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HIT provides information to make better decisions
HIT Tools include computers, clinical guidelines, medical terminologies, information, and communication

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Health informatics increases efficiency of healthcare, decreases cost, and increases productivity
Improves patient outcomes and safety
Healthcare easily shareable and managed between patient and provider

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This article discusses a new technology (REMOTE-CR) that was developed to make cardiac rehab more accessible to everyone. A population of patients who cannot leave their house due to transportation issues can now access this care from their homes.

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Machine learning clinical decision support tool in primary care and the treatment of UTI's

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Epic is the electronic health system that I have used in my practice, and it is getting more and more popular. Not only do the providers love it, patients can also use it by creating a MyChart account.
Epic houses all of the patient's medical information. This includes labs, imaging, medications, hospitalizations and all notes from the hospitalization, procedures, demographics and so much more.
Epic also contains patient quality index scores such as the rothman index, and clinical practice guidelines.

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Competencies were creating to decrease medical errors and improve quality of patient care and patient safety.
QSEN- Quality and Safety Education for Nurses
AACN- American Association of Colleges of Nursing
TIGER- Technology Informatics Guiding Education Reform Initiative

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Created for nurses but has grown to include pharmacists, dieticians, public health, and more.
Interprofessional approach: informatics to be the core of practice across all types of providers.
7 Key Pillars: communication and collaboration, education, informatics design, information technology, culture, management and leadership and policy.

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Included on this website are courses that are available for graduate students. One that I hope to take is the End of Life Nursing Education Consortiums because I am interested in palliative care, and this course goes through an introduction, how to communicate, and pain management, and symptom management.

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Our Mission

The American Association of Colleges of Nursing (AACN) is the national voice for academic nursing. AACN works to establish quality standards for nursing education; assists schools in implementing those standards; influences the nursing profession to improve health care; and promotes public support for professional nursing education, research, and practice.

"AACN is the only place that I can come and truly be among peers."

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American Association of Colleges of Nursing

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Advance your nursing education and career with AACN. Discover our nursing programs, resources, and initiatives driving the future of healthcare.

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"The big six" - patient-centered care, teamwork and collaboration, EBP, QI, safety, and informatics

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Patient safety and quality of care are two of the main cornerstones of nursing practice. We all strive to provide safe environments for our patients by doing our best to avoid errors. However, landmark studies, such as the Institute of Medicine's To Err Is Human: Building a Safer Health System, have demonstrated that the healthcare profession has been fraught with errors. In this 1999 report, the estimated cost of medical errors was between $17 billion and $29 billion at hospitals across the country, with death rates between 44,000 and 98,000.

The follow-up report Keeping Patients Safe: Transforming the Work Environment of Nurses made several recommendations, which prompted many agencies, such as The Joint Commission and the Agency for Healthcare Research and Quality, to develop standards for healthcare organizations to employ in an effort to reduce the number of errors. For example, one recommendation suggested voluntary nationwide error reporting while conducting research and developing tools for patient safety. Another option that many states have adopted is the Just Culture Initiative, which looks at systems rather than people when errors are made.

These initiatives have had a positive impact on quality and safety, but there are still too many errors and issues with quality of care. For example, five experts were interviewed on progress made in the area of quality and patient safety during the last decade. All five stated that there has been progress; however, it has been somewhat inconsistent. Furthermore, they unanimously agreed that we need to continue to address this issue and that greater transparency is warranted.

In 2005, the Robert Wood Johnson Foundation funded a national study to educate nurses about patient safety and quality because nursing plays a central role in patient outcomes. The project was designed to address the gap between education and practice and was developed in three phases. Phase I involved a team of experts who examined factors related to quality and safety. In Phase II, the Quality and Safety Education for Nurses (QSEN) competencies, which would be included in undergraduate and graduate curricula, were developed. Phase III focused on faculty development and integration of the competencies into curricula, research, accreditation, and licensing. The overall goal was to improve patient outcomes by providing nursing students with a solid foundation so they have the knowledge, skills, and attitudes needed to provide safe and effective quality care.

Educators and accreditation, licensing, and certification organizations should ensure that students andworking professionals develop and maintain proficiency in five core areas:

delivering patient-centered care

working as part of interdisciplinary teams

practicing evidence-based medicine

focusing on quality improvement

using information technology.

Because QSEN competencies are relatively new, many nurses haven't been taught about them, creating a need for all nurses to develop new skills centering around these competencies. We'll take a look at the core QSEN competencies, along with strategies on how to incorporate them into your practice.

What's QSEN?

There are six QSEN competencies that were developed for pre-licensure and graduate nursing programs: patient-centered care, teamwork and collaboration, evidence-based practice (EBP), quality improvement (QI), safety, and informatics. Many of these competencies are already being addressed in the healthcare setting, but there's a need to further integrate them into our everyday practice and utilize similar language in our competency statements.

For each competency, there are expectations relating to the knowledge (understanding), skills (implementation), and attitudes (values) that should be achieved. By the time nursing students graduate, they should have achieved these competencies and should continue to address and utilize them in their professional practice role. After nursing students graduate, they look to experienced RNs as their preceptors and mentors, and to nurse managers for guidance throughout their transition, which is why it's crucial that these competencies are comprehended and embraced by all nurses.

The big six

The first competency is patient-centered care, which focuses on including patients in all decisions and providing compassionate care that's based on a patient's needs and values. An example of a knowledge-related competency statement is “Describe how diverse cultural, ethnic, and social backgrounds function as sources of patient, family, and community values.” Although this seems like something we'd all espouse, there are times we may not realize that we aren't taking our patients' perspectives, beliefs, or cultural backgrounds into consideration.

The second competency is teamwork and collaboration, which relates to interdisciplinary collaboration and shared decision making among the healthcare team. A competency statement related to attitudes would be “Value the perspectives and expertise of all health team members.” Many hospitals have interdisciplinary rounds during which the healthcare team meets to review the care plan for each patient on a particular unit.

The third competency is EBP, which relates to the utilization of current evidence when providing collaborative care. An example of a skills competency statement is “Read original research and evidence reports related to the area of practice.” The use of research and evidence in our practice has become widely embraced, especially at Magnet® hospitals and hospitals on the Magnet journey. You may be able to join the research committee at your organization or suggest that one be started. You might also spearhead an interdisciplinary study on a clinical issue in your practice area.

The fourth competency is QI, which relates to data collection, evaluation, and improvement of patient outcomes. The following is considered a skill-related competency statement: “Participate in a root cause analysis of a sentinel event.” According to The Joint Commission, a sentinel event is an unexpected occurrence that may result in death or a serious adverse patient outcome. When something like this occurs, hospitals are required to conduct a root cause analysis. You might want to ask to be part of the taskforce as an observer or active participant to learn more about this process.

The fifth competency is safety, which focuses on preventing harm to patients. A knowledge-related competency would be “Describe factors that create a culture of safety (such as open communication strategies and organizational error reporting systems).” You're probably aware of many patient safety initiatives such as The Joint Commission's National Patient Safety Goals. You can help nursing students and new nurses understand these goals by being a positive role model and sharing your knowledge.

The final competency is informatics, which relates to the utilization of technology to promote safety and quality. An example of a competency on attitudes is “Value nurses' involvement in design, selection, implementation, and evaluation of information technologies to support patient care.” Technology is always improving and the use of electronic medical records (EMRs), medication administration programs, and other equipment and programs has been shown to improve patient safety. For example, it has been suggested that the use of computerized physician order entry reduces the risk of prescribing errors. On the other hand, it has been noted that the use of EMRs doesn't necessarily decrease patient safety errors; however, a 2011 study found that they do decrease costs and patient deaths by 34%.

Clearly, we have more work to do, but we're making strides and will continue to do so as more nurses and other healthcare practitioners embrace initiatives such as the QSEN competencies.

Putting it into practice

The QSEN competencies can help nurses positively impact patient outcomes. Although many of these competencies are already being addressed in healthcare settings, you can continue to integrate them into your practice and serve as a role model to nursing students and new nurses on your unit. Consider becoming a QSEN advocate and join the safety or quality committee at your hospital. Has your unit participated in an EBP project? If not, perhaps you and your colleagues can develop a project on a clinical issue related to your specialty.

Participating in multidisciplinary rounds is another way to promote teamwork and collaboration in addition to providing patient-centered care. Make sure to check out the QSEN website at http://www.qsen.org/. It has a wide variety of resources that you may utilize when looking to improve safety outcomes within your organization. These competencies have the ability to guide the entire healthcare system in the delivery of safe and effective quality care.

Learn more about it

Agency for Healthcare Research and Quality. http://www.ahrq.gov.

Cronenwett L, Sherwood G, Barnsteiner J, et al. Quality and safety education for nurses. Nurs Outlook. 2007;55(3):122–131.

