D220 Nursing Informatics Study Guide and Questions

D220 Nursing Informatics Study Guide and Questions

Student Name

Western Governors University

D220 Information Technology in Nursing Practice

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Date

Study Questions

Competency 1: Information Management

What is the role of nurses as knowledge workers?

Nurses function as knowledge workers by utilizing information acquired through their education and clinical experiences to collect patient data and make informed decisions regarding patient care on a daily basis. For instance, if a nurse observes a respiratory rate of 40 breaths per minute in a patient, they recognize this as abnormal and promptly contact a physician or respiratory therapist for further intervention, preventing adverse patient outcomes. Moreover, nurses continuously engage in lifelong learning and strive to apply current evidence-based practices to enhance patient care quality.

How are the concepts of Data, Information, Knowledge, and Wisdom (DIKW) defined in nursing, and what are examples of each?

The DIKW framework helps to understand the hierarchy of data processing in nursing:

What informatics competencies are expected at various nursing levels?

Informatics competencies vary according to nursing roles and experience:

How do information literacy and computer literacy relate to evidence-based practice?

Computer literacy refers to the basic ability to use computers, software, spreadsheets, databases, and digital communication tools effectively. It builds upon fundamental literacy skills like reading and writing. Information literacy is the capacity to understand written and numerical information and recognize when new information is required. Together, these literacies form the foundation for evidence-based practice by enabling healthcare professionals to locate and comprehend current research, ultimately leading to improved patient outcomes through consistent, high-quality care.

What are the advantages and disadvantages of using Electronic Health Record Systems (EHRS) in patient-centered care?

Advantages of EHRS include:

• Access to accurate and up-to-date patient data at the point of care.

• Facilitated communication and coordination among healthcare providers.

• Secure storage and sharing of patient information.

• Enhanced diagnosis, reduced medical errors, and safer care delivery.

• Improved patient-provider interactions.

• More reliable medication prescribing.

• Legible, complete documentation and streamlined billing processes.

• Increased staff efficiency and goal achievement.

Disadvantages of EHRS include:

• Privacy and cybersecurity risks.

• Potential inaccuracies in recorded data.

• Difficulty accessing all necessary medical information promptly.

• Time-consuming implementation and system updates.

• High financial costs for setup and maintenance.

• Requirement for ongoing resources to manage the system effectively.

How do clinical information systems (CIS) differ from administrative information systems (AIS)?

Clinical Information Systems (CIS) support healthcare delivery by managing clinical tasks such as order entry, results retrieval, documentation, and decision-making across multiple care locations. Administrative Information Systems (AIS), in contrast, manage non-clinical functions including financials, patient demographics, payroll, human resources, and quality assurance reporting, supporting the overall administration of healthcare facilities.

Competency 1 Continued: Legislative Acts and IT Development

What is the significance of key legislative acts in advancing health information technology?

Competency 2: Leadership in IT

How is an informatics culture created within healthcare organizations?

Building an informatics culture begins by assessing the current organizational state to identify gaps in policies, knowledge, and technology. This foundation requires securing adequate funding and developing necessary educational programs, policies, and guidelines before implementation. Engaging healthcare providers in decision-making fosters ownership and successful adoption. Emphasizing patient-centered care, while ensuring computer, information, and health literacy, is essential to cultivating a robust informatics environment.

What roles do nurses play in selecting and implementing patient information systems?

Nurses contribute at various levels—from formal roles like Chief Nursing Informatics Officers and Informatics Specialists to bedside nurses serving as data collectors and knowledge workers. They provide valuable insights on system usability and contribute to defining the competencies necessary for effective system utilization, ensuring that patient information systems meet clinical needs.

How do strategic plans, missions, and visions differ in healthcare organizations?

• Strategic Plan: A comprehensive roadmap that defines the organization’s direction, incorporating vision and mission statements, goals, objectives, and action plans to achieve desired outcomes.

• Mission: Articulates the organization’s core purpose and fundamental goals, distinguishing it from other entities. Typically communicated via a mission statement clarifying what the organization does and whom it serves.

• Vision: A forward-looking, aspirational statement outlining what the organization aims to become in the future, often serving as a starting point for strategic planning.

What are the phases and activities of the Project Management Life Cycle (PMLC)?

