Nursing informatics introduction
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This document provides information about a Nursing Informatics course, including the instructor, schedule, course description, objectives, outline, and definitions of key terms. The course deals with using information technology and standards in nursing, managing patient data, and clinical decision-making. It is worth 3 credits, includes both lecture and lab hours, and covers topics such as computer hardware and software, electronic health records, issues in informatics, and applications for practice, research, and the future of the field.
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Nursing informatics introduction
- 1. Nursing InformaticsInstructor: Ian Jasper MangampoSchedule: 13:00 – 16:00 MTW RM319(LAB) 13:00 – 16:00 ThF RM302(LEC)
- 2. Course DescriptionThis course deals with the use of information technology system and data standards based on nursing informatics principles/theories. It further deals with the utilization of clinical information systems in the management and decision-making of patient care.
- 3. Course Credit2 units Lecture1 unit LaboratoryContact Hours:36 Lecture Hours54 Laboratory Hours
- 4. Course ObjectivesAt the end of the course and given relevant actual or simulated situations/conditions, the student will be able to:Apply concept, theories and principles of informatics in nursing and health careDiscuss issues and dtrends in informatics relevant to nursing and health.
- 5. Course OutlineComputers and NursingComputers and NursingHistorical Perspectives of Nursing and the ComputerElectronic Health Record from a Historical perspectiveComputer SystemComputer HardwareComputer Software and SystemsOpen Source and Free SoftwareProprietary SoftwareSystem SoftwareApplication SoftwareData Processing SoftwareThe Internet, a Nursing ResourcePDA and Wireless DevicesIncorporating Evidence: Use of Computer-Based Clinical Decision Support System for Health Professionals
- 6. Issues in InformaticsNursing Informatics and Healthcare PolicyThe Role of Technology in the Medication-Use ProcessHealthcare Data StandardsElectronic Health Record SystemsDependable Systems for Quality CareNursing Minimum Data Set SystemsInformatics TheoryTheories, Models and FrameworkAdvanced Terminology SystemsImplementing and Upgrading Clinical Information Systems
- 7. Practice ApplicationPractice ApplicationCritical Care ApplicationCommunity Health ApplicationsAmbulatory Care SystemsInternet Tools for Advanced Nursing PracticeInformatics Solutions for Emergency Preparedness and Response.Vendor Applications
- 8. Administrative ApplicationAdministrative Applications of Information Technology for Nursing ManagersTranslation of Evidence, Clinical Practice Guidelines, and Automated Implementation ToolsData Mining and Knowledge DiscoveryConsumer’s Use of InformaticsConsumer and Patient Use of Computers for HealthDecision Support for ConsumersEducational ApplicationsThe Nursing Curriculum in the Information AgeAccessible, Effective Distance Education Anytime, AnyplaceInnovations in Telehealth
- 9. Research ApplicationComputer Use in Nursing ResearchComputerized Information ResourcesInternational PerspectivesNursing Informatics in CanadaNursing Informatics in EuropePacific RimNursing Informatics in AsiaNursing Informatics in South AmericaThe Future of InformaticsFuture Directions
- 11. Informatics Informatics comes from the French word informatique which means computer science.Informatics is defined as computer science + information science.Used in conjunction with the name of a discipline, it denotes an application of computer science and information science to the management and processing of data, information, and knowledge in the named discipline.
- 12. What is nursing informatics?
- 13. Hebda (1998 p. 3), defines nursing informatics as:“The use of computers technology to support nursing, including clinical practice, administration, education, and research.“
- 14. American Nurses Association (ANA) (1994) has defined nursing informatics as: “The development and evaluation of applications, tools, processes, and structures which assist nurses with the management of data in taking care of patients or supporting the practice of nursing.”
- 15. Graves, J. R., & Corcoran, S. (1989). The Study of Nursing Informatics. Image: Journal of Nursing Scholarship, 27, 227-231. define nursing informatics as: “A combination of computer science, information science and nursing science designed to assist in the management and processing of nursing data, information and knowledge to support the practice of nursing and the delivery of nursing care.”
- 16. Framework for Nursing InformaticsThe framework for nursing informatics relies on the central concepts of data, information and knowledge:A DATA is defined as discrete entities that are described objectively without interpretationAn INFORMATION as data that is interpreted, organized or structuredA KNOWLEDGE as information that has been synthesized so that interrelationships are identified and formalized.Resulting in DECISIONS that guide practice
- 17. Application of Nursing InformaticsNursing Informatics can be applied to all areas of nursing practice, which include; clinical practice, administration, education, and research.
