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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
• Describe computer applications in clinical
care, education, and research.
• Retrieve evidence-based information.
• Outline steps to maintain security and
confidentiality.
Copyright © 2013, 2009, 2003, 1999, 1995,
1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
2
Computer Applications
• 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
Copyright © 2013, 2009, 2003, 1999, 1995,
1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
3
Copyright © 2013, 2009, 2003, 1999, 1995,
1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
4
Computer Applications (cont.)
Copyright © 2013, 2009, 2003, 1999, 1995,
1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
5
Computer Applications (cont.)
• Respiratory care management information
systems include:
– Charting & billing
– Assign respiratory care orders
– Manage staff productivity
– Report clinical results
– Execute respiratory care protocols
Copyright © 2013, 2009, 2003, 1999, 1995,
1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
6
Computer Applications (cont.)
• Respiratory Care Practitioners
– Must know how to efficiently retrieve electronic
information
• From evidence-based resources
– Implement best practices & improve patient
outcomes
Copyright © 2013, 2009, 2003, 1999, 1995,
1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
7
All of the following are functions of a respiratory
care management information system, except?
A.
B.
C.
D.
Charting and billing
Manage staff productivity
Blood gas results
Assign respiratory care orders
Copyright © 2013, 2009, 2003, 1999, 1995,
1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
8
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
Copyright © 2013, 2009, 2003, 1999, 1995,
1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
9
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)
Copyright © 2013, 2009, 2003, 1999, 1995,
1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
10
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
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1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
11
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
Copyright © 2013, 2009, 2003, 1999, 1995,
1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
12
Applications in Diagnostics (cont.)
• Blood Gas Laboratories
– Computerized blood gas analyzers
– Allow for immediate results
– Computer assisted quality assurance
Copyright © 2013, 2009, 2003, 1999, 1995,
1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
13
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
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1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
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Copyright © 2013, 2009, 2003, 1999, 1995,
1990, 1982, 1977, 1973, 1969 by Mosby, an
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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
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1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
16
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
Copyright © 2013, 2009, 2003, 1999, 1995,
1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
17
Clinical decision support has helped decrease
unnecessary hospital admissions for which of the
following inappropriately diagnosed diseases?
A.
B.
C.
D.
CHF
Myocardial infarctions
Cardiac ischemia
Asthma
Copyright © 2013, 2009, 2003, 1999, 1995,
1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
18
Clinical Decision Support (cont.)
• 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)
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1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
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Copyright © 2013, 2009, 2003, 1999, 1995,
1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
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Clinical Decision Support (cont.)
• 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
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1990, 1982, 1977, 1973, 1969 by Mosby, an
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21
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
Copyright © 2013, 2009, 2003, 1999, 1995,
1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
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Clinical Decision Support (cont.)
• 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
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1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
23
“E-Health” applications for COPD patients have
facilitated all of the following, except?
A.
B.
C.
D.
education
self-management
feedback from health care providers
assisting with a diagnosis
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1990, 1982, 1977, 1973, 1969 by Mosby, an
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24
Information Retrieval
• 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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1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
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Copyright © 2013, 2009, 2003, 1999, 1995,
1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
26
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)
Copyright © 2013, 2009, 2003, 1999, 1995,
1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
27
Information Retrieval (cont.)
Copyright © 2013, 2009, 2003, 1999, 1995,
1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
28
Information Retrieval (cont.)
Copyright © 2013, 2009, 2003, 1999, 1995,
1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
29
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
Copyright © 2013, 2009, 2003, 1999, 1995,
1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
30
All of the following is a valuable aspect of
information retrieval in evidence-based respiratory
care?
A.
B.
C.
D.
Dictates patient interaction
Provides evidenced based patient protocols
Automates clinical decisions for whole groups
Uses cost effective techniques
Copyright © 2013, 2009, 2003, 1999, 1995,
1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
31
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
Copyright © 2013, 2009, 2003, 1999, 1995,
1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
32
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
Copyright © 2013, 2009, 2003, 1999, 1995,
1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
33
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
Copyright © 2013, 2009, 2003, 1999, 1995,
1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
34
Applications in Management &
Administration (cont.)
Copyright © 2013, 2009, 2003, 1999, 1995,
1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
35
Applications in Management &
Administration (cont.)
• 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
informationCopyright
for clinicians
& patients
© 2013, 2009, 2003, 1999, 1995,
1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
36
Applications in Management &
Administration (cont.)
Copyright © 2013, 2009, 2003, 1999, 1995,
1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
37
Applications in Education
• 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
Copyright © 2013, 2009, 2003, 1999, 1995,
1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
38
Applications in Education (cont.)
Copyright © 2013, 2009, 2003, 1999, 1995,
1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
39
Applications in Education (cont.)
Copyright © 2013, 2009, 2003, 1999, 1995,
1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
40
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 affiliates
Copyright © 2013, 2009, 2003, 1999, 1995,
1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
41
Applications in Education (cont.)
Copyright © 2013, 2009, 2003, 1999, 1995,
1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
42
Applications in Education (cont.)
• 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
Copyright © 2013, 2009, 2003, 1999, 1995,
1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
43
Applications in Education (cont.)
• Pulmonary Artery Catheter Education Project
(www.paep.org)
– Provides excellent online training in hemodynamic
monitoring
– Includes Web casts w/ audio & slides; pre- & posttesting for each module; case studies for many of
modules
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1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
44
Applications in Research
• 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
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1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
45
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
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1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
46
Security & Confidentiality
• 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-toknow basis
– Thumb-print protected security
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1990, 1982, 1977, 1973, 1969 by Mosby, an
imprint of Elsevier Inc.
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