Informatics

What is the basic premise underlying pay-for-performance?

Evidence-based care alone is sufficient to qualify for financial rewards.

__________ systems use artificial intelligence to model a decision that experts in the field would make.

Expert

Construct basic and advanced usability tests for health informatics applications.

Five steps for planning and conducting usability tests include: • Definition of purpose • Assessment of constraints • Use of an HCI framework to refine each component • Emphasis on components of interest • Matching methods to the purpose, constraints, and framework assessment

Determining output

Analyses of the current and desired workflows provide this information Specifications must be agreed to or signed off by managers in the areas that will be impacted Constant changes delay the project and increase costs

Hardware Requirements

Analysis of needs must be done early in the implementation phase Considerations - network infrastructure, workstations and mobile devices, placement of workstation and printer needs

Getting to know the system by the implementation committe

Base system - supplied by vendor without any changes training for committee - onsite training by the vendor, vendor training at corporate headquarters, consultants may provide training

________________ are used to access client data that are used to plan, implement, and evaluate care.

Clinical information systems (CIS)

Password selection and handling

choose passwords that are 8-12 characters long, avoid obvious passwords never share passwords change frequently do not... post or write down passwords, leave computers or applications running when not in use, re-use the same password for different systems, use the browser save feature

Define the different types of terminology structures, such as a classification system (e.g., NANDA, NIC, NOC) versus a reference terminology (ICNP, SNOMED-CT).

classification system- an arrangement of concepts based on essential charcteristics. arranged in a single hierarchy. used to categorize the details of the clinical encounter. Reference terminology - A set of terms representing concepts in a particular field or domain, for example, problems, observations. consists of a set of concepts with definitional relationships.

Differentiate between computer and information literacy.

computer literacy refers to a familiarity with the use of personal computers, including the use of software tools such as word processing, spreadsheets, databases, presentation graphics and email. information literacy is the ability to recognize when info is needed as well as te skills to find, evaluate and use needed info effectively.

The sharing of private information in a situation in which a relationship has been established for the purpose of treatment, or delivery of services, with the understanding that this information will remain protected is ________.

confidentiality

Hx of telehealth

correlates to federal funding, in 1996 telecommunications act allowed for competitive communication alternatives the american recovery and reinvestments act in 2009 provided billions of dollars in stimulus funding

The Health Insurance Portability and Accountability Act (HIPAA) is best known for which of the following?

created legal protection for PHI

Security Rule

establishes a national set of security standards for protecting certain health information that is held or transferred in electronic form. Goal is to protect the privacy of individuals health information while allowing covered entities. Maintains the integrity and availalbity of electronic information

Who uses telehealth?

hospitals, clinics, home health agencies, pharmacies, public health departments, theyre all using information and communication technologies

The project timeline is established in what phase of the information system life cycle?

implementation phase

ICNP - intl classification of nursing practice

implemented at both point of care and a reference terminology unified nursing language for nursing practice that facilitates the development and the cross mapping of existing terminologies ICNP has developed guidelines to develop nursing diagnosis, outscome and internvetion statements

driving forces of telehealth

improved access to care improved quality of care improved continuity of care improved client record quality

NOC

nursing outcomes classification is a systems that described patient outcomes sensitive to nursing interventions. it evaluates the effects of nursing care as part of healthcare

Which of the following represents the most effective strategy for fostering evidence-based practice among staff nurses?

provide a series of educational programs on how to search databases, critique research articles and incorporate research findings into interventions

The American Recovery and Reinvestment Act of 2009 (ARRA)

provided funds for health information technology (HIT)

Standardized Nursing Terminology

ANA committee for nursing Practice Information Infrastructure (CNPII)

Health Information Technology

As an informaticist and a healthcare provider it is our responsibility to recognize and embrace HIPPA requirements

Discuss present and proposed telehealth applications.

Examples include monitoring activities, diagnostic evaluations, decision-support systems, storage and dissemination of records for diagnostic purposes, image compression for efficient storage and retrieval, research, electronic prescriptions, voice recognition for dictation, education of healthcare professionals and consumers, and support of caregivers. Real-time videoconferencing between physicians or healthcare professionals and clients and the transmission of diagnostic images and biometric data are examples of high-tech applications. An example of a low-tech application is a home glucose-monitoring program that uses a touch-tone telephone to report glucose results. Desktop PCs outfitted with microphones and video cameras can provide telehealth opportunities for applications that do not require high resolution. Ambulatory care settings. Clients are connected with automated systems to monitor medication adverse events and medication nonadherence. Clinicians have real-time information on a patient's experience with medications. • Cardiology. ECG strips can be transmitted for interpretation by experts at a regional referral center, and pacemakers can be reset from a remote location. • Counselling. Clients may be seen at home or in outpatient settings by a counselor at another site. • Data mining. Research may be conducted on large databases for educational, diagnostic, cost/benefit analysis, and evidence-based practice. • Dermatology. Primary physicians may ask specialists to see a client without the client waiting for an appointment with the specialist and travelling to a distant site. • Diabetes management. Clients may report blood glucose readings by using the touch-tone telephone. • Mobile unit post-disaster care. Emergency medical technicians (EMTs) and nurses at the site of a disaster can consult with physicians about the health needs of victims. • Education. Healthcare professionals in geographically remote areas can attend seminars to update their knowledge without extensive travel, expense, or time away from home. • Emergency care. Community hospitals can share information with trauma centers so that the centers can better care for clients and prepare them for transport. • Fetal monitoring. Some high-risk antepartum clients can be monitored from home with greater comfort and decreased expense. • Geriatrics. Videoconference equipment in the home permits home monitoring of medication administration for a client who has memory deficits but who is otherwise able to stay at home. • Hypertension management. Clients receive automated reminders and education feedback regarding hypertension treatment guidelines. • Home care. Once equipment is in the client's home, nurses and physicians may evaluate the client at home without leaving their offices. • Hospice. Palliative and end-of-life services via technology can increase access to services in remote areas or supplement traditional care. • Military. Physicians at remote sites can evaluate injured soldiers in the field via the medic's equipment. • Pharmacy. Data can be accessed at a centralized location. • Pathology. The transmission of slide and tissue samples to other sites makes it easier to obtain a second opinion on biopsy findings. • Psychiatry. Specialists at major medical centers can evaluate clients in outlying emergency departments, hospitals, and clinics via teleconferences. • Radiology. Radiologists can take calls from home and receive images from the hospital on equipment they have in place. Rural hospitals do not need to have a radiologist onsite. • School clinics. School nurses, particularly in remote areas, can quickly consult with other professionals about problems observed. • Social work. Social workers can augment services with telehealth home visits. • Speech-language pathology. More efficient use can be made of scarce speech/language pathologists. • Virtual intensive care units. Remote monitoring capabilities and teleconferencing allow experts at medical centers to monitor patients in distant, rural hospitals, particularly when weather conditions or other factors do not allow transport. • Extended emergency services. Remote monitoring and teleconferencing support allow emergency care physicians to view and monitor ambulance patients, supervise EMTs, and initiate treatments early and redirect patients to the most appropriate facilities, such as burn centers or trauma units, without being seen first in the emergency department.

__________ is a combination of hardware and software that forms a barrier between systems, or different parts of a single system to protect those systems from unauthorized access.

Firewall

Go live planning

Go live - system running and used to collect and process actual client data implementation strategy - phased vs big bang conversion - bring in old data develop support schedule and hire support staff, "super-users" develop procedure to request post go live changes

A benefit of the electronic medical record is __________.

Improved access to information

What is SNOMED-CT and what relevance, if any, does it have to the adoption and meaningful use of EHRs?

SNOMED-CT refers to Systematized Nomenclature of Human and Veterinary Medicine Clinical Terms, a globally recognized vocabulary that provides a common language for EHRs, that supports interoperable data collection.

Explain what an interface engine is and how it works.

Software application that allows different computer systems to access and exchange information. This provides the ability to transfer information from the sending system to one or many receiving systems and allows users of different information systems to access and exchange information both in real-time and batch processing.

Which of the following can be used as a tool to facilitate the delivery of telehealth services?

Tele- or videoconferencing

Proper handling and disposal

acceptable uses audit trails to monitor access encourage review for accuracy shred or use locked receptacles for the disposal of items containing personal health information

Nursing informatics - a careers

avg salary = 90K, with certification - 100-120K includes roles in leadership, education, practice, policy

Training class content should address the following area(s): _____.

basic computer literacy, workflow, policies and human factors

Simulation Training

bridge between classroom learning and real life clinical experience without risk for patient and healthcare worker.

What is the most important factor in maintaining the proper use of an information system?

education

In addition to ease of use and potential for unintended error, usability also considers which of the following?

efficiency, user satisfaction, and training issues

CCC - clinical care classification

facilities patient care documentation at the point of care documents the six steps of the nursing process

Telehealth differs from telemedicine in that _____.

telehealth encompasses telemedicine, but is a broader term that emphasizes the provision of information to health care providers and consumers

Who determines the project implementation strategy?

the implementation committee

Changes in federal privacy and security provisions with major impacts for medical practices, hospitals, health plans, and their business associates include which of the following?

the requirement to notify individuals whose PHI has been breached within 60 days of the breach

At which point during the strategic planning process should the data be collected?

when scanning the external and internal environments

Describe the current status of the national health information network and HIEs in the United States.

?

Role of informatics Nurse

BS degree in nursing and has additional interest in IT Proficient with informatics applications to support all areas of nursing practice Demonstrates critical-thinking, data management, decision-making, and system development and computer skills identifies/provides data for decision making

One criterion for eligibility for meaningful use requires the adoption and use of EHRs that have been certified. Which of the following statements best describes the certification process?

Certification provides the assurance that the EHR system has the technical capacity, functionality, and security to meet the meaningful use criteria.

Antivirus software

Computer programs that can locate and eradicate viruses and other malicious programs from scanned memory sticks, storage devices, individual computers and networks

Discuss the relationship between strategic planning and information technology.

The overall strategic plan used to guide an organization must have an analogous information technology strategic plan to support goals and objectives.

Information Security

the protection of information against threats to its integrity, inadvertent disclosure or availability determines the survivability of a system

Maintenance of an information system includes all of the following except __________.

training

Understand the significance of security for information

A set of policies, procedures, and security systems needs to be applied to effectively deter access to information. The HIPAA Privacy Rule was crafted to protect the privacy of people who seek healthcare

Expert System

A type of decision support system that implements the knowledge of one or more human experts without human intervention differs from a DSS that relies on the wisdom of the user to take appropriate action to the provided recommendations (e.g. insulin pump giving insulin w/o involvement of user)

Predictors of Personal Health Records (PHRs) use include which of the following?

Awareness of PHRs, ease of access, personal motivation, higher levels of education and health literacy

Personal Health Record (PHR) use for management of chronic conditions is felt to hold great promise for which of the following reasons?

PHRs may help health systems achieve greater efficiency through facilitating prescription refills, communication, and improved coordination of chronic conditions as well as quality of care.

Alleged benefits associated with PHRs include the following:

Improved client satisfaction, outcomes and communication with fewer telephone calls and outpatient visits

American Reinvestment and Recover Act and The HITECH act- provides financial incentives

implementation of the Electronic health record and inititatives supporting patient safety and quality of care will drive information tech plans and spending the next several years

Discuss the relevance to system integration efforts of the data dictionary, master patient index, uniform language efforts, and clinical data repository.

The data dictionary defines terminology to ensure consistent understanding and use across the enterprise. Terms defined in the data dictionary should include synonyms found in the various systems used within the enterprise. The master patient index (MPI) is a database that lists all identifiers assigned to one client in all the information systems used within an enterprise. It assigns a global identification number for each client and allows clients to be identified by demographic information provided at the point of care. One major step in the integration process is the development of a uniform definition of terms, or language. This is essential for the easy location and manipulation of data. Uniform languages are essential to ensure semantic interoperability within EHRs. clinical data repository - In addition to the uniform definition of terms, integration standards facilitate the exchange of client data by providing a set of rules and structure for formatting the data. like HL7 and DICOM

Explain the importance of using the mission statement in determining the organization's information needs.

The needs assessment committee should start the process by examining the vision and mission statements of the organization as well as the strategic plan. This will guide the committee in looking to the future and determining the organization's information needs while continuing to support the mission.

Define the term life cycle as it relates to information systems.

This term describes the ongoing process of developing and maintaining an information system. This cycle can be divided into four main phases that cover the life span of information systems.

Upcoming tech solutions

nationwide interoperability national patient data base biometric id, access and security innovations (Pyxis medication stations have fingerprint ID access mechanisms) voice recognition tools (hands free assessment charting is being tried out for DRs and nurses) hands free communication

The Patient Protection and Affordable Care Act:

guarantees access to healthcare for all Americans and incentives to change clinical practice to foster better coordination and quality of care

BCMA - barcode medication administration

uses barcode on the medication package and patient armband to ensure right patient, right drug, right dose, right time, right route, greatly reduces med admin errors by providing positivie patient ID PPID, provides warning alerts when scanning incorrect patients, doses, routes or if contraindications exist.

