nursing issues

Published on February 2017 | Categories: Documents | Downloads: 38 | Comments: 0 | Views: 309
of 33
Download PDF   Embed   Report

Comments

Content

463,965 Nurses talking about nursing Central | Jobs for Nurses | Books for Nurses | Newsletter

þÿ

Search

Home Nurses Specialty News Students Region Degrees Picks Help Register - it's free! | Site Map | What's New | Log In Nursing Student Assistance / Biggest problems facing nursing today.

Articles Blogs

st Unread

3,657 Readers Online

est problems facing nursing today.

004 12:22 PM written by lumpy | 4 Comments Email Follow

is Nicole. I am a first year nursing student. I have an assignment to ask a t she/he feels are the biggest problems facing nursing today. If anyone e to weigh in, and/or e-mail me I would really appreciate it. Thank you.

[email protected] Ads by Google

urnal Archives

Follow allnurses.com
Get the hottest nursing topics of the week.

ext articles from thousands of journals - Free Trial. .com/NursingJournals

ular Books

assortment ready-to-ship. No shipping fee on orders over $99 otext.com

• • •
þÿ

allnurses.com Official Newsletter Nursing Student Journal Offers from Trusted Partners

ssification

ffective mix of skills, schedule & time to improve care. ealthcare.com

h & Posting: AyosDito Free Job Posting, No Sign Ups! www.AyosDito.ph

Subscribe Today

ts
• • • •

PATL

2004, 06:07 PM

y Posted by lumpy

is Nicole. I am a first year nursing student. I have an assignment to ask a t she/he feels are the biggest problems facing nursing today. If anyone e to weigh in, and/or e-mail me I would really appreciate it. Thank you.

[email protected] re are several key issues that are facing nursing today and they have the o impact nursing significantly as we move into the future.

common ground for educational standards to enter nursing. Most ns have a common entry-level standard that defines them as a profession. For in order to be a dietitan, you must possess a minimum of a bachelor's me for lawyer, teacher, etc. For nursing, there is no real common entry-level auses a great deal of confusion to young people looking at nursing as a nal career path. In addition, other health care disciplines have increased their al standards to meet the increasing technology available in health care, yet ontinues to have no common thread in relationship to education for entryregistered professional nurse. This issue is frustrating in that it causes great nurses as they are deeply divided on entry-level themselves. Do a search on and you will find many hotly debated discussions on the topic.

Nursing Degrees
• • • •

RN to BSN, RN to MSN, LPN/LVN to BSN, Health Care Management

Nursing News
3

respect as a professional. Many nurses will claim that they receive little om other health care providers, including physicians, administrators and in s even advanced practice nurses . As a result of this direct lack of respect, w their voice as limited in health care. Nurses today are placed in some of dangerous positions in relationship to providing care to patients. Nurses in pitals have far too many patients to safely care for. Nurses have limited h administrators and many nurses feel that the only way to have a voice is nion, which is not necesssarily the answer.

Former nurse charged with felony Int encouragement of... 1 Frontline: Facing Death 0 America's Most Popular Jobs

2 Bye Bye Darvocet 7 7 Nurses’ Role in the Future of Health C 8

th care advances and technology improves, the overall cost of health care is . Nurses believe that their wages do not fairly compensate for the the service rm. It really is a sad note on society when a famous football player earns f dollars, but the nurse caring for your mother and holding the security of compensated less than $45,000 per year in most cases :angryfire . in benefits (decreased contributions to 401(k), elimination of retirement etc.), increasing costs of health care insurance and no loyality by employers e long term employment relationships all add to the lack of security that

Slow job market for nurses just a temporary blip, health... Healthcare sector among top adopters 4 iPad 1 American healthcare system ranked w 0 among richest...

Nursing Articles
1 You Better Have Fun! 1 A Full Moon at the Hospital

ve with their jobs.

2 What I Learned My First Day of Clin 1

a is increasingly becoming more litigous and nurses are being named in This alarming trend will only increase in the future without proper nt intervention. As lawsuits increase in numbers and awards to plantiffs are s, overall health care costs are going to increase. Many people looking at a viable career choice are thinking twice about the option without tort d reform of the current system.

Acupuncture for menopause, a person experience

he above contribute to the lack of nurses willing to work at the patient's Many studies have shown that there is really no true nursing shortage, rather, direct lack of willingness for registered nurses to work in these increasly sing situations. This adds to the shortage. Couple the shortage with an aging n and you have a true disaster in nursing on the horizon. 2008 will be the hat the baby boomers will begin reaching retirement. Government reports at the overall cost on the social security system will be overwhelming, not to Medicare. Nurses will be on the front line dealing with aging baby ... How will the profession meet the challenges that it will face? Not sure I er this.

1 My Cup Runs Over and Over 1 9 A Heartbeat Stops - Another Begins 6 The story is in the soil.... 3 Whatever Happened to Nursing? 5

l, I think there is hope and I pray that as we move into the future, someone ing will engage nurses to unite and speak with one common voice for health care and better standards for patient care as well as better working s for nurses. California began this process with mandated nurse to patient California can initiate such reform, why can't this reform spread across the t can and when nurses begin to realize that they have one of the most voices in the country, only then will WE as a professional body be able to nd see change for our patients and for our working conditions. As a student , you are on the front line also and you can be part of that powerful voice. e is not all doom and gloom for us, it can indeed be very bright and and wonderful if we all come together and work to change our profession ak subservant occupation, to a profession that is strong, vocal with n and able to provoke change for the future.

my opinions. Thank you and good luck with your project.

Fokker

2004, 12:48 PM

t RNPATL - Thanks! :-)

notic_nurse

2004, 01:28 PM

y Posted by RNPATL re are several key issues that are facing nursing today and they have the o impact nursing significantly as we move into the future. said.

_nneji

2010, 02:55 AM

points, i am about to apply to nursing school and i have to write an essay his same question. this has given me ideas on what to write.

