NURSING INFORMATICS 9 -16

Session 9 WEB 2.0

Definition of terms

• Wiki: A collaborative website that can be edited by anyone that can access it.

• Social bookmarking: Bookmarking sites allow users to save URLs to web pages that can be shared.
Teachers and students can build monitored, subject specific resource lists that they can easily share.

• Social networking: online interaction in the community format where people share personal info., etc.

• Blog: a shared on-line journal where people can post diary entries about their personal experiences
and hobbies

• Captcha: A distorted image of letters and numbers used to prevent automated use of websites

• Podcast: a pre-recorded audio/video program that is posted to a website and is made available for
download so people can listen/view them on personal computers or mobile devices. Some use the term
podcasting to refer to video

• Folksonomy: keyword-based classification system based on collaborative tagging (social tagging)

• Mashups: keyword-based classification system based on collaborative tagging (social tagging)

What is Web 2.0 technology?

• the term means such internet applications which allow sharing and collaboration opportunities to
people and help them to express themselves online

• The term was invented by Darcy DiNucci in 1999 and later popularized by Tim O'Reilly and Dale
Dougherty at the O'Reilly Media Web 2.0 Conference in late 2004.

• "Web 2.0 is the business revolution in the computer industry caused by the move to the internet as a
platform, and any attempt to understand the rules for success on that new platform."- Tim O' Reilly.
(2004)

• It's a simply improved version of the first world wide web, characterized specifically by the change
from static to dynamic or user-generated content and also the growth of social media.

• The concept behind Web 2.0 refers to rich web applications, web-oriented architecture, and social
web.

• It refers to changes in the ways web pages are designed and used by the users, without any change in
any technical specifications.

Key characteristics of Web 2.0

1. Web-based applications can be accessed from anywhere

2. Simple applications solve specific problems

3. Data can be readily shared

4. Employees and customers can access and use tools on their own

5. Social tools encourage people to create, collaborate, edit, categorize, and promote information

6. Network effects are encouraged; the more people who contribute, the better the content gets

Examples of Web 2.0 applications

• hosted services (Google Maps),

• Web applications (Google Docs, Flickr),

• Video sharing sites (YouTube),

• wikis (MediaWiki), blogs (WordPress),

• social networking (Facebook).

• folksonomies (Delicious),

• podcasting (Podcast Alley) & content hosting services and many more.

• Microblogging (Twitter),

• So the major difference between web 1.0 and web 2.0 is that web 2.0 websites enable users to create,
share, collaborate and communicate their work with others, without any need of any web design or
publishing skills. These capabilities were not present in the Web 1.0 environment.

• Now-a-days, the way web users are getting information has drastically changed. Today, users use
content they are specifically interested in, often using Web 2.0 tools.

Advantages of Web 2.0:

⁃ Available at any time, any place.

⁃ Variety of media.

⁃ Ease of usage.

⁃ Learners can actively be involved in knowledge building.

⁃ Can create dynamic learning communities.

⁃ Everybody is the author and the editor, every edit that has been made can be tracked.
⁃ User-friendly.

⁃ Updates in the wiki are immediate and it offers more sources for researchers.

⁃ It pro vides real- time discussion.

Web 2.0 tools and their features:

• Use and impact of Web 2.0:

Adobe Flash, Microsoft Silverlight, and JavaScript are used as rich web technologies in delivering web 2.0
in addition to Ajax, RSS and Eclipse.

• Its applications are based on the reorganized download methodology that made BitTorrent so fruitful
that each downloader of content is also a server, sharing the workload and making the content more
accessible

• It can be a powerful lure for an enterprise; with interactivity promising to fetch more employees into
daily contact at a lower cost. The use of web 2.0 technologies and tools aids greater participation in
projects and idea-sharing, thus ideally leading to better thought-out design and more efficient
production, strengthening bonds with customers and improving communications with partners.

What is the future - Web 2.0 or Web 3.0?

• The business forecasters are all claiming that Web 2.0 is an intermediate phase between the World
Wide Web's existence and a more established phase they're calling Web 3.0.

Welcome to the exciting workd of web 2.0

• profiles

• blog

• groups

• micro blog

• wiki

My web 2.0 Groups

• Discussion boards - discuss current topics with members of your groups. Post a question, provide your
expertise, or just read along.

• Documents - share documents with members of your groups. Write collaboratively with members to
create new documents.
• Bookmarks - bookmark interesting sites and share them with your group. Research a topic by
searching group bookmarks.

What are the major differences between Web 1.0, Web 2.0 and Web 3.0?

• Web 1.0

⁃ Content - destination sites and personal portals

⁃ Search - critical mass of content derives need for search engines

⁃ Commerce - goes mainstream; digital good rise

• Web 2.0

⁃ Speedy - more timely information and more efficient old to find information

⁃ Collaborative - actions of users, a mass, police and prioritize content

⁃ Trustworthy - users establish trust networks and home trust radars

• Web 3.0

⁃ Ubiquitous - available at anytime, anywhere and through any channel or device

⁃ Efficient - relevant and contextual information find able instantly

⁃ Individualized - filtered and shared by friends or trust networks

 Session 10 Policies, Guidelines and laws in Nursing Informatics
Privacy & Netiquette

POLICIES, GUIDELINES AND LAWS IN NURSING INFORMATICS

• Policy

⁃ This is a deliberate system of principles to guide decisions and achieve rational outcomes.

⁃ This is a statement of intent, and is implemented as a procedure or protocol.

⁃ Policies are generally adopted by a governance body within an organization. defined as a course of
action that guides present and future decisions.

⁃ Action based on given conditions are selected from among identified alternatives.

Health care Policy

⁃ Health policy refers to decisions, plans, and actions that are undertaken to achieve specific health care
goals within a society.

⁃ An explicit health policy can achieve several things: it defines a vision for the future which in turn helps
to establish targets and points of reference for the short and medium term. It outlines priorities and the
expected roles of different groups; and it builds consensus and informs people.

⁃ Is established on local and national levels to guide the implementation of solutions for the population's
health needs.

• The events to be included are the nursing shortage, a concern for patient safety, national informatics
initiatives, and delivery of services through Telehealth

• The national alliance for health information technology (NAHIT) is a partnership of diverse healthcare
leaders who are working to influence the use of technology to improve patient's safety, quality and
efficiency.

Intellectual property code of the Philippines

Republic Act No. 8293

• An Act prescribing the intellectual property code and establishing the intellectual property office,
providing for its powers functions, and other purposes.
• recognizes that an effective intellectual and industrial property system is vital to the development of
domestic and creative activity, facilitates transfer of technology, attracts foreign investments, and
ensures market access for our products.

• It shall protect and secure the exclusive rights of scientists, investors, artists and other gifted citizens
to their intellectual property and creations, particularly when beneficial to the people, for such periods.

• Intellectual property refers to the creations of the mind: inventions, literary and artistic works,
symbols, names and images used in commerce.

• Intellectual property rights under the intellectual Property Code are as follows: 1. Copyright and
related rights: refers to the legal right of the owner of intellectual property. In simpler terms, copyright
is the right to copy. This means that the original creators of products and anyone they give authorization
to are the only ones with the exclusive right to reproduce the work.

• 2. Trademarks and service marks: is a distinctive sign that identifies certain goods or services produced
or provided by an individual or a company.

3. Geographic indications: is a sign used in goods that have a specific geographical origin and possess
qualities or a reputation due to the place of origin.

4. Industrial designs: are applied to a wide variety of industrial products and handicrafts. They refer to
the ornamental or aesthetic aspects of an article including composition of lines or colors or any three-
dimensional forms that give a special appearance to a product or handicraft. The design must have an
aesthetic appeal.

5. Patents: is an exclusive right granted for an invention - a product or process that provides a new way
of doing something, or that offers a new technical solution to a problem. It provides the owners with
protection for their inventions. Protection is granted for a limited period, generally 20 years.

6. Layout designs (topographies) of integrated circuits

The agency of the government in charge of the implementation of the Intellectual Property Code is the
intellectual Property Office which replaced the Bureau of Patents, Trademarks and technology Transfer.
It is divided into six Bureaus, namely:

7 Protection of undisclosed information.

1. Bureau of Patents

2. Bureau of Trademarks

3. Bureau of Legal Affairs

4. Documentation, Information and technology Transfer Bureau

5. Management information system and EDP Bureau and

6. Administrative, Financial and personnel Services Bureau

Intellextual property law

• Deals with the rules for securing and enforcing legal rights to inventions, designs and artistic works.

• Give an incentive for people to develop creative works that benefit society, by ensuring they can profit
from their works without fear of misappropriation by others.

