Nursing Informatics
id principle provisions of health information portability and accountability act (HIPAA) related to information security
The Health Insurance Portability and Accountability Act (HIPAA) provides legal protection for personal health information, set standards for electronic data interchange of claims data, and named specific code sets for use in all Medicare-related transactions.
adaption
when a form or structure is modified to fit a changed environment.
information system
the use of computer hardware and software to process data into information to solve a problem
Analyze the potential impact of emerging technologies on healthcare delivery.
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Compare the clinical and non-clinical practice of telehealth.
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analyze how patient data can be used to facilitate quality improvement
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recognize functions of clinical decision support tool
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information processing
cognitive processing theory, how mind functions. acquisition, recording, organization, retrieval, display, and dissemination of information.
assess benefits of using electronic health record system
see handout.
differentiate among various types of health information systems
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objectives
state how and when an organization will meet its goals.
explain how technology can facilitate a culture of safety
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information system technologies used in the healthcare environment
designed to meet needs of one or more depts or fxns within organization. adopt vendor based solutions with little customization to allow implementation to occur quicker. either standalone or work w/ other systems to provide sharing and seamless functionality. seen as the means to achieve improved productivity, safety, increase quality of care, meet regulatory and reimbursement requirements, and reduce costs across the enterprise. IT acheived thru evidence-based care, improved work flow, and better mgt of resources. electronic health records, clinical decision support systems, bedside med administration using + pt id, computerized provider order entry (CPOE), pt surveillance, clinical data warehouse (CDW).
clinical information systems (CISs)
large computerized database management systems that support several types of activities that may include provider order entry, result retrieval, documentation, and decision support across distributed locations. AKA client care information systems. ex. nursing, lab, pharm, radiology, medical information systems, ED systems, physician practice mgt systems, long term and home care information systems
Administrative information systems
support client care by managing financial and demographic information and providing reporting capabilities. includes client mgt, financial, payroll, and HR, and quality assurance systems
nomenclature
set of terms composed according to pre-established rules. NANDA
Explain the effect of socioeconomic factors on the use of telehealth.
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Identify the principle characteristics of various types of telehealth.
Telehealth:is the use of telecommunications technologies and electronic information to exchange healthcare information and to provide and support services such as long-distance clinical healthcare to clients. Telehealth is an expansion of telemedicine with preventive, promotive, and curative applications widely used by members of the healthcare community. • Continuity of care. Clients can stay in the community and use their regular healthcare providers. • Centralized health records. Clients remain in the same healthcare system. • Incorporation of the healthcare consumer as an active member of the health team. The client is an active participant in videoconferences. • Collaboration among healthcare professionals. Cooperation is fostered among interdisciplinary members of the healthcare team. • Improved decision making. Experts are readily available. • Education of healthcare consumers and professionals. Offerings are readily available. • Higher quality of care. Access to care and access to specialists is improved. • Removes geographic barriers to care. Clients living away from major population centers or in economically disadvantaged areas can access care more readily. • May lower costs for healthcare. Eliminates travel costs. Clients are seen earlier when they are not as ill. Treatment may take place in local hospitals, which are less costly. • Improved quality of health record. The record contains digitalized records of diagnostic tests, biometric measures, photographs, and communication.
Recognize important historical developments in the evolution of telehealth
The American Recovery and Reinvestment Act of 2009 provides for billions of dollars in stimulus funding for research, operations, and grants in the telemedicine, telehealth, and informatics sectors. More than 24 government agencies provide grant monies to fund telehealth, telemedicine, and health information technologies, including the U.S. Departments of Health and Human Services, Homeland Security, Defense, Veterans Affairs, Commerce, Agriculture, Energy, Justice, Interior, Education, Labor, State, and Transportation. There are also private, nonprofit, national, and global groups such as the Center of Excellence for Remote and Medically-Underserved Areas and the Acumen Fund that use entrepreneurial approaches to solve health services problems.
INCP
The International Classification for Nursing Practice (ICNP), a common code language for data, falls under the professional practice arena. The ICNP is extremely important for meaningful exchange of electronic data in a format that retains its meaning across settings and countries.
explain how health information systems promote or inhibit collaboration among healthcare teams or patients
Well-designed systems can allow for improvements in patient safety, the number of errors, data entry, information displays, and information interpretation, and contribute to sound decision making. Other overall impacts include decreases in the time to complete tasks, user disruptions, training time, software rewrites, burden on support staff, and user frustration. Usability techniques allow informatics to identify issues with technology. More important, usability methods address why users are having those problems. Issues can then be addressed before technology is released. The broad goals of usability are promoting acceptance and use of systems through improved interactive systems and software, developing new kinds of applications to support specific work, and promoting job optimization with the use of information systems. goals: effectiveness, efficiency, and satisfaction.
explain challenges in developing universal electronic health record
cost. caregiver resistance. Despite its many benefits, setting realistic expectations, planning for culture change, instituting safeguards to protect patient information, and caregiver resistance are the major impediments to the development of an EHR. Issues that must be considered when developing the EHR include data integrity, ownership of the patient record, privacy, and electronic signature.
ICD-9/ICD-10
dev by WHO. international standard diagnostic classification for all general epidemiological, many health mgt purposes, and clinical use. used to classify mortality and morbidity data from inpt and outpt records. classify diseases and other health problems recorded on many types of health and vital records, including death certificates and health records. original intent for stats and research. now for reimbursement.
analyze potential barriers to patient-centered care created by the use of various technologies
expensive. using base platforms that have been in place since 1980's. adaptation to adoption. compliance with regulatory and reimbursement issues, Meaningful Use. development of electronic infrastructure and cost. lack of common vocabulary, privacy, security, and confidentiality issues, resistance among caregivers, failure to adequately consider organizational change, determine realistic timeline, lack of IT staff to create and support necessary infrastructure, legal issues surrounding discovery of medical information. need a testing and certification program to test and certify EHR technology.
North American Nursing Diagnosis International (NANDA-I)
first terminology to be recognized by the ANA. A nursing diagnosis is a clinical judgment about individual, family, or community experiences and responses to actual or potential health problems and life processes. NANDA-I diagnoses are used to identify human responses to health promotion, risk, and disease. Each nursing diagnosis has a description, a definition, and defining characteristics. The defining characteristics are manifestations, signs, and symptoms that assist the nurse in determining the correct diagnosis to assign.
Information science
interdisciplinary field primarily concerned with analysis, collection, classification, manipulation, storage, retrieval, movement, and dissemination of information.
data mining
is the process of analyzing healthcare data from different perspectives and summarizing it into useful information that can be used to improve patient safety and quality of care and cut costs. It is becoming an important tool to transform data into information. Data mining is the key component in the analysis of workflow in complex healthcare organizations. It is also used for research. The data mining process is carried out by the collection of standardized data with their associated codes from EHRs. Analyzed results from data mining can identify patterns or trends in patient care and outcomes.
Clinical Care Classification (CCC) System
nursing classification designed to document the six steps of the nursing process across the care continuum. It facilitates patient care documentation at the point of care.
life cycle--needs assessment
purpose is to determine the gap b/t an organization's current state and overall needs of the organization w/ consideration to the strategic plan. eval +/-. understand current workflow and long-term goals.
recognize the various roles of nurses in selecting and implementing patient information systems
role of chief nursing informatics officer (CNIO): key decision maker in the strategic planning process as well as the aligned information technology strategic planning activity. The key responsibility of CNIOs is to capitalize on their nursing informatics knowledge and skills which encompass an understanding of computer, information, and nursing sciences, in order to lead strategically and operationally. The CNIO is focused on the design, selection, and implementation of health information systems and for managing the adoption of other supporting clinical initiatives
computer science
scientific and practical approach to computation and its applications. It is the systematic study of the feasibility, structure, expression, and mechanization of the methodical processes (or algorithms) that underlie the acquisition, representation, processing, storage, communication of, and access to information, whether such information is encoded in bits and bytes in a computer memory or transcribed engines and protein structures in a human cell.
QSEN project
seeks to prepare future nurses with the knowledge, skills, and attitudes (KSAs) needed to continuously improve the quality and safety of the healthcare delivery system. These six competencies include: • Patient-centered care • Teamwork and collaboration • Evidence-based practice • Quality improvement • Safety • Informatics
Nursing Interventions Classification (NIC)
standardized classification of interventions that describes the activities that nurses perform. NIC is used in all care settings. An intervention is described as "any treatment, based upon clinical judgment and knowledge, that a nurse performs to enhance patient/client outcomes".
analyze issues surrounding use of decision support tools
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analyze nurse's role in protecting electronically stored information
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The Alliance noted that the primary distinction b/t EMR and EHR was
ability to exchange information outside of a single healthcare delivery system.
information systems
study of complementary networks of hardware and software that people and organizations use to collect, filter, process, create, and distribute data.
id various functions performed within an EHR system
The EHR must provide secure, real-time, point-of-care (POC), patient-centric information for clinicians at the time and place that clinicians need it. The EHR must also provide evidence-based decision support, automate and streamline the clinician's workflow, and support the collection of data for uses other than direct client care. These indirect uses include billing, quality management, outcomes reporting, resource planning, and public health disease surveillance and reporting
continuity of care document (CCD)
This record is intended to improve continuity of care when clients move between various points of care. The CCD is comprised of contributions from many types of caregivers, including physicians, nurses, physical therapists, and social workers with each providing a summary of care provided. The record supports the patient's safety and has a positive impact on the quality and continuity of care. The Health Level 7 (HL7) and ASTM International standards groups created the CCD based upon work done by earlier groups. The CCD is a snapshot of patient status, rather than a comprehensive record. The CCD has been named in U.S. Meaningful Use regulations for the exchange of clinical information
classification systems
Approach that uses mutually exclusive categories for specific purposes such as describing the details of a patient encounter for clinical, administrative, or reimbursement issues. example group data to determine costs and outcomes of treatment options. ICD, not consist of definitions or definitional r/t ships b/t terms.
Becoming a specialist in nursing informatics has two avenues.
