Technology: Benefits And Future Trends For Nursing

NURSING INFORMATICS AND THE FOUNDATION OF KNOWLEDGE

THIRD EDITION

The Pedagogy

Nursing Informatics and the Foundation of Knowledge, Third Edition drives comprehension through a variety of strategies geared toward meeting the learning needs of students, while also generating enthusiasm about the topic. This interactive approach addresses diverse learning styles, making this the ideal text to ensure mastery of key concepts. The pedagogical aids that appear in most chapters include the following:

NURSING INFORMATICS AND THE FOUNDATION OF KNOWLEDGE

THIRD EDITION

Dee McGonigle, PhD, RN, CNE, FAAN, ANEF Chair, Virtual Learning Environments and Professor, Graduate Programs

Chamberlain College of Nursing Member, Informatics and Technology Expert Panel (ITEP)

American Academy of Nursing Member, Serious Gaming and Virtual Environments Special Interest Group for the Society for Simulation in Healthcare (SSH)

Kathleen Mastrian, PhD, RN Associate Professor and Program Coordinator for Nursing

Pennsylvania State University, Shenango Sr. Managing Editor, Online Journal of Nursing Informatics (OJNI)

World Headquarters Jones & Bartlett Learning 5 Wall Street Burlington, MA 01803 978-443-5000 info@jblearning.com www.jblearning.com

Jones & Bartlett Learning books and products are available through most bookstores and online booksellers. To contact Jones & Bartlett Learning directly, call 800-832-0034, fax 978-443-8000, or visit our website, www.jblearning.com.

Substantial discounts on bulk quantities of Jones & Bartlett Learning publications are available to corporations, professional associations, and other qualified organizations. For details and specific discount information, contact the special sales department at Jones & Bartlett Learning via the above contact information or send an email to specialsales@jblearning.com.

Copyright © 2015 by Jones & Bartlett Learning, LLC, an Ascend Learning Company

All rights reserved. No part of the material protected by this copyright may be reproduced or utilized in any form, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without written permission from the copyright owner.

The content, statements, views, and opinions herein are the sole expression of the respective authors and not that of Jones & Bartlett Learning, LLC. Reference herein to any specific commercial product, process, or service by trade name, trademark, manufacturer, or otherwise does not constitute or imply its endorsement or recommendation by Jones & Bartlett Learning, LLC and such reference shall not be used for advertising or product endorsement purposes. All trademarks displayed are the trademarks of the parties noted herein. Nursing Informatics and the Foundation of Knowledge, Third Edition is an independent publication and has not been authorized, sponsored, or otherwise approved by the owners of the trademarks or service marks referenced in this product.

There may be images in this book that feature models; these models do not necessarily endorse, represent, or participate in the activities represented in the images. Any screenshots in this product are for educational and instructive purposes only. Any individuals and scenarios featured in the case studies throughout this product may be real or fictitious, but are used for instructional purposes only.

The authors, editor, and publisher have made every effort to provide accurate information. However, they are not responsible for errors, omissions, or for any outcomes related to the use of the contents of this book and take no responsibility for the use of the products and procedures described. Treatments and side effects described in this book may not be applicable to all people; likewise, some people may require a dose or experience a side effect that is not described herein. Drugs and medical devices are discussed that may have limited availability controlled by the Food and Drug Administration (FDA) for use only in a research study or clinical trial. Research, clinical practice, and government regulations often change the accepted standard in this field. When consideration is being given to use of any drug in the clinical setting, the health care provider or reader is responsible for determining FDA status of the drug, reading the package insert, and reviewing prescribing information for the most up-to-date recommendations on dose, precautions, and contraindications, and determining the appropriate usage for the product. This is especially important in the case of drugs that are new or seldom used.

Production Credits Executive Publisher: William Brottmiller Senior Editor: Amanda Martin Editorial Assistant: Rebecca Myrick Production Editor: Keith Henry Senior Marketing Manager: Jennifer Stiles Photo Research and Permissions Coordinator: Joe Veiga VP, Manufacturing and Inventory Control: Therese Connell Composition: diacriTech Cover Design: Kristin E. Parker Cover Image: (top) © antishock/ShutterStock, Inc., (bottom) © James Daniels/ShutterStock, Inc. Printing and Binding: Edwards Brothers Malloy Cover Printing: Edwards Brothers Malloy

