nursing tics reports

8/8/2019 Nursing tics Reports

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GROUP 5 WRITTEN

OUTPUT

(Chapter 37-42)

Submitted by:AMANSE, JOTESSAPEREZ, LEA ANN

MAULION, FRANCISVARGAS, MERLAND

BLANCE, MARY GRACECEDO, APRIL

TURIANO, APRIL KRISTINELASTRELLA, RONALYNE

SAN JOSE, JEDAHSAN JOSE, JILLIAN

Submitted to:Jonathan Orea, R.N, M.A.N


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INTERNATIONAL

PERSPECTIVES

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NURSING INFORMATICS IN CANADA

The Canadian Nurses Association (CNA) has taken the position

that registered nurses and other stakeholders in healthcare delivery

require information on nursing practice and its relationship to client

outcomes. A coordinated system to collect, store and retrieve nursing

data in Canada is essential for health human resource planning and to

expand knowledge and research on determinants of quality nursing

care CNA believes that registered nurses should advocate and lead in

implementing the collection, storage and retrieval of nursing data at

the national level. (Canadian Nurses Association, 2001)

Focus of NI in Canada is the role of nursing within healthcare

organization. In most HC organizations, nurses manage both patient

care and patient care units within organization. Usually nurse clinicians

manage patient care and nurse managers administer the patient care

units within the organization. Therefore, for some time, nursings rolein the management of information has been considered to include both

the information necessary to manage patient care using nursing

process and the information necessary for managing patient care units

within the organization.

Nurses must be able to manage and process nursing data,

information, and knowledge to support patient care delivery in diverse

care delivery settings (Graves & Corcoran, 1989). There is an essentiallinkage among access to information, client outcomes and patient

safety. As Lang has succinctly and aptly described the present

situation: If we cannot name it, we cannot control it, finance it, teach

it, research it or put it into public policy (Clark & Lang N., 1992).

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HEALTH SERVICES

DELIVERY SYSTEM

Maldistribution of

professionalcare ivers

Rising labor cost

Effectiveness

(Outcomes)Quality of

Efficiency (fiscalaccountability)

Decreasinggovernment

expenditures on

health care

1. Economic reason2. Eroded tax base

3. Reducedintergovernmental

transfer of funds

Managed care

Demographicchanges

Shifting paradigm to

community-based

care

Access to information about their practice arms nurses with evidence

to support the contribution of nursing to patient outcomes. Outcomes

research is an essential foundation for evidence based nursing

practice. Evidence based practice is a means of promoting and

enhancing patient safety.

CONTEXTUAL FACTORS INFLUENCING THE DEVELOPMENT OF

HEALTH INFORMATION IN CANADA

Pressure on health services delivery systems

[New treatments, new programs, new

technologies]

NATIONAL HEALTH INFORMATION ORGANIZATIONS

Canadian Institute for Health Information

The establishment of the National Health Information Council in the

late 1980s lead to the National Task Force on Health Information, also

known as the Wilk Task Force, which presented comprehensive goals

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ca

Risingdrug


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and a strong vision for a nationwide health information system

(National Task Force on Health Information, 1990, November).

Subsequently, the recommendations of the Wilk Task Force (National

Task Force on Health Information, 1991) resulted in the merger of four

existing entities to create the Canadian Institute for Health Information

(CIHI) in 1992 (Canadian Institute for Health Information, 2002;

Project Team for the Planning of the Canadian Institute for Health

Information, 1991, December). CIHI is an independent, national, not

for profit organization, established jointly by federal and

provincial/territorial ministers of health,

During the decade of its existence CIHI has become an

acknowledged and trusted source of quality, reliable and timely

aggregated health information for use in understanding and improving

the management of the Canadian health systems and the health of the

population of Canada.

Canada Health Infoway Inc.As CIHI, and its various aggregated databases, evolved and

matured, their focus was on health indicators and population health as

well as information to manage the health care system. The health care

community came to realize that there was still limited information

available to support decision making related to clinical care of

individuals and groups of patient/clients of the health systems. The

need for a pan-Canadian electronic health record gradually emerged

during the later half of the 1990s beginning with the report of the

National Forum on Health (National Forum on Health, 1997, February).

The recommendations in this report resulted in the commitment in

October, 2000 by the federal government of $500 million to support

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the development and coordination of pan-Canadian health information

systems necessary to achieve an Electronic Health Record. This

funding was recognition by federal, provincial and territorial

governments of the potential of information and communications

technologies to improve the efficiency, cost-effectiveness, access,

quality and safety of health services in Canada. The

Federal/Provincial/Territorial Advisory Committee on Health

Infostructure (Advisory Committee on Health Infostructure, 2001,

November) set its top priority on the development of electronic health

records (EHR) and telehealth. It identified the need to begin working

immediately on the building blocks for the next stages in development

of EHRs.

Canada Health Infoway Inc. (Infoway) was incorporated in January

2001 and began its first year of operation in April, 2001. The Infoway

Mission (Canada Health Infoway Inc., 2005) is Fostering and

accelerating the development and adoption of electronic health

information systems with compatible standards and communication

technologies on a pan-Canadian basis with tangible benefits toCanadians. Infoway will build on existing initiatives and pursue

collaborative relationships in pursuit of its mission.

The emerging pan-Canadian EHR will ultimately incorporate data

related to patient assessment and interventions contributing to patient

outcomes and providers patterns of practice. It is imperative that

nursing assessments, interventions and practice patterns are included

in the EHR because nursing is the single largest group of health careproviders.

Standards Council of Canada

The Canadian Advisory Council (CAC) on Health Informatics (Z295)

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advises the Canadian Stands Association (CSA). CSA is accredited by

the Standards Council of Canada (SCC) as the Standards Development

Organization that advises SCC on matters related to Health Informatics

Standards. SCC is the official Canadian member of International

Standards Organization (ISO). The CAC/Z295 provides representation

on behalf of Canada at the ISOs Technical Committee 215 on Health

Informatics Standards where CAC/Z295 representatives speak on

behalf of Canada. The CAC/Z295 has a dual role: first, to provide

technical input to SCC on the Canadian perspective on Health

Informatics standards development internationally and secondly to

provide advise to SCC through CSA on appropriate health information

standards for use in Canada as National Standards of Canada. The goal

of the CAC/Z295 is to harmonize national health information standards

with international. The CAC/Z295 has two co-chairs one responsible

for Canadas international participation in health informatics standards

development at ISO TC 215 and one responsible for coordinating

domestic health informatics standards activities. Members of

CAC/Z295 represent key stakeholder groups in the area of healthinformation and health informatics in Canada, and reflect a balance of

interest from industry, governments, users and general interest

groups. These members have an obligation to consult widely within

their respective constituencies with a view to having the greatest

possible input to both domestic standards work and Canadian input to

international standards development. (Hannah, 2004)

Another national organization, the Canadian Organization for the

Advancement of Computers in Health or COACH, founded in 1975,

has actively initiated professional protocols for using computer

systems in Canadian health care. One important document, Guidelines

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to Promote Confidentiality and Security of Automated Health-related

Information (1979), has been incorporated into the national

accreditation guidelines approved by the Canadian Council of Health

Facilities Association in 1991. These guidelines were also supported by

the CNA in 1993.