Increasingly, masters level nursing informatics programs are being developed. Working in the field of informatics in a clinical agency can also qualify an RN for status as a nurse informatician. The American Nurses Credentialing Center offers certification in nursing informatics
knowledge builder
Nurses display this role when they aggregate clinical data and show patterns across patients that serve to create new knowledge or can be interpreted within the context of existing nursing knowledge. examine aggregate data (this capability is not available at the bedside in all facilities) for relationships among variables and interventions.
nursing science
This belief gave rise to a new branch of nursing science: nurmetrics. Nurmetrics uses mathematical forms and statistics to test, estimate, and quantify nursing theories and solutions to problems.
cognitive science
an interdisciplinary field that studies the mind, intelligence, and behavior from an information processing perspective.
information science within the context of nursing practice
knowledge
point of care terminology
AKA interface terminology. is what clinicians see on the screen and consists of terms of which clinicians are familiar w/. made up of synonyms from the reference terminology and supports entry of pt related info into computer programs.
vision
The vision statement is a future-oriented, lofty view of what an organization would like to become. The vision statement is often the first consideration in strategic planning.
classification
arrangement of concepts based on essential characteristics. arranged in single heirarchy
healthcare terminology standards
designed to enable and support widespread interoperability among healthcare software applications for the purpose of sharing information. use of standardized terminology is a means of ensuring that the data collection is accurate and valid.
nurses in roles of educator and researcher
educators track info about students class and clinical performance and compare with norm. nsg ed prepare students handle data: teach basic computer and info literacy, use nsg info systems, realize significance of automated data collection for quality assurance purposes and recognize benefits of using computers to manage clinical data for research.
QSEN
quality and safety of the healthcare delivery system. seeks to prepare future nurses with the knowledge, skills, and attitudes (KSAs) needed to continuously improve the quality and safety of the healthcare delivery system. 6 competencies: pt-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics
healthcare information system and hospital information system (HIS)
refer to group of systems used within a hospital or enterprise that support and enhance healthcare.
knowledge management
refers to the creation of systems that enable organizations to tap into the knowledge, experiences, and creativity of their staff to improve their performance. it is a structured process for the generation, storage, distribution, and application of both tacit knowledge (personal experience) and explicit knowledge (evidence) in organizations.
informatics
science and art of turning data into information. defined as the study of the application of computer and statistical techniques to the management of information. provides tools to help process, manage, and analyze data and information collected for the purposes of documenting and improving pt care, as well as support knowledge that adds to the scientific foundation for nursing; provides value to nursing knowledge and work; and improves the public image for nursing by building a knowledge-based identity for nurses.
terminology
set of terms representing concepts in particular field or domain, for example, problems, observations
explain how decision support tools contribute to a safe practice environment for both patients and healthcare providers
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id characteristics of a decision support tool
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id informatics tools for collecting and analyzing patient data
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id role of policies and regulations r/t security
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id technologies that support the medication administration cycle (Pyxis, omnicell, centralized pharmacy)
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network security
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physical device/hardware security
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r/t ship b/t quality patient outcomes and meaningful use
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recognize common data access security threats
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recognize various types of health information systems
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reflect on how cybercrime can potentially affect hospitals or patient healthcare in general
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explain how health information technology for economic and clinical health (HITECH) act enhanced the security provisions of HIPAA)
The HITECH, part of the 2009 American Recovery and Reinvestment Act, authorized CMS to reimburse providers who succeed at becoming "Meaningful Users" of the EHR starting in 2011. Incentives will decrease gradually with penalties imposed for failure to achieve Meaningful Use by 2015
life cycle--needs assessment--steering committee
The steering committee should include members of upper management and managers and staff most likely to be impacted by the new informatics system. The committee can be divided among specialties or areas, depending upon the size and scope of the project. The committee aligns the project with the organization's goals and vision. Committee members must learn all the details of the current informatics system, including its problems and strengths. Finally, they must determine the system requirements and classify them as wants or needs (needs taking priority over wants, particularly if the budget is an important consideration).
data
collection of numbers, characters, or facts that are gathered according to some perceived need for analysis and possibly action at a later point in time. Examples of data include a client's vital signs. Other examples of data are the length of hospital stay for each client; the client's race, marital status, or employment status; and next of kin. Sometimes these types of data may be given a numeric or alphabetic code. a collection of data can be examined for patterns and structure that can be interpreted.
ergonomics
is concerned with human performance as it relates to the physical characteristics of tools, systems, and machines. Ergonomics focuses on designs for safety, comfort, and convenience. Examples of ergonomics issues include nurses complaining that a workstation on wheels is too bulky, heavy, and not convenient to take into a patient room. Ergonomics addresses the design of a cooking utensil to fit a human hand, the design of computer chairs to promote comfort and safety, and/or the intuitive operation of drinking fountains.
informatics nurse specialist
possesses a sophisticated level of understanding and skills in information management and computer technology, demonstrating most of the competencies seen at the previous three levels. The INS is the innovator who sees the broad vision of what is possible and how it may be attained. The Scope and Standards of Nursing Informatics Practice (ANA 2008) calls for educational preparation for the INS that enables him or her to conduct informatics research and generate informatics theory. This preparation and expertise makes the INS well suited to work in a variety of areas and functional roles including project management and administration.
ontology
set of concepts formally organized by meaning. help facilitate interoperability in that concepts are organized by their concept meaning that describes definitional structure-relationship. ex concept of finger is part of concept of hand.
entry level competencies
The Scope and Standards of Nursing Informatics Practice (ANA 2008) calls for the following competencies for the beginning nurse: • Basic computer literacy, including the ability to use basic desktop applications and electronic communication • The ability to use IT to support clinical and administrative processes, which presumes information literacy to support evidence-based practice • The ability to access data and perform documentation via computerized patient records • The ability to support patient safety initiatives via the use of IT • Recognition of the role of informatics in nursing.
relate concept of information literacy to nursing informatics
The significance of information literacy for nursing is that it represents an important step in promoting evidence-based nursing practice because the information-literate nurse can weigh the quality and significance of research findings for application. Despite the recognition of information literacy as a bridge to evidence-based practice, the connection is not automatic. Problems include a lack of awareness of the importance of evidence-based practice, inconsistent role modeling by registered nurses (RNs), a lack of comfort in using database searches, and a lack of exposure to evidence-based clinical practice
codes
concepts have unique identifiers known as codes. codes are made up letters, numbers, or a combo of both, used to designate concepts in a computer system. concept w/ assigned code = codified. concept codes facilitate dev of EBP and decision support rules, report administrative and financial healthcare standards for diagnoses, procedures, drugs, quality measures. codified data track disorders, nsg problems, allergies, procedures, and s/s.
information
is data that have been interpreted. example, individual temperature readings are data. When they are plotted onto a graph, changes in the client's temperature over time and comparison with normal values become evident, thus turning into information.
Select appropriate telecommunication technologies to facilitate more effective communication in a given healthcare environment.
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analyze r/t ship b/t technologies and patient outcomes
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analyze role of workflow analysis in advancing practice
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analyze the influence of technology on interdisciplinary collaboration
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recognize the importance of active participation in the implementation of technology
Good communication between information systems personnel and clinicians is critical to the success of any project. It is essential to elicit support from nurses and physicians in the selection of any system that they will use and to listen to their feedback. Nurses are resistant to change unless they see the potential benefits. Physicians will not use a system if it is not easy to access and use. More and more, that translates to the ability to access information at the bedside, office, or from home or other locations using a variety of devices, including traditional computers, PDAs, and other devices. No system should hinder clinical staff. implementation of EHR and initiatives supporting pt safety and quality of care will drive info tech plans and spending for next several years.
personal information
Personal information is information that identifies a person or could identify a person. Obvious examples of identifying personal information include name, address, phone number, or e-mail address but could also be photos, videos, workplace name, as well as opinions and preferences. Such identifying information can potentially allow unauthorized access to medical records, financial records, birth records, educational records, credit records, work records, and so on. There is a trend toward integrating privacy commissions or agencies with information technology agencies to be in a better position to coordinate laws and regulations with information technology developments and intrusion prevention measures.
id common security measures used in health settings to protect electronic information
The EHR system must be configured to allow access only to those who have been identified as authorized users. The system must authenticate the user's identity with user IDs and passwords and possibly biometrics. HIPAA considerations include the need to be able to provide the client, upon request, with a log of caregivers who have accessed his or her chart. Data that are communicated via the Internet must be encrypted. Firewalls must be in place when data are sent and received via the Internet to safeguard data integrity. Meaningful Use requirements also include measures to protect patient information that strengthen HIPAA requirements.
HITECH (year act/legislation introduced, components, relationships b/t them, presence of penalties for breach/non-adherence)
The Office of the National Coordinator (ONC) was later mandated legislatively in the Health Information Technology for Economic and Clinical Health Act (HITECH Act) of 2009. provided stimulus money to increase the use of electronic health records across the country in what many felt were aggressive timelines.
recognize the importance of active participation in the selection of technology
When selecting a monitoring system, information regarding the technologies that are currently available may be obtained from vendors. All pertinent regulatory and accreditation requirements must also be investigated. A scan of the internal environment may include an inventory of equipment currently in use throughout the enterprise. Insufficient data comprises one of the pitfalls of strategic planning
NLN position paper: preparing next generation of nurses to practice in a technology rich environment: an informatics agenda
called for nursing education and the NLN itself to take steps to ensure that every nursing graduate demonstrate computer and information literacy as well as up-to-date skills in informatics. intent of the position paper was to reform nursing education to support quality measures to produce a graduate capable of working in a technologically rich healthcare delivery system.
