History of nursing informatics in the philippines

1. History of Nursing Informatics inthe Philippines

2. The Philippine nursing community have longsought to keep up with increasing use ofinformation and
technology in the healthcaresystem. Nursing Informatics follows thefootsteps of biomedical informatics
which hasgained relative popularity earlier than its otherallied medical counterparts. Despite being inits
early stages of development thesubspecialty of nursing informatics on thePhilippines have more than
decade of whichled to future programs and activities.

3. Some of the major milestones in nursinginformaticshistory in the Philippines which includes

theparticipation of the Philippine NursesAssociation (PNA) in the development ofStandards for Health
Information in thePhilippines(SHIP) in 1999, the formation ofthe Master of Science in Health
Informatics(MSHI) whichbegan in 2005 and the formation of thePhilippine Nursing Informatics
Association(PNIA) in 2010 as a sub-specialtyorganization of PNA for nursing informatics.

4. Introduction:The words "nursing informatics"were unfamiliar among the nursingcommunity until

theyear 2008. There were only a handful ofpeople with knowledge and experience innursing informatics
but the disciplinehave not yet found its recognition as asub-specialty of nursingarts and science in the
country. Theorigin of this budding discipline indirectlycame fromthe pioneers of health informatics in
the

5. The Philippine Medical Informatics Society(PMIS) and its founders had stronginfluence inthe
development of health informatics inthe Philippines. The PMIA was officiallyregisteredunder the
Securities and ExchangeCommission in 1996 by its boardcomposed of elevenphysician. The organization
was headedby Dr. Alvin Marcelo.

6. OriginsSince 1998, several faculty members ofthe University of the Philippines beganformal education
and training. Dr. HermanTolentino took a post-doctoral fellowship inmedical informatics at the
University oWashington. Dr. Alvin Marcelo followed ayear later for his training at the NationalLibrary of
Medicine. Dr. Cito Maramba wentto Coventry for his Masters in InformationSciences at the University of
Warwick. Theywere later followed by other physicians suchas Dr. Micheal Muin and Dr. Ryan Bañez.

7. By the year 2003, a Master of Science inHealth Informatics was proposed to be offeredby UP-Manila
College of Medicine (major inmedical informatics) and the College of Artsand Science (major in
bioinformatics) and waslater approved to be offered starting academicyear 2005-2006. In 1999, a study
group wasformed headed by the National Institute ofHealth of the University of the PhilippinesManila.

8. This group identified international standardsfor health information and their adaptabilityin the
Philippines. The document is referredto as the "Standards of Health Informationin the Philippines, 1999
version" or"SHIP99".Representatives from various sectorscollaborated on this project including
thePhilippine Nurses Association (PNA) in theperson of Ms. Evelyn Protacio.

9. CHED as a CatalystThe nursing community was still yet to follow itsinternational counterparts in the
adoption of information,communication and technology in nursing practice in thePhilippines. Despite
the inclusion of Informatics coursein the undergraduate curriculum which focused on basicdesktop
applications, the need for genuine nursinginformatics course had not yet been realized. In 2008,Nursing
Informatics course in the undergraduatecurriculum was defined by the Commission on HigherEducation
(CHED) Memorandum Order 5 Series of2008. This was later revised and included as HealthInformatics
course in CHED Memorandum Order 14Series of 2009. This will be first implemented in thesummer of
2010.

10. OrganizationEarly in 2009, Mr. Kristian R. Sumabat and Ms.Mia Alcantara-Santiago, both nurses and
graduatestudents of Master of Science in Health Informaticsat the University of the Philippines, Manila
begandrafting plans to create a nursing informaticsorganization. In February 2010, they began
recruitingother nursing informatics specialists and practitionersto organize a group which later became
as thePhilippine Nursing Informatics Association.

11. They were joined by founding members Ms.Sheryl Ochea, a graduate of MAster of Sciencein Nursing
major in nursing informatics atXavier University (Ohio, USA), Ms. AlexrandraBernal, a graduate student
and telehealthnurse of the National Telehealth Center, Ms.Pia Pelayo, a former telehealth nurse and
aproject coordinator of the NationalEpidemiology Center, Department of Healthand Mr. Sid Cardenas,
also a telehealth nurse.Other founding members include Mr. NoelBañez, Ms. Rona Abcede, and Mr.
HarbyOngbay Abellanosa.

