APPLICATION OF HEALTH INFORMATICS

I. Application of Health Informatics in Clinical Practice

A. Electronic Health Record

- The increase in the adoption of electronic health records (EHRs) was due in large part to
the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act,
which paid incentives for meaningful use of EHRs.
- The intent of Meaningful Use is to improve quality, safety, efficiency, and reduce health
disparities (HealthIT.gov, 2015, February 6).

Stage I of Meaningful Use

- Began in 2011 and required the capture of health data electronically that could be shared
and tracked with regards to key clinical conditions.

Stage II of Meaningful Use

- Followed in 2014, this stage included the goal of electronic transmission of patient care
summaries across multiple settings. Health portals technology and self- service kiosks
emerged to meet the mandate for engaging patients and their families in their own health
care.

Health Portals Technology

 Appointment Scheduling: Portals streamline the appointment scheduling process, allowing
patients to book appointments online based on their availability and preferences.
 Medication Refills: Patients can request medication refills through the portal, reducing the need
for phone calls or visits to the doctor's office and ensuring timely access to necessary
medications.
 Billing Services: Portals facilitate online bill payment, simplifying the billing process for patients
and healthcare providers alike.
 Lab Test Results: Patients can securely review their lab test results online, promoting
transparency and enabling proactive management of their health.
 Secure Messaging: Some portals feature secure messaging functionality, enabling patients to
communicate with their healthcare providers outside of regular office hours for non-urgent
health-related inquiries.

Stage III of Meaningful Use

- It was implemented in 2016 with the objective of having providers show how the use of this
EHR is meaningful through improved outcomes, quality, safety, and efficiency.

An EHR is a digital version of a patient’s medical history. Instead of being stored in a paper folder in a
filing cabinet, EHRs are kept in a digital file. However, it contains the same kinds of information as
paper records, including:
 Medical history, including demographic information and immunization records
 Clinical data, such as vital signs and lab results
 Prescriptions and medication dates
 Images, such as X-rays, MRIs, ultrasounds, and CT scans
 Plans of care, progress notes, and outcomes

Under the EHR model, one’s health information is available from any location where there
is Internet access and a health information exchange (HIE) exists. The three key forms of HIE are:
 Directed Exchange: ability to send and receive secure information electronically between care
providers to support coordinated care.
o Query-Based Exchange: ability for providers to find and/or request information on a
patient from other providers, often used for unplanned care.
 Consumer Mediated Exchange: ability for patients to aggregate and control the use of their
health information among providers.

Disadvantages of EHR:
 The ramifications of a disaster
  The potential for hacking
 Viruses

Benefits of Electronic Record:

 Continuity of Care: Provides ways to make healthcare safer with the use of real-time
documentation and instant communication with all providers who need access to the
information wherever they are—in another department or in a remote office.
 Private and Secure Information: The electronic record includes an audit trail that details
information about when the record was accessed, the original point of access, what particular
components were accessed, the date, and times.
 Searchable and Analyzable Information: The ability to search and extract information and to
trend the information to create knowledge to inform practice is another benefit of the electronic
record.
 Real-Time Information: The electronic record provides the opportunity for real-time information
that can be collected and communicated in an effective and efficient manner.
 Improved Quality: Improved patient care outcomes.

B. Telemedicine
1. Telehealth
- Provides a range of services, such as remote consultation via call centers, teleconsulting
between specialists and healthcare providers such as general practitioners or nurse
practitioners, electronic referrals to specialists and hospitals, and telenursing for home
care.

2. Telehealth Basics
- Generally, technology can be used in two ways to deliver telehealth: store and forward
(S&F) and two-way communication. The line between these two modes is becoming less
and less distinct because many services use both types of communication.

 Store and Forward Technology: In S&F technology, a digital camera, scanner, or

technology (e.g., x- ray machine) that generates electronic images captures a still image
electronically and then that image is sent to a specialist for interpretation later (American
Telemedicine Association, 2018).
 Specialties like radiology, dermatology, pathology, and wound care are well-
suited for S&F techniques.
 S&F enables asynchronous transmission of clinical data between locations.
 Typically utilized for communication between healthcare providers.
 S&F provides an affordable means of medical practice in remote communities
like Alaska.
 Commonly used example: a radiologist interpreting an x-ray taken at a
different site
 Synchronous Telehealth: Synchronous telehealth involves the patient and the provider
interacting at the same time by using interactive video/television. Synchronous telehealth
requires the use of telecommunications devices that permit two-way communication. Any
two-way communication technology offering both audio and video has, or will find, a use
in telehealth.

3. Telenursing
- Telenursing lowers healthcare costs overall while giving nurses the opportunity to take on
more independent and collaborative roles. Telenurses now operate in a variety of
environments.
- According to a renowned worldwide study conducted in 2004 and 2005, 37% of telenurses
said they worked in hospital and university settings (Grady & Schlachta- Fairchild, 2007).
Replication of the study has not yet occurred.
- Telenursing involves nurses utilizing telehealth technologies, often learned on the job.
- Despite many nurses lacking prior telehealth experience, a majority believe it should be
included in basic nursing education.
- While telehealth is not yet a standard part of entry-level nursing education in the US, some
faculty introduce it in community nursing courses.

