LESSON 1: NURSING INFORMATICS
of nursing, its information management with
INTRODUCTION
• Dramatic reform and innovation in nursing is
needed to create and shape the future of nursing
practice
• Nursing is a dynamic profession with universal
needs.
• Computer Technology can transform the nursing
profession.
• Clinical Information system are common to
modern healthcare.
CLINICAL INFORMATION SYSTEM (CIS)
• 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.
• The computer is the most powerful technological
tool to transform nursing profession prior to the new
century.
• The computer has transformed the nursing paper
based record to computer based record
• COMPUTER AND INTERNET is very essential for
all settings where nurses function.
• Nurses are becoming more computer literate and
the nursing profession is implementing practice
standards for its clinical care and data standards for
its nursing information technology system.
• Nursing informatics (NI) is specialist emerged as a
new specialty in the field of professional nursing
practice
TERMINOLOGIES
• Computer - is a general term referring to
information technology (IT) and computer systems.
In nursing it synonymous into nursing information
system (NIS).
 Computers are used to manage information
in patient care, monitor quality of nursing
care and evaluate care outcomes.
• Networks with internet are used in
communicating and accessing resources and
interacting w/ the patient on the (WWW).
• Nursing Informatics - is refers to the integration
information processing and information technology
to support the people worldwide.
 It is a specialty that integrates nursing,
computer and information science to
manage and communicate data information
and knowledge in nursing practice. (AMA)
ANA DEFINITION OF NURSING
The American Nurses’ Association (2003) defines
nursing in this way: “Nursing is the protection,
promotion, and optimization of health and abilities,
prevention of illness and injury, alleviation of
suffering through the diagnosis and treatment of
human response, and advocacy in the care of
individuals, families, communities, and
populations.”
NURSING INFORMATICS AS A SPECIALTY
• In 1992, the ANA established nursing informatics
as a distinct specialty in nursing with a distinct body
of knowledge.
• The American Nurses Credentialing Center
(ANCC) established a certification examination and
process in 1995 to recognize those nurses with
basic informatics specialty competencies.
• The scope of nursing informatics practice includes
activities such as developing and evaluating
applications, tools, processes, and strategies that
assist registered nurses in managing data to
support decision- making.
MODELS FOR NURSING INFORMATICS
• Their model placed data, information, and
knowledge in sequential boxes with one-way
arrows pointing from data to information to
knowledge. The management processing box is
directly above, with arrows pointing in one direction
from management processing to each of the three
boxes (Graves and Corcoran, 1989).
• The model provides a framework for identifying
significant information needs, which in turn can
foster research. The four elements are the raw
materials (nursing-related information), the
technology (a computing system), the users
(nurses, students, and context), and the goal or
objective toward which the preceding elements are
directed. Bidirectional arrows connect the three
base components of raw material, user, and
computer system to form the pyramid’s triangular
base. The goal element is placed at the apex of the
pyramid to show its importance. Similarly, all
interactions between the three base elements and
the goal are represented by bidirectional arrows
(Schwirian, 1986).
• Turley, writing in 1996, proposed another model in
which the core components of informatics
(cognitive science, information science, and
computer science) are depicted as intersecting
circles. Nursing science is a larger circle that
completely encompasses the intersecting circles.
Nursing informatics is the intersection between the
discipline-specific science (nursing) and the area of
informatics (Turley, 1996).
DATA, INFORMATION, AND KNOWLEDGE
• Data - “discrete entities that are described
objectively without interpretation” and would include
some value assigned to a variable.
• Information - reflects interpretation, organization,
or structuring of data (ANA, 2001b)
 is a result of processing data. Data
processing occurs when raw facts are
transformed through the application of
context to give those facts meaning or via
the organization of data into a structure that
connotes meaning (Graves and Corcoran,
1989)
• Knowledge - emerges from the transformation of
information.
 “Knowledge is information that is
synthesized so that relationships are
identified and formalized” (ANA, 2001b)
 Knowledge is necessary to the processing
of data and information. Knowledge itself
may be processed to generate decisions
and new knowledge (Graves and Corcoran,
1989)
COMPETENCIES
• Staggers, Gassert, and Curran recently published
information about their research identifying the
informatics competencies necessary for all nurses.
• Their conceptual framework guiding the research
included computer skills, informatics knowledge,
and informatics skills as the informatics
competencies (Staggers, Gassert, and Curran,
2002)
• Their research, however, only identified
informatics competencies for four levels of nurses:
beginning nurse, experienced nurse, informatics
specialist, and informatics innovator.
NURSING
• Thus the focus of nursing is on the human
responses to actual or potential health problems,
and advocacy for various clients.
• Nurses must possess the technical skills to
manage equipment and perform procedures,
interpersonal skills to interact appropriately with
people, and cognitive skills to observe, recognize
and collect data, analyze and interpret data and
reach a reasonable conclusion that forms the basis
of a decision.
• Nursing is an information intensive profession.
• The steps of utilizing information, applying
knowledge to a problem, and acting with wisdom
form the basis of nursing practice science.
• We acquire data and information in bits and
pieces and then transform the information into
knowledge.
NURSING SCIENCE
• One of the most frequently quoted and widely
accepted definitions of nursing informatics is that it
is a combination of nursing science, information
science and computer science.
• In this chapter, we will focus on nursing science
as one of the building blocks of nursing informatics,
although in this text we extend the traditional
definition of nursing informatics to include cognitive
science as one of the building blocks.
USE OF KNOWLEDGE
• Individuals have an amazing ability to manage
knowledge. This ability is learned and honed from
birth.
• We experience our environment and learn by
acquiring, processing, generating and
disseminating knowledge.
NURSING AND KNOWLEGE
• Nurses are knowledge workers, working with
information and generating information and
knowledge as a product.
