Compare Results of Retrieval Processes

The Google search engine was extremely fast and is the process I have used most over the last ten years. However, Google provided 154,000,000 results for medical home which is an incomprehensible number. As I looked at the first few citations, it was interesting how the article we read came to life. One that sounded really good by title was truly an advertising site for electronic training modules and appeared very biased once I looked at the source. the PubMed searches, though broad in the first steps, did reduce the number of credible sources in just four steps total. I did apply MeSH terms, Limits of date terms and added on operational term, "AND cost" to further reduce the search to a much more manageable as well as relevant citation listing. PubMed provided a context relevant option that seemed similar to the automatic concept mapping in NGC that matches terms against a standard table derived from the U.S. National Library of Medicine. When I applied the matching terms, my citations dropped from 25,000 to 1537 in one simple step. I did not apply the use of quotes to locate guidelines bu will need to do that this week for another class. The ability to store these citations for later retrieval is invaluable to me. Though I expect to get faster with practice, I also expect to glean more pertinent information.

RefWorks Management Software Program

RefWorks is a web based program that is available to all students and faculty at the University of Arkansas Medical Science Campus. It has the capacity to import data, convert references from other bibliographic management products, import from saved text files, or from Really Simple syndication Feeds. It allows manually entered references, attaching files to a reference, importing online catalogs. In RefWorks one can create folders, put references into folders, sort references, and globally edit references. RefWorks provides online support, email support, at support@refworks.com and webinars of complimentary training. They have technical support via phone. On our campus, we have a person who is the contact for training users, and she was a valuable support for me.

Clinical Problem and Electronic Index

The clinical problem investigated was: "What is a medical home, and what impact might a medical homes have on the management of chronic disease?" Since it is a broad medical model concept, I decided to stay within the PubMed electronic index believing it to be the most powerful for such a wide survey issues. PubMed provided 25,000 citations. An "also try" feature on the right of the screen suggested adding medical home model to filter the search and reduced the number to 1537 citations. Adding a five year limit reduced the number to 604 publications and the Boolean tool of "AND cost" dropped the number to 94 citations. I ran this search alone and with help a number of times to better grasp how to navigate and narrow the number for more relevant publications. Each time the process grew smoother, and I soon realized that it doesn't matter which steps one takes first or second which reduced my fear of the process considerably. There isn't a substitute for practice. Barriers were mainly my lack of use of the system, my fear of getting totally lost in the steps, and the tutorials along the pathway that were time consuming and a blur as they appear in so many windows. I had to create another log in for utilization of the library and free resources and need an index to keep up with all of the log ins now created over the last few months. As for barriers at work, the clinical I have been working has access to six central shared computers and a number in private side offices allowing on-line searches. No matter where one is in the world, these eresources are available to faculty and providers within our system. One must simply have the knowledge and take the time to look for them.

Probably the most outstanding feature of quality with the usage of informatics in the Ambulatory Care Clinic at the Institute on Aging is that the intradisciplinary team has access to all appropriate and approved features allowing better continuity of care. Clients do not have to give the same informatin repeatedly, once employees are properly trained and approved for accessing the system, the client information is availble at the touch of a screen. The one element that is highly guarded is the psychological testing which has limited access due to the sensative nature of the information stored there. Confidentiality is guarded just as in other hard copy charts.

Structured Documentation Present

Each discipline accesses an electronic patient chart and then moves to review summary or previous visits, medications or labs, then opens and documents the new visit history and physical details along with prescriptions and other orders. The system has flags for follow up and can send postings to others involved on the team with care for each individual patient. There are signatures required and certain elements that must be posted prior to closing the chart and filing it away completed. The system has drop boxes and the ability to look up searches for specific persons such as doctors or elements within a given record.

IT Clinical Happenings

In the Institute on Aging ambulatory care clinic, there are doctors, advanced practice nurses, social workers, dietitians, and pharmacist who provide optimal health decisions for every person who visits the clinic. This team approach happens in an area called the "war room." Other team members are in the same building to assist with physical therapy and occupational therapy when needed. The Institute on Aging was the first on campus to integrate an elaborate informatics program that allows one to access the record and follow the client in all elements of care. The continuity of care is greatly strengthened as a result.

Information Management for Nursing

As an APN, in the University of Arkansas campus system, it is important to be trained on their information systems program in order to access, navigate, and insure confidentiality to client records. Accessing these integrated programs allows one to view lab results, medications and reports of visits to others involved in the care of each client.

I am Sandra N. Berryman, commonly called Sandy. My nursing passion is for care of the elderly. I currently am a Clinical Assistant Professor at the University of Arkansas for Medical Sciences Campus in the College of Nursing. I am the course coordinator for Older Adult Health, which is the geriatric course taught to senior nursing students in a BSN program.