Discuss key factors in the infrastructure of an HIE.

1. An individual level for care to enhance personal health outcomes 2. A professional level for clinical decision making to diagnose, plan interventions and surveillance, coordinate care, and evaluate patient outcomes 3. An agency/organization level for managing operations and fiscal resources and monitoring processes for quality and continuous improvement 4. A public health and national level for accreditation and regulatory bodies to evaluate population health and safety and recommend changes in policy

Informatics Nurse Specialist (INS)

Advanced graduate education in nursing informatics or related field plus holds national certification in informatics Focuses on nursing's information needs Evaluates the performance and impact of information management tech on clinical practice, education, administration and research playing a role in design and testing of information systems. advocates for the use of IS contributes to overall body of nursing knowledge

Discuss how potential solutions are derived from data analysis.

After data have been collected during the internal and external environmental scans, the project implementation team must perform analysis, identifying trends in the current operations as well as future needs and expectations, and determine feasibility from technical, financial, time, and resource perspectives. Information technology trends such as e-health, the Internet, telemedicine, client/server technologies, and the computerized client record must also be addressed. The next step in the planning process involves the identification of potential solutions, which may be in the form of system upgrades or replacements. At this point, the strategic planning team should be aware of the information system needs of the end users.

Some Professional Organizations related to nursing informatics field:

American Medical Info Assoc (AMIA) Health Info and Mgmt Sys Society (HIMSS)-first organization Alliance of nursing informatics (ANI)-collaboration of nursing informatics groups American nursing information assoc (ANIA)

The development of a comprehensive long-range plan for guiding the activities and operations of an organization is _______.

strategic planning

Strategic planning is an outcome of strategic thinking. Define strategic thinking:

strategic thinking is a vision or process that an organization uses to determine what its future should look like

The challenges

DSS and Expert systems aid in and strengthen the selection of viable options using the information of an organization to facilitate decision making and overall efficiency Has direct effect on patient outcomes, caution is advised and ethical and clinical judgement warranted

Understand the differences between stand-alone, tethered, and integrated PHRs.

As definitions continue to evolve, a common distinction is whether the patient-accessible information is tethered to data in a specific health system's EHR or is standalone, that is, not tied to any particular healthcare system. Even some stand-alone applications are likely to become tethered to health data repositories and ultimately serve as patient portals that allow a consumer to pull his or her information from multiple sources. a tethered PHR is inextricably linked to a single entity or health system. Examples of tethered PHRs include Kaiser's HealthConnect and the Veteran Health Administration's My Healthe Vet, Medicare

_________ is the continual process of measuring services and practices against the toughest competitors in the healthcare industry.

Benchmarking

List tools or processes that may be used to evaluate the outcome of and provide feedback to the planning process.

Benchmarking is the continual process of measuring services and practices against the toughest competitors in the healthcare industry. An example of benchmarking is to compare the number of IS staff required to support the clinical applications for the enterprise to that of other healthcare providers with similar demographic and volume statistics. When needs are no longer met, or the organization falls far below the benchmark, the process of identifying potential solutions and selecting the best option is begun again.

Define the term personal health record (PHR).

Electronic personal health record (PHR) [is]: a private, secure application through which an individual may access, manage and share his or her health information. The PHR can include information that is entered by the consumer and/or data from other sources such as pharmacies, labs, and health care providers. The PHR may or may not include information from the electronic health record (EHR) that is maintained by the health care provider and is not synonymous with the EHR. PHR sponsors include vendors who may or may not charge a fee, health care organizations such as hospitals, health insurance companies, or employers. In their simplest concept, PHRs are electronic systems that allow people to record, access, and share health-related information in order to help them better manage their health and healthcare.

Biometrics

ID based on a unique biological trait such as fingerprint, voice or iris pattern, retinal scan, hand geometry, face recognition, ear pattern, smell, blood vessels in the palm, gait recognition, or keystroke cadence.

An order entry system can do all of the following except ___________.

Integrate results of data collected at the bedside

Identify several methods for analyzing the current system.

Methods for accomplishing this include questionnaires and observation of day-to-day activities. Every data item used in the current paper or automated system should be analyzed. Some examples of data items include client name, sex, marital status, and diagnosis. Next, the committee must decide what information should be kept, what information is redundant, and what information is unnecessary. They should evaluate the strengths and weaknesses of the current manual or automated information system to determine the needs of the healthcare enterprise.

Potential barriers to Personal Health Record (PHR) use that must be considered include the following:

No or poor Internet access, poorly designed applications, limited clinical integration

Define the role of the nurse in system integration efforts.

Nurses must be involved in identifying and defining data elements that an interface may be able to supply. One way to ensure this is to recruit staff nurses to provide input during the interface design.The nursing profession must also be involved in determining measures to assure the quality of the data that are exchanged among individual information systems and in the formation and maintenance of the EHR. If data quality cannot be assured, then clinical decision support and other important features will be suspect.

Identify several security measures designed to protect information and discuss how they function.

Physical security: 1. Lock up the server room 2. Set up surveillance 3. Make sure the most vulnerable devices are in that locked room 4. Use rack mount servers 5. Safeguard the workstations 6. Keep intruders from opening the case 7. Protect the portables 8. Pack up the backups 9. Disable the drives 10. Protect your printers Secure modems and encryption are particularly useful in conjunction with remote access. Daily backups and portable storage devices such as an external drive help to prevent data loss. It is essential to include wireless devices as part of organizational standards, policies, and procedures to ensure that risk management and preventive measures are taken. Utilize Authentication, id management, firewall, antivirus software, application security, spyware detection software, passwords or Encrypted key-based authentication biometric authentication, which is based on a unique biological trait, such as a fingerprint, voice or iris pattern, retinal scan, hand geometry, face recognition, ear pattern, smell, blood vessels in the palm, gait recognition, or keystroke cadence For employees: Plan for audit trails, establish acceptable computer uses, collect only required data, encourage client review of files for accuracy and error correction, establish controls for the use of info after hours and off-site

Usability is important to informatics nurse specialists for which of the following reasons?

Poor usability can lead to errors, jeopardize patient safety, and impact acceptance and use of technology

Which of the following statements best reflects acceptance of the International Classification for Nursing Practice (ICNP®) as a standard for nursing terminology?

Present nursing classification systems map it to a very high degree.

Identify the benefits of using structured terminologies within electronic healthcare records.

Standardized terminology beneficiaries include the patient, the provider, the organization, and the healthcare industry. The use of standardized terminologies provides access to complete and accurate healthcare data and ensures compliance with standards coming forth for Meaningful Use, quality measures, and interoperability.

______ is the use of telecommunications and computer technology for the delivery of nursing care.

Telenursing

Describe the ways HIEs will impact healthcare delivery in the future.

The Secretary of Health and Human Services has approved a number of interoperability standards. T

System Implementation

Third phase of the life cycle that begins with purchase of the system which requires planning before purchase and entails selection of the implementation committee and stratagey to support people and process changes. Getting buy-in from end users and upper management is crucial for any system implementation

Relate issues arising from implementation of HITECH programs.

Title XIII of ARRA is the Health Information Technology for Economic and Clinical Health Act (HITECH). The HITECH Act makes several significant changes to the current HIPAA Security and Privacy Rules and provides funds and incentives to increase the use of EHRs by physicians and hospitals that meet eligibility criteria Beginning in 2011, Medicare and Medicaid will provide financial incentives from $40,000 to $65,000 per eligible physician and up to $11 million per hospital for Meaningful Use of HIT. Negative incentives will begin in 2015 for physicians and hospitals that do not use certified information technology meaningfully. The HITECH Act also funds the establishment of 70 or more regional centers to help promote EHR adoption. These centers will offer technical assistance, guidance, and information on best practices.

To communicate effectively we must utilize:

a standardized nursing terminology a standardized multidisciplinary terminology its designed to support widespread interoperability among health care software applications

A system is installed during the __________ phase

implementation

The impact of the internet on HIPPA

introduces new threats like email and instant messages may carry personal health information that can be intercepted unapproved use of messages or web sites can introduce malicious programs web sites used for personal health information may be inappropriately accessed

Strategic planning partners:

led by upper management - includes board of directors and CEO, Chief Strategy Office (CSO) role emerged to oversee the detailed plan- drives change and monitor timelines and progress, Chief Information Officer (CIO) helps management see the role of IT in meeting goals - ensures that executives understand the role of IT and how it can advance the goals Dept heads-supports planning by giving info on current operations and possible future needs.

How are hospitals using telehealth technologies?

to communicate with long distance partners and improve in-house care like order management and communication (standard order sets) integration of dept systems: lab, radiology, pharmacy (digital images on electronic media for later display on high resolution monitor) electronic bed management systems (update patient census, monitor patient movement and track lengths of stay) staff scheduling by provider skill set and patient acuity multiple fixed and mobile devices

Compare and contrast methods employed in usability studies.

usability tests are systematic and structured examinations of the effectiveness, efficiency, or satisfaction of any component or interactions in the HCI framework. Usability studies can be informal or formal, simple or complex, and use a few individuals or a wide range of users. Usability researchers can design sophisticated studies combining usability precepts with traditional, experimental, or mixed methods research designs. Common usability methods include task analysis, think aloud protocols, cognitive walkthroughs, focused ethnographies, and usability questionnaires.

Define the term electronic health record (EHR).

"an electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be created, managed, and consulted by authorized clinicians and staff across more than one health care organization."

List the phases of the life cycle of an information system

1 Needs assessment 2 System selection 3 Implementation 4 Maintenance

Differentiate between clinical data networks and HIEs.

?

Administrative Safeguards

A covered entity must identify, analyze and reduce risks to electronic data vulnerabilities. HIPPA requires designation of a security official who is responsible for developing and implementing its security policy and procedures. The information can only be shared if such access is appropriate based on the user or recipient's role. A covered entity must provide for appropriate authorization and supervision of workforce members who work with electronic personal health information and train them on policies

Security Measures to take

Access on a need to know basis firewalls - barrier created from software and hardware automatic sign-off physical restrictions to system access encryption - prevents data leakage antivirus and spyware detection user sign on and passwords or other means of identity management

Review the benefits of successful information system integration for healthcare providers and healthcare professionals.

Allows instant access to applications and data • Improves data integrity with single entry of data • Decreases labor costs with single entry of data • Facilitates the formulation of a more accurate, complete client record • Facilitates information tracking for accurate cost determinations

Steps to security

Assessment of risks and assets an organizational plan a culture of security the establishment and enforcement of policies

Discuss standardized terminologies used for the different parts of the nursing process and their similarities and differences.

Assessment: includes vital signs, physiological signs, and patient symptoms nursing diagnosis: problem is determined via NANDA and ICD codes for billing outcomes: When the goal is evaluated and given an outcome measurement value, such as improved, it is then considered an outcome. via OMAHA, PNDS and SNOMED-CT

Compare and contrast available methods of authentication in terms of levels of security, costs, and ease of use.

Authentication is the process of determining whether someone is who he or she professes to be. This usually involves a username and a password, but can include other methods of proving identity, such as a smart card, retina scan, voice recognition, or fingerprints. ID management is a broad administrative area that deals with identifying individuals in a system and controlling their access to resources within that system by associating user rights and restrictions with an established identity. Passwords are simply secret words or phrases.

Identity management

Broad administrative area that deals with identifying individuals in a system and controlling their access to resources within that system by associating user rights and restrictions with the established identity

Primary database used for searching nursing literature

CINAHL

Which of the following statements most accurately reflects what the Informatics Nurse Specialist (INS) needs to know when working with end users to purchase or design an information system relative to reimbursement of services?

Can the current system, or the system under consideration, support reimbursement requirements? Compliance deadlines? Automatic capture of charges?

Identify at least two large health systems using PHRs.

Centers for Medicare & Medicaid Services (CMS)

What is a decision support system?

Computer applications designed to facilitate human decision making processes. Usually rule-based, using a specified knowledge base and set of rules to analyze data and information and provide recommendations to users. Develops "What-If" Models to analyze the options or choices and alternatives Can have alerts with abnormal vital signs or medication contra-indications or even lab results, can act as preventative reminder for vaccinations, house screening and clincal guidelines for disease treatment Also referred to as CDS - clinical decision support based off evidence-based medicine

How does computer literacy differ from information literacy?

Computer literacy refers to a familiarity with the use of personal computers, while information literacy is the ability to recognize when information is needed as well as the skills to find, evaluate, and use needed information effectively.

Informatics Innovator

Conducts informatics research and generates informatics theory sophisticated level of skills and understanding in computer tech and information management Proficient with informatics applications to support all areas of nursing practice

_________ is the processing of data collected during the course of a study to identify trends and patterns of relationships.

Data analysis

List several concerns that must be resolved before implementation of the EHR.

