Discussion: Integrating PHRs Into EHR Platforms

When electronic health records (EHRs) first entered the market, their primary focus was to collect and analyze patient information within health care settings. As technological capabilities grew, so did the interest in making these records available to patients. In addition, many health care professionals saw benefits in allowing the patient to enter his or her own health data into EHR platforms. Though many patients are already utilizing personal health records (PHRs) to manage and track their own health, some believe that an integrated system would provide a better, more comprehensive picture of a patient’s health history.

As a result, many EHR platforms are now equipped with a PHR tool. This PHR tool allows patients to enter health information as they would in a stand-alone PHR system. In addition, web-based portals within the EHR allow patients to access information entered by their physicians and health care providers.

Like many emerging trends and technologies, there is much discussion about the potential benefits and challenges of this type of integrated system. While many health care professionals are excited about the empowerment provided to patients, others express significant concerns about access, security, ethics, and other implications.

In this Discussion, you explore how integrating PHRs into EHR platforms could impact you and your patients.

To prepare:

• Review the media Patient-Centered Technologies, and reflect upon Dr. Simpson’s statements about the ownership of patient data.
• Review the article, “Dreams and Nightmares: Practice and Ethical Issues for Patients and Physicians Using Personal Health Records” found in this week’s Learning Resources. Consider how PHR capabilities can be integrated into EHR platforms.
• Examine the “dreams” and the “nightmares” the authors associate with this type of integrated health record. Select one benefit or one challenge of integrating PHRs into EHR platforms. Then, consider its potential impact on health care providers and patients. Why is this considered to be a benefit or challenge for health care professionals and patients?

By Day 3

Post a brief description of your selected benefit (I choose Promoting data use or Promoting responsibility) or challenge and support your selection. Explain the potential impact on health care professionals and patients.

APA Style, 600 characters minimum (not including the reference on this 600 words count)

 

As I write above, I choose Promoting data use or Promoting responsibility one of those. 

Required Readings

Saba, V. K., & McCormick, K. A. (2015). Essentials of nursing informatics (6th ed.). New York, NY: McGraw-Hill.
Review Chapter 1, “Historical Perspectives of Nursing Informatics”
In this chapter, the authors explain the transition from paper-based records to electronic records. The chapter provides an overview of the historical events that contributed to the rise of electronic health records. 

Chapter 25, “Care Delivery Across the Care Continuum: Hospital-Community-Home”
Chapter 25 analyzes the impact of home health on the health care system. The chapter explains the current level of home health technology and how the Patient Protection and Affordable Care Act (PPACA) changes this aspect of health care. 

Chapter 44, “Initiation and Management of Accessible, Effective Online Learning”
This chapter explores the past and present perspectives of distance education, important teractive electronic tools and essential strategies for the online learner. 

Chapter 45, “Social Media in the Connected Age: Impact on Healthcare Education and Practice”
The focus of this chapter is on the evolution of the Internet, mobile tools and the use of social media in healthcare education. 

Chapter 35, “Consumer/Patient Engagement and eHealth Resources”
As access to health care information increases, patients are becoming more informed about and engaged in their health. This chapter discusses current trends in health care, including patient empowerment, consumerism, and widespread use of computers and technologies for health.

Crilly, J. F., Keefe, R. H., & Volpe, F. (2011). Use of electronic technologies to promote community and personal health for individuals unconnected to health care systems. American Journal of Public Health, 101(7), 1163–1167.
Retrieved from the Walden Library databases.

The authors of this article describe technologies that have been used to increase access to health care for underserved populations. The authors present strategies, benefits, and challenges of addressing this issue, and they provide examples of successful programs.

Walker, J., Leveille, S. G., Ngo, L., Vodicka, E., Darer, J. D, Dhanireddy, S., … Delbanco, T. (2011). Inviting patients to read their doctors’ notes: Patients and doctors look ahead: Patient and physician surveys. Annals of Internal Medicine, 155(12), 811–819.
Retrieved from the Walden Library databases.

In this article, the authors discuss the results of their study on the outcomes of allowing patients to read their doctors’ notes. The study highlights the benefits of sharing notes with patients and how doing so can promote better outcomes.

Wynia, M., & Dunn, K. (2010). Dreams and nightmares: Practical and ethical issues for patients and physicians using personal health records. Journal of Law, Medicine & Ethics, 38(1), 64–73.
Retrieved from the Walden Library databases.

The authors of this article highlight the primary uses and benefits of personal health records (PHRs) as an electronic health record (EHR) tool. In addition, the article presents an overview of practical and ethical issues that may emerge from integrating PHR components into EHR systems. 

 

1. During morning rounds, your patient states, “I will never get better, I can’t get any sleep in this place…can you help me?”  What are some independent nursing interventions you could implement to assist this patient?”

2.  What is your family’s cultural background?  How do your various family members respond to pain?  Is your response to pain consistent with your cultural influence?

3.  As a nurse, how would you respond if you were caring for a patient with a terminal illness who said to you, “I am in such pain and I can’t take it anymore, please help me die now.”

