Practice

Applications
 Nursing informatics: An evolving
definition
• since 1980, nursing • A combination of nursing
informatics has been science, information
defined broadly either science, and computer
with a focus on the science to manage and
technologic aspects, on process nursing
the concept of nurses data, information and
interacting with knowledge to support the
technology to produce practice of nursing and
greater knowledge, or on the delivery of nursing
the role of nurses who care - Grave & Corcoran
specialized in 1989
developing applications
of technology to nursing
practice - ANA, 2001
 A 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, and
research; and to expand nursing knowledge. The
purpose of nursing informatics is to: analyze
information requirements; design, implement and
evaluate information systems and data structures
that support nursing; and identify and apply
computer technologies for nursing. – ANA, 1992
 Nursing informatics is the
specialty that integrates
nursing science, computer
science, and information
science in
identifying, collecting, proces
sing, and managing data and
information to support nursing
practice, administration, educa
tion, research and the
expansion of nursing knowledge.
- ANA, 1994
 Goal of Nursing Informatics, said the
ANA, is to;
• Improve the health of
populations, communities,
families, and individuals by
optimizing information
management and
communication. This includes
using technology in the
direct provision of care;
establishing administrative
systems; managing and
delivering educational
experiences; supporting
life-long learning, and
supporting nursing research.
 Nursing Informatics: Scope and
Standards of Practice
• Nursing informatics (NI) integrates nursing
science, computer and information science, and
cognitive science to manage, communicate, and
expand the data, information, knowledge, and
wisdom of nursing practice. Nurses trained in NI
support improved patient outcomes through
their expertise in information processes,
structures, and technologies, thus helping nurses
and other care providers to create and record the
evidence of their practice.
Critical Care Applications
Chapter 21
Jade Mojica
Critical Care Nursing:
• Is the nursing specialty that deals
with human responses to life-
threatening problems.

Critical Care:
• Multidisciplinary healthcare specialty
that cares for patients with acute,
life-threatening illness or injury.
 In 1986…
• Saba and McCormick estimated that the
volume of data collected by nurses in critical
care settings on a daily basis was as high as
1,500 data points

– A data point is a discrete unit of information. In a general sense, any single fact is a data
point. In a statistical or analytical context, a data point is usually derived from a
measurement or research and can be represented numerically and/or graphically. The
term data point is roughly equivalent to datum, the singular form of data.
As technology expands

Available information expands

Making it increasingly difficult to access and

manage the volume of data.

The clinician integrates data from:

• Hemodynamic devices
• Mechanical ventilators
• Bedside testing devices
• Observation from direct patient assessments
 Focuses of Discussion
• Physiologic monitors
• Arrhythmia monitors
• Hemodynamic monitors
• CCISs
 Developments
– Functions
• Rapidly analyzed small samples of gas or fluids
• Maintained near-normal physiologic ranges with life-
supporting equipment
• Stored large volumes of data that would otherwise be
disorganized, lost, inaccurate, or illegible.
• Address alarms and clinical alerts
 Information Technology Capabilities
and Applications in Critical Care Settings
– Process, store, and integrate physiologic and diagnostic
information from various sources
– Present deviations from preset ranges by an alarm or an
alert
– Accept and store patients care documentation in a lifetime
clinical repository
– Trend data in a graphical presentation
– Provide access to vital patient information form any
location, both inside and outside of the critical care setting
– Comparatively evaluate patients for outcomes analysis
– Preset clinical data based on concept-oriented views
(organize data by patient problem, or by system)
 Bedside physiologic Monitoring
Equipment
• Basic components
– Sensors (e.g., pressure transducer, ECG electrode)
– Signal conditioners to amplify or filter the display
device (e.g., amplifier, oscilloscope, paper recorder)
– File to rank and order information (e.g., storage file,
alarm signal)
– Computer processor to analyze data and direct
reports (e.g., paper reports, storage for graphic files,
summary reports)
– Evaluation or controlling component to regulate the
equipment or alert the nurse (e.g., a notice on the
display screen, alarm signal)
 Hemodynamic Monitors
• Can be used to
– Measure hemodynamic parameters
– Closely examine cardiovascular functions
– Evaluate cardiac pump output and volume status
– Recognize patterns (arrhythmia analysis) and extract features
– Assess vascular system integrity
– Evaluate the patient’s physiologic response to stimuli
– Continuously evaluate blood gases and electrolytes
– Estimate cellular oxygenation
– Continuously evaluate glucose levels
– Store waveforms
– Automatically transmit selected data to a computerized patient
database
 Arrhythmia Monitor
• Computerized monitoring and analysis of cardiac
rhythm

