Informatics Chapter Objectives (1,2,5,6,13,14,22)
Define "federal requirements" in the context of EHR adoption and the impact on health practitioners. (Chapter 6)
(HITECH) Act: Authorized programs designed to improve healthcare quality, safety, and efficiency using health IT. Health Information Exchange networks (HIE): Meaningful Use (MU) of certified EHRs: Provides incentives for healthcare providers to use health IT in a meaningful way - Improve quality, safety, and efficiency in patient care - MU objectives implemented in 3 stages
Explore future directions for EHR adoption and integration. (Chapter 6)
-Personalized medicine- medications, diet & exercise, screening for early disease detection -Advanced computing systems will assist providers in decision-making
Provide guidance for writing social media policies (Chapter 13)
3 critical elements of a social media policy: □ Information disclosure □ Professional integrity □ Productivity
Describe the essential components and attributes of an EHR. (Chapter 6)
Administrative Processes: financial and administrative functions associated with institutional operations and patient management Communication and Connectivity: Provides a medium for electronic communication between healthcare providers and patients Decision Support: Provides reminders, alerts, and resource links to improve the diagnosis and care of the patient. Dentistry and Optometry: Ability to incorporate dental records and vision prescriptions Health Information and Data: Ability to enter and access key info needed to make clinical decisions. Order Entry Management: Ability to enter all types of order via the computer system Patient Support: Provides patient education and self-monitoring tools Results Management: Provides ability to mange current and historical information related to all types of diagnostic reports Population Health Management: Provides data collection tools to support public and private reporting requirements.
Define healthcare informatics. (Chapter 1)
Both a discipline and a profession. Professional groups and agencies include information technologies in their programs, including the healthcare arena. Everything is based on evidence, to prove that we can improve patient care, if we use informatics and help with tasks, such as collecting data. HEALTHCARE PROFESSIONALS MEET INFORMATION TECHNOLOGIST (IT)
Analyze the benefits of an EHR related to cost, access, quality, safety, and effectiveness. (Chapter 6)
COST -Increased productivity -Efficiency in billing -Improved reimbursement rates from insurance companies -Faster payments on accounts ACCESS -Better and faster access to patient care information -Restricts user access so that they can only view information they need to do their job -Clinicians have access to drug information, clinical decision support tools, and resources to help with patient care -Alerts and triggers warn users of potential drug interactions and allergies- prevents medication errors QUALITY -Proving data that are readable, organized, accurate, and complete. -Patient satisfaction, improved care coordination, and support for benchmarking. SAFETY & EFFECTIVENESS -Better management of health information -Improved data integrityReducing medication errors -Clinical decision support- early warning signs of changes in patient status = reduction in medical errors -Clinical and operational efficiencies in communication, workflow, documentation, and administrative functions
Examine EHR applications used in the clinical setting. (Chapter 6)
CPOE- a software design to allowing clinicians to enter orders, meds, dietary services , lab requisitions via a computer. eMAR- a medium to view and document med. use for patients. BCMA- method to address patient safety and reduce errors that occur during administration of meds. RFID- Also used for med. administration by using electronic tags embedded in an ID badge/band to track and monitor activities. Clinical documentation- Application used to record, manage, and report patient care activities. Format may differ between systems and by organizational preference. Specialty Application-Software programs created to address the specific requirements of a specialized department, such as the operating room, obstetric unit or emergency department Clinical Decision Support-Tools and applications that assist the healthcare provider in some aspect of decision making Ancillary system-Software applications used in patient care support departments, such as laboratory, radiology, or pharmacy
Explain how Change theory affects health informatics. (Chapter 2)
Change Theory is the study of change in individuals or social systems such as organizations. The more positive of an approach a company has on the system the more effective the system change will be overall
Analyze terms and definitions associated with electronic health record (EHR) (Chapter 6)
Electronic Health Record: An electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be created, managed, and consulted by authorized clinicians and staff across more than one health care organization. Electronic Medical Record: electronic version of the traditional record used by the healthcare provider. - Electronic information resource used in healthcare to capture patient data - Episodic view of patient encounters - One facility - Patient doesn't enter this data Personal Health Record (PHR): - Component of EHR - Patient/consumer controlled - Could make records more comprehensive
Discuss the significance of health informatics within healthcare delivery (Chapter 1)
Improved efficiency with tasks in the clinical setting, such as scheduling, data collection and entering to overall improve patient care. Prevent medical errors! EHRs make healthcare safer.
