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(BQ) Part 2 book “Nursing informatics and the foundation of knowledge” hass contents: Patient engagement and connected health, using informatics to promote community/population health, data mining as a research tool, bioinformatics, biomedical informatics, and computational biology,… and other contents.
SECTION IV: Nursing Informatics Practice Applications: Care Delivery Chapter 14 The Electronic Health Record and Clinical Informatics Chapter 15 Informatics Tools to Promote Patient Safety and Quality Outcomes Chapter 16 Patient Engagement and Connected Health Chapter 17 Using Informatics to Promote Community/Population Health Chapter 18 Telenursing and Remote Access Telehealth Nursing information systems must support nurses as they fulfill their roles in delivering quality patient care Such systems must be responsive to nurses’ needs, allowing them to manage their data and information as needed and providing access to necessary references, literature sources, and other networked departments Nurses have always practiced in a field where they have needed to use their ingenuity, resourcefulness, creativity, initiative, and skills To improve patient care and advance the science of nursing, clinicians as knowledge workers must apply these same abilities and skills to become astute users of available information systems In this section, the reader learns about clinical practice tools, electronic health records, and clinical information systems; informatics tools to enhance patient safety, provide consumer information, and meet education needs; population and community health tools; and telehealth and telenursing Information systems, electronic documentation, and electronic health records are changing the way nurses and physicians practice Nursing informatics systems are also changing how patients enter and receive data and information Some institutions, for example, are permitting patients to access their own records electronically via the Internet or a dedicated patient portal Confidentiality and privacy issues loom with these new electronic systems HIPAA regulations (covered in the Perspectives on Nursing Informatics section) and professional ethics principles (covered in the Building Blocks of Nursing Informatics section) must remain at the forefront when clinicians interact electronically with intimate patient data and information The material within this book is placed within the context of the Foundation of Knowledge model (Figure IV-1) to meet the needs of healthcare delivery systems, organizations, patients, and nurses Readers should continue to assess their personal knowledge progression The Foundation of Knowledge model challenges us to reflect on how our knowledge foundation is ever-changing and to appreciate that acquiring new information is a key resource for knowledge building This section addresses the information systems with which clinicians interact in their healthcare environments as affected by legislation, professional codes of ethics, consumerism, and reconceptualization of practice paradigms, such as in telenursing All of the various nursing roles— practice, administration, education, research, and informatics—involve the science of nursing Figure IV-1 Foundation of Knowledge Model Designed by Alicia Mastrian CHAPTER 14: The Electronic Health Record and Clinical Informatics Emily B Barey, Kathleen Mastrian, and Dee McGonigle Objectives Describe the common components of an electronic health record Assess the benefits of implementing an electronic health record Explore the ownership of an electronic health record Evaluate the flexibility of the electronic health record in meeting the needs of clinicians and patients Key Terms » Administrative processes » American Recovery and Reinvestment Act of 2009 (ARRA) » Connectivity » Decision support » Electronic communication » Electronic health records » Health information » Health Information Technology for Economic and Clinical Health Act of 2009 (HITECH) » Interoperability » Meaningful use » Order entry management » Patient support » Population health management » Reporting » Results management Introduction The significance of electronic health records (EHRs) to nursing cannot be underestimated Although EHRs on the surface suggest a simple automation of clinical documentation, in fact their implications are broad, ranging from the ways in which care is delivered, to the types of interactions nurses have with patients in conjunction with the use of technology, to the research surrounding EHRs that will inform nursing practice for tomorrow Although EHR standards are evolving and barriers to adoption remain, the collective work has a positive momentum that will benefit clinicians and patients alike A basic knowledge of EHRs and nursing informatics is now considered by many to be an entry-level nursing competency Various nursing workgroups have delineated nursing informatics competencies from entry level to nursing informatics specialists, and other groups have identified competencies specific to the EHR The American Health Information Management Association (AHIMA) collaborated