Terms

information science

"Information science is a discipline that investigates the properties and behavior of information, the forces governing the flow of information, and the means of processing information for optimum accessibility and usability. It is concerned with that body of knowledge relating to the origination, collection, organization, storage, retrieval, interpretation, transmission, transformation, and utilization of information. This includes the investigation of information representations in both natural and artificial systems, the use of codes for efficient message transmission, and the study of information processing devices and techniques, such as computers and their programming systems."

GIGO

"garbage in garbage out,"

workarounds

(a method used to circumvent a problem without solving it).

subsystem

A subsystem is any system within the target system.

theory

A theory explains the process by which certain phenomena occur.16 Theories vary in scope depending on the extent and complexity of the phenomenon of interest.

closed systems

Closed systems are enclosed within an impermeable boundary and do not interact with the environment.

evidence-based practice (EBP)

Knowledge is at the heart of EBP. Within the EBP paradigm, knowledge must be transformed through a number of forms to increase its utility at the point of care.1 The ultimate goal of EBP is improving systems and microsystems within healthcare, with these improvements based on science. Using computerized methods and resources to support the implementation of EBP holds great potential for improving healthcare. Delivering evidence to the point of patient care can align care processes with best practices that are supported by evidence. EBP is about using evidence to guide practice.

Kurt Lewin

Kurt Lewin is frequently recognized as the father of change theory.61 His theory of planned change divides change into three stages: unfreezing, moving, and refreezing.

user interface

Logically, a well-designed user interface would require fewer resources to support, less time and effort in training, and decreased time on support calls.

biomedical informatics

Many educational programs changed their names to biomedical informatics to solve this issue, and there have been suggestions to change the names of the IMIA and AMIA to use biomedical in place of the term medical30; however, not all members may consider the term biomedical as more inclusive than medical informatics.

wisdom

Nelson Model. Within this model, wisdom is defined as the appropriate use of knowledge in managing or solving human problems. It is knowing when and how to use knowledge in managing patient needs or problems. Effectively using wisdom in managing a patient problem requires a combination of values, experience, and knowledge. The concepts of data, information, knowledge, and wisdom overlap and interrelate as demonstrated by the overlapping circles and arrows in the model.

discount usability methods

Nielsen developed techniques he called discount usability methods to reduce the number of required users in usability projects and to use early design prototypes. Meant for UX experts, this method has proven useful for others involved in designing projects.64,65 A discount usability method offers economies of time, effort, and cost and can be completed at any point in the systems life cycle. The most common technique is heuristic evaluation.

open systems

Open systems are enclosed within a semipermeable boundary and do interact with the environment. Open systems have three types of characteristics: purpose, structure, and functions.

comparative effectiveness research

PBE requires a multidisciplinary team approach for comparative effectiveness research and ensures inclusion of a wide spectrum of variables so that differences in patient characteristics and treatments are measured and controlled statistically.67 The next step for comparative effectiveness research is to conduct more rigorous, prospective large-scale observational cohort studies.

e-iatrogenesis

Patient harm caused at least in part by the use of health IT.

receiver

Shannon-Weaver Information-Communication Model. The sender is the originator of the message or the information source. The transmitter is the encoder that converts the content of the message to a code. The code can be letters, words, music, symbols, or a computer code. A cable is the channel, or the medium used to carry the message. Examples of channels include satellites, cell towers, glass optical fibers, coaxial cables, ultraviolet light, radio waves, telephone lines, and paper. Each channel has its own physical limitations in terms of the size of the message that can be carried. Noise is anything that is not part of the message but occupies space on the channel and is transmitted with the message. Examples of noise include static on a telephone line and background sounds in a room. The decoder converts the message to a format that can be understood by the receiver. When listening to a phone call, the telephone is a decoder. It converts the signal back into sound waves that are understood as words by the person listening. The person listening to the words is the destination.

