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Health Informatics - E-Book

Health Informatics - E-Book

Ramona Nelson | Nancy Staggers

(2016)

Additional Information

Book Details

Abstract

Awarded second place in the 2017 AJN Book of the Year Awards in the Information Technology category. See how information technology intersects with health care! Health Informatics: An Interprofessional Approach, 2nd Edition prepares you for success in today’s technology-filled healthcare practice. Concise coverage includes information systems and applications such as electronic health records, clinical decision support, telehealth, ePatients, and social media tools, as well as system implementation. New to this edition are topics including data science and analytics, mHealth, principles of project management, and contract negotiations. Written by expert informatics educators Ramona Nelson and Nancy Staggers, this edition enhances the book that won a 2013 American Journal of Nursing Book of the Year award!

  • Experts from a wide range of health disciplines cover the latest on the interprofessional aspects of informatics — a key Quality and Safety Education for Nurses (QSEN) initiative and a growing specialty area in nursing.
  • Case studies encourage higher-level thinking about how concepts apply to real-world nursing practice.
  • Discussion questions challenge you to think critically and to visualize the future of health informatics.
  • Objectives, key terms and an abstract at the beginning of each chapter provide an overview of what you will learn.
  • Conclusion and Future Directions section at the end of each chapter describes how informatics will continue to evolve as healthcare moves to an interprofessional foundation.
  • NEW! Updated chapters reflect the current and evolving practice of health informatics, using real-life healthcare examples to show how informatics applies to a wide range of topics and issues.
  • NEW mHealth chapter discusses the use of mobile technology, a new method of health delivery — especially for urban or under-served populations — and describes the changing levels of responsibility for both patients and providers.
  • NEW Data Science and Analytics in Healthcare chapter shows how Big Data — as well as analytics using data mining and knowledge discovery techniques — applies to healthcare.
  • NEW Project Management Principles chapter discusses proven project management tools and techniques for coordinating all types of health informatics-related projects.
  • NEW Contract Negotiations chapter describes strategic methods and tips for negotiating a contract with a healthcare IT vendor.
  • NEW Legal Issues chapter explains how federal regulations and accreditation processes may impact the practice of health informatics.
  • NEW HITECH Act chapter explains the regulations relating to health informatics in the Health Information Technology for Education and Clinical Health Act as well as the Meaningful Use and Medicare Access & CHIP Reauthorization Act of 2015.

Table of Contents

Section Title Page Action Price
Front Cover Cover
Inside Front Cover ES2
Health Informatics: An Interprofessional Approach iii
Copyright iv
Dedication v
About the Authors vii
Contributors ix
Reviewers and Ancillary Writers xiii
Acknowledgments xv
Preface xvii
Uses of the Book xvii
Vendors, Applications, Foundations and Institutions xvii
Organization of the Book xvii
Teaching and Learning Package xviii
For the Instructor xviii
For the Student xviii
Contents xix
Chapter 1: An Introduction to Health Informatics 1
Introduction 1
Definition of health informatics 2
Topics and areas of study in informatics 3
Unit 1: Fundamental Information in Health Informatics 3
Why Informatics Is Needed in Healthcare: An Example 3
Unit 2: Information Systems and Applications for the Delivery of Healthcare 3
Healthcare Applications Improving Healthcare: An Example 3
Unit 3: Participatory Healthcare Informatics (Healthcare on the Internet) 4
Unit 4: Managing the Life Cycle of a Health Information System 5
Using the Systems Life Cycle: An Example 5
Unit 5: User Experience, Standards, Safety, and Analytics in Health Informatics 5
Using Big Data: A Real-Life Example 6
Unit 6: Governance Structures, Legal, and Regulatory Issues in Health Informatics 6
Health Policy in Operation: An Example 6
Unit 7: Education and Health Informatics 6
Unit 8: International Health Informatics Efforts 7
Unit 9: Historical Implications and Future Directions in Health Informatics 7
Conclusion and future directions 8
References 8
Discussion Questions 9
Case Study 9
Case Study Questions 9
Chapter 2: Theoretical Foundations of Health Informatics 10
Introduction 11
Foundational Literacies for Health Informatics 11
Definition of Basic Literacy 11
Definition of Computer Literacy/Fluency 12
Definition of Information Literacy 12
Definition of Digital Literacy 12
Definition of Health Literacy 13
Understanding theories and models 14
Theories and Models Underlying Health Informatics 15
Systems Theory 15
Characteristics of Systems 16
Systems and the Change Process 17
Complex Adaptive Systems 18
Characteristics of a CAS 18
Cynefin Framework for Managing Uncertainly in CAS 19
Simple Domain 20
Complicated Domain 20
Complex Domain 20
Chaotic Domain 21
Disorder Domain 21
Information Theory 21
Shannon-Weaver Information-Communication Model 21
Blum Model 22
Graves Model 23
Nelson Model 23
Learning Theory 25
Cognitive and Constructionist Learning Theories 25
Adult Learning Theories 27
Learning Styles 27
Change Theory 28
Planned Change 29
Diffusion of Innovation 29
