Summary WGU C790 Nursing Informatics Study Guide 2023 Complete Solutions Verified

goal of EBP
is improvement of systems and microsystems within healthcare, with these improvements based on science

STEEEP principles
The Institute of Medicine (IOM) expert panel issued recommendations for urgent action to redesign healthcare so that it is safe, timely, effective, efficient, equitable, and patient-centered

(S) in STEEEP
Safe-Avoid injuries to patients from the care that is intended to help them.

(T) in STEEEP
Timely-Reduce waits and sometimes harmful delays for both those who receive and those who give care.

(E) in STEEEP
Effective-Provide services based on scientific knowledge to all who could benefit, and refrain from providing services to those not likely to benefit.

(E) in STEEEP
Efficient-Avoid waste, including waste of equipment, supplies, ideas, and energy.

(E) in STEEEP
Equitable-Provide care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status.

(P) in STEEEP
Patient-centered Provide care that is respectful of and responsive to individual patient preferences, needs, and values, and ensure that patient values guide all clinical decisions.

ACE Star Model of Knowledge Transformation
Advancing Research and Clinical Practice through Close Collaboration (ARCC)
Model of Evidence-Based Practice in Nursing and Healthcare
Johns Hopkins Nursing Evidence-Based Practice Model and Guidelines
Iowa Model of Evidence-Based Practice
Stetler Model of Research Utilization
FOCUS: EBP, research use, and knowledge transformation processes

DESCRIPTION: Direct a systematic approach to synthesizing knowledge and transforming research findings to improve patient outcomes and the quality of care
Address both individual practitioners and healthcare organizations Focus on increasing the meaningfulness and utility of research findings in clinical decision making

Promoting Action on Research Implementation in Health Services (PARiHS)
Vratny and Shriver Model for Evidence-Based Practice Pettigrew and Whipp Model of Strategic Change
Outcomes-Focused Knowledge Translation
Determinants of Effective Implementation of Complex Innovations in Organizations
Ottawa Model of Research Use
FOCUS: Strategic and organizational change theory to promote uptake and adoption of new knowledge

DESCRIPTION:Trace mechanisms by which individual, small group, and organizational contexts affect diffusion, uptake, and adoption of new knowledge and innovation
Premise is that interventions, outcomes evaluations, and feedback are important methods to promote practice change

Collaborative Model for Knowledge Translation between Research and Practice Settings
Framework for Translating Evidence into Action
Knowledge Transfer and Exchange
Canadian Institutes of Health Research Knowledge Translation within the Research Cycle Model or Knowledge Action Model
Interactive Systems Framework for Dissemination and Implementation
FOCUS: Knowledge exchange and synthesis for application and inquiry

DESCRIPTION: Structure ongoing interactions among practitioners, researchers, policy-makers, and consumers to facilitate the generation of clinically relevant knowledge and the application of knowledge in practice
All parties are engaged in bidirectional collaboration across the translation continuum

Knowledge Transformation
(Ace Star Model)
is defined as the conversion of research findings from discovery of primary research results, through a series of stages and forms, to increase the relevance, accessibility, and utility of evidence at the point of care to improve healthcare and health outcomes by way of evidence-based care.

Ace Star Model
These five points are discovery research, evidence summary, translation to guidelines, practice integration, and evaluation of process and outcome

clinical practice guidelines (CPGs)
The IOM defines clinical guidelines as “systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances.

usability
1.Increased user productivity and efficiency 2.Decreased user errors and increased safety 3.Improved cognitive support

human factors
is “the scientific discipline concerned with the understanding of interactions among humans and other elements of a system, and the profession that applies theory, principles, data and methods to design in order to optimize human well-being and overall system performance.”

In healthcare, human factors might concern the design of a new operating room to better support teamwork and patient flow.

ergonomics
used interchangeably with human factors by the HFES in Europe but in the U.S. and other countries its focus is on human performance with physical characteristics of tools, systems, and machines

i.e. power drill fitting in hand

Human-computer interaction (HCI)
is the study of how people design, implement, and evaluate interactive computer systems in the context of users’ tasks and work

usability
is often used interchangeably with HCI when the product is a computer but usability also concerns products beyond computers. Usability is also more focused on interactions within a specific context or environment for a specific product.

Formally, the ISO defines usability as the extent to which a product can be used by specific users in a specific context to achieve specific goals with effectiveness, efficiency, and satisfaction.

allows users to achieve goals

joint cognitive systems
imply that information is shared or distributed among humans and technology. This framework is useful for examining teamwork in healthcare where team members work together on patient care

Health Human-Computer Interaction (HHCI) Framework
Humans or products can initiate interactions. The information is processed through either the product or the humans according to characteristics. The recipient then reacts to the information; for example, a healthcare provider could read and respond to email from a patient or a product might process interactions after the “enter” key is pressed. Iterative cycles continue as humans behave and products act according to defined characteristics. Goals and planning are implicit within the tasks displayed in the framework.

discount usability methods
reduce the number of required users in usability projects and to use early design prototypes.

These methods offer economies of time, effort, and cost and can be completed at any point in the systems life cycle.

Two common techniques are heuristic evaluation and think-aloud protocol.

Heuristic evaluations
compare products against accepted usability guidelines to reveal major and minor usability issues.

think-aloud protocol
also involves a small number of users and has them talk aloud while they interact with a product. Users voice what they are trying to do, indicate where interactions are confusing, and provide other thoughts about the product during interactions.