To order this product, use ISBN: 978-1-284-04351-8

Library of Congress Cataloging-in-Publication Data Nursing informatics and the foundation of knowledge / [edited by] Dee McGonigle, Kathleen Mastrian.—3e.

p. ; cm. Includes bibliographical references and index. ISBN 978-1-284-04158-3 (paperback) I. McGonigle, Dee, editor of compilation. II. Mastrian, Kathleen Garver, editor of compilation. [DNLM: 1. Nursing Informatics. 2. Knowledge. WY 26.5] RT50.5 651.5’04261—dc23

2013046566

6048

Printed in the United States of America 18 17 16 15 14 10 9 8 7 6 5 4 3 2 1

Special Acknowledgments We want to express our sincere appreciation to the staff at Jones & Bartlett Learning, especially Amanda, Becky, and Keith, for their continued encouragement, assistance, and support during the writing process and publication of our book.

Contents

Preface Acknowledgments Authors’ Note Contributors

SECTION I: BUILDING BLOCKS OF NURSING INFORMATICS

1 Nursing Science and the Foundation of Knowledge Kathleen Mastrian and Dee McGonigle

Introduction Quality and Safety Education for Nurses Summary References

2 Introduction to Information, Information Science, and Information Systems Dee McGonigle and Kathleen Mastrian

Introduction Information Information Science Information Processing Information Science and the Foundation of Knowledge Introduction to Information Systems Information Systems Summary References

3 Computer Science and the Foundation of Knowledge Model June Kaminski

Introduction The Computer as a Tool for Managing Information and Generating Knowledge Components What Is the Relationship of Computer Science to Knowledge? How Does the Computer Support Collaboration and Information Exchange? What Is the Human–Technology Interface? Looking to the Future Summary Working Wisdom Application Scenario Internet and Software Resources References

4 Introduction to Cognitive Science and Cognitive Informatics Dee McGonigle and Kathleen Mastrian

Introduction Cognitive Science Sources of Knowledge Nature of Knowledge How Knowledge and Wisdom Are Used in Decision Making Cognitive Informatics CI and Nursing Practice What Is AI? Summary References

5 Ethical Applications of Informatics Kathleen Mastrian, Dee McGonigle, and Nedra Farcus

Introduction Ethics Bioethics Ethical Issues and Social Media Ethical Dilemmas and Morals Ethical Decision Making Theoretical Approaches to Healthcare Ethics Applying Ethics to Informatics Case Analysis Demonstration New Frontiers in Ethical Issues Summary References

SECTION II: PERSPECTIVES ON NURSING INFORMATICS

6 Overview of Nursing Informatics Ramona Nelson and Nancy Staggers

Introduction Metastructures, Concepts, and Tools of NI The Future of NI Summary References

7 Informatics Roles and the Knowledge Work of Nursing Julie A. Kenney and Ida Androwich

Introduction The Nurse as a Knowledge Worker The Knowledge Needs and Competencies of Nurses What Is Nursing Informatics Specialty Practice? The Future of Nursing Informatics Summary References

8 Information and Knowledge Needs of Nurses in the 21st Century Lynn M. Nagle, Nicholas Hardiker, Kathleen Mastrian, and Dee McGonigle

Introduction Definition and Goal of Informatics Health Information Technologies Impacting Nursing Nurses Creating and Deriving New Knowledge Generating Nursing Knowledge Challenges in Getting There The Future Summary References

9 Legislative Aspects of Nursing Informatics: HITECH and HIPAA Kathleen M. Gialanella, Kathleen Mastrian, and Dee McGonigle

Introduction Overview of the HITECH Act How a National HIT Infrastructure Is Being Developed How the HITECH Act Changed HIPAA Implications for Nursing Practice Summary References

SECTION III: NURSING INFORMATICS ADMINISTRATIVE APPLICATIONS: PRECARE AND CARE SUPPORT

10 Systems Development Life Cycle: Nursing Informatics and Organizational Decision Making Dee McGonigle and Kathleen Mastrian Introduction Waterfall Model Rapid Prototyping or Rapid Application Development

Object-Oriented Systems Development Dynamic System Development Method Computer-Aided Software Engineering Tools Open Source Software and Free/Open Source Software Interoperability Summary References

11 Administrative Information Systems Marianela Zytkowski, Susan Paschke, Dee McGonigle, and Kathleen Mastrian Introduction Types of Healthcare Organization Information Systems Communication Systems Core Business Systems Order Entry Systems Patient Care Support Systems Department Collaboration and Exchange of Knowledge and Information Summary References

