C790 Nursing Informatics (WGU), Unit 8 taxonomies, Unit 1 & 2 Define Health Informatics and theoretical Foundations/models, Unit 3, Unit 4 system Development Life Cycle., Unit 5 Project Management, Unit 7. Standardized Taxonomies, Unit 8 Taxonomies,...

project management

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

abstraction

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

joint cognitive systems

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

UP Phases

inception, elaboration, construction, and transition

implementation (predictive)

includes programming and testing the system.

Use limitation

Organizations should use PII solely for the purposes specific in the notice. Sharing PII should be for a purpose compatible with the purpose for which the PII was collected.

Data quality and integrity

Organizations should, to the extent practicable, ensure that PII is accurate, relevant, timely, and complete.

1) Centralization

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

3) Formalization

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

standards development organizations (SDO) or standards-setting organizations (SSO)

Organizations that set standards based on three primary sources: (1) standards related to the technology used in health informatics, (2) standards related to healthcare in general, and (3) standards specific to health informatics.

5) Organizational Slack

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

chaos theory.

"The quantitative study of dynamic nonlinear systems "

Workflow

"a modular sequence of tasks, with a distinct beginning and end, performed for the specific purpose of delivering clinical care" Workflows are specified at up to four levels of detail: 1) clinical workflow, 2) phase, 3) task & action, and 4) sub -action.

American Telehealth Association

"promote professional, ethical and equitable improvement in healthcare delivery through telecommunications and information technology" through education, research, and communication.Mission-driven, nonprofit organization that seeks to incorporate telehealth seamlessly into healthcare so that it is not necessarily a separate program but integrated into healthcare delivery as a whole.

HUMAN FACTORS

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

Covered Entity

(1) healthcare providers such as hospitals, physicians, clinics, psychologists, dentists, nursing homes, and pharmacies if they transmit any information in an electronic format; (2) insurance companies, HMOs, and government plans that pay for healthcare; and (3) healthcare clearinghouses that process nonstandard health information they receive from another entity into a standard format or vice versa.

Knowledge Transformation

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

database management system

(DBMS)

metadata

(information describing the content)

OAT

(office of Advancement of Telehealth )

unfinished

*

project iteration schedule

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

retrospective

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

workaround

a method used to circumvent a problem without solving it

HL7

provides a framework and related standard for the exchange, sharing and retrieval of healthcare information across systems.

2013 HIPAA Omnibus Final Rule (Nelson 441) Nelson, Ramona, PhD, RN-BC, ANEF, FAAN and Staggers, PhD, RN, FAAN. Health Informatics: An Interprofessional Approach, 2nd Edition. Mosby, 022017. VitalBook file.

1. HIPAA Privacy, Security, and Enforcement Rules and HITECH Act. The final rule modifies the Privacy, Security, and Enforcement Rules. These modifications include the following: • Changes regarding business associates • Limitations on the use and disclosure of PHI for marketing and fundraising • Prohibition on the sale of PHI without authorization • Expanded rights to receive electronic copies of health information and to restrict disclosures to a health plan concerning treatment paid out of pocket in full • Requirement to modify and redistribute notice of privacy practices • Modified individual authorization and other requirements to facilitate research, disclose child immunization proof to schools, and access decedent information by family members/others 2. Enforcement Rule. Final rule adopts changes to the HIPAA Enforcement Rule to incorporate the increased and tiered civil money penalty structure provided by the HITECH Act. 3. Breach Notification Rule. Final rule adopts the Breach Notification for Unsecured PHI created under the HITECH Act and replaces the Breach Notification Rule's "harm" threshold with a more objective standard. 4. HIPAA Privacy Rule as It Relates to Genetic Information. Final rule modifies the HIPAA Privacy Rule as required by the Genetic Information Nondiscrimination Act (GINA) to increase privacy protections for genetic information by prohibiting most health plans from using or disclosing genetic information for underwriting purposes.

Steps in Planning a Database

1. List questions to be asked. 2. Determine fields needed to provide the answers and list them. 3. Study the fields to see what topics they represent. 4. Allocate the fields to tables based on the topic. 5. Identify primary key fields. 6. Determine the relationships between the tables. 7. Add foreign key fields where needed. 8. Designate the types of fields and allocate space for fields that will contain text. 9. Designate terminology for any look-up fields. a.Confer with users. b.Write a description of the terms. c.Get agreement from users for definitions and terms. 10. Plan the queries needed and ascertain if the structure supports the queries. Replan where necessary. 11. Plan the forms for data entry and ascertain if the structure supports the forms. a.Add notes for constructing the form. b.Make a sketch of the proposed form. c.Confer with those will enter the data. d.Replan where necessary. 12. Plan the reports and ascertain if the structure supports the forms. a.Add notes for constructing the report. b.Make a sketch of the reports. c.Confer with those who will enter the data. d.Replan where necessary. 13. Design views for the data—both screen (forms) and paper (reports)—and ascertain if the structure supports the queries. Replan where necessary. 14. Study the entire plan to be certain that it is valid

Ten Commandments for Effective CDS

1. Speed is everything. 2. Anticipate needs and deliver in real time. 3. Fit into the user's workflow. 4. Little things can make a big difference. 5. Recognize that physicians will strongly resist stopping. 6. Changing direction is easier than stopping. 7. Simple interventions work best. 8. Ask for additional information only when you really need it. 9. Monitor impact, get feedback, and respond. 10. Manage and maintain your knowledge-based systems.

Information Storage and Retrieval: Tools, Elements and Theories

1963: The first textbook that treated information science as a discrete discipline was published

Expert system

A computer system that uses knowledge and a set of rules or procedures to interpret data and information and make decisions. Such a system differs from a decision support system in that the final decision is made by the computer as opposed to the provider. This term has also been used to refer to a type of clinical decision support system that provides diagnostic or therapeutic advice in a manner consistent with a clinical domain expert.go beyond decision support and actually automate the decision-making process.

flat database

A database consisting of a single table

Six Sigma

A disciplined, data-driven approach for eliminating defects (driving toward six standard deviations toward the mean and the nearest specification limit) in any process from manufacturing to transactional and product to service.

Root cause and degree of impact

A downtime risk assessment will be developed based on which of the following?

Task analysis

A generic term for a set of more than 100 techniques that range from a focus on cognitive tasks and processes (called cognitive task analysis) to observable user interactions with an application (e.g., a systematic mapping of team interactions during a patient code). Used to understand what users are doing or required to do with a health IT product. They focus on tasks and behavioral actions of the users interacting with products. Helpful to identify task completeness, the correct or incorrect sequencing of tasks (especially their fit to cognitive tasks), accuracy of actions, error recovery, and task allocation between humans and products. Task analysis is typically used early in the systems life cycle to determine user requirements for design or to determine redesign when rich data are needed. This technique may be used to analyze areas for redesign.

Bayesian knowledge base

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

Safegaurds

A nurse working in a healthcare facility forgets to lock her computer after accessing a patient's personal health information, allowing an unauthorized user access to the file. Which fair information principle is being violated in this case?

Personal Representative.

A person with authority under state law to make healthcare decisions for the individual.

Defining success factors

A strategy for successful management of the implementation of a healthcare information system is to have baseline metrics. This project management activity aligns with which of the following project management implementation steps?

database

A structured collection of data elements, associated data values, and data relationships stored on computer-readable media

task & action

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

triggers, input data, interventions, and action steps

A taxonomy developed by the NQF is composed of four functional categories:

report

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

form

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

Mind Mapping

A visual way to capture ideas and how they relate to one another.

Five rights of CDS

A. Right information B. Right person C. Right CDS intervention format D. Right channel E. Right point in workflow

ADT Testing

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

(1) the Nursing Minimum Data Set (NMDS) as a framework for collecting nursing care data, and (2) the Nursing Management Minimum Data Set (NMMDS) as a framework for collecting nursing service data elements.

ANA also recognizes two minimum datasets

Authenticity

Able to be verified and trusted; confidence in the validity of a transmission, a message, or message originator.

AHRQ

Agency for Healthcare Research and Quality

HITECH act

American Recovery and Reinvestment act created the __________________________ so each person in the United States would have a certified digital medical record by 2014, including the electronic exchange of health information across healthcare institutions to improve quality of healthcare.

ATA

American Telehealth association

System Vision Document

An effective way to define the problem is to use a ___________________________

Systems Life Cycle SLC

Analyze: The existing environment and systems are evaluated. Major problems and deficiencies are identified using informal or formal methods. A needs assessment is developed. Gaps are noted and current capabilities and limitations are outlined. Initial user and system requirements are formulated. •Plan: The proposed system is planned comprehensively. Planning includes strategic levels, such as whether the system will be developed internally, purchased and tailored, or designed and developed jointly with a vendor. •Develop or purchase: At this stage either the system is purchased or the new system development begins. New components and programs are obtained and installed. For vendor-supported solutions, extensive tailoring occurs. •Test: At this stage extensive testing occurs just before Stage 5 and "go" or "no go" decisions are made about deadlines. Toward the end of this phase, marketing and communication efforts are accelerated to make users aware of the impending change. •Implement or go-live: The system is implemented using a selected method best suited to the organization and its tolerance for risk. User training is completed. •Maintain and evolve: Once the system has been formally acknowledged as passing user acceptance testing, typically at 90 or 120 days after go-live, it enters a maintenance phase. •Evaluate: Activities in each phase are assessed for their quality and effectiveness.

Cybersecurity Framework

Best practices, industry standards, and guidelines are organized and presented. These are organized into five functions: Identify, Protect, Detect, Respond, and Recover. Each function is further organized into subcategories and aligned with Informative References.

chaos theory

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

complexity theory

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

CDS

CDS can support several aspects of patient care decision making such as the following: • Reminding about a specific care need (e.g., patient due for an immunization). • Alerting about a specific care action that may impose risk to the patient (e.g., a drug interaction). • Providing intelligent views of a patient's record that help cultivate a better understanding of the patient's status (e.g., intensive care reports, chronic disease management dashboards). • Providing tools that assist in implementing and documenting decisions more efficiently and accurately (e.g., documentation tools, order sets, medication reconciliation tools). • Providing clinicians and patients with seamless access to patient-specific reference information available in online knowledge resources. • Providing access to information about similar patients in the population along with their treatments and outcomes. • Integrating information from nontraditional sources into the clinical workflow, such as patient self-reported outcomes, vital signs collected via wearable sensors, and patient dietary information, as well as relevant data about the patient's environment, such as air pollution and infectious disease rates. • Applying advanced analytics to estimate risks for a specific individual, such as risk for hospital readmissions,

Order Facilitators

CPOE

Usability

Can include the following dimensions: Speed and errors in interactions with a health IT product .Ease of learning and remembering interactions after time has elapsed. User satisfaction or perceptions about the interactions with health IT • Efficiency and accuracy of interactions. Designs to promote error-free or error-forgiving products . Seamless fit of an information system to the tasks and goals of users

five internal organizational characteristics

Centralization Complexity Formalization Interconnectedness Organizational slack

Certified EHR

Certified EHR by the Office of National Coordinator for Health Information Technology (ONC)

Reverberation.

Change within any part of the system will be reflected across the total system.

Chaordic

Chaos and order

CDS

Clinical Decision Support

Data

Comes in the form of numbers, words, discrete facts about objective reality. Can be verified.

CER

Comparative effectiveness Research

ten key principles relevant to successful clinical systems integration.

Comprehensive Services across the Continuum of Care, Patient Focus, Geographic Coverage and Rostering, Standardized Care Delivery through Interprofessional Teams, Performance Management, Information Systems, Organizational Culture and Leadership, Physician Integration, Governance Structure, and Financial Management

NMDS nursing minimum data set

Comprised of 16 items of nursing care, demographics, and organization identifiers

Identify the problem

Core Process one

False

Cost management is easy to predict in Agile projects. True or False

CDS Repositories

Create tags based on the taxonomy to enable workflow-related organization and searches

Integrity

Data or information have not been altered or destroyed in an unauthorized manner.

Availability

Data or information is accessible and useable on demand by an authorized person.

Confidentiality

Data or information is not made available or disclosed to unauthorized persons or processes.

Agile Scope management

Defining and controlling the functions that are to be included in the system as well as the scope of the work to be done by the project team. The scope isn't well understood and that there will be many changes, updates, and refinements to the requirements as the project progresses

• Documentation of clinical detail over time (problems, interventions, outcomes) • Structuring data entry (with flexibility of expression—novice to expert) • Retrieval of coded data using multiple attributes and at different levels of specificity than originally coded • Decision support (common links to clinical knowledge bases) • Shared understanding across the continuum of care (different clinicians, different sites of care, different languages, different systems) • Identifying and monitoring health needs and outcomes by pooling data from multiple sources • Auditing the quality of service and benchmarking • Supporting research activities • Enabling reporting of externally-specified health statistics—both clinical and educational • Identifying individuals in need of proactive intervention

Describe five reasons why using a standardized terminology is important.

• Enhance health care experiences for individuals • Expand knowledge about disease and appropriate treatments • Strengthen understanding about the effectiveness and efficiency of our health care systems • Generate quality metrics Support public health and security goals • Support public health and security goals • Aid businesses in meeting the needs of their customers

Describe the need for secondary use of data or data repurposed. Secondary use of health data can

PNDS Perioperative nursing Data Set

Developed by the AORN, crossmapped with snowmed, and used in peri-operative settings for patients from preadmission until d/c. It captures nursing diagnoses, interventions and outcomes.

Patient records contain words, terms, and concepts that are used in a variety of ways. A word is a unit of language, while a term is a linguistic label used to represent a particular concept. A concept is defined as a construct representing the unique meaning for one or multiple terms. For example, sudden pain in lower back is composed of five words, and the term sudden pain is identical to the term acute onset pain, consisting of three words. In this case, both terms can be denoted with the concept acute pain. Also, the concept pressure ulcer can be represented with diverse terms such as bedsore, decubitus, pressure sore, decubitus ulcer, and pressure ulcer. These examples indicate that various expressions (including abbreviations) used with identical meanings can be characterized using a representative concept in patient records

Differentiate between terms and concepts.

