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Nursing tics Reports

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NURSING INFORMATICS IN CANADA The Canadian Nurses Association (CNA) has taken the position that “registered nurses and other stakeholders in healthcare delivery require information on nursing practice and its relationship to client outcomes. A coordinated system to collect, store and retrieve nursing data in Canada is essential for health human resource planning and to expand knowledge and research on determinants of quality nursing care… CNA believes that registered nurses should advocate and lead in implementing the collection, storage and retrieval of nursing data at the national level.” (Canadian Nurses Association, 2001) Focus of NI in Canada is the role of nursing within healthcare organization. In most HC organizations, nurses manage both patient care and patient care units within organization. Usually nurse clinicians manage patient care and nurse managers administer the patient care units within the organization. Therefore, for some time, nursing’s role in the management of information has been considered to include both the information necessary to manage patient care using nursing process and the information necessary for managing patient care units within the organization. Nurses must be able to manage and process nursing data, information, and knowledge to support patient care delivery in diverse care delivery settings (Graves & Corcoran, 1989). There is an essential linkage among access to information, client outcomes and patient safety. “As Lang has succinctly and aptly described the present situation: If we cannot name it, we cannot control it, finance it, teach it, research it or put it into public policy” (Clark & Lang N., 1992).


Access to information about their practice arms nurses with evidence to support the contribution of nursing to patient outcomes. Outcomes research is an essential foundation for evidence based nursing practice. Evidence based practice is a means of promoting and enhancing patient safety. CONTEXTUAL FACTORS INFLUENCING THE DEVELOPMENT OF HEALTH INFORMATION IN CANADA Pressure on health services delivery systems [New treatments, new programs, Risin g drug costs
Shifting paradigm to community-based care


Demographic changes

1. Economic reason 2. Eroded tax base 3. Reduced intergovernmental transfer of funds

Managed care

Decreasing government expenditures on health care


Maldistribution of professional caregivers Rising labor cost Effectiveness (Outcomes)

Efficiency (fiscal accountability)

Quality of


Canadian Institute for Health Information

The establishment of the National Health Information Council in the late 1980’s lead to the National Task Force on Health Information, also known as the Wilk Task Force, which presented comprehensive goals


and a strong vision for a nationwide health information system (National Task Force on Health Information, 1990, November). Subsequently, the recommendations of the Wilk Task Force (National Task Force on Health Information, 1991) resulted in the merger of four existing entities to create the Canadian Institute for Health Information (CIHI) in 1992 (Canadian Institute for Health Information, 2002; Project Team for the Planning of the Canadian Institute for Health Information, 1991, December). CIHI is an independent, national, not for profit organization, established jointly by federal and provincial/territorial ministers of health, During the decade of its existence CIHI has become an

acknowledged and trusted source of quality, reliable and timely aggregated health information for use in understanding and improving the management of the Canadian health systems and the health of the population of Canada.

 Canada Health Infoway Inc.
As CIHI, and its various aggregated databases, evolved and matured, their focus was on health indicators and population health as well as information to manage the health care system. The health care community came to realize that there was still limited information available to support decision making related to clinical care of individuals and groups of patient/clients of the health systems. The need for a pan-Canadian electronic health record gradually emerged during the later half of the 1990’s beginning with the report of the National Forum on Health (National Forum on Health, 1997, February). The recommendations in this report resulted in the commitment in October, 2000 by the federal government of $500 million to support


2001. quality and safety of health services in Canada. (Infoway) was incorporated in January 2001 and began its first year of operation in April. access.. It identified the need to begin working immediately on the building blocks for the next stages in development of EHRs. It is imperative that nursing assessments.the development and coordination of pan-Canadian health information systems necessary to achieve an Electronic Health Record. interventions and practice patterns are included in the EHR because nursing is the single largest group of health care providers. Infoway will build on existing initiatives and pursue collaborative relationships in pursuit of its mission. November) set its top priority on the development of electronic health records (EHR) and telehealth. provincial and territorial governments of the potential of information and communications technologies to improve the efficiency.” The emerging pan-Canadian EHR will ultimately incorporate data related to patient assessment and interventions contributing to patient outcomes and providers’ patterns of practice. 2001. The Infoway Mission (Canada Health Infoway Inc. on The Health Federal/Provincial/Territorial Advisory Committee Infostructure (Advisory Committee on Health Infostructure.  Standards Council of Canada The Canadian Advisory Council (CAC) on Health Informatics (Z295) 6 . This funding was recognition by federal. cost-effectiveness. 2005) is “ Fostering and accelerating the development and adoption of electronic health information systems with compatible standards and communication technologies on a pan-Canadian basis with tangible benefits to Canadians. Canada Health Infoway Inc.

has actively initiated professional protocols for using computer systems in Canadian health care. the Canadian Organization for the Advancement of Computers in Health or COACH. (Hannah. and reflect a balance of interest from industry. The goal of the CAC/Z295 is to harmonize national health information standards with international. These members have an obligation to consult widely within their respective constituencies with a view to having the greatest possible input to both domestic standards work and Canadian input to international standards development.advises the Canadian Stands Association (CSA). Members of CAC/Z295 represent key stakeholder groups in the area of health information and health informatics in Canada. The CAC/Z295 provides representation on behalf of Canada at the ISO’s Technical Committee 215 on Health Informatics Standards where CAC/Z295 representatives speak on behalf of Canada. to provide technical input to SCC on the Canadian perspective on Health Informatics standards development internationally and secondly to provide advise to SCC through CSA on appropriate health information standards for use in Canada as National Standards of Canada. founded in 1975. The CAC/Z295 has a dual role: first. users and general interest groups. One important document. SCC is the official Canadian member of International Standards Organization (ISO). governments. CSA is accredited by the Standards Council of Canada (SCC) as the Standards Development Organization that advises SCC on matters related to Health Informatics Standards. Guidelines 7 . The CAC/Z295 has two co-chairs one responsible for Canada’s international participation in health informatics standards development at ISO TC 215 and one responsible for coordinating domestic health informatics standards activities. 2004) Another national organization.

