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· Midterm Study guide NR 599 Informatics
General principles of Nursing Informatics Nursing informatics is the specialty that integrates nursing science with multiple information management and analytical sciences to identify, define, manage, and communicate data, information, knowledge, and wisdom in nursing practice. One of the most frequently quoted and widely accepted definitions of nursing informatics is that it is a combination of nursing science, information science and computer science · Knowledge
- All nurses have the opportunity to be involved in the formal dissemination of knowledge via their participation in professional conferences either as presenters or attendees.
- All nurses, regardless of the practice arena, must use informatics and technology to inform and support that practice. · Wisdom
- Wisdom is the application of knowledge to an appropriate situation.
- In the practice of nursing science, we expect action and/or actions directed by wisdom.
- Wisdom uses knowledge and experience to heighten common sense and insight to exercise sound judgment in practical matters. It is developed through knowledge, experience, insight and reflection. · Scientific Underpinning The scientific underpinnings of practice provide the basis of knowledge for advanced nursing practice. These scientific underpinnings include sciences such as biology, physiology, psychology, ethics, and nursing. · The Foundation of Knowledge Model According to Mastrain and McGonigle (2009), one of the most prominent models associated with nursing informatics is the Foundation of Knowledge model. This theory involves integrating four main kinds of knowledge , which are: knowledge acquisition, knowledge dissemination, knowledge generation and knowledge processing. Knowledge acquisition : application of knowledge acquired through education, research, and practice to provide services and interventions to patients to maintain, enhance, or restore their health, and to acquire,
process, generate, and dis- seminate nursing knowledge to advance the nursing profession. Knowledge Dissemination: Disturbing and sharing of knowledge learned Knowledge Generation: Creating new knowledge by changing and evolving knowledge based on your experience, education and input from others Knowledge Processing: The activity or process of gathering, collecting or perceiving, analyzing, saving and transmitting knowledge The Foundation of Knowledge model specifically prompts nurses to extend their theoretical and metaphorical knowledge into practical, holistic determinations based on a variety of factors and contexts. Because competencies in informatics include but are not limited to information literacy, computer literacy, and the ability to use strategies and system applications to manage data, knowledge, and information, the ability of nursing students to use computer-mediated communication skills is essential to their success in the nursing field and as a means to improve patient safety.
- Organizing conceptual framework for text
- Helps to explain the ties between nursing science and informatics and knowledge
- Informatics is viewed as a tool for founding knowledge · Computer science · Computer science is introduced through a focus on computers and the hardware and software that make up these evolving systems; computer science is one of the building blocks of nursing informatics. Computer science offers extremely valuable tools that, if used skillfully, can facilitate the acquisition and manipulation of data and information by nurses, who can then synthesize these into an evolving knowledge and wisdom base. Data storage, management, retrieval, and processing. · Cognitive science Interdisciplinary field that studies the mind, intelligence, and behavior from an information processing perspective. A field that involves both cognitive informatics and artificial intelligence. The science of understanding what information is housed in and processed by the brain (Cognitive informatics) · Information science the science of information studying the application and usage of information and knowledge in organizations and the interfacing or interaction between people,
-comprised of structured and unstructured data · Human-Technology Interface The hardware and software through which the user interacts with any technology (e.g., computers, patient monitors, telephone, etc.). · Health Information Technology Management and processing of information with the assistance of computers. Computers and IT provide tools that aid data collection and the analysis associated with research to support the overall work of nurses. · Alarm fatigue You get so many alerts that you get numb to them and begin ignoring them · Digital natives Not computer smart, unable to navigate through computers easily. Lack of computer skills. · Information Literacy Competency Standards for Nursing Developed by the TIGER initiative. Three components identified: (1) information literacy, (2) computer literacy, and (3) clinical information management
- Information literacy a. Ability to identify when information is needed as well as the skills to find, evaluate, and effectively use the same b. Evaluation of online resources for quality c. Able to search literature databases effectively
- Computer literacy a. Basic familiarity with computer uses and common applications b. Ability to navigate hyperlinks c. Able to set up and use a database
- Clinical information management a. Uses clinical decision making (CDS) and system safeguards to protect patients and protected health information (PHI) b. Able to request and evaluate reports for the purpose of informed decision making c. Participate in the selection, design, and evaluation of clinical information systems and patient-care technologies d. Uses available technologies to appropriately and effectively communicate · HITECH Act
push for more technology to be used especially for education · TIGER-based Nursing Informatics Competencies Model The work of the Technology Informatics Guiding Education Reform team. This team of nursing leaders developed a vision for utilizing information technology to transform nursing practice. Pillars of the TIGER vision include: management and leadership, education, communication and collaboration, informatics design, information technology, policy, and culture.
