Nursing Informatics

Jude L. Tayaben
College of Nursing
University of the Cordilleras
Course Description

INFORMATION
TECHNOLOGY DATA STANDARDS

NURSING
Course Credit
 2 units Lecture
 1 unit Laboratory
 Contact Hours:
◦ 36 Lecture Hours
◦ 54 Laboratory Hours
 Apply concept, theories
and principles of
informatics in nursing and
health care

Discuss issues and trends

in informatics relevant to
nursing and health.

Course Objectives
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. Practice Application
2. Critical Care Application
3. Community Health Applications
4. Ambulatory Care Systems
5. 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. Consumer’s 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. Nursing Informatics in Canada
2. Nursing Informatics in Europe
3. Pacific Rim
4. Nursing Informatics in Asia
5. Nursing Informatics in South America
K. The Future of Informatics
1. Future Directions
Part 1

WHAT IS
INFORMATICS?
 French word
Informatique Computer science

INFORMATION COMPUTER
SCIENCE SCIENCE

MANAGEMENT AND
PROCESSING OF DATA AND
INFORMATION
WHAT IS NURSING
INFORMATICS?
USE OF COMPUTERS TECHNOLOGY

CLINICAL
PRACTICE ADMINISTRATION

CLINICAL PRACTICE
ADMINISTRATION
EDUCATION RESEARCH
 Graves, J. R., & Corcoran, S. (1989).
The Study of Nursing Informatics. Image:
Journal of Nursing Scholarship, 27, 227-
231. 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.”
 American Nurses Association
(ANA) (1994) has defined nursing
informatics as:
“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.”
 Nursing Informatics Defined (ANA,
2008)
 Nursing informatics (NI) is a specialty that
integrates nursing science, computer
science, and information science to manage
and communicate data, information
knowledge and wisdom in nursing practice.
NI supports consumer, patients, and other
providers in their decision-making in all
roles and settings. This support is
accomplished through the use of
information structures, information
processes, and information technology.
 Nursing Informatics (ANA, 2014)
 It 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.
 It supports nurses, consumers, patients,
the interprofessional healthcare team,
and other stakeholders in their decision-
making in all roles and settings to achieve
desired outcomes.
 This supports is accomplished through
the use of information structures,
information processes, and information
technology.
Framework for Nursing
Informatics
 The framework for nursing informatics relies
on the central concepts of data, information
and knowledge:
◦ A DATA is defined as discrete entities that are
described objectively without interpretation
◦ An INFORMATION as data that is interpreted,
organized or structured
◦ A KNOWLEDGE as information that has been
synthesized so that interrelationships are
identified and formalized.
◦ Resulting in DECISIONS that guide practice
 Metastructures:
Data, Information, Knowledge and
Wisdom

Nursing Informatics: Scope and Standards of Practice, ANA

2008
 Advancing Practice with Technology

Technology must capture Technology must be Technology

the tasks performed but designed to enhance is key to embrace
not limit practice scope of practice and and shape so
to the rituals and routines evidence-based practice practice is truly
of traditional practice at the point of care knowledge-driven

Scope of Knowledge-
Tasks
Practice Worker

Wesorick, Troseth & Cato (2004) Intentionally Designed Automation. Healthcare Technology (vol. 2)
McBride (2005) Nursing and the Informatics Revolution. Nursing Outlook.
Nursing Informatics Roles – Wide
Variety

Practice Education

NI
Roles

Industry Government
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 searching-CINAHL,
Medline and Web sources
◦ The adoption of standardized language related
to nursing terms-NANDA, etc.
◦ The ability to find trends in aggregate data,
that is data derived from large population
groups-Statistical Software, SPSS
Key Nursing Reports, Journals and
Books

Identify key nursing

reports, journals and
books shaping nursing
informatics impact in
healthcare
Key Reports Shaping Nursing
Informatics Impact

 IOM (Institute of
Medicine – 2010).
The Future of
Nursing: Leading
Change, Advancing
Health. Washington,
DC: The National
Academies Press.
Other IOM Reports www.nap.edu

Digital Infrastructure for the Learning

Health System: The Foundation for
Continuous Improvement in Health and
Health Care (May 2011)

Learning What Works: Infrastructure

Required for Comparative Effectiveness
Research (June 2011)

Health IT and Patient Safety: Building

Safer Systems for Better Care
(November 2011)
 New IOM Report www.nap.edu

Best Care at Lower Cost: The Path to

Continuously Learning Health Care in
America (September, 2012)

“Although unprecedented levels of information are available, patients and

clinicians often lack access to guidance that is relevant, timely, and useful for
the circumstances at hand. Overcoming this challenge will require applying
computing capabilities and analytic approaches to develop real-time insights
from routine patient care, disseminating knowledge using new technological
tools and addressing the regulatory challenges that can inhibit progress.”
 Concluded that technology can and
should:
• Improve access to patient
data
• Streamline monitoring of
public health patterns and
trends
• Expand ability to conduct
clinical trials
• Create new high-tech
markets and jobs

PCAST Report (December

2010)
President’s Council of Advisors on Science and Technology Report
Key Nursing Informatics Books
www.nursingknowledge.org/STTI/bo
oks
www.powerof10book.org
Do you think patient care improves
or suffers as patient-care and
reporting technology increases?
Explain

