Nursing Informatics

Instructor: Ian Jasper Mangampo

Schedule:
13:00 16:00 MTW RM319(LAB)
13:00 16:00 ThF RM302(LEC)

Course Description
This

course deals with the use of

information technology system
and data standards based on
nursing
informatics
principles/theories.
It
further
deals with the utilization of
clinical information systems in
the management and decisionmaking of patient care.

Course Credit
2

units Lecture
1 unit Laboratory
Contact Hours:
36 Lecture Hours
54 Laboratory Hours

Course Objectives
At

the end of the course and

given relevant actual or
simulated situations/conditions,
the student will be able to:
1. Apply concept, theories and
principles of informatics in nursing
and health care
2. Discuss issues and dtrends in
informatics relevant to nursing and
health.

Course Outline
A.

Computers and Nursing

1.Computers and Nursing
2.Historical Perspectives of Nursing and the Computer
3.Electronic Health Record from a Historical perspective

B.

Computer System
1.Computer Hardware
2.Computer Software and Systems
a.Open Source and Free Software
b.Proprietary Software
c. System Software
d.Application Software
e.Data Processing Software

3.The Internet, a Nursing Resource

4.PDA and Wireless Devices
5.Incorporating Evidence: Use of Computer-Based Clinical
Decision Support System for Health Professionals

C.

Issues in Informatics
1. Nursing Informatics and Healthcare Policy
2. The Role of Technology in the Medication-Use
Process
3. Healthcare Data Standards
4. Electronic Health Record Systems
5. Dependable Systems for Quality Care
6. Nursing Minimum Data Set Systems

D.

Informatics Theory
1. Theories, Models and Framework
2. Advanced Terminology Systems
3. Implementing and Upgrading Clinical Information
Systems

E.

Practice Application
1.
2.
3.
4.
5.

Practice Application
Critical Care Application
Community Health Applications
Ambulatory Care Systems
Internet Tools for Advanced Nursing
Practice
6. Informatics Solutions for Emergency
Preparedness and Response.
7. Vendor Applications

F.

Administrative Application
1. Administrative Applications of Information Technology
for Nursing Managers
2. Translation of Evidence, Clinical Practice Guidelines,
and Automated Implementation Tools
3. Data Mining and Knowledge Discovery

G.

Consumers Use of Informatics

1. Consumer and Patient Use of Computers for Health
2. Decision Support for Consumers

H.

Educational Applications
1. The Nursing Curriculum in the Information Age
2. Accessible, Effective Distance Education Anytime,
Anyplace
3. Innovations in Telehealth

I.

Research Application
1. Computer Use in Nursing Research
2. Computerized Information Resources

J.

International Perspectives
1.
2.
3.
4.
5.

K.

Nursing Informatics
Nursing Informatics
Pacific Rim
Nursing Informatics
Nursing Informatics

in Canada
in Europe
in Asia
in South America

The Future of Informatics

1. Future Directions

WHAT IS
INFORMATICS?

Informatics
Informatics

comes from the French

word
informatique
which
means
computer science.
Informaticsis
defined
ascomputer
science + information science.
Used in conjunction with the name of a
discipline, itdenotes an application of
computer science and information
science to the management and
processing of data, information, and
knowledgein the named discipline.

WHAT IS NURSING
INFORMATICS?

Hebda

(1998
p.
3),
definesnursing informaticsas:
The
use
of
computers
technology to support nursing,
including
clinical
practice,
administration, education, and
research.

American

Nurses Association
(ANA)
(1994)
has
definednursing informaticsas:
The development and evaluation
of applications, tools, processes,
and structures which assist
nurses with the management of
data in taking care of patients or
supporting
the
practice
of
nursing.

 Graves,

J. R., & Corcoran, S. (1989).

The Study of Nursing Informatics. Image:
Journal of Nursing Scholarship, 27, 227231.define nursing informatics as:
A combination of computer science,
information science and nursing science
designed to assist in the management
and
processing
of
nursing
data,
information and knowledge to support
the practice of nursing and the delivery
of nursing care.

