Healthcare Professionals

NURSING INFORMATICS

KEY TERMS HANDHELD PC (H/PC)

• Clinical Guidelines - is a computer built around a form factor which is
• Fast Healthcare Interoperability Resources (FHIR) significantly smaller than any standard laptop
• Continuing Education computer.
• Health Information Exchange (HIE) - It is sometimes referred to as a palmtop computer.
• Continuous Quality Improvement (CQI)
• Interprofessional Collaboration PERSONAL DIGITAL ASSISTANT/ENTERPRISE DIGITAL
• Procedures ASSISTANT
• Protocols - is a variety mobile device which functions as a
personal information manager.
- mostly displaced by the widespread adoption of
CHAPTER OVERVIEW
highly capable smartphones, in particular those
- Clinical Informatics is evident throughout the
based on iOS and Android.
healthcare system.
- Nurses are expected to enter the field with
GRAPHING CALCULATOR
baseline knowledge of clinical informatics as well
- a handheld computer that is capable of plotting
as understanding of its application to clinical
graphs, solving simultaneous equations, and
guidelines, protocols, and procedures.
performing other tasks with variables.
- Moreover, many quality improvement (QI)
techniques aimed at preventing medical errors
POCKET COMPUTER
involves informatics and are necessary to achieve
- 1980s-era user programmable calculator sized
cost reduction as well as patient and clinician
computer that had fewer screen lines
satisfaction.
- often fewer characters per line, than the Pocket
- The role of the nurse in informatics related to
sized computers introduced beginning in 1989.
interprofessional practice, practice workflow, and
leadership in information technology (IT) will be
TABLET COMPUTER
discussed in this chapter.
- A type of computer that can be carried easily
- Finally, nursing education curricula and their
- has no physical keyboard or trackpad, though
alignment with the expectations of a complex
users sometimes add those things.
healthcare system related to clinical informatics
- control mostly by using its touch screen with
will be described.
multitouch technology similar to a smartphone.
__________________________________________________ __
GUIDELINES, PROTOCOLS, AND PROCEDURES ➢ HANDHELD GAME CONSOLES
- Clinical Informatics as it applies to clinical
guidelines, protocols, and procedures may be the NINTENDO DS
most easily understood application for nurses.
- A struggle for clinicians prior to the 21st century
was maintaining awareness of current guidelines
as many of these groups update their guidelines GAME, GAME BOY COLOR
every few years as new evidence evolves
- Through clinical informatics, and the advent of
handheld devices, the most up-to-date, clinical
guidelines are at every clinician’s fingertips.
HANDHELD DEVICES
- have become a craze in the new millennium
- a pocket-sized computing device with a display GAME BOY ADVANCE
screen and input/output interface like an external
or touch screen keyboard.

POPULAR HANDHELD DEVICES SEGA GAME GEAR

➢ MOBILE COMPUTERS

LAPTOP/LAPTOP COMPUTER/NOTEBOOK
- small, portable personal computer(PC) with a
clamshell form factor, typically having a thin LCD PC ENGINE GT
ULTRA-MOBILE PC
- An ultra-mobile PC (ultramobile personal
computer or UMPC) is a miniature version of a pen
computer, a class of laptop whose specifications
were launched by Microsoft and Intel in spring
2006.

LESLIE ANN CANALES | RLE

Healthcare Professionals
NURSING INFORMATICS

POKEMON MINI ➢ COMMUNICATION DEVICES

• MOBILE PHONES
• CORDLESS TELEPHONE
• PAGER

NEOGEO POCKET, NEOGEO

COLOR BENEFITS OF HANDHELD DEVICES & GADGETS
OFFICE ON THE GO:
- Enable you to literally take your office with you. You
can send and receive emails, browse the net
ATARI LYNX
wirelessly at 3G speeds, access secure office files
through VPNs, edit files and much more on your
handheld mobiles. No longer limited by either size
or mobility to increase your productivity.
PANDORA
HIGH CONVENIENCE:
- Can do all the functions that your traditional
computer can do, and more. Have inbuilt GPS
navigation services, which was unthinkable just a
few years back
GP2X/GP32
NEW ENTERTAINMENT FORMS:
- As technology has progressed and computing
prowess has found its way on small and
miniaturized gadgets, new entertainment forms
GIZMONDO have also emerged.

