informatics test 1

which of these home health clients is least suitable for telehealth services

-54 year old client with congestive heart failure who is developing new onset chest pain

confidentiality

-a situation in which a relationship has been established and private information is hared with the expectation that it will not be re-disclosed -the protection of healthcare information is mandated by the health insurance portability and accountability act (HIPAA) and the joint commission requirements -breaches occurs from carelessness of users -common mistake including not disposing confidential information appropriately (throwing away patients papers instead of shredding them -key to assessment, diagnosis, and treatment of health related problems

web-based

-advantages: can be accessed from any networked PC, provides 24-hour availability, easily updated and revised, may allow user to bookmark and return to the same spot, can be proficiency -disadvantage: require knowledgeable webmaster, requires an existing infranet that can be accessed by all employees

job aids

-advantages: decrease need to memorize, decrease training time, decrease help request, can be created quickly and inexpensively -disadvantage: not effective if access is liminted

instructor-led class

-advantages: flexible, easy to update, can include demonstration, allows for individual help, can test proficiency -disadvantages: often relies on lecture, increase class size makes decreased effectiveness of demonstrations, consistency varies with trainer, difficult to maintain pace good for all

computer-based training

-advantages: self-paces, interactive, increased retention (used technology to teach technology), 24 hour availability (good option for night shift, can be offered online or offline, can be done in increments, facilitates mastery learning, emulates "real" system without threat of harm -disadvantages: time and labor intensive to develop and revise, requires great attention to accompanying materials, limited usefulness of vendor supplied materials that are not specific to customization, lacks the flexibility of access to an actual information system- only programmed options can be tried

password selection

-choose passwords that are at least 12, preferably 14 characters long -select stronger passwords for higher levels of security -avoid using the same password for more than one application -do not use the browser "password save" feature -use combination of uppercase and lowercase letters, numbers, punctuation marks, and symbols -do not use proper names, initials, words taken from the dictionary or account names -do not use words that are spelled backwards or with reversed syllables -do not use dates or telephone number, license plate, or social security numbers -do not store or automate passwords in the computer -avoid repeated numbers or letters -keep passwords private -change frequently -use entire keyboard

implications for mobile computing

-devices should require authentication and encryption to safeguard information security -devices should never be left where information may be seen by unauthorized viewers -devices are easily stolen -verify wireless networks before use -responsibility for information and information system security is shared through handheld computers, PDAs, and smart phones

impact of HIPAA

-enforces standards for health information and guarantee security and privacy of health information -lowers healthcare fraud and abuse -makes providers more cautious of what they are sharing -healthcare consumers feel more comfortable about sharing personal information with health care professionals

end users

-healthcare workers who use an information system to view or document client information -grouped by job class responsibilities to guide what applications and level of access they will have in the information system -most can have access to view demographic data, allergies, diagnosis, emergency contacts, and recent medical history -information system require technical, operational, and training support -training considerations include system upgrades to the computer training environment, training responsibility for updates regarding regulatory changes, raining budget and cost, trainer selection and supervision, realism in training, confidentiality. competency and meeting the training needs of all end users

historical background of telehealth

-interest declined with a decrease in funding during the 1980s -technical developments in recent years makes telehealth feasible -the military development applications that feed images from the battlefield for the treatment of casualties and robotics equipment for surgery -began with telephone consultants -US government sponsored efforts (NASA, military, Indian health services, and grant monies) -state sponsored efforts (healthcare for inmates)

safety conerns with internet

-overload (results in slowness because of increasing users) -security: construct separate firewalls, keep antiviral systems up to date, limit access to webpages -hackers: can endanger costumers and libel charges -contamination of viruses, worms, and other malware

major issues in healthcare

-patient safety through CPOE, e-prescribing, barcodes, decision-support software, and smart technology -nursing shortage, work flow changes, evidence based nursines, genomics, magnet status push, IT as means of retaining aging nurses, pressure to implement IT, research, disease management, costomer demand, and online report cards