Development of an electronic infrastructure and cost have been two of the biggest impediments to the creation of a fully functioning EHR. Other issues have included the lack of a common vocabulary, privacy, security, and confidentiality issues; resistance among caregivers; failure to adequately consider organizational change; determining a realistic timeline; a lack of IT staff to create and support the necessary infrastructure; and legal issues surrounding the discovery of medical information

Identify characteristics that define nursing informatics as a specialty area of practice.

Diff practice: Nursing informatics differs from other specialties within nursing because it focuses on data, information, and knowledge; Diff research goals: research centered primarily on the development of a standard language for use within nursing, which would allow nurses from different regions of a country or the world to establish that they were describing the same phenomenon and to conduct studies that could be replicated. Diff representation: AMIA and IMIA Formal ed programs: experience and education in computer science and information science

Strategic information systems Planning should include?

Does tech support business and clinical decisions? Is tech used effectively? Does tech enhance the image? Is tech cost effective? Does tech promote safety? Are market and regulatory requirements met? Must also include applications and systems that are under consideration, needed infrastructure change, additional resources needed like equipment, staff and training

Which of the following statements most accurately describes evidence-based practice (EBP)?

EBP requires that decisions about healthcare be based on the best available, current, valid and relevant evidence providing quality essential to transform healthcare.

Tech sources that support quality improvement and patient safety

EHR -electrionic health records CPOE - computerized physician order entry BCMA - barcode medication administration E-prescribing CDS - Clinical Decision support Dashboard reports Smart technology

Confidentiality

Electronic Personal Health Information is not available or disclosed to unauthorized or disclosed to unauthorized persons

Illustrate how using standardized healthcare terminologies correlates to the U.S. Meaningful Use criteria.

For CMS-eligible hospitals and physicians who meet the Meaningful Use requirements, the use of standardized terminology is necessary for data collection and reporting of established quality measures.

Goals and Objectives

Goal-open ended statement that describes what is to be accomplished Objectives - specify how and when goals will be met Vision statement- lofty view of what an organization would like to become (first consideration of strategic planning and includes goals and objectives)

List several barriers related to patient use of PHRs.

Factors such as education, health literacy, race, income, and high-speed Internet access appear to impact PHR use Among those with chronic disease, disabilities may play a role in the capacity to use technology. Access. Ability to connect to the Internet is essential. Many rural communities remain "unwired." While this barrier goes beyond the scope of medical care, patients can be asked about access through friends, family members, work, and libraries. Some large health systems such as the VA provide computer access in libraries. • Awareness. Patients and caregivers must know about PHR tools and understand their value. Promotion and marketing are important, including word of mouth, social networking, and clinician endorsement. Dedicated staff can help design promotional materials, demonstrating tools and disseminating through a variety of channels. • Usability. How easy is the application to use? PHR systems that utilized, during their development, a user-centered design process, conducted usability testing, and were modified on user input can have greater ease of use and be more intuitive. • eHealth literacy. Patients bring a wide variation in their capacity to use information technology. Those having lower levels of literacy and Internet abilities are likely to have greater challenges in using the PHR as intended. Ensuring a high level of usability, including easy navigation, simple functionality, and readability can enhance willingness and ability to use the PHR. • Meaningful Use. PHR usage will be dependent upon users' perception of benefit. Patients must perceive that PHRs will be relevant to their health and beneficial to their lives. Incorporating features such as secure messaging, laboratory results, appointment, and medication requests will be most valuable to patient and caregivers. • Clinical integration. Nurses, physicians, and other professionals providing care have an important role in the successful deployment and adoption of PHRs. As patients will continue to see health professionals as a source of expert information, encouraging and demonstrating use of these tools to patients and families will be important.

Compare and contrast the different HIE models for their respective advantages and disadvantages.

Government-led HIE with a direct government program that provides services for the HIE infrastructure, and oversight for the HIE has been used in states. • Public utility HIE with government oversight where a public sector will serve an oversight role and regulate the private-provided services of the HIE. • Private sector-led HIE with government collaboration where the government collaborates and advises as stakeholders in the private sector HIE services have been used. • Public authority HIE with state government creating a public instrumentality of the state in the form of a nonprofit authority with comprehensive and extensive powers to operate the state HIE in a business-like manner.

What is the relationship between Health Information Exchanges (HIEs) and the EHR?

HIEs help to provide the framework needed to provide widespread data exchange and subsequently support the EHR.

How do Health Information Exchanges (HIEs) impact healthcare delivery?

HIEs increase the efficiency and potentially the quality of the healthcare delivery system.

A standard for the exchange of clinical data between information systems by means of an extensive set of rules that apply to all data sent is the ________.

Health Level 7 (HL7)

The __________ is a nurse who has received educational preparation to conduct informatics research and generate informatics theory and who has a broad vision of what can be attained using information technology.

Informatics Nurse Specialist (INS)

Understanding the 4 I's

Information Science (roots)- primarily focused on input, processing, output, and feedback through tech integration, incorporates features from communication science, computer science, social science, library science and cognitive science, applies tech to make info usable, supports the colletion and mgmt of information Information Technology (branch)- aids in clinical decision making, major resource for many organization., use computers to trasmit data (eg EHR, Barcode Med Admin) Informatics (trunk of tree) - aids in clinical decision making, major resoure for many organization, combo of nursing, computers and information science, information technologies that support nursing practice Information Systems ( branch)- used to collect, create and distribute useful data, the development, use and mgmt of an organizations IT infrastructure, an umbrella term for sub-categories such as clinical info systesm, core busines systems, case mgmt systems and communication systems

Which of the following are issues associated with the practice of telehealth and telenursing?

Lack of reimbursement, privacy and confidentiality concerns, licensure and liability issues

Based upon your reading, what do you see as the future areas for health information technology policy development?

Large datasets resulting from Meaningful Use and other incentives will provide increased bodies of evidence to support HIT policy decisions that weigh national as well as global implications.

NANDA - north american nursing diagnosis assoc intl

NANDA - I diagnoses are used to ID human responses to health promotion, risk and disease each nursing diagnosis has a description, definition and defining characteristics, describes patient reaction to the diesease and treatment

What is the role of nursing in the adoption and use of standard terminologies?

Nursing needs to adopt standard terminologies as a means to collect data that has a uniform meaning across settings as a way to increase the body of nursing knowledge.

Nurse informaticist responsibilities

Nursing should have a voice in the systems that they use Nurse Informaticists act as: Liaisons, systems development and implementation, quality initiatives, strategic planning and education

Information system security

Ongoing protection of both information housed on the system and the system itself from threats or disruption primary goals - protection of client confidentiality, protection of information integrity and ready availablity of information when needed prevents anyone from disclosing, tampering or destroying computer data.

What type of system supports the nurse by automatically notifying the dietary department to hold a client's breakfast, the pharmacy to send the appropriate medications, and the radiology department to schedule the test for a barium enema?

Order entry system

Understand the differences between privacy, confidentiality, information privacy, and information security and the relationships among them.

Privacy is a state of mind, a specific place, freedom from intrusion, or control over the exposure of self or of personal information. Privacy includes the right to determine what information is collected about an individual, how it is used, and the ability to access collected personal information to review its security and accuracy. Confidentiality refers to a situation in which a relationship has been established and private information is shared. In a healthcare environment, it is the ethical principle or legal obligation that a healthcare professional will not disclose information relating to a patient unless the patient gives consent permitting the disclosure. Information/data privacy is the relationship between data collection, information technology, an individual's expectation of privacy, and the legal, ethical, and political issues related to these relationships. It is the right to choose the conditions and extent to which information and beliefs are shared

Which of the following is NOT an advantage for using a nursing information system?

Reduction in time spent with clients

Archetypes - think of it as a template

Reusable, clinical models of content. The open EHR initiative supports the usable archetype and that contains a header, definitition and ontology section. By using archetypes, a standardized pattern of information exchange

Standardized Multidisciplinary Terminology

SNOMED-CT - systemized nomenclature of human and veterinary medicine clinical terms.provides common language for electronic healthcare applications LOINC - logical observation identifiers names and codes, includes clinical and lab observations ICD 9/ICD 10 - international classification of disease, standard diagnostic classification for general medical condititions CPT - common procedural terminology codes - is a billing and reimbursement of outpatient procedures and interventions (used for all procedures except alternative med) UMLS-united medical language system - meta thesaurus containing over 100 source vocabularies to provide web based application so user can do mutiple searches identifying synonymous acceptible terms

Security Planning

Saves time and money guards against: downtown, breeches in confidentiality, loss of consumer confidence, cybercrime, liability, lost productivity Helps to ensure compliance with HIPPA

Which of the following most closely approximates the current version of the personal health record (PHR)?

Secure application through which an individual may access, manage and share health information he or she has entered or was supplied by providers, pharmacies, and labs.

Understand how Web-based tools can provide an alternative method for obtaining patient information from diverse information systems.

Several years ago Web-based tools and Internet technology were seen as a means to provide access to data from disparate information systems. This was largely a local solution that improved access to clinical information for the providers at a single hospital or healthcare system,

Understand what standardized healthcare terminology is and why it is important to nursing.

Standardized terminologies are structured and controlled languages that have been developed according to terminology development guidelines and have been approved by an authoritative body. Healthcare terminology standards are designed to enable and support widespread interoperability among healthcare software applications for the purpose of sharing information. The use of standardized terminology is a means of ensuring that the data collection is accurate and valid,Data exchange between EHR application systems must take place without loss of meaning.

Standardized healthcare terminology is important to nursing for which of the following reasons?

Standardized terminology provides the ability to share accurate, up-to-date information among different providers and settings while ensuring uniform meaning and supporting the development of nursing knowledge.

Explain the functions of a nursing information system.

Support the way that nurses function, allowing them to view data, collect necessary information, provide quality client care, and document the client's condition and the care that was given. • Support and enhance nursing practice through improved access to information and tools such as online literature databases, drug information, and hospital policy and procedure guidelines.

Discuss legislative efforts to stimulate the adoption of healthcare information technology.

The American Recovery and Reinvestment Act of 2009 (ARRA) has specific provisions for information technology in general and health information technology (HIT) in particular. These provisions include funding for a Smart Grid Information Clearinghouse, the Small Business Administration, the Department of Education, the Veterans Administration, and other government agencies for improving information technology systems. ARRA also provides $2 billion for ONCHIT discretionary spending and sets a goal that an EHR will be used for each person in the United States by 2014

The American Recovery and Reinvestment Act and Health Information Technology for Economic and Clinical Health Act were important to U.S. HIT policy for which of the following reasons?

The Department of Health and Human Services was authorized to establish programs to improve healthcare quality, safety, and efficiency through HIT inclusive of the call for health information exchange (HIE).

Which of the following best typifies the role of the Informatics Nurse Specialist (INS) in relationship to legislation?

The INS needs to be aware of the implications of legislation for HIT design and use and to appropriately educate users.

What is the role of the Informatics Nurse Specialist (INS) in the adoption and use of standard terminologies?

The INS needs to play an active role on a local, national, and international level in the adoption and use of standard terminologies.

National Provider Identifier Standards

The National Provider Identifier is a unique identification number for all covered health care providers

Privacy Rule

The Privacy Rule establishes standards for privacy of individually identifiable health information. Goal is to ensure that individual's health information is properly protected while allowing the flow of health information needed to provide and promote high quality healthcare and to protect the public's health and well being

Describe the goals of usability and its three axioms.

The broad goals of usability are promoting acceptance and use of systems through improved interactive systems and software, developing new kinds of applications to support specific work, and promoting job optimization with the use of information systems. 3 axioms are... • An early and central focus on users in the design and development of systems • Iterative design of applications • Systematic usability measures or observations of users and information systems

Define the term computer-based patient record (CPR).

The computerized patient record (CPR) is a comprehensive lifetime record that includes all information from all specialties

National Certifications

The first certification examination for NI was taken in 1995 two certifications are: ANCC american nurses credentialing center and HIMSS health information and management systems society

Recognize the relationship between Meaningful Use and the adoption and use of the EHR in hospitals, physician offices, and other settings.

The framework for Meaningful Use of the EHR evolved from a set of national priorities to help focus performance improvement efforts identified in the National Priorities & Goals report released by the National Priorities Partnership (2008), which was convened by the National Quality Forum. The HITECH, part of the 2009 American Recovery and Reinvestment Act, authorized CMS to reimburse providers who succeed at becoming "Meaningful Users" of the EHR starting in 2011. Incentives will decrease gradually with penalties imposed for failure to achieve Meaningful Use by 2015. The Meaningful Use requirement is a major driver in the adoption and use of EHR systems across U.S. healthcare delivery systems and physician practices today One of the major considerations in the implementation of an EHR system at this time is the selection of a system certified as capable of supporting Meaningful Use requirements to enable eligible providers to receive financial incentives. Meaningful Use rules provide direction as to the technical and content standards for the EHR.

The Health Information Technology for Economic and Clinical Health Act (HITECH) is best known for which of the following?

The funds and incentives it provided to increase the use of EHRs by physicians.