Tagged Topics
• • • • • • • • • • • • • • • • • • • •

#staffpicks 2011 accelerated adn advice bsn california cna college crna education exam gpa hesi hospital icu interview job jobs license

• • • • • • • • • • • • • • • • • • • •

lpn ltc lvn msn nclex new grad nicu nurse nurses nursing nursing school online pre-nursing registered nurse school student study teas texas transfer

Advertise | Site Map | Boards of Nursing | Terms Of Service | Privacy | Contact Us | Newsletter | Copyright © 1996-2010 allnurses.com INC United States International Nursing Advanced Practice Nursing Critical Care Nursing Nursing Specialties

Telehealth: Issues For Nursing
Introduction The growing use of and interest in the use of telecommunications technologies in the delivery of health care services has led to far-ranging discussions on telehealth (or "telemedicine") and its potential role in the health care system. The American Nurses

Association (ANA) is committed to the use of telemedicine/telehealth in a manner that enhances access to quality, affordable health care services. As part of its participation in the national dialogue on telemedicine/telehealth, ANA on August 29, 1996, submitted preliminary comments to a Joint Working Group (JWG) convened by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services. ANA continues to develop a more detailed and comprehensive analysis of the broad range of issues relevant to the continued growth and development of telehealth. The following is adapted from ANA's initial comments to HRSA. Because the use of telecommunications technologies in providing health care services is broader than the discipline or practice of medicine, ANA generally refers to "telemedicine" as "telehealth" -- a much more inclusive and accurate term, and preferable to one predicated on solely a medical model. ANA offers the following background comments specific to licensure and regulatory issues which may be viewed as barriers to the effective use of telecommunications technology. The application of telecommunications technology in health care is evidenced through a variety of telehealth practices including telemedicine, telenursing and teleradiology. The mechanisms of telecommunication used include telephones, computers, interactive video and teleconferencing. While the application of this new technology offers the possibility of significant benefits to the health of individuals, it is important to anticipate and prepare for the concerns and problems attendant to this technologic advancement. ANA strongly believes that the strength and promise of telehealth lie in providing increased access to health care services by augmenting existing services, not in replacing them. Telehealth technologies should not be used to replace needed access to in-person health care services. The potential for abuse of these technologies by providing "cheaper" substitutes for in-person care needed in homes, communities, schools, nursing homes, hospitals and other settings requires the development and enforcement of standards that ensure these technologies will be used appropriately. Regulatory Issues Telecommunications has the potential to expand access to health care services across state borders and even internationally. This has major implications for a health care regulatory system that is state-based with its primary responsibility being the protection of the public. How can such a regulatory system effectively adapt to the increased utilization of telecommunications in health care while safeguarding the safety and welfare of the citizens it serves? The advantages of a state-based licensure system are that it is administered at the state level and can be tailored to the needs, standards and expectations of the population the

licensed provider services. In addition, given a discreet jurisdiction, disciplinary actions of providers can be closely monitored. For many professions, including nursing, one of the chief difficulties presented by this system is that each state has developed its own specific scope of practice and standards based on that locality resulting in a patchwork of scopes, standards and requirements from state to state. There have been various proposals made to amend the current state-based system to adapt to the increasing demands of telehealth. Of these, California State Senate Bill 1665 has advanced the farthest. It addresses some of the issues related to telehealth -- for instance, by allowing for consultation services from an out-of-state practitioner -- but leaves open many other issues related to provision of care other than consultation, including primary health services. The issue of cross-state practice becomes even more complex as they pertain to nursing. Because laws and regulations governing nursing practice differ from state to state, it is often not clear which laws apply to nurses providing telehealth services across state boundaries. Do the laws of one state requiring practice under a protocol or agreement with a physician, for instance, pertain if a nurse is providing consultation to a practitioner and patient in a state where no such requirements exists? This could limit the consumer's access to care as well as increase health care costs by requiring a consulting physician to be involved in the care. The use of new technologies has also allowed the increased use of protocols for triage, consultation and advice by telephone or computer. The use of protocols, standardized guidelines or computerized algorithms cannot be allowed to substitute for the independent assessment and judgment of registered nurses, who extend the assessment process to obtain contextual and situational information and will determine whether a particular guideline fits a specific patient's condition and needs. Privacy, Confidentiality, and Security The increasing uses of telecommunications technology in the delivery of health care raises new questions about issues of privacy, confidentiality and security of health information. Nurses have a longstanding commitment to promoting and maintaining patient privacy and confidentiality. There is concern on behalf of the nursing community that existing laws, regulation, policies and protocols do not provide sufficient protection of health-related information. Adequate privacy and security protection measures for health information should be an integral part of the development of telecommunications technology in health care. The following are fundamental measures that need to accompany the initiation of this technology in patient care:  previously established confidentiality and privacy protections of health information must be maintained as well as scrutinized to establish if they are sufficient for this new technology  patients who are the recipients of telehealth interventions should be informed of the potential risks (e.g., limitations to securing transmissions over the airwaves or by direct line) and benefits

 patient access to information generated through telehealth is guaranteed  dissemination of patient data or identifiable patient images (e.g., voice) will be controlled by the explicit consent of the patient  patients are informed if other individuals outside the health team (e.g., technical staff, observers) are involved  individuals who violate established privacy, confidentiality and security regulations and misuse information will be subject to enforceable penalties Vital to the responsible use of emerging telecommunication technologies within health care is the development of policy, standards and regulations. The need for wellestablished safeguards and monitoring mechanisms cannot be overemphasized. Nurses, by virtue of their distinct relationships with patients and their role in the delivery of health care, can provide significant leadership and are essential participants in discussion and decision making around these issues. 10/9/96 For more information regarding the Policy Series, policy products specialist, at (202) 651-7022. If you have specific questions about this document, please mention No. 96PRA-03.
THIS INFORMATION COPYRIGHT 1997 AMERICAN NURSES ASSOCIATION

Challenges and Issues Related to Implementation of Nursing Vocabularies in Computerbased Systems Patricia Button, RN, EdD, Ida Androwich, RN, PhD, Lyn Hibben, RN, MSN, Valeria Kern, RN, MS, Gay Madden, RN, BSN, Karen Marek, RN, PhD, Bonnie Westra, RN, PhD, Chris Zingo, RN, MS, and Charles N. Mead, MD, MS Affiliations of the authors: Oceania, Inc., Oakland, California (PB, VK); Loyola University, Chicago, Illinois (IA); CareCentric Solutions, Duluth, Georgia (LH, CNM); ERGO Systems, Mission, Kansas (GM); University of Pennsylvania, Philadelphia, Pennsylvania (KM); Epsilon Systems, Minneapolis, Minnesota (BW); Kaiser Permanente Southern California Region, Pasadena, California (CZ). Correspondence and reprints: Patricia Button, RN, EdD, Oceania, Inc., 5203 Leesburg Pike, Suite 900, Falls Church, VA 22041. e-mail: <<[email protected] >. Received March 19, 1998; Accepted March 19, 1998. This article has been cited by other articles in PMC.


Other Sections▼ o Abstract o Challenges and Issues o Implications o References

Abstract As key stakeholders from the clinical setting and vendor communities, the authors share a summary of their collective experience related to the challenges and issues associated

with implementing the vocabularies recognized by the American Nurses Association in several installations of commercially available clinical information systems. Although the focus of the article is on summarizing the challenges and issues, it is of note that the authors' experiences across care settings suggest that the experience and effort of using one of the ANA-recognized vocabularies in a computer-based system are essentially worthwhile and positive. The issues and challenges fall into two categories: 1) those related to the developmental status of nursing vocabularies, and 2) those related to the adoption or implementation of new technology.


