Handbook of Informatics for Nurses &

Healthcare Professionals 6th Edition

(eBook PDF)
Go to download the full and correct content document:
https://ebooksecure.com/product/handbook-of-informatics-for-nurses-healthcare-profe
ssionals-6th-edition-ebook-pdf/
More products digital (pdf, epub, mobi) instant
download maybe you interests ...

Handbook of Informatics for Nurses & Healthcare

Professionals 6th Edition (eBook PDF)

http://ebooksecure.com/product/handbook-of-informatics-for-
nurses-healthcare-professionals-6th-edition-ebook-pdf/

(eBook PDF) Handbook of Informatics for Nurses &

Healthcare Professionals 5th Edition

http://ebooksecure.com/product/ebook-pdf-handbook-of-informatics-
for-nurses-healthcare-professionals-5th-edition/

(eBook PDF) Informatics for Health Professionals

(Navigate 2 Advantage Access)

http://ebooksecure.com/product/ebook-pdf-informatics-for-health-
professionals-navigate-2-advantage-access/

(eBook PDF) Medical Terminology for Healthcare

Professionals, 10th edition

http://ebooksecure.com/product/ebook-pdf-medical-terminology-for-
healthcare-professionals-10th-edition-4/
(eBook PDF) Statistics for Advanced Practice Nurses and
Health Professionals

http://ebooksecure.com/product/ebook-pdf-statistics-for-advanced-
practice-nurses-and-health-professionals/

(Original PDF) Infection Control Manual for Healthcare

Professionals Australia

http://ebooksecure.com/product/original-pdf-infection-control-
manual-for-healthcare-professionals-australia/

Gahart's 2021 Intravenous Medications: A Handbook for

Nurses and Health Professionals 37th Edition Betty L.
Gahart Rn - eBook PDF

https://ebooksecure.com/download/gaharts-2021-intravenous-
medications-a-handbook-for-nurses-and-health-professionals-ebook-
pdf/

Electrocardiography for healthcare professionals 4th

edition Edition Booth - eBook PDF

https://ebooksecure.com/download/electrocardiography-for-
healthcare-professionals-ebook-pdf/

Electrocardiography For Healthcare Professionals Ise

(paperback) 5th Edition - eBook PDF

https://ebooksecure.com/download/electrocardiography-for-
healthcare-professionals-ise-paperback-ebook-pdf/
SIXTH EDITION
 ••
Content VII

Public Health Informatics 422 Appendix A: Hardware and Software 435

Athena Fernandes
Public Policy Driving Informatics Change 425
Appendix B: The Internet
Current Public Health Informatics and the Worldwide Web 439
Systems 426 Athena Fernandes
New Technological Sources of Public Appendix C: An Overview of Tools
Health Information 428 for the Informatics Nurse 441
Carolyn Sipes
Future Directions 430
Glossary 446
Summary 432 Index 454
This page intentionally left blank
 he idea for Handbook of Informatics for Nurses &
Healthcare Professionals first came from the realiza-
tion that there were few resources that provided
practical information about computer applications and
information systems in healthcare. From its inception,
this book served as a guide for nurses and other health-
care professionals who needed to learn how to adapt and
use computer applications and informatics in the work-
place. Over time, this text became a reliable resource
for students in a variety of healthcare professions who
needed to develop informatics competencies. This book
serves undergraduates who need a basic understanding,
as well as those who require more depth, such as infor-
matics nurse specialists, clinical nurse leaders, doctoral
students, and other healthcare professionals.
After a thorough revision in response to reviewers
and users of the book, the sixth edition reflects the rapid
changes in healthcare information technology (HIT)
and informatics. The authors endeavour to provide an
understanding of the concepts, skills, and tasks that
are needed for healthcare professionals today and to
achieve the federal government's national information
technology goals to help transform healthcare delivery.
The sixth edition builds upon the expertise pro-
vided by contributors currently involved in day-to-day
informatics practice, education, and research. Both the
primary editors and the contributors share an avid inter-
est and involvement in HIT and informatics, as well
as experience in the field, involvement in informatics
groups, and a legacy of national and international pre-
sentations and scholarly publications.
New to This Edition
• New! All chapters thoroughly revised to reflect the
current and evolving practice of health information
technology and informatics
• New! Chapter on informatics theory and prac-
tice connects theoretical concepts to applications
(chapter 2)
• New! Coverage of technology and caring and their
symbiotic relationship
• New! Content on ethical use of information lays
encompasses appropriate and inappropriate behav-
iour and actions, and of right and wrong.
• New! Information on analytics and data science that
explains how Big Data applies to healthcare
• New! Cutting-edge content on wearable and mobile
technology security, and its impact on nursing and
patient care
• New! Academic electronic health record resources and
the role they play in educating the next generation of
healthcare providers on documentation principles
• New! Hardware and software appendix (appendix A)
• New! Guide to the Internet (appendix B)
• New! An Overview of Tools for the Informatics
Nurse (appendix C)
Changes to This Edition
• The sixth edition streamlines content by combining
chapters with topics that fit together, and shifting
hardware, software, and information on the Inter-
net to new appendices.
• This edition reworks previous content on informa-
tion systems training and presents it within the
context of workforce development. The content still
retains the emphasis upon privacy and confidential-
ity, introduction of information policies, educational
methods and resources. New content on evaluation
models and training on backup procedures has also
been added.
• Former content on integration, interoperability
and health information exchange is now presented
within the context of information networks and
information exchange.
• Moves from defining evidence-based practice to a
discussion of levels of evidence and using informat-
ics to support evidence-based practice and research.
• Separate chapters on policy, legislation, regulatory,
reimbursement, and accreditation issues were com-
bined to better show the connection among these
•
IX
x Preface
areas and the relationship between them and infor-
mation system design and use.
• Experts from various health disciplines cover the
latest on the interprofessional aspects of infor-
matics with more emphasis on interdisciplinary
approaches.
• Increases focus on current electronic health record
issues while decreasing coverage of the historical
evolution of EHRs.
• Highlights strategic planning and project
management.
• Underscores the importance of patient engagement
and shared decision making.
• Expands content on simulation and virtual learning
environments.
Hallmark Features
Leaming Objectives Learning Objectives
appear at the beginning of each chapter and
identify what readers can expect to learn in the
chapter.
Future Directions As the last section in each
chapter, Future Directions forecasts how the
topic covered in the chapter might evolve in the
•
upcoming years.
Case Study Exercises Case studies at the end
of each chapter discuss common, real-life appli-
cations, which review and reinforce the concepts
presented in the chapter.
Summary The Summary at the end of each
chapter highlights the key concepts and
information from the chapter to assist in the
•
review.
References Resources used in the chapter
appear at the end.
Glossary The glossary familiarizes read-
ers with the vocabulary used in this book and
in healthcare informatics. We recognize that
healthcare professionals have varying degrees
of computer and informatics knowledge. This
book does not assume that the reader has prior
knowledge of computers. All computer terms
are defined in the chapter, in the glossary at
the end of the book, and on the Online Student
Resources Web site.
Organization
The book is divided into three sections: Information and
Informatics, Information Systems Development Life
Cycle, and Specialty Applications. The major themes
of privacy, confidentiality, and information security are
woven throughout the book. Likewise, project manage-
ment is a concept introduced in the strategic planning
chapter and carried through other chapters. Chapters
include content on the role of the informatics profes-
sional, future directions relative to the topic, summary
bullet points, and a case study.
Section I: Information and Informatics
This section provides a foundation for why information
and informatics are important to healthcare. It details
the relationship between policy, legislation, regulation
and accreditation and reimbursement and information
system use.
• Chapter 1: Provides a definition of informatics and
its significance for healthcare, discusses healthcare
professionals as knowledge workers, addresses the
need for uniform data and the relationship between
data, big data, and evidence. This chapter also
addresses the increased prevalence of information
technology in healthcare, major issues in healthcare
that are driving the adoption of information tech-
nology, what is necessary to create an informatics
culture, and includes a special section on caring and
technology.
• Chapter 2: Provides information on informatics
theory and practice, and nursing informatics as a
discipline.
• Chapter 3: Emphasizes effective and ethical use of
data and information, and includes a discussion of
big data challenges and issues. Data characteristics,
types, integrity, and management are covered. Cli-
nician and informaticist roles pertaining to this area
are discussed.
• Chapter 4: Addresses electronic resources for
healthcare professionals, basic concepts and appli-
cations of the Internet, including criteria for evalu-
ating the quality of online information.
• Chapter 5: Discusses informatics to support
evidence-based practice and research. Concepts
include levels of evidence, information literacy,
managing research data and information, creating

