informatics test 2

legislation efforts

-E- sign -MIPPA -HIPPA -ARRA -HITECH page 380

accreditation

-a review process that monitors performance against predetermined standards -determines whether providers will receive funding -enhances provider image

virtual learning environment

-any system that uses the Internet to assist the educator in developing, managing, and administering educational materials for students -exists whenever a learner and teacher do not meet face to face, but rather communicate "at a distance" to enable learning. -system that uses the internet to assist the educator in developing, managing, and administering educational materials for students -provide tracking capability -blended learning -provide email, chat, and discussion capability ex.) wiki -began with distance learning

Healthcare enterprise benefits of EHR

-better record security -instant notice of eligibility/procedure authorization -decreased need for record storage, x ray film, filing -faster turnaround for accounts -decreased length of stay (from support and reminders to do things like turn patient)

ESIGN

-clinton passed this in 2000 -gives electronic signatures the same legal status as handwritten signatures

e learning advantages

-convenience (for CEUs) -flexibility -available anytime and anywhere there is an internet connection -self paced instruction -may occur via mobile devices such as PDAs, iPods, or cellular phones

consumer benefits of EHR

-decreased wait time -increased access/control over health info -increase ability to ask informed questions -increased responsibility for own care -alerts and reminders for appts and schedules tests -increased satisfaction and understanding of choices

attributes of PHR

-each person controls his or her own -contain info from ones entire lifetime -contain info from all healthcare providers -are accessible from any place at any time -private and secure -transparent. ind can see who entered each piece of data, where it was transferred from, and who has viewed it -permit easy exchange of info across healthcare systems

meaningful use of EHR

-federal incentives allocated for facilities that can demonstrate they are "meaningfully using" certified EMR technology to improve patient care -medicare and medicaid EMR incentive programs are stages in 3 steps with increasing requirements for each stage -CMS has defined core objectives that measure the impact of an EMR evolved from a set of national priorities to help focus performance improvement efforts identified in the national priorities and goals report released by the national priorities partnership which was convened by the national quality forum. priorities include: -patient engagement -reducing racial disparites -improved efficiency -increased safety -coordination of care -measures to improve pop health page 281

patient protection and affordable care act

-guarantees access to healthcare for all americans -creates new incentives to change clinical practice and improve quality of care -gives practitioners more info to improve practice -gives patients more info to make conscious decisions

unstructured data

-history and physical -consultation findings -social services text report

distance education

-improve student access -meet student demands -extend geographic boundaries -remain viable -keep students on the cutting edge of technology -self paced

advantages of virtual learning

-improved reading habits (learners can proceed at a pace conductive to comprehension) -convenience, learning offered at any site that has computer access (programs available for single users on freestanding PCs or via network connections -reduced learning time (learners can proceed at their own pace; they can swim through familiar content and focus on weak areas -increased retention (related to active nature of the media that facilitates learner participation) -24 hr access -consistent instruction in a safe environment (allows learners to practice new skills without fear of harm to themselves or others) -flexibility of faculty schedules (makes it easier to teach around clinical instruction)

EHR current status

-no country has an operational EHR -Bush called for adoption of the EHR by 2014 -dept. of defense, health and human services, veterans admin, and centers for medicare and medicaid services mandated the EHR for their facilities and operations

disadvantages of virtual learning

-poor instructional design (many virtual applications do nothing more than automate page turning) -lack of feedback (can be frustrating) -lack of control (control encompasses the ability to advance, repeat, or review portions of the program, or quit at any point) -lack of intellectual simulation (programs that fail to maintain interest may cause learners to feel that they wasted their time)

quality initiatives

-prevent avoidable complications -movement towards reimbursing institutions for quality and performance -holding institutions accountable for secondary infections and complications (high rate of infections at hospitals=no reimbursement -goal of quality initiatives is to improve patient outcomes

advantages of electronic health records

-provides secure, reliable real time access to client health record info where and when it is needed to support care -records and manages episodic and longitudinal EHR info -functions as clinicians primary info resources during the provision of client care -assists with the work of planning and delivery of evidence based care to ind and groups of clients -captures data used for continuous quality improvement, utilization reviews, risk management, resource planning, and performance management -captures the patient health related info needed for medical record and reimbursement -provides longitudinal, appropriately masked info to support clinical research, public health reporting, and population health initiatives -supports clinical trials and evidence based research -more on page 282

policy making process

-recognition of a problem or issue -policy formation -adoption -implementation -analysis -evaluation

