Textbook Mastering Informatics A Healthcare Handbook For Success 1St Edition Patricia Sengstack Ebook All Chapter PDF
Textbook Mastering Informatics A Healthcare Handbook For Success 1St Edition Patricia Sengstack Ebook All Chapter PDF
Textbook Mastering Informatics A Healthcare Handbook For Success 1St Edition Patricia Sengstack Ebook All Chapter PDF
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Praise for Mastering Informatics
“A fantastic book! This is a timely and needed healthcare informatics book that can help both practic-
ing informaticians and students. It includes essential knowledge needed in the current healthcare en-
vironment and helpful tools that can be used for diverse health IT projects. I am very grateful for the
authors’ generous sharing of their expertise with others.”
–Eun-Shim Nahm, PhD, RN, FAAN
Professor and Program Director
Nursing Informatics
University of Maryland School of Nursing
“The experience and diversity of the authors bring together a rich compendium of forward-thinking
and practical advice that covers most aspects of the informatics lifecycle. I highly recommend this
valuable resource for today’s informaticiansÂ�—from novice to experienced.”
–Deborah Ariosto, PhD, RN
Director, Patient Care Informatics & CNIO
Vanderbilt University Medical Center
“Mastering Informatics provides a critical resource for those working to improve health and healthcare
through the practice of informatics. The authors articulate a clear, well organized, pragmatic approach
to the multiple challenges in this field. The chapters present the basics and then move beyond to offer
application of principles, lessons learned by informatics experts, helpful tips, and a vision for future
directions. This book offers outstanding support to facilitate and enhance the mastery of informatics
practice.”
–Carol A. Romano, PhD, RN, FAAN, FACMI
Rear Admiral (Ret), U.S. Public Health Service
Professor and Associate Dean, Uniformed Services University, Bethesda, Maryland
Former Senior Consultant for Clinical Research Informatics, National Institutes of Health
“Sengstack and Boicey have provided the necessary elements for mastering informatics for profes-
sionals engaged in the design and delivery of systems to support the changing model of care. This
book presents emerging trends facing the delivery system and how informatics and informatics pro-
fessionals can respond to the demands for consumer quality outcomes and experience of care.”
–Andrea Mazzoccoli, PhD, RN, FAAN
Chief Nursing Officer, Bon Secours Health System
Center for Clinical Excellence and Innovation
“This is sure to become the ‘go to’ book for implementers of all types of health IT. The pragmatic
lessons and practical examples will assist both those new to health informatics and those experienced
who are looking for new ideas. This introspective text will help implementers understand informatics
and how to use health IT to advance the vision of better health, better care, and lower costs.”
–Judy Murphy, RN, FACMI, FHIMSS, FAAN
Chief Nursing Officer, IBM Healthcare
All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmit-
ted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from
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the property of their respective owners. Their use here does not imply that you may use them for similar or any other purpose.
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port the learning, knowledge, and professional development of nurses committed to making a difference in health worldwide.
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ISBN: 9781938835667
EPUB ISBN: 9781938835674
PDF ISBN: 9781938835681
MOBI ISBN: 9781938835698
________________________________________________________________________________________________________
Library of Congress Cataloging-in-Publication Data
Mastering informatics : a healthcare handbook for success / [edited by] Patricia Sengstack, Charles Boicey.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-938835-66-7 (print : alk. paper) -- ISBN 978-1-938835-67-4 (EPUB) -- ISBN 978-1-938835-68-1 (PDF) --
ISBN 978-1-938835-69-8 (MOBI)
I. Sengstack, Patricia, 1959- , editor. II. Boicey, Charles, 1959- , editor. III. Sigma Theta Tau International, issuing body.
[DNLM: 1. Medical Informatics--methods. 2. Electronic Health Records. 3. Health Information Management. 4. Telemedicine.
W 26.5]
R855.3
610.285--dc23
2014039190
________________________________________________________________________________________________________
A huge thank you to all our contributing authors who put in a significant effort to develop
chapters that reflect more than just textbook information, but content infused with both evi-
dence and experience to give readers some great tools.
I would like to acknowledge the support from the Bon Secours Health System in the writ-
ing and editing of this book—in particular, my boss, Andrea Mazzoccoli, RN, PhD, FAAN,
who supported me by giving me the time and encouragement to make this possible. I would
also like to acknowledge my wonderful husband, Glenn J. Sengstack, who had to take over
cooking, laundry, and sundry other tasks, so I could disappear for a few months and dedicate
my time to this effort, and to my comedic son, Donald G. Sengstack, for his constant remind-
ers to “quit procrastinating.”
