21Fundamentals of Nursing: The Art & Science of Person Centered Care, 10th Edition; Taylor, Lynn, Bartlett. Chapter 21 Informatics and Health Care Technologies

A nurse informaticist is using the steps of the SDLC to design a new system for home health care documentation. The nurse analyzes the old system and develops plans for the new system. What step of this process will the nurse take next?

a Testing

b Designing

c Implementing

d Evaluating

b. The SDLC focuses on the areas of Analyze and Plan, Design and Build, Test, Train, Implement, Maintain, and Evaluate. After analyzing and planning the new system, the nurse would move on to the design step in which the basic design of the new system is developed. The nurse would then test the system, train employees, and implement, maintain, and evaluate the new system in that order.

After instituting a new system for recording patient data, a nurse evaluates the “usability” of the system. Which actions will the nurse include in this step? Select all that apply.

a Checking that the screens are formatted to allow for ease of data entry

b Reordering the screen sequencing to maximize effective use of the system

c Ensuring that the computers can be used by specified users effectively

d Checking that the system is intuitive and supportive of nurses

e Improving end-user skills and satisfaction with the new system

f Ensuring patient data is shareable across health care systems

a, c, d.

Usability refers to the extent to which a product can be used by specified users to achieve specified goals with effectiveness, efficiency, and satisfaction in a specified context of use. Checking that screens are formatted to allow ease of data entry, ensuring that computers can be used by specified users effectively, and checking that the system is intuitive and supportive of nurses are all tasks related to the “usability” of the system. Maximizing screen sequencing and improving end-user skills and satisfaction with the new system refer to optimization. The ability to share patient data across health care systems is termed interoperability.

A nurse is using informatics technology to determine which patients may be at risk for readmission. What term best describes this type of analytic?

a Data visualization

b Predictive analytics

c Big data

d Data recall

b. Predictive analytics uses statistical techniques to analyze current and historical facts to make predictions about future or otherwise unknown events. This is used by health care organizations to identify patients who are at risk for readmission, allowing case managers to intervene. Data visualization presents data in a pictorial or graphical format for analysis. Big data comprises the accumulation of health care–related data from various sources, transforming the data to information, to knowledge, and ultimately to wisdom. Data recall is not a technical term for analytics.

Nursing students enrolled in an informatics course question the purpose of “big data.” Which statement do the students find best describes use of big data?

a Gathering data from multiple sources to help organizations answer questions and make predictions in multiple settings

b Predicting patients likely to be readmitted, allowing early intervention

c Promoting the most efficient staffing model for the organization

d Developing charts or graphs to visualize large amounts of complex data

a

As organizations transition from traditional fee-for-service models to value-based payment models, information about populations rather than individuals is needed. Big data comprises the accumulation of health care-related data from multiple sources, combined with new technologies that allow for the transformation of data to information for patient care regardless of setting. Sources of available data can include the EHR; medical devices such as monitors, ventilators, and smart pumps; radiology, laboratory, and pathology systems; wearable devices and home monitoring systems; financial databases; genomics; open sources; patient portals; and real-time location systems. Predictive analytics uses statistical techniques to make predictions about future or unknown events, such as patients who are at risk for readmission. Data visualization presents data in a pictorial or graphical format for analysis. The growing population of older adults with complex health needs and a potential understaffing are important but are not the driving force for the development of this technology.

A nurse incorporates use of the patient portal in the discharge teaching for a patient who received a kidney transplant. What services does the nurse explain are available with this technology? Select all that apply.

a Reviewing diagnostic and lab test results

b Making follow-up appointments

c Using health and fitness apps

d Entering clinical data, such as blood pressure

e Providing digital medication reminders

f Requesting prescription refills

a, b, c, d, f.

The patient portal can streamline services by allowing access to medical history and other health information; facilitating completion of online forms and questionnaires; offering secure and convenient communication with providers; and having the ability to place request prescription refills, pay bills, review lab results, schedule appointments, receive reminders for screenings and immunizations, enter clinical data such as blood pressure, glucose levels, weight, and other activity tracking data, review progress notes, and access educational materials based on diagnosis or procedure.

A nurse is testing a new computer program designed to store patient data. During which phase of testing does the nurse determine whether the system can handle high volumes of end users and care providers using the system at the same time?

a Unit

b Function

c Integration

d Performance

d. Performance testing is technical and ensures proper functioning of the system and its ability to handle high volumes of care providers using the system at the same time. Unit testing is basic testing that occurs initially. Function testing uses test scripts to validate that a system is working as designed for one particular function. Integration testing uses test script to validate that a system is working as designed for a workflow that integrates multiple components of the system.