4. Other Telehealth Examples

 Telehomecare
 - Telehomecare refers to the monitoring and delivery of healthcare in the patient’s home
rather than the provider’s work setting (Emtekær Hæsum et al., 2016). It aligns with the
"medical home" model, providing comprehensive, coordinated, accessible, and patient-
centered care while prioritizing quality and safety. Ongoing monitoring helps identify issues
before they escalate, contributing to cost-effectiveness by reducing unnecessary
emergency room and hospital visits.
 Telehealth for Chronic Disease Care
- For patients with chronic diseases, such as cardiac, pulmonary, diabetes, and chronic
renal failure, telehealth can be a powerful self-management tool. Home health monitoring
services provide patients with devices that can collect and transmit vital signs: cardiac
rhythm, blood glucose, and weight.
 Portable Monitoring Devices
- Portable monitoring devices, offered by various vendors, typically consist of an input
device and peripheral monitoring equipment. Input devices often feature touch screens for
patient assessment questions, with responses ranging from true/false to numerical scales.
Some devices include branching questions and provide patient education based on
responses. While most devices connect to a central monitoring station via telephone lines,
others use high- speed or wireless connections.
 Consumer and Healthcare Provider Telehealth Devices
- Healthcare consumer self-monitoring is growing in popularity with the release of low-cost
or free health and wellness apps available without a prescription. There are thousands of
health and wellness apps for smartphone and tablets available from the Apple and Google
Play stores.
 Automatic Pill Dispenser/Reminders
- Automatic pill dispensers/reminders are another type of telehomecare device. The pill
dispensers include auditory reminders to prompt patients to take their medications, even if
the medication is not a pill. Some of the automatics pill dispensers provide patient
reminders to take the medication with food or to take an insulin injection.
 Smart Wearables
- Emerging wearable biometric garment technology allows for a proactive approach that
allows for early identification of symptoms before problems develop. Early identification of
symptoms has the potential for maintaining the patient’s quality of life, reducing acute
exacerbations of disease processes, and avoiding unnecessary medical costs.
 Telemental Health
- Healthcare providers use telehealth to deliver care for various mental health problems. Its
use is more prevalent in rural areas, prisons, and other areas where access to a mental
health professional is difficult or impossible.
 Clinic Visits
- Use of telehealth benefits rural areas where residents traditionally have few options for
healthcare and few, if any, specialists.
 E-Intensive Care Units
- According to the Leapfrog Group, the mortality rate of ICU patients is 10% to 20%;
however, the use of intensivists to manage or comanage patients can reduce hospital
mortality by 30% and ICU mortality by 40%. Telepresence in critical care is currently being
delivered with the use of videoconferencing tools, such as eICU and robotics.
 Tele-Intensive Care Units
- This allows off-site intensivists and critical care nurses to remotely assist the bedside team
during patient rounds.
 Robotics
- Robotics, such as the RP-7i robot, are being used in healthcare settings to provide
telepresence of medical experts. These robots, equipped with cameras and two-way
audio, allow remote physicians to control the robot and interact with patients and
healthcare providers in real-time. They are being used in various areas, including stroke
care and neonatal care, to provide expert assistance and prevent the need for patient
transfer.
 Teletrauma Care
- Telehealth services, specifically teletrauma, have been beneficial for rural hospitals and
clinics to enhance trauma care. These services allow medical experts to provide second
opinions and advice remotely, saving patients from traveling long distances for specialized
care. Studies have shown positive outcomes, including reduced hospital stays, decreased
transfer times, and lower healthcare costs for patients receiving teletrauma care.
 Disaster Health Care
 -Telehealth has proven to be crucial in providing healthcare during disasters. Disaster
planning efforts, such as the development of telemedicine systems and the use of
electronic health records, have helped ensure continuity of care and minimize difficulties in
delivering healthcare during crises. Telehealth companies and organizations have also
played a significant role by offering free phone and video services, including medical and
psychological counseling, to help meet the healthcare needs of those affected by
disasters.
 Educational Component of Telehealth Projects
- Telehealth projects often include patient education, which can be delivered during
telehealth visits or through web pages. Telehealth is also valuable for healthcare
professionals' educational needs, offering continuing education and preparing
practitioners, particularly in rural areas where recruitment and travel barriers exist.
Successful education projects, such as the Native People for Cancer Central Telehealth
Network, have shown the cost-effective use of telehealth for providing education and
training, supporting best practices in various healthcare settings.

Issues with Telehealth:

Telehealth offers numerous benefits, including improved patient care, reduced travel time,
increased productivity, access to specialists, and expanded educational opportunities; however, it
also brings challenges related to reimbursement, medicolegal issues, technical issues, and research.
 Reimbursement Issues: The adoption of telehealth is hindered by reimbursement challenges,
with only 45 states offering some form of reimbursement for telehealth services. The lack of
uniformity in reimbursement, except for the Veteran's Administration, highlights the need for
collaboration between states, the federal government, and private payers. However, private
payers such as Anthem Blue Cross Blue Shield are starting to support telehealth services,
making them more accessible to patients.
 Medicolegal Issues: Telehealth raises medicolegal issues such as licensure, liability, and
medical malpractice, especially when providers are located in different states or countries.
State-level decisions on certification and licensure requirements, as well as the lack of specific
regulations for telehealth, further complicate these issues.
 Technical Issues: Patient safety is a top concern when implementing new technology, and thus
far, telehealth projects have maintained high standards without compromising safety. The
American Academy of Ambulatory Care Nursing (AAACN) established standards for telehealth
nursing practice, including staffing, competency, ethics, patient rights, and the use of the
nursing process. The ATA has also adopted core standards for telemedicine operations,
covering administrative, clinical, and technical aspects to ensure safety and quality in
telehealth.

C. E-Health
E- health according to WHO: E-health is a cost-effective and secure use of information and
communications technologies in support of health and health-related fields which includes health-
care services, health surveillance, health literature, and health education, knowledge and research.

