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Health Informatics

An Interprofessional Approach

SECOND EDITION

Ramona Nelson, PhD, RN-BC, ANEF, FAAN Professor Emerita, Slippery Rock University, Slippery Rock, Pennsylvania President, Ramona Nelson Consulting, Allison Park, Pennsylvania

Nancy Staggers, PhD, RN, FAAN President, Summit Health Informatics; Adjunct Professor, College of Nursing and Department of

Biomedical Informatics, University of Utah, Salt Lake City, Utah

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Table of Contents

Cover image Title page Copyright Dedication About the Authors Contributors Reviewers and Ancillary Writers Acknowledgments Preface

Uses of the book Vendors, applications, foundations and institutions Organization of the book Teaching and learning package

Unit 1: Foundational Information in Health Informatics 1: An Introduction to Health Informatics

Abstract Introduction Definition of health informatics Topics and areas of study in informatics Conclusion and future directions Discussion Questions Case Study Case Study Questions

2: Theoretical Foundations of Health Informatics Abstract Introduction Understanding theories and models Additional informatics-related models Conclusion and future directions Discussion questions Case study Discussion Questions

3: Evidence-Based Practice, Practice-Based Evidence, and Health Informatics Abstract Introduction Evidence-based practice Evidence-based practice models Stevens star model of knowledge transformation Informatics and evidence-based practice Relationship of EBP and PBE Practice-based evidence Informatics and practice-based evidence Conclusion and future directions Discussion questions EBP case study Discussion Questions PBE Case study Pressure Ulcer Case Study Negative Association With Likelihood of Developing a Pressure Ulcer (Less Likely) Positive Association With Likelihood of Developing a Pressure Ulcer (More Likely) Discussion Questions

4: Models, Theories, and Research for Program Evaluation Abstract Introduction Purposes of evaluation Theories and frameworks Methods, tools, and techniques Conclusion and future directions Discussion questions Case study Discussion Questions

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5: Technical Infrastructure to Support Healthcare Abstract Introduction Electronic health record component model System integration and interoperability Networking systems Other infrastructure models Current challenges Conclusion and future directions Discussion questions Case study Discussion Questions

Unit 2: Information Systems and Applications for the Delivery of Healthcare

6: Electronic Health Records and Applications for Managing Patient Care Abstract Introduction Electronic health record components, functions, and attributes Sociotechnical perspectives Electronic health record applications used in the clinical setting Electronic health record benefits Stakeholder perspectives Key issues Conclusion and future directions Discussion questions Case study Discussion Questions

7: Administrative Applications Supporting Healthcare Delivery Abstract Introduction Major Types of Applications Conclusion and Future Directions Discussion questions Case Study Michael H. Kennedy, Kim Crickmore, and Lynne Miles Discussion Questions

8: Telehealth and Applications for Delivering Care at a Distance Abstract Introduction Telehealth technologies Telehealth clinical practice considerations for healthcare professionals Telehealth operational and organizational success factors and barriers Telehealth challenges: licensure and regulatory issues for healthcare professionals Telehealth and direct patient health services Conclusion and future directions Discussion questions Case Study Discussion Questions

9: Home Health and Related Community-Based Systems Abstract Introduction Evolution and milestones Practice models Standardized datasets Supporting home health with electronic health records and health information technology Standardized terminologies Omaha system Conclusion and future directions Discussion questions Case Study Discussion Questions

10: Clinical Decision Support Systems in Healthcare Abstract Introduction Clinical decision support types and examples Clinical decision support impact Clinical decision support best practices Recent progress toward disseminating clinical decision support on a national level Research challenges Conclusion and future directions Discussion questions Case study Discussion Questions

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11: Public Health Informatics Abstract Introduction Public health: A population perspective The value of informatics for the domain of public health Conclusions and future public health informatics strategies Discussion questions Case study Discussion Questions

Unit 3: Participatory Healthcare Informatics 12: The Engaged ePatient

Abstract Historical background and drivers of the epatient evolution Convergence of epatients, clinicians, patient-centered models of care, and informatics Health 3.0 emerges Conclusion and future directions Discussion questions Case study Discussion Questions

