Bellevue College--WACMHC Health IT Curriculum Web viewNursing Outlook, 56(6), ... Pentagon....

Health Informatics 101This project was funded by the Office of the National Coordinator for Health IT U.S. Department of Health and Human Services ARRA Grant # 90CC07701

1. Introduction to Health IT(5 hours; lectures 3 hrs., 13 min.)

Topics, Descriptions and Objectives

a. History of Quality Improvement and Patient Safety

This unit describes the history of the use of information technology as a part of quality improvement and patient safety.

Objectives ONC lecture file TimeDescribe the background to the Institute of Medicine reports on Patient Safety.

Summarize the main findings from several Institute of Medicine reports on quality, patient safety, and health information technology (HIT).

Describe various ways in which HIT has evolved to improve quality or enhance patient safety.

Comp 5, Unit 14 20 min.

b. HIT Professional Organizations and Standards Development Organizations

This unit describes the history of health IT organizations.

Objectives ONC lecture file TimeDescribe the background and original constituencies of AMIA, HIMSS, and AHIMA.

Describe the changes in major interests that have occurred at AMIA, HIMSS, and AHIMA over time.

Comp 5, Unit 16a 16 min.

Describe the origins, current focus, and relationships among the following standards development organizations: HL-7, HITSP, and ONC Health IT Standards Committee.

Comp 5, Unit 16b 5 min.

c. What is Health Informatics?

This unit defines information management, information technology, and informatics; describes the fundamental theorem of informatics; explains the meaning of biomedical and health

informatics as a field of study; and offers definitions of the major biomedical informatics areas of applications. It also provides an overview of informatics drivers and trends in the health care field.

Further, this unit defines the informatics team, their skills, roles and responsibilities, and identifies how health informaticians process data into information and knowledge for health care tasks with the support of information technology to improve patient care.

Objectives ONC lecture file TimeDefine information management, information technology and informatics.

Explain the basic theoretical concept that underlies informatics practice.

Define the meaning of biomedical and health informatics as a field of study.

Describe the biomedical informatics areas of applications.Summarize the informatics drivers and trends.


Describe the major hardware components of a computer and major types of software used in computer systems.


Describe major types of network configurations Comp 6, Unit 2b 15 min.

d. Hardware and Software Supporting Health Information Systems

The first lecture defines the concept of an information system and its characteristics, describes the different types of information systems, and describes various types of technologies that support health care information systems.

The second lecture examines the challenges presented by emerging trends in information technology (e.g., mobility, web services, the Internet, Intranet, and wireless computing), social media, and global communications and discusses the advantages and disadvantages of using the Internet as a platform for health care applications.

Objectives ONC lecture file TimeDescribe the major hardware components of a computer and major types of software used in computer systems.


Describe major types of network configurations. Comp 6, Unit 2b 15 min.

e. Introduction to Quality Improvement and Health Information Technology

This unit introduces the concept of health care quality and the importance of meaningful use of health information technology in improving healthcare quality. The Institute of Medicine quality improvement aims and the Institute of Healthcare Improvement’s triple aim are used to frame discussion of the role of health information technology in leading to improvements in patient safety, efficiency, effectiveness, equity, timeliness and patient centeredness.

Health Informatics 101 2

Also provided are examples of how Health IT can facilitate quality improvement as well as unintended consequences of health IT than can result from poor system design and user work-arounds.

Objectives ONC lecture file TimeIdentify the current challenges in health care quality.

Examine the components of the healthcare system that have an impact on quality.

Comp 12, unit 1a 20 min.

Explain healthcare quality and quality improvement (QI).Describe quality improvement as a goal of meaningful use.

Comp 12, unit 1b 21 min.

Describe QI as a goal of meaningful use of HIT Comp 12, unit 1c 15 min.

Analyze the ways that HIT can either help or hinder quality improvement.

Comp 12, unit 1d 9 min.

Optional Resources

History of Quality Improvement and Patient Safety Brown, C., Bailey, J., Davis, M., Garrett, P., and Rudman, W. (2005) Improving patient safety

through information technology. Retrieved from http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_028123.html

Harrison, J., Daly, M. (2007) Leveraging health information technology to improve patient safety. Public Administration and Management, 13(3), 218-237.

Herzer, K. (2009) A success story in American Health Care: Using health information technology to improve patient care in a Community Center in Washington. HealthReform.GOV, 1-4.

Small, S., Barach, P. (Dec. 2002) Patient safety and health policy: a history and review. BMJ, 16(6), 1463-1482.

Wachter, R. (2010) Patient safety at ten: Unmistakable progress, troubling gaps. Health Affairs, 29(1), 1-9.

The History of Hardhats History of VistA

Related News and Current Events

Dowd, M. (27 September 2011). Decoding the God complex. New York Times, Op-Ed Column.

Johnson, D. (22 September 2011). A $42 million gift aims at improving bedside manner. The New York Times, U.S.

Sack, K. (8 September 2011). Patient data posted online in major breech of privacy. The New York Times. (related Online discussion: http://www.healthitlawblog.com/2011/09/articles/major-data-breach-at-stanford-hospital/)


http://www.healthitlawblog.com/2011/09/articles/major-data-breach-at-stanford-hospital/

http://www.healthitlawblog.com/2011/09/articles/major-data-breach-at-stanford-hospital/

http://www.nytimes.com/2011/09/09/us/09breach.html?_r=3&hp=&pagewanted=all

http://www.nytimes.com/2011/09/22/us/university-of-chicago-gets-42-million-gift-for-bucksbaum-institute.html

http://www.nytimes.com/2011/09/28/opinion/dowd-decoding-the-god-complex.html?_r=2&ref=opinion

http://worldvista.sourceforge.net/vista/history/index.html

http://www.hardhats.org/history/hardhats.html

http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_028123.html

Professional Organizations AMIA

o Home page o Organizational summary

HIMSSo Home page o Video description and purpose (length 5:29 )

AHIMAo Home page o Description and resources o Video description (length: 6:29)

HL 7o Home page

HITSPo Home page

ONCo Health IT standards o Why are health IT standards important? (video)

What is Health Informatics? http://www.youtube.com/watch?feature=player_embedded&v=pzS--PaGC9o (6:04 YouTube

Video) Haux, R. (2006) Medical Informatics: Past, Present, and Future. International Journal of Medical

Informatics, 79(9), 599-610. Hersh, W. (2009) A stimulus to define informatics and health information technology. BMC

Medical Informatics and Decision Making, 9(24), 1-6.

What Do You Think? (non-graded questions for learners prior to reviewing the content)

1. Most medical errors in hospitals are the result of provider negligence. (T/F*)

Feedback:

*False: Correct! Medical errors in hospitals are more commonly linked to flawed systems and not provider neglect.

True: The lectures in this module will explain that errors are largely a result of flawed systems.

2. The single most effective way to reduce medical errors in hospitals is to provide additional training for providers. (T/F*)

Feedback:

*False: Correct! More often, in addition to poorly designed systems, errors are the result of factors such as sleep-deprived staff, an over-reliance on memory, and lack of use of information systems that can reduce errors by making high-quality information available for medical decision-making.

True: As you delve into this module, you’ll find that more often, errors are caused by poorly designed systems and factors such as sleep-deprived staff, an over-reliance on memory, and


http://www.youtube.com/watch?feature=player_embedded&v=pzS--PaGC9o

http://www.youtube.com/watch?v=9Mwolay9HQE

http://healthit.hhs.gov/portal/server.pt/community/standards_and_certification/1153/home/15755

http://www.hitsp.org/

http://www.hl7.org/

http://www.youtube.com/watch?v=TZzIw6RpQVg

http://www.ahima.org/about/default.aspx

http://www.ahima.org/advocacy/arrahitech.aspx

http://www.himss.org/ASP/about_YIRvideo.asp

http://www.himss.org/

http://www.who.int/workforcealliance/members_partners/member_list/amia/en/index.html

http://www.amia.org/

lack of use of information systems that can reduce errors by making high-quality information available for medical decision-making.

3. According to a 1999 Institute of Medicine report, approximately how many people die each year as the result of medical error?

a) *98,000b) 30,000c) 10,000

Feedback:

a. Excellent! An alarming statistic, isn’t it?

b, c. Believe it or not the number is much higher—98,000. Alarming, isn’t it?

Discussion Questions

1. What is Health Informatics? "Health Informatics" is a concept that can mean many different things to many different people. Consequently, what it means to be an effective "health informatician" is subject to debate. Some people argue that clinical background is most important (MD, nurse pharmacist, etc.); others suggest a technology background is more important (computer scientist, database administrator, project manager, etc.). Each of these arguments has merits: Each of the people described bring valuable experience and knowledge to the table.

For this discussion, what has your experience been? Consider the groups you have seen that successfully managed HIT projects. What was the group composition (e.g., backgrounds and roles) and what were their competencies? If you have been involved with an informatics project, describe the backgrounds and skills of the individuals involved, the process (including decision-making), and results.

2. Cognitive science was defined in the fourth lecture (Comp 6, Unit 1a) as: the study of the nature of various mental tasks and the processes that enable them to be performed. What role do you think cognitive science plays in health informatics? Think about an informatician helping to design a system to support clinical work: what would someone with training in cognitive science bring to the conversation? If applicable, describe an informatics project you’ve worked on and anything you might have done differently if you had had a better understanding of cognitive processes.

3. The Department of Health and Human Services has launched an initiative to aggregate health data and make it publicly available. Please visit the following site and watch the related videos: http://www.youtube.com/watch?v=vLrJ-y_3GhY&feature=related; http://www.youtube.com/watch?v=Ny2mo3z61ds Can you think of additional ways to leverage EHRs and/or health data in your work environment to improve efficiency, patient care, and/or medical research?

4. Find and share several examples of how telemedicine is being used to increase the effectiveness or accessibility of care. Feel free to share links to articles and videos you find.


http://www.youtube.com/watch?v=Ny2mo3z61ds

http://www.youtube.com/watch?v=vLrJ-y_3GhY&feature=related

Quiz Questions

1. According to the lecture, an important feature of the HITECH Act is:

a) Medical errors will now be easier to prove in a court of law.b) Doctors will have to “meaningfully use” certain reference books and not rely on their

memory.c) *Hospitals and providers may get money from the government if they adopt and

“meaningfully use” EHRs.d) Doctors will get bonus payments if they improve the quality of care they provide.

Feedback: Information on this topic can be found in Component 5, unit 14, slide 19.

2. According to one of the lectures in this module, the main “takeaway” point from the first IOM report on patient safety was:

a) *Errors occur because good people work in a bad system.b) Many less people die from errors than was at first believed.c) Nurses make more errors than doctors.d) Patients need to take a more proactive role in their own care.


3. What is the current body that will be recommending standards for electronic health records in the U.S.?

a) American National Standards Instituteb) Health Level 7c) *ONC Health IT Standards Committeed) Health Information Technology Standards Panel (HITSP)

Feedback: Information on this topic can be found in Component 5, unit 16b, slide 6-7.

4. Studies of medical error have identified which of the following as a way to prevent medical error?

a) Reduce reliance on memory.b) Improve access to information so that decisions aren’t based on incomplete data.c) Avoid hand-written orders.d) *All of the above.

Feedback: Information on this topic can be found in Component 5, unit 14, slides 4, 12.

5. True or false. Biomedical informatics as a field of study is narrow in that it focuses on use of biomedical information.

a) Trueb) *False

Feedback: Information on this topic can be found in Component 6, unit 1a, slide 10.


6. Which of the following definitions of informatics were presented by notable informatics organizations or professionals?

a) Informatics is the science of information, where information is defined as data with meaning.b) Biomedical and health informatics has to do with all aspects of understanding and promoting

the effective organization, analysis, management, and use of information in health care.c) Biomedical informatics is the scientific field that deals with biomedical information, data, and

knowledge—their storage, retrieval, and optimal use for problem solving and decision making.

d) *All of the above.

Feedback: Information on this topic can be found in Component 6, unit 1a, slides 5, 10 - 13.

7. True or False. The basic theoretical concept that underlies informatics practice involves a partnership between a person and an information resource.

a) *Trueb) False


8. In the context of Health Information Systems, what is a good example of how Decision Support Systems might be used?

a) Billing patientsb) *Helping providers make decisions by identifying drug-drug interactionsc) Schedulingd) Recruiting new providers


9. An example of a workaround that can result in unintended consequences is ___________.

a) Reporting a patient fall via an on-line event reporting systemb) *Having nurses enter prescriber orders because the prescriber is too busyc) Using a patient locator board to track patientsd) Using paper-based report sheets to communicate changes in patient condition

Feedback: Information on this topic can be found in Component 12, unit 1d, slides 7 - 10.

