NI B-C

Describe the factors necessary for information quality.

-Timeliness: the necessary data is available (and retrievable) as needed. -Precision: System dictionaries shall describe uniform wording and clear definitions. -Accuracy: The data should be as error-free as possible. -Measurability: The information should be quantifiable so that comparisons can be made. -Independently verifiable: The integrity of the information remains constant regardless of the individual reporting it. -Availability: The information should be accessible where it is needed. In the hospital or clinic environment, the information should usually be available at the patient's location.

Discuss administrative computer related policies.

A healthcare facility much have a policy regarding computer system use. This policy should be discussed during the orientation process and before the employee is allowed access to the computer system. The policy should outline regulations pertaining to client confidentiality, ethical use of computers, and the disciplinary actions that will be taken against employees who do not adhere to the policy. Many organizations insist that staff sign an agreement (which stages that system misuse can result in disciplinary action) before system access instructions. System access is usually achieved by entering user name and password. Security measures may include setting the complexity of the password and the password change intervals.

Discuss the following methods to maximize reimbursement: Pay-for-performance or value-based purchasing.

A reimbursement system called pay-for-performance (P4P) or value-based purchasing, one element of the Affordable Care Act of 2010, is an alternative to standard pay-for-care reimbursement. Some states, such as California, have P4P plans in effect, and Medicare also has a number of P4P initiatives and demonstration projects. The primary objective of P4P programs is to reward healthcare providers when patients have good results (e.g. discharged within a defined period without complications), although there remains some controversy regarding measuring quality performance. Payment is related to quality rather than quantity of service, so ongoing quality improvement processes must be in place to maximize reimbursement. In some cases, bonus incentives may be provided. Disincentives, such as reduced payment for never events (inexcusable outcomes), are also considered. There are both hospital-based P4P and physician-based P4P plans.

Define the steps needed for workgroup formation.

A workgroup is s small number of people working together toward a common goal. An advantage of working in groups is that the environment allows for increased insight and creativity. A disadvantage is that workgroups sometimes fail because members of the group allow personal conflicts (in terms of personality and work styles) to interfere with the group's goal. A popular concept identifies identifies 4 stages in group development. 1.Forming-this is were a group is formed and the members begin to get to know one another. Typically, individuals are quiet and polite to one another. 2.Storming-this is the stage where conflicts normally arise. Effective communications must be occurring. 3.Norming-typically, conflicting factions make peace and come tother. Less communication is necessary. 4.Performing-this is the stage in which the group begins to really work well. Communication is free flowing.

Discuss the following professional organizations for Informatics Nursing: American Nursing Informatics Association (ANIA) and Alliance for Nursing Informatics (ANI)

American Nursing Informatics Association (ANIA): is an organization that merged 2 existing informatics organization and aims to provide an organization for nurses and others interested in nursing informatics and to advance the profession. There are 4 ANIA regions: West, Central, northeast, and southeast. ANIA provides an interactive website and resources for members, an online digital library, webinars, continuing education courses, an open forum, a monthly electronic newsletter, and an annual ANIA conference. Alliance for Nursing Informatics (ANI): is a collaboration of different nursing informatics groups and includes organizations representing different types of nursing, such as AORN and ASPN, as well as individual members and groups involved in the field of informatics. ANI serves as intermediary to promote communication, education, and professional development. Members receive an online subscription to Computer Information Nursing (CIN) as well as news updates.

Discuss methods to promote an environment for ethical decision-making and patient advocacy.

An environment for ethical decision-making and patient advocacy does not appear when it is needed; it requires planning and preparation. The expectation for the institution should clearly communicate that nurses are legally and morally responsible for assuring competent care and respecting the rights of patients and other stakeholders. Decisions regarding ethical issues often must be made quickly to with little time for contemplation; therefore, ethical issues that may arise should be identified and discussed. Clearly defined procedures and policies for dealing with conflicts, including an active ethics committee, in-service training, and staff meetings, must be established. Patients and families need to be part of the ethical environment, which means empowering them by providing patient/family information (e.g. print form, video, audio) that outlines patient's rights and procedures for expressing their wishes and dealing with ethical conflicts. Respect for privacy and confidentiality and a non punitive atmosphere are essential.

Discuss continuing education options related to nursing informatics.

ANCC nurse informatics certification is granted a 5-year period. Renewal requires 75 hours of mandatory hours of continuing education and proof of activity in one to eight of the renewal categories, which include CE hours, academic credits (5 semester credits or 6 quarter credits, presentations (≥ 5hours), publication or research, preceptor hours (120), professional service (≥2 years of volunteer services) practice hours (≥1000), and retaking the assessment exam. Continuing education requirements include: -At least half must be directed related to nurse informatics. -At least half must be formally approved and provided by accredited provider and may include continuing nursing education (CNE) and continuing medical education (CME). -Approved independent study or electronic learning may account for 100% of hours. -Academic courses can be converted to contact hours: 1 semester credit equals 15 contact hours and 1 quarter credit equals 12.5 credit hours (maybe contact hours?) The nurse should maintain all records of completion of continuing education contact hours for 5 years, including the completion certificate that has the dates, title, provider, and number of contact hours.

Compare electronic medical records (EMR) and electronic health records (EHR).

Although many in healthcare use the terms EMR and EHR interchangeably, there are major distinctions between the two. The EMR is created by a hospital or other health care delivery organization (CDO). The CDO owns the information in the EMR. The EMR consists of clinical documentation, orders, medications, treatments, and other clinical decision support, and is a legal record. The EHR includes information from EMRs, likely from multiple health care delivery organizations. The EHR relies on the information from the EMR to complete it. The EHR is owned by the patient and stakeholders, which could include the government, insurance companies, and healthcare providers among others. Important in the EMR is using controlled medical vocabulary so that information will be comparable among providers and other interested stakeholders. Currently in the U.S. the use of EHRs is limited, mostly due to many healthcare delivery organizations not having an established EMR using decided predetermined standards. There may soon be an increase in the number of organizations using EMRs with standardized language conducive to EHRs, as organizations now receive financial incentives to install EMR and EHR systems from health care reform.

Discuss the following method to maximize reimbursement: Do-not-pay-list.

As a means to control quality of care and to cut costs, Medicare instituted a do-not-pay list for serious, preventable, hospital-acquired conditions and complications for which Medicare will not reimburse hospitals; thus, avoiding these complications is a critical element in maximizing reimbursement and requires ongoing monitoring of quality care and staff educations. Additionally, some insurance companies are following suit, so this has the potential to impact reimbursement seriously. For example, if surgery is done on the wrong side or botched, Medicare will not pay the costs. If a blood clot occurs after hip replacement surgery, Medicare will not pay for the treatment. There are currently over 40 categories on the do-not-pay list, including the following: • Fall or other trauma that causes serious injury • Stages III or IV pressure ulcers • Vascular catheter-associated infections • Transfusion reaction from blood incompatibility • Postoperative dehiscence • Surgical deaths associated with treatable serious complications

Discuss cognitive science: Theory of cognitive development developed by Jean Piaget--Sensorimotor Stages I & II (birth to 4 months of age).

JP's theory of cognitive development discusses how children assimilate new experiences and deal with them through accommodation. Piaget believed children go through stages of development, beginning with sensorimotor, which has six substages. Stage I: (Age 0-1 month) Description: Reflexes (sucking, rooting, grasping, crying) are primary. Stage II: (Age 1-4 months) Description: Reflexive behavior is replaced by voluntary behavior, recognizing a stimulus and a response (primary circular reactions).

Discuss cognitive science: Attribution theory developed by Bernard Weiner.

Bernard Weiter developed the cognitive theory known as attribution theory, which focuses on explaining behavior. Weiner suggested that people attempt to attribute cause to behavior, based on 3-stages, which include 1. observing behavior 2. determining that the behavior is intentional 3. attributing the behavior to internal or external causes According to this theory, there are 4 factors to which achievement can be attributed: 1. individual effort 2. ability 3. difficulty of task 4. good or bad luck People often view their own achievement as the result of effort and ability and the achievements of others as the result of luck. By the same token, people may view personal failures as the result of bad luck and the failure of others as the result of lack of effort or ability. Attributions are classified according to 3 factors: 1. locus of control (internal/external) 2. stability of causes of behavior 3. ability to control cause

Discuss adult learning theories: Bloom's taxonomy developed by Benjamin Bloom.

Bloom's taxonomy developed by Benjamin Bloom outlines behaviors that are necessary for learning, and this can apply to healthcare. The theory describes 3 type of learning: Cognitive: (Gaining intellectual skills to master six categories of learning.) -Knowledge -Analysis -Comprehension -Application -Analysis -Evaluation Affective: (Recognizing five categories of feelings and values.) -Receiving phenomena: accepting the need to learn -Responding to phenomena: taking and active part in care -Valuing: understanding the value of becoming independent in care -Organizing values: understanding how surgery or treatment has improved life -Internalizing values: accepting condition as part of life; being consistent and self-reliant Psychomotor: (Mastering 6 motor skills necessary for independence.) -Perception: uses sensory information to learn tasks -Set: shows willingness to perform tasks -Guided response: follows directions -Mechanism: does specific tasks -Complex overt response: displays competence in self-care -Adaption: modifies procedures as needed -Origination: creatively deals with problems

Discuss information science: Information theory developed by Claude Shannon.

