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C468 Study Questions Guide
Competency 1 Information Management
1. Describe the role of nurses as knowledge workers. Knowledge workers are continuous learners and specialists in their field of practice. KW generate knowledge. Nurses are continuous learners. In the role of knowledge workers, nurses function as data gatherers, information users, knowledge users, and knowledge builders. Data gatherers use a system to gather and store data for access. Information users interpret information while knowledge users compare data and notice trends. Knowledge builders examine data and patterns to create new data to interpret or to suggest patient care from. 2. Define the terms in the DIKW theory in nursing and provide an example for each. 1. Data – most discrete part of DIKW a. Observations with little interpretation, not meaningful when presented separate from other observations b. Smallest factors describing a patient, disease state, health environment, etc. c. Example: Patient medical diagnosis 2. Information – data that has been interpreted to give it meaning a. Different data points put together and presented in a specific context to construct a meaningful clinical picture
b. Continuum of clustered and developing data – answers questions of who, what, when, where c. Example: Detailed relevant data such as divorced, hypertension, chronic kidney disease, etc. when referring to a patient, such as a homebound older adult
- Knowledge – information that has been processed and organized so that relations and interactions are identified a. Derived by discovering patterns of relationships between different clusters of information b. Affected by assumptions and central theories of scientific discipline c. Answers why or how d. Example: Determining a patient is high risk for readmission based on the information provided that they are an older adult age 75, divorced, live alone, and have comorbidities of uncontrolled diabetes and stage 1 kidney disease after a surgery leaving the patient with complex wound care
- Wisdom - appropriate use of knowledge to manage and solve problems a. Includes ethics or knowing why certain things or procedures should or should not be implemented b. Guides nurses in recognizing the situation at hand based on nurse’s expertise, patient and patient family values, and patient healthcare knowledge c. Nurse decides on a nursing intervention or action d. Clinical judgment integrating senses, emotions, and intuition
c. Competencies include domains of data and training
- Informatics Innovator – educationally prepared to conduct informatics research and generate informatics theory; also have advanced understanding and skills in information management and computer technology a. Competency in domains of research, practice, and fiscal management 4. Relate the concepts of information literacy and computer literacy to evidence- based practice. Information literacy involves both the ability to locate information and to interpret information in a manner that is relevant to the user. Computer literacy is the ability to use a computer and understanding how computers work and operate. These concepts relate to evidence-based practice by research. Evidence based practice is based on research. Information literacy helps an individual determine if a source of research is credible by interpreting the information provided and the type of source providing the information. It also helps the individual locate information, such as the understanding that a good source of information is a scientific database. Computer literacy is necessary to perform research as many sources of up to date research are located online, and computers are used to access this information. For an information driven culture, the foundational skills of computer literacy, information literacy, and (consumer) health literacy are required. 5. Describe the advantages and disadvantages of using an EHRS as it relates to patient-centered care.
- Advantages to patient centered care
a. Improved data integrity – information is more readable, better organized, and more accurate b. Increased productivity – improved client care due to ability of staff to make timely decisions based on appropriate data c. Improved quality of care – support of decision-making processes for physicians and nurses, allowing better monitoring of responses to treatment and patient conditions d. Improved record security e. Decreased wait times f. Improved access and control over health information g. Improved ability to ask informed questions h. Greater responsibility for own care i. Increased medication safety j. Quicker turnaround times for ordered treatments k. Alerts and reminders for upcoming appointments and scheduled tests l. Increased satisfaction m. Greater clarity to discharge instructions n. Elimination of healthcare disparities
- Disadvantages to patient centered care a. Issues with tracking and documenting relevant behavioral health and physical health information b. Issues with supporting communication and coordination of care among integrated teams
information systems, anesthesia information management systems, critical care information systems, and clinical decision support systems AIS – support client cases by managing financial and demographic information and providing reporting capabilities
- Supports functions of an organization
- Includes registration and scheduling, ADT system, acuity and staffing, financial systems, pharmacy systems, risk management systems, human resource information systems, and quality assurance systems 7. List the significance of each legislative act to the development of Information Technology: American Recovery & Reinvestment Act (ARRA) Authorized incentive payments with HITECH act to specific types of hospitals and healthcare professionals for adopting and using interoperable health information technology and EHRs Health Information Technology for Economic and Clinical Health Act (HITECH) Ensured the collection of aggregate data that could be used to improve policy decisions relative to allocation of services and population health. Digital data facilitates collection of data needed to measure quality of healthcare delivery, as well as improving data dissemination, as digitation allows easier data sharing. Technology Informatics Guiding Education Reform (TIGER) Initiative Formed to advance nurse competency in informatics. Primary objective is to develop US nursing workforce and make it capable of using EHRs to improve delivery of healthcare.