• We are knowledge acquirers, providing
convenient and efficient means of capturing and
storing knowledge.
• We are knowledge users, individuals or groups
who benefit from valuable, viable knowledge.
• Nurses are knowledge engineers, designing,
developing, implementing and maintaining
knowledge.
• We are knowledge managers, capturing and
processing collective expertise and distributing it
where it can create the largest benefit.
• We are knowledge developers or generators,
changing and evolving knowledge based on the
tasks at hand and information available.
USE OF KNOWLEDGE
• Knowledge must also be viable.
• Knowledge viability refers to applications (most
technology based) that offer easily accessible,
accurate and timely information obtained from a
variety of resources and methods and presented in
a manner as to provide us with the necessary
elements to generate new knowledge.
• All nurses have the opportunity to be involved in
the formal dissemination of knowledge via their
participation in professional conferences either as
presenters or attendees.
• All nurses regardless of the practice arena must
use informatics and technology to inform and
support that practice.
KEY TERMS DEFINED
• Knowledge - The awareness and understanding
of a set of information and ways that information
can be made useful to support a specific task or
arrive at a decision; abounds with others’ thoughts
and information; information that is synthesized so
that relationships are identified and formalized;
understanding that comes through a process of
interaction or experience with world around us; info
that has judgment applied to it or meaning
extracted from it; processed information that helps
to clarify or explain some portion of our
environment or world that we can use as a basis for
action or upon which we can act; internal process
of thinking or cognition; external process of testing,
senses, observation, interacting.
• Knowledge acquisition - Act of acquiring or
getting knowledge.
• Knowledge dissemination - Distribution and
sharing of knowledge.
• Knowledge generation - Creating new
knowledge by changing and evolving knowledge
based on your experience, education, and input
from others.
• Knowledge processing - The activity or process
of gathering or collecting, perceiving, analyzing,
synthesizing, saving or storing, manipulating,
conveying, and transmitting knowledge.
• Knowledge worker - Work with information and
generate information and knowledge as a product.
• Wisdom - Knowledge applied in a practical way
or translated into actions; uses knowledge and
experience to heighten common sense and insight
to exercise sound judgment in practical matters;
sometimes thought of as the highest form of
common sense resulting from accumulated
knowledge or erudition (deep thorough learning) or
enlightenment (education that results in
understanding and the dissemination of
knowledge);
 it is the ability to apply valuable and viable
knowledge, experience, understanding and
insight while being prudent and sensible; is
focused on our own minds; the synthesis of
our experience, insight, understanding and
knowledge; the appropriate use of
knowledge to solve human problems. It is
knowing when and how to apply knowledge.
USE OF WISDOM
• Wisdom is the application of knowledge to an
appropriate situation.
• In the practice of nursing science, we expect
action and/or actions directed by wisdom.
• Wisdom uses knowledge and experience to
heighten common sense and insight to exercise
sound judgment in practical matters. It is developed
through knowledge, experience, insight and
reflection.
BEYOND NURSING PRACTICE
• In order for nurse educators to be effective, they
must be in the habit of constantly building and
rebuilding their foundation of knowledge about
nursing science.
• Nurse researchers must acquire and process new
knowledge as they design and conduct their
research studies.
NURSING IN THE FUTURE
• The future of nursing science and nursing
informatics is intimately associated with the nursing
education and nursing research arenas.
• Skiba (2007) suggests that we need techno-saavy
and well-informed faculty who can demonstrate the
appropriate use of technologies to enhance the
delivery of nursing care.
• Informatics and the use of technology in the
practice of nursing are equally important in the
nursing research arena.
• Participants in the development of The National
Nursing Research Agenda (NNRA) identified these
two technology related priorities (among other
research priorities) for nursing research:
- Nursing Informatics: Enhancing Patient Care
- Technology Dependency across the Life-span
• Goosen (2002) believes that the focus on nursing
informatics research should be on the structuring
and processing of patient information and how
these inform nursing decision making in clinical
practice.
• It is clear that the increasing use of technology to
enhance nursing practice, nursing education, and
nursing research will open new avenues for
acquiring, processing, generating, and
disseminating knowledge.
TERMINOLOGIES
• The nursing minimum data set (NMDS)
developed through Dr. Harriet Werley’s research is
considered the foundational work for nursing
languages and represents the first attempt to
standardize the collection of essential nursing data.
• Nursing terminologies offer systematic,
standardized ways of describing nursing practice
and include data sets, taxonomies, nomenclatures,
and classifications systems.
• Data set - a specific, purposeful group of data
elements, representing a subset of concepts within
a discipline.
• Nomenclatures - terms or labels for describing
concepts in nursing such as diagnoses,
interventions, and outcomes.
• Classifications - ordering of entities, including
nomenclatures, into groups or classes on the basis
of their similarities.
• Taxonomy - study of classification, and
simultaneously refers to the end product of a
classification.
NANDA
▪ Includes 167 recognized diagnoses that are very
different from the pathology and mortality focus of
the ICD-9 CM terms used for medicine and third
party payment claims.
Nursing Interventions Classification (NIC)
▪ Contains 514 nursing interventions that describe
the treatments nurses perform, updated linkages
with NANDA diagnoses, and core interventions
identified for 44 specialty practice areas (including
three new specialties).
Nursing Outcomes Classification (NOC)
▪ Has 330 research-based outcomes to provide
standardization of expected patient, caregiver,
family, and community outcomes for measuring
effect of nursing interventions.
Clinical Care Classification (CCC) [Formerly
Home Health Care Classification (HHCC)]
▪ a research-based nomenclature designed to
standardize the terminologies for documenting
nursing care in all clinical care settings.
Omaha System
▪ includes an assessment component (Problem
Classification Scheme), and intervention
component (Intervention Scheme), and an
outcomes component (Problem Rating Scale for
Outcomes).