Copyright law of the Philippines Republic Act No. 8293

• Took effect on January 1, 1998, under the presidency of Fidel V. Ramos

• A copyright is the legal protection extended to the owner of the rights in an original work

• In the Intellectual Property (IP) Code of the Philippines, literary and artistic works include books,
writings, musical works, films, paintings and other works including computer programs.

Types of rights under the law of copyright

A. Economic Rights

⁃ Replication of the work, or a portion of the work

⁃ Transformation or dramatization of the original work

⁃ The first public distribution of the original work and each copy of the work

B. Moral Rights

⁃ rights of creators of copyrighted works generally recognized in civil law jurisdictions and, to a lesser
extent, in some common law jurisdictions. Require the authorship of the work be attributed to him or
her, meaning that the author may require that his or her name be displayed in a prominent fashion ona
copy or public distribution or use of the work.

⁃ To make any transformation or adjustment to the work, or withhold it from publication

⁃ To oppose any and all mutilation or any other derogatory action to the work which could potentially be
detrimental to the author's honor and reputation

C. Resale Rights

⁃ The author and his or her heirs have the inalienable right to partake of 5% of proceeds of the sale or
lease of his or her original work. This inalienable right is in effect during the lifetime of the author, and
for fifty years after his or her death.

D. Related Rights
⁃ Are the rights of those whose help the author avails of in order to assist him in producing his work, and
distributing this work to the public. These rights are also referred to as "neighboring rights" and include
the following:

⁃ Rights of performers

⁃ Rights of producers and sound recordings

⁃ Rights of broadcasting organizations

Privacy of Personal and Public Domains

• A network domain is an administrative grouping of multiple private computer networks or hosts within
the same

• Domains can be identified using a domain name; domains which need to be accessible from the public
Internet can be assigned a globally unique name within the Domain Name System (DNS)

What is Domain Privacy?

• When you register a domain name with any provider, your details (name, address, email and phone
number) are automatically added to a public WHOIS directory. This is a regulatory requirement for
anyone who registers their domain.

• With domain privacy you can hide your personal Information from public view, protecting you from
spammers, data miners and marketers to reduce unsolicited phone calls and emails.

The Computer Ethics Institute (CEI)

• This was founded in 1985 to serve as a forum and resource for identifying, assessing, and responding
to ethical issues associated with the advancement of information technologies and to facilitate the
recognition of ethics in the development and use of computer technologies.

• CEI developed the Ten Commandments of Computer Ethics. The eHealth Code of Ethics, developed by
Health Informatics Europe (2005), is "to ensure that people worldwide can confidently and with full
understanding of known risks realize the potential of the Internet in managing their own health and the
health of those in their care." The Health Insurance Portability and Accountability Act (HIPAA) of 1996
sets the standards on how security and confidentiality of healthcare information must be maintained.

• The act also sets the penalties for any breach in security of healthcare data. The Internet Healthcare
Coalition, founded in 1997, was created to promote quality health resources online and to ensure that
consumers and professionals are able to find reliable, quality information online.

Healthcare policy and nursing informatics as a specialty

• Nurses have contributed to the purchase, design, and implementation of IS since the 1970s.

• In 1992, the American Nurses Association (ANA) recognized NI as a specialty.

• Attempts in 1989 to be recognized as a specialty failed, but political forces within ANA supported the
requests when it was repeated in 1992.

• The term NI first appeared in the literature in the 1980's. -The definition of NI has constantly evolved
since that time, molded by the maturation of the field and influenced by health policy.

To be acknowledged as a specialty with nursing, informatics had to :

• demonstrate a differentiated practice base.

• identify the existence of educational programs in the field,

• show support from nationally recognized organizations, and

• develop a research agenda.

Healthcare policy impact on nursing informatics practice

• Nursing has experienced a number of shortages in recent history.

• It is predicted that the shortage will result in a large deficit of nurses unless something is done the
shortage will rise from 6% in 2000 to 29% in 2020, or more than 800,000 nurses short of the number
needed

• Nursing organizations have been actively advocating for increased federal funding to expand programs
and increase loans, scholarship, and incentives to attract more young people into nursing.

• In 2002 the American Academy of Nursing (AAN) Commission on Workforce launched a multiphase
project to develop IT that will help support nurses in their day-to-day Work, thereby reducing the
demands of their jobs. *Given the average age of nurses is 45.2, technology devices would enable some
nurses to stay in their careers longer.

National Health Information Infrastructure

• Another national initiative that will impact NI is the National Health Information Infrastructure (NHII).
This voluntary initiative, involving a three-stage process over 10 years, is intended to improve the
effectiveness. efficiency and overall quality of health and healthcare

• The vision and process for building the NHII is outlined in a report "Information for Health Information
Infrastructure released in Nov. 2001
• NHII calls for comprehensive knowledge based networks that integrate clinical, public health and
personal health information to improve decision making by having information available to providers.

Health Insurance Portability and Accountability Act (HIPAA)

• A federal law designed to improve the efficiency and effectiveness of the health care system

• HIPAA was passed in 1996 and is intended to improve public and private health programs by
establishing standards to facilitate the efficient transmission of electronic health information (Public
Law, 104-191, 1996). HIPAA preempts state law and payer-specific variations of data standards; and
mandates input from private, standard-setting organizations,

• The law also designates financial setting penalties for noncompliance with standards related specific
transactions. To avoid further duplication of effort, the law requires the DHHS to adopt standards from
those already approved by private standards-setting organizations.

• HIPAA has a significant impact on informatics; IT must be designed to comply with Title II of the act.

• Nurses must be aware of HIPAA and HITECH rules among the most critical activities

⁃ Keep passwords private

⁃ Do not leave screens containing protected health information unattended.

⁃ Access charts only of clients to whom you are assigned

⁃ Always verify that you are charting on the correct client's chart and that the information is recorded

National Agenda for Nursing Informatics

• Health Resources and Services Administration HRSA is responsible for setting national policy to guide
thepreparation of the nursing workforce, including preparation in the area of NI.

• The Division of nursing (DN) recognized the importance of information management and technology
long before the title NI was used to describe the field of practice and has funded projects focused this
area since 1972.

• Although the DN supported NI projects, the nursing workforce has continued to be deficient in
informatics skills.

• As a result, in 1997 the DN convened the National Nursing Informatics Work Group (NNIWG) to make
recommendations to the National Advisory Council for Nurse Education and practice. The strategic
direction of NI is as follows:

1. to include core informatics knowledge and skill in all undergraduate, graduate, and continuing
education programs.
2. to increase the number of nurses with specialized skills in informatics. Having more opportunity to
complete advanced informatics preparation has increased the number of NI specialists in practice, but
more are needed.

3. to enhance nursing practice and education through informatics projects.

4. to improve faculty skills in NI so that they in turn can promote the development of informatics
competency in students.

Intellectual Property Code of the Philippines Republic Act No. 8293: an act prescribing the intellectual
property code and functions. for other purposes.

• It shall protect and secure the exclusive rights of scientists, investors, artists and other gifted citizens
to their intellectual property and creations, particularly when beneficial to the people, for such periods
as provided in this act.

• Intellectual Property Rights Under the Intellectual Property (IP) code are as follows:

1. Copyright & related rights

2. Trademark & service marks

3. Geographical indications

4. Industrial design

5. Patents

6. La designs

7. Protection of undisclosed information.

- Information privacy: the client's right to control how his/her personal health information is collected,
used and disclosed

⁃ Security: refers to the processes and tools that ensure confidentiality of information.

(QCIPA) Quality of Care Information Protection Act, 2016: provides broad protection to quality of care
information

• purpose is to promote open discussion of adverse events, peer review activities and quality of care
information, while protecting this information from being used in litigation or accessed by clients

• Personal Health Information (PHI); any identifying information about an individual in oral or recorded
form, as it relates to their physical or mental health, their family, donations of body parts or substances,
their health number, or an individual's substitute decision-maker

"Netiquette", or network etiquette, is the code of common courtesy for users of the Internet.
• One should always use this courtesy when participating in e-mail communications, discussions, chat
rooms, blogs, and all other types of computer communication.

• Internet users should learn the rules of proper netiquette to avoid offending others with violations of
courteous Internet communication.

• Netiquette rules may vary slightly when one is engaging in personal communications with a close
friend, or whether this individual is composing a professional electronic communication to be viewed by
others at work.

• Nurses engaging in professional electronic communications with other healthcare professionals and/or
patients should learn and understand this form of etiquette.

Why should nurses use "Netiquette"?

• Nurses are in an occupation where a strict code of professional conduct is important for both the
nurse and the profession as a whole.

• In order to advance the nursing profession and promote nurses as professionals, these health care
workers should engage in a professional manner in all methods of action and communication.

