Prep U (COMBINED) - Chapter 20: Informatics

A nurse has a two-way video communication with the specialist involved in the care of a client in a long-term care facility. This is an example of what nursing informatics technology?

Telemedicine and mobile technology Explanation: Telemedicine and mobile health technology facilitate client engagement, while helping providers deliver more cost-effective care. Telemedicine embraces applications and services that include two-way video communications, e-mail, and wireless phones. Mobile health features multiple technologies integrated into the increasingly wireless and mobile health care delivery system. Client engagement technology would include the concept of client portals (where clients can access an electronic medical record system and personal health information); online appointments scheduling; and personalized, condition-focused alerts/reminders in the form of e-mails, automated telephone calls, or text messages. Data aggregation is a process that involves data collection, analysis, use, reporting, and delivery of feedback throughout the organization. Organizations will use process and outcomes data to measure what they achieve for clients and population-based communities. Population health management technology performs data mining, risk stratification, and analysis. Searches can be conducted for disease trends, diagnoses, procedures, and missed appointments.

A informatics nurse is working as part of a team that is working to develop a new electronic health record system that will be used in the facility. The team has thoroughly analyzed, planned, and designed an appropriate system and is planning to test the system. Which type of testing would the team do first?

Unit Explanation: Unit testing is done during design and development. This is the type of testing that is done initially. This testing is then followed by function, integration, and performance testing.

An informatics nurse specialist is involved with testing an update to a facility's clinical information system. The specialist is in the integration testing phase. Which phase has the informatics nurse specialist already completed? Select all that apply.

Unit testing Function testing Explanation: Integration testing is the third phase of testing and occurs after unit testing and function testing, but before performance testing and user-acceptance testing.

Several nurses are discussing their impressions of the newly implemented electronic health record with an informatics nurse specialist. They say, "There is so much information on one screen, it hard to tell what we should do first. It's not really clear." The informatics nurse specialist interprets the comments as reflecting an issue with which area?

Usability Explanation: The nurses' statement reflects usability. Electronic health records and order-entry systems are complex. Sometimes the way screens are formatted can be confusing, making it a real challenge to perform nursing tasks in a way that makes sense. Interoperability refers to the ability to share data across health care systems. Optimization refers to strategies to improve processes, maximize effective use, reduce errors, reduce costs, eliminate workflow inefficiencies, improve clinical decision support, and improve end-user skills and satisfaction with the system. Security refers to the ability to keep information private and confidential.

An informatics nurse specialist is presenting an in-service program for a group of staff nurses on using the electronic health record. As part of the presentation, the nurse specialist is emphasizing the need for maintaining security and privacy of the record. During a break in the program, the nurse specialist overhears a conversation among several of the staff nurses. Which statement would the nurse specialist identify as a cause for concern?

"I always put a sticky note on the computer terminal with my password on it in case I forget it." Explanation: Nurses are responsible to minimize the risk of harm to clients and providers through both system effectiveness and individual performance. Ensuring secure and appropriate access to clinical systems starts with good management of passwords. Passwords should never be shared or placed in an area where the password could be identified. Putting a password on a sticky note in a visible location such as a computer terminal would be inappropriate. Using different passwords, making the password unique to the individual, and having a password of at least 8 characters in length are appropriate strategies for strong passwords that would keep data safe.

An informatics nurse specialist is conducting an in-service program for a group of staff nurses about this specialty. One of the nurses asks, "What exactly is nursing informatics?" Which response by the informatics nurse specialist would be most appropriate?

"It combines nursing science with information management and analytical sciences." Explanation: The ANA defines nursing informatics (NI) as "the specialty that integrates nursing science with multiple information management and analytical sciences to identify, define, manage, and communicate data, information, knowledge, and wisdom in nursing practice." It is more than just working with computers or the electronic health record (although this is the core of informatics practice). Client education can be one component of a clinical information system with which nursing informatics may be involved.

A client comes to the primary care provider's office for a routine follow-up visit. While completing the assessment, the nurse tells that client about a new patient portal that the office has begun to use. The client asks the nurse, "I guess this is a good thing, but what is it and what does it do?" Which response by the nurse would be appropriate? Select all that apply.

"It's a site you can access through your home computer or smartphone." "It allows you to get information about your health status and care." "You can communicate with your provider through the system." "It allows you to request refills for your prescriptions." Explanation: A patient portal is a tool that promotes client engagement in his or her health and healthcare. Portals can be accessible via a home computer or a smartphone, making engagement even easier. Although services vary depending on the vendor, common services include access to medical history and other health information; communicating securely and conveniently with providers; and requesting prescription refills. Typically, patient portals do not include access to health insurance companies.

