Quality and Safety Education for Nurses 16 Summary 18 References 19
2 Introduction to Information, Information Science, and Information Systems 21 Kathleen Mastrian and Dee McGonigle Introduction 21 Information 22 Information Science 25 Information Processing 26 Information Science and the Foundation of Knowledge 27 Introduction to Information Systems 28 Summary 32 References 33
3 Computer Science and the Foundation of Knowledge Model 35 Dee McGonigle, Kathleen Mastrian, and June Kaminski Introduction 35 The Computer as a Tool for Managing Information and Generating Knowledge 36 Components 38 What Is the Relationship of Computer Science to Knowledge? 53 How Does the Computer Support Collaboration and Information Exchange? 54 Cloud Computing 57 Looking to the Future 59 Summary 61 Working Wisdom 61 Application Scenario 62 References 62
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4 Introduction to Cognitive Science and Cognitive Informatics 65 Kathleen Mastrian and Dee McGonigle Introduction 65 Cognitive Science 65 Sources of Knowledge 68 Nature of Knowledge 69 How Knowledge and Wisdom Are Used in Decision Making 69 Cognitive Informatics 70 Cognitive Informatics and Nursing Practice 71 What Is AI? 72 Summary 73 References 74
5 Ethical Applications of Informatics 77 Dee McGonigle, Kathleen Mastrian, and Nedra Farcus Introduction 77 Ethics 78 Bioethics 79 Ethical Issues and Social Media 80 Ethical Dilemmas and Morals 81 Ethical Decision Making 82 Theoretical Approaches to Healthcare Ethics 83 Applying Ethics to Informatics 86 Case Analysis Demonstration 91 New Frontiers in Ethical Issues 95 Summary 96 References 97
SECTION II: PERSPECTIVES ON NURSING INFORMATICS 99
6 History and Evolution of Nursing Informatics 105 Kathleen Mastrian and Dee McGonigle Introduction 105 The Evolution of a Specialty 106 What Is Nursing Informatics? 108 The DIKW Paradigm 109 Capturing and Codifying the Work of Nursing 112 The Nurse as a Knowledge Worker 117 The Future 123 Summary 123 References 124
7 Nursing Informatics as a Specialty 127 Dee McGonigle, Kathleen Mastrian, Julie A. Kenney, and Ida Androwich Introduction 127 Nursing Contributions to Healthcare Informatics 127
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Scope and Standards 128 Nursing Informatics Roles 129 Specialty Education and Certification 131 Nursing Informatics Competencies 133 Rewards of NI Practice 138 NI Organizations and Journals 138 The Future of Nursing Informatics 139 Summary 141 References 142
8 Legislative Aspects of Nursing Informatics: HITECH and HIPAA 145 Kathleen M. Gialanella, Kathleen Mastrian, and Dee McGonigle Introduction 145 HIPAA Came First 145 Overview of the HITECH Act 148 How a National HIT Infrastructure Is Being Developed 153 How the HITECH Act Changed HIPAA 154 Implications for Nursing Practice 161 Future Regulations 165 Summary 165 References 166
SECTION III: NURSING INFORMATICS ADMINISTRATIVE APPLICATIONS: PRECARE AND CARE SUPPORT 169
9 Systems Development Life Cycle: Nursing Informatics and Organizational Decision Making 175 Dee McGonigle and Kathleen Mastrian Introduction 175 Waterfall Model 178 Rapid Prototyping or Rapid Application Development 180 Object-Oriented Systems Development 181 Dynamic System Development Method 181 Computer-Aided Software Engineering Tools 184 Open Source Software and Free/Open Source Software 184 Interoperability 185 Summary 186 References 187
10 Administrative Information Systems 189 Marianela Zytkowski, Susan Paschke, Kathleen Mastrian, and Dee McGonigle Introduction 189 Types of Healthcare Organization Information Systems 190 Communication Systems 190 Core Business Systems 191 Order Entry Systems 193 Patient Care Support Systems 194
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Interoperability 195 Aggregating Patient and Organizational Data 197 Department Collaboration and Exchange of Knowledge and Information 202 Summary 203 References 204