What are classification systems and reference terminologies in healthcare informatics?

• Classification System: Organizes clinical data into mutually exclusive categories for specific purposes. For example, NANDA provides standardized nursing diagnoses, while ICD codes classify diseases for morbidity and mortality tracking.

• Reference Terminology: A comprehensive set of concepts with defined relationships used for data analysis, evidence-based practice, and quality improvement. SNOMED-CT is a widely adopted global terminology that enables consistent health data capture and sharing across specialties and care settings.

How do standardized terminologies relate to financial incentives in meaningful use programs?

Meaningful use criteria emphasize the adoption of standardized terminologies to enable accurate, complete clinical data exchange, thereby improving patient care efficiency and quality. Healthcare organizations demonstrating meaningful use of these terminologies can qualify for financial incentives aimed at promoting the widespread implementation of electronic health records.

Competency 3: Health Information Systems

What are typical applications for clinical information systems (CIS) and administrative information systems (AIS)?

What distinguishes a Personal Health Record (PHR), Electronic Health Record (EHR), and Electronic Medical Record (EMR)?

• Personal Health Record (PHR): Patient-controlled data collection accessible by both patients and providers.

• Electronic Health Record (EHR): A comprehensive, lifetime digital record that can be shared across healthcare disciplines and facilities.

• Electronic Medical Record (EMR): An earlier digital record focused on specific healthcare settings, containing diagnostic and treatment information isolated within one practice or facility.

How do user experience, human factors, ergonomics, human-computer interaction, and usability differ?

• User Experience (UX): Encompasses all user interactions with a product or system, aiming for seamless and positive engagement.

• Human Factors: Studies how humans interact with tools and environments, focusing on improving performance and safety.

• Ergonomics: Concerned with optimizing physical designs for comfort, safety, and efficiency, often overlapping with human factors.

• Human-Computer Interaction (HCI): Focuses on the design and use of computer technology, emphasizing user interfaces.

• Usability: Measures how effectively, efficiently, and satisfactorily users can achieve goals with a product.

Human-Computer Interaction (HCI) in Healthcare

Human-Computer Interaction (HCI) is the interdisciplinary study focused on how people design, implement, and evaluate interactive computer systems within the context of users’ tasks and work environments. It integrates principles from psychology, cognitive science, sociology, and information science to inform the development, purchase, implementation, and evaluation of technological applications. For example, in healthcare, a practical application might be choosing an electronic device for nurses that is neither too bulky nor heavy, thus enhancing inpatient care usability.

HCI encompasses various specific scenarios, such as designing intuitive menus for patient-controlled analgesia devices, evaluating user satisfaction with patient portals, and understanding users’ perceptions of clinical documentation systems. It also addresses the meaning and effectiveness of icons, group-supportive applications, and principles of web design. Furthermore, HCI considers social computing issues like managing virtual groups, how tasks are divided between humans and machines, and cognitive user modeling.

What is Usability, and How Does It Relate to HCI?

Usability is often used interchangeably with HCI but specifically focuses on the interactions of particular users with technology in specific contexts. It includes how safely, efficiently, and effectively applications support user goals and the cognitive workflow of healthcare professionals. Key considerations include the effort required to learn a system, ease of recalling its use after time lapses, user satisfaction, and designing interfaces that minimize errors.

Some practical examples of usability considerations are the time it takes to enter clinical notes during or after patient visits, managing simultaneous documentation, and creating error-forgiving interfaces. Usability strives to make users focus on their primary clinical tasks without being hindered by the technology itself.

What is the Relationship Between Usability and Clinical Outcomes?

The primary goals of usability are to enhance system acceptance and promote effective, efficient, and satisfying use. Systems with high usability reduce clinical error rates and improve both patient safety and healthcare provider satisfaction. When users find technology intuitive and supportive, they are less likely to make mistakes, thus enhancing productivity and safeguarding patients.

Why Are Integration and Interoperability Important for Knowledge Sharing and Collaboration?

Integration refers to the seamless exchange of data between different information systems without disrupting the user experience. Interoperability is the capability of two systems—human or machine—to exchange and use data predictably, preserving the original meaning.

For healthcare organizations, new systems must connect with legacy systems and other software to enable effective data exchange. Both integration and interoperability are essential to support efficient knowledge sharing, collaboration, and coordinated care across diverse healthcare settings.

