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Handbook of Informatics for Nurses and
Healthcare Professionals TONI HEBDA I KATHLEEN HUNTER I PATRICIA CZAR
Handbook of Informatics for Nurses and Healthcare Professionals
Toni Hebda, PhD, RN-C, CNE MSIS Professor MSN Program Chamberlain College of Nursing, Downers Grove, IL 60515
Kathleen Hunter, PhD, FAAN, RN-BC, CNE Professor MSN Program Chamberlain College of Nursing, Downers Grove, IL 60515
Patricia Czar, RN Information Systems Consultant Pittsburgh, PA
330 Hudson Street, NY NY 10013
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Publisher: Julie Alexander Director of Portfolio Management, Nursing: Katrin Beacom Editorial Assistant: Erin Sullivan Managing Content Producer: Melissa Bashe Content Producer: Michael Giacobbe Design Coordinator: Mary Siener Vice President of Sales and Marketing: David Gesell Vice President, Director of Marketing: Brad Parkins Director, Digital Studio: Amy Peltier Digital Project Manager: Jeff Henn Full-Service Project Management and Composition: SPi Global Full-Service Project Managers: Sreemeenakshi Raghothaman, Anitha Vijayakumar, SPi Global Editorial Project Manager: Dan Knott, SPi Global Manufacturing Buyer: Maura Zaldivar-Garcia, LSC Communications, Inc. Cover Designer: Laurie Entringer
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Notice: Care has been taken to confirm the accuracy of information presented in this book. Theauthors, editors, and the publisher, however, cannot accept any responsibility for errors or omissionsor for consequences from application of the information in this book and make no warranty, expressor implied, with respect to its contents.
Cataloging in Publication data is available at the Library of Congress
ISBN 10: 0-13-471101-7 ISBN 13: 978-0-13-471101-0
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Preface ix Acknowledgments xiii Contributors xv Reviewers xvii About the Authors xix
1 An Overview of Informatics in Healthcare 1 Jennifer A. Brown, Taryn Hill, Toni Hebda
The Relevance of Informatics for Healthcare 3
Creating an Informatics Culture 8
Caring for the Patient Not the Computer 12
Future Directions 13
2 Informatics Theory and Practice 20 Maxim Topaz
Overview of Theory 20
Critical Theories Supporting Informatics 22
Informatics Specialties within Healthcare 30
Informatics Competencies for Healthcare Practitioners 33
TANIC AND NICA 37
Future Directions 37
3 Effective and Ethical Use of Data and Information 42 Toni Hebda, Kathleen Hunter
Overview of Data and Information 42
Using Data for Quality Improvement 44
Data Management 46
Big Data, Data Analytics, and Data Modeling 47
Ethical Concerns with Data and Information Use 52
Future Directions 52
4 Electronic Resources for Healthcare Professionals 58 Brenda Kulhanek
Information Literacy 58
Critical Assessment of Online Information 59
Social Media—Responsibilities and Ethical Considerations 61
Healthcare Information and Services 62
Online Services for Healthcare Professionals 64
Professional Organizations and Watchdog Groups 65
Healthcare Websites of Interest for Healthcare Providers 66
Using Information Technology to Organize and Use Information Effectively 68
Future Directions 70
5 Using Informatics to Support Evidence-Based Practice and Research 73 Melody Rose
Levels of Evidence 75
Applying Information Literacy to Find the Highest Levels of Evidence 77
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Integration of EBP into Clinical Systems and Documentation 78
Managing Research Data and Information 80
Creating and Maintaining the Infrastructure to Support Research 81
Ethical and Legal Principles for Handling Data and Information in Research 83
Practices for Collecting and Protecting Research Data 84
Supporting Dissemination of Research Findings 86
Effecting Practice Change 87
Future Directions 88
6 Policy, Legislation, and Regulation Issues for Informatics Practice 94 Sunny Biddle, Jeri A. Milstead
The Policy Process 95
Legislation and HIT/Informatics 98
Regulation (Rule-Making) and Implications for Informatics 101
Policy Making, Interprofessional Teams, and Informatics 106
Future Directions 108
7 Electronic Health Record Systems 112 Rayne Soriano, Kathleen Hunter
Meaningful Use 114
Benefits of EHRSs 119
Current Status of EHRSs 121
Considerations When Implementing the EHRS 123
Future Directions 128
8 Healthcare Information Systems 135 Carolyn Sipes, Jane Brokel
Clinical Information Systems 136