Nursing Outcomes Classification (NOC)
classification system that describes patient outcomes sensitive to nursing interventions. The NOC is a system to evaluate the effects of nursing care as a part of healthcare. NOC consists of outcomes for individual patients, families, and communities. An outcome is "a measurable individual, family, or community state, behavior, or perception that is measured along a continuum and is responsive to nursing interventions".
life cycle
describes ongoing process of developing and maintaining an information system. divided into 4 main phases: needs assessment system selection implementation maintenance
informatics innovator and informatics knowledge and experience
is an informatics nurse specialist who sees the broad vision of what is possible and how it may be attained. Examples of roles of an informatics innovator are; develops models for simulation purposes, develops new methods of organizing data, applies advanced analysis and design concepts and evaluates performance and impact of information management technologies. An informatics innovator possesses the ability to apply learned concepts to visionary applications, to look at the "the big picture". uses holistic view, works across settings, and is enabled by access to information (derived from multiple resources and formats, but from a single platform).
knowledge
is the synthesis of information derived from several sources to produce a single concept or idea. based on a logical process of analysis and provides order to thoughts and ideas and decreases uncertainty. dynamic and derives meaning from its context. Validation of information provides knowledge that can be used again. Historically, nursing has acquired knowledge through tradition, authority, borrowed theory, trial and error, personal experience, role modeling, reasoning, and research. Current demands for safer, cost-effective, quality care require evidence of the best practices supported by research.
information technology (IT)
management and processing of information with the assistance of computers. computers and IT provide tools that aid data collection and the analysis associated with research to support the overall work of nurses.
computer literacy
popular term used to refer to a familiarity with the use of personal computers, including the use of software tools such as word processing, spreadsheets, databases, presentation graphics, and e-mail. The majority of students admitted to nursing schools now enter with some level of computer literacy.
mission
purpose or reason for the organization's existence and represents the fundamental and unique aspirations that differentiate the organization from others. The mission statement should incorporate meaningful and measurable criteria. The mission statement is an important tool when used to guide the planning process and should resonate with those involved with the organization.
Omaha System
research-based taxonomy that provides a framework for integrating and sharing clinical data. It is widely used in settings such as home care, hospice, public health, school health, and prisons. onsists of three relational components: an assessment component (Problem Classification Scheme), an intervention component (Intervention Scheme), and an outcomes component (Problem Rating Scale for Outcomes).
vocabulary
terminology accompanied by definitions or descriptions
strategic planning
the process of determining what an organization wants to be in the future and planning how it will get there. mgt tool that allows an organization to consciously move toward a desired future while responding to dynamic internal and external environments. it is a process, not a 1-time event. dev of future, long range plan that is effective.
goals of information systems strategic planning
to support business and clinical decisions. to make effective use of emerging technologies. to enhance the organization's image. to promote satisfaction of market and regulatory requirements. to be cost-effective. to provide a safer environment for pts.
examples of how informatics and computers support the various areas of nursing and consumer health-nursing administration
• Automated staff scheduling • Online bidding for unfilled shifts • E-mail for improved communication • Cost analysis and finding trends for budget purposes • Quality assurance and outcomes analysis • Patient tracking and placement for case management
describe the important aspects of network security in your healthcare system
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determine appropriate security technologies and policies used to prevent common security threats
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distinguish among various methods for accessing an EHR
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recognize common social engineering security threats
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recognize obstacles nurses face in assuming a leadership role in technology-based decision making
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recognize principles of a culture of safety
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recognize role of technology as a change agent
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analyze the legal and ethical issues related to breaches of security and confidentiality
Healthcare entities, as well as their business associates, must notify individuals whose health information is breached within 60 days of that breach. The entity also needs to notify the DHHS and local news media if more than 500 individuals are affected by a breach of information security. If data are encrypted, notification of a breach is not required. However, an entity has to validate whether data encryption works and meets federal standards. Patients can now restrict some disclosures of personal health information (PHI) in certain circumstances. These restrictions are limited in scope. If a medical practice uses EHRs, the practice has to respond to patient requests for an accounting of all PHI disclosures up to 3 years. The Patient Protection and Affordable Care Act (Affordable Care Act), signed into law in March 2010, brings major changes to the U.S. health system. It guarantees access to healthcare for all Americans, creates new incentives to change clinical practice to foster better coordination and quality of care, gives practitioners more information so they can improve their clinical practice, gives patients more information to help them become more value conscious, and changes the healthcare payment system to reward value.
ARRA (year act/legislation introduced, components, relationships b/t them, presence of penalties for breach/non-adherence)
The American Recovery and Reinvestment Act of 2009 (ARRA) has specific provisions for information technology in general and health information technology (HIT) in particular. These provisions include funding for a Smart Grid Information Clearinghouse, the Small Business Administration, the Department of Education, the Veterans Administration, and other government agencies for improving information technology systems. Under ARRA, every person now has the right to have an electronic copy of an EHR and to have a copy directly transmitted to any designated entity
distinguish b/t EHR and health information system
The electronic health record (EHR) has the potential to integrate all pertinent patient information into one lifetime record, which will help to improve the quality of health information, improve care coordination, patient safety, and productivity; contain costs; support research; decrease wait time for treatment; and contribute to the body of healthcare knowledge. HIS = refer to group of systems used within a hospital or enterprise that support and enhance healthcare.
relationship of information science, computer science, cognitive science, and nursing science within context of nursing practice.
nursing informatics is a combo of nsg science, computer science, and information science (core sciences). must be able to integrate other sciences when needed (organizational and change mgt sciences). overall, nurse informatics is data, info, knowledge, and the core sciences combined.
informatics nurse specialist (INS)
has advanced, graduate education in nursing informatics or a related field and may hold ANCC certification. needs to play an active role in research and theory development and in the design and testing of information systems and the human-computer interface; he or she also needs to help shape policy and serve as an advocate for the design and use of informatics to serve other healthcare professionals and the public. Other facets of the INS role include responsibilities in administration, telehealth, education and professional development, compliance issues, and discovery in databases and analysis. The INS is prepared to assess work processes and subsequently design, select, implement, and evaluate data structures and suggested technology intended to improve productivity and contribute to the body of nursing knowledge.
data integrity
is a comprehensive term that encompasses the notion of wholeness when data is collected, stored, and retrieved by the authorized user. For data to be complete and orderly, systematicity must exist so that data integrity is preserved to ensure a state of current and correct form. Data integrity is crucial in the healthcare environment because data serves as a driving force in treatment decision making. For example, if data is faulty or incomplete, the quality of derived information may be poor, resulting in decisions that may be inappropriate and possibly harmful to clients. For example, if the nurse interviewing a client collects data related to allergies but fails to document all reported allergies, the client may be given drugs that cause an allergic reaction. In this case, the data were collected but not stored properly.
decision-support software (DSS)
is the alerts and reminders used within an EHR. The ability to collect codified data provides vital information that can be used for decision support
usability
is the extent to which a product can be used by specific users in a specific context to achieve specific goals with effectiveness, efficiency, and satisfaction according to the International Standards Organization 9241-11, 2006. That is, a usable product is one that allows users to achieve specific goals with a product in a specific context. Usability is multidimensional, including topics such as: • Using an application • Learning to use a system • Remembering interactions with technology after time has elapsed • User satisfaction • Efficiency • Error-free/error-forgiving interactions • Seamless fit of an information system to the task(s) at hand
human factors
is used to describe the interactions between humans and tools of all kinds. Human factors is a broad term that can include topics such as the design of motorcycle controls to fit human hands and feet or an evaluation of how work is performed within the layout of a hospital room in an intensive care unit.
determine available clinical technologies and how they impact the nursing process
nursing information system supports use and documentation of nsg processes and activities, and provides tools for managing the delivery of nsg care. effective nsg information system must accomplish 2 goals: 1. support the way that nurses fxn, allowing them to view data, collect necessary info, provide quality client care, and document client's condition and care that was given. 2. support and enhance nsg practice thru improved access to info and tools such as online literature databases, drug info, and hospital policy and procedure guidelines.
recognize the importance of active participation in the evaluation of technology
Identifying the goals and scope is the second step in strategic planning. The goals of the project must meet the needs of the users as well as support the mission and goals of the institution. The identified goals will then provide the direction for the remainder of the planning process. The scope of the project is developed after initial analysis has been completed and provides a detailed description of the project, which includes what is in and what is out of the scope. In other words, it provides the boundaries around what can become a limitless project.
role of nurses as knowledge workers
managers of knowledge workers have the responsibility to optimize the work process through improvements in the design of the workplace as well as the application of technology. The unfortunate reality is that resource allocation for health information technology (HIT) has lagged behind other industries, and the current healthcare environment has yet to fully realize its potential. IT can streamline paperwork, transform data into information and knowledge, and eliminate redundancy. A common factor found in a recent survey of the 100 top U.S. hospitals was the use of technology, EHRs, and health information exchange
informatics nurse
This individual has advanced preparation in information management and possesses the following skills (ANA 2008): • Proficiency with informatics applications to support all areas of nursing practice including quality improvement activities, research, project management, system design, development, analysis, implementation, support, maintenance, and evaluation • Fiscal management • Integration of multidisciplinary language/standards of practice • Skills in critical thinking, data management and processing, decision making, and system development, and computer skills • Identification and provision of data for decision making
system check
is a mechanism provided by the computer system to assist users by prompting them to complete a task, verify information, or prevent entry of inappropriate information. Computer systems facilitate data collection and verification in several ways. Examples of computer system safeguards and generated prompts include the following: a. data cleansing technology--best illustrated when the system asks the user to confirm whether there is a match already in the database for a patient, thereby eliminating duplicate entries with several variants in name or address. b. Requesting information about a client's allergies when no entry has been made regarding allergies. In the absence of an entry regarding allergies, the system may not accept medication and radiology orders. c. Informing the user that an order already exists when the user attempts to enter a duplicate order. The system requests verification before processing the duplicate order. This can prevent unintentional repetition of expensive diagnostic tests. For example, a physician previously ordered a complete blood count (CBC) to be drawn on the current day. Another physician has ordered a hemoglobin and hematocrit (H&H), also to be drawn on the current day. When the order for the H&H is entered into the computer, the system will alert the user that this is a duplicate order, because the H&H is part of the CBC. d. Producing printouts alerting the nurse that a prescribed medication has not been documented as given. This improves the quality of client care and documentation.
wisdom
occurs when knowledge is used appropriately to manage and solve problems. It results from understanding and requires human effort. The trip from data to wisdom is neither automatic nor smooth. comes from cumulative experiences, as the result of learning skills and ways of thinking that can be viewed as predecessors to wisdom, and via the creation of conditions that help participants to use their accumulated knowledge effectively. It represents the human part of the equation in the move along the continuum from data to information to knowledge to wisdom.
informatics nurse (IN)
refers to the RN who works in the area of informatics. This individual has experience or an interest in the area but no formal informatics preparation. employs strategies that transform data into information and information into knowledge and ensures that information is disseminated at appropriate times for appropriate uses in the healthcare continuum.
analyze decision support tools and system safeguards meant to enhance a safe practice environment
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analyze the impact of informatics technology on patient safety
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aspects of secure network
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recognize important terms relevant to various healthcare information systems
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data gatherer
In this role the nurse collects clinical data such as vital signs. facilitated when input from monitoring devices is fed directly into clinical documentation systems.
