C O N T E N T ?

UNIT 1 BACKGROUND AND ACE Star Model of Knowledge Transformation, 43

FOUNDATIONAL Point I: Discovery Research, 44 Point 2: ~videnc; Summary, 44 Point 3: Translation to Guidelines, 46

1 Introduction: The Evolution of Health Informatics, 2 Ramona Nelson

Introduction, 2 The Roots of Informatics within the Computer and Information Sciences, 3

Computer Science, 3 Information Science, 3 Health Informatics, 4

Establishing the Specialty of Health Informatics, 5

Books, 5 Journals, 6 Professional Organizations, 7 Educational Programs, 9 Certification, 10

Recognition of the Specialty, 12 Naming the Specialty-Naming the Discipline, 13 Conclusion and Future Directions, 16

2 Theoretical Foundations of Health Informatics, 18 Ramona Nelson and Nancy Staggers

Introduction, 19 Theories and Models Underlying Health Informatics, 20

Systems Theory, 20 Chaos Theory, 23 Complexity Theory, 24 Information Theory, 25 Learning Theory, 29 Change Theory, 32

The Systems Life Cycle Model, 35 Staggers and Nelson Systems Life Cycle Model (SLCM), 35

Additional Informatics-Related Models, 37 Conclusion and Future Directjons, 38 ,

3 Evidence-Based Practice andl Infor,matila, 40 Kathleen R. Stevens and Sandra A. Mitchell

Introduction, 40 I

Evidence-Based Practice (EBP) Models, 42

Point 4: Practice Integration, 48 Point 5: Evaluation, 50

Conclusion and Future Directions, 51 4 Knowledge Discovery, Data Mining, and

Pradice-Based Evidence, 54 Mollie R. Cummins Ginette A. Pepper, and Susan D. Horn

Introduction, 54 Research Designs for Knowledge Discovery, 55 EHRs and Knowledge Discovery, 55 Knowledge Building Using Health IT, 56

Knowledge Discovery and Data Mining, 56 Retriwing a Dataset for Analysis, 57 Sampling and Partitioning, 59 Data Mining, 61 Evaluating Data Mining Models, 61

Practice-Based Evidence, 62 PBE Features and Challenges, 62 Steps in a PBE Study, 64 Limitations and Strengths of PBE Studies, 68

Conclusion and Future Directions, 68 5 Program Evaluation and Research

Techniques, 72 Charlene R. Weir

Introduction, 72 Purposes of Evaluation, 73

Formative versus Summative Evaluation, 73 Generalizability and Scope, 74 Program Continuance versus Growth, 74

Theories and Frameworks, 74 Social Science Theories, 75 Information Technology Theories, 76 Program Implementation Models, 77 Program Theory Models, 79

Methods, Tools, and Techniques, 80 Quantitative versus Qualitative Questions, 80 Qualitative Methods, 80 Quantitative Methods, 82 Instruments, 82

Conclusion and Future Directions, 83

CONTENTS

UNIT 2 INFORMATION SYSTEMS 1 7 Applications for Managing Institutions

IN HEALTHCARE ' Delivering Healthcare, 106

DELIVERY Michael H. Kennedy, Kathy H. Wood and Gerald R. Ledlow

J

6 Electronic Health Records and Applications for Managing Patient Care, 87 Charlotte Seckman

Introduction, 87 Early Terms and Dejinitions, 88 Electronic Medical Record (EMR) versus Electronic Health Record (EHR), 88

EHR Components, Functions, and Attributes, 89 Sociotechnical Perspectives, 89

EHR Adoption, 89 Meaningful Use, 89 EMR Adoption Model, 91 Health Practitioner Role in EHR Adoption and Meaningful Use, 91

EHR Applications Used in the Clinical Setting, 92

Computerized Provider Order Entry (CPOE), 92 Electronic Medication Administration Record ( e m ) , 93 Bar Code Medication Administration (BCMA), 93 Clinical Documentation, 94 Specialty Applications, 95 Clinical Decision Support (CDS), 95 Ancillary Systems, 95

EHR Benefits, 96 cost, 97 Access, 97 Quality, Safety, and Eficiency of Care Delivery, 97