In 2001, COACH, as Canada's Health Informatics Association,

launched the Patron Program. As an individual member based

organization, COACH promotes understanding and effective utilization

of information and information technologies within the Canadian

Healthcare industry through education, information, networking and

communication. With the development of the Patron program,

members are hoping to build stronger links between COACH and

private and public enterprise in pursuit of this mission. It is an

opportunity for corporations to join in partnership with COACH.

COACH's vision is to be THE catalyst in advancing the practice of

health information management in Canada.

Today, COACH is a leading organization with an evolving

membership. It is in the forefront of the Canadian Healthcareinformation resource and technology field by working cooperatively

with health institutions, professions, associations, consultants, vendors

of information technology and applications, government and regulatory

organizations in the pursuit of its mandate.

The backgrounds of COACH members range from health executives,

physicians, nurses and allied health professionals, researchers and

educators to information systems managers, technical experts,consultants, and information technology vendor representatives.

Organizations represented include the broad range of healthcare

institutions, community and public health, private practice,

government, consulting firms, commercial providers of information and

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telecommunications technologies, educational institutions and

industry.

The Canadian Nursing Informatics Association

In 2001, a new group, the Canadian Nursing Informatics

Association (CNIA) received emerging group status from the CNA and

affiliate status in 2003. The CNIA now has full associate status with the

CNA.

The mission of the CNIA is to be the voice for Nursing Informatics in

Canada. Recognizing the importance of the work the CNIA is

undertaking, the Canadian Nurses Association has granted associate

group status to the CNIA. The CNIA is also affiliated with COACH,

Canada's National Health Informatics Association. Through this

strategic alliance CNIA is the Canadian nursing nominee to the

International Medical Informatics Association - Special Interest Group

in Nursing Informatics (IMIA-SIGNI).

The CNIA conducted a study in 2002 - 2003 on the Informatics

Educational Needs of Canadian Nurses, funded by the Office of Health

and the Information Highway, Health Canada or OHIH called EducatingTomorrow's Nurses: Where's Nursing Informatics?

The intent of the study was to describe the current state of:

informatics education opportunities currently available to

students of nursing across the country,

the level of preparedness of nursing faculty to deliver these

offerings,

information and communication technology infrastructure andsupport for faculty in delivering these offerings, and

opportunities to enhance nursing curricula, faculty preparedness,

and ICT infrastructure and support in schools of nursing across

Canada.

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The study was conducted across Canada and included a

representative sample of nursing schools from across the country. A

Kwantlen nursing faculty is a longtime member of the CNIA Executive

Board. June Kaminski (Kwantlen Polytechnic University, author of this

informatics curriculum) was Director of Communications (and designer

of the CNIA website) and is now the President of the Association. The

Canadian Journal of Nursing Informatics was launched by the CNIA in

2006, which invites papers, multimedia, and other electronic media

focused on the diverse arena of nursing informatics.

The Canadian Nurses Portal Project, NurseONE, E-Nursing

Strategy

Over the last two decades Canadian leaders in nursing informatics

have discussed and conceptualized a nation wide nursing informatics

strategy that would benefit all nurses and nursing students. In 2006,

the Canadian Nurses Association launched the Canadian Nurses

Portal Project, shortened to NurseONE to address this vision, in the

form of a e-nursing strategy. The purpose of the e-nursing strategy is

to guide the development of ICT initiatives in nursing to improvenursing practice and client outcomes (Canadian Nurses Association,

2006, p. 7).

Initial goals of this e-nursing strategy include:

advocating for nurses' access to ICT and the resources required

to integrate ICT into nursing practice;

supporting the development and implementation of nursing

informatics competencies among the competencies required forentry-to-practice and continuing competence; and

advocating for the involvement of nurses in decision-making

about information technology and information systems.

(Canadian Nursing Association, 2006, p. 10).

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The e-nursing strategy will address these goals by adopting a three

pronged approach:

Access better connectivity in work environment, more access

to a variety of computer technologies, e.g. PDAs, hardware,

software, station computers.

Competency- ongoing ICT skill development, integration into

nursing curriculum

Participation - as knowledge workers in this technological age, it

is essential that nurses play an increased role in the

development of ICT solutions (Canadian Nursing Association,

2006, p. 15).

OBSTACLES TO EFFECTIVE NURSING MANAGEMENT OF

INFORMATION IN CANADA

1. In Canadian health care delivery organizations, like hospitals

and health care agencies in other countries, the major obstacles to

more effective nursing management of information are: the sheervolume of information, the lack of access to modern information

handling techniques and equipment, and the inadequate information

management infrastructure. The volume of information that nurses

manage on a daily basis, either for patient care purposes or

organizational management purposes, is enormous and continuing to

grow. Nurses continue to respond to this growth with incredible mental

agility. However, human beings do have limits and a major source of job dissatisfaction among Canadian nurses is information overload

resulting in information induced job stress.

2. Antiquated manual information systems and outdated

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information transfer facilities are information redundant and labor

intensive processes, to say nothing of an inappropriate use of an

expensive human resource, that is to say nursing time and energy.

Modern information transfer and electronic communication systems

allow rapid and accurate transfer of information along electronic

communication networks. Yet, the nursing contribution to patient care

is not even on the radar screen for the pan-Canadian EHR or any

provincial EHR. Nursing documentation is being captured in some

regional or facility based patient records e.g. the Integrated Cancer

Care Network of the Alberta Cancer Board, St John Regional Hospital.

3. Software and hardware for modern electronic communication

networks are only two aspects of an information infrastructure. The

other major aspect is lacking in most hospitals and health services

organizations, that is, the absence of appropriate infrastructure to

facilitate information management. Infrastructure includes but is not

limited to: data management policies and procedures, methods for

data stewardship and custodianship, user training and informationmanagement support staff. Support staffs are necessary to support

nurses in appropriately analyzing and interpreting aggregated

information.

ISSUES RELATED TO EFFECTIVE NURSING MANAGEMENT

OF INFORMATION

1. Lack of adequate educational programs in information

management techniques and strategies for nurse clinicians and nursing

managers. At the time of writing, there are only a few pre-service

nursing education programs in Canada offering a course in modern

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information management techniques and strategies related to nursing.