Analyze the impacts of telehealth on the delivery of healthcare.
Technology is a pervasive part of everyday life. It is an integral part of home appliances and found throughout the healthcare delivery system. It is frequently invisible to the user but does require a bevy of behind-the-scenes people to ensure both its ongoing and optimal use. Technology will continue to develop and evolve in ways that are difficult for us to imagine today. Devices will become smaller and easier to use. This process will extend the capabilities of providers and create new disciplines. One area that is expected to have a large impact in the near future is nanotechnology. Nanotechnology is the science and technology of engineering devices at the molecular level. Nanotechnology is already used in cosmetics and sunscreens and other industries. Work is under way to create electrical circuits that would allow the development of smaller computers, design new monitoring technologies, and develop smart drug delivery systems. At this time the effects of nanotechnology on human health are not known and will need to be monitored over time.
Computer systems facilitate data collection but may increase the potential for entry of incorrect data through input errors.
These errors may include hitting the wrong key on a computer keyboard, selecting the wrong item from a screen using touch or a mouse, or failing to enter all data collected. Several measures can be taken to decrease the likelihood of input errors, including educating personnel, conducting system checks, and verifying data.
computerized patient record (CPR)
a comprehensive lifetime record that includes all information from all specialties.
electronic patient record (EPR)
an electronic client record, but not necessarily a lifetime record, that focuses on relevant information for the current episode of care
concept
an expression w/ single unambiguous meaning. have 1+ representations called synonyms or terms. clinical concepts used to document ideas or express orders, assessment, and outcomes w/in EHR.
example of knowledge
can be seen in the determination of the most effective nursing interventions for the prevention of skin breakdown. If a research study produces data related to the prevention of skin breakdown achieved through specific interventions, these data can be collected and analyzed. The trends or patterns depicted by the data provide information regarding which treatment is more effective than others in preventing skin breakdown. The validation of this information through repeated studies provides knowledge that nurses can use to prevent skin breakdown in their clients.
clinical decision-support (CDS)
computer application that analyzes data and presents them in a fashion that facilitates decision making. It can incorporate lab values, standards of care, and other patient-specific information. It also contains alerts that help to promote safety. Filtered expert information used to guide decisions for clinical care. The underlying premise of DSS is that the amount of knowledge today exceeds the retention abilities of any one person. DSS is a tool that extends human capabilities. It may be an integral part of CPOE and e-prescribing programs. There are also tools related to drugs and clinical pathways.
Analyze the potential benefits of telehealth for a specific population.
• Consult with colleagues • Conduct interviews • Assess and monitor clients • View diagnostic images • Review slides and laboratory reports • Extend scarce healthcare resources • Decrease the number of hospital visits for patients with chronic conditions • Decrease healthcare costs • Tackle isolation and loneliness • Provide health education • Improve case management services • Improve the equity of access to services • Improve the quality of client care • Improve the overall quality of the client's record
examples of how informatics and computers support the various areas of nursing and consumer health-nursing practice
• Worklists to remind staff of planned nursing interventions • Computer-generated client documentation including discharge instructions and medication information • Monitoring devices that record vital signs and other measurements directly into the client record • Computer-generated nursing care plans and critical pathways • Automatic billing for supplies or procedures with nursing documentation • Reminders and prompts that appear during documentation to ensure comprehensive charting • Quick access to computer-archived patient data from previous encounters • Online drug information
explain how human factors often lead to errors in practice of patient care and medication errors
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explain the challenges and opportunities in leveraging healthcare technologies
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healthcare information (pt info) security
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recognize common features of various health information systems
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recognize common physical and hardware security threats
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The IOM identified the following 12 major components of the CPR, which it considered the "gold standard" attributes
1. Provides a problem list that indicates current clinical problems for each encounter, the number of occurrences associated with all past and current problems, and the current status of the problem 2. Evaluates and records health status and functional levels using accepted measures 3. Documents the clinical reasoning/rationale for diagnoses and conclusions. Allows sharing of clinical reasoning with other caregivers and automates and tracks decision making. 4. Provides a longitudinal or lifetime client record by linking all client data from previous encounters 5. Supports confidentiality, privacy, and audit trails 6. Provides continuous access to authorized users at any time 7. Allows simultaneous and customized views of the client data 8. Supports links to local or remote information resources, such as various databases using the Internet or organization-based intranet resources 9. Supports decision analysis tools 10. Supports direct entry of client data by physicians 11. Includes mechanisms for measuring the cost and quality of care 12. Supports existing and evolving clinical needs by being flexible and expandable
meaningful use (MU) stage 1 core requirements
1. Record demographic information (preferred language, gender, race ethnic background, date of birth, date/cause of death (inpatient setting only)). 2. Computerized provider order entry. 3. Clinical decision support and the ability to track compliance with rule(s). 4. Automatic, real-time drug-drug and drug-allergy interaction checks based on the medication list, allergy list. 5. Maintain an active medication list. 6. Maintain an active medication allergy list. 7. Record and retrieve vital signs (height, weight, blood pressure, BMI, growth charts for ages 2-20 years). 8. Record smoking status for patients 13 years old and older. 9. Mechanisms to protect information created or maintained by the certified EHR technology that include access control. 10. Electronically exchange key clinical information among providers and patient-authorized entities. 11. Supply patients with an electronic copy of their health information upon request. 12. Supply patients with an electronic copy of their discharge instructions upon request. 13. Report required clinical quality measures to CMS. 14. Maintain up-to-date problem lists of current and active patient diagnoses. Optional stage 1 core measures: 1. Incorporate clinical lab test results as structured data. 2. Generate patient lists by specific conditions to use for quality improvement, reduction of disparities, research or outreach. 3. Submit electronic data to immunization registries. 4. Submit syndromic public health surveillance data electronically in accordance with applicable law. 5. Identify and provide patient-specific education resources. 6. Drug-formulary checks. 7. Support medication reconciliation. 8. Generate summary care records for transition of care/referral. 9. Electronic submission of reportable lab results. 10. Advance directives for patients 65 years old and older.
The importance of interoperability will continue to grow. One driver will be the 2010 Affordable Care Act Medicare Shared Savings Program calls for the operation of Accountable Care Organizations (ACOs) for Medicare in 2012
An ACO is a provider organization that assumes the responsibility of providing for the health needs of a defined population which includes the total cost of care and quality and effectiveness of services. While an ACO may be a single hospital and affiliating physicians, it may be comprised of larger entities. The concept behind the ACO is to shift the paradigm away from payment per service rendered instead to a model that focuses upon wellness. ACOs will require high levels of interoperability among participants to facilitate the care of assigned populations and track outcomes. A high level of integration and interoperability will be required to enhance clinical and administrative aspects of care.
determine importance of collaboration in selecting a health information system
Consultants may be hired for assistance in any phase of the selection process, including recommendations for the composition of the steering and selection committee, assessing the current information system, system planning, testing, security, policy and procedure development, and implementation. The steering committee membership must be multidisciplinary, including representation from all departments affected by the new system and incorporating the clinical, administrative, and information system divisions. This strategy is essential for id of all pertinent issues and reduces the possibility of overlooking potential problems. The committee should be large enough to make a good decision but small enough to be effective and efficient.
move to evidence-based practice as a means to meet demands for quality and cost-effective care now lies within the grasp of virtually every healthcare professional with the implementation of the electronic record.
Electronic records and the systems that house them make it easier and faster to collect information. Data stripped of individual patient identifiers can then be downloaded into other applications for the identification of patterns and further analysis. Much of this process can be performed automatically so that the time frame from data collection to interpretation is shortened and findings can be disseminated and applied more quickly.
id essential components of EHR
HIMSS identified the following attributes of the EHR: 1. Provides secure, reliable real-time access to client health record information where and when it is needed to support care 2. Records and manages episodic and longitudinal EHR information 3. Functions as clinicians' primary information resources during the provision of client care 4. Assists with the work of planning and delivery of evidence-based care to individual and groups of clients 5. Captures data used for continuous quality improvement, utilization review, risk management, resource planning, and performance management 6. Captures the patient health-related information needed for medical record and reimbursement 7. Provides longitudinal, appropriately masked information to support clinical research, public health reporting, and population health initiatives 8. Supports clinical trials and evidence-based research
analyze importance of interoperability in terms of knowledge sharing and collaboration
Interoperability=The ability of two entities, human or machine, to exchange and predictably use data or information while retaining the original meaning of that data. The need to exchange health data continues to grow in response to the demands placed by managed care, consumers seeking improved levels of healthcare, Meaningful Use requirements, and the mandate for comparative effectiveness research. To derive the utmost benefit from data, it must have a consistent or standard meaning across institution, enterprise, and alliance boundaries, facilitating the exchange of client data. One major step in the integration process is the development of a uniform definition of terms, or language. This is essential for the easy location and manipulation of data. Uniform languages are essential to ensure semantic interoperability within EHRs. The Systematized Nomenclature of Medicine-Clinical Terms (SNOMED-CT) is globally recognized as a common language for electronic health applications. Health Level 7 (HL7)=A major standard for the exchange of clinical data for integration is Health Level 7 (HL7). HL7 refers to both an organization and its standards for the exchange of clinical data. The mission statement of Health Level 7 International states that its purpose is to provide standards for interoperability "that improve care delivery, optimize workflow, reduce ambiguity and enhance knowledge transfer among all of our stakeholders" . HL7 provides a structure that defines data and elements and specifies how the data are coded. It is integration that allows data from many disparate information systems to be accessed from one point by the user, but it is interoperability that allows for the meaningful exchange of information that retains its meaning as it crosses from one system to another, ultimately providing a complete record for each client. When information system professionals speak of integration, interoperability is the implied outcome.
personal health record (PHR)
Lifelong tool for managing health information such as disease conditions, allergies, medications, past surgeries, and other relevant information. one example of a consumer-centric innovation, which, by definition is subject to the review and control of consumers who view, and sometimes supply information for the record, and dictate what other entities may view their record. Electronic personal health record (PHR) [is]: a private, secure application through which an individual may access, manage and share his or her health information. The PHR can include information that is entered by the consumer and/or data from other sources such as pharmacies, labs, and health care providers. The PHR may or may not include information from the electronic health record (EHR) that is maintained by the health care provider and is not synonymous with the EHR. PHR sponsors include vendors who may or may not charge a fee, health care organizations such as hospitals, health insurance companies, or employers. In their simplest concept, PHRs are electronic systems that allow people to record, access, and share health-related information in order to help them better manage their health and healthcare. • The PHR continues to evolve as technology and information exchange advances. • This record is expected to play a greater role in personal health management in the future. • The PHR is a consumer-centric, lifetime health record. Early forms were entirely paper-based. Recent developments make the PHR available via Internet connections. • Information in the PHR may be supplied from the individual, healthcare providers, pharmacies, third-party payers, therapists, laboratory tests, and radiology results, as well as other information deemed appropriate by the individual such as exercise routines and herbal supplements. • The concept behind the PHR is that access and information are controlled by the consumer. • Patients may use PHRs to better manage health conditions by entering their results for their own use as well as review by their providers. • PHRs may also provide a means to verify and obtain authorization for treatment and to determine claim status. • Portability, privacy, and accuracy of data populated by providers or payers constitute some of the big concerns related to PHR use. • PHRs provide the potential to improve consumer health via the ability to generate reminders for appointments, blood tests, prescription refills, results, and wellness reminders.
