NR599 Midterm
Patient-centered information's systems
EMRs, aggregate information systems, patient unique identifiers. • Aggregated data are used for the generation of routine reports and indicators, and for strategic planning and guidance within the health system. • Focused on collecting data and disseminating info related to direct care. • Most commonly types found in healthcare organizations: o Clinical documentation systems o Pharmacy info systems o Laboratory info systems o Radiology info systems
Electronic Medical Records
Electronic version of a patient's medical history, that is maintained by the provider over time, and may include all of the key administrative clinical data relevant to that persons care under a particular provider, including demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology report • Computer-based data warehouses or repositories of information regarding the health status of a client, which are replacing the former paper-based medical records. • Systematic documentation of a client's health status and health care in a secure digital format, meaning that they can be processed, stored, transmitted, and accessed by authorized interdisciplinary professionals for the purpose of supporting efficient, high-quality health care across the client's healthcare continuum. • Improves patient care by: o Reducing the incidence of medical error by improving the accuracy and clarity of medical records. o Making the health information available, reducing duplication of tests, reducing delays in treatment, and patients well informed to take better decisions. o Reducing medical error by improving the accuracy and clarity of medical records
Health Information Technology (HIT)
HIT has been promoted as a key strategy to achieve better care, affordable care, and healthy populations and communities. • Comprised of "hardware, software, integrated technologies or related licenses, intellectual property, upgrade, or packaged solutions sold as services that are designed for or support the use by healthcare entities or patients for the electronic creation, maintenance, access or exchange of health information. • Involves the exchange of health information in an electronic environment. Widespread use of health IT within the health care industry will improve the quality of health care, prevent medical errors, reduce health care costs, increase administrative efficiencies, decrease paperwork, and expand access to affordable health care. • It is imperative that the privacy and security of electronic health information be ensured as this information is maintained and transmitted electronically.
HITECH Act
Health Information Technology for Economic and Clinical Health Act was created to motivate the implementation of electronic health records (EHR) and supporting technology in the United States. • President Obama signed HITECH into law on February 17, 2009 as part of the American Recovery and Reinvestment Act of 2009 (ARRA), an economic stimulus bill. [8] • Creates incentives related to health care information technology, including incentives for the use of electronic health record (EHR) systems among providers. • HITECH strengthened HIPPA security. • Providers that comply with meaningful use requirement (EHRs) qualify for additional reimbursement over a period of several years. Penalties will be imposed for providers that do not use approved technology to comply with meaningful use. • Goal is to decrease health disparities.
Information
A group of data elements that have been organized and processed do that one can interpret the significance of the data elements. For example height, weight, age, and gender are data elements that can be used to calculate the BMI. The BMI can be used to determine if the individual is underweight, overweight, normal weight or obese.
Knowledge Dissemination
Acquires yet more knowledge he us engaged to rethink reflect on, and re-explore
Wisdom
Appropriate use of data, information, and knowledge in making decisions and implementing nursing actions. • Guides the nurse in recognizing the situation at hand based on patients' values, nurse's experience, and healthcare knowledge. • Implies a form of ethics, or knowing why certain things or procedures should or should not be implemented in healthcare practice. [2] • Includes the ability to integrate data, information, and knowledge with professional values when managing specific human problems. • The use of knowledge and experience to heighten common sense and insight so as to exercise sound judgment in practical matters. • Thought to be the highest form of common sense, resulting from accumulated knowledge. • Ability to apply viable and valuable knowledge, experience, understanding, and insight while being prudent and sensible. • Appropriate use of knowledge to solve human problems.
Knowledge
Awareness and understanding of a set of information and ways that information can be made useful to support specific task or arrive at a decision. Information that 's synthesized so that relationship are identified and formalized. Processed information that helps to clarify or explain some portion in our environment or world that we can use a as basis for action or upon which we can act. Often affected by assumptions and central theories of a scientific discipline and is derived by discovering patterns of relationships between different clusters of information. Answer questions of why and how.
BCMA
Bar Code Medication Administration
EMAR
Bar code technology provides a system of checks and balances to ensure medication safety.
TANIC Assessment has 4 paths
Basic computer literacy Clinical info management Information Literacy
Computer Literacy
Basic familiarity with computer uses and common applications o Ability to navigate hyperlinks o Able to set up and use a database to collect and retrieve information
NI competency nursing skill levels needed to be categories
Beginning Nurse Experienced Nurse Informatics Nurse Specialist Informatics Innovator
Knowledge managers
Capturing and processing collective expertise and distributing it.
CPU
Central Processing Unit; the brain of the computer.
Knowledge developers and generators:
Changing and evolving knowledge based on the tasks at hand and the information available.