With the development of the Patron program. Organizations represented include the broad range of healthcare community health. associations. researchers and educators to information and systems managers. networking and communication. institutions. information. nurses and allied health professionals. These guidelines were also supported by the CNA in 1993. COACH is a leading organization with an evolving membership. has been incorporated into the national accreditation guidelines approved by the Canadian Council of Health Facilities Association in 1991. practice. government and regulatory organizations in the pursuit of its mandate. as Canada's Health Informatics Association. consulting firms. consultants. technical experts. professions. Today. It is in the forefront of the Canadian Healthcare information resource and technology field by working cooperatively with health institutions. consultants. In 2001. members are hoping to build stronger links between COACH and private and public enterprise in pursuit of this mission. As an individual member based organization. The backgrounds of COACH members range from health executives. It is an opportunity for corporations to join in partnership with COACH. information and technology public vendor representatives. COACH promotes understanding and effective utilization of information and information technologies within the Canadian Healthcare industry through education.to Promote Confidentiality and Security of Automated Health-related Information (1979). COACH's vision is to be THE catalyst in advancing the practice of health information management in Canada. private government. commercial providers of information and 8 . COACH. vendors of information technology and applications. physicians. launched the Patron Program.

Recognizing the importance of the work the CNIA is undertaking. technologies. information and communication technology infrastructure and support for faculty in delivering these offerings.Special Interest Group in Nursing Informatics (IMIA-SIGNI). a new group. The CNIA conducted a study in 2002 . Through this strategic alliance CNIA is the Canadian nursing nominee to the International Medical Informatics Association . The CNIA now has full associate status with the CNA. Health Canada or OHIH called Educating Tomorrow's Nurses: Where's Nursing Informatics? The intent of the study was to describe the current state of: • informatics education opportunities currently available to students of nursing across the country. and ICT infrastructure and support in schools of nursing across Canada.2003 on the Informatics Educational Needs of Canadian Nurses. faculty preparedness. The mission of the CNIA is to be the voice for Nursing Informatics in Canada. • • 9 . Canada's National Health Informatics Association. the Canadian Nurses Association has granted associate group status to the CNIA. and opportunities to enhance nursing curricula. funded by the Office of Health and the Information Highway.telecommunications industry. educational institutions and The Canadian Nursing Informatics Association In 2001. • the level of preparedness of nursing faculty to deliver these offerings. The CNIA is also affiliated with COACH. the Canadian Nursing Informatics Association (CNIA) received emerging group status from the CNA and affiliate status in 2003.

shortened to NurseONE to address this vision. NurseONE. The Canadian Journal of Nursing Informatics was launched by the CNIA in 2006. The Canadian Nurses Portal Project. A Kwantlen nursing faculty is a longtime member of the CNIA Executive Board. Initial goals of this e-nursing strategy include: • advocating for nurses' access to ICT and the resources required to integrate ICT into nursing practice. 7). multimedia. the Canadian Nurses Association launched the Canadian Nurses Portal Project. E-Nursing Strategy Over the last two decades Canadian leaders in nursing informatics have discussed and conceptualized a nation wide nursing informatics strategy that would benefit all nurses and nursing students. p. 10).The study was conducted across Canada and included a representative sample of nursing schools from across the country. in the form of a e-nursing strategy. supporting the development and implementation of nursing informatics competencies among the competencies required for entry-to-practice and continuing competence. June Kaminski (Kwantlen Polytechnic University. author of this informatics curriculum) was Director of Communications (and designer of the CNIA website) and is now the President of the Association. which invites papers. and other electronic media focused on the diverse arena of nursing informatics. and advocating for the involvement of nurses in decision-making about information technology and information systems. 2006. (Canadian Nursing Association. “The purpose of the e-nursing strategy is to guide the development of ICT initiatives in nursing to improve nursing practice and client outcomes” (Canadian Nurses Association. 2006. In 2006. p. • • 10 .

PDAs. Antiquated manual information systems and outdated 11 . station computers. the lack of access to modern information handling techniques and equipment. software. 2006. e.ongoing ICT skill development. the major obstacles to more effective nursing management of information are: the sheer volume of information. hardware. Nurses continue to respond to this growth with incredible mental agility. like hospitals and health care agencies in other countries. and the inadequate information management infrastructure. In Canadian health care delivery organizations. is enormous and continuing to grow. The volume of information that nurses manage on a daily basis. human beings do have limits and a major source of job dissatisfaction among Canadian nurses is information overload resulting in information induced job stress. 15). However. it is essential that nurses play an increased role in the development of ICT solutions” (Canadian Nursing Association. either for patient care purposes or organizational management purposes. 2. p.The e-nursing strategy will address these goals by adopting a three pronged approach: • Access – better connectivity in work environment.“as knowledge workers in this technological age. Competency. integration into nursing curriculum Participation .g. more access to a variety of computer technologies. • • OBSTACLES TO EFFECTIVE NURSING MANAGEMENT OF INFORMATION IN CANADA 1.

Yet. the nursing contribution to patient care is not even on the radar screen for the pan-Canadian EHR or any provincial EHR. that is to say nursing time and energy. St John Regional Hospital. The other major aspect is lacking in most hospitals and health services organizations.g. ISSUES RELATED TO EFFECTIVE NURSING MANAGEMENT OF INFORMATION 1. user training and information management support staff. At the time of writing. Lack of adequate educational programs in information management techniques and strategies for nurse clinicians and nursing managers. the Integrated Cancer Care Network of the Alberta Cancer Board. there are only a few pre-service nursing education programs in Canada offering a course in modern 12 . Software and hardware for modern electronic communication networks are only two aspects of an information infrastructure. 3. to say nothing of an inappropriate use of an expensive human resource.information transfer facilities are information redundant and labor intensive processes. the absence of appropriate infrastructure to facilitate information management. that is. Modern information transfer and electronic communication systems allow rapid and accurate transfer of information along electronic communication networks. methods for data stewardship and custodianship. Nursing documentation is being captured in some regional or facility based patient records e. Support staffs are necessary to support nurses in appropriately analyzing and interpreting aggregated information. Infrastructure includes but is not limited to: data management policies and procedures.

In any Canadian health care delivery organization. Regrettably. therefore. 2. the use of spreadsheets. provinces and national organizations. Ideally such courses would also introduce concepts and provide hands-on experience related to the use of patient care information systems. Nursing is frequently under represented in the decision making related to health information systems and EHRs in Canada. At a minimum. They then complain when the systems do not meet the needs of nursing. such a program must include advanced study of information management techniques and strategies such as information flow analysis. Leaders in provincial and federal EHR and health information systems initiatives must also recognize the importance of nursing input into the strategic planning process and decision/policy making related to such initiatives.information management techniques and strategies related to nursing. Canadian senior nursing executives must recognize the importance of allocating staff and money to participate in the strategic planning process and policy making for information systems and EHRs in their organizations. nurses are the single largest group of professionals using a patient care information system or EHR and nursing represents the largest part of the budget. Nursing. represents the single largest stakeholder group in Canada related to either patient care information systems or EHRs. databases and word processing packages. even when the opportunity is available. many senior nurse managers fail to recognize the importance of this activity and opt out of the process. CANADIAN INITIATIVES DIRECTED AT THE DEVELOPMENT OF NURSING COMPONENTS OF HEALTH INFORMATION (HI:NC) 13 .