Stakeholder Perspectives, 97 Consumers, 97 Nurses, 97 Healthcare Providers, 98 Healthcare Organizations, 98 Insurance Payers, 98 State and National Governments, 98

Key Issues, 99 cost, 99 Ownership, 99 Data Integrity, 99 Privacy and Confzdentiality, 100 Standards, 100 Organizational Culture, 100 Human Factors, 100

Conclusion and Future Directions, 101

Introduction, 106 Vendor Resource Guides, 107

Major Types of Applications, 107 Financial Systems, 107 Practice Management Systems, 1 14 Materials Management, 115 Human Resources Information Systems, 11 8 Business Intelligence Systems, 121

Conclusion and Future Directions, 122 8 Telehealth and Applications for Delivering Care

at a Distance, 125 Loretta Schlachta-Fairchild, Mitra Rocca, Vicky Elfiink Cordi, Andrea Haught, Diane Castelli, Kathleen MacMahon, Dianna Vice-Pasch, Daniel A. Nagel, and Antonia Arnaert

Introduction, 125 Examples of Successsf1 Telehealth Programs, 126 Telehealth Historic Milestones, 127 Leading Telehealth Organizations, 127

Telehealth Technologies, 128 Synchronous or "Real-Time" Technologies, 128 Asynchronous or "Store-and-Forward" Technology, 130 Technical Standards in Telehealth, 130

Telehealth Clinical Practice Considerations for Healthcare Professionals, 130

Equal to or Better Than In-Person Care?, 130 Telehealth Clinical Competency, 131 Confidentiality, Privacy, and Informed Patients, 131 Scope of Clinical Practice, 132 Types of Clinical Telehealth Applications, 132

Telehealth Operational and Organizational Success Factors and Barriers, 132

B.E.L. T. Framework, 132 Operationalizing Telehealth, 133 Telehealth Acceptance and Training, 133 Telehealth Implementation, 134

Telehealth Challenges: Licensure and Regulatory Issues for Healthcare Professionals, 135

Licensure, 136 Credentialing and Privileging, 137

Reimbursement, 138 Malpractice and Liability, 138

Telehealth and Direct Patient Health Services, 138

Patient-to-Provider Telehealth-Delivered Care, 138 Remote Telehealth Home Visits and Biosensors, 139 Telehealth Technology and Healthcare Consumers, 140

Conclusion and Future Directions, 141 Telehealth Industry Growth, 142 Telehealth to uHealth, 142 Improve Healthcare Provider Shortages and Access to Care, 142

9 Home Health and Related Community-Based Systems, 147 Karen S. Martin and Karen B. Utterback

Introduction, 147 Evolution and Milestones, 148 Practice Models, 148

Home Health, 148 Palliative Care and Hospice, 149 Public Health, 149 Nurse-Managed Health Centers, 149 Other Practice Sites, 149 Similarities among Practice Models, 149

Standardized Datasets, 150 Outcome and Assessment Information Set (OASIS), 151 Continuity Assessment Record and Evaluation (CARE) Tool, 151 Hospice Quality Measures, 151 Patient Experience Surveys, 151

Supporting Home Health with Electronic Health Records and Health Information Technology, 151

Billing Solutions, 152 Point-of-Care Solutions, 152 Clinical Decision Support (CDS) Systems, 153

Standardized Terminologies, 153 Omaha System, 154

Description, 154 Clinical Example from Practice, 158

Conclusion and Future Directions, 161 10 Clinical Decision Support Systems in

Healthcare, 164 Kensaku Kawamoto and Guilherme Del Fiol

Introduction, 164 Definition of CDS, 165 History, 165

CDS Types and Examples, 166

Medication Dosing Support, 166 Order Facilitators, 166 Point-of-Care Alerts and Reminders, 167 Relevant Information Display, 167 Expert Systems, 169 Workflow Support, 170

CDS Impact, 170 Evidence of Efiectiveness, 170 Examples of CDS Impact Studies, 170 Financial Impact of CDS, 171 CDS Adoption, 171 Challenges and Barriers to CDS Adoption, 171

CDS Best Practices, 172 Recent Progress toward Disseminating CDS on a National Level, 173