Administrative Information Systems 139
Smart Technology 141
Current Topics in Healthcare Information Systems 143
9 Strategic Planning, Project Management, and Health Information Technology Selection 149 Carolyn Sipes
Overview of Strategic Planning 150
Information Management Components 152
One Vendor versus Best of Breeds 155
Ease of Use/Usefulness of Systems 156
Planning at the Project Level—The Project Management Process 157
The Informatics Nurse’s Role as Project Manager 161
Essential Skills in Other Advanced Nurse Practice Roles 162
Future Directions 163
10 Improving the Usability of Health Informatics Applications 167 Nancy Staggers
Introduction to Usability 168
Definitions of Terms and Interrelationships of Concepts 169
The Goals of Usability 171
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Information System Security 242
Security Mechanisms 249
Administrative and Personnel Issues 256
Levels of Access 257
Audit Trails 260
Handling and Disposal of Confidential Information 260
Special Considerations with Mobile Computing 262
Security for Wearable Technology/Implanted Devices/Bedside Technology 263
Future Directions 266
14 Information Networks and Information Exchange 271 Jane M. Brokel
Health Information Network Models 272
Clinical Data Networks or Health Information Networks 273
International Standards 278
Nationwide Health Information Network 279
Implications of Interoperability 280
Process and Use Cases for Health Information Exchange 280
Key Factors 281
Driving Forces 284
Current Status 285
Future Directions 286
Usability and the System Life Cycle 172
Human–Computer Interaction Frameworks 172
Usability Methods 175
Usability Tests 179
Steps in Conducting Usability Tests 183
Future Directions 185
11 System Implementation, Maintenance, and Evaluation 191 Sue Evans
System Implementation 192
System Installation 203
System Evaluation 206
12 Workforce Development 210 Diane Humbrecht, Brenda Kulhanek
Workforce Population 210
Devising a Workforce Development Preparation Plan 212
Identifying the Scope of Efforts 214
Target Technology and Related Competencies 217
Education Methods 219
Training Resources 225
Evaluating Success 226
When Information Technology Fails (Training on Backup Procedures) 228
Future Directions 229
13 Information Security and Confidentiality 238 Ami Bhatt, Patricia Mulberger
Privacy, Confidentiality, Security, and Consent 239
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15 The Role of Standardized Terminology and Language in Informatics 293 Susan Matney
Introduction to Terminology 293
Languages and Classification 297
Benefits of Implementing Standardized Terminologies 309
National Healthcare Reporting Requirements 312
Issues and Concerns 313
Future Directions 313
16 Continuity Planning and Management (Disaster Recovery) 320 Carolyn S. Harmon
Introduction and Background 320
What Is Continuity Planning? 321
Steps in the Developing a Preparedness Program 324
Advantages of Continuity Planning 328
Disasters Versus System Failure 329
Continuity and Recovery Options 329
Planning Pitfalls 337
Using Post-Disaster Feedback to Improve Planning 338
Legal and Accreditation Requirements 338
Future Directions 340
17 Using Informatics to Educate 343 Diane A. Anderson, Julie McAfooes, Rebecca J. Sisk
Why Informatics? 344
Preparing the Learner 344
Educational Software Sources 344
Barriers and Benefits 345
Necessary Tools 346
Simulation and Virtual Learning Environments 354
Future Directions 363
18 Consumer Health Informatics 370 Melody Rose, Toni Hebda
Driving Forces 372
Consumer Health Informatics Applications 377
The Role of the Informatics Nurse with CHI 385
The Future of CHI 388
19 Connected Healthcare (Telehealth and Technology-Enabled Healthcare) 398 Lisa Eisele
History of Connected Health 399
Current State 400
Driving Forces 400
Connected Health Modalities 403
Implications for Practitioners 408
The Role of the INS in Connected Health 412
Future Directions 413
20 Public Health Informatics 418 Marisa L. Wilson
Exploring Public Heath 419
Public Health Mandate 419
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Public Health Informatics 422
Public Policy Driving Informatics Change 425
Current Public Health Informatics Systems 426
New Technological Sources of Public Health Information 428
Future Directions 430
Appendix A: Hardware and Software 435 Athena Fernandes
Appendix B: The Internet and the Worldwide Web 439 Athena Fernandes