and maintaining the infrastructure needed to sup-
port research, dissemination of evidence, and effect-
ing practice change.
• Chapter 6: Examines the relationship between pol-
icy, legislation, accreditation, reimbursement and
HIT design and use.
• Chapter 7: Provides information on electronic
health records including definition, components,
incentives for adoption, benefits, current status,
selection criteria, implications for collection of
meaningful data and big data, current issues, and
future directions.
• Chapter 8: Provides an overview of types of health-
care information systems, including clinical infor-
mation systems and administrative information
systems, as well as decision support, knowledge
representation, and smart data.
Section II: Information Systems
Development Life Cycle
This section covers information and issues related to the
information systems development life cycle.
• Chapter 9 This chapter discusses the importance
of strategic planning for information management,
HIT acquisition and use and provides an overview
of project management and information system
selection considerations. The role of informatics
professionals, particularly informatics nurse spe-
cialists, in the planning process and project manage-
ment are addressed, as is the process to introduce
change.
• Chapter 10: Addresses the concepts of usability
and health informatics applications inclusive of the
role that usability plays in the system life cycle and
methods of usability assessment.
• Chapter 11: Covers information system implemen-
tation, maintenance, and evaluation.
• Chapter 12: Provides a comprehensive look at
workforce development in relation to health infor-
mation technology use.
• Chapter 13: Discusses information security and
confidentiality, including practical information on
ways to protect information housed in informa-
tion systems and on mobile devices and addresses
security for wearable and implantable information
technology.
•
Preface XI
• Chapter 14: Provides detailed information about
health information exchanges.
• Chapter 15: Provides an overview of the role of
standardized terminology and language in infor-
matics. Also includes an outline of individual lan-
guages and classifications used in healthcare.
• Chapter 16: Discusses the relationship between
strategic planning for the organization and the sig-
nificance of maintaining uninterrupted operations
for patient care. Also touches on legal requirements
to maintain and restore information. Much of this
chapter is geared for the professional working in
information services.
Section III: Specialty Applications
This section covers specialty applications of informatics.
• Chapter 17: Details ways that information tech-
nology and informatics can support education of
healthcare professionals, including sections on sim-
ulation and virtual learning environments.
• Chapter 18: Emphasizes the relationship between
health and information literacy, patient engage-
ment, shared decision-making, changing healthcare
delivery models, patient satisfaction, outcomes, and
healthcare reform. Discusses applications of con-
sumer health informatics.
• Chapter 19: Examines telehealth and connected
healthcare applications, starting with a historical
perspective and including driving forces, appli-
cations, and implications for providers as well as
informatics professionals.
• Chapter 20: Explores public health informatics and
its use to maintain and improve population health.
Three appendices are included. Appendix A pro-
vides basic information on hardware and software for
the reader who needs a better understanding of this
area. Appendix B provides information on the Internet.
Appendix C provides an overview of some tools for the
informatics nurse.
Instructor Resources
Lecture PowerPoint showcases key points for
each chapter.
Test Generator offers question items, making
test creation quick and simple.
 ••
XII Preface