Cronenwett L, Sherwood G, Pohl J, et al. Quality and safety education for advanced nursing practice. Nurs Outlook. 2009;57(6):338–348.

Dey S, Kudumovic M. The role of information technology in preventing medical errors. Review of Global Medicine and Healthcare Research. 2010;1(1):89–95.

Encinosa WE, Bae J. Health information technology and its effects on hospital costs, outcomes, and patient safety. Inquiry. 2011–2012;48(4):288–303.

Institute of Medicine. Health Professions Education: A Bridge to Quality. Washington, DC: National Academies Press; 2003.

Institute of Medicine. To Err is Human: Building a Safer Health System. Washington, DC: National Academies Press; 1999.

Larkin H. 10 years, 5 voices, 1 challenge. To Err is Human jump-started a movement to improve patient safety. How far have we come? Where do we go from here? Hosp Health Netw. 2009;83(10):24–28.

Lewis M, Lamb G. A comprehensive model for teaching quality and safety education for nurses (QSEN) competencies. Dean's Notes. 2011;32(5):1–3.

Quality and Safety Education for Nurses. http://www.qsen.org.

Sullivan DT. Connecting nursing education and practice: a focus on shared goals for quality and safety. Creat Nurs. 2010;16(1):37–43.

© 2012 Lippincott Williams & Wilkins, Inc.

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Standardized terminology is necessary for structured data entry, decision support, identifying and monitoring health needs and outcomes, supporting research activities, and more.
Big Data can be used to improve the health care system

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"Smart Inhalers" are discussed in this video. I found this concept really interesting because I have asthma and frequently use my inhaler due to the many triggers that I have. Smart inhalers can notify the provider when they are used, where it is used, and this can help the provider understand the patient's condition better

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Using Big Data to Improve Healthcare Services | Tiranee Achalakul | TEDxChiangMai

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Process data
Customized approach to care, ex: cancer patients
One centralized thinking hub on the cloud
Turning data into knowledge

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Health Informatics and the Health Care Team. This article discusses the importance of health informaticians being a part of the interprofessional health care team.

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Academic and nonacademic health informatics (HI) professionals (informaticians) serve on interprofessional health care teams with other professionals, such as physicians, nurses, pharmacists, dentists, and nutritionists. 1 Presently, we argue for investing greater attention to the role health informaticians play on interprofessional teams and the best practices to support this role.

The Role of Health Informaticians on Interprofessional Health Care Teams

In interprofessional health care teams, individuals with distinct professional training supply unique expertise and work together to solve health care problems. 2 3 When these teams span different branches of knowledge or subspecialties, they are also considered interdisciplinary. 2 4 Interprofessional teams in health care are effective because they draw on diverse expertise to address complex problems in holistic ways. 5 6 Interprofessional teams operate in health care facilities, academic institutions, and community or public health settings. 7 In clinical settings, interprofessional teams provide less fragmented, 8 9 higher quality, 9 10 safer, 11 and more effective 12 13 14 care. Interprofessional teams are recommended by the World Health Organization 15 16 and the National Academy of Medicine. 17 Further, educational institutions and accreditors, 18 including the Accreditation Committee for Graduate Medical Education (ACGME), 19 embrace interprofessional education (IPE), to prepare health care professionals "for the world of intercollaborative practice." 7 In parallel, the National Institutes of Health and others urge interdisciplinary "team science" in biomedical research. 20

Are health informaticians considered members of interprofessional teams? Our informal review of major textbooks, 21 22 reports, 7 and articles 1 23 24 25 found no mention of health informaticians as members of interprofessional health care teams. A published 2013 review described the make-up of interprofessional teams in 17 articles 26 ; informaticians were not included in any (see Supplementary Material , available in the online version). Furthermore, including HI students in IPE initiatives appears to be an exception, not the rule. 27 28 When HI is mentioned in the literature on interprofessional health care, it is as a set of tools that "has the capacity to support the work of health care teams" 29 and improve IPE. 30

We argue that health informaticians have a professional role on teams, apart from providing direct care. This role should be better defined and communicated to other professions. When a problem involves data or information, informaticians add value by applying competencies in "management and use of biomedical information." 31 This is evident in realms such as evidence-based health care delivery, 32 precision medicine, 33 population health management, 34 public health surveillance, 35 and learning health systems. 36 37 Health informaticians are qualified to handle both electronic health records and larger health care data sets to answer questions, support care delivery, improve quality and efficiency, and reduce costs. 38 Examples include building or identifying databases or data sets, mining structured/unstructured data, applying computational procedures, interpreting data/results, and sharing data. In many other cases, health informaticians add value by applying competencies in "design, development, adoption, and application of information technology (IT)-based innovations." 39 Informaticians can develop methodologies and technologies to advance team research, design tools and networks to facilitate interprofessional collaboration and communication, and develop standards and terminologies to support system interoperability. 40

We argue health informaticians are useful members of interprofessional teams in all stages of problem-solving-problem assessment, solution development, implementation, and evaluation, as illustrated in . In part, this is because HI education is interdisciplinary, covering health, social, and technical domains, such as biomedical sciences, computer and data sciences, human factors and decision-making, and social and behavioral science. 41 42 Furthermore, properly trained health informaticians gain interprofessional collaboration and leadership competencies, including leading and managing change. 41 42 43 This is evidenced by the inclusion of team competencies in HI accreditation and board certification requirements. 41 44 The American Medical Informatics Association (AMIA) Accreditation Committee, for instance, lists interprofessional collaborative practice (F9) and leadership (F10) among its 10 foundational domains of HI. 41 Health informaticians can thus play the role of visionary, innovator, bridge, facilitator, and evangelist on interprofessional teams. 8 In our experience, one of the most important though undervalued roles informaticians play on teams is the figurative multilinguistic (symphonic) conductor . This entails sufficiently learning each team member's discipline- or profession-specific values, norms, practices, vocabularies, theories, and methods to coordinate and translate between dissimilar members.

Table 1

Project phase

Health informatician involved

No involvement of health informatician

Situation assessment

* Data obtained from health system used to assess the situation
* Simulation and predictive models built to identify most prevalent unsafe medications
* Interviews, surveys, and observations performed to learn patient and clinician information needs and decision-making process

* Key data missing from problem assessment
* Could not prioritize or focus on specific medications
* Clinical priorities emphasized, patient information needs ignored
* Incorrect assumptions made about how individuals make decisions

Solution development

* Solution includes patient- and clinician-facing software changes
* Solution applies rules to target most prevalent unsafe medications
* Decision support solution created using user-centered design and iterative testing
* Solution is interoperable

* Software not part of the solution
* Targeting too many medications leads to untenable solution
* Solution does not conform with usability principles, is not usable or acceptable to end-users
* Solution does not work with existing software and technical infrastructure

Implementation and evaluation

* Intervention deployed and tracked in health system's EHR system
* Medication data mined from EHR, compared pre-post intervention at individual and group levels
* Informatician presents technical and business plans to leadership
* Key organizational and political constraints successfully navigated

* Intervention cannot be deployed to all EHR system users
* Data not available to perform objective pre-post evaluation
* Contradictory technical and business plans written by different individuals
* Failure to consider social (organizational/political) aspects results in unanticipated resistance

A question facing HI and other disciplines is whether teams must include a formally trained HI professional, rather than someone possessing informatics competencies. The answer depends on access to health informaticians, availability of HI training available to noninformaticians, and the ability of the team to cover the breadth of relevant HI competencies described above. For example, a team should not replace a health informatician with a software engineer unfamiliar with the health care domain.

Best Practices for Health Informatician Involvement in Interprofessional Teams

Having argued for the need to recognize and define the role of health informaticians on interprofessional teams, we now turn to best practices for optimizing this role ( ). Our seven suggested best practices were compiled from the literature and our experience with interprofessional collaboration and education. We also illustrate how each best practice was applied in a project addressing the opioid crisis in a university-based IPE course involving students and faculty coaches representing HI, nursing, medicine, art and design, and engineering (see ). The best practices and recommendations apply to HI students, certified clinical informaticians, HI researchers, and other HI professionals.

