Final Nursing Informatics
What is the ultimate goal of workflow/process analysis?
the primary intention is to create a future-state solution that maximizes the use of technology and eliminates non-value-added activities
What is ethical decision making?
the process of making informed choices about ethical dilemmas (:arise when moral issues raise questions that cannot be answered with a simple, clearly defined rule, fact, or authoritative view) based on a set of standards differentiating right from wrong
What is ethics?
the process of systematically examining varying viewpoints related to moral questions of right and wrong
What is medical coding?
the use of alphanumeric codes to communicate with payers about which procedures were performed and why; a code must be submitted for each individual claim
What is predictive analytics?
CDS tool that takes available data and applies logic/algorithms to calculate the liklihood of en event (i.e., fall risk tool, weighted sepsis score tool)
What does HIPAA require to ensure protection of PHI?
*HIPAA requires data encryption and identity authentication through the use of usernames and passwords
What is data mining and what can it help with?
-A process of utilizing software to sort through data so as to discover patterns and ascertain/establish relationships; may help to discover/uncover previously unidentified relationships among the data in a database. -Can help with managing population health, assist with and inform administrative processes, provide metrics for quality improvement, support value-based reimbursement, and provide data for registry software that helps population health management.
What are examples of Clinical Support Tools?
-computerized alerts and reminders; drug-drug interaction alerts; underdose/overdose alerts; clinical guidelines; patient data reports/summaries/ documentation templates; diagnostic support; reference information -predictive analytics -prescriptive analytics
What are the consequences to CDSs?
-loss of clinician autonomy (i.e. hard stops) -alert fatigue -financial implications to design and maintain -workflow disruption -user errors/system errors
What mobile apps are regulated by the FDA?
-mobile medical devices are regulated by the FDA and distinctly defined by the FD & C Act; usually apps intended for medical use are considered mobile medical devices. POC devices are regulated. -most mobile apps are not medical devices -the FDA does not regulate consumer-operated apps like calorie counters -some apps meet the definition of a medical app but do not pose a great risk to patients, and are therefor not regulated by the FDA -the FDA manages cybersecurity risks and hospital network security.
What is workflow?
-term used to describe the action or execution of a series of tasks in a prescribed sequence; a progression of steps (tasks, events, interactions) that constitute a work process, involve two or more persons, and create/add value to an organization's activities
Who was the "Mobile Medical Applications Guidance for Industry and Food and Drug Administration Staff" released by and what was it intended for?
-the guidance was released by the FDA and it distinguishes regulated mobile medical applications from unregulated mobile applications and those with potential to pose a greater risk to patients -high risk: drug dosing schedule, low risk: GCS calculator For the creators of apps, a risk assessment conducted by app creators can identify the need for safeguards or for the inclusion of a disclaimer.
What is bioethics/ bioethical standards?
-the study and formulation of healthcare ethics; takes on relevant ethical problems experienced by healthcare providers in the provision of care to individuals and groups - refers to the gathering, manipulation, classification, analysis, synthesis, retrieval, and maintenance of databases related to ethical cases, the effective reasoning applied to various ethical dilemmas, and the resulting ethical decisions
What are the steps in a SRA?
1.) review the existing security of pHI 2.) identify threats and vulnerabilities 3.) assess risks for likelihood & impact 4.) mitigate risks (risk mitigation) 5.)monitor results
What are Common Procedural Terminology (CPT) codes?
5 digit universally recognized codes that reflect the procedure or medical services performed by physician/nonphysician providers; presented in 6 sections: evaluation and management; anesthesiology; surgery; radiology; pathology; and medicine. -Provides a logical means to track healthcare data, trends, and outcomes
What are International Classification of Diseases- Clinical Modification (ICD-10) codes?
A shorthand for diagnosis that must correspond with the CPT code used
What is prescriptive analytics?
CDS tool that leads the clinician on a defined pathway to address the identified issue (i.e., triggered sepsis guideline order set based on weighted sepsis score)
Why is medical billing/coding important in the U.S.' current healthcare system?
Coding is important because the United States operates on a fee-for-service healthcare system, which means accurate documentation must communicate the visit/procedure performed and the medical necessity so a set amount of monetary reimbursement from payers can be provided.
What are ethical standards for social networking/social media?
