LECTURE AND LABORATORY IN NURSING INFORMATICS

CMO No. 5 series 2008 – passed by the CHED in Jan., 2008 to all deans of colleges of nursing throughout the country
1. to replace the basic computer subject with the 3-unit Nursing Informatics
2. to maintain the global competitiveness of Philippine nurses.
CMO no. 14 series 2009- passed in April 2009 to subject code Nursing Informatics with IT

Factors that paved the way for the development of Healthcare informatics.

Origin of Healthcare informatics:

1. increase in Knowledge
- many specialties and subspecialties
- better but fractionalized treatment (difficult to view the entire patient)
2. increased number of health cases - (pop’n, discovery of more diseases, extension of life expectancy)
3. difficult to merge data that we find and K we already have
4. lack of time to channel them to information and knowledge
> INFORMATICS = A science that combines domain science, computer science, information science, and cognitive science.
> HEALTHCARE INFORMATICS = Defined as the integration of healthcare sciences, computer science, information science, and
cognitive science to assist in the management of healthcare information. Also called health informatics

SUBDOMAINS OF HEALTHCARE INFORMATICS:

1. Medical informatics
2. Dental informatics
3. Pharmacy informatics
4. Nursing informatics

 The main goal of nursing informatics

o Improve patient care
o Solve problems in the nursing workplace
o Produce globally-competitive nurses
 Florence Nightingale – an early public health informaticist in 1800, Crimean war, thought of developing an efficient
documentation system to compare outcomes after applying the best interventions to wounded war patients.
- led to a total reorganization of how healthcare statistics should be collected.

Nurses
 absorb the most impact since they are the ones in the most direct and most prolonged contact with the patient who ultimately
receives the latest treatment and care technologies.

NURSES’ TOP 4 PROBLEMS IN THE WORKPLACE

1. Documentation is excessive
• Eats up to 30 to 60 percent of work time
• Seldom engage in a normal comforting conversation with the patient
• Paperless, 15% of a nurse’s shift.
2. Turnaround time too long
- Starts from the time a request is made to the time it is fully accomplished.
- Ideal is 15 minutes for lab pro with simpler prep
3. Accuracy of processes
• Medication errors (ordering and admin) 1st
• Labeling errors (2nd)
• Automation of these processes mostly done beside a patient leads to a greater reduction of errors.
 4 Communication between members of the healthcare team is not efficient
- Chat, telephony, videoconferencing, e-mail, text messaging

NURSING INFORMATICS

 Practice & science of integrating nursing information & knowledge with technology to manage & integrate health
information
 goal of nursing informatics is to improve the health of people and communities while reducing costs
 “specialty that integrates nursing science with multiple information and analytical sciences to identify, define, manage and
communicate data, information, knowledge, and wisdom in nursing practice”.

WHY THE TRENDS TOWARDS INFORMATICS?

• Increasingly present in our profession due to rapidly changing technological advances

• healthcare systems are assimilating technology into daily practice at a quick pace
• security and patient privacy must be upheld while achieving the goal of transforming data into useful knowledge\

THE ROLE OF INFORMATICS IN NURSING

• Help identify potential problems earlier

• Identifying changes in patient status can occur quickly
• Information is readily available
• data are interpreted, systematized, & arranged
• formalize an appropriate plan of action
• aligns nursing best practices with clinical workflows & care
• Improves clinical policies, protocols, processes & procedures
• Standardizing nursing language
• Use of a template can remind you of important information required in the documentation of patient care
• Strengthen nurses’ clinical decision-making skills
• enhance nursing practice
• quicker access to patient information
• improve overall efficiency
• reduction in potential errors
• nursing informatics has the potential to change nursing practice for the better → patient care delivery
• Provides training & learning based on objective data
• selects and tests new health devices
• reduces health care errors & costs
• enhances end –to-end treatment and continuity of care

LABORATORY:
TERMS TO REMEMBER

 Computer hardware – the physical components of the computer

 Central processing unit (CPU) – the brain of the computer that contains a control unit and memory
 Read Only Memory (ROM) – a type of permanent storage
 Random Access Memory (RAM) – a type of temporary storage
 Hard drive – a storage facility used for storing and retrieving data
 CD ROM – a rigid disk used for storage
 USB disk – a small removable hard drive used for the storage of information
 Mega Hertz (MHz) – a computer speed of one million cycles per second
 Bits and bytes – the unit of data in the computer file
 Giga Hertz (GHz) – a computer speed of one billion cycles per second