1993a. Nurses built consensus (Canadian Nurses Association. To prevent nurses in Canada from losing control of nursing data. nurses must take a proactive stance and mobilize resources to ensure the development and implementation of a national health data base and a pan. 2001. relative to the health status of clients (McGee. 1993b.Canadian EHR that is congruent with the needs of nurses in all practice settings in Canada.In Canada nurses are in the fortunate position of recognizing the need for nursing data elements at the time when the national health infostructure is under development. colleagues on the NMDS. Building on work of our U. 1990. June). Under the leadership of the Canadian Nurses Association. and in response to contextual factors influencing nursing in Canada. The challenge for nurses is to capitalize on this timing and speak with one voice to promote the inclusion in the CIHI DAD and the Infoway EHR of those data elements required by nurses in Canada. nurses have more than 15 year of experience in initiatives directed at building awareness and consensus regarding the definition and coding of these essential nursing components of health information (Canadian Nurses Association. Some initiatives intended to promote the vision. are in progress. of nursing date integrated into the pan-Canadian EHR and national health data base. 14 .S. June). 2001. 1993). November) on the five essential nursing components of health information: • Client status is broadly defined as a label for the set of indicators that reflect the phenomena for which nurses provide care. nurses in Canada have recognized the importance of the collection and storage of essential data elements (Canadian Nurses Association. April. 1990.

2002) or an EHR such as that being developed under the leadership of Infoway.e. • Nursing intensity “refers to the amount and type of nursing resource used to [provide] care” (O’Brien-Pallas & Giovannetti. based on assessment of client status. which are designed to bring about results which benefit clients (Alberta Association of Registered Nurses (AARN). the CIHI DAD[Discharge Abstract Database] (Canadian Institute for Health Information. community care. 1993b).g.g. in the same way as medical diagnosis. • Nursing interventions refer to purposeful and deliberate health affecting interventions (direct and indirect). nursing diagnosis) are merely one aspect of client status at a point in time. acute care. 1993). It is one component of fully integrated health information data.The common label “client status” is inclusive of input from all disciplines. 1993) • Primary Nurse identifier is a single unique lifetime identification number for each individual nurse. public health) or employer. the five nursing data elements were identified collectively as the Nursing Components of Health Information (Health Information: Nursing Components. It is influenced to varying degrees by the interventions of all care providers. Therefore. This identifier is independent of geographic location (province or territory). HI: NC) (Canadian Nurses Association. Client outcome is defined as a “clients’ status at a defined point(s) following health care [affecting] intervention”(Marek & Lang. 15 . The summative statements referring to the phenomena for which nurses provide care (i. practice sector (e. 1994). e.

nurses faced an immediate challenge to determine the most effective and efficient means to collect and code data elements that reflect nursing practice. stored and retrieved from a national health information data base. At a time when we are in the midst of profound health care reform it is essential that nurses demonstrate the central role of nursing services in the restructuring of the health care delivery system. Nursing leaders must respond to the challenge to identify those data essential for the management of patient care and patient care units.Identifying those data elements that represent the most important aspects of nursing care is only the first step. Historically health policy has been created in the absence of nursing data. To collect the data reflecting nursing contributions within the larger health information system. The nursing components of health information have the potential to provide nurses with the data required to build information for use in reshaping 16 . In Canada. 1998). IMPLICATIONS OF THE NURSING COMPONENTS OF HEALTH INFORMATION The definition of nursing components of health information is essential to influence health policy decision-making. CONCLUSION It is clear that a priority for nursing in Canada is the inclusion in electronic health records and national health data sets of the nursing components of health information that have been identified. “there is a need for consistent data collection using standardized languages to aggregate and compare data” (Canadian Nurses Association. those essential nursing data elements that must be collected.

We must ensure that the vision of nursing components in our national health information system becomes a reality for nursing in Canada.nursing. 17 . the window of opportunity to have nursing data elements included in a national data set is narrowing. as a profession prepared to respond to the health needs of Canadians in the twenty-first century. However.

• The Europe Union (EU) is a driving force of healthcare informatics development by funding projects that are all crosscultural involving healthcare professional users. obliged to document nursing care (SFS. which is the practice of medicine and nursing over a distance where data and documents is are transmitted through telecommunication system. The main mission in Europe is to establish a stable infrastructure that improves healthcare quality. 1990). • • Widespread of use of IT in healthcare services is very limited in comparison to other areas of society. Electronic Patient Record • All RN in Sweden are by law. implementing and evaluating nursing care and that nursing diagnoses in the patient record is a part of that responsibility (SOSFS. social systems and other living condition. educators. since 1986. and administrators. • Telemedicine or telehealth. 18 . 1985) • Regulations emphasize that RN’s have an autonomous responsibility for planning. participating.Nursing Informatics in Europe • Europe is a continent with over 750 million inhabitants in about 50 countries with many different languages. cultures. widely always with three or more countries disseminated in parts over Europe. facilitates the reduction of errors and delivery of evidenced based and cost effective care.

The aim of the association is to support the development of standardized classifications. Intervention and outcomes (ACENDIO). which was established in 1995. 19 . and data sets for sharing and comparing nursing data. Provides resources for such as reference and lists and sample nursing methodologies developing evaluating publications and presentations to advance vocabularies and by providing interpretation of international standard for terminologies and classifications. • • Serves as a network for nurses in different European countries so that they can share knowledge about developments.Nursing Practice in Europe • Association for Common European Nursing Diagnoses. terminologies. ACENDIO • Supports the development of nursing informatics by biannual conferences. understanding.

telepediatrics 20 . Online technologies provide products and services that enhance patient care and improve clinical outcomes through evidence-based health information and decision support systems. 2001). Higher speed networks including wireless and broadband are enabling information in a variety of formats to be shared. The Web environment and the use of powerful integration engines.NURSING INFORMATICS IN THE PACIFIC RIM Trends in Healthcare New Zealand has seen more collaborative approach resulting in integrated care being seen as a priority. telepsychiatry. Integrated care is being supported by technology. it has a surprising number of health IT companies who are producing software that is being used both locally and internationally. Improvements in portability are now allowing the use of technology in a greater range of settings. Technology Trends New Zealand has been embracing changes in technology. Placed over multiple hospital information systems this connection provides a “single patient view” of data across all medical applications. the i-Health. Exploration into telehealth has occurred in a number of fields and including teledermatology. No longer is information restricted to individuals and organizations. Although New Zealand is a small country. is now providing contextual views of data that is browserbased and single logon. (Oakley. Personal Digital Assistants (PDAs) and tablets are being used in the clinical setting by students teleradiology.

