NURSING INFORMATICS
- It is a tool that can be used to tell a story about what is happening in our communities. - Community Mapping can empower the public by providing opportunities to have a lasting, positive influence on their community.
Community mapping/ public participatory information systems (PPGIS)
-coping with "crowdedness" -now sees actions at least partly in terms of longer-term goals -conscious deliberate planning - standardized and routinized procedures
Competent
A machine that uses electronic components and instructions to the components to perform calculations and repetitive and complex procedures, process text, and manipulate data and signals
Computer
An electronic document that contains the clients medical, personal and health information but is controlled by the client, rather than the health care providers.
Computer Based Client Records/ Electronic Medical Records (EMR)/ Computer Based Patients Records (CPRs)
- defined as all of the physical components of a computer - attached to a component called a motherboard. - includes the physical, tangible parts or components of a computer, such as the cabinet, central processing unit, monitor, keyboard, computer data storage, graphic card, sound card, speakers and motherboard
Computer Hardware
A system where physician document their medical orders
Computer Physician Order Entry System
Health statistical survey is used to collect quantitative information about items in population to establish certain information from the obtained data
Computer based survey system
Bedside computer terminal access can facilitate real-time charting and increase nursing time at bedside.
Computer on Wheels (COW)
An alert system that can be used in conjunction with the hospital pharmacy. A system design is created to alert both pharmacy and health staff when two or more drug prescriptions are incompatible.
Computerized clinical alert
Some are simple alarms that appear when the medical order conflict with another aspect of client's situation (allergies, contraindications)★ signals an alert every time there is something wrong with the patient's vital signs
Computerized clinical alert
Other systems allow for data collection outside of the clinic using a range of mobile technology such as Internet-based patient portal websites, mobile technology and text messaging, and computerized telephone surveys.
Computerized prescriber order entry (CPOE)
the set of terms and relationships that describe the phenomena, processes, and practices of a discipline such as nursing.
Concept
Component of computer's central processing unit (CPU) that directs operations of the processor. It tells the computer's memory, arithmetic logic unit and input and output devices how to respond to a program's instructions. However, the CU doesn't process data's
Control Unit (CU)
•Online fully integrated medication •Significant time reduction associated with transcription medications to paper •Decrease transcription error •Significant time reduction associated to documenting medications
Medication Management
The electronic storage devices or chips found on the motherboard.
Memory
- Also known as Personal Computer or PCS - Designed to support a single user
Microcomputers
In hospitals, they are used to: ● Patient classification ● Nurse staffing ● Scheduling × Often placed in cart to: ● Recording nurse notes ● Ordering tests ● Treatments ● Looking up medications
Microcomputers
Commonly called as Visual Display Unit (VDU)- Main output device of a computer- Form image from tiny dots called pixels that are arranged in rectangular form- The sharpness of the image depends on the number off pixels
Monitor
- Heart of any computer is the motherboard a thin, flat sheet made of a firm or flexible nonconducting material on which the internal components— printed circuits, chips, slots, and so on—of the computer are mounted. - Made of a nonconducting plastic or fiberglass material. Copper (or other metal) conducting lines (circuits) are embedded into the board - Has holes or perforations through which components can be affixed so they can transmit data across the circuits. - Contains the microchips (including the CPU), and the wiring, and slots for adding components.
Motherboard
-Most popular pointing device and cursor-control device - It has a small palm size box with a round ball at its base that senses the movement of the mouse and sends corresponding signals to CPU when mouse buttons are pressed.
Mouse
Alphabetical listing in the mid 1980's to a conceptual system that guides the classification of nursing diagnoses in a taxonomy and includes definitions and defining characteristics
NANDA-I
To enhance the emergency preparedness and response system, a special system such as the national electronic disease surveillance system can be coupled and integrated to the national health information system.
National electronic disease surveillance system
it will link all hospitals, practices and health practitioners as well as students in the country through the use of computer-based communication channels.
National health information system (NHIS)
-rigid adherence to taught rules or plans - little situation perception - no discretionary judgment
Novice
An expert who combines computer, information and nursing sciences
Nurse informaticist
Serves as developer of policies and procedures that promote effective and secure use of computerized records by nurses and other healthcare professionals.
Nurse informaticist
The practice and science of integrating nursing information and knowledge with technology to manage and integrate health information.
