American Recovery and Reinvestment Act (ARRA)
**Authorized INCENTIVE PAYMENTS to specific types of hospitals & healthcare professionals for adopting & using interoperable Health Information Technology and EHR’s.
The purposes of this act include the following: (1) To preserve/create jobs and promote economic recovery. (2) To assist those most impacted by the recession. (3) To provide investments needed to increase economic efficiency by spurring technological advances in science and health. (4) To invest in transportation, environmental protection, and other infrastructure that will provide long-term economic benefits. (5) To stabilize state and local government budgets, in order to minimize and avoid reductions in essential services and counterproductive state and local tax increases.
AHQR (Agency for Healthcare Research and Quality)
Produced evidence making healthcare safer, improve quality, accessibility and affordability
Asynchoronous Applications
No contact with patient for data collection. EX: Remote pt monitoring, Using health technologies to share health metrics and data w/ providers. STORE & FORWARD APPS (ex: photos)
Administrative Information System
can include registration and scheduling; tracking through admission, transfer and discharge; patient acuity and staff scheduling; financial or accounting systems; risk management; payroll and human resources; quality assurance; and contract management functions.
Affordable Care Act
law passed in 2010 to expand access to insurance, address cost reduction and affordability, improve the quality of healthcare, and introduce the Patient’s Bill of Rights, increasing the number of insured persons.
Alarm Fatique
Becoming desensitized to patient care alarms and missing or delaying their response to the alarm.
ANA (American Nurses Association)
Professional organization for all RNs. Concerned with licensure, collective bargaining and education
Analytics
A term describing the extensive use of data, statistical and quantitative analysis, explanatory and predictive models, and fact-based management to drive decisions and actions.
Audit trail
a report that traces who has accessed electronic information, when information was accessed, and whether any information was changed
Authentication
A method for confirming users’ identities
Authorization
The process of giving someone permission to do or have something
Barcode Scanning Technology
Scans drug and patients wristband to verify medication order, inventory control, + pt identification, correct med admin
Big Data
a collection of large, complex data sets, including structured and unstructured data, which cannot be analyzed without the use of information technology
Bioinformatics
application of mathematics and computer science to store, retrieve, and analyze biological data
Biometrics
the identification of a user based on a physical characteristic, such as a fingerprint, iris, face, voice, or handwriting
Business Continuity Plan
A plan for how an organization will recover and restore partially or completely interrupted critical function(s) within a predetermined time after a disaster or extended disruption
Business Intelligence
Information collected from multiple sources such as suppliers, customers, competitors, partners, and industries that analyzes patterns, trends, and relationships for strategic decision making
Change Control Board (CCB)
A committee that evaluates the worthiness of a proposed change and either approves or rejects the proposed change.
Chief Nursing Officer (CNO)
The senior manager (usually a registered nurse with advanced education and extensive experience) responsible for administering patient care services
Clinical Care Classification (CCC)
“Two interrelated taxonomies, the CCC of Nursing Diagnoses and Outcomes and the CCC of Nursing Interventions and Actions, that provide a standardized framework for documenting patient care in hospitals, home health agencies, ambulatory care clinics, and other healthcare settings”
CPOE (Computerized Physician Order Entry)
An order entry and decision support system that allows direct entry of orders and immediately shared w/ others
Change Management
The process, tools and techniques that help people implement changes to achieve a desired outcome. (Supports the adoption of a medication Administration System)
Change Control
Helps to prioritize limited resources and ensures system standards are upheld.
Connected health
a model of health care delivery using technology to provide services including information and education.
Technology assisted healthcare is delivered between at least 2 points involving either asynchronous or synchronous exchange.
Consumer Health Informatics
Use of electronic info & communication to improve medical outcomes & healthcare decision making from pt perspective.
Patient view and structures and process that enable consumer to manage their own care.
Clinical Research Informatics
Discovery and management of new knowledge pertinent to health and disease from clinical trials via secondary data use.
C-CDA (Consolidated Clinical Document Architecture)
Allows interoperability of health information exchange between to hospitals.
21st Century Cures Act
designed to help accelerate medical product development and bring new innovations and advances to patients who need them faster and more efficiently.
Provisions that will improve workflow & exchange of electronic info. ONC (responsible for implementing) seamless & secure access, exchange and use of electronic health info.
5 rights of clinical decision support
Right information
Right person
Right intervention format
Right channel
Right time in workflow
Clinical Informatics
concentration on the delivery of timely, safe, effective , EB and pt centered care.
C
Clinical Decision Support System
A special subcategory of clinical information systems that is designed to help healthcare providers make knowledge-based clinical decisions
Ex: Alerts for abnormal VS, labs results, med contraindications, screenings, standing orders, reminders in EHR ect…
Clinical Information Systems
Ex: May be specific to certain departments. Lab, radiology, pharm(Both), or particular pt population.
Functions may include order entry, results reporting, scheduling and documentation.
Lg computerized database used to access the pt data that are needed to plan, implement and evaluate care.
Clinical Nurse Specialist
Expert clinician in a specialized area of practice who engages in research and helps direct practice change.
clinical terminology
standardized terms and their synonyms used to record pt data with sufficient detail to support clinical care, decision support, outcomes research, and quality improvement, flow sheets, vital signs, assessments and nursing notes.
Computer Literacy
The ability to use computers for basic tasks, such as developing documents, sending emails and searching the internet for information.
Confidentiality
Relationship has been established where private info shared but NOT disclosed w/out permission
configurability
Refers to the extent that a given software product can be adapted or changed to meet a user’s preference
Contextual Inquiry
involves studying customers’ use of a product at their place of work
Focusing on users point of view.
CCR (Continuity of Care Record)
Snapshot/standardized summary of the most relevant and timely health information about pt and shared to a physician who does not have access to pts EHR.
Continuous Quality Improvement (CQI)
Continuous monitoring of performance and supports audit capability also known as QUALITY ASSURANCE SYSTEM
Critical Care Information System
Integrates captured physiological data w/ practitioner documentation and clinical data management functions, as well as access and communication w/ remote experts.
Data
Facts, figures, and other evidence gathered through observations.
Database
A collection of data organized in a manner that allows access, retrieval, and use of that data
Data cleansing/scrubbing
A process that weeds out and fixes or discards inconsistent, incorrect, or incomplete information
Data Governance
refers to the overall management of the availability, usability, integrity, and security of company data
Data Integrity
The correctness of data after processing, storage or transmission.
Ability to store, retrieve, correct and complete data are available to authorized users
Data Mining
the application of statistical techniques to find patterns and relationships among data for classification and prediction using software.
Data Analysis
processing of data that identifies trends and patterns of relationships
Data Warehousing
Powerful method of managing and analyzing data
DICOM (Digital Imaging and Communications in Medicine)
Transmits digital imaging
(DICOM & HL7 support standardization in health care data
DIKW theory
Data, Information, Knowledge, Wisdom
(data is most discrete)
Data=pt monitoring, labs, diagnostic systems (CT scans)
Information=Clinical Info systems, & DSS (alerts/reminders)
Knowledge=Lg databases (med articles) & Artificial Intelligence
Data Modeling
the process of determining the users’ information needs and identifying relationships among the data to support processes for an info system (key step in design of EHR)
DSS (decision support system)
an interactive, flexible, computerized information system that enables managers to obtain and manipulate information as they are making decisions r/t patient care
device integration
Capturing data from patient monitors and anesthesia machines, and filing them directly to a patient’s chart in EHR. Ex: entering VS, cardiac monitor download data into EHR
Disease Registries
collections of secondary data related to patients with a specific diagnosis, condition, or procedure.
disruptive innovation
a process by which a product or service takes root initially in simple applications at the bottom of a market and then relentlessly moves up market, eventually displacing established competitors
Dissemination
the act of spreading widely or scattering data including research knowledge.