Appendix C: An Overview of Tools for the Informatics Nurse 441 Carolyn Sipes
Glossary 446 Index 454
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The idea for Handbook of Informatics for Nurses & Healthcare Professionals first came from the realiza-tion that there were few resources that provided practical information about computer applications and information systems in healthcare. From its inception, this book served as a guide for nurses and other health- care professionals who needed to learn how to adapt and use computer applications and informatics in the work- place. Over time, this text became a reliable resource for students in a variety of healthcare professions who needed to develop informatics competencies. This book serves undergraduates who need a basic understanding, as well as those who require more depth, such as infor- matics nurse specialists, clinical nurse leaders, doctoral students, and other healthcare professionals.
After a thorough revision in response to reviewers and users of the book, the sixth edition reflects the rapid changes in healthcare information technology (HIT) and informatics. The authors endeavour to provide an understanding of the concepts, skills, and tasks that are needed for healthcare professionals today and to achieve the federal government’s national information technology goals to help transform healthcare delivery.
The sixth edition builds upon the expertise pro- vided by contributors currently involved in day-to-day informatics practice, education, and research. Both the primary editors and the contributors share an avid inter- est and involvement in HIT and informatics, as well as experience in the field, involvement in informatics groups, and a legacy of national and international pre- sentations and scholarly publications.
New to This Edition • New! All chapters thoroughly revised to reflect the
current and evolving practice of health information technology and informatics
• New! Chapter on informatics theory and prac- tice connects theoretical concepts to applications (chapter 2)
• New! Coverage of technology and caring and their symbiotic relationship
• New! Content on ethical use of information lays encompasses appropriate and inappropriate behav- iour and actions, and of right and wrong.
• New! Information on analytics and data science that explains how Big Data applies to healthcare
• New! Cutting-edge content on wearable and mobile technology security, and its impact on nursing and patient care
• New! Academic electronic health record resources and the role they play in educating the next generation of healthcare providers on documentation principles
• New! Hardware and software appendix (appendix A)
• New! Guide to the Internet (appendix B)
• New! An Overview of Tools for the Informatics Nurse (appendix C)
Changes to This Edition • The sixth edition streamlines content by combining
chapters with topics that fit together, and shifting hardware, software, and information on the Inter- net to new appendices.
• This edition reworks previous content on informa- tion systems training and presents it within the context of workforce development. The content still retains the emphasis upon privacy and confidential- ity, introduction of information policies, educational methods and resources. New content on evaluation models and training on backup procedures has also been added.
• Former content on integration, interoperability and health information exchange is now presented within the context of information networks and information exchange.
• Moves from defining evidence-based practice to a discussion of levels of evidence and using informat- ics to support evidence-based practice and research.
• Separate chapters on policy, legislation, regulatory, reimbursement, and accreditation issues were com- bined to better show the connection among these
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areas and the relationship between them and infor- mation system design and use.
• Experts from various health disciplines cover the latest on the interprofessional aspects of infor- matics with more emphasis on interdisciplinary approaches.
• Increases focus on current electronic health record issues while decreasing coverage of the historical evolution of EHRs.
• Highlights strategic planning and project management.
• Underscores the importance of patient engagement and shared decision making.
• Expands content on simulation and virtual learning environments.