At a minimum, such a program must include advanced study of

information management techniques and strategies such as

information flow analysis, the use of spreadsheets, databases and

word processing packages. Ideally such courses would also introduce

concepts and provide hands-on experience related to the use of

patient care information systems.

2. Nursing is frequently under represented in the decision

making related to health information systems and EHRs in Canada.

Regrettably, even when the opportunity is available, many senior

nurse managers fail to recognize the importance of this activity and

opt out of the process. They then complain when the systems do not

meet the needs of nursing. Canadian senior nursing executives must

recognize the importance of allocating staff and money to participate

in the strategic planning process and policy making for information

systems and EHRs in their organizations, provinces and national

organizations. Leaders in provincial and federal EHR and health

information systems initiatives must also recognize the importance ofnursing input into the strategic planning process and decision/policy

making related to such initiatives. In any Canadian health care

delivery organization, nurses are the single largest group of

professionals using a patient care information system or EHR and

nursing represents the largest part of the budget. Nursing, therefore,

represents the single largest stakeholder group in Canada related to

either patient care information systems or EHRs.

CANADIAN INITIATIVES DIRECTED AT THE DEVELOPMENT OF

NURSING COMPONENTS OF HEALTH INFORMATION (HI:NC)

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In Canada nurses are in the fortunate position of recognizing the

need for nursing data elements at the time when the national health

infostructure is under development. The challenge for nurses is to

capitalize on this timing and speak with one voice to promote the

inclusion in the CIHI DAD and the Infoway EHR of those data elements

required by nurses in Canada. To prevent nurses in Canada from

losing control of nursing data, nurses must take a proactive stance and

mobilize resources to ensure the development and implementation of a

national health data base and a pan- Canadian EHR that is congruent

with the needs of nurses in all practice settings in Canada. Some

initiatives intended to promote the vision, of nursing date integrated

into the pan-Canadian EHR and national health data base, are in

progress.

Building on work of our U.S. colleagues on the NMDS, and in

response to contextual factors influencing nursing in Canada, nurses in

Canada have recognized the importance of the collection and storage

of essential data elements (Canadian Nurses Association, 1990, June).

Under the leadership of the Canadian Nurses Association, nurses havemore than 15 year of experience in initiatives directed at building

awareness and consensus regarding the definition and coding of these

essential nursing components of health information (Canadian Nurses

Association, 1990, June). Nurses built consensus (Canadian Nurses

Association, 1993a, 1993b, 2001, April, 2001, November) on the five

essential nursing components of health information:

Client status is broadly defined as a label for the set ofindicators that reflect the phenomena for which nurses

provide care, relative to the health status of clients

(McGee,

1993).

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The common label client status is inclusive of input from all

disciplines. The summative statements referring to the phenomena for

which nurses provide care (i.e. nursing diagnosis) are merely one

aspect of client status at a point in time, in the same way as medical

diagnosis.

Nursing interventions refer to purposeful and deliberate

health affecting interventions (direct and indirect), based

on assessment of client status, which are designed to

bring about results which benefit clients (Alberta

Association of Registered Nurses (AARN), 1994).

Client outcome is defined as a clients status at a defined point(s)following health care [affecting] intervention(Marek & Lang, 1993). It

is influenced to varying degrees by the interventions of all care

providers.

Nursing intensity refers to the amount and type of

nursing resource used to [provide] care (OBrien-Pallas &

Giovannetti, 1993)

Primary Nurse identifier is a single unique lifetimeidentification number for each individual nurse. This

identifier is independent of geographic location (province

or territory), practice sector (e.g. acute care, community

care, public health) or employer.

It is one component of fully integrated health information data,

e.g. the CIHI DAD[Discharge Abstract Database] (Canadian Institute

for Health Information, 2002) or an EHR such as that being developedunder the leadership of Infoway. Therefore, the five nursing data

elements were identified collectively as the Nursing Components of

Health Information (Health Information: Nursing Components, HI: NC)

(Canadian Nurses Association, 1993b).

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Identifying those data elements that represent the most important

aspects of nursing care is only the first step. In Canada, nurses faced

an immediate challenge to determine the most effective and efficient

means to collect and code data elements that reflect nursing practice.

To collect the data reflecting nursing contributions within the larger

health information system, there is a need for consistent data

collection using standardized languages to aggregate and compare

data (Canadian Nurses Association, 1998).

IMPLICATIONS OF THE NURSING COMPONENTS OF HEALTH

INFORMATION

The definition of nursing components of health information is

essential to influence health policy decision-making. Historically health

policy has been created in the absence of nursing data. At a time when

we are in the midst of profound health care reform it is essential that

nurses demonstrate the central role of nursing services in the

restructuring of the health care delivery system.

CONCLUSION

It is clear that a priority for nursing in Canada is the inclusion in

electronic health records and national health data sets of the nursing

components of health information that have been identified, those

essential nursing data elements that must be collected, stored and

retrieved from a national health information data base. Nursing leadersmust respond to the challenge to identify those data essential for the

management of patient care and patient care units. The nursing

components of health information have the potential to provide nurses

with the data required to build information for use in reshaping

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nursing, as a profession prepared to respond to the health needs of

Canadians in the twenty-first century. However, the window of

opportunity to have nursing data elements included in a national data

set is narrowing. We must ensure that the vision of nursing

components in our national health information system becomes a

reality for nursing in Canada.

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Nursing Informatics in Europe

Europe is a continent with over 750 million inhabitants in about

50 countries with many different languages, cultures, social

systems and other living condition.

Widespread of use of IT in healthcare services is very limited in

comparison to other areas of society.

The main mission in Europe is to establish a stable infrastructure

that improves healthcare quality, facilitates the reduction of

errors and delivery of evidenced based and cost effective care.

The Europe Union (EU) is a driving force of healthcareinformatics development by funding projects that are all cross-

cultural involving healthcare professional users, educators, and

administrators, always with three or more countries

participating.

Telemedicine or telehealth, which is the practice of medicine and

nursing over a distance where data and documents are

transmitted through telecommunication system, is widelydisseminated in parts over Europe.

Electronic Patient Record

All RN in Sweden are by law, since 1986, obliged to document

nursing care (SFS, 1985)

Regulations emphasize that RNs have an autonomousresponsibility for planning, implementing and evaluating nursing

care and that nursing diagnoses in the patient record is a part of

that responsibility (SOSFS, 1990).

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Nursing Practice in Europe

Association for Common European Nursing Diagnoses.

Intervention and outcomes (ACENDIO), which was established in

1995. The aim of the association is to support the development

of standardized classifications, terminologies, and data sets for

sharing and comparing nursing data.

