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CHAPTER 16 Dependability of Nursing Informatics System

CHAPTER 17- Nursing Minimum Data Set

CHAPTER 18- Theories Models and Frameworks

SUBMITTED BY:

Cabanalan, Romar C.

Ladjarani, Sandra H.

Maulana, Dayang Almira H.

Sharif Masdal, Sarah P.

Musa, Shiedjian A.

BSN-IIB

SUBMITTED TO:

Mr. Roderick P. Go

Nursing Informatics Professor

DATE SUBMITTED:

May 10, 2013

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CHAPTER 16

Dependability of Nursing Informatics System

Dependable System is the measure of the reliability, integrity and performance of

the system. It is defines as trustworthiness of a computing system which allows reliance

to be justifiably placed on the service it delivers. It is the collective term used to describe

the availability performance and its influencing factors: reliability performance,

maintainability performance and maintenance support performance.

In nursing informatics, dependability is the measure of the effectiveness of the

health care delivery, quality of service and quality of care through the use of health

information system. It encompasses the reliability, integrity, confidentiality and security

of the data, information and the process.

Factors that affects dependability of systems

A. Error

In the health care information system, it is the discrepancy between actual results and

behavior from the expected or the reference condition or expected performance. In

hospitals and clinics, data error or inaccuracy of the information is resulted when an

incorrect reading is registered in the measuring equipment, the measuring device is

malfunctioning unnoticeably, mishandling of data, incorrect reading of data (honest

mistake), the computer system does not properly process the data, a potential bug is

existing in the program, the data process by the computer program overflows, incorrect

processing of tables and indexes, etc.

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Hour Systolic Diastolic

H-01 140 110

H-02 145 110

H-03 140 115

H-04 140 110

H-05 135 100

H-06 140 95

H-07 135 95

H-08 135 100

H-09 130 105

H-10 140 110

H-11 110 160

H-12 135 100

H-13 140 100

H-14 145 100

H-15 145 95

Based on the historical pattern, systolic reading is greater than diastolic reading. A

diastolic reading of 160 mmHg which is more than the systolic reading of 110 mmHg is

an indication that there is an error in reading the data.

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B. Fault

Sometimes due to computer bug which is considered a defect in the system. The

presence of a fault in health information system may or may not lead to a failure

BSA (m ) Height (cm) Weight (kg)

1.45484 152 50

1.88569 213 60

0.76000 180 52

1.68762 117 58

160006 165 56

1..1276 162 51

1.49276 171 47

Converting the table into chart, we can evidently see that there is an error in the results.

Based on our knowledge, if the height and/or weight is increase there is corresponding

increase in the body surface area (BSA), on the contrary, point number 14 of the figure

shown below, gives an opposite results. We can say that is an error in processing the

data and not the inputting of the data, since the height and weight is correct.

C. Failure

It is a condition in which the system performs unnecessarily or the function is contrary to

its specification or the expected condition. An error may not necessarily cause a failure;

however a persistent fault can have an impact that mitigates a failure condition.

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Example is a problem in the network occurs resulting to unavailability of the

communication system. This common problem should be anticipated; as such

preventive measures and contingency plan should be incorporated in the planning and

implementation of the health information.

CHAPTER 17

Nursing Minimum Data Set

Health Information technology offers a large number of benefits to the nurses and

healthcare providers as well as the patients and consumers such as the quality and

effectiveness of healthcare delivery and service.

Migration from the paper-based to electronic/computer health records minimizes

irregularities in the workflow process and decision making process. To accurately and

consistently document, accumulate, combined, translate, and retrieve health information

data, fields, data set, and data elements must have an equivalent vocabularies and/ or

terminologies within the healthcare record before it stores in the database.

The Nursing Minimum Data Set (NMDS) provides a formal structure for electronic

healthcare data elements and components to support nursing care in all settings.

What is Minimum Data Set?

The minimum data set providers the specific reference information for the user such

as the drug uses, dosage requirement, and direction for use, active ingredients, dates,

and other relevant information.

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The Nursing Minimum Data Set/Elements

The Nursing Minimum Data Set (NMDS) is categorization scheme for the

standardization of collection, integration, storage, classification, retrieval and reporting

of essential nursing data. The collected data will essentially provide an accurate

description of nursing decision, nursing diagnose, nursing care, nursing resources,

nursing services, etc. used when providing patient care. The Nursing Minimum Data Set

endeavors the standardization of the aggregated of essential nursing data.

Drug Fact

Active Ingredients Purpose

Uses

Warnings

Directions

Other Information

Inactive Ingredients

Other Information

Questions/ Comments?