According to European Commission: It is the use of modern information and communication

technologies in support of the health and health- related fields including healthcare, health
surveillance and health education, knowledge and research

Applications of E- Health:
 Medical and Healthcare Management: Streamlining administrative processes, appointment
scheduling, and resource allocation, enhancing efficiency and patient care.
 Health Education: Facilitating access to reliable health information, empowering individuals to
make informed decisions about their well-being.
 Strategic Health Planning: Leveraging data analytics and predictive modeling for better
resource allocation and disease management strategies.
 Medical Education and Training: Providing online platforms for continuous medical education,
fostering professional development and knowledge sharing among healthcare practitioners.
 Patient Care and Support: Enabling remote monitoring, personalized care plans, and
teleconsultations, enhancing accessibility and convenience for patients.
 Preventive Health Services: Promoting proactive health management through reminders,
health tracking apps, and targeted interventions to mitigate health risks.
 Electronic Medical Records (EMR): Digitizing patient records for easy retrieval, sharing, and
analysis, improving coordination of care and reducing medical errors.
  Telemedicine Communication: Facilitating remote consultations, diagnosis, and treatment,
particularly beneficial for patients in remote or underserved areas.
 Evidence-Based Medicine: Providing healthcare professionals with access to the latest
research, clinical guidelines, and decision support tools to deliver optimal care based on best
practices.
 Epidemiological Surveillance: Monitoring and tracking disease outbreaks, trends, and public
health indicators in real-time, facilitating early detection and response to health threats.

Key Challenges of E-health:

o Lack of adequate awareness of the value of medical informatics and e-health in the
development of health services.
o The absence of a clear vision among the health institutions designated to provide
health care services.
o Lack of interest in developing the basic strategic plans appropriate to the situation of
the medical institution.
o Inability to bear the costs of developing the infrastructure and the application of the e-
health services.
o Lack of experience and lack of good and qualified human capabilities in the field of
medical information.
o Weak infrastructure, including the rehabilitation of human cadres medical and non-
medical deal with the concept of e-health.

Characteristics of E- Health The 10 E's

1. Efficiency: Decreases costs, avoids duplication, involves patients for better communication.
2. Enhancing quality of care: Allows comparisons between providers, directs patients to best
quality care.
3. Evidence-based: Interventions must be scientifically proven.
4. Empowerment: Expands patient knowledge, access to electronic records.
5. Encouragement: Promotes cooperation between patients and experts.
6. Education: Expands knowledge for patients and providers.
7. Enabling: Facilitates easy exchange of information and communication.
8. Extension: Provides online health services from international providers.
9. Ethics: Raises ethical challenges in patient-physician communication, privacy, consent.
10. Equity: Should be accessible to all, addressing digital and economic disparities.

Advantages of E- health:
 Ease of use: This means that e-health has improved access to healthcare and bridges the gap
between patients and healthcare providers especially those in the underserved areas or
remote locations.
 Enhanced convenience and Efficiency: It allowed patients access their medical records,
schedule appointments and receive personalized reminders through mobile apps or online
platforms.
 Speed: No need to wait for appointments.
 Less demand for physical consultations
 Help keep up to date records of patients
 Overall improvement of patient outcomes
 Cost Effective: Digital health solutions have the potential to reduce healthcare costs in various
ways. By enabling remote consultations, digital health can reduce hospital admissions and
readmissions, lowering healthcare expenses. Additionally, preventive and proactive healthcare
through digital tools can identify health issues at an earlier stage, leading to more cost-
effective treatments.

Disadvantages of E- Health:
o Some data privacy risk: The collection, storage, and transmission of personal health data raise
privacy and security concerns. Healthcare systems need robust safeguards to protect patient
information from unauthorized access, breaches, or misuse. The potential for data breaches
and identity theft can erode trust in digital health technologies.
o Technical challenges and reliability: Digital health relies heavily on technological infrastructure
and connectivity. Technical issues such as network disruptions or software glitches can hinder
the availability and reliability of digital health services.
o Digital illiteracy: Not everyone, especially older individuals that have limited exposure to
technology may not engage much.
 o Potential loss of revenue for healthcare providers
o Inability to access the internet or even digital devices

II. Application of Health Informatics in Administration

A. Clinical and Administrative Health Information System

Healthcare Information Systems (HISs)
- A composite made up of all the information management systems that serve an
organization’s needs.
These includes application that:
 Track patients
 Manage financial data associated with the staff payroll
 billing for services rendered and;
 patient care services including nursing, pharmacy, radiology, and laboratory services.

Quality Measures for Health Information Technology:

 Vendor systems
- Primarily used in healthcare staffing to find, hire, and oversee contingent workers /such as
technicians, nurses, doctors, physical therapists, and other clinical and non-clinical
professionals/. This makes it possible for healthcare companies (use) to maximize their
staffing and flexible workforce strategies.
- A well-designed system has an interface that facilitates data sharing, eliminating the need
for data re-entry.
- An interface allows for the sharing of data between systems.

Two approaches are used when selecting a vendor system:

1. Best-of breed approach: Refers to the selection of systems that best meet the needs of
particular services or departments from different vendors. Requires building an integrated
interface at the institutional level.
2. Integrated interface approach: Refers to the selection of a collection of HISs that are already
interfaced.
Integrated enterprise system - An information system designed to meet the needs of the organization
at large, which may include multiple geographically separated hospitals and clinics.

 Quality Payment Program

- Under this program is the Merit-based Incentive Payment System that provides financial
incentives to eligible suppliers who submit quality data.
- MIPS makes use of payment changes and incentive payments to encourage reliable
reporting in unsatisfactory documentation or monitoring.

