Data Management and Health Care Technology

Explain data presentation: Dashboard.

A dashboard (also called a digital dashboard), like the dashboard in a car, is an easy-to-read computer program that integrates a variety of performance measures or key indicators into one display (usually with graphs or charts) to provide an overview of an organization. It can include data regarding patient satisfaction, infection rates, financial status, or any other measurement that is important to assess performance. The dashboard provides a running picture of the status of a department or organization at any point in time and may be updated as needed- daily, weekly, or monthly. An organization-wide dashboard provides numerous benefits: • Broad involvement of all departments • A consistent and easy to understand visual representation of data • Identification of negative findings or trends so that they can be corrected • Availability of detailed reports • Effective measurements that demonstrate the degree of efficiency Assistance with making informed decisions

Define the term telenursing and describe its liability policy.

A subset of telehealth, telenursing is defined by the National Council of State Boards of Nursing (NCSBN) as "the practice of nursing over distance using telecommunication technology." In this case, telecommunications includes telephone, fax, and the internet. Although this type of nursing has been in practice for decades, it was not until the mid 1990s that the NCSBN formulated its definition and set practical rules of liability regarding its practice. The NCSBN recognized that a nurse does not have to physically be present with a patient to practice nursing. It found that telenursing forms the legal status of "duty to care" and must be regulated. One problem with regulating telenursing involves the complexity that the patient may be in one state and the nurse in another. This may cause regulatory violations due to individual state's laws. This example shows the importance of creating uniform nationwide regulation of tel ehealth in general.

Describe mHealth.

As computers become more prevalent, smaller, and more powerful, they can be used in more facets of everyday life. This advance of technology has allowed for a new sector in healthcare known as mHealth. Mobile computers and wireless communication technology work together to improve the way healthcare is delivered. This trend has grown as mobile systems have become less expensive and wireless communication becomes more wide spread. Devices used in mHealth include diabetes monitors, IV delivery systems, and fetal dopplers. These intelligent devices are networked into mHealth systems. The way these devices communicate is to use standard computer communication standards. The standards that are at the forefront of this technology include digitized voice, third-generation broadband, and packet-based transmission. This technology allows patients to have real time control and monitoring of their medical conditions.

data management

Data management in healthcare refers to the use of computers to store, access, and secure patient information. Personnel who are responsible for data management include those who input the information, system analysts, programmers, and database administrators. Information may be stored as tables in a relational database. Some organizations may connect to data warehouses in order to access very large amounts of stored information. Data warehouses are often used to store results from clinical trials or insurance membership information. Many healthcare organizations have stopped using paper documents all together because of the cost required to store and retrieve paper files. Paper documents are also more susceptible to physical damage and loss than computerized data. Some companies have scanned paper documents into their new computer systems through a process known as document imaging. Additionally, some facilities use document imaging to transfer patient test results (e.g., radiological film) into their computerized record system.

Describe the terms: management information systems, bibliographic retrieval systems, stand alone systems, transaction systems, and physiologic monitoring systems.

Management Information Systems (MIS): Strategic information technology (IT) planning that relates the capabilities of the organization to its customers and competitors. Includes the measured performance standards and the allocation of resources (for both human and technology needs). Includes operational support that provides information necessary for the day-to-day functioning of the organizational business units. Bibliographic Retrieval Systems: Stores data for easy retrieval. As an example, MEDLINE is used to access journal articles and health information. Stand Alone Systems: May also be called dedicated or turnkey systems. Used only for a specific function that does not require any connectivity. Transaction Systems: Process specific transactions and produce reports that have the same format every time. Physiologic Monitoring Systems: An input of electric impulses is converted to an output of waveforms. Examples: ECG, EEG, and the nonstress test

Explain the things that can go wrong with disaster recovery planning.

Many things can go wrong with a disaster recovery plan after a disaster. Unfortunately, many organizations fail to provide adequate support for operating under extreme situations. Some common areas that are sometimes found to be deficient include: • Documentation: Critical documents should be stored in several locations (both digitally and in paper format). • Equipment: As new equipment is purchased, it needs to be added to the plan. • Data storage: Design the plan to allow quick recovery of critical information without needing to open an archive (or recover a database). • Keeping the plan updated: Failing to keep the plan updated and failing to test the plan are two very common errors. Plans should be updated frequently and tested after each update.

Discuss hardware technical specifications: Limitations.

Technical specifications or requirements are usually described in detail, including operational characteristics and limitations. Technical specifications may include operations, operating system, version, display requirements, software requirements, capacities, features, devices, connections, supported environments, and data sources. Understanding the limitations of hardware is necessary for installation and use. Limitations may relate to the equipment (e.g., an inability to do some functions, standards, nonpermitted devices, limited number of slave devices), requirements (e.g., operating system, software packages that must be installed, type of power supply, environmental temperature), system managers (e.g., support not provided if operating system or equipment is modified, types of reports that can and cannot be generated), and users (e.g., help function limited to specific criteria, limits in access, sequence of key strokes for specific actions).

Describe several common methods to preserve data integrity.

There are several common methods that preserve data integrity: • Staff education: Employees who receive training on the documented correct use of the information system will be better equipped to enter and access information and determine that the information is correct • System checks: System error checks are written into computer programs so users are less likely to enter incorrect or inappropriate information (or omit mandatory information). • Data verification: Data verification involves asking the patient to look over their information and verify whether it is correct or not. This process may be done in one of three ways. First, a staff member may read back the information to the patient and ask for a verbal confirmation. Second, the staff member may ask the patient to read and verify the information off the computer screen, continuing only once the data is verified. Third, the information may be printed onto paper with the patient reading it and formally signing a statement that it is correct • Minimization of fraudulent information: Establishing controls (such as checking a photo ID) to assure that the information entered is from the correct individual.

Define the terms: bits and bytes.

Computers use binary code to store data. Binary code has only two conditions: zero (off) and one (on). This is because early computers used physical relay switches with an on or off switch. A bit (binary digit) is defined as a single symbol of the binary code (its value equals zero or one). These bits are arranged into an eight-symbol unit (called a byte) to code meaningful information such as letters of the alphabet or numbers. From a series of eight bits, 255 different combinations of bytes can be formed. The cost of computer memory has come down in recent years and most home computers come with a minimum of 512 mega-bytes (MB) of main (active) memory, and a hard drive that can store 60 gigabytes (GB) of data.

Explain data aggregation.

Data aggregation refers to the collection and summation of data for further use, such as for statistical analysis. For example, data aggregation may be used to collect information about an individual from multiple sources, often for targeted marketing purposes. Most summary reports now contain aggregate data, but some data aggregation may be ineffective, impacting the results, so data aggregation must be planned and implemented accurately. Criteria include the following: • Applications should integrate with existing hardware, software, and applications and should be adaptable and easy to manage. • Applications should be flexible, using industry standards and supporting multiple reports. • Performance should be fast, effective, and predictable. • Results should be scalable. • Implementation should be fast and efficient and require little training. • Use of hardware and software should be efficient, requiring little increase in hardware, software, and storage. Application should be cost-effective for the organization.

Discuss the difference between hierarchical and relational databases.

Databases are computerized file structures that contain organized and accessible stored data. Hierarchical databases, the earliest type, are organized in a tree or parent-child formation with one piece of information connected to many (one-to-many), but in descending order only (not many-to-one). Hierarchical databases are appropriate only for simple structures (e.g., lists of e-mail addresses or telephone numbers) and have limited use in health care. Hierarchical databases have largely been replaced with relational databases (Edgar F. Codd, 1940), which are built on a multiple table structure with each individual item in a table having a unique identifier. The tables (or relationships) can be manipulated. Each table represents an item or thing. Tables are comprised of rows (i.e., records, which must be unique) and columns (i.e., fields). Relational databases allow both one-to-many and many-toone relationships. Relational databases may contain over 1000 tables, but through querying, new tables, using the relationships among existing data, can be produced.

Discuss system and database design concepts: Eliminating redundancy.

Eliminating redundancy is essential so as not to inflate a database. The first step is to identify attributes that are identifiers and those that provide information; then the redundant identification attributes can be removed. Redundancy also occurs when the same field is present in more than one table, which can lead to anomalies and data corruption. Normalization is the procedure used to eliminate redundancy and problems and to ensure that information is available from the database through querying. Large database tables are typically broken into smaller tables where redundancy is reduced and the relationship among the various tables is defined. Modifications (including insertions and deletions) in data should occur in one table rather than multiple tables.

Define the term: data retrieval and its related factors.

Information that has been stored in a computer system will eventually need to be accessed at some point This process of accessing data is known as data retrieval. When choosing a system for data retrieval, the following factors are of importance: • Performance: Performance should be measured by the time it takes for data to be retrieved and the number of requests that can be processed at one time. • Capacity: Capacity refers to not just the number of files that can be stored, but also how large each file can be. • Data security: Protecting the information from people who are not authorized to view it is a function of data security. • Cost: There are three areas of concern involving cost: support personnel (those individuals who maintain the system), software (programs used for information retrieval), and hardware (the actual machines where the information is stored).

Describe the Logical Observation Identifiers Names and Codes, International Classification for Nursing Practice, and Nursing Management Minimum Data Set for classification systems.

Logical Observation Identifiers Names and Codes (LOINC): This database of terms is used primarily for laboratory results. By using uniform terms, the data can be grouped for analysis or transmitted to other computer systems. Begun for laboratory terms 32,000 terms that include clinical information and codes for nursing observations International Classification for Nursing Practice (ICNP): The ICNP provides uniform terms for nursing data. Again, the goal is to create a system in which data can be examined and transmitted to other computers systems in a recognizable way. Sponsored by the International Council of Nurses Categories for diagnosis, interventions, and outcomes Nursing Management Minimum Data Set (NMMDS): The NMMDS is a dynamic collection of standardized terms related to nursing. The goal is to create terms that will allow data to be compared across a wide swath of computer systems. Terminology for describing context and environment Include categories for personnel characteristics, financial resources, and population data.