COMPUTER HARDWARE

 Central processing unit

 o The computer’s central processing unit (CPU) is the portion of a computer that retrieves and executes instructions
 Computer Memory and Storage
o Computer data storage is a technology consisting of computer components and recording media that are used to
retain digital data. It is a core function and fundamental component of a computer
INPUT DEVICES

 Keyboard
o Is an input device that allows a person to enter letters, numbers, and other symbols (these are called characters in
a keyboard) into a computer
o is a typewriter-style device that uses an arrangement of buttons or keys to act as mechanical levers or electronic
switches
 Mouse - is a pointing device with buttons used to choose items or initiate an action
 Microphone - a device that captures audio by converting sound waves into an electrical signal. This signal can be amplified
as an analog signal or may be converted to a digital signal, which can be processed by a computer or other digital audio
device.
 Scanners - a device usually connected to a computer. Its main function is to scan or take a picture of the document, digitize
the information and present it on the computer screen.
 Output Devices - An output device is any piece of computer hardware equipment that converts information into human-
readable form. It can be text, graphics, tactile, audio, and video. Some of the output devices are Visual Display Units

EXAMPLES OF OUTPUT DEVICES

1. Monitor
2. Printer
3. Headphones
4. Computer speakers
5. Projector
6. GPS
7. Sound card
8. Video card
 Communication Devices - a hardware device capable of transmitting an analog or digital signal over the telephone, other
communication wire, or wirelessly.

Different types of communications devices

 Bluetooth devices.
 Infrared devices.
 Modem (over phone line)
 Network card (using Ethernet)
 Smartphone.
 Wi-Fi devices (using a Wi-Fi router);

LECUTURE #2

HISTORICAL PERSPECTIVE OF NURSING AND THE COMPUTER

• The computer is the most powerful technological tool to transform the nsg profession prior to the new century.

• It has transformed nursing paper-based records into computer-based records.

• The computer and the Internet are essential for all settings where nurses function: (hospitals, ambulatory care centers, health
maintenance organizations, community health agencies, academic institutions, research centers, and schools of nursing)

USES OF COMPUTERS IN NURSING

1. To manage information in patient care

2. Monitor the quality of care

3. Evaluate the outcomes of care

4. For communicating (sending/receiving) data and messages via the Internet

 5. Accessing resources

6. Interacting with patients on the World Wide Web

7. For planning, budgeting, and policy-making for patient care services

8. Enhancing nursing education and distance learning with new media modalities

9. Support nursing research

10. Test new systems

11. Design new knowledge databases

12. Advance the role of nursing in the healthcare industry

HISTORICAL PERSPECTIVE OF NURSING AND COMPUTERS, ANALYSED ACCORDING TO:

A. SIX (6) TIME PERIODS

1. Prior to the 1960s
- there were only a few experts who attempted to adapt computers to health care and nursing
- computers were initially used in healthcare facilities for basic business office functions. These early computers used
punch cards to store data and card readers to read computer programs, and sort, and prepare data for processing.

2. 1960’s
- studies were conducted to determine how comp tech could be utilized effectively in the healthcare industry and what areas
of nursing should be automated. The nurse’s station was viewed as the hub of info exchange, the most appropriate center for
the development of computer applications.
- Hospital Information Systems (HIS) was developed primarily to process financial transactions and serve as billing and
accounting systems.
- vendors of computer systems were beginning to enter the health care field and market software applications for various
hospital functions; however, because of tech limitations, lack of standardization, and diversity of paper-based patient care
records, progress was low.

3. 1970’s
- integration of computers into nursing continued.

GIANT STEPS TAKEN IN BOTH NURSING AND COMPUTER TECH:

1. nurses recognized the computer’s potential for improving the documentation of nursing practice, the quality of patient care,
and the repetitive aspects of managing patient care

2. They assisted in the design and dev’t of nsg applications for the HIS and other environments where nurses function

 Computer applications for the financial and management functions of patient-care systems were perceived as cost-saving
technologies

4. 1980’s

- The field of Informatics emerged in the healthcare industry and nursing. Nursing Informatics became an accepted specialty
and many nursing experts entered the field.

- It became apparent that the nursing profession needed not only to update its practice standards but also determine its data
standards, vocabularies and classification schemes that could be coded for the Computer-based Patient Record System
(CPRS)

- Many mainframe HISs emerged with nursing subsystems. These systems documented several aspects of the pt’s record;
namely, order entry emulating the Kardex, results reporting, vital signs, and other systems that documented narrative
nursing notes via word-processing packages. Discharge planning systems were developed and used as referrals to
community healthcare facilities in the continuum of care.

