C468 Unit 1: information management
-data gatherer (collects clinical data) -information user (interprets clinical data, and determines NUR interventions and decision making). -knowledge user (compares data to current knowledge) -knowledge builder (amasses data to show patterns that can be interpreted using existing knowledge or used to create new knowledge) **NUR research role!
Describe the role of nurses as knowledge workers.
-electronic health record system (EHRS) refers to the database management soft-ware enabling the functions needed to create and maintain an EHR. -The electronic medical record (EMR) preceded the EHR bringing together information within a specific setting initially for a single encounter or visit. -The personal health record (PHR) is a collection of patient data controlled by the patient that may be accessible to providers. PHR allows users to electronically collect, track, and share past and current information about their health or someone in their care
EHR vs EMR vs PHR
1. Systematized Nomenclature of Medicine (SNOMED) 2. Current Procedural Terminologies (CPT) 3. Nursing Interven-tions Classification (NIC)
Examples of standardized nomenclatures
American Recovery & Reinvestment Act (ARRA): **Established the Health Information Technology for Economic Clinical Health Act (HITECH Act)** -Provided economic stimuli and incentives for the adoption of EHRs -Gave $19.2 billion for health information technology (HIT) allocated to help hospitals and physicians' offices for implementation of electronic medical records (EMR) -Amended both Medicare and Medicaid to create financial incentives for Health information technology (HIT) adoption by certain health-care providers -provide incentive payments under Medicare and Medicaid to "Meaningful Users" of Electronic Health Records
How did American Recovery & Reinvestment Act (ARRA) affect the development of Information Technology
-Established by American Recovery & Reinvestment Act (ARRA) -Encouraged healthcare providers to adopt electronic health records and improved privacy and security protections for healthcare data. -Achieved through financial incentives for adopting EHRs and increased penalties for violations of the HIPAA Privacy and Security Rules. -HITECH also ensured the collection of aggregate data that could be used to improve policy decisions relative to allocation of services and population health. REQUIREMENTS: -Gov certified EHR -Demonstrate "meaningful use"
How did Health Information Technology for Economic and Clinical Health Act (HITECH) affect the development of Information Technology
TIGER Initiative: **OBJECTIVE was to develop a US nursing workforce capable of using electronic health records to improve the delivery of health care -Enables nurses and interprofessional colleagues to use informatics and emerging technologies -Purpose is to make healthcare safer, more effective, efficient, patient-centered, timely, and equitable by interweaving evidence and technology seamlessly into practice, education, and research. -Initiative aims to enable practicing nurses and nursing students to fully engage in the unfolding digital electronic era in healthcare. -Basic computer competencies- HW, SW, Security, Internet, email -Information literacy - set of abilities allowing individuals to recognize when info is needed and to locate, evaluate and use the info -Information management - consists of collecting data, processing the data and presenting and communicating the processed data as info or knowledge. DIKW
How did Technology Informatics Guiding Education Reform (TIGER) Initiative affect the development of information technology
-Computerized charting -Documentation prompts -Device integration -Decision support systems
How does information technology (IT) support nurses?
Level 4: Informatics innovator: -Educationally prepared to conduct informatics research and generate informatics theory -advanced understanding and skills in information management and computer technology. -developings innovative and analytic techniques for scientific inquiry in nursing informatics, practice of applying advanced analysis and design concepts to the system life cycle process, and fiscal management to obtain research funding ***Educationally prepared to conduct info research and generate info theory and have advanced understanding and skill in info mgmt. and computer technology.
Informatics competencies for: Informatics innovator.
