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
CDS
Clinical decision support
Benefits of a CPOE:
- prompts that warn against possible drug interaction, allergy, or overdose
- accurate and current meds
- drug specific info that eliminates confusion among drug names that sound alike and look alike
- improved communication b/t docs and pharm
- decreased healthcare costs caused by improved efficiencies
When was bar code medication labeling mandated by FDA?
2004
What does bar code technology help with?
Processes of procurement, inventory, storage, preparation, and dispensing
These technologies are designed for safe administration of high hazard drugs and to reduce the adverse drug events during IV med admin
Smart pump technologies
How to ensure safe implementation of smart pumps:
Ensure standardized drug concentrations Standardized dosing units for a given drug (mg vs mcg) Standardized nomenclature (KCL)
This technology has both supply chain and patient care applications to patient safety.
RFID
These terms are used to describe a cooperative relationship among actively engaged professionals where health care decision making is shared, combining their collective knowledge and skills to care for their patients.
Interdisciplinary collaboration or interprofessional collaboration
This term is used to describe the gap between those who have and those who do not have access to online information
Digital divide
Who is less likely to have internet access?
Those with chronic diseases
What factors are associated with the digital divide?
Elderly Chronic disease Ethnicity Income Level of education
This gap reflects the fact that solutions to global health problems exist but are not implemented in a timely fashion because of the lack of access to important health information
Know-do gap
Parker, Ratzan, and Laurie state that this many people in the US have health literacy problems and lament that in a time is money economic climate, healthcare practitioners are not always reimbursed for patient education activities.
One-third
This was developed to address the growing need for managing health information and to promote technology as a means of improving health information exchange
EHealth Initiative
What is a major goal for eHealth initiative?
Continue to empower consumers to understand their health needs better and to take action appropriate to those needs
List barriers to eHealth initiative:
Poor interoperability among healthcare systems
Failure to embrace national data standards for health care
How does an HCO move from a static medium to a dynamic medium to improve engagement?
Dvd’s and videotapes that were shown to groups or broadcast over dedicated channels in pt rooms
This term refers to the difference in electronic connectivity by age.
Gray gap
ICT’s
Information and communication technologies
This survey describes the certifications and accreditation symbols that identify trusted health sites.
Health on the net foundation 2005 (HON)
This should help reduce the digital access disparity associated with those who have limited keyboard or mouse skills.
Voice interactivity
What is a major widespread barrier to the adoption of email and text messaging among health care providers
The reimbursement mechanism for electronic health care interventions are inadequate or non-existent
These direct patients and families to credible websites, including government and HCO websites and wikis and blogs that may help them understand their health issues or share information with and seek support from others who have similar issues.
Information prescriptions
How can a provider practice tele-health?
Must be licensed in all states that they are performing tele-health
What is the first critical step in a patient participating in telehealth?
Informed consent
This is the use of medical information exchanged from one site to another via electronic communications to improve patient’s health status
Telemedicine
What terms are used for the technologies presently used as part of multifunctional telehealth care platforms and application servers:
Central stations, web servers, and portals
What are key components of telehealth that can be as minimal as a single screen display or as comprehensive as software applications that provide various functions, including triageing the data based on medical alerts, which allows clinicians to quickly identify how those patients require immediate attention:
Central stations and web servers
These can consist of fully integrated systems such as a vital signs monitor or they may be stand alone telecommunications ready devices such as BP cuff and BS meters
Peripheral biometrics (medical) devices
What is the most familiar household communication tool used in tele-healthcare
Telephones
How many americans use prescription drugs?
49% , 32million are taking three or more meds daily, with even more being taken by those over 65
What’s an important goal of telehealth?
When patient achieves a good understanding of and perform self care by the end of their home health admission period
When did SARS appear in china?
2002
These kind of systems use data that are not diagnostic of a disease but that might indicate the early stages of an outbreak.
Surveillance systems
What’s another name for surveillance systems?
Syndrome surveillance systems
What is the overriding purpose of syndrome can surveillance?
Outbreak detection
What are other benefits of syndrome surveillance?
Enhanced case finding and monitoring the course and population characteristics of a recognized outbreak
Information acquired by the collection and processing of population health data becomes the basis for knowledge in the field of?
Population health
_______ about disease trends and other threats to immunity health improved program planning, decision making, and care delivery
Knowledge
What are the core public health functions?
Assessment and monitoring of the health of communities and populations at risk to identify health problems and priorities
Who is the father of public health informatics (PHI)?
Dr. John Snow he plotted cholera deaths in 1854
______ efficiently and effectively organizes and manages data, information, and knowledge generated and used by public health professionals to fulfill the core functions of public health (assessment, policy, assurance)
PHI
______ ____ changes the social conditions and systems that affect everyone within a given community
Public health
The scope of PHI practice includes knowledge from a variety of additional disciplines:
Management, organization theory, psychology, political science, and law and fields r/t public health (epidemiology)
4 principles that define and guide the activities of PHI per Yasnoff:
- Applications promote the health of populations
- Applications focus on disease and injury prevention
- Applications explore prevention at all vulnerable points in the casual changes
- PHI reflects the governmental context in which public health is practiced
This defines the role of public health as fulfilling society’s interest in assuring conditions in which people can be healthy
The Institute of Medicine
Functions of public health:
Prevent epidemics and the spread of disease, protection against environmental hazards, promote health, disaster response and recovery, providing access to health care
The initiative of integrating the health care enterprise to ensure that health care information can be shared more easily and used more effectively has inspired the creation of the domain known as:?
Quality, research, and public health (QRPH)
These are tools that allow assessment of potential hazards in the environment
Risk assessment tools
What else may a risk assessment be called?
A threat and risk assessment
This is a harmful act such as the deployment of a virus or illegal network penetration
A threat
This is the expectation that a threat may succeed and the potential damage that can occur.
A risk
4 basic steps to a risk assessment:
Hazard identification
Exposure assessment
Dose-response assessment
Risk characterization
This seeks to determine the types of health problems that could be caused by exposure to a potentially hazardous material.
Hazard identification
This is done to determine the length, amount, and pattern of exposure to the potentially hazardous material
Exposure assessment
This is an estimation of how much exposure to the potential hazard would cause varying degrees of health effects
Dose-response assessment
This is an assessment of the risk of the hazardous material causing illness in the population
Risk characterization
CRA
Community risk assessment
This is a function of cost, service, and outcome per Ball (2003)
VALUE
What is the goal of a CRA?
Risk reduction and improved health
NRDM
National retail data monitor (created by Univ of Pittsburgh Realtime Outbreak and disease surveillance laboratory)
What does the NRDM do?
Collects data on over the counter medication and other health care products from 28,000 stores and uses computer algorithms to detect unusual purchase patters that could signal a disease outbreak
How would PHI appropriately process public health data?
Standardized vocabulary and coding structure
These have been established to support data sharing via health information exchanges promoted by the meaningful use criteria of the electronic health record.
Health information organizations (HIO)
Yasnoff identified grand challenges still facing PHI:
Development of national public health information systems
A closer integration of clinical care with public health, and concerns of confidentiality and privacy