Nursing Informatics
The 4th edition of the NIC contains 514 nursing interventions that describe the treatments nurses perform, updated linkage with the NANDA diagnoses , and core interventions identified for 44 specialty practice areas.
Nursing Interventions Classification (NIC)
Includes terms to describe the context and environment of nursing practice, and includes terms for nursing delivery unit/service, patient/client population, care delivery method, personnel characteristics and financial resources
Nursing Management Minimum Data Set (NMMDS)
The latest edition of NOC has 330 research based outcomes to provide standardization of expected patient, caregiver, family and community outcomes for measuring the effect of nursing interventions. • Each outcome features a definition, a set of specific indicators, measures to facilitate clinical implementation and references
Nursing Outcomes Classification (NOC)
-A form of a small, erasable, programmable, read-only memory (EPROM), a bit like the ROM chips in a computer. - It functions a bit like a removable hard drive that is inserted into the USB port of the computer. - Also known as pen drive, jump drive, thistle drive, pocket drive, and so forth.
USB Flashdrive
A system software designed to help to analyze, configure, optimize or maintain a computer. - It is used to support the computer infrastructure - in contrast to application software, which is aimed at directly performing tasks that benefit ordinary users.
Utility Software
is the part of a software program that most computer users don't ever see; it's the code computer programmers can manipulate to change how a piece of software.
source code
Hard Drive USB Flash Drive Optical Media Cloud Storage
storage media
Computational - oriented computers Designed for: - Scientific applications requiring gigantic amount of calculations (at super fast speeds) - Analysis of scientific & engineering problems - Mathematically intensive research applications
supercomputers
The largest type of computer
supercomputers
- Collection of programs designed to operate, control, and extend the processing capabilities of the computer itself. - Composing programs written in low-level languages, which interact with the hardware at a very basic level.
system software
Bedside monitoring system acquires data such as heart rate from the ECG, parameters from arterial and pulmonary arterial invasive blood pressure, temperatures, noninvasive blood pressure and arterial saturation and heart rate from pulse oximetry.
vital signs monitoring
1. increased accountability 2. The need to continuous support 3. Privacy and confidentiality of information 4. Accessibility and security of data and information 5. Integration and support to the other system
what are the issues in ambulatory care information system?
•Outpatient clinics •Urgent care centers •Emergency rooms, ambulatory or same day surgery centers •Diagnostics and imaging centers •Community health centers •Occupational health centers •Mental health clinics
where do we provide the ambulatory care services?
Electronic Health Record (EHR)
It automates and streamlines the clinician's workflow and has the ability to generate a complete record of clinical patient encounter, as well as supporting other care-related activities directly or indirectly via interface including evidence-based decision support, quality management, and outcomes reporting.
2002
JCAHO identified a clinical information system as a way to improve safety and recommended that hospitals adopt technology.
- Most common and very popular input device that helps inputting data - It consists of keys that are capable of inputting alphabets, numbers and special characters. - Can navigate using the keyboard and perform shortcut
Keyboard
Originated as a database of standardized laboratory terms for results reporting for chemistry, hematology, serology, microbiology and toxicology
Logical Observation Identifiers Names and Codes (LOINC)
In what year was the First International Nursing Informatics Teleconference held in Australia?
1995
What year the Health Insurance Portability and Accountability Act was enacted?
2003
Establishment of the National Health Information Coordinator.
2004
To enhance the emergency preparedness and response system, a special system such as the national electronic disease surveillance system can be coupled and integrated to the national health information system.
Community electronic disease surveillance system
- Computers on carts - Known to be more useful than the fixed computers at the patient bedsides
"WOW" Workstation on Wheels and "COW" Computer on Wheels
- Punch cards - Card readers -Sort and prepare data for processing - teletypewriters
1960s
During this period, computer technology advanced, while the number of healthcare facilities increased.
1960s
In what year did Maryland University launch a graduate program in nursing informatics?
1989
What year was the electronic library established?
1993
- Control Unit - Arithmetic Logic Unit - Memory (RAM, ROM, Cache)
3 components of CPU
PATIENT NAVIGATION - New models of mobile phone apps are now emerging so that patients are not tethered to their desks, but rather always have much of this information at their fingertips.
