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NR599 MIDTERM STUDY GUIDE
INFORMATICS 2023/2024 GRADED A
GeneralprinciplesofNursingInformatics Nursinginformaticsisthespecialtythatintegratesnursingsciencewithmultipleinformati on management and analytical sciences to identify, define, manage, andcommunicatedata,information,knowledge,andwisdominnursingpractice. Oneofthemostfrequentlyquotedandwidelyaccepteddefinitionsofnursinginformaticsisthatitisa combinationofnursingscience,informationscienceandcomputerscience · Knowledge
- Allnurseshavetheopportunitytobeinvolvedintheformaldisseminationofknowledgeviatheirpa rticipationinprofessionalconferenceseitheraspresentersorattendees.
- Allnurses,regardlessofthepracticearena,mustuseinformaticsandtechnologytoinformand supportthat practice. · Wisdom
- Wisdomistheapplicationofknowledgetoanappropriatesituation.
- Inthepracticeofnursingscience,weexpectactionand/oractionsdirectedbywisdom.
- Wisdomusesknowledgeandexperiencetoheightencommonsenseandinsighttoexercisesound judgmentinpracticalmatters.Itisdevelopedthroughknowledge,experience,insightand reflection. · ScientificUnderpinning Thescientificunderpinningsofpracticeprovidethebasisofknowledgefor advanced nursing practice. These scientific underpinnings includesciencessuchasbiology,physiology,psychology,ethics,andnursing. · TheFoundationofKnowledgeModel AccordingtoMastrainandMcGonigle(2009),oneofthemostprominent models associat ed with nursing informatics is the Foundation of Knowledge model. Thistheory involves integrating four main kinds of knowledge , which are: knowledge acquisition,
knowledge dissemination, knowledge generation and knowledge processing. Knowledgeacquisition :applicationofknowledgeacquiredthrougheducation,r esearch,andpracticetoprovideservicesandinterventionstopatientstomaintain,e nhance,orrestoretheirhealth,andtoacquire,
organizationsandinformationsystems.Integratesfeaturesfromcognitivescience,communic ationscience,computerscience,libraryscienceandsocialsciences · InformaticsCompetencies Have been developed to encompass all levels of practice and ensure that entry- levelnursesarereadytoenterthemoretechnologicallyadvancedfieldofnursing.Andestablish advancedcompetenciesforspecialtypractice.Thesecompetenciesmaybeusedtodeterminet heeducationalneedsofcurrentstaffmembers · Informationliteracy Ability to recognize when info is needed as well as the skills to evaluate and useneeded info effectively. this nurse can recognize significant, relevant research andknowhowtoapplyittopractice.abilitytorecognizewheninformationisneededaswellasth eskillstofind,evaluate,anduseneededinformationeffectively · Healthliteracy degree to which individuals can obtain, process, and understand basic healthinformationandservicesneededtomakeappropriatehealthdecisions · MeaningfulUse useofhealthinformationtechnologytocollectspecificdatawiththeintenttoimprovecare,engag epatients,improvepopulationhealth,andensuretheprivacyandsecurity · Patient-centeredInformationSystems supportstheuseanddocumentationofnursingactivities
- providestoolsformanaginganddeliveryofnursingcare
- twogoals:nursingfunctionsandnursingpractic eClinicalDecisionsupportsystems A computer-based program designed to assist clinicians in making clinical decisions byfilteringorintegratingvastamountsofinformationandprovidingsuggestionsforclinicalinte rvention. · ElectronicMedicalRecords legalrecordcreatedinhospitalsandambulatoryenvironmentsthatisthesourceofdataforthe EHR
- longreferredtoassingleepisodetreatment
