What informatics challenges to improve pt outcome?
-equipment failure** (IT error)
-Data errors or (Human errors)
-Security problems
-alarms/alerts
... [Show More] issues with in system
-Documentation takes too much time away from pt care.
What act recognizes patients need more power in own healthcare and access to information is KEY?
21st Century Cure's Act
2 Fundamental, ethical principals of health informatics and why is it important for nurses to know about these?
**privacy, security and confidentiality for pt information.
Integrity
Respect for peoples rights
-information privacy
-Uphold data integrity
Important for nurses because we are all involved with using healthcare technology and it is our job to help keep PHI safe and private.
How to ensure pt records are protected? HIPAA guidelines
LOGICAL=automatic sign off. Encryption. Antivirus. Passwords.
PHYSICAL =Locks. Limit access. Surveillance.
What are 2 main categories of Health Information System and example?
Clinical=Lab, monitor, vitals, radiology
Administrative=Admit, discharge, schedule, payroll
What is the structure that provides balance between privacy and access, comply with state, national, international ethical and legal requirements?
Governance structure
Describe how health data from various sources is used in decision making process?
Variety of options, able to see a full picture
ex: Vitals, labs, imagine help decide how to treat appropriately.
5 properties of BIG DATA
5 V's
Volume= amount
Velocity= how quick it moves
Variety= type
Veracity= quality and accuracy
Value= value data can provide
Health Information System (HIS)
System used to support and enhance pt care
Administration= Registration, payroll, schedule, risk management
Clinical=Lab, monitoring, imaging, ordering system, radiology, pharmacy
HL7 (Health Level 7)
Standard for exchange and interoperability of data between systems.
Data
Facts, figures, numbers, etc. gathered through observations.
data integrity
Collect, store, complete and current data
available for authorized users.
American Recovery and Reinvestment Act (ARRA)
2009
Help economy, create jobs
*Federal funding= Incentives for organization to use health information technology (HIT)
Meaningful Use and using EHR's
21st Century Cures Act
2016
Provide funding and promote research
Prevent and CURE serious illnesses
Develop medication and medical devices
Support mental health efforts
Improve interoperability and Health Info Exchange (HIE) - seamless access to EHR's
**Pt in charge of own health is KEY- better information technology needs addressed to help with this.
Health Information Technology for Economics and Clinical Health (HITECH) Act
2009
Dept of Health and Human Services (HHS) authority to get programs to improve healthcare Quality, Safety, and Efficiency.
-proposed Meaningful use
-Directs providers to adopt EHR and HIT and interoperability.
-Support HIPAA rules and regulations
-Improve exchange of information privacy
**Financial incentive and penalties
**Use of meaningful use and HIT to decrease health cost - improve health.
Health Literacy
-Person ability to learn, process, understand basic health information and services.
-Able to make health decisions
**Why is it important -So they can manage own health. If low literacy may take wrong dose of meds, delay treatments. Patient safety issues.
Gap Analysis
Compares actual performance with potential / desired performance.
GRADE
-Grading of Recommendations, Assessments, Development and Evaluations.
-Input from contributors for grading system.
-Bring forward ideas, approach to grade research evidence.
**Grades=High, moderate, low, very low
**Number of participants, risk of bias trials, heterogeneity, methodological quality of review.
Meaningful Use (MU)
ARRA including HITECH authorized incentive payments to adopt and use interoperable health information technology and EHR. To implement the incentive the CMS developed sets of Meaningful Use criteria. MU requires EHR's result in improved Quality, Safety, and Efficiency. Pt involved in own care. 3 stages.
MU stages
Promoting interoperability program consists of these stages.
