D220 Definitions Flashcards
Access Levels
User can only see information that they have access to. (Ex. CNA cannot see everything an RN can).
Administrative Safeguards of Electronic Health Information
Restricting access of all authorized users of the EHR according to their position within the healthcare system.
Admission-Discharge-Transfer (ADT) System
Classified under the hospitals’ administrative info system. It’s one foundational system that allows operational activities such as bed placement, transportation, coordination, room readiness, and the general coordination of services focused on the patients phase of movement. Tracks patients activities and location from admission to discharge.
American Recover & Reinvestment Act (ARRA)*
Authorized incentive payments to specific types of hospitals and healthcare professionals for adopting and using interoperable Health Information Technology & EHRs. ARRA provides economic stimuli and incentives for the adoption of EHRs.
Health Information Technology for Economic and Clinical Health Act (HITECH Act)***
The HITECH Act provides funds and incentives to increase EHRs by providers, improve policy decisions and allocate services, funded workforce training, and new technology research. HITECH strongly recommends increasing meaningful use of HIT to decrease overall healthcare cost and to improve population health.
Differentiate the focus of the ARRA and the HITECH technology for economic and clinical health acts
ARRA: Established incentive payment for eligible pros (EPs), eligible hospitals, and critical access hospitals (CAHs) to promote the adoption and meaningful use of Certified Electronic Health Record.
HITECH: Provided economic stimuli and incentives for the adoption of EHRs. It also insured the collection of aggregate data that could be used to improve policy decisions relative to allocation of services and population health.
What is the difference between ARRA and HITECH?
ARRA: Authorized incentive payments to certain hospitals and health care professionals for adopting and using HIT and EHRs. Helps to stimulate the economy.
HITECH: Is a provision of ARRA that helped to ensure that healthcare organizations were not only adopting EHRs but were only using them for the following recommendations of Meaningful use which includes better quality, safety, and accuracy and by reducing inconsistencies in health care and improving patient outcomes.
HITECH info*
-Directs eligible healthcare providers and healthcare organizations to adopt electronic health records to improve the exchange of information and to improve privacy and security protections for healthcare data.
-The HITECH Act of 2009 provides the Department of Health and Human Services (HHS) with the authority to establish programs to improve care quality, safety, and efficiency through the promotion of health IT, including electronic health records and private and secure electronic health information exchange.
Which barrier to healthcare informatics use does the HITECH Act aim to reduce?
Financial
Meaningful Use***
Use of health information technology (HIT) legislated by ARRA of 2009 to collect specific data with the intent to improve care and population health. engage patients, ensure privacy and security, with financial incentive from Medicare and Medicaid to providers.
**Goals: engage patients, exchange data in an accurate/complete way, improve healthcare overall.
**Used by inpatient and outpatient settings. Enable providers to be financially compensated.
**Requires standardized terminology (allows for uniformity and easier retrieval of nursing-related data.
What were two objective of meaningful use as defined by the American reinvestment and recovery act (ARRA)?
Document patient collected data directly into the EHR and submit electronic data to health information exchanges (HIEs).
Meaningful Use (MU) Care Requirements***
*Centers for Medicare and Medicaid Services (CMS) developed core criteria that defined basic functions of EHRs must demonstrate. Basic entry of clinical information, requiring standardized terminology across the board, use of several software applications, entry of clinical orders with safety measures.
MU Core Requirement Stages
Stage 1: Electronic capturing and sharing of data between hospitals/providers.
Stage 2: Requires patients to view, download, or transmit their health information online, capability for secure messaging between providers/patients, and reporting public health measures, advancing clinical processes.
Stage 3: Focus on the enhanced use of EHRs to promote health information exchange and improve care, and improving patient outcomes (ex. electronic prescribing) implemented in 2018.
Which government organization describes the application of meaningful use?
The Centers for Medicare and Medicaid Services (CMS).
-One of the goals of the 2016 CMS Quality Strategy calls for improving safety and reducing unnecessary and inappropriate care, by teaching healthcare professionals how to better communicate with people who have low health literacy and by more effectively linking healthcare decisions to person-centered goals.
