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Human acts and voluntariness, this is about the human act and acts of man, Summaries of Bioethics

University of Southern NevadaBioethics

This topic talks about the knowledge not enough knowledge freedom voluntariness however we could always be accused also of lacking prudence one of the cardinal virtues we should know at least uh i'm not saying in passing because we will study it we need it one of the cardinal birches cardinal virtus are like hinges in which all the other virtues depend on this cardinal virtues so at least we have that idea

Typology: Summaries

2022/2023

Uploaded on 03/15/2023

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Care and delivery Application
CLINICAL INFORMATION SYSTEM
- Designed to support care by
providing instant access to
information for clinicians.
Features of Early CIS:
• Interpretation of Laboratory Results
• Medication Formulary
• Drug Information Summary
Goal of CIS:
- Expand the scope to become a
comprehensive system that provides
clinical decision support
TRACKING CLINICAL OUTCOMES
- Ability to measure outcomes can be
enhanced by the way an information
system is designed and used.
Approaches:
1. Narrative
- Provides a very good picture of the
patient status by narrative (free text).
- No coded entry is used — making it
difficult to analyze the care given or
the patient response.
Outcomes:
▪ Inconsistent
▪ Fragmented
▪ Disorganized
2. Integration of Standardized Nursing
Terminologies
- Not all clinicians are equally skilled in
free-text form of communication.
- Integration of standardized
terminologies enhances the ability of
reporting and further research.
- Provides a foundation for
interoperability by improving the
effectiveness of information
exchange.
Standardized EHR codes for care
application
1. LOINC (Logical Observation Identifiers
Names and Codes)
- Is a universal code system for
identifying health measurements,
observations, and documents.
2. UCUM (The Unified Codes for Units of
Measurement)
- is a code system intended to include
all units of measures used in
international science, engineering
and business to facilitate
unambiguous electronic
communication of quantities
together with their units.
3. SNOMED CT (Systematized
Nomenclature of Medicine- Clinical Terms)
- These codes often represent the
“answer” for a test or measurement
to the LOINC “question” code.
4. RxNorm
- provides normalized names for
clinical drugs and links its names to
many of the drug vocabularies
commonly used in pharmacy
management and drug interaction
software.
5. RadLex
- is a unified language of radiology
terms for standardized indexing and
retrieval of radiology information
resources.
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Care and delivery Application

CLINICAL INFORMATION SYSTEM

  • Designed to support care by providing instant access to information for clinicians. Features of Early CIS:
  • Interpretation of Laboratory Results
  • Medication Formulary
  • Drug Information Summary Goal of CIS:
  • Expand the scope to become a comprehensive system that provides clinical decision support TRACKING CLINICAL OUTCOMES
  • Ability to measure outcomes can be enhanced **by the way an information system is designed and used. Approaches:
  1. Narrative**
  • Provides a very good picture of the patient status by narrative (free text).
  • No coded entry is used — making it difficult to analyze the care given or the patient response. Outcomes: ▪ Inconsistent ▪ Fragmented ▪ Disorganized 2. Integration of Standardized Nursing Terminologies
  • Not all clinicians are equally skilled in free-text form of communication.
  • Integration of standardized terminologies enhances the ability of reporting and further research.
  • Provides a foundation for interoperability by improving the effectiveness of information exchange.

Standardized EHR codes for care

application

  1. LOINC (Logical Observation Identifiers Names and Codes)
    • Is a universal code system for identifying health measurements, observations, and documents.
  2. UCUM (The Unified Codes for Units of Measurement)
    • is a code system intended to include all units of measures used in international science, engineering and business to facilitate unambiguous electronic communication of quantities together with their units.
  3. SNOMED CT (Systematized Nomenclature of Medicine- Clinical Terms)
    • These codes often represent the “answer” for a test or measurement to the LOINC “question” code.
  4. RxNorm
    • provides normalized names for clinical drugs and links its names to many of the drug vocabularies commonly used in pharmacy management and drug interaction software.
  5. RadLex
    • is a unified language of radiology terms for standardized indexing and retrieval of radiology information resources.