Hallmark Features Learning Objectives—Learning Objectives appear at the beginning of each chapter and identify what readers can expect to learn in the chapter.
Future Directions—As the last section in each chapter, Future Directions forecasts how the topic covered in the chapter might evolve in the upcoming years.
Case Study Exercises—Case studies at the end of each chapter discuss common, real-life appli- cations, which review and reinforce the concepts presented in the chapter.
Summary—The Summary at the end of each chapter highlights the key concepts and information from the chapter to assist in the review.
References—Resources used in the chapter appear at the end.
Glossary—The glossary familiarizes read- ers with the vocabulary used in this book and in healthcare informatics. We recognize that healthcare professionals have varying degrees of computer and informatics knowledge. This book does not assume that the reader has prior knowledge of computers. All computer terms are defined in the chapter, in the glossary at the end of the book, and on the Online Student Resources Web site.
Organization The book is divided into three sections: Information and Informatics, Information Systems Development Life Cycle, and Specialty Applications. The major themes of privacy, confidentiality, and information security are woven throughout the book. Likewise, project manage- ment is a concept introduced in the strategic planning chapter and carried through other chapters. Chapters include content on the role of the informatics profes- sional, future directions relative to the topic, summary bullet points, and a case study.
Section I: Information and Informatics This section provides a foundation for why information and informatics are important to healthcare. It details the relationship between policy, legislation, regulation and accreditation and reimbursement and information system use.
• Chapter 1: Provides a definition of informatics and its significance for healthcare, discusses healthcare professionals as knowledge workers, addresses the need for uniform data and the relationship between data, big data, and evidence. This chapter also addresses the increased prevalence of information technology in healthcare, major issues in healthcare that are driving the adoption of information tech- nology, what is necessary to create an informatics culture, and includes a special section on caring and technology.
• Chapter 2: Provides information on informatics theory and practice, and nursing informatics as a discipline.
• Chapter 3: Emphasizes effective and ethical use of data and information, and includes a discussion of big data challenges and issues. Data characteristics, types, integrity, and management are covered. Cli- nician and informaticist roles pertaining to this area are discussed.
• Chapter 4: Addresses electronic resources for healthcare professionals, basic concepts and appli- cations of the Internet, including criteria for evalu- ating the quality of online information.
• Chapter 5: Discusses informatics to support evidence-based practice and research. Concepts include levels of evidence, information literacy, managing research data and information, creating
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and maintaining the infrastructure needed to sup- port research, dissemination of evidence, and effect- ing practice change.
• Chapter 6: Examines the relationship between pol- icy, legislation, accreditation, reimbursement and HIT design and use.
• Chapter 7: Provides information on electronic health records including definition, components, incentives for adoption, benefits, current status, selection criteria, implications for collection of meaningful data and big data, current issues, and future directions.
• Chapter 8: Provides an overview of types of health- care information systems, including clinical infor- mation systems and administrative information systems, as well as decision support, knowledge representation, and smart data.
Section II: Information Systems Development Life Cycle This section covers information and issues related to the information systems development life cycle.
• Chapter 9 This chapter discusses the importance of strategic planning for information management, HIT acquisition and use and provides an overview of project management and information system selection considerations. The role of informatics professionals, particularly informatics nurse spe- cialists, in the planning process and project manage- ment are addressed, as is the process to introduce change.
• Chapter 10: Addresses the concepts of usability and health informatics applications inclusive of the role that usability plays in the system life cycle and methods of usability assessment.
• Chapter 11: Covers information system implemen- tation, maintenance, and evaluation.
• Chapter 12: Provides a comprehensive look at workforce development in relation to health infor- mation technology use.
• Chapter 13: Discusses information security and confidentiality, including practical information on ways to protect information housed in informa- tion systems and on mobile devices and addresses security for wearable and implantable information technology.
• Chapter 14: Provides detailed information about health information exchanges.
• Chapter 15: Provides an overview of the role of standardized terminology and language in infor- matics. Also includes an outline of individual lan- guages and classifications used in healthcare.
