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1
Q
  1. Compare the super user and job-aid training approaches for information system training.
A

There are two major on-the-job training methods:

  • Super user, a regular user of the system who has in-depth knowledge of the information system. Understands clinical areas and information system, any user may apply. Must take time away from clinical position.
  • Job aides-learning tools at the workstation. Decreases need to memorize large amounts of information, decrease time for training. Access must be complete and up to date. User friendliness is key, all users must be given same information.
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2
Q
  1. Describe peer training and self-directed text-based courses used for information system training.
A

Two methods:

  • Peer training: new users are trained by existing users. New users shadow peer. Adv: training is tailored directly to the function needed, proficiency can be easily tested. Dis: training may not be knowledgeable in principles of education, bad habits passed along. Tip: trainer should have knowledge of adult education, works better with lower level staff.
  • Self directed text-based: self directed (self-paced) by use of provided materials. Usually in the form of workbooks, very little interaction with subject matter experts. Adv: works at own pace, proficiency easily tested, system does not need to be in place for training. Dis: motivation must be high. Tips: very structured material.
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3
Q
  1. Describe web-based and on-the-job training approaches to information systems.
A
  • Web based training: delivers content directly to students via the internet.
    • ADV: accessible from any PC that is connected, available 24hrs.
    • DIS: expert web master needed, intranet must already be in place. Tips: online learner assessment is included.
  • On-the-job: delivered to the student in person, usually at the work site.
    • ADV: can be tailored to individual, learning applied immediately, proficiency tested by trainer.
    • DIS: lower productivity, bad habits passed on, interruptions are bothersome. Tips: trainer should have adult education experience.
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4
Q
  1. Describe the role of support personnel who work with healthcare information systems.
A

Super user: employee with advanced knowledge about computers and is familiar with the work done at the department level.

Help desk: hospital must have 24hr information system help. PC specialists: BS in computer science assists with training and system setup.

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5
Q
  1. Describe the Logical Observation Identifiers Names and Codes (LOINC)

International Classification for Nursing Practice (ICNP)

Nursing Management Minimum Data Set (NMMDS) for classification systems.

A

LOINC: database terms primarily for lab results. 32,000 terms that include clinical information and codes for nursing observations.

ICNP: uniform terms for nursing data. Sponsored by the International Council of Nurses. Categories for diagnosis, interventions and outcomes.

NMMDS: dynamic collection of standardized terms related to nursing. Goal was to create terms that could be used by wide range of computer systems. Terms for describing context and environment, categories for personnel characteristics, financial resources and population data.

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6
Q
  1. Describe the informatics nurse responsibilities
A
  • Teaching
  • Security
  • System effectiveness
  • System works as designed
  • Systems upgrade
  • Finding new ways to use technology in nursing
  • Compliance
  • Project management
  • Research in informatics
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7
Q
  1. Describe the Perioperative Nursing Data Set (PNDS)

SNOMED CT

Patient Care Data Set (PCDS).

A

PNDS: uniform terms for patient problems that may occur during an operation.

Systematized Nomenclature of Medicine Clinical Terms: 357,000 concepts defined and categorized, 957,000 descriptions, English, German and Spanish.

PCDS: data dictionary designed to provide standard clinical set of terms for inclusion in healthcare information systems, classification for problems, goals and orders.

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8
Q
  1. Describe the advantages and disadvantages of expert systems.
A

ADV:

  • Consistency in decision making
  • Central knowledge depository database can be larger than human experts can remember and information survives staffing changes
  • Ability to review answers and generate reports

DIS:

  • Software lacks common sense
  • Logic is locked down lacks creativity
  • Programming can be complex and is not adaptable,making it difficult to change
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9
Q
  1. Describe some of the roles that the informatics nurse plays.
A
  • Developing informatics theories: what should be captured and how to analyze the data.
  • Analyzing the information needs of the organization
  • Help choose the computer system
  • Customize the purchased computer system
  • Design the system
  • Test and upgrade systems
  • Teach/training
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10
Q
  1. Describe the two primary data entry systems used in healthcare informatics:

Clinical Care Classification (CCC) system and the

Omaha System.

A

CCC: two major subsets of information: diagnosis and outcomes, interventions and actions. 21 care components that cover functional, physiological and psychological, compatible with ICD10.

Omaha: problem classification scheme (assessment), Intervention scheme and Problem rating scale which ranges from 1-5 similar to Likert scale, home care public health and community nursing.

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11
Q
  1. Outline three classification systems used in informatics:

NANDA-I (North American Nursing Diagnosis, Definitions and Classifications)

Nursing Interventions Classification (NIC)

Nursing Outcomes Classification (NOC) system.

A

NANDA-North American Diagnosis Association International: 167 classified diagnosis defined and characterized in this system.

NIC: 514 treatments performed by nurses, provides NANDA diagnosis, categorized into 44 specialties.

NOC-Nursing Outcomes Classification: 330 disease states that provide expected outcomes for patient, caregiver, family and community, includes definitions, indicators, measurement tools and references. Using these tools ensures terms are standardized and thus comparable across organizations, also compatible when published.

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12
Q
  1. Explain data mining.
A
  • Electronically searching through large amounts of information to find relevant items.
  • Associated rule mining-looks for patterns of data showing up repeatedly not random.
  • Classification: data group membership such as number of sunny days in year.
  • Clustering: organized data according to their similar characteristics into clusters.
  • Mining is also called knowledge discovery. Results can be used to make predictions. Sample size needs to be considered, possible ethical considerations.
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13
Q
  1. Describe expert systems.
A

These systems are programmed with information that a human expert would use to handle a particular problem, in some cases provide a list of recommendations. The knowledge base is created by individuals that are asked to provide guidelines to solve very specific problems. Its tested to verify outcomes. They may use true/false or fuzzy logic which is generally not as accurate as true/false.

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14
Q
  1. Describe four types of data warehouses.
A

Data warehouses are separate entities to free up space and improve response times on servers.

  • Offline operation databases-simple copies of operation system.
  • Offline data warehouse-regular copy used in report-oriented system.
  • Real-time warehouse-similar to offline data warehouse but updated realtime.
  • Integrated-updated, processed and returns results to central system for use daily.
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15
Q
  1. Describe three major parts of data warehouse and storage of data.
A
  • Infrastructure-refers to hardware and software used.
  • Data-diagram representations of the structures that send and store information and how they relate.
  • Process-how information gets from one place to another. Most warehouses use Codd rules of normalization which breaks it down into tables to show relations.

Two types of data design:

  • Dimensional-breaks data into numerical facts that are easy to use and operate quickly but are hard to modify.
  • Normalized-third normal form, they tend to be slow and difficult to use.
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16
Q
  1. Define EHR and its guidelines.
A

HIMSS defines EHR as “secure, real-time, point-of-care, patient-centric information resource for clinicians”. According to the model it should: manage information for long and short term, clinicians main resource when caring for patients, use evidence based planning for individual and community, QI, performance management, risk management, utilization review, resource planning, billing, clinical research since data is standardized and up to date.

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17
Q
  1. Define the term data retrieval and four important factors.
A

Accessed data that has been stored.

  • Performance-speed and ability to process requests.
  • Capacity-number of files and size of files.
  • Security-protecting data.
  • Cost-support personnel, software and hardware.
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18
Q
  1. Explain the term data management.
A

The storage, access and security of patient data that includes paper documents as well as x-rays that are handled by analyst, programmers and database admins.

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19
Q
  1. Describe the term automated documentation.
A

Charting by exception allows nurse to view normal values and change only those that the patient does not conform. Standardized nursing languages allow drop down menus that are free from ambiguity.

