Chapter 20 - Nursing Informatics

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

analytics

discovery and interpretation of meaningful patterns in data

meaningful use

the use of certified electronic health record technology to achieve health and efficiency goals, with a financial incentive from Medicare and Medicaid

Predictive Analytics

-variety of techniques -current and historical facts to make predictions about future -actuarial science, marketing, financial services, insurance, telecommunications, retail, travel, healthcare, pharmaceuticals

patient portal

A secure online Web site that gives patients 24-hour availability to health care providers.

Uses of Patient Portals #1

Access medical history and other health information Complete various forms and questionnaires online Communicate securely and conveniently with providers Request prescription refills Pay bills Review lab results Schedule appointments Receive reminders for appropriate screenings

An informatics nurse specialist is meeting with a primary care provider's staff members. The office has agreed to implement a patient portal. When describing this tool, the nurse specialist would identify which aspects as being possible for clients? Select all that apply.

Access their medical history Schedule office appointments Communicate with the health care provider

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

Components of System Development Lifecycle (SDLC)

Analyze and plan Design and build Test Train Implement Maintain Evaluate

An informatics nurse specialist is using data visualization to present information about client populations admitted to the health care facility. Which type of format would the nurse most likely use? Select all that apply.

Bar graphs Infographics Pie charts

Types of Health Care Analytics

Clinical Administrative Financial

An informatics nurse specialist working at an ambulatory care center is interviewing clients about their experiences in using the center's patient portal. A majority of the clients have voiced dissatisfaction, stating that they "find the display screen confusing and are not sure what to click on to get the necessary information." They also talk about difficulties in trying to find their test results. Based on this information, the nurse specialist identifies a need to talk with the information technology team about ways to make the portal easier for clients to use. The informatics nurse specialist is demonstrating which ANA informatics competency?

Collaboration

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

Informatics Scop and Standards Definitions: DIKW

Data: Discrete entities that are described without interpretation Information: Data that have been interpreted, organized, or structured Knowledge: Information that is synthesized so that relationships are identified Wisdom: Appropriate use of knowledge to manage and solve human problems

Improve quality, safety, efficiency, and reduce health disparities Engage patients and family Improve care coordination and population and public health Maintain privacy and security of patient health information

EHR

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

Uses of Patient Portals #2

Enter clinical data, such as blood pressure, glucose levels, weight, Fitbit data, and other activity tracking data Review progress notes Access educational materials based on diagnosis or procedure

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 NIghtengale

Who was the first informatics nurse?

Florence NIghtengale

Meaningful Use of Electronic Health Record

Improve quality, safety, efficiency, and reduce health disparities Engage patients and family Improve care coordination and population and public health Maintain privacy and security of patient health information

A nurse working in a primary care provider's office is using the clnical 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

An informatics nurse specialist is conducting a presentation to a group of health care providers about informatics and genomic health care. When describing the difference between genetics and genomics, which information about genomics would the nurse most likely include? Select all that apply.

Interrelationship among genes Potential influence on growth and development Use as part of a person's clinical care

An informatics nurse is planning a training program for the staff of a facility. A new module for outcome identification and evaluation will be added to the current clinical information system. Which type of training would be most appropriate for the staff? Select all that apply.

Online training Web-based training

Emerging areas in the field of informatics

Patient Portals Health Care Analytics Telehealth and Mobile Technology Genetics andGenomics: Precision Medicine

Important Informatics Concepts

System usability System optimization Standard terminologies Interoperability Security and privacy

A healthcare provider in a different state is reviewing the x-rays and scans of a patient who lives in another state. The patient's primary care provider has asked the other healthcare provider for their interpretation of the tests and to obtain the provider's opinion about the diagnosis. Which technology is being used?

Telehealth

Telehealth and Mobile Technologies

Telehealth: 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: 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: refers to technology that allows consumers to stay safe and independent in their own homes.

A client comes to the health care provider's office for a follow up. The client was recently hospitalized for heart failure. The nurse reviews the client's discharge plan, which included the client being supplied with telecommunications technology for monitoring daily weights and blood pressure. Then each day, after completing those tasks, the client would receive a phone call from the nurse practitioner about the results and adjust the client's medication schedule. The nurse identifies this specifically as reflecting which type of care?