WEEK ONE READING/KEY POINTS
McGonigle, D. & Mastrian, K. (2018). ● Chapter 1 ○ Nursing informatics: specialty that integrates nursing science, computer science, cognitive science, and information science ○ For information to be valuable & quality it must be: ■ Accessible & Utility: right user obtain right information at the right time in the right format ■ Accurate: ■ Timely: available when needed for the right purpose at the right time ■ Complete: contains all necessary essential data ■ Cost-effective ■ Flexible: information may be used for a variety or purposes ■ Reliable: authoritative or credible source ■ Relevant: subjective descriptor that has relevant information that is useful ■ Simple ■ Verifiable ■ Transparency: allows user to apply their intellect to accomplish tasks while tools housing the information disappears into the background ■ Secure ■ Reproducibility: ability to produce the same information again ● Chapter 2 ○ Data: raw facts ○ Information: processed data that has meaning ○ Data integrity: whole, complete, correct, and consistent data ○ Dirty data: database that contains errors such as duplicate, incomplete, or outdated records
■ Productivity software
● Provide all the basic programs that a user needs to do their work (word, spreadsheet, email, etc) ■ Creativity software ● Allows user to draw, paint, render, record music and sound, and incorporate multimedia in professional aesthetic ways to share and convey information and knowledge ■ Communication software ● Allows user to share, dialogue, and network with other users via exchange of email or instant message ○ Cloud computing: web-browser based login-accessible data, software, and hardware that you can access and use ■ Public cloud: owned and operated by companies offering public access to computing resources ■ Private cloud: operated for a single organization with the infrastructure being managed internally or outsourced to a third party ● Chapter 4 ○ Cognitive science: fourth of four basic building blocks used to understand informatics-- studies the mind, intelligence, and behavior from an information-processing perspective ○ Connectionism: component of cognitive science that uses computer modeling through artificial neural networks to explain human intellectual abilities ■ Neural network: interconnected simple processing device of the brain and nervous system that consists of a considerable amount of elements or units linked together in a pattern of connections ○ Sources of knowledge ■ Empiricism: knowledge derived from experiences or senses ■ Rationalism: knowledge derived from reason ■ Instinct, reason, intuition ○ Epistemology: the study of the nature and origin of knowledge ○ Wisdom: knowing when and how to apply knowledge (knowledge is understanding information in a way that it can be made useful) ○ Cognitive informatics: field of study that bridges the gap in understanding how information is processed in the mind and in the computer ○ AI: field that deals with the conception, development, and implementation of informatics tools based on intelligent technologies-- uses cognitive science and computer science to replicate and generate human intelligence ● Chapter 6
● Chapter 7 ○ Advocate/policy developer ■ A nurse informatics specialist who is key to developing the infrastructure of health policy. Policy development on the local, national, and international levels is an integral part of this role. ○ Certification ■ System for validating that a nurse possesses certain skills and knowledge or is competent to complete a task. Competence and skill level are determined by or based on an external review, assessment, examination, or education. ○ Consultant ■ A person hired to provide expert advice, opinions, and recommendations based on his or her area of expertise. ○ Data ■ Raw facts that lack meaning. ○ Decision support/outcomes manager ■ Person charged with reviewing the effects of interventions suggested by the computerized decision support system. ○ Educator ■ Sage, leader, and/or guide who assists in the process or practice of learning. ○ Entrepreneur ■ Person who assumes the risks of beginning an enterprise or business and accepts responsibility for organizing and managing the organization. ○ Informatics ■ A field that integrates a specialty’s science, computer science, cognitive science, and information science to manage and communicate data, information, knowledge, and wisdom in a specialty’s practice. ○ Informatics innovator ■ One who makes enhancements or improvements and creative, novel, and inventive solutions in the informatics specialty. ○ Informatics nurse specialist ■ A registered nurse with formal, graduate education in the field of informatics or a related field, who is considered a specialist in the field of nursing informatics. ○ Knowledge worker ■ Those who work with information and generate information and knowledge as a product. ○ Medical informatics