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20
Q
  1. Describe the factors necessary for information quality.
A
  • Timeliness-available as needed.
  • Precision-system dictionaries shall describe uniform wording and definitions.
  • Accuracy-Error free as possible.
  • Measurable-quantifiable so that comparisons can be made.
  • Independently verifiable-information remains constant regardless of individual reporting it.
  • Availability-access as needed and at the appropriate location.
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21
Q
  1. Outline some of the hazards related to storage on computer.
A

Safer on a computer than paper but hazards are:

  • Environmental and physical.
  • Control-keeping records from being erased, storing or altered.
  • Planning-creating backup copies.
  • Time restraints-archiving, how long to keep records.
  • Transfer-salvage records that may become degraded.
  • Maintenance-of system that reads and writes data.
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22
Q
  1. Describe the attributes that help to assure accuracy of information.
A
  • Objective reporting-unbiased.
  • Comprehensive-all information that is available to complete requests.
  • Appropriateness-users are able to access information necessary for job.
  • Unambiguous-data is clear.
  • Reliable-data keyed in by different people is the same.
  • Up to date-most recent data is listed first.
  • Convenience-not difficult to find data.
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23
Q
  1. Describe supportive, scooped key, minimum-motion, and straight column keyboards.
A
  • Supportive-support wrist but may cause fluid build up.
  • Scooped key-puts keys closer together and allows an extra row.
  • Minimum motion-light touch keyboard.
  • Straight-lessons stress on left hand little effect on right.
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24
Q
  1. Outline the steps for human centered design.
A
  • Define and understand the organizations requirements and individual requirements.
  • Define and understand the logistics of how and where the system will be used.
  • Break down tasks by priority, duration, frequency and probability of completion.
  • Define key functions-logical and intuitive to user.
  • Find common errors that may occur, optimize to process.
  • Interfaces and workstations so they work for users.
  • Test with actual users and then make adjustments.
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28. Three factors that contribute to software usability.
* Learnability-time it takes to learn and figure out. * Memorability(efficiency)-time it takes to perform task w/o using instructions, intuitive design. * Discovery-time taken to find feature.
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29. Explain the term usability when choosing software.
Useability is based on the user-centric design of the software. Measurements from focus groups, interviews, questionnaires. Balance between utility and usability.
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30. Outline the International Council of Nurses Code of Ethics for nurses in regards to practice and profession.
* Keep up to date with education. * Look after ones own health. * Dont take on more than reasonably handled. * High standard of conduct. * All new applications of tech are safe and dont compromise dignity. * Put in place ethical standards in clinical, management, education and research.
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31. Describe the International Council of Nurses Code of Ethics for nurses in regards to coworkers.
* Cooperative and professional * Patients are safe, deal with unprofessional conduct * Dont delegate more than individual can handle * Promote continuing education * Keep communication open between departments
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32. Describe the framework for nursing informatics as defined by the American Nurses Association.
Standards: * Assessment * Diagnosis * Identification of outcomes * Planning implementation * System planning * Performance:QA, effective * research * ethics * peer cooperation * allocation of resources * communication
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33. Describe the International Council of Nurses Code of Ethics in regards to patients.
* Best patient care. * Patient rights, religion beliefs. * Informed consent. * Privacy. * Community health.
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34. Describe the essential elements in the practice of nursing informatics.
* Focus on patient * Keeping up to date * Working environment * Working with others * Knowledge of data structures (hierchical, network, relational, object oriented) * Knowledge of computer networking * Knowledge of hardware * Training skills * BS Minor in computer science
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36. Benefits of wireless technology.
* Less chance of human error * Less chance of information being seen by unauthorized personnel * Time saving * Decreased error from transcription * More secure than paper * No need to update files, saving time.
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37. Describe trend toward mHealth.
Trend will grow as cheaper and less expensive wireless becomes more wide spread. Devices include: diabetes monitors, IV delivery, fetal dopplers. Popular are digitized voice, third gen broadband, packet based transmission allowing patients to have real time control of medical conditions.
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38. Describe digital picture archiving and communication systems
PACS are becoming more feasible because of the decrease in cost of memory. PACS needs to be integrated into existing EHR. PACS can save time and resources and good investment for organizations.
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39. Describe computerized provider order entry systems.
* Real time and safest treatment possible * Intuitive-resembles a paper record and can be personalized * Secure * Portable-accessible anywhere * Improves billing and coding.
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40. Describe the Health Insurance Portability and Accountability Act.
Created in 1996. * Rules regarding how electronic transactions are processed * Unique identifier code for all providers, health plans and employers * A way to keep information secure and private * Granted certain rights for patients to view their own records * Providers can keep PHI on their computer.
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41. Areas of concern related to computer systems used in healthcare outlined by JCAHO.
* Databases outside organization need to be secured * PHI is secure * Knowledge based systems should be developed to allow local expertise to be used in organization * Link physician systems while protecting PHI * Support QI programs * Data integrity and security * Same controls for current procedures for computer * Assessment for future needs and growth.
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42. Describe role of the CIO, CPO, CehealthO
CIO-Hires information system staff, budgeting, design, and new systems. CPO-Federal mandated position responsible for PHI, usually someone in another position. Ehealth-Works with web to promote online interactive patient service.
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43. Describe the role of security officer for information systems.
* Responsible for assigning system access codes * making sure passwords are updated and kept secret * Physical security * P&P.
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44. Describe the roles of: Compliance Planning and Recovery officers Interface engineers
* Compliance-Making sure staff are following federal and accrediting requirements. * Planning-keeping disaster and recovery plans up to date and integrated between departments * Interface-Making sure information integrity is maintained when data is exchanged between systems.
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45. Describe the history of HIPAA
Enacted in 1996 * 2002-code sets to be identified * 2003-Privacy standards are to be set * 2004-Standards for employer identification are to be set * 2005-Standards for system and data security to be set * 2007-Standards for provider identification are to be set * Standards to be set to ensure efficient monitoring to provide patient privacy.
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46. Describe the roles of analyst, liaisons and programmers.
Analyst-Primarily define the way clinical data is entered and processed by system Liaison-Works between IT team and clinical staff. Programmers-individuals that write code for system.
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47. Describe the role of network administrator and trainer.
* Network admin-have access to all areas of system therefore must be held to high standards of ethical accountability * Manage current and design new system * Help to organize hardware * Trainer-teach staff how to use computer systems
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48. Discuss nursing theories Stages of clinical _competence_. developed by Patricia Benner.
Stages of clinical competence * Novice-depends on rules and learned behavior * Adv beg-has some experience * Competent-2-3yrs experience can cope well given time for planning * Proficient-looks at situations holistically, can adapt plans to changing needs * Expert-wealth of experience, cares intuitively rather than rules, able to focus in on care needed.
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49. Discuss nursing theories Philosophy of human caring developed by Jean Watson.
Views the individual holistically. Has ten caritas: * loving kindness and equanimity * sustaining spiritual beliefs * Cultivating personal spiritual practice * Maintaining caring relationship * Support both neg and pos feelings * creative in caring * Teaching withing patients frame of reference * healing environment * Basic human needs * Being open to spiritual concepts of life and death
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51. Discuss information science: Information theory developed by Claude Shannon.
Shannon identified problems that required solutions. The essential factors in a system of communication include the source of power, the bandwidth, the noise, and the decoder/receiver. * Signal-to-noise indicates the ratio between a signal’s magnitude and interfering “noise” magnitude. * Channel capacity, which determines the amount of information that can be transmitted with the smallest rate of error. * Entropy refers to the amount of energy, code, or bits, required to communicate or store one symbol in the communication process. The lower the entropy, the more efficient the process of communication.
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54. Discuss nursing theories: Florence Nightingale founder of modern nusing.
Created first training school. Set standards for sanitary conditions, nutrition and kindness.
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55. Discuss nursing theories: Nursing process theory developed by Ida Jean Orlando.
Published the Dynamic Nurse-Patient Relationship. Nursing process includes: * Behaviour of the patient * Nurses reaction * Subsequent nursing actions needs may be different than what patient expresses.
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56. Discuss nursing theories: General theory of nursing developed by Dorothea Orem.
Actually three theories: * Self-care * Self-care deficit-nursing necessary to provide care * Nursing systems-actions to meet patients self-care needs.
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57. Discuss nursing theories: Total-person systems model developed by Betty Neuman.