Other Sections▼ o Abstract o Challenges and Issues o Implications o References

In the past ten years, progress in the development of nursing vocabularies has been significant.1,2,3,4,5 Much of this development has taken place in parallel with the articulation of the requirements for the integration of clinical terminologies into computer-based systems.6,7 As a result, the development of nursing vocabularies and the various efforts to use nursing vocabularies in clinical systems have not been guided by a comprehensive set of requirements aimed at ease of implementation and integration in computer-based systems. In this article, as key stakeholders from the clinical setting and vendor communities, the authors share a summary of their collective experience related to the challenges and issues associated with implementing the vocabularies recognized by the American Nurses Association (ANA) in several installations of commercially available clinical information systems. The clinical settings, vocabularies, and computer systems that provide the framework for the discussion are summarized in Table 1. Table 1 Summary of Settings, Vocabularies, and Computer Systems Represented Although the focus of this article is on summarizing the challenges and issues, it is worth noting that the authors' experiences across care settings suggest that the experience and effort of using one of the ANA-recognized vocabularies in a computer-based system are essentially worthwhile and positive. In particular, the progress toward the capture of clinical data in a structured, standardized manner that documents nursing practice and facilitates analysis of its contribution to health care outcomes is of prime value.


Other Sections▼ o Abstract o Challenges and Issues o Implications o References

Challenges and Issues The challenges and issues of each clinical setting are from the perspective of a dyad consisting of a nurse from the clinical organization and a member of the vendor's development or implementation team. As shown in Table 2, the issues and challenges fall into two categories: 1) those related to the developmental status of nursing vocabularies, and 2) those related to the adoption or implementation of new technology. The issues and challenges related to the development status of the nursing vocabularies concur with the formal evaluation literature reviewed by Henry et al. in this issue (see p. 321); because nursing vocabularies were designed primarily for the purpose of classification, they do not fully meet requirements such as those of the Computer-based Patient Record Institute Framework7 that are focused primarily on concept representation.8 Of particular interest in the second category are the challenges that occur when both a new technology and a new “language” are implemented simultaneously. Table 2 Challenges and Issues Related to Implementation of Nursing Vocabularies



Other Sections▼ o Abstract o Challenges and Issues o Implications o References

Implications The authors' experiences viewed within the current context of evolving requirements for implementation of health care vocabularies in terms of both vocabulary-dependent and human factors support two implications. First, and primary, is the need for education of all of the key stakeholders in the nursing vocabulary efforts (e.g., vocabulary developers, nurse informaticists, clinical implementors, and vendors) regarding the evolving framework for health care vocabularies. In this effort, it is important that the U.S. nursing community continues to collaborate with and learn from the experience of others, including our colleagues in medical informatics and in nursing at the international level.9,10 The AMIA Nursing Informatics Work Group has taken the leadership role in providing educational offerings at both basic and advanced levels in conjunction with the AMIA Annual Fall Symposium and Spring Congress. Second is the need for a framework or model of implementation that is comprehensive and addresses both categories of issues and challenges—the required features of vocabularies suitable for implementation in computer-based systems and the pragmatic issues of use. Such a framework and research regarding the role of the various components in the framework are necessary in order to produce valid, reliable data regarding “what nurses do” within the multidisciplinary provision of health care. Notes This article is based on presentations given at the invitational conference of the AMIA Nursing Working Group, entitled “Implementation of Nursing Vocabularies in

Computer-based Systems,” which was held on May 28, 1997, in conjunction with the AMIA Spring Congress.


Other Sections▼ o Abstract o Challenges and Issues o Implications o References

References 1. Martin KS, Scheet NI. The Omaha System: Applications for Community Health Nursing. Philadelphia, Pa: WB Saunders Co, 1992. 2. McCloskey JC, Bulechek GM. Nursing Interventions Classification. 2nd ed. St. Louis, Mo: CV Mosby Co, 1996. 3. North American Nursing Diagnosis Association. NANDA nursing diagnoses: definitions and classification, 1992-1993. Philadelphia, Pa: NANDA, 1992. 4. Saba VK. Home Health Care Classification. Caring Mag. 1992;11(4): 58-60. 5. Johnson M, Maas M (eds). Nursing Outcomes Classification (NOC). St. Louis, Mo: CV Mosby Co, 1997. 6. Cimino JJ, Hripcsak G, Johnson SB, et al. Designing an introspective, multipurpose, controlled medical vocabulary. Proc 13th Annu Symp Comput Appl Med Care. 1989: 513-8. 7. Campbell J, Carpenter P, Sneiderman C, et al. Phase II evaluation of clinical coding schemes: completeness, taxonomy, mapping, definitions, and clarity. J Am Med Inform Assoc. 1997;4(3): 238-51. [PMC free article] [PubMed] 8. Henry SB, Warren JJ, Lange L, Button P. A review of major nursing vocabularies and the extent to which they have the characteristics required for implementation in computer-based systems. J Am Med Inform Assoc. 1998;5: 321-8. [PMC free article] [PubMed] 9. Spackman KA, Campbell KE, Côté RA. SNOMED RT: a reference terminology for health care. Proc AMIA Annu Fall Symp. 1997: 640-4. [PMC free article] [PubMed] 10. Hardiker N, Kirby J. A compositional approach to nursing terminology. In: Gerdin U, Tallberg M, Wainwright P (eds). Nursing Informatics: The Impact of Nursing Knowledge on Health Care Informatics. Stockholm, Sweden: IOS Press, 1997: 3-7. Figures and Tables Articles from Journal of the American Medical Informatics Association : JAMIA are provided here courtesy of American Medical Informatics Association Challenges and Issues Related to Implementation of Nursing Vocabularies in Computerbased Systems Patricia Button, RN, EdD, Ida Androwich, RN, PhD, Lyn Hibben, RN, MSN, Valeria Kern, RN, MS, Gay Madden, RN, BSN, Karen Marek, RN, PhD, Bonnie Westra, RN, PhD, Chris Zingo, RN, MS, and Charles N. Mead, MD, MS

Affiliations of the authors: Oceania, Inc., Oakland, California (PB, VK); Loyola University, Chicago, Illinois (IA); CareCentric Solutions, Duluth, Georgia (LH, CNM); ERGO Systems, Mission, Kansas (GM); University of Pennsylvania, Philadelphia, Pennsylvania (KM); Epsilon Systems, Minneapolis, Minnesota (BW); Kaiser Permanente Southern California Region, Pasadena, California (CZ). Correspondence and reprints: Patricia Button, RN, EdD, Oceania, Inc., 5203 Leesburg Pike, Suite 900, Falls Church, VA 22041. e-mail: <<[email protected] >. Received March 19, 1998; Accepted March 19, 1998. This article has been cited by other articles in PMC.


