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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
● 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
○ Nursing informatics: specialty that integrates nursing science with multiple information and analytical sciences to identify, define, manage, and communicate data, information, knowledge and wisdom in nursing practice ■ NI supports nurses, consumers, patients, the interprofessional healthcare team and all other stakeholders in their decision making in all roles and settings to achieve desired outcomes ● Tools to achieve this may include EHR, barcode med admin programs, patient monitoring devices, and telehealth tools ○ DIKW paradigm: data, information, knowledge, and wisdom ■ Also known as the conceptual framework ● Data: discrete facts, describe the patient or their environment-- ex: medical dx (CHF), living status (alone) ● Information: data + meaning, answers questions such as who, what, where, when-- ex: (CHF, unspecified) (78 yo living alone) ● Knowledge: information synthesized so that relations and interactions are defined and formalized, answers questions of why or how (CHF, unspecified, living alone, 70 yo, d/c from hospital on blood thinners- indicated high risk for ADR) ● Wisdom: use of knowledge to manage and solve human problems-- ex: nurse prioritizes patient above others ○ International classification of nursing practice:initiative to standardize the language of nursing practice ■ Better communication among nurses and providers, increased visibility of nursing interventions, improved patient care, enhanced data collection to evaluate nursing care outcomes, greater adherence to standards of care, and facilitation of assessment of nursing competency ○ Knowledge worker: advanced formal education and is able to apply theoretical and analytical knowledge ■ Innovators that work to produce the foundation for organizational sustainability and growth ■ Nurses transition from knowledge users to knowledge builders when they examine clinical data and trends across groups of patients
WEEK TWO READING/KEY POINTS
McGonigle, D. & Mastrian, K. (2018).
■ 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.
○ High-hazard drugs ■ Drugs known to cause significant adverse side effects when administered inappropriately ○ Human factors engineering ■ Recognizing the limitations of human performance and developing products to overcome these limitations. ○ Just culture ■ An atmosphere of trust ○ Never events ■ Events that should never occur, such as wrong-site surgeries and retained surgical objects. ○ Radio frequency identifier (RFID) ■ An identification chip that stores information for retrieval. ○ Root-cause analysis ■ Similar to failure modes and events analysis; analysis to discover why a process is faulty or produces an undesired result. ○ Safety culture ■ An organizational commitment to patient safety and the prevention of medical errors. ○ Smart pump ■ Machine used to infuse medication that includes dose-checking technology and safeguards ○ Smart rooms ■ Patient rooms that are equipped with technologies to increase patient safety and improve patient care. ○ Systems engineering ■ An approach where technology manufacturers partner with organizations to identify risks to patient safety and promote safe technology integration. ○ Wearable technology ■ The study or practice of inventing, designing, building, or using miniature body-borne computational and sensory devices. McBride, S., & Tietze, M. ● Chapter 2 ○ Advanced practice ■ Designed to improve the science of simulation and share best practice and provide evidence based guidelines. ○ Interprofessional
○ 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
■ Analytic technique that focuses on how a task must be accomplished, including detailed descriptions of task-related activities, task characteristics and complexity, and the environmental conditions required for a person to perform a given task. ○ Usability ■ The ease with which people can use an interface to achieve a particular goal. Issues of human performance during computer interactions for specific tasks within a particular context. ○ Workarounds ■ Ways invented by users to bypass the system to accomplish a task; usually indicate a poor fit of the system
● Chapter 14 (pages 266-269)
○ EHR
■ Computer-based data warehouses or repositories of information regarding the health status of a client, which are replacing the former paper-based medical records; they are the systematic documentation of a client’s health status ○ HITECH ■ Title XIII of the American Recovery and Reinvestment Act, which was enacted in February 2009. Under this act, healthcare organizations can qualify for financial incentives based on the level of meaningful use achieved; the HITECH Act specifically incentivizes health organizations and providers to become “meaningful users.” ○ American Recovery and Reinvestment Act (ARRA) ■ An economic stimulus package enacted in February 2009 that was intended to create jobs and promote investment and consumer spending during the recession. This act has also been referred to as the Stimulus or Recovery Act. There was a push for widespread adoption of health information technology, ○ Meaningful use ■ The American Recovery and Reinvestment Act of 2009 specifies three main components of meaningful use: ● (1) the use of a certified electronic health record (EHR) in a meaningful manner, such as e-prescribing ● (2) the use of certified EHR technology for electronic exchange of health information to improve quality of health care