12 The Human–Technology Interface Judith A. Effken, Dee McGonigle, and Kathleen Mastrian Introduction The Human–Technology Interface The Human–Technology Interface Problem Improving the Human–Technology Interface A Framework for Evaluation Future of the Human–Technology Interface Summary References

13 Electronic Security Lisa Reeves Bertin, Dee McGonigle, and Kathleen Mastrian Introduction Securing Network Information Authentication of Users Threats to Security Security Tools Off-Site Use of Portable Devices Summary References

14 Nursing Informatics: Improving Workflow and Meaningful Use Denise Hammel-Jones, Dee McGonigle, and Kathleen Mastrian Introduction Workflow Analysis Purpose Workflow and Technology Workflow Analysis and Informatics Practice Informatics as a Change Agent Measuring the Results Future Directions Summary References

SECTION IV: NURSING INFORMATICS PRACTICE APPLICATIONS: CARE DELIVERY

15 The Electronic Health Record and Clinical Informatics Emily B. Barey, Kathleen Mastrian, and Dee McGonigle Introduction Setting the Stage Components of Electronic Health Records Advantages of Electronic Health Records Ownership of Electronic Health Records Flexibility and Expandability The Future Summary References

16 Informatics Tools to Promote Patient Safety and Clinical Outcomes Kathleen Mastrian and Dee McGonigle Introduction What Is a Culture of Safety? Strategies for Developing a Safety Culture Informatics Technologies for Patient Safety Role of the Nurse Informaticist Summary References

17 Supporting Consumer Information and Education Needs Kathleen Mastrian and Dee McGonigle Introduction Consumer Demand for Information Health Literacy and Health Initiatives Healthcare Organization Approaches to Education Promoting Health Literacy in School-Aged Children Supporting Use of the Internet for Health Education Future Directions Summary References

18 Using Informatics to Promote Community/Population Health Margaret Ross Kraft, Ida Androwich, Kathleen Mastrian, and Dee McGonigle Introduction Core Public Health Functions Community Health Risk Assessment: Tools for Acquiring Knowledge Processing Knowledge and Information to Support Epidemiology and Monitoring Disease Outbreaks Applying Knowledge to Health Disaster Planning and Preparation Informatics Tools to Support Communication and Dissemination Using Feedback to Improve Responses and Promote Readiness Summary References

19 Telenursing and Remote Access Telehealth Original contribution by Audrey Kinsella, Kathleen Albright, Sheldon Prial, and Schuyler F. Hoss; revised by Kathleen Mastrian and Dee McGonigle Introduction History of Telehealth Nursing Aspects of Telehealth Driving Forces for Telehealth Telehealth Care Telenursing Telehealth Patient Populations Tools of Home Telehealth Home Telehealth Software Home Telehealth Practice and Protocols Legal, Ethical, and Regulatory Issues A Day in the Life of a Home Telenurse The Patient’s Role in Telehealth Telehealth Research The Foundation of Knowledge Model and Home Telehealth Parting Thoughts for the Future and a View Toward What the Future Holds Summary References

SECTION V: EDUCATION APPLICATIONS OF NURSING INFORMATICS

20 Nursing Informatics and Nursing Education Heather E. McKinney, Sylvia DeSantis, Dee McGonigle, and Kathleen Mastrian Introduction: Nursing Education and the Foundation of Knowledge Model Knowledge Acquisition and Sharing Hardware and Software Considerations Delivery Modalities Technology Tools Internet Tools: Webcasts, Searching, Instant Messaging, Chats and Online Discussions, Electronic Mailing Lists, and Portals Promoting Active and Collaborative Learning

Knowledge Assessment Methods Knowledge Dissemination and Sharing The Future Exploring Information Fair Use and Copyright Restrictions Summary References

21 Simulation in Nursing Informatics Education Nickolaus Miehl Introduction Nursing Informatics Competencies in Nursing Education A Case for Simulation Incorporating EHRs into the Learning Environment Challenges and Opportunities What Does the Future Hold? Summary References

22 Games, Simulations, and Virtual Worlds for Educators Brett Bixler Introduction Case Scenario Educational Games Educational Simulations Virtual Worlds Choosing Among Educational Games, Simulations, and Virtual Worlds The Future of Games, Virtual Worlds, and Simulations Summary References

