Nursing Informatics Hand Outs

NURSING INFORMATICS AND COMPUTER TECHNOLOGY
NURSING INFORMATICS
The Scope of Nursing Informatics Practice
HealthCare Informatics:
Is the integration of information science, health science, computer science and cognitive science.
Is the derivative of the holistic objective of the medical practitioners such as the nurse, healthcare
providers, physicians, and healthcare staffs.
Definition of Nursing Informatics

Nursing informatics (NI) is a specialty that integrates nursing science with multiple information
management and analytical sciences1 to identify, define, manage, and communicate data, information,
knowledge, and wisdom in nursing practice. NI supports consumers, patients, nurses, and other
healthcare professionals in their decision-making in all roles and settings to achieve desired outcomes.
This support is accomplished through the use of information structures, information processes, and
information technology.
Nursing Informatics
Is a specialty that integrates nursing science, computer science, and information science to
manage and communicates data, information, and knowledge in nursing practice.
It facilitates the integration of data, information, and knowledge to support patients, nurses, 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 Specialist
Is responsible for providing clinical information and data analysis for effective patient care and
monitoring.
Works with computer systems, data and information analysis systems such as a statistical
information system to ensure optimal healthcare is provided.
Specific Role of Nurse Information Specialist

1. Employs informatics theories, concepts, methods, and tools to analyze information and
information system requirements.
2. Design, select, implement, and evaluate information systems, data structures, and decision
support mechanisms that support patients, nurses, and their human-computer interactions within
health care contexts.
3. Facilitates the creation of new nursing knowledge.
Application of Computer to Health Professions
1. Automatic searching of parallel records for medically ill person and critical medical information
2. Automatic searching of nationwide database holding registries or patients with critical problems
3. Automated review of similar patients to determine expected lengths of stay, cost, and rates of
complications allowing better financial forecasting for the hospital and better information for
the patient and caregiver.
4. System will allow the user to very easily pull information from vast number of patients.
5. Improved communication between multiple providers to reduce the it slipped through the
cracks syndromes that plague the smooth running of operating rooms.
6. Patient care and management care providers are using data entry devices to document care
given both at the bedside and a central terminals.
7. Patient records-compilation of patient or test data, maintenance and retrieval of these records and
use of these records for billing and usage and outcome analysis.
8. Patient monitoring by recording patient data on line and from various tests
9. Exchange of medical data from the compilation and maintenance of databases.
10. Interactive medical education from database and tutorial software.
11. Physician decision making from the use of patient records and databases.
HISTORY OF NURSING INFORMATICS IN THE PHILIPPINES

The Philippine nursing community has long sought to keep up with increasing use of information
and technology in the healthcare system. Nursing Informatics follows the footsteps of biomedical
informatics which has gained relative popularity earlier than its other allied medical counterparts.
Despite being in its early stages of development the subspecialty of nursing informatics on the
Philippines have more than decade of which led to future programs and activities.
Some of the major milestones in nursing informatics history in the Philippines which includes
the participation of the Philippine Nurses Association (PNA) in the development of Standards for Health
Information in the Philippines (SHIP) in 1999, the formation of the Master of Science in Health
Informatics (MSHI) which began in 2005 and the formation of the Philippine Nursing Informatics
Association (PNIA) in 2010 as a sub-specialty organization of PNA for nursing informatics.
Introduction
The words "nursing informatics" were unfamiliar among the nursing community until the year
2008. There were only a handful of people with knowledge and experience in nursing informatics but
the disciplines have not yet found its recognition as a sub-specialty of nursing arts and science in the
country. The origin of this budding discipline indirectly came from the pioneers of health informatics in
the Philippines.
The Philippine Medical Informatics Society (PMIS) and its founders had strong influence in
the development of health informatics in the Philippines. The PMIA was officially registered under the
Securities and Exchange Commission in 1996 by its board composed of eleven physicians. The
organization was headed by Dr. Alvin Marcelo.
Origins:
Since 1998, several faculty members of the University of the Philippines began formal education
and training. Dr. Herman Tolentino took a post-doctoral fellowship in medical informatics at the
University of Washington. Dr. Alvin Marcelo followed a year later for his training at the National
Library of Medicine. Dr. Cito Maramba went to Coventry for his Masters in Information Sciences at
the University of Warwick. They were later followed by other physicians such as Dr. Micheal Muin
and Dr. Ryan Baez.
By the year 2003, a Master of Science in Health Informatics was proposed to be offered by UPManila College of Medicine (major in medical informatics) and the College of Arts and Science (major
in bioinformatics) and was later approved to be offered starting academic year 2005-2006. In 1999, a
study group was formed headed by the National Institute of Health of the University of the Philippines,
Manila.
This group identified international standards for health information and their adaptability in the
Philippines. The document is referred to as the "Standards of Health Information in the Philippines,
1999 version" or "SHIP99". Representatives from various sectors collaborated on this project including
the Philippine Nurses Association (PNA) in the person of Ms. Evelyn Protacio.
CHED as a Catalyst:
The nursing community was still yet to follow its international counterparts in the adoption of
information, communication and technology in nursing practice in the Philippines. Despite the inclusion
of Informatics course in the undergraduate curriculum which focused on basic desktop applications, the
need for genuine nursing informatics course had not yet been realized. In 2008, Nursing Informatics
course in the undergraduate curriculum was defined by the Commission on Higher Education (CHED)
Memorandum Order 5 Series of2008. This was later revised and included as Health Informatics course
in CHED Memorandum Order 14Series of 2009. This will be first implemented in the summer of 2010.
Organization:
Early in 2009, Mr. Kristian R. Sumabat and Ms. Mia Alcantara-Santiago, both nurses and
graduate students of Master of Science in Health Informatics at the University of the Philippines, Manila
began drafting plans to create a nursing informatics organization. In February 2010, they began
recruiting other nursing informatics specialists and practitioners to organize a group which later became
as the Philippine Nursing Informatics Association.
They were joined by founding members Ms. Sheryl Ochea, a graduate of Master of Science in
Nursing major in nursing informatics at Xavier University (Ohio, USA), Ms. Alexrandra Bernal, a
graduate student and telehealth nurse of the National Telehealth Center, Ms. Pia Pelayo, a former
telehealth nurse and a project coordinator of the National Epidemiology Center, Department of Health
and Mr. Sid Cardenas, also a telehealth nurse. Other founding members include Mr. Noel Baez, Ms.
Rona Abcede, and Mr. Harby Ongbay Abellanosa.
Issues and Challenges:
Like many other disciplines, nursing informatics face many challenges while in its infancy stage.
The inclusion of informatics as an integral part of the undergraduate curriculum has been one of the
most influential factors for the increased awareness and interest in this field of nursing. However, the
contents of the curriculum were adapted from international materials which do not match the local
needs.
A community-centered approach to the use of information, communication and technology in
nursing practice must be adapted to ensure the impact of the program in the local healthcare system.
Lack of certification and credentialing programs in post-graduate levels are also absent with the scarcity
of local nursing informatics experts. This new field has yet to gain acceptance and recognition in the
nursing community as a sub-specialty.
Future Direction:
Development of training, certification and credentialing programs are in the pipeline for the
Philippine Nursing Informatics Association. Future partnerships with local and international nursing and
health informatics organizations have started as well. Other programs are expected to be slowly
delivered with PNIAs CORE X strategic platform which stands for Competency, Organization,
Recognition, Experience and Expertise. It is also a major thrust to support the use of health information
standards in the Philippines and to have nursing informatics specialists in every hospital in the country.
References:
http://www.scribd.com/doc/6120543/Nursing-Informatics
http://www.snomed.org/
http://himss.org
http://www.amia.org/niwg
http://www.healthitcertification.com/about.html
http://www.caringonline.org/
http://www.imia.org/ni/index
NURSING INFORMATICS AND NURSING PROCESS