Using Change Theory 31
The Systems Life Cycle Model 31
Staggers and Nelson Systems Life Cycle Model 32
Additional informatics-related models 33
Conclusion and future directions 33
References 34
Discussion questions 36
Case study 37
Discussion Questions 37
Chapter 3: Evidence-Based Practice, Practice-Based Evidence, and Health Informatics 38
Introduction 38
Evidence-based practice 39
Evidence-based practice models 40
Stevens star model of knowledge transformation 42
Point 1: Discovery Research 42
Point 2: Evidence Summary 43
Resources and Examples 43
Point 3: Translation to Guidelines 44
Resources and Examples 44
Point 4: Practice Integration 46
Resources and Examples 47
Point 5: Evaluation 48
Resources and Examples 48
Informatics and evidence-based practice 49
Relationship of EBP and PBE 50
EHRs and PBE Knowledge Discovery 50
Knowledge Building Using Health Information Technology 50
Practice-based evidence 50
Practice-Based Evidence Features and Challenges 50
Steps in a PBE Study 51
Create a Multisite, Multidisciplinary Project Clinical Team 51
Control for Differences in Patient Severity of Illness 52
Controls for Patient Factors 52
Controls for Treatment and Process Factors 53
Controls for Outcome Factors 53
Implement Intensive Data Collection and Check Reliability 53
Create a Study Database 53
Successively Test Hypotheses 53
Validate and Implement Findings 54
Limitations and Strengths of Practice-Based Evidence Studies 54
Informatics and practice-based evidence 54
Conclusion and future directions 55
References 56
Chapter 4: Models, Theories, and Research for Program Evaluation 60
Introduction 60
Purposes of evaluation 61
Formative Versus Summative Evaluation 61
Generalizability and Scope 62
Program Continuance Versus Growth 62
Theories and frameworks 62
Social Science Theories 63
Social Cognitive Theories 63
Diffusion of Innovations Theory 63
Cognitive Engineering Theories 63
Information Theory 63
Information Foraging Theory 63
Information Technology Theories 64
Information System Success 64
Unified Theory of Acceptance and Use of Technology 64
Program Implementation Models 64
PRECEDE-PROCEED Model 65
Promoting Action on Research Implementation in Health Services 65
Reach Effectiveness Adoption Implementation Maintenance 65
Consolidated Framework for Implementation Research 66
Sociotechnical Model for Informatics Interventions 66
Quality Improvement 67
Program Theory Models 67
Six Steps 67
Logic Models 67
Methods, tools, and techniques 68
Quantitative Versus Qualitative Questions 68
Qualitative Methods 68
Structured and Semi-Structured Interviews 69
Observation and Protocol Analysis 69
Ethnography and Participant Observation 69
Quantitative Methods 70
Research Designs 70
Time Series Analysis 70
Regression Discontinuity Design 70
Multiple Baseline With Single Subject Design 70
Instruments 70
User-Satisfaction Instruments 71
Social Network Analysis 71
Cost-Effectiveness Analysis 71
Conclusion and future directions 71
References 71
Discussion questions 73
Case study 73
Discussion Questions 74
Chapter 5: Technical Infrastructure to Support Healthcare 75
Introduction 75
Electronic health record component model 75
Clinical Data Repository 76
Central Versus Distributed Storage 77
Encounter-Based Versus Longitudinal-Based Storage 77
Master Person Index 77
Clinical Applications 78
Review and Reporting 78
Data Collection 78
Patient Management 79
Clinician Productivity 79
Data Dictionary 79
Knowledge Base 80
Clinical Decision Support System 80
System integration and interoperability 81
Interface Engine 81
Interoperability Standards 82
Networking systems 82
Regional Health Information Organization, Health Information Exchanges, and Health Information Organizations 82
eHealth Exchange 83
Other infrastructure models 83
Application Service Provider 83
Cloud Computing 84
Current challenges 84
Conclusion and future directions 85
Mobile Apps 85
Service-Oriented Architecture 86
Open Source Software 86
SMART 87
References 87
Discussion questions 88
Case study 89
Discussion Questions 89
Chapter 6: Electronic Health Records and Applications for Managing Patient Care 90
Introduction 90
Early Terms and Definitions 91
Electronic Medical Record Versus Electronic Health Record 91
Electronic health record components, functions, and attributes 92
Sociotechnical perspectives 93
Electronic Health Record Adoption 93
Federal EHR Requirements 93
Electronic Medical Record Adoption Model 94
Health Practitioner Role in Electronic Health Record Adoption and Meaningful Use 94
Electronic health record applications used in the clinical setting 95
Computerized Provider Order Entry 95
Electronic Medication Administration Record 95
Bar Code Medication Administration 96
Clinical Documentation 96
Specialty Applications 97
Clinical Decision Support 97
Ancillary Systems 98
Electronic health record benefits 99
Cost 99
Access 99
Quality, Safety, and Efficiency of Care Delivery 99
Stakeholder perspectives 99
Consumers 99
Nurses 100
Healthcare Providers 100
Healthcare Organizations 100
Insurance Payers 101
State and National Governments 101
Key issues 101
Cost 101
Ownership 101
Data Integrity 102
Privacy and Confidentiality 102
Standards 102
Organizational Culture 103
User Experience 103
Patient Access to the Electronic Health Record 103
Patient-Generated Health Data 104
Conclusion and future directions 105
References 105
Chapter 7: Administrative Applications Supporting Healthcare Delivery 111
Introduction 111
Vendor Resource Guides 112
Major Types of Applications 112
Financial Systems 112
Evolution of Healthcare Financial Information System 112