Competency 2 Leadership in IT
1. Describe the process required to create an informatics culture. a. Requires a vision to develop policies, funding, infrastructure, education, and the tools to gather and analyze data. i. The first step is to assess the current state to determine gaps (EHR plays a key role in this step). ii. Foundational skills required include computer literacy (basic understanding and use of computers), information literacy (ability to read and understand written words and numbers), and health literacy (for consumers, understanding and acting upon basic health care information). iii. Creating a policy, legal, and reimbursement framework is achieved by involvement with national and organizational policy setting through means such as informatics groups (AMIA, ANI, HIMSS) iv. Creation of an ethical framework is guided by four principles. Professional associations for informatics also have codes of ethics that provide guidance for ethical use of data and information:
- Autonomy - the individual’s freedom to control interferences by others, retaining a personal capacity for intentional action.
- Nonmaleficence -the obligation for doing no intentional harm
- Beneficence - actions that result in positive outcomes in which benefits and utility are balanced.
- Justice - the standards practiced by healthcare professionals.
vi. Creating a technical infrastructure - result of policy, legislation, funding, a multitude of agencies that are working to advance HIT for the benefit of healthcare, and technical standards
- Technical data standards – provide directions to ensure data and information can be exchanged with uniform meaning on both sides of an exchange a. Content – establish structure and organization of content b. Transport – set forth format exchange c. Vocabulary – terminology, improve communication with structured terms and facilitate organization of data d. Privacy and security – protect personal health information (privacy) and provide administrative, physical, and technical actions that provide patient confidentiality, availability, and integrity of health information (security)
- Must be harmony in interaction between people and technology a. System design and nurturing user abilities 2. Recognize the various roles of nurses in selecting and implementing patient information systems. Nurse’s roles in patient information systems include clinicians who use the systems and experts of workflow. When selecting a system, nurse’s offer their knowledge of daily workflows to select a system that will help them document effectively, reduce strain, and improve interdisciplinary collaboration. By designing the system for ease of use and to workflow needs, patient outcomes are improved.
3. Differentiate between a strategic plan, mission, and vision within a healthcare organization. Strategic plan – initiated when the organization realizes and approves needed changes; includes developing the project plan (including a scope and charter document), goals, objectives, project timeline, team selections with roles and responsibilities, and a work breakdown structure - Steps include identifying goals based on organization mission and vision, justify decisions to leadership, identifying measurable goals by administration for strategic planning and identify must-haves vs. nice-to-haves. - Also includes risk management, communication plans, change management processes, implementation, monitoring and control strategies, a list of final deliverables, final close processes with evaluations, and knowledge transfers Mission – Purpose or reason for an organization’s existence, representing the fundamental and unique aspirations that differentiate it from others Vision - Future-oriented, high-level view of what an organization would like to become that provides direction for planning purposes. 4. Describe the activities in each phase of the PMLC.
- Design/initiation – includes the creation and development of the tools needed to manage the project: scope and charter documents, which guide how the system will be implemented and what officially can and cannot be done, then evaluated including adding metrics to monitor measures of success progress
- Implementation – implementing the plan developed and approved by leadership. a. For EHRS implementation, as the system goes live, it is time to apply all of the tools previously developed in phases one and two b. System go live occurs when all of the new applications and functionality are accessible to the end users i. Will be monitored and controlled closely using the tools developed in phase two
- Monitoring and control -
- Lessons learned with knowledge transfer 5. Define different types of terminology structures, such as a classification system (e.g., NANDA,) versus a reference terminology (SNOMED-CT). Standardized terminologies – developed for use within an EHRS
- Structured controlled languages developed according to terminology- development guidelines and approved by an authoritative body Classification system – used to categorize the details of a clinical encounter
- Does not capture detail necessary to document specific items at POC
- Consist of mutually exclusive categories that can be used for specific purposes SNOMED-CT systemized nomenclature of human and veterinary medicine clinical terms
- Globally recognized as controlled healthcare vocabulary that provides a common language for electronic health applications
- Multidisciplinary terminology tool
LOINC logical observation identifiers, names, and codes
