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06 – Data and Data PRACTICE of nursing informatics was included

for the FIRST TIME in the 2008 American
Processing Nurses Association (ANA) Scope and
NCM 110: Nursing Informatics Standards of Practice for Nursing Informatics
(American Nurses Association, 2008).
Key Words
o Big data
o Curating
o Dashboard
o Data
o Database
o Data analytics
o Data lake
o Data mining
o Data warehouse
o Information
o Knowledge
o Knowledge discovery in databases
(KDD)
o Wisdom

Introduction
In 2012, the White House released a document
titled FACT SHEET: Big Data Across the
Federal Government that lists big data projects
that the Federal Government has undertaken
(The White House, 2012).
A list of the KEY legislative initiatives includes
the following:
Generating Data
Data Definition - Context
Data is “a fact represented as an ITEM or
EVENT out of context” (Mullins, 2013, p. 686).
Data alone DO NOT provide insights. As noted
in the previous section, without context it is
DIFFICULT to make judgments on data alone.

o 21st Century Cures Act (Cures Act) Data States

o The Medicare Access and CHIP
Reauthorization Act of 2015 (MACRA)
o The Health Information Technology for
Economic and Clinical Health (HITECH)
Act of 2009
o Section 618 of the Food and Drug
Administration Safety and Innovation Act
(FDASIA) of 2012
o The Health Insurance Portability and
Accountability Act (HIPAA) of 1996
o AFFORDABLE CARE Act of 2010
The Nelson Data to Wisdom Continuum
The Data, Information, Knowledge and
Wisdom Model (Nelson D-W) depicting the
megastructures and concepts underlying the
When DISCUSSING digital data, it is important
to discuss the three states of data—data AT
REST, data IN MOTION, and data IN USE
(Rouse & Fitzgibbons, 2019).
Data Sources – Including Patient-
Generated Data and Population
Health Data
Data have always been IMPORTANT part of
healthcare. BEFORE digitization, handwritten
nurses’ and doctors’ notes, charts, and drawings
provided insight when making decisions about
health and health trends.
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Data Input Operation
Since data COME from a variety of sources and
devices, it is important to note that ONE of the
most important aspects of data processing is
to CAREFULLY define the healthcare
processes that RELATE to the input of data.
Big Data
The term Big Data has gained increasing
recognition over the last decade. For several
decades, NURSES have collected and stored
data, but the ability to analyze or “do” anything
with data has NOT COME to fruition until
recently.
Volume
When speaking about the volume of big data, this
means the amount of data CREATED on a
given day.
Variety
A SECOND aspect of big data is the variety of
data being produced and combined in order to
GAIN insights.
Velocity
The THIRD aspect of big data as defined by IBM
is the velocity of data.
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Veracity
One of the potential pitfalls of relying on big data
is that the veracity of the data is OFTEN not
verified.
Value
The FIFTH aspect of big data is clinically
relevant data that bring value to BOTH the
patient and healthcare systems.
Variability
ADDRESSES the extent and speed that the
structure of the data are changing as well as
the frequency of the CHANGE.
Data Repositories (Storing Data)
Database Management Systems
A database by definition is an organized
COLLECTION of data. A database management
system (DBMS) is software that contains the
database as well as a collection or set of
programs for ACCESSING and PROCESSING
these data in the database thereby IDENTIFYING
relationships between the data.
Advantages of Database Management Systems
The main advantage of a DBMS is that it
IMPOSES a structure onto the data that allows
interaction between the end user and the data.
Client-Server Configuration
Because a DBMS is a software product that
allows you to structure and organize your data,
there are SEVERAL organizational systems
that developers have developed.
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Cloud vs. In-house:
• One of the BIGGEST developments in
the recent past is cloud computing.
Distributed vs. Centralized:
• One of the DECISIONS that needs to be
made is whether the database is going
to be distributed or centralized.
Structure of DBMS
In general, a DBMS consists of data that
designers STRUCTURE into tables and JOIN by
relationships
Relational Database Models – is still the MOST
popular form of DBMS, but Non-Relational
Databases (e.g.MpSQ) are on the rise.
NoSQL Database Models – is an agile system
that EASILY PROCESSES unstructured data
and semi-structured data.
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Entity Relationship Model – In an Entity
Relationship (ER) Model the database
FEATURES the organization of the data around
entities (Mullins, 2013).
Graph-Oriented Object Data Model – In a
Graph-Oriented Object Data (GOOD) Model the
underlying organization is NOT a system of
tables and relationships, but rather a graph
representation of the objects in the database.
Data Warehouses
Purpose of a Data Warehouse
The purpose of a data warehouse is to PROVIDE
a PLACE to store multiple forms of data in a
lightly summarized way.
Function of a Data Warehouse
The function of the data warehouse is to serve as
a central information repository. In TRUE
DATA warehouse situations, once the data are
curated and stored in the data warehouse, there
is NO NEED to search for data anywhere else.
Other Types of Storage
Data Marts: A data mart is a DBMS that is for a
single unit of work and may contain a subset of
data STORED in a warehouse.
Data Lakes: A data lake is a freer form of a
DBMS where the STRUCTURE of the data is
loose and varied including structured, semi-
structured, and unstructured data.
Data Stores: Lastly, a data store is a generic
term used to describe a DBMS that LUMPS
several diverse data sources together.
Selecting a Data Storage Repository
When selecting any form of a DBMS it is
important to REALIZE that with the advent of
cloud computing there are literally HUNDREDS
of different configurations, but there are DBMS
criteria that might help when choosing a system
(Wasson, Wilson, Buch, Salomaki, & Lee, 2018).
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Compare & Contrast
Most modern-day systems are client server
systems. This allows for a shared DBMS that
many users can access.
When thinking about which SOLUTION to
choose, it is important to consider several things,
some of which are as follows:
Network configuration: What type of network
will the system be running on? For example, local
area network (LAN), wide area network (WAN),
and wireless local area network (WLAN).
Type of data being stored: If there will be a lot
of medical images, videos, or sounds, it is
IMPORTANT to realize that these need a lot of
space.
Amount of data: How much data are there? If
there is a large amount of data, a system that
allows for FASTER RETRIEVAL from the system
may be necessary.
Systems interoperability: Are there
REQUIREMENTS that the system interface with
another system?
Budget considerations: How much money is
being dedicated to the database project?
Access
Lastly, another consideration discussing
database management systems is WHO will
need access to the data.
Curating Data
Ensuring Data Quality
• One must take into account several
aspects when thinking about the quality
of data.
Interoperability (Moving Data between
Systems)
• One of the biggest advantages of the
data movement, as well as the use of
DBMS IN GENERAL, is the ability to
export data from one system and input
it into another.
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Auditing Aspects of Data
• Another useful feature of DBMSs is the
ability to pull reports FOR auditing
purposes.
Retrieving Data (Producing Information)
Retrieval Examples
• One example of portals is a patient
portal that allows a patient to GO IN and
VIEW his or her medical data on the
Internet or through another type of
application.
SQL T
• The method of data retrieval is often
through the use of SQL queries. SQL
(see-kwel) stands for Structured Query
Basic SQL Structure
• Basic SQL commands take the form of an
ACTION being taken on a table WHERE
a piece of criteria is constrained in a
DEFINED way.
SQL Functions
• In the previous example, the SELECT
function was used
Interpreting Data
(Producing Knowledge & Making Decisions)
Data Analysis and Presentations
• Once data is STORED and in a
retrievable form, it is important to
produce knowledge and present the
data in a form for decision-making.
Analytics
• Once the data has been stored, curated,
and retrieved, it is then the
responsibility of the end user to go
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through and PERFORM ANALYTICS on
the data.
Dashboards
• The presentation of data may also take
the FORM of a dashboard
Data Mining
• Traditional methods of retrieving
information from databases NO
LONGER WORK with the sheer amount
of data that the healthcare industry is
producing.
Predictive Analytics
• One of the main outcomes of data
mining is usually predictive analytics.
Predictive analytics allow us to
ANALYZE and MINE the data FROM the
past with the intention of being able to
predict the future.
Benchmarking
• The process of benchmarking is “the
CONTINUOUS PROCESS by which an
organization can measure and
compare its own processes with those
of organizations that are leaders in a
particular area” (Benson, 1994, para 1).
Decision Analysis and Decision Support
Systems
• PACKAGING of data into decision
analysis and decision support systems is
a CRITICAL STEP in healthcare. The
purpose of this system is NOT TO
REPLACE the decision-making ability
of the healthcare professional, but
rather to supplement it by showing
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TRENDS or by SUPPORTING the
decision of the professional.
Using Knowledge (Producing Wisdom)
The end goal of data and data processing is to
gain wisdom in order to make BETTER
DECISIONS that result in IMPROVED patient
outcomes, patient centric care, and value-based
healthcare. By understanding the knowledge
and the implications of that knowledge, nurses
are able to MANAGE a wide range of human
health problems
Expert Systems
• Expert systems REPRESENT the
present and future vanguard of
nursing informatics. These systems
aim to help make the NURSE “more
intelligent” in providing quality care
based on evidence.
Evidence-Based Practice
• The concept of evidence-based practice
is widely accepted across each of the
healthcare disciplines; however, the
REALITY of providing evidence-based
care at the point of care is often an
elusive goal. With the advent of Big
Data and data analytics techniques
capable of analyzing Big Data along with
expert systems capable of analyzing
unstructured data and using natural
language to present the resulting
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conclusions, real-time evidence-based

practice is a potential reality

Value-Based Patient Centric Care

• Value-based healthcare is a DELIVERY
MODEL where the focus is on
outcomes. This means that healthcare
providers receive payment based on
outcomes, NOT FEE for services.
• The idea is that patients would pay less
for achieving better health, patient
satisfaction would GO UP, costs would
be reduced for payers, and society
becomes HEALTHIER (NEJM Catalyst,
2017)