NR599 Informatics Midterm

Computerized medical records, often stored on a centralized server. What is the longitudinal electronic record of patient health information produced by encounters in one or more care settings?

Electronic Medical Records

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.

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 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 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 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 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 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.

1. Informatics competencies are essential in a healthcare delivery system that is not only heavily dependent upon HIT but attempting to use it as a means to transform healthcare delivery. 2.NI has implications for all areas of nursing practice including advanced practice because it supports all areas of nursing practice as well as healthcare consumers and other healthcare professionals. 3. The phenomena of NI interest are the structures and processing of data, information, and knowledge; it is not enough to use technology it needs to be used well to avoid negative consequences

General principles of Nursing Informatics:

Improve health of populations, communities, families and individuals by optimizing information management and communication

Goal of nursing informactics

Ethical Decision Making

1. Clarify the ethical dilemma 2. Gather additional data 3. Identify options 4. Make a decision 5. Act 6. Evaluate

HITECH strengthened HIPAA security and privacy rules and provided monies and incentives to increase the adoption of EHRs that meet eligibility requirements for Meaningful Use. Health Information Technology for Economic and Clinical Health - 2009Promotes adoption and meaningful use of health IT Title XIII of the American Recovery and Reinvestment Act, which was enacted in February 2009. 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 users."

HITECH Act

the use of various forms of technology to improve the quality of health services to individuals and communities Hardware, software, integrated technologies or related licenses, intellectual property, upgrades, or packaged solutions sold as services that are designed for or support the use by healthcare entities or patients for the electronic creation, maintenance, access, or exchange of health information

Health Information Technology

HIPPA

Health Insurance Portability and Accountability Act protection of personal health information (PHI) 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

a person's capacity to learn about and understand basic health information and services, and to use these resources to promote one's health and wellness Recognizing when information is needed and having the ability to locate, evaluate, and effectively use the needed information. An intellectual framework for finding, understanding, evaluating, and using information.

Health literacy

Nurses must practice to the fullest extent of their levels of education and experience. Redesign of nursing education to promote a seamless progression for nurses seeking higher levels of education and training. Nurses must be full partners with other healthcare professionals in healthcare redesign. Better data collection and information structures are needed to inform effective workforce planning and policy.

Changes nurses need to make to be a full partner in the healthcare delivery process

computerized programs used within the health care setting to support decision making

Clinical Decision Support Systems

how the human mind works from an information processing perspective. Branch of engineering (application of science) that studies the theoretical foundations of information and computation and their implementation and application in computer systems. The study of storage/memory, conversion and transformation, and transfer or transmission of information in machines— that is, computers—through both algorithms and practical implementation problems. Algorithms are detailed, unambiguous action sequences in the design, efficiency, and application of computer systems, whereas practical implementation problems deal with the software and hardware.

Cognitive Science

theory underpinning information and computation and their implementation in computer systems

Computer science

Risk-based E&M Codes

History Physical Medical Decision Making (MDM)

The portion of the assistive technology system with which the user interacts The hardware and software through which the user interacts with any technology (e.g., computers, patient monitors, telephone).

Human Technology Interface (HTI)

three main components in determining the E&M code:

Hx, PE, and MDM

Additionally, health care providers must be able to determine what information is needed, utilize the appropriate resources to find the information, use valid resources to critique the information, provide evidence-based care based on this information, and evaluate the outcomes of the process.

In addition to the 3 TIGER competencies, healthcare providers must be able to what?

Nurses need to know how to use a computer, compare data across time, look for patterns in ct responses to tx

Informatics Competencies

use of digital technology to locate, navigate, manage, integrate, evaluate, create, and effectively communicate in a rapidly changing information environment in the pursuit of knowledge. Determine the extent of information needed Access the needed information effectively and efficiently Critically evaluate the procured information and its sources, and as a result, decides whether or not to modify the initial query and/or seek additional sources and whether to develop a new research process Use information effectively to accomplish a specific purpose Understand the economic, legal, and social issues surrounding the use of information and access and use information ethically and legally

Information Literacy Competency Standards for Nursing

is a set of abilities allowing individuals to "recognize when information is needed and how to locate, evaluate, and use effectively the needed information." use of digital technology to locate, navigate, manage, integrate, evaluate, create, and effectively communicate in a rapidly changing information environment in the pursuit of knowledge. Recognizing when information is needed and having the ability to locate, evaluate, and effectively use the needed information. An intellectual framework for finding, understanding, evaluating, and using information.

Information literacy

the retrieval and management of information as well as human-computer interaction. The science of information, studying the application and usage of information and knowledge in organizations and the interfacings or interaction between people, organizations, and information systems. An extensive, interdisciplinary science that integrates features from cognitive science, communication science, computer science, library science, and social sciences

Information science

cognitive science

Interdisciplinary field that studies the mind, intelligence, and behavior from an information processing perspective.