11 The Human–Technology Interface 207 Dee McGonigle, Kathleen Mastrian, and Judith A. Effken Introduction 207 The Human–Technology Interface 208 The Human–Technology Interface Problem 211 Improving the Human–Technology Interface 212 A Framework for Evaluation 221 Future of the Human–Technology Interface 221 Summary 223 References 224
12 Electronic Security 229 Lisa Reeves Bertin, Kathleen Mastrian, and Dee McGonigle Introduction 229 Securing Network Information 229 Authentication of Users 231 Threats to Security 232 Security Tools 237 Offsite Use of Portable Devices 238 Summary 241 References 242
13 Workflow and Beyond Meaningful Use 245 Dee McGonigle, Kathleen Mastrian, and Denise Hammel-Jones Introduction 245 Workflow Analysis Purpose 245 Workflow and Technology 249 Workflow Analysis and Informatics Practice 251 Informatics as a Change Agent 256 Measuring the Results 258 Future Directions 259 Summary 260 References 261
SECTION IV: NURSING INFORMATICS PRACTICE APPLICATIONS: CARE DELIVERY 263
14 The Electronic Health Record and Clinical Informatics 267 Emily B. Barey, Kathleen Mastrian, and Dee McGonigle Introduction 267 Setting the Stage 268
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Components of Electronic Health Records 269 Advantages of Electronic Health Records 274 Standardized Terminology and the EHR 278 Ownership of Electronic Health Records 280 Flexibility and Expandability 283 Accountable Care Organizations and the EHR 285 The Future 285 Summary 287 References 287
15 Informatics Tools to Promote Patient Safety and Quality Outcomes 293 Dee McGonigle and Kathleen Mastrian Introduction 293 What Is a Culture of Safety? 294 Strategies for Developing a Safety Culture 296 Informatics Technologies for Patient Safety 301 Role of the Nurse Informaticist 313 Summary 315 References 317
16 Patient Engagement and Connected Health 323 Kathleen Mastrian and Dee McGonigle Introduction 323 Consumer Demand for Information 324 Health Literacy and Health Initiatives 325 Healthcare Organization Approaches to Engagement 327 Promoting Health Literacy in School-Aged Children 329 Supporting Use of the Internet for Health Education 330 Future Directions for Engaging Patients 335 Summary 337 References 338
17 Using Informatics to Promote Community/Population Health 341 Dee McGonigle, Kathleen Mastrian, Margaret Ross Kraft, and Ida Androwich Introduction 341 Core Public Health Functions 343 Community Health Risk Assessment: Tools for Acquiring Knowledge 345 Processing Knowledge and Information to Support Epidemiology and Monitoring Disease Outbreaks 347 Applying Knowledge to Health Disaster Planning and Preparation 349 Informatics Tools to Support Communication and Dissemination 350 Using Feedback to Improve Responses and Promote Readiness 351 Summary 353 References 355
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18 Telenursing and Remote Access Telehealth 359 Original contribution by Audrey Kinsella, Kathleen Albright, Sheldon Prial, and Schuyler F. Hoss; revised by Kathleen Mastrian and Dee McGonigle Introduction 359 The Foundation of Knowledge Model and Home Telehealth 359 Nursing Aspects of Telehealth 361 History of Telehealth 362 Driving Forces for Telehealth 363 Telehealth Care 366 Telenursing 370 Telehealth Patient Populations 372 Tools of Home Telehealth 375 Home Telehealth Software 378 Home Telehealth Practice and Protocols 380 Legal, Ethical, and Regulatory Issues 381 The Patient’s Role in Telehealth 382 Telehealth Research 383 Evolving Telehealth Models 385 Parting Thoughts for the Future and a View Toward What the Future Holds 386 Summary 387 References 388
SECTION V: EDUCATION APPLICATIONS OF NURSING INFORMATICS 393
19 Nursing Informatics and Nursing Education 397 Heather E. McKinney, Sylvia DeSantis, Kathleen Mastrian, and Dee McGonigle Introduction: Nursing Education and the Foundation of Knowledge Model 397 Knowledge Acquisition and Sharing 398 Evolution of Learning Management Systems 398 Delivery Modalities 400 Technology Tools Supporting Education 405 Internet-Based Tools 413 Promoting Active and Collaborative Learning 420 Knowledge Dissemination and Sharing 423 Exploring Information Fair Use and Copyright Restrictions 426 The Future 427 Summary 428 References 429