10. An example of a structure used to evaluate quality of health care information technology is ________.

a) *A policy describing the prescriber’s role and responsibilities with respect to provider order entry

b) Data on medication errors noted in the on-line event reporting systemc) Data on how well physicians and nurses document problems on the electronic problem listd) Patient satisfaction

Feedback: Information on this topic can be found in Component 12, unit 1b, slides 13-17.


2. Electronic Health Records and Data Standards(5 hours; lectures 3 hrs., 33 min.)

Topics, Descriptions and Objectivesa. Electronic Health RecordsThis unit defines an electronic medical record (EMR) and an electronic health record (EHR) and explains their similarities and differences, identifies attributes and functions of an EHR, discusses the issues surrounding EHR adoption and implementation, and describes the impact of EHRs on patient care.

In addition, the unit links EHRs to the Health Information Exchange (HIE) and the Nationwide Health Information Network (NHIN) initiatives, discusses how HIE and NHIN impact health care delivery and the practice of health care providers, summarizes the governmental efforts related to EHR systems including meaningful use of interoperable health information technology and a qualified EHR, describes the Institute of Medicine’s vision of a health care system and its possible impact on health management information systems, and lists examples of the effects of developments in bioinformatics on health information systems.

Objectives ONC lecture file TimeState the similarities and differences between an electronic medical record (EMR) and an electronic health record (EHR).

Identify attributes and functions of an EHR.

Describe the perspectives of health care providers and the public regarding acceptance of or issues with an EHR, which can serve as facilitators of or major barriers to its adoption.

Explain how the use of an EHR can affect patient care safety, efficiency of care practices, and patient outcomes.


Discuss how a health information exchange (HIE) and the Nationwide Health Information Network (NHIN) impact health care delivery and the practice of health care providers.

Outline issues regarding governmental regulation of EHR systems such as meaningful use of interoperable health information technology and a qualified EHR.

Summarize how the Institute of Medicine’s Vision for 21st Century Health Care and Wellness may impact health management information systems.


b. Clinical Decision Support


The first lecture offers a definition of clinical decision support systems, provides some historical context surrounding these systems, describes the requirements of a clinical decision support system, and discusses the relationship of clinical practice guidelines and evidence-based practice to clinical decision support systems.

Lecture 2 identifies challenges and barriers in building and using clinical decision support systems, explains how legal and regulatory considerations may affect their use, and introduces the future directions for clinical decision support systems.

Objectives ONC lecture file TimeDescribe the history and evolution of clinical decision support

Describe the fundamental requirements of effective clinical decision support systems

Discuss how clinical practice guidelines and evidence-based practice affect clinical decision support systems;


Identify the challenges and barriers to building and using CDDSs.

Discuss legal and regulatory considerations related to the distribution of CDDSs.

Describe current initiatives that will impact the future and effectiveness of CDDSs.


c. Consumer Health Informatics

This unit provides definitions of health communication, e-Health, consumer health informatics and interactive health communication, identifies how the Internet has impacted consumer health informatics, explains how current and emerging technologies may affect consumer health informatics, and introduces the role of genomics in consumer health informatics. Lecture Comp 6, Unit 8.2 offers definitions of personal health records or PHRs, describes the role of PHRs and their implications within health care, and discusses the challenges of consumerism in health information systems.

Objectives ONC lecture file TimeExplain how current and emerging technologies – including the Internet – have impacted and may continue to affect consumer health informatics.


Describe the role of genomics in consumer health informatics.


Describe the emergence of Personal Health Records and their implications for patients, health care providers, and health systems.



Objectives ONC lecture file Time

Discuss how consumerism influences the ongoing development and use of health information systems.

Comp 6, Unit 8aComp 6, Unit 8b

22 min.24 min.

d. Basic Health Data Standards

In this unit, participants will examine the relationship of administrative, billing, and financial systems to the health care information system, explain applications that need to be integrated in health care information systems, explore health care organizations’ integration strategies, identify the critical elements for integration of these systems with clinical information systems, and discuss how health care organizations may gain valuable insights from integrated data through data analytics and trending. They will also define a master patient index (MPI) and describe its core elements as well as discuss current trends to establish a unique patient identifier.

Objectives ONC lecture file TimeDiscuss why it is necessary to use a common set of data elements with common names to be able to exchange and understand data from other places.

Define what is meant by semantic interoperability.


Describe many of the sets of controlled vocabularies in use today – how they are used and who requires their use.


20 min.24 min.

Describe the interrelationship among sets of controlled vocabularies in use today.

Identify the more common controlled vocabularies in use today: ICD, CPT, DRG, NDC, RxNorm, and LOINC.


Optional Resources

Electronic Health Records Abraham, S. (2010). Technological trends in healthcare: Electronic health record. The Health

Care Manager, 29(4), 318-323.

Ash, J., Sittig, D., Poon, E., Guappone, K., Campbell, E., & Dykstra, R. (2007). The extent and importance of unintended consequences related to computerized provider order entry. Journal of the American Medical Informatics Association, 14 (4), 415-423.

Blumenthal, D., & Tavenner, M. (2010). The “Meaningful Use” regulation for electronic health records. The New England Journal of Medicine, 363(6), 501-504.


CBS News video (2:47) Are Electronic Medical Records the Future?

Miller, R., & Sim, I. (2004). Physicians’ use of electronic medical records: Barriers and solutions. Health Affairs, 23(2), 116-126.

Shea, S., & Hripcsak, G. (2010). Accelerating the use of electronic health records in physician practices. New England Journal of Medicine 362(3), 192-195.

Tang, P., Ash, J., Bates, D., Overhage, M., & Sands, D. (2006). Personal health records: Definitions, benefits, and strategies for overcoming barriers to adoption. Journal of the American Medical Informatics Association, 13(2), 121-126.

Ueckert, F., Goerz, M., Ataian, M., Tessman, S., & Prokosch, H. (2003). Empowerment of patients and communication with health care professionals through an electronic health record. International Journal of Medical Informatics, 70(2-3), 99-108.

Consumer Health Informatics

Alpay, L., Verhoef, J., Xie, B., Te’eni, D., & Zwetsloot-Schonk, J. (2009.) Current challenges in consumer health informatics: Bridging the gap between access to information and information understanding. Biomedical Informatics Insights, 09(2), 1-10.

Civan-Hartzler, A., McDonal, D.W., Powell, C., Skeels, M.M., Mukai, M., & Pratt, W. (2010). Bringing the field into focus: User-centered design of a patient expertise locator. Proceedings of CHI 2010, 1675-1684.

Eysenbach, G., & Jadad, A. (2001). Evidence-based patient choice and consumer informatics in the Internet age. Journal of Medical Internet Research, 3(2), 1-16. Available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1761898/?report=printable.

Keselman, A., Logan, R., Smith, C., Leroy, G., & Zeng-Treitler, Q. (2008). Developing informatics tools and strategies for consumer-centered health communication. Journal of the American Medical Informatics Association, 15(4), 473-484.

Mantas, H. J. (2007). Education and consumer health informatics. AMIAYearbook of Medical Informatics 2007, 90-95.

McDaniel, A., Schutte, D., & Keller, L. (2011). Consumer health informatics: From genomics to population health. Nursing Outlook, 56(6), 216-227.

Veinot, T.C. (2010). We have a lot of information to share with each other: Understanding the value of peer-based health exchange. Information Research, 15(4), Paper 452. Available at http://informationr.net/ir/15-4/paper452.html


1. The difference between an electronic medical record (EMR) and an electronic health record (EHR) is that an EMR is the electronic equivalent of an individual’s medical record for use by


http://informationr.net/ir/15-4/paper452.html

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1761898/?report=printable

http://www.moodle.org/0.38246372665139916

http://www.cbsnews.com/stories/2009/05/19/eveningnews/main5026117.shtml

providers and staff at one health care location where as an EHR is an individual’s health record for use by providers and staff at more than one health organization. (T*/F)

Feedback:

*True: Correct! Though EMR and EHR are often confused, the electronic health record indicates that the data collected here is for use by providers and staff in multiple health organizations and not limited to one office or health system.

False: Nice try. You are not the first to confuse these two terms. In this module's lectures you'll see the difference between EMR and EHR and how EHR is for use by providers and staff in multiple health organizations and not limited to one office or health system.

2. Which of the following is an example of how the use of an electronic health record (EHR) can affect patients’ outcomes?

a) Provides seamless exchange of information*b) Reduces billing costsc) Establishes new workflow processesd) None of the above

Feedback:

a. Correct! EHRs can help affect and hopefully improve patient outcomes by ensuring that all health information about a patient be in one place and can be easily accessed by all providers assisting a particular patient. This type of care coordination can have a positive impact on patient outcomes.

b, c, d. Good try. Though EHRs can have many benefits, such as eliminating the costs of duplicate services, the seamless exchange of information has the most significant impact on patient outcomes through improved care coordination.

3. While some consumers might maintain their own Personal Health Record (PHR) of illness or family history, the information contained in the PHR is often too subjective and is of no benefit to a health care provider who might be providing care to a consumer. (T/F)

Feedback:

*False: Correct! A PHR can be a valuable communication tool and may contain information that would aid the provider in determining the best treatment.

True: Good try. Though a PHR may include data and information that is more qualitative or subjective, it can help bridge an information gap between what a single health care provider may know, and the total picture.

4. Following is an example of clinical decision support: You are a primary care physician in a large group practice that uses an electronic health record (EHR). At the beginning of each visit, you view a dashboard of preventive care measures –such as flu vaccine, colon cancer screening, cholesterol tests - that are due for your patient, based on age, medical history (problem list), and medication list stored in the EHR.


Feedback:

*True: Correct! Though there are a variety of ways a clinical decision support system can support care, the presentation of just-in-time information based on patient data is a strong example of a clinical decision support system at work.

False: Nice try. A strong example of a clinical decision support system at work is thepresentation of just-in-time information based on patient data.


1. Think about how the use of an EHR affects patient care, safety, efficiency of care practices, and patient outcomes. Answer the following questions: What are the major benefits of an electronic record to the patient, the clinician, the health

care facility, and the public? What benefits do you see for patients? What are the major challenges faced by staff in your department (if you are working in a

healthcare organization) or healthcare staff in general regarding EHR use? What can be done to address those challenges?

What steps might be taken to promote the benefits and overcome barriers to widespread adoption of EHRs?

2. Do you know anyone who uses a Personal Health Record (PHR) system? This could be a PHR through a provider or something publically available such as Microsoft HealthVault. Think about and discuss how a patient's use of a PHR could enhance or degrade the patient-provider relationship. How do you expect the use of a PHR to affect the care a patient receives? How do you think it might affect a patient visit if the patient has a PHR? Please share your experiences as a patient, provider, or caregiver using a PHR, if you are

comfortable doing so.

3. Data standards are an important topic in health informatics. Why are standards so important in this field? Why do you think it has been so hard to get a single standard for health informatics use

cases? What other industries require the use of standards (not necessarily a data standard)? Are

there any parallels that can be drawn between those industries and the health care industry? Are they further along than health care in the adoption of a standard or set of standards? Can we learn anything from their experiences?

4. The Five Rights of Clinical Decision Support is a communication framework for supporting clinical decisions to improve healthcare outcomes. The Five Rights include:1. Right information2. Right person3. Right CDS intervention format4. Right channel5. Right point of workflow

(Click http://www.himss.org/content/files/5RightFlowchart.pdf to see a flowchart depicting the 5 Rights.)


http://www.himss.org/content/files/5RightFlowchart.pdf

Describe a scenario that you've witnessed or participated in where you see CDS at work, outlining the process in terms of the Five Rights. Is the process foolproof? What are some of the challenges you see and how might CDS be improved, particularly given the scenario you described?

Quiz Questions

1. Which electronic records encapsulates a record of medical care provided in a single health care organization, i.e., intra-organizational?

a) *Electronic Medical Record (EMR)b) Computerized Patient Record (CPR)c) Computerized Patient Medical Record (CPMR)d) Electronic Health Record (EHR)


2. Which of the following is not a fundamental requirement of a clinical decision support system?

a) Inference engineb) *Clinical workflow toolsc) Knowledge based) Communication mechanism

Feedback: Information on this topic can be found in Component 6, unit 5a, slides 8-11.

3. True or false. Health consumerism can be seen as an inhibitor in the development of patient-centric health information systems.

a) Trueb) *False

Feedback: Information on this topic can be found in Component 6, unit 8b, slide 14.

