Nursing Informatics Test 1|106 Questions with Verified Answers,100% CORRECT

Nursing Informatics Test 1|106 Questions with Verified Answers What is informatics - CORRECT ANSWER •Informatics - computer information systems science •Nursing Informatics - A subspecialty of nursing that focuses on managing information pertaining to nursing •Healthcare Information Technology (HIT) - Focuses on information management, not computers •Information management is an integral part of nursing We are not taking this class to learn about computers and to be IT techs. While we have to have some abilities with computers and programs, Information is the key! We are going to focus on information management. How are we going to collect the information? Process the information? Use the information? Improve patient care and safety. Informatics in healthcare - CORRECT ANSWER •Have you seen technology being used in healthcare? •Can you give examples? •How do you think you will use technology in healthcare? ---Electronic Charting Systems ---Mobile Devices and Apps ---Smart Pumps ---Telecommunication ---Wearable Devices ---Robotics ---Artificial Intelligence With all of this technology, think about the information that is gathered....Big Data How can we use this to improve patient care? The potential of Big Data in healthcare relies on the ability to detect patterns and to turn high volumes of data into actionable knowledge for precision medicine and decision makers. Informatics and healthcare technologies - CORRECT ANSWER •Information, communication technologies and informatics processes are used to provide care, gather data, form information to drive decision making, and support professionals as they expand knowledge and wisdom for practice. •Informatics processes and technologies are used to manage and improve the delivery of safe, high-quality, and efficient healthcare services in accordance with best practice and professional and regulatory standards. •Healthcare professionals interact with patients, families, communities, and populations in technology-rich environments. •Nurses, as essential members of the healthcare team, use information and communication technologies and informatics tools in their direct and indirect care roles. Why am I taking this course? - CORRECT ANSWER Informatics is a core competency of •Nursing education •Patient safety organizations Informatics impacts: •The nurse •The patient •Healthcare in general Stimulate real world experiences The Essentials. The AACN (American Association of Colleges of Nursing. •Core competencies for professional nursing education •Competencies divided into 10 Domains •Domain 8 is Informatics and Healthcare Technology QSEN Competency •Quality and Safety Education for Nurses •quality and safety competencies for nursing •knowledge, skills, and attitudes to be developed in nursing pre-licensure programs for each competency •Patient-Centered Care •Teamwork & Collaboration •Evidence-Based Practice •Quality Improvement •Safety •Informatics Activity focused Also in the Essentials: Concepts of Nursing Practice •Clinical Judgment •Communication •Compassionate Care •Diversity, Equity, and Inclusion •Ethics •Evidence-Based Practice •Health Policy •Social Determinant of Health •Personal, social, economic, and environmental factor impact health •How will these social determinants impact our teaching? •The Health People initiative is a national effort to improve the health and wellness of the American population •mHealth project will focus on this initiative Quality and Safety Education for Nurses(QSEN) - CORRECT ANSWER •QSEN Competencies •quality and safety competencies for nursing •knowledge, skills, and attitudes to be developed in nursing pre-licensure programs for each competency •Patient-Centered Care •Teamwork & Collaboration •Evidence-Based Practice •Quality Improvement •Safety •Informatics The Quality and Safety Education for Nurses (QSEN) project addresses the challenge of preparing future nurses with the knowledge, skills, and attitudes (KSAs) necessary to continuously improve the quality and safety of the healthcare systems within which they work. The Essentials. The AACN (American Association of Colleges of Nursing) - CORRECT ANSWER •Core competencies for professional nursing education •Competencies divided into 10 Domains Domain 1: Knowledge for Nursing Practice provides the context for understanding nursing as a scientific discipline. The lens of nursing, informed by nursing history, knowledge, and science, reflects nursing's desire to incorporate multiple perspectives into nursing practice, leading to nursing's unique way of knowing and caring. Domain 2: Person-centered care is the core purpose of nursing as a discipline. Domain 3: Population health spans the healthcare delivery continuum from public health prevention to disease management of populations and describes collaborative activities with both traditional and non-traditional partnerships from affected communities, public health, industry, academia, health care, local government entities, and others for the improvement of equitable population health outcomes. Domain 4: The generation, synthesis, translation, application, and dissemination of nursing knowledge to improve health and transform health care (AACN, 2018). Domain 5: Provision of safe, quality care necessitates knowing and using established and emerging principles of safety science in care delivery. Domain 6: Intentional collaboration across professions and with care team members, patients, families, communities, and other stakeholders to optimize care, enhance the healthcare experience, and strengthen outcomes. Domains cont. - CORRECT ANSWER Domain 7: Responding to and leading within complex systems of health care. Nurses effectively and proactively coordinate resources to provide safe, quality, and equitable care to diverse populations. •Using evidence-based methodologies, nurses lead innovative solutions to address complex health problems and ensure optimal care. •Understanding of systems-based practice is foundational to the delivery of quality care and incorporates key concepts of organizational structure, including relationships among macro-, meso-, and microsystems across healthcare settings. •Knowledge of financial and payment models relative to reimbursement and healthcare costs is essential. •In addition, the impact of local, regional, national, and global structures, systems, and regulations on individuals and diverse populations must be considered when evaluating patient outcomes. •As change agents and leaders, nurses possess the intellectual capacity to be agile in response to continually evolving healthcare systems, to address structural racism and other forms of discrimination, and to advocate for the needs of diverse populations. •Systems-based practice is predicated on an ethical practice environment where professional and organizational values are aligned, and structures and processes enable ethical practice by all members of the institution. Domains cont. - CORRECT ANSWER Domain 8: Information and communication technologies and informatics processes are used to provide care, gather data, form information to drive decision making, and support professionals as they expand knowledge and wisdom for practice. Informatics processes and technologies are used to manage and improve the delivery of safe, high-quality, and efficient