This allows a detailed examination of the specified tasks, in particular to uncover major effectiveness issues.

used in conjunction with other techniques

task analysis
generic term for a set of more than 100 techniques that range from a focus on cognitive tasks and processes (called cognitive task analysis) to observable user interactions with an application (e.g., a systematic mapping of team interactions during a patient code).

Task analyses are systematic methods that are used to understand what users are doing or required to do with a product by focusing on tasks and behavioral actions of the users and products.

These methods provide a process for learning about and documenting how ordinary users complete actions in a specific context.

Methods of task analysis include the following: •Interviews •Observations •Shadowing users at their actual work sites •Observing users doing tasks •Conducting ethnographic studies or interviews

focused ethnographies
concentrate on individuals’ points of view, their experiences and interactions in social settings, rather than on just the actions of those individuals

During observations, detailed descriptions are generated with an emphasis on social relationships and their impact on work.

Usability Questionnaires
System Usability Scale (SUS)- industry standard, 10-scale

Questionnaire for User Interaction Satisfaction (QUIS)-computer system or application assessed

Purdue Usability Testing Questionnaire-100 open ended questions

Software Usability Measurement Inventory (SUMI)-

Exploratory Test
conducted early in the systems life cycle after requirements are determined. These tests are conducted on very basic or preliminary designs or redesigns where few resources have been committed to programming the product. The objective of an exploratory test is to assess the effectiveness of emerging design concepts

informal

Assessment Test
conducted early in or midway through the development of a product application. After the organization and general design are determined, this kind of test assesses lower-level operations of the application, stressing the efficiency goals of the product (versus effectiveness) and how well the task is presented to users.

conducted whens system partially developed

validation test
completed later in the systems life cycle using a more mature product. This type of test assesses how this particular product compares to a predetermined standard, benchmark, or performance measure.

Comparison Study
can conduct comparison studies at any point in the systems life cycle but they are more commonly done to compare an existing design with a redesign or an early prototype with a more mature product.

The major objective of this usability test is to determine which application, design, or product is more effective, efficient, and satisfying

Steps for Conducting Usability Tests
1) define a clear purpose
2) assess constraints
3) Use an HCI framework to define pertinent components.
4) Match methods to the purpose, constraints, and framework assessment.

human factors
The complex interactions among multiple users, products, and environments with varying characteristics in health information technology is referred to

project
is a planned undertaking, with a beginning and end that produces a well-defined result or product.

information system development project
a planned undertaking that produces a new information system

predictive approach to the SDLC
assumes that the development project can be planned and organized and that the new information system can be developed according to the plan

useful for building systems that are well understood and defined.

company may want to convert its old networked client/server system to a newer Web-based system that includes a smartphone app. In this type of project, the staff already understands the requirements very well, and no new processes need to be added

traditional (70s-90s)

adaptive approach to the SDLC
is used when the system’s requirements and/or the users’ needs aren’t well understood. In this situation, the project can’t be planned completely.

Some system requirements may need to be determined after preliminary development work.

(late 90s-today)

project initiation (predictive)
In predictive approaches, there is a group of activities that identifies the problem and secures approval to develop a new system

Project planning (predictive)
In predictive approaches, there is a group of activities that identifies the problem and secures approval to develop a new system

map out the project’s overall structure

analysis (predictive)
focuses on discovering and understanding the details of the problem or need. The intent here is to figure out exactly what the system must do to support the business processes

design (predictive)
focuses on configuring and structuring the new system components. These activities use the requirements that were defined earlier to develop the program structure and the algorithms for the new system

implementation (predictive)
includes programming and testing the system.

deployment (predictive)
involves installing and putting the system into operation.

phases of the system development project (predictive)
project initiation, project planning, analysis, design, implementation, and deployment

support phase (predictive)
includes the activities needed to upgrade and maintain the system after it has been deployed. The support phase is part of the overall SDLC, but it isn’t normally considered part of the initial development project

waterfall model (predictive)
the phases of the project flow down, one after another.

This model assumes that the phases can be carried out and completed sequentially.

After a project drops over the waterfall into the next phase, there is no going back

rigid planning, doesn’t work very well

interative approach (adaptive)
Using iterations, the project is able to adapt to any changes as it proceeds. Also, parts of the system are available early on for user evaluation and feedback, which helps ensure that the application will meet the needs of the users.

overlapping phases

is adaptive because with each iteration’s analysis, design, and implementation, modifications can be made to adapt to the changing requirements of the project

incremental development
related concept to interative SDLC

based on an iterative life cycle

basic idea is that the system is built in small increments

may be developed within a single iteration or it may require two or three iterations. As each increment is completed, it is integrated with the whole

“grown” in an organic fashion

gets into user’s hands faster

walking skeleton
based on interative approach

provides a complete front-to-back implementation of the new system but with only the “bare bones” of functionality.

gets into user’s hands quickly

system development methodology
provides guidelines for every facet of the system development life cycle.

model
representation of an important aspect of the real world

abstraction
people abstract (separate out) an aspect that is of particular importance to them.

tool
software support that helps create models or other components required in the project.

integrated development environments (IDEs)
sets of tools that work together to provide a comprehensive development and programming environment for software developers

visual modeling tools
tools that help analysts create and verify graphical models and may also generate program code

technique
a collection of guidelines that specify a method for how to carry out a development activity or task

Sometimes, a technique applies to an entire life cycle phase and helps you create several models and other documents.