12. Issues and ChallengesLike many other disciplines, nursinginformatics face many challenges while in
itsinfancy stage. The inclusion of informaticsas an integral part of the undergraduatecurriculum has
been one of the mostinfluential factors for the increasedawareness and interest in this field ofnursing.
However, the contents of thecurriculum was adapted from internationalmaterials which does not match
the localneeds.

13. A community-centered approach to the useof information, communication and technologyin nursing
practice must be adapted toensure the impact of the program in the localhealthcare system. Lack of
certification andcredentialing programs in post-graduate levelsare also absent with the scarcity of
localnursing informatics experts. This new field hasyet to gain acceptance and recognition in thenursing
community as a sub-specialty.

14. Future DirectionDevelopment of training, certification andcredentialing programs are in the pipeline
for thePhilippine Nursing Informatics Association. Futurepartnerships with local and international
nursingand health informatics organizations have startedas well. Other programs are expected to be
slowlydelivered with PNIAs CORE X strategic platformwhich stands for Competency,
Organization,Recognition, Experience and Expertise. It is also amajor thrust to support the use of
healthinformation standards in the Philippines and tohave nursing informatics specialists in
everyhospital in the country.
The History of Nursing Informatics

The purpose of this blog is to educate nursing professionals on the history of an important specialty,
Nursing Informatics. Informatics is an essential element of healthcare and the nursing profession. Nurses
must learn the history and evolution of informatics in order to gain a full understanding of this topic.

In the beginning....

It is believed that Scholes and Barber in an address in 1980 at the MEDINFO conference in Japan, first
introduced and defined the term "nursing informatics." To date, no formal, definitive consensus has
been reached on how to define nursing informatics (Thede & Sewell, 2010, p. 7).

The definition of nursing informatics has evolved with time. Initial defnitions of nursing informatics
focused more on technology. In the mid 1980s, Schwirian established a more information oriented
definition. Then in 1989 Graves and Corcoran broke away from technology based definitions to concepts
or a combination of nursing, information, and computer science in the administration of nursing care.
Additionally, in 1996 Turley expanded the definition of nursing informatics to include the discipline of
cognitive science (Thede & Sewell, 2010, p. 7).

According the American Nurses Association (ANA) nursing informatics refers to a specialty which utilizes
information, computer, and nursing science to handle and communicate information, data, and
knowledge in the realm of nursing. Nursing informatics is an important element of healthcare which
allows the synthesis of information, data, and knowledge to make decisions and support nurses,
patients, and other providers (Thede & Sewell, 2010, p 8).

Since the 1960s nurses practicing in the United States have worked with information technology. In
1992, the American Nurses Association (ANA) recognized nursing informatics as a subspecialty (Thede &
Sewell, 2010, p. 6).

Reference:

Thede, L & Sewell, P. (2010). Informatics and Nursing Competencies and Applications. Philadelphia:
Wolters Kluwer Health/Lippincott Williams & Wilkins.
 Nursing Informatics may be regarded as a specialty that has
evolved with time.  Some of the main elements of Nursing Informatics, information and
computers, are utilized by people every day. Nurses are among the largest group of health care
professionals, therefore the development of nursing informatics as a specialty was a matter of
time (The History of Nursing Informatics, n.d.).

When I consider the history of Nursing Informatics and how this specialty has evolved with time,
I recognize the profound impact it has had on my own career as a nurse.  How have I seen
informatics change during my nursing career?

As a new graduate, I drowned in paper documentation which proved to be tedious, repetitive,

and overwhelming.  I remember times where documentation on one patient took up to one
hour.  Over the course of my 5 year career, informatics has made my life as a nurse much
easier.  Documentation has become more efficient because it is electronically based, which
allows me to spend more time with my patients. In addition, nursing informatics allows
enhanced communication with doctors, because physicians can access patient records, vitals,
and assessments as soon as documentation is entered in the computer.  Furthermore,
physicians can access patient records remotely from home which also improves care.

Reference:
N.d.  The History of Nursing Informatics.  Retrieved
fromhttp://www.ehow.com/about_5101338_history-nursing-informatics.html.
History of Nursing Informatics
Nursing Informatics Defined

Nursing informatics (NI) is a specialty that integrates nursing science, computer science, and
information science to manage and communicate data, information, knowledge, and wisdom
in nursing practice. NI supports consumers, patients, nurses, and other providers in their
decision- making in all roles and settings. This support is accomplished through the use of
information structures, information processes, and information technology
Nursing informatics, as defined by the American Nurses Association (ANA), is a specialty that
integrates nursing science, computer science and information science to manage and
communicate data, information and knowledge in nursing practice. Nursing informatics
facilitates the integration of data, information and knowledge to support patients, nurses
and other providers in their decision-making in all roles and settings. This support is
accomplished through the use of information technology and information structures, which
organize data, information and knowledge for processing by computers. 1
An international viewpoint was adopted at the 1998 meeting of the International Medical
Informatics Association Workgroup on Nursing Informatics in Seoul, Korea: Nursing
informatics is the integration of nursing, its information and information management with
information processing and communication technology, to support the health of people
worldwide.