EHR attributes

-secure, reliable access where and when needed -records and manages episodic and longitudinal info -assists with planning and delivery of evidence based care -supports clinical research, public health reporting, population health incentives (BMI) -captures data for quality improvement, utilization review, risk management, resource planning, performance management, reimbursement (if done correctly)

PHR combined within EHR

-shared medical record with patient: lab and test results, medication lists, appointment, after visit summaries, visit notes, patient clinical reminders

course/learning management systems

-system that uses the internet to assist in developing, managing, and administering educational materials for students (blackboard) -facilite learning -provide tracking capacity -provide email, chat, and discussion capability

Web based instruction

-uses attributes and resources of the WWW -may be used to supplement traditional courses or a stand-alone instruction

structured data

-vital signs -lab results

levels of automation

0- not all ancillary systems operational 1- major ancillary clinical systems 2- major ancillary clinical systems + CDR (clinical data repository) 3- some documentation and retrieval 4- CPOE (computerized physician order entry), support for evidence based practice 5- BCMA (bar code medication administration) + identification technology + CPOE (computerized physician order entry) 6- physician documentation, DS, alerts, PACS (picture archiving and communication system) 7- fully electronic paperless environment

ARRA

American Recovery and Reinvestment Act includes provision for info technology in general and health info technology

simulation

advantages: -standardized student learning opportunities -safe learning environment -unusual or high risk clinical situations -mastery of skills -stimulate critical thinking and teamwork -1 hr simulation=2 hrs of clinical disadvantages: -initial cost -instructor training

EHR incentives

beginning in 2011, medicare and medicaid have provided financial incentives to physicians and hospitals for meaningful use of health information technology. negative incentives began in 2015

healthcare reform

brought forth to public attention via IOM report, to Err is human: Building a safer health system -president bush created national health information technology coordinator -president obama supported 2014 goal for EHRs by signing American Recovery and Reinvestment Act (provides better customer service) -in 2009, the American Recovery and Reinvestment Act supported adoption of a nationwide health information infrastructure

HIPPA

called for the establishment of an electronic patient records system and privacy rules. it also affects all aspects of health info management, including privacy and security of patient records, coding, and reimbursement

health policy making process

decision made by government bodies that are intended to support or improve health citizens (not an easy process) -nurses need to realize the benefits of medical breakthroughs and innovations requires the design of a better healthcare delivery system -nurses need to be able to bring the problem to the notice of the organization or government in order to work toward action

electronic patient record

electronic client record, but not necessarily a life time record that focuses on relevant info for the current episode of care

electronic health record

electronic record of health related info on an ind that conforms to nationally recognized interoperability standards and that can be created, managed, and consulted by authorized clinicians and staff across more than one health care organization -has the ability to exchange info outside of a single healthcare delivery system unlike EMR -supports other care- related activities directly or indirectly, evidence based decisions, support, quality management, and outcomes reporting

impact of HIT

expected to save 34 billion in 10 years just through the requirements for healthcare providers to use HIT as a condition of participating in Medicare -expected gains in the quality of care and improved population health

eHeath initiative

group of more tahn 200 organization s representing all healthcare stakeholders and attempts to educate and help members navigate different healthcare issues, policies and strategy

