Ch 11,12,13,14,15 Flashcards
What is considered now to be an entry level health care competency?
Basic knowledge of ehr’s and health informatics
HIMSS has been tracking ehr adoption since 2005 and there are 7 stages
Health information management systems society
What are the basic components of an ehr?
Components of laboratory, radiology, and pharmacy ancillaries, clinical data repository
This legislation included the HITECH act that sought to incentivize health organizations and providers to become meaningful users of ehr’s
American recovery and Reinvestment Act of 2009 (ARRA)
Stage 1 is the _____ ____ criteria that focus’ on data capturing and sharing
Meaningful use
HIE
Health information exchange
The IOM definition of an EHR has broken it down into 8 essential components with an emphasis on patient safety
- Health info and data
- Results management
- Order entry management
- Decision support
- Electronic communication and connectivity
- Patient support
- Administrative processes
- Reporting and population health management
____ ___ entails the use of computer reminders and alerts to improve the diagnosis and care of a patient, including screening for correct drug selection and dosage screening for medication interactions with other medications
Decision support
Electronic communication and _____ include the online communication among health care team members, their care partners, and patients; includes emails, web messaging and an integrated health record within and across settings, institutions, and telemedicine
Connectivity
____ ____ are activities carried out by the electronic scheduling, billing, and claims management systems, including electronic scheduling for inpatient and out patient visits
Administrative processes
Reporting and ____ ____ management are the data collection tools to support public and private reporting requirements including data represented in a standardized terminology and machine readable format.
Population health
4 most common benefits cited for EHR’s:
- Increased delivery of guidelines based care
- Enhanced capacity to perform surveillance and monitoring disease conditions
- Reduction in medication errors
- Decreased use of care
AHRQ studied the value of an EHR in an ambulatory care and pediatric settings including its overall economic value
Agency for Healthcare Research and Quality
What award may be the best resource for combined quantitative and qualitative results of successful EHR implementation. It recognizes health care organizations that have achieved both excellence in implementation and value from health information technology
HIMSS Davies Award
CIS
Clinical information systems
What is the first step in ownership of an ehr?
Vendor selection process for a commercially available ehr
This phase should concentrate on understanding the current state of the health information technology industry to identify appropriate questions and the next steps in the selection process
Pre-acquisition phase
____ planning should occur concurrently with the selection process particularly the assessment of the scope of the work, initial sequencing of the ehr components to be implemented and resources required
Implementation
To promote adoption of an EHR a ____ ______ plan must be developed in conjunction with the ehr implementation plan
Change management
____ must be work flow based and reflect real clinical processes.
Training
What step is often overlooked and results in benefits falling short of expectation because the resources are not available to realize them permanently.
Implementation plan bc it should include long term optimization of the ehr
An EHR must be _____ and expandable to meet the needs of patients and caregivers in all settings despite challenges.
Flexible
Interoperability exists through a ____ of ____ document that includes the patient demographis, medications, allergy, and problem lists among other things and the formatting and exchange of the continuity of care document required to be supported by ehr vendors and health care organizations seeking ARRA meaningful use incentives
Continuity of care document
The intentions of this exchange were to promote patient safety and increase health care efficiencies across the state, it raised significant concerns about security and privacy.
Minnesota Health Information Exchange 2007
What report is widely credited with launching the current focus on patient safety?
The institute of medicine (2000) “to err is human”
AHRQ
Agency for healthcare research and quality
What did the AHRQ primer 2012 suggest for organizations?
Strive for high reliability by committing to improving health care quality and prevent med errors to demonstrate overall commitment to patient safety
Features of safety culture by AHRQ:
Acknowledgment of the high risk nature of an organization activities and the desire to achieve consistent safe operations
Blame free environment
Encouragement of collaboration to seek solutions to patient safety problems
Organizational commitment of resources to address safety concerns
How can organizations engage themselves in examine medical errors closely and to determine the system processes that need to be changed to prevent similar future errors?
RCA’s
Failure modes and effects analysis
Where does individual accountability fit in with a blame free environment?
The AHRQ says the way to balance these competing cultural values is to establish a just culture where systems or process issues can e addressed by changing practices or work flow processes, clearly stating reckless behavior wont be tolerated
There are 3 types of behavior in the just culture approach:
- Human error (unintentional mistakes)
- Risky behaviors (work around)
- Reckless behavior (total disregard for est policies and protocols)
Two primary organizations that have strategies related to patient safety:
- AHRQ
2. IHI (institute for healthcare improvement)
This organization in relation to patient safety suggests that teamwork training, executive walk-around, and unit based safety teams have improved safety culture perceptions but have not led to a significant reduction in error rates.
AHRQ
This organization in relation to patient safety stresses that organizational leaders must drive the culture changes by making a visible commitment to safety and by enabling staff to share safety information openly
IHI
What are some of the strategies suggested by IHI to improve patient safety?
Appointing a safety champion for every unit
Create an adverse event response team
Re enacting or simulating adverse events to better understand the organizational or procedural processes that failed
Ebben, Gieras, and Gosbee note a term that means “ the discipline of applying what is known about human capabilities and limitations to the design of products, processes, systems, and work environments.”
Human factors engineering- its application to system design improves the ease of use, systems performance and reliability and user satisfaction, while reducing operational errors and stress.
These kind of technologies are frequently designed to improve patient safety, streamline work processes, and improve the quality and outcomes of health care delivery.
Healthcare technologies
Who urged the adoption of IT processes to improve safety?
Bates and Gawande
What does Bates and Gawande suggest?
IT improves communication, reduces errors, and adverse events, crease the rapidity of the response to adverse events, makes knowledge more accessible to clinicians, assist with decision and provide feedback on performance.
These are functions that direct or restrict actions or orders implemented by computer technologies.
Technology-based forcing functions- ex. Restricting inappropriate dosing route for meds
This act began a series of funding streams to promote health IT, promote sharing of best practices in health IT, and help organizations implement health IT
The wired for health care quality act 2005
What are the most frequent errors and most visible errors because of the administration cycle has poorly designed work processes with many areas for human error?
Medication errors
BCMA
CPOE
Bar code medication administration (preceeded the EHR)
Computer physician order entry