THE NURSING PROCESS
Is the core of patient care delivery. In the nursing process continuum, nurses are constantly faced
with data and information. Data and information are integrated in each step of the nursing process:
Assessment
Diagnosis
planning
implementation, and
evaluation
Nursing documentation, which is often identified as the sixth step in the nursing process, is vital
in information management. Therefore, it is necessary for nurses to document accurately and precisely
to determine the desired outcome. Remember the Rule Garbage In-Garbage Out also applies to
nursing documentation.
THE ROLE OF NURSE INFORMATICIST OR NURSE INFORMATICSSPECIALISTS
Nurse Informaticists are often perceived as the techy nurse, super-user, or the go-to person
when new technology is implemented. They are often referred to as bi-lingual nurses who can speak
the nursing process and information technology language.
Being an expert in both fields and a liaison between the two worlds, nurses have assumed
different roles and positions in the arena of informatics. The introduction of robust and dynamic
information technology in healthcare paved the way of creating different roles in Nursing Informatics. A
recent survey conducted by Healthcare Information and Management Systems Society (HIMSS)
revealed that 14% of nurses are in nursing informatics role. Nurses comprise the biggest workforce in
healthcare. This being said, nurses are the largest work-group of end-users of electronic medical record
and clinical information systems; therefore, it is imperative that nurses are well-represented in the
selection, design, implementation, and evaluation of clinical information systems. Evidence has shown
that nurses who were involved in the clinical information system cycle have more buy-in, useracceptance, and positive perception which all are precursors to successful implementation.
ROLES OF A NURSING INFORMATICIST
Vendors
Acute care
Hospital Systems
Consultant
Education/Research
Long-term care
Ambulatory
Home care
THE VALUE OF NURSE INFORMATICIST

Every nurse is an informaticist. When information is well managed, patient outcomes are
favorable. The Nursing Informatics Task Force of HIMSS identified the following value of the nursing
informaticist:
Supports nursing work processes using technology

Increases the accuracy and completeness of nursing documentation
Improves nursing workflow by streamlining and eliminating redundancy in documentation
Automates the collection and reuse of nursing data
Facilitates analysis of clinical data and quality measurements
Provides content to standardized nursing language (i.e. Nursing Intervention Classification
(NIC), NANDA -North American Nursing Diagnosis Association (NANDA), and Nursing
Outcome Classification (NOC)).
THE SCIENCE OF NURSING INFORMATICS

The emergence of the specialty known as nursing informatics is not a recent phenomenon. That
nurses have been using computers since the 1950s and emerged as an advanced specialty in the 1980s.
According to Graves and Corcoran devised a conceptual framework describes the relationship among
computer science, information systems science, and nursing science. The framework for nursing
informatics relies on the central concepts of data, information and knowledge:
Data - is defined as discrete entities that are described objectively without interpretation
Information as data that is interpreted, organized or structured
Knowledge as information that has been synthesized so that interrelationships are identified and
formalized.
Resulting in decisions that guide practice.
The management and processing components may be considered the functional components of
informatics.
Example: The collection of individual data element "Raw Data" the transition of raw data to
knowledge is a three-phased process.
"Nursing Data" is the raw data such as client name, age, gender, diagnosis when the nurse form
a relationships between the raw data elements" form fully picture of client's clinical status this is called
"Nursing Information then the nurse acts on this information by formulating a set of
interventions to deal with the particulars of a specific client care situation. Those are in a form that can
be subjects to analysis and interpretation. Nursing information readily lends itself to archiving or storage
in computer databases that allow rational grouping of nursing information then allows for aggregation of
information and the systematic study of nursing related phenomena. Sets of nursing information that
conform to theoretical and conceptual frameworks are known as "Nursing Knowledge.
Hence, computerized information systems used in the community health nursing practice setting
can assist in the development of nursing knowledge through the automated process of collecting.
APPLICATION OF NURSING INFORMATICS
Nursing Informatics can be applied to all areas of nursing practice, which include; clinical
practice, administration, education, and research.
Below are some examples of how nursing informatics, information technology and computers,
are used to support various areas of nursing practice.
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 tonsure 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 derivedfrom large population groupsStatistical Software, SPSS.
BENEFITS OF COMPUTER AUTOMATION IN HEALTH CARE
Many of these benefits have come about with the development of the
Electronic medical records, which is the electronic version of the client data found in the traditional
paper record. EMR benefits include:
Improved access to the medical records. 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 collections 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.
Other 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. An example of this, is the documentation of patient allergies in the computer system.
The health care providers would be alerted to any discrepancies in the patient medication orders.
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.
ELECTRONIC HEALTH RECORD FROM A HISTORICAL PERSPECTIVE
Davis Program is a program that has a goal of improving and developing patient record. This
curriculum has greatly influenced the medical field indeed. Davis Program is named from Dr. Nicholas
E. Davies, an Atlanta based Physician, president elect of the American College of Physicians, and a
member of Institute of Medicine (IOM) committee on improving patient record. [1]
EHR (Electronic Health Record) is an evolving concept defined as a systematic collection of
electronic health information about individual patients or populations. (Gunter T.D., Terry N.P.
(2005). [2]
EHRs may include a range of data, including demographics, medical history, medication and
allergies immunization status, laboratory test results, radiology images, vital signs, personal stats like
age and weight, and billing information. [3] EHR is really significant because it helped make the field
more advanced and highly developed that would help the nurses make their jobs faster and more
accurate. Because of this system, error in documenting the patients record was avoided; there was
transparency in doing gathering and doing their reports, hassle was prevented also, vital signs are being
checked, billing information can be computed and this record is competent of being shared across the
different health care settings thus knowledge will be gathered as on to evaluate the possible outcomes of
the patient. EHR provides confidentiality and security of the information that are being typed and
processed by the nurse or the person who is in charged and to add this up it is a tool that supports
clinical decision making, evaluation of the outcomes and etc.
On the other hand, there are also issues regarding of implementing the EHR. Even though it has
many advantages of helping the medical field, it has also barriers regarding its uses. For example, some
hospitals might not have the resources or does not know how to get started or to use it because they
dont have experience or get an enough training to really manage it well. This issue really concerns me
because as a nursing student I also want to have an idea or knowledge about this. We need to help each
other to provide efficient and competent care to the patients.
Can my community come up with an EHR? For me, yes. I think so if we just have sufficient
resources and budget that would possibly have an EHR. I think that all we need is to help, cooperate or
collaborate to be able to come up with an EHR. If we are all determined and responsible in everything
we do, I know that we can do it. We just also have to stay positive and have faith in God.
The Electronic Health Record (EHR) is a longitudinal electronic record of patient health
information generated by one or more encounters in any care delivery setting. - Health Information
Management Systems Societys (HIMSS)
Automates and streamlines the clinician's workflow.

Has the ability to generate a complete record of a clinical patient encounter, as well as supporting
other care-related activities directly or indirectly via interface including evidence-based decision
support, quality management, and outcomes reporting.
Introduction to Davies
The Nicholas E. Davies EHR Recognition Program

Recognizes healthcare provider organizations that successfully use EHR systems to improve
healthcare delivery
Objectives
Promote the vision of EHR systems through concrete examples.

Understand and share documented value of HER systems.
Provide visibility and recognition for high-impact HER system.
Share successful EHR implementation strategies.
Computer-based Patient Record Institute (CPRI)
Non-profit membership organization founded in 1992

A unique organization representing all stakeholders in healthcare focusing on clinical
applications of Information Technology.
Initiate and coordinate activities to facilitate and promote the routine use of computer-based
patient records (CPRs) throughout healthcare.
CPR project evaluation criteria in 1993

Four major areas of initial Criteria
Management
Functionality
Technology
Impact
o Provided a framework through which to view an implementation of computerized
records.
o Foundation for the Nicholas E. Davies Award of Excellence Program.
Davies Program
Named for Dr. Nicholas E. Davies, an Atlanta-based physician
President elect of American College of Physicians
A member of Institute of Medicine (IOM) committee on improving patient record
Died on a plane crash
This national program is intended to award and bring to national attention excellence in the
implementation of computerized medical records.
Computerized Patient Record
Electronic Medical Record
Electronic Health Record
The union of HIMSS and CPRI-HOST

