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FOR HEALTH PROFESSIONALS

Kathleen Garver Mastrian Dee McGonigle © Jones & Bartlett Learning, LLC, an Ascend Learning Company. NOT FOR SALE OR DISTRIBUTION 9781284157888_FMxx_00i_xxvi.indd 1

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FOR HEALTH PROFESSIONALS Kathleen Garver Mastrian, PhD, RN

Associate Professor and Program Coordinator for Nursing Pennsylvania State University, Shenango Senior Managing Editor, Online Journal of Nursing Informatics (OJNI) Member, Health Information Management Systems Society (HIMSS)

Dee McGonigle, PhD, RN, CNE, FAAN, ANEF

Director, Virtual Learning Experiences and Professor, Graduate Program Chamberlain College of Nursing Fellow, American Academy of Nursing Secretary, Expert Panel on Informatics and Technology (EPIT) for the American Academy of Nursing Member, Serious Gaming and Virtual Environments Special Interest Group for the Society for Simulation in Healthcare (SSH) Fellow, NLN Academy of Nursing Education Member, Health Information Management Systems Society (HIMSS)

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World Headquarters Jones & Bartlett Learning 5 Wall Street Burlington, MA 01803 978-443-5000 [email protected] www.jblearning.com Jones & Bartlett Learning books and products are available through most bookstores and online booksellers. To contact Jones & Bartlett Learning directly, call 800-832-0034, fax 978-443-8000, or visit our website, www.jblearning.com. Substantial discounts on bulk quantities of Jones & Bartlett Learning publications are available to corporations, professional associations, and other qualified organizations. For details and specific discount information, contact the special sales department at Jones & Bartlett Learning via the above contact information or send an email to [email protected] Copyright © 2017 by Jones & Bartlett Learning, LLC, an Ascend Learning Company All rights reserved. No part of the material protected by this copyright may be reproduced or utilized in any form, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without written permission from the copyright owner. The content, statements, views, and opinions herein are the sole expression of the respective authors and not that of Jones & Bartlett Learning, LLC. Reference herein to any specific commercial product, process, or service by trade name, trademark, manufacturer, or otherwise does not constitute or imply its endorsement or recommendation by Jones & Bartlett Learning, LLC and such reference shall not be used for advertising or product endorsement purposes. All trademarks displayed are the trademarks of the parties noted herein. Informatics for Health Professionals is an independent publication and has not been authorized, sponsored, or otherwise approved by the owners of the trademarks or service marks referenced in this product. There may be images in this book that feature models; these models do not necessarily endorse, represent, or participate in the activities represented in the images. Any screenshots in this product are for educational and instructive purposes only. Any individuals and scenarios featured in the case studies throughout this product may be real or fictitious, but are used for instructional purposes only. 15788-8 Production Credits VP, Executive Publisher: David D. Cella Publisher: Cathy L. Esperti Editorial Assistant: Carter McAlister Vendor Manager: Sara Kelly Marketing Manager: Grace Richards Manufacturing and Inventory Control Supervisor: Amy Bacus Composition and Project Management: Cenveo® Publisher Services Cover Design: Kristin Parker Rights & Media Specialist: Jamey O’Quinn Media Development Editor: Troy Liston Cover Image: © Waj/Shutterstock Printing and Binding: Edwards Brothers Malloy Cover Printing: Edwards Brothers Malloy Library of Congress Cataloging-in-Publication Data Names: Mastrian, Kathleen Garver, author. | McGonigle, Dee, author. Title: Informatics for health professionals / Kathleen Garver Mastrian, Dee McGonigle. Description: Burlington, MA : Jones & Bartlett Learning, [2017] | Includes bibliographical references and index. Identifiers: LCCN 2016004458 | ISBN 9781284157888 (pbk. : alk. paper) Subjects: | MESH: Medical Informatics—methods | Knowledge | Professional Competence Classification: LCC R858 | NLM W 26.5 | DDC 610.285—dc23 LC record available at http://lccn.loc.gov/2016004458 6048 Printed in the United States of America 20 19 18 17 16 10 9 8 7 6 5 4 3 2 1