ACENDIO

Supports the development of nursing informatics by biannualconferences, publications and presentations to advance

understanding.

Serves as a network for nurses in different European countries

so that they can share knowledge about developments.

Provides resources such as reference lists and sample

methodologies for developing and evaluating nursing

vocabularies and by providing interpretation of internationalstandard for terminologies and classifications.

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NURSING INFORMATICS IN THE PACIFIC RIM

Trends in Healthcare

New Zealand has seen more collaborative approach resulting in

integrated care being seen as a priority. Integrated care is being

supported by technology.

The Web environment and the use of powerful integration

engines, is now providing contextual views of data that is browser-

based and single logon. Placed over multiple hospital information

systems this connection provides a single patient view of data across

all medical applications. Online technologies provide products and

services that enhance patient care and improve clinical outcomes

through evidence-based health information and decision support

systems.

Although New Zealand is a small country, it has a surprising

number of health IT companies who are producing software that is

being used both locally and internationally, the i-Health.

Technology Trends

New Zealand has been embracing changes in technology. No

longer is information restricted to individuals and organizations. Higher

speed networks including wireless and broadband are enabling

information in a variety of formats to be shared. Exploration into

telehealth has occurred in a number of fields including

teledermatology, teleradiology, telepsychiatry, and telepediatrics(Oakley, 2001).

Improvements in portability are now allowing the use of

technology in a greater range of settings. Personal Digital Assistants

(PDAs) and tablets are being used in the clinical setting by students

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and healthcare professionals. Some Australian nurses are using PDAs

for point-of-care information and clinical documentation for community

and acute hospital nursing, hospital-based infection control and wound

management.

Funding for the use of the technologies is probably one of the

biggest limitations imposed in embracing new technologies to enhance

care delivery. Nurses need to be prepared to work alongside and use

technology to best care for clients.

Current National Initiatives

The New Zealand Ministry of Health, in 2001, prepared a 5-year

broad strategic directive for information and technology developments,

referred to as The WAVE Report. The report was produced by means

of collaboration among industry, clinicians, government and healthcare

managers. The report has also formed the foundations for long-term

issues such as EHRs.

Following the WAVE report, the drive for collaboration from the

bottom-up has consolidated as the district health boards (DHBs)replace their isolated departmental systems with more integrated and

dynamic Web-based technologies that support a more connected

delivery network. Such arrangements have reduced duplication and

contributed to more effective and efficient management of

infrastructure.

1993 Establishment of the National Health Data Dictionary.

1999 The first national strategic information action plan,Health Online was initiated. This was followed by a number of projects

initiated by the Australian government: HealthConnect, MediConnect,

the provision of quality health information for consumers known as

HealthInsite, along with more than 360 projects.

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2005 It was expected that a strengthened governance model

with greater central leadership will be implemented to enable better

use of information technologies. The overall aim is to improve health

outcomes while containing cost increases driven by advances in

medical technologies and an ageing population.

Standards Development and Adoption

The minister of health directed that a WAVE working group, the

Ministerial Committee on a Health Information Standards Organization

(HISO), be established to investigate the implications of establishing a

nonstatutory organization to manage health information standards.

The scope of development activities that HISO will be involved with

includes standards associated within the following categorization

scheme:

Records structure and content data formats.

Vocabulary codes for medical and other healthcare terms.

Messaging standards used for interchange of data.

Security and privacy how access to information is managed.HISO, and supported by the Ministry of Health produced the New

Zealand Draft National Health Standards Information Plan (NZHSP) to

assist in its role of developing health information standards for the

health and disability sector. HISO enhances the New Zealand e-

Government Interoperability Framework (e-GIF) direction.

The HZHSP proposes a framework for describing the sector

priorities, standards development processes, governance andleadership, and presents a clear statement of the proposed plan.

HISOs role is aimed at the acceptance throughout the health and

health-related industries of such standards. The availability of detailed

and clinically relevant data is essential for clinical care decisions and

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for oversight groups making decisions related to the quality of that

care.

Standardized terminology systems are essential to permit the

use and exchange of clinical data across applications and IT systems.

Give point-of-care documentation, technology is now available to build

electronic health information systems that will efficiently meet a

variety of needs. This includes providing immediate feedback to care

providers by, for example, exchanging critical patient information in a

timely manner across the healthcare continuum, and reducing provider

burden associated with current documentation requirements.

Archetypes are constraint-based models of domain entities and

were first defined by the Australian-based OpenEHR group, an

international not-for-profit foundation working toward interoperable

lifelong EHRs.

In July 2004, NHIG endorsed L7 as the standard for healthcare

messaging in Australia. This represents a small step toward the

implementation and an increase in the adoption of available standards.

Research

Health-related information has a number of uses. Apart from the

direct use of information in the care of clients, there is a growing

awareness of the need for timely and accurate data for research. Two

specific areas that are currently gaining more attention within NI are

clinical pathways and evidence-based practice. In the New Zealand,

this is demonstrated by The Centre for Evidence Based Nursing Aotearoa (CEBNA) and the New Zealand Guidelines Group (NZGG).

CEBNA is a partnership between the Auckland District Health

Board and the University of Auckland, School of Nursing. It

collaborates with the Joanna Briggs Institute for Evidence Based

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Nursing and Midwifery, the lead, centre, in an Autralasian-wide

collaboration, that includes centers throughout Australia, Hong Kong,

and Singapore. These centers are committed to an evidence-based

approach to healthcare and to promoting an evidence-based culture in

nursing.

NZGG is an informal network of expertise and information on

guidelines development and implementation. It is funded by the

Ministry of Health and through contracts with other health agencies

such as ACC.

HISA organizes an annual conference where between 40 and 60

papers are presented each year. These are indexed in CINAHL and

provide a good overview of progress in health informatics in Australia.

Health informatics does not exist as a research category for the major

government research funding organizations which makes it difficult o

obtain research funds from these organizations. It is anticipated that

this will change in the near future as part of the Australian

governments health workforce capacity building initiative.

Education

In New Zealand, NI has been recognized as significant by the

Ministries of Health and Education since the early 1990s. A national

Guidelines for Teaching Nursing Informatics curriculum was

introduced into the undergraduate preparation of nurses programs in

1991. Undergraduate nurse education reflects the need for computer

literacy. The new nursing student, most commonly from secondaryschool, enters with increased computer skills than ever before.

Since the mid-1990s nurses registering for practice in New

Zealand also complete an undergraduate degree. Furthermore, the

changes in health service delivery in New Zealand and the

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establishment of new roles and career opportunities for nurses are

drivers for an increased demand for postgraduate nursing education.