Perioperative Nursing Data Set
▪ provides a universal language for perioperative
nursing practice and education and a framework to
standardize documentation.
SNOMED CT
▪ Core clinical terminology containing over 357,000
healthcare concepts with unique meanings and
formal logic-based definitions organized into
multiple hierarchies.
ABC Codes
▪ Provide a mechanism for coding integrative health
interventions by clinician by state location for
administrative billing and insurance claims.
Patient Care Data Set (PCDS)
▪ Includes terms and codes for patient problems,
therapeutic goals, and patient care orders.
Logical Observation Identifiers Names and
Codes (LOINC)
▪ Originated as a database of standardized
laboratory terms for results reporting from
chemistry, hematology, serology, microbiology, and
toxicology.
International Classification for Nursing Practice
(ICNP)
▪ Combinatorial terminology for nursing practice
developed by the international nursing community
under sponsorship of the International Council of
Nurses (ICN).
Nursing Management Minimum Data Set
(NMMDS)
▪ Includes terms to describe the context and
environment of nursing practice, and includes terms
for nursing delivery unit/service, patient/client
population, care delivery method, personnel
characteristics, and financial resources.
American Medical Informatics Association
▪ an individual membership organization dedicated
to the development and application of medical
informatics in the support of patient care, teaching,
research, and healthcare administration.
Healthcare Information and Management
Systems Society
▪ Represents a membership of over 14, 000
individuals and 200 corporations interested in
healthcare informatics, clinical systems, information
systems, management engineering, and
telecommunications.
National League for Nursing
▪ Advance quality nursing education that prepares
the nursing workforce to meet the needs of diverse
populations in an ever-changing healthcare
environment.
Society for Health Systems
▪ Individual membership organization that exists to
enhance the career development and continuing
education of professionals who use industrial and
management engineering expertise for productivity
and quality improvement in the healthcare industry.
Association for Computing Machinery
▪ Founded in 1947 and has become a major force
in advancing skills of information technology
professionals and students worldwide.
ARMA International
▪ Not-for-profit association serving more than
10,000 information management professional in the
United States, Canada, and over 30 other nations.
American Society for Information Science and
Technology
▪The society for information professionals leading
the search for new and better theories, techniques,
and technologies to improve access to information.
THOUGHT PROVOKING QUESTION
• Imagine you are in a social situation and someone
asks you, “What does a nurse do?” Think about
how you will capture and convey the richness that
is nursing science in your answer.
NURSING INFORMATICS THEORIES
Nursing Informatics theories
 Nursing informatics theory (Information theory
 Sociotechnical theory and social informatics.
 Change theory.
 General system theory
 Chaos theory.
 Cognitive science theory.
 Usability theory.
 Learning theories
 Contribution of theories to informatics
A. General Models
1) GRAVES AND CORCORAN's (1989)
Nursing informatics as the linear progression - from
data into information and knowledge. Data,
Information and knowledge in sequential boxes with
one-way arrows pointing from data to information to
knowledge.
2) SCHIWIRIAN'S MODEL (1986)
Patricia Schwerin - proposed model of nursing
informatics intended to stimulate and guide
systematic research in this discipline.
The model provides a framework for identifying
significant information needs, which in turn can
foster research.
3) TURLEY'S MODEL (1986)
Review the literature and found 3 themes (Core
components of informatics):
1. Cognitive science: use and position of
computer and computer science as central
to definition.
2. Information science: focus on conceptual
issues that represent nursing knowledge
and information
3. Computer Science: focus in on how the
computer help nurses enter, organize, and
retrieve information.
5 component of information literacy
1- Acknowledge awareness of a need for
information literacy.
2- Identify and retrieve information.
3- Evaluate information for relevance.
4- Integrate information into practice.
5- Evaluate the effect of the information on
problem or issues.
B. Specific Informatics Models
1.) Philippine Healthcare Ecosystem model
- nursing informatics is a huge network that
encompasses all the sectors of the health care
delivery system - government agencies, healthcare
facilities, practitioners, insurance companies,
pharmaceutical companies, academic institutions,
and suppliers.
• The government, different nursing associations
and development agencies maintain and balance
the network.
2.) Intel's shift left model
- Patient care shifts/progresses from a high quality
delivery of life through technology with increased
costs (right side) into quality of life with minimal
health costs
- Inverse relationship between quality of life and
cost of care/day
3.) Patient medical record information model
(PMRI): Basis of HER
The type and pattern of documentation in the
patient record will be dependent on 3 interacting
dimensions of healthcare:
1. Personal health dimension - personal
health record maintained and controlled by
the individual or family: non clinical
information e.g. self-care trackers,
directories of health care, and other
supports
2. Health care provider dimension –
promotes quality patient care, access to
complete accurate patient data 24/7e.g.
provider's notes/ prescription, clinical orders
decision support systems, practice
guidelines.
3. Population health dimension - information
on the health of the population and the
influences to health; helps stakeholders
identify and track health threats, assess
population health, create and monitor
programs and services, and conduct
research.
B-Theories that lend support to Informatics
Informatics relies on principles from other
disciplines such as:
1. Nursing informatics theory (Information
theory).
The core concepts of informatics: Data are discrete,
objective facts or elements that have not been
interpreted (Clark, 2009) or are out of context they
are at the atomic level. Data are describe
objectively without interpretation. They are the
building blocks of meaning but lack context, and
hence are meaningless.
Information is data that has some type of
interpretation or structure; that is, it has a context is
derived from combining different pieces of data
(Clark, 2009). A set of data, Such as vital signs
when interpreted over a period of time is
information.
