Quiz 1 Informatics
five core competences that should be achieved by all healthcare professionals
1. Delivering patient-centered care 2.Working as part of interdisciplinary teams 3.Practicing evidence-based medicine 4. Focusing on quality improvement 5.Using informatics
Turley's Nursing Informatics Model
The five primary concepts are cognitive science, information science, computer science, informatics, and nursing science. The concepts of cognitive science, information science, and computer science are depicted as three overlapping circles, with informatics at the junction of all three. Nursing science surrounds and provides a context for the overlapping circles.
The NI Pyramid Model
The four primary concepts are raw nursing information, the technology, the users, and the goal or objective, arranged in a pyramid with a triangular base. Although the stated purpose was to describe concepts in NI, the model probably better describes human-computer interaction concepts.
A committee
a relatively stable and formally composed group
System Theory
•A system is a set of related interacting parts enclosed in a boundary
Advantages of groups
1.Greater knowledge and information: Obtaining a broader and wider range of knowledge and experiences creates a higher-quality input into group problem solving. The insights of one member can stimulate the thinking of other group members. This is especially true with today's highly specialized health care workers. 2.Increased acceptance of solutions: If there is a decision to be made in an organization, people can get together in a group to talk about it so that the people themselves are more committed to the decision 3.More approaches to a problem: Complex problems are typically more manageable when a number of perspectives are mixed together to address the problem. Individual expression: Groups allow for individual expression, and in organizations specifically, there may be few mechanisms for expression of individual perspectives. Sharing information and getting input are best done in groups 4.Lower costs: If the group is functioning in a positive and constructive manner, the use of a group can be less expensive than the use of individual effort to accomplish a task.
Disadvantages of groups
1.Negativity: Research suggests that people working in groups tend to be more negative than if they work individually. 2.Passivity: People may become passive participants in a group versus being active participants. Unbalanced participation may lead to feelings of resentment, jealousy, and disillusionment. Some may "slide by" on the work effort of others. 3.Individual focus and individual domination: Individuals may have difficulty thinking globally and objectively. Instead, they may focus on how a discussion affects them as an individual. 4.Groupthink: Groups may reach quick agreement and be unwilling to challenge or debate. Sometimes decisions result from pressure—by the group, leader, or external deadlines—to complete the work 5.Vocal minority: Groups have a tendency to allow the most vocal members of a group represent the overall views of the group even when they are the minority of members 6.Ethical dark side: Groups have the potential, based on the power of the group, to not support ethically positive choices. 7.Disruptive conflicts: If people perceive an adverse effect on a group member or members or if they feel threatened, conflicts usually emerge.
Nursing outcome databases are critical for two reasons
1.Nurses are able to measure and document how nurses influence patient outcomes across care providers for populations of patients 2.The study of nursing -sensitive outcomes allows comparisons among interventional strategies and advances the science of nursing care delivery.
Advantages of groups
1.Synergy: Groups have the potential to perform at higher levels than an individual would on his or her own. 2.Positive individual impacts: Groups have the potential to improve every member of the group or at least help each one reach his or her highest potential. 3.Motivation: Groups have the potential to motivate their individual members and provide encouragement, constructive criticism, and praise. 4.Diverse thinking: Groups have the potential to engage in diverse thinking, thereby identifying problems that might otherwise go unnoticed or ignored and exploring solutions. 5.Linkage to the larger organization: Groups have the potential to make individuals feel more connected to the larger organization.
Meaningful use of HIT brought with it four goals:
1.improve quality of care and safety 2.engage patients and their families in care 3.improve care coordination 4. improve population health
Systems Life Cycle (SLC)
8 Stages •Analyze •Plan •Develop or Purchase •Test •Implement •Maintain and evolve •Evaluate •Return to analyze
Cloud Computing
A system in which all computer programs and data is stored on a central server owned by a company (e.g. Google) and accessed virtually Computing services are supplied by public or private organizations and shared by the community. Examples are software as a service, infrastructure as a service, and platform as a service.
Medical error reporting system
Blame-free reporting of a system or process failure or results of proactive risk assessments
Nursing Management Minimum Data Set (NMMDS)
Formulation of the NMDS was an effort to standardize the collection of essential nursing information for comparison of nursing data
Goosen's Framework for Nursing Informatics Research
Goosen's model builds on and extends the Graves model. The concepts of data, information, knowledge, decision, action, and evaluation are depicted as six boxes, with each of these concepts progressing to the next. Each of these six concepts interacts with the seventh concept in the model: Nursing Management and Processing to Patient Care.
