1. Interoperability can only be achieved when provider organizations do the work necessary to participate. Do provider organizations have the necessary incentives to do that work?

2. Private health information exchanges seem to be growing at a faster pace than public health information exchanges. Public exchanges should arguably offer more value to patients and lower costs to provider organizations. Why the discrepancy?

3. The INPC, originated as a research project, was initially funded by grants and one of the ongoing value propositions is research use of the data. Is research necessarily critical to success of a health information exchange?

4. Establishing and operating a health information exchange requires a variety of investments including computing and network infrastructure, software systems of various types, legal and operational costs. Would you agree that data capture and normalization is the largest investment required?

5. Computing infrastructure, networking technology, software and clinical information standards will continue to evolve rapidly and investments in the technology will depreciate relatively rapidly. What are the core assets of an HIE if not these things?

Respond to the 4 colleagues  by suggesting a different way of framing their critical question. Cite sources to support your posts and recommend to colleagues. provide at least 2 references each.

PLEASE RESPOND TO THE FOLLOWING IN 50 WORDS OR MORE:

2. Nursing‐sensitive indicators are the criteria for changes in health status that nursing care can directly affect. Nursing‐sensitive indicators have been increasingly adopted as valid and reliable tools due to their features such as objective assessment, improvement of clinical practice, evaluation of nursing care quality and performance, and informed decision‐making capability for patients in selecting a hospital to receive care. The use of nursing‐sensitive indicators affects the outcomes of nursing care by defining the structure and processes of nursing care. Indicators can be used for quality improvement purposes in applied settings to monitor performance and progress and to support evidence-based decision making, to support informed policy analysis related to regulatory or accreditation requirements, workforce development, and reimbursement, and to research the role of nursing care in determining patient safety outcomes by examining structure-outcome, process-outcome, and structure-process-outcome relationships. I believe that no one nursing sensitive indicator is sufficient on its own for measuring the profession’s impact on patient care and outcomes. Rather, several elements must be considered together to provide a comprehensive view of nursing practices and results, such as patient falls with and without injuries, RN satisfaction survey, nosocomial infections, nursing hours per patient day. Indicators not included in the database statistics, but which professional nurses should consider, nonetheless are patient satisfaction with pain management, patient satisfaction with nursing care. For example, assessment and treatment of pain is complex, and optimal pain care remains elusive. Only 63-74% of patients report that their pain was well-controlled. Personal biases may interfere with healthcare’s ability to accurately assess pain management needs, but nurses who keep in mind the ethical principles of autonomy, beneficence, non-maleficence, and justice will be better equipped to make sound judgments. 

Reference:

Oner, B., Zengul, F. D., Oner, N., Ivankova, N. V., Karadag, A., & Patrician, P. A. (2021). Nursing-sensitive indicators for nursing care: A systematic review (1997-2017). Nursing open, 8(3), 1005–1022. https://doi.org/10.1002/nop2.654

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