NUSING INFORMATICS INFORMATION SYSTEM

SYSTEM ELEMENTS Is the collection and integration of various

pieces of hardware and software and the
Interdependent Parts human resources that meet data collection,
 Most defining attribute of a system, it storage, processing, and report generation
interacts to conduct processes. needs of organization.
Input
 Any factor from the external environment INFORMATION SYSTEM TYPES
that is taken into the system. May serve to
initiate system functioning. 1. Management Information System
Process • Provides managers information about
 Activity of the system. Input to create their business operations.
some outputs or results. • Organized system for managing the flow
Output of information in an organization in a
 Any product or waste produced as a result timely manner.
of system process. • Primary use is assisting in decision
Controls making processes.
 Refer to any component or activity that • Support strategic planning, management
serve to prevent or correct problems or control, operations support.
errors in the system’s input, process or
output. 2. Bibliographic Retrieval System
Feedbacks • Retrieval system that generally refers to
 Output from one part of a system process bibliographic data, document information,
that serve as input or part of another part or literature primarily used to store and
of the system process. retrieve data and not to conduct any
computations per se.
 Used as part of a system’s self regulation
• Example: CINAHL MEDLINE
function.
(http://igm.nlm.nih.gov)
CLASSIFICATION OF SYSTEMS
a. Closed System
• Also known as Self-containment or Self- 3. Stand-Alone, Dedicated, Turnkey
regulation System
• Special purpose system, developed for a
• Defined as a system with the following
single application or set of functions.
characteristics: differentiation, isolation,
• Example: Patient Classification System
independence, self-sufficiency.
• Boundaries are clearly defined and rigid.
Access if highly restricted because only inputs 4. Transaction System
• Used to process predefined transactions
acceptable are inputs from another part of
and produce predefined reports.
itself. b. Open System
• It is designed for repeated operations
• System that exhibit integration, fluid or fuzzy
using a fixed list.
boundaries and interaction with their
• Example: Inventory
environments.
System,Admission/Discharge/Transfer
• Overlaps other system and maybe a
system
subsystem within a larger system.