How do methodologies, models, tools, and techniques fit together?
A methodology includes a collection of techniques that are used to complete activities within each phase or iteration of the system development life cycle. The activities include the completion of a variety of models as well as other documents and deliverables. Like any other professionals, system developers use software tools to help them complete their activities

Agile development
a guiding philosophy and set of guidelines for developing information systems in an unknown, rapidly changing environment

compliments adaptive approaches

Agile modeling
a philosophy about how to build models, some of which are formal and detailed, others sketchy and minimal

“”Manifesto for Agile Software Development” four values
▪ Value responding to change over following a plan
▪ Value individuals and interactions over processes and tools
▪ Value working software over comprehensive documentation
▪ Value customer collaboration over contract negotiation

chaordic
a term used to describe adaptive projects because they are chaotic yet ordered

Agile Modeling (AM)
a guiding philosophy in which only models that are necessary, with a valid need and at the right level of detail, are created

The Unified Process (UP)
is an object-oriented system development methodology

defines a complete methodology that uses UML for system models and describes a new, adaptive system development life cycle. In the UP, the term development process is synonymous with development methodology.

UP Phases
inception, elaboration, construction, and transition

Inception Phase (UP)
develop an approximate vision of the system, make the business case, define the scope, and produce rough estimates for cost and schedule

usually one iteration

Elaboration Phase (UP)
define the vision, identify and describe all requirements, finalize the scope, design and implement the core architecture and functions, resolve high risks, and produce realistic estimates for cost and schedule

usually several iterations

Construction Phase (UP)
iteratively implement the remaining lower-risk, predictable, and easier elements and prepare for deployment

several iterations

Transition Phase (UP)
complete the beta test and deployment so users have a working system and are ready to benefit as expected

one or more final iterations

UP discipline
a set of functionally related activities that combine to enable the development process in a UP project

disciplines include:
business modeling,
requirements, design,
implementation,
testing, deployment, configuration and change management,
project management
environment

Extreme Programming (XP)
an adaptive, Agile development methodology

an attempt to take the best practices of software development and extend them “to the extreme.

characteristics:
Takes proven industry best practices and focuses on them intensely
Combines those best practices (in their most intense forms) in a new way to produce a result that is greater than the sum of its parts

XP Core Values
communication- documentation, verbal discussion (open and frequent)

simplicity- techniques to reinforce this principle and make it a standard way of developing systems

feedback- Feedback on functionality and requirements should come from the users, feedback on designs and code should come from other developers, and feedback on satisfying a business need should come from the client

courage- XP practices are designed to give developers the courage to “do it right.”

XP Practices (12)
planning-focuses on making a rough plan quickly and then refining it as things become clearer.

testing- two major types of tests: unit tests, which test the correctness of a small piece of code, and acceptance tests, which test the business function

pair programming- divides up the coding work. First, one programmer might focus more on design and double-checking the algorithms while the other writes the code. Then, they switch roles

simple designs-accomplishes the desired result with as few classes and methods as possible and that doesn’t duplicate code

refactoring the code- revising, reorganizing, and rebuilding part of a system so it is of higher quality

owning the code collectively- everyone is responsible for the code

continuous integration- embodies XP’s idea of “growing” the software. Small pieces of code—which have passed the unit tests—are integrated into the system daily or even more often.

on-site customer- embodies XP’s idea of “growing” the software. Small pieces of code—which have passed the unit tests—are integrated into the system daily or even more often.

system metaphor- s unique and interesting approach to defining an architectural vision. It answers the questions “How does the system work?” and “What are its major components?” And it does it by having the developers identify a metaphor for the system.

small releases- point at which the new system can be turned over to users for acceptance testing and even for productive use.

forty-hour week and coding standards- set the tone for how the developers should work.

XP system development approach
three levels: system (the outer ring), release (the middle ring), and iteration (the inner ring).

occur once during each development project

Scrum
the objective of which is to be quick, agile, and intense and to go the entire distance

focus is primarily on the team level

social engineering that emphasizes individuals more than processes and describes how teams of developers can work together to build software in a series of short mini-projects

Software is developed incrementally, and controls are imposed empirically—by focusing on things that can be accomplished.

product backlog

product backlog
a prioritized list of user requirements used to choose work to be done in a Scrum project

Scrum organization
three main organizational elements that affect a Scrum project are the product owner, the Scrum master, and the Scrum team or teams.

product owner
the client stakeholder for whom the system is being built

scrum master
the person in charge of a Scrum project—similar to a project manager

scrum team
small group of developers—typically five to nine people—who work together to produce the software

sprint
a time-controlled mini-project that implements a specific portion of a system

daily meetings with the Scrum team to report issues

time boxing

weaknesses of agile process:
requires meaningful stakeholder participation

Agile cannot define what will be delivered at the end of a project.

Agile requires a strong team of process subject matter experts.

No “Scrum Master” role. Unlike with software development teams, in healthcare there is likely no one who is coaching the team on Agile practices, such as defining work in iterations. This is where a subject matter lead role, sponsor, or even project manager will need to lead.

