NURSING INFORMATICS 3.

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INFORMATION TECHNOLOGY SYSTEM APPLICABLE IN
NURSING PRACTICE
A. HOSPITAL/CRITICAL CARE APPLICATIONS
CRITICAL CARE NURSING
Is the nursing specialty that with human responses to
life-threatening problems.
alarm signal)
4. Computer processor to analyze data and direct
reports (Paper reports, storage for graphic files,
summary reports)
5. Evaluation or controlling component to regulate the
equipment or alert the nurse (Notice on the display
screen, alarm signal)

CRITICAL CARE NURSE ARRYTHMIA MONITORS

Is responsible to ensure that critically ill patients are Computerized monitoring and analysis of cardiac
seriously conditioned individuals, ensure that families of rhythm
the medically ill patients should receive optimal care.
BASIC COMPONENTS
CRITICAL CARE APPLICATIONS
1. Sensors
Areas where patients require complex assessment, high
2. Signal conditioner
intensity medication, continuous therapy and
interventions, and unrelenting nursing attention and 3. Cardiograph
continuous watchfulness.
4. Pattern recognition
1986
5. Rhythm analysis
Saba and McCornick estimated that the volume of data
6. Diagnosis
collected by nurses in critical care settings on a daily
basis was as high as 1,500 points 7. Written report
A data point is a discrete unit of information. In a HEMODYNAMIC MONITORS
general sense, any single facts is a data point. In a
statistical or analytic context, a data point is usually Can be used to:
derived from a measurement or research and can be 1. Measure hemodynamic parameters
represented numerically and/or graphically. The term
data is roughly equivalent to datum, the singular form 2. Closely examine cardiovascular functions
of data. 3. Evaluate cardiac pump output and volume status
INFORMATION TECHNOLOGY CAPABILITIES AND 4. Recognize patterns (arrhythmia analysis) and
APPLICATIONS IN CRITICAL CARE SETTINGS extract features
 Physiologic Monitors 5. Assess vascular system integrity
 Arrythmia Monitor
 Hemodynamic Monitors 6. Evaluate the patient’s physiologic response to
 CCISs stimuli

7. Continuously evaluate blood gases and electrolytes

PHYSIOLOGIC MONITORS
8. Estimate cellular oxygenation
BASIC COMPONENTS
9. Continuously evaluate glucose levels
1. Sensors (Pressure transducer , ECG electrode)
10. Store waveforms
2. Signal conditioners to amplify or filter the display
11. Automatically transmit selected data to a
device (amplifier, oscilloscope, paper recorder)
computerized patient database
CRITICAL CARE INFORMATION SYSTEM (CCIS)
1. Provide real-time resources 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.
2. Enable 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.
3. Automated collection and management of medical
information will become the important task of the
critical care information system.
This infrastructure is used to send the workload
generated by the patient care devices in the modern
critical care setting.
MEDICAL INFORMATION BUS (MIB)
 Provides a generalized method of attaching patient
monitoring devices to a common interface
 it eliminate need for custom connector and
software presently needed to interface such device
 This interface converts the unique manufacturer
data communications protocol into a standardized
hardware and software system.
 Has the ability to filter, store and select information
sent for inclusion into the clinical medical record on
the clinical computer system

ADVANTAGES OF CCIS
MEDICAL DEVICES
 Intelligently integrates and process physiologic and
IEEE 1073
diagnostic information and store it to secured
clinical repository - “medical information bus”
 Creates trend analysis graphical representation of - Based on OSI 7 – layer model
results
THE SEVEN LAYERS OSI REFERENCE MODEL
 Offline stimulation can be performed to test the
condition of the patient 1. Physical
 Provide clinical decision support system 2. Data link
 Provide access to vital patient information 3. Network
 Providing feedback and quick evaluation of the 4. Transport
patient condition and provide alert 5. Session
6. Presentation
COMPONENTS OF THE CCIS
7. Application
1. Patient management
B. COMMUNITY HEALTH APPLICATIONS
2. Vital sign monitoring
Collective term for the methodical application of
3. Diagnostic testing results information science and technology to community and
public health process.
4. Clinical documentation to support the process of
physical assessment findings ● Focuses on the health information system of the
community, it is centered on the majority part of
5. Decision support
the public.
6. Medication management
● Emphasizes the prevention of the disease, medical
7. Interdisciplinary plans of care intervention and public awareness.

8. Provider order entry ● Fulfills a unique role in the community, promoting

DEVICE CONNECTIVICITY INFRASTRUCTURE
In concept, the term Medical Information Bus (MIB) is
used to classify the backbone of information exchange,
allowing data to be moved from one point another.
and protecting the health of the community at the
same time maintaining sustainability an integrity of
health data and information.
GOAL OF COMMUNITY HEALTH INFORMATICS
Effective and timely assessment that involves C. AMBULATORY CARE SYSTEM
monitoring and tracking the health status of
President George Bush (April 27, 2004 E.O 2004)
populations including identifying and controlling disease
outbreaks and epidemic Announced a goal to establish electronic health records
(EHRs) for all citizens within a 10-year time frame.
COMMUNITY HEALTH APPLICATION SYSTEM
Created the position of a national health information
Encourages optimal application of computer system, technology coordinator to develop a nationwide
computer programs and communication system for the interoperable health technology infrastructure.
benefit of majority of individual families and community
Tommy G. Thompson
PRIMARY FOCUS OF COMMUNITY HEALTH
Health and Human Services Secretary. Announced the
INFORMATION SYSTEM
"Decade of Healthcare Information Technology" and
1. Preventing, 1. Educating 1. effective announced the publication of a report which reveals
identifying, and transformation how vital it is to have automation in the physician's and
investigating, empowering of data into ambulatory offices.
and eliminating individuals to formation
communicable adopt health 4 MAJOR GOALS
problems. lifestyle
GOAL 1: INFORM CLINICAL PRACTICE
2. Accessibility of 2. facilitate 2. effective Bringing information tools to the point of care,
data and the retrieval integration of especially by investing EHR systems in physician offices
information of data information to and hospitals
through other
communication disciplined to GOAL 2: INTERCONNECTED CLINICIANS
concretized
knowledge and Building an interoperable health information
creates better infrastructure, so that records follow the patient and
understanding clinicians have access and involvement in health
decisions

COMPUTER BASED SURVEY SYSTEM GOAL 3: PERSONALIZE CARE

HEALTH STATISTICAL SURVEYS Using health information technology to give consumers

 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 its purpose and many surveys
involves administering questions to individuals
ADVANTAGES OF COMMUNITY HEALTH SYSTEM
 Consistent exchange of response
 Disease tracking
 Building strategies
 Control of spread of disease
 Building strong communication
 National alertness and preparedness
 Synchronization of the decision
more access and involvement in health decisions
GOAL 4: IMPROVE POPULATION HEALTH
Expanding capacity for public health monitoring quality
of care measurement, and bringing research advances
more quickly into medical practice
WHERE AMBULATORY CLIENTS ARE BEING TREATED:
 Ambulatory Clinics
 Surgery Centers
 Single and Multispecialty Group
 Diagnostics Laboratory
 Health Maintenance organizations
 Independent physician organizations
 Birthing Centers
 College and Universities health Services
Applications Necessary in the Ambulatory Resource Based Relative Value Scale (RBRVS)
Environment
Is a model designed by the Department of Health and
Ambulatory Care Information System are designed to: Human Services (DDHS).

• Store Current Procedural Terminology (CPT)

• Manipulate
Codes describe medical procedure performed by
• Retrieve information for planning, organizing
physicians and other health providers.
directing, and controlling administrative
• Clinical activities associated with the provision and Ninth Revision of the International Classification of
use of ambulatory care services and facilities Diseases

FINANCIAL BENEFITS It is designed for the classification of morbidity and

1. Cost Effective mortality information for statistical purposes, for the
2. Accurate insurance information obtain indexing of hospital records by diseases and operation,
3. Timely bill submission processed resulting and for data storage and retrieval.
decreased days in account payable HCFA HPCS (2004)
4. Reduction of rejected claims
Is a collection of codes that represent procedures,
ADMINISTRATIVE BENEFITS supplies, products, and services which may be provided
1. Reduction in size of the record room to Medicare beneficiaries and to individuals enrolled in
2. Reduce time spent finding and delivering chart private health insurance programs.
3. Increase privacy of data National Drug Code
4. Formats that are legible
5. Comply with legal regulations Identifies pharmaceutical in detail including packaging.
6. Promotions of quality assurance Its use is required by the FDA for reporting and it is used
7. Improve patient satisfaction in many healthcare information systems to aid
8. Ability for home access by the physician and nurse reimbursement.
practitioners
NDC directory
9. Alerts for incomplete data
10. Integration of clinical data Is limited to prescription drugs and few selected over-
the-counter products.
CLINICAL BENEFITS
Medicare's ambulatory payment classification (APC)
1. Medical record
system
2. Vital signs
3. Progress notes Is a prospective payment system for hospital outpatient
4. Results from laboratory services.
5. Radiology departments
APCs
6. Flow sheets
7. Growth Charts Were mandated by Congress as part of Balanced Budget
8. Immunization records Act of 1997
8. Medication allergies
9. Profiles Software
10. Alerts Is available to help ambulatory care organizations
11. Reminders determine outpatient payment and verify payment
12. Follow-up system received.
13. E-prescribing
14. Evidence-based medicine Centers for Medicare and Medicaid Services

Formerly known as the Health Care Financing

REGULATORY REQUIREMENTS Administration
Health Plan Employer Data and Information Set
(HEDIS)
Is a standardize, comprehensive set of indicators to
measure the performance of a health plan
 a moment to moment “situational analysis”
 Real time information to assess needs and available
resources that can change suddenly and
unexpectedly.