While interviewing a client who has come to the clinic, the client says to the nurse, "I've seen all these apps that are available to monitor my health, but I'm not sure which one would be best. Do you have any suggestions?" Which response by the nurse would be most appropriate?

"It's important that the app is high quality. Be sure to make sure the app is credible." Explanation: Nurses, physicians, other care providers, and clients are using apps that enable quick and easy access to screens that provide information and can track progress. They often provide a communication platform that allows discussion amongst key stakeholders including between peers, clients with similar conditions, or care providers. With over 40,000 health-related apps available, it is important to evaluate the credibility and reliability of the app prior to use. Apps are not considered a fad. In 2012, 85% of adults in the United States owned a mobile phone, and 53% of these phones were categorized as smartphones with ability to install apps. Additionally, nearly 19% of U.S. adults who owned a smartphone had at least one health care-related application on their phone. And the numbers continue to grow.

An informatics nurse specialist is conducting a discussion with a group of staff nurses who have been participating in the implementation of an updated electronic protocol system. The informatics nurse specialist is gathering information about the system's optimization. One of the participants asks, "Why is this information important?" Which response by the informatics nurse specialist would be appropriate?

"We can make improvements to the system to improve our delivery of care." Explanation: Once a clinical information system is in use, and as nurses and other care providers become more proficient with the system, the need for improvements to better support and improve care delivery will usually become evident. That is the goal of optimization. It is not done to meet standards for accreditation, demonstrate fiscal accountability, or meet federal regulations.

The nursing student is discussing the benefits of electronic charting with a precepting nurse who is frustrated with computerized documentation. Which statement by the student requires intervention from the nursing instructor?

"You can make extra money with overtime pay with end-of-shift charting." Explanation: There are many benefits to electronic charting, though there may be some learning curves involved in knowing how to use electronic formats. It is incorrect to suggest that overtime pay can be earned with end-of-shift charting. Therefore, this statement requires intervention. The other statements are appropriate.

An informatics nurse specialist has completed the evaluation of an update to a current clinical information system used by the staff at the local hospital and has documented the results. Documentation reveals the need for an improvement in the screen display. Which action would be next?

Analyze and Plan Explanation: Evaluation may be the last phase of the system development lifecycle, but it represents an essential step for nurses to be involved in before circling back to Analyze and Plan based on the results of the evaluation. This step is important to complete before making updates or improvements to a system already in place. Once this step is completed, the other steps of the system development lifecycle would follow.

An informatics nurse specialist is involved in the development of a clinical system in a facility. As part of this process, the nurse is applying the system development lifecycle. Place the phases of the system development lifecycle in the order that they would occur from first to last.

Analyze and plan Design and build Test Train Implement Maintain and evaluate Explanation: The concepts or phases of the system development lifecycle (SDLC) are very similar to the concepts of the nursing process but with an informatics or technology focus. The SDLC requires focus in the areas of Analyze and Plan, Design and Build, Test, Train, Implement, Maintain, and Evaluate.

An informatics nurse is preparing a training program for staff nurses in the facility. The facility will be implementing a new electronic health record. To ensure the best results, which type of training would the informatics nurse most likely use?

Classroom education Explanation: The type of training required depends on the implementation project. For the installation of a new EHR, a classroom model of education will most likely be needed. If you are adding only a new module to a current system, web-based or online training may be adequate. If the change is a simple addition to current functionality, a tip sheet or just-in-time training may suffice.

An informatics nurse specialist is involved in evaluating a new electronic health record being used by the facility. The nurse specialist will be evaluating the effectiveness of the early warning system for rapid response on reducing the number of codes being called. The nurse specialist has also developed the following question: "Has the new alert system resulted in a reduction in the number of codes being reported?" What would be the nurse specialist's next step?

Complete a literature search of peer-reviewed journals Explanation: The informatics nurse specialist has determined what was to be evaluated and developed the appropriate question for evaluation. Next the nurse specialist would conduct a literature search. This would be followed by identifying the data elements to be collected, the appropriate study design, and method of data collection.

An informatics nurse specialist is working with a team to design a clinical information system. To ensure system usability, the team would make sure that the language meets which criterion? Select all that apply.