Nurses test new technology in phases. When will the nurses plan to “test drive” the new system?

a Unit

b Function

c User acceptance

d Integration

c. During the phase “user acceptance,” the nurse would “test drive” the new system to ensure it’s working as designed. Unit testing is basic testing that occurs initially. Function testing uses test scripts to validate that a system is working as designed for one particular function. Integration testing uses test script to validate that a system is working as designed for an entire workflow that integrates multiple components of the system.

A nurse is using the steps in informatics evaluation to assess a patient portal. Which activities might occur in the “determining the question” step? Select all that apply.

a Developing a clear, focused question to determine the data to be collected

b Determining what to evaluate

c Determining how the data ultimately should be reported

d Deciding what specific data elements need to be collected

e Clarifying exactly how the data will be collected

f Performing comprehensive documentation of the data collected

a, c.

The nurse develops a clear, focused question to determine the data to be collected and the nurse determines how the data ultimately should be reported during the “determine the question” step. The nurse determines what to evaluate during the step “determine what will be evaluated.” The nurse decides what specific data elements need to be collected during the “determine the needed data” step. The nurse clarifies exactly how the data will be collected during the “determine the data collection method and sample size” step. The nurse performs comprehensive documentation of the data collected during the “document your outcome evaluation” step.

When signing in to the electronic medical record, a nurse is prompted to change their password. Which best-practice guideline does the nurse use to formulate the new password?

a Password should be at least 8 characters long and unique.

b Passwords should be memorable and used in other applications.

c Date of birth makes an ideal password.

d Nurses should share their passwords with their nurse managers.

a. Passwords should contain 8 to 15 characters, never be shared or re-used, and be easy to remember but hard to guess. Using multifactor authentication and a password manager can help organize and protect information. The password should not be shared with the nurse manager or others.

A nurse designing a new EHR system for a pediatric office follows usability concepts in system design. Which concepts are recommended in system design? Select all that apply.

a Users should not explore with forgiveness for unintended consequences.

b Shortcuts for frequent users should not be incorporated into the system.

c Content emphasis should be on information needed for decision making.

d The less times users need to apply prior experience to a new system the better.

e All the information needed should be presented to reduce cognitive load.

f The number of steps it takes to complete tasks should be minimized.

c, e, f.

When designing a system, content emphasis should be on information needed for decision making. All the information needed should be presented to reduce cognitive load. The number of steps it takes to complete tasks should be minimized. The more users can apply prior experience to a new system, the lower the learning curve, the more effective their usage, and the fewer their errors. Forgiveness means that a design allows the user to discover it through exploration without fear of disastrous results or unintended consequences. Minimizing the number of steps needed to complete tasks and to provide shortcuts for use by frequent and/or experienced users facilitates efficient user interactions.

A nurse wants to be an ethical practitioner. When using informatics, which action best represents ethical practice?

a Selecting appropriate standardized care plans to meet the patient’s needs

b Gathering data for research studies using the electronic health record of multiple patients

c Maintaining confidentiality of patient records within legal and regulatory parameters

d Carrying out all electronic orders entered by the health care provider

c. The ANA asserts ethical use of informatics principles, standards, and methodologies to establish and maintain health care consumer confidentiality be used within legal and regulatory parameters.

During a feedback session on the updates to the electronic health record, nurses complain that they must use standard terminology rather than enter “free text” data in their own words. How will the nurses developing the system explain the purpose of standardization?

a It leads to fewer spelling errors and less misrepresentation of data.

b It provides for easier retrieval of data for use.

c The program was designed this way, and we cannot change it.

d Standardization uses preselected terminology, reducing lawsuits.

b. Using standard terminology in the electronic health record allows data to be easily retrieved and better captures nursing’s contribution to care delivery and patient outcomes. For example, to capture all patients using canes, quad canes, and walkers, a common phrase such as “uses assistive device” allow data for all these mobility issues to be captured.

A nursing student who is planning their career trajectory tells the nurse preceptor how much they enjoy working with the electronic health record and informatics. What type of graduate program could the preceptor suggest?

a Clinical nurse specialist

b Nurse leader

c Superuser

d Informatics nurse specialist (INS)

d. The INS is a registered nurse with formal graduate-level education in informatics. This nurse participates in strategy development, implementation, and maintenance and evaluation of clinical systems, in collaboration with multiple disciplines. The information nurse (IN) is a registered nurse with an interest or experience in informatics, who can assist with the implementation of the EHR or other types of informatics. “Superusers,” often trained on the job, assist others to navigate the EHR. The clinical nurse specialist and nurse leader are patient care focused leadership roles.