Chapter 7 Computer Applications in Respiratory Care Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier

Chapter 7

Computer Applications in Respiratory Care

Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an

imprint of Elsevier Inc.

Learning Objectives

2



• Describe computer applications in clinical care, education, and research.

• Retrieve evidence-based information.• Outline steps to maintain security and

confidentiality.

Computer Applications

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• Relied upon by healthcare team in clinical care, diagnostics, management, education, & research

• Hospital information systems – Support hospitals’ administrative & clinical

missions– Permit virtual chart review of clinical data at both

central & remote locations– Allow clinicians access to blood gas reports, chest

radiographs, blood test results, etc… from all parts of health care system

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Computer Applications (cont.)

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• Respiratory care management information systems include:– Charting & billing– Assign respiratory care orders– Manage staff productivity– Report clinical results– Execute respiratory care protocols


• Respiratory Care Practitioners– Must know how to efficiently retrieve electronic

information• From evidence-based resources

– Implement best practices & improve patient outcomes


imprint of Elsevier Inc.7



All of the following are functions of a respiratory care management information system, except?

A.Charting and billing

B.Manage staff productivity

C.Blood gas results

D.Assign respiratory care orders

Applications in Clinical Care

• Mechanical Ventilators—use of microprocessors– Control flow and pressure for triggering, limiting, & cycling breaths– Equilibrate measured values w/ target values– Control ventilator alarms– Archive history of set & measured values– Aim to enhance patient-ventilator synchrony via automation that is

highly responsive to patient• Mode examples:

– Proportional assist ventilation – Neutrally adjusted ventilatory assist



Applications in Clinical Care (cont.)• Automation of patient-driven protocols

– Accurate & consistent documentation of ventilator settings

– Automated protocols can assist with spontaneous breathing trials. (e.g., for ventilator weaning & management of acute respiratory distress syndrome (ARDS)

– Computerized ventilator charting applications • Improve quality & consistency of ventilator

charting• Improve patient outcomes (evidence based)





How does the use of microprocessors benefit the use of mechanical ventilation ?

A.They equilibrate measured values with target values

B.They help extubate patients

C.They alarm when the patient is due for a treatment

D.They can do a timed ventilator check on their own

Applications in Diagnostics

• Hemodynamic Monitoring– Thermodilution technique used in pulmonary

artery catheters; computers calculate cardiac output

– Thermistor is linked to computer– Reads subsequent change in temperature of

solution & deduces amount of blood flow or cardiac output



Applications in Diagnostics (cont.)

• Blood Gas Laboratories– Computerized blood gas analyzers – Allow for immediate results– Computer assisted quality assurance



Applications in Diagnostics (cont)

• Pulmonary Function Laboratories – Computer algorithms aid in interpretation of

pulmonary function tests (PFTs)– Include spirometry, lung volume, diffusing

capacity, & bronchodilator response Most cardiopulmonary exercise & metabolic

measurement systems use desktop or notebook computers





Clinical Decision Support• Information technology Applications

– Assist clinicians w/ preventive measures, diagnosis, & drug dosing– Useful in preventive care, vaccination & screening reminders,

counseling & adherence to medications– Response to critical laboratory values– Evidence-based care – Clinical practice guidelines – Chronic disease management– Communicates recommendations to clinicians via hospital information

systems, email, pagers, mobile phones, or printouts



Clinical Decision Support (cont.)

• Decreases unnecessary hospital admissions – By decreasing inappropriately diagnosed diseases

• Improves respiratory disease care—(e.g. decreased tidal volume & more consistent monitoring of plateau pressures)

• Improves patient clinical outcomes by determining optimal drug dosages– Faster time to achieve therapeutic drug levels– Reduced toxic drug levels– Decreased adverse drug reactions– Decreased hospital length of stay





Clinical decision support has helped decrease unnecessary hospital admissions for which of the following inappropriately diagnosed diseases?

A.CHF

B.Myocardial infarctions

C.Cardiac ischemia

D.Asthma


• Telemedicine– Use of computers & telecommunications to

provide patient care in remote sites– Access to diagnosis, monitoring, & treatment for

medically underserved who are geographically far away

– Used in home care, emergency departments, & intensive care units (ICU)






• Treatment of Tobacco Use & Dependence– “eHealth” applications– Online, individually tailored treatment – Support via e-mail, texting, adjunct to quitline counseling

Management of Chronic Respiratory Diseases 7 out 10 deaths in U.S. from chronic disease As “baby boomers” age, population of 65 or older is

expected to double Computers & “Ehealth” applications can help provide

cost-effective care of patients with chronic pulmonary disease



Clinical Decision Support (cont.)• Asthma

– Monitor patient data to tailor plan of care– Improvement in knowledge, self-management skills, peak flow rates,

adherence to inhaled corticosteroid controller medications– Fewer symptoms, missed school days, nighttime awakenings,

emergency department visits, hospitalizations; improved level of control over time

• Chronic Obstructive Pulmonary Disease (COPD) – Education, self-management, & health care provider feedback




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• Improved outcomes include:– Earlier identification of deteriorating symptoms– Better response to exacerbations– Increased rate of sustained exercise after

pulmonary rehabilitation– Decreased emergency departments visits &

hospitalizations



“E-Health” applications for COPD patients have facilitated all of the following, except?