General Ledger 113
Payroll Application 113
Patient Accounting Application 114
Claims Processing and Management System 114
Claims Denial Management Application 114
Contract Management Application 114
Fixed Asset Management Application 115
Financial Reporting 115
Challenges with Financial Information Systems 115
Analyzing Accountable Care Organizations and Pay for Performance 116
Financial Information Systems Integration 118
Efficiency Tools 119
Practice Management Systems 119
Patient Outreach System 120
Online Billing and Payment Tool 120
Hospital–Healthcare Provider Connection 120
A Matter of Perspective 121
Supply Chain Management 121
Healthcare Supply Chain and Informatics 121
Integrated Applications in Supply Chain Management 122
Supply Cost Capture 123
Human Resources Information Systems 124
Human Resources Information Systems as a Competitive Advantage 124
Human Resources Information Systems Vendors 125
Human Resources Subsystems 125
Personnel Administration 125
Managing Human Resources Strategically and Operationally 125
Staffing and Scheduling 125
Training and Development 126
Compensation, Benefits, and Pension Administration-Payroll Interface 126
Performance Evaluation 126
Underrepresented Subsystems 126
Business Intelligence Systems 126
Conclusion and Future Directions 127
References 128
Discussion questions 129
Case Study 129
Michael H. Kennedy, Kim Crickmore,a and Lynne Milesa 129
Discussion Questions 130
Chapter 8: Telehealth and Applications for Delivering Care at a Distance 131
Introduction 131
Examples of Successful Telehealth Programs 132
Telehealth Historic Milestones 133
Leading Telehealth Organizations 133
American Nurses Association 133
United States Federal Government Agencies 134
American Telemedicine Association 134
International Council of Nurses 134
Telehealth technologies 134
Synchronous or ``Real-Time´´ Technologies 134
Video Conferencing 134
Patient Monitoring Technologies 134
Asynchronous or ``Store-and-Forward´´ Technology 136
Technical Standards in Telehealth 136
Telehealth and Health Information Technology 136
Telehealth clinical practice considerations for healthcare professionals 136
Equal To or Better Than In-Person Care? 137
Telehealth Clinical Competency 137
Confidentiality, Privacy, and Informed Patients 137
Scope of Clinical Practice 138
Types of Clinical Telehealth Applications 138
Telehealth operational and organizational success factors and barriers 138
B.E.L.T. Framework 138
Operationalizing Telehealth 139
Telehealth Acceptance and Training 139
Telehealth Implementation 141
Preimplementation Phase 141
Implementation Phase 141
Postimplementation Phase 141
Telehealth challenges: licensure and regulatory issues for healthcare professionals 141
Licensure 142
Credentialing and Privileging 143
Reimbursement 144
Malpractice and Liability 144
Telehealth and direct patient health services 144
Patient-to-Provider Telehealth-Delivered Care 144
Delivering Direct Care Using Health Monitoring Tools and Biometric Sensors 145
Remote Telehealth Home Visits and Monitoring Devices 145
Sensor Technology 146
Telehealth Technology and Healthcare Consumers 147
eHealth Literacy: Critical Element for Telehealth Adoption 147
Conclusion and future directions 147
Telehealth Industry Growth 148
Telehealth to uHealth 149
Improve Healthcare Provider Shortages and Access to Care 149
References 149
Chapter 9: Home Health and Related Community-Based Systems 153
Introduction 153
Evolution and milestones 154
Practice models 154
Home Health 154
Palliative Care and Hospice 155
Community-Based Public Health 155
Nurse-Managed Health Centers 155
Other Practice Sites 155
Similarities Among Practice Models 155
Standardized datasets 156
Outcome and Assessment Information Set 156
Hospice Item Set 157
Patient-Experience Surveys 157
Supporting home health with electronic health records and health information technology 157
Billing Solutions 158
Point-of-Care Solutions 158
Clinical Decision Support Systems 159
Standardized terminologies 159
Omaha system 159
Description 160
Problem Classification Scheme 160
Intervention Scheme 161
Problem Rating Scale for Outcomes 161
Clinical Example from Practice 163
Interpretation of the Clinical Example 163
Examples of Electronic Health Record Screen Images 166
Conclusion and future directions 166
References 167
Discussion questions 168
Case Study 169
Discussion Questions 169
Chapter 10: Clinical Decision Support Systems in Healthcare* 170
Introduction 170
Definition of Clinical Decision Support 171
History 171
De Dombal Computer-Aided Diagnosis of Acute Abdominal Pain 171
Computer Reminders at Regenstrief Institute 171
Clinical Decision Support Examples from the HELP System 172
Clinical decision support types and examples 172
Medication Dosing Support 172
Order Facilitators 173
Point-of-Care Alerts and Reminders 173
Relevant Information Display 173
Expert Systems 175
Workflow Support 175
Clinical decision support impact 176
Evidence of Effectiveness 176
Examples of Clinical Decision Support Impact Studies 176
Financial Impact of Clinical Decision Support 177
Clinical Decision Support Adoption 177
Challenges and Barriers to Clinical Decision Support Adoption 177
Clinical decision support best practices 178
Recent progress toward disseminating clinical decision support on a national level 178
Value-Based Payment Models 179
Meaningful Use Incentives for Electronic Health Record and Clinical Decision Support Adoption 179
Statewide Health Information Exchanges 179
Clinical Decision Support Standards 179
National Clinical Decision Support and Knowledge Management Initiatives 179