Describe obstacles to HIE development and sustaining operation.

The obstacles to sustainability result from underestimating the size and scope of the project, identifying critical mass of data to exchange (e.g. standards for medication history, allergies, side effects, indications, weight/height), identifying critical mass of participants (e.g., pharmacies), the collaboration between common competitors in communities, the resistance to changes in workflow, and the numbers of unskilled workforce with HIT. The challenge with HIE models is to be self-sustaining over time with funding. Many were started with public funds, some charge for access to patient information while others charge only for other services or generate revenue from the secondary use of data. Third-party incentives for HIE include quicker reimbursement payment for services. ID individuals for governing board w/knowledge and skills adoption of standardization in clincaincal data, new workflows and new functions is time intensive

Review the benefits of using a weighted scoring tool when selecting a course of action.

The organization then can create weighing criteria that take into account importance to organization process. For example, essential features may be given a weight factor of 5, and desirable but not essential features may be given a weight factor of 3. Weighing of each desirable system feature should be completed before the various systems are scored. This helps pick a solution that works for the end users

Understand the relationship between strategic planning for information systems and planning for the overall organization.

The overall strategic plan used to guide an organization must have an analogous information technology strategic plan to support goals and objectives.

The Joint Commission continues to add standards that impact the design and use of information systems. The following represent examples of some of these later requirements:

Uniform data sets throughout a healthcare delivery system and medication reconciliation updates upon admission, transfer, and discharge

Review the key features and impacts on nursing and other healthcare professionals associated with order entry, laboratory, radiology, and pharmacy information systems.

With order entry systems, orders for medications and treatments are entered into the computer and are directly transmitted to the appropriate areas such as the pharmacy, laboratory, radiology, social service, or another area. The preferred method is direct entry of orders by the physician, nurse practitioner, physical therapist, or other provider because this eliminates issues related to illegible handwriting and transcription errors, checks orders for accuracy and completeness, speeds the implementation of ordered diagnostic tests and treatment modalities, decreases adverse drug events, enhances staff productivity, saves money, promotes safety, and improves outcomes when used in conjunction with evidence-based practices Rules provide guidelines to assist physicians to select the preferred and most cost-effective medication along with the best route and dose for a particular patient problem. Rules can also provide prompts for when patients should be seen next and diagnostic tests that should be performed. These automated reminders help to improve the quality of care by reducing reliance upon memory, providing evidence-based practice guidelines, and informing the prescriber when a more cost-effective oral medication is available in lieu of an intravenous form

Which of the following is an example of a low-tech telehealth application?

a home glucose-monitoring program that uses a touch-tone phone to report glucose results

Which of the following is a mechanism that logs a user off the system after a specified period of inactivity on his terminal or computer?

automatic sign-off

Implications for mobile computing

devices are easily stolen devices should require authentication and encryption to safeguard information security devices should never be left where information may be seen by unauthorized viewers verify wireless networks before use

Support out nurses

different types of decision support are needed at different stages of the nurses knowledge level the knowledge needs of nurses will continue to improve as the systems improve

The delivery of content and stimulation of learning primarily through the use of telecommunication technologies and often used for corporate training is ______.

distance learning

An electronic version of the client data found in the traditional paper medical record is the __________.

electronic medical record (EMR)

What are the driving forces behind the Health Information Exchange (HIE) movement?

federal legislation, and demands for safer, more efficient healthcare

Discuss the value of using a weighted scoring tool during the selection phase.

first understand the organization's requirements for operation. then prioritize or weight the list of "musts" and "wants" from high to low. The criteria should also be grouped into functional categories to present a comprehensive picture of the system requirements.

Implementation committee

formed after the organization has purchased the informatics system. Project leader identified - needs to be involved in the entire process. committee members: need to buy into new process, should represent all disciplines in the decision and work towards a common goal. (tech staff, clincal staff at bedside, lab and pharmacy and informatics nurses or informatics nurse specialist) Wise to have nurse as project leader cuz understand needs of customers and how system affects those working at point of care Goal is to create a timeline, scheduling all the critical elements for implementation - what task is necessary, scope of task, whos responsible for accomplishing each task and start and completion dates, necessary resources and constraints

Discuss some issues pertaining to the practice of telenursing.

note that the majority of telenurses are not certified in telemedicine, telenursing, or nursing informatics at present, they believe that basic telehealth principles should be integrated into the basic nursing curriculum, which may lead to certification.

Identify several telenursing applications.

nurses currently use telephones, faxes, computers, smart phones, sophisticated voice and video interactive teleconference systems, and the Internet in the practice of telenursing. Potential applications are varied, but common uses are telephone triage, follow-up calls, and checking biometric measurements. Other examples include education, professional consultations, obtaining test results, and taking physician instructions over the phone. Interactive television or teleconferences enable home health nurses to make electronic house calls to clients in their homes; thus nurses can see more clients per day than would be possible via on-site visits Telenursing currently addresses aging populations and chronic disease problems, community and home-based care needs, geographic health services access problems, and nursing shortage issues

future directions

organizations must make a commitment to a culture of safety where everyone at every level is committed to tech and workflow processes designed to promote patient safety

Barriers of telehealth

tech staff required in addition to medical staff potential for exposure of private info due to security risks so we need to institute legal, technical and security measure to alleviate patients concerns initial start up costs can be substantial, train end users and patients to use it insurance reimbursement

3 types of interoperability

technical -ability to exchange data from one point to another semantic - guarantees that the meaning of the exchange data remains the same on both ends of transaction process - coordinates processes to enable business processes at an organization, housing systems to work together

System testing

test environment: copy of the info system software that is used to make changes from the base system, programmed changes are tested to ensure that they work as designed test plan: ID long range goals and test items, script that follows a series of transactions from beginning to end for all associated functions, requires input and participation from users from all areas of the facility, evaluation -examine output

Formulate a list of contract demands for a vendor once a system has been chosen.

the enterprise's legal and purchasing representatives may request the names of the three highest ranked vendors, as well as their RFP responses. In this way, the contract negotiations will be able to address issues not specifically included in the RFP responses, such as cost justification and expected implementation schedules.

implementation pitfalls

underestimation of time and resources needed ongoing addition of changes and more features failure to consider costs for annual maintenance and other expenses problems with testing or training lack of system ownership by users

maintenance

user feedback analyzed and changes user support - resource staff available to staff at all shifts at all times during times of transition updates applied to all three environments-testing training and production (live) technical maintenance - like problem solving, building and maitinaing interface, installing system upgrades, updating recover yplan

Threats to system security and information

viruses, worms, trojan horses, hackers, compromised devices, unauthorized insider access, poor password management, human error, power fluctuations, fires and natural disasters, malware

Interoperability

when healthcare providers communicate effectively better description regarding patient care are made: extent to which systems and devices can exchange and interpret data.

Identify several integration issues, including factors that impede the process.

• Unrealistic vendor promises. Vendors often promise that their information systems are interoperable with other systems. Many customers find, however, they face difficult, lengthy, and costly integration efforts after they have already purchased a system. • Unrealistic institutional timetable. This is often based on a lack of understanding of the complexity of the integration process. • Changing user specifications. As the integration process proceeds, users frequently request additional capabilities or change their minds regarding initial specifications. • Lack of vendor support. Vendors may not provide enough support and assistance to facilitate integration efforts. • Insufficient documentation. Information regarding existing systems and related programming is imperative for achieving successful integration. • Lack of agreement among merged institutions. Individual facilities within a merged enterprise may wish to continue use of their existing systems. This means there are more systems to integrate. • All components of a vendor's products may not work together. Although difficulties are expected in attempts to integrate competing vendors' products, there may also be problems in integrating products developed by the same vendor.

Nurses role in informatics

-good information mgmt provides the right info at the right time to the right ppl. -knowledge mgmt creates systems that enable organizaitions to tap into the knowlege, experiences and creativity of their staff to improve their performance. it is a structured process for the generation, storage distribution, and application of personal experience along with knowledge evidence in organizations -tech resources include clinical guidelines, standards of practice, policy and procedure manuals, research findings, drug databases and information on community resources and reduces redundant data collection -Knowledge work - non repetitive, non routine work that entails a significant amount of cognitive activity (e.g. interpreting trends in labs or in patient systems) -knowledge worker - a continuous learner and specialist in their field, has advanced formal education, can apply theoretical and analytical knowledge and generates knowledge as a product. spend 50% of time searching for and evaluating information - nurses/ knowledge workcare data gatherers like vitals, patient history, assessment data then -when they interpret the data recorded they become the information user. In this role, they evaluate, analize and interpret data like when BP is elevated and patients reports pain. This role needs data to be in a format that allows for easy recognition of patterns and trends. -then the nurse becomes a knowledge user when they begin to notice trends in the patient's clinical data and determine if that clinical data falls within or outside the normal data range. so the nurse compares the data they collected with existing nursing knowledge - then she becomes a knowledge builder when she examines clinical data that shows patterns across patients and that info can offer patient care information...quality mgmt and nurse research roles. -HOW IT supports nursing roles: by computerize charting, documentation prompts, device integration, decision support systems. Application to support the knowledge user in the clinical setting are those that are at the point of care like clinical practice guidelines, expert systems, or research that supports evidence based care or online drug databases - NOVICE Nurse- possess basic computer skills, uses info systems to manage patients, access data and charts electronically, support patient safety initiatives using info tech. recognize role of informatics in nursing. -Experienced NURSE - pulls trends out of data, support specialty area, including quality improvement and other activities, via IT, use evidence based databases, promote technology applications, use information systems and work with IT Staff to enact system improvements -Informatic NURSE - proficient with informatics applications to support all areas of nursing practice, demonstrates critical thinking, data management, decision making and system development and computer skills, identified/provides data for decision making - The next generation of knowledge workers - IT to bridge the gap from task based nursing to knowledge based profession, increase support from organizations for innovation and outcomes tied to knowledge work, transition of knowledge workers into self-directed innovators

Understand the significance of the 12 characteristics of the CPR defined by the Institute of Medicine for today's EHR.

1. Provides a problem list that indicates current clinical problems for each encounter, the number of occurrences associated with all past and current problems, and the current status of the problem 2. Evaluates and records health status and functional levels using accepted measures 3. Documents the clinical reasoning/rationale for diagnoses and conclusions. Allows sharing of clinical reasoning with other caregivers and automates and tracks decision making. 4. Provides a longitudinal or lifetime client record by linking all client data from previous encounters 5. Supports confidentiality, privacy, and audit trails 6. Provides continuous access to authorized users at any time 7. Allows simultaneous and customized views of the client data 8. Supports links to local or remote information resources, such as various databases using the Internet or organization-based intranet resources 9. Supports decision analysis tools 10. Supports direct entry of client data by physicians 11. Includes mechanisms for measuring the cost and quality of care 12. Supports existing and evolving clinical needs by being flexible and expandable

Technical Safeguards

A covered entity must implement technical policies and procedures that allow only authorized persons to access electronic protected health information. A covered entity must implement hardware, software, and/or procedural mechanisms to record and examine access and other activity in information systems that contain or use electronic personal health information. Policies and procedures must be implemented to ensure that the information is not improperly altered or destroyed. Must implement technical security measures that guards against unauthorized access to the info that is being trasmitted over and electronic health network

Physical Safeguards

A covered entity must limit physical access to its facilities while ensuring that authorized access is allowed. Policies and procedures regarding transfer, disposal, and reuse of electronic media to ensure appropriate protection of electronic personal health information is in place

Consider how standards for the exchange of clinical data affect integration efforts.

A major standard for the exchange of clinical data for integration is Health Level 7 (HL7). L7 provides a structure that defines data and elements and specifies how the data are coded. The structure of the data element must follow HL7 rules, such as those specifying the length of the fields and the code nomenclature. The use of HL7 standards in individual applications improves the integration of these applications with other applications or systems using an interface engine. Benefits include easier and less costly integration within an organization and more accurate and useful data integration nationally and globally.

Identify ways that mobile devices such as personal digital assistants, tablet computers, and iPods can improve the utility of healthcare information systems.

Ability to view and review tests and procedures with the care team • Electronic "just in time" dietary menu options • Ability to order personal items from the hospital gift shop • Survey of patient experience Systems may allow the patient to make nonurgent requests such as requesting a blanket, water, toiletries, or nutrition electronically and send the request directly to the person who can deliver the service. The technology can also be used for education of patient and family-related education related to conditions and procedures. Documentation of the education can be interfaced with the EMR. The education can be designed interactively with learning customized for a particular patient's needs, the ability to answer questions regarding understanding of materials presented, and the ability to document questions that the patient might want to ask of the caregiver for clarification. The daily plan of care can be displayed for patients so that they know what to anticipate for the day. Goals for discharge can be made available to keep the patient, family, and entire care team on track with the plan. The system may also include distractions for patients such as relaxation videos, electronic games, and e-mail availability. Patients who are in the hospital for a particularly long stay appreciate the ability to receive pictures and messages from their family and friends electronically and have pictures displayed in a slide show fashion if they desire.

