Nursing Informatics

Sanil Varghese
HEALTH CARE INFORMATICS- HISTORY
 MEANING
• Informatics comes from the French word
“informatique” which means “computer
science”.
• Informatics is defined as computer
science+information science.
 DEFINITION
• Hebda (1998), defines nursing informatics as the
use of computers technology to support nursing,
including clinical practice, administration,
education and research.
• ANA (American Nurses Association) 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.
 APPLICATION OF NURSING
INFORMATICS / GENERAL PURPOSE
Nursing Clinical Practice:
• 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 (EMR).
• 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 system)
• 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
programmes.
• Internet resources- formal nursing courses and
degree programmes.
• Presentation software for preparing slides and
handouts- power points and MS words.
Nursing Research:
• Computerized literature searching- CINHAL,
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- SPSS.
 Patient Education:
• Nursing informatics can be used for symptom
management and patient education. The nurse can
access the information for the patient or teach the
patient where to find appropriate and helpful
information. For example, on an oncology unit, nursing
informatics can be used to teach patients effective
symptom management of the treatment modalities
which often cause pain, fatigue and poor nutritional
status. Nursing informatics can also aid in other nursing
interventions of the oncology nurse, such as analgesic
administration and stress-reduction techniques.
 Clinical Alert System:
• The computerized clinical alert system can be
used in conjunction with the hospital
pharmacy. A system design is created to alert
both pharmacy and health staff when two or
more drug prescriptions are incompatible.
 Patient Data:
• Nursing informatics can also be useful in a
physician’s clinic. In a managed care environment,
information systems make administrative
management more efficient. The private
practitioner, program or facility to manage every
aspect of patient care can use one data
management system. In each of these health care
settings data management systems can be
applied to treatments, diagnostics,
documentation, practice management, insurance
claims and referrals and protocols as well as
treatment and diagnostics results.
 Telehealth:
• Telehealth includes the use of telephones and sophisticated
image transmission systems like ECG, faxes and remote
camera imaging. Telehealth places the ambulance personnel
in touch with the Emergency Department and it also operates
to put the generalist “nurses and doctors” at the ED in touch
with specialists. Telehealth is used to evaluate the stroke
victims while they are in transit so appropriate therapy can be
initiated quickly upon arrival at the ED. In similar fashion, a
nurse practitioner in a remote ED might be guided via
telephone in the proper procedure for inserting chest tubes
so a man with a collapsed lung could be stabilized for
subsequent transport to a major hospital. Finally, nursing
informatics can be useful for interdepartmental
communication such as ordering supplies from central supply,
lab work, etc.
 Clinical Information:
• In order for the nurse to ensure the patient is receiving the
most up-to-date care for a variety of chronic conditions, the
National Institute of Health (NIH) have an agency designed
to offer such guidance. Clinical practice guidelines can be
found at http://www.nhlbi.nih.gov/guidelines/index.htm.
The practice guidelines found at this site provide
management information for asthma, cholesterol,
hypertension and obesity.
• Clinical practice guidelines for the management of diabetes
mellitus and menopause can be found at
http://www.aace.com/clinguideindex.htm. Further
information can be found through the Medscape Nurses
site and National Institute of Health- http://www.nih.gov.
 SIGNIFICANCE OF NURSING
INFORMATICS
I. Nursing informatics facilitates
communication.
II. Nursing informatics allows articulation of
organized information.
III. Nursing informatics leads to credibility.
 BENEFITS OF COMPUTER
AUTOMATION IN HEALTH CARE
 EMR
• Improved access to the medical ward: 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:
• 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.
TRENDS NURSING INFORMATICS:
 Past Nursing Informatics
• Nursing informatics was first defined as the
use of computer technology to support
nursing, including clinical practice,
administration, education and research.
• The first generation of nursing information systems was
designed to speed paperwork and communication. In
general, the systems accomplished this by transferring
information to the computer, what nurses had done on
paper and by telephone. These systems replaced paper
records, filing cabinets and pneumatic tubes. Although
this was helpful and effective in reducing the time
spent on documentation and communication it did not
address many of the fundamental issues for nurses’ use
of data, information and knowledge to guide effective
care (Executive summary, 2004).
