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Metastructure of NI

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The ability of the nurse to utilize data, information, and knowledge to make wise clinical decisions.

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Definition of Nursing Informatics

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A speciality that integrates nursing science with multiple information and analytical sciences to identify, define, manage and communicate data, information, knowledge and wisdom in nursing practice.

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Meaningful Use

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Using certified electronic health record technology to: - improve quality, safety, efficiency, and reduce health disparities - engage patients and families - improve care coordination, population and public health

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Total Quality Management (TQM)

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Used to depect Quality Management measures. Examples include: - cause and effect diagrams - flowcharts - histograms - Pareto charts - Run charts - Control charts - scatter diagrams

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Quality and Safey Education for Nurses (QSEN)

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Goal is to tackle the task of preparing nurses to enhance "the quality and safety of the healthcare systems in which they work" Used in Nursing Education and focuses on six competencies: • Patient-centered care • Teamwork and collaboration • Evidence-based practice • Quality improvement • Safety • Informatics

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Failure mode and Effects Analysis (FMEA)

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A systematic, proactive approach for evaluating a process to identify where and how it might fail and to assess the relative impact of different failures.

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Ishikawa Diagram (Fishbone)

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Used for brainstorming and to help identify root causes for performance improvement by visualizing causes and effects. The effect is the "head" and the causes are the "bones"

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Root Cause Analysis

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Structured method to analyze serious adverse events. Identifies underlying problems that increase the likelyhood of errors (retrospective approach)

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FOCUS Model and PDCA

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An preformance improvement model F- find a process to improve 0- organize an effort C- clarify current knowledge U- understand process variation/capability S- select a strategy for continious improvement PDCA: repetitive process during FOCUS stages Plan - Do - Check - Act

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Turley's Model of Nursing Informatics

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Nursing Informatics is is the center of computer, cognitive, and informations sciences under the umbrella of Nursing Science

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Lewin's Theory of Change

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Used infacilitating change, the concepts of this theory include: Unfreezing - Movement - Refreezing Driving and restraining forces Deals with disconfirmation Cogintive redefinition Creation of psychological safety or overcoming learning anxiety

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Lean Six Sigma

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Focus on removing wasteful practices and making processes smoother and more efficient

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Six Sigma

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Used for process improvement. Project increase quality and yield while reducing defects and variations. Define, Measure, Analyze, Improve, Control

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Leapfrog Group

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Triggers giant leaps in the safety, quality, and affordability of healthcare by: - supporting informed healthcare decisiona - promoting high-value healthcare through incentives and rewards Good Leapfrog scores - more patients

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Regulatory and Accreditation Requirements

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-Joint Commission -Centers for Medicare and Medicaid Services (CMS) -Meaningful Use -HITECH (health information technology for economic and clinical health) -Affordable Care Act -ADA regulations (Americans with Disabilities Act)

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Models Supporting Practice

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Data: 1st step of database design; conceptual design Workflow: Swimlane models, Lean Six Sigma, value stream mapping Predictive: (Analytics) used to predict future outcomes

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Ludwig Von Bertalanffy Systems theory

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The Nursing Informatics specialist must understand the fundamentals of systems and how systems affect the decision-making process; closed versus open systems

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Shannon-Weaver Model of Communication Theory

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Sender - Message - Receiver Obstacles to effective communication: - Interference (noise) - Facilitation - Block (body language, assumptions) Communication is a continuous loop

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Maslow's Hierarchy of Needs

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Depicted as a pyramid, needs listed from the base of the pyramid to the top. Based on importance to survival. Physiological needs Safety Social Self-Esteem Self-actualization

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Cognitive Theory

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-Learning process may be unique to the student -Learning involves mental associations that cannot be observed -Knowledge is organized -Learning relates information to experience

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Benner's Stage's of Clinical Competence Novice to Expert Nurse

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Novice: little experience, rule-governed Advanced Beginner: some experience with new situations Competent: ability to master new situations, needs extra planning time, lacks flexibility Proficient: thinks holistically, relies on experience, adaptable Expert: wealth of experience, acts intuitively

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Computer Science

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Foundation of NI; the study of the principles and the use of computers.

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Information Science

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Foundation of NI; the study of processes for storing and retrieving information, especially scientific or technical information.