Other Sections▼ o Abstract o Challenges and Issues o Implications o References

Abstract As key stakeholders from the clinical setting and vendor communities, the authors share a summary of their collective experience related to the challenges and issues associated with implementing the vocabularies recognized by the American Nurses Association in several installations of commercially available clinical information systems. Although the focus of the article is on summarizing the challenges and issues, it is of note that the authors' experiences across care settings suggest that the experience and effort of using one of the ANA-recognized vocabularies in a computer-based system are essentially worthwhile and positive. The issues and challenges fall into two categories: 1) those related to the developmental status of nursing vocabularies, and 2) those related to the adoption or implementation of new technology.


Other Sections▼ o Abstract o Challenges and Issues o Implications o References

In the past ten years, progress in the development of nursing vocabularies has been significant.1,2,3,4,5 Much of this development has taken place in parallel with the articulation of the requirements for the integration of clinical terminologies into computer-based systems.6,7 As a result, the development of nursing vocabularies and the various efforts to use nursing vocabularies in clinical systems have not been guided by a comprehensive set of requirements aimed at ease of implementation and integration in computer-based systems. In this article, as key stakeholders from the clinical setting and vendor communities, the authors share a summary of their collective experience related to the challenges and issues associated with implementing the vocabularies recognized by the American Nurses Association (ANA) in several installations of commercially available clinical information

systems. The clinical settings, vocabularies, and computer systems that provide the framework for the discussion are summarized in Table 1. Table 1 Summary of Settings, Vocabularies, and Computer Systems Represented Although the focus of this article is on summarizing the challenges and issues, it is worth noting that the authors' experiences across care settings suggest that the experience and effort of using one of the ANA-recognized vocabularies in a computer-based system are essentially worthwhile and positive. In particular, the progress toward the capture of clinical data in a structured, standardized manner that documents nursing practice and facilitates analysis of its contribution to health care outcomes is of prime value.


Other Sections▼ o Abstract o Challenges and Issues o Implications o References

Challenges and Issues The challenges and issues of each clinical setting are from the perspective of a dyad consisting of a nurse from the clinical organization and a member of the vendor's development or implementation team. As shown in Table 2, the issues and challenges fall into two categories: 1) those related to the developmental status of nursing vocabularies, and 2) those related to the adoption or implementation of new technology. The issues and challenges related to the development status of the nursing vocabularies concur with the formal evaluation literature reviewed by Henry et al. in this issue (see p. 321); because nursing vocabularies were designed primarily for the purpose of classification, they do not fully meet requirements such as those of the Computer-based Patient Record Institute Framework7 that are focused primarily on concept representation.8 Of particular interest in the second category are the challenges that occur when both a new technology and a new “language” are implemented simultaneously. Table 2 Challenges and Issues Related to Implementation of Nursing Vocabularies



Other Sections▼ o Abstract o Challenges and Issues o Implications o References

Implications The authors' experiences viewed within the current context of evolving requirements for implementation of health care vocabularies in terms of both vocabulary-dependent and

human factors support two implications. First, and primary, is the need for education of all of the key stakeholders in the nursing vocabulary efforts (e.g., vocabulary developers, nurse informaticists, clinical implementors, and vendors) regarding the evolving framework for health care vocabularies. In this effort, it is important that the U.S. nursing community continues to collaborate with and learn from the experience of others, including our colleagues in medical informatics and in nursing at the international level.9,10 The AMIA Nursing Informatics Work Group has taken the leadership role in providing educational offerings at both basic and advanced levels in conjunction with the AMIA Annual Fall Symposium and Spring Congress. Second is the need for a framework or model of implementation that is comprehensive and addresses both categories of issues and challenges—the required features of vocabularies suitable for implementation in computer-based systems and the pragmatic issues of use. Such a framework and research regarding the role of the various components in the framework are necessary in order to produce valid, reliable data regarding “what nurses do” within the multidisciplinary provision of health care. Notes This article is based on presentations given at the invitational conference of the AMIA Nursing Working Group, entitled “Implementation of Nursing Vocabularies in Computer-based Systems,” which was held on May 28, 1997, in conjunction with the AMIA Spring Congress.


Other Sections▼ o Abstract o Challenges and Issues o Implications o References

References 1. Martin KS, Scheet NI. The Omaha System: Applications for Community Health Nursing. Philadelphia, Pa: WB Saunders Co, 1992. 2. McCloskey JC, Bulechek GM. Nursing Interventions Classification. 2nd ed. St. Louis, Mo: CV Mosby Co, 1996. 3. North American Nursing Diagnosis Association. NANDA nursing diagnoses: definitions and classification, 1992-1993. Philadelphia, Pa: NANDA, 1992. 4. Saba VK. Home Health Care Classification. Caring Mag. 1992;11(4): 58-60. 5. Johnson M, Maas M (eds). Nursing Outcomes Classification (NOC). St. Louis, Mo: CV Mosby Co, 1997. 6. Cimino JJ, Hripcsak G, Johnson SB, et al. Designing an introspective, multipurpose, controlled medical vocabulary. Proc 13th Annu Symp Comput Appl Med Care. 1989: 513-8. 7. Campbell J, Carpenter P, Sneiderman C, et al. Phase II evaluation of clinical coding schemes: completeness, taxonomy, mapping, definitions, and clarity. J Am Med Inform Assoc. 1997;4(3): 238-51. [PMC free article] [PubMed] 8. Henry SB, Warren JJ, Lange L, Button P. A review of major nursing vocabularies and the extent to which they have the characteristics required for implementation in

computer-based systems. J Am Med Inform Assoc. 1998;5: 321-8. [PMC free article] [PubMed] 9. Spackman KA, Campbell KE, Côté RA. SNOMED RT: a reference terminology for health care. Proc AMIA Annu Fall Symp. 1997: 640-4. [PMC free article] [PubMed] 10. Hardiker N, Kirby J. A compositional approach to nursing terminology. In: Gerdin U, Tallberg M, Wainwright P (eds). Nursing Informatics: The Impact of Nursing Knowledge on Health Care Informatics. Stockholm, Sweden: IOS Press, 1997: 3-7. Figures and Tables Articles from Journal of the American Medical Informatics Association : JAMIA are provided here courtesy of American Medical Informatics Association

