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What is nursing informatics?

 A specialty that integrates nursing science, computer science, &
information science to manage & communicate data, information,
What is NURSING INFORMATICS?
knowledge, & wisdom in nursing practice
 Facilitate the integration of data, information, knowledge,& wisdom to
support patients, nurses & other providers in their decision-making in
all roles and settings.
 This support is accomplished through the use of information
structures, information process, & information technology (ANA,2008)

Models
for Nursing

Informatics

Acronyms to remember
 ANA: American nurse’s association
 NI: nursing informatics What are models?
 HIS: hospital information system
 CPRs: computer based patient records system  Models are representation of some aspects of the real world
 CPRI: computer based patient record institute  Models show particular perspective of a selected aspect and may
 CIS: clinical information system illustrate relationships
 EPR: electronic patient record  Models evolve as knowledge about the selected aspect changes and
 EHR: electronic health record are dependent on the “world view” of those developing the model
 HIPAA: health insurance portability & accountability act of 1996  It is important to remember that
 INS: informatics nurse specialist different models reflect different
viewpoints and are not necessarily
competitive, that is, there is no
Definition of NI “right model”
 Designed to assist in the
management and processing of nursing
data, information and knowledge to
support the practice of nursing and the Graves and corcoran’s model
delivery of nursing care (Grave & Corcan,
1989)  Data, information and knowledge in sequential boxes with one-way
arrows pointing from data to information to knowledge

1994, ANA definition of NI

 The specialty that integrates nursing science, computer science and

information science in identifying, collecting, processing and
managing data and information to support nursing practice,
administration, education, research and the expansion of nursing
knowledge

2008 ANA definition of NI

 A specialty that integrates nursing science, computer science and

information science to manage and communicate
data , and knowledge, & wisdom in nursing Patricia Schwirian’s model, 1986
practice
 Support concumers, patients, nurses & other  Proposed model of NI intended
providers in their decision-making in all roles & to stimulate and guide
setting systematic research
 This support is accomplished through the use  The model provides a
of information structures, information framework for identifying
processes, & information technology significant information needs,
(ANA,2008) which in turn can foster
research
 It has 4 primary elements
 Arranged in a pyramid with
triangular base
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c. Stage 3: decision making- committing to adoption of the
innovation
d. Stage 4: implementation- putting it to use
e. Stage 5:confirmation- the ultimate acceptance (or rejection) of
the innovation (Rogers, 2003)

 The 4 elements are:

a. The raw material ( nursing related information)
b. The technology (a computing system comprised of a hardware
& software)
c. The user surrounded by context (nurses, student)
d. The goal/ objective toward which the preceding elements are
directed

1. Change theory

 Change can be looked at in terms of planned or unplanned change

*unplanned change is represented by
*Roger’s diffusion of innovation theory
*Planed change- lewin’s change theory

Roger’s diffusion of innovation theory Lewin’s change theory

 When planning changes in how documentation is done, if they are to

be successful, this planning must also take into account preparing
users for this change
Lewin divided these changes into 3 stages:
 Unfreezing
 Moving
 Refreezing

 In this theory adopters are divided into 5 categories:
a. Innovators- who readily adopt the innovation (Anderson,2001)
b. Early adopters- they are respectable opinion leaders who
function as promoters of the innovation
c. Early majority-those who are averse to risk, but will make safe
investment
d. Late majority- the adopters need to sure that the innovation is
beneficial
Unfreezing
- to become motivated to change
- To unfreeze
- it is necessary to reduce the restraining forces and allow the driving
forces to become dominant
- restraining forces are often personal, psychological defenses or group
norms
- driving forces can be involvement in the process, having ones opinion
respected, and continuous communication during the process
Moving- the planned change is implemented
- Not a comfortable period; period of confusion
Refreezing- to make change permanent
- The planned change becomes the norm, but it is surrounded by the usual
driving and restraining forces

e. Laggards- suspicious about innovation

Categories of Innovativeness

a. Early adopters- respectable people. Opinion leaders. Try out

new ideas, but in a careful way
b. Early majority- thoughtful people, careful but accepting change
more quickly than the average
c. Late majority- skeptic people will use new ideas or products
only when the majority is using it