Concentric circles of physiological, psychological, sociocultural, spiritual, developmental provide defenses for individual. Model focuses on reactions to stress. Interventions include: Primary-preventive steps before stress develops. Secondary-prevent damage to central core and remove stressors. Tertiary-promote reconstitution and reduce energy needs support after secondary intervention.
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60. Four steps in evidence-based practice.
Steps include: * Make diagnosis * Research * Apply research * Evaluate outcome
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61. Discuss integrating the results of data analysis.
These data should be used for long-term strategic planning but also for identifying opportunities for performance improvement. It includes: Identifying issues for tracking, reviewing patterns and trends, process improvement, evaluating systems, monitor specific cases and outcomes.
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62. Discuss evidence-based practice: Strategies.
* Access to journals at POC * Clinical understanding of how to interpret results of research * Classes or on-site help should be available
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63. Discuss evidence-based practice: Steps to developing guidelines.
* Focus on the topic/methodology * Evidence review * Expert judgment * Policy considerations * Policy * Review
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64. Discuss benchmarking: External benchmarking and internal trending.
* Analyzing outside data compared to organizations outcomes * External data must be equivalent to internal data * Internal is comparing departments within the organization. This can still be a problem since each area is different
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65. Discuss benchmarking: Xerox Corp 10-step model.
Moves through four phases: planning, analysis, integration and action. The steps: * Identify targets * Identify organization/providers to which to compare * Collect data * Evaluate current performance * Project future performance * Communicate findings and reach agreement * Recommend changes based on benchmark data * Develop action plan * Implement actions and adjust according to monitoring * Update benchmarks
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66. Explain data presentation: Scattergram.
Graphic display of one piece of data plotted on x and another on Y. A pattern may emerge with enough data. Example age and ER admissions. If the pattern is straight line there may be correlation between variables.
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68. Explain data presentation: Balanced scorecard.
Performance measures that include: financials, customers, clinical outcomes, education/learning, community, growth.
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70. Explain data analysis: Chi-square test and t test.
* Chi-square-is a method of comparing rates or ratios. The chi-square test is a means by which to establish if a variance in categorical data (as opposed to numerical data) is of statistical significance. Lets you know whether two groups have significantly different opinions, which makes it a very useful statistic for survey research. Rates of infection compared between two surgical procedures. * T test-The t test is used to analyze data to determine if there is a statistically significant difference in the means of both groups. The t test examines two sets of data that are similar, such as the average number of miles walked each week by women over 65 who have breast cancer as compared to women over 65 who do not have breast cancer.
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71. Explain data analysis: Regression analysis.
Regression analysis is used when two or more variables are thought to be systematically connected by a linear relationship. Like temp and drying time. Used to evaluate the data sets found in scattergrams. The correlation coefficient range from 1 to -1. -1 indicates as one variable increases the other decreases. 1 indicates that both variables increase or decrease. 0 indicates no relationship.
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72. Explain definitions used in data analysis.
* Sensitivity-data includes all positive cases, taking into account all variables decreasing false-negatives. * Specificity-data only include those specific to measurement. * Stratification-data are classified by subsets, taking variables into consideration. * Recordability-ability to collect necessary data. * Reliability-reproducible. * Usability-collection tool should be easy to use. * Validity-results have predictive value.
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73. Explain data analysis: Knowledge discovery in database and data mining.
Knowledge discovery in database (KDD)-method to identify patterns in large amounts of data. Perturbation (a deviation of a system, moving object, or process from its regular or normal state of path, caused by an outside influence) may be used to hide names while still accessing the useful data. Data mining-analysis of large amounts of data for hidden patterns. Steps include: * Anomalies * Identifying relationships * Clustering * Classifying * Regressing and summarizing
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74. Explain data analysis: Measures of distribution such as range, variance and standard deviation.
* Range-highest to lowest number. Interquartile denotes the range between the 25th and 75th percentile. * Variance-measures the distribution spread around an average value. * Standard deviation-shows the dispersion of data above and below the mean. In normal distribution 68% are within 1 standard deviation, 95% 2 and 99.7% 3.
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75. Explain data analysis: Measures of averages such as mean, median and mode.
* Mean-actual average * Median-middle of data * Mode-most frequently occurring number.
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76. Explain data aggregation.
Collection and summation of data for further use such as for statistical analysis.
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77. Discuss data representation: Unicode standard coding scheme.
Provides a specific numerical value to represent text for most languages allowing ease of use across platforms. Approximately 110,000 characters.
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78. Discuss data representation: Hexadecimal coding system.
Representation of decimal numbers in format that uses fewer characters than binary. 1-9 and A-F.
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79. Discuss data representation: Binary code.
Base 2 0's and 1's to represent values. 8Bits = 1byte.
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81. Discuss types of health care-related data: Medical/clinical, knowledge-based, comparison and aggregate data.
Medical/clinical-patient specific. Knowledge-based-staff has been given access to information to make good practice care. Comparison-benchmarked data for best practice. Aggregate-data not included in clinical record, financials, demographic, etc.
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82. List the major steps used in strategic planning.
* Mission statement * Determine goals * Create strategy * Identify solutions * Select action * Implement * Evaluate
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83. List important questions that should be asked when performing strategic planning for information systems.
* OS open or closed, can programmers access * What tech is the system built * Is the user interface friendly * Does it comply with current standards * How easy it is it to create reports from raw data * How is system performance measured * Can users customize views * How many users can it support * Is it upgradeable * Will system decrease paper use * Timeline for implementation.
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84. Define the term management science.
The study of business decision making using various analytical methods.
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85. Explain the way goals are set in an organization.
Goals are based on the needs assessment. Either long or short term.
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86. Define the term computer science.
The study of information manipulation to solve problems.
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87. Explain the factors that are important for information systems in the accreditation process.
* Measures to protect PHI * Training for users that encourages standard data entry * Information should be available on computer and print form.
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88. Explain the National Institutes of Health (NIH) push for standards in information storage, creation, analysis and retrieval.
Standard is called ISCAR: information storage, creation, analysis, retrieval. The point is to make data more comparable reviewable and verifiable
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89. Outline the factors that JCAHO has identified as important to patient information security.
* Information available in 24hrs in best format for user * Orders entered as quickly as possible * Test results quickly * Systems in place to help eliminate errors * Communication methods reviewed for efficiency * Clinical and non-clinical should talk * Records customizable * Creation of reports by users * Ability to compare organizations
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90. Define the steps for workgroup formation.
ADV: increased creativity and insight. DIS: fail because of personal conflicts. * Forming * Storming * Norming * Performing
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91. Explain the term systems theory.
The system is not just a grouping of individual parts but an entity itself. Natural and designed. Embedded and entangled. Important factor is the complexity.
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92. Describe the advantages of telehealth.
Allow virtual house calls. Consults by monitoring patient status during a surgery.
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93. Discuss regional health improvement plans.
Developed to improve delivery of health care. Cover all aspects of health care including: * risk * diagnosis * treatment * disability * social mental factors as well as delivery including hospital and clinics and individual practitioners Working to improve care will reduced costs.
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94. Discuss implications of health care reform.
* Initiatives to change from paper to electronic * Increasing number of people covered on plans * Increasing demands on health care providers * Emphasis on data analysis to improve care while decreasing costs * Increasing literacy is necessary so they better understand their options.
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95. Discuss the personal health records: patient use.
Encouraging patients to participate in their own health care. Allowing them to enter some of their own data, b/p, history blood sugars. Delegation-allowing assignment of others to allow access and still restrict certain areas like sexual and treatment history. Messaging-allowing the sending of secure messages.
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96. Discuss health information exchanges and regional health information organizations.
* HIE have been developed to allow transfer of PHI between providers in an area or region, to save costs and speeding access * Grants are allowed from the National Coordinator of Health Information Technology to establish RHIO to facilitate HIEs * The RHIO is a neutral organization with basic function of allowing data to be effectively and securely exchanged across local state and regional HIEs