Claude Shannon devised the information theory in 1948, which is used to determine the effectiveness of communication systems, especially related to compressing, transmitting, and storing data. Shannon identified problems that required solutions. The essential factors in a system of communication include the source of power, the bandwidth, the noise, and the decoder/receiver. Information is carried by symbols, such as words or codes. The three steps involved in communication include encoding a message (e.g., bits, words, icons), transmission through a channel of communicaion (e.g., voice, radio, computer), and decoding when reaching a destination. Note that signal-to-noise indicates the ratio between a signal's magnitude and interfering "noise" magnitude. Another element is channel capacity, which determines the amount of information that can be transmitted with the smallest rate of error. Entropy refers to the amount of energy, code, or bits required to communicate or store one symbol in the communication process. The lower the entropy, the more efficient the process of communication.

Describe the methods to avoid the installation of malicious software.

In order to avoid malicious software (such as viruses or Trojan horses), use the following proven methods: • Monitor and verify that only licensed software is uploaded into the system. • Make sure that all network computers have updated virus detection software installed and that it is setup to make daily scans of the entire system. • Be wary of emails and never open a file attachment from an unfamiliar source. • Keep copies of computer startup files, original software, work files, and directory structure in case problems arise. Keep a list of where each piece of hardware or software is purchased, the date of purchase, and all serial numbers in a secure location separate from the system. • Update software regularly to fix security vulnerabilities. • Finally, be sure that all staff members are familiar with the appropriate use of software, hardware, and email.

Discuss change theory developed by Kurt Lewin and modified by Edgar Schein.

Change theory was developed by Kurt Lewin and modified by Edgar Schein. This management theory is based on 3 stages: 1. Motivation to change (unfreezing): Dissatisfaction occurs when goals are not met, but as previous beliefs are brought into question, survival anxiety occurs. Sometimes, however, anxiety about having to learn different strategies causes resistance that can lead to denial, blaming others, and trying to maneuver or bargain without real change. 2. Desire to change (unfrozen): Dissatisfaction is strong enough to override defensive actions. The desire to change is strong but must be coupled with identification of needed changes. 3. Development of permanent change (refreezing): The new behavior that has developed becomes habitual, often requiring a change in perceptions of self and establishment of new relationships.

Discuss communication theories: Communication accommodation theory developed by Howard Giles & Cultivation theory developed by George Gerbner.

Communication accommodation theory (CAT) developed by Howard Giles to explain why people alter their communication styles. Individuals may practice convergence, modeling the communication style (i.e., accent, dialect, vocabulary) after the other if seeking approval, or may practice divergence, intentionally using differences in communication to emphasize social differences. Components of CAT include the following: -Context (social and historical) influences communication. -Accommodative orientation includes 3 factors: personality, positive or negative feelings, and understanding areas of conflict. -Immediate communication is affected by social and political states, motivations, goals, convergence, divergence, linguistic choices, and attributions. Cultivation theory developed by George Gerbner to explain the effect media, primarily television, have on cultivating ideas and beliefs related more to the media than the real world. Gerbner believed that media cultivate beliefs that already exists but spread these beliefs through society, thus affecting people's belief systems and perceptions of reality.

Discuss systems theory: Complex adaptive theory.

Complex adaptive theory holds that complex systems are interdisciplinary systems with multiple components or agents that depend on interaction and adaptation as part of learning. Adaptive systems are open systems that are able to adapt readily to changes and problems. The original adaptive theory referred to biology, but the model has expanded to encompass families, communities, and organizations. Interactions tend to be rich and nonlinear with close associates and with much feedback. Interactions are often random rather than planned. Change is often mutual: Agents change, causing system to change, and the system changes, causing the agents to change. Adaptive systems are dynamic by nature with interdependent agents acting together to bring about change. Adaptive systems that are self-adjusting are able to avoid chaos even though changes may bring them to the brink. Adaptive systems tend to favor effectiveness over efficiency and are less rule governed than nonadaptive systems.

Define the term: Computer science

Computer science is often misunderstood to be solely the study of computers. It long began before modern computers were ever created. Computer science is the study of how information is manipulated to solve problems or answer questions. In essence, computational science has been automated by the technology of modern computers. There are many subfields within computer science including computer graphics, computational complexity theory, programming language theory, computer programming, and human/computer interaction or interface. The history of computer science is founded in mathematics and the two fields continue to influence one another. The first modern computers were designed to perform complex mathematical calculations related to projectile trajectories for the battlefield. Computer science maybe thought of as the study of computation and its associated principles. More commonly, however, the education that computer scientists often receive focuses more on programming and the specific computational problems found in associated with software engineering.

Discuss conflict resolution

Conflict is an almost inevitable product of teamwork, and the leader must assume responsibility for conflict resolution. While conflicts can be disruptive, the can produce positive outcomes by forcing team members to listen to different perspectives and opening dialogue. The teams should make a plan for dealing with conflict resolution. The best time for conflict resolution is when differences emerge but before open conflict and hardening of positions occur. The leader must play close attention to the people and the problems involved, listen carefully, and reassure those involved that their points of view are understood. Steps to conflict resolution include: -Allow both sides to present their side of conflict without bias, maintaining a focus on opinions rather than on individuals. -Encourage cooperation through negotiation and compromise. -Maintain the focus, providing guidance to keep the discussions on track and avoid arguments. -Evaluate the need for renegotiation, formal resolution process, or third party. -Utilize humor and empathy to diffuse escalating tensions. -Summarize the issues, outlining key arguments. -Avoid forcing resolution if possible.

Discuss nursing theories: Interpersonal relations model of nursing developed by Hildegard Peplau.

Developed in 1952, focusing on the quality of the nurse-client interaction. Peplau believed patients deserved human care by educated nurses and that they should be treated with dignity and respect. She also believed that the environment (i.e., social, psychosocial, physical) could affect health in a positive manner. Peplau viewed the nurse as a person who could make a substantial difference for the patient and who acts as a "maturing force". The nurse can focus on the way in which patients react to their illness and can help patients use illness as an opportunity for learning and maturing through the nurse-client interactions. The nurse helps the patient to understand the nature of his or her problem and to find solutions. Peplau's theory stresses the importance of collaboration between the patient and the nurse. The nurse-client relationship is viewed as a number of overlapping phases: orientation, identification of the problem, explanation of potential solutions, and resolution of the problem.

Discuss nursing theories: Total-person systems model developed by Betty Neuman.

Developed in 1972. The concentric circle of variables (e.g., physiological, psychological, sociocultural, spiritual, developmental) provides defenses for the individual; these defenses should be considered simultaneously for the individual, who directly interacts with and is influenced by the environment. This model focuses on how the individual reacts to stress, using defense mechanisms and resistance, and how this feedback affects the individual's stability. Stressors are environmental forces that may provide negative or positive reactions, affecting the individual's stability. Stressors maybe intrapersonal, interpersonal, or extrapersonal. -Primary (health promotion, education): Preventative steps are taken before a reaction to a stressor develops. -Secondary: The goal is to prevent damage of the central core by facilitating internal resistance and by removal of stressors. -Tertiary: Efforts are made to promote reconstitution and reduce energy needs, supporting then client after secondary interventions.

Describe some of the roles that the informatics nurse plays.

Developing informatics theories: Assemble what sort of information should be captured on the system and how the data should be analyzed. Analyzing the information needs of the organization: Sort through the large amounts of data collected to determine the best information for the organization. Helping the organization choose computer systems: Assist in the system requirements, both for now and in the near future. Customizing purchased computer systems: Work with IT to customize the system so that it will be the most useful. Designing computer information systems: Assist IT in the overall design of the system. Testing new or upgraded computer systems: Conduct robust tests of the system when changes or upgrades are performed. Teaching other people to use the computer system: Set up training and education programs to encourage the most effective use of the system.

Discuss device access control.

Device access control can encompass a wide range of technologies and procedures. The first step is to determine what class of users has access to different devices and what method of authentication (e.g., password, biometrics) for role and entity-based access is required. Clear policies and procedures must be in place for both access and use of devices. Role and entity-based access should be determined by the individual role and function within the organization rather than on hierarchy. Networked medical devices and information technology devices maybe on the same network, and handheld devices may connect to multiple networks; thus, these situations pose additional security risks. All handheld devices, which pose the most risk, must be password protected. Security of access control must be strictly enforced, and those who violate security policies and procedures should have restricted use. Each potential device user must be correctly identified and access controlled. Commercial access control programs are available for health care organizations.

Discuss nursing theories: General theory of nursing developed by Dorothea Orem.

Dorothea Orem developed a general theory of nursing in 1959. Orem believed that the goal of nursing was to serve patients and assist them to provide self-care through three steps: identifying the reason a patient needs care, planning for delivery of care, and managing care. Orem's theory is a actually a collection three theories: -Self-care: there are two agents, the self-care agent (i.e., the individual) and the dependent-care agent (i.e., the other caregiver). There are 3 categories of needs, consisting of universal needs (i.e., food, air), developmental needs (i.e., maturation or events), and health needs (i.e., illness, injury). -Sel-care deficit: Occurs if the self-care agent cannot provide for his or her own care. Nursing assists though five means: providing care, guiding, instructing, and adjusting the environment to help the patient in self-care. -Nursing systems: Actions to meet the patient's self-care needs maybe completely compensatory (i.e., patient is dependent), partly compensatory (i.e., patient provides some self-care), or supportive (i.e., patient needs assistance to provide self-care).

Strategies for integrating EBP

EBP must be part of the mission and goal of a health care organization, and strategies to attain this must be supported at all levels. Information technology tools, such as internet capability or access to information databases, should be available at the point of care so that health care providers are able to access journal articles and other clinical information. Links may be available through the patient's health risk evaluation as well. All staff should receive training in the use of equipment and methods of researching and retrieving information and have an understanding of how to interpret research findings; the inability of health care providers to understand and interpret findings can be a significant barrier to EBP. Because EBP often results in change, institutional support for change must be evident and my involve incentives. Continuing education classes should be available on-site to help health care providers gain the research skills they need.

