Theories, Models, Frameworks

Advanced Terminology Systems

Implementing and Upgrading Clinical
Information System
2001, the ANA published the Code of Ethics for Nurses
and Interpretative Statements, a complete revision of
previous ethics provisions and interpretative statements
that guide all nurses in practice.
2003, Nursing’s Social Policy Statement, 2nd Edition
provided a new definition for nursing.
2004, Nursing Scope and Standards of Practice,
reinforces the recognition of nursing as a
cognitive profession begin with decision making
components of the nursing process.
Informatics
Science that combines the domain science,
cognitive science, information science, and
cognitive science.
Healthcare Informatics
Integration of health sciences, computer
science, information science, and cognitive
science to assist in management of health
care information.
Nursing Informatics
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, research, and expansion of nursing knowledge
(ANA, 1994)
 Grave’s and Corcoran’s Seminal Work
 Patricia Schwirian (1986) Model
 Turley (1996) Model
 Placed data, information, and knowledge in
sequential boxes with one-way arrows pointing
from data to information to knowledge. A direct
depiction of their definition of NI.
Intends to stimulate and guide systematic research in
this discipline.

Provides framework for identifying significant

information needs, which in turn foster research.
 
Four Primary Elements
 Raw material (nursing related information)
 Technology (Computing system)
 Users (Nurses, students. and context)
 Goal or Objective
Core components of informatics (cognitive science,
information science, and computer science) are
depicted as intersecting circles.
 Nursing Science
Nursing Informatics

In 1996, Turley
introduced a model that
accurately illustrates
the intersection of the
sciences that contribute
to nursing informatics,
adding cognitive
science to Graves and
Corcoran’s definition to
include such topics as
problem-solving,
memory, language
processing, mental
models and visual
attention
 Benner Dreyfus Model of Skill Acquisition (1982)
 Staggers, Gassert, Curran
 ANCC (American Nurses Credentialing Center)
 Health Information and Management Systems
Society
 Novice level

Advanced Beginner

Competent

Proficient Expert Level

 Published about their research identifying the information
competencies necessary for all nurses.

Conceptual framework
 Computer skills
 Informatics knowledge
 Informatics skills
 Beginning Nurse

Experienced Nurse

Informatics Specialist

Informatics Innovator
Develops and maintains the nursing informatics
certification examination.
Topics Included in Test Content Outline
 Human factors
 System life cycle (planning, analysis, design,
implementation and testing, evaluation, maintenance
and support)
 Information technology (hardware, software,
communications, data representation, security)
 Information management and knowledge generation
(data, information, knowledge)
 Professional practice, trends and issues (roles, trends,
issues, ethics)
 Models and theories
 Established a certification program.

Examples of Certification
 Certified Professional in Healthcare Information and
Management Systems (CPHIMS)
 Certified in Health Security (CHS)
 Certification in Healthcare Privacy (CHP)
 Certified in Healthcare Privacy and Security (CHPS)
Other Names: CPR (Computerized Patient Record),
EMR (Electronic Medical Record), EPR
(Electronic Patient Record), CMR (Computerized
Medical Record)
Data Elements

Data Sets

Value Assignment

Database Storage
Modern Database
 Used for storing data in such a way that maintains
the logical relationships among data elements, and
are stored in a computer.
Identified the PMRI (Patient Medical Record
Information) as a model for the specific content
necessary for the EHR
Healthcare Provider
 Promotes quality patient care, access to complete
accurate patient data 24 hours a day 7 days a
week, includes provider notes, clinical notes,
decision support programs, and practice
guidelines.
Personal Health
 Includes personal health record maintained and controlled
by individual or family; non clinical information (self
trackers, directories of healthcare, public health care
providers); other supports to manage wellness and
healthcare decision making.
Population Health Dimension
 Includes information on the health population and
influences on health.
 Compliance with law and regulation
 Adherence to standard with accrediting agency
 Communication with others providing healthcare
 Conduct of research and clinical trials
 Provision for basis of costing out services
 Creation of claims for payment of services
Concept Representation
 Set of terms and relationships that describes
the phenomena, processes, and practices of
discipline
 Example: data elements, classification,
nomenclatures, vocabularies