Knowledge is the synthesis of information with
relationship identified and formalized or it is
information is collected to produce knowledge. For
example, interpreting a set of vital signs over period
of time and deciding on an action based on this
information combined with nursing knowledge and
experience is an example of knowledge.
Wisdom is achieved through evaluating knowledge
with reflection. Knowing when and how to use
knowledge to situation (ANA 2008). It requires
people to combine their knowledge, values and
experience with the three types of data.
For example, wisdom would interpreting vital signs
in a postsurgical patient as indicative of an infection
and taking the appropriate action.
2. Sociotechnical theory and social informatics
Sociotechnical theory developed in the middle of
the last century when it became evident that not all
implementations of technology were increasing
productivity. The overall focus is the impact of
technology implementation on an organization.
To this end, it focuses on interactions of an
organization between information management
tools and techniques and the knowledge, skills,
attitudes, values and needs of its employees as
well as the rewards and authority structures
3. Change theory
Computerization of information is a new experience
that create a change that affect workers, this
change may be unplanned represented by Rogers
change theory of diffusion and innovation address
how change occurs in society and individual.
And may be planned represented by lewin's change
theory who talks about stages in moving people
from comfortable state before the change, and
finally back to a comfort with the change.
A. Rogers's diffusion of innovation theory
(unplanned change)
His theory examines the patterns of acceptance
that innovations follow as they spread across the
population of people who adopt it. Adopters are
divided into five categories:
Social changes:
1. Innovators (12.5%): people who adopt the
innovation.
2. Early adopters (13.5%): they are respectable
opinion leaders who function as promoters of
the innovation.
3. Early majority (34%): people who are averse
to risks but will make safe investment.
4. Late majority (34%): make up another group of
adopters, they need to be sure that the
innovation is beneficial, they adopt the
innovation not because they see a use of it, but
because of peer pressure
5. Laggards (16%): they are suspicious about the
innovation and change, they see their
resistance as rational and must be certain that
innovation will not fail before they are willing to
adopt it.
Lewin’s change theory: (planned change)
Lewin’s divided his theory into three stages
(unfreezing, moving and refreezing). The ways to
move from the first stage to the last stage must be
a part of the plan for implementation of a system.
KURT LEWIN THEORY
Unfreezing stage:
This stage is based on the idea that human
behaviour is supported by a balance of driving
forces and restraining forces that create an
equilibrium. When a driving force toward change
occurs. A countering restraining force develops to
allow the maintenance of equilibrium. Thus to
unfreeze. It is necessary to reduce the restraining
forces and allow the driving forces to become
dominant.
General system theory
General theory is a method of thinking about
complex structures such as an information system.
In system theory the focus is on the interaction
among the various parts of the system instead of
individual parts, it is based on the premise that the
whole is greater than the sum of its parts.
General theory described that any change in one
part of the system will be reflected in other parts of
the system. Computer is a living example of the
system any change in one area will affect other applied. It is interdisciplinary, includes philosophy,
sections. psychology, artificial intelligence, neuroscience,
linguistics and anthropology and is a part of social
The system is described as being either open or
informatics.
closed.
It focus on how the brain perceives and interprets a
Open system - is continually exchanges
screen (Turley, 1996). Additionally, cognitive
information with the environment outside the
science addresses the amount of information that
system itself or higher levels of complexity in the
an individual can absorb and use constructively.
system.
Learning theories
Closed system - is isolated from the environment
and receive no input from outside or disorganized Learning theories are important in informatics as
breakdown of the system. well as in all nursing endeavors. Users must be
taught to use a system, and use of these theories
Chaos theory
can decrease the time for training as well as the
Chaos theory, such as general systems theory, time for learning.
addresses an entire structure without reducing it to
Chaos theory: Improve the design of an
the elemental parts. This makes it useful with
information system
complex systems such as information systems.
Cognitive science theory: Improve the ability of
The idea behind this theory is that what may
user to gain knowledge from an information system.
appear to be chaotic actually has an order. It is
based on the recognized fact that events and Usability theory: Improve ease of use and
phenomena depend on initial conditions. satisfaction with an information system.
Chaos theory is nonlinear. It allows us to question Learning theories: Teach use of a system and
assumptions that we normally might reach using design or select computer-aided instruction.
linear thought (Vincenzi, 1997). Seeing things
Contribution of theories to informatics
reframed as a whole can stimulate new thinking
and new approaches. 1. Nursing informatics - convert data into
information and information to knowledge. Nurse
Usability theory
add wisdom.
*It uses information from both cognitive science and
2. Sociotechnical theory and social informatics.
sociotechnical theories.it involves the ease of use,
Improve interaction between an information system
users' satisfaction that they have achieved their
and the organizational culture.
goals, and the aesthetics of the technology.
3. Change theory - increase the chance of
The five goals of usability
success in implementing a system by attending to
1. It is easy for users to accomplish basic the reactions to the change.
tasks the first time they use the product.
4. General system theory- contribute to the
2. Once learned, the design permits users to
understanding of the complexity of an information
quickly and easily perform the needed
system.
tasks.
3. It is not used for a period of time, it is easy LESSON 2: MAJOR HISTORICAL
to re-establish one's proficiency in using the PERSPECTIVES of NURSING and
product.
COMPUTERS
4. Users make very few errors, but any that
they do make easily remedied. Computer technology emerged in nursing in
5. The design is pleasant to use. response to the changing and developing
technologies in the health care industry and in
Cognitive science
nursing practice.
