Clinical Informatics Exam 1 Set 2

What does system design and testing include?

-Roll out -Bugs & debugging -Regression testing -Integration testing -Workflow redesign (documenting workflow) -Preparing system users

Licensing fees and standardized nursing terminologies

-Some of the standardized terminologies have licensing fees for use in order to provide support to the customer -Those without licensing fees might not have the resources for routine maintenance and updates to the terminology

What is consumer informatics?

-Subspeciality of healthcare informatics -Applied science using concepts from communication, education, behavioral science, and social networking -Focus on the consumer as the end user -Part of the movement to empower healthcare consumers

Controlling

-System maintenance is an ongoing process -All issues should be documented, prioritized, and tracked by using a database

What did a survey about cost/benefits report?

A survey conducted by Medical Economics reported that 70% of physicians states that purchase of the EHR was not worth the costs

What is "buyer beware" situation an example of?

A way to evaluate web resources

Needs for interoperability

Ability to share data

Important note to remember about Assessing Health/Numeracy literacy

Although all of the tools are valid and reliable, the problem is the time necessary to administer the tools, as well as potential embarrassment of the patient

What is vital to global health?

Information exchange

Semantic interoperability

Information transmitted so that it is understandable, but at this level, the interpretation and action on messages exchanged by two computers occur without human intervention

What is step one of project management?

Initiating

Improving communication

Interoperability is the technologic solution to a lack of communication among disparate systems

Electronic Records weaknesses

Loss of data due to equipment failure/hacking/virus

What does the accessibility of an EHR do?

Makes it easier for patients who visit multiple providers to supply each one with an up-to-date record, and the information available will usually be more than what a referring provider sends.

What is not a true EHR?

Many agencies refer to their EMR as EHR, but an electronic record that cannot interface with outside agencies is not a true EHR

What are some design considerations for project management?

Need for workflow redesign

Is access of smart cards automatic?

No, users must provide a password, a PIN to gain computer access, or both, and possibly a biometric

What is the second step in project management?

Planning

What are the two components of HIPAA law?

Privacy and Security

What do PHRs provide?

Provide clients access to their healthcare information and may allow clients to enter data into their records

What does meaningful use do?

Provides a means for eligible providers, hospitals, and critical access hospitals to use and communicate data to improve patient outcomes

What is cyberchondria?

Term that describes people who become distressed and frightened after repeated and excessive web searches for health information

Business continuity plan

Term used by IT for disaster recovery

What did a research report estimate about cost/benefits?

That health IT adoption could dave more than $1 billion annually (that savings has not yet occured)

Who has recognized standard terminologies that meet certain criteria?

The American nursing association (ANA)

Example of mapping

The NANDA nursing diagnosis, "ineffective airway clearance", could be mapped with CCC nursing diagnosis, "airway clearance impairment".

Where should you report unlawful internet pharmacies?

The U.S. Department of Justice Drug Enforcement Administration maintains a website that allows the public to report unlawful Internet pharmacies

Interoperability

The ability of 2 or more systems to pass information between them and to use the exchanged information

Foundation interoperability

The ability of one system to transmit data and another to receive the data without the ability of the receiving system to interpret the data

What is health literacy?

The ability to understand and process health-related information

Granularity

The detail that is captured by a term or phrase; the greater the granularity, the greater the detail or specificity of the term or phrase

Who owns and manages EMRs?

The institution or provider that creates them

What do Nomenclature & ontology describe?

The levels of classification

Why did physicians not think EHR was worth the purchase?

The physicians did not: -Have clear expectations when selecting an EHR -Receive appropriate training -Have the knowledge and experience to make purchase choices for computers and equipment

Structural Interoperability

The purpose of structural interoperability is to coordinate work processes. It refers to the uniform format or structure of the exchanged messages

What happens as healthcare agencies merge and form large corporations?

Those with the required authorization often combine these EMRs so that information from all member agencies and providers is accessible

Why did the ONC create six programs for HITECH?

To serve as a foundation to assure the success of HITECH and to achieve IT adoption, all of which require interoperability and standards to have successful outcomes

What is special about the EHR model?

Under the EHR model, one's health information is available from any location where there is internet access and a health information exchange (HIE) exists

What level should patient education materials be written at?

Written at no higher than a fifth grade reading level

Do consumers have access to their own health information in EMRs?