Rogers proposed a 5-stage model for the diffusion of innovation

a. Stage 1: knowledge- learning about the existence & function of

the innovation
b. Stage 2: persuasion- becoming convinced of the value of
innovation

Input- adding information to a system.
Throughput- processing that the system does with the information.
Output- information or process that results from the processing of the
input.
4. Learning Theories
 Can be applied in informatics to help individuals learn to use computer
applications.
 Impossible to categorize theories, but most either fall somewhere on a
continuum between stimulus - response as represented by behaviourism
and self-learning, as presented by constructivism/cognitivism.
A. Behaviourism/Ojectivism
 Is a theory of animal and human learning that focuses on observable
behaviours.
 Learning is defined as the acquisition of a new behaviour.
 Behaviours that are reinforced will recur whereas behaviour that
negative reinforcement will be extinguished.
B. Constructivism
 Learning is seen as a process that occurs when a learner attempts to
interpret the world.
 The result is that knowledge is seen as a personal belief, rather that an
independent, verifiable entity.
 Learning therefore, consists of either adjusting one’s model or
creating a completely new model.
 These principles explain why people with no computer skills find it very
difficult to learn to use a system.
 No knowledge structures that computer user has, hence have no
mental model into which to place the new information.
 Results in lack of understand of the material being presented &
inability to implement what is being taught.
C. Adult Learning Theory (Knowles)
 Emphasizes that adults expect to take responsibility for decisions and
that they are self-directed.
 Makes the assumptions that adults need to know why they need to
learn, they need to learn by doing, they approach learning as a
problem-solving exercise, and they learn best when they believe the
topic is of immediate value to them.
kolb's cycle of experiential learning
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HISTORY
 Background Information: p.271 (Saba & McCormick, 2006)
 The concept of EHR emerged initially as a computer - based patient
record or CPR and was given impetus by a 1991 report fro Institute of
medicine (IOM) that advocated the adoption of CPR as
 CPR is a longitudinal medical record receiving date from multiple
worldwide sources, not simply an electronic copy of the traditional
paper medical record.
 Other terms used for CPR: electronic medical record (EMR), electronic
patient record (EPR), computerized medical record (CMR)
 Gradually, the informatics community has been adopting EHR as a
name more in keeping with modern perspective on a comprehensive
health care, health maintenance and multidisciplinary practice.
What is EHR?
 Any information related to the past, present, & future physical/mental
heath, or condition of an individual.
 The information resides in the electronic systems used to capture,
transmit, receive, store, retrieve link, and manipulate multimedia data
for the primary purpose of providing health care and health related
services.
The Nicholas E. Davies Program
 Founded by the Computer-based Patient Record Institute (CPRI) in
1993
 Awards excellence in EHR implementation.
The four major areas of initial criteria are:
1. Management
2. Functionally
3. Technology
4. Impact
Advance & Disadvantages of EHR’s
Please read the journal article, Benefits and drawbacks of electronic
health systems by Nir Menachemi and Taleah H Collum (2011)
[go to the article]
BENEFITS OF NURSING INFROMATICS
To Healthcare:
1. Data previously buried in inaccessible records become usable.
2. Informatics is not just collecting data but making it useful
3. Aggregated data (assimilated) can provide data about patterns
Ex: prevalence of staphylococcus infection
4. Improves patient safety.
Ex: the use of CPOE: which reduces prescribing errors to 50%
To Nursing:
1. Enhances nursing practice
2. Development of science-data are available for researches
3. Improves documentation
(please see video clip for additional benefits of NI as perceived by nurses)
Standardized Nursing Terminologies
A standardized nursing terminology consists of nursing concepts that
represent the domain of nursing.
Ex. Acute postoperative pain, vital signs, bladder irrigation.
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Trial:ABC Codes
Why Standardize Nursing Terminologies? 1. NIC
 Provide valid clinical data 2. NMDS
 Allow data sharing across today’s HIT and EHR systems 3. ICNP
 Support evidence-based decision making 4. PNDS
 Facilitate evaluation of nursing processes 5. LOINC
 Permit the measurement of outcomes 6. NMMDS
 Facilitate aggregation and comparison for clinical, translational and 7. SNOMED-CT
comparative effectiveness of research, for development of practice- 8. NOC
based nursing protocols and evidence-based knowledge 9. CCC System
 Support continuity of care and data exchange (interoperable) 10. Omaha System
SNOMED-CT
 Possesses both reference properties and user interface terms
 Considered to be the most comprehensive, multilingual clinical
healthcare terminology in the world
 Integrates, through external mappings, concepts from many nursing
terminologies
Nursing Minimum Data Set (NMDS)
Identifies essential, common & core data elements to be collected for all
patients receiving nursing care
3 elements:
1. Nursing care
2. Patient demographics
3. Service elements