CDS
Clinical decision support To promote accurate medical diagnoses and suggest appropriate medical and nursing interventions based on patient data.
Information Science
Deals with the retrieval and management of information as well as human-computer interactions. • Studies the application and usage of information and knowledge in organizations and the interface or interaction between people. • Concerned with the input, processing, output, and feedback of data and information through technology integration with a focus on comprehending the perspective of the stakeholders involved and then applying IT as needed. • An interdisciplinary, people-oriented field that explores and enhances the interchange of information to transform society, communication science, computer science, cognitive science, library science, and the social sciences. • Encompasses aspect of computer science, cognitive science, social science, communication science, and library science to deal with obtaining, gathering, organizing, manipulating, managing, storing, retrieving, recapturing, disposing of, distributing, and broadcasting information. • Studies everything that deals with information and can be defined as the study of ISs. • Enables the processing of information. • Links people and technology • Impacts information interfaces, influencing how people interact with information and subsequently develop and use knowledge.
Health Literacy
Degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. • Is dependent on individual and systemic factors: Communication skills of lay persons and professionals. • Is a major goal of Healthy People 2010
Knowledge engineers:
Designing developing, implementing, and maintaining knowledge
Wearable Technology
Devices and wireless area networks body area network or patient area networks.
Consultant
INS who takes consultant role provides expert advice, opinions and recommendations based on his area of expertise.
Informatics Competencies
Information Literacy: Refers to the use of digital technology to locate, navigate, manage, integrate, evaluate, create, and effectively communicate in a rapidly changing healthcare environment. The most important aspects of information literacy reflect information discovery, retrieval, and delivery as well as the ability to acquire, process, generate, and disseminate knowledge in ways that help those managing the knowledge reevaluate and rethink what an individual understands. o Ability to identify when information is needed as well as the skills to find, evaluate, and effectively use the same o Evaluation of online resources for quality o Able to search literature databases effectively • Computer Literacy o Basic familiarity with computer uses and common applications o Ability to navigate hyperlinks o Able to set up and use a database to collect and retrieve information • Clinical Information Management o Uses clinical decision making (CDS) and system safeguards to protect patients and protected health information (PHI) o Able to request and evaluate reports for the purpose of informed decision making o Participate in the selection, design, and evaluation of clinical information systems and patient-care technologies o Uses available technologies to appropriately and effectively communicate
IOM
Institute of Medicine Healthcare that could include safe, effective, pt -centered timely, efficient and equitable care.
Knowledge
Knowledge is built on a formalization of the relationships and interrelationships between data and information. A knowledge base makes it possible to understand that an individual may have a calculated BMI that is over 30 and not be obese. At this time, several automated decision support systems included a knowledge base and a set of rules for applying the knowledge base in a specific situation. o For example, the knowledge base may include the following information. A fever or elevated temperature often begins with a chill. At the beginning of the chill the patient's temperature may be normal or even sub-normal but in 30 minutes it is likely the patient will have spiked a temp. A rule might read: if a patient complains of chills, then take the patient's temperature and repeat in 30 minutes.
Applications (Apps)
Mobile apps are being used by and prescribed for patients
The Foundation of Knowledge Model
Model that proposes that humans are organic information systems constantly acquiring, processing, and generating information or knowledge in both their professional and personal lives. • Involves integrating four main kinds of knowledge, which are: knowledge acquisition, knowledge dissemination, knowledge generation and knowledge processing. o Knowledge worker: working with info. And generating info and knowledge as a product. o Knowledge acquirer: Providing convenient and efficient means of capturing and storing knowledge. o Knowledge engineers: Designing developing, implementing, and maintaining knowledge. o Knowledge managers: Capturing and processing collective expertise and distributing it. o Knowledge developers and generators: Changing and evolving knowledge based on the tasks at hand and the information available. • With time, we begin to transform our experiences and applied knowledge into it highest form known as...wisdom. • Knowledge is a powerful tool and that nurses focus on information as a key building block of knowledge.
