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Nursing Informatics Lecture Notes Nursing Informatics Nursing informatics is 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 nursing practice, education, research, and administration (Graves & Corcoran, 1989). "Information is an essential phenomenon of study for an information-based discipline such as nursing,". Nursing informatics can be applied to model the human processing of data, information, and knowledge within a computer system in order to automate the processing of nursing data to information and the transformation of nursing information to nursing knowledge. "In the current Information Age, the doubling of knowledge every five years and the increased specialization of knowledge make it imperative that nurses have access to the latest scientific information to assist in the delivery of high quality care,"(Hudgings, 1992, p.7). Nursing Informatics is a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, and knowledge in nursing practice. Nursing informatics facilitates the integration of data, information and knowledge to support patients, nurses and other providers in their decision-making in all roles and settings. This support is accomplished through the use of information structures, information processes, and information technology. (ANA Scope and Standards of Nursing Informatics Practice, 2001, pg vii)

Computers and Nursing Health and nursing information science is the study of how health care data is acquired, communicated, stored, and managed, and how it is processed into information and knowledge. This knowledge is useful to nurses in decision-making at the operational, tactical, and strategic planning levels of health care. Information systems used in health care include the people, structures, processes, and manual as well as automated tools that collect, store, interpret, transform, and report practice and management information. The realization that health care data and information can be effectively managed and communicated using computer systems, networks, modems and telecommunications has catalyzed the emergence of the science of nursing informatics. As Virginia Saba (1992) predicted, "By the turn of the century, most health care delivery systems will function with computers and will be managed by computer literate nurses. I believe, that by the turn of the century, "high tech and high touch" will be an integral part of the health care delivery system," (p. xv). At present, nursing informatics is an emerging field of study. National nursing organizations support the need for nurses to become computer literate and versed in the dynamics of nursing informatics. We are at a transition period. Becoming educated in nursing informatics is, for the most party, a selfdirected and independent endeavor. Programs that offer basic and further education in nursing informatics are beginning to spring up around the globe, but many more are needed to provide easy access for motivated nurses

Application of Computer to Health Professions Automatic searching of parallel records for medically ill person and critical medical information Automatic searching of nationwide databases holding registries of patients with critical problems. Automated review of similar patients to determine expected lengths of stay, costs, and rates of complications allowing better financial forecasting for the hospital and better information for the patient and caregiver. System will allow the user to very easily pull information from vast numbers of patients (without names!) into spreadsheets, databases, graphing packages to create instant displays of outcome, treatment paths and options. Improved communication between multiple providers to reduce the it slipped through the cracks syndromes that plague the smooth running of operating rooms Patient care and management care providers are using data entry devices to document care given both at the bedside and at central terminals.

Prepared by: Michael Gustilo, R.N- Instructor

Patient records - compilation of patient or test data, maintenance and retrieval of these records and use of these records for billing and usage and outcome analysis. Patient monitoring - by recording patient data on-line and from various tests. Exchange of medical data - from the compilation and maintenance of databases. Interactive medical education from database and tutorial software. Physician decision making from the use of patient records and other databases. Reference: ESSENTIALS OFNURSING INFORMATICS by Virginia K. Saba and Kathleen A. McCormick

Historical Perspectives of Nursing and the Computer Nursing informatics has emerged as a new term encompassing these technologies enabling nurses to manage health care and patient care more efficiently and effectively. Computers in nursing are used to manage information in patient care, monitor the quality of care, and evaluate the outcomes of care. Computers and networks are now used for communicating -Sending/receiving data and messages via the internet -Accessing resources -Interacting with patients on the World Wide Web (WWW) Nurses are increasingly involved with systems used for planning, budgeting, and policy-making for patient care services as well as enhancing nursing education and distance learning with new media modalities. Computers are also used to support nursing research, test new systems, design new knowledge databases and advance the role of nursing in the healthcare industry.

Major Historical Perspectives of Nursing and the Computer Computer technology emerged in nursing in response to the changing and developing technologies in the health care industry and in nursing practice. It is analyzed according to: 1. Six time periods Prior to the 1960s, 1960s, 1970s, 1980s, 1990s and post 20002. Six time period Prior to 1960s simple beginnings Use of punch cards and teletypewritters. 1960s Use of computers in healthcare is questioned Studies on computers in nursing is started. Introduction of cathode ray tubes Development of Hospital Information System for financial transactions 1970s Nurses assisted in the design of HIS(hospital information system) Computers used in financial and management functions Several communities developed Management Information system 1980s Nursing Informatics is formally accepted as new nursing specialty. Nursing Education identified need for update Emergence of microcomputers/PC 1990s Computer technology became an integral part of the healthcare setting. Policies and legislation on promoting computers in healthcare were adopted. Approval of NI by ANA as a new nursing specialty. Dr. Nicholas Davies excellence award is given for excellence in health information technology. Post 2000 Clinical Information System became individualized in the electronic patient record. Mobile computing device were introduced New technologies were utilized Internet provided new means of development

Prepared by: Michael Gustilo, R.N- Instructor

Health Insurance Portability and Accountability Act of 1996 was enacted. 2. Four major nursing areas Nursing practice, administration, education, and research 3. Standards initiatives Nursing practice, nursing data, and healthcare standards

Electronic Health Record from a Historical Perspective Computer-Based Patient Record Institute (CPRI) Non-profit membership organization founded in 1992. Focused on clinical applications of IT Electronic Health Record (EHR) An electronic record of patient health information generated by one or moreencounters in any care delivery setting. EHR Contents Demographics Progress notes Medical problems Medications Vital signs Past medical history Immunizations Laboratory data Radiology reports Key Components of Electronic Health Records Administrative System Components Patient identification: Name Demographics Next of kin Employer information Chief complaint Laboratory System Components Integrates: Doctors orders Laboratory results Instruments Schedules Billing Other administrative information Radiology System Components Contains patient radiology data: Orders Interpretations Patient identification Information Images Patient tracking Scheduling Results reporting Image tracking functions

Prepared by: Michael Gustilo, R.N- Instructor

Used with picture archiving communications systems (PACS), which manage digital radiography studies. Pharmacy System Components Contains clients medication data and inventory of pharmacy stocks. Computerized Physician Order Entry (CPOE) Permits clinical providers to electronically order laboratory, pharmacy, and radiology services. Pharmacy ordering capabilities Ancillary service ordering Alerts Customized order sets Result reporting Clinical Documentation Provides electronic capture of: Clinical notes Patient assessments Medication administration records Other parts of the clients chart Consideration of Standards Standard established by consensus and approved by a recognized body that provides rules, guidelines or characteristics for activities. Key Standards Clinical vocabularies Healthcare message exchanges EHR ontologies (ex. content and structure of the data entities in relation to each other) Clinical Vocabularies Means of encoding data for exchange, comparison, or aggregation among systems. Specific Uses of Clinical Vocabularies Search knowledge resources (ex. key word searches, tagging). Identify the correct guidelines, critical paths, and reminders to be used in prompting high quality patient care. Support practice analysis, quality improvement, and outcomes research. Provide data for clinical epidemiological analyses.

Prepared by: Michael Gustilo, R.N- Instructor