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Information Management and the Application of Technology Notes Information Management 17% of assessment 10 questions -The graduate analyzes the role of info management in the delivery of timely, hi ... gh-quality, patient-centered careInformatics and Information Science 3 questions - I.T. Information Science --- Informatics - Information systems ● Information Science are the roots to the tree of Informatics with Information Technologies and Information Systems as branches. Information Systems vs. Information Science ● Information Science: Primarily focused on input, processing, output, and feedback through technology integration. ■ Incorporates features from communication science, computer science, social science, library science, and cognitive science. ■ Applies technology to make information usable. ■ Supports the collection and management of info. ■ This is the focus on how to gather, process and transform information into knowledge. It also incorporates features from these five other sciences: communication science, computer science, social science, library science, and cognitive science. ● Information Systems: Computer systems that use hardware and software to process data into information in order to solve a problem. ○ Using the EHR to document care of a patient with a femur fx is an example of using the EHR in which way?—Information System ○ Information systems are used to collect, create, and distribute useful data. ○ The development, use, and management of an organization's I.T. infrastructure. ○ An umbrella term for sub-categories such as: clinical information systems, core business systems, case management system, and communication systems. ● Life cycle of Information Systems ○ Needs Assessment Phase: *determine needs and wants in an information system*, gap analysis ○ System Selection Phase: The organization seeks out a vendor company that provides a system that best fits the needs. There are three documents that are used: ■ 1) Request for information document: (RFI) Initial contact with the vendor. Get essential information about the *company’s history* (How many other organizations have used them?) ■ 2) Request for Proposal document: (RFP) Organization prioritizes or rates their needs and wants. Sends the outline to the vendor and asks if they can meet this need. ■ 3)Request for Quote document: (RFQ) Pricing, finances, and contract terms.■ It’s not important that selection committee board members understand software and electronic processes. *They aren’t the end users who need to be trained* in the system. They just have to have a general understanding of it. ○ System Implementation Phase: Go live planning→ Train staff (including end users)→ Analyst starts building screens and templates according to organization and its policies→ Apply any changes specific to that organization→ Go live. ■ Presenting the system design to management is not the responsibility of the project implementation team. ○ Maintenance Phase: Problem solving, any debugging, files backed up routinely and install any system upgrades, make sure it’s working as intended. ● It is a continuous cycle. ● System Evaluation IS NOT a phase of the information system life cycle. ● Investigating current deficits and needs of the organization IS NOT a role in they system implementation phase. It is a role in the Needs Assessment phase. ● ● Informatics vs. Information Technology ○ Informatics: A combination of nursing science, computer science, and information science. ■ Specific information technologies that support nursing practice. ■ It is the science and art of turning data into information. ○ Information Technologies: A general term used to refer to the management and processing of information with the assistance of computers, ex → EHR, barcode medication administration… (Uses computers to transmit data.) ■ CPOE, barcode medication administration and clinical decision support are all examples of Information Technologies. ○ Commonalities: Both aid in clinical decision making and are a major resource for many organizations. ● Discuss the relationship between the terms: ○ Data: A collection of numbers, characters, or facts that are gathered according to some perceived need for analysis and possibly action at a later point in time. ■ A patient's height, weight, code status, and date of birth are all examples of data. Once data is analyzed and interpreted, it then becomes information. ○ Information: Data that have been interpreted. ○ Knowledge: The synthesis of information derived from several sources to produce a single concept or idea. It is based on a logical process of analysis and provides order to thoughts and ideas and decreases uncertainty. ■ The Foundation of Knowledge Model: This is the basis for which knowledge is used to meet the needs of the healthcare delivery system. It is derived from its three key elements of● 1) knowledge acquisition ● 2) knowledge processing ● 3) knowledge dissemination. ○ Wisdom: Occurs when knowledge is used appropriately to manage and solve problems. ● Relate the concept of information literacy to nursing informatics: ○ Information literacy: The ability to recognize when information is needed as well as the skills to find, evaluate, and use needed information effectively. Nursing and Informatics 3 questions ● Nursing Informatics: The use of technology and information to help support all aspects of nursing practice. ○ Includes direct delivery of care, administration, education, and research. ● Recognize the role of nurses as knowledge workers: ○ A knowledge worker is a: specialist in their field. ■ They have advanced formal education. ■ They can apply