Student Resources Notice Care has been taken to confirm the accuracy of information pre-
sented in this book. The authors, editors, and the publisher, however,
New! eText offers a rich and engaging experi- cannot accept any responsibility for errors or omissions or for conse-
ence with interactive exercises. Readers can ac- quences from application of the information in this book and make no
warrant~ express or implied, with respect to its contents.
cess online or via the Pearson eText app. Note:
Faculty can opt to package an eText access code
card with the print textbook, or students can
purchase access to the eText online.
 pecial thanks to Kathy Hunter, who agreed to join me on this 6th edition,
lending her knowledge, insights, and support when I most needed it and
never said ''no'' despite her many other commitments.
A special thanks to Patricia Czar, RN, without whom there would be no
Handbook of Informatics for Nurses & Healthcare Professionals today. Pat actively
contributed to the book from the original outline through to the present, provid-
ing her knowledge, insights, organizational skills, support, and friendship. Pat
was active in informatics for more than 25 years, serving as manager of clini-
cal systems at a major medical center where she was responsible for planning,
design, implementation, and ongoing support for all of the clinical information
systems. Pat was also active in several informatics groups, presented nationally
and internationally, and served as a mentor for many nursing and health infor-
matics students. She is now fully retired and enjoying time with her family.
We acknowledge our gratitude to our loved ones for their support as we
wrote and revised this book. We are grateful and excited to have work from our
contributors who graciously shared their knowledge and expertise for this edi-
tion. We are grateful to our co-workers and professional colleagues who provided
encouragement and support throughout the process of conceiving and writing
this book. We appreciate the many helpful comments offered by our reviewers.
Finally, we thank Lisa Rahn, Michael Giacobbe, Susan Hannahs, Daniel Knott,
Taylor Scuglik, and all of the persons who worked on the production of this edi-
tion for their encouragement, suggestions, and support.

his edition brings in work from multiple contributors for a robust coverage
of topics throughout the book. We thank them for their time and expertise.
We would also like to thank all of the reviewers who carefully looked at
the entire manuscript. You have helped shape this book to become a more useful
text for everyone.

• ••
XIII
This page intentionally left blank
Contri utors
Diane A. Anderson, DNP, MSN, RN, CNE
Chapter 17: Using Informatics to Educate
Associate Professor, MSN Specialty Tracks - Nurse
Educator, Chamberlain College, Downers Grove, IL
Ami Bhatt, DNP, MBA, RN, CHPN, CHCI
Chapter 13: Information Security and Confidentiality
Dr. Bhatt is currently enrolled in the DNP to PhD program
at University of Nevada, Las Vegas, NV
Sunny Biddle, MSN, RN
Chapter 6: Policy, Legislation, and Regulation Issues
for Informatics Practice
Circulating Nurse in the Operating Room at Genesis
Healthcare in Zanesville, OH and Clinical Instructor for
Central Ohio Technical College in Newark, OH
Jane M. Brokel, PhD, RN, FNI
Chapter 8: Healthcare Information Systems
Chapter 14: Information Networks and Information
Exchange
Section Instructor at Simmons College, Boston, MA
Adjunct faculty for the University of Iowa College of
Nursing, Iowa, City, IA
Jennifer A. Brown, MSN, RN, HNB-BC
Chapter 1: An Overview of Informatics in
Healthcare
Faculty, Bronson School of Nursing at Western
Michigan University in Kalamazoo, Michigan in the
undergraduate and RN-BSN programs.
Lisa Eisele, MSN, RN
Chapter 19: Connected Healthcare (Telehealth and
Technology-enabled healthcare)
Chief - Quality, Performance & Risk Management
Manchester VA Medical Center, Manchester VA
Sue Evans, MSN RN-BC
Chapter 11: System Implementation, Maintenance,
and Evaluation
Informatics Nurse II University of Pittsburgh Medical
Center East, Monroeville, PA
Athena Fernandes DNP, MSN, RN-BC
Appendix A: H ardware and Software
Appendix B: A Guide to the Internet and World Wide Web
Senior Physician Systems Analyst, Penn Medicine
Chester County Hospital, West Chester, PA
Carolyn S. Harmon, DNP, RN-BC
Chapter 16: Continuity Planning and Management
Clinical Assistant Professor and Program Director for
the Masters of Nursing Informatics and the Masters
of Nursing Administration at University of South
Carolina, Columbia, SC
Toni Hebda, PhD, RN-BC, MSIS, CNE
Chapter 3: Effective and Ethical Use of Data and
Information
Chapter 18: Consumer Health Informatics
Professor, Chamberlain College of Nursing MSN
Program, Downers Grove, IL
Taryn Hill, PhD, RN
Caring for the Patient Not the Computer in Chapter 1:
An Overview of Informatics in Healthcare
Dean of Academic Affairs for Chamberlain College of
Nursing, Columbus, OH
Diane Humbrecht, DNP, RN
Chapter 12: Workforce Development
Chief Nursing Informatics Officer, Abington Jefferson
H ealth, Abington, PA
Kathleen Hunter, PhD, RN-BC, CNE
Chapter 3: Effective and Ethical Use of Data and
Information
Chapter 7: Electronic Health Record Systems
Professor, Chamberlain College of Nursing MSN
Program, Downers Grove, IL
Brenda Kulhanek, PhD, MSN, MS, RN-BC
Chapter 4: Electronic Resources for Healthcare
Professionals
Chapter 12: Workforce Development
AVP of Clinical Education for HCA in Nashville, TN
xv
xvi Contributors

