Midterm Final

Beauchamp and Childress (1994) proposed four guiding principles

(1) respect for autonomy, (2) nonmaleficence, (3) beneficence (4) justice.

Five-Rights Framework for Success of Clinical Decision Support 1. Right information 2. Right person 3. Right CDS intervention format 4. Right channel 5. Right point in the workflow

1. Evidence-based and actionable information constitutes the "what" 2. constitute the correct individuals impacted by the CDS program-the "who". 3. what the end-user sees a. order sets, algorithms, and alerts define the "how" 4. The vehicle for delivering the CDS program, such as the EHR, smartphones or mobile Apps-the "where". 5. The process when clinical care is delivered that will be impacted by the CDS program - the "when".

List some Apps NOT Considered Medical Devices

1. Mobile apps that are intended to provide access to , e-books, audio books or other reference materials 2. a portal for healthcare providers to distribute educational information to their patients 3. Apps that help match patients with potentially appropriate clinical trials 4. Mobile apps that automate billing codes like ICD-10 or Insurance claims processing apps to detect fraud

List mobile apps for which the FDA (2013) intends to exercise enforcement discretion

1. Mobile apps that provide or facilitate supplemental clinical care, by coaching or prompting, to help patients manage their health for specific diseases such as CV, DM or HTN 2. Mobile apps that provide information to patients' health conditions or treatments beyond a medical reference IE: best practice treatment guidelines influenza; or drug-allergy look-up tools 3. Mobile apps that perform simple calculations routinely used in clinical practice- IE: calculators for Body Mass Index (BMI), Total Body Water / Urea Volume of Distribution, or drug dosing schedules for warfarin dosage, based on INR

telehealth" is intended to encompass three broad methods of digital care delivery that are "away" from the patient Explain each

1. Telemedicine 2. Remote management/monitoring/coaching 3. Mobile health (mHealth)

Home Telehealth Software 1. · Trending 2. · Triage 3. · Communications 4. · Data Access and Information Sharing

1. Telemonitoring that creates a record over time 2. sets an acceptable range of values such as oxygen saturation ect. More sophisticated SW looks at readings from multiple equipment. helps clinicians organize their work and arrange for appropriate interventions. 3. systems that have the capacity to communicate back to the patient or seek additional information 4. telemonitoring systems house information in Web-based formats

1. What is the FDA's role in regulating Mobile Devices and Apps? 2. · In 2013, the FDA released its final guidance entitled "Mobile Medical Applications Guidance Explain

1. The (FDA) oversees medical applications and assesses their potential misuse or malfunction in order to reduce these risks to the public 2. The guidance offers clear distinction between an unregulated "mobile application" and a "mobile medical application" which are subject to overt FDA regulation

Examples of telemonitoring include the following, define them: 1. Telephone triage 2. a tele-intensive care nurse

1. a "process between the nurse and the client that occurs over the telephone and involves identifying the nature and urgency of client health care needs and determining the appropriate disposition 2. · These nurses provide expert consultation for patients in rural ICUs by examining real-time data collected at the bedside. · there are three practice models: o Continuous Care Model: monitoring of the patient without interruption o Scheduled Care Model: occurs during patient rounds. o Responsive (Reactive) Care Model: prompted by an alert

Authentication of Users is broken down into 1. Something a user knows such as 2. something the user has 3. something the user is includes

1. a password 2. an identification (ID) card 3. biometrics. § Devices that recognize thumbprints, retina patterns, or facial patterns

Clinical uses for telehealth technologies and clinical apps include the following: 1. Transmitting images for assessment or diagnosis 2. Transmitting clinical data for assessment, diagnosis, or disease management 3. Providing disease prevention and promotion of good health 4. Using telephonic or video interactive technologies to provide health advice in emergent cases 5. Using real-time video

1. digital images, such as images of wounds for assessment and treatment consults 2. remote patient monitoring and transmitting patients' objective or subjective clinical data, such as vital signs and answers to disease management questions 3. case management provided via telephone or smartphone app and patient education 4. performing teletriage in call centers such as real-time stroke consultation between a rural health center and an academic medical center 5. exchanging health services or education live via videoconference

List Legal Nursing Implications in light of the HITECH laws 1. the sanctions imposed by the OCR, violations can lead to 2. state laws require reporting violations to 3. other laws require reporting 4. State Boards of Nursing have the authority

1. disciplinary actions by employers and professional licensing boards, as well as litigation 2. prospective employers of the nurse 3. to the State Board of Nursing 4. to publicly discipline a nurse who has engaged in professional misconduct