The communication-information model

provides an excellent framework for analyzing the effectiveness and efficiency of information transfer and communication.

Transition

During this phase, one or more final iterations involve the final user acceptance and beta tests, and the system is made ready for operation. After the system is in operation, it will need to be supported and maintained.

True

Employing usability processes in health information technology helps to improve individual and organizational productivity and efficiency, therefore contributing to improved patient, clinician, and organizational outcomes. (True or False)

Diffusion of innovation

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

XP

Everyone owns the code

Peripherals

Examples are printers, magnetic tape devices, computer terminals, scanners, and projectors.

PMI

Name a professional organization that promotes project management worldwide with a well-respected and rigorous certification program, and many corporations encourage their project managers to become certified.

Dominant Vendors

Examples of this process for establishing standards are demonstrated by both the Microsoft and Apple operating systems. Today several companies unrelated to either Microsoft or Apple have designed their applications to run on top of one or both of these operating systems. While there are other computer operating systems, the vast majority of applications for personal computing use one or both of these operating systems.

Exceptions • PHI that is not part of a designated record set because the information is not used to make decisions about individuals. This includes records that are used for business decisions more generally rather than to make decisions about individuals such as quality assessment data. • Psychotherapy notes, which are the personal notes of a mental healthcare provider documenting or analyzing the contents of a counseling session that are maintained separate from the rest of the patient's medical record. • PHI is in a designated record set that is part of a research study that includes treatment that is still in progress, provided the individual agreed to the temporary suspension of access when consenting to participate in the research.

Exceptions to HIPAA rule

▪ Reporting the project's status and progress ▪ Working directly with the client (the project's sponsor) and other stakeholders ▪ Identifying resource needs and obtaining resources

Externally, the project manager is the main contact for the project. He or she must represent the team to the outside world and communicate the team members' needs. What are some Major external responsibilities of the PM?

XP

Extreme Programming

Promoting Action on Research Implementation in Health Services (PARiHS) Vratny and Shriver Model for Evidence-Based Practice Pettigrew and Whipp Model of Strategic Change Outcomes-Focused Knowledge Translation Determinants of Effective Implementation of Complex Innovations in Organizations Ottawa Model of Research Use

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

1.Accountability and auditing 2. Security 3 Data quality and integrity 4. Use Limitation 5. Data Minimization 6. Purpose specification 7. Individual participation 8. Transparency

Fair Information Practice Principles

FHIR

Fast Healthcare Interoperability Resources an HL7 standard

SLC Stages

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

atomic-level data

Fields in a database contain_________________, or the smallest recognizable entity necessary to obtain meaning. To keep data at the atomic level, three fields are used to collect a name—first name, middle initial, and last name—a

HIPAA

First federal U.S. legislation to broadly address the privacy and security of health data. This act set a standard in the United States for protecting an individual's health information, although other countries already had such laws. It began in 1996. with subsequent revisions and effective dates:

De Dombal Computer-Aided Diagnosis of Acute Abdominal Pain

First study to compare CDS with clinician performance

HCI frameworks and models

Fit Between Individuals, Task, and Technology (FITT), with the elements connected by interactions and influences49 • User, Function, Representation, and Task Analyses (UFuRT, or TURF). System knowledge is distributed across multiple users who have differences in expertise and cognitive characteristics. It includes a task analysis portion to describe steps in tasks and interactions.58 More recently, this framework was renamed TURF.59 • A framework for employing usability methods to redesign a fielded system54 • A framework for technology-induced error51 • A combined health IT adoption and HCI model52 • Joint cognitive systems53 • Systems Engineering Initiative for Patient Safety (SEIPS) 2.0, which incorporates human factors concepts of configuration, engagement, and adaptation, a model at a higher level of abstraction for systems

NIC Nursing Intervention Classification

Focus on nursing interventions-physiological, psychosocial and health promotion interventions.

Scrum

Focuses primarily on the team level. It is a type of social engineering that emphasizes individuals more than processes and describes how teams of developers can work together to build software in a series of short mini-projects. Key to this philosophy is the complete control a team exerts over its own organization and its work processes. Software is developed incrementally, and controls are imposed empirically—by focusing on things that can be accomplished.

planned and organized.

For a system development project to be successful, it must be ________________

data manipulation.

Forms and reports are based on the results of ______________

the Common Security Framework (CSF)

Framework developed by the Health Information Trust Alliance (HITRUST) provides a proven approach to risk management and regulatory compliance. Through the HITRUST CSF Assurance Program, healthcare organizations may perform internal assessments of their privacy and security practices or contract with a third-party assessor to achieve CSF certification.

project-planning model,

Gantt chart or net present value (NPV), represent the system development project itself, highlighting its tasks and other considerations.

the safe harbor method and the expert determination method,

HIPAA Omnibus Rule for De-identification of data used in Marketing or research

confidentiality, integrity, and availability (CIA) of PHI.

HIPAA safeguards ensures _________

• Information Security Management Program • Access Control • Human Resources Security • Risk Management • Security Policy • Organization of Information Security • Compliance • Asset Management • Physical and Environmental Security • Communications and Operations Management • Information Systems Acquisition, Development and Maintenance • Information Security Incident Management • Business Continuity Management

HITRUST CSF Control Categories

Healthy People 2010.

Health literacy is "the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions

Health Insurance Portability and Accountability Act (HIPAA) in 1996 and subsequent rules on privacy and security (2000) • CMS Security Standard • Confidentiality of Alcohol and Drug Abuse Patient Records • The Privacy Act of 1974 • Family Educational Rights and Privacy Act (FERPA) • Gramm-Leach-Bliley Act CMS, Centers for Medicare and Medicaid Services.

Healthcare-Related Privacy and Security Laws and Regulationsa •

a quaternary sort

If the alphabetizing of last names within each zip code were required, a _________________ would be performed.

The National Library of Medicine (NLM)

In 1972 began training physicians and other health scientists in the use of computer technology for medical education and the provision of healthcare. This was the beginning of its informatics training programs.Played a major role in the development of the health informatics specialty.

Blum Model

In his analysis he identified three types of healthcare computing applications. Blum grouped applications according to the objects they processed. The three types of objects he identified are data, information, and knowledge. Blum defined data as uninterpreted elements such as a person's name, weight, or age. Information was defined as a collection of data that have been processed and then displayed as information such as weight over time. Knowledge results when data and information are identified and the relationships between the data and information are formalized. A knowledge base is more than the sum of the data and information pieces in that knowledge base. A knowledge base includes the interrelationships between the data and information within the knowledge base.

International Medical Informatics Association

In informatics, sample business ethics are codified by the _____________________

True

In order to meet the requirements for Stage 1 (data capture and sharing) of meaningful use, an EHR system must demonstrate the use of standardized terminologies and interoperability. (True or False)

project initiation (predictive)

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

1) the actual content of the decision support module, or 2) the presentation of the information on the computer screen.

In the article "Some Unintended Consequences of Clinical Decision Support Systems" the researchers found that unintended consequences were generated in what two main areas?

Benefits of Improving user experience

Increased Individual Effectiveness 1. Increased user productivity and efficiency 2. Decreased user errors and increased safety 3. Improved cognitive support 4. Increased Organizational Efficiencies 5. Decreased Maintenance Costs 6. Decreased Customer and Individual Training and Support Costs 7. Decreased Development Time and Costs

integrated testing

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

The mere selling or providing of software to a covered entity does not give rise to a business associate relationship if the vendor does not have access to the protected health information of the covered entity. If the vendor does need access to the protected health information of the covered entity in order to provide its service, the vendor would be a business associate of the covered entity.

Is a software vendor a business associate or a covered entity?

HCAHPS

It is a standard, 27-item survey of patient experience that measures level of satisfaction and perspectives of inpatient hospital care along six axes: communication with nurses and doctors; pain control; timeliness of care; discharge instructions; hospital cleanliness; and treatment with courtesy and respect

population- or unit-based data

It is important to note that HCAHPS provides__________________ , not patient-level data.

Agile risk management

Iterative projects address risks first.

Ceremony

Level of formality. The measure of the amount of documentation generated, the traceability of specifications, and the formality of the project's decision-making processes.

RX NORM

Managed by the national Library of medicine and is used to record and process drug information. Contains prescription and OTC drugs. Does not contain non-therapeutic radio pharmaceuticals, bulk powders, contrast media, food and dietary supplements

cost/benefit analysis.

Many organizations like to compare the estimated costs with the anticipated benefits to calculate whether the benefits outweigh the costs.

Iterative design

Means having rounds of design and having key users evaluate product prototypes to determine their effectiveness and efficiency in the care process and health decisions. One design is never adequate, and typically at least three rounds are necessary. Once a design is available, even on paper or in PowerPoint, designers or informaticians work with users to determine any issues by having them systematically interact with and respond to the design.

UP, XP, Scrum

Name Three Methodologies

medication dosing support, order facilitators, point-of-care alerts and reminders, relevant information display, expert systems, and workflow support.

Name several types of clinical decision support types.

Nelson Model

Nelson extended the Blum and Graves and Corcoran data-to-knowledge continuum by including wisdom. data, information, knowledge, wisdom computerized decision making, healthcare applications decision support electronic expert system

NANDA

Nursing diagnosis, definitions and classifications used in nursing practice across all care settings.

Comparison test

Of four different usability tests, which has the objective of determining which application, design, or product is more effective, efficient, and/or satisfying and can be completed anytime in the systems life cycle?

validation test

Of four different usability tests, which will interact with users to determine if 80% of the users can retrieve the correct lab results within 10 seconds of interacting with the system and if users can complete admission orders for a patient with no errors?

5) Maintenance and Evaluation

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

Open System (Systems Theory)

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

tertiary sort.

Ordering the records so that those with the same zip code in each city were next to one another would be a _____________________________.

2) Complexity

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

4) Interconnectedness

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

Accountability and auditing

Organizations should be accountable for complying with these principles, providing training to all employees and contractors who use PII and auditing the actual use of PII to demonstrate compliance with these principles and all applicable privacy protection requirements.

Transparency

Organizations should be transparent and notify individuals regarding collection, use, dissemination, and maintenance of personally identifiable information (PII).

Individual participation

Organizations should involve the individual in the process of using PII and, to the extent practicable, seek individual consent for the collection, use, dissemination, and maintenance of PII. Organizations should also provide mechanisms for appropriate access, correction, and redress regarding use of PII.

Data minimization

Organizations should only collect PII that is directly relevant and necessary to accomplish the specified purpose(s) and only retain PII for as long as is necessary to fulfill the specified purpose(s).

Security

Organizations should protect PII in all media through appropriate security safeguards against risks such as loss, unauthorized access or use, destruction, modification, or unintended or inappropriate disclosure.

Purpose specification

Organizations should specifically articulate the authority that permits the collection of PII and specifically articulate the purposes for which PII is intended to be used.

user experience (UX)

Person's perceptions and responses that result from the use or anticipated use of a product, system or service." A seamless merging must occur from the talents of multiple disciplines, such as engineering, graphic and industrial design, interface design, psychology, and domain experts

phase

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

Core Process 2

Plan and monitor the project

PMBOK

Project Management BODY of Knowledge

Agile Project Time Management.

Project Time Management. Creating a detailed schedule of all project tasks and then monitoring the progress of the project against defined milestones. Small work projects, in which the tasks are performed at nearly the same time (i.e., within one iteration), will a meaningful schedule be developed. The project team, not the project manager or team leader, will schedule its own work. Each iteration is usually planned as the first task within the iteration. The tasks are identified, estimates of the effort are developed, and work is assigned by the project team members.

True

Project risk and feasibility analysis verifies whether a project can be started and completed successfully. True or False

ANSI American National Standards Institute

Promotes the use of standards internationally.

Safeguard

Protective measures prescribed to meet the security requirements (i.e., confidentiality, integrity, and availability) specified for an information system. May include security features, management constraints, personnel security, and security of physical structures, areas, and devices. Synonymous with security controls and countermeasures.

Health Level Seven (HL7) International

Provides a framework and related standards for the exchange, integration, sharing, and retrieval of electronic health information that supports clinical practice, and management, delivery, and evaluation of health services.

• Application of privacy provisions and penalties to business associates of covered entities • Application of security provisions and penalties to business associates of covered entities; annual guidance on security provisions • Notification in the case of breach • Education on health information privacy • Limitations on certain contacts as part of healthcare operations • Breach notification requirement for vendors of personal health records and other non-HIPAA covered entities • Expanded use of business associate contracts • Application of wrongful disclosures criminal penalties • Required audits

Provisions of HIPAA Expanded by the HITECH Act

QI

Quality Improvement

True

Question : Nursing informatics is a discipline-specific informatics practice within the broader category of health informatics? (True or False)

sociotechnical system

Question : The complex interactions among multiple users, products, and environments with varying characteristics in health information technology is referred to as which of the following:

CDS Implementers

Refer to the taxonomy when developing maps of the workflows and can use the terms to improve communication with their CDS vendor

SNOWMED CT

Reference terminology with a broad coverage of medical and healthcare concepts and crossmapped to a number of nurse terminologies. US standard and adopted by US Govt. NLM distributes free to anyone in us.

Privacy

Restricting access to subscriber or relying party information in accordance with federal law and agency policy.

UMLS Unified Medical Language System

Service of the US national library of medicine at the NIH to map different terminologies so info can be shared.

False. XP conforms to the principles of Agile modeling by avoiding the "Big Design Up Front" approach. Instead, it views design as so important that it should be done continually, although in small chunks. As with everything else, the design must be verified immediately by reviewing it along with coding and testing.

Simple Designs Opponents say that XP neglects design, True or False?

Think-aloud protocol

Small number of actual application users (vs. experts). Users talk aloud while they interact with a product and observers record their experienced usability problems. As users voice what they are trying to do, they indicate where interactions are confusing and provide other thoughts about the product. This allows a detailed examination of the specified tasks, in particular to uncover major effectiveness issues. This method may be used in the design, redesign, development, or evaluation of applications at any time in the systems life cycle.

finishing on time, finishing within budget, and effectively meeting the need as expressed by the original problem definition.