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Contents Preface Acknowledgments Contributors A Visual Walkthrough

xv xix xxi xxiv

SECTION I: BUILDING BLOCKS OF HEALTH INFORMATICS

1

1

5

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Informatics, Disciplinary Science, and the Foundation of Knowledge Kathleen Mastrian and Dee McGonigle Introduction The DIKW Paradigm The Foundation of Knowledge Model Core Informatics Competencies Summary Thought-Provoking Questions Apply Your Knowledge References

5 6 8 12 18 18 18 19

Introduction to Information, Information Science, and Information Systems

21

Introduction Information Information Science Information Processing Information Science and the Foundation of Knowledge Introduction to Information Systems Information Systems Summary Thought-Provoking Questions Apply Your Knowledge References

21 22 24 25 27 28 28 31 31 32 32

Dee McGonigle, Kathleen Mastrian, and Craig McGonigle

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vi CONTENTS

3

4

5

Computer Science and the Foundation of Knowledge Model

33

Introduction The Computer as a Tool for Managing Information and Generating Knowledge Computer Components What is the Relationship of Computer Science to Knowledge? How Does the Computer Support Collaboration and Information Exchange? What is the Human–Technology Interface? Looking to the Future Summary Thought-Provoking Questions Apply Your Knowledge Additional Resources References

33 34 36 49 50 51 53 56 56 57 57 57

Introduction to Cognitive Science and Cognitive Informatics

59

Introduction Cognitive Science Sources of Knowledge Nature of Knowledge How Knowledge and Wisdom are used in Decision Making Cognitive Informatics Cognitive Informatics and Health Care Practice What is Artificial Intelligence? Summary Thought-Provoking Questions Apply Your Knowledge References

59 60 61 62 62 63 64 65 66 66 67 68

Ethical and Legal Aspects of Health Informatics

69

Introduction Ethics Ethical Dilemmas and Morals Ethical Decision Making

69 70 72 72

June Kaminski, Dee McGonigle, Kathy Mastrian, and Craig McGonigle

Dee McGonigle and Kathleen Mastrian

Kathleen Mastrian, Dee McGonigle, and Kathleen M. Gialanella

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Contents vii Theoretical Approaches to Health Care Ethics Applying Ethics to Informatics Case Analysis Demonstration New Frontiers in Ethical Issues Legal Aspects of Health Informatics Overview of the HITECH Act How the HITECH Act Changed HIPAA Implications for Practice Ethical and Legal Issues and Social Media Summary Thought-Provoking Questions Apply Your Knowledge Additional Resources References

SECTION II: CHOOSING AND USING INFORMATION SYSTEMS

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73 76 81 85 85 88 91 97 98 103 103 104 104 105

109

Systems Development Life Cycle

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Introduction Waterfall Model Rapid Prototyping or Rapid Application Development Object-Oriented Systems Development Dynamic System Development Method Computer-Aided Software Engineering Tools Open-Source Software and Free/Open-Source Software Interoperability Summary Thought-Provoking Questions Apply Your Knowledge References

113 116 119 119 120 122 123 123 125 125 125 126

Administrative Information Systems

127

Introduction Types of Health Care Organization Information Systems Communication Systems

127 128 129

Dee McGonigle and Kathleen Mastrian

Marianela Zytkowski, Susan Paschke, Dee McGonigle, and Kathleen Mastrian

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viii CONTENTS

8

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Core Business Systems Order Entry Systems Patient Care Support Systems Department Collaboration and Exchange of Knowledge and Information Summary Thought-Provoking Questions Apply Your Knowledge References

130 132 132 138 140 140 140 141

The Human–Technology Interface

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Introduction The Human–Technology Interface The Human–Technology Interface Problem Improving the Human–Technology Interface A Framework for Evaluation Future of the Human–Technology Interface Summary Thought-Provoking Questions Apply Your Knowledge Additional Resources References

143 144 146 147 153 154 156 156 156 157 157

Electronic Security

161

Introduction Securing Network Information Authentication of Users Threats to Security Security Tools Off-Site Use of Portable Devices Summary Thought-Provoking Questions Apply Your Knowledge Additional Resources References

