COMMUNITY HEALTH APPLICATION
- is a synthesis of nursing practice and public
health practice applied to promoting and
preserving health of populations. (ANA, 1980).
The focus is on the population as a whole.
- It helps to provide support and improve
collaboration among the doctors, community
health provider and patients.
- It is also useful in monitoring and tracking the
health status of the community.
The goal of community health informatics:
“Effective and timely assessment that involves
monitoring and tracking the health status of
populations including identifying and controlling
disease outbreaks and epidemics.”
Community Health Nursing Development
It supports clinical care delivery, electronic billing,
and had the potential for multiple user access.
The further advancements led to four domains of
concentration which directed unique management
information systems for practice:
1) public health that focused on population
interventions and outcomes r/t epidemiologic or
mortality/ morbidity trends;
2) home health that focused on skilled nursing care
for individuals in aggregated populations;
3) special population community practices that
focused on specific diagnostic care; and
4) outpatient care that focused on intermittent,
episodic, or preventive care for individuals
Home Health
1. Medicare and Medicaid Legislation
It is enacted in 1965 which allowed reimbursement
for home care services. This expanded the demand
for home care services, increased number of home
health agencies, and increased information needs
that created the driving force for computer systems.
2. Balanced Budget Act
The need for information moved beyond billing
information, and the tracking of clinical data. The
Center for Medicare and Medicaid Services (CMS)
instituted a prospective payment system for
medicare home health beneficiaries.
Public Health
It is the coordinated effort at the local, state, and
federal levels whose mission is fulfilling society’s
interest in assuring conditions in which people can
be healthy (Institute of Medicine, 2004).
Home Health Information Systems
It supports home healthcare, hospice, and private
duty programs provided by home health agencies
in order to collect and process data to prepare
documents for payment of home healthcare
services.
1. Time-Sharing Systems
Computer-based systems developed by service
bureaus/vendors that are shared by many home
health agencies. The service bureaus purchase
their own computer hardware with sufficient
storage to share the data from other agencies
and develop their own proprietary computer
programs.
2. Stand-Alone Systems
It is a commercial systems developed for direct
installation and implementation in a home health
agency. The commercial vendor generally
develops the software for processing the data,
maintains, updates, and supports all software
programs to meet federal regulations.
3. Portability of Data
A point-of-care technology that uses a computer
input device to input and retrieve clinical data at
the point of care in the home.
4. Point-of-Care Systems
It offers software-aided care planning and critical
pathways allowing for care delivery based on
evidence-based practice standards to reach
desired clinical outcome.
5. Reimbursable Models
It is designed to furnish information essential for
reimbursement of services provided to patients
eligible for Medicare, Medicaid, and other third-
party payers.
6. Managed Care
Most vendors have responded by expanding the
back-end financial reporting capabilities and
emphasizing reports that will help agencies
identify the factors that impact delivery cost and
profitability.
7. Scheduling Systems
Used to enhance home health agency services.
They are designed to schedule the clinicians
providing services with the patients requiring the
visit matching the clinician capacity with the
required patient care.
I. DATA SETS
A data set is a collection of related sets of
information composed of separate items, which
can be manipulated as a unit by a computer.
- Healthcare analytics is based on data and
data sets in particular. Healthcare data sets
include a vast amount of medical data,
various measurements, financial data,
statistical data, demographics of specific
populations, and insurance data, to name just
a few, gathered from various healthcare data
sources.
Types of Data Set
1. Uniform Data Set for Homecare and Hospice
- it is developed by the National Association
of Home Care (NAHC) for the Home Care and
Hospice. It is organized in two major
categories:
1) Organizational Level which includes items
that describes the organization, its services,
aggregates, financial and personnel data
2) Individual Level includes demographic,
clinical, service, and utilization data for
patients/clients.
2. Outcome and Assessment and Information
Set (OASIS)
- is a standardized data set designed to
facilitate the rigorous and systematic
measurement of patient home health care
outcomes to assess the quality of home
health services. It is also used as the basis
of reimbursement. The set was designed to
gather data about Medicare beneficiaries
who are receiving services from a home
health agency. It includes a set of core
data items that are collected on all adult
home health patients.
Two important purposes:
a) it is the basis for determining payment for