Client engagement is considered to be critical to achieving healthcare reform. Fully functional PHRs support which of the following principles that engage clients in their own care?

Client control, individualized care based upon client needs and values, and shared knowledge with easy flow of information

Describe each of the ANA-recognized terminologies and the benefits of use when implemented within an electronic healthcare record.

Clinical Care Classification (CCC)-a nursing classification designed to document the six steps of the nursing process across the care continuum (Saba 2007). It facilitates patient care documentation at the point of care. NANDA International (NANDA-I), Nursing diagnoses, Diagnoses—Clinical findings -diagnoses are used to identify human responses to health promotion, risk, and disease Nursing Intervention Classification (NIC), Intervention Labels, Interventions—Procedures - a standardized classification of interventions that describes the activities that nurses perform. Nursing Outcomes Classification (NOC), Outcome labels, Outcome labels—Observable entity - classification system that describes patient outcomes sensitive to nursing interventions. Omaha System, Problem Classification Scheme, Problem classification scheme, Signs and symptoms—Clinical findings, Intervention scheme interventions—Procedures - research-based taxonomy that provides a framework for integrating and sharing clinical data. Perioperative Nursing Data Set (PNDS), Diagnoses, Intervention, and Outcome, Diagnoses—Clinical findings, Interventions—Procedures Outcomes—Clinical findings - a standardized perioperative nursing vocabulary that provides nurses a clear, precise, and universal language for clinical problems and surgical treatments. The International Classification of Nursing Practice (ICNP)-responsible for ensuring that the content reflects the domain of nursing.

Identify equipment and technology needed to sustain telehealth.

Computers, interactive video transmissions, teleconferences by telephone or video, and direct links to healthcare instruments are tools used to deliver these services. Electronic, visual, and audio signals sent during these conferences provide information to consultants from remote sites. teleconferencing, videoconferencing, desktop videoconferencing Current telehealth technologies can be grouped into at least nine broad categories, although for general discussion purposes, there are two types: store-and-forward and interactive conferencing. Store-and-forward is used to transfer digital images and data from one location to another. It is appropriate for nonemergent situations. It is commonly used for teleradiology and telepathology. Interactive conferencing primarily refers to videoconferencing and is used in place of face-to-face consultation. Interactive conferencing is frequently used for telepsychiatry. Basic DTV Components for Telehealth Applications • PC • PC adapter cards • Camera • Microphones • Video overlay cards • External speakers on existing PCs with broadband switches • Special adaptive tools, such as an electronic stethoscope

List the advantages of telehealth.

Continuity of care. Clients can stay in the community and use their regular healthcare providers. • Centralized health records. Clients remain in the same healthcare system. • Incorporation of the healthcare consumer as an active member of the health team. The client is an active participant in videoconferences. • Collaboration among healthcare professionals. Cooperation is fostered among interdisciplinary members of the healthcare team. • Improved decision making. Experts are readily available. • Education of healthcare consumers and professionals. Offerings are readily available. • Higher quality of care. Access to care and access to specialists is improved. • Removes geographic barriers to care. Clients living away from major population centers or in economically disadvantaged areas can access care more readily. • May lower costs for healthcare. Eliminates travel costs. Clients are seen earlier when they are not as ill. Treatment may take place in local hospitals, which are less costly. • Improved quality of health record. The record contains digitalized records of diagnostic tests, biometric measures, photographs, and communication.

Impact on Mediation Administration

DSS or CDS can ensure the 5 rights are implemented checks for drug to drug interactions and allergies when ordering, it can prompt the clinician to select the appropriate medication based on client data (like height and weight or creatinine clearance)

Define the terms data, information, knowledge, and wisdom.

Data are a collection of numbers, characters or facts that are gathered according to some perceived need for analysis and possibly action at a later point in time. Information is data that has been interpreted Knowledge is the synthesis of information derived from several sources to produce a single concept or idea Wisdom occurs when knowledge is used appropriately to manage and solve problems.

Explain the purpose of decision support and expert systems.

Decision support and expert systems use data from both the clinical and the administrative information systems, and can provide information related to clinical and administrative users. Decision support systems aid in and strengthen the selection of viable options using the information of an organization or a field to facilitate decision making and overall efficiency. Decision support software organizes information to fit new environments. It provides analysis and advice to support a choice. The final decision rests with the practitioner.Tools may include clinical practice guidelines, alerts and reminders, order sets, patient data reports and dashboards, diagnostic support, workflow tools, and financial applications.

Scope of the mission

Defines the type of activities and services that will be performed Should be clearly identified to help employees and customers understand the priorities of the organization

Discuss the similarities and differences between the EHR, EMR, and the CPR.

EMR is considered a building block in the creation of the EHR the primary distinction between the EMR and EHR was the ability to exchange information outside of a single healthcare delivery system. Unlike the EMR, the EHR provides interactive patient access as well as the ability for the patient to append information CPR - This database allows retrieval of multiple elements of client data regardless of their system of origin.

Compare the types of educational opportunities available in nursing informatics.

Graduate, doctoral, and certificate programs are now available in nursing informatics. Abundant continuing education opportunities exist to help bridge the gap between undergraduate and graduate programs and help nurses with preparation in the field up-to-date. T

Describe the role of the nurse as knowledge worker.

Historically, nursing has acquired knowledge through tradition, authority, borrowed theory, trial and error, personal experience, role modeling, reasoning, and research. Current demand for safer, cost-effective, quality care requires evidence of the best practices supported by research. Nurses must be active participants in the design of automated documentation to ensure that information is recorded appropriately and in a format that can be accessed and useful to all healthcare providers. Nurses need to be adept at using patient-centered IT tools to access information to expand their knowledge in a just-in-time, evidence-based fashion. There must be a shift from critical thinking to critical synthesis.

Workflow optimization

ID the present workload process gap analysis used to ID needed changes in the current workflow once moving to the new system

Discuss the significance of good information and knowledge management for healthcare delivery, healthcare disciplines, and healthcare consumers.

Increasing demands for improvements in healthcare delivery call for the use of IT as a means to automate and share information for quality measurement and improvement, research, and education. These might include clinical practice guidelines, expert systems to support decision making, or research that supports evidence-based care and/or online drug databases. Part of good information management ensures that care providers have the resources that they need to provide safe, efficient, quality care. Some examples of these resources include clinical guidelines, standards of practice, policy and procedure manuals, research findings, drug databases, and information on community resources. IT can help to ensure access to the most recent versions of these types of resources via tools such as intranets, electronic communities, or blogs

Distinguish between medical informatics, nursing informatics, and consumer informatics.

Informatics is the science and art of turning data into information. Medical informatics refers to the application of informatics to all of the healthcare disciplines as well as to the practice of medicine. nursing informatics is the use of information and computer technology to support all aspects of nursing practice including direct delivery of care, administration, education and research Consumer informatics involved tech advances, internet savy pop, need for increased accountability in the selection of healthcare services, an acceptance of online and telephone transactions over face to face, concerns for safety, HSAs, and change to individuals assuming greater responsibility for payment of services.

Discuss how information system security affects privacy, confidentiality, and security.

Information security is the protection of information against threats to its integrity, inadvertent disclosure, or availability. Poorly secured information systems can threaten record confidentiality because records may be accessed from multiple sites with immediate dissemination of information, making clients vulnerable to the redisclosure of sensitive information.

What role, if any, does information technology have in the Magnet journey?

Information systems support the process by providing aggregate data related to quality improvement.

Recognize the importance of system integration and interoperability for healthcare delivery.

Integration is the process by which different information systems are able to exchange data in a fashion that is seamless to the end user. An interface is a computer program that tells two different systems how to exchange data. Without integration, providers cannot realize the full advantages of automation, since sharing data across multiple systems is limited and redundant data entry by various personnel takes place. When this occurs, the likelihood of errors is increased. interoperability is the ability of two entities, whether those are human or machine, to exchange and predictably use data or information while retaining the original meaning of that data

Which of the following statements about virtual reality are true?

It is a widely used form of multimedia that fully envelops learners in an environment providing the next best option to performing the skill on a real person but without any risks to the learner or the client.

Which of the following statements best summarizes the accreditation process in healthcare?

It provides assurance to the public that the facility or program meets nationally accepted standards.

Identify the typical membership composition of the system selection steering committee.

Its membership should include board members to ensure that information technology is aligned with the organization's overall strategy. The committee chairperson may be a manager, director of information services, or an informaticist, or have an administrative position elsewhere in the hospital, such as chief financial officer (CFO), chief nursing officer (CNO), or medical director. The committee membership must be multidisciplinary, including representation from all departments affected by the new system and incorporating the clinical, administrative, and information system divisions. A general rule to follow is that any department or area that uses the information or is affected by it must have a voice in the selection process. Representation of the voice of the patient should be considered during the evaluative and/or decision-making process. The committee should be large enough to make a good decision but small enough to be effective and efficient.

Discuss the Technology Informatics Guiding Education Reform Initiative and contrast the different informatics competencies needed for nurses entering into practice, experienced nurses, and informatics nurses and nurse specialists.

Its purpose was to create a vision for the future of nursing to provide a safer, higher-quality patient care through the use of IT. The group identified leadership, education, technology-enabled processes that facilitate teamwork and relationships throughout the care continuum, systems that support education and practice, and a supportive culture and policies as key factors to attain this vision beginning nurse:• Basic computer literacy, including the ability to use basic desktop applications and electronic communication • The ability to use IT to support clinical and administrative processes, which presumes information literacy to support evidence-based practice • The ability to access data and perform documentation via computerized patient records • The ability to support patient safety initiatives via the use of IT • Recognition of the role of informatics in nursing experienced nurse: Proficiency in his or her area of specialization and the use of IT and computers to support that area of practice including quality improvement and other related activities (ANA 2008) • Knowledge representation methodologies for evidence-based practice • The ability to use information systems and work with informatics specialists to enact system improvements • Proficiency in using evidence-based databases • The promotion of innovative applications of technology in healthcare informatics nurse: Proficiency with informatics applications to support all areas of nursing practice including quality improvement activities, research, project management, system design, development, analysis, implementation, support, maintenance, and evaluation • Fiscal management • Integration of multidisciplinary language/standards of practice • Skills in critical thinking, data management and processing, decision making, and system development, and computer skills • Identification and provision of data for decision making informatics nurse specialist: The INS possesses a sophisticated level of understanding and skills in information management and computer technology, demonstrating most of the competencies seen at the previous three levels.

The mission of which of the following accrediting bodies focuses on the improvement of the quality of care delivered to the public, the development standards of quality in conjunction with health professionals, and encourages organizations to meet or exceed these standards through the accreditation process?

Joint Commission for Accreditation of Healthcare Organizations (JCAHO)

Review the implications of telehealth for nursing and other health professions.

Major issues for nurses include questions of liability when information provided over the telephone is misinterpreted, when advice is given across state lines without a license in the state where the client resides, or, particularly, when an unintentional diagnosis comes from the use of an Internet chat room. Liability is unclear in these areas. Regulation of telenursing practice by boards of nursing is difficult when practice crosses state lines. Unless nurses are licensed in every state in which they practice telenursing, respective regulatory boards are unaware of their presence. The majority of states have laws or regulations that require licensure for telehealth practice

Forecast the roles that nursing informatics and health information technology will play in the healthcare delivery system 5 years from now.

Nursing informatics has an important role to play in the improvement of health through its contributions to the development of standard languages, design and evaluation of IT, assisting peers to develop the competencies needed in an increasingly complex environment, facilitating consumer acceptance and use of technology, and contributions to nursing's scientific body of knowledge. IN specialists must serve as leaders to help drive the changes necessary to transform the healthcare delivery system, improve quality of services delivery, and improve safety.

Standardization of EHR's

OpenEHR initiative is an international effort to provide semantic interoperability thru the creation of specifications, strives to create high quality, reusable, clinical models of content and process that are defined by clinicians HL7 - health level seven - purpose is to provide standards of interorperability that improve care delivery, optimize work flow, reduce ambiguity, and enhance knowledge transfer among all stakeholders. Provides structure that defines data and elements and specifies how the data are coded. The structure and data element must follow HL7 rules, such as those specifying the length of fields and the code nomenclature DICOM- first developed for the transmission of medical images and their associated information. Now used for production, display, storage, retrieval and printing of medical images

Recognize potential threats to system security and information.

