Introduction To Health Informatics WK5-A

Final Assignment

For  the Final Assignement, you will prepare a four- to five-minute audiovisual  presentation on a health informatics topic that includes the following:

• Audiovisual format: To meet the audiovisual  requirement, your project must contain something to see and something to  hear; however, the format is up to you. Be sure to copy the link to  your video, paste it into a Word document and upload the document using  the Assignment Submission button. Please review the following list of  suggested free software:
  • Screencast-O-Matic (Links to an external site.)Links to an external site. is a freely available online tool that allows you to create and share screencasts.  Review the Screencast-O-Matic Quick-Start Guide (Links to an external site.)Links to an external site. for more information to help you get started.
  • You may also search on your own to locate a program of your choice.

Note: If you have difficulty creating or  viewing videos using the programs above, you may need to update your  browser.  To perform a browser check, view this HelpNow! video (Links to an external site.)Links to an external site. and learn how to update your browser.

• Title page: Include a title page with the following:
  • Title of Final Project
  • Student’s name
  • Course name and number
  • Instructor’s name
  • Date submitted
• Topic: During this course, we explore many different  components of health informatics.  Pick a topic of interest to you and  prepare a four- to five-minute video.  This should reflect new  information and not be a recap of information learned in this course or  another course. Choose one topic from the list:
  • Evidence-based practice and informatics
  • Telehealth
  • Public health informatics
  • The evolving ePatient
  • International efforts, issues, and innovations related to informatics
  • Simulation in health care
  • Analytics and design-led innovations and management
  • Big data: challenges, opportunities, and realities
  • Incorporating mobile devices and sensors into daily routines.  The  potential impact for mHealth is enormous. For example, an individual  might spend 15 minutes or less per year with a primary-care physician,  whereas the same person has nearly constant contact with a mobile  device.
  • Applying clinical care guidelines on, and within, mobile platforms
  • Gathering and using data (particularly intensive longitudinal data) to study effectiveness of an mHealth intervention
  • Consumer informatics
  • Applications of social media in health care
  • Biomedical applications based on sensor data
  • Chronic disease management and preventative solutions
• Content:
  • The four- to five-minute presentation should be set up as a staff educational session on your selected topic.
  • Your presentation must:
    • Define your topic and explain its relevance to health informatics.
    • Describe any ethical issues associated with your topic.
    • Describe any associated laws, regulations, or voluntary standards that are relevant to the topic.
    • Explain how the topic relates to or impacts health care delivery, administration, education, data administration, or research.
    • Summarize associated data capture tools and technologies.
    • Describe a specific example of your topic in use in health care.
• References: Include five scholarly references, in  addition to the textbook, formatted according to APA style as outlined  in the Ashford Writing CenterChapter 31 Future Directions and Future Research in Health Informatics

  Nancy Staggers

  Ramona Nelson

  David E. Jones

  Health informatics can be described as an interprofessional discipline that is grounded in the present while planning for the future.

   

  Objectives

  At the completion of this chapter the reader will be prepared to:

   

  1.Explore major trends and their implications for future developments in healthcare, health informatics, and informatics research

  2.Analyze techniques and challenges of planning for future directions and trends

  3.Apply futurology methodologies in identifying trends and possible, probable, and preferred futures

  4.Describe the field of nanotechnology and its subdisciplines, the role of informatics in nanotechnology, and implications for healthcare

  5.Analyze the advantages and disadvantages of nanotechnology in health and health informatics

   

  Key Terms

  Backcasting, 499

  Cytotoxicity, 505

  Data visualization, 502

  Extrapolation, 497

  Futures research, 495

  Nanofabrication, 503

  Nanoinformatics, 505

  Nanomedicine, 504

  Nanotechnology, 502

  Trend analysis, 497

  Abstract

  This chapter expands on the future directions sections included in the individual chapters to provide broad guidance about the future of informatics. First, healthcare trends in society are outlined. Second, futures studies or futurology (methods to analyze probable future directions in any field) is discussed. Third, an overview of potential future directions in informatics are discussed, including the following informatics trends: (1) patient engagement, consumerism, and informatics; (2) electronic health records (EHRs) 2.0; (3) usability and improving the user health information technology (health IT) experience; (4) big data and data visualization; and (5) nanotechnology and nanoinformatics. The last trend is discussed in more detail as an example of the major influence each of these trends will likely have on the future of healthcare and society as a whole. The organization and depth of the nanotechnology-related content also provides a guide for readers to develop similar material in informatics areas of specific interest.

