NURSING INFORMATICS LECTURE – MODULE 3: ISSUES IN INFORMATICS
INTRODUCTION
Nursing Informatics is a specialized field in nursing with which
in need of a solid-based knowledge in nursing and application
in the fields of informatics. It is important that this
specialization must be defined. A concrete policy must be
involved to ensure the safety of the patients and the nurse
informaticist.
Despite the use of technology, the nurse informaticist must
ensure that in the use of technology, patients are still the
priority as possible. The issues inherent in this profession, like
the healthcare policies, the use of technology in the clinical
area, the standards and challenges in data privacy in using
the electronic health record system, and the quality of care in
the integration of informatics.
LESSON A: Nursing Informatics and Healthcare Policy
ANA SCOPE OF PRACTICE FOR NI
NI brings an added dimension to nursing practice
that focuses on knowledge and skill in information and
information management techniques
REQUIREMENTS FOR SPECIALTY PRACTICE
1. Educational programs -1988 to 1992 DN and HSRA
funded two masters NI programs and doctoral program in
NI at the University of Maryland
2. Certification - informatics nurses eligible for certification
can take the exams through the American Nurses
Credentialing Centers as Generalist NI
3. Research - NI researchers described 7areas needing
scientific study in 1993
4. Organization - American Organization of Nurse
Executives with ANA and National league for nursing,
AMIA and the Health Information Management Systems
Society
NURSING SHORTAGE AND NURSING INFORMATICS
• 2002- AAN Commission on Workforce launched a
multiphase project to develop IT that will help support
nurses in their day-to-day work
• 2003 - PHASE II of the AAN technology project began
nurses from 3 hospitals were asked to identify and verify
the most difficult aspects of their practice and how
technology would improve their tasks
PATIENT SAFETY AND NURSING INFORMATICS
Implementation of computerized physician order
entry (CPOE) systems requiring the prescriber to enter data
directly into the computer systems to reduce medication errors
NATIONAL ALLIANCE FOR HEALTH INFORMATION
TECHNOLOGY (NAHIT)
A partnership of diverse health care leaders who are
working to influence the use of technology to improve patient
safety, quality and efficiency.
CONNECTING FOR HEALTH (CPH)
• Another private-public collaborative established by the
Markle Foundation with additional support from the
Robert Wood Johnson Foundation.
• A private philanthropy that works to enable technology to
improve people’s lives.
NATIONAL INFORMATICS INITIATIVES AND NURSING
INFORMATICS
• Clinical Information System (CIS) Introduced in 1970s
• IOM report on patient safety: Achieving a new standard of
care states even more emphatically that electronic
medical records, using standard data elements are a
critical tool to improve patient safety
• 2001 Report from the President’s Information Technology
Advisory Committee (PITAC) highlighted key issues in IT
indicated that the US lacks a broadly disseminated and
accepted national vision for IT in healthcare and
recommended the appointment of a senior IT person to
provide strategic leadership
• April 27, 2004 EO Incentives for the use of Health
1. Establish a national health information
technology coordinator position
2. Work to develop a nationwide interoperable
health IT infrastructure
3. Develop, maintain and direct implementation of
a strategic plan to guide implementation of
interoperable health IT
GUIDELINES FOR THE INFRASTRUCTURE
• Appropriate information is available at the time and place
needed for medical decisions
• Health quality is improved and evidence based medical
care is delivered
• Healthcare costs are reduced
• More information is available to promote greater
competition
• Health information is exchanged
• Identifiable health information is secure and protected
NATIONAL HEALTH INFORMATION INFRASTRUCTURE
This involuntary initiative involving a three-stage
process over 10 years, is intended to improve the
effectiveness, efficiency and overall quality of health and
healthcare in the United States
HEALTH INSURANCE PORTABILITY AND
ACCOUNTABILITY ACT (HIPAA)
• Passed in 1996 and is intended to improve public and
private health programs by establishing standards to
facilitate the efficient transmission of electronic health
information
• Standard unique identifier was published in the federal
register on Jan. 23,2004
NATIONAL AGENDA FOR NURSING INFORMATICS
• National Advisory Council for Nurse Education and
Practice (NACNEP)
• Setting the nations nursing informatics agenda (NIA) for
nursing education and practice
5 KEY DIRECTIONS OF NI IN NURSING EDUCATION AND
PRACTICE
• Educate nursing students and practicing nurses in core
informatics content
• Prepare nurses with specialized skills in informatics
• Enhance nursing practice and education through
information projects
• Prepares nursing faculty in informatics
• Increase collaborative efforts in NI
Maniulit, Cherry G.
BSN3G-1
1998 LEGISLATION
Informatics as one of the seven priority areas for
strengthening capacity and is consistent with the NIAs
TELEHEALTH
The use of electronic information and
telecommunications technologies to support long distance
clinical healthcare, patient and professional health related
education
FACTORS ADVANCING TELEHEALTH TECHNOLOGIES
• Decreasing costs of telehealth devices and applications
• Resolution of interoperability issues
• Convergence of telehealth and telecommunications
technologies, IT and the internet
• Lack of reimbursement has been identified as the key
barrier to expanding healthcare practice
• Informatics nurses must keep up to date on both licensure
and reimbursement issues in telehealth
LESSON B: The Role of Technology and the Medication
COMPUTERIZED PRESCRIBER ORDER ENTRY (CPOE)
A system used for direct entry of one or more types
of medical orders by a prescriber into a system that transmits
those orders electronically to the appropriate department.
ADVANTAGES OF CPOE
• Can improve quality patient outcomes and safety by a
variety of factors such as increasing a preventive health
guideline compliance
• Provide preventive care by encouraging compliance with
recommended guidelines
• Identifying patients needing updated immunizations or
vaccinations
• Suggesting cancer screening and diagnosis reminders
prompt
• Reductions in the variation in care to improve disease
management by improving follow-up of newly diagnosed
conditions
• Reminder’s system to improve patient management
• Automating evidence- based protocols
• Adhering to clinical guidelines
• Providing screening instruments to help diagnosis
disorders
• Improve drug prescribing and administration by improving
antibiotic usage
• Medication refill compliance can be increased using
reminder systems to increased adherence to therapies
• Improved drug dosing especially those drugs that is
based on laboratory results
• Reductions in Adverse Drug Events (ADEs)
• Reduced errors of omissions
• Eliminated Handwriting and interpretation issues
• Fewer hands-offs if CPOE was linked to the information
systems in ancillary departments
• Fewer loss of misplaced orders and faster delivery time
• Eliminated the need for staff members in those
departments to manually enter the orders into their
information systems
• Access to pertinent literature and clinical information
knowledge bases
• Increase efficiency, productivity and cost effectiveness
• Reduce the cost in providing healthcare
• Allow for instantaneous capturing of charges and
therefore enhancing revenue
• Improve communication by decreasing the amount of
time needed for referral system

