Ch. 10 ~ Information technology (exam 3)

information systems

they are tech-based or other based systems, that store, process, and manage information at both the individual level and the organizational level

Personal health record

An electronic form of a patient's medical recordthat the patient can take with him or her or sendto a health-care provider --> here, the patient manages the PHR, including setting up, accessing, and updating the record

is there a difference between the EMR and the EHR?

- EMR is the electronic record of a patient that is used by a single organization - EHR is used by more than one organization, provides information throughout the continuum of care, and can be shared by other organizations -- the EHR also provides interoperability among systems or locations

nursing informatics include:

- analytical and informational sciences including computer science, information science, and many more. - Integrates nursing science, computer science,information science, and information technology to manage and communicate data, information,knowledge, and wisdom

what should nurses review to ensure a smooth transition

- current state - future state - gap analysis - start / stop/ continue documentation

Legislative and Regulatory Impacts onInformatics

- federal and state governments as well as independent institutions are establishing standards and accreditation guidelines to encourage further implementation of information systems within the health-care setting - includes: privacy rule, security rule, and breach notification rule

electronic records do what

- improve research and quality management, metrics, data quality, and access to data that support population health

importance of nursing data

- improving practice - monitoring health-care and patient outcome trends - making judgments based on trends - evaluating and revising patient care processes - collaborating with others in the development - adoption - implementation of information systems

regulatory requirements

- includes the joint commission, the centers for medicare and medicaid services (CMS), and the U.S Department of health and human services are all regulatory bodies that have standards that must be met --> the EHR assists in meeting these requirements

once implementation begins for informatics...

- productivity will decrease initially while staff members are learning and becoming comfortable with the change - people learn at different rates and in different ways - motivation to change comes from a positive assessment of the upcoming change - communication is the key to successful change management - the environment should be one that does not expect perfection.

how can EHRs be strengthened?

- they can be augmented through the use of tools for financials and clinical decision support --> these tools can provide the ability to compare or combine data from clinical, financial, and administrative sources, thus supplying and added benefit to the organization

meaningful use program

-a CMS program that requires use of the electronic record to improve pt care -purpose --> to move health care to electronic records -ensures that certain required components will be available --> many regulatory requirements also have financial implications. This is one of them. meaningful use is a CMS program that requires use of the electronic record to improve patient care

5. A nurse is taking care of a patient whose health information has been requested by a consulting physician during a phone conversation. In providing that health information to the consulting physician, which option would help prevent health information from being distributed to others in consideration of the Health Insurance Portability and Accountability Act (HIPAA)? 1. Use encryption methods to send requested health information. 2. Have health-care workers acknowledge a privacy disclosure s

1 (As the consulting physician is part of the team taking care of the patient, he or she should have access to all relevant information in order to provide appropriate care. Thus, the nurse should use encryption methods to send requested health information. It would not be appropriate to send via e-mail, unless the system was encrypted. Having the health-care worker attest to a privacy disclosure statement at the time of each log-in would not provide a mechanism of action for appropriate transfer of information. Only those nursing staff who are taking care of the individual patient should have access to the medical chart.)

12. A health-care provider uses the computerized provider order entry (CPOE) system to initiate a medication order for a patient. Which option is not included in the CPOE for the medication? 1. medication barcode 2. Identification of allergies 3. Notification of pharmacy 4. transcription of name of medication

1 (Medication barcode refers to the administration process whereby the clinician scans both the patient's identification bracelet in conjunction with barcodes on the medication to help assist in the verification of the five rights of medication administration. Identification of allergies is contained within the CPOE system, along with notification of pharmacy (and other interdisciplinary departments) along with transcription of name of the medication.)

2. A patient is going to a new health-care provider. Which documentation system would contain his or her medical record files and be brought by the patient to the scheduled office visit? 1. Personal health record (PHR) 2. Electronic medical record (EMR) 3. Electronic health record (EHR) 4. The patient does not have access to this type of information.

1 (Medication barcode refers to the administration process whereby the clinician scans both the patient's identification bracelet in conjunction with barcodes on the medication to help assist in the verification of the five rights of medication administration. Identification of allergies is contained within the CPOE system, along with notification of pharmacy (and other interdisciplinary departments) along with transcription of name of the medication.)

