D220 Informatics Review Revision 2024

American Recovery and Reinvestment Act (ARRA) - answers**Authorized INCENTIVE PAYMENTS to specific types of hospitals & healthcare professionals for adopting & using interoperable Health Information Technology and EHR's. The purposes of this act include the following: (1) To preserve/create jobs and promote economic recovery. (2) To assist those most impacted by the recession. (3) To provide investments needed to increase economic efficiency by spurring technological advances in science and health. (4) To invest in transportation, environmental protection, and other infrastructure that will provide long-term economic benefits. (5) To stabilize state and local government budgets, in order to minimize and avoid reductions in essential services and counterproductive state and local tax increases. AHQR (Agency for Healthcare Research and Quality) - answersProduced evidence making healthcare safer, improve quality, accessibility and affordability Asynchoronous Applications - answersNo contact with patient for data collection. EX: Remote pt monitoring, Using health technologies to share health metrics and data w/ providers. STORE & FORWARD APPS (ex: photos) Administrative Information System - answerscan include registration and scheduling; tracking through admission, transfer and discharge; patient acuity and staff scheduling; financial or accounting systems; risk management; payroll and human resources; quality assurance; and contract management functions. Affordable Care Act - answerslaw passed in 2010 to expand access to insurance, address cost reduction and affordability, improve the quality of healthcare, and introduce the Patient's Bill of Rights, increasing the number of insured persons. Alarm Fatique - answersBecoming desensitized to patient care alarms and missing or delaying their response to the alarm. ANA (American Nurses Association) - answersProfessional organization for all RNs. Concerned with licensure, collective bargaining and education Analytics - answersA term describing the extensive use of data, statistical and quantitative analysis, explanatory and predictive models, and fact-based management to drive decisions and actions. Audit trail - answersa report that traces who has accessed electronic information, when information was accessed, and whether any information was changed Authentication - answersA method for confirming users' identities Authorization - answersThe process of giving someone permission to do or have something Barcode Scanning Technology - answersScans drug and patients wristband to verify medication order, inventory control, + pt identification, correct med admin Big Data - answersa collection of large, complex data sets, including structured and unstructured data, which cannot be analyzed without the use of information technology Bioinformatics - answersapplication of mathematics and computer science to store, retrieve, and analyze biological data Biometrics - answersthe identification of a user based on a physical characteristic, such as a fingerprint, iris, face, voice, or handwriting Business Continuity Plan - answersA plan for how an organization will recover and restore partially or completely interrupted critical function(s) within a predetermined time after a disaster or extended disruption Business Intelligence - answersInformation collected from multiple sources such as suppliers, customers, competitors, partners, and industries that analyzes patterns, trends, and relationships for strategic decision making Change Control Board (CCB) - answersA committee that evaluates the worthiness of a proposed change and either approves or rejects the proposed change. Chief Nursing Officer (CNO) - answersThe senior manager (usually a registered nurse with advanced education and extensive experience) responsible for administering patient care services Clinical Care Classification (CCC) - answers"Two interrelated taxonomies, the CCC of Nursing Diagnoses and Outcomes and the CCC of Nursing Interventions and Actions, that provide a standardized framework for documenting patient care in hospitals, home health agencies, ambulatory care clinics, and other healthcare settings" CPOE (Computerized Physician Order Entry) - answersAn order entry and decision support system that allows direct entry of orders and immediately shared w/ others Change Management - answersThe process, tools and techniques that help people implement changes to achieve a desired outcome. (Supports the adoption of a medication Administration System) Change Control - answersHelps to prioritize limited resources and ensures system standards are upheld. Connected health - answersa model of health care delivery using technology to provide services including information and education. Technology assisted healthcare is delivered between at least 2 points involving either asynchronous or synchronous exchange. Consumer Health Informatics - answersUse of electronic info & communication to improve medical outcomes & healthcare decision making from pt perspective. Patient view and structures and process that enable consumer to manage their own care. Clinical Research Informatics - answersDiscovery and management of new knowledge pertinent to health and disease from clinical trials via secondary data use. C-CDA (Consolidated Clinical Document Architecture) - answersAllows interoperability of health information exchange between to hospitals. 