with the Health Professions Network and the Employment and Training Administration to create a graphic depiction of competencies necessary for EHR interaction The Electronic Health Records Competency Model is divided into six levels: Personal Effectiveness Competencies, Academic Competencies, Workplace Competencies, Industry-Wide Technical Competencies, Industry-Sector Technical Competencies, and a Management Competencies level shared with Occupation Specific Requirements The EHR Competency Model can be viewed at: www.careeronestop.org/CompetencyModel/competencymodels/electronic-health-records.aspx Hovering over each block in the model provides a definition of each of the competencies covered by the model For example, the industry-sector technical competencies section includes health information literacy and skills, health informatics skills using the EHR, privacy and confidentiality of health information, and health information data technical security This drive to adopt EHRs was underscored with the passage of the Health Information Technology for Economic and Clinical Health Act of 2009 (HITECH) It is essential that EHR competency be developed if nurses are to participate fully in the changing world of healthcare information technology This chapter has four goals First, it describes the common components of an EHR Second, it reviews the benefits of implementing an EHR Third, it provides an overview of successful ownership of an EHR, including nursing’s role in promoting the safe adoption of EHRs in day-to-day practice Fourth, it discusses the flexibility of an EHR in meeting the needs of both clinicians and patients and emphasizes the need for fully interoperable EHRs and clinical information systems (CISs) Setting the Stage The U.S healthcare system faces the enormous challenge of improving the quality of care while simultaneously controlling costs EHRs were proposed as one solution to achieve this goal (Institute of Medicine [IOM], 2001) In January 2004, President George W Bush raised the profile of EHRs in his State of the Union address by outlining a plan to ensure that most Americans have an EHR by 2014 He stated that “by computerizing health records we can avoid dangerous medical mistakes, reduce costs, and improve care” (Bush, 2004) This proclamation generated an increased demand for understanding EHRs and promoting their adoption, but relatively few healthcare organizations were motivated at that time to pursue adoption of EHRs The Healthcare Information and Management Systems Society (HIMSS) has been tracking EHR adoption since 2005 through its “Stage 7” award, and in 2013 reported that most U.S healthcare organizations (77%) were in Stage 3, reflecting only implementation of the basic EHR components of laboratory, radiology, and pharmacy ancillaries; a clinical data repository, including a controlled medical vocabulary; and simple nursing documentation and clinical decision support (HIMSS, 2013) Higher stages of the electronic medical record adoption model include more sophisticated use of clinical decision support systems (CDSSs) and medication administration tools, with HIMSS Stage 7—the highest level—consisting of EHRs that have data sharing and warehousing capabilities and that are completely interfaced with emergency and outpatient facilities (HIMSS Analytics, 2013) Real progress is being made on the adoption of more robust EHRs HIMSS Analytics (2015) reports that 1,313 hospitals in the United States have achieved Stage 6 with full physician documentation, a robust CDSS, and electronic access to medical images Healthcare IT News (2015) reported that, to date, over 200 hospitals have achieved Stage 7 and are totally paperless, and that more organizations reach this goal every day In President Barack Obama’s first term in office, Congress passed the American Recovery and Reinvestment Act of 2009 (ARRA) This legislation included the HITECH Act, which specifically sought to incentivize health organizations and providers to become meaningful users of EHRs These incentives came in the form of increased reimbursement rates from the Centers for Medicare and Medicaid Services (CMS); ultimately, the HITECH Act resulted in payment of a penalty by any healthcare organization that had not adopted an EHR by January 2015 The final rule was published by the Department of Health and Human Services (USDHHS) in July 2010 for the first phase of implementation Stage 1 meaningful use criteria focused on data capture and sharing (USDHHS, 2010a) Stage 2 criteria, implemented in 2014, advanced several clinical processes and communications, 380 data access and information sharing, 380 trending, 379 triage, 379–380 office suite, 49t open source, 46, 47f OS, 46–48 productivity, 48 software as a service (SaaS), 58, 58f sound card, 44 sources of knowledge, 68 SOX See Sarbanes-Oxley Act speakers, 53 spear phishing, 236 special needs telecommunications-ready devices, 378 specialty, evolution of, 106–108 spreadsheets, 48, 439 SPSS See Statistical Package for Social Sciences spyware, 234 SQL See Structured Query Language Squires Quest, 330 stacking, 483 staff development tool, 277–278b