Information Technology System

Applicable in Nursing Practice Part 1

Define Technology
Hospital/Critical Care Applications
- For many people, information
 More than 150 years ago, Florence
technology (IT) is basically
Nightingale spoke about the critical
synonymous with the guys
importance of nursing informatics
and gals you call when you
in patient care. “Decision making
need help with a computer
must be based upon the use of
issue. While that view of
accurate data”, she said (Ulrich,
information technology isn’t
1992, p.68)
totally wrong, it drastically
understates the scope of this
 The nursing pioneer also spoke of
critical career field.
frustration from difficulties of
Information Technology exacting such critical patient-
related data from hospital record.
 It's the application of technology to
solve business or organizational
 It was more than a century after
problems on a broad scale.
Florence Nightingale’s era that
 The phrase “information
computer made their appearance on
technology” goes back to a 1958
the hospital landscape.
article published in the Harvard
Business Review. Authors Harold
 The first hospital information
J. Leavitt and Thomas L. Whisler
system arrived in the late 1950’s to
defined several types of
the mid-1960, although these
information technology:
systems focused primarily on
✔ Techniques for the fast processing processing financial and
of information administrative information

✔ The use of statistical and Goal of Nursing Informatics, said by the

mathematical models for decision-
making
✔ The “simulation of higher-order
thinking through computer programs.”
•Hospital/Critical care applications
•Community health application
•Emergency preparedness and response
•Administrative assistive devices and
workplace technologies
•Telehealth
ANA, is to;
o Improve the health of populations,
communities, families, and
individuals by optimizing
information management and
communication.
o It 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.
MANAGEMENT INFORMATION
SYSTEM IN HEALTH CARE
System – A collection of
components that work together to
achieve a common objective
Information System – A system that
provides information support to the
decision-making process at each
level of an organization.
Health Information System – A
system that integrates data
collection, processing, reporting,
and use of the information
necessary for improving health
service effectiveness and efficiency
through better management at all
levels of health services.
Health Management Information
System – An information system
specially designed to assist in the
management and planning of health
programmes, as opposed to
delivery of care.
HEALTHCARE INFORMATION
SYSTEM (HIS)
o Healthcare is a business and, like
every business, it needs good
management to keep the business
running smoothly
o Healthcare information systems
means meticulously maintaining a
patient's healthcare records and
ensuring that confidential
information is securely kept.
o Those in healthcare information
systems must have tremendous
attention to detail
o They are responsible for
maintaining, updating, and
securing all of a patient's healthcare
information.
Healthcare Service Providers who use
HIS
o Hospitals
o Nursing and residential care
facilities
o Physicians and surgeons
o Other ambulatory health care
service
o Medical and diagnostic laboratories
o Dentists and dental clinics
o Home health care services
o Other health practitioners
o Outpatient care centers
HEALTH INFORMATION
PROFFESIONALS
 They apply the science of
informatics to the collection,
storage, use, and transmission of
information to meet the legal,
professional, ethical and
administrative records-keeping
requirements of health care
delivery.
o Health information
managers
o Medical records and health
information technicians
o Health Information
Administrator
o Implementation managers
o Trainers
ELECTRONIC MEDICAL RECORD
SYSTEM
 Clinicians rely on complete and
accurate data in order to make
decisions about patient care
 Without a solid system for health
information exchange in place
between facilities, it is impossible
 to ensure that a clinician has the
entire clinical picture.
 Without complete historical
information on a patient, treatment
plans are often askew, which can
mean suboptimal, sometimes even
lethal, outcomes
Historical Background of Electronic
Health Records
- Recognizable efforts in the development
of EHR are distinguished by the Nicholas
E. Davis Awards of Excellence Program
whose history describes the improvement
of EHR in different settings.
- The Computer-Based Patient Record
Institute (CPRI), founded in 1992. It was
an organization representing all the
stakeholders in healthcare, focusing on the
clinical applications of information
technology.
- It was among the first nationally based
organizations to initiate and coordinate
activities to facilitate and promote the
routine use of Computer-Based Patient
Records (CPRs) throughout healthcare.