Alarm Fatigue
Multiple false alarms by smart technology that cause workers to ignore or respond slowly to them. • the desensitization of a clinician to an alarm stimulus that results from sensory overload causing the response of an alarm to be delayed or missed According to The Joint Commission (TJC) between 2009 and 2012, there were reports of 98 alarm-related sentinel events, in which 80 resulted in death, 13 in permanent loss of function, and five in unexpected prolonged care conditions
Digital Natives
Person born or brought up during the age of digital technology and therefore familiar with computers and the Internet from an early age. • The term digital native doesn't refer to a particular generation. Instead, it is a catch-all category for children who have grown up using technology like the Internet, computers and mobile devices
Clinical Decision Support Systems (CDS)
Provides clinicians, staff, patients or other individuals with knowledge and person-specific information, intelligently filtered or presented at appropriate times, to enhance health and health care. • CDS encompasses a variety of tools to enhance decision-making in the clinical workflow. o These tools include computerized alerts and reminders to care providers and patients; clinical guidelines; condition-specific order sets; focused patient data reports and summaries; documentation templates; diagnostic support, and contextually relevant reference information, among other tools. • Provides HIT functionality that builds upon the foundation of an EHR to provide persons involved in care processes with general and person-specific information, intelligently filtered and organized, at appropriate times, to enhance health and health care • Promotes accurate medical diagnoses and suggest appropriate medical and nursing interventions based on patient data.
Knowledge acquirer
Providing convenient and efficient means of capturing and storing knowledge.
TIGER-based Nursing Informatics Competencies Model (Technology Informatics Guiding Education Reform)
Purpose is to create a vision for the future of nursing that bridges the quality chasm with information tech, enabling nurses to use informatics in practice and education to provide safer, higher-quality patient care. • Pillars of TIGER vision include (p14) o Management and leadership: drives empowers and executes the transformation of health care. o Education: Maximize the possibilities of technology toward knowledge development and dissemination. o Communication and Collaboration: standardized, person-centered, technology-enabled processes to facilitate teamwork across the continuum of care. o Informatics Design: Evidence-based, interoperable intelligence systems o Information Technology: smart people centered technology-enabled processes o Policy: consistent, incentives-based initiatives that support advocacy and coalition-building o Culture: A respectful, open system that leverages technology and informatics across multiple disciplines
QSEN
Quality and Safety Education in Nursing Seeks to prepare future nurses who will have the knowledge, skills, and attitude necessary to continuously improve the quality and safety of the healthcare systems within which they work.
RFID
Radiofrequency identification; technology that uses radio signals to communicate with a tag placed in or attached to an object, an animal, or a person. more expensive than bar-coding for packing the RFID tags are reprogrammable and issues associated with bar-code printing imperfections and bar-code scanner resolution can be mitigated
Information Literacy
Refers to the use of digital technology to locate, navigate, manage, integrate, evaluate, create, and effectively communicate in a rapidly changing healthcare environment. The most important aspects of information literacy reflect information discovery, retrieval, and delivery as well as the ability to acquire, process, generate, and disseminate knowledge in ways that help those managing the knowledge reevaluate and rethink what an individual understands. o Ability to identify when information is needed as well as the skills to find, evaluate, and effectively use the same o Evaluation of online resources for quality o Able to search literature databases effectively
Informatics
Science and art of turning data info.
Standard Terminology
Standardized terminologies (STs) contribute to the development of knowledge because they ensure that all professionals share the same understanding or meaning of a given concept, to clarify communication, facilitate research, and provide structure for decision support tools and EHRs. • As you look at the Foundation of Knowledge model, STs support knowledge acquisition, dissemination, generation, and processing. • Structured controlled languages developed to represent concepts in a given domain in a clear, unambiguous fashion that conveys the exact same meaning for data, information, and knowledge across settings. • Guidelines addressed aspects that include content, concepts, and identification of concepts, hierarchy, relationships and formal definitions. • Are based upon concepts rather than terms and allow for growth over time. • Current Terminology: o Nomenclature refers to a system of rules and procedures for adding names used in an art or science, such as nursing. o Classification systems that capture categories, which are then used to determine costs or outcomes but are insufficient in detail for clinical documentation purposes. o Taxonomy which uses classification according to a predetermined system, with the resulting catalog used to provide a conceptual framework for discussion, analysis, or information retrieval. o Data set which refers to a named collection of data consisting of individual information organized in a prescribed fashion. • International Statistical Classification of Diseases and Related Health Problems (ICD) and Current Procedural Terminology (CPT) provides a description and a classification of known diseases and injuries. [4] o Collection of morbidity and mortality statistics o Automated clinical decision support o Assignment of codes to medical diagnoses and procedures assoc. with hospital utilization in the US. • It improves communication, supports data reuse, contributes to the further development of nursing knowledge and provides a framework for EHRs.
Computer Science
Studies the theory underpinning information and computation and their implementation in computer systems. • Looks at how the human mind works from an information processing perspective. • Studies the theoretical foundations of information and computation and their implementation and application in computer systems. • Study of storage/memory, conversion and transformation, and transfer or transmission of information in machines. • Algorithms are detailed, unambiguous action sequences in the design, efficiency and application of computer systems, whereas practical implementation problems deal with the software and hardware. • Facilitates the acquisition and manipulation of data and information by nurses, who can then synthesize these into evolving knowledge and wisdom base
Cognitive Science
Study of thought, learning, and mental organization, which draws on aspects of psychology, linguistics, philosophy, and computer modeling. • Interdisciplinary field that studies the mind, intelligence, and behavior from an information processing perspective.
