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The worlds of health care, communication, and information
technologies are ever evolving, separately and together. As nurses in
the the community expand thier practice definition to embrace new
information technologies, opportunities for improved health care to
populations seem endless. This evolution is seen as a merger of health
care technology with information and communications technology,
fostering the design and implementation of health care management
information systems in a variety of clinical practice settings.the clinical
practice settings involved in this new technology include both the
acute care and community-based practice environments. Organizations
such as hospitals and community-based agencies such as public health
departements and home agencies use information and
communications technologies to collect, restore, retrieve, analyze, and
present client care data in the care delivery settings. Health care
continues to be a human endeavor that is necessarily complex in
nature. Decisions related to client care continue to increase in
complexity, with the need for rapid, accurate information for clinical
decisions making as a priority for effective care.

  
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Nurses have been delivering compassionate care using
technology since the time of Florence Nightingale. Technology, coined
from the Greek language ³tekhnolohiga´ meaning systematic
treatment, is defined as a scientific method of achieving a practical
purpose. As healthcare evolves to meet the needs of mankind, nurses
are faced with greater challenges on how to apply technology in
practice, education, and research. Now more than ever, the term

 
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technology exponentially covers a greater meaning in healthcare to

include informatics.

Coined from the French word ³informatique´, Gorn (1983) first

defined informatics as computer science plus information science. As it
relates to nursing, it has been labeled as Nursing Informatics.
American Nurses Association Scope and Standards (2001) defines
Nursing Informatics as a specialty that integrates
1) Nursing science,
2) Computer science, and
3) Information science
4) To manage and communicate data information and knowledge
in nursing information

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1980s ± Health Informatics loosely practiced
½Y àiomedical Informatics is practiced in the Philippines
½Y Îord processors to capture patient information
½Y Data àase Management Systems
1990s ± Medical Informatics
‡ PMIS
‡ MIU
1980s ± 2009
‡ Nursing Informatics is loosely practiced in the Phil
‡ March 2010 ± PHILIPPINE NURSES INFORMATICS
ASSOCIATION




 
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The nursing process is the core of patient care delivery. In the
nursing process continuum, nurses are constantly faced with data and
information. Data and information are integrated in each step of the
nursing process:
*Y assessment
*Y diagnosis,
*Y planning,
*Y implementation, and
*Y evaluation
Nursing documentation, which is often identified as the sixth
step in the nursing process, is vital in information management.
Therefore, it is necessary for nurses to document accurately and
precisely to determine the desired outcome. Remember the Rule
³Garbage In±Garbage Out´ also applies to nursing documentation.

 
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Nurse Informaticists are often perceived as the ³techy´ nurse,
³super-user´, or the ³go-to´ person when new technology is
implemented. They are often referred to as ³bi-lingual´ nurses who can
speak the nursing process and information technology language. àeing
an expert in both fields and a liaison between the two worlds, nurses
have assumed different roles and positions in the arena of informatics.
The introduction of robust and dynamic information technology in
healthcare paved the way of creating different roles in Nursing
Informatics. A recent survey conducted by Healthcare Information and
Management Systems Society (HIMSS) revealed that 14% of nurses
are in nursing informatics role. Nurses comprise the biggest workforce

 
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in healthcare. This being said, nurses are the largest work-group of

end-users of electronic medical record and clinical information
systems; therefore, it is imperative that nurses are well-represented
in the selection, design, implementation, and evaluation of clinical
information systems. Evidence has shown that nurses who were
involved in the clinical information system cycle have more buy-in,
user-acceptance, and positive perception which all are precursors to
successful implementation.

ROLES OF A NURSING INFORMATICIST

oY uendors
oY Acute care
oY Hospital Systems
oY Consultant
oY Education/Research
oY Long-term care
oY Ambulatory
oY Home care

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Every nurse is an informaticist. Îhen information is well
managed, patient outcomes are favorable. The Nursing Informatics
Task Force of HIMSS identified the following value of the nursing
informaticist:
1) supports nursing work processes using technology,
2) increases the accuracy and completeness of nursing
documentation,
3) improves nursing workflow by streamlining and eliminating
redundancy in documentation,

 
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4) automates the collection and reuse of nursing data,

5) facilitates analysis of clinical data and quality measurements,
and
6) provides content to standardized nursing language (i.e.
Nursing Intervention Classification (NIC), NANDA -North American
Nursing Diagnosis Association (NANDA), and Nursing Outcome
Classification (NOC)).

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The emergence of the specialty known as nursing informatics is
not a recent phenomenon. That nurses have been using computers
since the 1950s and emerged as an advanced specialty in the 1980s.
According to Graves and CorcoranYdevised a conceptual framework
describes the relationship among computer science, information
systems science, and nursing science.
The framework for nursing informatics relies on the central
concepts of data, information and knowledge:
½Y {
is defined as discrete entities that are described objectively
without interpretation
½Y a

a as data that is interpreted, organized or structured
½Y ^ { as information that has been synthesized so that
interrelationships are identified and formalized.
½Y Resulting in decisions that guide practice
The anageent and processing coponents may be
considered the functional components of informatics.