13: Social Media Tools for Practice and Education Abstract What is social media? Social media tools Social media statistics Benefits of social media Challenges of social media Social media in education Policy Conclusion and future directions Discussion questions Case study Social Media in Education and Healthcare Discussion Questions

14: Personal Health Records Abstract Definitions of the personal health record The development of the electronic personal health record Principles of an ideal personal health record Examples of existing personal health records Current evidence of benefits of personal health records Current use of personal health records Barriers to personal health record adoption The future of personal health records Discussion questions Case study Discussion Questions

15: mHealth: The Intersection of Mobile Technology and Health Abstract Introduction Driving forces of mobile health Mobile health benefits and challenges Future directions of mobile health and conclusions Discussion questions Case study Discussion Questions

Unit 4: Managing the Life Cycle of a Health Information System 16: Strategic Planning and Selecting an Information System

Abstract Introduction Strategic vision and alignment Systems life cycle Conclusion and future directions Discussion questions Case study Key Considerations for System Selection

17: Project Management Principles for Health Informatics Abstract Introduction The need for project management in healthcare organizations Project, program, and portfolio management Roles and responsibilities: project, program, and portfolio managers Project management tools Project and portfolio management software selection

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Conclusions and future directions Discussion questions Case study Discussion Questions

18: Contract Negotiations and Software Licensing Abstract Introduction Overview of licensing agreements Major steps or stages in the performance of a license agreement Specific components of the licensing agreement Conclusions and future directions Discussion questions Case study Discussion Questions

19: Implementing and Upgrading an Information System Abstract Introduction Reasons to implement or upgrade a healthcare information system New implementation versus an upgrade Implementation and the systems life cycle Preparing for go-live Go-live Post-live maintenance Conclusion and future directions Discussion questions Case study Discussion Questions Case Study Follow-Up Discussion Questions

20: Downtime and Disaster Recovery for Health Information Systems Abstract Introduction Downtime risk assessment Downtime And Response Planning Downtime policies and procedures Information technology impact and planning Disaster planning Conclusion and future directions Discussion Questions Case Study Discussion Questions

Unit 5: User Experience, Standards, Safety, and Analytics in Health Informatics

21: Improving the User Experience for Health Information Technology Abstract Introduction to improving the user experience Definitions of terms and their relationships The goals of usability User-centered design Human-computer interaction frameworks for health informatics Selecting methods to improve the user experience Formal user testing Selecting a type of usability test Conclusion and future directions Discussion questions Case study Discussion Questions

22: Informatics-Related Standards and Standards-Setting Organizations Abstract Introduction Standardized healthcare terminologies relevant to patient care Healthcare data standardization Data exchange efforts Application of standardized terminologies Conclusion and future directions Discussion questions Case study Discussion Questions

23: Data Science and Analytics in Healthcare Abstract Introduction Data science in healthcare Characteristics of big data

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Data science for clinical and translational research Benefits of data science Approaches to analyses Knowledge discovery and data mining Conclusions and future directions Discussion questions Case study

24: Patient Safety and Quality Initiatives in Health Informatics Abstract Introduction Definitions National initiatives driving adoption and use of health it National efforts related to quality data standards Evaluating quality and patient safety Success factors and lessons learned Conclusion and future directions Discussion questions Case study Discussion Questions

Unit 6: Governance Structures, Legal, and Regulatory Issues in Health Informatics

25: Legal Issues, Federal Regulations, and Accreditation Abstract Introduction Legal system Fraud and abuse and billing issues related to electronic health record use Accreditation The intersection of new technology and regulation Conclusion and future directions Discussion questions Case study Discussion Questions

26: Privacy and Security Abstract Introduction Definitions and concepts Legal and historical context Principles, laws, and regulations guiding practice The importance of information security Current security vulnerabilities Current security challenges Managing security risks with security controls Resources Conclusions and future directions Discussion questions Case study Discussion Questions

27: The Health Information Technology for Education and Clinical Health Act, Meaningful Use, and Medicare Access and CHIP Reauthorization Act of 2015

Abstract Introduction Federal initiatives to drive health information technology Conclusion and future directions Discussion questions Case study Discussion Questions