Human factors science focused on:
Human performance Interaction of humans in different situations Application to errors in healthcare environments and with technology
data dictionary
Is the source for medical vocabulary terms used in the system Is the source for term relationships (eg, hierarchical, associative) Provides unique codes for terms stored in patient records Is the key to a "content-driven" infrastructure
Reason's Swiss Cheese model
Layers of defense Latent conditions Gaps Near-miss event Adverse advent Active failures Trade-offs
Longitudinal
Longitudinal record stores a patient's lifetime record, no matter where or when the data were collected. Improves the view of long-term data relevant to the patient's care, but may decrease data access performance and increase data clutter. Stores data across all encounters. Is often referred to as a "cradle-to-grave" or "womb-to-tomb" repository because data may span the entire life span of an individual
Clinical Decision Support System
Provides the environment for automated assistance with clinical and healthcare processes Clinical decision support system (CDSS) parts: Inference engine Data services Communication system Can be data-driven, time-driven, or user-driven
IRO Model
This model includes two component models. First is a five-phase systems development life cycle depicted as a circle in the center of the IRO model. This is surrounded by the process of evaluation, which occurs throughout the life cycle. The outer ring includes four constructs that interact with each other and the inner circle. These are (1) the client, (2) NI interventions, (3) outcomes, and (4) the cultural, economic, social, and physical context.
Collaboration
a complex phenomenon that brings together two or more individuals, often from different professional disciplines, who work to achieve shared aims and objectives such as working together toward a common goal for the patient
A task force
a temporary group of individuals formed to carry out a specific mission or project. Task forces may solve a problem that requires a multidisciplinary approach.
Digital literacy
ability to operate and understand digital devices of all types, including the technical skills to operate these devices, the conceptual knowledge to understand their functionality, and the ability to creatively and critically use these devices to access, manipulate, evaluate, and apply data, information, knowledge, and wisdom in activities of daily living.
Contemporary skills
ability to use current computer applications such as word processors, spreadsheets, or an internet search engine, using the correct tool for the right job (e.g., spreadsheets when manipulating numbers and word processors when manipulating text).
What are some responsibilities or roles of Nursing Informatics?
allows nurses apply their understanding of IT to assist the healthcare team in managing data and assimilating increasingly complex information to achieve the desired outcomes. •
Nursing classifications
also referred to as interface terminologies, are generally implemented at the point of care to describe and document clinical practice
A council
an advisory group of individuals who may be elected or appointed and that has a defined charter or purpose and meets regularly
Data
are defined as discrete, objective entities, without interpretation, no meaning, no organization
Foundational concepts
are understanding the how and why of information technology. This knowledge gives the person insight into the opportunities and limitations of social media and other information technologies.
A group
as any collection of interconnected individuals working together for some purpose
team building
as the process of deliberately creating and unifying a group into a functioning team.
Types of teams:task force
consists of members from different departments who have gotten together to achieve a task, usually the team is disbanded when the project is accomplished
Successful use of technology
dependent on basic literacy, computer literacy, information literacy, digital literacy, and health literacy
A work group
is a collection of individuals who are charged with completing a specific activity or mission.
Information
is data that are structured, organized, or interpreted, answer basic who what when types of questions
Wisdom
is knowing when and how to apply evidence based knowledge with client information to solve problems. Answers the Question Why
Knowledge
is synthesized information with identified relationships and meaning. Understanding and answers the question how
Distributed Storage
model allows storage of data at source systems. May improve reliability because there is no single source of failure for data and so decreases need to map data to a central model, but may decrease data access performance and can create multiple sources of failure. each data collection application stores its information in its own repository, and data are federated (joined) through a real-time data access methodology. In this case, a results review application may have to access separate repositories for the lab, microbiology, or radiology, for example, to provide a composite view of information
Central storage
model implies that all data are stored in a single location (eg., single database). Can improve data access capabilities/efficiency, but increase data integration complexity. a single repository is used to store all (or most) clinical data, and it is used as the primary source for reviewing data. There may still be departmental or function-specific clinical information systems, as well as automated data collection devices, that are used to gather data.
Informatics nursing specialists (INSs)
the practice of nursing informatics views the relationship of data, information, knowledge, and wisdom as a continuum with increasing complexity and interrelationships as nurses aggregate and apply it in decisions making.