Open Source, Freely Available Resources 180
Research challenges 180
Conclusion and future directions 180
References 181
Chapter 11: Public Health Informatics 184
Introduction 184
Public health: A population perspective 185
Social and Political Challenges That Affect Public Health Informatics 189
Sociological Context of Public Health 189
The value of informatics for the domain of public health 191
Surveillance 191
Immunization Information Systems 193
Health Information Exchange 194
Public Health Reporting 195
Conclusions and future public health informatics strategies 197
Transforming Practice With New Strategies 197
Advancing the Technical Infrastructure 199
References 201
Discussion questions 202
Case study 202
Discussion Questions 203
Chapter 12: The Engaged ePatient 204
Historical background and drivers of the epatient evolution 204
ePatient as a Pioneering Concept 204
Our Connected World 205
Policy and Legislative Influences 208
Characteristics of Digital Healthcare Consumers 208
Convergence of epatients, clinicians, patient-centered models of care, and informatics 210
Participatory Patient-Centered Healthcare 210
The New Role of Clinicians and Informaticians in ePatient Care 211
Health Informatics and ePatients 211
Transparency and Access to Data 212
Health 3.0 emerges 213
Virtual Patient Communities and Research Networks 213
Conclusion and future directions 215
21st Century Health and Healthcare 215
References 216
Discussion questions 218
Case study 219
Discussion Questions 219
Chapter 13: Social Media Tools for Practice and Education* 220
What is social media? 220
Social media tools 221
Social Networking 221
Blogging and Wikis 222
Microblogging (Twitter) 222
Social Bookmarking 222
Video and Image Sharing Content 223
Social media statistics 223
Benefits of social media 224
Challenges of social media 225
Privacy and Confidentiality 226
Inappropriate Behaviors 227
Security 228
Regulatory Issues 229
Market Pressure 229
Social media in education 231
Policy 231
Guidelines for Writing Policies 232
Resources for Policy Development 234
Conclusion and future directions 234
References 234
Chapter 14: Personal Health Records 241
Definitions of the personal health record 241
The development of the electronic personal health record 242
Blue Button for Patient Access to Electronic Health Records 243
Principles of an ideal personal health record 244
Proposed Benefits of an Ideal Personal Health Record 245
Types of Personal Health Records 246
Examples of existing personal health records 246
Current evidence of benefits of personal health records 247
Experience of Care 247
Quality of Care 248
Cost/Utilization 248
Current use of personal health records 248
Barriers to personal health record adoption 249
Awareness 249
Usability 249
Privacy Concerns 249
The Digital Divide 249
Provider Engagement 249
Interoperability 250
Summary of Adoption 250
The future of personal health records 250
References 251
Discussion questions 253
Case study 254
Discussion Questions 254
Chapter 15: mHealth: The Intersection of Mobile Technology and Health 255
Introduction 255
What Is Mobile Health? 255
Mobile Health Tools, Applications, and Examples of Uses 256
Client Education and Behavior Change 258
Sensors and Point-of-Care Diagnostics 259
Registries and Vital Events Tracking 259
Data Collection and Reporting 259
Electronic Health Records 259
Electronic Decision Support 259
Communication (Provider-Provider, Patient-Provider) 259
Provider Work Planning and Scheduling 260
Provider Training and Education 260
Human Resource Management 260
Supply Chain Management 260
Financial Transactions and Incentives 260
Driving forces of mobile health 261
Technology 261
Access 261
Range and Capabilities 261
Consumer/Patient Engagement and Empowerment 261
Global Health and Connected Healthcare 262
Research, Policy, and Business 262
Research 262
Policy 262
Business: Economic Potential and Cost Savings 263
Mobile health benefits and challenges 263
Mobile Health Evolution and Evidence 263
Benefits 263
Challenges 264
Patient Misinterpretation of Data 264
Data Privacy Risks 264
Legal Risks: Safety, Regulation, and Oversight of Data 264
Leading mHealth Organizations, Key Resources, and Information Repositories 265
Future directions of mobile health and conclusions 265
References 266
Discussion questions 269
Case study 269
Discussion Questions 270
Chapter 16: Strategic Planning and Selecting an Information System 271
Introduction 271
Strategic vision and alignment 271
Systems life cycle 273
Analysis and Requirements Definition 273
Project Planning 277
Develop or Purchase 278
Developing, Obtaining, and Evaluating Requests for Information and Requests for Proposals 278
Evaluating Vendors 279
Selecting the System 279
Preparing for Contract Negotiations 281
Establishing a Working Relationship with the Vendor 281
Conclusion and future directions 282
References 282
Discussion questions 283
Case study 283
Key Considerations for System Selection 283
Findings from Inventory of Current Systems and Functionality 283
Findings from Inventory of Paper Documents and Forms 283
Findings from Staff Interviews and Observations 283
SWOT Analysis 283
Chapter 17: Project Management Principles for Health Informatics 284
Introduction 284
The need for project management in healthcare organizations 285
Project, program, and portfolio management 286
Project Management 286
Project Process Groups 287
Key Knowledge Components 288
Benefits of Improved Project Performance 289
Program Management 289
Portfolio Management 290
Benefits of Portfolio Management 290
Portfolio Governance 291