5. Physiologic Monitoring System

• Widely used in hospital patient care units
• Example: Heart monitor
6. Decision Support System HOSPITAL INFORMATION SYSTEM
• Computer system that supports some
aspect of the human decision making Provides support for a wide variety of both
process. Work with user to support, but not administrative and clinical functions.
replace, human judgment in a a decision Purpose:Manage information needed to
making situation. facilitate daily hospital operations by all health
• Example: Nurse Staffing care personnel.
Administrators: manage financial budgets
7. Expert System and establish charges for services. Physician:
• Computer system containing the diagnose, treat, evaluate patient condition.
information and decision making Nurses: assess, plan, provide patient care
strategies of an expert to assist non experts
in decision making. HIS CONFIGURATION
• Designed for users to simulate the cause • Mainframe computer with hardwired
and effect reasoning that an expert would terminals or workstations
use if confronted with the same situation • Local Area Network
in a real live environment
PROGRAM MODULES AVAILABLE FOR
8. Artificial Intelligence Systems HIS
• System that attempts to model human • Admission and discharge
reasoning processes. • Patient tracking
• Concerned with symbolic inference and • Finance, Payroll, Billing, Budgeting support
knowledge representation. • Inventory
• Track the accuracy of its predictions and • Management reporting program
judgments and alter its own decision • Administrative programs: Cost accounting,
making rules based on new knowledge it patient billing, inventory control, bed census,
generates for itself. medical records, patient classification system
• Symbolic Inference – concerned with
deriving new knowledge from known facts SEMI-CLINIC MODULES
and the use of logical inference rules. Ex:
If A > B and B > C, then A must be greater Admission/Discharge/Transfer (ADT)
than C. • Monitors and controls the flow of patient in
• Knowledge Representation – the field a hospital from admission to discharge.
concerned with devising ways to represent Order-Entry-Result-Reporting Module
and use abstract knowledge and then store (OE)
those representation and use rules in a • Staff can enter laboratory, pharmacy,
computer system. radiology orders online.
• Results can also be posted.
9. Natural Language System CLINICAL SUPPORT SYSTEM
• A system that can understand and process Charting System
commands given in the user’s own natural, • Includes medication administration, Reports,
spoken language. admission assessment, shift assessment,
• Does not require the user to learn special special assessment, some elements of NCP
vocabulary, syntax, and set of (nursing diagnosis, interventions), and vital
programming rules and instructions. signs.
Point-of-Service System / Point-of-Care • Free, less expensive than acquiring propriety
System alternatives
• Special type of clinical system • Leads to development of local software
• Uses a hand held or bedside PC to ensure capacity.
data are entered at the point at which they are
collected ISSUES IN OSS/FS
• Designed to save time by recording critical • Licensing
clinical data, provides access key to patient • Copyright and Intellectual property
information for health care providers • Total Cost of Ownership (TCO) - Sum of all
expenses directly related to the ownership and
Laboratory, Pharmacy, Radiology Modules use of product over a given period of time.
• Support -Do not have the same level of
OPEN SOURCE SOFTWARE (OSS) AND documentation, training, and support.
FREE SOFTWARE (FS) • Business Models
Definition of Terms • Security and Stability
Free Software
• Matter of the user’s freedom to run, copy, DATA PROCESSING
distribute, study, change, and improve Data
software. Free in terms of freedom to change Raw uninterrupted facts that are without
not the price. meaning.
Kinds of Freedom Approaches to Data Organization
• Freedom to run program for any purpose • Sorting
• Freedom to study how the program works • Classifying
and adapt it to your needs. • Summarizing
• Freedom to redistribute copies so as you can • Calculating
help your neighbor Information
• Freedom to improve the program and release • Produced when data is processed
improvements to public so that the whole and interpreted.
community benefits. Information System
• Used to process data and produce
Open Source Software information.
• Provide free access to programmer’s • Examples: Computer System,
instructions to computer in programming Human Information System,
language in which they are written. Manual Information System
Freeware Database
• Software that is offered free of charge but • An organized collection of related
without the freedom to modify the source code data.
and redistribute changes. • Example: Phonebook Building
Shareware Blocks
• Offered on a try before you buy basis. • Field –Record-Files-Database
Factors Affecting Finding of Information
Proposed Benefits of OSS/FS • How the data are named (indexed) and
• Electronic equivalent of generic drugs organized
• Accessible to user, anyone can see the how • The size and complexity of the database
the software works and can make changes to • The type of data within the database
the functionality. • The methodology or tools used to research
database.
 Types of Data b. PROCESSING FILES > COMMAND
a. Computer-Based Data Types FILES
Grouped either by numbers, letters, or  Are set of instructions that perform a set of
combination of both. functions as opposed to running a whole
b. Conceptual Data Types program.
Reflect how users view data, can be based on  Example: autoexec.bat (batch files that
event that data are attempting to capture and tells the computer to open or start a virus
based on the source of data. checking program when the computer is
booted)
DATABASE MANAGEMENT SYSTEM c. DATA FILES
Computer programs used to input, store,  Contain data that have been captured and
modify, process, and access data in a database. stored on a computer using a software
Example: Computerized library system, program.
Automated Teller Machine  Example: .doc, .txt, .ppt
** Master Index File – contains unique
STEPS OR PROCESSES RELATED TO identifier and related indexes for all
DBMS entities in the database. Example is
identification file for all patient records
 Database System Design (Process of DATABASE MODELS
configuring the database software)
 Database software (DBM Software) is American National Standard Institute
used to enter project data into the (ANSI) Standard Planning and
computer. Requirements Committee (SPARC) Model
 Three interacting parts must be present:  Proven effective since 1970s
data, DBMS configures software program,  Identifies three views or models of data
query language used to access data. elements and their relationships
Three views:
ADVANTAGES OF AUTOMATED DBMS a.User’s View - Wish of all requirements that
1. Decrease data redundancy the user will have for the database. List of
** Data redundancy – occurs when data functional specifications describing queries,
are stored in the database more than once. reports, and procedures that can be produced
2. Increase data consistency by the database
3. Improve access to data b. Logical View
c. Physical View
TYPES OF FILES CONCEPTUAL MODELS
a. PROCESSING FILES >  Includes a diagram and a narrative
EXECUTABLE FILES description of the data, elements, their
 Consist of a computer program or set of attributes, and the relationship between the
instructions that, when execute, causes the data
computer to open or start a specific
 Defines the structure of the whole
computer program of function. database in terms of the attributes of the
 Files that tell a computer what actions the entities (data elements), relationships,
computer should perform when running a constraints, and operations.
program.  Include all data elements, the definition
 Example: set-up.exe (tell the computer to and attributes of each datum, and all
begin installing the related computer relationships between data. One-to-one
program on the computer. One-to-many relationship
 Network Model
 Developed from hierarchical models.
 Child node is not limited to one parent
 Represent many-to-many relationship