- Nowadays the Nicholas E. Davies
Awards Excellence Program is managed
by the Healthcare Information
Management Systems Society, and has the
following program objectives:
- The Healthcare Information and
Management Systems Society (HIMSS) is
the healthcare industry's membership
organization exclusively focused on
providing global leadership for the optimal
use of healthcare information technology
(IT) and management systems for the
betterment of healthcare.
HOSPITAL MANAGEMENT
INFORMATION SYSTEM
 It is essentially a computer system
that can manage all the information
to allow health care providers to do
their jobs effectively.
 These systems have been around
since they were first introduced in
the 1960s
 They manage the data related to the
clinic, finance department,
laboratory, nursing, pharmacy and
also the radiology and pathology
departments.
 The system must be user friendly
and should include training by the
vendor
HIGHLIGHTS OF HOSPITAL
MANAGEMENT INFORMATION
SYSTEM
o Patient-centered approach
o User-friendly, easy-to-use & web-
enabled applications
o Multi-level distributed hospital
information system
o Security & privacy (authentication,
authorization, privacy
o Integration
o Patient identification
o Single log-in
o Use of controlled vocabularies for
coding
o Data consistency
o Transparency

Critical Care Application
Critical Care Nursing:
- Is the nursing specialty that
deals with human responses to
lifethreatening problem.
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
- 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
Critical Care Information System
- Provide real-time resource utilization
data and management of information and
access critical care areas through the
integration of the medical facilities in the
critical to an intelligent computer system
which is capable of processing all data.
- Enables the electronic collection of
hospital and patient-specific critical care
data of the entire patient in the critical care
areas which can be processed to create a
patient profile which generate real time
and historical report
- Automated collection and management
of medical information will become the
important task of the critical care
information system
Medical Information Bus (MIB)
- Provides a generalized method of
attaching patient monitoring devices to a
common interface.
- This interface converts the unique
manufacturer data communications
protocol into a standardized hardware and
software system.
- It eliminates the need for custom
connector and software presently needed
to interface such device.
- Has the ability to filter, store and select
information sent for inclusion into the
clinical medical record on the clinical
computer system.
Advantages of Critical Care
Information System
 Intelligently integrates and process
physiologic and diagnostic
information and store it to secured
clinical repository
 Creates trends analysis with
graphical representation of results
 Offline stimulation can be
performed to test the condition of
the patients.
 Provide clinical decision support
system
  Provide access to vital patient
information
 Providing feedback and quick
evaluation of the patient condition
and provides alert.
Information Technology Capabilities
and Applications in Critical Care
Settings
o Process, store, and integrate
physiologic and diagnostic
information from various sources
o Present deviations from preset
ranges by an alarm or an alert
o Accept and store patients care
documentation in a lifetime clinical
repository
o Trend data in a graphical
presentation
o Provide access to vital patient
information form any location,
both inside and outside of the
critical care setting
o Comparatively evaluate patients for
outcomes analysis
o Preset clinical data based on
concept-oriented views (organize
data by patient problem, or by
system)
Community Health Application
 Collective term for the methodical
application of information science
and technology to community and
public health process.
 Focuses on the health information
system of the community, it is
centered on the majority part of the
public.
 Emphasizes the prevention of the
disease, medical intervention and
public awareness.
 Fulfils a unique role in the
community, promoting and
protecting the health of the
community at the same time
maintaining sustainability and
integrity of health data and
information.
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 Application
 Encourages optimal application of
computer system, computer
programs and communication
system for the benefit of majority
of individuals, families and
community.
Public Health Challenges
 Issues of bioterrorism
 Health plans recognizing need to
evaluate prevention activities to
improve quality of live and reduce
costs.
 Healthcare providers recognizing
need to integrate public data into
individual health records.
 Health depts. Needing to monitor
impact of community – wide
interventions for improving the
health of populations in
communities.
- Software developers
responded with developing
electronic IT systems instead
of outdated data processing /
computer systems.
Allow for:
1. Relational database that facilitate
retrieval of data for multiple purposes
without rekeying.
2. Manipulation of data to create
information and knowledge.
3. Point of care devices, computerized
(CPRs) and/or EHRs
4. Clinical repositories as a strategic
resource for quality and justice
5. Electronic interfacing systems to
facilitate the sharing of data.