1993 – Establishment of the National Health Data Dictionary. clinicians. This was followed by a number of projects initiated by the Australian government: HealthConnect. Such arrangements have reduced duplication and contributed to more effective and efficient management of infrastructure. MediConnect. Funding for the use of the technologies is probably one of the biggest limitations imposed in embracing new technologies to enhance care delivery. Current National Initiatives The New Zealand Ministry of Health. 1999 – The first national strategic information action plan. along with more than 360 projects. The report has also formed the foundations for long-term issues such as EHRs. the provision of quality health information for consumers known as HealthInsite. The report was produced by means of collaboration among industry. prepared a 5-year broad strategic directive for information and technology developments. Health Online was initiated. in 2001. Some Australian nurses are using PDAs for point-of-care information and clinical documentation for community and acute hospital nursing. government and healthcare managers. Following the WAVE report. 21 . the drive for collaboration from the bottom-up has consolidated as the district health boards (DHBs) replace their isolated departmental systems with more integrated and dynamic Web-based technologies that support a more connected delivery network.and healthcare professionals. hospital-based infection control and wound management. referred to as “The WAVE Report”. Nurses need to be prepared to work alongside and use technology to best care for clients.

2005 – It was expected that a strengthened governance model with greater central leadership will be implemented to enable better use of information technologies. Vocabulary – codes for medical and other healthcare terms. the Ministerial Committee on a Health Information Standards Organization (HISO). HISO. standards development processes. Standards Development and Adoption The minister of health directed that a WAVE working group. and presents a clear statement of the proposed plan. HISO enhances the New Zealand eGovernment Interoperability Framework (e-GIF) direction. Security and privacy – how access to information is managed. HISO’s role is aimed at the acceptance throughout the health and health-related industries of such standards. and supported by the Ministry of Health produced the New Zealand Draft National Health Standards Information Plan (NZHSP) to assist in its role of developing health information standards for the health and disability sector. be established to investigate the implications of establishing a nonstatutory organization to manage health information standards. The availability of detailed and clinically relevant data is essential for clinical care decisions and 22 . Messaging – standards used for interchange of data. The HZHSP proposes a framework for describing the sector priorities. The overall aim is to improve health outcomes while containing cost increases driven by advances in medical technologies and an ageing population. The scope of development activities that HISO will be involved with includes standards associated within the following categorization scheme: • • • • Records structure and content – data formats. governance and leadership.

for example. This includes providing immediate feedback to care providers by. In the New Zealand. Standardized terminology systems are essential to permit the use and exchange of clinical data across applications and IT systems. In July 2004. CEBNA is a partnership between the Auckland District Health Board and the University of Auckland. an international not-for-profit foundation working toward interoperable lifelong EHRs. This represents a small step toward the implementation and an increase in the adoption of available standards.for oversight groups making decisions related to the quality of that care. exchanging critical patient information in a timely manner across the healthcare continuum. School of Nursing. this is demonstrated by The Centre for Evidence Based Nursing – Aotearoa (CEBNA) and the New Zealand Guidelines Group (NZGG). Give point-of-care documentation. It collaborates with the Joanna Briggs Institute for Evidence Based 23 . NHIG endorsed L7 as the standard for healthcare messaging in Australia. Research Health-related information has a number of uses. Archetypes are constraint-based models of domain entities and were first defined by the Australian-based OpenEHR group. Apart from the direct use of information in the care of clients. Two specific areas that are currently gaining more attention within NI are clinical pathways and evidence-based practice. there is a growing awareness of the need for timely and accurate data for research. technology is now available to build electronic health information systems that will efficiently meet a variety of needs. and reducing provider burden associated with current documentation requirements.

These centers are committed to an evidence-based approach to healthcare and to promoting an evidence-based culture in nursing. These are indexed in CINAHL and provide a good overview of progress in health informatics in Australia. most commonly from secondary school. enters with increased computer skills than ever before. NI has been recognized as significant by the Ministries of Health and Education since the early 1990s. in an Autralasian-wide collaboration. the changes in health service delivery in New Zealand and the 24 . that includes centers throughout Australia. Undergraduate nurse education reflects the need for computer literacy. It is funded by the Ministry of Health and through contracts with other health agencies such as ACC. the lead.Nursing and Midwifery. centre. It is anticipated that this will change in the near future as part of the Australian government’s health workforce capacity building initiative. A national “Guidelines for Teaching Nursing Informatics” curriculum was introduced into the undergraduate preparation of nurses programs in 1991. Since the mid-1990s nurses registering for practice in New Zealand also complete an undergraduate degree. Education In New Zealand. and Singapore. Hong Kong. HISA organizes an annual conference where between 40 and 60 papers are presented each year. Health informatics does not exist as a research category for the major government research funding organizations which makes it difficult o obtain research funds from these organizations. Furthermore. NZGG is an informal network of expertise and information on guidelines development and implementation. The new nursing student.

Most universities offer one unit of study within their undergraduate nursing pre. While NI as a postgraduate specialist subject has not been recognized in New Zealand. The University of Auckland commenced offering postgraduate programs that include courses in health informatics in 2001. the University of Otago offered for the first time a diploma in health informatics. Informatics education for nurses in Australia varies considerably from one university to another. nurses are favouring the health informatics options.establishment of new roles and career opportunities for nurses are drivers for an increased demand for postgraduate nursing education. there is active resistance to its introduction. CHAPTER 40 25 .and postregistration programs as an elective. In 1998. Nurses are found throughout the country and the nature of nursing necessitates shift work. In some instances. This enables all registered nurses either to obtain a double degree or convert their hospital-based certificate into a Bachelor’s degree. often in environments where fellow nurse academics have little or no knowledge of informatics. Some schools of nursing integrate informatics into their undergraduate nursing program to some extent. Both tertiary education providers have given nurses the opportunity to study informatics in abroad context alongside other health professionals. The first Australian experiences of nurses using computers were compiled into a edited text by Graham MacKay and Anita Griffin in 1989. which is generally based in urban areas. Most have one person attempting the impossible. Yet there have been barriers to nurses accessing postgraduate education.