The team needs to function at a high level, and thus requires experienced team members with high levels of demonstrated professionalism.

project management
organizing and directing other people to achieve a planned result within a predetermined schedule and budget.

oversight committee
clients and key managers who review the progress and direct the project

Level of formality or ceremony
the rigor of holding formal meetings and producing detailed documentation

Agile Project Management
a way of balancing flexibility and chaos: how to be agile and flexible while maintaining control of the project schedule, budget, and deliverables.

agile time frame-difficult to create/maintain project schedule

cost estimates are difficult to make, especially with a project in which the requirements are expected to change throughout. project manager controls cost

quality management: each iteration has a deliverable. testing spread throughout project, also process evaluations of each iteration

system vision document (SVD)
a document to help define the scope of a new system

business benefits
the benefits that accrue to the organization; usually measured in dollars (part of SVD)

system capabilities
the required capabilities of a new system; part of a System Vision Document (part of SVD)

cost/benefit analysis
process of comparing costs and benefits to see whether investing in a new system will be beneficial

net present value (NPV)
the present value of dollar benefits and dollar costs of a particular investment

break-even point
the point in time at which dollar benefits offset dollar costs

payback period
the time period during which the dollar benefits offset the dollar costs

tangible benefit
a benefit that can be measured or estimated in terms of dollars

intangible benefit
a benefit that accrues to an organization but that can’t be measured quantitatively or estimated accurately

project dashboard
allows all types of project information to be posted and viewed by Web browsers

project iteration schedule
the list of iterations and use cases or user stories assigned to each iteration

detailed work schedule
the schedule that lists, organizes, and describes the dependencies of the detailed work tasks

Work Breakdown Structure (WBS)
the list or hierarchy of activities and tasks of a project; used to estimate the work to be done and to create a detailed work schedule

Gantt chart
a bar chart that portrays the schedule by the length of horizontal bars superimposed on a calendar

critical path
a sequence of tasks that can’t be delayed without causing the entire project to be delayed

retrospective
a meeting held by the team at the end of an iteration to determine what was successful and what can be improved

Core Process 1
the objective of which is to identify the business need and to get the project initiated. These activities include:

▪ Identifying the problem
▪ Extending the project approval factors
▪ Performing risk and feasibility analysis
▪ Reviewing with the client and obtaining approval

Tall Man Lettering
mixed case lettering
ie NiFEDipine

scope creep
occurs when requirements are added after the initial project is defined and those added requirements are substantial enough to affect the project timeline.

Best of Breed implementation of EHR
involves reviewing several vendors for their “best” module or application, such as an admission, discharge, and transfer (ADT) system or emergency department module. Then multiple modules are purchased from different vendors to create a full suite of functions.

Integrated Health System
an electronic health record system that includes a suite of modules to support care. It is typically easier to install and easier to support and usually has a similar-looking user interface across modules, which helps users to learn the EHR more quickly.

Systems Life Cycle SLC
Analyze: The existing environment and systems are evaluated. Major problems and deficiencies are identified using informal or formal methods. A needs assessment is developed. Gaps are noted and current capabilities and limitations are outlined. Initial user and system requirements are formulated.

•Plan: The proposed system is planned comprehensively. Planning includes strategic levels, such as whether the system will be developed internally, purchased and tailored, or designed and developed jointly with a vendor.

•Develop or purchase: At this stage either the system is purchased or the new system development begins. New components and programs are obtained and installed. For vendor-supported solutions, extensive tailoring occurs.

•Test: At this stage extensive testing occurs just before Stage 5 and “go” or “no go” decisions are made about deadlines. Toward the end of this phase, marketing and communication efforts are accelerated to make users aware of the impending change.

•Implement or go-live: The system is implemented using a selected method best suited to the organization and its tolerance for risk. User training is completed.

•Maintain and evolve: Once the system has been formally acknowledged as passing user acceptance testing, typically at 90 or 120 days after go-live, it enters a maintenance phase.

•Evaluate: Activities in each phase are assessed for their quality and effectiveness.

workaround
a method used to circumvent a problem without solving it

ADT Testing
ADT testing involves testing for every possible type of ADT transaction used in the organization for inpatients, outpatients, serial patients, and preadmits. These transactions include admit; discharge; transfer; cancel admit; cancel discharge; cancel transfer; change beds, rooms, or departments; merge accounts; etc.

Unit Testing and functional testing
Unit testing is a very basic type of testing where the tester runs through the basic functionalities and features of an application. It is a high-level cursory walk-through of the application. The goal is to identify deviations from the expectations and to correct these unexpected results. The tester will not test every order or documentation field but will need to test every possible scenario.

integrated testing
Integrated testing tests the transmission of messages between all systems such as the healthcare information system, laboratory, radiology, pharmacy, dietary, cardiology, etc. This test includes testing all bidirectional order messages and results going across the interface(s)

ARRA-related Meaningful Use testing
With the introduction of Meaningful Use, eligible providers, hospital organizations, and Critical Access Hospitals (CAH) must test their ability to collect required information and demonstrate that they meet Meaningful Use criteria.

big bang go live
occurs when all applications or modules are implemented at once. This approach is favored by vendors and facilities conducting large upgrades

phased go live
both paper and electronic environments exist at the same time within the healthcare institution; however, the existence of both paper and electronic environments forces the clinician to use different work flows in patient units that have implemented the system than in units that have not, potentially creating safety concerns.