healthcare services in accordance with best practice and professional and regulatory standards. Domain 9: Formation and cultivation of a sustainable professional identity, including accountability, perspective, collaborative disposition, and comportment, that reflects nursing's characteristics and values. Domain 10: Participation in activities and self-reflection that foster personal health, resilience, and well-being; contribute to lifelong learning; and support the acquisition of nursing expertise and the assertion of leadership. Concepts of nursing practice, AACN - CORRECT ANSWER •Clinical Judgment •Communication •Compassionate Care •Diversity, Equity, and Inclusion •Ethics •Evidence-Based Practice •Health Policy We will lay the foundation for many of these concepts and future classes will build on each concept. •Social Determinant of Health •Personal, social, economic, and environmental factor impact health •How will these social determinants impact our teaching? •The Health People initiative is a national effort to improve the health and wellness of the American population •mHealth project will focus on this initiative Meaning of informatics - CORRECT ANSWER Informatics integrates computer, cognitive and information science to manage and communicate data, information, and knowledge. Nursing informatics - CORRECT ANSWER Combines and manages nursing and computer science science to effectively community data and knowledge to improve healthcare delivery and efficiently. Use of informatics - CORRECT ANSWER Goals: 1. Combines and manages nursing and computer science to effectively communicate data and knowledge. 2. Improves health care delivery and efficiency. 3. Facilitates integration of data, information, and knowledge to aid in decision making. Data regulation - CORRECT ANSWER Health Insurance Portability and Accountability Act (HIPAA) 1996 1. HIPAA-National standards for the protection of client health information 2. Effective exchange of data American Recovery and Reinvestment Act (ARRA) 2009 1. To stimulate the struggling economy 2. Part A: includes (Health Information Technology for Economic and Clinical Health act) HITECH 3. Part B: provides financial incentives for health professionals and facilities to adopt and engage in the use of electronic health record technology. Role of informatics in improving client care - CORRECT ANSWER • Advantages of integrating nursing informatics- locate, compare, and analyze local, national, and global data. • Client safety o Quality and Safety Education for Nurses (QSEN) competencies. TIGER - CORRECT ANSWER = (Technology Informatics Guiding Education Reform Initiative) nursing community initiative (2007). o 8 pillars to bridge the quality chasm with IT (common global vision) 1. Embrace change 2. Drive technology 3. Consistent advocacy 4. Consistent policy building 5. Share best practice 6. Evidence Based Practice 7. Intelligent solution 8. Affordable and universal Integrating nursing informatics with education - CORRECT ANSWER o Improves quality of interprofessional care o Improves professional nursing practice Nurse client relationship - CORRECT ANSWER o Exists away from the computer screen. No change in nursing goals. o Still establish trust and be an advocate for the client. Nomenclature - CORRECT ANSWER = (established standard nursing terms) o Nursing Diagnosis, Definition, and Classification (NANDA) 1950 1. Emphasized the independent practice of nurses 2. Individualized client care plans Omaha system - CORRECT ANSWER 1. Research-based, comprehensive, and standardized taxonomy a. Assessment b. Intervention c. Evaluation Other systems and sets (nomenclature) - CORRECT ANSWER o Nursing Interventions Classification System (NIC) 1. Standardized nursing terminologies o Nursing Outcomes Classification System (NOC) 1. Evaluates the effect of nursing interventions 2. Linked to NANDA, NIC and Omaha o Nursing Management Minimum Data Sets (NMDS) 1999 by ANA 1. Quantifies and qualifies nursing care based on cost centers and data collection a. Nursing care elements (nursing diagnosis and intervention) b. Demographic elements (allowing for individualization) c. Service elements (identifiers for numerical identification). o Systemized Nomenclature of Medicine (SNOMED) 1. International data system Impact of computer technology on nursing practice - CORRECT ANSWER • Electronic Health Care Records • Assistive Technology • Health Information Literacy • Health Information Access o Crucial for evidenced-based nursing practice o Online databases 1. Cocrin 2. Medline 3. Cenline 4. Obid o Administrative support is needed to pay for database subscription! • Coordinating Electronic Health Records- Accurate and up to date information about the client. Allows team to see trends in client's health. • Monitoring Client Care outcomes requires accurate and timely documentation. • Making better use of technology includes better flow of data, data mining, integrated computer programs • Reporting data includes core measures that relate client outcomes, safety, and cost. • Using technology to reduce care-related errors Nurses role in culture of safety - CORRECT ANSWER o Make a difference in client outcomes 1. Outcomes and satisfaction tie to reimbursement from facility agencies. Tracking nosocomial infections - CORRECT ANSWER o EHR technology can track wound, UTI, and ventilator infections o Agency Healthcare Research and Quality (AHRQ) 1. Provided evidence-based guidelines 2. Facilities are required to adopt evidence-based interventions o Documentation of interventions ensures compliance Nursing contribution - CORRECT ANSWER Decision-support systems help verify presence of risk factors and support diagnosis formulation. Measuring nursing care - CORRECT ANSWER o National Database of Nursing Quality Indicators (NDNQI) system 1. Aggregates data and develops comparison reports 2. Allows identification of units with more incidents 3. Comparison to similar facilities Adequate staffing - CORRECT ANSWER o Automated staffing, scheduling based on clients' acuity levels o Staff mix can include RNs, LPN, and Aps o Higher ratio of RNs to clients produces better outcomes Informatics - CORRECT ANSWER Computer information systems science The use of information technology in healthcare Focus is on information, not computers Healthcare informatics - CORRECT ANSWER -The capture; retrieval; storage; presenting; sharing; use of biomedical information, data, and knowledge of providing care; problem solving; and decision-making. -The purpose of healthcare informatics is to improve the use of healthcare data, information, and knowledge in supporting patient care, research, and education. -The focus is on the information (subject), not the computer (tool) Sewell: Like the stethoscope (tool) is to gathering information about heart and lung sounds. Nursing informatics - CORRECT ANSWER -A subspecialty of nursing that focuses on managing information pertaining to nursing -In 1992, the American Nurses Association (ANA) recognized nursing informatics as a specialty -Nursing informatics degree-MSN -Certification-Registered Nurse-Board Certified (RN-BC) AACN Certification (meets at least one) •2000 practice hours in the last 3 years •1000 practice hours in informatics in in last 3 years plus 12 hours grad level informatics nursing program •Completion of graduate program in informatics with a minimum