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NURSING INFORMATICS
INTRODUCTION TO NURSING INFORMATICS
• This course deals with the use of
information technology system and data
standards based on nursing informatics
principle/theories.
• It further deals with the utilization of
clinical information systems in the
management and decision-making of
patient care. A laboratory session shall
be provided for practice application.
COURSE OUTLINE
A. Computers and Nursing
• Computers and nursing
• Historical perspectives of nursing and the
computer
B. Computer System
• Computer hardware
• Computer software and systems
• Open source and free software
• Data processing
• The internet: a nursing resource
C. Issues in informatics
• The role of technology in the medication-
use process
• Healthcare data standards
• Electronic health record systems
• Dependable systems for quality care
• Nursing minimum data set systems
D. Informatics theory
• Theories, models, and frameworks
• Advanced terminology status
E. Practice application
• Critical care applications
• Community health applications
• Ambulatory care systems
• Internet tools for advanced nursing
practice
• Informatics solutions for emergency
preparedness and response
• Vendor Applications
F. Consumer’s use of informatics
• Consumer and patient use of computers
for health
• Decision Support for Consumers
G. International perspectives
• Nursing informatics in Canada
• Nursing informatics in Europe
• Pacific rim
• Nursing informatics in Asia
• Nursing informatics in South America
INFORMATICS
• French word “informatique” - computer
science
• The study of computers, including both
hardware (physical, what we can
manipulate) and software (applications,
programs needs to be updated) design.
• Informatics is defined as computer
science + information science
• Body of knowledge that provides
theoretical basis for information
technology
• Used in conjunction with the name of a
discipline, it denotes an application of
computer science and information
science to the management and
processing of data, information, and
knowledge in the named discipline
NURSING INFORMATICS
• “The use of computers technology to
support nursing, including clinical
practice, administration, education and
research” - Hebda (1998 pp.3)
• “The development and evaluation of
applications, tools, processes, and
structures which assist nurses with the
management of data in taking care of
patients or supporting the practice of
nursing” - American Nurses Association
(ANA) 1994
• “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 practive of nursing and the delivery
of nursing care” - Graves, J.R & Corcoran,
S., 1989

NURSING INFORMATICS
APPLICATION OF NURSING INFORMATICS
Nursing Informatics can be applied to all areas
of nursing practice which include:
• Clinical practice
• Administration
• Education and
• Research
ORIGIN OF NURSING INFORMATICS
• Increase in knowledge has led to the
development of many specialties and
subspecialties
• The number of cases increased with
increase in population, discovery of
more diseases and extension of life
expectancy
• Due to increase workload, lack of time to
channel into useful information or
knowledge - lead to development of
healthcare informatics
TOP 4 PROBLEMS OF NURSES IN THE
WORKPLACE:
1. DOCUMENTATION IS EXCESSIVE
• writes narratives (patient's history,
progress notes, care plans and special
reports)
• fills up forms, records VS in graphing
paper and writes in tables input/output
2. TURNAROUND TIME IS TOO LONG
• Turnaround time starts from the time a
request is made to the time it was fully
accomplished
o ex. laboratory tests or ancillary
orders
o Automation helps accelerate the
processes of request and facilitate
presentation of current status of
result of the request
3. NURSING PROCESS ARE INACCURATE
• Rushing of nursing process may lead to
commission of errors
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• ERRORS: Medication errors; wrong entries,
dictation, translation and transcription of
orders.
• Automation of these processes mostly
done beside a patient leads to a great
reduction of errors.
4. COMMUNICATION IS POOR
• Communication between healthcare
providers and between departments is
POOR when served with telephone
systems because of its real time nature
that requires the presence of both.
• Phone lines may be tapped or bugged
breaching privacy and confidentiality
• Computers provide different modes of
communications like chat, telephony, or
video-conferencing or e-mail and
simple text messaging whatever is most
convenient and appropriate.
FRAMEWORK FOR NURSING INFORMATICS
Relies on the central concepts of data,
information and knowledge: DIKD
1. A DATA is defined as discrete entities that are
described objectively without interpretation
2. An INFORMATION as data that is interpreted,
organized or structured
3. A KNOWLEDGE as information that has been
synthesized so that interrelationships are
identified and formalized.
4. Resulting in DECISIONS that guide practice
Teaching Nursing Informatics is a must in the
Philippines.
• January 2008 - CHED memorandum
order CMO NO. 5 series of 2008 to all
deans of the colleges of nursing
throughout the country.
CMO NO. 5 series of 2008
• It requires the replacement of basic
computer with 3-unit Nursing Informatics
in the new curriculum.