- comprisedofstructuredandunstructureddata · Human-TechnologyInterface Thehardwareandsoftwarethroughwhichtheuserinteractswithanytechnology(e.g.,compute rs,patientmonitors,telephone,etc.). · HealthInformationTechnology Managementandprocessingofinformationwiththeassistanceofcomputers.Comp uters and IT provide tools that aid data collection and the analysis associatedwithresearchtosupporttheoverallworkofnurses. · Alarmfatigue Yougetsomanyalertsthatyougetnumbtothemandbeginignoringthem · Digitalnatives Notcomputersmart,unabletonavigatethroughcomputerseasily.Lackofcomp uterskills. · InformationLiteracyCompetencyStandardsforNursing DevelopedbytheTIGERinitiative.Threecomponentsidentified:(1)informationliteracy, (2)computerliteracy,and(3)clinicalinformationmanagement
- Informationliteracy a. Abilitytoidentifywheninformationisneededaswellastheskillstofind,evaluat e,andeffectivelyusethesame b. Evaluationofonlineresourcesforquality c. Abletosearchliteraturedatabaseseffectively
- Computerliteracy a. Basicfamiliaritywithcomputerusesandcommonapplications b. Abilitytonavigatehyperlinks c. Ableto setupand use a database
- Clinicalinformationmanagement a. Usesclinicaldecisionmaking(CDS)andsystemsafeguardstoprotectpatient sandprotectedhealthinformation(PHI) b. Abletorequestandevaluatereportsforthepurposeofinformeddecisionmaking c. Participateintheselection,design,andevaluationofclinicalinformationsyste msandpatient-caretechnologies d. Uses availabletechnologiestoappropriatelyandeffectivelycommunicate · HITECHAct
○ Informationscience:studyofinformationscience-- concernedwithinput,processing, output, and feedback of data and information throughtechnologyintegrationwithafocusoncomprehendingtheperspectiv eofthestakeholdersinvolvedandthenapplyingITasneeded. ■ Systemically based-- deals with big picture, opposed to individualpiecesoftechnology ■ Integrates communicationscience, computerscience,cognitivescience,libraryscience,andsocialscien ce ■ Linkspeopleandtechnology ■ Machines(inorganicISs)Humans(organicISs) ■ Focusesonwhyandhowtechnologycanbeputtobestusetoserveth einformationflowwithinanorganization ○ Informationsystems:handletheneedsoftheentireorganization(co mmunication,tracking,andresearch) ○ Input:collectingandacquiringrawdata ■ Keyboards,touchscreen,mice,lightpens,automaticscanners ○ Processing:retrieval,analysis,synthesisofdata-- transformsdataintousefulinformationandoutputs ■ Storingforfutureuse,makingcalculations,comparingdata ○ Output:dissemination--produceshelpfulinformation ■ Reports,documents,summaries,alerts,outcomes ● Chapter ○ Motherboard:centralnervoussystemofthecomputer-- facilitatescommunicationamongallcomponentsofthecomputer ○ Hard disk: permanent data storage area that holds gigabytes of data,information,documentsevenwhenthecomputeristurnedoff.Backingupi mportantfilesareimportantbecausediskdrivesarenotinfallible ○ Random-access memory: temporary storage that allows the processor toaccess program codes and data while working on a task--the contents ofRAMarelostoncethesystemisrebootedorshutsoff ○ Software:applicationprograms ■ OSsoftware ● Mostimportantsoftwareonanycomputer ● Very first program to load on computer start-up and isfundamentalfortheoperationofallothersoftwareandtheco mputerhardware ● Allowsusertomultitaskwithease ● Describedin6basicprocesses:Memory,device,processor,andst oragemanagement,applicationanduserinterface ■ Productivitysoftware