of 200 hours of faculty supervised practicum in informatics Nursing informatics - CORRECT ANSWER -First informatics nurse specialist -Florence Nightingale envisioned the importance of making decisions using comparable information long before computers were invented. -Recognizing the value of data in affecting healthcare, she collected data and systematized recordkeeping practices helping to improve patient outcomes. Florence was a pioneer in nursing science, theory, and quality - the first informatics nurse specialist The ultimate goal is to provide better care. Informatics nurse - CORRECT ANSWER uSystems educator-plans, coordinates, and facilitates education uInformation technology nursing advocate-assesses the needs and opportunities for nurses with the technology uSuperuser-supports the system for a specific unit uSystem specialist-acts a link between nursing and information services uClinical systems coordinator/analyst-coordinating of clinical information systems, troubleshooting and support Informatics nurse specialist - CORRECT ANSWER uProject manager-plans and implements informatics projects uConsultant-provides expert advise uDirector of clinical informatics-facilitates the development, implementation, and integration for the information system uResearcher-uses informatics to create new knowledge uProduct developer-participates in the development of new information systems uPolicy developer-contributes to health policy development uEntrepreneur-analyzes nursing information needs in clinical areas, education, administration, and research; develops and markets solutions Goal of nursing informatics - CORRECT ANSWER uCombine nursing and computer science to effectively: uCommunicate data uImprove health care delivery uFacilitate integration of data, information, and knowledge to aid in decision making Data regulation - CORRECT ANSWER uEthical and legal responsibility of all healthcare workers to protect personal health information uFacilities have confidentiality guidelines for employees uFederal initiatives created rules for proper use and protection of patient information Hippa act - CORRECT ANSWER uHealth Insurance Portability and Accountability Act (HIPAA), 1996 ---A law that protects the privacy and security of health information and provides patients the right to see their own health records. u2003 privacy requirements for compliance, punitive actions for non-compliance uNursing Responsibilities: Automatic sign-off, unique passwords, shredding of documents, not sending unsecured electronic information American recovery and reinvestement act (ARRA) - CORRECT ANSWER u2009 uEconomic Stimulus Act that included initiatives to standardize and protect healthcare information utilizing technology. uPart A included HITECH uPart B provided financial incentives for health professionals & facilities to adopt the use of EHR technology Following the recession of 2007, federal government wanted to help stimulate the struggling economy Example: Changing over from paper to computer. HITECH act - CORRECT ANSWER uHealth Information Technology for Economic and Clinical Health Act. uPart of the ARRA which outlined four purposes: 1.To define meaningful use uUse of collected aggregated data from EHRs for decision making to improve healthcare delivery 2.To use incentives and grant programs to foster the adoption of EHRs 3.To gain the trust of the public regarding the privacy and security of electronic healthcare data 4.To promote IT innovation Why the need for change? - CORRECT ANSWER •Black hole-information disappears after discharge •Inefficient •Safety concerns •EKG example Federal Health IT goals - CORRECT ANSWER 1.Advance person-centered and self-managed health 2.Transform healthcare delivery and community health 3.Foster research, scientific knowledge, and innovation 1.Advance the nation's health IT infrastructure Evidenced based care - CORRECT ANSWER uTo fulfill the goals of the Federal Health IT goals, paper needs to be eliminated as the major source of data collection. uFive components to provide evidence-base care 1.Standardization of terminologies and structured documentation 2.The use of digital information 3.Standards to permit healthcare data exchange between entities 4.The ability to capture data relevant to the actual care provided 5.Competency among practitioners to use the data Meaningful Use" is a term describing documentation of demographic and health data into an electronic health record (EHR) with the purpose of improving safety and quality of care and reducing health disparities with "meaningful" information. Evidence-based strategies can assist providers with meeting these objectives and integrating the electronic health record into daily work-flow. Client safety - CORRECT ANSWER Quality and Safety Education for Nurses (QSEN) uUse information and technology to communicate, manage knowledge, mitigate error, and support decision making uKnowledge, skills and attitudes necessary for nurses when integrating technology: 1.Identify essential information and technology skills necessary 2.Apply principles of lifelong learning 3.Analyze, interpret and participate in the decision-making process 4.Recognize and embrace technology as the data storage and collection, outcome monitor, line of defense which is essential for client safety TIGER - CORRECT ANSWER Technology Informatics Guiding Education Reform uAn invitational TIGER Summit was held in 2006, during which a 10-year vision and 3-year action plan were developed to engage nurses in the revolution of evidence and informatics in healthcare. uToday, the TIGER initiative provides the global health workforce with innovative informatics/eHealth tools and resources to transform health uIdentifies interprofessional healthcare informatics core competencies Who needs informatics skills? - CORRECT ANSWER uAll nurses should use evidence-based practice when caring for clients uThis requires that all nurses should have basic computer skills and information literacy uInformation literacy: the ability to know when one needs information and how to locate, evaluate, and effectively use it. Information literacy - CORRECT ANSWER uLearned competency requiring repeated practice to develop expertise uKnowing when and why you need the information, where to find it, and how to evaluate, use and communicate it in an ethical manner uInformation Literacy Competency Standards for Nursing (2013)-Association of Colleges and Research Libraries (ACRL) Information literacy competencies of nursing - CORRECT ANSWER uStandard 1: Define and articulate the need for information (PICO process: P-patient, problem, or population, I-intervention, C-comparison, O-outcome). uStandard 2: Identifying a variety of types and formats of potential sources of information (Retrieving information using PICO search strategies). uStandard 3: Have a working knowledge of literature in related fields and how it is produced (How good is the information?). uStandard 4: Consideration for the costs and benefits of acquiring the necessary information (Using the information to address the clinical practice problem and sharing the findings with others). uStandard 5: Reassess the kind and amount of information needed. Why are nurses important to informatics - CORRECT ANSWER uNurses are the end user uInformatics nurses bring a viewpoint to support the needs of the end user to inform system development