Informatics for health professionals 2nd edition free pdf

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1 FOR HEALTH PROFESSIONALS Kathleen Garver Mastrian Dee McGonigle

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3 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)

4 World Headquarters Jones & Bartlett Learning 5 Wall Street Burlington, MA Jones & Bartlett Learning books and products are available through most bookstores and online booksellers. To contact Jones & Bartlett Learning directly, call , fax , or visit our website, 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 to 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 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 ISBN (pbk. : alk. paper) Subjects: MESH: Medical Informatics methods Knowledge Professional Competence Classification: LCC R858 NLM W 26.5 DDC dc23 LC record available at Printed in the United States of America

5 Contents Preface Acknowledgments Contributors A Visual Walkthrough xv xix xxi xxiv SECTION I: BUILDING BLOCKS OF HEALTH INFORMATICS 1 1 Informatics, Disciplinary Science, and the Foundation of Knowledge 5 Kathleen Mastrian and Dee McGonigle Introduction 5 The DIKW Paradigm 6 The Foundation of Knowledge Model 8 Core Informatics Competencies 12 Summary 18 Thought-Provoking Questions 18 Apply Your Knowledge 18 References 19 2 Introduction to Information, Information Science, and Information Systems 21 Dee McGonigle, Kathleen Mastrian, and Craig McGonigle Introduction 21 Information 22 Information Science 24 Information Processing 25 Information Science and the Foundation of Knowledge 27 Introduction to Information Systems 28 Information Systems 28 Summary 31 Thought-Provoking Questions 31 Apply Your Knowledge 32 References 32 v

6 vi CONTENTS 3 Computer Science and the Foundation of Knowledge Model 33 June Kaminski, Dee McGonigle, Kathy Mastrian, and Craig McGonigle Introduction 33 The Computer as a Tool for Managing Information and Generating Knowledge 34 Computer Components 36 What is the Relationship of Computer Science to Knowledge? 49 How Does the Computer Support Collaboration and Information Exchange? 50 What is the Human Technology Interface? 51 Looking to the Future 53 Summary 56 Thought-Provoking Questions 56 Apply Your Knowledge 57 Additional Resources 57 References 57 4 Introduction to Cognitive Science and Cognitive Informatics 59 Dee McGonigle and Kathleen Mastrian Introduction 59 Cognitive Science 60 Sources of Knowledge 61 Nature of Knowledge 62 How Knowledge and Wisdom are used in Decision Making 62 Cognitive Informatics 63 Cognitive Informatics and Health Care Practice 64 What is Artificial Intelligence? 65 Summary 66 Thought-Provoking Questions 66 Apply Your Knowledge 67 References 68 5 Ethical and Legal Aspects of Health Informatics 69 Kathleen Mastrian, Dee McGonigle, and Kathleen M. Gialanella Introduction 69 Ethics 70 Ethical Dilemmas and Morals 72 Ethical Decision Making 72

7 Contents vii Theoretical Approaches to Health Care Ethics 73 Applying Ethics to Informatics 76 Case Analysis Demonstration 81 New Frontiers in Ethical Issues 85 Legal Aspects of Health Informatics 85 Overview of the HITECH Act 88 How the HITECH Act Changed HIPAA 91 Implications for Practice 97 Ethical and Legal Issues and Social Media 98 Summary 103 Thought-Provoking Questions 103 Apply Your Knowledge 104 Additional Resources 104 References 105 SECTION II: CHOOSING AND USING INFORMATION SYSTEMS Systems Development Life Cycle 113 Dee McGonigle and Kathleen Mastrian Introduction 113 Waterfall Model 116 Rapid Prototyping or Rapid Application Development 119 Object-Oriented Systems Development 119 Dynamic System Development Method 120 Computer-Aided Software Engineering Tools 122 Open-Source Software and Free/Open-Source Software 123 Interoperability 123 Summary 125 Thought-Provoking Questions 125 Apply Your Knowledge 125 References Administrative Information Systems 127 Marianela Zytkowski, Susan Paschke, Dee McGonigle, and Kathleen Mastrian Introduction 127 Types of Health Care Organization Information Systems 128 Communication Systems 129

