Long Seminar

On
Computer Application For
Patient Care Delivery
System And Nursing Practice

Submitted to : Submitted By:

Mrs. Revathi Mam T. Venkataramana
Government College Of Nursing Msc(N) 1 st Year
Somajiguda. Government Colleege Of Nursing
Nursing

Somajiguda

Submitted On:
INTRODUCTION
• Computers influence every sphere of human activity and bring in
many changes in industry, education, health care, scientific research,
social service, law and even in arts, music and painting.

• The computer revolutionized the nursing Profession. Clinical and

technological advancements led to a nursing specialty called nursing
informatics the application of computer and information science to promote
and support the practice of nursing and the delivery of nursing care.

HISTORICAL PERSPECTIVES OF COMPUTERS AND NURSING

• In 1960’s, use of computers in healthcare is questioned, but Studies
on computers in nursing are started.
• 1970’s, nurses assisted in the design of HIS. Computers are Used in
financial and management functions, and several
• In 1980’s, nursing Informatics is formally accepted as new nursing
speciality.
• In 1990’s, computer technology became an integral part of the Health
care setting
• In the year 2000, Clinical Information System became individualized
in the electronic patient record, mobile computing Device were introduced.
Definitions
• A electric device that stores, retrieves and processes data, And can
be programmed with instructions. A computer is composed of hardware
and software, and can exit in a variety of sizes and configurations.
• Computer can also be defined in terms of functions it can perform. A
computer can:

-Accept data
-Storedata
-Process data as desired -Retrieve the stored data as and when required;
and
-Print the result in desired format.
The major characteristics of a computer are high speed, Accuracy,
Diligence, versatility And storage.

ANATOMY OF A COMPUTER
A with most products, computer are designed in a variety ways. There are,
however, major similarities of the brand (e g. Dell, Apple, Acer,Hp, lenovo)
of the computer. Then are two main types of computers, desktops and
laptops .

Howell cities the following component

• Monitor
• CPU
• Keyboard
• Mouse

Uses of Computer in nursing and Practice

A) Admission, Discharge and transfer (ADT)

ADT system allows nurses to obtain basic biographical information

on clients before they arrive to the unit. When a discharge or transfer is
entered in the computer, all the appropriate departments (Eg: dietary,
house keeping, pharmacy) are automatically notified, thus, saving the
nurses from many phone calls. Information about beds and a client’s
location on the unit is also readily available.

b) Nursing Documentation

Nursing assessments, client’s care plans, medication, administration

records, nursing notes and dis charge plans are some of the forms of
nursing documentation that are computerized. Computerized
documentation has many advantages. It is typed and therefore legible. The
computer can be programmed to identify the data and time of all entries as
well as the initials or the name of the person making the entry.
 The computer can store standard nursing care plans in a format
determined by the institution, to be used by nurses as the basis for
developing individualized client care plan. The computer is often
programmed to automatically print a list of medication to be administered at
pre-determined times, during the day. A nurse using a print out for a
particular client, administers the medication and then charts it on the
computer (If the medication is not charted and given within a specified time
after the scheduled time, the computer prints reminder that the medication
is overdue). Computer can perform drug dosage calculation faster and
nurses provide more accurately. Nurse's notes can be entered quickly by
choosing statements, appropriate for a particular client from multiple
preprogrammed choices.

Further computer can help with staffing requirements in three ways:

1. They can classify patients and are categorized according to some

assessment of their nursing care requirements for a specified period of
time.
2. Computer can translate patient care needs into the number of nurses
required so that the set number of nurses could be provided. This process
called staffing includes determining shift by shift the need for nurses
provided on the acuteness of patient as shown in the patient classification.
3. Computers help schedule the nursing staff which is to list out nurses on
a day-to-day basis,

Scheduling with Computers

Scheduling is another way in which computers can help nurses. Prior to the
usage of computers, the head nurse would take a list of the names of all
nursing unit employees and their request for days off for the next schedule
cycle and start the tedious process of creating another schedule.

1. Nurses cover the entire unit,

2. Nurse needs to work only 6 days per week.
3. Nurse has every weekend.'
Patient information
Nursing manager is responsible for reviewing the quality of patient care. A
nurse rounds, that is walking from bedside to bedside looking at patient and
reviewing the care they are receiving were the traditional means of
accomplishing this goal.

