NURSING INFORMATICS

Clinical Information System (CIS) is a computer-based system that is designed for collecting, storing, manipulating and making
available clinical information important to the healthcare delivery process
Nursing informatics (NI) is specialist emerged as a new specialty in the field of professional nursing practice. It is refers to the
integration of nursing, its information management with information processing and information technology to support the people
worldwide.
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.
• 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.
•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 standardized 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 fro 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 professionals 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.

NURSINGINFORMATICS THEORIES
General Models
Graves and Corcoran, 1989- Their model placed data, information, and knowledge in sequential boxes with one-way arrows
pointing from data to information to knowledge.
Schwirian, 1986- Bidirectional arrows connect the three base components of raw material, user, and computer system to form the
pyramid’s triangular base.
Turley 1996, proposed another model in which the core components of informatics (cognitive science, information science, and
computer science) are depicted as intersecting circles. Nursing informatics is the intersection between the discipline-specific
science (nursing) and the area of informatics.
Specific Informatics Literacy
Philippine Healthcare Ecosystem Model- the government, nursing associations and developmental agencies maintain and balance
the network.
Intel Shift Left Model- inversed relationship between quality of life and cost of care per day.
Patient Medical Record Information Model- pattern of documenting the patient’s personal health dimension, healthcare provider
dimension and population health dimension.
Theories that lend support to Informatics
Nursing Informatics Theory (Information Theory)- the core concepts of informatics.
o Data- discrete, objective facts or elements that have not been interpreted.
o Information- data that has some type of interpretation or structure.
o Knowledge- synthesis of information with relationship identified and formalized.
o Wisdom- achieved through evaluating knowledge with reflection.
Sociotechnical Theory and Social Informatics- developed in the middle of the last century where it talks about implementation
of technology will not always result to increase in productivity.
Change Theory- computerization of information is a new experience that create a change that affects workers.
o Rogers’s Diffusion of Innovation Theory (unplanned change)- examines the pattern of acceptance that innovations
follow as they spread across the population of people who adopt it (innovators, early adopters, early majority, late
majority and laggers).
o Lewin’s Change Theory (planned change)- dynamic balance of forces working in opposing directions (unfreezing,
moving and refreezing).
General System Theory- is a method of thinking about complex structures such as an information system, this describe that
any change in the system can reflect to the other part of the system (open system- continually exchanges information, closed
system-isolate itself)
Chaos Theory- addresses an entire structure without reducing it to the elemental parts, this may appear chaotic but actually
has an order.
Usability Theory- uses information from both cognitive science and sociotechnical theories.
Cognitive Science- study of the mind and intelligence, and how information can be applied.
Learning Theory- teach us the use of a system and design or select computer-aided instruction.

MAJOR HISTORICAL PERSPECTIVES of NURSING and COMPUTERS

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 oftoday’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 mainframes 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
 Workstations and local area networks or (LANs) were developed for hospital nursing units
 Smaller and faster computers laptops, and notebooks
 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 EHR 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

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.”
The Nicholas E. Davies (Atlanta based physician) EHR Recognition Program- recognizes healthcare provider organizations that
successfully use EHR systems to improve healthcare delivery.
Computer-based Patient Record Institute (CPRI)- non-profit membership organization founded in 1992, it is a unique organization
representing all stakeholders in healthcare focusing on clinical applications of Information Technology.
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 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.
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
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 Pennsylvania, 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.

FIRST GENERATION COMPUTERS

 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.
2ND GENERATION COMPUTERS
 They use transistors instead of vacuum tubes. This meant less heat, improved reliability, and much greater speeds.
 Access speeds were measured in millionths rather than thousandths of a second (microseconds).
 Quite large, but transistors were smaller and more durable than vacuum tubes.
 They also allowed for the development of much more powerful computers.
THIRD GENERATION COMPUTERS
 Third Generation Computers In this generation, they used microminiature, solid state components.
 Third generation CPU access speeds were measured in billionths of a seconds (nanoseconds) IBM 360 these were the
classic computers in this generation IBM 370.
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.
2 TEENAGED BOYS
 Steve Jobs & Steve Wozniak
 They share their intense interest in electronics. They bought microprocessor for $ 25 and build a very simple computer called
“APPLE”
 On 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 the first PC were born.

CLASSES OF COMPUTER
Analog computer
Operates on continuous physical or electrical magnitudes, measuring, ongoing continuous analog quantities such
as voltage, current, temperature and pressure.
Digital computer
Operates on 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 Computers
As its name implies, contains features of both the 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.
Supercomputers
This is a computational-oriented computer designed for scientific applications requiring gigantic amount of
calculations.
Mainframes.
This is the fastest, largest, and most expensive type of computer used in corporations for processing, storing and
retrieving data
Microcomputers or Personal Computer (PC) Desktops
Can serve as stand-alone workstation and can be linked to a network system to increase the capabilities.
Handheld Computer
Are small, special function computers and some have claimed to have almost the same function and processing
capabilities as the standard desktop microcomputer.