 EHR Certification
- Standardizing EHR systems to enable data extraction for useful purposes
- Certification is a quality control measure for interoperability and healthcare data exchange
is certification.
- National Institute (NIST) acknowledges EHR certification programs (NIST, 2018). NIST
created the interoperability testing instruments, test cases, protocols, and test data needed
to satisfy the relevant use.

 HIT Research and Analysis Reports

- In order to help healthcare providers and institutions make purchases, several
organizations focus on conducting research on HIT solutions. The research findings also
help suppliers decide how to change their systems to better suit the needs of the industry.

Example of vendor research companies:

o HIMSS offers benchmarking data derived from details about the provider
o KLAS generates reports using data from suppliers who score the frameworks

 Specialty Healthcare Information Systems

- Access to the patient electronic record
- Ability to send charges to the financial management department
  Admission, Discharge, and Transfer
- One of the first information systems used in healthcare
- Backbone of the clinical and business portion of most hospital systems.
- 0Stand-alone best-of-breed systems with an interface to financial systems.
- Part of integrated enterprise solutions now.
- Provides and tracks patient details such as: demographics and insurance information,
medical record numbers, care providers, and next of kin.

 Financial Systems
- Second backbone of the system because they track financial interactions and provide the
fiscal reporting necessary to manage an institution.
- Mission critical
Functions:
1) Ensure a higher collection rate from payers
2) Expedite payments for accounts receivable
3) Minimize third-party payer denials of care
4) Prevent underpayment for care.

Examples of EHR that makes fraud easier:

o Copy/paste-type frauds
➔ occur when the provider does not verify information for accuracy
o Over Documentation fraud
➔ occurs when there is incorrect or irrelevant documentation that suggests services were
rendered but they were not.

Clinical Information Systems

- CISs are a conglomerate of integrated and interoperable information systems and
technologies that offer data regarding medical treatment.

Ancillary Systems
Integrated set of files, procedures, and equipment for the storage, manipulation, and retrieval of
information.
● Laboratory systems integrate data from all the standard laboratory departments including
hematology, chemistry, microbiology, blood bank, and pathology.
● Radiology systems integrate data from patient diagnostic and therapeutic services, including
the picture archiving and communication system (PACS) which allows for digital versions of all
diagnostic images to be stored in the electronic patient record.
● Pharmacy system provides a means for stocking and recording medications dispensed by the
pharmacy.

Clinical Documentation
- A strong documentation system facilitates real-time information sharing and is an integral
element of the clinical workflow. When done right, data collection enhances rather than
interferes with the clinical process as it ought to offer flexibility for entering and accessing
data required for patient care.
Advantages:
 Entering data with abnormal values stands out because they are displayed in a different color.
 These systems remove the need to find the paper charts
 Make information available to everyone utilizing the electronic chart whenever and wherever
it's needed
 Practitioners can be alerted by the system with a pop-up box to complete or verify essential
information,
 Numerical laboratory data can be displayed in a graph format to visualize trends

Aggregated data: collection of data that are useful in seeing the big picture; can be the foundation for
decision support systems and are useful in determining best practices and evidence-based care

Computerized Provider Order Entry

- Using a computer screen, a clinician can place an order by just choosing the patient and
the service they require.
- Saves time, and it prevents transcription errors
- Make it easier to record financial data for restocking and billing purposes.
Clinical decision support system (CDSS)
- A sophisticated set of criteria (such as allergies, drug dosage, administration routes,
frequency of administration, and drug-to-drug interaction) and displays information to help
knowledge workers make decisions.
In other words, the provider will be notified if a pharmaceutical order is entered and the dosage is
higher than usual for that prescription. Additionally, the system must offer details regarding patient
allergies and any medication incompatibilities.

Medication Administration
Use of HIT goes with CPOE for medication administration with the purpose of making patient care
safer by reducing potential and actual errors.
Electronic medication administration is addressed with the use of the eMAR.

eMAR
- A multidisciplinary record that communicates the complex process of medication use.
- Guides the nurse to use the six rights when administering medications.
- They can use it to display scheduled medications, ones that are pending, past due, and/or
previously administered.
- The eMAR provides a mechanism for efficient nurse time utilization as well as facilitates the
delivery of safe care.

Positive Patient Identifier

- A PPID uses a bracelet with a barcode to verify the patient’s identification.
o Closed-loop: the right patient received the right medication.
o Passive RFID: handheld or built into a laptop or tablet computer.
o Active RFID: battery powered and constantly transmitting signals, the use of a scanning
device is not necessary, because the identifier will be recognized by the computer; more
expensive that passive RFID.

The most promising feature of barcode scanning is to reduce potential dispensing errors by 85%.
However, nurses who find the method challenging come up with other methods but they might not be
aware of the potential drawbacks. Work-arounds can lead to unintended errors and must be
investigated.
The types of work-arounds were as follows:
● Scanning the medication without verifying the medication list, drug name, and dose.
● Physicians not verifying the eMAR current medication list, resulting in additional medication
given to the patient .
● Administering the medication without reviewing the parameters for administration.
● Bypassing the policy for a check by a second provider or the second nurse confirms without
verifying the medication.
● Administering medications without reviewing new medication orders.
● Administering medications without scanning the patient barcode to confirm the patient’s
identification.
● Administering the medication without scanning the medication barcode to confirm the correct
medication, dose, and time

Managing Patient Flow

- The problems associated with patient flow are multifactorial and based on the principle of
supply (staffing, hospital beds, and resources) and demand (patients).
- Clients utilize emergency services during outbreaks or flu season, and emergency beds fill up
quickly due to a shortage of hospital beds for patients who need to be admitted, creating a
patient traffic congestion.

