NI LECTURE

Module 3: NURSING PRACTICE APPLICATION (Topic 1)

Florence Nightingale

- called the first nursing theorist (environmental theory)

- “Mother of modern nursing”
- “lady with the lamp”
- Most famous nurse during Crimean war (war between Turkish and English)
- Spoke about the critical importance of nursing informatics in patient care, and she stated that
“decision making must be based upon the use of accurate data” (e.g. assessment of data
(subjective and objective data) in order to give proper intervention.
 when we gather objective cues, we use IPPA (inspection, Palpation, Percussion & Auscultation)
- her frustration from the difficulties of extracting such critical patient related data from hospital
records

Meadows – “the voice arises from nurses as they participate in the process of using clinical information system
to analyze data and information; exploring and understanding the informational and cognitive foundations
specific to nursing wisdom and then applying to affect patient care

-we have to be involved in information system, as this is integrated in our profession to transform data to
information to knowledge to wisdom

Abbott – “the greatest struggle in nursing informatics is in the representation of nursing in a language that
computer can use”

Essential Elements of Nursing Informatics: Dynamic Interactions

- these diverse elements are involved in the dynamic process by which nurses use computers to
make sound data base as well as content specific decisions about patient care
Database – are organize related data
- is a structured set of data held in a computer especially one that is accessible in various ways

Parts of Scientific Elements:

A. Metaparadigm
B. Metastructures (Nelson Data-Wisdom Continuum)
C. Scientific Foundations
D. Tools

4 Essential Elements of Nursing Informatics:

1. Nurse 2. Patient

3. Health 4. Environment

- These 4 (nurse, patient, health and environment) are considered as 4 Concepts of

Metaparadigm – considered as the highest level of nursing knowledge, followed by the
philosophy in nursing

A. Metaparadigm – is a set of theories or ideas that provides structure for how a discipline should function

- for nursing discipline these theories consist of basic concepts that address patient as a whole, patient’s health
and well-being, patient’s environment (includes external and internal) , and the nursing responsibilities / nurse.

B. Metastructures (Nelson Data-Wisdom Continuum):

1. Data 3. Knowledge

2. Information 4. Wisdom

C. Scientific Foundations:
1. Computer Science

2. Information Science

3. Nursing Science

D. Tools from:
1. Information Science
2. Computer Science
3. Information Technology (includes computer hardware, computer software and network technology derived
primarily from computer science)
4. Information Structure- refers to organizing data, information and knowledge for processing by computer
5. Management & Communication
Informatics Competencies

- Needed by all nurses whether they specialize or not in nursing informatics (ANA)
- (ANA) all nurses must be both information and computer literate
- As a future nurse, you need to have informatics competencies because nursing settings
becomes ubiquitous computing environments, when you go to a station, there are technologies,
so we have to adapt and embrace
- In the standards of practice, ANA has made a definitive statement about informatics
competencies needed in the nursing practice today
- The scope and depth of these competencies are set forth by the organization increased within
each level of 3 domains

3 Major Domains

1. Computer Literacy Skills –these skills include our skills to use a word processor, to access a data base,
to create a spread sheet, to communicate thru email
2. Information Literacy Skills – these skills refers to our ability to recognize the need for information as
well as the skills to access, evaluate, and interpret information correctly
3. General informatics Competencies – include our skills to identify, collect and record data relevant to
nursing care of patients, analyzing and interpreting patients and nursing information as well as our
ability in using applications of informatics as integral part of the nursing process and implementing
institutional and public policies regarding privacy, confidentiality and security of information
 EHR- we have to safeguard the safety, security, and confidentiality of the information; do not
disclose the information to people who are not directly involve

Technical IQ or Technical Intelligence

- Interrelatedness between the technology, people and systems

- Looking into the future, the success of the leader will be measured by the persons “Ability to
integrate the very complex issues of patient care and technology in a way that make sense “
(Kerfoot)
- Although competencies in informatics is critical for all nurses in practice, (Kerfoot) said that
technical IQ is not only knowing about the specific functioning of the technology, but is
about also understanding the interrelatedness between the technology, people and systems,
and also how the people and the systems interact with these technology and how can this be
translated into outcomes

NI Standards of Practice: The Problem-Solving Framework

- Issue is information issue or informatics problem

1. Assessment – involves using data, information, and knowledge to clarify the presenting issue or
problem
- focuses on collecting data using different methodologies (interview, browsing chart)
2. Identify and Evaluate – possible solutions to information issues
3. Set Activities – these activities are related to identification of appropriate informatics solution and
planning for its application
 4. Implementation – informatics specialist acts as a process consultant and project manager for all
interventions and activities related to the informatics application
- Also the informatics specialist skillfully watches the capabilities and limitations of hardware and
software
-Informatics specialist role is connected with the information system and technology effectively and
efficiently
5. Evaluation – we set criteria to be used to evaluate the efficiency and effectiveness of decisions, plans,
activities, and applications

Nursing Terminologies

- Nursing needs to electronically document nursing practice using standardized nursing

terminology with coded concepts in order to measure the effectiveness of the care delivery and
thus generation evidence
Standardized Nursing Terminology
-consists of nursing concepts that represent the nursing domain
-it must include standardized nursing data that represent the essential building blocks for nursing practice
and such nursing data are critical to the development of data sets that can be used for analysis and integrated
with the data of other healthcare discipline
- The standardized nursing data sets might also serve research data to advance the science of nursing
practice
- ANA recognized 12 terminologies and data sets and are divided into 3 types

3 Three types of Data Sets:

1. Data Element Sets

2. Interface Terminologies (User / Point of Care Terminologies)

3. Multidisciplinary Terminologies

1. Data Element Sets –

a. NMDS (Nursing Minimum Data Set) – nursing care service, client demographic elements , all
nursing , Clinical data elements
b. NMMDS (Nursing Management Minimum Data Set) – focuses more on nurse managers or nurse
executives, All settings, Nursing , administrative data, Elements
- a research based management data set that needs the nurse managers, or nurse executives need for a
specific nursing data management data capture system that will produce accurate, reliable, and
useful data for decision making
-minimum collection of core variables needed by nurse managers to make decisions and compare
nursing practice across institutions and geographical areas

2. Interface Terminologies (User / Point of Care Terminologies) - ps that nurses and understand in daily
practice
a. (CCC) Clinical Care Class – formerly known as Home Healthcare Classification
- provides standardized framework
- all settings
- this provides a standardized framework and a unique coding structure for assessing,
documenting and classifying patient care by nurses and other clinical practitioners
- composed of 2 sets of interrelated terminologies – these are the nursing diagnosis and
interventions which are classified using a coded framework consisting of 21care components
which are modeled around the steps of the nursing process standards of care
b. (ICNP) International Classification of Nursing Practice - produced and owned by ICN
(International Council of Nursing)
- unified nursing language system describing nursing practice,
- establish to provide international standard for the description and comparison of nursing
practice and also to facilitate the development of cross mapping between local terms and other
terminologies
- used to represent nursing diagnoses, interventions and outcomes
- Setting is all nursing only
- contents include diagnoses, interventions and outcomes
 - based on 7 Axes model (focus, judgment, time, location, means, action, and client)
- can be used along with existing terminologies through cross mapping to develop new
vocabularies and also to identify new relationships between concepts and vocabularies
c. (NANDA) North American Nursing Diagnosis Association – provides evidenced based
definitions, list of defining characteristics, etiologic factors, risk factors
- focuses on diagnosis
- Nursing diagnosis different from medical diagnosis
- PES format (problem, etiology, secondary)
- Nursing Diagnosis is a clinical judgment concerning human response to health conditions or
health processes or a vulnerability for that response by either an individual person, family,
community, or a group
- provides the basis for selection for nursing interventions to achieve outcomes for which we
nurses are accountable
- developed based on data obtained through nursing assessment and this enables the nurse
develop a care plan
- Identify nursing priorities, and help direct nursing interventions based on identified priorities
- provide common language and forms a basis for communication and understanding with
between nursing professionals and healthcare team and it provides also a basis of evaluation to
determine if nursing care was beneficial to the client or cost effective
- helps the formulation of expected outcomes or quality assurance requirements, also it identifies
how a client or group response to actual or potential health and life processes and knowing
their available sources of strength that can be drawn upon and help to solve problems
- effective tool to sharpen critical thinking skills of students

d. (NIC) Nursing Intervention Classification – focus is on intervention, standardized classification

system or treatments performed by nurses
- setting is all nursing
- group into 30 classes within 7 domains: behavioral, community, family, health system, basic
level physiological, complex level physiological and safety
- the domains, classes and interventions include definitions and interventions includes sets of
activities to carry out the interventions and references for background reading
e. (NOC) Nursing Outcome Classification - focuses on outcomes
- setting is all nursing
- provides standardized classification system of patient outcomes for evaluating the effects of
nursing interventions
- group into 34 classes, 7 domains: functional health, physiologic health, psychosocial health,
health knowledge and behavior, perceived health, family health and community health
- the outcomes includes definitions, list of indicators for evaluating patient status in relation to
the outcome, references for background reading, and a 5-point Likert scale to measure patient
status
f. Omaha System – settings include home care, public health and community
- content includes diagnoses, interventions and outcomes
- used to document client needs, describe practitioner interventions and measure client outcomes
- consists of 3 components designed to be used together : problem classification scheme (used
for client assessment), intervention scheme (used for health related care plans and services) ,
problem rating scale for outcomes(used for client progress evaluation)
g. (PNDS) Perioperative Nursing Data Set – setting is perioperative , involves surgical operation
involving period prior to operation, intraoperative period and post-operative period
- contents include diagnoses, interventions and outcomes
- it is a standardized nursing language designed to support evidenced based perioperative
nursing practice
- this contains terminologies for nursing assessment, evaluations, outcomes and problems
- outcomes are organized into 5 domains : 1)safety, 2) physiologic responses, 3) behavioral
responses, patient and family on knowledge and psychosocial, 4)behavioral responses of
patient and family on rights, ethics and competency, and 5)health system
 3. Multidisciplinary Terminologies- does not only includes nursing discipline but also includes other
disciplines
a. (ABC codes) Alternative Billing Concept – are 5 digit HIPPA compliant alpha codes used by
licensed and non-licensed healthcare practitioners on standard healthcare claim forms, includes
descriptions of integrative healthcare services , remedies and supplies,
- Is a 5 letter string, followed by a 2 character code modifier
- The string identifies the service, remedy or supply item while the code modifier identifies the
practitioner type
- Maybe used by healthcare practitioners, and ensures for updating medical records, billing
processing claims and managing benefits
- Settings is nursing and others
- Content includes interventions
b. (LOINC) Logical Observation Identifiers Names and Codes – contents include outcome and
assessment
- provides a set of universal name and numeric identifier codes for laboratory and clinical
observations measurements
- Settings is nursing and others
c. (SNOMED CT) Systemized Nomenclature of Medicine - Clinical Terms – used to index
human and veterinary medical vocabulary, and includes signs and symptoms, diagnosis and
procedures
- Settings is nursing and others
- Contents includes diagnoses, interventions and outcomes

ANA – Recognized Terminologies and Data Sets

Care Planning- computerized patient record facilitates the automation of nursing care planning process, and
the ability to electronically record, integrate and analyze data and information and ables nurses to quickly move
to the synthesis of nursing knowledge and development of nursing wisdom which they can then apply to patient
care

- when data are readily available, transform from data to knowledge

- in today’s care planning, process includes a mix of individual patient data standards and data
which can be used for decision making, such as facility standards of care, age specific
guidelines, care areas standards of practice, or specific patient problems identified by different
disciplines or physicians orders
- right now, managers are able to query the clinical record with questions about supervision and
the results of care and the results from the system are useful to process improvement,
performance evaluation and strategic planning

(CDSS) Clinical Decision Support System - includes an array of computer-based applications that assist
healthcare clinicians in a day-to-day work of patient care.

- Is linked to information systems that carry vital patient data, form laboratory, pharmacy,
radiology, admit discharge transfer , computerized physician order entry, and electronic health
record
- A tool used in healthcare to give data meaning, or to bundle data in clinically significant ways
for application to patient care with minimum temporal delay
- Includes programs that involve artificial intelligence and different types of knowledge
- Predict future events, can offer valuable resource
- Nursing documentation systems incorporate exert systems and artificial intelligence, and also
CDSS can offer nurses evaluable resource and that’s the ability to improve clinical decision
making at the point of care in real time
- CDSS can provide the best clinical data, it does not forget, it does not misplace information, its
unresponsive to stress, and does not get distracted
- Artificial intelligence (AI) is defined as the aptitude exhibited by smart machines broken
down into perceiving, thinking , planning , learning and the ability to manipulate objects, so the
concepts and development of AI defined as computer systems able to perform tasks that
usually require human intelligence (English Oxford, 2018)
- Through that AI can enhance and expedite the critical component of nursing care delivery
namely decision making
- It also includes different types of knowledge:
 Types of Knowledge

1. Uncertainty - epistemic (means relating to knowledge or degree of its validation) situation

involving imperfect or unknown information, this applies predictions of future events
2. Heuristics – are general decision making strategies based on little information yet very often
correct, they are mental shortcut that reduce the cognitive burden associated with decision
making
3. Fuzzy logic- helps solve problem after considering all available data then it takes the best
possible decision for the given input, it has been applied to various fields for control theory to
artificial intelligence, it was designed to allow the computer to determine distinctions among
data which neither true nor false something similar to the process of human reasoning

Discharge Planning – documentation starts with admission and ends with a discharge care plan

- Discharge care planning systems provide for continuity of care from home to hospital and back
to community, another care facility, outpatient department or the home
- provide for continuity of care, starts with admision

Component of a Typical Discharge plan

1. Summary of admission assessment

2. Summary of learning needs that the patient had at discharge
3. Multidisciplinary plan including problems still unresolved and outcomes not met during hospitalization
4. Medications and procedures that the patient must continue
5. Summary of selected patient outcomes that a multidisciplinary team desired as minimal criteria for
patient to have achieved during hospitalization

Advantages of Computerized Discharge Plan

1. Closely coordinated communication among healthcare providers which can result to up to date discharge
plan that can be sent home with the patient or to different institutions
2. Also a computerized discharge plan can be used for other purposes beyond direct care such as quality
assurance, auditing, research and coding at discharge for perspective payment

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Module 3: CRITICAL CARE APPLICATION (Topic 2)

Critical Care Nursing - is a nursing specialty that deals with human responses to life threatening problems
Critical Care – is a multidisciplinary healthcare specialty, it does not only involve nursing discipline, it
involves other disciplines as well, that cares for patients with acute life threatening illness or injury
Critically Ill Patient – is someone who is physically unstable with real or potential life threatening health
problems, and this patient requires continuous, intensive assessment and interventions
Clinicians – in this type of care integrate data coming from monitoring devices like hemodynamic devices or
physiological monitors, mechanical ventilators, respirators, bedside testing devices, and observations also form
direct patient assessment to form comprehensive picture of patients status and the effect of care

IT Capabilities and Applications in Critical Care Settings

-process, store and integrate physiologic and diagnostic information from various sources
-present deviations from preset ranges by an alarm or alert, if there is something wrong with the device, or vital
signs of the patient
-accept and store patient care documentation in a lifetime clinical repository
-trend data in a graphical presentation, ECG or Cardiac monitor
-provide clinical decision support through alerts, alarms and protocols
-provide access to vital patient information from any location, both inside and outside of the critical care setting
-comparatively evaluate patients for outcomes analysis
-present clinical data based on concept-oriented views
-also through information technology or software application or information system data can be organized by
patient problem or by system
Data Connectivity Infrastructure
- in Critical Care Set-up, there is also a possibility that data from the bedside monitoring devices can be send to
essential monitor at the station, so that by just sitting there, the nurse can look at the different conditions of the
client and checking also the physiologic indexes even if the nurse will not visit the patient in their respective
area, so we call that (Data Connectivity Infrastructure)
-the term medical information bus (MIB) is used to classify the backbone of information exchange,
allowing data to be moved from one point to another
- bedside monitoring devices are capable of sending information to software applications
-used to send the workload generated by the patient care devices such as monitors, ventilators, infusion
pumps, etc. in modern critical care setting

Physiologic Monitoring Systems – gather physiologic data

- Measure and display waveform, and also numerical data for various parameters like ECG,
Respiratory rate, blood pressure, body temperature, arterial hemoglobin, oxygen saturation,
mixed venous oxygen saturation, and cardiac output,
- continuous monitoring is a valuable tool helps provide additional information to the medical
nursing staff about the physiological condition of the patient
- Using this information , the clinical staff can better evaluate a patient’s condition and make
appropriate treatment decisions
History of Physiologic Monitoring Systems
- 1960s: the systems were developed by NASA to oversee the vital signs of astronauts
- 1970s: the systems found in hospital setting replacing the manual methods of gathering
patients’ vital signs; but the early systems were large and cumbersome and had limited
capacity
- 1980s: the technology became cheaper, smaller and significantly more powerful which
really improved the over-all patient monitoring capabilities
- 1990s: the development was focused on the integration of monitoring data into information
systems

5 Basic Components of Physiologic Monitoring System

A. Sensor: the instrument that is coupled to the patient that transforms the physiologic signal such
as temperature, pressure, and ionic current (charged group of atoms) into an electrical signal that can
be directed by the monitor; examples are ECG, electrode, pressure transducer

B. Signal Conditioner: amplifies or filters the display device; devices that convert one type of electronic
signal into another type of signal primarily used to convert a signal that may be difficult to read by
conventional instrumentation into a more easily read format; examples are amplifier, paper recorder and
oscilloscope/o-scope/scope (shows signal voltages and used to observe the exact wave shape of
electrical signal, displays the waveform of the heartbeat such as in the ECG)

C. File: ranks and orders or holds information; examples are alarm signal and storage file

D. Computer Processor: analyzes data and directs reports, it also analyzes information, stores pertinent
information in specific place and controls the direction of the reporting; examples are paper reports,
storage for graphic files and summary reports

E. Evaluation of Controlling Component: regulates the equipment or alerts the nurse; examples are
notice on the display screen and alarm signal

Hemodynamics- term refers to forces which circulate the blood through the body, is used to describe the
intravascular pressure (inside the blood vessel) and flow that occurs when the heart muscle contract and
pumps blood throughout the body, main focus is the heart’s function, the vascular system, including veins,
arteries, are closed circuit, meaning pressure and flow variations in the venous compartment will necessarily
affect the arterial compartment and vice versa
Hemodynamic Monitors
- allow for calculation of hemodynamic indices (e.g. cardiac output, pulmonary artery pressure, O2Sat,
mean arterial pressure, etc) with limited data storage
 -Hemodynamic measurement is a minute to minute pressure and flow variation that occurs within and
between our arterial and vascular compartments
-the expert collection and analysis of qualitative and quantitative data of cardiopulmonary functions
-include clinical observation, the use of electrical photometric, pressure transducing equipment, and
other non-invasive devices, as well as the application of several intravascular catheters
Hearts Function
- Heart’s functions is the main focus of hemodynamic studies, the heart is not only the factor
influencing pressure and flow

I. Factors that influence hemodynamics :

1) intravascular volume – the amount of fluid circulating in within the blood vessel or in the
vasculature
2) inotropy – refers to the force or strength of the myocardial contraction
3) Vasoactivity – refers to the expanding and contracting of blood vessels to accommodate variation in
blood flow, regulate arterial pressure and meet the metabolic demands of organs and body tissues
4) chronotropy – the timing or the rate of heart’s contraction
II. Common Values Associated with Hemodynamics:
1) Afterload – describes the resistance that the heart has to overcome during every beat for the heart to
send blood into Aorta , may refer to the pressure found into the Aorta or the systemic circulation
2) Cardiac Output – refers to the volume of the blood pumped by the heart every minute, an
increased cardiac output may indicate a high circulating volume, a decrease may indicate low
circulating volume or a decrease in the strength of ventricular contraction
3) Central Venous Pressure – is used to approximate the right ventricular end diastolic pressure
which intern assesses the right ventricle function and general fluid status , increase CVP may
indicate over hydration or maybe increased venous return or right sided heart failure, decrease in
CVP may indicate hypovolemia, decrease in blood volume ,or decrease venous return
4) Mean Arterial Pressure – reflects changes in the relation between the cardiac output and systemic
vascular resistance, this reflects the arterial pressure in the vessels perfusing the organs; increased
values indicate increased cardiac workload, and decreased values indicates decreased blood flow
through the organs
5) Preload – refers to the combination of pulmonary blood filling the atria and the stretching of the
myocardial fibers, refers to the force of blood flow that stretches the ventricles prior to contraction
6) Pulmonary Artery Pressure – the blood pressure in the pulmonary artery; high pap may indicate
left to right cardiac shunt or pulmonary artery hypertension or due to COPD/emphysema,
pulmonary embolus (blood clot in the pulmonary vasculature) or pulmonary edema
7) Stroke Volume - refers to the volume of the blood ejected by the heart per beat
Uses of Hemodynamic Monitors
-measure hemodynamic parameters like pulmonary artery pressure, cardiac output, O2Sat
-closely examine cardiovascular problems
-evaluate cardiac pump and volume status
-recognize patterns and extract features like arrhythmia analysis
-assess vascular system integrity
-evaluate the patient’s physiologic response to stimuli
-continuously assess respiratory gases like CO2
-continuously evaluate blood gases and electrolytes like sodium, magnesium, potassium
-estimate cellular oxygenation
-continuously evaluate glucose levels
-automatically transmit selected data to a computerized patient database

Examples of Hemodynamic Monitors:

1. Non-invasive Hemodynamic Monitors – less risky, less dangerous
a. Oscillometric techniques: the standard method for automated blood pressure measurement,
place the cough around the patient’s arm and the cuff bladder is inflated until the external pressure
exceeds the intra-arterial systolic pressure and arterial flow pass the cuff and its seizes, digital
sphygmomanometer
b. Pulse Oximetry: used to measure the oxygenation specifically SaO2 (or the level of oxygen
saturated in the artery, refers to the degree to which the hemoglobin in our red blood cells has
bonded with oxygen molecules) = 95-100%, below 90% are considered low
 - PaO2 is the pressure of oxygen in the artery, normal is 80-100 mmHg
c. Doppler: used to measure the cardiac output in a variety of different ways all based on the
measurement of blood velocity at some point in the circulation

2. Invasive Hemodynamic Monitors

a. Pulmonary Artery Catheter : used to measure pulmonary artery and wedge pressures,
common catheter used in the Swan-Ganz catheter, is only for diagnostic purpose, only for
detection of heart failure or sepsis, evaluation of hypovolemic, fluid status, cardiac output,
prophylactic condition for high risk surgeries
- allows for direct and simultaneous measurement of pressure in the right atrium, right ventricle,
pulmonary artery and the filling pressure of the left atrium
- potential complications includes infection, hemorrhage and embolism
- because it’s risky, so the safe and appropriate measures were questioned by
- (PACCO) pulmonary artery consensus conference organization – organization that ensures the
safety and correct usage of pulmonary artery catheter ; an organization made up of professional
nursing and medical societies; according to this organization, it’s appropriate to use PAC when
either conventional hemodynamic therapies have not produced desirable results or
hemodynamic therapies require the monitoring provided by the pulmonary artery
catheterization
b. Thermistor or Thermodilution: used to measure cardiac output though accuracy is high user
dependent, what happens in this procedure is that a bolus of a known solution and volume is
ejected into the right atrium and the result change in the body temperature is detected by a
thermistor which was previously placed in the right atrium with a pulmonary catheter
c. Fiber-Optic Technology: used to measure mixed venous oxygen saturation

Critical Care Information System (CCIS)

- designed to collect, store, organize, retrieve, and manipulate all data related to care of the critically ill
patient
- focused on individual patients and the information directly related to patient’s care
- primary purpose: organization of patient’s current and historical data for use by all care providers
in patient care
- the power of modern CCIS integrates information from a variety of sources and also to manipulate
information into meaningful ways
- includes data and information from bedside devices, results from ancillary departments,
medications, orders, physical assessment findings gathered from the clinical team and comprehensive
plans of care to guide patient care, the integration of these data results in a more complete representation
of patient’s status and can promote safety, quality and efficiency patient care

Components of CCIS
1. Patient Management - admission, transfer, and discharge data from the information system
of admission’s department
- prognostic scoring systems to assess the severity of illness of critically ill patients
- healthcare organization’s system to schedule patient care activities, treatments, and diagnostic
testing
2. Vital Signs Monitoring - vital signs and other physiologic data from bedside instruments that are
automatically acquired from bedside instruments are incorporated into the clinical database
- interfaced to monitoring system like the cardio hemodynamic flow sheet which collates vital
sign data, performs calculations, and summarizes critical therapies that may have influenced the
patient information
- graphic displays of most data in the clinical database can be constructed; these displays may be
preconfigured or may be developed dynamically as needed
- groups of information display for easy viewing and trending
- monitor and device data are interfaced to CCIS flow sheet along with ventilation parameters
3. Diagnostic Testing Results - results are displayed in flow sheets (laboratory, radiology, and cardiology)
- clinicians can access picture archival information
4. Clinical Documentation to support the process of physical assessment findings
- patient assessment flow sheets and organized by body system (neurologic flow sheet- can provide
comprehensive picture about patient)
- all disciplines can document patient assessment findings into the CCIS
- alerts automatically generated for patients at risk for falls, pressure ulcers and other factors
- automatic calculations of physiologic indices, patient acuity, classification, productivity measures
and other indicators
5. Decision Support - provides alerts and reminders to guide care in accordance with evidence
- based guidelines such as required documentation, protocols on restraint management, pain
management, and ventilator weaning-point-of-care access to knowledge bases that contain
information on evidence
- based guidelines of care, drug information, procedures, and policies can guide decision
making to improve quality and safety
- can be integrated with data information gathered outside of the critical care episode for outcome
analysis, performance improvement effort and to aide also a research
6. Medication Management - use of bar code scanning and electronic medication administration
- medication administration flow sheets
- calculation of IV medications dosage, IV flow rates, hyper alimentation (a procedure in
which nutrients and vitamins are given to a person through liquid form through a vein),
aminoglycoside dose and total intake/output schedules
7. Interdisciplinary Plans of Care - supports multidisciplinary documentation and planning of patient care
- special flow sheets incorporating required treatments and interventions
- workflow management solutions that help arrange all the numerous, simultaneous processes patient
care, this is by pushing task to individual work lists monitoring to ensure each task is completed
8. Provider Order Entry - electronic entry and communication of patient orders combined with rules
and alerts related to evidence-based care
- order set displays to guide clinicians to adhere to evidence based medical practice
- integration of provider order entry with interdisciplinary plans of care that generate patient
- focused work lists to guide the entire clinical team towards a common goal
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Module 3: COMMUNITY HEALTH APPLICATIONS (Topic 3)

Community Health Nursing – a synthesis of nursing practice and public health practice applied to promote
and preserve the health of populations

- focus is on population as a whole

- standards: incorporate health promotion, health maintenance, health education, health
- a unique blend of nursing and public health practice woven
- ultimate goal is to raise the level of health of the citizenry

Computer Application

CHN System Development – CHN agencies have used computers since the late 1960s when computers
were introduced into the healthcare industry

- early systems focused on regulatory compliance, billing applications, and statistical reporting
related to community health which encompasses public health and home health compliance,
there were not used to deliver care
- the changing health care trends have been the impetus for increasingly sophisticated
management information systems
- advancements led to four domains of concentration which directed management
information systems for practice:

Public Health – focused on population interventions and the outcomes related to epidemiologic and/or
mortality or morbidity trends

Home Health – focused on skilled nursing care for individuals in the home and the outcomes related to
care delivery for individuals or aggregated populations

Special Population Community Practices – focused on specific diagnostic care and/or treatment
needs and the outcomes related to care delivery for individuals, diagnostic groups, and/or aggregated
populations

Outpatient Care – focused on intermittent, episodic, or preventive care for individuals and the outcomes
related to interventions for individuals and/or aggregate groups

Public Health – defined by the Institute of Medicine (IOM) as coordinated effort at different levels whose
mission is to fulfill society’s interest in assuring conditions in which people can be healthy
 -focus of public health professionals prevent, identify, investigate, and eliminate community health
problems assure that the community has access to competent personal healthcare services educate
and empower individuals to adopt to healthier behaviors

Clinical Care Classification (CCC) System - previously known as the HHCC system
- a standardized language/vocabulary consisting of two interrelated taxonomies
- the CCC of nursing diagnoses and CCC of nursing interventions
- designed to document, code, and classify for computer
- processing patient care in any clinical setting by any healthcare provider using a standardized
framework
- used to electronically track and analyze patient care over time, across settings, population groups and
geographic locations
- uses the nursing process for its conceptual model with different labels for its 6 phases care components:
(assessments) diagnoses/problems; (diagnosis) expected outcome; (outcome identification) nursing;
interventions (planning); type of action (implementation); actual outcome (evaluation)

2 taxonomies - classified according to care components:

A. CCC of Nursing Diagnoses – consists of 182 nursing diagnoses and/or patient problems which use 3
modifiers: improve patient’s conditions, stabilize patient’s conditions and support patient’s
deteriorating condition
B. CCC of Nursing Interventions – consists of 198 nursing interventions/services which use 4
modifiers: assess or monitor, care or perform, teach or instruct and manage or refer

Community Health Systems - refer to computerized IT systems specifically developed and designed for
use by community health agencies, local and state health departments, community programs, and services-
address the broad areas of healthcare programs, agencies and settings

- support health promotion and disease preventive programs, statistical information required
by health department programs in different levels, and funding information
- assist community health agencies in the decision
- making processes for the management of nursing facilities
- used to evaluate the impact of no institutional nursing services on patients, families, and
community health conditions

Some of typically used systems on community health:

a. Categorical Program Systems -designed to support data processing and tracking specific
programs such as cancer detection, mother and child immunization, and/or family planning
- collect uniform longitudinal data for a specific disease condition like diabetes that can be used for
national databases for tracking incidence and prevalence of disease conditions
b. Screening Programs – used to detect individuals afflicted with a specific disease or predisposing
health condition
- generally, use computer system to collect important health information that may be mandated by
different levels
- results are tracked so that data analysis can be used to measure the effectiveness of the
screening program
c. Registration Systems – designed to identify patients eligible for CHN services in clinics and
homes-can be accessed from local/district units prior to providing services
d. Management Information Systems – focus on the management of statistical and operational needs
of the agency and professionals
e. Statistical Reporting – developed to collect and process statistical information for health
departments such as epidemiologic and immunization data
f. Special Purpose System – developed to collect statistical data for administering a specific program,
regardless of what type of agency offers the program
g. Public Health Information Network – enables consistent exchange of response, health, and disease
tracking data between public health partners through defined data and vocabulary standards
- 5 key components: detection and monitoring, analysis, information resources and knowledge
management, alerting and communications and response
 Module 4: INTERNATIONAL PERSPECTIVE (TOPIC 6)

Asia and South Africa

IMIA –associations of associations

- Pr

Nursing Informatics in South Africa – very large public sector and small private sector

I. Intended Learning Outcomes

Discuss the history of nursing informatics in South Africa and identify problems of implementing the computerization in
a resource-constrained environment.

II. Introduction
- In 1978, an International Medical Informatics Association (IMIA) working conference was held in Cape Town
on hospital information systems, led by Dr. Marion J. Ball.
- 10 years later, in 1988, the first nursing informatics workshop was held in Rustenburg which was attended by a
number of nurses keen to take on the specialty of nursing informatics.
- The Western Cape province of South Africa was, at that time, the focus area for health informatics,
with an informatics department being established at the Groote Schuur Hospital, which has active participation
from its members.
- At MEDINFO 95 , a paper was presented titled, “Recognizing Nursing Informatics”, which emphasized the
need for nursing informatics to be separated from medical informatics.
- Sadly, the status quo remains, with no further advancement in the South African nursing informatics
environment. However, there has been very little progress as far as nursing informatics is concerned.
- NI is defined as combining healthcare, information science, and computer science, and if that is anything to go
by, South Africa sure has a long way to go, regarding career paths and implementation of the specialty.
- The emphasis currently is to find enough nursing and medical staff to provide the basic healthcare, and
although there are hospital information systems in certain hospitals, the staff implementing the systems could
be from any discipline in the hospital, not necessarily having nursing or medical staff having input into the
implementation.
- SAAHIA

III. Content/Concept

Nursing Education- the national strategic plan for nursing education, training and practice was launched in
February 2013 which deals with the assignment for nurses, and specifies the requirements for the various
categories of nurses

- nursing education in the country offers 3 main programs: a 4-year nursing degree, a 4-year nursing
diploma, and the 2-year enrolled nurse’s course
- the new curriculum includes some hours of computer usage providing basic training-the government is
encouraging computer training by providing training courses, but there’s a little chance of practice as when
the nurses return to their place of work, there are no computers available for them to work on and
become proficient
- NI is not mentioned in any list of nursing specialties, and thus there are no specific qualifications,
although post-graduate qualifications in medical or health informatics and telemedicine are offered at
certain universities eHealth Strategy
- in 2012, the government released the document, “National eHealth Strategy, South Africa 2012-2016”,
which details the strategy to reach the vision of “enabling a long and healthy life for all South Africans” with
the aims to support the medium term priorities of the public health sector, pave the way for future public
sector eHealth requirements, lay the requisite foundations for the future integration and coordination of all
eHealth initiatives in the country (both public and private sectors)

Asia – very vibrant and diverse region, socio economy, forty nine sovereign countries

Japanese, Chinese, Korean - each syllable occupies 2-bytes

English – single byte in computer memory

Helath informatics in Asia- correlates with socioeconomic government

Overview

-computers were introduced into the healthcare sectors of Asian countries in 1970s

-first applications if IT on healthcare in Asian countries: administration, billing and insurance

- government have played a vital role in introducing IT into healthcare sector

In most Asian countries, computers were used in nursing during the early

APAMI

- Asia-pacific Association for Medical Informatics

- Established in 1993 as IMIA regional member of IMIA to promote regional cooperation and development of
health informatics
- Actively promotes telemedicine )exchange of medical information from one location to another ), bioinformatics
)according to Merriam web, refers to the collection, classification , storage and analysis of biochemical and
biological , and public health informatics
- Addresses public health informatics, research and development such as informatics deployed

South Korea

- The use ofcomputers started in the late 1970s in hospital finance and administration systems
- The national health insurance system expanded to cover the whole population
- MEDINFO98 and NI2006 conferences held in Seoul provided excellent opportunities for Korean nurses to
become acquainted with nursing informatics at the global level )theme was consumer center
- Computing in healthcare becoming a popular issue
- Telemedicine continues to grow with the increasing numbers of elderly

KOSMI – Korean Society of Medical Informatics

- Serevs as a form for both academicand industrial scientist in health informatics

- Established by leaders in academia and industry of healthcare informatics fields to meet the demands for
advancing

JApAN

- Began asy access to healthcare

- Began to pay attention to the use of computers in health care duringthe late 1970’s
- Hosted the MEDINFO80 and during this time the Japanese Association of the Medical Informatics )JAMI)was
founded, aims to support health informtaics in this country
- E-Japan strategy

CHINA

- China Medical Inforatics Association

- Other professional societies related to medical ifromatics: Chinese Society of Medical Information under the
China Medical Assocition
- Many nursing schools in Taiwan provide NI courses and some have set up NI programs
- HongKong hospitals have a well-established clinical management

Future Directions

- Expand the role of the informatics nurse specialist

- Strengthen

Philippines

- The Philippine Nursing Informatics Association ) pNIA is sub-specialty of specialty of Philippine Nurses
Association ) pNA)
- - pnia envisions to advance nursing informatics in the philippines
 --------- End ---------

NI LABORATORY

Module II: Hospital and Health Information System (Topic 1)

- Today, hospitals are adapting information technology as a vital solution in the automation of
hospital management processes to be faster and be made easier
- Being one of the solutions, it plays a vital role in digitalizing the healthcare industry, technology
today is rapidly becoming the game changer and improving the way healthcare is delivered across
the globe
- Surveys indicates that providers increasing their investments, both private and public sectors have
engaged in numerous efforts to promote the use of information technology within healthcare
institutions
- Health information technology encompasses a broader range health IS may include hospital IS
- Health information system may include broader range than the hospital information system because
this is included already in health information system; hospital IS only includes hospitals and health
associated clinics
- Health information system refers to a system designed to manage healthcare data, this includes
systems that collects, store, manage and transmit a patients electronic medical record (EMR), a
hospitals management or a system supporting healthcare policy decisions, it does not only transmit
medical record but as well as the operational management of the hospital
- Health information system also include those systems that handle data related to the activities of
providers and health organization, so as an integrated effort, this may be leverage to improve patient
outcomes, inform research and influence the making of the policies and decision making in the
hospital

Hospital Information System (HIS) – an application software used by healthcare organizations to simplify
clinical, financial and administrative processes

- Facilitates the seamless flow of data across various departments of hospitals, it also helps them to
do their jobs more effectively in a paperless manner
- Enables physicians, management and authorized users to share data and streamline processes across
an organization
- It is a computer system that can manage all the information related to healthcare providers allowing
them to do their job effectively; in most hospitals, software systems used by nurses are based in a
hospital information system, it is a multipurpose program designed to support many applications in
hospitals and their associated clinics
- It is also known as “Hospital Management Software” or “Hospital Management System”

HISTORY OF HIS

1960s: computers and storage were large and expensive; hospitals usually shared their networks with each
other; hospital accounting systems where the main thing back in the 1960s

1980s: HIS began to improve; smaller and much cheaper and quicker computers; hospitals were able to get
large amount of information from both clinical and financial systems

2000s: technology has advanced; hospitals created applications that would assist in commercial and real-time
decisions; the software had become much more accessible this is due to the widespread use personal computers
form the smallest

Health Information System – refers to a system designed to manage healthcare data, these data includes
systems that collect, store, manage and transmits a patient’s electronic medical record (EMR), hospitals
operational management or a system supporting healthcare policy decisions

- includes systems that handle data related to activities of providers and health organizations, as an
integrated effort, this may be leverage to improve patient outcomes, inform research and influence
the policy making and the decision making of the healthcare providers
 - Because Health information systems commonly access, process or maintain large volumes of
sensitive data, security is of primary concern

Key Components of a Health Information System

1. Resources – includes the legislative, regulatory and planning frameworks required for system to
function properly
- This includes the personnel, financing, logistics, support, information and communication technology
(ICT), also mechanisms for coordinating both within and between the 6 components
- Prerequisites that need to be in place for a health information system to function includes legal and
policy frameworks which are in place supported by sufficient human and financial resources,
infrastructure and others
2. Indicators – complete set already, these are signpost of change along the path to development, they
describes the way to track intended results and are critical for monitoring and evaluation
- Good performance indicators are a critical part of the results framework
- Core health indicators include determinants of health, health system inputs, outputs and outcomes, and
health status which includes the morbidity and mortality
- Health indicators should be valid, reliable, specific, sensitive, feasible or reachable, accessible and
affordable to measure, they must be relevant and useful for decision making processes
3. Data Sources – these are key data available form 6 main sources such as your census, vital events
monitoring, health facilities statistics, public health surveillance, population based-surveys, resource
tracking and standards for their use, household surveys, civil registration, vital statistics (morbidity and
mortality rate), health facility and community information system, disease surveillance, health systems
data and non-health sectors sources
4. Data Management – optimal processes for collecting, sharing and storing of data as well as data flows
and feedback loops
5. Information Products – these are accurate and reliable data which are available for health status, health
systems and determinants of health
6. Dissemination and Use – dissemination of information and effective use of data for advocacy, planning
and decision making

Examples of Health Information System

1. Electronic Health Record – includes health data, test result, and treatments and designed to share
data with other EHRs so that other healthcare providers can access a patient’s healthcare data, this is
being interchangeably with electronic medical record (EMR) which replaces the paper version of a
patient’s medical history
- it includes health data of the patient, test results in the laboratory and treatments
2. Practice Management Software – helps healthcare providers manage daily operations such as
scheduling and billing; healthcare providers form small practices hospitals use this to automate many
of the administrative tasks
3. Master Patient Index – connects separate patient records across databases; contains a record for
each patient that is regis00tered at a healthcare organizations and indexes all other records for the
patient
- These are used to reduce duplicate patient records and inaccurate patient information that can
lead to claim denials
4. Patient Portals – allows patients to access their personal health data such as appointment
information, medications and lab results over an internet connection
- Some patient portals allow active communication with their physicians through telemed or
telehealth, their ability to accept appointments through online
5. Remote Patient Monitoring – allows medical sensors to send patient data to healthcare
professionals, it frequently monitors blood glucose level and blood pressure with patients with
chronic conditions; data are also used to detect medical events that require interventions and possibly
become part of a larger population health study
6. Clinical Decision Support – analyzes data from various clinical and administrative systems to help
healthcare providers make clinical decisions, the data can help prepare diagnosis or predict medical
events such as drug interactions, filter data and information to help clinicians care for individual
patients

Benefits of Health Information System

 1. Data Analytics – healthcare industry constantly produces data, HIS help gather, compile and
analyze health data to help manage population, health and reduce healthcare cost
- Healthcare data analysis can improve the patient care
2. Collaborative Care – patient is often receiving treatments from different healthcare provider, HIS
such as the Health information exchanges allow healthcare facilities to process common health
records
3. Cost Control – using digital networks to exchange healthcare data creates efficiencies and cost
savings so when regional markets use the heath information exchanges to share data, healthcare
providers may reduce cost
- On a smaller scale, the hospitals aim for the same efficiencies with electronic health record
4. Population Health Management – information systems can aggregate patient data, analyze them
and identify trends in populations, the technology also works in reverse, clinical decision support
systems can use big data to help diagnose individual patients and treat them

Module II: System Life Cycle (Topic 2)

System Life Cycle – this focuses on tasks that multiple discipline must accomplish to produce technically
sound and regulatory complaint and user friendly system (wherein it is safe, effective, and efficient care
delivery) task not only nursing discipline must accomplish but also other disciplines in (when you want to
create a device there should be different disciplines involved),nurses do not create the system but we will be the
ones to manipulate it.

Regulatory complaint – system should uphold rules and regulations. Code of ethics by the
International Council of Nurses. The use of technology must be about patient safety and use of
technology. Should not be harmful and uphold patient’s safety and dignity.

- Creating a system implementation, evaluation analyzing doing all the phases and the steps in
the SLC
- These involves more than one discipline
- List of tasks that multiple disciplines must accomplish to produce
technically sound, regulatory compliant, and user-friendly system EHR*
- consists of four major phases: planning; analysis; design, develop and
customize; and implement, evaluate, support and maintain
- To support safe, effective, and efficient information system and patient
care delivery.

Electronic health record – A longitudinal electronic record of patient health

information generated by one or more encounters in any care delivery setting
included in this is patient demographics, progress note, medications, and vital
signs, past medical history, immunizations, lab data, radiology reports and
others.
- Automates and streamlines the clinician’s workflow
- Has the ability to generate a complete record of a clinical patient encounter
as well as support care related activities directly or indirectly via the
interface
- Skills required to deliver direct patient care include the ability to
understand and coordinate the work of multiple disciplines and
departments and as multiple departments work in concerned for optimum
and safe patient care delivery, the components of EHR integrate data in a
coordinated fashion to provide an organization’s administration and
clinician’s demographic, financial and clinical info. SLC provides a
framework to attain a successful implementation not only of EHR but also
of other information systems.
Evidence-based medicine -Systematic approach to clinical problem solving
which allows the integration of the best available research evidence with clinical
expertise and patient values.
- 3 pillars of evidence-based medicine: clinical expertise, patient values
and preferences, and best research evidence.
- In the last 20 yrs, the term EBM has been increasingly applied in all areas
of medicine and is often use for decision making in the medical and public
health sector. It is also used to verify significance or effectiveness of other
therapies.
- Original definition of EBM rests on the 3 pillars.
 - The conscientious, explicit, and judicious use of current best evidence in
making decisions about the care of individual patients
- Its purpose is to utilize scientific studies to determine the best
course of treatment Technology: Cost, Benefit, and Risk
- Technology costs are high and increasing the risk of significant financial
losses if information system purchase has a poor implementation.
- The success of an information system project often rests on a well-planned
and well-executed implementation
- A well-planned implementation dovetails an organization strategic goals
and culture with introduction of and ability to assimilate technology and
workflow changes into daily practice of healthcare delivery
- SLC provides a structured implementation approach to accomplish a well-
planned and well-executed implementation on the other hand provides a
high level of risk medication and cost containment.
- It’s important to remember that technology is not the best solution to every
problem and failure to recognize problems caused by inefficient processes
from an information system, problems contributes to risk and potential
costs of a system.

1st phase of SLC: Planning

- Begins once an organization has determined an existing requirement may
be filled or solved by the development of implementation of EHR or
application
- Key documents created in this phase: Project governance structure,
Gap analysis, definition of the project’s goals/purpose, feasibility study,
environmental assessment, project scope document and timeline,
development of a high-level work plan and resource requirements.

a. Project governance structure: clinical leadership of an organization is

highly involve in the establishment of committee structure and also the
organization strategic goals and priorities must be reviewed and
considered.
b. definition of the project’s purpose or goal: is essential and often
readily apparent not until all the information requirements of the project or
the stated goals and outcomes are precisely defined with the real
characteristics of the requirements be revealed.
- Defining goals/ purpose is important. Take into consideration what we
really want to happen.
c. Feasibility study: preliminary analysis to determine if the proposed
problem can be solved by the implementation of an electronic health
record or component application.
- not only clarifies the problem or the stated goal but also it helps identify
the info needs, objectives, and scope of the project.
- helps the committee understand the real problem and the goal by
analyzing multiple parameters and by presenting possible solutions.
d. Environmental assessment: project is defined in terms of support. It
provides to both the mission and strategic plans of the organization.
Consider the impact of legal regulatory and ethical considerations.
e. Scope of the proposed system: establishes a system constraints and
also outlines what the proposed system will and will not produce. Include in
the scope are the criteria by w/c the success of the project will be judged.
f. Project timeline: developed providing an overcome of the key milestone
events of the project and the projected length of time for each major phase
of the project is establish.

2nd Phase of SLC: Analysis

- The fact-finding phase
- All data needs related to the requirements are defined in the project scope
agreement developed in this phase
- Key documents created in this phase: gap analysis; technical
requirements for hardware, software, networks; functional design
document; system proposal document
a. Gap analysis: comparison of what is available in the current processes
and what is desired in the new system
 Analysis has 3 steps:
 1. Collection of data reflecting the existing problem or goal and 2 important
documents are created as a result of data collection
- creation of a workflow document for each major goal or problem to be
resolved by the implementation of the new software system or new system.
- Functional design document outlining how the new system will result the
identified goals or problem.
2. Analysis of collective data – provides a data for development of an
overview of the clinical requirements and/or stated goal defined in the
project scope agreement.
3. Review the data

3rd Phase of SLC: Design, Development & Customization Phase

Design - details to develop the system and the detailed plans for
implementing and evaluating the system*
- Policies and procedures are reviewed and updated
- Thorough testing of the new system and detailed plans are executed

4th Phase of SLC: Implement, Evaluate, Maintain & Support

- The preparation of documents to describe the system for all users is an
ongoing activity
- Documentation should begin with the final system proposal
- Manuals are prepared
- 3 Manuals prepared: User’s manual, reference manual, operator’s
maintenance manual. These manuals provide guides to the system
components and outline how the entire system has been developed.

Summary/ Main Points

Process of designing, implementing, and/or upgrading a clinical information
system/EHR in a patient care facility
Four phases of SLC process – planning, system analysis, system design,
development, implementation, and evaluation and system maintenance and
support* *the upgrading process reviews all of the components described to
assure and ensure a technically sound regulatory complete implementation
supporting safe patient care and streamline workflow.
The planning phase determines the problem scope and outlines the entire
project and also to determine if the system is feasible and worth developing or
worth implementing.
The analysis phase assesses the problem being studied through extensive
data gathering and analysis
The design phase produces detailed specifications of the proposed system;
development involves the actual preparation of the system, support of
workflow, review of policies and procedures w/c impacted by the new system
and detailed implementation planning.
Training focuses on the use of the system to improve everyday workflow
Implementation outlines the detailed plans for moving the new system into
the production or live environment
Evaluating the system determines the positive and negative results of the
implementation effort and suggests ways to improve the system
Upgrading the system involves expansion or elaboration of initial functions*
*Upgrading projects requires all implementation phase to be review to assure
success.

MIDTERM QUIZ #1 A N S W E R K E Y 0CTOBER 17, 2020

Instruction: PLEASE ANSWER THE FOLLOWING QUESTIONS BASED ON MY LECTURE ON

HOSPITAL/HEALTH INFORMATION SYSTEM.

1. The year when hospitals were able to get large amount of information from both clinical and financial
systems. 1980s
2. It refers to systems that handle data related to activities of providers and health organizations. HEALTH
INFORMATION SYSTEM

3. 3-5 Give examples of HIS:

Master Patient Index (MPI), Medical Billing Software, Patient Portals, Health Information Exchange (HIE),
Activity Based Costing (ABC), Remote Patient Monitoring (RPM), Scheduling Software, E-Prescribing
Software, Laboratory Information Systems, Hospital Patient Administration Systems (HPAS), Electronic Health
Record, Practice Management Software

6. They are signposts of change along the path to development. INDICATORS

7. 7-12 Six main data sources

7. CENSUSES

8. VITAL EVENTS MONITORING

9. HEALTH FACILITY STATISTICS

10. PUBLIC HEALTH SURVEILLANCE

11. POPULATION-BASED SURVEYS

12. RESOURCE TRACKING

13. True or False. Health indicators should be broad, valid, reliable, sensitive, and affordable to measure.
SPECIFIC

14. They are prerequisites that need to be in place for a health information system to function. RESOURCES
15. Refers to optimal processes for collecting, sharing, and storing data, as well as data flows and feedback
loops. DATA MANAGEMENT

16. Information products are accurate and reliable data available for HEALTH STATUS, 17. HEALTH
SYSTEMS, 18. and DETERMINANTS OF HEALTH/HEALTH DETERMINANTS.

19. One of the key components of the Health Information System is the dissemination of information and
effective use of data for advocacy, PLANNING, 20. and DECISION-MAKING.

21. It includes health data, test results, and treatments. ELECTRONIC HEALTH RECORD (EHR)

22. It helps healthcare providers manage daily operations such as scheduling and billing. PRACTICE
MANAGEMENT SOFTWARE

23. It contains a record for each patient that is registered at a healthcare organization. MASTER PATIENT
INDEX

24. It allows active communication of patients with their physicians, prescription refill requests, and the ability
to schedule appointments. PATIENT PORTALS

25. They are used to reduce duplicate patient records and inaccurate patient information that can lead to claim
denials. MASTER PATIENT INDEX

26. It allows patients to access their personal health data. PATIENT PORTALS

27. It enables medical sensors to send patient data to healthcare professionals. REMOTE PATIENT
MONITORING

28. Analyzes data from various clinical & administrative systems to help prepare diagnoses or predict medical
events. CLINICAL DECISION SUPPORT

29. It uses digital networks to exchange healthcare data creates efficiencies and cost savings. COST CONTROL

30. A benefit of Health Information System that allows healthcare facilities to access common health records.
COLLABORATIVE CARE
NURSING INFORMATICS LABORATORY

MIDTERM QUIZ #1 A N S W E R K E Y 0CTOBER 31, 2020

Instruction: PLEASE ANSWER THE FOLLOWING QUESTIONS BASED ON MY LECTURE ON

SYSTEM LKFE CYCLE.

1. It automates and streamlines the clinician’s workflow. ELECTRONIC HEALTH RECORD

2. Its goal is to utilize scientific studies to determine the best course of treatment. EVIDENCE-BASED
MEDICINE

3. A systematic approach to clinical problem-solving that allows the integration of the best available
research evidence with clinical expertise and patient values. EVIDENCE-BASED MEDICINE

4. It gives support to other care-related activities directly or indirectly via interface. ELECTRONIC
HEALTH RECORD

5-9. Give at least 5 of the patient’s information included in the electronic health record
DEMOGRAPHICS, PAST MEDICAL HISTORY

6. PROGRESS NOTES, IMMUNIZATIONS

7. PROBLEMS, LABORATORY DATA

8. MEDICATIONS, RADIOLOGY REPORTS

9. VITAL SIGNS

10. What happens when the technology costs are high?

INCREASES THE RISK OF SIGNIFICANT FINANCIAL LOSSES FROM A POOR

IMPLEMENTATION

11-12. Modified True or False. Write true if the statement is true and write false if the statement is false.
Change the underlined word only if it is false to make the statement true. FALSE

12. A well planned and executed implementation provides, a high level of risk migration and cost
containment. MITIGATION

13. A preliminary analysis to determine if the proposed problem can be solved by the implementation of
an EHR or component application. FEASIBILITY STUDY

14. It begins once an organization has determined an existing requirement may be solved by the
development of an application. PLANNING

15. It is developed providing an overview of the key milestone events of the project. TIMELINE

16. It establishes system constraints and outlines what the proposed system will and will not produce.
SCOPE/SCOPE OF THE PROPOSED SYSTEM

17-18. Modified True or False. Write true if the statement is true and write false if the statement is false.
Change the underlined word only if it is false to make the statement true. FALSE

18. The project is defined in terms of the support it provides to both the mission and specific plans of the
organization. STRATEGIC

19. It is the fact-finding phase of the system life cycle. ANALYSIS 2 / 2

20. A comparison of what is available in the current processes and what is desired in the new system.
GAP ANALYSIS

21. It involves a thorough testing of the new system and detailed plans are executed. DESIGN,
DEVELOPMENT & CUSTOMIZATION PHASE

22. The phase where manuals are prepared which guides to the system components and outline how the
entire system has been developed. IMPLEMENT, EVALUATE, MAINTAIN & SUPPORT
23-24. Modified True or False. Write true if the statement is true and write false if the statement is false.
Change the underlined word only if it is false to make the statement true. TRUE

24. Documentation should commence with the final system proposal. TRUE

25. Policies and procedures are reviewed and updated in this phase of the system life cycle. DESIGN,
DEVELOPMENT & CUSTOMIZATION PHASE