Table 2

BP1. Adopt the characteristics of effective teams
* Clear vision and goals 43 45
* Mutual respect and shared values 7 41
* Supportive climate 45
* Diverse skill mix across team members 45
* Clear roles and boundaries for each member 43 46 47
* Continuous learning and training 45 48
* Formal process for conflict management 49 50
* Practice performance monitoring and feedback, back-up behavior, and adaptation 51 52

BP2. Practice leadership and followership
* Clearly identify a leader to direct, support, and supervise the team 45
* Leaders should be appointed or quickly emerge 53
* The leader should be credible, honest, competent, able to inspire, and able to focus the team on the vision 41
* The team must understand the importance and roles of leadership in coordinating the team's contributions 54 and achieving its goals 41
* Team members should practice good followership 41
* Use leadership tools, for example, for planning and performance review 50
* A team leader establishes a shared belief in the value of collaboration 55
* Leaders focus, coordinate, and create shared mental models for the team 53

BP3. Clearly communicate with the aid of tools
* Communication success begins with shared understanding, mutual respect, and agreed-upon ground rules 7 41
* Use informatics knowledge to establish effective communication technology and tools 55
* Use communication tools 50 such as SBAR, 56 Call-Out, Check-Back, and Hand-off
* Err on the side of over- rather than under-communication, for example, making sure to include all recipients on e-mails
* Create artifacts to summarize and organize information for shared situation awareness and future reference (e.g., meeting notes, project charters, Gantt charts)

BP4. Design team meetings for effectiveness and efficiency
* Good meetings are a result of careful planning, attention to participants' needs, and follow-through 57
* Use early meetings to establish the team's purpose, goals, members' roles and responsibilities, meeting and reporting plan, deliverables, and timetable 43
* Adopt a team meeting framework and recommendations (see Schleyer et al 43 for detail)
* If possible, organize in-person meetings 55

BP5. Articulate your skills with respect to health informatics
* Explain to teammates the breadth of HI
* Explain to teammates the specialization(s) within HI represented by HI team members
* Act politely and be forgiving when a team member has incorrect assumptions or perceptions of your skills: offer gentle corrections with the goal of educating and enhancing your effectiveness and efficiency in the team
* Inform team members of data needs early in the project lifecycle, to facilitate future access to health care data 58
* Ensure team members' understanding and use of proper terminology and techniques related to health data 58

BP6. Develop skills and knowledge in interprofessional teamwork and domains
* Understand roles and values of all team members 7 41 45
* Interact with and learn from other professions, being attentive to their languages and practices 59
* Seek out interprofessional collaboration and cross-training opportunities before graduation 60
* Establish interprofessional collaborative practice culture and team (not individual) reward systems 30
* Work to improve team skills such as self-assessment of strengths and weakness, listening, and managing shared goals, in addition to gaining domain knowledge 62

BP7. Ensure health informatics education supports interprofessional collaboration
* Align HI professional education with above best practices 47
* Offer opportunities for hands-on health care problem solving in interprofessional teams, using interdisciplinary informatics approaches, with faculty feedback and support 48 50
* Faculty should provide interprofessional opportunities, feedback, and support 48 50 as well as themselves come from different disciplines 61
* Use simulation-based training with real-world scenarios to train HI students for work environment 48
* Partner with campus IPE programs

Table 3

* BP1. Adopt the characteristics of effective teams
○ Faculty divided teams to promote diverse mix of professions and skills
○ Team leader brought team to early consensus on project scope
* BP2. Practice leadership and followership
○ Leader emerged in the first week, with team consensus and faculty coach approval
○ Team leader created the plan, assigned roles and tasks, and held team members accountable
○ Leader communicated with outside stakeholders on behalf of the team
* BP3. Clearly communicate with the aid of tools
○ Teams had regular scheduled meetings face-to-face or using online conferencing system; face-to-face meetings were most effective but more difficult to achieve
○ Teams used online cloud-based storage, for viewing progress and team documents
* BP4. Design team meetings for effectiveness and efficiency
○ Team members agreed to and held each other accountable for regular, in-person meetings of the entire team
○ Team used meetings for updates on progress and updating the plan
○ Team used resources such as white boards and note-taking to support meetings
* BP5. Articulate your skills with respect to health informatics
○ HI team members corrected team members' assumptions when asked to play a role outside their HI specialty
○ HI team members provided team mates with an explanation of HI breadth and their specific skill/knowledge areas
○ HI team members tackled barriers to acquiring data from stakeholders to assess the situation or test an informatics solution
* BP6. Develop skills and knowledge in interprofessional teamwork and domains
○ HI team members spent extra time learning about the practices and assumptions of teammates' professions
○ HI team members had to learn professional and clinical jargon
○ HI team members had to learn the realities of health care delivery, which clinical teammates had gained through hands-on experience
* BP7. Ensure health informatics education supports interprofessional collaboration
○ The IPE course allowed HI students to work with students representing other professions
○ HI students received coaching and education in interprofessionalism, teamwork, and problem solving
○ Diverse faculty, guest judges, and community stakeholders representing multiple professions and disciplines provided a guided learning experience

Best Practice #1 - Adopt the Characteristics of Effective Teams

There are multiple evidence-based accounts of the characteristics of effective teams and how to achieve them, 48 63 64 listed in . Successful teams set goals, monitor each others' performance, balance workload between team members, and adapt to deviations. 52 65 Health informaticians can make teams more effective by increasing the team's skill mix and setting clear expectations for their roles and duties relative to their skills. 43 For instance, a health informatician could take the responsibility for data analysis or management tasks.

Best Practice Implication #2-Practice Leadership and Followership

According to the AMIA's HI core competencies, leadership refers to the "process for which the output is vision, guidance, and direction." 41 Leadership facilitates action, in addition to supporting team psychosocial needs, such as morale, motivation, and confidence. 51 In interprofessional teams, leaders must instill the belief that collaboration adds value. 55 Likewise, a health informatician leader must convince the team of the value and applicability of HI. Leaders often hold others accountable and represent the team to outside stakeholders, meaning HI professionals must learn to interact with decision-makers who are noninformaticians (e.g., avoiding or explaining informatics jargon). HI competencies also dictate practicing followership and supporting leaders from other professions. 41 Although traditionally there is one leader, there is theoretical and practical guidance for shared or distributed leadership approaches. 66 67 Shared leadership may be relevant when the health informatician is in charge of methodological aspects but a clinical professional provides clinical leadership.

Best Practice #3-Clearly Communicate with the Aid of Tools

HI professionals should be skilled in applying the "principles of interprofessional communication in a responsive and responsible manner that supports a team approach." 41 Good communication starts with a common language and shared understanding, which means health informaticians need to learn and respect their teammates' language and professional identities, 55 while carefully selecting which informatics terms and concepts to introduce. Early on, communication can be aided by creating artifacts, such as team charters or social contracts, which explicitly establish expectations for communication, including frequency, method, and what constitutes timely and respectful responses. As team projects move forward, other tools and artifacts become more useful, for example, hand-off procedures, stable communication channels (e.g., mailing lists, chat rooms), and storage space for team documents (e.g., meeting minutes). A health informatician may need to advise on appropriate communication technologies, especially when the communication concerns sensitive patient data, large data sets, or the use of clinical information systems (e.g., internal messaging).

Best Practice #4-Design Team Meetings for Effectiveness and Efficiency

Despite their bad reputation, team meetings can yield irreplaceable benefits with careful planning, attention to participants' needs, and follow-through. 57 In the beginning, well-designed meetings help establish the team's purpose, membership, structure, process, and resources. They are also an opportunity to learn the value of each team member, beyond their professional titles. This is especially important when the team has vague or incorrect knowledge of the HI profession. During the course of project work, meetings provide a forum for reporting progress, planning and replanning, resolving conflict, team brainstorming and feedback, and relationship building. Schleyer et al 43 provide a framework and specific guidance for effective and efficient team meetings for HI professionals, covering topics such as in-person versus electronic meetings, meeting space and technology, the use of agendas and meeting minutes, and meeting procedures.

Best Practice #5-Articulate Your Skills with Respect to Health Informatics

HI is itself interdisciplinary, producing professionals with differing subspecializations and roles. 68 Members of interprofessional health care teams are already dissimilar, 46 47 but health informaticians have an added burden of representing a profession lesser known within the health care community. Specifically, HI has wide-ranging meanings, 69 so team members may have a restricted understanding of their health informatician teammates, leading to misaligned expectations. For example, an informatician may be viewed as a "data person" or "technology person"; these are true of some, but not all. A team member might also have an erroneous understanding of HI, for example, believing informaticians merely provide "programming" or "tech support." The breadth of HI has two implications for interprofessional teamwork. First, an HI professional must be ready to articulate the full extent of HI, for the education of teammates, and the good of the profession. Second, the HI professional must define their personal training, experience, and specialization(s) on the continuum of HI competencies. (Similar considerations apply to working on intraprofessional HI teams.)

A corollary best practice is once the team understands the HI team member's skills, there is an additional challenge of assigning and supporting an appropriate role for him or her. This is facilitated by, for example, the ubiquity of information and IT in health care. However, in our experience, many HI contributions require access to data, and data may not be readily accessible to or understood by the interprofessional team. This may be especially common in limited-resource or educational settings, prohibiting the HI team member from exercising their competencies in data analytics, modeling, and mining. 41 70 Health informaticians are therefore advised to secure as early as possible the resources they need to play their role on the team.