theoretical and analytical knowledge. . ■ continuous learner, use technology to support and inform nursing practice, and generate knowledge as a product. ● Explain the relationship of information science, computer science, and nursing science within the context of nursing practice: ○ These are the core sciences of nursing informatics/they are combined to make up nursing informatics. ● New technologies are continuously impacting the practice of nursing. Nursing informatics will continue to evolve with changes in the profession, the healthcare delivery system, and informatics in general. ● Distinguish among the: ○ Novice/Beginning nurse: These Rns are more task based, but transition to knowledge based as they gain experience. ■ They possess basic computer skills and can use information systems to manage pts. ■ They can access data and charts electronically and can support pt safety initiatives using I.T. ■ They recognize the role of informatics in nursing. ○ Experienced nurse: A nurse who is able to pull trends out of data. ■ They support specialty areas (including quality improvement and other activities) via Information Technologies. ■ They use evidence-based databases, promote technology applications, use information systems, and work with I.T. staff to enact system improvements. ○ Informatics nurse: A nurse with advanced preparation in information management who is capable of transforming data into information and information into knowledge that is disseminated at appropriate times, for appropriate uses. ■ They are proficient with informatics applications to support all areas of nursing practice and can provide a valuable communication link between healthcare and technology professionals.■ They demonstrate critical thinking, data management, decision making, and computer skills. ■ They identify/provide data for decision making. ○ Informatics nurse specialist (INS): A nurse who has educational preparation to conduct informatics research and generate informatics theory by using their critical thinking skills, data management skills, and computer skills to contribute to the overall body of nursing knowledge. ■ An INS plays a role in the design and testing of information systems, help shape policy, and serve as an advocate for the design and use of informatics. ■ An INS focuses on nursing’s information needs and evaluates the performance and impact of information management technologies on clinical practice, education, administration, and/or research. ○ Informatics innovator: Someone who conducts informatics research and generates informatics theory. ■ The innovator uses a holistic view, they work across setting and have a vision of what’s possible and a keen sense of timing to make things happen. ■ They have a sophisticated level of skills and understanding in computer technology and information management. ■ They are proficient with informatics applications to support all areas of nursing practice. ● Identify diverse nursing informatics roles: ○ Data gatherer: When nurses collect clinical data and document their findings. ○ Information user: When nurses evaluate and analyze the data. ○ Knowledge user: When nurses compare the data they have collected with the current nursing knowledge base. ○ Knowledge builder: When nurses take their longitudinal data and offer patient care suggestions. Information Management 4 questions ● Significance of information and knowledge management: ○ Good information management provides the right info at the right time to the right people (reduces redundancy). ○ Knowledge management creates systems that enable organizations to tap into the knowledge, experiences, and creativity of their staff to improve their performance. ● Differentiate among information system technologies used in the healthcare environment: ○ Clinical and Administrative systems (see Health Information Systems) ● Determine available clinical technologies and how they impact the nursing process: ○ Clinical pathways and computer generated care plans are examples of how informatics can affect nursing practice. ○ Computerized charting, documentation prompts, device integration, decision support systems... ○ I.T. impact: Strengthen clinical databases and support evidence based care.○ Nursing Information Systems: It supports the use and documentation of nursing process and activities and it provides tools for managing the delivery of nursing care. ■ Support the way that RNs function, allowing them to view data, collect the necessary information, provide quality pt care, and document the pt’s condition and the care given. ■ Support and enhance RN practice through improved access to information and tools such as online databases, drug information, and the hospital’s PPM. ■ Two approaches to RN care and documentation: ● Nursing process approach: Allows documentation of RN care using well established formats (IPOCs, admission assessments, nursing progress notes..) and using standardized languages. ● Critical pathway or protocols: A multi-disciplinary format for planning and documenting pt care. ● Identify the clinical information systems available to support patient-centered care: ○ Nursing information, Monitoring, CPOE, EHR Lab, Radiology, Pharmacy… ■ Health plans are providing access to claims and care management as well as member service applications. ○ Information systems enable decision makers to examine trends and make informed choices during these times of healthcare reform. ● Determine desired clinical outcomes supported by information systems: ○ Improved workflow. ○ Improved pt safety and increased quality of care. ○ Better management of resources, improved productivity, and reduced cost. ● Analyze potential barriers to patient-centered care created by the use of various technologies: ○ Using Personal Health Records (PHRs) → people may not be aware of available technology. ○ Security → pt privacy could be compromised. ○ Payment for performance of care. ○ Waiting until the end of the shift to document your patient assessments into the EHR. ○ The position of the computer can be seen as a potential barrier if it constricts the view between the patient and healthcare professional. ○ Leadership in Information Technology 10% of assessment 2 questions -The graduate analyzes the relationships among nursing initiatives, professional organizations, and leadership as they influence nursing informaticsState of the Field ● Recognize national trends and initiatives related to informatics: ○ Less consumer accountability IS NOT an emerging trend in healthcare.