Value-Based Payment Models, 173 Meaningful Use Incentives for EHR and CDS Adoption, 173 Statewide Health Information Exchanges, 173 CDS Standards, 173 National CDS and Knowledge Management Initiatives, 173 Open Source, Freely Available Resources, 174

Research Challenges, 174 Conclusion and Future Directions, 174

1 1 Public Health Informatics, 178 Catherine Junes Staes, Marisa Wilson, and Leslie Lenert

Introduction, 179 Public Health: A Population Perspective, 179

Social and Political Challenges That Afiect Public Health Informatics, 183 Sociological Context of Public Health, 183

The Value of Informatics for the Domain of Public Health, 185

Surveillance, 185 Immunization Information Systems, 187 Health Information Exchange, 189 Public Health Reporting, 189

Conclusions and Future Public Health Informatics Strategies, 192

Transforming Practice with New Strategies, 192 Advancing the Technical Infrastructure, 193

12 Technical Infrastructure to Support Healthcare, 197 Scott I? Narus

Introduction, 197 EHR Component Model, 197

Clinical Data Repository, I98

L CONTENTS

Master Person Index, 199 Clinical Applications, 200 Data Dictionary, 201 Knowledge Base, 202 Clinical Decision Support System, 202

System Integration and Interoperability, 203 Interface Engine, 2d3 Interoperabiliv Standards, 203

Networking Systems, 204 RHlOs, HIES, and HIOs, 204 Nationwide Health Information Network (NwHIN), 205

Other Infrastructure Models, 205 Application Service Provider, 205 Cloud Computing, 205

Current Challenges, 206 Conclusion and Future Directions, 206

Mobile Apps, 207 Sewice-Oriented Architecture, 207 Open Source Software, 208 SMART, 208

PARTICIPATOR HEALTHCARE INFORMATICS

13 The Evolving ePatient, 2 12 Sally Okun and Christine A. Caligtan

Historical Background and Drivers of the ePatient Evolution, 212

ePatient as a Pioneering Concept, 212 Technology, Policy, and Legislative Influences, 213 Characteristics of Online Healthcare Consumers, 216

Convergence of epatients, Clinicians, Patient-Centered Models of Care, and Informatics, 2 17

Participatory Patient-Centered Healthcare, 217 The New Role of Clinicians and Informaticists in epatient Care, 218 Health Informatics and epatients, 219 Personal Health Records, Transparency, and Access to Data, 21 9

Evolution of Health 2.0 and Beyond, 220

Health 2.0 Environment, 220

Health 2.0 and the Creation of Virtual Patient Communities, 220

Conclusion and Future Directions, 221 Moving toward Health 3.4221

14 Social Networking and Other Web-Based Applications in Healthcare, 225 Diane J. Skiba, Paul Guillory, and Elizabeth S. Dickson

What Is Social Media?, 225 Social Media Tools, 226

Social Networking, 226 Blogging and Wikis, 227 Microblogging (Ilkitter), 227 Social Bookmarking, 227 User-Generated Content, 227

Social Media Statistics, 228 Benefits of Social Media, 228 Challenges of Social Media, 229

Privacy and Conjidentiality, 229 Inappropriate Behaviors, 230 Security, 231 Regulatory Issues, 232 Market Pressure, 233

Poky, 234 Guidelines for Writing Policies, 234

Resources for Policy Development, 235 Conclusion and Future Directions, 235

15 Personal Health Records (PHRs), 244 Bryan Gibson

Definitions of the Personal Health Record, 244 The Development of the Electronic Personal Health Record, 245 Principles of an Ideal Personal Health Record, 247

Proposed Benejits of an Ideal PHR, 248 m e s of Personal Health Records, 248 Examples of Existing Personal Health Records, 248 Current Evidence of Benefits of PHR Use, 250

Experience of Care, 250 Quality of Care, 250 Cost and Utilization, 251

Current PHR Use, 25 1 Barriers to PHR Adoption, 251

Awareness, 251 Usability, 252 Privacy Concerns, 252 The Digital Divide, 252 Interoperability, 252 Law and Policy, 252

Conclusion and Future Directions, 253

I'

+ - - - UNIT 4 PROJECT MANAGEMENT:

