NR599 Final exam Study Guide

Smart documentation forms - forms that are tailored based on patient data to emphasize data elements pertinent to the patient's conditions and healthcare needs. Order sets, care plans and protocols - Structured approaches to encourage correct and efficient ordering, promote evidence-based best practices, and provide different management recommendations for different patient situations. Parameter guideline - algorithms to promote correct entry of orders and documentation. Critiques and "immediate warnings" - Alerts that are presented just after a user has entered an order, a prescription or a documentation item, to show a potential hazard or a recommendation for further information. Relevant data summaries - A single-patient view that summarizes, organizes and filters a patient's information to highlight important management issues. Multiple monitors - a display of activity among all patients on a care unit, which helps providers prioritize tasks and ensures that important activities are not omitted while providers are multitasking among patients. Predictive and retrospective analytics: - Analytic methods that combine multiple factors using statistical and artificial intelligence techniques to provide risk predictions, stratify patients and measure progress on broad initiatives. "Info" buttons - filtered reference information and knowledge resources within fields or "buttons" where info is provided to the end user in the context of the current data display also referred to as metadata, or "data about data". Expert workup and management advisers - Diagnostic and expert systems that track and advise a patient workup and management of the patient based on evidence-based protocols. Event-triggered alerts - Warnings triggered within the system based on data that alert the clinical user to a new event occurring asynchronously, such as an abnormal lab result. Reminders - Time-triggered events within the system reminding the clinical user of a task needed to be based on predetermined time within the system. clinical transformation - relative to workflow redesign; it is a complete alteration of the clinical environment and should be used cautiously to describe redesign efforts; transformation is defined as "a radical change approach that produces a more responsive organization that is more capable of performing in unstable and changing environments that organizations continue to be faced with"; - this would imply that the manner in which work is carried out and the outcomes achieved are completely different from the prior state. which is not always true when the change involves implementing technology - technology can be used to launch or in conjunction with a clinical transformation initiative but the implementation of technology alone is not considered transformational. - Optimization - - when workflow analysis occurs post implementation, it is often referred to as ________________ - it is the process of moving conditions past their current states and into more efficient and effective methods of performing tasks. -it is considered to be the act, process, or methodology of making something (as a design, system or decision) as fully perfect, functional, and effective as possible. Process Analysis - breaking down the work process into a sequential series of steps that can be examined and assessed to improve effectiveness and efficiency; explains how work takes place, gets done, or how it can be done. Workflow analysis - observation and documentation of workflow to better understand what is happening in the current environment and how it can be altered is referred to as this process. - it requires careful attention to detail and the ability to moderate group discussions, organize concepts, and generate solutions. - this is part of every functional area the INS engages in. Process Map - a typical output of workflow analysis is a visual depiction of the process called a ______ ________; this provides an excellent tool to identify specific steps in the workflow analysis process. - it also provides a vehicle for communication and a tool upon which to build educational material, procedures and policies. - an example is the swim-lane technique workflow - - a term used to describe the action or execution of a series of tasks in a prescribed sequence. - a progression of steps (tasks, events, interactions) that consitute: 1) a work process 2) involves two or more persons 3) creates and adds value to the organizations activities. - also known as a process or process flow particularly in the context of implementation. swim-lane technique - because workflow crosses many different care providers, it may be useful to construct the process map using this technique, which uses categories such as functional work groups and roles to visually depict groups of work and to indicate who performs the work. Value-added activity - - is a step that brings the process closer to completion or changes the product or service for the better. - an example is placing a label or name tag on a specimen sample, The name tag is necessary for the laboratory personnel to identify the specimen. Non-Value-Added Activities - does not alter the outcome of a process or product - activities such as handling, moving, and holding. these activities should be evaluated during workflow analysis. -ex: manipulating papers, moving through computer screens, and walking or transporting items. - Tasks