Identify ethical and legal issues related to the practice of telehealth.
The Centers for Medicare & Medicaid Services (CMS) have not formally defined telemedicine for the Medicaid program, and Medicaid does not recognize telemedicine as a distinct service. Medicaid reimbursement for telehealth services is available at the discretion of individual states as a cost-effective alternative to traditional services or as a means to improve access for rural residents. First, there is the possibility that the client may perceive it as inferior because the consulting professional does not perform a hands-on examination. The American Nurses Association (ANA) cautions that telehealth shows great promise as long as it is used to augment, not replace, existing services. Second, professionals who practice across state lines deal with different practice provisions in each state and may be subject to malpractice lawsuits in multiple jurisdictions, raising questions about how that liability might be distributed or which state's practice standards would apply. Theoretically, clients could choose to file suit in the jurisdiction most likely to award damages. The basic question here is, where did the service occur? Third, how might liability be spread among physicians, other healthcare professionals, and technical support persons? And fourth, HIPAA legislation added new concerns to the mix. These issues remain concerns today.
id principle provisions of health information technology for economic and clinical health (HITECH) act related to information security
The Health Information Technology for Economic and Clinical Health Act (HITECH) strengthened HIPAA security and privacy protection and provides financial incentives for the user of EHRs. While HIPAA and HITECH have designated some technical standards as mandatory, those standards are insufficient to enable collection, management, and exchange of the mandated data. Technical standards are needed to ensure that structured and codified terminologies, sufficiently comprehensive to capture all of healthcare, are widely available, that data can be securely and easily exchanged within and across organizations, and that a valid, safe, and reliable patient-centered community-care record can be created and maintained. Healthcare entities, as well as their business associates, must notify individuals whose health information is breached within 60 days of that breach. The entity also needs to notify the DHHS and local news media if more than 500 individuals are affected by a breach of information security. If data are encrypted, notification of a breach is not required. However, an entity has to validate whether data encryption works and meets federal standards.
HIPAA (year act/legislation introduced, components, relationships b/t them, presence of penalties for breach/non-adherence)
The Health Insurance Portability and Accountability Act (HIPAA) of 1996 created landmark legal protection for personal health information (PHI). PHI refers to individually identifiable health information such as demographic data; facts that relate to an individual's past, present, or future physical or mental health condition; provision of care; and payment for the provision of care that identifies the individual. Examples include name, address, birth date, Social Security number, allergies, claims data, lab results and other diagnostic history, prescription history, records about past visits to physicians, emergency rooms and other healthcare encounters, vaccination records, and prior in- and outpatient procedures. Transactions are electronic exchanges involving the transfer of information between two parties for specific purposes. When a healthcare provider sends a claim for payment of services, a transaction has taken place. HIPAA mandated the adoption of selected standard transactions for electronic data interchange (EDI) of healthcare data. These standard transactions are claims and encounter information, payment and remittance advice, claims status, eligibility, enrollment and disenrollment, referrals and authorizations, and premium payment. Under HIPAA, every person has the right to examine and obtain a copy of protected information. Typically, requested copies have been in paper form. Under ARRA, every person now has the right to have an electronic copy of an EHR and to have a copy directly transmitted to any designated entity.
The HIMSS Analytics EMR Adoption Model was developed in 2005 and was recently revised to show how individual hospitals and integrated healthcare systems in the United States and Canada fared in their levels of EMR capabilities
The criteria associated with each stage are listed here. Stage 0: Some clinical automation exists but the laboratory, pharmacy, and radiology systems are not all operational. Stage 1: The major ancillary clinical systems—the laboratory, pharmacy, and radiology systems—are all installed. Stage 2: Major ancillary clinical systems send data to a clinical data repository (CDR) that allows physicians to retrieve and review results. The CDR also contains a controlled medical vocabulary and clinical decision rules engine that checks for conflict. Document imaging systems may also be linked to the CDR. Stage 3: Basic clinical documentation (vital signs, flow sheets) is required. Nurses' notes, care plans, and/or electronic medical administration records may be present and are integrated with the CDR for at least one hospital service. Basic clinical decision support is available for error checking with order entry. Some availability is present for the retrieval and storage of diagnostic imaging. Typically this refers to the picture archiving communications systems (PACS) used for x-rays and other diagnostic images. Stage 4: Computerized provider order entry (CPOE) and a second level of clinical decision support for evidence-based practice are added to the previous stages. Stage 5: At least one service area has the closed loop medication administration process where barcode medication administration (BCMA), radio frequency identification (RFID), or other identification technology is in place and integrated with CPOE and the pharmacy to maximize patient safety. Stage 6: At least one service area has full physician documentation, third-level clinical decision support for all clinicians for protocols and outcomes with variance and compliance alerts, and a full PACS system. Stage 7: This is a paperless environment where all information is shared electronically and the EHR can produce a continuity of care document (CCD).
knowledge user
This role is seen when individual patient data are compared with existing nursing knowledge. clinical practice guidelines, expert systems to support decision making, or research that supports evidence-based care and/or online drug databases.
Systematized Nomenclature of Human and Veterinary Medicine Clinical Terms (SNOMED-CT)
globally recognized controlled healthcare vocabulary that provides a common language for electronic health applications. SNOMED-CT enables a consistent way of capturing, sharing, and aggregating health data across specialties and sites of care. The use of SNOMED-CT within EHRs provides interoperable data collection that can be analyzed and used in the implementation of evidence-based practice, decision-support rules, reporting of quality measures, and administrative billing. clinical terminology comprised of codes, concepts, and relationships used in recording and representing clinical information across the scope of healthcare. SNOMED-CT is concept-based, meaning that each concept has a distinct definition with a unique code identifier. SNOMED-CT is used to document care by clinicians, specialists, and domains using an interdisciplinary approach. It is used to document patient care across all sites of care and healthcare facilities (acute care, home care, hospice care, spiritual health, long-term care, and healthcare clinic visits, as well as community and public health). The documentation of assessments, flow sheets, care plans, task lists, order sets, education plans, problem lists, allergies and allergic reactions, task lists, and medication administration records can be encoded to SNOMED-CT.
privacy
is a state of mind, a specific place, freedom from intrusion, or control over the exposure of self or of personal information. Privacy includes the right to determine what information is collected about an individual, how it is used, and the ability to access collected personal information to review its security and accuracy. HIPAA regulations require that clients be given clearly written explanations of how facilities and providers may use and disclose their health information. The content and limits of what is considered private differs among cultures and even among individuals, but they do share some basic common themes. The efforts to protect privacy have become an international trend. Privacy is typically related to personal information.
human-computer interaction
is the study of how people design, implement, and evaluate interactive computer systems in the context of users' tasks and work. HCI blends psychology and/or cognitive science, applied work in computer science, sociology, and information science into the design, development, purchase, implementation, and evaluation of applications. Sample HCI topics include: • The design and use of devices such as a mouse, or patient-controlled analgesia machine • User satisfaction with a patient portal • Users' perceptions of the effectiveness of the design of clinical documentation integrated with medication barcoding • The meaning of icons • The design and evaluation of applications or systems to support groups of people • Principles of effective Web, graphical user interface (GUI), or adaptive interface design • Social issues in computing such as dropping an individual from your virtual group • Functional allocation of work between humans and computers • User modeling such as cognitive analyses of users
adoption
is to take over an idea or practice as if it were one's own. Adoption happens at different rates for different people. Background, exposure, experience, and generation have a significant impact on how willingly or quickly people adopt new ideas, practices, or workflow. A key element of a successful piece of smart technology is it is simple and intuitive to use for all.