15. Which criteria should a nurse use to evaluate online websites for accuracy with regard to providing health information to the public? Select all that apply. 1. Assess the sites for relative strengths and weaknesses. 2. Make sure that there is a physician documented as providing the information. 3. Evaluate websites for use of credible information supported by evidence-based practice. 4. Websites that require a paid subscription typically provide more accurate information. 5. Websites that a

1, 3 (When trying to determine if a website is providing accurate information to the public, it is important for the nurse to assess sites for their relative strengths and weaknesses while at the same time looking to make sure that the information provided is based on evidence-based practice. Whether or not a physician provides information in itself may not indicate that the information is accurate. Whether a website required a paid subscription similarly does not mean that the information provided is accurate. Last, updating websites on a regular basis also does not mean that the information provided is accurate.)

14. When using an electronic documentation system in the clinical environment, which situations should the nurse anticipate will occur? Select all that apply. 1. planned downtime 2. rolling power outages 3. unable to access information once a shift 4. periodic comprise of backup system 5. system maintenance

1, 5 (It is reasonable to expect that with all electronic documentation systems in the clinical environment, there will be some planned downtime for specific upgrades or enhancement to the system. Additionally, when using any electronic documentation system, one should anticipate that scheduled system maintenance will occur. The nurse would not anticipate that there would be rolling power outages or that he or she would not be able to access information once a shift as the system operates in real time. Additionally, the nurse would not anticipate that there would be periodic compromise of existing backup systems.)

13. A new nurse working on a medical-surgical unit needs some assistance with working within the electronic documentation system. Which individuals would the nurse contact in order to develop to help with application of this system in the context of delivery of care? Select all that apply. 1. superuser: expert 2. Clinical analyst 3. Network engineer 4. superuser: shift 5. superuser: unit

1,4,5 (A super user is a designated individual within the organization who has been given additional training with the technology system and as such can help staff with adaptation to delivery of care. One common model utilized in clinical settings is to have three levels of super users—expert, shift, and unit—available to working nurses for assistance. A clinical analyst would provide information relative to design, testing, and implementation of the system. A network engineer would be needed if there were technical issues.)

2 major types of information systems

1- administrative 2- clinical

3 most common types of electronic records

1- electronic medical record (EMR) 2- EHRs 3- personal health records --> all of these work to contain medical information and details about the care these electronic records contain medical information and details about the care provided to the patient

interoperability requirements

1- electronic prescribing with a focus on opioid treatment and monitoring 2- health information exchange to promote the sharing of health information

IOM's 8 core functions of an EHR

1- health and information data 2- result management 3- order management 4- decision support 5- electronic communications and connectivity 6- patient support 7- administrative process and reporting 8- reporting and population health

IOM's report for a future nurse

1- improving access to care 2- fostering interprofessional collaboration 3- Promoting nursing leadership 4- transforming nursing education 5- increasing diversity in nursing 6- collecting workforce data

some examples of the way IT supports safe and quality patient care

1- providing cues in the tools that are used for documentation that align with nursing best practice 2- providing data elements for data collection 3- real-time display of pertinent patient information

3. Nurses on the unit are trying to find out if there is a correlation between hospital admissions for community acquired pneumonia (CAP) and noncompliance with pneumonia vaccinations. Which action would lead to information that might help support the nurses' hypothesis? 1. data mining 2. database 3. data interface 4. demographic data related to gender

1. (Data mining refers to extracting patient information to help identify patterns and trend results. If an association is found with the retrieved data, then the hypothesis will be supported. If no association is found, then the nurses would have to look at other factors. A database is considered a repository of information, but the process of data mining would examine specific characteristics rather than look at the entire dataset. Data interface looks at examination of data points across systems. Knowledge of gender in and of itself will not provide information related to vaccination status and as such would not help to support the hypothesis.)

6. There has been a violation of the Health Insurance Portability and Accountability Act (HIPAA) in the hospital setting. The nurse understands that violation of HIPAA would cause legal action at which level? 1. state 2. federal 3. regional 4. hospital

2 (HIPAA law is initiated at the federal level, not at the state or regional level. While this action may have occurred in the hospital setting, legal action is taken at the federal level.)