Describe the advantages of telehealth.

One of the most valuable trends in medicine today is telehealth. Compared to telemedicine, telehealth includes prevention and promotion of healthier lifestyles in addition to the curative focus of telemedicine. Thanks to the prevalence of personal computers and internet access, doctors can consult with one another, share information in real-time, or make "virtual house calls" in which they are able to both speak to and view the patient over an internet connection. Virtual house calls can help patients with many illnesses. For example, clients with diabetes can be coached to manage their diet and exercise regime at home. One way that doctors can consult is through the use of intraoperative monitoring (10M) during surgery. Intraoperative monitoring allows a specially trained surgeon to constantly monitor a patient remotely during the operation. Using 10M, surgery can be performed in one location while the 10M specialist monitors the patient from afar. This reduces the risk of patient death or complications.

Describe the two primary data entry systems used in healthcare informatics: Clinical Care Classification system and the Omaha System.

Outlined below is the Clinical Care Classification system and the Omaha System used for data entry in the medical field: • Clinical Care Classification (CCC) This system was formerly known as Home Health Care Classification (HHCC). The system uses two major subsets of information: • Diagnoses and outcomes: The terms used in the specific diagnosis and outcomes of a disease state. • Interventions and actions: For a given disease state, the appropriate interventions and actions. There are 21 "Care Components" which classify care over a wide range of factors such as functional, physiological, and psychological. • Omaha System Uses a Problem Classification Scheme (assessment). This scheme allows for evaluating the condition of the patient Intervention Scheme. The intervention scheme prescribes the appropriate interventions to treat the problem (or disease state). Problem Rating Scale for Outcomes (in terms of knowledge, behavior, and status). The scale ranges from 1 to 5 (a Likert type scale)

Discuss the personal health records: Elements.

Personal health records (PHRs) are electronic records that are generated by health care providers and the individual patient, allowing the patient to access, record, and share health information. Many different applications exist for creating a PHR. Elements of a PHR should include the following: • The individual has the ability to control the PHR. • The information in the PHR is comprehensive and covers the patient's lifetime. • The information in the PHR derives from all health care providers. • The PHR can be easily accessible at any time from any location with access. • The information contained in the PHR is secure and cannot be accessed without proper authorization. • The PHR discloses who enters data as well as who has accessed the data and when. • Exchange of information with different health care providers across the health care system is efficient • PHRs should help to deliver care more cost-effectively and efficiently.

Define the term telehealth and describe its various uses.

Telehealth refers to the delivery of health care services to patients who are not physically present with the health care professional, usually due to remote location or disability. Telehealth can be delivered over a telephone, via e-mail, or by video conference. The primary benefits of telehealth are that it allows for the extension of precious healthcare resources, lowers the overall cost ofhealthcare, and allows patients to receive healthcare who would not normally have access to it. There are a number of ways in which telehealth is useful to healthcare professionals: • Consultation with colleagues • Patient interviews • Monitor a patient's biometric values and asses their condition • Evaluate diagnostic images which allows physicians to remotely view and evaluate these images even if they are located overseas (e.g., India) • Evaluation of microscope slides and laboratory reports

Describe the structure and function of the computer keyboard.

The computer keyboard allows data to be typed into a computer by the user. Currently, the computer keyboard is the primary way humans communicate with the computer itself. In the future, other methods of communication including voice (or even thought) recognition technologies will evolve. The typical computer keyboard has six different types of keys: 1. Typewriter keys: largest section, follows the QWERTY arrangement of a typewriter 2. Function keys: Fl-F12 act according to the instructions of software programs and are used with Shift, Ctrl, and Alt to allow for a greater number of commands 3. Numeric keyboard: additional set of numerical keys which are labeled 0-9 in reverse order from a calculator 4. Cursor keys: activated by switching off the Num Lock Key 5. Toggle keys: Num Lock, Caps Lock, Scroll Lock, and Insert/Type over allow the keyboard keys to assume different functions based on whether they are toggled "off' or "on" 6. Special operation keys: created for use with computers and include: Esc (escape), Tab, Del (delete), Enter, and Home

Discuss generating reports to identify trends and respond to quality measures: Control chart.

The control chart is similar to the run chart, but it has a mean line (the average of the data points) as well as upper and lower control limit lines, based on normal distribution. With any process, there is some normal variation (common cause or random variation) so the line values may vary; however, when the line crosses the control limits, this suggests that there is a specific cause (special cause variation) that requires investigation. The control limits are usually set at 2-3 standard deviations from the mean. Thus, the line shows the normal variations and excessive variations. The control chart can include horizontal lines, indicating each standard deviation for more precise information, dividing the graph into zones. Zone C is 1 standard deviation from the mean; zone B is 2 standard deviations from the mean; and zone A is 3 standard deviations from the mean. Positive values are above the mean line, and negative values are below. The data can be analyzed for specific trending, depending on the number of data points in each zone.

Describe three common threats for information stored in computerized systems.

The following are three main threats for information stored in computerized systems: • Quality - Information quality may be compromised by the alteration of files. This may happen by accident (e.g., data corruption) or intentionally (e.g., forgery). There may also be an alteration of the system itself. This tends to happen during system upgrades or the introduction of unwanted programs (e.g., viruses, worms, or trojan horses). • Availability - Availability of information may be threatened by power outages, damage to the system (or its parts), disaster or sabotage, or the system becoming overloaded. • Confidentiality- Confidentiality may be compromised by personnel disobeying company policies (or procedures) or unauthorized individuals viewing printed records or computer screens.

Discuss generating reports to identify trends and respond to quality measures: Run chart.

The run chart is a line graph with a horizontal x axis (independent variables) and a vertical y axis (dependent variables, outcomes). The run chart, which provides a running record of a process over time, adds a horizontal median line, calculated according to the number of data points (data points+ 1 divided by 2). A run is a sequence of data points on one side of the median line, ending when the line crosses the median. Runs may be color-coded. For example, a run chart may plot the number of urinary infections by month for a 1-year period with increased runs indicated by a different color. It is important that data be recorded for a long enough period that normal variations are not misconstrued as significant runs. Run charts (with more than twenty-five data points) may demonstrate shifts (eight points or more on one side of median line), trends (six data points in the same direction), and patterns (eight or more similar fluctuations). These changes point to specific causes that require investigation.

Discuss data representation: Unicode standard coding scheme.

The unicode standard coding scheme, used with the Universal Character Set, is a standardized coding system that has a large capacity and can be used to represent text for most languages, including Asian languages. Coding is available to represent technical characters, punctuation, and mathematic symbols. Unicode provides a specific numeric value for each character and can be used across multiple platforms. Unicode comprises approximately 110,000 characters, representing all alphabets of the world languages, ideographic sets, symbols, and 100 scripts, and is particularly valuable for making coding accessible internationally. Unicode is used in many technologies and operating systems. Unicode is promoted and supported by the Unicode Consortium. Unicode also allows private codes so users can assign values as needed.

Outline the primary patient benefits of using telehealth for healthcare needs.

There are many patient benefits associated with the use oftelehealth. Several are outlined below: • The patient does not have to travel to seek the advice of specialists who may be located many miles away. • Electronic healthcare records can be accessed anywhere and at anytime. This access must be balanced with the privacy needs of individual patients and regulations (e.g., HIPAA). • The patient becomes an active member in his or her own health care. • Healthcare professionals from many different disciplines are able to collaborate and decide on the most appropriate course of action for the patient. • Patients and family members have access to educational materials that are useful in helping the patient manage their condition. • More patients have access to a specialist. • Reduces or eliminates the cost of travel and thereby lowers the overall cost of health care. • Digital records are easily accessible by health care providers.

Discuss telecommunications: Voice-over Internet Protocol.

Voice-over Internet Protocol (VoiP) includes the protocols and technology involved in allowing audio and multimedia transmission, such as audio, FAX, messaging, and short-messaging service (SMS), which is text messaging, over the Internet. VoiP is also referred to as broadband telephone or Internet telephone, and companies, such as Vonage, market their service as an alternative to landline telephones. Some companies, such as Skype, which is based on peer-to-peer networking, allow use but limit contacts only to those in the same network. VoiP technology encodes audio into digital files for streaming transmission, using a number of codecs, such as versions of G. 711 and G.722. VolP allows SMS or calls from nonphone devices with access to Wi-Fi, 3G, or 4G. A number of network protocols are in use, but Session Description Protocol is common. Many organizations are switching to VoiP devices and eliminating landline telephones as a cost-saving measure because voice and data can use the same network.

Describe the term: data warehouse and its related characteristics.

An organization's past computerized information is kept in a data warehouse. This is the information that is not required on a daily basis by the typical system user, but is used by management to make decisions. It is important that a data warehouse be configured so that a data analyst can research information quickly and effectively. An effective data warehouse as has the following characteristics: • Subject-oriented: This refers to the fact that all events or objects that are the same are linked in a traceable manner. • Time-variant: This is the ability to look at how information changes as a function of time. • Non-volatile: This means that once information is recorded, it can never be deleted or manipulated in a manner that could cause its loss. • Integrated: This refers to the fact that information from all areas of the enterprise is placed into the same database for the sake of analysis.

Discuss decision support solutions: Alerts.