Roles and responsibilities: project, program, and portfolio managers 291
Project Manager 291
Program Manager 293
Portfolio Manager 293
Project management tools 293
Gantt Charts 294
Project and portfolio management software selection 294
Conclusions and future directions 296
References 296
Discussion questions 296
Case study 297
Discussion Questions 297
Chapter 18: Contract Negotiations and Software Licensing* 298
Introduction 298
Overview of licensing agreements 299
Intellectual Property Concepts Relevant to Software 299
Why Are Contracts Used for Software Licensing? 300
The Concept of Licensing Versus Sale 300
``On-Premises´´ Licensing Versus Licensing Through the ``Cloud´´ 300
The Vendor's Contract: Healthcare Organizations, Beware! 301
The Mechanics and Process of Contract Negotiation for a Software License 301
Before the Agreement Is Signed: Due Diligence 301
Use the Request for Proposal Process 302
The ``Entire Agreement´´ Clause: Know What This Means! 302
Major steps or stages in the performance of a license agreement 302
Specific components of the licensing agreement 303
Definitions of Terms 303
Time Schedule 303
Scope of the License 303
Who Are the Users? 303
Rights 304
Restrictions and License Metrics 304
Scope of Use 304
Number of Copies 304
Environments and Instances 304
Derivative Works 304
Software and Software as a Service Escrows 305
Specifications 305
Software Warranties 305
Service Level Agreements 305
Uptime 306
Performance 306
Response Time and Resolution Time 306
Problem Severity 307
Remedies 307
Acceptance of the Software 307
Remedies for Rejection 308
Maintenance and Support 308
Maintenance Fees 309
Other Services 309
System Implementation or Installation Support 309
Outsourcing to Data Centers for Hosting and Software Management Services 310
Revenue Recognition and Payments 310
Payments 310
Overview of Termination 310
Termination for Breach 310
Is the Breach Curable? 311
Transition and Transition Period 312
Exclusive Remedy Clauses 312
Limitations and Exclusions of Liability 313
Limitation of Liability 313
Exclusion of Liability 313
Reciprocity and Exceptions 313
Insurance 313
Dispute Resolution 313
Special Clauses 313
Confidentiality 313
Intellectual Property Infringement 314
Indemnification by the Healthcare Organization and Disclaimers by the Vendor of Responsibility 314
Restrictive Covenants and Feedback Clauses 314
Governing Law and Forum Clauses 314
Right to Assign the Agreement and License 315
Use of the Healthcare Organization's Name, Marks, and Logos 315
Data Usage and Data Ownership 315
Conclusions and future directions 315
References 315
Discussion questions 315
Case study 315
Discussion Questions 316
Chapter 19: Implementing and Upgrading an Information System 317
Introduction 317
Reasons to implement or upgrade a healthcare information system 318
Changing Government Regulations 318
The American Recovery and Reinvestment Act 318
The Transition from ICD-9-CM to ICD-10-CM Codes and from HIPAA Version 4010 to HIPAA Version 5010 319
Best Practices: Incorporating Evidence-Based Content and Clinical Decision Support Systems 320
Patient Safety and Improved Quality of Care 321
New implementation versus an upgrade 322
Sufficient Resources 322
Risk Factors 322
Scope Creep 322
Best of Breed Versus an Integrated Health System 323
Opportunities for Improvement 323
Implementation and the systems life cycle 324
Phases of the Systems Life Cycle 324
Project Planning 324
Defining Success 324
Executive Management Support 325
Engage Stakeholders 325
Redesigned Workflows 325
Building or Tailoring the Product 327
Testing 327
Preparing for go-live 330
Big Bang or Incremental Go-Lives 330
Detailed Go-Live Plan 331
Education and Training 331
Trainers 332
Training Methodology 332
Length of Class and Class Schedule 332
Go-live 333
Post-live maintenance 333
Conclusion and future directions 334
References 334
Discussion questions 335
Case study 336
Chapter 20: Downtime and Disaster Recovery for Health Information Systems 337
Introduction 337
Downtime risk assessment 338
Downtime And Response Planning 342
Clinical Impact and Planning: Acute Care Focus 345
Redundant Systems 346
Downtime policies and procedures 347
Information technology impact and planning 347
Disaster planning 347
Disaster Recovery 348
Business Continuity 348
Communication 349
Responsibilities 350
Conclusion and future directions 350
References 350
Chapter 21: Improving the User Experience for Health Information Technology 352
Introduction to improving the user experience 352
The Current User Experience With Health Information Technology Products 352
Definitions of terms and their relationships 353
User Experience 353
Human Factors 353
Ergonomics 353
Human-Computer Interaction 354
Usability 354
The goals of usability 354
User-centered design 354
Design Thinking 355
Potential Benefits of Improving the User Experience 355
Increased Individual Effectiveness 356
Increased User Productivity and Efficiency 356
Decreased User Errors and Increased Safety 356
Improved Cognitive Support 356
Increased Organizational Efficiencies 356
Decreased Maintenance Costs 356
Decreased Customer and Individual Training and Support Costs 356
Decreased Development Time and Costs 356
Human-computer interaction frameworks for health informatics 357
Human Factors and Human–Computer Interaction Frameworks 357
The Health Human–Computer Interaction Framework 357
Essential Components for Improving the User Experience 358
Selecting methods to improve the user experience 358
Discount Usability Methods 359
Heuristic Evaluation 359
Examples of a Heuristic Evaluation Project 359