Electronic Health Records (EHR) and Electronic Health Record Systems (EHRS)

What is the difference between an EHR and an EHRS?

An Electronic Health Record (EHR) is the comprehensive digital record of a patient’s health information, designed for sharing across healthcare facilities and specialties. Conversely, the Electronic Health Record System (EHRS) refers to the software and database infrastructure that facilitates the creation, maintenance, and management of EHRs.

What are the essential components of an EHR?

The critical elements include:

• Patient demographics

• Medical problems and history

• Current medications

• Signs and symptoms

• Immunization records

• Allergies

• Laboratory and radiology reports

Table 1: Essential EHR Components

Benefits of Electronic Health Records

EHRs contribute significantly to healthcare by improving clinical decision-making, enhancing practice efficiency, supporting evidence-based care, reducing medical errors, lowering costs, and increasing staff productivity.

• Caregivers benefit through better communication, easier data access, and clearer documentation.

• Healthcare systems experience enhanced productivity and research capabilities.

• Consumers receive safer, higher-quality care and greater access to their health data, empowering them to participate actively in their own care.

What is Meaningful Use (MU), and What Are Its Core Requirements?

Meaningful Use was initiated by the U.S. government in 2009 to incentivize healthcare providers to use EHR technology effectively, improving safety, efficiency, and quality in care delivery. The program is administered through the Centers for Medicare and Medicaid Services (CMS).

Core MU Requirements Include:

1. Recording demographic data (language, gender, race, date of birth/death)

2. Computerized provider order entry

3. Clinical decision support and compliance tracking

4. Automated drug interaction checks

5. Maintaining active medication and allergy lists

6. Recording vital signs and smoking status

7. Protecting health information with access controls

8. Electronic exchange of clinical data

9. Providing patients with electronic copies of their records and discharge instructions

10. Reporting clinical quality measures

What is Health Information Exchange (HIE), and What Is Its Future Impact?

Health Information Exchange (HIE) facilitates the secure electronic transfer of medical data among healthcare providers and patients. The information moves with patients across care settings, adhering to national standards. HIE supports regional and state health networks and enables treatment coordination, operational efficiencies, and payment processes.

The future of HIE promises enhanced care coordination, reduced redundancies, and better clinical outcomes through timely, accurate data sharing.

Information Security in Healthcare

What Do Privacy, Confidentiality, Information-and-Data Privacy, and Information Consent Mean?

• Privacy is the individual’s right to control access to personal information, including decisions about collection, sharing, and usage.

• Confidentiality is the ethical and legal obligation to protect patient information from unauthorized disclosure within established relationships.

• Information-and-Data Privacy involves legal, ethical, and social considerations regarding data collection and usage.

• Information Consent refers to the patient’s informed permission to use and share their health data, including understanding associated risks.

What Are Common Threats to Information Security?

Healthcare data systems face diverse threats, including cyberattacks (hackers, viruses), natural disasters, human error, and system failures. The proliferation of technology has increased vulnerability, requiring robust protections against malicious activities.

How Do HIPAA and HITECH Work Together?

The Health Information Technology for Economic and Clinical Health (HITECH) Act encouraged widespread EHR adoption by offering financial incentives, aiming for universal digital records by 2014. HITECH also fosters public health improvements through electronic reporting.

HIPAA protects personal health information by restricting unauthorized disclosures. However, for public health purposes, HIPAA allows necessary sharing of data for disease control and surveillance, sometimes overridden by HITECH provisions for public health needs.

Securing Networks: Physical and Logical Methods

Physical Security Practices:

• Locking data centers and servers

• Using surveillance systems

• Limiting physical access

• Protecting workstations and portable devices with encryption

• Securing backup media and printing devices

Logical Security Practices:

• User authentication and strong passwords

• Automatic logoffs

• Firewalls and antivirus software

• Biometric access controls (fingerprint, retinal scans)

• Proximity card readers

Using Patient Data to Improve Quality

Patient data is fundamental in driving quality improvement initiatives by reducing duplicate testing, enhancing care quality, and fostering public trust. Baseline and post-intervention data comparisons identify progress and gaps, informing evidence-based changes that improve patient outcomes.