legal and privacy issues of telehealth

-reimbursement and licensure issues remain two of the major barriers to the growth and practice of telehealth CMS will reimburse for follow-ups -medicaid reimbursements: discretion of states -balanced budget act of 1997: payment for some services -do not count telehealth follow-ups as the same as face-to-face so not always reimbursed -has to be secure video because of HIPAA (cannot skype, facetime, or text)

patients rights regarding PHI

1. obtain a copy of health records 2. request amendment or addendum to their PHI 3. receive notice of an agencies privacy practices and how an agency will use PHI only for treatment, payment, and operations 4. permission required to use and disclose PHI (specific: what PHI is to be shared, with whom, for what purpose) 5. receive accounting of disclosures- obtaining report on when/why information was shared 6. access PHI (except psychotherapy notes) 7. right to request that information be shared or not shared with other care providers 8. file privacy law complaint 9. HIPAA exceptions

identification of training needs

Who? (end user and user class), what?, when?, how?, how long?, where?, with what?

data mining

a technique that uses software to look for hidden patterns in a system -uses artificial intelligence, statistical computation, and computerization to drill down through the large data sets in order to identify potential inter-relationships -determine healthcare outcomes -also used in politics to determine outcome of votes -naturally leads to the knowledge discovery in database paradigm -software includes trendstar, IMB watson (healthcare), SPSS (statistical analysis), SAS (business solutions)

which of the following is an example of data cleansing or scrubbing?

abbreviations are compared using software to ensure standard language used

data integrity

ability to collect, store, and retrieve correct, complete, current data so it will be available to authorize users when needed -systematicity must exist -crucial because data serves as a driving force in treatment decision making -faulty or incomplete data gives rise to poor quality information and poor decisions

a certified nursing assistant (CNA) at a local nursing home logs on to the faculties clinical information system. the CNA can only see information about the clients that were assigned by the registered nurse for that day. the CNA cannot see finical data regarding any of the assigned clients. this situation is an example of which of the following?

access levels

the nurse gathers much data when caring for clients, which is an example of the higher level information useful in caring for clients?

after receiving rocephin 1.0 gram IV yesterday, the client has a decreased temperature and reported feeling better

protected health information (PHI)

all individually identifiable health data including formation -treatment and care that may be transmitted or maintained in any form or medium -exceptions to PHI that can be disclosed: education records covered by the family educational right and private act and records described at 20 USC

radiology system

allows direct order entry or accepts orders from other systems -provides scheduling of diagnostic test -generates clients instructions -permits transcription of results -provides picture arching and transmission of images and tracking of film -generates charges once procedures done -generates safety checks such as MRI questionnaire or pregnancy screen -PAKS: provider can pull up patients image in their own room

public health informatics

application of information and computer science and technology to public health practice, research, and learning

on-the-job training

appropriate for short training, subjects to interruptions -advantages: individualized, permits immediate application, can test proficiency -disadvantage: trainer often does not know educational principles, may lose productivity of two workers, seasoned employees may pass on poor habits, difficult to achieve with many interruptions

barcode

automates the storage, dispensing, returning, restocking, and crediting of barcoded medications improving safety by ensuring that the right medications is dispensed to the right patient

information systems interact to provide checks and alerts throughout the medication ordering and administration process. which of the following are steps in this process in which bar codes are utilized for medication ordering and administration?

bar code on patients identification bracelet is scanned

firewalls

barrier created from software and hardware, blocks unauthorized access while permitting authorized communications

antivirus

can locate and destroy malware such a viruses and worms

data

characters, numbers, or facts gathered for analysis and possibly late action -ex: clients vital signs, length of hospital stay, marital status

which statement is true regarding telehealth?

clients may stay within their own community to be assessed and treated, lowering potential cost

philosophy

commitment to: effort, resource allocation, budget, hours, staffing, timing in relation to go-live date -should be free of work related interruptions and distractions

monitoring system

compromised of devices that monitor and automatically input into a clinical information system -alarms notify caregivers of readings that are outside the range of "normal" -alarms, portable monitoring, record of past abnormal findings, download capabilites

dental informatics

computer and information sciences to improve dental practice, research, education, and management

security is an important issue for all websites, which best secures a website?