Issues and Status of Nursing Use and Attitudes
“We’re lost but we’re making good time” (Yogi Bera) Mobile computing can provide a path to improved real time, information-driven clinical care. But most nurses do not yet actively use mobile information technology for their core work. The critical issues that affect nursing use of information systems are not technical, but social. Typically, potential new users resist the adoption of any/all information technology because they see the use of these systems as a threat to themselves and the status quo. Resistance to change is a natural human behavior, but there are additional factors at play in the nursing profession which impede the adoption of IT. 1) An aging population of nurses who have had little or no training in the use of information technology 1. 2) Insufficient technical training at the baccalaureate level 3) A false perception among nurses that IT is “dehumanizing” 4) Misconceptions about hardware functionality. Hardware: Opposition to point-of-care computerized clinical support is commonly ascribed to technical barriers, such as a lack of features. This misconception has caused much of the discussion in nursing circles to focus on the technical barriers to wide spread acceptance of mobile clinical support systems. Technical barriers to nursing acceptance of mobile computing did, in fact, exist in the early models of handheld devices. Often cited shortcomings were/are:

a) Small and/or difficult to read screens b) Poor data entry due to the lack of a keyboard c) Insufficient memory All of these concerns have been addressed by the manufacturers of handheld devices. a) Screen resolution has improved and will continue to do so. Moreover the newly introduced color screens have effectively eliminated the complaint.

b) Data Entry Solutions:


Attachable keyboards: Landware GoType



On Screen Keyboard alternatives such as the FITALY Keyboard



Advanced handwriting recognition software: CIC's Jot

c) Mass storage for handhelds is now available: Packing one Gigabyte (GB) of data storage capacity on to a disk the size of a quarter. IBM's Microdrive can hold up to:
o

1,000 high-resolution photographs

o o

1 thousand 200-page novels 18 hours of high-quality digital audio music.

Price: Price is another issue often cited as a barrier to adoption. However with each stage of computing since the advent of the mainframe in the 1960s, the number of users has been successively greater. Prices of handheld computers are an order of magnitude less than the PC, just as the PC is an order of magnitude less than the minicomputer. The lower prices will enable handhelds to eventually reach substantially more users than the PC, just as the lower PC prices enabled the PC to reach substantially more users than the minicomputer.

Software The large data sets like: ePocrates qRx , present untapped information sources and clinical tools for nursing.

compelling software The utility and clinical relevance of software applications will be the solutions key to winning nurses over to mobile computing. are the key to nursing Personal Digital Assistants (PDAs) are replacing the multiple acceptance reference books and ragged patient index cards that have fought for pocket space for so long.

Is Nursing Use/Acceptance Required?

The benefits of mobile computing for physicians are now being realized and are being published in the literature. However to realize the full potential of this powerful clinical support system, the entire healthcare team must adopt mobile computing. Maintaining dual (computerized and paper based) systems to accommodate those who refuse to use the new technology can increase costs by 130% to 240% 2. An even more compelling reason is the opportunity presented by handheld computing to enhance patient safety and care. A recently published report by investigators at Brigham and Women's Hospital states: 50% of physicians using ePocrates qRx handheld drug reference guide avoided one or more serious adverse drug events per week Over 90% of clinicians surveyed reported that it took them 20 seconds or less to find information 80% said that ePocrates qRx improved their drug knowledge 83% said that their patients were better informed as a result 54% reported higher levels of satisfaction with their medical care

Nursing Advances in Mobile Computing Nurses are putting aside their fears and misconceptions about mobile information technology and are acknowledging the emergence of personal digital assistants (PDAs) as devices that are becoming increasingly important in patient care. 1) Korea: MobileNurse, the Implementation of a Mobile Computing System in a Clinical Environment 2) Australia: Case Study: A day in the life of Nurse Heavensent 3) Canada: Nurse-driven community-based diabetes centre first to implement PDA technology to monitor diabetes information. RNpalm introduces the first nursing specific Palm OS software and launches the world's first website dedicated to the use of PDAs in nursing

4) United States: The Midwest Alliance for Nursing Informatics - "Handheld Technology and it's Clinical Applications for Nursing" “Point of Care Ware” software developed by Lynette Jones RN Ph.D. Deri Dority RN, CCRN, BSN establishes the second website dedicated to the use of PDAs in Nursing. Nightingale Tracker system: a proprietary handheld home health clinical communication system. 5) United Kingdom: Colin Nicholls RN, RMN builds on the momentum and introduces: Practical Nurse Palm Helper This site is in its early stages but Colin tells us that he will be adding to it at a steady rate over the coming weeks/months.

Discussion Only six moths ago it was difficult to find any information on the use of PDAs in nursing, now articles are starting to appear in the press: Advance for Nurse Practitioners: Special Report on Handheld Tenewchnology Nursing Executive Watch: Palm pilots: Popular among MDs, less so with RNs (membership & registration required) Nurses.com: Is a personal digital assistant in your future? Nurses Week: Finding the right digital assistant Handheld computers are the next step in the evolution of computing, the Mobile Information Age has arrived. Its time for all members of the heathcare team to embrace this new technology... resistance is futile :)
Notes: 1) Reader Response: "Ken, your editorial about involving more nurses in the use of handheld technology, especially the Palm Pilot type of technology, is generally right on target. Access to clinical and scientific information when it is

needed is going to be more and more important as knowledge expands and work loads increase. However, I take exception to the point about the aging nurse population being a barrier to acceptance. This same point was made about the general adoption of computer technology by nurses when such technologies were being introduced. But, there was no supporting evidence for this stereotype. In fact, as studies were done, the age and educational background of nurses were not influential factors. Experienced nurses, who tend to be older, are a tougher customer because they have been through the "fads" and they can rapidly determine what will help them. If a technology obviously provides a benefit, older nurses are more likely to be able to integrate it into practice because they are more experienced." Kathleen Milholland Hunter, PhD, RN Independent Practice in Informatics K&D Hunter Associates, Inc. 2) Schoenbaum SC, Barret GO. Automated ambulatory medical records systems: An orphaned technology. In J Tech Assessment in Healthcare 1992; 8; 598-609 • •

TECHNOLOGY IN ACTION GO AHEAD, PRACTICE In 1899, Charles H. Duell, a commissioner for the United States Office of Patents, reportedly said: “Everything that can be invented has been invented.” He obviously was wrong. Technology continues to change, often with dizzying speed, and no industry is immune. For decades, the ANA has viewed technology as having a crucial role in health care, one that could greatly benefit nurses and patients if implemented wisely. Most recently, the ANA’s House of Delegates approved a resolution stating that technology should be used to augment, not replace, RNs’ decision making when determining patient safety practices. The resolution also calls for RNs to be integrally involved in the research, development, evaluation, and purchase of technological systems aimed at improving the safety and quality of patient care, and that these systems don’t create an undue burden on nurses who already are struggling to provide direct care to their patients. “You can’t just shove technology at people and expect that all the problems that led to staffing shortages will go away,” says Susan Newbold, MS, RN,BC, FAAN, cochairperson of a state-commissioned workgroup that looked at ways that workplace technology could ease the nursing shortage in Maryland. “Trouble may be just starting if the wrong technology is introduced.” And there are cases when the technology is good but it’s implemented poorly, says Dana Womack, MS, RN, a health care technology expert.