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Cognitive Science

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Foundation of NI; much of learning cannot be observed or predicted, in that, the individual is processing information based on experience, associations, and subjective interpretation

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Nursing Science

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Foundation of NI; the ethical application of knowledge aquired through education, research and practice to provide services and interventions to patients in order to maintain, enhance, or restore their health; to advocate for health, and to aquire, process, generate, and disseminate nursing knowledge to advance the nursing profession

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Data Standards

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standards that provide a common language and set of expectations that enable interoperability between systems and/or devices

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Interoperability

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The ability to exchange data in a meaningful and comparable way

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Metadata

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Data about Data - a set of data that describes and gives information about other data - describes content, quality, condition and other characteristics of the data

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Semantic Representation

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Relating to meaning in language or logic - the study of meaning in language -pertains to the meaning or interpretation of a word, sign or other representation

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Taxonomies

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The study of classification

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Classification

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Ordering of entities into groups or classes

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Terminologies

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A concept-based representation of a collection of domain-specific terms

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Nomenclature

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Terms or labels for describing concepts in nursing; synonymous with "vocabulary"

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Clinical Care Classification

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The standardized nursing terminology system that includes nursing diagnoses, outcomes, interventions, and actions

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Perioperative Nursing Data Set

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PNDS- Used for perioperative diagnosis, interventions, and outcomes

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Nuring Intervention Classification

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NIC- Classification used for nursing interventions for all healthcare settings

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Nursing Outcomes Classification

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NOC- Classification used for patient outcomes

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North American Nursing Diagnosis Association-International

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NANDA-I- Used for standardized classification of nursing diagnoses according to a multiaxial taxonomy of domains and classes

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OMAHA System

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Comprehensive documentation of patient care that includes: -assessment -problem classification scheme -intervention scheme -problem rating scale for outcomes

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SNOMED-CT

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(Systematized Nomenclature of Medicine - Clinical Terms) is a standardized, multilingual vocabulary of clinical terminology that is used by physicians and other health care providers for the electronic exchange of clinical health information

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Current Procedural Terminology (CPT)

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Used to code traditional medical treatments provided by physicians or nurse practitioners

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ICD-9/10 International Classification of Disease

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Used to code for diseases which are classified numerically by etiology and anatomic system.

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Healthcare Common Procedure Coding System Level II (HCPCS II)

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Used to code for services and equipment for outpatient services

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ABC Codes

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Used to bill for Intergrative or alternative healthcare practices (yoga, renki)

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LOINC

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A common language (set of identifiers, names, and codes) for identifying health measurements, observations, and documents. If you think of an observation as a "question" and the observation result value as an "answer."

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Hierarchical Database

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Tree-like structure where data is stored as linked records

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Relational Database

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Data is stored in tables and each table has a key field that connects it to other tables, so all tables are related

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Data Integration

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The combination of techincal and business processes used to combine data from disparate sources into meaningful and valuable information

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Data Warehouse

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A large collection of data imported from several systems into one database. Data is inputted and the output is information. Shows the "big picture" and trends over time.

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Data Marts

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Smaller collections of data

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Data Mining

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Applying computational techinques to find patterns and trends in data stored in data warehouses.

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Data Representation

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Alpha: alphabetic characters (A-Z) Numeric: numbers (0-9) Alphanumeric: combination of numbers and letters

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Data Aggregation

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Information (data) is gathered in a summarized form for analytical purposes

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Database Features

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Each field in a table is an ATTRIBUTE with fields being columns and records being rows

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Data Organization

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Must be processed and organized so patterns and relationships are apparent

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Data

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Discrete entities, described objectively with no content or pattern.

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Data System Model

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Input - System - Output

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Data Input

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Any data that is entered into an information system for storage or processing via forms, screens, voice or interactive web fill-in forms

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Data Output

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Information delivered to users through the information system by way of intranet, extrants or the web on printed reports, displays, or via audio

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Information

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A group of data that is interpreted, organized, structured

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System Design Lifecycle

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1. Planning 2. Analysis 3. Design/Build 4. Testing/Education/Implementation 5. Evaluation/Maintenance/Support

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Feasibility Study

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Determines whether a project is possible. 3 types: Techincal Economic Operational

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Gap Analysis

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Techinque for determining the steps to be taken to move from current state to future state. 1. List's what is 2. List's what should be 3. List's what is needed

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GANTT Chart

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Bar chart used to illustrate a project schedule. Indicates start/finish dates of terminal elements

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PERT Diagram

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Program Evaluation Review Technique: used to schedule, organize and coordinate tasks within a project

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System Planning

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Key Components: Multidisciplinary approach System planning concepts Strategic goals and priorities (outcomes) Feasibility analysis and needs assessments Vendor, product, and market analtsis Resource and benefit analysis (ROI)

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Conceptual Framework

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Determines the architecture of the plan Determines the type of plan to be used Determines the philosophical and intellectual approach of the plan

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System Analysis

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A way of determinig how seperate parts or functions work together to form a result. Similar to the nursing process.