Software development success is often measured using three criteria:

STEEEP principles

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

Relational database model

The database consists of several tables. A unique field within the tables is used to combine or join the tables.need to know only the name of a table in order to locate data.

collection of data

The database is the

desired health outcomes

The desired short- and long-term health status, functional status, and well-being of individuals resulting from an intervention by a health professional

reliability, robustness, efficiency, and fitness for purpose.

The end result of a system development project is to produce a high-quality information system as measured by _______________________

1) Feasibility and analysis (SLC)

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

over the telephone.

The first documented report of healthcare delivery at a distance was conducted 1897 ___________________

primary sort.

The first sort, by state, would be a _________________

• To represent and educate broad public sector health and health services research interests on privacy and security issues • To focus on priorities related to privacy, security, and data standardization • To balance the need for individual privacy, confidentiality, and security with the need for use of data for public health and research activities

The goals of Public Health Data Standards Consortium are ____________

anatomy of a database

consists of fields, records, and tables Tables are the basic building blocks of a relational database.

Designated Record Sets.

The group of records maintained by the covered entity and/or business associate used to make decisions about the diagnosis, management, and treatment of the patient. This includes medical records, billing records, enrollment, payment, claims adjudication, and any other records used to make decisions about the patient.

system development methodology

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

Nursing Informatics

The integration of health data, computer science, nursing science, and information science to communicate and manage information, data, knowledge, and wisdom in with in the nursing realm is known as:

Prose literacy:

The knowledge and skills needed to search, comprehend, and use continuous texts such as editorials, news stories, brochures, and instructional materials.

field name

The label at the head of a column is called a___________________. There are usually several fields in a table, each one containing a piece of data relating to the entity.

waterfall model,

The most predictive SDLC approach (i.e., farthest to the left on the predictive/adaptive scale) is called the ____________________ with the phases of the project flowing down, one after another.Phases completed sequentially with no overlaps

Work Breakdown Structure (WBS)

the list or hierarchy of activities and tasks of a project; used to estimate the work to be done and to create a detailed work schedule

convert data into meaningful information.

the main goal of data mining is to ______________

3) Develop or Purchase (SLC)

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

4) Implementation (SLC)

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

Project Risk Analysis

The objective of this activity is to identify and assess the potential risks to project success and to take steps to eliminate or at least ameliorate these risks. They should be identified during the project approval process so all stakeholders are aware of the potential for failure.

fields

a vertical column in a database. It contains data that represent the same characteristic, or entity, for all of the records. For example, a column labeled "First Name" would include the first name of each individual. atomic level data

Literacy

ability to identify, understand, interpret, create, communicate, and compute, using printed and written materials associated with varying contexts.

National Database of Nursing Quality Indicators TM (NDNQI)

This database collects nurse-sensitive and unit-specific indicators from health care organizations, compares this data with organizations of similar size having similar units, and sends the comparison findings back to the participating organization. This activity facilitates longitudinal benchmarking as the database has been ongoing since the early 1990's

Agile

able to change directions rapidly, even in the middle of a project.

True

True or False. Meaningful use requires that an eligible professional or entity must use certified EHRs "meaningfully" to obtain Medicare payments. This task contains the radio buttons and checkboxes for options.

False, 13000

True or False. The ICD-9-CM system had 43,000 codes to define diagnoses and procedures.

true

True or False: CDS that is intelligently-filtered to reach the right person at the right point in the workflow leads to more successful implementations and improves healthcare quality more that CDS tools that do not account for workflow

True

True or False: Failing to organize usually causes wasted time and effort as well as confusion and may even cause the project to fail.

True

True or False: Increased usage brings increased risk for data breaches. The increase in the number of users, types of use, and volumes of health IT-based data is directly proportional to the increased opportunities for privacy and confidentiality breaches.

True

True or False: One of the major challenges of Agile project management is how best to balance the flexibility and chaos of an Agile team with the order and control needed for a project. More than anything else, Agile project management is a way of balancing these two conflicting requirements: how to be agile and flexible while maintaining control of the project schedule, budget, and deliverables.

True

True or False: Overuse of CDS - particularly presenting too many alerts and other interventions that force the clinician to take time out from other work tasks - is one of the most common causes of CDS failure, either by causing user dissatisfaction that leads to de-implementation, or by causing providers to ignore or bypass both the excess and the important alerts.

True

True or False: The ICD-10-CM codes have three to seven characters in which the first and third characters are always alpha characters, the second character is always numeric, and characters four through seven are either alpha or numeric.ICD-10-CM version contains over 68,000 diagnostics codes, which allows for a more detailed definition and better reporting for reimbursement and biosurveillance.

True

True or false. In a relational DBMS there is a separation between the data storage and the manipulation methods. This separation of data and methods for manipulating those data add to the complexity of the database. This is especially true with large databases.

True

True or false? Incongruent descriptions of patient care contribute to poor quality care and hinder the Meaningful Use of EHRs.

Reverberation

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

1. ethical principles such as autonomy, equality and justice, beneficence, nonmalfeasance, impossibility, and integrity as applied to informatics 2. The second section concerns the rules of ethical conduct for health informatics professionals.

What are the two major sections of the IMIA code of ethics?

Terminology harmonization

is regarded as one way to support interoperability, considering variations in terminology adoption in practice.

orting the data and querying the data.

What are the two overall types of data manipulation in a database: They are dependent on the structure of the data and the entries in the fields.

(1) best of breed and (2) monolithic or fully integrated EHR. T

What are two approaches to implementing an EHR:

Systems theory and Chaos Theory

What are two major theories that help us analyze and explain the occurrences or instances of certain phenomena with health informatics?

to understand what you are building and to communicate important aspects of the solution system

What are two reasons to build models?

Net Present Value

What do companies use to measure the overall benefits of the project?

Meaningful Use

What is MU

Handling product to achieve specified goals with effectiveness, efficiency, and satisfaction in a specified context and avoidance of risks or problems

What is an example of usability achieving patient safety with privacy, security and technology?

▪ The estimated time for project completion ▪ The estimated cost for the project and system ▪ The anticipated benefits from the deployment of the new system

What is needed for project approval?

data standardization and data exchange

What is needed to make EHRs optimally beneficial, to facilitate clear, concise communication as well as the collection and aggregation of healthcare data across settings.

Personal privacy involves access to one's person, and information privacy involves access to health data about one's person.

What is the difference between personal privacy and information privacy?

Meaningful use and incentives, HITECH act

What is the federal legislation that authorized the federal government to provide reimbursement incentives for hospitals and eligible providers who take steps to become "meaningful users" of certified EHR technology to improve care quality and better manage costs?

To bring order to the tasks

What is the purpose of Project planning or project management?

Determine the organizational risks and feasibility. ▪ Evaluate the technological risks and feasibility. ▪ Assess the resource risks and feasibility. ▪ Identify the schedule risks and feasibility.

What tasks are assigned to determine project feasibility?

discovery research, evidence summary, translation to guidelines, practice integration, and evaluation of process and outcome

Which activities represent the five points of the ACE star?

Accuracy and completeness of health information

Which definition most accurately describes data integrity?

Computers, information, and health sciences

Which foundational science contributes systematic and logical approaches, processes, and procedures for understanding phenomena and solving problems to the study of informatics?

Mathematics

Which foundational science contributes systematic and logical approaches, processes, and procedures for understanding phenomena and solving problems to the study of informatics?

The Unified Process (UP)

________________________ is an object-oriented system development methodology originally offered by Rational Software, which is now part of IBM. Defines a complete methodology that uses UML for system models and describes a new, adaptive system development life cycle. The term development process is synonymous with development methodology. Iterative approach

cognitive systems engineering

sociotechnical systems, or complex technologies embedded within social systems, are increasingly prevalent

HIT enabled e-indicators

Which of the following describes innovative measures that would not generally be possible outside of the HIT context? Example: Meaningful use measures such as the percent of unique patients in a given practice who are provided online access to their health information (i.e., laboratory test results) within 4 business days after the information is available to the provider. This task contains the radio buttons and checkboxes for options. The shortcut keys to perform this task are A to H and alt+1 to alt+9.

HIT system management e-indicators

Which of the following describes measures needed to implement, manage, evaluate, and generally improve HIT systems, and are primarily intended for use by the parent organization to improve local systems? Example: Percentage of providers who override medication safety alerts in the electronic healthcare record (EHR).

E-iatrogenesis e-indicators

Which of the following describes measures of patient harm caused at least in part by the application of health information technology? Example: Percentage of patients who received an incorrect intervention due to an error in the clinical decision support provided by the EHR. This task contains the radio buttons and checkboxes for options.

Cybersecurity Framework

consists of three parts that work together to manage cybersecurity risk. The first part, Framework Core, includes activities, desired outcomes, and references common across multiple industries.

Translational E indicators

Which of the following describes measures that have been translated from existing ("traditional") measurement sets for use in HIT platforms? Example: Healthcare Effectiveness Data and Information Set (HEDIS) or NQF standard measures.

HIT facilitated e-indicators

Which of the following describes measures that, while not conceptually limited to HIT-derived data sources, would not be operationally feasible in settings without HIT platforms? Example: Population health measures such as body mass index (BM) for 100% of patients.

Database model

Which of the following models is used to structure the data in a database?

Professional organizations and their conferences Health informatics books and journals University-level education and certification programs

Which three activities helped define health informatics?

Client, Oversight Committee and Users

Who are the people who are not part of the project team that the project manager must interact with?

Users

Who are the people who will actually use the new system.

Client

Who pays for the development of the new system, gives funds and project approval. This role may be an executive committee or a vice president.

-Changing Government Regulations -Best Practices: Incorporating Evidence-Based Content and Clinical Decision Support Systems -Patient Safety and Improved Quality of Care

Why change to an EHR?

ARRA-related Meaningful Use testing

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

Dominant vendors.

With this process, the standard becomes the de facto established standard due to market dominance of the vendor.

Steering or Oversight committee

Works with large, mission-critical projects. This consists of clients and other key executives who have a vision of the organization's strategic direction and a strong interest in the project's success.

excel spreadsheet

Worksheet or spreadsheet with 2d rows and columns

Sychronous or Asynchronous

Telehealth services can be delivered using two overarching types of technologies:

Integrated system

The "Best of Breed" approach involves reviewing several vendors for their best module or application that can be customized and enhanced quickly but requires interfaces between multiple modules purchased from different vendors to create a full suite of functions.

the software

The DBMS is .

clinical practice guidelines (CPGs)

The IOM defines clinical guidelines as "systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances.

secondary sort

Sorting by the cities within the states would be a __________________.

HITECH ACT

Specific new requirements were outlined in 2009 for notifying individuals, the media, and the HHS. Any individuals affected by a breach must be notified about the details of the breach within a specific time frame. When a breach affects more than 500 residents of a state or jurisdiction, the covered entity or business associate is required to provide notice to prominent media in addition to notifying the affected individuals. For 500 or more individuals, the secretary of the HHS also must be notified.

SSO

Standard Setting Organizations

1. Dominant vendors. 2. Official SSO.

Standards are established primarily through one of two different processes:

x12N

Standards for those exchanges related to health insurance. Developed by the ASC Accredited Standards committee.

wildcard

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

Usability Questionnaires

System Usability Scale (SUS)- industry standard, 10-scale Questionnaire for User Interaction Satisfaction (QUIS)-computer system or application assessed Purdue Usability Testing Questionnaire-100 open ended questions Software Usability Measurement Inventory (SUMI)-

SDLC

Systems Development Life Cycle

Extreme Progamming

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

clinical or nonclinical.

Telehealth services can be classified as______________

National Library of Medicine (NLM)

The UMLS Metathesaurus is distributed by the_______________ every 6 months and includes more than 3.2 million concepts and 13 million unique concept names

True

The Unified Process, is formal, with high ceremony. Each iteration is precisely defined, with such specific outcomes as specifications, diagrams, prototypes, and deliverables. True or False

Elaboration Phase

The aspects of the system that pose the greatest risk are identified and implemented first. Until developers know exactly how the highest-risk aspects of the project will work out, they can't determine the amount of effort required to complete the project. Identify more realistic estimates for the project's cost and schedule, and the business case for the project can be confirmed. design, implementation, and testing of key parts of the system are completed. do the necessary research and fact-finding so all the user requirements are identified. A high percentage of time is spent on understanding and analysis.

Provide decision support automatically as part of clinician workflow Deliver decision support at the time and location of decision making Provide actionable recommendations Use a computer to generate the decision support

The authors identified four features of CDSS that improve clinical practice. What are they?

relational database

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

Scrum

The basic work process is called a sprint, and all other practices are focused on supporting a sprint.

clinical decision support (CDS) systems.

The central goals of leveraging IT in medicine have been to help clinicians in their decision-making process to prevent errors, to maximize efficiency, to enable evidence-based care, and ultimately to improve health and healthcare. Over time, tools that support the clinical decision-making process have been generally designated as ___________________

human factors

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

Encryption

The component of information security that converts data into a form, called a ciphertext, which cannot be easily understood by unauthorized people is an example of:

the hardware used to run the DBMS

The computer is

True

The primary reasons projects fail are a lack of executive involvement and a lack of management skills. The other major reason is lack of involvement by the user community. True or False

querying, query

The process of selecting desired records is called ____________________________ and the feature that permits this is a _____________________

querying

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

2) Planning (SLC)

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

False the purpose is more than just to implement an EHR, it's also to leverage the technology to improve quality, safety, and efficiency in patient care.

The purpose of meaningful use is to promote EHR implementation and accelerate the development and adoption of healthcare information technology. (True or False)

Accountability

The requirement for actions of an entity to be traced uniquely to that entity.