SECTION VI: NURSING INFORMATICS: RESEARCH APPLICATIONS

23 Research: Data Collection, Processing, and Analysis Heather E. McKinney, Sylvia DeSantis, Kathleen Mastrian, and Dee McGonigle Introduction: Nursing Research and the Foundation of Knowledge Model Knowledge Generation Through Nursing Research Acquiring Previously Gained Knowledge Through Internet and Library Holdings Fair Use of Information and Sharing Informatics Tools for Collecting Data and Storage of Information Tools for Processing Data and Data Analysis The Future Summary References

24 Data Mining as a Research Tool Dee McGonigle and Kathleen Mastrian Introduction: Big Data, Data Mining, and Knowledge Discovery KDD and Research Data Mining Concepts Data Mining Techniques Data Mining Models Benefits of KDD Ethics of Data Mining Summary References

25 Translational Research: Generating Evidence for Practice Jennifer Bredemeyer and Ida Androwich Introduction Clarification of Terms History of Evidence-Based Practice Evidence Bridging the Gap Between Research and Practice Barriers to and Facilitators of Evidence-Based Practice The Role of Informatics Developing EBP Guidelines Meta-Analysis and Generation of Knowledge

The Future Summary References

26 Bioinformatics, Biomedical Informatics, and Computational Biology Dee McGonigle and Kathleen Mastrian Introduction Bioinformatics, Biomedical Informatics, and Computational Biology Defined Why Are Bioinformatics and Biomedical Informatics So Important? What Does the Future Hold? Summary References

SECTION VII: IMAGINING THE FUTURE OF NURSING INFORMATICS

27 The Art of Caring in Technology-Laden Environments Kathleen Mastrian and Dee McGonigle Introduction Caring Theories Presence Strategies for Enhancing Caring Presence Reflective Practice Summary References

28 Emerging Technologies and the Generation of Knowledge Peter J. Murray, W. Scott Erdley, Dee McGonigle, and Kathleen Mastrian Introduction Looking Back from the Future Historical Overview Some Technologies of Today Some Views of What Will Affect the Future Some Emerging Technologies and Other Issues That Will Impact Nursing and Health Care 491 Summary References

29 Nursing Informatics and the Foundation of Knowledge Dee McGonigle and Kathleen Mastrian Introduction Foundation of Knowledge Revisited Knowledge Use in Practice Summary References

Abbreviations Glossary Index

Preface

The idea for this text originated with the development of nursing informatics (NI) classes, the publication of articles related to technology-based education, and the creation of the Online Journal of Nursing Informatics (OJNI), which Dee McGonigle cofounded. Like most nurse informaticists, we fell into the specialty; our love affair with technology and gadgets and our willingness to be the first to try new things helped to hook us into the specialty of informatics. The rapid evolution of technology and its transformation of the ways of nursing prompted us to try to capture the essence of NI in a text.

As we were developing the first edition, we realized that we could not possibly know all there is to know about informatics and the way in which it supports nursing practice, education, administration, and research. We also knew that our faculty roles constrained our opportunities for exposure to changes in this rapidly evolving field. Therefore, we developed a tentative outline and a working model of the theoretical framework for the text and invited participation from informatics experts and specialists around the world. We were pleased with the enthusiastic responses we received from some of those invited contributors and a few volunteers who heard about the text and asked to participate in their particular area of expertise.

In the second edition, we invited the original contributors to revise and update their chapters. Not everyone chose to participate in the second edition, so we revised several of the chapters using the original work as a springboard. The revisions to the text were guided by the contributors’ growing informatics expertise and the reviews provided by textbook adopters. In the revisions, we sought to do the following:

• Expand the audience focus to include nursing students from BS through DNP programs as well as nurses thrust into informatics roles in clinical agencies.

• Include, whenever possible, an attention-grabbing case scenario as an introduction or an illustrative case scenario demonstrating why the topic is important.

• Include important research findings related to the topic. Many chapters have research briefs presented in text boxes to encourage the reader to access current research.

• Focus on cutting-edge innovations, meaningful use, and patient safety as appropriate to each topic. • Include a paragraph describing what the future holds for each topic.

New chapters that were added to the second edition included those focusing on technology and patient safety, system development life cycle, workflow analysis, gaming, simulation, and bioinformatics.

In this, the third edition, we reviewed and updated all of the chapters, reordered some chapters for better content flow, eliminated duplicated content, split the education and research content into two sections, integrated social media content, and added two new chapters: Data Mining as a Research Tool and The Art of Caring in Technology-Laden Environments.