International Minimum Data Set (i-NMDS)

Includes the core, internationally relevant, essential, minimum data
Development of ISO 18104:2003 elements to be collected in the course of providing nursing care
 Development was motivated by a desire to harmonize the plethora of Benefits that are being realized through use of advance terminology
nursing terminologies in use around the world systems:
 ISO 18104:2003 development was intended to be consistent with the  Facilitation of evidenced based practice
goals & objectives with other specific health terminology models in  Matching of potential research subjects to research protocols for
order to provide a more unified reference health model. which they are potentially eligible
 ISO Standard is intended to be of use to those who develop coding  The detection and prevention of potential adverse outcomes
systems, terminologies, terminology models for other domains, health  Linking online information sources
information models, information systems software for natural  Increased reliability and validity of data for quality evaluation
language processing and markup standards for representation of  Data mining of concepts for purposes like clinical research, health
health care documents. services research or knowledge discovery
Ontologies Security and Privacy
Terminology models may be formulated & elucidated in an ontology Privacy- individual rights
language that represents classes & their properties Security- deals with protection
Ex. OWL-Web Ontology Language Security measures are critical to protecting personal privacy & patient
OWL Representation of ICNP safety & care quality
 OWL is intended for use, 8 privacy principles
where applications, rather than 1. Individual access
humans, process information 2. Correction
 ICNP in maintained in 3. Openness & transparency
OWL-it is a compositional 4. Individual choice
standards - based terminology for 5. Collection and use
nursing practice. 6. Data quality & integrity
7. Safeguards
8. Accountability
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HIT Trust Framework The major CIS requirements for nursing:

Layer 1: Risk Management 1. Administer a nursing department
2: Policy Foundation 2. Assist the management of nursing practice
3: Physical Safeguards 3. Assist nursing education
4: Operational Safeguards 4. Support nursing research
5: Architectural Safeguards the nursing component of a CIS ca be designed as a stand-alone, a
6: Technical Safeguards subsystem of a lager system, or an integral part of the healthcare
7: Usability Features organization’s overall information system.
Regardless of the size or type of system, any CIS or single application
design/ implementation or upgrade must complete the eight phases of
implementation.
System Life Cycle Phases
1. Planning
2. Analysis
3. Design, Develop and Customize
4. Implement, Evaluate, Support and Maintain

Building trustworthiness in HIT always begins with objective risk

assessment, a continuous process that serves as the basis for developing &
implementing a sound information assurance policy & physical,
operational, architectural & technological safeguards to mitigate &
manage risks to patient safety, individual privacy, care quality, financial
stability & public trust.
Implementing and Upgrading Clinical Information System
(System Life Cycle)
What is Clinicall Information System?
A CIS assists clinicians with data necessary for decision making & problem
solving.
A CIS must serve the organization and the patient in much the same way
an efficient health care delivery system involves all appropriate
departments in establishing health care delivery processes.
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