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Nursing Process

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Observe, assess, diagnose, plan, implement, evaluate

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Requirements Definition

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Agree on objectives Identify needs of business and end users Involve users from all levels in the organization Involve leadership, strategic planners Requirements become apart pf RFI, RFP document

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Process Analysis

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The activities, skills, and specific actions required to gain the desired output/result. Indentifies: -Users -What they are doing -How they carry out actions -When they execute the actions -Why are the actions necessary

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Decision Trees

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Predictive models that help reach conclusions about probable outcomes

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Flow Charts

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Schematic representation of an algorithm or process

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Workflow Diagram

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Demostrate the flow of work on a unit or department or process

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Swimlane Diagram

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Depicts the steps in a process based on each unit

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System Design

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Defines the architecture, componets, modules, interfaces, and data for a system to satisfy specific requirements

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Hardware and Software Design

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Used to streamline the design process, optimize hardware partitioning to reduce product costs and ease integration by automatically generating interfaces.

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Critical Success Factors

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-The design must align with and be compatible with the mission of the organization -Fiscal factors must be considered -Question shared resources -What are the interfaces/interactions between technology and manual subsystems -Question performance dictated by protocols (internal/external) -Question adequate support

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Algorithm

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A definite set of specific steps or actions for completing a given task from beginning to end to reach a specific outcome.

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Fundamental Programming Concepts

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Support theoretical basis and practical applications

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Design Software

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New research area focused on the design of small embedded systems

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Analytical Science

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Allows for decision-making based on available information

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Compliance

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A facility undertakes activities or establishes practices or policies in accord with the requirements or expectations of an external authority.

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Benchmarking

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A comparison of one organization to another to identify their comparative strengths and weaknesses and learn how to improve.

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Business Decision Support Systems

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Focused on financial metrics and models

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Decision Support Systems

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Computer applications designed to facilitate human decision making by analyzing data and providing recommendations.

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Clinical Decision Support Systems

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Focus on healthcare and outcomes. Help answer questions and make recommendations for assessments and/or actions. Helps support best practice and use of evidence-based methods. (allergy checking, interactions, abnormal labs, contraindications).

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Expert Systems

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A complex computer-based system that captures and uses the knowledge of an expert for solving a particular problem.

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Clinical Practice Guidelines

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Statements that include recommendations intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options.

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Wisdom

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Appropriate use of knowledge to manage and solve human problems. Knowing when and how to apply knowledge to deal with complex problems or specific human needs.

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Human Computer Interaction (HCI)

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The aspect of a computer that enables communications between humans and the computer. The layer of the computer between humans and the computer. Needs continuous user input and is centerd around the user.

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Human Systems Integration

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A disciplined, unified, and interactive approach to design. The integration of human considerations (cognitive and physical) into system design.

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Ergonomics (Human Factors)

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An applied science concerned with designing and arranging things people use so that the people and things interact most efficiently and safely.

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Case Management Information Systems

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Provide standardized plans of care that support best practice. Utilizes decision support software to guide preventative measures and development of the care plan.

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Acuity System

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Facilitates staffing ratios according to patient acuity. Uses the 5 rights of staffing: 1. Right number of staff 2. Right skills 3. Right location 4. Right time 5. Right patient assignments

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FMEA Method

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A 12 step process that begins with describing the process in detail then brainstorming each step looking for potential faliures and adverse outcomes. Then a risk priority number is assigned. Then methods are determined to reduce failures and identify performance measures.

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Knowledge Acquisition

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Obtaining knowledge

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Knowledge Generation

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Creating new knowledge by changing and evolving

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Knowledge Processing

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Collecting, analyzing, sythesizing, saving and storing knowledge

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Knowledge Dissemination

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Distributing and sharing knowledge

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Scope Creep

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The tendency of a project to enlarge in scope due to additions and changes as well as problems encountered in completing the tasks and miscalculations.

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Peplau's Theory of Nursing

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Stresses the importance of collaboration between the nurse and the patient.

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Validation

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Process to ensure that information being stored in a data warehouse is correct, reliable, and consistant. Prevents submitting the wrong data, submitting data by an unauthorized person, asking the system to perform an unacceptable function

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Information Processing

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The aquisition, recording, organization, retrival, display and dissemination of information. Locates and captures information using software to manipulate it into a desired form and outputting the data.