RELATIONAL DATABASE MODEL

 Consist of a series of files set up as tables.
Each column represents an attribute, and
each row/tuple is a record.
 Joins any two or more files and generates
a new file from the records that meet the
matching criteria.
OBJECT-ORIENTED DATABASE
MODEL
 Developed because the relational model
has a limited ability to deal with binary
large objects or BLOBs.
 Entity as well as attributes of the entity are
STRUCTURAL OR PHYSICAL MODEL stored with the object.
Includes each of the data elements and the  ** BLOBs – complex data types such as
relationship between the data elements, as they images, sounds, spreadsheets, or text
will be physically stored on the computer. messages.

Approaches of structural or physical model: DATABASE LIFE CYCLE

Hierarchical Database
 All access data starts at the top of the INITIATION
hierarchy or at the root  Occurs when a need or problem is
 Effective at representing one-to-many identified and the development of DBMS
relationships is seen as a potential solution.
 Looks at the needs, current approaches,
what are the potential options for dealing
with the need.

PLANNING AND ANALYSIS

 Begins with an assessment of the users
view and the development of the
conceptual model.
 Includes internal and external uses of
information.
DETAILED SYSTEM DESIGN support the management decision making
 Begins with the selection of the physical process.
model, hierarchical, relational or object PURPOSES
oriented. • Spares users from the need to learn different
 Revisions may be expected. application.
• Makes it possible to separate analytical from
IMPLEMENTATION operational processing.
 Includes training the users, testing the
system, developing a procedure manual FUNCTIONS
for the use of the system, piloting DBMS, • Extract data from various computer systems
and finally going live. and import data into the warehouse.
• Function as a database able to store and
EVALUATION AND MAINTENANCE process all the data in the database.
• Deliver data into the warehouse back to the
COMMON DATABASE OPERATIONS user in the form of information.

1. Data Input Operations ACTIVITIES SUPPORTED BY DATA

• Used to enter new data, update data in the WAREHOUSE
system, or change/modify data in the DBMS. • Decision support for caregivers at the point
• A well designed screen is important, it will of care
discourage data entry errors. • Outcome measurements and quality
improvement
2. Data Processing Processes • Clinical research and professional education
• DBMS-directed actions that the computer • Reporting to external agencies
performs on the data once entered into the • Market trend analysis and strategic planning
system. • Health service management and process
• Used to convert raw data into meaningful reengineering
information. • Targeted outreach to patients, professionals,
** Online Transaction Processing – real time and other community groups
processing of transactions to support day- DATA 2 KNOWLEDGE (D2K)
today operations. • Process of extracting information and
knowledge from large-scale databases
3. Data Output Operations • Uses powerful automated approaches for the
• Includes online and written reports. extraction of hidden predictive information
• Approach to designing these reports have an from large databases.
impact on the information the reader actually Process of D2K
gains from the report.  Carefully assessing questions that users
need to answer
DATA WAREHOUSE  Prepare the data (selected, cleaned,
• Largest collection of data imported from transformed into consistent format)
several different systems within one database.  Data mining processes can be done.
• Data sources could either be internal or ** Predicting – discovering variables that
external. predict or classify a future event.
• Definition by Bill Immon (father of data ** Discovery – discovering patterns,
warehouse): subject oriented integrated, time association, or clusters within large
variant, non volatile collection of data used to dataset.
 ** Deviation – discover norm via pattern USE OF THE INTERNET
recognition and then discover deviations
from these norm File Transfer Protocol (FTP)
 Interpret, evaluate and use data mining • Upload files and download files from distant
result within institution. computers.
** Uploading – process of moving a file from
INTERNET: A NURSING RESOURCE the user’s computer to another computer
ISOC (Internet Society) ** Downloading – transfer of file from
• Overall organizing force of Internet another computer to user’s computer.
• An international, non-profit group,
professional membership organization with no Telnet
government allegiances • Allows a connecting computer to behave like
• Comprised of 150 organization, 16000 a terminal for distant computers regardless of
individual members that represent 180 nations the type of computer that is either the target or
• Maintain standards, develop public policy, the originator of the Telnet session.
provide education, increase membership • Example: Internet Service Providers (ISP)