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97. Types of personal health records.
* Paper * Non-tethered- not connected to particular system * Tethered-tied to a particular system secure patient portal is provided * Networked-data derived from multiple sources allowing more flexibility.
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99. Disuss applying current research findings to practice: Model of integration.
Integration of data analysis and research for performance improvement or best practice guidelines depending on the model of integration: * Organizational-teams report to one individual * Functional/coordinated-risk and quality management are not integrated they draw from same data source * Functional/integrated-staff to specialties with cross-training, a case management approach so that the patient can be followed through the system.
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100. Discuss the personal health records: elements.
* Individual has the ability to control PHR * Information is comprehensive, pts lifetime * Information from health care providers * Easily accessed at any time any location * Secure and only accessed with proper auth * Discloses who, when entered data * Exchanges information with different providers * Should deliver care cost-effective and efficiently
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101. Explain issues related to instructing and advising staff on changes in policies, procedures or working standards.
* Policies-updated after period of discussion with admin and staff, staff alerted during meetings or notices. * Procedures-changed to improve efficiency or safety, communicated in workshops with demonstrations * Working standards-changed because of regulatory or accrediting discussed in workshops, handouts so implications understood.
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102. Explain a review of informatics policies and procedures.
Review done in response to surveillance/evaluation * Acheivement of goals-may need to set new goals * Analysis of variances and assessing risk factors * Staff input-meetings and questionnaires regarding compliance, knowledge and training * Training review-ongoing and coupled with clear expectations of compliance.
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103. Discuss interpersonal communication skills: Team building.
* Initial interactions-define roles, develop relationships, determining comfort of group * Power issues-determine who controls meeting, alliances form * Organizing-team begins to work together, gaining respect working toward common goal * Team identifications-interactions become less formal, more willing to help each other to achieve goals. * Excellence-good leadership, committed team members, clear goals, high standards, external recognition, shared commitment to the process.
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104. Discuss development of policies.
Based on best practice, conform to state, federal and accreditation regulations and guidelines. Use of computer equipment may be more specific.
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105. Discuss the project scope and project plan.
Project scope-the goals of the information system project, outlining both the content and complexity. Alternate solutions should be identified. Project plan should include: * Objectives of the project and characteristics * Requirements * Acceptance criteria * Limitations, boundries and contraints * Assumptions * Premilinary timetable and schedule taking into consideration skill levels of assigned staff * Risks and methods to attenuate * Initial work breakdown
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106. Discuss communication skills needed for leading intra- and interdisciplinary teams
* Open communication, encourage participation * Avoid interrupting or interpreting * Avoid jumping to conclusions * Active listening, asking questions for clarification * Respect opinions of others * Facts not feelings * Clarification to avoid misunderstanding * Keeping unsolicited opinions to a minimum.
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107. Discuss the legal implications: Privacy and security rules.
Privacy-applies to electronic, paper and verbal communications, billing. Security-applies to: * electronic * admin * physical * technical along with P&P. Auth users only, unique identifiers, auto logoff, encryption, data not altered or destroyed, secure transmissions * Break-the-glass procedures.
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108. Discuss legal implications: Proprietary data.
Monitor proprietary software associated with patient lists, copyright, financials and other details about the organization need to sign nondisclosure agreement.
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109. Discuss legal implications: Patient data misuse.
* Identity theft * Unauthorized access * Privacy violations * Security breaches.
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110. Discuss legal implications: Liability.
* Delay between data entered and acted upon * Errors of data entry due to improper training * Interface engine errors causing data errors * Delay in response to emails.
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111. Discuss legal implications: Malpractice and negligence.
Negligence care is below established standards leading to malpractice.
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112. Discuss methods to promote an environment for ethical decision-making and patient advocacy.
Clear P&P should be defined for dealing with conflicts, ethics committee and training for staff.
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113. Discuss the synergy model: Advocacy and moral agency.
Advocacy-working in best interest of patient/stakeholders. Agency-recognition of issues and acting on them. Moral agency-recognize needs and take action to influence outcome.
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114. Discuss issues related to the fair distribution of health information access.
Allowing access to EHR data as well as journals while maintaining privacy and giving training on use of products. Telehealth for those that dont have access.
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115. Advanced practice nursing: Discuss ethical principles in practice.
* Treats individuals with respect * Primary commitment is to individual * Advocacy * Responsible for own care practice and delegation * Respect for own competence * Environment is conducive to good care * Improved education opportunities * Collaborates with others * Promotes profession.
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116. Discuss the International Medical Informatics Association code of Ethics.
Part 1 begins with a set of fundamental ethical principles and a brief list of general principles of informatic ethics that apply to electronic gathering, processing, storing, communicating, using, manipulating and accessing of health information in general. These general principles of informatic ethics are high-level principles and provide general guidance. Part 2 This part lays out a detailed set of ethical rules of behaviour for HIPs. They are more specific than the general principles of informatic ethics, and offer more particular guidance. * right to privacy * Open process of data collection pt informed * Security * Right to access personal data * legitimate infringement for greater good of society * Infringement of right to privacy * Accountability of infringement
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117. Discuss the American Nurses Association definition scope and functional areas of the informatics nurse specialist.
INS has completed graduate or certification. Functions include: * Providing tools for standardized documentation * Managing information * Re-engineering information processes and promoting standardization * Participation in research * Analyzing data * Providing nursing management * Consultant in informatics * Promoting/providing professional development * Advocate for staff/pt. * Ensuring implementation of EHR and CPOE * Support for applications.
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118. List the questions that should be asked when evaluating an information systems HIPAA compliance.
* Where is data stored * Unique login each user * Workstations physically secure * Auto logoff * Safe from unauthorized users * Hardware/software up to date * Backup security * Printed copies disposed of correctly.
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119. Discuss system security and integrity: Device access control.
Determine what class of users has access to different devices and then what method of authentication for role and entity-based access is required. Medical devices may be on same network, mobile devices on multiple networks this poses additional risks. They must be password protected any violation of security policies must get restricted access.
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120. Discuss system security and integrity: time out.
Workflow should be considered in scheduling log off. Part of HIPAA security rule.
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121. Discuss system security and integrity: security failures.
* System penetration * Destruction/sabotage * Mistake/errors * Password management * Device compromise-mobile devices.
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123. Discuss audit trails.
Activity related to systems, applications, users access and use.
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124. Discuss Federal regulations pertaining to security and privacy: Health Information Technology for Economic and Clinical Health Act.
2009. HITECH. * Incentive payments for EHR that meet meaningful use. Penalties for those that dont adopt. * Individuals/HHS must be notified of breach * Business partners much meet security regulations * Sale or marketing of PHI restricted * Patients must have access to electronic information * Individuals must be notified of disclosures * Matching grants for higher education, research, development and Indian Health services.
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126. Discuss user security:Tokens
Types include: * ID cards-employee badges * drivers license, easily falsified * Challenge-response-token with user/password * Smart cards-microchips that are programmable, like debit card.
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127. Discuss telecommunications:Radio-frequency identification.
RFID-automatic identification with embedded digital memory chips with unique codes to track patients, medical devices, medications and staff. Chips have ability to read/write data making them more flexible than bar codes. Dont read well on metal or liquids. Two types-Active: continuous signals between chips and sensors. Passive:signals transmitted when in proximity to sensor. Passive for admin of meds, active to track movements of staff, equipment, patients.
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130. Describe the four types of computer networks.
* LAN-computers connected in a single area * Metropolitan area-MAN used to connected computers in separate buildings typically ethernet or phone * WAN-Large geographic area connected by VPN * Internet-worldwide network of computers.
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132. Describe the three major _classes_ of computers.
Analog-measure temp, pressure, HR, fetal monitor. Digital. Hybrid-ECG and EEG are two types of this type.
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133. Describe some less commonly used peripherals.
Light pen, touch screen, OCR, computer enhanced include CAT and MRI.