Level 3: Informatics specialist: -Has advanced skills specific to health-information management and computer technology -Focuses on information needs for the practice of nursing, which includes education, administration, research, and clinical practice. -Uses critical thinking, process skills, data-management skills such as identifying, acquiring, preserving, retrieving, aggregating, analyzing, and transmitting data -Has expertise in the systems development life cycle and computer skills. -Constructs data structures and maintains data sets -Designs and develops training plans, screen layouts, report formats, and custom views of clinical data *evaluates performance and impact of info management technologies on clinical practice, education, administration, and research
Informatics competencies for: Informatics specialist
Level 1: beginner nurse: -Has basic computer skills -Uses information systems to manage pts -Accesses data and charts electronically -Support pt safety initiatives using information technology -Recognizes role of informatics in nursing
Informatics competencies for: beginner nurse
Level 2: Experienced nurse: -Pulls trends out of data -supports specialty area, including QI and other activities via information technology (IT) -Use of EBP databases -Promotes technology applications -Use information systems & work with IT staff to enact syst improvements
Informatics competencies for: experienced nurse,
three stages: Stage 1: Data capturing and sharing of clinical info Stage 2: advanced clinical processes. Calls for patients to view, download, or transmit their health information online, and for the capability for secure messaging between providers and patients, and reporting public health measures. Requirements for percentages of participation were later modified. Stage 3: focused on the advanced use of EHRS to promote health-information exchange and improved outcomes for patients
What are the 3 stages of "Meaningful use" in order to participate in the EHR incentive programs?
REQUIREMENT to obtain financial benefits from Health Information Technology for Economic and Clinical Health Act (HITECH) -Meaningful use requires that use of an EHRS is being used PROPERLY, resulting in improved quality, safety and efficiency and reducing inconsistencies in healthcare -increases patients' and families' active involvement in their care -increases the coordination of healthcare; advances the health of the public; and safeguards the privacy and security of personal health data and information
What is "meaningful use"
Basic functions EHRSs must demonstrate include: -basic entry of clinical information such as demographic data, vital signs, medications, and allergies -use of several software applications to improve the safety, quality, and efficiency of care through clinical decision support -entry of clinical orders with safety measures within the software. -In addition to these core requirements, MU included a menu of 10 other EHR tasks from which providers could choose to implement 5 in 2011 to 2012. These tasks included abilities to perform drug formulary checks, incorporate clinical laboratory results into EHRSs, provide reminders to patients for needed care, identify and provide patient-specific health education resources, and employ EHRSs to support the patients' transitions between care settings or personnel
What is CMS basic criteria for EHRs
Computerized provider (or practitioner) order entry (CPOE) -facilitates selection of scripted orders; includes precise start-and-stop times, timing of orders, and much more detail. -The CPOE applications support the prescribers' decisions to enter orders and immediately share the orders with appropriate health professionals who execute the orders and the departments that need to dispense, schedule, or immediately deliver services to patients. -This application allows integration of nursing orders with physician orders; if so, all orders can be viewed together. -The application may include team-designed evidence-based order sets or care sets and may connect orders to links that provide descriptions, context, and current evidence to support decisions for ordering a test, medicine, or intervention.
What is Computerized provider (or practitioner) order entry (CPOE)?
Information science= primarily focused on input, processing, output, and feedback thru technology integration -Applies technology to make information usable -Supports collection and management of information
What is Information science?
information system= combination of computer hardware and software that can process data into information to solve a problem. The terms healthcare information system and hospital information system (HIS) both refer to an information system used in a healthcare enterprise. -A HIS typically comprises two major types of information systems: clinical information systems and administrative information systems.
What is an information system?
Clinical decision support systems (CDSSs): applications that support healthcare practitioners in making patientcare decisions. -Combines one patient's specific data with up-to-date clinical knowledge to generate recommendations or guide-lines for that particular patient -The clinical knowledge is applied through using modeling, data-processing techniques specific to medical data, and methods of artificial intelligence. -Results of CDSS action include clinical guidelines and reminders; drug-dosing support; and alerts for drug allergy, drug-drug interaction, and drug-laboratory interaction
What is clinical data support systems (CDSS)
information processing= the acquisition, recording, organization, retrieval, display, and dissemination of information
What is information processing?
nursing informatics= science and practice that integrates nursing, its information and knowledge, with information and communication technologies to promote the health of people, families, and communities worldwide. Nursing informatics is the specialty that integrates nursing science, computer science, and information science in identifying, collecting, processing, and managing data and information to support nursing practice, administration, education, research, and the expansion of nursing knowledge
What is nursing informatics?