Outcome and Assessment Information Set

New Technologies
A data set for use in home health agencies and is an
These technologies are being used and evaluated to
initiative from the Health Care Financing Administration
improve patient care and tracking, foster greater safety
the purpose is to provide a comprehensive assessment
for patients and providers, enhance incident
for an adult home care patient and measure patients
management at the scene, coordinate response efforts,
outcomes for purpose of outcome-based quality
and enhance informatics support at both the scene of
improvement
the disaster and at the community resource levels.
D. EMERGENCY PREPAREDNESS AND RESPONSE
Technologies such as:
Early informatics contributions to the emergency
 Smart devices
planning and response agenda have focused largely on
 Wireless connectivity
surveillance of threat detection.
 Positioning technologies
 A broader assessment of possible informatics
contributions unveils that informatics can also
Interagency Standing Committee (IASC) of the UN
contribute to increasing the efficiency in
Office of Humanitarian Affairs (UN-OCHA)
disaster response as well as providing a tele-
presence for remote medical caregivers.  Initiated changes called the “humanitarian reform”
 Organized clusters whose principal mission was to
Special challenges for data management occur every
assist the impacted government with coordination
emergency or disaster.
of all responses and with evaluation of the impact
 Tracking of victims, electronic health records of intervention.
and supply inventory are a few of the
contributions that informatics can play during
World Health Organization (WHO)
disasters.
 Appointed as the lead agency for health.
Early Response
 Includes coordination and production of health
Earlier response by the informatics community focused information
on contributions toward:  At global level, it aims at discouraging individual and
organizational response efforts that were not part
 Surveillance of threat detection
of this coordinated response.
 Biosurveillance and biogent detection
 Increasing the efficiency in disaster response
 Providing a telepresence for remote medical care The Centers for Disease Control and Prevention (CDC)
givers
 Monitors influenza activity and trends virus
characteristics through a nationwide surveillance
Consistent Challenge system
 Estimates the burden of flu illness using statistical
A challenge for emergency and disaster response
modelling
continues to be communication and information
management. National Retail Data
EFFECTIVE RESPONSE  Monitoring system tracked the real time purchase
of over the counter medication, such as fever,
Requires:
 reducers and influenza treatments, in over 29,000
retail pharmacies, groceries and mass merchandise
stores.
 Provides early detection of naturally occurring
outbreaks as well as bioterrorism
Electronic Surveillance System for Early Notification of
Community Based Epidemics (ESSENCE)
 Is a Department of Defense (USA) tool that fuses
syndromic information from multiple data resources
that differ in their medical specificity, spatial
organization, and scale and time series behaviours
to provide early warning at the community level.
Real time Outbreak Disease Surveillance (RODS)
 Took chief complaint information from clinical
encounters hospitals and classified it into one of
seven syndrome categories using Bayesian
classifiers.
 Data is stored in relational database, used
univariate and multivariate statistical detection.
 Alerted users of when algorithms identify
anomalous patterns in the syndrome count
Healthcare Consumers Contribute to Surveillance
Activities
 Now more than ever before consumers have
opportunity to contribute to surveillance activities.
 Some cases, the participation is a conscious
decision, but in others consumers may be
unknowingly contributing to this information
process.
Advantage
 Shorten the typical lag time to publication for CDC’s
publicly reported data which can be from 10 to 14
days.
Telephone Triage Data
 Is being used to track influenza in specified
geographic location with the added advantage that
the data is real time in nature.
Google Flu Trends
 Assumption that there was a relationship between
how many people search the internet for flu related
topics and how many people flu-like symptoms.
 Comparing to CDC published data, they found the
search based flu estimates had a consistently strong
correlation.
Competency Based Learning and Informatics Needs
 Nurses must be appropriately and consistently
educated to provide the right response
Competency based Education:
 Provides an international infrastructure for nurses
to learn about emergency preparedness and
response.
 However, there are no accepted, standardized
requirements for disaster nursing training or
continuing education.
International Nursing Coalition for Mass Casualty
Education
 Later renamed the Nursing Emergency
Preparedness Coalition.
 Generated a list of 104 competency statements for
all nurses responding to disasters using domains
developed by the American Association of Colleges
of Nursing.
Detection of and Response to the Threat of
Bioterrorism
Requires:
 Continuous monitoring of a variety of data
 Standards for combining data from different
sources and coordinaton of such efforts
 Computes based processing and analysis that help
detect unusual and statistical significant patterns.
 Communication technologies
Informatics and Incident Management
 Incident management systems (IMS) was first used
by firefighters to control disaster scenes in a
multijurisdictional and interdepartmental manner.
 Calls for a hierarchical chain command led by the
incident manager or commander.
 Each job assignment is consistently followed by
assigned personnel who refer to a specific job
action sheet.
Benefits
 Improves communication through a common
language
 Allow staff to move between management location
 Facilities all responders to understand the
established chain of commands.
Emergency Operations Center (EOC)
 Is a physical location where the Incident
Management Team convenes to:
•Make decisions
•Communicate
•Coordinate the various activities in response to
an incidents
 Accurate, real time data acquisition regarding:
• Patient needs
• Rescue personnel
• Resources available
Technology and Informatics Contributions to Incident
Management
Technology can be used to capture and represent data
for purposes of increasing situational awareness in the
Emergency Operations Center (EOC) for making the
most informed and efficient decisions.
Informatics and Volunteerism
 Healthcare volunteers are a necessary components
of mass casualty events but can also create
challenges.
 Questions to think about:
 How are liability issue dealt with?
 How do you educate them so that they can perform
effectively when needed?
Disaster Medical Assistance Teams
 Federal government system for organizing teams
that are willing to travel to other regions if the
country in the event of an emergency.
 When activated, members of the teams are
federalized or made temporary workers of the
federal government.
Medical Reserve Cops
 National network of community based volunteer
units that focused on improving the health, safety,
and resiliency on their local communities.
 Include medical and public health professionals
such as:
 Physicians
 Nurses
 Pharmacists
 Dentists
 Veterinarians
 Epidemiologist
Volunteers
 Require education prior to responding to an event.
 MRC unities have competency based education
requirements.
 American Red Cross has a long history of
volunteerism
 Regardless the group, nurses are urged to be a part
of an organized group rather than just showing up
to the disaster.
Future Advances
 Health information technology investments are a
necessary foundation in healthcare reform, linking
potentially valuable information such as vaccination
records and subsequent use of healthcare services
to provide information about adverse events as well
as vaccine effectiveness.
Grids
 Using “grids” to connect multiple computers across
the country will allow data sources to share and
view large amounts of health information
 Grid participants will be able to analyse data in
other jurisdiction without moving the actual data.
Electronic Health Records
 Expanding the use of electronic health records
should help both patients and their healthcare
providers during times of emergencies and
disasters.
 Improve clinical data and sharing of clinical
information for displaced patients.
E. ADMINISTRATIVE ASSISTIVE DEVICES AND
WORKPLACE TECHNOLOGIES
Assistive Devices
● Facilitate the clients' communication abilities, their
performance of the activities of daily living, their
highest possible level of independence, the
prevention of the complications associated with
immobility, and it also enhances the patient's
feelings of self-esteem and self-worth. Nurses must
assess and reassess the client's safe and appropriate
use of all assistive devices.
Canes
● Typically used to facilitate the client's balance and
to facilitate ambulation when the client is physically
and cognitively able to use it rather than a walker.
There are a variety of different canes including a
standard one foot cane, a tripod cane with three
feet, and the quad cane which has four feet. Some
canes like a wooden cane are not adjustable to the
client's height and others can be adjusted to meet
the height needs of the client.
Walkers
● Are indicated when the patient needs more support
with ambulation than a cane can safely offer them.
Walkers can be with or without wheels, with or
without brakes, and with or without a seat that the
client can use when they need to rest during a long
walk.
Hearing Aid
● A device designed to improve hearing by making
sound audible to a person with hearing loss.
Word boards
● It is designed as communications board available for
those patients who are unable to communicate
verbally, the patient is able to indicate his or her
status or needs by pointing to words in real time.
Improved patient-provider communication
enhances the patient’s hospital stay and wellness.
Evaluation of using Assistive Devices
● The client's correct use of assistive devices is
evaluated and monitored by observing the client
using these devices and evaluating whether or not
the client has remained without injury secondary to
the improper use of these devices.
Workplace technologies
● The nursing profession finds many of these new
medical technologies help them with routine
processes, and can decrease human mistakes and
errors that can come from too few nurses, working
long hours, with too many patients. While
technological advancements aren’t a cure-all as
healthcare solutions, new technology is changing
the way nurses work in positive ways.
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. It 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.
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.
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.
Smart Beds
● Smart bed technology can help nurses track
movement, weight, and even vitals. It 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.
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.
Evaluation
● New clinical healthcare technology is exciting and
transformative for healthcare. With new
innovations impacting the industry every day, now
is the perfect time to advance your nursing career.
As new technology changes the field, you need to
change with it. Earning a degree will help you be
prepared to take on new roles and be qualified for
the responsibilities that are coming your way.
F. TELEHEALTH
Telehealth is the use of digital information and
communication technologies, such as computers and
mobile devices, to access health care services remotely
and manage your health care. These may be
technologies you use from home or that your doctor
uses to improve or support health care services.
 Use a mobile phone or other device to upload
food logs, medications, dosing and blood sugar
levels for review by a nurse who responds
electronically.
 Watch a video on carbohydrate counting and
download an app to your phone.
The goals of telehealth, also called e-health or m-
health (mobile health), include the following:
 Make health care accessible to people who live in
rural or isolated communities.
 Make services more readily available or convenient
for people with limited mobility, time or
transportation options.
 Provide access to medical specialists.
 Improve communication and coordination of care
among members of a health care team and a
patient.
 Provide support for self-management of health
care.
The following examples of telehealth services may be
beneficial for your health care.
Patient portal
Your primary care clinic may have an online patient
portal. These portals offer an alternative to email, which
is a generally insecure means to communicate about
private medical information. A portal provides a more
secure online tool to do the following:
 Communicate with your doctor or a nurse.
 Request prescription refills.
 Review test results and summaries of previous
visits.
 Schedule appointments or request appointment
reminders.
Virtual appointments
● Some clinics may provide virtual appointments that
enable you to see your doctor or a nurse via online
videoconferencing. These appointments enable you
to receive ongoing care from your regular doctor
when an in-person visit isn't required or possible.
● Other virtual appointments include web-based
"visits" with a doctor or nurse practitioner. These
services are generally for minor illnesses, similar to
the services available at a drop-in clinic.
● When you log into a web-based service, you are
guided through a series of questions. The doctor or
nurse practitioner can prescribe medications,
suggest home care strategies or recommend
additional medical care.
● Similarly, a nursing call center is staffed with nurses
who use a question-and-answer format to provide
advice for care at home. A nursing call center
doesn't diagnose an illness or prescribe
medications.
While these services are convenient, they have
drawbacks:
 Treatment may not be coordinated with your
regular doctor.
 Essential information from your medical history may
not be considered.
 The computer-driven decision-making model may
not be optimal if you have a complex medical
history.
 The virtual visit lacks an in-person evaluation, which
may hamper accurate diagnosis.
 The service doesn't easily allow for shared doctor- The Potential Of Telehealth
patient decision-making about treatments or
 Technology has the potential to improve the quality
making a plan B if an initial treatment doesn't work.
of health care and to make it accessible to more
Remote monitoring people. Telehealth may provide opportunities to
make health care more efficient, better coordinated
A variety of technologies enable your doctor or health
and closer to home.
care team to monitor your health remotely. These
technologies include:  Research about telehealth is still relatively new, but
it's growing. For example, a 2016 review of studies
 Web-based or mobile apps for uploading
found that both telephone-based support and
information, such as blood glucose readings, to your
telemonitoring of vital signs of people with heart
doctor or health care team
failure reduced the risk of death and hospitalization
 Devices that measure and wirelessly transmit
for heart failure and improved quality of life.
information, such as blood pressure, blood glucose
or lung function The Limitations Of Telehealth
 Wearable devices that automatically record and
 While telehealth has potential for better
transmit information, such as heart rate, blood
coordinated care, it also runs the risk of
glucose, gait, posture control, tremors, physical
fragmenting health care. Fragmented care may lead
activity or sleep patterns
to gaps in care, overuse of medical care,
 Home monitoring devices for older people or
inappropriate use of medications, or unnecessary or
people with dementia that detect changes in
overlapping care.
normal activities such as falls
 The potential benefits of telehealth services may be
limited by other factors, such as the ability to pay
Personal health records
for them. Insurance reimbursement for telehealth
An electronic personal health record system — often still varies by state and type of insurance. Also,
called a PHR system — is a collection of information some people who would benefit most from
about your health that you control and maintain. improved access to care may be limited because of
regional internet availability or the cost of mobile
● A PHR app is accessible to you anytime via a web-
devices
enabled device, such as your computer, laptop,
tablet or smartphone. In an emergency, a personal
health record can quickly give emergency personnel
INFORMATICS APPLICATIONS IN EVIDENCE BASED
vital information, such as current diagnoses,
NURSING PRACTICE
medications, drug allergies and your doctor's
contact information. OBJECTIVES:
Personal health apps • To understand what is evidence based nursing
practice.
A multitude of apps have been created to help
• To apprehend;
consumers better organize their medical information in
one secure place. These digital tools may help you:
1. Computer Generated Nursing Care Plans.
 Store personal health information. 2. Critical Pathways
 Record vital signs. 3. Clinical Guidelines
 Calculate and track caloric intake. 4. E-journals
 Schedule reminders for taking medicine.
 Record physical activity, such as your daily step
One of the key principles in medicine today is evidence-
count.
based practice in nursing (EBP). This is the practice of
medicine based on solid research, and it adheres to
standards for high quality and safety, all while focusing
on patients’ needs. This is also why EBP is typically part • A complete computer based patient care record is
of RN to BSN program curriculum. not without legal risk