Information Technology System
Applicable in Nursing Practice Part 2
•Hospital/Critical care applications
•Community health application
•Emergency preparedness and response
•Administrative assistive devices and
workplace technologies
•Telehealth
INFORMATICS SOLUTION FOR
EMERGENCY PREPAREDNESS AND
RESPONSE
- According to the TIME’s website "the
Philippines is the most storm-exposed
country.” the Philippines is the most
exposed country in the world to tropical
storms. With more than 7,000 islands, the
coastline is vulnerable to storm surges.
- Here in the Philippines we experienced
all kinds of calamities and Disasters like
landslide, earthquake, drought, typhoons
and many more. Informatics can also
contribute to increasing the efficiency in
disaster response as well as providing a
tele-presence for remote medical
caregivers.
- Informatics is not only used in hospital
but also in disaster response. It can be used
in tracking victims.
- Electronic health records, supply
inventory and surveillance of threat
detection. also, it helps in informing the
volunteers about the plans and reports.
- We don’t know when these calamities
and disaster strike but we need to be ready.
we don’t want to repeat what happen in the
past wherein many people died and lost
their loved one as well as their properties
that they work hard. having the informatics
in emergency planning and responses is a
big help in our people because it can help
in giving status and reports that can warn
them of an upcoming typhoon or other
disaster
Importance of Active Surveillance
During a Disaster
 Complement to regular reporting
mechanisms
 Rapidly detect outbreaks and
define health problems
 Identify groups at risks for adverse
health events
 Determine needs of special
populations
Use of Informatics in Disasters
 Real-time and accurate
epidemiologic data is critical to
decision making
 Delivery of appropriate public
health services during emergency
events such as disease outbreaks or
disasters is essential.
 Agencies must receive data from
the field quickly and have the
ability to compare results across
 jurisdictions when multiple states
are affected.
o Optimize the relief response
o Monitor the effectiveness of
the relief effort
o Respond to public concerns
and media inquiries
o Facilitate planning for
future disasters
Informatics Solutions:
▪ Healthcare members develop a bar code
system to log and track victims
- Three Units Focusing on
Emergency Planning and
Response
o CDC – Centers for
Disease Control &
Prevention
o AHRQ – Agency for
Healthcare Research
and Quality
o HRSA – Health
Resource and Services
Administration
CDC – Centers for Disease Control &
Prevention
- CDC works 24/7 to protect America from
health, safety and security threats, both
foreign and in the U.S. Whether diseases
start at home or abroad, are chronic or
acute, curable or preventable, human error
or deliberate attack, CDC fights disease
and supports communities and citizens to
do the same.
- CDC increases the health security of our
nation. As the nation’s health protection
agency, CDC saves lives and protects
people from health threats. To accomplish
our mission, CDC conducts critical science
and provides health information that
protects our nation against expensive and
dangerous health threats, and responds
when these arise.
CDC's Role
 Detecting and responding to new
and emerging health threats
 Tackling the biggest health
problems causing death and
disability for American
 Putting science and advanced
technology into action to prevent
disease
 Promoting healthy and safe
behaviors, communities and
environment
 Developing leaders and training the
public health workforce, including
disease detectives
 Taking the health pulse of our
nation
AHRQ – Agency for Healthcare
Research and Quality
- It is the lead Federal agency charged with
improving the safety and quality of
America's health care system. AHRQ
develops the knowledge, tools, and data
needed to improve the health care system
and help Americans, health care
professionals, and policymakers make
informed health decisions
- Its mission is to produce evidence to
make health care safer, higher quality,
more accessible, equitable, and affordable,
and to work within the U.S. Department of
Health and Human Services and with other
partners to make sure that the evidence is
understood and used.
HRSA – Health Resource and Services
Administration
- It is an agency of the U.S. Department of
Health & Human Services (HHS),
provides health care to people who are
geographically isolated, and/or
economically or medically vulnerable.
This includes people living with
HIV/AIDS, pregnant women, mothers and
their families, and those otherwise unable
to access high quality health care.
HRSA supports the training of health
professionals, the distribution of providers
to areas where they are needed most, and
improvements in health care delivery.