161 162 163 164 167 168 171 171 171 172 172

Judith A. Effken, Dee McGonigle, and Kathleen Mastrian

Lisa Reeves Bertin, Dee McGonigle, and Kathleen Mastrian

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Contents ix

Flow and Meaningful Use 10 Work Denise Hammel-Jones, Dee McGonigle, and Kathleen Mastrian Introduction Work Flow Analysis Purpose Work Flow and Technology Work Flow Analysis and Informatics Practice Informatics as a Change Agent Measuring the Results Future Directions Summary Thought-Provoking Questions Apply Your Knowledge Additional Resources References

SECTION III: INFORMATICS APPLICATIONS FOR CARE DELIVERY Electronic Health Record and Clinical Informatics 11 The Emily B. Barey, Kathleen Mastrian, and Dee McGonigle Introduction Setting the Stage Components of Electronic Health Records Advantages of Electronic Health Records Ownership of Electronic Health Records Flexibility and Expandability of Electronic Health Records The Future Summary Thought-Provoking Questions Apply Your Knowledge References

Tools to Promote Patient Safety, Quality Outcomes, 12 Informatics and Interdisciplinary Collaboration Dee McGonigle and Kathleen Mastrian

Introduction What is a Culture of Safety?

173 173 173 175 178 183 184 186 188 188 189 189 189

191 195 195 196 197 200 205 208 210 211 211 211 212

215 215 216

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x CONTENTS Strategies for Developing a Safety Culture Informatics Technologies for Patient Safety Interdisciplinary Collaboration Role of the Health Informaticist Summary Thought-Provoking Questions Apply Your Knowledge Additional Resources References

218 220 228 229 232 232 233 233 234

Engagement and Connected Health 13 Patient Kathleen Mastrian and Dee McGonigle

237

Introduction Consumer Demand for Health Information Health Literacy and Health Initiatives Health Care Organization Approaches to Engagement Promoting Health Literacy in School-Aged Children Supporting Use of the Internet for Health Education Future Directions for Engaging Patients Telehealth: A Tool for Connected Health Telehealth Care Tools of Home Telehealth The Patient’s Role in Telehealth Health Care in the Future Summary Thought-Provoking Questions Apply Your Knowledge Additional Resources References

Informatics to Promote Community/Population Health 14 Using Margaret Ross Kraft, Ida Androwich, Kathleen Mastrian, and Dee McGonigle Introduction Core Public Health Functions Community Health Risk Assessment: Tools for Acquiring Knowledge Processing Knowledge and Information to Support Epidemiology and Monitoring Disease Outbreaks Applying Knowledge to Health Disaster Planning and Preparation

237 238 239 241 243 244 246 249 251 253 256 258 259 259 259 259 261

263 263 265 266 267 269

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Contents xi Informatics Tools to Support Communication and Dissemination Using Feedback to Improve Responses and Promote Readiness Summary Thought-Provoking Questions Apply Your Knowledge References

SECTION IV: ADVANCED CONCEPTS IN HEALTH INFORMATICS Tools to Support Health Care Professional Education 15 Informatics and Continuing Education

Heather E. McKinney, Sylvia DeSantis, Kathleen Mastrian, and Dee McGonigle Introduction: Professional Education and the Foundation of Knowledge Model Knowledge Acquisition and Sharing Hardware and Software Considerations Delivery Modalities Technology Tools Supporting Education Internet-Based Tools Promoting Active and Collaborative Learning Knowledge Dissemination and Sharing Fair use and Copyright Restrictions The Future Summary Thought-Provoking Questions Apply Your Knowledge Additional Resources References

Mining as a Research Tool 16 Data Dee McGonigle, Kathleen Mastrian, and Craig McGonigle

Introduction: Big Data, Data Mining, and Knowledge Discovery KDD and Research Data Mining Concepts Data Mining Techniques Data Mining Models Ethics of Data Mining Summary Thought-Provoking Questions

270 271 273 274 275 275

277 281 281 282 282 283 286 295 301 303 305 306 307 307 307 307 309

311 311 316 318 318 322 325 326 326

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xii CONTENTS Apply Your Knowledge Additional Resources References

Understanding, and Applying Research Evidence in Practice 17 Finding, Jennifer Bredemeyer, Ida Androwich, Heather E. McKinney, Kathleen Mastrian,