28: Health Policy and Health Informatics Abstract Introduction Developing and implementing health information technology policy Driving forces for creating health information technology policy Leadership competencies for developing and implementing health information technology policies Leading policy activities through organizational work and leadership Discipline-specific policies: nursing Conclusion and future directions Discussion Questions Case Study Discussion Questions

29: Health Information Technology Governance Abstract Introduction Health information technology governance: need and core components Key insights

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Recommendations Conclusion and future directions Discussion Questions Case study Discussion Questions

Unit 7: Education and Health Informatics 30: Informatics in the Curriculum for Healthcare Professionals

Abstract Introduction and background Teaching and learning in an evolving healthcare and technology environment Framework for informatics curriculum It takes a village: roles and competencies Conclusion and future directions Discussion questions Case study Discussion Questions

31: Distance Education: Applications, Techniques, and Issues Abstract Introduction Historical development Terminology Course delivery systems: course management systems Instructional design for distance education and learning Student (learner) support services Issues Conclusion and future directions Discussion Questions Case Study Discussion Questions

32: Informatics Tools for Educating Healthcare Professionals Abstract Introduction Comprehensive education information system Computerized teaching tools Impact on the teaching and learning process Impact on the faculty role Conclusion and future directions Discussion Questions Case study Discussion Questions

33: Simulation in Healthcare Education Abstract Introduction The simulation process Application of simulation Conclusion and future directions Discussion questions Case study Discussion Questions

Unit 8: International Health Informatics Efforts 34: International Efforts, Issues, and Innovations

Abstract Introduction Key initiatives in world regions International organizations with ehealth involvement International standards efforts Global challenges to ehealth Conclusion and future directions Discussion questions Case study Discussion Questions

Unit 9: Historical Implications and Future Directions in Health Informatics

35: The Evolution of Health Informatics Abstract Introduction The roots of informatics within the computer and information sciences Establishing the specialty of health informatics Recognition of the specialty Naming the specialty—naming the discipline Conclusion and future directions Discussion questions

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Case study Discussion Questions

36: Future Directions and Future Research in Health Informatics Abstract Introduction Futures research (futurology) The future of health informatics Clinical informatics Improving the user experience for health information technology Analytics (big data) and data visualization Predictive analytics Data visualization Conclusion and future directions Discussion questions Case study Discussion Questions

Glossary Index

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Copyright

3251 Riverport Lane St. Louis, Missouri 63043 HEALTH INFORMATICS: AN INTERPROFESSIONAL APPROACH, SECOND EDITION ISBN: 978-0-323-40231-6 Copyright © 2018 by Elsevier Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means,

electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions.

This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein).

Notices Knowledge and best practice in this field are constantly changing. As new research and

experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary.

Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility.

With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions.

To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein.

Previous edition copyrighted 2014. International Standard Book Number: 978-0-323-40231-6 Executive Content Strategist: Kellie White Content Development Manager: Lisa Newton Senior Content Development Specialist: Danielle M. Frazier Publishing Services Manager: Jeff Patterson Senior Project Manager: Jodi M. Willard Design Direction: Ryan Cook Printed in China Last digit is the print number: 9 8 7 6 5 4 3 2 1

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Dedication

To my husband, Glenn M. Nelson, who always manages to be there To my daughters, who managed to pick wonderful husbands,

Dorianne & Michael Hollis and Leslie-Ann & Kristopher Bidelson and

To my grandchildren, who are today’s joy and tomorrow's hope, Mackenzie, Hope, Ella, and Molly

Ramona Nelson To my father, Forest Thorpe, who supported education for women

during an age when it was deemed superfluous and

To my husband, Bob Staggers, who has always been a champion of strong women Nancy Staggers

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About the Authors

Ramona Nelson holds a baccalaureate degree in nursing from Duquesne University and a master's degree in both nursing and information science and a PhD in education from the University of Pittsburgh. In addition, she completed a postdoctoral fellowship at the University of Utah. Prior to her current position as president of her own consulting company, Ramona was a Professor of Nursing and Chair of the Department of Nursing at Slippery Rock University. Today Ramona continues her association with Slippery Rock University in the role of Professor Emerita. Her primary areas of interest include informatics education for health professionals, social media and empowered patients, and the application of theoretical concepts in health informatics practice.