• One area of particular importance is electronic communication via the Internet, Intranet, electronic
mail. or organizational

• When one uses this method of communication, he or she may forget to use the traditional grammar,
punctuation, and simple etiquette rules established for more traditional means of interaction.

• In this manner, the idea of "netiquette" provides individuals, such as working professionals, with a
standard of etiquette that is specifically designed for the electronic communication methods used by
numerous individuals today.

Rules of Netiquette

⁃ online, security, safety and ethics

⁃ internet threats

⁃ protecting reputations online

⁃ copyright

⁃ contextualized online search and research skills

The standards of "Netiquette"

• Some of the standards for basic netiquette include thinking and revising before posting an electronic
communication.
• One should always check a document for spelling and grammatical errors before sending. In addition,
one should remember that a real individual is reading the sent message. In this manner, one should
include the recipient's name, a greeting, closing, and signature. One should also keep electronic
messages short and to the point. Furthermore, one should reply to messages promptly and be honest
and respectful in all messages. It is important to note that the intended recipient may not be the only
person reading the electronic message, so one should avoid judgments and assumptions.

• One should never assume that any communication sent from a work computer is private. In this
manner, one should follow strict netiquette rules when using company computers/Intranet, and one
should be familiar with company computer communication policies. In addition, one should avoid using
common "net speak" acronyms and abbreviations when writing electronic communications to others
while in the workplace. Although some individuals are familiar with these "net-speak" abbreviations,
other persons may misunderstand the intended meanings of these abbreviations. It would be better to
spell out the entire word or phrase to avoid confusion and even offense.

• It is important to note that netiquette rules apply not only to communication via computer. One
should use these standards when communicating via electronic devices such as PDAs, Blackberries, and
cell phone electronic mail. If one should find that an individual who has sent an electronic
communication has committed a serious netiquette violation, one may wish to politely correct this
individual. By correcting the problem immediately, one can educate this individual and keep his/her
from making another violation. If one feels that a correction is in order, one should send a private email
to this individual to avoid embarrassment. One might include the netiquette infraction as well as the
proper netiquette technique.

Don'ts of "Netiquette"

• Never send an e-mail or communication when angry. One should always review the message when he
or she is calm.

• Never use profanity in an electronic communication.

• Never send lengthy multiple attachments for the reader to review. Keep electronic messages short, to
the point,

• Never use all caps in electronic communication. Capital letters may be interpreted as shouting.

• Never forward chain letters and chain mail in electronic communications. When forwarding electronic
messages, all previous email addresses to protect the privacy of others or ask the original sender if and
on subject.

Common "Net Speak" terms

Nurses should avoid using the following common "net-speak" abbreviations in their professional
electronic communications because one who is not familiar with these abbreviations may
misunderstand the intended meaning.
lol- laugh out load

btw- by the way

ttyl - talk to you later

ur- your

b4- before

cu - see you

pls- please

tnx- thanks

imho- in my humble opinion

eod-end of discussion

f2f-face to face

brb-be right back

tia- thanks in advance

CORE RULES OF NETIQUETTE

Netiquette, or network etiquette, is concerned with the "proper" way to communicate in an online
environment. Consider the following "rules," adapted from Virginia Shea's The Core Rules of Netiquette,
whenever you communicate in the virtual world.

Rule 1 : Remember the Human

• When communicating electronically, whether through email, instant message, discussion post, text, or
some other method, practice the Golden Rule: Do unto others as you would have others do unto you.
Remember, your written words are read by real people, all deserving of respectful communication.
Before you press "send" or "submit," ask yourself, "Would I be okay with this if someone else had
written it?"

Rule 2: Adhere to the same standards of behavior online that you follow in real life

• While it can be argued that standards of behavior may be different in the virtual world, they certainly
should not be lower. You should do your best to act within the laws and ethical manners of society
whenever you inhabit "cyberspace." Would you behave rudely to someone face-to-face? On most
occasions, no. Neither should you behave this way in the virtual world.

Rule 3: Know where you are in cyberspace

• "Netiquette varies from domain to domain." (Shea, 1994) Depending on where you are in the virtual
world, the same written communication can be acceptable in one area, where it might be considered
inappropriate in YOU text to a friend may not be appropriate in an email to a classmate or colleague.
Can you think of another example?

Rule 4: Respect other people's time and bandwidth

• Electronic communication takes time: time to read and time in which to respond. Most people today
lead busy lives, just like you do, and don't have time to read or respond to frivolous emails or discussion
posts. As a virtual world communicator, it is your responsibility to make sure that the time spent reading
your words isn't wasted. Make your written communication meaningful and to the point, without
extraneous text or superfluous graphics or attachments that may take forever to download.

Rule 5: Make yourself look good online

• One of the best things about the virtual world is the lack of judgment associated with your physical
appearance, sound of your voice, or the clothes you wear (unless you post a video of yourself singing
Karaoke in a clown outfit.) You will, however, be judged by the quality of your writing, so keep the
following tips in mind:

⁃ Always check for spelling and grammar errors

⁃ Know what you're talking about and state it clearly

⁃ Be pleasant and polite

Rule 6 : Share expert knowledge

• The Internet offers its users many benefits; one is the ease in which information can be shared or
accessed and in fact, this "information sharing" capability is one of the reasons the Internet was
founded. So in the spirit of the Internet's "founding fathers," share what you know! When you post a
question and receive intelligent answers, share the results with thers. Are you an expert at something?
Post resources and references about your subject matter. Recently expanded your knowledge about a
subject that might be of interest to others. Share that as well.

Rule 7: Help keep flame wars under control

• What is meant by "flaming" and "flame wars?" "Flaming is what people do when they express a
strongly held opinion without holding back any emotion." (Shea, 1994). As an example, think of the
kinds of passionate comments you might read on a sports blog. While "flaming" is not necessarily
forbidden in virtual communication, "flame wars," when two or three people exchange angry posts
between one another, must be controlled or the camaraderie of the group could be compromised. Don't
feed the flames; extinguish them by guiding the discussion back to a more productive direction.

Rule 8: Respect other people's privacy

• Depending on what you are reading in the virtual world, be it an online class discussion forum,
Facebook page, or an email, you may be exposed to some private or personal information that needs to
be handled with care. Perhaps someone is sharing some medical news about a loved one or discussing a
situation at work. What do you think would happen if this information "got into the wrong hands?"
Embarrassment? Hurt feelings? Loss of a job? Just as you expect others to respect your privacy, so
should you respect the privacy of others. Be sure to err on the side of caution when deciding to discuss
or not to discuss virtual communication.

Rule 9: Don't abuse your power

• Just like in face-to-face situations, there are people in cyberspace who have more "power" than
others. They have more expertise in technology, or they have years of experience in a particular skill or
subject matter. Maybe it's you who possesses all this knowledge and power! Just remember knowing
more than others do or having more power than others may have does not give you the right to take
advantage of anyone. Think of Rule 1: Remember the human.

Rule 10: Be forgiving of other people's mistakes

• Not everyone has the same amount of experience working in the virtual world. And not everyone
knows the rules of netiquette. At some point, you will see a stupid question, read an unnecessarily long
response, or encounter misspelled words; when this happens, practice kindness and forgiveness as you
would hope someone would do if you had committed the same offense. If it's minor "offense," you
might want to let it slide. If you feel compelled to respond to a mistake, do so in a private email rather
than a public forum.
 Session 11: Hospital and critical care application

Critical Care Nursing

~ An area of expertise within nursing that focuses specifically with human responses to life-threatening
problems.

Critical Care Nurse.

⁃ is responsible to ensure that critically ill patients are seriously conditioned

individuals

⁃ Ensure that families of the medically ill patients should receive optimal care.

⁃ Rely upon a dedicated knowledge, skills and experience and of course automated system of support
and intelligent system to provide care to patients and families and create environments that are healing.

Critical Care Applications

⁃ Areas where patients require complex assessment, high-intensity medication, continuous therapy and
interventions, and unrelenting nursing attention and continuous watchfulness

⁃ Intensive care units, Pediatric Intensive Care Units, Neonatal Intensive Care Units, Cardiac Catheter
Labs, Telemetry Units, Progressive Care Units. Emergency Departments and recovery rooms are among
the special. area of critical care application that need immediate attention when it comes to proper
automation and computerization.

⁃ Critical care providers and nurses rely upon a dedicated knowledge, skills and experience and
automated system of support and intelligent system to provide care to patients and families and create
environments that are healing, compassionate and caring

⁃ Technology contributes to the healthcare areas, making it easier for patients to recover, and keeps
proper management of health.