BREAKING THE COMMUNICATION BARRIER:

- Previously snail mail was the only way to keep in
touch with your friends, loved ones and in many
cases with your business associates too. With
umpteen forms of communication devices and
PLAYSTATION PORTABLE tools making appearance almost daily, the
communication barrier is well and truly broken.
Today you may just ‘tweet' your status on your
mobile, or book a railway ticket through your cell
N-GAGE while sitting in a bus.

CLINICAL GUIDELINES, PROTOCOLS, AND PROCEDURES

ACRONYMS

➢ MEDIA RECORDERS • ADA – American Diabetes Association

• DIGITAL VIDEO CAMERA (DVC/ DIGITAL
CAMCORDER)
• DIGITAL AUDIO RECORDERS
- In digital recording, audio signals picked up by a
microphone or other transducer or video signals
picked up by a camera or similar device are
converted into a stream of discrete numbers,
representing the changes over time in air pressure
for audio, luminance values for video, then
recorded to a storage device.
• MEDIA PLAYERS/DISPLAYERS
• PORTABLE MEDIA PLAYER
• E-BOOK READER
- a book publication made available in digital form,
consisting of text, images, or both, readable on the
flat panel display of computers or other electronic
devices
• NHBLI – National Heart, Lung and Blood Institute
• JNC – Joint National Committee
• DOI – Digital Object Identifier
GUIDELINES
- primarily evidence-based recommendations
- are usually generated from an authority group
consisting of experts in the field and are publish
regularly.
CLINICAL PRACTICE GUIDELINES
- statements that include recommendations intended
to optimize patient care that are informed by a
systematic review of evidence and an assessment of
the benefits and harms of alternative care options