ADVANTAGES OF PERSONAL HEALTH RECORDS
PATIENT PORTAL web portals enable patients to communicate with their physicians, request prescription refills and appointments, and access their health records, laboratory test results, and x-rays and other images
ADVANTAGES OF PERSONAL HEALTH RECORDS
SEARCHING FOR INFORMATION - Patients who learn about proposed treatments seem to have a clearer understanding about what to expect through the processes of diagnosis, acute treatment, and recovery. -This gathered knowledge increases health literacy and therefore has the capacity to make patients more actively involved in decision-making processes.
ADVANTAGES OF PERSONAL HEALTH RECORDS
-guidelines for action based on attributes or aspects - situational perception still limited - all attributes and aspects are treated separately and given equal importance
Advanced Beginner
- Increased efficiency -Improved documentation - Improved quality of care - Improved security - Reduced documentation expenses
Advantages of electronic medical record
The CPU is considered the brain of the computer. It performs all types of data processing operations, stores data, intermediate results and instructions (program). It controls the operation of all parts of computer
Central Processing Unit (CPU)
A research based nomenclature designed to standardize the terminologies for documenting nursing care in all clinical care settings
Clinical Care Classification (CCC)
Ambulatory care covers a wide range of health care services that are provided for patients who are not admitted overnight to a hospital.
Ambulatory care system
Record and integrate data on patient vital signs soft copy version of the patient's data
Clinical documentation
Products are designed to satisfy a particular need of a particular environment.
Application Software
The logical part of the brain. When any mathematical calculation or decision/logic needs to be carried out, the instruction is passed on the ALU
Arithmetic Logic Unit (ALU)
- Tracking of a group of clients the caseload. - Keeps abreast of the latest regulations affecting eligibility for health care benefits, the reporting requirements of the payer's agencies, the detailed facts about the variety of services providers that the client needs to access.
Case management
1.automating both the administration and the scoring of the assessment 2. increasing patient satisfaction and ease of use 3. minimizing missing data and the time delay in reporting results to providers. 4. Electronic assessments also facilitate patient-centered care by enabling customization of the assessments and increasing flexibility in selecting the frequency and locations of assessments. 5. ePRO systems can also promote patient-centered care by providing flexibility in choosing the location and method of assessment
Benefits of ePRO Assessment
-Hospital Information System - From patient's hospital records to personal information and laboratory examination results and procedures - Nurses, doctors, pharmaceutical and billing have access to it -Patients not under your care does not guarantee your access which is part of the hospital's security policies - Have access to discharge patient and alert anMGH tag - Can view medications taken by the patient - Transactions are automated to patient's billing account - Lab requests for examinations to be done to patient
Bizbox
A system designed to collect, store, organize, retrieve, and manipulate all data related to care of the critically ill patient
CRITICAL CARE INFORMATION SYSTEM(CCIS) / MEDICAL INFORMATION BUS (MIB)
Category 1: Immediately reportable diseases/syndromes/events × Category 2:Weekly reportable diseases/ syndrome/ events
Case based/indicator based
- An example of a local EMR applied in the public health setting - The first electronic medical record system in the Philippines.
Community Health Information and Tracking System (CHITS)
terms for which data are collected and for which values are assigned
Data element
specific purposeful group of data elements representing a subset of concepts within a discipline.
Data set
The normal ECG pattern is programmed into computer, any deviations will be detected from component ECG waves
Detection surveillance
can be provided on their own, or as part of a wellness or treatment program. They include X-Rays, lab and blood tests, MRIs and screening for various cancers and illnesses
Diagnosis
Can process analog signals, interpret abnormal ECG patterns and generate an analysis report that is confirmed by cardiologist
Diagnostic interpretative
SYSTEM ALERTS THE NURSE IMMEDIATELY IF ANY INCONSISTENCIES OR POTENTIAL PROBLEM EXIST. •Online and integrated Rules and Alerts •Drug allergy alerts based on order entry •Drug- drug interaction alerts •Alerts for abnormal lab values and vital signs •Alerts for new orders •Alert for order renewals •Alert for scheduled patient events
Different types of alerts
In Primary Health Center it is designed to lessen paperwork responsibility, get better data accuracy, and facilitate village health workers to provide timely care and information to the rural population. •Example: EMR ( Electronic Medical Recod)
Documentation
The collection and interpretation of structured information from patients can inform and guide clinical care.
