NR599 Final Exam (2022/2023) Graded A

NR599 Final Exam (2022/2023) Graded A Ethical Decision Making -Process that requires striking a balance between science and morality -Making informed choices about ethical dilemmas based on a set of standards differentiating right from wrong. Ethical Decision Making Process 1. Identify the ethical dilemma 2. Discover alternative actions 3. Decide who might be affected 4. List the probable effects of the alternatives 5. Select the best alternative Rational justification developed through a logical process of decision making that gives proper attention to such things as facts, alternative perspectives, consequences to all stakeholders, and ethical principles. American Nurses Association- Code of Ethics for Nurses with Interpretive Statements. provides specific guidance for ethical decision making and provides a valuable framework that can be used when working with HIT issues having an ethical component includes the following 1. Failure to adopt technology or use it adeptly 2. Lack of regard for data integrity such as discrepancies. in record information that are noted but no corrective action is taken. 3. Failure to address threats to privacy and personal health information. 4. Inappropriate access of PHI without a need to know. 5. Failure to keep informed of emerging developments and issues. 6. Failure to recognize and use technology to advance the profession. 7. Failure to engage in policy discussion that impact healthcare delivery. 8. Failure to recall that the patient is their primary focus. 9. Failure to actively participate in the selection use, and/or evaluation of technology that has the potential to improve healthcare. ANAs Code of Ethics for Nurses 1. Respect for human dignity 2. Respect for individual right to self-determinism 3. Primary commitment is to the patient (individual, family, group or community) 4. Advocacy for the patient 5. Participation in the creation, maintenance, and improvement of healthcare environments 6. Advancing the Profession 7. Collaboration with others to meet health needs 8. Shaping social policy. 6 contemporary Bioethical Standards Autonomy freedom veracity privacy beneficence fidelity What is the Husted bioethical decision making model centered on healthcare professionals implicit agreement with the patient Virtue Ethics Approach moral behavior stems from personal virtues Example of virtue ethics approach If a manager develops good character traits and learns to overcome negative traits, he or she will make ethical decisions based on personal virtue Telehealth use of technology to deliver health care, health information, or health education (i.e. telephone, videophone, computer, store and forward imaging, streaming media, terrestrial and wireless communications) telemedicine medical information exchange from one site to another via electronic communications to improve patients health status Telehealth tools Central stations, web servers, and portals Peripheral biometric(medical) devices telephones videocameras personal emergency response systems sensor and activity monitoring medication management devices special needs telecommunications ready devices(preprogrammed infusion pumps, peak flow meters) Telemedicine applications types (2) Store-and-forward or asynchronous real-time or synchronous Store and forward or asynchronous applications exchange prerecorded data between 2 or more individuals at different times real time or synchronous applications all involved individuals are present for immediate exchange of information mHealth generation, aggregation, and dissemination of health info via mobile and wireless devices How can mHealth wearable devices reduce mortality rates wrist monitors that can monitor vital signs including respiratory rate, bp, hr, spo2, and temp which can send the info to an EHR which can calculate a wellness index based on the stats and a 0-5 scale (below 2.9 is good but above 3.0 is potentially bad) action / execution of tasks in a sequence is what workflow observation and documentation of workflow and how it can be altered is workflow or process analysis how is workflow analysis usually depicted visually , in a process map what is it called if workflow analysis is performed AFTER a new technology is implemented optimization Maya, autodesk and Promodel are examples of workplace analysis process mapping tools Computer applications designed to facilitate human decision-making processes. Usually are rule based, using a specified knowledge base and a set of rules to analyze data and information and provide recommendations to users ---- what is this clinical decision support system / CDS or CDSS what is the difference between expert systems and CDS systems expert - not really used right now, systems that generate information / automatically intervene without requiring human action CDS - guide clinicians to make choices, require clinician involvement What is the ICD10? alphanumeric coding for medical diagnosis / grouping like disease provides payer info on the necessity of the visit/procedure shorthand for dx What is a CPT code? Current Procedural Technology (CPT) code represent treatments and procedures performed by a physician in a 5-digit format. for billing and reimbursement 6 sections of cpt coding evaluation and management anesthesiology surgery radiology pathology medicine ICD 10 is maintained by world health org CPT coding is maintained by Am med association what is LOINC Logical Observation Identifiers, Names and Codes LOINC. , provides names and codes for laboratory test results and other observations. What is SNOMED CT? SNOMED CT or SNOMED Clinical Terms is a systematically organized computer processable collection of medical terms providing codes, terms, synonyms, and definitions used in clinical documentation and reporting. what is the purpose of SNOMED and LIONC vocabulary used in more advanced / detailed coding systems Diagnosis-related groups (DRGs) System that categorizes into payment groups patients who are medically related with respect to diagnosis and treatment and statistically similar with regard to length of stay CPT is a DRG (diagnosis related group) or MDC (major diagnosis codes) DRG - DRGs are more commonly associated with payment and reimbursement Major Diagnosis Category (MDC) organize diagnosis that relate to similar physiological systems computer aided translators using technology to translate language or coding Evaluation and Management (E/M Codes) these are listed 1st in the CPT manual b/c they are