■ A specialty that integrates medical science, computer science, cognitive science, and information science to manage and communicate data, information, knowledge, and wisdom in medical practice. ○ Product developer ■ One who designs, creates, and builds a product ○ Project manager ■ Person responsible for the success of a project, who manages the planning and enactment of the project. ○ Researcher ■ The one who researches ○ TIGER initiative ■ The work of the Technology Informatics Guiding Education Reform team. This team of nursing leaders developed a vision for utilizing information technology to transform nursing practice. ● Chapter 15 ○ Adverse events ■ Any undesirable experiences or outcomes in a patient related to the use of a medical treatment or product. ○ Agency for Healthcare Research and Quality (AHRQ) ■ An agency within the U.S. Department of Health and Human Services that supports health services research initiatives. ○ Bar-code medication administration (BCMA) ■ A system using bar-code technology affixed to the medication ○ Clinical decision support (CDS) ■ A computer-based program designed to assist clinicians in making clinical decisions by filtering or integrating vast amounts of information and providing suggestions for clinical intervention. ○ Computerized physician order entry (CPOE) ■ Clinicians place orders within these systems instead of using traditional handwritten transcription onto paper. ○ Electronic medication administration system (eMAR) ■ A system that uses bar-coding technology in order to submit and fill prescriptions. ○ Failure modes and effects analysis (FMEA) ■ A systematic evaluation of a process to determine how and why it failed to produce the desired results. ○ Government Accountability Office (GAO) ■ The highest audit institution of the federal government that provides auditing, evaluation, and investigative services for the U.S. Congress.
■ Collaborating and interacting with other healthcare professionals to ensure positive patient outcomes. ● Chapter 24 ○ Competencies ■ Rely primarily on methods that self-report through survey instrumentation methods. Valid and reliable methods to evaluate informatics competencies measurably and objectively within simulation centers are not currently available. ○ electronic health record ■ Creating a significant change in the way clinicians access, read, digest, and use the information within the health record to treat patients. ○ Simulation ■ Simulation-based learning requires learners to actively participate in dynamic experiences as opposed to static, traditional modes of learning.
WEEK THREE READING/ KEY POINTS
McGonigle, D. & Mastrian, K.
● Chapter 11
○ Cognitive task analysis ■ Examination of the nature of a task by breaking it down into its component parts and identifying the performers’ thought processes. ○ Cognitive walkthrough ■ Within cognitive walkthrough when evaluators assess a paper mockup, working prototype, or completed interface by observing the steps users are likely to take to use the interface ■. This analysis helps designers determine how understandable and easy to learn the interface is likely to be for these users and the typical tasks ○ Cognitive work analysis ■ Cognitive work analysis was developed for the analysis of complex, high-technology work domains ■ A complete CWA includes five types of analysis: (1) work domain, (2) control tasks, (3) strategies, (4) social–organizational, and (5) worker competencies ■ Work domain analysis describes the functions of the system and identifies the information that users need to accomplish their task goals
○ Earcons ■ Auditory tones that are combined to represent relationships among data elements, such as the relationship of systolic blood pressure to diastolic blood pressure. ○ Ergonomics ■ describe the physical characteristics of equipment—for example, the optimal fit of a scissors to a human hand. ○ Field study ■ Study in which end users evaluate a prototype in the actual work setting prior to its general release. Also called field test, alpha test, or beta test. ○ Gulf of evaluation ■ The gap between knowing one’s intention (goal) and knowing the effects of one’s actions. ○ Gulf execution ■ The gap between knowing what one wants to have happen (the goal) and knowing what to do to bring it about (the means to achieve the goal). ○ Heuristic evaluation ■ An evaluation in which a small number of evaluators (often experts in relevant fields such as human factors or cognitive engineering) evaluate the degree to which an interface design complies with recognized usability principles (the “heuristics”). ○ human -computer interaction ■ How people use and interact with computers; the study of how people use computers and software applications and the ways that computers influence people. ○ Human factors ■ Recognizing the limitations of human performance and developing products to overcome these limitations. ○ Human tech interaction ■ How users interact with technology. The study of that interaction. ○ Mapping ■ How environmental facts (e.g., the order of light switches or variables in a physiologic monitoring display) are accurately depicted by the information presentation. ○ Situational awareness ■ The ability to detect, integrate, and understand critical information that leads to an overall understanding of a problem or situation. ○ Task analysis
● (3) the use of certified EHR technology to submit clinical quality and other measures. ○ The criteria for meaningful use will be staged in three steps. ■ Stage 1 (2011–2012) set the baseline for electronic data capture and information sharing. ■ Stage 2 (2013) ■ Stage 3 (expected to be implemented in
- will continue to expand on this baseline and be developed through future rulemaking.