Ethical standards for health-related internet sites includes: candor, honesty, quality, informed consent, privacy, professionalism, responsible partnering, accountability. These are voluntary and not overseen.
What is the Ethical Model for Ethical Decision Making?
Examine the ethical dilemma; Thoroughly comprehend the possible alternatives available; Hypothesize ethical arguments; Investigate, compare, and evaluate the arguments for each alternative; Choose the alternative you would recommend; Act on your chosen Alternative; Look at the ethical dilemma and examine the outcomes while reflecting on the ethical decision
What is a security risk assessment (SRA)?
It's a process composed of steps hospitals and clinics can engage in to identify risk/threats & vulnerabilities to PHI and therefor HIPAA breaches
Examples of public entity payers and private entity payers
Payers can be private entities like insurance companies or public entities like Medicare and Medicaid.
What are some examples of ethical values and behavior expected of HIT nurses?
Respect for human dignity Respect for individual right to self-determinism Privacy commitment to the patient (defined as individual, family, group, or community) Advocacy for the patient Participation in the creation, maintenance, and improvement of healthcare environments Advancing the profession Collaboration with others to meet health needs Shaping social policy
What type of coding is E&M based on and what are the principles of this coding?
Risk Based . 1.) History (Hx) 2.) Physical (PE) 3.) Medical Decision Making (MDM), which each must have a specific number of elements documented to meet the requirements -Your documentation regarding Hx, PE, and MDM must meet the requirements for the code's level of service; failure to do so is considered fraud → subject to repayment of fees, additional fines, and sanctions This can be checked using available tools on the Internet/apps on mobile devices.
What guidance for ethical decision making related to Health Information Technology was released and what organization released it?
The American Nurses Association released guidance for ethical decision making (Code of Ethics for Nurses with Interpretive Statements); the document is not specific to HIT, but the framework can still be applied.
What is the biggest ethical challenge that nurses fail to embrace their role in?
The biggest ethical challenge is when nurses fail to embrace their role in shaping health policy and social change.
What is the human-technology interface?
The hardware and software through which the user interacts with any technology (e.g., computers, patient monitors, telephone) to enter direct categorical data, including diagnosis and procedure data; in the EHR, interface terminologies and their subsets are usually presented in a drop-down menu and can be located using search functionality.
What is confidentiality?
The mandate that all personal information be safeguarded by ensuring that access is limited to only those who are authorized to view that information
What is the most important component to promote patient safety within medical apps? Who does the responsibility remain with in terms of this-- the clinician or the medical app?
The most important factor that ensures patient safety is the accuracy and reliability of information within apps. The responsibility for good clinical care remains with the clinician despite the influence of apps in the clinical workplace. The importance of patient safety is why medical applications are regulated.
Do POC devices require FDA regulation?
These devices often require FDA approval because there are medical devices that interact with the patient.
How do Diagnosis-related groups (DRGs) organize E&M codes & how do Major-diagnostic Categories (MDCS) organize E&M codes?
These groups facilitate payment through the prospective payment system while these categories organize diagnoses that affect similar physiological systems
What is the Patient Protection and Affordable Care Act (ACA) and what ethical principle does it capture?
This is a piece of HIT legislation intended to reform healthcare by improving care & reducing disparities; it illustrates distributive justice, an ethical principle
What is the difference between sequential and parallel workflow?
While in a sequential workflow each step depends on the occurence of the previous step, in a parallel workflow, two or more steps can occur concurrently
What elements is MDM based on?
a component of E&M risk based coding, which gives us credit for the excess work involved in management of a more complex patient, is based on three elements: 1.) Risk 2.) Data 3.) Dx (Diagnosis)
What are antivirus softwares?
a computer program that is designed to recognize and neutralize computer viruses (: malicious codes that replicate over and over and eventually take over the computer's memory and interfere with its normal functioning)
What is an antivirus software?
a computer program that is designed to recognize and neutralize computer viruses (: malicious codes that replicate over and over and eventually take over the computer's memory and interfere with its normal functioning)
What is medical billing?
a concept of administrative data; the process of submitting and following up on claims/bills via alphanumeric codes made to a payer in order to receive payment for medical services rendered by a healthcare provider
What is the federal Health Information for Economic and Clinical Health Act of (HITECH) act?