21st Century Cures Act - answersdesigned to help accelerate medical product development and bring new innovations and advances to patients who need them faster and more efficiently. Provisions that will improve workflow & exchange of electronic info. ONC (responsible for implementing) seamless & secure access, exchange and use of electronic health info. 5 rights of clinical decision support - answersRight information Right person Right intervention format Right channel Right time in workflow Clinical Informatics - answersconcentration on the delivery of timely, safe, effective , EB and pt centered care. C - answers Clinical Decision Support System - answersA special subcategory of clinical information systems that is designed to help healthcare providers make knowledge-based clinical decisions Ex: Alerts for abnormal VS, labs results, med contraindications, screenings, standing orders, reminders in EHR ect... Clinical Information Systems - answersEx: May be specific to certain departments. Lab, radiology, pharm(Both), or particular pt population. Functions may include order entry, results reporting, scheduling and documentation. Lg computerized database used to access the pt data that are needed to plan, implement and evaluate care. Clinical Nurse Specialist - answersExpert clinician in a specialized area of practice who engages in research and helps direct practice change. clinical terminology - answersstandardized terms and their synonyms used to record pt data with sufficient detail to support clinical care, decision support, outcomes research, and quality improvement, flow sheets, vital signs, assessments and nursing notes. Computer Literacy - answersThe ability to use computers for basic tasks, such as developing documents, sending emails and searching the internet for information. Confidentiality - answersRelationship has been established where private info shared but NOT disclosed w/out permission configurability - answersRefers to the extent that a given software product can be adapted or changed to meet a user's preference Contextual Inquiry - answersinvolves studying customers' use of a product at their place of work Focusing on users point of view. CCR (Continuity of Care Record) - answersSnapshot/standardized summary of the most relevant and timely health information about pt and shared to a physician who does not have access to pts EHR. Continuous Quality Improvement (CQI) - answersContinuous monitoring of performance and supports audit capability also known as QUALITY ASSURANCE SYSTEM Critical Care Information System - answersIntegrates captured physiological data w/ practitioner documentation and clinical data management functions, as well as access and communication w/ remote experts. Data - answersFacts, figures, and other evidence gathered through observations. Database - answersA collection of data organized in a manner that allows access, retrieval, and use of that data Data cleansing/scrubbing - answersA process that weeds out and fixes or discards inconsistent, incorrect, or incomplete information Data Governance - answersrefers to the overall management of the availability, usability, integrity, and security of company data Data Integrity - answersThe correctness of data after processing, storage or transmission. Ability to store, retrieve, correct and complete data are available to authorized users Data Mining - answersthe application of statistical techniques to find patterns and relationships among data for classification and prediction using software. Data Analysis - answersprocessing of data that identifies trends and patterns of relationships Data Warehousing - answersPowerful method of managing and analyzing data DICOM (Digital Imaging and Communications in Medicine) - answersTransmits digital imaging (DICOM & HL7 support standardization in health care data DIKW theory - answersData, Information, Knowledge, Wisdom (data is most discrete) Data=pt monitoring, labs, diagnostic systems (CT scans) Information=Clinical Info systems, & DSS (alerts/reminders) Knowledge=Lg databases (med articles) & Artificial Intelligence Data Modeling - answersthe process of determining the users' information needs and identifying relationships among the data to support processes for an info system (key step in design of EHR) DSS (decision support system) - answersan interactive, flexible, computerized information system that enables managers to obtain and manipulate information as they are making decisions r/t patient care device integration - answersCapturing data from patient monitors and anesthesia machines, and filing them directly to a patient's chart in EHR. Ex: entering VS, cardiac monitor download data into EHR Disease Registries - answerscollections of secondary data related to patients with a specific diagnosis, condition, or procedure. disruptive innovation - answersa process by which a product or service takes root initially in simple applications at the bottom of a market and then relentlessly moves up market, eventually displacing established competitors Dissemination - answersthe act of spreading widely or scattering data including research knowledge. Doctorate of nursing practice (DNP) - answersdegree w/ emphasis on EBP, quality improvement and system leadership EHR system - answers3 elements: Data, Info, Knowledge. Decrease med errors, increase provider documentation. Function ex: Bar Code Admin. EMR (electronic medical record) - answersa record of one episode of care, source data for EHR, Brings together diagnositc & Tx info in a specific healthcare setting. Ergonomics - answersThe study of workplace equipment design or how to arrange and design devices, machines, or workspace so that people and things interact safely and most efficiently. EHR - answersPt data stored in electronic form(collection of pt healthcare data) **Successful if pt needs met PHR (personal health record) - answersLifelong tool for managing health info, controlled by pt - data can be provided by MD or pharmacy. (conditions, allergies, meds, surgeries) Barriers: Poor or no internet, poorly designed apps, limited clinical integration Predictors: Awareness of PHR's, ease of access, personal motivation, increased levels of education and health literacy. emerging trends - answers• Secondary data • Technology-based data management • Digital information acquisition and retrieval • International client base • Information management (patient safety & error reduction) EBP (evidence based practice) - answersUsing current best evidence for pt care decision in order to improve pt outcomes (found in standing orders) Ex: sepsis protocols & CDS Expert Systems - answersType of CDS/DDS but does NOT need human intervention (artificial intelligence) Ex: Personal Insulin Pump EMRAM (Electronic Medical Record Analytical Model) - answersMeasures clinical outcomes, pt engagement & clinical use of EMR technology to strengthen organizational performance & health outcomes across pt populations "Basically, evaluates Health Information System" feature creep - answersoccurs when developers add extra features that were not part of the initial requirements Finacial system - answersuses pt demographic data and insurance info to charge for services & reimbursment Functional Testing - answersFinal process in Project Management Phase 2 (planning) that ensures the innovation works as designed. Fish boning - answersCause/effect diagram, can help in brainstorming to identify possible causes of a prob. Firewalls - answershardware, software, or both designed to prevent unauthorized persons from accessing electronic information, while allowing authorized communication. Gantt Chart - answersA time and activity bar chart that is used for planning, managing, and controlling major programs that have a distinct beginning and end.(used for a glance at management) Gap Analysis - answersa type of analysis that compares the differences between the consumer's expectations about and experiences with a service based on dimensions of service quality (Planning) Go Live - answersthe official time and date that the facility begins using the new system (Implementation Phase) HIE (Health Information Exchange) - answersElectronic sharing of pt info (demographic data, allergies, diagnostic tests, and other revelant data between providers, specialists, hospitals, and insurance companies. HIS Health Information System - answersBroad term used to describe administrative and clinical systems to streamline work flow processes efficiency. Hardware/software dedicated to the collection, storage, processing, retrieval and communication of patient care info. healthcare terminology standards - answersdesigned to enable and support widespread interoperability among healthcare software applications for the purpose of sharing information HIPAA (Health Insurance Portability and Accountability Act) - answersKennedy Kassebaum Bill, Federal legislation to protect client records & mandate that all electronic transactions included only HIPAA compliant codes. Sets nation standards of PHI, legal protection of PHI. (signing in devices requires encryption) HIT - Health Information Technology - answersTechnology that is used to record, store, and manage patient healthcare information. Ex: CDS, CPOE, EMR, EHR, PHR, Telehealth, E-scribe National & Global implications Health literacy definition - answersa person's capacity to learn about and understand basic health information and services, and to use these resources to promote one's health and wellness HIS (Hospital Information System) - answersWhat is the name of the computer system that tracks admission and discharge information, diagnostic and treatment services, pharmaceutical and equipment information, and billing information? Advantages: Better communication, decreased errors & better access to info. HITECH (Health Information Technology for Economic and Clinical Health Act) - answers2009 ARRA includes HITECH - promote adoption and meaningful use to HIT. Goal: Improve quality care, Pt safety, Decrease costs by using meaningful use *Improves Population Health Outcome* HL7 (Health Level 7) - answersAcronym used to refer a standard of interoperability and exchange of clinical data (HL7 & DICOM-Standardization) HIMSS Healthcare Information & Management Systems Society - answersformal group of healthcare organizations that seek to improve delivery of healthcare by advancing technology & data management. *work almost exclusively w/ data *They protect & handle pt data of all kinds (diagnosis, symptoms, test results, med hx, procedures) *They ensure info is accurate, accessible, secure and of high quality *Cause-based, Nonprofit, Global organization focused on better health through info & tech. Health Informatics Management - answersfocus on info technology needed to store and retrieve pt data accurately, securely