Shannon-Weaver Model of communication

The sender encodes the message and sends it to the receiver through a technological channel like telephone and telegraph. The sender converts the message into codes understandable to the machine. The message is sent in codes through a medium. The receiver has to decode the message before understanding it and interpreting it. The receptor machine can also act as a decoder in some cases. The channel can have noise and the receiver might not have the capacity to decode which might cause problems in communication process.

Shannon Weaver information communication model

The sender is the originator of the message or the information source. The transmitter is the encoder that converts the content of the message to a code. The code can be letters, words, music, symbols, or a computer code. The telephone or cable line is the channel, or the medium used to carry the message. Each channel has its own physical limitations in terms of the size of the message that can be carried. Noise is anything that is not part of the message but that occupies space on the channel and is transmitted with the message. The decoder converts the message to a format that can be understood by the receiver.

staff, budget, and physical or environmental constraints.

The three major resources that will have the most impact on whether to implement a new system or to upgrade an existing one are ______________________

public health monitoring or surveillance, research, and marketing.

The three most common secondary uses of personal health information are ____________

model

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

Model

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

Ace Star Model

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

Official SSO.

These organizations are founded with the mission of developing or coordinating specific standards. They use a formal process that stresses the building of consensus through open communication. Referred to as de jure standards.

Social Cognitive Theories

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

System Thinking

Thinking that is curious and wanting to know the next step.

Privacy Act in 1974

This act protects certain personal information held by federal agencies in computerized databases.

Medication Dosing Support

This category of CDS includes tools that assist clinicians in finding and monitoring the most appropriate doses for medication orders. Tools vary from simple "pick lists" with allowed dose options to more complex dose calculation algorithms based on parameters such as patient weight, height, renal function, and hepatic function

Systems Life Cycle Model (SLC) (SLCM) or systems development life cycle model (SDLCM)

This model is used in project management to describe stages or phases of an informatics project and it guides system implementation from initial feasibility through a more completed stage of maintenance and evaluation of the products. entire life cycle can last many years, average life cycle is a decade

Construction

This phase involves several iterations that continue the design and implementation of the system. The core architecture and highest-risk aspects of the system are already complete. Focus of the work turns to the routine and predictable parts of the system—for example, detailing the system controls, such as data validation, fine-tuning the user-interface design, finishing routine data maintenance functions, and completing the help and user preference functions. The team also begins to plan for deployment of the system.

"lethal lag" or "fatal lag."

This time lag between the discovery of new treatment options and the use of this new knowledge at the point of care is sometimes called the ____________________________

(1) the public trust, (2) legal requirements and fines, and (3) increasing security threats to healthcare data.

Three areas emphasize the importance of health information security today:

to write down exactly what one wants to know.

Thus the first step in planning a database is _________________________________

(T) in STEEEP

Timely-Reduce waits and sometimes harmful delays for both those who receive and those who give care.

Infobuttons

To facilitate access to information resources and reduce barriers to their use in patient care, researchers have been enabling access to research info within EHR systems through an increasingly popular approach to CDS known as _____________________ . a physician prescribing a medication for a patient who has chronic kidney disease might want to know if the medication is contraindicated or if its dose needs to be adjusted based on the patient's condition. This is positioned beside the drug name within the EHR would provide access to this kind of information from an external drug knowledge resource.

professional

To have a database program included in an office suite, it is necessary to purchase what is called the _______________ version of the suite.

1. Recognize the need for improvements in human-computer interfaces for delivering CDS. 2. Implement tools that automatically summarize the patient's clinical data, helping clinicians to understand the patient's condition and status. 3. Prioritize and personalize CDS recommendations to the user. 4. Account for patient's comorbidities. 5. Leverage the large amount of narrative text typically available in EHR systems. Create New Clinical Decision Support Interventions 1. Help organizations prioritize CDS content development and implementation. 2. Leverage large clinical databases to create CDS. The third category addresses some of the barriers to the wide adoption of CDS. Disseminate Existing Clinical Decision Support Knowledge and Interventions 1. Disseminate CDS best practices. 2. Create a framework for sharing CDS knowledge and capabilities. 3. Create online CDS repositories.

Top 10 Grand Challenges in Clinical Decision Support Improve the Effectiveness of Clinical Decision Support Interventions

True

True or False Errors in healthcare are caused by process errors, information overload, and knowledge gaps. Several factors further aggravate this problem, including rapidly evolving domain knowledge, an aging population having multiple comorbidities, and an increasingly complex healthcare delivery system. Ultimately this leads to a clinical information overload that significantly exceeds the human cognitive capacity

True

True or False. An executive order was signed by President George W. Bush in 2004, which outlined the federal initiative of granting federal dollars to incentivize healthcare providers to implement and use health IT.

think-aloud protocol, task analysis, and contextual inquiry/focused ethnographies

UX examinations of health products and processes Name three

Unit Testing and functional testing

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

CDS Designers

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

NOC Nursing Outcome classification

Used to document outcomes. Outcomes are used to evaluate the impaction of interventions and are designed to be used across the care continuum.

Reference Terminology

Used to provide a common language across a diverse landscape. EX snowmed-CT and LOINC

UCD

User Centered Design

Form and reports

Ways to view data are __________

Multi-Patient Monitor

You are a care manager in an emergency department. Thirty patients are in the unit right now, and new lab results, imaging studies, and orders are constantly being posted on all of them. You have a visual "air traffic" tracking display (_______________________________________) which indicates which patients have not been seen yet, which have new orders to process, which have abnormal lab results, which ones have been in the unit more than four hours, which have inpatient beds ready, and more. Your status display filters and reformats all the information to help you know where to direct your attention next.

• The right to receive copies of all information in the medical records, including clinical laboratory test results, medical images such as X-rays, wellness and disease management program files and clinical case notes, all billing and payment records, and insurance information. • The right to request a change to any information the individual believes is wrong as well as to add information the individual believes is missing or incomplete. If the covered entity believes the information is correct or complete, the individual has the right to have the disagreement noted in their file within 60 days. • The right to receive test results directly from clinical laboratory that is a covered entity. The designated record set includes not only the laboratory test reports but also the underlying information generated as part of the test, as well as other information concerning tests a laboratory runs on an individual. Patients may still obtain their results from their physician's office, but are not required to use that option. • A personal representative also has the right to access PHI in a designated record set as well as the right to direct the covered entity to transmit a copy of the PHI to a designated person or entity of the individual's choice. A personal representative also has the right to access PHI in a designated record set as well as the right to direct the covered entity to transmit a copy of the PHI to a designated person or entity of the individual's choice.

What Patient Rights Are Included in HIPAA?

inception, elaboration, construction, and transition,

What are 4 phases of Unified Process (UP)

1. Value based payment models 2. Meaningful Use Incentives for Electronic Health Record and Clinical Decision Support Adoption 3. Statewide health information exchanges 4. Clinical decision support standards 5. National Clinical Decision Support and Knowledge Management Initiatives Open Source, Freely Available Resources

What are some initiatives are being developed to tackle the challenges and barriers to CDS adoption

▪ Developing the project schedule ▪ Recruiting and training team members ▪ Assigning work to teams and team members ▪ Assessing project risks ▪ Monitoring and controlling project deliverables and milestones

What are some internal responsibilities of a project manager?

▪ Undefined project management practices ▪ Poor IT management and poor IT procedures Inadequate executive support for the project ▪ Inexperienced project managers ▪ Unclear business needs and project objectives ▪ Inadequate user involvement

What are some of the primary reasons for software system development failure:

▪ Project Integration Management. ▪ Project Scope Management. ▪ Project Time Management. ▪ Project Cost Management. ▪ Project Quality Management. ▪ Project Human Resource Management. ▪ Project Communications Management. ▪ Project Risk Management. ▪ Project Procurement Management. ▪ Project Stakeholder Management.

What are the 10 knowledge areas of the PMBOK

Exploratory test, Assessment test, Validation test, Comparison test

What are the 4 different usability tests?

1. Project initiation. 2. Project planning 3. analysis 4. design 5. Implementation 6. deployment

What are the 6 Phases to the predictive approach

Business modeling ▪ Requirements ▪ Design ▪ Implementation ▪ Testing ▪ Deployment

What are the 6 main up disciplines?

1. Information—privacy and disposition 2. Openness 3. Security 4. Access 5. Legitimate infringement 6. Least intrusive alternative 7. Accountability

What are the General Principles of Informatics Ethics Included in the IMIA Code of Ethics for Health Informatics Professionals

I. Comprehensive services across the care continuum II. Patient focus on III. Geographic coverage and rostering IV. Standardized care delivery through interprofessional teams V. Performance management VI. Information systems State of the art information systems to collect, track and report activities VII. Organizational culture and leadership VIII. Physician integration IX. Governance structure X. Financial management

What are the Ten key principles for integration of EHR?

• Defines standardized, appropriate care and reduces variability of care for common diagnoses. • Defines local or facility-owned orderables (elements that can be ordered using computerized provider order entry [CPOE] available at that facility. • Triggers alerts and other CDS features based on locally built logic (rules). • Collects detailed metrics for specific reports required to meet MU criteria. • Enables a more timely update of treatment plans based on best practices.

What are the advantages of using a system that incorporates evidence-based content and CDS?

communication, simplicity, feedback, and courage

What are the four core values of XP?

• Installing and testing new hardware, software, and wireless networks • Designing, building, and modifying applications • Testing new applications and interfaces • Providing staff education and support • Maintaining hardware, software, and wireless networks

What are the skill sets of staff needed to implement an EHR?

▪ Configuration and change management ▪ Project management ▪ Environment

What are the three additional support disciplines are necessary for planning and controlling the project

the problem description, the anticipated business benefits, and the system capabilities.

What are the three components of a System Vision Document?

The product owner, the Scrum master, and the Scrum team or teams.

What are the three main organizational elements that affect a Scrum project

Stage 1: capturing patient data that was expected to be shared with other healthcare professionals and the patient. Stage 2: advanced clinical practices and providing patient portals where patients could access their medical records. Stage 3: accentuates data interoperability and patient outcomes while increasing the thresholds for the objectives and clinical measures.

What are the three stages in the EHR Incentive Program?

the Medicare EHR Incentive Program administered by the Centers for Medicare and Medicaid Services (CMS) and the Medicaid EHR Incentive Program, which is governed by individual states and territories.

What are the two EHR incentive programs Within the HITECH Act?

Critiques and Warnings

You are a nurse on a busy med-surg unit in an acute care hospital. Every time you administer a medication, you are required to scan the bar codes on the patient's wristbands and the medication. Occasionally, this process prompts an alert(_______________________________)that the medication you are about to administer is contraindicated for your patient at this time. You contact the attending physician to communicate this and obtain an order for an alternate medication.

Event-Driven Alert ,Critiques and Warnings

You are an ICU physician. You are in your office at the hospital and you receive vital sign trends on your patients using your smartphone. You set a "smart alert" on a particular elderly patient on mechanical ventilation whom you suspect may be prone to sepsis (_______________________). You are notified of the vital sign trends on your patient, which show, among other parameters, a noticeable increase in temperature and heart rate over the past hour and decreasing urine output, as indicated from the Intake and Output accumulations. You call the unit to verify these data and decide to access the CPOE system to order stat blood tests to confirm the onset of sepsis, and you also start antibiotics. The EMR notifies you that your patient is allergic to one of the particular antibiotics you were originally ordering (___________________________), so you select one that has no contraindications.

Order Sets/Care Plans/Protocols ,Filtered Reference Information and Knowledge Resources

You are an attending physician in an urban emergency department. A 60-year-old male is complaining of pain and presents swelling in the right leg. Upon examination, you observe red discoloration on the surface of the right calf with the appearance of visible surface veins. Suspecting a possible deep vein thrombosis (DVT), you prepare to admit the patient and go to order heparin. When you choose the DVT order set in the CPOE system (_________________________), it highlights a link to an updated American College of Chest Physicians guideline (___________________,), which suggests that low-molecular-weight heparin may be a better medication for certain patients. After reading the new information, you decide to change from heparin to enoxaparin, and another option in the order set facilitates the proper dosing of the new medication.

LOINC is designed for documenting laboratory and clinical test results or observations, while SNOMED CT is the most comprehensive clinical terminology. SNOMED CT contains most nursing diagnoses, interventions, actions, outcomes and therefore allows for coding of clinical questions for assessment and measureable outcomes. LOINC has been widely adopted for ordering and exchanging laboratory and clinical observations. Therefore, it would allow for lab test results into a care plan using a Health Level Seven International (HL7) interface.

You are an informatics nurse specialist at your 200-bed hospital and have been asked to use terminologies within your EHR for nursing care planning. What terminologies would you use and why?

Breaches

_____________ are defined as an impermissible use or disclosure of PHI.

Semantic interoperability

______________ is the ability of computer sys- tems to exchange information and have that information properly interpreted by the receiving system in the way as intended by the transmitting system

walking skeleton

_______________ is a development approach In which the complete system structure Is built but with bare-bones functionality. Iterative process

Authentication

________________ is defined as the technology and techniques for verifying the identity of human users of an information or computer system. It means verifying that the person is who he or she claims to be.

Clinical telehealth

________________ services include, for example, diagnosis; patient communication and education; disease management, triage and advice; remote monitoring; caregiver support; and provider-to-provider teleconsultations.

A terminology life cycle

_________________ contains three major phases: change requests, terminology editing, and terminology publication.

Confidentiality

_________________ relates to protecting and safeguarding health information from inappropriate access, use, and disclosure. It is about the information. It is about the responsibility of healthcare providers because they are responsible for keeping patients' information private.

Boolean searching

_________________ uses and/or/not in selecting records.

algorithm

__________________ a set of rules to follow that are inclusive of all cases. Allows greater speed and accuracy than a human. Ex. Alphabetization

Relational databases

__________________ consist of four main objects: table, query, form, and report.

Privacy

__________________ is the right of individuals to control access to their person (body privacy) or information about themselves (information privacy).

Security

__________________ relates to the administrative, technical, and physical safeguards implemented to prevent privacy and confidentiality breaches and also to ensure integrity and availability of information.

nonclinical telehealth

__________________ services include distance education for healthcare consumers or clinicians, video conferencing or conference call meetings, research, healthcare administration, and healthcare management.