Overview Comparing the use of manual versus computerized

nursing prescriptions found that overall satisfaction was
Evidence-based practice is a conscientious, problem-
significantly higher with electronic devices. In addition
solving approach to clinical practice that incorporates
to eliminating manual documentation, computer-
the best evidence from well-designed studies, patient
generated forms make it possible to execute
values and preferences, and a clinician's expertise in
computerized prescriptions based on nursing diagnosis,
making decisions about a patient's care. Unfortunately,
improving the review and recovery of associated clinical
no standard formula exists for how much these factors
notes
should be weighed in the clinical decision-making
process. It was verified that the electronic prescription of nursing
has greater usability when compared to the manual
However, there are a variety of rating systems and
process; and it is important to emphasize the clinical
hierarchies of evidence that grade the strength or
application of the systems for improvement. The
quality of evidence generated from a research study or
development of the present study highlights that the
report. Being knowledgeable about evidence-based
computerized nursing process generates positive effects
practice and levels of evidence is important to every
on nursing care and has implications for practice as the
clinician as clinicians need to be confident about how
use of software increases the satisfaction of
much emphasis they should place on a study, report,
professionals, reflecting in a greater time spent with
practice alert or clinical practice guideline when making
direct care to patients
decisions about a patient's care.
Benefit of Computer-Based Patient Health Records
Evidence-based Nursing Practice
• It improves health care service by providing nurses
• Computerized evidence-based decision making
and healthcare providers with better data access,
process can be integrated to health information
quicker data retrieval, readily translated data into
system through the use of statistical information
information, more versatile data output and
system. The decision will be reinforce by factual
presentation, less mathematical skills, no need to
information translated by the software that is
memorized index, patient profile and tablets for
incorporated or embedded in the program.
references.
Computerized evidence based decision making
involves combining the knowledge arising from • In addition computer based patient record can also
one’s clinical expertise, patient preferences, support decision making for diagnose and provide
research evidence couples with computer guaranteed patient support.
programming skills.
• Automated patient health records can be integrated
Computer Generated Nursing Care Plan to statistical information system to enhance the
results of the information for evaluation and
The largest number of studies found in this study on the
analysis witch can be used to predict results to
development of software using it is due to the fact that
scenarios and create trending output.
this is a terminology that brings together, in a single
structure, the diagnostics, interventions and results that • If the computer based patient health records are
can be computerized use. Other taxonomies used are establish, it will certainly increase hospital efficiency
the NANDA-I classification systems, used to improve the by reducing cost, creating parallel works with
reliability, validity, and usability of documentation different conditions and systems, optimizing the
schedule off the staff and facilities, optimizing the
• Software programs allow nurses to enter
capabilities of nurses and health care provider,
assessment data
improved coordination works, minimized
• Computers generate nursing care plans and
irregularities and errors, eliminate redundancy in
document care.
workloads, reduction of patients waiting time and
 create hierarchy in prioritizing decisions. Several
sources support these conclusions.
The first step toward patient record improvement is
careful planning and suitable conceptualization of the
use of technologies available.
• Identify the potentials barriers and problems
for migration to new system and effective
strategy for implementation.
• The data is translated into information which is
generated by nurses and health care providers
thru continuous interaction with the patient or
with individuals who have personal knowledge
of the patient.
• The data and the information will reside in a
secured protected and protected data
warehouse to maintain confidentiality and
privacy.
• A derived patient record can be extracted from
the repository which accessibility are granted if
proper approval are completed.
• Derived record contains selected data elements
which can be used only for evaluation.
Critical Pathways
• Critical Pathways area care plans that detail the
essential steps in patient care with a view to
describing the expected progress of the patient.
• The use of critical pathways reduces the cost of
care and the length of patient stay in the
hospital.
In modern health care delivery:
Critical pathways are structured, multidisciplinary plans
of care designed to support the implementation of
clinical guidelines and protocols.
They are designed to support clinical management,
clinical and non-clinical resource management, clinical
audit and also financial management.
Clinical practice guidelines
• also called evidence-based guidelines
• "are systematically developed statements to assist
practitioner and patient decisions about
appropriate health care for specific clinical
circumstances". According to the National Guideline
Clearinghouse (NGC), sponsored by the Agency on
Healthcare Research and Quality (AHRQ)
• such "guidelines are not fixed protocols that must
be followed" (NGC, 2007) but are intended to
identify generally recommended interventions to be
considered by a knowledgeable healthcare
provider.
• They are intended to offer concise instructions on
how to provide healthcare services.
• The most important benefit of clinical practice
guidelines is their potential to improve both the
quality or process of care and patient outcomes.
• Can be used to reduce inappropriate variations in
practice and to promote the delivery of high quality,
evidence-based health care.
• They may also provide a mechanism by which
healthcare professionals can be made accountable
for clinical activities.
• Guidelines are developed by panels or groups of
experienced individuals who carefully weigh
syntheses of evidence and the strength of the
evidence before developing recommendations for
interventions.
• Although most of the development and evaluation
of clinical guidelines has occurred in the field of
medicine, nurses are becoming more interested in
the use of guidelines as one means of facilitating
evidence-based practice.
Guideline development
• Clinical guidelines can be developed either locally
(internal guidelines) or regionally or nationally
(external guidelines). Although internal guidelines
may need fewer resources and may be more likely
to be adopted into clinical practice because of local
ownership, local groups may not have the skills
required for guideline development. An alternative
is the development of guidelines at regional or
national levels and subsequent modification to suit
local circumstances.
• Guideline development has 4 stages. Firstly, it is
essential that guidelines are based on the best
 available research evidence, and therefore a
detailed literature search is done.
• Literature search to identify evidence from research
studies about the appropriateness and effectiveness
of different clinical strategies.
• Using the research evidence, guideline
construction takes place, usually through some
form of small group work, with representation from
as many interested parties as possible.
• Then, the guideline is tested by asking professionals
not involved in the guideline development to review
it for clarity, internal consistency, and acceptability.
• Finally, the guideline should be reviewed after a
specified time period and modified to take into
account new knowledge.
• If guidelines are to be effective, they need to have
most, if not all, of the following 11 characteristics:
validity, cost effectiveness, reproducibility,
reliability, representative development, clinical
applicability, clinical flexibility, clarity, meticulous
documentation, scheduled review, and
unscheduled review.
• Validity means that if a guideline is followed it
should lead to the health gains and costs predicted.
• Cost effectiveness means that the improvements in
health care should have acceptable costs.
• Reproducibility means that given the same
evidence, another guideline development group
would produce similar recommendations, whereas;
• Reliability means that given the same clinical
circumstances, another health professional would
apply the recommendations in a similar fashion;
• Guideline development should be undertaken by a
group with representation from all key disciplines
and interests, including patients.
• For a guideline to be clinically applicable, the target
population should be defined in line with scientific
evidence;
• Guidelines should also be flexible by identifying
exceptions and how patient preferences are to be
taken into account in the decision making process.
• Guidelines should be clear, using precise definitions
and user friendly formats.
• Meticulous documentation of the guideline
development process should include details of who
took part, methods used, and assumptions made,
and should link recommendations to the available