Do you see a generational divide

between nurses who embrace
technology vs. nurses who don’t?
Explore the topic and way to bridge
real or perceived generational gaps
related to technology

Where is technology missing

in nursing? Think futuristic:
Where could technology
really improve your practice
or patient care? Go way
outside the box!
Key Informatics Journals impacting
Nursing
Key Informatics On-Line Journals
impacting Nursing
Nursing Informatics and Social
Media
Part 2

Computer
Automation in
Health Care
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 and
decreased potential for error.
◦ 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 tools as well as alerts and reminders
notify the clinician of possible concerns or omissions.
◦ Effective data management and trend-finding include the
ability to provide historical or current data reports.
◦ Extensive financial information can be collected and
analyzed for trends. An extremely important benefit in this
era of managed care and cost cutting.
◦ Data related to treatment such as inpatient length of stay
and the lowest level of care provider required can be used
to decrease costs.
 Nursing Informatics
 Recognized as a specialty by the ANA in
1992

Nursing Informatics: Scope and Standards of Practice, ANA 2008

Informatics Nurse- Nurse Who is
interested and Involved (ANA,
2014)
 Applied Job Titles
◦ Super user
◦ Trainer/ Educator
◦ Systems Analyst
◦ Support Analyst
◦ Systems Administrator
◦ IT Training Manager
◦ Project Manager
◦ Project Leader
 Entry Level:
◦ Basic Computer Competencies
◦ Information Literacy Competencies
◦ Information Management Competencies
Nursing Informatics Specialist
 Because of the increased importance of
computers and information technology in
the practice of professional nursing; a new
role has emerged, the Nursing
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 that performs 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 computer’s 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 Perspectives of
Nursing and Computers
 Six time period

◦ Prior to 1960’s – simple beginnings

 Use of punch cards and teletypewritters.
 1960’s
◦ 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
 1970’s
◦ Nurses assisted in the design of HIS
◦ Computers used in financial and management
functions
◦ Several communities developed Management
Information sytem
 1970’s
◦ Nurses assisted in the design of HIS
◦ Computers used in financial and management
functions
◦ Several communities developed Management
Information sytem
 1980’s
◦ Nursing Informatics is formally accepted as
new nursing specialty.
◦ Nursing Education identified need for update
◦ Emergence of microcomputers/PC
 1990’s
◦ 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 information
technology, this is managed by HIMSS.
 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 enacted.
Assignment 1
 1. Read the Health Insurance Portability
and Accountability Act of 1996
(downloadable via internet)
 2. Summarize the provision, or/and discuss
important points to remember
 3. Give its significance in terms of nursing
practice, education, and research
 1- page paper (500 words)
 MS word, 8.5 x 11
 12f, Times New Roman
 1 inch each side
 Submit via online via Canvas
 Date of Submission: January 31 2024 5p
COMPUTERS in Computers can perform a wide range of

NURSING
activities that save time and help Nurses
provide quality nursing care.

NURSING NURSING
PRACTICE EDUCATION

NURSING NURSING
MANAGEMENT RESEARCH
Nursing Practice
 Computer systems, patient care data and
NCP’s are integrated to Electronic Health
Record
 Need for EHR was perceived
 New Nursing Terminologies were
recognized by ANA
mHealth
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.
Online Seminar
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.
Assignment (Individual)
 The Effect of Hospital Electronic
Health Record Adoption on Nurse-
Assessed Quality of Care and
Patient Safety
 Dr Ann Kutney-Lee and Deena Kelly,
Center for Health Outcomes and Policy
Research, School of Nursing, University of
Pennsylvania, Philadelphia
 Journal of Nursing Administration. 2011
November ; 41(11): 466–472.
doi:10.1097/NNA.0b013e3182346e4b.
 Read the FULL article
 Write the significant and concrete
contributions of the article to nursing
informatics in health care setting (at least
500 words)
 Espouse the relevance to Philippine
setting HIS (500 words)
 Submit via Canvas on January 31 (12mn)
Key Nursing Informatics
Organizations

Identify
key nursing
informatics organizations
shaping nursing
informatics in healthcare
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
HIMSS (Healthcare Information and Management Systems Society)
Nursing Informatics (www.himss.org/ni)
American Nursing Informatics
Association
www.ania.org
AMIA-NIWG
http://www.amia.org/programs/working-groups/nursing-informatics
Alliance for Nursing Informatics
www.allianceni.org
TIGER WEBSITE
www.thetigerinitiative.org
•TIGER Newsletter
•TIGER Calendar
•TIGER Listserv
•TIGER VLE updates
Part 3
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 Neumann’s Computer
Architecture

CPU I/O Devices

I/O Devices
MAJOR COMPONENTS
OF COMPUTERS
 Hardware Devices
 Hardware is 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.
◦ 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/Nursing
-Informatics
 http://www.snomed.org/
 http://himss.org
 http://www.amia.org/ni-wg
 http://www.healthitcertification.com/about.ht
ml
 http://www.caringonline.org/
 http://www.imia.org/ni/index.html
 http://en.wikipedia.org/wiki/Nursing_Informa
tics