Conciseness Clarity Familiarity for the user Explanation: All language used in a clinical information system should be concise and unambiguous. Terminology used also must be familiar and meaningful to the end users in the context of their work; no terms related to computers, technology, HL7, databases, and so forth should appear in the user interface.

An informatics nurse specialist is working with a team to design a clinical information system. To ensure system usability, the team would make sure that the language meets which criterion? Select all that apply. Conciseness Clarity Jargon-like Familiarity for the user Computer-based

Conciseness Clarity Familiarity for the user Explanation: All language used in a clinical information system should be concise and unambiguous. Terminology used also must be familiar and meaningful to the end users in the context of their work; no terms related to computers, technology, HL7, databases, and so forth should appear in the user interface.

An informatics nurse specialist is describing the framework underlying informatics practice. Which component of the framework would the nurse specialist describe as discrete entities without interpretation?

Data Explanation: Data is the component that involves discrete entities that are described without interpretation. Information refers to data that have been interpreted, organized, or structured. Knowledge refers to information that is synthesized so that relationships are identified. Wisdom refers to the appropriate use of knowledge to manage and solve human problems.

An informatics nurse specialist is working as part of a team that will be developing and implementing a new client assessment tool. During which phase of the system development lifecycle would the team be integrating information about workflow patterns, standard terminology, and recommendations for screen layout from supportive research?

Design and build Explanation: Mapping out workflow patterns, using standard terminology, and integrating evidence-based research findings for screen layouts would be accomplished during the design and build phase of the system development lifecycle. During the analyze and plan phase, the team would determine the purpose of the technology and the problem to be solved to establish the need. Testing is done once the technology is designed and built. Training of the end-users occurs after the system is tested but before it is implemented.

An informatics nurse specialist is working on a team that is considering a new technological system for the facility. Which aspect would be most important for the team to do as the first step?

Determine the need or problem to be solved Explanation: Before considering the use of any new technology or an update to the system, analysis and planning must occur. This involves determining the need for the technology or update or identifying the problem to be solved. Once that step is completed, then design (such as using standard terminology), testing and training would occur.

A nurse is reading a journal article about telemedicine. The nurse demonstrates understanding of this concept by identifying which type of service as being provided? Select all that apply. Provider training Diagnostic testing Administrative meetings Access to specialist at a different location Client progress monitoring

Diagnostic testing Access to specialist at a different location Client progress monitoring Explanation: Telemedicine refers to the use of telecommunications technologies to support the delivery of all types of medical, diagnostic, and treatment-related services, usually by physicians or nurse practitioners. Examples include conducting diagnostic tests, monitoring a client's progress after treatment or therapy, and facilitating access to specialists that are not located in the same place as the client. Telemedicine involves only remote clinical services. Administrative meetings and provider training may be provided by telehealth.

An informatics nurse is evaluating a new clinical information system for usability. The nurse notes that the system requires the user to complete a maximum of 3 steps to complete a task. The system also provides shortcuts to frequent users of the system. The nurse would determine that which concept of usability is being addressed?

Efficient interactions Explanation: Efficient interactions is demonstrated by actions that facilitate efficient user interactions. An example is to minimize the number of steps it takes to complete tasks and to provide shortcuts for use by frequent and/or experienced users. Consistency involves the ability of the users to apply prior experience to a new system so that the lower the learning curve, the more effective their usage, and the fewer their errors. Naturalness refers to how automatically "familiar" and easy to use (intuitive) the application feels to the user.

A group of nurses are participating in being the first group of staff to use a new electronic pain assessment tool. The group is discussing whether or not the system is easy to use. During the discussion, the group mentions that "the shortcuts provided are really helpful and save valuable time." The informatics nurse specialist interprets this statement as reflecting which concept?

Efficient interactions Explanation: The statement reflects efficient interactions. One of the most direct ways to facilitate efficient user interaction is to that minimize the number of steps it takes to complete tasks and to provide shortcuts for use by frequent and/or experienced users. Forgiveness means that a design allows the user to discover it through exploration without fear of disastrous results. Naturalness refers to how automatically "familiar" and easy to use (intuitive) the application feels to the user. Effective use of language involves the use of concise, unambiguous language with terminology that is familiar and meaningful to the end users in the context of their work.

An informatics nurse is participating in an online continuing education course about nursing informatics. The nurse demonstrates successful comprehension of the course by identifying which individual as being considered the first informatics nurse?

