MIDTERMS REVIEWER Unit III: Open Source and Free Software (OSS/FS) Overview • Describes basic

concepts of OSS and FS. • Explains differences between OSS, free software, and proprietary software,
especially licensing. • Highlights importance of understanding OSS in healthcare context. • Describes
available OSS and free software applications for healthcare and general office/productivity use. •
Introduces organizations and resources for exploring OSS. • Encourages nurse exploration of OSS
through creating an example. A. Open source software (OSS/FS) encompasses various concepts such as
OSS, FS, and GNU/Linux. The two major philosophies in the OSS/FS world are the free software
foundation (FSF) and the open source initiative (OSI). Both philosophies aim to make source code
available to users by the programmer, but differ in restrictions on redistributed source code. FSF is
committed to no restrictions, while OSI focuses on practical issues. OSS/FS is different from proprietary
or commercial software, which is proprietary and restricts access to source code. It should not be
confused with freeware or shareware, which are commercial software offered free of charge but without
the freedom to modify source code. Shareware is offered on a "try before you buy" basis. a.) Free
Software Definition and Usage • Free Software Foundation (FSF) defines four freedoms for software
users: use, study, redistribute, and improve. • Users should be free to redistribute copies of their
software, either free or charged, to anyone, anywhere. • The term "free" is defined in terms of liberty,
not price. • Acronyms like FLOSS or OSS/FS are used to overcome confusion. • Free software refers to
four kinds of freedom: running the program for any purpose, studying how the program works,
redistributing copies, and distributing modified versions to others. • Access to the source code is a
precondition for these freedoms. b.) Open Source Software Overview • Promotes software reliability and
quality through independent peer review and rapid evolution of source code. • Allows free access to
programmer's instructions and modifications and redistribution. • OSI created a certification mark, "OSI
certified," ensuring free distribution and use of software. • Source code must be accessible to all and
distribution terms must comply with OSI's 10 criteria. • Open source extends beyond access to source
code. Open Source Software Distribution Criteria: 1.) Free Redistribution- The license does not restrict
the sale of the software as part of an aggregate distribution containing programs from multiple sources.
It does not require a royalty or other fee for such sale. 2.) Source Code- The program must include
source code and allow distribution in source code as well as compiled form. The source code must be the
preferred form for program modification. 3.) Derived Works- The license must allow modifications and
derived works to be distributed under the same terms as the original software license. 4.) Integrity of the
Author’s Source Code- The license may restrict source code from being distributed in modified form only
if the license allows the distribution of “patch files” with the source code for the purpose of modifying
the program at build time. 5.) No Discrimination Against Persons or Groups- The license must not
discriminate against any person or group of persons. 6.) Distribution of License- The rights attached to
the program must apply to all to whom the program is redistributed without the need for execution of
an additional license. 7.) License Must Not Be Specific to a Product- The rights attached to the program
must not depend on the program’s being part of a particular software distribution. 8.) License Must Not
Restrict Other Software- The license must not place restrictions on other software that is distributed
along with the licensed software. 9.) License Must Be Technology-Neutral- No provision of the license
may be predicated on any individual technology or style of interface. 10.) No Discrimination Against
Fields of Endeavor- The license must not restrict anyone from making use of the program in a specific
field of endeavor. Open Source Software for Healthcare Applications • Open Source Software for Health
(OSS/FS) could provide competition to the closed market of proprietary software, encouraging
innovation. • OSS/FS could solve problems faced by health information systems (HISs), such as lack of
interoperability, vendor lock-in, cost, difficulty of record, and system maintenance. • OSS/FS conforms to
standards and its source code is open to inspection and adaptation, reducing the risk of dominance by
any single interest group. • Advantages of OSS/FS include ease of modification, a large developer
community, increased compliance with open standards, enhanced security, and flexibility of source code.
• Cost-effectiveness of OSS/FS is beneficial for communities or organizations requiring such an approach.
• Current EHR systems are expensive, inflexible, difficult to maintain, and rarely interoperable across
health systems, often due to their proprietary nature. • OSS/FS has potential to integrate functional EHR
systems into wider health systems, improving healthcare in the United States and other areas
worldwide. • There is interest in interoperability testing of systems, not only between proprietary
systems but also among OSS/FS systems. • Integrating the Healthcare Enterprise (IHE) has developed
tools to test healthcare interoperability according to the standards profiled by the IHE in its technical
frameworks. Data Processing • Data- Raw, uninterpreted facts that require processing for interpretation
and information production. • Database- Organized collection of related data, such as notes or medical
records. • Types of Data- Computer-based data (alphanumeric, numerical, logic) and conceptual data
types. • Files: Data Files- Store data captured and stored using software programs, like Microsoft Word
documents. • Processing Files- Computer programs or instructions that initiate specific computer
programs or functions. • Conceptual Data Types- Reflect user views of data, based on the source or
event being captured. Unit IV: Internet as Nursing Resource The internet operates without any owners,
censors, or stockholders. It relies on standard communication protocols, such as TCP and IP , which allow
computers to connect and exchange data. TCP breaks messages into small packets, IP decides packet
routing, HTTP supports the World Wide Web, FTP allows users to send electronic files, and Telnet
enables remote access. Domain Name System Overview • Provides globally unique names to networks
and computers. • Benefits include easier rememberability and ability to change physical location. •
Pioneered by Paul Mockapetris. Top Level Domain (TLDs) • Each country has a two-letter TLD as of