• Chapter 16: Discusses the relationship between strategic planning for the organization and the sig- nificance of maintaining uninterrupted operations for patient care. Also touches on legal requirements to maintain and restore information. Much of this chapter is geared for the professional working in information services.
Section III: Specialty Applications This section covers specialty applications of informatics.
• Chapter 17: Details ways that information tech- nology and informatics can support education of healthcare professionals, including sections on sim- ulation and virtual learning environments.
• Chapter 18: Emphasizes the relationship between health and information literacy, patient engage- ment, shared decision-making, changing healthcare delivery models, patient satisfaction, outcomes, and healthcare reform. Discusses applications of con- sumer health informatics.
• Chapter 19: Examines telehealth and connected healthcare applications, starting with a historical perspective and including driving forces, appli- cations, and implications for providers as well as informatics professionals.
• Chapter 20: Explores public health informatics and its use to maintain and improve population health.
Three appendices are included. Appendix A pro- vides basic information on hardware and software for the reader who needs a better understanding of this area. Appendix B provides information on the Internet. Appendix C provides an overview of some tools for the informatics nurse.
Instructor Resources Lecture PowerPoint showcases key points for each chapter.
Test Generator offers question items, making test creation quick and simple.
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Student Resources New! eText offers a rich and engaging experi- ence with interactive exercises. Readers can ac- cess online or via the Pearson eText app. Note: Faculty can opt to package an eText access code card with the print textbook, or students can purchase access to the eText online.
Notice Care has been taken to confirm the accuracy of information pre- sented in this book. The authors, editors, and the publisher, however, cannot accept any responsibility for errors or omissions or for conse- quences from application of the information in this book and make no warranty, express or implied, with respect to its contents.
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Special thanks to Kathy Hunter, who agreed to join me on this 6th edition, lending her knowledge, insights, and support when I most needed it and never said “no” despite her many other commitments. A special thanks to Patricia Czar, RN, without whom there would be no
Handbook of Informatics for Nurses & Healthcare Professionals today. Pat actively contributed to the book from the original outline through to the present, provid- ing her knowledge, insights, organizational skills, support, and friendship. Pat was active in informatics for more than 25 years, serving as manager of clini- cal systems at a major medical center where she was responsible for planning, design, implementation, and ongoing support for all of the clinical information systems. Pat was also active in several informatics groups, presented nationally and internationally, and served as a mentor for many nursing and health infor- matics students. She is now fully retired and enjoying time with her family.
We acknowledge our gratitude to our loved ones for their support as we wrote and revised this book. We are grateful and excited to have work from our contributors who graciously shared their knowledge and expertise for this edi- tion. We are grateful to our co-workers and professional colleagues who provided encouragement and support throughout the process of conceiving and writing this book. We appreciate the many helpful comments offered by our reviewers. Finally, we thank Lisa Rahn, Michael Giacobbe, Susan Hannahs, Daniel Knott, Taylor Scuglik, and all of the persons who worked on the production of this edi- tion for their encouragement, suggestions, and support.
This edition brings in work from multiple contributors for a robust coverage of topics throughout the book. We thank them for their time and expertise. We would also like to thank all of the reviewers who carefully looked at the entire manuscript. You have helped shape this book to become a more useful text for everyone.
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Diane A. Anderson, DNP, MSN, RN, CNE Chapter 17: Using Informatics to Educate Associate Professor, MSN Specialty Tracks ~ Nurse Educator, Chamberlain College, Downers Grove, IL
Ami Bhatt, DNP, MBA, RN, CHPN, CHCI Chapter 13: Information Security and Confidentiality Dr. Bhatt is currently enrolled in the DNP to PhD program at University of Nevada, Las Vegas, NV
Sunny Biddle, MSN, RN Chapter 6: Policy, Legislation, and Regulation Issues for Informatics Practice Circulating Nurse in the Operating Room at Genesis Healthcare in Zanesville, OH and Clinical Instructor for Central Ohio Technical College in Newark, OH
Jane M. Brokel, PhD, RN, FNI Chapter 8: Healthcare Information Systems Chapter 14: Information Networks and Information Exchange Section Instructor at Simmons College, Boston, MA Adjunct faculty for the University of Iowa College of Nursing, Iowa, City, IA
Jennifer A. Brown, MSN, RN, HNB-BC Chapter 1: An Overview of Informatics in Healthcare Faculty, Bronson School of Nursing at Western Michigan University in Kalamazoo, Michigan in the undergraduate and RN-BSN programs.