4. True or false. LOINC is widely used in the US for the names of laboratory tests.

a) *Trueb) False


5. Match the following words with their definition.

1) Vocabulary2) Terminology3) Nomenclature4) Classification5) Taxonomy6) Ontology


a) This is a formal representation of a set of concepts within a domain and the relationships between those concepts.

b) This refers to a system of names or terms used in a particular science or art. It is a consistent, systematic method of naming to denote classifications and avoid ambiguities. Example: Names of anatomical structures or organs of the body.

c) This is a set of words used to express a concept or thought.d) This considered by most to be a synonym of vocabulary. It is a finite, enumerated set of

terms intended to convey information unambiguously. It is a body of terms assigned to or used for a particular type of thing.

e) This is a grouping of objects into a class or classes according to some common relations or attributes.

f) This is the practice and science of classification. These are typically arranged in a hierarchical structure and exhibit parent-child relationships.

1--(a) Ontology2--(b) Nomenclature3--(c) Vocabulary4--(d) Terminology5--(e) Classification6--(f) Taxonomy



3. Health Data Exchange and Privacy and Security(5 hours; lectures 1 hr., 51 min.)


a. Health Data Interchange Standards

This unit explores the functional requirements and standards for electronic health records (EHRs).

Objectives ONC lecture file TimeIdentify architecture for an EHR.

Identify and understand key standards for the EHR.


Describe the HL7 EHR Functional Model Standards.

Define functional profiles.


25 min.25 min.

Describe the standards for Functional Models for the PHR. Comp 9, Unit 5b 25 min.

Define the certification requirements for EHR, PHR, and functional profiles.

Comp 9, Unit 5aComp 9, Unit 5bComp 9, Unit 5c

25 min.25 min.27 min.

b. Privacy, Confidentiality, and Security Issues and Standards

This unit explores issues related to creating an environment in which to transport data in a secure manner that ensures privacy and confidentiality.

Objectives ONC lecture file TimeExplain the concepts of privacy and confidentiality requirements and policies and learn how to implement the requirements.

Describe how to secure data storage and transmission using data encryption, signatures, validation, non-repudiation, and integrity (PKI, certificates, and security protocols).


Define access control methods.Analyze access restrictions to data storage and retrieval (physical and software).


Optional Resources


Health Data Interchange

Blumenthal, D., Tavenner, M. (2010). The ‘Meaningful Use’ regulation for Electronic Health Records. Journal of Medicine, 363, 501-504.

Ferris, P. (2010) Electronic Health Records Standards. Health Affairs, 30(9), 1-4.

Hammond, W. (2010). Connecting information to improve health. Health Affairs, 29(2), 85-91.

Hammond, W. (2005). The making and adoption of Health Data Standards. Health Affairs, 24(5), 1205-1215.

Kush, R. (2009). What the patient should order. Science Translational Medicine, 1(3 3mc3), 1-5.

Mead, C. (2004). Data Interchange Standards in health IT--computable semantic interoperability: Now possible but still difficult, do we really need a better mousetrap? Journal of Healthcare Information Management, 20(1), 71-79.

U.S. Department of Health and Human Services, Office of the National Coordinator for Health Information Technology (28 July 2010). Health Information Technology: Initial Set of Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology: Final Rule. Federal Register, 75 (144) #44590-654.

Wise P. (2010). The meaning of meaningful use: Several technology applications are needed to qualify. Healthcare Executive, 25, 20-1.

HR7 EHR System Functional Model Sample Profiles

EHR Functional Profile Working Group Research Study

Requirements for an Electronic Health Record Reference Architecture. ISO 18308:2011. Geneva, Switzerland: ISO.

Electronic Health Record Standards – A Brief Overview

How HL7 works (3:00 Vimeo video)

Links to Online Standards Resources

EHR Standards and Certification Criteria Final Rule

HL7 EHR Homepage

Health Information Technology Standards - PHDSC Glossary

Healthcare Information Technology Standards Panel

EHR Functional Profile Project

Privacy, Confidentiality, and Security Issues and Standards


http://www.eclinicalforum.org/Default.aspx?alias=www.eclinicalforum.org/ehrcrproject

http://www.hitsp.org/default.aspx

http://www.phdsc.org/standards/health-information-tech-standards.asp

http://www.hl7.org/EHR/

http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__standards_and_certification/1153

http://www.himss.org/ASP/topics_FocusDynamic.asp?faid=450

http://blog.interfaceware.com/hl7/how-does-hl7-work/

http://lob.kuhp.kyoto-u.ac.jp/document/icict06_20060810.pdf

http://www.eurorec.org/files/filesPublic/ehrworkshop/2008/HL7%20EHRCR%20Functional%20Profile%20Rel%201.pdf

http://www.providersedge.com/ehdocs/ehr_articles/HL7_EHR_System_Functional_Model-Sample_Profiles.pdf

Ferreira, A., Cruz-Correia, R., Antunes, L., Chadwick, D. (2007). Access control: How can it improve patients' healthcare? Studies in Health Technology Informatics, 127, 65-76.

Hurdle, J. (2007). A code of professional ethical conduct for American Medical Informatics Association. Journal of the American Medical Informatics Association, 14(4), 391-393. [pdf]

Lohr, S. (26 February 2011). Carrots, sticks, and Digital Health Records. The New York Times, BU3. Available at http://www.nytimes.com/2011/02/27/business/27unboxed.html?_r=1

Wainer, J., Campos, C., Salinas, M., Sigulem, D. (2008) Security requirements for a lifelong Electronic Health Record System: An opinion. The Open Medical Informatics Journal, 2, 160-165.

Win, K.T. (2005). A review of security of electronic health records. Health Information Management Journal, 34(1), 13-18.

ONC Privacy and Security Standards

HIPPA Privacy Components and Guidelines and their Application in Health Information Technology

EMR and HIPPA, an Open Forum Discussing Current Issues

Summary of Federal Laws and Regulations Addressing Confidentiality, Privacy and Security

HIPAA IT Security: Moving Beyond HIPAA to EHR Security as a Healthcare Provider (8:28 YouTube video)

HITECH Act

Usability

Bardram, J. (2005). The trouble with login: On usability and security in ubiquitous computing. Personal and Ubiquitous Computing, 9, 357-367.

Blobel, B. (2001). Advanced and secure architectural EHR approaches. International Journal of Medical Informatics, 75, 186-190.

McGinn, C., Grenier, S., Duplantie, J., Shaw, N., Sicotte, C., Mathieu, L., Leduc, Y., Legare, F., Gagnon, M. (2011). A comparison of user groups' perspectives of barriers and facilitators to implementing electronic health records. BMC Medicine, 9(46), 1-10.

Miller-Jacobs, H., Smelcer, J. (2007). Usability of electronic medical record system: An application in its infancy with a crying need. Proceedings of the 2007 Conference on Human Interface: Part II, 759-765.

Lewis, N. (1 November 2011). NIST: Make EHRs more user-friendly. Information Week.

Russ, A., Saleem, J., Justice, C., Woodward-Haag, H., Woodbridge, P., Doebbeling, B. (2010). Electronic health information in use: Characteristics that support employee workflow and patient care. Health Informatics Journal, 16(4), 287-305.


http://www.informationweek.com/news/healthcare/EMR/231902018

http://www.hhs.gov/ocr/privacy/hipaa/administrative/enforcementrule/hitechenforcementifr.html

http://www.youtube.com/watch?v=7dPg45cIGUM

http://healthit.hhs.gov/portal/server.pt/gateway/PTARGS_0_11113_911059_0_0_18/Federal%20Privacy%20Laws%20Table%202%2026%2010%20Final.pdf

http://www.emrandhipaa.com/tag/ehr-security/

http://www.hhs.gov/ocr/privacy/hipaa/understanding/special/healthit/

http://www.hhs.gov/ocr/privacy/hipaa/understanding/special/healthit/

http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__privacy_and_security/1147

http://www.nytimes.com/2011/02/27/business/27unboxed.html?_r=1

Smelcer, J., Miller-Jacobs, H., Kantrovich, L. (2009). Usability of Electronic Medical Records. Journal of Usability Studies, 4(2), 70-84.


1. HL7v2 is a common messaging standard used by nearly 90 percent of hospitals in the US. (*T/F)

Feedback:

*True: Correct! ! HL7 version 2 defines a series of electronic messages to support administrative, logistical, and financial as well as clinical processes. These messaging standards support the exchange, integration, sharing, and retrieval of electronic health information and are the most commonly used in the world.

False: Good try! HL7 version 2 defines a series of electronic messages to support administrative, logistical, and financial as well as clinical processes. These messaging standards support the exchange, integration, sharing, and retrieval of electronic health information and are the most commonly used in the world.

2. The Health Information Portability Accountability Act (HIPAA) is a government mandate that does all of the following EXCEPT:

a) Ensures that individuals have rights to their own health care informationb) Mandates that all employers pay for health insurance coverage for their employees*c) Defines policies, procedures, and guidelines for maintaining the privacy and security of

individually identifiable health information; outlines offenses and sets penalties for violationsd) Limits restrictions that a group health plan can place on benefits for preexisting conditions

Feedback:

b. Correct! While HIPAA offers many protections for those who have health insurance as well as the information contained in one’s health record, it does not mandate that employers pay for employee health care coverage.

a, c, d. Good try. While HIPAA offers many protections for those who have health insurance as well as the information contained in one’s health record, it does not mandate that employers pay for employee health care coverage.

3. (T/*F) Digital signatures can be changed and customized by the healthcare provider and are more ornamental, providing little value to health information systems.

Feedback:

False: Correct! Digital signatures are created by using secure private key encryption. Only the originator has the key, so the data couldn’t have been created by anyone else, and a system can track all orders and data entries back to the originator. In information systems, digital signatures are assigned and by nature are non-transferable.


True: Good try. Digital signatures are created by using secure private key encryption. Only the originator has the key, so the data couldn’t have been created by anyone else, and a system can track all orders and data entries back to the originator. In information systems, digital signatures are assigned and by nature are non-transferable.


1. Imagine you are advising the CIO of a large healthcare network. The CIO is trying to make a decision about priorities and requirements for purchasing a new clinical system. She wants to know if she should pay what she feels is a reasonable amount for a system with HL7 v2 capabilities but no V3 capabilities, or invest significantly more to include HL7 v3. What would your advice be? Do you think HL7 V3 will “catch on”? Point to an outside source such as an article, white paper, or blog to support your opinion.

2. Sometimes security and privacy concerns seem like a burden, requiring we spend extra time logging in, using tokens, and preventing us from accessing information we feel that we need. But what if your health information or the health information of a loved one were to be compromised? Would you be concerned? Are concerns and the steps we take to protect information going too far? Give examples from healthcare or other areas like banking or financial services.

3. Dr. Jones has worked as a provider in the Cedar Hills clinic for many years. She knows that the receptionist’s husband has Parkinson’s and you recently saw a patient who was doing very well on a particular treatment suggested by a specialist in the next town. At Cedar Hills everyone takes confidentiality and privacy very seriously, but Dr. Jones is considering telling the receptionist about this patient and his treatment. What would happen at your workplace if Dr. Jones took a screenshot from the patient’s record and emailed it to the receptionist? How could Dr. Jones communicate this information and stay within ethical and legal boundaries? Respond to the suggestions of other students if you agree or disagree with their suggestions.

4. On the Internet, search and find a recent (within the last year) security breach – it can be in healthcare or another industry. In your post, describe the security breach. How did it take place? Were the criminals caught? How? What reaction did industry/government/general population have to this breach? Tell how the breach could have been prevented and what types of security measures should be put in place to stop the incident from happening again. Be sure to include any terms or concepts covered in this module.

Quiz Questions

1. ________ is based on an object information model called the Reference Information Model (RIM), Patient Records.

a) *HL7 v3b) DICOM v2.nc) XML v3.nd) HL7 v2.n

Feedback: Information on this topic can be found in Component 9, unit 5b, slides 4, 5.

2. _________ is the standards developing organization that focuses primarily on device standards.


a) X12Nb) NCPDPc) DICOMd) *IEEE

Feedback: Information on this topic can be found in Component 9, Unit 5c slide 9.

3. _______ messaging standard is easy to use and understand. It is based on an implicit information model.

a) HL7 v3b) DICOM v2.nc) XML v3.nd) *HL7 v2.n

Feedback: Information on this topic can be found in Component 9, Unit 5a slide 7.