Clinical decision support (CDS) systems may include general information as well as guidelines regarding treatment and medications based on symptoms or diagnosis. Alerts are an important component of CDSs and may be used for cost-effectiveness, safety, and preventive health. Alerts should not be excessive, which results in "fatigue" with users ignoring or overriding repeated alerts. Types of alerts may include the following: • Warnings regarding medication interactions • Reminders for preventive actions, such as routine scheduling of mammogram • Notification of duplicate testing • Activation of help wizard to assist the user Issues to consider with alerts include whether or not: • The data are accurate enough to avoid inappropriate alerts. • The data can be overridden (e.g., ignoring a drug-drug interaction) and what types of alerts can be overridden. • An alert should apply to all patients or to a select group, such as those with a particular diagnosis. • Alerts focus on reminding users to use an order or warning them to avoid an order. • Viewing the alert requires activation or is automatic.

System and database design concepts: Discrete data.

Discrete data, usually used to represent the count of something, are those that have a specific value and cannot be further quantified. Because the person creating the database and the person providing data are often different, eliciting the correct discrete data can pose problems, especially if the person providing data is not well versed in database design. One of the first steps to ensuring adequate data is to do a requirement analysis, which involves eliciting information through case studies, interviews, focus groups, and observations. Identifying the types of data and interactions with the data is necessary to help determine what data are needed because data input must result in desired output.

Describe the terms: decision support systems, expert systems, artificial intelligence systems, and natural language systems.

Healthcare facilities may utilize a number of different systems: 1. Decision Support Systems • Help people make judgments. • Take all available data for a problem, generate results, implement the results in a simulation, and choose the optimum solution. • Often used to make staffing decisions. 2. Expert Systems • Similar to decision support systems, but using logic derived from specific task experts. • Operate using "If, then" type logic drawing from a database of knowledge in the problem area. 3. Artificial Intelligence Systems • Work using a model of human reasoning processes. • Use the rules of inference such as "If A>B and B>C, then A must be greater than C." • Attempt to find new ways to represent abstract ideas. • Actually learn by trial and error. 4. Natural Language Systems • Understand and process information in human language rather than programming language. • Enable speech and handwriting recognition.

Describe the term: hospital information systems (HIS).

Information systems dedicated to medical facilities are known as Hospital Information Systems (HIS). Typically, HIS use a mainframe computer (server) with satellite terminals (or workstations) located throughout the facility. These terminals may be hardwired together (or linked using a local area network (LAN)) to communicate with the central server. There are three broad types of HIS: administrative, semiclinical, and clinical. They are described below: 1. Administrative: handle non-medical management issues such as payroll. 2. Semi-clinical: partly administrative and partly medical. • Tracks the flow of patients into and out of the hospital. • Performs order-entry results reporting. 3. Clinical: handles medical issues. • Point-of-Service (POS): information is entered directly into the system at the patient's bedside rather than having the information transcribed from written notes. • Specialty Support Programs: there are many systems currently available that support healthcare facility issues such as laboratory, pharmacy, and radiology.

Outline the three classification systems used in nursing informatics: NANDA-1, Nursing Interventions Classification, and Nursing Outcomes Classification systems.

Outlined below are three classification systems used in nursing informatics: 1. NANDA-1 (North American Diagnosis AssociationInternational) • There are 167 classified diagnoses defined and characterized in this system. 2. Nursing Interventions Classification (NIC) • There are 514 treatments performed by nurses. • System also provides Jinks to NANDA diagnoses. • System is categorized by 44 specialty practice areas. 3. Nursing Outcomes Classification (NOC) • Provides expected outcomes for patients, caregivers, family members, and community members for 330 disease states. • System includes definitions, indicators, measurement tools, and references. Using these in designing information systems ensures that terms and conditions follow established standards that can be compared across a wide swath ofhealthcare organizations. Consistent information is also helpful when publishing results.

Explain the function of the computer monitor.

The computer monitor is a device that allows the user to see the various outputs such as programs, data, and performance information. Its appearance and function is very similar to a television screen. In the last few years, monitors have become much thinner (such as flat screens) and much larger than previous models. The standard monitor for a personal computer is 17 inches for a desktop model and 15 inches for a laptop model. The resolution of a computer monitor is related to the number of illuminated dots (or pixels) per inch. A higher number of pixels result in better resolution of images. There are monitors now entering the market that are large enough to view two full sized program images (side-by-side) which allows for greater ease in data correction and comparison.

Discuss generating reports to identify trends and respond to quality measures: Trending analysis.

A trending analysis is applied to the run chart or control chart In some cases, the data points on the chart may clearly go upward or downward, indicating a trend, but in other cases, there may be many variations, making the trend difficult to analyze. There are a number of rules applied to trending to help determine if variations are common-cause variations or special-cause variations: • Run (shift): Seven or more consecutive data points are all above or all below the median (run chart) or mean (control chart). • Trend: Seven or more consecutive data points are in either ascending or descending order with twenty-one or more total data points or six or more consecutive data points with fewer than twenty-one total data points. • Cycle: An up and down variation forms a sawtooth pattern with fourteen successive data points, suggestive of a systemic affect on data. If the trend is related to common-cause variation, the variation may be demonstrated with four to eleven successive data points. • Astronomical value: Data points unrelated to other points indicate a sentinel event or special-cause variation.

Discuss the personal health records (PHRs): Networked PHRs.

Basic principles for networked personal health records (PHRs) include: • Transparency: Individuals should know the type of information that can be gathered about them, purpose, data location, who has access, and how individuals gain access. • Purpose: The purpose of data collection should be provided when collected, and individuals should be apprised of change in purpose. • Consent limitations: Individuals should consent to collection of information, and information should be limited to that necessary to fulfill the purpose of collection. Data should not be disclosed, distributed, or accessed for nonspecified purposes. • Control: Individuals should control access to PHRs and know who stores information about them and for what purpose. They should also be able to review the method in which their information is used or stored. • Quality: All information should be up-to-date and accurate. • Privacy and security: Data should be safeguarded against unauthorized access, use, destruction, or alterations. • Oversight: Those in control of data are responsible for implementing and maintaining principles. • Troubleshooting: Methods must be readily available to address any breaches of security or privacy.

Discuss data representation: Hexadecimal coding system.

Because the binary system for representing decimal numbers results in much longer strings of digits, the hexadecimal coding system is often used. Hexadecimal characters represent 4 binary bits; thus, 1 byte can be represented by 2 hexadecimal characters. Hexadecimal coding uses a base of 16 and 16 symbols (usually the numeral1-9, representing values 0 to 9 and Arabic letters A through F, representing values 10-15). One digit (4 bits) is referred to as a nibble, and 8 bits/1 byte are an octet Additionally, coding may use # or &H in front of the code to indicate it is hexadecimal. For example, the number 10 is represented as #A. Binary code 1,000 is represented in hexadecimal code as 8. Conversion charts are available, so binary and hexadecimal coding can be easily converted from one to the other.

Explain definitions used in data analysis.

Definitions used in data analysis must be based on a solid understanding of statistical analysis and epidemiological concepts. Specific issues that must be addressed include the following: • Sensitivity: The data include all positive cases, taking into account variables and decreasing the number of falsenegatives. • Specificity: The data include only those cases specific to the needs of the measurement, excluding those from a different population thereby decreasing the number of false-positives. • Stratification: Data are classified according to subsets, taking variables into consideration. • Recordability: The tool/indicator collects and measures the necessary data. • Reliability: Results should be reproducible. • Usability: The tool or indicator should be easy to use and understand. • Validity: Collection measures the target adequately, so that the results have predictive value.

Describe the term grand rounds and the ways telehealth can be applied to this process.

Grand rounds have traditionally been a primary teaching tool for health care professionals. In grand rounds, a group of healthcare practitioners looks over a patient's case history and current condition. They then work together to develop a treatment plan. Using telehealth (faxes, e-mails, and video conferencing), individuals scattered from one another can work together for the benefit of both students and patients involved with grand rounds. Two major benefits of using this process are: (1) lower costs due to the participants not having to travel to a specific location: (2) allow a wider audience of healthcare trainees, experts, and patients to participate in grand rounds. This is an example of how technology can leverage resources to benefit patients. As healthcare resources become more rationed due to budgetary constraints, tools such as telehealth become more important

Describe the terms: input and output devices.

Input devices: Information is delivered to a computer via input devices. Examples of common input devices include keyboard, mouse, scanner, touch screen, light pen, and even the human voice. Some less common examples of input devices include security scanners for fingerprints, retinal prints, voiceprints, electrodes, optical scanners; magnetic-ink character recognition readers; MRis; and CAT scans. Output devices: Information that is provided from the computer flows through output devices. Output devices send this information to where it can be seen or heard. The printer, monitor, and speakers are all output devices. Additionally, the computer can send various signals to receiving units to allow for status checks, abnormal conditions, or security breeches. Some peripherals can be used for both input and output, including modems, floppy disks, CD-ROM's, DVDs, and USB drives (sometimes referred to as thumb drives).

Discuss logging and data logging.

Logging is an automatic process to record actions and events occurring in an information system in system log files, which contain a record of events for various components of the information system. Different systems have different log files, but they commonly provide information about devices, changes, and operations. Logs should be reviewed on a routine basis with reviews documented. Log files are used for auditing and are especially useful to evaluate applications, such as server applications, that have little end-user interaction. Log analysis software is available to assist in the evaluation of a log. Data logging allows the user to collect data, analyze, save, output results, and control the type of information collected, essentially as a method of computerized research. Data loggers are stand-alone devices that are used to acquire data, such as temperature and humidity in a server room.