ten key principles relevant to successful clinical systems integration.
Comprehensive Services across the Continuum of Care, Patient Focus, Geographic Coverage and Rostering, Standardized Care Delivery through Interprofessional Teams, Performance Management, Information Systems, Organizational Culture and Leadership, Physician Integration, Governance Structure, and Financial Management

point of service (POS)
device is a computer or information system that is located where information is required or where the data are collected.

client server
is system architecture that splits an application into a front-end client application and a back-end server component as the basis for distributed applications. The term client in this context refers to the computer.

system architecture
ensures efficient and effective access to data by enabling rapid screen flips or field filling, consistent and timely network communication, and decreased downtime.

interface
or an exchange of information between systems

core vendor system
primary vendor supplying the information system that serves as the basis for any other systems that are integrated within an organization. This vendor provides the backbone architecture for the HIS. Other applications are either purchased from the core vendor or able to interface/integrate with the core vendor.

data integration
accomplished by interfacing a number of information systems

clinical data repository
the single database captures information from numerous systems and aggregates the data over time for single use

clinical data repository (CDR)
is the storage component for all instance data of patient clinical records

central versus distributed storage

encounter-based versus longitudinal-based storage

central storage model
a single repository is used to store all (or most) clinical data and is used as the primary source for reviewing data.

improves the ability of a single application to display data from multiple original sources and locations and provides the capability to perform clinical decision support (CDS) more efficiently across multiple data types

usually requires that data collected from secondary systems be transformed (mapped) to a common storage model and terminology before being stored in the repository.

distributed storage model
each data collection application stores its information in its own repository and data are federated through a real-time data access methodology

results review application may have to access separate repositories for lab, microbiology, radiology, etc., in order to provide a composite view of information.

provides some reliability to the EHR because, for example, if one repository goes down, the user may still be able to access information from the other repositories. It also allows the most efficient storage and access for particular data types and lessens the complexity of having to map data from one system to another.

disadvantages: can limit performance, many single points of failure, makes integrated tasks such as CDS much more difficult.

Encounter-based (or episodic) storage
older, hospital based EHRs

data are collected according to the current patient encounter and then are usually purged or archived from the repository when the patient is discharged

very efficient in terms of system performance for supporting the current encounter because the data in the repository are always the most current and reflect only what has been collected as relevant to the present circumstances

longitudinal-based repository
stores data across all encounters.

“cradle to grave” or “womb to tomb” repository because data may extend over the entire lifespan of an individual.

disadvantage is that a patient’s record (and therefore the entire repository) can grow tremendously large with data that become less relevant over time.

master person index (MPI)
the repository for the information used to uniquely identify each person, patient, or customer of a healthcare enterprise.

“golden record”

rich client (also called a fat, heavy, or thick client)
a client-server architecture or network that provides rich functionality independent of the central server.

In contrast, a thin client refers to a client-server architecture that is heavily dependent on a server’s applications.

clinical applications
can be divided into four broad areas of functionality: review and reporting, data collection, patient management, and clinician productivity.

review application
typically focused on one area of clinical data (e.g., a lab results review application, a vital signs review module)

doesn’t necessarily allow for data entry

reporting application
often has a broad range of clinical data that displays to the user (e.g., a 24-hour rounds report that combines lab, vitals, medications, intake and output (I/O), invasive line status, assessments, and plan in one view).

doesn’t necessarily allow for data entry

data dictionary
contains the medical vocabulary terms used to store data within the repository.

particularly useful in the EHR because it is the central source for defining all terms and their corresponding codes used by the EHR.

Instead of hard-coding these terms and codes within applications, the data dictionary allows more flexibility at application runtime to access new and updated terms as they become available over the lifetime of the EHR.

domains and subdomains

knowledge base (knowledge repository)
a component within the EHR that stores and organizes a healthcare enterprise’s information and knowledge used by the enterprise for clinical operations

usually organized by attaching metadata to content items, allowing categorization of the knowledge content based on contextual need.

allows an EHR to become a “content-driven” system as opposed to a system whose knowledge is hard-coded in software programs.

metadata
(information describing the content)

metadata model
detailed data format description

interface engine (IE)
allows each network data source to have one outbound interface that can then be connected to any receiving system on the network. The IE is able to queue the messages from a data source, transform the messages to the proper format for the receiving systems, and then transmit the messages to appropriate systems.

application service provider (ASP)
a company that hosts an EHR or departmental system solution for a healthcare enterprise and provides access to the application via a secure network

formative evaluation
an assessment of how well the program is being implemented and to describe the experience of participants.

Topics for formative evaluation include the fidelity of the intervention, the quality of implementation, the characteristics of the organizational context, and the types of personnel. Needs assessments and feasibility analyses are included in this general category.

What is the nature and scope of the problem that is being addressed by health IT?
What is the extent and seriousness of the need?
How well is the technology working and what is the best way to deliver it?
How are participants (and users) experiencing the program?
How did the intervention change after implementation?

summative evaluation
an assessment of the outcomes and impact of the program.

Cost-effectiveness and adverse events analyses are included in this category.

To what degree were the outcomes affected by the product?
What is the cost effectiveness of the product?
What were the unintended consequences of the product?

Social Science Theories
relevant to both the design of interventions and products and the structure of the evaluation

include social cognitive theories, diffusion of innovation theory, cognitive engineering theories, and information theories.

