COMPUTERS AND

NURSING
CHAPTER 1
DEFINING 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, is defined as a scientific method of achieving a
practical purpose . 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. As it relates to nursing, it has been
labeled as Nursing Informatics.
The 3 parts of the Nursing Informatics model
NURSING SCIENCE
• the study of theories and practical concepts for improving how clinicians and
patients administer care and manage conditions.
COMPUTER SCIENCE
• the study of the principles and use of computers.
INFORMATION SCIENCE
• the study of processes for storing and retrieving information, especially
scientific or technical information.
 NURSING
INFORMATICS
NI is defined by American Nurses
Association (ANA, 2001): A
specialty that integrates nursing
science, computer science, and
information science to manage
and communicate data,
information, and knowledge in
nursing practice. Figure 1.1 Nursing Informatics Model
Nursing Informatics
• represents the transition of data and data information and knowledge into
action.
• facilitates the integration of data, information, and knowledge to support
patients, nurses, and other providers in their decision-making in all roles and
settings.
• represents the practice, administration, community health, nursing education,
and nursing research applications.
Nursing Informatics
• represents the transition of data and data information and knowledge into
action.
• facilitates the integration of data, information, and knowledge to support
patients, nurses, and other providers in their decision-making in all roles and
settings.
• represents the practice, administration, community health, nursing education,
and nursing research applications.
CIS – Clinical Information System
• is a computer based system that is designed for collecting, storing,
manipulating and making available clinical information important to the
healthcare delivery process.
• designed to support clinical nursing practice.
• The increased interest in NI occurred because of the concerted efforts of
several groups that promoted nursing as an integral part of the EHR
(Electronic Health Record) systems being implemented in healthcare.
Demand for Nursing Informatics
In 2009, Congress passed a bill ordering medical facilities to transition to an
electronic health records system as a condition of receiving Medicare and
Medicaid payments. Recent natural disasters have also demonstrated the need
for electronic records. With the paper records destroyed, health care providers
had no way to access vital medical records for patients in need of urgent care.
As computers have become more commonplace and relied upon in a medical
setting, health care facilities have placed greater importance on hiring
professionals who understand the link between the two.
Where Nurse Informaticists Work?
Nurse informaticists work not only in hospitals, but also in the corporate and
industrial sectors and academia. They also work in every aspect of health care,
including acute care, home health and long-term care. Some primarily teach,
training both aspiring and current nurses how to more effectively use
technology and computers. Others take on administrative roles, such as chief
information officer, where they oversee technology for an entire medical
facility.
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 with each step of the nursing process:
1. assessment
2. diagnosis
3. planning
4. Implementation
5. evaluation
Nursing documentation, which is often identified as the sixth step in the nursing
process, is vital in information management. Therefore, nurses must 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 for 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 a nursing informatics role.
• Nurses comprise the biggest workforce in healthcare. This being said, nurses are the largest
work-group of end-users of the electronic medical record and clinical information systems;
therefore, nurses must be 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.
Typical Job Duties
Rather than provide hands-on, direct patient care, nurse informaticists work
behind-the-scenes to improve the overall health care experience and make
things easier for the nurses at the bedside. For example, they might work with
the hospital’s IT department and the nursing staff to streamline the electronic
health records system. At some organizations, they play a technical role. For
example, they may set-up and troubleshoot the equipment patients use at home
to record health-related information and transmit it to their health provider.
Education and Training
While nurse informaticists merge nursing care and technology, they usually
come from a nursing background. They typically start out as registered nurses
and later return to school to pursue a graduate degree in a technological field,
such as computer science or information technology. Some universities, such as
Vanderbilt University in Tennessee, offer graduate degrees in nursing
informatics. Students in these programs take both technology-related courses
and classes focusing on project management and nursing outcomes.
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.
HISTORICAL PERSPECTIVES OF NURSING AND
THE COMPUTER
MAJOR HISTORICAL
PERSPECTIVES OF
NURSING AND
COMPUTERS

