Healthcare Informatics - Quiz 3
Human Factors Engineering
"The discipline of applying what is known about human capabilities and limitations to the design of products, processes, systems, and work environments". Its application to system design improves "ease of use, system performance and reliability, and user satisfaction, while reducing operational errors, operator stress, training requirements, user fatigue, and product liability" (Ebben, Gieras, & Gosbee, 2008, p 327).
Promoting a Safety Culture
- AHRQ suggests that teamwork training, executive walk-arounds, and unit-based safety teams have improved safety culture perceptions, but have not demonstrated a significant reduction in error rates. - IHI strategies include appointing a safety champion for every unit, creating an adverse event response team, and reenacting or simulating adverse events to better understand the organizational or procedural processes that failed.
Benefits of EHR
- Better health care by improving all aspects of patient care, including safety, effectiveness, patient-centeredness, communication, education, timeliness, efficiency, and equity. - Better health by encouraging healthier lifestyles in the entire population, including increased physical activity, better nutrition, avoidance of behavioral risks, and wider use of preventative care. - Improved efficiencies and lower healthcare costs by promoting preventative medicine and improved coordination of healthcare services, as well as by reducing waste and redundant tests. - Better clinical decision making by integrating patient information from multiple sources.
What is the Just Culture of Safety?
- Blame-free environment to encourage error reporting - System or process issues that lead to unsafe behaviors and errors are addressed by changing practices or workflow processes - Clear message is communicated that reckless behaviors are not tolerated
Health Informaticists' Role
- Ensure that the technology systems are properly configured and maintained. - Routinely monitor and check these systems while making sure that their human potential, the users, are capable of using the systems accurately to avoid errors. - Health informaticists must be involved in all stages of the system development life cycle (SDLC) with a focus on safety. Safety concerns and remedies need to be analyzed, synthesized, and integrated throughout the SDLC to have a robust tool that provides meaningful information and enhances patient care while preventing errors and promoting patient safety
RFID uses
- Helps patient tracking during procedures and testing, or functions as part of the EHR communicating pertinent information to clinicians at the bedside - Track medical supplies and equipment - Imbedded into surgical supplies to automate supply counting procedures - Reduce the likelihood of wrong patient, wrong site surgical procedures - Reducing the potential that a counterfeit medication is inadvertently introduced into the supply, and providing for efficient medication recalls - Specialized tags can detect temperature fluctuations and thus ensure that the blood or blood product was stored at the optimum temperature for safe administration
Standard EHR Administrative and Reference Terminologies
- ICD_10 - CPT
Information Chaos
- Information overload (i.e., too much unnecessary information) - Information underload (i.e., missing or not enough information) - Information scatter (i.e., information located in many different places and difficult to find) - Erroneous or conflicting information (WHO, 2016, p.6).
alarm fatigue
- Medical equipment alarms frequently and inappropriately - May be related to the sensitivity of alarm parameters
EHR benefits to patients
- Personal access to records - Ability to correct incorrect information - Patient portals, access to physicians - Secure information exchange, maintenance reminders for chronic illness care - Identifying medication interactions - Big data for population health management - Greater efficiency and quality of care resulting in cost savings
Bar Code Medication Administration (BCMA)
- Provides a system of checks and balances to ensure medication safety - Nurse scans name badge, thus logging in as the person responsible for medication administration. - Bar code on the patient's ID bracelet is scanned, prompting the electronic system to pull up the medication orders. - Bar code on each of the medications to be administered is scanned. - This technology checks to ensure that the 5 rights of medication administration—right patient, right med, right dose, right route, and right time—are met.