326 327 327

329

and Dee McGonigle

Introduction Information Literacy Acquiring Knowledge Through Internet and Library Holdings Information Sharing and Fair Use Clarification of Research Terms History of EBP Evidence Bridging the Gap Between Research and Practice Barriers to and Facilitators of EBP Informatics Tools to Support EBP Developing EBP Guidelines Meta-Analysis and the Generation of Knowledge The Future Summary Thought-Provoking Questions Apply Your Knowledge Additional Resources References

Biomedical Informatics, and Computational Biology 18 Bioinformatics, Dee McGonigle and Kathleen Mastrian Introduction Bioinformatics, Biomedical Informatics, and Computational Biology Defined Why are Bioinformatics and Biomedical Informatics so Important? What Does the Future Hold? Summary Thought-Provoking Questions Apply Your Knowledge References

329 330 331 333 334 335 336 337 337 338 341 342 343 344 344 345 345 345

349 349 350 353 356 358 358 359 359

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Contents xiii

SECTION V: PRACTICE IN THE FUTURE Art of Delivering Patient-Centered Care in Technology-Laden 19 The Environments Kathleen Mastrian and Dee McGonigle

Introduction Caring Theories Presence Strategies for Enhancing Caring Presence Reflective Practice Summary Thought-Provoking Questions Apply Your Knowledge Additional Resources References

and Managing Organizational Knowledge 20 Generating Dee McGonigle and Kathleen Mastrian

A B

361 365 365 366 369 369 371 373 373 373 374 374

375

Introduction Foundation of Knowledge Model Revisited Knowledge Use in Practice Managing Knowledge Across Disciplines Summary Thought-Provoking Questions Apply Your Knowledge References

375 376 378 381 384 384 384 385

Allied Health Professional Organizations

387

Emerging Health Care Technologies by Discipline

399

Abbreviations Glossary Index

401 407 435

Contributed by Craig McGonigle Contributed by Craig McGonigle

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Preface Authors’ Note This text provides an overview of health informatics from the perspective of diverse experts in the field, with a focus on health informatics and the Foundation of Knowledge model. We want our readers and students to focus on the relationship of knowledge to informatics and to embrace and maintain the caring functions essential to all of health care—messages all too often lost in the romance with technology. We hope you enjoy the text!

About this Book The idea for this text originated with the publication of the third edition of Nursing Informatics and the Foundation of Knowledge (2015). We realized that other health care professionals also needed to learn about informatics and the ways that informatics supports professional practice. We know that the idea of informatics is new to many health care professionals, and we believe that all health care professionals need to be better prepared for 21st-century practice by developing a strong foundation in informatics. According to the Association of Schools of Allied Health Professions (http://www.asahp.org/wp-content/uploads/2014/08/Health-ProfessionsFacts.pdf), allied health professionals represent 60% of the health workforce and are “the segment of the workforce that delivers services involving the identification, evaluation and prevention of diseases and disorders; dietary and nutrition services; and rehabilitation and health systems management” (para 1). Specifically, this text is designed to introduce dental hygienists, diagnostic medical sonographers, dietitians, medical technologists, occupational therapists, physical therapists, radiographers, respiratory therapists, and speech-language pathologists to health informatics. Collectively, we have years of experience teaching and writing about informatics. Like most nurse informaticists, we fell into the specialty; our love affair with technology and gadgets and our willingness to be the first to try new things helped to hook us into the specialty of informatics. The rapid evolution of technology in the health care system and the role of technology in the transformation of the system initially prompted us to try to capture the