20 Simulation, Game Mechanics, and Virtual Worlds in Nursing Education 433 Dee McGonigle, Kathleen Mastrian, Brett Bixler, and Nickolaus Miehl Introduction 433 Simulation in Nursing Informatics Education 434 Nursing Informatics Competencies in Nursing Education 436 A Case for Simulation in Nursing Informatics Education and Nursing Education 437
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Incorporating EHRs into the Learning Environment 441 Challenges and Opportunities 445 The Future of Simulation in Nursing Informatics Education 445 Game Mechanics and Virtual World Simulation for Nursing Education 446 Game Mechanics and Educational Games 448 Virtual Worlds in Education 450 Choosing Among Simulations, Educational Games, and Virtual Worlds 451 The Future of Simulations, Games, and Virtual Worlds in Nursing Education 452 Summary 453 References 454
SECTION VI: RESEARCH APPLICATIONS OF NURSING INFORMATICS 459
21 Nursing Research: Data Collection, Processing, and Analysis 463 Heather E. McKinney, Sylvia DeSantis, Kathleen Mastrian, and Dee McGonigle Introduction: Nursing Research and the Foundation of Knowledge Model 463 Knowledge Generation Through Nursing Research 464 Acquiring Previously Gained Knowledge Through Internet and Library Holdings 466 Fair Use of Information and Sharing 468 Informatics Tools for Collecting Data and Storage of Information 469 Tools for Processing Data and Data Analysis 471 The Future 473 Summary 473 References 474
22 Data Mining as a Research Tool 477 Dee McGonigle and Kathleen Mastrian Introduction: Big Data, Data Mining, and Knowledge Discovery 477 KDD and Research 481 Data Mining Concepts 482 Data Mining Techniques 483 Data Mining Models 486 Benefits of KDD 489 Data Mining and Electronic Health Records 490 Ethics of Data Mining 491 Summary 491 References 492
23 Translational Research: Generating Evidence for Practice 495 Jennifer Bredemeyer, Ida Androwich, Dee McGonigle, and Kathleen Mastrian Introduction 495 Clarification of Terms 495 History of Evidence-Based Practice 498 Evidence 498 Bridging the Gap Between Research and Practice 499 Barriers to and Facilitators of Evidence-Based Practice 500 The Role of Informatics 500
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Developing EBP Guidelines 503 Meta-Analysis and Generation of Knowledge 504 The Future 505 Summary 506 References 507
24 Bioinformatics, Biomedical Informatics, and Computational Biology 511 Dee McGonigle and Kathleen Mastrian Introduction 511 Bioinformatics, Biomedical Informatics, and Computational Biology Defined 511 Why Are Bioinformatics and Biomedical Informatics So Important? 514 What Does the Future Hold? 516 Summary 518 References 519
SECTION VII: IMAGINING THE FUTURE OF NURSING INFORMATICS 521
25 The Art of Caring in Technology-Laden Environments 525 Kathleen Mastrian and Dee McGonigle Introduction 525 Caring Theories 526 Presence 529 Strategies for Enhancing Caring Presence 530 Reflective Practice 533 Summary 534 References 535
26 Nursing Informatics and the Foundation of Knowledge 537 Dee McGonigle and Kathleen Mastrian Introduction 537 Foundation of Knowledge Revisited 537 The Nature of Knowledge 539 Knowledge Use in Practice 541 Characteristics of Knowledge Workers 544 Knowledge Management in Organizations 545 Managing Knowledge Across Disciplines 547 The Learning Healthcare System 548 Summary 550 References 551
Abbreviations 553 Glossary 556 Index 586
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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 Infor- matics (OJNI), which Dee McGonigle cofounded with Renee Eggers. 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 pre- sented 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 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.