Information that is synthesized so that relationships are identified and formalized The awareness and understanding of a set of information and ways that information can be made useful to support a specific task or arrive at a decision; abounds with others' thoughts and information. Information that is synthesized so that relationships are identified and formalized. Understanding that comes through a process of interaction or experience with the world around us. Information that has judgment applied to it or meaning extracted from it. Processed information that helps to clarify or explain some portion of our environment or world that we can use as a basis for action or upon which we can act. Internal process of thinking or cognition. External process of testing, senses, observation, and interacting.

Knowledge

-Has fundamental information management and computer technology skills. -Uses existing information systems and available information to manage practice.

Level 1

Has proficiency in a domain of interest (e.g., public health, education, administration).- - Highly skilled in using information management and computer technology skills to support their major area of practice. -Sees relationships among data elements and makes judgments based on trends and patterns within these data. -Uses current information systems but collaborates with the informatics nurse specialist to suggest improvement to systems.

Level 2- Experienced Nurse

An RN with advanced preparation possessing additional knowledge and skills specific to information management and computertechnology.* Focuses on information needs for the practice of nursing, which includes education, administration, research, and clinical practice.* Practice is built on the integration and application of information science, computer science, and nursing science.* Uses the tools of critical thinking, process skills, data management skills (including identifying, acquiring, preserving, retrieving,aggregating, analyzing, and transmitting data), systems development life cycle, and computer skills

Level 3- Informatics Nurse Specialist

Educationally prepared to conduct informatics research and generate informatics theory.* Has a vision of what is possible and a keen sense of timing to make things happen.* Leads the advancement of informatics practice and research.* Functions with an ongoing, healthy skepticism of existing data management practices and is creative in developing solutions.* Possesses a sophisticated level of understanding and skills in information management and computer technology.* Understands the interdependence of systems, disciplines, and outcomes, and can finesse situations to maximize outcomes

Level 4- Informatics Innovator

The set of standards defined by the Centers for Medicare & Medicaid Services (CMS) Incentive Programs that governs the use of EHRs and allows eligible providers and hospitals to earn incentive payments by meeting specific criteria Established to-Improve quality, safety, and efficiency-Engage patients and families in care-Improve coordination of care-Improve public and population health-Ensure privacy and security The American Recovery and Reinvestment Act of 2009 specifies three main components of meaningful use: (1) the use of a certified electronic health record (EHR) in a meaningful manner, such as e-prescribing; (2) the use of certified EHR technology for electronic exchange of health information to improve quality of health care; and (3) the use of certified EHR technology to submit clinical quality and other measures. The criteria for meaningful use will be staged in three steps. Stage 1 (2011-2012) set the baseline for electronic data capture and information sharing. Stage 2 (2013) and Stage 3 (expected to be implemented in 2015) continue to expand on this baseline and be developed through future rule making.

Meaningful Use (MU)

Cybersecurity

Measures taken to protect a computer or computer system against unauthorized access or attack

3rd component to E&M

Medical Decision Making Risk Data Dx

Nursing Informatics

Nursing Informatics: defined as a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, knowledge, and wisdom in nursing practice o Building Blocks of Nursing Informatics: § Information Science § Cognitive Science § Computer Science § Nursing Science

Data, Information, Knowledge, Wisdom

Nursing informatics focuses in what four concepts?

E&M Codes

Outpatient-Office Visit NewEstablished Minimal/RN visit99201 & 99211 Problem focused99202 & 99212 Exp. problem focused99203 & 99213 Detailed99204 & 99214 Comprehensive99205 & 99215

augment traditional approaches to health information management with specific functions designed to support patient participation in health care decision making and treatment activities.

Patient-centered Information Systems

Basic Data Capturing and Sharing Certified EHRs must have elctronic exchange of perscriptions (ePrescriptions) Ability to capture and report quality metrics

Phase 1 of MU under HITECH act

Advancing Clinical Processes" Patient Centerdness" Increased capacity to exchange data

Phase 2 of MU

Improved Outcomes More structured data, better reporting, better exchange of data across states, etc **Technical standards to support population health standards while still using patient centered care

Phase 3 of MU

Reimbursement Coding

Reimbursement codes are assigned contingent upon data input from clinical team members based on a summative review of the clinical record by trained coders.

Confidentiality

Respecting the privacy of both parties and keeping details secret

The scientific underpinnings of practice provide the basis of knowledge for ad- vanced nursing practice. These scientific underpinnings include sciences such as biology, physiology, psychology, ethics, and nursing.