Her past publications include textbooks, monographs, book chapters, journal articles, World Wide Web publications, abstracts, and newsletters. She has been recognized as a Nursing Informatics Pioneer by the American Medical Informatics Association. In addition, she was named a fellow in the American Academy of Nursing in 2004 and in the National League for Nursing Academy of Nursing Education Fellows.

Nancy Staggers is a nursing informatics pioneer who is actively involved in informatics user experience research. Her education was at the University of Wyoming and the University of Maryland School of Nursing, culminating in a PhD with a concentration on informatics and research. Her background includes both health informatics practice and academia. She was a health informatics executive in the Department of Defense and elsewhere, leading enterprise acquisitions and installations of inpatient electronic health records. Her academic career includes professorships at both the University of Utah and the University of Maryland. Nancy’s academic work began with developing nursing informatics competencies and later leading teams to revise the American Nurses’ Association document on the scope and practice of nursing informatics in the United States in 2002 and 2008. Her research program focuses health IT support and redesign for complex activities such as electronic medication administration records and handoffs/care transitions. Recently she led a team on the user experience community at the Healthcare Information and Management Systems Society to identify nursing user experience issues and solutions for nurses’ interactions with health IT. She was elected as a fellow in the American Academy of Nursing in 1999 and received the American Medical Informatics Association Virginia K. Saba nursing informatics award in 2013 for her contributions to informatics. She owns her own health informatics company, which focuses on research consultations and international collaborations. She is also adjunct professor of informatics at the Department of Biomedical Informatics and College of Nursing, University of Utah, and she teaches user experience research methods for the Health Informatics program at the University of Alabama Birmingham. Nancy publishes widely on health informatics topics, concentrating on user experience research.

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Contributors

Antonia Arnaert, RN, MPH, MPA, PhD Associate Professor, Ingram School of Nursing, McGill University Montreal, Quebec, Canada

Nancy C. Brazelton, RN, MS Application Service Director, Information Technology Services, University of Utah Health Care, Salt Lake City, Utah

Christine A. Caligtan, RN, MSN Health Data and Patient Safety Clinical Specialist, Health Data Integrity, PatientsLikeMe, Cambridge, Massachusetts

Robin L. Canowitz, AB, JD Senior Attorney, Vorys, Sater, Seymour and Pease, LLP, Columbus, Ohio

Heather Carter-Templeton, PhD, RN-BC Assistant Professor, Capstone College of Nursing, The University of Alabama, Tuscaloosa,

Alabama Associate Professor and Reference Librarian, Health Sciences Library, University of Tennessee

Health Science Center, Memphis, Tennessee Diane Castelli, RN, MS, MSN Adjunct Clinical Nursing Instructor Cape Cod Community

College West Barnstable, Massachusetts Kathleen G. Charters, PhD, RN, CPHIMS Clinical Information Systems Specialist, Defense

Health Agency Healthcare Operations Directorate, Clinical Support Division, Integrated System Support, Measurements & Clinical Reporting, Falls Church, Virginia

Jon C. Christiansen, BS, JD Attorney, TechLaw Ventures, PLLC, Salt Lake City, Utah Helen B. Connors, PhD, RN, DrPS (Hon), FAAN, ANEF Executive Director, Center for

Health Informatics; Associate Dean, University of Kansas School of Nursing, Kansas City, Kansas Vicky Elfrink Cordi, PhD, RN Clinical Associate Professor Emeritus, The Ohio State

University, Columbus, Ohio Mollie R. Cummins, PhD, RN, FAAN Associate Dean for Research and the PhD Program;

Associate Professor, College of Nursing; Adjunct Associate Professor, Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah

Andrea Day, RN, MS, PMP Informatics Nurse Consultant New Market, Maryland Mical DeBrow, PhD, RN Associate Director, Health Economics and Outcomes Research,

Boehringer Ingelheim Pharmaceuticals, Houston, Texas Guilherme Del Fiol, MD, PhD Assistant Professor, Department of Biomedical Informatics,