Example:
The collection of individual data element "Raw Data" the
transition of raw data to knowledge is a three-phased process.

 
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Nursing Data is the raw data such as client name, age,

gender, diagnosis when the nurse form a relationships between the
raw data elements " form fully picture of client's clinical status this is
called Nursing Information³ then the nurse acts on this information
by formulating a set of interventions to deal with the particulars of a
specific client care situation. Those are in a form that can be subjects
to analysis and interpretation. Nursing information readily lends itself
to archiving or storage in computer databases that allow rational
grouping of nursing information then allows for aggregation of
information and the systematic study of nursing related phenomena.
Sets of nursing information that conform to theoretical and conceptual
frameworks are known as Nursing Knowledge
Hence, computerized information systems used in the
community health nursing practice setting can assist in the
development of nursing knowledge through the automated process of
collecting.


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Nursing Informatics can be applied to all areas of nursing
practice, which include; clinical practice, administration, education,
and research. àelow are some examples of how nursing inforatics,
inforation technology and coputers, are used to support various
areas of nursing practice.
Nursing Clinical Practice (Point-of-Care Systems and Clinical
Information Systems)
½Y Îork lists to remind staff of planned nursing interventions
½Y Computer generated client documentation
½Y Electronic Medical Record (EMR) and Computer-àased Patient
Record (CPR)

 
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½Y Monitoring devices that record vital signs and other

measurements directly into the client record (electronic medical
record)
½Y Computer - generated nursing care plans and critical pathways
½Y Automatic billing for supplies or procedures with nursing
documentation
½Y Reminders and prompts that appear during documentation to
ensure comprehensive charting
Nursing Administration (Health Care Information Systems)
½Y Automated staff scheduling
½Y E-mail for improved communication
½Y Cost analysis and finding trends for budget purposes
½Y luality assurance and outcomes analysis
Nursing Education
½Y Computerized record-keeping
½Y Computerized-assisted instruction
½Y Interactive video technology
½Y Distance Learning-Îeb based courses and degree programs
½Y Internet resources-CEU's and formal nursing courses and degree
programs
½Y Presentation software for preparing slides and handouts-
PowerPoint and MS Îord
Nursing Research
½Y Computerized literature searching-CINAHL, Medline and Îeb
sources
½Y The adoption of standardized language related to nursing terms-
NANDA, etc.
½Y The ability to find trends in aggregate data, that is data derived
from large population groups-Statistical Software, SPSS

 
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Many of these benefits have came about with the development
of the 
 a{a {, which is the electronic version of
the client data found in the traditional paper record.
EMR benefits include:
Vproved access to the edical record. The EMR can be
accessed from several different locations simultaneously, as well as by
different levels of providers.
Decreased redundancy of data entry. For example, allergies and
vital signs need only be entered once.
Decreased tie spent in docuentation. Automation allows
direct entry from monitoring equipment, as well as point-of-care data
entry.
Vncreased tie for client care. More time is available for client
care because less time is required for documentation and transcription
of physician orders.
Facilitation of data collection for research. Electronically stored
client records provide quick access to clinical data for a large number
of clients.
Vproved counication and decreased potential for error.
Improved legibility of clinician documentation and orders is seen with
computerized information systems.
Creation of a lifetie clinical record facilitated by inforation
systes.

Other benefits of automation and computerization are related to the

use of {a a

 

  computer software programs that

 
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organize information to aid in decision making for client care or

administrative issues; these include:
½Y Decision-support tools as well as alerts and reminders notify the
clinician of possible concerns or omissions. An example of this, is
the documentation of patient allergies in the computer system.
The health care providers would be alerted to any discrepancies
in the patient medication orders.
½Y Êffective data anageent and trend-finding include the ability
to provide historical or current data reports.
½Y Ê tensive financial inforation can be collected and analyzed for
trends. An extremely important benefit in this era of managed
care and cost cutting.
½Y Data related to treatent such as inpatient length of stay and
the lowest level of care provider required can be used to
decrease costs.





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Hardware is the physical part of the computer and its associated

equipment. Computer hardware can comprise many different parts,
these include:
6YYY
Y 
: used to enter data; keyboard, mouse, trackball,
touch screen, light pen, microphone, bar code reader, fax
modem card, joystick, and scanner.
6Y ‘Y 
: used to view and hear processed data; video
monitor screens, printers, speakers, and fax.
6Y O
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Y
YO "brain" of the computer, three

components:

 
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*Y Arithmetic Logic Unit (ALU): number "crunching"

*Y Memory: is the storage area in which program
instruction (code) reside during execution.

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

power is off. A start-up instruction for the computer is an example of
ROM.
Random access memory (RAM) is a temporary storage area for
program instructions and data that is being processed; it is only active
while the computer is turned on. (Located on the motherboard not part
of CPU)

Control Unit: manages instructions to other parts of the computer,

including input and output devices "traffic cop"

 
Y: provides space to retain data in an area

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

*Y uper coputers, are the largest and most

expensive, can perform billions of instructions every
second
*Y painfraes, large computers capable of processing
several millions instructions per second. They
support organizational functions, therefore have

 
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been the traditional equipment in hospitals.