I would like to acknowledge Patty Sengstack for providing me the opportunity to play a role
in the production of this manuscript as well as authoring a chapter. It was an excellent learn-
ing experience. Special acknowledgements to my family, Ana and Bryan, for their patience
over the years and for being cool with late nights, early mornings, and weekends at work.
I would also like to acknowledge Dr. Howard Belzberg; Dr. William Shoemaker; Emma
Farmer, RN; Jim Murry; Lisa Dahm, PhD; Carol and Carolyn Bloch, RN, for giving me inspi-
ration and the freedom to take the road less traveled; and to Patricia Ramos, RN, for travel-
ing with me on that road for 10 years.
• Written by the top informaticists in healthcare, the book covers everything from planning and analysis to
designing, testing, training, implementing, maintaining, evaluating, security, patient safety, analytics, mo-
bility, and much more.
• When you use the unique discount code from the affixed card in the front of the book to purchase the
Mastering Informatics course from www.nursingknowledge.org/educationalproducts.html, you get 30+
hours of CNE—a $250 value—for only $50!
• Proceed to checkout, enter the unique discount code in the Discount Codes box, and click Apply Coupon.
When the coupon code has been accepted, you will see the discount in your Shopping Cart Totals.
• Once your purchase is complete, your online course is available. Go to My Accounts (top right of the page)
and select CNE from the left-hand side of your screen. You will then be routed to our e-learning platform,
where you can access Mastering Informatics-ONLINE COURSE.
What if You Bought This Book Used or Do Not Have an Access Code?
I f you do not have an access code, you can still obtain the CNE. However, you will have to pay full retail price. You
can access the CNE by going to www.nursingknowledge.org/educationalproducts.html and selecting Mastering
Informatics-ONLINE COURSE.
Sigma Theta Tau International is an accredited provider of continuing nursing education by the American Nurses Credentialing Center
(ANCC) Commission
Sigma Theta on Accreditation.
Tau International is an accredited provider of continuing nursing education by the American Nurses Credentialing
Center (ANCC) Commission on Accreditation.
Sengstack received her BSN from the University of Maryland and went on to receive
her master’s degree in Healthcare Administration and a post-master’s degree in Nursing
Informatics, also from the University of Maryland. She now serves on the curriculum
advisory Board for the University of Maryland’s Nursing Informatics program. She re-
ceived her doctor of nursing practice degree from Vanderbilt University in Nashville,
Tennessee, and now serves on that faculty and instructs informatics students at both the
master’s and doctoral levels. In May 2014, she received the Dean’s Award for Recognition
of Faculty Achievement in Informatics from the Vanderbilt University School of
Nursing. She is now the President of the American Nursing Informatics Association
and has served on its board of directors since 2012. Her nursing background includes
working as an ICU Nurse and a Clinical Nurse Specialist in the Washington, D.C. met-
ropolitan area. She has multiple publications, most recently in the Journal of Healthcare
Information Management on the configuration of safe CPOE systems. She has presented
at the national level in multiple venues, including the 2014 HIMSS and AONE annual
conferences. She is board certified in Nursing Informatics and has been certified as a
professional in health information management (CPHIMS) since 2008. Her focus over
the last several years has been health IT’s impact on patient safety as well as building a
program to improve the evaluation process of healthcare IT systems.
Nursing Information Systems, LAC + USC Medical Center; and Nurse Manager,
Trauma/Surgical Intensive Care Unit, LAC + USC Medical Center.
Boicey received his diploma in Nursing from the Los Angeles County General
Hospital School of Nursing, his BS in Business Administration from the University of
Phoenix, and his master’s degree in Technology Management from Stevens Institute
of Technology, Hoboken, New Jersey. He is the vice president of the American
Nursing Informatics Association and has served on its board of directors since 2010.
He is a member of the HIMSS National Innovation Committee, a former member of
the HIMSS National Nursing Informatics Committee, and the former Chair of the
HIMSS SoCal Chapter Clinical Informatics Committee. He has given more than 50
national/regional presentations and webinars to such professional organizations as
HIMSS, AORN, ANIA, and AMIA. He is board certified as an Informatics Nurse and
holds certifications as a Project Management Professional (PMP), Certified Legal
Nurse Consultant (CLNC), and Certified Professional in Healthcare Information and
Management Systems (CPHIMS).