This information can include patient census by unit with diagnosis acuity
classification, special diagnostic or surgical procedure or whatever
information nursing managers believe is necessary in monitoring the quality
of care delivered.

Employee information
Nursing administration is responsible for maintaining files on each
employee. To be certain that the employee benefit program is being
managed properly and ascertain that all required records are current. The
computer can help maintain these files including the following:

1. Alpha index of employee.

2. License verification
3. Performance evaluation
4. In-service education
5. Vacation

Nursing care plan

The care plans are a permanent part of the patient record. Computerized
nursing care plans benefit such as:

1. Accuracy
2. Reduce the time required to generate the care plans
3. Congruence with JCAH requirements.
4. Ability to use the nursing process and nursing diagnosis both of which
the newer graduate have learned in school 5. More care plans prepared
and completed
6. Follow-up with patients who are involved in their own care and setting
their own goals.
7. Potential for individualization and updating as necessary without
typing and retyping.

Nurse assessment
Computer application helps nurse plan to implement nursing care and
generate the following forms:

1. Current orders summary

2. Daily orders summary 3. Medical care plan
4. Weekly mediation survey
5. Nursing records: In nursing records the following are taken care:

• Admission nursing note

• Nursing assessment
• Nursing care plan
• Documentation against the nursing care plan
• Revised nursing care plan
• Discharge nursing care
• Nursing record at discharge

Administrative application
There are eight major management functions such as

1. Planning: How to do? When to do?

2. Organizing: Lead the program
3. Staffing: Recruit, promotion, depromotion
4. Directing: Setting vision, command
5. Coordinating: Interaction with other department with good manner
6. Controlling: Supervision
7. Budget: Prepare the budget based on income and expenditure

Budget preparation
Budget preparation which is used to include long hours of speculating
calculating and predicting is no longer needed. A spreadsheet or any
application software can be developed to complete all phase of the capital
personnel and supply and expense budget. Thus, budgeting is made easier
through computers.

8. Report: Send feedback 9.

Audit: Verification.

Use of Computers in Nursing Administration

Computers are useful tools for Nurse Administrators. A number of
computer programmes are designed to assist nurse administrators.
Computerized patient's classification system can be used to assign nursing
staff based on how severely ill clients are. Clients are assessed on a
number of criteria and their abilities or need for nursing care are rated. A
client's total rating score indicates how much nursing care the client
requires. Computerized inventory system keeps track of supplies received
and disbursed. They can also be integrated with the client billing system.
General computer application software such as word processing, electronic
spread sheets and data base management system help Nurse
administrator to prepare reports and letters, create budgets and maintain
personnel records and mailing lists. Computers can calculate daily the
number of Nurses needed on each unit, computer can be used to schedule
Nurse's days off so that an optionalnumber of nurses are working at one
time.

Multi Specialty Clinic or Hospitals

In such set-ups, the system schedules appointments for more
number of patients a year according to the availability of doctors within
hospital for consultation A similar clinic program SYSTEM RX that
manages patient billing, account receivable, insurance, payroll and
accounts payable. It also schedules appointment, reminds users of
important events and participates in similar related administrative functions.
SYSTEM RX can also generate reports on demand which a function is
commonly called adhoc reporting.
Community Health Nursing
Computer Stored Ambulatory Record COSTAR) was developed by the
Laboratory computer Science at the Massachusetts General Hospital for
the Harvard Community Health Plan.

The Indian Health Service also uses computers, specifically an online

Patient Care Information System (PCIS), that contains all health care data
for residents of the Papago Reservation in Tucson, Arizona. Before making
visits to the reservation, the community health nurses can access the prior
medical records by using a computerized microfiche printout medical and
nursing health care visits.

Data Confidentiality, Privacy and Security

A review of laws clearly show that both the health care sector and the
medical professionals to term it as its ethical responsibility to keep the
medical information given to them confidential.