Informatics is modeled after the French word informatique and was first used as medical
informatics in the late 1970s, followed by use in nursing in the 1980s. The ANA designated
nursing informatics as a specialty practice in 1992, although nurses had earlier incorporated
informatics concepts. Subsequently, volunteer ANA members have developed a scope and
standards for practice, which serves as guides for the practice.2,3
The standards of practice created by the ANA in 1995 reflect professional performance
common to informatics nurses. For example, the informatics nurse contributes to the
professional development of peers, colleagues and others.3 In 1995, a certification
examination was created at the generalist practitioner level and since that time more than
400 nurses have been certified in nursing informatics.
The Evolution of Nursing Informatics
Nurses have been delivering compassionate care using technology since the time of
Florence Nightingale. Technology, coined from the Greek language “tekhnolohiga” meaning
systematic treatment (1), is defined as a scientific method of achieving a practical purpose
(2). As healthcare evolves to meet the needs of mankind, nurses are faced with greater
challenges on how to apply technology in practice, education, and research. Now more than
ever, the term technology exponentially covers a greater meaning in healthcare to include
informatics.

Coined from the French word “informatique”, Gorn (1983) first defined informatics
as computer science plus information science (3). As it relates to nursing, it has been
labeled as Nursing Informatics. American Nurses Association Scope and Standards (2001)
defines Nursing Informatics as a specialty that integrates 1) nursing science, 2) computer
science, and 3) information science to manage and communicate data information and
knowledge in nursing information (4).

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: 1) assessment, 2) diagnosis, 3) planning, 4)
implementation, and 5) evaluation.

Nursing documentation, which is often identified as the sixth step in the nursing process, is
vital in information management. Therefore, it is necessary for nurses to document
accurately and precisely to determine the desired outcome. Remember the Rule “Garbage
In–Garbage Out” also applies to nursing documentation.

The Role of Nurse Informaticist

Nurse Informaticists are often perceived as the “techy” nurse, “super-user”, or the “go-to”
person when new technology is implemented. They are often referred to as “bi-lingual”
nurses who can speak the nursing process and information technology language. Being an
expert in both fields and a liaison between the two worlds, nurses have assumed different
roles and positions in the arena of informatics. The introduction of robust and dynamic
information technology in healthcare paved the way of creating different roles in Nursing
Informatics. A recent survey conducted by Healthcare Information and Management
Systems Society (HIMSS) revealed that 14% of nurses are in nursing informatics role.5

Nurses comprise the biggest workforce in healthcare. This being said, nurses are the largest
work-group of end-users of electronic medical record and clinical information systems;
therefore, it is imperative that nurses are well-represented in the selection, design,
 implementation, and evaluation of clinical information systems. Evidence has shown that
nurses who were involved in the clinical information system cycle have more buy-in, user-
acceptance, and positive perception – all are precursors to successful implementation.

Advantages and Disadvantages of Nursing Informatics

Advantages:

 shared data;
 centralized control;
 disadvantages of redundancy control;
 improved data integrity;
 improved data security, and database systems; and,
 flexible conceptual design.
Disadvantages:

 a complex conceptual design process;

 the need for multiple external databases;
 the need to hire database-related employees;
 high DBMS acquisition costs;
 a more complex programmer environment;
 potentially catastrophic program failures;
 a longer running time for individual applications; and,
 highly dependent DBMS operations.

 Informatics in the Health Care Professions Hardware, Software,

 and Roles of Support Personnel

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, pharmacy informatics and so on. 

Hebda (1998 p. 3), defines nursing informatics as "the use of computers technology to

support nursing, including clinical practice, administration, education, and research."  
American Nurses Association (ANA) (1994) has defines 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."

Graves, J. R., & Corcoran, S. (1989). The Study of Nursing Informatics. Image:
Journal of Nursing Scholarship, 27, 227-231. define nursing informatics as "a
combination of computer science, information science and nursing science designed
to assist in the management and processing of nursing data, information and
knowledge to support the practice of nursing and the delivery of nursing care."

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.