Traditional Usability Methods 360
Think-Aloud Protocol 361
Task Analysis 361
Example of a Task Analysis 361
Contextual Inquiry or Focused Ethnographies 361
Example of a Focused Ethnography or Contextual Inquiry 362
Formal user testing 362
Usability Questionnaires 362
Selecting a type of usability test 362
Determining User Needs and Requirements 362
Example of a Requirements Determination Usability Study 362
Formative Tests 364
Examples of Formative Tests 364
Validation Test 364
Example of a Validation Test 364
Comparison Test 365
Examples of a Comparison Study 365
Identifying Usability Issues With Fielded Health IT Products 365
Steps for Conducting User Experience Tests 365
Conclusion and future directions 366
References 366
Chapter 22: Informatics-Related Standards and Standards-Setting Organizations 370
Introduction 370
Standardized healthcare terminologies relevant to patient care 371
Healthcare data standardization 373
Definitions 373
Evaluation of the Quality of Terminology 373
Multidisciplinary Terminologies 376
Logical Observation Identifiers Names and Codes 376
Systematized Nomenclature of Medicine-Clinical Terms 377
Classifications Used for Reimbursement 378
RxNorm 378
World Health Organization Family of International Classifications 379
Nursing Terminologies 379
Clinical Care Classification 379
International Classification for Nursing Practice 380
NANDA International Nursing Diagnoses 380
Nursing Interventions Classification 380
Nursing Outcomes Classification 381
Omaha System 381
Perioperative Nursing Data Set 382
Data exchange efforts 382
HL7 Standards 383
Terminology Harmonization 383
Application of standardized terminologies 384
Designing User Interfaces Using Terminologies 384
Supporting Data Retrieval and Exchange 385
Monitoring the Quality of Care 385
Discovering Knowledge Through Research 385
Conclusion and future directions 386
References 386
Discussion questions 389
Case study 389
Discussion Questions 390
Chapter 23: Data Science and Analytics in Healthcare 391
Introduction 391
Data science in healthcare 392
Characteristics of big data 393
Data science for clinical and translational research 393
Benefits of data science 394
Approaches to analyses 394
Exploratory Data Analysis 394
Predictive Analytics 394
Prescriptive Analytics 394
Knowledge discovery and data mining 395
Retrieving a Dataset for Analysis 395
Preprocessing Clinical Data 396
Preprocessing Text Data 397
Preprocessing Coded (Structured) Data 397
Sampling and Partitioning 397
Data Mining 398
Statistical Approaches 398
Machine Learning 398
Evaluating Data Mining Models 399
Model Deployment 400
Organizational Considerations for Data Science 401
Data Science Personnel 401
Recommended Skills for a Data Science/Health Analytics Professional 402
Tools and Platforms 403
Data Standardization 404
Data Governance 404
Conclusions and future directions 404
References 405
Discussion questions 407
Case study 407
Chapter 24: Patient Safety and Quality Initiatives in Health Informatics 408
Introduction 408
Definitions 409
Quality of Care 409
Patient Safety 409
National initiatives driving adoption and use of health it 409
National efforts related to quality data standards 411
Evaluating quality and patient safety 413
Conceptual Framework for Patient Safety and Quality 413
Medication Safety 414
Chronic Illness Screening and Management 415
Nursing Sensitive Quality Outcomes: Patient Falls and Pressure Ulcers 416
Success factors and lessons learned 416
Conclusion and future directions 417
References 418
Discussion questions 420
Case study 420
Discussion Questions 421
Chapter 25: Legal Issues, Federal Regulations, and Accreditation 422
Introduction 422
Legal system 423
Federalism and the Constitution 423
Federal Healthcare Regulatory Framework 423
Laws 423
Regulations and Rule Making 424
Guidance and Advisory Opinions 425
Enforcement 425
Administrative Enforcement 425
Court System 425
Fraud and abuse and billing issues related to electronic health record use 426
Stark Law 426
Federal Anti-Kickback Statute 426
Safe Harbors 427
Health and Human Services Donation Safe Harbor 427
False Claims Act 427
Wire/Mail Fraud 428
Fraud and Abuse and the Electronic Health Record 428
State Law 429
Accreditation 429
The Joint Commission Health Information Management Standards 429
Sentinel Event Alerts 430
The intersection of new technology and regulation 431
Medical Devices 431
mHealth Wearable Devices and Telehealth 432
Privacy and Ownership of Data Collected by mHealth and Wearable Devices 432
Liability Issues 432
Social Media and Informatics 433
Conclusion and future directions 433
References 433
Chapter 26: Privacy and Security 436
Introduction 436
Definitions and concepts 437
Legal and historical context 437
Fair Information Practice Principles 437
Code of Ethics for Health Informatics Professionals 438
International Medical Informatics Association 438
Principles, laws, and regulations guiding practice 438
National Privacy and Security Framework for Health Information Laws and Regulations 439
International Laws 439
U.S. Federal Law 440
The History of HIPAA 440
HITECH Act 441
HIPAA Omnibus Final Rule of 2013 441
ONC Tool for Integrating Privacy and Security into Health Practices 442
Federal-State Collaboration 443
HIPAA and Secondary Uses of Electronic Health Data 443
Public Health Monitoring or Surveillance and HIEs 443
De-identification of Data 443
The importance of information security 444
The Public Trust 444
Legal Requirements and Fines 446
Increasing Security Threats to Healthcare Data 447
Current security vulnerabilities 448
External Events 448