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xvi PREFACE essence of nursing informatics in a text. Here is a bit of background on the nursing informatics text evolution that helped to set the stage for this text. As we were developing the first edition, we realized that we could not possibly know all there is to know about informatics and the way in which it supports practice, education, administration, and research. We also knew that our faculty roles constrained our opportunities for exposure to changes in this rapidly evolving field. Therefore, we developed a tentative outline and a working model of the theoretical framework for the text and invited participation from informatics experts and specialists around the world. We were pleased with the enthusiastic responses we received from some of those invited contributors and a few volunteers who heard about the text and asked to participate in their particular area of expertise. In this textbook, we have retained some of this valuable information from these original contributors to the first edition of the nursing informatics text. We believe that this text provides a comprehensive elucidation of this exciting field. The theoretical underpinning of the text is the Foundation of Knowledge model. This model is introduced in its entirety in the first chapter (Informatics, Disciplinary Science, and the Foundation of Knowledge), which discusses disciplinary science and its relationship to health informatics. We believe that humans are organic information systems that are constantly acquiring, processing, and generating information or knowledge in both their professional and their personal lives. It is their high degree of knowledge that characterizes humans as extremely intelligent, organic machines. Individuals have the ability to manage knowledge— an ability that is learned and honed from birth. We make our way through life interacting with our environment and being inundated with information and knowledge. We experience our environment and learn by acquiring, processing, generating, and disseminating knowledge. As we interact in our environment, we acquire knowledge that we must process. This processing effort causes us to redefine and restructure our knowledge base and generate new knowledge. We then share (disseminate) this new knowledge and receive feedback from others. The dissemination and feedback initiate this cycle of knowledge over again as we acquire, process, generate, and disseminate the knowledge gained from sharing and reexploring our own knowledge base. As others respond to our knowledge dissemination and we acquire new knowledge, we engage in rethinking and reflecting on our knowledge, processing, generating, and then disseminating anew. The purpose of this text is to provide a set of practical and powerful tools to ensure that the reader gains an understanding of health informatics and moves from information through knowledge to wisdom. Defining the demands of health professionals and providing tools to help them survive and succeed in the Knowledge Era remains a major challenge. Exposing allied health students to the principles and tools used in health informatics helps to prepare them to meet the challenge of practicing in the Knowledge Era while striving to improve patient care at all levels.

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Preface xvii The text provides a comprehensive framework that embraces knowledge so that readers can develop their knowledge repositories and the wisdom necessary to act on and apply that knowledge. The text is divided into five sections: • The Building Blocks of Health Informatics (HI) section covers the building blocks of HI: disciplinary science, information science, computer science, cognitive science, and the ethical and legal aspects of managing information. • The Choosing and Using Information Systems section explains how systems are developed, covers important functions of administrative application systems in health care, discusses the human–technology interface, provides important information on electronic security, and explains work flow and meaningful use in relation to electronic systems. • The Informatics Applications for Care Delivery section covers health care delivery applications including electronic health records (EHRs), patient engagement and connected health, patient safety and quality outcomes technologies, interdisciplinary collaboration, and informatics tools for community and population health promotion. • The Advanced Concepts in Health Informatics section presents subject matter on informatics tools for health professional education, data mining, translational research for generating best practices, and the exciting fields of bioinformatics and computational biology. • The Practice in the Future section focuses on the future of health informatics, emphasizes the need to preserve caring and patient-centered functions in technology-laden environments, and summarizes the relationship of informatics to the Foundation of Knowledge model and organizational knowledge management. The introduction to each section explains the relationship between the content of that section and the Foundation of Knowledge model. This text places the material within the context of knowledge acquisition, processing, generation, and dissemination. It serves health care professionals who need to understand, use, and evaluate knowledge. Throughout the text where appropriate, we have included case scenarios demonstrating why a topic is important and research briefs presented in text boxes to encourage the reader to access current research and to focus on cutting-edge innovations, meaningful use, and patient safety as appropriate to each topic. As college professors, our major responsibility is to prepare the practitioners and leaders in the field. Our primary objective is to develop the most comprehensive and user-friendly HI text on the market to prepare health professionals for current and future practice challenges. In particular, this text provides a solid groundwork from which to integrate informatics principles into practice.

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xviii PREFACE Goals of this text are as follows: • Impart core HI principles that should be familiar to every health professional. • Help the reader understand knowledge and how it is acquired, processed, generated, and disseminated. • Demonstrate the value of the HI discipline as an attractive field of specialization. The overall vision, framework, and pedagogy of this text offers benefits to readers by highlighting established principles while drawing out new ones that continue to emerge as health care and technology evolve.

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Acknowledgments We are deeply grateful to the contributors who provided this text with a richness and diversity of content that we could not have captured alone. Joan Humphrey provided social media content integrated throughout the text. We especially wish to acknowledge the superior work of Alicia Mastrian, graphic designer of the Foundation of Knowledge model, which serves as the theoretical framework on which this text is anchored. We would also like to thank Craig McGonigle for his insightful contributions to this text. We could never have completed this project without the dedicated and patient efforts of the Jones & Bartlett Learning staff, especially Cathy Esperti, Sara Peterson, and Carter McAlister. Both fielded our questions and concerns in a very professional and respectful manner. Kathy acknowledges the loving support of her family: husband Chip, children Ben and Alicia, sisters Carol and Sue, and parents Bob and Rosalie Garver. Kathy also acknowledges those friends who understand the importance of validation, especially Katie, Lisa, Kathy, Anne, and Barbara. Dee acknowledges the undying love, support, patience, and continued inspiration of her best friend and husband, Craig, and her son, Craig, who has also made her so very proud. She sincerely thanks her friends and family for their support and encouragement.