Florence Nightingale Explanation: Many have documented that the first informatics nurse was Florence Nightingale, who compiled and processed data to improve sanitation conditions in military hospitals during the Crimean War in the 1850s. Orem, Peplau, and Henderson are nursing theorists.

A nurse is reading a journal article about health information technology and the need for this technology to demonstrate meaningful use. Which information would the nurse anticipate reading about as reflective of meaningful use? Select all that apply.

Improvement in health care quality Greater client engagement Reduction in privacy breaches of client information Explanation: Meaningful use would be reflected by improved quality, safety, efficiency, and reduced health disparities; engagement of clients and family; improved care coordination and population and public health; and maintenance of privacy and security of client health information.

An informatics nurse specialist is working with a group of staff nurses who are testing an electronic documentation system. The nurses using the system find that the different components of the system are working as they should from the time a client is admitted and throughout the client's care. The group is involved with which phase of testing?

Integration Explanation: Integration testing uses test script to validate that a system is working as designed for an entire workflow that integrates multiple components of the system. Unit testing is the testing that occurs initially during design and development, making sure that the right information appears on the screens, in the right place, and with nothing left out. Function testing uses test scripts to validate that a system is working as designed for one particular function. Performance testing ensures that the system is functioning properly when there are high volumes of end-users using the system at the same time.

An informatics nurse specialist is working with a team to design a new clinical information system for the facility. The team is focusing on making sure that the information being presented will be effective. Which aspect would the specialist identify as facilitating this goal? Select all that apply,

Keep the number of times the screen changes to a minimum. Present understandable information that can be scanned quickly. Explanation: For effective information presentation: screen density and the relevant information presented needs to be appropriate rather than trying to pack as much as possible onto a screen; color should be used to convey meaning to the user, rather than using it to make the screen attractive; screen readability also is a key factor in objectives of efficiency and safety because clinical users must be able to scan information quickly with high comprehension; screen changes and visual interruptions should be kept to a minimum during completion of a particular task. Technology-based language should be avoided because it is not meaningful to the end user.

An informatics nurse specialist is interviewing several nurses who have participated in testing a new electronic assessment tool. The nurses report that the tool "feels so familiar, like we know exactly what it is that we're supposed to do." The nurse specialist interprets this as indicating which concept?

Naturalness Explanation: Naturalness refers to how automatically "familiar" and easy to use (intuitive) the application feels to the user. Consistency involves the user's ability to apply prior experience to a new system. The more that users can apply prior experience to a new system, the lower the learning curve, the more effective their usage, and the fewer their errors. Simplicity involves design and refers to everything from lack of visual clutter and concise information display to inclusion of only functions that are needed to effectively accomplish tasks. Forgiveness means that a design allows the user to discover it through exploration without fear of disastrous results.

An informatics nurse specialist is involved in the development of an electronic documentation system to be used by the nursing staff at the facility. The nurse specialist is planning to use standard terminology that focuses on both diagnoses and interventions. Which terminology set would be appropriate for the nurse specialist to consider using? Select all that apply.

Omaha System Perioperative Nursing Data Set International Classification for Nursing Practice Explanation: Approved terminologies/data sets that address diagnoses and interventions include the Omaha System, Perioperative Nursing Data Set, and the International Classification for Nursing Practice. NANDA focuses only on diagnoses. The Nursing Minimum Data Set focuses on clinical data elements. The Logical Observation Identifiers Names and Codes focuses on assessments and outcomes.

An informatics nurse specialist is involved with implementing strategies to improve the performance of the clinical information system being used. As part of this process, the nurse specialist is working on updating the plans of care in the system to reflect changes to a procedure based on new evidence. The nurse is also working to streamline the display screens to reduce the need to document the same information in three different areas. The nurse specialist is addressing which aspect of the system?

Optimization Explanation: Optimization commonly includes strategies to improve processes, maximize effective use, reduce errors, and eliminate workflow inefficiencies. Updating and streamlining reflect such strategies. Usability refers to the ease of use of the system. Standard terminology refers to the use of specific data entry elements that allow the development of reports and data. Interoperability reflects the ability of the system to share data across health care systems.

An informatics nurse specialist is conducting an orientation for the staff of a primary care provider's office about a new web-based tool that they will be implementing. The goal of the tool is to promote patient engagement. The informatics nurse specialist is most likely orienting the staff to which system?