Internal Vulnerabilities 448
Medical Devices 448
Current security challenges 449
Managing security risks with security controls 449
Administrative 449
Conducting Risk Assessments or Risk Analysis 450
Technical 450
Physical 450
Resources 451
Conclusions and future directions 451
References 451
Discussion questions 453
Case study 454
Discussion Questions 454
Chapter 27: The Health Information Technology for Education and Clinical Health Act, Meaningful Use, and Medicare Access ... 455
Introduction 455
Federal initiatives to drive health information technology 456
Executive Order 13335 456
The American Recovery and Reinvestment Act of 2009 456
Office of the National Coordinator for Health Information Technology 456
Health Information Technology Policy Committee 458
Health IT Standards Committee 458
Office of the National Coordinator for Health Information Technology Standards and Interoperability Framework 458
Regional Extension Centers 459
Financial Incentives 459
Eligible Entities and Eligible Professionals 460
Medicare and Medicaid Payments 460
Meaningful Use 461
Medicare Access and Children's Health Insurance Program Reauthorization Act of 2015 471
Conclusion and future directions 472
References 472
Chapter 28: Health Policy and Health Informatics 474
Introduction 474
Developing and implementing health information technology policy 475
Role of the Federal Government 475
Office of the National Coordinator for Health Information Technology 477
Driving forces for creating health information technology policy 480
Patient Safety 481
Institute of Medicine Report on Health Information Technology and Patient Safety 481
Unintended Consequences of Health Information Technology Implementation 481
Quality Initiatives 482
National Quality Strategy 482
Leadership competencies for developing and implementing health information technology policies 482
Ensuring That Health Practitioners Are Positioned on Key Committees and Boards 483
Responding to Requests for Comments 483
Developing Position Statements 484
Leading policy activities through organizational work and leadership 484
Strategies 484
Discipline-specific policies: nursing 486
Use of Health Information Technology to Advance the Future of Nursing 486
The Future of Nursing Report Recommendations 486
Implications for Time and Place of Care 486
Expand Opportunities for Nurses to Lead and Diffuse Collaborative Efforts 487
Prepare and Enable Nurses to Lead Change to Advance Health 487
Center to Champion Nursing in America 487
Advancing Education Transformation 488
Fostering Interprofessional Collaboration 488
Healthcare Information and Management Systems Society Nursing Informatics Position Statement 488
Assessing Progress on the Institute of Medicine Report The Future of Nursing 488
Conclusion and future directions 489
References 489
Discussion Questions 490
Case Study 491
Discussion Questions 491
Chapter 29: Health Information Technology Governance 492
Introduction 492
Health information technology governance: need and core components 493
Key insights 494
Respect Current Decision-Making Structures 494
Shift in Organizational Mindset 494
The Continual Increase in Demand for Health Information Technology 495
Governance Does Not Depend on Specific Technology Choices 495
Coordination and Collaboration with Diverse Stakeholders 495
Recommendations 495
Conduct a Health Information Technology Capability Maturity Assessment 495
Investigate Peer Informatics Governance Models 496
Design, Implement, and Iteratively Enhance Informatics Governance 497
Conclusion and future directions 497
References 497
Chapter 30: Informatics in the Curriculum for Healthcare Professionals 499
Introduction and background 499
Overview of Informatics and Health Information Technology 499
Education Reform Initiatives 500
Accreditation, Certification, and Credentialing 500
Challenges of Technology-Enhanced Education 502
Faculty Expertise 502
Health IT Tools 505
Teaching and learning in an evolving healthcare and technology environment 505
The Role of Informatics in the Curriculum 505
The History of Informatics Competency Development 505
The Science of Informatics and Curriculum Design 506
Framework for informatics curriculum 506
The Learning Health System 506
Pedagogy 507
Teaching Tools and Learning Strategies 507
It takes a village: roles and competencies 508
Health IT Workforce Roles 508
Community College Training Overview 509
University-Based Education Overview 510
Educating the Generalist 511
Educating Healthcare Specialists at the Graduate Level 511
Educating the Health Informatics Specialist 511
Educating the Health Informatics Researcher and Innovator 512
Continuing Professional Development 512
Conclusion and future directions 512
References 512
Discussion Questions 514
Case Study 515
Discussion Questions 515
Chapter 31: Distance Education: Applications, Techniques, and Issues 516
Introduction 516
Historical development 517
Terminology 517
Course delivery systems: course management systems 520
Portals 521
Ellucian 521
Jenzabar 521
Proprietary Course Management Systems and Learning Management Systems 522
Blackboard 522
Desire2Learn 522
SharePoint Learning Management System 522
Open Source 522
Moodle 523
Sakai 524
Cloud Based 524
Partnerships 524
Selection Criteria and Role of the Selection Committee 524
The Future of Course Management Systems 525
Instructional design for distance education and learning 526
Learners and How They Learn 526
Goals and Objectives (Outcomes) 528
Instructional and Learner Activities 528
Evaluation 528
Student (learner) support services 529
Library 529
Tutoring Services 529
