Ethical Decision Making in Healthcare Technology: A Guide for Professionals, Exams of Nursing

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Ethical Decision Making - answer>>-Process that requires striking a balance between science and morality

-Making informed choices about ethical dilemmas based on a set of standards differentiating right from wrong.

Ethical Decision Making Process - answer>>1. Identify the ethical dilemma

2. Discover alternative actions
3. Decide who might be affected
4. List the probable effects of the alternatives
5. Select the best alternative

Rational justification - answer>>developed through a logical process of decision making that gives proper attention to such things as facts, alternative perspectives, consequences to all stakeholders, and ethical principles.

American Nurses Association- Code of Ethics for Nurses with Interpretive Statements. - answer>>provides specific guidance for ethical decision making and provides a valuable framework that can be used when working with HIT

issues having an ethical component includes the following - answer>>1. Failure to adopt technology or use it adeptly

2. Lack of regard for data integrity such as discrepancies. in record information that are noted but no corrective action is taken.
3. Failure to address threats to privacy and personal health information.
4. Inappropriate access of PHI without a need to know.

5. Failure to keep informed of emerging developments and issues.
6. Failure to recognize and use technology to advance the profession.
7. Failure to engage in policy discussion that impact healthcare delivery.
8. Failure to recall that the patient is their primary focus.
9. Failure to actively participate in the selection use, and/or evaluation of technology that has the potential to improve healthcare.

ANAs Code of Ethics for Nurses - answer>>1. Respect for human dignity

2. Respect for individual right to self-determinism
3. Primary commitment is to the patient (individual, family, group or community)
4. Advocacy for the patient
5. Participation in the creation, maintenance, and improvement of healthcare environments

6. Advancing the Profession
7. Collaboration with others to meet health needs
8. Shaping social policy.

6 contemporary Bioethical Standards - answer>> Autonomy

freedom

veracity

privacy

beneficence

fidelity

What is the Husted bioethical decision making model centered on - answer>>healthcare professionals implicit agreement with the patient

Virtue Ethics Approach - answer>>moral behavior stems from personal virtues

Example of virtue ethics approach - answer>>If a manager develops good character traits and learns to overcome negative traits, he or she will make ethical decisions based on personal virtue

Telehealth - answer>>use of technology to deliver health care, health information, or health education (i.e. telephone, videophone, computer, store and forward imaging, streaming media, terrestrial and wireless communications)

telemedicine - answer>>medical information exchange from one site to another via electronic communications to improve patients health status

Telehealth tools - answer>> Central stations, web servers, and portals

Peripheral biometric(medical) devices

telephones

videocameras

personal emergency response systems

sensor and activity monitoring

medication management devices

special needs telecommunications ready devices(preprogrammed infusion pumps, peak flow meters)

Telemedicine applications types (2) - answer>>Store-and- forward or asynchronous

real-time or synchronous

Store and forward or asynchronous applications - answer>>exchange prerecorded data between 2 or more individuals at different times

real time or synchronous applications - answer>>all involved individuals are present for immediate exchange of information

mHealth - answer>>generation, aggregation, and dissemination of health info via mobile and wireless devices

How can mHealth wearable devices reduce mortality rates - answer>>wrist monitors that can monitor vital signs including respiratory rate, bp, hr, spo2, and temp which can send the info to an EHR which can calculate a wellness index based on the stats and a 0-5 scale (below 2.9 is good but above 3.0 is potentially bad)

action / execution of tasks in a sequence is what - answer>>workflow

observation and documentation of workflow and how it can be altered is - answer>>workflow or process analysis

how is workflow analysis usually depicted - answer>>visually , in a process map

what is it called if workflow analysis is performed AFTER a new technology is implemented - answer>>optimization

Maya, autodesk and Promodel are examples of - answer>>workplace analysis process mapping tools

Computer applications designed to facilitate human decision-making processes. Usually are rule based, using a specified knowledge base and a set of rules to analyze data and information and provide recommendations to users ---- what is this - answer>>clinical decision support system / CDS or CDSS

what is the difference between expert systems and CDS systems - answer>>expert - not really used right now,

systems that generate information / automatically intervene without requiring human action

CDS - guide clinicians to make choices, require clinician involvement

What is the ICD10? - answer>>alphanumeric coding for medical diagnosis / grouping like disease

provides payer info on the necessity of the visit/procedure

shorthand for dx

What is a CPT code? - answer>>Current Procedural Technology (CPT) code represent treatments and procedures performed by a physician in a 5-digit format.

for billing and reimbursement

6 sections of cpt coding - answer>>evaluation and management

anesthesiology

surgery

radiology

pathology

medicine

ICD 10 is maintained by - answer>>world health org

CPT coding is maintained by - answer>>Am med association

what is LOINC - answer>>Logical Observation Identifiers, Names and Codes LOINC.

, provides names and codes for laboratory test results and other observations.