BENEFITS OF CPOE TO NURSES

• More time with patients due to enhanced productivity due
to reduced frequency in contacting prescribers
• Reductions in time wasted in transcribing duplicate orders
for the same medications or tests
• Greater standardization of orders
FEATURES OF CPOE
• Lessening the need to understand and adhere to diverse
• Acute care setting regimens and schedules
• Ambulatory care setting
• Improved efficiency when ordering tests or procedures
• Access records and enters records from their office or
home • Less need to enter voice orders into the system as
prescribers gain access to the system from other units
• Prescriber selectable standardized single orders or order
sets • Orders would be usually executed faster
• Implementation of organization-specific lists of • Medications will be accessible more quickly and patients
medications or formulary receive prompt care
• Passive feedback systems that present-patient –specific
data in an organized fashion
• Tests results BAR CODE-ENABLED POINT-OF-CARE TECHNOLOGY
• Charges • The system helps to verify that the right drug is being
• Reference materials administered to the right patient at the right dose by the
• Progress notes right route and at the right time
• Active feedback systems to provide clinical decision- • On admission patients are issued an individualized bar
code wristband that uniquely identifies their identity
making tools
• When a patient is to receive a medication, nurses scan
• Provision of specific assessments or recommendations
their bar-coded employee identifier and the patient’s bar
through alerts and reminders
code wristband to confirm their identity