4. HL7 messages are composed of reusable segments, each identified by a __ -letter mnemonic.

a) twob) *threec) fourd) five


5. ___________ is defined as making sure that only authorized individuals have access to information.

a) Integrityb) Availabilityc) *Confidentialityd) Nonrepudiation


6. __________ means that the data on a system is the same as the data from the original source. It has not been altered.

a) *Integrityb) Availabilityc) Confidentialityd) Nonrepudiation


7. ________ provides proof that a certain action has taken place or that something/someone is what they claim to be.

a) Integrityb) Availability


c) Confidentialityd) *Nonrepudiation


8. ______ defines who or what is allowed access to a particular resource and what level of access they are allowed.

a) *Access controlb) Authenticationc) Accessibilityd) Authorization


9. ________ is (are) used to verify the identity of the source. It binds a public key with information about the source.

a) PKIb) Encryptionc) *Certificatesd) Hashes


10. Security is __________?

a) The quality or state of being secureb) Freedom from fear or anxietyc) Measures taken to guard against espionage or sabotage, crime, attack or escaped) *All of the above



4. Workflow Analysis(5 hours; lectures 2 hrs.,1 min.)


a. The Concepts of Health Care Processes and Process Analysis

This unit focuses on the six aims for health care process improvement. In this unit, students are helped to understand the concepts of systems, systems thinking and health care processes. Such understanding provides a foundation for the study of clinical process analysis and redesign.

Objectives ONC lecture file TimeIdentify the elements involved in providing patient care within a complex health care setting that must be taken into consideration when examining and proposing changes in workflow processes.

Identify processes in the healthcare setting that support workflow analysis and redesign.


Critically analyze the workflow processes in a selected health care setting to determine their effectiveness from the perspective of those being served (i.e., patients), those providing the services (i.e., professional and non-professional staff), and the organization’s leadership (i.e., decision makers).


32 min.28 min.

Identify ways in which quality improvement methods, tools and health IT can be applied within a healthcare setting to improve workflow processes.

Suggest approaches that would ensure the success of workflow redesign from development and presentation of the implementation plan, to facilitation of decision making meetings, implementation of the changes, evaluation of the new processes, sustainability of new workflow processes, and continuous quality improvement efforts to achieve meaningful use.

Apply to these activities an understanding of health IT, meaningful use, and the challenges practice settings will encounter in achieving meaningful use.


b. Process Mapping Theory and Rationale

This unit covers the background necessary for graphically representing processes. It uses flowcharts and basic flowchart symbols to provide an introduction to graphical process


representation, also called process diagramming. Separate units cover complete symbol sets and conventions for different types of process diagrams.

Objectives ONC lecture file TimeArticulate the value of process mapping.

Describe standard processing mapping symbols and conventions.

Analyze an existing workflow process chart in terms of the information that could be generated, and the sequence of steps that are being communicated.

Choose the correct scope and detail level for a process map.

Choose an appropriate process mapping methodology.

Create a process map for a health care system (or system component) using correct symbols and conventions.


c. Acquiring Clinical Process Knowledge

This unit covers the concepts and methods for acquiring clinical process knowledge in the health care setting that are needed by the health care Workflow Analysis and Redesign Specialist.

Objectives ONC lecture file TimeIdentify how the strategic goals and stakeholders for a given health care facility can influence workflow processes in that facility.Create an agenda for an opening meeting to discuss workflow processes in a health care facility, taking into account that facility’s strategic goals and stakeholders.

Compare and contrast different types of knowledge and their impact on organizations.

Analyze a health care scenario according to CMMI levels.


Identify the workflow processes that are likely to be used by a healthcare facility.


18 min.14 min.

Identify the workflow processes that are essential to document and analyze in order to determine how best to streamline the operations in a given health care facility.

Identify key individuals the analyst should meet with or observe in order to gain an understanding of the nature and complexity of their work.



Objectives ONC lecture file Time

Given a process observation scenario, formulate the questions that would facilitate a productive discussion of the workflow of information, activities and roles within that facility.

Suggest ways to successfully respond to common challenges encountered in knowledge acquisition.

Given a practice scenario, choose an appropriate knowledge acquisition method.


18 min.14 min.

Given a process analysis scenario including list of observations, create an agenda for a visit closing meeting and an initial meeting report.



Given a set of diagrams and observations from an information gathering meeting, draft a summary report.

Comp 10, Unit 4bComp 10, Unit 4c

14 min.17 min.

Optional Resources

Workflow Analysis

Workflow Analysis – What you Need to Do Drives How You Set Up a System

Workflow Redesign in Support of the Use of Information Technology within Healthcare (presentation).

Health Informatics for Different Needs and Settings Curioso, W.H., Peinado, J., Crisogono, F.R., & Castagnetto, J.M. (2009). Biomedical and health

informatics in Peru: Significance for public health. Health Information and Libraries Journal, 26, 246-251.

Geis, J.R. (2007). Medical imaging informatics: How it improves radiology practice today. Journal of Digital Imaging, 20(2), 99-104.

Hynes, D.M., Weddle, W., Smith, N., Whittier, E., Atkins, D. & Francis, J. (2010). Use of health information technology to advance evidence-based care: Lessons from the VA QUERI program. Journal of General Internal Medicine, 25(1), 44-49.

Kern, L.M., Wilcox, A.B., Shapiro, J., Yoon-Flannery, K., Abramson, E., Barron, et al. (2011). Community-based health information technology alliances: Potential predictors of early sustainability. The American Journal of Managed Care, 17(4), 290-295.

Koch, S., & Hagglünd, M. (2009). Health informatics and the delivery of care to older people. Maturitas, 63(3), 195-199.


http://www.himss.org/content/files/Workflow_RedesignMEPI040201.pdf

http://www.himss.org/content/files/Workflow_RedesignMEPI040201.pdf

http://www.radiologytoday.net/archive/rt061608p30.shtml

McGregor, J., Brooks, C., Chalasani, P., Chukwuma, J., Hutchings, H., Lyons, R.A., et al. (2010). The health informatics trial enhancement project (HITE): Using routinely collected primary care data to identify potential participants for a depression trial. Trials 2010, 11:39, 1-6.

Protti, D.J. (2005). Health and medical informatics in the 21st century: Will the future be about EbM2C? Informatics in Primary Care, 13, 1-2.

Shapiro, J.S., Mostashari, F., Hripcsak, G., Soulakis, N., and Kuperman, G. (2011). Using health information exchange to improve public health. American Journal of Public Health, 101(4), 616-623. ]

Stephens, M.B., & Von Thun, A.M. (2009). Military medical informatics: Accessing information in the deployed environment. Military Medicine, 174(3), 259-264.


1. The physical layout of a clinic can impact effective workflow. T*/F

Feedback:

True: Yes! Inconvenient layouts can increase the length of time a process takes; that time can add up over an 8-hour period.

False: As you’ll see when you view the module lectures, inconvenient layouts can actually increase the length of time a process takes; that time can add up over an 8-hour period.

2. Workflow and information flow are two distinct but related processes. T*/F

Feedback:

True: Yes! Nice work.

False: Good try. As you’ll see when you view the module lectures, the steps in a workflow may not capture the subsequent use and flow of information entered during a particular process. Information flow typically needs to be documented separately from a process workflow.

3. Everyone in an organization is involved in some aspect of a workflow process. T*/F

Feedback:

True: Excellent. Yes, workflows are ubiquitous in organizations.

False: After you delve into this module and get a clear understanding of workflow, you’ll likely agree that all employees are involved in at least one workflow process.


1. For understanding processes in a healthcare organization, which do you think is more important:a) being able to talk with people


b) having access to documentation

What are the respective pros and cons of each approach? If you were asked to document processes for an organization, what would you consider the ideal information-gathering process?

2. Most people have encountered organizations with inefficient processes. Have you worked in or interacted with an organization that could have improved workflow? Please describe this organization, which does not need to be an employer. Maybe you’ve had an experience at the Department of Licensing or at the local coffee shop (you can also change the details so that the organization or processes cannot be identified, if necessary). Were information systems involved?

Describe the situation and talk about how the inefficiencies were resolved, or, if they were not resolved, suggest processes that should be changed.

3. Have you ever experienced a situation where an information system was introduced and the workflow or processes were completely changed? Do you think that workflow is usually made more efficient or less efficient by the introduction of an information system? Back up your assertion with evidence or anecdotes from your own experience.

4. Have you been involved in or observed a workflow redesign project that was negatively impacted by change management and/or leadership issues? If so, please describe the situation and how these issues could have been mitigated.

Quiz Questions

1. The Institute of Medicine-based goals of healthcare process analysis and redesign include improving which of the following?

a) Patient safetyb) Evidence-based carec) Patient-centered cared) *All of the above


2. Which of the following is usually NOT examined as part of a process analysis?

a) The steps/activities in the processb) The order of steps in the processc) *How the existing process originatedd) What information is needed or generated


3. True or false? The type of process flaws that process redesign can improve include gaps, inefficiencies, lack of alignment with best practices, redundancies, delays, and rework.

a) *Trueb) False



4. What symbol should be used to diagram the following process step: "If the patient is a new patient, then . . . ."

a) *Diamondb) Ovalc) Pentagond) Rectangle


5. Indicate which statement is true:

a) Information flow and workflow are the same thing.b) Information flow and workflow can be shown on a context diagram.c) Information flow and process flow can be shown on an E-R diagram.d) *Information flow and process flow can be shown on a flowchart.

Feedback: Information on this topic can be found in Component 10, unit 2a, slide 14-20

6. Indicate which statement is true:

a) * Process maps document the tasks involved in a process as well as their sequence.b) There is only one type of diagram for each process aspect.c) Different organizations typically each have their own unique set of symbols for process

maps.d) There is only one correct representation for any process.

Feedback: Information on this topic can be found in Component 10, unit 2a, slides 6, 18.

7. Which best describes the goal of Knowledge Acquisition (KA)?

a) To increase the analysts' clinical knowledgeb) *To gather and capture process knowledgec) To create process diagramsd) To document clinical procedures


8. A process inventory is developed from which of the following?

a) UML diagramb) *A list of clinical servicesc) Clinic stakeholder diagramd) Patient and family services


9. Which of the following types of knowledge is the easiest for organizations to share with others?


a) *Coded knowledgeb) Tacit knowledgec) Sticky knowledged) Experiential knowledge


10. Which of the following stakeholders is NOT typically interviewed or observed as part of the information gathering process in a clinic?

a) A patientb) A physicianc) A receptionistd) *A health IT vendor

Feedback: Information on this topic can be found in Component 10, unit 4c, slides 7-8.


5. Process Redesign(5 hours; lectures 3 hrs., 25 min.)


a. Process Redesign

This unit covers the background and methodology for process redesign in the health care facility.

Objectives ONC lecture file TimeIdentify the factors that optimize workflow processes in health care settings.

Describe how information technology can be used to increase the efficiency of workflow in health care settings.

Comp 10, Unit 6a 24 min

Identify aspects of clinical workflow that are improved by EHR.

Comp 10, Unit 6aComp 10, Unit 6c

24 min.19 min.

Propose ways in which the workflow processes in health care settings can be redesigned to ensure patient safety and increase efficiency in such settings.



Use knowledge of common software functionality to inform a process redesign for a given clinic scenario.

Comp 10, Unit 6c 19 min.

b. Quality Improvement Methods

This unit covers quality improvement methods recommended for use in the health care setting. Many different approaches to quality improvement have been used in the health care arena. An awareness of the history, methods, and tools of quality improvement is critical.

Objectives ONC lecture file TimeDescribe strategies for quality improvement.

Describe the role of leadership in quality improvement.

Describe and recommend tools for quality improvement.

Compare and contrast the quality improvement methodologies and their appropriate uses in the health care setting.


c. Leading and Facilitating Change


This unit introduces the concepts of change and the impact of such change on the providers and staff within a health care facility. It enhances the understanding that workflow analysts must be sensitive to the human component as they examine and propose modifications in processes. Students will be prepared to recognize and address common change management problems, and to work with individuals and groups to facilitate change.

Objectives ONC lecture file TimeExplain concerns expressed by participants in a process analysis and redesign scenario in terms of common change management concepts.

Propose strategies to gain acceptance of changes in work process.

Create and critique a facilitation plan, including appropriate facilitation tools for a given process analysis and redesign scenario.

Given a health care change management scenario, explain outcomes in terms of common change management concepts.


d. People and Technology

This unit covers cognitive research methods, sources of usability evidence, and principles of user-centered design that inform decisions regarding systems evaluation, technology evaluation, and iterative design.

Objectives ONC lecture file TimeExplain the importance of technology in health.

Describe the contributions of Human-Computer interaction to the Health field.

Describe the seven stages of user activity in Norman’s Theory of Action.


Demonstrate concept knowledge of principles of user-centered design, methods of cognitive research, and sources of usability evidence.

Apply the principles of user-centered design to addressing the challenges to effective design.

Compare and contrast usability evaluation methods.

Comp 10, Unit 6bComp 15, Unit 1a

21 min.15 min.

Identify and differentiate various types of errors in medicine.