Susan Matney, PhD, RN-C, FAAN Rebecca J Sisk, PhD, RN, CNE
Chapter 15: The Role of Standardized Terminology Virtual Learning Environment in Chapter 17: Using
and Language in Informatics Informatics to Educate
Senior Medical Informaticist, Intermountain Professor, Chamberlain College Downers Grove, IL
Healthcare, Murray, UT
Rayne Soriano, PhD, RN
Julie McAfooes, MS, RN-BC, CNE, ANEF, FAAN Chapter 7: Electronic Health Record Systems
High-fidelity simulation, software, support, and Regional Director for Medicare Operations and Clinical
certification in Chapter 17: Using Informatics to Educate Effectiveness. Kaiser Permanente, San Francisco, CA
Web Development Manager for the online
Nancy Staggers, PhD, RN, FAAN
RN-to-BSN Option at the Chamberlain of Nursing,
Chapter 10: Improving the Usability of Health
Downers Grove, IL
Informatics Applications
Jeri A. Milstead, PhD, RN, NEA-BC, FAAN President, Summit Health Informatics and adjunct
Chapter 6: Policy, Legislation, and Regulation Issues professor, Biomedical Informatics and College of Nurs-
for Informatics Practice ing University of Utah College, Salt Lake City, UT
Professor and Dean Emerita, University of
Maxim Topaz PhD, MA, RN
Toledo College of Nursing, Toledo, OH
Chapter 2: Informatics Theory and Practice
Patricia Mulberger, MSN, RN-BC Harvard Medical School & Brigham Women's Health
Special Considerations with Mobile Computing in Hospital, Boston, MA, USA
Chapter 13: Information Security and Confidentiality
Marisa L. Wilson DNSc MHSc RN-BC CPHIMS FAAN
Clinical Informatics Quality Supervisor, Kalispell
Chapter 20: Public Health Informatics
Regional Healthcare, Kalispell MT
Associate Professor and Specialty Track coordinator
Melody Rose, DNP, RN for the MSN Nursing Informatics program at the Uni-
Chapter 5: Using Informatics to Support versity of Alabama at Birmingham School of Nursing.
Evidence-based Practice and Research
Chapter 18: Consumer Health Informatics
Assistant Professor of Nursing. Cumberland University
Jeanette C. Rudy School of Nursing, Lebanon, TN
Carolyn Sipes, PhD, CNS, APN, PM~ RN-BC
Chapter 8: Healthcare Information Systems
Chapter 9: Strategic Planning, Project Management,
and Health Information Technology (IT) Selection
Appendix C: An Overview of Tools for the
Informatics Nurse
Professor, Chamberlain College, Downers Grove, IL
 •
ev1e ers

Janet Baker DNP, APRN, ACNS-BC, CPHQ, CNE

Associate Dean Graduate Nursing Programs
Ursuline College, The Breen School of Nursing
Pepper Pike, Ohio

Theresa L. Calderone, EdD, MEd, MSN, RN-BC

Assistant Professor of Nursing
Indiana University of Pennsylvania
Indiana, PA

Vicki Evans, MSN, RN, CEN, CNE

Assistant Professor of Nursing
University of Mary-Hardin Baylor
Belton, TX
Kathleen Hirthler DNP, CRNP, FNP-BC
Chair, Graduate Nursing; Associate Professor
Wilkes University, Passan School of Nursing
Wilkes Barre, PA

Arpad Kelemen, Ph.D.

Associate Professor of Informatics
University of Maryland School of Nursing
Baltimore, MD

Michelle Rogers, PhD, MS, MA, BS

Associate Professor of Information Science
Drexel University
Philadelphia, PA

Charlotte Seckman, PhD, RN-BC, CNE, FAAN

Associate Professor, Nursing Informatics Program
University of Maryland School of Nursing
Baltimore, MD

Nadia Sultana, DNP, MBA, RN-BC

Program Director and Clinical Assistant Professor, Nursing Informatics
Program
New York University
NewYork,NY

••
XVII
This page intentionally left blank
 outt eAut ors

Toni Hebda, PhD, RN-C, CNE, is a professor with the Chamberlain College of
Nursing. MSN Program teaching in the nursing informatics track. She has held
several academic and clinical positions over the years and worked as a system
analyst. Her interest in informatics provided a focus for her dissertation, subse-
quently led her to help establish a regional nursing informatics group, obtain a
graduate degree in information science, and conduct research related to informat-
ics. She is a reviewer for the Online Journal of Nursing Informatics. She is a member
of informatics groups and has presented and published in the field.

Kathy Hunter, PhD, FAAN, RN-BC, CNE, is a professor with the Chamberlain
College of Nursing MSN Program, teaching in the nursing informatics track.
She has more than 40 years of experience in the fields of nursing informatics,
healthcare informatics, and nursing education. After conducting clinical prac-
tice in critical care and trauma nursing for several years, she began practicing
nursing informatics (NI), working with end users and w ith information systems
design, development, testing, implementation and evaluation. She has presented
nursing-informatics research in national and international meetings as well as
publishing numerous articles in peer-reviewed journals. Collaborating in a com-
munity of practice w ith nursing-informatics faculty at Chamberlain, Dr. Hunter
led the work resulting in the development of the TIGER-based Assessment of
Nursing Informatics Competencies (TANIC) tool.