Results-reporting is an application that facilitates the sharing of laboratory values and results from other diagnostic tests within the electronic health records for clinicians to view. -The values can be displayed in different formats along with associated reference ranges to help in the interpretation of values.
What is results reporting?
Federal entity charged with coordinating national efforts to implement and use health information technology (HIT) and electronic exchange of health information **ONCHIT provides EHR certification
What is the US Office of the National Coordinator for Health Information Technology (ONCHIT) responsible for?
American Association of Colleges of Nursing (AACN): -US-based organization that establishes quality standards for nursing education -Assists schools of nursing in implementing those standards -Provides accreditation for baccalaureate and graduate nursing education. ***AACN's accreditation process evaluates the curricula of each particular educational organization and ensures that an essential set of professional competencies are addressed
What is the role of the American Association of Colleges of Nursing (AACN)?
Benefits associated with EHRSs include: -improved data access, integrity, productivity, and quality of care -greater satisfaction, improved eligibility for reimbursement -decision support and alerts -improved workflow -enhanced compliance, safety, and improved tracking and benchmarking for individual and population health. -Accurate documentation -ID trends early; improve pt survival -Better care coordination & interdisciplinary collaboration -Purposeful interaction -Decreased costs -Enhance safety with warnings **Paramount in the healthcare environment today for data collection, collaboration, and communication
advantages of using an EHRS as it relates to pt care
Clinical information systems (CISs) focus on management of clinical (patient) data and information as compared to administrative information systems.
clinical information systems (CIS) vs administrative information systems (AIS).
administrative information syst= focus on business functions of organization -support client care by managing financial and demographic information and providing reporting capabilities. -This category includes client management, financial, coding, payroll, human resources, and quality assurance applications.
define administrative information systems (AIS).
clinical information systems= focus on management of clinical (patient) data -large, computerized database management systems that support several types of healthcare activities Ex: including provider/ practitioner order entry, results retrieval, documentation, and decision support across locations -They enable practitioners and patients to be involved in acquiring, reviewing, and using data at various points of care. -Include many applications that integrate and use the information obtained from other applications and healthcare devices. -The clinical information systems provide infrastructure to bring these applications together so healthcare professionals may have functional use of the data, information, and knowledge that is stored and/or collected for an electronic health record.
define clinical information systems (CIS)
-Computer literacy is a term used to refer to the basic understanding and use of computers, software tools, spreadsheets, databases, presentation graphics, social media, and communication via email. *The fundamentals of basic literacy—the ability to read, write, and comprehend—are prerequisite.
define computer literacy
data= characters, numbers, or facts gathered for analysis; raw material
define data
the science of how to use data, information and knowledge to improve human health and the delivery of health care services. Its the processing data of data for storage and retrieval; information science. **Combo of nursing science, computer science, and information science**
define informatics
information= interpreted data
define information
Information literacy= the ability to read and understand the written word and numbers, as well as the ability to recognize when information is needed. **One of the biggest challenges today is making health information accessible to all without regard to background, education, or level of literacy. (most teaching pamphlets are created to be understable by a 5th grader)
define information literacy
Uses computers to transmit data Ex: EHR and barcode medication administration
define information technology
knowledge= synthesis of information from several sources to produce a single concept
define knowledge
wisdom: the use of previous knowledge and experience applied appropriately to take action or intervene in some fashion
define wisdom
-Reliance on technology -More time documenting vs with patient -Alarm fatigue Challenges: -Integration of behavioral health and primary care workflows -Information exchange -Limited resources -Work-arounds (variations in procedures and processes created to accomplish work when systems or workflows are deficient or inefficient which can, and frequently do, defeat positive features such as safety)
disadvantages of using an EHRS as it relates to pt care...challenges?
information systems= Used to collect, create, and distribute meaningful data -The development, use, and management of an organization's information technology (IT) infrastructure
what are information systems