University of Cebu – Banilad

Campus College of Nursing

Gov. M. Cuenco Ave, Cebu
City, 6000

NCM 110:
NURSING INFORMATICS

Topic 38:
Nursing Informatics
in Europe

By: Quimpo, Princess Angel D.

Maria Cleofe D. Claridad, RN

Clinical Instructor
NURSING INFORMATICS IN EUROPE

Europe is a continent with 750 million of inhabitants and 50 countries with different languages,
cultures, and social system.

Rationale for Implementing a greater use of IT in the healthcare sector

- Improve safety and quality
- Improve patient outcomes
- Reduces costs of healthcare

In Europe, the main mission is to establish a stable infrastructure that improves:

- Healthcare quality
- Facilitates in reduction of errors
- Delivery of evidence based and costs effective care

Some core building blocks are

- EHR

IT IN THE EUROPEAN UNION (EU)

• In May 2004, the EC adopted an action plan “e- Health Action Plan”
- Aims to deliver better quality healthcare in Europe
-
• The plan covers many aspects of nursing informatics;
- Electronic prescriptions
- Computerization of patient record
- Information system to cut out waiting time and reduce errors
• To set out objectives of “European e- Health Area” there is practical steps to reach this
- High speed internet access for health system is need

The goal is that by the end of 2005

1) Member states of EU must develop their own roadmaps for e- health
2) EU public health portal should be up and running to provide a one-stop- shop to access
health information

Europe is strong on healthcare and electronic business and this will be used for the benefit of the
patients.

The goal is the that four out five (4 out of 5) European physicians have access to Internet and
one out of four (1 out of 4) European citizens use the Internet to get information on health and
illness.

NATIONAL IT STRATEGY
The government’s IT policy in Sweden has three objectives;
- Confidence in It
- Competence to use It
- Information about society services available to all citizens

Confidence in It also implies that citizens must trust that information retrieved is secure and visible
to others when needed (electronic signature will facilitate this).

Admitting data that should be possible to share among healthcare professionals and geographical
areas to enhance the security and also adhere to the idea of data once entered are used many
times.
GOALS
- On goal is that all household and companies in all parts of Sweden within a few years
should have access with a high sped connection. The government supports private
enterprises to reach this and other IT related goals.
- Another goal is the ability to communicate between systems. The directors of all the
regional healthcare services in Sweden have agreed to develop their hospital system so
they can communicate with each other nation wide and still keeping confidentiality rules.

PROBLEMS
- Available knowledge and information on the Internet are most frequently presented in
English, which is not the first language of Europe.
- There are not enough data standards agreed on or implemented to allow comparison of
information based on aggregation of data from different sites. This deficiency hampers
the current ability to build knowledge from patient care data.

PATIENT PARTICIPATION
- Improved patient participation and consideration of patient preferences have improved
outcomes and treatment adherence as well as increased patient satisfaction with their
care.

CONTINUITY OF CARE AND AVAILABBILITY OF INFORMATION

• Key concepts in Europe are:
- Continuity of care and care provider
- Meet the healthcare needs of a more mobile population
• This is supported by many projects aiming at making data available in different setting
including patient’s home and also by practicing telemedicine or telehealth.
According to their own reporting, many countries are participating telemedicine such as;
- Austria
- Germany
- Greece
- Slovenia
- France
- United Kingdom
- Ireland
- Belgium
- Denmark
- Norway
- Finland
- Sweden
- Iceland
- Portugal
- Spain
- Italy

ELECTRONIC PATIENT RECORD

All registered nurse (RN) in Sweden are by law, since 1986, obliged to document nursing care.
- Regulations emphasize the RNs have an autonomous responsibility for planning,
implementing, evaluating nurse care and that nursing diagnoses in the patient record is a
part of that responsibility.
- Nurses gradually have accepted the idea of nursing diagnoses, but there are no agreed
standardized expressions or routinely implemented nursing diagnoses in practice. Sweden
nurses prefer the use of problem statements.
A Sweden study by the National Board of Health and Welfare (2000) can be used to illustrate the
increasing amount of information in healthcare:
- In 1971 a 4-week hospital stay generated three sheets of paper
- In 1984 it generated 18 sheets and
- In 1999 a shorter stay of 10 days generated 34 sheets of record information.
The solution is not to write more and more, but instead to focus on the relevant information.

DISSEMINATION OF ELECTRONIC PATIENT RECORDS

In Norway and Sweden EPRs are quite common both in primary healthcare and in hospitals.
- In Sweden the estimated occurrence of EPR in primary healthcare is 85-90% while the
percentage for hospitals is about 40%.
- In Norway there are EPRs for 81% of the hospital beds.

DEVELOPMENT OF COMMON TERMINOLOGIES FOR NURSING PRACTICE IN EUROPE

Some of the common factors that may have contributed to the development of uniform
terminologies for nursing in different European countries are:
- Increasing cost constraints in the mostly publicly financed healthcare systems, which have
raised demands for cost-effective care and quality improvement.
- Professionalization of nursing, the effort to make nursing visible and aspirations for
greater accountability have been additional influencing factors.

Belgium
“People needs for nursing care” by the World Health Organization that was accomplished in many
European countries in the 1980s was an important milestone in Europe nursing, which raised the
awareness about the need to make nursing care more visible.
Belgium is the European country that has made nursing care most visible and where early on
the contribution of nursing in healthcare has been acknowledge by National level policy makers.
Since 1988, it is mandatory for all hospitals in the country to collect data four times per year, using
the Belgian nursing minimum data sets (B-NMDS)

The NMDS consists of 23 nursing interventions, medical diagnoses, patient demographics,

nurses’ variables, and institutional characteristics. The 23 nursing interventions have been derived
from extensive testing, and cover areas such as hygiene mobility, elimination and feeding
assistance, and wound care.