○ Blogging as a means to give report IS NOT a national trend related to nursing informatics. ○ A push for patient safety, error reduction, and additional regulatory requirements are all emerging trends in healthcare. ○ Barcode scanning for medication administration is a national trend related to nursing informatics. ○ EHR Incentives: Beginning in 2011, Medicare and Medicaid will provide financial incentives from $40,000 to $65,000 per eligible physician and up to $11 million per hospital for Meaningful Use of HIT. ○ Meaningful Use (MU): Created by both the Health Information Technology Policy and Standards Committees to determine how organizations would receive reimbursement for their implementation. ■ Use of health information technology (HIT) legislated by the American Recovery and Reinvestment Act of 2009 to collect specific data with the intent to improve care, engage patients, improve population health, and ensure the privacy and security. ■ MU requires standardized nursing terminology to meet its criteria. ■ This is an initiative geared to spur the adoption and use of electronic health records for the purpose of gathering and reporting data that can then be used to improve population health. ○ The TIGER initiative: A plan to promote informatics competencies among nurses in order to transform healthcare. ○ The Medicare Improvements for Patients and Providers Act (MIPPA): Provides financial incentives for providers who use e-prescribing. ○ HITECH Act: Portion of ARRA that amended HIPAA Security and Privacy Rules and provided funds and incentives to increase the use of electronic health records by physicians and hospitals who meet eligibility criteria for Meaningful Use. ○ The American Recovery and Reinvestment Act of 2009 (ARRA): Provided funds for the position of the Office of the National Coordinator for Health Information Technology (ONCHIT) and for the adoption of technology, and provides the right for every individual to receive an electronic copy of his or her EHR or to have a copy transmitted to any designated party. ● Identify standard dataset formats: standardization in documentation to support interoperability. ○ Billing codes → ICD, ABC, and CPT ○ Clinical terminologies → SNOMED-CT, LOINC ○ Nursing terminologies → see Intro to EHR ● Recognize the principles of standardization of nursing terminology and data: ○ Standardized terminology is essential for successful development and implementation of an EHR. ○ Terminology is required to represent, communicate, exchange, manage, and report data, information, and knowledge. ○ It enables safe, patient-centric, high-quality healthcare that optimizes data collection for the measurement of patient outcomes.○ EHRs can no longer be developed or implemented without standardized terminologies. Data exchange between EHR application systems must take place without loss of meaning. ● Explain the influence of technology on nursing practice: ○ Computerized documentation, MAR, Point of care tests, vitals link, pt education, continuing education… ○ Clinical pathways and computer generated care plans are examples of how informatics can affect nursing practice. ■ Both are also examples of clinical decision support. ○ Radio frequency identifier (RFID): A type of technology that is used to identify and track supplies, medical equipment, medication, a patient’s location within a healthcare environment. ○ The next generation of knowledge workers: ■ I.T. to bridge the gap from task based nursing to a knowledge based profession. ■ Transition of knowledge workers into self directed innovators. ■ Increased support from organizations for innovation and outcomes tied to knowledge work. ● Explain the challenges and opportunities in leveraging healthcare technologies: ○ Leadership 2 questions ● Recognize the various roles of nurses in selecting and implementing patient information systems: ○ It’s important to secure staff nurses active participation when implementing a health information system because nurses knowledge of current patient care workflow may improve implementation decisions. ○ The selection committee should be aware of the amount of money available for the purchase, installation, and maintenance of a new system, as this influence will guide their questions and impact available choices. ○ Nurses knowledge of current patient care workflow may improve implementation decisions. Rns are frontline employees who will actually be using the system. ■ Rns must be involved in identifying and defining data elements that an interface may be able to supply. ■ Rns must also be involved in determining measures to assure the quality of the data that’s exchanged among individual information systems and in the formation & maintenance of the EHR. ○ A study of more than 1,000 nurses found that the involvement of an informatics nurse and nurses in information technology decisions can accelerate IT integration. ○ The selection and implementation of a system should include a detailed plan. The nurse on the implementation team must carefully prepare the staff for implementation. Consider many different training techniques available to educate the staff about the system. Any implementation strategy should include long-term maintenance and training plans that enable the system to survive initial implementation and solve the informatics issues it was adopted to address. ● Interoperability: Allows for meaningful exchange of information that retains its meaning as it crosses from one system to another. It describes the extent to which systems/devices can exchange data and interpret shared data. ○ Technical interoperability: Ability to exchange data from one point to another.