Scientific Underpinning

A standardized nursing terminology is a nursing terminology that is in some way approved by an appropriate authority (de jure standardization) or by general consent (de facto standardization). 1. Standardized terminologies (STs) are structured, controlled languages developed to represent concepts in a given domain in a clear, unambiguous fashion. 2. The STs enable the representation, communication, exchange, reuse, and reporting of data, information, and knowledge that are key to the development of an EHR and health information exchange. 3. There are multiple benefits associated with ST adoption and use that include improved communication, data-reuse, and improved processes and patient outcomes. 4. Nurse leaders have an obligation to understand the potential benefits and issues surrounding the adoption and use of STs and to advocate for their use.

Standard Terminology

Basic Computer competenices Information literacy Information management

TIGER competencies

The Technology Informatics Guiding Education Reform (TIGER) Initiative (2009), compiled and posted a list of competencies on its website that every nurse should display. TIGER continues its focus on the use of informatics and technology to make healthcare safer, more effective, efficient, patient-centered, timely and equitable by interweaving evidence and technology seamlessly into practice, education and research fostering a learning healthcare system and is a useful resource

TIGER-based Nursing Informatics Competencies Model

The basis for which knowledge is used to meet the needs of the healthcare delivery system It is derived from its 3 key elements of knowledge acquisition, knowledge generation, knowledge processing, and knowledge dissemination Model proposing that humans are organic information systems constantly acquiring, processing, generating, and disseminating information or knowledge in both their professional and personal lives

The Foundation of Knowledge Model

patient safety

The number one focus of EHR as stated by the IOM?

Mobile apps that are generic aids or general purpose products.

These apps are not considered devices because they are not intended for use in the diagnosis of disease o

Mobile apps that are intended to provide access to electronic "copies" (e.g., e-books, audio books) of medical textbooks or other reference materials with generic text search capabilities.

These apps are not devices because they are intended to be used as reference materials and are not intended for use in the diagnosis of disease

Mobile apps that automate general office operations in a health care setting

These apps are not intended for use in the diagnosis of disease or other conditions

Mobile apps that are intended for general patient education and facilitate patient access to commonly used reference information. These apps can be patient-specific (i.e., filters information to patient-specific characteristics), but are intended for increased patient awareness, education, and empowerment, and ultimately support patient-centered health care.

These are not devices because they are intended generally for patient education, and are not intended for use in the diagnosis of disease

Telehealth

Use of technology to deliver health-related services and information, including telemedicine

data

What are raw facts that lack meaning?

Computer science, nursing science, information science

What are the three sciences that nursing informatics utilized in the definition?

What is the ability to apply appropriate use of knowledge to manage and solve human problems?

Wisdom Knowledge applied in a practical way or translated into actions; the use of knowledge and experience to heighten common sense and insight so as to exercise sound judgment in practical matters. Sometimes thought of as the highest form of common sense, resulting from accumulated knowledge or erudition (deep, thorough learning) or enlightenment (education that results in understanding and the dissemination of knowledge). Wisdom is the ability to apply valuable and viable knowledge, experience, understanding, and insight while being prudent and sensible. It is focused on our own minds; it is the synthesis of our experience, insight, understanding, and knowledge. Wisdom is the appropriate use of knowledge to solve human problems. It is knowing when and how to apply knowledge.

Multiple false alarms by smart technology causing workers to ignore or respond slowly to them.

alarm fatigue

Bioethical Standards

are lenses to analyze and understand ethical situations; they make it possible to resolve ethical dilemmas and to see and understand other people.

Mobile apps that are intended for healthcare providers to use as educational tools for medical training or to reinforce training previously received.

are not devices because they are intended generally for user education and are not intended for use in the diagnosis of disease

To identify established or new patient?

been seen in the last 3 years, established patient

a generation of people born after 1982 who have been raised in a digital age typically born after 1982 and may also be referred to as "Generation Y." This generation prefers to learn using technology and learns quite well if information is presented in a format to which they are accustomed, such as an interactive video game to introduce them to a topic. This group is also comfortable using information that they can access via their handheld devices, such as smartphones and tablets, as well as wearable devices such as smartwatches. Those born before 1982 have learning styles that range from preferring to learn in a classroom setting to reading a book about the topic to learning using a hands-on, interactive approach

digital natives

6 bioethical standards

fidelity beneficence self-assertion objectivity freedom and autonomy.

FDA Oversight for Medical Devices

oversees the safety of medical devices addressing the management of cybersecurity risks and hospital network security. introduction of malware into the medical equipment or unauthorized access to configuration settings in medical devices and hospital networks.

ICD-10 Coding

shorthand for the patient's diagnose s , which are used to provide the payer information on the necessity of the visit or procedure performed . This means that every CPT code must have a diagnosis code that corresponds.

Workflow analysis

study of the way work moves through an organization

privacy

the right of people not to reveal information about themselves

Medical Applications

these 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.

Evaluation and Management Coding

you must first identify the p lace of service, type of service , and the patient status