Role of Technology as a Change Agent

Technology catalyzes change by enabling scientific advances and evidence-based practice improvements. It supports innovation in patient care and healthcare delivery processes, transforming how healthcare is practiced.

Value-Based Reimbursement vs. Pay-for-Performance

• Value-Based Reimbursement prioritizes quality of services over quantity, rewarding outcomes and patient-centered care.

• Pay-for-Performance and volume-based models focus on meeting service quantity targets or performance metrics to receive compensation.

Workflow Analysis and Clinical Decision Support Systems (CDS)

Workflow analysis systematically examines healthcare processes, identifying roles, responsibilities, and outcomes. It facilitates integration and evaluation of changes to optimize practice.

CDS systems help implement evidence-based guidelines by analyzing patient data, setting reminders, aiding decision-making, and saving clinician time.

Advantages of CDS:

• Time-saving

• Promotes quality care

• Automates routine processes

Potential Disadvantages:

• Risk of system errors

• Reduced individualized care

• Ethical decision challenges

Technology and Culture of Safety

Safety technology enhances employee well-being, productivity, and morale. It facilitates timely data collection and quicker response to hazards, reducing injuries and fatalities. For patients, safety is promoted through automated alerts and adherence to standardized, evidence-based protocols.

Telehealth and Connected Health

What Drives the Growth of Telehealth?

• Faster regulatory approvals increase access and competitiveness.

• Patient demand for convenience and engagement grows.

• Providers seek increased productivity and cost savings.

• Enhanced data management capabilities facilitate telehealth expansion.

Advantages and Challenges

Challenges include privacy concerns, technology barriers, and continuity of care issues.

Types of Connected Health Applications

• Asynchronous: Non-real-time communication, such as emails or online forums.

• Synchronous: Real-time interactions like video calls or virtual visits, requiring simultaneous presence.

Non-Clinical Telehealth Applications

1. Monitoring public health trends (e.g., COVID-19 exposure data).

2. Administrative functions such as virtual meetings and online training.

Ethical and Legal Issues in Telehealth

Telehealth raises confidentiality concerns, credentialing challenges, prescribing regulations, malpractice liability questions, licensure restrictions, and informed consent complexities. Policies vary across jurisdictions, requiring ongoing attention to legal and ethical frameworks.

Emerging Healthcare IT Trends

Precision Medicine: Personalizes care using molecular, clinical, environmental, and lifestyle data to tailor treatments.

Sharing Society: Emphasizes community-based care and self-management supported by remote monitoring, personal health records, and online health communities.

Artificial Intelligence and Automation: Enhances workflow, reduces errors, and forecasts risks through advanced data analytics.

Virtual Care: Expanding rapidly, especially post-pandemic, virtual care integrates telehealth across care settings, transforming healthcare delivery.

References

• HealthIT.gov. (n.d.). Meaningful Use. https://www.healthit.gov/topic/meaningful-use-and-macra

• Office of the National Coordinator for Health Information Technology. (2021). What is HIE? https://www.healthit.gov/topic/health-it-and-health-information-exchange-basics/health-information-exchange

• U.S. Department of Health and Human Services. (n.d.). HIPAA Privacy Rule. https://www.hhs.gov/hipaa/for-professionals/privacy/index.html

• Centers for Medicare & Medicaid Services. (n.d.). Electronic Health Records. https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms

D220 Nursing Informatics Study Guide and Questions

• American Medical Association. (2020). Telehealth Implementation Playbook. https://www.ama-assn.org/practice-management/digital/ama-telehealth-playbook

• American Nurses Association. (2015). Nursing informatics: Scope and standards of practice (2nd ed.). ANA.
• HealthIT.gov. (n.d.). What is electronic health record (EHR)? https://www.healthit.gov/faq/what-electronic-health-record-ehr
• McGonigle, D., & Mastrian, K. (2021). Nursing informatics and the foundation of knowledge (5th ed.). Jones & Bartlett Learning.
• Sensmeier, J. (2017). The TIGER initiative: Developing competencies in health IT. Nursing Management, 48(5), 22-25.
• Wager, K. A., Lee, F. W., & Glaser, J. P. (2017). Health care information systems: A practical approach for health care management (4th ed.). Jossey-Bass.