V is the nursing specialty that deals with

human responses to life threatening

problems. It is a multidisciplinary
healthcare specialty that cares for
patients with acute life-threatening illness
or injury.
V Orocess, store and integrate physiologic and diagnostic
information from various sources.
V Oresent deviations from present ranges by an alarm or an
alert
V Accept and store patient care documentation in a
lifetime clinical repository
V Trend data in a graphical presentation·
V Orovide clinical decision support through alerts, alarms
and protocols
V Orovide access to vital patient information from any
location both inside and outside of the critical care setting
V Comparatively evaluate patients for outcomes analysis
V Oresent clinical data based on concept-oriented views
(organize data by patient problem or by system)
V O
 


 
×emodynamic monitors ²advanced
hemodynamic monitoring systems allow
for calculation of hemodynamic indices
and limited data storage. It can be
invasive or non-invasive.

Arrhythmia monitors ² computerized

monitoring and analysis of cardiac
rhythm have proved reliable and
effective in detecting potentially lethal
heart rhythms.
V j  


A mechanical ventilator is a machine
that generates a controlled flow of gas
into a patient·s airways. Oxygen and air
are received from cylinders or wall
outlets, the gas is pressure reduced and
blended according to the prescribed
inspired oxygen tension (FiO2),
accumulated in a receptacle within the
machine, and delivered to the patient
using one of many available modes of
ventilation.
V ii 
 

 
a CCIS is a system designed to
collect, store, organize, retrieve and
manipulate all data related to care
of the critically ill patient. It is
focused on individual patients and
the information directly related to
the patients· care. It is for the
organization of a patient·s current
and historical data for use by all
care providers in patient care.
Components of CCIS:

V Oatient management
V Vital sign monitoring
V Diagnostic testing results
V Clinical documentation
V Decision support
V Medication management.
V Interdisciplinary plans of care
V Orovider order entry
V a synthesis of nursing practice and public
health practice applied to promote and
preserve health of populations.
V ×    ² the provision of
preventive, therapeutic, restorative and
supportive health care in the home.
V O   the Institute of Medicine
(IOM) defines public health as coordinated
effort at the local, state and federal levels
whose mission is fulfilling society·s interest in
assuring conditions in which people can be
healthy.
Focus on:
½ Oreventing, identifying, investigating and
eliminating community health problems
½ Assuring that the community has access to
competent personal healthcare services
½ Educating and empowering individuals to adopt
more healthy behaviors
V x  a uniform data set is a minimum set of items of
information with uniform definition and categories
concerning the specific dimensions of the service or practice
setting that meets the essential information needs of multiple
data users within the scope of the service or practice setting.
    
½ ë
     
   the National
Association of ×ome Care (NA×C) Resource Committee
initiated a task force to develop a uniform data set for
×ome Care and ×ospice to achieve a standardized
comparable home care and hospice data. The data set is
organized into two major categories of organizational and
individual level data elements.
 

 description of the organization, services,
aggregate utilization and financial and personnel data.
 
 demographic, clinical, service, and
utilization data for clients/patients.
V  
 

 
 
 this is a group of items that
represents the core items of a
comprehensive assessment for an adult
home health patient and forms the basis for
measuring patient outcomes for purposes
of Outcome-Based Quality Improvement
(OBQI).

V   
 


 it includes two components,
Outcome analysis and outcome
enhancement.
½ Outcome analysis
½ Outcome enhancement
V ×  O
 
x

 
 
× xa set of standardized performance
measures designed to ensure that purchasers and
consumers have the information for reliably
comparing the performance of managed
healthcare plans. There is also a standardized
survey of consumers· experiences that evaluates
plan performance related to customer service,
access to care, and claims processing.
V a

 
-are validated clinical reference
languages, taxonomies or terminologies
that make health care knowledge more
usable and accessible. The language,
vocabulary or taxonomy enables a
consistent way of capturing, sharing and
aggregating health data across sites of
care. The vocabulary serves as a vehicle to
format messages that are exchanged
between computer system and the coding
and classification scheme used within the
messages, for messages to have
agreement in syntax so that individual data
can be structured in a common way.
The two most common nursing vocabularies
or taxonomies in use for C×N:

V i
i i
iii
 - a
standardized language/vocabulary consisting of
two interrelated taxonomies ² the CCC of nursing
diagnoses and the CCC of nursing interventions
(both Version 2.0). The CCC is designed to
document, code, and classify for computer-
processing care in any clinical setting by any
health care provider using a standardized
framework. They are used to electronically track
and analyze patient care overtime across settings,
population groups, and geographic locations.
V   
 ² is a researched based
comprehensive taxonomy designed to generate
meaningful data following usual or routine
documentation of client care. It consists of three
components ² the problem classification scheme,
intervention scheme and problem rating scale for
outcomes. The system provides a method for
linking clinical data to demographic, financial,
administrative and staffing data.
V i 