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134. Define the terms: bits and bytes.
Bit-binary digit. Byte-eight symbol unit.
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137. Describe several common methods to preserve data integrity.
* Education * System checks-system error checks help eliminate inappropriate info or omit mandatory information * Data verification-having patient visual verify info * Minimize fraudulent info-checking photo ID
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138. Describe the classification of programming algorithms by their design.
* Divide and conquer * Dynamic programming-breaks the problem into problems that have already been solved * Greedy method-makes sure of approximate answers and can be the fastest way to find solutions * Linear-inputs are restricted based on predetermined construct * Reductive-change the problem into simpler problem * Search and enumeration-specify rules in the form of graph.
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139. Describe three common threats for information stored in computerized systems.
* Quality-compromised by alteration of files either accidental or intentional (virus, worms, trojan horses). * Availability-power outages, damage to system, disaster, sabotage or system overload. * Confidentiality-compromised by personnel or unauthorized individuals.
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140. Define the term: data transformation.
Process of changing information from a given source into information that can be understood by a destination point (such as database) * 2 step process: * data mapping-how information flows from one place to another and which needs to be transformed. * Code generation-actual transformation of data into form compatible with destination. Following any transformation it is important to conduct test of data integrity. Random tests should also be performed.
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141. Describe programming algorithms and how they are applied to information systems.
* Recursion-calls itself repeatedly until match is made * Iterative-constructs that repeat themselves many times with possible addition of other information to find solution * Logical-uses controlled dedication of axioms, algorithm=logic+control * Serial-one instruction after another. Parallel and Distributed-breaks into parts that are solved on different machines then brought together for results * Deterministic/Non-deterministic-uses precise decisions or uses heuristically designed system of guessing. * Exact/Approximate-concrete answer or one that is close enough.
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142. Discuss disaster recovery plans.
Ability to continue operation at some level and return to full function once disaster is over. Should cover every conceivable scenario, it may be helpful to break into sub plans.
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143. Explain the things that can go wrong with disaster recovery planning.
Documentation-should be stored in several locations(paper and digital). Equipment-new equipment needs to be added to plan. Data storage-plan should allow quick recovery of critical information w/o using archive. Keeping plan updated-updating and testing are common.
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144. What is important about end user acceptance and what are the six steps to analyse user acceptance.
Is done to determine if end users will use computer technology in the way that its designed. Without acceptance users may avoid or misuse tech or remain dissatisfied, impacting job performance. Steps to analyze end user acceptance: * Analyzing basic requirements of the system and the organization * Identify end user acceptance scenarios * Describe a testing plan include different severity levels based on real-wold conditions * Design testing plan and test cases, considering the risks and skills of end users * Conducting the tests * Evaluating and recording results
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145. Human-computer interactions: Framework developed by Nancy Staggers.
Psychology and technology to explain human interactions with computers over a period of time in different contexts. Contexts include:providers, patients, interactions between patients and providers.
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146. Explain the term: programming languages.
Five generations based on how close they mimic human language. * Binary, then assembler which looks like language but relates to binary making it diffucult to understand. * Cobol, fortran, java, vb are third generation. * Most interact with computers using fourth generation allowing users to use menus. * Fifth generation will be verbal commands.
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147. Describe utility programs for computers.
Antivirus, language translation, web browsers, assembly, compilers and GUI's are also utilities.
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148. Define the terms architecture and topology as they apply to computers.
Architecture is the type of computer used in system like LAN. Topology is they way interconnected like star or bus.
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149. Discuss user modeling studies: Cognitive walkthrough and ease of learning.
Is a method used to determine each step in the process to complete a task. Having the user verbalize the desired actions and evaluating how easy the process is to learn. Sessions may be video or audiotaped for later playback.
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150. Conducting usability studies.
Counting number of errors and type of errors. There are low level, medium and high level type.
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151. Describe the six elements of a system.
1. Interdependency 2. Inputs 3. Process 4. Output 5. Control-works to prevent or correct problems 6. Feedback
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152. Describe the five logical steps of computer programming.
1. Problem 2. Design 3. Coding 4. Testing 5. Implementation.
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153. Define the term: system theory.
Is a method to detect ways to connect seemingly unrelated ideas or functions * The parts are interdependent * Inputs through process produce outputs * Any problems must be corrected at primary level * It is more than sum of its parts.
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154. Describe the terms: open and closed system.
Open-no fixed boundries. Interacts with environment, ie nurse in hospital, access to source code. Closed-defined boundries, other than power source, ie IV pump. Adaptations from vendor.
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155. Describe the term: hospital information systems HIS.
* Administrative-non-clinical * Semi-clinical-part admin/part clinical * Clinical
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156. Describe the term: network systems.
Linked group of computers. Ability to share data over servers. Easier to upgrade since only one upgrade necessary.
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157. Describe terms: management information systems Bibliographic retrieval systems Stand alone systems Transaction systems Physiologic monitoring systems
* MIS-Operational support that provides day-to-day functioning of both human and tech needs * Bibliography- allowing access and retrieval of journal info like Medline. * Standalone- turnkey systems that are not linked with other systems. * Transaction systems-produce reports with same format each time. * Physiological- ECG or EEG outputs.
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158. Describe the terms: Decision support systems Expert systems Artificial intelligence systems Natural language systems
* DSS-take avaliable data generate results choose optimum solution. * Expert-similar to DSS but uses logic derived from task experts. * Artificial intelligence-using model of human reasoning, learning by trail and error. * Natural language-understanding and process info using human language, speech and handwriting recognition.
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159. Describe the Accredited Standards Committee and the Pharmacy Standards Association.
Accredited Standards Committee (ASC)-They have created universal standards for healthcare computerized tasks in US. Current version X12N used nationwide for claims, enrollment and determining insurance eligibility. NCPDP (National Council Prescription Drug Program)-nearly 100% of retail pharmacy claims processed in real-time. Works with HL7 and X12N for use in EHR.
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160. Describe the industry standards associated with nursing informatics.
* IEEE developed Medical Information Bus standards to aid in transfer of information between medical devices and mainframe computer systems. 802.11 can also do this wireless * DICOM digital imaging communications in medicine is also a standard in the US.
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161. Explain the significance of sabotage, errors and disasters on an information system.
* Sabotage-the majority are angry or unhappy employees, the rest are external hackers. * Errors-poor design, incorrect data entry. * Disasters-may cause system to be down for extended period. Need to have backup procedures and to be tested.
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162. Describe the American Society for Testing and Materials (ASTM).
E1384-96, E1633-95 and E31 are the primary standards in healthcare. * E1384-96 developed in 1996 provides standards for computer based patient record (cpr). * E31 will specify the CCR (continuity of care record) and how it should be presented in electronic format.
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163. Describe the methods to avoid the installation of malicious software.
* Only licensed software * Updated virus protection with daily scans * Never open attachments from unfamiliar sources * Keep original software and inventory hardware in secure location * Update software regularly * Train staff on proper use of software.
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164. Outline the different types of malicious software that may be a threat.
* Virus-can damage, must be running to spread * Worms-Use LAN and WAN to spread * Trojan Horse-Appears legitimate but actually something else * Logic bombs-Type of virus triggered by specific data. Bacteria-type of virus, not attached to other programs.
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165. Describe the fundamentals of computer security mechanisms.
Both physical and electronic. Firewalls as well as physical locks.
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166. Outline the three levels of user authentication security.
* Level 1-password, will log out, and updates with specific level of complexity * Level 2-encrypted key, will logout when too far from system * Level 3-biometric.
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167. Define data dictionary and master patient index.
* Data dictionary-list of common terms, their definition and synonyms. De facto standard that all departments can use. Meta data, the what and where of the database information, often another table in the db. * Master patient index-each patient be listed along with name, ss#, dob and should allow scaling.
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168. Describe the term:computer system integration.
Integration is necessary for company information to be more useful. Two types: * Point-to-Point-connects two systems directly to each other * Software reliance system-an interface engine, can be either real time or batch processed.
