Textbook Notes Flashcards
There are foundational skills that are required for an information-driven culture. These include ___ literacy, ___ literacy, and (for the consumer), ___ literacy.
computer, information, health
Without computer literacy, ___ cannot be accessed/addressed
the other forms of literacy (information, health)
Joint Commission International (2017) lists six patient safety goals that focus upon correct ___, effective ___, improved safety of ___ medications, procedures that do not ___, decreased risk of ___, and reduced risks of harm secondary to ___.
identification, communication, high-alert, introduce harm, healthcare-acquired infections, falls
HIT can improve safety and quality through alerts and decision support that help to improve the ___ process—a point where many errors occur—and through the use of ___.
hand-off, checklists
___ errors include mistakes, slips, and lapses made by ___, while ___ errors occur with imperfect organization design such as those seen with incomplete procedures, poor training, and poor labeling.
Active, clinicians, latent
Administrative information systems (AIS) support client care by managing ___ and ___ information and providing ___ capabilities.
financial, demographic, reporting
___ information systems (___) focus on management of clinical (patient) data and information as compared to ___ information systems.
Clinical (CIS), administrative (AIS)
Client scheduling and discharge would be part of the ___ information systems (___)
administrative (AIS)
___ systems focus upon the acquisition, review, and use of patient data. Functions may include order entry, results-reporting, scheduling, and documentation.
Clinical information systems (CISs)
___ systems can include registration and scheduling; tracking through admission, transfer and discharge; patient acuity and staff scheduling; financial or accounting systems; risk management; payroll and human resources; quality assur-ance; and contract management functions.
Administrative (AIS)
The American Recovery and Reinvestment Act (ARRA) of 2009 included the Health Information Technology for Economic and Clinical Health Act (HITECH), which authorized incentive payments to specific types of hospitals and healthcare professionals for adopting and using ___
interoperable health information technology and EHRS
(In addition to the standard requirements) MU included a menu of ___ other EHR tasks from which providers could choose to implement ___ in 2011 to 2012.
10, 5
The Centers for Medicare and Medicaid Services (CMS) developed core criteria that defined basic functions EHRSs must demonstrate, including: basic entry of ___ such as demographic data, vital signs, medications, and allergies; use of several ___ that begin to realize the true potential of EHRSs to improve the safety, quality, and efficiency of care through clinical decision support; and entry of ___ with safety measures within the software.
clinical information, software applications, clinical orders
The Medicare and Medicaid EHR Incentive Programs include ___ stages with increasing requirements for participation.
three
What is a goal of the health information exchange (HIE)?
data sharing between providers, patients, insurance, etc.
Nurse informaticists, sometimes called ___ nurses, work in the interdisciplinary area of ___ in healthcare organizations. They organize patient care software and electronic medical records, using their clinical nursing knowledge to optimize these systems.
informatics nurses
information technology (IT)
A clinical systems vendor and a medical device manufacturer would be likely to employ a ___ nurse
informatics
Duplicate orders cause quality issues in patient care.
What helps to resolve this problem?
Providing training and reminders
The HIMSS Electronic Medical Record Adoption Model (EMRAM) is exclusively designed to assess ___. It is used for ___ only. To assess ___ communities, refer to HIMSS ___
acute hospital settings, inpatients only
outpatient, HIMSS Outpatient EMRAM (O-EMRAM)
___ is a/an eight stage model used to assess ___ for hospitals and health systems
Rated from 0 to 7
EMRAM (Electronic Medical Record Adoption Model)
EMR implementation and adoption
The benefits of interoperability include increased ___, reduced ___, and reduced ___.
productivity, costs, errors
Codes which support outpatient billing
Current procedural terminology (CPT)
One major benefit of nursing informatics is that it improves ___ among the healthcare team to improve ___.
communication, outcomes
What reduces and organizes terms for easier searches
Taxonomic vocabularies
A ___ is typically a controlled vocabulary with a hierarchical structure, with the understanding that there are different definitions of a hierarchy. Included terms have relations to other terms within. These are typically: parent/broader term, child/narrower term, or often both if the term is at mid-level within a hierarchy.
taxonomy
A provider electronically orders blood work at a laboratory. The provider must ensure the local lab system can properly communicate with the provider’s system for the results to be usable.
Which is the correct term that would be found in these systems?
Logical observation identifiers names and codes (LOINC)
The Logical Observation Identifiers, Names, and Codes (LOINC) is a terminology that includes ___ and ___ observations.
laboratory, clinical
___ is:
- A common language (set of identifiers, names, and codes) for clinical and laboratory observations.
