Definitions: 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. Thus we have, medical informatics, nursing informatics, P Hebda (1998 p. 3), defines nursing informatics as "the use of computers technology to support nursing, including clinical practice, administration, education, and research." Pharmacy informatics and so on. 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 Framework of nursing informatics: The framework for nursing informatics relies on the central concepts of data, information and knowledge: Data is defined as discrete entities that are described objectively without interpretation Information as data that is interpreted, organized or structured Knowledge as information that has been synthesized so that interrelationships are identified and formalized. Resulting in decisions that guide practice The management and processing components may be considered the functional components of informatics. MANAGEMENT & PROCESSING Data Information Knowledge Nursing Process Enables the professional nurse to be the Coordinator of each patients care Communicate & coordinates care with ALL other clinical disciplines Coordinate discharge planning, education & teaching, transition of care Manages ALL information related to the nursing process and patient Because information management is integrated into the Nursing Process and Practice, some Nursing Communities identify a 5th step in Nursing Process DOCUMENTATION Automation of Documentation Up-to-date, accurate information of each step of the Nursing Process is the Po Successful Automation Successful implementation of information Systems requires well designed systems that support Nursing Process within the culture of an organization and/or

specific care providers Acceptance & integration of information systems into the regular workflow of nursing process & patient care Resources that can support the above Support nursing work processes using technology Design systems to match clinical workflows Tele health were behind safe, high quality patient-centered care

Home health Ambulatory care Long-term care Acute care all specialties Outpatient settings Software development Redesign work flows

The Value of Nursing Informatics Increase the accuracy and completeness of nursing documentation Improve the nurses workflow Eliminate redundant documentation Automate the collection and reuse of nursing data Facilitate analysis of clinical data Nursing Informatics promotes and facilitate. Access to resources and references for nurses and the e Benefits for nurses and the interdisciplinary team: Support for their mission to deliver high quality, evidence-based care Support for better service by facilitating true interdisciplinary care Promotes improvement in key relationships with physicians, peers Interdisciplinary care team members, patients & families Benefits in the administrative setting Support for cost savings and productivity goals Facilitate change management . The goal of Nursing Informatics;- is to improve the health of populations, communities, families, and individuals by optimizing information management and communication. This includes the use of technology in the direct provision of care, in establishing effective administrative systems, in managing and delivering education experiences, in supporting life-long learning, and in supporting nursing research. Scope of Standards of Nursing Informatics Practice - American Nurses Association 2001

Clinical Work Information and Communication technologies Organisation of medicine and health care

Stages of Model of Nursing Informatics Assesses and understands what and for what reasons things happen Assesses and understands the context and identifies consequence s for clinical work and imperatives for change Selects and prioritises opportunities, problems, imperatives and requirements for change Knows of appropriate technological developments and relates them to information requirements; knows of opportunities and imperatives for change

 Creates an information and technology and strategy plan Involves, informs, persuades, prepares for these technologies and other changes Plans and introduces new technologies and other changes Evaluates, reviews and assesses the impact and values it select the appropriate information and communication technologies, involve perceived beneficiaries, identify the prospective benefits, successfully plan, implement and evaluate the impact of change General purpose of Nursing Informatics The main point of nursing informatics is to use technology to enhance patient care and nursing practice. Nursing informatics is a narrower, specialized field inside of the wider medical informatics. Nursing informatics represents the way that nurses utilize technology in their daily duties. This includes using the latest developments to help make nursing more modern and efficient while still providing excellent personalized patient care. Indeed, with nursing informatics, it is often easier to give the proper individualized patient care because the vital statistics that nurses need are often right at their fingertips. Nursing informatics is a way of keeping patient information properly organized. with what they need. change of shift runs smoothly, and time isnt taken up with trying to convey information. results. The idea is that technology and information should be easily accessible to nurses so that they can do a better job of caring for their patients

nurses make better decisions. Nursing skill need related to informatics and technology: Use information and communication technology to document and evaluate patient care, advance patient education & enhance the accessibility of care. Use appropriate technology to assess and monitor patients. Work on an interdisciplinary team to make ethical decisions regarding the application of technologies and the acquisition of data. Adapt the use of technologies to meet patient needs. Teach patients about health care technologies Protect the safety and privacy of patients in relation to the use of health care and information technologies. Use information technologies to enhance ones own knowledge base.