Framework for Nursing

Informatics
The

framework for nursing informatics

relies on the central concepts of data,
information and knowledge:

A DATAis defined as discrete entities that

are
described
objectively
without
interpretation
An
INFORMATIONas
data
that
is
interpreted, organized or structured
A KNOWLEDGEas information that has
been synthesized so that interrelationships
are identified and formalized.
Resulting in DECISIONSthat guide practice

Application of Nursing
Informatics
Nursing

Informatics can be
applied to all areas of nursing
practice, which include; clinical
practice,
administration,
education, and research.

 Nursing

Clinical Practice (Point-of-Care Systems and

Clinical Information Systems)

Work lists to remind staff of planned nursing interventions

Computer generated client documentation
Electronic Medical Record (EMR) and Computer-Based
Patient Record (CPR)
Monitoring devices that record vital signs and other
measurements directly into the client record (electronic
medical record)
Computer - generated nursing care plans and critical
pathways
Automatic billing for supplies or procedures with nursing
documentation
Reminders
and
prompts
that
appear
during
documentation to ensure comprehensive charting

Nursing

Administration (Health
Care Information Systems)
Automated staff scheduling
E-mail for improved communication
Cost analysis and finding trends for
budget purposes
Quality assurance and outcomes
analysis

Nursing

Education

Computerized record-keeping
Computerized-assisted instruction
Interactive video technology
Distance Learning-Web based courses
and degree programs
Internet resources-CEU's and formal
nursing courses and degree programs
Presentation software for preparing slides
and handouts-PowerPoint and MS Word

Nursing

Research

Computerized literature searchingCINAHL, Medline and Web sources

The
adoption
of
standardized
language related to nursing termsNANDA, etc.
The ability to find trends in
aggregate data, that is data derived
from
large
population
groupsStatistical Software, SPSS

Benefits of Computer
Automation in Health Care:
Many

of

these benefits have

came
about
with
the
development of the electronic
medical record (EMR),which is
the electronic version of the
client
data
found
in
the
traditional paper record.

EMR benefits include:

Improved

access to the medical record.

The EMR can be accessed from several different

locations simultaneously,as well as by different levels
of providers.
Decreased

redundancy of data entry.

For example, allergies and vital signs need only be

entered once.
Decreased

time spent in documentation.

Automation allows direct entry from monitoring

equipment, as well as point-of-care data entry.
Increased

time for client care.

More time is available for client care because less time

is required for documentation and transcription of
physician orders.

 Facilitation

of

data

collection

for

research.
Electronically stored client records provide
quick access to clinical data for a large
number of clients.
Improved

communication
decreased potential for error.

and

Improved legibility of clinician documentation

and orders is seen with computerized
information systems.
Creation

of a lifetime clinical record

facilitated by information systems.

 Benefits

of automation and computerization are

related
to
the
use
of
decision-support
software,computer
software
programs
that
organize information to aid in decision making for
client care or administrative issues; these include:

Decision-support toolsas well as alerts and reminders

notify the clinician of possible concerns or omissions.
Effective data management and trend-findinginclude the
ability to provide historical or current data reports.
Extensive financial informationcan be collected and
analyzed for trends. An extremely important benefit in
this era of managed care and cost cutting.
Data related to treatmentsuch as inpatient length of stay
and the lowest level of care provider required can be used
to decrease costs.

Nursing Informatics
Specialist
Because

of
the
increased
importance of computers and
information
technology
in
the
practice of professional nursing; a
new role has emerged, theNursing
Informatics Specialist (NIS).
The NIS is a nurse who has formal
education,
certification
and
practical
experience
in
using
computers in patient care settings.

THE
ROLE
OF
THE
NURSING INFORMATICS
SPECIALIST (NIS)

The American Nurses Association

(ANA, 1994), lists several functions
of the NIS:
Theory

development.

