3 NURSING INFORMATICS
a programming language which made it easier to
Nursing Informatics
• Integrates nursing science, computer science, and
information science to manage and communicate data,
information and knowledge in nursing practice (ANA,
2001).
• Facilitates integration of data, information and knowledge
to support patients, nurses and other providers in decision-
making in all roles and settings.
HISTORY OF NURSING INFORMATICS
Prior to the 1960’s
• Adapted computers to health care and nursing
• Computer: basic business office functions
• Care readers: read computer programs, sort, and prepare
data for processing
HISTORY
• 1949
o Germany's Dr. Gustav Wagner established the
German Society for Medical Documentation,
Computer Science, and Statistics, the world's first
professional organization for informatics.
o His work paves the way for informatics to become an
integral part of the healthcare industry in Europe and
the rest of the world.
• 1952
o Dr. Arthur E. Rappoport spoke about using the McBee
manual punch card, the first computer used in clinical
practice, at the American Society for Clinical
Pathology
• 1959
o Ledley & Lusted published their influential paper
"Reasoning Foundations of Medical Diagnosis," which
suggests computers should be integrated into the
healthcare field to automate physician's work and
reduce errors.
Before the “digital revolution” and “desktop computing” and the
“internet”, there were MCBEE KEYSORT CARDS
1960’s Nurses’ Station
• The hub of information exchange
• Real time processing
• Where ADC takes place (Admission, Discharge,
Confinement)
1960
• Vendors of computer systems emerge
• Software applications for hospital functions
Cathode Ray Tube (CRT) Terminals
• Special, Electronic vacuum tubes that use focused
electron beams to display images.
• Used in TVs, computers, ATMs and radar displays
Hospital Information System (HIS)
• Process financial transactions
• Billing and accounting systems
• Few HIS documented and processed a limited number of
medical orders and nursing care activities
HISTORY
• 1967
o Utah's Latter Day Saint's Hospital is one of the first in the
United States to use an electronic medical record, the
Health Evaluation through Logical Programming
(HELP) software.
fcnlxa – St. Luke’s College of Nursing
o Pappalardo, Marble and Greenes developed MUMPS,
create medical databases and integrate into
healthcare environments.
o It's the basis of many contemporary healthcare
records software today.
• 1970
o Release of computerized provider order entry system
ICPOE), Technicon Medical Information Management
System Early adopter El Camino Hospital, California,
enjoyed great success with the software.
o Computers: cost-saving technologies
o Mainframe HIS
o Early systems were funded by private and federal
agencies.
o Improved nursing practice:
– Documentation
– Quality patient care
– Repetitive aspects of managing patient care
Management Information Systems (MIS)
• Contracted by several states and communities
• Provided statistical information
• Home health agencies provided billing and financial
information required of reimbursement of patient services
by third-party payers (ex. Health Maintenance
Organizations)
Computer Information System
• HIS emerged to supports clinical nursing practice
1974
• Nursing research papers presented at an international
• Medical informatics conference (MEDINFO)
o Four research papers on NI from the U.K., and one from
U.S. wherein nurses adapting and implementing an
information system
1979
• The journal of nursing administration features a monthly
column
• “Automation in Nursing”
1980
• Discharge planning systems: referrals to community health
care facilities
• Computers: more accessible, affordable and usable by
health care providers
• Improvement in nursing software, computer technologies,
and practice standards.
• The term “Nursing Informatics” was originated by Scholes
and Barber
Computer Information System
HIS emerged to supports clinical nursing practice:
• Order entry
• Results reporting
• Vital signs
• Documented nursing notes via word-processing packages
Requires understanding of nursing practice process but also the
application of science to function electronically.
PC
• Microcomputers
• Linked to mainframes
• Stand-alone systems (workstations)
• User-friendly
• Allows nurses to create their own applications
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HISTORY 2010
• 1985 • Internet
o Launch of patient scheduling software, Cadence. • Tablet computer
• Personal Digital Assistant (PDA)
• 1988 • Smart phones
o US Government invests $1.02 billion into Science • Voice Over Internet Protocol (VOIP) for health organizations
Applications International Corporation’s Composite • Improved Electronic Health Record (EHR)
Health Care System for all local and OCONUS military
health centers 2020’s
o This system continues to be the foundation of the 1. Telemedicine
Department of Defense’s electronic hc records 2. Artificial intelligence
o Launch of the American Medical Informatics 3. Nanotechnology
Association to educate healthcare professionals in 4. Virtual and augmented reality
informatics standards and systems. 5. 3D-printing
6. Stem cell treatment
1990 7. Robotic surgery
• Computers became integral part:
o Health care settings HISTORY OF NURSING INFORMATICS IN THE PHILIPPINES
o Nursing practice
o Nursing profession Philippines Medical Informatics Society– The Philippine’s Official
• Electronic Health Records Representative to the International Medical Informatics Association
o CIS became individualized
o Lifelong patient record 1996
• The Philippine Medical Informatics Society (PMIS) headed
1992 by Dr. Alvin Marcelo, was officially registered under the
• NI approved as a nursing specialty by American Nurses Securities and Exchange Commission by its board
Association (ANA) composed of eleven physicians.