In this fourth edition, we reviewed and updated all of the chapters based on technological advance- ments and changes to the healthcare arena, including reimbursement mechanisms for services. We have pared this edition down to 26 chapters from the previous edition’s 29; one chapter each was deleted from Sections II, V, and VII. Section I includes updates to the same five chapters on the building blocks of nurs- ing informatics, with extensive changes to Chapter 3, Computer Science and the Foundation of Knowledge Model. To improve flow, we combined content. In Section II, the previous four chapters were narrowed to three. New Chapters 6, History and Evolution of Nursing Informatics and 7, Nursing Informatics as
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a Specialty, were developed and appropriate material from previous Chapters 6, 7, and 8 were assimi- lated. This section ends with an updated Chapter 8, Legislative Aspects of Nursing Informatics: HITECH and HIPAA (formerly Chapter 9). Section III contains the same five chapters, although all were updated and Chapter 13, Workflow and Beyond Meaningful Use (formerly Chapter 14) now reflects the payment models and reimbursement issues that we are adjusting to after meaningful use has gone away. Section IV contains the same five chapters with updated content and some name changes to reflect the current status of informatics and healthcare. Chapter 15 was renamed to Informatics Tools to Promote Patient Safety and Quality Outcomes, and Chapter 16 has been changed to Patient Engagement and Connected Health. Section V went from three chapters to two chapters: Chapter 19 (formerly Chapter 20) was updated, while the new Chapter 20, Simulation, Game Mechanics, and Virtual Worlds in Nursing Education, had content from former Chapters 21 and 22 integrated during its development. Section VI was renamed to Research Applications of Nursing Informatics. It still has the same four chapters, which have been updated, but the first chapter in this section, 21, was renamed to reflect nursing research; its new name is Nursing Research: Data Collection, Processing, and Analysis. Section VII went from three chapters to two chapters. Because emerging technologies are discussed throughout the text, the chapter focusing specifically on that was removed. The two chapters that remain are Chapter 25, The Art of Caring in Technology-Laden Environ- ments, and the new Chapter 26, Nursing Informatics and Knowledge Management. In addition, the ancil- lary materials have been updated and enhanced to include competency-based self-assessments and mapping the content to the current NI standards.
We believe that this text provides a comprehensive elucidation of this exciting field. Its theoretical under- pinning 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 inter- acting with our environment and being inundated with information and knowledge. We experience our envi- ronment 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 re- structure 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 re-exploring 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.
• Section I, Building Blocks of Nursing Informatics, covers the building blocks of NI: nursing science, information science, computer science, cognitive science, and the ethical management of information.
• Section II, Perspectives on Nursing Informatics, provides readers with a look at various viewpoints on NI and NI practice as described by experts in the field.
Preface xvii
• Section III, Nursing Informatics Administrative Applications: Precare and Care Support, covers important functions of administrative applications of NI.
• Section IV, Nursing Informatics Practice Applications: Care Delivery, covers healthcare delivery applications including electronic health records (EHRs), clinical information systems, telehealth, patient safety, patient and community education, and care management.
• Section V, Education Applications of Nursing Informatics, presents subject matter on how informat- ics supports nursing education.
• Section VI, Research Applications of Nursing Informatics, covers informatics tools to support nursing research, including data mining and bioinformatics.
• Section VII, Imagining the Future of Nursing Informatics, focuses on the future of NI, emphasizes the need to preserve caring functions in technology-laden environments, and reviews the relationship of nursing informatics to 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 acqui- sition, 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 ground- work 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 princi- ples so that they efficiently and effectively function as current and future nursing professionals to enhance the nursing profession and improve the quality of health care. The overall vision, framework, and peda- gogy 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.
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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, Emma Huggard, and Christina Freitas, all of whom fielded our questions and concerns in a very professional, respectful, and timely manner.
Dee acknowledges the undying love, support, patience, and continued encouragement of her best friend and husband, Craig, and her son, Craig, who has 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, espe- cially Renee.
Kathy acknowledges the loving support of her family: husband Chip; children Ben and Alicia; sisters Carol and Sue; and parents Robert and Rosalie Garver. She dedicates her work on this edition to her dad, Robert, who died September 17, 2016. Kathy also acknowledges those friends who understand the impor- tance of validation, especially Katie, Lisa, Kathy, Maureen, Anne, Barbara, and Sally.
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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!
Authors’ Note
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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
Judith Effken, PhD, RN, FACMI University of Arizona College of Nursing Tucson, AZ
Nedra Farcus, MSN, RN Retired from 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
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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 Oregon Health Sciences University Monmouth, OR
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
Peter J. Murray, PhD, RN, FBCS Coachman’s Cottage Nocton, Lincoln, UK
Susan M. Paschke, MSN, RN The Cleveland Clinic Cleveland, OH
Sheldon Prial, RPH, BS Pharmacy Sheldon Prial Consultance Melbourne, FL
Jackie Ritzko Pennsylvania State University Hazelton, PA
Marianela Zytkowsi, MSN, RN The Cleveland Clinic Cleveland, OH