6. MEDCIN

  • is a medical terminology, maintained by Medicomp Systems, that encompasses symptoms, history, physical examination, tests, diagnoses and therapies.
  1. ICD- 10
  • is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems(ICD), a medical classification list by the World Health Organization(WHO). It contains codes for diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases.
  1. CPT (R) (Current Procedural Terminology)
  • is a code set, maintained by the American Medical Association (AMA) used to bill outpatient and office procedures.
  1. CDC CVX and MVX
  • The Centers for Disease Control and Prevention (CDC) provide a number of code sets for vaccines (Vaccines Administered (CVX)) and manufacturers (Manufacturers of Vaccines (MVX)). These codes can be used in immunization messages.
  1. NDC (National Drug Code)
  • is maintained by the Food and Drug Administration (FDA) and provides a list of all drugs manufactured, prepared, propagated, compounded or processed for commercial distribution. The NDC database can be searched here.
  • Healthcare Information and Management System Society (HIMSS), www.himss.org, retreived: February 18, 2019 The Electronic Health Record in Caring
  • A simple automation of clinical documentation IMPLICATIONS:
  • Care Delivery
  • Nurse-Client Interaction
  • Research Governing Law:
  • Health Information Technology for Economic and Clinical Health Act of 2009 (HITECH)

ACCREDITING ORGANIZATIONS:

1. Drummond Group - Provides high-level testing services for software developers in the healthcare practice, as well as in other industries. Test offerings: Auditing, Quality Assurance, Conformance Testing, Customer Software, Software Certification, Web Service Tests, Interoperability Testing. 2. CCHIT (Certification Commission for Health Information Technology) - A non-profit group which focused on advancing health information technology. GOAL: ▪ Create a credible, efficient and sustainable certification programs

8. Reporting and Population Health Management - Data collection tools to support public and private reporting requirements. o Field Health Information System (FHSIS) ADVANTAGES OF ELECTRONIC HEALTH RECORDS - Increased delivery of guidelines- based care - Enhances capacity to perform surveillance and monitoring for disease conditions - Reductiion in medication error - decreased use of care SIMPLE BENEFITS: - No longer having to interpret poor - handwriting and written orders. - Maximize time especially in the administration - of first dose medications (Antibiotics) - Reduced turnover time for lab results in and ER department. OWNERSHIP OF ELECTRONIC HEALTH RECORDS KEY: From the Executive Level to the Clinician at the point of care - > Sense of ownership to make the implementation successful for themselves INDICATOR: Clinician adoption of the tool for selection, implementation, evaluation and optimization of the HER

STEPS OF EHR OWNRS

1. Vendor selection process of commercially available EHR. - Survey the organization’s level of interest - Identify possible barriers to participation - Document desired functions of an EHR - Assess the willingness to fund implementation - Assess the needs and readiness of executive leadership. 2. Select a system based on the organization’s current predicted needs - Based on the completed needs assessment , the organization should established key evaluation criteria to compare the different vendors and products. Criteria: (subjective and objective topics of concern) ▪ Clinical Workflow ▪ Decision Support ▪ Reporting ▪ Usability ▪ Technical Buils ▪ Maintenance of the system **Providing the vendor with these guidelines will ensure that the process meets the organization needs.

  1. Implementation Planning**
    • Implementation planning should occur concurrently with the selection process.
  • A time where metrics are identified by which to measure the success of an EHR COMMON METRICS FOCUS ON:
  • Reduction in the number of duplicate lab test through duplicate orders
  • Reduction of adverse drug events through **the use of bar codes.
  1. End-user Adoption**
  • Clinicians must engage to use the EHR successfully in their practice and daily workflows. OUTPUT: ▪ Captured data drive the decision support that underlies behind patient care.