● Provideallthebasicprogramsthatauserneedstodotheirwork(w ord,spreadsheet,email,etc) ■ Creativitysoftware ● Allows user to draw, paint, render, record music and sound,andincorporatemultimediainprofessionalaestheticways toshareandconveyinformationandknowledge ■ Communication software ● Allowsusertoshare,dialogue,andnetworkwithotherusersviaex changeofemailorinstantmessage ○ Cloud computing:web-browser based login- accessibledata,software,andhardwarethatyoucanaccessanduse ■ Publiccloud:ownedandoperatedbycompaniesofferingpublicacces stocomputingresources ■ Private cloud: operated for a single organization with theinfrastructurebeingmanagedinternallyoroutsourcedtoathirdp arty ● Chapter ○ Cognitivescience:fourthoffourbasicbuildingblocksusedtounderstandinform atics-- studies the mind, intelligence, and behavior from aninformation- processingperspective ○ Connectionism: component of cognitive science that uses computermodelingthroughartificialneuralnetworkstoexplainhumanintelle ctualabilities ■ Neural network: interconnected simple processing device of thebrainandnervoussystemthatconsistsofaconsiderableamountofele mentsorunitslinkedtogetherinapatternofconnections ○ Sourcesofknowledge ■ Empiricism:knowledgederivedfromexperiencesorsenses ■ Rationalism:knowledgederivedfromreason ■ Instinct,reason,intuition ○ Epistemology:thestudyofthenatureandoriginofknowledge ○ Wisdom:knowingwhenandhowtoapplyknowledge(knowledgeisunder standinginformationinawaythatitcanbemadeuseful) ○ Cognitiveinformatics:fieldofstudythatbridgesthegapinunderstandinghowin formationisprocessedinthemindandinthecomputer ○ AI:fieldthatdealswiththeconception,development,andimplementationof informatics tools based on intelligent technologies-- uses cognitivescience and computer science to replicate and generate humanintelligence ● Chapter
● Chapter ○ Advocate/policydeveloper ■ A nurse informatics specialist who is key to developing theinfrastructureofhealthpolicy.Policydevelopmentonthelocal,n ational,andinternationallevelsisanintegralpartofthisrole. ○ Certification ■ System forvalidatingthatanurse possesses certain skills andknowledge or is competent to complete a task. Competence andskill level are determined by or based on an external review,assessment,examination,oreducation. ○ Consultant ■ A person hired to provide expert advice, opinions, andrecommendationsbasedon his or herareaofexpertise. ○ Data ■ Rawfactsthatlackmeaning. ○ Decisionsupport/outcomesmanager ■ Personchargedwithreviewingtheeffectsofinterventionssug gestedby the computerizeddecisionsupport system. ○ Educator ■ Sage,leader,and/orguidewhoassistsintheprocessorpracticeoflearnin g. ○ Entrepreneur ■ Person who assumes the risks of beginning an enterprise orbusinessandacceptsresponsibilityfororganizingandmanagingthe organization. ○ Informatics ■ A field that integrates a specialty’s science, computer science,cognitive science, and information science to manage andcommunicate data, information, knowledge, and wisdom in aspecialty’spractice. ○ Informaticsinnovator ■ Onewhomakesenhancementsorimprovementsandcreative,nove l,andinventivesolutionsintheinformaticsspecialty. ○ Informaticsnursespecialist ■ A registered nurse with formal, graduate education in the field ofinformaticsorarelatedfield,whoisconsideredaspecialistinthefieldo fnursinginformatics. ○ Knowledgeworker ■ Thosewhoworkwithinformationandgenerateinformationandkno wledgeasaproduct. ○ Medicalinformatics
■ A specialty that integrates medical science, computer science,cognitive science, and information science to manage andcommunicatedata,information,knowledge,andwisdominmedical practice. ○ Productdeveloper ■ One who designs,creates,and builds aproduct ○ Projectmanager ■ Personresponsibleforthesuccessofaproject,whomanagestheplannin gandenactmentoftheproject. ○ Researcher ■ Theonewhoresearches ○ TIGERinitiative ■ TheworkoftheTechnologyInformaticsGuidingEducationReformteam