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Information Management

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An elemental process by which one files, stores, manipulates and reports data for various uses.

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Personal Health Record

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A health record "owned" by the patient where the patient maintains and updates their information.

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Evidence Hierarchy

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Level I - systematic reviews of RCT and non-RCT Level II - single RCT or non-RCT Level III - systematic review of observational studies Level IV - single observational study Level V - systematic review of descriptive/qualitative studies Level VI - single descriptive/qualitative study Level VII - opinions of authorities/experts

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Organizational Change Management

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A structure approach to helping those in an organization accept and work through the process of moving from current state to future state

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Column Graph

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Useful for showing data changes over a period of time, or comparisons for 3 or more groups

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Line Graph

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Used to compare changes over the same period of time for more than one group.

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Bar Graph

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Used to compare things between different groups or to track changes over time, especially large changes

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Pie Chart

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Used for comparing parts of a whole. They do not show changes over time.

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SWOT Analysis

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A framework for identifying and analyzing the internal and external factors that can have an impact on the viability of a project, product, place or person. (strengths, weaknesses, opportunities and threats)

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Force Field Analysis

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A method for listing, discussing, and assessing the various forces for and against a proposed change by analyzing all of the forces impacting on the change and weighing the pros and cons. Used to develop strategies to reduce the impact of the opposing forces and strengthen the supporting forces. (Kurt Lewin)

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Adaptation Curve

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Innovators - pull the change Early Adaptors - will try new ideas but careful Early Majority - careful but accept change quicker Late Majority - will accept change after majority Laggards - accept change only after new way becomes tradition

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Shannon's Information Theory

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Evaluates the effectiveness of comminucations systems. Elements include: -Signal to noise (S/N) ratio -Channel capacity (max information transmitted with minimal error) -Entropy (amount of energy, code, or bits needed for storage or communication of one signal)

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Weiner's Attribution Theory

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Explains people's behaviors and the cause for the behavior by observing behaviors, judging that the behavior was intentional, and attributing the cause for the behavior on internal or external causes.

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Data Archiving

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Moving data from current storage to a seperate device for long-term storage of data that is no longer necessary for active use.

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Low Level Data Input Error

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Wrong sequence of steps triggers an alarm/hardstop until correct; fairly easily corrected

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Moderate Level Data Input Error

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Inputting data incompatible with the system

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High Level Data Input Error

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The system is unable to make a decision about the corrective action or unable to correctly interpret outcomes data.

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Cache Memory

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Stores in-process data for quick retrevial

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Random Access Memory (RAM)

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Temporary memory used when working on a task (lost when turned off)

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Read Only Memory (ROM)

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Permanent or semi-permanent memory that stores saved data. Essential to the OS

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Virtual Memory

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Temporary use of the hard drive for memory when many programs are running at the same time.

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Small Computer System Interface (SCSI)

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An interface that provides the means for an attachment of additional hardware devices. Ex. Scanner

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Integrated Drive Electronics Controller (IDE)

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Primary interface for the hard drive, CD-ROM, and DVD drive

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Peripheral Component Interconnection Bus (PCI)

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Connects plug-in components to the computer with a series of slots on the motherboard. Ex. mouse, keyboard

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Basic Input/Output System

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Boot firmware. Type of ROM that the computer uses when it boots up.

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Qualified EHR

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Contains demographics, clinical health information, medical history and problem lists. Capable of providing support for clinical decisions and entry of physician orders. Has the capacity to capture and query information relevant to healthcare quality and exchange electronic health information with and integrate information from other sources.

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Certified EHR Technology

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An EHR that meets specific governmental standards for the type of record involved.

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Health Information Technology for Economic and Clinical Health Act (HITECH)

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Addresses the development, adaptation, and implementation of HIT policies and standards and provides enhanced privacy and securities protections for patient information.

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Reference Database

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Focuses on one type of information. A good place to begin a search for specific types of information

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SQL Database

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A standardized programming language used for managing relational databases and performing various operations on the data in them.

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Relational Model

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A collection of data items organized as a set of formally-described tables from which data is accessed or reassembled in different ways without reorganizing the table

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Small Form Factor

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Computers that have less volume, therefor taking up less desk space, than standard computers

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Enterprise Integration

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The electronic linkage of healthcare providers, health plans, the government, and other interestes parties. Enables the electronic exchange and use of health information amoung all the components in the health care infrastructure.