Which statement describes the application of Meaningful Use?
Provider needs to show the use of EHRs technology.
Which act in 2009 did Meaningful Use originate?
ARRA act in 2009
What Meaningful Use stage can you generate and transmit prescriptions electronically?
Stage 3
What did Meaningful Use promote?
Increased interoperability
Which statement describes the application of Meaningful Use?
Patient satisfaction improved, which results in better patient satisfaction scores.
What described the goal of EHR incentive programs, such as Meaningful Use?
To promote the achievement of quality, safety, and efficiency measures.
Identify five rights associated with Meaningful Use
Right information
Right person
Right intervention format
Right channel
Right time and workflow
Identify the importance of standardized terminologies for Meaningful Use
Improves better communication among nurses and other healthcare providers. It also improves patient care leading to patient satisfaction and treatment adherence.
Relationship between standardized terminologies, quality improvement, and financial awards related to Meaningful Use?
Use of health information technology legislative by ARRA of 2009 to collect specific data with the intent to improve patient care, engage patients in their own care, and to ensure privacy and security with financial incentives for Medicare and Medicaid to providers. If providers are all using the same standard of terminology this will in turn give patients a better understanding and they will engage more in their own care. This will help meet Meaningful Use requirements, thus providing financial rewards to providers.
The 21st Century Cures Act
Is designed to help accelerate medical product development and bring new innovations and advances to patients who need them faster and more efficiently. It also requires patient electronic health information be made available to patients without delay (with few exceptions), at no cost.
What is the focus of the 21st Century Cures Act?
Recognizes that patients need more power in their healthcare and access to information is key to making that happen.
What act puts patients in charge of their healthcare records?
The 21st Century Cures Act
21st Century Cures Act Info:
One of the provisions of the 21st Century Cures Act is the elimination of information blocking. Information blocking is defined as a practice by a health IT stakeholder that, except as required by law or specified by the Secretary of Health and Human Services (HHS) as a reasonable and necessary activity, is likely to interfere with access, exchange, or use of electronic health information from provider to provider or provider to patient.
The American Nurses Association Code of Ethics Provision 3:
Stresses that a nurse’s obligation is to protect patients from harm. Protecting the patients right to privacy and confidentiality protects the patient from harm.
Merit-Based Incentive Payment Systems (MIPS) - Quality
Ensures Medicare patients get the right care at the right time. Uses PQRS (physician quality reporting systems) and Medicare EHRs that will be measured on quality, resource use, clinical-practice environment, and meaningful use of EHRs technology. For physicians to qualify for MIPS, they must bill Medicare more than $90,000/year and see more than 200 Medicare patients annually.
Which MIPS merit-based incentive payment system performance replaces MU for physicians?
HITECH Act
Which merit-based incentive payment system (MIPS) performance category replaces MU for physicians?
Quality of care
What do the goals of MU and merit-based incentive programs have in common?
Improving quality of care
Joint Commission - Accreditation
Key standards of information management: protect and aggregate data, uniform definitions/language, teach information management (training), and address disaster and preparedness.
An informatics nurse is on a task force planning committee to ensure data storage measures are safe and accessible. Besides the provider and the client, which groups needs are important to consider?
The Joint Commission
What is the Affordable Care Act of 2010?
US legislation intended to improve healthcare quality through using information technology, ensuring affordable care, and increasing the number of insured persons.
Patient Protection and Affordable Care Act
Guarantees access to healthcare for all Americans and incentives to change clinical practice to encourage better coordination and quality care.
Which legislative act that mandated research become accessible to facilitate better decisions based on evidence?
Affordable Care Act
Technology Informatics Guiding Education Reform (TIGER Initiave)
Formed in 2004 to advance nurses’ competencies related to informatics. Primary objective to develop a US nursing workforce capable of using electronic health records to improve delivery of health care.
Analytical Science
Uses variety of methods and instruments to answer two basic questions: What do I have? How much of it do I have?
Environment, pharmacy, safety and security, fraud detection, and healthcare diagnostics.