Agile modeling (AM)

___________________ is a guiding philosophy in which only models that are necessary, with a valid need and at the right level of detail, are created

Model

___________________ is a representation of an important aspect of the real world. Sometimes, the term abstraction is used because people abstract (separate out) an aspect that is of particular importance to them. It is useful when people need to record or communicate information.

Telenursing

___________________ is the use of telehealth technology to deliver nursing care and conduct nursing practice.

Reports

____________________ have the ability to sort the records by multiple criteria.

An interface terminology

____________________ is a collection of task-oriented terms considered to support data entry and display in EHRs.11

Encryption

____________________ is a primary method of rendering PHI unusable, unreadable, or indecipherable to unauthorized individuals, either when the data are stored (at rest) or traversing a network (in transit). It is not required by HIPAA but often makes the difference in determining whether an incident constitutes a breach or not. The Final Breach Notification Rule indicates that if data are unusable, unreadable, or indecipherable to unauthorized individuals, then notification is not required following an impermissible use or disclosure. To qualify for this "safe harbor," the data must have been encrypted in compliance with NIST guidelines.

Scope creep

____________________ is one of the most frequent causes of project delays. Changes in the scope of the project during the implementation that frequently necessitates other changes resulting in additional expenses, resources, and time. It occurs when requirements are altered after the initial project is defined and those added requirements are substantial enough to affect the project timeline.

Encryption

____________________ is the mathematical conversion of data into a form, called ciphertext, that cannot be easily understood by unauthorized people. This technical method protects PHI against unauthorized access. To be able to access the data, an authorized person has to decrypt the data—that is, change the ciphertext back into the original, understandable data. This is accomplished through the use of a security key such as a password.

Telemedicine

____________________ is the use of medical information exchanged from one site to another via electronic communications for the health and education of the patient or healthcare provider and for improving patient care, treatment, and services.

A system development methodology

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

Relevant Information Display

_____________________ addresses clinicians' information overload in the process of care in both patient information and domain knowledge. includes CDS tools that provide seamless access to relevant patient information or summarize prominent aspects of a patient's record to help clinicians understand the patient's condition and status. Intensive care daily reports that assist clinicians in patient rounds are one example of such tools. Another example is disease management dashboards that summarize relevant data for managing a specific condition.

Input data

_____________________ are the additional data used in the background to constrain or modify the CDS, such as patient conditions, medications, diagnostic tests, and the care plan.

Terminology editing

_____________________ begins with the activation of a new concept, revision of an existing concept, or inactivation of a concept, and follows formal concept change and version management guidelines. When completed with subsequent documentation, a series of tasks is performed throughout the terminology publication phase to release a new version of terminology for public use.

best of breed

_____________________ involves reviewing several vendors for their "best" module or application, such as an admission, discharge, and transfer (ADT) system or emergency department module.

Agile development

_____________________ is a philosophy and set of guidelines for developing information systems in an unknown, rapidly changing environment, and it can be used with any system development methodology. Usually complements adaptive approaches to the SDLC and methodologies that support it.

Point-of-care alerts and reminders

_____________________ raise the clinician's or the patient's attention to important conditions or recommendations based on the patient's clinical data. EX. an alert that notifies clinicians when a drug being prescribed interacts with other drugs the patient is already receiving, duplicate therapy alerts, drug allergy alerts, and an alert when a patient's condition contraindicates the use of a particular drug. Alerts for immunizations, cancer screening, fall prevention, and pain assessment.

A predictive

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

standardized terminology

______________________ is a terminology that meets specific requirements established by an SDO, it is referred to as a standardized terminology

intangible benefit

_______________________ Is a benefit that accrues to an organization but that can't be measured quantitatively or estimated accurately

tangible benefit

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

a project

_______________________ is a planned undertaking with a beginning and an end, which produces a predetermined result and is usually constrained by a schedule and resources.

Project management

_______________________ is organizing and directing other people to achieve a planned result within a predetermined schedule and budget.

Interventions

_______________________- are the possible actions that result from the CDS system, such as sending a message to a clinician, displaying relevant clinical knowledge or patient information, and logging that a particular event took place.

An adaptive

________________________ approach to the SDLC is used when the system's requirements and/or the users' needs aren't well understood.

Triggers

________________________ are the events that initiate a CDS rule (e.g., a drug prescription).

A technique

________________________ is a collection of guidelines that helps an analyst complete an activity or task. It often includes step-by-step instructions for creating a model, or it might include more general advice on collecting information from system users. Examples include data-modeling techniques, software-testing techniques, user-interviewing techniques, and relational database design techniques.

The practice of evidence based medicine

________________________ means integrating individual clinical expertise with the best available external clinical evidence from systematic research. It involves making decisions for clinical care based on the most current recommended treatments for specific diagnoses. These recommendations are derived from an ongoing review and analysis of high-caliber, peer-reviewed scientific studies in the literature.

A monolithic or fully integrated health information system

_________________________ is an EHR system that includes a suite of modules to support care. easier to install and to support. usually has a similar-looking user interface across modules, which helps users learn the EHR more quickly. All applications share a common database makes quicker.. The initial installation is frequently faster and less expensive because a scaled-down IT department is required at the local site.

A terminology

_________________________ is often called a classification when concepts or expressions are organized according to their conceptual similarities rather than semantic (meaning) resemblances. For example, a set of concepts related to the human body could be arranged by physiologic function or body structure. For instance, chest pain and growing pain are semantically close in that both are considered a type of pain. Therefore both terms can be categorized as a finding of the sensory nervous system.

Telehealth

__________________________ Often used interchangeably with the terms telemedicine, eHealth, or mHealth (mobile health), It is "the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health, and health administration."

interoperability

__________________________ is defined as the extent to which healthcare systems and devices can exchange data and users can interpret that shared data

Action steps

__________________________- are actionable alternatives offered to the CDS user, such as collecting or documenting information (e.g., reason to override an alert, completion of care recommended by CDS), requesting an order, and acknowledging a CDS recommendation.

(EACH)EHR Alternative Certification for Healthcare Providers program

___________________________ is a three-step program to certify homegrown systems or existing EHR technology not already covered by a vendor certification. The program provides a mechanism to obtain certification by demonstrating that the system meets the U.S. Department of Health & Human Services (HHS) MU requirements.

adaptive approaches, such as lean, iterative, or Agile methods,

___________________________ lend themselves to being managed with much less formality. The inherent characteristics of an iterative approach, with its "just in time" project plans, easily adjust to less documentation, fewer diagrams for specifications, and less-formal status reporting.

the Agile philosophy

___________________________ takes the opposite approach, providing more flexibility in project schedules and letting the project teams plan and execute their work as the project progresses.

An integrated system

____________________________ includes a suite of modules or applications to support care and is typically easier to install, easier to support, and has a similar-looking user interface across the modules, helping users to learn the EHR more quickly.

A concept

____________________________ refers to a class in ontology, where the meaning of a concept is formally specified using properties and its relationships with other concepts through inheritance.

order facilitators

______________________________ are tools that assist clinicians in the order entry process in general. Expedites the order process. Assist clinicians by providing a set of commonly used orders for a specific condition (e.g., community-acquired pneumonia) or service (e.g., internal medicine hospital admission orders, vascular surgery postoperative orders). Reduce errors and promote consistent care, reducing unnecessary variability, enabling more complete orders, and reducing the need for verbal orders.

an ontology

______________________________ contains multiple subsumptions or subclass relationships of a concept based on its formal definition. A reasoner or classification software can be used to assist in this process by automatically determining logical placements of asserted concepts and creating an inferred hierarchy.

A "fractured development team"

________________________________ means that the project manager and team leaders were unable to manage the project.

business benefits

_________________________________ contains the results that the organization anticipates it will accrue from a new system. Business benefits are normally described in terms of the specific results that can change the financial statements, either by decreasing costs or increasing revenues.

A methodology

__________________________________. includes a collection of techniques that are used to complete activities within each phase or iteration of the system development life cycle. The activities include the completion of a variety of models as well as other documents and deliverables.

Privacy

___________________________________________ concerns who has access to information, a patient's right to keep information private, and what constitutes inappropriate or unauthorized access. It is about the person, . It is about the rights of the patient.

A reference terminology

________________________serves as a resource to represent domain knowledge of interest and thus facilitate data collection, processing, and aggregation. May not be sufficient to design and structure documentation forms used by healthcare providers in daily practice.

The structure

_____________________is concerned with the fields and how these fields are combined into tables.

Mainframe

______________computer is used to run a large health care organization's core software applications. Because of the cost of such systems and increases in the capacity of lower-cost systems, there has been a trend over the past 15 years for health care organizations to transfer most of their new computing applications to less expensive mid-range and minicomputers.

CDS

__________comprises a variety of tools and interventions that "provide clinicians, staff, patients, or other individuals with knowledge and person-specific information, intelligently filtered or presented at appropriate times, to enhance health and health care. The NQF defined it as "any tool or technique that enhances decision-making by clinicians, patients, or their surrogates in the delivery or management of health care."

Gantt chart

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

intangible benefit

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

rich client (also called a fat, heavy, or thick client)

a client-server architecture or network that provides rich functionality independent of the central server. In contrast, a thin client refers to a client-server architecture that is heavily dependent on a server's applications.

application service provider (ASP)

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

knowledge base (knowledge repository)

a component within the EHR that stores and organizes a healthcare enterprise's information and knowledge used by the enterprise for clinical operations usually organized by attaching metadata to content items, allowing categorization of the knowledge content based on contextual need. allows an EHR to become a "content-driven" system as opposed to a system whose knowledge is hard-coded in software programs.

loose coupling—

a condition where departments in an organization have autonomy and decision-making power at their organizational level; vertical and horizontal integration;

Agile modeling

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

central storage model

a single repository is used to store all (or most) clinical data and is used as the primary source for reviewing data. improves the ability of a single application to display data from multiple original sources and locations and provides the capability to perform clinical decision support (CDS) more efficiently across multiple data types usually requires that data collected from secondary systems be transformed (mapped) to a common storage model and terminology before being stored in the repository.

fluid outsourcing—

a situation in which some internal functions are contracted to an external organization while maintaining a core of full-time employees; and integrated information systems.

database management system (DBMS)

a software program that is used to manage, organize, and retrieve data and information from a database

Wisdom

a state of awareness, a paradigm or set of principles, it is the ultimate context and frame of reference

database

a structured collection of individual data elements.

logic model

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

chaordic

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

sprint

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

data integration

accomplished by interfacing a number of information systems

• Decreased travel time or distance and removal of travel barriers • More immediate access to care • Early detection of disease processes or health issues • Ownership of healthcare and feelings of empowerment • Long-term health and independence • Caregiver reassurance • Patient satisfaction with healthcare

advantages of telehealth to patients

Boolean logic

all decisions are reduced first to "true" or "false."

interface engine (IE)

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

NMMDS nursing management minimum data set

allows nursing leaders to make decisions and compare nursing practice across the country. It contains 19 data elements related to staffing, patient populations, model of care delivery and type nursing unit

formative evaluation

an assessment of how well the program is being implemented and to describe the experience of participants. Topics for formative evaluation include the fidelity of the intervention, the quality of implementation, the characteristics of the organizational context, and the types of personnel. Needs assessments and feasibility analyses are included in this general category. • What is the nature and scope of the problem that is being addressed by health IT? • What is the extent and seriousness of the need? • How well is the technology working and what is the best way to deliver it? • How are participants (and users) experiencing the program? • How did the intervention change after implementation?

summative evaluation

an assessment of the outcomes and impact of the program. Cost-effectiveness and adverse events analyses are included in this category. • To what degree were the outcomes affected by the product? • What is the cost effectiveness of the product? • What were the unintended consequences of the product?

Integrated Health System

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

HIPAA

applies to "covered entities" (healthcare providers, health plans, and healthcare clearinghouses) and their "business associates."

Interoperability

applies to the role of informatics in that it is critical in supporting a clinicians access to information in a clinical setting

Fair information practices (FIPs), also referred to as fair information practice principles (FIPPs),

are a set of internationally recognized practices for addressing privacy of information.

Nursing-sensitive indicators

are defined as measures that reflect the structure, process and outcomes of nursing care

Nursing-sensitive outcome indicators

are defined measurement strategies for patient or caregiver states that are sensitive to nursing care

Organizations

are the structure and process through which health care is delivered to individuals, families, and communities.

Learning theory

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

walking skeleton

based on interative approach provides a complete front-to-back implementation of the new system but with only the "bare bones" of functionality. gets into user's hands quickly

1986, the Hospital Management Systems Society (HMSS

became the Healthcare Information and Management Systems Society (HIMSS), reflecting the growing influence of information systems and telecommunications professionals within HIMSS as well as healthcare. In 1993, HIMSS became an independent, not-for-profit corporation.

The National Library of Medicine (NLM)

began offering national online access to MEDLINE

1964: The National Library of Medicine (NLM)

began using the computerized Medical Literature Analysis and Retrieval System (MEDLARS) as a mechanism to create Index Medicus.9 •

phased go live

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

HUMAN COMPUTER INTERACTIONS(HCI)

can be addressed throughout the systems life cycle to include the design, development, purchase, implementation, and evaluation of applications.

clinical applications

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

Comparison Study

can conduct comparison studies at any point in the systems life cycle but they are more commonly done to compare an existing design with a redesign or an early prototype with a more mature product. The major objective of this usability test is to determine which application, design, or product is more effective, efficient, and satisfying

CDS Repositories

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

CDS implementers

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

CDS designers

can use the taxonomy to identify points in the workflow when CDS can be used and design a CDS tool to fit that context. they can then tag the CDS tools with terms from the taxonomy to inform practices about the intended use of the CDS.