each 60-day episode of care, and
b) it measures the quality and outcomes of
services delivered by home health agency
clinicians.
3. Outcome Based Quality (OBQI)
- In outcome-based healthcare, the focus on
reducing variation in how a variety of
diseases and conditions are treated. The
process requires all clinicians to provide
accurate diagnosis and treatment
algorithms to improve patients’ outcomes.
Health system are constantly striving to
overcome inefficiencies and provide high
quality care to patients.
4. Health Plan Employer Data and Information
Set (HEDIS)
- A set of standardized measures of health
plan performance allowing comparisons of
quality, access, patient satisfaction,
membership, utilization, finance and health
plan management.
II. VOCABULARIES AND CLASSIFICATIONS
USED FOR COMMUNITY HEALTH SYSTEMS
1. Clinical Care Classifications
a) CCC of Nursing Interventions/ Actions
MODIFIERS:
-assess/ monitor
-care/perform
-teach/instruct
-manage/refer
b) CCC of Nursing Diagnoses
MODIFIERS:
-improve
-stabilize
-support
2. OMAHA System
-oldest of the nursing classifications.
-was designed for nurses in the community
and public health services.
-used to generate data following a routine,
documenting client care
3 PARTS
1) Problem: Environmental, psychosocial,
physiological, or health related behaviors
Modifiers: individual, family as health
promotion, potential, or actual problem.
There are signs and symptoms specific to
each problem
2) Intervention: Health teaching, guidance and
counselling
3) Outcome: rated for degree of response
when patient is discharge
3. Nursing Classification Systems
are vocabularies which can be represented
as hierarchies and which have as a main
 emphasis the disjunctive and exhaustive
classification of terms
4. North American Nursing Diagnosis
Association (NANDA)
classification of nursing diagnoses by human
response pattern. Related factors and
defining characteristics are included for each
diagnosis.
(ex. Impaired skin integrity, activity
intolerance, knowledge deficit)
5. Home Health Care Classification (HHCC)
- a nomenclature consisting of two interrelated
and standardized vocabularies: diagnoses
and intervention.
- The purpose is to provide a structured and
consistent method to assess and classify
patients in order to determine the resources
required to provide home health and
ambulatory care services including the
outcome of care.
6. Nursing Interventions Classification (NIC)
- A comprehensive, research based-standard,
standardized classification of intervention
that nurses perform
- Each intervention is listed with a label name,
definition, a set of activities to carry out the
intervention, and background readings
III. COMMUNITY HEALTH SYSTEMS
-computerized IT systems developed for use
by community agencies
Addresses broad areas of:
-healthcare programs
-agencies
-settings
Types of Community Health Systems
1. MANAGEMENT INFORMATION SYSTEMS
-management of statistical operational needs
of an agency
-provides better exchange of information
across the community and thus, enables
better performance in the health sector
2. CATEGORICAL PROGRAM SYSTEMS
-supports data processing and collects
information
-it also organizes data from the community
according to categories such as based on
location, gender, and health records
a) Client/ Personal Management System
-it is a framework of collecting data from
individual clients by providing template
interview questionnaires or information
sheet that is applicable in the community
setting (ex. OHIO)
3. SCREENING PROGRAMS
-detects individuals with a specific disease or
predisposing health condition
(ex. Expanded Program on Immunization,
Cancer Prevention, Family Planning)
4. STATISTICAL REPORTING SYSTEMS
-process statistical information for
epidemiologic and immunization data
5. REGISTRATION SYSTEMS
-identifies clients eligible for CHN services in
clinics
6. SPECIAL PURPOSE SYSTEMS
-collects specific data for administering a
specific program
7. NATIONAL ELECTRONIC DISEASE
SURVEILLANCE SYSTEMS
-promotes the use of data and information
system standards to advance the
development of efficient and integrated
surveillance systems
8. SCHOOL HEALTH SYSTEMS
-computerized systems that emerged to
improve data collection and monitor and
evaluate of school age students. It can be
individual school-based or district-based
allowing for collecting aggregate data about
an educational district
IV. COMMUNITY HEALTH TELEMEDICINE
Electronic transfer of medical information and
services.
BENEFITS:
-patient and provider satisfaction
-time saving in tracking and receiving
information
-reduced need to see healthcare provider “face
to face”
-increased reliance on computer based
information
-more cost effective care
CAN BE USED BY PATIENTS TO:
-assist in self-diagnosis and preventive
medicine
-reduce unnecessary outpatient visits
 -provide self-directed triage

Reporters:
Dela Cruz, Jorge Emmanuel
Padiangan, Kemuel John
Agmata, Maureen Joy
Anselmo, Apple Ghale
Bullong, Nikki Shein
Castillo, Infanta Isabella
Hermillos, Camille Joyce
Tambalque, Hannah Marjorie
Tulinao, Reygelyn
(Group 2- BSN 2A)

References:
Saba, V.K. & McCormick, K.A., Essentials of
Nursing Informatics (4th Edition), p355-381.

Jimenea, K.C., Nursing Informatics and the

Community, Chapter 22.