NR599 Midterm
What is a heuristics evaluation?
**A method to evaluate usability; a popular method of "discount usability evaluation" because methods are typically easy to do, involve fewer than 10 experts in relevant fields, and are much less expensive . Heuristic: principles. Evaluators assess the degree to which the design complies with recognized __________ rules of thumbs/ heuristics (principles)
Meaningful Use (MU)
*45 certification criteria that aim to make the EHR more robust, interoperable, and functional to meet the needs of patients and users *primary purpose is to ensure that EHRs across the nation meet an adequate standards for performance and that this standard increases in complexity over time to meet the expanded needs of the nation -Protect PHI -Clinical decision support -CPOE -HIE -Patient-specific education -Medication reconciliation -Patient electronic access -Secure messaging -Public health -Patient engagement
Transparency
*A __________ interface is so easy to use that users no longer think about it, but only about the task at hand *Technology should support the nurse-patient interaction *Allows users to apply their intellect to accomplish their tasks while the tools housing the information disappear into the background
Direct Messaging
*A basic function needed across the nation to allow secure messaging between and among providers Similar to email, but with additional security requirements because of the required PHI and HIPAA protection *Data/electronic information (i.e., lab results, patient referrals, discharge summaries) is encrypted. *Participants include providers, laboratories, hospitals, pharmacies, and patients
Usability
*A term that denotes the ease with which people can use an interface to achieve a particular goal *__________ should be evaluated early and often throughout the interface's development *Common methods to evaluate __________: Surveys of Potential or Actual Users Focus groups Cognitive walkthrough: evaluators assess a paper mockup, working prototype, or completed interface by observing the steps users are likely to take to use the interface to accomplish typical tasks Heuristics evaluation: a popular method of "discount usability evaluation" because methods are typically easy to do, involve fewer than 10 experts in relevant fields, and are much less expensive .Heuristic: principles. Evaluators assess the degree to which the design complies with recognized __________ rules of thumbs/ heuristics (principles) Formal __________ Test: uses either experimental or observational studies of actual users to accomplish real-world tasks Field Study: end users evaluate a prototype in the actual work setting just before its general release
*A type of Office Suite Software; Integrated __________ program to send and receive electronic mail i.e. Microsoft Outlook
Informatics Nurse Specialist
*An RN with graduate level education in informatics/related field who uses computer skills, process skills, data management skills, critical thinking, & systems life cycle development * Level 3 of the TANIC assessment developed by TIGER: fluent in nursing informatics/nursing terminologies, teach other nurse information management skills, applied aspects of human technology interface to screen, device, and software design
EHR Benefits and Challenges
*Benefits versus challenges -Benefits: --The ability to engage patients in their care --Able to provide venues to access caregivers virtually, using email and web platforms: easy and convenient --Fewer repeat procedures and reduced number of medication errors → improved patient safety --Diagnostic tests and follow-up visits decrease; cost savings increases --Computer reminders help ensure care is followed through with --Help store, manage and deliver information in volumes that exceed human abilities; allow multiple clinicians to simultaneously access the same patient record from different locations -Challenges: --Difficult to move MU beyond the low bar set by Stage 1 --EHRs vary in their ability to support advanced functionalities, such as patient engagement and population-based care management --Barriers to interoperability persist --Implementation difficulties --Time required to use them --Difficult user-interface --Risk of patient story being lost --Risk of privacy invasion --Pointless narrative notes --Lack of data standards --No plug-and-play functionality to lower implementation costs & encourage data exchange --Based on limited data sets
Health Information Technology (HIT)
*Comprised of "hardware, software, integrated technologies or related licenses, intellectual property, upgrades, 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" *_________ tools support our practice and help us to collaborate and communicate with other healthcare professionals. _________ tools help us achieve 3 aims: better care, affordable care, and healthy populations and communities. A 4th aim includes care of the provider within interdisciplinary teams. -examples include Electronic health records (EHRs), bar-code medication administration systems, smart pumps, clinical decision support/ other expert systems, patient monitoring devices, telehealth tools , computerized provider order entry
Knowledge worker
*Defined as nonrepetitive, nonroutine work that entails a significant amount of cognitive activity (i.e., Interpreting trends in laboratories and symptoms ) *Nurses collect data → turned into information → knowledge → wisdom: process of _______ ;Nurses work with information and generate more information and knowledge as a product. *Technology aids knowledge work by helping nurses collect data, see trends, process information, and create knowledge *A _______ has an advanced formal education and is able to apply theoretical and analytical knowledge; a continuous learner and specialist in the field who spends at least 50% of his/her work searching for/evaluating information
Information-literate nurse skills
*Determine the extent of information needed *Access the needed information effectively and efficiently *Evaluate information and its sources critically *Incorporate selected information into one's knowledge base *Use information effectively to accomplish a specific purpose *Understand the economic, legal, and social issues surrounding the use of information and access and use information ethically and legally
Website Credibility
*Different website addresses/domains indicate who is responsible for creating the website. -Although a .edu website is hosted by an educational institution, this does not mean it is legitimate. It could have been written by a student stating personal opinion, gossip, or guesswork. -.gov sites are maintained by the government and usually have professional contact information *Check the date of the most recent update (how old is the page?), contact information (is there a bibliography?), and links to relevant external sources *Nurses/healthcare providers must embrace the Internet as a source of health information for patient education & health literacy -We need to arm patients with the skills to identify credible resources. -"Information prescriptions": direct patients and families to credible websites, including government and HCO websites, to help them better understand their health issues/ share information with/ find them support from others with similar issues
