Course Description: This course deals with use of information technology system and data standards based on nursing

informatics principles/theories. It further deals with the utilization of clinical information systems in the management and decision making of patient care. A laboratory session shall be provided for practice application. Course Credit: 2 units lecture, 1 unit laboratory Contact Hours / Semester: 36 hours lecture, 54 hours laboratory Placement: 2nd year, Summer

Course Objectives: At the end of the course and given relevant actual or simulated situation or conditions, the student will be able to:
Apply concept, theories, and principles of informatics in nursing and health care. Discuss issues and trends in informatics relevant to nursing and health.

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Computers and Nursing Historical Perspective of Nursing and Computer Electronic Health Record from a Historical Perspective Laboratory: Flowchart of History of Nursing, Informatics, and Nursing Informatics

1.

Basic element or part of nursing informatics such as: 1. Information science 2. Computer science 3. Cognitive science 4. Nursing science

Branch of engineering (application of science) that studies the theoretical foundations of information and computation and their implementation and application in computer systems Study of storage/memory, conversion and transformation,

Study of the application and usage of information and knowledge in organizations and the interfacings or interaction between people, organizations and information systems. It is an extensive, interdisciplinary science that integrates features from cognitive science, communication science, computer science, library science and social sciences.

An interdisciplinary field that studies the mind, intelligence and behavior from an information processing perspective.

The ethical application of knowledge acquired through education, research and practice to provide services and interventions to patients in order to maintain, enhance or restore their health; to advocate for health, and to acquire, process, generate and disseminate nursing knowledge to advance the nursing profession.

A specialty that integrates nursing science, computer science, cognitive science, and information science to manage and communicate data, information, knowledge and wisdom in nursing practice. Facilitates the integration of data, information, and knowledge to support patients, nurses, and other providers in their decision-making in all roles and settings.

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Six time periods: before 1960s, 1970s, 1980s, 1990s and post 2000 Four major nursing areas: nursing practice, administration, education and research Standards initiatives: nursing practice, nursing data and health care data standards Significant event landmark: milestone chart

Few experts use computers Nursing profession was undergoing major changes Nursing practices and services was expanding in scope and complexity Computers were initially used for office functions Punch cards and card readers Teletypewriters and paper tapes

Why computers What should be computerized? Introduction of cathode ray tube (CRT) terminals, online data communications Hospital information systems (HIS) billing and accounting dept

Nurses began to recognize the value of computers Aside from HIS, computer-based management information system (MIS) was developed by diff health agencies Third party payers- Medicare patient services on billing and financial info

NI became an accepted specialty and many nursing experts entered the field Computer-based patient record systems (CPRS) Kardex, reporting of results, VS, Discharge planning system was developed for Community health care facilities in the continuum care

IT and informatics were promoted in health care esp. nursing field 1992 NI was approved by ANA as a new nursing specialty Database for nursing vocabularies, taxonomies, classification schemes were developed Laptops, notebooks Workstation and LAN were developed for hospital nursing units

Internet brought new cyberspace forming building blocks for sophisticated IT 1995 e-mail, file transfer protocol (FTP),www protocols High performance computing and communication (HPCC)

Individualized electronic patient record (EPR) and EHR Wireless tablet computers, personal digital assistants, cellphones, voice over internet protocols were developed to enhance healthcare facilities telenursing

Health Insurance Portability and Accountability Act of 1996 (HIPAA) was enacted to streamline health care transactions 2004 protect the security, ensure privacy and confidentiality was implemented

The origin of the Year 2000 problem began with these cards (Randall, 1997). They were limited in the data they could store by the number of columns. To save space they decided to omit the century. Punch card technology was not widespread in 1900 so this omission caused few problems. Because this system worked well and storage was still expensive (even through the early 1990's), serious efforts were not made to rectify this until about 1995. The difficulty occurred because computers were not be able to distinguish between the year 2001 and 1901. This may not seem like a problem until one realizes that computers do "date arithmetic," that is they can subtract or add a given number of days from dates, or determine the number of days between dates.