Identify patient safety issues in the workplace and at home.



e. Requirements Engineering

This unit covers the application of requirements engineering methods to inform design and technology selection.

Objectives ONC lecture file TimeExplain the role of requirements gathering in usability evaluation.

Identify the uses, advantages, and disadvantages of data collection.

Identify the Methods used for requirements gathering.

Demonstrate an understanding of how to conduct a workflow analysis.

Identify contextual design principles as they apply to the healthcare setting.

Describe the methods to interpret results of data collection.


f. Cognition and Human Performance

This unit covers cognition and human performance models and their relevance to systems evaluation methods.

Objectives ONC lecture file TimeDefine the concept of cognitive engineering.

Describe the representational effect as it applies to human computer interaction and web design.


Describe how humans process information and obtain skills.

Describe the Gestalt principles of perception and their relevance to human computer interaction and cognitive theory.


Describe the processes of memory and their relationship to web-design.

Explain how cognition and human performance models should inform iterative design processes.


Optional Resources


Usability and Requirements

Goldberg, L., Lide, B., Shneiderman, B., et al. (2011). Usability and accessibility in consumer health informatics current trends and future challenges. American Journal of Preventive Medicine, 40(5 Suppl 2), S187-S197.

Ping L. (2005). Cognitive task analysis: A cognitive approach to evaluate evidence-based nursing websites. OCLC Systems and Services, 21(3), 252-256.

Moore, M., Bias, R., Prentice, K., Fletcher, R. &, Vaughn, T. (2009). Web usability testing with a Hispanic medically underserved population. Journal of the Medical Library Association, 97(2), 114-121.

Usher W. (2009). General practitioners' understanding pertaining to reliability, interactive and usability components associated with health websites. Behavior & Information Technology, 28(1), 39-44.

Valimaki, M., Anttila, M., Kuosmanen, L., et al. (2008). Design and development process of patient-centered computer-based support system for patients with schizophrenia spectrum psychosis. Informatics for Health & Social Care, 33(2), 113-123.

http://www.youtube.com/watch?v=C1nO_rWZkjc&feature=player_embedded (1:27 YouTube Video)

What Do You Think? (non-graded questions for learners prior to reviewing the content):

1. Patient preference is not one of the factors considered when optimizing clinic workflow. T/F*

Feedback:

False: Correct! In patient-centered healthcare environments, patient preferences should definitely be considered when redesigning a workflow process.

True: Good try. Although staff may ultimately decide not to include a patient preference in a redesigned workflow -- especially if doing so would negatively impact patient safety and quality of care -- patient preferences should at least be considered when re-designing a workflow process.

2. When faced with change, each individual moves through the different psychological states that occur at his/her own pace. T*/F

Feedback:

True: Yes! This is important for process redesign project managers to consider when implementing a change.

False: Good try. When faced with change, individuals often move through a variety of psychological states ranging from denial and confusion to acceptance. The pace of these transitions varies among individuals.


http://www.youtube.com/watch?v=C1nO_rWZkjc&feature=player_embedded

3. A 2005 study on process improvement related to invoicing time found that:

a) The introduction of technology resulted in a 25% improvement; the addition of workflow redesign boosted the degree of improvement to 80%.*

b) The introduction of technology alone resulted in a 75% improvement.c) The introduction of workflow process redesign alone resulted in a 10% improvement.d) None of the above.

Feedback:

a. Nice job! The combination of technology and process redesign is very powerful.

b., c, d. Good try. The combination of technology and process redesign is very powerful.

Discussion Questions1. In Component 15, Unit 3, it is asserted that when the designer’s model is closely aligned with

the user’s mental model, a system will have fewer usability issues. Discuss an example of a system that, in your opinion, either has very good or very poor usability (not necessarily a health-related system). How do the design and the mental model align, or how are they misaligned? Is it possible that different users have different mental models? Why do you think the designer’s model is so close to or far from the user’s mental model?

Look at the systems presented by those in your discussion group and discuss the similarities or differences in what you present.

2. You are the medical director of a medium-sized adult-focused family practice clinic. You recently conducted an internal quality audit and found that most of your quality measures are below the national average. You have no idea where inefficiencies or lower quality care is “sneaking in” to your clinic. You have budgeted for one administrative staff member to work full time on this project for a year. Should he focus first on collecting data, researching a new EMR, or some other task?

Outline the first steps you’d like to take in beginning a quality improvement initiative at your clinic. Discuss your reasons for prioritizing these initial steps. Read the responses of others in your discussion group and feel free to re-post if you would like to revise your answer or if you disagree with the post of someone in your group.

3. This module discussed several methods for eliciting requirements: questionnaires, interviews, focus groups, workshops, naturalistic observation, documentation analysis, and cognitive research. In many cases, because we have neither unlimited resources nor unlimited time we're forced to select just a few of these methods. Discuss the relative strengths and weaknesses of each method and which you would select if you could only choose two methods.

4.

Quiz Questions

1. Which of the following is NOT a primary goal of healthcare clinic process redesign as described in this unit?


a) Improving the quality and safety of careb) *Making changes in the practicec) Enhancing patients’ care experienced) Decreasing the cost of care


2. Implementing a self-service appointment scheduling system is an example of which of the following?

a) *Control relocationb) Control additionc) Automationd) Exception handling

Feedback: Information on this topic can be found in Component 10, unit 6a, slides 18, 20-21.

3. Which of the following is a good candidate for automation?

a) Clinical diagnosesb) *Checking patients in to the clinicc) Making referrals to specialistsd) Process incoming documents


4. Which of the following is the best reason to use human-centered design principles in process redesign?

a) Software will be customized for each clinic.b) Clinic software systems impact patient care.c) *People interact with clinic software systems.d) Patient care needs to be automated.


5. Which of the following have an impact on clinic workflow?

a) Clinical decision supportb) Physical layout of the clinicc) System interfacesd) *All of the above


6. Which of the following is NOT a part of Quality Improvement methods in Health care?

a) Evaluationb) Causes of variationc) *A focus on each case/patientd) Involves multiple disciplines in the clinic



7. The quality of a user’s experience when interacting with the technological system refers to which of the following concepts?

a) *Usabilityb) Gulf of executionc) Iterative designd) Digital-divide


8. All of the following are reasons for design requirements EXCEPT for which one?

a) Clarify communication between users and development team.b) Evaluate the functions of a system during design testing.c) Reduce the time and costs involved in system development.d) *Increase security measures of patient records in a system design.


9. Which of the following is a unique aspect of a cognitive engineering approach?

a) Strong adherence to quantitative studies of computing performanceb) *Focus on attention, perception, memory, and decision-makingc) Emphasis on iterative designd) Great promise to conquer the digital dividee) Reliance on cutting edge neuroscientific methods


10. Which of the following is a useful change management concept/practice?

a) People need to think through the reasons why a change is needed, considering the pros and cons of a change themselves.

b) Giving users the chance to express their opinions on proposed changes can facilitate acceptance of a change.

c) Clear communication about why a change is needed and why the proposed change is deemed the best alternative can help equip team members to think through the change process and can facilitate acceptance.

d) *All of the above

Feedback: Information on this topic can be found in Component 10, unit 9, slide 15, 19-20.


6. Usability and Human Factors(5 hours; lectures 2 hrs., 4 min.)


a. Human Factors and HealthcareIn this unit, students will learn to apply concept knowledge of human factors to the evaluation of systems design and the study of human errors and patient safety.Objectives ONC lecture file TimeDistinguish between human factors and human computer interactions (HCI) as they apply to usability.

Explain how cognitive, physical and organization ergonomics can be applied to human factors engineering.


Describe how the concepts of mental workload, selective attention and information overload affect usability.


Describe the different dimensions of the concept of human error.

Describe a system-centered approach to error and patient safety.


Apply methods for measuring mental workload and information overload.


15 min.16 min.

Describe how human factors analysis can be applied to the study of medical devices.


16 min.15 min.

b. Usability Evaluation MethodsThis unit will teach students how to select the most appropriate usability evaluation method, given a particular system, setting and development phase.

Objectives ONC lecture file TimeDescribe the importance of usability in relation to health information technologies.

List and describe usability evaluation methods.

Given a situation and set of goals, determine which usability evaluation method would be most appropriate and effective.


c. Electronic Health Records and UsabilityIn this unit, students will apply principles of usability and design to critiquing EHR systems and to making recommendations for iterative improvement.


Objectives ONC lecture file TimeExplain the challenges of EHR design and usability in typical workflow.

Identify and explain usability methods for enhancing efficiency of use and minimizing the likelihood of user error (HIMSS document).


d. Decision Support Systems: A Human Factors Approach

This unit covers the diagnosis of problems associated with a clinical decision support system.

Objectives ONC lecture file TimeIdentify the cognitive basis for decision-making and its effect on clinical errors.

Discuss Clinical Decision Support Systems (CDSS).

Describe and define usability as it pertains to clinical decision support.


Optional Resources

Human Factors and Healthcare

Adela, S.M. Lau (2011). Hospital-based nurses' perceptions of adoption of Web 2.0 tools for learning and knowledge sharing, learning, social interaction and the production of collective intelligence. Journal of Medical Internet Research, 13(4). Available at http://www.jmir.org/2011/4/e92/.

Board on Health Care Services. (2011). Health IT and Patient Safety: Building Safer Systems for Better Care. Washington, D.C.: Institute of Medicine. eBook.

Corrao, N., Robinson, A.G.,Swiernik, M.A., & Naeim, A. (2010). Importance of testing for usability when selecting and implementing an electronic health or medical record system. Journal of Oncology Practice, 6(3), 120-124.

Holden, R. (2011). Cognitive performance-altering effects of electronic medical records: An application of the human factors paradigm for patient safety. Cognition, Technology & Work, 13(1), 11-29.

Huser, V., Rasmussen, L.V., Oberg, R., & Starren, J.B. (2011). Implementation of workflow engine technology to deliver basic clinical decision support functionality. BMC Medical Research Methodology, 11:43 1-19.

Joshi, A., Arora, M., Dai, L., Price, K., Vizer, L., & Sears, A. (2009). Usability of a patient education and motivation tool using heuristic evaluation. JMR. Full-text (html) available at http://www.jmir.org/2009/4/e47/


http://www.jmir.org/2009/4/e47/

http://books.nap.edu/openbook.php?record_id=13269

http://books.nap.edu/openbook.php?record_id=13269



Thyvalikakath, P.T., Monaco, V, Thambuganipalle, H., & Schleyer, T. (2009). Comparative study of heuristic evaluation and usability testing methods. Studies in Health and Technology Informatics, 143, 322-327.

Redish, J., & Lowry, Z. S. (2010). Usability in health IT: Technical strategy, research, and implementation. Summary of National Institutes of Standards and Technology Workshop on Usability in IT (NISTIR 7743).

Russ, A.L., Baker. D.A., Fahner, W.J., Milligan, B.S., Cox, L., Hagg, H.K., et al. (2010). A rapid usability evaluation (RUE) method for health information technology. AMIA 2010 Symposium Proceedings, 702-706.

Wiegmann, D., & Dunn, W.F. (2010). Changing culture: A new view of human error and patient safety. Chest, 137, 250-252.

Wright, A., & Sittig, D.F. (2008). SANDS: A service-oriented architecture for clinical decision support in a National health information network. Journal of Biomedical Informatics, 41(6), 962-981.

Yen, P. Y., Wantland, D., & Bakken, S. (2009). A comparison of usability evaluation methods: Heuristic evaluation versus end-user think-aloud protocol --an example from a web-based communication tool for nurse scheduling. AMIA 2009 Symposium Proceedings, 714-718.

Yen, P. Y., Wantland, D., & Bakken, S. (2010). Development of a customizable health IT usability evaluation scale. AMIA 2010 Symposium Proceedings, 917-921

Implementing a National Health Monitoring Evaluation and Case Surveillance in Haiti: Lessons and Perspectives by Kurt Jean Charles, August, 2009. [length 59:10]

Using CDS to achieve meaningful Use-HIMSS Exhibitor Solutions Presentation [length 22:01]

Clinical decision support for evidence-based care. Dramatization of an NHS (Great Britain) patient’s experience from diagnosis to treatment, employing CDS [length 11:08]


1. T*/F: Workload is an important consideration in the design of new systems.

Feedback:

True: Correct! Workload, as it relates to both work responsibilities and mental processing capacity, is a concept that is important to understanding the impact on human performance. It’s a consideration for both the study of error and the design of new systems.

False: Good try. Workload, as it relates to both work responsibilities and mental processing capacity, is a concept that is important to understanding the impact on human performance. It’s a consideration for both the study of error and the design of new systems.