ABC codes

capture non-physician and alternative medicine health services provided by health professionals. they are used to automate reimbursement and facilitate comparative effectiveness research (CER)

The American Documentation Institute (ADI)

changed its name to the American Society for Information Science in 1968 and then to the American Society for Information Science and Technology in 2000

dynamic systems

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

user-centered design

composed of the following three axioms: • An early and central focus on users in the design and development of products • Iterative design • Systematic measures of the interactions between users and products

alert fatigue

clinicians tend to ignore alerts because they are frequently false positives and not clinically significant.

National Academy of Science

coined the term FIT persons to describe people who are fluent with information technology.

Information

comes from providing context to data. Data with meaning and purpose.

Heuristic evaluations (HEs)

compare products against accepted usability guidelines to reveal issues. A "rule of thumb" or guideline.

Digital Library

comprised of a set of electronic resources with related capabilities to create, organize, search, store to retrieve information to meet the needs of the community of users.

relational databases

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

A table

consists of all of the records.

tables

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

Hierarchical Databases

contain many levels. conceptualized as a family tree wherein each child has one parent. The root is the head of the family. The branches, or second level, are the children who are descended from the root. The third level, the grandchildren, are descended from the second-level parents. Communication among the descendants occurs by passing information up or down to the common parent or child until the desired level is reached. older mainframe DBMS works well for data sets with one-to-many relationships requires professional programmers for maintenance

the Unified Medical Language System (UMLS®) Metathesaurus®

contains more than 190 source terminologies, classifications, and ontologies used in the healthcare domain. Regardless of the structure of a source terminology, It consolidates all source concepts in a unified framework so that it is possible to examine lexical and semantic relations within and across source terminologies.

SNOMED CT

contains preferred terms and the related synonyms (including Spanish translations of preferred terms) organized in a hierarchical tree structure with top-level concepts, such as body structure, clinical finding (e.g., diseases, disorders, drug actions), event, observable entity, procedure (e.g., treatment or therapy, surgical procedure, laboratory procedure), specimen, and substance. Concepts lower in the hierarchy are more specific in meaning than those higher in the hierarchy, creating multiple levels of granularity. Defining attribute relationships using description logics further details the meaning of a concept by relating all necessary and sufficient conditions.

A record

contains the different pieces of data belonging to a given entity. It is made up of fields, with each field containing data pertaining to the entity that the record represents.

data dictionary

contains the medical vocabulary terms used to store data within the repository. particularly useful in the EHR because it is the central source for defining all terms and their corresponding codes used by the EHR. Instead of hard-coding these terms and codes within applications, the data dictionary allows more flexibility at application runtime to access new and updated terms as they become available over the lifetime of the EHR. domains and subdomains

CDS repositories

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

Hierarchical

databases contain many levels. Can be conceptualized as a family tree. each child has one parent. The root is the head of the family. The branches, or second level, are the children who are descended from the root. The third level, the grandchildren, are descended from the second-level parents.

business modeling

define the business environment

requirements

define the requirements that that portion of the system must satisfy

Standard

defined as an established specification, guideline, or characteristic that describes the measurement, material, product, processes, and/or services required for a specific purpose.

The WHO

defined health literacy as "the cognitive and social skills that determine the motivation and ability of individuals to gain access to, understand, and use information in ways which promote and maintain good health.

Staggers and Nelson Systems Life Cycle Model (SLCM)

depicts the cycle as a spiral. incorporates revious work from Thompson, Synder-Halpern, and Staggers. Steps: Analyze, Plan, Develop or Purchase, Test, Implement or Go-Live, Maintain and Evolve, Evaluate, Return to Analyze

DIKW Framework

describes a hierarchal relationship between data, information, knowledge and wisdom

design

design a solution for that portion of the system that satisfies the requirements

HUMAN COMPUTER INTERACTIONS(HCI) topics include

design and use an intravenous pump or a touchpad on a computer . User satisfaction with computerized provider order entry (CPOE) Patient usage rates of mHealth apps or personal health records. Users' perceptions of eMARs. The standardization (or not) and meaning of icons on a patient portal. Principles of effective screen design, including mobile application design. Analysis of the capabilities and limitations of users and matching these to mHealth designs

ERGONOMICS

design of a power drill to fit a human hand or the design of chairs to promote comfort and safety. In healthcare, ergonomics can be the number, types, and locations of computer workstations or the physical design of a mobile device to support care, design of a surgical instrument to fit the human hand to perform desired functions effectively and efficiently.

network databases

designed to solve the redundancy problem that occurs with the hierarchical model Although this model is very similar to the hierarchical model, children are permitted to have more than one parent. The records are linked together by pointers that use a key piece of data (e.g., a patient medical record number). requires professional programmers for maintenance

metadata model

detailed data format description

Inception Phase (UP)

develop an approximate vision of the system, make the business case, define the scope, and produce rough estimates for cost and schedule usually one iteration

Clinical Care classification terminology CCC

developed by Virginia Saba and used to document Nursing care in EHR. Formerly known as Home healthcare classification system.

ISO International Organization for Standardization

develops and coordinates standards

IEEE Institute of Electrical and Electronics Engineers

develops industry standards across a broad range of technologies.

American Society for Testing and Materials ASTI

develops international standards for materials, products, systems and services. Specifically the E31 healthcare informatics standards

point of service (POS)

device is a computer or information system that is located where information is required or where the data are collected.

diffusion of innovation theories

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

Information science

discipline that investigates the properties and behavior of information, forces governing flow of information, and the means of processing information for optimum accessibility and usability. Concerned with body of knowledge relating to the origination, collection, organization, storage, retrieval, interpretation, transmission, transformation, and utilization of information.

pair programming

divides up the coding work. First, one programmer might focus more on design and double-checking the algorithms while the other writes the code. Then, they switch roles; thus, over time, they both think about design, coding, and testing. decisions are developed by two brains, and fewer "quick and dirty" shortcuts are taken. The quality of the code is always higher

HUMAN COMPUTER INTERACTIONS(HCI)

draws on the disciplines of psychology and cognitive science, computer science, sociology, and information science and on the discipline of the user at hand.

distributed storage model

each data collection application stores its information in its own repository and data are federated through a real-time data access methodology results review application may have to access separate repositories for lab, microbiology, radiology, etc., in order to provide a composite view of information. provides some reliability to the EHR because, for example, if one repository goes down, the user may still be able to access information from the other repositories. It also allows the most efficient storage and access for particular data types and lessens the complexity of having to map data from one system to another. disadvantages: can limit performance, many single points of failure, makes integrated tasks such as CDS much more difficult.

object-oriented model

each object belongs to a class and has a given set of attributes that can be applied to it. such as Windows, by Right clicking on a selected object yields a menu of options that can be applied to the selected object. Advantages is that it reduces the amount of programming needed. Permits the storage of complex data that are not easily accommodated by a relational DBMS

system architecture

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

HUMAN FACTORS

examples include a design for opening a door efficiently, how to turn on the lighting for one area of a room from a bank of light switches, and how to safely and efficiently operate the controls to drive a car, new operating room to better support workflow, teamwork, and patient flow, or identifying obstacles to intensive care nurses in their task performance

Kurt Lewin

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

population management workflows

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

Organizational behavior theories

focus on small groups and individuals in organizations. Research from this perspective examines individual and interpersonal work issues, such as career development, job satisfaction, motivation, productivity, group dynamics, work life, ethics, values, and culture

1937: The American Documentation Institute (ADI)

focus was the development of microfilm as an aid to information dissemination.

NMMDS

focuses on collecting variables associated with nursing environment, nurse resources, and financial resources to support administrative analysis and decision making of nurse executives.37-39

design (predictive)

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

Design

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

Analysis

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

the American Medical Association (AMA)

formed a committee on computers in medicine in 1969.

Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009

funding for workforce development through health IT education

A wide area network (WAN)

generally links a number of LANs owned by the organization so that users can communicate with each other and with the organization's information systems

The International Health Terminology Standards Development Organisation (IHTSDO)

has developed a set of principles to guide SNOMED CT development and quality improvement. SNOMED CT is continually updated to meet users' needs.

organization science

has its theoretical roots in psychology, sociology, anthropology, management, and public administration.

Cross-mapping

healthcare terminologies is essential to preserve the meaning of exchanged information and facilitate integration of clinical data in a disparate information system so that the comprehensive picture of healthcare delivery can be understood.

The Royal Society of Great Britain

held a conference to demonstrate the growing importance of managing information.

records

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

Project Initiation

identifies the problem and secures approval to develop a new system

object oriented database management system

in a relational DBMS there is a separation between the data storage and the manipulation methods. This separation of data and methods for manipulating those data add to the complexity of the database. This is especially true with large databases Right clicking on a selected object yields a menu of options that can be applied to the selected object. The same principles apply to data in an object-oriented DBMS. reduces the amount of programming needed

Risk assessments

include an evaluation of how and where PHI is stored within the organization, who is managing these data, how these data are being used, and where data are transmitted. Includes a review of the security measures and technical architecture.

message--centric workflows

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

Performance measures

include customer satisfaction, clinical productivity and efficiency per physician per workday, financial cost per relative value unit of service, internal operations efficiency (average length of stay or waiting time for visits and patient complaints per 1000 patients), employee satisfaction and employee demographics of diversity, and social commitment as shown by community outreach.

Implementation

includes programming and testing the system.

support phase

includes the activities needed to upgrade and maintain the system after it has been deployed. It is part of the overall SDLC, but it isn't normally considered part of the initial development project

contextual control model, or CoCom,

includes the following elements: event, modifies, constructs, determines, acts, and produces

joint cognitive systems

information is shared or distributed among humans and technology. This framework is useful for examining teamwork in healthcare, such as those for patient care.

5 groups of individuals in an organization

innovators, early adopters, early majority, late majority, and laggards

a tool

is software support that helps create models or other components required in the project. Simple drawing programs for creating diagrams, data definitions, use case descriptions, and other artifacts. Microsoft Project.

Video conferencing

integrates audio, video, computing, and communications technologies to allow people in different locations to collaborate electronically face to face, in real time, and to share information, including data, documents, sound, and picture. Enables patient-provider consultations, provider-specialist discussions, and health education. The technology requires live presence of the healthcare provider and patient or provider and medical specialist in an interactive environment.

Focused ethnographies and contextual inquiry

involve interacting with users in their actual sites or "field settings." They concentrate on individuals' points of view and their experiences and interactions in social settings, rather than on just the actions of those individuals.

Technical safeguards

involve protecting the confidentiality, integrity, and availability of PHI. Include authentication, access management and control, encryption, protection from malware and hacking attacks, disaster recovery planning, and privacy-enhancing technologies.

chaos theory and complexity theory,

involve the study of dynamic nonlinear systems that change with time and demonstrate a variety of cause-and-effect relationships between inputs and outputs because of reiterative feedback loops.

Deployment

involves installing and putting the system into operation.

Best of Breed implementation of EHR

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

Data Mining

is a data management tool that engages software to uncover inter-relationships within large data sets.

A terminology change request

is a formal mechanism for users to submit requests for any changes or additions with respect to a given terminology.

Threat

is a human act or an act of nature that has the potential to cause harm to an informational asset.

The ACE Star Model of Knowledge Transformation

is a model of five points to integrate evidence-based practice into informatics solutions.

Meaningful use

is a multidimensional concept that incorporates complex processes; workflow; interoperability; decision support; performance evaluation; and quality improvement.

PHDSC Public Health Data Standards Consortium

is a national, nonprofit, membership-based organization of federal, state, and local health agencies; professional associations; academia; public and private sector organizations; international members; and individuals. Its mission focuses on promoting health IT standards to empower health communities to improve individual and community health. Privacy, Security, and Data Exchange Committee addresses individual and organizational privacy and security standards related to maintaining and sharing health information in electronic form for public sector health programs and health services research purposes.

A local area network (LAN)

is a network within a building that can be managed entirely within the organization. Typically owned and managed by the network group within the organization.

RxNorm

is a normalized drug-naming system derived from 14 drug terminologies containing drug names, ingredient, strength, and dose form. Micromedex RED BOOK, Food and Drug Administration (FDA) National Drug Code Directory, SNOMED CT, and the Veterans Health Administration National Drug File. the NLM produces normalized generic and brand names of prescription drugs and over-the-counter drugs available in the United States. The NLM uses the UMLS framework to maintain and distribute allowing consistent communication among various hospital and pharmacy systems. It preserves original drug names as synonyms and semantic relationships among drugs.

a project

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

project

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

Data mining

is a process of pattern and relationship discovery within large sets of data. The context encompasses several fields, including pattern recognition, statistics, computer science, and database management.

UP discipline

is a set of functionally related activities that contributes to one aspect of the development project. Include business modeling, requirements, design, implementation, testing, deployment, configuration and change management, project management, and environment. Each iteration usually involves activities from all disciplines.

The Scrum team

is a small group of developers—typically five to nine people—who work together to produce the software. For projects that are very large, the work should be partitioned and delegated to smaller teams. I

Database mgt system

is a software program that is used to manage, organize, and retrieve data and information from a database. DBMS, computer, and database are sometimes used interchangeably.

A field

is a vertical column in a database that contains data that represent the same characteristic, or entity, for all of the records. For example, a column labeled "First Name" would include the first name of each individual. Each first name is in the field for that record.

Vulnerability

is a weakness in the information system, device, or environment that could endanger or cause harm to an informational asset.

Incremental development

is always based on an iterative life cycle. The basic idea is that the system is built in small increments. An increment may be developed within a single iteration or it may require two or three iterations. As each increment is completed, it is integrated with the whole. The system, in effect, is "grown" in an organic fashion. The advantage of this approach is that portions of the system get into the users' hands much sooner so the business can begin accruing benefits as early as possible.