×  


!
 i×! was
a prototype classification tool that included 15
parameters that represented the same four home
health domains as the Omaha System. Each of the 15
parameters included patient profiles to illustrate the
extent of nursing input required for patient care for four
levels of care contained within each parameter, for a
total of 60 profiles. A profile was selected for each
parameter and then the rater implicitly integrated these
into a categorical rating for the patient·s resource
requirements. The ratings were as follows:

 Level 1-minimun requirement

 Level 2-moderate requirements
 Level 3 ² major requirements
 Level 4- extreme requirements
V i 

×  
  connotes
those computerized IT systems specifically
developed and designed for use by
community health agencies, local, and
state health departments, community
programs and services. Community health
systems address the broad areas of ²
healthcare programs, agencies, and
settings. They support health promotion and
disease preventive programs, statistical
information required by state/local health
department programs and funding
information for federal block grants,
categorical grants or other grant programs.
The following are some of the typically used
systems in community health systems:
V Categorical systems
V Screening programs
V Registration systems
V Management information systems
V Statistical reporting systems
V Oublic health information system
V National Electronic Disease Surveillance
System
V Special purpose systems
V School health systems
V × ×  
 

  home health
systems are designed to support home health care,
hospice and private duty programs provided by
×ome ×ealth Agencies (××A) such as Visiting
Nurses Association (VNAs), nonprofit ××As and
hospital-based programs. These systems collect
and process data and include applications on
clinical service delivery, integrated financial
functions, scheduling packages, decision support
functions, payroll, personnel management,
accounts payable, billing functions, general
ledger, financial reporting and statistical reporting
capabilities.
V á  

  communication
telemedicine systems link patients homes to
healthcare facilities and healthcare professionals,
home care workers to their supervisors and patient
and families with community resources. This allow
for reduction of inconvenient and expensive visits
to health care providers and omit unnecessary
visits to healthcare facilities.
V i 

  
"#
  is an innovative
ambulatory care system specially developed to
provide services by computer. Computer terminals
are placed in homes of ´heavy users of health careµ
such as families with young children, pregnant
women, disabled and the elderly. The system allows
the subscribers to telephone for assistance and
guidance on services offered via the terminal. The
system performs actions but not necessarily
diagnoses:
½ Download the patient record from the hospital to the
home database
½ Enters series of questions about symptoms using expert
system logic until the pathways are concluded
½ Track self care and, depending on the responses to
questions, call or make an appointment with a clinician.
½ Orovide additional information on the condition if self care
is chosen to assist the client to resolve the problem.
V ×      


  are using
computers to link patients at home to health care
facilities. They allow healthcare providers to
monitor the progress of their patients. It allows
transmission of healthcare information being used
not only for diagnosis and treatment but also
prevention. The data is then reviewed by health
care providers in the central station and are
alerted for abnormal assessments/parameters for a
particular patient.
V Another monitoring device is a remote defibrillator
that allows hospitals to diagnose and resuscitate a
homebound patient who had suffered a cardiac
arrest.
V Sophisticated telemetry devices such as digitized x-
ray and ECG, electronic stethoscopes and
interactive video equipment are also using
telecommunications technology to enable
specialists to examine patients in remote clinics.
V Another is alert systems that allow the homebound
to signal for help in an emergency.
V 
 


  provide
communication linkages, information access, and
educational materials that meet the clients need
to reach beyond their environment. These systems
may also offer screening for compliance with
health prevention standards and linkages to
education
V As a response to increasing costs of
providing health care, the healthcare
industry has moved away from the
expensive inpatient acute care
environment to caring for clients in various
ambulatory care settings.
V They include ambulatory clinics and surgery
centers, single and multi-specialty group
practices, diagnostic laboratories, health
maintenance organizations, independent
physician associations, birthing centers and
college and university health services.
V 3



Cost effective and timely bill submission process resulting in
decreased days in accounts receivable and the reduction of
rejected claims.
V  
 

Reduction in the size of the record room, reduced to time spent
finding and delivering charts, increase in the privacy of data,
formats that are legible and comply with legal regulations, and
the promotion of quality assurance and improved patient
satisfaction.
Ability for home access by physicians and nurse practitioners,
alerts for incomplete data and integration of clinical data.