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Nationwide Health Information Network (NwHIN)

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Ensures the secure internet exchange of information through standards, policies, and services. The primary goal is to assist HCP to mover from paper to EHR that is easily accessible and able to evaluate the quality of care.

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Social Organizational Analysis

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Identifies the different responsibilities of various users so HCI can support collaboration.

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Strategies Analysis

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Evaluates the manner in which work is actually carried out by users.

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Worker Competencies Analysis

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Considers design restraints associated with the users.

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Control Task Analysis

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Considers the control structure with which the user must interact.

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Work Domain Analysis

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Evaluates system functions and the information needed by users.

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Malware

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Specifically designed to gain access or damage a computer without knowledge of the owner.

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Bugs

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Anomaly and failure in the system; a coding error

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Black Box Testing

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Used in software testing to determine the functional workings of the system.

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Benchmark Testing

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Compares hardware and software performance

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Operational System Testing

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Assesses how well a system functions after the introduction of a new component

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User Acceptance Testing

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Completed during alpha or beta testing; confirms all user requirements are met.

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Subsystem Integration Testing

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Ensures that the program components integrate into the subsystems. Ensures that the subsystems integrate properly into the application.

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Load Testing

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Performance testing that checks applications ability to perform under anticipated user loads

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Stress Testing

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Preformance testing under extreme workloads to see how it handles high traffic

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Endurance Testing

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Performace testing performed to make sure the software can handle expected loads over time

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Spike Testing

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Performence testing that checks reaction to sudden larger loads

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Volume Testing

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Performance testing that checks the software's performance under varying volumes

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Scalability Testing

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Performance testing that checks the effectiveness in scaling up to support increase in user load.

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Standards of Professional Performance

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- Evaluates qualitu and effectiveness of NI practice -Performance appraisal -Maintains knowledge and NI competency (life-long learning) -Contributes to professional development of others -Bases decisions and actions on ethical principles -Collaborates with others -Contribute to body of informatics research

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Competencies of the NI

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-Advanced computer skills -Information literacy -Nursing competency -Process inprovement skills -Project management skills -Communication -Team building -Conflict management -Staff development

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NI Standards of Practice

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-Assessment -Diagnosis -Outcomes identification -Planning -Implementation -Evaluation -Ethics -Education -Evidence-based practice and research -Quality of practice -Communication -Leadership -Collaboration -Professional practice evaluation -Resource utilization -Enviromental health

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Adult Teaching/Learning Principals

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-Adults tend to be self-directed -Adults have a reservoir of experience, can be a resorce for learning -Adults tend to have life, task, problem-centered orientation to learning -Adults tend to have an internal/intrinsic motivation to learn

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Asynchronous Learning

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A student-centered teaching method that uses online learning resources to facilitate information sharing outside the constraints of time and place among a network of people

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Synchronous Learning

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A learning event in which a group of students are engaging in learning at the same time.

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Didactic Learning

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The pedagogy of instruction and immutable facts, of authority and telling, and of right and wrong answers - it is teacher-centred and values learners who sit still and listen quietly and attentively, passively accepting the teacher as the knower and expert, both the source of knowledge and judge-jury of knowing.

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Traditional Learning

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A back-to-basics, conventional education or customary education

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Hybrid Learning

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Combines online digital media with traditional classroom methods. It requires the physical presence of both teacher and student, with some element of student control over time, place, path, or pace.

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End-to-End Testing

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Verifies proper function of the system from client to network to server to database

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Alpha Testing

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An initial phase of testing often used in software testing

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Beta Testing

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Final stage of testing before release

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Re-engineering

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Identifies, analyzes, and redesigns the core business process to achieve dramatic improvement in critical performance measures; cost, quality, service and speed

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Logical Database Design

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Steps followed to produce a detailed data model of a database 1. Scope 2. Logical Design 3. Technical Optimization 4. Implementation

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Primary Keys

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Unique identifiers used in relational databases columns

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Secondary Keys

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Secondary unique identifiers used in relational databases that are not assigned as primary

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Physical Database Design

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Translates the Logical Database Design through 3 phases: 1. Concept- produces a data model that develops relevant entities and relationships fpr the application domain 2. Logic- procedures and measures that maximize the potential for the database 3. Physical- specifies how database records are stored, accessed, and related for the best performance

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Hashing

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Performing a calculation on a record key to determine a physical address

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Indexing

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A look-up procedure on a field value that determines a physical location from a primary key

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Quality Assurance

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The planned and systematic activities implemented in a quality system so that quality requirements for a product or service will be fulfilled

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Auditing

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An evaluation to indicate needed corrective responses through the observation of techniques and activities

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Parallel Implementation

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Running two systems simultaneously. Expensive and time-consuming.