ELECTRONIC PATIENT- REPORTED OUTCOMES ASSESSMENT
- In collaboration with the government is providing emergency response services which enables distress calls - It reaches out to rescue people involved in critical accidents and emergencies.
Emergency management research institute (EMRI)
ESR (Event-based Surveillance and response) - Compliments existing indicator- based diseases surveillance (PIDSR) in detecting events with added advantage of rapid reporting, greater geographic spread and relatively low cost
Event Based
-no longer relies on rules, guidelines, or maxims -intuitive grasp of situations based on deep tacit understanding -analytic approaches used only in novel situations or when problems occur -vision of what is possible
Expert
This kind of software is frequently called 'proprietary software' or 'closed source' software, because its source code is the property of its original authors, the only ones legally allowed to copy or modify it.
Free software
is exactly as the term implies, free of charge; but that does not necessarily mean the user has a license to access, change or distribute that software.
Free software
data, information and knowledge in sequential boxes with one-way arrows pointing from data to information to knowledge
GRAVES AND CORCORAN SEMINAL WORK.
are small, special function computers, have almost same functionality and processing capabilities as microcomputers but are limited in their expansion capabilities.
Handheld computers
Application of computer and information science in all basic and applied biomedical sciences to facilitate the acquisition, processing, interpretation, optimal use and communication of health-related data"
Health Informatics
integration of information science, health science, and computer science
Health Informatics
Facilitates effective monitoring of programs
Health information system
Software systems used by nurses
Hospital Information System (HIS)
1985
In what year did the American Nurses Association (ANA) approve the formation of the Council?
1960s
In what year did the introduction of cathode ray tube (CRT) terminals, online data communication, and real-time processing add significant dimensions to computer systems, making machines more accessible and "user-friendly"?
1992
In what year was Nursing Informatics approved by the American Nurses Association as a new nursing specialty with its own Scope of Nursing Informatics Practice Standards, specific credentialing examinations, and increased demand for nursing expertise?
1970's
In what year were nurses involved in the implementation of the Hospital Information Technology (HIT) system?
-Nurses no longer struggle to read physicians handwriting -Reduces verbal orders - Increased patient safety - physician's orders are made more accessible even in mobile phones
Interdisciplinary plan of care
A combinatorial terminology for nursing practice developed by the international nursing community under sponsorship of the International Council of Nurses (ICN). It includes nursing diagnosis, nursing interventions, and nursing outcomes.
International Classification for Nursing Practice (ICNP)
focus on the patient and care process and are used to capture, store, and manipulate data in EHRs
Nursing Terminologies
integrates nursing, computer, and information sciences to manage and communicate data, information, knowledge and wisdom into nursing practice in order to support patients, nurses and other providers in their decision-making in all roles and settings
Nursing informatics
responsible for providing clinical information and data analysis for effective patient care and monitoring
Nursing informatics Specialist
Software whose source code is available for modification or enhancement by anyone.
Open Source Software
It is an integrated set of specialized programs used to manage overall resources and operations of the computer. It is a specialized software that controls and monitors the execution of all other programs that reside in the computer, including application programs and other system software.
Operating Systems
Include compact disks, digital versatile disks, and Blu-Ray. CD-ROMs and DVDs are rigid disks that hold a higher density of information and have higher speed.
Optimal media
intended to stimulate and guide systematic research in this discipline
PATRICIA SCHWIRIAN'S MODEL
To reduce morbidity and mortality through an institutionalized, functional integrated disease surveillance and response system nationwide.
PIDSR: philippine integrated disease surveillance and response
Provides a universal language for perioperative nursing practice and education and a framework to standardize documentation. The diagnostic component is based on NANDA, the interventions are NIC terms and the outcomes are from NOC.
Perioperative Nursing Data Set (PNDS)
is a very small special function handheld computer that provides calendar, contacts, note-taking functions and may provide word processing, spread sheet and other functions.
Personal digital assistants (PDA)
sometimes referred to as personally controlled health records, are electronic tools used by individual patients to store and share medical information
Personal health records (PHRs)
s a class of tools that help people collect personally relevant information for the purpose of self-reflection and self-monitoring. These tools help people gain self-knowledge about one's behaviors, habits, and thoughts. It goes by other names such as living by numbers, personal analytics, quantified self, and self-tracking.