Meaningful Use
The American Recovery and Reinvestment Act of 2009 specifies 3 main components of meaningful use: o Use of certified HER in a meaningful manner, such as e-prescribing o Use of certified HER tech. for electronic exchange of health info. to improve quality of health care o Use of certified HER tech. to submit clinical quality and other measures. • Defined by the use of certified EHR technology in a meaningful manner (for example electronic prescribing); ensuring that the certified EHR technology connects in a manner that provides for the electronic exchange of health information to improve the quality of care. • Developed as an incentive program to assure that EHRs are used according to standards that achieve quality, safety, and efficiency measures • Staged in 3 steps o Stage 1: baseline for electronic data capture and info sharing o Stage 2 & 3 continues to expand on this baseline and be developed through future rule making.
Project Manger
The INS is responsible for the planning and implentation of informatics projects. The INS uses communication, change management, process analysis risk assessment scope definition, and team building.
Standard Two
The information literate nurse accesses needed information effectively and efficiently. o Selects the most appropriate investigative methods or information retrieval systems for accessing the needed information. o Constructs and implements efficient and effectively designed search strategies. o Retrieves information online or in person using a variety of methods. o Refines the search strategy, if necessary o Extracts, records, and manages the in-formation and its sources.
Standard Three
The information literate nurse critically evaluates the procured information and its sources, and, as a result, decides whether or not to modify the initial query and/or seek additional sources and whether to develop a new research process. o Summarizes the main ideas to be extracted from the information gathered. o Selects information by articulating and applying criteria for evaluating both the in-formation and its sources. o Synthesizes main ideas to construct new concepts. o Compares new knowledge with prior knowledge to determine the value added, contradictions, or other unique characteristics of the information. o Validates understanding and interpretation of the information through discourse with other individuals, subject-area experts, and/or practitioners o Determines whether the initial query should be revised. o Evaluates the procured information and the entire process
Standard One
The information literate nurse determines the nature and extent of the information needed. o Defines and articulates the need for information. o Identifies a variety of types and formats of potential sources for information. o Has working knowledge of the literature in nursing-related fields and how it is produced. o Considers the costs and benefits of acquiring the needed information. o Re-evaluates the nature and extent of the information need.
Standard Five
The information literate nurse understands many of the economic, legal, and social issues surrounding the use of information and accesses and uses information ethically and legally. o Understands many of the ethical, legal, and socio-economic issues surrounding information and information technology. o Follows laws, regulations, institutional policies, and etiquette related to the access and use of information resources. o Acknowledges the use of information sources in communicating the product or performance.
Standard Four
The information literate nurse, individually or as a member of a group, uses information effectively to accomplish a specific purpose. o Applies new and prior information to the planning and creation of a particular product. o Revises the development process for the product. o Communicates the product effectively to others.
Information Literacy Competency Standards for Nursing
The purpose of the Information Literacy Standards for Nursing is to: o provide a framework for faculty and students of nursing at the associate, baccalaureate, master's, and doctoral levels in the development of information literacy skills for evidence-based nursing practice o encourage the use of a common language for nursing faculty and librarians to discuss student information-seeking skills; o guide librarians and nursing faculty in creating learning activities that will support the growth of information literacy skills over the course of a program of nursing education and for lifelong learning; [7] o provide administration and curriculum committees a shared understanding of student competencies and need; and o provide a framework for continuing education in the area of information literacy for the field of nursing practice and research • Standard One: The information literate nurse determines the nature and extent of the information needed. o Defines and articulates the need for information. o Identifies a variety of types and formats of potential sources for information. o Has working knowledge of the literature in nursing-related fields and how it is produced. o Considers the costs and benefits of acquiring the needed information. o Re-evaluates the nature and extent of the information need. • Standard Two: The information literate nurse accesses needed information effectively and efficiently. o Selects the most appropriate investigative methods or information retrieval systems for accessing the needed information. o Constructs and implements efficient and effectively designed search strategies. o Retrieves information online or in person using a variety of methods. o Refines the search strategy, if necessary o Extracts, records, and manages the in-formation and its sources. • Standard Three: The information literate nurse critically evaluates the procured information and its sources, and, as a result, decides whether or not to modify the initial query and/or seek additional sources and whether to develop a new research process. o Summarizes the main ideas to be extracted from the information gathered. o Selects information by articulating and applying criteria for evaluating both the in-formation and its sources. o Synthesizes main ideas to construct new concepts. o Compares new knowledge with prior knowledge to determine the value added, contradictions, or other unique characteristics of the information. o Validates understanding and interpretation of the information through discourse with other individuals, subject-area experts, and/or practitioners o Determines whether the initial query should be revised. o Evaluates the procured information and the entire process. • Standard Four: The information literate nurse, individually or as a member of a group, uses information effectively to accomplish a specific purpose. o Applies new and prior information to the planning and creation of a particular product. o Revises the development process for the product. o Communicates the product effectively to others. • Standard Five: The information literate nurse understands many of the economic, legal, and social issues surrounding the use of information and accesses and uses information ethically and legally. o Understands many of the ethical, legal, and socio-economic issues surrounding information and information technology. o Follows laws, regulations, institutional policies, and etiquette related to the access and use of information resources. o Acknowledges the use of information sources in communicating the product or performance.