Example:

Data: 140 systolic

Information: 50 year-old male, day 3 of hospitalization, BP 140/70

Knowledge: Pt. demographics, record of BP readings, circulation system: anatomy &

physiology, pharmacokinetics of ordered medication

Decisions: That guide practice

Application of Nursing Informatics:  

Nursing Informatics can be applied to all areas of nursing practice, which
include; clinical practice, administration, education, and research. Below are some
examples of how nursing informatics, information technology and computers, are
used to support various areas of nursing practice.

Nursing Clinical Practice (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 documentation
 Reminders and prompts that appear during documentation to ensure
comprehensive charting

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

Nursing Education

 Computerized record-keeping
 Computerized-assisted instruction
 Interactive video technology
 Distance Learning-Web based courses and degree programs
 Internet resources-CEU's and formal nursing courses and degree programs
 Presentation software for preparing slides and handouts-PowerPoint and MS
Word

Nursing Research

 Computerized literature searching-CINAHL, Medline and Web sources

 The adoption of standardized language related to nursing terms-NANDA, etc.
 The ability to find trends in aggregate data, that is data derived from large
population groups-Statistical Software, SPSS
Benefits of Computer Automation in Health Care:

Many of these benefits have came about with the development of the electronic
medical record, which is the electronic version of the client data found in the
traditional paper record. 

EMR benefits include:

Improved access to the medical record. The EMR can be accessed from several
different locations simultaneously, as well as by different levels of providers.

Decreased redundancy of data entry. For example, allergies and vital signs need only
be entered once.

Decreased time spent in documentation. Automation allows direct entry from

monitoring equipment, as well as point-of-care data entry.

Increased time for client care. More time is available for client care because less time
is required for documentation and transcription of physician orders.

Facilitation of data collection for research. Electronically stored client records

provide quick access to clinical data for a large number of clients.

Improved communication and decreased potential for error. Improved legibility of

clinician documentation and orders is seen with computerized information systems.

Creation of a lifetime clinical record facilitated by information systems.

Other benefits of automation and computerization are related to the use of decision-
support software, computer software programs that organize information to aid in
decision making for client care or administrative issues; these include:

 Decision-support tools as well as alerts and reminders notify the clinician of

possible concerns or omissions. An example of this, is the documentation of
patient allergies in the computer system. The health care providers would be
alerted to any discrepancies in the patient medication orders.
 Effective data management and trend-finding include the ability to provide
historical or current data reports.
 Extensive financial information can be collected and analyzed for trends. An
extremely important benefit in this era of managed care and cost cutting.
 Data related to treatment such as inpatient length of stay and the lowest level
of care provider required can be used to decrease costs.
The Role of the Nursing Informatics Specialist (NIS):

Because of the increased importance of computers and information technology in the

practice of professional nursing; a new role has emerged, the nursing informatics
specialist (NIS). The NIS is a nurse who has formal education, certification and
practical experience in using computers in patient care settings. The American Nurses
Association (ANA, 1994), lists several functions of the NIS:

Theory development. The NIS contributes to the scientific knowledge base of nursing

informatics.

Analysis of information needs. The identification of information that nurses' need to in

order to accomplish their work; client care, education, administration, and research

Selection of computer systems. The NIS, guides the user in making informed

decisions related to the purchase of computer systems.

Design of computer systems and customizations. The NIS collaborates with users and
computer programmers to make decisions about how data will be displayed and
accessed.

Testing of computer systems. Systems must be checked for proper functioning before

they are made available for use in patient care.

Training users of computer systems. Users need to be trained in how the system

works, the importance of accurate data entry, and how the system will benefit them,
and more importantly how it will improve patient outcomes

Evaluation of the effectiveness of computer systems. The unique role of the NIS

makes them the ideal person to evaluate the effectiveness of computer systems.

Ongoing maintenance and enhancements. The NIS makes sure the computerized

system functions properly and explores possible enhancements to the system that will
better serve the users and the patients.

Identification of computer technologies that can benefit nursing. The NIS must keep
abreast of the changes in the fields of computers and information technology,
including new hardware and software that will benefit the nurse and patient.

Hardware, Software, and the Roles of Support Personnel: 

 
Hardware is the physical part of the computer and its associated equipment. Computer
hardware can comprise many different parts, these include: 
 

Input Devices: used to enter data; keyboard, mouse, trackball, touch screen,
light pen, microphone, bar code reader, fax modem card, joystick, and scanner.

Output Devices: used to view and hear processed data; video monitor screens,
printers, speakers, and fax.