a piece of HIT legislation that is part of the American Recovery and Reinvestment ACT and aimed to provide everyone in the US with an EHR; provides monetary incentives for providers who engaged in Meaningful use OF hit
What is ransomware?
a specific type of malware or malicious code that cripples the computer network until a ransom is paid by the organization whose network was compromised
What is a firewall?
a tool that can be either hardware, software, or a combination of both and examines all incoming messages or traffic to the network; a tool that serves as electronic security guards at the gate of the corporate network to protect networks attached to the internet
What is clinical transformation?
a type of workflow redesign that involves the complete alteration of the clinical environment and the manner in which work is carried out, and the outcomes achieved being total different from the prior state
What is optimization?
a type of workflow redesign that occurs after the implementation of technology; the process of moving conditions past their current state and into a more efficient and effective method of performing tasks
what are biometric devices
a variety of telecommunications-ready measurement devices (i.e., blood pressure cuffs, blood glucose meters, pulse oximeters, PT/INR meters, peak flow meters, ECG monitors or fully integrated systems like vital signs monitors) that typically use the household telephone jack to transmit patient data to a central server location
What is privacy and what piece of HIT legislation protects it?
an important issue related to personal information about the owner or other individuals that focuses on sharing this information with others electronically and the mechanisms that restrict access to this personal information; HIPAA addresses this.
What is administrative data? How are codes derives from this data?
billing information derived from insurance companies, inpatient discharges, and outpatient visits & includes documentation of clinical diagnosis & use of health services as recorded through coding. -A trained coder reviews the clinical record --> assigns reimbursement codes through predefined systems such as the International Classification of Diseases -Clinical Modification (ICD-10-CM) and Common Procedural Terminology (CPT) system .
What is Workflow/Process Analysis?
observation and documentation of workflow to better understand what is happening in the current environment and how it can be altered
What are firewalls?
can be either hardware, software, or a combination of both that examines all incoming messages or traffic to the network; a tool that serves as electronic security guards at the gate of the corporate network to protect those attached to the internet
What is social media?
communication tools that promote real-time information exchange (user-generated content) i.e., Twitter, Facebook, Snapchat, Youtube, Linkedin, blogs,
What is the definition of Clinical Decision Support systems (CDSs)?
computer-based programs designed to assist clinicians in making clinical decisions by filtering or integrating vast amounts of information and providing suggestions for clinical intervention; a process designed to aid directly in clinical decision making, in which characteristics of individual patients are used to generate patient specific interventions, assessments, recommendations, or other forms of guidance that are then presented to a decision-making recipient (i.e., clinician, patients, others involved in care delivery)
What strategies can be taken to protect privacy of PHI?
data encryption, protecting data from being shared with third parties (i.e., insurance companies, advertisers)
How are E&M codes arranged? What is an issue people have with E&M codes and how is ths being addressed
from simple complexity --> high complexity. -those considered higher complexity/higher service, there are more existing documentation standards. Many clinicians have found these standards burdensome → 2023 revisions have been made (i.e., history and/or PE, MDM or minimum time spent on date of service) There are different codes for patients being seen for a complete physical exam (i.e. preventative visit), which includes additional time spent on health risk assessment and providing education →additional reimbursement applies.
What is the human-technology interface?
hardware and software through which the user interacts with any technology (i.e., computer, phone, patient monitor); plays an important role in supporting direct entry of categorical data by healthcare providers to indicate diagnosis and procedures. -them and their subsets are usually coded in the EHR as as a drop-down menu with an enabled search function
what are questions that should be asked to evaluate the critical appraisal criteria of credibility?
how ________ are the sources of information? Are they peer-reviewed?
what are questions that should be asked to evaluate the critical appraisal criteria of relevancy?
how current is the information in the app? When was the last update? Is the content consistent with evidence-based literature or best practices?
What is the U.S.'s Fee-for-service Healthcare System?
in this model, a provider is given a set amount of monetary reimbursement for a specific visit/procedure performed that is adjusted for geographical location ; this payment is dependent on the medical necessity of the service rendered that is communicated through accurate documentation
what does reliability, a criteria of critical appraisal for medical apps, measure?
it accurately measures what it is intended to measure
What does POC technology promote?
it allows for quick on-the-spot testing and diagnosis right at the patient's side that can be conducted anywhere the patient is, like the home, doctor office, ambulance, or hospital bedside → results downloaded directly into the EHR through interface engines → reduced risk of error in manually entered results; results immediately available to caregivers for treatment decisions → reduced overall cost of care delivery and improved patient safety/quality. Examples: those that allow the patient to monitor and maintain his health from home (insulin pumps, pacemakers, defibrillators).