Disorder Domain

Showden uses the term disorder to name this domain. Each of the other domains is focused on the type of situation or state of the organization. In the fifth domain, it is not the organization that is in disorder but rather the leader. The leader does not know which domain is predominant. If the leaders are aware of their confusion, they can begin by using the Framework to assess the situation. However, managers do not always realize what they do not know. If they do not realize the need to diagnosis the situation, there is a tendency to continue using their preferred management style.

sociotechnical system

The expansion of mobile health (mHealth) and electronic health records (EHRs) in particular has resulted in complex interactions among multiple users, IT products, and environments, all with varying characteristics. These complex interactions, known as a sociotechnical system, coupled with complex health systems, are magnified as users interact with health IT.

lead part

The mainframe is the lead computer or lead part. This structure demonstrates a centralized approach to managing the computer structure.

supersystem

The supersystem is the overall structure in which the target system exists.

think-aloud protocol

Think-aloud protocol involves a small number of actual application users (vs. experts). Even as few as five users can offer rich data about UX issues. Users talk aloud while they interact with a product and observers record their experienced usability problems. As users voice what they are trying to do, they indicate where interactions are confusing and provide other thoughts about the product. This allows a detailed examination of the specified tasks, in particular to uncover major effectiveness issues. This method may be used in the design, redesign, development, or evaluation of applications at any time in the systems life cycle. Think-aloud methods are often used in conjunction with other techniques.

user-centered design

UX experts employ a process of user-centered design composed of the following three axioms: • An early and central focus on users in the design and development of products • Iterative design • Systematic measures of the interactions between users and products

Ergonomics

is used interchangeably with human factors by the HFES in Europe, but in the United States 354and other countries, its focus is on human performance with physical characteristics of tools, systems, and machines.

information theory

refers to more than one theory. In this chapter, two theoretical models of information theory are examined: the Shannon-Weaver information-communication model and the Nelson data-information-knowledge-wisdom model (DIKW) that evolved from Blum's and Graves's initial work.

reiterative feedback loop

that exists within these systems has a major effect on how inputs will affect outputs. A minor change in input can create a major change in output. On the contrary, a major change in input can result in minor changes in output.

work breakdown structure (WBS)

work breakdown structure (WBS) is a list of all the required individual activities and tasks for the project.

andragogy

Andragogy is the art and science of helping adults to learn.

Chaotic Domain

In the chaotic domain, there is no discernable relationship between cause and effect; therefore it is impossible to determine and manage the underlying problem. In healthcare, the term crash is often used for this situation.

information literacy

Recognizing the changing world of information creation, access, and use, ACRL has expanded the definition of information literacy: Information literacy is the set of integrated abilities encompassing the reflective discovery of information, the understanding of how information is produced and valued, and the use of information in creating new knowledge and participating ethically in communities of learning.

The diffusion of innovation theory

Rogers. Based on their responses, individuals can be classified into five groups—innovators, 30early adopters, early majority, late majority, and laggards—with the number of individuals in each group following a normal distribution.

nursing informatics

The 1980s were characterized by several publications dealing with computers and nursing. Well-recognized examples include the first edition of Essentials of Computers by Virginia Saba and Kathleen McCormick in 1987 and Guidelines for Basic Computer Education in Nursing by Diane Skiba and Judith Ronald. In 1988, the first book using the term nursing informatics (NI) in its title was published. This book, authored by Ball, Hannah, Newbold, and Douglas, was titled Nursing Informatics: Where Caring and Technology Meet.18 In 1990, one of the first medical informatics textbooks, titled Medical Informatics: Computer Applications in Health Care and Biomedicine, was published by Shortliffe, Perreault, Wiederhold, and Fagan.

medical informatics

While the term medical informatics was not explicitly defined in these initial publications, it was generally accepted to mean the use of a computer to process medical data and information.14

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.

human-computer interaction (HCI)

is the study of how people design, implement, and evaluate interactive computer systems in the context of users' tasks and work. As with human factors, HCI draws on the disciplines of psychology and cognitive science, computer science, sociology, and information science and on the discipline of the user at hand. HCI can be addressed throughout the systems life cycle to include the design, development, purchase, implementation, and evaluation of applications.