Social Cognitive Theories
These theories predict intentions and behavior as a function of beliefs about the value of an outcome, the likelihood that the outcome will occur given the behavior, and the expectations of others and self-efficacy beliefs about the personal ability to engage in the activity.

predict intentions and behavior across a wide variety of settings.

diffusion of innovation theories
diffusion is the process by which an innovation is communicated through certain channels over time among the members of a social system organization

Cognitive Engineering Theories
naturalistic decision making (NDM), control theory, and situation awareness (SA).

these theories focus more on the interaction between the context and the individual and are more likely to predict decision making, perception, and other cognitive variables.

NDM is a broad and inclusive paradigm. SA is narrower and is particularly useful in supporting design.

Program theory evaluation
recommended practice for all program evaluation and an important approach regardless of whether the program is the implementation of a new documentation system or an institution-wide information system

CDCs six steps:
1.Engage stakeholders to ensure that all partners have contributed to the goals of the program and the metrics to measure its success.
2.Describe the program systematically to identify goals, objectives, activities, resources, and context. This description process involves all stakeholders.
3.Focus the evaluation design to assess usefulness, feasibility, ethics, and accuracy.
4.Gather credible evidence by collecting data, conducting interviews, and measuring outcomes using a good research design.
5.Justify conclusions using comparisons against standards, statistical evidence, or expert review.
6.Ensure use and share lessons learned by planning and implementing dissemination activities.

logic model
a systematic and visual way to present and share your understanding of the relationship among the resources you have to operate your program, the activities you plan, and the changes or results you hope to achieve. The most basic logic model is a picture of how you believe your program will work.

Workflow
“a modular sequence of tasks, with a distinct beginning and end, performed for the specific purpose of delivering clinical
care”

Workflows are
specified at up to four levels of detail: 1) clinical workflow, 2) phase, 3) task & action, and 4) sub
-action.

patient-centric workflows
occur when the patient is onsite and interacts with
the staff and clinicians. Patient centric workflows begin when the patient enters the office or ward and ends when the patient leaves or is discharged.

message–centric workflows
include care activities that
occur when the patient is not present; they typically begin with a message, may continue over an extended period of time, and end when the message is considered handled.

population management workflows
focus on prevention and care management activities that involve proactive review and
outreach to a defined population
or to individuals within that population.

phase
Phase: corresponds to the physical location of the
patient; used only if the patient changes
location during a workflow

task & action
A task is an activity that is relatively short and constitutes a discrete step in the care
process. For example, ‘measure and record vital signs’ is considered a task.
•
In this taxonomy, action
s are used to relate tasks to a more general typology of clinical activities.
For example, ‘document’ is the action associated with ‘measure and record
vital signs’. Actions were based on the information available in the National Quality
Forum’s “Health IT Assessment Framework for Measurement: A Consensus

sub-action
specific activities that constitute or comprise an action. Continuing the example
above, ‘Document weight’ is a sub
-action of ‘measure & record vital signs’. The NQF Framework for Measurement was also used to inform the subactions

CDS repositories
create tags based on the taxonomy to enable workflow-related organization and searches

CDS designers
use the taxonomy to identify points in the workflow when CDS can be used and create a CDS tool to fit that context

CDS implementors
refer to the taxonomies when developing maps of the workflows and can use the terms to improve communication with their CDS vendor

Bayesian knowledge base
A knowledge base built using decision trees and a branch of statistical inference that permits the use of prior knowledge in assessing the probability of an event in the presence of new data. For example, if a patient has a fever and increased white blood cells, the Bayesian knowledge base provides the probability that the patient has an infection versus another disorder that also creates an inflammatory process.

unfinished
*

database
a structured collection of individual data elements.

database management system (DBMS)
a software program that is used to manage, organize, and retrieve data and information from a database

database model
model that is used to structure the data in a database

ie- relational database model (microsoft office)

Hierarchical Databases
contain many levels.

conceptualized as a family tree wherein each child has one parent. The root is the head of the family. The branches, or second level, are the children who are descended from the root. The third level, the grandchildren, are descended from the second-level parents. Communication among the descendants occurs by passing information up or down to the common parent or child until the desired level is reached.

older mainframe DBMS

works well for data sets with one-to-many relationships

requires professional programmers for maintenance

network databases
designed to solve the redundancy problem that occurs with the hierarchical model

Although this model is very similar to the hierarchical model, children are permitted to have more than one parent. The records are linked together by pointers that use a key piece of data (e.g., a patient medical record number).

requires professional programmers for maintenance

relational database
The basic structure in this model is a table. The database consists of several tables. A unique field within the tables is used to combine or join the tables. In contrast to users of hierarchical and network databases, users of relational databases need to know only the name of a table in order to locate data

object oriented database management system
in a relational DBMS there is a separation between the data storage and the manipulation methods. This separation of data and methods for manipulating those data add to the complexity of the database. This is especially true with large databases

Right clicking on a selected object yields a menu of options that can be applied to the selected object. The same principles apply to data in an object-oriented DBMS.

reduces the amount of programming needed

anatomy of a database
consists of fields, records, and tables

Tables are the basic building blocks of a relational database.

fields
a vertical column in a database. It contains data that represent the same characteristic, or entity, for all of the records.

For example, a column labeled “First Name” would include the first name of each individual.

atomic level data

records
horizontal rows are called records. A record contains the different pieces of data belonging to a given entity. In this table the entity is a person, and the fields contain his or her name and mailing address. Thus a record is made up of fields, with each field containing data pertaining to the entity that the record represents.

tables
consists of all of the records.