First 9-year existence
Sources and References:
[1](
Source: http://apps.himss.org/davies/)
("The Emergence of National Electronic Health Record Architectures in the United States and
Australia: Models, Costs, and Questions". J Med Internet Res 7: 1.)
[3](
Habib JL. EHRs, meaningful use, and a model EMR.Drug Benefit Trends. May
2010;22(4):99-101. Thus, I can say that EHR have really changed the outlook or the viewpoint
in the medical field. )
[2]
Incorporating Evidence:
Use of Computer Based Clinical Decision Support System for Health Professionals
Use of Computer Based Clinical Decision Support System for Health Professionals Decision
support system (DSS) automated tools designed to support decision-making activities and improve the
decision-making process and decision outcome Clinical decision support system (CDSS) designed to
support healthcare providers in making decisions about the delivery and management of patient care
Goals of CDSS
Patient safety
Improved outcomes for specific patient populations
Compliance with clinical guidelines, standards of practice, and regulatory requirements.
Nursing decision support systems (NDSS) tools that help nurses improve their effectiveness,
identify appropriate interventions, determine areas in need of policy or protocol development, and
support patient safety initiatives and quality improvement activities.
Purposes of a DSS
Assist in problem solving
Support the judgment of a manager or clinician
Improve the effectiveness of the decision-making process
Types of DSS
Administrative and organizational systems included in the field of healthcare decision support
are systems that support organizational, executive/managerial, financial, and clinical decisions.
Integrated systems able to support outcomes performance management .
Characteristics of DSS
Functional class feedback provided to the clinician, the organization of the data, the extent of
proactive information provided, the intelligent actions of the system and the communication
method.
Logical class includes substitute therapy alerts, drug family checking, structured entry,
consequent actions, parameter checking, redundant utilization checking, relevant information
display, time-based checks, templates and order sets, and profile display and analysis.
Structural elements include triggering, dispatching, process control, action choices, notification
or acknowledgement, action execution and rule editor.
Key CDSS functions Administrative
Support for clinical coding and documentation
Management of clinical complexity and details: keeping patients on research and chemotherapy
protocols, tracking orders, referrals, follow-up and preventive care
Cost control: monitoring medication orders and avoiding duplicate or unnecessary tests
Decision support: supporting clinical diagnostic and treatment plan processes promotion of best
practices.
Use of condition-specific guidelines, and population-based management Classifications of CDSS
Data-based system capitalized on the fundamental input into any intelligent system, data;
provide decision support with a population perspective and use routinely collected longitudinal,
cohort and cross-sectional database
Model-based DSSs are driven by access to and manipulation of a statistical, financial, optimization
and/or simulation model Knowledge-based system rely on expert knowledge that is either embedded
in the system or accessible from another source and uses some type of knowledge acquisition process to
understand and capture the cognitive processes of healthcare providers Graphics-based system take
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advantage of the user interface to support decisions by providing decision cues to the user in the form
of color, graphical representation options, and data visualization Elements for real-time CDSS
-Integrated real-time patient database needed to provide context for results interpretation
- Data-drive mechanism allows event triggers to go into effect and activate alerts and reminders
automatically
- Knowledge engineer who can translate the knowledge representation scheme used in the system Time-driven mechanism to permit automatic execution of programs at a specific time to alert provider
to carry out a specific action or insure that the action had been completed
- Long-term clinical data repository data collected over time from a variety of sources allowing a
longitudinal patient record Knowledge and cognitive processes Declarative knowledge know what
Procedural knowledge know why, know how
Cognitive task analysis (CTA) a set of methods that attempt to capture the skills, knowledge, and
processing ability of experts in dealing with complex tasks Steps of CTA:
1. Identification of the problem to target in the analysis
2. Generation of cases
3. Observation of a record of an expert problem solving
4. Observation of the novice and the intermediate problem solving
5. Analyses of expert vs less than expert problem solving
6. Recommendation of system needs, design specs and knowledge base components Responsibility of
user
The legal responsibility for treatment and advice given to a patient rests with the clinician regardless of
whether a CDSS is used.
A CDSS will be only as effective as the strength and accuracy of underlying evidence base. Increasing
inclusion of patient
- The computer can become a patient health medium with reference databases, library access for
healthcare information, drug and disease management information, self-help programs, and advice about
prevention available. Nursing needs to better understand the relationship between patient autonomy and
well-being. Dual purpose of documentation
- Every nurse must understand the dual purpose of documenting and capturing information in a
automated manner, first that of improving care for the individual patient and second that of improving
care for future populations of patient via aggregated information used for clinical decision-making.
- Current evidence indicates that CDSS can improve patient care quality, reduce medication errors,
minimize variances in care, improve guideline compliance, and promote cost savings
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HARDWARE, SOFTWARE, AND THE ROLES OF SUPPORTPERSONNEL

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; keyboard, mouse, trackball, touch screen, light pen,
microphone, bar code reader, faxmodem card, joystick, and scanner.
Output Devices: used to view and hear processed data; video monitor screens, printers,
speakers, and fax.
Central Processing Unit (CPU) is the "brain" of the computer, three components:
Arithmetic Logic Unit (ALU): number "crunching"
Memory: is the storage area in which program instruction (code) reside during execution.
1
2
3
Read-only memory (ROM) is permanent; it remains when the power is off. A start-up
instruction 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)
Control Unit: manages instructions to other parts of the computer, including input and
output devices "traffic cop"
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 and CD-ROM drives.
COMPUTER CATEGORIES
Super computers, are 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, is 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)
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
many different users could also access a word processing program. Networks, no matter how small or
large, operate with the client/server technology.
A Server stores files and programs that are accessed by the client on the network. When you
access the Internet from home, you the client (your computer), requests files from a Server (another
computer), you see the results displayed on your screen through a browser. You may also access a
network in your clinical practice; you the client, accesses a patient record on the floor from a server,
which stores the patient record.
TYPES OF NETWORKS
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They range from small (home network) to very large (Internet)

Home Networks - within a home
Local Area Networks (LAN) - networks within an area, location or business. The University
connects all its computers on a LAN.
Wide Area Networks (WAN) - several LAN connected together
Internet many WAN connected together around the globe to give us the Internet that we use
today
Intranets - private company networks that are protected from outside access Kaiser HMO and
its clinics and hospitals is an example.
Extranets - several Intranets connected together, Kaiser maintains Extranet a network
connection with its suppliers
SELECTION CRITERIA FOR COMPUTER EQUIPMENT

When selecting a computer system or related hardware, you must take into consideration the
following:
The types of applications required. Some people need word processing, while others may need
database or spread sheet software.
The program execution time and computer capacity needed to process jobs. Complex jobs
require more processor speed and memory.
The amount of information that must be kept and the length of time that it must be retained deter
mine storage Capacity Needs.
Backup Options. When information is critical to conduct daily business, another backup system
may be need if the primary one fails.
OPERATING SYSTEMS
An operating system is the collection of programs that manage all of the computers activities,
including the control of hardware, execution of software, and management of information.
Operating Systems provides a user interface by which the individual interacts with the
computer. Types include; text based commands, graphical user interfaces (GUI), and object-oriented
interfaces (OOI) a graphic interface in which visual metaphors are employed.
ROLES OF SUPPORT PERSONNEL
Support for computer systems and networks are extremely important in order to maintain system
functionality, support includes:
1
2
3
4
Planning system upgrades.

Installation of upgrades for operating systems and various applications.
Troubleshooting.
User education and training.
Super user:
This person has additional experience over the average employee and serves as a local
resource person. In the hospital setting this is user who know the clinical area and the computer
system.
Micro computer Specialist:
Provides PC information and training; has special training and degree in computer science or
a related area.
Analyst:
They are frequently clinicians, who become involved in system selection and training. Many
have learned their role on the job and furthered their education by taking computer or information
science classes.
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Programmer:
Writes code, computer instructions; they often lack the clinical experience. For this reason
the analysts are responsible for communicating user needs to programmers
Network Administrator:
They are responsible for the planning, management and expansion of network.
Director, Information Services:
These individuals should have a board view of the needs of the institution and the design,
implementation, and evaluation of information systems. Responsibilities include planning, policy
development, budgeting, information security, and overall management of the information systems.
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The study of information: Interdisciplinary messages (pp. 121-140). New York:John
Wiley &Sons.
American Nurses Association.Scope and Standards of Nursing Informatics Practice.Washington, DC:
American Nurses Publishing; 2001.Nursing Informatics Job Titles. Retrieved July 1, 2010 from HIMSS
website :http://www.himss.org/content/files/CBO/Meeting9/Nursing_Informatics_Survey.pdf
Mc Lane, S. (2005). Designing an EMR planning process based on staff attitudestoward and opinions
about computers in healthcare. CIN: Computers,Informatics, Nursing, Mar-Apr; 23(2): 85-92 (45
ref)Nursing Informatics Taskforce. The Value of Nursing Informaticist. Retrieved July 1, 2010 from
HIMSS website:http://www.himss.org/handouts/NI101.pdf
Alcantara-Santiago, Mia Angelica R.N. Nursing Informatics 2010: Defining the Future of Nursing.
Retrieved July 2, 2010 fromScribd website:http://www.scribd.com/doc/31972834/Nursing-tics
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MANUAL HEALTHCARE SYSTEM AND COMPUTER INFORMATION SYSTEM