* Critical Care Information System

⁃ Provide real-time resource utilization data and management of information and access critical care
areas through the integration of the medical facilities in the critical care or intensive care unit to an
intelligent computer system which is capable of processing all data.

⁃ Enables the electronic collection of hospital and patient-specific critical care data of the entire patient
in the critical care areas which can be processed to create a patient profile which generates real time
and historical report on indicators including bed occupancy, delayed discharges, readmission rates, and
outcomes

⁃ Automated collection and management of medical information will become the important task of the
critical care information system.

⁃ The hospitals in the Philippines with critical care information system should have a large clinical
computer system that uses information from many different areas such as information from the clinical
laboratory, pharmacy, radiology, pulmonary, cardiology, bedside nurse charting, and other areas are all
combined and correlated to provide reporting, feedback and suggestions to hospital staff.

⁃ Special software is installed in the computer system which enables the user to have an access and use
of the critical care information system.

⁃ The bedside monitoring system acquires data such as heart rate from the ECG, parameters from
arterial and pulmonary arterial invasive blood pressures, temperatures, non-invasive blood pressures
and arterial saturation and heart rate from pulse oximetry.

⁃ Other electronic devices at the patient's bedside such as infusion pumps, mechanical ventilators,
mixed venous oxygen saturation monitors, and fluid collection devices that measure chest drainage and
urine output are also sources of important clinical information.

⁃ Information from these devices, many of which are microprocessor based, is typically manually
entered by nurses and critical care staff at the terminal located at each patient's bedside.

⁃ The manual and automatic information collected is used for complete computerized charting and for
computerized decision making

⁃ As such, the critical care information system has built-in statistical information which prepares all the
charting and statistical analysis and reporting systems.

• Medical Information Bus (MIB)

- Provides a generalized method of attaching patient monitoring devices to a common interface.

⁃ This interface converts the unique manufacturer data communications protocol into a standardized
hardware and software system

⁃ It eliminates the need for a custom connector and software presently needed to interface such
devices.
⁃ Has the ability to filter, store and select information sent for inclusion into the clinical medical record
on the clinical computer system. Infusion pumps, ventilators, pulse and other patient equipment are
now transmitting clinical information for use in clinical data reporting and decision making

Advantages of Critical Care Information System

✔ Inteligently integrates and process physiologic and diagnostic information and store it to a secured
clinical repository

creates trends analysis with graphical representation of results

offline simulation can be performed to test the condition of the parents

provide clinical decision support system

provide access to vital patient information

providing feedback and quick evaluation of the patient's condition and providing alert.
 Session 12 Community Health Application

Community Health Application

• Population level informatics has its own special treatment, systems, issues and deliberation.

• Creating information systems at the population level, from a development perspective is somewhat
difficult due to a very large number of resources, data elements, diverse parameters, components, and
information content.

• The health information system should have integration with medical care environment, food and
water supply, . disease treatment, disaster management and control, health environment, health risk
factors, economical status,

• Community health information system is a collective term for the methodical application of
information science and technology to community and public health processes.

• Community health information system focuses on the health information system of the community, it
is centered on the majority part of the public.

• Environmental factors are among the common concerns of the health information system.

• Community health information system also emphasizes the prevention of disease, medical
intervention, and public awareness.

• By relating health status to a variety of demographic, geographic, environmental, and other factors, it
is possible to develop a correlation and identify risk factors that contribute to health problems.

• Community health information system is reinforced by government institutions such as the

Department of Health.

• Policy development in community health is based on science, but it is also derived from the values,
beliefs, and opinions of the society it serves.

• Public health officials who wish to promote certain health behaviors or to promulgate regulations
concerning the majority of public health should have an automated system.

• Hospital information system, clinical information system, patient monitoring electronic health record
focused more on individual and single resource contrary to community health information systems
which is focused on information about majority of populations.
Goal of Community Health Informatics

• One of the key goals of community health informatics is the effective and timely assessment that
involves monitoring and tracking the health status of populations including identifying and controlling
disease outbreaks and epidemics.

Community Health Nursing

• Comprehensive directed towards the majority of individuals, families, and the community at large.

COMMUNITY HEALTH APPLICATION

• The nature of community health is comprehensive directed towards the majority of individuals,
families and the community at large.

• The community health information system fulfilis a unique role in the community, promoting and
protecting the health of the community at the same time maintaining sustainability and integrity of
health data and information.

• Community health information system encourages optimal application of computer systems,

computer programs.

Primary Focus of Community Health Information System

• Preventing, identifying, investigating and eliminating communicable health problems

• Accessibility of data and information through communication

• Educating and empowering individuals to adopt health lifestyles

• Facilitate the retrieval of data

• Effective transformation of data into information

• Effective integration of information to other disciplines to concertize knowledge and create better
understanding.

• Creation of computerized patient records, medical information system

• Central repositories of all data such as data warehouse

• Simple Graphical User Interface (GUI) for nurses and other healthcare provider, patient and consumer

COMPUTER BASED SURVEY SYSTEM

• An experiment involves the collection of measurements or observations about populations that are
treated or controlled by the experimenter.

• A survey, in contrast to an experiment, is an examination of a system in operation in which the

investigator does not have an opportunity to assign different conditions to the objects of the study.

• Both of these methods of data collection may be the subject of statistical analysis however, in the case
of surveys some cautions are in order.

• Health statistical surveys are used to collect quantitative information about items in a population to
establish certain information from the obtained data

• Surveys of human populations and institutions are common and helpful in health science application
and implementation of procedures and solutions to health problems

• Health surveys may focus on opinions or factual information depending on its purpose, and many
surveys involve administering questions to individuals.

• A statistical survey can either be a structured survey when administered by a researcher and self-
administered survey when referred with a questionnaire.

• To obtain accurate and good results, very reliable and informative inputs should be considered and
should be supported.

• Automated systems can be used to integrate all of the information obtained using the different
processes.

• The data can be translated effectively through the use of statistical information systems.

• The data can be directly fed to a computer system that statistically processes the data

• The computer program is coupled to an intelligent system which provides prediction, provides
decision, provides, target measures, and provides coordination.

• All of these processes are maintained in a secured and private system to preserve the integrity of data
and information.

COMMUNITY ELECTRONIC DISEASE SURVEILLANCE SYSTEM

• To enhance the emergency preparedness and response system, a special system such as the national
electronic disease surveillance system can be coupled and integrated to the national health information
system.

⁃ Environmental status

⁃ Health records

⁃ Demographic population

⁃ Area Category
⁃ Health Awareness program

⁃ Society level

Advantages of integration of Community Health Systems

• Consistent exchange of response

• Disease tracking

• Date and information sharing

• Building strategies

• Early detection and monitoring of disease and sick

• Control of spread of disease

• National alertness and preparedness

• Building strong communication

• Maintaining strong relation between nurses and other healthcare provider

• Continuous coordination of the healthcare professionals

• Synchronization of the decisions

• Streamlining of the process

• Effective management of data and information

• Optimal operation of hospital and clinics

 Session 13 Ambulatory Care System

Ambulatory Care Information System

Ambulatory Care

⁃ Covers a wide range of health care services that are provided for patients who are not admitted
overnight to a hospital.

⁃ These services are performed at outpatient clinics, urgent care centers, emergency rooms, ambulatory
or same-day surgery centers, diagnostic and imaging centers, primary care centers, community health
centers, occupational health centers, mental health clinics, and group practices.

• Ambulatory Care Information System

⁃ Provides automated processing of data and information such as allergies and medical alerts, patients
accounting system such as charging, billing, discounts and concessions, diagnostics imaging treatments,
and etc.

⁃ With this system, the patient waiting time is optimized through effective queue management.

⁃ It involves one-time registration required per visit. It also facilitates the management of doctor's
schedules.

• Advantages of Ambulatory Care Information System

⁃ Real-time and easy access to patient's medical records by healthcare providers.

⁃ Improved workflow, which allows more time for comprehensive patient counseling and review.

⁃ Reduced errors with the availability of various automation engines - drug interaction engine; medical
alert engine: patient billing engine, etc.

⁃ Automated and integrated back-end process such as pharmacy, billing, purchasing, inventory
management, etc
⁃ Improved clinical outcome analysis enhanced research productivity through data mining and facilitate
institutional handling of managed care challenges in a timely manner.

⁃ Improvement in hospital inventory management.

⁃ Better monitoring and management of costs-prescription, consumables, doctor's fees, etc.

• Issues in Ambulatory Care Information System

⁃ Increased accountability

⁃ The need for continuous support

⁃ Privacy and confidentiality of information

⁃ Accessibility and security of data and information

⁃ Integration and support to the other system

The Role of Health Information System in the Ambulatory Care System

• Health informatics is a specialty that integrates health science, computer science, and information
science to manage and communicate data, information and knowledge in health practice.