University of Utah, Salt Lake City, Utah Vikrant G. Deshmukh, PhD, MS, MSc Adjunct Assistant Professor, Population Health

Sciences, University of Utah School of Medicine; Adjunct Assistant Professor, College of Nursing, University of Utah; Lead Principal Data Warehouse Architect, Enterprise Data Warehouse, University of Utah Health Care, Salt Lake City, Utah

Patricia C. Dykes, PhD, RN, FAAN, FACMI Senior Nurse Scientist, Program Director, Center for Patient Safety Research and Practice, Program Director, Center for Nursing Excellence, Brigham and Women's Hospital, Boston, Massachusetts

William Scott Erdley, DNS, RN, CHSE Simulation Education Specialist, The Behling Simulation Center, Jacobs School of Medicine and

Biomedical Sciences, University at Buffalo, Buffalo, NY Adjunct Professor, School of Nursing, Niagara University, Niagara University, New York David L. Gibbs, PhD, CPHIMS, CHPS, CISSP Assistant Professor, Department of Health

Information Management, Texas State University, San Marcos, Texas Bryan Gibson, DPT, PhD Assistant Professor, Department of Biomedical Informatics,

University of Utah, Salt Lake City, Utah Teresa Gore, PhD, DNP, FNP-BC, NP-C, CHSE-A Associate Professor and Director of Experiential Learning College of Nursing, University of

South Florida, Tampa, Florida President, International Nursing Association for Clinical Simulation and Learning (INACSL),

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Morrisville, North Carolina Nicholas R. Hardiker, PhD, RN, FACMI Professor of Nursing and Health Informatics, School of Nursing, Midwifery, Social Work &

Social Sciences, University of Salford, Salford, England Director, eHealth Programme, International Council of Nurses, Geneva, Switzerland Adjunct Professor, College of Nursing, University of Colorado, Denver, Colorado Angel Hoffman, MSN, RN Principal/Owner, Advanced Partners in Health Care Compliance,

Pittsburgh, Pennsylvania Susan D. Horn, PhD Adjunct Professor, University of Utah School of Medicine, Health

System Innovation and Research Program, Salt Lake City, Utah Valerie M. Howard, EdD, MSN, RN Dean and University Professor, School of Nursing and

Health Sciences, Robert Morris University, Moon Township, Pennsylvania Sarah J. Iribarren, PhD, RN Postdoctoral Research Fellow, School of Nursing, Columbia

University, New York City, New York Jonathan M. Ishee, JD, MPH, MS, LLM Assistant Professor, School of Biomedical

Informatics, University of Texas Health Science Center; Partner, Vorys, Sater, Seymour and Pease, LLP, Houston, Texas

David E. Jones, PhD Applied Public Health Informatics Fellow, Utah Department of Health, Salt Lake City, Utah

Irene Joos, PhD, MSIS, MN, BSN, RN Professor & Former Director, Online Learning, Department of Information Technology; Adjunct Faculty, Department of Nursing, La Roche College, Pittsburgh, Pennsylvania

Kensaku Kawamoto, MD, PhD, MHS Associate Chief Medical Information Officer, University of Utah Health Care; Assistant Professor, Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah

Jacob Kean, PhD, MA, BS Research Speech-Language Pathologist, VA Salt Lake City Health Care System; Associate Professor, Population Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah

Michael H. Kennedy, PhD, MHA, FACHE Associate Professor, Department of Health Services and Information Management, East Carolina University, Greenville, North Carolina

Tae Youn Kim, PhD, RN Associate Professor, Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, California

Gerald R. Ledlow, PhD, MHA, FACHE Chair and Professor, Department of Health Policy and Management, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia

Kim Leighton, PhD, RN, ANEF Assistant Dean, Research & Simulation Faculty, Development, Institute for Research & Clinical Strategy, DeVry Medical International, Iselin, New Jersey

Louis Luangkesorn, PhD Research Assistant Professor, Industrial Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania

Ann M. Lyons, PhD, RN Medical Informaticist, Data Science Service, University of Utah, Salt Lake City, Utah

Kathleen MacMahon, RN, MS, CNP Telehealth Nurse Practitioner, American Telecare, Minneapolis, Minnesota