Six-time periods

four major nursing

areas

Standards
initiatives

Significant
landmarks events
Six-Time Periods
• Prior to the 1960s, Only a few experts who formed a cadre of pioneers attempted to
adopt computers to health care and nursing. Computers were initially used in health care
facilities for basic business office functions. punch cards – store data card readers – read
computer programs teletypewriters – print output
• 1960s Questions arise: Why computers? What should be computerized? Introduce of
cathode ray tube(CRT) terminals, online data communication, and real-time processing.
• Hospital Information Systems (HISs) was developed primarily to process financial
transactions and serve as billing and accounting systems. . . .because of technology
limitations, lack of standardization and diversity of paper-based patient care records,
progress was slow.
• 1970s Nurses recognized the computer’s potential for improving the documentation of
nursing practice, the quality of patient care and the repetitive aspects of managing patient
care. Several states and large community health agencies developed or contracted for their
own computer-based management information systems (MISs).
Six-Time Periods (cont.)
• 1980s NI became an accepted specialty and many nursing experts entered the field. Many
mainframe HISs emerged with nursing subsystems. The microcomputer or PC emerged.
• 1990s Computer technology became an integral part of health care settings, nursing
practice, and the nursing profession. Policies and legislation were adopted promoting
computer technology in health care including nursing. In 1992, NI was approved by the
American Nurses Association (ANA) as a new nursing specialty.
• Brought smaller and faster computers to the bedside and all of the point-of-care settings.
LANs were developed for hospital nursing units. WANs were developed for linking care
across health care facilities. The Internet started to be used for linking across different
systems.
• Cyberspace tools: e-mail Gopher WWW protocols FTP Telnet Web became the means for
communicating online services and resources to the nursing community.
Six-Time Periods (cont.)
• Post-2000 Information technologies continued to advance with mobile technology such as
with wireless tablet computers, PDAs, and smart cellular telephones. Voice over Internet
Protocol(VoIP) promises to provide cheap voice communication for health care organizations.
• Smart cards were realized in Europe. Recommended health care providers use a provider
identification number (PIN) to maintain the privacy and security of patient information. -
eHealth Initiative and Institute -Consolidated Health Information (CHI) initiative -National
Health Information Infrastructure (NHII) initiative
Four Major Nursing Areas

Nursing Practice
• Computer systems with nursing and patient care data are integrated into one interdisciplinary
patient health record in EHR. Nursing practice data emerged that were recognized by ANA and
used an EHR. The electronic version of nursing practice-the computer-has revolutionized and
transformed nursing practice.
Nursing Administration
• Most policy and procedure manuals are accessed and retrieved by computer. The Internet is being
used by nurses to access digital libraries, online resources, and research protocols.
Nursing Education
• Campus-wide computer systems are available for students to communicate via e-mail, transfer data
files, access the digital libraries, and retrieve online resources of millions of Internet WWW sites.
Time, distance and cost are no longer barriers to educational programs.
Nursing Research
• It provides the impetus to use the computer for analyzing nursing data. Software programs are
available for processing both quantitative and qualitative research data.
Standards Initiatives