Medicare Improvement Act

includes a provision calling for financial incentives for e-prescribing -get more $$ if prescribers use E-prescriptions

policy development

issues: -lack of motivation, resistance to change, cost, protecting security, EHR may increase activity for fraud

electronic medical record

legal record created in hospitals and ambulatory environments that is the source of data for the EHR -typically referred to a single encounter with no, or very limited ability to carry info from one visit to another within a care delivery system -comprised of structured (#'s) and unstructured data includes: -clinical messaging and email -results reporting -data repository -decision support -clinical docmentation -order entry

HITECH Act

makes changes to HIPPA and provides more funding for EHRs

HIT is slow to develop in US

one of the biggest obstacles to expand it are that it is an overly narrow focus on ways to increase its adoption instead of an overall consideration of all related issues -requires leadership by the gov to organize the efforts -requires economic incentives and policies that make quality improvements and cot reduction essential to providers in order to accomplish their financial and professional goals -the identification of the type of data most used in quality assessment and the creation of unique clinician identifiers ;

stand alone vs tethered

page 328 -stand alone (PHR or EMR) systems are not tied to any healthcare system -tethered systems (EHR) are tied into a healthcare system (My healthVet PHR from the VA)

role of nursing in HIT

page 374 -to act in the best interest of of the public they serve -be prepared to influence the process to ensure the representation of nursing -become active in policy formation -be involved in all levels of policy to facilitate the movement away from from disease focus to wellness policies and procedures -be responsive to big changes taking place in with the passage of ARRA and Meaningful Use requirements -education programs -expansion/integration of informatics competencies -sharing best practices using HIT effectively to improve delivery of nursing care BOX 18-2 for more info on pg 375

impact of legislation

page 383 -healthcare delivery systems are scrambling to acquire, install, and use EHRs and health information systems -most facilities will have to expand their capabilities to support transformation of clinical care -cost was a problem until the HITECH Act but coverages are not immediately clear -availability of working technical standards is also a problem, so data is securely and easily exchangeable within and across organizations and that valid, safe, and reliable patient-centered community-care record can be created and maintained -informaticist are needed to mine data, analyze data aggregates , help in care-process redesign and design functional clinically valid decision support

impact Joint Commission has

page 410 -mission: "to continuously improve health care for the public in collaboration with other stakeholders by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value" -this accreditation benefits providers by helping them meet all or portions of, state and or federal licensure and certification guidelines for improvement of care, services, and programs. -community confidence in the organization and improved staff recruitment and retention -Standards listed on pg 410

CMS

page 415 -Centers for medicare and medicaid services -measures how often clinical benchmarks are met and makes the information available via hospital compare website

ANCC

page 415, pg 101 -American Nurses Credentialing Center -indicates that a certain level of nursing has been met -focuses on making available to individual registered nurses and organizations practice resources for pursuing excellence in practice -ANCC credentials individual nurses in various nursing specializations and credits providers for continuing education for nurses

TIGER

page 416 -recognize the need for transformational leadership -model used to help transform organizations to meet the needs of the future

e learning environment

page 468 -delivery of content and stimulation of learning primarily through the use of online telecommunication technologies such as blogs, podcasts, video, email, bulletin board systems, electronic whiteboards, inter-relay chat, videoconferencing, and the world wide web

mobile applications

page 472 -"Osborne" was the first mobile computer -rate of change in speed and storage capacities Box 23-2 list things to think about when choosing a mobile device -handheld technology helps to provide evidence-based research to point of care, clinical guidelines, simple calculations, potential to facilitate communities, and increase patient safety and improved outcomes

levels in which healthcare consumers use online info

page 484 1. search for health info 2. exchange email with family members and friends 3. seek guidance from online patient helpers 4. participate in online support groups 5. join with online consumers to research their shared concerns 6. use online medical guidance systems 7. interact with volunteer online health professionals 8. use the paid services of online medical advisors and consultants 9. engage in electronic conversations with their local clinicians 10. receive one way electronic messages from their clinicians

smart phone technology

page 491 -become nearly universal in the US -moves from provider focus to patient-centered focus -allows healthcare to be mobile -applications for disease management -