“To this day nurses don’t have the input they should when computerized systems and other technology are selected,” says Newbold, a Maryland Nurses Association member. “We really need to be at the table when those decisions are being made.” Besides RN involvement at the unit level, Womack says that more nurses need to ...

Newspapers Examine Issues Related To Health Care Technology
Main Category: Medical Devices / Diagnostics Article Date: 28 Jun 2006 - 17:00 PDT email to a friend Ads by Google
Current Article Ratings:

printer friendly

opinions

Patient / Public: Healthcare Prof:

2 (2 votes)

Article Opinions:

0 posts

Find other articles on: "technology issues in healthcare"

Two newspapers on Monday published articles on issues related to health care technology. Summaries appear below.


Elder care: The Wall Street Journal on Monday examined how companies such as Intel, Philips Electronics and Accenture have begun to develop products to monitor the health of elderly patients "that try to be as unobtrusive as possible while keeping people safe and connecting them to the outside world." Products that can remotely monitor activities, blood pressure and cognitive function could help elderly patients to live in their homes longer, "thus reducing the need for care in costly settings," such as nursing homes or hospitals, the Journal reports. Russ Bodoff, executive director for the Center for Aging Services Technologies, said, "Where we've spent money on technology is in hospitals and operating rooms, ... but we do so little to care for a person before they get to the hospital and after they get out." However, the costs of such products are "big barriers ... to widespread adoption," the Journal reports (Lueck, Wall Street Journal, 6/26).



Electronic health records: The Los Angeles Times on Monday examined concerns about whether efforts by the federal government to encourage use of EHRs will increase risk for theft of personal medical information. Deborah Peel, founder of the Patient Privacy Rights Foundation, asked, based on past thefts of personal information, "why would any patient believe their personal, sensitive health data is safe online?" John Halamka, chief information officer for Harvard Medical School and chair of the Health Information Technology Standards Panel formed by the Bush administration, said that a national EHR system would use a "very decentralized approach" to help protect personal medical information. Halamka said, "I would be worried if there were a centralized database in the basement of the White House that could be hacked, but we're not building that" (Foreman, Los Angeles Times, 6/26).

Technology in Healthcare Safety Issues
By an eHow Contributor 1. Technology has allowed for advances in health care. It also creates safety issues in areas such as privacy, computer system malfunction and human error. Computer system malfunction can make electronic medical records (EMR) inaccessible, including important patient information such as medical history, allergies and medication lists. Human errors such as typographical mistakes create safety issues in health care systems that rely on accurate information.

Privacy
2. Privacy laws protect the privacy of patients' personal information, including demographics, medical history and insurance information. Federal law requires that all patient information be kept confidential. By law, personal information may be shared only with those who need the information to provide a service.

Technology used in health care must provide a way to ensure that patient information remains private. When unauthorized individuals are kept from accessing a patient's address or contact information, the patient is protected from identity theft, fraud and other threats.

Computer System Malfunction
3. Computer system malfunction prevents health care providers from accessing needed information. Information stored on a computer system may be lost or corrupted. Health care providers rely on the patient data saved in the system to keep track of patients and their conditions and treatments.

A patient's safety can be jeopardized when his physicians and nurses are denied access to his information. For example, if a patient's EMR states that the patient has an allergy to penicillin and the EMR is unavailable, his physician may prescribe penicillin and provoke an allergic reaction.

Human Error
4. Human error such as typographical errors can lead to safety issues. An example of this is a medication dosage error. A physician writes a prescription instructing a patient to take one 1 mg pill daily. The information is entered into the computer to be filled as 10 mg tablets. This typographical error has the patient taking a much larger does than intended, which can lead to safety issues including medication overdose.

Entering incorrect information into an EMR can also lead to safety issues. If a nurse brings summaries of physicians' orders for multiple patients to a receptionist at the same time, safety can become a concern. If the employee accidentally enters patient A's information into patient B's file, medical errors may result.

Read more: Technology in Healthcare Safety Issues | eHow.com http://www.ehow.com/list_7452303_technology-healthcare-safetyissues.html#ixzz161dg34Ed

Guide to Critical Issues in Health Care Technology Contracting.
Publication: Mondaq Business Briefing Publication Date: 22-MAY-06 Ads by Google Healthcare CI Primary Competitive Intelligence Specialist in Healthcare Industry www.fletchercsi.com/healthcare Medical Equipment Online See Items For Sale Or Post Ads For Free on Ayos Dito. No Sign Ups! www.AyosDito.ph The B. Braun Group Your partner for medical products, services and knowledge. Worldwide. www.bbraun.com Article Excerpt Introduction Today's health care providers operate in a constantly changing environment shaped by increased regulation and competition. In an effort to meet these challenges, health care providers increasingly are embracing the latest in technological advances. Many health care technology vendors lure providers with a siren song of lowered costs, increased efficiencies, access to more and better data, and improved patient care. Given the substantial cost of these technologies, their "mission-critical" nature, and the myriad of legal and operational issues related to their acquisition, implementation, and use, these solutions also present substantial risk to providers who follow the lure of these promises without careful planning and implementation. This Guide to Critical Issues in Health Care Technology Contracting addresses some of the critical legal issues presented in a typical acquisition of health care technology. Due to our extensive experience in health care technology we recognize that each transaction presents unique legal and operational issues, and that the particular method(s) of addressing these issues will change substantially with each transaction and each particular vendor. Although this guide does not attempt to identify all of the potentially important issues that your organization will face, we hope it will be a useful resource as your organization navigates through the quagmire of health care technology acquisitions. Issue One Ensuring Your Project Is On Time and Under Budget Most, if not all, health care entities have experienced technology acquisition projects that significantly exceeded budgets and/or project timelines. In today's competitive environment, budget overruns and endless implementation projects are more Format: Online Delivery: Immediate Online Access