Michele P. Madison, JD Partner, Morris, Manning and Martin, LLP, Atlanta, Georgia Shannon Majoras, JD Associate, Vorys, Sater, Seymour and Pease, LLP, Cleveland, Ohio E. LaVerne Manos, DNP, RN-BC Faculty, School of Nursing, University of Kansas; Program

Director, Interprofessional Master of Science in Health Informatics and Post-Master's, Interprofessional Certificate in Informatics Center for Health Informatics, University of Kansas; Director of Nursing Informatics, Center for Health Informatics, University of Kansas, Kansas City, Kansas

Karen S. Martin, RN, MSN, FAAN Health Care Consultant, Martin Associates, Omaha, Nebraska

Cynthia M. Mascara, RN, MSN, MBA Principal Clinical Consultant, Strategic Clinical Consulting, Cerner Corporation, Kansas City, Missouri

Susan A. Matney, PhD, RN-C, FAAN Medical Informaticist, Healthcare Data Dictionary (HDD) Team, 3M Health Information Systems, Salt Lake City, Utah

Christine D. Meyer, PhD, RN Healthcare IT, Independent Consultant, Bridgeville,

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Pennsylvania Michele Mills, MBA.PM, PMP, CPHIMS, FHIMSS Director, Information Technology

Services, University of Utah Health Care, Salt Lake City, Utah Sandra A. Mitchell, PhD, CRNP, FAAN Research Scientist, Outcomes Research Branch,

National Cancer Institute, Rockville, Maryland Judy Murphy, RN, BSN, FACMI, FHIMSS, FAAN Chief Nursing Officer, Global Healthcare

& Life Sciences, IBM, Washington, DC Daniel A. Nagel, RN, BScN, MSN, PhD(c) Lecturer, Department of Nursing & Health

Sciences, University of New Brunswick, Saint John, New Brunswick, Canada Scott P. Narus, PhD Medical Informatics Director, Intermountain Healthcare Associates;

Professor, Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah Ramona Nelson, PhD, RN-BC, ANEF, FAAN Professor Emerita, Slippery Rock University, Slippery Rock, Pennsylvania President, Ramona Nelson Consulting, Allison Park, Pennsylvania Sally Okun, RN, MMHS Vice President, Advocacy, Policy, and Patient Safety,

PatientsLikeMe, Cambridge, Massachusetts Hyeoun-Ae Park, PhD Professor, College of Nursing, Seoul National University, Seoul, South

Korea Mitra Rocca, Dipl. Inform. Med. Senior Medical Informatician, Center for Drug Evaluation

and Research U.S. Food and Drug Administration, Silver Spring, Maryland Kay M. Sackett-Fitzgerald, BSN, RN, MEd, MSN, EdD Fitzgerald Consulting, Jenkintown,

Pennsylvania Loretta Schlachta-Fairchild, RN, PhD, FACHE, LTC (Ret.) U.S. Army Nurse Corps Health

Information Sciences Research Program Manager, Joint Program Committee-1 (JPC-1), U.S. Army Medical Research and Materiel Command/Department of Defense Health Agency, Fort Detrick, Maryland

Rebecca Schnall, PhD, MPH, RN-BC Assistant Professor, School of Nursing, Columbia University, New York, New York

Kumiko O. Schnock, PhD, RN Research Fellow, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts

Charlotte A. Seckman, PhD, RN-BC, CNE Assistant Professor, Course Director, Organizational Systems and Adult Health, School of Nursing University of Maryland, Baltimore, Maryland

Joyce Sensmeier, MS, RN-BC, CPHIMS, FHIMSS, FAAN Vice President, Informatics, Healthcare Information and Management Systems Society, Chicago, Illinois

Catherine Janes Staes, BSN, MPH, PhD Assistant Professor, Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, Utah

Nancy Staggers, PhD, RN, FAAN President, Summit Health Informatics; Adjunct Professor, College of Nursing and Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah

Teresa Stenner, MA Program Manager, Center for Health Informatics, University of Kansas Medical Center, Kansas City, Kansas

