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Nursing documentation is the record of nursing care that is planned and delivered to individual clients by qualified nurses or other caregivers under the direction of a qualified nurse. It contains information in accordance with the steps of the nursing process. Nursing documentation is the principal clinical information source to meet legal ...
The National Board publishes standards of “accomplished teaching” for 25 certificate areas [8] and developmental levels for pre-K through 12th grade. These standards were developed and validated by representative councils of master teachers, disciplinary organizations and other education experts.
Health Level Seven, abbreviated to HL7, is a range of global standards for the transfer of clinical and administrative health data between applications with the aim to improve patient outcomes and health system performance. The HL7 standards focus on the application layer, which is "layer 7" in the Open Systems Interconnection model.
A nursing care plan promotes documentation and is used for reimbursement purposes such as Medicare and Medicaid. The therapeutic nursing plan is a tool and a legal document that contains priority problems or needs specific to the patient and the nursing directives linked to the problems. It shows the evolution of the clinical profile of a patient.
Medcin, is a system of standardized medical terminology, a proprietary medical vocabulary and was developed by Medicomp Systems, Inc. MEDCIN is a point-of-care terminology, intended for use in Electronic Health Record (EHR) systems, [1] and it includes over 280,000 clinical data elements encompassing symptoms, history, physical examination, tests, diagnoses and therapy. [2]
All Cerner Millennium health information technology software uses CCL/Discern Explorer to select from, insert into, update into and delete from a Cerner Millennium database and allows a programmer to fetch data from an Oracle database and display it as the user wants to see. With features like Record Structure and subroutines it allows a user ...
In 1938, National League for Nursing Education (NLNE) began accreditation for registered nurse education programs. Beginning in 1964, federal funding for nursing education under the US Nurse Training Act was contingent upon the compliance of schools of nursing with Title VI of the Civil Rights Act of the same year.
Given their centrality to the generation of health data and information, two of the largest EHR vendors have also created communities to support LHS: Cerner’s Learning Health Network and Epic System's Health Research Network. Still, much of the LHS development has been concentrated in large academic medical centers and health systems with a ...