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Electronic Health Record (EHR)

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Integrates all pertinent information into one lifetime record, which will help to improve quality of health information, improve care coordination, patient safety, productivity, contain costs, support research, decrease wait time for treatment, and contribute to the body of healthcare knowledge -More than an episodic record at an organization

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Barriers to EHR implementation

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-Development of electronic infrastructure -Cost -Lack of common vocabulary -Privacy -Security -Confidentiality -Resistance among caregivers -Lack of IT staff -Failure to consider organizational change -Determining a realistic timeline -Legal issues surrounding the discover of medical information

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Standardized Languages

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-SNOMED (common language for certified EHRs) -NANDA -NIC -NOC -ICD-10 (billing)

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EHR vs. Traditional Paper Records

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-Paper records are episode oriented -Separate for each visit -Only one person can access at a time -Cannot incorporate diagnostic studies that include images and sound -Do not make sure of decision support systems -Impede collection of data for tracking patient outcomes and comparative effectiveness of research

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Advantages of EHR vs. Paper Records

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-Increase data integrity and quality -Increases productivity -Increases satisfaction for caregivers -Decreases redundant data collection -Allows data comparison from prior visits -Ongoing record -Supports decision support -Better/faster data access -Supports research -Improved documentation -Prompts to ensure administration of treatments and medications -Supports trending -Better record security -Instant notice of eligibility / procedure authorization

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Disadvantages of EHR vs. Paper Records

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-Just because an EHR is implemented does not mean benefits will be achieved -Rush to implement EHR system for meaningful use compliance can lead to poor purchase decisions and inadequate planning for chance

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EHR makes patient care safer by

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-Increased medication safety -Decreased wait time for treatment -Increased access/ control over health information -Increase ability to ask informed questions -Increased responsibility for own care -Alerts and reminders for appointments and scheduled tests -Increased satisfaction and understanding of choices

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EHR Captures Data For

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-Quality improvement -Utilization review -Risk management -Resource planning -Performance management -Reimbursement (ICD-10)

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Joint Commission

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-Continuously improve health care for the public, in collaboration of other stakeholders, by evaluation health care organizations and providing safe and effective care of the highest quality and value

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Joint Commission Impact on Nurses

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Nations oldest and largest standards setting and accrediting body in health care

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Joint Commission Impact on Patients

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Consumer advocate and educator, as well as enforcing patient safety

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US Agency for Healthcare Research and Quality (AHRQ)

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-Electronic documentation could improve quality of care -To produce evidence to make healthcare safer, higher quality, more accessible, equitable, and affordable -Research provides evidence-based information on healthcare outcomes, quality cost, use and access -Saws electronic documentation could improve quality of life

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ANCC Magnet-Role in Healthcare

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-High recognition and indicators of quality nursing patient care

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Minimum Data Set (MDS)

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Documentation that must be complete for compliance and reimbursement with the Joint Commission, medicare, and medicaid -Includes things like background information, cognitive patterns, communications, medication use and change in status

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Personal Health Record (PHR)

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-Private, secure application which an individual may access, manage, and share his or her own health information -Contains information from one's entire lifetime and from all healthcare providers -Accessible at any place and any time

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Attributes of ideal PHR

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-Each person controls his or her own PHR -PHRs contain information from one's entire lifetime -PHRs contain information from all healthcare providers -PHRs are accessible from any place at any time -PHRs are transparent; individuals can see who entered each piece of data, where it was transferred form, and who has viewed it

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Pros of PHR

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-Reduces wait time -Avoids letters/phone calls -Allows patients to check and improve quality of medication list

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Cons of PHR

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-May confuse/worry patients -May be incomplete or inaccurate if information if from many healthcare providers

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Stand alone systems

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-Not tied to any healthcare system Ex: Google Health PHR (discontinued) Ex: Microsoft Health Vault

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Tethered Systems

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-Tied into a healthcare system Ex: My HealtheVet PHR from the VA

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PHR combined with EHR

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Shared Medical record with patient including: -Lab and test results -Medication lists -Appointment -After-visit summaries -Visit notes -Patient clinical reminders

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Best candidates for distance learning

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-People in remote locations who cannot get to a school easily

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Distance education

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-Extends geographic boundaries -Improves student access -Meets student demands -Keep students on the cutting edge of technology -Remain viable

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Meaningful use

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Use of health information technology (HIT) legislated by the American Recovery and Reinvestment Act of 2009 to collect specific data with the intent to improve care, engage patients, improve population health, and ensure privacy and security -Federal incentives allocated for facilities that can demonstrate that they are "meaningfully using" certified EMR technology to improve patient care -Medicare and Medicaid EMR incentive programs in three stages

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Stage 1:

answer

-Focuses on electronic capture and sharing of information -Record demographic info -CPOE -Drug-drug, allergy interaction checker -Medication list -Vital signs, BMI, smoking status -Purchase equipment and start using it (2 years)

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Stage 2:

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-HIT use at POC for quality improvement -Lab results as structured data -Medicine reconciliation -Submit electronic data to immunization registries -Have information in, will use it for statistics to help communities

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Stage 3:

answer

Improved outcomes and population health

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Meaningful use of EHR

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-Patient engagement -Reducing racial disparities -Improved efficiency -Increased safety -Coordination of care -Measures to improve population health

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EMR

answer

Eight levels

question

1

answer

Lab, pharmacy and radiology are running

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2

answer

Clinical data repository (CDR) exists that allows MDs to view results; controlled medical vocabulary and clinical decision rules engine that checks for conflicts

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3

answer

Basic clinical documentation is present (vital signs, flow sheets)

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4

answer

CPOE

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5

answer

Closed loop medication administration, BCMA

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6

answer

At least one service has full MD documentation; fully functional PACS (most of the facilities around here)