1 - Data capture and share: w/hosp and providers
2- Advanced clinical processes: Standard term, transmit info by pt and pt view info online and message provider
3-Improve clinical outcomes: Enhanced use of EHR to improve care. (ex: scripts. Clinical qualitative measure)
MU requirement by CMS
-Basic entry of clinical info
-Standard terminology
-Use of several software apps
-Entry of clinical orders with safety measures
Health Insurance Portability and Accountability Act (HIPAA)
-1996 AKA Kennedy Kassebaum Bill
-Protect automatic client records (protected health information-PHI)
-All electronic transactions include HIPAA compliant codes
**Signing in devices requires encryption
**Fines= $100-50,000 and 1 year jail
De-Identified HIPAA
-No restrictions
-Doesn't provide information to identify individual
-Removal of identifiers and relatives and anything that would identify them.
Required Disclosures HIPAA
-2 situations
-To individuals when requested or an accounting of disclosure of their PHI
-To Health and Human Services (HHS), when it is undertaking a compliance investigation or review or enforcement action.
Permitted uses and disclosures of PHI - HIPAA
-Permitted, not required without individual permission
**To the individual (accounting disclosures)
-Treatment and payment and health care operations
-Opportunity to agree or object
etc....
Disclosure of psychotherapy notes - HIPAA
Requires written authorization from individual
Disclosure to covered entities - HIPAA
-Covered entities (healthcare, health plans) may disclose PHI to...
-Public health by law to prevent or control disease
-Child abuse and neglect
-FDA for adverse event reporting, tracking products or recalls.
Disclosure-victims of abuse/neglect- HIPAA
Workers compensation
-Covered entities may disclose PHI to right government authorities in regards to abuse and neglect.
-May disclose to comply with workers comp laws, work related injury or illness.
Disclosure - Limited - HIPAA
-Protected health info (PHI) where specific identifiers removed: relatives, household, employees.
-Disclosed for research, health care ops, public health purpose.
**Person enters into data use agreement promising protection of info.
Authorized uses - HIPAA
-Must obtain written authorization for use of PHI that is not for treatment or payment.
ex: Disclosure to life insurer for coverage purposes.
Disclosure of psychotherapy notes - HIPAA
-Don't need authorization if for their own training
- Not needed if defending self legally (therapist)
Limited use disclosure minimum necessary - HIPAA
-Entity makes responsible effort to use, disclose and request minimum amount of PHI needed to accomplish purpose.
-Policies by entity to limit use and disclosure to minimum necessary.
Privacy practice notice - HIPAA
-Provide notice of privacy practices
-Notice have certain elements
-Describe the way entity may use and disclose PHI
-State duties to protect privacy
Special case minor - disclosure - HIPAA
Parents are representative for children (most time)
Personal Representative disclosure - HIPAA
-Personal representative treated like the individual themselves. Legally authorized to make healthcare decisions for person or deceased.
-Unless entity has reason to believe representative is abusing.
Governance structure
Created to give balance between privacy and access while complying to state, national, and international ethical and legal requirements.
DIKW
Data, Information, Knowledge, Wisdom
-American Nurses Assoc. adopted DIKW
-Guide scope and standards of practice for informatics nurse.
Data (DIKW)
-Observation with little interpretation
-Small factors: Ht, wt, married etc..
-Not meaningful by itself
Information (DIKW)
-Progressively developing, cluster of data
-Relations/ interactions not yet evident
-Meaningful clinical picture
-Who, what, where, when
Knowledge (DIKW)
-Information processed and organized
-Relations, interactions identified
-Patterns between different information
-Question of why and who
Wisdom (DIKW)
-Proper use of knowledge
*experience to manage and solve problems
-Know why things or procedures should or should not be implemented.
HIPAA Protected Health Information (PHI)
-Name, address, birthdate, SS #, phone #, email
and then associated with health data like a medical bill.
Must be identifiable and related to medical information listed below. ex: a phone number in a phone book is not PHI because it is not associated with medical information.
-Individuals past, present, future physical or mental health condition.
-Provision of healthcare to the person.
-Past, present, future payment for provision of healthcare to the person
4 Levels of nurse informatics
-Beginner: Basic information and computer skills and knowledge.
-Experienced: Specific area of expertise. Analytic skills and work with specialist.
-Informatics nurse specialist: Advanced skills specific to health information management and computer tech. Design and develop.
-Innovator: Informatics research, generate, theory, innovator. [Show Less]