NR599 Chamerlain- Informatics

Casuist approach

Casuistry is a specific ethical reasoning method that analyzes the facts of a case in a sound, logical, and ordered or structured manner.

Clinical Support Tools examples

-Computerized alerts and reminders for providers and patients -Drug-drug interaction alerts -Underdose or overdose alerts based on renal or liver functions or age or drug levels -Actionable clinical guidelines -condition specific order sets -Focused pt data reports and summaries -Diagnostic support -Contextually relevant info

Alert fatigue

-Defined as simply disrupting clinical workflow -Can result in dismissed alerts -Contributes to resistance to CDSSs -Alert fatigue and clinical burnout are common byproducts of poorly implemented clinical decision support features that overwhelm users with unimportant information or frustrating workflow freezes that require extra clicks to circumvent.

Rationale for NOT being considered medical device per FDA

-Ebook, audiobooks, medical textbooks: intended to use for reference and not for diagnosing -Mobile apps for providers that is used for education or to reinforce facts already known: Intended for user education and NOT diagnosing -Apps for general patient info: " "

Ethical decision making

-Ethical decision making refers to the process of making informed choices about ethical dilemmas based on a set of standards differentiating right from wrong. -The E-Health Code of Ethics (eHealth code, n.d.), which includes eight standards for the ethical development of health-related Internet sites: (1) candor, (2) honesty, (3) quality, (4) informed consent, (5) privacy, (6) professionalism, (7) responsible partnering, and (8) accountability. -the concept of nonmaleficence ("do no harm") will be broadened to include those individuals and groups whom one may never see in person, but with whom one will enter into a professional relationship of trust and care.suggests that both autonomy and justice are enhanced with universal access to information, but that tensions may be created in patient-provider relationships as a result of this access to outside information. Healthcare workers need to realize that they are no longer the sole providers and gatekeepers of health-related information; ideally, they should embrace information empowerment and suggest websites to patients that contain reliable, accurate, and relevant information

Apps for being considered medical device per FDA

-Mobile apps that provide or facilitate supplemental clinical care, by coaching or prompting, to help patients manage their health in their daily environment - Examples include apps that coach patients with conditions such as cardiovascular disease, hypertension, diabetes or obesity, and promote strategies for maintaining a healthy weight, getting optimal nutrition, exercising and staying fit, managing salt intake, or adhering to pre-determined medication dosing schedules by simple prompting. -Mobile apps that provide patients with simple tools to organize and track their health information - Examples include apps that provide simple tools for patients with specific conditions or chronic disease (e.g., obesity, anorexia, arthritis, diabetes, heart disease) to log, track, or trend their events or measurements (e.g., blood pressure measurements, drug intake times, diet, daily routine or emotional state) and share this information with their health care provider as part of a disease-management plan. -Mobile apps that provide easy access to information related to patients' health conditions or treatments (beyond providing an electronic "copy" of a medical reference) -Examples include apps that use a patient's diagnosis to provide a clinician with best practice treatment guidelines for common illnesses or conditions such as influenza;Apps that are drug-drug interaction or drug-allergy look-up tools. -Mobile apps that are specifically marketed to help patients document, show, or communicate to providers potential medical conditions - Examples include apps that serve as videoconferencing portals specifically intended for medical use and to enhance communications between patients, healthcare providers, and caregivers;Apps specifically intended for medical uses that utilize the mobile device's built-in camera or a connected camera for purposes of documenting or transmitting pictures (e.g., photos of a patient's skin lesions or wounds) to supplement or augment what would otherwise be a verbal description in a consultation between healthcare providers or between healthcare providers and patients/caregivers. -Mobile apps that perform simple calculations routinely used in clinical practice-Examples of such general purpose tools include medical calculators for Body Mass Index (BMI), Total Body Water / Urea Volume of Distribution, etc. -Mobile apps that enable individuals to interact with PHR systems or EHR systems-Examples include apps that provide patients and providers with mobile access to health record systems or enables them to gain electronic access to health information stored within a PHR system or EHR system. -Mobile apps that meet the definition of Medical Device Data Systems -Examples include apps that are intended to transfer, store, convert format, and display medical device data, without controlling or altering the functions or parameters of any connected medical device.