Consolidated Clinical Document Architecture (C-CDA) Release 1.1

is an implementation guide required by Meaningful Use stage 2 for the exchange of patient information within the following measures: transitions of care, data portability, patient engagement, view, download and transmit to a third party, and clinical summary.

validation test

is completed later in the systems life cycle and assesses how a product compares to a predetermined standard, benchmark, or performance measure and how all modules in a technology work as an integrated whole. Uses processes to decide how a vendor supports critical tasks such as medication barcoding or medication reconciliation.

health literacy

is concerned with the ability to access, evaluate, and apply information to health-related decisions,

exploratory test

is conducted early in the systems life cycle after requirements are determined.Conducted on very basic or preliminary designs or redesigns where few resources have been committed to programming the product. This test evaluates the effectiveness of emerging design concepts by asking about basic functionality to users, navigation and information flow intuitive, missing content, and computer experience user needs.

assessment test

is conducted early or midway into the development of a product application on lower-level operations of the application, stressing the efficiency goals of the product (versus effectiveness), and how well the task is presented to users.

Computer science

is defined as the "systematic study of algorithmic methods for representing and transforming information, including their theory, design, implementation, application, and efficiency.

client server

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

Risk

is the likelihood that something adverse will happen to cause harm to an informational asset (or its loss).

Evidence-based medicine

is the management of individual patients through individual clinical expertise integrated with the conscientious and judicious use of current best evidence from clinical care research.3 This approach makes allowances for missing, incomplete, or low-quality evidence and requires the application of clinical judgment

Systematized Nomenclature of Medicine—Clinical Terms (SNOMED CT)

is the most comprehensive clinical terminology and has become an international standard for coding healthcare data.

Negentropy

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

AMIA

is the professional home for informatics professionals who are concerned with basic research in the field or any of the biomedical or health application domains, either as researchers or practitioners.

Complexity theory

is the qualitative aspect tudy of dynamic nonlinear systems "

clinical data repository (CDR)

is the storage component for all instance data of patient clinical records central versus distributed storage encounter-based versus longitudinal-based storage

change theory

is the study of change in individuals or social systems such as organizations. 2 perspectives Kurt Lewin's theory, which focuses on how a change agent can guide the change process. This is referred to as planned change. The second perspective focuses on the process by which people and social systems make changes

HUMAN COMPUTER INTERACTIONS(HCI)

is the study of how people design, implement, and evaluate interactive computer systems in the context of users' tasks and work.

Refactoring

is the technique of improving the code without changing what it does. XP programmers continually do this. Before and after adding any new functions, XP programmers review their code to see whether there is a simpler design or a simpler method of achieving the same result. Produces high-quality, robust code.

Entropy

is the tendency of all systems to break down into their simplest parts. As it breaks down the system becomes increasingly disorganized or random. In data transmission, entropy measures the loss of information when a signal is transmitted. All systems eventually must be replaced.

Equifinality

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

Clinical Documentation architecture (CDA)

is used to represent clinical documents using eXtensible Mark-up Language (XML) and standard terminologies in defined reusable patterns called templates. Specify the structure of clinical documents and semantic relations among the subcomponents of clinical documents. Used to exchange documents such as patient assessments, discharge summaries, imaging reports, and quality reports between healthcare providers.

A database model

is used to structure the data in a database.

Scrum

it begins quickly, is a very intense effort, involves the entire team, and usually only lasts for a short duration. Agile. responsive to a highly changing, dynamic environment in which users might not know exactly what is needed and might also change priorities frequently.

OAT

it increases the use and quality of telehealth delivery through: • Fostering partnerships within HRSA and with other federal agencies, states, and private sector groups to create telehealth projects • Administering telehealth grant programs • Providing technical assistance • Evaluating the use of telehealth technologies and programs • Developing telehealth policy initiatives to improve access to quality health services • Promoting knowledge exchange about "best telehealth practices"

Document literacy:

knowledge and skills needed to perform a search, comprehend, and use noncontinuous texts in various formats such as job applications, payroll forms, transportation schedules, maps, tables, and drug or food labels.

reiterative feedback loop

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

Tall Man Lettering

mixed case lettering ie NiFEDipine

database model

model that is used to structure the data in a database ie- relational database model (microsoft office)

Cognitive Engineering Theories

naturalistic decision making (NDM), control theory, and situation awareness (SA). these theories focus more on the interaction between the context and the individual and are more likely to predict decision making, perception, and other cognitive variables. NDM is a broad and inclusive paradigm. SA is narrower and is particularly useful in supporting design.

patient-centric workflows

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

big bang go live

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

scope creep

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

reporting application

often has a broad range of clinical data that displays to the user (e.g., a 24-hour rounds report that combines lab, vitals, medications, intake and output (I/O), invasive line status, assessments, and plan in one view). doesn't necessarily allow for data entry

USABILITY

often used interchangeably with HCI when the product is a computer. Concerns products beyond computers. The extent to which a product can be used by specific users in a specific context to achieve specific goals with effectiveness, efficiency, and satisfaction. Allows users in a particular context to achieve their goals when interacting with a product. Fundamentally concerned with human performance, and in the case of healthcare, interactions that promote safety rather than only subjective data.

Encounter-based (or episodic) storage

older, hospital based EHRs data are collected according to the current patient encounter and then are usually purged or archived from the repository when the patient is discharged very efficient in terms of system performance for supporting the current encounter because the data in the repository are always the most current and reflect only what has been collected as relevant to the present circumstances

Literate Person

one who can, with understanding, both read and write a short simple statement on his or her everyday life.

interface

or an exchange of information between systems

atomic level data

or the smallest recognizable entity necessary to obtain meaning. To keep data at the atomic level, three fields are used to collect a name—first name, middle initial, and last name The address is divided into the street address, city, state, and zip code. Keeping data at this lowest level provides flexibility in data use.

open systems,

organizations respond to environmental demands and changes in resources through the use of technology, policies and procedures, employees, organizational behavior, and task requirements for work.

Logical Observation Identifiers Names and Codes- Reference terminology LOINC

originally standards for labs but now for other results.

Relevant Data Summary

ou are a primary care physician in a large group practice that uses an electronic health record (EHR). At the beginning of each visit, you view a dashboard (___________________________) of preventive care measures—such as flu vaccines, colon cancer screenings, and cholesterol tests—that are due for your patient, based on age, medical history (problem list), and medication list stored in the EHR.

ERGONOMICS

physical characteristics of tools, systems, and machines.

Project Planning

planning, organizing, and scheduling the project. These activities map out the project's overall structure.

Omaha

practice and documentation standardized taxonomy designed to describe client care. Consist of an assessment component (problem classification scheme) a care plan services (intervention scheme) and evaluation component (problem rating scale for outcomes) It started in nursing homecare and is now used by multidisciplinary team and crossmapped with smomed-CT

The Reference Taxonomy of Clinical Workflows

provides a common set of terms to CDS designers and implementers to support communication about CDS and its use in clinical workflows.

core vendor system

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

Privacy act of 1974

privacy of health data is considered within the larger context of privacy in general. The Privacy Act is not specific to the protection of health data but provides for protection of health-related data in federal agencies with health-related databases such as the Veterans Health Administration (VHA), Military Health System (MHS), and Medicare. Second, this legislation reflected the code of FIPs described previously. Third, included specific legislation about cross-referencing data in multiple federal and state databases because combining databases could create information that clearly identifies individuals.

cost/benefit analysis

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

Microsoft excel

program that provides worksheets comprised of rows and columns. Has the ability to perform simple to complicated math calculations.

adaptive approach

project activities—including plans and models—are adjusted as the project progresses. Include iterations used to create a series of mini-projects that address smaller parts of the application. One of these smaller parts is analyzed, designed, built, and tested during a single iteration; then, based on the results, the next iteration proceeds to analyze, design, build, and test the next smaller part.

phases of the system development project (predictive)

project initiation, project planning, analysis, design, implementation, and deployment

Inception Phase

project manager develops and refines a vision for the new system in order to show how it will improve operations and solve existing problems. Makes the business case for the new system, proving that the new system's benefits will outweigh the cost of development. The scope of the system must also be defined so it is clear what the project will accomplish. Defining the scope includes identifying many of the key requirements for the system.

OAT

promotes the use of telehealth technologies for healthcare delivery, education, and health information services.

Frameworks

provide guidance for understanding essential components that improve the UX. They are helpful in completing UCD processes, usability tests, IT adoption evaluations, and usability research.

The telecommunications department

provides support for the telephone systems within health care organization. Support for a main switchboard both internal and external calls, paging physicians and responding to emergency events such as alarms for fire and emergency (stat) medical events, is part of telephone systems support.

HIPAA Omnibus Final Rule of 2013

provisions to expand and strengthen the privacy and security protections for health information first established under HIPAA. this final rule adds patients' privacy protections, provides individuals new rights to their health information, and strengthens the government's ability to enforce the law.

IMIA

published a Code of Ethics for Health Informatics Professionals that is closely related to the FIPs.This code has two major sections. The first addresses fundamental ethical principles: autonomy, equality and justice, beneficence, nonmalfeasance, impossibility, and integrity as applied to informatics (Table 26.3). The second section concerns the rules of ethical conduct for health informatics professionals.

deployment

put the part of the system that is completed and tested into operation for users

synchronous

real-time technologies. live, two-way interactive telecommunications technology and/or patient monitoring technologies to connect a healthcare provider to a patient for direct care, to other healthcare providers for consultation and collaboration, or to a combination of the two. video conferencing or telephone-based interaction.

The STEEEP

recommendations and redesign principles reflected in health professional education programs to improve the quality of care and are best described as:

Program theory evaluation

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

discount usability methods

reduce the number of required users in usability projects and to use early design prototypes. Offers economies of time, effort, and cost and can be completed at any point in the systems life cycle. The most common technique is heuristic evaluation.

True

refactoring revising, reorganizing, and rebuilding part of a system creates higher quality. True or false

CDS implementors

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

information system development project

refers to a planned undertaking that produces a new information system.

information theory

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

It and IT systems

refers to technology that has the capacity to accumulate, retrieve, control or accept information by electronic means.

Dynamic homeostasis

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

phases

related groups of development activities, such as initiation, planning, analysis, design, implementation, deployment, and support

Social Science Theories

relevant to both the design of interventions and products and the structure of the evaluation include social cognitive theories, diffusion of innovation theory, cognitive engineering theories, and information theories.

NMDS

requires patient demographics, nursing process data (i.e., assessments, diagnoses, interventions, and outcomes), and service elements (e.g., agency and admission and discharge dates) to assess the quality of care.

Organization theory

seeks to explain why and how organizations change and suggests actions to increase effectiveness when planning change.

information literacy

set of abilities requiring individuals to recognize when information is needed and have the ability to locate, evaluate, and effectively use the needed information.

algorithm

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

integrated development environments (IDEs)

sets of tools that work together to provide a comprehensive development and programming environment for software developers

integrated development environments (IDEs)

sets of tools that work together to provide a comprehensive development and programming environment for software developers. smart editors, context-sensitive help, and debugging tools.

Quantitative literacy

skills required for identifying and performing computations, either alone or sequentially, using numbers embedded in printed materials such as balancing a checkbook, figuring out a tip, completing an order form, or determining the amount.

Chaordic

software projects always have unpredictable elements. Agile philosophy recognizes this unpredictability, handling it with increased flexibility and by trusting the project team to develop solutions to project problems. Depending too heavily on a plan and predefined processes exacerbates problems when unpredictable requirements arise. Developers need to accept a certain amount of chaos and mix that with other Agile modeling and development techniques that help to provide order and structure to the project.

Clinical decision support system (CDSS).

software that designed to be a direct aid to clinical decision-making, in which the characteristics of an individual patient are matched to a computerized clinical knowledge base and patient-specific assessments or recommendations are then presented to the clinician or the patient for a decision.

sub-action

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

Asynchronous

store-and-forward

longitudinal-based repository

stores data across all encounters. "cradle to grave" or "womb to tomb" repository because data may extend over the entire lifespan of an individual. disadvantage is that a patient's record (and therefore the entire repository) can grow tremendously large with data that become less relevant over time.

WEDI Workgroup for Electronic Data Interchange

supports standards with the goal of enhancing quality of care, improving efficiency, and reducing cost of healthcare.

Telehealth technologies

telephones; facsimile machines; e-mail systems; cellphones; mobile apps; video conferencing; web-based, remote patient-monitoring devices; transmission of still images; and internet applications (eHealth) including patient portals, remote vital signs monitoring, continuing medical education, and direct consumer applications such as online physician consultations via the internet.

Negetropy

tendency of living systems to grow and become more complex. This is demonstrated in the growth and development of an infant, as well as in the increased size and complexity of today's healthcare system.

acceptance tests

test the business function. Written by the users.

unit tests

test the correctness of a small piece of code, written by developers.

Agile Quality management

testing and quality control are spread across the entire project and usually provide a better-tested and more robust system. Evaluation conducted after each iteration.

visual modeling tools tools

that help analysts create and verify graphical models and may also generate program code. Draw such diagrams as class diagrams or activity diagrams.

XP

the business issues are decided by the users and clients, whereas technical issues are decided by the development team. The plan, especially in the early stages of the project, consists of the list of stories (from the users) and the estimates of effort, risk, and work dependencies for each story (from the development team).

product owner

the client stakeholder for whom the system is being built. maintains the product backlog list. For any function to be included in the final system, it must first be placed on the product backlog. Maintains product backlog. Any request must first be approved and agreed to by the product owner.

Unicode standard code

the data representation method that can be used across multiple platforms to represent text for most languages. Unicode is utilized by many technologies and operating systems.

quality of care

the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge"

Core Process 1

the objective of which is to identify the business need and to get the project initiated. These activities include: ▪ Identifying the problem ▪ Extending the project approval factors ▪ Performing risk and feasibility analysis ▪ Reviewing with the client and obtaining approval

Scrum master

the person in charge of a Scrum project—similar to a project manager. He or she is the focal point for communication and progress reporting—just as in a traditional project. Doesn't set the schedule or assign tasks. The team does. One of the primary duties is to remove impediments so the team can do its work. facilitator.

Data Collection

the process of collecting usable data for analysis

AHIMA

the professional home for health information management professionals, with a focus on those elements of informatics that fall under the health informatics area of applied research and practice

master person index (MPI)

the repository for the information used to uniquely identify each person, patient, or customer of a healthcare enterprise. "golden record"

clinical data repository

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

Knowledge

the synthesis of multiple sources of information, over time to create multiple frameworks, theories or axioms.