 SOUTH KOREA Comprises of 8 provinces with 7 metropolitan cities. creates a forum for sharing of experiences and knowledge among both experts and users of these countries. 720. Billing. China and South Korea has been expedited by the hosting of the International Medical Informatics Association (IMIA) triannual conference in 1980. as well as within the information technology industry and via related government organizations. 1989. This chapter provides historical events of nursing informatics in  South Korea  Japan  Taiwan  China  Thailand The progress in Japan.-----organizes conference .licensed midwives and nurses (81. Education. Total population: 47 million in 2002 190. seminars and workshops.Now these countries are moving toward implementing paperless electronic health records.computers were first introduce in Asian Countries.and 1997.478 are practicing) departments and existing professional 26 . The adoption of Informatics in Asian countries occurred in Nursing care practice. The first applications of information technology in healthcare in Asian countries were in Administration. and Insurance.NURSING INFORMATICS IN ASIA 1970s. and research organizations.

International Medical Informatics Association. IMIA conference MEDINFO98 held in Seoul----provided an excellent opportunity for Korean nurses to become acquainted with NI. USE PRACTICE Year 2000—according to report published by Korean Health Industry Development Institute that has hospital information system: 100%.Use of computers in South Korea healthcare began - Used in hospital finance and administration system to expedite insurance and reimbursement.- Health informatics in Korea grown with the professional outreach activity of KOREANN SOCIETY OF EDICAL INFORMATICS (KOSMI) as well as with the help of: - Government Private businesses Academic institutions Medical and Nursing organizations HISTORY OF NURSING INFORMATICS IN KOREA 1970. -Since Nursing informatics Group was held its own session at biannual conference of KOSMI. 1993.Teaching hospitals OF INFORMATION TECHNOLOGY IN CLINICAL 27 . 1987.The Nursing Informatics Special Interest Group was organized as one of five special interest groups of the KOSMI.Korean nurses represented the country at IMIA-NI Group ( International Medical Informatics Association). 1995.KOSMI (Korean Society of medical Informatics) was founded and introduced the term “Health Informatics” and “Nursing Informatics” in Korea. IMIA.

General hospital 75%. -The nurse work list could be viewed on screens or printed so that nurses did not need to copy medication schedules or care activities onto Kardex.Private clinics All Teaching Hospital and 40% of General Hospital Use Order Communication System---Which enable physician to communicate with other departments for practice related requisitions and the retrieval of data. while the remaining offer introductory computer courses. HEALTH INFORMATICS EDUCATION According to recent survey in health informatics as computer education program in South Korea 21% of nursing schools and 25% of medical schools—offer health informatics courses. -Most nursing schools in Korea are adding informatics to graduate curricula—so that graduate students can take informatics courses as an elective. patient-care departments component could added---These system allowed physician to enter medical orders computer and major receive requisitions and enter test results. -Some administration directly into hospitals and initially later used a computers mainly for was billing. and to communicate electronically with other non-healthcare team members. Home Healthcare System-Community based practice They use laptop computers to note and check medication and progress on electronic patients record.96%. 28 .

North American Nursing Diagnosis Association NIC. The majority of existing nursing terminologies: • • • • • NANDA. TECHNOLOGY TRENDS -The need for telemedicine continues to grow in Korea with an increasing numbers of elderly. GOVERNMENT INITIATIVES -The Government has contributed to the development of health information by funding or other incentive and guidelines in telemedicine. patients with chronic disease.Telecare at home--Telepractitioners at these centers 29 .Nursing Intervention Classification HHCC.STANDARDIZATION ACTIVITIES There are Korean representative actively involved in several international initiatives toward the end such as INTERNATIONAL ORGANIZATION for STANDARDIZATION/TECHNICAL COMMITTEE 215 and Health level seven. 2. and patients who are discharged early. South Korea advanced Research Network---which is mainly use for research activity. Nationwide commercialized network built by telecommunication companies. 2 Information Highways 1. Example of telemedicine: 1.Nursing Outcome Classification ICNP.International Classification for Nursing Practice.Home Healthcare Classification NOC. emergency medical systems. infectious disease reporting system and standardization.

teleconsultation fee is reimbursed by Health  JAPAN Population: 127 million –twice that united kingdom---half that of US Number of hospitals: 10. and their financial contribution to health insurance.maintain special schedules for their remote clients. 000 yen to the medical treatment of a person over 1 month. 1980.Japan hosted the IMIA (International Medical Informatics Association) conference MEDINFO80. JAMI. 000 hospitals Number of nurses: about 750.Japanese Association of Medical Informatics was also founded during 1980s with the aim of supporting health informatics in Japan.Japan began to pay attention to the use of computers in healthcare. --In Japan all citizens can choose healthcare institutions and doctors freely.—260. -Standardization is one of the problems in the use of Healthcare medial doctors—90. 000—including 220. 000 dentist—230. -currently. -The hospitals received reimbursement for the balance from the national health insurance. -The Japanese government contribute maximum of 70. 000 30 . 00 nurses aides. HEALTH INFORMATICS IN JAPAN 1970s.000 pharmacist. -They set aside 1-2 days per week to take care of their clients using virtual reality technology via the Internet. Insurance.

was organized by IMIA was held in Tokyo. 31 junior colleges. There is little development of educational tools 3. 120 universities and 45 graduate schools in Tokyo Japan. Barriers to the development of NI in Japan: 1. MEDINFO80.---some baccalaureate programs and graduate schools include NI courses in their curricula. NURSING INFORMATICS PRACTICE -The Japan Nursing Association does not recognized the training for electronic health record and information systems. 1990s. and there are now 100 universities offering baccalaureate programs and 40 universities offering graduate p0rograms.information technology that needs to be resolved. NURSING INFORMATICS EDUCATION April 2004. There are few researchers and educators in Japan 2. HISTORY OF NURSING INFORMATICS IN JAPAN 1980. The cost of improving the network and computer environment is high.The Third International Congress on Medical Informatics. -The Japanese Nurses Association prepared course of nursing information management as first step of continuing education curriculum for ward managers. -Universities provided elementary computer literacy education during the first half of 1990s.there were 486 professional schools.Nursing education in Japan rapidly shifted to a more academic orientation. -Hospitals are looking for new healthcare staff with knowledge of both healthcare and information technology who can control 31 .