- Language that includes laboratory and clinical observations NANDA – North American, not globally accepted 5. Describe the relationship between standardized terminologies and financial rewards related to Meaningful Use. Using standardized terminologies ensures compliance with standards coming forth for meaningful use, quality measures, and interoperability. Competency 3 Health Information Systems 1. Describe two or more applications for each type of system: CIS and AIS. CIS – computerized physician order entry, barcode medication administration, clinical decision support AIS – Registration, ADT system. risk management and quality assurance 2. Differentiate between PHR, EHR, and EMR. PHR – personal health record, collection of patient data controlled by the patient, accessible by patient and providers EHR – generic term for all electronic health records, now known as term for individual’s lifetime health record, represents both displayed and printed record and supporting software system is known as EHRS
4. What is the relationship between usability and clinical error rate, satisfaction, productivity, and patient safety? Usability goals include creating HIT for improved user efficiency, effectiveness, and satisfaction. HIT outcomes include improved patient safety and decision making. The less usable a system is, the more errors occur. This also leads to decreased productivity and satisfaction. 5. Discuss the importance of integration and interoperability in terms of knowledge sharing and collaboration. Interoperability – ability of two or more health information systems to exchange electronic clinical information with and use information from other health systems Integration – combining Interoperability is possible due to health systems using common standards, providing access to longitudinal information that follows consistent and shared ways of representing the meaning of clinical terms and concepts, aids in understanding meanings among healthcare providers Competency 4 Electronic Health Record 1. Distinguish between electronic health record (EHR) and an electronic health record system (EHRS). EHR – electronic version of a patient’s medical history, records from multiple physicians EHRS – systems that contain EHR (Med Host, Epic, CPRS) 2. Identify the essential components of an electronic health record.
Essential components include recognition of a universal patient identifier, interoperability, comparability, decision support, and POC data capture. EHRs must be electronically linked.
3. Describe the general benefits of EHRs, and then specific for caregivers, the healthcare system, and consumers of healthcare. General Benefits - improve the quality and safety of patient care through benefits such as: improving the accuracy and completeness of patient health information; increasing the speed at which care is provided; enhancing the coordination of care; and increasing transparency of health information for patients and their families. Also add decision support and flag potentially dangerous drug interactions, verify medications, and reduce the needs for risky tests and procedures. - Improved data integrity. Information is more readable, better organized, and more accurate and complete. - Increased productivity. Caregivers are able to access client information whenever it is needed and at multiple convenient locations. This can result in improved client care due to their ability to make timely decisions based on appropriate data. - Improved quality of care. The EHRS supports clinical decision-making processes for physicians and nurses. For example, the clinician can tailor a view of patient information that shows the most recent labs, vital signs, and current medications on one screen or select another view that graphs lab values and vital signs over time. This capability could be used to show renal response to ordered medications or for any number of other scenarios.
- Reduced medical record department costs because pulling, filing, and copying of charts are decreased.
- Improved verification of client eligibility for healthcare coverage.
- Faster turnaround for outstanding accounts with electronic coding and claim submission.
- Decreased need for x-ray film and physical filing, storage, and transport of films.
- Improved cost evaluation based on clinical outcomes and resource utilization data. Consumer Benefits
- Decreased wait time for treatment.
- Improved access and control over health information.
- Increased use of best practices with incorporation of decision support.
- Improved ability to ask informed questions. • Greater responsibility for one’s own care.
- Increased medication safety (Seibert, Maddox, Flynn, & Williams, 2014).
- Quicker turnaround time for ordered treatments.
- Alerts and reminders for upcoming appointments and scheduled tests.
- Increased use of preventive care.
- Increased satisfaction.
- Greater clarity to discharge instructions.
- Elimination of healthcare disparities 4. Discuss the origin and meaning of Meaningful Use (MU). Within your professional experience, list at least 5 core requirements/core measures that are implemented within that EHRS. Meaningful Use (MU) originated to implement incentive payments as part of the ARRA act of 2009 along with HITECH, which authorized incentive payments to specific types of hospitals
and healthcare professionals for adopting and using interoperable health information technology and EHRS. It was developed by the Medicare and Medicaid EHR Incentive Programs in 2011 as incentive criteria. Core Criteria of EHRS
- basic entry of clinical information (demographic data, vital signs, medications, allergies)
- use of several software applications that begin to realize the potential of EHRSs to improve safety, quality, and efficiency of care through clinical decision support
- entry of clinical orders with safety measures within software
- abilities to perform drug formulary checks
- incorporate clinical laboratory results into EHRSs 5. What is HIE (Health Information Exchange) and how do you think it will impact healthcare in the future? HIE – sharing health information, means to reduce redundant tests, improve quality of care, and improve public confidence Competency 5 Information Security 1. Apply the terms Privacy, Confidentiality, Information-and-data privacy, and Information consent to health information.