Potential threats to information and system security come from a variety of sources. These can include thieves, hackers, crackers, denial of service attacks, terrorists, viruses, snatched Web sites, flooding sites with fictitious data, power fluctuations that damage systems or data, revenge attacks, fires and natural disasters, and human error. Social networking. Sites such as Facebook, Bebo, and MySpace offer cybercriminals a vast new world in which to target unsuspecting users. 2. Malware attacks. Cyber criminals are using more creative means to package and deliver malware (viruses, worms, Trojan horses, etc.), especially in e-mails. 3. Scareware. Attackers and fraudsters use online pop-ups designed to look like messages from the operating system, warning of a problem or virus infection to coerce users to download a program to "correct" the problem. 4. Microsoft. Windows 7 is expected to be widely adopted by Microsoft users worldwide. This massive user base is a prime target for the opportunistic hacker looking to attack a new, unfamiliar operating system. 5. The insider threat. Information is stored in files and folders, accessible remotely by large numbers of users. 6. Localized attacks. Often attempts to deceive victims fail because they are clearly fraudulent, text used is grammatically incorrect, spelling errors raise red flags, and graphics are poor replicas. 7. Smartphones. The convergence of telecommunications and computing is creating a new target for hackers. 8. Mac OS X. There is a widespread misconception that relative to personal computers (PCs), Macs are resistant to attack. 9. Embedded computing. As society relies increasingly on information and communications technology (ICT) across all aspects of life, national critical information infrastructures—such as energy, transport, and telecommunications—will become more and more connected to and reliant on the Internet. 10. Virtualization and cloud computing. Lower budgets and improvements in distributed computing and high-speed Internet access make cloud computing and virtualization appealing alternatives to costly and complex conventional computing methods but open alternative paths for intrusion (Espion 2010). 11. Wireless networks (WLANs)—The increase in the use of WiFi networks in healthcare facilities can make patient information and associated information system vulnerable if not properly secured.

Define Mission

Purpose for the organizations existence, represents fundamental and unique aspirations that make the organization different from others, guides the planning process.

Describe legal and practice issues that affect telehealth.

Reimbursement and licensure issues remain two of the major barriers to the growth and practice of telehealth. The CMS (2009a) currently provides for telehealth reimbursement for physician follow-up consultation when communicating with the patient via telehealth (G0425-G0427 reimbursement codes for 2010). The Centers for Medicare & Medicaid Services (CMS) have not formally defined telemedicine for the Medicaid program, and Medicaid does not recognize telemedicine as a distinct service. Medicaid reimbursement for telehealth services is available at the discretion of individual states as a cost-effective alternative to traditional services or as a means to improve access for rural residents.Currently 39 states acknowledge at least some reimbursement for telehealth services At the present, questions have not been fully resolved as to who will train healthcare professionals to participate in telehealth and how compensation will be derived for the additional hours associated with installation, training, and use of telehealth technology. There is also an issue of confidentiality. Technical support staff who are present during the exchange of client information need to be aware of institutional policies as well as laws such as HIPAA that are designed to protect client privacy. professionals who practice across state lines deal with different practice provisions in each state and may be subject to malpractice lawsuits in multiple jurisdictions, raising questions about how that liability might be distributed or which state's practice standards would apply. Regulatory barriers. State laws are either unclear or may forbid practice across state lines. • Lack of reimbursement for consultative services. Most third-party payers do not provide reimbursement unless the client is seen in person. • Costs for equipment, network services, and training time. Equipment capable of transmitting and receiving diagnostic-grade images is still expensive, although costs are declining. • Fear of healthcare system changes. Personnel may fear job loss as more clients can be treated at home and hospital units close. • Lack of acceptance by healthcare professionals. This may stem from liability concerns and discomfort over not seeing a client face-to-face. • Lack of acceptance by users. This may stem from discomfort with technology, the relationship with the provider, and concerns over security of information and confidentiality.

Project management

Set of practices intended to raise the likelihood that a project will succeed

USer system training

Starts once all changes have been completed in the test environment. Training environment -separate copy of the information system software that work the same way as the actual system and is populated by fictitious clients before this assess end users computer competency by providing basic entry level educational computer skills

Identify the participants in the strategic planning process.

Strategic planning is led by members of the organization's upper management, including the board of directors and chief executive officer (CEO), who is ultimately responsible for the organization's strategic management. The CSO, chief strategy officer, must clarify the vision created by the CEO and leadership team for his or her own benefit and for all managers and employees. It is then up to the CSO to drive change and monitor the timelines and progress toward realization of the strategic plan. tHe chief information officer (CIO), the chief medical informatics officer (CMIO), and/or the chief nursing informatics officer (CNIO). The CIO is generally the senior team member, guiding technology acquisition and ensures executives understand the role info tech can be used to advance the goals, while the CMIO and CNIO guide the acquisition and use of information technology for those large groups of providers while enruing effective and efficient use at point of care. department heads, are responsible for supporting the planning process by providing information related to the current operations as well as insight into future needs of the organization. administrators, clinicians, and information services personnel can provide input on Consumer demands represent a major driver in the current market, forcing providers to analyze the actual costs for every service rendered, prepare for the scrutiny of comparison shopping, develop competitive prices, make prices and payment options available to consumers, and restructure billing statements for increased clarity The stakeholders are those internal or external individual customers, organizations, community members, and governing bodies that have a direct or indirect stake in the organization mission, scope, and goals.

Describe how strategic planning is related to an organization's mission, scope, vision, goals, and objectives.

Strategic planning requires that choices be made about your organization's future, which will be driven by your organization's mission and vision, long-term goals, services to be offered, populations to be served, and the resources to be acquired. The strategic planning process includes defining the corporate vision and mission, specifying achievable goals and objectives, developing strategies, and setting policy guidelines. This entails a determination of what products and services to offer and to what markets. The mission is the purpose or reason for the organization's existence and represents the fundamental and unique aspirations that differentiate the organization from others. The scope of an organization's mission defines the type of activities and services it will perform. The vision statement is a future-oriented, lofty view of what an organization would like to become. A goal is an open-ended statement that describes in general terms what is to be accomplished. Objectives state how and when an organization will meet its goals.

Review the system criteria that should be addressed during the selection process.

Technical criteria include those hardware and software components necessary for the desired level of system performance. Administrative criteria describe how the system may be administratively controlled for appropriate and effective use of the information. The registration criteria are essential for ensuring that the client is properly identified for all aspects of information management. ORder entry/CPOE/Results reporting criteria - These criteria ensure that accurate entry of physician orders is accomplished in a timely and efficient manner, resulting in improved client care. Documentation/billing -encompass a comprehensive architecture for documentation across the organization. Documentation should integrate key clinical events across ancillary, nursing, and physician documentation. scheduling - These criteria should support the patient scheduling at many levels. Typically organizations utilize scheduling for appointments, procedures, and testing. Specialties - should be applied in organizations that intend to utilize the same vendor product across all venues for a best-of-breed approach. Med records -The medical records criteria should support the storage of all pertinent client data obtained from various information systems, allowing the user to access a longitudinal record of all client activities and events or visits. Accounting -facilitate reimbursement for services rendered and help to ensure the financial stability of the enterprise.

Define the term telehealth.

Telehealth is the use of telecommunications technologies and electronic information to exchange healthcare information and to provide and support services such as long-distance clinical healthcare to clients. Telehealth services include health promotion, disease prevention, diagnosis, consultation, education, and therapy.

Describe the American Nurses Association (ANA) recognition criteria established for recognizing standardized terminology

The American Nurses Association (ANA), through the Committee for Nursing Practice Information Infrastructure (CNPII), recognizes terminologies appropriate for use by nursing (Warren & Bakken 2002). Terminologies must meet defined criteria for approval. The criteria specify that terminologies must be used to support nursing practice reflecting the nursing process. The nursing process data elements include assessment, diagnosis, outcome identification (goal), planning, implementation (interventions), and evaluation. The terminologies have to contain concepts that are clear and unambiguous with a unique identifier The terminology developer should have an outlined maintenance and submission process. The Nursing Management Minimum Data Set, Nursing Minimum Data Set, and ABC are data sets approved by the ANA but will not be discussed in this chapter

Discuss the implications of the HIPAA privacy and security rules as they relate to the protection of medical information.

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 created landmark legal protection for personal health information (PHI). PHI refers to individually identifiable health information such as demographic data; facts that relate to an individual's past, present, or future physical or mental health condition; provision of care; and payment for the provision of care that identifies the individual. Examples include name, address, birth date, Social Security number, allergies, claims data, lab results and other diagnostic history, prescription history, records about past visits to physicians, emergency rooms and other healthcare encounters, vaccination records, and prior in- and outpatient procedures.

Review legislation impacting the protection of healthcare information.

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 created landmark legal protection for personal health information (PHI). PHI refers to individually identifiable health information such as demographic data; facts that relate to an individual's past, present, or future physical or mental health condition; provision of care; and payment for the provision of care that identifies the individual. Examples include name, address, birth date, Social Security number, allergies, claims data, lab results and other diagnostic history, prescription history, records about past visits to physicians, emergency rooms and other healthcare encounters, vaccination records, and prior in- and outpatient procedures. HIPAA mandated the adoption of selected standard transactions for electronic data interchange (EDI) of healthcare data. These standard transactions are claims and encounter information, payment and remittance advice, claims status, eligibility, enrollment and disenrollment, referrals and authorizations, and premium payment. HIPAA also named specific code sets for use in all Medicare-related transactions. Under HIPAA, every person has the right to examine and obtain a copy of protected information. Typically, requested copies have been in paper form.

Evaluate RFP responses from vendors.

The RFI should ask the vendor to provide a description of the system and its capabilities. Often the vendor responds to the request by sending written literaturea bout hx and finances of company, # of installed sites, system architecture and hardware config, state of the art tech, integration with other systems, user support provided, future plans, procedures to distribute software updates. The next step is to evaluate this information and prepare a formal document called the request for proposal (RFP). An RFP is a document sent to vendors that describes the requirements of a potential information system. The RFP prioritizes or ranks these requirements in order of their importance to the organization. Its purpose is to solicit proposals from many vendors that describe their capabilities to meet the "wants" and "needs." The vendors' responses may then be used to narrow the number of competitors under consideration. Evaluate RFP: Was the response submitted by the deadline date? • Does it represent the work of a professional team and company? • Were the vendor representatives responsive and knowledgeable? • Does the proposal address the requirements outlined in the RFP, or does it appear to be a standard bid? The prioritization and ranking of the requirements that were previously developed by the steering committee now are used to weight each item in the RFP. Examining the scores for the "wants" and discussing the vendor's proposed costs are components of the final decision-making process.

Explain the importance of assessing the internal and external environments during the planning process.

The external environment includes those interested parties and competitors who are outside of the healthcare institution, such as vendors, payers, competitors, clients, the community, and regulatory agencies. The internal environment includes employees of the institution, as well as physicians and members of the board of directors. The purpose of scanning the environment is twofold: to define the current situation and to identify areas of need. This step should also include surveying the changing internal environments of the organization with the goal to determine how each change affects the other.

Understand the importance of developing a timeline during the implementation phase of strategic planning.

The first step in the implementation process is to identify the working committee for the implementation phase. Development of a timeline is one of the initial tasks the committee will perform. Once all of the individual components of the timeline have been identified, the tasks can be assigned and initiated. Other tasks during this phase include budgeting, procedure development, and execution of the plan. The timeline helps prioritize the order in which to implement.

Define the concept of health information exchanges.

The health information exchange (HIE) is defined as the electronic movement of health-related information among organizations according to nationally recognized standards

Nursing informatics is defined as

The integration of nursing science, computer science, and information science to manage and communicate data, information, knowledge, and wisdom into nursing practice

Distinguish between appropriate and inappropriate password selection and processing.

The keys to password strength are length and complexity. An ideal password is long and has letters, punctuation marks, symbols, and numbers. The greater the variety of characters in a password, the greater is its strength. users should not use the same password for access to more than one site or system. Individuals should not share passwords or leave computers logged on and unattended. Choose passwords that are at least 12, preferably 14, characters long. • Select stronger passwords for higher levels of security. • Avoid using the same password for more than one application. • Do not use the browser "password save" feature. • Use combinations of uppercase and lowercase letters, numbers, punctuation marks, and symbols. • Do not use proper names, initials, words taken from the dictionary, or account names. • Do not use words that are spelled backwards or with reversed syllables. • Do not use dates or telephone number, license plate, or Social Security numbers. • Do not store or automate passwords in the computer. • Avoid repeated numbers or letters. • Keep passwords private. • Change passwords frequently, with no reuse of passwords for a specified period. • Use the entire keyboard, not just the letters and characters you use or see most often.

Differentiate between the nursing process and critical pathways/protocol approaches to the design of a nursing system.

The nursing process approach to automated documentation often uses the nursing diagnosis and traditional paper processes long used by nurses as the organizational framework which included: Documentation of nursing admission assessment and discharge instructions., Generation of a nursing worklist that indicates routine scheduled activities related to the care of each client., Documentation of discrete data or activities such as vital signs, weight, and intake and output measurements., Documentation of routine aspects of client care, such as bathing, positioning, blood glucose measurements, notation of dietary intake, and/or wound care in a flowsheet format., Standardized care plans that the nurse can individualize for clients as needed.,Documentation of nursing care in a progress note format, Documentation of medication administration The critical pathway is often used in a multidisciplinary manner, with many types of care providers accessing the system for information and to document care and includes: The nurse, or other care provider, can select one or more appropriate critical pathways for the client. Interaction with physician orders., Tracking of protocol variances.