Discuss cognitive science: Psychosocial development model developed by Eric Erikson.

EE's psychsocial development model covers the life span, focusing on conflicts at each stage and the virtue that is the outcome of finding a balance in the conflict. The first 5 stages relate to infancy and childhood and the last 3 stages to adult-hood, but childhood development affects later adult development: Stage Trust vs mistrust: (Age birth-1 year) Description: Can result in mistrust or faith and optimism. Stage Autonomy vs shame/doubt: (Age 1-3 years) Description: Can lead to doubt and shame or self-control and willpower. Stage Initiative vs guilt: (Age 3-6 years) Description: Can lead to guilt or direction and purpose. Stage Industry vs inferiority: (Age 6-12 years) Description: Can lead to inadequacy and inferiority or competence. Stage Identify vs role confusion: (Age 12-18 years) Description: Can lead to role confusion or devotion and fidelity to others. Stage Intimacy vs Isolation: (Age Young adulthood) Can lead to lack of close relationships or lead to love and intimacy. Stage Generativity vs stagnation: (Age Middle age) Can lead to stagnation or caring and achievements. Ego integrity vs despair: (Age Older Adulthood) Can lead to despair (failure to accept changes of aging) or wisdom (acceptance).

Provide an overview of evidence-based practice.

Evidence-based practice is the use of current research and individual values in practice to establish a plan of care for each individual. Research maybe be the result of large studies of best practices or individual research from observations in practice about the effectiveness of treatment. Evidence-based practice requires a commitment to ongoing research and outcomes evaluations. Many resources are available, such as the Guide to Clinical Preventive Services by the Agency for Healthcare Research and Quality of the U.S. Department of Health and Human Services (http://www.ahrq.gov/clinic/cps3dix.htm). Evidence-based practice requires a thorough understanding of research methods to evaluate the results and determine if they can be generalized. Results must also be evaluated in terms of cost-effectiveness. Steps to evidence based practice include: -Making a diagnosis -Researching and analyzing results -Applying research findings to a plan of care -Evaluating outcomes

Discuss nursing theories: Florence Nightingale, founder of modern nursing.

Florence Nightingale (1820-1910), founder of modern nursing, created one of the first training schools for nurses. Nightingale observed that the disciplined care provided to the sick by nuns was superior to the haphazard and untrained care of nurses in England. Based on her experiences in the Crimean War, Nightingale set standards for patient care that included sanitary conditions (e.g., cleanliness, improved ventilation, less crowding), adequate nutrition, and kindness. She used statistical anaylsis to show the number of deaths related to poor sanitation. Nightingale reformed the ways in which hospitals provided care for patients. She set standards for nursing and developed the Nightingale Pledge, which is still recited by nurses at graduation ceremonies. Reciting this pledge, nurses swear that they will practice the profession faithfully, do no harm, maintain and elevate the standards of the nursing profession, maintain confidence in personal matters, aid the physician, and devote themselves to the welfare of the patient.

Describe the history of the Health Insurance Portability and Accountability Act (HIPPA).

HIPPA was passed in 1996 to protect patients privacy rights. This is especially important given the large amount of sensitive data that is now handled electronically through large databases. Some key compliance dates for HIPPA are listed below (for large health plans): •October 16, 2002: Electronic transactions and code sets are to be identified. •April 14, 2003: Privacy standards are set. •July 30, 2004: Standards for employer identification are to be set. •April 21, 2005: Standards for system and data security are to be set. • May 23, 2007: Standards for provider identification are to be set. These uniform standards will allow the data repositories of large healthcare systems to be efficiently monitored for adherence to the HIPAA regulations, thus assuring patients rights to privacy are honored.

Discuss implications of health care reform

Health care reform initiatives are spurring the switch from paper to electronic health records and sharing of health care information among health care providers, increasing the demand for health information technology and people with expertise in informatics. New programs have been developed to focus on wellness with an increased emphasis on cost-effective measures because of increases in health costs. Internal data analysis and research are becoming important means by which to identify waste, institute best practices, and reduce costs. Increasing numbers of people are covered by health plans, even those with preexisting conditions, placing more demand on health care providers for services. There is an increased need for health literacy so that people are better informed about the services available, especially those newly insured. Medicaid costs have increased, resulting in some cutbacks in care. Early transfer from acute facilities to extended care or home health care is also increasing.

Discuss cognitive science: Theory of multiple intelligences developed by Howard Gardner.

Howard Gardner developed the. theory of multiple intelligences, which states that there are at least 7 categories of "intelligence" that people use to comprehend the world and learn. Gardner proposed that teaching that engages multiple intelligences is more effective than teaching focused primarily on linguistic or logical and mathematical intelligences (the most commonly addressed in education). Students should be assessed to determine the strengths of their personal intelligence, and teaching should address the student's preferences. -Linguistic intelligence is the ability to use and understand written or spoken language. -Logical/mathematical intelligence is the ability to use deductive and inductive reasoning, numbers, and abstract thinking. -Spatial intelligence is the ability to visualize and comprehend spatial dimensions. -Bodily/kinesthetic intelligence is the ability to control physical action -Musical intelligence is the ability to create and appreciate musical forms. -Interpersonal intelligence is the ability to communicate and establish relationship with others -intrapersonal intelligence is the ability to use self-knowledge and to be self-aware

Discuss nursing theories: Nursing process theory developed by Ida Jean Orlando.

Ida Jean Orlando developed the nursing process theory in the late 1950s and published them in 1961 in The Dynamic Nurse-Patient Relationship, based on her observations of what comprises good or bad nursing care. She theorized that the nursing process includes the following: -Behavior of the patient: Behavior is an indication of need, which may be expressed directly or through actions. -Nurse's reaction: The nurse must evaluate the needs of the patient based on perception and evaluation of this perception, exploring with the patient the meaning of the patient's behavior. -Subsequent nursing actions: Actions are based on the nurse's determination of the patient's real needs, which may be different from expressed needs, and then finding the appropriate action to meet these needs. When the patient's needs are met, the patient's distress is decreased and his or her sense of well-being is improved.

Discuss adult learning theories: Theory of adult development developed by Robert Peck.

In his theory of adult development, Robert Peck expanded on Eric Erickson's stages of adult development, believing there were 7 important tasks required during the last two stages of life. In middle age: -Mental flexibility vs. mental rigidity -Valuing wisdom vs. physical powers -socializing vs. sexualizing -cathectic (libidinal energy) flexibility vs. cathectic impoverishment Negative outcomes lead to weak relationships, inflexibility, resistance to change. Positive outcomes lead to strong relationships, flexibility in lifestyle, and adaptability to change In order adulthood: -ego differentiation vs. work role preoccupation -body transcendence vs. body preoccupation -ego transcendence vs. ego preoccupation Negative outcomes lead to loss of identity after retirement, depression, inability to accept bodily or functional changes, and fear of death. Positive outcomes lead to meaningful life after retirement, acceptance of bodily or functional changes, acceptance of death, and feeling that life has been good.

List the questions that should be asked when evaluating an information system's Health Insurance Portability and Accountability Act (HIPAA) compliance.

In order for a healthcare organization to comply with HIPAA, the should evaluate their system's compliance on a frequent basis. The following is a list of questions that should be asked during the evaluation procedure: • Where is the patient data stored? • Does each user have a unique sign-on that must be entered before gaining access to the system? • Are workstations physically secured (e.g., in a locked room?) • Does the system have an auto-log off function? • Is the system safe from unauthorized users? • Is all hardware and software up to date? • Where are the backup devices kept? • Are print copies of information disposed of properly (e.g., shredded)?

Discuss adult learning theory: Theory of social learning developed by Albert Bandura.

In the 1970s, Albert Bandura proposed the theory of social learning, in which learning develops from observation, organizing, and rehearsing behavior that has been modeled. Bandura believed that people were more likely to adopt the behavior if they valued the outcomes, if the outcomes had functional value, and if the person modeling had similarities to the learner and was admired because of the status. Behavior is the result of observation of behavioral, environmental, and cognitive interactions. There are 4 conditions required for modeling: 1. Attention: The degree of attention paid to modeling depends on many variables (e.g., physical, social, environmental). 2. Retention: A person's ability to retain models depends on symbolic coding, creating mental images, organizing thoughts, and rehearsing (mentally or physically). 3. Reproduction: The ability to reproduce a model depends on physical and mental capabilities. 4. Motivation: Motivation may derive from past performances, rewards, or vicarious modeling.

Discuss applying current research findings to practice: Model of Integration.

Integrating the results of data analysis and research into performance improvement or best practice guidelines varies from one organization to another depending on the model of integration that the organization uses: -Organizational: processes for improvement are identified, and teams or individuals are selected to participate in different areas or departments, reporting to one individual, who monitors progress. -Functional/coordinated: While staff specialties, such as risk management and quality management, are not integrated, they draw from the same data resources to determine issues related to quality of care and efficiency. -Functional/integrated: While staff specialties remain, there is cross-training among specialties. A case management approach to individual care is used so that one person follows the progress of a patient through the system and coordinates with the various specialties, such as infection control and quality management.

Discuss cognitive science: Theory of cognitive development developed by Jean Piaget--reoperational, concrete, and formal operational, years of age to adult.