used by all different specialties. they cover physician services that are performed to determine the best course for pt care. they are a category of CPT codes used for reimbursement who determines whether a mobile application is regulated for medical use FDA are mobile apps intended to provide access to electronic copies of medical textbooks with generic text search capabilities considered a medical devices? No recuasse they are reference materials and not tools for dx of disease or condition are mobile apps that are intended for healthcare providers to use as educational tools for medical training a medical device? No, they are intended for general user education and not for dx medical devices Any equipment, instrument, implant, material, or apparatus used for the diagnosis, treatment, or monitoring of patients. what makes a medical app not a medical device Apps that are not intended for use in the diagnosis of disease or other conditions, or in the cure, mitigation, treatment, or prevention of disease. Privacy Practice of maintaining the security and confidentiality of patient records. Confidentiality The act of holding information in confidence, not to be released to unauthorized individuals. cybersecurity -Measures taken to protect a computer or computer system against unauthorized access or attack APN role in cybersecurity determine if appropriate safeguards to protect phi are in place and if HIPPA requirements are met Who is the main regulatory agency of cybersecurity FDA examples of mobile apps that the FDA intends to enforce discretion on apps that provide or facilitate supplemental clinical care, by coaching or prompting apps that provide patients with simple tools to organize and track their health information apps that provide easy access to information related to patients' health conditions or treatments apps marketed to help patients document, show, or communicate to providers potential medical conditions apps that perform simple calculations routinely used in clinical practice apps that enable individuals to interact with PHR systems or EHR apps that meet the definition of Medical Device Data Systems Are all medical mobile applications also medical devices no FDA oversight on medical devices contain oversees mobile apps that are medical devices and whose functionality could pose a risk to a patient's safety if the mobile app were to not function as intended. -Also oversee the cybersecurity management of these devices as well as the hospital network security. who regulates medical devices FDA major areas for mHealth growth preventative medicine and health promotion can be utilized through education and awareness apps portable dx devices that allow monitoring of human conditions in clinical or offsite locations Applications for data management, training medical personnel, and mobile payments POE/CPOE/CDS POE- practitioner order entry, CPOE- computerized practitioner order entry, CDS- clinical decision support clinical decision support systems a computer-based program designed to assist clinicians in making clinical decisions by filtering or integrating vast amounts of information and providing suggestions for clinical intervention Human Technology Interface The hardware and software through which the user interacts with any technology. for example computers patient monitors and telephones. The human technology interface addresses the user's ability and the technologies functionality to complete the task demand. Human information technologies (HIT) hardware software integrated technologies are related licenses intellectual property upgrades or packaged solutions sold as services that are designed for or support the use by healthcare entities or patients for the electronic creation maintenance access or exchange of health information patient-centered information systems patient centered information systems focused on collecting data and disseminating information related to direct care four most common types of PCS systems clinical documentation systems pharmacy information systems laboratory information systems radiology information systems Evaluation and Management Coding process by which physician-patient encounters are translated into five digit CPT codes to facilitate billing. Three major questions must be asked when identifying an E/M code: 1) Is the patient new or established? 2) Where is the service provided? 3) What is the degree of the service rendered? What makes someone a new patient has not received service from a provider in the practice within 3 years What is necessary for establishing E/M Codes Place of Service; Type of Service; Patient Status Components of Risk Based E/M Coding History; Physical; Medical Decision Making Medical Decision Making (MDM) in regards to E/M codes 1 of 3 components to establishing E/M codes; way of quantifying the complexity of thinking that is required for the visit. Medical Decision Making (MDM) Health care management process done after performing a history and physical examination on a patient that results in a plan of treatment. It is based on establishing one or more diagnosis and/or selecting a management or treatment option, amount of data or complexity of data reviewed, and complication and/or morbidity or mortality 3 key elements to medical decision making risk data dx Reimbursement Coding -Claims and documentation filed by providers using medical diagnosis and procedure codes. -Assigned contingent upon data input from clinical team members based on a summative review of the clinical record by trained coders. DRG vs MDC DRG- facilitates payment through prospective payment system MDC-organizes dx that affect similar physiological systems both primary purpose for billing medical billing process of submitting claims to receive payment medical coding codes to communicate procedures performed and why each billing claim must contain what two things A CPT (procedural)code and ICD-10 (dx) code Why do you need a cpt and an ICD code to determine reimbursement. if dx does not explain need for the procedure there is no payment how many levels of care are there for e/m coding and what are they 5 Minimal/RN visit Problem focused exp problem focused detailed comprehensive E/m coding for each level of a new patient Minimal/RN visit- 99201 Problem focused- 99202 exp problem focused- 99203 detailed- 99204 comprehensive- 99205 E/m coding for each level of an established patient Minimal/RN visit-99211 Problem focused-99212 exp problem focused-99213 detailed-99214 comprehensive-99215