Lesson 3

Week Prelims

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Notes

Healthcare Informatics is a combination of computer science, healthcare science,

information science and cognitive science.

What is Healthcare Informatics

Computer science: development, configuration, architecture of computer

hardware and software

Healthcare science: body of knowledge on which healthcare profession bases

their practice. The science 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

What is 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

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 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”

Director of Clinical Informatics, Clinical Informatics Coordinator, Clinical

System Analyst, Clinical Informatics Specialist

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 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 System Society (HIMMS) Level 7

Stages Cumulative Capabilities

7 Medical record fully electronic; care delivery organization able to contribute

to electronic health record as byproduct 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

Why it is Important

Nurses need to develop competencies in informatics

Informatics enables nurses to use information and communication technologies

in the:

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 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

Patient Charting

Staff Schedules

Clinical Data Integration

Decision Support

Patient Charting: A patient’s vital signs, admission and nursing assessment,

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 late 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 form 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

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 s/sx , etiologies/related factors and patient populations. Online access to
medical resources can also be made available

Roles of the Nurse Informatics

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 assist in the training and implementation of those
systems

Informatics nurse managers who manage or administer information system

Nurse vendor representatives who demonstrates system to potential

costumers

What can an informatics nurse do?

1. Support nursing work processes using technology

Design system to match clinical workflows

Telehealth

Homehealth

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

What can an Informatics Nurse do?

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 Admitting a patient

Admission Assessment in computer

Placing orders

Requesting consults

Sending data to NIS/HIS

Resolving clinical reminders

These things to 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 medication 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

Competencies Required

Most theorist also emphasized 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

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 Technical Competencies

Related to the actual psychomotor use of computer 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

Database (simple to complex)

Desktop Publishing

World Wide Web

E-mail programs

Expert data systems

Multimedia

Telecommunication devices

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 Nursing Information systems

Hospital information system

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 (Power

point, 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

conduct online and database literature searches

uses decision support system, expert systems and other aids for clinical
decision making and care planning

uses computer applications to document client care

uses computer application 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

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 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

navigate 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

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 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

Summary

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

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