What does HIPAA protect and what must be true to fall within its scope?
it protects the privacy of digital PHI and applies to health apps functioning within a medical institution and those that transmit information between an app and health care professionals. -To fall under HIPAA's scope, PHI must be communicated between covered entities such as healthcare providers and health plans.
are mHealth (mobile health) apps covered under HIPAA Legislation?
no, because because some of the apps have been generally available & may be used by consumers to collect their own health data
What is the typical output of workflow analysis?
process map: visual depiction of process that ranges from simplistic to fairly complex; swim lake technique is an example of a process map
What is cybersecurity and who regulates medical device cybersecurity?
protection from danger or loss; this is overseen by the FDA
What are the benefits to CDSs?
reduced clinical variation, ensured patient safety, and avoided complications to reduce expensive hospital readmisisons
what are haptic devices
sense of touch; the science of applying tactile sensation or touch to human computer interactions allowing for users to use special input/output devices (i.e., joysticks, data gloves, ect.) to feel or sense and manipulate/control virtual, 3-D object's attributes of texture, shape, surface, temperature. and/or weight.
what are Haptic devices
sense of touch; the science of applying tactile sensation or touch to human computer interactions allowing for users to use special input/output devices (i.e., joysticks, data gloves, ect.) to feel or sense and manipulate/control virutal, 3-D object's attributes of texture, shape, surface, temperature, and/or weight.
What is telehealth?
telecommunication-ready technologies (i.e., telephone, videophone, computer) used to deliver health-related services or to connect patients and healthcare providers to maximize patients' health status such as applications like Pocket Doctor and iTriage -used to broaden access to care by extending access of reach *transmission of digital images for assessment/diagnosis or treatment *submission of objective/subjective clinical data for assessment/diagnosis or treatment *case management provided via telephone/smartphone app to offer disease prevention and promotion of good health *providing health advice in emergent cases via telephonic or video interactive technologies *using real time live video to exchange health services/education
What HIT guidance did the American Nurses Association release?
the Code of Ethics for Nurses with Interpretive Statements
What is confidentiality?
the mandate that all personal information be safeguarded by ensuring that access is limited to only authorized users
What is mobile health (mHealth)?
the use of wireless communication (i.e. mobile phones, smartphones, tablet computers, smartphones, and POC patient monitoring devices such as wearable monitors to track vital signs) to support efficiency in public health and clinical practice; facilitated by mobile applications (apps) executed on a mobile platform or a web-based software application tailored to a mobile platform. -includes "community" groups and social media -information is sent to the EHR
What must be identified before determining an Evaluation & Management (E&M) code?
three elements. the place of service (i.e., inpatient, outpatient, ect.), type of service (i.e., consultation, hospital admission, office visit), and patient status (i.e., new: a patient who has not received professional service from a provider/partner within the same group practice within the last 3 years vs established) must first be identified.
What is the primary goal of CDSs?
to leverage data and scientific evidence to help guide appropriate decision making
Why are the ICD-10 & CPT used?
to standardize terminology --> increase interoperability. Shorthands that simplify medical records.
What mobile apps are considered medical devices?
usually apps intended for medical use are considered mobile medical devices *Drug-drug interaction, drug allergy-look up tools *Apps that coach patients with conditions by simple prompting *Apps that provide tools for disease management such as to log, track or trend events/measurements & share the information with healthcare providers *Apps that use a patient's diagnose to provide clinicians with best practice guidelines *Videoconferencing portals intended to enhance communication between patients and providers *Apps that provide simple clinical calculations (i.e. BMI) *Apps that provide patients with access to their EHRs
what are practices an APN must take to abide by HIPAA regulations
wLimiting access to individuals with a right to know Signed disclosures to release information Fax cover sheets
are mHealth (mobile health) apps covered under FDA scope?
yes, if malfunction/misuse of the app threatens patient safety or if it includes diagnostic assessment and treatment recommendations