- 18. Nursing Clinical Practice (Point-of-Care Systems and Clinical Information Systems)Work lists to remind staff of planned nursing interventionsComputer generated client documentationElectronic Medical Record (EMR) and Computer-Based Patient Record (CPR)Monitoring devices that record vital signs and other measurements directly into the client record (electronic medical record)Computer - generated nursing care plans and critical pathwaysAutomatic billing for supplies or procedures with nursing documentationReminders and prompts that appear during documentation to ensure comprehensive charting
- 19. Nursing Administration (Health Care Information Systems)Automated staff schedulingE-mail for improved communicationCost analysis and finding trends for budget purposesQuality assurance and outcomes analysis
- 20. Nursing EducationComputerized record-keepingComputerized-assisted instructionInteractive video technologyDistance Learning-Web based courses and degree programsInternet resources-CEU's and formal nursing courses and degree programsPresentation software for preparing slides and handouts-PowerPoint and MS Word
- 21. Nursing ResearchComputerized literature searching-CINAHL, Medline and Web sourcesThe adoption of standardized language related to nursing terms-NANDA, etc.The ability to find trends in aggregate data, that is data derived from large population groups-Statistical Software, SPSS
- 22. Benefits of Computer Automation in Health Care:Many of these benefits have came about with the development of the electronicmedical record (EMR), which is the electronic version of the client data found in the traditional paper record.
- 23. EMR benefits include:Improved access to the medical record. The EMR can be accessed from several different locations simultaneously, as well as by different levels of providers.Decreased redundancy of data entry. For example, allergies and vital signs need only be entered once.Decreased time spent in documentation.Automation allows direct entry from monitoring equipment, as well as point-of-care data entry.Increased time for client care. More time is available for client care because less time is required for documentation and transcription of physician orders.
- 24. Facilitation of data collection for research. Electronically stored client records provide quick access to clinical data for a large number of clients.Improved communication and decreased potential for error. Improved legibility of clinician documentation and orders is seen with computerized information systems.Creation of a lifetime clinical record facilitated by information systems.
- 25. Benefits of automation and computerization are related to the use of decision-support software, computer software programs that organize information to aid in decision making for client care or administrative issues; these include:Decision-support tools as well as alerts and reminders notify the clinician of possible concerns or omissions. Effective data management and trend-finding include the ability to provide historical or current data reports.Extensive financial information can be collected and analyzed for trends. An extremely important benefit in this era of managed care and cost cutting.Data related to treatment such as inpatient length of stay and the lowest level of care provider required can be used to decrease costs.
- 26. Nursing Informatics SpecialistBecause of the increased importance of computers and information technology in the practice of professional nursing; a new role has emerged, the Nursing Informatics Specialist (NIS).The NIS is a nurse who has formal education, certification and practical experience in using computers in patient care settings.
- 27. The Role of the Nursing Informatics Specialist (NIS)
- 28. The American Nurses Association (ANA, 1994), lists several functions of the NIS:Theory development. The NIS contributes to the scientific knowledge base of nursing informatics.Analysis of information needs. The identification of information that nurses' need to in order to accomplish their work; client care, education, administration, and researchSelection of computer systems. The NIS, guides the user in making informed decisions related to the purchase of computer systems.
- 29. Design of computer systems and customizations. The NIS collaborates with users and computer programmers to make decisions about how data will be displayed and accessed.Testing of computer systems. Systems must be checked for proper functioning before they are made available for use in patient care.Training users of computer systems. Users need to be trained in how the system works, the importance of accurate data entry, and how the system will benefit them, and more importantly how it will improve patient outcomes
- 30. Evaluation of the effectiveness of computer systems. The unique role of the NIS makes them the ideal person to evaluate the effectiveness of computer systems.Ongoing maintenance and enhancements. The NIS makes sure the computerized system functions properly and explores possible enhancements to the system that will better serve the users and the patients.Identification of computer technologies that can benefit nursing. The NIS must keep abreast of the changes in the fields of computers and information technology, including new hardware and software that will benefit the nurse and patient.
- 31. What is a Computer?Computer
- 32. A general term referring to information technology ( IT) and computer systems.
- 33. An electronic device that performs tasks, such as calculations or electronic communication, under the control of a set of instructions called a program. Programs usually reside within the computer and are retrieved and processed by the computer’s electronics. The program results are stored or routed to output devices, such as video display monitors or printers. Computers perform a wide variety of activities reliably, accurately, and quickly. Computers “Nursing Perspective”In nursing computers are synonymous to nursing information system (NIS).