APPLICATION OF NURSING INFORMATICS IN NURSING PRACTICE, EDUCATION & RESEARCH Definition: In 2008, the American Nurses Association (ANA) defined this growing field in its Scope and Standards for Nursing Informatics Practice as a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, knowledge and wisdom in nursing practice. Goal: The goal of Nursing Informatics is to improve the health of populations, communities, families, and individuals by optimizing information management and communication. This includes the use of technology in the direct provision of care, in establishing effective administrative experiences, in supporting life-long learning, and in supporting nursing research. (ANA, 2001) History: Early hospital computer systems developed from business computing systems in the late 1950s and early 1960s, and were used for accounting, billing, inventory and similar business-related functions. Others were developed during the 1960s primarily for storing patient information to be used by medical staff. Nurses have worked in informatics roles for over twenty-five years, but the phrase nursing informatics was not seen in the literature until 1984. Since 1984, nursing informatics has established itself as a specialty in the nursing field. Nurses identified as informatics specialists numbered 15 in 1981; there were over 5,000 by 1991 (Saba& McCormick1996). In 1992, the American Nurses Associations Congress of Nursing Practice supported the recommendation of the Council on Computer Applications in Nursing to officially recognize NI as a nursing specialty .

APPLICATION OF NURSING INFORMATICS IN CLINICAL PRACTICE: NURSING INFORMATICS AND NURSING PROCESS The nursing process is the core of patient care delivery. In the nursing process continuum, nurses are constantly faced with data and information. Data and information are integrated in each step of the nursing process: Assessment Diagnosis Planning Implementation and Evaluation

Practical application (Point-of-Care Systems and Clinical Information Systems) Work lists to remind staff of planned nursing interventions Computer generated client documentation Electronic 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 pathways, automatic billing for supplies or procedures with nursing documentati Monitoring System: Comprehensive patient monitoring systems that can be configured to measure and display various patient parameters.

Pulse Oximeter: Measure the arterial haemoglobin oxygen saturation of the patient's blood. Intracranial Pressure Monitors: are connected to sensors inserted into the brain through a cannula or bur hole. Apnoea Monitors: Use electrodes or sensors placed to detect cessation of breathing, display respiration parameters, and trigger an alarm. Ventilators: Consist of a flexible breathing circuit, gas supply, heating/humidification mechanism, monitors, and alarms

Infusion Pumps: Employ automatic, programmable pumping mechanisms to supply the patient with fluids intravenously or epidurally through a catheter. Crash Carts: Also called resuscitation carts or code carts, are strategically located in the ICU for immediate availability when a patient experiences cardio-respiratory failure. Intra-Aortic Balloon Pump: Use a balloon placed in the patient's aorta to help the heart pump. Clinical Information System: Consists of information technology that is Applied at the point of clinical care. They include electronic medical records, clinical data repositories, decision support programs, handheld devices for collecting data and viewing reference material, imaging modalities and communication tools such as electronic messaging system Mobile Technology: Refers to portable devices to create, store, retrieve and transmit data in real time between end users for the purpose of improving patient safety and quality care. Wireless Area Networking: Mobile electronic health tools such as cell phones and telemedicine technologies are rapidly transforming the face and context of health care service delivery. Picture Archiving and Communication systems (PACS): Enables images as x-rays and scans to be stored electronically and viewed on screen, creating a filmless process and improved diagnosis. Method Single Sign-On (SSO): Is a mechanism whereby single action of user authentication and authorization can permit a user to access all computers and systems where he has permission without the need to enter multiple passwords. Electronic health records (EHR): From paper to paper-less communication is the mantra of Informatics. Repository of electronically maintained information about an individual's lifetime health status and health care, stored such that it can serve the multiple legitimate users of the record.

APPLICATION OF NURSING INFORMATICS IN NURSING ADMINISTRATION: Nursing Administration (Health Care Information Systems) Automated staff scheduling E-mail for improved communication Cost analysis and finding trends for budget purposes Quality assurance and outcomes analysis. APPLICATION OF NURSING INFORMATICS IN NURSING EDUCATION: 1. Computerized record-keeping 2. Computerized-assisted instruction 3. Interactive video technology 4. Distance Learning-Web based courses and degree programs 5. Internet resources-CEU's and formal nursing courses and degree programs 6. Presentation software for preparing slides and handouts- PowerPoint and MS APPLICATION OF NURSING INFORMATICS IN NURSING RESEARCH: 1. Computerized literature searching-CINAHL, Medline and Web sources 2. The adoption of standardized language related to nursing terms-NANDA, etc. 3. The ability to find trends in aggregate data, that is data derived from large population groups-Statistical Software, SPSS 4. Effective data management and trend-finding include the ability to provide historical or current data reports. 5. Extensive financial information can be collected and analyzed for trends. Anextremely important benefit in this era of managed care and cost cutting 6 Data related to treatment such as inpatient length of stay and the lowest level of care provider required can be used to decrease costs COMPUTER USES IN HOSPITAL AND COMMUNITY Uses in community When it comes to importance of computers in Hospitals, it is undoubtedly an important aspect to keep in the pace of the technologically advanced world. Healthcare is again a field where technology has made things lot better and increased the efficiency in patient care. Below are some of the points which highlight the uses of computers in hospitals. Storage of Patient Data: For any organization proper and systematic storage of information is a mandate requirement. Nurses can use computers to take down and store notes of the patients, as they observe their condition while on rounds. As the supervised rounds involve a lot of patients and a lot of information, using a computerized personal digital assistant makes it easier to access the right medical information at the right time instead of carrying a bunch of paper work and then take