His work for the past 4 years has centered on bringing the Big Data technologies that
power Yahoo!, Facebook, LinkedIn, and Twitter to healthcare. He was a founding mem-
ber of the team that developed the Health and Human Services award-winning applica-
tion “MappyHealth” and he developed “Saritor,” which is a novel Big Data healthcare
data platform for advanced healthcare analytics.
Bove received her DNP from Duke University in North Carolina in 2013, focus-
ing on informatics and the value of bedside documentation. Lisa Anne was also on
the American Nursing Informatics Association Board of Directors from 2005–2012
and was Conference Co-Chairperson from 2010–2012. Lisa Anne is an active confer-
ence planning committee member of the Delaware Valley Nursing Computer Network
(DVNCN). Lisa Anne has published and spoken on numerous topics, including infor-
matics and project management.
Seth D. Carlson, BS
Seth D. Carlson has more than 16 years experience in the field of Information
Technology, with the past 9 years in healthcare IT. He currently works as a principal
business analyst and integrator of new IT systems. In a former position, he served as a
Testing Lead for several years and specialized in the testing of Clinical Health Systems,
HL7 interfaces, and databases. He received his bachelor of science degree in Computer
Science in 1997 from the University of Maryland in College Park. He is currently en-
rolled in the master of science in Business and Management, Information Systems pro-
gram at the University of Maryland in College Park.
(Disclaimer: The views and opinions of the author expressed in “Testing in the
Healthcare Informatics Environment,” Chapter 4, do not necessarily state or reflect
those of the U.S. government.)
Farnum brings his clinical experience to improving healthcare IT system usability and
intelligence. He received his master’s degree in Medical Informatics degree from the
Northwestern University’ Feinberg School of Medicine. He has been implementing
information systems, developing clinical decision support and business intelligence fea-
tures, and working to improve the experiences of clinicians for more than two decades.
Gagnon has been a nurse for 30 years and has worked both as a clinician and in lead-
ership positions in acute care, public health, and home healthcare, as well as corporate
positions in healthcare and IT. For the past 15 years, Mr. Gagnon has focused his profes-
sional attention on home healthcare, in operations, startups, and informatics. He has
been a certified agency administrator, a branch manager, and a private duty manager,
and also served as the director of operations for private duty for one of the largest home
care companies in the United States, with 55 agencies reporting to him. He has worked
in a variety of healthcare software settings, including hospital IT and informatics, enter-
prise patient access, scheduling, and physician orders management, in implementation,
education, and systems analytics roles.
Currently, Gracie leads his team in the build of CPOE with the Epic project at the
Medical University of South Carolina. In this role, he also serves as a project lead for
the Meaningful Use and Regulatory Reporting planning and implementation. Prior to
this, he served in roles that focused on the implementation of healthcare IT solutions
and frontline staff support at the Medical University of South Carolina. Gracie also
teaches informatics and healthcare quality and leadership as adjunct faculty at a num-
ber of nursing schools.
With more than 30 years experience, Susan has served in a variety of roles trans-
forming health and improving health of populations, including nursing and health sys-
tem executive, new healthy community partnership and community health information
network (CHIN) executive, clinical informatics and decision support executive, con-
sultant and action researcher, and designing and managing a new Children’s Hospital
Emergency Service. Susan is the founder and CEO of WellSpring Consulting, support-
ing healthcare organizations and communities in the United States and Canada since
1994 to strengthen their capacity for innovation in services, products, and impact.
She recently served as the chief health informatics officer for Diversinet and the vice
president of the Elsevier CPM Resource Center, has served on the NeHC Consumer
e-Health Advisory Board and the ONC FACA Consumer Technology Standards
Workgroup, and serves on the Tiger Initiative Foundation board.
Tess earned her MHA from University of Minnesota Carlson School of Business, and
her MA in Nursing (CNS) from the College of St. Scholastica. She was co-founder and
president of the MInnesota Nursing INformatics Group (MINING) from 2000–2007,
where Tess established an annual nursing informatics conference program featuring in-
ternationally recognized informaticists, and collaborated to launch the first and second
Minnesota T.I.G.E.R. conferences. She has served on boards of directors for Alliance for
Nursing Informatics, Center for Healthcare Innovation, Minnesota Epic User Group,
and Community Health Information Collaborative (Minnesota), and served on the
management committee for the Minnesota Center for Health Electronic Commerce.
