Mutlidisciplinary Team Terminology Ans- (SNOMED-CT) Systematized Nomenclature of Human and
Veterinary Medicine Clinical Terms- clinical terms covering nurisng, medicine, & allied health
Standardized Terminology Supports Ans- Data Mining
PHR - Private Health Record Ans- Lifetime health record, supplied by ind., healthcare providers,
pharmacies, therapist, lab test, - Controlled by the consumer,
E-Sign Ans- Same legal status as a hand written signature
MIPPA - Medicare Improvement for Patients & Providers Act provides Ans- financial incentive for e-
prescribing to providers
HIPPA provides Ans- legal protection for personal health info, set standards for elect. data interchange
of claims data, named specific code sets for use in Medicare related transactions, & Privacy
ARRA provides Ans- provide funds for adoption of technology & provides the right for every individual to
receive and electronic copy of EHR
HITECH provides Ans- strengthened HIPPA security & privacy protection, & provides financial incentive
for the user of EHR
EMR -electronic medical record provides Ans- Legal record often restricted to a Single episode of care ,
building block of EHR,
EHR- Electronic Health Record is Ans- Longitudinal record that includes client data, demographics,
clinician notes, medications, diagnostics.
- Major driver for US Adoption are "Meaningful Use" financial incentives from HITECH part of ARRA
Affordable Care Act provides Ans- guarantee access to healthcare, encourage PCP,
, Data is Ans- collection of #, characters, or facts (body weight- 128lb), little meaning alone
Information is Ans- Collection of data examined for patterns or structure that can be interpreted. ex
notes prior BP and informs doc
Knowledge is Ans- Synthesis of info from several sources to produce a single concept or idea, ex read a
journal about BP
Computer Technology is Ans- collection of data for analysis, which can be used to justify the efficacy of
particular interventions & improve quality of care
HIS HEalthcare Information System is Ans- Administrative System + Clinical Information System,
Clinical Systems include: order entry, radiology, pharmacy, physician management system
Adm system : non clinical, demographics, scheduling, risk mgmt, decision support,
Administrative System includes these functions Ans- Managing nonclinical, client-related information
(demographics, codes for procedures, & Insurance
Hippa - Compliant Codes inlcude Ans- (ICD) International Classification of Disease, Common Procedural
Terms, (ABC) Alternative Billing Codes,
ANA recognizes these terminologies Ans- (CCC) Clinical Care Classification, (ICNP) International
Classification of Nursing Practice, NANDA, NIC, NOC, the Omaha System, (PNDS) Perioperative Nursing
Data Set
Teleconferencing is Ans- use of computers, audio, & video equip. and high-grade dedicated telephone
line, cable/sat connections to provide interactive communication between 2+ ppl at 2+ sites