We believe that this text provides a comprehensive elucidation of this exciting field. Its theoretical underpinning is the Foundation of Knowledge model. This model is introduced in its entirety in the first chapter (Nursing Science and the Foundation of Knowledge), which discusses nursing science and its relationship to NI. We believe that humans are organic information systems that are constantly acquiring, processing, and generating information or knowledge in both their professional and personal lives. It is their high degree of knowledge that characterizes humans as extremely intelligent, organic machines. Individuals have the ability to manage knowledge— an ability that is learned and honed from birth. We make our way through life interacting with our environment and being inundated with information and knowledge. We experience our environment and learn by acquiring, processing, generating, and disseminating knowledge. As we interact in our environment, we acquire knowledge that we must process. This processing effort causes us to redefine and restructure our knowledge base and generate new knowledge. We then share (disseminate) this new knowledge and receive feedback from others. The dissemination and feedback initiate this cycle of knowledge over again, as we acquire, process, generate, and disseminate the knowledge gained from sharing and reexploring our own knowledge base. As others respond to our knowledge dissemination and we acquire new knowledge, we engage in rethinking and reflecting on our knowledge, processing, generating, and then disseminating anew.

The purpose of this text is to provide a set of practical and powerful tools to ensure that the reader gains an understanding of NI and moves from information through knowledge to wisdom. Defining the demands of nurses and providing tools to help them survive and succeed in the Knowledge Era remains a major challenge. Exposing nursing students and nurses to the principles and tools used in NI helps to prepare them to meet the challenge of practicing nursing in the Knowledge Era while striving to improve patient care at all levels.

The text provides a comprehensive framework that embraces knowledge so that readers can develop their knowledge repositories and the wisdom necessary to act on and apply that knowledge. The text is divided into seven sections.

• The Building Blocks of Nursing Informatics section covers the building blocks of NI: nursing science, information science, computer science, cognitive science, and the ethical management of information.

• The Perspectives on Nursing Informatics section provides readers with a look at various viewpoints on NI and NI practice as described by experts in the field.

• The Nursing Informatics Administrative Applications: Precare and Care Support section covers important functions of administrative applications of NI.

• The Nursing Informatics Practice Applications: Care Delivery section covers healthcare delivery applications including electronic health records (EHRs), clinical information systems, telehealth, patient safety, patient and community education,

and care management. • The Education Applications of Nursing Informatics section presents subject matter on how informatics supports nursing

education. • The Nursing Informatics: Research Applications section covers informatics tools to support nursing research, including data

mining and bioinformatics. • The Imagining the Future of Nursing Informatics section focuses on the future of NI, emphasizes the need to preserve caring

functions in technology-laden environments, and summarizes the relationship of informatics to the Foundation of Knowledge model and organizational knowledge management.

The introduction to each section explains the relationship between the content of that section and the Foundation of Knowledge model. This text places the material within the context of knowledge acquisition, processing, generation, and dissemination. It serves both nursing students (BS to DNP/PhD) and professionals who need to understand, use, and evaluate NI knowledge. As nursing professors, our major responsibility is to prepare the practitioners and leaders in the field. Because NI permeates the entire scope of nursing (practice, administration, education, and research), nursing education curricula must include NI. Our primary objective is to develop the most comprehensive and user-friendly NI text on the market to prepare nurses for current and future practice challenges. In particular, this text provides a solid groundwork from which to integrate NI into practice, education, administration, and research.

Goals of this text are as follows: • Impart core NI principles that should be familiar to every nurse and nursing student • Help the reader understand knowledge and how it is acquired, processed, generated, and disseminated • Explore the changing role of NI professionals • Demonstrate the value of the NI discipline as an attractive field of specialization

Meeting these goals will help nurses and nursing students understand and use fundamental NI principles so that they efficiently and effectively function as current and future nursing professionals. The overall vision, framework, and pedagogy of this text offer benefits to readers by highlighting established principles while drawing out new ones that continue to emerge as nursing and technology evolve.

Acknowledgments

We are deeply grateful to the contributors who provided this text with a richness and diversity of content that we could not have captured alone. Joan Humphrey provided social media content integrated throughout the text. We especially wish to acknowledge the superior work of Alicia Mastrian, graphic designer of the Foundation of Knowledge model, which serves as the theoretical framework on which this text is anchored. We could never have completed this project without the dedicated and patient efforts of the Jones & Bartlett Learning staff, especially Amanda Martin and Becky Myrick. Both fielded our questions and concerns in a very professional and respectful manner.