evidence, which should be graded according to its
method
• Guidelines should also be reviewed periodically and
modified to incorporate new knowledge
Guideline dissemination and implementation
• Once a clinical guideline is ready for use, 2 stages
facilitate its introduction into practice:
dissemination and implementation.
• Dissemination refers to the method by which
guidelines are made available to potential users.
Dissemination strategies include publication in
professional journals, sending guidelines to targeted
individuals, as well as strategies involving an
educational intervention. Dissemination alone,
without an appropriate implementation strategy, is
unlikely to influence behaviour substantially.
E-Journals
• E-Journals is a digital periodical that publishes on
the Internet or World Wide Web (WWW). An E-
journal may not be all that different from a print
journal in the fundamental editorial process. That is,
articles are submitted by individuals in the academic
and practice community, are peer reviewed by
editorial board members of the journal to be
accepted or rejected, and subsequently published.
It is the digital medium of presentation that is
different.
E-Journal Formats
• E-journal full-text will generally be of two types:
HTML or PDF.
• HTML (hypertext markup language) is the coding
used to create Web pages that can be displayed by
Web browsers (such as Netscape or Internet
Explorer). This column, for example, appears on
your monitor as text, but has actually been
prepared as an HTML document.
• PDF (portable document file) is a format that allows
a user to view a document in its original format
without requiring that the user have the originating
software application. Documents viewed in this
format provide an image view that is the same as
viewing a published print equivalent. Therefore, this
format is not only pleasing to the eye, but also
nicely accommodates graphical material such as
article tables and figures. Because this is an image
format, however, it is not possible to cut and paste
as you can with a text document.
Clinical Relevance
• Nurses rely on the published literature to
inform their practice and ensure that it is based
on evidence. Guidelines for publishing in the
scholarly literature assist clinicians and scholars
to ensure that published articles are complete,
current, concise, and accurate.
Intellectual Property Law
Deals with the rules for securing and enforcing legal
rights to inventions, designs, and artistic works. Just as
the law protects ownership of personal property and
real estate, so too does it protect the exclusive control
of intangible assets. The purpose of these laws is to 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.
• Patents give inventors the right to use their product in
the marketplace or to profit by transferring that right to
someone else.
• Trademarks protect symbols, names, and slogans used
to identify goods and services. The purpose is to avoid
confusion, deter misleading advertising, and help
consumers distinguish one brand from another
• Copyrights apply to writings, music, motion pictures,
architecture, and other original intellectual and artistic
expressions. Protection is not available for theories or
ideas, or anything that has not been captured in a fixed
medium
Protecting Against Infringement
Infringement refers to the unauthorized use of an
intellectual property. To protect against infringement,
owners should take steps to put the world on notice
that their rights exist.
Copyright Law
The copyright law of the United States is intended to
encourage the creation of art and culture by rewarding
authors and artists with a set of exclusive rights.
Copyright law in the U.S. is based on the Copyright Act
of 1976, a federal statute that went into effect on
January 1, 1978. We'll refer to this statute throughout
the book as the Copyright Act.
"States cannot enact their own laws to protect the same
rights as the rights provided by the Copyright Act.
For example, a state cannot pass a law to extend
copyright protection on works in the state beyond the
term of protection given by the Copyright Act. State
"copyright" laws exist, but they are limited to works
that cannot be protected under federal copyright law.
(Requirements for federal protection are discussed in
"Standards," later in these materials.)"
Copyright law is important for multimedia developers
and publishers for two reasons:
1. Original multimedia works are protected by
copyright. The Copyright Act's exclusive rights
provision gives developers and publishers the right
to control unauthorized exploitation of their works.
2. Multimedia works are created by combining
"content" - music, text, graphics, illustrations,
photographs, software - that is protected under
copyright law. Developers and publishers must avoid
infringing copyrights owned by others.
Privacy of Personal and Public Domains
Public domain personal data protected under the law
Personal data, be it publicly available or not, is subject
to protection under the Personal Data Privacy
Ordinance.
Privacy Risks
At the very least, personal data in the public domain, if
used and re-used indiscriminately and without
appropriate safeguards, would result in loss of control
over the accuracy, retention and security of the data,
thus jeopardizing the interests of the data subjects.
Profiling and re-use of the personal data in the public
domain could generate immense economic efficiency
and societal benefits. At the same time, such activities
also pose grave privacy risks.
Example:
An example is the compilation of bankruptcy and
litigation records of individuals by certain data brokers
based on the Judiciary’s daily cause lists and cause
books as well as the bankruptcy order notices in the
Government gazette.
This is the subject of our recent investigation into a
smartphone application which enabled subscribers to
search such records by name and view the combined
data in one go. The data subjects concerned could be
harmed unknowingly if the data is used, for example,
for checking their employability or credit-worthiness.
Firstly, as different persons can share the same name or
have similar names, it is problematic to ascribe the data
to a target individual according to his name.
Secondly, a person involved in litigation could be
perfectly innocent but the database did not as a rule
include the court’s decision in his favour.
Thirdly, bankruptcy is normally discharged after four to
eight years, while the Rehabilitation of Offenders
Ordinance prevents unauthorized disclosure of a
previous minor conviction, provided the offender has
not been reconvicted for three years. Retention and use
of the bankruptcy and litigation data indefinitely would
therefore unduly stigmatize the individual and bar him
from leading a normal life free from encumbrances.
Data Privacy and Data Security
Data Security and data privacy are often used
interchangeably, but there are distinct differences:
• Data Security protects data from compromise
by external attackers and malicious insiders.
• Data Privacy governs how data is collected,
shared and used.
Netiquette Rules and Guidelines
A nurse who uses informatics makes decisions and
performs actions on behalf of patients and clients; these
decisions and actions are based on ethical principles:
• Practice according to the Code for Nurses
• Maintain privacy, confidentiality, and security of
patient and client data
• Act as an advocate of system users, both
patients and clients
• Practice in a non-judgmental and non-
discriminatory manner that is sensitive to
human diversity.
• Practice in a manner that preserves and
protects human autonomy, dignity, and rights
• Seek available resources to help formulate
ethical decisions
• Protect patient and client data from
unauthorized use
• Incorporate relevant laws and regulations into
informatics practice
What is Netiquette?
Netiquette is a set of rules that was developed to
instruct Internet users on how to act properly.
Privacy of the Internet
Computer mediated conversations aren’t private.
All email is potentially public because the original
receiver can intentionally or accidentally forward,
print, and circulate a personal message to others.
Email can bounce from its intended receiver for a
number of innocent reasons and subsequently be
made available for others to read. What may seem
to be private communication can easily become
public, and what may seem to be a “friendly
discussion” can easily become a permanent written
document of communication.
Maintaining Confidentiality and Privacy
Individual members of discussion lists are
responsible for maintaining confidentiality and
privacy in their posts. Some list moderators include
a disclaimer in the list directions stating that
individual members are responsible for the content
of their messages.
DATA PRIVACY ACT
DATA BREACH
A data breach is an incident wherein information is
stolen or taken from a system without the
knowledge or authorization of the system's owner.
Prevention:
• Up-to-date Security Software  Privileged Communication –interaction
between two parties which the law recognizes
• Regular Risk Assessments
as private and protected relationship. Whatever
• Encryption and data backup is communicated shall remain confidential and
the law cannot force disclosure.
• Staff training and awareness
 Processing -operations include, but are not
• Ensure vendors and partners maintain high data limited to the collection, recording,
protection standards organization, storage, updating or modification,
Republic Act No. 10173 or the Data Privacy Act of retrieval, consultation, use, consolidation,
2012 blocking, erasure, or destruction of data.