Netherlands

Information Aggregated for

International Sharing

Information Aggregated
for Institutional Purposes

Interpretation and Decisions by the

Nurse

Patient Data
In the Netherlands, a nursing information reference model (NIRM) has been developed to
accommodate both the information needs nurses at the clinical level and for aggregating data at
higher level. This model identifies the following
- base model of patient data;
- a second level of interpretation and decisions by the nurse, including nursing diagnoses,
interventions, and outcomes;
- a third level of aggregated data on nursing diagnoses, interventions, and outcomes for
institutional purposes;
- and a fourth level of information aggregated for international sharing.

Denmark
In the early 1990s, Danish nurses initiated the joint project, “Telenurse” within the EU (European
Union) to promote standardization of nursing data in electronic health record. This project was
later linked to the International Council of Nurses (ICN) project for development of an
International Classification for Nursing Practice (ICNP), which has had an impact on the interest
for the ICNP in Europe.

VIPS model (acronym for the Swedish spelling Well-being, Integrity, Prevention, and Safety) was
developed with the purpose of conceptualizing the essential elements of nursing care, clarifying
and facilitating systematic thinking and nursing recording. VIPS model is used throughout Sweden
as well as in Finland, Norway, Denmark, Estonia and Latvia.

Association for common European Nursing Diagnoses, Interventions and Outcomes (ACENDIO),
which was established in 1995 to support the development of standardized classification,
terminologies, and data sets for sharing and comparing nursing data.

The European standardization organization is called CEN from the French name “Commite’
European de Normalisation” and is the European body similar to the International
Standardization Committee (ISO). The CEN in turn meets with national healthcare standardization
bodies in the different European countries.

INTERNATIONAL COUNCIL OF NURSES (ICN)

Has been initiated the development of the ICNP (International Classification for Nursing Practice),
which has been translated into at least 12 European languages and tested in several countries.

CONCEPT AND PROCESS MODELING

- In Sweden, one model on care processes is called the SAMBA model (Structured Architectural
for Medical Business Activities).
- The mission of SAMBA was to develop a process model for the workflow of Swedish healthcare
when dealing with one individual subject care.
The model was divided into three parts:
 Clinical process- core process
 Management process- monitors and evaluates the clinical process based on mandate to
provide healthcare
 Communication process- deals with information and interaction with the surrounding
world as documents or message

IMPLEMENTATION OF IT IN HEALTHCARE
In a technical context, implementation most often stands for the process of installation of a
computer code/program into a hardware environment.
Process including many steps and phases:
- The first step, most often being the technical installation of hardware (e.g., local net, servers,
PCs, and printers) and the chosen software, is the actual application (e.g., EPR/EHCR, PAS, and
HIS).
 - Following the technical installation, after a period of tests, comes the functional
implementation. This phase includes activities to introduce the users to the application and
its functionality. Typically, this includes basic computer skills (if necessary) and application
training, i.e. how to use the functionality within the application (e.g., to order an x-ray and
register nursing notes). In many cases this would be seen as the completion of the
implementation, as the application is up and running and all users know how to use it.
- But in recent years, there has been a growing awareness of what has been named
organizational implementation, a process where the change of workflow and organizational
structure are important factors.

CLINICAL AND NURSING IMPLEMENTATION

The price to pay concept illustrates that it takes human effort to create better healthcare and that
clinicians therefore play a very important role when implementing EPR systems. To exemplify this,
it is necessary to focus on some of the essential advantages of the EPR opposed to paper-based
patient record (PPR), namely the possibility to present data in various views, decision support, and
sharing data between different parties.
- Variety of views on data appears to be a very attractive advantage.
- The structures of data is important if data are to be reused and presented in several different
ways.
- Decision support is advantageous if the clinician enters the data. There would be limited use
of a sophisticated alert system proposing, e.g, nursing protocols or pointing out a potential
risk for medication interaction, if medical record clerk enters the record.
- Support of the other data analysis may prove an important feature for quality control, quality
improvement, and resources management.
- Electronic data exchange and sharing care support assumes reuse of data. i.e., data are
entered only once.

FUTURE DEVELOPMENT
The future development needed for nursing informatics in Europe is
- Implementation of decision support systems
- integration of research-based knowledge in patient records, and feedback of clinical
experience by aggregated data from patient records as well as emphasis on educating
practicing nurses, students, and educators.
- Most of all we need nurses educated in NI that can take a lead in the development of NI in
different countries in Europe.

CONCLUSION
- One of the main challenges for Europe and the rest of the world is the process of getting
standards for EPR.
- The possibility of aggregating data on groups of patients requires standardized information
in the individual patient record. This is the same idea as atomic-level patient data collected
once, used many times
- Generally speaking, there is a beginning of development of NI in Europe. Signs of this are
doctoral work in NI, scientific papers, research funding available (some very large from the
EU), research groups in many countries, support from professional organizations in nursing
in many countries, European and international networks are at hand, and their possibilities
to study NI both in graduate and undergraduate schools.

REFERENCES:

Europe. (n.d.). Nursing Informatics. https://pearliansubcninfo.weebly.com/europe.html

Saba, V. K., & McCormick, K. A. (2021). Essentials of nursing informatics (7th ed.). McGraw Hill
Professional
Mantas, J. (2015). Health and medical informatics education in Europe. IOS Press