YES

ePHR

electronic personal health record

Electronic Medical Record (EMR)

electronic version of traditional record

Implementation

go-live is a significant milestone

Standards

-Agreed upon terms and definitions for how we capture information -Important in our quest to achieve nationwide interoperability

Nurses & Leadership

-All users of computerized clinical information systems must have effective technology -All providers and staff should assist with planning and training for a new system -Computer competency tests to assess learning needs

Facts about business continuity plan

-An organization's strategy for maintaining service or product delivery in the face of disaster -An essential component for maintaining the integrity of patient data in the event of a disaster -Usually includes redundancy of data in an off-site storage center -Addresses system maintenance in the event of a shortage of personnel -Federal Emergency Management Agency (FEMA)

What are advantages of online support groups?

-Asynchronous -Unrestricted membership -Message carefully thought out rather than thinking on feet -Diverse perspectives -Anonymity

Examples of different levels of granularity being needed for different purposes

-At the clinical level, very granular data are usually needed -Billing and secondary data uses often requires less granular data

What are the six programs that serve as a foundation for HITECH?

-Beacon Community Programs -Consumer eHealth Program -State Health Information Exchange Cooperative Agreement Program -Health Information Technology Extension Program -Strategic Health Information Technology Advanced Research Projects (SHARP) Program -Workforce Development Program

Improved provider-patient communication

-Benefit of PHR -A PHR tethered with the EHR allows to share individualized information with the client providing more personalized & higher quality care -improved communication will give consumers a better understanding of their healthcare responsibilities and disease management

Collaborative care

-Benefit of PHR -A partnership between the patients and their healthcare providers -the healthcare provider can help the patient to understand his or her condition and work together to achieve an agreed upon goal

Self-management

-Benefit of PHR -The ability to manage one's disease treatment more effectively

Cost savings

-Benefit of PHR -reduces administrative costs associated with electronic prescription refills and scheduling appointments

Comprehensive Health Enhancement Support System

-CHESS -vendor-supported service

What are different forums for support groups?

-Combination of patient portals -Message boards -Email list -Chat room -Any combination -Variable in sponsorship and information quality: use of moderators, discussion and postings

Electronic records strengths

-Continuity of care -Private and secure -Searchable and analyzable -Real-time information -Improved quality

What are the four purpose of HITECH?

-Defining meaningful use -Using incentives and grant programs to foster the adoption of EHRs -Gaining the trust of the public -Promoting IT innovation

Why did we need the NIC?

-Different terminologies were used for the same interventions -more importantly, interventions were often based on "how we've always done it" instead of evidence-based

Notes about searching internet resources

-Documents that provide needed information are located all over the world and are not always easy to discover -Documents can merely contain personal opinions and so must be evaluated for accuracy

Problem areas with Usability

-Dropdown menus -Information on screen -Text & Background -Content clarity and language

Consumer empowerment related to PHR

-Economic consequences for low-quality care -improves healthcare by providing consumers with data (the cost & quality of services & information for self-diagnosis and referral to appropriate providers)

EHR

-Electronic health record -an interoperable electronic healthcare record that can contain data from EMRs of all healthcare providers, including care facilities, clinicians, laboratories, and pharmacies involved with the patient's care

EMR

-Electronic medical record -Digital healthcare record of a single encounter

Florence Nightingale

-Emphasis on research & data collection -Kept careful statistics on diseases & mortality and analyzed data to make recommendations about environmental hygiene

What is project management?

-Essential skill of nursing informatics specialist -Management of project from start to finish -Systems life cycle as backbone

Closing

-Evaluation should be a part of every phase of the systems life cycle -Planned at least 6 months after implementation

What some consumer expectations?

-Expect to receive understandable information about their health conditions -Expect to be full partners in their healthcare, not passive recipients -Want to make intelligent decisions about healthcare based on cost and quality

What is full potential

-Integration of all healthcare records -Full interconnectedness

How does an EHR provide safer care?

-It provides safer care in the advent of an emergency when regular records may not be available -A record of all the consumer prescriptions can minimize adverse drug effects

Why does lack of documentation of nursing date in the EHR continue?

-Lack of adoption of the terminologies -high patient workload -poor design

Paper records strengths

-Light, transportable -No wasting time at computer terminal, no log in -No electricity, maintenance, or down time

What is consumer empowerment?