The NIS contributes to the scientific

knowledge base of nursing informatics.
Analysis

of information needs.

The identification of information that nurses'

need to in order to accomplish their work;
client care, education, administration, and
research
Selection

of computer systems.

The NIS, guides the user in making informed

decisions related to the purchase of computer
systems.

Design

of computer systems and

customizations.

The NIS collaborates with users and computer

programmers to make decisions about how data will
be displayed and accessed.
Testing

of computer systems.

Systems must be checked for proper functioning

before they are made available for use in patient
care.
Training

users of computer systems.

Users need to be trained in how the system works,

the importance of accurate data entry,and how the
system will benefit them, and more importantly how
it will improve patient outcomes

Evaluation

of the effectiveness of computer

systems.
The unique role of the NIS makes them the ideal person
to evaluate the effectiveness of computer systems.
Ongoing

maintenance and enhancements.

The NIS makes sure the computerized system functions

properly and explores possible enhancements to the
system that will better serve the users and the patients.
Identification

of computer technologies that

can benefit nursing.

The NIS must keep abreast of the changes in the fields

of computers and information technology, including new
hardware and software that will benefit the nurse and
patient.

What is a Computer?

Computer

A general term referring to information

technology ( IT) and computer systems.
An electronic device thatperforms tasks, such
as calculations or electronic communication,
under the control of a set of instructions called
a program. Programs usually reside within the
computer and are retrieved and processed by
the computers electronics. The program
results are stored or routed to output devices,
such as video display monitors or printers.
Computers perform a wide variety of activities
reliably, accurately, and quickly.

Computers Nursing
Perspective
In

nursing computers are synonymous

to nursing information system (NIS).
Computers
are used to manage
information in patient care, monitor
quality of nursing care and evaluate
care outcomes
Networks with internet are used in
communicating
and
accessing
resources and interacting w/ the
patient on the (WWW).

"Computers are incredibly fast, accurate and stupid.

Human beings are incredibly slow, inaccurate and
brilliant.
Together they are powerful beyond imagination." Albert Einstein

POINT TO PONDER....

Nursing and the Computer

HISTORICAL
PERSPECTIVES

Major historical perspectives

of nursing and computers
Six

time periods

Four

major Nursing areas

Standard

Initiatives

Significant

land mark events

Major Historical Persepectives of

Nursing and Computers
Six

time period

Prior to 1960s simple beginnings

Use of punch cards and teletypewritters.

1960s

Use of computers in healthcare is

questioned
Studies on computers in nursing is
started.
Introduction of cathode ray tubes
Development of Hospital Information
System for financial transactions

1970s

Nurses assisted in the design of HIS

Computers used in financial and
management functions
Several communities developed
Management Information sytem

1970s

Nurses assisted in the design of HIS

Computers used in financial and
management functions
Several communities developed
Management Information sytem

1980s

Nursing Informatics is formally

accepted as new nursing specialty.
Nursing Education identified need for
update
Emergence of microcomputers/PC

1990s

Computer technology became an

integral part of the healthcare
setting.
Policies and legislation on promoting
computers in healthcare were
adopted.
Approval of NI by ANA as a new
nursing specialty.
Dr. Nicholas Davies excellence award
is given for excellence in health

Post

2000

Clinical Information System became

individualized in the electronic
patient record.
Mobile computing device were
introduced
New technologies were utilized
Internet provided new means of
development
Health Insurance Portability and
Accountability Act of 1996 was

COMPUT in

NURSI
ERS
NG

Computers can perform a

wide range of activities that
save time and help Nurses
provide quality nursing
care.

NURSING
PRACTICE

NURSING
EDUCATION

NURSING
MANAGEMENT

NURSING
RESEARCH

Nursing Practice
Computer

systems, patient care

data and NCPs are integrated to
Electronic Health Record
Need for EHR was perceived
New Nursing Terminologies were
recognized by ANA

Nursing Administration
Computers

linked department

together.
Hospital data are accessed
through computers.
Hospital process goes on line
Internet was utilized.