Yet there have been barriers to nurses accessing postgraduate

education, which is generally based in urban areas. Nurses are found

throughout the country and the nature of nursing necessitates shift

work.

While NI as a postgraduate specialist subject has not been

recognized in New Zealand, nurses are favouring the health

informatics options. In 1998, the University of Otago offered for the

first time a diploma in health informatics. The University of Auckland

commenced offering postgraduate programs that include courses in

health informatics in 2001. Both tertiary education providers have

given nurses the opportunity to study informatics in abroad context

alongside other health professionals.

The first Australian experiences of nurses using computers were

compiled into a edited text by Graham MacKay and Anita Griffin in

1989.

Informatics education for nurses in Australia varies considerablyfrom one university to another. Most have one person attempting the

impossible, often in environments where fellow nurse academics have

little or no knowledge of informatics. In some instances, there is active

resistance to its introduction.

Some schools of nursing integrate informatics into their

undergraduate nursing program to some extent. Most universities offer

one unit of study within their undergraduate nursing pre- andpostregistration programs as an elective. This enables all registered

nurses either to obtain a double degree or convert their hospital-based

certificate into a Bachelors degree.

CHAPTER 40

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NURSING INFORMATICS IN ASIA

1970s- computers were first introduce in Asian Countries.

The first applications of information technology in healthcare in

Asian countries were in Administration, Billing, and Insurance.-

Now these countries are moving toward implementing paperless

electronic health records.

The adoption of Informatics in Asian countries occurred in

Nursing carepractice, Education, and research organizations, as

well as within the information technology industry and via related

government departments and existing professional

organizations.

This chapter provides historical events of nursing informatics in

South Korea

Japan

Taiwan

China

Thailand

The progress in Japan, China and South Korea has

been expedited by the hosting of the International Medical

Informatics Association (IMIA) triannual conference in 1980,

1989,and 1997.-----organizes conference , seminars and workshops,

creates a forum for sharing of experiences and knowledge among both

experts and users of these countries. SOUTH KOREA

- Comprises of 8 provinces with 7 metropolitan cities.

Total population: 47 million in 2002

- 190, 720- licensed midwives and nurses (81,478 are practicing)

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- Health informatics in Korea grown with the professional outreach

activity of KOREANN SOCIETY OF EDICAL INFORMATICS

(KOSMI) as well as with the help of:

- Government

- Private businesses

- Academic institutions

- Medical and Nursing organizations

HISTORY OF NURSING INFORMATICS IN KOREA

1970- Use of computers in South Korea healthcare began

- Used in hospital finance and administration system to expedite

insurance and reimbursement.

1987- KOSMI (Korean Society of medical Informatics) was

founded and introduced the term Health Informatics and Nursing

Informatics in Korea.

1993- The Nursing Informatics Special Interest Group was

organized as one of five special interest groups of the KOSMI.

-Since Nursing informatics Group was held its own session at

biannual conference of KOSMI.1995- Korean nurses represented the country at IMIA-NI Group

( International Medical Informatics Association).

IMIA- International Medical Informatics Association.

- IMIA conference MEDINFO98 held in Seoul----provided an

excellent opportunity for Korean nurses to become acquainted

with NI.

USE OF INFORMATION TECHNOLOGY IN CLINICALPRACTICE

Year 2000according to report published by Korean Health

Industry Development Institute that has hospital information system:

100%- Teaching hospitals

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96%- General hospital

75%- Private clinics

All Teaching Hospital and 40% of General Hospital

- Use Order Communication System---Which enable physician to

communicate with other departments for practice related

requisitions and the retrieval of data.

-Some hospitals initially used computers mainly for

administration and billing, later a patient-care component was

added---These system allowed physician to enter medical orders

directly into computer and major departments could receive

requisitions and enter test results.

-The nurse work list could be viewed on screens or printed so

that nurses did not need to copy medication schedules or care

activities onto Kardex.

Home Healthcare System-Community based practice- They use laptop computers to note and check medication and

progress on electronic patients record, and to communicate

electronically with other non-healthcare team members.

HEALTH INFORMATICS EDUCATION

According to recent survey in health informatics as computer

education program in South Korea 21% of nursing schools and 25% of

medical schoolsoffer health informatics courses, while the remainingoffer introductory computer courses.

-Most nursing schools in Korea are adding informatics to

graduate curriculaso that graduate students can take informatics

courses as an elective.

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STANDARDIZATION ACTIVITIES

There are Korean representative actively involved in several

international initiatives toward the end such as INTERNATIONAL

ORGANIZATION for STANDARDIZATION/TECHNICAL COMMITTEE 215

and Health level seven.

The majority of existing nursing terminologies:

NANDA- North American Nursing Diagnosis Association

NIC- Nursing Intervention Classification

HHCC- Home Healthcare Classification

NOC- Nursing Outcome Classification

ICNP- International Classification for Nursing Practice.

GOVERNMENT INITIATIVES

-The Government has contributed to the development of health

information by funding or other incentive and guidelines in

telemedicine, emergency medical systems, infectious disease reporting

system and standardization.2 Information Highways

1. South Korea advanced Research Network---which is mainly

use for research activity.

2. Nationwide commercialized network built by

telecommunication companies.

TECHNOLOGY TRENDS

-The need for telemedicine continues to grow in Korea with anincreasing numbers of elderly, patients with chronic disease, and

patients who are discharged early.

Example of telemedicine:

1.Telecare at home--- Telepractitioners at these centers

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maintain special schedules for their remote clients.

-They set aside 1-2 days per week to take care of their clients

using virtual reality technology via the Internet.

-currently, teleconsultation fee is reimbursed by Health

Insurance.

JAPAN

Population: 127 million twice that united kingdom---half that of

US

Number of hospitals: 10, 000 hospitalsNumber of nurses: about 750, 000including 220, 00 nurses

aides.260,000 medial doctors90, 000 dentist230, 000

pharmacist.

--In Japan all citizens can choose healthcare institutions and

doctors freely, and their financial contribution to health insurance.

-The hospitals received reimbursement for the balance from the

national health insurance.-The Japanese government contribute maximum of 70, 000 yen

to the medical treatment of a person over 1 month.

HEALTH INFORMATICS IN JAPAN

1970s- Japan began to pay attention to the use of computers in

healthcare.

1980- Japan hosted the IMIA (International Medical Informatics

Association) conference MEDINFO80.JAMI- Japanese Association of Medical Informatics was also

founded during 1980s with the aim of supporting health informatics in

Japan.

-Standardization is one of the problems in the use of Healthcare

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information technology that needs to be resolved.

HISTORY OF NURSING INFORMATICS IN JAPAN

1980- The Third International Congress on Medical Informatics,

MEDINFO80,was organized by IMIA was held in Tokyo.