JP's theory of cognitive development includes sensorimotor stage (0-24 months of age, broken down in the aforementioned 6 stages) and three additional stages Stage Preoperational: (Age 2-7 years) Description: From 2-4 years of age, during the preconceptual substage, children use language and symbols, have poor logical ability, and show egocentrism. From 4-7 years of age, during the intuitive substage, children establish a concept of cause and effect, but it may be faulty because of transductive reasoning. They may engage in magical thinking, centration, and animism. Stage Concrete Operational: (Age 7-11 years) Cause and effect is better understood, and children understand concrete objects and the concept of conservation. Stage Formal operation: (Age 11 years to adult) Children exhibit mature thought processes and the ability to think abstractly. Children and young adults can evaluate different possibilities and outcomes.

Discuss nursing theories: Philosophy of human caring developed by Jean Watson

Jean Watson developed the philosophy of human caring in 1979. Watson focused on transpersonal caring, which views the individual holistically from the perspective of the interrelationship among health, sickness, and behavior with a nursing goal to promote health and prevent illness. Watson's theory encompasses ten caritas (methods of caring) the nurse can employ during opportunities to provide care and caring moments. The 10 caritas include: -Having loving kindness and equanimity -being present and sustaining the spiritual beliefs of patients and self -cultivating personal spiritual practice -developing and maintaining a caring relationship -support both negative and positive feelings of the patient -being creative in caring -providing teaching-learning experiences within the patient's frame of reference -creating a physical and spiritual healing environment -providing for basic human needs -being open to spiritual concepts related to life and death of self and the patient.

Describe the fundamentals of computer security mechanisms.

Keeping computer systems safe requires a mixture of both physical and electronic security. •Physical security maybe maintained by placing computers or servers in restricted areas. Laptop and other portable computers should be fitted with locks or alarms and have extensive password protection in place. •Since many systems are open to remote, it is important that even if they are physically secure that they have electronic protection also. Firewalls help protect systems from unauthorized access by presenting an electronic barrier between the system and the remote user. A firewall is able to look at incoming information and only let through that which is approved. Firewalls may also be placed within a system to keep parts of it off limits to individuals who are authorized users of the system in general. It is a good practice to use a firewall to protect such things as payroll, personnel data, and client information.

Discuss team building.

Leading, facilitating, and participating in performance improvement teams requires a thorough understanding of the dynamics of team building: -Initial interactions: This is the time when members begin to define their roles and develop relationships, determining if they are comfortable in the group. -Power issues:The members observe the leader and determine who controls the meeting and how the control is exercised, beginning to form alliances. -Organizing: Methods to achieve work are clarified and team members begin to work together, gaining respect for each other's contributions and working toward a common goal. -Team identification: Interactions often become less formal as members develop rapport, and members are more willing to help and support each other achieve goals. -Excellence: This develops through a combination of good leadership, committed team members, clear goals, high standards, external recognition, spirit of collaboration, and a shared commitment to the process.

Discuss the Lean Six Sigma process improvement plan and application to informatics nursing.

Lean-Six Sigma, a method that combines Six-Sigma with concepts of "lean" thinking, focuses process improvement on strategic goals rather than on a project-by-project basis. This type of program is driven by strong senior leadership that establishes long-term goals and strategies. Physicians are an important part of the process and must be included and engaged. The basis of this program is to reduce error and waste within the organization through continuous learning and rapid change. This is especially important in the field of informatics because of the continually evolving nature of information technology and the costs involved in maintaining currency. There are 4 characteristics to Lean-Six Sigma: Long term goals with strategies in place for one to three year periods. -Performance improvement as the underlying belief system. -Cost reduction through quality increase, supported by statistics evaluating the cost of inefficiency. -Incorporation of improvement methodology, such as DMAIC, PDCA, or other methods.

Discuss nursing theories: Crisis theory developed by Lee Ann Hoff.

Lee Ann Hoff developed the crisis theory of nursing. Crisis theory considers those stress-related events that are turning points in a person's life and can lead to danger or opportunity. These may be health issues (e.g. cancer), environmental issues (e.g. earthquakes), criminal issues (e.g. rape), or any other issues that precipitate a crisis reaction. During a crisis, people are overwhelmed with anxiety and are unable to function effectively. Crisis management helps the person and those in his or her social network to deal with the crisis issues and reach resolution. The nurse and others, such as police, social workers, physicians, and ministers, depending on the type of crisis, are in the position to provide crisis intervention. Crisis care comprises a number of steps, including assessing the situation, making plans to resolve the crisis, implementing actions, and following up to ensure that the crisis has been resolved.

Discuss cognitive science: Theory of cognitive dissonance developed by Leon Festinger.

Leon Festinger's theory to cognitive dissonance states that individuals attempt to escape dissonance and try to avoid inconsistencies between their beliefs and actions. If dissonance occurs, then beliefs and ideas are more likely to change than actions or behavior. Dissonance can be resolved by understanding and attaching less importance to dissonant beliefs, seeking beliefs that are more consonant to outweigh those that are dissonant , or changing beliefs to avoid inconsistencies. Dissonance is especially a concern when the individual is faced with choices and decision-making. Because people want to avoid dissonance, they may avoid individuals or situations in which dissonance occurs. A cognition is considered a piece of knowledge. When faced with dissonance, the person can: -Change one cognition others, or change all to bring them in line. -Eliminate one cognition, or add more to bring about consonance. -Alter the importance of cognitions.

Discuss nursing theories: transcultural theory of nursing developed by Madeline Leininger

Madeline Leininger developed transcultural theory of nursing in 1974, based on anthropological concepts. Transcultural nursing considers cultural issues as central to providing care and promotes study of cultural differences as they pertain to people's beliefs about illness, behavioral patterns, and caring behavior as well as nursing behavior. Leininger recognized that response to illness is often rooted in cultural beliefs and traditions. Based on research, the goal is to identify and provide care that is both culture-specific (i.e., fitting the needs of a specific cultural group based on their belief systems and behavior) and universal (i.e., based on belief systems and behavior that hold true for all cultures). Nurses are expected to determine the most appropriate approach to care, considering not only the needs of ethnic or minority populations but also gender issues. Transcultural theory tries to find ways to accommodate traditional belief systems with modern and to prevent cultural conflict.

Discuss adult learning theories: Theory of andragogy developed by Malcolm Knowles.

Malcom Knowles developed the theory of andragogy in relation to adult learners, who are more interested in process than in information and content. Knowles outlined some principles of adult learning and typical characteristics of adult learners that an instructor should consider when planning strategies for teaching parents, families, or staff. Practical & goal orientated -Provide overviews or summaries and examples. -Use collaborative discussions with problem solving exercises. -Remain organized with the goal in mind. Self-directed -provide active involvement, asking for input. -allow different options toward achieving goals. -give them responsibilities. Knowledgeable -show respect for their life experiences or education. -validate their knowledge and ask for feedback. -relate new material to information with which they are familiar. Relevancy-orientated -explain how information will be applied. -clearly identify objectives. Motivated -Provide certificates of achievement or some type of recognition achievement.

Discuss an overview of methods to maximize reimbursement.

Methods to maximize reimbursement include: • Recording of information and sending of claims in a timely manner. • Using care managers to determine the most cost-effective care plan. • Using standardized billing codes (Current Procedural Terminology, International Classification of Diseases [ICD]). • Ensuring that the health care provider's National Provider Identifier is present on all claims. • Updating systems promptly when new coding (e.g., ICD-10) and billing regulations (e.g., pay-for-performance) are issued rather than waiting for the end of the grace period so that problems can be identified and corrected early. • Ensuring that the presentation on admission (Medicare severity diagnosis-related group code) diagnosis is correct to avoid a different discharge diagnosis. • Monitoring quality of care to prevent complications and reduce costs related to the do-not-pay-list. • Sending claims in the correct form and to the correct address for different entities: insurance companies, Medicaid, and Medicare.

Discuss systems theory: Family systems theory developed by Murry Bowen.

Murry Bowen's family systems theory suggests that one must look at the person in terms of his or her family unit because the members of a family have different roles and behavioral patterns; thus a change in one person's behavior affects the others in the family. There are 8 interrelated concepts: 1. Triangle theory: Two people comprise a basic unit, but when conflict occurs, a third person is drawn into the unit for stability with the resulting dynamic of two supporting one or two opposing one. This, in turn, draws in other triangles. 2. Self-differentitation: People vary in their need for external approval. 3. Nuclear family patterns: Marital conflict, one spouse dysfunctional, one or more children with problems, and emotional distance constitute some familiar nuclear family patterns. 4. Projection within a family: Problems (emotional) are passed from parent to child. 5. Transmission (multigenerational): There are small differences transmission from parent to child. 6. Emotional isolation: Reducing or eliminating family contact results in emotional isolation. 7. Sibling order: Sibling order can have a profound influence on behavior and development. 8. Emotional process (society): Interactions in society result in regressive or progressive social movements.

Describe the role of network administrator and trainer

Network administrators and trainers are two types of support personnel needed primarily when an organization implements a new information system. They perform the following functions: Network administrator: are given access to all areas of the system and must be held to a high standard of ethical accountability. These individuals take on the bulk of managing existing systems and planning new systems. They should also help the organization make hardware decisions and manage the lower level information systems employees such as PC specialists and programmers. Trainer: Trainers teach the organization's staff how to use computer systems. Trainers may be full-time employees of the organization, provided by the software vendor as part of the system contract, or temporary workers. They need to be up to date regarding healthcare information systems and the functions they support.

Discuss the following methods to maximize reimbursement: Present on admission Medicare severity diagnosis-related group.