• Health information system has another system to understand which facilitates the integration of data,
information and knowledge to support patients, healthcare providers and other providers in their
decision making in all roles and settings.

• The very basic objective of the automated ambulatory care information system is to easily integrate
the data to the other data and easily translate these data into information.

• The effective transformation of data can be integrated to the other processes to transform it into
knowledge.

• The ambulatory care nurse and other healthcare provider should be capable enough to implement the
process effectively.
 Session 14 Emergency preparedness and response
INFORMATION SYSTEM FOR EMERGENCY PREPAREDNESS AND RESPONSE

• Health information System is the integration of science of information, the practice of information the
engineering of information systems.

• Health information systems also capture the scenario or condition where the emergency preparedness
and immediate response is prioritized.

• Information system is a collective term referring to a system of data records and activities that
processes and translates the data to information in an automated process.

• The processing of data involves the use of computer systems and specialized software that
manipulates the information-processing activities of the organization.

• There is various application of health information systems such as:

⁃ decision support systems for patient care

⁃ patient data profiling, knowledge discovery and management, transaction records processing systems,

⁃ hospital information systems,

⁃ pharmacy health system,

⁃ clinical information system,

⁃ electronic health records,

⁃ critical care system,

⁃ patient care management,

⁃ hospital facility management,

⁃ ambulatory and laboratory information system,

• This application can have a derivative solution for emergency preparedness and timely and accurate
response.

Emergency and Response Process

There has been a rise in terrorism incidents and natural disasters worldwide. Natural events range from
earthquakes, tsunamis, floods, hurricanes, typhoons to pandemic disease. The very basic objective of
the emergency and response. process is to halt the spread of diseases, infection, widespread sickness,
epidemics, etc.

• Health care providers become first responders in this situation victims 1st appear at ED, clinics, and
schools must identify patterns of symptoms, and other irregularities

• Early response is focused on contributions toward:

⁃ Surveillance of threat detection

⁃ Biosurveillance and bioagent detection

⁃ Increasing the efficiency in disaster response

⁃ Providing a telepresence for remote medical caregivers.

• Effective response requires a moment-to-moment "situational analysis", real-time information to

assess needs and available resources that can change suddenly and unexpectedly

• New technologies are being used and evaluated to improve patient care and tracking, foster greater
safety for patients and providers, enhance incident management at the scene, coordinate response
efforts, and enhance informatics support at both the scene of the disaster and at the community
resource levels. Technologies such as

⁃ Smart devices

⁃ Wireless connectivity

⁃ Positioning technologies

National Electronic Disease Surveillance (NEDSS) is one of the CDC initiatives that require informatics
suppor Purposes of NEDSS:

⁃ To detect outbreaks rapidly and to monitor the health of the nation

⁃ Facilitate the electronic transfer of appropriate information from clinical information systems in
thealthcare system to public health departments.

⁃ Reduce provider burden in the provision of information

⁃ Enhance both the timeliness and quality of information provided

WHO phases of pandemic alert

1. low risk of human cases

2. higher risk of human cases

3 no, or very limited human to human cases

4.increased human to human cases

5.significant human to human transmission

6.efficient/sustained human to human transmission

4 PHASES OF DISASTER RESPONSE

• Preparation- plan, train and educate for events that cannot be prevented

• Response - decrease morbidity, mortality and property damage after a disaster has happened

• Mitigation/Prevention - reduce the negative consequences of a disaster or decrease the probability of

it happening

• Recovery - actions taken to return to normal after a disaster

Response: defined as the actions taken to decrease mortality and morbidity, and to prevent further
property damage when the hazard occurs. Response is putting preparedness plans into action which
includes immediate actions to save livas, protect property, and meet basic human needs. Response
activities may include

⁃ search and rescue

⁃ triage

⁃ acute medical care

⁃ fire fighting

⁃ sheltering victims

⁃ relocating medical records

Recovery: defined as the actions taken to return to normal following an event.

Prevention/Mitigation: defined as "sustained actions that decrease the risk of a hazard (probability of
occurrence) of an event

-Repairing buildings.

-Replacing homes

hazard, or to reduce the potential negative consequences suffered by people and/or property." It can
involve such actions as:

⁃ Laws and regulations restricting deforestation to prevent mudslides

⁃ Relocating or elevating structures to minimize the effects of floods

⁃ Securing shelves and hot water heaters to walls in earthquake zones

⁃ Developing, adopting and enforcing building codes and standards

⁃ Engineering roads and bridges to withstand earthquakes

⁃ Using fire-retardant materials in new construction to reduce the risk of fire

Preparedness: takes the form of plans or procedures designed to minimize physical and property
damage when an the occurs. These activities ensure that when a disaster strikes, disaster (emergency)
managers will be able to provide the best response possible. The essential elements include:

A Planning

B Training personnel

C. Table top disaster drills

Health information system can address problems such as lack of preparation, indices for references,
statistical quantification of impact, measurable parameters, response time, likelihood of events,
probability of an event and prediction for response can be captured.

Assessment of the Current System Health Information System

• A Health Information System should be capable enough to predict possible scenarios and case
conditions
• It should also be used as an effective tool for emergency preparation and response, meanwhile, this
system should possess good components of information structure which should be coupled to an expert
system.

• Through the effective use of technology, the healthcare industry can have immediate and
instantaneous processed information, and in this way nurses and other healthcare providers can have a
proper preparation for emergency and execute correct and timely response to the prioritized
individuals.

• The electronic health record system, hospital information system, clinical information system, patient
information management system, healthcare information system, etc are integrated through a central
database system controlled and protected by a government health institution such as the Department
of Health.

• With the hospital departmental computer systems such as laboratory, microbiology, and pharmacy
connected to the network, institutions generally collect and store data in a central data repository.

• The integration of national health information system in every hospital information system and clinical
information system can improve health care service by providing nurses and healthcare providers with
better data access, quicker data retrieval, readily translated data into information, more versatile data
output and presentation, less mathematical skills, no need to memorize index, patient profile, tables for
references and good visualization of the results.

• Automated patient health records can be integrated into statistical information systems to enhance
the results of the information for evaluation and analysis which can be used to predict results to
scenarios and create trending output

• This system can certainly increase the effectiveness of healthcare emergency preparedness and
response.

• Hospital and clinic efficiency are also promoted by reducing costs, creating parallel works with
different conditions and systems, optimizing the schedule of the staff and facilities, optimizing the
capabilities of the nurses and healthcare provider, improved coordination works, minimized
irregularities and errors, eliminate redundancy in workloads, reductions of patient waiting time and
creates hierarchy in prioritizing decisions.

Standardization of Data Transformation and Information Reporting

• The resolution of data should be defined up to the necessary details. Ex. Instead of showing the
number of dengue cases in a certain community, it is best to illustrate the number of dengue cases for
adults, young and teenagers.

• The details can also include the age bracket, status of the individual, environment, case condition, etc.

• The reporting system should have an option whether it is expressed in percent, numbers, and the
numbers are expressed in terms of time series so that the numbers of events are easily monitored and
integrated per interval by per day basis
• Submission of data should be done in real-time so that immediate preparedness will be applied to
unaffected areas or community and proper response from the healthcare providers are provided
instantaneously

• Segregation of data should also be captured in the reporting system to eliminate redundancy of data
and maintain integrity of results .

National Electronic Disease Surveillance System: enhance the emergency preparedness and response
system. The system includes the following:

⁃ Environmental Status

⁃ Health Records

⁃ Demographic Population

⁃ Area Category

⁃ Health Awareness Program

⁃ Society Level

⁃ Emergency Response

⁃ Effective Preparedness

⁃ immediate Solution

⁃ Program Launching

⁃ Strategy Development

⁃ Real-Time Awareness

⁃ Sharing of information

⁃ Campaign drive

⁃ Information Dissemination

Definition of terms:

• All hazards approach: process approach for all sectors to prepare for any emergency disaster that may
occur • Pandemic: outbreak of disease that affects populations worldwide, for example, pandemic
influenza causes serious illness worldwide.
• Bioterrorism attacks/pandemics: area with most serious knowledge deficit

• Disaster condition: significant natural disaster or man-made event that overwhelms the affected state
and necessitates both federal public health and medical care assistance.