Maniulit, Cherry G.
BSN3G-1
• Prior to medication administration each bar-coded
package of medication to be administered at the bedside
is scanned.
• The system can verify the identity with their medication
profile in the pharmacy information system and
electronically record the administration of the medication
in an online MAR
FEATURES OF BAR CODE-ENABLED POINT-0F-CARE
TECHNOLOGY
• Increased accountability and capture of charges for items
such as unit-stock medications
• Up-to-date drug reference information from online
medication reference libraries
• Customizable comments on alerts (look alike sound-alike
drug names)
• Monitoring the pharmacy and the nurse’s response to
predetermined rules or standards
• Reconciliation for pending or stat orders
• Capturing the data for the purpose of retrospective
analysis of aggregate data
• Verifying blood transfusion and laboratory specimen
collection identification
SIGNIFICANT NEGATIVE EFFECTS
• Nurses were sometimes caught “off guard” by the
programmed automated actions
• The BPOC seemed to inhibit the coordination of patient
information between prescribers and nurses when
compared to a traditional paper-based system
• Nurses found it more difficult to deviate from the routine
medication administration sequence with the BPOC
system
• Nurses felt that their main priority was the timeliness of
medication administration because BPOC required
nurses to type in an explanation when medications were
given even a few minutes late
• Nurses used strategies to increase efficiency that
circumvented the intended use of BPOC
ERROR THAT CAN OCCUR I USING BPOC SYSTEM
• Omissions - after the patient’s bar code armband and
medication have been scanned, the dose is inadvertently
dropped into the floor
• Extra dose - an extra dose maybe given when there are
orders for the same drug to be administered by a different
route
• Wrong drug - in administration of wrong drug which has
not been labeled with a bar code
• Wrong dose - in situations where the nurse has difficulty
in scanning medication and proceeds to scan the
medication twice
• Unauthorized drug - an order to hold a medication
unless a lab value is at a certain level such as an
aminoglycoside
• Charting errors - distinguish the indication for the
administration of the medication
• Wrong dosage form - certain drug shortages may force
a pharmacy to dispense a different strength and
concentration
AUTOMATED DISPENSING CABINETS (ADC)
• A computerized point-of-use medication-management
system that is designed to replace or support the
traditional unit-dose-drug delivery system
• The device requires a staff to enter a unique log on and
password to access the system using a touch screen
monitor or by using a finger print identification
• A nurse can obtain patient-specific-medications from
drawers or bins that open after a drug is chosen from a
pick list
RATIONALE OF WIDE ACCEPT OF ADC
• Improving pharmacy productivity
• Improving nursing productivity
• Reducing costs
• Improving charge capture
• Enhancing patient quality and safety
PROBLEMS IN USING ADC
• Choosing of the wrong medication from an alphabetic
pick list
• High- alert medications placed, stored and returned to
ADCs are problematic
• Storage of medications with lookalike names and/or
packaging
• Development of workarounds for ineffective or inefficient
systems can be devastating for patient’s safety
ISSUES IN USING ADC
• Consider purchasing a system that allows for patient
profiling so pharmacists can enter and screen drug orders
• Carefully select the drugs that will be stocked in the
cabinets
• Place drugs that cannot be accessed without pharmacy
order entry and screening in individual matrix bins
• Place drugs that cannot be accessed without pharmacy
order entry and screening in individual matrix bins
• Use individual cabinets to separate pediatric and adult
medications
• Periodically reassess the drugs stocked in each unit-
based cabinet
• Remove only single dose of medication ordered
• Develop a check system to assure accurate stocking of
the cabinets
Maniulit, Cherry G.
BSN3G-1
• Place allergy reminders for specific drugs such as
antibiotics and opiates and non-steroidal anti-
inflammatory drugs NSAIDs
• Routinely run and analyze override reports to help track
and identify problems
SMART INFUSION PUMP DELIVERY SYSTEM
• Are primarily used to deliver parenteral medications
through IV or epidural lines and can be found in a variety
of clinical settings
• Smart pumps include comprehensive libraries of drugs,
usual concentrations, dosing units and dose limits
• Software that incorporates institution-established dosage
limits, warnings to the practitioner when dosage limits
exceeded and configurable settings by patients type or
location
• Software that enables to provide an additional verification
of the programming of medication delivery
• System that can allow organizations to configure unit-
specific profiles, which include customized sets of
operating variables, programming options and drug
libraries
ISSUES IN IMPLEMENTATION OF TECHNOLOGY
• Outlining goals for the type of automation to be
implemented
• Developing a wish list-of-desired features and
determining which one, given budgetary constraints are
practical
• Investigating systems that are presently available
• Analyzing the current workflow and determining what
changes are needed
• Identify the required capabilities and configuration of new
system
• Sell the benefits and objectives of automation to staff
• Development of an implementation plan
LESSON C: Health Care Data Standards
DATA STANDARDS
Used to described those standards having to do with
the structure and content of health information, it may be
useful to differentiate data, information and knowledge