On admission to acute hospitals under the Medicare Inpatient Prospective Payment System (IPPS), patients must be given a present-on-admission (POA) Medicare severity diagnosis-related group (MS-DRG) diagnosis. The MS-DRG should include primary and secondary diagnoses present during the admission process. This is a concern regarding maximizing reimbursement because hospital-acquired conditions may not be covered if there is a change at discharge from the POA diagnosis. A POA indicator must be on all claims: Y: Medicare pays for a condition if a hospital-acquired (HAC) condition is N: Medicare will not pay for a condition if a HAC is present on discharge but not on admission. U: Medicare will not pay for a condition if a HAC is present and documentation is not adequate to determine if the condition was present on admission. W: Medicare will pay for condition if a HAC is present and if the health care provider cannot determine if the condition was present on admission.

Discuss how time-outs enhance system security and integrity.

Once a person has logged in and gained access to a computer, the computer is vulnerable if that user leaves the computer and fails to log out, so computers connected to a secure system routinely have a time-out feature (automatic log off) in which there is no mouse or keyboard activity. Some software programs and applications also have time-out features. Once the time out is initiated, a person must log in again in the prescribed manner to gain access. Time out/automatic logoff is one of the security procedures that must be addressed for part of the Health Insurance Portability and Accountability Act's security rule. The users' workflow and type of use of devices should be considered when scheduling automatic log off.

Discuss types of patient data misuse.

Patient data misuse is an increasing problem with rapid proliferation of electronic health records (EHRs). Types of misuse include: Identity theft: Health records often contain identifying information, such as social security numbers, credit card numbers, birthdates, and addresses, making patients vulnerable. Unauthorized access: Although EHRs and computerized documentation systems are password protected, providers sometimes share passwords or unwittingly expose their passwords when logging in, inadvertently allowing access to information about patients. Privacy violations: Even professionals authorized to access a patient's records may share private information with others, such as family or friends. Security breaches: Data are vulnerable to security breaches because of careless, inadequate security, especially when various business associates, such as billing companies, have access to private information.

Describe encryption methods designed to protect confidential information.

Patient information that is stored in databases is of a sensitive and confidential nature. Therefore, it is a requirement to use encryption when transmitting this information to other locations. Encryption is the process using mathematical formulas to code data so that is is unrecognizable if it is intercepted by someone outside of the system. There are 3 distinct ways that encryption can be handled by a company: 1. at the desktop, 2. administrated, or 3. server-wide. When an employee encrypts messages at their desktop, it protects the message, but unfortunately they may also hide information (such as viruses) from detection by the system administrator. A company may also assign an encryption administrator to handle the coding and the decoding of messages. With today's computer systems, the most effective way to encrypt messages is to have the central server encrypt every outgoing message automatically. This requires no manual procedures whatsoever.

Discuss nursing theories: Stages of clinical competence developed by Patricia Benner

Patricia Benner developed the stages of clinical competence for nurses based the Dreyfus Model of Skill Acquisition in 1984. There are five stages of clinical competence for nurses: Novice: has little experience, depends on rules and learned behavior, and is not able to adapt easily. Advanced beginner: has some experience in coping with new situations and is able to formulate some principles of action. Competent: The competent nurse has 2-3 years of experience, has some mastery of new situations and goals, and can cope well but my require time for planning and lack flexibility Proficient: looks at situations holistically, relies on experience to determine goals and plans, can adapt plans to changing needs, and can make decisions based on the understanding of maxims. Expert: has a wealth of experience form which to draw and can provide care intuitively rather than relying on rules and maxims. The nurse is able to understand needs and determine quickly the most effective focus for providing care.

Discuss physical security.

Physical security is essential for computer systems. The first step is to determine who has access to different types of equipment and then to apply methods to limit access to only those authorized through use of usernames and passwords or tokens. Servers should be rack-mounted in locked, climate- controlled rooms that have regular surveillance. Vulnerable devices should remain in the locked room. Data should be backed up routinely and stored or archived in a secure remote location. Workstations should be secure, including printers. Cable lock systems should be used to secure equipment, including laptops, to furniture. Operating systems should be locked when not in use, and encryption software should be used to secure routers that are used for wireless transmission. Equipment should be in restricted areas. Remote access should be done with secure modems and encryption. Public access to the internet should be on a different network from that used to transmit healthcare information.

Discuss propriety data and the legal implications surrounding it.

Propriety data derive from propriety software that has been developed internally or used under contract with a company, such as Cisco, which developed the software. Propriety software should be protected by patent or copyright and use restricted to protect intellectual property, such as patient lists, financial reports, or details about an organization. Those who use propriety software should require that all those working with the data, including third parties, sign a nondisclosure agreement to prevent information regarding the software or data from being stolen or misused. Stealing propriety data is common when people leave an organization and is often used to benefit a new employer; however, stealing legally protected information is an act of fraud. Security experts should constantly monitor software and data to ensure that they have not been invaded by malware (malicious software), which can steal information, damage systems, or disrupt operations.

Explain a review of informatics polices and procedures.

Review of informatics policies and procedures should be done in response to surveillance/evaluation reports, as policies and procedures should be written with clear goals and outcomes in mind. A comprehensive review should include: Analysis of achievement of goals: if goals are meant or exceeded, then new goals may need to be set. If goals are not met, then policies and procedures, or training were either inadequate or unrealistic. Analysis of variances and assessing risk factors. Staff input: Meetings to discuss adequacy or problems with current policies and procedures can be held to gather opinions of staff. In addition, cross-sectional questionnaires regarding compliance, knowledge, and training can be used. Training review: Training should be ongoing and coupled with clear expectations of staff compliance.

Discuss legal implications of malpractice and negligence.

Risk management must attempt to determine the burden of proof for acts of negligence, including compliance with duty, breaches in procedures, degree of harm, and cause as a finding of negligence can lead to a malpractice suit. Negligence indicates that proper care, based on established on established standards, has not been provided. State regulations on regarding negligence may vary, but all have some statues of limitation. There are a number of different types of negligence. •Negligent conduct indicates that an individual failed to provide reasonable care or to protect/assist another, based on standards and expertise. •Gross negligence is willfully providing inadequate care while disregarding the safe and security of another. •Contributory negligence involves the injured parties contributing to the harm done. •Comparative negligence attempt to determine what percentage of negligence is attributed to each individual involved.

Discuss adult learning theories: Theory of adult development development Robert Havighurst.

Robert Havighurst, in his theory of adult development, stated that there were a number of tasks that needed to be accomplished during each stage of development and that remaining active is important. His adult stages reflect stereotypical roles to some degree related to the 1960s when marrying young was more typical than now. Stage: (early adulthood) Tasks: finding a mate, marrying, having children, managing a home, getting started in an occupation or profession, assuming civic responsibility, and finding a congenial social group Stage: (middle age) Tasks: Achieving civic & social responsibility, maintaining an economic standard of living, raising teen-agers & teaching them to be responsible adults, developing leisure activities, accepting physiological changes related to aging, & adjusting to aging of parents. Stage: (older adulthood) Tasks: adjusting to a decrease in physical strength and health, death of a spouse, life in retirement, and reduced income. Other tasks include establishing ties with those in the same age-group (senior citizen's groups/retirees), meeting social and civic obligations, and establishing physical living arrangements that are satisfactory.

Explain the significance of sabotage, errors, and disasters on an information system.

Sabotage: The willful destruction of computer equipment (or database records) is defined as sabotage. The majority of these types of acts are committed by angry or unhappy employees. The others are caused by external hackers to the system who destroy (or erase) records for their own notoriety. Errors: There are several ways that errors occur in computer systems: poor design, incorrect data entry, or retrieval of an incorrect entry. It is important that when errors are found, they be reported to the system administrator immediately. Disasters: A disaster may cause the system to be shut down entirely for an undefined length of time. For this reason, it is important to have backup procedures (both manual and at a remote site) in place and to conduct practice drills regularly so that the entire operation will not be put at risk.

Discuss nursing theories: Science of unitary human beings developed by Martha E. Rogers.

Science of unitary human beings was developed by Martha E. Rogers in the 1980s and 1990s. The individual is viewed art a unitary energy source within the larger universe, constantly interacting with the environment. The 4 primary characteristics of this theory include the following: -Energy field: This is basic to all living and nonliving things. -Openness: The individual and the environment exist together with an openness that allows a continuous exchange of energy -Pattern: This energy wave distinguishes and identifies the source of energy. -Pan-dimensionality: This domain is nonlinear and not constrained by time or space, which are arbitrary means that people use to describe events. Basic concepts derived from the above characteristics include the following: -Unitary human being: Humans are energy fields that can be identified by patterns and characteristics. The holistic human cannot be predicted by parts but only by being viewed as a unified whole. -Environment: The environmental energy field is integral to that of the human energy field. -Homeodynamics: Good health and illness constitute part of the same continuum.

Discuss security failures

Security failures may occur as the result of a number of different problems. • System penetration: Penetration can result from undetected vulnerabilities. Penetration tests should be conducted to identify vulnerabilities. Perpetrators maybe cyberhackers, hackers, computer specialists, authorized users, unauthorized users, and opportunists. • Destruction/sabotage: This includes physical damage to the system or purposeful alterations in applications. Perpetrators may be anyone who has access to the computer system or who has issues with management or other aspects of the organization. • Mistakes/errors: Errors may result from poor design; incorrect entries; system changes; poorly trained personnel; and absence of adequate procedures, policies, and education. • Password management: Poor management procedures, such as sharing passwords or posting usernames and passwords where they can be accessed by unauthorized persons, can allow unauthorized people to access a system. • Device compromise: Handheld devices, such as digital assistants and smartphones, are vulnerable to theft and can easily transmit viruses and worms.

Describe the role of security officer for information systems.