• Until 1948, primary care remained in the home. With the
development of Hill-Burton Act of 1948, money was
provided for the building of hospitals and promoted a
catalyst for change in healthcare. In the 1960’s, Medicare
and Medicaid provided reimbursement for services to
many individual patients and the health insurance industry
grew. This provision of funding allowed many new
innovations: new drugs, advanced surgical procedures, new
technologies and equipment, and sophisticated diagnostic
procedures. All of which led to the development of medical
specialties, each treating a different part of the patient and
creating its own records for what patient (Thede, 2003).
• It is not unusual to find a patient being treated
by several physicians at the same time. These
physicians share little information; they may
duplicate tests or prescribe medications that
are not compatible with those prescribed by
another physician. The current healthcare
system relies primarily on paper records that
are oriented to episodes and providers
(Thede).
• During the past four decades the U.S.
government has played a major role in the
development and promotion of telehealth
through various agencies. Although interest
waned as funds were depleted in the 1980’s,
technological advancements made it a more
attractive prospect. Federal monies and
Agriculture Department’s 1991 Rural
Development Act laid the groundwork for
bringing the information superhighway to rural
areas for education and telehealth purposes
(Hebda, et al, 2001).
• The most aggressive development of
telehealth consults for Armenian earthquake
victims in 1989, while more recently the
military has been working on several projects
to feed medical images from the battlefield to
physicians in hospitals for improved treatment
of casualties (Hebda, et al, 2001).
 Present Nursing Informatics
• Although the history of nursing informatics
extends only some twenty years, the field is
advancing rapidly as a scientific discipline and
has significant implications for patient care
(Executive Summary, 2004).
• As research in nursing informatics evolves, it
has become apparent that the issues are far
more complex than reducing time spent on
paper work. The high-intensity generation,
management, processing of data and
knowledge are integral components of nursing
care. Informatics gives nurses the means to
carry out these aspects of care efficiently and
effectively to improve outcomes for patients.
• Nursing informatics impacts nurses today. Today,
evolving standards of practice increase the
nurse’s accountability. The malpractice crisis has
strengthened accountability and increased
emphasis on complete and detailed nursing
documentation. Changes in reimbursement
methods are affecting nursing care delivery. Cost
containment and consumerism place additional
pressures on not only the individual nurse but
also the entire nursing profession (Ball, et al.
2000).
 Future Nursing Informatics
• Nursing informatics has arrived and the baby
has started to walk. In the process, nursing
informatics has introduced new challenges
and opportunities along with new computer
applications.
• Nursing informatics is a growing field for
advancement and offers many potential areas
for cost containment.
• Nursing informatics and managed care, make
telehealth an attractive tool to save
healthcare dollars: Telehealth may provide
savings in the following areas: improved
access to care, allowing clients to be treated
earlier and with fewer interventions.
• Clients may receive treatment in their own
community where services cost less,
improving quality of care and improved
continuity of care through convenient follow-
up.
• Telehealth applications vary greatly and
include client monitoring, diagnostic
evaluations, decision support systems, storage
and dissemination of records for diagnostic
purposes, image compression for efficient
storage and retrieval, research, voice
recognition for dictation and education of
healthcare professionals and consumers.
• Many providers expect that telehealth will
revolutionize healthcare. It promises to
improve speed and accuracy of
communicating with medical providers to
gather information and address concerns.
• Nursing informatics and telehealth will
continue to grow and become commonplace
(Hebda, et al, 2001).
• Telehealth is an expansion of telemedicine and
unlike telemedicine (which more narrowly
focuses on the curative aspect) it encompasses
preventive, promotive and curative aspects.
Originally used to describe administrative or
educational functions related to telemedicine,
today telehealth stresses a myriad of technology
solutions. For example, physicians use email to
communicate with patients, order drug
prescriptions and provide other health services.
 JOURNAL REFERENCES
• Exploring the impact of health information
technology on communication and
collaboration in acute care nursing.
• Nurses’ experiences using a nursing
information system: early stage of technology
implementation.
• The perfect role for nursing informatics:
Nursing staff development.
 USE OF COMPUTERS IN HOSPITAL
AND COMMUNITY
CLINICAL IMPLICATION
• Assessment:
• Patient monitoring:
• Documentation:
• Nursing minimum data sheet:
• Telemedicine:
• Electronic Medical Records (EMR):
 Increased efficiency:
Improved documentation:
Improved quality of care:
Improved security:
Reduced documentation expenses:
ADMINISTRATION:
• Provision of data required by the nurse
administrators to:
• Define the cost of nursing services.