Best Practice #6-Develop Skills and Knowledge in Interprofessional Teamwork and Domains

At the same time, HI professionals need to understand and respect other professions, facilitated by IPE and other interprofessional interactions. 41 71 Another avenue of learning outside the HI profession is cross-training, which can range from experiential learning in "real-world" contexts to reading about outside disciplines. 33 72 This is especially important for those health informaticians who have limited clinical exposure or prior training, and need to work with professionals who have accumulated clinical experience, vocabularies, and assumptions over such a long time that it is implicit (i.e., learned intuition). Health informaticians must therefore learn not only HI skills, but also teamwork and at least the basics of other professions. 59 Similarly, they must find ways to become knowledgeable in their application domains (e.g., pediatrics, decision-making, artificial intelligence), as must their teammates. These recommendations can be addressed in part by involving HI students in IPE offerings.

Best Practice #7-Ensure Health Informatics Education Supports Interprofessional Collaboration

Ensuring HI students are trained in interprofessional collaboration is a natural extension of the preceding best practices and aligned with HI core competencies and foundations. 41 73 HI education should engage students to collaborate with other professionals, solve "real-world" health care challenges, and apply interdisciplinary methodologies. 74 HI programs should strive for both integration with other campus IPE initiatives and creation of living laboratories for hands-on application of HI competencies. 33

Conclusion

The evolution of health care systems encourages-even requires-involving HI expertise in interprofessional health care teams and real-world problem solving. Our present objective is to heighten interest in defining and improving health informatician involvement in interprofessional teams. We encourage others in the discipline to join the conversation, including scientifically validating and applying the above best practices and contributing their own.

Multiple Choice Questions

1. Which of the following statements is the most accurate?

1. Health informaticists add value to interprofessional health care teams, and are always considered members of these teams

2. Health informaticists add value to interprofessional health care teams, but are rarely considered members of these teams

3. Health informaticists do not add value to interprofessional health care teams, and are rarely considered members of these teams

4. Health informaticists do not add value to interprofessional health care teams, unless they are the team leader

Correct Answer: The correct answer is option b, health informaticists add value to interprofessional health care teams, but are rarely considered members of these teams.

2. To be effective as an interprofessional team member, what should a health informatics professional do?

1. Avoid learning the terminologies used by noninformatician team members.

2. Refuse to offer advice on which communication tools to use because it is beneath them.

3. Privately select their own goals and work on only these.

4. Take courses in which they practice working with other professions to solve real-world problems.

Correct Answer: The correct answer is option d, take courses in which they practice working with other professions to solve real-world problems.

Acknowledgments

We thank the participants in the Indiana University interprofessional education course, particularly the students, faculty, guest judges, and community stakeholders. We thank Dr. Julie Poore and Dr. Josette Jones for their review of the manuscript and the journal editor and reviewers for their comments. We thank Dr. Malaz Boustani, who originated the concept of the multilinguistic conductor.

Conflict of Interest None.

Authors' Contributions

All authors (R.J.H., S.B., J.P., S.H.P.V.) contributed to conception, design, drafting, and critical revision.

Protection of Human and Animal Subjects

No human subjects were involved.

a We note some informaticians do provide direct care as trained and licensed physicians, nurses, dentists, pharmacists, therapists, social workers, midwives, etc. Further, as the scope of health professionalism changes, some informaticians who practice in public health, care coordination, or wellness coaching may be thought to provide care. However, our main point is a team member in the domains of health and healthcare can impart value without providing direct care.

b We admit to a mix of amusement and frustration when looked upon as experts at setting up teleconferencing or navigating file storage systems; this is especially so when we are indeed the best on the team at these technical tasks.

References

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Best Practices for Health Informatician Involvement in Interprofessional Health Care Teams

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Academic and nonacademic health informatics (HI) professionals (informaticians) serve on interprofessional health care teams with other professionals, such as physicians, nurses, pharmacists, dentists, and nutritionists. 1 Presently, we argue for investing greater attention to the role health informaticians play on interprofessional teams and the best practices to support this role.

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How it will be used "a common terminology for communication (i.e. sending SNOMED CT codes to other healthcare providers)"
That is one way it will be used. It is very important to have a common terminology so that there's shared understanding across the healthcare system.

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Description

Including SNOMED CT in our GP Practice Management Software for recording and searching.

Location: Mallow, Ireland

Scope

Including SNOMED CT in our GP Practice Management Software for recording and searching.

How SNOMED CT will be used

A standard full coding set that will be used as:

a code system to store clinical information (i.e. storing SNOMED CT identifiers in your patient records)

an indexing system to retrieve clinical information (i.e. to find patient records by mapping to SNOMED CT etc.)

a common terminology for communication (i.e. sending SNOMED CT codes to other healthcare providers)

a dictionary to query, analyse and report (i.e. by mapping to SNOMED CT)

a dictionary to link health records to clinical knowledge resources (i.e. clinical decision support, clinical guidelines, clinical research)

SNOMED CT will be used in the Laboratory Information Management System (LIMS), Radiology, clinical documentation, research, decision support, personal health record and for reporting.

Why SNOMED CT was selected

SNOMED CT has been selected on a national level to be included in GP documentation.

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Including SNOMED CT in our GP Practice Management Software for recording and searching.

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This article goes over the value of interoperability, especially when using TeleMedicine for the aging population. As a nurse practitioner, it will be important to have the most up to date and detailed information. Elderly people tend to have a lot of comorbidities, hospitalizations, surgeries, etc., so it will be useful to have a system that can deliver all of this health information to the provider.

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Can turn a data point into wisdom by incorporating information and knowledge
The life cycle of changing systems
How to incorporate a new EHR system
SDLC- system development life cyle

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As a nurse practitioner, we will be using these codes for medical claims so we can get pai for interventions that are used. There are codes for diagnoses, labs, imaging, medications, and more.

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This article talks about the code for social determinants of health. "These codes allow physicians, hospitals, health systems and payers to better track patient needs and identify solutions to improve the health of communities"

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Recognition of the impact that social determinants of health (SDOH) have on patients’ outcomes is growing, as is the desire to incorporate SDOH factors into patient-care plans. But awareness of an existing data infrastructure that could help physician practices do so is limited.

“The clinical care we provide only accounts for about 50% of the health factors that ultimately determine our health outcomes,” according to Margie Andreae, MD, Michigan Medicine’s chief medical officer of billing compliance. “The other 50% are determined by social determinants of health, making them just as important to address if we want to improve the health of our patients.”

Changes to the evaluation and management (E/M) outpatient and office-visit documentation and Current Procedural Terminology (CPT®) coding guidelines facilitate capturing SDOH data as it relates to the complexity level or length of the office visit, Dr. Andreae said during the CPT and RBRVS 2022 Annual Symposium.

“This is important because payment for the visits will now incorporate the work that is already being performed by many and is now encouraged,” said Dr. Andreae, a member of the AMA/Specialty Society RVS Update Committee (RUC).

With the implementation of 2021 CPT E/M outpatient- and office-visit coding guidelines, the level of the E/M service is now based on either the total time on the date of the encounter or the level of medical decision-making (MDM).

For instance, with use of E/M codes 99204 and 99205, which are used for moderate levels of MDM for a new patient and 99214 and 99215 for established patients, SDOH factors may raise the risk of complications, morbidity or mortality by limiting treatment options and diagnosis capability.

In an example, Dr. Andreae described the case of a young man with a knee injury presenting for an initial evaluation. It’s determined that he should have an MRI and be referred to an orthopaedist and remain nonambulatory until his pain resolves. But he has a low-paying job with no health insurance, so he refuses the MRI and the referral.

“Because you're not able to get the additional data that you would like, this makes your management decisions more complicated and a higher level of risk,” Dr. Andreae explained. “So now you have in your medical decision-making: one undiagnosed new problem with an uncertain diagnosis, which makes this a moderate-level problem complexity.”

Learn how data drives health system effort on social determinants of health.

SDOH? There’s an ICD-10 code for it

In a related presentation, Nelly Leon-Chisen said how an important but seldom-used section of the International Classification of Diseases 10th Revision codes (ICD-10) address SDOH.

ICD-10 Z codes represent subsets of diagnosis codes describing factors influencing health status. Code categories Z55-Z65 identify SDOH.

These codes allow physicians, hospitals, health systems and payers to better track patient needs and identify solutions to improve the health of communities, said Leon-Chisen, the American Hospital Association’s executive director of coding and classification and executive editor coding clinic publications.