Since there are many regulatory patient privacy requirements (e.g. HIPAA), security officers are essential members of the healthcare information information system team. It is important that confidential information is not accessible to unauthorized users or abused by employees. The security officer is responsible for assigning system access codes, making sure passwords are kept secret (and updated), and monitoring the overall use of the system. They may also be in charge of the physical security of the computers and peripherals. A stolen hard drive or laptop computer could contain sensitive information and be a target for information thieves. It is important that the security officer work with the information systems department and the organization's management to create enterprise wide policies and procedures, which describe the proper and ethical use of equipment and information. These standards should apply to all staff members.

Discuss communication theories: Social exchange theory.by George C. Homans, John Thibaut, and Harold Kelley; social penetration theory by Irwin Altman and Dalmas Taylor; spiral of science theory by Elisabeth Noelle-Neuman; and face-negotiation theory by Stella Ting-Toomey

Social exchange theory developed by George C. Humans, John Thibaut, & Harold Kelley, describes communication as an exchange system in which people attempt to negotiate a return on their "investment" in much the same way that people engage in commerce. Those involved in communication seek a balance between investment and return. Social penetration theory, developed by Irwin Altman and Dalmas Taylor, describes the manner in which people use communication to develop closeness to others, proceeding from superficial communication to more explicit self-disclosure, which causes vulnerability but allows for a closer relationship. Spiral of silence theory, developed by Elisabeth Noelle-Neuman, looks at the role mass media has in influencing communication and suggests that people fear isolation so that they conform to public opinion as espoused by mass media and mute dissent. Face-negotiation theory developed by Stella Ting-Toomey assumes that all culture are concerned with maintaining face, and this affects conflict resolution. The theory encompasses the concept of "positive face" and "negative face" and suggests that people in individualistic cultures are likely to be less compromising than those in collectivist cultures.

Discuss cognitive science: Theory of cognitive development developed by Jean Piaget--Sensorimotor Stags III & IV (4 months to 12 months of age).

Stage III: (Age 4-8 months) Description: There is an intensification of stage II, with children developing a sense of causality, time, and personal separateness. They begin to imitate and show different affects. They develop a sense of object permanence between 6-8 months (secondary circular reactions). Stage IV: (Age 9-12 months) Description: There is a transitional stage with further intellect development, including understanding that a hidden object is not gone. Children begin to behave with intention, to associate words and symbols (bye-bye) with events, and attempt to climb over obstacles.

Discuss cognitive science: Theory of cognitive development developed by Jean Piaget-- Sensorimotor stages V & VI (13 months to 24 months of age).

Stage V: (Age 13-18 months) Description: Newly acquired motor skills allow children to experiment and demonstrate the beginning of rational judgement and reasoning. Children further differentiate themselves from objects, understand cause and effect, but have little transfer ability. Children gain spatial awareness (tertiary circular reactions). Stage VI: (Age 18-24 months) Description: Preparation for more complex intellectual activities. Children understand object permanence, begin to use language, and engage in sex-role behavior. They have some sense of time, but time is exaggerated.

Discuss steps to developing guidelines based on evidence

Steps to developing EBP guidelines include the following: -Focus on the topic/methodology: this includes outlining possible interventions/treatments for review, choosing individual populations and settings, and determining significant outcomes. Search boundaries (e.g. journals, studies, dates of studies) should be determined. -Evidence review: review of literature, critical analysis of studies, and a summary of results, including pooled meta-analysis -Expert judgement:Recommendations based on personal experience from a number of experts may be used, especially if there is inadequate evidence based on reviews but this subjective evidence should be explicitly acknowledged. -Policy considerations: This includes cost-effectiveness, access to care, insurance coverage, availability of qualified staff, and legal implications -Policy: A written policy must be completed with recommendations. Common practice is to use letter guidelines with "A" the most highly recommended, usually based on the quality of supporting evidence. -Review: The completed policy should be submitted to peers for review and comments before instituting the policy.

Explain the term System penetration

System penetration occurs when someone other than the authorized system personnel access a private computer system. System penetration can lead to lost time and money in addition to negative public relations. Losing private information has become a regular headline in the news. In today's world of cyber criminals, the robbery of personal information from a computer system is a far larger threat than physical breaking and entering. There are typically three types of people who can attempt system penetration: opportunists, hackers, and information specialists. Opportunists are those individuals who have valid access to a computer system and use the information stored there for nefarious purposes. Hackers may see system security as a challenge to rise to and attempt system penetration for the thrill. Similar to hackers, an information specialist is someone who has been trained to work with computers on a professional level, but then uses this training to commit crimes.

Explain the general concepts of systems theory.

Systems theory is a method to detect ways to connect seemingly unrelated ideas or functions. An underlying principle of systems theory is that all systems have common ways of processing information. By understanding the basic principles of systems theory an individual can detect, understand, and predict most systems environments. This theory is effective since a system is not just a grouping of individual parts, but also an entity of its own. There are two types of systems: natural and designed. -Natural systems are those that have not been created by human intervention. -Designed systems may contain hybrids of human created and natural systems. An important factor of any system is complexity. Complexity refers to the number of parts that are connected, embedded, and entangled with one another. Embedded is defined as one system being completely housed inside another system. Entangled is defined as one system existing only as part of another system.

Discuss the systems theory developed by Ludwig von Bertalanffy

Systems theory, developed by Ludwig von Bertalanffy in the 1940s, is an approach that considers an entire system holistically rather than focusing on component parts. Bertalanffy believed all of the elements of a system and their interrelationships need to be understood because all interact to achieve goals; a change in any one element impacts the other elements and alters their outcomes. There are five elements in a system: -Input: This is what goes into a system in terms of energy or materials. -Throughput: These are the actions that take place in order to transform input. -Output: This is the result of the interrelationship between input and processes. -Evaluations: This is monitoring success or failure. -Feedback: This is information that results from the process and can be used to evaluate end result. To achieve desired outcomes, every part of the process must be considered. The individual parts added together do not constitute the whole because viewing the parts separately does not account for the dynamic quality of interaction that takes place.

Describe the framework for nursing informatics as defined by the ANA

The ANA has laid out standards for the INS. These standards are based on a "problem-solving framework", which includes both traditional aspects of nursing as well as those aspects mores specific to the informatics nurse. The standards are: -Assessment -Problem or Issues -Outcomes Identification -Planning -Implementation >Coordination of activities >Health Teaching, Health Promotion and Education for Informatics Solutions >Consultation -Evaluation -Education -Professional Practice Evaluation -Quality of Practice -Collegiality -Collaboration -Ethics -Research -Resource Utilization -Advocacy -Leadership

Discuss the Health Information Technology for Economic and Clinical Health Act

The American Recovery and Reinvestment Act of 2009 included Health Information Technology for Economic and Clinical health Act (HITECH). HITECH provides incentive payments to Medicare practitioners (usually physicians) to adopt electronic health records (EHRs). EHRs must be certified and meet the requirements for "meaningful use". Additionally, HITECH provides penalties in the form of reduced Medicare payments for those who do not adopt EHRs, unless exempted by hardship (e.g. rural practices). Security provisions include the following: -Individuals and Health and Human Services must be notified of a breach in security of personal health information. -business partners must meet security regulations or face penalties. -The sale or marketing of personal health information is restricted. -Individuals must have access to electronic health information. -Individuals must be informed of disclosures of personal health information. HITECH also provides matching grants to institutions of higher education and funding for training for health information technology, promotes research and development of health information technology, and provides grants to the Indian Health Services for adoption of health internet technology.

Discuss organization accreditation standards: Centers for Medicare and Medicaid Services

The Centers for Medicare and Medicaid Services (CMS) maintain a list of approved accreditation organizations for health care providers, as providers and suppliers who have been accredited by one of these national accrediting agencies are exempt from state surveys in determining if they are in compliance with Medicare-mandated conditions. Approved organizations include the Joint Commission, Community Health Association Program, and the Accreditation Commission for Health Care. The CMS has established an incentive program for adoption, upgrade, or use of electronic health records (EHRs). Those applying for incentive programs must use certified EHR systems that demonstrate that they can store and share patient data securely. Health care providers who are eligible for incentive pay from Medicare or Medicaid can receive up to $44,000 over a 5-year period, while eligible hospitals and critical access hospitals can receive a beginning base payment of $2 million. Medicare eligibility guidelines and Medicaid eligibility guidelines vary for both eligible professionals and eligible hospitals.

Define and discuss the DIKW pyramid as it relates to informatics nursing.

The DIKW pyramid is a hierarchical method to show the relationship between the different elements of information processing and focuses on both the function and structure. The lower levels contribute to the upper, and one can review a process by going up and down the pyramid: -Data (base): signs and signals, such as numbers, symbols, letters, and words used to describe empirical informations that can be verified as factual although some models include subjective data, which cannot always be verified. -Information-Results after context is applied to data that is entered into a system. Information can be inferred from data and used to answer questions. -Knowledge- knowledge considers information is terms of meaning, including subjective assessment. knowledge derives from experience and facilitates development of theories and frameworks. -Wisdom(apex)-wisdom is an appreciation and understanding of the whole and ethical considerations. lower levels of the pyramid contribute to knowledge and wisdom, which form a frame of reference.

Discuss privacy and security rules.

The Health Insurance Portability and Accountability Act of 1996 mandates privacy and security rules (Code of Federal Regulations, Title 45, part 164) to ensure that health information and individual privacy are protected. -Privacy rule: Protected information includes any information included in the medical record (electronic or paper), conversations between the physician and other health care providers, billing information, and any other form of health information. Procedures must be in place to limit access and disclosures. -Security rule: Any electronic health information must be secure and protected against threats, hazards, or nonpermitted disclosures, in compliance with established standards. Implementation specifications must be addressed for any adopted standards. Administrative, physical, and technical safeguards must be in place as well as policies/procedures to comply with standards. Security requirements include: limiting access to those authorized, use of unique identifiers for each user, automatic log off, encryption and decryption of protected healthcare information, authentication that healthcare data have not been altered or destroyed, monitoring of logins, and security of transmission. Access controls must include a unique identifier, procedures to access the system in emergencies, time out, and encryption/decryption.