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Contributors Ida Androwich, PhD, RN, BC, FAAN Loyola University Chicago School of Nursing Maywood, IL Emily Barey, MSN, RN Director of Nursing Informatics Epic Systems Corporation Madison, WI Lisa Reeves Bertin, BS, EMBA Pennsylvania State University Sharon, PA Brett Bixler, PhD Pennsylvania State University University Park, PA Jennifer Bredemeyer, RN Loyola University Chicago School of Nursing Skokie, IL Steven Brewer, PhD Assistant Professor, Administration of Justice Pennsylvania State University Sharon, PA Sylvia M. DeSantis, MA Pennsylvania State University University Park, PA Judith Effken, PhD, RN, FACMI University of Arizona College of Nursing Tucson, AZ xxi

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xxii CONTRIBUTORS Kathleen M. Gialanella, JD, RN, LLM Law Offices Westfield, NJ Associate Adjunct Professor Teachers College, Columbia University New York, NY Adjunct Professor Seton Hall University, College of Nursing and School of Law South Orange and Newark, NJ Denise Hammel-Jones, MSN, RN-BC, CLSSBB Greencastle Associates Consulting Malvern, PA Glenn Johnson, MLS Pennsylvania State University University Park, PA June Kaminski, MSN, RN Kwantlen University College Surrey, British Columbia, Canada Julie Kenney, MSN, RNC-OB Clinical Analyst Advocate Health Care Oak Brook, IL Margaret Ross Kraft, PhD, RN Loyola University Chicago School of Nursing Maywood, IL Wendy L. Mahan, PhD, CRC, LPC Pennsylvania State University University Park, PA Craig McGonigle, MBA, BSB CEO, Mick Enterprise, Inc. Dillon, SC Heather McKinney, PhD Pennsylvania State University University Park, PA

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Contributors xxiii Nickolaus Miehl, MSN, RN Clinical Instructor and Simulation Specialist Oregon Health and Science University Monmouth Campus Portland, OR Lynn M. Nagle, PhD, RN Assistant Professor University of Toronto Toronto, ON, Canada Jeff Swain Instructional Designer Pennsylvania State University University Park, PA Denise D. Tyler, MSN/MBA, RN-BC Implementation Specialist Healthcare Provider, Consulting ACS, a Xerox Company Dearborn, MI

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A Visual Walkthrough Informatics for Health Professionals drives comprehension through a variety of strategies geared toward meeting the learning needs of students while also generating enthusiasm about the topic. This interactive approach addresses diverse learning styles, making this the ideal text to ensure mastery of key concepts. The pedagogical aids that appear in most chapters include the following:

Key Terms

1

c h a p t e r

Informatics, Disciplinary Science, and the Foundation of Knowledge Kathleen Mastrian and Dee McGonigle

OBJECTIVES

Key Terms

1. Define health informatics. 2. Illustrate the relationship between disciplinary science and informatics. 3. Introduce the Foundation of Knowledge model as the organizing conceptual framework for the text. 4. Explain the data, information, knowledge, wisdom (DIKW) paradigm. 5. Establish health care professionals as knowledge workers.

Introduction Health care is an information intensive endeavor. Our patients are complex, often presenting with multiple health challenges and requiring interventions by several health care disciplines at the same time. Interprofessional collaboration and communication are essential for the coordination of this care and to ensure that all are working toward the same clinical outcomes while promoting safe, evidencebased, efficient, and cost-effective care. The use of technology tools, especially the electronic health record (EHR), helps us collect, integrate, and manage all of the important clinical information to provide the best possible care and facilitate communication among the various disciplines interacting with patients. Data collected from EHRs and the aggregation of these data may provide insights into the health of populations and identify global health challenges. Informatics is the term used to describe the science of information management in health care.