Lisa Eisele, MSN, RN Chapter 19: Connected Healthcare (Telehealth and Technology-enabled healthcare) Chief - Quality, Performance & Risk Management Manchester VA Medical Center, Manchester VA
Sue Evans, MSN RN-BC Chapter 11: System Implementation, Maintenance, and Evaluation Informatics Nurse II University of Pittsburgh Medical Center East, Monroeville, PA
Athena Fernandes DNP, MSN, RN-BC Appendix A: Hardware and Software Appendix B: A Guide to the Internet and World Wide Web Senior Physician Systems Analyst, Penn Medicine Chester County Hospital, West Chester, PA
Carolyn S. Harmon, DNP, RN-BC Chapter 16: Continuity Planning and Management Clinical Assistant Professor and Program Director for the Masters of Nursing Informatics and the Masters of Nursing Administration at University of South Carolina, Columbia, SC
Toni Hebda, PhD, RN-BC, MSIS, CNE Chapter 3: Effective and Ethical Use of Data and Information Chapter 18: Consumer Health Informatics Professor, Chamberlain College of Nursing MSN Program, Downers Grove, IL
Taryn Hill, PhD, RN Caring for the Patient Not the Computer in Chapter 1: An Overview of Informatics in Healthcare Dean of Academic Affairs for Chamberlain College of Nursing, Columbus, OH
Diane Humbrecht, DNP, RN Chapter 12: Workforce Development Chief Nursing Informatics Officer, Abington Jefferson Health, Abington, PA
Kathleen Hunter, PhD, RN-BC, CNE Chapter 3: Effective and Ethical Use of Data and Information Chapter 7: Electronic Health Record Systems Professor, Chamberlain College of Nursing MSN Program, Downers Grove, IL
Brenda Kulhanek, PhD, MSN, MS, RN-BC Chapter 4: Electronic Resources for Healthcare Professionals Chapter 12: Workforce Development AVP of Clinical Education for HCA in Nashville, TN
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Susan Matney, PhD, RN-C, FAAN Chapter 15: The Role of Standardized Terminology and Language in Informatics Senior Medical Informaticist, Intermountain Healthcare, Murray, UT
Julie McAfooes, MS, RN-BC, CNE, ANEF, FAAN High-fidelity simulation, software, support, and certification in Chapter 17: Using Informatics to Educate Web Development Manager for the online RN-to-BSN Option at the Chamberlain of Nursing, Downers Grove, IL
Jeri A. Milstead, PhD, RN, NEA-BC, FAAN Chapter 6: Policy, Legislation, and Regulation Issues for Informatics Practice Professor and Dean Emerita, University of Toledo College of Nursing, Toledo, OH
Patricia Mulberger, MSN, RN-BC Special Considerations with Mobile Computing in Chapter 13: Information Security and Confidentiality Clinical Informatics Quality Supervisor, Kalispell Regional Healthcare, Kalispell MT
Melody Rose, DNP, RN Chapter 5: Using Informatics to Support Evidence-based Practice and Research Chapter 18: Consumer Health Informatics Assistant Professor of Nursing. Cumberland University Jeanette C. Rudy School of Nursing, Lebanon, TN
Carolyn Sipes, PhD, CNS, APN, PMP, RN-BC Chapter 8: Healthcare Information Systems Chapter 9: Strategic Planning, Project Management, and Health Information Technology (IT) Selection Appendix C: An Overview of Tools for the Informatics …