Tall Man Lettering

(i.e., the use of mixed-case lettering) for look-alike names of medications 322recommended by the Institute for Safe Medication Practices (ISMP).

conceptual framework

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.

production job

A computer program that is run by the computer operations staff on a routine basis to perform some data-processing need of the organization such as producing patient statements or payroll checks

interface engine

A computer system or program that translates and formats data for exchange between two or more independent computer applications. The purpose of the interface engine is to ensure that messages are reliably delivered to the receiving application programs (Ch. 6).

contextual inquiry

A method of usability testing that involves interacting with users in their actual sites or setting. Focused ethnographies and contextual inquiry involve interacting with users in their actual sites or "field settings." They concentrate on individuals' points of view and their experiences and interactions in social settings, rather than on just the actions of those individuals.75,76 However, researchers are observers rather than a part of the society. During observations, detailed descriptions are generated with an emphasis on social relationships, interactions with IT, and their impact on work. Ethnographies have become important in understanding the UX and describing the impact of complex products.

Simple Domain

A simple domain is highly ordered. Cause and effect are evident to the people involved in the setting. Processes are carried out using known procedures that are effective and efficient. This process involves (1) sensing or collecting the pertinent data, (2) categorizing the data, and (3) applying the appropriate response.

digital literacy

ALA's Digital Literacy Task Force, describes it as "the ability to use information and communication technologies to find, understand, evaluate, create, and communicate digital information, an ability that requires both cognitive and technical skills.

human factors

According to the Human Factors and Ergonomics Society (HFES), human factors is "the scientific discipline concerned with the understanding of interactions among humans and other elements of a system, and the profession that applies theory, principles, data and methods to design in order to optimize human well-being and overall system performance."

critical care monitoring applications

Applications and devices used for electronic monitoring of critically ill patients. These devices are attached to the patient to collect and record specific data (e.g., electrocardiograph data) from the patient on a second-to-second basis. These applications are used to support the care of critically ill patients and may be interfaced with clinical information systems

attributes

Attributes are the properties of the parts or components of the system. When discussing computer hardware, these attributes are usually referred to as specifications.

theoretical model

Because theoretical frameworks explain a combination of related theories and concepts, they can be used to guide practice and generate additional research questions. With this definition, one can argue that the concept of a theoretical framework can be conceived as a bridge between a middle-range theory and a grand theory. A theoretical model is a visual representation of a theoretical framework. Many of the models in healthcare and health informatics use a combination of theories in explaining phenomena of interest within these disciplines and fit the definition of a theoretical framework.

data

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

information

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

knowledge

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

reverberation

Change within any part of the system will be reflected across the total system. This is referred to as reverberation. Reverberation is reflected in the intended and unintended consequences of system change. When planning for a new healthcare system, the team will attempt to identify the intended consequences or expected benefits to be achieved.

computer science

Computer science is defined as the "systematic study of algorithmic methods for representing and transforming information, including their theory, design, implementation, application, and efficiency. The roots of computer science extend deeply into mathematics and engineering.

target system

For example, if the target system is a LAN, each computer is a subsystem.

health informatics

Health informatics has evolved as a discipline and an area of specialization within the health professions. It incorporates processes, procedures, theories, and concepts from a number of different health professions and is therefore a unique interprofessional field of study as well as an area of specialization within the different health professions. As both a practice specialty and a field of study, health informatics incorporates processes, procedures, theories, and concepts from computer and information sciences, the health sciences (e.g., nursing and medical science), and the social sciences (e.g., cognitive psychology and organizational science). Health informatics professionals use information technology (IT) tools to collect, store, process, and communicate health data, information, knowledge, and wisdom. IT and related hardware, as well as software, are viewed as tools to be used by consumers, patients, and clients; healthcare providers; and administrators to achieve the goals of health informatics. The goals of health informatics include both supporting healthcare delivery and improving the health status of all people. This chapter explores the evolution of health informatics as both a discipline and a specialty practice within healthcare.

health literacy

Health literacy is "the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions."12 • The WHO has defined health literacy as "the cognitive and social skills that determine the motivation and ability of individuals to gain access to, understand, and use information in ways which promote and maintain good health." Health literacy means more than being able to read pamphlets and successfully make appointments. By improving people's access to health information and their capacity to use it effectively, health literacy is critical to empowerment. It is the degree to which people are able to access, understand, appraise, and communicate information to engage with the demands of different health contexts to promote and maintain good health across the life-course.13

joint cognitive systems

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

dynamic system

In a constant state of nonlinear change. In a linear system, the output is consistently proportional to the input. Increase the input and the output increases at the same rate. In a nonlinear system, the output of the system is not proportional to the input.