7. With regard to the concept of meaningful use, which statement is accurate? 1. Completion of eight core functions according to the Institute of Medicine guidelines 2. Completion of three stages is regulated by Centers for Medicare and Medicaid Services (CMS) 3. Certification by representatives of The Joint Commission that standards have been met 4. Compliance with Institute of Medicine guidelines

2 (Meaningful use is a regulatory requirement that has financial implications for reimbursement of services. It is part of the CMS Quality Incentive program and consists of meeting established standards in three phases: data capture and sharing, advanced clinical processes, and improved outcomes. Completion of eight core functions by the IOM refers to electronic health records. Certification of compliance with meeting The Joint Commission standards addresses the entire health-care organization. Compliance with IOM as an organization does not relate to meaningful use.)

10. Which option would represent a method that can be used to maintain data security when using the electronic medical record system in the clinical setting by a staff nurse on a medical-surgical unit? 1. Utilize a password that contains the nurse's last name. 2. Use a random generator to come up with an access code. 3. Use the same password while employed at the hospital. 4. Keep logged in on the computer throughout the shift as long as a screen saver is in place.

2 (Use of a randomly generated password will help to promote and maintain data security. Using a password that contains one's available personal information such as his or her last name can be considered as being easy to break or re-create. Keeping the same password while employed at the hospital cannot be done as most institutions enforce a mandatory password change at established intervals. Keeping logged in on the computer throughout the shift can lead to a security breach if someone else has access to an already logged-in screen regardless of whether or not a screen saver is used.)

9. A patient is reviewing an explanation of benefits (EOMB) in relationship to insurance reimbursement for a medical evaluation in which he had an incision and drainage procedure performed for an infected abscess as a complication of diabetes. Which code would represent the incision and drainage procedure? 1. discrete data 2. ICD (international classification of diseases) 3. CPT (Current procedural terminology) 4. Data sets

3 (A procedural code relative to the incision and drainage procedure would be reflected by a CPT code. An ICD code would indicate information relative to the medical diagnosis. Discrete data reflect patient information that can be used for interpretation, analysis, and trending of data. Data sets refer to a collection of data entries that help to provide a framework for statistical analysis.)

How would one explain the underlying framework of nursing informatics? 1. Nursing science and philosophical beliefs 2. Informational technology assisting nurses to obtain information relative to patient care 3. Combination of sciences from different disciplines such as nursing, computer, information, and information technology to provide information so as to support and effect change in nursing practice 4. Utilization of electronic documentation in the clinical setting 5. Helps to promote use o

3 (Combination of sciences from different disciplines such as nursing, computer, information, and information technology to provide information so as to support and effect change in nursing practice is the correct answer. Understand that by integrating various components from different disciplines, nursing informatics integrates this information and applications to benefit problem solving and decision making in the clinical environment. Although nursing science is included, philosophical beliefs are associated with philosophy. The application of informational technology does provide information, but this is one aspect of the discipline of nursing informatics. Nursing informatics provides information and approaches to affect nursing practice, not just individual patient care. Utilization of electronic documentation in the clinical setting is an aspect of communication. Helping to promote use of computer technology can be perceived as a secondary benefit of applying nursing informatics,

8. Which is an example of discrete data that could be used by nurses in the research process? 1. Narrative text describing patient's clinical response to pain medication 2. Client's noted response as to why he or she was admitted to the hospital 3. Documented patient weight 4. Documented history and physical by health-care provider

3 (Discrete data can be pulled from a data repository, such as a number or category, and as such is easy to retrieve and then analyze. Narrative text information is much harder to retrieve and analyze in terms of quantitative measurement.)