TYPES OF STANDARDS
1. First Type of Standard
o Equipment specifications such as processor
type or network transmission protocols
2. Second Type of Standard
o Involves specification of data structures and
content and would include such standards as
message formats and core data sets
3. Third Type of Standards
o Addresses the interpretation of that data as
information including how it should be acted on
within a particular context
HEALTHCARE DATA INTERCHANGE STANDARDS
Address primarily the format of messages that are
exchanged between computer systems, documents and
architecture, clinical templates, user interface, and patient
data linkage
MESSAGE FORMAT STANDARDS
• Medical device communication
• Digital imaging communications
• Administrative data exchange
• Clinical data exchange
National Committee on Vital and Health Statistics
(NCVHS)
• Uniform data standards for patient medical record
information (PMRI)
• Digital Imaging Communication in Medicine Standards
(DICOM)
• National Prescriptions Drug Programs (NCPDP)
• SCRIPT
• Institute of Electrical and Electronic Engineers
INSTITUTE OF ELECTRICAL AND ELECTRONIC
ENGINEERS
• Medical Information Bus (MIB)
• Support real time continuous, and comprehensive
capture and communication of data from bedside medical
devices such as those found in intensive care units, OR
and ER departments
• Include physiologic parameter measurements and device
settings
NATIONAL ELECTRICAL MANUFACTURERS
ASSOCIATION (NEMA)
Develop a generic digital format and a transfer
protocol for biomedical images and image related information
ACCREDITED STANDARDS COMMITTEE (ASC) X12N
Developed a broad range of electronic interchange
(EDI) standards to facilitate electronic business transactions
to the healthcare arena
NATIONAL COUNCIL FOR PRESCRIPTION DRUG
PROGRAMS (NCPDP)
• Develops standards for information processing for the
pharmacy services sector of the health care industry.
• 1 was named as the official standard for pharmacy claims
with HIPAA
STANDARDIZED TERMINOLOGIES
Ability to represent concepts in an unambiguous
fashion between both the sender and receiver of the message
INTERNATIONAL STATISTICAL CLASSIFICATION OF
DISEASES AND RELATED HEALTH PROBLEMS: NINTH
REVISION AND CLINICAL MODIFICATIONS
• ICD9-CM- the sole classification used for morbidity
reporting in the US since 1979
• Been adopted for number of purposes including data
collection, quality of care analysis, resource utilization,
and statistical reporting
Maniulit, Cherry G.
BSN3G-1
INTERNATIONAL STATISTICAL CLASSIFICATION OF
DISEASES AND RELATED HEALTH PROBLEMS: TENTH
REVISION AND CLINICAL MODIFICATIONS
• ICD classification system for mortality and morbidity
which is used worldwide
• Encompasses nomenclature structures
• The US version ICD-10-CM
CURRENT PROCEDURAL TERMINOLOGY, FOURTH
REVISION (CPT-4)
Is a listing of descriptive terms and codes for
reporting medical services and procedures
SYSTEMIZED NOMENCLATURE OF HUMAN AND
VETERINARY MEDICINE INTERNATIONAL, CLINICAL
TERMS (SNOMED)
Is a comprehensive, multiaxial nomenclature and
classification system created for indexing human and
veterinary medical vocabulary, including signs and symptoms,
diagnosis and procedures
LOGICAL OBSERVATION IDENTIFIERS NAMES AND
CODES (LOINC)
Provides a set of universal names and numeric
identifier codes for laboratory and clinical observations and
measurements in a database structure
RxNorm
Is a clinical drug nomenclature produced by NLM in
consultation with the Food and Drug Administration (FDA). It
provides standard names for clinical drugs (active ingredients
strengths dose form) and for dose form as administered
UNIFIED MEDICAL LANGUAGE SYSTEM
Specialized vocabularies, code sets and
classifications systems for almost every practice domain in
health care
DATA CONTENT STANDARDS
• A minimum set of items with uniform definitions and
categories concerning a specific aspect or dimension of
the healthcare system which meets the essential needs
of multiple users
• A standard data element with a uniform definition and
coding convention to collect data on persons and on
events or encounters
NATIONAL UNIFORM CLAIM COMMITTEE
RECOMMENDED DATA SET FOR A NONINSTITUTIONAL
CLAIM (NUCC)
Organized in 1995 to develop, promote and maintain
a standard data set for use in non-institutional claims and
encounter information
STANDARD GUIDE FOR CONTENT AND STRUCTURE OF
THE COMPUTER-BASED-PATIENT RECORD (ASTM
E1384-96)
The American Society for testing materials (ASTM)
is one of the largest SDOs in the world and publishes over
9,000 standards covering all sectors in the economy
CONCEPT OF A SECURE PATIENT-CENTERED EHR
• Safeguards personal privacy
• Rises standardized medical terminology that can be
correctly read by any care provider
• Eliminates the danger of illegible handwriting and missing
patient information
• Can be transferred as patient’s care requires over a
secured communications infrastructure for electronic
information exchange
INTEGRATING THE HEALTHCARE ENTERPRISE (IHE)
Provides a detailed framework for implementing
standards, filling the gap between standards and their
implementation
STANDARD COORDINATION EFFORTS
Developed at the international, regional and national
levels to try and create a synergetic relationship between their
member organizations
INTERNATIONAL ORGANIZATION STANDARDS (ISO)
An organization that develops and publishes
standards internationally
EUROPEAN TECHNICAL COMMITTEE
• CEN TC 251
• Works to develop a wide variety of standards in the area
o9f healthcare data management and interchange
AMERICAN NATIONAL STANDARDS INSTITUTE (ANSI)
• Serves as the coordinator for voluntary standard activity
in the US
• The US representative to ISO and is responsible in