Doctorate of nursing practice (DNP)
degree w/ emphasis on EBP, quality improvement and system leadership
EHR system
3 elements: Data, Info, Knowledge.
Decrease med errors, increase provider documentation.
Function ex: Bar Code Admin.
EMR (electronic medical record)
a record of one episode of care, source data for EHR, Brings together diagnositc & Tx info in a specific healthcare setting.
Ergonomics
The study of workplace equipment design or how to arrange and design devices, machines, or workspace so that people and things interact safely and most efficiently.
EHR
Pt data stored in electronic form(collection of pt healthcare data) **Successful if pt needs met
PHR (personal health record)
Lifelong tool for managing health info, controlled by pt – data can be provided by MD or pharmacy.
(conditions, allergies, meds, surgeries)
Barriers: Poor or no internet, poorly designed apps, limited clinical integration
Predictors: Awareness of PHR’s, ease of access, personal motivation, increased levels of education and health literacy.
emerging trends
- Secondary data
- Technology-based data management
- Digital information acquisition and retrieval
- International client base
- Information management
(patient safety & error reduction)
EBP (evidence based practice)
Using current best evidence for pt care decision in order to improve pt outcomes (found in standing orders) Ex: sepsis protocols & CDS
Expert Systems
Type of CDS/DDS but does NOT need human intervention (artificial intelligence) Ex: Personal Insulin Pump
EMRAM (Electronic Medical Record Analytical Model)
Measures clinical outcomes, pt engagement & clinical use of EMR technology to strengthen organizational performance & health outcomes across pt populations “Basically, evaluates Health Information System”
feature creep
occurs when developers add extra features that were not part of the initial requirements
Finacial system
uses pt demographic data and insurance info to charge for services & reimbursment
Functional Testing
Final process in Project Management Phase 2 (planning) that ensures the innovation works as designed.
Fish boning
Cause/effect diagram, can help in brainstorming to identify possible causes of a prob.
Firewalls
hardware, software, or both designed to prevent unauthorized persons from accessing electronic information, while allowing authorized communication.
Gantt Chart
A time and activity bar chart that is used for planning, managing, and controlling major programs that have a distinct beginning and end.(used for a glance at management)
Gap Analysis
a type of analysis that compares the differences between the consumer’s expectations about and experiences with a service based on dimensions of service quality (Planning)
Go Live
the official time and date that the facility begins using the new system (Implementation Phase)
HIE (Health Information Exchange)
Electronic sharing of pt info (demographic data, allergies, diagnostic tests, and other revelant data between providers, specialists, hospitals, and insurance companies.
HIS Health Information System
Broad term used to describe administrative and clinical systems to streamline work flow processes efficiency.
Hardware/software dedicated to the collection, storage, processing, retrieval and communication of patient care info.
healthcare terminology standards
designed to enable and support widespread interoperability among healthcare software applications for the purpose of sharing information
HIPAA (Health Insurance Portability and Accountability Act)
Kennedy Kassebaum Bill, Federal legislation to protect client records & mandate that all electronic transactions included only HIPAA compliant codes.
Sets nation standards of PHI, legal protection of PHI.
(signing in devices requires encryption)
HIT – Health Information Technology
Technology that is used to record, store, and manage patient healthcare information.
Ex: CDS, CPOE, EMR, EHR, PHR, Telehealth, E-scribe
National & Global implications
Health literacy definition
a person’s capacity to learn about and understand basic health information and services, and to use these resources to promote one’s health and wellness
HIS (Hospital Information System)
What is the name of the computer system that tracks admission and discharge information, diagnostic and treatment services, pharmaceutical and equipment information, and billing information?
Advantages: Better communication, decreased errors & better access to info.
HITECH (Health Information Technology for Economic and Clinical Health Act)
2009 ARRA includes HITECH – promote adoption and meaningful use to HIT.
Goal: Improve quality care, Pt safety, Decrease costs by using meaningful use
Improves Population Health Outcome
HL7 (Health Level 7)
Acronym used to refer a standard of interoperability and exchange of clinical data
(HL7 & DICOM-Standardization)
HIMSS
Healthcare Information & Management Systems Society
formal group of healthcare organizations that seek to improve delivery of healthcare by advancing technology & data management.
*work almost exclusively w/ data
*They protect & handle pt data of all kinds (diagnosis, symptoms, test results, med hx, procedures)
*They ensure info is accurate, accessible, secure and of high quality
*Cause-based, Nonprofit, Global organization focused on better health through info & tech.
Health Informatics Management
focus on info technology needed to store and retrieve pt data accurately, securely and management of the people & processes.
HIE forms
Direct – send/recieve secure info electronically between providers ex: immunization data, quality measures sent to Medicaide/Medicare
Query – find & request info, often used for unplanned care (ER, pregnancy)
Consumer mediated – pts to aggregate and control the use of health info among providers (correcting info, tracking their health, providing providers w/ info)
Informatics
the science and art of turning data into information
*Interdisciplinary field
Data to info, Info to knowledge, Knowledge to wisdom
Implementation Science
study how interventions, which have been shown to be effective in one setting, can be applied to sustain improvements to population health
Information Epidemiology
science of distribution of information in an electronic format w/ te ultimate aim to inform public health and public policy
Informatics Competencies
the ability to perform the tasks associated w/ informatics
information
A continuum of progressively developing and clustered data.
Collection of data that has been interpreted & examined for patterns and structures
information literacy
the ability to figure out the type of information you need, find that information, evaluate it, and properly use it
- Ability to read and understand works/numbers and ability to recognize when info is needed.
Information System
a set of hardware, software, data, people, and procedures that work together to produce information
“Data Collection”
Information Technology (IT)
Transmit Data
Ex: EHR, CDST (clinical decision support tool)
information science
Primarily focused on input processing output and feedback through technology intergration
5 rights of Informatics
Right –
Information
Person
Intervention
Channel
Time in workflow
Informatics Innovator
Conducts information and RESEARCH & generate THEORY & have advanced understanding in info management & computer technology
ICD-10
Used to classify mortality and morbidity data from inpatient/outpatient records, used for reimbursement
Integration
Process of two systems exchanging data in a way that is seamless to end user.
Interoperability
Ability of 2 entities, human/machine to exchange & predictably use data/info while retaining original meaning of data
Ex: Dr-Dr, Hosp-Hosp(C-CDA), escript-pharm
Interface
Bridge/connector to send info from 2 different systems
interoperable systems
Expected outcomes=error reduction, improved revenue, increased communication.
Systems share limited processes and data
Information Security
Security Rule – Nation set of security standards health info in electronic form
GOAL: Protect privacy while adopting new technologies to improve quality & efficiency of pt care
“Need to KNow basis”
The Joint Comission Standards
Standard
The hospital respects the patient’s right to receive information in a manner he or she understands.
Elements of Performance
The hospital provides language interpreting and translation services
Note: Language interpreting options may include hospital employed language interpreters, contract interpreting services, or trained bilingual staff, and may be provided in person or via telephone or video. The hospital determines which translated documents and languages are needed based on its patient population.
–do not have family or children translate!