• AN ACT PROTECTING INDIVIDUAL PERSONAL Who implements the DPA?

INFORMATION IN INFORMATION AND
COMMUNICATIONS SYSTEMS IN THE
GOVERNMENT AND THE PRIVATE SECTOR,
CREATING FOR THIS PURPOSE A NATIONAL
PRIVACY COMMISSION, AND FOR OTHER
PURPOSES
What acts are covered by the DPA?
The DPA and its Implementing Rules and
Regulations (IRR) apply to all acts done or practices
engaged in and outside of the Philippines if:
The National Privacy Commission (NPC) is in charge
of administering and implementing the DPA. It is
also tasked to monitor and ensure compliance of
the Philippines with international standards for
personal data protection. The major functions of
the NPC are as follows:
1. Rule making
2. Advisory
3. Public education

• If the person, either an individual or an 4. Compliance and monitoring

institution, involved in the processing of
5. Complaints and investigations
personal data is located in the Philippines;
6. Enforcement
• The act or practice involves personal data of a
Philippine citizen or Philippine resident;

• The processing of personal data is done in the

Philippines; or

• The act, practice or processing of personal data

is done by an entity with links to the Philippines,
subject to international law and comity.

The processing of the personal information shall be

allowed, subject to compliance with the
requirements of this Act and other laws allowing
disclosure of information to the public and
adherence to the principles of transparency,
legitimate purpose and proportionality.
CONSENT
 Personal information -refers to all types of
- refers to any freely given, specific, informed indication
personal information.
of will, whereby the data subject agrees to the
 Privileged information -refers to any and all collection and processing of personal information about
forms of data which under the Rules of Court and/or relating to him or her.
and other pertinent laws.
- Consent shall be evidenced by written, electronic or
recorded means. It may also be given on behalf of the
data subject by an agent specifically authorized by the
data subject to do so
RIGHTS OF DATA SUBJECT
1. Right to be informed
Data subject has right to be fully informed of several
factors of the data collecting process. This list includes,
but isn’t limited to:
1. the purpose for use
2. scope and methods for access
3. the recipients or classes of recipients to whom they
are or may be disclosed;
4. the identity and contact details of the personal
information controller
5. the period for which the information will be stored
for
6. access to their rights
2. Right to Access
3. Right to Object
4. Right to Erasure or blocking
5. Right to Rectify
6. Right to Data Portability
7. Right to File a Complaint
8. Right to Damages
PENALTY
Unauthorized processing of personal information
- shall be penalized by imprisonment ranging from 1
year to 3 years and a fine of not less than
Php500,000.00 but not more than Php2,000,000.00
Unauthorized processing of personal sensitive
information
- shall be penalized by imprisonment ranging from 3
years to 6 years and a fine of not less than
Php500,000.00 but not more than Php4,000,000.00
Companies and healthcare professional must ensure
that the methods of their data collection and processing
regarding health information are properly handled with
confidentiality and the data subjects must be well-
aware of the process, including a breach of security,
should there be any.
A Data Protection Officer must be appointed to create
privacy knowledge programs and privacy and data
policies to regulate the handling of all types of
information and to regularly review the quality of data
protection.
HEALTHCARE TEAM
• The healthcare team, regardless of whether you’re
treated at a large academic institution or small,
rural private practice, is the group of professionals
who contribute to your care and treatment as a
patient.
• Typical members of a healthcare team are a doctor
and a registered nurse.
• In some cases, there might be a Nurse practitioner
instead of or as well as a doctor. In others, physical
therapist, occupational therapist, and social
workers may be part of the TEAM.
• Office managers also plays an important role in the
healthcare team.
MEMBERS OF THE HEALTHCARE TEAM
Functions/role of MD
Doctors can:
• Take medical histories
• Update charts and patient information to show
current findings and treatments
• Order tests for nurses or other healthcare staff to
perform
• Review test results to identify any abnormal
findings
• Recommend and design a plan of treatment
• Address concerns or answer questions that patients
have about their health and well-being.
• Help patients take care of their health by discussing
such topics as proper nutrition and hygiene.
• Diagnose and treat injuries or illnesses.
• Some doctors, like surgeons, can operate on
patients to treat injuries.
Go to doctor for an initial examination, a diagnosis, and
prescribed treatment plan. A doctor will gather a full
understanding of your condition and prescribe the
treatment options he or she thinks will be most
effective in managing your disease. A doctor will
monitor you throughout your treatment make sure you
condition improves.
FUNCTIONS/ROLE OF REGISTERED NURSE
Registered Nurses can:
• Provide and coordinate patient care
• Record patient’s medical histories and symptoms
• Administer patients’ medicines and treatments
• Set up plans for patients’ care or contribute to
existing plans
• Observe patients and record observations
• Consult and collaborate with doctors and other
members of the healthcare team
• Operate and monitor medical equipment
• Help perform diagnostic tests and analyse the
results
• Educate patients and the public about health
conditions
• Provide advice and emotional support to patients
and their family member.
It is likely that the majority of your time accessing
healthcare from a professional will be spent with a
registered nurse. Go to an RN for any questions or
concerns you have about your treatment, symptoms,
side effects, or anything else. A nurse will work with you
to ensure that you can access the necessary care.
Registered nurses communicate all information they
gather with the rest of the healthcare team and ac as
your voice
FUNCTION/ROLE OF APRN
• APRN is an advanced practice registered nurse. This
can included Nurse midwives and Nurse
Anesthetists, but it is likely you will encounter
APRNs in the form of Nurse Practitioner (NP’s).
Nurse Practitioners can:
• Coordinate patient care
• Provide Primary and specialty healthcare
• Take and record patients’ medical histories and
symptoms
• Perform physical exams and observe patients
• Create plans for patients’ care or contribute to
existing plans
• Perform and order diagnostic tests
• Operate and monitor medical equipment
• Diagnose various health problems
• Analyze test results or changes in a patients’
condition, and alter treatment plans as needed
• Give patients medicines and treatments
• Evaluate a patient’s response to medicines and
treatments
• Consult with doctors and other healthcare
professionals, as needed
• Counsel and teach patients and their families how
to stay healthy or manage their illnesses or injuries
• Conduct research
FUNCTION/ROLE OF OFFICE MANAGER
Office manager are also called Healthcare executives or
healthcare administrator and they:
• Plan, direct, and coordinate medical and health
services
• Manage an office, facility, department, or clinical
area
• Direct changes that conform to changes in
healthcare laws, regulations, and technology
• Work to improve efficiency and quality in delivering
healthcare services
• Develop departmental goals and objectives
• Ensure the facility in which they work is up to date
on and complaint with new laws and regulations
• Recruit, train, and supervise staff
• Manage the finances of the facility
• Create work schedules
• Prepare and monitor budgets and spending to
ensure departments operate within allocated funds
• Represent the facility at investor meetings or on
governing boards
• Keep and organize records of the facility’s services,
such as the number of inpatient beds used
• Communicate with members of the medical staff
and department heads
Office manager is there to ensure that the facilities you
use are safe, up to date, and able to provide the best
quality care to you. They are there to coordinate the
goals of the medical staff, ensuring that each has you at
its center. You can go to your office manage with
questions about insurance or other accessibility issues.
If you have concerns about how another member of the
healthcare team practices, you can bring them up to
your office manager and trust he or she will address you
concerns.
INFORMATION TECHNOLOGY TEAM
• Health information technology (health IT) specialists
handle the technical aspects of managing patient
health information. Depending on their position,
health IT professionals might build, implement, or
support electronic health records (EHRs) and other
systems that store patient-related data. They know
what data is needed, where is it stored, and how
the data is used.
• Their work affects quality of care tremendously.
And, as they move up the ladder, health IT
specialists become more involved in collaborating
with other healthcare teams to drive improved
outcomes, lowered costs, and new developments in
patient care. Explore the role of healthcare
IT specialists, including where they work, what their
responsibilities are, and how to become one.
Where do health information
technology specialists work?
• Health information technology specialists support
clinicians and staff across many healthcare settings,
including inpatient rehabilitation facilities, acute
care hospitals, long-term care facilities, physician
offices, mental health facilities, and outpatient
clinics. Others work for organizations that do not
provide direct medical care, such as consulting
firms, public health and other government agencies,
insurance companies, and software vendors.
Graduates of the HIMT health IT track work at a wide
range of organizations, including:
• Marshfield Clinic Information Systems
• Hospital Sisters Health System
• Aurora Health Care
• Sauk Prairie Hospital
• American Red Cross
Most health IT staff work in a professional office setting.
A common misconception is that a health IT or EHR
implementation department is the same as an IT
department. In healthcare, they are separate entities.
Traditional IT staff focus on hardware and do not have
expertise in clinical documentation, medical
terminology, or caregiver workflows, which is needed to
support EHR systems.
What are common job titles for health IT specialists?
• Systems analyst
• EHR implementation specialist
• Data architect
• Programmer analyst
• Software developer