•
XIX
This page intentionally left blank
 en
Q)
O'l

--- - C'O
E
-
•
>,
Q)

-
c,
en
Q)
O'l
C'O
-0E
,._
Q)
I

Chapter 1
•
n verv1ew o n ormatics
•
In eat care
Jennifer A. Brown, MSN, RN, HNB-BC
Taryn Hill, PhD1 RN
Toni Hebda, PhD, RN-C

Learning Objectives
After completing this chapter, you should be able to:
• Provide an overview of the current state of healthcare delivery.
• Discuss the role that technology plays in healthcare.
• Provide a definition for informatics.
• Discuss the significance of informatics for healthcare.
• Describe the process required to create an informatics culture.
• Examine the relationship between technology, informatics, and caring.

The healthcare delivery system today is a complex system faced with multiple, competing
demands. Among these demands are: calls for increased quality, safety, and transparency;
evolving roles for practitioners; a shift in consumer-provider relationships; eliminating dis-
parities in care; adopting new models of care; the development of a learning health sys-
tem (LHS); advanced technology as a means to support healthcare processes and treatment
options; and providing a workforce with the skills needed to work in a highly technology-
laden environment that is reliant upon data and information to function.
Technology is a pervasive part of every aspect of society including healthcare delivery.
Many suggest that health information technology (HIT) provides the tools to enable the
delivery of safe, quality care in an effective, efficient manner while improving communication
and decreasing costs (Institute of Medicine, 2012). HIT was named as one of nine levers that
stakeholders could use to align their efforts with the National Strategy for Quality Improve-
ment in Health Care, a collaborative effort also known as the National Quality Strategy, a
mandate of the 2010 Affordable Care Act (ACA). The National Quality Strategy, published in
2011, represented input from more than 300 groups and organizations from various sectors of

1
2 Chapter 1

healthcare industry and the public (Agency for Healthcare Research and Quality, 2017). Yet,
the healthcare sector has been slow to adopt and use technology to its full potential. Lucero
(2017) noted that the failure for technology in healthcare to live up to its full promise to the
present is not surprising given the complexity of healthcare delivery. So, what is information
technology? Information technology (IT) is a broad term referring to the process of search-
ing, organizing, and managing data supported by the use of computers. It has also come to
include electronic communication. IT represents only a portion of the technology found in
healthcare today, but is significant because data leads to information, which in tum provides
knowledge. This chapter and the book as a whole will discuss the role that informatics plays
to help address the multiple challenges facing healthcare today.

Informatics
Before we can discuss the role of informatics in healthcare, infomatics must first be defined.
The American Medical Informatics Association (AMIA) (2017, Para. 1) states that informatics
is an interdisciplinary field that draws from, as well as contributes to, ''computer science,
decision science, information science, management science, cognitive science, and organi-
zational theory." Informatics drives innovation in how information and knowledge man-
agement are approached. Its broad scope encompasses natural language processing, data
mining, research, decision support, and genomics. Health informatics encompasses several
fields that include:
• Translational bioinformatics. This area deals with the storage, analysis, and interpretation of
large volumes of data. It includes research into ways to integrate findings into the work
of scientists, clinicians, and healthcare consumers.
• Clinical research informatics. This area concentrates on discovery and management of
new knowledge pertinent to health and disease from clinical trials and via secondary
data use.
• Clinical informatics. The concentration here is on the delivery of timely, safe, efficient,
effective, evidence-based and patient-centered care (Levy, 2015). Examples include
nursing informatics and medical informatics. Nursing informatics has its own scope
and standards for practice as set forth by the American Nurses Association (ANA) as
well as certification established by the American Nurses Credentialing Center (ANCC)
(American Nurses Association, 2015a). AMIA began the process, in 2007, of defining clini-
cal informatics and its competencies, to lay the foundation for a credentialing process to
recognize competence of clinical informaticists (Shortliffe, 2011). There is also discussion
at a global level on specialty-board certification for physicians in clinical informatics
(Gundlapall et al., 2015).
• Consumer health informatics. The focus here is the consumer, or patient, view and the
str11ctures and processes that enable consumers to manager their own health.
• Public health informatics. Efforts here include surveillance, prevention, health promotion,
and preparedness.
As might be surmised from a review of the above list, there are areas of overlap among the
fields.
Informatics and its subspecialties-including nursing informatics-continue to
evolve as has the terminology used to discuss this field. For example, medical informatics
was previously used as the umbrella term under which the subspecialties of health
informatics fell.
 An Overview of Informatics in Healthcare 3

The Relevance of Informatics for Healthcare

Informatics is an essential component of healthcare today. The Institute of Medicine (2013a)
noted its vision for the development of a continuously learning health system in which sci-
ence, informatics, incentives, and culture are aligned for continuous improvement and inno-
vation, and new knowledge is captured as a by-product of care processes. Together, HIT
and informatics have been hailed as tools that can streamline processes, improve the quality
of care delivered, reduce mortality, cut costs, and collect data to support learning (Institute
of Medicine, 2012, 2015; Kohli & Tan, 2016; Lucero, 2017; Luo, Min, Gopukumar, & Yiqing,
2016; McCullough, Parente, & Town, 2016; Pinsonneault, Addas, Qian, Dakshinamoorthy, &
Tamblyn, 2017). In fact, the Institute of Medicine (2013b, p. 1) stated that ''digital health data
are the lifeblood of a continuous learning health system.'' Achieving this learning health
system will require the work of many individuals and organizations.
There are several factors to consider on the journey to a learning healthcare system.
These include:
• Healthcare professionals are knowledge workers.
• Structures must be in place to support the collection, interpretation, and reuse of data in
a meaningful way.
• Evidence-based practices are a pre-requisite to achieving optimal outcomes.
• Big data and data analytics are quickly becoming a major source of evidence, augment-
ing, and even replacing, other traditional forms of evidence such as clinical trials.
• HIT and all forms of technology are present but best use is inconsistent.
• Healthcare reform and a learning healthcare system are intricately linked.
• Patient safety and the need to improve quality of care are drivers for healthcare reform.
Each of these will be discussed briefly.