-don’t have to have one there the whole time – but having one there for discharge would be very important
Joint Commision
ACCREDIATATION
key standard of information management: Protect & aggregate data, uniform language, teach info management (training), disaster and preparedness
knowledge
Skills, experience, and expertise coupled with information and intelligence that creates a person’s intellectual resources
Knowledge Database
A database that not only manages raw data but also integrates them with information from various reference works
knowledge translation
applying research to practice
Knowledge Management (KM)
structed process for the generation, storage, distribution and application of both tacit(personal) knowledge and explicit (evidence) knowledge
knowledge workers
Generate knowledge as product
Knowledge work
gathering data which is then used to create info and knowledge
Kotter’s 8 steps for leading organizational change
- establish a sense of urgency
- create the guiding coalition
- develop a vision and strategy
- communicate the change vision
- empower the broad-based action
- generate short-term wins
- consolidate gains and produce more change
- anchor new approaches in the culture
Lewin’s Change Model
- Unfreezing
- Changing
- Refreezing
Leading others through planned change
malicious software (malware)
Software that is designed to infiltrate or affect a computer system without the owner’s informed consent. The term “malware” is usually associated with viruses, worms, Trojan horses, spyware, rootkits, and dishonest adware.
Meaningful Use (MU)
Part of the requirements of the Health Information Technology for Economic and Clinical Health (HITECH) Act, which is meant to increase the use of an electronic health record through monetary incentives provided the HER is used in a meaningful way to improve patient care. At the time of publication, the Meaningful Use regulations are undergoing revision.
Meaningful use requirements
Requirements established by the Centers for Medicare and Medicaid Services (CMS) as part of the Electronic Health Records (EHR) Incentives Program. The program provides financial incentives for healthcare organizations that “meaningfully used” their certified EHR technology. The requirements include implementing security measures to ensure the privacy of patients’ EHRs.
Meaningful Use Stages
Stage 1: Data capture and sharing
(between hosp/providers)
Stage 2:Advance clinical processes
(standardized lang/terminology, Requires patients to view, download, or transmit their health info online. Capability for secure messaging between providers/pts)
Stage 3:Improved outcomes
Focused of the enhanced use of EHR’s to promote HIE & improve care. Ex: electronic Rx
(clinical Quality Measures)
MU defined by ARRA
a certified EHR used in a meaningful way to use HIT to collect specific data w/ the intent to IMPROVE CARE & POPULATIONS HEALTH, ENGAGE PTS & ENSURE PRIVACY/SECURITY.
*Inpatient/Outpatient.
Mission Planning
purpose of an organizations existence, representing the fundamental and unique aspirations that differ it from others.
LONG RANGE PLAN (not short term)
MIPS (Merit-Based Incentive Payment System)
Program that combines other physician quality reporting system (PRRS) & Medicare EHRs based on QUALITY, resource use, clinical practice environment & meaningful use of EHR tech.
“Quality”
Meaningful use requirements by CMS
*Basic entry of clinical information/REQUIRES STANDARDIZED TERMINOLOGY (ALLOWS FOR UNIFORMITY & EASIER RETRIEVAL OF NURSING RELATED DATA)
*Use of several software apps
*Entry of clinical orders w/ safety measures
M-Health (mobile health)
the use of wireless communication devices to support public health and clinical practice
medical informatics
Application of informatics to all of the healthcare disciplines as well as to the practice of medicine
LOINC (Logical Observation Identifiers Names and Codes)
Standard for identifying laboratory and clinical observation for exchange (LAB)
NANDA
North American Nursing Diagnosis Association, purpose is to define, refine, and promote a taxonomy of nursing diagnostic terminology of general use to professional nurses.
- Standardized data language for nursing diagnosis
Nursing Interventions Classification (NIC)
A listing of research-based nursing intervention labels that provides standardization of expected nursing interventions.
National Library of Medicine (NLM)
Helps to provide validity of health information
MACRA
Medicare Access and CHIP Reauthorization Act
GOAL: drive healthcare reform towards providing improved reimbursement for care based on volume and quality rather than quantity.
Omaha System
A research-based taxonomy designed to generate data following routine client care.
Used in homecare, hospice, public health, school health and prisons.
Ontology
system that organizes concepts by meaning, describing their definitional structure as well as organizing the concept for storage and retrieval of accurate data
Patient Protection and Affordable Care Act (PPACA)
2010 federal legislation designed for comprehensive health reform, with an intent to expand coverage, control health care costs, and improve the health care delivery system
*Guarantee’s access to healthcare for ALL Americans & incentives to change clinical practice to encourage better coordination & quality care. Insures can’t charge for preexisting conditions or demographic status (Except age)
personal health record (PHR)
An electronic record of health-related information about an individual that conforms to nationally recognized interoperability standards and that can be drawn from multiple sources but that is managed, shared, and controlled by the individual.
Pharmacy information system (PIS)
A key tool in providing optimal patient care and assisting providers in ordering, allocating, and administering medication, with a focus on patient safety issues, especially medication errors
Predictive Analytics
Uses past and current data to forecast the likelihood that an event will occur.
Privacy
the right of people not to reveal information about themselves
Project Management Life Cycle (PMLC) stages
“Initiating/Design, Planning, Executing/Implementing, Monitoring and Controlling, Evaluation and Lessons learned with knowledge transfer”
PMLC
(1) Design/Plan: Scope document: Official document that details how the project will be managed & what the project requirements are.
Scope Creep- Unapproved change, which can cause serious delays or even project failure.
As the scope & charter are developed, a GAP analysis is completed. Used to identify needed changes in workflow.
GAP Analysis: A list of features & functions desired, but not immediately available in the new system as identified.
(2) Implementation: Training the staff/ end-users in this phase. With change, different behaviors can develop. For example, Resignation, resistance, feelings of loss, etc.
Lewin’s Change Theory- One of several foundational theories for leading other through planned change. Identifies 3 Steps: Unfreezing, Changing, Refreezing. INVOLVE EMPLOYEES IN THE DECISION-MAKING PROCESS!!
Kotter’s Change Management
Big Bang Conversion: “All-at-Once” implementation
Rollout: Gradual/ staggered implementation
Pilot: Small groups of individuals to evaluate potential issues
Parallel Conversion: Operates both the old and new systems for a limited time.
(3) Monitor & Control
(4) Evaluation
(5) Lessons learned with knowledge transfer
Project Implementation Team/Committee
The First Task of this Committee is to Develop a Timeline!!
· Compromised of representatives from the user departments. The project team needs to be actively involved as an end-user. The implementation Committee determines the project implementation strategy. Interdisciplinary will plan, test, train, etc. after the EHR is purchased.
Project Scope
describes the business need (the problem the project will solve) and the justification, requirements, and current boundaries for the project
*Defines the size and details of a collaborative effort.
Public Health Informatics
application of information and computer science and technology to public health practice, research, and learning
Project Planning
The SECOND phase of the project management process that focuses on defining clear, discrete activities and the work needed to complete each activity within a single project.
Phishing
Deceptive method to steal sensitive info via internet.
(1st email, 2nd open email, 3rd Hackers have info
Physical Security
The protection of physical items, objects, or areas from unauthorized access and misuse.
patient data
personal information about a patient, as well as information about the patient’s medical insurance coverage.
Name, age, wt, VS
PGHD (Patient-generated health data)
Health related data created, recorded, or gathered by the pt/cg to help address health concerns.