Entropy

the tendency of all systems to break down into their simplest parts. As it breaks down, the system becomes increasingly disorganized or random. the tendency of all systems to wear out. Even with maintenance, a healthcare information system will reach a point where it must be replaced.

national council for prescription drug programs- NCPD

think standards supporting drug prescribing, dispensing, monitoring, managing, and paying for meds and pharm services.

testing

thoroughly test that portion of the system

XP system development approach

three levels: system (the outer ring), release (the middle ring), and iteration (the inner ring). occur once during each development project

Chaos Theory, Systems Theory

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

review application

typically focused on one area of clinical data (e.g., a lab results review application, a vital signs review module) doesn't necessarily allow for data entry

CDS designers

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

Graves Model

used Blum's concepts and added Barbara A. Carper's four types of knowledge: empirical, ethical, personal, and aesthetic. Each of these represents a way of knowing and a structure for organizing knowledge. "The Study of Nursing Informatics," by Graves and Corcoran This article is considered the foundation for most definitions of nursing informatics.

relational database model

used by the database programs in the PC-based software office suites (e.g., Microsoft Office). It is also used most often by health care personnel who are not informatics specialists.

Current Procedural Terminology CPT

used to code procedures

ICNP International Classification for Nursing Practice

used to describe nursing phenomena, nursing actions and nursing outcomes. It includes nursing diagnoses, outcomes and interventions.

Clinical Documentation Architecture CDA

used to share documentation across systems, an HL7 standard.

Digital Imaging and Communications in Medicine- DICOM

used to share medical imaging and results.

The network database model

was designed to solve the redundancy problem that occurs with the hierarchical model. The records are linked together by pointers that use a key piece of data (e.g., a patient medical record number). Which pieces of data are linked influences the way that the data are accessed.

to create a baseline standard of quality telehealth care.

what is purpose of Core Principles

fractal-type patterns

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

implementation

write and integrate the computer code that makes that portion of the system work

American Medical Informatics Association Recommendations for Improving Electronic Health Records Usability

• Accelerate a research agenda for usability a human factors in health IT. • Create new policies. • • Develop industry guidelines. Create clinical end-user recommendations.

Types of task analysis

• Interviews • Observations • Shadowing users at their actual work sites • Observing users doing tasks • Conducting ethnographic studies or interviews

Barriers to CDS

• Lack of incentives: healthcare payment model that often fails to reward the provision of higher-quality care • Implementation challenges • Low EHR adoption • Multiple data sources with little information exchange: a patient may have relevant data for CDS stored with many different healthcare organizations. They are not shared with the EHR providing the CDS or not shared in a format that can be readily used by the CDS system. A fundamental requirement for CDS adoption is the ability to exchange information with multiple data sources, ideally through a standards-based approach. • Lack of adequate CDS tools and capabilities in most EHR systems: As mentioned earlier, most EHR systems offer only basic CDS capabilities and do not necessarily replicate successful CDS interventions developed and evaluated with "homegrown" or internally developed EHR systems. • Lack of a framework for sharing CDS logic and capabilities: limited ability to scale most existing CDS logic and capabilities across healthcare organizations and health information systems.1

A real-time live environment

• Video conferencing units with a codec (compressor-decompressor) capable of encoding and decoding the video conferencing data stream. • Peripheral cameras such as high-definition cameras with remote control pan, tilt, and zoom. • Video display devices such as computer monitors, television sets such as ultra-high density plasma or LCD displays, and LCD projectors are used to show the images received from the video conferencing codec. • Audio components (microphones and speakers), a network connection, and the user interface—before the availability of high-bandwidth internet connections, signals were carried over point-to-point connections established via Integrated Services Digital Network (ISDN) lines and plain old telephone service (POTS). The internet has now simplified some of the connectivity issues and the high-bandwidth requirement of video conferencing.

GOALS OF USABILITY

□ Effectiveness is the accuracy and completeness with which specified users achieve specified goals in particular environments, including worker and consumer or patient safety. □ Efficiency includes the resources expended in relation to the accuracy and completeness of goals achieved. □ Satisfaction is the level of comfort and acceptability that users and other people associate with the product or work system and deals with users' perceptions.

Intangible benefits

▪ Increased levels of service (in ways that can't be measured in dollars) ▪ Increased customer satisfaction (not measurable in dollars) ▪ Survival ▪ Need to develop in-house expertise (such as a pilot program with new technology)

intangible costs

▪ Reduced employee morale ▪ Lost productivity (the organization may not be able to estimate it) ▪ Lost customers or sales (during some unknown period of time)

Manifesto for Agile Software Development" identifies four basic values, which represent the core philosophy of Agile development:

▪ Value responding to change over following a plan ▪ Value individuals and interactions over processes and tools ▪ Value working software over comprehensive documentation ▪ Value customer collaboration over contract negotiation

system vision document (SVD)

a document to help define the scope of a new system

Steps for Conducting Usability Tests

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

usability

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

critical path

a sequence of tasks that can't be delayed without causing the entire project to be delayed

How do methodologies, models, tools, and techniques fit together?

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

Agile development

a guiding philosophy and set of guidelines for developing information systems in an unknown, rapidly changing environment compliments adaptive approaches

Health Human-Computer Interaction (HHCI) Framework

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

Project planning (predictive)

In predictive approaches, there is a group of activities that identifies the problem and secures approval to develop a new system map out the project's overall structure

Agile Modeling (AM)

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

information system development project

a planned undertaking that produces a new information system

product backlog

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

(E) in STEEEP

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

(E) in STEEEP

Efficient-Avoid waste, including waste of equipment, supplies, ideas, and energy.

(E) in STEEEP

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

ACE Star Model of Knowledge Transformation Advancing Research and Clinical Practice through Close Collaboration (ARCC) Model of Evidence-Based Practice in Nursing and Healthcare Johns Hopkins Nursing Evidence-Based Practice Model and Guidelines Iowa Model of Evidence-Based Practice Stetler Model of Research Utilization

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

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

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

(P) in STEEEP

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

(S) in STEEEP

Safe-Avoid injuries to patients from the care that is intended to help them.

interative approach (adaptive)

Using iterations, the project is able to adapt to any changes as it proceeds. Also, parts of the system are available early on for user evaluation and feedback, which helps ensure that the application will meet the needs of the users. overlapping phases is adaptive because with each iteration's analysis, design, and implementation, modifications can be made to adapt to the changing requirements of the project

tangible benefit

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

technique

a collection of guidelines that specify a method for how to carry out a development activity or task Sometimes, a technique applies to an entire life cycle phase and helps you create several models and other documents.

UP discipline

a set of functionally related activities that combine to enable the development process in a UP project disciplines include: business modeling, requirements, design, implementation, testing, deployment, configuration and change management, project management environment

sprint

a time-controlled mini-project that implements a specific portion of a system daily meetings with the Scrum team to report issues time boxing

Agile Project Management

a way of balancing flexibility and chaos: how to be agile and flexible while maintaining control of the project schedule, budget, and deliverables. agile time frame-difficult to create/maintain project schedule cost estimates are difficult to make, especially with a project in which the requirements are expected to change throughout. project manager controls cost quality management: each iteration has a deliverable. testing spread throughout project, also process evaluations of each iteration

project dashboard

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

think-aloud protocol

also involves a small number of users and has them talk aloud while they interact with a product. Users voice what they are trying to do, indicate where interactions are confusing, and provide other thoughts about the product during interactions. This allows a detailed examination of the specified tasks, in particular to uncover major effectiveness issues. used in conjunction with other techniques

Extreme Programming (XP)

an adaptive, Agile development methodology an attempt to take the best practices of software development and extend them "to the extreme. characteristics: Takes proven industry best practices and focuses on them intensely Combines those best practices (in their most intense forms) in a new way to produce a result that is greater than the sum of its parts

predictive approach to the SDLC

assumes that the development project can be planned and organized and that the new information system can be developed according to the plan useful for building systems that are well understood and defined. company may want to convert its old networked client/server system to a newer Web-based system that includes a smartphone app. In this type of project, the staff already understands the requirements very well, and no new processes need to be added traditional (70s-90s)

oversight committee

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

XP Core Values

communication- documentation, verbal discussion (open and frequent) simplicity- techniques to reinforce this principle and make it a standard way of developing systems feedback- Feedback on functionality and requirements should come from the users, feedback on designs and code should come from other developers, and feedback on satisfying a business need should come from the client courage- XP practices are designed to give developers the courage to "do it right."

Heuristic evaluations

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

Transition Phase (UP)

complete the beta test and deployment so users have a working system and are ready to benefit as expected one or more final iterations

validation test

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

focused ethnographies

concentrate on individuals' points of view, their experiences and interactions in social settings, rather than on just the actions of those individuals During observations, detailed descriptions are generated with an emphasis on social relationships and their impact on work.

Assessment Test

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

Exploratory Test

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

Elaboration Phase (UP)

define the vision, identify and describe all requirements, finalize the scope, design and implement the core architecture and functions, resolve high risks, and produce realistic estimates for cost and schedule usually several iterations

analysis (predictive)

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

task analysis

generic term for a set of more than 100 techniques that range from a focus on cognitive tasks and processes (called cognitive task analysis) to observable user interactions with an application (e.g., a systematic mapping of team interactions during a patient code). Task analyses are systematic methods that are used to understand what users are doing or required to do with a product by focusing on tasks and behavioral actions of the users and products. These methods provide a process for learning about and documenting how ordinary users complete actions in a specific context. Methods of task analysis include the following: •Interviews •Observations •Shadowing users at their actual work sites •Observing users doing tasks •Conducting ethnographic studies or interviews

support phase (predictive)

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

deployment (predictive)

involves installing and putting the system into operation.

human factors

is "the scientific discipline concerned with the understanding of interactions among humans and other elements of a system, and the profession that applies theory, principles, data and methods to design in order to optimize human well-being and overall system performance." In healthcare, human factors might concern the design of a new operating room to better support teamwork and patient flow.

The Unified Process (UP)

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

goal of EBP

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

usability

is often used interchangeably with HCI when the product is a computer but usability also concerns products beyond computers. Usability is also more focused on interactions within a specific context or environment for a specific product. Formally, the ISO defines usability as the extent to which a product can be used by specific users in a specific context to achieve specific goals with effectiveness, efficiency, and satisfaction. allows users to achieve goals

Human-computer interaction (HCI)

is the study of how people design, implement, and evaluate interactive computer systems in the context of users' tasks and work

adaptive approach to the SDLC

is used when the system's requirements and/or the users' needs aren't well understood. In this situation, the project can't be planned completely. Some system requirements may need to be determined after preliminary development work. (late 90s-today)

Construction Phase (UP)

iteratively implement the remaining lower-risk, predictable, and easier elements and prepare for deployment several iterations

XP Practices (12)

planning-focuses on making a rough plan quickly and then refining it as things become clearer. testing- two major types of tests: unit tests, which test the correctness of a small piece of code, and acceptance tests, which test the business function pair programming- divides up the coding work. First, one programmer might focus more on design and double-checking the algorithms while the other writes the code. Then, they switch roles simple designs-accomplishes the desired result with as few classes and methods as possible and that doesn't duplicate code refactoring the code- revising, reorganizing, and rebuilding part of a system so it is of higher quality owning the code collectively- everyone is responsible for the code continuous integration- embodies XP's idea of "growing" the software. Small pieces of code—which have passed the unit tests—are integrated into the system daily or even more often. on-site customer- embodies XP's idea of "growing" the software. Small pieces of code—which have passed the unit tests—are integrated into the system daily or even more often. system metaphor- s unique and interesting approach to defining an architectural vision. It answers the questions "How does the system work?" and "What are its major components?" And it does it by having the developers identify a metaphor for the system. small releases- point at which the new system can be turned over to users for acceptance testing and even for productive use. forty-hour week and coding standards- set the tone for how the developers should work.

discount usability methods

reduce the number of required users in usability projects and to use early design prototypes. These methods offer economies of time, effort, and cost and can be completed at any point in the systems life cycle. Two common techniques are heuristic evaluation and think-aloud protocol.

incremental development

related concept to interative SDLC based on an iterative life cycle basic idea is that the system is built in small increments may be developed within a single iteration or it may require two or three iterations. As each increment is completed, it is integrated with the whole "grown" in an organic fashion gets into user's hands faster

model

representation of an important aspect of the real world

weaknesses of agile process:

requires meaningful stakeholder participation Agile cannot define what will be delivered at the end of a project. Agile requires a strong team of process subject matter experts. No "Scrum Master" role. Unlike with software development teams, in healthcare there is likely no one who is coaching the team on Agile practices, such as defining work in iterations. This is where a subject matter lead role, sponsor, or even project manager will need to lead. The team needs to function at a high level, and thus requires experienced team members with high levels of demonstrated professionalism.

scrum team

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

tool

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

business benefits

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

product owner

the client stakeholder for whom the system is being built

Scrum

the objective of which is to be quick, agile, and intense and to go the entire distance focus is primarily on the team level social engineering that emphasizes individuals more than processes and describes how teams of developers can work together to build software in a series of short mini-projects Software is developed incrementally, and controls are imposed empirically—by focusing on things that can be accomplished. product backlog

scrum master

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

waterfall model (predictive)

the phases of the project flow down, one after another. This model assumes that the phases can be carried out and completed sequentially. After a project drops over the waterfall into the next phase, there is no going back rigid planning, doesn't work very well

break-even point

the point in time at which dollar benefits offset dollar costs

net present value (NPV)

the present value of dollar benefits and dollar costs of a particular investment

system capabilities

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

Level of formality or ceremony

the rigor of holding formal meetings and producing detailed documentation

detailed work schedule

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

payback period

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

Scrum organization

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

visual modeling tools

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

ergonomics

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

""Manifesto for Agile Software Development" four values

▪ Value responding to change over following a plan ▪ Value individuals and interactions over processes and tools ▪ Value working software over comprehensive documentation ▪ Value customer collaboration over contract negotiation