Dee acknowledges the undying love, support, patience, and continued encouragement of her best friend and husband, Craig, and her son, Craig, who has also made her so very proud. She sincerely thanks her cousins Camille, Glenn, Mary Jane, and Sonny, and her dear friends for their support and encouragement, especially Renee.

Kathy acknowledges the loving support of her family: husband Chip; children Ben and Alicia; sisters Carol and Sue; and parents Bob and Rosalie Garver. Kathy also acknowledges those friends who understand the importance of validation, especially Katie, Bobbie, Kathy, Anne, and Barbara.

Authors’ Note

This text provides an overview of nursing informatics from the perspective of diverse experts in the field, with a focus on nursing informatics and the Foundation of Knowledge model. We want our readers and students to focus on the relationship of knowledge to informatics and to embrace and maintain the caring functions of nursing—messages all too often lost in the romance with technology. We hope you enjoy the text!

Contributors

Ida Androwich, PhD, RN, BC, FAAN Loyola University Chicago School of Nursing Maywood, IL

Emily Barey, MSN, RN Director of Nursing Informatics Epic Systems Corporation Madison, WI

Lisa Reeves Bertin, BS, EMBA Pennsylvania State University Sharon, PA

Brett Bixler, PhD Pennsylvania State University University Park, PA

Jennifer Bredemeyer, RN Loyola University Chicago School of Nursing Skokie, IL

Steven Brewer, PhD Assistant Professor, Administration of Justice Pennsylvania State University Sharon, PA

Sylvia M. DeSantis, MA Pennsylvania State University University Park, PA

Eric R. Doerfler, PhD, NP Pennsylvania State University School of Nursing Middletown, PA

Judith Effken, PhD, RN, FACMI University of Arizona College of Nursing Tucson, AZ

William Scott Erdley, DNS, RN Niagara University Niagara University, NY

Nedra Farcus, MSN, RN Pennsylvania State University, Altoona Altoona, PA

Kathleen M. Gialanella, JD, RN, LLM Law Offices Westfield, NJ Associate Adjunct Professor Teachers College, Columbia University New York, NY Adjunct Professor

Seton Hall University, College of Nursing & School of Law South Orange & Newark, NJ

Denise Hammel-Jones, MSN, RN-BC, CLSSBB Greencastle Associates Consulting Malvern, PA

Nicholas Hardiker, PhD, RN Senior Research Fellow University of Salford School of Nursing & Midwifery Salford, UK

Glenn Johnson, MLS Pennsylvania State University University Park, PA

June Kaminski, MSN, RN Kwantlen University College Surrey, British Columbia, Canada

Julie Kenney, MSN, RNC-OB Clinical Analyst Advocate Health Care Oak Brook, IL

Margaret Ross Kraft, PhD, RN Loyola University Chicago School of Nursing Maywood, IL

Wendy L. Mahan, PhD, CRC, LPC Pennsylvania State University University Park, PA

Heather McKinney, PhD Pennsylvania State University University Park, PA

Nickolaus Miehl, MSN, RN Pennsylvania State University Erie, PA

Peter J. Murray, PhD, RN, FBCS Coachman’s Cottage Nocton, Lincoln, UK

Lynn M. Nagle, PhD, RN Assistant Professor University of Toronto Toronto, Ontario, Canada

Ramona Nelson, PhD, RN-BC, FAAN, ANEF Professor Emerita, Slippery Rock University President, Ramona Nelson Consulting Pittsburgh, PA

Nancy Staggers, PhD, RN, FAAN Professor, Informatics University of Maryland Baltimore, MD

Jeff Swain Instructional Designer Pennsylvania State University University Park, PA

Denise D. Tyler, MSN/MBA, RN-BC Implementation Specialist

Healthcare Provider, Consulting ACS, a Xerox Company Dearborn, MI

The Editors also acknowledge the work of the following first edition contributors (original contributions edited by McGonigle and Mastrian for second edition):

Kathleen Albright, BA, RN Strategic Account Manager at GE Healthcare Philadelphia, PA

Schuyler F. Hoss, BA Northwest Healthcare Management Vancouver, WA

Audrey Kinsella, MA, MS Information for Tomorrow Telehealth Planning Services Asheville, NC

Susan M. …