NURSING INFORMATICS
COMMON COMPUTER-RELATED ACRONYMS IN
NURSING INFORMATICS
CAI - Computer Assisted Instruction
CPOE - Computer Provider (or Physician) Order
Entry
CPR - Computer-based Patient Record
EDI - Electronic Data Incharge
EHR - Electronic Health Record
HIS - Hospital Information System
MIS - Management Information System
PDA - Personal Digital Assistant
PHI - Protected Health Information
PHR - Personal Health Record
COMPUTERS IN NURSING EDUCATION
Computer Assisted Education
• software programs that help student
nurses learn and demonstrate learning
• topics include drug dosage calculations,
ethical decision making, etc. in the form
of tutorials, drills, online practice sheets,
stimulations, mock tests with diagrams,
graphics animations, videos and audio
files
• may be available through CD-ROM or
through the internet
Computer Assisted Education makes uses of the
following:
• PDA(Personal Digital Assistants)
• LCD Projectors
• Wireless routers
• Desktops
• Laptops
• Smartphone
• Videos / Animations
• Distance learning
• Testing (NCLEX)
• Student and course record
management
Distance learning
• educational opportunities delivered
under situations in which the teacher
and the learner are not physically in the
same place at the same time
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• can be synchronous and/or
asynchronous
• makes use of educational platforms/ e-
learning management systems, online
storage folders or programs, online
libraries, YouTube and even podcasts
• allows users to create virtual communities
Testing
• computers are ideal for conducting
learning evaluations
• large banks of potential test items can be
made to allow computers to randomly
generate different exam questions for
students
• students’ scores can be scored
electronically and stored for future
reference
• best example: NCLEX
Student and Course Record Management
• accessible for students and faculty
members
• used for keeping records of students’
progress, including grades or
attendance, computing tests scores and
publishing results to be viewed by each
students in private
• data can be stored in computers,
allowing cumulative results to be
calculated, which is an example of data
warehousing (accumulation of large
amounts of data that are stored over
time and can be generated into
different types of reports)
• best examples : Automate and Quipper
COMPUTERS IN NURSING PRACTICE
Functions
1. Records client information
2. Provides access to other departments
3. Used to manage client scheduling
4. Documentation of clients status & medical
records keeping
• Provides access to standardized forms,
policies and procedures

NURSING INFORMATICS
• Access data about client that may be
somewhere in the
5. Bedside Data Entry
• Records clients assessments, medication
administration, progress notes, care plan
updating, client acuity and accrued
charges
6. Computer Based Client Record EMRs/CPRs
• Provides easy retrieval of specific data
such as trends in vital signs, immunization
records, current problems
• It can be designed to work providers
about conflicting medications or client
parameters that indicate dangerous
conditions
7. Electronic Access to Clients
• Used extensively in healthcare to assess
and monitor clients conditions
• Data accumulated from various
electronic devise are stored for research
purposes
• Can monitor client
• Computerized diagnosis
• Telemedicine
8. Practice Management
• Used to order supplies, tests, meals, and
services, from other departments
• Allows nursing service to determine the
most costly items used by a particular
nursing unit.
• May provide information or decisions to
modify budget, provide different staffing,
move supplies to different locations, or
make other changes for more efficient
and higher quality care
COMPUTERS IN NURSING RESEARCH
1. PROBLEM IDENTIFICATION
• Useful in locating current literature about
the problem and related concepts.
• Helps in searching for existing documents,
and e-mail to colleagues.
2. LITERATURE REVIEW
• Software facilitate searches, contains
thesauruses so that the most appropriate
terms can be selected.
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3. RESEARCH DESIGN
• Search literature for instruments that
have already been established or to
design and test instruments that need to
be developed for past study.
4. DATA COLLECTION AND ANALYSIS
• Helps create forms for the collection of
data such as informed consent,
demographic data, and recording
forms.
• Commonly used software for
quantitative data analysis:
SPSS( statistical package for social
sciences), SAS (statistical analysis system),
Sys STAT, MYSTAT
5. RESEARCH DISSEMINATION
• computer word processing programs are
used to author the final reports of
research and send research to various
readerships.
• Help speeds completion or research
projects
COMPUTERS IN NURSING ADMINISTRATION
Human Resources
• employers maintain an employee
database containing the ff:
demographic and salary data; records
of unique fields and special certifications,
health requirements, immunization
records and performance appraisals
• allows communication with employees,
determines staffing patterns and creates
budget projections
Medical Records Management
• for research and client care
• human time and energy plus inefficiency
in accessing contents > storage of paper
documentation
• allows access to information regarding
most common diagnosis, case numbers,
client outcomes, most expensive cases,
length of stay
• they increase the ability to demonstrate
the value of nursing care

NURSING INFORMATICS
Facilities Management
• computer control of facilities like heating,
air conditioning, ventilation , and alarm
systems
• Inventory management other examples:
security devices like readers scan
identification cards, bar codes
• Magnetic strips permit only authorized
personnel to enter client or private areas
Budget and Finance
• in computerized billing, claims are
transmitted more quickly with greater
likelihood of being accurate and
complete compared to handwritten
documents
• clerical service time is reduced
• special spreadsheet programs allow
tracking, forecasting and planning of
budget
Quality Assurance and Utilization Review
• used in internal and external audit
• once standards, pathways, key
indicators and other vital data have
been identified and described,
computers can facilitate the
accumulation and analysis of data
• also used for examining trends and
proposing advantageous uses of
resources
• “Quality is a process, not an endpoint”
Accreditation
• efficient online mechanisms used in
monitoring quality indicators help reduce
the difficulty and time involved in the
accreditation process
• health care agencies must maintain
databases of policies and procedures,
standards of care, employee
accomplishments, continuing education
and in-service training
• computer systems that assess outcomes
rather than processes are required
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AUTOMATED SYSTEM IN THE PHILIPPINES
1970s
• computers were mainly used to
automate billing.
• Hospital networks expanded to include
information process in admission,
discharge and transfer (ADT) (mid 70s)
• Networks included pharmacy section,
connecting 3 big departments:
accounting, ADT and pharmacy. (late
70s)
1980s
• Laboratory and imaging departments
started using their special computers
(early 80s)
• Integrated system expanded to the
clinical area. (mid 80s)
• 90's hospital bought conversion software
and hardware in order to deliver the
laboratory and imaging machines to link
their main system creating interfaced
systems.
2000s
• LABORATORY INFORMATION SYSTEM (LIS)
& RADIOLOGY INFORMATION SYSTEM (RIS)
started to encroach into the main
hospital information systems.
• Late 2000s - The Philippine Heart Center
will soon implement the internet-based
hospital information system (HIS) to allow
healthcare team to access and access it
anywhere
COMPUTER
PARTS OF THE COMPUTER SYSTEM
Computer systems have four parts:
1. Hardware
2. Software
3. Data
4. User
HARDWARE
• Mechanical devices in the computer;
physical components of the machine
• Anything that can be touched
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o Electronic circuits, microchips, • Some devices are input and output

processors & motherboard - main o Touch screens
circuit board that all other internal
components connect to (placed STORAGE DEVICES
inside computer housing) • Hold data and programs permanently
o PERIPHERAL DEVICES (input & • Different from RAM
output devices) • HARD DRIVE
o very fast means of storing and
ESSENTIAL COMPUTER HARDWARE retrieving data as well as having a
• Computers use the same basic hardware large storage capacity
Hardware categorized into four types: • MAGNETIC STORAGE
PROCESSING DEVICES o Floppy/DISKETTE and hard drive
• Brains of the computer o Uses a magnet to access data
• Carries out instructions from the program • OPTICAL STORAGE
• Manipulate the data o CD and DVD drives
• Most computers have multiple o Uses a laser to access data
processors
• Central Processing Unit (CPU) SOFTWARE
• Secondary processors • Tell the computer what to do; describe
• Processors made of silicon and copper the function or the contribution of the
sets of commands, procedures in the
MEMORY DEVICES computer system
• Stores data or programs • Also called a program
• Random Access Memory (RAM) • Thousands of programs exist
o Volatile o Operating system
o Stores current data and programs o Word processor
(temporarily) o database
o More RAM results in a faster system benefits the nursing from doing a manual
o changeable and used for primary preparation of reports and documents, due to
storage readily available information, the nurse will have
• Read Only Memory (ROM) more time synthesizing and analyzing
o Permanent storage of programs; information
does not change; can't be erased
or altered SOFTWARE RUNS THE MACHINE
o Holds the computer boot Two types
directions • System software
• Application software
INPUT AND OUTPUT DEVICES
• Allows the user to interact SYSTEM SOFTWARE
• Input devices accept data • " boots up" (starts up and initializes) the
o Keyboard, mouse computer system; controls, input, output
• Output devices deliver data to external and storage; and controls the operation
world (text, data files, sound, graphics or of the application software
signals) • Most important software
o Monitor, printer, speaker • Operating system
o Windows XP
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• Network operating system (OS) • Processing

o Windows Server 2003 • Output
• Utility • Storage
o Symantec AntiVirus
TYPES OF COMPUTERS
APPLICATION SOFTWARE SUPERCOMPUTERS
• includes the various programs that users • largest type of computer; a world class
require to perform day-to-day tasks. They "number cruncher".
are the programs that support the actual • It is a computational-oriented computer
work of the user. Accomplishes a specific specially designed for scientific
task applications requiring gigantic amounts
• Most common type of software ○ MS of calculations.
Word • designed primarily for analysis of
• Covers most common uses of computers scientific and engineering problems and
for tasks requiring millions or billions of
THIRD TYPE OF SOFTWARE = utility programs computational operations and
• Used to help maintain the system, calculations.
• Clean unwanted programs, • It is found primarily in areas such as
• Protect the system against viruses and defense and weaponry, weather
• Access the World Wide We forecasting and scientific research.

DATA MAINFRAMES
•Pieces of information • It is the fastest, largest and most
•Computer organize and present data expensive type of computer used in
Computer data corporate America for processing,
• Fact with no meaning on its own storing and retrieving data.
• Stored using the binary number system • It is a large multiuser central computer
• Data can be organized into files that meets the computing needs of a
large organization such as repetitive
USERS calculations of bills and payrolls.
• People operating the computer • A mainframe has an extremely large
• Most important part memory capacity and fast operating
• Tell the computer what to do and processing time and it can process
Computer users a large number of functions at one time.
• Role depends on ability
o Setup the system MICROCOMPUTERS (Personal Computer)
o Install software • being used for an increasing number of
o Manage files independent applications as well as
o Maintain the system serving as a desktop link to the programs
• "Userless" computers of the mainframe.
o Run with no user input • Desktops can serve as stand-alone
o Automated systems workstations and can be linked to a
network system to increase their
INFORMATION PROCESSING CYCLE capabilities.
Steps followed to process data:
• Input
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HANDHELD COMPUTERS Knowledge Management:

• These are small, special function
computers. ; smaller size than the
standard desktop microcomputers,
some have claimed to have almost the
same functionality and processing
capabilities as the standard desktop
microcomputer.
• More popular are the palm-sized
computers such as personal digital
assistant (PDA) = provides calendar,
contacts and note-taking functions and
may provide word processing and
spread sheet.
OPEN SOURCE AND FREE SOFTWARE
OPEN SOURCE SOFTWARE
• " The open source concept is said to
promote software reliability and quality
by supporting independent peer review
and rapid evolution of source code, as
well as making it freely available.
• In addition to providing free access to
the programmer's instructions to the
computer in the programming language
in which they were written, many versions
of open source license allow anyone to
modify and redistribute the software.
• The Open Source Initiative (OSI) created
a certification mark, "OSI certified"
• in order to be OSI certified, the software
must be distributed under a license that
guarantees the right to read, redistribute,
modify and use the software freely.
• The actual category of software that is
considered free is almost exactly the
same as the actual category of software
that is considered open source.
Databases:
• LDAP
• MySQL (database)
• PostgreSQL (relational database with
ability to do stored procedures)
• Plone (open source content
management system)
• Knowledge Tree
Telephony:
• Asterisk (A Phone systém [PBX] that also
supports Voice Over IP technology)
• Elastix
• FreePBX
• Trixbox CE
FREE SOFTWARE
• software that respects users' freedom
and community. freedom to run, copy,
distribute, study, change and improve
the software.
• Thus, "free software" is a matter of liberty,
not price.
• Operating systems and Desktop
environments
• Linux - Operating system kernel
• Ubuntu - Linux distribution with full
compliment of software for everyday use.
• See also Kubuntu that runs the KDE
desktop which some people find this
easier if they previously used MS Windows.
Ubuntu is an easy to use operating
system based on and made possible by
the Debian project.
• Google Chrome OS - Lightweight
operating system based around the web
browser
• Android smart-phone operating system -
by Google /Open Handset Alliance
• Symbian smart-phone operating system
- by Nokia
"FOUR ESSENTIAL FREEDOMS"
• "to run the program as you wish, for any
purpose (freedom 0).
• To study how the program works, and
change it so it does your computing as
you wish (freedom 1).
• Access to the source code is a
precondition for this. to redistribute

NURSING INFORMATICS
copies so you can help your neighbor
(freedom 2).
• to distribute copies of your modified
versions to others (freedom 3).
• "Free software" does not mean
"noncommercial"
• But regardless of how you got your
copies, you always have the freedom to
copy and change the software, even to
sell copies.
• Most free software licenses are based on
copyright, and there are limits on what
kinds of requirements can be imposed
through copyright
• However, some free software licenses
are based on contracts, and contracts
can impose a much larger range of
possible restrictions. That means there
are many possible ways such a license
could be unacceptably restrictive and
nonfree.
COMPARE/CONTRAST
• free software and open source
ideologies are distinct
• basically refer to the same software
licenses, with a few minor exceptions
• The term "open source" software is used
by some people to mean more or less the
same category as free software.
• accept some licenses that we consider
too restrictive. and there are free
software licenses they have not
accepted.
• nearly all free software is open source,
and nearly all open source software is
free.
• OSS/FS has been described as the
electronic equivalent of generic drugs.
• In the same way as the formulas for
generic drugs are made public, so
OSS/FS source code is accessible to the
user. Any person can see how the
software works and can make changes
to the functionality.
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• As the OSS/FS can be obtained royalty
free, it is less expensive to acquire than
proprietary alternatives.
• This means OSS/FS can transform
healthcare in developing countries just
as the availability of the generic drugs
have.
VistA: (Veterans Health Information System and
Technology Architecture)
• VistA is the "mother of all health care
applications". It is not strictly OSS/FS but
has been promoted by it.
• patient records, prescriptions, laboratory
results, and other medical information.
• It contains among other components,
integrated hospital management,
patient records management, and
medical imaging systems.
DATA PROCESSING
• "The collection and manipulation of
items of data to produce meaningful
information.”
• It is the process of putting information into
a computer so that the computer can
organize it, change its form, and etc.
• It is also the conversion of raw data to
machine-readable form and its
subsequent processing (as storing,
updating, rearranging, or printing out) by
a computer.
• Nurses continually collect data about
their clients. The data are organized and
processed, producing information about
client needs and potential interventions.
• Using an intensive nursing knowledge
database, the information is interpreted.
• The goal of this plan is to provide caring
cost-effective quality care.
• in modern healthcare, the process of
moving from data collection to
implementing and evaluating and
individualized plan of care is highly
dependent on automated database
systems
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DATA PROCESSING FUNCTIONS

1. Validation
• Ensuring that supplied data is "clean,
correct and useful"
2. Sorting
• "arranging items in some sequence
and/or in different sets.
3. Summarization
• reducing detail data to its main points.
4. Aggregation
• combining multiple pieces of data.
5. Analysis
• the "collection, organization, analysis,
interpretation and presentation of data.".
6. Reporting
• list detail or summary data or computed
information.
7. Classification
• separates data into various categories.

DATA PROCESSING FLOWCHART