Practice

Application

Vendor Critical Care

Applications Application

Informatics Community
Solution Health
Application

Internet Ambulatory
Tools Care System
•More than 150 years ago, Florence Nightingale spoke about the
critical importance of nursing informatics in patient care.
“Decision making must be based upon the use of accurate data”,
she said (Ulrich, 1992, p.68)
•The nursing pioneer also spoke of frustration from difficulties of
exacting such critical patient- related data from hospital record.
•It was more than a century after Florence Nightingale’s era that
computer made their appearance on the hospital landscape. The
first hospital information system arrived in the late 1950’s to the
mid-1960, although these systems focused primarily on
processing financial and administrative information
A specialty that integrates nursing science, computer science, and
information science in identifying collecting, processing and
managing data and information to support nursing practice,
administration, education and research; and to expand nursing
knowledge. The purpose of nursing informatics is to analyze
information, requirements design, implement and evaluate
information systems and data structures that support nursing and
identify and apply computer technologies to nursing. (ANA, 1992)
Information literacy skills: these are the basic computer
skills needed to use a word processor; access a database;
create a spreadsheet; communicate with the e-mail; and
interact with clinical documentation systems.
General informatics competencies: these basic skills are
required for all nurses but are not sufficient for
specialists: identifying, collecting and recording data
relevant to the nursing care of patient; analyzing and
interpreting patient and nursing information; using
applications of informatics as an integral part of the
nursing process; and implementing institutional and
public policies regarding privacy, confidentiality and
security of information. (ANA, 2011, p.26)
According to the ANA
(2001), the informatics
nurse specialist moves
beyond the foundational
competencies and into a
practice specialty in which
there are organized and
recognized standards of
practice and performance
include six major areas
that mirror the traditional
nursing process. (ANA,
2011, pp. 32-39)
At the beginning of the new
century, much was written about
the reality that information
technology had become
important in the delivery of
contemporary healthcare. A
federal report (U.S Department
of Health and Human Services,
2011) on proposed strategies to
build a national health
infrastructure emphasized the
need for all health care providers
to be skilled in using technology
for decision-making.
 Nursing documentation in the
In 1989, the patient record has become
steering more complex as nursing
Committee was practice has expanded to
establish encompass care to critically ill
and specialty patients, and as
technologic advances have
become standards of care in
practice.

In 1993, the ANA house of Delegate

passed a resolution to “develop
nursing classifications specifically
aimed at diagnosis, interventions, and
nursing sensitive patient outcomes,
and support activities directed toward
the inclusion of nursing data elements
in healthcare databases.

•The computer-based patient
record facilities the automation
of the nursing care planning
process. The benefits and the
challenges of integrating
computerized systems with the
care planning have been
extensively reported in the
literature during the last decade.
Broadly defined the term clinical
support system (CDSS) includes an
array of computer-based
applications that assist healthcare
clinicians in the day-to-day work of
patient care. These may include
programs that involve artificial
intelligence (AI); different types of
knowledge such as uncertainty,
heuristics and fuzzy logic; expert
systems; and decision support
systems.
•Expert system
•Machine Learning
 A chapter on the use of computers in nursing
practice today would be incomplete without a
description of how informatics is being used to
organize and implement systems for outcomes
management.

A look at outcomes management provides a

powerful illustration of how nurses use
informatics in daily practice to evaluate the
relationship between patient goal attainment and
nursing interventions.
The documentation of patient care
usually begins with the admission
assessment and ends with the
discharge care plan.

Discharge care plan systems

provide for continuity of care from
the home to the hospital and back
to the community, another care
facility, an outpatient department,
or the home
 Summary of the admission assessment

Summary of learning needs that the patient had at discharge

Multidisciplinary plan including problems still unresolved and

outcomes not met during hospitalization

Medication and procedures that the patient must continue

Summary of selected patient outcomes that a multidisciplinary team

desired as minimal criteria for the patient to have achieved during
hospitalization. (Romano, McCormick, and McNeely,1982)
 Collaboration with other members of the healthcare
team has always been a critical component of nursing.

Advances in technology, however, have changed the ways

in which members of interdisciplinary healthcare teams
are and will be communicating in new millennium.