Cognitive science/Cognitive Informatics
*Interdisciplinary field that studies the mind, intelligence, and behavior from an information processing perspective *Utilizes informatics and computing techniques to investigate cognitive science problems, such as memory, learning, and reasoning *Utilizes cognitive theories to investigate problems in informatics, computing, and software engineering *Looks at how the human mind works from an information processing perspective
The Foundation of Knowledge Model
*Model proposing that humans are organic information systems constantly acquiring, processing, generating, and disseminating information/ knowledge in both their professional and personal life *An organizing framework/model that contains bits, bytes (a computer term used to quantify data) data, and information at the base. Growing out of the base are knowledge acquisition, knowledge generation, and knowledge dissemination. At the intersection is knowledge processing. Encircling and cutting through all the knowledge cones is feedback. *As knowledge grows and expands, its use becomes more transparent
EHR Primary vs Secondary Uses
*Primary uses: The primary purposes of the health record are associated directly with the provision of patient care services. *Secondary uses: The EHR provides large pools of de-identified data (aggregate data/ secondary /big data) that can be used to improve care, discover patterns, reduce costs, support research, and identify and respond to consumer preferences. The process of tapping this data is known by many terms, such as analytics, data mining, knowledge discovery in data bases, or business intelligence. The result is that the analysis provided can support better and timelier decision making, decrease risks, and discover valuable insights if appropriate tools are used.
computer science
*Studies the theory underpinning information and computation and their implementation in computer systems -Facets include hardware, software, communications, as well as solutions to related problems *Nursing Informatics: nursing science + computer science + cognitive science + information science
Informatics Competencies
*Technology Informatics Guiding Education reform (TIGER)-based Nursing Informatics Competencies Model: in 2008, the TIGER initiative identified 3 components for the informatics competencies model: Basic computer competencies: basic familiarity with computer uses and common applications; able to navigate hyperlinks; able to set up/use a database to collect and retrieve information Information literacy: able to identify when information is needed as well as the skills to find, evaluate, and effectively use the same; evaluation of online resources for quality; able to search literature databases effectively Information management: uses clinical decision making and system safeguards to protect patients and PHI; able to request/ evaluate reports for informed decision making; participate in the selection, design, and evaluation of clinical information *Additionally, this initiative stresses that health care providers must be able to determine what information is needed, utilize the appropriate resources to find the information, use valid resources to critique the information, provide evidence-based care based on this information, and evaluate the outcomes of the process. *They developed an online self-assessment instrument, TANIC, which assesses a nurse's informatics competencies by skill level. Level I: Beginning Nurse, Level 2: Experienced Nurse Level 1: start the computer and securely login to select applications/ software; access/send email, and collect and enter patient data into information system Level 2: identify risks/limitations of internet surfing to locate evidence-based practice information; gather data → synthesize conclusion; explain how to sustain integrity of information resources Eventually, level 3: informatics nurse specialist and level 4: informatics innovator were developed Level 3: fluent in nursing informatics and nursing terminologies; Teach nurses how to locate, access, retrieve, and evaluate information; Applied aspects of human technology interface to screen, device, and software design Level 4: analyze systems; transform software programs to support data analysis and aggregation; lead research efforts to determine and address application needs *Four Levels of Nursing Informatics Competencies Level 1: Nurses with fundamental information management and computer technology skills use existing information systems and available information to manage their practice. Level 2:Nurses have proficiency in their domain of interest (e.g., public health, education, administration). These nurses are highly skilled in using information management and computer technology skills to support their major area of practice. They see relationships among data elements and make judgments based on trends and patterns within these data. Experienced nurses use current information systems but collaborate with the informatics nurse specialist to suggest system improvements. Level 3: Registered nurses who are prepared at least at the baccalaureate level possess additional knowledge and skills specific to information management and computer technology. They focus on information needs for the practice of nursing, which includes education, administration, research, and clinical practice. Informatics specialists' practices are built on the integration and application of information science, computer science, and nursing science. In their practice, informatics specialists use the tools of critical thinking, process skills, data-management skills (includes identifying, acquiring, preserving, retrieving, aggregating, analyzing, and transmitting data), systems development life cycle, and computer skills. Level 4: Nurses are educationally prepared to conduct informatics research and to generate informatics theory. These nurses lead the advancement of informatics practice and research because they have a vision of what is possible and a keen sense of timing to make things happen. Innovators function with an ongoing healthy skepticism of existing data-management practices and are creative in developing solutions. Innovators possess a sophisticated level of understanding and skills in information management and computer technology. They understand the interdependence of systems, disciplines, and outcomes, and can finesse situations to maximize outcomes.