Recognize the purpose of the needs assessment.

The purpose of the needs assessment is to determine the gap between an organization's current state and the overall needs of the organization with consideration to the strategic plan. Evaluation of the strengths and weaknesses of the organization related to efficiency, quality, and financial strengths should be considered. Understanding an organization's current state workflow process as well as long-term goals related to efficiency, quality, and financial outcomes by creating a gap analysis can assist the decision-making group.

Describe the request for information and request for proposal (RFP) documents.

The request for information (RFI) is often the initial contact with vendors. An RFI is a letter or brief document sent to vendors that explains the institution's plans for purchasing and installing an information system. The purpose of the RFI is to obtain essential information about the vendor and its systems to eliminate those vendors that cannot meet the organization's basic requirements.

Distinguish among the terms human factors, ergonomics, human-computer interaction, and usability.

The term human factors is used to describe the interactions between humans and tools of all kinds. Human factors is a broad term that can include topics such as the design of motorcycle controls to fit human hands and feet Ergonomics is concerned with human performance as it relates to the physical characteristics of tools, systems, and machines - focus on design for safety, comfort and convenience Human-computer interaction is the study of how people design, implement, and evaluate interactive computer systems in the context of users' tasks and work - like design and use of PCA machines, The term usability is often used interchangeably with HCI. More formally, usability is the extent to which a product can be used by specific users in a specific context to achieve specific goals with effectiveness, efficiency, and satisfaction according to the International Standards Organization 9241-11, 2006 (e.g. learning and using an application, user satisfaction, efficiency, error free and forgiving inteactions)

In what way can clinical decision support systems save healthcare dollars?

They aid in diagnosis and provide access to practice guidelines which subsequently decrease the length of hospital stays and costs for treatment

Which of the following statements best describes meaningful use?

This is an initiative geared to spur the adoption and use of electronic health records for the purpose of gathering and reporting data that can then be used to improve population health.

Describe the functions of client registration and scheduling, and coding systems.

This system is used to collect and store client identification and demographic data that are verified and updated at the time of each visit. For this reason, these may also be known as admission/discharge/transfer (ADT) systems. The system uses predetermined rules for determining how resource and client information should be used to schedule a particular type of appointment. This provides the capability to schedule a patient in one location. In addition, scheduling across all facilities in an enterprise can be accomplished using one system. The benefits associated with using a scheduling system include increased staff productivity, increased client satisfaction, and cost savings to the organization.

criteria of Meaningful use in 5 intitiatives:

To improve the quality, the safety, and efficient manner of record transmissions and sharing and thus reduce health disparities in medical records. 2. To engage patients and their families in their medial record maintenance and accuracy. 3. To improve care coordination between specialties, facilities, and ancillaries. 4. To improve the information of the population that seeks public health facilities and treatment. 5. To ensure privacy and security of electronically shared information in accordance to HIPAA standards. (Murphy 2010)

Analyze the impact of these laws on nursing informatics practitioners.

To meet the demands for PHI protection and compliance reporting, every healthcare practice and hospital will need these electronic systems. Infrastructure, including skilled personnel, will be needed to make effective use of increased data, redesign the delivery of patient care, and improve outcomes (patient, staff, and organizational) and the performance of both staff and organization The demand for well-prepared, clinically savvy informatics practitioners will increase. Nursing informatics, clinical informatics, and medical informatics are now essential elements of strategic planning for any healthcare organization (Arlotto 2010). Informaticists are needed to mine data, analyze data aggregates, help in care-process redesign—especially information workflows—and design functional and clinically valid decision support. This demand will increase the number of undergraduate and graduate programs in informatics as well as the enrollment in these programs.

Demonstrate how standard terminologies facilitate the use of evidence-based practice and decision-support rules.

Using standardized terminologies ensures compliance with standards coming forth for Meaningful Use, quality measures, and interoperability. Terminology facilitates the monitoring of trends and problems of the health of populations, developing clinical decision support, and expanding our knowledge of diseases and treatments and outcomes through research and clinical data mining.

Review the current status of the EHR, including impediments

While no country has yet implemented an operational national EHR, the HITECH Act has sparked new interest and brings focus and consistency to U.S. EHR adoption efforts, making clear what needs to be done even if the time that it will take remains unclear. Meaningful Use rules provide direction as to the technical and content standards for the EHR. For example, the content standard for a patient summary will be the CCD or continuity of care record. SNOMED-CT, NCPDP Script, RxNorm, HL7, and LOINC are standardized terminologies that have been identified as a means to enable the interoperability required to realize Meaningful Use of EHRs. The DOD and the Department of Veterans Affairs (VA) lead the United States in EHR adoption. Together they operate two of the nation's largest healthcare systems using EHRs to manage patient. Impediments: These include increased workloads and delayed information retrieval as clinicians are forced to search multiple data sources for client information. For example the clinician may need to find or document key information which now requires several steps instead of one. Development of an electronic infrastructure and cost have been two of the biggest impediments to the creation of a fully functioning EHR.

Review the current status of the EHR, including impediments.

While no country has yet implemented an operational national EHR, the HITECH Act has sparked new interest and brings focus and consistency to U.S. EHR adoption efforts, making clear what needs to be done even if the time that it will take remains unclear. The DOD and the Department of Veterans Affairs (VA) lead the United States in EHR adoption. Together they operate two of the nation's largest healthcare systems using EHRs to manage patient information. Both are involved in an initiative to modernize their systems and work collaboratively to establish the virtual lifetime electronic record. Impediments are These include increased workloads and delayed information retrieval as clinicians are forced to search multiple data sources for client information. For example the clinician may need to find or document key information which now requires several steps instead of one.

List several concerns related to patient self-entered data.

While patient-centered care is the goal, concerns arise about (a) patients as accurate suppliers of data and (b) responsibility of data review. In-person encounters do not always lead to complete and accurate information in the record. Patients may hesitate to disclose information. Answers may reflect what patients feel clinicians care to know. As visits get shorter, discussions are limited. Computerized screening can be particularly effective for sensitive issues such as substance use and sexual behaviors

Discuss the impact that Internet technology has on the security of health-related information.

With increasing globalization and the increased use of the Internet, information technology (IT)-related risks have multiplied, including identity theft, fraudulent transactions, privacy violations, lack of authentication, redirection, phishing and spoofing, data sniffing and interception, false identities, and fraud attempts.

Discuss common functionality available in the PHR.

a suite of tools allowing patients to access and enter health information, and to communicate with providers and the health system. PHR features: access to EHR-provided health information, secure messaging, self-entered data (like prior medical history; major illnesses; health information on family members; as well as vitamins, supplements, or complementary and alternative medication), proxy or delegation access (proxy is someone who serves as a caregiver on behalf of the patients and a proxy can view info on PHR to obtain test results or refill meds or use secure messaging. pt gives level of access to proxy), and administrative and financial data (bills, account balance, coverage benefits, online bill pay).

E prescribing benefts

allows the physician to enter the prescription and then electronically sent to the pharmacy from computers PDS provides a longitudinal prescription record checks formulary compliance and reimbursement provides alerts about drug interactions generates reminders to order home meds for the discharged client eliminates phone authorization for refills

EHR Attributes

captures data for quality improvement, risk manangement, resource planning, performance management supports clinical research trials and evidence based research

What do they do with telehealth?

collect, store, display, transfer, receive, analyze, interpret data. allows healthcare practitioners and clients the benefit of long distance communication without the barriers (consult from doctors all over the world can occur via teleconferencing,) it improves accessibility to services through case management/education, accessibility to patients records, and accessibility to statistical data

Passwords

collection of alphanumeric characters that the user types into the computer may be required after the entry of an access code or user name assigned after successful system training inexpensive but not most effective means of authentication

Computer resistance by nurses is often the result of which of the following?

computer anxiety, limited computer skills, and poor communication on the part of administration to consult nurses during the change process

Impact on healthcare spending

decision support systems save healthcare dollars by aiding in diagnosis and providing access to practice guidelines which subsequently decrease the length of hospital stay and cost for treatment

Benefits to standardized terminologies

decreased cost, increased quality, improved safety, outcomes measurement

Strategic Planning Process include

define corporate vision and missions specify achievable goals and objectives develop strategies set policy guidelines determine products, services and markets

project scope

defines the size and details of an effort

System security involves protection against _________.

deliberate attacks, errors, omissions, disasters and viruses

Workstations and mobile devices

determine advantages/disadvantages of each type of device determine number and location of devies involve staff in the decision - promotes user buy-in and allows end users to determine ease of use and functionality of the device

procedures and documentation

determine how the system will be used before end user training starts evaluate/revise policies and procedures for system use and include in training develop user guides

The first task of the project implementation team is to ________.

develop a timeline

HIPAA rules apply to covered healthcare entities

doctors, clinics, psychologists, dentists, chiropractors, nursing homes, pharmacies

Potential IT solutions: you need to answer yes to these questions

does it meet our federal mandates in order to increase reimbursement? can it increase our customer base or improve our customer relationships? What are the advantages? Does it maximize the use of existing resources? is it user friendly? Do we have interoperable IT system that can maximize our data sharing? Whats its capability for expansion? Can it improve our overall efficiency? What are its report capabilities?

Discuss the relationship between major issues in healthcare and the deployment of information technology.

push for patient safety - The Patient Safety and Quality Improvement Act of 2005 sought to improve patient safety by encouraging voluntary and confidential reporting of events that adversely affect patients. It created patient safety organizations to collect, aggregate, and analyze confidential information reported by healthcare providers. The bulk of other federal legislative efforts focus on incentives to the adoption of IT as a means to promote efficiency and improve safety. The Patient Safety Act represents an important move in the correct direction where information is shared about adverse events for learning purposes for the benefit of all. Approximately one-half of the states have passed their own medical error reporting laws, with a few establishing patient safety centers. patient identification - For this reason, the Joint Commission required organizations to investigate and plan for technology that could assist with the process of positive patient identification when it designated improving the accuracy of patient identification as a potential National Patient Safety Goal for 2008. Barcodes and radio frequency identification (RFID) are the dominant technologies for this area. For example, the results of a recent Agency for Healthcare Research and Quality (AHRQ 2010) study demonstrated that barcode technology when used in conjunction with an electronic medication administration record substantially reduced errors. Medication errors: The desire to reduce or eliminate medication errors focuses attention on computerized physician (or provider/prescriber) order entry (CPOE), barcode medication administration (BCMA), and e-prescribing. When properly used, technologies such as automated drug dispensing systems, smart IV pumps, electronic medical records, computerized documentation at the beside, barcoding, and CPOE reduce adverse events through the introduction of additional checks and balances to existing systems Order entry: Its benefits include a reduction in transcription errors; a decrease in elapsed time from order to implementation; standardization and more completeness of orders; fewer medication errors; and the ability to incorporate CDS, alerts for critical lab values, and prompts when certain tests are due. Information is drawn from separate systems such as the hospital, pharmacy, and laboratory systems with drug databases to warn prescribers of potential problems with dosages, potential drug interactions, allergies, and contraindications such as pregnancy or other health conditions E-prescribing:refers to the electronic transmission of drug prescriptions from a hospital-based inpatient ordering system (CPOE) or handheld device. Errors are reduced because problems with illegible handwriting are eliminated, and the system incorporates lists of patient allergies and other medications. Information may also be available that suggests the best drug for a particular problem, dosing recommendations, drug interactions, contraindications, off-label uses, allowable formulary drugs for a particular individual, and insurance co-payments. Barcode scanning of med admin: Barcode scanning technology for medication administration automates the storage, dispensing, returning, restocking, and crediting of barcoded medications, improving safety by ensuring that the right medication is dispensed to the right patient particularly when used with barcoded patient ID bands. It is frequently referred to as BCMA. Decision-support software: Decision-support software (DSS) is a type of computer application that analyzes data and presents them in a fashion that facilitates decision making. It can incorporate lab values, standards of care, and other patient-specific information. It also contains alerts that help to promote safety. The underlying premise of DSS is that the amount of knowledge today exceeds the retention abilities of any one person. nursing shortage:The situation necessitates redesign of care delivery models and the way that nurses are educated. There must be an increased emphasis upon the development of problem-solving and analytical skills in an increasingly complex, rapidly changing environment where there is an exponential growth of knowledge that exceeds any individual's ability to keep up-to-date work flow changes:There is a shift away from tasks to knowledge work and the demand for best practices. need to retain aging nurses:examines retention of the older nurse to retirement age and beyond as a means to deal with the "nursing shortage," noting that aging baby boomers represent the largest untapped labor market and the value of the accumulated wisdom found within this group. It emphasizes the need to use well-designed technology to enable the work of the nurse, not complicate it. From a technology perspective this includes improved ergonomics in both high-tech equipment and low-tech applications that allow older workers to effect patient transfers safely without risk of injury to either the patient or themselves.