It is the study of the mind and intelligence
SIX TIME PERIODS
(Thagard, 2010) and how this information can be
Prior to the 1960s
 The use of computers in the health care
industry grew
 Computers were initially used in health care
facilities for basic business office functions
 Use punch cards to store data and card readers
to read computer programs, sort and prepare
data for processing
1960s
 Uses of computer technology in health care
setting began to be questioned
 The nurses’ station in the hospital was viewed
as the hub of information exchange
 The introduction of cathode ray tube (CRT),
online data communication, and real-time
processing added important dimensions to the
computer system
Hospital information system (HIS) were
developed primarily to process financial
contractions and serve as billing and accounting
systems
1970S
 Nurses began to recognize the value of the
computer for their profession
 Several mainframe HISs were designed and
developed, a few of which eventually became
forerunners of a number of today’s system
 Several states and large community health
agencies developed and/or contracted for their
own computer-based management information
system (MISs)
 MISs provided statistical information required by
local, state, and federal agencies for specific
program funds
 Home health agencies provided billing and
other financial information required for
reimbursement of patient services by Medicare,
Medicaid, and other third-party payers
1980s
• NI became an accepted specialty and many
nursing experts entered the field
• Microcomputer or personal computer emerged
• They were user-friendly and allowed nurses to
create their own applications
Many mainframe HISs emersion:
- Documents patient’s record
- Kardex
- Vital signs
- Discharge plan
- online source
- Nurse’s notes
1990s
 Computer technology became an integral part
of health care setting, nursing practice and the
nursing profession
 NI was approved by the American Nurses
Association (ANA) as a new nursing specialty
 Smaller and faster computers, laptops, and
notebooks
 Workstations and local area networks or (LANs)
were developed for hospital nursing units
 Wide area networks were developed for linking
care across health care facilities
 Internet started to be used for linking across the
different systems
Post 2000
• Development of wireless point-of-care
• clinical information system became
individualizes in Electronic Patient Record
(EPR)
• Electronic Health Record (EHR)- life
longitudinal record
• Personal Digital Assistant (PDA)
• Use of Voice-over Internet Protocol (VoIP)
• Health Insurance Portability and Accountability
Act (HIPAA) of 1996 was enacted
• Critical Care Units are monitored remotely by
health care providers (eICU)
FOUR MAJOR NURSING AREAS
NURSING PRACTICE
 It has become an integral part of the EHR
 used to assess problems, document care, track
the care process, and measure outcomes
 electronic version of nursing practice has
revolutionized and transformed nursing practice
NURSING ADMINISTRATION
 Workload measures, acuity systems, and other
nursing department systems are online and
integrated with the hospital for patients HER
system or in separate nursing department
system
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.
NURSING RESEARCH
 Nursing research provides the impetus to use
the computer for analyzing data
Standard Initiatives
- Influenced the nursing profession and its need for
computer systems, information technology, and
terminologies to gain acceptance among the
healthcare policy makers
Nursing Practice Standards
- have been developed and recommended by the
ANA
- Have also been set by the Joint Commission on
Accreditation of Hospital Organizations
(JCAHO)
- Included the contents of EHR, such as what
data should be collected and how the data
should be organized in the electronic database
Nursing Data Standards
- Emerged as a new requirement for the EHR
- ANA is responsible for the recognition of the
terminologies and for determining if they have meet
the criteria to be included in the National Library of
Medicine
Health Care Data Standards Organizations
• American National Standards Institute (ANSI)
• American Society for Testing and Materials
(ASTM)
• SNOMED
• National Committee on Vital and Health
Statistics (NCVHS)
Early Computer-Based Nursing Applications
• Developed before the mid-1970s as part of
larger HISs
• Focused on documentation of nursing practice
and management of patient care
• Designed for hospitals, ambulatory care
settings, and community health agencies
Landmark Events in Nursing and Computers
• Introduced into the nursing profession over 35
years ago
• Major milestones of nursing are interwoven with
the advancement of computer and information
technologies, the increased need for nursing data,
development of nursing applications, and changes
making the nursing profession an autonomous
discipline
LESSON 3: ELECTRONIC HEALTH RECORD
FROM A HISTORICAL PERSPECTIVE
INTRODUCTION
• An electronic record composed of health
information regarding an individual patient that
exists as part of a complete system designed to
provide access to, and management of, such
information.
• The EHR is developed and managed by the
health facility or provider. The term Electronic
Health Record has largely replaced the older
“Electronic Medical Record.”
HISTORICAL BACKGROUND OF ELECTRONIC
HEALTH RECORDS
ELECTRONIC HEALTH RECORD (EHR)
• An electronic record composed of health
information regarding an individual patient that
exists as part of a complete system designed to
provide access to, and management of, such
information.
• The EHR is developed and managed by the
health facility or provider. The term Electronic
Health Record has largely replaced the older
“Electronic Medical Record.”
• It is much more than an electronic replacement of
existing paper systems. The EHR can start to
actively support clinical care by providing a wide
variety of information services. However, it is hard
to understand what information is really important
to clinical care and what is simply occasionally
desirable.
• The EHR bring uncountable advantages in
primary health care detaching such as faster
access to information, and updated information.
• It allows having a clinical process with all the
patient clinical information and an easier access to
information (ex: allows the simultaneous access
from different locations).
• 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.
INTRODUCTION TO DAVIES
• The Nicholas E. Davies EHR Recognition
Program
• recognizes healthcare provider organizations
that successfully use EHR systems to improve
healthcare delivery
Objectives
• Promote the vision of EHR systems through
concrete examples;
• Understand and share documented value of
EHR systems;
• Provide visibility and recognition for high-impact
EHR system; and
• Share successful EHR implementation
strategies.
Computer-based Patient Record Institute (CPRI)
o Non-profit membership organization
founded in 1992
o A unique organization representing all
stakeholders in healthcare focusing on
clinical applications of Information
Technology.
o Initiate and coordinate activities to facilitate
and promote the routine use of computer-
based patient records (CPRs) throughout
healthcare.
• CPR project evaluation criteria in 1993
• Four major areas of initial Criteria
Management
- The organizational aspects of EHR
implementation; strategy, planning, project
management and governance
Functionality
- delivered by the EHR to meet the organizational
objectives and the needs of patients and end-
users
Technology
- Technical design and architecture that enable
the EHR to deliver the required functionality and
performance
Impact/Value
- Provided a framework through which to view an
implementation of computerized records.
- Foundation for the Nicholas E. Davies Award of
Excellence Program.
THE NICHOLAS E. DAVIES AWARDS OF
EXCELLENCE PROGRAM
 The Computer-Based Patient Record Institute
(CPRI), founded in 1992, 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.
 The CPRI group on CPR Systems Evaluation
developed the CPR project evaluation criteria
in 1993 which became the basis in assessing
accomplishments of CPR projects and provided
the Foundation of Nicholas E. Davies Awards
Excellence Program
DAVIES PROGRAM
• named for Dr. Nicholas E. Davies
- e-based physician
- President elect of American College of
Physicians
- A member of Institute of Medicine (IOM)
committee on improving patient record
- Died on a plane crash
•This national program is intended to award and
bring to national attention excellence in the
implementation of computerized medical records.
• The HIMSS Nicholas E.Davies Awards of
Excellence recognize excellence in the
implementation and use of health information
technology, specifically EHRs for healthcare
organizations, private practices and public health
systems.
• 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
MANAGEMENT SYSTEMS SOCIETY (HIMSS)
• 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.
HIMMS Vision
- Advancing the best use of information and
management systems for the betterment of
health care
Mission
- To lead change in the healthcare information and
management systems field through knowledge
sharing, advocacy, collaboration, innovation, and
community affiliations
HIMSS OBJECTIVES:
- Promote the vision of EHR systems through
concrete examples
- Understand and share documented value of
EHR systems
- Provide visibility and recognition for high impact
EHR system
- Share successful EHR implementation
strategies
- encourages and recognizes excellence in the
implementation of EMREHR systems:
Implementation, Strategy, Planning, Project
Management and Governance- Strategy
LESSON 4: ENHANCING CLINICAL CARE
THROUGH NURSING INFORMATICS
HEALTH CARE TECHNOLOGY
If you are under 20 you are a DIGITAL NATIVE.
If you are over 20, no matter how tech savvy you
are, you are a still a DIGITAL IMMIGRANT.
If you are over 40 and have steadfastly avoided
technology, you are a DIGITAL DINOSAUR.
HEALTHCARE INFORMATICS
• A combination of computer science, healthcare
science, information science and cognitive
science.
Computer science: development, configuration,
architecture of computer hardware and software.
Healthcare science: body of knowledge on which
healthcare profession bases their practice. The
sciences of anatomy, physiology and knowledge
specific to each profession.
Information science: also includes information
technology which involves the process of sending
and receiving information.
Cognitive science: the process of human thinking,
understanding and remembering.
NURSING INFORMATICS (NI)
“Nursing Informatics is a specialty that integrates
nursing science, computer science, and information
science to manage and communicate data,
information, and knowledge in nursing practice.
Nursing informatics facilitates the integration of
data, information, knowledge, and wisdom to
support patients, nurses and other providers in their
decision-making in all roles and settings. This
support is accomplished through the use of
information structures, information processes, and
information technology.” (ANA Scope & Standards
of Nursing Informatics Practice, 2008)
• Like any knowledge-intensive field these days,
nursing is greatly impacted by the explosive growth
of computer technology.
• Nursing informatics is a new and exciting specialty
that combines nursing skills with computer
expertise.
• Nurse informatics specialists manage and
communicate nursing data and information to
improve decision making by consumers, patients,
nurses and other health care providers.
SCOPE & STANDARDS OF PRACTICE
• System Lifecycle
• Human Factors
• Information Technology
• Information Management
• Professional Practice
• Models and Theories
IN vs. INS
• IN - Informatics Nurse:
- RN who works in the area of informatics
- This RN is not formally prepared in
informatics but has an interest and/or
experience working in the area.
• INS - Informatics Nurse Specialist:
- RN with advanced, graduate education in
nursing informatics or information
management
NURSING INFORMATICS JOB TITLES
• 14% “clinical analysts”
• 14% “informatics nurse specialist” or “nursing
informatics specialist”
• 9% “consultant”
• 40% identified “other”
o Director of Clinical Informatics, Clinical
Informatics Coordinator, Clinical
Systems Analyst, Clinical Informatics
Specialist
NI SPECIALIST SALARY
The HIMSS blog recently published a nursing
informatics salary survey, and according to the
survey, salaries in the field are on the rise: “the best
news is that salaries are substantially higher in the
2011 survey, with the average salary reported at
$98,703, a 16% increase since 2007 and a 42%
increase since 2004.”
NURSE INFORMATICS CAREER OUTLOOK
• The demand for all types of nurses is expected to
increase significantly over the next ten years.
• In general, the more training, certifications and
experience a nurse has, the more demand there
will be for his or her skill set.
HEALTHCARE INFORMATION AND
MANAGEMENT SYSTEMS SOCIETY (HIMSS)
LEVEL 7
STAGE CUMMULATIVE CAPABILITIES
7 - Medical record fully electronic; care delivery
organization able to contribute to electronic health
record as by product of electronic medical record
6 - Physician documentation, full clinical decision
support system (variance and compliance), full
PACS
5 - Closed-loop medication administration
4 - CPOE, clinical decision support system (clinical
protocols)
3 - Nursing documentation, eMAR, clinical decision
support system (error checking), PACS
2 - Clinical data repository, controlled medical
vocabulary, clinical decision support interface
engine, document imaging
1 - Ancillaries: laboratory, radiology, pharmacy
0 - All three ancillaries not installed
• Nurses need to develop competencies in
informatics.
• Informatics enables nurses to use information and
communications technologies in the:
• Collection of data,
• Use of information
• Generation of knowledge to support nursing
practice
• The trend in hospitals are computerizing nursing
documentations
• For effective and efficient data management such
as workload statistics, performance monitoring, etc.
• promotes and improves evidence-based nursing
practice and patient outcomes.
• Nursing informatics enables nurses to quickly
move to the synthesis of nursing knowledge and
the development of nursing wisdom.
• Gone were the days of manual documentation
that consumes most of your time, now, more time
are used in applying nursing knowledge and
wisdom to everyday care because of informatics.
NURSING INFORMATION SYSTEMS (NIS)
includes:
1. Patient Charting
2. Staff Schedules
3. Clinical Data Integration
4. Decision Support
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
changed by a scheduling coordinator or manager.
Shift modules are designed to handle absences,
overtime, staffing levels and cost-effective staffing.
Clinical Data Integration: Here clinical information
from all the disciplines can be retrieved, viewed and
analyzed by nursing staff and then integrated into a
patient’s care plan.
Decision Support: Decision support module can
be added to NIS, and they provide prompts and
reminders, along with guides to disease linkages
between signs/symptoms, etiologies/related factors
and patient populations. Online access to medical
resources can also be made available.
INFORMATICIST
• Nurse programmers who write or modify
computer programs for use by nurses
• Nurse communicators who work with other
nurses to identify computer system needs or
to min the training and implementation of
those systems
• Informatics nurse managers who manage or
administer information systems
• Nurse vendor representatives who
demonstrates systems to potential
customers
WHAT CAN AN INFORMATICS NURSE DO?
1. Support nursing work processes using
technology
• Design systems to match clinical workflows
• Telehealth
• Home health
• Ambulatory care
• Long-term care
• Acute care - all specialties
• Outpatient settings
• Software development
2. Increase the accuracy and completeness of
nursing documentation
3. Improve the nurse’s workflow
• Eliminate redundant documentation
4. Automate the collection and reuse of nursing
data
5. Facilitate analysis of clinical data
• Admitting a patient
• Admission Assessment in computer
- Placing orders
- Requesting consults
- Sending data to NIS/HIS
- Resolving clinical reminders
• These things involve a computer as well
- Take V/S
- Give medications
- Consent for surgery
- Make the bed
Prepare/provide workload statistics
- How many new orders written on Ward X in
a day?
- How many medications given on Ward X in
a week?
- Nurses bypassing BCMA by using Manual
Medication Entry
- Show me all restraint orders for the past
month
6. Information system management
7. Documenting patient education
• Incorporated into daily charting
8. Training/educating
• New employees
• Student nurses
COMPENTENCIES REQUIRED
• Most theorists also emphasize the need for every
nurse whether employed in the practice or
education setting, to develop a minimum of a "user"
level in computer literacy and informatics theory.
TECHNICAL COMPENTENCIES
• Related to the actual psychomotor use of
computers and other technological equipment.
• Specific nursing informatics competencies include
the ability to use selected applications in a
comfortable and knowledgeable way.
• It is important that nurses feel CONFIDENT in
their use of computers and software in the practice
setting, especially at the bedside, in order to be
able to attend to the client at the same time.
LEVEL OF COMPETENCIES
• Beginner, entry or user level
• Intermediate or modifier level and;
• advanced or innovator level of competency.
COMPUTER APPLICATIONS
All three levels of competencies - users, modifiers
and innovators need to develop a working
knowledge of the following computer programs and
processes:
• Word processing
• Keyboarding
• Spreadsheets
• Presentation Graphics
• Databases (simple to complex)
• Desktop Publishing
• World Wide Web
• E-mail programs
• Expert data systems
• Multimedia
• Telecommunication devices
• Nursing information systems
• Hospital information systems
• Peripherals (Printers, CD/DVD)
USER LEVEL TECHNICAL COMPETENCIES
INCLUDE:
• uses word processing applications
• demonstrates keyboarding skills
• uses spreadsheet applications
• uses telecommunication devices to
communicate with other systems
• uses e-mail systems to communicate with
other health care professionals
• Uses presentation applications to create
slides, displays, overheads (PowerPoint,
Corel Presentation, etc.)
• uses multimedia presentations
• uses internet resources to locate client
support groups, online resources
• uses sources of data that relate to nursing
practice and care
• accesses, enters and retrieves data related
to client care via available hospital or
nursing information systems
• uses database management programs to
develop and access databases and tables
• uses database applications to enter and
retrieve data and information
• Conducts online and database literature
searches
• uses decision support systems, expert
systems and other aids for clinical decision
making and care planning
• uses computer applications to document
client care
• uses computer applications to plan client
care, including discharge planning
• uses computer applications to enter client
data (demographic, V/S, physiological data)
• uses information management systems for
client education
• Uses technology based client monitoring
systems
• operates peripheral devices (bedside and
hand held)
• uses operating systems
• uses computer peripheral devices (CD
ROMs, DVD, zip drives)
• uses computer technology safely
• navigates in Windows environment
effectively
• demonstrates basic technology skills (load
paper, change toner, unjam printers, print)
MODIFIER LEVEL TECHNICAL COMPETENCIES
INCLUDE:
• applies technology support to provide
evidenced based practice
• synthesizes data from more than one
source and applies to practice
• demonstrates awareness of and ability to
access data and information from multiple
sources
• uses decision support systems in practice
• accesses pertinent literature resources and
incorporates into practice and professional
development
• creates and accesses research and other
documents electronically
INNOVATOR LEVEL TECHNICAL
COMPETENCIES INCLUDE:
• participates in the design and development
of information systems for nursing practice
• develops inventive ways to access data and
interact with information systems
• participates in the design and develop
design and development of new
applications for nursing practice
 • participates in developing new methods for
data and information organization
• collaborates with information technology
consultants and other members of
information system development team
• collaborates, negotiates with and directs
information technology vendors
• Proficiency in diverse computer application
programs
• manipulates and enhances nursing data
sets
• organizes and directs applications of shared
data sets
• develops data gathering tools and
processes for literature search access for
nurses
• develop charting and documentation
templates for use in nursing practice
• Design and development of evidenced
based practice documentation and
processing within practice area
NURSING I.T. TRENDS
• Barcode
• Technology
• Improving
• Patient Safety
Looking into the Future of Health Care
• Informatics can make nursing practice visible in
local, national, and international health care data
sets, thus empowering nurses with information to
influence policy.
