NCM 110
• A specialty that combines nursing science,
NURSING INFORMATICS
I. INTRODUCTION TO NURSING
INFORMATICS
THEORETICAL BASIS OF NURSING
INFORMATICS
NURSING INFORMATICS
• The use of computer technology in all nursing
endeavors: nursing services, education, and
research (Scholes & Barber, 1980)
computer science and information science to
manage and communicate data, information,
and knowledge to support nurses and
healthcare providers in decision-making.
(American Nurses Association, 2001)
ANA (2015) Definition of Nursing Informatics
• NI supports consumers, patients, the
interprofessional healthcare team and other
stakeholders in their decision making in all roles
and settings to achieve desired outcomes
Means of support: use of information
structures, information processes and
information technology
Goal of NI
• Optimize information management and
communication to improve health of
individuals, families, populations, and
communities
“In all types of health care organizations,
nursing is the hub of the information flow.
Developing the science and technology of
nursing informatics will enhance the
information available to nurses for clinical
practice, management, education, and research
and will facilitate the role of nurses as
communicators.”
Patricia F. Brennan (1996) American Medical
Informatics Association
Graves & Corcoran (1989) Model for NI
Key Terms
• Data – raw facts; discrete entities that are
described objectively without interpretation
• Information – interpretation, organization or
structuring of data
• Knowledge – information that is synthesized
so that relationships are identified and
formalized
KNOWLEDGE
• The awareness and understanding of a set of
information and ways that information can be
made useful to support a specific task or arrive
at a decision
• Can be redefined and restructured
Information is made functional through the
application of knowledge.
WISDOM
• The highest form of common sense, resulting
from accumulated knowledge or erudition
(deep, thorough learning) or enlightenment
(education that results in understanding and
the dissemination of knowledge)
• The application of knowledge to an
appropriate situation
• The foundation of the art of nursing
Nursing (ANA, 2016)
“Nursing is the protection, promotion, and
optimization of health and abilities, prevention
of illness and injury, facilitation of healing,
alleviation of suffering through the diagnosis
and treatment of human response, and
advocacy in the care of individuals, families,
groups, communities, and populations.”
Information Science
• study of the application and usage of
information and knowledge in organizations
and the interface or interaction between
people, organizations, and information systems
(ISs)
• primarily concerned with the input,
processing, output, and feedback of data and
information through technology integration
with a focus on comprehending the perspective
of the stakeholders involved and then applying
information technology (IT) as needed
Cognitive Science
• Study of the mind and how information is
processed in the mind
• Connectionism – component of cognitive
science that uses computer modeling through
artificial neural networks to explain human
intellectual abilities
CONNECTIONISM: NEURAL NETWORK
• Input units – analogs of sensory units
• Hidden units – analogs to all the other
neurons

• Output units – analogs of motor neurons

Computer

• An electronic information-processing machine

that serves as a tool with which to manipulate
data and information

Computer Science
• Offers extremely valuable tools that, if used
skillfully, can facilitate the acquisition and
manipulation of data and information by
nurses, who can then synthesize these into an
evolving knowledge and wisdom base

Information Age

• An age when data, information, and

knowledge are both accessible and able to be
manipulated by more people than ever before
in history
HISTORY AND EVOLUTION OF
NURSING INFORMATICS
UNITED STATES
Prior to : computers were initially used in
1960s health care facilities for basic
business office functions
1960s : “Why computers?” and “What
should be computerized?”; Dr.
Harriet Werley insisted that the ANA
make research about nursing
informatics a priority.
: hospital information systems (HISs)
were developed primarily to process
financial transactions and serve as
billing and accounting systems
1970s : nurses began to recognize the value
of the computer for their profession;
health agencies developed and/or
contracted their own computer-
based Management Information
System (MISs)
1980s : emergence of the microcomputer
or personal computer (PC);
computer-based patient record
systems (CPRSs); NI became an
accepted specialty
1990s • NI was approved by the American
Nurses Association as a new nursing
specialty (1992)
• Computer technology became an
integral part of health care settings,
nursing practice and nursing
profession
• Local area networks (LANs) for
hospital nursing units; wide area
networks (WANs) for linking care
across health care facilities; Internet
for linking across different systems
Post • Wireless tablet computers,
2000s personal digital assistants (PDAs),
smart cellular telephones
• 2004: Bush called for adoption of
interoperable electronic health
record (EHR) for most Americans by
2014; established the Office of the
National Coordinator for Health
Information
PHILIPPINES
1996 : official registration of the
Philippine Medical Informatics
Society (PMIS) under the Securities
and Exchange Commission by its
board composed of eleven
physicians, headed by Dr. Alvin
Marcelo.
1999 : participation of the Philippine
Nurses Association (PNA) in the
development of Standards for
Health Information in the
Philippines (SHIP)
2005 : formation of the Master of
Science in Health Informatics
(MSHI)
2010 : formation of the Philippine
Nursing Informatics Association
(PNIA) as a sub- specialty
organization of PNA for nursing
informatics
2008 : inclusion of NI in the BSN
curriculum (first implemented in
2010)
NURSING INFORMATICS AS SPECIALTY
HEALTH CARE INFORMATICS
• Focuses on managing information in all
healthcare disciplines
• Capture, storage, retrieval, presentation,
sharing, use of biomedical information, data
and knowledge for providing care; problem
solving; and decision, making
General Foci of NI
1. Using data, information, and knowledge for
patient care
2. Defining data in patient care
3. Acquiring and delivering patient care
knowledge
4. Creating new tools for patient care from new
technologies
5. Applying ergonomics to nurse-computer
interfaces
6. Integrating systems
7. Evaluating the effects of nursing systems
2. Highly skilled in using information
management and computer technology to
support their major area of practice:
❑ make judgments based on trends and
patterns within data elements
❑ collaborate with informatics nurse specialists
to suggest improvements in nursing systems

