NURSING INFORMATICS

KARITSAKESIAH A. ARCEO,UKRN, HAAD RN/SN, RN

VIRTUAL
ETIQUETTE
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If possible and able, please make sure you have a
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BE RESPECTFUL.
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Stay seated and be present.
VIRTUAL
ETIQUETTE
PLEASE SPEAK CLEARLY
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voice clear enough for everybody to hear.

DRESS APPROPRIATELY
The way you dress is the way you present yourself.
Be presentable.

AVOID DISTRACTIONS
Keep away things that can distract you and the class.
Please FOCUS during the lecture.
GOALS:
Students may be able to :
● Describe how EMR, EHR, and EPHR relate to emerging
clinical information system

● Describe the benefits of using standardized terminology in

Healthcare as well as its issues surrounding it

● Analyze and determine the opportunities that electric

documentation brings to nursing

● Discuss and describe barriers and critical success factors,

legal implications for health information privacy breaches by
health professional
What are Healthcare Information System, / CLinical
Information System?
Healthcare on its own is a very complex topic, combine with
Healthcare Information System makes it more complex .

Is an information system for processing data, information, and

knowledge in healthcare environments.

It can be defined as an integrated effort to collect, process, report

and use health information and knowledge to influence
policy-making, program action, and research.

Computerized Medical record systems, expert systems, and

decision support systems are becoming more prevalent in clinical
setting.
Why is there a need for Healthcare records to be
Electronic?
PAPER RECORDS

Strengths:
Weaknesses:
● very transportable
● Potential to be incomplete
● Requires no maintenance, no
● Logistical issue - do not have back
electricity, and no downtime
up
● We can chart very quickly
● Illegibility and medical errors
● Can be used as backup for
● Difficulty in trending data
charting when e-system is not
working
What are the benefits and disadvantages of Electronic Health
Record?
Strengths:

● Continuity of care
● Private and secure Information
● Searchable and analyzable
Information
● Real time information
● Improved quality

Weaknesses:

● In times of disaster (tornado, fire,

hurricane destroying the HIS
location or mainframe
● Equipment failures
 EXAMPLES OF HEALTHCARE INFORMATION
SYSTEMS
Electronic Medical Record (EMR)

Electronic Health Record (EHR)

Electronic Patient Health Record (EPHR) /

Patient Health Record (PHR)
What informations and data are included or excluded in
the each system?

THE LOCAL SYSTEM

● Is an internal system within an organization like a clinic, a

clinician’s office or hospital, which allows them to organise their
medical records .
● Contains notes gathered by clinician, allowing them to diagnose
and treat patients effectively.
BENEFITS:

Track patients improvements over time

Identify patients who needs screenings

Improve their diagnosis and treatment

Identify patients with particular needs

DISADVANTAGES:

Doesn’t support interoperability or

exchange of information

Limited functionality

Can become obsolete in the near future

What informations and data are included or excluded in
the each system?

THE GLOBAL SYSYTEM

● Is an inter-organizational system.
● Similar to EMR - digital version of patient medical record -
difference – includes data from all clinicians and healthcare
organizations involved in patients care.
● Support exchange of infomration – interoperable
● Are built to travel between organizationn – contain all information
from ALL THE CLINICIANS that patient have met
 BENEFITS:

Medical practitioners can get cross-

provider medical information

Diagnoses and allergies

Medications and other treatment plans

Immunization dates

Test results and radiology results

Provider contact information

EHR is very essential to share data among providers and

coordinate best care for patients
DISADVANTAGES:

Can be attacked by hacker, so there are concerns about

potential privacy and cybersecurity issues

If there is a patient portal in an EHR system, patients can

be exposed to information that can needlessly frighten
them

Development of the system is not simple and

can take significant time and money

To perform effectively, EHR systems needs

updates that also results in money spending
What informations and data are included or excluded in
the each system?

THE PATIENT- CENTRIC SYSYTEM

● Is a patient -centered organizational system.

● Similar to EHR – owned, set up and managed by PATIENTS
● Contains diagnoses, medications, immunizations, family
medical histories, and provider contact infornation
Information can come from many different sources:

1. From the EHR of healthcare providers like clinicians,

testing centres, and hospitals
2. From healthcare devices like home monitoring devices,
FItbit, Apple Watch, point of care devices etc.
3. From patients themselves entering data manually, like
over- the - counter medications, lifestyle choices.

BENEFITS:
Patient can access it
Patient can make more informed decisions for their health by
viewing their medical records in private and transparent
environment
Patient can manage their medical information in private,
controlled environment.
Makes patient empowered and enable them to manage their
medical records easily.
DISADVANTAGES:
Document management can be difficult for patients

Possibility of incorrectness if information entered by the

patients

Elderly people can be challenged by how to operate the

system

HIPAA (Health Insurance Portability and Accountability

Act) regulations are applied to specific conditions

There is a possibility of data misunderstanding, which

may lead to patients’ anxiety
SUMMARY AND MAIN DIFFERENCES OF THE 3
SYSTEMS
 CRITICAL THINKING QUESTIONS?

In what way does any of the system helps the

healthcare professionals especially the nurses.
Discuss and elaborate.

Given the advancement of technology and

digitalizing all documents and data of patients,
what do you think are the advantages and
disadvantages? Cite examples.
 STANDARDIZED TERMINOLOGIES

According to the WHO (World Health Organization) , ST (Standardized

TErminologies) is a “compilation of terms used in clinical
assessment, management and care of patients, which includes
agreed definitions that adequately represents the knowledge behind
these terms and link with a standardized coding and classification
system”.

These terminologies provide data elements in a standard format that

can be combined with other data sources to evaluate care delivery
and continuously improve practice.
 HEALTH TERMINOLOGIES
These are widely used in administrative applications.

ICD ( International Classification of Diseases - to report mortality

and morbidity statistics internationally (WHO, 1992). U. S.
Federal government, have adopted this terminology for payment
if healthcare services.

CPT - Current Procedural TErminology (CPT) - additional

terminologies for payment of their specific services for surgical
procedures (AMA 2014)

LOINC- Logical Observation Identifiers Names and Codes - for

laboratory test and assessments (Regenstrief Institute, 2014).
 HOW DID NURSING STANDARDIZED NURSING
TERMINOLOGIES CAME ABOUT?

In 2012 , The Institute of Medicine (IOM) stated the deplorable state of

clinical data, noting that patient care data is POORLY captured and
managed, and scientific evidence is poorly used.

There was a need to quantify nursing resources to effectively use the

EHR systems that were entering the care environment , and to enable
the application of a growing body of evidence-based nursing practice
available in electronic knowledge bases. (Saranti, Moss, & Jylha, 2010)
1859 - Florence Nightingale named her 6 canons of care as “what
nurses do” in her text NOTES ON NURSING (1859).

● She considered the 6 canons are to be measured of “good

standards” that are essential for the practice of nursing.

1939 - Virginia Henderson published the TEXTBOOK OF THE

PRINCIPLES AND PRACTICES OF NURSING

● She delineated her 14 patterns of daily living.

● Her works were followed by the works by the works of several
nurse-theorists who presented their theories and standards of
nursing practice such as King’s “Process of Nursing,” Roger’s
“Four Building Blocks,” or Abdellah’s 21 Problems” (Fordryce,
1984).
● These models were all developed as approaches to patient care–
however none of these referred to or predicted the use of
computers to support the implementation of nursing practice
standards
1970 - ANA (American Nurses Association) approved the Nursing
Process as the standard of professional nursing practice.

● Nursing Process - provided the framework for gathering patient

care data, beginning with the assessment phase, through
diagnosis, goal designation, planning, and evaluation. (Yura &
Walsh, 1983, pp. 152 -155).

1989 - ANA’s Steering Committee on Databases to Support Nursing

Practice created a process to recognize terminologies and vocabularies
that support nursing practice.

2008 - ANA recognizes minimum data sets, interface terminologies, and

reference terminologies that support nursing practice.
Terminology Recognition Approved by
ANA’s Congress on Nursing Practice
and Economics (2008)

Current American Nurses

Association(ANA) - Recognized
Terminologies and Data Sets
MINIMUM DATA SETS
ANA recognizes 2 minimum data sets

a. NURSING MINIMUM DATA SETS (NMDS)

b. NURSING MINIMUM MANAGEMENT DATA SETS (NMMDS)

Minimum data sets define an essential set of data elements for

describing nursing practice or nursing management.

Each data element has a standard definition and code that

enables it to be used in a variety of setting and systems,
maintaining the same meaning when moved from the originating
system into a larger pool of data
NURSING MINIMUM DATA SETS
(NMDS)
● Identifies essential, common, and core data elements to be
collected for all patients/clients receiving nursing care
(Werley & Lang, 1988)
● Includes three (3) broad categories of elements
○ Nursing care
○ Patient or client demographics
○ Service elements
● NMDS elements are consistently collected in the majority of
patient/client records across healthcare settings, especially
patient and service elements.
The U.S. Nursing Minimum Data Set (NMDS) Data Elements
NURSING MANAGEMENT MINIMUM DATA SETS
(NMMDS)
● Defines 18 elements that are essential to support management
and delivery of nursing care across all types of settings
(Kunkle et al., 2012).
● Theses elements are organized into three (3)
categories:(Werley, Devine,Zorn, Ryan, & Westra, 1991)
○ Environment
○ Nursing care resources
○ Financial Resources
● NMMDS provides the structure for the collection of uniform
information that influences quality of patient care, directly and
indirectly.
Hierarchy of Elements within the Nursing Management Minimum Data Set
(NMMDS)
INTERFACE TERMINOLOGIES
● are designed for use of point of care.
● They use terms and concepts that are familiar to practicing
nurses.
● They vary in scope, structure and content.

REFERENCE TERMINOLOGIES

● Acts as a common reference point that can facilitate

cross-mapping between interface and terminologies
● ANA recognized two (2) reference terminologies (Nursing
Resources for Standards and Interoperability, 2017)
○ LOINC
○ SNOMED-CT
LOINC ( Logical Observation Identifiers Names
and Codes)
● initiated in 1994 by Regenstrief Institute - a non-profit
medical research organization associated with Indiana
University
● Is the universal standard that is comprised of more than
71,000 observation terms primarily used to represent
laboratory tests, measurements and observations.
● It is also a clinical terminology for laboratory test orders and
results, clinical measures such as vitals signs and other
patient observations. (LOINC, 2015)
● 1999 - was identified by the Health LEvel Seven (HL7)
Standard Development Organization (SDO) as preferred code
set for laboratory names in transactions between healthcare
facilities, laboratories, laboratory testing devices and public
health authorities
● 2002 - LOINC established a Clinical LOINC Nursing
Subcommittee top provide LOINC codes primarily for patient
assessments.
● Available at NO COST and is also one of the suites of
designated standards for use in U.S. Federal government
systems for electronic exchange of clinical health
information(Nursing Resources for Standards and
Interoperability, 2015)
SNOMED-CT
● Was developed collaboratively by College of American
Pathologists (CAP) and the UK National Health Service
(Wang, Sable & Spackman, 2002) . It now falls under the
responsibility of SNOMED International.
● SNOMED - CT possesses both reference properties and
user interface terms.
● Considered to be the most comprehensive, multilingual,
healthcare terminology in the world that integrates concepts
from many nursing terminologies.
● This is distributed at NO COST in member countries by their
national coordinating center such as the NLM in the U.S.
● This is also one a suite of designated standards for use for
the electronic exchange of health information, and is also a
required standard in interoperability specifications of the U.
S. Health Information Technology Standards Panel ( HITSP)
(National Library of Medicine, 2019).
NURSING TERMINOLOGY CHALLENGES
2 MAJOR CHALLENGES

1. Existence of Multiple, specialized terminologies- this has

resulted in areas of overlapping content, areas for which
there was no content and large number of different codes and
terms for the same concepts ( Chute, Cohn, & Campbell,
1998; Cimino, 1998a).

2. Existing terminologies most often were developed to provide

set of terms and definitions of concepts for human interpretation,
with computer interpretation only as a secondary goal (Rossi
Mori, Consorti, & Galeazzi,1998).
NURSING TERMINOLOGIES IN USE
1. Used in variety of easy in practice setting
2. They can provide a conceptual guidance and a data model, and can
link concepts from practice to a granular data definitions provided
by reference terminologies.
3. These are needed to:
a. Provide valid clinical care data
b. Allow data sharing across today’s EHR’s systems
c. Support evidence-based decision making
d. Facilitate evaluation of care processes
e. Permit the measurement of outcomes
4. Standardized nursing data elements are needed to facilitate
aggregation and comparison for clinical, tralational and comparative
effectiveness research as well as for the development of
practice-based nursing protocols and evidenced-based knowledge,
including generation of healthcare policy (Hardiker, Bakken, Casey,
& Hoy, 2002).
ELECTRONIC HEALTH RECORD AND
MEANINGFUL USE
● Originated with the American Recovery and Reinvestment Act
(ARRA)(Recovery.gov.2014) signed into law by President Obama on
February 17, 2009.
● ARRA and the Health Information Technology for Economic and
Clinical Health (HITECH) Act, a part of ARRA were milestones in the
history of HIT.
● The HITECH Act outlined four (4) purposes:
○ Define meaningful use
○ Use incentives and grant programs to foster the adoption of
EHR’s
○ Gain trust of the public regarding the privacy and security of
electronic healthcare data
○ Promote IT innovation
Meaningful Use - refers to the use of information from EHR’s to make
improvements in the delivery of healthcare (Blumenthal & Tavenner, 2010)

● HITECH Act provided monetary incentives to hospitals and eligible

providers that met “meaningful use” requirements.

Meaningful Use requires an interoperable HIS for data exchange.

Meaningful Use has three (3) stages:

1. Stage 1- focuses on data capturing and sharing

2. Stage 2 - focuses on advanced clinical processes
3. Stage 3 - focuses on improved clinical outcomes

Eligible providers, hospital, and critical access hospitals must meet the
thresholds for the first stage prior to meeting ones for the second stage
The ultimate GOAL of Electronic Data Exchange is for
meaningful use of deidentified data
REFERENCES:

Sewell, J. P. (2016). Electronic Healthcare Information System,

Electronic Health Records, and Meaningful Use. In Informatics and
nursing: Opportunities and challenges. essay, Wolters Kluwer.

Saba, V. K., & McCormick, K. (2021). standardized

Nursing Terminologies. In Essentials of Nursing
Informatics (7th ed.). essay, McGraw Hill.

Ehr vs emr vs PHR and PP: Spot the difference. EHR vs EMR
vs PHR vs PP: Which Solution to Choose? (n.d.). Retrieved
February 25, 2023, from
https://emerline.com/blog/ehr-vs-emr-vs-phr-vs-pp
(she/her), F. A. K. (n.d.). EMR, EHR, PHR: The actual
difference between these 3 confusing terms. LinkedIn.
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