2. T*/F: Human Factors Design Principles can have a compelling impact on improving the safety of medical devices.


http://www.youtube.com/watch?v=zoxpuzH4B_0

http://www.youtube.com/watch?v=zoxpuzH4B_0

http://www.youtube.com/watch?v=QvnLQCQWcoM

http://www.youtube.com/watch?v=2jD3kS9G_bk

http://www.youtube.com/watch?v=2jD3kS9G_bk

Feedback:

True: Correct! User-centered design relies on data about how a user utilizes a system in a particular environment. Human Factors Design Principles help bring to light information and data about when, where, how, and why a person might use a medical device.

False: Good try. User-centered design relies on data about how a user utilizes a system in a particular environment. Since medical devices are used by/on people, safety is a top priority. Human Factors Design Principles can help influence medical device development, illuminating where, how, and why a device is being used.

3. What percentage of clinical information systems are either abandoned or fail to meet minimum safety and regulatory requirements?

a) 10%b) 20%c) *40%d) 50%

Feedback:

c. Correct! A surprising number of clinical information systems are never fully deployed because they fail to meet minimum safety and regulatory requirements.

a, b, d. Good try. Many organizational factors influence the successful deployment and integration of a clinical information system, so it is no wonder that 40% of these systems are abandoned or fail to meet requirements.

4. T*/F: When conducting usability testing, it is important to assess both objective and subjective data.

Feedback:

True: Correct! Though objective data is indisputable, considering subjective data, such as how something is perceived by a user, is also very important when assessing usability data.

False: Good try. Although objective data is indisputable, considering subjective data, such as how something is perceived by a user, is also very important when assessing usability data.


1. Describe an alert (computer or non-technical) that you see and ignore/dismiss on a regular basis. This alert could be related to healthcare if you work in a healthcare setting, or could be an alert you see while doing your regular work or going about personal tasks if you are not a clinician. Justify the fact that you ignore this alert. Could ignoring the alert be dangerous?

2. Advances in technology are offering new possibilities for clinical computing that may augment or replace the standard desktop PC. Consider how mobile computing devices such as Smartphones, tablets, or wearable computers might be used in different clinical settings. How might these devices assist providers in a clinical setting? What might be some challenges or concerns if providers move to mobile computing devices in a clinical setting? Discuss factors


that may affect the usability of these devices for viewing and interacting with an electronic health record.

3. In Component 15, Unit 4, Lecture B, active and latent failures were discussed. Jason Reason explains that although active failures are immediately felt, latent failures, which are less visible, are equally important. Latent conditions are “enduring systemic problems that may not be evident for some time, but they combine with other system problems to weaken the system defenses and make errors possible.” Describe a situation where latent errors have combined to create a failure in a health care environment. Please include any weblinks or attachments as appropriate.

4. You’ve been hired by a hospital to work on a team of human factors analysts. The hospital’s administrators are trying to understand why, after moving to a new facility and upgrading their CPOE and EHR systems, they have been experiencing such a high rate of medical errors in the past year.

Here are a few examples of the types of medical errors they have experienced: Drug-drug interaction errors Wrong surgery site errors (wrong arm, leg or organ operated on, most often problems of

symmetry) Several cases of missed diagnoses on initial visit, subsequent discharge and worsening of

patient condition, two deaths, several other poor outcomes. Drug dosage errors at the pharmacy Adverse outcome traced to physician not fully understanding the current patient's history.

Using the usability principles and heuristics from Component 15, Unit 5, Lecture A, slides 20-24, make a list of the principles that may have played a role in this case. Include at least five of the principles discussed. Explain.

Quiz Questions

1. Designing a computer software program to enhance the ability of physicians to make decisions is an example of which ergonomic domain?

a) Organizationalb) Physicalc) *Cognitived) a and be) All of the above


2. Selective attention is characterized by an ability to do which of the following?

a) Make the right decision in the right context.b) Reduce errors by concentrating on the correct feature set.c) *Ignore extraneous information and focus on relevant inputs.d) Reduce visual noise in one channel while concentrating one’s efforts on an auditory

channel.



3. According to James Reason, which of the following conditions refers to the enduring systemic problems that lie dormant for some time and combine with other system problems to weaken the system’s defenses and make errors possible?

a) Active conditionsb) *Latent conditionsc) Cognitive conditionsd) Human conditions


4. Which of the following best explains why stress and burnout due to heavy workload can have a negative impact on performance?

a) They can lead to frustration and negative attitudes towards one's job.b) Nurses will often fail to administer the appropriate medication dosages.c) They deplete one’s attentional resources and leave an employee with insufficient time to

perform tasks safely.d) *They result in reduced physical and cognitive resources, which impacts the ability to

perform adequately.

Feedback: Information on this topic can be found in Component 15, unit 6c, slide 26.

5. According to the Health Information and Management Systems Society (HIMSS), what is perhaps one of the most important factors hindering the adoption of EHR systems?

a) Cost of systemb) *Usabilityc) Time for trainingd) Lack of resourcese) Resistance to change


6. Which type of interview would be most appropriate for exploring ideas early in the design cycle?

a) Structured interviewb) *Unstructured interviewc) Semi-structured interviewd) Focus groups


7. As information management problems increase, mental workload increases. Which of the following are reasons why there is a need for well-designed decision support systems to help clinicians cope with high mental workload conditions?

a) Under time pressure, clinicians have less time and patience to navigate through poorly designed technology.

b) Under a more significant mental workload, individuals can no longer adapt or compensate in order to maintain cognitive performance.


c) When demands imposed by the system are too great, they actually exceed the attentional resources or mental capacity of the person.

d) A and Ce) *A, B and C


8. Which of the following best characterizes the notion of “biases” as given in this module?

a) Biases are rules of thumb for making decisions.b) Biases reflect usability violations in the design of clinical decision support systems.c) *Biases reflect systematic deviations from normative standards.d) Biases provide explicit criteria of a normative standard for decision excellence.


9. Which of the following is NOT an example of a slip?

a) Nurse neglects to change the dose of medication as requested by the resident.b) *Physician mistakenly dismisses early signs of congestive heart failure as asthma due to

allergiesc) Pharmacist mixes up medication labels causing the wrong medication being given to a

patient.d) Nurse prepares an infusion pump drip and executes every step except pressing the start key

to initiate the process.e) All of the above are examples of slips.


10. Which statement best characterizes the process of the Cognitive Walkthrough?

a) *It involves identifying sequences of actions and sub-goals to successfully complete a task.b) It is perhaps the most comprehensive method for usability testing and is the gold standard.c) It utilizes several analysts to critique a system to identify and diagnose usability problems.d) It can be used to identify usability principles in all phases of design.



7. Systems Design and Designing for Safety(5 hours; lectures 2 hrs., 4 min.)


a. Approaches to Design

In this unit, students will learn how to effectively plan projects and develop a project management plan.

Objectives ONC lecture file TimeExplain a user-centered design approach.

Define conceptual models.

Explain the iterative design process.


Describe how requirements analysis influences design.

Characterize the role of prototypes in design.

Describe the principles of participatory design.


Describe principles of sound design to support usability.

Describe how Nielsen’s heuristics and design principles apply to user interface design.

Explain the difference between low fidelity and high fidelity prototypes and when it would be appropriate to use one versus the other.


b. Designing for Safety

In this unit, students will learn to diagnose various types of error and create or select potential solutions.

Objectives ONC lecture file TimeDefine “workflow analysis” and methods for examining and addressing human errors.

Design a workflow analysis study.


Identify common sources of error documented in research studies in medicine.


18 min.13 min.


Objectives ONC lecture file TimeApply the cognitive taxonomy of errors. Comp 15, Unit 10b 18 min.

Apply the principles underlying the design of healthcare systems for safety.


c. Information Visualization

This unit describes how information visualization can support and enhance the representation of trends and aggregate data.

Objectives ONC lecture file TimeIdentify/describe the role of information visualization and describe its purpose in enhancing usability of health technology.


Describe how information visualization can support and enhance the representation of trends and aggregate data.


Optional Resources

Systems Design and Designing for Safety

Aggarwal, V., Backman, C.A., Sager, K., & Sannyasi, A. (2010). Workflow redesign in support of the use of information technology within healthcare. Proceedings of HIMSS 10, Atlanta, GA, March 1-4, 2010.

Bardram, J.E. (2005). Activity-based computing: Support for mobility and collaboration in ubiquitous computing. Personal and Ubiquitous Computing, 9, 312–322.

Bardram, J.E., & Christensen, H.B. (2007). Pervasive computing support for hospitals: An overview of the activity-based computing project. The IEEE Computer Society, 1536-1268/07, 44-51.

Borriello, G., Stanford, V., Narayanaswami, V., & Menning, W. (2007). Pervasive computing in healthcare. The IEEE Computer Society, 1536-1268/07, 17-19.

Cain, C., & Haque, S. (2008). Organizational workflow and its impact on work quality. Patient Safety and Quality: An Evidence-Based Handbook for Nurses: Vol. 2 (pp. 2-217-2-244). AHRQ Publication No. 08-0043, Rockville, MD.

Carayon, P., & Wood, K.E. (2010). Patient safety: The role of human factors and systems engineering. Studies in Health Technology and Informatics, 153, 23-46.


Eber, M.R., Laxminarayan R., Perencevich, E.N., Malani, A. (2010). Clinical and economic outcomes attributable to health care-associated sepsis and pneumonia. Internal Medicine, 170(4), 347-353.

Gawande, A. (2011). Cowboys and pit crews. The New Yorker.

Nielsen, J. (1994). Ten usability heuristics. Originally published in Usability Engineering. Retrieved from http://www.useit.com/papers/heuristic/heuristic_list.html

Reeder, B., Hils, R.A., Demiris, G., Revere, D., Pina, J. (2011). Reusable design: A proposed approach to public health informatics system design. BMC Public Health, 11(116), 1-8.

Reeder, B., Turner, A. (2011). Scenario-based design: A method for connecting informational system design with public health operations and emergency management. Journal of Biomedical Informatics, 1-11.

Riedmann, D., Jung, M., Hackl, W.O., Stühlinger, W., Van der Sijs, H., & Ammenwerth, E. (2011). Development of a context model to prioritize drug safety alerts in CPOE systems. BMC Medical Informatics and Decision Making, 11:35, 1-11.

Rieman, J., Franke, M., & Redmiles, D. (1995). Usability evaluation with the cognitive walkthrough. Proceedings of the Conference on Human Factors in Computing Systems, Denver, CO, May 6-11, 1995. Retrieved from http://www.sigchi.org/chi95/proceedings/tutors/jr_bdy.htm

Shortliffe, E.F. (2010). Testimony to HIT Policy Committee, Adoption/Certification Workgroup. Office of the National Coordinator for Health Information Technology, Department of Health and Human Services.

Vankipuram, M., Kahol, K., Cohen, T., & Patel, V.L. (2010). Toward automated workflow analysis and visualization in clinical environments. Journal of Biomedical Informatics, 1-9.


1. Most medical errors are caused by inaccurate diagnoses on the part of providers. (T/F*)

Feedback:

False: Yes! Most medical errors are the result of ineffective systems.

True: Good try. Most medical errors are the result of ineffective systems.

2. If you are designing a computer interface and you know that a certain transaction in the system (e.g., launching a video file) will take some time, you should include some sort of visual clue to the user that processing is underway. (T*/F)

Feedback:

True: Correct! In the absence of information, users tend to think the system is not working or that they did something wrong.


http://www.sigchi.org/chi95/proceedings/tutors/jr_bdy.htm

http://www.useit.com/papers/heuristic/heuristic_list.html

http://www.newyorker.com/online/blogs/newsdesk/2011/05/atul-gawande-harvard-medical-school-commencement-address.html

False: Good try. In the absence of information, users tend to think the system is not working or that they did something wrong. So, if a task takes a while to process, letting users know that they will need to wait is helpful.

3. It is possible to anticipate user errors. (T*/F)

Feedback:

True: Right! Early usability testing can identify potential trouble spots.

False: Good try. Early usability testing can be helpful identifying potential trouble spots.


1. In the Component 15, Unit 10 lectures (Designing for Safety), you learned about the use of checklists to improve care and reduce error in clinical settings. Checklists were cited as a way to allow nurses to correct doctors. This significantly shifts the traditional hierarchy. What are the reactions and results, positive and negative, that this shift would likely engender? If you feel strongly about the use of checklists or changes to the traditional hierarchy, argue for what you believe. Respond to the opinions of your colleagues, who may have varied views.

2. Imagine you are helping a critically ill family member find specialty care. If he was treated at a hospital that was using an old CPOE system run on very old machines and worked quite slowly, what is the potential impact on patient safety or quality of care? What are the potential problems of the family member being treated at a hospital where new CPOE and billing systems were both going to “go live” across the entire hospital during the coming week? If you have personal experiences with either working with a very old system or a new system rollout, please share these to help guide others.