Communication
the style and extent of interactions both among members and between members and those outside the team. It also refers to the way conflict, decision making, and day-to-day interactions occur
available
• Accessible • Secure • Timely or current
Information Quality
• Accurate • Coherent • Comprehensive or complete • Objective or free from bias • Verifiable
knowledge
• Accurate • Relevant • Type
usable
• Appropriate or relevant • Economical • Clear or understandable
Attributes of Data, Information, and Knowledge Data
• Descriptive qualitative • Measurable quantitative
format
• Quantifiable • Precise • Organized for specific use
Electronic Medical Records (EMR)
•"A longitudinal collection of electronic health information for and about persons [immediate] •Electronic access to person- and population-level information by authorized users •Provision of knowledge and decision-support systems [that enhance the quality, safety, and efficiency of patient care] and •Support for efficient processes for health care delivery"
systems life cycle (SLC) model
•A commonly used model of the stages within this change •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.
Clinical data repository (CDR)
•Accessibility is the ability to get to repository data in an efficient manner. •Reliability refers to the dependability and consistency of access to the repository. •Security covers many technical aspects of the repository to prevent inadvertent and inappropriate access to data.
Clinical decision support systems (CDS)
•CDS may be designed to remind clinicians of things they intend to do but should not have to remember, •Provide information when clinicians are unsure what to do, •Correct errors clinicians have made, or •Recommend that the clinicians change their plans.
Clinical Data Repository Characteristics
•Central versus distributed storage model •Encounter-based versus longitudinal record
Managing disruptive behavior in groups
•Clarify working expectations •Avoid embarrassment •Structure positive/constructive group roles •Employ peer pressure
Electronic Health Records Component Model
•Clinical decision support system •Knowledge base •Data dictionary •Clinical application •Clinical application •Repository
Disruptive roles and behaviors
•Compulsive talkers A common disruptive behavior is seen in individuals who are compulsive talkers. Often their behavior can be modified •Nontalkers The no talkers are the quiet ones. They may not be comfortable speaking in front of a group or may process information more slowly than other members of the group •Interrupters The interrupter must be addressed because this person is demonstrating a lack of awareness or self-control. The interrupter can be a problem in groups because the person can stifle conversation •Squashers Squashers try to squash an idea before it is even developed. Suggestions about processes or procedures that have not been proven or even tried are much easier to criticize than are facts or •Distracted or unreliable members Unreliable members really may not be committed to the group's work. They may be distracted, which they exhibit in a variety of ways, including arriving late, leaving early, answering phone calls, texting, or reading e-mails during the meeting.
Pitfalls of assigned teams
•Confusion about the team's work •Team lacks real authority •Team lacks structural team building •Dysfunctional behavior is tolerated •Team-based outcomes/coaching are lacking
International Efforts and IT
•Cost was the largest healthcare issue •Dynamic market forces, such as the increasing role of government, workforce shortage, demand for improving access to care, and consumerism, are requiring providers and health plans to rethink traditional business models. •Adoption of new digital health IT advances (e.g., EHRs, mHealth applications, and predictive analytics) are transforming the way physicians, payers, patients, and other healthcare stakeholders interact and function within the healthcare system. •The increased use of government regulation to protect patient health, safety, and privacy
Change Theory
•Each of the theories presented in this chapter includes an element of change. Change theory is the study of change in individuals or social systems such as organizations. Understanding change theory provides a framework for effectively planning and implementing change in social systems and organizations.
Group Roles and Behaviors
•Initiator •Encourager •Opinion giver •Clarifier •Listener •Summarizer •Tension reliever •Compromiser •Gatekeeper •Harmonizer Recorder
Master person index (MPI)
•Is a repository of information that uniquely identifies the patient •Usually includes demographic data age, DOB •Maps a patient's unique identifiers to a single, "master" identifier •Is used by clinical and administrative applications to search for and identify patients
Quality of care
•Is the extent that health services increase the likelihood for the desired health in a population •Standardize information
Patient safety
•Is the freedom from accidental injury as a result of medical care or medical errors. • An error is defined as the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim.
Group Rules
•Meetings begin and end on time •Members need to be on time, prepared, and stay for the entire meeting •No cell phone or computer use during the meeting except on scheduled breaks •One person speaks at a time •No sidebar conversations
System Integration and Interoperability
•Must be able to integrate and interoperate with many systems in the health IT infrastructure. •Interface engines are critical integration components. Interface engines decrease the number of interfaces and the complexity of a highly integrated system. •Interoperability standards for messaging and terminology exist. Examples: SNOMED CT, ICD-9, ICD-10, CPT, RxNorm.
