Nursing Informatics

What is INFORMATICS?
Informatics

Informatics comes from the French word informatique which means

computer science.

Informatics is defined as computer science + information science.

Used in conjunction with the name of a discipline, it denotes

an

application of computer science and information science to the

management and processing of data, information, and knowledge in the
named discipline.

What is nursing informatics?

Hebda (1998 p. 3), defines nursing informatics as:

The use of computers technology to support nursing, including clinical
practice, administration, education, and research.

American Nurses Association (ANA) (1994) has defined nursing

informatics as:
The development and evaluation of applications, tools, processes, and
structures which assist nurses with the management of data in taking
care of patients or supporting the practice of nursing.

Graves,

J. R., & Corcoran, S. (1989). The Study of Nursing

Informatics. Image: Journal of Nursing Scholarship, 27, 227-231. define

nursing informatics as:

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 the practice of nursing and
the delivery of nursing care.

Framework for Nursing Informatics

The framework for nursing informatics relies on the central concepts of

data, information and knowledge:
A DATA is defined as discrete entities that are described objectively
without interpretation
An INFORMATION as data that is interpreted,
structured

organized or

A KNOWLEDGE as information that has been synthesized so that

interrelationships are identified and formalized.
Resulting in DECISIONS that guide practice

Application of Nursing Informatics

Nursing Informatics can be applied to all areas of nursing practice,

which include; clinical practice, administration, education, and research.

Nursing

Clinical

Practice

(Point-of-Care

Systems

and

Clinical

Information Systems)
Work lists to remind staff of planned nursing interventions
Computer generated client documentation
Electronic Medical Record (EMR) and Computer-Based Patient Record
(CPR)
Monitoring devices that record vital signs and other measurements
directly into the client record (electronic medical record)
Computer - generated nursing care plans and critical pathways

Automatic billing
documentation

for

supplies

or

procedures

with

nursing

Reminders and prompts that appear during documentation to ensure

comprehensive charting

Nursing Administration (Health Care Information Systems)

Automated staff scheduling
E-mail for improved communication
Cost analysis and finding trends for budget purposesQuality
assurance and outcomes analysis

Nursing Education
Computerized record-keeping
Computerized-assisted instruction
Interactive video technology
Distance Learning-Web based courses and degree programs
Internet resources-CEU's and formal nursing courses and degree
programs
Presentation software for preparing slides and handouts-PowerPoint
and MS Word

Nursing Research
Computerized literature searching-CINAHL, Medline and Web sources
The adoption of standardized language related to nursing termsNANDA, etc.
The ability to find trends in aggregate data, that is data derived from
large population groups-Statistical Software, SPSS
Benefits of Computer Automation in Health Care:

 Many of these benefits have came about with the development of the
electronic medical record (EMR), which is the electronic version of
the client data found in the traditional paper record.

EMR benefits include:

Improved access to the medical record.

The EMR can be accessed from several different

simultaneously, as well as by different levels of providers.

locations

Decreased redundancy of data entry.

For example, allergies and vital signs need only be entered once.

Decreased time spent in documentation.

Automation allows direct entry from monitoring equipment, as well

as point-of-care data entry.

Increased time for client care.

More time is available for client care because less time is required
for documentation and transcription of physician orders.

Facilitation of data collection for research.

Electronically stored client records provide quick access to clinical
data for a large number of clients.

Improved communication and decreased potential for error.

Improved legibility of clinician documentation and orders is seen

with computerized information systems.

Creation of a lifetime clinical record facilitated by information

systems.

Benefits of automation and computerization are related to the use of

decision-support software, computer software programs that
organize information to aid in decision making for client care or
administrative issues; these include:

Decision-support tools as well as alerts and reminders notify the

clinician of possible concerns or omissions.
Effective data management and trend-finding include the ability to
provide historical or current data reports.
Extensive financial information can be collected and analyzed for
trends. An extremely important benefit in this era of managed care
and cost cutting.
Data related to treatment such as inpatient length of stay and the
lowest level of care provider required can be used to decrease costs.

Nursing Informatics Specialist

Because of the increased importance of computers and information

technology in the practice of professional nursing; a new role has
emerged, the Nursing Informatics Specialist (NIS).

The

NIS is a nurse who has formal education, certification and

practical experience in using computers in patient care settings.

The Role of the Nursing Informatics Specialist (NIS)

The American Nurses
functions of the NIS:

Association

(ANA,

1994),

lists

several

Theory development.

The NIS contributes to the scientific knowledge base of nursing

informatics.

Analysis of information needs.

The identification of information that nurses' need to in order to

accomplish their work; client care, education, administration, and
research

Selection of computer systems.

The NIS, guides the user in making informed decisions related to the
purchase of computer systems.

Design of computer systems and customizations.

The NIS collaborates with users and computer programmers to make

decisions about how data will be displayed and accessed.

Testing of computer systems.

Systems must be checked for proper functioning before they are

made available for use in patient care.

 Training users of computer systems.

Users need to be trained in how the system works, the importance of

accurate data entry, and how the system will benefit them, and
more importantly how it will improve patient outcomes

Evaluation of the effectiveness of computer systems.

The unique role of the NIS makes them the ideal person to evaluate
the effectiveness of computer systems.

Ongoing maintenance and enhancements.

The NIS makes sure the computerized system functions properly and
explores possible enhancements to the system that will better serve
the users and the patients.

Identification of computer technologies that can benefit

nursing.

The NIS must keep abreast of the changes in the fields of computers
and information technology, including new hardware and software
that will benefit the nurse and patient.

What is a Computer?

Computer
A

general term referring to information technology ( IT) and

computer systems.

 An

electronic device that performs tasks, such as calculations or

electronic communication, under the control of a set of instructions

called a program. Programs usually reside within the computer and
are retrieved and processed by the computers electronics. The
program results are stored or routed to output devices, such as
video display monitors or printers. Computers perform a wide variety
of activities reliably, accurately, and quickly.
Computers Nursing Perspective

In nursing computers are synonymous to nursing information system

(NIS).

Computers are used to manage information in patient care, monitor

quality of nursing care and evaluate care outcomes

Networks

with internet are used in communicating and accessing

resources and interacting w/ the patient on the (WWW).

Point to Ponder....

"Computers are incredibly fast, accurate and stupid. Human beings are
incredibly slow, inaccurate and brilliant.
Together they are powerful beyond imagination." - Albert Einstein
Historical Perspectives
Nursing and the Computer

Major historical perspectives of nursing and computers

 Six time periods

Four major Nursing areas
Standard Initiatives
Significant land mark events
Major Historical Persepectives of Nursing and Computers

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

Computers used in financial and management functions

Several communities developed Management Information sytem

1970s

Nurses assisted in the design of HIS

Computers used in financial and management functions

Several communities developed Management Information sytem

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, this is managed by HIMSS.

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

Health Insurance Portability and Accountability Act of 1996 was

enacted.

Nursing Practice

Computer systems, patient care data and NCPs are integrated to

Electronic Health Record

Need for EHR was perceived

New Nursing Terminologies were recognized by ANA
Nursing Administration

Computers linked department together.

Hospital data are accessed through computers.
Hospital process goes on line
Internet was utilized.
Nursing Education

Most nursing schools offered computer enhanced courses.

Campus-wide computer systems became available.

 Computer technology integrated into teaching methodologies

World wide web facilitates student-centered instructional settings.
Nursing Research

Provides an avenue for analyzing data

Softwares are available for processing qualitative and quantitative data
Research databases emerged
Online access
Standard Initiatives

ANA considered as the official nursing organization that contributes in

the development and recommendation of standards of nursing practice
worldwide.

Joint commission on Accreditation of Hospital Organizations ( JCAHO)

focuses on the need for adequate records on patients in hospital and
practice of standards in documentation of care
Significant Landmark of Event

1961 Healthcare Information and Management systems Society was

founded

1965 Development of one of the first hospital Information system in

California

 1973 First Conference on Management Information Sytem

1981 First National Conference on Computer Technology in Chicago

1984 First Nursing Computer Journal is published.
1989 graduate program in Nursing Informatics is introduced in
Maryland university

1993-establishment of electronic library

1995 first International Nursing Informatics Teleconference held in
Australia

2002-JCAHO identified clinical information system as a way to

improve safety and recommends that hospitals adopt technology.

2003 Health Insurance Portability and Accountability Act was enacted

2004 Establishment of the National Health Information Coordinator.
Historical Background of Electronic Health Records
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.

It is much more than an electronic replacement of existing paper

systems. The EHR can start to actively support clinical care by providing
a wide variety of information services. However, it is hard to understand
what information is really important to clinical care and what is simply
occasionally desirable.

The

EHR bring uncountable advantages in primary health care

detaching such
information.

It

as

faster

access

to

information,

and

updated

allows having a clinical process with all the patient clinical

information and an easier access to information (ex: allows the

simultaneous access from different locations).

Recognizable efforts in the development of EHR are distinguished by

the Nicholas E. Davis Awards of Excellence Program whose history
describes the improvement of EHR in different settings.

The Nicholas E. Davies Awards of Excellence Program

The Computer-Based Patient Record Institute (CPRI), founded in 1992,

was an organization representing all the stakeholders in healthcare,
focusing on the clinical applications of information technology.

It was among the first nationally based organizations to initiate and

coordinate activities to facilitate and promote the routine use of
Computer-Based Patient Records (CPRs) throughout healthcare.

The CPRI group on CPR Systems Evaluation developed the CPR project
evaluation criteria in 1993 which became the basis in assessing
accomplishments of CPR projects and provided the Foundation of
Nicholas E. Davies Awards Excellence Program

The Program was named after Dr. Nicholas E. Davis, an Atlanta-based

physician, president elect of the American College of Physicians, and
member of Institute of Medicine (IOM) committee in improving patient
records. He was killed in a plane crash just as the IOM report on CPRs
was being released

The

HIMSS Nicholas E. Davies Awards of Excellence recognize

excellence in the implementation and use of health information

technology, specifically EHRs, for healthcare organizations, private
practices and public health systems.

 Nowadays

the Nicholas E. Davies Awards Excellence Program is

managed by the Healthcare Information Management Systems Society,

and has the following program objectives:

The Healthcare Information Management Systems Society (HIMSS)

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.
HIMMS
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
HIMSS objectives:

Promote the vision of EHR systems through concrete examples

Understand and share documented value of EHR systems
Provide visibility and recognition for high impact EHR system
Share successful EHR implementation strategies

 Encourages

and recognizes excellence in the implementation of

EMREHR systems: Implementation, Strategy,

Management and Governance Strategy

Planning,

Project

Computer Systems

The Basic System Components

The

basic operational design of a computer system is called its

architecture.

John Von Neumann, a pioneer in computer design, is given credit for

the architecture of most computers in use today.

A typical Von Neumann system has three major components:

the central processing unit (or CPU)

memory, and

input/output(or I/O).

Von Neumanns Computer Architecture

Major Components of Computers
Hardware Devices

Hardware is the physical part of the computer and its associated

equipment.

Computer hardware can comprise many different parts, these include:

Input Devices:

used to enter data;

Examples:

keyboard, mouse, trackball, touch screen, light pen,

microphone, bar code reader, fax modem card, joystick, and
scanner.

Output Devices:

used to view and hear processed data;

Examples:

video monitor screens, printers, speakers, and fax.

Input Devices
Output Devices

Central Processing Unit (CPU)

Brain" of the computer

Three components:

Arithmetic Logic Unit (ALU):

Number "crunching

Registers

Control Unit:

Similar to memory but has special purposes

manages instructions to other parts of the computer,

including input and output devices "traffic cop

Primary Memory:

The storage area in which program instruction (code) reside

during execution.

Read-only memory (ROM) is permanent; it remains when

the power is off. Start-up instructions for the computer is an
example of ROM.

Random access memory (RAM) is a temporary storage area

for program instructions and data that is being processed, it is
only active while the computer is turned on. (located on the
motherboard not part of CPU)

Secondary Storage:

Provides space to retain data in an area separate from the

computer's memory after the computer is turned off, these
include; hard disk drives, floppy disks, tape, zip drives, optical
drives, flash memory, and CD-ROM drives.

Networks

A network is "a combination of hardware and software that allows

communication and electronic transfer of
computers" (as cited in Hebda, 1998, p. 19).

information

between

 Hardware

may be connected permanently by wire (Ethernet), or

temporarily by wireless communication, and modems/telephone lines.

This allows the sharing of computer and software resources, through the
use of the network. For example, several computers may share one
computer, or a word processing program could also be accessed by
many different users.
Computer Categories

Super computers

The largest and most expensive, can perform billions of instructions

every second

Mainframes

Large computers capable of processing several millions instructions

per second.
They support organizational functions, therefore have been the
traditional equipment in hospitals. Customized software results in
high cost.

Minicomputer

A scaled-down version of the mainframe, since they are now

becoming more powerful they can now be found in hospitals and
HMO's

Microcomputers (PCs),

Inexpensive processing power for an individual user.

 Laptop or Notebook, Handheld, and Personal Digital Assistants

(PDAs)

Portable devices which can be used almost anywhere.

References:

http://www.scribd.com/doc/6120543/Nursing-Informatics
http://www.snomed.org/
http://himss.org
http://www.amia.org/ni-wg
http://www.healthitcertification.com/about.html
http://www.caringonline.org/
http://www.imia.org/ni/index.html
http://en.wikipedia.org/wiki/Nursing_Informatics