Logical Security
uses technology to limit access to only authorized individuals to the organization’s systems and information, such as password controls
Quantitative Research
Focus on #’s and frequencies
GOAL: Finding relationships or variables specific to outcome
Qualitative Research
Variable (not focused on counting)
Questionnaire’s, survey’s, interviews, lists “Data Capturing”
Ex: personal digital assistants/laptops
QSEN (Quality and Safety Education for Nurses)
focus on competency needed to continuously improve quality of care in their work environment
Patient centered
Teamwork and Collaboration
Evidence-Based Practice
Quality Improvement
Safety
Informatics-Electronic charts
Quality indicators 4 Types:
- Prevention
- Inpatient
- Patient Safety
- Pediatric
Real time analytics
the provision of analyzed data relatively instantly to support decision making. IBM’s Watson is the best example we have today
RMS Risk Management System
identifies and documents potential risks and develops strategies to deal w/ them
Shared electronic health record
a type of EHR supported by an EHR system that allows clinicians to access an individual patients EHR data located in different facilities
Scope Creep
The uncontrolled expansion to product or project scope without adjustments to time, cost, and resources.
SNOWMED CT
systematized nomenclature of medicine clinical terms
enables consistent way of capturing sharing aggregating health data across specialties site of care
teminology for anatomy dx med problems nursing
- Provides common language for EHR.
Standardized Terminologies
Structured, controlled languages developed according to terminology development guidelines and approved by an authoritative body.
Strategic Planning
the process of determining the major goals of the organization and the policies and strategies for obtaining and using resources to achieve those goals
NOT SHORT TERM GOALS
System Development Life Cycle (SDLC) Stages
(1) Design
(2) Plan (Where S.W.O.T. Analysis is done)
(3) Implement
(4) Analyze (Look at technical requirements)
(5) Evaluate
SDLC (Systems Development Life Cycle)
(1) Needs Assessment: Determine the needs & wants in an Information System
(2) Selection System Phase: An organization seeks out a vendor company that provides a system that best fits the needs.
· 3 Documents are used:
- Request for Information Document: Initial contact with a vendor. Get essential information about the company’s history.
- Request for Proposal Document: Organization priorities or rates their needs & wants. Send an outline to vendors & see if request can be met.
- Request for Quote Document: Pricing, finance, and contract terms.
(3) System Implementation Phase: Go live PLANNING. Train staff, including end-users. Analysts start building screens and templates according to the organization and its policies, then apply any changes and go live.
(4) Maintenance Phase: Problem solving, any debugging, files are backed up & updates (security protections) are installed routinely, to ensure the program is working as intended.
S.W.O.T. Analysis: Done in the PLANNING phase of the Information System Life Cycle. It’s a type of strategic planning. Helps identify gaps in the current system, as well as potential opportunities if a new or updated system is implemented. S.W.O.T. is a process that examines the strengths, weakness, opportunities, and threats of a given situation.
Steps in SDLC
- Needs – Needs/wants in system
- System selection phase:
-Request Info Doc
- Request Proposal Doc
- Request Quote Doc
- System Implementation Phase – GO Live, train
staff/end users - Maintanence Pharse: Prob solving, debuggin, file back up, security
SWOT analysis
identifying internal strengths (S) and weaknesses (W) and also examining external opportunities (O) and threats (T)
(Planning Phase)
Telenursing
use of telecommunications and information technology to provide nursing practice at a distance
Telehealth
the use of electronic information and telecommunications technologies to support long-distance clinical healthcare, health-related education, public health, and health administration
*Does not always involve clinical services
Telemedicine
Involves the use of video, audio, and computer systems to provide medical and/or health care services.
Translational Bioinformatics
Ex: DDS/Decision Support System
Relatively new term that supports the National Institute for Health road map for medical research
Ability to translate voluminous biomedical data into proactive, predictive, preventive, and participatory health
Information disseminated to a variety of stakeholders, including biomedical scientists, clinicians, and patients
TIGER (Technology Informatics Guiding Educational Reform)
2004, Advance RN competencies in informatics
Develop US workforce capable of using EHR to improve delivery of care.
Wisdom
Application of knowledge to manage and solve problems
User inference
Allows humans and computers to cooperatively perform tasks/goals
value-based model
Policy Reform 2008, focused on incentives to providers on quality (value) vs Volume.
Value vs volume
Hope is to reduce the number of unnecessary or limit value tests and treatments.
Usability
The quality of the users experience when interacting w/ a product system software or application.
EFFECTIVENESS, EFFICIENCY AND USER SATISFACTION
DRA (Deficit Reduction Act of 2005)
“Do Not Pay” CMS oversee’s the Hosp Acquired Conditions present on Admit (HAC-POA) Program
Ex: stage III & IV pressure ulcer, Falls, Trauma, Cath assoc infection, surgical site infections, DVT’s, Vasc. Cath Assoc Infections.
(ONCHIT) Office of the National Coordination for Health Information Technology
Federal government driving healthcare Info standards.
2 Federal Advisory Committees:
HITPC – framework for nationwide infrastructure & HIT standards for communities
HITSC – develop standards, certifications and implementations strategies.
AHIMA Standards of Ethical Coding
Standards developed by the Council on Coding and Classification of the American Health Information Management Association (AHIMA) to give health information coding professionals ethical guidelines for performing their coding and grouping tasks.
Barcode Medication Administration (BCMA)
: Mandated by the FDA Real-time, automated documentation of patient’s medication. Needs CPOE, A pharmacy system, & an EMAR system to function.
Interoperability
When 2 or more systems (Human or Machine) exchange data or information while retaining the original meaning of data. A nurse informaticist can increase interoperability by promoting standardized vocabulary & coding. ** Using an interoperable system, you can expect a reduction in errors, increase in revenue, and increased communication**
Types of Interoperability
Technical Interoperability-ability to exchange the data from one point to another
Semantic Interoperability-exchange of data in wh/ the meaning remains the same at both ends.
Process Interoperability – Coordinates systems enabling business processes at organizations & allowing systems to work together.
Benchmarking
The continual process of measuring services and practices against the toughest competitors in the healthcare industry
Store and Forward Applications
Asynchronous. Transmit recorded health information through a secure communications network to a provider (Photos).
de-indentified health information/HIPAA
There are no restrictions on the use or disclosure of de-identified health information.14 De-identified health information neither identifies nor provides a reasonable basis to identify an individual. There are two ways to de-identify information; either: (1) a formal determination by a qualified statistician; or (2) the removal of specified identifiers of the individual and of the individual’s relatives, household members, and employers is required, and is adequate only if the covered entity has no actual knowledge that the remaining information could be used to identify the individual.
Required Disclosures
A covered entity must disclose protected health information in only two situations: (a) to individuals (or their personal representatives) specifically when they request access to, or an accounting of disclosures of, their protected health information; and (b) to HHS when it is undertaking a compliance investigation or review or enforcement action
Permitted uses and disclosures of PHI
A covered entity is permitted, but not required, to use and disclose protected health information, without an individual’s authorization, for the following purposes or situations: (1) To the Individual (unless required for access or accounting of disclosures); (2) Treatment, Payment, and Health Care Operations; (3) Opportunity to Agree or Object; (4) Incident to an otherwise permitted use and disclosure; (5) Public Interest and Benefit Activities; and (6) Limited Data Set for the purposes of research, public health or health care operations.18 Covered entities may rely on professional ethics and best judgments in deciding which of these permissive uses and disclosures to make.
disclosures of psychotherapy notes
Most uses and disclosures of psychotherapy notes for treatment, payment, and health care operations purposes require an authorization as described below.23 Obtaining “consent” (written permission from individuals to use and disclose their protected health information for treatment, payment, and health care operations) is optional under the Privacy Rule for all covered entities.24 The content of a consent form, and the process for obtaining consent, are at the discretion of the covered entity electing to seek consent.