and management of the people & processes. HIE forms - answersDirect - send/recieve secure info electronically between providers ex: immunization data, quality measures sent to Medicaide/Medicare Query - find & request info, often used for unplanned care (ER, pregnancy) Consumer mediated - pts to aggregate and control the use of health info among providers (correcting info, tracking their health, providing providers w/ info) Informatics - answersthe science and art of turning data into information *Interdisciplinary field Data to info, Info to knowledge, Knowledge to wisdom Implementation Science - answersstudy how interventions, which have been shown to be effective in one setting, can be applied to sustain improvements to population health Information Epidemiology - answersscience of distribution of information in an electronic format w/ te ultimate aim to inform public health and public policy Informatics Competencies - answersthe ability to perform the tasks associated w/ informatics information - answersA continuum of progressively developing and clustered data. Collection of data that has been interpreted & examined for patterns and structures information literacy - answersthe ability to figure out the type of information you need, find that information, evaluate it, and properly use it * Ability to read and understand works/numbers and ability to recognize when info is needed. Information System - answersa set of hardware, software, data, people, and procedures that work together to produce information "Data Collection" Information Technology (IT) - answersTransmit Data Ex: EHR, CDST (clinical decision support tool) information science - answersPrimarily focused on input processing output and feedback through technology intergration 5 rights of Informatics - answersRight - Information Person Intervention Channel Time in workflow Informatics Innovator - answersConducts information and RESEARCH & generate THEORY & have advanced understanding in info management & computer technology ICD-10 - answersUsed to classify mortality and morbidity data from inpatient/outpatient records, used for reimbursement Integration - answersProcess of two systems exchanging data in a way that is seamless to end user. Interoperability - answersAbility of 2 entities, human/machine to exchange & predictably use data/info while retaining original meaning of data Ex: Dr-Dr, Hosp-Hosp(C-CDA), escript-pharm Interface - answersBridge/connector to send info from 2 different systems interoperable systems - answersExpected outcomes=error reduction, improved revenue, increased communication. Systems share limited processes and data Information Security - answersSecurity Rule - Nation set of security standards health info in electronic form GOAL: Protect privacy while adopting new technologies to improve quality & efficiency of pt care "Need to KNow basis" The Joint Comission Standards - answersStandard The hospital respects the patient's right to receive information in a manner he or she understands. Elements of Performance The hospital provides language interpreting and translation services Note: Language interpreting options may include hospital employed language interpreters, contract interpreting services, or trained bilingual staff, and may be provided in person or via telephone or video. The hospital determines which translated documents and languages are needed based on its patient population. --do not have family or children translate! -don't have to have one there the whole time - but having one there for discharge would be very important Joint Commision - answersACCREDIATATION key standard of information management: Protect & aggregate data, uniform language, teach info management (training), disaster and preparedness knowledge - answersSkills, experience, and expertise coupled with information and intelligence that creates a person's intellectual resources Knowledge Database - answersA database that not only manages raw data but also integrates them with information from various reference works knowledge translation - answersapplying research to practice Knowledge Management (KM) - answersstructed process for the generation, storage, distribution and application of both tacit(personal) knowledge and explicit (evidence) knowledge knowledge workers - answersGenerate knowledge as product Knowledge work - answersgathering data which is then used to create info and knowledge Kotter's 8 steps for leading organizational change - answers1. establish a sense of urgency 2. create the guiding coalition 3. develop a vision and strategy 4. communicate the change vision 5. empower the broad-based action 6. generate short-term wins 7. consolidate gains and produce more change 8. anchor new approaches in the culture Lewin's Change Model - answers1. Unfreezing 2. Changing 3. Refreezing Leading others through planned change malicious software (malware) - answersSoftware that is designed to infiltrate or affect a computer system without the owner's informed consent. The term "malware" is usually associated with viruses, worms, Trojan horses, spyware, rootkits, and dishonest adware. Meaningful Use (MU) - answersPart of the requirements of the Health Information Technology for Economic and Clinical Health (HITECH) Act, which is meant to increase the use of an electronic health record through monetary incentives provided the HER is used in a meaningful way to improve patient