V i


Can provide a problem list, automated, automated ambulatory
care provider order entry (ACOOE), a medication record, vital
signs, progress notes, results from the laboratory and radiology
departments, flow sheets, growth charts, immunization records,
medication allergies, profiles, alerts and reminders, and a follow-
up system. Other applications for the clinical area can
encompass a clinical decision support system, eOrescribing and
evidence based medicine.
V ! 
 $

The ambulatory care arena just like other
health care requires data in order to manage
care. The ×ealth Care Oortability and
Accountability Act of 1996 requires 6 code sets.
Behind the scenes, a database must be
maintained of all current coding schemes used
for the ambulatory environment. These include:
½ Current Orocedural Terminology 4th edition (COT)
½ The Ninth Revision of the International Classification
of Diseases (ICD-9-CM)
½ The ×ealthcare Common Orocedure Coding System
(×COCS)
½ The National Drug Code (NDC) managed by FDA
½ Code on Dental Orocedures and Nomenclature
V á  
 

 
 

 


½ user of the data contained in automated
systems, to take the data and put it together in
meaningful ways, making information.
½ reports are generated that can be used in
better management of the health of the patient,
managing the administrative aspects of the
practice, generating financial information, or in
conducting research.
½ a nurse may be involved in the selection of
automated systems based on a needs
assessment of the environment.
½ the ambulatory nurse can be instrumental in the
implementation of an automated system
whether administrative, financial or clinical.
V j  

 
 

½ the American Academy of Ambulatory Care Nursing (AAACN)
½ -the American Medical Informatics Association (AMIA)
½ -the Society of Ambulatory Care Orofessionals I
½ -the Federated Ambulatory Surgery Association (FASA)
½ -the American Association of Ambulatory Surgery Centers
(AAASC)
½ -the Association of Ambulatory Behavioral ×ealthcare (AAB×)
½ -the American ×ealth Information Management Association
(A×IMA)
½ -the ×ealthcare Information Management Systems Society
(×IMSS)
V  



½ Accreditation Association for Ambulatory ×ealth Care (AAA×C)
½ COLA
½ The National Committee for Quality Assurance (NCQA)
½ The Joint Commission on Accreditation of ×ealthcare
Organization (JCA×O)
V i %i 

The eCLINICALOG is part of an educational strategy, initially
designed to build data entry, analysis and synthesis skills in
nurse practitioner students. It becomes relevant to
undergraduate education as well. Like other logs, eClinicalog
started out as a paper and pencil format. Nurse practitioner
students used logs to track the number of patients seen in
clinical practical and record basis demographic data,
medical diagnoses, and medications prescribed.
V x 

   to develop a
computer simulation model for city wide
response planning for mass prophylaxis and
vaccination during bioterrorist attacks and
other public health emergencies.
V 

   
  IT systems can aid
intensively in detection of a disease outbreak
before the actual disease or mechanism of
transmission is identified. Example is the Real-
time Outbreak Disease Surveillance (RODS)
system that provides early warning of possible
infectious disease outbreaks caused by
bioterrorism or other public health
emergencies.
V × 


 
  it
contributes in providing training and
education modules to teach healthcare
professionals to identify various biologic
agents. A system can also allow real-
time transmission of clinical impressions
and symptoms, which will aid in
bioterrorism surveillance.
V a
 

 used to
organize bulk volunteers, educate them
and how tasks are given.
V vendors are delivering more robust and tightly integrated clinical
solutions that better address the needs of all care providers for more
coordinated, streamlined patient care delivery.

V Unlike with earlier systems that primarily automated the paper chart
and basic patient care processes, vendors are now expected to
deliver ´next generationµ clinical applications that:
½ Support multi and interdisciplinary care with all provider orders,
care plans, and notes online and integrated in a common
patient-centric patient record.
½ Oromote data integrity via data validity checks and embedded
tools. Ex. Calculations
½ Orovide ready access to internal standards. Ex. Oolicies and
procedures, drug databases, and reference guides
½ Collect workload management data as byproduct of clinical
documentation including deriving prospective acuity data from
orders and retrospective acuity data from clinical
documentation.
½ Support productivity management, staffing and budgeting
activities.
½ Support process and outcomes monitoring, management, and
continual improvement via standard reports and database
mining.
½ Support charge capture, supply management and inventory
reconciliation. Ex. Replenishment of supplies and medications as
byproduct of clinical documentation.
½ Support for medical, disease and population management.
[


 


 

 
 



V Oatient Access
V Admission Assessments
V Diagnosis/Oroblems
V Nursing and Multidisciplinary Orders and Olans of
Care
V Integrated Olans of Care
V Kardex
V Workplans/tasklists
V Results
V Clinical Documentation
V Discharge Summaries
V Summary Reports
V Outcomes Variance Reports