Technology and Decision-Making Paper

More than ever before, information technology is helping clinicians and health care systems improve the collection and management of data along with the ability to aid in decision–making for clinical and business issues. Information technology has led to significant improvements in quality of care, patient safety, and communication between clinicians. The key to information technology and decision-making is to develop relationships between information technology and the users to make effective decisions.

Systems that support decision-making assist the user’s ability to make short and long-term decisions by providing information to make decisions concerning particular situations. Health care informatics “incorporates theories from information, science, computer science, and cognitive sciences” (Englebardt & Nelson, 2002, p. 5). Health care informatics specialists use theories, and the Data, Information, and Knowledge (DIK) Model to guide their practice, which in turn supports clinical practice and optimizes health care delivery. Systems and Informatics Theories

Theories are useful in several ways. Theories form a reference point for information technology and users. Without theories users would spend time condensing information and data from empirical sources. According to John Holmes, chairperson of the American Medical Association, every informatician “should need to know about information systems theory. You should be able to write a small program in a reasonably modern language, know the key areas of research, clinical vocabularies, decision-support systems, and have grounding in evaluative sciences” (Gardner et al. , 2009, para. 4).

The system theory views a system as separate parts enclosed in a boundary but interacting and working together. Systems are either open or closed (Englebardt & Nelson, 2002). “Closed systems are enclosed in an impermeable boundary and do not interact with the environment” (Englebardt & Nelson, 2002, p. 5). Whereas open systems “are enclosed in semipermeable boundaries and do interact with the environment” (Englebardt & Nelson, 2002, p. 5). An open system takes information from the environment, processes the information, and then returns the output into the environment, which becomes feedback for the system.

Garbage in, garbage out (GIGO) refers to the input-output process of the open system (Englebardt & Nelson, 2002). Quality input is needed to have quality output returned. The three characteristics of an open system are “purpose, function, and structure” (Englebardt & Nelson, 2002, p. 6). A system can have more than one purpose. An example of purpose would be employee communication. Function is the activity the system will carry out to support the purpose of communication. If the employee communication is the purpose then e-mail is the function in which employees communicate.

Once the function is defined then the structure can be determined. Structure can be either hierarchical or a web model. A hierarchical structure is a type of networking architecture that describes the physical arrangement of all of the networks (O’Leary & O’Leary, 2010). The web structure is the interrelationship between different networks. According to Gregor (2006) “To understand information systems, theory is required that links the natural world, the social world, and the artificial world of human construction” (para. 15). The Shannon and Weaver Information-Communication Model is one of many types of information theories.

The concept of the model is the sender originates the message and the encoder converts the message into a code. The message is sent through electronic channels such as sound waves or telephone lines. The decoder converts the message so that the receiver will understand the message. “The communication-information model provides an excellent framework for analyzing the effectiveness and efficiency of information transferred and communicated” (Englebardt & Nelson, 2002, p. 12). Effective communication has three levels. The first is the technical level, asking if the systems hardware and software function effectively.

The second is the semantic level, asking was the message conveyed and understood. The third level measures the effectiveness of the communication, did the meaning of the message produce the desired outcomes from the sender. Health care informatics specialists use theories to guide their practice, the same as nurses use theorists such as Jean Watson to guide theirs. Data, Information, and Knowledge Model The Health Informatics Model (DIK) is a hierarchy with data as the base of the model, establishing information, and the potential to generate knowledge. The DIK model has three parts to its hierarchy: data, nformation, and knowledge.

According to (Georgiou, 2002) “Health informatics involves the spreading and dissemination of knowledge; however, this is only a part, not the equivalent of the complex process of generating knowledge” (128). Health informatics develops initiatives that provide management, clinical decisions, and technical support. Data takes on the character of facts or observations, which initially have little meaning. The information provides context to manage data. The manipulation of data ensures its value. Data must be valid, reliable, possess meaning, and accessible.

Data is like a watch; timely, accurate, and relevant. For information, awareness of how the hierarchy affects the flow and availability of information is pivotal. Knowledge generates through deduction (subtraction), induction (causing), and assessment of data and information, which is subject to scientific debate, trials, and experiments. The knowledge base includes the interrelationship between the data and information. “Knowledge results when data and information is identified and the relationship between the two formalized” (Englebardt & Nelson, 2002, p. 13). Expert Systems Health informatics is “used to understand echnology and the people who interact with the technology” (Englebardt & Nelson, 2006, p. 5).

An Expert System is an open system that responds like a human expert in a given field. The program involves; “decision making, diagnosis, and predictions” (Encyclopedia of Cognitive Science, 2005, p. 1). They are designed on current knowledge from human experts, and clarify a problem by responding to questions posed by the system. The computer system includes imprecise and problematic reasoning with an inference engine that allows the system to follow lines of reasoning and request information to provide the situation information.

An explanation program is included and a language processor that allows the user to converse in natural language (Encyclopedia of Cognitive Science, 2005, p. 1). Expert Systems are also heuristics-based and good for problems that cannot solve themselves with an algorithm. Many health care organizations embrace computer technology to improve the effectiveness and efficiency of daily operations. At the individual level, Expert Systems are essential to accomplish daily task and make decisions. Expert Systems are important to the organization and the individual user.