Discuss the benefits associated with the EHR.

general: Improved data integrity, Increased productivity, Improved quality of care. Increased satisfaction for caregivers. nursing: Facilitates comparisons of current data and data from previous events • Supports an ongoing record of the client's education and learning response across encounters or visits • Eliminates the need to repeat collection of baseline demographic data with each encounter, saving nursing time • Provides universal data access to all who have access to the EHR • Improves data access and quality for research • Provides prompts to ensure administration and documentation of medications and treatments • Improves documentation and quality of care (Nelson 2007) • Facilitates automation of critical and clinical pathways • Supports the development of a database that facilitates research, provides information useful to administrators and clinicians, and allows recognition of nursing work in measurable units when used with a common unified structure for nursing language healthcare providers: Improved eligibility for reimbursement • Simultaneous record access by multiple users • Previous encounters may be accessed easily • Faster chart access waiting for old paper records to be located and delivered from the medical records department • More comprehensive information is available • Fewer lost records than with paper systems • Improved efficiency of billing inclusive of automated charge capture • Better reporting tools. Trends and clinical graphics are available on demand. • Reduced liability through better decision making and documentation • Improved reimbursement rates • Enhanced compliance through system-generated prompts with preventive care protocols Enhanced ability to meet regulatory requirements such as the physician quality reporting initiative (Bell & Thornton 2011) • Supports pay-for-performance bonuses • Early warnings of changes in patient status • Supports benchmarking for how well physicians manage patients with chronic disease conditions (Novogoratz 2007) • Improved population health • Increased efficiencies in workflow consumer: Decreased wait time for treatment • Improved access and control over health information. • Increased use of best practices with incorporation of decision support • Improved ability to ask informed questions • Greater responsibility for one's own care • Increased medication safety • Quicker turnaround time for ordered treatments (Thompson et al. 2010) • Alerts and reminders for upcoming appointments and scheduled tests • Increased use of preventive care • Increased satisfaction • Greater clarity to discharge instructions • Improved understanding of treatment choices

drawbacks to informatics

high startup costs ongoing maintenance costs adoption can be slow cost of implementation and training temporary loss in productivity when learning new system disruption in workflow reporting is only as accurate as the data recorded susceptibility to network hackers over-dependency on technology

Define the terms healthcare information system, hospital information system, clinical information system, nursing information system, physician practice management system, long-term care information system, home care information system, and administrative information system.

hospital information system (HIS) and healthcare info system is the same and is used within a hospital or enterprise that support and enhance healthcare. Clinical information systems (CISs) are large, computerized database management systems that support several types of activities that may include provider order entry, result retrieval, documentation, and decision support across distributed locations. Administrative information systems support client care by managing financial and demographic information and providing reporting capabilities. This category includes client management, financial, payroll and human resources, and quality assurance systems. a nursing information system supports the use and documentation of nursing processes and activities, and provides tools for managing the delivery of nursing care. Physician practice management systems with Features typically include the ability to capture some demographic information, schedule appointments, maintain lists of insurance payers, perform billing tasks, track outcomes, and generate reports and tied to electronic patient records. long-term care info systems: for the improvement of quality of care, better management of the complex needs of the population, and a decrease in adverse drug effects also financial and reimbursement system Home care info system: systems could be tailored to streamline the work of nurses, improve quality of care delivery, and improve payment for services because billing personnel can find needed information more quickly, allowing them to send out bills earlier. it will communicate with hospital information systems for access to test results, medication lists and allergy information, and possibly order entry. Administrative systems: client registration system is used to collect and store client identification and demographic data that are verified and updated at the time of each visit, gives each pt an ID code...scheduling systems allows a healthcare organization to schedule clients and resources efficiently. it uses predetermined rules for determining how resource and client information should be used to schedule a particular type of appointment.

Identify the major components of human-computer interaction models.

human-computer interaction (HCI) guide informaticists in creating and purchasing technologies that users find effective, efficient, and satisfying to use. - so effectiveness, efficiency and satisfaction

Provide specific examples of how nursing informatics impacts the healthcare consumer as well as professional practice, administration, education, and research.

improved access to info, error reduction and improved communication, decreased redundancy of data entry, convenience, decreased time spein in med admin and documentation, increased time for client care, facilitation of data collection for research, improved quality of documentation, improved compliance with regulatory requirements, improved record security, improved quality of care and pt. satisfaction, decreased admin costs for location and maintenance of client records, creation of lifetime clinical record facilitated by IS.

Well-designed systems can lead to which of the following outcomes?

improved information availability, displays, and interpretation

smart technology

improves quality, safety and efficiency in patient care optimization of workflow by reducing and creating better workflow for clinicians benefits clinicians and patients keep in mind- adoption can at times be slow and expensive (e.g. smart pumps can pull info into EHR taking data on iv input and output)

Which of the following might be considered to be advantages for consumers associated with the delivery of healthcare services via telehealth?

increased access to otherwise underserved populations, decreased travel time and costs, and access to services for consumers who are "on the road"

Benefits of EHR

increased data integrity and quality, increase productivity, increase satisfaction for caregivers, decrease redundant data collection, ongoing record, allows data comparison from prior visits, improved efficiency with better/faster data access, supports decision support and research, improved documentation, prompts to ensure administration of treatments and medications, supports trending

CPOE - computerized physician order entry

initiative to improve the quality of care and reduce medication errors eliminate transcription error expedites treatment encourages more accurate, complete order (order sets for blood transfusions and everything you need to do in order to process this correctly)

_______ is the process by which different information systems are able to exchange data in a fashion that is seamless to the end user.

integration

A computer program that tells two different systems how to exchange data is called _______.

interface

VIDEO-strategic planning

is the development of a comprehensive, long-range plan for guiding the activities and operations of an organization. its figuring out what an organization wants in the future and how its going to get there.

at risk patient safety factors

med accuracy, similarly named medications, nurse hand-off communications, critical lab values, rapidly deteriorating patients (to prevent delerium, sepsis, cardiac events), central line infections, pressure ulcers, falls

What is a super-user?

members of implementation team sole purpose is to support end-users works various shifts to accommodate user needs technically savvy individuals - show interest in nursing informatics, great leaders and educators, effective communicators, champions of the new system

informatics as a specialty area

nursing informatics was first recognized as a specialty by the AN in 1992 NI is a combo of 3 core sciences by ANA: nursing, computer and information science

NIC

nursing interventions classification described activities that nurses perform - any treatment based upon clinical judgement and knowledge to enhance outcomes

Driving forces for EHR

patient safety, need to restructure healthcare delivery system to improve the quality of care, cost containment

Telehealth tech in physicians office

patient scheduling ordering of tests like lab and xray prescription order directly to pharmacy internet patient education

Discuss the patient-centered benefits associated with PHRs.

pts would like to interact remotely with their provider, by using secure messaging or scheduling appointments Tethered PHRs offer a menu of transactions and services; frequently used features include viewing test results, medication refill requests, and secure messaging. In general secure messaging with healthcare teams receives high satisfaction ratings from patients, as does the ability to refill medications and view test results quickly. Increased Timeliness due to quick response time to secure messaging increases patient satisfaction , so efficiency gains improve quality of care, improves self- care and health outcomes

dashboard reporting

quality indicators such as infection rates, falls, and pressure ulcers can be tracked and comparisons can be made from one facility to the next allows for data transparency keep in mind- reports are only as good as the data recorded EG national database of nursing quality indicators - comparison reports to monitor the quality of their patient care

home health technology

real time patient monitoring continual vital sign monitoring resident motion sensors computerized medication dispensing

HIPAA

regulation protecting the privacy and security of certain health information. rules include privacy, security, confidentiality, transaction and code sets and national provider identifiers and enforcement

The ability to use a health enterprise's information system from outside locations such as a physician's office is known as ___________.

remote access

project implementation team

reps from the user departments like managers and front line staff. look at current work flows, design for needed system and implement needed changes. important to get end-users involved. analysts and programmers are involved to implement needed changes getting input from clinicians who will be using the system is critical to the success of system design and implementation

project manager

responsible for the success of a project by managing the planning and enactment of the project. Brought in when no margin of error and time constraints. They can motivate ppl, build consenses on impt decisions, can communicate progress, resolve conflicts, idetify who is responsible for tasks and the timelines when those tasks must be done. Able to est benefits, resources cost and timeliness for each project plus re-evalutate priorities when new things come into play.

Which of the following actions on the part of the informatics nurse best exemplifies strengthening the Meaningful Use of EHR systems?

review of information system screens to ensure that Meaningful Use fields cannot be bypassed and educating end users on the need to collect data needed for Meaningful Use even though they may not view it as relevant to the client's presenting symptoms

PNDS - perioperative nursing data set

standardized perioperative nursing vocabulary that provides nurses a clear and precise and universal language for clinical problems and surgical treatments, establishes plan of care for the perioperative clincal setting

Clinical Decision Support CDS

suggest appropriate medical and nursing interventions based on patient data can facilitate decision making and overall efficiency CDS can organize information and trigger prompts to the clinician thereby decreasing patient safety risks and increasing positivie patient outcomes (scoring systems like vitals and labs when they are becoming abnormal and the nurse can rapidly care providers to bedside for further treatment)

An advantage to using super users for system training is that __________

super users have a specialized knowledge of both the system and clinical areas

Informatics Advantages

support for work proesses, improved records, decreased redundancy, increased convenience, improved data collection, prompts to improve documentation, improved safety with better patient ID, decision support and tracking, improved communication and access to information

Define the term electronic medical record (EMR).

the "legal record created in hospitals and ambulatory environments that is the source of data for the EHR.The EMR typically referred to a single encounter with no, or very limited, ability to carry information from one visit to another within a care delivery system Consists of: • Clinical messaging and e-mail • Results reporting • Data repository • Decision support • Clinical documentation • Order entry

Transaction and code set rules

the adoption of standardization. under HIPAA, if a covered entity conducts one of the adopted transactions electronically they must use the adopted standard. Covered entities must adhere to the content and format requirements of each transaction

The TIGER initiative states that transformation of the healthcare delivery system through the development of a national health information infrastructure requires nursing leaders who understand and promote good use of HIT. Which of the following represents a way that might help to create this type of leadership?

the integration and expansion of nursing informatics competencies throughout nursing programs, and nurse leadership programs in particular

NMDS - nursing minimum data set

the min data elements necessary for defining the cost and quality of nursing care, made up of nursing care elements: nursing diagnosis, intervention, outcome and the intensity of care patient demographic elements: personal ID, date of birth, sex, race, ethnicity, residence service elements: unique facility ID numbers, unique patient healthcare numbers, episode encounter dates

Provide common examples of confidential forms and communication seen in healthcare settings and identify proper disposal techniques for each.

the primary sources of inadvertent disclosure of information were printouts of portions of client records and faxes. This may entail using shredders or locked receptacles for shredding and incineration later. Shredding on-site may offer better control as well as cost savings. Nurses may also be responsible for erasing from a computer's hard drive files containing calendars, surgery schedules, or other daily records that include Confirm that fax numbers are correct before sending information. This helps to ensure that information is appropriately directed. • The use of a cover sheet. This is a particularly important practice when the fax machine serves a number of different users. A cover sheet eliminates the need for the recipient to read the fax transmission to determine who gets it. The cover sheet may also contain a statement to remind recipients of the presence of confidential information. Figure 12-3 displays an example of a fax cover sheet. • Authentication at both ends of the transmission before data transmission. This action verifies that the source and destination are correct. This is done through the use of a fax cover sheet listing intended recipient, the sender, both phone and fax numbers, and the transmittal confirmation sheet that lists the fax number. Electronic Files-destruction of the storage media or electronically writing over files to ensure that no information can be retrieved from them Emails Instant Messages and Internet-Nonencrypted messages can be read, and public e-mail password protection of mailboxes can be cracked. When looking at encryption, ask whether e-mail and IM software encrypts all messages between users, whether messages are encrypted both in transit and when stored in the mailbox, and whether messages remain encrypted when sent between different e-mail programs. Unauthorized, or dormant, mail accounts should be destroyed and firewalls used for additional protection. File deletion software overwrites files with meaningless information so that sensitive information cannot be accessed.

Define strategic planning.

the process of determining what an organization wants to be in the future and planning how it will get there.

what lays the foundation for developing the design and implementation of collaborative health mgmt systems in a variety of clinical practice settings

the union of healthcare technology with information and communications technology

telehealth

the use of electronic info and telecommunications technologies to support long distance clinical health care, patient and professional health related education, public health and health administration eg. provider training and admin meetings also included

Base vs custom system

this decision impacts implementation customization requires time and resources customization may also have ripple effects on other systems and interoperability The more you stray from the base system, the less vendor resources you might have and it can drive up cost .

All of the following are examples of goals of information systems strategic planning except _______.

to limit the need for other technologies

OHHCS - omaha home health care system

widely used in settings such as home care, hospice, public health, school health and prisons. involves assessment, intervention and outcome component that creates a problem solviing model for practice education and research (home care, hospice, public health, school health and prisons