Scientific Underpinning
The scientific underpinnings of practice provide the basis of knowledge for advanced nursing practice. • These scientific underpinnings include sciences such as biology, physiology, psychology, ethics, and nursing. • The sciences underpinning nursing informatics: Nursing science, information science, and computer science • The advent of nursing science, specifically middle-range nursing theories, expanded the discipline of nursing. Thorough understanding of nursing theory provides a solid foundation for advanced nursing practice. • The importance of using science-based concepts to evaluate and enhance health care delivery and improve patient outcomes
Nursing Informatics (ANS)
The specialty that integrates nursing science with multiple information and analytical sciences to identify, define, manage, and communicate data, information, knowledge, and wisdom in nursing practice Nursing Informatics supports nurses, consumers, patients, the inter-professional healthcare team, and all other stakeholders in desired outcomes. 2 levels NI practice: generalists and informatics - nurse specialists.
Human Technology Interface
The study of interaction between human and technology. • With the evolution of technology and computer science, healthcare has been through many developments in respond to tech-world. • Human-Technology Interface in nursing defined as the application of computer technology to all fields of nursing. [6] • It is hardware and software through which the user interacts with any technology (e.g., computers, patient monitors, and digital screens). • Indeed, the use and the development of technology in the clinical areas has become a necessity. Such technology has been already practiced in many nursing departments. o For example, the cardiac monitoring systems, defibrillators, electronic thermometers, intravenous pumps, Patient-controlled analgesia (PCA) pumps and many others hardware. • May present information using text, numbers, images, icons or sound. o Auditory, visual, or even tactile alarms may alert users to important information. • Problems may include: o Nurses devise workarounds, such as removing armband from the patient o Major cause of as many as 87% of all patient monitoring incidents
TANIC
Tiger Based Assessment of Nursing Informatics Competencies
Data
Uninterpreted items often referred to as data elements An example might be a person's weight. Without additional data elements such as height, age, overall well-being it would be impossible to interpret the significance of an individual number.
NI Competencies
User Developer Expert Computer skills Informatics Knowledge Informatics Skills
Clinical Information Management
Uses clinical decision making (CDS) and system safeguards to protect patients and protected health information (PHI) o Able to request and evaluate reports for the purpose of informed decision making o Participate in the selection, design, and evaluation of clinical information systems and patient-care technologies o Uses available technologies to appropriately and effectively communicate
General Principles of Nursing Informatics
Verbalize the importance of health information systems with clinical practice. Have knowledge of types and clinical and administrative uses of health information systems. Ensure confidentiality of protected patient health information. Assure access control in the use of health information systems.
motherboard
central nervous system of computer because it facilated communication among all of the different computer components.
CPOE
computerized physician order entry Automated dispensing machines, smart pump technologies for iv drug administration and bar code medication administration (BCMA) frequently preceded the adoption of the EHR in many institutions because of the cause of the cost associated with implementing
DIKW Paradigm
data, information, knowledge, wisdom. NI centers on these core concepts. Data- Naming, collecting, organizing, Information- Organizing Interpreting Kno
Nomenclature
refers to a system of rules and procedures for adding names used in an art or science, such as nursing.
Classification
systems that capture categories, which are then used to determine costs or outcomes but are insufficient in detail for clinical documentation purposes.
Epistemology
the study of the nature and origin of knowledge that is what it means to know
Data Set
which refers to a named collection of data consisting of individual information organized in a prescribed fashion.
Taxonomy
which uses classification according to a predetermined system, with the resulting catalog used to provide a conceptual framework for discussion, analysis, or information retrieval.
Knowledge worker
working with info. And generating info and knowledge as a product