1990s- Nursing education in Japan rapidly shifted to a more

academic orientation, and there are now 100 universities offering

baccalaureate programs and 40 universities offering graduate

p0rograms.---some baccalaureate programs and graduate schools

include NI courses in their curricula.

-The Japanese Nurses Association prepared course of nursing

information management as first step of continuing education

curriculum for ward managers.

NURSING INFORMATICS EDUCATION

April 2004- there were 486 professional schools, 31 junior

colleges, 120 universities and 45 graduate schools in Tokyo Japan.

-Universities provided elementary computer literacy education

during the first half of 1990s.Barriers to the development of NI in Japan:

1. There are few researchers and educators in Japan

2. There is little development of educational tools

3. The cost of improving the network and computer environment

is high.

NURSING INFORMATICS PRACTICE-The Japan Nursing Association does not recognized the training

for electronic health record and information systems.

-Hospitals are looking for new healthcare staff with knowledge of

both healthcare and information technology who can control

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information flow.

JAPANESE GOVERNMENT INITIATIVES AND STANDARDS

DEVELOPMENT IN JAPAN

-The standardization of medical information is one of the main

themes in healthcare sector.

The Ministry of Health, Labor and Welfare announced a

grand design for healthcare, and set the following achievement goals

for 2006:

1) Electronic Health Records will be introduced into 60% of

hospitals with more than 400 beds and of 60% of clinics .

2) The electronic health expenditure payment system will be

introduce into 70% of all hospitals.

-Nursing terminology are currently under development, nursing

actions and observation items in nursing terminology are available to

the public since 2004.

-Continuous 24-hour observation of nursing care can be shared,

indicating that the use of such system is very useful for the medical

profession.

China

According to the Fifth National Census reported by the National

Bureau of Statistics, the population of China was almost 1.3 billion in

2000. The population is aging fast, with those 65 years old and older

representing 6.96% of the population in 2000 compared to 5.57% in

the 1990 census. Only 5 and 20% of registered nurses in China havebaccalaureates and 3-year diplomas, respectively.

In China, the majority of the population is found in rural

areas, and thus the overall healthcare level, stability of society, and

economic development of the whole China is influenced by healthcare

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services in rural areas. The primary healthcare systems in rural China

include providing medical services, the training of healthcare staff,

hygiene education, and the development of a patriotic health

campaign.

The SARS epidemic in China leads to reconsiderations of

the current healthcare systems in rural areas. Some Chinese consider

that more effort should be devoted to epidemic prevention, and that a

new system of cooperative medical care and new salvation system of

the poor should be set up to ensure health in rural areas and enhance

the stability of society and economic development of country. The

SARS epidemic also led to suggestions of an integrated system for

responding to public health emergencies and for disease control and

prevention.

The China Medical Informatics Association (CMIA) was

founded in 1981. This is an academic group and is a member of the

IMIA. There are two other professional societies related to medical

informatics in China: the Chinese Society of Medical Information and

the Chinese Hospital Information Management Association. TheChinese Society of Medical Information was founded in 1993, and its

activities include holding academic conferences and seminars,

continuing education, and training. The Chinese Hospital Information

Management Association was founded in 1996, and its activities

include holding national and international academic collaborations and

exchanges, establishing rules and standards of national hospital

management, and training hospital information management staff.

Nursing Information System in China

The development of nursing information management

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systems began in China in late 1970's and they were first used in

1987. The first software implementation was a computer-assisted

primary nursing care system. The development of information

management systems for nursing in Chinese traditional medicine

began in 1994. Some examples include a nursing information system

for the management of nursing staff, nursing operation work,

continuing education, scientific research, and finance and economics;

nursing information systems for nursing records and nursing

management based on an army satellite project called the No. 1

Project of PLA; and an Internet-based nursing information

management system.

History of Nursing Informatics in China

The Nursing Informatics Special Interest Group with 20 hospital

nurses was founded as a branch of the CMIA in 191. A year later an

expert group for nursing information technology was founded by the

Nursing Department of the Chinese Ministry of Health, its missionbeing to establish criteria for nursing management and the training of

nursing administrators for nursing information management.

The first article referring to the term nursing information

science appeared in China in 1999, and this led to the application of

information technology in the field of nursing science for education and

research. The term NI was first used in the Chinese literature in 2002.

Nursing Informatics Education

Higher nursing education was introduced in 1983. By

2001, at least one computer course is required at the baccalaureate

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level, and nursing students can select other computer courses as

elective courses.

According to a literature review, computer-assisted

instruction began at nursing institutes in China during the mid-1990's.

Distance learning is also being used for nursing continuing education in

China.

Nursing Informatics Research

NI is at its infancy in China, with only 30 research articles

published in domestic nursing journals from 1994 to 2004.

Nursing Informatics Practice

The use of NI in clinical practice in China includes nursing

quality management, staff management, nursing information

management, and training clinical skills for staff nurses. Several expert

systems for nursing diagnoses, nursing care plan, and nursingassessment have been reported.

The major weakness of nursing information management

systems in China is the lack of national standards and the low level of

computer literacy and informatics skill exhibited by nurses.

Thailand

Thailand has a population of about 65 million living in 76

provinces. The life expectancy of males and females is 71.6 and 74.7

years, respectively. There were 92 regional/general hospitals, 707

community hospitals, and 9,559 health centers across Thailand in

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2004 The government is currently launching a Universal Healthcare

Coverage policy in order to improve the access to and quality of

healthcare, as well as to contain healthcare expenditure. The nThai

government is restructuring its healthcare system by placing more

emphasis on primary care and health promotion.

The NI was introduced as small special interest groups and

later expanded to the national level through the support of the Nurse's

Association of Thailand, the WHO, and the Ministry of Public Health

(MOPH).

The Development of a Health Information System

In 1997, the Thai MOPH began to implement a

national health information system which included the development of

a nursing component. The former director of the MOPH Nursing

Division, Mrs. Areeya Suppalak, considered it important to provide

nurses with the means of using information technology. Funding was

received from the WHO in 1999 as a result of a collaborative effortbetween the Center for Nursing Research at the Department of

Nursing, The Faculty of Medicine, Ramathibodi Hospital, Mahidol

University, and the MOPH Nursing Division to develop the ideal nursing

minimum data set (NMDS) and a preliminary nursing classification

system. The NMDS was identified as essential for developing an

efficient nursing database.

Development of an NMDS

There were 23 items of nursing data identified, including

patient name, hospital number, ID number, admission number,

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patient's address and phone number, address and phone number of

significant person, gender, birth date, religion, education, health

insurance, patient and family medical history/allergy, admission date

medical diagnosis, laboratory test, nursing problem, nursing

intervention, nursing outcome, discharge/expired date, discharge plan,

condition before discharge, referral, and home visit.