In addition, HRSA oversees organ, bone
marrow, & cord blood donation. It
compensates individuals harmed by
vaccination, and maintains databases that
flag providers with a record of health care
malpractice, waste, fraud, and abuse for
federal, state and local use.
AMBULATORY CARE SYSTEM
Ambulatory care
- It is a medical care provided on an
outpatient basis, including diagnosis,
observation, treatment, and rehabilitation
services.
- The ambulatory care nurse focuses on
patient safety and the quality of nursing
care by applying appropriate nursing
interventions, such as identifying and
clarifying patient needs, performing
procedures, conducting health education,
promoting patient advocacy, coordinating
nursing and other health services, assisting
the patient to navigate the health care
system, and evaluating patient outcomes.
- It covers a wide range of services that
can be offered to patients that needs
medical attention, by integrating the
ambulatory care information system in the
nursing practice will really help in making
the work easy like the processing of data
and information and the billing & charges
and etc.
- There are advantages of the ambulatory
care information system like first, the
access of medical records of patients to
health care providers.
- Second, the nurses will be able to give
quality care and improve workflow, reduce
medical errors, and lastly the management
and monitoring of the billing, doctor’s
fees, prescriptions and many more.
- One of the most important responsibility
of a nurse is to make sure that the patient
receives the care that he/she needed and
with the use of this system I believe the
quality of care can be given.
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:
o Ambulatory Clinics
o Surgery Centers
o Single and Multispecialty
Group
o Diagnostics Laboratory
o Health Maintenance
organizations Independent
physician organizations
Birthing Centers
o College and Universities
health Services
Issues for Ambulatory Care
o Increased accountability
o The need for continuous support
o Privacy and confidentiality of
information
o Accessibility and security of data
and information
o Integration and support to the other
system
The Role of Nurse Using Information
System in the Ambulatory Care System
- The very basic objective of the
automated ambulatory care information
system is to easily integrate the data to the
other data and easily translate these data
into information.
- The effective transformation of data can
be integrated to the other processes to
transform it into knowledge.
- The ambulatory care nurse and other
health care provider should be capable
enough to implement the process
effectively.
Administrative Assistive Devices and
Workplace Technologies
ADMINISTRATIVE APPLICATIONS
OF INFORMATION TECHNOLOGY
FOR NURSING MANAGERS
- Fewer students are taking up Nursing
School. Therefore, we have shortage of
nurses in our hospital. Years from now
those working registered nurses will get
old and retired and there’s no one to
replace them in their place. Sad to say
there is no simple solution for this
problem. We must approach the problem
from all direction.
- Nurse Manager – nurses who hold an
administrative position at the nurse
manager level are responsible for:
Implementing the philosophy, goals, and
standards. Implementing clinical nursing
services, planning, organizing,
implementing and controlling care.
Three major issues:
nursing shortage
increased demand for Patient safety
need for visibility
**How will the administrative application
of nursing informatics for nurse managers
help?
- In hospital nurses took hours of making
the paperwork of each patient which is
really disturbing. NI has a lot to offer this
could to save time that could help in giving
the care and safety that patient needs. The
nurse managers can use the system in
collecting the data needed in planning,
reporting and budgeting
Nursing Informatics
- A specialty that integrates nursing
science, computer science and information
science to manage and communicate data,
information, and knowledge in nursing
practice to support patients, nurses, and
other providers in their decision-making in
all roles and settings.”
(American Nurses Association, 2008)
Scholes and Barber (1980)
- “ It is the application of computer
technology to all fields of nursing -
nursing service, nurse education, and
nursing research”
- 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
(Graves & Corcoran, 1989)
- “Nursing Informatics (NI) is the
application of computer science and
information science to nursing. NI
promotes the generation, management and
processing of relevant data in order to use
information and develop knowledge that
supports nursing in all practice domains”
(Hebert, 2000)
THEREFORE WE CAN CONCLUDE
THAT……
- Nursing informatics can be applied to
model the human processing of data,
information, and knowledge within a
computer system in order to automate the
processing of nursing data to information
and the transformation of nursing
information to nursing knowledge.