construct separate firewalls for each web server

advantages of telehealth

continuity of care; centralized health records; incorporation of the health care consumer as an active member of the health team; collaboration among healthcare professionals; improved decision making; education of healthcare consumers and professionals; higher quality of care; removes geographic barriers to care; may lower cost for healthcare; and improved quality of health record

information system securtiy

continuous protection of both information housed on a computer system and the system itself from threats or disruptions -goal: protection of patient confidentiality, protection of information integrity, and ready availability of information when needed (availability is dependent of survivability)

timetable and training schedule

coordinated with go-live dates -considerations: number of persons to be trained, amount of time required to train each user group, amount of time needed for all training, and budget requirement

system check

data cleansing, forces users to complete "required" felids to progress (allergies and height and weight), altering users of duplicate entries, generating reports of actions that have no been completed -mechanism provided by the computer system to assist users by prompting them to complete a task, verify information, or prevent entry of inappropriate information

spyware

data collection mechanism that installs itself without the users permission -can include cookies that track web use as well as applications that capture credit card, bank, and pin numbers

offline storage

data that are needed less frequently, or for long-term data storage, as may occur with old client records -can be done on any secondary storage device -access data is slower -disadvantage: easily lost or stolen and need storage space

laboratory information system

decrease turn around time, decrease duplicate testing, decrease errors with patient ID, identification of abnormal results -alerts providers when new or stat tests results are back or valves are critical -send results to clinical systems for view -accept input from bedside devices -generate labels for specimen collection -uses rules to order additional test when indicated -documents are very specific -automatically transfer results to EMR from lab system, integrates POC results into EMR

user class

defines the level of access to an information system -defined and categorized as the personnel who performs similar functions -based upon job description: refines the type of training classes needed for implementation (nurses and physician may need the same training)

training plan

designed and developed to help ensure instructional success and address; provides blueprint for employes and focuses on developed knowledge and skills -align with the organizations strategic initiatives -designed to ensure instructional success -components: philosophy, identification of training needs, approach, timetable and training schedule, resources (instructors and budget), and evaluation strategy

clinical information systems

directly support care. may be stand alone or integrated systems -goal: quick, safe access to patient information -support safe patient care through: ordering appropriate medications and treatments, implement cost-effective treatments,prevent duplicate treatments -includes nursing, monitorting, order entry, laboratory, pharmacy, and radiology

advantage of impleting a CPOE system

each department is notified simultaneously

ensure accuracy of data

educate staff, perform system checks, verify data, and minimize fraudulent information

E-care

electronic provision of health information, products, and services online as well as the electronic automation of administrative and clinical aspects of care deliver

email is an efficient means of disseminating information quickly and inexpensively. however, HIPAA regulations affect email and routing infrastructures. when you potentially sensitive information be sent via email?

email is sent encrypted

super user

employees who are proficient in the use of the information system and can serve as a mentor to other end users in their department -may be from any user class and have special knowledge in both the information system and clinical area -understand department workflow

no agreement exist between healthcare groups in the US regarding a common electronic data interchange standard. this statement is true because of which of the following?

experts have not yet finished the discussion phase leading to agreement

validation

facts and studies are sited; information traced back to reputable university or organization

minimize fraudulent information

financial loss (organization and payer); potential negative credit reporting; patient harm and death -prevent strategies: biometrics, ID, acknowledgement that fraud is illegal

security measures

firewalls, antivirus and spyware detection, access on a need to know bases, automated sign off, physcial restrictions to system access

training

focuses on acquiring practical knowledge and skilled behaviors and is an organized approach to providing large numbers of staff and healthcare workers with the knowledge needed to use an information system in a clinical setting -healthcare workers use information systems to access and document patient information training plays a vital role in the adoption and integration of computer technology