care. At the time of publication, the Meaningful Use regulations are undergoing revision. Meaningful use requirements - answersRequirements established by the Centers for Medicare and Medicaid Services (CMS) as part of the Electronic Health Records (EHR) Incentives Program. The program provides financial incentives for healthcare organizations that "meaningfully used" their certified EHR technology. The requirements include implementing security measures to ensure the privacy of patients' EHRs. Meaningful Use Stages - answersStage 1: Data capture and sharing (between hosp/providers) Stage 2:Advance clinical processes (standardized lang/terminology, Requires patients to view, download, or transmit their health info online. Capability for secure messaging between providers/pts) Stage 3:Improved outcomes Focused of the enhanced use of EHR's to promote HIE & improve care. Ex: electronic Rx (clinical Quality Measures) MU defined by ARRA - answersa certified EHR used in a meaningful way to use HIT to collect specific data w/ the intent to IMPROVE CARE & POPULATIONS HEALTH, ENGAGE PTS & ENSURE PRIVACY/SECURITY. *Inpatient/Outpatient. Mission Planning - answerspurpose of an organizations existence, representing the fundamental and unique aspirations that differ it from others. LONG RANGE PLAN (not short term) MIPS (Merit-Based Incentive Payment System) - answersProgram that combines other physician quality reporting system (PRRS) & Medicare EHRs based on QUALITY, resource use, clinical practice environment & meaningful use of EHR tech. "Quality" Meaningful use requirements by CMS - answers*Basic entry of clinical information/REQUIRES STANDARDIZED TERMINOLOGY (ALLOWS FOR UNIFORMITY & EASIER RETRIEVAL OF NURSING RELATED DATA) *Use of several software apps *Entry of clinical orders w/ safety measures M-Health (mobile health) - answersthe use of wireless communication devices to support public health and clinical practice medical informatics - answersApplication of informatics to all of the healthcare disciplines as well as to the practice of medicine LOINC (Logical Observation Identifiers Names and Codes) - answersStandard for identifying laboratory and clinical observation for exchange (LAB) NANDA - answersNorth American Nursing Diagnosis Association, purpose is to define, refine, and promote a taxonomy of nursing diagnostic terminology of general use to professional nurses. * Standardized data language for nursing diagnosis Nursing Interventions Classification (NIC) - answersA listing of research-based nursing intervention labels that provides standardization of expected nursing interventions. National Library of Medicine (NLM) - answersHelps to provide validity of health information MACRA - answersMedicare Access and CHIP Reauthorization Act GOAL: drive healthcare reform towards providing improved reimbursement for care based on volume and quality rather than quantity. Omaha System - answersA research-based taxonomy designed to generate data following routine client care. Used in homecare, hospice, public health, school health and prisons. Ontology - answerssystem that organizes concepts by meaning, describing their definitional structure as well as organizing the concept for storage and retrieval of accurate data Patient Protection and Affordable Care Act (PPACA) - answers2010 federal legislation designed for comprehensive health reform, with an intent to expand coverage, control health care costs, and improve the health care delivery system *Guarantee's access to healthcare for ALL Americans & incentives to change clinical practice to encourage better coordination & quality care. Insures can't charge for preexisting conditions or demographic status (Except age) personal health record (PHR) - answersAn electronic record of health-related information about an individual that conforms to nationally recognized interoperability standards and that can be drawn from multiple sources but that is managed, shared, and controlled by the individual. Pharmacy information system (PIS) - answersA key tool in providing optimal patient care and assisting providers in ordering, allocating, and administering medication, with a focus on patient safety issues, especially medication errors Predictive Analytics - answersUses past and current data to forecast the likelihood that an event will occur. Privacy - answersthe right of people not to reveal information about themselves Project Management Life Cycle (PMLC) stages - answers"Initiating/Design, Planning, Executing/Implementing, Monitoring and Controlling, Evaluation and Lessons learned with knowledge transfer" PMLC - answers(1) Design/Plan: Scope document: Official document that details how the project will be managed & what the project requirements are. Scope Creep- Unapproved change, which can cause serious delays or even project failure. As the scope & charter are developed, a GAP analysis is completed. Used to identify needed changes in workflow. GAP Analysis: A list of features & functions desired, but not immediately available in the new system as identified. (2) Implementation: Training the staff/ end-users in this phase. With change, different behaviors can develop. For example, Resignation, resistance, feelings of loss, etc. Lewin's Change Theory- One of several foundational theories for leading other through planned change. Identifies 3 Steps: Unfreezing, Changing, Refreezing. INVOLVE EMPLOYEES IN THE