Knowledge Work
Nurses and other healthcare professionals have a long tradition of gathering data, which is
then used to create information and knowledge. When previous knowledge and experience
are applied appropriately to take action or intervene in some fashion, it is known as wisdom.
These processes constitute a major part of the clinician's day and, when done well, yield good
outcomes. As an example, a piece of data without context has no meaning. The number 68 in
isolation conveys nothing. It could be an age, a pulse rate, or even a room number, but in and
of itself, there is no way to know what it means. However, if 68 is determined to be a pulse
rate, the nurse can make the determination that this falls within the normal range, indicating
that the patient is in no distress and requires no intervention. On the other hand, if that same
number represents the rate of respirations per minute, the patient is in respiratory distress
and immediate intervention is required.
Gaberson and Langston (2017) noted that changes in the healthcare system, inclusive of
demands for safe, accessible, quality care, have increased both the awareness of and demand
for well-prepared knowledge workers. Gaberson and Langston also cited the assertion of the
landmark 2010 Institute of Medicine report, The Future of Nursing: Leading Change, Advancing
Health, that nursing is an appropriate profession to play a major role in transforming the
healthcare system; yet, nursing education has not adequately prepared its graduates for
this role. As a consequence, there is a need to better prepare nurses and other healthcare
professionals during their basic education for this role and to provide better options to aid
4 Chapter 1

the new professional to assume the knowledge-worker role and to maintain essential com-
petencies in this area.

Structures to Support Meaningful Use of Data

To be useful, data and information must be available when needed, to whom it is needed,
and in a form that can be analyzed or used. Historically, the healthcare delivery system
has collected huge amounts of data and information from different sources and in different
formats, creating data silos within departments and facilities. Without organization, this
data and information has limited value, even at its collection site, and is not amenable to
sharing for learning purposes. The use of electronic health records (EHRs) moved data and
information to a digital format, which is conducive to organization, analysis, and sharing,
but differences in format still make analysis difficult. Data exists in raw and processed
states and unstructured and structured forms. Examples of unstructured data include docu-
ments, email, and multimedia. Structured data fits into predetermined classifications such
as that seen with a list of selectable options that can easily be quantified. Even before the
widespread adoption of EHRs, there was a growing recognition that improved commu-
nication among professionals required the adoption of standardized languages and ter-
minologies to ensure that a concept had the same meaning in all settings; this also makes
generalization of research findings possible. One example of a standardized language that
is familiar to most nurses is NANDA, which was created by the North American Nursing
Diagnosis Association to provide standardized terms for nursing diagnoses. Standardized
languages and terminologies can be integrated into EHRs. A lack of data standardization
jeopardizes opportunities for learning because important data may not be available for
analysis (Auffray et al., 2016). Standardization of data and its collection in a digital format in
databases facilitate collecting, sorting, retrieval, selection, and aggregation of data to a degree
never before possible. Aggregate data can be analyzed to discover trends and, subsequently,
to inform and educate.
Researchers use both qualitative and quantitative methods to analyze data. Qualitative
methods focus on numbers and frequencies, with the goal of finding relationships or vari-
ables specific to an outcome. Qualitative methods are variable and not focused on counting.
These methods can include any data captured. This data can be in the form of questionnaires,
surveys including web surveys, interviews, list serves, and email. Electronic data collection
tools include personal digital assistants or laptop computers.
Another important facet of information access is related to the electronic literature data-
bases for the health sciences, business, history, government, law, and ethics that healthcare
professionals and administrators use to keep up-to-date and inform their practices. Libraries
purchase electronic literature databases that users can easily search using keywords, Boolean
search operators, title, author, or date to find relevant information. Literature databases use
key terms to index collections. Medical subject headings (MeSH) are used by the controlled
vocabulary thesaurus of the National Library of Medicine (NLM) to index articles in PubMed,
a free search engine maintained by the NLM. PubMed is used to access the MEDLINE biblio-
graphic database. Some other examples of literature databases relevant for healthcare include
EBSCO, Ovid, ProQuest, CINAHL, and Cochrane Library. Becoming familiar with the data-
bases most relevant to one's purpose or focus is important. Adept use requires time and
practice. When searching a database, one should define the subject and the question; then,
search for the evidence in multiple components of the literature: for example, use evidence
from multiple studies (not just one random study), incorporate what was learned into prac-
tice, and evaluate the impact of what was implemented.
Another random document with
no related content on Scribd:
Gutenberg” is associated) is accessed, displayed, performed,
viewed, copied or distributed:

This eBook is for the use of anyone anywhere in the United

States and most other parts of the world at no cost and with
almost no restrictions whatsoever. You may copy it, give it
away or re-use it under the terms of the Project Gutenberg
License included with this eBook or online at
www.gutenberg.org. If you are not located in the United
States, you will have to check the laws of the country where
you are located before using this eBook.