Nursing practice standards

• ANA -the official professional nursing education - published The Standards of Clinical Nursing
Practice which focused not only on the organizing principles of clinical nursing practice but also on
the standards of professional performance.
• Has been set by the Joint Commission on Accreditation of Hospital Organizations (JCAHO) which
stressed the need for adequate records on patients in hospitals and practice standards for the
documentation of care by the nurse.
• Nursing data standards 13 nursing terminologies that have been recognized by the ANA in which it
was developed at different times, have different characteristics and is used for documenting
different aspects of nursing practice.
• ANA is responsible for the recognition of the terminologies and for determining if they have met the
criteria to be included in the National Library of Medicine (NLM) Unified Medical Language
Systems (UMLS).
Standards Initiatives (cont.)
Health care data standards
• American National Standards Institute (ANSI)a private nonprofit membership organization. ANSI was combined
with the Health Care Informatics Standards Board(HISB) to form ANSI-HISB to fulfill a request by the European
standards coordinating organization to represent the U.S. standards effort
• The ANSI-HISB organization acts as one linking to the two major organizing in Europe European
Standardization Committee(CEN) International Standard Organization (ISO) American Society for Testing and
Materials (ASTM): ASTM E-31 Committee on Healthcare Informatics is an accredited committee that develops
standards for health information and HISs designed to assist vendors, users, and anyone interested in
systematizing health information.
• Health Level Seven(HL7) an organization accredited by the ANSI, which was created to develop standards for
the electronic interchange of clinical, financial and administrative information among dependent healthcare-
oriented information systems
• SNOMED International is another organization that serves as an umbrella of the structured nomenclatures and
its merger with the Read Codes from the National Health Service in UK. SNOMED CT the newly named that
serves as the coding strategy and has become a national standard for EHR aspects
• The National Committee on Vital and Health Statistics(NCVHS) Workgroup on Computer-based Patient
Records was created to help the Department of Health and Human Services (DOHHS) investigate and approve
health care standards for the federal government to use to implement federal legislation.
History of Nursing Informatics in the Philippines
• The Philippine nursing community has long sought to keep up with the increasing use of information and
technology in the healthcare system. Nursing Informatics follows the footsteps of biomedical informatics which
has gained relative popularity earlier than its other allied medical counterparts. Despite being in its early
stages of development the subspecialty of nursing informatics in the Philippines have more than a decade of
which led to future programs and activities.
• Some of the major milestones in nursing informatics history in the Philippines includes the participation of the
Philippine Nurses Association (PNA) in the development of standards for Health Information in the
Philippines(SHIP) in 1999, the formation of the Master of Science in Health Informatics(MSHI) which began in
2005 and the formation of the Philippines Nursing Informatics Association(PNIA) in 2010 as a sub-specialty
organization of PNA for nursing informatics.
• Introduction: The words "nursing informatics" were unfamiliar among the nursing community until the year 2008.
There were only a handful of people with knowledge and experience in nursing informatics but the discipline
has not yet found its recognition as a sub-specialty of nursing arts and science in the country. The origin of this
budding discipline indirectly came from the pioneers of health informatics in the The Philippine Medical
Informatics Society(PMIS) and its founders had a strong influence in the development of health informatics in
the Philippines. The PMIA was officially registered under the Securities and Exchange Commission in 1996 by
its board composed of eleven physicians. The organization was headed by Dr. Alvin Marcelo.
History of Nursing Informatics in the Philippines
• Origins Since 1998, several faculty members of the University of the Philippines began formal education and
training. Dr. Herman Tolentino took a post-doctoral fellowship in medical informatics at the University of
Washington. Dr. Alvin Marcelo followed a year later for his training at the national library of Medicine. Dr.
Cito Maramba went to Coventry for his Masters in Information Sciences at the University of Warwick. They
were later followed by other physicians such as Dr. Micheal Muin and Dr. Ryan Bañez.
• By the year 2003, a Master of Science in Health Informatics was proposed to be offered by UP-Manila
College of Medicine (major in medical informatics) and the College of Arts and Science (major in
bioinformatics) and was later approved to be offered to start the academic year 2005-2006. In 1999, a
study group was formed headed by the National Institute of the health of the University of the Philippines
Manila.
• This group identified international standards for health information and their adaptability in the Philippines.
The document is referred to as the "Standards of Health Information in the Philippines, 1999 version"
or"SHIP99".Representatives from various sectors collaborated on this project including the Philippines Nurses
Association (PNA) in the person of Ms. Evelyn Protacio.
History of Nursing Informatics in the Philippines
• CHED as a Catalyst The nursing community was still yet to follow its international counterparts in the adoption
of information, communication, and technology in nursing practice in the Philippines. Despite the inclusion of the
Informatics course in the undergraduate curriculum which focused on basic desktop applications, the need for a
genuine nursing informatics course had not yet been realized. In 2008, the Nursing Informatics course in the
undergraduate curriculum was defined by the Commission on Higher Education (CHED) Memorandum Order 5
Series of 2008. This was later revised and included as a Health Informatics course in CHED Memorandum
Order 14 Series of 2009. This will be first implemented in the summer of 2010.
• Organization Early in 2009, Mr. Kristian R. Sumabat and Ms. Mia Alcantara-Santiago, both nurses and
graduate students of the Master of Science in Health Informatics at the University of the Philippines, Manila
began drafting plans to create a nursing informatics organization. In February 2010, they began recruiting
other nursing informatics specialists and practitioners to organize a group that later became the Philippines
Nursing Informatics Association.
• They were joined by founding members Ms. Sheryl Ochea, a graduate of Master of Science in Nursing major
in nursing informatics at Xavier University (Ohio, USA), Ms. Alexrandra Bernal, a graduate student and
telehealth nurse of the National Telehealth Center, Ms. Pia Pelayo, a former telehealth nurse and a project
coordinator of the National Epidemiology Center, Department of Health and Mr. Sid Cardenas, also a
telehealth nurse. Other founding members include Mr. Noel Bañez, Ms. Rona Abcede, and Mr. Harby Ongbay
Abellanosa.
History of Nursing Informatics in the Philippines
• Issues and Challenges Like many other disciplines, nursing informatics face many challenges while in its infancy
stage. The inclusion of informatics as an integral part of the undergraduate curriculum has been one of the
most influential factors for the increased awareness and interest in this field of nursing. However, the contents
of the curriculum were adapted from international materials which do not match the local needs.
• A community-centered approach to the use of information, communication, and technology in nursing practice
must be adapted to ensure the impact of the program in the local healthcare system. Lack of certification and
credentialing programs at post-graduate levels is also absent with the scarcity of local nursing informatics
experts. This new field has yet to gain acceptance and recognition in the nursing community as a sub-specialty.
• Future Direction Development of training, certification, and credentialing programs are in the pipeline for the
Philippines Nursing Informatics Association. Future partnerships with local and international nursing and health
informatics organizations have started as well. Other programs are expected to be slowly delivered with
PNIAs CORE X strategic platform which stands for Competency, Organization, Recognition, Experience, and
Expertise. It is also a major thrust to support the use of health information standards in the Philippines and to
have nursing informatics specialists in every hospital in the country.
Assignment 3

Create a video cast in explaining your answer:

• Is there existing legislation in our country that regulates the use of computers,
internet social media, cyber transactions, etc. and penalizes any forms of cyber-
crimes?
• If yes, does it affect our health care systems? Explain how.
• If No, do you think the need for this legislation is imperative in our country? Explain
your stand.
THANK YOU
markjoseph.a.asucion@isu.edu.ph