- In the 1980s. the microcomputer or personal computer (PC) emerged. This made computers more accessible, affordable,
and usable by nurses and other health care providers.
5. 1990’s

- Beginning with the early 1990s, comp tech became an integral part of healthcare settings, nursing practice and the nursing
profession. The professional organization identified initiatives hat addressed IT’s and informatics.

- Policies and legislation were adopted promoting comp tech in health care including nursing.

- In 1992, NI was approved by the American Nurses Association (ANA) as a new nursing specialty

- The 1990s brought smaller and faster computers- laptops and notebooks-to the bedside and all of the ppoint-of-care
settings. Workstations and Local Area Networks (LAN) were developed for hospital nursing units Wide Area Networks
(WAN ) were developed for linking care across healthcare facilities, and the Internet started to be used for linking across the
diff systems.

- The Internet began to be used for High-Performance Computing and Communication (HPCC) or the “information
superhighway”

- Telemetry, a new nursing function that allows distant monitoring of patients was developed.

6. Post-2000

- The early years of the new millennium continued the torrid pace of hardware and software development and growth. The growth
is reflected in health care and nursing, with developments such as wireless point-of-care serious consideration for open source
solutions, regional database projects, and increased IT solutions targeted at all healthcare environments.

- Clinical Information Systems became individualized in the Electronic Patient Record (EPR) and patient-specific systems
considered for the lifelong longitudinal record or the Electronic Health Record (EHR)

- Telenursing, a recognized specialty since the late 1990s, is increasing in popularity and providing patient care in an efficient and
expeditious fashion.

- The Health Insurance Portability and Accountability Act of 1996 (HIPAA) was enacted to streamline healthcare transactions and
reduce costs Standardized transactions and code sets were selected to protect security as well as ensure the privacy and confidentiality
and were implemented in early 2004.

- The legislation recommended health care providers to use a Provider Identification Number (PIN) to maintain privacy and security
of patient information

- The development of more rugged tablet PCs and Personal Digital Assistant (PDA), programs with advanced reliability and secure

features and wireless technology made it possible to automate and optimize many nursing practices on bedside or Point-Of-Care
(POC)

-Telenursing or Distant Nursing was developed.

B. Four Major Nursing Areas

1. Nursing Practice
o Has become an integral part of the EHR.
o Computer systems with nursing and patient care data, nursing care plans are no longer separate subsystems of the
computerized HIS, but rather integrated into one interdisciplinary patient health record in the EHR.
2. Nursing Administration
o Most policy and procedure manuals are accessed and retrieved by computers
o Workload measures, acuity systems, and other nursing dep’t systems are online and integrated with the hospital or
patient’s EHR system or in a separate nursing department’s system.
3. Nursing Education
o Most universities and schools of nursing offer computer enhanced courses, online courses, and/or distance
education.
4. Nursing Research
o Computer is used to analyze nursing data. Software programs are available for processing both quanti ang quali
research data.
C. STANDARD INTIATIVES
1. Nursing practice standards
 a. Have been developed and recommended by the ANA, the official professional nursing organization. ANA
published The Standards of Clinical Nursing Practice which focused not only on the organizing principles of
clinical nursing practice but also the Stand. of Prof’l Performance
b.Nursing practice Standards have also been set by the JCAHO which stressed the need for adequate records on
patients in hospitals and practice standards for the documentation of care by nurses.

2. Nursing data standards

a. Critical Care Classification (CCC)
b.Nursing Information Classification (NIC)
c. Snomed CT

3. Health Care Data Standards Organizations

organizations that emerged to develop or recommend health care data standards to the federal gov’t

a. American National Standards Institute- (ANSI) a private non-profit membership organization. It was instituted
to coordinate and approve voluntary standards efforts in the US.
b. American Society for Testing and Materials
(ASTM) – The ASTM E-31 Committee on Healthcare Informatics: an accredited committee that develops
standards for health informatics and health informatics systems designed to assist vendors, users, and anyone
interested in systematizing health information
c. Health Level 7 (HL7) – an org’n accredited by the ANSI, w/c was created to dev standards for the electronic
interchange of clinical, financial, and administrative info among independent htcare –oriented info systems
d. SNOMED Int’l is another org’n that serves as an umbrella of the structured nomenclatures

D. LANDMARK EVENTS IN NURSING AND COMPUTERS

o Major milestones of nursing are interwoven w/ the advancement of computer and IT, the increased need for nursing
data, dev’t of nsg applications and changes making the nsg prof’n an autonomous discipline
The landmark events were described by the ff categories:

1. early conferences, meetings

2. early academic initiatives
3. initial ANA initiatives
4. initial National League for Nursing initiatives
5. early international initiatives
6. initial educ’l resources
7. significant collaborative events