approach

follows needs assessment -determines: content, instructional interventions, delivery methods, creation or purchase of training materials, in house trainers vs outsources training

to be able to process data into information, it is important to:

have quality data

telehealth growth areas

homecare: monitoring, prompts to take medication, prompts for appointments, smart homes, robots -disease management: reduce frequency of admissions and number of hospital days

complete

if it doesn't have all information, it is not complete -shouldn't have to go to another site for more information

evaluation quality of information

includes credentials; validation; accuracy; complete; and date; bias and sponsorship

what is the main goal for using technology in health care today

increased patient safety

administrative system

indirectly support patient care by supporting the processes involved in providing the care indibidual systems may stand along -includes: client management (registration), scheduling, financial, payroll, human resources, quality assurances, contract management, risk management (cross reference and compare losses), materials management

which one of these are true about using automated pharmacy systems?

individual patient data is made available to pharmacist with up-to-date information about allergies

which of the following is the protection of information against threats to its integrity, inadvertent discloser, or availability?

information security (private is choice)

computer provider order entry (CPOE)

initiative by the institute of medicine and leap frog group to improve the quality of care and reduce medication errors -eliminates transcription error, expedites treatment, encourages more accurate, complete orders, mobile computing -has to be complete before the prescription goes through -benefit: safety, checks for order accuracy and completeness, speeds the implementation of ordered diagnostic tests and treatments, enhance staff productivity, save money, and improve outcomes -safety is enhanced through built in reminders and alerts -challenges: buy-in by staff, changes to work-flow process, difficulty system sign-ons, limited access, slow response time, funding, physician pre-conceived perceptions

nursing informatics specialty

integrates nursing science, and information science into nursing practice -facilitates the integration of data, information, knowledge, and wisdom -through use of information structures, information processes, and information technology -sophisticated level of understanding and skills in information management and computer technology -has entry-level care competencies, experiences nurse, and informatics nurse combinded

information

interpreted data -ex: individual temperature readings are data but when plotted on a graph and changed over time, it turns into information

which of the following measures should organizations take to protect PHI?

keep medical records in supervised or locked areas, require passwords to access computerized medical records, and put policies in place that prohibit employees from looking at everyones

physical restriction

locking server room, setting up surveillance, tracking devices, disabling the drives

automatic sign off

logs a user off after a specific time period of inactivity

IT as means of retaining aging nurses

make it easier to direct care, reduce injury to patent and nurse when transporting nurse, and easier to read screens

which of these is the best example of a monitoring system?

manual blood pressure of 132/82 is entered into the vital section of the graphic sheet

blended approach

maximizes retention, target different learning styles, and encourage active participation -ex: webinar for overview, simulation for hands on training, and a web meeting for demonstration

medical informatics

may be used to refer to the application of information science and technology to acquire, process, organize, interpret, store, use, and communicate medical data in all of its forms in medical education, practice and research, patient care, and health managements -the term may also refer more broadly to the application of informatics to all of the healthcare disciplines as well as the practice of medicine

which of the following can be used with CISs to allow information entry and retrieval at the point of care or wherever it is needed by the health care professional?

mobile and wireless technology

clinical health informatics

multidisciplinary feild that focuses on the enhancement of clinical information management at the point of healthcare throught improvement of information processes, implementation of clinical information systems, and the use and evaluation of CDS tools as a means to improve the effectiveness, quality, and value of the services rendered

extranets

networks that sit outside the protected internal network organization and use of internet software and communication protocols for electronic commerce intranet -outside supplies and costumers- may be used to price and purchase healthcare products -more private than public website but more open than intranets -more prone to hackers and viruses than intranet

which of the following is considered a threat to information quality?

not verifying information

which of the following is not considered an issue pertaining to the practice of telenursing?