1. Individual passwords and sign-on identification are essential. Sign on

identification and passwords are codes that identify each user and link him
or her with the computer functions needed to perform the job.
2. Access to terminal should be controlled. Nurses should have access
to terminals only on the nursing unit.
3. As hospital personnel leave the employment there should be a
method for immediately removing the sign on and password codes from the
system.
4. When developing security policies and procedures, system designers
must be concerned with the patient privacy.
5. The system and its security controls need to be reviewed at regular
intervals by a security coordinator.
6. All personnel who use the system must be educated on the
importance of tient confidentiality. The confidentiality of patient records is
more likely to be protected when the data is stored on a computer.

Real Life Uses of Computers in Education

1) Teaching Learning process Instructions

• Instructing the students using Power Point slides, Word documents or

Web pages and using hyperlinks for better concept clarity.
• Helps in improving pronunciation of students by using microphones,
headphones, speakers, specially prepared software and special
dedicated websites.
• Video conferencing, chat and email helps in better communication, hence
better concept clarity. Also concept of E-tutor has given access to
teachers instantly and given teachers a better chance to earn.
• Current syllabus can be viewed through website of the concerned school
board; made available to students if teacher has made a website and
uploaded using Internet; and updating- using web could be done easily. •
Inspiring students to express their imagination using Paint Brush.
• Encouraging the students to surf web pages and gather relevant detailed
information through web pages.
• Ready made software could give practice material to students

Learning
• Collecting notes pictures/videos from web pages for detailed information
and projects/ assignments.
• Saving the documents as soft copy for future use.
• Learning through animations, as they are much near to the students.
• E-books/online libraries/online encyclopedias help to guide in minutes and
save precious time and resources.
• Creating videos using images, albums for better power Point slides.
• Simulated Learning gives them an idea of the real situation.
• Publication of pamphlet/brochures for awareness with institution and
among community members.

2) Testing and Evaluation process

• Keeping records of students for their academic scores.
• Keeping records in relation to personal history.
• Creating question bank for students. Using computers for testing by
asking Questions.
• From question bank.
• Online testing and evaluation.
• Analysis and interpretation oevaluation
• Previous year question papers and sample papers using web sites.

3) Guidance purposes
• With reference to collective records of the Students maintained year
wise, stored in computers.
• Testing for aptitude, interest, psychology using Computer data bases
and internet.

4) Library
• Documents stored as soft copy for students/ faculty members use.
• Online magazines, journals, brochures, research articles.
• Records of the books/record of the books maintained using special library
software.
• Records of the issues and returns of the books.

5) School Administration
• Records of students (personal, academic,Financial)
• Records of employees of school.
• Accounts of the institution. Decision making process.
• Aid to memory with minimum paper work.
• Eye on current regulations of government and affiliating school boards
and related authorities, School canteen for billing. • Fees collection and
maintenance of fees record. Circulation of instruction/notices and getting
it in printed form.
• Preparation of school magazine.
Nursing Software
Probably the most overlooked and under appreciated resource in the
operating room which nursing professionals require is nursing software that
performs multiple services. It minimizes non-clinical time, improves time
management and facilitates access to information allowing them to do the
job they were trained to do that is to deliver patient care. Nursing software
is easy to use and helps to reduce operating cost and improves
inefficiencies. Some important software listed below:

1. SIS Nursing Software

SIS nursing software includes a series of modules that address each
nursing related phase of the surgery case and more. SIS nursing software
modules include the following:

Pre-admissions Testing
This software consists of documents of all data gathered in patient
screenings and interviews prior to the day of surgery.

Preoperative
This software collects and records pre-surgery information on the actual
day of surgery about nursing assessments, medication history, pre-existing
conditions, prior anaesthesia and surgical history, family history, lab results,
and more.

Intra-operative
This software provides complete electronic patient record for surgery.
Personalizes screens to fit your hospital's current documentation
standards. This software captures information on procedures, personnel,
material usage, all case times, counts,

diagnosis, drugs, and every event or action that occurs during a case.. This
software utilizes special modular options for Cardiovascular, Pediatric, and
Same Day cases. Thus, the system matches the special needs of these
case types.
Postoperative or PACU
In this software, we get document recovery scores, material usage; criteria-
based discharges, drug responses, surgical return statistics, vital signs,
pain score calculations, and all other important data following surgery.