that are not necessary for the purpose of compliance or regulatory reasons should be eliminated. waste - a key underpinning of the lean philosophy is the removal of _____ activities. - Seven forms: 1. overproduction 2. waiting 3. transport 4. inappropriate processing 5. unnecessary inventory 6. unnecessary motion 7. defects Variation - in workflow this is considered the enemy of all good processes and should be eliminated when possible. - this occurs when workers perform the same function in different ways. - it usually arises because of flaws in the way a process was originally designed, lack of knowledge about the process, or inability to execute a process as originally designed due to disruption or disturbances in the workflow gap analysis - necessary to move from the current state to the future state; - zeros in on the major area most affected by the change--namely, technology. - generates ideas from the group about how best to utilize the technology to transform practice. 6 techniques to overcome resistance to change - 1. Education and Communication 2. Participation and Involvement 3. Support and Facilitation 4. Negotiation and Agreement 5. Manipulation and Co-optation 6. Explicit and Implicit Coercion Metrics - provide an understanding about the performance of a process or function. -within clinical technology projects, we identify and collect ___________ about the performance of the technology or capture the level of participation or adoption. -should focus on the variables of time, quality, and costs. - examples include: turnaround times, cycle times, throughput, change-over time, set-up time, system availability, patient satisfaction, and employee satisfaction The goal of workflow analysis - is to create a future-state solution that maximizes the use of technology and eliminates non-value added activities. Health Information exchange/Medical Home model - - requires the NI to visualize how patients move through the entire continuum of care and not just a specific patient care area. - an information technology platform that enables the seamless exchange of important patient information among many providers in a healthcare system. - Typically the pcp (__________ _____________) initiates the collection of patient data, coordinates the care of the patient and helps to maintain the accuracy of such data. - other care providers access the information and add to it as they provide services to patients. Big Data - many different types - including indexes; images and videos; social networks such as Twitter and Facebook; surveillance data; company records including medical records; and data heavy fields such as astronomy; genetics and economics. - the masses of unstructured textually rich data within the EHR are among the prime examples. 5 Uses of Big data in the healthcare industry - 1.) Big data explorations and mining techniques to improve decision making. 2.) 360-degree view of the customer, extending the ability to view the healthcare consumer by internal and external data sources. 3.) Security and intelligence to lower risk, detect fraud and monitor cybersecurity. 4.) Operational and clinical analysis to improve healthcare outcomes, quality and cost. 5.) Ability to augment data warehouse capabilities to integrate and use big data to increase efficiencies and improve outcomes. Data mining - a method in computer science that is used to discover patterns and trends within large data sets. Anomaly detection - a data mining technique - pattern detection of data errors or unusual deviations from the norm - ex: detection of disease outbreaks. Association rule learning - a data mining technique that identifies association between variables to predict outcomes. - Identifies relationships in variables associated with an outcome of interest; can be preliminary work to predictive modeling Cluster Analysis - - Discovering groups or structures in the data - a data mining technique that discovers groups or structures in the data, such as clusters of patients who tend to go to one hospital in a given ZIP code or county. Classification - a data mining technique - Generalizing known structure to new data or information - Classifying patient safety errors related to HIT can support taxonomy development Regression Modeling - a data mining technique - Modeling data for prediction or explaining some phenomenon with the least amount of error as possible - often used for predictive analytics such as predicting factors that are associated with mortality or 30-day readmission. Summarization - a data mining technique - business intelligence (BI) tools that aggregate cubic views of data or report certain outcomes. - tools allow an end user to drag and drop and quickly identify patterns and trends in the data based on the summarization of tables. mobile health (mHealth) - - the use of wireless communication to support efficiency in public health and clinical practice. - generation, aggregation, and dissemination of health information via mobile or wireless device. - examples of areas of growth are: 1. prevention medicine and health promotion can be leveraged through education and awareness applications. 2. portable diagnostic devices that allow monitoring of human conditions in clinical settings or offsite locations. 