As the nurse informatician moves toward implementation of a system, user support becomes paramount. Procedure manuals will be developed that will describe how to perform business tasks while using the system.
Gap analysis is used to determine the steps required to move from a current state or actual performance or situation to a new one or potential performance or situation, and the “gap” between the two that requires action or resources. Steps to gap analysis include:
- assessing the current situation and listing important factors, such as performance levels, costs, staffing, and satisfaction, and all processes
- identifying the current outcomes of processes
- identifying the target outcomes for projected processes
- outlining the process required to achieve target outcomes
- identifying the gaps that are present
- identifying resources and methods to close the gaps
While performance appraisal is sometimes prompted by disciplinary action, this is not usually the case, and while the actual review of the performance appraisal may be scheduled and the time in which an individual should reach a goal limited, generally performance appraisal should be an ongoing process that continues from one review period to another (usually annually) in order to provide feedback to the individual and help the individual reach goals.
The GUI (graphical user interface) facilitates interaction between the user and the computer. The user interface is the means by which the individual interacts with the computer. Provided by Microsoft Windows, the GUI provides a means of navigating within the computer environment. The GUI is part of the computer operating system. It is the “desktop”screen, usually with icons that can be activated by clicking them with a mouse or selecting with a trackball or other device, such as menus, windows, and other standard screen features intended to make using a computer as intuitive as possible. The design of the GUI should be intuitive so that the user can determine what actions to take without written instructions, and thus decreasing the amount of time required to learn new programs and eliminate the need to memorize commands.
A dashboard (also called a digital dashboard), like the dashboard in a car, is an easy access and read computer program that integrates a variety of performance measures or key indicators into one display (usually with graphs or charts) to provide an overview of an organization. It might include data regarding patient satisfaction, infection rates, financial status, or any other measurement that is important to assess performance. The dashboard provides a running picture of the status of the department or organization at any point in time, and may be updated as desired, such as daily, weekly, or monthly.
- dashboard display
- is intended to piece all of relevant information together from various systems on one screen
- reflect real-time data
- bring together key performance indicators for business decisions or clinical data from several systems into clinical dashboard
The ADA provides disabled persons, including those with mental impairment, access to employment and the community. Employers are only allowed to ask applicants if they need accommodations, not if they have disabilities. Applicants may be asked if they can carry out essential functions of a job, not incidental, and medical examinations can only be required after a job is offered. Accommodations can include alterations in a work station, speech recognition software, screen magnifying software, optical character recognition systems, video captioning, Braille readers and screen readers, adapted keyboards, and on-screen keyboard, TTYs (text telephones), and amplification systems.
- developed by the American Medical Association (AMA) in 1966
- define those licensed to provide services and describe medical and surgical treatments, diagnostics, and procedures.
- The use of CPT codes is mandated by both CMS and HIPPA to provide a uniform language and to aid research.
- The code set is copyrighted by the AMA and is continually evaluated and updated annually in October of each year coordination with CMS.
- These codes are used primarily for billing purposes for insurances (public and private). HHS has designed CPT codes as part of the national standard for electronic health care transactions: (Medicare utilizes an adjusted form of CPT, the HCPCS code. While ICD-9 codes are used to code for procedures, ICD-9 coding is used only for inpatients.
- 3 categories of CPT
- Category I: Identify a procedure or services
- evaluation and management
- pathology and laboratory
- Category II: Identify performance measures, including diagnostic procedures
- Category III: Identify temporary codes for technology and data collection
- Category I: Identify a procedure or services
- The HCPCS: developed to covered the CPT coded services and other services, such as DME, supplies, drugs, or ambulance services.
- is in 2 levels
- level I: same as CPT codes
- level II: more extensively for supplies, equipment, and auxilliary services not normally passing through a physician’s office.
- is in 2 levels
The primary disadvantage to scanning paper documents into an EHR rather than coding them is that the data cannot be mined. If only a few patient records are involved, the problem may not be of statistical concern, but in a large institution with large numbers of patients, this may skew data. During implementation of an EHR, the organization should determine what information is most critical and that information should be coded even if the documents are scanned. The same type of problem arises if staff use excessive free text in documentation.
When the informatics nurse notes that there has been a marked increase in help-desk tickets to one hospital unit, the first action should be to analyze the types of help-desk tickets to determine if, for example, they relate to the same or similar problems or to various types of problems. Then the informatics nurse should interview the help desk staff members about the types of problems and their perceptions of the causes. After this, the informatics nurse should interview the staff members on the unit. Additional training may or may not be needed, depending on the results of the investigation.
If, when reviewing user data, the informatics nurse notes that one staff person has far higher error rates than others, the best method of dealing with this is to speak to the person face-to-face to discuss the reasons for the errors and any need for additional training. The informatics nurse should avoid accusatory language or attitudes and instead focus on collaborating with the person to identify the person’s needs and reduce the error rate.
The nurse informatician has gathered a group of end users who will test scenarios in a clear test region of the system. In the Systems Development Life Cycle process, this is known as : Alpha testing (requires that end users ensure the acceptability of the system by conducting scenarios in the test region)
- In the systems development life cycle process, informatician observe the end users and note problems.
- Alpha testing is testing of the system when development is about to complete. Minor design changes can still be made as a result of alpha testing.