Unified Medical Language System (UMLS)
large metathesaurus that contains more than a hundred source vocabularies. The NLM provides a Web-based application to the UMLS in which users can do multiple types of searches such as finding synonymous terms from two or more sources and the association between concepts
electronic medical record (EMR)
legal record created in hospitals and ambulatory environments of a single encounter or visit that is the source of data for the EHR. basic EMR components include clinical messaging and email, results reporting, data repository, decision support, clinical documentation, and order entry. the data in the EMR is the legal record of pt care during an encounter at the healthcare delivery system and is owned by that system. building block in the creation of EHR. The Electronic Medical Record (EMR) contains data related to one specific encounter. It's still sparingly used for example, in private physician practices who are not affiliated with larger healthcare delivery systems. Therefore, the EMR is a means to electronically capture and track patient data specific to that patient's visits within that practice but do not travel beyond those walls.
computerized physician order entry (CPOE)
process by which the physician or another healthcare provider, such as a nurse practitioner, physician's assistant, or physical or occupational therapist, directly enters orders for client care into a hospital information system. Its benefits include a reduction in transcription errors; a decrease in elapsed time from order to implementation; standardization and more completeness of orders; fewer medication errors; and the ability to incorporate CDS, alerts for critical lab values, and prompts when certain tests are due. Information is drawn from separate systems such as the hospital, pharmacy, and laboratory systems with drug databases to warn prescribers of potential problems with dosages, potential drug interactions, allergies, and contraindications such as pregnancy or other health conditions.
confidentiality
refers to a situation in which a relationship has been established and private information is shared. In a healthcare environment, it is the ethical principle or legal obligation that a healthcare professional will not disclose information relating to a patient unless the patient gives consent permitting the disclosure. Confidentiality is essential for the accurate assessment, diagnosis, and treatment of health-related problems. Once a client discloses confidential information, control over the release of this information lies with the persons who access it. Confidentiality is one of the core tenets of medical practice. Yet every day, healthcare professionals face challenges to this long-standing obligation to keep all information between them and patients private. Private information should be shared only with parties who require it for client treatment. The ethical duty of confidentiality entails keeping information shared during the course of a professional relationship secure and secret from others. This obligation involves making appropriate security arrangements for the storage and transmission of private information, and ensuring that the hardware, software, and networks used for storage and transmission of information is secure and that measures are implemented to prevent the interception of e-mail, instant messages (IMs), faxes, and other types of correspondence that contain private information. Nurses are obligated by the American Nurses' Association Code of Ethics and state practice laws to protect patient privacy. The obligation of confidentiality prohibits healthcare professionals from disclosing information about a patient's case to other interested parties and encourages them to take precautions with the information to ensure that only authorized access occurs.
health informatics
refers to use of educational technology for healthcare clients or the general public. The application of computer and information science in all basic and applied biomedical sciences to facilitate the acquisition, processing, interpretation, optimal use, and communication of health-related data. The focus is the patient and the process of care, and the goal is to enhance the quality and efficiency of care provided.
An IOM report (2006) noted problems with the healthcare delivery system, including incentives for a high volume of services rather than quality services and better outcomes.
same report calls for better coordination of care among providers and across episodes of illness and identifies design principles for payment for performance and its implementation. An earlier report provides a set of starter measures. The IOM notes that public reporting of outcomes would motivate improved provider behavior and provide consumers with information that they could use to make treatment decisions.
The Logical Observation Identifiers, Names, and Codes (LOINC)
terminology that includes laboratory and clinical observations. The laboratory portion of the LOINC database contains the usual laboratory categories such as chemistry, hematology, and microbiology. The domain and scope of clinical LOINC is extremely broad. Some of the sections of terms include vital signs, obstetric measurements, clinical assessment scales, outcomes from standardized nursing terminologies, and research instruments.
recognize principles of standardization of nursing terminology and data
Terminology is required to represent, communicate, exchange, manage, and report data, information, and knowledge. It enables safe, patient-centric, high-quality healthcare that optimizes data collection for the measurement of patient outcomes. EHRs can no longer be developed or implemented without standardized terminologies. Data exchange between EHR application systems must take place without loss of meaning. The use of standardized nursing terminology will result in better communication to the interdisciplinary team, increase the visibility of nursing interventions, enhance data collection used to evaluate and analyze patient care outcomes, and support greater adherence to standards of care. Further, the use of standardized nursing terminology can be used to assess nursing competency. Healthcare facilities are required to demonstrate the competency of staff for the Joint Commission. The nursing interventions delineated in standardized terminologies can be used as a means to assess nurse competency in the performance of these interventions
In years past healthcare institutions, nurses, and consumers were affected by managed care.
This system imposed limits upon what providers could charge, and payers provided a set reimbursement by diagnosis. Downsizing, acquisitions, and mergers occurred in an attempt to increase efficiency along with automation and cross-training of personnel. One legacy of this era was that fewer people were left to do the work. Another result was that remaining providers had the ability to extend their reach by offering a more comprehensive set of services and encouraging consumers to stay within their healthcare network. These types of alliances foster the sharing of information as merged entities gravitate to computer systems that can exchange information and as administrators turn to IT as a means to maximize efficiencies. While the emphasis remains on the bottom line the healthcare delivery system is moving toward a model where providers are paid for performance.
Meaningful Use
Use of health information technology (HIT) legislated by the American Recovery and Reinvestment Act of 2009 to collect specific data with the intent to improve care, engage patients, improve population health, and ensure privacy and security. recent adoption of Meaningful Use requirements and subsequent collection of data will also foster comparative effectiveness research (CER). Comparative effectiveness research provides evidence on the efficacy, benefits, and harms of treatment options so as to better inform healthcare decisions. The ARRA of 2009 allocated monies for CER The framework for Meaningful Use of the EHR evolved from a set of national priorities to help focus performance improvement efforts identified in the National Priorities & Goals report released by the National Priorities Partnership (2008), which was convened by the National Quality Forum. These priorities included (Meaningful Use Workgroup 2009): • Patient engagement • Reducing racial disparities • Improved efficiency • Increased safety • Coordination of care • Measures to improve population health
nursing informatics definition
may be broadly defined as the use of information and computer technology to support all aspects of nursing practice, including direct delivery of care, administration, education, and research. The definition of nursing informatics is evolving as advances occur in nursing practice and technology; there have been many different definitions throughout the years as the discipline has evolved. t is important to nursing because it represents the nursing perspective, identifies a practice base for nurses, produces unique knowledge, and provides needed standardized nursing language. INs have a role in developing health policy and in assessing the usability of devices for consumers and other healthcare professionals.
diverse nursing informatics roles
see handout in topic 744.1.1
The American Medical Association (AMA) Current Procedural Terminology (CPT)
classification system used for billing and reimbursement of outpatient procedures and interventions. CPT is the most widely accepted medical nomenclature used to report medical procedures and services under public and private health insurance programs. CPT codes are used to code all medical procedures performed in healthcare except for alternative medicine. CPT code sets are copyrighted by the AMA and are released once each year.
reference terminology
consists of set of concepts w/ definitional r/t ships. frequently an ontology and can therefore be used to support data aggregation, disaggregation, and retrieval. necessary to analyze data, develop EBP, and improve quality of care. retrieve data across healthcare settings, domains, and specialities, in a standardized manner.
Advantages of an Information System
• Better access to information • Enhanced quality of documentation through prompts • Improved quality of client care • Increased productivity • Improved communications • Reduced errors of omission • Reduced hospital costs • Increased employee satisfaction • Compliance with agency regulations • Common clinical database • Improved client perception of care • Enhanced ability to track records • Enhanced ability to recruit/retain staff • Improved hospital image • Improved mandatory reporting capability
data and information are collected when nurses record the following activities:
• Initial client history and allergies • Initial and ongoing physical assessment • Vital signs such as blood pressure and temperature • Response to treatment • Client response and comprehension of educational activities
explain importance of information security standards for protected health information
• The primary goals of healthcare information system security are the protection of client confidentiality and information availability and integrity. • Privacy and confidentiality are important terms in healthcare information management. Privacy is a choice to disclose personal information, while confidentiality assumes a relationship in which private information has been shared for the purpose of health treatment. • Information privacy is the right to choose the conditions under which information is shared and to ensure the accuracy of collected information. • Threats to information and system security and confidentiality come from a variety of sources, including system penetration by thieves, hackers, unauthorized use, denial of service and terrorist attacks, cybercrime, errors and disasters, sabotage, viruses, and human error. • Planning for security saves time and money and is a form of insurance against downtime, breaches in confidentiality, and lost productivity. • Security mechanisms combine physical and logical restrictions. • Examples include automatic sign-off, physical restriction of computer equipment, strong password protection, and firewalls. • Ultimately, healthcare administrators are responsible for protecting client privacy and confidentiality through education, policy, and creating an ongoing awareness of security. • One aspect of system security management includes monitoring the system for unusual record access patterns, as might be seen when a celebrity receives treatment. • Health information on the Internet requires the same types of safeguards provided for information found in private offices and information systems. • All chart printouts, forms, and computer files containing client information should be given the same consideration as the client record itself to safeguard confidentiality. • More secure methods of authentication are needed as even the best passwords can be compromised.
Determine how telehealth technologies are used to facilitate nursing practice.
• Telehealth is the use of telecommunication technologies and computers to provide healthcare information and services to clients at another location. • Telehealth is a broad term that encompasses telemedicine but includes the provision of care and the distribution of information to healthcare providers and consumers. • Efforts to contain costs, improve the delivery of care to all segments of the population, and meet consumer demands make telehealth an attractive tool. Telehealth can help healthcare providers treat clients earlier when they are not as ill and care costs less, provide services in the local community where it is less expensive, improve follow-up care, improve client access to services, and improve the quality of the client's record. • Telehealth applications vary greatly and include client monitoring, diagnostic evaluation, decision support and expert systems, storage and dissemination of records, and education of healthcare professionals. • Teleconferencing and videoconferencing are tools that facilitate the delivery of telehealth services. • Desktop videoconferencing (DTV) is an important development that enables the expansion of telehealth applications into new areas. DTV uses specially adapted personal computers to link persons at two or more sites. • Telenursing uses telecommunications and computer technology for the delivery of nursing care and services to clients at other sites. • Neither telemedicine nor telenursing is new. Applications include education of healthcare consumers and professionals as well as the provision of care. In addition to the use of the telephone for triage and information, clients may be monitored at home via telephone or teleconferences. Telehealth is a tool that helps healthcare providers to work more efficiently. • Major issues associated with the practice of telehealth and telenursing include a lack of reimbursement, infrastructure, plug-and-play standards, licensure and liability issues, and concerns related to client privacy and confidentiality. • The successful use of telehealth and telenursing is best ensured through the development and implementation of a plan that addresses current services and deficits, goals, technical requirements, compliance with standards and laws, reimbursement, and strategies to handle telecommunication breakdowns. • Telehealth and telenursing applications are expected to become more commonplace once reimbursement and licensure barriers are removed and technical standards for the exchange of information between telehealth devices and clinical information systems are established. • Telehealth has the capacity to revolutionize the delivery of healthcare and has already started to do so.