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The Nursing Minimum Data Set (NMDS) encompasses three categorical scheme or

elements which includes the following:

Nursing Care Elements

Nursing Diagnosis

Nursing Intervention

Nursing Outcome

Nursing Care Intensity

Patient Demographic Elements

Personal Identification

Date of Birth

Sex

Nationality

Residence

Service Elements

Unique facility or agency number elements

Unique patient health record number

Unique number of principle Registered Nurse

Episode admission

Discharge or termination date

Disposition of patient

Expected payer for medical bill

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CHAPTER 18

Theories Models and Frameworks

Informatics System in Health Care Industry

Information system is collective term referring to a system of data records and

activities that processes and translate the data to information in an automated process.

The processing of data involves the use of computer systems and specialized software

that manipulates the information- processing activities of the organization. Computer-

based information systems are in the field of information technology. Thus, the

discipline of nursing informatics is related to the processing of the data of patients

records into information which are supported by information systems.

Information Systems in the Hospital

Transaction processing Information System

Operation System

Individual Patient record

Hospital Information System

Nursing Information System

Pharmacy Health System

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Preservation of Healthcare Quality Theory in Nursing Informatics

In the Philippines, many organizations such as Department Of Health are trying

to educate and inform the public about health care quality.

The purpose of implementing quality health care is to offer expert advice and

suggest noteworthy approaches to solve medical problems, illnesses, sickness, ailment,

disorder and complaints.

Notwithstanding the readiness of the solution, the solution typically involves a

multitude of strategies including regulatory forms, financial incentives, independent

oversight and patient education.

HEALTH INFORMATION TECHNOLOGY (HIT)

Article 8 section 11 of the 1987 constitution of the Philippines

States the the state shall adopt an integrated and comprehensive approach to

health development which small endeavor to make essential goods, health and

other social services available to all people.

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Health Informatics Paradigm Shift

Basic Steps to properly implement the nursing information system in the Hospital:

health care provider are provided simultaneously.

6

4

5

STAGE 2

Project Evaluation

Support from the Client

Dissemination of Information

3

1

2

Stage 1

Translate Data into

Information (with

statistical

Collecting andAnalyzing the Data

Commencing the

Project

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Defining Component of Nursing Informatics

Data

It simply exists and has no significance beyond its existence. It can exist in any form,

usable or not. It does not have meaning of itself. In computer parlance, a spreadsheet

generally starts out by holding data.

Information, often in the form of facts or figures obtained from experiments or

surveys, used as a basis for making calculations or drawing conclusions.

Information, for example, numbers, text, images, and sounds, in a form that is

suitable for storage in or processing by a computer.

Information

It is a date that has been given meaning by way of relational connection. In computer

parlance, a relational database makes information from the data stored within it.

Definite knowledge acquired or supplied about something or somebody.

The collected facts and data about a particular subject.

A telephone service that supplies telephone numbers to the public on request.

The communication of facts and knowledge.

Computer data that has been organized and presented in a systematic fashion to

clarify the underlying meaning

A formal accusation of a crime brought by a prosecutor, as opposed to an

indictment brought by a grand jury.

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Knowledge

It is the appropriate collection of information, such that its intent is to be useful.

Knowledge is a deterministic process. When someone "memorizes" information (as less

aspiring test bound students often do), then they have amassed knowledge.

General awareness or possession of information, facts, ideas, truths, or

principles.

Clear awareness or explicit information, for example, of a situation, or fact.

All the information, facts, truths, and principles learned throughout time.

Familiarity or understanding gained through experience or study

Understanding

Understanding is an interpolative and probabilistic process. It is cognitive and

analytical. It is the process by which I can take knowledge and synthesize new

knowledge from the previously held knowledge. The difference between understanding

and knowledge is the difference between "learning" and "memorizing". In computer

parlance, Al systems possess understanding in the sense that they are able to

synthesize new knowledge from previously stored information and knowledge.

Converting Data into Information

Patient data, medical records and nursing documents becomes information when

it is applied to some purpose and adds value for the recipient. Process of converting

data to information are tabulated below, the first column shows the enormous amount of

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data that the nurse may process, while the second column shows how the various types

of data could be processed to create useful information.

Patients Data and Medical

Records

Possible Methods of Converting

Data into Information

Systolic and Diastolic Readings

Plot charts, create tables and

identify trends

Body Temperature

Find average, typical readings and

variances

Body Mass Index, Bone MassDensity etc

Present complex data as a chart

on graph

Drug Dosage Requirement

Monitor changes over time and

forecast future values

Cost of hospitalization, laboratory

records, patient mapping

Compare figures, identify

similarities and prepare trending

Nurses Schedules, Health care

management

Assess whether a result is

significant or occurred by chance

Accident recordsAssess whether one thing is

related to another

Collecting data is expensive and to merit the effort, you need to be very clear

about why you need it and how you plan to use it. One of the main reasons that

organizations collect data is to monitor and improve performance of healthcare delivery

and services. Some other data are irrelevant and does not provide accurate benefits in

decision making, unless late connections elsewhere are causing the problem. Just as

important, the nurses must use the data correctly and processes properly. Wrong

interpreting the results may lead to more serious problems.