and information uIT personnel have a limited perspective when designing or implementing workflow uNursing input guides product development uNursing documentation-aggregated data used in the EBP process uNeed for uniformity, common language Nomenclature - CORRECT ANSWER - universal standarized language Nursing Diagnosis, Definition, and Classification (NANDA) ►1950 ►Communication method to emphasize independent practices for nurses ►Made up of diagnostic labels ►A Nursing Diagnosis is a clinical judgment concerning a human response to health conditions/life processes, or a vulnerability for that response, by an individual, family, group or community. Most common Using standard language allows for consistent data collection from hospital to hospital, state to state, country to country Nursing Diagnosis A nursing diagnosis is a clinical judgment concerning a human response to health conditions/life processes, or a vulnerability for that response, by an individual, family, group or community. A nursing diagnosis provides the basis for selection of nursing interventions to achieve outcomes for which the nurse has accountability. (Approved at the ninth NANDA Conference; amended in 2009 and 2013.) Nursing care plan - CORRECT ANSWER UCA is using the NCSBN clinical judgment measurement model Many hospitals still base charting of NANDA nursing diagnoses Nomenclature - CORRECT ANSWER ►Nursing Interventions Classification System (NIC) - comprehensive, research-based, standardized classification of interventions that nurses perform. There are 565 nursing interventions grouped into 30 classes and 7 domains. ►Nursing Outcomes Classification System (NOC) - Comprehensive, standardized classification of patient, family and community outcomes. There are 540 nursing outcomes with 34 classes and 7 domains. Standardized outcomes are essential for documentation in electronic records, for use in clinical information systems, for the development of nursing knowledge and the education of professional nurses and students. An outcome is defined as a measurable individual, family, or community state, behavior or perception that is measured along a continuum in response to nursing interventions. ►Omaha System - Research-based taxonomy developed by Karen Martin; Comprehensive nursing terminology system that allows aggregation and analysis of clinical data. ►Nursing Management Minimum Data Sets (NMDS) 1999 by ANA, quantifies, qualifies nursing care based on cost centers and data collection ►Systematized Nomenclature of Medicine (SNOMED)-international data system that facilitates consistent, uniform storage of data and enhances research capabilities worldwide These are not all the standardized language systems recognized to ANA SLSs are a prerequisite for the construction of Electronic Health Records (EHRs), aiming to retrieve information for research studies statistical analysis Benchmarking big data data interoperability between the different health systems ensure continuity and quality of care Workflow analysis - CORRECT ANSWER Workflow analysis, root cause analysis, and cause-and-effect charts can be used to investigate the circumstances around a near miss or error (AHRQ, n.d.). A workflow analysis depicts how work is currently accomplished and then describes how the same might best be accomplished using the new electronic system. (Sewell, 2019). Interoperability - CORRECT ANSWER LEVELS OF INTEROPERABILITY (Sewell, 2019, p. 248) The three levels of interoperability are foundational, structural, and semantic (HIMSS, 2018). Foundational interoperability is the lowest and most basic level of interoperability and refers to the ability of one system to transmit data and another to receive the data without the ability of the receiving system to interpret the data. Foundational interoperable systems are able to send and receive usable data from different systems. Structural interoperability is the intermediate level in which the structure or format of the exchanged data is defined by message formats. The purpose of structural interoperability is to coordinate work processes. It refers to the uniform format or structure of the exchanged messages. It is necessary to preserve the meaning and purpose of the information. With structural interoperability, data exchanged between information systems allow for interpretation at the data field level. Interoperability continued - CORRECT ANSWER Semantic interoperability is the highest level of interoperability and takes this one step further. In semantic interoperability, not only is the information transmitted so that it is understandable, but at this level, the interpretation and action on messages exchanged by two computers occur without human intervention. The effectiveness of semantic interoperability depends on the interaction between algorithms (rules), the data used in the message, and the terminology used to designate those data. Semantic operability allows authorized users to receive information from different EHRs to plan and provide safe and effective care. The functionality enables exchange of data from a laboratory system with the pharmacy system. It also enables exchange of data from one healthcare provider with another. Not only is interoperability a goal of the HITECH Act, seamless exchange of information should improve the quality and reliability of information clinicians and increase efficiency of healthcare operations (Apfield et al., 2014, March). However, interoperability continues to be a challenge as hospitals and ambulatory care providers merge to become health systems. Many times each entity in the merger possesses different EHR systems that share information (Sherer et al., 2015). If interoperability between systems is an essential requirement of the project, this need must be captured during the needs assessment period. Boxes 19-2 and 19-3 have examples of interoperability issues. (Sewell, 2019, p. 321 Information management systems - CORRECT ANSWER ´Software ´Hardware ´Telecommunication networks ´Electronic Health Record (EHR) ---supports client care ---improves outcomes ´Combination of all parts helps streamline data flow ´Systems differ by location size and type Electronic health record - CORRECT ANSWER Longitudinal record from birth to death ´Demographics ´Allergies ´Lifestyle ´Immunizations ´Medications ´Lab reports ´There are various types of companies In a perfect world, according to the Federal IT goals, a person's EHR would be accessible anywhere for any provider. Federal IT goals (p. 4, Sewell): 1.Advance person centered and self-managed care 2.Transform health care delivery and community health 3.Foster research, scientific know, and innovation. (increase access to, accelerate development of technology and development, how IT can improve health and care delivery 4.Advance the nation's health IT infatuation Are we there yet? •It's fascinating and scary all at the same time to think of this capability. •Imagine if everyone' chart were available to HCPs. How would this be beneficial to healthcare providers? •ER? •Primary Care Provider? Hospital information management system - CORRECT ANSWER Moc Doc in one example of company providing a Hospital Management System Hospital Management Systems manage the data related to all departments of healthcare such as: Clinical Pharmaceutical Financial Radiology Laboratory Pathology Inpatient Material management