Tracking Systems Solutions

- Tracking systems solutions allow hospitals the ability to improve the flow of a patient through
the system.
- Popular patient-tracking systems include the visual display of beds, which indicates the patient
status locators (discharge, fall risk, [MRSA]), bed availability, instant transport notification, and
equipment (e.g., wheelchairs and intravenous pumps).

Voice Communication Systems

 - Facilitate the exchange of information needed by the various healthcare disciplines.
- Enhance information flow within the organization and workflow patterns by allowing voice
communication, text messaging etc.
Examples:
o e-mail
o Internet
o Intranet systems

POINT-OF-CARE SYSTEMS
Clinical systems should be accessible at both the point of care and quiet places where the nurse is
able to sit down and reflect on patient care events to chart accurately. The ease of use or complexity
of healthcare systems may have an impact on nurses' views regarding their use. As a solution,
facilities have chosen to use lightweight tablet computers with built-in scanning devices for barcode
recognition.
- POS systems enable providers to document ADLs near the point of care to help improve
accuracy and timeliness of documentation.
● POC Testing: blood glucose testing, blood gas and electrolytes analysis, rapid coagulation
testing, urine strips testing, pregnancy testing, hemoglobin diagnostics

III. Application of Health Informatics in Education

The application of information and communication technologies to manage medical records and
improve patient care.
In education, it has revolutionized education in healthcare by leveraging digital technologies to
enhance learning experiences and facilitate knowledge dissemination.

Benefits:
 Enhances learning experiences: Health informatics integrates technology into education,
providing students with interactive and engaging learning experiences. Students can have
access to diverse educational resources and activities that cater to different learning styles.
These immersive experiences foster deeper understanding, critical thinking, and retention of
knowledge, ultimately enhancing the overall learning process.
 Promotes digital literacy and competency: By navigating different digital platforms and utilizing
digital resources effectively, students develop proficiency in using technology to access
information, communicate with colleagues, and deliver patient care, thus enhancing their
readiness for modern healthcare practice.
 Prepares students to thrive in technology-driven healthcare environments: Health informatics
equips students with the knowledge and skills needed to navigate and leverage technology in
healthcare settings. Students will be prepared to adapt to and thrive in technology-driven
healthcare environments. By integrating health informatics into education, students are better
positioned to meet the demands of a rapidly evolving healthcare landscape and contribute to
improving patient outcomes through the effective use of technology.

Health Informatics has enabled flexible, interactive, and accessible educational opportunities
for students across various healthcare disciplines.

Importance of Health Informatics in Education:

 Personalized Learning: Informatics tools can analyze data on student performance and
learning styles to tailor educational materials and activities to individual needs. This
personalized approach enhances student engagement and understanding.
 Remote Learning: Health informatics enables the delivery of education beyond traditional
classroom settings through online platforms and virtual tools. This flexibility allows students to
access learning materials and interact with teachers remotely, promoting continuous learning
opportunities.
 Health Monitoring: Health informatics solutions can track students' health indicators, such as
physical activity levels and nutrition habits. By monitoring these factors, educators can
promote healthy lifestyles and provide targeted interventions to support student well-being.
 Data Analysis: Health informatics tools can process and analyze large volumes of data to
identify trends and patterns in student performance. This data-driven approach helps
educators make informed decisions, implement effective teaching strategies, and measure
the impact of interventions.
 Communication and Collaboration: Health informatics platforms facilitate communication and
 collaboration among students, teachers, parents, and administrators. Through messaging
systems, discussion forums, and shared platforms, stakeholders can engage in meaningful
interactions and work together to support student learning.
 Professional Development: Health informatics education programs provide opportunities for
educators to enhance their skills and knowledge in utilizing technology for teaching and
learning. By participating in professional development activities, teachers can stay abreast of
technological advancements and improve their instructional practices.
 Student Engagement: Health informatics tools, such as educational apps and interactive
simulations, can enhance student engagement by making learning more interactive and
enjoyable. These tools create a stimulating learning environment that motivates students to
actively participate in their education.
 Administrative Efficiency: Health informatics systems streamline administrative tasks in
educational institutions, such as managing student records, scheduling classes, and tracking
academic progress. This efficiency allows educators to focus more on teaching and
supporting student learning.
 Research and Innovation: Health informatics enables educators to conduct research and
implement innovative teaching practices based on data analysis and technology integration.
By leveraging research findings and technological tools, educators can enhance the quality of
education and drive continuous improvement efforts.

A. E-LEARNING
- Defined as “learning that is enabled electronically”.
- The use of computers / technologies to enhance and facilitate learning.
- Conducted on the internet, where students can access their learning materials online at
any place and time.
- Most often takes place in the form of online courses, online degrees, or online programs.

Benefits for the Learner:

 Allows learners to take ownership of their learning.
 Provides mechanisms to allow the learner to interact with knowledge concepts and to practice
and evaluate learning gains.
 Provides a foundation for nurses who want to advance their education and obtain college
degrees when time, work, family, or distance makes it difficult to attend to school in the
traditional setting.
 Used in healthcare facilities to provide continuing education (CE) programs to nurses at times
they are mentally and physically able to learn, rather than after a busy 12-hour work shift.
 Provide a means for nurses to obtain CE hours to acquire and maintain their specialty
certification.
 Used in primary care settings to assist with training the healthcare force.