4.  A patient is stressed about an upcoming surgery and asks you to pray with her.  Would you?  Is this the role of the RN?  How could you facilitate prayer with the patient?

 Respond to at least two of your  colleagues who were assigned to a different case than you. Explain how  you might apply knowledge gained from your colleagues’ case studies to  you own practice in clinical settings. 

NOTE: Positive Comment

                                       Main Post

      Case #13 the 8-year-old girl who was naughty  

         

This  case study will examine an 8-year-old girl who initially presents to  the pediatrician’s office with complaints of a fever and sore throat.  After further examination, the client is diagnosed with attention  deficit hyperactivity disorder (ADHD) and oppositional defiant disorder  (ODD). According to Ghosh, Ray, & Basu (2017), characteristics of  ODD include persistent anger or irritable mood, argumentativeness,  defiance, and vindictiveness for at least 6 months. ADHD is  characterized by a pattern of inattention, hyperactivity, and  impulsivity that interferes with daily functioning or development  (American Psychiatric Association, 2013). 

3 Additional Assessment Questions for the Client:

1.  I would ask the client and her mother how often her daughter displays  symptoms that are congruent with ODD and? According to the authors  Ghosh, Ray, & Basu (2017), the occurrence of ODD symptoms must be  disproportionate to the child’s developmental stage and age. 

2. I  would ask the client if she had trouble learning in class when she was  younger. The onset of ADHD symptoms usually occurs before a child  reaches age 12, and in some children, these symptoms are noticeable at  age 3 (Sibley, Rohde, & Swanson, 2017). 

3. A  final question that I would ask the client is if she interrupts her  classmates when they are speaking. Children suffering from ADHD feel the  need to be constantly active and struggle with controlling impulsive  behaviors (American Psychiatric Association, 2013).  

Feedback From the Client’s Loved Ones

The  first person in this client’s life that I would like to further  interview is the client’s mother. According to Stahl (2019), the  client’s mother is 26 years old and is a single parent of two children,  ages 8 and 6. I would want to ask the client’s mother more about her  daughter’s academic performance in earlier grades. Identifying the  precise onset of the client’s ADHD symptoms will assist the provider in  creating the most appropriate treatment for the client (Stahl, 2014). I  would also like to interview the client’s teacher in order to gain  another perspective on the client’s behavior in the classroom. The  client’s teacher did use an ADHD rating scale, but scales of that nature  are very broad and do not elaborate on the child’s specific classroom  behaviors. A third person that I would interview is the client’s  6-year-old sister. According to Stahl (2019), the client began  displaying signs of anger and resentfulness when her sister was born. I  would ask the client’s sister if she felt safe at home and if she and  her sister fought often, in order to determine if the home environment  is safe for both children. 

Physical Exams and Diagnostic Tests

The  physical assessment of the client is essential for developing an  appropriate diagnosis and treatment plan. Visual assessment of the  client’s behaviors during the physical assessment will be extremely  useful to the provider. The provider would also want to obtain and  review the client’s report cards along with any behavior reports, and  attendance records from the client’s school (Adesman, 2011). The  healthcare provider should also review the client’s pediatric health  records to see if her symptoms are congruent with a learning disability,  auditory processing disorder, signs of language delay, spacial  orientation confusion, and complete a more thorough family history  involving learning disabilities (Adesman, 2011). A complete blood count  should be down to rule out physical illness as a causetive factor for  the client’s ODD symptoms. The client is currently suffering from a  fever and sore throat, which could be an indicator of PANDAS (pediatric  autoimmune neuropsychiatric disorder associated with streptococcal  infections). Since  the client does have a current sore throat, a rapid strep test should  be ordered. If the client does test positive for strep, it could explain  the client’s symptomologies impulsivity, temper tantrums, and aggressiveness.  

Differential Diagnoses

Autism Spectrum Disorder: there  are deficits in social-emotional reciprocity, ranging from an abnormal  social approach and failure to communicate in a standard back-and-forth  conversation (American Psychiatric Association, 2013). There is also a  reduced sharing of interests, emotions, or affect, along with a failure  of the patient to initiate or respond during social interactions (American Psychiatric Association, 2013). The client’s history does not show any indication of impaired communication. 

Conduct Disorder:  characterized by behavior that violates either the rights of others or  major societal norms, the symptoms must be present for at least 3 months  with one symptom having been present in the past 6 months. The symptoms  of conduct disorder must cause significant impairment in social,  academic or occupational functioning (American Psychiatric Association,  2013). Per the client’s medical record, her symptoms fit the time frame  for conduct disorder, however, her behavior is not this severe in  nature. 

ADHD with Co-occurring ODD: The authors Ghosh, Ray, & Basu (2017), describe the characteristics  of ODD as persistent anger or irritable mood, argumentativeness,  defiance, and vindictiveness for at least 6 months. ADHD is  characterized by a pattern of inattention, hyperactivity,  and impulsivity that interferes with daily functioning or development  (American Psychiatric Association, 2013). The client’s behavior is  congruent with ADHD with co-occurring ODD.