  Introduction

  Informatics will play a large role in the future of healthcare. Which informatics trends will prevail and in what depth is unclear. In each of the chapters in this book authors outlined expanding areas of influence, from knowledge discovery to the epatient, from cloud computing to standards integration with public health data sharing, and from initial EHR installations to mobile health. In this chapter unequivocal healthcare trends are listed, followed by methods that readers may use to predict likely trends in the future. These techniques are called futurology or futures research methods. Subsequently, five major trends are discussed: (1) patient engagement, consumerism, and informatics; (2) EHRs 2.0; (3) usability and improving the user experience for health IT; (4) big data and data visualization; and (5) nanotechnology and nanoinformatics. Special attention is given to nanotechnology and nanoinformatics.

  The purpose of informatics is to provide support for clinical care, public health, and other practices. Thus to understand the future of health informatics, major health trends need to be acknowledged. Examples of unequivocal trends in society include:

   

  •Rising healthcare costs. In the U.S. alone, costs are expected to nearly double to $4.5 trillion by 2019, up from $2.5 trillion in 2009.1

  •Aging populations. By 2050 the global population of those aged 60 years or older will be more than 2 billion.2

  •Increase in patients with chronic diseases. By 2030 chronic diseases will be the leading cause of deaths worldwide.3 Diabetes rates alone will increase by 2.8% to 4.4%.4

  •Predicted shortage of healthcare providers. By 2025 the U.S. will have a shortage of an estimated 260,000 registered nurses5 and 124,000 physicians.6

  •Health insurance reform. Several health reform measures are scheduled to take effect in 2014, according to the provisions of the Patient Protection and Affordable Care Act signed into law on March 10, 2010.7

   

  These trends clearly have implications for informatics support in the future but how does one determine or perhaps even create future trends? Futures research or futurology, the methods used to determine future trends in any field, may help to answer this question.

  Futures Research or Futurology

  Health informatics can be described as an interprofessional discipline that is grounded in the present while planning for the future. Health informatics specialists are selecting and implementing today’s healthcare information systems, thereby creating the foundation for the systems of tomorrow. By reviewing current trends and predictions, as well as employing tools for predicting and managing the future, health informatics specialists can prepare for their leadership role in planning for the effective and innovative healthcare information systems of the future. This section introduces the reader to levels of change that can be anticipated in future trends. By analyzing methodologies and tools for predicting, planning for, and managing the future, health informatics specialists are introduced to the kind of leadership roles they will play in planning future healthcare information systems. With a better understanding of the potential future, informatics professionals can make better current decisions.

  Defining Futures Research or Futurology

  Futures research is the rational and systematic study of the future with the goal of identifying possible, probable, and preferable futures. The formal study of the future goes by a number of names, including foresight and futures studies, strategic foresight, prospective studies, prognostic studies, and futurology. Using a research approach to formally study the future began after World War II. Since that time a number of institutes, foundations, and professional associations were established supporting the field of futures studies. Examples of these are included in Box 31-1. However, from the beginning, this field of study aroused skepticism. Today researchers and corporate strategists may use numerous concepts, theories, principles, and methods that are based on the field of futures research but they may not associate these methods with the field of futurology.8 A number of educational programs related to futures studies now use the various futurology terms to describe their programs. Box 31-2 includes examples of educational programs related to this field. Despite the initial skepticism about the topic, today the futures studies techniques are accepted, educational programs are available, and these methods can be very useful for informaticists.

  The focus of futures studies has evolved over time. Initially, futures studies tended to focus on a longer time horizon of at least 10 years. Today researchers are typically studying the world anywhere from 5 to 50 years from now.9 This creates an overlap of futures studies with traditional forecasting and planning disciplines that examine political, economic, and market trends on a 1- to 5-year horizon.

  Health informatics can use traditional forecasting and planning methods in combination with futures studies methods as well as futures studies. Strategic planning in health informatics typically focuses on projects 1 to 3 years in the future. Institutional long-range planning tends to focus on 5 to 10 years in the future. For example, vendor contracts for major healthcare informatics systems often cover a 5- to 10-year period spanning both strategic and long-range planning. However, there are some differences between forecasting and futures studies.

  First, forecasters focus on incremental changes from existing trends while futurists focus on systemic, transformational change. Second, futurists do not offer a single prediction. Rather, they describe alternative, possible, and preferable futures, keeping in mind that the future will be created, in most part, by decisions made today. The technical, political, and sociocultural infrastructure being built today will have a major impact on the choices of tomorrow. Both types of change are key to planning health informatics products.10 Understanding the impact of future trends and using this information for planning begins by understanding the degree and scope of change that occurs over time.