Disclosure to Covered entities
Covered entities may disclose protected health information to:
(1) public health authorities authorized by law to collect or receive such information for preventing or controlling disease, injury, or disability and to public health or other government authorities authorized to receive reports of child abuse and neglect;
(2) entities subject to FDA regulation regarding FDA regulated products or activities for purposes such as adverse event reporting, tracking of products, product recalls, and post-marketing surveillance;
(3) individuals who may have contracted or been exposed to a communicable disease when notification is authorized by law; and
(4) employers, regarding employees, when requested by employers, for information concerning a work-related illness or injury or workplace related medical surveillance, because such information is needed by the employer to comply with the Occupational Safety and Health Administration (OHSA), the Mine Safety and Health Administration (MHSA), or similar state law
Disclosure – Victims of Abuse, Neglect or Domestic Violence
Victims of Abuse, Neglect or Domestic Violence. In certain circumstances, covered entities may disclose protected health information to appropriate government authorities regarding victims of abuse, neglect, or domestic violence
Disclosure – Workers Compensation
Workers’ Compensation. Covered entities may disclose protected health information as authorized by, and to comply with, workers’ compensation laws and other similar programs providing benefits for work-related injuries or illnesses.4
Disclosure – Limited Data Set
Limited Data Set. A limited data set is protected health information from which certain specified direct identifiers of individuals and their relatives, household members, and employers have been removed.43 A limited data set may be used and disclosed for research, health care operations, and public health purposes, provided the recipient enters into a data use agreement promising specified safeguards for the protected health information within the limited data set.
Authorized Uses
A covered entity must obtain the individual’s written authorization for any use or disclosure of protected health information that is not for treatment, payment or health care operations or otherwise permitted or required by the Privacy Rule.44 A covered entity may not condition treatment, payment, enrollment, or benefits eligibility on an individual granting an authorization, except in limited circumstances.45
Examples of disclosures that would require an individual’s authorization include disclosures to a life insurer for coverage purposes, disclosures to an employer of the results of a pre-employment physical or lab test, or disclosures to a pharmaceutical firm for their own marketing purposes.
Disclosure of Psychotherapy Notes
A covered entity must obtain an individual’s authorization to use or disclose psychotherapy notes with the following exceptions48:
The covered entity who originated the notes may use them for treatment.
A covered entity may use or disclose, without an individual’s authorization, the psychotherapy notes, for its own training, and to defend itself in legal proceedings brought by the individual, for HHS to investigate or determine the covered entity’s compliance with the Privacy Rules, to avert a serious and imminent threat to public health or safety, to a health oversight agency for lawful oversight of the originator of the psychotherapy notes, for the lawful activities of a coroner or medical examiner or as required by law.
Limiting Uses and Disclosures to the Minimum Necessary
A central aspect of the Privacy Rule is the principle of “minimum necessary” use and disclosure. A covered entity must make reasonable efforts to use, disclose, and request only the minimum amount of protected health information needed to accomplish the intended purpose of the use, disclosure, or request.50 A covered entity must develop and implement policies and procedures to reasonably limit uses and disclosures to the minimum necessary. When the minimum necessary standard applies to a use or disclosure, a covered entity may not use, disclose, or request the entire medical record for a particular purpose, unless it can specifically justify the whole record as the amount reasonably needed for the purpose.
The minimum necessary requirement is not imposed in any of the following circumstances: (a) disclosure to or a request by a health care provider for treatment; (b) disclosure to an individual who is the subject of the information, or the individual’s personal representative; (c) use or disclosure made pursuant to an authorization; (d) disclosure to HHS for complaint investigation, compliance review or enforcement; (e) use or disclosure that is required by law; or (f) use or disclosure required for compliance with the HIPAA Transactions Rule or other HIPAA Administrative Simplification Rules.
Privacy Practices Notice
Privacy Practices Notice. Each covered entity, with certain exceptions, must provide a notice of its privacy practices. The Privacy Rule requires that the notice contain certain elements. The notice must describe the ways in which the covered entity may use and disclose protected health information. The notice must state the covered entity’s duties to protect privacy, provide a notice of privacy practices, and abide by the terms of the current notice. The notice must describe individuals’ rights, including the right to complain to HHS and to the covered entity if they believe their privacy rights have been violated. The notice must include a point of contact for further information and for making complaints to the covered entity. Covered entities must act in accordance with their notices. The Rule also contains specific distribution requirements for direct treatment providers, all other health care providers, and health plans.
Personal Representatives – Disclosure
Personal Representatives. The Privacy Rule requires a covered entity to treat a “personal representative” the same as the individual, with respect to uses and disclosures of the individual’s protected health information, as well as the individual’s rights under the Rule.84 A personal representative is a person legally authorized to make health care decisions on an individual’s behalf or to act for a deceased individual or the estate. The Privacy Rule permits an exception when a covered entity has a reasonable belief that the personal representative may be abusing or neglecting the individual, or that treating the person as the personal representative could otherwise endanger the individual.
Special Case: Minors – Disclosure
Special Case: Minors. In most cases, parents are the personal representatives for their minor children. Therefore, in most cases, parents can exercise individual rights, such as access to the medical record, on behalf of their minor children. In certain exceptional cases, the parent is not considered the personal representative. In these situations, the Privacy Rule defers to State and other law to determine the rights of parents to access and control the protected health information of their minor children. If State and other law is silent concerning parental access to the minor’s protected health information, a covered entity has discretion to provide or deny a parent access to the minor’s health information, provided the decision is made by a licensed health care professional in the exercise of professional judgment.
Civil Penalty $$
Civil Penalty Amount
$100 to $50,000 or more per violation
$1,500,000 Calender Yr CAP
A penalty will not be imposed for violations in certain circumstances, such as if:
the failure to comply was not due to willful neglect, and was corrected during a 30-day period after the entity knew or should have known the failure to comply had occurred (unless the period is extended at the discretion of OCR); or
the Department of Justice has imposed a criminal penalty for the failure to comply
Criminal Penalties
Criminal Penalties. A person who knowingly obtains or discloses individually identifiable health information in violation of the Privacy Rule may face a criminal penalty of:
- up to $50,000 and up to one-year imprisonment.
*$100,000 and up to five years imprisonment if the
wrongful conduct involves false pretenses,
*and to $250,000 and up to 10 years imprisonment if the
wrongful conduct involves the intent to sell, transfer,
or use identifiable health information for commercial
advantage, personal gain or malicious harm.
The Department of Justice is responsible for criminal prosecutions
Which three common policies, laws, or regulations affect health information technology?
ARRA (American Recovery and Reinvestment Act),
21st Century CURES Act, and
FDASIA (Food and Drug Administration Safety and Innovation Act)
HITECH Act
The HITECH Act directs eligible healthcare providers and healthcare organizations to adopt electronic health records to improve the exchange of information and to improve privacy and security protections for healthcare data.
FDASIA (FDA Safety and Innovation Act)
FDASIA has improved the FDA’s ability to speed patient access to digital records and improve the safety of drugs, medical devices, and biological products.
The 21st Century CURES Act is designed to
The 21st Century CURES Act is designed to help accelerate medical product development and bring new innovations and advances to patients who need them faster and more efficiently. It also requires patient electronic health information be made available to patients without delay (with few exceptions), at no cost.
One of the provisions of the 21st Century CURES Act is the elimination…….