• Mass casualty incident (MCI). (or mass casualty event/MCE): Disaster situation that results in a large
number of victims who need the response of multiple organizations

• Chemical agents injure/kill vesicant, nerve, blood and respiratory spreads easily through air to cause
immediate effects, require decontamination require trained HAZMAT teams/PPE less toxic than biologic
agents

• Biologic agents: disease causing organisms small quantities can have large effects spread through large
areas can remain on air/surfaces difficult to prepare against most cause flu-like symptoms
plague/smallpox are most contagious timing is critical for treatment

• Radiologic agents: radiation strips electrons from atoms causing chemical changes in molecules
expression may be delayed, depends on time, distance, shielding and quantity psychological effects are
substantial often used w/ explosives "dirty bomb" decontamination 1st, then patient care radiation,
bums, poisoning cancer, contamination of drinking water

• Nuclear agents: damage consists of blast range effects, thermal and nuclear radiation, and radioactive
fallout contamination can remain for many years' psychological effects are substantial symptomatic
thermal burns, shrapnel injuries, and radioactive fallout depends on distance and time of exposure

• Explosive agents: most common method for terrorist capable of violent decomposition, pressure,
temperature changes and propellants can cause injury/death symptomatic, often requires treatment for
burns
 Session 15 Administrative Assistive and Workplace technologies
Telehealth and Telenursing

Goals of informatics

1. Integrates computer, cognitive, and information science to manage and communicate data,
information, and knowledge within a specialty's practice.

2. Nursing informatics combines and manages nursing and computer science to effectively communicate
data and knowledge to improve health care delivery and efficiency

3. Facilitates the integration of data, information, and knowledge in all roles and settings to support
clients, nurses,

4. Communication, education, and research are the purpose of electronic health care data entry,
analysis, and and other providers in decision-making retrieval.

5. Information technology is the backbone of nursing informatics, streamlining nursing practice for
efficiency, safety, and quality.

The Digital health care community

• Informatics provide health care with an opportunity to create a digital culture of interconnectedness
that serves many clients and team members

• Allows to be proactive response to wellness promotion, disease prevention, treatment of illness, and
advancement of knowledge

Computerized data- risk manager perspective

• Helps improve client safety

• Evaluate evidence based practice intervention

Data regulation
• Health Insurance Portability and Accountability act 1996 (HIPAA)

• American Recovery and Reinvestment Act 2009 (ARRA)

The Health Insurance Portability and Accountability Act of 1996 (HIPAA)

• It is a federal law that requires the creation of national standards to protect sensitive patient health
informationfrom being disclosed without the patient's consent or knowledge.

• Rules contain privacy, security, and breach notification requirements that apply to individually
identifiable healthinformation created, received, maintained, or transmitted by health care providers
who engage in certain electronic transactions, health transactions, health plans, health care
clearinghouses, and their business associates.

• Five main components of HIPAA: (1) Privacy Rule, (2) Transactions and Code Sets Rule, (3) Security
Rule, (4)Unique Identifiers Rule, and (5) Enforcement Rule. Privacy rule.

• HIPAA examples

1. Automatic sign offs when leaving a computer screen

2. Alarms on mobile device to prevent theft

3. Hierarchical passwords

4. Unique passwords

5. Shredding of documents

6. Placement of fax machines an computers in secure area

American Recovery and Reinvestment Act 2009 (ARRA)

• Part A The Health Information Technology for Economic and Clinical Health Act (HITECH)

• Part B - provides financial incentives or health professionals, facilities to adapt, engage in use of
electronic health record technology

Health Information Technology for Economic and Clinical Health Act (HITECH)

• Addresses the development, adoption, and implementation of health information technology policies
and standards, and provides privacy and security protection for client information.

Bar coding technology

• A nurse at a client's bedside scans medication barcodes and the client's hospital ID band before giving
the client's medications

HealthCare Information and Management Systems Society (HIMSS)

• Provides guidelines for sharing electronic information through the development and integration of
electronic interfaces.

ADMINISTRATIVE ASSISTIVE AND WORKPLACE TECHNOLOGIES

As technology advances, so does its influence healthcare. Nurses must now be tech savvy to navigate
online charting systems, update health records, schedule care and more. In days past, patient
information was kept in carefully filed, handwritten charts. Now, technology in nursing has made it
easier than ever to keep patient info efficiently recorded and stored.

"There can be temporary drawbacks when a technology is first implemented, but these are outweighed
by the long-term benefits of the technology," explains Anthony Sartor, registered nurse. "It's of vital
importance that nurses are given the necessary education to use new technologies that are being
introduced in their workplaces." Technological advances aren't likely to slow down any time soon. So
what are the repercussions of integrating tech into nursing? Is there a general consensus about its ability
to help or hurt the system? Join us as we dig deeper.

What are some recent examples of technology changes in nursing?

• One of the biggest technological changes that's arisen in the field of nursing is electronic charting.
Instead of filling out charts with pen and paper, most nurses are now required to review information
and fill out charts online. Many patients can now also access their own medical records and test results
through these online patient portals. This assists in closing the communication gap and getting
information to patients quickly and efficiently.

• Other updates include pagers or cell phones for enhanced communication between nurses, doctors
and patients, GPS tagging and tracking of medical equipment, enhanced diagnostic devices, smarter
alarm systems and lifting devices that allow nurses to lift patients without injuring themselves.

Stand out technologies transforming medical care, and as nurses are educated about new medical
technologies and practices, patients and providers benefit.

1. Automated IV pumps.
• Automated IV pumps control the dosages and drips given to patients. Software and medical tech
allows nurses to change the drip amounts and medication doses so patients aren't waiting for changes.

• There are IV pumps for nutrition, which gives needed meals at the right times. Additionally, there are
controlle amount of pain medication for themselves.

• Automated IV pumps help speed up nursing processes, and can be crucial if there is a need for
immediate adjustment. Changing medication through an automated process also removes elements of
human error that could present issues for clinical patients and hospitals.

• Automated IV kits give nurses opportunities to focus on other areas of work, instead of having to
measure and give medication or food.

• Hospitals all have different kinds of automated IV pumps, so training and education is often based on
the specific hospital or clinic where nurses work.

• Additionally, many nursing schools give training and information on new software and technology,
including how automated IV pumps work and why they are valuable.

2. Portable monitors.

• Portable monitor equipment allows nursing professionals to check up on patients even if they are on
the move, or busy helping someone else.

• Portable devices monitor vital signs like ECG, respiratory rates, and oxygen saturations while
transmitting the information back to a central monitor. This means that nurses will get an alarm
notification if there is any emergency.

• Most hospitals have nurses check on levels hourly. Portable monitoring technology allows nurses to
track and note stats at the right time, even if there are a lot of other things going on.

• This helps patients be constantly monitored from anywhere in the hospital, and the alerts and alarms
sent to nurses through the portable monitor can save lives.

• Nurses learn at their specific hospital how to utilize portable monitors, and nursing schools help teach
students the value and general use of many common pieces of equipment.

3. Smart beds.

• Smart bed technology can help nurses track movement, weight, and even vitals.

• Smart beds also play a major role in keeping patients safe and comfortable during a long hospital stay.
With the number of falls and patient injuries inside hospitals, smart beds are very important for patient
safety.

• Smart bed technology gives nurses a constant monitor in a room that provides them with regular
updates and communications on a patient's activities. It can also help them identify patterns, which can
lead to a new diagnosis or a different understanding of a condition.
• Nurses also spend less time coming in and adjusting supplies and medical equipment for comfort or
safety, because they can help control that with their smart bed. It allows providers to get back to other
important work that needs to be done by humans.

4. Wearable devices.

• Wearable devices and mobile apps are transforming the healthcare industry. Devices that help track
heart rates, exercise, sleep, respiration, and more, are helping people take their health into their own
hands.

• With increased accessibility to iPhones, nurses also benefit from apps and devices that help them care
for patients. For example, the Steth 10 smartphone stethoscope is essentially a stethoscope app that
allows nurses and doctors to simply use their smartphone to get breathing sounds and see heart rates.
Using a phone can be less intimidating, especially for younger patients, and gives providers a full range
of informationand easy tracking of medical needs.

• Wearable devices from health tracking, to specific patient monitoring, are often called the future of
healthcare. With access to huge amounts of data, wearable devices can help the entire healthcare
process; from diagnosis to recovery.

• Wearable devices help remove elements of human error for nurses, because the communication of
data comes directly from the device itself. It allows for faster record keeping, and helps patients and
nurses maintain consistent monitoring of health.

5. Electronic health records.

• Electronic health records (EHR) are taking over older paper filing methods. Electronic health records
allow nursing experts to document care provided to patients, and retrieve information that can help
prioritize care. Additionally, information entered into computer systems, can then be accessed by the
care team, including doctors and even patients themselves when necessary.

• While security continues to be a concern for electronic health records HIPAA laws ensure security and
privacy of electronic records are maintained by healthcare organizations, and new technology like block
chain and cryptography are easing privacy concerns.

