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● Ethical decision making ○ When making choices about ethical issues based on the standards of right vs wrong. ○ It requires a systematic framework for addressing the complex and often controversial moral questions. ● Bioethical standards ○ The study of healthcare ethics ○ Bioethics takes on relevant ethical problems seen by healthcare providers in relation to care ● Telehealth ○ wide range of health services that are delivered by telecommunications ready tools, such as telephone, videophone, and computer ○ is needed to help fill the nursing shortage allowing nursing to see more patients quicker, as well as the aging population ○ Telecommunication technologies used to deliver health-related services or to connect patients and healthcare providers to maximize patients’ health status. ○ A relatively new term in the medical/nursing vocabulary, referring to a wide range of health services that are delivered by telecommunications-ready tools such as the telephone, videophone, and computer. ● Medical Applications ○ Software developed for medical purposes, including home medical monitoring system, medical databases for healthcare professionals, etc. ● Medical Devices ○ is any device intended to be used for medical purposes ● FDA Oversight for Medical Devices ● Privacy ○ An important issue related to personal information ○ Restricted access of patient information or data ● Confidentiality ○ To ensure that all personal information is protected by ensuring that limited access is only given to those who are authorized to view that information. ■ Protecting privacy of personal information or data ● Cybersecurity ○ the state of being protected against the criminal or unauthorized use of electronic data, or the measures taken to achieve this.
○ With the expansion of technology. Facilities are taken more precautions to prevent cyber attacks. With the move towards advancing cybersecurity is important, technology continues to grow.
E/M coding to be reimbursed by Medicare, Medicaid programs, or private insurance for patient encounters. ● Reimbursement Coding
○ Is based on claims and documentation filed by providers using medical diagnosis and procedure codes. ○ Commercial payers must use standards defined by the U.S. Department of Health and Human Services (HHS) but are largely regulated state-by-state. ● Clinical Support Tools ○ are designed to help sift through enormous amounts of digital data to suggest next steps for treatments, alert providers to available information they may not have seen, or catch potential problems, such as dangerous medication interactions ○ Such as CDS clinical decision support, a program used by providers. ○ Or various applications use by healthcare professionals to allow for communicate between provider to provider and provider to patient ○ The tools are all used to benefit patient outcome ● Workflow analysis ○ Not an optional part of clinical implementations, but rather a necessity for safe patient care fostered by technology. ○ The ultimate goal of workflow analysis is not to “pave the cow path,” but rather to create a future-state solution that maximizes the use of technology and eliminates non–value- added activities. ○ Although many tools and methods can be used to accomplish workflow redesign, the best method is the one that complements the organization and supports the work of clinicians. ○ needs to be done as well as working in optimization (moving conditions past their current state into a more effective method of performing.
WEEK FIVE READING/ KEY POINTS
Key points from the lessons and modules ● Clinical Decision Support (CDS) ○ Generate patient specific interventions, assessments and recommendations ○ CDS tools existed prior to development of EHRs ○ The primary goal of implementing a CDS tool is to leverage
○ Avoiding complications that may result in readmissions ○ Create alerts about drug-drug interactions ○ Drug allergy contraindications ● CDS challenging healthcare ○ Alarm fatigue ○ Clinical burnout ○ Occur with poorly implemented CDS features ○ Financial burden ● Workflow Design ○ Used to describe the action or execution of a series of tasks in a prescribed sequence ○ Progression of steps (tasks, events, interactions) that constitute a work process ○ In a sequential workflow, each step depends on the occurrence of the previous step; in a parallel workflow, two or more steps can occur concurrently. ○ Nursing informatics is uniquely positioned to engage in the analysis and redesign of processes and tasks surrounding the use of technology. ● Changes in workflow, poor system design and usability issues, lack of understanding about these systems and their capabilities, user errors and system errors, and lack of defined protocols can all lead to process breakdowns and errors. McGonigle Chapter 13 ● EHR and information systems provide POC decision support to prevent medical errors to save lives and money ● Workflow must be considered before implementing technology or it can be more dangerous ○ Computerized provider order entry (CPOE) focuses on considering the workflow ● Barriers to implement technology: cost & length of time to incorporate it, frequent upgrades interrupting the workflow ● American Recovery and Reinvestment Act (ARRA)- used financial incentives to implement Meaningful Use (MU) rules and regulations ○ Stage 1: data capturing and sharing ○ Stage 2: advanced clinical processes ○ Stage 3: improve outcomes ● Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) took over and created a quality payment program (QPP) to replace Medicare reporting programs
○ Merit Based Incentive Payment (MIPS or Alternative Payment Models (APM) to allow clinicians to choose what suites their needs the best, simplify process for achievement, align with Health IT Certification criteria, emphasize interoperability, information exchange, security measures, and patient access to information, reduce number of measures, and exempt clinicians from reporting if EHR is not applicable to their practice ● Hospitals have small profit margins so they need to work smarter and not harder with the help of technology to keep the margins from getting smaller ○ Workflow analysis needs to be done as well as working in optimization (moving conditions past their current state into a more effective method of performing. ● More research is needed in the area of financial implications of workflow inefficiencies and their impact on patient care ○ This is hard due to lack of standardized terminology in this area ● Workflow redesign- one of the fundamental skills sets that make up the discipline of an informatics nurse ● Process owners: those that directly engage in the workflow to be analyzed and redesigned ● Six Sigma or Lean Departments: efficient and effective delivery of care ○ Key underpinning is the removal of waste ● Variation: when workers perform the same function in different ways- should be eliminated when possible ● Involve operational staff when possible to ensure the buy-in of staff ● To move from current state to future state gap analysis is necessary-- zeros in on the major areas most affected by the change ● Chapter 13 Workflow and Beyond Meaningful Use ○ Alternative Payment Models (APM)’s ■ The Reauthorization Act of 2015 (MACRA) reformed Medicare payments by making changes that created a quality payment program (QPP) to replace the hodgepodge system of Medicare reporting programs. ■ The MACRA QPP has two paths—merit-based payment system (MIPS) or alternative payment models (APMs)—that will be in effect through 2021 and beyond. ■ The APMs are not just incentives, but fundamental changes in how we pay for health care in the United States. It is these models, particularly those dealing with total cost of care, that have the potential to fundamentally alter the value we receive from health care.
