NCM110NIF: NURSING INFORMATICS
MIDTERM
BSN 2 LEININGER
Module 2
Lesson 1: Informatics Application in
Evidenced based Nursing Practice
Evidence based nursing practice
- Usage of information or the application of
nursing practice based on research
Care Planning
- computerized patient record facilitates the
automation of the nursing care planning
process*
- Today’s care planning process includes a mix of
individual patient data standards and data
which can be used for decision-making.**
- Documentation or the clinical records of the
patient with the use of the computer system
- Can often be difficult and time consuming
- Can significantly enhance the effectiveness of
creating the patient’s specific care plans
Discharge Planning
- documentation starts with admission and ends
with a discharge care plan
- discharge care planning systems provide for
continuity of care from home to hospital and
back to the community, another care facility,
outpatient department or the home.
- Process used to decide what a patient needs
from one level of care to the other
- Only the physician can release the patient from
the hospital – but the actual planning is done by
the nurses
Components of a Typical Discharge Plan
- summary of admission assessment
- summary of learning needs that the patient had
at discharge
- multidisciplinary plan including problems still
unresolved and outcomes not met during
hospitalization
- medications and procedures that the patient
must continue
- summary of selected patient outcomes that a
multidisciplinary team desired as minimal
criteria for patient to have achieved during
hospitalization
Clinical/critical pathways
Definition
- Clinical Pathways (CP) is multidisciplinary plans
of best clinical practice for specified groups of
patients with a particular diagnosis that aid the
co-ordination and delivery of high quality care.
- They are both, a tool and a concept, which
embed guidelines, protocols and locally agreed,
evidence-based, patient-centered, best practice,
into everyday use for the individual patient"
- Tools that helps the medical hcw to coordinate a
particular case type or particular condition
- CP usually recommends the total treatment
regimen
Why Clinical Pathways?
- To improve patient care
- To maximize the efficient use of resources
- To help identify and clarify the clinical processes
- To support clinical effectiveness, clinical audit
and risk management
As Active Management Tools
• Eliminate prolonged lengths of stay arising from
inefficiencies, allowing better use of resources
• Reduce mistakes, duplication of effort and
omissions
• Improve the quality of work for service providers
• Improve communication with patients as to their
expected course of treatment
• Identify problems at the earliest opportunity and
correct these promptly
• Facilitate quality management and an outcomes
focus
Four Components of a Clinical Pathway
• A timeline.
• Categories of care or activities and their
interventions
• intermediate and lone-term outcome entera
• Variance record
Optimum development and implemetnation
strategies
Select a topic
• Topic of high-volume, high-cost diagnoses and
procedures
• For example: critical pathway development for
cardiovascular diseases and procedures
Select a Team
• Active physician participation and leadership is
crucial
• Reperesentatives from all groups
Evaluate the Current Process of Care
o Key to understanding current variation
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 o A careful review of medical records
o Identify the critical intermediate outcomes, rate-
limiting steps, and high-cost areas on which to
focus.
Evaluate Medical Evidence and External Practices
• Evaluate the literature to identify evidence of
best practices
• In the absence of evidence, comparison with
other institutions, or "benchmarking, is the most
reasonable method to use.
Document and Analyze Variance
• The most important processes in the critical
pathway
• Identification of factors the key features in
process improvement
• Variance in clinical pathways is a result of the
omission of an action or the performance of an
action at an inappropriate (often, a late) time
period.
• Team to concentrate on a few critical items in
the pathway that have been identified in
advance
• For example: length of stay in the intensive care
unit
• The most important processes in the critical
pathway
• Identification of factors the key features in
process improvement
• Variance in clinical pathways is a result of the
omission of an action or the performance of an
action at an inappropriate (often, a late) time
period.
• Team to concentrate on a few critical items in
the pathway that have been identified in
advance
• For example: length of stay in the intensive care
unit
Benefits
• Support the introduction of evidence-based
medicine and use of clinical guidelines
• Support clinical effectiveness, risk management
and clinical audit
• Improve multidisciplinary communication,
teamwork and care planning
• Can support continuity and co-ordination of care
across different clinical disciplines and sectors;
• Provide explicit and well-defined standards for
care
• Help reduce variations in patient care (by
promoting standardization)
• Help improve clinical outcomes
• Help improve and even reduce patient
documentation
• Support training
• Optimize the management of resources
• Can help ensure quality of care and provide a
means of continuous quality improvement
• Support the implementation of continuous
clinical audit in clinical practice
• Support the use of guidelines in clinical practice
• Help empower patients
• Help manage clinical risk
• Help improve communications between different
care
sectors
• Disseminate accepted standards of care
• Provide a baseline for future initiatives
• Not prescriptive: don't override clinical judgment
• Expected to help reduce risk
• Expected to help reduce costs by shortening
hospital stays
Limitations of Clinical Pathways
• Implementation of the care pathways has not
been tested in a scientific or controlled fashion.
• No controlled study has shown a critical pathway
to reduce length of stay, decrease resource use,
or improve patient satisfaction.
• Most importantly, no controlled study has shown
improvements in patient outcome
Potential Problems and Barriers to the
Introduction of Clinical Pathways
• May appear to discourage personalized care
• Risk increasing litigation
• Don't respond well to unexpected changes in a
patient's condition
• Suit standard conditions better than unusual or
unpredictable ones
• Require commitment from staff and
establishment of an adequate organizational
structure
• Problems of introduction of new technology
• May take time to be accepted in the workplace
• Need to ensure variance and outcomes are
properly recorded, audited and acted upon.
Distinguish Critical Pathways from Clinical Protocols
• Protocols are treatment recommendations that
are often based on guidelines. Like the critical
pathway, the goal of the clinical protocol may be
to decrease treatment variation.
• Protocols are most often focused on guideline
compliance rather than the identification of rate-
limiting steps in the patient care process.
• In contrast to critical pathways, protocols may or
may not include a continuous monitoring and
data-evaluation component.
• Protocols are treatment recommendations that
are often based on guidelines. Like the critical
pathway, the goal of the clinical protocol may be
to decrease treatment variation.
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 • Protocols are most often focused on guideline
compliance rather than the identification of rate-
limiting steps in the patient care process.
• In contrast to critical pathways, protocols may or
may not include a continuous monitoring and
data-evaluation component.
Are Clinical Practice Guidelines and Clinical
Pathways related?
Characteristics of Clinical practice guidelines
• Attempt to define practice questions and
explicitly identify all their decision options and
outcomes
• Explicitly identify, appraise and summarize the
best evidence about prevention, diagnosis,
prognosis, therapy, harm, and cost-effectiveness
• Identify the range of potential decisions and
provide the physicians with the evidence which,
when added to individual clinical judgment and
patient's values and expectations, will help them
their own decisions in the best interest of the
patient.
• Attempt to define practice questions and
explicitly identify all their decision options and
outcomes
• Explicitly identify, appraise and summarize the
best evidence about prevention, diagnosis,
prognosis, therapy, harm, and cost-effectiveness
• Identify the range of potential decisions and
provide the physicians with the evidence which,
when added to individual clinical judgment and
patient's values and expectations, will help them
their own decisions in the best interest of the
patient.
• Attempt to define practice questions and
explicitly identify all their decision options and
outcomes
• Explicitly identify, appraise and summarize the
best evidence about prevention, diagnosis,
prognosis, therapy, harm, and cost-effectiveness
• Identify the range of potential decisions and
provide the physicians with the evidence which,
when added to individual clinical judgment and
patient's values and expectations, will help them
their own decisions in the best interest of the
patient.
E-Journals
• focuses to promote excellence in nursing and
health care through the dissemination of
evidence-based, peer-reviewed clinical
information and original research, discussion of
relevant and controversial professional issues.
• promotion of nursing perspectives to the health
care community and the public.
• This E- journal is an international open access
online scientific journal, which archives research
and review studies of practical and professional
nursing.
Lesson 2: Policies, Guidelines and
Laws in Nursing Informatics
Intellectual Property Law
• Deals with laws to protect and enforce rights of
the creators and owners of inventions, writings,
music, designs, and other works, known as
"Intellectual Property".
• Intellectual Property Code of the Philippines was
signed into law on June 6, 1997 and became
effective January 1, 1998.
Brief History
• 1879: Spanish Law on Intellectual Property,
known as the first copyright law in the
Philippines.
• 1896: Outbreak of the Philippine revolution,
defeat of Spain in the Spanish-American War,
Treaty of
• Paris was signed.
Treaty of Paris mentions existent intellectual
property system in the Philippines:
• The rights of property secured by copyrights and
patents acquired by Spaniards in the Island of
Cuba and in Porto Rico, the Philippines and
other ceded territories, at the time of the
exchange of the ratifications of this treaty, shall
continue to be respected..."
• Act No. 3134 "An Act to Protect Intellectual
Property" passed in 1924 making it the main
intellectual property law after PH independence
from US.
• PH enacted two laws to strengthen Intellectual
Property System: Republic
• Act 165 and Republic Act 166 in 1947.
Marcos Administration: Presidential Decree No. 49
which governed Copyright works.
• 19505 - 1960s: Philippines joined in international
conventions which helped establish WIPO
(World Intellectual Property Organization) in
1967.
• 1987: Philippine Constitution promulgated the
importance of intellectual property in Article
• XIV, Section 13: "The state shall protect and
secure the exclusive rights of scientists,
inventors, artists, and other gifted citizens to
their intellectual property and creations,
particularly when beneficial to the people, for
such period as may be provided by law.
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What is Intellectual Property
(IP)?
• Refers to creations of the mind, such as
inventions, literary and artistic works; designs;
and symbols, names, and images used in
commerce.
• Property that arises from human intellect;
product of human creation.
• Divided into two distinct form: a. Literary or
Artistic Works, b.
• Industrial Property
• By protecting IP, it enables people to earn
recognition or even financial benefit from what
they invent or create.
• + AIM of IP Laws: foster an environment in
which creativity and innovation can flourish.
World Intellectual Property Organization (WIPO)
• + Specialized agency of the United Nations + It
promotes the protection of Intellectual Property
throughout the world
• + Headquarters: Geneva, Switzerland + April 26:
World Intellectual Property Day
Republic Act No. 8293
Intellectual Property Code of the Philippines
• The state recognizes that an effective intellectual
and industrial property system is vital to the
development of domestic and creative activity,
facilitates, transfer of technology, attracts foreign
investments, and ensures market access for our
products.
• It shall protect and secure the exclusive rights of
scientists, inventors, artists and other gifted
citizens to their intellectual property and
creations, particularly when beneficial to the
people, for such periods as provided in this Act.
• The State shall promote the diffusion of
knowledge and information for the promotion of
national development and progress and the
common good.
Copyright Law
(Still under Republic Act 8293)
• Copyright - legal protection extended to the
owner of the rights to an original work, including
books, writings, musical works, films, painting,
and other works including computer programs.
• Automatic Protection
• Work must be original and "fixed in a durable
medium."
• Ideas are not protected but the expression of an
idea is.
Copyright Infringement
• Occurs when there is a violation of any of the
exclusive economic or moral rights granted to
the copyright owner. Also included
aiding/abetting such infringement. There is also
liability of a person who at the time when
copyright subsists in a work has in his
possession an article which he knows, or ought
to know, to be an infringing copy of the work for
the following purposes:
1. selling/letting for hire,
2. distributing article for the purpose of trade or any
prejudice against the copyright owner's work,
3. trade exhibit of the article in public.
• The copyright owner can file a criminal, civil, or
administrative action for copyright infringement
after giving the offender a Copyright
Infringement Notice.
Under Philippine law, copyright infringement is
punishable by the following:
• Imprisonment of between 1 to 3 years and a fine
of between 50,000 to 150,000 pesos for the first
offense.
• Imprisonment of 3 years and 1 day to six years
plus a fine of between 150,000 to 500,000 pesos
for the second offense.
• Imprisonment of 6 years and 1 day to 9 years
plus a fine ranging from 500,000 to 1,500,000
pesos for the third and subsequent offenses.
EXAMPLES
1. Recording a film in a movie theater.
2. Posting a video on your company's website
which features copyrighted words or songs.
3. Using copyrighted images on your company's
website.
4. Downloading music or films without paying for
their use.
5. Creating merchandise for sale which features
copyrighted words or images.
6. Modifying an image then displaying it on your
company's website.
TIPS TO AVOID COPYRIGHT INFRINGEMENT
• Understand what copyright laws protect.
• If it's not your work, then don't use it.
• What you find on the internet is generally not fair
game.
Trademark
• word, phrase, or symbol which represent a
company or product. They distinguish the
products or services of one company or
organization from those of its competitors.
• Trademark is valid for 10 years from application
date then it can be renewed upon payment of
fees.
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TM – for product • Helps businesses and other uses to fight fraud
R – for service: Registered Trademark and safeguard public interest.
• + Upholds overall user confidence in the internet
as an efficient and reliable means of
communication by helping users to identify
which entities or persons are responsible for
services and content online.
• + Tracks down spam or malicious behaviors.

VOCABULARY:
What is "Fair Use"?
• Gives permission to use copyrighted materials if
certain criteria are met.
• Protects freedom of speech. Promotes public
benefits like education.
Privacy of Personal or Public Domains
WHOIS
• Network Domain - an administrative grouping of
multiple computer networks or host within the
same infrastructure.
• widely used internet record listing that identifies
who owns a domain and how to get in contact
with them.
• Domain Name - host names that the DNS uses
to identify and map to websites.
• Subdomain - domain that is component of a
larger domain.
• URL - Uniform Resource Locator; distinguishes
where an identified resource is available along
with the mechanism retrieving it
• UDRP – Uniform Domain name Dispute
Resolution Policy: resolves domain name
disputes in the case of abusive registrations or
trademark infringement
• TLD - Top Level Domains; names at the top of
the DNS naming hierarchy. Ex: net, . com, . edu)
• CCTLD - Country Code Top Level Domain;
domains that have two letters to the right of the
last period in a domain name. Example: co. uk, .
jp, ar, . ph)

ICANN
• Internet Corporation for Assigned Names and
Numbers; regulate domain name registration
and ownership. Non-profit organization that is
responsible for internet protocol address space
allocation, protocol identifier assignment, country
code.

Purpose and value of WHOIS System:

• Reinforces stability and security of the internet
by providing network operators, computer
incident response teams with appropriate
contacts.
• Regulates registration status of domain names
• Supports law enforcement officials participating
in nation or international investigations.
• Assisting in battle against abusive uses of
information communication technology, including
illegal and other acts motivated by racial
discrimination, violence, hatred, xenophobia,
intolerance, child abuse, child pornography,
pedophilia, and exploitation and human NETIQUETTE RULES AND GUIDELINES
trafficking. Core Rules of Netiquette
• Supports inquiries and necessary steps to carry • Netiquette or "Network Etiquette" is concerned
out trademark clearances and to help expose with the proper way to communicate in an online
intellectual property infringment, theft, and environment.
misuse.

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The following are "rules" adapted from Virginia
Shea's The Core Rules of Netiquette:
Rule 1: Remember the Human
• GOLDEN RULE: Do unto others as you would
have others do unto you..
• Your written words are read by real people, all
deserving of respectful communication. Before
you press send or submit, ask yourself: "Would
be okay with this if someone else had written it?"
Rule 2: Adhere to the same standards of behavior
online that you follow in real life
• Standards in the internet is different from real
world but they should not be lower. You should
do your best to act within the laws and ethical
manners of society whenever you inhabit
"cyberspace".
• Would you behave rudely to someone face to
face? On most occasions, no. Neither should
you behave this way in the virtual world.
Rule 3: Know where you are in cyberspace
• "Netiquette varies from domain to domain"
(Shea, 1994). Depending on where you are in
the virtual world, the same written
communication can be acceptable in one area
but it might be considered inappropriate in
another. What text to a friend would be
inappropriate in an email to a classmate, a
professor, or an elder relative?
RULE 4: Respect Other People's Bandwidth
• Electronic communication takes time: time to
read and time to respond. As a virtual world
communicator, it is your responsibility to make
sure that the time spend in reading your words
isn't wasted. Make your written communication
meaningful and to the point, without extraneous
text or superfluous graphics or attachments that
may take forever to download.
• Be mindful of the time when you are sending a
message.
Rule 5: Make yourself good online
• One of the best things in the virtual world is the
lack of judgment associated with your
appearance, sound of your voice, clothes you
wear. You will be judged for your quality of
writing. (Please note that this was written in
• 1994.)
• Keep in mind: Always check for spelling and
grammar errors, know what you're talking about
and state it clearly, and be pleasant and polite.
Rule 6: Share expert knowledge
• There is an ease of information in the internet
which can be shared or accessed. In fact
"Information Sharing" is one of the main reasons
why the internet was founded. Share what you
know! Are you an expert at something? Post
resources and references about your subject
matter.
• If you want to learn, you can check out websites
such as skillshare.
Rule 7: Help keep flame wars under control
• "Flaming is what people do when they express a
strongly held opinion without holding back any
emotion."
• (Shea, 1994)
• Flame wars happen when two or three people
exchange angry posts between one another. It
must be controlled or the camaraderie of the
group would be compromised. Do not feed the
flames! Extinguise them by guiding the
discussion back to a more productive
discussion.
Rule 8: Respect other people's privacy
• Perhaps someone is sharing some medical
news about a loved one or discussing a situation
at work? What do you think would happen if this
information "got into the wrong hands"?
Embarrassment? Hurt feelings? Loss of a job?
Just as you expect others to respect your
privacy, so should you respect the privacy of
others.
• Be sure to err on the side of caution when
deciding to discuss or not to discuss virtual
communication.
• Please avoid screenshots of sensitive
information or conversations.
Rule 9: Don't abuse your power
• Power here refers to people who might have
more expertise than you or have years of
experience with a particular skill.
• Maybe it is you who is the expert. Just keep in
mind that knowing more than others do or
having more power does not give you the right to
take advantage of anyone. Remember rule 1:
Remember the Human.
Rule 10: Be forgiving of other people's mistakes
• Not everyone has the same amount of
experience working in the virtual world. At some
people you will see a stupid question, read an
unnecessarily long response, or encounter
misspelled words, when this happens, practice
kindness and forgiveness as you would hope to
receive if you were the one who committed the
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 same offense. If it's a "minor" offense, you can
simple let it slide. If you feel compelled to
respond, do so in a private email than in a public
forum.
LESSON 3: Nursing Information
System Team
ROLES FOR NURSES IN THE INFORMATICS
SPECIALTY
Informatic Nurses vs. Informatics Nurse Specialist
Nursing Informatics as a Specialty
• Nursing is a subspecialty in informatics, with
roles and tasks in both disciplines. *
INFORMATICS NURSE
• are those who enter the nursing informatics field
because of an interest or experience. (Nursing
Informatics Scope & Standards of Practice)
• Informatics Nurse Specialist
• are nurses with either a graduate education
degree in nursing informatics or a field relating to
informatics. (American Nurses Association
[ANA], 2015)
• The roles of Informatics nurses vary with their
job and specialty in healthcare, but the general
foci of nursing informatics are the following
seven areas, as set out in seminal work by the
National Institutes of Health , National Center for
Nursing Research (NCNR), Priority Expert Panel
on NUrsing Informatics (1993):
1. Using data, information, and knowledge for patient
care
2. Defining data in patient care.
3. Acquiring and delivering patient care knowledge
4. Creating new tools for patient care from new
technologies
5. Applying ergonomics to nirse-computer interfaces
6. Integrating systems
7. Evaluating the effects of nursing systems
INFORMATICS NURSE
1. SYSTEM EDUCATOR
• Plans, coordinates, and facilitates education for
all computer applications and computer software
for all user groups.
• Develops and trains all user groups on clinical
computer applications and online
documentations processes.
2. INFORMATION TECHNOLOGY NURSING
ADVOCATE
• Assess the needs and opportunities for nurses
with the technology.
• Looks at both the functional and operational
needs of clinical users,*
3. SUPERUSER
• Supports the system for a specified unit.
• Assists users with functionality, procedural
issues, and basic troubleshooting.
• Often holds a clinical position in the assigned
unit.
4. SYSTEM SPECIALIST
o May work at many different levels from the unit
to the full agency.
o Acts as a link between nursing and information
services and is both a nursing resource and a
representative.
5. CLINICAL SYSTEMS COORDINATOR/ ANALYST
o Responsible for coordinating aspects of
planning, designs, development,
implementation, maintenance, and evaluation of
the clinical information system.
o Troubleshoot issues with systems.
o Supports a clinical system.
INFORMATICS NURSE SPECIALIST
1. Project Manager
• Plans and implements an informatics project.
• Must be able to communicate effectively with all
levels of management, users, and system
developers.
• Must also be cognizant of all factors involved in
the project including, but not limited to,
managing change, assessing the need for the
new project planning for its implementation
2. DIRECTOR OF CLINICAL INFORMATICS
• Facilitates the development, implementation,
and integration for an agency information system
• Assist in developing the strategic and tactical
plans of the system.
• Develops plan for implementation and gaining
acceptance of systems
3. RESEARCHER
• Uses informatics to create new knowledge.
• Encompasses research in any area of nursing
informatics.
• May be involved in basic research on the
symbolic representation of nursing phenomena,
clinical decision-making, or applied research of
information systems.
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 • Could be involved in developing decision
support tools for nursing or models of
representation fo nursing phenomena
4. PRODUCT DEVELOPER
• Participates in the development of new
information systems including designing,
developing, and marketing of informatics
solutions for nursing • problems.
• Must understand the needs of both business and
nursing
5. POLICY DEVELOPER
• Contributes to health policy development by
identifying nursing data, its availability, structure,
and content, which are used to determine health
policy.
• These policies encompass not only information
management but also health infrastructure
development and enomics.
6. ENTREPRENEUR
• Analyzes nursing information needs in clinical
areas, education, administration, and research
• Develops and markets solutions
INFORMATIC NURSES AND INFORMATICS NURSE
SPECIALIST
INFORMATICS ORGANIZATIONS
American Nursing Informatics Association
(ANIA) GROUPS
• In the United States, the largest nursing
informatics professional association.
• Has annual educational conferences, provides
continuing education forums, and disseminates
informatics updates with an organization
newsletter
• ANIA members also receive a discounted
subscription rate for Computers, Informatics
Nursing: CIN journal.
• American Medical Informatics Association
(AMIA), represent United States and European
Federation for Medical Informatics (EFMI),
represents
Europe*
• Members of IMIA also take part in MedINFO**
Healthcare Information and Management Systems
Society (HIMSS)
• International organization
• Has offices in Chicago; Washington, DC; and
other locations acro the United States and
Europe
• Founded in 1961
• Not-for-profit organization dedicated to
promoting a better understanding of healthcare
information and management system3.
• In 2003, formed a Nursing Informatics
Community*
• Offer accreditation as a Certified Professional in
Healthcare
Information and Management Systems.
American Health Information Management
Association (AHIMA)
• Formed in 1928 by American College of
Surgeons to improve clinical records.
• The name, AHIMA, reflects today's situation in
which clinical data have expanded beyond either
a single hospital or a provider.
• Offers credentials programs in health information
management, coding, and healthcare privacy
and security.

MULTIDISCIPLINARY GROUPS

International, Medical Informatics Association

(IMIA)
• Established in 1967 as TC4, a Technical
Committee within the International Federation for
Information Processing.
• A nonpolitical, international scientific
organization whose goals include:
promoting informatics in healthcare
o promoting biomedical research
o advancing international cooperation
o stimulating informatics research and
education
o exchanging information

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