- Alpha testing is typically performed by end users.
- Alpha testing is final testing before the system go-live. It has two phases:
- In the first phase of alpha testing, the system is tested by in-house developers.
- In the second phase of alpha testing, the system is handed over to the end users, for additional testing in an environment that is similar to the intended use.
- Alpha testing is simulated or actual operational testing by potential users/customers or an independent test team at the developers’ site. Alpha testing is often employed for off-the-shelf software as a form of internal acceptance testing, before the software goes to beta testing. (retrieved from http://istqbexamcertification.com/what-is-alpha-testing/ )
When assigning roles to team leaders, the informatics nurse should first consider their education and skills in order to match members to the most appropriate roles because members are more likely to be effective if they are dealing with roles with which they have some familiarity. The members’ available time investment is also important to ensure that the members actually have the time needed to carry out the roles. Commitment to learn efforts is also important but can be modified by effective or ineffective leadership. Personality types vary widely but should not be a deciding factor.
Privacy rule: Protected information includes any information included in the medical record, conversations between the doctor and other healthcare providers, billing information, and any other forms of health information. Security rule: Any electronic health information must be secure and protected against threats, hazards, or nonpermitted disclosures. Implementation specifications must be addressed for any adapted standards. Security requirements include limiting access to those authorized, use of unique identifiers for each user, automatic logoff, encryption and decryption of protected health care information, authentication that health care data have not been altered/ destroyed, monitoring of logins, authentication, and security of transmission.
privacy rules: (reading notes retrieved from: Nursing Informatics and the Foundation of Knowledge, 3rd ed.)
- define protected health information as “information relating to one’s physical or mental health, the provision of one’s health care, or the payment for that health care, that has been maintained or transmitted electronically and that can be reasonably identified with the individual it applies to”
- propose that authorization by patients for release of information is not necessary when the release of information is directly related to treatment and payment for treatment. Specific patient authorization is not required for research, medical or police emergencies, legal proceedings, and collection of data for public health concerns. all other releases of health information require a specific form for each release and only information pertinent to the issue at hand is allowed to be released. all releases of information must be formally documented and accessible to the patient on request.
- establish patient ownership of the healthcare record and allow for patient-initiated corrections and amendments.
- mandate administrative requirement for the protection of healthcare information. all healthcare organizations are required to have a privacy official and an office to receive privacy violation complaints. as specific training program for employees that includes a certification of completion and a signed statement by all employees that they will uphold privacy procedures must be developed and implemented. all employees must re-sign the agreement to uphold privacy every 3 years. sanctions for violations of policy must be clearly defined and applied.
- mandate that all outside entities that conduct business with healthcare organizations (such as attorneys, consultants, auditors, etc.) must meet the same standards as the organization for information protection and security.
- allow protected health information to be released without authorization for research studies. patients may not access their information in blinded research studies because this access may affect the reliability of the study outcomes.
- propose that protected health information may be deidentified before release in such a manner that the identity of the patient is protected. the healthcare organization may code the deidentification so that the information can be reidentified once it has been returned.
- apply only to health information maintained or transmitted by electronic means.
- the privacy rule provides certain rights to patients:
- the right to request restriction to access of the health record
- the right to request an alternative method of communication with the provider
- the right to receive a paper copy of the notice of privacy practices
- the right to file a complaint if the patient believes his or her privacy rights were violated
- the right to inspect and copy one’s health record
- the right to request an amendment to the health record
- the right to see an account of disclosures of one’s health record
When exploring the organizational feasibility, the nursing informaticist knows that one must first determine the Project Champion (a high-level executive, generally, who supports the project and understands the importance. The project champion is usually the organizational political support.
If the informatics nurse has found a new application that may enhance the existing EHR with CPOE CDS system, the first concern before recommending the application is: Compatibility. If application will not work within the existing system or it requires extensive workaround, then it is not a good choice. The informatics nurse should consult with the vendor as well as IT personnel and programmers to determine whether there are compatibility issues.
The Health Information Technology for Economic and Clinical Health (HITECH) Act under the Enforcement Interim Rule provides criminal/ civil penalties for violations of HIPAA rules. HITECH outlines 4 levels of violations and corresponding penalties, which can not exceed $1.5 million for all violations of the same provision. Lack of awareness of the rules and regulations is not considered a defense or protection from penalties. HITECH establishes the Health IT Policy Committee, which makes recommendations regarding implementation of a national health IT infrastructure.
During the design phase, the nurse informatician may be involoved in systems integration development because: often you need to integrate a legacy system with new systems. Although you may purchase multiple new systems to integrate, there is often a legacy system that has been in use for years.
An one-on-one interview is an example of a qualitative approach to obtaining user feedback about a computer information system. Qualitative data are narrative rather than numerical (quantitative) although some quantitative approaches may be applied to qualitative data. Qualitative feedback is utilized to determine the users’ perceptions of the information system and to help provide cause. For example, if quantitative data show increased documentation errors, qualitative research may be able to help ascertain the reason.
The nurse informaticist is aware of the ethical responsibility to safeguard the accuracy of data. This can be done using input integrity controls that include a check digit, which is a data validation control. (A data validation control is generated based on a calculation from data previously entered.)