Structuring the data in fields and records in a table makes it possible to manipulate and/or select records or fields based on specific data elements in the fields.

atomic level data
or the smallest recognizable entity necessary to obtain meaning.

To keep data at the atomic level, three fields are used to collect a name—first name, middle initial, and last name

The address is divided into the street address, city, state, and zip code. Keeping data at this lowest level provides flexibility in data use.

querying
The process of selecting desired records is called querying, and the feature that permits this is a query.

form
A view of the data in a table that, although derived from the data in a table or tables, can be structured to present specified fields, calculated data based on data in a table, or fields from many tables. The form demonstrates the structure that will be used to format a report. It is this ability that makes possible the data entry concept of “entry once, use many times”

report
A view of the data in a printed table. The data can be structured in any way that is useful to the viewer. Among possibilities, data can come from multiple tables, be grouped by criteria, or be calculated. Because reports are organized to be meaningful for the viewer, they can also be defined as the display of information

algorithm
set of rules to follow that are inclusive of all cases.

wildcard
Symbols that are used to represent the characters in the truncation process. In many systems the use of an asterisk (*) denotes any number of and any kind of character, and a question mark (?) denotes one character

relational databases
consist of four main objects: table, query, form, and report. The table, with the data organized into fields (vertical columns) and records (horizontal lines), is the heart of any database. A table is where one starts when physically constructing a database. Without it, none of the other objects can be created.

flat database
A database consisting of a single table

Steps in Planning a Database

List questions to be asked.
Determine fields needed to provide the answers and list them.
Study the fields to see what topics they represent.
Allocate the fields to tables based on the topic.
Identify primary key fields.
Determine the relationships between the tables.
Add foreign key fields where needed.
Designate the types of fields and allocate space for fields that will contain text.
Designate terminology for any look-up fields.

a.Confer with users.
b.Write a description of the terms.
c.Get agreement from users for definitions and terms.

Plan the queries needed and ascertain if the structure supports the queries. Replan where necessary.
Plan the forms for data entry and ascertain if the structure supports the forms.

a.Add notes for constructing the form.
b.Make a sketch of the proposed form.
c.Confer with those will enter the data.
d.Replan where necessary.

Plan the reports and ascertain if the structure supports the forms.

a.Add notes for constructing the report.
b.Make a sketch of the reports.
c.Confer with those who will enter the data.
d.Replan where necessary.

Design views for the data—both screen (forms) and paper (reports)—and ascertain if the structure supports the queries. Replan where necessary.
Study the entire plan to be certain that it is valid

Open System (Systems Theory)
Open systems take input (information, matter, and energy) from the environment, process the input, and then return output to the environment. The output then becomes feedback to the system. Open systems are sometimes referred to as closed. This reference does not mean that the system is truly a closed system but rather that the boundaries are less permeable and as a result input is limited.

Dynamic homeostasis
refers to the processes used by a system to maintain a steady state or balance. Feedback loop-goal of maintaining a steady state can affect how clinical settings respond when changes are made or a new system is implemented.

Equifinality
is the tendency of open systems to reach a characteristic final state from different initial conditions and in different ways. Example: two different clinics with different charting systems adopt a new system, and end up with the same result.

Entropy
is the tendency of all systems to break down into their simplest parts. As it breaks down the system becomes increasingly disorganized or random.

In data transmission, entropy measures the loss of information when a signal is transmitted.

All systems eventually must be replaced.

Negentropy
is the opposite of entropy. This is the tendency of living systems to grow and become more complex.

Reverberation
is reflected in the intended and unintended consequences of system change. Chaos theory was developed in the 50s to explain the phenomena of unintended consequences.

dynamic systems
chaotic systems. While chaotic systems vary in their state of stability, they are in a constant state of change. The change is nonlinear. In a nonlinear system the output of the system is not proportional to the input.

reiterative feedback loop
major impact on how imput affects output. A minor change in input can cause a major change in output (butterfly effect).

fractal-type patterns
while the output or behavior of a chaotic system will appear unstable, aperiodic, and even random, these systems are deterministic. Their output is determined by the initial input, reiterative feedback loops, and the dynamic changes that occur over time. Out of chaos comes order: snowflake

chaos theory
Both chaos and complexity theory involve the study of dynamic nonlinear systems that change with time and demonstrate complex relationships between inputs and outputs due to reiterative feedback loops. “The quantitative study of these systems is chaos theory. Complexity theory is the qualitative aspect drawing upon insights and metaphors that are derived from chaos theory.”

complexity theory
Both chaos and complexity theory involve the study of dynamic nonlinear systems that change with time and demonstrate complex relationships between inputs and outputs due to reiterative feedback loops. “The quantitative study of these systems is chaos theory. Complexity theory is the qualitative aspect drawing upon insights and metaphors that are derived from chaos theory.” (complexity theory=pseudoscience ?)

information theory
refers to more than one theory, such as Shannon-Weaver information-communication model and the Nelson data-information-knowledge-wisdom model

Shannon Weaver information communication model
The sender is the originator of the message or the information source.

The transmitter is the encoder that converts the content of the message to a code. The code can be letters, words, music, symbols, or a computer code.

The telephone or cable line is the channel, or the medium used to carry the message. Each channel has its own physical limitations in terms of the size of the message that can be carried. Noise is anything that is not part of the message but that occupies space on the channel and is transmitted with the message.