LESLIE ANN CANALES | RLE

Healthcare Professionals
NURSING INFORMATICS
EXAMPLES OF COMMONLY USED CLINICAL RESOURCES
TOPIC RELEASE DATE
Hypertension 2007
Asthma 2014
Colorectal Cancer 2016
Screening
Diabetes 2017
PICO FORMAT
- Population, Intervention, Comparison, Outcome
- to address clinical issues
PROTOCOLS
- usually evidence-based but tend to be beam-based
approaches to practices in a locale or region.
- Through shared drives and web-based applications,
teams of clinicians can share and access protocols to
improve uniformity and best practices germane to a
particular practice.
PROCEDURES
- commonly performed skills in practice setting.
- These procedures can be accessed, shared, and
easily updated with the emergence of new evidence
with the use of clinical informatics.
- The application of clinical informatics allows the nurse
to review procedures prior to performing them and
also adds to the uniformity of procedures performed
within a given practice.
COMMON MEDICAL APPLICATIONS
Epocrates and UptoDate, offer a centralized repository of
many guidelines, protocols, and procedures
EPOCRATES
- a mobile medical reference app, owned by
Watertown, Massachusetts-based athenahealth, that
provides clinical reference information on drugs,
diseases, diagnostics and patient management.
UpToDate, Inc.
- a company in the Wolters Kluwer Health division of
Wolters Kluwer whose main product is UpToDate,
- a software system that is a point-of-care medical
resource.
- The UpToDate system is an evidence-based clinical
resource
QUALITY IMPROVEMENT TECHNIQUES &
NURSING INFORMATICS
EHR VS EMR
- EMR term came along first, and early EMRs were
“medical” and were for use by clinicians mostly for
diagnosis and treatment
- In contrast, “health relates to “The condition of being
sound in body, mind, or spirit; especially freedom
from physical disease or pain. The general
- condition of the body.”
- The word “health” covers a lot more territory than the
word “medical.”
- EHRs go a lot further than EMRs.
DISADVANTAGES OF EHR & EMR
- Much more expensive to implement initially
- Unless properly built, there’s a chance the system will
malfunction, destroy all data
ELECTRONIC HEALTH RECORD (EHR)
- is more than just a computerized version of a paper
chart in a provider’s office.
- It’s a digital record that can provide
comprehensive health information about your
patients.
- is software that's used to securely document, store,
retrieve, share, and analyze information about
individual patient care.
- are hosted on computers either locally (in the
practice office) or remotely. Remote EHR systems
are described as “cloud- based” or “internet-
based.”
- is a digital version of a patient’s paper chart.
- are real-time, patient-centered
- records that make information available instantly
and securely to authorized users.
- does contain the medical and treatment histories
of patients, an EHR system is built to go beyond
standard clinical data collected in a provider’s
office and can be inclusive of a broader view of a
patient’s care.
✓ Contain a patient’s medical history, diagnoses,
medications, treatment plans, immunization dates,
allergies, radiology images, and laboratory and
test results
✓ Allow access to evidence-based tools that
providers can use to make decisions about a
patient’s care
✓ Automate and stream line provider
- One of the key features of an is that health
information can be created and managed by
authorized providers in a digital format capable of
being shared with other providers across more
than one health care organization.
- are built to share information with other health care
providers and organizations – such as laboratories,
specialists, medical imaging facilities, pharmacies,
emergency facilities, and school and workplace
clinics – so they contain information from all
clinicians involved in a patient’s care.
INFORMATION IS AVAILABLE WHENEVER & WHEREVER IT IS
NEEDED
IMPROVED PATIENT CARE
- Quick access to patient records from inpatient and
remote locations for more coordinated, efficient care
- Enhanced decision support, clinical alerts, reminders,
and medical information
- Performance-improving tools, real-time quality
reporting
- Legible, complete documentation that facilitates
accurate coding and billing
- Interfaces with labs, registries, and other EHRs
- Safer, more reliable prescribing
LESLIE ANN CANALES | RLE
Healthcare Professionals
NURSING INFORMATICS
- Reduced need to fill out the same forms at each
office visit
- Reliable point-of-care information and reminders
notifying providers of important health interventions
- Convenience of e-prescriptions electronically sent to
pharmacy
- Patient portals with online interaction for providers
- Electronic referrals allowing easier access to follow-
up care with specialists
INCREASED PATIENT PARTICIPATION
- Providers and patients who share access to
electronic health information can collaborate in
informed decision making.
- Important in managing and treating chronic
conditions such as asthma, diabetes, and obesity
➢ Ensure high-quality care
- Can give Px full and accurate information about all
their medical evaluations
- Providers can also offer follow up information after an
office visit or hospital stay
➢ Create and avenue for communication with their Px
- Can manage appointments schedules electronically
and exchange email with their Px
- Quick and easy communication to identify symptoms
earlier
- Providers can be more proactive by reaching out to
patients
IMPROVED CARE COORDINATION
- Have advanced, the delivery of sophisticated, high-
quality medical care has come to require teams of
health care providers—primary care physicians,
specialists, nurses, technicians, and other clinicians.
• WITH HER, every provider can have the same
accurate and up-to-date information about a
patient. This is especially important with patients who
are:
- Seeing multiple specialists
- Receiving treatment in emergency settings
- Making transitions between care settings
- Better availability of patient information can reduce
medical errors and unnecessary tests.
- Better availability of information can also reduce the
chance that one specialist will not know about an
unrelated (but relevant) condition being managed
by another specialist.
- Better care coordination can lead to better quality of
care and improved patient outcomes.
IMPROVED DIAGNOSTICS & PATIENTS OUTCOMES
- have access to complete and accurate information,
patients receive better medical care.
MEDICAL PRACTICE EFFICIENCIES & COST SAVINGS
- HER, improve medical practice management by
increasing practice efficiencies and cost savings.
- BENEFITS:
• Reduced transcription costs
• Reduced chart pull, storage, and re-filing costs
• Improved documentation and automated coding
capabilities
• Reduced medical errors through better access to
patient data and error prevention alerts
• Improved patient health/quality of care through
better disease management and patient education
ADVANTAGES OF EHR
- Providing accurate, up-to-date, and complete
information about patients at the point of care
- Enabling quick access to patient records for more
coordinated, efficient care
- Securely sharing electronic information with patients
and other clinicians
- Helping providers more effectively diagnose patients,
reduce medical errors, and provide safer care
- Improving patient and provider interaction and
communication, as well as health care convenience
- Enabling safer, more reliable prescribing
- Helping promote legible, complete documentation
and accurate, streamlined coding and billing
- Enhancing privacy and security of patient data
- Helping providers improve productivity and work-life
balance
TRANSFORMED HEALTH CARE
(EHRs) are the first step to transformed health care.
Benefits include:
- Better Health Care by improving all aspects of patient
care, including safety, effectiveness, patient-
centeredness, communication, education,
timeliness, efficiency, and equity.
- Better Health and equity. by encouraging healthier
lifestyles in the entire population, including increased
physical activity, better nutrition, avoidance of
behavioral risks, and wider use of preventative care.
- Better Clinical Decision Making by integrating patient
information from multiple sources.
- Enabling providers to improve efficiency and meet
their business goals
- Reducing costs through decreased paperwork,
improved safety, reduced duplication of testing, and
improved health.
EHR CONTAINS Px INFORMATION:
• Administrative and billing data
• Patient demographics
• Progress notes
• Vital signs
• Medical histories
• Diagnoses
• Medications
• Immunization dates
• Allergies
• Radiology Images
• Lab and test results
BENEFITS OF EHR OVER EMR
- Health Information and data
- Results management
- Order Entry
- Decision support
- Electronic communications and connectivity
- Patient support
- Administrative processes
LESLIE ANN CANALES | RLE
Healthcare Professionals
NURSING INFORMATICS