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169. Explain the telehealth applications of IDEATel, RLI and Health Buddy.
* IDEATel-program that aggressively monitors blood sugar and allows physician to change medication daily * Resource Link of Iowa-gives video link to chronically ill to provide high level of care while decreasing physical appointments * Health Buddy-electronic device that asks patients questions, sends reminders and communicates medical status to physician. Other devices can be linked to device.
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170. Discuss four major threats to computer systems.
* Environmental * Human error * Human mischief * Equipment failure
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171. Describe the important information surrounding attributes used in conceptual data models.
* Name of attribute-like gender, date of birth * Domain of attribute-like male or female.
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172. Discuss type of programming language: structured query language.
SQL is fourth generation programming language 4GL that is different than Java which is 3GL. Both ANSI and International Organization for Standardization have adopted SQL. There is portability issues though associated with vendors not using the entire standard.
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173. Discuss CPOE.
Standard format for entering physician orders. About 50% of medication orders are made in error, so can make huge impact on patient safety.
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174. Discuss barcode medication adminstration.
BCMA. The intent is to increase accuracy of admin of medications of meds and dose.
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175. Discuss boolean logic.
Developed in 1800s by George Boole. Uses operators like AND, OR and NOT. Allows truncation with "\*", wildcards like "?".
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176. Discuss standards: Clinical Context Object Workgroup.
CCOW is an HL7 workgroup that developes standard protocols for the sharing of information among applications at the point of care through context management. For example data about patient may be contained in a number of different applications and locations but the CCOW allows users to do one search (for a patient) and finds information in all applications. CCOW defines the standards that allow the interoperability that is technology neutral. Works in http and Active X.
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177. Discuss International Organization for Standardization.
ISO. In 164 countries. Developes volunatary standards based on consensus of governments, business and users. Does not provide certification or accreditation.
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178. Discuss communication theories: Social Exchange theory by George C. Homans, John Thibaut and Harrold Kelley.
Describes communication as an exchange system in which people attempt to negotiate a return on their investment, those involved in communication seek a balance between invenstment and return.
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178. Discuss communcation theories: Social penetration theory by Irwin Altman and Dalmas Taylor.
Descrbes the manner in which people use communication to develop closeness to others, proceding from superficial to more explicit sef disclosure which causes vulnerability but allow for closer relationship.
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178. Discuss communication theories: Spiral of science theory by Elisabeth Noelle-Neuman.
Looks at the role mass media has in influencing communication and suggests that people fear isolation so that they conform to public opinion as espused by mass media and mute dissent. Noelle holes black holes, spiral into black hole, black hole of media.
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178. Discuss communication theories: Face-negotiation theory by Stella Ting-Toomey.
Assumes all cultures concerned with maintaining face and that those with idividualistic cultures are less likely to be compromising than those with collectivist cultures. Ting-Toomey face gloomey.
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179. Discuss communication theories: Communication accomodation theory by Howard Giles.
CAT is effected by context (social and historical). It argues that when people interact they adjust their speech, their vocal patterns and their gestures, to accommodate to others. Giles the cat, that wears a hat, to accomodate others.
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179. Discuss communication theories: Cultivation theory by George Gerbner.
Explains the effect that media, primarily tv has on cultivating ideas and beliefs related more to media than real life. Media speads these ideas that may already exist affecting perceptions of reality. Of all of the professionals, scientists seem to have the short end of the stick and they seem to be portrayed in a slightly more negative light. Scientists are tended to be portrayed as “smarter and stronger than other professionals." While this may not be all bad things, they tend to be unbecoming characteristics that could shed a negative light on the entire profession. Gerbner, gerber, baby with hoe, cultivating scientist.
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180. Discuss change theory: Theory of reasoned action by Martin Fishbein and Icek Ajzen.
Actions people take voluntarily can be predicted according to their personal attitude and their perception of how others will view their action. Fishbein and Ajzen, fishing actions, smart fish, reasoning, reasoned action, concerned with how other fish will view them.
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181. Discuss change theory: Theory of planned behavior developed by Icek Ajzen.
Basically this theory relates to the persons confidence based on beliefs and social influence of others that he ro she can actually do an action and that the outcome of this action will be positive. This theory considers the power of emotions such as apprehension and fear when predicting behavior.
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182. Theory of adult development by Robert Peck.
Middle age-Neg:week relationships, inflexibility and resistance to change, Pos:strong relationships, flexibility and adatptable to change. Older adult-Neg:loss of identity after retirement, inability to accept bodily function changes, fear of death, Pos:meaningful like after retirement, accept body changes, feel that like has been good. Old pecker, flexible pecker good, inflexible bad.
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183. Theory of adult learning theories: Theory of adult development by Robert Havighurst.
Stages that were needed during each stage relective of development in the 60's. Early adult-finding mate, children, start occupation. Middleage-achieving civic social responsibility, raising teen agers, accepting psychological changes related to aging, aging of parents. Older adult hood-decreasing health, death of spouse, retirement and reduced income. Havighurst, aging worse.
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185. Family system theory by Murray Bowen.
A person needs to be looked at in the context of their family unit. Bowen, family bowling.
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186. Complex adaptive theory.
Complex systems are interdisciplinary with multiple components that interact and adapt to allow learning. Adaptive systems are open that allow adaptation that readily allow changes to those problems. Originaly biological, but can be applied to families, communities and organizations. Adaptive systems are more effective than efficient and have fewer rules than nonadaptive systems.
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187. Change theory by Kurt Lewin and Edgar Schein.
Management theory that has three stages: * Motivation and change (unfreeze)-change forces stress that leads to denial, blame and bargaining without real change * Desire to change (unfrozen)-desire is high enough to actual identification of needed changes * Development of permanent change (refreezing)-new behaviour becomes habitual.
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188. Cognitive flexibility by Rand Spiro, Paul Feltovitch and Richard Coulson.
Information needs to be presented in a variety of ways and in context. Avoid oversimplification, build knowledge by interaction with material and interconnect instructional sources.
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189. Theory of multiple intelligences by Howard Gardner.
At least seven categories like: Linguistic, logic, spatial, body, musical, interpersonal-communicate with others, intrapersonal-self aware.
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190. Theory of cognitive dissonance by Leon Festinger.
Avoidance of inconsistencies between beliefs and actions. If it occurs then change in beliefs and ideas are more likely to change than actions/behaviors.
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191. Attribution theory by Bernard Weiner.
Four factors that affect acheivement: * Effort * ability * difficulty * luck. People will view own acheivements from lack of effort or ability and rate others on luck. On personal failure it will be luck, while other people it will be because of effort or ability.
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192. Advantages and disadvantages of multimedia training.
ADV: interactive, instructer can be asked questions, tests of proficiency can be used. DIS:teacher and student need to be avail at those times, tech problems, access to computer and network.
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192. Advantages and disadvantages of online tutorials.
ADV: Available 24hrs, trainee can revisit sections, offline exams can be administered. DIS:dependent on richness of design, trainee may not be as focused as live setting.
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193. Discuss enterprise wide strategic planning.
Organization looks to the needs of the organization, community, customers both short 2-4yrs and long 10-15yrs to establish goals. * Collect data and analysis of customer need * Analyze internal services and functions * Understand strengths and weaknesses of organization * Develop or revise mission/vision statements * Establish specific goals
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194. Discribe advantages and disadvantages of email training.
ADV: Trainees receive training materials electronically, email messages are easy to assemble and target to trainees. DIS: Must open email, response may be slow or not at all.
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194. Describe advantages and disadvantages of video training.
ADV: Available 24hrs, exposes many trainees from single point, easy to distribute and share. DIS: Expense of equipment, familiar with training through video medium.
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195. Discuss Cost-utility analysis.
A sub type of cost-effective analysis. The results are more difficult to quantify, like decrease in teen pregnancy or life expectancy. Results are usually expressed in society values instead of monetary.
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196. Discuss Cost-effective analysis.
Measures the effectiveness of intervention instead of monetary savings. A decrease in suffering as compared to a decrease in health care costs, both of which may be possible.
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196. Discuss Efficacy studies.
A comparison of series of cost benefit analyses to determine the best intervention of cost-benefit. ie comparison of four different computer systems to determine which had the lowest error rate.