Its Origin

Sackett and Erdley (2002), a Russian Scientist in 1966 coined the term informatika" and defined it as "The discipline of science which investigates the structures and properties (not specific content) of scientific information..." (Collen as cited in Sackett & Erdley).

A Frenchman, in the 1970's, Francois Gremy is credited with coining the term informatique medical, translated to medical informatics It was defined as the informational technologies which are concerned with patient care and the medical decision making process. Another definition stated that medical informatics is the complex data processing by the computer to create new information.

The term "nursing informatics," was probably first used and defined by Scholes and Barber in 1980 in their address to the MEDINFO conference that year in Tokyo. Health-care Informatics, however, is truly interdisciplinary. In its truest form it focuses on the care of the patient, not a specific discipline. Thus, although there are specific bodies of knowledge for each health care profession, nursing, dentistry, dietetics, pharmacy, medicine, etc., they interface at the patient.

"The use of information technology in relation to any of the functions which are within the purview of nursing and which are carried out by nurses. Hence, any use of information technology by nurses in relation to the care of patients, or the educational preparation of individuals to practice in the discipline is considered nursing informatics." (P. 181)

"...a specialty that integrates nursing science, computer science, and information science in identifying, collecting, processing, and managing data and information to support nursing practice, administration, education, and research; and to expand nursing knowledge. The purpose of nursing informatics is to: analyze information requirements; design, implement and evaluate information systems and data structures that support nursing; and identify and apply computer technologies for nursing."

Nursing informatics: recognized by the ANA as a specialty in 1992 Scope and Standards of Nursing Informatics Practice offers guidelines for the specialist Certification examination offered by ANCC Formal education programs prepare the RN for entry into nursing informatics specialty Formal representing organizations include the American Medical Informatics Association (AMIA) and International Medical Informatics Association (IMIA) Defined research priorities seek a standardized language Differentiated practice focuses upon data information and knowledge

Toni Lee Hebda, Patricia Czar, Cynthia M. Mascara

Handbook of Informatics for Nurses & Health Care Professionals, 3e

Copyright 2005 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

"It is concerned with the legitimate access to and use of data, information, and knowledge to standardize documentation, improve communication, and support decision-making process." (p. 222) "The use of technology and/or a computer system to collect, store, process, display, retrieve, and communicate timely data and information in and across health care facilities that:
Administer nursing services and resources. Manage the delivery of patient and nursing care. Link research resources and findings to nursing practice. Apply educational resources to nursing education." (p. 226)

A specialty that integrates nursing science, computer science, cognitive science, and information science to manage and communicate data, information, knowledge and wisdom in nursing practice; Nursing informatics facilitates the integration of data, information, and knowledge to support patients, nurses, and other providers in their decision-making in all roles and settings.

The American Nurses Association (2003) 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. Thus the focus of nursing is on the human responses to actual or potential health problems, and advocacy for various clients.

Nurses must possess the technical skills to manage equipment and perform procedures, interpersonal skills to interact appropriately with people, and cognitive skills to observe, recognize and collect data, analyze and interpret data and reach a reasonable conclusion that forms the basis of a decision. Nursing is an information intensive profession. The steps of utilizing information, applying knowledge to a problem, and acting with wisdom form the basis of nursing practice science. We acquire data and information in bits and pieces and then transform the information into knowledge.

The awareness and understanding of a set of information and ways that information can be made useful to support a specific task or arrive at a decision; abounds with others thoughts and information; information that is synthesized so that relationships are identified and formalized;

Nurses are knowledge workers, working with information and generating information and knowledge as a product. We are knowledge acquirers, providing convenient and efficient means of capturing and storing knowledge. We are knowledge users, individuals or groups who benefit from valuable, viable knowledge.

The future of nursing science and nursing informatics is intimately associated with the nursing education and nursing research arenas. Skiba (2007) suggests that we need techno-saavy and well-informed faculty who can demonstrate the appropriate use of technologies to enhance the delivery of nursing care. Goosen (2002) believes that the focus on nursing informatics research should be on the structuring and processing of patient information and how these inform nursing decision making in clinical practice. It is clear that the increasing use of technology to enhance nursing practice, nursing education, and nursing research will open new avenues for acquiring, processing, generating, and disseminating knowledge.