Complex Domain

In the complex domain, the cause-effect relationship is not known. If the cause-and-effect relationship is not known, what data are pertinent data is also unknown. Decisions must be based on incomplete data in an environment of unknown unknowns. The difference between a complicated situation and complex situation can be demonstrated in analyzing the difference between a computer and a person. A computer expert can identify all of the parts of a computer and how they interact. The expert can predict with high accuracy how a computer will react in different situations.

clinical practice guidelines (CPGs)

In the third stage of EBP, translation, experts are called on to consider the evidence summary, fill in gaps with consensus expert opinion, and merge research knowledge with expertise to produce clinical practice guidelines (CPGs). This process translates the research evidence into clinical recommendations. The IOM defines clinical guidelines as "systematically developed statements to assist practitioner and patient decisions about appropriate healthcare for specific clinical circumstances."35

Complicated Domain

In this domain, the relationship between cause and effect is known but it is not obvious to everyone in the domain. As a result, knowledge and expertise are very important for managing complicated problems. These types of problems are managed by collecting and analyzing data before responding. The expert will know what data are pertinent, as well as different approaches for analyzing these data and different options for responding. There is often more than one right answer. Different experts may solve the problem in different ways. In addition, experts can identify an effective solution but not be able to articulate every detail of the cause-and-effect relationship.

dental informatics

In this same year, the first dental informatics book, Dental Informatics: Strategic Issues for the Dental Profession, part of the series Lecture Notes in Medical Informatics, was edited and published by John J. Salley, John L. Zimmerman, and Marion Ball.

scope creep

Is one of the most frequent causes of project delays. Scope creep is defined as changes in the scope of the project during the implementation that frequently 323necessitates other changes resulting in additional expenses, resources, and time. Scope creep occurs when requirements are altered after the initial project is defined and those added requirements are substantial enough to affect the project timeline. Well-defined objectives for the parameters of the project and strong project management can help minimize scope creep.

Cognitive and Constructionist Learning Theories

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

design thinking

Many UX professionals embrace a creative process called "Design Thinking." The process is complementary to User-Centered Design (UCD) discussed previously because it focuses on understanding problems from a user's perspective but the process concentrates on innovative solutions. Design thinking began in earnest in 1987 with Peter Rowe's book titled Design Thinking. Stanford University expanded this work for business, calling it a process for creative solutions. Essentially design thinking is a formal process of addressing ill-defined problems through creative design, using an iterative process of creating and testing multiple designs, as in UCD, to evaluate their fit as an appropriate solution.25

FIT persons

Over 15 years ago, the National Academy of Science coined the term FIT persons to describe people who are fluent with information technology. That definition remains current. FIT persons possess three types of knowledge: • Contemporary skills are the 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). • 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. • Intellectual capabilities are the ability to apply information technology to actual problems and challenges of everyday life. An example of this knowledge is the ability to use critical thinking when evaluating health information on a social media site.3

practice-based evidence (PBE)

PBE is about obtaining evidence from practice. PBE is an innovative prospective research design that uses data gathered from current practice to identify what care processes work in the real world. With the increasing interoperability of health IT, a shared learning culture extends beyond the local department or institution with the opportunity to create generalizable knowledge to improve care worldwide. Typical PBE questions are: • Are treatments used in daily practice associated with intended outcomes? • Can we predict adverse events in time to prevent or ameliorate them? • What treatments work best for which patients? • With limited financial resources, what are the best interventions to use for specific types of patients? • What types of individuals are at risk for certain conditions? Answers to these questions can help clinicians, patients, researchers, healthcare administrators, and policy-makers learn from and improve real-world, everyday clinical practice.

focused ethnographies

Research methods borrowed from anthropology and sociology in which the focus is on the person's point of view and his or her experiences and interactions in social settings. Focused ethnographies and contextual inquiry involve interacting with users in their actual sites or "field settings." They concentrate on individuals' points of view and their experiences and interactions in social settings, rather than on just the actions of those individuals.75,76 However, researchers are observers rather than a part of the society. During observations, detailed descriptions are generated with an emphasis on social relationships, interactions with IT, and their impact on work. Ethnographies have become important in understanding the UX and describing the impact of complex products.