• Software engineer
• Consultant
• Data quality analyst
• Chief information security officer
• Chief technology officer
• Chief information officer
What are a health IT professional’s primary
responsibilities?
Getting the right patient information to the right
caregiver at the right time is absolutely critical. It’s a big
responsibility handled—in most healthcare facilities—by
three departments:
• Health IT: implementation and maintenance of
EHRs
• Health information management (HIM): patient
data and data quality
• Data analytics: analytics and reporting
• While the other departments deal with data
directly, health IT specialists build, implement, and
support EHR and other systems that capture,
manage, and store patient data. These professionals
must have a strong understanding of information
and technology systems, including programming
and data structures, storage structure for data and
information, and information and communication
technologies. The privacy and security of patient
data when it is stored and transmitted is also at the
top of their priority list.
• Depending on the size of the healthcare
organization, health information
technology specialists may take on very different
roles. In a small facility, a health IT specialist may
need diverse technical knowledge and skills to work
with several EHR systems or applications. In a larger
facility, it’s more likely that a health
IT specialist would specialize in a certain EHR
application or set of workflows.
• At the end of the day, all health IT specialists ensure
that electronic health data managed by HIM staff is
maintained and exchanged accurately and
efficiently. Their work is extremely important; it
drives improvements in patient care and reductions
in healthcare costs.
With whom do health IT specialists work?
• Health information technology specialists play
important roles in projects that impact entire
organizations. On a typical day, health
IT specialists may interact with clinicians and staff at
all levels, from a unit clerk to a CIO. They work with
subject matter experts to build and maintain the
systems they use daily.
• Constant collaboration with stakeholders across an
organization requires strong communication skills as
well as experience in problem solving, time
management, organization, and adaptability.
• A health IT specialist might also train physicians,
nurses, case managers, chief financial officers, and
others how to use EHR software. In fact, there is
strong demand for multifaceted individuals who can
implement EHR systems, train clinicians and staff,
and consider the needs of these end users when
maintaining and updating software.
What promotional pathways are available to health
IT specialists?
• Highly skilled health IT specialists have ample
opportunity to move up in position and salary. For
specific career pathways in healthcare information
technology, see the career map created by the
American Health Information Management
Association (AHIMA).
• Emerging, executive-level professionals, such as
chief information officers and chief information
security officers, are in high demand right now. The
required skillset for these positions—healthcare
experience, specialized technical knowledge, and
leadership skills—is critical yet difficult to find.
Employers are forced to recruit from industries
outside healthcare, but this presents tremendous
opportunity to entry- and mid-level health IT
specialists with the right mix of education,
experience, and certification.
How can I become a health IT specialist?
• Because there are so many EHR regulatory
requirements, health technology is constantly
changing—and this translates to strong job security
for health IT professionals. Combine this with very
high demand, and can rest assured that health IT is
a smart career choice.
• Some health IT specialists have backgrounds in
computer science or medical coding, but some
come from other fields such as nursing, radiology,
or even dairy science. To get hired today, it must
have specialized knowledge of healthcare
organizations and an unparalleled understanding of
how EHR systems work within these organizations.
• Get this very specific skillset by earning a bachelor’s
degree in health information technology. It can also
improve the hiring outlook and salary potential by
gaining health IT work experience and certifications.
LISTSERVS and NEWSGROUP
LISTSERVS
A Listserv is actually an e-mail subscription list. A
mailing list program copies and distributes all e-mail
messages to subscribers. All mail goes through a central
computer that acts as the server for the list. Some
groups have a moderator who first screens messages
for relevance. Listservs are sometimes referred to as
discussion groups, mailing lists, or electronic
conferences. Listservs provide information on
thousands of topics. Subscription may be open to
anyone with an e-mail address or restricted. A complete
list of listservs may be obtained by visiting the Tile.net
site (www.tile.net).
To subscribe to a listserv, individuals must send the e-
mail message “sub” or “subscribe,” followed by their
first and last names. Exact commands may vary slightly.
Most listservs provide help and instructions on request.
Subscribers may participate in discussions or just
monitor them. Listserv participants should read their
mail frequently and skim messages for subjects of
interest to keep up with discussions. Subscribers may
terminate their participation at any time by sending an
“unsubscribe” message.
NEWSGROUP
Usenet news groups are another available Internet
feature. Usenet groups are similar to listservs in content
and diversity. More than 100,000 discussion groups
exist, each dedicated to a different topic. These groups
provide a forum where any user can post messages for
discussion and reply. Users do not subscribe to these
groups, nor do they receive individual messages.
Instead, they may participate at any time free of charge.
ISPs do not carry every news group. ISP administrators
decide which news groups will be available to their
customers and how long messages will be stored. Only
messages that are currently stored on the user’s ISP
computer may be read.
Some ISPs restrict access to usernet groups or restrict
the length of time that messages are saved. It may be
necessary to subscribe to a usernet service to view
older postings. Special browser programs called news
reader software are needed by the individual users to
read messages posted on the news group. Many
different news readers are available. News readers
come bundled with Web browsers. A list of Usenet
groups may also be found at the Tile.net site. Some
examples of nursing Usenet groups are the following:
Some examples of nursing Usenet groups are the
following:
● sci.med.nursing. This is a general forum for the
discussion of all types of nursing issues. A
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Leadership Role of the Nurse in the Management of
Nursing Information System
• For decades, the nurse manager’s primary role was
to oversee nursing staffs and their patients. Today,
nurse managers have assumed additional
 responsibilities including integrating healthcare
information technology into the workplace and
assisting the nursing staff to master informatics
competencies to promote patient well-being.
• Healthcare informatics — leveraging healthcare
technology to improve patient care goals — has
become essential to nurse leadership. The American
Nurses Association (ANA) said nursing informatics is
used to identify, define, coordinate and
communicate data, information and knowledge in
nursing practice. Studies show nurse leaders who
use technology improve outcomes for all
stakeholders, including other nurses, consumers,
patients and healthcare teams.
The American Organization of Nurse Executives (AONE)
said the impact of technology reaches beyond patient
care and clinical workflow to the quality, safety and
financial well-being of health systems.
• “Emerging nursing informatics leadership roles
engage in the necessary transformation
activities and bridge the new care delivery
models into clinical practice with the right
technology solutions for organizational
transformations,” AONE said in a position
paper.
• By definition, the goal of nursing management
is to actualize leadership functions, including
informatics research, over nurses in practice. As
advanced practice healthcare leaders, nurses
with their DNP are positioned to use informatics
research for the betterment of patient care.
With the growing importance of implementing
informatics into patient care, the leading
nursing programs — such as Duquesne
University’s online DNP program — provide
multiple opportunities for advanced students to
put the rapid changes into practice.
The Evolution of Informatics in Nursing
• Nursing informatics, also called health
information technology, can be traced to the
earliest days of the modern nursing movement
under Florence Nightingale. During the Crimean
War, Nightingale began documenting patient
care to track health outcomes. In 2004,
President George W. Bush’s administration
mandated the implementation of electronic
health records (EHRs) so vital information could
be shared among providers. In 2009, the
American Recovery and Reinvestment Act
required that providers adopt and demonstrate
meaningful use of EHRs to continue receiving
Medicaid and Medicare funding.
• In the past decade, providers have been
working to use technologies productively to
benefit patients and medical staff. Many of the
efforts have been focused on developing and
delivering informatics competencies to nurses
at all levels.
• In 2006, a group of prominent nurses launched
the Technology Informatics Guiding Educational
Reform (TIGER) Initiative to advance the use of
information technology (IT) skills and
informatics competencies in healthcare. TIGER
quickly picked up steam, earning the support of
organizations that include the Robert Wood
Johnson Foundation.
Essential Informatics Competencies for Nurse Leaders
TIGER determined that nurses should follow three
informatics literacies to provide quality care:
1. Mastery of basic computer competencies
TIGER found that nurses need basic computer skills to
assist patients. The organization said nurse computer
competencies should focus on:
 The concepts of information and
communication technology (ICT)
 Using computers and managing files
 Using word processing and spreadsheet
applications
 Making presentations
 Web browsing and basic communication
2. Comprehension of information literacy
The American Library Association (ALA) defines
information literacy as the ability to recognize when
information is needed and to be able to locate, evaluate
and use the information as necessary.