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Domains

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Copies of the software system at various states. Also known as "enviroments".

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Fountain Method

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Strategy where implementation occurs in stages with considerable overlap.

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Waterfall Method

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Strategy when implementation occurs in stages when one phase leads to another.

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Pilot Implementation

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Strategy where implementation occurs on a stand alone unit with minimal interactions with other units.

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Build and Fix Method

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Strategy of implementation where codes are written and modified until the outcome is achieved. Most risky implementation method.

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Spiral Method

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Strategy of implementation that allows for reiteration of earlier stages and a progressive implementation.

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Big Bang Approach

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Strategy of implementation where are users are switched from the original system to a new system at once.

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Backup and Recovery

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-Backup should be stored on multiple devices -Backups should be performed during times of minimal access -Systems should be backed up at least weekly and tested at least monthly -"Warm Site" off site back up system containing patient data. Able to activate within hours and located 50 miles from home site.

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User Authentication

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User access that requires valid username and password combinations. Should be changed every 30-60 days.

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NI Functional Areas

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-Quality and Performance Improvement -Operational Architecture -Genetics and Genomics -Analyst -Compliance and Integrity -Consultants -Coordination, Facilitation, and Integration -Development of systems, products, resources -Education and Professional development -Research and Evaluation -Informatics Administrator/Officer

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Performance Improvement

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Setting goals, implementing systematic changes, measuring outcomes, and making subsequent appropriate improvements to meet the needs of patients.

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Quality Improvement

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Systematic and continuous actions that lead to measurable improvement

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Knowledge Management

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The creation of systems that enable organizations to tap into the knowledge, experiences, and creativity of their staff to improve their performance

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Technology Informatics Guiding Education Reform (TIGER) Initiative

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focused on education reform and interprofessional community development. Maximizes the integration of technology and informatics into seamless practice, education and research resource development.

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NI Entry-Level Core Competencies

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Focuses primarily on developing and using skills that rely upon the ability to retrieve and enter data in an electronic format that is relevant to patient care, the analysis and interpretation of information as part of planning care, the use of informatics applications designed for nursing practice, and the implementation of policies relevant to information. • Basic computer literacy, including the ability to use basic desktop applications and electronic communication • The ability to use IT to support clinical and administrative processes, which presumes information literacy to support evidence-based practice • The ability to access data and perform documentation via computerized patient records • The ability to support patient safety initiatives via the use of IT • Recognition of the role of informatics in nursing

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NI The Experienced Nurse

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This practitioner has the expertise to serve as a content expert in system design, to see relationships among data elements, to execute judgments based on observed data patterns, to safeguard access to quality of information, and to participate in efforts to improve information management and communication •Proficiency in his or her area of specialization and the use of IT and computers to support that area of practice including quality improvement and other related activities (ANA 2008) • Knowledge representation methodologies for evidence-based practice • The ability to use information systems and work with informatics specialists to enact system improvements • Proficiency in using evidence-based databases • The promotion of innovative applications of technology in healthcare

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NI The Informatics Nurse

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This individual has advanced preparation in information management and possesses the following skillS: • Proficiency with informatics applications to support all areas of nursing practice including quality improvement activities, research, project management, system design, development, analysis, implementation, support, maintenance, and evaluation • Fiscal management • Integration of multidisciplinary language/standards of practice • Skills in critical thinking, data management and processing, decision making, and system development, and computer skills • Identification and provision of data for decision making

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NI The Informatics Nurse Specialist

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Possesses a sophisticated level of understanding and skills in information management and computer technology, demonstrating most of the competencies seen at the previous three levels. Tthe innovator who sees the broad vision of what is possible and how it may be attained. The Scope and Standards of Nursing Informatics Practice (ANA 2008) calls for educational preparation to conduct informatics research and generate informatics theory. Well suited to work in a variety of areas and functional roles including project management and administration.

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Department of Health and Human Services (HHS)

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(2009) Government body that establishes programs to improve healthcare quality, safety, and efficiency through the use of HIT.

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Forming

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In this first stage, team members are getting to know each other; there is little friction and the team is polite and will offer few opinions. At this stage they do not fully understand what work is required or how each will work together. At this point the PM must be directive and make sure the team has clear objectives. It is also a good time to evaluate individual skills and personalities.