Stage 7 Awards (HIMSS), 274 stakeholders, 26, 202 standardized language, 112 standardized nursing terminology, 114b standardized plan of care, 190 standards, 77, 149 standards-developing organizations (SDOs), 157b Stanford Encyclopedia of Philosophy (2010), 66 static dynamic random-access memory, 42 static medium, 327 Statistical Package for Social Sciences (SPSS), 472 stethoscope, 283 Stetler model, 498, 504t “Stimulus” law See American Recovery and Reinvestment Act storage capacities, 44–45b store-and-forward telehealth transmission, 367 strategies analysis, 216 strategy games, 449 StratWorld, 446–448 structural interoperability, 196 Structured English Query Language (SEQUEL), 201b Structured Query Language (SQL), 200, 201–202b suicide prevention community assessment tool, 347 summaries, 31 supercomputers, 40 Surveillance, 342 surveillance data systems, 349 Swain, Jeff, 162–163b, 408–412b, 542–543b swim-lane technique, 253 examples of, 254f Synchronous dynamic random-access memory (SDRAM), 42 syndromic surveillance systems, 342, 342f synthesis, 30 Systematized Nomenclature of Medicine (SNOMED), 107 —Clinical Terms (SNOMED CT), 279–280, 280b systems development life cycle (SDLC), 175 analysis phase, 179 case scenario, 176–178 computer-aided software engineering tools, 184 design phase, 179 dynamic system development method, 181–184 implement phase, 179 interoperability, 185–186 maintenance phase, 179 object-oriented systems development, 181 open source software and free/open source software, 184–185 rapid prototyping or rapid application development, 180–181, 180f test phase, 179 waterfall model, 178–180, 178f systems engineering, 296 systems feasibility, 178 T tables, 198 tacit knowledge, 539–540 TANIC See TIGER-based Assessment of Nursing Informatics Competencies task analysis, 215 tasks, 249 task–technology fit model, 221 TB See terabytes teams multidisciplinary team, 118 workflow redesign team, 252–253 technological feasibility, 178 technologist, 117 technology, 246 art of caring, 525–526 for baccalaureate nursing graduates, 14–15 certified EHR technology, 145, 149 computer, 36 game and simulation technology, 60 haptic, 37 human interfaces See human–technology interface informatics, for patient safety, 301–313 radio frequency identifier, 307 robotics, 312 smart pump, 307–308 telehealth technology, 209 wearable, 311, 337 workflow and, 249–251 technology acceptance model, 221 Technology Informatics Guiding Education Reform (TIGER), 13, 14, 134, 287, 405, 445 Teladoc, 385 Tele-ICU, 372, 382 telecommunications, 30 teleconsultations, 368–369 telehealth, 129, 359 clinical uses of, 366–367 description of, 366 driving forces chronic diseases and conditions, 364 demographics, 363–364 economics, 365–366 educated consumers, 364–365 nursing and healthcare worker shortages, 364 evolving models, 385–386 future of, 386–387 history of, 362–363 home telehealth See home telehealth legal, ethical, and regulatory issues, 381–382 mHealth, 369 nursing aspects of, 361 patient populations, 372–375 assisted living and subacute patients, 375 at-risk populations, 373 chronic diseases, 373 concerned patients and families, 374 emergency response situations, 374 employers and wellness programs, 375 hospitalized patients, 374 incarcerated patients, 374 isolated patients, 373 patient’s role in, 382–383 physician-to-physician consult using, 368f real-time (or interactive), 367–369 remote monitoring, 369 research, 383–384 research and information centers, 385b store-and-forward, 367 technologies, nonclinical uses of, 369–370 telehealth care See telehealth care telenursing See telenursing telephony, 369 transmission formats and clinical applications, 367 telehealth care, 366–370 clinical uses of, 366–367 nonclinical uses of, 369–370 transmission formats and clinical applications of mHealth, 369 real-time/interactive telehealth, 367–369 remote monitoring, 369 store-and-forward telehealth, 367 telephony, 369 telehealth devices, 369 Telehealth Resource Center, 382 telehealth technology, 209 telehome care, 368 telehospice, 369 TeleICU Model of Success, 372 TeleICU Nursing Practice Guidelines, 372 Telemed Tablet, 386 telemedicine, 362, 366, 373 telemental health, 368 Telemetry Charge Nurse, 298 telemonitoring, 362, 369 applications of See home telehealth care at-risk populations, 373 home See home telemonitoring telenursing, 370–372 telepalliative care, 369 telepathology, 362 telephones, 376 telephony, 369 teleradiology, 362 telerehabilitation, 368 TELOS strategy, 178 terabytes (TB), 44 terminology, 114b administrative and reference, 280b ANA-recognized terminologies, 279 standardized, 278–280 Theory of Human Caring, 526 three-dimensional (3D) view, 446 three dimensional virtual world, 451 throughput/processing components, 52–53 thumb drives, 233 tiering, 197 TIGER See Technology Informatics Guiding Education Reform TIGER-based Assessment of Nursing Informatics Competencies (TANIC), 46, 135 self-assessment instrument, 137 timeboxing, 183 timely information, 24 To Err Is Human, 152, 294 touch pad, 52 touch screen, 52 TPO exception, 160 TPS See Transaction Processing System Transaction Processing System (TPS), 