The decoder converts the message to a format that can be understood by the receiver.

Blum Model
In his analysis he identified three types of healthcare computing applications. Blum grouped applications according to the objects they processed. The three types of objects he identified are data, information, and knowledge.

Blum defined data as uninterpreted elements such as a person’s name, weight, or age.

Information was defined as a collection of data that have been processed and then displayed as information such as weight over time.

Knowledge results when data and information are identified and the relationships between the data and information are formalized. A knowledge base is more than the sum of the data and information pieces in that knowledge base. A knowledge base includes the interrelationships between the data and information within the knowledge base.

Graves Model
used Blum’s concepts and added Barbara A. Carper’s four types of knowledge: empirical, ethical, personal, and aesthetic. Each of these represents a way of knowing and a structure for organizing knowledge.

“The Study of Nursing Informatics,” by Graves and Corcoran
This article is considered the foundation for most definitions of nursing informatics.

Nelson Model
Nelson extended the Blum and Graves and Corcoran data-to-knowledge continuum by including wisdom.

data, information, knowledge, wisdom

computerized decision making,
healthcare applications
decision support
electronic expert system

Learning theory
attempts to determine how people learn and to identify the factors that influence that process.

Learning theories that are included under the heading of information processing theories divide learning into four steps, as follows: 1.How the learner takes input into the system 2.How that input is processed and constructed 3.What type of learned behaviors are exhibited as output 4.How feedback to the system is used to change or correct behavior

change theory
is the study of change in individuals or social systems such as organizations.

2 perspectives
Kurt Lewin’s theory, which focuses on how a change agent can guide the change process. This is referred to as planned change. The second perspective focuses on the process by which people and social systems make changes

Kurt Lewin
father of change theory

His theory of planned change divides change into three stages: unfreezing, moving, and refreezing.

Diffusion of innovation
Everrett Rogers
is the process by which an innovation is communicated through certain channels over time among members of a social system. Innovations may be either accepted or rejected.

5 groups of individuals in an organization
innovators, early adopters, early majority, late majority, and laggards

five internal organizational characteristics
Centralization
Complexity
Formalization
Interconnectedness
Organizational slack

1) Centralization
Organizations that are highly centralized with power concentrated in the hands of a few individuals tend to be less accepting of new ideas and therefore less innovative.

2) Complexity
Organizations in which many of the individuals have a high level of knowledge and expertise tend to be more accepting of innovation. However, these types of organizations can have difficulty reaching a consensus on approaches to implementation.

3) Formalization
Organizations that place a great deal of emphasis on rules and procedures tend to inhibit new ideas and innovation. However, once a decision has been made to move ahead this tendency toward rules and procedures does make it easier to implement an innovation.

4) Interconnectedness
Organizations in which there are strong interpersonal networks linking the individuals within the organization are better prepared to communicate and share innovation. This can be seen, for example, in organizations in which Web 2.0 tools are an integral part of organizational communication. •

5) Organizational Slack
Organizations with uncommitted resources are better prepared to manage innovation. These resources may be people and/or money. With the current emphasis on cost control, healthcare institutions have less and less organizational slack.

Systems Life Cycle Model (SLC) (SLCM) or systems development life cycle model (SDLCM)
This model is used in project management to describe stages or phases of an informatics project and it guides system implementation from initial feasibility through a more completed stage of maintenance and evaluation of the products.

entire life cycle can last many years, average life cycle is a decade

SLC Stages
Feasibility and analysis, planning, develop or purchase, implementation, maintenance and evaluation

1) Feasibility and analysis (SLC)
The existing environment and systems are evaluated. A readiness assessment may be conducted. User needs and information system deficiencies are identified using informal or formal methods. New system requirements are defined. Deficiencies in the existing system are addressed with specific proposals for improvement.

2) Planning (SLC)
The proposed system is planned and designed. Planning includes extensive work in myriad topics: physical construction, hardware, operating systems, programming, communications, implementation support, evaluation, and security issues. A workflow analysis and process reengineering may be completed as a basis for determining the scope of system functions and the flow of information and activities within care processes.

3) Develop or Purchase (SLC)
The new system is developed or purchased. New components and programs are obtained and installed. For vendor-supported solutions, extensive tailoring occurs. Users are trained in its use and all aspects are tested. Ideally, adjustments are made at this stage to correct gaps in the scope of system functions or work processes.

4) Implementation (SLC)
The new system is developed or purchased. New components and programs are obtained and installed. For vendor-supported solutions, extensive tailoring occurs. Users are trained in its use and all aspects are tested. Ideally, adjustments are made at this stage to correct gaps in the scope of system functions or work processes.

5) Maintenance and Evaluation
Once the new system is up and running, it should be evaluated exhaustively. A maintenance phase begins to focus on maintaining system integrity, upgrades, and correcting issues that arise. Evaluation occurs at the end of the cycle.

Staggers and Nelson Systems Life Cycle Model (SLCM)
depicts the cycle as a spiral. incorporates revious work from Thompson, Synder-Halpern, and Staggers.

Steps: Analyze, Plan, Develop or Purchase, Test, Implement or Go-Live, Maintain and Evolve, Evaluate, Return to Analyze

model
The visual representation that illustrates what is occurring and how one understands the intervention to solve a problem is called

Chaos Theory, Systems Theory
two major theories that help us analyze and explain the occurrences or instances of certain phenomena with health informatics