3. Find an article on a hospital error—summarize the error and explain what might have prevented it. (e.g., checklist, training, testing by typical users, interface design), OR Watch this 6-minute video on the ROI of user experience-based design. What were your key take-aways from the video? The video talks about costs in terms of money. What might the costs of insufficient user experience analysis be in a healthcare setting? What types of behavior occur in healthcare settings in reaction to a poorly designed interface?

4.

Quiz Questions

1. Which of the following is not one of the guiding principles for participatory design?

a) *Continuous iterative design is crucial to the design process.b) All stakeholders can contribute to the design process.c) There is much to learn from observing the practice of workers.d) A system is more than a wired network of computers and technology.e) There is a need to find concrete ways to improve the working lives of participants.


2. Which of the following best describes “retrospective incident analysis”?


http://www.youtube.com/watch?v=O94kYyzqvTc&feature=player_embedded

http://www.youtube.com/watch?v=O94kYyzqvTc&feature=player_embedded

a) It is used to analyze incident history to determine factors leading to adverse conditions.b) It is only applicable to near misses.c) It shows that once a near-miss or adverse incident has occurred there is no possibility of

recovery.d) *It is used to analyze and identify opportunities and mechanisms for recovery from errors.e) It pertains to planned recovery opportunities.


3. Which of the following are examples of unintended consequences of CPOE?

a) Less work for clinicians and smoother workflowb) Reduction of the total number of errorsc) Changes in the power structured) Generation of new kinds of errorse) *C and D


4. An important philosophical consideration in trying to reduce errors is:

a) Increasing individuals’ expert knowledge and training so that they can have perfect performance

b) *Creating a system which can promote identification and recovery from situations leading to errors

c) Identifying responsible parties so that they can be made accountabled) Isolating the step immediately before the error occurs


5. Match the design concepts on the left with the system designer's action they suggest.

1) Provide users with easy ways to recover when they make mistakes, such as including undo and redo options.

2) Include alerts and other tactics for preventing user error. For example, if the user is trying to delete an important item, include an “Are you sure you want to delete this?” dialog box.

3) Create interfaces that include items that might be intuitively recognizable from the user’s general life experience. For example, use an arrow (→) to indicate “next screen” as they are likely familiar with that symbol through use of the Internet.

4) Make objects, actions, and options visible, or easily retrievable vs. taxing the user’s ability to remember where to find elements.

5) Let users know where they are in the system. For example, if they are clicking through ten screens, label each screen –3/10.

a) User control and freedomb) Match system to real worldc) Error preventiond) Visibilitye) Recognition, not recall

1-(a) User control and freedom


2-(c) Error prevention3-(b) Match system to read world4-(e) Recognition, not recall5-(d) Visibility

Feedback: Information on this topic can be found in Component 15, unit 8c, slides 6-23.


8. Effective Training(5 hours; lectures 4 hrs., 2 min.)


a. Introduction to Training and Adult Learning

This unit applies the Instructional Systems Design (ISD) method and the phases of the ADDIE model of instruction design, to a given population of adult learners.

Objectives ONC lecture file TimeDefine the levels of learning per Bloom’s Taxonomic Domains (Cognitive, Affective, Psychomotor).

Describe the characteristic of adult learners and factors that could impact training design and learning outcomes.


Describe the recommended training cycle of the ISD method. Comp 20, Unit 1b 32 min.

Describe the five phases of the ADDIE model of instructional design.


b. Needs Analysis

This unit discusses planning and implementing an instructional needs assessment, given a specific population of users in a health care setting.

Objectives ONC lecture file TimeIdentify an instructional design problem for a given group of learners and training setting.

List a range of useful data collection methods for conducting needs assessments in healthcare settings.

Identify the principles of the planning and implementation process of an instructional needs assessment in a health organization setting.


Analyze learner, task and situational characteristics.

Recognize the special training needs and constraints in a health care setting (such as time constraints and work pressures, resistance to change, impact of system on



Objectives ONC lecture file Timeworkflow and patient care, security requirements for EHRs, etc.)

Generate instruction plans based on data gathered from a needs assessment.


24 min.16 min.

c. Creating a Lesson Plan

This unit demonstrates how to construct a lesson plan using appropriate instructional methods and approaches, given a specific population of learners.

Objectives ONC lecture file TimeWrite measurable goals and learning objectives for a training program which meet the SMART (Specific, Measurable, Attainable, Relevant, and Time-bound) criteria.

Write specific learning objectives based on Bloom’s Taxonomy, classifying learning from the simplest to the most complex levels.

Write learning objectives that are tied to needs analysis and outcomes.

Select appropriate activities for training objectives.Identify the appropriate instructional approaches tied to a needs analysis, situational characteristics, and subject matter domain when designing a lesson plan.


d. Selecting and Working with Media

This unit shows students how to construct an instructional product (simple online tutorial) using appropriate media such as customized images and video.

Objectives ONC lecture file TimeSelect appropriate instructional media for a given lesson plan and objective goals.

Select and customize images to embed in training materials.

Select and customize video to embed in training materials.


Design simple online tutorials using screen capture software. Comp 20, Unit 4b 15 min.

e. Building an Effective PowerPoint Presentation


This unit describes how to create a custom PowerPoint presentation using the principles of effective PowerPoint design, given a particular training program and learner population.


Objectives ONC lecture file TimeConstruct a script or storyboard for a presentation.

Design a custom slide background for a training program.

Demonstrate appropriate use of color and text in a presentation.

Embed graphics and video in a presentation.


Demonstrate the use of ‘builds’ and ‘actions’. Comp 20, Unit 5b 12 min.

Use the PowerPoint graph and chart functions for designing instructional materials.


14 min.12 min.

Assess the training environment.

Modify a presentation to compensate for presentation constraints.

Demonstrate effective public speaking skills.

Operate necessary computer and AV equipment to make an effective multimedia presentation.


f. Assessment

This unit discusses how to conduct student outcome assessments and program evaluations in given training contexts.


Objectives ONC lecture file

Time

Design appropriate assessment/testing instruments and procedures aligned with instructional goals/objectives.

Administer assessments as a component of training/instructional design.

Conduct formative evaluations in one-on-one and group contexts.

Select an appropriate platform for a particular training program.

Comp 20, Unit 6

13 13 min.

g. Learning Management Systems

This unit covers considerations for designing training programs in Learning Management Systems (LMS) that adhere to the standards and open source initiatives in online learning.

Objectives ONC lecture file TimeDescribe the basic functions and technologies in Learning Management Systems (LMS), Content Management Systems (CMS), Reusable Learning Objectives (RLO), and Learning Content Management Systems (LCMS)

Identify the role of standards and open source initiatives in online learning


Describe why an instructional designer would SCORM

Give two approaches to modify e-learning content to meet Section 508 Compliance guidelines

Build a training program in an LMS using appropriate standards for online learning



h. Web 2.0 and Social Networking Tools

This unit focuses on how to select and implement Web 2.0 technologies as instructional technologies given a specific platform and training program.

Objectives ONC lecture file TimeDistinguish between synchronous and asynchronous learning.

Use basic functions of an LMS or CMS.

Utilize different tools within the design and delivery of online training.

Select an appropriate platform for a particular training program.


Optional Resources

Introduction to Training and Adult Learning

Bryan, R., Kreuter, M., Brownson, R. (2009) Integrating adult learning principles into training for public health practice. Health Promotion Practice, 10(4), 557-563.

Holyoke, L., et. al. (2009) Engaging the adult learner generational mix. Journal of Adult Education, 38(1), 12-21.

Illeris, K. (2003) Adult education as experienced by the learners. International Journal of Lifelong Education, 22(1), 13-23.

Merli, C. (July 2011) Effective training for adult learners. Professional Safety, 56(7), 49-51.

Thoms, K. (2002) They’re not just big kids: Motivating adult learners. Proceedings of the Annual Mid-South Instructional Technology Conference.

Needs Analysis

University of Washington I-Tech (2006) Training needs assessment: Working with adult learners. Training Toolkit. Accessed at: http://www.go2itech.org/HTML/TT06/toolkit/assessment/adults.html

Creating a Lesson Plan


http://www.go2itech.org/HTML/TT06/toolkit/assessment/adults.html

Dunn, R., et. al. (2010) Light at the end of tunnel vision: Steps for improving lesson plans. The Clearing House, 85, 194-206.

Milkova, S. (2011) Strategies for effective lesson planning. Center for Research on Learning and Training. Accessed at: http://www.crlt.umich.edu/gsis/P2_5.php

Thomas, E. (2007) Thoughtful planning fosters learning transfer. Adult Learning, 18(3/4), 4-8.

Toney, M. (1991) Lesson plans-Strategies for learning. Training and Development. 45(6), 15-19.

M.I.T. (2011) Teaching Materials: Writing Learning Objectives. Available at http://web.mit.edu/tll/teaching-materials/learning-objectives/index-learning-objectives.html

Selecting and Working With Media

Cherrett, T., et. al. (2009) Making training more cognitively effective: Making videos interactive. British Journal of Educational Technology, 40(6), 1124-1134.

Issenburg, S., et. al. (1999) Simulation technology for health care professional skills training and assessment. Journal of the American Medical Association, 282(9), 861-866.

Building an Effective Power Point Presentation

Four Steps to a Better Power Point Presentation (length 2:30)

Sliderocket Tutorials. Available at http://www.sliderocket.com/resources/

Web 2.0 and Social Networking Tools

Adela, S.M. Lau (2011). Hospital-based nurses' perceptions of adoption of Web 2.0 tools for learning and knowledge sharing, learning, social interaction and the production of collective intelligence. Journal of Medical Internet Research, 13(4). Available at http://www.jmir.org/2011/4/e92/.

Chou, W., Hunt, Y., Beckjord, E., Moser, R., Hesse, B. (2009) Social Media use in the United States: Implications for health communications. Journal of Medical Internet Research, 11(4). Available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2802563/.

Eysenbach, G. (2008) Medicine 2.0: Social Networking, Collaboration, Participation, Apomediation, and Openness. Journal of Medical Internet Research, 10(3). Available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2626430/

Harmon, K. (2010) The Future of Your Data: How Health Care is Becoming Better Connected a la Facebook, Changing the way Patients, Doctors, and Institutions Interact. Scientific American, 6, 1-3. Available at http://www.scientificamerican.com/article.cfm?id=future-of-medical-data

Hawn, C. (2000) Take 2 aspirin and tweet me in the morning: How Twitter, Facebook, and other Social Media are reshaping healthcare. Health Affairs, 28(2), 361-368.


http://www.scientificamerican.com/article.cfm?id=future-of-medical-data

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2626430/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2802563/



http://www.sliderocket.com/resources/

http://www.youtube.com/watch?v=5b_sv9rqjrg&feature=player_embedded

http://web.mit.edu/tll/teaching-materials/learning-objectives/index-learning-objectives.html

http://www.crlt.umich.edu/gsis/P2_5.php

Sharp, J. (2010) Social media in health care: Barriers and future trends. iHealthBeat. Available at http://www.ihealthbeat.org/perspectives/2010/social-media-in-health-care-barriers-and-future-trends.aspx.

What Do You Think? (non-graded questions for learners prior to reviewing the content):

1) True or False: According to adult learning theory, adults learn better and faster than children.

False: Correct! Adult learning theory isn’t about adults learning better or faster, but rather recognizing that adults bring to training experiences different goals, motivations, constraints and assets than children do.

True: Nice try. It isn’t that adults learn better or faster, just differently. Adult learning theory recognizes that adults bring a wealth of experience to any training, they tend to be goal driven, their motivation varies, and as busy adults, they want the learning experience to have relevance to their life

2) Images are processed more quickly (cognitively) and are more memorable than words (T/F)

True – Correct! People do indeed process images more quickly than words and can generally recall them more easily.

False – Nice try. People actually do process images more quickly than works and generally recall them more easily.

3) Learners retain what percentage of what they say or repeat?

a) 20%b) 30%c) 50%d) *70%

D – Perfect! It isn’t enough for learners to just see or hear something, they need to process and do something with the information they are presented for it to be retained.

A, B, C – Nice try - Active learning, such as describing, or discussing, or applying what one has learned is more effective in retaining information than just simply reading, hearing or seeing something.



http://www.ihealthbeat.org/perspectives/2010/social-media-in-health-care-barriers-and-future-trends.aspx

http://www.ihealthbeat.org/perspectives/2010/social-media-in-health-care-barriers-and-future-trends.aspx

1. Many people have taken a driver's education course. (If you haven't, choose some other training such as a blood-drawing, asthma training, childbirth classes or training on how to use a machine like an autoclave.) From what you've learned during this course, do you think it would be easier to train a person to use a clinical information system or to teach someone to drive a car? What are the similarities and differences between the two types of training? Which aspects would be a bigger challenge in information system training and which would be more challenging when teaching someone to drive a car? Why?