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197. Discuss gap analysis.
Determines the steps required to move from current state or performance level to a new one and what that gap is. Steps include: * Assessment of current situation * Identify current outcomes * Identify target outcomes * Outline process to achieve targets * Identify the gaps * Identify the resources needed to close gaps
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198. Discuss clinical flow chart.
Often used to analyze quality improvement. Typically uses the following symbols:parallelogram, arrow, diamond and circle. Flow top to bottom, left to right.
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199. Discuss request for information.
RFI is used early in system analysis to gather information from vendors to help in selection process. Topics are:history of financials, current users and number of sites, system architecture, hardware/software requirements, user support, integration with other systems.
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200. Discuss data flow diagram.
Shows data flow in a system from one process to another. A simplified flow chart with four symbols:square, rounded triangle, arrow,three sided open rectangle.
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201. Discrete data
Data that has specific value and cannot be further quantified. Database designer and users may have different ideas of what is discrete thus causing problems is database build.
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202. Current procedural terminology (CPT) codes.
Developed by AMA. Medical/surgical treatments, diagnosis and procedures. Updated each Oct. Mandated by Medicare/Medicaid. Cat 1-procedure/service, Cat 2-performance measures, Cat 3-Temporary for tech and data collection.
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203. Pay for performance P4P or value based purchasing.
Payment is based on quality instead of quantity of service. Disincentives like inexcusable outcomes are also considered.
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204. Americans with disability act (ADA).
Disabled including mental impairment access to employment and community. Prevents discrimination with employers with more than 15 employees. Employers can only ask if accomodations are needed. They can only do jobs that they would normally be able to do.
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205. Control chart
Has mean line and an upper and lower control limits that are nomally 2-3 standard deviations from the mean.
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206. Do not pay list.
Medicare will not reimburse for these complications, so its critical to avoid these: * Fall * stage 3-4 pressure ulcer * vascular cath infection * cath UTI * transfusion reaction * post op dehis * surgical death with treatable complications.
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207. Areas of training for information systems.
* Cover each area the user will use * Simulation of potentially challenging situations * Basic troubleshooting and help screens * Basics of the system * How system impact areas of responsibility * Support should be painstakingly covered so that they are aware whats available.
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208. Four tools that informaticist uses to evaluate ongoing training needs.
* End user questionnaires and interviews to determine user acceptance and where training needs are. * Real time observations- to evaluate user efficiency. * Analysis of errors/repairs-may be most cost effective since it will target those that make errors. * Reviewing staff changes-note new staff since they may have little or no training.
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209. Discuss common problems with conversion of new system.
* Inadequate time allotted * Scope creep related to programming revisions * Underestimating level of customization needed * Failure to budget for service contracts, tech support, power and ongoing operation of system * Inadequate testing * Failure to adequately train or budget for training and materials * Failure to understand user resistance
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210. Discuss three when/why system enhancements.
* May be better to schedule every six weeks as opposed to introduction whenever there are changes made * Committee to decide on enhancements may help decide which are really necessary * Additional time and training is necessary and needs lead time
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211. Archive legacy data.
* Audit to eliminate redundancy * Determine what is needed for business/legal reasons * Determine what should be active/inactive * Review policies regarding data retention * Develop plan for archiving and decommissioning data * Validate data integrity
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212. Discuss conversion and go live data conversion/migration.
With new systems, but may also need to be done with updates. * Planning stage-inventory of systems, types and amount of data, determine most cost effective process, start mapping * Performance stage-creating backups and extraction, normalizing and performing testing * Validation-checking to ensure data converted accurately, no dupes or formatting errors.
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213. Discuss interoperability.
* Technical-two systems from different manufacturers that can exchange data with each other * Syntactical-transfer of data formats without necessarily ensuring meaning intact, HL7 * Semantic-transfer so that people recognize the content as being the same, codesets * Process-process and specs that facilitate exchange of data from one organization to another.
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214. Discuss system performance effectiveness: Maintenance, recovery, regression.
* Maintenance-testing of software when it has changed in some way * Recovery-purposely crashing system and evaluating system recovery * Regression-testing system after change like a patch.
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215. Discuss analysis of system performance effectiveness: smoke/power on, software performance and usability.
* Smoke/power on-initial testing to identify failures * Software performance * systems ability to perform under specified workloads * load testing * stress * endurance * spike * Usability-end user testing for: * performance * accuracy ability to recall steps * duration of time on steps
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216. Big bang implementation.
Complete switch to new system. ADV: rapid change, less updating of documentation, focused training DIS:confusion, lost data, learning curve, startup problems, need fallback plans
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217. Phased implementation.
Phased in by module, unit or geography. ADV:using those that started system as trainers DIS:disruption of operations, difficulty in accessing complete data.
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218. Parallel implementation.
Legacy and new system used. ADV:allows users to learn new system while using old, allows to test accuracy of new system which makes it less risky DIS:may cause more errors because of duplicate data entry
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219. System performance effectiveness: sanity, scalability and security.
* Sanity-rapid run through to determine if system works correctly * Scalability-testing for increased load (scaling up) and nodes (scaling out) * Security-test authentication, access controls, availability, nonrepudiation.
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220. Discuss system performance effectiveness: ad hoc compatibility exception handling
* Ad hoc- usually just once to find a specific problem, error guessing. * Compatibility-testing in different environments, web browsers, bandwidths, peripherals to databases. * Exception handling-test for incorrect programming, coding and if it has negative effects like corrupted data. Both hardware/software.
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221. Discuss methods used to analyze end user acceptance.
* Using testing scenarios * Interviews * Questionnaires * Comparative studies * Direct observation * Indirect observation * Analysis of data for accuracy
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223. Run chart
A line graph showing outcomes over time, like infections. Has a median line which allows a “run” on one side of the median line. Either 6 points in same direction or 8 on one side of the median need investigation.
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224. Documentation of quality indicators (QI).
AHRQ-agency for healthcare research and quality provides software. It includes SAS and windows interface w/SQL server. MONAHRQ-allows quality reporting and viewing free to federal, state and local agencies and consumers can also access.
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225. Trending analysis.
Applied to run chart or control chart. Run-7 or more consecutive data points above or below the median. * Trend-7 or more consecutive data points either ascending or descending with 21 or more points, or 6 with less than 21 points * Cycle-An up and down sawtooth pattern * Astronomical- points unrelated to other points indicate sentinel or special cause variation
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226. Programming changes.
Updates due to changes in user needs or regulatory requirements. Usually updated every 18 months, usually one can be skipped w/o major disruption. Cost, obsolescence, productivity and regulations need to be considered.
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227. Classroom response systems (CRS).
Students can answer with a clicker to allow the instructor to know if the class understands the questions. Allows all students to input in back and ones that are quiet.
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228. Four phases of system development life cycle.
* Needs (Intiate)-requirements are collected from future users of system. * System selection (Analysis/Design)-information system is selected that can meet requirements. * Implementation-phase which system is scaled up and performance tested. * Maintenance (Support)-help desk set up and system is regularly backed up and updated.
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229. Items that need to be evaluated when performing system selection in SDLC.
* Costs related to hardware/software and network * Vendor reputation, knowledgeable staff and financial stability * System capabilities, ease of use, meet organization needs, security, expandability and interface with other systems.
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230. Items that need to be evaluated when performing needs assessment in SDLC.
* Compatability of hardware/software * Downtime for system testing/installation * Set up of live and test environments * Response times and concurrent users * User support system * Adminstration of system * Security of system * Disaster recovery * User interface and reports * Routines for registration, records and billing.
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231. Individuals that should be included on steering committee of information system implementation.
* Hospital admin. * Finance * Nurse admin. * Director information systems * Medical records
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232. Reasons to conduct feasibility study.
* How will outcomes be measured * What research has been done to back up proposal * What are the risks * How long will the implementation work * Will it require dedicated staff, contractors?