■ The complete alteration of the clinical environment; widespread change accompanies transformational activities, and clinical transformation implies that the manner in which work is carried out and the outcomes achieved are completely different from the prior state, which is not always true in the case of simply implementing technology. ■ Technology can be used to launch or in conjunction with a clinical transformation initiative; however, the implementation of technology alone is not justifiably transformational ability. Therefore, this term should be used cautiously to describe redesign efforts. ○ Events ■ Occurrences that might be significant to other objects in a system or to external agents ■ for example, creating a laboratory request is an example of a healthcare event in a laboratory application. ■ An event is defined and could be a triggering event for the task or workflow; a task or workflow can have several triggering events. ○ Information systems ■ The manual and/or automated components of system of users or people, recorded data, and actions used to process the data into information for a user, group of users, or an organization. ○ Lean ■ Lean and Six Sigma are a complementary combination of activities that focus on doing the right steps and actions (Lean) and doing them right the first time ○ Medical home models ■ An information technology platform that enables the seamless exchange of important patient information among many providers in a healthcare system. ■ Typically the primary care physician (medical home) initiates the collection of patient data, coordinates the care of the patient, and helps to maintain the accuracy of such data. ■ Other care providers access the information and add to it as they provide services to patients. ○ Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)
■ An act that reformed Medicare payment by making changes that created a quality payment program (QPP) to replace the hodgepodge system of Medicare reporting programs. ○ Metrics
○ Six Sigma ■ Business management tactic that seeks to improve the quality of process outputs by identifying and removing the causes of errors and reducing inconsistency and variability in processes ○ Workflow/Work process
■ A progression of steps (tasks, events, and interactions) that constitute a work process; involve two or more persons; and create or add value to the organization’s activities. ■ In a sequential workflow, each step depends on the occurrence of the previous step; in a parallel workflow, two or more steps can occur concurrently. ■ The term “workflow” is sometimes used interchangeably with “process” or “process flow,” particularly in the context of implementations. ■ A sequence of connected steps in the work of a person or team of people—that is, the process or flow of work within an organization; a virtual illustration of the “real” work or steps (flow) that workers enact to complete their tasks (work). ■ The purpose of examining and redesigning workflow is to streamline the work process by removing any unnecessary steps that do not add value or might even hinder the flow of work. ○ Workflow analysis ■ Not an optional part of clinical implementations, but rather a necessity for safe patient care fostered by technology. ■ The ultimate goal of workflow analysis is not to “pave the cow path,” but rather to create a future-state solution that maximizes the use of technology and eliminates non– value-added activities. ■ Although many tools and methods can be used to accomplish workflow redesign, the best method is the one that complements the organization and supports the work of clinicians. McBride, S., & Tietze, M. (2018). ● Chapter 6 Computers in Health Care ○ application software ■ generally has a purpose or function specific to its use (e.g., accounting/financial applications ○ Database
■ Various system settings that allow for computers or other hardware to work ○ human factors ■ the field of study focused on understanding human elements of systems, in which ‘systems’ may be defined as software, medical devices, computer technology, and organizations ○ network typology ■ Network topology is the arrangement of the elements of a communication network. ■ Network topology can describe the arrangement of various types of telecommunication networks, including command and control radio networks, industrial field busses and computer networks. ● Tree network ○ one builds off the switch and connects a switch to switch, and this configuration works using the Internet. ■ Expansion is available with this network ● Star network ○ Typically connected via a switch or hub, with a limited number of computers on the network ● Ring network ○ set up in a circular configuration with the signals transmitting around the ring until the envelope containing the data, or package of information, finds the designated address. ○ Difficult to add to a computer ○ When one computer goes down the whole network goes down ● Bus network ○ Bus configurations are dependent on the total length of the network and the distance the computers are spaced within the network. ○ Total distance, number of computers, and spacing are relevant to the efficiency with a bus configuration. ■ Various networks have pros and cons depending on the configuration. ○ programming languages ■ is a mechanism for transforming information into a
computer in the form of machine code, which instructs the computer to do some type of task ■ First generation
sending queries ○ reports ○ Software types ■ Business software
● Used by and for specific business functions in healthcare ● Embedded within the EHR ■ Messaging software ● Used to exchange files and messages between systems remotely ● Healthcare systems require encryption of data to meet HIPAA regulatory requirements when using communications ■ Data-management software ● Source software with the primary function of managing a database in a particular structure, usually relational or object oriented ■ Graphics software ● allows the end user to manipulate graphic images on the computer ■ Simulation software ● allows the end user to model real phenomena with a set of mathematical formulas used in healthcare professional training to simulate events rather than have students practice on patients ■ Gaming software ● uses interaction with a user interface to generate visual feedback on a video device ■ Spreadsheet software ● allows data to be analyzed in a tabular format with data organized in rows and columns that can be manipulated by formulas ■ Word processors ● performs processing of text (words) to compose, edit, format, or print written material ■ Workflow software ● reflect a process or steps within a process that provides functionality to create workflows with a diagram-based graphical designer approach ■ Presentation software ● used to create slide presentations that allow typesetting and graphical design to create a professional-looking presentation quickly ○ system software ■ Used to start and run a computer