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Storming

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In the second stage, there may be conflict among team members; there may be challenges to the PM decisions; members may jockey for positions. At this stage, the PM may need to clarify roles if they have not been clear in the past; at this stage authority may be challenged. The APN PMs must remember that they are ultimately responsible for the project.

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Norming

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In the third stage, the team starts to work better together and resolve their differences; they better understand and respect their different roles as well as those of the PM. As the team moves along and as new tasks come up, there may be periods when they move back to storming as they again clarify their roles. It will be important to facilitate further collaboration among the team members.

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Performing

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In the fourth stage, the team, without friction, moves toward accomplishing the project goals and objectives. At this point, the APN may more easily delegate much of the work, but must always remember the ultimate responsibility for the entire project lies with the PM

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Status Meetings

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Provide the timely status of the project at least on a weekly basis. The reports provide updates to the planning and implementation process and establish a pattern of a way to keep everyone informed.

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Access code

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Unique identifier generally provided by a name and password for the specific purpose of restricting computer or information system use to persons who have legitimate authority to view or use information found in the computer or information system.

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Accountable care organizations (ACOs)

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Payment and healthcare delivery reform model that ties provider reimbursement to quality metrics and reductions in the total cost of care for a given patient population.

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Administrative information systems

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Systems that support patient care by managing financial and demographic information and providing reporting capabilities.

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Aggregate data

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Data that are derived from large population groups.

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American Recovery and Reinvestment Act of 2009 (ARRA)

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Legislation that included provisions for health information technology and funding for the Office of the National Coordinator of Health Information Technology (ONCHIT).

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Archetypes

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Re-usable clinical models of content and processes significant for an initiative to develop a lifelong electronic record.

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Architecture

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Structure of the central processing unit and its interrelated elements within an information system.

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Arden Syntax

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Standard language used in the healthcare industry for writing rules.

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Asynchronous Transfer Mode (ATM)

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High-speed data transmission method suitable for voice, data, image, text, and video information that use fiber or twisted pair cable. It is faster than ISDN, but less frequently used for reasons of cost, availability, and a lack of standards.

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Authoring tools

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Software programs that allow persons with little or no programming expertise to create instructional computer programs.

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Backloaded

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Information that is preloaded into the system before the go-live date.

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Batch processing

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Manipulation of large amounts of data into meaningful applications at times when computer demands are lowest as a means to maintain system performance during peak utilization hours. Batch-processed information is not available before processing and is little used today except to run reports.

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Bennett Bill

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Although not passed into law, the Medical Records Confidentiality Act of 1995 was a significant piece of legislation because it attempted to establish the role of healthcare providers in the protection of client information; to fix conditions for the inspection, copying, and disclosure of protected information; and to institute legal protection for health-related information.

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Bibliography database manager (BDM)

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Software that allows the importation of references directly from databases. Selected examples include EndNote, Reference Manager, ProCite, Biblioscape, and the Web-based Zotero.

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Business continuity management

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Process to ensure that organizations can withstand any disruption to normal functioning.

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Business continuity planning (BCP)

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Combines information technology and disaster recovery planning with business functions recovery planning.

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Business impact assessment or analysis (BIA)

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Process of determining the critical functions of the organization and the information vital to maintain operations as well as the applications and databases; hardware; and communications facilities that use, house, or support this information.

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File Transfer Protocol (FTP)

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Set of instructions that controls both the physical transfer of data across a network and its appearance on the receiving end.

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Healthcare Information Exchange (HIE)

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Electronic sharing of patient information such as demographic data, allergies, presenting complaint, diagnostic test values, and other relevant data between providers such as primary physicians, specialists, hospitals, and ambulatory care settings according to nationally recognized standards.

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International Classification of Nursing Practice (ICNP)

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A system that serves to unify various approved nursing languages and classification systems to ensure the acceptance of common meanings across different settings.

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Mapping

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Process by which the definition of terms used in one information system are associated with comparable terms in another system, thereby facilitating the exchange of information from one system to another.

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Master patient index (MPI)

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Database that lists all identifiers used in connection with one particular client in a healthcare alliance. Identifiers may include items such as Social Security number, birth date, and name.

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Nursing Minimum Data Set (NMDS)

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Collection of data comprised of nursing diagnoses; interventions; and outcomes that allows comparison of data across different healthcare settings in order to project trends and stimulate research.

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Ontology

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System that organizes concepts by meaning describing the definitional structure/relationship and organizes concepts for storage and retrieval of semantically accurate data.