Online Textbook Distributors 529
Help Desk 530
Administrative Services, Academic Support, and Community Building 530
Issues 531
Legal 531
Digital Millennium Copyright Act of 1998 531
Technology, Education, and Copyright Harmonization Act 531
Higher Education Opportunity Act 532
Intellectual Property 532
Family Educational Rights and Privacy Act 532
Disability Issues 533
Quality 533
Readiness 534
Institution 534
Students (Learners) 534
Conclusion and future directions 534
References 535
Chapter 32: Informatics Tools for Educating Healthcare Professionals* 538
Introduction 538
Comprehensive education information system 539
Computerized teaching tools 540
Hardware 540
Interactive Whiteboards 540
eReaders and Digital Books 541
Smartphones 542
Tablets 542
Laptops and Desktop Computers 543
Clickers 543
Educational Software 544
Learning and Content Management Systems 544
Mind Maps 544
Digital Portfolios 545
Web-Based Student Testing 545
Student Journaling Software 545
Gaming 546
Virtual Worlds 546
Impact on the teaching and learning process 547
Teaching From a Global Perspective 547
Impact on the faculty role 548
Using Best Practices for Technology-Enhanced Course 548
Scenario 549
Impact of Technology Enhanced Courses on Faculty Evaluation 549
Conclusion and future directions 553
References 554
Chapter 33: Simulation in Healthcare Education 557
Introduction 557
Types of Simulations 557
Fidelity 558
Benefits of Simulation 559
Challenges and Opportunities 560
Cost 560
Technology 560
Faculty Development 560
Organizations 561
Faculty or Administrative Buy-In 562
The simulation process 562
Learning Theories Applied to Simulation 562
International Nursing Association for Clinical Simulation and Learning Standards of Best Practice: Simulation 564
Glossary46 565
Professional Integrity of the Participants 565
Participant Objectives and Outcomes 565
Facilitation 565
The Debriefing Process 565
Participant Evaluation 566
Simulation-Enhanced Interprofessional Education 566
Simulation Design 566
Application of simulation 567
General Application of Simulation to Education 567
Application of Simulation for Evaluation 567
Application of Simulation to Interprofessional Education 568
Example 569
Conclusion and future directions 571
References 573
Chapter 34: International Efforts, Issues, and Innovations 577
Introduction 577
Key initiatives in world regions 577
eHealth Initiatives in Europe 577
The European Federation for Medical Informatics 578
eHealth Initiatives in the Asia-Pacific Economic Cooperation Region 578
Asia Pacific Association for Medical Informatics 579
eHealth Initiatives in the Pan American Health Organization Region 581
International Medical Informatics Association for Latin America and the Caribbean 581
eHealth Initiatives in Africa 582
Health Informatics in Africa 582
International organizations with ehealth involvement 583
eHealth and Health Informatics at the World Health Organization 583
The eHealth Resolution 583
Global Observatory for eHealth 584
World Health Organization Family of International Classifications 584
International Medical Informatics Association 585
IMIA-NI 586
International standards efforts 587
International Organization for Standardization 587
International Council of Nurses 588
International Classification for Nursing Practice 588
The ICN Telenursing Network 589
Connecting Nurses 589
Health Level Seven 590
International Health Terminology Standards Development Organisation 590
Global challenges to ehealth 590
Global Interoperability 590
Human Resources for eHealth 590
eHealth Infrastructure 590
Legal and Regulatory Framework for eHealth 591
Conclusion and future directions 591
References 591
Discussion questions 592
Case study 593
Discussion Questions 593
Chapter 35: The Evolution of Health Informatics 594
Introduction 594
The roots of informatics within the computer and information sciences 594
Computer Science 595
Information Science 595
Health Informatics 596
Establishing the specialty of health informatics 597
Books 597
Journals 598
Professional Organizations 599
Educational Programs 600
Accreditation for Health Informatics Education Programs 602
Certification 602
Recognition by the U.S. Bureau of Labor Statistics 604
Recognition of the specialty 605
Naming the specialty—naming the discipline 605
Conclusion and future directions 607
References 609
Discussion questions 610
Case study 611
Discussion Questions 611
Chapter 36: Future Directions and Future Research in Health Informatics 612
Introduction 612
Futures research (futurology) 613
Defining Futures Research (Futurology) 613
Future Directions and Scope of Change 614
The Challenge of Anticipating Future Directions 615
Approaches for Predicting 616
Trend Analysis and Extrapolation 616
Content Analysis 616
Scenarios 616
Backcasting 617
Application of Futures Research 617
The future of health informatics 618
Person-Centered Health and Informatics 618
Care Anywhere 619
Personal Data Integration 619
Technical Trends 619
The Internet of Things 619
Cybersecurity Threats and Mitigation 620
Clinical informatics 620
Beyond EHRs 1.0 620
Improving the user experience for health information technology 621
Analytics (big data) and data visualization 621
Predictive analytics 622
Data visualization 623
Nanotechnology 624
History of Nanotechnology 624
Nanofabrication and Nanomedicine 624
Nanofabrication 624
Nanomedicine 625
Cautions About Nanotechnology 625
Nanoinformatics 625
Issues in Regulation and Ethics 626
Conclusion and future directions 626
References 626
Glossary 630
Index 638
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