The most common of these, according to Centers for Medicare & Medicaid Services (CMS) claims data, is Z59.0 for persons experiencing homelessness. Use of these codes is voluntary and, while CMS and commercial payers have expressed “great interest” in the use of the SDOH codes, they don’t offer financial incentives to do so, Leon-Chisen said.

“There is a great interest on addressing some of these social needs, but—if you don't code it, you can't count it—and it's not showing up in the claims,” she said. “The idea is that, with enough data on specific diagnosis codes, SDOH can eventually be considered to reflect higher severity and intensity of services that will result in additional coverage and reimbursement.”

The most-recent Z-code statistics are from 2017. Of the 33.7 million Medicare fee-for-service beneficiaries, only about 467,000 (1.4%) had claims with Z-code data.

Payers are interested in collecting SDOH information by the simplest way possible—which is claims data, Leon-Chisen said.

“More importantly, for many of us, is the ability to make the case for additional funding or coverage or reimbursement for addressing the social needs that are impacting the health of patients,” she said.

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Social determinants of health and medical coding: What to know

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Social determinants of health data can be incorporated into the CPT coding for E/M office visits. Learn with the AMA how to use it in your practice.

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Project Planning
Analysis and requirements definition
Design
Implementation

Integration and testing

Acceptance

Installation

Deployment

Maintenance

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This video discussing the transition from charting as a hospital RN to using an EHR as a practitioner in a private practice

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How to Choose an EHR for your Private Practice

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Stage 1: Data capture and sharing
Stage 2: Advance clinical processes
Stage 3: Improve clinical processes

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Incentivised program to get providers to buy a government approved EHR and properly implement it by completing their requirements.

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The HITECH Act: Electronic Health Records and Meaningful Use

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Patient health information
Clinical decision support
Computerized provider order entry
E-prescribing
Health information exchange
Patient specific education
Medication reconciliation
Patient electronic access
Secure messaging
Public health

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EMR- all inclusive record that is institution specific and does not interact with outside systems and is provider controlled within the organization
EHR- favored term for a lifetime patient record, it includes data from all specialties, and patients can interact with the system
Clinical Decision Support- process for enhancing health related decision and actions with pertinent, organized clinical knowledge and patient information, to improve health and healthcare delivery

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EHR's can have specialty applications for specific groups. In EPIC, there is a specialty application for maternity so that the nurses can document on both mother and baby, and there is another application for providers who work in the emergency department.

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drug-drug interactions
drug-allergy interactions
pick lists
alerts
links to local policies
documentation templates
relevant data displays
diagnostic decision support tools

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Why do I have to complete a CAPTCHA?

Completing the CAPTCHA proves you are a human and gives you temporary access to the web property.

What can I do to prevent this in the future?

If you are on a personal connection, like at home, you can run an anti-virus scan on your device to make sure it is not infected with malware.

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Another way to prevent getting this page in the future is to use Privacy Pass. You may need to download version 2.0 now from the Chrome Web Store.

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Mayo Clinic, K Health Collaboration Unveils Hypertension Treatment Algorithm

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K Health launched a personalized hypertension treatment algorithm that uses de-identified data from Mayo Clinic to help reduce the time between diagnosis and treatment and improve care overall.

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Artificial intelligence in healthcare: opportunities and challenges | Navid Toosi Saidy | TEDxQUT

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HIE
- securely share patient health information
- more efficient
Datasets
Types of data
- public vs. private

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What is Connie?

is Connecticut's official Health Information Exchange (HIE). An HIE is a safe , confidential way of sharing health information electronically among doctors' offices, hospitals, labs, radiology centers, and other healthcare organizations.

Overseen by an appointed tate of Connecticut. Board of Directors, was established in 2019 to oversee and drive services to support the exchange of health data in the s Connie is an independent, not-for-profit, neutral and trusted organization.

is authorized by state statute and our purpose is to create a platform to support health care delivery, quality, safety, and value for Connecticut healthcare organizations, providers, and residents.

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is Connecticut's official Health Information Exchange (HIE). An HIE is a safe , confidential way of sharing health information electronically among doctors' offices, hospitals, labs, radiology centers, and other healthcare organizations. Overseen by an appointed tate of Connecticut.

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Data- raw numbers collected and stored at level which the unit of analysis was observed
Statistics- analyzed raw data reported in a meaningful way
Metadata- set of data that described and gives information about other data
Ontologies- set of concepts and categories in a subject area or domain that shows their properties and the relations between them

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Using Data to Improve Nursing Home Clinical Care

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Using Data to Improve Nursing Home Clinical Care

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We are excited to be back on the blog beat to share our newest data resource for the research community! We've previously written about how the IMPACT Collaboratory supports embedded pragmatic clinical trials (ePCTs) and demonstration projects to improve the well-being of persons living with dementia and their caregivers.

In response to the coronavirus pandemic, IMPACT Collaboratory researchers developed data sharing and reporting systems to track the effects of the COVID-19 vaccines administered to frail older adults, including people living with dementia. These efforts to strengthen future collaborative and innovative ePCTs have since grown into a new resource full of research opportunities for NIA-funded scientists: the Long-Term Care (LTC) Data Cooperative.

Expanding to evaluate clinical care

Through its LTC Data Cooperative, NIA aims to improve the quality of care in skilled nursing facilities by building one of the largest data collections ever assembled from U.S. nursing homes and their residents. The primary goal - through observational studies or pragmatic randomized trials - is to test the impact of treatments and other interventions intended to better the lives of nursing home residents.

Data Cooperative researchers are using nursing home residents' privacy-protected electronic medical records (EMRs) that can also be linked to Medicare claims data. The Data Cooperative's comprehensive database is helping researchers generate real-world evidence on the effectiveness of different treatments and care practices for older adults, individuals with disabilities, and people living with dementia in nursing homes.

For nursing home residents who are Medicare beneficiaries, this readily accessible EMR data will link with both historical and future Medicare claims data from all other medical care providers. This data set can help pragmatic trial researchers reduce data collection, complex file merging, and the relevant costs, particularly for data such as vital signs, physician orders, and medication administration.

Additionally, the Data Cooperative is supporting public health surveillance by streamlining feedback reports to skilled nursing facilities to assist with care coordination. It also aids the conduct of randomized controlled trials in nursing homes willing to participate in treatment effectiveness studies by boosting the assembly of uniform outcome data from EMRs and long-term follow-up from Medicare data.

Researchers who are planning a trial may want to consider asking nursing home administrators with whom they are working to join the Data Cooperative if they have not already done so. There is no cost to nursing homes to join.

Connect to help us increase the IMPACT

We need your help to grow the use of the LTC Data Cooperative! To get started, visit the LTC Data Cooperative website or email LTCDataCooperative@AHCA.org. The IMPACT Collaboratory website provides additional information about its many other resources and opportunities for engagement, including pilot funding opportunities, grand rounds/podcasts, knowledge repositories, and more.

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Using data to improve nursing home clinical care

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We are excited to be back on the blog beat to share our newest data resource for the research community! We've previously written about how the IMPACT Collaboratory supports embedded pragmatic clinical trials (ePCTs) and demonstration projects to improve the well-being of persons living with dementia and their caregivers.

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One thing this video pointed out is the length of admission assessments and documentation. The questions asked when they arrive to the floor are also asked in the ED, but they are re-asked and re-documented anyways. For example, asking why they are here, allergies, past medical history, medications, etc.

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Essential clinical dataset collaborative initiative reduces nursing documentation

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Telemedicine- use of medical information exchange from one site to another via electronic communications to improve a patient's health status
- primary care health professional
- specialists

Remote patient monitoring- use different devices to collect data and send information to a central location who can identify and assess it

Consumer medical and health information- use of internet for consumers to obtain specialized health information or online discussions in groups or peer to peer support.

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The COVID-19 Telehealth Accelerator | Jack Miner | TEDxTraverseCity

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Gamification- game thinking and mechanics to engage consumers and solve problems

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Build a Healthy Plate- American Diabetes Association
The Diabetic Dog Game
Nanobots Revenge
Sea Heroquest- trying to collect research about dementia

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Mango Health
QuitSTART
Zombies, Run!

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Who needs a smartwatch when you can have a smart tattoo? The tech team at Chaotic Moon Studios, a software design company, has made it possible, though you shouldn't expect any cool flaming skulls or eagles just yet. These temporary wearables work by combining conductive paint with tiny electronic components, creating working circuits on the surface of the skin.
Related: Cyborgs Among Us: Human 'Biohackers' Embed Chips In Their Bodies
A heart rate monitor, thermometer, NFC chip or any number of other sensors could easily be attached -- allowing the tattoo to work either as a fitness tracker, medical wearable, or even a payment system. Imagine checking out at Starbucks by tapping your tattooed bicep to the card reader.