Nursing Education
Most

nursing schools offered

computer enhanced courses.
Campus-wide computer systems
became available.
Computer technology integrated
into teaching methodologies
World wide web facilitates
student-centered instructional
settings.

Nursing Research
Provides

an avenue for analyzing

data
Softwares are available for
processing qualitative and
quantitative data
Research databases emerged
Online access

Standard Initiatives
ANA

considered as the official nursing

organization that contributes in the
development and recommendation of
standards of nursing practice worldwide.

Joint

commission on Accreditation of
Hospital Organizations ( JCAHO) focuses
on the need for adequate records on
patients in hospital and practice of
standards in documentation of care

Significant Landmark of
Event
1961

Healthcare Information
and Management systems
Society was founded
1965 Development of one of
the first hospital Information
system in California
1973 First Conference on
Management Information Sytem

1981

First National Conference

on Computer Technology in
Chicago
1984 First Nursing Computer
Journal is published.
1989 graduate program in
Nursing Informatics is introduced
in Maryland university

1993-establishment

of electronic

library
1995 first International Nursing
Informatics Teleconference held
in Australia
2002-JCAHO identified clinical
information system as a way to
improve safety and recommends
that hospitals adopt technology.

2003

Health Insurance
Portability and Accountability Act
was enacted

2004

Establishment of the
National Health Information
Coordinator.

HISTORICAL
BACKGROUND OF
ELECTRONIC HEALTH
RECORDS

Electronic Health Record

(EHR)

An electronic record composed of

health
information
regarding
an
individual patient that exists as part of
a complete system designed to provide
access to, and management of, such
information.
The EHR is developed and managed by
the health facility or provider. The term
Electronic Health Record has largely
replaced the older Electronic Medical
Record.

It

is much more than an

electronic replacement of existing
paper systems. The EHR can start
to actively support clinical care
by providing a wide variety of
information services. However, it
is hard to understand what
information is really important to
clinical care and what is simply
occasionally desirable.

The

EHR bring uncountable

advantages in primary health
care detaching such as faster
access
to
information,
and
updated information.
It allows having a clinical process
with all the patient clinical
information and an easier access
to information (ex: allows the
simultaneous
access
from
different locations).

Recognizable

efforts
in
the
development
of
EHR
are
distinguished by the Nicholas E.
Davis Awards of Excellence
Program whose history describes
the improvement of EHR in
different settings.

The Nicholas E. Davies Awards of Excellence Program

The

Computer-Based Patient Record

Institute (CPRI), founded in 1992, was
an organization representing all the
stakeholders in healthcare, focusing on
the clinical applications of information
technology.
It was among the first nationally based
organizations to initiate and coordinate
activities to facilitate and promote the
routine use of Computer-Based Patient
Records (CPRs) throughout healthcare.

The

CPRI group on CPR Systems

Evaluation developed the CPR
project evaluation criteria in 1993
which became the basis in
assessing accomplishments of
CPR projects and provided the
Foundation of Nicholas E. Davies
Awards Excellence Program

The

Program was named after Dr.

Nicholas E. Davis, an Atlantabased physician, president elect
of the American College of
Physicians, and member of
Institute
of
Medicine
(IOM)
committee in improving patient
records. He was killed in a plane
crash just as the IOM report on
CPRs was being released

The

HIMSS Nicholas E. Davies

Awards of Excellence recognize
excellence in the implementation
and use of health information
technology, specifically EHRs, for
healthcare organizations, private
practices and public health
systems.

Nowadays

the Nicholas E. Davies

Awards Excellence Program is
managed by the Healthcare
Information
Management
Systems Society, and has the
following program objectives:

The Healthcare Information Management Systems Society

(HIMSS)

The

Healthcare Information and

Management Systems Society
(HIMSS)
is
the
healthcare
industry's
membership
organization exclusively focused
on providing global leadership for
the optimal use of healthcare
information technology (IT) and
management systems for the
betterment of healthcare.

