CHAPTER 1

OVERVIEW
1. NURSING INFORMATICS refers to the field of
applied computer science
2. Computers are an essential tool in HEALTH
INFORMATION TECHNOLOGY (HIT) systems.
3. HIT refers to technology that:
A. captures health information
B. processes health information
C. generates health information
NURSING INFORMATICS
A specialty that integrates NURSING
SCIENCE, COMPUTER
SCIENCE, and INFORMATION
SCIENCE to manage and
communicate data, information, and
knowledge to support patients,
nurses, and other providers in their
decision-making in all roles and
settings. (American Nurses
Association/ ANA, 2001).
 OVERVIEW
4. Computerization affects:
a. Documentation of patient care
b. Education of providers
c. Research for advancing healthcare delivery
d. Administration
e. Reimbursement
f. Legal and ethical implications
g. Safety and quality issues
 OVERVIEW
5. Shift towards
a. Integrating multiple technologies
b. Invisible storage devices
c. User-friendly, menu driven, touchscreen
6. Computers in nursing are used for
d. Managing patient care
e. Monitoring quality
f. Evaluating outcomes
 OVERVIEW
d. Communicating data
e. Accessing resources
f. Interacting with patients
g. Documenting care
h. Supporting nursing research
i. Testing new systems
j. Designing new knowledge databases
k. Developing data warehouses
l. Advancing the role of nursing
MAJOR HISTORICAL PERSPECTIVES
OF NURSING AND COMPUTERS
1. Prior to the 1960s
a. Computers were used for administrative work
and accounting
2. 1960s
a. Increased time devoted to documentation
b. Emerging computer-based information
systems
MAJOR HISTORICAL PERSPECTIVES
OF NURSING AND COMPUTERS
3. 1970s
a. Hospitals began developing information
systems
i. Physician order entry
ii. Results reporting
iii. Pharmacy
iv. Laboratory
v. Radiology reports
vi. Information for financial and management
vii.Monitoring for intensive care units
MAJOR HISTORICAL PERSPECTIVES
OF NURSING AND COMPUTERS

b. Some systems included:

i. Decision support
ii. Problem lists
iii. Interdisciplinary problem lists
 MAJOR HISTORICAL PERSPECTIVES
OF NURSING AND COMPUTERS
c. Nurses were often involved in implementing
systems
d. Interest began to emerge in public and home
health
e. Conferences helped public and home health
nurses:
i. Understand the importance of data to
Medicare and Medicaid
ii. See the usefulness of computers for
capturing information
MAJOR HISTORICAL PERSPECTIVES
OF NURSING AND COMPUTERS
f. Hospitals and public health agencies
investigated computers
g. Educational use of computers began
h. Early networks expanded awareness on
practice
i. National Institutes of Health(NIH)
implemented TDS
j. TDS was the first system to include
nursing practice protocols
 MAJOR HISTORICAL PERSPECTIVES
OF NURSING AND COMPUTERS
4. 1980s
a. Field of nursing informatics exploded
b. Nursing profession updated practice standards
c. Many mainframe systems emerged with nursing
subsystems
d. Systems documented aspects of patient records
MAJOR HISTORICAL PERSPECTIVES
OF NURSING AND COMPUTERS
e. PCs emerged
f. First Nursing special interest group on
computers met during the Symposium on Computer
Applications in Medical Care (SCAMC) - 1981
g. American Nurses Association (ANA) approved
formation of Council for Computer Application in
Nursing (CCAN)
h. CCAN became powerful force
i. First edition of this book (Essentials of Nursing
Informatics) - 1986
MAJOR HISTORICAL PERSPECTIVES
OF NURSING AND COMPUTERS

5. 1990s
a. Advances in relational databases
b. Better application development
c. Legislative action paved the way for Health
Insurance Portability and Accountability Act
(HIPPA)- 1996
MAJOR HISTORICAL PERSPECTIVES
OF NURSING AND COMPUTERS
5. 1990s (cont…)
d. Technology shaped new roles for nursing
e. ANA recognized new nursing specialty
f. Demand for Nursing Informatics increased
g. ANA developed Nursing Information and Data
Set Evaluation Standards (NIDSES) – to evaluate
and recognize nursing Information system.
 MAJOR HISTORICAL PERSPECTIVES
OF NURSING AND COMPUTERS
5. 1990s continued
h. Technology rapidly changed in the 90s
• PCs became smaller
• Computer notebooks became affordable
• Computers were linked through networks
• The Internet became mainstream
• The World Wide Web (WWW) increased
access to information
 MAJOR HISTORICAL PERSPECTIVES
OF NURSING AND COMPUTERS
6. 2000s
a. Healthcare information became digitalized
b. In 2004 Executive Order 13335
i. Established Office of the National Coordinator for
Health Information Technology(ONC)
ii. Recommendation issued for adoption of EHRs
c. IT solutions increased
d. Bar coding and RFID use increased
e. Mobile devices in hospitals increased
f. VOIP provided cheap communications
g. Development of clinical applications
h. Integration of nursing data into HIT systems
 MAJOR HISTORICAL PERSPECTIVES
OF NURSING AND COMPUTERS
7. 2010s
a) Impact of Nursing Minimum Data Set (NMDS) showed
need for continued effort
b) New nursing research agenda emerged as critical based
on National Institute for Nursing Research (NINR)
c) Meaningful Use (MU) legislation outlined
d) Ultimate goal is interoperable EHR in all hospitals
e) MU designed to be implemented in three stages
f) MU stage1 focused on Computerized Physician Order
Entry (CPOE)
 MAJOR HISTORICAL PERSPECTIVES
OF NURSING AND COMPUTERS
7. 2010s continued
h. MU stage 2 focused on Quality Indicators
i. Quality Indicators guide in patient safety
j. MU stage3 – focused on outcome measures
k. Center for Medicare and Medicaid Services
(CMS) to increase reimbursement for MU
l. CMS may penalize for failure to meet MU
m. MU made NI part of all nursing services
 HISTORICAL PERSPECTIVE OF
NURSING INFORMATICS
B. Consumer-centric healthcare system
1. Shift due to escalating costs of healthcare
2. Consumers encouraged to be active partners in
managing health
3. Variety of technologies have evolved
4. Consumers can share across healthcare providers
5. Personal Health Records have multiplied
6. Consumers increasingly healthcare literate
 NURSING INFORMATICS PIONEERS
A. History Project
1. 1995, Saba initiated history of NI at the National
Library of Medicine (NLM)
2. 2001 the Nursing Informatics Working Group (NIWG)
of the American Medical Informatics ASsociation
(AMIA) became involved
3. The NI History Committee was established
4. Archival material to be housed in the NLM
5. 145 pioneers were identified
6. Each pioneer contacted to submit historical documents
7. Videotaped stories recorded
8. Videos and documents available online
 NURSING INFORMATICS
PIONEERS
A. History project continued
9. The website provides “use cases” for ideas
how to use the information for teaching
and learning more about the pioneers
10.The pioneers came from a variety of
backgrounds
11. Pioneers influenced informatics from data
through health policy and funding
 NURSING STANDARDS
INITIATIVES
A. Nursing Practice Standards
1. Standards developed by ANA
2. Nursing Scope & Standards of Practice
(ANA, 2010) focused on:
a. The organizing principles of clinical
nursing practice
b. Standards of professional performance
 NURSING STANDARDS INITIATIVES
A. Nursing Practice Standards
3. Nursing Scope & Standards of Practice (ANA,
2010):
a. Builds on clinical practice standards
b. Outlines importance of standards to support
nursing
B. Nursing Education Standards
1. NLN’s Nursing Forum on Computers in
Healthcare and Nursing supported integration of
computers in nursing curriculum
NURSING STANDARDS INITIATIVES
A. Nursing Education Standards continued
2. The American Association of Colleges of
Nursing (AACN) revised The Essentials
for Doctoral Education for Advanced
Nursing Practice (AACN, 2006) and The
Essentials of Baccalaureate Education
for Professional Nursing Practice
(AACN, 2008) to require the use of
computers
 NURSING STANDARDS
INITIATIVES
C. Nursing Content Standards
1. Nursing data elements in EHRs are
essential for exchange
2. Standardization of healthcare data began
in 1893 with the List of International
Causes of Death
3. Standardization of nursing began with
Florence Nightingale’s six canons -
‘Notes on Nursing’
 NURSING STANDARDS
INITIATIVES
C. Nursing Content Standards
4. In 1955, Virginia Henderson published her 14
Patterns of Living
5. The ANA has recognized 12 nursing
terminologies
6. The ANA selected 6 ANA recognized nursing
languages for inclusion in UMLS
7. There are a large number of standards
organizations
 VIRGINIA HENDERSON
• The 14 Basic Human Needs:
• Breathe normally. 
• Eat and drink adequately.
• Eliminate body wastes.
• Move and maintain desirable postures.
• Sleep and rest.
• Select suitable clothes-dress and undress.
• Maintain body temperature within normal range by adjusting clothing and modifying
environment
• Keep the body clean and well groomed and protect the integument
• Avoid dangers in the environment and avoid injuring others.
• Communicate with others in expressing emotions, needs, fears, or opinions.
• Worship according to one’s faith.
• Work in such a way that there is a sense of accomplishment.
• Play or participate in various forms of recreation.
• Learn, discover, or satisfy the curiosity that leads to normal development and health and
use the available health facilities.
 NURSING STANDARDS
INITIATIVES
D. Confidentiality and Security Standards
1. Electronic exchange of data raises
privacy concerns
2. 2009 HIPAA strengthened in HITECH
Act (Health Information Technology for
Economic and Clinical Health) Act
 ELECTRONIC HEALTH RECORDS
FROM A HISTORICAL PERSPECTIVE
A. The Institute of Medicine (IOM)
1. Raised awareness of paper patient records
B. The computer based Patient Record
Institute
1. Made criteria to evaluate Computerized
Patient Records (CPR) accomplishments
 LANDMARK EVENTS IN NURSING
AND COMPUTERS
A. Major Milestones
1. Computers introduced over 40 years ago
2. Major milestones in nursing and computers
interwoven
3. Increased need for nursing data makes nursing
profession an autonomous discipline
4. Conferences and symposia provide chances for
nursing informatics to network
 NURSING INFORMATICS
(PHILIPPINES)
• The Philippine nursing community have long
sought to keep up with increasing use of
information and technology in the healthcare
system.
• Nursing Informatics follows the footsteps of
biomedical informatics which has gained
relative popularity earlier than its other allied
medical counterparts.
 NURSING INFORMATICS
(PHILIPPINES)
• Nursing informatics - unfamiliar until 2008
• The origin of this budding discipline in
directly came from the pioneers of HEALTH
INFORMATICS in the Philippines.
 NURSING INFORMATICS
(PHILIPPINES)
• The Philippine Medical Informatics
Society(PMIS) and its founders had strong
influence in the development of health
informatics in the Philippines.
• The PMIS was officially registered under the
Securities and Exchange Commission in 1996
by its board composed of eleven physicians.
The organization was headed by Dr. Alvin
Marcelo.
 NURSING INFORMATICS
(PHILIPPINES)
• Since 1998 – several faculty members of UP began formal
education and training.
• Dr. Herman Tolentino took a post-doctoral fellowship in
medical informatics at the University of Washington.
• Dr. Alvin Marcelo followed a year later for his training at the
National Library of Medicine.
• Dr. Cito Maramba went to Coventry for his Masters in
Information Sciences at the University of Warwick.
• They were later followed by other physicians such as Dr.
Micheal Muin and Dr. Ryan Bañez.
epresentatives from various sectors collaborated on this project including the Philippine Nurses Association (PNA) in the person of Ms. Evelyn Protacio

NURSING INFORMATICS
(PHILIPPINES)
• In 1999, a study group was formed headed by the
National Institute of Health of the University of the
Philippines Manila.
• This group identified international standards for
health information and their adaptability in the
Philippines
• SHIP99 - the "Standards of Health Information in the
Philippines, 1999 version"
• Representatives from various sectors collaborated on
this project including the Philippine Nurses
Association (PNA) in the person of Ms. Evelyn
Protacio.
By the year 2003, a Master of Science in
Health Informatics was proposed to be offered
by UP-Manila College of Medicine (major in
medical informatics) and the College of Arts
and Science (major in bioinformatics) and was
later approved to be offered starting academic
year 2005-2006.
CHED as a Catalyst.
In 2008, Nursing Informatics course in the
undergraduate curriculum was defined by the
Commission on Higher Education (CHED)
Memorandum Order 5 Series of2008.
This was later revised and included as Health
Informatics course in CHED Memorandum Order
14Series of 2009.
This was first implemented in the summer of 2010.
• Organization.
• Early in 2009, Mr. Kristian R. Sumabat and
Ms.Mia Alcantara-Santiago, both nurses and
graduate students of Master of Science in
Health Informatics at the University of the
Philippines, Manila began drafting plans to
create a nursing informatics organization.
• In February 2010, they began recruiting other
nursing informatics specialists and
practitioners to organize a group which later
became as the Philippine Nursing Informatics
Association (PNIA).
• They were joined by founding members Ms.Sheryl
Ochea, a graduate of MAster of Science in Nursing
major in nursing informatics at Xavier University
(Ohio, USA),
• Ms. Alexrandra Bernal, a graduate student and
telehealth nurse of the National Telehealth Center,
• Ms.Pia Pelayo, a former telehealth nurse and aproject
coordinator of the NationalEpidemiology Center,
Department of Health
• Mr. Sid Cardenas, also a telehealth nurse.
• Other founding members include Mr. Noel
Bañez, Ms. Rona Abcede, and Mr. Harby
Ongbay Abellanosa.
 ISSUES AND CHALLENGES OF
NURSING INFORMATICS IN THE
PHILIPPINES
• The inclusion of informatics as an integral
part of the undergraduate curriculum has been
one of the most influential factors for the
increased awareness and interest in this field
of nursing.
• However, the contents of the curriculum were
adapted from international materials which
does not match the local needs.
 ISSUES AND CHALLENGES OF NURSING
INFORMATICS IN THE PHILIPPINES