1.E.2. If an individual Project Gutenberg™ electronic work is

derived from texts not protected by U.S. copyright law (does not
contain a notice indicating that it is posted with permission of the
copyright holder), the work can be copied and distributed to
anyone in the United States without paying any fees or charges.
If you are redistributing or providing access to a work with the
phrase “Project Gutenberg” associated with or appearing on the
work, you must comply either with the requirements of
paragraphs 1.E.1 through 1.E.7 or obtain permission for the use
of the work and the Project Gutenberg™ trademark as set forth
in paragraphs 1.E.8 or 1.E.9.

1.E.3. If an individual Project Gutenberg™ electronic work is

posted with the permission of the copyright holder, your use and
distribution must comply with both paragraphs 1.E.1 through
1.E.7 and any additional terms imposed by the copyright holder.
Additional terms will be linked to the Project Gutenberg™
License for all works posted with the permission of the copyright
holder found at the beginning of this work.

1.E.4. Do not unlink or detach or remove the full Project

Gutenberg™ License terms from this work, or any files
containing a part of this work or any other work associated with
Project Gutenberg™.
 1.E.5. Do not copy, display, perform, distribute or redistribute
this electronic work, or any part of this electronic work, without
prominently displaying the sentence set forth in paragraph 1.E.1
with active links or immediate access to the full terms of the
Project Gutenberg™ License.

1.E.6. You may convert to and distribute this work in any binary,
compressed, marked up, nonproprietary or proprietary form,
including any word processing or hypertext form. However, if
you provide access to or distribute copies of a Project
Gutenberg™ work in a format other than “Plain Vanilla ASCII” or
other format used in the official version posted on the official
Project Gutenberg™ website (www.gutenberg.org), you must, at
no additional cost, fee or expense to the user, provide a copy, a
means of exporting a copy, or a means of obtaining a copy upon
request, of the work in its original “Plain Vanilla ASCII” or other
form. Any alternate format must include the full Project
Gutenberg™ License as specified in paragraph 1.E.1.

1.E.7. Do not charge a fee for access to, viewing, displaying,

performing, copying or distributing any Project Gutenberg™
works unless you comply with paragraph 1.E.8 or 1.E.9.

1.E.8. You may charge a reasonable fee for copies of or

providing access to or distributing Project Gutenberg™
electronic works provided that:

• You pay a royalty fee of 20% of the gross profits you derive from
the use of Project Gutenberg™ works calculated using the
method you already use to calculate your applicable taxes. The
fee is owed to the owner of the Project Gutenberg™ trademark,
but he has agreed to donate royalties under this paragraph to
the Project Gutenberg Literary Archive Foundation. Royalty
payments must be paid within 60 days following each date on
which you prepare (or are legally required to prepare) your
periodic tax returns. Royalty payments should be clearly marked
as such and sent to the Project Gutenberg Literary Archive
Foundation at the address specified in Section 4, “Information
 about donations to the Project Gutenberg Literary Archive
Foundation.”

• You provide a full refund of any money paid by a user who

notifies you in writing (or by e-mail) within 30 days of receipt that
s/he does not agree to the terms of the full Project Gutenberg™
License. You must require such a user to return or destroy all
copies of the works possessed in a physical medium and
discontinue all use of and all access to other copies of Project
Gutenberg™ works.

• You provide, in accordance with paragraph 1.F.3, a full refund of

any money paid for a work or a replacement copy, if a defect in
the electronic work is discovered and reported to you within 90
days of receipt of the work.

• You comply with all other terms of this agreement for free
distribution of Project Gutenberg™ works.

1.E.9. If you wish to charge a fee or distribute a Project

Gutenberg™ electronic work or group of works on different
terms than are set forth in this agreement, you must obtain
permission in writing from the Project Gutenberg Literary
Archive Foundation, the manager of the Project Gutenberg™
trademark. Contact the Foundation as set forth in Section 3
below.

1.F.

1.F.1. Project Gutenberg volunteers and employees expend

considerable effort to identify, do copyright research on,
transcribe and proofread works not protected by U.S. copyright
law in creating the Project Gutenberg™ collection. Despite
these efforts, Project Gutenberg™ electronic works, and the
medium on which they may be stored, may contain “Defects,”
such as, but not limited to, incomplete, inaccurate or corrupt
data, transcription errors, a copyright or other intellectual
property infringement, a defective or damaged disk or other
medium, a computer virus, or computer codes that damage or
cannot be read by your equipment.

1.F.2. LIMITED WARRANTY, DISCLAIMER OF DAMAGES -

Except for the “Right of Replacement or Refund” described in
paragraph 1.F.3, the Project Gutenberg Literary Archive
Foundation, the owner of the Project Gutenberg™ trademark,
and any other party distributing a Project Gutenberg™ electronic
work under this agreement, disclaim all liability to you for
damages, costs and expenses, including legal fees. YOU
AGREE THAT YOU HAVE NO REMEDIES FOR NEGLIGENCE,
STRICT LIABILITY, BREACH OF WARRANTY OR BREACH
OF CONTRACT EXCEPT THOSE PROVIDED IN PARAGRAPH
1.F.3. YOU AGREE THAT THE FOUNDATION, THE
TRADEMARK OWNER, AND ANY DISTRIBUTOR UNDER
THIS AGREEMENT WILL NOT BE LIABLE TO YOU FOR
ACTUAL, DIRECT, INDIRECT, CONSEQUENTIAL, PUNITIVE
OR INCIDENTAL DAMAGES EVEN IF YOU GIVE NOTICE OF
THE POSSIBILITY OF SUCH DAMAGE.

