informatics test 2

the joint commission

"to continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organization and inspiring them to excel in providing safe and effective care of the highest quality and value" -focused on client safety and the safe administration of medications. also includes business continuity and disaster recover planning, data, and information retention, decision support, and specific documentation areas and formats. promotes community confidence and improved staff retention. shapes practice and documentation -ex: home health care facilities, long term care facilities, and hospitals. does not exist for child and adult daycare facilites

level 5 of automation

BCMA + identification technology + CPOE -closed loop medication adminisatration -BCMA- barcoding, scan barcode and give the right patient the right medicine -radio frequency identification

database used for evidence base research in nursing

CINAHL (cumulative index for nursing and alli health literature)

level 4 of automation

CPOE (computerized provider order entry), support for evidence- based practice (2nd level of clinical decision support) -be able to link things together

which of the following was recommended for PHRs in order to avoid breaches

a PHR certification process

decision support

a clinician can tailor view of patient information that shows the most recent labs, vital signs, current medication on one screen. also can have built in promps -ex: if a physician orders an x-ray on a women that is child-bearing age, they can receive a prompt asking if they want a pregnancy test orders

the hospital is preparing for an update to the electronic medical record. Which form of training would best fit the needs of a night shift nurse?

an online tutorial that can be accessed when it best fits the nurses time off

virtual learning

any system that uses the internet to assist the educator in developing, managing, and administering education materials for students. facilitate learning, provide tracking capability, provide e-mail, chat, and discussion capability, blended learning, duke SON second life, and virtual patient care stimulation

advantages of course learning management system

atleast as effective as other methods; introduction of technology into education; provides a tool for distance education; available 24 hours a day; may facilitate learning; and provides for flexibility in scheduling

your hospital has been disignated as a stage 3 facility. this means...

basic clinical documentation and retrieval

impact of legislation on protected healthcare information

beginning in 2011, medicare and medicaid have provided financial incentives to physicians and hospitals for meaningful use of health information technology. negative incentives will begin in 2015 -healthcare entities as well as their business associates must notify individuals whose health information is breached -patients can now restrict some disclosures of personal health information in certain circumstances -HITECH also increases penalties for violations of HIPAA and DITECH security rules

a nurse practitioner approaches a computer terminal at the local health care facility. in order to gain access..

biometric authentication

health insurance portability and accountability act (HIPAA)

called for the establishment of an electronic patient records system and privacy rules. it also affects all aspects of health information management, including privacy and security of patient records, coding, and reimbursement. 1996 legal protection for PHI -put things into place for health insurance and breaches of privacy -local news is notified if more than 500 individuals are breached

a hospital is preparing to go live with a new electronic medical record (EMR). Which environment will result in the highest rate of staff retention?

conduct the training when employees do not have assigned patient care responsibilities

technology informatics guiding education reform (TIGER)

create a vision for the future of nursing and provide a safer, higher-quality patient care through the use of IT. it required informatics competencies for every nurse and active involvement in advancing HIT -redesign of nursing education to keep up with rapid changes in technology, active participation by nurses in the design of informatics tools, and increased visibility by nurses in the national health IT agenda -plan to promote informatics competencies among nurses in order to transform healthcare

unstructured data

data that doesn't follow any particular format and is often provided as text report such as consultation findings, nurses nots, operative report, narrative physical, and history report

E-learning

delivery of content and stimulation of learning primarily through the use of online telecommunication technologies such as blogs, podcast, video, email, bulletin board systems, electronic white boards, inter-relay chat, videoconferencing, and World Wide Wed. it has convenience, flexibility, available anytime and anywhere there is an internet connection, self paced instruction, and may occur via mobile devices such as PDAs, ipods, or cellular phones

advantages of PHR (personal health record)

each person controls his or her own records -PHRs contain information from ones entire lifetime, contain information from all healthcare providers; private and secure; transparent (individuals can see who enters each piece of data, where it was transferred from and who has viewed it); permit easy exchange of information across healthcare systems

level 9 online information

engage in electronic conversations with local clinicians -can call to solve immediate problems but can also prepare questions for future visits

level 2 online information

exchange email with family and friends -communicating with loved ones about health issues to seek feedback, advice, and support

meaningful use

federal incentives allocated for facilities that can demonstrate they are "meaningfully using" certified EMR technology to improve patient care; medicare and medicare EMR; incentive programs are stages in three steps with increasing requirements for each stage; CMS has defined core objectives that measure the impact of an EMR

american nurses credentialing center (ANCC)

focuses on making available to individual registered nurses and organizations practice resources for pursuing excellence in the practice -credentials individual nurses in various nursing specializations

level 7 of automation

fully electronic paperless environment -fully functional EHR (can take years or be rapid to get to this stage) -full commitment

electronic signature in global and national commerce act (ESIGN)

gives electronic signatures the same legal status as handwritten signatures. signed into law by president clinton in 2000 -main focus of act was to increase eCommerce -just as important as handwritten signatures

patient protection and affordable care act

guarantees access to healthcare for all americans. creates new incentives to change clinical practice and improve quality of care. gives practitioners more information to improve practice. -give patients more information to make conscious decisions. 2010 -prohibits insurance discriminations based on wages. better access for americans

structured data

have redefined formate (discrete data) -ex: assessments, vital signs, lab values

which act makes seceral significant changes to the current HIPAA security and privacy rules and provides funds and incentives to increase the use of electronic health records (EHRs) by physicians and hospitals who meet eligibility criteria?