○ Semantic interoperability: Guarantees that the meaning of exchanged data remains the same on both ends of the transaction. ○ Process interoperability: Coordination of business processes at an organization allowing them to work together. ● System Integration: One of the biggest benefits of systems integration is time savings. When systems are integrated, one entry can be populated across systems, and multiple sources of data and information can be reached through a single access point. ○ Integration: Process by which different information systems are able to exchange data in a fashion that is seamless to the end user. Allows for different information systems to be accessed from one point by the user. ○ Interface: A computer program that tells two different systems how to exchange data. ■ Point to point: The point-to-point approach enables two systems to communicate; however, it is expensive because it involves developing a completely customized program. ■ Interface engine: The point-to-point approach enables two systems to communicate; however, it is expensive because it involves developing a completely customized program. ● Real time processing: Allows instant interaction between systems. ● Batch processing: Allows for the daily transfer of info in large batches; typically used for system needs that aren’t critical and can be done once a day. These engines are not seen by the user & are less expensive. ■ The interface engine takes all the data from the disparate institutional systems & stores it in a clinical data repository. ● Clinical data repository: A database where information from many different information systems is stored and managed, allowing retrieval of elements without regard to their point of origin. ■ The software then uses mapping tech to enable a system to understand the terminology used in another system ● Mapping: A process by which the definition of terms used in one information system are associated with comparable terms in another system, thereby facilitating the exchange of information from one system to another. ● Integration with interoperability is a process by which different information systems are able to exchange data seamlessly to the end user. ● Recognize the importance of active participation in the evaluation, selection, implementation of technologies. ○ Strategic Success for Informatics Systems: SWOT - strengths, weaknesses, opportunities, & threats; Institutions that integrate this self-examination into their structure are best able to cope with the dynamic change that exemplifies informatics technology. ○ The process must include key stakeholders across the institution, including staff who will be using the systems and anyone else who may have an interest in the project's outcome. All these stakeholders shouldbe involved in the strategic planning for the technology's adoption. Open communication and inclusive plans help institutions overcome their technological planning challenges. ○ Getting input from clinicians who will be using the system is critical to the success of system design and implementation. ○ Implementation of the EHR and initiatives supporting pt safety and quality of care will drive information technology plans and spending for the next several years. ● Recognize obstacles nurses face in assuming a leadership role in technology-based decision making: ○ Challenges of integration and interoperability: ■ 1) Vendors setting unrealistic goals. ■ 2) A lack of support from vendors. ■ 3) Changes in user specifications. ● Analyze the influence of technology on interdisciplinary collaboration: ○ Technology helps eliminate redundant data entry & interventions. ○ It provides access to more complete data along the care continuum. ■ Integration of related systems such as radiology, picture archiving communication system, and the EHR provides clinicians with a more comprehensive view of the pt that can be access from many points within the hospital. ○ It improves the quality of documentation. ○ It permits improved tracking of pts and pt outcomes. ○ It’s important that departments collaborate with on another when selecting a health information system because collaboration leads to knowledge sharing. ○ Project Scope: The size and details of a collaborative effort. Health Information Systems 10% of assessment 6 questions -The graduate determines appropriate features and functions of health information systems necessary to meet the needs of healthcare deliveryFeatures and Functions 6 questions ● Be sure you know how to define the following terms and describe how they are used in health information management: ○ Computerized Physician Order Entry (CPOE):Process by which the provider directly enters orders for pt care into a hospital information system. ○○ Clinical Decision-Support (CDS): Filtered experr [Show More]

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