nursing must be certified in telehealth nursing

wisdom

occurs when knowledge is used appropriately to manage and solve problems -results from understanding and requires human efforts -comes from cumulative experience -perform intervention and continue to monitor

order entry systems

orders entered into the computer are transmitted to the appropriate areas such as the pharmacy, laboratory, radiology, and social services -direct entry of orders by the physician, nurse practitioner, physical therapist, or other provider -makes more efficient -can be wireless; computer on wheels

intranets

private computer networks that are accessible only by an organization member or employee -only accessibly by organization employees -collaborative sharing of information among employes of an organization -internal publications like organizational policies -protected by firewalls -alot safer from getting hacked

computerized physician order entry (CPOE)

process by which the physician or another health care provider directly enters orders for client care into a hospital information system -reduces transcription errors, decreased in elapsed time from order to implementation, more complete orders, prompts when certain test are due -includes entry with simple checking for allergies and drug interactions

evaluation

proficiency testing: may be done electronically, can provide immediate feedback, and reflects need for basic skills to perform job -need to incorporate procedures -must consider how remediation will be handled

E-prescribing

provides a longitudinal prescrition record, checks formulary compliance and reimbursement, alerts about interactions, reminders to order home medications for discharges patients, and eliminates phone authorization for refills

online storage

provides access to current data -rapid, using high-speed hard disk drives or storage space allocated on the network -can be costly

pharmacy information systems

provides checks in order and administration process using evidence- based guidelines; decreased errors when used with barcode technology; use lab results, allergy, and integration information from clinical systems; track medication use, cost, and billing -makes sure patients are getting the right amount of medications at the right times -barcode needs to be on person -pharmacy dispensing systems (robots), unit base dispensing cabinets in care areas, and barcode and RFID medication administration -e-perscribing -also tracks use and wastage of narcotics, to help track nurses diverting narcotics

computer literacy

refer to a familiarity with the use of personal computers, including use of software tools such as word processing, spreadsheets, database, and email -majority of students admitted to nursing schools now enter with some levels of this

date

should have date made and date revised -unreliable if its too far dated

training nonemployees

significant number of students require training and access; must consider this population in overall training plan; must identify most efficient manner to train; must consider implication for non employees who violate need to know access -1 option: include students in existing end user class, eliminating the need to create a separate curriculum. ex: nursing student attend a class with register nurses -other option: include use of technology-based learning utilizing faculty to instruct students of integrating an informatics course into this curriculum

accuracy

site should identify legitorganization; identify contact persons or cite references

privacy

state of mind, freedom from intrusion, or control over the exposure of self or of personal information (choice) -includes right to determine: what information is collected, how it is used, the ability to review collected information for accuracy and security -ethical principle or legal obligation that a healthcare professional will not disclose information relating to a patent unless the patient gives consent permitting the disclosure

consumer health informatics

study of patient use of online information and communication to improve health outcomes and decisions

who are employees who are proficient in the use of the formation system and can serve as mentors to others in their department

super users

nursing information system

supports the use and documentation of nursing activities and provides tools for managing the delivery of nursing care -goals: support the way the the nurses function and support and enhance nursing practice through online data base -advantages: improves access to information, better documentation, improved quality of care, improved productivity and communications, tracking capability, and enhanced regulatory compliences -telephone triage, follow-up calls, checking biometric measurements, education, consultations, patient assessment, and electronic house calls

knowledge

synthesis of information from several sources to produce a single concept -logic process of analysis and provides order to thoughts and ideas and decreases uncertainty -validation of information -ex: do we need to perform an intervention of the blood pressure?

nuring shortage

technology can help prevent errors by giving busy nurses a system of double check

evidence bases nurses

technology is expected to help remove barriers in information and evidence-based practive

for over 40 years, the US government played a major role in the development and promotion of telehealth through various agencies. which was the first telehealth service provided?

telephone consultation

telehealth uses

telephone triage

E-health

term used interchangeably with telehealth -provision of electronic health information, products, and services using information technologies

firewall

the "gateway" to a computer which examines material coming into the computer before permitting access -the more firewalls, the better safety