Effective Meetings
•Preparing for meetings In the most effective groups, all members are clear about the purpose of the meeting they are attending, are prepared, and help the group stay focused on the purpose •Leader duties The leader of the group can facilitate meeting effectiveness by preparing and dealing with both the task and the people involved. The leader should listen carefully, process the interactions, control the flow, and keep the meeting directed toward accomplishing the objectives
Why Groups Are Formed
•Provide a personal/professional socialization and exchange forum •Provide a mechanism for interdependent work accomplishment
Clinical Decision Support Systems (CDS)
•Provide clinicians, patients, or caregivers with clinical knowledge and patient-specific information to help them make decisions that enhance patient care •Patient's characteristics are matched to evidence-based parameters present in patient-specific assessments.
Six aims from the Institute of Medicine (IOM) state that healthcare should be
•Safe •Effective •Patient-centered •Timely •Efficient •Equitable
Group Decision Making Process
•Slow process •Time consuming •May be vested in a group •Authoritative decision making •Consultative decision making •Joint decision making •Delegated decision procedure
Business Intelligence and IT Examples
•Treatment planning based on symptoms •Coordinating and scheduling staff based on patient volumes •Facility supply chain management •Provider alerts that tell providers what services patients need, eliminating need for multiple visits •Identifying patients who need follow-up care •Create and track against scorecards for readmission rates
Effective teams have:
•Trust •Communication •Collaboration •Teams grow and mature •Team norms are established
Classification systems
•are non-combinatorial hierarchical languages designed to categorize objects. In health care classification systems, objects classified are generally patient diagnoses. •Outcomes, and care interventions. •systems help provide the evidence-based terms used in documenting practice, and the reference terminology model provides the structure for organization with other interdisciplinary teams' documentation in the database.
grand theory
•are wide in scope and attempt to explain a complex phenomenon within the human experience. For example, a learning theory that attempted to explain all aspects of human learning would be considered a grand theory. •A common expression in computer science is "garbage in garbage out," refers to the input-output process.
Electronic documentation
•patient's clinical assessments, preferences, planning, scheduling treatments, and direct-care interventions to support more efficient and effective decision making and clinical care delivery
Stages of Theory Development
1. A specific phenomenon is observed and noted. 2. An idea is proposed to explain the development of the phenomenon. 3. Key concepts used to explain the phenomenon are identified, and the processes by which the concepts interact are described. 4. A conceptual framework is developed to clarify the concepts and their relationships and interactions. Conceptual frameworks can be used to propose theories and generate research questions. The conceptual framework can also be used to develop a conceptual model. A conceptual model is a visual representation of the concepts and their relationships. 5. A theory and related hypothesis are proposed and tested. 6. Evidence accumulates, and the theory is modified, rejected, replaced, or it gains general acceptance.
A team
"a small number of people with complementary skills who are committed to a common purpose, performance goals, and approach for which they hold themselves mutually accountable."
Health literacy
"the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions
Types of Teams
Three types of teams found in health care are: (1) primary work teams (2) leadership teams (3) ad hoc teams
Electronic Medical Records
purpose is to document patient care in a single repository as a clinical, financial, and legal record. The EMR is a virtual record of retrospective, concurrent, and prospective information to support continuous, efficient, and integrated health care
encounter-based
stores data according to the current patient encounter and may purge or archive records at the end of the encounter. May improve access performance for data relevant to current encounter, but can't get a longitudinal view of data.
Scope of Health IT examples
•Tele-intensive care units (ICUs). •Behavioral health at-a-distance. •Sensors. •Healthcare for islanders
Business intelligence
•as a platform that enables and organization to build application capabilities for analysis such as online analytical processing (OLAP), information delivery such as reports and dashboards, and platform integration such as business intelligence metadata management and development environment with self-service analytics allowing professionals to perform queries and generate reports on their own".
Learning Theory
•attempts to determine how people learn and to identify the factors that influence that process.
Clinical information systems (CIS)
•capture clinical data from device download monitors, ventilators), scanning (e.g., barcodes on medications or supplies),
Storage for patient data
•considered the most essential aspect of the EHR: Stored data such as laboratory, VS, medications
Theory
•explains the process by which certain phenomena occur. •Theories vary in scope depending on the extent and complexity of the phenomenon of interest.
Meaningful Use (MU)
•is using certified EHR technology to improve quality, safety, efficiency, and reduce health disparities; engage patients and family; improve care coordination, and population and public health; and maintain privacy and security of patient health information. •will result in better clinical outcomes, improved population health outcomes, increased transparency and efficiency, empowered individuals, and more robust research data on health systems