time to search the piece of paper to access information when you need to be quick, efficient and accurate. Computerized Presentations: We all would agree that computerized power point presentations are much more efficient and has more impact on the receiver when it comes to presenting data. Even in the field of nursing education, computers help the nursing tutors/educators to present the large and complicated detailed form of data, which of course is a part of the medical study, in a very simplified and effective form. When speaking of uses of computers in medicine, features like power point presentations, slide shows, and videos are used to present medical procedures and techniques for better understanding of complex medical procedures and their treatments. Teaching nurses through Simulations: The field of medicine involves the concept of "hands-on work". I mean be it a doctor or a nurse, countless procedures are done on patients regularly. Nursing education therefore, must involve a lot of practice programs to make the students efficient to face the real life scenario. Computer programs which enable simulate such procedures therefore are of great use. Computerized Self Evaluation: Computers also contribute and help the students know their strengths and weaknesses. There are many computerized quiz and medical tests with immediate feedback that can help you brush and develop your medical facts and requirements without any delay. Your queries are solved, you know the answers and you know where you stand. A regular use of such computer applications definitely makes you more equipped and well researched for your field. Using Computers To Advance Health Care Using computers in health care can improve the quality and effectiveness of care and reduce its cost. However, adoption of computerized clinical information systems in health care lags behind use of computers in most other sectors of the economy. Improved Quality Automated hospital information systems can help improve quality of care because of their far-reaching capabilities. Hospital information systems (HMS) in a hospital can combine the use of computers for storing and transferring information with using them for giving advice to solve clinical problems Decreased Costs When a physician orders a test by computer, it can automatically display information that promotes cost-effective testing and treatment. Uses of Computers in Hospitals Computers are being included in hospitals and medical clinics throughout the world. Some uses of computers in hospitals and clinics have been described in the following paragraphs. To know more about the advantages of such advanced systems in hospitals, read on

Application of Computers in Hospitals Importance of computers in medicine is growing and spreading rapidly. The only disadvantage is that a full fledged installation of all the computerized systems in hospitals is a lengthy and costly process. There are however, some hospital systems which already work on the basis of computers. Here's an explanation to all such systems, which work on computers Computers in Hospitals: Medical Data Every day hospitals and clinics which are attached to it churn out enormous volumes of data regarding patients, ailments, prescriptions, medications, medical billing details, etc. Such medical records, are now a days recorded into medical billing software. Such mammoth databases are known as Electronic Medical Records (EMR) and Electronic Health Records (EHR). These databases are operated by a set of computers and servers, and come in handy during medical alerts and emergencies. The concept of EHR is a bit broader than the EMR, as the database is accessible from different clinics and hospitals. Thus, a patient's medical history can be retrieved from any hospital by medical practitioners. Medical Imaging 'Tests' are medical procedures where specified components of the human body are scanned. A test can be as simple as a regular blood test or it can be a complex CT /MRI scan. This process is often referred to as a medical imagery. In order to increase the precision of such procedures, computers have been adopted and integrated into the testing equipment. The Ultrasound and the MRI are the best examples where computers have been adopted, in order to make the process faster and precise. Thus medical tests and tools have become more advanced as a result of the use of computers. Medical Examination Many systems are underway for the development of medical monitoring which will help humans to properly monitor their own health. In many cases doctors and surgeons also use sophisticated computer aided equipment to treat their patients. Such systems and procedures include, bone scan procedure, prenatal ultrasound imaging, blood glucose monitors, advanced endoscopy which is used during surgery and blood pressure monitors. Basically these medical tests and tools provide significant convenience to medical practitioners. Advantages of Computers in Hospitals Precise 'tests' and medical examinations Faster medical alerts, which are more accurate time-wise Enhanced data about a patients medical history