Components of a Hospital Information System Consist of Two or

More of the Following
• Clinical Information System (CIS)
• Financial Information System (FIS)
• Laboratory Information System (LIS)
• Nursing Information Systems (NIS)
• Pharmacy Information System (PIS)
• Picture Archiving Communication System (PACS)
• Radiology Information System (RIS)

1. Clinical Information System

A Clinical Information System (CIS) is a computer based system that is
designed for collecting, storing, manipulating and making available clinical
information important to the health care delivery process. Clinical
Information Systems may be limited in extent to a single area (e.g.
laboratory systems, ECG management systems) or they may be more
widespread and include virtually all aspects of clinical information (e.g.
electronic medical records).

Clinical Information Systems provide a clinical data repository that stores

clinical data such as the patient's history of illness and the interactions with
care providers. The repository encodes information capable of helping
physicians decide about the patient's condition, treatment options, and
wellness activities as well as the status of decisions, actions undertaken
and other relevant information that could help in performing those actions.
2. Financial Information System
Financial Information Systems (FIS) are computer systems that manage
the business aspect of a hospital. While health care organizations' primary
priority is to save lives and not making profits, they do acquire running
costs from day to day operations; including purchases and staff payroll.

Health care business activities can be quite complex and the introduction of
Financial Information Systems aims to ease that daunting task that faces
hospitals Some of the features of Financial Information Systems are:

• Payroll: Handles all the recurring and non recurring payments and
deductions for employees. All recurring transactions can be
automatically generated each payroll period with non-recurring
transactions such as overtime added to the payroll upon approval. It
is also possible to maintain employee pay rates, entitlements, full
salary movements and payroll histories.
• Patient Accounting: This concentrates on financial transactions
generated during a patient's visit to the hospital. These include
inpatient and outpatient charges, doctors' fees generated across the
hospital, the cost of procedures, operations and medications.
• Accounts Payable: Handles the processing of invoices and payments
within the hospital.
• Accounts Receivable: This provides support for and the maintenance
of the records of all clients, invoices and payments.
• General Ledger: This handles the collection, processing and
reporting of financial data generated by all transactions, enabling a
current, accurate and instant view of the financial status of the
hospital at any point in time.
• Fixed Asset Management: This deals with asset data retention and
depreciation forecasting. The transfer of fixed assets between
locations, cost centres or departments; reclassification of assets and
reassessments of asset values can functions that can be done by the
Financial Information System.
• Claims Management: Manages all claims that are made to insurance
companies
 • Contract Management: Keeps track of all ongoing contracts.

3. Laboratory Information Systems

A laboratory information system (LIS) is a computer information system that
manages laboratory information for all the laboratory disciplines such as
clinical chemistry, hematology and microbiology. Laboratory Information
Systems provide modules for sending laboratory tests order to the
instruments through its multiple instrument interfaces, some are known as
to have as many as five hundred, track those orders and then capturing the
results as soon as they become available. The result can then be analysed
and a report the generated from it. This report can be sent off for printing at
a specific point, sent off to other systems either to be added to patient's
electronic medical record or for billing. Laboratory Information
Systems.communicate with other information systems using clinical
information standard such as HL7. Laboratory systems might also make
use of LONIC (Laboratory Observation Identities, Names and Codes) to
exchange laboratory results with other systems.

4. Nursing information system

Some of the features that are provided by Nursing Information Systems
include:

• Patient Charting: A patient's vital signs, admission and nursing

assessments, care plan and nursing notes can be entered into the
system either as structured or free text. These are the stored in a
central repository and retrieved when needed.
• Staff Schedules: Nurse can self schedule their shifts using scheduling
rules provided in shift modules. The shifts can later be confirmed or bill
changed by a scheduling coordinator or manager. Shift modules are
designed to handle absences, overtime, staffing levels and
costeffective staffing.

• Clinical Data Integration: Here clinical information from all the

disciplines can be retrieved, viewed and analysed by nursing staff and
then integrated into a patient's care plan.
 • Decision Support: Decision support module can be added to Nursing
Information Systems, and they provide prompts and reminders, along
with es guides to disease linkages between signs and symptoms,
etiologies or related factors and patient populations. Online access to
medical resources can also be made available.