Define interoperability and its major elements (Chapter 5)
Interoperability- the ability for systems to reliably exchange data and operate in a coordinated, seamless manner. MAJOR ELEMENTS: Clinical applications can be divided into four broad areas of functionality: REVIEW and REPORTING, DATA COLLECTION, PATIENT MANAGEMENT, and CLINICIAN PRODUCTIVITY.
Discuss learning theory and how it relates to health informatics. (Chapter 2)
Learning theory attempts to determine how people learn and identify the factors that influence that process. This learning theory can help with the understanding of the implementation of a system.
Evaluate stakeholder perspectives and key issues that affect EHR adoption. (Chapter 6)
STAKEHOLDERS -groups of people that share a stake in the outcome of the implementation of EHR. -Stakeholders may have similar concerns about technology but different needs and approaches to a solution COST -Annual maintenance can be 18%-20% of the purchase price -Initial and ongoing training of staff -Technical support -Hardware & software upgrades OWNERSHIP A comprehensive, fully interoperable EHR system would cross institutional boundaries and include patient interaction, making ownership more complex DATA INTEGRITY - Human errors - Critical patient info. should be updated at each episode of care - Lack of educating the staff on the use of EHR in case of system failure, users may not recognize the failure- could lead to inaccuracies in data. -Support mechanisms PRIVACY & CONFIDENTIALLY - Computer breaches , Hackers STANDARDS - A universal language would allow us to consistently capture, represent, access, and communicate clinical data, information, and knowledge across all settings
Use basic terms and resources available to health professionals regarding data standardization, health information exchange, and interoperability. (Chapter 22)
Standards have been established to regulate data exchange and integration using standardized terminologies and other terminology harmonization efforts. Interoperability: the ability of health information systems to work together within and across organizational boundaries to advance the effective delivery of healthcare for individuals and communities.
Review the systems life cycle (SLC) model and describe how it guides system implementation, maintenance, and evaluation of health information. (Chapter 2)
System Implementation- System implemented; mass user training; users begin using system for patient care Maintenance- Integrated into normal operations; evolves over time Evaluation of health information-Evaluation at each step- begins in planning
Explain the technology-related literacies and their relationship to health informatics. (Chapter 2)
Technology-related literacy- Goes beyond being able to read and understand what is written on a computer screen Technology-related literacy includes Health literacy, Digital literacy, Computer fluency, Basic literacy. They all work together to make up technology- related literacy in health informatics
Provide an overview of health informatics-related topics. (Chapter 1)
The use of technology in healthcare is growing at a rapid rate. Overall goal is to support healthcare delivery and improve the health status of all.
Describe the key technical components of electronic health records and their interrelationships (Chapter 5)
Understanding the information technology (IT) architecture underlying a healthcare organization's information systems is foundational to understanding how that system actually functions. Decisions about the technical infrastructure have important consequences for the overall system, in terms of both functional capabilities and support for clinical workflow. Many aspects of a clinical IT infrastructure are unique to the healthcare setting or have different properties or priorities. Understanding the needs of a clinical data repository (CDR) or health data interface network as compared with their counterparts in other industries can mean the difference between successful and failed implementations
Describe social media tools and their benefits. (Chapter 13)
Web-based platforms that facilitate interaction and networking among communities so that sharing can take place online
Explore issues affecting the adoption of current PHRs. (Chapter 14)
a) 2008-3% logged in, 2014-20% logged in. b) Awareness of PHRs, c)usability. d) interoperability of current systems. e) individual's concerns over privacy.f) digital divide. g) provider's promotion of PHRs and integration of them into the clinical workflows. ("note this may be a select all that apply question on the test").
Describe the importance of data exchange across settings and the role of standardized terminologies in the development process of data exchange. (Chapter 22)
a) Health terminologies constantly evolve to include changes in clinical practice, health policy, and advances in science. b) It is unlikely that one standard language will be able to support all clinical practices within the different disciplines functioning within a healthcare system. c) Standards have been established to regulate data exchange and integration using standardized terminologies and other terminology harmonization efforts. Massive volumes of data are collected using free text- developing quality terminologies and classifications is of critical importance for system design, data retrieval and exchange, quality improvement, and clinical research
Explain the different types of PHRs and the pros and cons of each type (Chapter 14)
a) Stand alone personal health records: pros- stores health information on an individual's computer or USB device. cons- they have not been widely adopted, required manual data entry by the user and records are not interoperable b) Untethered personal health records. pros- are web based systems separate from an EHR, are accessible anytime. cons- they do not link to healthcare providers. c) Tethered personal health records pros- linked to a single clinic or healthcare system or patient portal. cons- the individual with multiple health care providers in different health care systems because only the information from the linked system is represented in their PHR. d) Network personal health records. pros-health information can be linked from multiple sources, different healthcare providers, health plans, or labs.