Kathleen R. Stevens, RN, MS, EdD, ANEF, FAAN Professor and Director, Improvement Science Research Network, School of Nursing, University of Texas Health Science Center, San Antonio, Texas

Jim Turnbull, DHA, MBA, BA Chief Information Officer, University of Utah Health Care, Salt Lake City, Utah

Karen B. Utterback, MSN, RN Independent Consultant, Homecare, Mitre, Hattiesburg, Mississippi

Dianna Vice-Pasch, MSN, RN, CCM, CTCP Associate Degree Nursing Faculty Kentucky Community and Technical College Systems Lexington, Kentucky

Judith J. Warren, PhD, RN, FAAN, FACMI Professor Emeritus, School of Nursing, University of Kansas Medical Center, Kansas City, Kansas

Charlene R. Weir, PhD, RN Associate Professor, Department of Biomedical Informatics, University of Utah School of Medicine; Associate Director, IDEAS Center of Innovation, Veterans Affairs Salt Lake City, Salt Lake City, Utah

Kathy H. Wood, PhD, FHFMA, CHFP Assistant Professor, College of Health, Human Services, and Science, Ashford University, San Diego, California

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Reviewers and ancillary writers

Reviewers Joanna V. Bachour, MSN, RN Assistant Professor and Lab Manager, MCPHS University,

School of Nursing, Worcester, Massachusetts Carol J. Bickford, PhD, RN-BC, CPHIMS, FHIMSS, FAAN Senior Policy Advisor,

Department of Nursing Practice & Work Environment, American Nurses Association, Silver Spring, Maryland

Connie B. Bishop, DNP, MBA, RN-BC Clinical Assistant Professor, College of Health and Human Services, School of Nursing, North Carolina A&T State University, Greensboro, North Carolina

Barbara Blackwell, EdD, RN-BC Director, School of Nursing (RN and LPN School), Holy Name Medical Center School of Nursing, Teaneck, New Jersey

Mary T. Boylston, RN, MSN, EdD, AHN-BC Professor of Nursing, Nursing Department, Eastern University, St. Davids, Pennsylvania

Kathleen M. Burke, PhD, RN Assistant Dean in Charge of Nursing, Professor of Nursing, Adler Center for Nursing Excellence, Ramapo College of New Jersey, Mahwah, New Jersey

Pat Callard, DNP, RN, CNL Associate Professor of Nursing, College of Graduate Nursing, Western University of Health Sciences, Pomona, California

Karen Chang, PhD, RN Associate Professor, School of Nursing, College of Health and Human Services, Purdue University, West Lafayette, Indiana

Amanda Dorsey, MSHI, FHIMSS Assistant Professor, UAB MS in Health Informatics Program, University of Alabama at Birmingham, Birmingham, Alabama

Judith A. Effken, PhD, RN, FACMI, FAAN Professor Emerita, College of Nursing, The University of Arizona, Tucson, Arizona

Matthew J. Fox, MSN, RN-BC Assistant Professor of Nursing, Ohio University-Zanesville, Zanesville, Ohio

Robert L. Garrie, MPA, RHIA Associate Professor, Health Services Administration, University of Alabama at Birmingham, Birmingham, Alabama

Lynda R. Hardy, PhD, RN Associate Dean for Research, College of Nursing, University of Tennessee, Knoxville, Knoxville, Tennessee

Gayle McGinty, MSN, RN Assistant Professor of Nursing, MCPHS University, School of Nursing, Worcester, Massachusetts

Carol M. Patton, PhD, FNP-BC, CRNP, CNE Informatics Health Certificate, CNE, Associate Clinical Professor, Drexel University, Philadelphia, Pennsylvania

Alison Pittman, RN, MSN, CPN Clinical Assistant Professor, Texas A&M Health Science Center, College of Nursing, Bryan, Texas

Teresa L. Scherer, MS, RN Clinical Instructor, School of Nursing, Idaho State University, College of Technology, Pocatello, Idaho

M. Kathleen Smith, MScEd, RN-BC, FHIMSS Managing Partner, Informatics Consulting and Continuing Education, L.L.C., Weeki Wachee, Florida

Nadia Sultana, MBA, RN, BC Clinical Assistant Professor, College of Nursing, New York University, New York, New York