ICNP Translation and Validation

A resolution o developing an international nursing

language was adopted during the 1989 ICN meeting in Seoul , Korea.

The ICN therefore committed itself to the development of an

international nursing taxonomy (i.e. the ICNP). The Nurse's

Association of Thailand, under the former president Dr. Tassana

Boontong, endorsed the development of the ICNP and agreed to

translate it into Thai and validate an alpha version thereof. Later, in

1999, the translation of the beta version of the ICNP was completed,

validated and disseminated. The content was further revised forimprovement as the Nurse's Association of Thailand continued to

further develop the nursing classification. The ICNP is currently used

as a basis for the data set describing the nursing care of patients and

their families.

Professional Outreach

The Thai Medical Informatics Society (TMI) introduced the

concept of medical informatics into Thailand. The founders were a

group of medical professors whose original idea was to apply computer

technology to medical care.

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The main objectives of TMI are as follows:

1. To be the center for coordinating and distributing medical

information

2. To develop means for the management of medical information in

administration and academic areas

3. To exchange information and experience in medical informatics

4. To support those who practice medical informatics

5. To provide suggestions and recommendations for medical

information sectors both within and outside the MOPH

6. To not be involved in any commercial or political activities

The main activities of TMI are as follows:

1. Holding an annual conference

2. Supporting the meeting, training, and information sharing for the

development of medical informatics in Thailand

3. Publishing and distributing four issues of documents per year as

approved by the board

4. Being the center for the coordination of the medical informationexchanges

5. Being the center for information and ideas focused on the

development of medical informatics

The TNI supports the development of NI, especially

nursing databases using the ICNP. The Nurse's Association of Thailand

currently aims to develop a standard nursing care pla for clinicalapplications using the ICNP.

The activities of TNI are as follows:

1. Holding a joint annual meeting with the Nurse's Association of

Thailand and TMI

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2. Publishing and distributing its newsletter every 4 months

3. Supporting other academic and research activities in NI

4. Responding to the NI training needs of Thai nurses

Taiwan

There were 610 hospitals and 175,000 healthcare professionals

in Taiwan in 2002, serving a population of 22.5 million. The healthcare

professionals included 34.3% registered nurses and 17.7% licensed

practicing nurses.

History of Nursing Informatics in Taiwan

The term NI was first used in Taiwan in 1990. At that time the

focus was on hospital information systems providing nursing data such

as personnel information, care planning, and scheduling. Since the

1980's, computers had been used in nursing education. Although a

formal master's program focusing on NI was not available until 2001.

All baccalaureate programs included at least one or two computer

courses.

Nursing Informatics Education

Computer-assisted instruction programs have been developed by

the Ministry of Education for nursing vocational education programs

since 1986. The content includes diet education for diabetic patients,

biostatistics, maternal child health, stress management, and patient

nutrition. Online courses are available for baccalaureate programs incounseling, teaching principles and strategies, and long-term care.

Nursing Informatics Research

NI research is still at its infancy in Taiwan, with only around 40

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papers published in domestic nursing journals in the period 1994-

2003. Standardized terminology such as existing nursing diagnosis

classification systems and the ICNP has been translated for clinical

use, and tests of their reliability and validity have been proposed in

Taiwan. Qualitative approaches such as interviews have been used to

explore how well nurses will accept the change from manual charting

to computerized documentation. Quantitative approaches such as

surveys have been applied to investigate the attitude and satisfaction

towards the use of PDAs for charting and for storage of nursing

records.

Nursing Informatics Practice

Computerized care plans are now common in clinical use.

Moreover, decision support systems to test the integration of medical

diagnoses and nursing diagnoses, and expert systems implemented on

PDAs for the emergency triage system have been reported. PDAs have

been recently used by nurses in their daily practice.

Nursing Informatics in South AmericaWhat is the objective of this chapter?

To present an overview of the development of Nursing

Informatics in South America.

To identify some initiatives in the field, including discussion

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on the current user of terminologies.

To identify imitative to disseminate nursing informatics

resources in the region.

Introduction:

Nursing Informatics in 13 South America countries has been

based more on ACTIVITIES of INDIVIDUALS than on a policy

established by governments or national efforts.

Each country has varied levels of development and deployment

of technological resources.

----Technology is visible tendency in1. Health

2. Nursing Education

3. Nursing Practice

4. Nursing research

5. Administration

The growth of information technology in Latin America and the

Caribbean was been consistently The worlds highest for 20 years.

Most developed parts of the country have better access and

ability to implement services and applications in nursing.

Health institutes and universities are exploring ways to introduce

news resources on order to facilitate the process of the patient care

and promote quality and safety.

BACKGROUND:

Historically nurses are used to facing challenges, adapting new

tools in to the practice to improve their performance.

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Creating new models to enhance patient care.

Technology can represent a unique instrument to help nurses

to face further challenges and discover how to use its resources

to involve and maybe to design their way taking care of thepeople.

Information is the key element for decision- making process in

the health care area.

---the more specific information in place to support

clinical decisions, the better care can be delivered to the

patient.

Technology plays an important role in facilitating access to the

information because for the information to be useful and

meaningful, it has to be timely.

In this, there is a clear trend in the direction of the

computerization of health records.

--peolple are able to connect to the internet that is a

telecommunication resource with no parallel to fast exchange data andinformation.

--In result we can expect to see better- informed healthcare

providers and consumers.

Considering trends and tendency in healthcare informatics and to

facilitate the process in South American countries, the PanAmerican health organization (PAHO) has published guidelines

and protocols to orient the development and deployment of

information and communicating technology in Latin America and

Caribbean (Pan America Association) World Health Organization

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1991, 2001 and 2003.)

Latin America and Caribbean region rank third in information

technology expenditure.

A study performed by the PAN America health Organization/World Health organization information, computer and social

infrastructure is evolving rapidly.

Nursing Informatics Initiatives

In South America countries

The initial motivation to develop computer systems

in yhe healthcare area was driven by financial andadministrative concerns.

The hospital sector can be considered the area better

served by information systems.

1. Brazil

2. Mexico

3. Argentina4. Colombia

5. Paraguay

These countries have clinical information systems in hospital or

health institutes.

In general

Patient data that are also used for nursing administrationare integrated in the systems or nurses have to collect and analyze

nursing data separately.

Hospitals have been working to design their own systems

in order to attend to specific needs and policies.

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National and International software industry become more

represented in South America health care worker.

They provide a broader range of solutions with systems

that address patient are documentation. Most of the computer systems implemented is intended to

control administration data.