One of the provisions of the 21st Century CURES Act is the elimination of information blocking. Information blocking is defined as a practice by a health IT stakeholder that, except as required by law or specified by the Secretary of Health and Human Services (HHS) as a reasonable and necessary activity, is likely to interfere with access, exchange, or use of electronic health information from provider to provider or provider to patient. TRUE
Promoting Interoperability Program (MU renamed in 2018 by CMS)
The shift moved the program beyond meaningful use into a new phase with increased focus on interoperability and improving patient access to health information.
The program objectives include:
Immunization Registry Reporting
Syndromic Surveillance Reporting
Electronic Case Reporting
Public Health Registries Reporting
Clinical Data Registries Reporting
Electronic Reportable Laboratory Test Reporting (for Hospitals only)
medical device data systems (MDDS) devices (per FDA)
MDDS is a device that is intended to transfer, store, convert or display medical device data without controlling or altering the functions or parameters of any connected medical devices. An MDDS may include software, electronic or electrical hardware, modems, interfaces, and a communications portal.
The Picture Archiving and Communication System (PACS)
The Picture Archiving and Communication System (PACS) facilitates storage, trans-mission, and sharing of medical images. including x-rays, magnetic resonance imag-ing (MRI), computerized tomography, and ultrasound.
During Downtime or Natural Disasters r/t charting
procedures are implemented that all must use, which often includes reverting back to documenting on paper until the system can be fixed and brought back up.
This disruption causes major obstacles since data is not readily accessible, orders cannot quickly flow to appropriate departments, and there may be duplicate orders and documentation when the system does come back up because there are both paper and electronic versions of the same items.
How often should computer systems be upgraded?
Implementing and maintaining computer systems is very expensive, as they must be upgraded every two to three years
Smart technology
the functionality behind the scenes that provides the capability of the electronic system to send real-time messages to all of the various areas required during a patient visit, where providers document the visit, order the medications while also checking alerts for errors, schedule appointments, and generate bills, to name just a few of the functions of an EHRS.
All of this is done because the different systems are tied or interfaced together so the electronic messages can cross systems.
3 textual knowledge representations for concepts in medicine and nursing
Systematized Nomenclature of Medicine (SNOMED), Current Procedural Terminologies (CPT),
and Nursing Interventions Classification (NIC)
Current functionality of EHR includes:
- Point of care (POC) access by practitioners.
- Support for multiple users to view data on same
patient at the same time. - Results review (laboratory, pathology, imaging, notes,
etc.)
. • Quality metrics. - Dashboards.
- Documentation.
- Electronic communication.
- Order management.
- Patient monitoring in real time.
- Patient summary displays.
- Patient support.
- Medication administration record.
- Population health.
- Bar code medication administration.
- External reference resources.
- Billing
Meaningful use requires that use of an EHRS results in
improved quality, safety and
efficiency while reducing inconsistencies in healthcare; increases patients’ and families’ active involvement in their care; increases the coordination of healthcare; advances the health of the public; and safeguards the privacy and security of personal health data and information
Remaining challenges to using EHRS include
: • Integration of behavioral health and primary care
workflows.
- Information exchange.
- Limited resources.
- Work-arounds.
Work-arounds
variations in procedures and processes created to accomplish work when systems or workflows are deficient or inefficient which can, and fre-quently do, defeat positive features such as safety.
EHRS implementation considerations include:
- Compliance with requirements including ONC Certification for MU, as well as other regulatory and accreditation demands.
- The creation of the electronic infrastructure, necessary policies and procedures to provide access to patient information.
- Funds for purchase costs, improvements, ongoing maintenance and support. • Standardization of terms. • Security, privacy, and confidentiality.
- Measures to ensure data integrity including creating
and maintaining master files and data dictionaries. - Backup options
- Ownership of patient information.
mHealth
a form of health information technology, not a health information system. It is used to analyze, aggregate, share, and protect health information data derived from or used in portable devices.
HIT is used to …..
used to support systems that collect data needed for patient care, population health management, and for the sharing of this information within a secure system.
The health information exchange (HIE) infrastructure
is a process for bi-directional sharing of patient health-related information among primary providers (nurse practitioners, physicians, and physician assistants), consulting specialists, hospitals, ambulatory centers, nursing homes, dentists, audiologists, optometrists, and occupa-tional-and school-health professional
CONCERN CDS
identifies nursing documentation patterns that are for patient deterioration and generates a predictive early warning score. The CONCERN CDS consists of two main components:
- the decision engine, which uses AI models to analyze the content and patterns of nursing EHR data (such as flow sheet entries and nursing notes)
- front-end interfaces that display the predicted CONCERN levels (green, yellow, red), with red indicating that a patient is at the highest risk for deterioration. A web application provides tracking of the CONCERN level over time and facilitates transparency of the AI models by displaying what factors contributed most to the current calculation.
Information management CDSS includes
patient education material, info buttons, or guidelines for practice
CDSS examples:
paper decision support tools, order sets, parameters for patient care, patient data, and patient monitors, Nursing literature
CDSS providing patient specific decision support
Elements such as depression scoring, patient goals, and body mass index provide information that could enhance patient specific decision support.
How is the use of predictive analytics better than the use of standard alerts for nurses’ decision-making?
Predictive analytics can provide a risk estimate of the patient for morbidity or mortality and acuity, providing a higher level of decision support for the nurse.
How does the HIE support informed decision-making for nurses and providers?
The timely sharing of patient information and at the point of care allows: the avoidance of readmissions the avoidance of medication errors the improvement of problem identification the improvement of diagnosis accuracy the reduction of duplicate testing
What does interoperability in healthcare mean?
It is the ability of different information systems and health information technologies to securely access, exchange, integrate, and cooperatively use data in a coordinated manner using a standardized format across several national and global boundaries.
Interoperability allows timely and seamless portability of information and optimizes the health of individuals and populations globally through this seamless exchange.
What is the difference between health information systems and health information technologies?
Health information systems manage health information for specific areas of healthcare. Health information systems are categorized as clinical information systems or administrative information systems.
Health information technology (HIT) is what is involved in the design, development, implementation, integration, creation, use, and maintenance of health information systems. HIT also refers to the area of healthcare that uses computer hardware, software, or infrastructure to record, retrieve, analyze, archive, secure, and share clinical administrative, and financial information. HIT is the backbone and foundational structure of many advancements in healthcare such as clinical decision support, computerized disease registries, computerized provider order entry, consumer health IT applications, electronic medical record systems (EMRs, EHRs, and PHRs), electronic prescribing, and telehealth.
Grading of Recommendations Assessment, Development, and Evaluation (GRADE)
identifies three domains as indirectness, inconsistency, and imprecision.
GRADE refers to quality of evidence
PARIHS framework defines three key elements that, when used together, will mutually influence each other for a successful EBP implementation…they are:
The three elements are: (1) evidence—sources of knowledge from multiple stakeholders, (2) context—quality of the environment EBP is to be implemented, and (3) facilitation—how change will be supported
Examples of four different types of tools frequently used when defining or monitoring a process include
workflows, cause-and-effect diagrams, checklists, and scatter diagrams.
This is a category of diagramming techniques to use when identifying risks and quality management concerns.
workflow
Using this process, defines what needs to be completed first, working through an entire sequence of activities step by step.
*moves through steps, then identifies a decision that
needs to be made before continuing
cause-and-effect diagram/fishbone diagram
is used to identify and trace problems and then track the cause back to the root.
*also called root-cause analysis.
*The first step in the process is to state what the problem is, then ask “why” any number of times until the source or cause has been identified. Examples of items on the arrows or causes might be people, technology, a process, or different environments.
Checklists
these are another simple way of gathering data in order to organize facts in an easy way so an issue or problem can be reviewed in more detail.