CQI (Continuous Quality Improvement)

CONS OF HER - a management philosophy that organizations use to
- Privacy and Cybersecurity Issues reduce waste, increase efficiency, and increase
- Inaccurate Data internal (meaning, employees) and external
- HER Require Time and Significant Investments (meaning, customer) satisfaction.
- HER-related clinician burnout - It is an ongoing process that evaluates how an
-
organization works and ways to improve its processes
ELECTRONIC MEDICAL RECORD (EMR) - Enable us to achieve our strategic goals and attain
- are a digital version of the paper charts in the our vision of becoming THE Model of Service
clinician’s office.
Excellence.
- contains the medical and treatment history of the
- A philosophy that encourages all health care team
patients in one practice.
members to continuously ask: “How are we doing”,
- Allows clinicians to:
• Track data over time “Can we do it better?”, “Can we do it more
• Easily identify which patients are due for efficiently, effective, faster, in a more timely way?”
preventive screenings or checkups
• Check how their patients are doing on ✓ Accountability
certain parameters—such as blood ✓ Idea Generation
pressure readings or vaccinations ✓ Learning
• Monitor and improve overall quality of ✓ Leadership
✓ Reward & Recognition
care within the practice
✓ Communication & Tracking
- EMR are not much better than a paper record
✓ Improvement Activities
✓ Customer Satisfaction
The National Academy of Medicine, highlights 6 MAIN
_______________________________________________________
AIMS OF HCPs: (Agency for Healthcare Research and
Quality ACRONYMS:

EFFECTIVENESS • FHIR - Fast Healthcare Interoperability Resources

- It is the ability of an intervention to have a meaningful • API - Application Programming Interface
effect on patients in normal clinical conditions • HL7 - Health Level Seven International
• HIEs - Health Information Exchanges
SAFETY
- In AHRQ, avoiding harm to patients from the care INTERPROFESSIONAL COLLABORATION &
that is intended to help them PRACTICE WORKFLOW
- Clinical informatics impact the ability of
EFFICIENCY professionals to interact and build upon one
- Effective operation as measured by comparison of another’s contribution to patient care.
production with cost (as in energy, time, and - With the application of clinical informatics,
money) clinicians now routinely collaborate through
portals and electronic medical records (EMR),
PATIENT-CENTEREDNESS
review and attest one another’s patient notes, and
- In AHRQ, providing care that is respectful of and
make referrals conveying critical information to
responsive to individual patient preferences, needs, other clinicians through informatics.
and values and ensuring that patient values guide
all clinical decisions. FAX (FACSIMILE)
- sometimes called telecopying or telefax
TIMELINESS - is the telephonic transmission of scanned printed
- In AHRQ, it refers to a practice’s ability to quickly
material (both text and images), normally to a
provide care after recognizing a need
telephone number connected to a printer or other
EQUITABILITY output device.
- In AHRQ, all individuals have access to affordable
high quality, culturally and linguistically appropriate
EMR EHR
• a digital version of a • allows a patient’s health
care in a timely manner paper chart that record to move with
___________________________________________________________________________________________________ contains all of a other health care
patient’s medical history provider’s specialist,
AHRQ (Agency for Healthcare Research & Quality) from one practice hospitals and nursing
- Is the primary provider of these vetted quality homes
measures, and a breakdown of these measures can • records services that • offers a more
be found on its National Quality Measures store the entire data of comprehensive view of
each patient in an the patient history, thus
Clearinghouse website electronic format giving the acting
physician a better