Clinical database Clinical practice guideline Competency Data Data mining Data–information– knowledge–wisdom paradigm Electronic health record Evidence Feedback Foundation of Knowledge model Health informatics Informatics Information Knowledge Knowledge acquisition Knowledge dissemination Knowledge generation Knowledge processing

Introductions

Objectives The chapter objectives provide instructors and students with a snapshot of the key information they will encounter in each chapter. They serve as a checklist to help guide and focus study. Objectives can also be found within the text’s online resources.

(continues)

Core Business Systems 131

RESEARCH BRIEF

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Found in a list at the beginning of each chapter, these terms will create an expanded vocabulary. The “www” icon directs students to the text’s online resources, where they can review these terms in an interactive glossary and use flash cards to nail down their definitions. Use the access code at the front of your book to access these additional resources. If you do not have an access code, one can be purchased at http://www.jblearning.com.

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Found at the beginning of each chapter, chapter introductions provide an overview highlighting the importance of the chapter’s topic. They also help keep students focused as they read.

Researchers attempted to quantify the costs of poor communication, termed “communication inefficiencies,” in hospitals. This qualitative study was conducted in seven acute care hospitals of varying sizes via structured interviews with key informants at each facility. The interview questions focused on four broad categories: (1) communication bottlenecks, (2) negative outcomes as a result of those bottlenecks, (3) subjective perceptions of the potential effectiveness of communication improvements on the negative outcomes, and (4) ideas for specific communication improvements. The researchers independently coded the interview data and then compared results to extract themes. All of the interviewees indicated that communication was an issue. Inefficiencies revolved around time spent tracking people down to communicate with them, with various estimates provided: 3 hours per nursing shift wasted tracking people down, 20% of productive time wasted on communication bottlenecks, and a reported average of five to six telephone calls to locate a physician. Several respondents pointed to costly medical errors that were the direct result of communication issues. Communication lapses also resulted in inefficient use of clinician resources and increased length of stay for patients. The researchers developed a conceptual model of communication quality with four primary dimensions: (1) efficiency of resource use, (2) effectiveness of resource use, (3) quality of work life, and (4) service quality. They concluded that the total cost of communication inefficiencies in U.S. hospitals is more than $12 billion annually and estimated that a 500-bed hospital could lose as much as $4 million annually because of such problems. They urge the adoption of information technologies to redesign work flow processes and promote better communication. Source: The full article appears in Agarwal, Sands, Schneider, and Smaltz (2010).

Research Briefs These summaries encourage students to access current research in the field.

their fiscal budgets. They often play a pivotal role in determining the strategic direction for an organization. Acuity systems monitor the range of patient types within a health care organization using specific indicators. They track these indicators based on the current patient population within a facility. By monitoring the patient acuity, these systems provide feedback about how intensive the care requirement is for an individual patient or group of patients. Identifying and classifying a patient’s acuity can promote better organizational management of the expenses and resources necessary to provide care. Acuity systems help predict the ability and capacity of an organization to care for its current population. They also forecast future trends to allow an organization to successfully strategize on how to meet upcoming market demands. Scheduling systems coordinate staff, services, equipment, and allocation of patient beds. They are frequently integrated with the other types of core business systems. By closely monitoring staff and physical resources, these systems provide data to the financial systems. For example, resource-scheduling systems may provide information about operating room use or availability of intensive care unit beds and regular nursing unit beds. These systems also provide great assistance to financial systems when they are used to track medical equipment within a facility. Procedures and care are planned

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A Visual Walkthrough xxv

Summaries Summary

Summaries are included at the end of each chapter to provide a concise review of the material covered, highlighting the most important points and describing what the future holds.

This chapter provided an overview of informatics and core informatics competencies, the DIKW paradigm, and the relationship of the paradigm to disciplinary science and established that health care professionals are knowledge workers. The Foundation of Knowledge model was introduced as the organizing conceptual framework for this text. Core informatics competencies were presented with an opportunity for selfassessment. In subsequent chapters, the reader will learn more about how informatics supports health care professionals in their many and varied roles. We suggest that in the future, health care research will make significant contributions to the development of the practice sciences for health care professionals. Technologies and translational research will abound, and clinical practices will be evidence based, thereby improving patient outcomes, decreasing safety concerns, and providing cost-effective care.