Precision in diagnosis Precision in billing Automated updating of medical history Electronic patient record system The EMR can be defined as the legal patient record created in hospitals and ambulatory environments that is the data source for the EHR. It is important to note that an EHR is generated and maintained within an institution, such as a hospital, integrated delivery network, clinic, or physician office, to give patients, physicians and other health care providers, employers, and payers or insurers access to a patient's medical records across facilities. Need of an hour ere's one constant in the healthcare industry, its change. Healthcare providers are driven to find new ways to cut costs while improving care. improve overall efficiency and enhance patient care. Need of an hour A case in point in the medical records arena is the completion of patient charts. While greatly improved through imaging, this remains a costly, laborious process which has a tremendous impact on healthcare enterprises. Need for CPR To manage escalating health care cost Evolving role of primary health care Guidelines are being promoted to reduce the variances of clinical practices Integrated delivery system Key Capabilities of an Electronic Health Record System To capture data at the point of care To integrate data from multiple internal and external sources To support caregiver decision making. core capabilities Health information and data: Having immediate access to key information - such as patients' diagnoses, allergies, lab test results, and medications - would improve caregivers' ability to make sound Result management: The ability for all providers participating in the care of a patient in multiple settings to quickly access new and past test results would increase patient safety and the effectiveness of care. linical decisions in a timely manner. Order management: The ability to enter and store orders for prescriptions, tests, and other services in a computer-based system should enhance legibility, reduce duplication, and improve the speed with which orders are executed. Electronic communication and connectivity: Efficient, secure, and readily accessible communication among providers and patients would improve the continuity of care, increase the timeliness of diagnoses and treatments, and reduce the frequency of adverse events. Patient support: Tools that give patients access to their health records, provide interactive patient education, and help them carry out home-monitoring and self-testing can improve control of chronic conditions, such as diabetes.

Advantages Improve quality of care 1. The implementation of electronic health records (EHR) can help lessen patient sufferance due to medical errors and the inability of analysts to assess quality. 2. EHR systems are claimed to help reduce medical errors by providing healthcare workers with decision support. 3. Computerized Physician Order Entry (CPOE)one component of EHRincreases patient safety by listing instructions for physicians to follow when they prescribe drugs to patients. Naturally, 4. Promote evidence-based medicine 5. EHRs provide access to unprecedented amounts of clinical data for research that can accelerate the level of knowledge of effective medical practices. 6. Realistically, these benefits may only be realized if the EHR systems are interoperable and wide spread (for example, national or regional level) so that various systems can easily share information. Record keeping and mobility 1. EHR systems have the advantages of being able to connect too many electronic medical record systems. 2. In the current global medical environment, patients are shopping for their procedures. Coordinating these appointments via paper records is a time-consuming procedure. 3. It is also easier to check in their records whether a patient as been admitted to such a medical centre or if they have any allergies since they have been admitted before. 4. Replace paper-based medical records which can be incomplete, fragmented (different parts in different locations), hard to read and (sometimes) hard to find. Provide a single, shareable, up to date, accurate, rapidly retrievable source of information, potentially available anywhere at any time. Require less space and administrative resources. 5. Potential for automating, structuring and streamlining clinical workflow. 6. Provide integrated support for a wide range of discrete care activities including decision support, monitoring, electronic prescribing, electronic referrals radiology, laboratory ordering and results display. 7. Maintain a data and information trail that can be readily analyzed for medical audit, research and quality assurance, epidemiological monitoring, disease surveillance. 8. Support for continuing medical education. 9. The meaningful use of EHRs intended by the US government incentives is categorized as follows: 10. Improve care coordination 11. Reduce healthcare disparities 12. Engage patients and their families 13. Improve population and public health 14 Ensure adequate privacy and security 15. Disadvantages 16. They spend more time entering data into an empty EHR than they used to spend updating a paper chart with a simple dictation. 17. Such hurdles can be overcome once the software has some data, as physicians learn to use templates for data entry, and as workflow in the practice changes, but not every practice gets that far.

18. Surveyors found that hospital administrators and physicians who had adopted EHR noted that any gains in efficiency were offset by reduced productivity as the technology was implemented, as well as the need to increase information technology staff to maintain the system. 19. Often, doctors do not want to spend the time to learn a new system. Some doctors believe that adopting a system with EHRs could reduce clinical productivity 20. Governance, privacy and legal issues ISSUES 1. Integrated systems require consistent use of standards in e.g. medical terminologies and high quality data to support information sharing across wide networks 2. Ethical, legal and technical issues linked to accuracy, security confidentiality and access rights are set to increase as national EMR systems come online. 3. Common record architectures, structures 4. Clinical information standards and communications protocols 5. Security and confidentiality of information 6. Patient data quality; data sets, data dictionaries