8 viii CONTENTS Core Business Systems 130 Order Entry Systems 132 Patient Care Support Systems 132 Department Collaboration and Exchange of Knowledge and Information 138 Summary 140 Thought-Provoking Questions 140 Apply Your Knowledge 140 References The Human Technology Interface 143 Judith A. Effken, Dee McGonigle, and Kathleen Mastrian Introduction 143 The Human Technology Interface 144 The Human Technology Interface Problem 146 Improving the Human Technology Interface 147 A Framework for Evaluation 153 Future of the Human Technology Interface 154 Summary 156 Thought-Provoking Questions 156 Apply Your Knowledge 156 Additional Resources 157 References Electronic Security 161 Lisa Reeves Bertin, Dee McGonigle, and Kathleen Mastrian Introduction 161 Securing Network Information 162 Authentication of Users 163 Threats to Security 164 Security Tools 167 Off-Site Use of Portable Devices 168 Summary 171 Thought-Provoking Questions 171 Apply Your Knowledge 171 Additional Resources 172 References 172

9 Contents ix 10 Work Flow and Meaningful Use 173 Denise Hammel-Jones, Dee McGonigle, and Kathleen Mastrian Introduction 173 Work Flow Analysis Purpose 173 Work Flow and Technology 175 Work Flow Analysis and Informatics Practice 178 Informatics as a Change Agent 183 Measuring the Results 184 Future Directions 186 Summary 188 Thought-Provoking Questions 188 Apply Your Knowledge 189 Additional Resources 189 References 189 SECTION III: INFORMATICS APPLICATIONS FOR CARE DELIVERY The Electronic Health Record and Clinical Informatics 195 Emily B. Barey, Kathleen Mastrian, and Dee McGonigle Introduction 195 Setting the Stage 196 Components of Electronic Health Records 197 Advantages of Electronic Health Records 200 Ownership of Electronic Health Records 205 Flexibility and Expandability of Electronic Health Records 208 The Future 210 Summary 211 Thought-Provoking Questions 211 Apply Your Knowledge 211 References 212 Informatics Tools to Promote Patient Safety, Quality Outcomes, and Interdisciplinary Collaboration 215 Dee McGonigle and Kathleen Mastrian Introduction 215 What is a Culture of Safety? 216

10 x CONTENTS Strategies for Developing a Safety Culture 218 Informatics Technologies for Patient Safety 220 Interdisciplinary Collaboration 228 Role of the Health Informaticist 229 Summary 232 Thought-Provoking Questions 232 Apply Your Knowledge 233 Additional Resources 233 References 234 Patient Engagement and Connected Health 237 Kathleen Mastrian and Dee McGonigle Introduction 237 Consumer Demand for Health Information 238 Health Literacy and Health Initiatives 239 Health Care Organization Approaches to Engagement 241 Promoting Health Literacy in School-Aged Children 243 Supporting Use of the Internet for Health Education 244 Future Directions for Engaging Patients 246 Telehealth: A Tool for Connected Health 249 Telehealth Care 251 Tools of Home Telehealth 253 The Patient s Role in Telehealth 256 Health Care in the Future 258 Summary 259 Thought-Provoking Questions 259 Apply Your Knowledge 259 Additional Resources 259 References 261 Using Informatics to Promote Community/Population Health 263 Margaret Ross Kraft, Ida Androwich, Kathleen Mastrian, and Dee McGonigle Introduction 263 Core Public Health Functions 265 Community Health Risk Assessment: Tools for Acquiring Knowledge 266 Processing Knowledge and Information to Support Epidemiology and Monitoring Disease Outbreaks 267 Applying Knowledge to Health Disaster Planning and Preparation 269