• Information is a critical component of effective
decision-making and high quality nursing practice.
The information and knowledge gained through
nursing informatics can bring increased awareness
and understanding of nursing and health care
issues.
• Nursing Informatics is committed to maintaining a
clinical perspective and promoting research that
would bear directly on improving patient care.
• Recognition of Nursing Informatics team value in
support of clinical excellence is crucial to any
healthcare organization’s success.
CONCLUSION
Computers cannot replace a nurse, they cannot
replace your intuition, and they cannot replace your
intelligence and certainly not your TLC.
Nurses cannot become robots, doing only what the
computer tells them to do.
QUOTE OF THE DAY
"Computers are incredibly fast, accurate and stupid.
Human beings are incredibly slow, inaccurate and
brilliant. Together they are powerful beyond
imagination.
FRIENDLY ADVICE
• Work towards achieving the INNOVATOR
LEVEL of technical competency
• Keep abreast of “latest greatest” technology
trends
• Assess newest technology for “fit” and
potential applicability in your nursing
profession
LESSON 5: HISTORY OF COMPUTERS
1943
 The first digital computer called
“COLOSSUS MARK I “ was built
 Bell laboratories was working on the
development of a computer
 2 scientists at the University of
Pennysylvania, J. Presper Eckert and
John Mauchly, later founders of Eckert-
Mauchly Corporation.
1950
 The Remington Rand Corporation bought
Eckert and Mauchly’s company.
1951
 The first large scale commercial computer
system called the “UNIVAC-I” was
marketed.
1955
 The Sperry Corporation merged with the
Remington Rand forming the giant “Sperry
Rand Corporation”
 The 1st commercial application was run
when General electric (GE) processed its
payroll on UNIVAC
 This year the age of business computing
was born
 The American recognized the value of the
machine that this could do thousands of
repetitive mathematical calculations
  In response companies such as
o BELL labs,
o National Cash Register (NCR)
o Burroughs,
o And international business machine
(IBM)
 Began to develop their business computer
products
 Today, the early computers are called First
generation computers.
FIRST GENERATION COMPUTER
 Used vacuum tubes as a design
 These computers ran hot and required a
great cooling
 Vacuum tubes got hot easily, and when they
get hot, they failed regularly.
 Physically huge (one computer took up a
large room), but their power was much less
than that of the average desktop computer
of the 1900’s
2 GENERATION COMPUTERS
nd
 They use transistors instead of vacuum
tubes. This meant less heat, improved
reliability and much greater speeds
 Access speeds were measured in millionth
rather than thousandth of a second
(microseconds)
 Quite large, but transistor were smaller and
more durable than vacuum tubes
 They also allowed for the development of
much more powerful computers.
THIRD GENERATION COMPUTERS
 They used microminiature, solid state
components
 Third generation CPU access speeds were
measured in billionth of seconds
(nanoseconds) IBM 360 these were the
classic computers in this generation IBM
370
Hertz
 60KHz
 60MHz
THE RISE OF THE MODERN PERSONAL
COMPUTER
 November 1972 Intel corporation introduced
the first commercial microprocessor, called
“Intel 8008”
 This invention made the PC, also known as
a microcomputer possible
TWO TEENAGE BOYS
 Steve jobs &Steve Wozniak
 They share there intense interest in
electronics. They bought microprocessor for
$25 and build a very simple computer called
“APPLE”
MAY OF 1976
 They introduced their first computer at a
meeting of the Homebrew computer club, at
which, PAUL TERRYL president of THE
BYTE shop chain ordered 50 units. The
apple computer company and first PC were
born
CLASSES OF COMPUTER
 Analog computer
o Operates on continuous physical or
electrical magnitudes, measuring,
ongoing continuous analog
quantities such as voltage, current,
temperature and pressure.
 Digital computer
o Operates discrete discontinuous
numerical digits using the binary
numbering system. It represents
data using discrete values for all
data, most of the computers use in
the health care industry for charting
and decision support are digital
computers
 Hybrid computer
o As its name implies contains
features of both analog and the
digital computer, it is used for
specific applications, such as
complex signal processing and other
engineering-oriented applications. It
is also found in some monitoring
equipment that converts analog into
digital ones for data processing
TYPES OF COMPUTERS
SUPER COMPUTER
  This is a computational-oriented compute
designed for scientific applications requiring
gigantic amount of calculations
MAINFRAME

 This is the fastest, Largent, and most

expensive type of computer used in
corporations for processing, storing and
retrieving video
MICROCOMPUTER OR PERSONAL COMPUTER
(PC) DESKTOP

 Can serve as stand-alone workstation and

can be linked to network system to
increase the capabilities
HANDHELD COMPUTERS

 Small, special function computers and

some have claimed to have almost the
same function and processing capabilities
as the standard desktop microcomputer
COMPUTER HARDWARE FUNDAMENTALS

 Central processing unit (CPU)

 Motherboard
 Memory
 Keyboard
 Mouse
 Diskettes
 Universal serial bus (USB)
 Hard drive
 CD-ROM