

• Staff to staff kudosStaff to staff kudos •

• Baby/marriage/get together announcementsBaby/marriage/get together announcements

•

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•

• Staff management

_{Staff management}

•

• Procedures and PoliciesProcedures and Policies

•

• Work schedule

_{Work schedule}

•

Respiratory Care Informatics

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•

Staff management

_{Staff management}

•

• Work scheduleWork schedule

•

• Shift assignments

Shift assignments

•

• Work acuity

Work acuity

•

Respiratory Care Informatics

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•

Staff management

_{Staff management}

•

• Payroll Payroll

•

• Staff education

Staff education

•

Respiratory Care Informatics

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Power Point Presentations

_{Power Point Presentations}

Introduction to new equipment Introduction to new equipment

Review of protocols and proceduresReview of protocols and procedures

General clinical care practicesGeneral clinical care practices

Inservices

_Inservices

Introduction to new equipment Introduction to new equipment

Review of protocols and proceduresReview of protocols and procedures

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•

Staff management

_{Staff management}

•

• Payroll Payroll

•

• Staff education

Staff education

•

• Staff evaluation

Staff evaluation

•

Respiratory Care Informatics

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•

• Patient management

_{Patient management}

•

• Procedures and Policies

Procedures and Policies

•

• Medical Records

Medical Records

•

• Charting

Charting

•

• Therapist driven protocols

Therapist driven protocols

clinical decision making

•

• QI (Quality Improvement)

QI (Quality Improvement)

Respiratory Care Informatics

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--

Electronic medical record (EMR) software

_{Electronic medical record (EMR) software}

Patient Care

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--

Data specific to respiratory care

_{Data specific to respiratory care}

-- General patient dataGeneral patient data

Age, sex, height, etc.

Diagnosis

Medical history

-- Ventilation dataVentilation data

-- Airway dataAirway data

-- Clinical presentationClinical presentation

-- Respiratory care recordRespiratory care record

-- BillingBilling

Respiratory Care (EMR)

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“

These are bags of rectangular

lego

blocks that we need to

create circles with.

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•Quality improvement data collected on BHP patients was inadequate to accurately quantify quantify protocol adherence, effect on patient outcome, or cost-effectiveness of care.

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- Strict adherence to the protocol recommendations was estim ated estimated at 45-55% prior to the initiation of the decision tree

tree flowchart

-Adherence was 67% following the introduction of the decision decision tree flowchart Adherence further increased to 81%

following adjustments to the flowchart questions and the

inclusion of detailed explanations to the decision tree flowchart flowchart

- Adherence is now at 85% (therapists are performing the

recommended care or more than the recommended care 95% of 95% of the time)

-Days on service decreased from 5.1 days to 3.75 days

-ICU transfers related to bronchial hygiene issues remained mostly unchanged (from 5.6% to 5.5%)

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•

• Staff Recruitment

_{Staff Recruitment}

•

• Department

_Department

’

_’

s mission

_{s mission}

•

• The goals set for your department that don

The goals set for your department that don

’

t fit

into the other two

•

• Ex: Part of our mission statement is community _{Ex: Part of our mission statement is community} outreach

outreach

Respiratory Care Informatics

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http://www.range.fairview.org/services/respiratory/ http://www.barnesjewish.org/careers/allied-health/respiratory http://www.mayoclinic.org/careerawareness/ce-resptherapist.ht ml resptherapist.html http://www.overlakehospital.org/programs.aspx?id=512 http://www.regionalhealth.com/Community-Outreach/Professional- Outreach/Professional-Education/Respiratory-Therapy-Program.aspx Program.aspx http://www-respcare.ucsd.edu/index.html http://www.mc.vanderbilt.edu/root/vumc.php?site=resp

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