bringing forward US standards to that organizations
OBJECT MANAGEMENT GROUP
• Representative of different approach in standards
development
• An international consortium of over 800 organizations,
primarily for-profit vendors of information systems
technology, who are interested in the development of
standards
HEALTH INSURANCE PORTABILITY AND
ACCOUNTABILITY ACT
• Enrolling an individual in a health plan
• Paying health insurance premiums
• Checking insurance eligibility
• Getting authorization to refer a patient to a specialist
• Filing a claim for insurance reimbursement
• Requesting additional information to support a claim
• Coordinating the processing of a claim Coordinating the
process of a claim across different insurance companies
• Notifying the provider about the payment of the claim
6 AREAS OF INTEREST NCVHS
• Message format standards that contain PMRI
• Medical terminology related to PMRI including data
element definitions
• Business case issues related to the development and
implementation of uniform data standards
• National healthcare Information Infrastructure (NHII) Data
quality, accountability and integrity related to PMRI
• Inconsistencies and contradictions among state laws that
discourage or prevent the creation, storage,
communication of PMRI
CONSOLIDATED HEALTH INFORMATICS
The goal is to develop and implement standard
means of exchanging and managing health information across
federal health providers
GOAL OF STRATEGIC ACTION
Goal 1 -Inform Clinical Practice
o Incentivize HER adoption
o Reduce risk of HER investment
o Promote HER diffusion in rural and underserved areas
Goal 2- Interconnect Clinicians
Maniulit, Cherry G.
BSN3G-1
o Foster regional collaborations
o Develop a national health information network
o Coordinate federal health information systems
Goal 3- Personalize Care
o Encourage use of PHRs
o Enhance Informed consumer choice
o Promote use of telehealth systems
Goal 4- Improve population Health
o Unify public health surveillance architectures
o Streamline quality and health status monitoring
o Accelerate research and dissemination of evidence
LESSON D: Electronic Health Record System
INSTITUTE OF MEDICINE DEFINITION OF EHR
The set of components that form the mechanism by
which patient records are created, used, stored and retrieved.
A patient record system is usually located within a healthcare
provider setting. It includes people, data, rules and
procedures, processing and storage devices, and
communication support facilities.
Key capabilities of EHR
• Longitudinal collection of electronic health information for
and about persons, where health information is defined
as information pertaining to the health of an individual or
healthcare provided to an individual
• Immediate electronic access to person and population –
level information by authorized, users
• Provision of knowledge and decision support that
enhances the quality, safety, and efficiency of patient care
• Support of efficient processes for healthcare delivery
Department of Veterans Affairs (VA)
• Computerized patient record system (CPRS) was created
in 1990
• Provided a single place for healthcare providers to review
and update a patient’s health record and order
medications, special procedures, x-rays, nursing orders,
diets and laboratory tests
Computerized Patient Record System (CPRS) Features
• A checking system that alerts clinician if an order they are
entering could cause a problem
• A notification system that immediately alerts clinicians to
clinically significant events
• A visual posting system that alerts healthcare providers
to issues specifically related to the patient on the opening
of the patient’s electronic chart, including crisis notes,
adverse reactions and advance directives
• A template system that allows the healthcare provider to
automatically create reports
• A clinical reminder system that electronically alerts
clinicians when certain actions such as examinations and
laboratory tests need to be performed
• Remote data viewing to allow clinicians to see the
patient’s medical history at all the VA facilities where the
patient was seen
Department of Defense (DO)
• Composite health care system II (CHCS II) was
developed in 2004
• Physician order entry capability that enables them to
order lab tests and radiology examinations and issue
prescriptions electronically
• Pharmacy data transaction service links military
treatment facilities, mail order and network pharmacies
Indian health Service (IHS)
• Resource and Patient Management System (RPMS)
was developed in 1970s
• Patient Care Component (PCC) has been in place in
1980s
• IHS- EHR
Office of the National Coordinator for Health Information
Technology (ONCHT)
• EO 2004 created the ONCHT to coordinate HIT efforts in
the federal sector
• Created 4 goals to achieve the vision of using IT to
improve healthcare
National Committee on Vital and Health Statistics
(NCVHS)
In 2002 it presented the concept of infrastructure that
emphasizes health-oriented interactions and information
sharing among individuals and institution rather than simply
the physical, technical and data systems that make those
interactions possible.
Agency for Healthcare Research and quality (AHRQ)
• 2003-2004 unveiled a major HIT portfolio, with grants,
contracts and other activities to demonstrate the role of
HIT in improving patient safety and quality of care.
• Funded demonstration grants to establish and implement
interoperable health information systems and data
sharing to improve the quality, safety, efficiency and
effectiveness of health care for patients and populations.
Centers for Medicare and Medicaid Services
• Has initiated several pilot projects to promote health IT,