Describe the International Council of Nurses (ICN) Code of Ethics for nurses in regards to coworkers.

The ICN has developed Code of Ethics for nurses in regards to coworkers. Healthcare is a team oriented process with all attention focused on the well-being of the patient. Effective interaction with other team members (coworkers) is a key to success in this environment. The following bullet points are key areas that need attention: -Keep relationships with coworkers cooperative and professional. -Make sure that patients are safe and promptly deal with unprofessional or dangerous conduct on the part of coworkers. -Take care not to delegate more work than the individual is able to handle. -Promote continuing education in the workplace. -Keep the lines of communication open between departments, management, etc. This is an area that needs constant monitoring by workers and management. Any drift from optimal conditions should be addressed before the patient is exposed to any negative effects of poor teamwork.

List standards related to computerized systems used in healthcare, as outlined by The Joint Commission.

The Joint Commission has described the need for computer system standards in the following areas: -Access to databases that are located outside the organization and used to compare information, need to be supported and secured. -Patient confidentiality related to personal health information (PHI) and data security must be ensured. -Knowledge-based (helps diagnose medical conditions) systems should be developed and promoted to allow resident organizational expertise to be used throughout the organization. -A means to link physician information systems while protecting patient privacy and data security. -Projects that are being designed to achieve quality improvements should be supported. -Data integrity and overall system security must be ensured. -Procedural controls that are currently in place for documentation should be integrated into the new computerized standards. -A regular assessment of needs and system and system capacity for growth should be supported.

Explain the factors that are important for information systems in the accreditation process.

The Joint Commission outlined factors it believes are important for information standards: -Measures must be adopted that are designed to protect an individual's personal health information. This may be accomplished by limiting access to information based on a user's need to know, having strict policies regarding the removal of records, and making sure data is physically and electronically safeguarded. -A national standard for data entry should be created and followed. All users should be trained both in system use an information management. Educational courses may include lectures on how information that is entered into a computer system is transformed into data that can be later used to perform statistical analysis and support decision-making. -All information should be available both on the computer and in print form.

Describe the attributes that help to assure accuracy of information.

The following information attributes are important in assuring accuracy: -Objective reporting-information should be completely free from bias and reported accurately. -Comprehensive-All the necessary information is available to complete reports and requests -Appropriateness-All users are able to access the information necessary to do their jobs. -Unambiguous-the data is clearly defined in order to reduce errors -Reliability-When identical information is keyed in by different people, it should always be uniform in the system. -Up to Date- The most recent information should be listed first. -Convenience- it should not be difficult for users to locate the information they need.

Outline the factors that The Joint Commission has identified as important to patient information security.

The Joint Commission outlined many factors that it believes are important to the security of patient information. The two major factors are: 1. Information should be transmitted accurately and quickly. • Requested information should be supplied within 24 hrs of the request. It should be transmitted in whatever format the user needs. • Orders should be put in place with as little delay as possible and test results should be entered into the system quickly. • Errors should be minimized. This could be achieved with the implementation of a computerized system such as a pharmacy system. • Methods of communication should be evaluated for efficiency. 2. Clinical and non-clinical systems should be fully integrated. • Records should be customizable to the patient and their individual needs. • The system should be able to create reports based on the users demands. • Comparisons between healthcare organizations should be fully supported.

Discuss development of policies.

The development of policies must be based on best practices and conform to state, federal, and accreditation regulations and guidelines. Empowerment includes encouraging participation of all staff in policy making. Objectives for policies should be clearly outlined. In some cases, policies may be broad and cover all aspects of an organization, but in other cases, polices may be much more specific, such as a policy regarding use of computer equipment. Conflict of interest policies should be in place to ensure that those involved in review activities should not be primary caregivers or have an economic or personal interest in a case under review. Policies should ensure that access to protected health information be limited to those who need the information to complete duties related to direct care or performance improvement review activities. Policy and procedure manuals should be readily available organization-wide in easily accessible format, such as online. Policy issues may include cost-effectiveness, insurance coverage, criteria for qualified staff, and legal implications.

Describe the essential elements in the practice of nursing informatics.

The essential elements within the practice of nursing informatics include traditional nursing aspects such as: -Focus on the patient and their well-being. -Healthcare in general. Keeping up to date on the latest state of the art in terms of nursing. -Working environment. This includes how things are laid out (to avoid errors and make things as efficient as possible). -Working with other. How to interact effectively with other healthcare practitioners and coworkers. In terms of informatics, the related skills include: -Knowledge of data structures (including metastructures). -Knowledge of computer networking. -Knowledge of computer hardware. -Information system training skills. Formal education includes: -A minimum of bachelor's degree in nursing or another relevant field. -Continuing education in informatics nursing, such as working toward a graduate degree.

Discuss issues related to the fair distribution of health information access

The fair distribution of health information access relates to information specific to the individual (e.g. electronic health records), data (both aggregate and comparative), and knowledge-based information (e.g. journals, websites). While people should have access to health information, considerations must include the right to privacy, regulations regarding intellectual property, and equitable access to information. One problem with access is that many people are unaware of their rights or lack the training tools to access information, so an important element of fair distribution must include providing public means of access, such as in libraries and through public health agencies and education (e.g. posters, handouts, videos) to educate the general public. People in rural or isolated areas may lack access to basic care and health information but may be served by Telehealth services, using telecommunications to provide information and internet health resources.

Describe the differences between clinical nurses and those who specialize in informatics.

The focus of a traditional clinical nurse revolves around taking care of patients. Their use of computerized systems is limited to the user level (i.e., enough knowledge to operate the equipment and enter data). Their concentration is on the accuracy of the information that they are interpreting or giving to other caregivers. They are trained to handle malfunctions and are used as a feedback source for the informatics developers. Their opinion of the computerized system is key as to whether or not the system is successful. Nurses who specialize in informatics focus on the information systems. They worry about the SECURITY and STABILITY of the systems installed at their facility. They are also very adept to troubleshooting problems (especially at the user level). They make sure the systems are user friendly as possible and, more importantly, reduce the number of tasks the traditional clinical nurse has to perform in their routine day. Efficiency and enhanced productivity are the key goals of the informatics nurse.

Describe the informatics nurse responsibilities.

The following is a list of responsibilities that are required of the informatics nurse: -Teaching policies involved with information systems. >This includes the standard operating procedures and system security features. -Deciding the effectiveness of a computer system. >This is based on overall performance (e.g. system response time) and how well the system design is working. -Making sure the system works as it was designed to. >By verifying that the system produces results that are expected and troubleshooting problems. -Deciding when computer systems need to be upgraded. >This is based on gauging the obsolescence of the hardware and system compatibility with modern software. -Finding new ways to use technology in nursing. >By looking for new and novel applications of technology. -Ensuring compliance in regulations regarding patient information. >This includes patient privacy regulations. -Managing projects as needed. -Conducting research into the field of nursing informatics.

Outline the International Council of Nurses (ICN) Code of Ethics for nurses in regards to practice and profession.

The following is an outline of the (ICN) Code of Ethics in regards to practice and profession: -Keep up to date with the practice of nursing through continued education. This entails taking continued education courses and adding certifications to one's resume. -Look after one's own health in order to maintain quality of care to the patient. It is very easy to forget about taking care of yourself when working with sick patients on long shifts. The importance of keeping healthy is a key to providing excellent care to patients. -Do not take on more than can be reasonably handled. In the current cost cutting healthcare environment, nurses are being asked to do more with less. This can lead to burnout and high staff turnover. -Uphold a high standard of personal conduct. -Make sure that all new applications of technology are safe for use in treatment and do not compromise the dignity of the patient. -Develop and put in place ethical standards in clinical, management, education, and research.

Describe the International Council of Nurses (ICN) Code of Ethics for nurses in regards to patients.

The following is an outline of the ICN Code of Ethics for nurses in regards to patients: -Foremost, the nurse's responsibility is to the patient. The patient must receive the best possible care and their rights and well-being are respected and maintained. -Respect and support the patient rights, religious beliefs, values and customs. The patient should be able to live their way of life while under care. This means they should be allowed to follow their culture and traditions as best as possible. -Make sure the patient gives informed consent for any treatment. The patient has the ultimate say as to whether or not they receive the treatment. The right of the patient is to accept or refuse a given treatment through the informed consent process is essential. -Keep the patient information confidential. The patient's right to privacy is protected under law and should be respected. In addition, nurses should be proponents for community health and act to promote environmentalism.

Discuss the American Nurses Association's (ANA) definition, scope, and functional areas of the informatics nurse specialist.

The informatics nurse is one who works in informatics because of experience or interest in the field but has not received formal training; an informatics nurse specialist (INS) has completed graduate studies in informatics and may also have certification. According to the ANA, nursing informatics is a nursing specialty integrating nursing, computer science, and information sciences, which support professionals and patients in decision-making through information processes and technology. INS functions include: -Providing tools for standardized documentation -Managing information and analyzing data -Re-engineering information processes and promoting standardization -Participating in research and collection of data -Providing nursing management and administration -Serving as a consultant in the field of informatics -Promoting and providing professional development activities, including training of human-computer interaction systems -Advocating for changes in policies -Serving as advocate for staff and patients -Ensuring implementation for EHR and computerized physician order entry systems -Providing support to clinical applications

Discuss updating documentation requirements based on changes to regulatory or accreditation standards.