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)
■ includes detailed specifications and requirements that typically serve as a more binding proposal or offer to accomplish the goals or product needs of the customer ○ return on investment (ROI) ■ electronic information systems and technology in the healthcare setting is an important consideration, but other success factors include improvements in quality, safety, and population health. ○ Scrum ■ is considered by some to be the most popular software development agile framework and is a term used for iteration ○ Sprint ■ is defined by the “scrum master” or the agile team’s facilitator. ○ Superuser ■ Users that have expert technology skills ○ system testing ■ is typically done by the system analyst to make sure the system functions as the designer understood it to be developed. ○ systems development life cycle (SDLC) ■ is a standardized approach used to develop and implement an information technology (IT). ■ This framework is often used across industries to structure best practices for IT development and deployment. ■ SDLC is a phased approach used to analyze and design information systems that is broken into distinct phases ○ unit testing ■ is one specific component or module that performs a specific task ○ Waterfall ■ approach to development occurs in a cascade fashion with analysts and users proceeding in a sequenced manner from one phase to the next. The phases are linear in approach and do not cycle back around to inform the former stage. ● Chapter 11 ○ Business associate agreements (BAA) ■ BAA is in place with each of their partners to maintain security and overall HIPAA compliance. ○ Centralized model ■ HIE data sharing is protected through data-sharing agreements, and data are stored for use by organizations through the data repository. This approach typically fosters the use of data within the community or region in a collaborative manner, supporting
● Chapter 16 ○ Blogs ■ Interactive, online weblogs. Typically a combination of what is happening on the Web as well as what is happening in the blogger’s or creator’s life. ○ Digital divide ■ The gap between those who have and those who do not have access to online information. ○ Domain name ■ A series of alphanumeric characters that forms part of the Internet address or URL ○ E-brochure ■ Electronic brochure. Patient education material that is typically tied to an agency website and may include such information as descriptions of diseases and their management, medication information, or where to get assistance with a healthcare issue. ○ E-health ■ Healthcare initiatives and practice supported by electronic or digital media. The most typical use is for patient and family education where information is communicated electronically. ○ eHealth Initiative ■ Initiative developed to address the growing need for managing health information and to promote technology ○ Empowerment ■ Promotion of self-actualization; achievement of power or control over one’s own life. ○ Gray gap ■ A term used to reflect the age disparities in computer connectivity; there are fewer persons older than age 65 who use computer technology than members of younger age groups. ○ HONcode ■ One of the two most common symbols that power users look for to identify trusted health sites. ○ Interactive technologies ■ Technologies that promote or support user communication with other persons ○ Know–do gap ■ Situation that exists because solutions to global health problems are available but are not implemented in a timely fashion because of the lack of access to important health information. ○ Static medium
■ Something that cannot be updated ○ Trust-e ■ One of the two most common symbols that power users look for to identify trusted health sites. ○ Voice recognition ■ A type of software that allows the user to input data or to navigate the Web using voice commands. ○ Web quests ■ Searches of the World Wide Web for information. ○ Weblog ■ A website that contains the contributions of single or multiple users about a particular topic or issue. ● Chapter 17 ○ Agency for Toxic Substances and Disease Registry (ATSDR) ■ A federal agency that acts as a repository for research and data regarding hazardous materials that serves the public by using the best science ○ Behavioral Risk Factor Surveillance System ■ An assessment system initially designed to collect information on the movement of mentally impaired persons from state-operated facilities into community settings. ○ Bioterrorism ■ The use of pathogens or other potentially harmful biological agents to sicken or kill members of a targeted population. ○ Centers for Disease Control and Prevention (CDC) ■ An agency of the U.S. Department of Health and Human Services that works to protect public health and safety related to disease control and prevention. ○ Community risk assessment (CRA) ■ A comprehensive examination of a community to identify factors that potentially affect the health of the members of that community. ○ Crowdsourcing ■ Information generated by individuals on social media. ○ Epidemiology ■ The field of study identifying things that come upon the people. Incidence, prevalence, and control of disease. ○ National Center for Public Health Informatics (NCPHI) ■ Center created in 2005 by the Centers for Disease Control and Prevention to provide leadership in the field of public health informatics. ○ National health information network