  Box 31-1 Futures Studies: Selected Associations, Institutes, and Foundations

   

  • Acceleration Studies Foundation, http://accelerating.org/index.html

  • Copenhagen Institute for Future Studies, www.cifs.dk/en/

  • Foresight Canada, www.foresightcanada.ca/

  • Fullerton and Cypress Colleges, and School of Continuing Education: Center for the Future, http://fcfutures.fullcoll.edu

  • The Arlington Institute, www.arlingtoninstitute.org

  • Association of Professional Futurists, www.profuturists.org

  • The Club of Rome, www.clubofrome.org

  • The Futurist, www.wfs.org/futurist/about-futurist

  • Institute for the Future, www.iftf.org/home

  • The Millennium Project, www.millennium-project.org

  • World Future Society, www.wfs.org/node/920

  • World Futures Studies Federation (WFSF), www.wfsf.org

   

  Box 31-2 Selected University Programs in Futures Studies

   

  • EBS Business School: Institute for Futures Studies and Knowledge Management, www.ebs.edu/11866.html?&L=1

  • Regent University: School of Business & Leadership, www.regent.edu/acad/global/degree_programs/masters/strategic_foresight/home.cfm

  • TamKang University: Graduate Institute of Futures Studies, http://future.tku.edu.tw/en/1-4.htm

  • University of Advanced Technology, http://majors.uat.edu/Emerging-Tech

  • University of Hawaii: Hawaii Research Center for Futures Studies, www.futures.hawaii.edu/academic-offerings.html

  • University of Houston: College of Technology, www.houstonfutures.org/program.html

  • University of Stellenbosch: Institute for Futures Research, www.ifr.sun.ac.za/Home

  • University of Turku: Finland Futures Research Centre (FFRC), www.utu.fi/en/units/ffrc/Pages/home.aspx/

   

  Future Directions and Level of Change

  The 1890 United States census count was finished months ahead of schedule and far under budget by using a punch card counting machine. This technology continued to be used by the U.S. Census Bureau well into the 1950s because the problem to be solved remained basically unchanged. Each decade, the Census Bureau was challenged to count the number of people in the population and certain characteristics about the population. Over the decades the population characteristics to be counted changed but the need to count these data remained the same.

  In the 1950s the Census Bureau introduced new technology in the form of computers and magnetic computer tape. The basic problem remained the same but new technology offered more efficient and effective methods for solving that problem. The Census Bureau’s introduction of new technology is an example of a first-level change. With a first-level change a new technology solves a problem in a more efficient or effective manner.

  For example, replacing a typewriter with a word processer is an example of a first-level change. One is still producing a document but the technology makes the process more effective and efficient. Another example is the use of Bar Code Medication Administration (BCMA) methods. Scanning a bar code before administering medication can make the process of administering medication safer. However, scanning bar codes does not change the basic role or responsibility of healthcare providers. Within the levels of change, first level change is the least disruptive and the most comfortable level of change. In many ways requests that new technology be designed to fit the work-flow of healthcare providers is, in reality, a request, or perhaps a demand, for first-level change only. In fact, if the equipment and related procedures do not support the current roles and responsibilities of the healthcare providers, they quickly develop workarounds to meet their requirements that the degree of change be limited to a first-level change.

  A second-level change involves changing how a specific outcome is achieved. For example, historically the peer review process used by professional journals involved sending a submitted manuscript to a limited number of selected experts for an anonymous opinion. The goal was to ensure that only the highest quality articles were published. The process of review and revision could take several weeks or months. In addition, with a limited number of experts screening what is published, some degree of professional censorship existed. Articles representing a paradigm shift in thinking risked being rejected as not on target by a limited set of reviewers. Today, professional online journals, where all readers can comment on material, are changing who is involved and how the peer review process is completed, with comments from readers assuming a more important role than in the past. Similarly, patient groups within social media applications are changing how patients learn about their health problems. Groups of patients help each other to read and interpret the latest research to create a whole new level of health literacy within these groups. Social media interactions not only change the process for achieving an outcome, but also change the relationships between the participants. For example, as patients become organized and knowledgeable, they take a more active role in their own care and move from the role of patients needing education about their diseases into more of a colleague role, sharing new and innovative findings with healthcare providers.