At this early stage the tattoos must be applied by hand, but the company envisions a time when they could be as easy to put on as ordinary temporary tattoos -- just stick on your arm and add a bit of warm water. Put one on before a marathon to track your position, or when you get sick to monitor your temperature, and all the data will be sent wirelessly to an app on your phone.

No word on when we'll actually be able to get these futuristic body mods, but the technology exists. Expect to hear more about these at CES in January.

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'Tech Tats' Use Conductive Ink to Put a Circuit on Your Skin

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Who needs a smartwatch when you can have a smart tattoo? The tech team at Chaotic Moon Studios, a software design company, has made it possible, though you shouldn't expect any cool flaming skulls or eagles just yet. These temporary wearables work by combining conductive paint with tiny electronic components, creating working circuits on the surface of the skin.

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Hopelab’s founding project came to life when co-founder Pam Omidyar was inspired to create a video game that might help young cancer patients with treatment compliance.

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Medical Errors
Overriding
Alerts
Patient portals and personal health records

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Two Minutes: What's the Risk? Alert Fatigue

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Patient Portal vs. Personal Health Record 

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Patient Portal vs. Personal Health Record 

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- Impact clinical care and interrupt workflow

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Appl Clin Inform 2021; 12(03): 528-538
DOI: 10.1055/s-0041-1730031

1   School of Industrial Engineering, Purdue University, West Lafayette, Indiana, United States

1   School of Industrial Engineering, Purdue University, West Lafayette, Indiana, United States

2   Regenstrief Center for Healthcare Engineering, Purdue University, West Lafayette, Indiana, United States

2   Regenstrief Center for Healthcare Engineering, Purdue University, West Lafayette, Indiana, United States

2   Regenstrief Center for Healthcare Engineering, Purdue University, West Lafayette, Indiana, United States

› Author Affiliations Funding This study was partly supported by the Regenstrief Foundation.

Abstract

Background Smart infusion pumps affect workflows as they add alerts and alarms in an information-rich clinical environment where alarm fatigue is already a major concern. An analytic approach is needed to quantify the impact of these alerts and alarms on nursing workflows and patient safety.

Objectives To analyze a detailed infusion dataset from a smart infusion pump system and identify contributing factors for infusion programming alerts, operational alarms, and alarm resolution times.

Methods We analyzed detailed infusion pump data across four hospitals in a health system for up to 1 year. The prevalence of alerts and alarms was grouped by infusion type and a selected list of 32 high-alert medications (HAMs). Logistic regression was used to explore the relationship between a set of risk factors and the occurrence of alerts and alarms. We used nonparametric tests to explore the relationship between alarm resolution times and a subset of predictor variables.

Results The study dataset included 745,641 unique infusions with a total of 3,231,300 infusion events. Overall, 28.7% of all unique infusions had at least one operational alarm, and 2.1% of all unique infusions had at least one programming alert. Alarms averaged two per infusion, whereas at least one alert happened in every 48 unique infusions. Eight percent of alarms took over 4 minutes to resolve. Intravenous fluid infusions had the highest rate of error-state occurrence. HAMs had 1.64 more odds for alerts than the rest of the infusions. On average, HAMs had a higher alert rate than maintenance fluids.

Conclusion Infusion pump alerts and alarms impact clinical care, as alerts and alarms by design interrupt clinical workflow. Our study showcases how hospital system leadership teams can leverage infusion pump informatics to prioritize quality improvement and patient safety initiatives pertaining to infusion practices.

Keywords

smart infusion pumps - analytics - clinical workflows - alerts - alarms

Protection of Human and Animal Subjects

There was no direct patient involvement in this study. The infusion pump data used in this study contained no patient identifier.

Publication History

Received: 14 December 2020

Accepted: 01 April 2021

Article published online:
30 June 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

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Quantifying the Impact of Infusion Alerts and Alarms on Nursing Workflows: A Retrospective Analysis

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Appl Clin Inform 2021; 12(03): 528-538DOI: 10.1055/s-0041-1730031 1   School of Industrial Engineering, Purdue University, West Lafayette, Indiana, United States 1   School of Industrial Engineering, Purdue University, West Lafayette, Indiana, United States 2   Regenstrief Center for Healthcare Engineering, Purdue University, West Lafayette, Indiana, United States 2   Regenstrief Center for Healthcare Engineering, Purdue University, West Lafayette, Indiana, United States 2   Regenstrief Center for Healthcare Engineering, Purdue University, West Lafayette, Indiana, United States › Author Affiliations Funding This study was partly supported by the Regenstrief Foundation.

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Health Insurance Portability and Accountability Act
HIPAA!
The 3 A's- authentication, authorization, and accountability

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The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal law that required the creation of national standards to protect sensitive patient health information from being disclosed without the patient's consent or knowledge. The US Department of Health and Human Services (HHS) issued the HIPAA Privacy Rule to implement the requirements of HIPAA. The HIPAA Security Rule protects a subset of information covered by the Privacy Rule.

HIPAA Privacy Rule

The Privacy Rule standards address the use and disclosure of individuals' health information (known as "protected health information") by entities subject to the Privacy Rule. These individuals and organizations are called "covered entities." The Privacy Rule also contains standards for individuals' rights to understand and control how their health information is used. A major goal of the Privacy Rule is to ensure that individuals' health information is properly protected while allowing the flow of health information needed to provide and promote high quality health care and to protect the public's health and well-being. The Privacy Rule strikes a balance that permits important uses of information while protecting the privacy of people who seek care and healing.

Covered Entities

The following types of individuals and organizations are subject to the Privacy Rule and considered covered entities:

Healthcare providers: Every healthcare provider, regardless of size of practice, who electronically transmits health information in connection with certain transactions. These transactions include claims, benefit eligibility inquiries, referral authorization requests, and other transactions for which HHS has established standards under the HIPAA Transactions Rule.

Health plans: Entities that provide or pay the cost of medical care. Health plans include health, dental, vision, and prescription drug insurers; health maintenance organizations (HMOs); Medicare, Medicaid, Medicare+Choice, and Medicare supplement insurers; and long-term care insurers (excluding nursing home fixed-indemnity policies). Health plans also include employer-sponsored group health plans, government- and church-sponsored health plans, and multi-employer health plans.
Exception: A group health plan with fewer than 50 participants that is administered solely by the employer that established and maintains the plan is not a covered entity.

Healthcare clearinghouses: Entities that process nonstandard information they receive from another entity into a standard (i.e., standard format or data content), or vice versa. In most instances, healthcare clearinghouses will receive individually identifiable health information only when they are providing these processing services to a health plan or healthcare provider as a business associate.

Business associates: A person or organization (other than a member of a covered entity's workforce) using or disclosing individually identifiable health information to perform or provide functions, activities, or services for a covered entity. These functions, activities, or services include claims processing, data analysis, utilization review, and billing.

Permitted Uses and Disclosures

A covered entity is permitted, but not required, to use and disclose protected health information, without an individual's authorization, for the following purposes or situations:

Disclosure to the individual (if the information is required for access or accounting of disclosures, the entity MUST disclose to the individual)

Treatment, payment, and healthcare operations

Opportunity to agree or object to the disclosure of PHI (Informal permission may be obtained by asking the individual outright, or by circumstances that clearly give the individual the opportunity to agree, acquiesce, or object)

Incident to an otherwise permitted use and disclosure

Public interest and benefit activities-The Privacy Rule permits use and disclosure of protected health information, without an individual's authorization or permission, for 12 national priority purposesexternal icon :

1. When required by law

2. Public health activities

3. Victims of abuse or neglect or domestic violence

4. Health oversight activities

5. Judicial and administrative proceedings

6. Law enforcement

7. Functions (such as identification) concerning deceased persons

8. Cadaveric organ, eye, or tissue donation

9. Research, under certain conditions

10. To prevent or lessen a serious threat to health or safety

11. Essential government functions

12. Workers compensation

Limited dataset for research, public health, or healthcare operations

HIPAA Security Rule

While the HIPAA Privacy Rule safeguards protected health information (PHI), the Security Rule protects a subset of information covered by the Privacy Rule. This subset is all individually identifiable health information a covered entity creates, receives, maintains, or transmits in electronic form. This information is called "electronic protected health information" (e-PHI). The Security Rule does not apply to PHI transmitted orally or in writing.

To comply with the HIPAA Security Rule, all covered entities must do the following:

Ensure the confidentiality, integrity, and availability of all electronic protected health information

Detect and safeguard against anticipated threats to the security of the information

Protect against anticipated impermissible uses or disclosures

Certify compliance by their workforce

Covered entities should rely on professional ethics and best judgment when considering requests for these permissive uses and disclosures. The HHS Office for Civil Rights enforces HIPAA rules, and all complaints should be reported to that office. HIPAA violations may result in civil monetary or criminal penalties.