-Means that patients have enough health information to make informed decisions -they can become consumers or clients, NOT patients

What can consumers do with patient portals?

-Most patient portals contain some type of decision support using computerized prompts -Some provide secure email messaging features -Consumers want similar services that other industry provides personalized information

NEDSS

-National Electronic Disease Surveillance System -Major comment of these efforts -the objective is to develop and support integrated surveillance systems that can transfer appropriate public health, laboratory, and clinical data efficiently and securely over the internet to allow quick identification and tracking of disease outbreaks, whether natural or from bioterrorism

Paper records weaknesses

-No backup system -Easily damaged or destroyed -Legibility issues -Tedious to trend data;prone to error/may be incomplete/no patient access -Large, heavy, and difficult to store if stay is lengthy

Has nursing data always been valued?

-No, although nurses have been documenting for over 100 years, the information captured by nurses has not always been valued -Nursing data were purged from the medical record for several decades prior to the 1970s

Bertha Harmer

-Nurses prescribe nursing care just as physicians prescribe medical care -Visionary about the value of documenting nursing data to improve nursing care and patient outcomes

Nursing Education: Nursing Interventions Classification (NIC)

-Nursing interventions for given conditions varied by textbooks

ComputerLink project

-One of the earliest provider-sponsored groups that supports caregivers of those with Alzheimer disease

What does evaluating web resources include?

-One set of yes/no criteria for web document evaluation is not valid -A rubric that allows rating the authority of the site, quality, currency, ease of use, privacy, and other resources provides a way to evaluate websites -The medicals library association has an online user's guide for finding and evaluating healthcare websites -HONcode icon

What is a part of the health literacy precautions toolkits?

-Oral communication: The general rules for effective oral communication -Written communication: Readability (Flesch Reading Ease, Flesch-Kincaid Grade level) & Strategies to improve readability

What patient information is necessary for safe delivery of care?

-Patient history vital -Medications -Diagnoses -Insurance information -Demographic information

PHR

-Personal health record -allows users maintain/manage their own health information and communicate the information with authorized providers. -if the PHR conforms to interoperability standards, it can contain data from the EHR, but still controlled by the individual

Initiating

-Project goal -Project scope -Project requirements

What are patient portals?

-Provide patients access to their EHR data -Patients can make routine appointments, request prescription refills, or receive alerts -Patients can manage their chronic conditions with the potential of saving healthcare dollars and improving their quality of life

What are some barriers to PHR implementation?

-Provider reluctance -Unique Patient Identifiers -Data Privacy & Security -Data Presentation -Consumers -Costs

Continuity of Care Document (CCD)

-Provides a "snapchat" of a patient's health information including insurance information, medical diagnoses and problems, medications, and allergies -To be integrated with EHRs to provide the share of data with multiple providers

Clinical Document Architecture (CDA)

-Provides a common structure for clinical documents -Three levels that provide the ability to send documents that have sufficient "code" in them to be machine readable and yet are easily interpretable as a document by a human

Ways to empower the healthcare consumer

-Providing enough information for informed decision-making -Advocated in the first report to the Secretary of Health and Human Services, supporting ability of consumers to select healthcare based on values and information -Ability to affect the rising rate of health plan costs -Improving healthcare by providing consumers with date such as cost and quality of healthcare services, information for self-diagnosis, and referrals -Preserving best elements of the present system of clinical support

PHIN

-Public Health Information Network -Part of the Centers of Disease Control and Prevention (CDC) -national effort to increase the ability of public health agencies to electronically use and exchange information by promoting the use of standards

Ways to assess Health/Numeracy Literacy

-Rapid Estimate of Adult Literacy of Medicine (REALM) -Test of Functional Literacy in Adults (TOFHLA) -Newest Vital Sign (NVS) -Single-Item Literacy Screener

Systems Life Cycle

-Systematic approach for the development, implementation, deployment, maintenance and eventually, retirement of informations systems -Analogous to nursing process -Never ending; changes made based on evaluation -Wording & steps differ by agency or author

What two types of data standards for data communication does the EHR use?

-The Clinical Document Architecture (CDA) -The Continuity of Care Document (CCD)

HITECH

-The Health Information Technology for Economic and Clinical Health -Act provided funding opportunities to advance health IT

HIPAA

-The Health Insurance Portability and Accountability Act of 1996 -Changes in 2013 addressed improved patient privacy protection and provided healthcare consumers new rights to their health information -The law is too often misunderstood

What is health numeracy?