Telemedicine

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

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

Questions to Ask in the Design Phase of SDLC

What should the screen display look like? How should it be laid out to be consistent with other screen layouts? Can the design support or improve the nurse's workflow as mapped out during the analysis and planning phase? Is there evidence supporting the effectiveness of the new technology and, if so, does it provide recommendations for the design? Can we use standard nursing terminology in the electronic system to better capture nursing's contribution to care delivery and patient outcomes?

Questions to be Answered in Analyze and Plan Phase of SDLC #2

Will it improve the overall usability and experience with the EHR? What technological options are available if there are more than one?

Electronic Health Record (EHR)

a digital version of a patient's paper medical chart. It provides real-time information instantly and securely to authorized users

Interoperablity

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

System Development Life Cycle (SDLC)

analysis, design, test, train, implementation, maintenance and evaluation

Clinical Information Systems

computer systems designed for use in healthcare delivery

An informatics nurse is demonstrating how to use an updated version of an electronic documentation system to a group of staff nurses. The nurse shows the staff that they can follow the same steps that they used with the previous system but need to add one additional final step to the process. The informatics nurse's actions reflect which concept of usabilty?

consistency

An informatics nurse specialist is describing the role of informatics in health care to a group of staff at a facility. The nurse specialist determines that the teaching was successful when the group identifies which as a core practice area?

electronic health record

usability

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

An informatics nurse specialist is working as part of a team to develop and implement a new electronic documentation and reporting system at the clinic. The team has analyzed the situation, created a plan based on supporting evidence, created a design, built the program, and has worked out issues with the system. Staff who will be using the system have received education about the system and how it works, as well as how to use it. The team would proceed to which phase of the system development lifecycle next?

implement

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

Nurse informaticist

nurse with specialized education focused on the use of technology in healthcare and the incorporation of standardized languages & classifications into nursing practice.

An informatics nurse specialist is conducting an in-service program for a group of informatics nurses. The nurse specialist is reviewing the components of the system development lifecycle and determines that the education was successful when the group identifies the phases of the lifecycle as similar to the:

nursing process

Nursing informatics

specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, and knowledge in nursing practice

Health Information Technology

standard and agreed upon terms used in an electronic health record to improve data trending and sharing; ANA approved nursing terminologies include those listed in Table 20-5

optimization

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

Genomics

study of whole genomes, including genes and their functions

Telecare

technologies that provide for patient safety and independence at home, such as health and fitness apps, sensors and tools that connect the patient with caregivers, digital medication reminder systems, and early warning and detection technologies

A nurse is assessing a client who comes to the clinic for an evaluation. During the assessment, the client tells the nurse, "I have this thing on my phone that reminds me to take my medicines when I'm supposed to." The nurse identifies this as reflecting which concept?

telecare

Interoperability

the capability of two or more computer systems to share data and resources, even though they are made by different manufacturers

Data Visualization

the presentation of data in a pictorial or graphical format

genitics

the study of heredity and the variation of inherited characteristics.

telehealth

the use of electronic information and telecommunications technologies to support long-distance clinical healthcare, health-related education, public health, and health administration

What are the core concepts in the implementation of maintenance of clinical information systems

usability optimization standard terminologies interoperability security and privacy

Pharmacogenomics

use of information about a person's genetic makeup, or genome, to choose the drugs and drug doses that are likely to work best for that person

Standard Terminology

use standard terms & abbreviations; - if office has its own abbreviation everyone in the office MUST know it

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."

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."

ANA definition of nursing informatics

"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."

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."

An informatics nurse specialist is talking with a group of health care providers at a local clinic about implementing a patient portal system. During the presentation, one of the providers asks the nurse specialist, "I understand what this portal is, but how will it help our clients?" Which response by the nurse would be appropriate? Select all that apply.