Manual Health Care System
The existing healthcare system of the hospitals, clinics, laboratories and pharmacies should
address the standard delivery of health care
Advantages
Easy to implement
Low cost
No extra training required
Requires minimum effort
Quick processing
Can be stored anywhere
Cannot be easily corrupted (with proper data
storage)
Easy to prepare
Data profiling can be processed easily
Readiness of data
Disadvantages
Problem with maintenance
Volume of date becomes a problem (storage)
Needs lots of paper
Problem with flavescent paper
Problem with interpretation or transcription
Data is not converted easily to information
Readiness of the information (not data)
Accessibility to any healthcare personnel and
accessibility to any healthcare institution.
Ounce the data is burned it cannot be
reproduced easily.
Coordination of data and information is a
problem
Integration with the other system such as
laboratory, accounting, etc is a problem
Data handling is a problem
Computer Information System

A computer system simply duplicates the performance of a manual system with lower
maintenance cost.
Advantages
Data maintenance
Low maintenance cost
Volume of data is not an issue
No paper is required
No problem with interpretation or transcription
Data can be converted easily to information
Readiness of the information and data
Accessibility to any healthcare personnel and
accessibility to any healthcare information
Data cannot be corrupted easily (with proper
backup)
Can be integrated with the other system such
as laboratory, pharmacy, accounting, and
management.
Data handling is easy
Data integrity is preserved
Data communication is possible
Statistical information system can be provided
Disadvantages
Implementation requires severe justification
High starting cost requires training for nursing
and healthcare giver
Requires additional effort to implement
Additional manpower is necessary
Special storage is necessary
Data communication system will have an
additional cot
Data can be easily corrupted (if no backup is
provided)
Readiness of data and information is possible
when software is provided in the healthcare
information system
Requires extensive planning, designing and
commercial implementation
Information management is essential
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Migration to other system is easy

Can be expanded
Easy data profiling
NURSE INFORMATICS SPECIALISTS

Converging Nursing with Computer Science and Information Technology
The increasing complexity of patient care has urged the use of more efficient and secured
information management system particularly for records management/health information systems
management/computer-based patient records. The utilization of computers and computer systems have
reduced the amount of paperwork to almost paperless. Because of this increasing importance of
computers and information technology in the practice of professional nursing, the nursing informatics
specialist (NIS) role has emerged. It is therefore important to understand that this practice involves
knowledge and skills of three fields: Nursing Science, Computer Science, and Information Technology.
The American Nurses Association has enumerated the specific functions of the NIS:
Theory development: contributes to the scientific base of nursing informatics
Analysis of information needs: identification of information that nurses need in order to
accomplish their work; client care, education, administration, and research
Selection of computer systems: guides the user in making informed decisions related to the
purchase of computer systems
Design of computer systems and customizations: collaborates with users and computer
programmers to make decisions about how data will be displayed and accessed
Testing computer systems: check for proper functioning before they are made available for use in
patient care.
Training users of computer systems: train on 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: nurse informaticists are in the ideal position
to evaluate effectiveness of computer systems
Ongoing maintenance and enhancements: ensure that computer systems function properly and
explores possible enhancements to the system that will better serve the users and the patients
Identification of computer technologies that can benefit can benefit nursing: keep abreast in the
changes in the fields of computers and information technology, including new hardware and
software that will benefit the nurse and patient
As more and more healthcare facilities are transforming their systems into computers, there is an
increasing demand in healthcare personnel to fulfill this. NI specialists typically earn $49,090 $95,194
annually which is actually higher than the salary of Staff Nurses in hospitals. This has paved way for
the increasing number of nursing informatics continuing education programs whether online or face-toface because of the evident increasing number of those interested in this field.
The American Nurses Credentialing Center (ANCC), the largest and most prestigious nurse
credentialing organization provides for the credential of Nurse Informaticists RN-BC (Registered
Nurse-Board Certified). To be eligible for certification, the nurse must meet the following:
1. Bachelors degree in nursing or higher degree in nursing
2. Holder of a current license to practice
3. At least 2 years full time practice as registered nurse
4. Completed 30 hours of continuing education in informatics within the last 3 years
5. Meet the required practice hours, any one of the following:
2,000 hours in nursing informatics within the last three years
1,000 hours in nursing informatics in the last three years and completed a minimum of 12
semester hours of academic credit in informatics courses which are a part of graduate level
informatics program
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Completed a graduate program in nursing informatics containing a minimum of 200 hours of

faculty supervised practicum in informatics
The largest organization of nurse informatics specialists is the American Nursing Informatics
Association-Capital Area Roundtable on informatics in Nursing (ANIA-CARING). Its purpose is
focused on the advancement of the field of nursing informatics through communication, education,
research and professional activities. In the Philippines, the recently established Philippine Nursing
Informatics Association (PNIA) is spearheading the recognition of this specialized field of nursing
practice.
NURSING INFORMATICS: THE EMERGING FIELD
"In all types of health care organizations, nursing is the hub of the
information flow. Developing the science and technology of nursing
informatics will enhance the information available to nurses for
clinical practice, management, education, and research and will
facilitate the role of nurses as communicators."
-Patricia F. Brennan (1996),
American Medical Informatics Association.
Nursing informatics is 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 nursing practice, education, research, and administration (Graves & Corcoran,
1989). "Information is an essential phenomenon of study for an information-based discipline such as
nursing," (p. 2). Nursing informatics can be applied to model the human processing of data, information,
and knowledge within a computer system in order to automate the processing of nursing data to
information and the transformation of nursing information to nursing knowledge. "In the current
Information Age, the doubling of knowledge every five years and the increased specialization of
knowledge make it imperative that nurses have access to the latest scientific information to assist in the
delivery of high quality care," (Hudgings, 1992, p.7).
Toffler (1990) described the 1990's as a new era for informatics, the process of gaining power
through the data-information-knowledge triad. This era continues as we enter the new millennium. The
need for nurses to feel comfortable working with computerized data and information is escalating.
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Health and nursing information science is the study of how health care data is acquired,
communicated, stored, and managed, and how it is processed into information and knowledge. This
knowledge is useful to nurses in decision-making at the operational, tactical, and strategic planning
levels of health care.
Charting Health Information
Information systems used in health care include the people, structures, processes, and manual as
well as automated tools that collect, store, interpret, transform, and report practice and management
information.
The realization that health care data and information can be effectively managed and
communicated using computer systems, networks, modems and telecommunications has catalyzed the
emergence of the science of nursing informatics. As Virginia Saba (1992) predicted, "By the turn of the
century, most health care delivery systems will function with computers and will be managed by
computer literate nurses. I believe, that by the turn of the century, "high tech and high touch" will be an
integral part of the health care delivery system," (p. xv).
At present, nursing informatics is an emerging field of study. National nursing organizations
support the need for nurses to become computer literate and versed in the dynamics of nursing
informatics. We are at a transition period. Becoming educated in nursing informatics is, for the most
party, a self-directed and independent endeavor. Programs that offer basic and further education in
nursing informatics are beginning to spring up around the globe, but many more are needed to provide
easy access for motivated nurses.
INFORMATICS THEORY
Theories, Model and Frameworks in Nursing informatics
A. Change Theory
Computerization of information system involves change, moving from paper-based
environment to a completely paperless environment. It can be minor or major change depending on
the maturity of the previous system, most importantly the users of the information system.
The Diffusion of Innovation Theory was first discussed historically in 1903 by the French
sociologist Gabriel Tarde who plotted the original S-shaped diffusion curve, followed by Ryan and
Gross (1943) who introduced the adopter categories that were later used in the current theory
popularized by Everett Rogers. Katz (1957) is also credited for first introducing the notion of
opinion leaders, opinion followers and how the media interacts to influence these two groups. The
Diffusion of Innovation theory is often regarded as a valuable change model for guiding
technological innovation where the innovation itself is modified and presented in ways that meet the
needs across all levels of adopters. It also stresses the importance of communication and peer
networking within the adoption process.
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Kurt Lewin's Change Management Theory, is a time-tested,

easily applied field theory that is often considered the epitome of change
models, suitable for both personal and organizational change. Kurt Lewin,
(1890 1947) a Gestalt social psychologist, has been acknowledged as the
father of social change theories since several contemporary models are at
least loosely based on Lewin's work. He is also lauded as the originator of
social psychology, action research, as well as organizational development.
The Novice to Expert Theory, (a construct theory first