- A rich catalog of measurements, including laboratory tests, clinical measures like vital signs and anthropomorphic measures, standardized survey instruments, and more.
- A standard which enables the exchange and aggregation of clinical results for care delivery, outcomes management, and research by providing a set of universal codes and structured names to unambiguously identify things you can ___ or ___.
LOINC
measure or observe
___ is:
- A common language (set of identifiers, names, and codes) for clinical and laboratory observations.
- A rich catalog of measurements, including laboratory tests, clinical measures like vital signs and anthropomorphic measures, standardized survey instruments, and more.
- A standard which enables the exchange and aggregation of clinical results for care delivery, outcomes management, and research by providing a set of universal codes and structured names to unambiguously identify things you can ___ or ___.
LOINC
measure or observe
___ is a set of ___ standards used to transfer and share data between various healthcare providers. More specifically, it helps bridge the gap between health IT applications and makes sharing healthcare data easier and more efficient when compared to older methods.
HL7
international
___ interoperability
The ability to exchange the data from one point to another
Technical
___ interoperability
The exchange of data in which the meaning remains the same on both ends of the transaction
Semantic
___ interoperability
Coordinates systems enabling business processes at the organization(s), and allowing the systems to work together
Process
___
The ability of two or more systems to pass information between them and use the exchanged information
Interoperability
A patient is being transferred to a trauma hospital in the area. The current hospital uses a different electronic health record (EHR) than the receiving hospital.
Which process allows interoperability of the health information exchange (HIE) between the two hospital systems?
Consolidated-Clinical Document Architecture (C-CDA)
Which measure is included in the vital signs section, in addition to temperature, blood pressure, respiration, and heart rate?
(the 5th vital sign)
Pain scale
What is the meaning of confidentiality of patient records
A healthcare provider can disclose health information with specific permission.
What are three types of networks or information exchanges?
Local area network (LAN)
internet
wide area network (WAN)
How does an informatics nurse institute manual and automated procedures to manage data security, accuracy, and integrity?
Monitors patterns and exceptions
___ is a not-for-profit, membership-based organization that works to improve healthcare through meaningful measurement
NQF
Which merit-based incentive payment system (MIPS) category replaces the reporting program that assesses care provided to Medicare patients, to ensure patients get the right care at the right time?
Quality
MIPS (Merit-based Incentive Pay System) includes four performance categories: ___, ___, ___ ___, and Promoting ___ (formerly ___ ___)
Quality, Cost, Improvement Activities, and Promoting Interoperability (formerly Meaningful Use)
What are two items that exempt eligible clinicians from a merit-based incentive payment system (MIPS)
Low-threshold provider who bills Medicare less than $90,000 yearly
Two hundred or fewer Medicare patients seen annually
In the context of health IT, meaningful use is a term used to define ___
minimum U.S. government standards for electronic health records (EHR)
Meaningful use Stage 1
___ to ___
Data ___ and ___
Meaningful use Stage 2
20__
Advance ___ ___
Meaningful use Stage 3
20__
Improved ___
Five rights of Clinical Decision Support (CDS)
(Hint: Right ___to the right___ in the right ___through the right___ at the right ___in___)
- The right information: evidence-based, suitable to guide action, pertinent to the circumstance
- To the right person: considering all members of the care team, including clinicians, patients, and their caretakers
- In the right CDS intervention format: such as an alert, order set, or reference information to answer a clinical question
- Through the right channel: for example, a clinical information system (CIS) such as an electronic medical record (EMR), personal health record (PHR), or a more general channel such as the Internet or a mobile device
- At the right time in workflow: for example, at time of decision/action/need
What can healthcare staff do to keep patient information that has been accessed with a mobile device protected?
Install device updates when available
Which mobile device feature may reside on a device indefinitely
Text messages
What is the correct order of the system development life cycle phases
Designing, planning, implementation, analysis, evaluate
___ ___ helps prioritize limited resources and ensures system standards are upheld.
Change control
Which phase of implementation uses small groups of individuals to evaluate potential issues that may occur when making a new systems transition
Pilot phase
When a new system is adopted instantly, with no transition period between the old and new systems (two terms)
Big bang adoption or direct changeover
___ conversion operates both the old and the new system for a limited time. ___ conversion changes to the new system in phases, introducing some of the new applications while still using some of the old applications, or converting some departments or locations at a time.