• Evaluate quality assurance programme.
• Demonstrate the cost effectiveness of nursing
care
• Justify new roles for nursing in the health care
system
NURSING PRACTICE:
• Enhance documentation by the nurse.
• Provision of data to enable research directed at
examining relationship between data elements and
nursing outcomes to identify optimal nursing care
for use in practice.
• Facilitate nursing process through use of the NMDS
in practice.
• Nursing workload measurement system: The three
most widely used nursing workload measurements
are:
 Project research in nursing:
 Medicus.
 GRASP (Grace- Reynolds application)
RESEARCH:
• The advent of computerized data bases of literature
helps to search rapidly and to retrieve abstracts of
literature immediately.
• Conduct online searches of data base.
• Provides online full text information on legal, news,
business and general information.
Eg: CINHAL, Medline, Science Direct.
• Preparation of research document:
• Data gathering:
There are three types of computer assisted
interviewing:
– Computer self administered interviewing:
– Computer assisted telephone interviewing:
• Data analysis:
 EDUCATION:
The use of computer in nursing education
includes:
• Computer assisted instruction:
• Computer assisted interactive video
instruction:
• Simulation:
• Tutorials:
 COMMUNITY SETTING:
The main uses of computers in community are:
• Gathering of epidemiological and
administrative statistics.
• Patient appointments- identification system.
• Patient assessment and data gathering.
• Monitoring.
• Documentation.
• Special need application.
 PATIENT RECORD SYSTEM
DEFINITION
• A ‘medical record’ is a patient record, consisting
of sufficient data written in sequence of events to
justify the diagnosis and warrant treatment and
end results. It must be adequately informative,
highly scientific and legally protective.
• It may be defined as a clinical, scientific,
administrative and legal document relating to the
patient’s care.
 IMPORTANCE OF MEDICAL RECORDS
• To the patient
It helps in the following ways:
– It serves to document the history of the patient’s illness.
– It serves to avoid omission and unnecessary repetition
of diagnosis and treatment measures.
– It assists in the continuity of care in the event that future
illness requires attention in or out of the hospital.
– It serves as evidence to support or to refute any legal
questions which may arise.
– It assists the patient and authorities concerned in fixing
disability entitlements under the Workman’s
Compensation Act.
• To the hospital
The medical records from the basis of many
phases of administrative efficiency:
– It provides the management with statistical
information necessary for decision making with regard
to utilization of resources, planning for administrative
control and future references.
– It also furnishes documentary evidence for purposes
of evaluation of hospital care in terms of quality,
quantity and adequacy (medical audit).
– It protects the hospital in the event of legal questions
(Torts suits).
• To the doctors
– It assures the doctor of the quality and adequacy
of the diagnostic and therapeutic measures
undertaken by him.
– It assures the doctor of the continuity of medical
care.
– It helps the doctor in self evaluation.
– It protects the doctor in case of legal suits.
• To the public health authorities
It provides a reliable mortality and morbidity
statistics and thus helps the public health
authorities to plan preventive and social
measures to meet the needs of the
community. Early warning of the incidence of
communicable diseases is often obtained from
hospital records.
• To medical education and research
Since recorded observations and case studies
are the basis of all clinical research, medical
records become invaluable in all research and
teaching programmes.
 CHARACTERISTICS OF GOOD PATIENT
RECORDS
• Complete: Sufficient data to identify the
patient, justify diagnosis and warrant
treatment and outcome.
• Adequate: All necessary forms and all relevant
clinical information.
• Accurate: Capable of quantitative analysis.
COMPUTERIZED PATIENT RECORD
Advantages of CPR:
• Have the patient’s entire history.
• Can flag drug reaction problems.
• Can eliminate redundancy in record keeping.
• Eliminate the need for taking repeated
histories.
• Can, if utilized properly, reduce error.
Disadvantages of CPR:
• Are very expensive to set up.
• Are less secure.
• Require standardized coding systems, which
force all users to use entries that the
computer can understand.
 FUNCTIONAL COMPONENTS OF A
COMPUTER-BASED PATIENT-RECORD
SYSTEM
• The five functional components are:
• Integrated view of patient data
• Clinical decision support
• Clinician order entry
• Access to knowledge resources
• Integrated communication support