Interoperability
*The Office of the National coordinator (ONC) within the Department of Health & Human Services was created by President George W. Bush in order to oversee and manage the adaptation of EHRs through developing standards of __________ *Levels of __________: Level 1 (Nonelectronic world): mail, phone Level 2 (Machine-transportable data): manual fax, scanned documents, secure email Level 3 (Machine-organizable data): secure email of free text, incompatible or proprietary file formats, and HL7 message Level 4 (Machine-interpretable data): automated entry of LOINC results from an external lab into a primary care provider's EHR *Data __________ is hindered when clinicians utilize free text documentation. Dropdown menus in the EHR permit standardized terminology that allows for better data interpretation. *Refers to the ability to exchange structured data ubiquitously (and electronically?), both between and across care settings.
Wisdom
*The application of knowledge to an appropriate situation; Foundation of the art of nursing * the use of knowledge + experience to heighten common sense and insight to exercise sound judgment in practical matters *The highest form of common sense, resulting from accumulated knowledge or erudition: (deep, thorough learning) or enlightenment: education → resulting understanding and knowledge dissemination *Focused on one's own mind and synthesis of experience, insight, understanding, and knowledge *Patient's values+ nurse's experience + healthcare knowledge = nurse is able to decide on nursing intervention/action *Nursing actions should be directed by _______.
Knowledge
*The awareness and understanding of a set of information and ways that information can be made useful to support a specific task or arrive at a decision. *You apply _______ to a problem. You turn data into information by processing it using _______. *_______ abounds with others' thoughts and information *Information that has been synthesized so that relations and interactions are defined and formalized; meaningful Three sources of _______ include: (1) instinct (2) reason (3) intuition
Health Literacy
*The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions *The acquisition of knowledge that promotes the ability to understand and manage one's health *Patients who are informed about their health have better outcomes & pay more attention to their health overall -Low _________ → less ability to manage a chronic illness → utilization of more health care services = higher incidence of disease *The ability to locate credible health information, analyze the risks/benefits of treatments, calculate dosages, and interpret test results
Five "Rights" related to Clinical Decision Support (CDS)
*The right information provided to the right person in the right format through the right channel at the right time in the workflow *_________ Support Systems (DSS) tools include computerized alerts and reminders, clinical guidelines/ best practice, online information retrieval (e.g., drug information), clinical order sets and protocols, and online access to organizational policies/procedures *The _________ tools can help during medication selection by considering client data, such as clinical condition, renal function, concurrent medications, and cost.
Accessibility
*The right user/authorized user must be able to obtain the right information at the right time and in the right format to meet his/her needs. *It should be easy to access the information and knowledge needed to deliver care or manage a health service.
Information Science
*The science of information; studying the application and usage of information and knowledge in organizations and the interfacings or interaction between people, organizations, and information systems *An extensive, interdisciplinary science that integrates features from cognitive science, communication science, computer science, library science, and social sciences * __________ deals with the retrieval and management of information as well as human-computer interaction *Informatics refers to the science and art of turning data into information
Meaningful Use Phases
*Three phases of Initiatives specified to achieve the goals necessary under national strategy, with each phase of MU escalating -Phase 1: instituted requirements for electronic capture of clinical data and providing patients with electronic access to their health information -Phase 2: encourages the use of HIT for continuous quality improvement at the point of care and the exchange of information in a structured format -Phase 3: emphasizes technical standards that support population health management and outcomes measurement while continuing to emphasize patient-centered care and engaging the individual in managing their health --Focuses on improved outcomes and interoperability --Includes improving quality, safety, and efficiency → improved health outcomes; decision support for national high-priority conditions; patient access to self-management tools; access to comprehensive patient data through patient-centered health information exchange; improving population health
What is the EHR?