WHY IS IT IMPORTANT?
o Nurses need to develop
competencies in informatics.
o Informatics enables nurses to use
information and communications
technologies in the:
 collection of data
-
 use of information
 generation of knowledge to
support nursing practice
Therefore, NI competencies need to
include both knowledge and skills
required:
o To use information and
communication technologies to
enter, retrieve and manipulate data.
o To interpret and organize data into
information to affect nursing
practice.
o To combine information to
contribute to knowledge
development in nursing.
SCOPE OF NURSING INFORMATICS
 P Practice
 E Education
 R Research
 A Administration
WHAT IS INFORMATION?
 communication or reception of
knowledge or intelligence
  a collection of facts from which
conclusions may be drawn
 Any fact or set of facts, knowledge,
news, or advice, whether
communicated by others or
obtained by personal study and
investigation; any datum that
reduces uncertainty about the state
of any part of the world;
intelligence; knowledge derived
from reading, observation, or
instruction.
THE IMPORTANCE OF
INFORMATION
 The healthcare of our clients is
largely dependent on information.
 Every action taken depends on
previous information and
knowledge.
 The delivery of health care requires
information about:
o Science of type of care
(nursing)
o Patient or client
o Provider
o Outcomes
o Process and systems for
delivery of care
THE IMPORTANCE OF
INFORMATION
The science of care (nursing)
 The “science of care” refers to the
scientific foundations of the
profession that provides healthcare.
 Science helps determine the body
of knowledge, language, and focus
of that profession.
 Scientific rationale or evidence
provides a foundation for decision-
making within that profession.
THE IMPORTANCE OF
INFORMATION
Patient or Client
 Information on the client is
required for his/her individual care.
 The assessment process consists of
gathering information.
 The use of technology can assist in
collecting this information.
 Information on the client can be
found in the patient record, the
patient’s history, lab results.
 Information on the client changes
and grows over time.
THE IMPORTANCE OF
INFORMATION
Provider
 Information about the provider of
care helps determine the type of
assessment and the focus of care
given.
 The provider can be an individual
professional such as a nurse, a
physician, a physiotherapist.
 The provider can also be the
facility in which care is provided
such as a public health unit, a
hospital.
THE IMPORTANCE OF
INFORMATION
Outcomes
 The outcome of treatment and care
now requires more attention than
ever.
 There is a growing interest in
ensuring that care results in quality
outcomes in a cost-efficient
manner.
  Outcomes can be difficult to
measure.
 Technology can assist in measuring
because it can enhance gathering,
analysis and dissemination of
outcomes
THE IMPORTANCE OF
INFORMATION
Process and systems for delivery of care
 Information about the process and
systems for delivery of care assists
in deciding on the type and the
amount of care required.
 This is the tracking on
interventions and the process used
for each intervention.
 Information about each of these
areas have an impact on the type
and the amount of care given.
 Information must be:
✔Accurate ✔Timely
✔Accessible ✔Understandable
THE FIVE RIGHTS OF
INFORMATION
Information has five rights:
✔Right information
✔Right person
✔Right time
✔Right place
✔Right amount
USING INFORMATION
 Evidence-based practice leads to:
o Determining standards and
guidelines
o Guide for decision-making
process
o Determines best practice
 Nursing informatics can enable
dissemination of new knowledge.
o Practitioners update
themselves of new
developments through
journals, conferences,
continuing education
sessions.
o The information is varied
and copious.
o There is a need to find the
relevant evidence in a
timely
Telemedicine
What is Telemedicine?
- Telemedicine is the remote delivery of
healthcare services and clinical
information using telecommunications
technology. This includes a wide array of
clinical services using internet, wireless,
satellites and telephone media.
Definition by WHO
- Delivery of healthcare services, where
distance is a critical factor, by all
healthcare professionals using information
and communication technology for
exchange of valid information for
diagnosis, treatment and prevention of
diseases and injuries, research and
evaluation, and for continuing education of
healthcare providers, all in the interests of
advancing the health of individuals and
their communities.