unacceptable than ever. Although these problems are all too common, there are a number of contractual tools available to ensure that your project is completed on time and under budget. Most standard vendor agreements do not contain enforceable project timelines. When pressed, most vendors seek to avoid the development of a detailed work plan until after the agreement is executed by the parties. Even when a detailed work plan is attached, vendors will usually attempt to use a "level of effort" (e.g., "commercially reasonable" efforts) standard to describe their contractual obligations. (See Sample One below.) > In addition to a lack of enforceable project timelines as exemplified in the language above, most vendor agreements contain an unlimited "time and materials" approach to project implementation services, with fees paid on a recurring (e.g., monthly) basis. Under this framework, if the actual work effort required is double the originally projected work effort, the vendor's implementation fees are doubled. In addition, the vendor receives regular payments regardless of its progress (or lack thereof) and regardless of whether the system and/or system components are working. Payment structures such as these invite budget overruns. Although implementation costs and timelines are the most obvious risks to your organization, there are a number of other areas where a failure to adequately address payment issues could result in hidden costs to your organization. For example, many agreements contain unclear licensing metrics (e.g., vaguely worded descriptions of how the vendor counts concurrent users) that can result in substantial unanticipated license fees. In addition, most vendors offer no protection that agreed-upon third-party software and hardware will be adequate to operate the vendor's software. As a result, if additional third-party technology is required, it is most likely your organization's financial responsibility (despite the fact that your organization may have purchased the exact thirdparty software and hardware configuration that was specified by the vendor). If these and other problems remain unaddressed in the agreement, project budgets and timelines amount to nothing more than your current "best guess," and are oftentimes based substantially upon oral conversations and vendor promises that are not included in the agreement. Using the tools described below, your organization can help ensure that the vendor appropriately shares the risk that the project will meet timelines and/or budget requirements. Guidelines: Develop a project plan and timeline before the execution of the agreement with the vendor, and attach it to the agreement as an exhibit. Obligate the vendor to meet the milestones described in the exhibit on or before the prescribed dates. Ensure that the vendor's obligations in this regard are clearly described, and avoid "level of effort" language that merely obligates the vendor to using "commercially reasonable efforts" (or

some other level of effort) to meet project timelines. Consider alternative payment methodologies for the vendor's implementation fees. These include "fixed fee" projects, "not-to-exceed" projects, or a "hybrid" structure whereby cost overruns progressively reduce the vendor's hourly or daily rate to the point where the vendor is providing services without charge. Regardless of the chosen methodology, payments should be milestone driven. Payments should be released to the vendor based upon actual results (e.g., the acceptance of a particular deliverable), not the passage of time. Ensure that the agreement clearly and unambiguously describes the applicable licensing metric(s). If necessary, include examples to ensure that both parties are in agreement regarding when additional licensing fees will be paid. Include appropriate configuration warranties to ensure that the vendor will bear any costs of unexpected additional third-party technology that may be necessary to support your use of the vendor's system. Include an "All Fees Stated" limitation that requires the vendor to specifically and succinctly describe any and all costs payable to the vendor under the agreement. Issue Two Limitations of Liability Almost all vendors use their standard agreements as a vehicle for limiting their liability in the event of a problem during the implementation or use of the vendor's product. Although these liability limitations take a variety of forms, they all share the fundamental purpose of shifting the risk of the vendor's nonperformance to your organization. The most common such clause is usually labeled as a "Limitation of Liability" and, for legal reasons, it is oftentimes drafted in capitalized or bold text. These clauses typically: prohibit the customer from recovering certain types of damages (usually indirect, consequential, incidental, special, and punitive damages); and limit the amount of recovery for other types of damages, even if the customer is able to prove that the vendor breached its obligations and that the breach caused the damages. (See Sample Two (A) below.) In a sense, this clause is the most important part of your organization's agreement with the vendor. If you successfully negotiate an agreement that contains very specific implementation timelines, functionality commitments and other vendor promises, these commitments are only as good as your organization's ability to enforce the agreement in the event of a vendor breach. If the limitation of liability protects the vendor from incurring any meaningful damages if it breaches the agreement, the value of these commitments is substantially reduced or eliminated. Many vendors also attempt to shift risk to the customer using a number of less obvious

methods. For example, vendors will often include a "blanket disclaimer" of responsibility for certain risks. Although these disclaimers may sound reasonable on the surface, they are almost always overly broad and include risks that are appropriately the vendor's responsibility. (See Sample Two (B) below.) (Note that additional, health care-specific disclaimers are discussed in connection with Issue Three on following pages.) >> Another common form of liability limitation is the use of "sole and exclusive remedy" clauses. (See Sample Two (C) below.) Pursuant to these clauses, the vendor usually commits to use a "commercially reasonable" level of effort to either fix or replace a defective product or to re-perform defective services and asks the customer to waive all other rights and remedies resulting from such defect. Although a fixed product is an appropriate remedy, it oftentimes should not be the only remedy. For example, if a patient is harmed by a defective product, the vendor's obligations should extend beyond a commitment to repair or replace the product. Similarly, if a product failure causes your organization to incur substantial damages (e.g., an inability to perform procedures) an obligation to fix or replace the product is an incomplete remedy, at best. > Finally, many vendors seek to limit their potential liability by limiting the customer's right to bring a claim after a certain period of time. (See Sample Two (D) below.) These "artificial" statutes of limitations are almost always shorter than the statute of limitations offered under state law. In addition, these clauses are oftentimes drafted in a one-sided manner such that the customer must bring any claims within a shortened time period, while the vendor reserves the luxury of filing claims within the longer statute of limitations offered by applicable state law. Limitations of liability are a critical aspect of health care technology transactions. In a health care environment, a product failure could cause an inability to treat patients or bill for services rendered. In the worst case scenario, a defective product could harm a patient. As a result, limitations of liability should receive careful scrutiny. Remember, just because limitations of liability are extremely common in the technology industry, this does not mean that they are always fair or reasonable to the customer. In most cases, they are neither. It is critical that your organization evaluate the risks posed by these limitations, and determine in each case whether it is acceptable for the vendor to shift the risk of its non-performance to your organization. > Guidelines: Remember that the commitments found elsewhere in the agreement are only as good as the limitation of liability. If the vendor provides "iron-clad" commitments elsewhere in the agreement, those commitments are worthless if the customer does not have the ability

to enforce them. Do not assume that all agreements must contain a prohibition on the recovery of consequential, indirect, incidental, punitive, and other similar damages. This issue, like all others, will be dictated by the course of the negotiation and the parties' respective bargaining positions. If the vendor insists on an overall cap on liability, ensure that the cap amount is sufficient to permit the recovery of your organization's potential damages. This will, of course, vary greatly depending on the type of product being acquired and the size of the transaction. All liability limitations and exclusions of damages should apply equally to both parties. Include "carve-outs" from any liability limitations to protect your organization from certain "worst case scenarios," or to address those situations where a limitation of liability cannot be justified under any circumstances. Consider the following carve-outs (in addition to any others that are relevant to the particular transaction): Damages caused by a breach of confidentiality obligations Damages covered by insurance, up to the amount of such insurance Damages caused by the intentional breach of the agreement Damages caused by the violation of applicable law Damages resulting from any third-party claims (including, without limitation, any contractual obligations to defend, indemnify, or hold the other party harmless from any third-party claim(s) and any damages caused by a breach of those obligations) Issue Three Responsibility for Harm/Damage Caused to Third Parties If a problem arises during the implementation or use of any technology, that problem may cause your organization to incur damages, but it also may harm third parties. In the context of health care transactions, these third-party risks can be more central than in other technology projects. Many health care technology products will serve as a repository for highly confidential patient data, while other products are used directly or indirectly in the treatment of patients. For these reasons, it is particularly important in the context of health care technology transactions to ensure that the relevant agreement fairly allocates the risk of these third-party claims. As you might expect, most vendor agreements attempt to shift the risk of third-party harm to the customer. For example, many vendors obligate their customers to defend and indemnify the vendor and hold the vendor completely harmless from a broad range of third-party claims. (See