- 34. Computers are used to manage information in patient care, monitor quality of nursing care and evaluate care outcomes
- 35. Networks with internet are used in communicating and accessing resources and interacting w/ the patient on the (WWW). Point to Ponder...."Computers are incredibly fast, accurate and stupid. Human beings are incredibly slow, inaccurate and brilliant.Together they are powerful beyond imagination." - Albert Einstein
- 36. Historical PerspectivesNursing and the Computer
- 37. Major historical perspectives of nursing and computersSix time periods
- 38. Four major Nursing areas
- 40. Significant land mark eventsMajor Historical Persepectives of Nursing and ComputersSix time periodPrior to 1960’s – simple beginningsUse of punch cards and teletypewritters.
- 41. 1960’sUse of computers in healthcare is questionedStudies on computers in nursing is started.Introduction of cathode ray tubesDevelopment of Hospital Information System for financial transactions
- 42. 1970’sNurses assisted in the design of HISComputers used in financial and management functionsSeveral communities developed Management Information sytem
- 43. 1970’sNurses assisted in the design of HISComputers used in financial and management functionsSeveral communities developed Management Information sytem
- 44. 1980’sNursing Informatics is formally accepted as new nursing specialty.Nursing Education identified need for updateEmergence of microcomputers/PC
- 45. 1990’sComputer technology became an integral part of the healthcare setting.Policies and legislation on promoting computers in healthcare were adopted.Approval of NI by ANA as a new nursing specialty.Dr. Nicholas Davies excellence award is given for excellence in health information technology, this is managed by HIMSS.
- 46. Post 2000Clinical Information System became individualized in the electronic patient record.Mobile computing device were introducedNew technologies were utilizedInternet provided new means of developmentHealth Insurance Portability and Accountability Act of 1996 was enacted.
- 47. COMPUTERSComputers can perform a wide range of activities that save time and help Nurses provide quality nursing care.inNURSING
- 48. Nursing PracticeComputer systems, patient care data and NCP’s are integrated to Electronic Health RecordNeed for EHR was perceivedNew Nursing Terminologies were recognized by ANA
- 49. Nursing AdministrationComputers linked department together.Hospital data are accessed through computers.Hospital process goes on lineInternet was utilized.
- 50. Nursing EducationMost nursing schools offered computer enhanced courses.Campus-wide computer systems became available.Computer technology integrated into teaching methodologiesWorld wide web facilitates student-centered instructional settings.
- 51. Nursing ResearchProvides an avenue for analyzing dataSoftwares are available for processing qualitative and quantitative dataResearch databases emergedOnline access
- 52. Standard InitiativesANA – considered as the official nursing organization that contributes in the development and recommendation of standards of nursing practice worldwide.Joint commission on Accreditation of Hospital Organizations ( JCAHO) – focuses on the need for adequate records on patients in hospital and practice of standards in documentation of care
- 53. Significant Landmark of Event1961 – Healthcare Information and Management systems Society was founded1965 – Development of one of the first hospital Information system in California1973 – First Conference on Management Information Sytem
- 54. 1981 – First National Conference on Computer Technology in Chicago1984 – First Nursing Computer Journal is published.1989 – graduate program in Nursing Informatics is introduced in Maryland university
- 55. 1993-establishment of electronic library1995 – first International Nursing Informatics Teleconference held in Australia2002-JCAHO identified clinical information system as a way to improve safety and recommends that hospitals adopt technology.
- 56. 2003 – Health Insurance Portability and Accountability Act was enacted2004 – Establishment of the National Health Information Coordinator.
- 57. Historical Background of Electronic Health Records
- 58. An electronic record composed of health information regarding an individual patient that exists as part of a complete system designed to provide access to, and management of, such information. The EHR is developed and managed by the health facility or provider. The term Electronic Health Record has largely replaced the older “Electronic Medical Record.”Electronic Health Record (EHR)
- 59. It is much more than an electronic replacement of existing paper systems. The EHR can start to actively support clinical care by providing a wide variety of information services. However, it is hard to understand what information is really important to clinical care and what is simply occasionally desirable.
- 60. The EHR bring uncountable advantages in primary health care detaching such as faster access to information, and updated information.It allows having a clinical process with all the patient clinical information and an easier access to information (ex: allows the simultaneous access from different locations).
- 61. Recognizable efforts in the development of EHR are distinguished by the Nicholas E. Davis Awards of Excellence Program whose history describes the improvement of EHR in different settings.
- 62. The Computer-Based Patient Record Institute (CPRI), founded in 1992, was an organization representing all the stakeholders in healthcare, focusing on the clinical applications of information technology.