Telehealth. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 350
Long-Term Acute Care Hospitals and Inpatient Rehabilitation Facilities . . . . . 353
LTPAC Provider Recommendations to the ONC. . . . . . . . . . . . . . . . . . . . . . . . . . . . 354
LTPAC Industry-Led Initiatives and Priorities for Action. . . . . . . . . . . . . . . . . . . . . 357
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 359
17 Connected and Mobile Health’s Promise for the Triple Aim . . . . 379
Susan C. Hull, MSN, RN
Mobile Health Is a Disruptive Innovation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 381
Mobility Is a New Care Model. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 382
mHealth Enables Co-producing Individualized and Personalized Health . . . . 385
mHealth’s Potential to Impact the Triple Aim. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 387
Current Experience. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 397
Patient and Consumer Apps. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 397
Clinical Care and Coordination. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 400
Pilots, Interoperability, Clinical Trials, Research, and FDA Regulation. . . . . . . . 401
mHealth Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 403
Future Directions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 404
A Global, Immersive, Invisible, Ambient Networked Sensing Environment . . . 404
Portable High Resolution Diagnostics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 405
Embedded Nanosensors with Signals to Smart Phones. . . . . . . . . . . . . . . . . . . . . 406
The Intelligent Home . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 406
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 406
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 407
As new nursing informaticists, we recognized along the way that we were in un-
charted territory. Not only did we need to seek recognition from the nursing profession
for this specialty, but we had to progress the science of nursing informatics at the same
time. Through successes and failures, we continued to seek new knowledge and varying
ways to support the informatics process in a variety of settings. We discovered a young-
er group of nurses who had no problem accepting the informatics challenge and taking
it on with renewed passion and interest.
These nurses weren’t afraid to accept the challenge of translating informatics to oth-
ers, particularly in relation to contributing to improved patient care. They were the
ones spending unmentionable hours at “go-lives” for their projects, or arguing daily
for improved user interfaces, or using new technologies for lifelong learning. The au-
thors and editors of this book are extraordinary examples of informaticists in the era I
describe. They have years of on-the-job experience, coupled with advanced education
that allows them to explore applications of informatics concepts in practical ways. This
book is their gift to the rest of us.
Those of us in educational informatics have often had a difficult time proving our
value when promoting the informatics agenda. I would argue that our best outcome
measurement would be the contributions of our graduates. I am honored to say that
both Patty Sengstack and Marcy Stoots have been my DNP advisees (both would have
been a joy for any advisor). I first met Patty at a HIMSS conference, where she spent
45 minutes convincing me that the advanced degree she wanted to seek was a DNP
and not a PhD. Given that she was employed at that time at the NIH Clinical Center,
I wasn’t convinced that a research-oriented PhD wasn’t what she needed. I will never
forget the convincing argument she delivered—that spunky “ball of fire” who knew that
she could make a difference in nursing informatics and that the DNP was just the ap-
plied vision she needed to push her horizons. She was impatient to start on her agenda,
and as her advisor, I remember telling her that the committee appointments and
leadership positions she wanted would come in time. I have only met Charles Boicey
on a few American Nursing Informatics Association (ANIA) occasions, but he is well-
equipped to serve as coeditor on this book. Informatics has always been an active par-
ticipant in Big Data, even before the terminology was used.
• Provide readers with resources, guidelines, ideas, and tools that can be
applied to current informatics practice
Although EHRs and clinical systems in general have been in existence for decades,
their use has been limited to the larger, more-affluent healthcare systems and aca-
demic medical institutions. With the signing of the Health Information Technology for
Economic and Clinical Health (HITECH) Act in 2009, however, EHRs have seen a sig-
nificant increase in adoption. Many organizations have already benefited from the CMS
incentive program and have received millions of dollars for the meaningful adoption
of these systems. With increasing adoption, the need for informatics resources has also
increased. Many nursing and clinical informaticists transitioned into their positions
from super-user roles during or after a system implementation. They proved themselves
during the process and found themselves enjoying the work. These informatics work-
ers possess “on the job” experience, but lack the applied science that exists in the field
of informatics. Informatics has evolved into a specialty that possesses a unique body of
knowledge backed by science, and this book provides an essential guide to surviving in