Discuss telecommunications: Radio-frequency identification.

Radio-frequency identification (RFID} is an automatic system for identification that employs embedded digital memory chips with unique codes to track patients, medical devices, medications, and staff. A chip can carry multiple types of data, such as expiration dates, patient's allergies, and blood types. A chip/tag may, for example, be embedded in the identification bracelet of the patient, and all medications for the patient are tagged with the same chip. Chips have the ability to both read and write data, so they are more flexible than bar coding. The data on the chips can be read by sensors from a distance or through materials, such as clothes, although tags do not apply or read well on metal or in fluids. There are two types of RFID: • Active: Continuous signals are transmitted between the chips and sensors. • Passive: Signals are transmitted when in proximity to a sensor. Thus, a passive system may be adequate for administration of medications, but an active system would be needed to track movements of staff, equipment, or patients.

Discuss regional health improvement plans.

Regional health improvement plans (RHIPs) are developed to improve the delivery of health care. RHIPs cover all aspects of health care, including risk factors, diagnosis, treatment, disability, and social/mental factors, as well as all delivery systems, including hospitals, clinics, and individual practitioners. RHIPs establish prioritized strategic goals, such as improving health care while reducing costs as well as research and protocols needed to achieve these goals. Some RHIPs are regional while others, such as Oregon's RHIP, are statewide initiatives. Elements usually included in RHIPs are adherence to federal guidelines, policies, design of system, outcome measures, quality improvement methods to integrate services, and education and workforce development Statewide RHIPs or those encompassing a large region may contain many subplans focused on particular areas of health care, such as mental health.

Discuss standards: International Organization for Standardization.

The International Organization for Standardization (ISO), a nongovernmental organization, encompasses a network of standard institutes, public and private, in 164 countries and develops and publishes voluntary international standards based on consensus. The standard institutes are the primary bodies approving standards for the countries they represent Standards for government, business, and society are developed in partnership with end-users, ensuring that those using the standards have input The ISO currently has over 19,500 international standards for a wide range of sectors, including health care, management, and organizational practice, although the ISO does not provide certification or accreditation. The ISO is also involved in conformity assessment to ascertain if standards are followed. The ISO has established partnerships with numerous organizations, such as the World Trade Organization, and collaborates with the United Nations. Additionally, the ISO has established a code of ethics that includes a commitment to meeting future needs, development of international standards in a fair and responsive manner, promoting implementation, monitoring, and protecting the image and integrity of the ISO, and helping developing countries.

Define system software.

There are two types of software: system and application. They are defined as follows: System software: System software includes the programs that instruct the computer how to run. Utility software may also be included under the definition of system software. The basic inputfoutputsystem (BIOS) is encoded directly onto a computer chip and activates each time the computer is started. Basic input output system is sometimes referred to as firmware. The BIOS finds and loads the computer's operating system (OS) into the random access memory (RAM). The OS manages the storage of data on the central processing unit (CPU), the interaction between CPU and peripherals, and the interaction between user and computer. The original user-computer interface was DOS (disk operating system). Disk operating system was a programming language that was difficult to learn and made home computer use impractical. The first graphical user interface (GUI) came onto the market in 1984 and is the standard for all personal computers today. Application software: Application software is targeted to the end-user and allows the user to conduct computer-aided processes such as word processing or spreadsheets.

Outline some of the hazards related to storage on a computer system.

Though storing information on computer is considered safer than storing it on paper or microfilm, there are a number of hazards that should be taken into account and managed: • Environmental and Physical Safety: This includes exposure to dust, extreme temperature, shock (e.g., earthquakes), humidity, water, and fire. Any one of these could compromise the integrity of computerized records. • Control: This entails the physical and electronic access control mechanisms designed to protect the records from being erased, stolen, or altered. • Planning: This is the process of creating backup copies of records and storing them in a separate location for safekeeping. • Time Restraints (Archiving): This process determines how long information must be retained according to state and federal regulations and sets up a system for destruction of obsolete records. • Transfer: These are plans to salvage records before they become unusable due to either degradation or changes in computer hardware. • Maintenance: This includes upkeep of the system that writes and reads the data.

Explain the telehealth applications of IDEA Tel, RLI, and Health Buddy.

Three specific applications oftelehealth currently in use are: 1. IDEA Tel, the Diabetes Education and Telemedicine Project, was started in February 2000. This program uses aggressive monitoring to track patients' blood glucose values and enables physicians to make small changes in the medication plan on a day-to-day basis. 2. RLI, Resource Link of Iowa, works with the chronically ill in Iowa. Patients are given a two-way interactive video device that allows them to have a high level of care while lowering the number of in person appointments with healthcare workers. 3. Health Buddy is a small electronic appliance that asks the patient questions, sends reminders, and communicates medical information to the physician. Several other devices, such as a glucose monitor, can be directly linked to the Health Buddy for ease in transferring data.

Describe utility programs for computers.

Utility programs provide enhancements to the overall computing environment Antivirus software (which protects against attacks from malicious code) is one type of utility program. Language translation software and web browsers are also classified as utility programs. Language translation utilities (also known as assembler, compilers, or interpreters) work to translate human language into binary code that can be understood by the computer. In order to access the internet, two types of utility software are needed: 1. The World Wide Web (WWW) is the system utility that allows one computer to communicate with another using the standard hypertext transfer protocol (HTTP), universal resource locator (URL), and Hypertext Markup Language (HTML). 2. The user must have a web browser (Netscape, Explorer, etc) that creates a graphical user interface (GUI) simplifying Internet access and use.

Describe the important information surrounding attributes used in conceptual data models.

Attributes are assigned to data that an organization collects. There are two important pieces of information that must be assigned to attributes: • Name: The name of an attribute should be a one or two word definition. This enables the user to quickly realize what information is needed for that particular attribute. Examples used in healthcare are gender, physician's name, or date of birth. If possible, abbreviations should not be used as this can become confusing to the software programmer and user. • Domain: The domain is the actual value an attribute can have. The attribute "gender" must be either male or female and "date of birth" must be a date. Domain information should have a defined format For example, date of birth should always be entered as day fmonthfyear with the year containing four digits. Defining domain formats allows the information entered by different users to be compared.

Discuss types of data: Qualitative, quantitative, primary, and secondary data.

Both qualitative and quantitative data are used for analysis, but the focus is quite different: Qualitative data-Data are described verbally or graphically, and the results are subjective, depending on observers to provide information. Interviews may be used as a tool to gather information, and the researcher's interpretation of data is important Gathering these data can be time-intensive and usually cannot be generalized to a large population. This information gathering is often useful at the beginning of the design process for data collection. Quantitative data-Data are described in terms of numbers within a statistical format This information gathering is done after the design of data collection is outlined, usually in later stages. Tools may include surveys, questionnaires, or other methods of obtaining numerical data. The researcher's role is objective. Primary data-Original data are collected for a particular purpose. Secondary data-Data were originally collected for another purpose.

Explain data analysis: Chi-square test and ttest

Chi-square (X2) is a method of comparing rates or ratios. The chi-square test is a means by which to establish if a variance in categorical data (as opposed to numerical data) is of statistical significance. There are a number of different approaches to chi-square testing. depending on the type of data, but it is generally used to show whether there is a significant difference between groups or conditions being analyzed. It may be used, for example, to compare the rates of surgical infections after two types of surgical procedures. The t test is used to analyze data to determine if there is a statistically significant difference in the means of both groups. The t test examines two sets of data that are similar, such as the average number of miles walked each week by women over 65 who have breast cancer as compared to women over 65 who do not have breast cancer.

Discuss the use of standardized terminology: Current procedural terminology codes.

Current procedural terminology (CPT) codes were developed by the American Medical Association and used to define those licensed to provide services as well as medical and surgical treatments, diagnostics, and procedures. The CPT 2012 codes cover specific procedures as well as typical times required for treatment The CPT codes are usually updated each October with revisions (additions, deletions) to coding. The use of CPT codes is mandated by both the Centers for Medicaid and Medicare and the Health Insurance Portability and Accountability Act (HIPAA) to provide a uniform language and to aid research. These codes are used primarily for billing purposes for insurance (public and private). Under HIPAA, Health and Human Services has designed CPT codes as part of the national standard for electronic health care transactions. Category I codes are used to identify a procedure or service. Category II codes are used to identify performance measures, including diagnostic procedures. Category III codes identify temporary codes for technology and data collection.

Discuss disaster recovery plans.

Disaster recovery plans are designed to make sure that the organization's operations can continue to function (at some level) throughout a disaster and return to full function once the disaster is over. Disaster recovery planning should be an ongoing process covering every conceivable scenario and involving all of the organization. It may be helpful to break a disaster recovery plan into modules (or sub-plans). Specific modules may include plans covering tests, maintenance, emergency, backup, and recovery. A test plan outlines ways that the organization can perform disaster recovery drills before they are actually needed. A maintenance plan outlines the steps needed to keep the whole disaster recovery plan up to date. An emergency plan is created to guide the organization during and right after a disaster. A backup plan lists all personnel who can be called in, alternate locations of data, and places that can be used to conduct business if the primary facility becomes unusable.

Knowledge discovery in database and data mining.

Knowledge discovery in database (KDD) is a method by which to identify patterns and relationships in large amounts of data, such as the identification of risk factors or the effectiveness of interventions. KDD may use data perturbation, the hiding of confidential information (e.g., names) while maintaining basic information in the database, and data mining. The steps to KDD include selecting data, preprocessing (e.g., assembling target data set, cleaning data of noise), transforming data, data mining, and interpreting results. Data mining is the analysis (often automatic) of large amounts of data to identify underlying or hidden patterns. The effectiveness of data mining depends on many factors, such as hardware and software applications. Data mining may identify similar groupings in data, and these groups can then be further analyzed. Data mining may be applied to multiple patients' electronic health records to generate information about the need for further examination or interventions. The steps to data mining include detecting anomalies, identifying relationships, clustering, classifying, regressing, and summarizing.