• Basic Components
– Sensor
– Signal conditioner
– Cardiograph
– Pattern recognition
– Rhythm analysis
– Diagnosis
– Written report
Critical Care Information System (CCIS)
• Designed to
collect, store, organize, retrieve, and
manipulate all data related to care of the
critically ill patient.
• Primary purpose is to organize patient’s
current and historical data for use by all care
providers in patient care
• Should include data and information from
bedside devices and comprehensive plans of
care to guide patient care
• Components of the CCIS
– Patient management
– Vital sign monitoring
– Diagnostic testing results
– Clinical documentation to support the process
of physical assessment findings
– Decision support
– Medication management
– Interdisciplinary plans of care
– Provider order entry
AMBULATORY
CARE SYSTEM

JOVELYN CABUNGCAL
President George Bush
April 27, 2004
White House E.O 2004
- announced a goal to
establish electronic health records
(EHRs) for all citizens within a 10-
year time frame. Created the
position of a national health
information technology
coordinator to develop a
nationwide interoperable health
technology infrastructure .
Tommy G. Thompson
Health and Human Services
Secretary Announced the
“Decade of Healthcare
Information Technology”
and announced the
publication of a report
which reveals how vital it
is to have automation in
the physician’s and
ambulatory offices.
 Four Major Goals
GOAL 1
Inform Clinical Practice. Bringing
information tools to the point of
care, especially by investing EHR systems
in physician offices and hospitals.
GOAL 2
Interconnect clinicians. Building an interoperable
health information infrastructure, so that records
follow the patient and clinicians have access and
involvement in health decisions

Goal 3:
Personalize Care. Using health
information technology to give
consumers more access and
involvement in health decisions.

Goal 4:
Improve population health. Expanding capacity
for public health monitoring, quality-of-care
measurement, and bringing research advances
more quickly into medical practice.
Where Ambulatory Clients are Being
Treated:
Ambulatory Clinics

Surgery Centers

Single and Multispecialty Group

Diagnostics Laboratory

Health Maintenance organizations

Independent physician organizations

Birthing Centers

College and Universities health Services

 Issues for Ambulatory Care
• Those who work in ambulatory care are
similar across the healthcare enterprise
including increased accountability , the need
for continuous and documented service
improvements, pressures to control
utilization, and the protection of confidential
information.
Applications Necessary in the Ambulatory
Environment Ambulatory
are design to store

manipulate

retrieve information for

planning, organizing, directing, and
controlling administrative

clinical activities associated with the

provision and use of ambulatory care
services and facilities
 Cost Effective

Accurate Timely bill

insurance Financial submission
processed resulting
information
obtain
Benefits decreased days in
accounts payable

Reduction of
rejected claims
 Administrative benefits
Reduction in size of the record room

Reduce time spent finding and delivering chart

Increase privacy of data

Formats that are legible

Comply with legal regulations

Promotions of quality assurance

Improve patient satisfaction

Ability for home access by the physician and nurse practitioners

Alerts for incomplete data

Integration of clinical data

CLINICAL BENEFITS
 Regulatory Requirement

Resource Department
Based of Health
Relative and Human
Value Scale Services
 Regulatory Requirement
Current
Procedural
Terminology
•codes describe medical
procedure performed
by physicians and
other health providers.
National Drug Code
• Identifies
Health Common
Procedural Coding
System,
•Collection of codes that
Ninth Revision of represent procedures,
the International supplies, products, and
services which maybe
Classification of provided to Medicare
Diseases beneficiaries and to
individuals enrolled in
private health insurance
programs .
pharmaceutical in
detail including
the packaging. Its
use is required by
the FDA for
reporting and it is
used in many
healthcare
information
systems to aid
reimbursement.
NDC directory - Is
limited to
prescription drugs
and few selected
over-the-counter
products .
Implementations Issues and
Challenges