LESLIE ANN CANALES | RLE

Healthcare Professionals
NURSING INFORMATICS

understanding of the ✓ Demonstrates skills in using patient-care technologies,

patient’s condition and information systems, and communication devices that
the past treatment support safe nursing practice.
• contains the standard • go beyond the data ✓ Use telecommunication technologies to assist in effective
medical and clinical collected in the communication in a variety of healthcare settings.
data gathered in one provider’s office and ✓ Apply safeguards and decision-making support tools
provider’s office include a more embedded in patient-care technologies and information
comprehensive patient
systems to support a safe practice environment for patients
history
and healthcare workers.
• Online patient’s medical • Online patient’s medical
✓ Understand the use of clinical information system to
info from one provider info from all provider
document interventions related to achieving nurse-sensitive
• Access to the patient’s • Access to data from outcomes.
data from only one more than one health ✓ Use standardized terminology in a care environment that
health organizations organization reflects nursing’ unique contribution to patient outcomes.
• Has to be printed as it • No need to print. ✓ Evaluate data from all relevant sources, including
cannot be shared Patient’s health can go technology, to inform the delivery of care.
electronically outside across geographical ✓ Recognize the role of the information technology in
the practice regions improving patient-care outcomes and creating a safe care
environment.
FHIR (Fast Healthcare Interoperability Resources) – ✓ Uphold ethical standards related to data security,
2017 regulatory requirements, confidentiality, and patients’ right
- a standard for electronically sharing healthcare to privacy
information, released an update and will soon move ✓ Apply patient-care technologies as appropriate to address
from a trial version to its final version the needs of a diverse patient population.
- FHIR (pronounced "fire") ✓ Recognize the redesign of workflow and care processes
should precede implementation of care technology to
- is a standard describing data formats and elements
facilitate nursing practice.
(known as "resources")
✓ Participate in evaluation of information systems in practice
- An API for exchanging electronic health records settings through policy and procedure development.
- The standard was created by (HL7) health-care
standards organization. ONGOING EDUCATION AND NURSING INFORMATION
✓ One of its goals is to facilitate interoperation The American Association of Colleges of Nursing,
between legacy health care systems, to make it summarizes the need for informatics content in
easy to provide health care information to health curricula:” Knowledge and skills in information
care providers management and patient care technologies are
✓ FHIR provides an alternative to document centric critical in the delivery of quality patient care.”
approaches by directly exposing discrete data
elements as services. CONTINUING EDUCATION
- is required for all nurses to stay current in practice,
HIEs (Health Information Exchanges) meet their state-mandated continuing education
- are high level systems that are designed to promote units (CEUs), and fulfill requirements for
rapid sharing of data across facilities. certifications/re certification in specialty practice.
ALAIR – American Library Association Institutional
• Public Health Organizations Repository
• Pharmacies
• Labs IT’S IMPORTANCE IN NURSING CAREER:
• EMS
TECHNOLOGY
• Community Health Centers
- The changing technology and its uses in the
• Primary Care Physicians
healthcare industry is something all nurses should
• Hospitals
learn and adapt to.
- Nurses need proper training to be able to use the new
NURSING CURRICULA AND CONTINUING EDUCATION
machines, software or equipment properly
The American Association of Colleges of Nursing,
summarizes the need for informatics content in CAREER ADVANCEMENT
curricula:” Knowledge and skills in information - Continuing education is essential for nurses who aim
management and patient care technologies are
for continuous career advancement
critical in the delivery of quality patient care.”
INCREASED OPPURTUNITIES AND PAY
Essentials of Baccalaureate Education for
professional Nursing practice: Information VIRAL SICKNESS
Management and Application of Patient Care
REQUIREMENT
Technology

LESLIE ANN CANALES | RLE