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7

answer

Paperless environment with fully functional EHR

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Basic EMR components

answer

-Results reporting -Data repository -Decision support -Clinical messaging and email -Documentation -Order entry

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Structured data

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-Predefined format (discrete data) Ex: vital signs, temperature

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Unstructured data

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-Data that doesn't follow any particular format and is often provided as text report Ex: Consultation findings, nurses notes, operative reports, narrative notes

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Best database for nursing research

answer

CINAHL

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Virtual Learning Environments (VLE)

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-Any system that uses the internet to assist the educator in developing, managing, and administering educational materials for students -May include streaming video, virtual reality or Web 2.0 technology (blogs, podcasts, vodcasts, wikis, youtube)

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VLEs

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-Facilitate learning -Provide tracking capability -Provide email, chat, and discussion capability -Blended learning -Flexibility in scheduling

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Advantages of VLE

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-Increased retention -Reduced learning time -Flexibility of faculty schedules -Good for viewing EMR documents or steps of a procedure -Consistent instruction in safe environment -Improved reading habits -Available 24 hours a day

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Disadvantages of VLE

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-Reduced interaction with instructor and peers -Lack of feedback -Possibility for poor design and lack of intellectual stimulation -Bad for hands on instruction

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E-learning

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Delivery of content and stimulation of learning primarily through the use of online telecommunication technologies such as blogs, podcasts, video, e-mail, bulletin board systems, electronic whiteboards, inter-relay chat, videoconferencing and the world wide web

question

Advantages of E-learning

answer

-Convenience -Flexibility -Available anytime and anywhere there is an internet connection -Self-paced instruction -May occur via mobile devices such as PDAs, iPods, or cellular phones

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Web-based instruction

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-Uses attributes and resources of the WWW for educational purposes -May be used to supplement traditional courses or as stand-alone instruction -Used by hospitals for annual education

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Advantages of Web-based instruction

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-Self-paced learning -24 hour availability -Often prompts feedback -Interactivity

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Advantages of Simulation Learning

answer

-Standardized student learning opportunities -Safe learning environment -Unusual or high risk clinical situations -Mastery of skills -Stimulate critical thinking and teamwork

question

Disadvantages of Simulation Learning

answer

-Initial cost -Instructor training

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Purpose of distance learning

answer

-Improve student access -Meet student demands -extend geographic boundaries -Remain viable -Keep students on the cutting edge of technology

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Mobile Learning

answer

The use of mobile technologies, such as the mobile phone, personal digital assistant (PDA) and iPod for learning purposes Ex: wiki, podcasts, webinars, virtual meeting spaces

question

Nurse Use of PDAs

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-Used at POC to ensure delivery of safe care -Reference tools -Calculators

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Nursing Students Use of PDAs

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-Reference tool -Podcasts -Upload clinical tools

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Patients Use of PDAs

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-Medical diaries or logs -Reminder messages for medications -Web access to physicians

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Evaluation of online information

answer

-Current revision date -HON accreditation seal (meets quality standards) -Source credentials -Ability to validate information -Accuracy -Comprehensive -Easy to use -Privacy policy and/or disclaimers

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Social Media Use: Nurses

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-HIPAA -Professional boundaries (recommend against being friends with patients) -Job implications

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Advantages for Social Media: nurses

answer

-Up to date on organization events, inspiring stories

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Disadvantages for Social media: nurses

answer

-Questionable content posted -Anxiety generation of patient -Confidentiality issues

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Social Media Use: Patients

answer

-Support groups -Social networking

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American Recovery and Reinvestment Act (ARRA) of 2009

answer

-Supports adoption of a nationwide health information infrastructure -Information technology in general and health information technology -Obama passed law -Goal for full implementation by 2014

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Electronic Signatures in Global and National Commerce Act (ESIGN) 2000

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-Gives electronic signatures the same legal status as handwritten signatures -Clinton signed it -To increase e-commerce

question

Health Insurance and Portability and Accountability Act (HIPAA) of 1996

answer

-Called for the establishment of an electronic patient records system and privacy rules -Affects all aspects of health information management, including privacy and security of patient records, coding and reimbursement

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HITECH Act

answer

Makes changes to HIPAA and provides more funding for EHRs

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Medicare Improvement Act (MIPPA)

answer

-Provision calling for financial incentives for e-prescribing -Penalties involved for not e-prescribing -Gives recommended doses for medication

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Patient Protection and Affordable Care Act

answer

-Guarantees access to healthcare for all Americans -Creates new incentives to change clinical practice and improve quality of care -Gives practitioners more information to improve practice -Gives patients more information to make conscious decisions

question

EHR Incentives

answer

-Medicare and Medicaid have provided financial incentives to physicians and hospitals for meaningful use of health information technology -Beginning in 2011 -Negative incentives in 2015

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Quality initiatives / accreditations

answer

-AHRQ -CMS -IOM -JCAHO -NQMC -TIGER -CARF -ANCC

question

JCAHO

answer

Joint Commission on Accreditation of Healthcare Organization -Promotes community confidence and improved staff retention -Shapes practice and documentation

question

AHRQ

answer

Agency for Healthcare Research and Quality -Electronic documentation could improve quality of care

question

Level 0:

answer

Not all ancillary systems operational

question

Level 1:

answer

Major ancillary clinical systems up

question

Level 2:

answer

Major ancillary clinical systems + CDR

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Level 3:

answer

Some documentation and retrieval

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Level 4:

answer

CPOE, support for evidence-based practice

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Level 5:

answer

BCMA + identification technology + CPOE

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Level 6:

answer

Physician documentation, DS, alerts, PACs

question

Level 7:

answer

Fully electronic paperless environment

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