*an individual's lifetime computerized record; a database of an individual's healthcare data during healthcare encounters
Information Literacy Competency Standards for Nursing
*being able to identify when information is needed as well as the skills to find, evaluate, and effectively use the same; evaluation of online resources for quality; able to search literature databases effectively *Technology and _________ competencies: -Integrates appropriate technologies for knowledge management to improve health care -Translates technical and scientific health information appropriate for various users' needs --Assesses the patient/caregiver's educational needs to provide effective, personalized health care --Coaches the patient/caregiver for positive behavioral chance *Demonstrates information literacy skills in complex decision making *Contributes to the design of clinical information systems that promote safe, quality and cost effective care *Uses technology systems that capture data on variables for the evaluation of nursing care
Health Literacy Umbrella
*how healthcare providers can assist patients in achieving the _________: *Build relationships -Values & preferences -Respect *Ensure understanding -Plain language -Clear dialogue -Follow-up -Terminology -Easy navigation *Partner -Peer support -Resources -education
Information Literacy
*the use of digital technology to locate, navigate, manage, integrate, evaluate, create, and effectively communicate in a rapidly changing information environment in the pursuit of knowledge *The healthcare provider and patient must demonstrate this skill -" a skill essential for lifelong learning and the production of an informed and prosperous citizenry." *An intellectual framework for finding, understanding, evaluating, and using information
What is a field study?
A method to evaluate usability; end users evaluate a prototype in the actual work setting just before its general release
What is a cognitive work through?
A method to evaluate usability; evaluators assess a paper mockup, working prototype, or completed interface by observing the steps users are likely to take to use the interface to accomplish typical tasks
What is a formal usability test?
A method to evaluate usability; uses either experimental or observational studies of actual users to accomplish real-world tasks
Transparent Wisdom
Applying knowledge in a practical way or translating knowledge into actions without conscious thought
HIPPA
HITECH strengthened _________ security and privacy rules
Longevity
Information should be usable beyond the immediate clinical encounter
What are common methods to evaluate usability?
Surveys of Potential or Actual Users Focus groups Cognitive walkthrough Heuristics evaluation Formal __________ Test Field Study
Portability
The Open Source (OS) Software (I.E. Microsoft Windows, Mac OS X) can be moved from one hardware architecture to another with few changes needed
Discernment
The ability to critique and filter information to facilitate the further development of wisdom
HITECH Initiatives & Programs
_________ : *Build the basic infrastructure to support the exchange of clinical information -HIE: the road *Provide financial incentives for purchasing tools that use the HIT -EHR incentive program: financing to buy a car *Provide technical support to those who use HIT in clinical settings -REC programs: driving instructions *Demonstrate how using HIT throughout a community can drive quality improvement -Beacon programs: learning how to navigate *Build workforce with technical skills to maintain the HIT infrastructure -community college & university based training programs: automobile mechanics, road maintenance *Spur innovation for newer and better tools -SHARP grants: designing a new engine, aerodynamic research
HITECH Act
_________ Act: Health Information Technology for Economic and Clinical Health Act *Passed as a part of the American Recovery and Reinvestment Act (ARRA) Provides a financial incentive for the use of EHRs; mandates that EHRs are used in a meaningful way ("meaningful use"/ MU) to achieve quality, safety, and efficiency measures . -Providers who comply qualify for additional reimbursement money; Payment of a penalty for any organization that has not adopted an EHR *Managed by the Office of the National Coordinator (ONC) within the Department of Health & Human Services and Centers for Medicaid and Medicare Services to improve patient care and clinical outcomes . *All providers (including first-time participants) will need to satisfy Stage 3 MU objectives by 2018. -Protect electronic PHI -Generate and transmit prescriptions electronically -Implement clinical decision -Use computerized provider order -Provide patients with electronic access to their health information and patient-specific data -Use certified EHR technology (CEHRT) to support coordination of care *In 2019, a new merit-based incentive payment system (MIPS) was established, but stage 3 requirements will be maintained.
What are indicators of usability?
ease of use, ease of learning, satisfaction with using, efficiency of use, error tolerance, and fit of the system to the task
Direct Messaging Project
provides a means for organizations to exchange secure data at the point of care at a reduced cost by creating a standard method of secure email exchange