ADVANTAGES AND DISADVANTAGES OF USING E-LEARNING IN THE HEALTHCARE

SETTING
ADVANTAGES DISADVANTAGES
1. E-learning can happen anywhere. 1. Technological Infrastructure and Digital
With e-learning, healthcare professionals Literacy.
can study in the office, at home, or even on Implementing e-learning in the healthcare
the train. e-Learning is mobile, which means sector requires a robust technological
it can be accessed with a laptop, tablet, or infrastructure capable of handling the
smartphone as long as the user has an demands of online platforms. This includes
internet connection. reliable internet connectivity, compatible
devices, and sufficient bandwidth.
 2. It May Be More Effective Than Traditional 2. Ensuring Privacy and Data Security in
Learning. Online Platforms.
Many people are skeptical about e- learning As healthcare deals with sensitive patient
because it allows people to learn from information, ensuring privacy and data
wherever they want. This makes it seem as security in e-learning platforms is
though it is easy, or there isn’t as much paramount. Compliance with data protection
information being delivered through this regulations, such as HIPAA in the United
medium. In addition, some people believe States, is crucial.
e-learning takes away some of the
discussion benefits that are often gained
inside of a classroom setting.

3. It is Less Expensive Than Traditional 3. Overcoming Resistance to Change and

Training Methods. Traditional Training Methods.
E-learning is much less expensive because Resistance to change can pose a significant
there is no need to pay a trainer. Learning challenge when introducing digital learning
materials are already possessed by users tools in healthcare organizations. Some
with a desktop, laptop, tablet, or healthcare professionals may be
smartphone. There is no need to reserve a accustomed to traditional training methods
training center, and professionals can learn and reluctant to embrace e-learning
whenever they are not caring for patients. solutions.
This means that they end up keeping their
productivity up, while getting the important
education they need to provide quality
care to their patients.

Types of e-Learning:
There are numerous types of e-learning ranging from tutorials, drill and practice to simulations
and virtual and augmented reality. The next section includes a brief overview of some of the e-
learning types.

1. Synchronous E-learning
- Any learning tool that is in real-time, that allows students and teachers to ask and
answer questions immediately.
- Classes occur on set schedules and time frames.
- Students and instructors are online at the same time in synchronous classes since
lectures, discussions, and presentations take place at specific hours.
Synchronous E-learning technology/tools include:
 Video/telephone conferencing, webcasts, virtual classrooms, live chats, webinars,
application sharing, etc.

2. Asynchronous learning
- Students typically complete the lessons on their own and merely use the internet as
a support tool rather than venturing online solely for interactive classes.
- Let students complete their work at a convenient time.
- Learning can be carried out even when the student or teacher is offline.
- It is said that asynchronous learning is by far the more popular learning type because
many of the learning tools are free, require minimal hardware, and are used at the
student’s pace.

3. Hybrid/Blended Delivery
- Traditional courses are more frequently being offered as online, virtual classes, i.e.,
“distance education”: learning that occurs elsewhere than in the traditional classroom.
Web-enhanced instruction allows technically ambivalent institutions to participate in the
technology revolution without huge budgetary expenditure and also addresses a
preference by some faculty for a way to include innovation and technology in classes
without giving up traditional classroom engagement.
4. Drill and Practice
- Assist learner to develop the cognitive structure necessary for the kind of reflective
thinking that produces critical thinking.
- The best use of the drill and practice method is as an aid for memorization. Pure
memorization provides learning which is essential in many areas to provide a foundation
for higher-level learning. This includes:
 Flashcards and questions with answers at http://www.cram.com and http://quizlet.com.
The users could be teachers and students.
 Proprietary software such as StudyMate Author allows faculty to create flash cards for
online use with an LMS, computer, or downloaded to a small-screen mobile device
(Respondus, 2018)
 Online electronic flashcards online from Skyscape at http://www.skyscape.com
and Amazon at http://www.amazon.com
 Printed textbooks
- Users can also create questions with fill-in-the-blanks, multiple choice, matching, and
true and false.
- Students can collaborate and share the learning resources with others.
- It is essential to memorize information such as medical terminology along with rules for
combining the terms to create other words to understand the nursing information in texts
and articles.

TUTORIALS
- Step-by-step programs designed to guide learners to understand information. The
quality of a tutorial is evident with the use of branching techniques.

TYPES OF TUTORIALS
LOW-END Programs that just inform the learner whether the answer is correct.
TUTORIALS
Offer more than one explanation for the same phenomenon and
HIGH-END
provide feedback on incorrect answers.
TUTORIALS
Provide information to students and the skills to find, evaluate,
understand, and apply this information attempt to mimic lectures by
guiding users through a series of objectives or tasks, usually allowing the
ONLINE user to do the work at his or her pace and may use animation, text,
TUTORIALS graphics, sound, questions, and different kinds of interactivity to engage
and intrigue the user.

- Tutorials do not have to “tell” the learners what they need to know. Instead, tutorials can
present learners with a situation and the tools necessary to discover the answer.
- Tutorials provide an opportunity for the learners to review the different modules and test
their learning.

SIMULATIONS
- Simulation in nursing has been used for over 100 years. Simulations imitate actual
experiences in safe settings. Combine high-fidelity equipment with real-time
demonstrations of simulated medical emergencies or patient situations and skill training
ranks as the most popular form of simulation, during which students hone repetitive skills
through interaction with a wide range of equipment.

TYPES OF SIMULATIONS:
1. Online Simulations
- The simulations are designed to enhance the student’s clinical reasoning skills. Nursing
instructors may use virtual simulations to reinforce classroom learning.
- SimPad PLUS (2018) developed topic-based simulated environments, for example,
diabetes, pressure ulcers, and fall prevention. The virtual simulations allow you to
practice anywhere available to access the program, a computer, and Internet access.
Nursing students may find the online simulations helpful to supplement classroom and
textbook learning.
 2. Patient Simulators
- Patient simulators allow the learner to practice a patient encounter by providing care to a
computerized mannequin. Mannequins can be low or high fidelity.