29b transcendent presence, 529 Translating Research into Practice Initiative (TRIP), 501 translational bioinformatics, 497 translational informatics, 501 translational research, 497, 497f transparency, 25 transparent wisdom, 8 treatment/payment/operations, 160 trending, 379 triage, 197, 379–380 TRIP See Translating Research into Practice Initiative Trip database, 503t Trojan horses, 234 Trust-e, 332 truth, 84 Tuesdays with Morrie (Albom), 529 tuples, 201b tutorials, 406 Tyler, Denise D., 276–278b, 333–334b U ubiquity, 113b uncertainty, 81 Unified Medical Language System (UMLS), 280b universal serial bus (USB), 40, 43–44 flash drive, 43, 236 University of Texas Medical Branch School of Nursing, 422 unstructured data, 477 upper-CASE tools, 184 U.S Copyright Law, 426 U.S Department of Energy, 70 U.S Department of Health and Human Services (USDHHS), 146, 156, 239, 335, 387 U.S Department of Veteran’s Affairs National Center for Patient Safety, 295 U.S National Library of Medicine, 332 usability, 218 consideration of, 383 USB See universal serial bus USDHHS See U.S Department of Health and Human Services user-centered design, 214 user-friendly aspects, 37 user interface, 47 utility, 25 V value-added activities/steps, 253–255 value added vs non–value added activities/step, 253–255 values, 77 variation, 255 veracity, 92 verifiable information, 25 video adapter cards, 44 video data, 22 videocameras, 376–377 videophones, 376–377 videopods, 419 Virginia Mason University Medical Center, 251 virtual memory, 42 virtual private networks (VPNs), 239 virtual reality, 60–61, 413, 427 virtual simulation, 433, 435f virtual worlds case scenario, 446–448 choosing among simulations, educational games, and virtual worlds, 451–452 in education, 450–451 future of, 452–453 simulation, game mechanics and, 446–448 virtue, 85 ethics, 85, 93 viruses, 234 Visible Analyst, 184 voice-activated communicators, 60 Voice over Internet Protocol, 298 voice recognition software, 335 Von Neumann, John, 38 VPNs See virtual private networks W W3C See World Wide Web Consortium Walgreens’ Healthcare Clinics, 385 Walt Disney Company, 258 Walter Reed Army Research Institute, 106 Washington Post, 211 waste, 255 waterfall model, 178–180 Watson, Jean, 526 wearable technology, 59, 311, 337 WEB 2.0, 55–56b Web-based courses, 398, 403 types of interactions in, 398f Web-based education, 402 Web-based medical chart (WMC), 441 Web-based simulation, 441 Web-based survey, 314 Web-based technology, 309 Web-enhanced courses, 398 Web-enhanced learning, 404 Web logs, 416 Web ontology language (OWL), 115b Web publishing, 408b Web quests, 323 Web search, 417b Web servers, 375 webcasts, 414 webinars, 414 weblog, 330 WebMD, 416 websites for ANA-approved nursing languages, 116b dynamic webpage shells, 441 health-related, 83 for patient education, 332b patient safety, 316t standards for ethical development of, 83 user surveys for design, 236 well-baby care, 181 Well-Intentioned Providers, 298 case scenario, 300 Wellness Alliance, 176–177, 181 Wellness Program Coordinator, 176 Werley, Harriet, 106 WHO See World Health Organization Wide-ranging Online Data for Epidemiologic Research, 348 Wi-Fi, 53 wiki, 414 Wikipedia, 414 Wired for Health Care Quality Act (2005), 303 wisdom, 35, 108, 110–111, 111f as cardinal virtue, 85 in decision making, 69–70 definition of, 69 knowledge and, 12 transparent, 8 working, 61 WISH Patient Safety Forum, 297 WMC See web-based medical chart word processing, 48 work domain analysis, 215 work process, 249 workarounds, 211, 295 worker competencies analysis, 216 workflow definition of, 249 paper-based, 251 and technology, 249–251 transitioning to future state, 255–256 variation in, 255 workflow analysis, 249 case study, 251 future directions, 259–260 and informatics practice, 251–256 optimization, 250–251 purpose, 245–248 value added vs non–value added activities/step, 253–255 workflow redesign, 260 team building for, 252–253 working wisdom, 61 Workplace Competencies, 267 workspace security discipline, 233 World Health Organization (WHO), 341 Alliance for Patient Safety, 294 World Views on Evidence-Based Nursing, 503t World Wide Web (WWW), 54 World Wide Web Consortium (W3C), 115b worms, 234 written documents, 470 WWW See World Wide Web X XML See Extensible Markup Language Y YB See yottabytes yottabytes (YB), 45 Youth Risk Behavior Surveillance System, 347 Z ZB See zettabytes zero day attack, 233 zettabytes (ZB), 45 Zika virus, 342 ... implementation of the EHR (Halamka, 20 06; HealthIT.gov, 20 12) , and certainly enough evidence to warrant further study of the use and benefits of EHRs Box 14 -2 describes some of the specific CIS functions of an EHR BOX 14 -2 THE EHR AS A CLINICAL... authorized to test and certify EHR vendors against the standards and test procedures developed by the National Institute of Standards and Technology (NIST) and endorsed by the Office of the National Coordinator... MRSA-positive patients (HIMSS, 20 09) At both organizations, there was qualitative and quantitative evidence of high rates of end user adoption and satisfaction with use of the EHR A 20 11 study of the effects of EHR adoption on nurse