11 Contents xi Informatics Tools to Support Communication and Dissemination 270 Using Feedback to Improve Responses and Promote Readiness 271 Summary 273 Thought-Provoking Questions 274 Apply Your Knowledge 275 References 275 SECTION IV: ADVANCED CONCEPTS IN HEALTH INFORMATICS Informatics Tools to Support Health Care Professional Education and Continuing Education 281 Heather E. McKinney, Sylvia DeSantis, Kathleen Mastrian, and Dee McGonigle Introduction: Professional Education and the Foundation of Knowledge Model 281 Knowledge Acquisition and Sharing 282 Hardware and Software Considerations 282 Delivery Modalities 283 Technology Tools Supporting Education 286 Internet-Based Tools 295 Promoting Active and Collaborative Learning 301 Knowledge Dissemination and Sharing 303 Fair use and Copyright Restrictions 305 The Future 306 Summary 307 Thought-Provoking Questions 307 Apply Your Knowledge 307 Additional Resources 307 References 309 Data Mining as a Research Tool 311 Dee McGonigle, Kathleen Mastrian, and Craig McGonigle Introduction: Big Data, Data Mining, and Knowledge Discovery 311 KDD and Research 316 Data Mining Concepts 318 Data Mining Techniques 318 Data Mining Models 322 Ethics of Data Mining 325 Summary 326 Thought-Provoking Questions 326

12 xii CONTENTS Apply Your Knowledge 326 Additional Resources 327 References 327 Finding, Understanding, and Applying Research Evidence in Practice 329 Jennifer Bredemeyer, Ida Androwich, Heather E. McKinney, Kathleen Mastrian, and Dee McGonigle Introduction 329 Information Literacy 330 Acquiring Knowledge Through Internet and Library Holdings 331 Information Sharing and Fair Use 333 Clarification of Research Terms 334 History of EBP 335 Evidence 336 Bridging the Gap Between Research and Practice 337 Barriers to and Facilitators of EBP 337 Informatics Tools to Support EBP 338 Developing EBP Guidelines 341 Meta-Analysis and the Generation of Knowledge 342 The Future 343 Summary 344 Thought-Provoking Questions 344 Apply Your Knowledge 345 Additional Resources 345 References 345 Bioinformatics, Biomedical Informatics, and Computational Biology 349 Dee McGonigle and Kathleen Mastrian Introduction 349 Bioinformatics, Biomedical Informatics, and Computational Biology Defined 350 Why are Bioinformatics and Biomedical Informatics so Important? 353 What Does the Future Hold? 356 Summary 358 Thought-Provoking Questions 358 Apply Your Knowledge 359 References 359

13 Contents xiii SECTION V: PRACTICE IN THE FUTURE A B The Art of Delivering Patient-Centered Care in Technology-Laden Environments 365 Kathleen Mastrian and Dee McGonigle Introduction 365 Caring Theories 366 Presence 369 Strategies for Enhancing Caring Presence 369 Reflective Practice 371 Summary 373 Thought-Provoking Questions 373 Apply Your Knowledge 373 Additional Resources 374 References 374 Generating and Managing Organizational Knowledge 375 Dee McGonigle and Kathleen Mastrian Introduction 375 Foundation of Knowledge Model Revisited 376 Knowledge Use in Practice 378 Managing Knowledge Across Disciplines 381 Summary 384 Thought-Provoking Questions 384 Apply Your Knowledge 384 References 385 Allied Health Professional Organizations 387 Contributed by Craig McGonigle Emerging Health Care Technologies by Discipline 399 Contributed by Craig McGonigle Abbreviations 401 Glossary 407 Index 435

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15 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 ( Facts.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 xv

16 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.

17 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.

18 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.

19 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. xix

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21 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

22 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

23 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

24 A Visual Walkthrough Informatics, Disciplinary Science, and the Foundation of Knowledge Kathleen Mastrian and Dee McGonigle OBJECTIVES 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. 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: c h a p t e r 1 Key Terms 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 (continues) Key Terms 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 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. Core Business Systems 131 Introductions 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. 5 RESEARCH BRIEF 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

25 A Visual Walkthrough xxv Summary 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 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. 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. Summaries 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. Thought-Provoking Questions 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. 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. Apply Your Knowledge 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. 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. 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 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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