Personal informatics
•Process, store and integrate physiologic and diagnostic information of patient •Present deviations or abnormalities by setting an alarm • Analyze and present data trends in graphical form
Physiologic monitoring system
- Effective integration of information to other disciplined to concretized knowledge and create better understanding. - Creation of computerized patient records, medical information system. - Central repositories of all data such as data warehouse. - Simple Graphical User Interface (GUI) for nurses and other healthcare provider, patient and consumer
Primary focus of community health information system
- Preventing, identifying, investigating and eliminating communicable health problems. - Accessibility of data and information, through communication. - Educating and empowering individuals to adopt healthy lifestyle. - Facilitate the retrieval of Data. - Effective transformation of data into information
Primary focus of community health information system
Output device, used to print information on papers
Printer
-sees situations holistically rather than in terms of aspects -sees what is most important in a situation -perceives deviations from the normal pattern -decision-making less labored× uses maxims for guidance, whose meaning varies according to the situation
Proficient
-The internal memory of the CPU for storing data, program, and program results. -Read and write memory and store data until the machine is working. Once the machine is switched off, the data is erased.
Random Access Memory (RAM)
- An only read memory and a non-volatile. - The information is stored permanently = never erased - It stores such instructions that are required to start a computer, called bootstrap - It is composed of the programs used by the control unit of the CPU to oversee computer functions.
Read Only Memory (ROM)
includes post-operative therapies, occupational and physical therapy and rehabilitation for drug and alcohol abuse.
Rehabilitation
A core clinical terminology containing over 357,000 healthcare concepts with unique meanings and formal logic based definitions organized into multiple hierarchies. • It is placed through the National Library of Medicine, it is available in English, Spanish, and German language editions.
SNOMED CT
- Detect early unusual increase of communicable and non-communicable conditions related to emergencies and disasters - Monitor health trends for appropriate public health action - Enable identification of appropriate response to handle the emergency.
SPEED (Surveillance in Post Extreme Emergencies and Disasters)
Allows to scan printed materials and convert it into a file format that may be used within the PC
Scanner
TRUE
TRUE OR FALSE In 1995, Saba initiated a history of nursing informatics at the National Library of Medicine. It was initiated based on the recommendation of Dr. Morris Collen who published the History of Medical Informatics in 1990.
Indicates that nursing informatics is the intersection between the discipline-specific science (nursing) and the area of informatics
TURLEY'S MODEL (1996)
This app replaced the COVID Kaya App for the DOH COVID-19 Dashboard.
TanodKontraCOVID App for the DOH COVID-19 Dashboard:
This is where the telenurse determines the appropriate nursing action
Telehealth
he use of digital information and communication technologies, such as computers and mobile devices, to access health care services remotely and manage your health care.
Telehealth
This is when the nurse can retrieve and display a client's physiological parameters across time. Furthermore, standardized nursing care plans, care maps, and critical pathways can be stored in the computer via EMR.
Tracking client status
These include same-day surgery centers, substance abuse clinics, chemotherapy and other forms of therapy.
Treatment
used to convey important data and information to others, the communication must be understood by the listener and be interpreted as having meanin
Terminologies
1986
The first edition of nursing informatics was published during this year
1990s
The internet was used for High-Performance Computing and Communication (HPCC) or the Information Superhighway and facilitated data exchange between computerized patient record systems across facilities and settings.
- A data storage device which includes a flash memory with an integrated USB interface - Typically removable and rewritable, and smaller than optimal disc
USB
1.Gathering epidemiological and administrative statistics. 2.Patient appointments - identification system. 3.Monitoring of programs in the community: 4.Documentation 5.Community mapping/ Public Participatory Information Systems (PPGIS)
The main use of computers in community settings
1980s
This is the year when microcomputer or personal computer (PC) emerged. This revolutionary technology made computers more accessible, affordable, and usable by nurses and other health care providers.
Mostly for prevention and basic medical care. They include doctor's clinics, such as primary care, as well as counseling centers for mental health and weight loss.
Wellness
Executive Order 13335
What Executive Order established the Office of the National Coordinator for Healthcare Information Technologies (ONC) in 2004?
1. Wellness 2. Diagnosis 3. Treatment 4. Rehabilitation
What are the 4 sub categories of ambulatory care?
raw material (Nursing related information) technology (computering system) the users (nurses, students and context) the goal or objective
What are the four elements of Patricia schwirian's model
- Make health care accessible to people who live in rural or isolated communities. - Make services more readily available or convenient for people with limited mobility, time or transportation options. - Provide access to medical specialists. - Improve communication and coordination of care among members of a health care team and a patient. - Provide support for self-management of health
What are the goals of telehealth?