3. Able to meet the information needs of

NURSING INFORMATICS SKILLS practicing nurses by integrating and applying
information, computer and nursing sciences
• Basic computer skills
4. Conduct informatics research and generate
Computer literacy – ability to perform various information theory
tasks with a computer.

Computer fluency – having an adequate

foundation in computer concepts, enabling one
to learn new computer skills and programs
independently.

• Information literacy

- ability to know when one needs

information, and how to locate,
evaluate and effectively use it
(American Library Association, 2016)
- requires critical thinking and problem
solving.

INFORMATICS COMPETENCIES

(Staggers, 2001, 2002)

1. Basic information management and

computer technology skills:

❑ access data

❑ use computer for communication

❑ use basic desktop software

❑ use decision support systems

II. INFORMATICS IN NURSING
PRACTICE
ELECTRONIC HEALTH RECORD AND
CLINICAL INFORMATICS
COMPONENTS OF HER (Institute of Medicine,
2003)
1. Health information and data
• Comprise the patient data required to make
sound clinical decisions
• Demographics, medical and nursing
diagnoses, medication lists, allergies, and test
results
• Details of patient visits and interactions with
patients, medication reconciliation, consents,
directives
• Nursing assessments and problem lists
2. Results management
• The ability to manage results of all types
electronically, including laboratory and
radiology procedure reports
3. Order entry management
• The ability of a clinician to enter medication
and other care orders directly into a computer
• Nursing orders
4. Decision support
• The use of computer reminders and alerts to
improve the diagnosis and care of a patient
(e.g., health risk screening and detection,
clinical guidelines for disease treatment)
5. Electronic communication and
connectivity
• Online communication among healthcare
team members, their care partners, and
patients
• Email, Web messaging, telemedicine,
interoperability
6. Patient support
• Patient education and self-monitoring tools
(e.g., home telemonitoring, telehealth systems,
interactive computer-based patient education)
7. Administrative processes
• Electronic scheduling, billing, claims
management systems
8. Reporting and population health
management
• Data collection tools to support public and
private reporting requirements
• Standardized terminology, machine-readable
format
EHR: ADVANTAGES
Better health care – safety, effectiveness,
patient-centeredness, communication,
education, timeliness, efficiency, equity
Better health – encouraging healthier lifestyles
in the entire population.
Improved efficiencies and lower healthcare
costs – preventive medicine, improved
coordination of healthcare services
Better clinical decision making – integrating
patient information from multiple sources.
INFORMATICS TOOLS TO PROMOTE
PATIENT SAFETY AND QUALITY
OUTCOMES
User-Technology-Patient Safety Scheme
COMPUTERIZED PHYSICIAN ORDER ENTRY
(CPOE)
• an electronic prescribing system designed to
support physicians and nurse practitioners in
writing complete and appropriate medication
and care orders for patients
Benefits:
• Prompts that warn against the possibility of
drug interaction, allergy, or overdose
• Accurate, current information about drugs
• Drug-specific information that eliminates
confusion among drug names that look and
sound alike
• Improved clinical decision support at the point
of care
Bar-code Medication Dispensing and
Administration
• Bar code – a series of alternating bars and
spaces that represents a unique code that can
be read by a special bar-code reader
• Bar-coded medications can also be dispensed
by robots capable of reading the codes or by
automated dispensing machines
• Helps with the processes of procurement,
inventory, storage, preparation and dispensing
BAR CODE MEDICATION ADMINISTRATION
(BCMA)
• Part of EHR
• A free-standing electronic medication
administration system (eMAR)
1. Scan nurse’s name badge (responsible
person)
2. Scan bar code on the patient’s ID bracelet
(pull up medication orders)
3. Scan bar code on each of the medications to
be administered
Automated dispensing machine
• Also known: automated dispensing cabinets
• unit-based cabinets
• automated dispensing devices
• automated distribution cabinets
Mobile apps
• For patient education
• For healthcare personnel – e.g., iScrub app to
monitor hand hygiene
Smart pump technologies for IV drug
administration
• For safe administration of high-hazard drugs
• Reduce adverse drug events during IV
medication administration
• Programmed to reflect the facility’s infusion
parameters and a drug library that compares
normal dosing rates with those programmed
into the pump
• Discrepancies generate alarm
CLINICAL DECISION SUPPORT (CDS)
• Promote accurate medical diagnoses and
suggest appropriate medical and nursing
interventions based on patient data
• 5Rs: right information provided to the right
person in the right format through the right
channel at the right time in workflow
Uses:
• collect patient medication compliance data
• computerized alerts and reminders for
providers and patients
• clinical guidelines
• condition-specific order sets
• focused patient data reports and summaries
• documentation templates
• diagnostic support
• contextually relevant reference information
RADIOFREQUENCY IDENTIFICATION
APPLICATIONS (RFID)
• More expensive than bar coding for packaging
• Reprogrammable
• Contains a tag affixed to an object or to a
person that functions as a radiofrequency
transponder and provides a unique ID code
• Helps with patient tracking during procedures
and testing
• May also be embedded into surgical supplies
to automate supply-counting procedures
SMART ROOMS
• Triggers “need to know’ data based on
caregiver status to be displayed on the monitor
in the patient’s room as the caregiver enters the
room
• Touch-screen technology
• Some include workflow algorithms to alert
clinicians about the procedures that need to be
implemented for the patient
WEARABLE TECHNOLOGY
• A small, unobtrusive monitor that collect and
transmit physiologic data via a cell phone to a
server for clinician review
ROBOTICS 1. Surveillance systems