Explain the difference between a standardized reference terminology and an interface terminology. (Chapter 22)
a) Standardized terminology- when a terminology meets specific requirements established by a Standards Development Organization b) Reference terminology- a resource to represent domain knowledge of interest and thus facilitate data collection, processing, and aggregation c) Interface terminology- a collection of task-oriented terms to support data entry and display in EHRs
Provide examples of existing PHRs, including their function and usage. (Chapter 14)
a) VHA's MyhealtheVet (MHV)- for vet. b) Kaiser Permanente (KP), an integrated nonprofit provider of both health insurance and healthcare in the U.S. c) Health Vault-a web based-PHR from Microsoft. The system integrates data from multiple sources. Page 246 (read complete examples details).
Benefits of PHR. (Chapter 14)
a) improved care coordination between providers. b) reduce repetitive tests and conflicting therapies. c) improve patient safety. d) delegation to caregivers (proxy)/family members to access and control their records. e) individualized custom health promotion to improve self-management of healthcare.
Discuss the future of PHRs.. (Chapter 14)
a) increase awareness. b) promote engagement of both patients and providers. c) Improve interoperability. d) improve functionality.
Describe the ideal PHR and its proposed benefits (Chapter 14)
a) it should be comprehensive, longitudinal, data storage. b) Data ownership, control, and privacy. c) portability. d) Data sharing e) access e) Unique and desired services f) Customization.
Describe trends and events leading to the development and adoption of electronic personal health records (PHRs) (Chapter 14)
a) the rise of personal computing devices and the internet. b) the development of electronic health records (EHR). c) governmental policies related to health information technology (health IT). d) consumer demands for the functions provided by a PHR.
Discuss the areas of future research and development in relation to data standardization and exchange from a nursing perspective. (Chapter 22)
• Designing user interfaces using terminologies ○ Interface terminologies can be used to facilitate data entry and storage of clinical data at the point of care • Supporting data retrieval and exchange ○ Data are encoded using unique identifiers or codes to prevent inconsistencies created by typing errors- retrieving coded data is much easier than free-text data • Monitoring the quality of care ○ When clinical data are coded in a standardized way, it is possible to monitor the quality of care by joining multiple data resources- clinicians can examine gaps between current practice and best practice, trends in patient outcomes associated with changes in the organization's policy, practice patterns, and nurse-patient ratios • Discovering knowledge through research ○Clinical researchers can access coded data from clinical repositories
Explain SNOMED-CT. (Chapter 22)
• Systematized Nomenclature of Medicine- Clinical Terms (SNOMED CT): the most comprehensive clinical terminology • Has become an international standard for coding healthcare data • Continually updated to meet users' needs • Contains preferred terms and the related synonyms organized in a hierarchical tree structure with top-level concepts such as body structure, clinical findings, event, observable entity, procedure, specimen, and substance. • Concepts lower in the hierarchy are more specific in meaning that those that are higher
Examine how the adoption of standardized terminologies can assist in the implementation of Meaningful Use criteria of electronic health records (EHRs) (Chapter 22)
• The healthcare delivery system is complex- we must have a comprehensive solution to promote data standardization and exchange • One set of terminology is unlikely to meet the needs of all of the disciplines in healthcare, but adopting quality terminology is required for Meaningful Use of EHRs.
Explore the current and potential use of social media in healthcare and healthcare education (Chapter 13)
○ Increased awareness of healthcare services ○ Dissemination of health promotion and preventative education ○ Recruit new patients- marketing ○ Connect patients to others with similar experiences ○ Increase access to health services
Analyze the issues and challenges associated with the use of social media in healthcare and healthcare education. (Chapter 13)
○ Technology engagement- digital literacy ○ Professionalism- a matter of opinion ○ Mistakes happen easily & violate policies/procedures ○ Patient confidentiality