  The scope of change at this level creates both excitement and anxiety within professional groups and among individual healthcare providers. The scope of practice, policies, procedures, and established professional customs, such as professional boundaries, are challenged and resistance to this challenge can be expected. For example, in healthcare the goals of improved health for individuals, families, groups, and communities have not changed but technology is changing the roles and responsibilities related to how these goals might be achieved.

  A third-level change alters the process and can also refocus the goal. For example, a hyperlinked multimedia journal, with a process for adding reader comments and linking to related publications, may change not only the definition of an expert, but also the historical gold standard for review of new information and knowledge. Another example can be seen in the use of knowledge discovery and data mining with big data to discover clusters and relationships, as opposed to using a theory and hypothesis to develop a traditional clinical trial, thereby redefining (or at least expanding) the concept of research. Third-level change involves changes at the societal and institutional level, typically occurring over long periods of time. For instance, the evolving role of the nurse from a handmaiden for the physician to a leader in healthcare delivery can be seen as a third-level change.

  Today, innovations in healthcare and computer technology are interactively creating first-, second-, and third-level changes, creating the future of healthcare within a society that is also undergoing change at all levels. Informatics experts are among the key leaders managing and guiding these change processes within healthcare. However, they face a number of challenges in achieving these goals.

  The Challenge of Anticipating Future Directions

  In 1970 Alvin Toffler published the book Future Shock.11 One of the themes in the book was “what happens to people when they are overwhelmed by change. It is about how we adapt or fail to adapt to the future.”11(p1) Interestingly, Future Shock was written long before the widespread use of personal computers or the Internet. Today innovations in practice and technology are changing healthcare delivery at an ever-increasing speed. As Toffler identified many decades ago in a slower-paced world, for many the degree and speed of change is overwhelming. This includes people in healthcare in the midst of a knowledge explosion who must do more than just adjust to overwhelming change.

  While there are no research methods for predicting the future with absolute certainty, techniques can be used to rationally predict future directions and trends. A historical example of this is the publication of the book Megatrends by John Naisbitt in 1982, well before the general population was even aware of the Internet or the potential of owning a computer. Megatrends are trends that affect all aspects of society. The 10 trends identified by Naisbitt are listed in Box 31-3. These trends, identified many years ago, continue to have a major influence on health informatics today.

  While health informatics specialists clearly recognize the importance of planning and the long-term implications of building today’s healthcare information systems, there are immediate challenges in thinking about the future. First, present issues are often more pressing and take a higher priority over tasks that can wait for another day. This type of thinking is sometimes referred to as “putting out fires.” For example, a health informatics specialist may spend an afternoon answering users’ questions but as the number of communications increases, the notes documenting these calls can become increasingly sparse. Trends and patterns that could be used as a basis for a new education and training program, or for upgrading functions in the current healthcare informatics system, can be lost in the pressing demands of the moment.

  Box 31-3 Naisbitt’s Megatrends for the 1980s

   

  Industrial society → Information society

  Forced technology → High tech/High touch

  National economy → World economy

  Short term → Long term

  Centralized → Decentralized

  Institutional help → Self-help

  Representative democracy → Participatory democracy

  Hierarchies → Networking

  North → South

  Either/Or → Multiple options

   

  Second, small rates of growth often seem insignificant. However, major trends start from small, persistent rates of growth. This is especially true when dealing with exponential growth. A few years ago very few patients asked for copies of their health reports and a very small percentage of those patients would have considered accessing their healthcare data via the Internet. In August 2012 the Veterans Health Administration (VHA) reported that the one millionth patient had used the Blue Button application to download data from his or her personal health record (PHR).12

  Third, there are intellectual, imaginative, and emotional limits to the amount of change that individuals and organizations can anticipate. The imagined future is built on assumptions developed in the past and therefore includes gaps and misinterpretations. Future predications can seem vague and the farther one looks into the future, the more disconnect there is between the present and the significance of the future. For example, nurses educated in small diploma schools 50 years ago usually called a physician to restart an intravenous (IV). Nurses from that time period would have struggled to anticipate the high levels of responsibility common in today’s staff nursing role.

  Approaches for Predicting

  Qualitative and quantitative methods are used in traditional forecasting and planning as well as by futurists to foresee, manage, and create the future. The use of established research methods separates these researchers from soothsayers. Multiple methods used in concert are needed to identify and address future challenges. Selected examples of these methods are presented here. In addition, Box 31-4 includes resources for exploring a number of other methodologies used in this field of study.

  Trend Analysis and Extrapolation