- 63. It was among the first nationally based organizations to initiate and coordinate activities to facilitate and promote the routine use of Computer-Based Patient Records (CPRs) throughout healthcare.The Nicholas E. Davies Awards of Excellence Program
- 64. The CPRI group on CPR Systems Evaluation developed the CPR project evaluation criteria in 1993 which became the basis in assessing accomplishments of CPR projects and provided the Foundation of Nicholas E. Davies Awards Excellence Program
- 65. The Program was named after Dr. Nicholas E. Davis, an Atlanta-based physician, president elect of the American College of Physicians, and member of Institute of Medicine (IOM) committee in improving patient records. He was killed in a plane crash just as the IOM report on CPRs was being released
- 66. The HIMSS Nicholas E. Davies Awards of Excellence recognize excellence in the implementation and use of health information technology, specifically EHRs, for healthcare organizations, private practices and public health systems.
- 67. Nowadays the Nicholas E. Davies Awards Excellence Program is managed by the Healthcare Information Management Systems Society, and has the following program objectives:
- 68. The Healthcare Information and Management Systems Society (HIMSS) is the healthcare industry's membership organization exclusively focused on providing global leadership for the optimal use of healthcare information technology (IT) and management systems for the betterment of healthcare. The Healthcare Information Management Systems Society (HIMSS)
- 69. Vision - Advancing the best use of information and management systems for the betterment of health careMission - To lead change in the healthcare information and management systems field through knowledge sharing, advocacy, collaboration, innovation, and community affiliations HIMMS
- 70. Promote the vision of EHR systems through concrete examples
- 71. Understand and share documented value of EHR systems
- 72. Provide visibility and recognition for high impact EHR system
- 73. Share successful EHR implementation strategies
- 74. Encourages and recognizes excellence in the implementation of EMREHR systems: Implementation, Strategy, Planning, Project Management and Governance– StrategyHIMSS objectives:
- 75. Computer Systems
- 76. BEFOREAFTER
- 77. BEFOREAFTER
- 78. The Basic System ComponentsThe basic operational design of a computer system is called its architecture.John Von Neumann, a pioneer in computer design, is given credit for the architecture of most computers in use today.A typical Von Neumann system has three major components: the central processing unit (or CPU)memory, and input/output(or I/O).
- 79. Von Neumann’s Computer ArchitectureI/O DevicesCPUI/O Devices
- 80. Major Components of Computers
- 81. Hardware DevicesHardware is the physical part of the computer and its associated equipment. Computer hardware can comprise many different parts, these include:Input Devices: used to enter data; Examples:keyboard, mouse, trackball, touch screen, light pen, microphone, bar code reader, fax modem card, joystick, and scanner.Output Devices: used to view and hear processed data; Examples:video monitor screens, printers, speakers, and fax.
- 82. Input Devices
- 83. Output Devices
- 84. Central Processing Unit (CPU) “Brain" of the computerThree components:Arithmetic Logic Unit (ALU): Number "crunching“RegistersSimilar to memory but has special purposesControl Unit: manages instructions to other parts of the computer, including input and output devices "traffic cop“
- 85. Primary Memory:The storage area in which program instruction (code) reside during execution.Read-only memory (ROM) is permanent; it remains whenthe power is off. Start-up instructions for the computer is anexample of ROM.Random access memory (RAM)is a temporary storage area for program instructions and data that is being processed, it is only active while the computer is turned on. (located on the motherboard not part of CPU)
- 86. Secondary Storage: Provides space to retain data in an area separate from the computer's memory after the computer is turned off, these include; hard disk drives, floppy disks, tape, zip drives, optical drives, flash memory, and CD-ROM drives.
- 87. NetworksA network is "a combination of hardware and software that allows communication and electronic transfer of information between computers" (as cited in Hebda, 1998, p. 19).Hardware may be connected permanently by wire (Ethernet), or temporarily by wireless communication, and modems/telephone lines. This allows the sharing of computer and software resources, through the use of the network. For example, several computers may share one computer, or a word processing program could also be accessed by many different users.
- 88. Computer CategoriesSuper computersThe largest and most expensive, can perform billions of instructions every secondMainframesLarge computers capable of processing several millions instructions per second. They support organizational functions, therefore have been the traditional equipment in hospitals. Customized software results in high cost.MinicomputerA scaled-down version of the mainframe, since they are now becoming more powerful they can now be found in hospitals and HMO'sMicrocomputers (PCs),Inexpensive processing power for an individual user.Laptop or Notebook, Handheld, and Personal Digital Assistants (PDAs)Portable devices which can be used almost anywhere.
Editor's Notes
- #24: Many of these benefits have came about with the development of the electronic medical record, which is the electronic version of the client data found in the traditional paper record.
- #26: - An example of this, is the documentation of patient allergies in the computer system. The health care providers would be alerted to any discrepancies in the patient medication orders.Effective data management and trend-finding include the ability to provide historical or current data reports.Extensive financial information can be collected and analyzed for trends. An extremely important benefit in this era of managed care and cost cutting.Data related to treatment such as inpatient length of stay and the lowest level of care provider required can be used to decrease costs.