Technology Behind the Internet TCP Usenet News and Online Forums
(Transfer Control Protocol) • Usenet, an early online discussion system, is
• Allows computers to connect to a network similar to modern online forums, but it's a
and exchange data. more decentralized and text-based system
• Carries out task of breaking messages into where users can post messages and engage in
small packets. threaded conversations within topic-specific
• Ensures that packets/programs are all groups called "newsgroups".
received and are in correct order.
Email
IP (Internet Protocol) • Anatomy of email address
• Lower level protocol responsible for making • Using email
decision about these packets and routing them. • Use of emoticons and abbreviations
• Organizing received files
Domain Name System (DNS) • File attachments
• Permits us to give globally unique names to • Cautions and suggestions
networks and computers
Mailing List
Examples: Top Level Domains (TLD) • First created by Eric Thomas in 1986
.aero (air transport industry) • Set up to provide an arena for discussion on
.biz (for businesses) specific topic
.com (commercial) • Have to mailing addresses (address of the
.coop (cooperatives) software that manages the list and the
.edu (educational institutions) subscribers)
.gov (government agencies)
.info (all users)
.net (network resources)
.org (non-profit organizations)
.pro (professionals)
 • Disclosure – purpose of the site, sponsor
• Links – quality of links
Worldwide Web (www) • Design – accessibility, easy navigation,
searchable
History • Interactivity – allow feedback, exchange
• Appeared in the last half of the 1990s
• First proposed by Tim Berners-Lee in 1989 PATIENT/CONSUMER USE OF THE
• First prototype appeared in 1990 with a INTERNET
subsequent release in 1991 • Many hospitals and insurance agencies
• 1992 first browser was released to the public including the federal government has web sites
as freeware setup for patients
– Hours and services
How www Functions – Maps or obtain location
• Browser – software programs that allow any – Locate and see physician’s credentials
computer to be a web client • Other organizations allow submission of
• Hypertext Transfer Protocol (HTTP) – information on online forms, checking of
enables transmitting and interpretation of files health care benefits and even ordering
not just text. Invented by Ted Nelson in 1960s. prescription medicines online
• Uniform Resource Locator (URL) -
contains the name of the computer where the PDA AND WIRELESS DEVICES
document you are seeking is located along
with other specifics to locate it. Desktops vs notebooks/laptops vs tablet vs
Example: http://www.yahoo.com/yahoogroups smart phones vs PDA