Congress, conferences, workshops, education and training

programs are being organized in the countries to share

experiences and information in nursing searching for

solutions that could enhance the delivery of patient care.

Distance Learning and the educational perspectives inNursing Informatics

Technology is transferring not only nursing practice but

also nursing training and education models.

Nurses became the PRIMARY USERS, responsible for data

input.

They become computer- Literate in order to use

computer technology in a efficient manner. To meet education and training needs, nursing schools and

hospitals initiated programs to prepare nurses to use

computers.

Computer applications in nursing education from a passive

teaching to an active changing nursing education from a

passive teaching to an active learning process.

The NUCLEO de Informatica em Enfermagen at Universidad

de Federal de Sao Paulo (NIEN/UNISEF) was the first center to

offer the specialization degree (certificate) in South America.

NIEN/UNISEF

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o Provides since 1989, the nursing informatics discipline in

its graduate and undergraduate nursing programs.

o The research line in nursing informatics is attended by

professionals from different regions of the country and hasbeen responsible for the preparation of several master and

doctoral students in nursing informatics.

o The student after graduation return to their own instates

to implement education and research programs and to

participate in the development of patient care systems.

The Latin America countries are investing a significant effort to

prepare professionals in health informatics.Nursing Terminologies and Documentation

Sharing and communicating information is essential to make

decisions and deliver care.

Exchange of information requires the communicationg parties to

agree on a communicating channel, an exchange protocol and a

common language.

The language includes an alphabetic words,phrases and symbolsthat express and assign meaning, understood by all users ( PAN

America Health Association/world health Organization,1997)

CLARK (1995)

- Pointed out that communicating among ourselves has always

been important but communicating with other people about

nursing has acquired a new urgency since we are forced to

recognize that the value of nursing is no longer apparent to

those who have the power to influence our practice.

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Other issues to be considered:

- Reimbursement

- Policies

-

Cost containment- Technological development in recent years

Nurses responsibility to decide not only what kind of data is

important to describe the continuous care but also to decide how

these data could be described.

SUMMARY

Nursing Informatics as an integrated part of health follows the

progress that has been made in the whole sector of health informatics.

Because of the variety among countries and even inside larger

countries, the development of nursing informatics is conducted on a

case-by-case basis, taking into consideration the specific requirements

of each region.

---The development and deployment of nursing informatics is

dependent on national priorities and human capabilities.

---The situation represents a great oppurnity for nursing.

The future is exciting because with technological advances

nurses have the change to drive their own professional destinies.Adapting technological resources to their practice help nurses to

see emerging trends in healthcare field as challenges and unique

opportunities for career growth. There are new roles, new areas and

new jobs demanding experts. Opportunities are wide open for those

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who have decided to incorporate information technology into their

daily practice in the process of taking care of patient.

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THE FUTURE OF

INFORMATICS

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Chapter 42 Future Directions (part 1 of 2; PP 671-674)

The New Twenty-First Century Scenario

The new science is revolutionizing the way we conduct science and

the way we will:

Prevent disease and diagnose and treat patients

Also allow the nurse to point to the particular patients reason for

a disease (eg: MI whether the person can regulate CA, K, NA

compared to normal persons)

Have the mechanism identified on the way that enzymes (such

as lipase) either work correctly or incorrectly in the metabolic

process.

The scenario begins and ends with the generic information (whether

the concerns of the nurse are prevention, diagnosis, sure or

rehabilitation). The types of IT needed to support these new

approaches to healthcare are grid technologies, high performance

computers, and robust integrated information systems based on

standards.

A President and a Secretary of Health Decree Acceleration

By computerizing health records, we can avoid dangerous medical

mistakes, reduce costs, and improve care.

- George W. Bush State of the Union Address January 20,

2004

Modern technology has not caught up with a major aspect of

healthcare and we have got to change that

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On April 27, 2004, the announcement of Presidents Bushs

groundbreaking Health Information Technology (HIT) Plan was

made during his speech at the American Association of

Community Colleges Annual Convention in Minneapolis, MN.

The president set a 10-year goal for a majority of Americans to

have EHRs when and where they are needed.

EHRs that are designed to share information privately and

securely among and between healthcare providers when

authorized by the patient.

David J. Brailer, MD, PhD the first National Health Information

Technology Coordinator, a sub-Cabinet level post at the Department of

Health and Human Services (HHS) on May 6, 2004.

Michael Leavitt Secretary of DHHS; in May 2005 he indicated that he

will unveil a plan to lead collaborative state efforts to create a digital

health care environment.

We will need 6,000 more physicians and 6,000 more nurses prepared

in information sciences to move in this direction.

- Dr. Charles Safran the former President of American Medical

Information Association (AMIA)

A Nations Health Information Technology Plan:

The federal government to accelerate the identification and

adoption of voluntary standards necessary for the safe and

secure sharing of health information among health providers.

Increased money for demonstration projects involving modern

electronic records systems that test IT and establish best

practices for wider adoption, including a doubling of

demonstration project funding to $100 million in the President

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Bushs budgets.

Creating federal incentives and opportunities that encourage

healthcare providers to use electronic medical records.

National Standards Endorsement on July 1, 2003

Honorable Tommy Thompson former secretary of HHS, announced

two new steps in building a national electronic healthcare system that

allowed patients and their doctors to access complete medical records

anytime and anywhere they are needed, leading to reduced medical

errors, improved patient care and reduce healthcare costs:

First the department had signed an agreement with the

College of American Pathologists (CAP) to license the Colleges

standardized medical vocabulary system (SNOMED) and make it

available without charge to throughout the US. These actions

open the door to establishing a common medical language as a

key element in building a unified electronic medical records

system in the US.

Second HHS has commissioned the Institute of Medicine (IOM)

to design a standardized model of an HER. The HL7 a

healthcare standards development organization evaluated the

model once it had been designed.

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Insurance Portability and Accountability Act (HIPAA)

The top technologies that the CIOs predict for the future were:

High speed networks

The internet

Client server systems

Wireless information systems

Trends Toward 2030:

Demographics the graying of America

Growth in Chronic Disease

Emerging infectious disease threats

Changes in health-seeking behavior toward the internet

Focus on quality = focus on IT

Security and biodefense

Genetic revolution

Demographic Trends

The US population will shift toward an aged population in the

next decade, thus shifting the focus form a youth-centric to an

aged-centric culture.

Aged persons have more health conditions, take more

medications and require more procedures than the younger

persons.

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There will be an increased focus on preventing, diagnosing, and

delivering care to this population.

New predictions by Olschansky warn us that this influx of aged

persons might cease and the mortality might actually decline in

the new century because of infectious diseases and obesity that

claim lives at any age.

nursing tics reports

Documents