There are benefits to be enjoyed by implementing Nursing Information

Systems and they include:
• Improved work load functionality: Staffing levels and appropriate skill
mix per shift can be more easily determined by the shift modules. This
leads to less time spent in designing and amending rosters.
• Better care planning: Time spent on care planning is reduced, while
the quality of what is recorded is improved. This makes for more
complete care plans and more complete assessments and evaluations.
• Better drug administration: Electronically prescribed drugs are more
legible, thus making it less likely that drugs would be wrongly
administered to patients.

5. Pharmacy Information Systems

Pharmacy information systems (PIS) are complex computer
systems that have been designed to meet the needs of a pharmacy
department. Through the use of such systems, pharmacists can supervise
and have inputs on how medication is used in a hospital some of the
activities which Pharmacy Information Systems have been employed in
pharmacy departments include:

Clinical Screening: The Pharmacy Information System can assist in patient

care by the monitoring of drug interactions, drug allergies and other
possible medication-related complications. When a prescription order is
entered, the system can check to see if there are any interactions between
two or more drugs taken by the patient simultaneously or with any typical
food, any known allergies to the drug, and if the appropriate dosage has
been given based on the patient's age, weight and other physiologic
factors. Alerts and flags come up when the system picks up any of these.
6. PACS (Picture Archiving Communication System)

Picture Archiving Communication System (PACS) is a loose term to

describe a set of systems that facilitate the archiving, processing and
viewing of digital radiological images and their related information.

The images are acquired, archived and retrieved over a network for
diagnosis and review by physicians. These images can be interpreted and
viewed at workstations, which can also double as archive stations for
image storage.

The introduction of client or server computing, improved digital imaging and

computer network technologies, along with the advancement of the DICOM
and HL7 standards have put PACS alongside radiology information
systems (RIS) as an ideal solution for managing radiological images. Some
of these images include:

- X-ray photos
- Cycloplegia, Retinoscopy
- Computed Tomography
- Magnetic Resonance Imaging
- Radio Isotope
- Ultrasound

Advantages of PACS

- Rapid access to critical information to decrease exam to-diagnosis

time.
This is especially useful in emergency and operating rooms. - Elimination of
film, handling and storage costs Images can be easily shared between
reading radiologists, other physicians and medical records. - Images can
be archived at secure locations using database servers manages the
transfer, retrieval and storage of images and relevant information; the
archive provides permanent image storage.
 - Radiologists can access soft-copy images instantly after acquisition
to expedite diagnosis and reporting at the almost any available
workstation.
- Web servers can be used to most cost-effectively share images with
other departments, even referring physicians across town. They can
access the images using the Internet or the local intranet.
- Hardcopy films or paper printouts can be made when needed for
traditional archiving or the provision of images to other departments.

7. Radiology Information System

A radiology information system (RIS) is a computersystem that
assists radiology services in the storing, manipulation and retrieving of
information, RIS were first used in the 1970s and their primary aim was to
manage and store radiology information. The introduction of client/server
computing, improved digital imaging and computer network technologies,
along with the advancement of the DICOM and HL7 standards have put
RIS alongside picture archiving communication system (PACS) as an ideal
solution for managing radiological images.

Since the 1990s, organizations have taken the steps to fully integrate
PACS with radiology information systems, when the basic features and
adapt needed to manage the acquisition, processing and storage of
radiological information, becomes the responsibility of the RIS. Some of the
areas that can be addressed by radiology information systems are:

- Patient Management: radiology information systems can be used to

manage a patient's entire workflow within the radiology department,
images and report scan be added to and retrieved from electronic medical
records (EMRs) and viewed by the authorized radiology staff.

- Scheduling: Patient appointments for inpatients and outpatients can be

scheduled when an order is received. Functions for scheduling the
various available radiology staff with the allocated time slots can also be
handled by the radiology information system.
- Patient Tracking: The patient can be tracked from admission to discharge,
with all the radiology procedures carried out recorded. This would include
the patient's past, present and future appointments.

- Results Reporting: Reports concerning the results of an individual patient,

a group of patients or a particular procedure can be generated using a
radiology information system.

- Film Tracking: Individual films can be tracked.

Conclusion

Hospital information systems can be used to improve the effectiveness of

patient care while making it more economical. These can all be available
from virtually any location. Clinical nurses can use their nursing information
system to replace manual systems of data recording.