Lindsay Tucker, BA, AAA, CPC Training and Education Manager, Moses Cone Health System, Adjunct Professor, Guilford Technical Community College, Greensboro, North Carolina

Dorothea M. Winter, PhD, RN Professor of Nursing, Nursing Department, Salisbury University, Salisbury, Maryland

ANCILLARY WRITER Jane M. Brokel, PhD, RN, FNI Adjunct Faculty, College of Nursing, University of Iowa, Iowa

City, Iowa; Section Instructor, School of Nursing and Health Sciences, Simmons College, Boston, Massachusetts

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Acknowledgments

Ramona Nelson; Nancy Staggers First, we would like to acknowledge Kellie White, Executive Content Strategist, whose overview

and coordination of this second edition is greatly appreciated. We also thank Danielle Frazier, Senior Content Development Specialist, who was responsible for providing support during the process of writing and editing; and especially Jodi Willard, Senior Project Manager, whose attention to detail was invaluable during the editing process. Finally, we would like to acknowledge Jeff Patterson, Publishing Services Manager, and Ryan Cook, Designer. Their expertise was imperative for developing a polished and professional product.

Each chapter of this book is supported with Evolve resources. We also wish to acknowledge the support of Umarani Natarajan, Senior Project Manager, and Hariprasad Maniyaan, Multimedia Producer, for the Evolve resources, as well as ancillary writer Jane Brokel and various content experts for their development of these resources.

Finally, we would like to acknowledge the reviewers. Their many suggestions, tips, and comments were invaluable in creating this book.

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Preface

Health informatics and our current information technology (IT) environment are inherently interdisciplinary. Over our many years of working in health informatics practice and teaching health informatics content, we recognized the need for a health informatics textbook that provides a solid overview of the field using an interdisciplinary approach. Therefore the title, authors, and content of this book reflect the comprehensive nature of contemporary informatics practice. The contributors to this book are leaders in health informatics and represent various disciplines and a wide variety of settings, areas of expertise, and positions.

Health Informatics: An Interprofessional Approach provides readers with a comprehensive understanding of health informatics, its practice, and relevant research on health informatics topics. Each chapter opens with key terms, learning objectives and an abstract that outlines the topics covered within the chapter. Chapter headings give readers a conceptual framework for understanding the content in the chapter. Each chapter ends with conclusions that include thoughts about future directions for the topic. Every chapter includes a set of discussion questions to encourage critical thinking and to encourage the reader to consider how the content in the chapter can be applied in the ever-changing world of healthcare. Case studies with analytic questions demonstrate how informatics applies in real-life practice.

Uses of the book This textbook is an excellent resource for use within and across various health disciplines. Every

attempt has been made to be culturally sensitive to the various disciplines within healthcare while encouraging readers to recognize themselves as key members of an interprofessional team. This book is written to be used for both intradisciplinary and interdisciplinary informatics courses. The text can span levels of education depending on the program of study, depth of informatics material needed, and the needs of faculty and students. This book is targeted to students needing introductory health or nursing informatics knowledge. As with the first edition, it is useful at several levels: for upper division or advanced undergraduate courses, for RN to BSN/MSN programs, for introductory health informatics content or courses in master’s programs and, particularly, for DNP students.

Vendors, applications, foundations and institutions Vendors, health IT applications, commercial products, and organizations and institutions are

discussed throughout the textbook. They are included for information purposes and to provide readers with examples of the variety of resources available. No endorsement of a specific company, product, or organization is intended.

Organization of the book The book is organized into nine units. The first unit is Foundational Information in Health

Informatics and focuses on material that is basic to understanding the discipline as a whole. Content includes the definition and significance of the field, theories and models, evidence-based practice and practice-based evidence, program evaluation, and technical infrastructures for health IT.

The second unit is Information Systems and Applications for the Delivery of Healthcare. This unit begins with an overview of electronic health records, followed by a discussion of financial and other administrative applications and clinical decision support systems. Remaining chapters focus on health IT in non–acute care settings: telehealth, home health, and public health informatics. This unit provides readers with content on major health applications in institutions and relevant settings.