Value of www Desktop

• Opens the world to you Heavy to hand carry
• Easy access of information Larger display
• Online journals Processing power (GHz)
• Professional information (organizations) Memory Capacity (GB)
• Continuing educations Not designed to run on battery power
• Tutorials Smart phones
Functions as telephone, email, internet
access and PDA organization function
Fits in a shirt pocket
Weigh ounces
Has 2 inch or slightly larger display
Limited memory
Limited storage capacity
Has 3hrs talk and 10 hours standby
battery life
THE INTERNET AS SOURCE OF Notebooks/laptops
INFORMATION Light enough to hand carry
Evaluating Information Has slightly smaller display
• Credibility – source, how current, Slightly less processing power and
usefulness, relevance storage capacity
• Content – hierarchy of evidence, presence of Possible to add external devices
original sources Run on battery power
Tablet USE OF COMPUTER BASED CLINICAL
Ability to provide input using stylus DECISION SUPPORT SYSTEM FOR
Lighter HEALTH PROFESSIONALS
Slightly smaller display
Slightly less processing power and Decision Support System
storage capacity • Automated tools designed to support
PDA decision making activities and improve the
Weighing 8 ounce or less decision making process and decision making
Small enough to fit a shirt pocket outcomes.
Comes w/ a miniature keyboard and a Nursing Decision Support System (NDSS)
stylus for data entry Tools that help nurses:
Possible to add external keyboard • Improve their effectiveness
• Identify appropriate interventions
MOBILE DEVICES CONTINUUM OF • Determine areas in need of policy or protocol
PORTABILITY development
• Support patient safety initiatives and quality
a. Portable improvement activities.
A device w/c can be rolled from room to
room Clinical Decision Support System (CDSS)
b. Mobile • Designed to support health care providers in
Devices w/c are small and lightweight making decisions about the delivery and
enough to be hand carried management of patient care.
c. Handheld • Typically designed to integrate a medical
Device w/c can be held in the palm of one knowledge base, patient data and an inference
hand and used w/ the other hand engine to generate case specific advice.
Goals of CDSS
USES OF PDA • Patient Safety
 Normal functions: to do, notepad, • Improved outcomes for specific patient
calculator, address book, date book populations
 WLAN, web browsers • Compliance with clinical guidelines,
 Document viewers standards of practice, regulatory requirement.
 Office utilities • Optimization of both efficiency and
 Reference material (journal, articles) effectiveness with which clinical decisions are
Application: NANDA, ECG, made and care is delivered.
Pharmacology, Dictionary, BMI Calculator
3 main purpose of (DSS)
• Assist in problem solving w/ semi structured
problems
• Support, not replace, the judgment of a
manager or clinician
• Improve the effectiveness of decision making
process
 HISTORY: EARLY SYSTEMS CLASSIFICATION OF CDSS
INTERNIST I From ontologic perspective (Tan and Sheps,
• Developed at Pittsburgh University in 1974 1998)
• Support the diagnostic process in general • Data-based system (population based)
internal medicine by linking disease with • Model-based system (case based)
symptoms • Knowledge-based system(rule based)
MYCIN I • Graphic-based system
• Rule based expert system to diagnose and
recommend treatment for certain blood Examples of CDSS application
infections Reminders and alerts
• Functional in 1976 Therapy critiquing and planning
COMMES (Creighton Online Multiple Diagnostic assistance
Modular Expert System) and CANDI Laboratory system w/ interpretation
(Computer-Aided Nursing Diagnosis and Prescribing decision support
Intervention Clinical workstations w/ online
• Assist nurses with care and planning and literature Image recognition and
nursing diagnosis. interpretation
Signal interpretation w/c activates
TYPES OF DSS interpretative alarms
a. Administrative and Organizational Natural language/speech recognition
System Evidence based quality improvement
– Supports organizational, executive Multitask tools for assessment,
/managerial, financial and clinical diagnosis and management
decisions
BARRIERS IN USING CDSS
b. Integrated System • Lack of noticeable benefits
– Supports outcomes performance • Insufficient cost benefits
management by integrating the operational • Inadequate staff training
data (the business side) w/ clinical data • Lack of system support
(the clinical side) • Lack of exposure to technology

KEY CDSS FUNCTIONS BY ESSENTIAL ELEMENTS NEEDED FOR

PERREAULT (1999) INFORMATICS STRUCTURE
1. Administrative- support for clinical (MCCORMICK,1998)
coding and documentation 1. Standardized vocabularies – To describe
2. Management of clinical complexity and patient diagnoses, intervention and
details- keeping patients on research and outcomes
chemotherapy protocols, tracking orders, 2. Computer based methods – Examine
referrals, follow up and preventive care linkages among patient problems,
3. Cost control- monitoring medication interventions, outcomes and variations
orders and avoiding duplicate or 3. Integrated clinical information system –
unnecessary tests Data required for improvement are
4. Decision support- supporting clinical collected and returned to the provider
diagnostic and treatment plan processes
promotion of best practice, use of
condition-specific guidelines, and
population based management
 FIVE ELEMENTS FOR REAL TIME
CDSS BY SITTIG (1999)
1. Integrated real-time patient database –
combines data from multiple sources.
2. Data driven mechanism – event triggers to
go in effect and activates alerts and reminders
automatically.
3. Knowledge engineer – translate knowledge
representation scheme.
4. Time driven mechanism – permit
automatic execution of program at specific
time.
5. Long clinical term repository – data
collected over time from variety of resources.

RESPONSIBILITY OF USER: ETHICAL

AND LEGAL ISSUES
• No legal ramification of not following CDSS
advice
• But the legal responsibility for treatment and
advice given to a patient rest w/ the clinicians
regardless of whether a CDSS is used.

IMPLICATIONS OF FUTURE USES OF

CDSS IN NURSING
• Allow patient to access to the knowledge
base of the system.
• Computer as health medium
• Development of CDSS program for other
clinical users including nurses END