Refers to stimulations that are not true to life.

LOW FIDELITY
Refers to models or mannequins that represent an anatomic structure.
Refers to realistic stimulated patients or situations.
Instructors can program high-fidelity mannequins to have heart and breath
HIGH FIDELITY sounds, breathe, and perform physical acts associated with illness, such as
coughing, bleeding, and seizures.
Example: Juno, Apollo, Istan, Lucina, Athena, HPS, Caesar, PediaSim,
BabySim

Advantages:
 Provides opportunities for the learner to develop higher-order thinking skills.
 Allows the learner to be an actual participant in a patient care situation that would be
too difficult, dangerous, or time-consuming to provide in a real clinical setting.

3. Electronic Health Record Simulation

- To prepare students’ informatics competencies, simulated EHRs are often used in
nursing education programs to allow students to practice electronic documentation
(George, Drahnak, Schroeder & Katrancha, 2016).
- The simulated EHR allows the nursing student to practice entering patient
documentation, accessing the laboratory, and other testing data, similar to the hospital
or clinic work setting.
- Examples of EHR simulations are DocuCarem SIMchart, iCare, and Neehr Perfect.
Simulated E-hEalth Delivery System (SEEDS) incorporated the use of HER along with
independent learning activities, case studies, simulation support for
medication administration, and interprofessional collaboration simulation (Manos, 2014).

4. Animations
- Provide visual representations of difficult concepts, processes, and models
- It supplements written information

5. Robotic Technology
- Use to enhance the learning experience through the use of telepresence robots that can
be “present” when nursing students are at a distance.
- Faculty have used the telepresence robot to serve as the “care provider” for
undergraduate students to contact as a resource during simulations.
- The use of telepresence robots to enable attendance at simulations has been found to
improve student satisfaction, engagement, and learning self-confidence (Rudolph, et al,
2017).

6. Virtual Reality (VR)

- Multiple sensory inputs, either mediated or generated by a computer, through visual
stimulation, audio input, and touch foster unintentional learning through game-like
technology to discover and create knowledge to accomplish something.
- The objective is to create a scene in which the participant is free to concentrate on the
tasks, problems, and ideas that he or she would face in a real situation.
Two main components of Virtual Reality:
o Has a model or visualization that resembles reality and allows manipulation of the
environment. Manipulation can be done by virtual keyboard enabled with Bluetooth
technology that can display on any surface for computer data entry.
o Second component is an interface that resembles the three-dimensional world. During
the VR experience, the “environment” reacts just as it would in the real world.

7. e-Portfolios
- Web-based evidence of knowledge and skills.
- Artifacts that represent evidence of learning experiences both inside and outside of
 the classroom.
- Electronic portfolios (e-portfolios) may also contain a blog element where students
reflect on their total experience and demonstrate growth in their areas of study.
- Can be made using PowerPoint or Web 2.0 and can be uploaded to institutional e-
portfolio systems like:
o Association for Authentic, Experiential and Evidence-Based Learning: www.aaeebl.org
o Digication: www.digication.com
o Facebook: www.facebook.com
o iWebfolio: www.iwebfolio.com
o LiveText: www.livetext.com
o MySpace: www.myspace.com
o PebblePAD: www.pebblepad.com
o TaskStream: www.taskstream.com/pub
o TypePad: www.typepad.com
B. TELECONFERENCING
- Teleconferencing is the use of a telecommunication device to communicate between two
or more people. This may include a conference call over the phone or through using
video chat software. It's a way for professionals to connect virtually without having to
meet in person.

PROS AND CONS OF TELECONFERENCING

PROS CONS
 Scheduling  Prone to technical challenge
 Collaboration  Less effective nonverbal communication
 Security  Space limitation
 Communication  Discourages team dynamics
 Inclusive  Eliminate informal interaction

Types of Teleconferencing:
1. Audio Teleconferencing
- Is voice only; It is also known as conference calling.
- The type of telephone used can vary but typically an audio conference includes
attendees that use handheld wired telephones, conference rooms, speakerphones that
can be shared by several people or individual cellular or mobile telephones.

2. Web Conferencing
- Web conferencing involves various levels of audio-video and graphics communication
from computer to computer.
- It can be as simple as instant messaging or more complex as evidenced by online
courses or online web meetings
- Web Conferencing is an online service by which you can hold live meetings,
conferencing, presentations and training via the internet particularly on TCP/IP
connections.

3. Video Teleconferencing
- Video conferencing originally entailed closed-circuit television systems consisting of a
camera and monitor at each end of the communication platform. Integrates video onto
the teleconference, therefore, transforming it into a new kind of remote meeting.

Use for Nurses:

 It allows Healthcare Service providers especially nurses to reach out people and serve more.
 It saves time and money.
 Video conferencing allows nurses to render personalized services.
 Video conferencing improves the quality of healthcare services.
 Video conferencing provides a secure virtual environment.
 Use to meet with other nursing professionals one-on-one or in a group to collaborate on
projects, event planning, or mastermind sessions.
 Use to meet with private clients one-on-one or in groups to discuss their concerns and
question.
 Sample uses of Teleconferencing (Telehealth):
 Remote patient monitoring (eg. KonsultaMD application)
 Healthcare employee monitoring
 Administrative meeting
 Health Education

BENEFITS OF VIDEO CONFERENCING LIMITATIONS OF VIDEO CONFERENCING

Enable the digital workforce Lack of personal interactions
Management and usability culture Network connectivity issues.
Rally communication and increase
Security meetings
communication reliability
Improve value and reduce redundancy Complying with laws and regulations

C. WEBINAR
- Web + Seminar
- An event held virtually, attended exclusively by an online audience.
- Conducted over the internet, typically in real-time, using video conferencing software or
other online platforms.