Explain data analysis: Measures of averages, such as mean, median, and mode.

Measures of averages locate the center point of a group of data: • Mean is the average number. However, since distribution can vary widely, the mean may not give an accurate picture. For example, if one unit has 20 infections per 100 and the other has 1 infection per 100, the mean (21 + 2) is 10.5 per 100, which has little validity. • Median is the 50th percentile. For example, consider the following numbers: 1, 3, 7, 9, and 15. The number 7 is the median (middle) number. If there were an even number, the 2 middle numbers would be averaged: 1, 3, 7, 9, 14, and 15. The numbers 7 and 9 are averaged so the median is 8. If there is an even distribution, the mean and median will be the same. The wider the difference between the two, the more uneven the distribution. • Mode is the number occurring with the highest frequency. There may be bimodal or trimodal numbers

Explain data analysis: Measures of distribution, such as range, variance, and standard deviation.

Measures of distribution show the spread or dispersion of data. • Range is the distance from the highest to the lowest number. The term interquartile denotes the range between the 25th percentile and the 75th percentile. Range is usually reported with the median to provide information about both the center point and the dispersion. • Variance measures the distribution spread around an average value. It is often used to calculate the effect of variables. A large variance suggests a wide distribution, and a small variance indicates that the random variables are close to the mean. • Standard deviation is the square root of the variance and shows the dispersion of data above and below the mean in equally measured distances. In a normal distribution, 68% of the data are within 1 standard deviation (measured distance) of the mean, 95% of the data are within 2 standard deviations of the mean, and 99.7% of the data are within 3 standard deviations of the mean.

Describe the American Society for Testing and Materials.

One of the largest standards development organizations is the American Society for Testing and Materials (ASTM). The role of the ASTM is to create standard methods for testing materials and procedural testing standards for different industries. For computing, the ASTM has established standards for content and verification of different computer protocols. The ASTM has developed over 9,000 standards in a wide range of fields. However, the E1384-96, E1633-95, and E31 are of primary importance to the healthcare industry. E1384-96 was developed by ASTM in 1996 and gives information on how to set computer-based patient record (CPR) content. E1633-95 was developed in 1995 and set the definition for coded values within a CPR. There are currently about 30 standards developed by ASTM by committee E31 that specify the information necessary for a patient's continuity of care record (CCR) and how that information should be presented in an electronic format, and many more standards are still in the process of being drafted.

Describe the four types of computer networks.

There are four types of computer networks: 1. Local area networks: Local area networks (LANs) are often used by companies to connect the computers in a single area or building. Local area networks are typically connected to a server (or servers) located in the same building. 2. Metropolitan area networks: Metropolitan area networks (MANs) are used to connect computers on a university campus or local government agencies housed in separate buildings within the same general area. These networks are typically wired with ethernet or telephone connections. 3. Wide area networks: Wide area networks (WANs) connect computers that are separated by a large geographical space such as individual hospitals owned by the same company. Wide area networks are typically connected via a virtual private network (VPN). 4. Internet: The Internet is a worldwide network of computers accessed by an Internet service provider.

Explain the National Institutes of Health (NIH) push for standards in information storage, creation, analysis, and retrieval.

The National Institutes of Health (NIH) is working toward implementing standards in the area of medical informatics. They recently began a push for standards in information storage, creation, analysis, and retrieval (ISCAR). Huge amounts of medical data are being created every year. In order for this information to be compiled effectively, international standards are necessary. The creation of interoperational databases is essential. There is far too much information produced each year to fit into a single database. As an example, one research laboratory can produce enough information to fill one million encyclopedias in the course of one year's work. In addition, key to this process is the importance of software that can analyze data taken from different databases. The rationale for this whole scheme is to allow for more comparative studies, make peer review simpler, and lend ease to verification of results.

Describe the major internal hardware units of a typical computer.

The following are the major internal types of hardware of all computers: • The motherboard is a thin piece of non-conducting plastic onto which the computer's circuits are printed. The motherboard also has areas where chips are mounted and slots are placed which allow the addition of other pieces of hardware. • The central processing unit (CPU) is comprised of different unit types: arithmetic, logic, control, and memory. Arithmetic and logic units control the computer's mathematical functions and test Boolean logic. • Control units perform fetch, execute, decode, and store functions based on the computer's machine language. Fetch is the process of retrieving information from storage. Decode is the process of making that information useable. Execute is the process of sending the decoded information to the arithmetic and logic unit Store is the process of putting the resulting information into the computer's memory.

List some advantages of using the World Wide Web as part of an organization's information system.

The following is a list of advantages of using the World Wide Web as part of an organization's information system: • End users only need a basic computer with World Wide Web connectivity to use the information system. • Web browser software is readily available and is free (in most cases). • Maintenance and upgrades occur at a central location, elevating the need to upgrade everyone's individual computer. • Web access is becoming broadly available, faster, and more dependable. • The Web connection can also be used for webcasts, email, and voice communications. • Access to the web allows users to conduct independent research and troubleshoot problems.

List some disadvantages of using the World Wide Web as part of an organization's information system.

The following is a list of disadvantages of using the World Wide Web as part of an organization's information system: • Connectivity quality is different from one site to another (e.g., connection speed, browser compatibility, etc.). • A web portal must be developed that has security features such as a firewall and high-level encryption capabilities. • A web portal is open 24 hours a day, 7 days a week to potential hackers and unscrupulous personnel. • The information system is vulnerable to technical issues that occur at the supplier of the web connections (e.g., telephone and cable companies). • Employees may use their World Wide Web connection for purposes other than work.

Discuss querying and reporting from databases: Structured query language.

The most common use of structured query language (SQL) is to obtain and display information from databases. SELECT is used with a number of optional keywords and extensions to access table data. The basic query includes SELECT, FROM (which columns and which table), WHERE, ORDER BY: • Asterisk (*): shortcut to indicate all columns, such as SELECT*FROM customers • Comma (,): used to list and separate specific columns, such as SELECT PatientlD, LastName, FirstName, FROM County • WHERE: limits the number of rows, such as SELECT PatientiD, LastName, FirstNAME, From County= 'Monterey' • NOT or <>: eliminates, such as FROM County<> 'Monterey' • BETWEEN: limits, such as WHERE ServiceDate BETWEEN "1-july- 2011' AND '1-September-2011' • NOT IN: limits, such as WHERE City NOT IN ('Salinas', 'King City') • LIKE: allows wild card characters"""'%, [],[A] • ORDER BY: dictates arrangement, such as SELECT PatientiD, LastName, FirstName FROM County, ORDER BY County

Define the terms architecture and topology as they apply to computers.

The terms architecture and topology are defined as follows: • Architecture: In the field of informatics, architecture is defined by the type of computer system used. Network architecture is the form of communication used between the computers involved. Broadcast communication, typically used in local area networks (LANs), involves sending the same data to every computer in the network. For example, a connection to the Internet consists of point-to-point communication where one computer sends information to only the specified computer. • Topology: The way that computers are interconnected in a LAN is known as topology. When computers are connected to the network by a direct line, this is called bus topology. Star topology relies on a central computer (called a server) to relay information to each separate computer. Early local area networks were built on a ring topology (all computers were directly connected with one another).

Describe the three major parts of a data warehouse and the storage of data.

There are three major parts of a data warehouse: 1. Infrastructure: The infrastructure (sometimes referred to as the technology perspective) refers to the hardware and software used in the system. 2. Data: Data are diagram representations of the structures that send and store information and how they relate to one another. 3. Process: Process is defined by how information gets from one place to another or how it is dealt with. Most data warehouses use the Codd rules of normalization, which breaks data down into a table in order to show the relationships between the various parts. Two widely used designs are: 1. Dimensional: The dimensional approach breaks data down into numerical facts and reference information. Dimensionally based databases are easy to use and operate quickly. However, their structures are difficult to modify. 2. Normalized: The normalized approach saves information in the "third normal form" and groups the information into tables according to their subjects. These databases can be slow and difficult to use.

Describe the peripherals: printers and modems.

Two major types of computer peripherals are: 1. Printers: Printers produce paper documents commonly referred to as "hard copies" of information stored on a computer. The most common printer for home use is the inkjet printer. Inkjet printers spray small amounts of ink onto the paper. They are affordable and fast, but they require regular purchase of replacement ink. The ink is also water-soluble and may smear. Laser printers are more durable and do not require as much maintenance, but are still primarily used by businesses. The output from laser printers is of very high quality. 2. Modems: Computers communicate with one another via modems. The modem (modulating and demodulating device) converts the computer's digital information into analog output and then converts the reply from analog back into digital. This allows communication across analog telephone (or cable TV) lines rather than digital-to-digital fiber optic connections. Combination fax modems can also send information to fax machines. Cable modems and DSL are rapidly replacing the older and slower dial-up modems.

Discuss the personal health records: Patient use.

personal health record (PHR) presents an opportunity for patient use, allowing patients to participate in their own health care in a number of ways: • Data entry: Most PHRs allow patients to enter some types of data, although this varies. A typical data entry includes personal and family health history, use of complementary therapy, and health behaviors (e.g., diet, exercise). Some also allow entry of health data, such as blood pressure readings, daily blood sugar, and weight • Delegation: PHRs usually allow the patient to assign a delegate or proxy (e.g., caregiver, immediate family member) to access the PHR In most systems, parents can access information for a child until age 13; the child may assign a parent as proxy after that age, although selected information (e.g., sexual history, treatment) may be blocked. • Messaging: Many systems allow patients to send secure messages to health care providers, in some cases routing them through a triage team.