TOOLS AND -- - PROCEDURES

ppppp -

16 Identifying and Selecting an hformation System Solution, 258, Cynthia M. Mascara and Mica1 DeBrow

Introduction, 258 Strategic Vision and Alignment, 258 Systems Development Life Cycle, 260

Analysis and Requirements Dejinition, 260 Project Planning, 264 Develop or Purchase, 265

1 Conclusion and Future Directions, 268 17 Implementing and Upgrading an Information

System Solution, 271 Christine D. Meyer

Introduction, 271 Reasons to Implement or Upgrade a Healthcare Information System, 272

New Implementation versus an Upgrade, 276

L, Decision Factors to Implement or Upgrade a System, 276

Implementation and the Systems Life Cycle, 278

Project Planning, 278 . , Preparing for Go-Live, 284

Big Bang or Incremental Go-Lives, 284 Detailed Go-Live Plan, 285 Education and Training, 285

Go-Live, 286 Postlive Maintenance, 287 Conclusion and Future Directions, 287

Health Information Systems: Downtime and Disaster Recovery, 290 Nancy C. Brazelton and Ann Lyons

Introduction, 290 Downtime Risk Assessment, 291 Downtime and Response Planning, 295

Clinical Impact and Planning: Acute Care

a Focus, 298 Redundant Systems, 299

Downtime Policies and Procedures, 300 IT Impact and Planning, 300 Disaster Planning, 300

Disaster Recovery, 302 Business Continuity, 302 Communication, 302 Responsibilities, 303

Conclusion and Future Directions, 303

UNIT 5 QUALITY, USABILITY, AND STANDARDS IN INFORMATICS

- - . - . -- - - -. - - - - - - --

19 Pnvacy, Confidentiality, Security, and Data Integrity, 307 Nancy Staggers, Lisa Gallagher, Luciana Schleder Gonqalves, and Ramona Nelson

Introduction, 307 Definitions and Concepts, 308 Legal and Historical Context, 308

Caregiver Requirements, 308 Patient Rights, 308 Fair Information Practice Principles, 309 Code of Ethics for Health Informatics Professionals, 309

Principles, Laws, and Regulations Guiding Practice, 309

National Privacy and Security Framework for Health Information, 31 1 Laws and Regulations, 31 1 Secondary Uses of Electronic Health Data, 313

The Importance of Information Security, 314 The Public Trust, 314 Legal Requirements and Fines, 314 Increasing Security Threats to Healthcare Data, 31 6 Recent Changes in Health Data Practices, 3 16

Current Security Vulnerabilities, 3 16 External Events, 31 6 Internal Vulnerabilities, 31 6

Current Security Challenges, 317 Managing Security Risks with Security Controls, 317

Administrative, 31 7 Technical, 318 Physical, 31 9

Resources, 3 19 Conclusion and Future Directions, 320

20 Patient Safety and Quality Initiatives in Informatics, 323 Patricia C. Dykes and Kumiko Ohashi

Introduction, 323 Dejinitions, 324 National Initiatives Driving Adoption and Use of Health IT, 324 National EfjCorts Related to Quality Data Standards, 324

Evaluating Quality and Patient Safety, 327

CONTENTS

Conceptual Framework for Patient Safety and Quality, 327 Medication Safety, 328 Chronic Illness Screening and Management, 329 Nursing Sensitive Quality Outcomes: Patient Falls qnd Pressure Ulcers, 329

Success Factors and Lessons Learned, 330 Conclusion and Future Directions, 330

Improving the User Experience for Health Information Technology Products, 334 Nancy Staggers

Introduction to Improving the User Experience, 335

The Current User Experience with Health IT Products, 335 Potential Benejits of Improving the User Experience, 335

Definitions of Terms and Their Relationships, 337

User Experience, 337 Human Factors, 337 Ergonomics, 337 Human-Computer Interaction, 338 Usability, 338

The Goals of Usability, 338 User-Centered Design, 338 Human-Computer Interaction Frameworks for Health Informatics, 339

Human-Computer Interaction Frameworks, 339 The Health Human-Computer Interaction Framework, 339 Essential Components for Improving the User Experience, 339