Patient portal Explanation: A primary patient engagement tool is the patient portal, a web-based tool that can be securely accessed and provides several functions to increase engagement. Telehealth is defined as the use of electronic information and telecommunications technologies to support and promote long-distance clinical health care, patient and professional health-related education, public health, and health administration. Telemedicine involves the use of telecommunications technologies to support the delivery of all types of medical, diagnostic, and treatment-related services, usually by physicians or nurse practitioners. Telecare generally refers to technology that allows consumers to stay safe and independent in their own homes.

An informatics nurse specialist is extracting data from the facility's electronic health record in an attempt to identify clients at risk for developing catheter-related bloodstream infections. When gathering this data, the nurse specialist is using which technique?

Predictive analytics Explanation: Predictive analytics encompasses a variety of statistical techniques that analyze current and historical facts to make predictions about future or otherwise unknown events. In health care, we see this used as organizations attempt to identify clients who are at risk for a condition, which in this case, would be catheter-associated bloodstream infections. Data visualization is the presentation of data in a pictorial or graphical format to enable decision makers to see analytics presented visually, so they can grasp difficult concepts or identify new patterns. Big data comprises the accumulation of health care-related data from various sources, combined with new technologies that allow for the transformation of data to information, to knowledge, and ultimately to wisdom. Genomics addresses all genes and their interrelationships in order to identify their combined influence on the growth and development of the organism.

Which strategy could be implemented by the nurse in ensuring the protection of electronic data at health care agencies?

The nurse locks out client information, except to those who have been authorized through appropriate security measures. Explanation: Locking out client information except to those who have been authorized through fingerprints or voice activation is correct. This action enhances confidentiality and protects electronic data in health care agencies. Less frequently changing access numbers and passwords could allow staff who have left the agency to compromise the system. Removing the automatic save and screen saver for data that have been displayed for prolonged periods could allow unscrupulous individuals onto the system. Providing unlimited data access to the multidisciplinary team so personnel from various departments can retrieve the data could allow all staff access to information that does not impact their jobs.

An informatics nurse is participating in an online continuing education course about informatics, health information technology, and the use of standard terminology. The informatics nurse demonstrates understanding of the information presented in the course by identifying which aspect as a characteristic of nursing standard terminologies? Select all that apply.

The terminology identifies concepts related to the delivery of nursing care. The terminology is structurally organized to reflect nursing knowledge. The terminology provides a means to code the delivery of nursing care. The terminology aids in promoting interoperability. Explanation: Nursing terminologies identify, define, and code care delivery concepts in an organized structure to represent nursing knowledge. They do not rate the concepts of care. The use of standard terminologies representing nursing care is a first step in promoting interoperability.

An informatics nurse specialist is conducting an in-service education program for a group of staff nurses. The topic is ensuring electronic client data is secure and private. The specialist determines that the teaching was successful when the group identifies which aspect as essential to ensuring the security of electronic data when using clinical systems?

Use of strong passwords Explanation: Nurses are responsible for minimizing the risk of harm to clients and providers through both system effectiveness and individual performance. Ensuring secure and appropriate access to clinical systems starts with good management of passwords, including the use of strong passwords. Interoperability and intuitive design are not associated components to ensure secure data. Testing is an important component in the system development lifecycle (SDLC).

An informatics nurse specialist is engaged in evaluating a clinical information system. At which time would the nurse specialist anticipate the need to obtain help from a statistician?

When determining the data collection method Explanation: It would be appropriate to secure the help of a statistician when the informatics nurse specialist is determining the data collection method and sample size. Securing help during the literature search would be too early. When preparing how to display the data or just prior to documenting the outcome evaluation would be too late. The nurse specialist would have had to analyze the data with the help of a statistician before displaying it.

An informatics nurse specialist is describing the components of nursing informatics practice to a group of staff nurses considering a career in nursing informatics. The informatics nurse specialist is describing which component as the appropriate use of synthesized information to solve human problems?

Wisdom Explanation: Wisdom is the component that involves the appropriate use of knowledge to manage and solve human problems. Data refers to discrete entities that are described without interpretation; information refers to data that have been interpreted, organized, or structured; knowledge refers to information that is synthesized so that relationships are identified.

A hospital is switching to computerized charting. The nurse recognizes that one advantage to an electronic client chart is:

retrieval of information is more efficient. Explanation: With the advance of computer technology, many institutions are transforming the client record to electronic format. Multiple people may access portions of the record from different sites at the same time.