 TIGER determined that nurse information
literacy competencies should focus on:
  Determining the nature and amount of
information needed
 Accessing the information quickly and efficiently
 Evaluating the information and sources
 Using the information for specific purposes
 Assessing the value of the information used
3. Understanding information management literacy
 Information management is the process of
collecting, processing, presenting
and communicating data as knowledge or
information. TIGER said information
management competencies for nurses should
focus on:
 Understanding and verbalizing the importance
of various types of health information systems
(systems used to manage healthcare data) in
clinical practice
 Using due care to protect patient privacy
and the security of health information systems
 Understanding the principles, policies and
procedure that health information systems use
to manage data
Informatics for the Future of Nurse Leadership
• TIGER, in its “Usability and Clinical Application
Design Collaborative Team” report, recommended
hospital administrators and leadership teams
construct a vision that allows nurses and inter-
professional colleagues to use informatics and
emerging technologies in practice.
• Other professional organizations, including the
National League for Nursing (NLN), the American
Association of Colleges of Nursing (AACN) and the
ANA, also recommended nursing leaders take
charge of the evolving role of informatics in the
field. The organizations suggest:
• Creating a process that ensures all nurses
adopt and adhere to the TIGER policies and
principles
• Conducting research and exploring how the
top medical and administrative staff can
utilize informatics
• Building a culture that embraces informatics
as a regular part of practice and supports
professional development, mentoring,
education and career path exploration.
• As technology and informatics continue to
evolve, nurse leaders will be increasingly
expected to put technology into practice.
Today, nurses who are studying to earn a
DNP degree often take coursework directly
that will advance the future of technology.
APPLICATIONS OF HEALTH INFORMATICS
A. Clinical Practice
Electronic Health Record
 The transition to the electronic health record (EHR)
has brought forth a rapid cultural shift in the world
of medicine, presenting both new challenges as well
as opportunities for improving health care. As
clinicians work to adapt to the changes imposed by
the EHR, identification of best practices around the
clinically excellent use of the EHR is needed
 Use of the electronic health record (EHR) during
clinical encounters is now a standard part of
contemporary medical practice. The EHR—like
other medical technologies—is designed to
optimize the efficiency and quality of health care
delivery, and ultimately—one hopes—improve
patient outcomes. However, as anyone who has
ever used or seen his/her health care provider use
the EHR during a clinic visit knows that use of the
EHR in a way that preserves or enhances clinical
excellence is challenging. The Johns Hopkins Miller-
Coulson Academy of Clinical Excellence (MCACE)
has previously identified the following domains of
clinical excellence: communication and
interpersonal skills, diagnostic acumen, skillful
negotiation of the health care system,scholarly
approach to clinical practice, professionalism and
humanism, )knowledge, and passion for clinical
medicine . To identify best practices around the
clinically excellent use of the EHR, the authors
conducted a literature review of the MCACE
domains and the EHR.
TELEMEDICINE
 The concept of telemedicine started with the
birth of telecommunications technology, the
means of sending information over a distance in
the form of electromagnetic signals. Early forms
of telecommunications technology included the
telegraph, radio, and telephone. In the late
19th century, the radio and telephone were just
starting to emerge as viable communication
technologies. Alexander Graham Bell patented
the telephone in 1876 and Heinrich Rudolf
Hertz performed the first radio transmission in
1887.
 But it wasn’t until the early 20th century that
the general population started to these
technologies, and imagine they could be applied
to the field of medicine. In 1925, a cover
illustration of the Science and Invention
magazine featured an odd invention by Dr.
Hugo Gernsback, called the “teledactyl.” The
imagined tool would use spindly robot fingers
and radio technology to examine a patient from
afar, and show the doctor a video feed of the
patient. While this invention never got past the
concept stage, it predicted the popular
telemedicine definition we think of today – a
remote video consult between doctor and
patient.
 Originally, health professionals developed this
technology to reach remote patients living in
the rural areas. But with time, medical staff and
the U.S. government saw the big picture – the
potential to reach urban populations with
healthcare shortages, and to respond to
medical emergencies by sharing medical
consults and patient health records without
delay. In the 1960s, heavy investments from the
U.S. Government, including the Public Health
Department, NASA, Department of Defense,
and the Health and Human Sciences
Department drove research and innovation in
telemedicine. Sending cardiac rhythms during
emergencies started at about this time. For
instance, in Miami, the university medical
center worked together with the fire rescue
department by sending electro-cardiac rhythm
signals over the voice radio channels from the
rescue sites.
 Telemedicine was originally created as a way to
treat patients who were located in remote
places, far away from local health facilities or in
areas of with shortages of medical
professionals. While telemedicine is still used
today to address these problems, it’s
increasingly becoming a tool for convenient
medical care. Today’s connected patient wants
to waste less time in the waiting room at the
doctor, and get immediate care for minor but
urgent conditions when they need it.
E-HEALTH
 E-Health activities are becoming commonplace
within today’s society and have the potential to
transform the health care delivery system in the
United States. Diffusion of technology continues
to increase within the health care community
with little guidance for physicians, their
patients, technology developers, and
policymakers. This paper attempts to provide
some insight for these stakeholders about the
current landscape of e-Health activities by
reviewing recent developments, extent of
usage, challenges, and benefits; recommend
policies and guidelines for incorporating e-
Health into health care in ways that support
improving quality, safety, efficiency, efficacy,
and access; and offer a framework for ongoing
discussions, analysis, and review of the impact
of e-Health activities on medical practice.
 E-health is an emerging field in the intersection
of medical informatics, clinical practice, public
health, and business, referring to health
services and information delivered or enhanced
through the Internet and related technologies.
Interestingly, a follow-up study of published
definitions on e-Health identified 51 unique
definitions for the term and provided the
following observations: The 51 unique
definitions that we retrieved showed a wide
range of themes, but no clear consensus about
the meaning of the term e-Health. We identified
2 universal themes (health and technology) and
6 less general (commerce, activities,
stakeholders, outcomes, place, and
perspectives).
 e-Health is defined as the following categories
of activities that current, although limited,
 studies suggest are an alternative means to  Once a trend is identified, case management
improving access and quality of care: systems provide decision support promoting
preventative care
1.) Telemedicine activities, defined in their initial phase
of development as remote monitoring and now more  Information collected by case management systems
generally known as e-Visits, include secure messaging is processed in a way that helps to reduce risk,
between patients and their physicians to further ensures quality and decrease costs.
preventive, acute, or chronic care or to effect or
 The Case Management Information System (CMIS)
improve care coordination. E-Visits allow the secure
is a user-built, patient-centric, electronic record of
exchange of clinical information, such as text,
care management activities in coordinating patient
photographs, and data from biometric devices, and
care.
often involve multiple physicians, with one serving as a
coordinating intermediary  Integrating communication systems with clinical
applications provides a real-time approach that will
2.) Patient use of online health-information sources,
facilitate care among the entire healthcare team,
which may be self-selected or recommended and vetted
patients and their families.
by his or her physicians.
 Communication Systems
3.)Patient use of an interactive Patient Portal or
Personal Health Record (PHR). These types of  designed for communication between staff
applications are relatively new to the care delivery members or staff and patients, as well as for the
system, and definitions of their functionality are general public, in a healthcare facility.
constantly evolving as knowledge of and experience
with these tools increase. Nonetheless, such  Examples:
applications typically provide access to patient-oriented  telephones, pagers, loudspeakers
views of the physician’s EHR with selected views of
health information retrieved from multiple sources.  radio frequency, microwaves
These consumer-oriented applications may also support  nurse call systems, pagers
the ability for patients to contact their physician’s office
or clinic via secure e-mail for administrative or non-  telephonic, message, paging
medical reasons, and provide links to vetted health
 loudspeaker systems
information sources.
 Core Business System
B. ADMINISTRATION
 core business systems enhance administrative tasks
CLINICAL AND ADMINISTRATIVE HEALTH
within healthcare organizations.
INFORMATION SYSTEM
 It provides the framework for reimbursement,
 ADMINISTRATIVE AND CLINICAL HEALTH
support of best practices, quality control and
INFORMATION SYSTEM
resource allocation.
 Types of information in healthcare organization
 Four common Core Business Systems:
 Case management information systems (CMISs)
 1. admission, discharge and transfer (ADT)
 Communication Systems
 2. financial
 - Identify resources, patterns and variances in care
 3. acuity
to prevent costly complications related to chronic
conditions and enhance the overall outcomes for  4. scheduling systems
patients.
 Order Entry Systems