Thought-Provoking Questions

Thought-Provoking Questions 1. Describe a scenario in your discipline where you used data, information, knowledge, and wisdom. 2. Choose a clinical scenario from your recent experience and analyze it using the Foundation of Knowledge model. How did you acquire knowledge? How did you process knowledge? How did you generate knowledge? How did you disseminate knowledge? How did you use feedback, and what was the effect of the feedback on the foundation of your knowledge? 3. Complete the self-assessment of informatics competencies presented in Table 1-1 and create an action plan for achieving these competencies.

Students can work on these critical thinking assignments individually or in a group while reading through the text. In addition, students can delve deeper into concepts by completing these exercises online.

Apply Your Knowledge This chapter introduced you to concepts related to the scientific basis of your profession and the relationship between health informatics and your discipline. 1. You are at a social event, and you are sharing a story about your education experience and your course on health informatics. A friend asks you, “What is informatics?” Answer the question by using terms and examples that a layperson will understand. 2. As the conversation continues, you share that you are excited about the allied health major you have chosen because of the scientific basis of the practice. Again, your skeptical friend asks, “What do you mean by the science of the discipline?” Answer this question by describing at least three examples of the scientific basis of practice for your discipline.

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Each chapter contains a content application scenario to promote active learning and critical thinking skills. These activities may be assigned individually to students or may be used as group activities. We believe that when used as group activity, there is better understanding and knowledge building potential. To use as a group activity, we suggest the following directions to students: Huddle with a fellow student or a team of students to read and craft responses to the application scenario. Share your responses, and compare and contrast them to craft a consensus response for the class. These activities also work well in an electronic environment with students chatting online synchronously or asynchronously in a discussion forum.

178 CHAPTER 10: Work Flow and Meaningful Use as Virginia Mason University Medical Center, among others, have experienced significant quality and cost gains from the widespread implementation of Lean development throughout their organization.

Work Flow Analysis and Informatics Practice The functional area of analysis identifies the specific functional qualities related to work flow analysis. Particularly, health informatics should develop techniques necessary to assess and improve human–computer interaction. Work flow analysis, however, is not relevant solely to analysis but rather is part of every functional area that the informatics support personnel engage in. Support personnel need to understand work flow and appreciate how lack of efficient work flow for health care professionals affects patient care. A critical aspect of the informatics support role is work flow design. Health informatics is uniquely positioned to engage in the analysis and redesign of processes and tasks surrounding the use of technology. Work flow redesign is one of the fundamental skills sets that make up the discipline of this specialty. Moreover, work flow analysis should be part of every technology implementation, and the role of the informaticist within this team is to direct others in the execution of this task or to perform the task directly. Unfortunately, many health care professionals find themselves in an informatics support capacity without sufficient preparation for a process analysis role. One area of practice that is particularly susceptible to inadequate preparation is the ability to facilitate process analysis. Work flow analysis requires careful attention to detail and the ability to moderate group discussions, organize concepts, and generate solutions. These skills can be acquired through a formal academic informatics program or through courses that teach the discipline of Six Sigma or Lean, by example. Regardless of where these skills are acquired, it is important to understand that they are now and will continue to remain a vital aspect of the informatics role.

Case Studies Case studies encourage active learning and promote critical thinking skills. Students can ask questions, analyze situations, and solve problems in a real-world context.

CASE STUDY In my experience consulting, I have seen several examples of organizations that engage in the printing of paper reports that replicate information that has been entered and is available with the electronic health record. These reports are often reviewed, signed, and acted on instead of using the electronic information. Despite the knowledge that the information contained in these reports was outdated the moment the report was printed and that the very nature of using the report for work flow is an inefficient practice, this method of clinical work flow remains prevalent in many hospitals across the United States. There is an underlying fear that drives the decisions to mold a paper-based work flow around clinical technology. There is also a lack of the appropriate amount of integration that would otherwise allow this information to be available in an electronic form. Denise Hammel-Jones

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for health professionals - Jones & Bartlett Learning

FOR HEALTH PROFESSIONALS Kathleen Garver Mastrian Dee McGonigle © Jones & Bartlett Learning, LLC, an Ascend Learning Company. NOT FOR SALE OR DISTRIB...

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