HIPAA

the Health Insurance Portability and Accountability Act -purpose: curtail healthcare fraud and abuse, enforce standards for health information, guarantee the security and privacy of health information, and assure health insurance portability for employed person -consequences: fines for institutions and individuals who violate the act. nurses can also be brought up by the state board

information literacty

the ability to recognize when information is needed as well as skills to find evaluate and use needed information effectively -forms bases for ongoing learning -can recognize significant, relevant research and know how to apply it to practice

bioinformatics

the application of computer and IT to the management of biological information including the development of data bases and algorithms to facilitate research

health informatics

the application of computer and information science in all basic and applied biomedical sciences to facilitate the acquisition, processing, interpretation, optimal use, and communication of health-related data. -the focus is the patient and the process of care, and the goal is to enhance the quality and efficiency of care provided

medication errors have been on the rise over the past decade. a national initiative to minimize....

the bar codes of the clients identification bracelet and prescription medication are scanned and compared

which statement regarding pressures that drive the healthcare delivery system today is NOT accurate?

the current and projected nursing shortage may be eliminated by instituting technology enhancements in acute care settings

e-prescribing

the electronic transmission of drug prescriptions from a hospital-based ordering system or handheld device -fewer errors, improved communication, greater efficiency, lower cost, less time -incorporates list of patients allergies and other medications

which of the following is an example of a system check?

the nurse ask clients to verify their names when prompted by the computer system

informatics

the science and art of turning data into information

nursing informatics

the use of information and computer technology to support all aspects of nursing practice, including direct delivery of care, administration, education, and research -evolving over time

threats to system security

thieves (cyber criminals steal personal data, destroy files, and create confusion often times for personal gain); hackers; terrorist; poor password management (sharing, posting IDS, staying logged in); compromised device (theft of information from a stolen device); viruses, worms; fires and natural disasters (manual back up procedures may compromise information); human error (access wrong patients information); unauthorized insider access (proper access levels and what to do when employee quits or is terminated)

work flow changes

through electronic records and more sophisticated data analysis techniques

which of the following statements is true regarding telehealth?

tlehealth can be used to treat prisoners

which example is the most appropriate use of data mining?

to document quality improvement when problems are identifies and targeted on a medical-surgical unit (bigger picture)

how can the trainer create an environment in which the staff will retain the information?

train when the employees do not have clinical duties

another employee needs to use the computer and ask to use it while you are logged on. if you allow that person to access the computer under your log in you have violated HIPAA

true

a _________ is one of the greatest threats that may come from inside sources, namely employees, contractors, consultants, outsources services, and vendors who view information inappropriately, disrupt information availability or corrupt data integrity?

unauthorized user

information system

use of computer hardware and software process data into information to solve a problem -support and enhance health care

telenursing

use of computer technology and telecommunication for the delivery of nursing care -within the practice of nursing (more for education and reminders) -telephone triage (audio but increased liability because patients could misinterpret) -follow up calls -checking biometric measurements (blood pressure, weight management) -education -consultations -patient assessment (as long as it doesn't involve smell or touch) -electronic house calls

proficiency examination is planned to ensure that employees have the required knowledge to use a new electronic medical record system. what is the most appropriate method at proficiency?

use of computerized, scenario based questions and specific actions the learner must complete

telehealth (telemedicine)

use of telecommunication technologies and computers to exchange healthcare information -provide services to patients at a location different from that of the people -people don't have to travel long distance -include health promotion (alerts and reminds to take medications), disease prevention, diagnosis (type 2 diabetes, high blood pressure), consultation, education (in geographically remote areas), and therapy (speech and phyceatric therapy) -more likely to fund rural areas and prison infirmary or third work countries, not urban settings

smart technology

used to refer to technology that integrated, saves time, and physical burdains, and improves patient outcomes

verify data

verbally (best choice): asking date of birth; on-screen review (problem with visually impaired); and printouts (have to shred correctly)

resources

where will the budget for resources come from? (salaries for trainers, support staff, replacement staff, and employes trained constitute that largest item in a training budget) -who will coordinate training? -who will teach?

credentials

with a professional; hospitals, universities, government; .edu or .gov