proposed by sibling researchers, Hubert and Stuart Dreyfus (1980) as
the Dreyfus Model of Skill Acquisition, and later applied and modified
to nursing by Patricia Benner in 1984,) provides a very useful and
important theory that clearly applies to nursing informatics. In fact, the
Dreyfus brothers developed the model while working with artificial
intelligence development and expert computer system programming.
The theory can be applied to:
the development of nursing informatics skills, competencies,
knowledge and expertise in nursing informatics specialists;
the development of technological system competencies in
practicing nurses working in an institution;
the education of nursing students, from first year to graduation and;
the transition from graduate nurse to expert nurse.
B. Information Theories
a. Blum's Theory - Blum stated in 1986 that computer functions can be categorized into 3 groups:
- data is processed
- information is processed
- knowledge is processed
b. Data-Information-Knowledge-Wisdom Continuum
c. Cognitive Theory - Cognitive science includes mental models, skills acquisition, perception and
problem solving that adds an understanding of how the brain perceives and interprets a computer
screen.
Metastructures: Data, Information, Knowledge, and Wisdom
In the mid-1980s Blum (1986) introduced the concepts of data, information, and knowledge as a
framework for understanding clinical information systems and their impact on health care. Blum classified
clinical information systems according to the three types of objects that these systems processed: data,
information, and knowledge. Blum noted that the classification was artificial, with no clear boundaries,
although they did represent a scale of increasing complexity.
In 1989, Graves and Corcoran built on these ideas in their seminal study of nursing informatics
using the concepts of data, information, and knowledge. They contributed two general principles to NI: a
definition of nursing informatics that has been widely accepted in the field and an information
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management model that identified data, information, and knowledge as key components of NI practice
(Figure 1).
FOOT NOTE 1
A partial listing of sciences that integrate with nursing informatics includes: computer science,
information science, the science of terminologies and taxonomies (including naming and coding
conventions), library science, heuristics, archival science, cognitive science, and mathematics.
Management
Processing
Data
Information
Knowledge
Figure 1. Conceptual Framework for the Study of Nursing Knowledge

Source: Graves and Corcoran (1989) Reprinted with permission of the publisher.
Drawing from Blums 1986 work, Graves and Corcoran defined the three concepts as follows:
Data are discrete entities that are described objectively without interpretation.
Information is data that are interpreted, organized, or structured.
Knowledge is information that is synthesized so that relationships are identified and formalized.
Data, information, and knowledge are of value to nurses in all areas of practice. Data may be
obtained from multiple sources, such as individuals, families, communities, and populations. Data are
then processed into information and then into knowledge. For example, data derived from direct care of
an individual can then be compiled across disease states and then aggregated for decision-making by
nurses, nurse administrators, or other health professionals. Further aggregation can encompass
geographical populations. Nurse-educators can create case studies using these data, and nurseresearchers can access aggregated data for systematic study.
The appropriate use of knowledge involves the integration of empirical, ethical, personal, and
aesthetic knowledge into actions. The individual must apply a high level of empirical knowledge in
understanding the current situation, apply a professional value system in considering possible actions, be
able to predict the potential outcome of these actions with a high level of accuracy, and then have the
means to carry out the selected action in the given environment.
Wisdom is defined as the appropriate use of knowledge to manage and solve human problems. It is
knowing when and how to apply knowledge to deal with complex problems or specific human needs
(Nelson & Joos, 1989; Nelson, 2002, Nelson & Staggers, 2014). While knowledge focuses on what is
known, wisdom focuses on the appropriate application of that knowledge. For example, a knowledge base
may include several options for managing an anxious family, while wisdom involves nursing judgment
about which of these options is most appropriate for a specific family, and the use of that option in the care
of the family. Nursing wisdom is a concept that requires specification of the consequences of actions
(which are selected by the nurse) as one of its defining characteristics (Walker & Avant, 1994).
Representation of the complexity of wisdom in nursing databases must include not only the nursing
problem to be addressed, but also the need for the nurse to select among a variety of interventions to
address the problem, and the evaluation of those interventions and outcomes.
Figure 2 builds on the work of Graves and Corcoran by depicting the relationship of data,
information, knowledge, and wisdom. As data are transformed into information and information into
knowledge, each level increases in complexity and requires greater application of human intellect. The
X-axis represents interactions within and between the concepts as one moves from data to wisdom; the
Y-axis represents the increasing complexity of the concepts and interrelationships.
Co
ns
ta
n
Fl
ux
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Wisdom
Understanding, applying, and applying with compassion
Knowledge
Interpreting, integrating, and understanding
Increasing
complexity
Information
Organizing and interpreting
Data
Naming, collecting, and organizing

Increasing Interactions and Inter-relationships
Figure 2. The Relationship of Data, Information, Knowledge, and Wisdom

Reprinted with modification from Englebardt & Nelson, 2002, Figure 1-4, page 13 with permission from Elsevier.
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Figure 3 reflects Nelsons recent evolution of her 2002 model depicting the inter- and intraenvironmental factors influencing the movement across and within the data to wisdom continuum.
Figure 3. Revised Data Information Knowledge Wisdom (DIKW) Model-2013 Version

(Copyright Ramona Nelson, Ramona Nelson Consulting. All rights reserved. Reprinted with permission.)
In a newly published model, Nelson identifies how information, decision support, and expert
systems represent and enable the evolution of data to information to knowledge to wisdom.
Figure 4. Moving from Data to Expert Systems.
Susan Matney (Unpublished Dissertation) describes the development of wisdom through the use
of knowledge in her model Wisdom-in-Action for Clinical Nursing This model denotes that
knowledge encompasses the center core of clinical judgment; values, relativism and tolerance; life span
contextualism; rich procedural knowledge and rich factual knowledge. Antecedents to this knowledge
are the person-related factors, and environmental factors of setting and systems. When a nurse is put to a
stressful situation that has a degree of uncertainty, their specialized knowledge mastery produces insight
and intuition into the decision-making needed for action. This learning, reflection, and discovery of
meaning for the situation become integrated into their inherent knowledge base or Wisdom for future
actions.
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NURSING INFORMATICS CRITICAL CARE APPLICATION

Critical Care Nursing
Is an area of expertise within nursing that focus specifically with human responses to lifethreatening problems.
Critical Care Nurse
Is responsible to ensure that critically ill patients are seriously conditioned individuals.
Ensure that families of the medically ill patients should receive optimal care.
Rely upon a dedicated knowledge, skills and experience and of course automated system of
support and intelligent system to provide care to patient and families and create environments
that are healing, compassionate and caring.
Critical Care Applications

Areas where patients require complex assessment, high-intensity medication, continuous therapy
and interventions, and unrelenting nursing attention and continuous watchfulness.
Critical Care Information System
Provide real-time resource utilization data and management of information and access critical
care areas through the integration of the medical facilities in the critical care or intensive care
unit to an intelligent computer system which is capable of processing all data.
Enables the electronic collection of hospital and patient-specific critical care data of the entire
patient in the critical care areas which can be processed to create a patient profile which generate
real time and historical report on indicators including bed occupancy, delayed discharges,
readmission rates, and outcomes.
Automated collection and management of medical information will become the important task of
the critical care information system.
Medical Information Bus (MIB)
Provides a generalized method of attaching patient monitoring devices to a common interface.

This interface converts the unique manufacturer data communications protocol into a
standardized hardware and software system.
It eliminates the need for custom connector and software presently needed to interface such
device.
Has the ability to filter, store and select information sent for inclusion into the clinical medical
record on the clinical computer system. Infusion pumps, ventilators, pulse, and other patient
equipment are now transmitting clinical information for use in clinical data reporting and
decision making.
Advantages of Critical Care Information System
Intelligently integrates and process physiologic and diagnostic information and store it to secured
clinical repository.
Creates trends analysis with graphical representation of results.
Offline stimulation can be performed to test the condition of the patients.
Provide clinical decision support system
Provide access to vital patient information
Providing feedback and quick evaluation of the patient condition and provides alert.
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NURSING INFORMATICS IN AMBULATORY CARE INFORMATION SYSTEM

Ambulatory Care
Covers a wide range of health care services that are provided for patients who are not admitted
overnight to a hospital.
These services are performed at outpatient clinics, urgent care centers, emergency rooms,
ambulatory or same-day surgery centers, diagnostic and imaging centers, primary care centers,
community health centers, occupational health centers, mental health clinics, and group
practices.
Ambulatory Care Information System
Provides automated processing of data and information such as allergies and medical alerts,
patients accounting system such as charging, billing, discounts and concessions, diagnostics
imaging treatments, and etc.
With this system, the patient waiting time is optimized through effective queue management.
It involves one-time registration required per visit. It also facilitates the management of doctors
schedule.
Advantages of Ambulatory Care Information System
Real-time and easy access to patients medical records by healthcare providers.
Improved workflow, which allows more time for comprehensive patient counseling and review.
Reduced errors with the availability of various automation engines drug interaction engine;
medical alert engine; patient billing engine, etc.
Automated and integrated back-end process such as pharmacy, billing, purchasing, inventory
management, etc.
Improved clinical outcome analysis enhanced research productivity through data mining and
facilitate institutional handling of managed care challenges in a timely manner.
Improvement in hospital inventory management.
Better monitoring and management of costs prescription, consumables, doctors fees, etc.
Issues in Ambulatory Care Information System
Increased accountability
The need for continuous support
Privacy and confidentiality of information
Accessibility and security of data and information
Integration and support to the other system
The Role of Nurse Using Information System in the Ambulatory Care System
The very basic objective of the automated ambulatory care information system is to easily
integrate the data to the other data and easily translate these data into information.
The effective transformation of data can be integrated to the other processes to transform it into
knowledge.
The ambulatory care nurse and other health care provider should be capable enough to
implement the process effectively.
computer based ambulatory care process 300x241 Nursing Informatics in Ambulatory Care
Information System
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COMMUNITY HEALTH INFORMATION SYSTEM