Areas for mHealth growth

-Preventive medicine and health promotion can be leveraged through education and awareness applications; -Portable diagnostic devices that allow monitoring of human conditions in clinical settings or offsite locations; -Applications for data management, training medical personnel, and mobile payments

Health Information Technology for Economic and Clinical Health Act of 2009 (HITECH)

-Under this act, healthcare organizations can qualify for financial incentives based on the level of meaningful use achieved -the HITECH Act specifically incentivizes health organizations and providers to become "meaningful user

Mobile health (mHealth)

-defined as the use of wireless communication to support efficiency in public health and clinical practice -To facilitate mHealth, mobile applications (apps) have been developed, which can be executed either on a mobile platform or on a web-based software application that is tailored to a mobile platform but is executed on a server. Mobile medical apps are accessories to a regulated medical device or are software that transforms a mobile platform into a regulated medical device. These mobile devices may include, but are not limited to, mobile phones or smartphones, tablet computers, smartwatches, and point-of-care (POC) devices.

Principlism

A foundation for ethical decision making by rational individuals and belief

Privacy

According to Healthit.gov (2014) Protecting Your Health Information, the privacy and security of patient health information is a top priority for patients and their families, health care providers and professionals, and the government. This was also previously discussed under HIPAA. It also requires that "key persons and organizations that handle health information to have policies and security safeguards in place to protect your health information whether it is stored on paper or electronically." An important issue related to personal information, about the owner or about other individuals, that focuses on sharing this information with others electronically and the mechanisms that restrict access to this personal information.

Cybersecurity

Another federal regulatory agency with a role in the privacy and security of health care data is the (FDA). The FDA oversees the safety of medical devices, which includes addressing the management of cybersecurity risks and hospital network security. Recent guidelines issued recommend that medical device manufacturers and health care facilities take steps to ensure that appropriate safeguards are in place to reduce the risk of failure caused by cyberattack. This could be initiated by the introduction of malware into the medical equipment or unauthorized access to configuration settings in medical devices and hospital networks. As medical devices are increasingly integrated within health care environments, there will be a need for vigilance toward cybersecurity practices to ensure all systems are adequately protected and patients remain safe from harm. Nurse Informaticists are frequently called on to evaluate safety and effectiveness of new devices and software. Considerations of cybersecurity must be included in any evaluation process.

Evaluation and Management Coding

Before you can determine your E&M, code you must first identify the p lace of service, type of service , and the patient status. The place of service refers to where the service was rendered There are several categories to choose from, but the two most common are the inpatient and outpatient settings. This is pretty straightforward. The type of service refers to t he type of service provided . Some examples of types of services include consultation, hospital admission, office visit, and so forth. Again, pretty straightforward. As a student in your practicum rotations, nearly all of your place s and types of service will be outpatient office visits. Finally, you need to identify the patient's status. Patient status refers to whether or not the patient is a new patient or an established patient of your practice. By definition, a new patient is one who has not received professional service from a provider from the same group practice within the past 3 years. Conversely, an established patient has received professional service from a provider of your office within the last 3 years. So, let's look at an example. Let's say that Jane is scheduled to see you today for a CC of sore throat. She has a medical record on file in your system, and you see that her last visit was in 2012 with your partner, Dr. Tom. Is she considered an established patient or a new patient? She is considered a new patient because e ven though she has been seen by someone in your office previously, it has been more than 3 years since her last visit. There are three key components that determine risk-based E&M codes. 1. History 2. Physical 3. Medical Decision Making (MDM) Each one of these components (history, physical, and MDM) must have a specific number of elements documented to meet the visit requirements .

Computer-aided translators (CAT tool)

Computer Aided Translation (CAT), is a broad term used to describe software that human translators use during the translation process to improve their productivity. Most professional translators use CAT tools. With a CAT tool, translators can work faster, eliminate repetitive translations, automatically correct mistakes, and achieve higher consistency of translations. Typical CAT tools are text editors that support bilingual file formats, and have built-in translation memory.