4. A nurse is admitting a patient to the hospital with congestive heart failure (CHF) using an electronic documentation system. While entering assessment data, pop-up windows are appearing asking for additional information. How would the nurse respond to this situation? 1. Continue to chart information, then close pop-up window and sign off note. 2. Close the pop-up window and disable pop-up blockers from the system. 3. Respond to the pop-up by providing the additional information that is requi

3 (Electronic medical record systems (EMRs) are designed with rules and alerts that serve as prompts or reminders to provide specific information related to a diagnosis or clinical admission. Therefore, it is important to respond appropriately and provide the requested information. Although the nurse may be able to continue charting, closing the pop-up window and signing off without providing the requested information is not reasonable documentation even if the note is signed. Closing the pop-up window and disabling pop-up blockers from the system would interfere with the system management of the EMRs. As rules and alerts typically come up as prompts in a new window, the nurse should not anticipate this as being a computer error. Thus, there is no need to close out of the system and then sign back in to the patient's chart.)

11. Which option is not included in an electronic medication record (eMAR)? 1. List of medications that the patient has been prescribed 2. Times for medication administration 3. Client history and physical 4. Notation of clinical response to medication

3 (The patient's history and physical are not included in the eMAR system. A list of medications that have been prescribed for the patient are included as well as times for medication administration. Additionally, there is a place to document medication administration along with space to note clinical response to medication.)

HIPA

3 rules: privacy, security, and breach notification --> HIPPA was made for safeguard for an individual's health information

roles and responsibilities in informatics departments

Chief Information Officer• Strategic planning for technology and computer systems in an organization Chief Medical Information Officer• A physician who integrates the field of medicine and IT Chief Nursing Information Officer• Integrates nursing and IT; in charge of strategic planning for the information system Project Manager• Responsible for planning, monitoring, and execution of an informatics project Clinical Systems Educator• Analyzes education needs of clinical staff who will utilize information system

overview of IT

Combines computer technology with data and telecommunications technologies to provide solutions to the health-care industry • Supports safe and quality patient care • Facilitates decision making in all nursing roles

data mining

EHRs contain a lot of data. to collect data from these records manually is an unrealistic undertaking. Data mining is the process of extracting specific data or knowledge that was previously unknown. --> this can be used to understand patients' symptoms, predict diseases, and identify possible interventions.

network

Fundamental framework of an information system that allows electronic devices to transfer information between each other. --> the internet is the most common example of a public network

what is nursing informatics

integrates nursing science with various analytic and informational sciences _ " to identify, define, manage, and communicate data, information, knowledge and wisdom in nursing practice"

american recovery and reinvestmant act of 2009

Health-care component known as the Health Information Technology for Economic and Clinical Health Act, or HITECH Act -->helped to advance the field of informatics. --> the health-care component of this bill is known as the health information technology for economic and clinical health act or HITECH act.

How Informatics Contributes to Patient Safety

Patient safety is the most important directive for electronic health record design. The use of evidence-based cues within the information system, rules and alerts, and reminders that decrease memory-based care contribute to improved patient outcomes.

3 stages of meaningful use

Stage 1: Data capture and sharing Stage 2: Advanced clinical processes Stage 3: Improved outcome

development of the concept of data along a continuum

These nursing informatics theorists describe the components of the Data, information, knowledge continuum as follows: 1- data - discrete elements that lack interpretation 2- information - data that has been interpreted, organized, or structured 3- Knowledge - information that has been synthesized so that interrelationships have been identified 4- Wisdom - appropriate use of knowledge in managing or solving human problems

interfaces

Used to match data points from one system to the other so data can be communicated between systems or sent to a main information system for collective use and analysis • Can send information as it is gathered (real-time processing) or with a delay (batch processing) to save system resources • Can also allow devices to communicate directly to an information system * these can allow devices to communicate directly with an information system, thereby reducing the time nurses spend manually entering the information, as well as eliminating data entry errors

Data

a collection of information, facts, or numbers. --> nurses collect and manage data constantly when caring for patients. Nurse leaders and managers gather, manage, analyze, and interpret data to ensure effective operation of the unit as well as safe and effective delivery of nursing care

application

a computer program that performs a certain function or activity. Switching between applications can be either seamless or very apparent.