Audit Trails
Software that is used for detecting security violations, performance problems, and flaws. Records activity by users and system. Goal is to improve/ensure data integrity.* An audit trail must contain the name of the user, the application triggering the audit, the workstation, the specific document, a description of event being audited, and the date/time to determine integrity of data.
Authentication
Action that verifies the authority of users to receive specified data.
FDASIA
Has improved the FDAs ability to speed patient access to digital records and improve the safety of drugs, medical devices, and biological products.
Benchmark
Continual process of measuring services and practices against the toughest competitors in the healthcare industry or comparing the performance of an organization or clinician to others.
Metrics related to stroke care and compare them across the country in a presentation?
Benchmarking
Big Data
Very large data sets beyond human capability to analyze or manage without the aid of information technology. Considered data originating from very large data sets that help identify patterns and trends. Big data cannot be managed without the use of technology to analyze its output.
5 properties: Variety, velocity, volume, value, veracity.
Velocity in big data refers to how fast it can be processed to generate knowledge.
Big Data Center
A term that refers to achieving the centralized processing, storage, transmission, exchange, and management of information within a physical space, in which computers, servers, and network and storage devices are generally considered the key equipment for the core of a data center.
Change Management/Change Control
Involves employees in the decision-making process. Helps prioritize limited resources and ensure systems standards are upheld. For example, medication administration. Should exclude subject matter experts when discussing change control. This should be internal people only; people who are doing and dealing with the problem directly.
Clinical Decision Support System (CDSS)
Supports healthcare practitioners in making patient care decisions by integrating patient data with current clinical knowledge. Provides recommendations for care and must be balanced with professional judgment, not used in place of it.
Decision Support Tool/Clinician Decision Support (CDS)
Decision Support System/Software (DDS)
Software app to help in human decision process. Software will look at the patients data and suggest appropriate medical/nursing interventions. Can also trigger prompts/alerts to user. Requires human user input. Decreases patient safety risk and increases positive patient outcomes (alerts for abnormal vital signs, lab results, medication contraindications, etc.). The right components of a CDS include a trigger, such as med order; input data, such as lab values, intervention information, such as other options provided, and action step, such as action selected by the doctor.
Expert System
A type of CDS/DDS but does not need human intervention, uses artificial intelligence (ex. insulin pump).
What term refers to the intelligent application of data manipulation which empowers nurses to work more efficiently with enhanced communication and informed decision support?
Artificial intelligence
What is the intent of the CDSS (Clinical Decision Support System)?
This is an application that supports healthcare in practitioners in making patient-care decisions and providing clinicians with knowledge and person - specific information.
What are two barriers of adopting the CDS in an EHR?
Limited resources and communication information exchange.
Five Right to Clinical Decision Support
Right information
Right person
Right intervention
Right time in the workflow
Right place
What is considered to be clinical decision support (CDS) within the EHR?
The condition or disease-specific order sets.
What is the primary purpose of a clinical decision support system (CDSS)?
It provides clinicians with suggested care information.
How is clinical decision support system (CDSS) represented in the EMR?
Through alerts and reminders
What to do when CDSS is ignored
Educate the staff on the importance.
Review each alert’s determinant significance and make a decision to maintain or eliminate. it recognizes unnecessary alert is dangerous because it might make that much less likely that a clinician will pay attention to the next alert that is necessary. Explore the possibility of the machines talking to each other to establish congruence and interpreting specific patient input that is aligned with the need for the alert to fire.
Four components of CDSS:
Trigger, input data, intervention information, action step.
Name two visual cues with CDSS. Why are visual ques important?
Order sets, reminders, checklist, data driven triggers.
These are important in preventing medication errors and promote patient safety.
What describes the role of decision support within the EHR?
It is designed to assist with timely clinical decision making.
Clinical Information System (CIS)
Software used to access client data, plan, implement and evaluate care. May be specific to certain departments: lab, radiology, pharmacy, or patient populations. Provides patient centered decision making functionality to help guide RN with decision making. Acquires patient data so that healthcare professionals can review it and use information to deliver care.
Define the term “Clinical Information System”
Large computerized database management systems used to access the patient data that are needed to plan, implement, and evaluate care.