Clinical terminologies
- SNOMED-CT - LOINC - RxNorm
AHRQ recommended steps of action planning:
- Understand, communicate, and discuss survey results. - Develop and communicate focused action plans and deliverables. - Implement action plans, track progress, and evaluate impact. Share what works
The National Patient Safety Foundation (NPSF.org) top patient safety issues (2013):
- Wrong site surgery - Hospital acquired infections - Falls - Hospital readmissions - Diagnostic error - Medication errors
Five Rights of Medication Administration
1. Right Client 2. Right Drug 3. Right Dose 4. Right Route 5. Right Time
Essential Components of EHR
1. health information and data 2. results management 3. order entry management 4. decision support 5. electronic communication and connectivity 6. patient support 7. administrative processes 8. reporting and population health management
Safety Initiatives
1999 Institute of Medicine (IOM) report: To Err is Human 2001 IOM Quality Chasm report Agency for Healthcare Research and Quality (AHRQ) launched initiatives focused on safety research for patients 2002 Joint Commission National Patient Safety Goals 2002 National Quality Forum (NQF) adverse events and 'never events' list, Creation in 2004 of the Office of National Coordinator for Health IT to computerize health care, 2004 World health Organization's (WHO) Alliance for patient safety 2005 Institute for Healthcare Improvement (IHI) 100,000 Lives campaign and 2008 5 Million Lives Campaign 2005 congressional authorization of Patient Safety Organizations (PSOs) created by the Patient Safety and Quality Improvement Act to promote blameless error reporting and shared learning 2008 "no pay for errors" Medicare initiative = $19 billion congressional appropriation to support electronic health records and patient safety
Definition of EHR
A data warehouse or repository of information regarding the health status of a client; replaces the former paper-based medical record
Clinical Decision Support (CDS)
A set of patient-centered tools embedded within EHR software that can be used to improve patient safety, ensure that care conforms to published protocol for specific conditions, and reduce duplicate or unnecessary care and its associated costs.
Describing educational games, simulations, and virtual worlds, which of the following statements are true?
All of these are correct.
Epidemiology is:
All of these are correct.
Home care telehealth includes which of the following activities?
All of these are correct.
Simulation episodes are concluded with:
All of these are correct.
The scope of public health informatics (PHI) practice includes knowledge from a variety of additional disciplines, including political science, law, and:
All of these are correct.
Medication Administration Cycle
Assessing need Ordering Dispensing Distributing Administering Evaluating Human error factors: Distractions, unclear thinking, lack of knowledge, short staffing, and fatigue
Patient Monitoring Technologies
Body Area Networks or Patient Area Networks provide the ability to wear a small unobtrusive monitor that collects and transmits physiologic data via a cell phone to a server for clinician review Wireless chip on a disposable band-aid with a 5-7 day battery promises to be able to monitor the patient's heart rate and electrocardiogram, blood glucose, blood pH, and blood pressure, allowing for the collection of important clinical data outside the hospital
RFID Tags (Radio Frequency Identification Tags)
Caps of pill bottles may contain RFID tags that monitor and collect data on when the bottle is opened, or contain flashing time reminders when a dose is due (Blankenhorn, 2010).
CPT
Current Procedural Terminology: used to code procedures for billing
Smart pump technology
Designed for safe administration of high-hazard drugs and to reduce adverse drug events during IV administration
Certification Criteria
Developed by the National Institute of Standards and Technology (NIST) and endorsed by the Office of the National Coordinator for Health Information Technology for EHRs
decision support
Entails the use of computer reminder and alerts to improve the diagnosis and care of a patient. -Includes screening for correct drug selection and dosing, medication interactions
_______ is done to determine the length, amount, and pattern of exposure to the potentially hazardous material.
Exposure assessment
Flexibility and Expandability
HHS recently loosened regulations so that physicians may now be able to receive healthcare IT software, hardware, and implementation services from hospitals in an effort alleviate the cost burden on individual providers and foster adoption of the EHR.
HITECH ACT
Health Information Technology for Economic and Clinical Health Act
EHR Adopted in Stages
Higher stages of the electronic medical record adoption model include more sophisticated use of decision support tools and medication administration tools, with Stage 7 consisting of EHRs that have data sharing and warehousing capabilities and complete interface with emergency and outpatient facilities (HIMSS Analytics, 2015).