HIPPA

HIPAA was enacted in 1996. While it is best known among consumers and healthcare professionals for its protection of personal health information (PHI) and the additional forms that each of us are asked to sign when we go to provider offices, HIPAA also ensures portability of insurance for individuals moving from one job to another, legal protection for PHI, and mandates standards for the electronic data interchange of healthcare data for encounter and claims information, and was intended to simplify the claims submission process by eliminating paper claims. HIPAA established legal sanctions for institutions and individuals who fail to protect PHI. As healthcare professionals, we are cognizant of HIPAA requirements before we share PHI via writing, electronic means, faxes, telephone, or in person. Specific measures to protect PHI include limiting record access to individuals with a right to know, signed disclosures to release information, encryption of e-mail and files, fax cover sheets, designated persons who may receive PHI, and the use of passwords to guarantee that PHI is only disclosed with persons designated by the consumer as having a right to know. HIPAA has also changed sign-in procedures for patients, disposal of forms containing PHI, and how we use whiteboards to show patient information.

Clinical Support Tools

Historical examples include practice guidelines carried in clinicians' pockets, patient cards used by providers to track a patient's treatments, and tables of important medical knowledge. The primary goal of implementing a CDS tool is to leverage data and the scientific evidence to help guide appropriate decision making

Workflow analysis

Observation and documentation of workflow to better understand what is happening in the current environment and how it can be altered is referred to as process or workflow analysis. A typical output of workflow analysis is a visual depiction of the process, called a process map. The process map ranges from simplistic to fairly complex and provides an excellent tool to identify specific steps.

Blockchain

Security of health data remains one of the challenges for HIEs and, in general, interoperability of health data and information. Blockchain is a standard increasingly put forth as a solution. Best known for its use for bitcoins, blockchain is extremely secure when coupled with encryption.

CAT tool functionality

Spell checkers, autocorrect—automatically highlight and fix spelling and grammar mistakes. In-context review—display multimedia documents with images, text box sizes and layout in real time in both source and target language. Integrated machine translation—suggest translations for segments from a connected MT engine. Adaptive machine translation—offer translations for segments from a connected MT engine as autosuggest pop-ups, learn from user input (examples: Lilt, YarakuZen, SDL Trados Studio 2017). Concordance—retrieve instances of a word or an expression and their respective context in a text corpus, such as a translation memory database, to check their usage. Electronic dictionaries—allow term search inside the tool, track usage statistics. Text search tools—find phrases or terms in the text for reference. Alignment—build translation memories texts from source text and its translation. When a translation company adopts a CAT-tool, they often use alignment to create their first TM databases.

Telehealth

Telehealth is still an evolving technology; while the offsite interventions or contacts often lead to less time being wasted on non-care-oriented tasks because of the efficiencies offered by the technology applications, its use must never be associated with less care. It is also important to note that nursing activity in telehealth still follows the same best practice standards as those espoused in conventional care.

FDA Oversight for Medical Devices

The FDA intends to apply its regulatory authorities to select software applications intended for use on mobile platforms. Given the rapid expansion and broad applicability of mobile apps, the FDA is issuing this guidance document to clarify the subset of mobile apps to which the FDA intends to apply its authority. Many mobile apps are not medical devices, meaning such mobile apps do not meet the definition of a device by the FDA. therefore, the FDA does not regulate them.Some mobile apps may meet the definition of a medical device but because they pose a lower risk to the public, the FDA intends to exercise enforcement discretion over these devices (meaning it will not enforce requirements under the FD&C Act). One example is a mobile app that makes a light emitting diode (LED) operate. If the manufacturer intends the system to illuminate objects generally (i.e., without a specific medical device intended use), the mobile app would not be considered a medical device. If, however, through marketing, labeling, and the circumstances surrounding the distribution, the mobile app is promoted by the manufacturer for use as a light source for providers to examine patients, then the intended use of the light source would be similar to a conventional device such as an ophthalmoscope.

Confidentiality

The mandate that all personal information be safeguarded by ensuring that access is limited to only those who are authorized to view that information. Consequently, stringent confidentiality laws and more widespread availability and use of social and mobile media, numerous ethical and legal dilemmas have been posed to all healthcare workers. What are not well defined are the expectations of healthcare providers regarding this technology. In some cases, APNs have been subjected to video and audio recordings by patients and families when procedure is performed. Providers must be aware of the institutional policy regarding audio/video recording by patients and families, as well as the state laws governing two-party consent. Such laws require consent of all parties to any recording or eavesdropping activity

ICD-10 Coding

The most common code sets used are the diagnostic and procedural coding or classification systems. The oldest and most established system is the ICD, which is promulgated and maintained by the World Health Organization (WHO). The United States converted to ICD-10-CM on October 1, 2015. An international standard does not exist for procedures. In the United States, there are separate standards for inpatient procedures and ambulatory care procedures. ICD-9-CM, volume 3, was historically used for inpatient procedures, with a new system, ICD-10-PCS, adopted on October 1, 2015. In late 2016, WHO publicly announced its development efforts for ICD-11. Specifically, ICD-11 will be designed to be compatible with electronic health applications and information systems.