As Alpay and Russel suggested, “the use of IT is part of

the development and delivery of health services”

The inevitable integration of
computers into nursing
practice has been
accompanied by speculation,
controversy, and research on
the benefits, barriers, and
real potential of NISs for
improving clinical practice
and giving nurses a voice in
the development of
healthcare policy.
Although related research on
the practice application of
computers in nursing will
certainly continue, there is
general agreement that
organization and use of data
with computers have exerted
a positive influence on the
provision of the patient care.
Critical Care Critical
Nursing Critical Care
Care Applications
Nurse
Is an area of Is responsible to Areas where patients
expertise within ensure that require complex
nursing that focus critically ill patients assessment, high-
specifically with are seriously intensity medication,
human responses to conditioned continuous therapy
life-threatening individuals. and interventions,
problems. Ensure that families and unrelenting
of the medically ill nursing attention
patients should and continuous
receive optimal watchfulness.
care.
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 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 generate
real time and historical report

Automated collection and management of

medical information will become the important task of
the critical care information system
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
custom connector and
software presently needed to
interface such device.
Has the ability to filter, store
and select information sent
for inclusion into the clinical
medical record on the clinical
computer system
Intelligently integrates and process physiologic and diagnostic information and store it to
secured clinical repository.

Creates trends analysis with graphical representation of results.

Offline stimulation can be performed to test the condition of the patients.

Provide clinical decision support system

Provide access to vital patient information

Providing feedback and quick evaluation of the patient condition and provides alert.
•Collective term for the methodical application of information science
and technology to community and public health process.

•Focuses on the health information system of the community, it is

centered on the majority part of the public.

•Emphasizes the prevention of the disease, medical intervention and

public awareness.

•Fulfils 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.
 Effective and timely
assessment that involves
Comprehensive directed
monitoring and tracking the
towards the majority of
health status of populations
individuals, families, and
including identifying and
the community at large.
controlling disease outbreaks
and epidemics.
Encourages optimal application of computer
system, computer programs and communication
system for the benefit of majority of individuals,
families and community.
•Preventing, identifying, investigating and eliminating
communicable health problems.
•Accessibility of data and information, through
communication

•Educating and empowering individuals to adopt health life

style
•Facilitate the retrieval of data

•Effective transformation of data into information

•Effective integration of information to other disciplined to
concretized knowledge and creates better understanding.
•Are used to collect quantitative information about items in a
population to establish certain information from the obtained
data.
•Focused on opinions or factual information depending on it’s
purpose and many surveys involves administering questions to
individuals.
 Consistent
exchange of
response

Synchronizati
Disease
on of the
tracking
decisions

National Building
alertness and strategies
preparedness

Building strong Control of

communication spread of
disease
 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,
Ambulatory community health centers, occupational health centers, mental
Care health clinics, and group practices.

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
Ambulatory treatments, and etc.
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.
•Improved clinical outcome analysis
•Improvement in hospital inventory
management.
•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 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 health care provider should
be capable enough to implement the process effectively.
Name precisely the Use a search string Enhances search strings
information being (one or more search by Boolean or natural
sought. If the search terms) rather than a language methods. Use
terns used precisely single word to increase Boolean terms: and, or,
chosen, the searcher the preciseness of a not. The term “AND” is
goes directly to the search. Enter the used when search terms
desired information. precise terms in a or strings need to be
string, rather than a added together. The
single term. term “OR” is used when
equivalent terms or
synonyms are used to
capture the information.
Regardless of the search engine used, certain search
methodologies, if applied correctly, increase the efficiency
of retrieval if needed information. The three strategies
are: name precisely the information being sought, use
search strings rather than single words, and enhance
search strings by using Boolean or natural language
methods.
This section is divided into the most basic components of
nursing process: assessment, diagnosis, treatment, and
outcome evaluation. These component provide the outward
structure for development of a clinical information database
for advanced practice nursing.
 Assessment refers to the Treatment is diagnostic
systemic collection of data specific. Hence, diagnosis
needed to arrive at one or and treatment information
more diagnoses. The tools categories are frequently not
included in this section discreet.
include forms,
miscellaneous screening The etymology of the word
tools, risk assessment “diagnosis” is based in its
instrument, and Greek roots. “Dia” means
information, and “through,” and “gnosis”
information of the means knowledge base of
manifestation of signs and the person diagnosing.
symptoms. These tools
represent a sampling of
assessment content
available on the internet.
 Mass Trauma
Preparedness
Response