For more information, visit the Department of Health and Human Services HIPAA websiteexternal icon .

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Health Insurance Portability and Accountability Act of 1996 (HIPAA)

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The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal law designed to prevent disclosure of sensitive patient health information without the patient's consent or knowledge. This page describes the types of individuals and organizations subject to the HIPAA Privacy Rule, outlines permitted uses and disclosures of protected health information, and discusses the HIPAA Security Rule.

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Ensure the confidentiality, integrity, and availability of all e-PHI
Detect and safegaurd against anticipated threats to the security of the information
protect against anticipated impermissible uses or disclosures that are not allowed by the rule
certify compliance by their workforce

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Dive Brief:

Two Democratic senators are urging the Biden administration to update the Health Insurance Portability and Accountability Act to prevent health data from being shared with law enforcement agencies targeting people who have an abortion, following the Supreme Court's decision last month to overturn Roe v. Wade, criminalizing the procedure in some U.S. states.

The HHS on Wednesday issued guidance saying providers are not allowed under HIPAA to disclose patient information unless faced with a court order. But regulators have the authority to do more, Sens. Michael Bennet, D-Colo., and Catherine Cortez Masto, D-Nev., wrote in a Friday letter to HHS Secretary Xavier Becerra.

The senators said the HHS should update HIPAA to limit when covered entities can share information on abortion or other reproductive health services, and specifically clarify that information can't be shared with law enforcement pursuing abortion patients.

Dive Insight:

Late last month, the Supreme Court overturned Roe v. Wade, ending decades of settled precedent and the constitutional right to abortion. In the wake of the bombshell decision, dozens of states quickly restricted access to the procedure or banned it outright, resulting in patchwork medical access across the U.S. and a legal quagmire for providers.

The decision has jump-started a nationwide conversation about privacy. In today's age of rampant data proliferation and collection, abortion and digital privacy advocates are concerned individuals' digital footprints could incriminate those who seek access to or information about an abortion online.

As a result, many women have begun deleting menstrual cycle tracking and other health-related apps following the Roe decision, and abortion advocates have warned people seeking the procedure to be wary of their text messages, browser histories, emails and other digital records, which have been used to prosecute pregnancy-related criminal charges. Such data is not protected under health data privacy rules.

The Supreme Court's ruling has also reinvigorated calls for legislation to enact greater data privacy protections, a push that has had bipartisan support in the past.

In the meantime, Masto and Bennet are calling on the HHS to use its existing scope of regulatory power to beef up HIPAA's privacy measures to better protect patients seeking reproductive healthcare. The privacy rule is meant to "define and limit" the circumstances when a person's health data can be used or disclosed by covered entities.

Along with updating the rule to clarify which organizations are covered entities, and limiting when that entity can share information on abortion services, the HHS should clarify that the data can't be shared with law enforcement agencies, the senators wrote.

In addition, the senators urged the HHS to determine that crisis pregnancy centers, which encourage people to carry their pregnancies to term, are required to follow HIPAA's privacy requirements.

"Following the Supreme Court's decision in Dobbs, millions of Americans have lost a fundamental constitutional right to make their own health and reproductive decisions. We must do all that we can to protect their fundamental right to privacy," the senators wrote.

Late last month, the HHS issued guidance finding that data disclosures without patient approval are permitted only in narrow circumstances under HIPAA, including if providers face a court order to comply with state law.

"Where state law does not expressly require such reporting, the Privacy Rule would not permit a disclosure to law enforcement," the HHS said.

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Democratic senators want stricter HIPAA rules to protect abortion patients

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Two Democratic senators are urging the Biden administration to update the Health Insurance Portability and Accountability Act to prevent health data from being shared with law enforcement agencies targeting people who have an abortion, following the Supreme Court's decision last month to overturn Roe v. Wade, criminalizing the procedure in some U.S.

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UPDATE: The 10 Biggest Healthcare Data Breaches of 2020, So Far

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The biggest healthcare data breaches in 2020 have been peppered with ransomware attacks, targeted, sophisticated phishing campaigns, improper patient records’ disposal, and other vulnerabilities.

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Machine Learning- area of computer science that aims to build systems and algorithms that learn from data
Data Mining- the processing and modeling of large amounts of data to discover previously unknown patterns of relationships
Text Mining- data mining to unstructured textual data, the free text fields
Big Data- large and increasing volumes of data that adhere to volume, velocity, variety, and veracity

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Descriptive- standard types of reporting describing current situations and problems
Predictive- simulation and modeling to identify trends of actions taken
Prescriptive- optimizing clinical, financial, and other outcomes

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Making data mean more through storytelling

Can lead to impact and change

https://www.youtube.com/watch?v=6xsvGYIxJok

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Better Medicine Through Machine Learning | Suchi Saria | TEDxBoston

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Data visualization- describes any effort to help people understand the significance of data, by placing it in a visual context
Exploratory analysis- what you do to understand the data
Explanatory- a specific thing you want to explain, a specific story you would like to tell
Question and Clean Data --> draw conclusions
Types of Charts

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Infographic- a visual image to represent information or data
Tips
- chose an interesting title
- include resources and statistics
- promote via social media
- make it easy for readers to engage
- remove clutter

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Crystallize the target data you discovered during the exploratory analysis
Focus on your message
Remember who is your audience
You know more than the audience does
Keep the message clean and to the point
Provide what you have found, not your entire data analysis

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How to Create an Infographic in Powerpoint 

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How to Create an Infographic in Powerpoint 

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How to Create an Infographic in Powerpoint - Part 1

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http://www.bonniegean.com/creating-and-using-infographics-to-command-attention-part-3/ How to Create an Infographic in Powerpoint - Part 1 Using no more than four columns and a template, you can easily design a great looking infographic with Powerpoint. Follow us on Facebook: http://www.Facebook.com/BonnieGeanFans Follow Us on Twitter: http://Twitter.com/BonnieGean Follow Us on Google +: https://plus.google.com/u/0/+BonnieGean

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Ethics- determine what is good or meritorious and which behaviors are desirable or correct in accordance with higher principles
Laws- directly tell us how to behave under various circumstances and prescribe punishments for individuals who do not comply with the law

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Principle of autonomy
Principle of equality and justice
Principle of beneficence
Principle of non-malfeasance
Principle of impossibility
Principle of integrity

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Principle of information-privacy and disposition
Principle of openness
Principle of security
Principle of access
Principle of legitimate infringement
Principle of the least intrusive
Principle of accountability

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Top Five Legal Issues Facing Health Care Employers - Frank Gumina

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A framework for making ethical decisions

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A framework for making ethical decisions

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Students and scholars in the field of Science, Technology and Society (STS) want to know how scientific knowledge is produced. We believe that the idealized accounts of knowledge production entrenched in our scientific belief system are inadequate, given the complexity of the process they claim to describe.

STS scholars seek to understand how science operates by analyzing historical case studies, observing contemporary scientists at work, examining representations of scientific ideas in textbooks or journals and studying the infrastructure of scientific institutions.

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Science, Technology and Society | Brown University

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The interdisciplinary field of Science, Technology and Society brings together anthropologists, philosophers, historians, art historians, literary theorists, sociologists and practicing scientists and technologists.

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Choosing which patients can go on a ventilator

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Minnesota emergency room nurse Cliff Willmeng remembers, during the early days of the pandemic, treating a patient at United Hospital who asked how the nurses were doing. The man was a Vietnam veteran, and Willmeng recalls that he said, ​"This is your war."

"I kind of laughed, like what do you mean by that?" said Willmeng, who recalled he didn't grasp at the time how horrible the pandemic would become. ​"He said, ​'We dealt with this in Vietnam. You don't know it yet but none of you are ever going to be the same again.'"

More than two years later, Willmeng, like countless other nurses and frontline workers nationwide, knows all too well how true those words turned out to be.

In recent years, academics and frontline workers have used the terms ​"moral injury" and ​"moral distress" to describe the debilitating combination of anxiety, fear, guilt, shame, anger and betrayal that results when workers like nurses are thrust into life-or-death situations without the resources and support structures to carry out the mission they've committed to.

The term ​"moral injury" was coined by former U.S. Department of Veteran Affairs psychiatrist Jonathan Shay based on his work with Vietnam veterans, as explained in a December 2020 white paper by the National Nurses United (NNU) union. Moral injury involves the ​"deleterious long-term, emotional, psychological, behavioral, spiritual, and/​or social effects" of ​"perpetrating or failing to prevent acts that transgress deeply held moral beliefs and expectations in a high-stakes environment," the paper notes.

Nurses describe deep parallels between the experiences of veterans who are thrust into horrifying conflicts, left to fend for themselves and forced to make painful choices by corrupt or absent leadership - then blamed or punished for their actions.