Sample Three (A) below.) Although in certain circumstances it may be appropriate for the customer to indemnify the vendor for certain third-party claims, most vendor-requested indemnification clauses are overly broad, and in many cases require the customer to indemnify the vendor for claims that were caused by the vendor itself (or the vendor's products). As noted in Sample Three (A), the customer is obligated to defend, indemnify, and hold the vendor harmless from any claim "related to the use of the Product or any other act or omissions of Customer." This overly broad obligation would actually require the customer to defend the vendor in a lawsuit resulting from a patient being harmed by a defective product, merely because the customer "used" the product! > In addition to the use of overly broad indemnification clauses, many vendors also seek to limit their responsibility by including a variety of "practice of medicine" disclaimers. (See Sample Three (B) on following page.) These disclaimers are similar to those discussed in the "Limitation of Liability" section above, but are particularly tailored to the health care setting and are intended to shift certain risks (usually the risk of patient harm) to the customer. Although these disclaimers may sound accurate at first (e.g., both parties can agree that the vendor does not practice medicine) they have the effect of simplifying a complex issue at the customer's expense. The reality is that in many cases, practitioners will rely on the data received from a clinical system or product. If a defective system (e.g., laboratory equipment) provides inaccurate information (a "false positive" blood test) which in turn leads to a misdiagnosis, the responsibility for any resulting patient harm should not be dictated by these simplistic and overly broad risk-shifting provisions. > Finally, almost all vendor agreements contain some form of indemnification for intellectual property claims. Although these clauses are commonly found in vendor agreements, they are oftentimes drafted in a manner that significantly limits the vendor's obligations to your organization for these claims. (See Sample Three (C) below.) These clauses should be reviewed carefully to ensure that your organization accepts no risk associated with a vendor's misappropriation of a third party's intellectual property. > Guidelines: Do not agree to overly broad indemnification obligations that extend to your organization's use of a product or its acts or omissions. These indemnification obligations could result in a duty to indemnify the vendor for claims that are properly the vendor's responsibility.

Do not agree to broad "practice of medicine" disclaimers. These clauses attempt to shift the risk of patient harm to the customer in all cases, even when the harm was primarily caused by the vendor. As discussed under "Limitations of Liability" above, it is critical that you ensure that thirdparty claims and damages are expressly carved out of all limitations or exclusions of liability. With respect to intellectual property indemnification clauses: Ensure that the clause covers infringement/misappropriation of "patents, copyrights, trademarks, trade secrets, and other propriety rights." Include obligations to defend, indemnify, and hold harmless your organization, its affiliates, and its and their respective employees, officers, directors, agents, and predecessors and successors-in-interest. Ensure that any exclusions from the vendor's obligations are appropriate and narrowly drafted. Issue Four Defining "Specifications" and Acceptance Testing Most vendor agreements tie all warranties and representations, and the performance of the product, to the vendor's standard "documentation." (See Sample Four (A) below.) > This approach has several significant pitfalls. First, it is unlikely that the relevant vendor documentation will be delivered or carefully reviewed prior to the execution of the agreement. If the vendor documentation serves as the standard for the performance of the product, any failure to carefully review this documentation is tantamount to permitting the vendor to define your organization's requirements. All too often, clients spend significant amounts of time analyzing competing products, defining requirements, drafting request for proposals (RFPs), and selecting vendors/products, only to ignore all of this hard work when it matters most -- when the vendor is actually being asked to commit to meet these standards and requirements. Second, the vendor's documentation is usually subject to change at any time by the vendor, and usually without notice to its customers. As a result, if the vendor experiences a particular problem, it can effectively remove its contractual obligation to fix the problem by deleting the particular description of that functionality from its documentation. Finally, the documentation will not include any reference to specific representations made by its sales representatives and technical staff regarding the

performance of the products in your environment. If your organization bases its vendor or product choice upon these representations, it is important to include them as vendor commitments in the agreement. To address these issues, we strongly recommend supplementing the vendor's documentation with other standards and requirements. These other materials will almost always include an exhibit or schedule to the agreement that describes your organization's key requirements for the acquired product. If your organization used an RFP, the RFP documents also should be considered for inclusion. Together with the vendor documentation, these additional materials should be defined collectively as the "Specifications" and used consistently throughout the agreement. The agreement also should clarify that in the event of any inconsistency between the vendor documentation and your defined requirements, your defined requirements should prevail. Finally, most vendor agreements do not refer to the concept of "acceptance." If a vendordrafted agreement does include an "acceptance" provision, it is likely to state that acceptance shall be deemed to occur upon a certain event and/or the expiration of a certain period of time. Invariably, these "deemed acceptance" clauses are triggered so early in the acquisition process that they effectively prevent any meaningful acceptance testing rights. (See Sample Four(B) below) > The agreement should be revised to include specific acceptance testing rights, processes to follow if the product fails to pass these tests, and the ultimate consequences of failed acceptance testing. If the vendor is unable to fix reported problems after a reasonable number of attempts, the customer should retain the option to terminate the agreement and receive a full refund of all amounts paid (including, without limitation, product costs and service fees) as well as reimbursement for other out-of-pocket expenses incurred as part of the failed project (e.g., the costs of obtaining third-party hardware in... Health care technology issues in home care

Marshelle Thobaben RN, C, MS, FNP, PHN Available online 9 April 2004.

,

,†

Abstract

Every 2 years the Federal Bureau of Labor Statistics updates its employment outlook for the next decade. In its publication, The Occupational Outlook Handbook, 1998–1999 edition, the agency projects that employment in home health care is expected to grow the fastest of all health care sections in the next decade. One of the main reasons for this trend is advances in health care technology that have allowed health care activities once performed only in hospitals or physicians' offices to be performed in clients' homes.

Article Outline
• References Corresponding author. Address for correspondence: Marshelle Thobaben RN, C, MS, PHN, FNP Department of Nursing Humboldt State University Arcata, CA 95521


Marshelle Thobaben, RN, C, MS, PHN, FNP, is a professor of nursing at Humboldt State

Sponsor Documents

Or use your account on DocShare.tips

Hide

Forgot your password?

Or register your new account on DocShare.tips

Hide

Lost your password? Please enter your email address. You will receive a link to create a new password.

Back to log-in

Close