Benefits of Webinar:
 Accessibility: Can be accessed via PC, Mac, tablet or smartphone. Participants can both
see and hear the speaker(s) through audio and video feeds.
 Interactivity: Enables 'one-to-many' communication, allowing a single presenter to
engage with an unlimited online audience from a single location. Offer features for
audience engagement, such as live chat, polls, and Q&A sessions.
 Cost-effective: Generally more affordable to host compared to physical events
 Flexibility: Can be accessed remotely, allowing students to participate at their convenience
without the need to travel to a physical location.
 Scalability: Can accommodate large numbers of participants simultaneously, making
them scalable for both small and large audiences.

ADVANTAGES AND DISADVANTAGES OF WEBINAR

ADVANTAGES DISADVANTAGES
1. Save time and money 1. Lack of Human Contact
One of the major advantages of a A major downside to webinars is that they lack
webinar is that participants can attend face-to-face human interaction. While the use
from their office. This means they don’t of audio-visual communication through
have to travel. This greatly reduces the webinar platforms is a great tool, it cannot
expense of logistics and event match physical interaction and the benefits the
organization. They also lose less working latter offers for learners. In fact, this limitation
time and can quickly return to their tasks is also very relevant to the trainer as well. It is
after the webinar. typically more challenging to fully engage
participants in a live webinar setting.

2. An interactive event 2. Technical challenges

A webinar is intended to be an Poor internet connection is the most common
interactive experience. Participants can problem remote webinar presenters
easily leave comments or ask questions experience.
to the speaker via a chat system. The
speaker can also use a survey to ask the
audience questions and receive an
instant response.
3. Content Creation 3. Lack of Attention
 Typically, webinars are recorded and During a remote event, Internet users are
uploaded to YouTube or the host's usually alone in front of their computer screen.
website. This makes the content easily It is therefore easy to be distracted and to
searchable and shareable, increasing the lose attention.
visibility and developing its image as an
expert in a specific field.
4. More flexible and convenient 4. Requires computer and internet access ;
Webinars offer more flexibility, ease of requires basic computer skills
access and convenience. Participants can
avail online courses from a place of their
choice, such as from the comfort of their
home or their office. If the webinar is pre-
recorded, they can watch it on demand, in
their own time and preferred pace. The
only prerequisite is access to an internet
connection and a pc or any smart device
with a camera and mic.

Types of Webinar:
1. On-Demand Webinars
- These are pre-recorded and can be watched at any time, making them convenient for
viewers who cannot attend a live webinar. On-demand webinars are also good for lead
generation, as viewers must provide their contact information to access the content.

STRENGTHS WEAKNESSES
Convenient for viewers: Viewers can watch the Limited audience interaction: Viewers cannot ask
webinar at their own time and pace. questions in real-time.

Good for generating leads: Viewers must Can be less engaging than live webinars:
provide their contact information to access the Viewers may be more likely to get distracted
content.

Cost-effective: No need to pay for live

production costs.

2. Live Webinars
- These webinars are held in real-time, with all the registrants logging in to listen to the
presentation while it is happening. Live webinars allow viewers to ask questions directly
to the experts. They are also a good option for product demonstrations and case
studies.

Strengths Weaknesses
High audience interaction: Viewers can ask Less convenient for viewers: Viewers must attend
questions in real-time. the webinar at a specific time.

More engaging than on-demand webinars: More expensive than on-demand webinars: You
Viewers are more likely to be focused and might have to pay for live production costs.
engaged.
Can be difficult to scale: Reaching a large
Good for product demonstrations and case audience with a live webinar is
studies: Live demos and case studies can be not easy.
more effective than pre-recorded ones.

3. Automated Webinars
- These webinars are a combination of pre-recorded and live elements. The video is pre-
recorded, but the host will select a particular time for the video to stream. This can
encourage conversation, as the host can answer questions from audience members as
they arise.
 Strengths Weaknesses

Can be as engaging as live webinars: Use pre- Can be less interactive than live webinars:
recorded video and audio to create an Viewers cannot ask questions in real-time.
engaging presentation.

More convenient for viewers than live Requires more upfront planning than on-
webinars: Viewers can watch the webinar at demand webinars: Need to pre-record the video
their own time. and audio.

Can be scaled more easily than live webinars:

An automated webinar can reach a larger
audience.

4. Hybrid Webinars
- Hybrid webinars integrate in-person and virtual components, combining diverse
audiences, including physical attendees and remote participants, utilizing a web-based
webinar platform.
- Hybrid webinars help maximize your audience reach since those who want all the
benefits of in-person, such as personal discussion and networking, can seize those
opportunities.

Strengths Weaknesses

Can reach a larger audience than any other Most expensive type of webinar: Need to pay for
type of webinar: Can combine in-person and live production costs and travel expenses for in-
virtual audiences. person attendees.

More interactive than on-demand webinars: Most logistically challenging type of webinar:
Viewers can ask questions in real-time. Need to coordinate logistics for in-person and
virtual attendees.
Can be more engaging than live webinars:
Viewers can benefit from in-person and virtual
elements.

Key Differences:
On-demand Live Automated
Feature webinars webinars webinars Hybrid webinars

Content Pre-recorded and

availability Pre-recorded Live Pre-recorded live

Audience
interaction Limited High Moderate High

Lead Good Good Moderate Good

generation
Cost Low Moderate Moderate High