Data Elements
 Terms for which data are collected and for
which values are assigned
Data Set
 Specific, purposeful group of data
elements, representing a subset of
concepts within a discipline.
 Foundational work for nursing
languages and represents the first
attempt to standardize the collection
of essential nursing data.
Categories
1. Nursing Care Elements
 Nursing diagnosis
 Nursing intervention
 Nursing outcome
 Intensity of nursing care
Nomenclatures / Vocabulary
 Terms or labels for describing concepts in
nursing such as diagnosis, interventions, and
outcomes.
 Set of words for naming concepts
Taxonomy
 Study of classification and
simultaneously refers to the end of the
product of a classification.

Classification
 Ordering of entities into groups
according to a set of criteria as well as
the end result of the ordering.
NANDA (in mid-1980s)

Alphabetical Conceptual System

listing (NANDA I) •Classification of
in 1980s diagnosis
•Definition
•Defining
characteristics
Nursing Intervention Classification (NIC)
 Contains 514 nursing interventions that describe
the treatments nurses perform, updates linkages
with NANDA diagnoses, and core interventions
identified for 44 specialty area.

Nursing Outcomes Classification (NOC)

 330 research-based outcomes to provide
standardization of expected patient, caregiver,
family, community outcomes for measuring the
effect of nursing intervention.
Clinical Care Classification (CCC)
 Formerly known as Home Health Care
Classification (HHCC)
 Research-based nomenclature designed to
standardize the terminologies for
documenting nursing care in all clinical
care settings.
Omaha System
 Most recent in November 2004
 Includes assessment component
(Problem Classification Scheme) ,
intervention component (Intervention
Scheme), and outcomes component
(Problem Rating Scale for Outcomes)
Perioperative Nursing Data Set (PNDS)
 Provides universal language for
perioperative nursing practice and
education and a framework to standardize
documentation.

SNOMED CT
 Core clinical terminology containing over
370,000 healthcare concepts with unique
meanings and formal logic based definitions
organized into multiple hierarchies.
ABC Codes
 Provide mechanism for coding integrative
health interventions by clinician by state
location for administrative billing and
insurance claims.

Patient Care Data Set (PCDS)

 Terms and codes for patient problems,
therapeutic goals, and patient care orders.
 Developed Dr. Judith Ozbolt
Logical Observation Identifiers Name
and Codes (LOINC)
 Originated as a database of
standardized laboratory terms for
results reporting for chemistry,
hematology, serology, microbiology,
and toxicology.
International Classification for
Nursing Practice (ICN)
 Developed by international nursing
community under sponsorship by
international Council of Nurses (ICN)
 Elements:

Nursing Nursing Nursing

phenomena Actions Outcomes
(Diagnosis) (Interventions)
Nursing Management
Minimum Data Set (NMMDS)
 Describe the context and
environment of nursing
practice, and includes terms for
nursing delivery unit/service,
patient population, care
delivery method, personnel
characteristics, and financial
resources.
 Development of multiple specialized terminologies
resulted to overlapping content, areas for which no
content exists, and In large numbers of codes and
terms
 Existing terminologies are most often developed to
provide sets of terms and definitions of concepts for
human interpretation, with computer interpretation as
only a secondary goal
 Knowledge of humans is often confusing, ambiguous,
or opaque to computers
 Relationship among the things in the world
(objects), our thoughts about the things in the
world (concepts), and the labels we use to
represent and communicate our thoughts about
things in the world (terms)
 Semiotic triangle
 Thought or reference

Symbol Referent
 Concepts (thought or reference) - Unit of
knowledge created by unique combination of
characteristics
› Characteristics - An abstraction of a property of an object
or of a set of objects.
 