Describe the physical database design model for information systems.

A physical database design describes how information is accumulated, stored, accessed, and linked within the information system. In designing the system, it is important to know how it will be used. There are three factors to consider: • Queries - The amount of data queries that will be required at any given time for the system. • Updates - The frequency of updates and their effect on the database functions. • Performance - The system speed, capacity, and overall robustness. The next step is to decide on the number and types of indexes (hash or tree) that should be created. It is best to create indexes that can be used for a number of queries. This will optimize both storage space and access time.

Discuss telecommunications: Bluetooth technology.

Bluetooth technology is proprietary technology developed by Ericsson and managed by Bluetooth Special Interest Group (SIG), which has established Bluetooth standards and oversees use. While this is considered open technology, licensing is required for permission to use various patents. Bluetooth is wireless technology that allows the use of short-wave radio transmissions (ISM 2400-2480 MHz) to exchange data in fixed devices and mobile devices, such as cell phones, faxes, global position system receivers, digital cameras, and computers. The user can create personal area networks that are secure. The master-slave concept is used with Bluetooth technology, so the "master" (primary device) can communicate with up to seven other "slave" devices, although the roles of master and slave are interchangeable. Range is usually relatively short but can vary. A typical example of a Bluetooth device is the hands-free headset that can be used instead of the mobile phone. Bluetooth, unlike Wi-Fi, is intended primarily for portable devices.

Discuss generating reports to identify trends and respond to quality measures: Run chart.

Clinical Context Object Workgroup (CCOW) is an HL7 workgroup that develops standard protocols for the sharing of information among applications at the point of care through context management. For example, data about a patient may be contained in a number of different applications and locations, but the CCOW allows a user to sign in one time and do one search (e.g., for a patient) for simultaneous access to information found in all the applications. CCOW may be used for Web based on non-Web-based access. CCOW defines the standards that allow interoperability and focuses on the use of technology neutral architecture and widely used computer technology. CCOW works in collaboration with the HL7 Security Workgroup to ensure protection of data. The CCOW does not do specific designs or implementation but aims to provide standards to facilitate implementation and effective design. CCOW allows both Web (http) and Active X (a Microsoft software) mapping.

Discuss clinical decision support systems.

Clinical decision support systems (CDSSs) are intended for the end user and comprise interactive software applications that provide information to physicians or other health care providers to help with health care decisions. The programs contain a base of medical knowledge to which patient data can be entered so an evidence-based inference system can provide patient-specific advice. For example, a CDSS system may be used in the Emergency Department so that staff can enter symptoms into the program and, based on the information entered, the CDSS program provides possible diagnoses and treatment options. The CDSS system may be used for a variety of purposes, such as: • Record keeping and documentation, such as authorization. • Monitoring of patient's treatments, research protocols, orders, and referrals. • Ensuring cost-effectiveness by monitoring orders to prevent duplication or tests that are not indicated by the condition or by presenting symptoms. • Providing support in physician diagnosis and ensuring treatment is based on best practices.

Describe the four major types of computers.

Currently, there are four major types of computers in widespread use: 1. Supercomputer: The supercomputer is physically the largest type of computer and is used for calculating extremely large equations found in defense, weather forecasting, and scientific research applications. 2. Mainframe computer: Mainframe computers are used by businesses as a central hub for processing, storing, and retrieving information for multiple users. These computers are very fast and can handle large amounts of information at one time. 3. Microcomputer: Microcomputers (also known as personal computers or PCs) are those seen on desktops both in an office and in homes. Those used in an office may stand-alone or may work linked to the mainframe. 4. Handheld computer: Handheld computers are generally made to perform specific functions (such as keeping an appointment calendar or receiving and sending emails). The advent of smaller, faster computer chips has meant the expansion of the handheld capabilities while maintaining a small size.

Describe digital picture archiving and communication systems.

Due to the logarithmic trend in affordable computer memory, memory intensive applications such as digital photos or video are now mainstream. Picture archiving and communication systems (PACS) have lead the way towards a "filmless" medical system. Digital images take the place of traditional radiological film. The system is able to acquire, display, send, and store digital images. Picture archiving and communication systems are used in a large number of radiology including mammography, magnetic resonance imaging, endoscopy, and X-rays. These systems allow practitioners to view and report on images without any restrictions on time and distance. It is important that PACS be integrated with any existing or planned information system in the organization. Picture archiving and communication systems save time and resources and are a very good investment for healthcare organizations.

Discuss the personal health records: Types.

Paper/personal files: Patient-maintained paper records can include booklets, files, notebooks, medication records, and handwritten notations. While data can be aggregated from various sources, this method is time-consuming; quality varies widely, and data cannot always be easily retrieved. Non-tethered: Nontethered PHRs are stand-alone and not connected to a particular system or electronic health record (HER). Information may be carried on a smart card, flash card, compact disc, or DVD. These pose more security risks than tethered PHRs and require more input from the individual to maintain accurate records. Tethered: Data are tied to a particular system and EHR and are often Web-based. A secure patient portal is provided so the individual can access all or parts of the records, including lists of medications and laboratory results. Examples include Kaiser's HealthConnect and the Veterans Administration's My Health Vet Interactivity varies but may include health diaries and logs. Net-worked: Data are derived from multiple sources in a network rather than one system. This allows for more flexibility.

Explain data presentation: Charts and graphs, such as line graphs, bar graphs, and pie charts.

Presenting data in the form of charts and graphs provides a visual representation of the data that is easy to comprehend. There are basically three types of graphs: line graphs, bar graphs, and pie charts. • Line graphs have an x andy axis; they are used to show how an independent variable affects a dependent variable. A line graph can be used to show the number of infections that occur each week, month, or year. • Bar graphs are used to compare the relationship between two or more groups. The graphs can show quantifiable data as bars that extend horizontally, vertically, or stacked. Bar graphs can be used to show comparison data of different populations or data from one time period to another. • Pie charts are used to show the percentage of an item as compared to the whole. A pie chart can show, for example, the distribution of infection-control resources.

Describe read only memory (ROM) and random access memory (RAM).

Read only memory (ROM) and random access memory (RAM) are the two types of memory accessed in a computer. Read only memory (ROM) is a permanent type of memory that is preprogrammed and never written to (or replaced) by computer instructions. The advantage of ROM is that it cannot be changed (or erased) and will not be lost when the computer is turned off. Programming that is necessary for start up and other functions (such as those that must occur repeatedly and quickly) are generally stored in ROM. Random access memory (RAM) is the computer's working memory used for data storage. RAM stores the application programs that allow user controlled tasks to be carried out by the CPU. RAM may be stored on computer chips, the computer's hard drive, floppy disks, or CD/DVDs (or any combination thereof). RAM is what most users think of when they store information on a computer.

Explain data analysis: Regression analysis.

Regression analysis is used to evaluate the data sets found in scattergrams; it compares the relationship between the dependent variable and the independent variable to determine if the relationship correlates. The strength of the relationship is indicated by the correlation coefficient (r), which ranges from 1 to + or- 1: -1 indicates a negative relationship in which one data set increases, and the other data set decreases; + 1 indicates there is a positive relationship in which both data sets increase or decrease in which case the scattergram forms a straight line. The degree to which the data points form a straight line (strong correlation), loosely structured line (moderate correlation), or no line (no correlation) is reflected in the rvalue. An rvalue ofO (midpoint) shows no relationship between the variables.

Define the term: electronic health record (EHR) and discuss its related guidelines.

The Healthcare Information and Management Systems Society (HIMSS) define the electronic health record (EHR) as a "secure, real-time, point-of-care, patient-centric information resource for clinicians." HIMSS has also published a series of guidelines for EHR known as the HIMSS Electronic Health Record Definitional Model. According to the model, the EHR should record and manage information for both the short- and long-term. The EHR should be the healthcare professional's main resource when taking care of patients. Evidence-based care can be planned using the EHR on both the individual and community level. Another important job of the EHR is its use in continuous quality improvement, performance management, risk management, utilization review, and resource planning. The EHR aids in the billing process as well. Finally, the EHR is a boon to evidence-based research, clinical research, and public health reporting. Since it is computerized, clinicians are assured that the EHR information is up to date and relevant for patients and research protocols.

Discuss the use of standardized terminology: International Classification of Disease codes.

The International Classification of Disease (lCD) codes, developed by the World Health Organization to acquire worldwide morbidity and mortality data, are used to code for diagnoses. ICD-10 (2010) is the current version, and adoption is required by 2013 because version 10 contains codes to implement electronic health records (EHRs) and other electronic transactions. Version 11, which can be used with health information systems, is in development and will facilitate Web-based editing. ICD-9 diagnoses were used by all providers, but ICD-9 procedures were used only for inpatients; however, use is expanding with ICD-10, which is much more specific. ICD-10 contains twenty-two chapters with numerous subcategories; for example, Chapter I, "Certain Infectious and Parasitic Diseases"(A00-899) lists inclusions, exclusions, and twenty-one subcategories, such as viral hepatitis (815-819). These subcategories have further divisions; for example, viral hepatitis 815 includes hepatitis with hepatic coma (815-0) and without (815-09). An electronic training tool is available on the Internet ICD-10 is consistent with the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision; cancer registry codes; and nursing classifications.

Describe several online resources for healthcare needs.

