Download NR599 Final study guide and more Study Guides, Projects, Research Nursing in PDF only on Docsity!
NR599 Final study guide
● 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.
○ 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 data and the scientific evidence to help guide appropriate decision making ● CDS improving healthcare ○ Reducing clinical variation and duplicative testing
○ Ensuring patient safety
○ 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. ○ Clinical transformation
■ 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
○ 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 ■ are defined as a large collection of data organized for rapid search and retrieval ○ hardware ○ hardware configuration
● Referred to as the “low language” ● consists of binary 0s and 1s ■ Second generation ● One step higher and constitutes assembly languages that use reserved words and symbols that have special and unique meaning ● It is considered a low-level language similar to machine language ● Uses symbolic operation code to represent the machine operation code ● The assembly code is specific to the machines, including computers ■ Third generation ● Intended to be easier to use, and higher level languages provided a programmer-friendly language. ● Some examples of this type of code include FORTRAN, BASIC, Pascal, and the C-family ■ Fourth generation ● More in line with the “human language” and therefore easier to work with than 3GL ● Domain-specific and high-productivity languages and include aspects such as database queries and report generators, as well as GUI creators, database programming, and scripts. ● Many of the 4GL are data oriented and use structured query language (SQL) developed by IBM and also adopted by the American National Standards Institute ■ Fifth generation ● Utilize visual tools to support programming ● One such frequently used language is Visual Basic ● 5GL to be a type of constraint logic or problem- solving-based programming ● PROLOG is a programming language that fits into this description ○ Query ■ computer languages used to make queries in databases and information systems ■ programming language that requests and retrieves data from database and information systems by 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 ■ is related to what the software does within the computer system to support the use of the computer
practice guidelines ○ Challenges to implementing CDS
■ Timing of when to receive alerts within provider workflow ■ Speed and ease of access to alerts ■ Autonomy desired by clinician related to how much control end users have over their response to CDS (whether the CDS alert is a hard stop preventing them from moving forward in the EHR until alert is addressed & whether it takes significant effort to override WEEK SIX READING/ KEY POINTS ● McGonigle Chapter 18 Telenursing and remote access telehealth ○ Telehealth: wide range of health services that are delivered by telecommunications ready tools, such as telephone, videophone, and computer ○ Foundation of knowledge model and home telehealth ■ Knowledge acquisition: receiving information from telehealth device such as vital signs taken in home and patients response to customized questions- information goes to remote server and accessed by telehealth nurse ■ Knowledge processing: take vital signs, subjective data, with pt history to get picture of the clinical situation ■ Knowledge generation: uses nursing skills & knowledge along with information from the patient to decide the best course of action to take and acts on the data. The nurse will reflect upon the situation to see if any more information needs to be gathered or if the physician needs to be consulted regarding tx plan. Additional questions may be asked if needed. ■ Knowledge dissemination: may include calling the doctor,obtaining change in med order, calling pt to notify of the change, education, continued monitoring ○ Allow easier and faster access to patients conditions ex. Pt’s response to medications in hours rather than in days ○ Telehealth is needed to help fill the nursing shortage allowing nursing to see more patients quicker, as well as the aging population (⅘ 50+ years old live with at least one chronic disease or condition). The amount of chronic conditions and number of people affected by chronic conditions is expected to continue rising-- ⅓ of people of all ages have limited ability to go to school or live independently due to chronic conditions ○ The U.S healthcare system spends $1.4 trillion each year on conventional medical care and will increase in the coming decades-- one solution is to
■ Early adopters look for the bugs in the system and seek to find solutions ■ They are willing to support the system with their peers and other staff, and to promote the use of the system. ■ They follow the defined workflows and ask questions in areas of uncertainty ■ Early adopters may look for better ways to perform specific workflows, if they feel the workflows are not optimized or could work better ■ They are supportive of the system but are also realistic in their approach, yet they remain positive while looking for solutions to problems or issues. ○ electronic health record ■ Is the systematized collection of patient and population electronically-stored health information in a digital format ■ These records can be shared across different health care settings ■ EHRs are real-time, patient-centered records that make information available instantly and securely to authorized users ○ Evaluation ■ An evaluation of how effective the adoption of an EHR has been can be measured through qualitative studies, such as surveys, questionnaires, focus groups or ethnographic observational methods, staff interviews, and workflow analysis before and after the implementation of the system. ■ An evaluation of the implementation should be done by all members of the project team, as well as by the staff using the system ○ Implementation ■ The implementation of an EHR follows a very specific process called SDLC ■ SDLC is used by engineers and developers in creating systems, but it is also the accepted process for managing a project, such as an EHR implementation, from decision making, to beginning a project, to the completion of the project ■ An SDLC approach has a definite time frame—a beginning or initiation point and an end or closure point. This section reviews the SDLC approach to EHR implementation
■ There are several different constructs for managing projects of the magnitude and scope of an EHR implementation, but SDLC follows a very specific group of activities defined within each phase, thus further defining the project steps and requirements ■ During the implementation phase, policies and procedures are written to define the workflows, training materials are developed, and testing is completed ■ The actual implementation, or “go-live,” occurs at a point and time that is usually supported by the builders, developers, and superusers for a specific time period ○ Innovators ■ Innovators on average account for about 2.5% of the organization’s population and may include nursing informaticists, champions, and superusers ■ They embrace the technology and understand the potential of the EHR and the ability to expand the infrastructure with new innovations to further improve safety and quality of patient care, as well as the clinician experience ■ They seek to help define the system and are often testers involved in the design of the workflows ■ Innovators often are innovators in other areas of their lives ■ Innovators constantly push for advanced functionality of the system, pushing the limits of the system and creatively thinking of ways to improve existing workflows and functionality. ○ Interoperability ■ Interoperability describes the extent to which systems and devices can exchange data and interpret that shared data ■ Interoperability is becoming more prominent and more robust in its use, due to advancement of standards, such as FHIR, and application program interface (API), which easily link data between multiple sources. ■ Systems can work together synergistically to enhance health information management, as well as reduce redundancy or data collection, allowing for aggregation of data for analytics and reporting ■ Among systems is what makes it possible to have different applications within an organization and also allows sharing of data between organizations, providers, or other stakeholders ○ Laggards