1.F.3. LIMITED RIGHT OF REPLACEMENT OR REFUND - If

you discover a defect in this electronic work within 90 days of
receiving it, you can receive a refund of the money (if any) you
paid for it by sending a written explanation to the person you
received the work from. If you received the work on a physical
medium, you must return the medium with your written
explanation. The person or entity that provided you with the
defective work may elect to provide a replacement copy in lieu
of a refund. If you received the work electronically, the person or
entity providing it to you may choose to give you a second
opportunity to receive the work electronically in lieu of a refund.
If the second copy is also defective, you may demand a refund
in writing without further opportunities to fix the problem.

1.F.4. Except for the limited right of replacement or refund set

forth in paragraph 1.F.3, this work is provided to you ‘AS-IS’,
WITH NO OTHER WARRANTIES OF ANY KIND, EXPRESS
OR IMPLIED, INCLUDING BUT NOT LIMITED TO
WARRANTIES OF MERCHANTABILITY OR FITNESS FOR
ANY PURPOSE.

1.F.5. Some states do not allow disclaimers of certain implied

warranties or the exclusion or limitation of certain types of
damages. If any disclaimer or limitation set forth in this
agreement violates the law of the state applicable to this
agreement, the agreement shall be interpreted to make the
maximum disclaimer or limitation permitted by the applicable
state law. The invalidity or unenforceability of any provision of
this agreement shall not void the remaining provisions.

1.F.6. INDEMNITY - You agree to indemnify and hold the

Foundation, the trademark owner, any agent or employee of the
Foundation, anyone providing copies of Project Gutenberg™
electronic works in accordance with this agreement, and any
volunteers associated with the production, promotion and
distribution of Project Gutenberg™ electronic works, harmless
from all liability, costs and expenses, including legal fees, that
arise directly or indirectly from any of the following which you do
or cause to occur: (a) distribution of this or any Project
Gutenberg™ work, (b) alteration, modification, or additions or
deletions to any Project Gutenberg™ work, and (c) any Defect
you cause.

Section 2. Information about the Mission of

Project Gutenberg™
Project Gutenberg™ is synonymous with the free distribution of
electronic works in formats readable by the widest variety of
computers including obsolete, old, middle-aged and new
computers. It exists because of the efforts of hundreds of
volunteers and donations from people in all walks of life.

Volunteers and financial support to provide volunteers with the

assistance they need are critical to reaching Project
Gutenberg™’s goals and ensuring that the Project Gutenberg™
collection will remain freely available for generations to come. In
2001, the Project Gutenberg Literary Archive Foundation was
created to provide a secure and permanent future for Project
Gutenberg™ and future generations. To learn more about the
Project Gutenberg Literary Archive Foundation and how your
efforts and donations can help, see Sections 3 and 4 and the
Foundation information page at www.gutenberg.org.

Section 3. Information about the Project

Gutenberg Literary Archive Foundation
The Project Gutenberg Literary Archive Foundation is a non-
profit 501(c)(3) educational corporation organized under the
laws of the state of Mississippi and granted tax exempt status by
the Internal Revenue Service. The Foundation’s EIN or federal
tax identification number is 64-6221541. Contributions to the
Project Gutenberg Literary Archive Foundation are tax
deductible to the full extent permitted by U.S. federal laws and
your state’s laws.

The Foundation’s business office is located at 809 North 1500

West, Salt Lake City, UT 84116, (801) 596-1887. Email contact
links and up to date contact information can be found at the
Foundation’s website and official page at
www.gutenberg.org/contact

Section 4. Information about Donations to

the Project Gutenberg Literary Archive
Foundation
Project Gutenberg™ depends upon and cannot survive without
widespread public support and donations to carry out its mission
of increasing the number of public domain and licensed works
that can be freely distributed in machine-readable form
accessible by the widest array of equipment including outdated
equipment. Many small donations ($1 to $5,000) are particularly
important to maintaining tax exempt status with the IRS.

The Foundation is committed to complying with the laws

regulating charities and charitable donations in all 50 states of
the United States. Compliance requirements are not uniform
and it takes a considerable effort, much paperwork and many
fees to meet and keep up with these requirements. We do not
solicit donations in locations where we have not received written
confirmation of compliance. To SEND DONATIONS or
determine the status of compliance for any particular state visit
www.gutenberg.org/donate.

While we cannot and do not solicit contributions from states

where we have not met the solicitation requirements, we know
of no prohibition against accepting unsolicited donations from
donors in such states who approach us with offers to donate.

International donations are gratefully accepted, but we cannot

make any statements concerning tax treatment of donations
received from outside the United States. U.S. laws alone swamp
our small staff.

Please check the Project Gutenberg web pages for current

donation methods and addresses. Donations are accepted in a
number of other ways including checks, online payments and
credit card donations. To donate, please visit:
www.gutenberg.org/donate.

Section 5. General Information About Project

Gutenberg™ electronic works
Professor Michael S. Hart was the originator of the Project
Gutenberg™ concept of a library of electronic works that could
be freely shared with anyone. For forty years, he produced and
distributed Project Gutenberg™ eBooks with only a loose
network of volunteer support.

Project Gutenberg™ eBooks are often created from several

printed editions, all of which are confirmed as not protected by
copyright in the U.S. unless a copyright notice is included. Thus,
we do not necessarily keep eBooks in compliance with any
particular paper edition.

Most people start at our website which has the main PG search
facility: www.gutenberg.org.

This website includes information about Project Gutenberg™,

including how to make donations to the Project Gutenberg
Literary Archive Foundation, how to help produce our new
eBooks, and how to subscribe to our email newsletter to hear
about new eBooks.