A nurse asks an informatics nurse, "How can I make sure that the passwords I create are strong enough to prevent a security problem?" Which action would be appropriate for the informatics nurse to suggest to the nurse? Select all that apply. "Make sure that your password is at least eight characters long." "Sharing your password with a coworker is okay but not with anyone else." "Wait at least 2 months before you reuse a password." "Try using a mnemonic that works only for you." "Avoid using multifactor authentication whenever possible."

"Make sure that your password is at least eight characters long." "Try using a mnemonic that works only for you." Explanation: To create strong passwords and promote data security and privacy, you should never share your password; never reuse passwords; use passwords that are easy to remember but hard to guess, such as by using a mnemonic device that works for you but is unlikely to work for someone else; use at least eight characters for your password; and consider using strong authentication or multifactor authentication to prevent unauthorized users from accessing your account via a device not belonging to you.

An informatics nurse specialist is collecting data from the clinical information system about the demographics of individuals diagnosed with heart failure admitted to the facility over the past five years. The nurse specialist is preparing a presentation to the facility's executive board. To promote understanding of this complex information, the nurse specialist prepares the data results using a pie chart and a bar graph. The nurse specialist is using which area of analytics?

Data visualization Explanation: Data visualization is the presentation of data in a pictorial or graphical format. It enables decision makers to see analytics presented visually, so they can grasp difficult concepts or identify new patterns. Predictive analytics encompasses a variety of statistical techniques that analyze current and historical facts to make predictions about future or otherwise unknown events. Big Data comprises the accumulation of health care-related data from various sources, combined with new technologies that allow for the transformation of data to information, to knowledge, and ultimately to wisdom. Data mining refers to the process of sorting through large amounts of data to identify patterns and solve problems.

A nurse working in a primary care provider's office is using the clinical information system to review a client's health information. The nurse is able to review the client's last visit to the primary care provider as well as information from a recent hospitalization, and also a visit that the client made to the cardiologist last week. The nurse's ability to review this information is based on which aspect of the clinical information system?

Interoperability Explanation: Interoperability refers to the ability to share client data across health care systems. The Office of the National Coordinator for Health Information Technology (ONC) defines interoperability as the ability of a system to exchange electronic health information with and use electronic health information from other systems without special effort on the part of the user. Usability refers to the ease of use and intuitiveness of a system. Optimization involves recommendations for improvements to better support and improve care delivery. Security refers to the system's ability to keep information private and confidential.

An informatics nurse specialist is working with a team to evaluate a new clinical information system. The team has collected and analyzed the data and is preparing to present the findings. The informatics nurse specialist suggests that the team present the findings using an infographic. One of the team members asks the nurse specialist, "Why can't we just tell them our results?" The nurse specialist would integrate which information into the response as a reason? Select all that apply.

Promote enhanced understanding of large amounts of complex data Promote understanding of difficult concepts and relationships Help to identify new or emerging trends or patterns Explanation: Data visualization is the presentation of data in a pictorial or graphical format. It enables decision makers to see analytics presented visually, so they can grasp difficult concepts or identify new patterns. Because of the way the human brain processes information, using charts or graphs to visualize large amounts of complex data is easier than poring over textual or numerical spreadsheets or reports (Boicey, 2015). Data visualization is a quick, easy way to convey concepts in a universal manner.

During a recent visit to the clinic, a client tells the nurse, "I've been using my cell phone to track and record the foods that I eat so that I can better understand if I'm making healthy food choices." The nurse interprets the client's statement as reflecting which technology?

mHealth Explanation: The term "mHealth" is used to describe the rapidly evolving use of mobile technologies to track and improve health outcomes. Nurses, physicians, other care providers, and clients are using apps that enable quick and easy access to screens that provide information and can track progress. Telemedicine refers to the use of telecommunications technologies to support the delivery of all types of medical, diagnostic, and treatment-related services, usually by physicians or nurse practitioners. Examples include conducting diagnostic tests, monitoring a client's progress after treatment or therapy, and facilitating access to specialists that are not located in the same place as the client. Telemedicine involves only remote clinical services. Patient portals are a web-based tool that promote client engagement. Pharmacogenomics uses information about a person's genetic makeup, or genome, to choose the drugs and drug doses that are likely to work best for that particular person.

A staff nurse at a facility asks an informatics nurse, "What training or education did you need to become an informatics nurse?" Which response by the informatics nurse would be most appropriate?

"I basically got my training on the job." Explanation: The informatics nurse is a registered nurse with an interest or experience in an informatics field. This may be a nurse who has assisted with the implementation of an EHR and is considered a "superuser," with training being primarily on the job. An informatics nurse specialist is a registered nurse with formal graduate-level education in the field of informatics.

