INTRODUCTION TO

HEALTH INFORMATICS
OBJECTIVES
Explain how Health and Nursing informatics relates to and facilitates
nursing practice
Explore how nurses can create and derive clinical knowledge from
information systems.
Explore standardization in clinical data management and terminology
approaches that capture and codify health information.
Describe the importance of data quality for the direct and
downstream usage of clinical data
AGENDA
Definition and application of health and nursing informatics
Data, Information, Knowledge, Wisdom framework
Importance of standardization and data quality in healthcare
Direct and downstream clinical data usage
WHAT IS.. (1 OF 2)
..Health Informatics (Clinical Informatics)
is the interdisciplinary study of the design, development, adoption and application of IT-
based innovations in healthcare services delivery, management and planning

National Library of Medicine (2009)

WHAT IS.. 2 OF 2
Nursing Informatics
is the specialty that integrates nursing science with multiple information management
and analytical sciences to identify, define, manage, and communicate data, information,
knowledge, and wisdom in nursing practice.

American Nurses Association (2015)

APPLIED NURSING INFORMATICS ROLES
Chief Nursing Informatics Officer (CNIO)
Informatics Nurse Specialist
Nurse Informatician
Clinical Knowledge Engineer
Informatics Project Manager
Clinical Data Analyst
Many more.
INFORMATICS COMPETENCIES FOR NURSING
Competency in informatics for all nurses and specifically
nurse leaders is essential for:
Health Information Technology (HIT) adoption
Electronic Health Record (EHR) implementation
System design
Data analysis
Innovation in nursing practice

Yen P, Phillips A, Kennedy M, Collins S. (2017)

DIKW PYRAMID
What is DIKW? (Complexity Labs, 2017)
Data, Information, Knowledge, and
Wisdom.
DIKW is central to Informatics
Multidirectional
Multidisciplinary

Figure 1. DIKW pyramid. (School of Data, 2014)

DIKW DEFINITIONS

Data: discrete entities that are described objectively without interpretation

Information: Data that are interpreted, organized, or structured
Knowledge: Information that is synthesized to identify and formalize
relationships
Wisdom: Application of knowledge to the management and solution of human
problems

McGonigle,D.,& Mastrian, K. (2018)

DIKW CLINICAL EXAMPLE

Data: A patients vital signs

Information: A set of vital signs on a given patient, placed into a context and used
for comparison.
Knowledge: Recognition of a pattern and identification of interventions
Wisdom: Accuracy of the synthesis of information and appropriate selection of
interventions

McGonigle,D.,& Mastrian, K. (2018)

MOVING FROM KNOWLEDGE TO WISDOM

Knowledge focuses on what is known. (e.g. abnormal vital signs; consider

intervention).
Wisdom focuses on the appropriate course of action related to the knowledge.
(e.g. medication administration; further assessment)
Example:
A knowledge base may include options or an algorithm for managing abnormal vital
signs, while wisdom would guide the decisions about which of these options are most
appropriate for the given patient and scenario.

McGonigle,D.,& Mastrian, K. (2018)

INDIVIDUAL EXERCISE: DIKW USE CASE

Consider an example from your current nursing practice of the DIKW

framework being used to illustrate the differenced between data,
information, knowledge and wisdom.
10 minutes individual contemplation

Review examples
Each student provides example
CLINICAL DATA IN HEALTHCARE
Data Quality/Integrity
Standardized clinical data
Downstream usage
Big data
Interoperability
More.
DATA QUALITY/INTEGRITY
Timely
Reliable
Accurate
Complete
Consistent
Unambiguous
Computable
GROUP EXERCISE-
DESIGNING A DATA MODEL FOR NURSING ASSESSMENT
Break into groups of 3-4 per group
Each group is a specific nursing specialty, care area, or unit (e.g. pediatric,
ambulatory, emergency room, med/surg unit, oncology, homecare)
Define data elements and value sets to capture a specific nursing
assessment
Clinical topic: clinical subject matter, theme, or focus (pain assessment; Skin
assessment)
Data Element: component of the clinical topic capturing a specific idea (skin
color)
Value-set: the allowed choices specified within a data element (red, pink)
GROUP EXERCISE-RESULTS
Review results of group models
Identify similarities and differences across groups
Determine data element consistency
Determine value-sets consistency

________________________________________________________________________

Typical situation in and across organizations:

Users often expect a high level of customization

Resulting Problem:
Many similar or identical data element are added to the dictionary
Prospective clinical data is NOT consistent or reliable and consequently NOT useful
More is not better!
STANDARDIZED CLINICAL DATA
Standard development organizations
Example-Health Language 7 (HL7)

Reference models/Minimum Data Sets

ONC S&I Framework -Structured Data Capture Initiative (SDC)
Standardized vocabularies and classifications
SNOMED CT
LOINC
ICD-10
RxNorm
NANDA:NIC,NOC; CCC, etc (Nursing specific)
DOWNSTREAM USE OF DATA

Operational Reports/Dashboards
Clinical Decision Support (CDS)
Quality Improvement Initiatives
Benchmarking
Clinical and Informatics Research
..
BIG DATA
Big Data to Knowledge-The Common Fund*
Office of the National Coordinator for Health IT -
Office of Strategic Coordination

Office of the National Coordinator for Health IT (2013)

INTEROPERABILITY
The Path To Interoperability
YouTube Video

National Institute of Health (2017)

INDIVIDUAL EXERCISE: INNOVATION IN INFORMATICS

Consider an example from your current nursing practice where you could
leverage an informatics solution to solve a current problem
Any healthcare setting
Direct or indirect nursing care
10 minutes individual contemplation

Review examples
Each student provides example
REFERENCES
REFERENCES
1. American Nurses Association . (2015). Nursing Informatics: Scope and standards of practice. (2nd Ed). Silver Springs,
MD: Nursesbooks.org
2. Complexity Labs. (2017, May 15). What is DIKW? Retrieved from https://youtu.be/h9gYk66yz-0
3. McGonigle,D.,& Mastrian, K. (2018). Nursing Informatics and the Foundation of Knowledge (4th Ed.). Boston: Jones and
Bartlett.
4. National Institute of Health (2017, September 27). Big Data To Knowledge. Retrieved from
https://commonfund.nih.gov/bd2k
5. National Library of Medicine (2009); Definition of Health Informatics. Retrieved from https://www.nlm.nih.gov/
6. Office of the National Coordinator for Health IT (2013, September 18). Interoperability. Retrieved from
https://www.youtube.com/watch?v=PaWcU7rqqyA
7. Yen P, Phillips A, Kennedy M, Collins S. (2017) Nursing Informatics Competency Assessment for the Nurse Leader:
Instrument Refinement, Validation, and Psychometric Analysis. Journal of Nursing Administration. May; 47(5):271-277.
doi: 10.1097/NNA.0000000000000478.
8. School of Data (2014). DIKW image. Retrieved from https://schoolofdata.org/files/2014/02/DIKW.png