Chapter 42

Future Directory

Kathleen A. McCornick

Objectives

§ Describe the future vision of nursing informatics in the first decade of the twenty-first century

§ Identify some of the key components of informatics technology (IT)

  § Describe some of the key scientific influences on the informatics future

  § Define the potential of genetics, genomics, and proteomics in healthcare and the need for bioinformatics.

  § Understand some of the core competencies nurses in informatics will need in the future

       Keywords

      § Future hardware and software applications

§ Demographic shifts

§ Infection and chronic diseases

§ Genetics/genomics/proteomics/bioinformatics

Ì The New Twenty-First Century Scenario

The nurse of this decade has much more evidence to point to in the patient’s genes, genomes, and proteomes. The new science is revolutionizing the way we conduct science and the way we will prevent disease and diagnose and treat patients.

Nurses may need environmental, agricultural, and health data combined. Before the medication is even administered to the patient; the possible impact of the drug on the condition and adverse reaction will be known.

Population data will be supported by genetic profiles in groups of patients who do or do not have a population condition. Obviously, those of you who read the scenario in the third edition want to know how close we are to achieving the vision that was described almost 5 years.

Ì A President and a Secretary of Health Decree Acceleration

There is a reason for optimism for a shortened future toward achieving the informatics goals described in this book. Saying modern technology has not caught up with a major aspect of healthcare and we have got to change that, the President set a10 goal for a majority of American to have EHRs when and where they are needed.

To accomplish this goal and to coordinate federal HIT efforts, the creation of a new, sub-cabinet level post at the Department of Health and Human Services (HHS) is another major tenet of President’s HIT Plan. President Bush appointed David J. Brailer MD, PhD to be the first nation National Health Information Technology Coordinator, a sub-Cabinet level post at the Department of Health Human Services (HHS) on May 6, 2004.

We have entered the new decade of the EHR. But in achieve that goal, Dr. Charles Safran, the former President of the American medical Informatics Association (AMIA), has said that we will need 6000 more physicians and 6000 more nurses prepared in information sciences to move in this direction.

National Standards Endorsement on July 1 2003

First, the former secretary announced that the Department had signed an agreement with the College of American Pathologist (CAP) on licensed the College’s standardized medical vocabulary system (SNOMED) and make it available without charge throughout the United States.

Secondly, the former Secretary announced that HHS had commission the institute of medicine (IOM) to design a standardized model of an EHR.

Ì It in Relationship to People, Organization, and Policies

In April 2004, a conference convinced by the AMIA brought together experts in the design, implementation and evaluation of EHRs. They recommended attention be paid to business process reengineering, organizational dynamics, and changing strategy when planning and implementing system.

Several Drivers of More Information Technology Today

A recent American Hospital Association and Cap Gemini study forecasts top issues. Healthcare and Hospitals are increasingly investing in IT to deal with several issues. The scarce labor pool of nurses (and in the future doctors) is driving changes in the way the healthcare is delivered. Patient safety is a national issue in the United States and abroad.

Still another focus is a result of September 11, 2001, which is pointed to deficiencies in public health reporting, the lack of public health information infrastructure, and a critical need integrated systems.

HIMSS Leadership Healthcare CIO surveys

Another way to monitor the tends in U.S. healthcare IT is from the healthcare Information Management Systems Society (HIMSS) annual surveys of healthcare Chief Information Officers (CIO). Upgrading security on IT system to meet insurance portability and accountability act requirements followed that issue:

Ø High speed network

Ø The internet

Ø Client server system

Ø Wireless information system

Over the half of the respondents mentioned the use of personal digital assistants, bar coding, and speech recognition and technologies that their facilities plan to implement in the near future.

Trends Toward 2030

Major trends in healthcare that will influence the IT development are listed in table 42.2. Each of these will be described briefly in the remainder of this chapter.

Demographic Trends

Aged person have more health conditions, take more medication and require more procedures and devices than younger persons. There will be an increased focus on preventing, diagnosing, and delivering care to this population.

Table 42.1 Future Trends in IT

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bar coding

bioinformatics/biomedical informatics/computational

biology claims processing

clients erver system

data warehousing

decision support

disease management/outcomes

electronic health record-clinical information system

computer based patient records-hospital/healthcare

information system

high speed network

HIPAA compliance

Identify management-smart cards

Laboratory information management system

Medication prevention/patient safety

Mobile computing

Outsourcing services

Personal digital assistance

Point of care computing

Practice management

Prescription management

Scheduling

Security upgrades

Speech recognition

Standards

Supply ordering/management

Telecomunications/telehealth/telemedicine

Vocabulary integration/interface

Web portals/internet access/to from staff/proffesionals

consumers

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Table 42.2 Trends in health affecting IT in the future

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Demographics-graying of America

Growth in chronic Disease

Emerging in chronic Disease threats

Changes in health seeking behavior toward the internet

Focus on quality= focus on IT

Security and biodefense

Genetic Revolution

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Growth in Chronic Diseases

Among the Chronic diseases expected in the future are ischemic heart disease, Unipolar Major Depression, Road Traffic accidents, Cerebrovascular Disease, Obstructive pulmonary Disease, Chronic Obstructive Pulmonary Disease, Lower Respiratory Infection, Tuberculosis, war, diarrheal Diseases, and HIV.