An informatics nurse is discussing the implementation of a new documentation system with a group of staff nurses who are using the system. Which response by the group would indicate to the nurse that the system's usability is effective? Select all that apply.

"We've noticed that this system really helps to save us valuable time." "Using the system is highly intuitive." "This system fits nicely into how we work." Explanation: The National Institute of Standards and Technology defines usability as "the extent to which a product can be used by specified users to achieve specified goals with effectiveness, efficiency, and satisfaction in a specified context of use" (NIST, 2017). Sometimes the way screens are formatted can be confusing, making it a real challenge to perform nursing tasks in a way that makes sense. Making clinical systems easy to use, intuitive, and supportive of nurses' workflow is what usability is all about. A system with effective usability can save time, reduce errors, and improve end-user satisfaction. A system that makes it challenging to complete tasks or screens that contain large amounts of information do not promote usability.

A facility plans to implement a new electronic medication documentation system. An informatics nurse specialist conducts a focus group with staff nurses to gather information. The nurse specialist asks the group about the current system being used, including a step-by-step account of the actions they perform. The nurse specialist also asks the nurses how they see this new system affecting this process and their overall daily tasks. The informatics nurse specialist is demonstrating which ANA informatics competency?

Assessment Explanation: In this situation, the informatics nurse specialist is demonstrating the competency of assessment by collecting information about the nurses' usual workflow to evaluate current practice as well as determine the needs of the system. The nurse also gathers information about the effect that the new system might have on the nurses' typical workflow. The competency of outcomes identification is reflected by the nurse specialist identifying expected outcomes for the plan based on the information gathered from the interviews. The competency of planning is reflected by the nurse specialist developing a customized plan that addresses the clinical needs voiced by the nurses but at the same time, meets the financial needs of the facility. Coordination of activities is reflected by the nurse specialist organizing the different parts of the plan for an integrated, efficient, cost-effective solution.

A nurse is documenting a client's vital signs, height, and weight in the electronic health record. Applying the framework for informatics practice, the nurse would identify these values as which component of the framework?

Data Explanation: Values such as vital signs, height, and weight would be considered data, discrete entities that are described without interpretation. Information refers to data that have been interpreted, organized, or structured; knowledge refers to information that is synthesized so that relationships are identified. Wisdom refers to the appropriate use of knowledge to manage and solve human problems.

An informatics nurse specialist attends a three-day seminar on current trends in health information technology. Experts are presenting sessions involving the current state of informatics, issues associated with this field, and new and innovative methods being developed based on current research. The informatics nurse specialist plans to share this information with the facility's health information technology team to see if they can incorporate it into the facility's current clinical information system. The informatics nurse specialist is demonstrating which ANA informatics competency? Select all that apply.

Education Evidence-based practice and research Explanation: Attending the seminar increases the informatics nurse specialist's knowledge base supporting the competency of education. Taking the research-based information back to the technology team to incorporate into the facility's system reflects the competency of evidence-based practice and research. The competency of ethics is reflected by the nurse specialist's application of the Code of Ethics as well as by using the appropriate methods to establish and maintain confidentiality. The competency of evaluation is reflected by the nurse specialist's ability to conduct a systematic, ongoing, and criterion-based evaluation of the progress toward outcome achievement. The competency of health teaching and health promotion is reflected by the nurse specialist's use of appropriate solutions to teach and educate others to promote health and a safe environment.

An informatics nurse specialist is recommending the addition of an alert system tool to the facility's patient portal. The tool would be designed to send alerts to the client to schedule routine screenings and immunizations. This recommendation most likely reflects which ANA informatics competency?

Health teaching and health promotion Explanation: The alert system tool for screenings and immunizations would reflect the competency of health teaching and health promotion because it would signal the clients about important health promotion activities. The competency of consultation would involve the informatics nurse specialist providing consultation to influence the identified plan, enhance the abilities of others, and effect change. . The competency of quality of practice is reflected by the nurse specialist's contributions to the quality and effectiveness of nursing and informatics practice, as evidenced by quality documentation and data analysis to improve practice and outcomes. The competency of leadership is reflected by the nurse specialist promoting the organization's goals and vision and mentoring colleagues.

An informatics nurse specialist is gathering data from electronic health records at the facility about clients who have had central venous catheters inserted for more than the recommended time as specified by the facility's protocol. The nurse specialist is collecting this data most likely for which purpose?