ID the acronym ETHICAL for ethical decision making 1. Examine the 2. Thoroughly comprehend the 3. Hypothesize 4. Investigate, compare, and evaluate 5. Choose the alternative 6. Act on 7. Look at the ethical dilemma and

1. ethical dilemma (conflicting values exist). 2. possible alternatives available 3. ethical arguments 4. the arguments for each alternative 5. you would recommend 6. your chosen alternative 7. · examine the outcomes while reflecting on the ethical decision

Define HIPPA and the legislative changes it brought 1. Defined protected health information as 2. Propose that authorization by patients 3. Establish patient ownership

1. information relating to one's physical health that has been maintained or transmitted electronically and that can be reasonably identified with the individual it applies to 2. for release of information is not necessary when info is directly related to treatment 3. of the healthcare record and allow for patient-initiated corrections and amendments

1. Bioinformatics provides what 2. This input would certainly be potent—but

1. it can gather, manipulate, classify, analyze, synthesize, retrieve, and maintain databases related to ethical cases 2. the resolution of dilemmas cannot be achieved simply by examining relevant cases from a databasethe

Tools of Home Telehealth (Define the following) 1. Def Peripheral biometric (medical) devices: 2. Telephones 3. ·Videocameras and Videophones 4. ·Personal Emergency Response Systems

1. measurement devices, such as blood pressure cuffs pulse oximeters, ect. that transmit patient data to a central server location 3. limited by the bandwidth favors the use of such images for assessment rather than diagnostic-quality images 4. signaling devices worn as a pendant when quickly access to emergency care is needed

2016 was a banner year for CMP (civil monetary penalties) between the OCR and organizations List common theme violations 1. Incomplete or nonexistent risk analyses 2. Failure to have adequate 3. Delayed reporting of 4. Weak auditing processes

1. of HIPAA privacy and security policies and procedures 2. business associate agreements (BAAs) in place 3. breach notification to the OCR 4. designed to detect, prevent, and mitigate HIPAA violations

Explain The Privacy Rule and the Security Rule - effective in 2005 1. Under the Privacy Rule 2. Under the Security Rule

1. patients have a right to expect privacy protections that limit the use and disclosure of their health information 2. providers are obligated to safeguard their patients' health information from improper use or disclosure, maintain the integrity of the information

1. Beneficence 2. Justice 3. Distributive justice refers to

1. refers to actions performed that contribute to the welfare of others 2. refers to fair, equitable, and appropriate treatment in light of what is due or owed to a person 3. · to fair, equitable distribution in society determined by norms o distributive justice is the major ethical principal underlying health-reform initiatives.

1. Autonomy 2. Nonmaleficence 3. Negligence (falls within nonmaleficence, explain)

1. refers to the individual's freedom from controlling interferences by others and from personal limitations that prevent meaningful choices, such as adequate understanding 2. asserts an obligation not to inflict harm intentionally and forms the framework for the standard of due care 3. a departure from the standard of due care toward others—includes intentionally imposing risks that are unreasonable and unintentionally but carelessly imposing risks.

Driving Forces for Telehealth 1. demographics 2. nursing and healthcare worker shortages 3. chronic diseases and conditions 4. the new, educated consumers 5. excessive costs of healthcare services

1. rising baby boomer's until 2025 2. there's a paradoxical trend looming a greater need for nurses and a significant decrease in the number of young people entering the nursing profession 3. Chronic conditions are the leading cause of illness accounts for more than 80% of healthcare expenditures 4. Today's burgeoning senior population, in particular, has become quite vocal about aging in place at home

Rules are more restrictive in scope than principles and are more specific in content 1. Substantive rules are 2. Authority rules 3. Procedural rules

1. rules of truth-telling and fidelity, and those pertaining to omitting treatment, physician-assisted suicide, and informed consent 2. indicate who may and should perform actions 3. establish procedures to be followed

1. the HITECH Act strengthens the enforcement of HIPAA. Explain 2. Before enactment of the HITECH Act, the federal government alone enforced HIPAA

1. stiffer civil monetary penalties (CMP) for violations of HIPAA became effective as soon as the HITECH Act became law in February 2009 2. Now, state attorneys general can play a significant role in the enforcement and prosecution of HIPAA violations

Store-and-forward, or asynchronous telemedicine involves real-time, or synchronous, telemedicine mainly includes Examples of telemedicine include:

1. the exchange of prerecorded data between two or more individuals at different times 2. videoconferencing, Telemental health, Telerehabilitation and Telehome care 3. · teledermatology, telepathology, and teleradiology

1. An ethical dilemma arises when 2. Morals refer to

1. when moral issues raise questions that cannot be answered with a simple, clearly defined rule, fact, or authoritative view. 2. social convention about right and wrong human conduct

A partial list of ethical issues includes the following 1. Inappropriate access to PHI 2. Lack of regard to data integrity 3. Failure to adopt 4. Failure to actively participate 5. Failure to engage in 6. Failure to recognize and use 7. Failure to keep informed of emerging

1. without a need to know 2. such as discrepancies are noted but no corrective action is taken 3. technology or use it adeptly 4. in the selection, use, and/or evaluation of technology 5. policy discussions that impact healthcare delivery 6. technology to advance the profession 7. developments and issues

Human Factors Design Principles takes into account basic principles. 1. Alert philosophy 2. Prioritization of alerts 3. Tailored interfaces 4. Hard stops:

1. · Develop an approach to "categories of problems" and how many priorities there should be for each category of risk." 2. Alerts should be developed with levels for low, medium, and high 3. to the end user 4. Use these types of alerts minimally and cautiously

on April 21, 2005, covered entities had to put administrative, physical, and technical safeguards of protected health information into place. Define each

1. · The administrative safeguards refer to the documented formal policies and procedures 2. The physical safeguards refer to the policies and procedures that must be in place to limit physical access to electronic information systems 3. · Technical safeguards are the policies and procedures used to control access whether the data and information are at rest, in storage, being processed or being transmitted in a network

The HITECH Act Enhanced HIPAA Protections. Explain 1. USDHHS is to provide annual guidance 2. HIPAA requirements now apply directly to any 3. The rules that pertain to providing an accounting to patients 4. Enforcement of HIPAA 5. protections under the Privacy Rule for genetic information

1. · about how to secure health information. 2. business associates of a covered entity 3. · who want to know who accessed their health information have changed 4. has been strengthened 5. are required by the GINA (genomics privacy law)

Tools of Home Telehealth (Define the following) 1. Sensor and activity-monitoring systems 2. Medication management devices 3. Special Needs Telecommunications-Ready Devices

1. · can track activities of daily living of seniors and other at-risk individuals in their place of residence such as bathroom usage, sleep disturbance ect., other sensors can detect whether a household appliance is left on 2. Some remind a person to take medications, others are pill organizers with audible reminders, and some can be programmed to dispense meds and alert a patient of a missed dose. 3. multifunctional infusion pumps including meds for pain management, hydration and nutrition; peak flow meters; electrocardiograms ect

Define HIPPA and the legislative changes it brought 1. Mandate administrative requirements 2. Mandate that all outside 3. Allow protected health information to be released 4. Propose that protected health information 5. This section also addressed

1. · for the protection of healthcare information o including training programs for employees, a signed certification and Sanctions for violations 2. entities that conduct business with healthcare organizations must meet the same standards 3. without authorization for research studies 4. may be deidentified before release 5. covered entities who transmit any health information in electronic form

Approaches to making ethical decisions 1. The casuist approach 2. The Husted bioethical decision-making model centers on

1. · grew out of the call for more concrete methods of examining ethical dilemmas. - A casuist approach prefers particular and concrete paradigms over the universal theories of principlism. 2. · the healthcare professional's implicit agreement with the patient or client and is based on bioethical standards

Approaches to making ethical decisions 1. The virtue ethics approach emphasize 2. A virtue is any characteristic 3. The consensus-based approach

1. · the ideal situation and attempt to identify and define ideals. 2. or disposition desired in others or oneself. and refers to what one expects of oneself and others 3. o Applys diverse ethical insights can be integrated to support a particular bioethical decision § including principles, circumstances, character, interpersonal needs, and personal meaning.