HIMMS
Vision - Advancing the best use of
information and management
systems for the betterment of
health care
Mission - To lead change in the
healthcare
information
and
management
systems
field
through
knowledge
sharing,
advocacy,
collaboration,
innovation,
and
community
affiliations

HIMSS objectives:

Promote the vision of EHR systems through

concrete examples
Understand and share documented value of
EHR systems
Provide visibility and recognition for high
impact EHR system
Share
successful
EHR
implementation
strategies
Encourages and recognizes excellence in the
implementation
of
EMREHR
systems:
Implementation, Strategy, Planning, Project
Management and Governance Strategy

COMPUTER SYSTEMS

BEFORE

AFTER

BEFORE

AFTER

The Basic System

Components
The

basic operational design of

a computer system is called its
architecture.
John Von Neumann, a pioneer in
computer design, is given credit
for the architecture of most
computers in use today.
A typical Von Neumann system
has three major components:
the central processing unit (or
CPU)
memory, and
input/output(or I/O).

Von Neumanns Computer

Architecture

CPU

I/O Devices

I/O Devices

MAJOR COMPONENTS
OF COMPUTERS

Hardware Devices
Hardwareis

the physical part of the

computer and its associated equipment.
Computer hardware can comprise many
different parts, these include:
Input Devices:
used to enter data;
Examples:

keyboard, mouse, trackball, touch screen, light pen, microphone,

bar code reader, fax modem card, joystick, and scanner.

Output Devices:
used to view and hear processed data;
Examples:
video monitor screens, printers, speakers, and fax.

Input Devices

Output Devices

 Central Processing Unit (CPU)

Brain" of the computer
Three components:
Arithmetic Logic Unit (ALU):
Number "crunching
Registers
Similar to memory but has special purposes
Control Unit:
manages instructions to other parts of the
computer, including input and output devices
"traffic cop

 Primary Memory:
The storage area in which program instruction
(code) reside during execution.
Read-only memory (ROM) is permanent; it
remains
when
the power is off. Start-up instructions for the
computer
is
an
example of ROM.
Random access memory (RAM) is a
temporary
storage
area
for
program
instructions and data that is being processed, it
is only active while the computer is turned on.
(located on the motherboard not part of CPU)

 Secondary Storage:
Provides space to retain data in an area
separate from the computer's memory
after the computer is turned off, these
include; hard disk drives, floppy disks,
tape, zip drives, optical drives, flash
memory, and CD-ROM drives.

Networks
A

network is "a combination of hardware and

software that allows communication and
electronic transfer of information between
computers" (as cited in Hebda, 1998, p. 19).
Hardware may be connected permanently by
wire (Ethernet), or temporarily by wireless
communication, and modems/telephone lines.
This allows the sharing of computer and
software resources, through the use of the
network. For example, several computers may
share one computer, or a word processing
program could also be accessed by many
different users.

Computer Categories
Super

computers

The largest and most expensive, can perform billions of instructions

every second

Mainframes

Large computers capable of processing several millions instructions per

second.
They support organizational functions, therefore have been the
traditional equipment in hospitals. Customized software results in high
cost.

Minicomputer

A scaled-down version of the mainframe, since they are now becoming

more powerful they can now be found in hospitals and HMO's

Microcomputers(PCs),

Inexpensive processing power for an individual user.

Laptop

or Notebook, Handheld, and Personal Digital

Assistants (PDAs)

Portable devices which can be used almost anywhere.

References:
http://www.scribd.com/doc/6120543/Nur

sing-Informatics
http://www.snomed.org/
http://himss.org
http://www.amia.org/ni-wg
http://www.healthitcertification.com/ab
out.html
http://www.caringonline.org/
http://www.imia.org/ni/index.html
http://en.wikipedia.org/wiki/Nursing_In

formatics