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From Flashcardlet > HAN 364: Informatics > Flashcards

HAN 364: Informatics Flashcards

1
Q

Health Care Informatics

A

Management of healthcare information through computers and other tech.

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2
Q

What does the Data, Information, Knowledge, Wisdom Hierarchy state?

A
  • There is much more data than information, knowledge or wisdom
  • As datum is consumed, amount of knowledge and wisdom produced is much smaller
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3
Q

Data

A
  • Symbols relating to differences in the world

“Character’s, numbers, or facts gathered for analysis”

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4
Q

Information

A
  • Data with meaning

“ICD- 9 code of 250.00 means type 2 diabetes”

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5
Q

Knowledge

A
  • Information that is justifiably believed to be true

“Synthesis of information from several sources to produce a single concept”

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6
Q

Wisdom

A
  • Use of knowledge to make intelligent decisions and to work through situations of signal versus noise
    “For example, a rising PSA could mean prostate infection and not cancer.”
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7
Q

Mining Data

A

Collecting and analyzing a variety of clinical, financial and administrative data to make wise clinical and business decisions.

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8
Q

Biomedical Information

A

Concerned with biological data particularly DNA and genomic information.

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9
Q

Health Information Technology (HIT)

A

The application of computers and technology in healthcare settings.

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10
Q

Health Information Management

A
  • Focused on paper medical records and coding

- With electronic health records, HIM specialists now have to deal with a new set of issues, such HIPAA implications

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11
Q

Institute of Medicine (IOM)

A
  • Evaluates policies for healthcare and gives feedback to Federal Government and Public Medical Errors
  • They believe that adopting HIT will promote quality care
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12
Q

Centers for Medicare and Medicaid

A
  • An insurer for about 100 million Americans
  • CMS reimburses for “meaningful use” of certified EHRs by clinicians and hospitals under Medicare or Medicaid
  • As of April 2014 they have paid out about $22 billion to clinicians and hospitals as part of the HITECH Act meaningful use program
  • They have a CMS Data Navigator that provides healthcare data from over 300 federal sources
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13
Q

Centers for Disease Control and Prevention (CDC)

A
  • They support the Public Health Information Network
  • They use HIT to improve and maintain public health using a variety of surveillance programs
  • They have a Data and Statistics section and a Health Data Interactive program
  • They have a variety of HIT-related projects, such as text messaging health education to patients
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14
Q

American Medical Informatics Association (AMIA)

A
  • Founded in 1989 and now has about 4000 members
  • Largely represents physicians and researchers involved with the biomedical sciences
  • They have about 20 working groups that focus of all aspects of Health Informatics
  • Membership includes subscription to the Journal of the American Medical Informatics Association (JAMIA)
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15
Q

Binary Data

A
  • Each zero or one is bite
    “Integers such as 345 or 669988”
    “Floating point numbers such as 14.1 or -1.23”
    “Characters such as a or z”
    “Character strings such as “hello” or “goodbye””
  • A series of 8 bites is a byte
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16
Q

What are all the Digital Components?

A
  • 0 = Off-bit
  • 1 = On-bit
  • 8 bits = 1 byte
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17
Q

What are all the conversions for bites?

A
  • 1,024 bytes = 1 kilobyte
  • 1,024 kilobytes = 1 megabyte
  • 1,024 megabytes = 1 gigabyte
  • 1,024 gigabytes = 1 terabyte
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18
Q

Images

A
  • The size of a grid of pixels

- You can tell how many rows or column are in a picture

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19
Q

Data Formats

A
  • Image files (JPG, GIG, PNG)
  • Text files
  • Sound files (WAV, MP3)
  • Video files (WMV, MP4)
  • Recognize that these formats just their categories
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20
Q

Online Data Storage

A
  • Provides access to current data
  • Rapid, using high-speed hard disk drives or storage space on the network
  • iCloud & Google Drive can save all documents offline
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21
Q

Offline Data Storage

A
  • For data you don’t need as ofter, or for long-term data storage of old client records
  • Not available at any time
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22
Q

Data Storage Considerations

A
  • Frequency of access needed
  • Environmental conditions and hazards
  • Control of equipment and media
  • Contingency planning, Storage period for each record type
  • Obsolescence of hardware and software
  • Maintenance of access devices (who takes care of it )
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23
Q

Why should you ensure correct data collection and entry?

A

Because input errors decrease data quality.

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24
Q

Perform System Checks prompt a user to what?

A
  • Complete a task
  • Verify information
  • Prevent entry of inappropriate information
  • Check for duplicate entries
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25
Q

Verify Data

A

You can verify:

  • Verbally
  • On-screen review
  • Printout review
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26
Q

Why minimize fraudulent information?

A
  • Leads to financial loss for organization and/or payer
  • Can ruin individual credit histories
  • Can lead to patient harm or death
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27
Q

Forms of Data Disposal?

A
  • Physical destruction
  • Shredding
  • Deform/destroy storage media
  • Software destruction/Overwrite data
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28
Q

Data Mining

A

Uses software to look for hidden patterns and relationships in large groups of data.

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29
Q

Information Retrieval

A

Technique that uses software to look for hidden patterns and relationships in large groups of data.

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30
Q

Data and Information Relevance

A
  • Computer data not only lacks meaning, but must include dates and units of measurement to gain significance
  • Everything must be standardized otherwise data won’t be interoperable
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31
Q

Information and Knowledge

A
  • Use a clinical data warehouse (CDW) to convert medical information to knowledge
  • Interpreting free text requires natural language processing (NLP)
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32
Q

Clinical Data Warehouses (CDWs)

A
  • Analyzing and reporting more healthcare data than the average EHR, which tends to focus on the individual
  • Used to evaluate a critical clinical process, cost estimates and analyze potential solutions
  • Track infections and report trends to public health
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33
Q

What makes information difficult?

A
  • It is difficult to model all of healthcare.
  • Biomedical information is difficult due to incomplete, imprecise, vague, inconsistent and uncertain information
  • Humans can adapt to this dynamic and vague information, but computers can not.
  • Clinical decision support in EHRs is precise, when in reality it might need to be flexible over time
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34
Q

Why do we need EHR?

A
  • Paper records are severely limited
  • Need for improved efficiency and productivity
  • Quality of care and patient safety
  • Patient expectations
  • Governmental expectations
  • Financial savings
  • Technological advances
  • Need for aggregated data
  • Need for integrated data
  • EHR as a transformational tool
  • Need for coordinated care
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35
Q

Computerized Physician Order Entry (CPOE)

A
  • An EHR feature that processes orders for medications, lab tests, imaging, consults and other diagnostic tests.
  • Potential to reduce medical errors
  • Difficult to implement in hospitals because it disrupts workflow and slows physicians down.
  • However, CPOE benefits others on the team, such as nurses and pharmacists
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36
Q

What are the potential benefits of CPOE?

A
  • Overcomes the issue of illegibility
    Fewer errors associated with ordering drugs with similar names,
  • More easily integrated with decision support systems than paper,
  • Easily linked to drug-drug interaction warning
  • More likely to identify the prescribing physician,
  • Able to link to adverse drug event (ADE) reporting systems
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37
Q

What is a Clinical Decision Support System (CDSS)?

A

Any software that assists decisions.

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38
Q

Knowledge Support

A

Programs embedded into the EHR that educate clinicians or patients.

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39
Q

Flow Charts and Graphs

A

Looks at lab or vital sign trends over time.

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40
Q

Order Sets

A

Inpatient clinical practice guidelines for specific scenarios (e.g. pneumonia), standardizing care.

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41
Q

Differential Diagnosis

A

Software exists that helps clinicians analyze symptoms and signs, to arrive at a diagnosis.

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42
Q

Lab and Imaging Decision Support

A

What tests are indicated and at what costs?

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43
Q

Public Health Alerts

A

Primarily infectious disease alerts for new outbreaks, e.g. MERS virus.

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44
Q

Electronic Prescribing (eRx)

A
  • Vast majoring of eRx occurs as part of an EHR and not a standalone program
  • 93% pharmacies use Surescripts
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45
Q

What are the benefits of eRxs?

A
  • Legible and complete prescriptions
  • Abbreviations+ unclear decimal points are avoided
  • The wait to pick up scripts shorter
  • Fewer duplicated prescriptions
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46
Q

What errors occur with eRx?

A
  • Wrong drug

- Wrong dose

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47
Q

Alert Fatigue

A

Too many alerts result in deletions, some justified, others not.

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48
Q

Ambulatory EHR Adoption

A
  • Roughly 79% have EHRs, but some are much more advanced than others
  • Larger practices adopt at a higher rate due largely to stronger finances
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49
Q

Inpatient EHR Adoption

A
  • Perhaps as many as 90% of US hospitals have EHRs and most are participating in the Meaningful Use program
  • Smaller urban and rural hospitals lag behind
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50
Q

Financial (Meaningful Use Challenge)

A

In spite of government reimbursement, some practices will gain and some will lose money.

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51
Q

Physician Resistance (Meaningful Use Challenge)

A

Complying with meaningful use can be onerous and may not result in any immediate and direct benefit to clinicians.

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52
Q

Loss of Productivity (Meaningful Use Challenge)

A

There is almost always initial loss of productivity and if the practice doesn’t change workflow habits there will be a long term losses as well.

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53
Q

Workflow Changes (Meaningful Use Challenge)

A

Everyone must adapt to doing business differently.

54
Q

Reduced Physician-Patient Interaction (Meaningful Use Challenge)

A

Less eye contact and interaction with patients.

55
Q

Usability Issues (Meaningful Use Challenge)

A

Some EHRs are not user friendly and require too many mouse clicks or illogical steps, impeding workflow.

56
Q

Integration With Other Systems (Meaningful Use Challenge)

A

Practices may need to build expensive interfaces to communicate with HIOs, practice management systems, etc.

57
Q

Lack of Interoperability (Meaningful Use Challenge)

A

EHRs are not capable of communicating with each other without additional technology

58
Q

Privacy Concerns (Meaningful Use Challenge)

A

Hacking into EHRs could result in loss of privacy for thousands, rather than a single paper chart.

59
Q

Legal (Meaningful Use Challenge)

A

It is not known if EHRs will increase or decrease malpractice over the long haul.

60
Q

Inadequate Proof of Benefit (Meaningful Use Challenge)

A

In spite on many published studies, there is not adequate proof that EHRs improve quality of care.

61
Q

Patient Safety and Unintended Consequences (Meaningful Use Challenge)

A
  • Evidence that new medical errors may occur with EHR use.
  • “E-iatrogenesis” means medical errors due to technology
  • Situation worsened by alert fatigue, frequent software upgrades, usability issues, stress to meet meaningful use objectives
  • Several sentinel failures of major EHRs in large healthcare systems have highlighted EHR vulnerability
62
Q

How does Medicare define Eligible Professions (EP)?

A

As doctors of medicine or osteopathy, doctors of dental surgery or dental medicine, doctors of podiatric medicine, doctors of optometry and chiropractors.

63
Q

How does Medicaid define Eligible Professions (EP)?

A
  • As physicians, nurse practitioners, certified nurse midwives, dentists and physician assistants (physician assistants must provide services in a federally qualified health center or rural health clinic that is led by a physician assistant)
  • Medicaid physicians must have at least 30% Medicaid volume (20% for pediatricians)
64
Q

Small EHR details

A
  • Low cost that includes 3 month free trial
  • Fully featured and compliant with Meaningful Use
  • Available as a client or web based (ASP) model
  • Appeals to small practices, particularly primary care
65
Q

Medium EHR details

A
  • Medium priced for medium sized practices of multiple specialty types
  • More clinician and patient features to include mobile and a health information exchange (HIE) solution
66
Q

Large EHR details

A
  • Intended for very large practices such as Kaiser-Permanente
  • Includes every aspect of Meaningful Use and numerous innovations such as a comprehensive patient portal and several mobile solutions
67
Q

How do you implement an EHR in new offices?

A
  • Develop an office strategy
  • Do research
  • List features
  • Analyze and re-engineer workflow
  • Use project management tools
  • Choose client versus ASP model
  • Practice management system needs
  • Survey your hardware and network needs
  • Develop a vendor strategy
  • Select a vendor
  • Training
  • Implementation
68
Q

Healthcare Data Potentially Shared

A
  • Clinical Results
  • Images
  • Documents
  • Clinical Summaries
  • Financial Information
  • Medication Data
69
Q

Health Information Exchange (HIE)

A
  • Electronic movement of health-related information among organizations according to nationally recognized standards
  • 2 way process
70
Q

Health Information Organization (HIO)

A
  • An organization that oversees and governs the exchange of health-related information among organizations according to nationally recognized standards
  • Being created for specific populations such as Medicaid or underinsured
  • Use HIO when addressing health information organizations and HIE to describe the act of moving or exchanging health information
72
Q

Nationwide Health Information Network (NwHIN)

A
  • Communicate with all EMR
  • Paper to electronic medical records
  • NwHIN is a set of standards that permit secure information sharing
73
Q

Blue Button Project

A

Allows patients to download their records and results using a recognized “blue button”.

74
Q

Interoperability

A

Two or more systems exchanging information and using it.

75
Q

What is an HIO function?

A
  • Link together healthcare systems into one entity

Note: Creation of mini-HIOs inhibit a nationwide information sharing system

76
Q

What are some Physical Safeguards for HIPAA?

A
  • Limit physical access to facilities
  • Workstation and device security policies and procedures covering transfer, removal, disposal, and re-use of electronic media
77
Q

What are some HIPAA Safeguards?

A
  • Security management processes to reduce risks and vulnerabilities
  • Security personnel responsible for developing and implementing security policies
  • Information access management-minimum access to perform duties
  • Workforce training and management
  • Evaluation of security policies and procedures
78
Q

What are some Technical Safeguards for HIPAA?

A
  • Access control that restricts access to authorized personnel
  • Audit controls for hardware, software, and transactions
  • Integrity controls to ensure data is not altered or destroyed
  • Transmission security to protect against unauthorized access to data transmitted on networks and via email
79
Q

Confidentiality

A
  • The prevention of data loss; HIPAA

- Usernames, passwords, and encryption are common measures implemented to ensure confidentiality

80
Q

Availability

A
  • Focuses on power loss or network connectivity outages.
  • Loss of availability may be attributed to natural or accidental disasters, but also refer to man-made scenarios
  • To counteract such issues, backup generators and peripherals are used to maintain availability
81
Q

Integrity

A

Make sure data is not modifiable in a malicious manner by anyone who can access it.

82
Q

What are the Three Pillars of Data?

A
  • Confidentiality
  • Availability
  • Integrity
83
Q

Authentication and Identity Management is achieved how?

A
  • With photo identification, biometrics, smart card technologies, tokens, and the old standard; user name and password
  • Basic Authentication may vary depending on sensitivity of data, the capabilities of the systems, resource constraints - both technical and monetary, and the frequency of access
84
Q

Policies regarding information security practices are often set by which organizational roles?

A
  • Chief information officers (CIOs)
  • Chief technology officers (CTOs)
  • Information technology (IT)
  • Directors or similar; often with input from chief medical informatics officers (CMIOs)
  • HIPAA compliance officers
85
Q

What are the different requirements for authentication and identity management?

A
  • Password combo can be set to change every couple of months or days
  • Key rings
  • ID cards
  • Single Sign On (SSO)
  • Smart Cards
86
Q

Smart Card details

A
  • Vital information with a self-contained processor and memory
  • Low cost, ease of use, portability and durability, and ability to support multiple applications
  • Capable of encrypted patient information, biometric signatures and personal identification (PIN)
  • Drawbacks: lack of standardization and positive identification
  • There must be assurance that the digital signature is valid and that it was placed by the person it is attributed to and in the case of patient records this digital signature also acts as the legal signature of the practitioner
87
Q

What are some Theft Countermeasures?

A

Encryption standards such as FIPS 140-2.

88
Q

Intrusions and Attacks

A

Attempting to compromise machines and user accounts through disguised email messages, corrupted PDF files and exploited webpages and social networking sites such as Facebook.

89
Q

What did the Nuremberg Code establish?

A
  • Voluntary consent
  • Right to withdraw from experiment
  • Right to qualified medical experimenter.
90
Q

What did the World Medical Associations (WMA) Declaration of Helsinki add?

A

Right to privacy and confidentiality of personal information of research subjects to the Nuremberg Code.

91
Q

What are Single Sign Ons (SSO)?

A

One set of credentials to easily access many of the resources one uses every day securely; example is Google.

92
Q

Duties within International Medical Informatics Association’s (IMIA) Code of Ethics

A
  • Patient’s Ethical Principles
  • Challenges in Transferring Ethical Responsibility
  • Electronic Communication with Patients and Caregivers
  • Measures to ensure data is protected
  • Simple data protection
  • Limiting collection of visitor data to your website
93
Q

What is the challenge in transferring ethical responsibility?

A

Even though keeping data secure should be the database manager’s fault, the research is still likely to be responsible.

94
Q

What are Patient’s Ethical Principles?

A
  • Right to privacy
  • Guard against excessive personal data collection
  • Security & Integrity of data
  • Must be kept current and accurate
  • Informed consent for patients
  • Awareness of existing laws
95
Q

What are the American Medical Associations (AMA’s) guidelines for Electronic Communication with Patients and Caregivers?

A
  • Make patient aware of who is reading the email
  • Delineate types of email topics that are acceptable
  • Use appropriate language
  • Provide tips for patients to ensure they can quickly reference relevant emails
  • Do not use email communication with new patients
96
Q

What is the Flesch-Kincaid Test?

A

Assigns a number corresponds to US school grade (1 – 14) .

97
Q

What is another measure to ensure documents are understood?

A
  • Flesch Reading Ease
  • Flesch-Kincaid
  • Proofing under Microsoft Word that gives a readability score on Flesch/Flesch-Kincaid test
98
Q

What are some simple data protection methods?

A
  • Encryption programs such as TrueCrypt
  • Anti-virus programs
  • Anti-spyware and malware software
  • Erase computer hard drives before discarding
  • Consider using encrypted email with programs (plug ins) such as Mailvelope
99
Q

What is a Flesch Reading Ease Test?

A

Assigns a value of 1 (most difficult) to 100 (easy).

100
Q

Diagnostic Errors

A

Can result from missed, wrong or delayed diagnoses.

101
Q

What are the most common outpatient errors?

A
  • Prescribing medications
  • Getting the correct laboratory test for the correct patient at the correct time
  • Filing system errors
  • Dispensing medications and responding to abnormal test results
102
Q

Harm

A

Inappropriate or avoidable injury to patient and/or family.

103
Q

Safety

A

Minimization of the risk and occurrence of patient harm events.

104
Q

Preventable Adverse Events

A

Errors that result in an adverse events that are preventable.

105
Q

Adverse Events

A

An injury resulting from a medical intervention.

106
Q

Overuse

A
  • The delivery of care of little or no value

“Widespread use of antibiotics for viral infections”

107
Q

Underuse

A
  • The failure to deliver appropriate care

“Vaccines or cancer screening”

108
Q

Crew Resource Management (CRM)

A
  • Practiced by Airlines

- Focuses on interpersonal communication, situational awareness, leadership and decision making

109
Q

Misuse

A
  • The use of certain services in situations where they are not clinically indicated
    “MRI for routine low back pain”
110
Q

Hitech Act 2009

A
  • By American Recovery & Reinvestment Act
  • Signed into law 2/17/09
  • Enforcement date 2/18/2010
111
Q

American Recovery & Reinvestment Act (ARRA)

A
  • Included HITECH (Health Information Technology for Economic and Clinical Health)
  • Included financial and regulatory incentives
112
Q

What is Meaningful Use in a nutshell?

A
  • Use of a certified electronic product complete w/ e-prescribing
  • Connected for the electronic exchange of PHI
  • Sent with submission of reports on clinical quality measures
113
Q

Health Information Exchange (HIE)

A

Improve patient safety by better communication between healthcare participants.

114
Q

What are the 3 US Federal Agencies?

A
  • Department of Health and Human Services (HHS)
  • Agency for Healthcare Research and Quality (AHRQ)
  • Centers for Medicare and Medicaid Services (CMS)
115
Q

Automated Dispensing Cabinets (ADCs)

A

Like ATM machines for medications on a ward.

116
Q

Home Electronic Medication Management System

A
  • Home dispensing

- Particularly for the elderly or non-compliant patient

117
Q

Pharmacy Dispensing Robots

A

Bottles are filled automatically.

118
Q

Electronic Medication Administration Record (eMAR)

A

Electronic record of medications that is integrated with the EHR and pharmacy.

119
Q

Intravenous (IV) Infusion Pumps

A

Regulate IV drug dosing accurately.

120
Q

Bar Coding Medication Administration

A

The patient, drug and nurse all have a barcoded identity.

121
Q

What are some benefits for Computerized Physician Order Entries?

A
  • Improved handwriting identification
  • Reduced time to arrive in the pharmacy
  • Fewer errors related to similar drug names
  • Easier to integrate with other IT systems
  • Easier to link to drug-drug interactions
122
Q

What are the objectives for meaningful use?

A
  • Use Computerized Provider Order entry (CPOE) for medication, laboratory, and radiology orders
  • Automatically track medications from order to administration using electronic medication administration record (eMAR)
123
Q

What does the IOM recommend in terms of patient safety being number 1?

A

Specific data standards so patient safety-related information can be recorded, shared and analyzed.

124
Q

What is MedWatch’s function?

A
  • Posts drug alerts

- Offers online reporting area Center for Devices and Radiological Health (CDRH).

125
Q

What are the goals for the National Patient Safety Foundation (NPSF)?

A
  • Identifying and creating a core body of knowledge

- Identifying pathways to apply the knowledge

126
Q

What are the five rights for medication safety?

A
  • right drug
  • right patient
  • right dosage
  • right route
  • right time – Most important
127
Q

What are some Non-Governmental organizations dedicated to patient safety?

A
  • The National Quality Forum
  • The Joint Commission
  • LeapFrog Group
  • HealthGrades
  • Institute for Safe Medication Practice (IMSP)
128
Q

What is Signal vs. Noise?

A

Not having to pay attention to all the instructions to figure out what to do. You only need a few words. The rest is “noise”.

129
Q

Verification can be flawed if the patient:

A
  • Responds without knowing the question
  • Cannot hear, see, or read,
  • Does not speak the same language
130
Q

How do you reduce input errors?

A
  • Educate staff

- Teach them the proper way to work systems

131
Q

What accounts for the largest percentage of malpractice claims, surpassing treatment errors in one study?

A

Diagnostic Errors

From Flashcardlet (104 decks)

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