· In the early stages of workflow redesign, the team should define high-level steps of the process. Explain

Avoid focusing on process steps in great detail as team members may get bogged down by focusing on details it may be useful to construct the process map using a swim-lane technique

Def Process analysis

Breaking down the work process into a sequential series of steps that can be examined and assessed to improve effectiveness and efficiency; explains how work takes place, gets done, or how it can be done Unfortunately, many nurses find themselves in an informatics capacity without sufficient preparation for a process analysis role

The terms efficient and effective are widely known in Six Sigma and Lean Define them

Effective delivery of care or workflow suggests that the process or end product is in the most desirable state An efficient delivery of care or workflow would mean there is little waste

To move from the current state to the future state, gap analysis is necessary. Explain

Gap analysis zeros in on the major areas most affected by the change—namely, technology- to avoid recreating the old process or IS

Challenges with POCs include

Mobile Access of POCs · Management of "dead" spots, where the Wi-Fi is inaccessible, slow, or drops POC Data Reliability and Validity - with POC testing, the competence of the clinician to obtain the test and validate the data must be ensured

workflow analysis The term workflow is sometimes used interchangeably with

Observation and documentation of workflow to better understand what is happening in the current environment work process, process, or process flows

USE OF CDS TO ALIGN IMPROVEMENT INITIATIVES Describe qualitative and quantitative measures and give examples

One qualitative evaluation strategy is to survey the stakeholders most impacted by clinical workflow changes. · Does the CDS program interfere with patient care Quantitative measures can include control charts and various tools - pay-for-performance programs and accreditation requirements

Standards-developing organizations Def

Organizations that create guidelines, standards, and rules to help healthcare entities collect, store, manipulate, dispose of, and exchange secure protected health information - HL7 is an SDO

More EHR-related claim events occurred in

Orthopedics, emergency medicine, and obstetrics/gynecology showed increases

Two tools available to CDS teams are: predictive analytics prescriptive analytics. Define them

Predictive analytics take the available data and apply logic or algorithms to calculate the likelihood of an event. Ie: A fall risk tool Prescriptive analytics are intended to lead the clinician on a defined pathway to address the identified issue. Can look at hundreds of data points Ie: a weighted sepsis risk score

Before the HITECH Act, HIPAA regulations provided an exception to the accounting requirements to patients known as the treatment/payment/operations (TPO) exception, Explain

Providers and other covered entities were not required to include in the accounting any disclosures that were made to facilitate treatment/payment/operations the TPO exception ended in January 2014

Information-based liability is an important issue for all clinicians. Explain

Providers could potentially be held liable for failing to access a computerized medical database, failing to use available CDS SW, or using this technology in an improper, inexpert, or inappropriate fashion

What is the FDA's goal in light of the Mobile Medical Applications Guidance?

The FDA intends to apply its regulatory oversight to only those mobile apps that are medical devices and whose functionality could pose a risk to a patient's safety if the mobile app were to not function as intended

the goal of workflow redesign is to capture enough details to accurately portray the process. Explain

The future-state workflow planning will be only as good as the reliability of the current state it is crucial to understand what is happening in the current state

Nursing Aspects of Telehealth · while telehealth leads to less time being wasted on non-care-oriented tasks its use must never be associated with less care. nursing activity in telehealth still follows the same best-practice standards Vital signs alone are not the answer. Explain

There's increased risk of hospitalization based on issues that are not vital sign related · The proposed solution to this large and growing problem is telehealth remote patient management focused on risk—not symptoms, not vital signs.

a healthcare organization has computers linked together to facilitate communication and operations within and outside the facility Define this

This is commonly referred to as a network

CDS can reinforce guidelines established nationally to address patient safety, quality, and population health. Give two examples

Vaccination adherence CV disease adherence protocols -such as the Million Hearts Campaign

· Variation in workflow is considered the enemy of all good processes. Explain

Variation occurs when workers perform the same function in different ways. It usually arises because of flaws in the way a process was originally designed

o Nurses and other healthcare workers who use social media must be aware that the overlapping of networks may unintentionally create privacy and confidentiality breaches. Explain

Where once it was relatively easy to separate work relationships from friends and family, networked communities tend to overlap, blurring the boundaries between them · Nurses sometimes use social network sites or blog about the patients they care for believing that if they omit the patient's name, they are not violating the patient's privacy this is FALSE

CDS tools often have unintended consequences The most vexing problem is: one way to address unintended consequences is to consider

alert fatigue' ·Human Factors design principles

The Privacy and Security Rules also mandate entities

are to conduct regular audits to ensure compliance and any breaches in the privacy or security of PHI must be remedied immediately

Principles are considered From principles, one can develop more detailed rules and policies

broad guidelines that provide guidance or direction but leave substantial room for case-specific judgment

As health care continues its journey into digital communications, telehealth and other HIT innovations Ethical decision-making frameworks will remain constant, but the

context for examining these moral issues or ethical dilemmas will become increasingly complex

The confidentiality policy should clearly watching over someone's back as that person is working, is still a major way that confidentiality is compromised and is called

define which data are confidential and how those data should be handled Shoulder surfing

·1. mHealth-Define 2. Figure 16.7 illustrates the distribution of mHealth app categories with what 3 categories being the largest?

defined as generation, aggregation, and dissemination of health information via mobile and wireless devices such as mobile phones, tablets, and PDAs 2. fitness, medical references, and wellness being the largest o 84% of the total mHealth application market revenue will come from products such as sensors

Covered entities include

hospitals and other healthcare providers that transmit any health information electronically, as well as health insurance companies and healthcare clearinghouses

MACRA mandates, the need to collect data to demonstrate improvement in:

in workflow after implementation or redesign efforts and the impact of technology on patient outcomes

Availability refers to

network information being accessible when needed accessibility policy covers issues associated with protecting the key hardware elements of the computer network o Examples include food and drinks spilled onto keyboards of computer units outage or a weather-related disaster or plans for data backup, storage, and retrieval

the HIMSS conducted a survey indicating (blank) were identified as the most significant resource in a project team that influences adoption and change management

nursing informaticists

Legal, Ethical, and Regulatory Issues of Telehealth · interstate practice of telenursing, for example, requires attending nurses to be licensed to practice in all of the states in which they provide telehealth services ID a possible solution to this?

o A possible solution is the development of Interstate Medical Licensure Compact (IMLC) and Nurse Licensure Compact (NLC) to facilitate portability of licensure across state lines

Central stations, Web servers, and portals are various terms for the technologies presently used as part of telehealthcare platforms Define each

o Central stations: Multifunctional telehealthcare platforms for receiving, retrieving, and/or displaying patients' vital signs ect transmitted from telecommunications-ready medical devices. o Web Servers: telemonitoring systems house information in Web-based formats. o Portals: Tools for organizing information from webpages into simple menus on one's desktop. Also function similar to central stations § They allow clinicians to build personal medical records for patients § They allow remote programing of medical devices

CDS tools include but are not limited to:

o computerized alerts and reminders for providers and patients o drug-drug interaction alerts o underdose or overdose alerts based on renal or liver function or age or drug levels o actionable clinical guidelines o condition-specific order sets o focused patient data reports and summaries o diagnostic support o contextually relevant reference information.

· The three main areas of secure network information are

o confidentiality, o availability o integrity

· Opponents of principlism claim that (those that support antiprinciplism)

o principles are too far removed from the concrete particularities of everyday human existence; - are too intangible and abstract and do not take into account a person's psychological factors, personality, life history ect.

Theoretical Approaches to Healthcare Ethics · Pellegrino (1993) traced the evolution of healthcare ethics from List the three principles approaches

o the Hippocratic ethic, o to principlism, o to the current antiprinciplism movement.

· An app is defined as a medical device and may be subject to regulation by the FDA when:

o the intended use of a mobile app is for the diagnosis of a disease or other conditions, or the cure, mitigation, treatment, or prevention of disease o if it is intended to affect the structure or function of the body of man

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 antiprinciplism movement emerged in the 21st century in response to what?

the expansive technological changes and the tremendous rise in ethical dilemmas

the best method of workflow design is the one that complements

the organization and supports the work of clinician

Metrics provide an understanding about? Process metrics are Examples of Metrics

the performance of a process or function. are collected at the initial stage are then benchmarked against internal indicators. · Turnaround times · Cycle times · Throughput · System availability · Patient satisfaction Employee satisfaction

a key role of nursing informatics (NI) with CDS is to be able

to articulate to end users what CDS can and cannot do effectively. · often clinicians think they want something until they learn what the downside of their request is

MACRA measures will push healthcare organizations

to focus on quality payment program (QPP) For an organization that seeks to meet these measures, they must be gathered and reported on electronically—necessitating the use of technology

Explain the Stage 2 of MU HITECH requirements for the Security Act of HIPPA

· In stage 2, requirements increase with the expectation that encryption/security of data stored in the certified EHR technology be addressed in accordance with the HIPAA Security Rule - · To meet MU requirements, all CEs must conduct a risk assessment

ethical codes for e-health websites seem to be increasing consumers' trust in the safety and quality of information found on the Web, but

· It is important to realize that the standards for ethical development of health-related Internet sites are voluntary; there is no overseer

Risk tools/algorithms focus on the following:

· Psychosocial factors · Level of patient engagement · Pharmacy regime—compliance and prescriptions · Number and type of chronic conditions · Symptom trends · Physician assessment findings

· the Internet for healthcare information may prompt entirely new types of ethical issues, such as who is responsible if a patient is harmed as a result of following online health advice. Explain

· Researchers discuss that a clear line separates information and practice. o Practice occurs when there is direct or personal communication between the provider and when there is a reasonable expectation that the patient will act in reliance on the information.