3. applications for data management, training medical personnel and mobile payments. mobile applications - to facilitate mHealth; -can be executed on either a mobile platform( i.e. a handheld commercial off the shelf computing platform, with or without wireless connection) or on a web-based software application that is tailored to a mobile platform but is executed on a server mobile medical applications - - incorporates device software functionality that meets the definition of devices intended to be used as an accessory to a regulated medical device or are software that transforms a mobile platform into a regulated medical device. - these mobile devices may include mobile phones, smartphones, tablet computers, smartwatches and point of care testing (POC). Medical Applications - 1. Apps providing access to electronic copies. 2. Apps for general patient education. 3. Generic aids or general purpose apps. 4. Apps as educational tools. 5. Apps automating office operations. medical device - "an instrument, apparatus, implement, machine, contrivance, implant, in vitro reagent, or other similar or related articles, including any component, part or accessory that is intended for use in performing a function for diagnosis of disease or other conditions or the cure, mitigation, treatment of prevention of disease" FDA regulated devices - An intended use of a mobile app determines whether it meets the definition of a "device" - "intended" use may be shown by labeling claims, advertising materials, or oral or written statements by manufacturers or their representatives. When the intended use of the mobile app is for the diagnosis of disease or other conditions, or the cure, mitigation, treatment, or prevention of disease or is intended to affect the structure or any function of the body of man, the mobile app is a device under section 201h of the FD&C act ; - if a software function is intended for use in performing a medical device function it is a medical device, regardless of the platform on which it runs. ex: mobile apps intended to run on smartphones to analyze and interpret EKG waveforms to detect heart function irregularities would be considered similar to software running on a desktop computer that serves the same function, which is regulated by the FDA. -FDA applies oversight and regulation only to those software applications whose functionality could pose a risk to a patient's safety if the software application were to no function as intended. Examples of regulated medical devices - glucose test system, calculator processing module for clinical use, monitoring spirometer, esophageal stethoscope with electrical conductors, apnea monitor, blood pressure computer, etc. apps providing access to electronic copies - mobile apps that are intended to provide access to electronic "copies" (e.g. e-books, audio books) of medical textbooks or other reference materials with generic text search capabilities. NOT considered medical devices because they are intended to be used as reference materials and not for diagnosis, tx, mitigation, cure, prevention of disease or to replace clinical judgment. Examples of apps providing access to electronic copies. - ex: Medical dictionaries, medical textbooks and literature articles such as the physician's desk reference or diagnostic and statistical Manual of Mental Disorders; library of clinical descriptions for disease and conditions, encyclopedia for first-aid and emergency care information; medical abbreviations and definitions; translations of medical terms across multiple languages. Apps for general patient education - mobile apps that facilitate patient access to commonly used reference information; These apps can be patient-specific (i.e. filter info to pt-specific characteristics), but are intended for increased patient awareness, education, and empowerment and ultimately to support patient-centered care. - NOT considered a medical device because they are intended generally for pt education. examples of mobile apps for general patient education - - provide a portal for healthcare providers to distribute educational information (e.g., interactive diagrams, useful links and resources) to their patients regarding their disease, condition, treatment, or up-coming procedures. -help guide patients to ask appropriate questions to their provider relevant to their particular disease, condition, or concern. - provide information about gluten-free food products or restaurants - help match patients with potentially appropriate clinical trials. - provide tutorials or training videos on how to administer first-aid or CPR. - Allow users to input pill shape, color or imprint and display pictures and names of pills that match this description. - find the closest medical facilities and providers. - provide lists of emergency hotlines and physician/nurse advice lines. - provide and compare costs of drugs and medical products at pharmacies in the user's location. generic aids or general purpose apps examples - - use a mobile platform as a magnifying glass (but are not specifically intended for medical purposes) - use a mobile platform for recording audio, note-taking, replaying audio with amplifications. - allow patients or healthcare providers to interact through email, web-based platforms, video or other communication mechanisms - provide maps and turn-by-turn directions to medical facilities - allow health care providers to communicate in a secure and protected method (for ex, using a hipaa compliant app to send messages between health care providers in a hospital) - translate unintelligible speech for better clarity.