data security

a critical aspect in a health-care environment. patient data can be lost, changed, or held hostage by viruses or malware attacks. --> there are several tools and methods used by health-care organizations to maintain data security --> the most basic level of security includes the use of unique usernames and passwords, biometric identification, and security token identification --> the use of unque usernames and passwords to allow the system to collect an audit trail of who has accessed the system, when they did, and often which areas of the information system they accessed

clinical data repository

a database in which data from a ll information systems within an organization are kept and controlled. --> Organizations may extract information from the database and use it to create new knowledge, establish best practice, or predict outcomes. this extraction is a form of data mining.

firewall

a mix of hardware and software tha aims to prevent unauthorized access to a health-care organization's system

alerts

a more obstructive decision support tool is an alert. this could be straightforward, such as a warning that a patient has tested positive for a resistant organism and to implement precautions per institutional policy. --> can be used to require the nurse to acknowledge the warning or select a reason for override ex: providers receive an alert when ordering a medication that is contraindicated for the patient. They may remove the warning and remove the order, or they may override it for a valid reason

patient portals

a secure website that provides patients access to their EHR data. lets patients email providers, request refills, and view information such as immunizations, medications, and lab results --> inpatient component provides discharge instructions, results on lab tests, medications, and clinician notes

data set

a standardized group of data. there are multiple types of data sets, which may be used for billing, research, or other data uses --> data sets are used to provide a standard set of data on a patient, as well as standard definitions of data elements

data encryption

a tool used to protect information that is transferred electronically

administrative

administrative systems encompass both administrative and financial systems

information systems used in healthcare

all nurses must understand some basics of information systems --> information systems are usually composed of several different applications that work together to provide a comprehensive record eMAR CPOE barcode medication administration patient portals telehealth

what do information systems provide?

an infrastructure for the organization - requires resources for development, maintenance, and eventual retirement - requires thoughtful decision and input from the members of the organizations, including nurses (it is a large investment)

nursing informatics requires all nurses to develop what?

basic computer literacy and information management skills

maintenance

begins after the implementation and close of the project. many of the project team members move on to other activities, but some team members continue to support the application and make enhancements to the system throughout the rest of the system life cycle

risk with alerting

can lead to an alert fatigue, where they become used to the warnings and start to ignore them, often not realizing what the warnings said. Rules and alerts should be used on a limited basis and focus on the most crucial patient care issues

information technology

combines computer technology with data and telecommunications technologies to provide solutions to the health-care industry

essential part of nursing informatics

computerized patient record --> these are needed for communication. legal documentation, and iblling and reimbursement

nursing informatics facilitates ____ in all nursing roles through the use of information systems and technology

decision making

nursing informatics facilitates what?

decision making in all nursing toles through the use of information systems and technology

privacy rule

designed to safeguard an individual's health information

addressing change management

essential for any informatics projects, such as the successful transition to a new EHR. --> change management includes analysis of how workflow will change.

security rule

establishes a set of national standards to protect electronic health information

how are information systems purchased?

from a vendor, an information system may be a homegrown system as well

superusers

generally representatives from the local nursing locations who receive enhanced training to help with implementation success and stability over the life of the system. they understand the new application and can help the staff members in the area integrate the new system or application into the future state workflow

implementation of an informatics project

identify potential issues in advance of implementation of the project is important. - superusers - conversion

requirements for ARRA

include metrics to improve patient care, quality, and public health. --> initially provides incentives when metrics are met by both physician practices and hospitals to move toward electronic documentation and processes to improve patient care

use of data in informatics

maintaining a high level of data quality is essential in informatics. standardizing data can help to provide a higher level of data quality. --> data quality should be kept in mind during design of electronic records is that discrete data elements are available

partial downtimes

may affect certain parts of the system that will determine what information is accessible

system downtime

need to be developed and communicated before implementation. staff members must know how they will obtain information when the system is down. --> there needs to be different levels of downtime taht will determine what may can be accessed in the system can be planned or unplanned

entire network downtime

no information is accessible

planned downtimes

occur when the system is taken down to make some spacific changes such as upgrades or other enhancements --> planning and communication done in advance to lessen effects. backup systems are put in place

conversion

point when you should switch from one system to another or turn on a new application

intranets

private company networks that allow employees to easily access, share, and publish information using internet software

barcode medication administration

process in which clinicians use a barcode reader to verify patient identity and drug information immediately prior to giving medication to a patient --> requires both the patient identifier (wrist band) and drug packaging to have a barcode. one of the best patient safety tools at the point of care