3. • Examples

include.CA,.UK,.DE,.BIZ,.COM,.COOP ,.EDU,.I NT, and.PRO. • Some TLDs have more than 1 dot. ICANN •
Created in 1998, responsible for internet technical coordination. Email Etiquette and Communication
Email Usage • Emails are a popular internet communication method, consisting of user names and
computer names. • They differ from telephone or face-to-face communication and are not considered
private. Emoticons and Abbreviations • Emoticons/smileys are small icons used to denote a mood. •
They are used to compensate for the inability of message recipients to accurately judge the sender's
mood. E-mail Etiquette • Basic guidelines include:

 Avoid sending anything but plain text.

 Be aware of the size of the messages and

attachments.

 Include a signature.

 Do not request a "read receipt" for every

email message.

 Double-check the "To" and "From" fields

before sending.

 Do not type in all caps or all lower case.

 Be to the point without rudeness or

abruptness. Business E-mail Etiquette • Prohibits sending threatening, slanderous, insubordinate,

racially/sexually harassing, or racially/sexually harassing messages. • Pyramid schemes are illegal and
should not be transmitted through email. • Representation of oneself as someone else or a message
sent anonymously is prohibited. Chat and Instant Message • Use abbreviations when possible, but only if
the reader will understand. • Smileys or emoticons can help convey intention. Resources for Cyber-
Protocol Tips • Visit sites like Netiquette 101, Business E-mail Etiquette Basics, Wikipedia – Netiquette,
Writers Write Internet Journal, Learn the Net, Netiquette Quiz, and Instant Messaging and Live Chat
Etiquette Tips. Unit V: Practice Applications Introduction Decision support systems (DSS) are automated
tools that aid in decision-making activities and improve outcomes. Clinical decision support systems
(CDSS) are designed to support healthcare providers in making decisions about patient care delivery and
management. They aim to optimize the efficiency and effectiveness of clinical decisions, promoting
clinical accountability and best practices. CDSS tools can assist nurses in improving care delivery,
identifying interventions, and supporting patient safety initiatives. The ideal CDSS should be available at
the point of care, require minimal training, and be user-friendly. However, the clinical user's experience
and knowledge base should not be replaced by CDSS. Implementation requires understanding available
tools, clinician readiness, and areas with significant risks to patient safety. CDSS Definitions and Concepts
Clinical Decision Support (CDS) is a process that enhances health-related decisions and actions by
providing clinicians, staff, patients, or other individuals with relevant, organized clinical knowledge and
patient information. CDS includes tools like computerized alerts, clinical guidelines, and patient data
reports. The American Medical Informatics Association (AMIA) developed a roadmap for action on CDS
in 2007, focusing on three pillars: best knowledge available when needed, high adoption and effective
use, and continuous improvement of knowledge and CDS methods. CDSS software aids clinicians in
decision-making, supporting semi-structured problems and improving decision-making effectiveness.
CDSS Impact on Clinicians CDSS impacts clinicians by providing evidence-based knowledge at the point of
care, preventing errors, and improving quality of care. Successful integration requires a system that
supports workflow while incorporating evidence. Healthcare professionals must be involved in CDSS
selection and consider its impact on organizational culture, practice, and personnel attitudes. The shift to
electronic health records enables the availability of new knowledge to support decision-making
processes Classic CDSS Content Healthcare decision support systems (DSSs) support organizational,
executive/managerial, financial, and clinical decisions. Administrative systems support business decision-
making processes, while clinical decision support systems focus on real-time decision support and
intelligence gathering. Combination systems offer optimal value by integrating operational data with