*Some of the most common examples are checklists for FREQUENCIES of an EVENT or CONSEQUENCES of using a particular PROCESS.
A scatter or correlation chart
provides a quick, visual way of looking at how one variable or item relates to another, either in a positive, negative way or no correlation.
The x-axis could represent something as simple as temperature, and the y-axis something like time.
EX: temperature goes up over time.
(RACI) checklist
known as responsible, accountable, consulted, and informed
When a group is assigned different levels of responsibilities where each member has a different task, it is important to track who is doing what; for example, who is responsible and who might just be consulted or just kept informed about the task.
A Gantt chart is
another way to track different tasks and provide a quick visual representation of due dates, including duration times and start and end dates as well as tasks, subtasks, and who is responsible for making sure the task is completed
Regression Testing
If anything is changed on an already-tested module, regression testing is done to be sure that this change has not introduced a new error into code that was previously correct.
The strategic plan supports the
mission, scope, vision, goals, and objectives of the organization.
Strategic planning is guided by
upper-level administrators and stakeholders including the CEO, CIO, CNO, and CNIO.
Evidence-Based Practice Council (EPC) refers to
strength of evidence
The following databases are commonly used when searching for original research articles:
- CINAHL.
- MEDLINE.
- Proquest Nursing & Allied Health.
- PsychINFO.
- PubMed.
The following databases are specific to systematic research reviews:
- Cochrane Library.
- Joanna Briggs Institute EBP Database.
- Database of Abstracts of Reviews of Effects (DARE).
Stetler Model
(1) preparation, (2) validation, (3) comparative evaluation/decision-making, (4) translation and application, and (5) evaluation. The model can be oriented toward the individual or team approach
Remaining challenges to using EHRS include
- Integration of behavioral health and primary care
workflows. - Information exchange.
- Limited resources.
- Work-arounds
Beginning nurse:
—expected to have fundamental information-management and computer-technology skills and use existing information systems and established information-management practices.
Experienced Nurse
expected to have a specific area of expertise (e.g., public health, education, administration); be skilled in using information management and computer technology; have strong analytic skills to learn from relationships between different data elements; and be able to collaborate with the informatics nurse specialist to suggest improvement to systems.
Informatics specialist:
defined as a nurse with advanced skills specific to health-information management and computer technology.
*focus on information needs for the practice of nursing, which included education, administration, research, and clinical practice and use critical thinking, process skills, data-management skills, expertise in the systems development life cycle, and computer skills.
Informatics innovator:
expected to be educationally prepared to conduct informatics research and generate informatics theory, have advanced understanding, skills in information management and computer technology. (e.g., developing innovative and analytic techniques for scientific inquiry, applying advanced analysis and design concepts to the system life cycle process), and fiscal management
Contact precautions diseases examples: (how are they diagnosed)
examples include:
norovirus, rotavirus and C-diff- stool
draining abscesses – look for worsening s/sx
MRSA – tissue sample/nasal
Droplet precautions examples (how are they diagnosed)
scarlet fever – rapid strep
pneumonia – CXR
pertussis/whooping cough – swab
influenza – swab
(Private room and mask)
Airborne precautions examples (how are they diagnosed)
chickenpox (varicella) – PCR/fluid from lesions
Herpes zoster/shingles – fluid from lesions/labs for antibodies
TB- CXR/Mantoux skin test/labs
GRADE
Grading of Recommendations Assessment, Development and Evaluation
*Goal is to address level of evidence
Radio Frequency Identification (RFID)
An example of this includes a mobile workstation that uses a Bluetooth device to connect the scanner to the computer. The nurse scans the patient identification band or a medication and verifies the right patient or the right medication with the right medical record.
*small chip in device as identifier
*Grant from the FCC to develop
Mutlidisciplinary Team Terminology
(SNOMED-CT) Systematized Nomenclature of Human and Veterinary Medicine Clinical Terms- clinical terms covering nurisng, medicine, & allied health
Standardized Terminology Supports
Data Mining
PHR – Private Health Record
Lifetime health record, supplied by ind., healthcare providers, pharmacies, therapist, lab test, – Controlled by the consumer,
E-Sign
Same legal status as a hand written signature
MIPPA – Medicare Improvement for Patients & Providers Act provides
financial incentive for e-prescribing to providers
HIPPA provides
legal protection for personal health info, set standards for elect. data interchange of claims data, named specific code sets for use in Medicare related transactions, & Privacy
ARRA provides
provide funds for adoption of technology & provides the right for every individual to receive and electronic copy of EHR
HITECH provides
strengthened HIPPA security & privacy protection, & provides financial incentive for the user of EHR
EMR -electronic medical record provides
Legal record often restricted to a Single episode of care , building block of EHR,
EHR- Electronic Health Record is
Longitudinal record that includes client data, demographics, clinician notes, medications, diagnostics.
- Major driver for US Adoption are “Meaningful Use” financial incentives from HITECH part of ARRA
Affordable Care Act provides
guarantee access to healthcare, encourage PCP,
Data is
collection of #, characters, or facts (body weight- 128lb), little meaning alone
Information is
Collection of data examined for patterns or structure that can be interpreted. ex notes prior BP and informs doc
Knowledge is
Synthesis of info from several sources to produce a single concept or idea, ex read a journal about BP
Computer Technology is
collection of data for analysis, which can be used to justify the efficacy of particular interventions & improve quality of care
HIS HEalthcare Information System is
Administrative System + Clinical Information System,
Clinical Systems include: order entry, radiology, pharmacy, physician management system
Adm system : non clinical, demographics, scheduling, risk mgmt, decision support,
Administrative System includes these functions
Managing nonclinical, client-related information (demographics, codes for procedures, & Insurance
Hippa – Compliant Codes inlcude
(ICD) International Classification of Disease, Common Procedural Terms, (ABC) Alternative Billing Codes,
ANA recognizes these terminologies
(CCC) Clinical Care Classification, (ICNP) International Classification of Nursing Practice, NANDA, NIC, NOC, the Omaha System, (PNDS) Perioperative Nursing Data Set
Teleconferencing is
use of computers, audio, & video equip. and high-grade dedicated telephone line, cable/sat connections to provide interactive communication between 2+ ppl at 2+ sites
Elearning provides
electronic media to present instruction, it allows users to skip information they already know
Distance Education is
the use of print, audio, video, computer, or teleconference capability to connect faculty & students; Can take place in real time or on a delayed basis
Web Based Instruction is
the attributes & resources of the internet to deliver & support education
Telehealth is
use of telecommunication technologies & computers to provide healthcare info & services to clients at another location
- consumers are chronically ill, isolated, assisted living families
- decrease er visits, decrease LOS, decrease Admissions, increased productivity for clinical
Telenursing is
telecommunications & computer technology for the delivery of nursing care & services to clients at other sites
Issues with telehealth & telenursing are
lack of reimbursement, infrastructure, plug-play standard, license & liability issues, & concerns r/t to client privacy & confidentiality
EBP- Evidence Based Practice is
the use of research & evidence to inform clinical practice, an approach to provide care that integrates nursing experience & intuition with valid and current clinical research to achieve the best patient outcomes
EBP provides
standardized best practices, reduce time that the nurse spends gathering & assessing data, provide care w/ clinical research
EBP contributes
increased job satisfaction, improved quality of care
how a nurse uses data
- accessing information
- collecting data
- Inputting Data
- analyzing data
quantitative research
concerned with objectivity, tight control over situations, define relationships between variables, seek correlation between data, ex. tries to discover how an intervention has impacted subjects IN DEPTH, tangible relations between variables,