Customized software results in high cost.
*Y pinicoputer, is a scaled-down version of the
mainframe, since they are now becoming more
powerful they can now be found in hospitals and
HMO's
*Y picrocoputers (PCs), inexpensive processing power
for an individual user.
*Y maptop or Notebook, Handheld, and Personal Digital
Assistants (PDAs)

Networks:

A network is "a combination of hardware and software that

allows communication and electronic transfer of information between
computers" (as cited in Hebda, 1998, p. 19).
Hardware may be connected permanently by wire (Ethernet), or
temporarily by wireless communication, and modems/telephone lines.
This allows the sharing of computer and software resources, through
the use of the network. For example, several computers may share
one computer, or many different users could also access a word
processing program. Networks, no matter how small or large, operate
with the client/server technology.

A Server stores files and programs that are accessed by the

client on the network. Îhen you access the Internet from home, you
the client (your computer), requests files from a Server (another
computer), you see the results displayed on your screen through a
browser. You may also access a network in your clinical practice; you

 
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the client, accesses a patient record on the floor from a server, which
stores the patient record.
Types of Networks: They range from small (home network) to very
large (Internet)

Home Networks - within a home

Local Area Networks (LAN) - networks within a area, location or
business. The University connects all its computers on a LAN.
Îide Area Networks (ÎAN) - several LAN connected together
Internet - many ÎAN connected together around the globe to give us
the Internet that we use today

Intranets - private company networks that are protected from outside

access Kaiser HMO and its clinics and hospitals is an example.
Extranets - several Intranets connected together, Kaiser maintains
Extranet a network connection with its suppliers

  
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Îhen selecting a computer system or related hardware, you must take

into consideration the following:
he types of applications required Some people need word processing,
while others may need database or spread sheet software.
he progra e ecution tie and coputer capacity needed to process
jobs Complex jobs require more processor speed and memory.
he aount of inforation that ust be kept and the length of tie
that it ust be retained deterine storage Capacity Needs.

 
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àackup Options Îhen information is critical to conduct daily business,

another backup system may be need if the primary one fails.



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A collection of programs that manage all of the computer's
activities, including the control of hardware, execution of software, and
management of information.

Operating Systems provides a user interface by which the

individual interacts with the computer. Types include; text based
commands, graphical user interfaces (GUI), and object-oriented
interfaces (OOI) a graphic interface in which visual metaphors are
employed.

  


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Support for computer systems and networks is extremely

important in order to maintain system functionality, support includes:
1) planning system upgrades, 2) installation of upgrades for operating
systems and various applications, 3) troubleshooting, and 4) user
education and training.

uper user: This person has additional experience over the average
employee and serves as a local resource person. In the hospital setting
this is user who know the clinical area and the computer system.
picrocoputer pecialist: Provides PC information and training; has
special training and degree in computer science or a related area.
Analyst: They are frequently clinicians, who become involved in
system selection and training. Many have learned their role on the job

  
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and furthered their education by taking computer or information

science classes.
rrograer: Îrites code, computer instructions; they often lack the
clinical experience. For this reason the analysts are responsible for
communicating user needs to programmers
Network Adinistrator: They are responsible for the planning,
management and expansion of networks.
Director, Vnforation ervices: These individuals should have a board
view of the needs of the institution and the design, implementation,
and evaluation of information systems. Responsibilities include
planning, policy development, budgeting, information security, and
overall management of the information systems.

 
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References:

technology. (n.d.). Merriam-Îebster's Medical Dictionary. Retrieved

July 1, 2010, from Dictionary.com website:
http://dictionary.reference.com/browse/technology

Corn. S. (1983). Informatics (computer and information science): Its

ideology,
methodology, and sociology. In F. Machlup & U. Mansfield (Eds.), The
study of
information: Interdisciplinary messages (pp. 121-140). New York:
John Îiley &Sons.American Nurses Association. Scope and Standards
of Nursing Informatics Practice.Îashington, DC: American Nurses
Publishing; 2001.
Nursing Informatics Job Titles. Retrieved July 1, 2010 from HIMSS
website:
http://www.himss.org/content/files/CàO/Meeting9/Nursing_Informatic
s_Survey.pdf

Mc Lane, S. (2005). Designing an EMR planning process based on staff

attitudes
toward and opinions about computers in healthcare. CIN: Computers,
Informatics, Nursing, Mar-Apr; 23(2): 85-92 (45 ref)
Nursing Informatics Taskforce. The ualue of Nursing Informaticist.
Retrieved July 1, 2010 from HIMSS website:
http://www.himss.org/handouts/NI101.pdf

Alcantara-Santiago, Mia Angelica R.N. Nursing Informatics 2010:

Defining the Future of Nursing. Retrieved July 2, 2010 from
Scribd website:
http://www.scribd.com/doc/31972834/Nursing-tics