• EHR's can tell registered nurses (RNS) whether steps still need to be taken for a patient, can monitor
small condition changes, and can give them information immediately as alerts or reminders.

• Real-time health updates impact the speed and accuracy of medical care. RNs learn how to use
software systems on the job, but their education and training will help them quickly understand what
different indications on medical records mean, and what their course of action should be; to ensure
improved patient outcomes.

6. Centralized command centers.

• One of the newest ideas for hospitals, centralized command centers, promises improved patient
experiences and better ways for RNs and doctors to manage supplies, clinical technology, and capacity.
This is done through software applications such as dashboards that provide real-time updates for an
organization.

• With shorter or non-existent delays between transitions of care, nurses and doctors can actively be
aware of room availability, OR schedules, and what individual patients still need in order to be
discharged. This allows everyone to do their job more efficiently, and help patients more effectively.

• Specifically designed for capacity management, command centers being piloted around the country
areperforming well. Many hospitals report operating at higher capacity, and overall improved patient
experiences.

7. Telehealth and applications

• Telehealth is a new and valuable element in healthcare. Hospitals and clinics allow patients to virtually
video-chat with a doctor or nurse. Patients are able to describe their symptoms, or show doctors things
like rashes or bumps.

• This allows patients to quickly be diagnosed, without leaving the comfort of their own home. They can
be told if they need to come in for further testing or diagnosis, be prescribed medicine, or given medical
advice.

• Telehealth saves patients and doctor's alike money and time. Similarly, it prevents sick patients from
coming to public places, and exposing other patients. This technology is changing the way clinics operate
and how patients are cared for.

• Similarly, medical apps and wearables help patients and doctors work to improve health. Doctors and
nurses can monitor vital signs of patients without them being in the office. They can be utilized for
overall health and wellness, or for specific medical concerns such as seizures or diabetes.

• Similarly, apps can help patients understand when they should call a doctor, and when a simpleover-
the-counter medication could help. This again conserves resources in clinics, and helps patients save
time and frustration.

• Mental health issues can also be addressed with the help of apps. Mindfulness apps help individuals
understand their mental health and energy, and remind them to take time for these important aspects
ofwellness.

• Increasing app and telehealth technology gives doctors, nurses, and patients themselves, more control

Computerized nursing systems on administrative application can help nursing manage and use
information to fulfil its unique data and requirements:

• Clinical needs (patient care, documentation, etc.)

• Strategic needs (organizational performance support processes etc.)

• Quality management need (outcome measurement and regulation compliance)

• Resource and personnel management needs (scheduling, continuing education, staff development)

Examples of Computer applications for Administrative information management:

• Nursing intensity

• Patient Classification System

• Staffing and Scheduling System

• Unit activity reports

• Error reports

• Incidental reports

• Infection control

• Training and education

• Financial planning

• Hospital expansion

• Personnel files

• Quality assurance

Benefits of using Information technology for Nurse Administrators

• Expanded use of nursing staff resources

• Improved quality of patient care monitoring

• Improved documentation

• Improved communication

• Improved planning

• Increased standardization of nursing practice

• Ability to define nursing practice and associated issues

• Ability to define methods to track patient care delivered, outcomes achieved and revenue generated

• Enhanced recruitment and retention

• Improved evaluation of care provided

• Support dynamic organization, capable of change

What are some potential drawbacks?

While technology certainly helps with communication and spurs other efficiencies, there can be a
learning curve when new technology is implemented.

• is a lack of ability to communicate effectively

• some privacy risks that come with these advancements. Real people are developing these
technologies, and sometimes, the wrong people can get a hold of important information and there can
be a breach in patient confidentiality.

TELEHEALTH

• The use of telecommunication technologies and computers to exchange healthcare information and to
provide services to clients at another location, previously known as telemedicine.

• is defined as the use of electronic information and telecommunications technology to support long-
distance clinical

• GOAL: to expand provision of healthcare services to locations/populations in need of those services

• Some examples include:

• video conferencing

• sharing images online,

• streaming media and wireless communication

• Examples of how telehealth is used:

• Patient portals

• Virtual appointments

• Wearable devices allowing for remote monitoring

• Travking health information in a personal health app

• Telehealth supports and promotes health care from a distance, connecting patients with healthcare
providers and the resources they need to control their own health. It also supports continuity of care
and allows healthcare professionals to better serve their patients.

Telehealth

• COLLABORATION - Easily transmitted e-Records allow doctors at different locations to work off the
same information reducing the chance of medical errors
• E-RECORDS - Medical information is entered once to compile a complete history making it easier to
track outcomes

• TELECONFERENCING - Doctors can consult with distant patients, reducing expensive office visits and
making advanced healthcare available to even the most remote patients

Benefits

• Increased access to care and to specialist

• Increase quality of care (home,time, continuous)

• Extend the care services

• Centralized health record

• Collaboration among healthcare professional

• Improved decision making

• Education

• May lower cost of healthcare


Legal and Privacy issues

• Reimbursement and licensure issues

• Referral and Payment

• Support personnel

• Liability

• Licensure issue

• Confidentiality issue

• Lack of standard

• Need for technical support

• Lack of available infrastructure

• Accreditation and regulatory requirements

• Quality of service rendered

• Limitations
• Lack of funding

• Teleconferencing: Implies that people at different locations have audio and possibly vide contact
which is used

• Video Conferencing: Implies that people meet face to face and view the same images through the use
telecommunications and computers even though they are not in the same location.

• Desktop Videoconferencing: Synchronous or real time encounter that uses specially equipped personal
computers with telephone line hook up, DSL or cable connections to allow people to meet face to face
and/or view papers and images simultaneously.

Types of Applications

• Store and Forward: digital images, video, audio, and clinical data are captured and stored on the client
computer or device; then, at a convenient time, the data are transmitted securely (forwarded) to a
specialist or clinician at another location for interpretation

• Real-time Telehealth: This service offers concurrent interactions between patient and doctor. This
service. includes phone conversations, online communication and home visits. Real-time or live
interaction

• Remote Patient Monitoring: This type is also called 'self-monitoring/testing. It facilitates the nurse to
check a patient remotely using different technological equipment. Devices are used to capture and
transmit biometric data

Applications of telehealth nursing

• Practice: Clinical applications comprise early patient assessments, diagnosis (tele-diagnosis), and
consultation (tele-consultation). Supervision of physicians and observation of patient status are likely.

• Education: Affords opportunities to educate healthcare consumers and professionals through

increased information accessibility via online resources (world wide web, distance learning, and clinical
instruction).

• Administrative: Administrative uses, for instance, conferences, preparation, utilization and quality
appraisal maybe offered.

• Research: Improved by aggregation of data from numerous sources and harmonization.

The use of telehealth/telemedicine technology to deliver nursing care and conduct nursing practice
Uses:

• Telephone triage

• Follow-up calls

• Obtaining test result & physiologic parameter

• Education & consultation

• Patient assessment

• Telepresent

TELENURSING

• Use of telecommunications and information technology for providing nursing services in health care
whenever a large physical distance exists between patient and nurse, or between any number of nurses.

• This is a subset of telehealth in which technology is used to deliver nursing care and conduct nursing
practice. It is specific to nursing as a profession.

• Telenursing is not a new mode of health care delivery rather it is an evolving model of health care
delivery that begun from the advent of telephone use in 1876

• Telenursing is one of the various innovative and improved methods of providing nursing care that
directly affects registered nurses and expands their capacity to practice nursing in a relatively new arena
as well as directly affecting clients

Objectives of Telenursing

1. To deliver care and expertise

2. For curative, preventive and rehabilitation

3. For training and information

Types of telenursing

1. Remote monitoring

• The nurse monitors the patient remotely from his/her house.

• Patients collect and transmit data to nurses; the nurse plans the intervention.

• Used for handling chronic diseases like heart disease, diabetes, asthma etc.
2. Interactive telenursing services.

• It involves a series of interactive sessions with clients via phone conversations and online
communication. Used to obtain history, physical tests, psychiatric assessments, ophthalmology
evaluation

3. Store and forward telenursing

• Used to obtain medical images, audio or video data that can be forwarded to a nurse at a suitable time
for evaluation offline.

• Areas utilized are dermatology, radiology and pathology

4. Specialist and primary care consultations

• Patient sees a nurse over a live video connection or using diagnostic images/video along with patient
data a specialist for viewing later

5. Imaging services

• Used in radiology, pathology and in cardiology

Methods of delivering telenursing

1. Point-to-point connections using private network

2. Web-based e-health patient service sites 3. Networked programs

4. Connections to monitoring Centre from home

5. Primary or specialty care to the home connections

Applications of telenursing

1. Home care

2. Patient consultations:

3. Telephone triage

4. Remote monitoring
5. Chronic disease management

Benefits of utilizing telenursing

Patient benefits

• Increase access to health care

• Economical

• Saves time

Nurses' benefits.