Clinical Bioterrorism
Agents Agents/Diseases

Recent
Outbreaks
and
Incidents
 Human Response
to Illness/ Health
Diagnoses

The International Methods of

Classification Contributing to
Functioning, Disability, Terminology Revision
and Health (ICF) and Development-
The term “treatment” is used in lieu of interventions
and nursing actions, because it expresses more
precisely the broad clinical management focus of this
section.
•Several Internet sites are
available for those who desire
more information on Saba’s
framework/structure
examples, a NIC intervention
example, Omaha System case
studies, and PNS examples
and outcomes. They are:
•Nursing Intervention
Classifications (NIC)
•Omaha System
•Peri-operative nursing
data set
•Internet tools are available
to facilitate calculations used
in planning treatment.
Examples include:
•Martindale’s Calculators
Online Part I: Nutrition
•Nursing calculators for
drug administration
purposes
•Medical calculators
developed by Cornell
University Medical
College, Pediatric Critical
Care Medicine.
 Center for Drug
research and
evaluation

FDA Safety
Food and Drug
Information and
Administration
Adverse Event
Reporting Program

Medwatch Adverse
NLM Clinical
Event and Product
Alerts Database
Problem Forms

NLM Clinical
Drug Alerts Database
Enforcement
Agency
 National Institutes
on Alcohol Abuse
and Alcoholism

The National National

Institutes of Institutes on
Health Drug Abuse

National Center for

Complementary and
Alternative Medicine

CDC Vaccines and

Immunization
Program

The Center for CDC National

Disease and Immunization
Control Program

More
information on
vaccines
 Drug
Management

Commercial sites that Commercial sites that

University sites are provide excellent provide readily
excellent sources of online clinical accessible
information educational manufacturer’s
information information on drugs

Medscape Rxlist
Center for National
National
Disease Institute of
Guidelines
and Health
Clearinghouse
Control
 Nursing
Nursing Home and
Patient
outcomes Home
safety
Healthcare
Setting
Outcomes

Office Tools Outcomes

Online Health Short Measurement:
Record Audit Form (SF) Internet-
and Patient Health Available Bio
Satisfaction Survey statistical and
Forms Analytical Tools
Healthcare settings are integrating clinical information
systems into all aspects of care planning, delivery, and
evaluation. To prepare clinicians to recognize and capitalize
on the potential of this information to affect health
outcomes, informatics needs to be integrated into the
clinical course work. The eClinicaLog is part of an
educational strategy, initially designed to build data entry,
analysis, and synthesis skills in nurse practitioner students.
As its version have evolved, eClinicaLog has become
relevant to undergraduate education as well.
•Events in the United States, such as the September 11,
2001 incident and the anthrax breakout lead the
government of the United States to respond at an
unprecedented pace to better prepare and manage
terrorist events. Informatics could contribute to increasing
the efficiency in disaster response as well as providing a
telepresence for remote medical caregivers.
•The purpose of this chapter is to explore current and
future roles of informatics in emergency preparedness and
response.

Community health is the
provision of healthcare
outside the hospital
infrastructure. As such, the
public health departments
have been viewed as the
major delivery system of
healthcare.
The U.S. Department of Health and
Human Services (DHHS) is responsible
for the education of healthcare
professionals in preparedness for
emergencies, including potential
terrorism. Three of the units focus on
emergency planning and response:
the CDC the Agency for Healthcare
Research and Quality (AHRQ), and
HRSA. Each of these agencies play a
critical role in emergency planning and
response.
Several of the CDC initiatives AHRQ’S involvement in
require informatics support. bioterrorism comes for the
The National Electronic Disease recognition that clinicians,
Surveillance System (NEDSS) is hospitals, and healthcare
an initiative that promotes the systems have essential roles in
use of data and information public health infrastructure.
system standards to advance
the development of efficient,
integrated, and interoperable
surveillance systems at federal,
state and local levels. It is a
major component of the Public
Health Information Network
(PHIN).

AHRQ’s Integrated Delivery
System Research Network
(IDSRN) is to develop a
computer simulation model
for citywide response planning
for mass prophylaxis and
vaccination during bioterrorist
attacks and other public
health emergencies.
It is a detection of a disease
outbreak before the actual
disease or mechanism of
transmission is identified.
Real-time outbreak and
disease Surveillance (RODS)
system is a system that
provides early warning of
possible infectious disease
outbreaks caused by
bioterrorism or other public
health emergencies.
•Provider training and education are also critical elements of a
comprehensive plan for bioterrorism and public health
preparedness in general.