 Object (referent) - Anything perceivable or
conceivable

 Term (symbol) -Verbal designation of a general

concept in a specific subject field.
 Terminology Model
› Concept- based representation of a collection of
domain-specific terms that is optimized for the
management of terminological definitions.
› Consist of:
 Schemata – domain specific knowledge about the
typical constellations of entities, attributes, and events
in the real world. May be supported by either formal or
informal composition rules
 Type Definition – obligatory conditions that state only
the essential properties of concept.
 Representation Language
 Ontology Language – GRAIL (GALEN
Representation and Integration Language), KRSS
(Knowledge Representation Specification Syntax),
OWL (Web Ontology Language)
› Represent classes (concepts, categories, or types) and their
properties (relations, slots, roles, or attributes).
› Able to support through explicit semantics the formal
definition of concept in term of their relationships with
other concepts.
› “pain”---acute pain
 Computer – Based Tools
› Implement representation language through software.
› Facilitate transformation of concept representation into
canonical form or support a set of sanctions that test
whether a proposed concept is sensible.
 First Generation
› Consist of list of enumerated terms, possibly arranged as a single
hierarchy
› Serve a single purpose or a group of closely related purposes and allow
minimal computer processing

 Second Generation
› Include an abstract terminology model or terminology model schema
that describes the organization of main categories used in a particular
terminology or set of terminologies
› Allow only limited computer processing

 Third Generation
› Support sufficient formalisms to enable computer-based processing
› Include a grammar that defines the rules for automated generation and
classification of new concepts.
 Allow much greater granularity through controlled
composition while avoiding a combinatorial explosion of
pre-coordinated terms.

 Advantages
› Describing Concepts
 Non-ambiguous representation of concepts
 Facilitation of data abstraction or de abstraction without the loss of
original data
 Non-ambiguous mapping among terminologies
 Data reuse in different context

› Manipulating and Reasoning about those Concepts Using

Computer-Based Tools
 Automated classification of new concepts
 Ability to support multiple inheritance of defining characteristics
 ISO 18104:2003
› Approved in 2003
› Developed by a group of experts within ISO Technical
Committee 215
› Covers reference terminologies for nursing diagnoses
› Intended to be consistent with goals and objectives of other
specific terminology models in order to provide a more
unified reference health model.
› Used to develop coding systems, terminologies,
terminology models, information system, software for
natural language processing, and mark up standards for
representation of health care documents.
 Facilitate the representation of nursing diagnosis and nursing
action concepts and their relationships in a manner suitable for
computer processing
 Provide framework for generation of compositional
expressions from atomic concepts within reference terminology
 Facilitate the mapping among nursing diagnosis and nursing
action concepts from various terminologies.
 Enable a systematic evaluation of terminologies and
associated terminology models for the purposes of harmonization
 Provide a language to describe the structure of nursing
diagnosis and nursing action concepts in order to enable
appropriate integration with information models
 GALEN Program
› Directly support clinical applications to supporting the
authoring, maintenance, and quality assurance of other
kinds of terminologies
 GRAIL (GALEN representation and
integration language)
› Ontology language for representing concepts and their
interrelationships
 Computer based modelling environment –
facilitates the collaborative formulation of models.
Allows authoring of clinical knowledge at different
levels of abstraction.
 
 Terminology server – software that implements
GRAIL. Also used to deliver a model for use by
clinical applications and other kinds of authoring
environments.
 Functions
› Internally managing and representing model
› Testing the validity of combinations of concepts
› Constructing valid composed concepts
› Transforming composed concepts into canonical form
› Automatically classifying concepts into the hierarchy
 SNOMED RT
 Reference terminology optimized for clinical data
retrieval and analysis.
 Functions
› Acronym resolution, Word completion, Term
completion, Spelling correction, Display of
authoritative for of the term entered by user,
Decomposition of unrecognized input
› Automated classification
› Conflict management, detection, and resolution
 OWL (Web ontology language)
 Intended for use where application, rather than
humans, are to process information.