ISSUES IN INFORMATICS
USE PROCESS
GROWTH OF NURSING
INFORMATICS
* Nursing informatics (NI) was first identified in the
1980 1NI was defined as the combination of
nursing, information and computer sciences to
manage and process nursing data into information
and knowledge for use in nursing practice (Graves
and Corcoran, 1989).Utilization of information
structures, processes and IT.Domain of NI includes
data and its structures, information management
and technology.
* It also includes concepts from linguistics,
organizational dynamics, communication
engineering, library science, cognitive science
DEVELOPMENT OF NURSING INFORMATICS AS A
SPECIALTY
* The nursing shortage has been seen as
detrimental in the delivery of quality healthcare.
Several factors have necessitated the use IT in
nursing:
* The number of hours that is needed for quality
care.
The aging of baby boomers.
- The development of health sciences.
* Average age of nurses is 45.2 (Spratley et al.,
2000)
The presence of training programs for nursing
informatics.
THE CONCERN FOR NURSING INFORMATICS
* The Institute of Medicine found out that 2.9 to
3.7% of admissions had experienced adverse
events.
* One recommendation was to computerize
doctors' orders.
* The reason for nursing informatics is to improve
patient safety.
CAN AUTOMATION SAVE NURSES?
* Computerization of hospital
documentation/processes have produced good
outcomes.
* Database, spreadsheet and document production
systems have streamlined organizational processes.
* Reduction in paper expenditure.
THE ROLE OF TECHNOLOGY IN THE MEDICATION-
* Safety is always the top concern.
* Healthcare is a high error-prone industry.
* Deaths in hospitals are usually attributed with
practitioners interacting with bad systems.
* Acquisition of computers were focused on
standalone system.
* Less than 10% of healthcare organizations have
put significant amount of resources in this areas.
COMPUTERIZED PRESCRIBER ORDER ENTRY (CPOE)
* A system that used for direct entry of one or
more types of medical orders electronically into a
system that transmits those orders electronically to
the department concerned (AHA, 2000).
* Paper-based system is still used as form of
communication among healthcare providers.
* It was hard to locate pertinent information on the
papers that hold the record.
* Illegible handwriting and multiple volumes of
patient records are also factors that considered in
the dev't of CPOE.
ADVANTAGES OF COE
* Medication errors are reduced by 55% (Bates et
al., 1998)Non-missed dose errors fell to 26.6/1000
(Bates et al., 1999)
* Handwriting misinterpretation would be
eliminated.
* Errors of omission would be reduced.
* Fewer handoffs will occur, thus minimizing
duplicated efforts.
* Transmission of information will be faster.
BARCODE-ENABLED POINT OF-CARE
TECHNOLOGY (BPOC)
* 38% of errors occur in medication administration
process (Leape et al., 1995).
* Barcodes have major impact on productivity and
identification.
* Includes a second identifier for a patient receiving
a medication.
* The system helps to verify that the right drug is
administered to the right patient at the right dose
and at the right time
There are negative effects:
* Nurses find it difficult to deviate from the norm.
* Nurses have their own strategies that SYSTEMS
circumvented the BPOC. * Removing all system vuln

HEALTHCARE DATA STANDARDS

* The methods, protocols, terminologies and
specifications for the collection, exchange, storage
and retrieval of information associated with
healthcare applications, including medical records
medications, radiological images, payments and
reimbursements, medical devices and monitoring
system and administrative processes.
* Data standards aim to reduce the level of
ambiguity in the communication of data.
* Address the format of messages that are
exchanged between computer systems, document
architecture, clinical templates, user interface and
patient data linkage.
* To achieve data compatibility between systems, it
is necessary to have prior agreement on the syntax
of the messages exchanged.
* Four broad classes of message format standards
have emerged: medical device communications,
digital imaging communications, administrative
data exchange and clinical data exchange.

STANDARDS DEVELOPMENT PROCESS

* The core of every system is the concept of secure,
patient-centered HR that:
* Safeguards personal privacy.Uses standardized
medical terminology
* Eliminates the danger of illegible handwriting and
missing patient info.Can be transferred as a
patient's care requires over a secure
communications infrastructure for electronic
information exchange.

DEPENDABLE SYSTEMS FOR QUALITY CARE

* Unfortunately, not all computer systems are
invincible to attacks.
* One example was what happened to CareGroup
in the US.
* August 2003, Blaster and SoBig worm attacks
invaded hospitals.
* The complexity of computer systems are always
prone to fail.

GUIDELINES FOR DEPENDABLE