qualitative research
concerned w/ finding out more about the human experience, accomplished thru interviews & over a long period of time, ex. how an intervention could impact an entire population, content analysis, computers can code responses to questionnaires which then can be inputted in the informatics sys for analysis,
types of patient information are
- standard
- general
- targeted
- personalized
- tailored
Standard patient information is
describes procedures that all patients will encounter, ex temperature or weight
General patient information is
ask consumers to follow a PREVENTIVE course of treatment that applies to everyone ex yearly physical
Targeted patient information is
geared toward ppl who are a SUBSET of the general population ex men >40 prostate exam
Personalized information is
gives info about a SPECIFIC condition the consumer has been diagnosed with ex. DMII
Tailored Information is
information that focuses Specifically on Ind Based on Specific Conditions , it is typically gleaned from EHR or EMR
Telemedicine
improve pt outcomes by permitting pts to remain at home, allows pts to communicate w/ provider about blood glucose test or video conference w/ them directly to develop pt specific education opportunities, directed by doctors
TIGER means
Technology Informatics Guiding Education Reform
ARRA means
American Recovery & Reinvestment Act
HITECH
Health Information Technology for Economic & Clinical HEalth
CPOE
Computerized Physician order entry
– needs downtime procedure or policy prior to implementation
DSS
Decision Support Software
Info Life Cycle is
- Needs assessment
- System selection
- Implementation
- Maintence
Input devices
enter info into the computer such as keyboard, touchscreen, mouse, microphone
2nd storage examples
hard disk, usb, dvd
out put devices
use to see info such as computer screen, printer, projector, speakers
Software
interprets data by binary code, tells the computer what to do at a given moment,
operating system
tells how to move, share, and treat files. It also provides a user interface that enables the user to enter info, ex windows
application
to perform a certain function; designed to document pt & provider activity ex physician orders
network
connect mult computers in different locations
LAN
connect a few computers to the server, over large area ex docs place orders remotely at home
IntrAnet and extranet
IntrAnet- private networks that can not be accessed outside the organization
Extranet- network outside the company that enables customers & suppliers access to the services
System Check
help guide thru data collection process, ex. patient allergies to prevent conflict
EDI Electronic data interchange
permits mult systems to acquire & share data
Nursing Information System
standardized nursing language (SNL), 2 main approaches,
- Nurisng Process Approach & Critical Pathway- mult discp. teams thru out, physicians orders are present for the multdisc team to observe & follow, allows the the multdisc. team to update the plan of care when variances in the pts condition are noted
- Protocol Approach- streamline doc of assessment, med info, discharge info, education
Firewall
between hardware & software
interfacing types
- point to point – enables to sys to communicate
- Interface
PACS
allows digital manipulation
Store & Forward
Part of telehealth, ex xray from clinic sent to hospital
clincal codes
designate concepts to facilitate development of EBP
clinical term
enables the capture of data for patient care documentation
Clinical Decision Support System
designed to support health care providers in making decisions about the delivery & mgmt of patient care
Consultant
expert advice, opinions, & recommendations
4 concepts of nursing informatics
- data
- information
- knowledge
- wisdom
Decision Support
recommendations for interventions based on computerized care protocols. ex additional screening, medication interactions, drug dosages
Informatics Innovator
process of making enhancements or improvements, creative,
Informatics Nurse
RN w/ an interest or experiece working in an informatics field
Novice
beginner w/ no experience with the situations in which they are expected to perform a task
- taught rules to guide actions
3 sciences of informatics
- nursing science
- information science
- computer science
Clinical Decision Support System Examples
reminders, alerts, drug checking, guidelines, protocols, image recognition, allergy to drug
CPU
consist of computer chip that processes all the computers functions & uses “brain”
Data integrity
means that whenever the data are accessed by a user, the data are as complete as when entered or created
Information Mgmt
to ensure that the right info. is available to the people at the right time; information is managed properly,
Knowledge Mgmt
system that enables organizations to learn from their staff to improve performance, help accumulate & store the collective knowledge
Experienced Nurse
expected to more fully integrate informatics throughout the course of practice, not just for basic data entry & retrieval
Informatics Nurse
advance knowledge & profienciency in the use of IT as it applies to nursing practice
Internet Security Measures
- Firewall- prevent unwanted access to the sys & its information
- Limit web page access
- Server Security- information is stored should not be able to access other systems if attacked
4, Update Security Software
Considerations for New Informatics System
- Technical Specifications – How much downtime for maintenance
- Response Time- time it takes the sys to process a request
- Architecture-structure of the sys, open system to communicate together
- Connectivity-able to interface with the sys in mult ways
- Testing- tested in different place than it is being used, no sys maintenance can be done w/ little inconvience
- Compatibility- w/ other systems,
Interfacing 2 Types
- Point to Point- enables 2 sys to communicate, expensive, has to have completely customized program
- Interface Engine -interfacing across several different sys
Smart Technology
links, syncs, & compiles disparate bits of info from different sys into a coherent one stop, real time documentation, provides reminders,
Stages of EMR adoption
0- organization has not installed all 3 key ancillary department sys (lab, pharm, & radiology)
1- all 3 key ancillary are installed
2- CDR-clinical data repository provides physician access for reviewing orders & results, Possibly HIE capable
3- Nursing/Clinical Documentation, eMAR, first level of clinical decision support is implemented
4-CPOE implemented
5- Closed loop med administration w/ Bar codes is implemented, 5 rights of medication adm
- Full Physician Documentation , Full radiology PACS
7-No more paper charts,
P4P
Pay for Performance is an outgrowth of Affordable Health Care Act, reward providers when pts have good outcomes
Single Risk Pool
prevent insurers from using insurance pools with markets to get around market reforms & charge ppl w/ greater health problems higher premiums by increasing their premiums at higher rates
Catastrophic
lower premiums, protect against high out of pocket costs, and cover recommended preventative services
Needs to be integrated
ICD-9, G-Codes, ICD-10, CPT, HCSPC
Does not need to be integrated
C-3P0, RUGs
Telehealth Options
- Store & Forward- items are transferred to experts who read and interpret information and send back results
- Real Time- interactive conferencing
Nursing Informatics Definition
integration of nursing science, computer science, and information science to manage and communicate data, information, knowledge, and wisdom into nursing practice
Computer Literacy vs Information Literacy
Computer Lit- a familiarity with the use of personal computers
Information Lit- Ability to recognize when information is needed as as the skills to find, evaluate, and use information
Computer System consist of
hardware, software, data, procedures, and users
Computer Hardware consist of
input device, the CPU, secondary storage, and output device
Network
a combination of hardware and software that allows communication and electronic transfer of information between computers
Example of Operating System
Windows Xp
Example of application System
Microsoft Word
Bit
Smallest unit of data
WWW
an information service that provides access to Internet resources by content instead of file name
Services of the internet include
file transfer, email, instant messaging
Web 2.0
online tool that permits collaboration and sharing online, such as facebook, twitter;
Provides education- wikis, web logs, virtual worlds, facebook
HIS
group of systems used within a hospital that support and enhance client care
CIS-
used to access client data that are used to plan, implement, and evaluate care
EMR
electronic version of the client data found in the traditional medical record
Basic Components of the EMR
clinical messaging & email, data repository, and clinical documentation
EHR information includes
past medical history, demographics, immunizations, and medication history
Bar Code Arm Bands provide
patient health record, medications
Registration System
HIS is used to collect and store client identification and demographics data that are verified and updated at the time of each visit