electronic health record (EHR)
Digital version of patient data found in traditional paper records. Increasingly used to refer to a longitudinal record ideally of all healthcare encounters. generic term for all electronic healthcare systems and recently became favored term for lifetime computerized record. an electronic record of health-related info on an individual 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. Because of the capabilities within healthcare technology and the federally mandated initiatives that are currently taking place, the exclusive use of the EHR is truly where healthcare is headed. • The electronic medical record (EMR) is the legal record created in hospitals and ambulatory environments and often is restricted to a single episode of care. • The electronic health record (EHR) is a longitudinal record that includes client data, demographics, clinician notes, medications, diagnostic findings, and other essential healthcare information. • The EMR serves as a building block for the electronic health record EHR. • Few hospitals or physician practices have attained the advanced stages of the EMR. • The Institute of Medicine identified 12 major components or characteristics of the CPR, which continue to provide the standard for current EHR systems with only slight refinement. • A major driver for U.S. adoption of the EHR at this time are the "Meaningful Use" financial incentives legislated by the Health Information Technology for Economic and Clinical Health Act (HITECH) of the 2009 American Recovery and Reinvestment Act. • The EHR offers benefits to nurses, physicians, and other healthcare providers, the healthcare enterprise, and, most importantly, the consumer. • The HITECH has sparked new interest in EHRs and brings focus and consistency to U.S. EHR adoption efforts. • One of the major considerations in the implementation of an EHR system at this time is the selection of a system certified as capable of supporting Meaningful Use requirements to enable eligible providers to receive financial incentives. • Other considerations in the adoption of EHR systems include creating the perquisite infrastructure, costs associated with system purchase and support, and the integration of standardized nomenclatures to support interoperability and research. Despite its many benefits, setting realistic expectations, planning for culture change, instituting safeguards to protect patient information, and caregiver resistance are the major impediments to the development of an EHR. • Issues that must be considered when developing the EHR include data integrity, ownership of the patient record, privacy, and electronic signature.
consumer informatics
Study of patient use of online information and communication to improve health outcomes and decisions. driven by several factors including technological advances, an increasingly internet-savvy population, a need for increased accountability in the selection of healthcare services, an acceptance of online and telephone transactions in lieu of face to face interactions, concerns for safety, the advent of health savings accts, and a change in the revenue model that calls for individuals to assume greater responsibility for payment for services.
determine desired clinical outcomes supported by information systems
seen as the means to achieve improved productivity, safety, increase quality of care, meet regulatory and reimbursement requirements, and reduce costs across the enterprise. IT acheived thru evidence-based care, improved work flow, and better mgt of resources.
the experienced nurse
The ANA (2008) has identified competencies to include the following: • Proficiency in his or her area of specialization and the use of IT and computers to support that area of practice including quality improvement and other related activities (ANA 2008) • Knowledge representation methodologies for evidence-based practice • The ability to use information systems and work with informatics specialists to enact system improvements • Proficiency in using evidence-based databases • The promotion of innovative applications of technology in healthcare.
experienced nurse and informatics knowledge and experience
The experienced nurse builds upon the competencies required for entry-level practitioners using basic computer skills to information regarding the patient. This practitioner has the expertise to serve as a content expert in system design, to see relationships among data elements, to execute judgments based on observed data patterns, to safeguard access to quality of information, and to participate in efforts to improve information management and communication. The ANA (2008) has identified competencies to include the following: • Proficiency in his or her area of specialization and the use of IT and computers to support that area of practice including quality improvement and other related activities (ANA 2008) • Knowledge representation methodologies for evidence-based practice • The ability to use information systems and work with informatics specialists to enact system improvements • Proficiency in using evidence-based databases • The promotion of innovative applications of technology in healthcare
scope
The scope of an organization's mission defines the type of activities and services it will perform. The scope should be clearly identified in the mission statement so that employees and customers understand which aspects of organizational operation are most important.
informatics nurse and informatics knowledge and experience
This individual has advanced preparation in information management and possesses the following skills (ANA 2008): • Proficiency with informatics applications to support all areas of nursing practice including quality improvement activities, research, project management, system design, development, analysis, implementation, support, maintenance, and evaluation • Fiscal management • Integration of multidisciplinary language/standards of practice • Skills in critical thinking, data management and processing, decision making, and system development, and computer skills • Identification and provision of data for decision making
International Classification of Nursing Practice (ICNP)
unified nursing language system developed by the ICN, in Geneva, Switzerland. ICN is responsible for ensuring that the content reflects the domain of nursing. contains nursing phenomena (diagnoses), nursing actions, and nursing outcomes.
examples of how informatics and computers support the various areas of nursing and consumer health-nursing research
• Computerized literature searching • The adoption of standardized language related to nursing terms • The ability to find trends in aggregate data, which is data derived from large population groups • Use of the Internet for obtaining data collection tools and conducting research • Collaboration with other nurse researchers
examples of how informatics and computers support the various areas of nursing and consumer health-nursing education
• Online completion of mandatory education requirements • Online course registration and scheduling • Computerized student tracking, testing, and grade management • Course delivery and support for Web-based education • Remote access to library and Internet resources • Teleconferencing and Webcast capability • Presentation software for preparing slides and handouts • Online test administration • Communication with students
id standard dataset formats
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goal
A goal is an open-ended statement that describes in general terms what is to be accomplished. Examples of goals include maintaining quality client care while promoting cost-effective operations, striving to increase market share by attracting a larger percentage of clients than the competitor's, and broadening the scope of services offered. The ability to achieve defined goals is especially important in the rapidly changing healthcare environment as hospitals merge into large enterprises and services evolve to meet changing needs. Prior to writing goals and objectives, administrators need to communicate the vision and mission to employees in a manner that elicits understanding and buy-in
AACN
American Association of Colleges of Nursing. organization that provides a voice for baccalaureate and higher degree nsg ed programs in US. provide curriculum elements and a framework for baccalaureate and higher degree nsg programs. established informatics as curriculum element for baccalaureate, master's, and doctoral programs. Baccalaureate: expected to provide skills needed to manage info and apply to pt care technology. MSN: expected to use pt care technologies to deliver and enhance care, use communication technologies to integrate and coordinate care, analyze data to improve pt outcomes, manage info for evidence based care and pt ed, use and facilitate electronic health records (EHRs) to improve pt care. Advanced practice grad should be able to answer questions that arise in practice, use new knowledge to analyze the outcomes of interventions and initiate change, use technology inclusive of information systems for the purpose of storage and retrieval of data, and query databases for the purpose of using available research in practice. DNP graduates should be active participants in the design, selection, and use of IT for the purpose of supporting patient care and healthcare systems
recognize national trends and initiatives related to informatics
Healthcare reform has re-emerged as a policy imperative in recent years. In 2004 President George W. Bush created the position of the national health information technology coordinator and called for the establishment of an EHR for every American by 2014 (Miller & West 2009). However, it was not until President Obama signed the American Recovery and Reinvestment Act (ARRA) and the Health Information Technology for Economic and Clinical Health (HITECH) Act into law in 2009 that the Department of Health and Human Services (HHS) was given authority to establish programs to improve healthcare quality, safety, and efficiency through the use of HIT and that funds were provided to support widespread adoption of HIT (McDermott Will & Emery 2009; Walker 2010). In 2005 WHO designated the Joint Commission and Joint Commission International as the WHO Collaborating Centre on Patient Safety Solutions. In 2007 the International Steering Committee of the Centre approved solutions for the following: • Look-alike, sound-alike medication names • Patient identification • Communication during patient handover • Correct procedure and body site • Electrolyte solution concentration control • Medication accuracy • Catheter and tubing misconnections • Needle reuse and injection device safety • Hand hygiene. The latter group of patient safety issues include follow-up on critical test results, falls, hospital-acquired central-line infections, pressure ulcers, care of the rapidly deteriorating patient, patient and family involvement in care, provider apology and disclosure, and medications with names that look or sound similar. The Centre coordinates the High 5s Project, which is developing standard operating procedures to address widespread patient safety problems across the globe. The drive for patient safety, transparency in healthcare, error reduction, increased efficiency, and additional requirements on the part of regulatory agencies will continue to shape healthcare delivery and informatics practice for many years to come. Consumers will assume a greater responsibility for their healthcare choices as they shoulder a larger portion of the costs.
explain the influences of technology on nursing practice
Nursing Practice: • Worklists to remind staff of planned nursing interventions • Computer-generated client documentation including discharge instructions and medication information • Monitoring devices that record vital signs and other measurements directly into the client record • Computer-generated nursing care plans and critical pathways • Automatic billing for supplies or procedures with nursing documentation • Reminders and prompts that appear during documentation to ensure comprehensive charting • Quick access to computer-archived patient data from previous encounters • Online drug information Nursing Administration: • Automated staff scheduling • Online bidding for unfilled shifts • E-mail for improved communication • Cost analysis and finding trends for budget purposes • Quality assurance and outcomes analysis • Patient tracking and placement for case management Nursing Education: • Online completion of mandatory education requirements • Online course registration and scheduling • Computerized student tracking, testing, and grade management • Course delivery and support for Web-based education • Remote access to library and Internet resources • Teleconferencing and Webcast capability • Presentation software for preparing slides and handouts • Online test administration • Communication with students Nursing Research: • Computerized literature searching • The adoption of standardized language related to nursing terms • The ability to find trends in aggregate data, which is data derived from large population groups • Use of the Internet for obtaining data collection tools and conducting research • Collaboration with other nurse researchers
information gatherer
The nurse interprets and structures clinical data, such as a client's report of experienced pain, into information that can then be used to aid clinical decision making and patient monitoring over time. Quality assurance and infection control activities exemplify other ways in which nurses use information to detect patterns. supported when computer capability quickly discerns patterns that help translate data into information, saves time and labor for nurse, and provides useful info in a timely fashion.
Large-scale use of data, information, and knowledge requires that they be accessible.
Traditionally, client data and information have been handwritten in an unstructured format on paper and placed in multiple versions of the patient record at hospitals, clinics, physician offices, and long-term and home health agencies. This process makes the location, abstraction, and comparison of information slow and difficult, limiting the creation of knowledge. Increasing demands for improvements in healthcare delivery call for the use of IT as a means to automate and share information for quality measurement and improvement, research, and education. Technology exists to move from paper-based to computer-based records. It is essential that nurses collaborate with technical personnel to plan what information to include, the source of the information, and how it will be used. Nurses must be active participants in the design of automated documentation to ensure that information is recorded appropriately and in a format that can be accessed and useful to all healthcare providers. Nurses also have a responsibility to safeguard the security and privacy of client information via education, policy, and technical means.