The impact of Expert Systems has caused fear among workers regarding job losses. This fear can cause resistance to the implementation and difficulty obtaining the advantages of the system. According to Youngohc & Gulmares (1995) “Expert Systems provide five critical success facts: top down corporate support, domain expert selection, support group, tool selection, and project decision” (p. 130). Expert systems provide problem-solving expertise on specific domains improving user and organizational productivity. Health Expert Systems provide correct information for diagnosis and provide immediate medical service.

The system must provide accuracy because it deals with human lives and lives are not replaceable if an error occurs. Decision Aids Decision aids are helpful because it gives the patient the power to decide and make informed decisions about his or her treatment options. Decision aids are tools that can help clinicians share evidence-based information about treatment options with patients in order to increase the likelihood that patients will be informed about research evidence and help them participate in the decision making process (Abadie et al. p. 492).

Physicians can sometimes overwhelm patients with too much information in a short time. Spending five to 10 minutes with the physician is not enough time to make sense of what is being asked of the patient. The patient may not understand the information because of anxiousness or medical terminology he or she has never heard before. Developing decision aids gives the patient time to understand his or her options. Decision aids could be literature in the patient’s primary language, a DVD, or a website. Decision aides improve communications skills between the doctor and patient.

In addition decision aids increase patient confidence in his or her treatment plan as well as decrease the patient’s anxiety level. Decision Support System Some practitioners may not be familiar with conditions that patients have and may need the opinion or wisdom of another practitioner who has the experience and knowledge of that condition. Decision support systems are important in making sure the patient has a suitable treatment plan. “Clinical decision support systems provide clinicians with patient-specific assessments or recommendations to aid clinical decision making” (Dowding et al. 009, p. 1160).

They can be “either paper-based or computerized and are considered to be a way of reducing variation in health care practice, with the assumption that this will reduce the number of adverse events or ‘errors’ that may occur”(Dowding et al. 2009, p. 1160). Decision support systems helps to ensure the patient receives the treatment he or she deserves. Additionally, decision support systems help to save time identifying the problem and more time proactively treating the patient along with a shorter hospital stay. Technology for Patient and Client Management

Technology for patient and client management is revolutionizing the health care system. A new device to monitor the blood flow to the heart for cardiac patients is underway. In Europe, cardiovascular patient can receive an implant into the heart and remotely the doctor views the activity of blood flow to the heart. This device helps many patients avoid unnecessary complications as the doctor could treat a problem sooner than later (Brooks, 2009). Another popular wave of technology in hospital and private medical practices is the patient’s electronic record.

The records from patient visits, assessments, and tests are inputted into a computer file for easy retrieval and updating as necessary. “The MedFlash USB device is a flash drive especially designed to keep health-related information. Images from x-rays, MRIs, CT scans are saved in addition to prescriptions lists, family medical histories, and emergency contact information” (Brooks, 2009, p. 1). Because of technology, patients have shorter stays in the hospital, no delays in treatment, and the hospital saves money. Additionally there is less paper for storage as the patient’s information is inputted electronically.

Analysis of the Impact of Technology on Health Care and Health Status The health care industry is slowly entering the technology world of the 21st century. A large number of surgical procedures are simplified by the advancement of medical technology; patients are recovering at a faster pace with fewer complications. According to Bednar (2004), the average length of stay in hospitals today is half of what it was in the 1980s. A classic example of what technology has brought to health care is how long a patient used to stay in the hospital for procedures such s cataract removal.

A patient was kept in the hospital for at least a week after cataract surgery. Because of new technology, cataract surgery is considered an outpatient procedure that last only about half a hour and the patient is sent home. Bednar (2004) suggest technology has led to improved health care delivery and patient outcomes. With the development of laparoscopic procedures for gallbladder removal or hernia repair, the patient can recover without worrying about large scars on the abdomen.

More patients are surviving complicated procedures because of the advanced medical equipment. Advance imaging equipment has also enable physicians to make a diagnosis without performing invasive procedures. Information Technology Information technology has changed the way health care is delivered. These include electronic prescribing and electronic health records (EHR). Electronic health records or electronic medical records (EMR) have the potential to improve health care delivery. Follen et al. (2007) highlights several benefits of electronic medical records.

EMR gives the provider the ability to deliver care in a timely and orderly manner, facilitate improved documentation, and sharing of the patient’s record with other health care providers. Some EMR systems allow pharmacists to dispense medications and cross check for allergies and possible drug interactions. Follen et al, (2007) also suggests EMR systems save time and money for the individual patient and the entire health care system. The time and money saved is achieved by preventing duplicate testing and the easy access to the patient health records.

Although cost has delayed some small health providers from adopting an EMR system, the reports in the article has shown the investment is worthwhile. Securing health care information is a major concern for all health care providers. As the technology advances, so does the task of keeping the patient’s information private. Technology has also changed the way a patient interacts with his or her health care providers. Technological advancement has made it possible for health care providers to assess and treat patients while improving the quality of care. Conclusion

Technology has created an everlasting impact on all aspects of human life. The introduction of the computer and Internet to health care has made it possible to communicate around the world in an instant. Important health care decisions are made every day with the help of the advancement of communication systems. Because of help from expert systems and decision aids, health care professionals are better equipped to provide individualized care to patients. As health care continues to grow, more emphasis will be directed toward technology and use in health care delivery.

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