Overview
Collective term for the methodical application of information science and technology to
community and public health process.
Focuses on the health information system of the community, it is centered on the majority part of
the public.
Emphasizes the prevention of the disease, medical intervention and public awareness.
Fulfils a unique role in the community, promoting and protecting the health of the community at
the same time maintaining sustainability and integrity of health data and information.
Goal of Community Health Informatics
Effective and timely assessment that involves monitoring and tracking the health status of
populations including identifying and controlling disease outbreaks and epidemics.
Community Health Nursing
Comprehensive directed towards the majority of individuals, families, and the community at
large.
Community Health Application System
Encourages optimal application of computer system, computer programs and communication
system for the benefit of majority of individuals, families and community.
Primary Focus of Community Health Information System
Preventing, identifying, investigating and eliminating communicable health problems.
Accessibility of data and information, through communication
Educating and empowering individuals to adopt health life style
Facilitate the retrieval of data
Effective transformation of data into information
Effective integration of information to other disciplined to concretized knowledge and creates
better understanding.
Creation of computerized patient records, medical information system
Central repositions of all data such as data warehouse
Simple Graphical User Interface (GUI) for nurses and other healthcare provider, patient ad
consumer
Computer Based Survey System
Health Statistical Surveys
Are used to collect quantitative information about items in a population to establish certain
information from the obtained data.
Focused on opinions or factual information depending on its purpose and many surveys involves
administering questions to individuals.
Advantages of Integration of Community Health Systems
25
Consistent exchange of response

Disease tracking
Data and information sharing
Building strategies
Early detection and monitoring of disease and sickness
Control of spread of disease
National alertness and preparedness
Building strong communication
Maintaining strong relation between nurses and other healthcare provider
Continuous coordination of the healthcare professionals
Synchronization of the decisions
Streamlining of the process
Effective management of data and information
Optimal operation of hospital and clinics
INFORMATICS NURSES SOCIETY OF THE PHILIPPINES (iNURSE SP)
About
Informatics Nurses Society of the Philippines or iNurse SP is a Nursing Informatics Organization
that serves as your portal to get involved with real life practices on information and communications
technology applied in nursing education, research, service and administration.
The group is currently led by Dr. Annabelle Borromeo of SLMC-GC, Mark Donald Renosa of
RITM, John Faustorilla of World Bank and UP Manila, Calixto Trillanes III of The Big Leap and Joel
Job Belen of SLMC-QC.
The American Nurses Association defined nursing informatics as a specialty that integrates
nursing science, computer science and information science to manage and communicate data,
information and knowledge in nursing practice. We can consider NI or nursing informatics as a
multifaceted interdisciplinary field of nursing science. Information integrity and ensuring the safety of
data transmission is an essential part, not only in nursing, but also, in the field of information and
communications technology (ICT). And with the progressive integration of ICT concepts and protocols
in the practice of nursing, whether in the clinical, academe or research, nurses should be prepared to
become globally competitive healthcare professionals.
In the Philippines, the Informatics Nurses Society of the Philippines has been leading in the
development and advancement of nursing informatics through local and international linkages and
collaboration.
Rationale
Pursuant to CHED Memorandum 14 series of 2009, otherwise known as Policies and Standards
for Bachelor of Science in Nursing [BSN] Program, Nursing schools across the country has been
implementing the course Informatics. However, there is a need to standardize the contents of the course
being implemented by nursing schools. Theoretical concepts and practical applications should be aligned
so that it may be applicable to the Philippine setting. In this regard, the concept of nursing informatics
needs to be concretized in the Nursing curriculum so that trained faculty members and instructors in the
Colleges of Nursing appropriately handle both the lecture and laboratory component of the course. More
so, nursing informatics need to be integrated to the realms of nursing education, practice and research.
Thus, PMIS-NI is created to translate these ideas into reality.
Vision
The Informatics Nurses Soc. of the Philippines (iNurse SP), Inc envisions itself to be the lead
organization in promoting a culture of excellence among its members through nursing informatics
applied to nursing education, research and practice dedicated towards paying forward to the society.
Mission
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iNurse SP aims to create a community of nurse informaticists and leaders dedicated to produce
scholarly works and meet nurse informatics competencies across levels of nursing expertise while
advocating nursing informatics in their own fields of education, research and practice to create outputs
designed to engage towards capacity building of communities.
Objectives
To be the premier membership and peer communication organization in nursing informatics in

the Philippines.
To be the lead organization in promoting and advocating for nursing informatics in the fields of
nursing education, research, practice and other advanced nursing specialties and certification.
To advance the field of nursing informatics in the Philippines by fostering innovation and
scientific exchange, educating professionals and the public, and influencing decision and policy
makers regarding the use of information in healthcare in general, and nursing, in particular.
To recommend the appropriate standards used in nursing informatics across the Philippines in the
fields of nursing education, research and practice.
To build health care informatics competencies among nursing leaders in the country to support
their need to integrate computer science, information science and nursing science in their
respective fields of expertise.
To widen the community of practice by which nursing informatics may be applicable.
Membership & Links

If you want to become a member of the Informatics Nurses Society of the Philippines, fill-up the
form that can be found here. Also, learn more about the program by visiting their website at
http://www.http://htmlimg4.scribdassets.com/6m4f9r1wjk2skccv/images/70b8046eaa0f.pnginursesp.org/.
The iNurse SP FB is http://bit.ly/inursespfb
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Advanced Terminology Systems

The primary motivation for standardized terms in nursing is the need for valid, comparable data
that can be used across information system applications to support clinical decision-making and the
evaluation of processes and outcomes of care.
The Vocabulary Problem
The failure to achieve a single, integrated terminology with broad coverage of the healthcare
domain
Reasons for the vocabulary problem in health and nursing informatics:
The development of multiple specialized terminologies has resulted in areas of overlapping content,
areas for which no content exists, and large numbers of codes and terms
Existing terminologies are most often developed to provide sets of terms and definitions of concepts for
human interpretation, which computer interpretation as only a secondary goal
Concept Orientation
A. The Semiotic Triangle
Concept (i.e., thought or reference) unit of knowledge created by a unique combination of
Characteristics a characteristic is an abstraction of a property of an object or of a set of objects
Object (i.e., referent) anything perceivable or conceivable
Term (i.e., symbol) verbal designation of a general concept in a specific subject field a general
concept corresponds to two or more objects which form a group by reason of common properties
B. Evaluation Criteria Related to Concept-Oriented Approaches
Atomic-based concepts must be separable into constituent components
Compositionality ability to combine simple concepts into composed concepts
Concept permanence once a concept is defined it should not be deleted from a terminology
Language independence support for multiple linguistic expressions
Multiple hierarchy accessibility of concepts through all reasonable hierarchical paths with
consistency of views
Nonambuiguity explicit definition for each term
Nonredundancy one preferred way of representing a concept or idea
Synonymy support for synonyms and consistent mapping of synonyms within and among
terminologies
* A single concept may be associated with multiple terms (synonymy); however, a term
should represent only one concept.
Terminology Model
28
A terminology model is a concept-based representation of a collection of domain-specific terms