health information technology for economic and clinical health act (HITECH)

electronic medical record results reporting ads data repository components include unstructured data. which of the following are examples of unstructured data. select all that apply

history and physical; consultation findings; a social service text report

advantages of virtual learning enviroment

improved reading habits, convenience, reduced learning time, increased retention, 24 hour access, consistent instruction in a safe environment, and flexibility of faculty schedules. Atleast as effective as other methods; introduction of technology into education; available 24 hours a day; offers the potential to free instructor time; streamline instruction and testing; and eliminate cost associated with employee travel -combine text, voice/sound, images, videos, or hardware and software that support the same; may include streaming video, virtual reality, or web 2.0; facilitates learning retention; form of multimedia that fully envelopes learners in an environment; used to help procedural skills; next best option to preforming the skill on a real person; provides a safe enviroment

american recovery and reinvestment act (ARRA)

include provision for information technology in general and health information technology. 2009 president Obama. -every person has a right to receive an electronic copy of their health information -HITECH act makes changes to HIPAA and provides more funding for EHRs-financial incentives to use the ARRA act

medicare improvement for patients and providers act (MIPPA)

included a provision calling for financial incentives for e-prescribing. 2008. -penalties involved for not e-prescribing -drug interaction and keeping people from over dosing on meds and cost involves -gives incentive to providers for using e-prescribing to increase providers using it -requires use of e-prescibing in 2011

according to ANCC (2011), the magnet recognition program recognizes health care organizations that provide nursing excellence and provide a means for disseminating successful nursing practices and strategies

informatics and information systems support the process by providing aggregate data related to quality improvement

level 7 online information

interact with volunteer online professionals -healthcare clinicians are available to anwser health related questions to pateints

a hospital client sees the nurse documenting information into the computer. shes ask the nurse why the computer is better than the "old patient chart like hospitals always have used". which points would be accurate to say?

it is more secure than paper record; more than one person can access the record; the record is available when and where needed; data are in real-time as things happen

level 5 online information

join with others to research shared concerns -conduct formal or informal research studies

EHR (electronic health record)

longitudinal health record. all your health records throughout your life and from every facility and entire medical service anywhere. -support other care-related activities directly or indirectly- evidence-based decision support, quality management, and outcomes reporting -can be created and managed by authorized clinicians across more than one health care organization

level 2 of automation

major ancillary clinical systems + CDR. Clinical data repository exists that allows MDs to view results. -also has controlled medical vocabulary and clinical decision rules engine that check for conflict -data warehousing and can collect data from system -document imaging systems may also be linked to the CDR

level 1 of automation

major ancillary clinical systems. -lab, pharm, and rad are running -fully operational -servers that house these documents are up and running

which of the following is not a potential benefit associated with the PHR and laboratory test?

may confuse and worry patients

which of the following about meaningful use is correct?

meaningful use will provide invaluable information that will improve patient outcomes and population health changing many current practices as we transform out healthcare delivery systems

to comply with the mandate to use EHRs by 2014, physicians and hospitals must have the EHR prepared and ready for implementation

medicare and medicaid

level 0 of automation

not all ancillary systems operational. some clinical automation, but no lab, pharmacy, or radiation. -atleast selected a vender -some documentaion

standalone systems

not tied to any healthcare systems. google health PHR, microsoft health vault, and patient is the one who has to enter in information -some are available commercially through the internet or other formats and users can add information to be customized to the individual -significant security risk

use of social media

nurse: HIPAA, professional boundaries, and job implications. advantages is up to date on organization events, inspiring stories -patients: support groups and social networking. disadvantage is questionable content posted, anxiety generation, and confidentiality issue

nursing roles in policy development

nurses have a professional responsibility and duty to understand the importance of the national health information technology agenda and be prepared to influence the process to ensure representation of nursing -american nurses association, national league for nursing, institute of medicine (has called for a greater nursing role in health care)

impact PDAs or smart phones have

nurses: used in POC to ensure delivery of safe care, reference tools, and calculators -nursing students: reference tool, podcast, and upload clinical tools -patients: medical diaries or logs, reminder messages for medication, and web access to physician

level 4 online information

participate in online groups -allows individuals to share stories and ask questions through communication on a specific website

meaningful use of EHR

patient engagement, reducing racial disparities, improved efficiency, increased safety, coordination of care, and measures to improve population health

what is a private, secure application through which an individual may access, manage, and share his or her health information

personal health records

level 6 of automation

physician documentation, DS, alterts, PACS -atleast one service has full MD documentation -fully functionally PACS (picture archiving computer system) -can pull up x rays on computer without big films -3rd level of clinical decision support for all clinicians for protocols and outcomes