Parallel, Phased
Kurt Lewin developed a change model involving three steps: ___, ___ and ___.
unfreezing, changing, refreezing
The process of change entails creating the perception that a change is needed, then moving toward the new, desired level of behavior and finally, solidifying that new behavior as the norm. The model is still widely used and serves as the basis for many modern change models.
“___ is the right to control access and disclosure or nondisclosure of information pertaining to oneself and to control the circumstances, timing, and extent to which information may be disclosed”
Privacy
The Technology ___ Guiding Education Reform (TIGER) Initiative was established in 2006 in the United States to develop key areas of informatics in nursing. One of these was to integrate ___ competencies into nursing curricula and life-long learning.
Informatics, informatics
___ ___ is a process in which organizational leaders determine their vision for the future as well as identify their goals and objectives for the organization
Strategic planning
A ___ Statement defines the company’s business, its objectives and its approach to reach those objectives. A ___ Statement describes the desired future position of the company.
Mission, Vision
The 5 basic phases in the project management process are:
- Project ___
- Project ___
- Project ___
- Project ___
- Project ___
- Initiation
- Planning
- Execution
- Monitoring and Controlling
- Closing
PM Phase 1 - Project ___
- Define ___
- Create a ___
- Complete a project ___
- Draw up list of ___
Initiation
- Define goals
- Create a business case
- Complete the project charter
- Draw up the list of stakeholders
PM Phase 2 - Project ___
- Define ___
- Create a project ___
- Set a ___ baseline
- Define ___ and ___
Planning
- Define scope
- Create a project plan
- Set a budget baseline
- Define roles and responsibilities
PM Phase 3 - Project ___
- Allocate project ___
- Manage project ___
- ___ the product or process
- ___ often and fix issues as they arise
Execution
- Allocate project resources
- Manage project resources
- Build the product or process
- Meet often and fix issues as they arise
PM Phase 4 - Project ___
- Track ___ and ___
- Monitor project ___
- Ensure ___
- Prevent any chance for ___
Monitoring and Control
- Track effort and cost
- Monitor project progress
- Ensure adherence to plan
- Prevent any chance for disruptions
PM Phase 5 - Project ___
- ___ deliverables
- ___ project deliverables
- Get project results ___
- Document project ___
Completion
- Handover deliverables
- Review project deliverables
- Get project results approved
- Document project learnings
NANDA
North American Nursing Diagnosis Association
A working definition of nursing diagnosis was adopted by the North American Nursing Diagnosis Association (NANDA) Biennial Business Meeting in March 1990.
A suite of designated standards for use in U.S. Federal Government systems for the electronic exchange of clinical health information and is also a required standard in interoperability specifications of the U.S. Healthcare Information Technology Standards Panel
SNOMED CT
An ___ is a record of healthcare information of an individual created and managed within one healthcare organization. An ___ is a record of healthcare information of an individual that conforms to recommended interoperability standards for ___ which is used across multiple healthcare organizations.
Meanwhile, a ___ is an electronic application through which patients can maintain and manage their health information (and that of others for whom they are authorized) in a private, secure, and confidential environment.
EMR, EHR
Standards for HIT (Health Information Technology)
PHR (Personal Health Record)
Meaningful Use incentives were imbibed into law in the ___
Health Information Technology for Economic and Clinical Health (HITECH) Act
The aim of the ___ incentive program is to improve the quality, efficiency, and coordination of patient care by leveraging certified EHR technologies securely and efficiently.
Meaningful Use
___ enable unauthorized users to gain access to your computer without being detected
Rootkits
A ___ replicates itself by infecting other computers that are on the same network. They’re designed to ___ and ___
Worm
consume bandwidth, interrupt networks
___-based care refers to the payment a health care provider receives for services a patient might need. The type of service and quality of service does not really make a difference in the amount a provider might receive.
(Sometimes referred to as a ___ care)
Volume
fee-for-service
___-based care is sometimes known as accountable care. This type of system focuses on getting value from quality services. Payments are based on this specialized care and other things, such as cost reduction, which could lead to an emphasis on ___ care.
Value, preventative
___ are computer-based programs that analyze data within EHRs to provide prompts and reminders to assist health care providers in implementing evidence-based clinical guidelines at the point of care. Applied to cardiovascular disease (CVD) prevention, for example, by reminding providers to screen for CVD risk factors, flagging cases of hypertension or hyperlipidemia, providing information on treatment protocols, prompting questions on medication adherence, and providing tailored recommendations for health behavior changes.
Clinical decision support systems (CDSS)
___ telemedicine is “store-and-forward video-conferencing,” which is the “transmission of a (pre-)recorded health history to a health practitioner, usually a specialist.”