2. Think about an exceptionally positive or negative learning experience that you’ve had either in the classroom or in a less formal training environment. What were the factors that made that experience positive or negative? What was the best (or worst) aspect of that experience? How would you change it or enhance it?

3. Imagine you are a trainer involved in a multi-site implementation of a new EHR. For this system, there are only a few providers at each site, and you’re worried that social learning that takes place at larger practices might not happen as easily because of the smaller practice size and geographically dispersed clinic locations. You only have the time and resources to implement one additional type of tool to complement your traditional, in-person training.

Which type of Social Media or Web 2.0 tool would be helpful in this situation? Describe some of the ways it might be used. What challenges might exist in adopting and rolling out this tool? How would you go about implementing this tool? Would you use this tool if you worked in one of the clinics and wanted to share information

or ask questions about the new system?

4. In your opinion, what exactly is learning? Is there a difference between 'teaching someone something' and 'helping someone learn'? If so, describe the impact of this difference on the learner as well as the instructor. Many factors influence adult learning. Which factors do you feel are the most crucial?

Quiz Questions

1. According to Bloom's Hierarchy of Cognitive and Affective Learning Outcomes, which of the following is at the lowest level?

a) Applyb) Createc) Understandd) *Remember


2. The recommended training cycle of the Instructional Systems Design method can best be described as which kind of process?

a) Bi-directionalb) *Cyclicc) Lineard) None of the above


Feedback: Information on this topic can be found in Component 20, unit 1c, slide 4.

3. According to the principles of instructional design introduced in this module, what is the most important step when planning an instructional program?

a) *Needs assessmentb) Establishing objectivesc) Available technologyd) Program assessment


4. Which of these data collection methods would be most appropriate to probe in depth about individual respondent’s opinions about a vendor-specific EHR system?

a) Surveyb) *Interviewsc) Observationd) Document review

Feedback: Information on this topic can be found in Component 20, unit 2b, slide 11 and 12.

5. Which of the following is NOT a main step in preparing a lesson plan?

a) Define the content.b) List materials needed.c) Plan evaluative procedures.d) *Identify the best learner in the group.


6. Which of the following best describes what you would do to add a chart to a slide in PowerPoint?

a. Create a table of data on the slide, select the data, and click on the Chart button to automatically create a chartb. Click on the Insert Chart button to get a blank datasheetc *Select the Title and Chart slide layout that best matches your purpose and modify the default chartd. Take a screenshot of a Chart created in Excel and insert it as a .jpeg image

Feedback: Information on this topic can be found in Component 20, unit 5b, slides 4-6

7. Based on recommendations of the module, which of the following lists contain good guidelines for color and text in a PowerPoint presentation?

a) Short bullets, 14-point fonts, and high contrast colors, any use of pictures or graphics, 40 slides for a 20-minute presentation

b) *Short bullets, 18-point fonts, pictures or graphics enhancing slide concepts, 20 slides for a 20-minute presentation

c) Complete sentences, 18-point fonts, high contrast colors, pictures or graphics enhancing slide concepts, 20 slides for a 20-minute presentation


d) Short bullets, 14-point fonts, any use of pictures or graphics, 40 slides for a 20-minute presentation

e) Complete sentences, 18-point fonts, high contrast colors, 20 slides for a 20-minute presentation

Feedback: Information on this topic can be found in Component 20, unit 5a, slide 8-10.

8. Which of the following lists include ALL the parts of a Reusable Learning Object?a. *Objective, learning activity, navigation, assessment, tagsb. Objective, lecture, assessmentc. Objective, learning activity, assessmentd. Learning activity, navigation, tags


9. Which standard helps to ensure that learning content is accessible to all people with disabilities?a. SCORM (Sharable Content Object Reference Model)b. RLO (Reusable Learning Objectives)c. *508 Complianced. LCMS (Learning Content Management System)


10. Which learning approach is defined as a classroom introduction with follow-up online activities, readings, case-based problem solving and discussions?

a) *Blended learningb) Social learningc) On-the-job trainingd) Team-based learning



Case Study

Case Study Description

Part I. Workflow Analysis

You are working as an analyst at a consulting firm specializing in work with healthcare organizations. Your firm has a contract with Peaceful Valley Medical Practice (PVMP). After implementing a new EMR system, staff members report that it now takes more time to serve the same number of patients. They are also concerned about some potential patient safety issues that have arisen as the result of missing patient data. However, they are not sure of the source of the problems. They have hired your firm to advise them on how to rectify this situation.

They are open to paying for EMR customization and changing their procedures. Before you visit the practice offices you are presented wsith a large stack of papers and several PDFs containing SOPs (Standard Operating Procedures) and other documentation for PVMP’s current EMR system. You look through these documents, but find that the SOPs are out of date, and refer to processes before the laboratory had electronic reporting implemented and when many of the providers were still using paper charts in combination with the EMR.

You decide that a visit to the clinic will be helpful so you set up appointments with five individuals in the office.

1. Determine which five individuals at a medium-sized (7 provider) office you would want to interview first.

2. Determine what kinds of questions you would present to these individuals.

3. Come up with an “elevator speech” explaining your role as a healthcare process analyst and redesign specialist. This speech should be less than five sentences and should give anyone on the office some general information about your role.

Following your initial meetings, you are able to provide information about this medical practice. You now know that the patient population is primarily adults over 60, most of whom make use of their Medicare benefits. The providers here deal with the majority of the common ailments of the patient population, but they often refer patients to outside specialists.

One physician also works at an orthopedic clinic and does surgery at a hospital in the city, so many of his appointments are follow-ups on surgeries. Of the seven providers, four are family practice physicians, two nurse practitioners and one Physician Assistant (PA). The practice also employs several RNs and Medical Assistants (MA) as well as eight administrative staff and a half-time IT support person.

After your initial meetings you came up with several typical scenarios that occur at this medical practice. One of these scenarios follows. Read the scenario, and then answer the questions below. You’ll be asked to come up with a list of tasks and define the individuals involved in this process.Patient Stanley has a scheduled appointment with Ms. James, a Nurse Practitioner at PVMP, for a sore throat. Medical Assistant Allie escorts Patient Stanley to the exam room, weighing him on the scale in


the hall on the way. In the exam room, Medical Assistant Allie asks Patient Stanley the reason for his visit while taking his vital signs. She asks him how long he’s had the sore throat and if he’s had a fever. Patient Stanley states that he has had a sore throat for three days, that it has been getting worse and is really painful to swallow. Medical Assistant Allie documents on paper Patient Stanley’s chief complaint and vital signs and then confirms Patient Stanley’s allergies and current medications. Stanley is allergic to one drug he took when he had pneumonia, but can’t recall the name of it. He is on several medications and has the bottles for two of them in his pocket. Allie writes down the two medications on a piece of paper before leaving the exam room.

Note: The medication section of the EMR includes only drop-down items for medications and dosage. Even if Allie were entering the information directly into the EMR, she would have no way to note the missing medication names or unknown drug allergy.

Before entering the exam room, NP James looks over Patient Stanley’s chart on the computer in the hallway and glances at the notes Allie left. She notices that his chief complaint is sore throat and recalls that she’s already seen 7 cases of strep this week. NP James closes the record on the hall computer, enters the exam room and asks Patient Stanley about his sore throat, how long ago it started, and if Patient Stanley had run a fever. NP James also asks Patient Stanley if he is taking any over-the-counter medications for his sore throat. Patient Stanley states that he has been running a high fever, 101.5 degrees F, and that he is using aspirin for the fever and throat spray and cough drops, and gargles with salt water, and he adds that it has been several years since he has had a sore throat like this. NP James listens to Patient Stanley’s heart and breathing, and then she examines his ears, nose, and throat. NP James asks if Patient Stanley has had a runny nose, cough or hoarseness. Patient Stanley states that he has not.

NP James tells Patient Stanley that there are an unusually high number of strep cases in the community over the past month, and that based on the appearance of his throat he may have strep throat. She would like to collect a sample by swabbing his throat and doing a rapid strep test. Patient Stanley agrees. NP James swabs his throat with a long cotton-tipped swab, and performs the test.

Five minutes later, NP James returns and tells Patient Stanley that the test was positive and that she would like to start him on an antibiotic. She looks over the notes Allie took about medications and allergies, then pulls Stanley’s record up on the computer in the exam room, enters the rapid strep result, and asks Patient Stanley if his Pharmacy is still the one on 555 Main St. Patient Stanley answers affirmatively, and NP James sends the prescription electronically. NP James tells Patient Stanley that the prescription will probably be ready on his way home, tells him to get some rest and to call the office if he does not feel better in three-to-five days or if his pain worsens.

1. Make a list of the individuals involved in this process.

2. Make a list of the individual tasks involved in this process.

3. Create an as-is workflow diagram [Information about free process mapping software here >>].

4. Identify problems with the existing patient intake/treatment processes.

5. Identify areas where the patient experience could be enhanced in this scenario (e.g., changes in appointment scheduling system, waiting room amenities, process for receiving test results, patient education…).

Part II. Process Redesign


http://learn.nwhit.org/file.php/55/Process_Mapping_Instructions_with_Gliffy_Flowchart.docx

1. Recommend changes in workflow, represented by revised workflow analysis.

2. Recommend EMR customizations.

Part III. Change Management

Your primary point of contact at PVMP has some concerns about effectively implementing the recommended changes and has asked for your advice. She told you that the initial EMR implementation was poorly planned and executed and that it engendered a fair amount of resentment and mistrust among both clinical and non-clinical staff.

1. Describe some strategies PVMP can use to reduce resistance and facilitate adoption of the recommended changes.

Case Study Guidelines

Overview: You will be assigned to a 5-person team based on your time zone. We also try to include a mix of clinical and non-clinical staff in each team. You'll work together to develop a case study solution. You will be assigned to a team by x date.

Basis for solution: Your group's case study solution should be based on members' ideas and experiences in conjunction with content covered in the required lectures. You may also want to include relevant content from the optional resources posted in the course site. Additional research outside of the resources provided within your course site may be helpful, but is not required.

Length: Your case study solution (one per team) should be approximately 4 pages in length.

Communication/collaboration tools: These can include Discussion forum: Communicate asynchronously (at different times) by posting ideas and

information in the small group discussion forum. Chat room: You can use an instant-messaging type of tool through your online learning platform

to communicate with group members at specifically scheduled times. Phone conference: A variety of free audio-conferencing tools are available to the general public.

Group process: Your group is free to work together in whatever way you wish. Ideally, your group will engage in discussion about the various points covered.To ensure success and timely submission of your case study solution, we recommend the following:

BY WEEK 3 - Establish roles, responsibilities and deadlines:

Following are some typical roles: Facilitator: provide leadership, setting timelines, reminding members of deadlines,

organizing/facilitating meetings Researcher: research and/or summarize relevant content from lectures and optional materials Synthesizer: compile key elements from the group's discussions Editor: edit drafts and post final submission.

Another way to manage the case study is for each member to take the lead on a particular question(s) and report back to the group.


BY WEEK 4 - Develop a communication plan:

Decide how and when you will meet. Options may include one or several of the following: Communicate through the case study small group discussion forum. Schedule chat times. Use a teleconference line, Skype, or collaboration tool of choice.

BY WEEK 5 - Exchange drafts of answers:

Exchange preliminary drafts of answers with one another to questions on Workflow Analysis

BY WEEK 6 - Exchange drafts of answers (cont.):

Exchange preliminary drafts of answers to all questions with one another

BY WEEK 7 - Submit final case study solution:

Submission Format: Post your case study solution to the case study forum as an attachment, noting your group name in the title (e.g., Group A) and listing the names of all contributors at the beginning of the document. The attachment should be either a WORD or PDF file.

IMPORTANT: Case Studies are due at the start of Week 7.

Grades: All group members who participate actively in the case study will receive the same grade. Following are general criteria for grades. Points Grading Criteria39-50 points All project elements completed

Content clear and well organized Content reflects an understanding of key

concepts presented in the course

26-38 Most project elements completed Content clear and reasonably organized Content reflects an understanding of key

concepts presented in the course

0-25 points Deliverables may have some merit, but are incomplete, poorly executed, or reflect a lack of understanding of key concepts.


Bellevue College--WACMHC Health IT Curriculum Web viewNursing Outlook, 56(6), ... Pentagon....

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