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Public key infrastructure (PKI)

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Provides a unique code for each user that is embedded into a storage device.

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Agency for Healthcare Research and Quality (AHRQ)

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An agency within the U.S. Department of Health and Human Services that supports health services research initiatives.

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Bagging

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The use of voting and averaging in predictive data mining to synthesize the predictions from many models or methods or for using the same type of a model on different data; it deals with the unpredictability of results when complex models are used to data mine small data sets.

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Casuist approach

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An approach to ethical decision making that grew out of the concern for more concrete methods of examining ethical dilemmas. Casuistry is a casebased ethical reasoning method that analyzes the facts of a case in a sound, logical, and ordered or structured manner. The facts are compared to the decisions arising out of consensus in previous paradigmatic or model cases.

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Classification and regression trees (CART)

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A decision tree method that is used for sorting or classifying a data set. A set of rules that can be applied to a new data set that has not been classified; the set of rules is designed to predict which records will have a specified outcome.

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Entity-relationship diagram (ERD)

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Diagram that specifies the relationships among the entities in the database. Sometimes the implied relationships are apparent based on the entities' definitions; however, all relationships should be specified as to how items relate to one another. There are typically three relationships: one to one, one to many, and many to many.

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Metrics

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Measurements or a set of measurements to quantify performance; they provide understanding about the performance of a process or function.

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National Health Information Infrastructure (NHII)

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An initiative intended to improve the effectiveness, efficiency, and overall quality of health and health care in the United States. A comprehensive knowledge-based network of interoperable systems of clinical, public health, and personal health information that would improve decision making by making health information available when and where it is needed. The set of technologies, standards, applications, systems, values, and laws that support all facets of individual health, health care, and public health. The NHII is voluntary and not a centralized database of medical records or a government regulation.

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Nationwide Health Information Network (NHIN)

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An agency of the U.S. Department of Health and Human Services charged with the development of a safe, secure, interoperable health information infrastructure.

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Office of the National Coordinator for Health Information Technology (ONC)

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An office within the U.S. Department of Health and Human Services that was established through the HITECH Act. The ONC is headed by the national coordinator, who is responsible for overseeing the development of a nationwide health information technology infrastructure that supports the use and exchange of information.

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Online analytical processing (OLAP)

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A fast analysis of shared data stored in a multidimensional database that allows the user to easily and selectively extract and view data from different points of view.

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Ontological approach

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Theory that considers ontology development (domain analysis) and its mapping to object models (specification of infrastructure). Based on enumerating all concepts used in a domain and in providing their formal definitions according to suitable formalisms (usually logic based).

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Ontology

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Study of that which is compositional in nature and a partial representation of the entities within a domain and the relationships that hold between them. An explicit specification of a conceptualization.

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Qualitative study

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A type of research design that focuses on the human experience of a phenomenon using words, concepts, language, and meanings rather than numbers to capture the essence of the subject under study. Subjective study.

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Quantitative study

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Research that looks at the what, where, and when to provide understanding of phenomena based on quantifying data and using statistical measures; depending on the research, a study may ascertain cause-and-effect relationships. Objective study.

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Radio frequency identification (RFID) chip

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An identification chip that stores information for retrieval.

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Sarbanes-Oxley Act (SOX)

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Legislation that was put in place to protect shareholders as well as the public from deceptive accounting practices in organizations.

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Standard Generalized Markup Language (SGML)

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Metalanguage; markup language for documents. Extensible Markup Language (XML) began as a simplified subset of SGML.

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Structured English Query Language (SQL)

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A database querying language, rather than a programming language. SQL is a standard language for accessing and manipulating databases. It simplifies the process of retrieving information from a database in a functional or usable form while facilitating the reorganization of data within the database.

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Synchronous dynamic random-access memory (SDRAM)

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The most common type of dynamic random-access memory found in personal computers.

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TELOS strategy

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An approach that provides a clear picture of the feasibility of a project; TELOS stands for "technologic and systems, economic, legal, operational, and schedule feasibility."

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Terabyte (TB)

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A measurement term for data storage capacity. One terabyte equals 1,024 gigabytes.

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Thick (fat) client

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A computer connected to a network designed primarily for data processing and not communications or storage.

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Thin client

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A computer that conveys input and output from the user to the server and back, but does no processing.

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Tuple

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A record in a database; also known as a row.

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Ubiquity

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State of being everywhere at once (or seeming to be everywhere at once). Presence in many places especially simultaneously. With changing models of healthcare delivery, information and knowledge should be available anywhere.

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