-The ability to interpret and act on all number-related information -Associated with medication errors

What does discovery of quality resources require us to understand?

-The different types of search engines -How to find information buried in the invisible web -Understand the criteria for scrutinizing the quality of the resources

What are the stages of meaningful use?

-The purpose of Stage 1 is to verify that the EHR could capture and share data -In Stage 2, users utilize advanced clinical processes to analyze data and make care improvements -As a result of the first two stages, improved outcomes are expected with Stage 3 of meaningful use

Secondary data use

-The re-use of nursing data to analyze the effectiveness of nursing care -Dependent on data entry using terms that are the same for each problem, intervention, and outcome

Issues with standardized nursing terminologies and alignment

-There is still no alignment on terminology standards for nursing content definition -Therefore, patient data cannot be shared across care settings

Client education about using online pharmacies

-To help your clients avoid the pitfalls of these suspect pharmacies, assess their sources for drugs and assist them to find a legitimate online pharmacy -Warn your clients that any online site that does not require a prescription operates outside the law and may send questionable drugs.

Electronic Health Record (EHR)

-Transportable subset of EMR -Used by healthcare organizations and physicians, and other providers -Using Clinical Document Architecture (CDA) data standards -Continuity of Care Document (CCD): using CDA architecture to provide "snapshot" of patient's health information

UMLS

-Unified Medical Language System -Interdisciplinary -Integrates and distributes key terminology, classification and coding standards, and associated resources to promote creation of more effective interoperable biomedical information services

What is OSPN?

-Used to study patient outcomes and their relationship to nurse patient ratio (ex. UTIs, pressure ulcers, pneumonia, length of stay) -more RNs =less adverse outcomes

training

-User training is another essential step that leads to a successful go-live

Examples of searching the invisible web

-Visible/surface web -Invisible/deep web

Standardized Clinical Documentation Terminology

-We can retrieve data for multiple patients from the EHR using criteria -This allows us to see the effectiveness of nursing care on many patients, not just one -Makes outcomes measurable

What should be included in teaching others to find & evaluate web-based information?

-Web address -Authority, qualifications, and credentials of the authors -About Us section of the site for: references for all medical info & the last update date

What are requirements for planning?

-Work flow analyses -Needs assessment -System design/selection -Interoperability -Communication with vendors -Health IT Systems Cost Benefits

What are things that should be included in workflow redesign?

-considerations of patient, work done by all providers, organizational needs -users' perceptions, barriers to change, strategies to work through barriers (purpose, goals, outcomes; tremendous work and collaboration between disciplines)

Standardized terminologies

-created bc nursing is complex -to capture the complexities of communication, research, and documentation, groups of scientists have worked together to identify a standard language that reflects nursing diagnoses, interventions, outcomes, and other essential elements of the care experience

Pilot conversion

-done to "test the waters" to see what issues might occur when making a transition to a new HIS -This approach enables system testing on a smaller scale

Tethered/connected PHR

-is linked to a specific healthcare organization's EHR system or to a health plan's information system -patients can access their own records through a secure portal

Nomenclature

-name of words -lowest level of classification -words in dictionary are examples of a list organized alphabetically for ease of use -another example: Pick list in computer documentation

What can be done within the EMR?

-order entry -computerized provider order entry (CPOE) -pharmacy -other applications for clinical documentation -searchable database

Stand-alone PHR

-patients fill in information from their own records, and the information is stored on patients' computers or the internet -may accept data from external sources

Big Bang conversion

-refers to all users transitioning to or uses a new system at the same time -This method is most frequently used when there is no initial system, the system in use is failing, or there is a requirement for implementation on a specific date, such as the beginning of a new fiscal year

Phased conversion

-refers to system go-live that takes place incrementally -phase conversion offers a degree of control since it is done incrementally

Parallel conversion

-requires the operation and support of the new and the old system for a period of time -This method allows an organization to allocate resources in an efficient manner -involves the least risks but increased workload for the users

Accessibility factors in web design

-screen readers -text alternatives -color blindness

American Recovery and Reinvestment Act (ARRA)

-signed into law in Feb 17, 2009 -Health Information Technology for Economic and Clinical Health (HITECH) part of the ARRA