clinical data. DSSs can be divided into data-based, model-based, knowledge-based, and graphics-based
systems. Data-based systems use population-based information, model-based systems manipulate
statistical or financial data, and knowledge-based systems rely on expert knowledge. Clinical protocols
are complex and require a "push-pull" approach, with distinctions becoming increasingly blurred. CDSS
Development Involves a team approach, identifying information needs, identifying stakeholders, and
addressing goals. It involves determining the frequency of use, addressing clinical issues, and
determining the system's capabilities. The knowledge base is defined, and interventions are selected.
The system is tested and launched, with ongoing evaluation and enhancement. A successful CDSS
supports performance improvement initiatives, focusing on patient benefits, evidence-based practices,
and decision-making. CDSS governance involves executive leadership, management oversight, project
managers, and end users. Effective communication with stakeholders and key end users is crucial.
Knowledge and Cognitive Processes in Healthcare Knowledge Engineering and Expert Systems •
Knowledge engineering involves knowledge acquisition and organization within a computer system. •
Building a knowledge-based or expert system requires understanding of healthcare providers' cognitive
processes and decision-making. • Expert clinicians recognize various types of knowledge, including
declarative knowledge, procedural knowledge, and reasoning and inference. Eliciting Knowledge from
Expert Clinicians • Techniques include "think aloud," surveillance, interviews with experts, Cognitive Task
Analysis (CTA), and visualization of patient data. • The visual display of data can lead to accurate or
inaccurate decisions. • Computer-based techniques and rating and sorting methods are used to assess
decision-making. CDSS and Meaningful Use • The Center for Medicare and Medicaid Programs provides
financial incentives for the "meaningful use" (MU) of certified EHR technology. • Implementation of MU
involves three stages: data capture and sharing, advancing clinical processes, and improved outcomes. •
CDSS can address the meaningful use objectives of drug, drug–drug, drug–allergy, and drug formulary
checks, and support the maintenance of a medication allergy list. • Effective deployment of CDSS can
optimize its value in targeted clinical outcome measures and assist in managing chronic conditions.
Patient Decision Support • Patient decision support is crucial for patients to become more engaged in
self-care. • Online tools can help patients identify areas in need of help when making healthcare
decisions. • Innovations in healthcare may be key to the development of more personalized and effective
patient decision support tools. CDSS User Responsibility: Ethical and Legal Issues • Legal responsibility
for patient treatment and advice lies with clinicians, regardless of the use of a Decision Support System
(DSS). • CDSS must adhere to high quality and safety standards, and a "duty of care" must be met for
safe integration into routine patient care. • CDSS documentation should address the system's purpose,
population, inclusion/exclusion criteria, use context, user skill level, evidence source(s), and review and
update methods. Future of CDSS • Despite challenges, the use of decision support will increase due to
diverse priorities, providers, and practice modes in healthcare. • CDSS development is promoted with
increased focus on Electronic Health Records (EHRs), understanding of CDSS benefits, and incentives for
meaningful use. • Vendors are beginning to include CDSS in their products, with acceptance largely
dependent on organizational culture, leadership attitudes, and provider involvement. Summary • CDSS
development requires significant investment but can reduce care costs and errors. • Evidence indicates
CDSS can improve patient care quality, reduce medication errors, minimize care variances, improve
guideline compliance, and promote cost savings. • Wider adoption of CDSS supports clinical care
decisions, but final decision authority remains with clinicians. • Ease of use within existing workflow
practice will determine the success of a CDSS.