Only 5 and 20% of registered nurses in China have baccalaureates and 3-year diplomas. China According to the Fifth National Census reported by the National Bureau of Statistics. Labor and Welfare announced a grand design for healthcare. The population is aging fast. respectively. nursing actions and observation items in nursing terminology are available to the public since 2004. the majority of the population is found in rural areas. and thus the overall healthcare level. -Nursing terminology are currently under development. and economic development of the whole China is influenced by healthcare 32 .96% of the population in 2000 compared to 5.3 billion in 2000. the population of China was almost 1. The Ministry of Health.57% in the 1990 census. indicating that the use of such system is very useful for the medical profession. In China. stability of society. and set the following achievement goals for 2006: 1) Electronic Health Records will be introduced into 60% of hospitals with more than 400 beds and of 60% of clinics . 2) The electronic health expenditure payment system will be introduce into 70% of all hospitals. -Continuous 24-hour observation of nursing care can be shared. JAPANESE GOVERNMENT INITIATIVES AND STANDARDS DEVELOPMENT IN JAPAN -The standardization of medical information is one of the main themes in healthcare sector.information flow. with those 65 years old and older representing 6.

and the development of a patriotic health campaign. and training hospital information management staff. the training of healthcare staff. and its activities include holding national and international academic collaborations and exchanges. This is an academic group and is a member of the IMIA.services in rural areas. and its activities include holding academic seminars. hygiene education. The primary healthcare systems in rural China include providing medical services. The China Medical Informatics Association (CMIA) was founded in 1981. The SARS epidemic in China leads to reconsiderations of the current healthcare systems in rural areas. The Chinese Hospital Information Management Association was founded in 1996. There are two other professional societies related to medical informatics in China: the Chinese Society of Medical Information and the Chinese Hospital Information Management conferences Association. and The Chinese Society of Medical Information was founded in 1993. continuing education. The SARS epidemic also led to suggestions of an integrated system for responding to public health emergencies and for disease control and prevention. and that a new system of cooperative medical care and new salvation system of the poor should be set up to ensure health in rural areas and enhance the stability of society and economic development of country. Some Chinese consider that more effort should be devoted to epidemic prevention. and training. establishing rules and standards of national hospital management. Nursing Information System in China The development of nursing information management 33 .

systems began in China in late 1970's and they were first used in 1987. at least one computer course is required at the baccalaureate 34 . and finance and economics. nursing operation work. History of Nursing Informatics in China The Nursing Informatics Special Interest Group with 20 hospital nurses was founded as a branch of the CMIA in 191. The first software implementation was a computer-assisted primary nursing care system. Some examples include a nursing information system for the management of nursing staff. The term NI was first used in the Chinese literature in 2002. By 2001. A year later an expert group for nursing information technology was founded by the Nursing Department of the Chinese Ministry of Health. its mission being to establish criteria for nursing management and the training of nursing administrators for nursing information management. and this led to the application of information technology in the field of nursing science for education and research. The development of information management systems for nursing in Chinese traditional medicine began in 1994. systems and an for nursing records nursing and nursing management based on an army satellite project called the No. The first article referring to the term “nursing information science” appeared in China in 1999. Nursing Informatics Education Higher nursing education was introduced in 1983. continuing education. scientific research. nursing Project information of PLA. 1 Internet-based information management system.

Thailand Thailand has a population of about 65 million living in 76 provinces. staff management. Several expert systems for nursing diagnoses. and nursing assessment have been reported. Nursing Informatics Practice The use of NI in clinical practice in China includes nursing quality management. 707 community hospitals. with only 30 research articles published in domestic nursing journals from 1994 to 2004. Distance learning is also being used for nursing continuing education in China. There were 92 regional/general hospitals. According to a literature review. and 9.level. computer-assisted instruction began at nursing institutes in China during the mid-1990's.6 and 74. respectively. and training clinical skills for staff nurses. nursing information management. Nursing Informatics Research NI is at its infancy in China. The major weakness of nursing information management systems in China is the lack of national standards and the low level of computer literacy and informatics skill exhibited by nurses.7 years. nursing care plan. The life expectancy of males and females is 71.559 health centers across Thailand in 35 . and nursing students can select other computer courses as elective courses.

Development of an NMDS There were 23 items of nursing data identified. The NMDS was identified as essential for developing an efficient nursing database. Mahidol University. considered it important to provide nurses with the means of using information technology. Areeya Suppalak. and the MOPH Nursing Division to develop the ideal nursing minimum data set (NMDS) and a preliminary nursing classification system. 36 . as well as to contain healthcare expenditure. admission number. including patient name. Mrs. hospital number. The nThai government is restructuring its healthcare system by placing more emphasis on primary care and health promotion. and the Ministry of Public Health (MOPH). Ramathibodi Hospital. the Thai MOPH began to implement a national health information system which included the development of a nursing component. The NI was introduced as small special interest groups and later expanded to the national level through the support of the Nurse's Association of Thailand. The Development of a Health Information System In 1997. The former director of the MOPH Nursing Division. Funding was received from the WHO in 1999 as a result of a collaborative effort between the Center for Nursing Research at the Department of Nursing. The Faculty of Medicine.2004 The government is currently launching a Universal Healthcare Coverage policy in order to improve the access to and quality of healthcare. the WHO. ID number.

patient's address and phone number. discharge/expired date. The ICN therefore committed itself to the development of an international nursing taxonomy (i. birth date. nursing intervention. referral. discharge plan. gender. in 1999. 37 .e. Professional Outreach The Thai Medical Informatics Society (TMI) introduced the concept of medical informatics into Thailand. patient and family medical history/allergy. The ICNP is currently used as a basis for the data set describing the nursing care of patients and their families. endorsed the development of the ICNP and agreed to translate it into Thai and validate an alpha version thereof. Korea. under the former president Dr. education. Later. and home visit. admission date medical diagnosis. The Nurse's Association of Thailand. religion. Tassana Boontong. The founders were a group of medical professors whose original idea was to apply computer technology to medical care. health insurance. address and phone number of significant person. nursing problem. nursing outcome. the translation of the beta version of the ICNP was completed. The content was further revised for improvement as the Nurse's Association of Thailand continued to further develop the nursing classification. laboratory test. the ICNP). condition before discharge. ICNP Translation and Validation A resolution o developing an international nursing language was adopted during the 1989 ICN meeting in Seoul . validated and disseminated.