McBride, S., & Tietze, M. (2018).
● Chapter 1 ○ Health information exchange (HIE) ■ Data translated into actionable information with extensive data management and reporting capability on which providers can manage and improve care ○ Medicare Access and CHIP Reauthorization Act (MACRA) ■ there is significant emphasis on expanding the requirement to capture more structured data, better quality reporting, and better capacity to exchange data using HIEs within and across states and regions ○ Merit-Based Incentive Payment System (MIPS) ■ with a focus on interoperability ○ National Strategy for Quality ■ Improvement in Health Care, several legislative components have been implemented. ○ Patient Protection and Affordable Care Act (ACA) ■ focused on providing all Americans with access to quality and affordable healthcare ○ The third content domain of the NEHI framework: goal to improve patient outcomes ■ Patient safety ■ Population health ■ Quality ● Chapter 8 ○ Agile ■ Agile development is a technique that is a programmer-driven technique that creates a feedback loop with the end users. This
technique is based primarily on verbal communication with the end user and does not rely on documentation strategies ○ Alpha testing ■ testing is done using test data or “made-up” data. ○ beta testing ■ gets a step closer to production with a sample of “real” data to test how the system functions and looks for any errors that might arise. ○ big-bang implementation ■ all units or hospitals in a system go live at once ○ command center ■ A 24-hour resource center on site for the first 3 days of each rollout. ○ commercial off-the-shelf products ■ require customization. Customization must be done in- house by a design team, or the design team is contracted through the vendor or a service provider company. This design work requires close alignment with end-user requirements. ○ core implementation team ■ The team is on site the first 24 hours and available by cell or pager for 2 weeks thereafter. ○ cost–benefit analysis ■ Is the cost worth the benefit ○ Evaluation ■ Evaluating how well the product is working ○ Implementation ■ Putting the product into effect ○ integration testing ■ one or more modules or components work together (integrate) and function as designed. ○ project management ■ is an essential tool of the design phase of the SDLC because it is required to keep implementation and development projects on time, in scope, and within budget. ○ rapid application development ■ RAD deploys software tools and analysis and design strategies to speed up development. The goal is to get systems rapidly into the hands of the end user to test and refine the product to meet the end-user requirements ○ request for information ■ is a shorter, less detailed request that surveys what type of products might fit the end user’s needs, ○ request for proposal (RFP)
through the data repository. This approach typically fosters the use of data within the community or region in a collaborative manner, supporting
initiatives to improve quality, patient safety, population health, and care coordination ○ Community Health Information Networks (CHINs) ■ Commercially driven endeavors with intents that were similar to those of our current HIEs. They focused on exchanging data across a community; however, these initiatives lacked payer and community stakeholders. CHINs were primarily transaction-based and provider- based data exchanges that did not store data within a centralized repository. ○ Data Use and Reciprocal Agreement (DURSA) ■ Serves as the main legal framework for eHEX participants continues to ensure that privacy protections are important at the eHEX and with its participants ○ Decentralized model or Federated model ■ An approach maintains the control of the source data at the originating organization, and data are cached and transmitted to the provider as needed at the point of care ○ Health information exchange (HIE) ■ health information follows the patient wherever and whenever they seek care, in a private and secure manner so that teams of doctors, nurses and care managers can provide coordinated, effective, and efficient care ○ Interoperability ■ the ability of computer systems or software to exchange and make use of information ○ Master patient index ■ Identify unique patients within a delivery system maintaining disparate information systems or across institutions within regions. An MPI is an important element for effective management of patient care across institutions ○ Regional Health Information Organizations (RHIOs) ■ Were the next concept to arise and were related to the exchange of regional data. RHIOs were defined as “neutral, third-party organizations that facilitate information exchange between providers within a geographical area to achieve a more effective and efficient healthcare
WEEK FOUR READING/ KEY POINTS
McGonigle, D. & Mastrian, K.