PHR- personal health record

private, secure application which an individual may access, manage and share his or her health information -evolving definition of PHR, different from EHR, driven by consumers- manages by patient, and multiple sources of health information and servies

Centers for medicare and medicaid (CMS)

published the final rule on the incentive program, including the objectives for meaningful use, in july of 2010 -CMS explains that the meaningful use requirements include a core set of objectives and a menu of set objectives -these sets are specific to eligible professionals or eligible hospitals and critical access hospitals

level 10 online information

receive one way messages from clinicians -send their patients unrequested messages that are not interactive but provide behavioral change or patient education materials

EMR (electronic medical record)

records only from that certain facility, intraoffice, have to start with this and the legal record of institutions and structured and unstructured data -"legal record created in hospitals and ambulatory enviroments that is the source of data for the EHR" -components include: results reporting, data repository, decision support, clinical mesaging and email (communicate with providers and flag things), documentation, and order entry

disadvantages of virtual learning environment

reduced interaction with instructor and peers, lack of feedback, possibility for poor design and lack of intellectual stimulation

level 1 online information

search for health information -consumers engage in "search and rescue" missions related to their disease and prepare for doctors appointments by searching for information

advantages of EHR

secure, reliable access where and when needed; records and manages episodic and longitudinal information; assists with planning and delivery of evidence-based care; supports-clinical research, public health reporting and population health initiatives; captures data for:quality improvement (decreased number of falls, what was effective, what wasnt), utilization review, risk management, resource planning, performance management, reimbursement (ICD-10)

level 3 online information

seek guidance from online patient-helpers -communicate online with another patient who has experienced the same condition and often gives the best online information

PHR combined within EHR

shared medical record with patient. lab and test results, medication list, appointments, after-visit summaries, visit notes, patient clinical reminders -viewing lab results may be confusing or worrying to patients if dont know abbreviations or how to interpret it -ex: if only marginally outside normal range -care must also be taken for serious diagnostic results such as cancer

videoteleconferencing

skype, gotomeeting, microsoft 365, -connect faculty and students located at 2 or more separate sites -may occur via real (synchronous) or delayed (asynchronous) approaches. synchrony influences instructional design, delivery, and interaction -infrastructure; more faculty preparation and organization; concerted effort by students to remain active participants; adaption by faculty and students to a different teaching/learning environment; course development and review guidelines -advance preparation for students and faculty

level 3 of automation

some documentation and retrieval -basic clinical documentation exits (flow charts, vital signs) -able to document and retrieve data -basic clinical decision support is available for error checking with order entry -some storage of diagnostic imagine

which of the following are characteristics of stand-alone PHRs? select all that apply

some fully standalone applications are available commercially; the PHR is not tired to any particular HCS; standalone PHR such as those on thumb drives

course learning management system

systems that use the internet to assist in developing, managing, and administering educational materials for students. facilitates learning, provide tracking capability, and provide email, chat, and discussion capability -ex: stellar, sakai, segue, and blackboard

which of the following laws, signed by president clinton in 2000, gives electronic signatures the same legal status as handwritten signatures?

the electronic signatures in global and national commerce act

standardized language

they are meant to foster rapid development and adoption of standard clinical terminology for EHRs and facilities interoperability due to common understanding of terms

tethered systems

tied into healthcare system -my healthevet PHR from the VA and records flow into health system -provides electronic access through a patient portal offering patients a longitudinal view of their record -can provide online medication refills or secure messaging with provider

distance learning

use of audio, video, computer, television, teleconferencing, or the WWW to connect educator and students who are located at a minimum of two different locations. it is to improve student access, meet student demands, extend geographic boundaries, remain viable, and keep students on the cutting edge of technology. -Ex: Rn to BSN

level 8 online information

use of the paid services of medical consultants -can include advice from a personal trainer, nutritionist, or weight loss

level 6 online information

use online medical guidance systems -consumers can enter the names of all drugs they are currently taking and receive information of all possible drug interactions

web-based instruction (WBI)

used attributes and resources of the World Wide Web for educational purposes; may be used to supplement traditional courses or as standalone instruction -benefits:self-paced learning, 24 hour avalability, often prompt feedback, interactivity -hospitals use this for annual education

web 2.0

used web as a platform for collaboration to enrich user experience -facilitates online communication, learning, and collaboration -blogs, podcast(content may be hear/viewed from any MP3 layer anywhere, anytimes), and wikis