 Departmental Collaboration and

Knowledge/Information Exchange
 Health Care Information System
 • are one of the most important systems in use
today.
 • These systems automate the way that orders have
traditionally been initiated for patients.
 • Provide major safeguards by ensuring that
physician orders are legible and complete thereby
providing a level of patient safety that was
historically missing with paper-based orders.
 Administrative information System
 - Contains primarily administrative and financial
data
 - Used to support the management functions and
general operations of the health care organization
 Clinical Information system
 - Contains clinical or health-related information
relevant to the provider in diagnosing, treating and
monitoring the patient’s care
 Information system
 - Data
 - Processes
 - People
 - Technology
 That interact to collect, process, store and provide
as output the information needed to support the
organization.
 - The implementation of systems within healthcare
is the responsibility of many people and
departments.
 - Knowledge exchange is the product of
collaboration when sharing an understanding of
information promotes learning from past
experiences to make better decisions in the future.
 - At an administrative level, collaboration among
key stakeholders is critical to the success of any
project.
 - Collaboration also occurs among the various
departments impacted by the system.
 - From collaboration comes the exchange of
information and ideas through knowledge sharing.
 - A multidisciplinary approach assures that systems
will work in the complex environment of healthcare
organizations with diverse and complex patient
populations.
Health Information System
 Patient Care Support Systems
 combination of vital and health statistical data from
multiple sources, used to derive information about
the health needs, health resources, use of health
services, and outcomes of use by the people in a
defined region or jurisdiction.
 - These patient-centered systems focus on collecting
data and disseminating information related to direct
care.
1. Clinical documentation systems
2. Laboratory information systems
3. Radiology information systems
4. Pharmacy information systems
 RIS are systems schedule, result and store
information as it relates to diagnostic radiology
procedures.
 - The benefit of RIS and PACS systems is their ability
to assist in diagnosing and storing vital patient care
support data.
 - Have also become a mainstream patient care
support system.
 - These systems typically allow pharmacists to
order, manage and dispense medications for a
facility.
 - Laboratory information systems were perhaps
some of the first systems ever used in healthcare.
 - It reports on blood, body fluid and tissue samples
along with biological specimens that are collected at
the bedside and received in a central laboratory.
 - Also known as Clinical Information Systems (CIS)
are the most commonly used type of patient care
support system within healthcare organizations.
 - Clinical information systems are designed to
collect patient data in real time.
C. EDUCATION
E-LEARNING
 Understanding E-learning is simple. E-Learning is
learning utilizing electronic technologies to access
educational curriculum outside of a traditional
classroom. In most cases, it refers to a course,
program or degree delivered completely online.
 It is interactive that you can also communicate with
your teachers, professors or other students in your
class. Sometimes, it is delivered live, where you can
“electronically” raise your hand and interact in real
time and sometimes it is a lecture that has been
prerecorded.
 There is always a teacher or professor interacting or
communicating with you and grading your
participation, your assignments and your tests.
 Philippines is one of the countries that have
switched to e-learning this time of coronavirus-19
outbreak. While education leaders concede “it’s not
ideal”, I think it is really good for the students. It is
an opportunity for students to continue their
learning while at home
E-Learning saves money and time
 With online learning, the learners can access
content anywhere and anytime. They do not need
to take time out from their jobs to attend classes. E-
learning is also a cost effective to the venue and
materials
E-learning leads to better retention
 Students would rather watch a video or listen to a
podcast than read through pages of a textbook. E-
learning tools enable learning designers to make
content interactive. The more engaging the content
is, the better the learners remember information. If
they enjoy learning, they can be able to recall and
apply the concepts of work.
E-learning is consistent
 In face-to-face sessions, every instructor has his or
her own method of teaching. Each varies in
approach and style and is susceptible to mistakes.
You can eliminate this issues with e-learning. Online
learning provides consistent and standardized
training every time. Each learner goes through the
same experience regardless of when and where he
or she takes the course.
E-learning is scalable
 Online learning is scalable. You can roll it out to
many students. The more learners take the course,
the faster you can write off the expense
 When compared to traditional learning, e-learning
may make a little or no difference in patient
outcomes or health professionals’ behaviors, skills
or knowledge. Even if e-learning could be more
successful than traditional learning in particular
medical education settings, general claims of it as
inherently more effective than traditional learning
may be misleading.
TELECONFERENCING
 Teleconferencing basically means meeting through
a telecommunications medium. It is a generic term
for linking people between two or more locations
by electronics. There are at least six types of
teleconferencing : audio, audiographic, computer,
video, business television and distance education
Webinar
 It is a blend of “web” and “seminar”. A webinar is an
event held in the internet which is attended
exclusively by an online audience. This distinguishes
it from a webcast, which also includes the presence
of a physical audience. Other terms used as
alternatives for webinar are web event, online
seminar, webcast, web lecture and virtual event
 A webinar is a form of one-to-many communication:
a presenter can reach a large and specific group of
online viewers from a single location. Providing it is
used effectively, interaction during a webinar can be
very powerful. In view of a larger audience, smart
tools are essential to channel that interaction.
 Webinar offers various interactive opportunities
 Ask a question
 Chat
 Poll
 TEST!
Webinars are a cost-effective learning tool

 Webinars are very cost-efficient for every party

involved. Students do not have to invest on
transportation or accommodation to get an
education. Similarly, the educational institution
does not have to make great investments to
accommodate additional students in terms of
footage or class size.

 There is something comforting about the anonymity

that comes with webinars. For starters, all students
or seminar attendees interact with the teachers or
presenters on equal footing. This means there are
plenty of people in any given webinar who may be
more willing and likely to participate than they
would in a face-to-face class. This improves
constructive discussions in the chat sections of the
webinars. With increased interaction, students can
achieve improved understanding of the contents of
the webinar.