The use of artificial intelligence or decisionmaking systems to support the use of the nursing process The use of a computer-based scheduling package to allocate staff in a hospital or health care organization The use of computers for patient education The use of computer-assisted learning in nursing education Nursing use of a hospital information system Research related to information nurses use in making patient care decisions and how those decisions are made

Administer nursing services and resources Manage delivery of patient and nursing care including documentation and planning Link research resources & findings to nursing practice. Apply educational resources to nursing education. administer nursing services and resources Manage delivery of patient and nursing care including documentation and planning Link research resources & findings to nursing practice. Apply educational resources to nursing education."

"Nursing informatics is the multi-disciplinary scientific endeavor of analyzing, formalizing and modeling how nurses collect and manage data, process data into information and knowledge, makes knowledge-based decisions and inferences for patient care, and uses this empirical and experiential knowledge in order to broaden the scope and enhance the quality of their professional practice.

Is a longitudinal electronic record of patient health information generated by one or more encounters in any care delivery setting.
patient demographics progress notes Problems Medications vital signs past medical history Immunizations laboratory data radiology reports

The EHR automates and streamlines the clinician's workflow. The EHR 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 interfaceincluding evidence-based decision support, quality management, and outcomes reporting. The Health Information Management Systems Societys (HIMSS)

The first known medical record was developed by Hippocrates, in the fifth century B.C.
He prescribed two goals: A medical record should accurately reflect the course of disease. A medical record should indicate the probable cause of disease.

Electronic health record (EHR): secure, real-time, point of care, patient-centric information resource for clinicians (HIMMS) Provides access to the patient health record information at the time and place the clinicians need it Evidenced based decision support

Computer-based patient record (CPR): lifetime patient record that includes all information from all specialties Problem list Health status and functional levels Clinical reasoning for diagnoses and conclusions Lifetime patient record Supports confidentiality
Toni Lee Hebda, Patricia Czar, Cynthia M. Mascara

Handbook of Informatics for Nurses & Health Care Professionals, 3e

Copyright 2005 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

More CPR Continuous access Views of client data Links to local and remote information resources Facilitates clinical problem solving Data entry Measures cost and quality of care Flexible and expandable

Toni Lee Hebda, Patricia Czar, Cynthia M. Mascara

Handbook of Informatics for Nurses & Health Care Professionals, 3e

Copyright 2005 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

Figure 12-1: A Sample of EHR components

Toni Lee Hebda, Patricia Czar, Cynthia M. Mascara

Handbook of Informatics for Nurses & Health Care Professionals, 3e

Copyright 2005 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

Figure 12-1: A Sample of EHR components

Toni Lee Hebda, Patricia Czar, Cynthia M. Mascara

Handbook of Informatics for Nurses & Health Care Professionals, 3e

Copyright 2005 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

Benefits of EHR Improved data integrity Increased productivity Improved quality of care Increased caregiver satisfaction

Toni Lee Hebda, Patricia Czar, Cynthia M. Mascara

Handbook of Informatics for Nurses & Health Care Professionals, 3e

Copyright 2005 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

Concerns to be resolved before implementing EHR Electronic infrastructure must be agreed upon by all stakeholders Cost Vocabulary standardization Security and confidentiality Caregiver resistance Data integrity
Toni Lee Hebda, Patricia Czar, Cynthia M. Mascara

Handbook of Informatics for Nurses & Health Care Professionals, 3e

Copyright 2005 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

Nursing informatics is a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information,knowledge, and wisdom in nursing practice. Nursing informatics facilitates the integration of data, information, knowledge, and wisdom to support patients, nurses, and other providers in their decisionmaking in all roles and settings. This support is accomplished through the use of information structures, information processes, and information technology.
American Nurses Association (2008). Nursing informatics: Scope and standards of practice, Silver Springs, MD, American Nurses Association. p.65.

Computers are a tool and only a tool Information technology in healthcare is the means to transformation, not the end goal

END