"Your clients will be able to actively participate in their care." "Your clients will be more motivated to get preventive care." "Your clients will be more likely to seek out care if needed." "Your clients will be able to manage their chronic problems better."

genomics

(1) study of the structure and interactions of all genes in the human body, including their interactions with each other as well as the environment; (2) emerging discipline in which genomic information about a person is used in their clinical care (e.g., for diagnostic or therapeutic decision making)

Examples of Technology Evaluation Steps

1.Determine what will be evaluated 2.Determine the question 3.Conduct a literature search 4.Determine the needed data 5.Determine the study type 6.Determine the data collection method and sample size 7.Collect, analyze, and display data 8.Document your outcome evaluation

Benefits of Patient Portals

Better health outcomes Chronic condition management Timely access to care Patient retentionPatient-centered medical home recognition

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

An informatics nurse is teaching a clinic staff about a newly implemented patient portal being used. The informatics nurse determines that the teaching was effective when the staff identify which aspect as being the focus of this technology?

Greater client engagement

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

Tasks Occurring During the Maintenance Phase for an EHR #1

Ongoing updates to hospital and ambulatory orders preference lists Ongoing updates to hospital and ambulatory medication preference lists Ongoing updates to provider patient lists Ongoing updates to scheduling blocks (ambulatory, radiology, and procedure areas) Monthly first data bank loads (new medications, medication pricing, and clinical alerts) Error work queue maintenance (example billing errors, sure script errors, many types of interface errors)

Emerging Areas in the Field of Informatics

Patient portals Health care analytics Data visualization Predictive analytics Big data

An informatics nurse specialist is preparing a presentation about patient portals for a group of primary care providers in an office practice. When describing the tasks that can be accomplished by clients using the portal, which activity would the informatics nurse specialist include? Select all that apply.

Paying their bill Checking their lab test results Scheduling appointments Receiving screening reminders

A nurse is reviewing the medical record of a client at the clinic. The nurse notes that the medication and dosage prescribed for the client was based on information gathered about the client's genetic makeup from the electronic health record. The nurse interprets this as:

Pharmacogenomics

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

Tasks Occurring During the Maintenance Phase for an EHR #2

Pricing updates Quality measures updates Clinical decision support tools/rules Monthly updates from EHR vendor

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

An informatics nurse specialist is conducting a seminar on the emergence of telehealth and its importance in health care delivery. The nurse specialist determines that additional discussion is needed when the group identifies which aspect as an advantage of this technology?

Promote the development of new health care services

An informatics nurse is reading a journal article about standard terminologies. The nurse demonstrates a need to reread the article when identifying which example as reflecting a standard terminology?

PubMed

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 viusually clean and uncluttered and that it provides only the information needed for decision making. Which concept of usability is the nurse incoroporating?

Simplicity

An informatics nurse specialist is evaluating a newly implemented electronic medication alert system for usability. Which area would the nurse evaluate? Select all that apply.

Simplicity Naturalness Consistency

An informatics nurse specialist is participating in a career day at a local job fair. When describing the primary responsibilties to a group of attendees, which responsiblities would the nurse specialist include? Select all that apply.

Strategy development Multidisciplinary collaboration Implementation of a clinical system System evaluation

An informatics nurse specialist is working with a team designing an update to a clinical information system being used by the nursing staff. When selecting the language to be used with the system, which characteristic would be most appropriate to address? Select all that apply.

Terminology is clear and concise for the nurses Terminology is familiar to the user Terminology reflects the users work context

big data

The accumulation and analysis of massive quantities of information

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

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

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 transactions

A client comes to see the cardiologist for a routine follow-up visit. At the visit, the nurse reviews the client's electronic health record. The nurse is able to access a report from the client's last visit to the primary care provider last month and the report from an emergency department visit two weeks ago for reports of shortness of breath. The record also lists two changes in the client's medication based on the emergency department visit. The nurse's ability to access this information reflects which concept?

interoperability

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

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

An informatics nurse is teaching a client recently diagnosed with heart failure how to use a web-based tool to learn more about this condition. The tool is provided by the client's primary care provider. The informatics nurse is teaching the client about:

patient portal

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

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

informatics

use information and technology to communicate, manage knowledge, mitigate error, and support decision making

Examples of Informatics Use in Today's Nursing Profession

Electronic health record Telehealth Mobile devices Patient portals Data analytics Technologies for educating nurses in academic settings Technologies for conducting research

An informatics nurse specialist is involved in evaluating a new electronic documentation system being used by the facility. The nurse specialist has collected the necessary data, analyzed it, and is now preparing to display the data using a bar graph to present the information. When displaying the data, which information would be important for the nurse specialist to include? Select all that apply.

