Chapter 21: Informatics and Health Care Technologies

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 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." "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 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 is applying the informatics framework to a clinical situation. Which component of the framework would the nurse apply first?

Data Explanation: When applying the informatics framework, the nurse would first take individual data elements and combine them to provide meaningful information that leads to knowledge and enhanced client care delivery. From there the nurse would use the knowledge appropriately to achieve wisdom.

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.

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 health care provider 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 specialist has received an update from the vendor who is providing the electronic health record. During which phase of the system development lifecycle would this update be made?

Maintain Explanation: Tasks such as updates from a vendor for the electronic health record would be made during the maintenance phase of the system development lifecycle. During the test phase, all components of the system are tested to make sure that they are working as designed and will support the workflow. The implementation phase involves the activation of the system. The evaluation phase determines if the system is doing what it is designed to do and how effective it is in achieving this goal.

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 Explanation: 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. Genetics scrutinizes the functioning and composition of the single gene. Genomics addresses all genes and their interrelationships in order to identify their combined influence on the growth and development of the organism. Telehealth refers to the use of electronic information and telecommunications technologies to support and promote long-distance clinical health care, client and professional health-related education, public health, and health administration. Technologies include videoconferencing, long distance imaging review, streaming media, and terrestrial and wireless communications and can involve more than just clinical services; it can also include remote nonclinical services such as provider training, administrative meetings, and continuing medical education.

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 a presentation for a group of staff nurses about a planned implementation of a new electronic documentation system. As part of the presentation, the nurse specialist will address the use of standard terminologies with the system. Which information would the nurse specialist identify as a key reason for using these terminologies? Select all that apply.

Allows for nursing activities to be measured Permits nursing care to be represented in the delivery of care Provides information about nursing's effects on client outcomes Provides data to plan assignments based on client's status Explanation: Using standard terminology ensures that information that represents client assessment, interventions, and resultant outcomes is consistent, so that the care delivered by nurses can be quantified and nursing's contributions represented. It also allows the development of reports and data that can help to make assignments based on client care needs, and permits the measurement and retrieval of the value and contributions that nursing makes to client outcomes. In addition, nursing terminologies identify, define, and code care delivery concepts in an organized structure so that nursing knowledge is represented.

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 usability?

Consistency Explanation: Consistency involves a user's prior experience. 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. The fact that the staff can follow the same steps as before and add only one additional step indicates that the system is consistent. 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. Minimizing cognitive load involves presenting all the information needed for the task at hand so that it is organized by meaningful relationships for the user.

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.

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 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 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.

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.

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 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.

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, health care providers, 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 health care providers 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.

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.

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 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 Explanation: Depending on the vendor, patient portals can enable the client to access their medical history and other health information; communicate securely and conveniently with providers; and schedule appointments. Having a diagnostic test or contacting a specialist usually are not components of patient portals.

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 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 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?

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 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.

An informatics nurse specialist is working as part of the team working on adding a new pain rating assessment tool to an already established electronic health record. The team is discussing which type of training would be best. After reviewing the various options available, the informatics nurse specialist determines that additional discussion is needed when the team identifies which type of training as being appropriate? Select all that apply.

Formal classroom sessions Tip sheet Just-in-time training 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 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 Explanation: Although improved client outcomes, health promotion and client monitoring may result from the use of patient portals, the primary goal of patient portals is to improve client engagement in their care.

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.

An informatics team is evaluating the implementation of a new system for admission assessments. The team has determined what to evaluate, developed the question for necessary data collection, and conducted a literature review. Place the steps listed below in the order that the team would follow to complete the evaluation.

Identify the specific data elements to be collected. Determine the design of the study. Clarify how the data will be collected. Display data that was collected and analyzed. Document the outcome evaluation. Explanation: Once the team determines what will be evaluated, developed the question for the data needed, and conducted the literature review, the next step would be to identify the specific data elements to be collected. Then the team would determine the study type and data collection methods, and then collect, analyze, and display the data. The final step would be to document the outcome evaluation.

An informatics nurse is assisting with the evaluation of a newly implemented system for electronic documentation of client assessments. The nurse is planning to involve staff nurses in this process. When beginning the evaluation process, the informatics nurse would focus on which area first?

Identifying what will be evaluated Explanation: In evaluating technology such as a newly implemented electronic documentation system, the informatics nurse would first need to determine what will be evaluated. Once that is determined, the informatics nurse would develop a clearly focused question to help determine what data will need to be collected and how that data would be reported. Next, the informatics nurse would conduct a literature search, followed by a determination of the specific data elements that would be collected.

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 Explanation: In this situation, testing has already been completed as evidenced by the information about working out issues in the system. The team's next step would be to implement the system and begin using it since all previous phases of analyze and plan, design and build, test and train have been completed. The implementation phase would be followed by maintenance and then evaluation.

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.

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 Explanation: Being able to access the client's information from multiple sources, that is share information across health care systems, reflects interoperability. Usability reflects a system's ease of use or intuitiveness. Optimization commonly includes strategies for improvement. Security reflects the privacy and confidentiality of the information.

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 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 client engagement. The informatics nurse specialist is most likely orienting the staff to which system?

Patient portal Explanation: A primary client 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, client 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 health care providers 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 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.

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 Explanation: Patient portals can be securely accessed and provide several functions to increase engagement. Portals can be accessible via a home computer or a smartphone, making engagement even easier. Depending on the vendor, patient portals can enable the client to access medical history and other health information; communicate securely and conveniently with providers (but not necessarily face-to-face); pay bills; review lab test results; schedule appointments; and receive reminders for appropriate screenings (e.g., mammograms, flu shots, colonoscopy).

The nurse is performing a quality improvement audit and gathering client records to begin the audit. How would the nurse use client records for quality assurance purposes?

Randomly select client records to determine whether certain standards of care were met and documented. Explanation: Quality assurance is when records are randomly selected to determine whether certain standards of care were met and documented. Care planning is when the nurse considers all data on the client record when developing, goals, outcome criteria, interventions, and evaluation criteria for and with clients. Research is performed when data are gathered from groups of records to determine significant similarities in disease presentation, to identify contributing factors, or to determine the effectiveness of therapies. The medical record can be used for educational purposes, such as when it is used by a student to learn how a disease might present itself in certain clients.

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 Explanation: All language used in an EMR or clinical information system should be concise and unambiguous. Terminology used also must be that which is 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 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. Explanation: The competency of implementation is demonstrated when the informatics nurse specialist partners with the health care team to implement the plan on time, within budget and within the plan requirements. Implementing at a time when problems would be minimized and beyond the scope would not reflect this competency.

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.