Emerging Infectious Disease Threats

Threats from emerging infectious diseases are given in the table 42.3 these are occurring threats from infectious diseases from a bioterrorism event. New It resources will be required to alert health professionals, to operationalize resources, and provide timely reporting of findings between government agencies and within public health personnel. Information systems such as path port and MIDAS will be ready for deployment. Nurses with IT background are currently being enlisted to work on teams for surveillance in large cities, state, region of the civilian and military components of the country.

Table 42.3 Emerging Infectious Diseases

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The Flu

Respiratory infections

HIV/AIDS

Diarrheal Diseases

Tuberculosis

Malaria

Measles

Pertussis

Tetanus

Meningitis

Syphilis

Antibiotic resistant disease

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Changes in Health Seeking Behavior on the Internet

Three chapters on this book have focus on consumers. Consumers are moving to the internet to obtain information. They are also obtaining information from TV ads, health magazine, and pharmacy sites.

Focus on Quality= Focus on Informatics

There have been almost a dozen reports from the IOM that have stress the importance and need for IT in improving the quality of healthcare, demonstrating that outcomes can be achieved .

Ì Security and Biodefense

To protect mitigate, responds, and recover from acts of bioterrorism, there are several IT technologies that nurses in public health and practice will become more familiar with in the future.

Weather threats are biologic, chemical, radiologic, and nuclear or high explosive resulting in trauma, all threats result in morbidity, mortality and diseases better supported by a robust information infrastructures.

Genetic Revolution

Advances in today’s sciences have resulted in growth in the computer system and analyze and link data from the testing of genes, genomes, and proteomes to different part of the EHR.

v Genes are segments of the chromosomes that regulate the fundamental physical and functional units of heredity. Genes regulates the synthesis of proteins

v Genomics is the identification and functional characterization of multiple genes. Microarray technologies help to decipher the functional implication of gene expression and unravel some of the information related to the gene function.

v Proteomics is the analysis of asset of proteins in a cell that in turn is determined by gene expression all the protein level

These advances have taken place, not only in research and healthcare, but also in industrial manufacturing and agriculture.

By studying the genetics of the disease, viruses, fungi or bacteria, the United States is discovering ways to develop new drugs, antibiotic vaccines and therapeutic to target specific diseases.

Combining the information known in biology about genetics with digital technology, future electronics will try to replicate and heal them in a way similar to what the human body does with genetics.

Ì Nanotechnology

Nanotechnology refers to the interaction of cellular and molecular components of engineered materials typically clusters of atoms, molecules, and molecular fragments at the most elemental level of biology.

Nanotechnology involves shrinking to the atomic scale, the diagnostics, treatments of our future, and studying the simplest parts of biology like the flow of water, calcium, sodium, and potassium, into and out of cells.

Nanotechnology is said to be the biggest natural bridge between life sciences and physical sciences and requires interdisciplinary research and application. If one can pinpoint the disease before it manifest itself or become malignant, then new treatments can be developed. Smart platform for collecting input from multiple mass spectrometry machines will help in faster disease recognition. Some of the treatments will involve in nanotechnology devices that control and temporal release of therapeutic agent, while monitoring the effectiveness in vivo of the disease cells.

Nursing and the Core Competencies foe the future

Nurses have been involved as genetic counselors and have defined the core curriculum for this specific domain. Genetic academic programs and other resources can be found in table 42.4

Table 42.4 Genetic Academy programs and other Resources

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University of Lowa College of Nursing MSN Genetics

Nursing Program

Cincinnati Children’s Hospital Medical center genetics

Program for Nursing

Genetic Health Nursing, College of Nursing Rush

University Chicago

University of Washington/ Seattle Advanced Practice

Genetics Nurse Program

University of California/San Francisco, genomic Specialty

Options, department of Physiologic Nursing

The National coalition of health Professional Education in genetics

Thew International Society of Nurses in Genetics

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Ì Ethical, social, and Legal Issues

Nurses will be involved in the ethical, social, and legal issues resulting from these new genetic discoveries. They will have to use information system to: