Nursing Informatics Lecture Notes

Nursing InformaticsNursing informatics is a combination of computer science, information science, and nursing science,

designed to assist in the management and processing of nursing data, information, and knowledge to support nursing practice, education, research, and administration (Graves & Corcoran, 1989).

"Information is an essential phenomenon of study for an information-based discipline such as nursing,".

Nursing informatics can be applied to model the human processing of data, information, and knowledge within a computer system in order to automate the processing of nursing data to information and the transformation of nursing information to nursing knowledge.

"In the current Information Age, the doubling of knowledge every five years and the increased specialization of knowledge make it imperative that nurses have access to the latest scientific information to assist in the delivery of high quality care,"(Hudgings, 1992, p.7).

“Nursing Informatics is a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, and knowledge in nursing practice. Nursing informatics facilitates the integration of data, information and knowledge to support patients, nurses and other providers in their decision-making in all roles and settings. This support is accomplished through the use of information structures, information processes, and information technology.” (ANA Scope and Standards of Nursing Informatics Practice, 2001, pg vii)

Computers and NursingHealth and nursing information science is the study of how health care data is acquired,

communicated, stored, and managed, and how it is processed into information and knowledge. This knowledge is useful to nurses in decision-making at the operational, tactical, and strategic planning levels of health care.

Information systems used in health care include the people, structures, processes, and manual as well as automated tools that collect, store, interpret, transform, and report practice and management information.

The realization that health care data and information can be effectively managed and communicated using computer systems, networks, modems and telecommunications has catalyzed the emergence of the science of nursing informatics. As Virginia Saba (1992) predicted, "By the turn of the century, most health care delivery systems will function with computers and will be managed by computer literate nurses. I believe, that by the turn of the century, "high tech and high touch" will be an integral part of the health care delivery system," (p. xv).

At present, nursing informatics is an emerging field of study. National nursing organizations support the need for nurses to become computer literate and versed in the dynamics of nursing informatics. We are at a transition period. Becoming educated in nursing informatics is, for the most party, a self-directed and independent endeavor. Programs that offer basic and further education in nursing informatics are beginning to spring up around the globe, but many more are needed to provide easy access for motivated nurses

Application of Computer to Health ProfessionsAutomatic searching of parallel records for medically ill person and critical medical informationAutomatic searching of nationwide databases holding registries of patient’s with critical problems.Automated review of similar patients to determine expected lengths of stay, costs, and rates of

complications – allowing better financial forecasting for the hospital and better information for the patient and caregiver.

System will allow the user to very easily pull information from vast numbers of patients (without names!) into spreadsheets, databases, graphing packages to create instant displays of outcome, treatment paths and options.

Improved communication between multiple providers to reduce the “it slipped through the cracks “syndromes that plague the smooth running of operating rooms

Patient care and management – care providers are using data entry devices to document care given both at the bedside and at central terminals.

1 Prepared by: Michael Gustilo, R.N- Instructor

Patient records - compilation of patient or test data, maintenance and retrieval of these records and use of these records for billing and usage and outcome analysis.

Patient monitoring - by recording patient data on-line and from various tests.Exchange of medical data - from the compilation and maintenance of databases.Interactive medical education – from database and tutorial software.Physician decision making – from the use of patient records and other databases.

Reference: ESSENTIALS OFNURSING INFORMATICS by Virginia K. Saba and Kathleen A. McCormick

Historical Perspectives of Nursing and the ComputerNursing informatics has emerged as a new term encompassing these technologies enabling nurses

to manage health care and patient care more efficiently and effectively.Computers in nursing are used to manage information in patient care, monitor the quality of care,

and evaluate the outcomes of care.Computers and networks are now used for communicating

-Sending/receiving data and messages via the internet-Accessing resources-Interacting with patients on the World Wide Web (WWW) Nurses are increasingly involved with systems used for planning, budgeting, and policy-making for patient care services as well as enhancing nursing education and distance learning with new media modalities.

Computers are also used to support nursing research, test new systems, design new knowledge databases and advance the role of nursing in the healthcare industry.

Major Historical Perspectives of Nursing and the ComputerComputer technology emerged in nursing in response to the changing and developing technologies

in the health care industry and in nursing practice.It is analyzed according to:

1. Six time periodsPrior to the 1960s, 1960s, 1970s, 1980s, 1990s and post 20002.

Six time periodPrior to 1960’s – simple beginningsUse of punch cards and teletypewritters.

1960’sUse of computers in healthcare is questionedStudies on computers in nursing is started.Introduction of cathode ray tubesDevelopment of Hospital Information System for financial transactions

1970’sNurses assisted in the design of HIS(hospital information system)Computers used in financial and management functionsSeveral communities developed Management Information system

1980’sNursing Informatics is formally accepted as new nursing specialty.Nursing Education identified need for updateEmergence of microcomputers/PC

1990’sComputer technology became an integral part of the healthcare setting.Policies and legislation on promoting computers in healthcare were adopted.Approval of NI by ANA as a new nursing specialty.Dr. Nicholas Davies excellence award is given for excellence in health information technology.

Post 2000Clinical Information System became individualized in the electronic patient record.Mobile computing device were introducedNew technologies were utilizedInternet provided new means of developmentHealth Insurance Portability and Accountability Act of 1996 was enacted.

2 Prepared by: Michael Gustilo, R.N- Instructor

2. Four major nursing areasNursing practice, administration, education, and research

3. Standards initiativesNursing practice, nursing data, and healthcare standards

Electronic Health Record from a Historical PerspectiveComputer-Based Patient Record Institute (CPRI)

Non-profit membership organization founded in 1992.Focused on clinical applications of IT

Electronic Health Record (EHR)An electronic record of patient health information generated by one or moreencounters in any care

delivery setting.

EHR ContentsDemographicsProgress notesMedical problemsMedicationsVital signsPast medical historyImmunizationsLaboratory dataRadiology reports

Key Components of Electronic Health Records

Administrative System ComponentsPatient identification:

Name Demographics Next of kin Employer information Chief complaint

Laboratory System ComponentsIntegrates:

Doctor’s orders Laboratory results Instruments Schedules Billing Other administrative information

Radiology System ComponentsContains patient radiology data:

Orders Interpretations Patient identification Information Images Patient tracking Scheduling Results reporting Image tracking functions Used with picture archiving communications systems (PACS), which manage digital

radiography studies.

3 Prepared by: Michael Gustilo, R.N- Instructor

Pharmacy System ComponentsContains client’s medication data and inventory of pharmacy stocks.

Computerized Physician Order Entry (CPOE)Permits clinical providers to electronically order laboratory, pharmacy, and radiology services.Pharmacy ordering capabilitiesAncillary service orderingAlertsCustomized order setsResult reporting

Clinical DocumentationProvides electronic capture of:

Clinical notes Patient assessments Medication administration records Other parts of the client’s chart

Consideration of Standards

Standard– established by consensus and approved by a recognized body that provides rules, guidelines or characteristics for activities.

Key StandardsClinical vocabulariesHealthcare message exchangesEHR ontologies (ex. content and structure of the data entities in relation to each other)

Clinical VocabulariesMeans of encoding data for exchange, comparison, or aggregation among systems.

Specific Uses of Clinical VocabulariesSearch knowledge resources (ex. key word searches, tagging).Identify the correct guidelines, critical paths, and reminders to be used in prompting high quality

patient care.Support practice analysis, quality improvement, and outcomes research.Provide data for clinical epidemiological analyses.

4 Prepared by: Michael Gustilo, R.N- Instructor