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Example

The date shown below is taken from 120 patient of certain hospital in Manila with the

height and weight which will be used to determine the body mass index (BMI).

Height (in) Weight (lbs) Height (in) Weight (lbs)

58.27 91.39 58.27 100.43

59.27 94.40 59.27 104.44

60.28 97.41 60.28 107.46

61.28 100.43 61.28 111.47

62.29 104.44 62.29 115.49

63.29 107.48 63.29 118.50

64.30 110.47 64.30 122.52

65.30 114.49 65.30 126.54

66.31 118.45 66.31 130.49

67.31 121.46 67.31 134.51

68.32 125.47 68.32 138.52

69.32 128.48 69.32 142.54

58.25 96.41 58.25 105.45

59.25 99.42 59.25 109.46

60.26 102.43 60.26 112.48

61.26 106.45 61.26 116.49

62.26 109.46 62.26 120.51

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63.27 113.48 63.27 124.53

64.27 116.49 64.27 128.54

65.28 120.51 65.28 132.56

66.28 124.47 66.28 136.51

67.29 127.48 67.29 140.53

68.29 131.49 68.29 144.54

69.29 135.51 69.29 149.56

58.24 129.55 58.24 138.59

59.25 133.57 59.25 143.61

60.25 138.59 60.25 148.63

61.26 143.61 61.26 153.65

Height (in) Weight (Lbs) Height (in) Weight (Lbs)

62.26 147.63 63.23 158.67

63.27 152.65 64.23 163.69

64.27 157.67 65.23 168.71

65.27 162.69 66.24 173.53

66.28 167.51 67.24 178.55

67.28 172.53 68.24 184.53

68.29 177.48 69.25 189.55

69.29 182.50 58.25 119.51

58.21 134.57 59.25 124.53

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64.27 145.62 60.26 128.54

65.28 150.64 61.26 132.56

66.28 155.58 62.26 136.58

58.24 110.47 66.26 148.56

59.24 114.49 67.27 153.58

60.25 118.50 68.27 158.43

61.25 122.52 69.27 162.44

62.26 126.54 62.26 142.60

63.26 130.55 63.26 146.62

64.27 134.57 64.27 151.64

65.27 138.59 65.27 156.66

66.27 142.54 66.27 161.50

67.28 146.55 67.28 166.51

68.28 151.57 68.28 171.47

69.29 155.58 69.29 176.48

58.23 115.49 69.29 128.54

59.23 119.51 59.24 133.57

60.24 123.52 60.25 137.58

61.24 127.54 61.25 164.45

62.25 131.56 68.29 169.46

63.25 135.57 58.24 124.53

64.25 140.60 63.27 141.60

65.26 144.61 67.29 159.60

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The date shown above can be translated into information shown below

Upon collecting data to different patients, the nurse can translate the data into

information and eventually the information can be converted to knowledge. The nurse

may learn that risk dactor for high blood pressure is age, weight, family history and

minor factor such as race and sex.

Variable Coefficients

Intercept -15.49

Age 0.077

Race 4.22

Sex 1.5

Change in Weight 0.13

65.0%

35.0%

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Characteristics of Data Quality

The characteristics of data quality are frequently described in terms of data

relevancy, completeness, accuracy, precision, accessibility and timeliness. This is

sometimes refer as data integrity.

Data Relevancy

Data are meaningful to the performance of the process or application for which

they are collected.

Primary Relevant Data Items

Name

Age

Sex

Irrelevant Data Items

Hobbies

Favorite Color

Organization

Secondary Relevant Data Items

Occupation

Health Habits

Environment

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Converting Information to knowledge

The tremendous amount of information that is translated is only usefu; if it can be

applied to create knowledge that is significant to the nurse and the healthcare giver.

Building and managing knowledge is one of the greatest challenges that have to

establish. Information on its own will not create a knowledge-based system but as a

guide in the decision making, we can simply conclude that information and knowledge is

the building blocks of the decision making process. The right information fuels the

development of intellectual capital which in turns drives innovation and performance

improvement.

Example

The statistical information system can interpret the results as follows;

Change in blood pressure = -15.49 + 0.077 (age) + 4.22 (race) + 1.5 (sex) + 0.13

(change in weight).