Central Processing Unit (CPU) "brain" of the computer, three components:

 Arithmetic Logic Unit (ALU): number "crunching"

 Memory: is the storage area in which program instruction (code)
reside during execution.

Read-only memory (ROM) is permanent; it remains when

the power is off. Start-up instructions for the computer is an
example of ROM.

Random access memory (RAM) is a temporary storage area

for program instructions and data that is being processed, it
is only active while the computer is turned on. (located on
the motherboard not part of CPU) 
 

 Control Unit: manages instructions to other parts of the computer,

including input and output devices "traffic cop"

 
Secondary Storage: provides space to retain data in an area separate from the
computer's memory after the computer is turned off, these include; hard disk
drives, floppy disks, tape, zip drives, optical drives and CD-ROM drives.

Computer Categories: 
 

 Super computers, are the largest and most expensive, can perform
billions of instructions every second
 Mainframes, large computers capable of processing several
millions instructions per second. They support organizational
 functions, therefore have been the traditional equipment in
hospitals. Customized software results in high cost.
 Minicomputer, is a scaled-down version of the mainframe, since
they are now becoming more powerful they can now be found in
hospitals and HMO's
 Microcomputers (PCs), inexpensive processing power for an
individual user.
 Laptop or Notebook, Handheld, and Personal Digital Assistants
(PDAs)

Networks: 
 
A network is "a combination of hardware and software that allows
communication and electronic transfer of information between computers" (as
cited in Hebda, 1998, p. 19).

Hardware may be connected permanently by wire (Ethernet), or temporarily by

wireless communication, and modems/telephone lines. This allows the sharing
of computer and software resources, through the use of the network. For
example, several computers may share one computer, or a word processing
program could also be accessed by many different users.

Networks, no matter how small or large, operate with the client/server

technology. 
 

A Server stores files and programs that are accessed by the client on the
network. When you access the Internet from home, you the client (your
computer), requests files from a Server (another computer), you see the
results displayed on your screen through a browser. You may also access
a network in your clinical practice; you the client, accesses a patient
record on the floor from a server, which stores the patient record.

Types of Networks: They range from small (home network) to very large

(Internet) 
 

Home Networks - within a home

Local Area Networks (LAN) - networks within a area, location or

business. The University connects all its computers on a LAN.
 Wide Area Networks (WAN) - several LAN connected together

Internet - many WAN connected together around the globe to give

us the Internet that we use today 
 

Intranets - private company networks that are protected

from outside access Kaiser HMO and its clinics and
hospitals is an example.

Extranets - several Intranets connected together, Kaiser

maintains Extranet a network connection with its suppliers

Selection Criteria for Computer Equipment: 

 

When selecting a computer system or related hardware, you must take

into consideration the following:

The types of applications required Some people need word processing,

while others may need database or spread sheet software.

The program execution time and computer capacity needed to process

jobs Complex jobs require more processor speed and memory.

Storage Capacity Needs are determined by the amount of information

that must be kept and the length of time that it must be retained.

Backup Options When information is critical to conduct daily business,

another backup system may be need if the primary one fails. 
 

Operating Systems: A collection of programs that manage all of the computer's

activities, including the control of hardware, execution of software, and management
of information. 
 
Operating Systems provides a user interface by which the individual
interacts with the computer. Types include; text based
commands, graphical user interfaces (GUI), and object-oriented
interfaces (OOI) a graphic interface in which visual metaphors are
employed. 
 
Roles of Support Personnel: 
 
Support for computer systems and networks is extremely important in order to
maintain system functionality, support includes: 1) planning system upgrades,
2) installation of upgrades for operating systems and various applications, 3)
troubleshooting, and 4) user education and training. 
 
Superuser: This person has additional experience over the average
employee and serves as a local resource person. In the hospital setting
this is user who know the clinical area and the computer system.

Microcomputer Specialist: Provides PC information and training; has

special training and degree in computer science or a related area.

Analyst: They are frequently clinicians, who become involved in system

selection and training. Many have learned their role on the job and
furthered their education by taking computer or information science
classes.

Programmer: Writes code, computer instructions; they often lack the

clinical experience. For this reason the analysts are responsible for
communicating user needs to programmers

Network Administrator: They are responsible for the planning,

management and expansion of networks.

Director, Information Services: These individuals should have a board

view of the needs of the institution and the design, implementation, and
evaluation of information systems. Responsibilities include planning,
policy development, budgeting, information security, and overall
management of the information systems.