The Technology Informatics Guiding Education Reform (TIGER) Initiative
emerged from a national gathering of leaders from nursing administration, practice, education, informatics, technology, and government, as well as other key stakeholders, who realized that nursing must transform itself as a profession to realize the benefits that electronic patient records can provide. purpose was to create a vision for the future of nursing to provide a safer, higher-quality patient care through the use of IT. requires informatics competencies for every nurse and active involvement in advancing HIT. called for the redesign of nursing education to keep up with rapid changes in technology, active participation by nurses in the design of informatics tools, and increased visibility by nurses in the national health IT agenda. It organized teams to work toward the common goals; obtained additional funding; developed work plans and outcomes for each team; and identified informatics competencies for all levels of nursing personnel, including nursing assistants.
clinical terminology
enables the capture of data at the level of detail necessary for pt care documentation and used to describe health conditions and healthcare activities. consist of concepts that support diagnostic studies, h&p exams, visit notes, ancillary dept info, nsg notes, assessments, flow sheets, vs, outcome measures. used for documenting pt care w/ in EHR
nursing informatics
may be broadly defined as the use of information and computer technology to support all aspects of nursing practice, including direct delivery of care, administration, education, and research. The definition of nursing informatics is evolving as advances occur in nursing practice and technology; there have been many different definitions throughout the years as the discipline has evolved. Nursing informatics is a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, knowledge and wisdom into nursing practice. Nursing informatics facilitates the integration of data, information, knowledge and wisdom to support patients, nurses, and other providers in their decision making in all roles and settings. This support is accomplished through the use of information structures, information processes, and information technology.
AACN-American Association of Colleges of Nursing
organization that provides a voice for baccalaureate and higher-degree nursing education programs in the United States, providing curriculum elements and a framework for baccalaureate and higher-degree nursing programs. established informatics as a curriculum element for baccalaureate, master's level, and doctoral programs, albeit expectations differ by level of education. Baccalaureate programs are expected to provide the skills needed to manage information and apply patient care technology. MSN graduates are expected to: • Use patient care technologies to deliver and enhance care • Use communication technologies to integrate and coordinate care • Analyze data to improve patient outcomes • Manage information for evidence-based care and patient education • Use and facilitate electronic health records (EHRs) to improve patient care.
Informatics Nurse Specialist and informatics knowledge and experience
The INS possesses a sophisticated level of understanding and skills in information management and computer technology, demonstrating most of the competencies seen at the previous three levels. The INS is the innovator who sees the broad vision of what is possible and how it may be attained. The Scope and Standards of Nursing Informatics Practice (ANA 2008) calls for educational preparation for the INS that enables him or her to conduct informatics research and generate informatics theory. This preparation and expertise makes the INS well suited to work in a variety of areas and functional roles including project management and administration.
Applicants for the credentialing examination are required to meet the following criteria:
a. A baccalaureate or higher degree in nursing or a baccalaureate in a relevant field b. A current, active license as a professional nurse in the United States or a legally recognized equivalent in another country c. The equivalent of 2 years of full-time professional practice as a nurse d. Thirty contact hours of continuing education applicable to nursing informatics within the past 3 years e. A minimum of 2,000 hours of practice in informatics nursing in the past 3 years, or a minimum of 12 semester hours of graduate credits in nursing informatics courses with at least 1,000 hours of practice in informatics nursing within the previous 3 years, or completion of a graduate program in nursing informatics that includes at least 200 hours of faculty supervised clinical practicum. The certification examination covers content on the theory; information management principles and database management; human factors; and the analysis, design, implementation, evaluation, support, and marketing of information systems as well as trends and issues.
beginning nurse and informatics knowledge and experience
focuses primarily on developing and using skills that rely upon the ability to retrieve and enter data in an electronic format that is relevant to patient care, the analysis and interpretation of information as part of planning care, the use of informatics applications designed for nursing practice, and the implementation of policies relevant to information. The Scope and Standards of Nursing Informatics Practice (ANA 2008) calls for the following competencies for the beginning nurse: • Basic computer literacy, including the ability to use basic desktop applications and electronic communication • The ability to use IT to support clinical and administrative processes, which presumes information literacy to support evidence-based practice • The ability to access data and perform documentation via computerized patient records • The ability to support patient safety initiatives via the use of IT • Recognition of the role of informatics in nursing
patient privacy. Emerging trends in healthcare delivery bring benefits as well as new threats to privacy and private health information.
growing number of Americans favor the use of electronic records as a means to improve the quality of care and lower costs. Most feel that the benefits of electronic records outweigh risks to privacy, but concerns over privacy remain one of the biggest obstacles related to health information exchange. quality patient care includes the protection of patients' private health information. This protection is mandated through the Health Insurance Portability and Accountability Act. Individual healthcare organizations employ a variety of safeguards to protect the privacy of health information. Despite these measures data security is a real issue in healthcare, with many hospitals reporting a lack in confidence in their ability to prevent data security breaches. Several well-publicized breaches have occurred in recent years leading to fines, litigation, damaged reputations, credit issues, and identity theft concerns. Some of the greatest risks have come from off-line data such as stolen or lost storage media or computers, although increased access to patient healthcare information from points both inside and outside of healthcare facilities and from mobile devices such as personal digital assistants (PDAs), laptops, and smartphones also raise the potential risk of unauthorized access to private health information. The Growing use of e-mail and Web 2.0 applications for health education, reminders, and other patient-provider communication further increases this risk.
information literacy
has a broad meaning. Information literacy is defined as the ability to recognize when information is needed as well as the skills to find, evaluate, and use needed information effectively. important in today's environment of rapid technological change and knowledge growth, with information available from many sources and in different formats, including text, graphics, and audio. important to all disciplines because it forms the basis for ongoing learning. In healthcare the definition of information literacy must also include an awareness of the conceptual differences between various classifications and standardized languages, critical thinking skills, the ability to use the tools offered by technology to solve information problems, as well as an understanding of the ethical and legal issues surrounding the access and use of information.
nursing informatics as a specialty area of practice. The Scope and Standards of Nursing Informatics Practice (ANA 2001) noted that nursing informatics displays 5 of the 12 defining characteristics that must be present for a nursing specialty.
include the following: • A differentiated practice. Nursing informatics differs from other specialties within nursing because it focuses on data, information, and knowledge; the structure and use are the same; and efforts to guarantee that nursing information is represented in efforts to automate health information. It shares an interest in the client, the environment, health, and nurses in other areas of specialty practice. • Defined research priorities. Target areas for research were identified and published in the early 1990s. These centered primarily on the development of a standard language for use within nursing, which would allow nurses from different regions of a country or the world to establish that they were describing the same phenomenon and to conduct studies that could be replicated. In more recent years, survey results identified additional areas deemed critical for research, although the development of a standard nursing language remains crucial. The development of databases for clinical information is another priority area. • Representation by one or more organization(s). This criterion is met because nursing informatics interests are represented by work groups within the AMIA and the IMIA, in a number of regional groups within the United States, and in national groups abroad. • Formal educational programs. Early leaders in nursing informatics obtained their expertise through experience as well as classes in related areas such as computer science and information science. Grant monies from the Division of Nursing of the Health Resources and Services Administration (National Advisory Council on Nurse Education and Practice 1997) were used to establish the first two graduate programs in nursing informatics at the University of Maryland in 1988 and at the University of Utah in 1990. There are now several graduate programs as well as certificate programs and doctoral education in this area. Some nurses still elect to enter programs in healthcare informatics and medical informatics as a means to pursue their interests. • A credentialing process. The American Nurses Credentialing Center (ANCC 2001) used the foundation provided by the ANA in its 1994 definition of nursing informatics and scope and standards of practice.
identify clinical information available to support patient-centered care
provider order entry, result retrieval, documentation, and decision support across distributed locations. documentation of nsg admission assessment, d/c instructions, nsg worklist w/ routine scheduled activities r/t to care of each client, documentation of discrete data (vs, wt, i/o), documentation of routine aspects of care (bath, positioning, blood gluc, dietary intake, wound care flowsheet), standardized care plans allow for individualization, document of nsg care in progress note format (narrative chart, chart by exception, or flowsheet chart), document of med administration,
medical informatics definition
refers to application of informatics to all of the healthcare disciplines as well as to the practice of medicine. focus primarily upon information technologies that involve patient care and medical decision making. May be used to refer to the application of information science and technology to acquire, process, organize, interpret, store, use, and communicate medical data in all of its forms in medical education, practice and research, patient care, and health management; the term may also refer more broadly to the application of informatics to all of the healthcare disciplines as well as the practice of medicine. Generally used as a broad term to include all the disciplines in the field with specific health-related areas beneath it, including nsg informatics and consumer informatics.
standardized terminologies
structured and controlled languages that have been developed according to terminology dev guidelines and have been approved by an authoritative body. AKA controlled terminologies. The requirement for standardized terminology development has increased tremendously to support the use of national and international health information standards. Standardized terminology is essential for successful development and implementation of an EHR.
As EHR adaptation is accelerated by hospitals, clinics, and private practices, the demand for nurses with IT skills grows. Opportunities exist in a wide-range of workplaces from large hospitals and clinics, to vendors and systems development. Informatics nurses also find employment opportunities as consultants because of relevant work experiences. Relevant work experiences and competencies often include:
• Collaboration and communication skills • Organizational and interpersonal skills • Ability to review, critique, and evaluate evidence available through clinical practice guidelines and research • Capacity to synthesize evidence as the basis for best practice • Aptitude for translating clinical practice recommendations into algorithms • Proficiency to disseminate research findings • Clinical experience in the venue of current project need (e.g., for acute care phenomena, experience in a medical-surgical, or critical care area working with adult patients in an acute care hospital is required) • Experience within a fully digital EMR system • Strong nursing leadership and management skills • Ability to articulate the vision for clinical workflow through technology that benefits patient care
Nursing curriculum reform has placed an emphasis on computer proficiency along with patient care technology knowledge. Technology-driven information management, communication tools, clinical equipment knowledge, and information literacy have been recognized by the Quality and Safety Education for Nurses Project. Basic competencies for nurses incorporate attitudes, knowledge, and skills that include:
• habit of lifetime learning of information and technology; • word processing skills, spreadsheet application; • capability to use electronic documentation; • ability to retrieve electronic data, including bibliographic information; • capacity to protect patient privacy and confidentiality when using EHRs; • aptitude to interpret and respond to technical equipment used at the point of care; • data mining skills; • ability to evaluate Internet resources and critically appraise Web sites.