History of Telemedicine
o 1905 – William Einthoven transfers provided through remote video
electrocardiogram s electronically conferencing.” - (American
o 1960s – First used by NASA to Telemedicine Association)
monitor health of astronauts in space - “78 % of ER, urgent care, and doctors
o 1990s – Telemedicine matures; wide- visits can be handled safely and effectively
spread acceptance of teleradiology over the phone. – (American Medical
practices Association)
o Now – Telemedicine seen as a viable
means for improving access, AIM
decreasing costs. - To deliver specialized medical care and
advice within reach of patient at distant
places
OBJECTIVES
o To provide specialized medical advice
FATHER OF TELEMEDICINE o To monitor patient condition
- First setup of telemedicine Boston Logan o To guide other medical staff about
Airport to Massachusetts General Hospital treatment procedure
1967 o Share patient data among institutions
for research purpose
- Dr. Jay Sanders MD President and CEO
of The Global Telemedicine Group
Specialties in Telemedicine FUNCTIONS
• Video Conferencing between
▪ Allergy/Immunology ▪ Internal Medicine
patient & specialist doctors
▪ Anesthesia ▪ Neurology • Video conferencing between
different specialist and other
▪ Cardiology ▪ Oncology/Hematology
healthcare professionals
▪ Critical Care ▪ Ophthalmology • Monitoring patient vitals and
statistics in ICU’s
▪ Dermatology ▪ OB/GYN
• Security in data connection
▪ Otolaryngology (ENT) ▪ Pediatrics • Transfer of Patient’s medical data
among hospitals
▪ Emergency Medicine ▪ Psychiatry
• Storage of information
▪ Endocrinology ▪ Pulmonology

▪ Family Practice ▪ Rheumatology

Essential Equipment's
▪ Gastroenterology ▪ Surgery
o Desktop PC
▪ Infectious Diseases ▪ Urology o Digital camera
o LCD Monitor
- “To date, no studies have identified any o ECG- Machine
patient subgroup that does not benefit o Scanner
from, or is harmed by mental healthcare
BENEFIT OF TELEMEDICINE
1. Window to expertise care
2. Economic for hospital and patient
3. Reduce the stress in patient and relatives
4. Save travel time of specialist and patient
5. Good for education and research
purpose
Why Healthcare Organizations are
Turning to Telemedicine
 Physician Shortages/High Cost of
Physician Employment
 Cost Reduction/Efficiency
Improvement Efforts
 Improved Access for Patients
 Better Technology/More
Acceptance from Patients,
Physicians
 Better Reimbursement Parity
 Retain Patients (Example: Stroke)
Which Data Can be Transferred
Basically four types of data are used in
telemedicine
Text – for patient notes, generally
having a file of less than 10 KB.
Audio – electronic stethoscope,
with file size of around 10 KB.
Still image X-rays – which are
still images having a size of around
1 MB.
Video movie – ultrasound / patient
visualization – movie images have
a sizeof 10 MB or more the patient
can be seen by a doctor at a remote
place using cameras.
LIMITATIONS TO SPREAD OF
TELEMEDICINE
Poor patient – Doctor Relationships
Patient Acceptance
Fear of Technology
Low Rates of Utilization
Infrastructure
Challenges and Issues
- If this transformation is to occur, the
healthcare profession must tackle some
key challenges and issues. Issues center in
legal, ethical, and public policy
Licensure
- The lack of infrastructure for interstate
licensure has been a key impediment to the
growth of telehealth.
- Currently, each state has established
practice acts for medical, nursing, and
allied health professionals that dictate the
procedures for obtaining and renewing a
license to practice within that state.
Liability and Malpractice
Malpractice cases hinge on 2 legal
questions:
1. whether a physician-patient relationship
existed
2. whether the physician breaches his or
her duty of care
- Medical liability originates when there is
injury due to breach in the standard of
care, the fact that the standard of care in
telehealth has not been defined is another
area of concern
Internet Connection
- Two of the most frequent causes of poor
Internet performance are spyware and
viruses. Spyware can slow your system by
interfering with your browser and
monopolizing your Internet connection.
Spyware monitors your Internet use and
keystrokes, which adds delays. Computer
viruses can also cause poor Internet
performance
TeleNursing
Definition of Telenursing
- Telenursing is a subset of tele health in
which the focus is an nursing practice via
telecommunication. - By American Nurses
Association
- Tele nursing is defined as the practice of
nursing using protocols through
telecommunication technology. - Arkansas
Staff Board of Nursing
THE PRACTICE OF TELEPHONE
NURSING
o Standards and Quality Center is
Telephone Nursing.
o Competencies Required in
Telephone Nursing
o High Quality Practice Settings.
o Decision Support Systems
o Using Nursing Titles applies to
telephone nursing practice.