Academic studies explain that moral injury is closely related to post-traumatic stress disorder, and can be a significant factor in veterans, emergency workers and others developing PTSD, as a number of studies have shown. It is not listed in the Diagnostic and Statical Manual related to mental illness, and moral injury is not considered to be a mental illness or to directly cause mental illness. This is in part because there is some ambiguity in defining exactly what moral injury entails, as it involves philosophical, social and ethical, as well as psychological, questions, which an article the British Journal of Psychiatry and other journals have explained.

In military situations, an individual can experience moral injury when they are forced to harm civilians or take unjustified military actions, and the emotional and mental impacts are worsened in situations like the Vietnam War, where veterans face blame and hostility from the general public, or situations like the Iraq War, where the general public is largely unaware of what the veterans have been through, studies note. Nurses report a dynamic that has some parallels: They don't have the resources to serve their patients well, but hospital administrators blame them for failings or don't acknowledge the extreme conditions they are working under. And where patients often treat them with hostility or even violence.

During the pandemic, experiences causing moral injury ranged from having to choose which patients got ventilators, to not being able to check in on Covid-19 patients regularly in order to minimize risk of transmission.

Elizabeth Lalasz, a registered nurse and NNU steward at Chicago's public hospital, explains that the burn-out, depression, stress and anxiety that nurses face has typically been framed as an individual experience, rather than a systemic injustice caused by a broken healthcare system driven by the bottom line.

In 2021, the United States ranked last among high-wealth countries in the quality of its healthcare system, despite spending the highest amount of these countries on healthcare. Countries with much better healthcare systems provide universal coverage so that finances don't prevent people from accessing healthcare, and money was not wasted on administrative burdens or siphoned off to insurance companies and massive profit for private healthcare companies.

Lalasz noted that the pandemic just exacerbated and laid bare longstanding problems with the healthcare system, including lack of access for poor people, and private - and cash-strapped public - healthcare systems trying to save money or maximize profit by not investing adequately in staffing and resources.

"We do this with the intention of trying to help and save lives," said Lalasz, who worked three stints in Covid-19 wards and contracted the disease herself, missing 18 days of work. ​"If you're not able to have what you need to be able to do that, it's systemic. All these things existed prior to the Covid-19 pandemic, but that really brought it to a head."

She said nurses like herself who contracted Covid-19 felt management was ​"minimizing" their experiences and their concerns, and ​"gaslighting" them into thinking they just had to toughen up.

During the pandemic, healthcare workers faced guilt and anxiety about bringing Covid-19 home to their families, on top of the trauma of being unable to adequately care for patients and fearing for their own lives. Meanwhile, workers had to fight and fundraise just to get the basic PPE that could help protect them and their patients and communities - a recipe for moral injury.

As the pandemic has evolved and become slightly less of an acute crisis, the behavior of healthcare institution management has accelerated a nursing shortage that has become its own crisis. Hundreds of thousands of healthcare workers have retired or otherwise left the profession during the pandemic. Meanwhile, thousands of nurses have left staff jobs - often unionized - to work as gig-worker ​"travel nurses" earning much higher hourly pay but without collective bargaining rights or job security.

A recent report by McKinsey & Company estimates the United States could face a nursing shortage of 200,000 to 450,000 available nurses - 10% to 20% fewer than needed - by 2025. A November 2021 industry study found that 90% of nurses surveyed are considering leaving the profession, citing burnout, staff shortages and unmanageable workloads as key reasons.

The nursing shortage makes conditions more stressful and dangerous for those who stay in the profession, creating an intense negative feedback loop rife with the potential for continued moral injury.

This cycle is also exacerbated when nurses leave unionized staff jobs to become traveling nurses with much higher pay but no job security, collective organizing rights or sense of permanency with their patients and community. In keeping with the cycle of blame and guilt typical of moral injury, traveling nurses have been criticized for taking high pay and abandoning their staff posts, when the underlying problem is hospitals' failure to create physically and morally sustainable staff jobs.

"There's not a shortage of nurses," said Lalasz. ​"There's a shortage of nurses who want to work under these conditions." She argued that the system takes advantage of the workforce made up largely of women, disproportionately women of color, assuming they will be willing to do the work without adequate protection or compensation. ​"It's like, ​'You're caring, you'll do this.' We're done with that. That's why people have gone [into] traveling [jobs]. The working conditions are so bad, the staffing is so horrendous, you're not respecting us, so we're done."

Especially at a ​"safety net" hospital like Chicago's John H. Stroger, Jr. Hospital of Cook County where Lalasz works, Lalasz notes, it's important to have staff nurses who understand the needs and deep vulnerability of their patients - like the people incarcerated in the county jail whom she treated early in the pandemic.

Ironically, the shift to travel nursing undermines the very organized labor system that is more necessary than ever in a time of crisis. Organizers stress that they want to identify and explain the concept of moral injury so that healthcare workers channel their trauma into organizing rather than turning inward or dropping out. The NNU white paper cites trauma experts saying that:

Those who experience moral injury as a perpetrator of an immoral act or from failing to prevent an immoral act typically respond with internalizing emotions such as guilt and shame, whereas those who experience moral injury as a witness who was unable to prevent an immoral act typically respond with externalizing emotions such as anger and resentment. It is crucial that those involved ascribe the blame to the responsible actor(s) and not inappropriately take responsibility for failing to prevent a transgression, if that was not in their power. Anger and resentment are more likely to lead to the collective action necessary to redress transgressions by authoritative leaders or institutions while emotions such as shame and guilt may lead to withdrawal.

Willmeng is disappointed that healthcare unions didn't do more to assert their rights and demand changes from the industry during the height of the pandemic. As NNU and other healthcare unions have reiterated, higher levels of unionization and a meaningful role for healthcare workers in making decisions about resource allocation and strategy would go a long way to providing better healthcare for patients and making the profession tolerable for workers. Ultimately, NNU and countless individual healthcare workers and leaders say that universal healthcare would vastly improve patient care, allowing access for people regardless of income and eliminating the profit motive that causes private hospitals and insurance companies to ration care and skimp on resources. A recent study published in the journal Proceedings of the National Academy of Sciences found that universal healthcare would have meant 338,000 fewer people dying of Covid-19.

Willmeng feels that now unions are better marshaling their forces, with Minnesota nurses threatening a statewide strike as multiple contracts for 15,000 nurses are in negotiations. In early June, nurses picketed at 11 Twin Cities-area hospitals, highlighting stratospheric executive pay even as nurses struggle with debilitating understaffing and Republican legislators killed a bill that would involve nurses in staffing plans and provide loan forgiveness for hospital nurses.

"U.S. capitalism is calling you essential, and you parlay that into what? We failed to rise to a major historical event - we're trying to put the pieces back together again now," said Willmeng, who started his current emergency room job hours after the union contract expired. He was fired by a different hospital during the pandemic for wearing hospital-issued scrubs, rather than his own, since he didn't want the extra contagion risk of bringing scrubs home. He was later reinstated and settled a wrongful termination lawsuit.

In late June, Chicago hosted the Labor Notes international convention of union members and activists, a gathering of progressive rank-and-file union members and leaders and labor activists from the United States and other countries. Much attention was focused on the need for mental healthcare for frontline workers.

Elizabeth White, a therapist in Kaiser Permanente's California system that serves many public union members, described the difficulty of getting crucial mental health appointments for her clients - and the toll that takes on therapists themselves.

​"You're basically always playing a game of Twister, twisting things to try to make it work for people," she said. ​"We want to do the right thing for our patients, and the employers take our good intentions and exploit that. That's the moral injustice."

During one Labor Notes session, nurses and other healthcare workers packed a large ballroom to speak out about their experiences, frequently mentioning moral injury and sharing their tactics for survival and organizing.

Marty Harrison is a staff registered nurse at Temple University's hospital in Philadelphia, serving among the country's poorest zip codes, where patients typically have multiple underlying conditions and complex problems.

She and others said that the hemorrhaging of staff nurses has obliterated the mentoring and organizing networks that used to exist for young nurses. ​"They're not letting new nurses even know what quality care would be," she said.

New nurses often leave the field or move to traveling jobs quickly, she and others said, overwhelmed by the lack of support and depth of dysfunction. While healthcare workers at Labor Notes said they understand that reaction, they hope their colleagues will turn their feelings of moral injury and distress into organizing.

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Nurses in the U.S. Are Suffering "Moral Injury"

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Minnesota emergency room nurse Cliff Willmeng remembers, during the early days of the pandemic, treating a patient at United Hospital who asked how the nurses were doing. The man was a Vietnam veteran, and Willmeng recalls that he said, ​"This is your war." "I kind of laughed, like what do you mean by that?"