•Researcher at the University of Alabama at Birmingham have

developed continuing medical education training modules to each
healthcare professionals to identify various biologic agents, as
many pathogens and conditions(such as smallpox) are rarely seen
in the United States, which limits clinicians from being familiar
with related infection.
•The Hospital Bioterrorism Preparedness Program and the
Bioterrorism Training and Curriculum Development Program (BTCD)
are 2 grant management programs that exist under the management
of the HRSA.

•The purpose of the National Bioterrorism Hospital Preparedness

Program is to aid state, territory, and care system, including hospitals,
emergency departments, outpatient facilities, emergency medical
services systems, and poison control centers, to respond to incidents
requiring mass immunization, isolation, decontamination, diagnosis,
and treatment, in the aftermath of terrorism or other public health
emergencies.
 The American College of Emergency Physicians (ACEP)
formed a nuclear, biologic, and chemical task force to
Competency – evaluate the status of bioterrorism training in the United
Based Learning States, identify barriers to this training, and offer
recommendations for effective education
and Informatics
Needs

The Incident management system (IMS) was first used by

firefighters to control disaster scenes in a multijurisdictional
Informatics and interdepartmental manner.
and the
Emergency
Operations
Center
This chapter presents the current trends, issues, obstacles, and
opportunities facing the nursing profession with regard to utilization
of HCIT. The focus was on leading HCIT vendors that provide
organization wide, hospital-centric information systems, and address
nursing applications in context of a patient-centric EMR. The response
of these vendors to the demand by nursing for improved information
systems was discussed. In addition, the demand for delivery of
standard-based nursing or clinical data sets with the software
application and how leading vendors are responding to this demand
were presented.
•“NICHE” applications focus on a discrete set
of nursing functions such as care planning.
•“DEPARTMENTAL” systems address a more
comprehensive set of functions. This is
either of the three: for a single point of
service such as labor and delivery; or
department such as cardiology; or closely
aligned group of departments such as the
perioperative suite.
New and emerging hardware and
software technologies such as
handheld devices are increasingly
being incorporated in nursing
applications. Key goals are to
improve quality of care, mobility of
caregivers and collaboration among
the care team. Currently, strong
emphasis is being placed on
delivering technology at the point of
care via bedside terminals and
wireless devices such as PDAs and
Laptops.
Historically, nurse executives have Today, the majority of
not widely embraced it as a
nursing-related patient care
strategic business tool. The
nursing profession has been
applications are acquired as
largely underserved by HCIT part of EHR decisions . But
vendors, even though Nursing is some of the products
one large beneficiaries of released are poorly
IT. There are a variety of reasons designed and user-
why Nursing is not highly unfriendly for nurses.
provided by these vendors. In
most national and local
healthcare debates, nursing has
been essentially invisible, partly
because this is the only profession
that does not charge for services
rendered.
Nursing is an untapped and underserved
resource in provider organizations

Automation is not highly priority

for nursing in their organizations

Vendors are out of sync with

nursing needs

Some new tools and technologies

have complicated rather than
simplified nursing practice, at times
decreasing productivity and
introducing an element of increased
risk to patients.
•Vendor product design processes driven by non-nurse
professionals
•Insufficient nursing representatives on vendor executive and
development teams
•Then HCIT industry’s overall woeful lack of adequate
requirements definition, functional specifications, and process
analysis
•Early focus on automation of the paper chart without a full
understanding of underlying nursing process, workflows, and
ergonomic challenges
•In response to patient safety concerns, vendors and provider
organizations have focused on two primary HCIT initiatives; (1)
Computerized Physician Order Entry [CPOE] and (2) Bar-Code
Medication Administration [BCMA].
In response to market demand, HCIT vendors are delivering more
robust and tightly integrated clinical solutions that better address
the needs of all health care providers for more coordinated,
streamlined patient care delivery. While some vendors offer clearly
superior nursing applications, no solutions; each has different
strengths and limitations.
 Responding to this market demand,
Despite the lack of a most of the major HCIT vendors now
national consensus deliver at least basic starter set of
regarding one standard terminology. An increase number of
nursing terminology or these vendors are including standards-
data set, HCOs expect based terminology with their clinical
their EHR vendor to documentation application as well as
deliver a Standards-based evidence-based standards of care with
set of nursing content for their care planning and clinical
charting and planning pathway applications, and some are
care. using standard terminologies that map
to SNOMED[Systematized
Nomenclature of Medicine].