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233. Computer based training, ADV/DIS.
*ADV:* * Self paced * Interactive * Available * Modules *DIS:* * Time and labor to develop * Lack of coaching
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234. Instructor led classes ADV/DIS.
*ADV:* * Uniformity * Coaching * Q&A * Demonstrations * Proficient testing *DIS:* * Dependent on trainer * Large classes less effective * Training above trainee's experience
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235. Describe four factors to consider when choosing training method for information system.
* Time * Cost * Learning styles-whats best for majority, demographic, age, gender, education * Learning retention-higher with hands on rather than self-taught.
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236. Describe steps for upgrading/implementing information systems.
* Planning-set key milestones * Hardware/software selected * Install-test * P&P * Training * Maintenance
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237. Load and volume testing.
Testing ability of system to function under different loads. Need to establish a safe working load (SWL) and needs to be done before live. * Load-users * Volume-data
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238. Functional testing.
Determines if code is functioning properly and if users are able to carry out features that are expected. Should be on units and on system as whole.
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239. System integration testing (SIT)
Part of hardware/software testing, making sure they work together, done after unit testing and before system and acceptance testing, involves how all units function together. Black box testing so programming knowledge not necessary.
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240. Black box testing.
Functional testing determines if input results in correct output using test cases. Does not require knowledge of code, may not detect all faults since it wont activate all codes.
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240. Fault injection.
Introduces fault into system to show what happens when component fails to function properly.
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240. Testing method: Operational systems.
Tests ability of system after introduction of component, this may require huge amount of testing though to determine how it deals with component failures/problems.
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240. Defense building.
Wrappers are used to limit software in some way, often employed when commercial software only partially meets requirements.
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241. Automated testing.
Often mimics the actions of users. Must have benchmarks and be able to produce reports to produce expected outcomes. Good for stress testing that needs a large number of simulated users.
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242. Interface.
Program that allows communication between two or more programs. * Direct-only allows point to point between the two programs. Interface engines allow data transfer from one to a number of different systems. Mapping is often required since terms vary. Serial peripheral interface (SPI) is defacto. Can be full or half duplex.
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243. System support.
* Ongoing communication between system admin and users, monthly newsletter, email, or focus groups. * 24hr help desk * Follow-up to verify problem was resolved
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244. Back loading data steps.
* What needs to be migrated * Who is responsible for loading * Set schedule for loading * Time frame for migration * Controls to ensure information accurate * Verify by testing.
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245. Creation of standard operating procedures (SOPs) and user manuals.
* Should be prepared before users are trained and go-live * Use old manual if possible * Disaster recovery, paper-based if system goes down * Vendors guides should be incorporated if possible.
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246. System testing during implementation.
* Develop overall test plan, install, operation and validation * Test scripts to stress system like actual users * Testing as soon as possible
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247. Steps of implementation plan.
* Develop schedule with milestones. Sometimes called the WBS (work breakdown structure) of project. * Assign tasks and verify completion * Communications in and outside of team * Test and stress in controlled environment.
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248. Describe the hardware infrastructure analysis that happens during implementation.
* Network infrastructure-cable/wireless, access points * Types of workstations * Location of workstations * Location of hardware (servers) * Connectivity/location of printers
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* 249. Discuss steering committee
* Form to evaluate current information system and research for new system * Should consist of representatives from all levels that will use the system * Establish leader that will own process * Establish goals and objectives * Determine if outside consultant is needed for complex/tech issues.
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250. Tasks of the steering committee.
* Project fits the organizations goals and mission statement * Reach consensus on requirements that system needs to satisfy * Verify the current system is not adequate * Ensure the new system will last 3-5 years.
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251. Components of system selection process.
* Needs assessment after decision has been made to upgrade. Typically meeting with vendors of systems. * Request for proposal (RFP)-once narrowed to 3 vendors then evaluation of RFP * Contract negotiation
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252. Items in a RFP (request for proposal).
* Description of organization * Mission statement, goals * Organizational structure * Type of healthcare facility * Proportion of clients in each pay type * Patient and facility statistics * Overall system requirements * Criteria for evaluating RFP * Deadline for submission
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253. Information to be gathered on site visit.
* System reliability and vendor support * Downtime and why * Backup procedures * User experiences with interfaces * Any customizations of system * Logs of training time * Security performance * Satisfaction with system
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254. Vendor attributes that are important for implementation success.
* Financial stability * Invest in new tech * How many sites using system * What hardware/network is required for system * Is tech state-of-art * Compatibility with other systems * Types of user support available * Any big changes in near future * How often do updates come out
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255. High fidelity vs low fidelity simulations.
High fidelity uses actual or realistic equipment for training, while low uses hand-outs, verbal or video, lower cost, but may not adequately measure expertise.
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256. Recommendations from National Quality Forum (NQF).
* Leadership necessary to provide awareness of safety issues and provide resources * Measurement and analysis for feedback and interventions * Team based patient care * Continuous
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257. National Quality Forums safe practices.
* Pt rights and responsibilities, informed consent * Well trained staff, ICU docs * Manage information, prompt reporting * CPOE for medications * Prevent infections * Measures to prevent operative errors * Ongoing assessments to prevent ulcers, blood clots, allergic rxs.
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258. Agency for Healthcare Research and Quality.
AHRQ-They have evidence based practice centers (EPCs) that develop practice guidelines.
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259. Agency for Healthcare Research and Quality quality indicators.
AHRQ-Distributes a software tool that allows adverse events or potential events to be identified. They areas covered are preventive, inpatient, patient safety and pediatric.
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260. CMS incentive payments for providers and hospitals.
Providers can receive $44,000 over 5 years, while hospitals can receive $2 million.
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261. Leapfrogs safety initiatives.
* Implement CPOE * Evidence based hospital referral * Intensivist trained physicians in ICU.
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262. The IOM.
Institute of Medicine is a non-profit charter of National Academy of Sciences that advises the government, but is not part of the government.
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263. One-on-one vs group instruction.
* One-on-one most costly but works best for confidential and complex training. * Group is best for general learning and learners need less control.
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264. Blooms taxonomy.
Behaviors that are necessary for learning. * Cognitive-use of intellectual skills. * Affective-feelings and values is slower to achieve than cognitive. * Psychomotor-mastering six motor skills necessary for independence.
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265. Theory of social learning by Albert Bandura.
People are more likely to adopt a behavior if they value the outcome, if the outcomes had functional value and if the person modeling had similarities to the learner and was admired.
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266. Usability and ease of use.
Useability is a measure of ease of use the three goals are effectiveness, efficiency and satisfaction.
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Five stages of Nursing Process
* Assess * Diagnose * Outcomes/plan * Implement * Evaluate
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For each run chart the following is calculated: Mean Maximum Minimum Sample Size Range Standard Deviation
* Mean the average of all the data points in the series. * Maximum the maximum value in the series. * Minimum the minimum value in the series. * Sample Size the number of values in the series. * Range the maximum value minus the minimum value. * Standard Deviation Indicates how widely data is spread around the mean
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Five stages of Standards of Nursing Informatics Practice
* Assess * Problem & issue identification * Outcomes/plan * Implement * Evaluation
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Project Managment phases
* Initiation * Plan * Execute * Control * Close
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Triple constraint
* Cost * Scope * Time
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Areas of WBS
WBS-work breakdown schedule * Executive summary-has high level schedule * Detailed project tasks-has SDLC phases * Special interest areas * In implement phase of SDLC
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Phases of SDLC
* Needs * Gap, needs, feasability, steering committee, costs * Selection * RFI, RFP, Site visit, useability * Implement * Implentation committee, WBS, Testing, training,procedures and documentation * Maintenance * Feedback, support
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Whats the difference between hub, bridge, switch and router.
Nurse Informatics
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