A.education

B.self-management

C.feedback from health care providers

D.assisting with a diagnosis

Information Retrieval

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• Enhances clinical expertise by providing information

• Vital to development of evidence-based patient protocols– Aids in clinical decisions for individual patients

• World Wide Web– Google Scholar—search engine for scholarly

publications

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Information Retrieval (cont.)

• PubMed (includes MEDLINE)– National Library of Medicine’s free search engine

for health information– Uses Boolean Logic– Users can combine search words or phrases with

connectors such “AND” or “OR” (narrows or broadens searches)









Information Retrieval (cont.) OVID search engine– Extensive collection of Web-based resources:

• Databases• Journals• Books• Searching software

– Used by medical libraries & large hospitals – Medical research articles– Practical instructional handouts for patients– Medical Encyclopedia– Videos of various surgical procedures– Online interactive tutorials for users





All of the following is a valuable aspect of information retrieval in evidence-based respiratory care?

A.Dictates patient interaction

B.Provides evidenced based patient protocols

C.Automates clinical decisions for whole groups

D.Uses cost effective techniques

Applications in Management & Administration

• Respiratory care managers – Use computer applications to plan, organize,

direct, evaluate

• Electronic health records – Patient medical records available across

continuum of care & varying geographic locations



Applications in Management & Administration

• Respiratory Care Management Information Systems– Organize & assign orders, measure staff

productivity, report clinical results, & execute respiratory care protocols

– Handheld computers facilitate organization & assignment of workload, fulfillment of physician orders, & improve documentation



Applications in Management & Administration (cont.)

• Benchmarking– American Association for respiratory Care (AARC)

provides an online benchmarking system– Managers can compare performance of their

department with that of similar departments– Valuable for planning, organizing, directing, &

evaluating– Benchmarked incidence of ventilator associated

pneumonia (VAP) in their hospital to that reported to the National Nosocomial Infections Surveillance (NNIS) system







• Hospital information system (HIS) – Form of communication & information

processing.– Includes networks, computer hardware &

software, & computerized patient records– Patient billing, reimbursement, &

communication– Means to report results

• Electronic Health Records– Improves access to patients’ updated health

information for clinicians & patientsCopyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an





Applications in Education

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• Clinical simulators– Computerized simulators: powerful learning

aids– Software for clinical scenarios – Simulated vital signs & physical examination

(e.g. complex airway management or advanced life support situations)

– Help develop psychomotor, critical thinking, decision making, & team building skills

Applications in Education (cont.)







• DataARC—for documenting clinical educational activities– Secured, password-protected, Web-based data

management system– Functions include time clock, daily log for

completed procedures & activities– Instructors validate competency evaluations – Includes surveys to accommodate questionnaires

for students, graduates, & clinical affiliatesCopyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an






• Computerized testing for NBRC credentialing of Respiratory Care Practitioners

• Distance Education– Use interactive video networks & internet to

deliver courses– Improves access to education for students in rural

areas




• Pulmonary Artery Catheter Education Project (www.paep.org) – Provides excellent online training in hemodynamic

monitoring– Includes Web casts w/ audio & slides; pre- & post-

testing for each module; case studies for many of modules



http://www.paep.org/

Applications in Research

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• Data sources– Data sources for outcomes research (e.g., birth

and death rates in certain populations)– E.g. National Health & Nutrition Examination

Survey (NHANES)• Data collection

– Handheld computers– Web-based surveys

• Statistical tests– SPSS, SAS, Statistical

Applications in Research (cont.)

• Protection of human research subjects– Research w/ human subjects must have ongoing

approval of institutional review board (IRB)– Use information technology systems to help

regulate researcher’s compliance w/ regulatory requirements



Security & Confidentiality

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• Prevention of infiltration by malicious software– Use of firewalls to filter exchange of information

w/ internet• Confidentiality

– HIPAA regulations concerning confidentiality are pertinent to electronic medical records & research data containing personal health information

– Patient data must be kept in password-protected files

– Access to patient files should be on a need-to-know basis

– Thumb-print protected security

Documents

Chapter 7 Computer Applications in Respiratory Care Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier