Information System – Final – Flashcards
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An Information System is the
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integration of several elements of a business process to achieve aspecific outcome
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System receives and processes
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Input and provides output
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Accurate data can
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Accurate data can provide physicians, nurses, and administrator with information to make sound decisions.
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Bad data can
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Bad data can create bad decisions that can affect the health of patients.
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All organizations generate information that must be
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All organizations generate information that must be managed and used in ways that allow them to accomplish their goals.
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An IS consist of
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Data, people and work processes and a combination of hardware (machines and media), software (computer programs), and communications technology (computer networks) known as information technology (IT)
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What is provided to the IS by end users
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Data, or raw facts
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The last component of an Information System is
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work business processes. Processes are the policies and procedures that users must follow to do their work. An IS automates many processes that are performed by end users.
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Information System activities are
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input, processing, output, storage, and controlling
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Input
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Input - The typical first activity. Example: A patient's identification, temperature, blood pressure, and heart rate
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Processing
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Processing - Can include performing calculations, making comparisons, or selecting alternative actions. ample: Patient's temperature and blood pressure readings may be compared against the normal values to determine if his or her vital signs are within normal range
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Output
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Output - Output of an Information System is usually considered information to be used in making decisions. Example: Providing a report of a patient's vital signs
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Storage
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Storage - Storage and control activities.
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Controlling
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Controlling - To control its own performance. Example: A hospital administrator might discover that the daily census output does not add up to the correct monthly census
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What is information system?
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A collection of related components that interact to perform a task in order to accomplish a goal. The integration of several elements in a business process to effect a specific outcome. A process that refines raw facts into meaningful information.
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What are the components of an information system??
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Data, people, and processes and a combination of hardware, software and communications technology
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What is the difference between data and information
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Data represent raw facts and figures, and information represents the meaningful interpretation of data
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What are the Information System Activities
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input, processing, output, storage, and controlling
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A physician ordering a lab test is an example of
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Business process
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Types of information systems
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operation support systems, enterprise-wide systems, management support information systems, expert systems, and knowledge management systems
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Operation support systems
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Used to process data created and used by business operations. The role of an operations support system is to business units, and update business databases. Example: A registration, admission, discharge, and transfer (R-ADT) system.
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What are the parts of an Operation support systems
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Transaction- processing system (TPS) and Enterprise collaboration system
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Transaction- processing system (TPS)
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An example of an operation support system. Manages the different kinds of transactions that occur in healthcare facility. Patient admissions, employee time cards, and supply purchases are examples of transactions that take place in healthcare facility.
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Enterprise collaboration system
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Another type of operation support system. Typically enhance teamwork and are sometimes called office automation systems. Example includes electronic mail and appointment scheduling, project management software to coordinate tasks and schedules, and videoconferencing systems to hold electronic meetings.
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Enterprise-wide systems
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Enterprise-wide system, sometimes referred to as an enterprise resource planning (ERP) system. A large IS that manages data for an entire healthcare business. It helps automate information at the point of service and analyzes business and clinical practices for outcome and cost improvements. It is intended to solve enterprise-wide problems.
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Enterprise-wide systems are products that allow an organization to perform activities such as:
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Human resource management; Financial management; Customer relationship management (CRM); Supply chain planning; Sales and logistics
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Management support information systems
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Information systems that provide information primarily to support manager decision making
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The three major information system fall into what three categories
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Management Information System (MIS); Decision Support System (DSS); and Executive Information System (EIF)
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Management Information System (MIS)
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Supported by a Transaction Processing System (TPS) which collects, stores, modifies and retrieves the transactions of an organization. Usually specialized and designed to support a particular area of the business. Example: Input data might include admission, discharge and transfer data; and data on the number of dictated reports, coded records, filed records.
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Decision Support System (DSS)
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Provides information to help users make accurate decisions. The means using a product that goes beyond supplying facts about a patient's medical condition. Example: A special type of DSS that helps a provider makes decisions about patient care. It may alert the physician when a lab result is outside the normal range.
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Executive Information System (EIF)
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A type of management information system intended to facilitate and support the information and decision-making needs of senior executives by providing easy access to both internal and external information relevant to meeting the strategic goals of an organization. Example: EIS can assist marketing executives in making effective marketing decision as it provides an approach to sales forecasting, which can allow the market executive to compare a sales forecast with past sales.
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Expert System
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ES is a knowledge system built from a set of rules applied to specific problems. System simulates the reasoning process of human experts in certain well-defined areas. Knowledge engineers interview the expert or experts and determine the rules and knowledge that must go into the system Example: Dr. Larry Weed's knowledge coupler system is an example of an expert system applied to the practice of internal medicine.
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Knowledge management systems
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KMS is a more recent type of information system that has the potential to increase work effectiveness. Supports the creation, organization, and dissemination of business or clinical knowledge and expertise to providers, employees, and managers throughout the healthcare enterprise. Usually composed of and electronic library or central repository of best practices that offers enhanced search capabilities. Information is organized by specific business domain in the electronic library.
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Dr. J is treating a patient with a rare disease. He enters the patient's signs and symptoms into a computer program that indicates the probability of the correct diagnosis with its treatment regime. The doctor then uses this information to determine the best treatment protocol for the patient.
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Expert
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Every week, an HIM department director receives statically information on the number of incomplete medical records for discharged patients. Summary reports show totals and trends by the physician responsible for completing each patient record
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Management Information System (MIS)
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Dr. J orders a series of lab tests on his patient with a rare disease. The computer-generated results signal several abnormal values. This prompts the physician to add three new medications to the patient's treatment protocol. The computer then reminds Dr. J. that serious drug interactions could occur when the new medications are combined with the original drug protocol. In response to this reminder, he stops the order for the new medications
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Decision support system
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The HIM department director receives daily reports on the number of new admissions to and discharges from the hospital
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Transaction- processing system (TPS)
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What are the major phases of an information System
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Planning; Analysis; Design; Implementation; and Maintenance (PADIM)
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Planning
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First step in adopting new IS technology. Process of identifying and assigning priorities to the various upgrades and changes that might be made in an organization's IS. Goal is to ensure that all changes contribute to the achievement of the organization's strategic goals and objectives by developing a strategic information system plan.
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Analysis
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Analysis phase of the SDLC is usually initiated by the submission of a project requisition or request from a department for the development, modification or purchase of an information system. The request typically includes an overview of the system purpose, desired functions, anticipated benefits, and costs. The systems analysis defines the what's of the proposed IS project.
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Design
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When the analysis phase has been completed and IS functions identified, the system must be designed. Specifies the functions of the system and provides the design or blueprint of the proposed system. System designers work with the system's requirements and the systems analysts to determine the most appropriate design model for the problem being analyzed.
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Implementation
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A complex undertaking and includes the development of the programs, testing of the system, and development of system documentation, user training and system conversion so that the system can be used instead of the old system
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Maintenance
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Last phase of the systems development life cycle is system maintenance and evaluation. Maintenance and evaluation activities ensure both the short- and long-term success of the information system. Technical support for critical systems should be available 24 hours a day, 7 days a week.
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The system development life cycle (SDLC);
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Is the traditional way to plan and implement an IS
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The first phase of the SDLC is the _____ phase
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Planning; Analysis; Design; Implementation; and Maintenance (PADIM)
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End-user requirements are identified in the ____ phase of the SDLC
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Design
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The method used to identify requirements for a proposed Information System is (are)
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Conducting site visits; Conducting a JAD; Developing a prototype
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Testing the new IS system is part of the _____ phase
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Implementation
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Categories of computers
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Supercomputers; mainframe system; Midrange system; microcomputers; handheld devices; cellular phones
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Supercomputers
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Supercomputers - The largest, fastest and most expensive type of computer that exists today
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Mainframe system
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Mainframe Systems - Computer architecture built with a single central processing unit to which dumb terminals and/or personal computers are connected. They are generally used in healthcare to handle input/output-intensive transactions. Used for payroll, personnel, billing and accounting data.
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Midrange system
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Two types minicomputer and workstation
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Minicomputer
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Minicomputers - A small, mainframe computer
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Workstation
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Workstation - A computer designed to accept data from multiple sources in order to assist in managing computer for daily activates and to provide a convenient means of entering data as desired by the user at the point of care
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Microcomputers
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Microcomputers - Also called personal computers. Com in a variety of sizes, including desktop, laptop, palmtop, and pen-based. Microcomputers can be used in a stand-alone environment or connected to a network
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Handheld devices
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Handheld Devices - Lightweight mobile devices that provide special functions such as taking notes, organizing telephone numbers and addresses, and calendaring. Include today's iPads and Kindles. Vast majority of these devices have web-based capabilities
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Cellular phones
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Cellular Phones - can be a web-based telephone having features of analog and digital devices, also referred to as a smart phone.
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Types of computers
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Analog Computer ; Digital Computer; and Hybrid Computers
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Analog Computer
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Continuously varying in quantity. Accept input in continuous analog signal form, and output is obtained in the form of scaled graphs. Example: Voltage, current, sound, speed, temperature, and pressure values.
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Digital Computer
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Digital means discrete. It refers to the binary system, which consists of only two digits (that is 0 and 1) In digital computers, quantities are counted greater than measured. Operates by counting numbers or digits and gives output in digital computer operatives by counting numbers or digits and gives output in digital form. Examples are calculators, personal computers, digital watches, digital thermometer. Most of the computers used in offices and homes are digital computers.
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Hybrid Computers
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Best features of both analog and digital computers. Users can process both the continuous (analog) and discrete (digital) data. Used in scientific fields and hospitals, and are used to watch the patient's health condition in the ICU.
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Computer Peripherals
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Peripherals - usually described in terms of the five basic computer functions: Input, processing, and memory, output, storage and communications
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Input
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Keyboards; microphones; scanners; pointing devices such as mice, track balls, light pens and intelligent tablets; sensors; and biometrics such as fingerprint, handprint, and iris scans. Selection of the appropriate type of input device for an IS depends on the user's workflow. Barcodes are being used more frequently in healthcare for data capture.
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Processing and memory
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A processor is a microchip implanted in a CPU's hard drive that processes instructions sent to it by the computer and software. Processors come in a number of sizes. Some corporations have developed a dual processor, which allows one processor to process multiple instructions at the same time without slowing down performance.
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Output
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Any piece of computer hardware equipment used to communicate the results of data processing carried out by an information-processing system to the outside world. Function of these devices is to translate the machine's response to a usable form for the user.
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Storage
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Secondary storage devices include a flash drive, hard disk drive, magnetic tape, and an optical disk drive. May be internal or external. Digital data can be stored permanently on any of these media, although the life span of each medium varies. Optical storage allows for extremely large quantities of data to be stored on one CD.
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Communications
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Used to assist communications among different computers. Modems translate digital data into analog data so that it can be transmitted over telephone lines and received by a remote computer. Remission expressed in terms of bits per seconds (bps) or kilobits per second (kbps)
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Programming Languages
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Machine Language; Assembly Language; High-level languages; Very high-level languages ; and Natural languages
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Machine Language
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Machine Language - First generation, machine language, consists of ones and zeros
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Assembly Language
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Assembly Language - Second generation, uses a standard set of abbreviations to replace some of the ones and zeros. Defined by manufacturer
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High-level languages
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High-level languages - Third generation, use words and arithmetic phrases to construct programs (COBOL and BASIC)
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Very high-level languages
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Very high-level languages - Fourth generation, includes report generators, query languages, data management languages, and application generators. Use and require fewer commands.
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Natural languages
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Natural languages - Allow users to speak in a more conversational way with the computer and are part of the expanding field of artificial intelligence
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System Software
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System software - The platform on which all applications reside and function. The computer when to start, what to do, and when to stop.
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Operating System
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Consists of the master programs, called the supervisor, that manage the basic operations of the computer. Reside in RAM while the computer is on and provide resource management services of many kinds. Includes BIOS, which manages the essential peripherals such as the keyboard, screen disk drives, and parallel and serial ports. Common operating systems include OS/2, Unix and Macintosh.
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Application Software
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Productivity software; Specialty software; Education and reference software and entertainment software
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Productivity software
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Productivity Software - used in almost all businesses to assist with word processing, accounting, database management, graphics, presentation, scheduling, e-mail
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Specialty software
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Specialty software - include programs designed for a specific industry such as desktop publishing
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Education and reference software
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Education and reference software - includes encyclopedias, anatomy atlases, and history searches.
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Entertainment software
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Entertainment software - games and audio/video entertainment
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Database
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Most critical resource in healthcare is patient data. A database is an organized collection of data saved as a binary-type file on a computer.
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Database Approach
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Relational database; Object-Oriented databases; and Object-relational database
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Relational database
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Relational database - stores data in predefined tables that contain rows and columns similar to a spreadsheet. Kinds of data that is stored in relational database are currency, real numbers, integers and strings (characters of data)
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Object-Oriented databases
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Object-Oriented databases - Stores objects of data. An object is a discreet or abstract thing such as a care or line at the grocery store. Data objects can model relational data or advanced data types such as graphics, movies and audio.
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Object-relational database
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Object-relational database - combines the best of the relational and object-oriented databases.
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DBMS
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Database management system (DBMS) is a collection of computer programs that controls the creation, maintenance, and use of a database
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Relational database
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Most popular database architectures. Store data in tables consisting of rows and columns. Retrieve and store data in tables using SQL to insert, update, delete, and query data from tables. Provide a level of security, usually by user and by table and column that each user is allowed to access.
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Data warehouses
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A special type of database that alleviates the problem of consolidating and storing data from various databases throughout the enterprise. Data warehouses are designed to perform data analysis rather than to support routine operations. Principal purpose is to provide data for improved decision support. Usually contains historical data that is derived from operation (transaction) system and is optimized for speed of retrieval of data.
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Data Mining
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Associated with data warehouses. A process that identifies patterns and relationships by searching through large amounts of data. Used to systematically analyze data. Healthcare, data mining is used to identify methods for cutting healthcare costs, suggest more appropriate medical treatments, and predict medical outcomes. Helps identify fraud and abuse practices and evaluate and reduce Medicare payment errors.
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Local- area Network
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Connects computers in a relatively small area. One special form of LAN is an intranet and is a specialized client/server network that uses Internet technologies and provides information within the organization.
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Wide-area Networks
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Devices across a large geographical area. World's largest WAN is the Internet.
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Wireless Networks
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Any type of network that is not connected by cables of any kind.
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Intranet
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Type of network that works as a private Internet
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World Wide Web
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System of Internet servers that supports specially formatted documents
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Extranet
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Type of network that allows the networks of separate organizations to communicate with one another
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LAN
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Computer network that connects devices in a small geographical area
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WAN
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Computer network that connects devices across a large geographical area
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Data warehouses
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Storage device for multiple databases that can be accessed via a single question-and-report interface
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Clients
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Computers that are used to access shared resources in a network
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Telecommunications
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Term used to describe a system of voice and data transmission
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Relational database
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Type of database that stores data in predefined tables made up of rows and columns
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Data Dictionary
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Description of the structure of a specific database
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Chapter 15
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...
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Clinical Information Systems
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Clinical Information System include systems that support patient care. Patient care management; Computerized provider order entry (CPOE); Results reporting; Nursing services; Departmental clinical management; Laboratory services; Medication administration (using bar-coding technology); Pharmacy services; Radiology services; and Clinical decision support
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Administrative Information Systems
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Support the business functions of the organization: Patient registration; Financial management; Human resource management; Materials management and Facilities management
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Management support systems
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Assist in organizational planning; Executive decision making; Financial modeling; Planning and marketing; Resource allocation (labor, supplies, and facilities planning); and Expert systems
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Research and data analytics system
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Turn data into information: Study diseases; Analyze data; and Perform research
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One of the major categories of information systems used in healthcare is the
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Clinical information system
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Clinical Information System is designed primarily to
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Designed primarily to support patient care by providing healthcare practitioners with access to timely, complete, and relevant clinical information.
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What are some of the systems that feed the EHR in Clinical Information Systems
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patient Registration Systems (Admission-discharge-transfer (ADT); Laboratory Information Systems; Pharmacy Information Systems; Radiology Information Systems; Nursing Information Systems; Emergency Medical Systems; and Patient Monitoring Systems
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Which clinical information system assists the physician in recording orders and in the decision making process
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Clinical decision support system
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I need a system that allows me to treat patients located at different site. I should use
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Telematics
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A medication being ordered is contraindicated due to a patient allergy. The physician is notified. This is an example of an
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Alert
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Dr. Rogers is sitting in his home office and reviewing digital images from a patient's MRI. He must be using a
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Picture archival communication System
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What is a Administrative information systems often called
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Management Information systems
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What are some parts of an Administration information system
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Financial Information system; Human Resource Management System (people training, education); Material Management systems (Supplies, purchases); and Facilities Management System (Buildings, Maintenance, Exterminators)
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Management Information Systems
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Focus on providing reports and information managers for day-to-day operations of the organizations.
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What are some of the common reports produced by an MIS:
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Periodic scheduled reports; Exception Reports and Demand reports
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Periodic scheduled reports
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Periodic schedule reports (daily hospital census and the financial monthly reports)
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Exception Reports
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Exception reports (Accounting report of past-due bills)
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Demand reports
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Demand reports (Ad hoc, produced as needed, whenever a manager demands or asks for it)
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Strategic Decision Support System is also known as a
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Decision Support System (DSS)
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Executive Information System
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A type of decision support system used by high-level managers. Draws data from the organizations other databases. Combines many of the features of the management information and decision support systems. Also has the capability called drill down. Drill down enables the user to find even more detailed information. Ability to look at key information in a concise format is why these types of IS are often referred to as dashboard reports or balanced scorecards reports.
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Research and Data Analytics System
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Data has to be turned into information so that they can be used to make decisions
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What would be used to manage productivity?
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Human resource System
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What is the difference between the executive information and decision support system
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The executive information system is designed to be used by high-level management
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I will be conducting some analysis of data but I only need a limited amount of data that are contained in the data warehouse. What system should I utilize
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Data Mart
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We receive a report each morning listing all of the admissions from the day
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Periodic scheduled
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Uses models and statically analysis to help decision makers solve problems
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Decision support system
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Displays concise information and may be called a dashboard report
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Executive Information system
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Tracks productivity and turnover
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Human resource management system
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Is updated periodically and used for strategic decision support
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Data warehouse
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Creates reports needed to manage the day-to-day activities of the organization
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Management Information System
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Ambulatory Care
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Frequently contains administrative and clinical functions. Many are the same as inpatient settings, such as documentation, billing, decision support and security. Outpatient systems must be tailored to the needs of the ambulatory care environment.
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Long-term Care
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RUG. Long-term care facilities are behind other healthcare providers. LTC could benefit because of the improved communications that will result in improved efficiency and improved compliance with federal guidelines and more Other benefits is improved quality, reduced care disparities, and the use of HIE to facilitate communication among providers. Much of the focus of long-term care information system includes census management, patient assessments, documentation orders, nutritional assessments, and pharmacy Are becoming part of the integrated delivery system
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Home Health
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Have very specific demands in an information system. Many health agencies utilize laptops or other mobile devices to access patient information and to document care Document and Manage patient care Transmit monitoring results More people are getting care in their homes Care includes telehealth, so the system must be accommodate to the recording of data, video, audio and other tools.
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What are some of the categories of information that can be captured and used to satisfy needs of Healthcare Information resources Management
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Patient-specific information; aggregate information; Expert knowledge-based information; and Comparative information
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Patient-specific information
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Consists of data that is linked to individual patients
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Aggregate information
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Aggregate information - Consists of detailed data sets that are combined to provide a summarization.
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Expert knowledge-based information
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Expert knowledge-based information - - A database of specialized facts about a specific subject area.
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Comparative information
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Comparative Information - Consists of data sets that have the same attributes but are from different sources and are evaluated or compared against each other.
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CIO
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Role of the Chief Information Officer (CIO): A senior-level executive; Responsible for leading the strategic IS planning process; Assisting the leadership team in using IS in support of strategic planning and management, and for overseeing the organization's IRM function; Typically reports directly to the organization's CEO
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Information System Steering Committee
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Most healthcare organizations establish an IS steering committee to take on this responsibility. Includes clinicians and administrators from key areas thought the enterprise as well as IS professionals and the CIO. To be successful, the committee needs senior-level support from the medical staff, nursing, and other clinical areas. All plans for new IS or technology projects should be channeled through the IS steering committee to ensure that they are in line with the organization's strategic vision
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CPO
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Chief Privacy Officer: Responsibilities include activities related to the development, implementation and maintenance of, and adherence to, the organizations policies and procedures regarding the privacy of and access to patient specific information
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CISO
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Typically CISO is responsible for overseeing the development, implementation, and enforcement of the organization's security policies. Manages the security of all patient-identifiable information. CISO has become better recognized within healthcare organization in the context of new security and confidentiality regulations. These groups oversee the development and implementation of policies related to the security and confidentiality of patient information. In addition to policy development and enforcement, the committee or council may develop and implement employee education and training programs.
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CMIO
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Arose as healthcare organization recognized the need to have physician leadership in the adoption of clinical IS A physician will staff the CMIO position
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What individual or group is responsible for developing the strategic vision for the organization information
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Steering committee
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Information resource management addresses information in what form
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Information stored in any format
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Which role works with physician to assist in the implementation of the EHR
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Chief Medical Information System Officer
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What individual or group is knowledgeable on accreditation and classification systems?
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Health Information management department
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Fifty percent of patients treated at our facilities have Medicare as their primary payer. This is n example of what type of information
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Aggregate
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EHR System Application
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Development of EHR systems most often begin in a healthcare organization with acquisition of source systems,, including administrative and financial systems and ancillary or department systems
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What are source systems
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Supply the EHR and other applications with data.
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Administrative and Financial systems
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Among the first systems implemented by healthcare organizations. Each of the systems with this category is usually managed by a specific department and are not considered departmental systems because they manage patient-specific data needed for all other applications and do not process data that aid in management of the departments as do ancillary, or departmental system. Administrative and financial systems include: Registration, Admission, Discharge and Transfer (R-ADT); and Patient Financial systems
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Registration, Admission, Discharge and Transfer (R-ADT)
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Register patients for admission or outpatient services; Capturing demographic and insurance data and supplying this information to other applications as needed; Patient Financial Systems; and Form creation Systems
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Patient Financial Systems
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Frequently called billing systems in physician practice, aid revenue cycle management (RCM). Encoders used to support accurate coding of diagnoses and procedures, eligibility verification, prior-authorization, claim attachment. As a result of standardization of claims data, there is increasing convergence of claims data with health data. Claims data and clinical data are used together; healthcare quality and cost improvement can be made.
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Ancillary or Department Systems
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Ancillary or Department Systems - Also called clinical departmental systems, serve primarily to manage the department in which they exists, while at the same time providing key clinical data for an EHR
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What are the three main departmental systems that are necessary for an EHR to function in a hospital
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Laboratory Information system (LIS); Radiology Information Systems (RIS) ; and Pharmacy Information Systems
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Laboratory Information system (LIS)
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Laboratory Information system (LIS) - Lab test; generate a work for list for specimen collection, labeling and accessing ongoing; retrieve results from auto-analyzer; perform quality control; maintain inventory of equipment and supplies needed to perform lab tests.
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Radiology Information Systems (RIS)
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Radiology Information Systems (RIS) - work with similar functions as order for a procedure; scheduling it; notifying hospital personnel or the patient and working to take x-rays and other imaging processes.
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Pharmacy Information Systems
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Pharmacy Information Systems - receives drug orders; aids the pharmacist in checking for contraindications; directs staff in compounding any drug requiring special preparation; aids in dispensing the drug in the appropriate dose and for the appropriate route of administration
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Core EHR Applications
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1. Results management (2) clinical documentation; (3) closed-loop medication management; (4) clinical decision support (CDS) and (5) analytics and reporting
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Results management
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Application that enables diagnostic study results (primary lab results) to be both reviewed in a report format and the data with the reports to be processed. Results management systems enable lab results to be used in integrative ways. Importance of results management cannot be emphasized enough. It has been observed that 70 percent of the ability to reach a diagnosis for a patient depends on lab results.
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Clinical documentation
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These systems are also called point-of-care charting systems because the intent of these applications is to direct what documentation needs to be recorded for the patient. Means to supply CDS at the time when the clinician is able to be most responsive to alerts and reminders. Are those that supply templates to the user o be completed primary via point-and click, drop-down, type ahead and other data entry tools. The user may choose the appropriate template. Physician documentation of the history and physical exam, consults, operative reports and discharge summary are largely dictated and electronically fed as an image into the EHR
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Closed-loop medication management
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Refers to the use of certain systems that help assure patient safety from a point a drug is ordered to the point it is administered. MU systems are requiring use of CPOE systems. CPOE systems can be used for entering all orders, such as patient admission, laboratory tests, x-rays and other diagnostic studies.
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Clinical decision support (CDS)
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CDS is a key component of the EHR, and sets it apart from simple automating paper documents. CDS functionality in the EHR helps physicians, nurses, and other clinical professionals, collectively referred to as clinicians as well as patients themselves make decisions about patient care. CDS templates can help determine what documentation of clinical findings is necessary; p provide suggestions for prescribing less expensive, but equally effective drugs; supply protocols for certain health maintenance procedures and alert for a duplicate lab test to name just a few.
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Analytics and reporting
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Final core EHR application Analytics refers to statistical processing of data to reveal new information. Analytics has been primarily performed in academic and research institutions, by health plans, at pharmaceutical manufactures and for public health departments. Analytics has brought the healthcare industry many clinical benefits, such as in genomic research and personalized medicine. Create business intelligence, such as in predicating prescribing patterns of physicians, or the impact of a diaster on local emergency services
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Which of the following is a source system: Laboratory information system; results management system; clinical decision support system; input devices
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Laboratory information system
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Which of the following is not considered a core EHR component: Computerized provider order entry; Pharmacy information system; Electronic medication administration record; Point-of-care charting
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Pharmacy Information system
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Dr. Smith always orders the same 10 things when a new patient is admitted to the hospital in addition to some patient specific orders. What would assist in assuring that the specific patient is not allergic to a drug being ordered
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Drug Knowledge database
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What provides alters and reminders to clinicians
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Clinical decision support system
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Point-of-care charting system in hospitals today are primarily used by
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Nurses
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What is the earliest effort to address clinical information systems (CIS)
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Earliest efforts to address clinical information systems (CIS) occurred into eh mid 1960. Clinical data are textual and contextual, making it difficult to develop a system that can collect and process these data effectively and efficiently.
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Clinical data is
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Textual and contextual making it hard to develop systems that can collect and process these data effectively and efficiently.
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Textual
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Largely textual because clinicians often (and prefer to) describe the patient's condition in narrative form. Narrative data also depend on context or situation to make the data meaningful
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Who suggested in the Mid 1980 that new technologies should be considered in improving the state of medical records
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Institute of Medicine (IOM)
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Patient Safety was addressed in
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In 2003, the IOM report entitled "Patient Safety: Achieving a New Standard for Care" addressed many of the standardization issues that were needed to improve patient safety through the use of the EHR,
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Implementation
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Refers a system having been installed and configured to meet a specific organization's need.
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Adoption
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Adoption my also require retraining, reinforcement (of change); further re-design of workflows and processes and even a system of rewards. Adoption may overlap with implementation. Unfortunately, some users may never reach full adoption
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Optimization
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Optimization includes activities that extend use of EHR beyond the basic functionality. Includes changed in the clinical practice of medicine. A clinical transformation often leads to acquisition of additional technology, such as more sophisticated CDS, different input devices as they become available on the market. Optimization is an ongoing state.
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Cost of EHR
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Cost is definitely an impediment to acquiring EHR even with federal incentives. For both hospitals and physicians practices there is also ongoing maintenance at about 20 percent of the base cost plus the cost of staffing and user time. EHR systems are highly sophisticated and generally have a high cost. Higher-priced systems will have greater technical capabilities than lower-cost products with less ability to customize.
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Benefits of EHR
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Most hospitals consider an EHR a cost of doing business today and do not anticipate very much financial return on the investment. Due to the nature of the US reimbursement system and the high costs of the system, a net monetary value is elusive and most costs savings associated with clinical changes often accrue more directly to health plan. Most hospitals do find some cost savings in administrative functions and believe that it is virtually impossible anymore to do without an EHR. (Savings in admission personnel, billers and warehousing costs) Many physic practices are finding direct cost savings as well as indirect savings from being able to prove the quality of their care to health plans
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A transition technology used by many hospitals to increase access to health record content during the evolution to EHR is
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EDMS
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The EHR component that is often the most challenging for which to gain adoption in a hospital is:
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Computerized provider order entry
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A system that is used by all intended users for at least basic functionality is
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Adopted
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Unintended consequences from using EHR technology are primarily due to issues with
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Human users
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The biggest complaint physicians have with using an EHR already installed relates to
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Productivity
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Government Initiatives
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IOM was instrumental in focusing the Administrative Simplification part of HIPAA on encouraging the development of a health information system. While many consider HIPAA to be only about privacy and security, HIPAA is actually based on automating financial and administrative transactions. ACA is adding new standards and operating rules. HIPAA also called recommendations relating to uniform data standards for what is called patient medical record information (PMRI)
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ONC
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Office of National Coordinator (ONC). ONC largely promoted adoption of EHR through supporting regulatory exceptions to anti-kickback laws so that hospitals could make limited donations of EHR and prescribing systems to physicians and by promoting a certification process in which vendors products were evaluated against a set of published criteria to ensure that such EHR would be sufficiently robust as to provide value
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Types of HIE
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Health Information Exchange (HIE). Federated model; Consistent Federated model and Centralized
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Federated model
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No central location of data. Most consider this a more private and secure model of HIE, even though it is often necessary to review actual patient records before identifying the correct patient and the overall security is only as strong as the weakest link across participating organization. Less efficient, with the potential for not finding all desired information about a patient
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Consistent Federated model
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Some of both federated and consolidated model. Independent vaults or databases are managed by the HIO, so the data are centrally managed but both logically and physically separated.
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Centralized model
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Central location of most of the data.
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HITECH
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Health Information Technology for Economic and Clinical Health (HITECH) Without incentives, the goal of EHR by 2014 would not be realized. President Obama included a significant amount of money for incentives and other programs to promote adoption of EHR in the HITECH legislation HITECH gave ONC legislative performance; a refocusing to achieving ER and HIE
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Meaningful Use (MU)
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Term used in the ARRA/HITECH legislation for providers to qualify for incentives for using EHR
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What are the parts of Meaningful use
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Standards for MU of EHR ; Certification that EHR technology meets the standards ; and Criteria for earning MU incentives
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Standards for MU of EHR
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Standards for MU of EHR - Provided in regulation released by ONC and include those to support structures to ensure that health data can be exchanged between systems and their use integrated, vocabulary standards to ensure consistent meaning across applications, and specific functionality. Not all the standards are new.
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Certification that EHR technology meets the standards
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Certification that EHR technology meets the standards - Comes from regulations released by ONC. Under MU incentive program, the certifying entity must be approved by the ONC as an ONC authorized testing and certifying body. A complete EHR product meets all the requirements in a modular EHR product meets only one or more but not all of the requirements.
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Criteria for earning MU incentives
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Criteria for earning MU incentives - Have been specified by CMS and identify the extent to which functionality must be used. It is anticipated that as the subsequent two stages of MU are rolled out, the criteria will become tighter.
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ACA
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Affordable Care Act - Does not address EHR technology, although it does include small, but important sections on enhancing the administrative simplification provisions of HIPAA ACA completes the adoption of financial and administration transactions and code sets under HIPAA and adds to these an electronic funds transfer standard and operating rules for the standard transaction. ACA introduces new Medicare reimbursement structures that essentially depend on having automated health information
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CCR
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Continuity of Care Record (CCR). Documentation of care delivery from one healthcare experience to another. Purpose of CCR was to eliminate data inconsistencies when patients were referred from one provider to another.
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CCD
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Continuity of Care Document(CCD). In the exchange of information with other providers and the patient, the CCD combines the content that physicians have agreed should be included in patient referrals with a means to format that data for electronic transmission.
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Exchange of a standard set of health information content between providers and with patients is facilities by
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Personal health record
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In what form of health information exchange are data centrally located but physically separated
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Consistent federated
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The function used to provide access controls, authentication and audit logging in an HIE is
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Identity Management
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In order for hospitals or physicians to earn meaningful use, their EHR technology must be
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Certified; Interoperable; Used in a meaningful way
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In order to participate in the nation wide health information network,, providers must
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Sign a special participation agreement
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CDR
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Clinical Data Repository. A central database that focuses on clinical information
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CDW
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Clinical Data Warehouse. A database that makes it possible to access data from multiple databases and combine the results into a single query and reporting interface, also called a data ware house
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Message Format Standard
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There are two primary ways different systems can exchange data with one another. One way is by simply sending a copy of data needed from one system to the other system. This requires that the two systems be structured in exactly the same way. Using an Data exchange standard which allows two different systems to talk to each other by establishing a protocol for writing software applications.
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What are the most common format standards
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Health Level Seven (H7); Digital Imaging and Communications in Medicine (DICOM);
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Health Level Seven (H7)
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Health Level Seven (H7) - A family of standards that aid the exchange of data among hospital systems; National Council for Prescription Drug Program (NCPDP); and
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Digital Imaging and Communications in Medicine (DICOM)
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Digital Imaging and Communications in Medicine (DICOM) - Helps exchange clinical images such as x-rays, CT scans and so on
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National Council for Prescription Drug Program (NCPDP)
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National Council for Prescription Drug Program (NCPDP) - Enables the communication of retail pharmacy eligibility inquires and claims (as mandated by HIPAA) and more recently provides a standard for the exchange of prescriptions from a physician practice electronic prescribing system directly to the retail pharmacy information
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American National Standards Institute (ANSI)
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American National Standards Institute (ANSI) Accredited Standards Committee X12 (ASC x 12) - Provides electronic data interchange (EDI) standards for hospital, professional, and dental claims, eligibility inquires, electronic, remittance advice
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Hardware Infrastructure
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Hardware Infrastructure includes computer to process data and computers to delivery data to or receive data from users, as well as networking and communications technology Architecture refers to the configurations, structure and relationships of all components
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Two types of Architecture:
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Client/server (C/S) architecture and Web services architecture (WSA)
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Client/server (C/S) architecture
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Client/server (C/S) architecture - Uses a combination of computers to capture and process data. They typically house all the application software and store data captured by all the client computers throughout the network. They then service multiple client computers, which have less powerful processors
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Web services architecture (WSA)
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Web services architecture (WSA) - Emerging architecture. Utilizes web-based tools to permit communication among different software applications.
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Migration Path
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Developing a migration path is to describe the strategic approach to EHR in an often-over looked planning activity. Outlines the major components needed to implement a new system.
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What are some of the Characteristics of data Quality
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Accessibility; Accuracy; Consistency; Comprehensiveness; Currency; Definition; Granularity; Relevancy; Precision; and Timeliness
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Determining an organization's readiness for EHR is
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Essential for every organization to ensure that everyone from top management down is prepared for the level of change
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Which of the following is a plan to provide access to content of previous visit information in an EHR? Change management; Chart conversion; Data conversion; Phasing
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Chart conversion
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A strategic plan that identifies applications, technology, and operational elements needed for the overall information technology program in a healthcare organization is
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Migration Path
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Which of the following make data entry easier but may harm data quality?? Use of templates; Copy and paste; Drop-down boxes; Structured data
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Copy and paste
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Chapter 17
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...
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Privacy
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The right of an individual to limit access to information about his or her person
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Confidentiality
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"Expectation that information shared by an individual with a healthcare provider during the course of care will be used only for its intended purpose
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Physicians have had a duty to keep a patient's information confidential. They may not disclose any medical information revealed by a patient or discovered by the physician in connection with the treatment of a patient."
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...
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Security
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Information security means - Protecting information and information systems from unauthorized access, use disclosure, disruption, modification, or destruction and includes ensuring information non-repudiation and authenticity through
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Information security includes variety of protections that safeguard data and computer programs and resources. These measures include
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Management practices; Physical safeguards; and technical measures
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Management practices
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Management practices - Prohibiting employees from sharing their passwords
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Physical safeguards
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Physical Safeguards - Ensuring that doors to areas that house major computer systems are locked or otherwise secured to keep out unauthorized persons
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Technical measures
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Technical measures - Ensuring that only certain passwords allow an individual access to patient data
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A good data security program embodies three basic concepts
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Protecting the privacy of data; Ensuring the integrity of data and Ensuring the availability of data
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Protecting the privacy of data
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Defending or safeguarding access to information; Only those individuals who need to know information should be authorized to access it; Privacy of other information in the healthcare organization should be protected as well; Information leaked to unauthorized individuals about providers, employees, or the organization can have as devastating an effect as information leaked about patients
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Ensuring the integrity of data
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means that data is complete, accurate consistent and up-to-date
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Ensuring the availability of data
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Making sure the organization can depend on the information system to performed exactly as expected, without error, and to provide information system to perform exactly as expected, without error, and to provide information when and where it is needed
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Basically, threats to data security from people can be classified into five categories
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Threats from insiders who make unintentional mistakes ;. Threats from insiders who abuse their access privileges to information; Threats from insiders who access information or computer systems for spite or profit; Threats from intruders who attempt to access information or steal physical resources; and Threats from vengeful employees or outsiders who mount attacks on the organization's information systems
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Threats from insiders who make unintentional mistakes
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Threats from insiders who make unintentional mistakes - Could be employees who accidentally make a typographical error, inadvertently delete files on a computer disk, or unknowingly give out confidential information
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Threats from insiders who abuse their access privileges to information
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Threats from insiders who abuse their access privileges to information - Employees who knowingly disclose information about a patient to individuals who do not have proper authorization. One of the biggest threats from employees who may abuse their access to information is storing it on a thumb or flash drive, removing it from the facility on a laptop or other storage device, and subsequently losing the device or having it stolen
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Threats from insiders who access information or computer systems for spite or profit -
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Threats from insiders who access information or computer systems for spite or profit - Employees seeking information for the purpose of committing fraud or theft.
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Threats from intruders who attempt to access information or steal physical resources
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Threats from intruders who attempt to access information or steal physical resources - Individuals may physically come onto the organization's property to access information or steal equipment.
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Threats from vengeful employees or outsiders who mount attacks on the organization's information systems
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Threats from vengeful employees or outsiders who mount attacks on the organization's information systems - Disgruntled employees might destroy computer hardware or software, delete or change data, or enter data incorrectly into the computer system.
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Threats Caused by Environmental and Hardware or Software Factors
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Natural disasters such as earthquakes, tornadoes, floods, and hurricanes can demolish physical facilities and electrical utilities; Electrical outages and power surges also cause problems.; Hardware or soft ware malfunction.; Malicious software or malware
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Components of a Security Program
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Employee awareness including ongoing education and training; Risk management program Access safeguards; Physical and administrative safeguards; Software application safeguards; Network safeguards; Business continuity plan; Data quality control processes
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Employee awareness
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Employees are often responsible for threats to data security A formal program should be offered that educates every new employee about the origination's security policies and the consequences of failing to comply with them. Each employee should receive a copy of its security policies as they relate to the employee's job function Every employee should sign a yearly confidentiality statement. All employees should receive periodic and ongoing security reminders.
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Risk Management Program
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Encompasses the identification, management, and control of untoward events Healthcare must take steps to prevent, detect and mitigate both external and internal incidents. A well-conceived risk management program can aid prevention, intrusion detection, and mitigation of security breaches including identity theft
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Access Safeguards
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Fundamental security strategy Being able to identify which employees should have access to what data. Identifying classes of information based on the employee's role in the organization and what type of information required to perform the job. (Role Based access)
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Identification
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Identification - Usually based on user name or number
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Authentication
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Authentication - The act of verifying a claim of identity.
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Typical Contents of BCP
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Assigning responsibility for development and implementation of the plan; Determining how a disaster is identified; Developing a recovery plan; and Testing the plan
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Data Quality Control Process
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Ensuring data quality is an essential part of any data security program; Dimensions of data quality are accuracy, accessibility, comprehensiveness, consistency, currency, definition, granularity, precision, relevancy, and timeliness. f. Data accessibility , data consistency and data definition
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Which of the following is a threat to data security: Encryption; People; Red flags; and Access controls
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People
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An HIT using her password can access and change data in the hospital's master patient index. A billing clerk, using his password, cannot performed the same function. Limiting the class of information and functions that can be performed by these two employees is managed by
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Access controls
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The patient's address is the same in the master patient index, the electronic health record, laboratory information system and other systems. This means that the data values are
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Consistent federated
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Data security policies and procedures should be reviewed at least
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Annually
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Employee who make typographical mistake
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People threat
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Chief security officer
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Oversight for security program
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Employee confidentiality agreement
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Employee awareness program
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Identification of most likely security threats
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Risk analysis
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Identification of the information that employees need to perform their job junctions
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Access controls
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Edit checks
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Application control
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Prevents hacking into a computer system
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Network control
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Computer terminals do not face public areas
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Physical controls
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HIPAA Security rule standards are grouped into five categories
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Administrative safeguards; Physical safeguards; Technical safeguards; Organizational requirements; and Policies and procedures and documentation requirements
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General Rules
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Provide the objective and scope for HIPAA security Rule as a whole. Specify that covered entities must develop a security program that includes a range of security safeguards that protect individually identifiable health information maintained or transmitted in electronic form.
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General Rules include the following
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Covered entities must demonstrate and document that they have done; Flexibility of Approach; Standards; Implementation specifications; Maintenance
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Which of the following provides the objective and scope for the HIPAA Security Rule as a whole
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General Rules
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Which of the following ensures that procedures are in place to handle an emergency response in the event of an untoward event such as power outage?
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A contingency Plan
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Which of the following ensures that a user has only the information needed to perform his or her job
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Access controls
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A visitor sign-in sheet to a computer area is an example of what type of control
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Facility access
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The process that encodes textual material, converting it to scrambled data that must be decoded is
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An encryption
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According to HIPAA standards, the designated individual responsible for data security:
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Must be identified by every covered entity
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Written business associate agreements are required with
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Any company where work is outsourced
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Covered entities must retain documentation of their security policies for at least
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Six years from the data of the last incident.
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Security policies
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must be maintained in written format
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Workforce security awareness and training is required
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For all workforce members.