Just Culture Error Types
Human error (unintentional mistakes) Perform FMEA to understand error Risky behaviors (workarounds or cutting corners) Examine workflow; educate Reckless behavior (total disregard for established policies and procedures) Enact zero-tolerance policy; disciplinary measures
Informatics Technologies and Safety
Improve communication Reduce errors and adverse events Increase the rapidity of response to adverse events Make knowledge more accessible to clinicians Assist with decisions: technology based forcing functions that direct or restrict actions or orders implemented by computer technologies. Provide feedback on performance
ICD_10
International Classification of Diseases version 10: medical diagnosis code set
Health information organizations (HIOs) have been established to support data sharing via health information exchanges (HIE) promoted by the meaningful use criteria of the electronic health record (EHR).
Learner-learner
Linda is an occupational therapist who works for a home health agency based in Pennsylvania, very near the Ohio border. She is assigned to monitor the home telehealth patients for one week to cover for another therapist who is on vacation. Which of the following is true?
Linda must be licensed to practice occupational therapy in both Pennsylvania and Ohio if telehealth patients are located in both states.
LOINC
Logical Observation Identifier Names and Codes: universal codes for laboratory and clinical observations
Which of the following tools organize information from webpages into simple menus so that the user may choose what they want to view and how they want to view it?
Portals
Computerized Physician Order Entry (CPOE) Benefits
Prompts warn against the possibility of drug interaction, allergy or overdose; Accurate, current information that helps physicians keep up with new drugs as they are introduced into the market Drug-specific information that eliminates confusion among drug names that sound alike* Improved communication between physicians and pharmacists* Reduced healthcare costs due to improved efficiencies
ARRA Requirements
Providers and hospitals must use a certified EHR that meets a set of standard functional definitions to be eligible for the increased reimbursement incentive. DHHS initially granted two organizations the authority to accredit EHRs: the Drummond Group and the Certification Commission for Healthcare Information Technology. In 2015, there were 5 recognized bodies for testing and certifying EHRs (HealthIT.gov 2015a).
Smart Room Technology
RFID tag on employee name badge announces to the patient on a monitor exactly who has entered the room and triggers 'need to know' data by caregiver status to be displayed on the monitor in the room Clinicians review patient data in real time and chart at the bedside using touch screen technology Alert clinicians as they enter the room about procedures that need to be implemented for the patient and can track individual clinician efficiency and effectiveness by aggregating data over time
Technology Integration into Cycle
Reduces the potential for human errors by: performing electronic checks providing alerts to draw attention to potential errors Tracks performance
meaningful use
Stage 1 (2011-2012): Data capture and sharing Stage 2 (2014): Advanced clinical processes Stage 3 (2016): Improved outcomes
SNOMED-CT
Systematized Nomenclature of Medicine: comprehensive clinical terminology
Order Entry Management
The ability for a clinician to enter medication and other care orders directly into a computer including laboratory, microbiology, pathology, radiology, nursing, supply orders, ancillary services and consults (IOM, 2003).
Which of the following creates the information that becomes the basis for knowledge in the field of public health?
The collection and processing of population health data
Determining the presence of risk factors in community is a key part of a community risk assessment (CRA). Communities may be concerned about which elements in the environment affect or may affect the community's health, the level of environmental risk, and other factors that should be included in public health planning.
True
Dr. John Snow can be designated as the "father" of public health informatics.
True
Games promote critical thinking and teamwork by pushing students to work together in groups to find answers.
True
Health information organizations (HIOs) have been established to support data sharing via health information exchanges (HIE) promoted by the meaningful use criteria of the electronic health record (EHR).
True
Public health informatics (PHI) represents "a systematic application of information and computer science and technology to public health (PH) practice, research, and learning".