1995 1998
• ANA credentialing exam • Several faculty members of the UP began formal
education and training. Dr. Herman Tolentino took a post-
HISTORY doctoral fellowship in medical informatics at the University
• 1992 of Washington, and others followed.
o Launch of EpicCare, the first Windows-based
electronic health records software 1999
• A study group was formed headed by the National Institute
• 2004 of Health of the University of the Philippines Manila. It
o “by computerizing health records, we can avoid identified international standards for health information
dangerous medical mistakes, reduce costs, and and their adaptability in the Philippines.
improve care,” said President Bush at his state of the • The group formed the "Standards of Health Information in
union address the Philippines, 1999 version" or "SHIP99".
o He vowed to make electronic health records available • Representatives from various sectors collaborated on this
to most Americans within the next decade project including the Philippine Nurses Association (PNA) in
the person of Ms. Evelyn Protacio.
• 2009
o President Obama called for a national electronic 2003
health record system by 2014 • Master of Science in Health Informatics was proposed to
2000s be offered by UP-Manila College of Medicine (major in
• Wireless point-of-care medical informatics) and the College of Arts and Science
• Regional database (major in bioinformatics) and was later approved to be
• Telenursing offered starting academic year 2005-2006.

2005 2008
• According to Thompson (2005), three main shifts catalyzed • Nursing Informatics course in the undergraduate curriculum
in: was defined by the Commission on Higher Education
o Moving from centralized data storage to (CHED) Memorandum Order 5 Series of 2008.
decentralized data access • This was later revised and included as Health Informatics
o Moving from paper charts to electronic health records course in CHED Memorandum Order 14 Series of 2009.
o Moving from relying on memory to continuously using • This will be first implemented in the Summer of 2010.
information resources
2009
HISTORY • Mr. Kristian R. Sumabat and Ms. Mia Alcantara-Santiago,
• 2012 both nurses and graduate students of Master of Science in
o Massachusetts General Hospital trials wearable health Health Informatics at the University of the Philippines, Manila
monitoring devices which record the movement, began drafting plans to create a nursing informatics
respiratory rate, heart rhythm, and other vital signs of organization.
expectant mothers during childbirth
o It plans to introduce the system in Uganda to curb 2010
infant mortality rates • Sumabat and Alcantara-Santiago began recruiting other
nursing informatics specialists and practitioners to organize
• 2013 a group which later became as the Philippine Nursing
o Nearly ¾ of physicians use tablets to maintain Informatics Association.
electronic health records • Focus on community health informatics.

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 • Students are asked to immerse themselves and to integrate
with local health facilities to understand the issues in health
information management at the grassroots level.
• Use and promotion of Free and Open Source Software
(FOSS)

CHALLENGES OF NURSING INFORMATICS IN THE PHILIPPINES

• Lack of health human resource
• Lack of network infrastructure (which also involves IT human
resource). While connectivity is an important component of
a health information systems, the availability of affordable
IT human resource and their retention remains an issue.
• Benefits of information technology have not yet dawned to
many decision-makers in the health sector. The huge
capital outlay for a health information system remains a CAREER REQUIREMENTS: NIS
stumbling block to the integration of IT in health operations. 1. Bachelor of Science in Nursing (BSN)
2. RN License: NCLEX-RN
INFORMATICS COMPETENCIES (3 three areas) 3. Two (2) years of nursing practice
• Computer literacy 4. Graduate degree in Informatics OR completed at least
o Allow individuals to use computer technology to 2,000 hours of practice as an informatics nurse.
accomplish tasks
• Informatics literacy ROLESOF NURSE INFORMATICS SPECIALIST
o Allows the individual to recognize how information is 1. Theory development
needed and to locate, evaluate, and use that 2. Information analysis
information appropriately. 3. Computer systems selection
• Informatics skills 4. Computer systems design
o Ability to use tools and techniques to improve 5. Computer systems testing
information and knowledge access, integration, 6. Training users of computer systems
management and use of technology. 7. Computer systems evaluation
8. Computer systems maintenance
INFORMATICS LEVELS OF COMPETENCIES 9. Identification of beneficial computer technologies
1. Beginner
2. Experienced 1. Theory development
3. Specialist • Contributes to the scientific knowledge base of nursing
4. Innovator informatics.

1. BEGINNER NURSE 2. Information analysis

• Has basic computer skills • Identifies the information that nurses need in order to
• Uses applications and data for care delivery, accomplish their work:
communication, and decision support – Client care
• Respects and protects patients’ rights to privacy and – Education
confidentiality – Administration
– Research
2. EXPERIENCED NURSE
• Evaluates the value of data and information 3. Computer systems selection
• Uses technology to interpret patient information for • Guides the user in making informed decisions related to the
decision support and communication purchase of computer systems.
• Advocates for technology solutions that improve care
delivery 4. Computer systems design
Collaborates with users and computer programmers to make
3. NURSE INFORMATICS SPECIALIST decisions about how data will be displayed and accessed.
• Assesses capabilities and limitations of technology and their
impact on users and organizations 5. Computer systems testing
• Improves information and knowledge available for clinical Pilot test systems for proper functioning before they are made
decision-making available for use in patient care

4. INFORMATICS INNOVATOR 6. Training users of computer systems

• Conducts research related to NI
• Influences top-level decisions and policy design which
impact clinical information management
• Builds theoretical models of NI
NURSING INFORMATICS SPECIALIST (NIS)
• Nurse who has formal education, certification and
practical experience in using computers in patient care
settings.
Trains users on how the system works, the importance of accurate
data entry, how the system will benefit them, and how it will improve
patient outcomes.
7. Computer systems evaluation
Evaluates the effectiveness of computer systems for both nurses and
patients.
8. Computer systems maintenance
Ensures computerized system functions properly and enhances the
system to better serve the users and the patients.

9. Identification of beneficial computer technologies

Updates themselves on computers and information technology
(both hardware and software) that will benefit the nurse and patient.

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