channel

Shannon-Weaver Information-Communication Model. The sender is the originator of the message or the information source. The transmitter is the encoder that converts the content of the message to a code. The code can be letters, words, music, symbols, or a computer code. A cable is the channel, or the medium used to carry the message. Examples of channels include satellites, cell towers, glass optical fibers, coaxial cables, ultraviolet light, radio waves, telephone lines, and paper. Each channel has its own physical limitations in terms of the size of the message that can be carried. Noise is anything that is not part of the message but occupies space on the channel and is transmitted with the message. Examples of noise include static on a telephone line and background sounds in a room. The decoder converts the message to a format that can be understood by the receiver. When listening to a phone call, the telephone is a decoder. It converts the signal back into sound waves that are understood as words by the person listening. The person listening to the words is the destination.

noise

Shannon-Weaver Information-Communication Model. The sender is the originator of the message or the information source. The transmitter is the encoder that converts the content of the message to a code. The code can be letters, words, music, symbols, or a computer code. A cable is the channel, or the medium used to carry the message. Examples of channels include satellites, cell towers, glass optical fibers, coaxial cables, ultraviolet light, radio waves, telephone lines, and paper. Each channel has its own physical limitations in terms of the size of the message that can be carried. Noise is anything that is not part of the message but occupies space on the channel and is transmitted with the message. Examples of noise include static on a telephone line and background sounds in a room. The decoder converts the message to a format that can be understood by the receiver. When listening to a phone call, the telephone is a decoder. It converts the signal back into sound waves that are understood as words by the person listening. The person listening to the words is the destination.

sender

Shannon-Weaver Information-Communication Model. The sender is the originator of the message or the information source. The transmitter is the encoder that converts the content of the message to a code. The code can be letters, words, music, symbols, or a computer code. A cable is the channel, or the medium used to carry the message. Examples of channels include satellites, cell towers, glass optical fibers, coaxial cables, ultraviolet light, radio waves, telephone lines, and paper. Each channel has its own physical limitations in terms of the size of the message that can be carried. Noise is anything that is not part of the message but occupies space on the channel and is transmitted with the message. Examples of noise include static on a telephone line and background sounds in a room. The decoder converts the message to a format that can be understood by the receiver. When listening to a phone call, the telephone is a decoder. It converts the signal back into sound waves that are understood as words by the person listening. The person listening to the words is the destination.

chaos theory

Starting in the 1950s, chaos theory, followed by complexity theory, began to develop and was seen as an approach for understanding complex systems. Both chaos and complexity theory involve the study of dynamic nonlinear systems that change with time and demonstrate a variety of cause-and-effect relationships between inputs and outputs because of reiterative feedback loops. "The quantitative study of these systems is chaos theory. Complexity theory is the qualitative aspect drawing upon insights and metaphors that are derived from chaos theory."

complexity theory

Starting in the 1950s, chaos theory, followed by complexity theory, began to develop and was seen as an approach for understanding complex systems. Both chaos and complexity theory involve the study of dynamic nonlinear systems that change with time and demonstrate a variety of cause-and-effect relationships between inputs and outputs because of reiterative feedback loops. "The quantitative study of these systems is chaos theory. Complexity theory is the qualitative aspect drawing upon insights and metaphors that are derived from chaos theory."

Star Model

The Star Model provides a framework for converting research knowledge into a form that has utility in the clinical decision-making process. The model articulates a necessary process for reducing the volume and complexity of research knowledge, evolving one form of knowledge to the next, and incorporating a broad range of sources of knowledge throughout the EBP process.

Boundary

The boundary of a system forms the demarcation between the target system and the environment of the system. Input flows into the system by moving across the boundary and output flows into the environment across this boundary.