Healthcare are using mHealth to monitor patients at home 90 days after a hospital visit. However, what happens after the hospital takes back its technology?

· Specifically, Honeywell Life Care Solutions is joining forces with mHealth vendor MobileHelp to offer a consumer-facing platform that would allow patients to monitor their vital signs and share them with providers

Social media is defined as

· a group of Internet-based applications that build on the ideological and technological foundations of Web 2.0 and that allow the creation and exchange of user-generated content" and instantaneous communication

Define: Point-of-Care Testing Give Examples

· allows for quick, on-the-spot testing, with immediately available results. · these results can be downloaded directly into the EHR through interface engines. Examples · blood glucose monitoring, iStat, electrolyte tests and tests for laboring patients such as protein and glucose· or Barcode Administration (BCMA)

Moral dilemmas arise with uncertainty,

· as is the case when some evidence a person is confronted with indicates an action is morally right and other evidence indicates that this action is morally wrong.

integrity refers to

· clear policies to clarify how data are actually inputted and who has the authorization to change such data, and track For example, the "floor supervisor" might be authorized to change the hours worked by an employee, whereas the "patient care assistant" cannot make such changes

A well-designed CDS system should provide alerts that are The primary goal of a CDSS is to leverage

· clinically relevant, reduce the likelihood of alert fatigue, and allow clinicians to detect adverse events · data and the scientific evidence to help guide appropriate decision making

Telehealth resource centers (TRCs

· funded primarily by the federal government seeks to expand the availability of healthcare to underserved populations · Nationally, there are 14 TRCs: 12 regional centers, all with different strengths and regional expertise, and two national centers · most geographical areas of the United States are adequately covered.

List examples of POC FDA-approved medical devices

· insulin pumps, · pacemakers, · defibrillators · can be interfaced with EHRs and patient portals.

Ethics Define

· is a process of systematically examining varying viewpoints related to moral questions of right and wrong · ethics refers to standards of right and wrong that prescribe what humans ought to do, ethics refers to the study and development of one's ethical standards

definition of workflow

· is a progression of steps (tasks, events, interactions) that constitute a work process 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.

A typical output of workflow analysis

· is a visual depiction of the process, called a process map.

Bioethics in the 1970s as health care began to change its focus from a mechanistic approach of treating disease to

· is defined as the study and formulation of healthcare ethics. · a more holistic approach of treating people with illnesses.

telehealth Define

· is often used to encompass a broader definition of remote health care that can but does not always include telemedicine. · Telehealth is the use of technology to deliver health care, health information or health education at a distance.

Telemedicine Define

· is the use of medical information exchanged from one site to another via electronic communications to improve patients' health status · falls within telehealth · Telemedicine applications can be classified into two basic types, - Store-and-forward, or asynchronous - real-time, or synchronous, telemedicine

· not all workflow analysis and redesign occurs prior to the implementation When workflow analysis occurs postimplementation

· it is often referred to as optimization.

CDS is not meant to make decisions for the clinician, but rather The "Ansatz conflict" arises when the suggested action from the CDS "best guess—Ansatz" conflicts

· make clinical decisions easier or clearer with the Ansatz arising from the experienced clinician's tacit knowledge

Define mobile platforms

· mobile platforms, include smartphones, tablets, and portable computers.

The Hippocratic tradition emerged from

· relatively homogenous societies shared common values. o The emphasis was on duty, virtue, and gentlemanly conduct.

Principlism arose as societies

· societies became more heterogeneous and members began experiencing a diversity of incompatible beliefs and values; it emerged as a foundation for ethical decision making.

State privacy laws differ widely, sometimes conflicting with and preempting federal privacy regulations by establishing greater protections Explain

· special protection exists for data such as HIV and STDs, mental health records, and information related to minors. · Informatics professionals must be familiar with state laws enforcing potential consequences of sharing data in new models of care such as (ACOs) and (HIEs)

Beauchamp and Childress also suggest three types of rules for guiding actions:

· substantive, · authority · procedural.

workflow design How is it a critical aspect of the informatics role?

· the analysis and redesign of processes and tasks surrounding the use of technology Nursing informatics is uniquely positioned to engage in this; one of the fundamental skills sets that make up the discipline of this specialty