Outpatient Perioperative Nursing **'all of this has to work together (very complex) Advance person centered and self managed care, transform healthcare delivery and improving population health, foster research to increase access to medical records to improve technology and improve how we deliver healthcare, and continue to improve nations infrastructure. Clinic information management system - CORRECT ANSWER ´In a clinic setting, systems are responsible for customizing and streamlining workflows --Each clinic has unique aspects that change workflow -----OB/Gyn clinic vs. Ortho clinic •Enhance the patient experience •Population health •Optimize and improve workflows •Financial management • Identify the IT goals within this video Are we there yet? No We are much closer? Yes Are you starting to see the benefits of a well-designed Information Management System or EMR? What changes will you see in your career in this area? HIPPA - CORRECT ANSWER ´Instantly access medical records ´Allow clients to ---View records ---Establish ownership ---Correct and amend records ´Patient Portals ---Be aware that what you chart is visible to patients ---Should everything be visible? Make good choice of words in your charting, avoid judgment wording, etc. What about pathology reports with cancer dx? - watch what they have access to, could see that they have cancer without the doctor even telling them first. Information security - CORRECT ANSWER Characteristics of health information ´Accurate, timely, consistent, accessible, confidential HIPAA (Health Insurance Portability and Accountability Act)guidelines ´HIPAA privacy rule: Defines the circumstances under which a person may disclose or use PHI. A facility may disclose PHI to facilitate treatment, payment, or health care operations. Otherwise, there must be signed consent to release PHI.*** ´HIPAA security rule: Sets the minimum standards for protecting electronic health information - Administrative, physical, and technical.*** ´HIPAA breach notification rule: The Department of Health and Human Services must be informed as soon as possible if there has been a data breach (as soon as possible, but within 60 days). The person involved must be notified.*** PHI- Protected Health Information Breath Notification Rule •In the event of a large-scale breach that affects more than 500 patients in a specific jurisdiction, the media should be informed as well. If its over 500 people who are breached, need to be shown on media. • HIPAA security rule •Administrative- How is the HCP (or health plan) protecting the security of the PHI regarding transfer of information and employee security? •Physical- Alarm systems, locking areas where PHI stored, shredding documents, etc. •Technical- Firewall, encryption, and data backup. What is PHI - CORRECT ANSWER 1.Name 2.Address 3.Any dates (except years) that are directly related to an individual, including birthday, date of admission or discharge, date of death, or the exact age of individuals older than 89 4.Telephone number 5.Fax number 6.Email address 7.Social Security number 8.Medical record number 9.Health plan beneficiary number 10.Account number 11.Certificate/license number 12.Vehicle identifiers, serial numbers, or license plate numbers 13.Device identifiers or serial numbers 14.Web URLs 15.IP address 16.Biometric identifiers such as fingerprints or voice prints 17.Full-face photos 18.Any other unique identifying numbers, characteristics, or codes PHI- Protected Health Information What people breach, and what needs to be reported if it does. Threats to protected health information (PHI) - CORRECT ANSWER ´External ´Internal ´Medical identify theft ´Organization threat ---Real-time access by multiple users opens doors to breaches in confidentiality ---Sharing information through online, electronic communication Organization responsibility in safeguarding information - CORRECT ANSWER ´Identification of users ---Passwords ---Microchips in photo IDs ----Biometric identifiers ´Acceptable use policy is set by administrators ----Guidelines for how each employee can use the system ´Security agreements with employees ´Reporting systems for breaches ´Penalties for breaches •Acceptable use: these include rules around accessing restricted information; changing access data, such as passwords; opening questionable email attachments; using public Wi-Fi services; and using company approved authentication procedures. • •Limiting access to only employee who need access. Pt care tech will have different access than a nurse. • •You sign an agreement and are trained on how to use the system. Self-accountability. • •Break the glass access-extra layer of protection for certain patients (celebrities, MH pts, employees) • •You leave electronic thumbprints, breadcrumbs in the charts that you access Anne Presely - CORRECT ANSWER •Administrators learned of the breach through an audit •Determined that 2 staff members had valid reason, fired 6 others •One physician accessed the chart out of curiosity •Put on administrative leave and had to undergo additional HIPAA training Personal responsibility in safeguarding PHI - CORRECT ANSWER ´Review policies ´Only access information necessary to do your job ´Share only information necessary to do your job ´Keep conversations containing PHI in a private setting ´Vocera or other communication tools ´Limit use of personal electronic devices ´Only use secured systems to transmit client information (use hospital email, not own). •Personal Computer use is okay to use if you have the required software. Never download patient information to your personal device. •HCPs have special apps for sharing PHI, no texting •Residents Benefits of EHR - CORRECT ANSWER ´Interdisciplinary professionals can access, store, and transmit information related to client care ---Continuity of care ´Facilitates best practice decisions ´Improves outcomes ´Creates database of similar clients to measure and improve quality of care Example: Congestive Heart Failure patients Data organized by diagnosis, able to track treatments and results to determine best practice evidence. Ultimately, improves patient outcomes. Streamlining workflow - CORRECT ANSWER ´Standardized plan of care ´Critical pathways ´Facilitates communication between client, nurse, and interdisciplinary team. ´Documentation guidelines ---Automated reminders for tasks ---Automated alerts for incomplete charting ´Meditech Hospital Training Guide (EHR example) ---Informatics Nurse would develop or teach this type of information! Critical Pathways: also known as clinical pathways, multidisciplinary pathways, collaborative paths, or care maps to name a few—utilize evidence-based practice and apply it to structured, multidisciplinary care tracts to provide guidelines for protocols and best practice. These pathways give caregivers guidance when developing a patient's care plan and assist in determining length of stay and outcomes. Reduction in medication errors - CORRECT ANSWER ´Computerized provider order entry (CPOE) ´Takes the guesswork out of handwriting ´Alerts provider to incomplete orders, allergies, interactions, dose adjustments Streamlining workflow ´Provider orders sent to pharmacist for review ´Nurse acknowledges new orders ´Automated dispensing machines—safety, inventory, regulatory compliance ´Barcode scanning—correct medication, dose, route, time Automated dyspensing