HL7

The most common healthcare messaging standard for text information Messaging standards ranging from patient administration to order entry to medical records management to personnel management, among other functions.

Clinical uses for telehealth

Transmitting images for assessment or diagnosis. One example is transmission of digital images, such as images of wounds for assessment and treatment consults. Transmitting clinical data for assessment, diagnosis, or disease management. One example is remote patient monitoring and transmitting patients' objective or subjective clinical data, such as monitoring of vital signs and answers to disease management questions. Providing disease prevention and promotion of good health. Examples include case management provided via telephone or smartphone app and patient education provided through asthma and weight management programs conducted in schools. Using telephonic or video interactive technologies to provide health advice in emergent cases. One example is performing teletriage in call centers or real-time stroke consultation between a rural health center and an academic medical center. Using real-time video. One example is exchanging health services or education live via videoconference.

Reimbursement Coding: Current Procedural Terminology Codes (CPT)

Used to code procedures for billing The CPT system offers the official procedural coding rules and guidelines required when reporting medical services and procedures performed by physician and nonphysician providers . CPT codes are recognized universally and also provide a logical means to be able to track hea l thcare data, trends, and outcomes. Each service or procedure is represented by a five-digit code that is presented in six sections , including evaluation and management; anesthesiology; surgery; radiology; pathology; and medicine.

Workflow design

Workflow is a term used to describe the action or execution of a series of tasks in a prescribed sequence. Another definition of workflow is a progression of steps (tasks, events, interactions) that constitute a work process, involve two or more persons, and create or add value to the organization's activities. In a sequential workflow, each step depends on the occurrence of the previous step; in a parallel workflow, two or more steps can occur concurrently. The term workflow is sometimes used interchangeably with process or process flows, particularly in the context of implementations. Observation and documentation of workflow to better understand what is happening in the current environment and how it can be altered is referred to as process or workflow analysis. A critical aspect of the informatics role is workflow design. Nursing informatics is uniquely positioned to engage in the analysis and redesign of processes and tasks surrounding the use of technology.

Clinical decision support (CDS)

a process designed to aid directly in clinical decision making, in which characteristics of individual patients are used to generate patient specific interventions, assessments, recommendations, or other forms of guidance that are then presented to a decision-making recipient or recipients that can include clinicians, patients, and others involved in care delivery.

Point-of-care-testing (POCT)

allows for testing and diagnosis at the patient's side and can be conducted anywhere the patient is, such as the home, physician office, ambulance, or hospital bedside. This technology allows for quick, on-the-spot testing, with immediately available results. Additionally, these results can be downloaded directly into the EHR through interface engines. This decreases the risk of error in manually entered results, and the results are immediately available to caregivers for making treatment decisions.

Bioethical standards

bioethical decision-making model centers on the healthcare professional's implicit agreement with the patient or client (1) autonomy, (2) freedom, (3) veracity, (4) privacy, (5) beneficence, and (6) fidelity.

DICOM (think digital)

is a messaging standard that is used to communicate diagnostic and therapeutic information on digital images and associated data.

Data Mapping

is defined as the process of linking interoperable components from one system to another, involving mapping "one component to another," and is an essential component for interoperability (McBride, Gilder, Davis, & Fenton, 2006). The International Organization for Standardization (ISO) defines data mapping as "the process of associating concepts or terms from one coding system to concepts or terms in another coding system and defining their equivalence in accordance with a documented rationale and a given purpose" Each map originates from a data or code set known as the source. The code or data set in which one is attempting to find a code or data representation with an equivalent meaning is known as the target.

Syndromic surveillance

mechanism that is used to identify disease clusters early, before diagnoses, to confirm and report findings to public health agencies

Translation Memory

reuses past translations to improve translation productivity. It works by splitting text into short segments and storing their translations in a database. Whenever a segment is repeated, the translator can reuse a fitting previous translation, or sometimes paste a translation of a similar segment with minor edits.