The nursing informatics specialist must update documentation requirements based on changes to regulatory or accreditation standards. This means that the nurse must be cognizant of accreditation standards, such as those by the Joint Commission, and current regulations, such as those related to the Centers for Medicare and Medicaid Services (CMS) or the Health Insurance Portability and Accountability Act, which must be monitored closely to determine if current documentation is adequate and what changes must be made. Accreditation standards require huge amounts of paperwork to demonstrate compliance, so building requirements into the system can save time when reports are due; thus, the nursing informatics specialist must consider the need to retrieve data as well as document necessary information when updating. While CMS provides updates regarding most federal regulations, states may have additional requirements that must be accommodated. Changes should be done well in advance of required compliance so that staff members can become familiar with changes, and problems with changes can be evaluated.

Describe the organizational development (OD) model of change

The organizational development model (OD) of change within an organization works by focusing on the entire culture of the organization rather than trying to change individual behaviors. OD encourages management-worker cooperation and free flowing communication. Its primary goal is to make the whole workplace an excellent environment for everyone to work towards common goals. There are several steps that must take place in order for OD to be beneficial: -First, the dynamics of the organization are studied and accurately described in a written document. -Next, a comprehensive strategic plan for problem solving should be carried out. -Finally, the necessary resources are obtained and the plan is put into place and carried out. These 3 comprehensive steps can be further broken down into the following: initial diagnosis, data collection/confrontation, action planning/problem solving, team building, intergroup development, evaluation and follow-up.

Define the term: management science.

The study of business decision-making using various analytical methods. There are several elements used in management science to help organizations make practical decisions: -Strategic planning: is based on an organization's goals and mission. -Influence diagrams: use mathematical representations and graphs to solve problems. -Problem Structuring: "soft-operations research." Management science may also be called operations research. Some experts consider operations research primarily academic in nature (focusing only on making operations more productive and efficient) while management science is regarding to be more related to the process of making business decisions that effect more than operations.

Discuss cognitive science: Cognitive flexibility developed by Rand J. Spiro, Paul J. Feltovich, and Richard L. Coulson

The theory of cognitive flexibility, focusing on the use of interactive technology, such as computerized programs, was developed by Rand J. Spiro and Richard L. Coulson. The theory recognizes the complexity and flexibility of learning and suggests that information must be presented in a variety of perspectives and that materials and presentations must be context specific. According to this theory, the primary factor in learning is the ability of the person to construct knowledge. Basic concepts include: •Providing multiple and varying presentations of content, including technological presentations (computerized) as well as input form instructors or experts, who can facilitate learning. •Avoiding oversimplification of content and ensuring that information relates to context (content?). •Building knowledge rather than transferring information. Learners must interact with the material, such as responding to questions or formulating hypotheses based on information presented, to construct their own conclusions. •Interconnecting instructional sources.

Discuss change theory: Theory of planned behavior developed by Icek Ajzen

The theory of planned behavior, developed by Icek Ajzen, evolved from the theory of reasoned action in 1985 when studies showed that behavioral intention does not necessarily result in action. The theory of planned behavior is more successful in predicting behavior. To the basic concepts of attitudes, subjective norms, and behavioral intentions encompassed by the earlier theory, Ajzen added the concept of perceived behavioral control, which relates to the individual's attitudes about self-efficacy kind outcomes. Ajzen's theory shows that beliefs are central: -behavioral beliefs lead to attitudes towards a behavioral of action. -normative beliefs lead to subjective norms. -control beliefs can lead to perceived behavioral control. All these beliefs interact to influence intention and action. Basically, this theory relates to the person's confidence, based on beliefs and social influence of others, that he or she can actually do an action and that the outcome of this action will be positive. This theory considers the power of emotions--such as apprehension or fear--when predicting behavior.

Discuss change theory: Theory of reasoned action developed by Martin Fishbein and Icek Ajzen

The theory of reasoned action, developed in 1975 by Martin Fishbein and Icek Ajzen, is based on the premise that the actions people take voluntarily can be predicted, according to their personal attitude toward the action and their perception of how others will view their doing the action. There are 3 basic concepts to the theory: 1. Attitudes: These are all of the attitudes about an action, and they may be weighted (i.e. some may be more important than others). 2. Subjective norms: People are influenced by those in their social realm (e.g., family, friends) and their attitudes toward particular actions. The influence may be weighted (e.g., the attitude of a spouse may carry more weight than the attitude of a neighbor). 3. Behavioral intention: The intention to take action is based on weighing attitudes and subjective norms (opinion of others), resulting in a choice to either take an action or avoid an action.

Outline the three levels of user authentication security.

There are three levels of user authentication security scaled to the amount of security offered (e.g., Level Three offers the most security): Level One: • Once and individual is logged into the system (using their name and password), their name appears on the screen and their access is tracked as they use the system. • Users are automatically logged out after some period of inactivity and must login again to continue using the system. • Must update their password (set to a specific level of complexity) on a regular basis (e.g.monthly). Level Two: • Encrypted key-based authentication. • User must present computer access card (CAC) to the system before they can log on. • Automatic log out if CAC is too far from the computer. Level Three: • Biometric authentication: Uses something unique to the individual such asP: fingerprint, retinal scan, or face recognition. Some newer laptops now come with a fingerprint scanner built in. • Cannot be lost or stolen.

Describe the role of chief information officer, chief privacy officer, and chief e-health officer.

There are three management level positions that deal with the function of an organization's information systems. Chief information officer: CIO is the head of the information services department. This individual is in charge of the hiring information systems staff, budgeting for maintenance of the system, and designing and implementing new systems as needed. Generally, the CIO holds a masters or doctorate degree in computer science. Chief privacy officer: CPO is a federally mandated position at any facility that treats patients. This individual is responsible for all forms of patient information. The title of CPO is generally bestowed on an employee already working for the organization rather than being an entirely separate job. Chief E-health officer: The e-health officer is a relatively new position created by the onset of interactive websites. Generally in charge of promoting and enabling the use of online interactive patient services.

Describe the Accredited Standards Committee and the Pharmacy Standards Association.

These organizations have created universal standards for healthcare computerized tasks in the United States. The goal is to create records that are more accurate, avoid duplication, and ensure communication between computer systems. • The Accredited Standards Committee (ASC) created the standards associated with administrative medical insurance tasks. The current version, X12N, is used nationwide. X12N helps with claims, enrollment, and determining insurance eligibility. • The National Council for Prescription Drug Programs (NCPDP) develops pharmacy standards for the U.S. Electronic claims processing under this standard was first introduced in 1992 and has gone on to make up nearly 100% of retail pharmacy claims being processed in real-time. Healthcare providers send EDI (electronic prescriptions) messages to the pharmacy directly. Another NCPCP set of standards, HL7, focuses on the communication of information within and between different healthcare facilities. Collaboration between X12N and HL7 has resulted in the EHR-S (electronic health record system) standards as a way to solidify all aspects of patient healthcare under a single system.

Describe the role of compliance officers, planning and recovery officers, and interface engineers.

Three information system support roles that are typically held by full-time employees in addition to working under their normal clinical role: Compliance officer: A compliance officer keeps track of state and federal regulations and accrediting requirements to make sure that the organization is in compliance. This job may be held by someone from the information systems department or one of the clinical staff members. Planning and recover officer: P & R officer must be sure that disaster plans are up to date and that they are integrated between departments. They must also be aware of what would be required to recover the full functionality of the information system in the event of a disaster. Interface engineer: The interface engineer should be an employee from the information system department who is capable of making sure that information integrity is maintained when data is exchanged between different systems.

Discuss how tokens contribute to user security.

Tokens are items used to authenticate a person's identity and allow access to a system. They commonly require the use of not only the token but also a personal identification number or username and password. Some devices, such as the SecureID token by RSA generate one-time passwords. Tokens maybe in the form of access cards, which may use different technologies: photos, optical-coding, electric circuits, and magnetic strips. They may also be contained in common objects, such as a key fob. Some tokens must be plugged directly into the computer. Different types of tokens include: -ID cards: These include driver's licenses and employee badges but provide very little security as they can easily be falsified or stolen. -Challenge-response tokens: These combine use of the token with user information, such as username and password. -Smart cards: These contain microchips with information that can be programmed to allow access, like a debit card. Typically, databases track who is accessing a system and the duration of access.

Describe the terms antivirus software and spyware

Two types of programs are essential to the security of today's computers: •Antivirus software: New computer viruses are being developed and detected all the time, making it necessary to have antivirus software that is completely updated. Many vendors of antivirus software allow the user to purchase updates for a small fee. These updates are generally downloaded from from the company's website using an internet connection. The software then should be scheduled to check for viruses on a regular basis (typically daily). •Spyware detection software: Spyware is a type of software that implants itself into a computer system and sends information back to its maker. Spyware is typically attached to many "free" software programs available for download on the internet. All computers connected to the internet are at risk to spyware. Therefore, updated spyware detection software should be run regularly to find and eradicate these programs.

Describe the unauthorized user and what threat they pose to system security.

While system access by an external hacker is a valid concern, the biggest security problem for health database systems is the unauthorized user. An unauthorized user is an employee of the company that has legitimate access to the database system, but access of information beyond what is needed for their job or task. This type of individual purposefully or inadvertently views data that they should not, creates a disruption in the availability of information, or corrupts the integrity of the stored data. Under HIPPA regulations, all healthcare facilities must guarantee patient information privacy under penalty of law. Because healthcare databases may be large and fragmented, it is sometimes difficult to restrict an employee's access to only those patients (or specific patient test results) to which they have a valid need to access.