DECISION-MAKING PROCESS!! Kotter's Change Management Big Bang Conversion: "All-at-Once" implementation Rollout: Gradual/ staggered implementation Pilot: Small groups of individuals to evaluate potential issues Parallel Conversion: Operates both the old and new systems for a limited time. (3) Monitor & Control (4) Evaluation (5) Lessons learned with knowledge transfer Project Implementation Team/Committee - answersThe First Task of this Committee is to Develop a Timeline!! · Compromised of representatives from the user departments. The project team needs to be actively involved as an end-user. The implementation Committee determines the project implementation strategy. Interdisciplinary will plan, test, train, etc. after the EHR is purchased. Project Scope - answersdescribes the business need (the problem the project will solve) and the justification, requirements, and current boundaries for the project *Defines the size and details of a collaborative effort. Public Health Informatics - answersapplication of information and computer science and technology to public health practice, research, and learning Project Planning - answersThe SECOND phase of the project management process that focuses on defining clear, discrete activities and the work needed to complete each activity within a single project. Phishing - answersDeceptive method to steal sensitive info via internet. (1st email, 2nd open email, 3rd Hackers have info Physical Security - answersThe protection of physical items, objects, or areas from unauthorized access and misuse. patient data - answerspersonal information about a patient, as well as information about the patient's medical insurance coverage. Name, age, wt, VS PGHD (Patient-generated health data) - answersHealth related data created, recorded, or gathered by the pt/cg to help address health concerns. Logical Security - answersuses technology to limit access to only authorized individuals to the organization's systems and information, such as password controls Quantitative Research - answersFocus on #'s and frequencies GOAL: Finding relationships or variables specific to outcome Qualitative Research - answersVariable (not focused on counting) Questionnaire's, survey's, interviews, lists "Data Capturing" Ex: personal digital assistants/laptops QSEN (Quality and Safety Education for Nurses) - answersfocus on competency needed to continuously improve quality of care in their work environment Patient centered Teamwork and Collaboration Evidence-Based Practice Quality Improvement Safety Informatics-Electronic charts Quality indicators 4 Types: - answers1. Prevention 2. Inpatient 3. Patient Safety 4. Pediatric Real time analytics - answersthe provision of analyzed data relatively instantly to support decision making. IBM's Watson is the best example we have today RMS Risk Management System - answersidentifies and documents potential risks and develops strategies to deal w/ them Shared electronic health record - answersa type of EHR supported by an EHR system that allows clinicians to access an individual patients EHR data located in different facilities Scope Creep - answersThe uncontrolled expansion to product or project scope without adjustments to time, cost, and resources. SNOWMED CT - answerssystematized nomenclature of medicine clinical terms enables consistent way of capturing sharing aggregating health data across specialties site of care teminology for anatomy dx med problems nursing * Provides common language for EHR. Standardized Terminologies - answersStructured, controlled languages developed according to terminology development guidelines and approved by an authoritative body. Strategic Planning - answersthe process of determining the major goals of the organization and the policies and strategies for obtaining and using resources to achieve those goals NOT SHORT TERM GOALS System Development Life Cycle (SDLC) Stages - answers(1) Design (2) Plan (Where S.W.O.T. Analysis is done) (3) Implement (4) Analyze (Look at technical requirements) (5) Evaluate SDLC (Systems Development Life Cycle) - answers(1) Needs Assessment: Determine the needs & wants in an Information System (2) Selection System Phase: An organization seeks out a vendor company that provides a system that best fits the needs. · 3 Documents are used: - Request for Information Document: Initial contact with a vendor. Get essential information about the company's history. - Request for Proposal Document: Organization priorities or rates their needs & wants. Send an outline to vendors & see if request can be met. - Request for Quote Document: Pricing, finance, and contract terms. (3) System Implementation Phase: Go live PLANNING. Train staff, including end-users. Analysts start building screens and templates according to the organization and its policies, then apply any changes and go live. (4) Maintenance Phase: Problem solving, any debugging, files are backed up & updates (security protections) are installed routinely, to ensure the program is working as intended. S.W.O.T. Analysis: Done in the PLANNING phase of the Information System Life Cycle. It's a type of strategic planning. Helps identify gaps in the current system, as well as potential opportunities if a new or updated system is implemented. S.W.O.T. is a process that examines the strengths, weakness, opportunities, and threats of a given situation. Steps in SDLC - answers1. Needs - Needs/wants in system