Pharmacological Agents for ADHD/ODD Therapy: 

Risperdal  is the first pharmacological agent that I would choose for this client.  This medication is not listed on the suggested medication list of the  case study, however, the medication list does list “other” as a possible  choice. According to Stahl (2014), Risperidone  is also used to treat behavior problems such as aggression,  self-injury, and sudden mood changes in teenagers and children 5 to 16  years of age. Risperidone  is in a class of medications called atypical antipsychotics. It works  by changing the activity of certain natural substances in the brain. The  second medication that was chosen for this client is Vyvanse.  Vyvanse increases norepinephrine and dopamine actions by blocking their  reuptake and creating an environment that allows their release (Stahl,  2013). Vyvanse also causes an enhancement of dopamine and  norepinephrine in specific areas of the brain that may improve  attention, concentration, executive dysfunction, and wakefulness (Stahl,  2013). According to Stahl (2014), it is thought that the increased  dopamine action caused by Vyvanse, may help with hyperactivity. I would  initially start this client on Vyvanse due to its efficacy in treating  symptoms of ADHD. If the child’s academic performance and classroom  behavior improve, perhaps ODD symptoms will improve. 

   

CheckPoints: 

According  to Stahl (2019), the closest child psychotherapist is an hour away,  therefore the client did not receive therapy. I would refer the client  and her mother to case management in order to connect the client with  resources that are closer to her home. I would also ask the client’s  school what type of resources are available in terms of psychotherapy.

Lessons Learned: 

Through  this case study I have learned that co-occurring childhood disorders  can be difficult to treat. Pediatric clients can respond differently to  medication dosages than adults, so careful dose titration is essential.  Pediatric clients also rely on their parents or caregivers to provide  them with their prescribed medications and transportation to medical  appointments. It is essential that the healthcare provider conveys how  important treatment regime compliance is to both the client and their  caregiver.

Adesman, A. R. (2011). The Diagnosis and Management of Attention-Deficit/Hyperactivity Disorder in 

    

           Pediatric Patients. Primary care companion to the Journal of clinical psychiatry, 3(2), 66-77. 

    

           https://doi.org/10.4088/pcc.v03n0204 

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders

(5th ed.). Washington, DC: Author.

Ghosh, A., Ray, A., & Basu, A. (2017). Oppositional defiant disorder: current insight. Psychology 

    

 research and behavior management, 10, 353-367. https://doi.org/10.2147/PRBM.S120582 

Sibley, M. H., Rohde, L. A., & Swanson, J. M. (2017). Late-Onset ADHD Reconsidered with 

    

            Comprehensive Repeated Assessments between Ages 10 and 25. American journal of psychiatry, 

    

 175(2), 140-149. https://doi.org/10.1176/appi.ajp.2017.17030298 

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (fourth ed.). New York, NY: Cambridge University Press.

Stahl, S. M. (2014). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

Stahl Online. (2019). Volume 1 case #5: The sleepy woman with anxiety. (PDF file). 

Retrievedfrom http://stahlonline.cambridge.org.ezp.waldenulibrary.org/viewPdf?p

age=csEP_05.pdf                

APA format. 350 word (3 paragraphs) Please read all instructions and use the references.MAKE SURE THAT YOU WATCH THE YOUTUBE LINKS  Please let me know if you have any questions.

Consider the following scenario: This is Debbie’s first year working as a nurse at the local health department in a rural county. Most of her days are spent in the clinic seeing clients who often do not have health insurance.

Over the past month, Debbie has noticed that several young Hispanic men have come to the health department, each diagnosed with tuberculosis. Debbie is concerned about what the outbreak of tuberculosis among the migrant workers could mean for the community. Through a community health profile, Debbie identifies the group of migrant farm workers as being at highest risk for contracting tuberculosis.

Using the Epidemiologic Triangle concept, consider the relationship among causal agents, susceptible persons, and environmental factors. Then, respond to the following:

1.As a BSN-prepared community health nurse, what steps should Debbie take next?

2.Considering economic and social considerations within the community, what are the primary, secondary, and tertiary interventions that Debbie might use in managing this outbreak?

3.Can similar interventions be applied to your community and its TB prevalence?

4.What considerations need to be addressed within your community that are different form Debbie’s community?

 References

Stanhope, M., & Lancaster, J. (2016). Public health nursing: Population-centered health care in the community (9th ed.). St. Louis, MO: Elsevier.
Chapter 10, “Environmental Health” (pp. 217–241)
Chapter 12, “Epidemiology” (pp. 256–285)
Chapter 13, “Infectious Disease Prevention and Control” (pp. 286–318)
Chapter 14, “Communicable and Infectious Disease Risks” (pp. 319–341)
Chapter 18, “Community as Client: Assessment and Analysis” (pp. 396–421)
 

  Zuñiga, J. A., Muñoz, S. E., Johnson, M. Z., & Garcia, A. (2014). Tuberculosis Treatment for Mexican Americans Living on the U.S.-Mexico Border. Journal Of Nursing Scholarship, 46(4), 253-262.
 

CDC Wonder. (2016). Retrieved from http://wonder.cdc.gov/

https://www.youtube.com/watch?v=yHQes6P5XnQ