that is optimized for the management of terminological definitions. It encompasses both
schemata and type definitions
Schemata incorporate domain-specific knowledge about the typical constellations of entities,
attributes, and events in the real world and, as such, reflect plausible combinations of concepts
Type definitions are obligatory conditions that state only the essential properties of a concept
Representation Language
Terminology models may be formulated and elucidated in an ontology language
Ontology languages represent classes (also referred to as concepts, categories, or types) and their
properties (also referred to as relations, slots, roles, or attributes)
Ontology languages are able to support, through explicit semantics, the formal definition of
concepts in terms of their relationships with other concepts
They also facilitate reasoning about those concepts
Computer-Based Tools
A representation language may be implemented using description logic within a software system
or by a suite of software tools.
Includes:
Management and internal organization of the model
Reasoning on the model (e.g. automatic classification of composed concepts based on their
formal definition
Facilitate transformation of concept representations into canonical form or support a set of
sanctions that test whether a proposed composed concept is sensible
Generations:
a. First-generation consist of a list of enumerated terms, possibly arranged as a single hierarchy;
serve a single purpose or a group of closely related purposes and allow minimal computer
processing
b. Second-generation include an abstract terminology model or terminology model schema that
describes the organization of the main categories used in a particular terminology or set of
terminologies
c. Third-generation support sufficient formalisms to enable computer-based processing; also
referred to as formal concept representation systems
Advantages of Advanced Terminology Systems
Allow much greater granularity through controlled composition while avoiding a combinatorial
explosion of precoordinated terms
Facilitate two important facets of knowledge representation for computer-based systems that
support clinical care: (a) describing concepts, and (b) manipulating and reasoning about those
concepts using computer-based tools
Advanced Terminological Approaches to Nursing
A. ISO 18104:2003
Motivated in part by a desire to harmonize the plethora of nursing terminologies around the
world and to integrate with other evolving terminology and information and model standards
Potential uses include to:
Facilitate the representation of nursing diagnosis and nursing action concepts and their
relationships in a manner suitable for computer processing
Provide a framework for the generation of compositional expressions from atomic concepts
within a reference terminology
Facilitate the mapping among nursing diagnosis and nursing action concepts from various
terminologies
Enable the systematic evaluation of terminologies and associated terminology models for
purposes of harmonization
Provide a language to describe the structure of nursing diagnosis and nursing action concepts in
order to enable appropriate integration with information models
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B. GALEN Program
Can be used in a range of ways, from directly supporting clinical applications to supporting the
authoring, maintenance and quality assurance of other kinds of terminologies
GRAIL (GALEN Representation and Integration Language) an ontology language for
representing concepts and their interrelationships the source material for the construction of
terminology models
Two integrated sets of tools are used in the development of a GRAIL model:
1. A computer-based modeling environment facilitates the collaborative formulation of
models; it allows authoring of clinical knowledge at different levels of abstraction
2. A terminology server a software system that implements GRAIL; performs a range of
functions:
- Internally managing and representing the model
- Testing the validity of combination of concepts
- Constructing valid composed concepts
- Transforming composed concepts into canonical form
- Automatically classifying composed concepts into the hierarchy
- Also used to deliver the model for use by clinical applications and other kinds of
authoring environments
Motivation for applying GALEN to nursing
The desire to meet the requirements of users of clinical applications
The need to provide a reusable and extensible model of nursing terminology
GALEN does not seek to replace existing nursing terminologies; rather, it seeks to contribute
to the development of those terminologies, to supplement them, to allow comparison among them,
and to make them available for describing day-to-day nursing care.
SNOMED RT
SNOMED Reference Terminology (TR) is a reference terminology optimized for clinical data
retrieval and analysis
1. Concepts and relationships in SNOMED are represented using modified KRSS (Knowledge
Representation Specification Syntax) rather than GRAIL
2. Concept definition and manipulation are supported through a set of tools with functionality such
as Acronym resolution, word completion, term completion, spelling correction, display of the
authoritative form of the term entered by the user, and decomposition of unrecognized input
o Acronym resolution, word completion, term completion, spelling correction, display of the
authoritative form of the term entered by the user, and decomposition of unrecognized input
o Automated classification
o Conflict management, detection, and resolution
3. SNOMED RT has been used as a foundation for a new terminology system SNOMED Clinical
Terms (CT) possess both reference terminology properties and user interface terms
Tenets of Nursing Informatics
The following tenets of nursing informatics provide a framework that characterizes the thinking and
actions of informatics nurses in all aspects of practice and in every setting:
Nursing informatics has a unique body of knowledge, preparation, and experience that are
aligned with the nursing profession. NI requires advanced preparation within nursing and
incorporates informatics concepts in specific application to the role of nursing in the healthcare
continuum.
NI involves the synthesis of data and information into knowledge and wisdom as a core
principle. The informatics nurse considers the impact of information and applied computer
science on healthcare delivery and the nursing process.
Nursing informatics supports data analytics, including quality of care measures, to improve
population health outcomes for global health. The INS understands that the real time application
of accurate information by nurses and other clinicians is a mechanism to change healthcare
delivery and affect patient outcomes.
30
Nursing informatics collaborates with multiple healthcare informatics specialties.

Nursing informatics supports the national agenda on interoperability and the efficient and
effective transfer and delivery of information.
Human factors, humancomputer interaction, ergonomics, and usability concepts are interwoven
throughout the practice of NI.
Nursing informatics promotes useful innovative information technologies.
Key ethical concerns of nursing informatics include advocating for privacy and ensuring the
confidentiality and security of healthcare data and information.
Nursing, the Nursing Process, and Language

Nursing is the protection, promotion, and optimization of health and abilities, prevention of
illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and
advocacy in the care of individuals, families, communities, and populations (ANA, 2010). The
established standards of professional nursing practice and accompanying competencies incorporate the
nursing process and its associated complexity. Identification, description, management, evaluation, and
communication of those concepts and actions demand equivalent representation and understanding by
all stakeholders.
Therefore, nursing leaders have identified many different languages and ways of organizing data,
information, and knowledge pertinent to nursing through numerous established research initiatives that
have spanned decades. In the early 1990s ANA began to formally recognize these languages and
vocabularies (listed in Table 1) as valuable representations of nursing practice and to promote the
integration of standardized terminologies into information technology solutions. As a complementary
program, ANAs Nursing Information and Data Set Evaluation Center (NIDSECSM) was responsible for
developing and disseminating standards pertaining to information systems that supported the
documentation of nursing practice and evaluated voluntarily submitted information systems against
these standards. The NIDSECSM was officially retired once integration of standardized terminologies
became more prominent in health information technologies.
Table 1. ANA Recognized Terminologies and Data Element Sets
Data Element Sets

NMDS
Nursing Minimum Data Set
NMMDS
Nursing Management Minimum Data Set
Nursing-Developed Terminologies*
CCC
Clinical Care Classification [former Home
Health Care Classification (HHCC)]
ICNP
International Classification for Nursing
Practice
NANDA
NANDA International
NIC
Nursing Interventions Classification
NOC
Nursing Outcomes Classification
Omaha System
Omaha System
PCDS
Patient Care Data Set* (retired)
Setting Where Developed
Content
All Nursing
Clinical Data
Elements
Nursing
Administrative Data
Elements
All Settings
All Nursing Care +

Diagnoses,
Other Health Professionals Interventions, and
Outcomes
All Nursing
Diagnoses,
Interventions, and
Outcomes
All Nursing
Diagnoses
All Nursing
Interventions
All Nursing
Outcomes
Home Care, Public Health, Diagnoses,