CLINICAL FUNCTIONS OF THE
TELEHEALTH NURSES
- Telehealth nurses are monitoring patients
with chronic diseases.
- Helping patterns manage their symptoms
and co-ordinations care of patients who
require service from homeruns health
professionals.
BENEFITS OF TELENURSING
- When patient stand seeing of their own
day, they stand connecting the data above
their processes.
- Managing their disease better reduce
their utilization of acute case services such
as emergency department visits &
Hospitalization
- Saving time achievable because driving
time to reach patient residence by
significally reduced.
- Nurses are able to spend more time on
direct patient care.
Telehealth Nurses Provide Nursing
Care by
- Using Clinical Algorithms, protocols, or
guidelines to systematically Assess Patient
needs and symptoms.
- Prioritizing the urgency of patients needs.
- Collaborating & Developing a plan of
care with the patient and supportive,
disciplines which may include
recommendation for cure, call back
educations.
“Telemedicine: one small step for the IT
industry, a giant leap for Healthcare!”
Theories, Frameworks, and Models of
Nursing Informatics
Theory
- An idea that is suggested or presented as - Patricia Schwirian – proposed a model
possibly true but that is known or proven intended to stimulate and guide systematic
to be true research in nursing informatics in 1986
Models/Frameworks - Model/framework that enables
identification of significant information
- A three-dimensional representation of a
needs, that can foster research (some what
person or thing or of a proposed structure,
similar to Maslow’s hierarchy of needs)
typically on a smaller scale than the
original.
- A basic concept structure of ideas.
Nursing Informatics Models
o Graves and Corcoran’s model
o Schiwirian’s model
o Turley’s model
o Data Information Knowledge (D-I-
K) model
o Benner’s Novice to Expert model
Benner’s Novice to Expert model
- Nursing informatics as the linear TURLEY’S MODEL (1996)
progression, from data into information
- Nursing informatics is the intersection
and knowledge. Management processing is
between the discipline-specific science
integrated within each elements, depicting
(nursing) and the area of informatics
nursing informatics as the proper
management of knowledge, from data as it Core components of informatics:
is converted into information and
knowledge. o Cognitive science
o Information science
o Computer science

SCHWIRIAN’S MODEL (1986)

- Nursing informatics involves
identification of information needs, Computer Science – Study of
resolution of the needs, and attainment of computers and computational
nursing goals/objectives system
 Information Science – The science
& practice dealing with the
effective collection, storage,
retrieval, & use of information.
Cognitive Science – The
interdisciplinary, scientific study of
the mind, and its processes.
---Scientific investigation of the
mind & intelligence.
DATA-INFORMATION-
KNOWLEDGE MODEL
- NI is a specialty that integrates nursing
science, computer science and information
science to manage and communicate data,
information, knowledge and wisdom into
nursing practice (ANA)
- Nursing informatics is an evolving,
dynamic process involving the conversion
of data into information, and subsequently
knowledge
- Important Note: Processing of
information does not always result in the
development of knowledge.
BENNER’S LEVEL OF EXPERTISE
MODEL
- Every nurse must be able to continuously
exhibit the capability to acquire skills (in
this case, computer literacy skills parallel
with nursing knowledge), and then
demonstrate specific skills beginning with
the very first student experience
Levels of Expertise (Benner):
 Novice – individuals with no
experience of situations and related
content in those situations where they
are expected to perform tasks
 Advanced Beginner – marginally
demonstrate acceptable performance
having built on lessons learned in their
expanding experience base; needs
supervision.
 Competent – enhanced mastery and the
ability cope with and manage many
contingencies
 Proficient – evolution through
continuous practice of skills, combined
with professional experience and
 knowledge; individual who appreciates
standards of practice as they apply in
nursing informatics
 Expert – individual with mastery of the
concept and capacity to intuitively
understand the situation and
immediately target the problem with
minimal effort or problem solving