ISSUES IN

INFORMATICS
UNIT V: INFORMATICS
(LECTURE)
GROWTH OF NURSING
INFORMATICS
 Nursing informatics (NI) was first identified in the 1980
 NI was defined as the combination of nursing, information
and computer sciences to manage and process nursing data
into information and knowledge for use in nursing practice
(Graves and Corcoran, 1989).
 Utilization of information structures, processes and IT.
 Domain of NI includes data and its structures, information
management and technology.
 It also includes concepts from linguistics, organizational
dynamics, communication engineering, library science,
cognitive science.
DEVELOPMENT OF NURSING
INFORMATICS AS A SPECIALTY
 The nursing shortage has been seen as detrimental
in the delivery of quality healthcare.
 Several factors have necessitated the use IT in
nursing:
 The number of hours that is needed for quality care.
 The aging of baby boomers.
 The development of health sciences.
 Average age of nurses is 45.2 (Spratley et al., 2000)
 The presence of training programs for nursing
informatics.
THE CONCERN FOR NURSING
INFORMATICS
 The Institute of Medicine found out that 2.9 to
3.7% of admissions had experienced adverse
events.
 One recommendation was to computerize doctors’
orders.
 The reason for nursing informatics is to improve
patient safety.
CAN AUTOMATION SAVE NURSES?

 Computerization of hospital
documentation/processes have produced
good outcomes.
 Database, spreadsheet and document
production systems have streamlined
organizational processes.
 Reduction in paper expenditure.
THE ROLE OF TECHNOLOGY IN
THE MEDICATION-USE PROCESS
 Safety is always the top concern.
 Healthcare is a high error-prone industry.
 Deaths in hospitals are usually attributed with
practitioners interacting with bad systems.
 Acquisition of computers were focused on stand-alone
system.
 Less than 10% of healthcare organizations have put
significant amount of resources in this areas.
COMPUTERIZED PRESCRIBER
ORDER ENTRY (CPOE)
 A system that used for direct entry of one or more types of
medical orders electronically into a system that transmits those
orders electronically to the department concerned (AHA, 2000).
 Paper-based system is still used as form of communication
among healthcare providers.
 It was hard to locate pertinent information on the papers that
hold the record.
 Illegible handwriting and multiple volumes of patient records
are also factors that considered in the dev’t of CPOE.
ADVANTAGES OF CPOE
 Medication errors are reduced by 55% (Bates et al., 1998)
 Non-missed dose errors fell to 26.6/1000 (Bates et al.,
1999)
 Handwriting misinterpretation would be eliminated.
 Errors of omission would be reduced.
 Fewer handoffs will occur, thus minimizing duplicated
efforts.
 Transmission of information will be faster.
BARCODE-ENABLED POINT-OF-
CARE TECHNOLOGY (BPOC)
 38% of errors occur in medication administration process
(Leape et al., 1995).
 Barcodes have major impact on productivity and identification.
 Includes a second identifier for a patient receiving a medication.
 The system helps to verify that the right drug is administered to
the right patient at the right dose and at the right time
 There are negative effects:
 Nurses find it difficult to deviate from the norm.
 Nurses have their own strategies that circumvented the BPOC.
HEALTHCARE DATA STANDARDS
 The methods, protocols, terminologies and specifications
for the collection, exchange, storage and retrieval of
information associated with healthcare applications,
including medical records medications, radiological
images, payments and reimbursements, medical devices
and monitoring system and administrative processes.
 Data standards aim to reduce the level of ambiguity in
the communication of data.
HEALTHCARE DATA STANDARDS
 Address the format of messages that are exchanged between
computer systems, document architecture, clinical templates,
user interface and patient data linkage.
 To achieve data compatibility between systems, it is necessary
to have prior agreement on the syntax of the messages
exchanged.
 Four broad classes of message format standards have emerged:
medical device communications, digital imaging
communications, administrative data exchange and clinical data
exchange.
STANDARDS DEVELOPMENT
PROCESS
 The core of every system is the concept of
secure, patient-centered EHR that:
 Safeguards personal privacy.
 Uses standardized medical terminology
 Eliminates the danger of illegible handwriting and
missing patient info.
 Can be transferred as a patient’s care requires over a
secure communications infrastructure for electronic
information exchange.
DEPENDABLE SYSTEMS FOR
QUALITY CARE
 Unfortunately, not all computer systems are
invincible to attacks.
 One example was what happened to CareGroup in
the US.
 August 2003, Blaster and SoBig worm attacks
invaded hospitals.
 The complexity of computer systems are always
prone to fail.
GUIDELINES FOR DEPENDABLE
SYSTEMS
 Removing all system vulnerabilities is not practical because
of its complexities and the heterogenous environments
where software and hardware changes are part of routine
operations.
 The more practical approach is to build a tolerant system
that can anticipate problems, detect faults, software glitches
and intrusions that take action so that services can continue
and data were protected from corruption.
GUIDELINES FOR DEPENDABLE
SYSTEMS
 Guideline 1: Architect for Dependability
 System must be developed bottom up so that no critical component is
dependent on a component less trustworthy than itself.
 Single-point dependencies should be avoided.
 Guideline 2: Anticipate Failures
 As computers get faster, they get more complex (Moore’s law) and
inevitably, failures happen.
 Software development should include fault detection and recovery from
failures.
 Clinical systems should fail in a safe state.
GUIDELINES FOR DEPENDABLE
SYSTEMS
 Guideline 3: Anticipate Success
 Systems should be designed to be open for expansion
 Models for more accurate care should be considered in systems design.
 Guideline 4: Hire Meticulous Managers
 Monitoring IT systems is a tedious job and failures happen when least
expected.
 Hire someone who is proactive rather than reactive.
 Manage emergencies and recovering from disasters
GUIDELINES FOR DEPENDABLE
SYSTEMS
 Guideline 5: Don’t Be Adventurous
 Do not acquire computer products that are not tested.
 Stick only to IT systems that will serve the need of the
organization, innovate as needed.
NURSING MINIMUM DATA SET
SYSTEMS (NMDS)
 To enter into automated healthcare information
system with potentially wide-scale application,
nursing community should standardize data.
 Once standardized, these data in now a valid
element of knowledge.
 To come up with standards, nursing profession
should convene.
 The data must include aspects of information that is
relevant to the needs of multiple users.
NURSING MINIMUM DATA SET
SYSTEMS (NMDS)
 NMDS should meet the following criteria:
 Data must be useful to most potential users
 The items in the set must be readily collectable with
reasonable accuracy.
 Items should not duplicate other available data.
 Confidentiality must not be violated.
US NMDS
 Only categories and not terminologies.
 Recognized terminologies are:
 NANDA (North American Nursing Diagnosis Assoc)
 NIC (Nursing Intervention Classification)
 NOC (Nursing Outcome Classification)
16 ELEMENTS OF NMDS

 Demographic Elements
 Personal Identification
 Date of birth
 Gender
 Race
 Residence
16 ELEMENTS OF NMDS

 Service Elements
 Service Agency Number
 Health Record Number
 Unique number of principal registered nurse provider
 Episode admission or encounter
 Discharge or termination date
 Disposition of client
 Expected Payee
16 ELEMENTS OF NMDS

 Nursing Care Elements