True
Technology in the Pharmacy
Verifying function is computer based, and the medication order is electronically checked via the knowledge database (E.D. exception): Allergy verification and medication reconciliation with other drugs already in use Barcode Medication labeling or RFID Technology: Assists with dispensing and administration Automated dispensing machines: storage, dispensing, controlling, and tracking Automated reports- medication reconcilliation; Med useage
Health Level Seven International (HL 7)
a not-for-profit, ANSI-accredited standards developing organization dedicated to providing a comprehensive framework and related standards for the exchange, integration, sharing and retrieval of electronic health information that supports clinical practice and the management, delivery and evaluation of health services.
Failure Modes and Effect analysis
a systematic, proactive method for evaluating a process to identify where and how it might fail, and to assess the relative impact of different failures in order to identify the parts of the process that are most in need of change"(IHI, 2011 para. 1)
Key Features of a Safety Culture
acknowledgment of the high-risk nature of an organization's activities and the determination to achieve consistently safe operations a blame-free environment where individuals are able to report errors or near misses without fear of reprimand or punishment encouragement of collaboration across ranks and disciplines to seek solutions to patient safety problems organizational commitment of resources to address safety concerns (AHRQ, n.d., para. 1)
An emerging technology in healthcare education, simulation, is used to allow students to:
actively use informatics in an authentic and realistic learning context.
Computerized Physician Order Entry (CPOE)
an electronic prescribing system designed to support physicians and nurse practitioners in writing complete and appropriate medication and care orders for patients.
eMedonline
collects patient medication compliance data by scanning package barcodes or RFID medication tags and using PDA or smart phone technology to send compliance data to the server
reporting and population health management
data collection tools to support public and private reporting requirements including data represented in standardized terminology and machine-readable format
results management
electronic reports of laboratory results and radiology procedures with automated display of previous results; electronic consultation reports
A major goal of the eHealth Initiative is to:
empower consumers to understand their health needs.
Health Information Technology for Economic and Clinical Health Act (HITECH)
enacted as part of the American Recovery and Reinvestment Act of 2009, was signed into law on February 17, 2009, promote the adoption and meaningful use of health information technology. Subtitle D of the HITECH Act addresses the privacy and security concerns associated with the electronic transmission of health information, in part, through several provisions that strengthen the civil and criminal enforcement of the HIPAA rules.
Health Information and data
information to make sound clinical decisions, such as past medical history, laboratory tests, allergies, current medications, and consent forms
One of the ways that healthcare organizations can utilize informatics for patient education is via:
kiosks.
Which of the following web domain suffixes is more likely to contain quality health education material?
org
patient support
patient education and self-monitoring tools, including interactive computer-based patient education, home telemonitoring, and telehealth systems
Ownership of EHR
process has multiple steps and requires integrating the EHR into both the organization's day to day operations and long term vision and the clinicians day to day practice first step is typically a vendor selection process certification ensures that a quality product will be selected
administrative processes
scheduling systems, billing and claims management, insurance eligibility, and inventory management
Clinical data captured electronically and transmitted to another location where it is interpreted by another clinician is known as:
store-and-forward telehealth.
RxNorm
terminology system for drug names providing links to drug vocabularies and interaction software
electronic communication and connectivity
the online communication among healthcare team members, their care partners, and patients, including email, Web messaging, and an integrated health record within and across settings, institutions, and telemedicine
Smart inhalers
track asthma medication compliance using a microprocessor that records and stores medication compliance.
SIMpill® Medication Adherence System
uses web based technology to monitor patient compliance and provide reminders about taking medications or to refill prescriptions by sending text messages to the patient or caregivers
The American Recovery and Reinvestment Act of 2009 (ARRA)
was signed into law by President Obama on February 17th, 2009. It established incentive payments for eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) to promote the adoption and meaningful use of Certified Electronic Health Record Technology (CEHRT).J
sentinel event
§A patient safety issue that results in death, permanent harm, or serious temporary harm requiring intervention is termed a sentinel event by The Joint Commission (2017).
Strategies to improve alarm response
· Add voice over Internet protocol (VoIP) phones · Feed alarm data into a reporting database for further analysis · Encourage nurses to round with physicians to provide input into alarm parameters