• In May, 2004, CMS awarded a 100.000 dollars grants to
the American Academy of Family Physician for a pilot
project to provide comprehensive standardized EHR
Connecting for Health
Addressing the barriers to development of an
interconnected health information infrastructure
eHealth initiative
An independent, nonprofit affiliated organization
established to foster improvement in the quality, safety and
efficiency of healthcare through information and IT
Maniulit, Cherry G.
BSN3G-1
Institute of Medicine (IOM)
• Has championed the advantages of use of IT to improve
healthcare
• The computer- based patient record was revised and
republished in 1997
Certification Commission for Health Information
Technology
• HIMSS and AHIMA and NAHT have joined together to
formed this group
• The goal of the group is to support Goal!, Strategy
2”Reduce risk of EHR investment
Health Level Seven (HL7)
Known for its large body of work in the production of
technical specification for the transfer of healthcare data.
LESSON E: Dependable System for Quality Care
DEPENDABILITY
Is a measure of the extent to which a system can
justifiably be relied on to deliver the services expected from it
6 ATTRIBUTES OF DEPENDABILITY
1. System reliability - the system consistently behaves in
the same way
2. Service reliability - required services are present and
usable when they are needed
3. Confidentiality - sensitive information is disclosed only
to those authorized to use it
4. Data Integrity - data are not corrupted or destroyed
5. Responsiveness - The system responds to user input
within as expected and acceptable time period
6. Safety - the system does not cause harm
5 FUNDAMENTAL GUIDELINES THAT CAN HELP
INCREASE DEPENDABILITY OF HEALTHCARE SYSTEM
Guideline 1: Architect for dependability
o Architecture should be developed from the bottom up so
that no critical component is dependent on a component
less trustworthy than itself
o the architecture are the physical and logical networks that
support the enterprise and provide the “pipes” that carry
data from system to system
o Safety and security functions
Guideline 2: Anticipate failures
o Features that are transparent to software applications
should be implemented to detect faults, to fail over to
redundant components when faults are detected, and to
recover from failures before they become catastrophic.
o Security features to discover malicious attacks
Guideline 3: Anticipate success
o The system planning process should anticipate business
success and the consequential need for larger networks,
more systems, new applications and additional
integration
Guideline 4: Hire meticulous managers
o Good system administrators meticulously monitor and
manage system and network performance, using out of
hand tools that do not themselves affect performance
Guideline 5: Do not be adventurous
o For dependability, one should use only proven been in
production, under conditions, and at a scale similar to the
intended environment
o The enterprise with a requirement for dependable system
should not be the first (or second) to adopt a new
technology
Healthcare architectures
Are among the most complex- a loose collection of
departmental systems that are unaware that each other exist
HIPAA- 8 SECURITY REGULATION FOR
DEPENDABILITY
1. Security Management, including security analysis and
risk management
2. Assigned security responsibility
3. Information Access management, including the isolation
of clearinghouse functions from other clinical functions
4. Security awareness and training
5. Security incident procedures, including response and
reporting
6. Contingency planning, including data backup planning,
disaster recovery planning and planning for emergency
mode operations
7. Evaluation
8. Business associate contracts that lock in the obligation of
business partners in protecting health information to
which they may have access
5 PHYSICAL SAFEGUARDS
1. Access control, including unique user identification and
an emergency access procedure
2. Audit controls
3. Data integrity protection
4. Person or entry authentication
5. Transmission security
ANTICIPATING FAILURES
• Medical technology and prescription drugs as well as
clinical treatment protocols, are required to undergo
extensive validation before they can be used in clinical
practice
ANTICIPATING SUCCESS
• Healthcare organizations expect their software
applications, computer systems and networks to work
• Providers assume their systems will work as well as any
other medical equipment despite the fact that many of the
software applications they are running on the same kind
of PCs that have failed them at home
IT MANAGEMENT
• Many provider organizations truly do recognize the
criticality of IT to their business success
• They have hired IT managers who appreciate the
important role of IT in a healthcare environment and who
recognize the need for dependable systems that can
anticipate and recover from failures
ADVENTUROUS TECHNOLOGY IN HEALTHCARE
• Healthcare clinicians including nurses, historically and
typically are very resistant to change,
• Before adopting any new idea, they watch someone else
try it, and then perhaps they may try it themselves
• Wireless networking and handheld computers can serve
as a good example of technologies that are not yet mature
enough for safety-critical applications
LESSON F: Nursing Minimum Data Set System
NURSING MINIMUM DATA STANDARDS (NMDS)
Is a standardized approach that facilitates the
obstruction of these minimum, common, essential core data
elements to describe nursing practice from both paper and
electronic records
Maniulit, Cherry G.
BSN3G-1
 3 BROAD CATEGORIES OF NMDS
1. Nursing care
2. Patient or Client Demography
3. Service Elements