systems - CORRECT ANSWER BD Pyxis™ MedStation™ ES, Automated Dispensing System - BD Nursing responsibility - CORRECT ANSWER ´Don't rely solely on technology! ´Visually verify medication, dosage, expiration date ´Use two client identifier Interdisciplinary care coordination - CORRECT ANSWER ´Client centered care ---Safe, timely, efficient ´Data electronically available to any member of the health care team ´Coordination of client data ---Identify needs: services and treatment ---Efficient follow-up, timely manner ´Reports sent to primary care providers, referring providers Improves communication within the hospital and after discharge. E-prescribing - CORRECT ANSWER ´Centers for Medicare & Medicaid Services (CMS) regulation ´E-prescribing enables a prescriber to electronically send an accurate, error-free and understandable prescription directly to a pharmacy from the point-of-care and is an important element in improving the quality of patient care. ´In 2018, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act) was enacted into law to address the opioid crisis. ´Schedule II-V controlled substances must be sent electronically in accordance with an electronic prescription drug program. Stair step implementation of technology, regulations now incentivize providers to e-prescribe and remove paper scripts. Improves safety, similar to CPOE. Prescription drug monitoring program - CORRECT ANSWER ´Arkansas Department of Health ´Provides controlled substance prescription monitoring ´Pharmacies are required to report the dispensation of a controlled prescription next business day ´Access: Prescribers, pharmacists, professional licensing boards, law enforcement drug investigators **improving population health Clinical decision support systems - CORRECT ANSWER Variety of tools and interventions, computerized as well as non- computerized ´Automated alerts in computerized physician order entry (CPOE) ´Clinical guidelines: Up-to-Date or ClinicalKey ---Use of EBP guidelines helps prevent medical errors ---Improved clinical decision making ´Focus attention: Critical lab values, Drug-drug interactions ´Advanced: Complex system of rules helps with decision-making process Sepsis example - CORRECT ANSWER ´Up-to-Date ´ ´Definition ´Prevalence ´Surviving Sepsis Campaign Bundles Information literacy-know when to you need it, where to get it, and how to use it! INTRODUCTION Sepsis is a clinical syndrome characterized by systemic inflammation due to infection. There is a continuum of severity ranging from sepsis to septic shock. Although wide-ranging and dependent upon the population studied, mortality has been estimated to be ≥10 percent and ≥40 percent when shock is present Pediatric sepsis clinical pathway - CORRECT ANSWER ´Johns Hopkins ´Sepsis Screen: EHR based form used to identify patients at risk for sepsis ´Sepsis Score: Score calculated by assessing vital signs and physical exam findings ´Sepsis Trigger: Best practice advisory(BPA) identifies patient of being at risk ´Patient evaluated for sepsis Page 19 VS triggers nurse to complete sepsis score Positive Sepsis triggers-RN calls APP/Resident/Attending for Sepsis Huddle: Providers (APP/Resident/Attending): Assess within 15 minutes of notification and STATE Huddle Outcome APPs or Residents MUST notify attending physician of Sepsis Huddle Follow an established critical pathway- •Consistent •Measurable •Improves patient outcomes Order set for: Sepsis Order Set Consistent Documentation: Sepsis template documentation **there is a sepsis scoring and monitor surviving sepsis guidlines - After HCPs alerted, quick action is essential for improving patient outcomes. SBAR - CORRECT ANSWER Be concise, focus on the problem. Report only what is needed for the situation Situation (objective): Introduce self and identify the patient you are calling about Background (objective): Reason for care/hospitalization, VS, select labs/diagnostics, mental status Assessment (subjective): What is the assessment of the situation. Is the situation life threatening? Recommendation (subjective): What needs does the patient have? Medications, tests, in-person evaluation? What follow-up is necessary? Benefits of Electronic health records - CORRECT ANSWER Use of Information Management Systems o Store__________, process__________, organize__________, and transmit Information_________________ • What is an Electronic Health Record (EHR) o Computerized database o Longitudinal______________ record o Can include demographics, meds, lab reports, immunizations information o Can include decision support, communication, and order entry • Viewing Records in a New Way o HIPAA Allows__________ patients to view own records • Government Mandates o Medical Centers Must____________ have electronic medical records • Benefits of EHRs o Document Data___________ as collected o Enhances continuity of care____________ o Access evidence-based Care___________ information Benefits of systems used to support client care - CORRECT ANSWER • Reduce medication _error_____________ • Provides Alerts_____________ about allergies or medical issues • Other benefits - helps with Research______________ issues and use the information • Help improve _communication______________ between team members Interprofessional care coordination - CORRECT ANSWER • Interdisciplinary Care___________ - facilitated by the EHR • safe, timely, and efficient = goals • Helps identify needs, services, and treatment Clinical decision support systems - CORRECT ANSWER • Automated guidelines and alerts • Helps make decisions • Using a Clinical Decision Support System • Automated guidelines use evidence-based practices • Clinical Decision Support System (CDSS) Works Information security - CORRECT ANSWER • Meaningful health data: Accurate_________, Timely__________, Consistent_________, Accessible__________, and Confidential_______________ • Confidential of patient information = HIPAA • HIMSS provides guidelines for Sharing___________ information • Threats can be external (outside an organization) and internal (within the system) • Medical identity theft - using someone else's record • Unauthorized access by authorized users is most common threat of personalized health organization • Personal laptops, PDSs, cell phones often lack needed safeguards • Safeguards: anti-virus software, firewalls, auto shutoffs of idle computers, screen filters, proxy servers Using technology - CORRECT ANSWER • Often provided: best practice guidelines, specific procedure guidelines, disease and medication information, checklists, prompts for care, • "Automatic Triggers" = send alerts about a lab report or new order • Charting prompts: Help nurse to chart additional information regarding a patient assessment and/or medication administration • Selecting information: always evaluate the validity of the information • Lifelong learning: Many reputable sources available including single learning session, courses, certification, and degrees Telehealth - CORRECT ANSWER • Use for Monitoring_________, Teaching__________, and Communicating_________________. • Includes: Telenursing and Telemedicine • Home medication dispensing systems: Helpful in assisting correct medication and making health care professionals be aware if medication dosages are not taken. • Legal/licensure issues can influence the ability to care for people in other states. • TIGER team: Four stages: Beginning___________ nurse, Experienced____________ nurse, Informatics_________ nurse specialist, and informatics Innovator____________. Telehealth - CORRECT ANSWER Telehealth: broader term; extends beyond delivery of clinical services Telemedicine: electronic exchange of patient information between two sites for the purpose of improving the patient's health status Telenursing: telecommunications technology in nursing to enhance patient care Telehealth - CORRECT ANSWER •Store-and-forward (S&F) technology •Still image captured electronically that generates electronic images sent to a specialist for interpretation at a later time •Asynchronous transmission of clinical data •Example: An x-ray sent from a remote area to a radiologist to read •Synchronous telehealth •Patient and provider interacting at the same time using interactive video •Any two-way communication technology offering both audio and video •Telepresence-the use of remote consultant interacting with patient Oldest of these is the telephone which is still used (especially during COVID). Higher quality service is preferred. •Lack of high-speed internet availability •Synchronous telehealth also makes use of special instruments that can transmit an image to a clinician at a different location. These include an ear-nose-throat scope, a camera that captures skin observations, and a special stethoscope. Telenursing - CORRECT ANSWER •Provides remote home nursing care •Responsibilities include remote patient monitoring, collaborating with healthcare team, and communicating with patients and their families. •Settings: Triage (nurse talks to pt before admitted to ER), pre-operative, home care during illness recovery, mental health, caring for patients with chronic conditions •Reduces the overall cost of healthcare and re-admission rates Example of nurse working from home for MD office: •Post hospital discharge follow up •Medication management •Diabetes management •Education •Case Management (making sure the patient has everything they need at home) --Durable Medical Supplies, home health therapies, etc. --Lowers readmission rate to hospital --Improves communication and keeps patients from falling through the cracks Telemedicine is a broad term that addresses more than just the delivery of clinical services. - CORRECT ANSWER False •Telemedicine is the electronic exchange of patient information between two sites for the purpose of improving the patient's health status. Telehealth is the broader term that extends beyond delivery of clinical services. Telehomecare - CORRECT ANSWER Monitoring and delivery of healthcare in the patient's home rather than in a medical clinic Patient centered-Encourages patient to take a role in their healthcare. Monitoring and delivery of healthcare in the patient's home rather than in a medical clinic - CORRECT ANSWER •Information sent directly to healthcare providers (HCPs) •Allows patient the comfort of their own home •Improves quality of life •Avoids time-consuming costly visits to office appointments •Reduces Emergency Department visits •Reduces re-admission rates, improves care, and reduces costs. Telehomecare for chronic disease care: •Powerful self management tool •Make patient more accountable for their health- How is a patient going to feel when they see an immediate spike in glucose after eating a large piece of cake? •Examples •Cardiac •Pulmonary •Diabetes •Chronic renal failure •VS: cardiac rhythm, blood glucose, and weight. Data transmitted is stored in pt's EHR through a secure connection to the clinic •Healthcare provider can see alerts to significant changes Remote patient home monitoring - CORRECT ANSWER From acute settings to a pt at home. Examples of telehome care - CORRECT ANSWER •Portable monitoring devices --Continuous Glucose Monitors (CGMs) •Pill dispensers/reminders •Wearable monitoring garments (biometric garment, nanotechnology) ---Smart Clothing-Monitoring ---Smart Underwear-Prevention •Consumer and Healthcare provider devices --Example: HemMobile Striiv Wearable wristband for hemophilia ------HemMobile-free to anyone with hemophilia •Some Health and wellness apps, many not approved by FDA, educate pts •FDA has not approved many of the health and wellness apps so they may have questionable value •HemMobile Striiv Wearable wristband for hemophilia •Tracks daily activity and intensity of the heart rate •Log bleeds and infusions •Monitor their factor supply •Set up appointment reminders Telehomecare for chronic disease management - CORRECT ANSWER •Encourages self-management •Devices collect and transmit vital signs to providers --Cardiac rhythm --Blood glucose --Weight •HCPs are altered to changes •Cardiac-ECG, heart rhythm, pacemaker & defibrillator monitoring, wt, BP, HR •Pulmonary-SpO2, sleep apnea •Diabetes-blood sugar monitoring, insulin pumps •Chronic renal failure-VS, wt, at home dialysis (teledialysis) Monitoring devices - CORRECT ANSWER Continuous glucose monitoring—CMG - Provides 24/7 monitoring to help individuals with diabetes track their blood sugar and adjust accordingly. Cardiac rhythm self-monitoring devices - AliveCor is FDA approved and marketed for detecting atrial fibrillation. Users can share tracings with their providers. Wearable health alert and monitoring devices - When immediate care is necessary, wearable health alert and monitoring devices help facilitate medical assistance. •Wearable devices also include smart watches like fitbit and apple watches. These can monitor activity, HR, sleep, weight, and can even alert emergency contacts in case of falls. •Several types of wearable devices for elderly which give the patient and family peace of mind-GPS included •FDA approved AliveCor Kardia Mobile-FDA approved available without a prescription Expanding - CORRECT ANSWER •As technology grows, the application for telehealth/telehomecare is endless •Multiple ways to monitor the body functions •BIS- Bispectral Index- monitoring of LOC •PPG-photoplethysmography-a simple optical technique used to detect volumetric changes in blood in peripheral circulation. ---Recently, there has been much interest from numerous researchers around the globe to extract further valuable information from the PPG signal in addition to heart rate estimation and pulse oxymetry readings. PPG signal's second derivative wave contains important health-related information. Thus, analysis of this waveform can help researchers and clinicians to evaluate various cardiovascular-related diseases such as atherosclerosis and arterial stiffness. Pill dispensers - CORRECT ANSWER MedaCube $1500 MediReady $150 •Auditory reminders to prompt patients to take their medications •Some systems will alert caregivers if the patient does not take medication within a certain amount of time •If caregiver doesn't answer, then a call center is notified Chronic renal failure - CORRECT ANSWER Southern Vermont Medical Center at home dialysis program •Tablo unit uploads all activity from patient's machine to a portal which is accessible to the staff back at SVMC's Renal Dialysis Unit •Better quality of life •Dx with polycystic kidney disease at the age of 14, William Celley of Bennington always knew that dialysis was in his future. •"We can see when William has done treatments and for how long, and we can see if he's had any issues with set-up or anything else. We have access to the exact same information related to his treatment that we would if he was still coming in for sessions. It's really remarkable Virtual clinic visits - CORRECT ANSWER Telemental health clinic visits •Research on the use of telemental health reports that care provided is comparable to face-to-face care •More prevalent in rural areas, prisons, other areas with decreased access to mental health professionals •Also used in veteran care. PTSD could be harder to treat in a busy medical center depending on severity. Travel can also be difficult. Improving telehealth access in rural arkansas - CORRECT ANSWER •Public New Service-Improving telehealth in rural AR •Almost 60 counties in the state do not have enough providers to serve their populations-Worse specialty providers •Health Resources and Service administration initiative • •Arkansans can explore their telehealth options •As a nurse you will need to think about availability of follow up Monthly discounts for bills through the Affordable Connectivity Program The Affordable Connectivity Program is an FCC benefit program that helps ensure that households can afford the broadband they need for work, school, healthcare and more. The benefit provides a discount of up to $30 per month toward internet service for eligible households and can also receive a one-time discount of up to $100 to purchase a laptop, desktop computer or tablet. For more information, please visit Lifeline is an FCC program that helps make communications services more affordable for low-income consumers. Lifeline provides subscribers a discount on qualifying monthly telephone service, broadband Internet service, or bundled voice-broadband packages purchased from participating wireline or wireless providers. The discount helps ensure that low-income consumers can afford 21st century connectivity services and the access the provide to jobs, healthcare, and educational resources. eICU services - CORRECT ANSWER •e-intensive care units --eICU: telepresence- ----Banner Telehealth Network ----Banner Health System located over seven states with the iCare Command Center located in Mesa, AZ which monitors critical care beds •Requires buy-in by staff, physicians and administrators •Requires extensive planning and communication as well as workflow design Banner Health system - Alaska, Arizona, California, Colorado, Nebraska, Nevada, and Wyoming. •Command Center has access to patient monitors, labs, x/rays. Cameras and microphones allow off site experts to speak with staff and patient via HIPAA compliant transmissions •Studies have shown that eICU implementation decreases length of ICU stay and cost •Requires buy-in by staff, physicians and administrators. Perceived usefulness by nurses was a key on acceptance of this service. Recommends that nurses and physicians be involved in the implementation process. •Requires extensive planning and communication as well as workflow design Robotics - CORRECT ANSWER •Robotics: RP-7 •RP-Remote Presence •Vita robot •5 ft 6 in robot with flat screen where face would be •Consultant interacts directly with patient, monitors, and EHR •Remote intensivist expert controls the robot using RP software and a joystick Examples: •PR7 telestroke network at wake forest 24-hour care available from stroke specialists. •Neonatal care-can prevent the transfer of infant to another facility The da vinci surgical system - CORRECT ANSWER •Telepresence-The use of technology to privde appearance of a person's presence, although he or she is located at a remote site. Other telehealth examples - CORRECT ANSWER •Teletrauma care •second opinions and advice from trauma care experts for rural hospitals •Video conferencing consultations •Research has shown promising evidence-based outcomes •Disaster healthcare •North Atlantic Treaty Organization (NATO) developed telemedicine systems for combat zones and disasters •US Dept of Health and Human Services develop a guide and toolkit to assist with disaster planning •Hurricane victims --EHR assisted with continuity of care when patients were transferred. --Several telehealth companies provided phone and video services with no fees. Others provided psychological counseling and virtual care to victims. Telehomecare is limited to the use of portable monitoring devices. - CORRECT ANSWER False •Telehomecare includes a variety of devices and measures, such as portable monitoring devices, pill dispensers/reminders, wearable monitoring garments, and telehomecare for chronic illness management. Telehealth education - CORRECT ANSWER •Useful in rural areas where it is difficult to recruit healthcare professionals •Barriers to travel for patients: Cost of travel, time away from the workplace •Educational meetings using teleconferencing --See Best Practices, page 363 •Beneficial for healthcare professionals also --Continuing education --Preparing practitioner •Most telehealth projects have a built-in patient education component •Native People for Cancer Central Telehealth Network, monthly meetings related to latest cancer updates Best Practices •Use multiple approaches, combining face-to-face and technology •Provide regularly scheduled meetings •Use interactive communication •Provide immediate feedback to questions •Keep pt information secure •Provide accurate and pertinent information •Address personal and cultural needs. •Provide coordinated care •Provide convenience, including the ability the ability to receive information at home. Issues with telehealth - CORRECT ANSWER Reimbursement •Limited to Health Professional Shortage Areas (HPSA) •Restrictions eased with COVID-19 Public Health Emergency (PHE) •COVID-19 PHE ended May 2023 •CMS extended flexibilities through December 2024 •No uniformity for reimbursement of telehealth/telemedicine services, varies from state to state. Before covid, telemedicine limited where and how it was used •Had to be between a remote provider and a clinic Medicolegal issues •Licensure-Issued by the state --Limits care from providers in other states or countries •Liability & Medical malpractice-Licensing/credentialing laws do not specify the use of telehealth Technical issues •Telecommunication infrastructure can be a problem •Patient safety •Set Standards --American Academy of Ambulatory Care Nursing (AAACN) created Telehealth Nursing Practice Administration and Practice Standards --Telehealth Nursing Practice Essential •Need redundancies for back up •Standards to guide clinical practice, EBP guidelines Core standards for telemedicine - CORRECT ANSWER Standards 1.Administrative •Human resources, HIPAA, research protocols, TH equipment, fiscal 2.Clinical •Professional practice and standards of care as they relate to TH 3.Technical •Safety and the function of TH equipment, policies & procedures, need for redundancy to ensure network connectivity Summary - CORRECT ANSWER •As technology improves, the possibilities are endless •S&F or real time •Telepresence eICU and emergency departments •Telehomecare monitoring devices •Telehealth is valuable in education: for patient and professional •Reimbursement and technical issue can still be a problem •Store & Forward-asynchronous method of sending images to distant locations •Real-time telehealth involved the patient and the consultant interacting at the same time •Telepresence used to augment care in critical care units and emergency departments •Telehomecare-live independently and be proactive in early detection of healthcare problems