Selecting Methods to Improve the User Experience, 340

Discount Usability Methods, 340 Traditional Usability Methods, 341

Usability Measures and Tests, 343 Usability Questionnaires, 343

Selecting a Type of Usability Test, 343 Determining User Needs and Requirements, 343 Exploratory Test, 345 Assessment Test, 345 Validation Test, 345 Comparison Study, 346 Identifling Usability Issues with Fielded Products, 346 Steps for Conducting Usability Tests, 346

Conclusion and Future Directions, 347

Standards, 351 1

Tae Youn Kim and Susan A. Matney Introduction, 352 Healthcare Data Standardization, 352

Dejinitions, 352 Evaluation of the Quality of Terminology, 353 Multidisciplinary Terminologies, 354 Nursing Terminologies, 359

Data Exchange Efforts, 363 HL7 Standards, 363 Terminology Harmonization, 363

Application of Standardized Terminologies, 363

Designing User Interface Using Terminologies, 364 Supporting Data Retrieval and Exchange, 364 Monitoring the Quality of Care, 365 Discovering Knowledge through Research, 365

Conclusion and Future Directions, 365

UNIT 6 GOVERNANCE AND ORGANIZATIONAL STRUCTURES FOR

23 Health Information Technology Governance, 371 Jim Turnbull and Kensaku Kawamoto

Introduction, 371 Health IT Governance: Need and Core Components, 371 Key Insights, 372

Respect Current Decision-Making Structures, 372 Shift in Organizational Mindset, 373 The Continual Increase in Demand for Health IT, 373 Governance Does Not Depend on Specific Technology Choices, 373 Coordination and Collaboration with Diverse Stakeholders, 373

Recommendations, 373 Conduct a Health IT Capability Maturity Assessment, 374 Investigate Peer Informatics Governance Models, 374

CONTENTS

Design, Implement, and Iteratively Enhance Informatics Governance, 375

: Gonclusion and Future Directions, 376 t Zegal Issues, Federal Regulations, and

Accreditation, 377 Michele Person Madison

Introduction, 377 Federal Initiatives to Drive Health IT, 378

Executive Order 13335,378 The American Recovery and Reinvestment Act of 2009,378

tederal Financial Incentives, 379 Eligible Entities and Eligible Professionals, 380 Medicare and Medicaid Payments, 380 Meaningful Use, 380

HIPAA Security Rule and Privacy Rules, 386 Administrative Safeguards, 386 Physical Safeguards, 389 Technical Safeguards, 389 Business Associates, 390 Breach and Notification, 391 Patient Rights, 391

Enhanced Penalties, 392 Federal Self-Referral Laws, 392

Anti-Kickback Statute, 392 Accreditation Standards, 393 Conclusion and Future Directions, 394

alth Policy and Informatics, 397 ce Sensmeier and Judy Murphy Introduction, 397 Key Health Policy Issues for Informatics, 398

EHR Adoption, 398 Patient Safety, 400

Impact of Informatics on Health Policy, 401 Meaningful "Meaningfil Use," 401 Quality Initiatives, 401

Process of Developing and Implementing Informatics Policy, 402

Ensuring That Health Practitioners Are Positioned on Key Committees and Boards, 402 Providing Expert Testimony, 402 Responding to Requests for Comments, 403 Developing Position Statements, 403

Leading Policy Activities through Organizational Work and Leadership, 403

Strategies, 403 Discipline-Specific Policies: Nursing, 404

Use of Health IT to Advance the Future of Nursing, 405

Conclusion and Future Directions, 406

EIUCATION AND '.

INFORMATICS w* ' :

26 Informatics in the Curriculum for Healthcare Professionals, 41 1 Helen B. Connors, Judith J. Warren, and E. LaVerne Manos

Introduction and Background, 41 1 Overview of Informatics and Health Information Technology, 41 1 Education Reform Initiatives, 412 Challenges of Technology-Enhanced Education, 414

Teaching and Learning in an Evolving Healthcare and Technology Environment, 414

The Role of Informatics i n the Curriculum, 41 4 The Science of Informatics and Curriculum Design, 415

Framework for Informatics Curriculum, 415 Pedagogy, 41 5 Teaching Tools and Learning Strategies, 41 6