. This team of nursing leaders developed a vision for utilizinginformationtechnologytotransformnursingpractice. ● Chapter ○ Adverseevents ■ Anyundesirableexperiencesoroutcomesinapatientrelatedtotheuseofa medicaltreatmentorproduct. ○ AgencyforHealthcareResearchandQuality(AHRQ) ■ AnagencywithintheU.S.DepartmentofHealthandHumanServic es thatsupportshealth servicesresearchinitiatives. ○ Bar-codemedicationadministration(BCMA) ■ Asystemusingbar-codetechnologyaffixedtothemedication ○ Clinicaldecisionsupport(CDS) ■ Acomputer- basedprogramdesignedtoassistcliniciansinmakingclinical decisions by filtering or integrating vast amounts ofinformationandprovidingsuggestionsforclinicalintervention. ○ Computerizedphysicianorderentry(CPOE) ■ Cliniciansplaceorderswithinthesesystemsinsteadofusingtraditi onalhandwrittentranscriptionontopaper. ○ Electronicmedicationadministrationsystem(eMAR) ■ Asystemthatusesbar- codingtechnologyinordertosubmitandfillprescriptions. ○ Failuremodesandeffectsanalysis(FMEA) ■ Asystematicevaluationofaprocesstodeterminehowandwhyitfailedt oproducethedesiredresults. ○ GovernmentAccountabilityOffice(GAO) ■ Thehighestauditinstitutionofthefederalgovernmentthatprovidesaudit ing, evaluation, and investigative services for the U.S.Congress.
■ Collaboratingandinteractingwithotherhealthcareprofessionalstoens urepositivepatientoutcomes. ● Chapter ○ Competencies ■ Rely primarily on methods that self-report through surveyinstrumentationmethods.Validandreliablemethodstoevalu ateinformatics competencies measurably and objectively withinsimulationcentersarenotcurrentlyavailable. ○ electronichealthrecord ■ Creatingasignificantchangeinthewaycliniciansaccess,read,digest, andusetheinformationwithinthehealthrecordtotreatpatients. ○ Simulation ■ Simulation-based learning requires learners to actively participatein dynamic experiences as opposed to static, traditional modes oflearning.
WEEKTHREEREADING/KEYPOINTS
McGonigle,D.&Mastrian,K.
● Chapter
○ Cognitivetaskanalysis ■ Examination of the nature of a task by breaking it down into itscomponentpartsandidentifyingtheperformers’thoughtprocesses. ○ Cognitivewalkthrough ■ Within cognitive walkthrough when evaluators assess a papermockup,workingprototype,orcompletedinterfacebyobservi ngthestepsusersarelikelytotaketousetheinterface ■ .Thisanalysishelpsdesignersdeterminehowunderstandableandeasy to learn the interface is likely to be for these users and thetypicaltasks ○ Cognitiveworkanalysis ■ Cognitiveworkanalysiswasdevelopedfortheanalysisofcomplex,high- technologyworkdomains ■ AcompleteCWAincludesfivetypes ofanalysis:(1)workdomain, (2)controltasks,(3)strategies,(4)social– organizational,and(5)workercompetencies ■ Work domain analysis describes the functions of the system andidentifiestheinformationthatusersneedtoaccomplishtheirtaskg oals
○ Earcons ■ Auditorytonesthatarecombinedtorepresentrelationshipsamongdata elements, such as the relationship of systolic blood pressuretodiastolicbloodpressure. ○ Ergonomics ■ describethephysicalcharacteristicsofequipment— forexample,theoptimalfitofascissorstoahumanhand. ○ Fieldstudy ■ Study in which end users evaluate a prototype in the actual worksettingpriortoitsgeneralrelease.Alsocalledfieldtest,alphatest,or betatest. ○ Gulfofevaluation ■ Thegapbetweenknowingone’sintention(goal)andknowingtheeffect sofone’sactions. ○ Gulfexecution ■ Thegapbetweenknowingwhatonewantstohavehappen(thegoal) and knowing what to do to bring it about (the means toachievethegoal). ○ Heuristicevaluation ■ Anevaluationinwhichasmallnumberofevaluators(oftenexpertsin relevant fields such as human factors or cognitive engineering)evaluate the degree to which an interface design complies withrecognizedusabilityprinciples(the“heuristics”). ○ human-computerinteraction ■ How people use and interact with computers; the study of howpeopleusecomputersandsoftwareapplicationsandthewaysthatc omputersinfluencepeople. ○ Humanfactors ■ Recognizing the limitations of human performance and developingproductstoovercometheselimitations. ○ Humantechinteraction ■ Howusersinteractwithtechnology.Thestudyofthatinteraction. ○ Mapping ■ Howenvironmentalfacts(e.g.,theorderoflightswitchesorvaria bles in a physiologic monitoring display) are accuratelydepictedbytheinformationpresentation. ○ Situationalawareness ■ Theabilitytodetect,integrate,andunderstandcriticalinformationthatl eadstoanoverallunderstandingofaproblemorsituation. ○ Taskanalysis
● (3)theuseofcertifiedEHRtechnologytosubmitclinicalqualit yandothermeasures. ○ Thecriteriaformeaningfulusewillbestagedinthreesteps . ■ Stage1(2011– 2012)setthebaselineforelectronic data capture and informationsharing. ■ Stage2(2013) ■ Stage3(expectedtobeimplementedin2015)will continue to expand on this baseline and bedevelopedthroughfuturerulemaking.
McBride,S.,&Tietze,M.(2018).
● Chapter ○ Healthinformationexchange(HIE) ■ Datatranslatedintoactionableinformationwithextensivedataman agement and reporting capability on which providers canmanageandimprovecare ○ MedicareAccessandCHIPReauthorizationAct(MACRA) ■ there is significant emphasis on expanding the requirement tocapture more structured data, better quality reporting, and bettercapacitytoexchangedatausingHIEswithinandacrossstatesandr egions ○ Merit-BasedIncentivePaymentSystem(MIPS) ■ withafocusoninteroperability ○ NationalStrategyforQuality ■ ImprovementinHealthCare,severallegislativecomponentshavebeen implemented. ○ PatientProtectionandAffordableCareAct(ACA) ■ focused on providing all Americans with access to quality andaffordablehealthcare ○ ThethirdcontentdomainoftheNEHIframework:goaltoimprovepatientoutco mes ■ Patientsafety ■ Populationhealth ■ Quality ● Chapter ○ Agile ■ Agile development is a technique that is a programmer- driventechniquethatcreatesafeedbackloopwiththeendusers.This
techniqueisbasedprimarilyonverbalcommunicationwiththeendusera nddoesnotrelyondocumentationstrategies ○ Alphatesting ■ testingisdoneusingtestdataor“made-up”data. ○ betatesting ■ getsastepclosertoproductionwithasampleof“real”datatotesthowthes ystemfunctionsandlooksforanyerrorsthatmightarise. ○ big-bangimplementation ■ allunitsorhospitalsinasystemgoliveatonce ○ commandcenter ■ A24-hourresourcecenteronsiteforthefirst3daysofeachrollout. ○ commercialoff-the-shelfproducts ■ require customization. Customization must be done in-house by adesignteam,orthedesignteamiscontractedthroughthevendoror a service provider company. This design work requires closealignmentwithend-userrequirements. ○ coreimplementationteam ■ Theteamisonsitethefirst24hoursandavailablebycellorpagerfor2week sthereafter. ○ cost–benefitanalysis ■ Isthecostworththebenefit ○ Evaluation ■ Evaluatinghowwelltheproductisworking ○ Implementation ■ Puttingtheproductintoeffect ○ integrationtesting ■ oneormoremodulesorcomponentsworktogether(integrate)andfunct ionasdesigned. ○ projectmanagement ■ is anessentialtoolofthedesignphaseoftheSDLCbecauseitisrequiredtoke epimplementationanddevelopmentprojectsontime,inscope,andwithi nbudget. ○ rapidapplicationdevelopment ■ RADdeployssoftwaretoolsandanalysisanddesignstrategiestospeed up development. The goal is to get systems rapidly into thehands of the end user to test and refine the product to meet theend- userrequirements ○ requestforinformation ■ isashorter,lessdetailedrequestthatsurveyswhattypeofprodu ctsmightfittheenduser’sneeds, ○ requestforproposal(RFP)
initiativestoimprovequality,patientsafety,populationhealth,andcare coordination ○ CommunityHealthInformationNetworks(CHINs) ■ Commercially driven endeavors with intents that were similar tothose of our current HIEs. They focused on exchanging data acrossa community; however, these initiatives lacked payer andcommunity stakeholders. CHINs were primarily transaction- basedand provider-based data exchanges that did not store data within acentralizedrepository. ○ DataUseandReciprocalAgreement(DURSA) ■ Serves as the main legal framework for eHEX participantscontinuestoensurethatprivacyprotectionsareimporta ntattheeHEXandwithitsparticipants ○ DecentralizedmodelorFederatedmodel ■ An approach maintains the control of the source data at theoriginatingorganization,anddataarecachedandtransmittedtothepr oviderasneededatthepointofcare ○ Healthinformationexchange(HIE) ■ health information follows the patient wherever and whenever theyseekcare,inaprivateandsecuremannersothatteamsofdoctors,nur ses and care managers can provide coordinated, effective, andefficientcare ○ Interoperability ■ theabilityofcomputersystemsorsoftwaretoexchangeandmakeuseofinforma tion ○ Masterpatientindex ■ Identify unique patients within a delivery system maintainingdisparate information systems or across institutions within regions.AnMPIisanimportantelementforeffectivemanagementofpatie ntcareacrossinstitutions ○ RegionalHealthInformation Organizations (RHIOs) ■ Werethenextconcepttoariseandwererelatedtotheexchangeofregiona l data. RHIOs were defined as “neutral, third-partyorganizations that facilitate information exchange betweenproviders within a geographical area to achieve a more effectiveandefficienthealthcare
WEEKFOURREADING/KEYPOINTS
McGonigle,D.&Mastrian,K.
● Chapter ○ Blogs ■ Interactive,onlineweblogs.Typicallyacombinationofwhatishap pening on the Web as well as what is happening in theblogger’sorcreator’slife. ○ Digitaldivide ■ Thegapbetweenthosewhohaveandthosewhodonothaveaccesst oonlineinformation. ○ Domainname ■ AseriesofalphanumericcharactersthatformspartoftheInternetaddre ssorURL ○ E-brochure ■ Electronicbrochure.Patienteducationmaterialthatistypicallytiedto an agency website and may include such information asdescriptions of diseases and their management, medicationinformation,orwheretogetassistancewithahealthcareissu e. ○ E-health ■ Healthcareinitiativesandpracticesupportedbyelectronicordigitalmedi a. The most typical use is for patient and family educationwhereinformationiscommunicatedelectronically. ○ eHealthInitiative ■ Initiativedevelopedtoaddressthegrowingneedformanaginghealt hinformationandtopromotetechnology ○ Empowerment ■ Promotionofself- actualization;achievementofpowerorcontroloverone’sownlife. ○ Graygap ■ Atermusedtoreflecttheagedisparitiesincomputerconnectivity;there are fewer persons older than age 65 who use computertechnologythanmembersofyoungeragegroups. ○ HONcode ■ Oneofthetwomostcommonsymbolsthatpoweruserslookfortoidentify trustedhealthsites. ○ Interactivetechnologies ■ Technologiesthatpromoteorsupportusercommunicationwithoth erpersons ○ Know–dogap ■ Situation that exists because solutions to global health problemsareavailablebutarenotimplementedinatimelyfashionbeca useofthelackofaccesstoimportanthealthinformation. ○ Staticmedium