Complex Adaptive System (CAS)

The characteristics of chaotic systems provide a foundation for understanding how complex systems adapt over time. "entity consisting of many diverse and autonomous parts which are interrelated, interdependent, linked through many interconnections, and behave as a unified whole in learning from experience and in adjusting (not just reacting) to changes in the environment. Each individual agent of a CAS is itself a CAS.

heuristic evaluations

The definition of a heuristic is a "rule of thumb" or guideline. Heuristic evaluations (HEs) compare products against accepted usability guidelines to reveal issues. Nielsen recommends that three to five experts complete independent evaluations and then combine issues into a master list after discussion and consolidation. HE violations of guidelines are made and severity scores are then assigned to the identified issues.65 Importantly, dual domain experts (experts in both UX and the field to which the application is geared) can find 81% to 90% of existing usability problems and increased numbers of major issues with the application.66 HE is a commonly employed technique, and readers can complete an HE after only a modest amount of training.

phenomenon

The development of a theory occurs in a recursive process moving on a continuum from the initial observation of the phenomenon to the development of a theory to explain that phenomenon.

systems life cycle (SLC)

The most common change for health professionals and informaticians is the introduction of or upgrade to a health information system. A commonly used model of the stages within this change is the systems life cycle (SLC) model. This model is used in project management to describe stages or phases of an informatics project and it guides system implementation from initial feasibility through a more completed stage of maintenance and evaluation of the products. Most authors use the title "systems development life cycle" to describe the model. However, the term development is too limiting in health informatics because we often purchase systems or applications from vendors and customize them rather than developing them from scratch.

informatics

The term informatics was established in the late 1960s and into the 1970s. Informatics is actually the English translation of terms used in other languages. Because of differences in language, it is difficult to determine whether the initial use of the word informatics was referring to the discipline of informatics, information science, computer science, or a combination of these.

Two different structural models

Two different structural models operating concurrently can be used to conceptualize healthcare technical infrastructures. These are hierarchical and web. The hierarchical model is an older architectural model, and the terms, such as mainframe, that are used to describe the model reflect that reality. The location and type of hardware used within a system often follow a hierarchical model; however, as computer systems are becoming more integrated, information flow increasingly follows a web model. The hierarchical model can be used to structure the distribution of the computer processing loads at the same time as the web model is used to structure communication of health-related data throughout the institution

basic literacy

UNESCO offered one of the first definitions of literacy. "A literate person is one who can, with understanding, both read and write a short simple statement on his or her everyday life."1, p. 12 This definition is still in frequent use today. In 2003 UNESCO proposed an operational definition that attempted to encompass several different dimensions of literacy. "Literacy is the ability to identify, understand, interpret, create, communicate, and compute, using printed and written materials associated with varying contexts. Literacy involves a continuum of learning in enabling individuals to achieve their goals, to develop their knowledge and potential, and to participate fully in their community and wider society."1 Although other UNESCO publications have provided additional definitions of literacy, the 2003 definition continues to be the more comprehensive definition.

clinical informatics

While the town hall discussion described clinical informatics as an interprofessional domain and AMIA adopted this as formal policy, the actual process for recognizing clinical informatics as a specialty since then has limited this recognition to clinical informatics as a medical specialty for physicians only.

phase go live

With a phased go-live approach, both paper and electronic environments exist at the same time within the healthcare institution; however, the existence of both paper and electronic environments forces the clinician to use different workflows in patient units that have implemented the system than in units that have not, potentially creating safety concerns.

Best of Breed

approach involves reviewing several vendors for their "best" module or application, such as an admission, discharge, and transfer (ADT) system or emergency department module. Then multiple modules are purchased from different vendors to create a full suite of functions. Purchase decisions are based on each module's or application's most desired or robust features and connectivity capabilities. This approach typically provides the customer with tools to customize the application according to local, specialized needs. Vendors typically incorporate enhancement requests more quickly in a hot fix (fast fix), through software patches (fixes), or in the next version. Both of these advantages can be important to large medical or research-intensive university centers. The disadvantages of this approach are the need for multiple complex interfaces to integrate all of the products, the need for highly skilled and specialized IT staff to support the different interfaces, and the existence of various hardware platforms and operating systems that may be on different versions of software and therefore complicate integration. Lastly, each module may have a different user interface, meaning that each application looks and acts differently to the end users. All of these factors make the best-of-breed approach more expensive and resource intensive, but this approach is frequently selected by large medical, university, and research medical centers.

big bang

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

Project Management

as "a temporary endeavor undertaken to create a unique product, service, or result. The temporary nature of projects indicates a definite beginning and end. The end is reached when the project's objectives have been achieved or when the project is terminated because its objectives will not or cannot be met, or when the need for the project no longer exists."1

learning theory

attempts to determine how people learn and to identify the factors that influence that process. Learning has been defined in a variety of ways, but for the purpose of this text, learning is defined as an increase in knowledge, a change in attitude or values, or the development of new skills.

fractal-type patterns

begin to emerge from these outputs. Fractals are repeating nonregular geometric shapes such as snowflakes, trees, or seashells. Thus out of chaos comes order.