The following online resources are an extension of modern telehealth: • Access to published guidelines of current standards of care. This includes news and discussions by medical experts. • Critical pathways for help in deciding a patient's course of care. A patient can research their condition and receive information from many different sources. • Information on drugs including: cost, effectiveness, and side effects. Patients can also research generic equivalent drugs (or drug combinations) that can help with the high cost of brand name prescription drugs. • Electronic prescriptions, which lower the incidence of fraud and help with insurance claims. This also allows the prescription to be delivered to the patient's door. • Patients may also search for journal articles and relevant medical literature related to their condition. • Bulletin boards and discussion groups are active on many healthcare related subjects.

Discuss types of health care-related data: Medical/ clinical, knowledge-based, comparison, and aggregate data.

There are basically four types of health care-related data: Medical/clinical data: This information is patient-specific and includes information regarding the patient, diagnosis, treatment, laboratory findings, consultations, care plans, physician orders, informed consent, and advance directives. The medical record includes all procedures, discharge summary, and emergency care. Knowledge-based data: This information includes methods to ensure that staff is provided training, support, research, library services or other access to information, and good practice guidelines. Comparison data: These data may relate to internal comparisons or external comparisons to benchmarks or best-practice guidelines. Aggregate data: These data include pharmacy transactions, required reports, demographic information, financial information, hazard and safety practices, and any data not included in the clinical record.

Explain the types and purpose of computer disks.

There are three major types of computer disks. All of these disks can be used as input and output devices, including: Floppy disks: Magnetic floppy disks were originally available as a flexible 5 lA inch or hard cased plastic 3 lh inch sizes. Although many computers are equipped with drives that accept floppy disks, they have nearly been completely phased out due to the compactness and higher storage capacity of optical disks. CD-ROMs: Compact Disc Read Only Memory can only be recorded once. Once data is stored on the disk, it is maintained in a read only format These disks have become the most popular because of the number of drives that support this technology currently installed into computer systems. The amount of storage is much larger than floppy disks. DVDs: Digital Versatile Disks are very similar to CD-ROMs. The main advantage of DVDs (compared to floppy disks and CD-ROMs) is their higher storage capacity. Both of these storage media (CD-ROMs and DVDs) are round and shiny. Information is etched onto the disk and read with a laser beam.

Explain data presentation: Scattergram.

A scattergram is a graphic display of the relationship between two variables with one variable plotted on the x axis and the other on they axis. For example, the x axis may indicate age, and they axis, admission to the emergency department A data point is then entered for each admission, correlating with age. Analysis of the scattergram would then indicate the most common age distributions of patients. The scattergram can be used to test for possible cause-effect relationships, although this type of relationship is not required, and the scattergram is not proof of a correlation between data. As the data are plotted, repeat values are circled. With enough input, the data may begin to form a pattern. If this pattern is a straight line, there is evidence that there is a correlation between the two variables.

Provide an overview of the hardware required for a computer network.

Computers that are linked to a server or network must have a network adapter (or network interface card) and some way to connect to the server or network. The most common network interface card (NIC) is called an ethernet card. An ethernet card (or alternative network adapter) is installed onto a networked computer and allows full time access to the local area network (LAN). The next step is to physically connect the computer to the network. This can be accomplished in any of the following ways: • Telephone: This is a dial-up connection using a modem. • Coaxial cable: This is similar to the cable that cable TV providers use. • Fiber Optic Cable: A very speedy connection using digital communication. • Wireless: A wireless router is installed that allows wireless communication between networked computers and hardware (such as printers).

Discuss querying and reporting from databases: Boolean logic.

Boolean logic, developed by the mathematician George Boole in the 1800s, is used to search databases and is recognized by most search engines, such as Google. Search is conducted for keywords connected by the operators AND, OR, and NOT. Boolean searching is often used with truncations and wildcards: • Truncations: "Finan*" provides all words that begin with those letters, such as "finance," "financial," and "financed." • Wildcards: "m?n" or "m*n" provides "man" and "men." • AND: "Wound AND antibiotic" produces all documents that contain both words. • OR: "Wound OR Infect* OR ulcer" produces documents that contain "wound" and either "infect*" or "ulcer." This query is especially useful to search for a number of synonyms or variant spellings. This query may return a large number of documents. OR may be combined with other operators: Wound OR ulcer AND Povidoneiodine. • NOT: Wound AND povidone-iodine NOT antibiotic NOT antimicrobial. NOT is used to exclude keywords

Define the terms: computer hardware and peripherals.

Computer Hardware: Computers are used to make complex calculations, store information, and speed data processing. Within the medical field, computers were first used only in the areas of billing, payroll, and scheduling. They are now used in nearly every aspect of medical care. Computers contain physical parts known as hardware. Hardware is usually housed inside a plastic case, but there may be components that exist outside of the case. The computer case usually houses the motherboard, microchips, processors, and electronic circuits that carry out the computer's primary functions. Peripherals: This term encompasses the hardware that is connected to the computer to make it fully functional. Peripherals include the keyboard, printer, monitor, storage devices, and mouse. Storage devices include floppy drives, disk drives, hard drives, and Universal Serial Bus (USB) drives.

Discuss computerized physician order entry.

Computerized physician order entry (CPOE) is a clinical software application that automates medication/treatment ordering, requiring that orders be typed in a standard format to avoid mistakes in ordering or interpreting orders. CPOE is promoted by Leapfrog as a means to reduce medication errors. About 50% of medication errors occur during ordering, so reducing this number can have a large impact on patient safety. Most CPOE systems contain a clinical decision support system as well so that the system can provide an immediate alert related to patient allergies, drug interactions, duplicate orders, or incorrect dosing at the time of data entry. Some systems can also provide suggestions for alternative medications, treatments, and diagnostic procedures. The CPOE system may be integrated into the information system of the organization for easier tracking of information and data collection. This system is cost-effective, replaces handwritten orders, and allows easy access to patient records.

Describe computerized provider order entry systems.

Computerized provider order entry (CPOE) systems greatly reduce paperwork and decrease errors. The system allows healthcare providers to enter prescription information or treatment orders via the computer. Once the information has been entered directly into the computer, it is checked for a wide variety of potential errors including: drug interactions, drug allergies, and patient condition alerts. The benefits ofCPOE include: • Patient centered: Changes are made in real-time and make for the safest treatment possible. • Intuitive: The interface resembles a paper document and can be personalized for an individual provider. • Secure: Meets all regulatory guidelines for secure access thanks to the use of electronic signatures. • Portable: No matter where a patient is seen throughout the United Sates, their healthcare provider can access their information. • Computerized provider order entry systems make billing easier and more accurate since the system codes the diagnosis at the time of entry.

Explain the term: data mining.

Data mining involves electronically searching through large amounts of information to find relevant items. Data mining uses several tools to look for patterns: • Association rule mining: This tool looks for patterns in which a certain data object shows up repeatedly (more than randomly) and is associated with an unrelated data object. • Classification: This tool looks for data group membership. An example would be the number of sunny days in a year. • Clustering: This tool organizes data objects according to their similar characteristics. This results in a natural pattern or clustering of similar data. Data mining can also be called knowledge discovery. The results can also be used for making predictions. When drawing conclusions by use of mined data, statistical significance of relationships should be based on the sample size (with stricter rules for smaller data sets). Even though data mining has been in use for decades, there has been a recent public outcry against it (citing privacy concerns). Overall, data mining is a powerful tool that can be used for good purposes when used ethically.

Discuss data representation: Binary code.

Data representation can be verbal (e.g., spoken/written representations), analog (e.g., television, radio, telephone, recorded), or digital (e.g., coded). Analog representation uses continuous waveform signals varying in intensity. Computerized representation of data uses codes (usually numeric), such as the binary code (base 2) to represent values. The binary code is comprised of strings of 1s and Os with 1s stored in magnetized areas of disks and Os stored in nonmagnetized areas; thus, 1 represents "on," and 0 represents "off." Each representation (0 or 1) is referred to as a bit (binary digit). Data are converted into bits for digital transmission: • 8 bits= 1 byte (can represent 256 characters). • 1,000 bytes = 1 kilobyte. • 1 million bytes = 1 megabyte. • 1 billion bytes = 1 gigabyte. • 1 trillion bytes = 1 terabyte. The coding scheme is the pattern of Os and 1s used to represent characters. For coding of English and European languages, the most common binary coding scheme is that of the American Standard Code for Information Interchange.

data transformation.

Data transformation is the process of changing information from a given source (such as a data entry terminal) into information that can be understood by a destination point (such as a large database). Data transformation is performed in two steps: 1. Data mapping. This process develops a map of how information flows from one place to another and figures out which parts of the information needs to be transformed. 2. Code generation. This is when the actual transformation occurs and the data is converted into a form compatible with its destination. Following any transformation of data, it is important to conduct a test of data integrity. This confirmatory test will allow the user to check that no information was lost or incorrectly transformed during the process. Once a data transformation system has been created and proven sound, random tests for data integrity should still be performed on a regular basis.

Describe the four types of data warehouses.

Data warehouses were created as separate entities from ordinary computer system structures beginning in the late 1980s. The major reason for this type of setup was that separating the two functions freed up space and improved response time on the system servers. This structure also allowed for a centralized warehouse that could be used to create reports for the entire organization. There are four types of data warehouses that have evolved: 1. Offline operation databases: Offline operational databases are simply copies of the operation system saved to a separate location or partition on the server. 2. Offline data warehouse: The offline data warehouse creates a regular copy of the operational system used in a reportorientated system. 3. Real-time data warehouse: Real-time data warehouses are similar to offline data warehouses except that they are constantly updated. 4. Integrated data warehouse: An integrated data warehouse is updated with information, processes it, and returns the results to the central system for use in daily activities.