• Saves time

• More efficient seeing distant patients

• Rural providers can receive continuing education

• Available as a specialty program

Hospital benefit

• Administrators save travel time and funds by attending meetings via telenursing

• Addresses shortage of nurses

• Service available to more clients

Disadvantages of Telenursing

• No therapeutic touch. Conferences/ videos can't replace valuable time between nurse and patient.

• Laws and a set code of rules and ethics will first need to be applied before telenursing can be used
regularly in various capacities

• Inability for patients to use equipment/ device.

• Equipment malfunction
Challenges in telenursing utilization

• Non acceptance by nurses: Older nurses who are not computer literate. Feeling of being replaced with
computers

• Reimbursement issues Patient confidentiality and security to private information may be difficult to
safeguard.

• Financial issues: cost of establishment, coat of transferring videos, audio, files.

Ethical and legal issues surrounding telenursing

• Confidentiality and the law: involvement of non-clinical personnel, hackers and cyber theft,
vulnerability of transmission lines to security breaches

• Patient-nurse relationship: it is difficult to establish when a nurse- patient relationship has been
established. know when a duty of care is owed to a patient

• Patient consent to disclosure of information

• Consent to treatment

Role of nurses in telenursing

• Ensure proper and accurate documentation in electronic or paper format

• Carry out only the activities you are competent and authorized to perform

• Ensure the privacy, security of patient information

• Establish client-nurse relationship so as to establish a duty of care

• Take into account client's spiritual and psychosocial needs and preferences as everybody is unique

Nurses have a key role to play in the application and implementation of telenursing services. It is
therefore expected of them to understand their role so as not to go beyond their locus of duty.

• Nurses should support the expanded role of telenursing

• Seminars and workshops should be put in place so as to increase the level of awareness among nurses

• Government should support the establishment of telenursing services in the country

 Session 16 Informatics applications in evidence - based practice NCP & clinical
pathways

COMPUTER GENERATED NURSING CARE PLANS

A computer information system can either stand alone or be part of a larger system the whole facility
uses. A nursing information system (NIS) can increase efficiency and accuracy in all phases of the nursing
process - assessment, nursing diagnosis, planning, implementing and evaluating. It can help you meet
standards of nursing practice and documentation. In addition, an NIS can help you spend more time
meeting patients' needs. Consider the following uses of computers in the nursing process.

A. Assessment

• Use the computer terminal to record admission information. As you collect data, enter further
information as prompted by the computer software program. Enter data about the patient's health
status, history, chief complaint and other assessment.

• Some software programs prompt you to ask specific questions, then offer pathways to gather further
information. In some systems, if you enter a value that's outside the usual acceptable range, the
computer will flag the entry so you can fix it.

B. Nursing diagnosis

• Most current programs list standard diagnoses with associated signs and symptoms as references.
After you use your clinical judgment to determine a nursing diagnosis for each patient, you can rapidly
get information related to the diagnosis.

• For example, the computer can generate a list of possible diagnoses for a patient with certain signs
and symptoms or it may enable you to retrieve and review a patient's records according to the nursing
diagnosis.

C. Planning

• To help you begin writing a plan of care, newer computer programs display recommended
interventions for the selected diagnoses and expected outcomes. Computers also can track outcomes
for large patient populations.

D. Implementing
• Use the computer to record interventions and patient information, such as transfer and discharge
instructions, and to communicate this information to other departments.

• Computer generated progress notes automatically sort and print out patient data such as medication
administration, treatments, and vital signs, making documentation more efficient and accurate

E. Evaluation

• You can use computers to compare large amounts of patient data, help identify outcomes patients are
likely to achieve based on individual problems and needs, and estimate the time frame for reaching
outcome goals.

• During evaluation, use the computer to record and store observations, patients' responses to nursing
interventions, and your own evaluation statements. You also may use information from other health
care team members to determine future actions and discharge planning. If a desired patient outcome
hasn't been achieved, record new interventions taken to ensure desired outcomes. Then reevaluate
them.

Nursing Process -> Scientific Method

Assessment - Ask question

Diagnosis - Identify problem

Planning - Hypothesis

Implantation - Experiment

Evaluation - Analyze/Conclusion

Standards of Professional Performance

Delivering quality care based on:

• The best of current knowledge

• Coordination with the health care team

• Consistency with professional ethics

• Collaboration to make the most effective use of the expertise of the health care team

• Effective use of community and client resources

• Cost-effectiveness

• Nursing research findings

Assessment is a process of discovering and making decisions about the nature of the client's problems or
needs. Ellective assessment depends on the quality of communication with the client and family in the
context of their culture and life experiences.

It involves:

• Data gathering about the client's present illness or situation and past health history (subjective or
client-reported data)

• Data gathering by physical examination (objective or directly observable data)

• Review of Functional Health Patternsfor subjective and objective data

Nursing Diagnosis is a clinical judgment about individual, family, or community responses to actual and
potential health problems or ife processes.

There are three types of nursing diagnoses:

• Wellness diagnoses

• Risk diagnoses

• Actual diagnoses, with otiologies and related factors specified

Planning - is essential to providing nursing care that meets the needs of the client in a timely fashion
because it provides direction to nursing care and identifies nursing interventions that are logically
expected to meet the goals of care.

it involves:

• Establishment of desired and acheivable outcomes

• Validation of expected outcomes with the client

• Selection of interventiona to achieve the outcomes

Nursing Intervention is "any treatment, based upon clinical judgment and knowledge, that a nurse
performs to enhance patienu/client outcomes" (lowa Intervention Project, 1966, p. xvii).

Nursing intervention may take many forms:

• Direct care

• Coordination

• Teaching
• Collaboration

• Health maintenance

• Restoration

• Counseling

• Health promotion

• Disease prevention

• Rehabilitation

Evaluation is the process of determining both the client's progress toward attainment of expected
outcomes and the effectiveness of nursing care (American Nurses Association, 1991, p.7).

It involves:

• Data gathering to confirm that the problem has been resolved

• It the problem has not been resolved:

⁃ Reassessment for the cause

⁃ Redefinition of the problem

⁃ Redefinition of the outcomes

⁃ Changing the interventions

• The construction of a plan of care for the patient is a collaborative process among the nurse, the
patient, and the other health team members

The nursing process is used

• as a tool identify patients' problems and an organized method to meet patients' needs

• to identify and manage the health problems of clients.

• as framework for nursing care

Distinct characteristics of Nursing Process

1. Within the legal scope of nursing

2 Based on knowledge
3. Planned

4 Client centered

5. Goal directed

6. Prioritized

7. Dynamic

• Standardized care plans are preprinted. Both computer-generated and standardized plans provide
general suggestions for managing the nursing care of clients with a particular problem. It is up to the
nurse to transform the generalized interventions into specific nursing orders and to eliminate whatever
is

• Nursing process promotes critical thinking, creativity, problem solving, and decision making practice.

• Critical thinking the process of objective reasoning; analyzing facts to reach a valid conclusion - ways to
improve critical thinking skills - Effective reading - Effective writing- Attentive listening- Effective
communication

• Apply the critical thinking process to a real-life problem to avoid having your decision cause injury to
anyone

CLINICAL PATHWAYS

A clinical pathway, also known as care pathway, integrated care pathway, critical pathway, or care map,
is the main tool used to manage the quality in healthcare concerning the standardization of care
processes. It has been shown that their implementation reduces the variability in clinical practice and
improves outcomes. Clinical pathways aim to promote organized and efficient patient care based on
evidence-based medicine and aim to optimize outcomes in settings such as acute care and home care.

• Clinical pathways differ from clinical guidelines and protocols as they are a set of practical treatment
processes detailing how to implement clinical guidelines, including both clinical guidelines and non-
clinical activities.

• Physicians use clinical pathways to give appropriate instructions on a daily basis. The nurses review the
orders and confirm their accomplishment. Other care team members such as the therapist, nutritionist,
interns and clerks carry out all the orders in the pathway pertaining to them.

• Patients' progress in the pathway will be reviewed and the variances will be recorded by nurses and
physicians.

• Pathways thus promote continuous improvement and reliable care. In addition, clinical pathways help
in pursuing the goals of improving patient care quality maximizing the efficient use of resources and
support clinical effectiveness of health care staff.
• Instead of the isolatd and error prone paper based pathways, the computerized and shared pathwag
tnroughout the treatment process will help in achieving a patient-centric process, improvinv care
coordination and efficiencym as well as reducing medical errors.