and Community
Interventions, and
Outcomes
Acute Care
Diagnoses,
Interventions, and
PNDS
Perioperative Nursing Data Set
Perioperative
Care Settings
31
Outcomes
Diagnoses,
Interventions and
Outcomes
Multidisciplinary Terminologies
ABC
Nursing and Other Health Interventions
ABC Codes
Professionals
LOINC
Nursing and Other Health Outcomes and
Logical Observation Identifiers, Names,
Professionals
Assessments
and Codes
SNOMED CT
Nursing and Other
Diagnoses,
Systematic Nomenclature of Medicine
Interventions, and
Clinical Terms
Outcomes
Source: ANA, 2013. Accessed on December 13, 2013, at
http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/NursingStandard
s/Recognized-Nursing-Practice-Terminologies.pdf (*Except for the retired PCDS, all nursing-developed
terminologies are still currently in use.)
The International Classification for Nursing Practice (ICNP), developed and maintained by
the International Council of Nurses (ICN), provides a global cross-map of nursing terminologies to unite
nursing practice through comparison, new research generation, and to inform and influence health
policy. ICNP has been harmonized with SNOMED CT and offers more than 18 different translations
(ICN 2013).
The Health Information Technology for Economic and Clinical Health Act of 2009 and its
accompanying funding resources have stimulated more rapid movement towards electronic data capture
and health information exchanges (HIE) (HealthIT.gov. HITECH Act. http://www.healthit.gov/policyresearchers-implementers/hitech-act-0, accessed May 31, 2013). Standardized terminologies have
become a significant vehicle to facilitate interoperability between different concepts, nomenclatures, and
information systems. The Systematized Nomenclature of Medicine, or SNOMED CT (IHTSDO, 2013),
is a comprehensive universal healthcare reference terminology and messaging structure. SNOMED CT
enables multiple nursing terminology systems to be mapped to one another through harmonized
concepts. Released in 2011, the Nursing Problem List Subset of SNOMED CT is the primary coding
terminology for nursing problems used in clinical documentation and based on nursing concepts found
within the National Library of Medicines Unified Medical Language System (UMLS) Metathesaurus.
The UMLS Metathesaurus includes more than 100 source vocabularies and is responsible for managing
the nursing terminologies mapped to SNOMED CT. Other mapping initiatives are underway.
The HITECH Act mandates the provision of incentive payments to eligible hospitals and
healthcare professionals who adopt and meaningfully use certified electronic health records (EHR)
technology. These efforts are coordinated by the Centers for Medicare & Medicaid Services (CMS) and
the Office of the National Coordinator for Health Information Technology (ONC) through the
development and implementation of electronically specified clinical quality measures. ONC established
the HIT Standards Committee whose role is to recommend the clinical vocabularies to be used in the
electronic specification process (Table 2). Clinical vocabularies define the concepts used to measure
clinical processes and patient outcomes. Harmonization between the different vocabularies is necessary
to ensure appropriate implementation of the electronic measures across all EHR systems.
Table 2. ONC HIT Standards Committee Recommended Clinical Vocabulary Standards
Vocabulary
CVX
Codes for Vaccines Administered
CPT*
Current Procedural Terminology
Setting Application
Nursing and Other
CDC-PHIN/VADS
Nursing and Other
Other
Content
Vaccines
(Administered)
Medical, Surgical, and
Diagnostic Services
Rendered for Claims
Patient Characteristic
CDC-Public Health Information

Network/Vocabulary Access and
Distribution System
HCPCS*
Healthcare Common Procedure Coding
System
ICD-9 CM*
International Statistical Classification of
Diseases and Related Health Problems Clinical Modification (9th ed)
ICD-9 PCS*
Diseases and Related Health Problems
-Procedural Coding System (9th ed)
ICD-10 CM*
Diseases and Related Health Problems Clinical Modification (10th ed)
32
(Administrative
Gender, Date of Birth)
Other
Nursing and Other
Medical, Surgical, and

Diagnostic Services
Rendered for Claims
Diagnoses and
Assessments
Nursing and Other
Diagnoses and
Assessments
Nursing and Other
Diagnoses and
Assessments
ICD-10 PCS*
Diseases and Related Health Problems
-Procedural Coding System (10th ed)
ICF
International Classification of
Functioning, Disability, and Health
ISO-639
International Organization for
Standardization Standard 639
LOINC
Logical Observation Identifiers, Names,
and Codes
RxNORM
Nursing and Other
Diagnoses and
Assessments
Nursing and Other
Functional Status
Nursing and Other
Representation of
Languages and
Language Groups
Outcomes and
Assessments
SNOMED CT
Systematic Nomenclature of Medicine
Clinical Terms
UCUM
The Unified Code for Units of Measure
Nursing and Other
Nursing and Other
Nursing and Other
Nursing and Other
Normalized Clinical
Drug Names
Diagnoses,
Interventions, and
Outcomes
Units of Measure for
Results
Source: CMS Measures Management System Blueprint v 10.0 September 2013 (* Code systems is an ONC HIT Standards
Committee Transitional Vocabulary Standard with a specified termination schedule for EHR implementation. More
information on ONC HIT Standards Committee vocabulary recommendations can be found at
http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__health_it_standards_committee/1271.)
The importance of languages and vocabularies cannot be overstated. Informatics nurses must
seek a broader picture of the implications of their work and the uses of languages and vocabularies for
documentation by end users and outcomes analysis. For instance, nurses mapping a home care
vocabulary to an intervention vocabulary must see beyond the technical aspect of the work to understand
how a case manager for a multi-system health organization or a home care agency may be basing
knowledge of nursing acuity and case mix on the differing vocabularies. By envisioning the varied uses
of the terminologies, the IN and INS promote continuity in the patient care process by harmonizing
concepts across disparate EHR systems.
Concepts and Tools from Information Science and Computer Science
Tools and methods from information and computer sciences are fundamental to NI, including:
Information management Information management is an elemental process by which one files,
stores, manipulates, and reports data for various uses.
33
Information communication Information communication enables systems to send data and to

present information in formats that improve understanding.
Information structures Information structures organize data, information, and knowledge for
processing by computers.
Information technology Information technology includes computer hardware, software,
communication, and network technologies, derived primarily from computer science. The use of
information technology distinguishes informatics from more traditional methods of information
management.

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NURSING INFORMATICS AND COMPUTER TECHNOLOGY

Definition of Nursing Informatics

Nursing Informatics Specialist

Specific Role of Nurse Information Specialist

NURSING INFORMATICS AND COMPUTER TECHNOLOGY

HISTORY OF NURSING INFORMATICS IN THE PHILIPPINES

NURSING INFORMATICS AND COMPUTER TECHNOLOGY

NURSING INFORMATICS AND COMPUTER TECHNOLOGY

NURSING INFORMATICS AND NURSING PROCESS

THE VALUE OF NURSE INFORMATICIST

Supports nursing work processes using technology

NURSING INFORMATICS AND COMPUTER TECHNOLOGY

THE SCIENCE OF NURSING INFORMATICS

NURSING INFORMATICS AND COMPUTER TECHNOLOGY

NURSING INFORMATICS AND COMPUTER TECHNOLOGY

ELECTRONIC HEALTH RECORD FROM A HISTORICAL PERSPECTIVE

Automates and streamlines the clinician's workflow.

The Nicholas E. Davies EHR Recognition Program

NURSING INFORMATICS AND COMPUTER TECHNOLOGY

Promote the vision of EHR systems through concrete examples.

Computer-based Patient Record Institute (CPRI)

Non-profit membership organization founded in 1992

CPR project evaluation criteria in 1993

The union of HIMSS and CPRI-HOST

Sources and References:

NURSING INFORMATICS AND COMPUTER TECHNOLOGY

NURSING INFORMATICS AND COMPUTER TECHNOLOGY

NURSING INFORMATICS AND COMPUTER TECHNOLOGY

HARDWARE, SOFTWARE, AND THE ROLES OF SUPPORTPERSONNEL

NURSING INFORMATICS AND COMPUTER TECHNOLOGY

They range from small (home network) to very large (Internet)

SELECTION CRITERIA FOR COMPUTER EQUIPMENT

Planning system upgrades.

NURSING INFORMATICS AND COMPUTER TECHNOLOGY

NURSING INFORMATICS AND COMPUTER TECHNOLOGY

MANUAL HEALTHCARE SYSTEM AND COMPUTER INFORMATION SYSTEM

Computer Information System

NURSING INFORMATICS AND COMPUTER TECHNOLOGY

Migration to other system is easy

NURSE INFORMATICS SPECIALISTS

NURSING INFORMATICS AND COMPUTER TECHNOLOGY

Completed a graduate program in nursing informatics containing a minimum of 200 hours of

NURSING INFORMATICS AND COMPUTER TECHNOLOGY

NURSING INFORMATICS AND COMPUTER TECHNOLOGY

Kurt Lewin's Change Management Theory, is a time-tested,

The Novice to Expert Theory, (a construct theory first

NURSING INFORMATICS AND COMPUTER TECHNOLOGY

Figure 1. Conceptual Framework for the Study of Nursing Knowledge

NURSING INFORMATICS AND COMPUTER TECHNOLOGY

Naming, collecting, and organizing

Figure 2. The Relationship of Data, Information, Knowledge, and Wisdom

NURSING INFORMATICS AND COMPUTER TECHNOLOGY

Figure 3. Revised Data Information Knowledge Wisdom (DIKW) Model-2013 Version

Figure 4. Moving from Data to Expert Systems.

NURSING INFORMATICS AND COMPUTER TECHNOLOGY

NURSING INFORMATICS CRITICAL CARE APPLICATION

Critical Care Applications

Medical Information Bus (MIB)

Provides a generalized method of attaching patient monitoring devices to a common interface.

Advantages of Critical Care Information System

NURSING INFORMATICS AND COMPUTER TECHNOLOGY

NURSING INFORMATICS IN AMBULATORY CARE INFORMATION SYSTEM

NURSING INFORMATICS AND COMPUTER TECHNOLOGY

COMMUNITY HEALTH INFORMATION SYSTEM