Being the center for the coordination of the medical information exchanges 5. and information sharing for the development of medical informatics in Thailand 3. To support those who practice medical informatics 5. Being the center for information and ideas focused on the development of medical informatics The TNI supports the development of NI. To not be involved in any commercial or political activities The main activities of TMI are as follows: 1. To provide suggestions and recommendations for medical information sectors both within and outside the MOPH 6. especially nursing databases using the ICNP. The activities of TNI are as follows: 1. Supporting the meeting. training. Publishing and distributing four issues of documents per year as approved by the board 4. Holding an annual conference 2. To develop means for the management of medical information in administration and academic areas 3. To be the center for coordinating and distributing medical information 2.The main objectives of TMI are as follows: 1. To exchange information and experience in medical informatics 4. Holding a joint annual meeting with the Nurse's Association of Thailand and TMI 38 . The Nurse's Association of Thailand currently aims to develop a standard nursing care pla for clinical applications using the ICNP.

serving a population of 22. with only around 40 39 .000 healthcare professionals in Taiwan in 2002. Publishing and distributing its newsletter every 4 months 3.3% registered nurses and 17. Nursing Informatics Research NI research is still at its infancy in Taiwan. Although a formal master's program focusing on NI was not available until 2001. Supporting other academic and research activities in NI 4. Responding to the NI training needs of Thai nurses Taiwan There were 610 hospitals and 175. and scheduling.7% licensed practicing nurses. computers had been used in nursing education. Since the 1980's. and patient nutrition. maternal child health. The healthcare professionals included 34. Online courses are available for baccalaureate programs in counseling. The content includes diet education for diabetic patients. and long-term care. stress management. At that time the focus was on hospital information systems providing nursing data such as personnel information. biostatistics. teaching principles and strategies. Nursing Informatics Education Computer-assisted instruction programs have been developed by the Ministry of Education for nursing vocational education programs since 1986. History of Nursing Informatics in Taiwan The term NI was first used in Taiwan in 1990. care planning.2. All baccalaureate programs included at least one or two computer courses.5 million.

decision support systems to test the integration of medical diagnoses and nursing diagnoses. and tests of their reliability and validity have been proposed in Taiwan. Standardized terminology such as existing nursing diagnosis classification systems and the ICNP has been translated for clinical use.papers published in domestic nursing journals in the period 19942003. To identify some initiatives in the field. Quantitative approaches such as surveys have been applied to investigate the attitude and satisfaction towards the use of PDAs for charting and for storage of nursing records. and expert systems implemented on PDAs for the emergency triage system have been reported. Nursing Informatics in South America What is the objective of this chapter? • • To present an overview of the development of Nursing Informatics in South America. Nursing Informatics Practice Computerized care plans are now common in clinical use. Qualitative approaches such as interviews have been used to explore how well nurses will accept the change from manual charting to computerized documentation. PDAs have been recently used by nurses in their daily practice. Moreover. including discussion 40 .

• To identify imitative to disseminate nursing informatics resources in the region. Nursing research 5.on the current user of terminologies. Health institutes and universities are exploring ways to introduce news resources on order to facilitate the process of the patient care and promote quality and safety. Administration • • • The growth of information technology in Latin America and the Caribbean was been consistently The world’s highest for 20 years. ----Technology is visible tendency in 1. Introduction: • Nursing Informatics in 13 South America countries has been based more on ACTIVITIES of INDIVIDUALS than on a policy established by governments or national efforts. Nursing Practice 4. 41 . BACKGROUND: • Historically nurses are used to facing challenges. Health 2. adapting new tools in to the practice to improve their performance. • Each country has varied levels of development and deployment of technological resources. Nursing Education 3. Most developed parts of the country have better access and ability to implement services and applications in nursing.

--peolple are able to connect to the internet information. --In result we can expect to see better.making process in the health care area. ---the more specific information in place to support clinical decisions.informed healthcare providers and consumers. • In this. • Information is the key element for decision.• • Creating new models to enhance patient care. the Pan American health organization (PAHO) has published guidelines and protocols to orient the development and deployment of information and communicating technology in Latin America and Caribbean (Pan America Association) World Health Organization that is a telecommunication resource with no parallel to fast exchange data and 42 . the better care can be delivered to the patient. Technology can represent a unique instrument to help nurses to face further challenges and discover how to use its resources to involve and maybe to design their way taking care of the people. • Technology plays an important role in facilitating access to the information because for the information to be useful and meaningful. it has to be timely. there is a clear trend in the direction of the computerization of health records. • Considering trends and tendency in healthcare informatics and to facilitate the process in South American countries.

A study performed by the PAN America health Organization/ World Health organization information. 43 . 2001 and 2003. Brazil 2. 1. • The hospital sector can be considered the area better served by information systems. • Hospitals have been working to design their own systems in order to attend to specific needs and policies. computer and social infrastructure is evolving rapidly. Colombia 5. In general… Patient data that are also used for nursing administration are integrated in the systems or nurses have to collect and analyze nursing data separately. Mexico 3. Paraguay These countries have clinical information systems in hospital or health institutes.) • • Latin America and Caribbean region rank third in information technology expenditure. Nursing Informatics Initiatives In South America countries… • The initial motivation to develop computer systems in yhe healthcare area was driven by financial and administrative concerns.1991. Argentina 4.

nursing schools and hospitals initiated programs to prepare nurses to use computers.• • • • National and International software industry become more represented in South America health care worker. To meet education and training needs. conferences. Congress. They provide a broader range of solutions with systems that address patient are documentation. education and training programs are being organized in the countries to share experiences and information in nursing searching for solutions that could enhance the delivery of patient care. • Computer applications in nursing education from a passive teaching to an active changing nursing education from a passive teaching to an active learning process. Most of the computer systems implemented is intended to control administration data. They become “computerLiterate” in order to use computer technology in a efficient manner. Nurses became the PRIMARY USERS. responsible for data input. workshops. Distance Learning and the educational perspectives in Nursing Informatics • • • • Technology is transferring not only nursing practice but also nursing training and education models. NIEN/UNISEF 44 . • The NUCLEO de Informatica em Enfermagen at Universidad de Federal de Sao Paulo (NIEN/UNISEF) was the first center to offer the specialization degree (certificate) in South America.

the nursing informatics discipline in its graduate and undergraduate nursing programs. The Latin America countries are investing a significant effort to prepare professionals in health informatics. an exchange protocol and a common language. • The language includes an alphabetic words. o The research “line” in nursing informatics is attended by professionals from different regions of the country and has been responsible for the preparation of several master and doctoral students in nursing informatics.phrases and symbols that express and assign meaning.o Provides since 1989. o The student after graduation return to their own instates to implement education and research programs and to participate in the development of patient care systems. understood by all users ( PAN America Health Association/world health Organization. 45 . Exchange of information requires the communicationg parties to agree on a communicating channel. Nursing Terminologies and Documentation • • Sharing and communicating information is essential to make decisions and deliver care.1997) CLARK (1995) Pointed out that “communicating among ourselves has always been important but communicating with other people about nursing has acquired a new urgency since we are forced to recognize that the value of nursing is no longer apparent to those who have the power to influence our practice”.

