NCM 200:

Nursing Informatics

Ms. Ma. Joya Jimenea Genzola, RN

Lecturer
Chapter 24:

Internet Tools for

Advanced Nursing Practice
 Basic and Advanced Internet Search Method

Three search strategies:

1. name precisely the information being sought

2. use search strings rather than single words

3. enhace search strings by using boolean or

natural language method
 Four Internet Domains
Government Domain (.gov)
• Food and Drug Adminitration (www.fda.gov)
• The National Center for Complementary and
Alternative Medicine

Educational Domain (.edu)

• Indiana University edu domain
• Purdue University Indianapolis P450 Drug Interaction

Organizational Domain (.org)

 frankp@chiro.org

Commercial Domains (.com)

• medscape.com
• rxlist.com
 Internet-Available Clinical Practice Tools

•Assessment
•Diagnosis
•Treatment
•Outcomes Evaluation
 Assessment

• Nursing Assessment is the first step in the nursing

process.

• Using cardinal signs

• Primary care practice

• Risk assessments
 Assessment

Examples of web-found health risk calculators:

• Body Mass Index Calculator from the National Heart,

Lung and Blood Institutes of Health

• Cancer Risk tools (Harvard Center for Cancer

Prevemtion)

• Coronary Heart Disease Risk Calculator

• Health Risk Calculators form the University of

Maryland Medicine for 24 Health conditions
 Diagnosis
Classification Systems

• Medical Classification of Disease (ICD-WHO,

American Medical Association)

• Nursing Classifications of Human responses to Illness

and Health (NANDA)

• Functional Health and Disability (ICFHD-WHO)

 Diagnosis

I. New Threats to Health

• Mass Trauma Preparedness and Response
• Bioterrorism Agents/Diseases
• Chemical Agents
• Recent Outbreaks and Incidents

II. Disease Directories

• Centers for Disease Control and Prevention

III. Examples of Specific Disease Information

• New York Online Access to Health (www.noah-
health.org)
 Diagnosis

IV. Easy Diagnosis Tool

• National Institute of Neurological Disorders and
Strokes

V. Standardized Diagnosis Terminologies

• NANDA Diagnoses and Classification (nanda.org)

VI. Unified Medical Language System (UMLS)

• National Library of Medicine (NLM UMLS)
 Diagnosis

II. Disease Diagnoses

• Disease Terminologies: International Classification of

Disease-9 & 10-CM

• Disease Directories: Centers for Disease Control and

Prevention

• Medical Dictionaries: Newcastle upon Tyne Dept. of

Oncology,( www.noah-health.org)
 Treatment
I. Nursing Treatment
• Home Health Care Classification
• Nursing Interventions Classification

II. Calculators
• Martindale's Calculators Online Part I: Nutrition
• Nursing Calculators for Drug Administration purposes

III. Drug Management

• Drug Enforcement Agency (www.dea.gov)

IV. Practice and Treatment Guidelines: Professional

Organization Sites
• American Diabetes Association, Clinical Recommendations
• American Cancer Society Guidelines for Screening,
Surveillance and Early Detection of Adenomatous Polyps
and Colorectal Cancer
Application Exercise #1
 
A 73 year old male, retired insurance agent, who smoked between 14-25 cigarettes
per day between the ages of 18 and 45 years but never any cigars, asks you what
his chances of developing lung cancer. How would you respond?
Additional Information:
• Patient had no prior history of cancer.
• Ate at least 3 fruits and vegetables daily
• Smoked between 14-25 cigarettes daily between 18-45 years old
• Never smoked cigars
• Lived in the city his entire life
• Was never exposed to asbestos, carcinogenic chemicals or manufacturing process
• Has no family history of lung cancer
To answer this patient’s question, the advanced practice nurse with the patient accesses
the Harvard Center for Cancer Prevention.
Access http://www.yourcancerrisk.harvard.edu/ and click on cancer.
After arriving the results, print the screen result (click PRINT SCREEN)
 
Access the same website and avail the cancer risk questionnaire using your personal
information. Then print the result (click PRINT SCREEN).
 
SUBMIT THESE TWO RESULTS WITH YOUR NAME, SECTION AND GROUP
NUMBER ON OR BEFORE MAY 11, 2010.
 