System Development Life Cycle (SDLC)

refers to the development of a system from the time it is first studied until the time it is updated or replaced

breach notification rule

requires all health-care organizations to report any data breaches

implementation support

requires technical, vendor, education, and support resources

telemedicine vs teleheatlh

telemedicine refers specifically to remote clinical services, whereas telehealth may also include provider training, administrative meetings, and continuing medical education in addition to clinical services telehealth is the use of digital technologies to deliver medical care, health education, and public health services by connecting multiple users in separate locations -- Specialty in which electronic devices andtelecommunication technology are used to serveeducation and health care to clinicians andpatients

electronic medication administration record (eMAR)

the application that supports documentation of medications. --> has many features that enhance patient care. it provides a list of medication orders and when they are due to be administered. --> once the medication is given, it also provides a place for documentation --> after it is documented, it also provides historical information regarding medications that have been given

database

the central place that stores data --> databases provide a key location for data to be stored and retrieved for analysis when needed. this is where the importance of discrete data, discussed in more detail later in this chapter, comes into play because these data can be stored in the same place within the database and easily compared - clinical data repository

biggest benefit of electronic records

the multiple clinicians are able simultaneously to access the patient's electronic chart, and this eliminates the risk of loss that often results from tracking paper documentation

system qcquisition

the process of obtaining an information system. The document that initiates this process with the vendor is a request for information (RFI) form from the vendor or a request for proposal form

coding

the process of taking the data in a patient's file and applying an industry-standard medical code to the data --> 2 basic types of coding systems: international classification of diseases, and current procedural terminology --> both of these coding systems are used to provide information for billing, research, and other data purposes

Rules and alerts

these can be used to provide decision support. --> should be used on a limited basis and focus on the most crucial patient care issues --> Rules require an action within the system to trigger or fire them, such as a patient being admitted with certain criteria, a lab result, or information documented by a health-care professional. ex: during flu season an organization may have a rule that is triggered by all patients admitted with an inpatient status from october through april that reminds the health-care provider to perform flu screening

unplanned downtimes

these do not allow the same preparation as planned downtimes. there needs to be a plan for these situations. the backup plan may e another electronic system or paper. --> a challenge here is communication to end users as the downtime is taking place. these must be established before.

computerized provider order entry (CPOE)

this allows providers within a health-care organization to enter orders directly into a patient's record, thus omitting any transcription errors. It also allows integration of decision support systems (such as allergy alert) and helps standardize patient care by encouraging groups of evidence-based orders. -CPOE can also improve workflow among ancillary services by allowing them to receive notice of an order immediately, rather than depending on someone to monitor paper orders

how do nurse leaders use data mining

to extract, predict, evaluate, and apply knowledge to develop best practices in patient care, delivery, staffing and scheduling, error reporting, incident reporting, budgeting, and forecasting and planning

robotics

used in healthcare for packing and handling inpatient medications to assistance with surgical operative procedures.

standardized languages

used in information systems to enable understanding among disciplines and across information systems --> this common language allows for streamlined sharing of information because the same terms are used by everyone to describe the same condition --> important for effective data mining and is required for nursing documentation in EHRs

vendors

vendors provide either a suite of applications within a single system to satisfy the organization's patient care needs or best-of-breed systems, which are designed for a specific specialty and do not tend to integrate well with other systems

nursing informatics allows nurses to deal with what?

volumes of information on a daily basis

decision support systems

with the use of an information system, a health-care organization may choose to use this. - this system provides warnings or other decision support methods to help health-care professionals become more aware of certain clinical information (infection precaution) or use evidence-based practices

artificial intelligence / machine-learning

with the widespread implementation and use of electronic data in health care, technologies are emerging that use this data to predict outcomes and improve patient care. this can be done thorugh including AI. * this is a Computer science theory that uses statistical techniques to give a computer or artificial intelligence the ability to progressively improve performance on a given task ex: AI was used to help researchers during covid by assisting with finding relevant research articles and proposing factors for a potential vaccine