---The development and deployment of nursing informatics is dependent on national priorities and human capabilities.Other issues to be considered: • Reimbursement Policies Cost containment Technological development in recent years Nurses’ responsibility to decide not only what kind of data is important to describe the continuous care but also to decide how these data could be described. new areas and new jobs demanding experts. There are new roles. Because of the variety among countries and even inside larger countries. the development of nursing informatics is conducted on a case-by-case basis. Adapting technological resources to their practice help nurses to see emerging trends in healthcare field as challenges and unique opportunities for career growth. taking into consideration the specific requirements of each region. Opportunities are wide open for those 46 . ---The situation represents a great oppurnity for nursing. SUMMARY Nursing Informatics as an integrated part of health follows the progress that has been made in the whole sector of health informatics. The future is exciting because with technological advances nurses have the change to drive their own professional destinies.

who have decided to incorporate information technology into their daily practice in the process of taking care of patient. 47 .


reduce costs. we can avoid dangerous medical mistakes. and improve care. high performance computers. sure or The types of IT needed to support these new approaches to healthcare are grid technologies. and robust integrated information systems based on standards. The scenario begins and ends with the generic information (whether the concerns of the nurse are prevention. Bush – State of the Union Address – January 20. K. rehabilitation).Chapter 42 – Future Directions (part 1 of 2. A President and a Secretary of Health Decree Acceleration “By computerizing health records.” George W. NA compared to normal persons) ♥ Have the mechanism identified on the way that enzymes (such as lipase) either work correctly or incorrectly in the metabolic process. 2004 “Modern technology has not caught up with a major aspect of healthcare and we have got to change that” 49 . diagnosis. PP 671-674) The New Twenty-First Century Scenario The new science is revolutionizing the way we conduct science and the way we will: ♥ Prevent disease and diagnose and treat patients ♥ Also allow the nurse to point to the particular patient’s reason for a disease (eg: MI – whether the person can regulate CA.

” Dr.000 more nurses prepared in information sciences to move in this direction. the announcement of President’s Bush’s groundbreaking Health Information Technology (HIT) Plan was made during his speech at the American Association of Community Colleges Annual Convention in Minneapolis. Brailer. including a doubling of demonstration project funding to $100 million in the President 50 . 2004.000 more physicians and 6. Charles Safran – the former President of American Medical Information Association (AMIA) A Nation’s Health Information Technology Plan: ♥ The federal government to accelerate the identification and adoption of voluntary standards necessary for the safe and secure sharing of health information among health providers. MD. a sub-Cabinet level post at the Department of Health and Human Services (HHS) on May 6.♥ On April 27. PhD – the first National Health Information Technology Coordinator. David J. 2004. ♥ Increased money for demonstration projects involving modern electronic records systems that test IT and establish best practices for wider adoption. ♥ The president set a 10-year goal for a majority of Americans to have EHRs when and where they are needed. in May 2005 he indicated that he will unveil a plan to lead collaborative state efforts to create a digital health care environment. “We will need 6. Michael Leavitt – Secretary of DHHS. MN. ♥ EHRs that are designed to share information privately and securely among and between healthcare providers when authorized by the patient.

♥ Second – HHS has commissioned the Institute of Medicine (IOM) to design a standardized model of an HER. National Standards Endorsement on July 1. leading to reduced medical errors. improved patient care and reduce healthcare costs: ♥ First – the department had signed an agreement with the College of American Pathologists (CAP) to license the College’s standardized medical vocabulary system (SNOMED) and make it available without charge to throughout the US.Bush’s budgets. model once it had been designed. The HL7 – a healthcare standards development organization evaluated the 51 . 2003 Honorable Tommy Thompson – former secretary of HHS. announced two new steps in building a national electronic healthcare system that allowed patients and their doctors to access complete medical records anytime and anywhere they are needed. ♥ Creating federal incentives and opportunities that encourage healthcare providers to use electronic medical records. These actions open the door to establishing a common medical language as a key element in building a unified electronic medical records system in the US.

American Hospital Association and Cap Gemini study forecasts top issues: ♥ Patient safety ♥ Rising costs and limited access to capital. ♥ Upgrading the security on IT systems to meet the Health 52 . people. Several Drivers of More Information Technology Today Healthcare and hospitals are increasingly investing in IT to deal with several issues. organizations and policies are dominant forces 90% of the time and IT is only 10% of the implementation.In the past 25 years of implementing systems. ♥ Scarce labor pool of nurses ♥ Complexities of healthcare conditions ♥ Complexities of medical reporting ♥ Competitions HIMSS Leadership Healthcare CIO Surveys: ♥ A way to monitor the trends in the US healthcare IT is from the Healthcare Information Management Systems Society (HIMSS) annual survey of healthcare Chief Information Officer (CIO).

Insurance Portability and Accountability Act (HIPAA) ♥ The top technologies that the CIOs predict for the future were: » High speed networks » The internet » Client server systems » Wireless information systems Trends Toward 2030: ♥ Demographics – the graying of America ♥ Growth in Chronic Disease ♥ Emerging infectious disease threats ♥ Changes in health-seeking behavior toward the internet ♥ Focus on quality = focus on IT ♥ Security and biodefense ♥ Genetic revolution Demographic Trends » The US population will shift toward an aged population in the next decade. 53 . » Aged persons have more health conditions. thus shifting the focus form a youth-centric to an aged-centric culture. take more medications and require more procedures than the younger persons.

diagnosing. » New predictions by Olschansky warn us that this influx of aged persons might cease and the mortality might actually decline in the new century because of infectious diseases and obesity that claim lives at any age. 54 . and delivering care to this population.» There will be an increased focus on preventing.

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