It Takes a Village: Roles and Competencies, 416

Educating the Generalist, 418 Educating Healthcare Specialists at the Graduate Level, 418 Educating the Informatics Specialist, 421 Educating the Informatics Researcher and Innovator, 421 Continuing Professional Development, 421

Conclusion and Future Directions, 421 27 Distance Education: Applications, Techniques,

and Issues, 424 Irene Joos

Introduction, 424 Historical Development, 425 Evolving Terms, 426 Course Management Systems (CMSs): Major Vendors and Players, 428

Campus-Based Portals, 428 Proprietary CMSs and LMSs, 429 Open Source, 430 Partnerships, 431 Selection Criteria and Role of the Faculty, 431 The Future of CMS, 432

Instructional Design for Distance Education and Learning, 432

Learners and How They Learn, 432

CONTENTS

Goals and Objectives (Outcomes), 433 Instructional and Learner Activities, 433 Evaluation, 433

Student (Learner) Support Services, 433 Library, 433 Tutoring Services, 434 Online Twctbook Distributors, 434 Help Desk, 434 Administrative Services, Academic Support, and Community Building, 435

Issues, 435 Legal, 435 Disability Issues, 437 Quality, 438 Readiness, 438

Conclusion and Future Directions, 439 28 Informatics Tools for Educating Health

Professionals, 442 W Scott Erdley and Kay M. Sackett

Introduction, 442 Comprehensive Education Information System (CEIS), 443 Computerized Teaching Tools, 444

Hardware, 444 Educational Sofhuare, 447

Impact on the Teaching and Learning Process, 450

National and International Perspectives on Education, 450

Impact on the Faculty Role, 450 Conclusion and Future Directions, 451

29 Simulation in Healthcare Education, 454 Valerie Howard, Kim Leighton, and Teresa Gore

Introduction, 454 Types of Simulations, 455 Fidelity, 455 Benefits of Simulation, 456 Challenges and Opportunities, 457

The Simulation Process, 459 Learning Theories Applied to Simulation, 459 Summary of Standards of Best Practice: Simulation, 460 Standards and Their Application to the Simulation Process, 460

Application of Simulation, 462 General Application of Simulation to Education, 462

Application of Simulation to Interprofessional Education, 462 Example, 463

Simulation Resources, 465

Organizaf ions, 465 Leaders, 465

Conclusion and Future Directions, 468

UNIT 8 INTERNATIONAL U

INFORMATICS EFFORTS

30 International Efforts, Issues, and Innovations, 473 Hyeoun-Ae Park

Introduction, 473 Key Initiatives in World Regions, 474

eHealth Initiatives in Europe, 474 eHealth Initiatives in the APEC Region, 476 eHealth Initiatives in the Pan American Health Organization (PAHO) Region, 478 eHealth Initiatives in Afiica, 479

International Organizations with Informatics Implications, 481

eHealth and Health Informatics at WHO, 481 International Medical Informatics Association (IMLA), 482

International Standards Efforts, 484 International Organization for Standardization (ISO), 484 International Council of Nurses, 486 Health Level Seven (HL7), 489 International Health Terminology Standards Development Organisation (IHTSDO), 489

Global Challenges to eHealth, 489 Global Interoperability, 489 Human Resources for eHealth, 489 Information and Communications Technology I n ~ t r u c t u r e , 489 Legal and Regulatory Framework for eHealth, 490

Conclusion and Future Directions, 490

UNIT'STHE PRESENT AND FUTURE

31 Future Directions and Future Research in Health Informatics, 494 Nancy Staggers, Ramona Nelson, and David E. Jones

Introduction, 494 Futures Research or Futurology, 495

- - CONTENTS

Dejining Futures Research or Futurology, 495 Future Directions and Level of Change, 496 The Challenge of Anticipating Future Directions, 497 Approaches for Predicting, 497 Application of Futures Research, 499

The Future of Informatics, 499 Consumerism and Informatics, 500

xxiii 1

EHRs 2.4500 Usability and Improving the User Experience for Health IT, 501 Big Data and Data Visualization, 501 Nanotechnology, 502

Conclusion and Future Directions, 506

Glossary, 509 Index, 5 17