AIM OF NMDS
• Is not to be redundant of other data sets, but rather to
identify what are minimal data needed to be collected
from records of patients receiving nursing care.

8 BENEFITS OF NMDS
1. Access to comparable, minimum nursing care, and
resources data on local, regional, national, and
international levels
2. Enhanced documentation and nursing care provided
3. Identification of trends related to patient or client
problems and nursing care provided
4. Impetus to improved costing of nursing services
5. Improved data for quality assurance evaluation
6. Impetus for further development and refinement of NISs
7. Comparative research on nursing care, including
research on nursing diagnosis, nursing interventions,
nursing outcomes, intensity of nursing care, and referral
for further nursing services
8. Contributions toward advancing nursing as a research-
based discipline

NATIONAL INFORMATION & DATA SET EVALUATION

CENTER (NIDSEC)
Develops and disseminates standards related to
nomenclature, clinical associations, clinical data repositories,
and system characteristics/ decision support/ contextual
variables pertaining to the data sets in information systems
that support the documentation of nursing practice

NURSING MANAGEMENT MINIMUM DATA SET (NMMDS)

DATA ELEMENTS
The 18 elements are organized into 3 categories:
1. Environment
2. Nursing Care
3. Financial Resources

NURSING MANAGEMENT MINIMUM DATA SET (NMMDS)

Is the minimum set of items of information with
uniform definitions and categories concerning the specific
dimension of the context of patient/client care delivery

INTERNATIONAL NURSING MINIMUM DATA SET (i-

NMDS)
Includes the core, internationally relevant, essential
minimum data elements to be collected in the course for
providing nursing care

i-NMDS WILL SUPPORT:

• Describing the human phenomena, nursing intervention,
care outcomes and resource consumption related to
nursing services
• Improving the performance of healthcare systems and the
nurses working within these systems worldwide
• Enhancing the capacity of nursing and midwifery services
• Addressing the nursing shortage, inadequate working
conditions, poor distributions and inappropriate utilization
of nursing personnel, and the challenges as well as
opportunities of global technological innovations
• Testing evidence-based practice improvements
• Empowering the public internationally

Maniulit, Cherry G.
BSN3G-1