smart phone

page 498 -removes the need for patients to remember self-motivated tasks by using newer technologies that provide automatic prompts and messages via smartphone -still needs work for usability with smartphones and older adults as screen and font size could be a problem

evidence based practice

page 542 NEED: essential to transform healthcare by providing proven effective treatments- -EBP is applicable to all healthcare disciplines and it contributes to the evolution of nursing as a profession -research can be applied to providing care the integrates nursing experience and intuition with valid and current clinical research to achieve best patient outcomes -entails development of best practices based on outcomes and ability of nurses access and evaluate current professional literature found in both print and online sources Processing requiring activités listed o pg 543 -it provides a better way to treat patients because it replaces tradition with practices supported by research, improving outcomes -provides shared experience for healthcare profession based on systematic and thorough review of scientific data on a given topic -reduce time provider spends gathering and accessing relevant data and can be obtained at bedside when most needed -helps facilities meet research and excellence requirements -contributes to job satisfaction and vitality because nurses and professionals feel better about the quality of care they are delivering -used in policy formation and revision -models mostly used are Steeler model, Iowa model and Rossworm and Larrabee Model Read pg 544-551 for status and strategies for EBP Research-based practice does not consider clinical expertise or patient preference while evidence-based practice used expertise to translate evidence into an innovative practice change

PDA use

page 547,548 -evidence-based clinical guidelines are often readily available through hospital libraries and the internet may be accessed using technology including mobile handheld devices such as PDAs -several attractive features -portable and allow clinician to have access to databased and EPB guidelines at the bedside -increasing evidence that patient safety and nurse satisfaction are increased with PDA use -provide current clinical best practice at bedside -record details of search -maintain notes on each review -prepare a suffinct summary of all studies reviewed

database searches

page 548 pg 81 -Feature allows users to conduct comprehensive literature searches over a shorter period of time than could be accomplished via a manual approach -"online" refers to databases that are available through internet connections -access to database searches is obtained through universities, public libraries, or a subscription basis using an internet connection. Previously searches were done using hardcopy manuals or periodic database increments on a. disk -some databases contain information on a specific population of people for exam cancer patients or cardiothoracic surgery -NIH offers access to several databases, along with several other agencies listed on pg 559 -database searches of professional journals and credible EBP websites significantly reduce time and effort one might spend examining a clinical question. Provides experts with reliable information -can engage with other health professionals -search filters allow you to narrow down the information you are looking for

standardized nursing language

page 565 NANDA, NIC, NOC (do it for us) -medical terminology

distance learning

preceded the virtual learning environment -use of audio, video, computer, tv, teleconferencing, or the WWW (world wide web) to connect educator and students who are located at a minimum or two different locations -learners are spread out throughout different geographic locations box on page 467

personal health records

private, secure application which an ind may access, manage and share his or her health info (use website or app) -usually stand alone -evolving def of a PHR -different for EHR -driven by consumers -multiple sources of health info and services

health policy and health info technolgy

requires informed policymakers, professionals, and an informed public -required the DHHS to establish a research center -RECS will work with nonprofit organizations that apply for and receive financial assistance from DHHS to incorporate HIT and best practices -page 373

health information technology

seen as a tool to aid the reform process with recognition of its potential to improve the safety and efficiency of healthcare delivery, facilitate transparency, increase engagement, personalize healthcare, and facilitate the sharing of info needed to improve the quality of care as well as decrease costs and disparities -having the greatest impact would be electronic health records, personal health records, and health info exchange -Walker and Crayton called for the redesign of HIT to support improved patient centered care rather than the isolated tasks of specific healthcare professionals, noting that this approach has a policy implications as HIT would mitigate the results of shortages of physicians through -requiring other healthcare providers and patients to learn new skills -increasing the numbers and use of clinical analysts, business process manages -improved human factors design -shift to payment for improved patient well being -shift from tasks to a patient centered approach

meaningful use of the EHR

stage 1- focuses on electronic capture and sharing of info stage 2- HIT use at POC (plan of care) for quality improvement stage 3- improved outcomes and population health