HIPAA compliant

-smart cards are tamper resistant to protect confidentiality

Internet pharmacies

-some lawful online pharmacies -numerous ones that allow purchase without prescription or consultation with the healthcare provider

Medicare severity diagnosis-related groups (MS-DRG)

-standardized patient classification system into patient groups determined the average consumption of hospital resources -served as the basis for hospital payment -the criteria used for assigning categories included medical diagnosis, surgery, complications, and usually age

SNOWMED-CT

-systematic nomenclature of medicine-clinical terms -patient-centered, interprofessional clinically-focused terminology -developed to be used in EHRs for data entry and retrieval

Ontology

-the highest level of organization of classification -complex and powerful, providing the ability for terms to be represented and linked to multiple concepts

What do nurses need to understand?

-the work that we do in nursing is not clear to others when they read our documentation -a lack of standardized terminology into electronic databases contributes to the invisibility of nurses

International Classification of Disease (ICD)

-useful for statistical and billing processes -present a one-dimensional view of disease— focus only on etiology

Planning

1) finalize the project's scope, budget, and timeline 2) determine project team membership 3) negotiate a contract with a system vendor 4) guide technology staff for system customization or build.

What are the two forms of phased conversions?

1) the organization implements a system one module at a time 2) the entire system goes live one unit at a time

How do smart cards work?

1. Insert card into reader - this decrypts, validates card and retrieves patient data 2. Verify identity & patient photo on computer 3. Involves patient record in ADT system - Complete full registration 4. Return card to patient

What is confidentiality?

Authorized care providers maintaining all personal health information as secret, except to other care providers who need access to that information and to others that the patient has consented to allow access

With no nursing data, how was nursing measured?

By negative qualities or adverse events

How do smart cards stress patient information?

By providing information about allergies, prescribed medications, and medical conditions to facilitate care

What is the fifth step in project management?

Closing

What skills does project management require?

Communication Teambuilding Organizational planning Time and resource management

What does a EHR provide?

Comprehensive birth-to-death record

What is the fourth step in project management?

Controlling

What does the demand for customized content by customers do?

Does not allow for standardization of the EHR

What can not using standards to promote interoperability result in?

Duplication of tests, the inability to mitigate medical errors because of lack of information, and a decrease in the ability to quickly respond to natural or manmade epidemics and disasters

What are examples of using search tools to search the web?

Engines (crawler or spider, human-powered directories, a combination)

What is the second step in project management?

Executing

Classification

Grouping of related ideas into a taxonomy based on one perspective

provider-sponsored groups

Healthcare providers, particularly hospitals or healthcare organizations, may provide online support for those for whom they provide care. These sites generally require passwords to enter and sometimes require specialized software

What are smart cards?

Identify patients when making contact with the healthcare system and transmit information that will assist treatment by healthcare providers

What is the goal of consumer informatics?

Improvement of consumer decision-making processes and healthcare outcomes via the use of electronic information and communication

Mapping

Refers to matching a concept in one standardized terminology with a concept in another standardized terminology

Search query

Retrieving lots of data across multiple patients from the EHR by putting in criteria

Project requirements

Risk; needs assessment -Return on investment (ROI); cost-benefit -Request for information (RFI) -Request for proposal (RFP)

Go-live

Rollout

What are online diagnosers?

Search for online health information: found this information affected people's understanding of any health problems they had and improved their health management

Management of information with smart cards

Simplifies hospital admissions and provides healthcare data in emergency situations

What is executing?

System design and testing (vanilla product)

It is expensive and resource intensive to map local content to reference terminologies, such as SNOWMED CT and LOINC T/F

TRUE

What is analysis of message content from online groups?

information exchange, encouragement and support, thanks, humor, prayer

GriefNet Support

offers support to person suffering from the loss of a loved one

Rollback

refers to backing out of the implementation—the cancellation of the system implementation

Contingency plan

should be detailed and address and control risks of significant implementation problems

What do advanced web searches utilize?

specialized tools

four main approaches used to implement health information systems

the big bang approach, pilot conversion, phased conversion, and parallel conversion

What is security?

the measures implemented to prevent unauthorized user access to the personal health information of patients

What is privacy?

the right of patients to control what happens to their personal health information

Scope creep

unanticipated project growth