Identify clients at risk for infection Explanation: Predictive analytics encompasses a variety of statistical techniques that analyze current and historical facts to make predictions about future or otherwise unknown events. In health care, organizations often use this information to identify clients who may be at risk for problems. This area of health care analytics is not involved with determining client satisfaction, evaluating client care, or correlating the client's diagnosis with interventions.

A facility is considering the addition of an alert system to the current electronic documentation system. The goal is to identify clients at risk for post-operative complications based on client data. A team consisting of an informatics nurse specialist, information technology experts, and nurses work on this. The team is currently in the "analyze and plan" phase of the system development lifecycle. Which activity would the team be involved with at this time? Select all that apply.

Identifying the specific purpose for this system Collecting data to determine the seriousness of postoperative complications Evaluating how the system might affect the current electronic documentation system Assessing how the system can be incorporated into the nurses' current workflow patterns Explanation: Before considering the employment of any type of new technology or an update to a system already in place, analysis and planning must take place. Activities that may be involved include: determining the purpose of the new technology or change to the current technology; identifying the problem to be solved; evaluating the data available to support how serious the problem is; evaluating how the system's use will be incorporated into the current workflow of the nurse; and how it will affect the overall usability and experience with the EHR.

An informatics nurse specialist has been involved in obtaining feedback about a clinical information system recently implemented in the facility. The information gathered provided recommendations for improving the satisfaction of the end users when using the system. Which aspect is the informatics nurse specialist addressing?

Optimization Explanation: System optimization includes strategies to improve processes, maximize effective use, reduce errors, reduce costs, eliminate workflow inefficiencies, improve clinical decision support, and improve end-user skills and satisfaction with the system. The need for improvements to better support and improve care delivery will usually become evident after a system is in use. Usability refers to a systems ease of use, intuitiveness, and degree of support for workflow patterns. Interoperability refers to the ability to share client data across health care systems. Meaningful use refers to the use of the certified electronic health record (EHR) technology to improve quality, safety, efficiency, and reduce health disparities; engage clients and family; improve care coordination and population and public health; maintain privacy and security of client health information.

An informatics nurse specialist is preparing a presentation for a local community group about advances in technology in health care. Part of the presentation will focus on technological advances to promote greater client participation in managing health. Which component would the nurse likely describe as playing a major role?

Patient portal Explanation: Although the electronic health record and clinical information systems are important technological advances in health care, engaging clients in their care and working together to improve health with supportive technology is an area that continues to advance. A primary client engagement tool is the patient portal. This web-based tool can be securely accessed and provides several functions to increase engagement. Predictive analytics encompasses a variety of statistical techniques that analyze current and historical facts to make predictions about future or otherwise unknown events. It does not involve client engagement.

The nurse is caring for a client in the intensive care unit who must be administered multiple medications. The client is often unresponsive and cannot offer information during assessment. When administering the medication, which step by the nurse is most important to avoid confusion and ensure safety?

Scan the client's wristband prior to administering medication to verify it is the correct client and correct medication. Explanation: In all situations, the nurse is responsible for ensuring client safety and that includes administering the correct medication to the correct client. The scanning system included with the electronic medication administration record (eMAR) is the appropriate method to verify the medication is being administered to the correct client at the correct time. Scanning the wristband is the most important step to ensure safety and accuracy. Verifying through checking the wristband visually is an older method and is not typically seen in practice currently. Verifying through family members is not an appropriate manner in which to verify information, and comparing the wristband to the eMAR and electronic health record (EHR) is not the most important method of ensuring safety.

An informatics nurse is assisting with the design of an clinical information system for use by the staff of a health center. The nurse is working to ensure that the system reflects usability by making sure that the screen display is visually clean and uncluttered and that it provides only the information needed for decision making. Which concept of usability is the nurse incorporating?

simplicity Explanation: Simplicity in design refers to everything from lack of visual clutter and concise information display to inclusion of only functionality that is needed to effectively accomplish tasks. A "less is more" philosophy is appropriate, with emphasis being given to information needed for decision making. Naturalness refers to how automatically "familiar" and easy to use (intuitive) the application feels to the user. Consistency involves a pattern. For example, the more users can apply prior experience to a new system, the lower the learning curve, the more effective their usage, and the fewer their errors. Forgiveness means that a design allows the user to discover it through exploration without fear of disastrous results. This approach accelerates learning while building in protections against unintended consequences.