The missing curriculum.
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Information technology, medical knowledge, and medical practice are on a collision course. The consequences of the impact will change the way physicians work, the way medical knowledge is processed, packaged, and distributed, and the way patients obtain medical care and information. Today's educators need to design an information technology curriculum to prepare students for this emerging world of practice. Computer labs, based on today's complex and unreliable desktop systems, are not the answer. What is needed by students who entered medical school in 1997-98 is an informatics curriculum that is based on the real-world requirements of 2003 and beyond. The authors draw upon academic studies and their own clinical and industry experiences to outline some predictable elements of what lies ahead. Their predictions--ubiquitous, simple network computing and "power tools" for managing medical knowledge--have implications for how schools cover such educational topics as patient confidentiality, systems thinking and error management, and knowledge resource evaluation.
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As the World Wide Web becomes more ubiquitous, physicians are increasingly using the information it provides as part of medical practice. The Web can be a valuable information resource for patient education and decision support or it can be a troubling source of misinformation for providers and patients alike. Attempts have been made to apply quality standards to Web sites, but these have been only moderately successful. Medical schools are designing curricula to confront the content of the medical information explosion, but they also have an obligation to teach students how to quality filter and critically analyze the sources of this information, particularly when it is delivered over the Web. The authors suggest some of the concepts that need to be considered when educating the next generation of what they have termed "information-astute physicians."
Critical care nurses in a large academic, tertiary care trauma center have adapted to a major system change since the implementation of a fully integrated Computerized Provider Order Entry (CPOE) system, an automated process of order entry. Working in a rapidly changing environment, clinicians are accustomed to viewing real-time discrete data and then using that data to provide safe, effective, and efficient intensive care to critically ill patients. This article describes how the implementation of the CPOE system from a major healthcare software vendor has changed the life of critical care nurses and the perceptions of the experience 1 year after the new technology was initiated. Through experience sharing, perhaps others may gain knowledge to ease their transition to CPOE.
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The Internet is a promising new tool for disseminating cancer prevention information. Barriers to full implementation include disparities in access and skill and availability of information relevant at the local level. A nutrition education Web site to promote fruit and vegetable intake is being produced for a tri-ethnic adult population in Colorado and New Mexico. Development is guided by findings from formative research including focus groups with local residents, a survey on computer and Internet use with 200 adults in 1998, an assessment of public access computer sites, and in-depth discussion with local community computer skills trainers.
Sophisticated health care consumers are beginning to use the Internet to educate themselves about their own health and manage their own care. As health care stakeholders (providers, payers, employers) feel pressure from consumers to implement Internet-related strategies, stakeholders must realize that obtaining Internet access is a challenge for many consumers. Stakeholders who expand consumer Internet access will, however, have a competitive advantage. This article outlines how stakeholders can expand consumer Internet access.
Home healthcare nurses work with families that include disabled adults and children. Blind and mobility-impaired clients can learn to use computers to modify their home environment. As a result, the clients' level of disability is decreased. This paper presents a realistic picture of the rewards, problems, and resources associated with the use of a computer as an assistive device.
Part I of this series discussed the many features of the internet and how to access this powerful tool. This article will focus on using the Internet's World Wide Web (WWW) as a home care nursing reference and way to access nursing, health-care, and home care knowledge. This article will also describe a few WWW sites that provide nursing and home care information for the practitioner and informational sites for families and caregivers.
This article examines the positive and negative aspects of working with a documentation and information management system from the unique perspective of a practicing home care nurse who was also a student. Aspects of the nightingale tracker technology that are comparable with others used in home care, experiences of field testing, and the nurse's observations can help home care nurses see how this technology can benefit their practice.
The Internet provides electronic communications and access to information around the globe. In only one decade of public use this format has emerged as the method of rapid access to information, and projections are for continued growth. The WWW consists of over 40,000,000 servers containing billions of pages of information on virtually every conceivable subject. This doesn't include news servers, FTP servers, bulletin boards, and other online information sources. The home healthcare nurse, now and in the future, needs knowledge about and access to this system, to tap into the most current government recommendations about medications and treatment protocols, to access health statistics, consumer information, and additional educational, professional, and client-centered articles and opportunities. We hope this new Home Healthcare Nurse feature, "Staying Connected," will develop into a source of ongoing, up-to-date information to assist you in accessing and utilizing this valuable resource. Next month, we'll provide some specific directions for navigating the information superhighway.
Today's home care clinicians are expected to begin employment with basic computer skills and to learn informatics skills applicable to the position. This article discusses the technology competencies clinical home care staff must master in agencies that use Point of Service (POS) documentation systems. It also shares tips that facilitate new clinicians' orientations to a POS system.
The economics and complexity of health care will continue to require better and faster methods of information access. As a multipurpose resource, physician networks can offer a host of benefits to institutions, caregivers, and patients. Early entrants into this technological arena can expect some degree of competitive advantage by attracting physicians who want sophisticated support systems and by expediting referrals for specialized care. Whether or not this proves to be of long-term merit, the need for administrative and patient care information systems will likely increase in the future. In this respect, innovation is purely a point in time.
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Studies on computers in nursing typically observed nurses' perceptions toward computers. This study examined the computer use of 528 nurses in three urban teaching hospitals, and compared nurse managers' with staff nurses' time spent at the computer and systems frequently used for work accomplishment. Differences were found in their experiences with computerized information systems (CISs) and expectations of CIS use. Although there was striking similarity in the systems used, nurse managers had significantly greater access to computers and technical support. Findings suggest the importance of integrating clinical and managerial tasks if unit work is to be accomplished efficiently and effectively.
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