What is SNOMED CT? - answer>>SNOMED CT or SNOMED Clinical Terms is a systematically organized computer processable collection of medical terms providing codes, terms, synonyms, and definitions used in clinical documentation and reporting.

what is the purpose of SNOMED and LIONC - answer>>vocabulary used in more advanced / detailed coding systems

Diagnosis-related groups (DRGs) - answer>>System that categorizes into payment groups patients who are medically related with respect to diagnosis and treatment and statistically similar with regard to length of stay

CPT is a DRG (diagnosis related group) or MDC (major diagnosis codes) - answer>>DRG - DRGs are more commonly associated with payment and reimbursement

Major Diagnosis Category (MDC) - answer>>organize diagnosis that relate to similar physiological systems

computer aided translators - answer>>using technology to translate language or coding

Evaluation and Management (E/M Codes) - answer>>these are listed 1st in the CPT manual b/c they are used by all different specialties. they cover physician services that are performed to determine the best course for pt care.

they are a category of CPT codes used for reimbursement

who determines whether a mobile application is regulated for medical use - answer>>FDA

are mobile apps intended to provide access to electronic copies of medical textbooks with generic text search capabilities considered a medical devices? - answer>>No recuasse they are reference materials and not tools for dx of disease or condition

are mobile apps that are intended for healthcare providers to use as educational tools for medical training a medical device? - answer>>No, they are intended for general user education and not for dx

medical devices - answer>>Any equipment, instrument, implant, material, or apparatus used for the diagnosis, treatment, or monitoring of patients.

what makes a medical app not a medical device - answer>>Apps that are not intended for use in the

diagnosis of disease or other conditions, or in the cure, mitigation, treatment, or prevention of disease.

Privacy - answer>>Practice of maintaining the security and confidentiality of patient records.

Confidentiality - answer>>The act of holding information in confidence, not to be released to unauthorized individuals.

cybersecurity - answer>>-Measures taken to protect a computer or computer system against unauthorized access or attack

APN role in cybersecurity - answer>>determine if appropriate safeguards to protect phi are in place and if HIPPA requirements are met

Who is the main regulatory agency of cybersecurity - answer>>FDA

examples of mobile apps that the FDA intends to enforce discretion on - answer>>apps that provide or facilitate supplemental clinical care, by coaching or prompting

apps that provide patients with simple tools to organize and track their health information

apps that provide easy access to information related to patients' health conditions or treatments

apps marketed to help patients document, show, or communicate to providers potential medical conditions

apps that perform simple calculations routinely used in clinical practice

apps that enable individuals to interact with PHR systems or EHR

apps that meet the definition of Medical Device Data Systems

Are all medical mobile applications also medical devices - answer>>no

FDA oversight on medical devices contain - answer>>oversees mobile apps that are medical devices and whose functionality could pose a risk to a patient's safety if the mobile app were to not function as intended.

-Also oversee the cybersecurity management of these devices as well as the hospital network security.

who regulates medical devices - answer>>FDA

major areas for mHealth growth - answer>>preventative medicine and health promotion can be utilized through education and awareness apps

portable dx devices that allow monitoring of human conditions in clinical or offsite locations

Applications for data management, training medical personnel, and mobile payments

POE/CPOE/CDS - answer>>POE- practitioner order entry, CPOE- computerized practitioner order entry, CDS- clinical decision support

clinical decision support systems - answer>>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

Human Technology Interface - answer>>The hardware and software through which the user interacts with any technology. for example computers patient monitors and telephones. The human technology interface addresses the user's ability and the technologies functionality to complete the task demand.

Human information technologies (HIT) - answer>>hardware software integrated technologies are related licenses intellectual property upgrades or packaged solutions sold as services that are designed for or support the use by healthcare entities or patients for the electronic creation maintenance access or exchange of health information

patient-centered information systems - answer>>patient centered information systems focused on collecting data and disseminating information related to direct care

four most common types of PCS systems - answer>>clinical documentation systems

pharmacy information systems

laboratory information systems

radiology information systems

Evaluation and Management Coding - answer>>process by which physician-patient encounters are translated into five digit CPT codes to facilitate billing.

Three major questions must be asked when identifying an E/M code: - answer>>1) Is the patient new or established?

2. Where is the service provided?

3. What is the degree of the service rendered?

What makes someone a new patient - answer>>has not received service from a provider in the practice within 3 years

What is necessary for establishing E/M Codes - answer>>Place of Service; Type of Service; Patient Status

Components of Risk Based E/M Coding - answer>>History; Physical; Medical Decision Making

Medical Decision Making (MDM) in regards to E/M codes

• answer>>1 of 3 components to establishing E/M codes; way of quantifying the complexity of thinking that is required for the visit.

Medical Decision Making (MDM) - answer>>Health care management process done after performing a history and physical examination on a patient that results in a plan of treatment. It is based on establishing one or more diagnosis and/or selecting a management or treatment

option, amount of data or complexity of data reviewed, and complication and/or morbidity or mortality

3 key elements to medical decision making - answer>>risk

data

dx

Reimbursement Coding - answer>>-Claims and documentation filed by providers using medical diagnosis and procedure codes.

-Assigned contingent upon data input from clinical team members based on a summative review of the clinical record by trained coders.

DRG vs MDC - answer>>DRG- facilitates payment through prospective payment system

MDC-organizes dx that affect similar physiological systems

both primary purpose for billing

medical billing - answer>>process of submitting claims to receive payment

medical coding - answer>>codes to communicate procedures performed and why

each billing claim must contain what two things - answer>>A CPT (procedural)code and ICD-10 (dx) code

Why do you need a cpt and an ICD code - answer>>to determine reimbursement. if dx does not explain need for the procedure there is no payment

how many levels of care are there for e/m coding and what are they - answer>>5

Minimal/RN visit

Problem focused

exp problem focused

detailed

comprehensive

E/m coding for each level of a new patient - answer>>Minimal/RN visit- 99201

Problem focused- 99202

exp problem focused- 99203

detailed- 99204

comprehensive- 99205

E/m coding for each level of an established patient - answer>>Minimal/RN visit-99211

Problem focused-99212

exp problem focused-99213

detailed-99214

comprehensive-99215