- Patient portal - Remote monitoring - Doctors talking to doctors - Personal Health Records - Personal Health Apps
What are the teleheath services
Cognitive Science Information Science Computer Science
What are the three Core Components of Turley's Model
1970s
What year did hospitals begin developing computer-based information systems, which initially focused on physician order entry and results reporting, pharmacy, laboratory and radio reports, financial and managerial information, and physiologic monitoring system in the intensive care unit, and a few systems began to include care planning, decision support, and an interdisciplinary problem list?
2000s
What year did the development of a wireless point-of-care system with a focus on open source solutions take place?
1981
What year did the first Nursing Special Interest Group on computers meet for the first time during SCAMC (Symposium on Computer Application in Medical Care)?
1961
What year was the Healthcare Information and Management Systems Society founded?
•Consistent exchange of response •Disease tracking •Data and information sharing •Building strategies •Early Detection and monitoring of disease and sickness •Control of spread disease •National alertness and preparedness •Building strong communication
advantages of CEDSS
•Maintaining strong relation between nurses and other healthcare provider •Continuous coordination of the healthcare professionals •Synchronization of the decision •Streamlining of the process •Effective management of data and information
advantages of CEDSS
Barcode on patients' bands and medication packaging helps to double check that the right medication is being given to the right patient at the right time
barcode technology
-Small form of ROM -It speeds up the processing by storing frequently called (used) data and commands in a small, rapid access memory location
cache
An extension of online storage service offered by individual vendors is cloud storage. Far more secure and reliable than a hard drive or back up drive.
cloud storage
Set of programs, which is designed to perform a well-defined function.
computer software
the set of terms and relationships that describe the phenomena, processes, and practices of a discipline such as nursing.
concept
terms for which data are collected and for which values are assigned.
data elements
specific purposeful group of data elements representing a subset of concepts within a discipline
data set
Provide access to vital patient information thus supporting clinical decision making Other electronic devices at patient's bedside such as infusion pumps, mechanical ventilators, mixed venous oxygen saturation monitors, fluid collection devices that measure chest drainage and urine output are also sources of important clinical information.
decision support
•Monthly report, no of birth immunization, communicable diseases, deaths, delivery •Field workers engaged in monitoring of epidemics, outbreaks and analyzing the morbidity trend of their village
gathering epidemiological and administrative statistics
- A peripheral component that has very high speed and high density. - It is a very fast means of storing and retrieving data as well as having a large storage capacity in comparison with some other types of storage. - the main storage device of many personal computers and is typically inside the case or box that houses other internal hardware.
hard drive
allow computer receive information from the outside world
input device
Electronic Health Record (EHR)
it is a longitudinal electronic record of patient health information generated by one or more encounters in any care delivery setting.
- Most common fast, large, and expensive - Used in large businesses: hospitals, large healthcare facilities for processing, storing, & retrieving data - they may have the electronic medical record.
mainframes
Machines and software that process transactions in high- volume are known as transaction processing system (TPS).
mainframes
Used for processing large amount of repetitive calculations involved in: ✓Billing ✓Payroll ✓Inventory control ✓Business operations computing
mainframes
Used to: ✓Document patient care ✓Obtain laboratory and radiology results ✓Record medication orders ✓Administration record ✓Information retrieval tasks
mainframes
are often used to support the entire Hospital Information Technology (HIT) system aka Hospital Information System.
mainframes
- It is much smaller and less powerful than a mainframe, and used one person at a time. - This is used for an increasing number of independent applications.
microcomputers
•Health Information System (HIS) •Computer Base Survey System •Statistical Information System in Community Health
monitoring of programs in the community
focus on the patient and care process and are used to capture, store, and manipulate data in EHRs
nursing terminologies
allow the computer to report its results to the external world
output device
•People can have access to the details of dispensaries, diagnostics centers, medical shop and hospital in the locality, medical colleges, rehabilitation centers.
patient appointments - identification system
- Terminals used to order supplies, tests, meals, and services from other departments. - Computer used extensively for scheduling (client appointment and staff scheduling requests) - For insurance keeping so that billing can be accurate.
practice management