• A community-centered approach to the use of

information, communication and technology
in nursing practice must be adapted to ensure
the impact of the program in the local
healthcare system.
 ISSUES AND CHALLENGES OF NURSING
INFORMATICS IN THE PHILIPPINES

• Lack of certification and credentialing

programs in post-graduate levels are also
absent with the scarcity of local nursing
informatics experts. This new field has yet to
gain acceptance and recognition in the
nursing community as a sub-specialty.
FUTURE DIRECTION OF PHILIPPINE
NURSING INFORMATICS
• Development of training, certification and
credentialing programs
• Future partnerships with local and
international nursing and health informatics
organizations
FUTURE DIRECTION OF PHILIPPINE
NURSING INFORMATICS
• PNIAs CORE X strategic platform which
stands for Competency, Organization,
Recognition, Experience and Expertise.
• It is also a major drive to support the use of
health information standards in the
Philippines and to have nursing informatics
specialists in every hospital in the country.
 MAJOR MILESTONES IN NURSING
INFORMATICS IN THE PHILIPPINES
• Philippine Nurses Association (PNA) – participated
in the:
 development of the Standards for Health
information in the Philippines (SHIP) in 1999
 the formation of the Master of Science in Health
Informatics (MSHI) which started 2005
 formation of the Philippine Nursing Informatics
Association (PNIA) in 2010