Asynchronous
While ___ refers specifically to remote clinical services, ___ can refer to remote non-clinical services, such as provider training, administrative meetings, and continuing medical ___, in addition to clinical services.
telemedicine, telehealth
continuing medical education
This system is comprised of the hardware and software that make up an organization’s infrastructure.
Information Systems
The terms healthcare information system and hospital information system (HIS) both refer to a group of systems used within a hospital or enterprise that support and enhance healthcare.
This science, originally a sub-discipline of computer science, supports the collection and management of information and applies technology to make information usable.
Information Science
This nurse is expected to have fundamental information-management and computer-technology skills and use existing information systems and established information-management practices.
The Beginning Nurse
Known as the ability to read and understand the written word and numbers as well as the ability to recognize when information is needed.
Information Literacy
This initiative called for improving nursing education competencies for the development of a workforce capable of delivering patient care through health information technology
The Technology Informatics Guiding Education Reform Initiative (TIGER)
This system is integrated with other administrative and clinical systems and tracks a patient’s activities and locations from hospital or clinic
Admission/Discharge/Transfer (ADT) system
This interdisciplinary team is tasked with planning, testing, training, and other responsibilities when an EHRS has been purchased.
Implementation team or committee
The first standardized nursing terminology recognized by the ANA and used for nursing diagnosis
North American Nursing Diagnosis Association International (NANDA-I)
A collection of patient data controlled by the patient and accessible by patient and providers
Personal Health Record
The implementation of __________ terminology within the EHR is essential for healthcare organizations to meet the criteria of Meaningful Use
standardized
This is a globally recognized controlled healthcare vocabulary that provides a common language for electronic health applications to exchange data
Systematized Nomenclature of Medicine - Clinical Terms (SNOMED-CT)
This is the primary reason nursing participation is essential on the implementation team
Knowledge of workflow/workflow analysis
This record provides a snapshot of a person’s current healthcare to a provider who does not have direct access to the EHR; intended to improve continuity and reduce errors
Continuity of Care Record (CCR)
This process that uses software to look for hidden patterns and relationships in large data sets
Data Mining
Unauthorized access to a server room is an example of this type of threat
Physical Threat
Any breach of confidentially within the healthcare environment is subject to the penalties of this act
Health Insurance Portability and Accountability Act (HIPAA)
This security measure protects the healthcare provider if they leave the computer abruptly
Automatic Sign-off
Software used for detecting security violations, performance problems, and flaws in applications by recording activity by users and systems
Audit Trails
This act authorized incentive payments for early EHR adopters and led to the development of Meaningful Use criteria
HITECH
Health Information Technology for Economic and Clinical Health
Type of environment that encourages reporting of errors or near misses, and focuses on systematic view of errors rather than individual causation
Blame-free environment
Defined as a vision to develop policies, funding, infrastructure, and education to instill knowledge and skills needed by all healthcare executives, clinicians, and informaticists, and the tools to gather and analyze amassed data
Culture of Informatics
Alerts, clinical pathways, order sets, dashboards, diagnostic support and drug-drug interaction tools are all examples of these
Decision-support software (DSS) or Clinical Decision Support Software (CDSS)
The phenomenon where too many insignificant CDSS warnings or recommendations are presented, and providers begin to dismiss them regardless of the importance
Alert fatigue
Since 2018, EHRs are required to demonstrate all the Core Requirements of Meaningful Use (MU). How many can you identify?
The use of telecommunication technologies and computers to provide healthcare information and services to clients at another location
Telehealth
Videoconferencing, Telestroke, Telepsychiatry, and Robotics belong in this category of services
Synchronous Connected Health Applications
Examples of this type of Telehealth include research/data mining, Grand Rounds, remote education, and expert consultation
Non-clinical Telehealth
Asynchronous telehealth application that can record and send photos, x-rays, and ECGs to a provider for evaluation
Store and Forward Technology
List at least 3 legal or business issues that must be considered prior to adoption of telehealth services by providers
- Privacy & informed consent
- Licensure Reimbursement
- Malpractice liability
- Online prescribing
- Credentialing
- Internet bandwidth
Skilled in using information management and computer technology; have strong analytic skills to learn from relationships between different data elements; and be able to collaborate with the informatics nurse specialist to suggest improvement to systems
Experienced Nurse
Analytics can be used to forecast the likelihood of ___
an event
___ changes are small, ___ changes are larger in scale
Adaptive (new role, new computer/software system)
Transformational (new process/procedure, new department)