Graves Model

classic article "The Study of Nursing Informatics," used the Blum concepts of data, information, and knowledge to explain the study of nursing informatics. *They incorporated Barbara A. Carper's four types of knowledge: empirical, ethical, personal, and aesthetic.* Each of these represents a way of knowing and a structure for organizing knowledge. This article is considered the foundation for most definitions of nursing informatics.

task analysis

is a generic term for a set of more than 100 techniques that range from a focus on cognitive tasks and processes (called cognitive task analysis) to observable user interactions with an application (e.g., a systematic mapping of team interactions during a patient code). Task analyses are systematic methods used to understand what users are doing or required to do with a health IT product. They focus on tasks and behavioral actions of the users interacting with products. These methods provide a process for learning about and documenting how ordinary users complete actions in a specific context.33,70,71 Task analyses are helpful to identify task completeness, the correct or incorrect sequencing of tasks (especially their fit to cognitive tasks), accuracy of actions, error recovery, and task allocation between humans and products. Task analysis is typically used early in the systems life cycle to determine user requirements for design or to determine redesign when rich data are needed. This technique may be used to analyze areas for redesign.

knowledge transformation

is defined as the conversion of research findings from discovery of primary research results, through a series of stages and forms, to increase the relevance, accessibility, and utility of evidence at the point of care to improve healthcare and health outcomes by way of evidence-based care.1

Portfolio Management

is even more complex and involves the creation of common programs and projects that are not necessarily related but are important to combine and view as a whole. One example would be a clinical portfolio where all projects and programs that directly affect patient care are managed or aligned in a common category. Other portfolios might be a financial or a technology infrastructure portfolio. Effective management of portfolios is essential for a healthcare organization to adequately prioritize and approve new project requests and to work strategically on projects throughout the years. Portfolio management provides an essential foundation for decisions and discussions in governance committees as projects are prioritized and funded.3

usability

is often used interchangeably with HCI when the product is a computer, but usability also concerns products beyond computers. Usability is also more focused on interactions within a specific context or environment for a specific product. Formally, the ISO defines usability as the extent to which a product can be used by specific users in a specific context to achieve specific goals with effectiveness, efficiency, and satisfaction.16 A product with good usability allows users in a particular context to achieve their goals when interacting with a product.24 Usability is, however, fundamentally concerned with human performance, and in the case of healthcare, interactions that promote safety rather than only subjective data.

negentropy

is the opposite of entropy. This is the tendency of living systems to grow and become more complex. This is demonstrated in the growth and development of an infant, as well as in the increased size and complexity of today's healthcare system. With the increased growth and complexity of the healthcare system, there has been an increase in the size and complexity of healthcare information systems. As systems grow and become more complex, they divide into subsystems and then sub-subsystems. This is the process of differentiation and specialization. Note how the human body begins as a single cell and then differentiates into different body systems, each with specialized purposes, structures, and functions. This same process occurs with healthcare. If the mainframe in Fig. 2.3 were to stop functioning, the impact would be much more significant than if an individual computer in one of the LANs were to stop functioning.

entropy

is the tendency of all systems to break down into their simplest parts. As it breaks down, the system becomes 18increasingly disorganized or random. Entropy is demonstrated in the tendency of all systems to wear out. Even with maintenance, a healthcare information system will reach a point where it must be replaced. Healthcare information that is transferred across many different systems in many different formats can also demonstrate entropy, thereby causing confusion and conflict between different entities within the healthcare system.

equinfinality

is the tendency of open systems to reach a characteristic final state from different initial conditions and in different ways.

Program Management

on the other hand, involves larger implementations, like a large-scale hospital document management application or an organization-wide EHR system. With program management, there are multiple, aligned projects affecting many teams or departments that are coordinated and managed in concert.

dynamic homeostasis

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