Discuss evidence-based practice: Overview.

Evidence-based practice is the use of current research and individual values in practice to establish a plan of care for each individual. Research may be the result oflarge studies of best practices or individual research from observations in practice about the effectiveness of treatment. Evidence-based practice requires a commitment to ongoing research and outcomes evaluations. Many resources are available, such as the Guide to Clinical Preventive Services by the Agency for Healthcare Research and Quality of the U.S. Department of Health and Human Services (http:/ jwww.ahrq.govfclinicjcps3dix.htm). Evidence-based practice requires a thorough understanding of research methods to evaluate the results and determine if they can be generalized. Results must also be evaluated in terms of cost-effectiveness. Steps to evidencebased practice include: • Making a diagnosis. • Researching and analyzing results. • Applying research findings to a plan of care. • Evaluating outcomes.

Discuss evidence-based practice: Strategies.

Evidence-based practice must be part of the mission and goal of a health care organization, and strategies to attain this must be supported at all levels. Information technology tools, such as Internet capability or access to information databases, should be available at the point of care so that health care providers are able to access journal articles and other clinical information. Links may be available through the patient's health risk evaluation as well. All staff should receive training in the use of equipment and methods of researching and retrieving information and have an understanding of how to interpret research findings; the inability of health care providers to understand and interpret findings can be a significant barrier to evidence-based practice. Because evidence-based practice often results in change, institutional support for change must be evident and may involve incentives. Continuing education classes should be available on-site to help health care providers gain the research skills they need.

Discuss health information exchanges and regional health information organizations.

Health information exchanges (HIEs) have been developed to allow exchange of health information among different health care providers in a specified area, region, or system. Information is shared electronically, saving costs and speeding access. Health Information Technology for Economic and Clinical Health included grants through the National Coordinator of Health Information Technology for the establishment of organizations, known as regional health information organizations (RHIOs), to facilitate HIEs. According to federal guidelines, an RHIO is a neutral organization that complies with the structure of participating organizations. RHIOs vary in structure, but basic functions include facilitating connectivity that allows data to be effectively and securely exchanged across local, regional, or state HIEs. RHIOs provide management services and oversight of HIEs. Other services provided by RHIOs include: improved patient care, avoidance of service duplication, improved administrative efficiency, integration of preventive care, improved response times, facilitated interchanges with public health departments, and education.

Describe the benefits of wireless technology.

Modern computer information systems operate (at least partially) on wireless technology. Wireless computing, in the form of wireless local area networks (Wi-Fi) and personal digital assistants (PDAs), enable healthcare workers to send and receive information at the same place where they care for the patient The major benefits to doing this include: • There is less chance of human error. • There is less chance of information being seen by unauthorized personnel. • There is a savings in time. • Human error is decreased because the necessity of having to transcribe information into a patient's chart from the physician written or spoken notes is eliminated. • Computer files are generally more secure than paper charts because they are accessed only with a user identification number and password so only authorized personnel can gain access to them. • Since information is directly input into the system, files are updated immediately, which eliminates the significant amount of time that was previously needed to manually update files.

Explain data presentation: Balanced scorecard.

The balanced scorecard (designed by R. S. Kaplan and D.P. Norton) provides performance measures in relation to the mission and vision statement and goals and objectives. A balanced scorecard includes not only the traditional financial information but also data about customers, internal processes, and education/learning. Each organization can select measures that help to determine if the organization is on track to meeting its goals. These measures may include the following: • Customers: types of customers and customer satisfaction • Financesfbusiness operations: funding and cost-benefit analysis • Clinical outcomes: complications, infection rates, inpatient and outpatient data, and compliance with regulatory standards • Education/learning: in-service training, continuing education, assessment of learning, use of new skills, and research • Community: ongoing needs • Growth: innovative programs If the scorecard is adequately balanced, it reflects both the needs and priorities of the organization itself and also those of the community and customers.

Describe some less commonly used peripherals.

Some less commonly used peripherals include: • Light pen: A light pen can highlight information and send data to the computer by touching a specially designed monitor that recognizes the pen. • Touch screens: Touch screens allow the user to physically tap the screen with their finger or a plastic pen device in order to make choices. • Optical character recognition (OCR): OCR allows data to be read by a special device directly from the source. This technology is used in grocery store checkouts and standardized test grading. A similar form of input reader is the magnetic-ink character recognition (MICR). Banks use MICR to read the routing and account numbers of checks. • Computer enhanced imaging: Computer enhanced imaging is of particular importance to the medical field. Two examples include CAT scans (computerized axial tomography) and MRI (magnetic resonance imaging).

Discuss querying and reporting from databases: Statistical Analysis System.

Statistical Analysis System (SAS) is an integrated group of software applications used to report, analyze, and access data. Some applications are intended for programmers and others, for management Statements and procedures are used to access functions. The three primary steps of an SAS program include the following: • Data: uses SQL or FOCUS (a 4GL used to query databases) to automate identifying files • Procedures: operate on the tables (data set) as a whole • Metaprogramming language: metalanguage to write computer programs that affect other programs in some way (i.e., manipulate, reduce necessary code) A number of different components are available, including the following: • Base SAS software (SAS procedures, DATA debugger, output delivery system, windowing environment) • Business intelligence dashboard: allows graphics that represent data • Data integration studio: extracts, transforms, and loads • Enterprise Business Intelligence services: collection of business tools • Enterprise miner: data mining tool • Information map studio: allows users to build information maps

Discuss evidence-based practice: Steps to developing guidelines.

Steps to developing evidence-based practice guidelines include the following: • Focus on the topic/methodology: This includes outlining possible interventions/treabnents for review, choosing individual populations and settings, and determining significant outcomes. Search boundaries (e.g., journals, studies, dates of studies) should be determined. • Evidence review: This includes review of literature, critical analysis of studies, and a summary of results, including pooled meta-analysis. • Expert judgment: Recommendations based on personal experience from a number of experts may be used, especially if there is inadequate evidence based on review, but this subjective evidence should be explicitly acknowledged. • Policy considerations: This includes cost-effectiveness, access to care, insurance coverage, availability of qualified staff, and legal implications. • Policy: A written policy must be completed with recommendations. Common practice is to use letter guidelines, with "A" the most highly recommended, usually based on the quality of supporting evidence. • Review: The completed policy should be submitted to peers for review and comments before instituting the policy.

Discuss the display of patient data for clinical decision-making.

The effective display of patient data for clinical decision-making requires that information be rapidly available with minimal cognitive effort. The decision tree is a common presentation with potential options, consequences, and expected outcomes. Other types of presentations include tables, various types of graphs, and icons. In most cases, multiple modes of data presentation provide the best information. For example, if a health care provider wants to know a patient's trend in blood sugars, a line graph is effective; however, if the provider wants the exact numbers to determine insulin dosage, getting this information is easier from a table. Patient data should be integrated in a meaningful manner. For example, a change in heparin dosage should automatically display the latest prothrombin time/international normalized ratio for the patient Visual indicators, such as different colors, may be used to highlight information, such as abnormal laboratory results. Pictorial displays can be effective, but multiple displays on one screen are distracting and slow the cognitive processing of data.

Describe the three major classes of computers.

There are three major classes of computers: 1. Analog: Analog computers measure specific continuous data and do not break the information down any further. They may measure temperature, pressure, heart rate, voltage, or current The fetal monitor is one example of an analog computer used by nurses. 2. Digital: Digital computers use binary code to represent data. This is the most common type of computer used at home and in businesses. Networked computers also communicate using binary code. 3. Hybrid: Hybrid computers have elements of both analog and digital computers. These computers are produced and used for highly specific tasks which are often based on physics and engineering. The ECG and EEG are two types of hybrid computers. They take analog inputs (brain waves in the case of the EEG) and transcribe them into binary data so that they can be studied and compared using a digital computer.

Describe the computer mouse, trackball, and touch pad.

There are three major types of input devices that are used to move the cursor around the screen: 1. Computer mouse: The computer mouse usually has two buttons (right and left) and a roller on top. The left button is used to open programs or select data, the right button is used per a specific program's instructions, and the roller allows the user to scroll up or down the screen information. The mouse rests on the desktop next to the keyboard and is connected to the computer via a long flexible wire. The user physically moves the mouse around on a pad whereupon a ball (or beam of infrared light) signals the computer where to move the cursor on the computer screen. 2. Computer trackball: Unlike a mouse, the computer trackball stays in one place while the user moves a ball on top to adjust the cursor on the computer screen. 3. Computer toucbpad: Touchpads are usually built into laptop computers. The user moves the cursor by moving a finger on its surface and selects items by gently tapping on buttons beneath the touch pad.

Describe the industry standards associated with nursing informatics.

There are two major standards associated with nursing informatics: 1. The Institute of Electrical and Electronic Engineers (IEEE) developed the P1073 Medical Information Bus (MIB) standards to aid in the transfer of information between patient medical devices and the hospital's mainframe computer system. Patient medical devices are updated in real-time as they are used in emergency rooms, intensive care units, and operating rooms. These standards are built into all such devices universally to avoid problems with data communication. The latest series of standards, 802.11 also known as Wi-Fi, allow for computers and medical devices to communicate wirelessly. 2. The National Electrical Manufacturers Association and the American College of Radiologists created Digital Imaging: and Communications in Medicine (DICOM). Digital Imaging and Communications in Medicine is used in association with biomedical images and image-related information. While not the only standard of its kind, it is the primary one used in North America.