It is recommended that you pass as a class in a brown envelop labelled with your section.
 Outcomes Evaluation
I. Nursing Home and Home Healthcare Setting
• Minimum Data Set (MDS) site (www.cms.hhs.gov)
• OASIS

II. Health Plan Outcomes

• Minnesota Department of Health HEDIS Reports (www.health.state.mn.us)
• Missouri Department of Health and Senior Services (www.dhss.mo.gov)

III. Office Tools: Online Healthcare Record Audit and Patient

Satisfaction Forms
• Patient Satisfaction Form (www.geomedics.com)

IV. Short Form Health Survey

• SF-36.org
• Medical Outcome Trust

V. Outcomes Measurement: Internet Available Biostatistical and

Analytical Tools
• Qualitative Database Software
Chapter 25:

Informatics Solution for

Emergency preparedness
and response
 Changes in the Federal System Affecting
Emergency Preparedness and Response

• A New Definition of Community

• Federal Responsibilities for Healthcare Providers

• New Visibility of CDC Promotes Informatics Solutions

 Purposes of the National Electronic
Disease Surveillance System (NEDSS)
• To detect outbreaks rapidly and to monitor the health of
the nation

• Facilitate the electronic transfer of appropriate information

from clinical information system to public health
departments

• Reduce provider burden in the provision of information

• Enhance both the timeliness and quality of information

provided
 Role of AHRQ in Stimulating New
Informatics Solutions

• Decision Support Systems

• Syndromic Surveillance

• Helping Clinicians Respond

 Role of HRSA in Promoting Informatics
Educational Solutions

• Hospital Bioterrorism Preparedness Program

• Bioterrorism Training and Curriculum Development

Program (BTCDP)
 Other Changes Affecting Emergency
Preparedness and Response

• Competency-Based Learning and Informatics Needs

• Informatics and the Emergency Operations Center

• Informatics and Volunteerism

• The National Health Information Infrastructure (NHII) in

Fighting National Threats
Chapter 26:

Vendor Applications
 Commonly reported perceptions:

• Nursing is an untapped and underserved resources in

provider organizations

• Workflow inefficiencies are not well addressed by

existing solutions

• Automation is not a high priority for nursing in their

organzitaions

• Vendors are out of sync with nursing needs

• Some new tools and technologies have complicated rather

than simplified nursing practice
 Root causes of poorly designed nursing
applications include:
• Vendor product design process driven by engineers,
financila system analysts or Mds

• Insufficient nursing representatives on vendor executive

and development teams

• The HCIT industry's overall woeful lack of adequate

requirements definition, functional specifications and
process analysis

• Early focus on automation of the paper chart without a full

understanding of underlying nursing process, workflows
and ergonomic challenges
 Vendor Response
Vendors are now expected to deliver “Next Generation”
clinical applications that:

• Support multi- and interdisciplinary care

• Promote data integrity via data validity checks and

embedded tools

• Provide ready access to interbal standards

• Enable evidence-based care via automation of integrated

multidisciplinary clinical pathways and incorporation of
decision support mechanisms
 Vendor Response
... continuation

• Collect work load management data as byproduct of

clinical documentation, including deriving prospective
acuity data from clinical documentation

• Support productivity management, staffing and budgeting

activities

• Support process and outcomes monitoring, management,

and continuan improvement via standard reports and
database mining

• Support charge capture, supply management, and

inventory reconciliation

• Support for medical disease and population management

Chapter 30:

Vendor Applications
 Application Areas: Consumer Use
of Computers for Health

Information Seeking

Communication and Support

Personal Health Records

Decision Support

Disease Management
 Issues in Consumer
Computing for Health
Variability in Quality of Information Available to Consumers

Lack of Security in Internet-based Transactions

Uneven Accessibility Across Age, Ethics and Socioeconomic

Groups: The Digital Divide

Educational and Cultural Barriers

Physical and Cognitive Disabilities

Impact on Relationship with Healthcare Providers

 The Nurse Informatician's Role
in Consumer and Patient Computing

•Scope and Standards of Nursing Informatics Practice

•Areas of Nursing Expertise that can be Applied to

Consumer/Patient Computing
– Deep expertise in patient education
– Cultural diversity in the workforce and a strong ethic of
cultural sensitivity
– Strong background in both patient- and community focused
research
– Strong heritage of patient advocacy and patient
empowerment

•Special Considerations in Designing Applications for Patients

and Consumers
 The Nurse Informatician's Role
in Consumer and Patient Computing
1. Lay versus professional nomenclature

2. General literacy and health literacy

3. Computer literacy and the digital divide

4. Special needs of the elderly

Chapter 31:

Decision Support for

Consumers
 The Nurse Informatician's Role
in Consumer and Patient Computing
I. Health-Related Decision-Making

II. Shared Decision-Making and Informed Choice

III. Patient Preferences

IV. ComputerTechnology and Patient Decision-Making

– Assessing Utilities of Health Outcomes
– Envisioning Treatment Options
– Facilitating Data Management
– Linking Preferences with Treatment Decisions

V. Efficacy of Decision Aids

VI. Points of Decision Support System Intervention

the end