Legends for colors Date range Sample size Title of the graph

An informatics nurse specialist is working with a group of nurses who are tasked to test a new electronic health record system. Which phase would the group be involved with as the last phase of testing?

User acceptance

An informatics nurse specialist is looking to evaluate the optimization of a clinical information system being used in the facility. On which area would the nurse focus? Select all that apply.

Ways to reduce errors Measures to eliminate inefficiencies in workflow Ways to improve clinical decision support Plans to improve basic processes

A nurse is conducting a client assessment and documenting the findings in the client's electronic health record (EHR). Which description would the nurse most likely enter as data in the system to document the client's activity level?

walks without assistance

An informatics nurse specialist teaches a group of staff nurses how to document client care in the new electronic health record. To document assessment findings, the nurses are to select the correct information from a drop-down list. During the teaching session, one of the nurses asks, "Why do we have to use this list. Why can't we just type in what we want to say?" Which response by the informatics nurse specialist would reflect the most important reason for documenting in this way?

"Documenting this way allows nurses' actions to be measured."

An informatics nurse specialist is working with the technology team to address errors in the clinical information system that was recently put into action at the facility. They are also addressing ongoing updates to the provider client lists. The nurse specialist and team are involved with which phase of the system development lifecyle?

maintain

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

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

Results of Meaningful Use Compliance (EHR)

Better clinical outcomes Improved population health outcomesIncreased transparency and efficiency Empowered individuals More robust research data on health systems

An informatics nurse specialist is preparing a presentation on nursing informatics for a group staff nurses. The group will be participating in the implementation of a new electronic system to support improved client care delivery. When describing the concepts that are key to nursing informatics, which concept would the informatics nurse specialist include? Select all that apply.

Data Information Knowledge Wisdom

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

An informatics nurse is part of a team working on developing a clinical information system for a facility. The team is working on ensuring that the system supports usability. During which phase of the system development lifecycle would the team integrate the principles of usability as a priority?

Design

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

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

An informatics nurse specialist is part of a team that will be implementing a new clinical information system at the facility. The nurse specialist advocates to include staff nurses who will be using the system to be involved in the process. The nurse specialist advocates for this based on which reason?

Improve the chances that the system will meet the intended need

Types of Nurse Informaticists

The Informatics Nurse A registered nurse with an interest or experience in an informatics field. oSuperuser oThe Informatics nurse specialist A registered nurse with formal graduate-level education in the field of informatics. oOften responsible for strategy development, implementation, and maintenance and evaluation of clinical systems requiring collaboration with multiple disciplines

An informatics nurse specialist is involved in the testing of a new clinical information system that is being planned for use by the health network. The system is currently undergoing unit testing. Which information would be addressed during this phase? Select all that apply.

The correct information appears on the screen. All information is included. There are no typographical errors. Information is in its proper location on screen.

An informatics nurse specialist is partnering with the health care team to implement a planned update to the clinical information system. The nurse specialist demonstrates the competency of implementation based on achievement of which outcome? Select all that apply.

The update was implemented on the day it was to happen. The update was implemented within the budget developed for it. The update was implemented using the specified requirements of the plan.

Questions to be Answered in Analyze and Plan Phase of SDLC #1

What is the purpose of this new technology or change to the current technology? What problem do we hope to solve?What data do we have to indicate the current state of the issue (how bad is the problem)? How will its use be incorporated into the current workflow of the nurse? Will it streamline nursing documentation, or will it increase the burden of documentation?

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

An informatics nurse specialist is participating in evaluating the a new clinical information system being used at a provider's office. The nurse specialist has determined what is being evaluated and the question being asked and has completed the literature search. Which action would the nurse specialist do next?

Determine the data elements to be collected

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

A staff nurse interested in nursing informatics is attending a seminar on the topic. As part the seminar, the concept of standard terminologies is being discussed. The nurse demonstrates a need for further discussion when she identifies which information as a reason for its use?

Directly measure client outcomes

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

Genetics and Genomics: Precision Medicine

The field of genomics has the potential to significantly change the way health care is delivered. Genomics play a role in 9 of the 10 leading causes of death, including heart disease, cancer, stroke, diabetes, and Alzheimer's disease (WHO, 2004). Because genomic health care is heavily dependent on data storage and interpretation, no other area is better suited than informatics to support this evolving work.