• Used in minimally invasive surgery • Might indicate early stages of an outbreak

• To assist with patient lifting • Enhanced case finding and monitoring the
course and population characteristics of a
• Performing routine functions such as recognized outbreak
emptying and disposing trash, cleaning rooms,
delivering supplies and meals, and dispensing
drugs.

EDUTAINMENT
• Nutrition education programs: Interactive
computer games, video games, cartoons

• Cancergame – an arcade-style video game for

cancer patients to relieve stress by visualizing
2. Risk Assessment Tools
the fighting of cancer cells
• pesticide use, exposure to harmful chemicals,
contaminants, toxic pollutants.
COMMUNITY/POPULATION HEALTH

PUBLIC HEALTH FUNCTIONS

• Assessment and monitoring of the health of
communities and populations at risk to identify
health problems and priorities
TELEHEALTH
• Formulation of public policies designed to
solve identified local and national health
problems and priorities TELEHEALTH
• Assure that all populations have access to • The use of technology to deliver health care,
appropriate and cost-effective care, including health information or health education at a
health promotion and disease prevention distance
services, and evaluation of the effectiveness of
that care Driving forces:

PUBLIC HEALTH INFORMATICS • Demographics; Shortage of nurses; Chronic

diseases and conditions; Educated consumers;
Economics

TELEMEDICINE
• the use of medical information exchanged
from one site to another via electronic
communications to improve patients’ health
status
Uses of Telehealth Technologies TELENURSING
• Transmitting images for assessment or • The use of telecommunications and
diagnosis information technology to provide nursing
services in health care and enhance care
• Transmitting clinical data for assessment,
diagnosis, or disease management (e.g., remote
monitoring of VS)
PERIPHERAL BIOMETRIC DEVICES
• Providing disease prevention and promotion
of good health (case management provided via • BP cuffs
telephone or smartphone app)
• Blood glucose meters
• Using telephonic or video interactive
technologies to provide health advice in • Pulse oximeters
emergent cases (e.g., tele triage)
• Spirometers
• Using a real-time video
• Peak flow meters

• ECG monitors
Store-and-forward telehealth transmission
• Digital images, video, audio, and clinical data PERSONAL EMERGENCY RESPONSE
are captured and stored on the client computer
SYSTEMS (PERS)
or device; then transmitted securely to a
specialist or clinician at another location • Signaling devices worn as a pendant or
otherwise made easily accessible to patients to
• Real-time (Interactive) telehealth –
ensure their safety and to enable them to
videoconferencing, interactive examination
quickly access emergency care when needed
• Telemental health; Telerehabilitation;
Telehome care; Teleconsultations; Telehospice
or telepalliative MEDICATION MANAGEMENT DEVICES
• A watch that reminds a person to take
medication
REMOTE MONITORING (Telemonitoring or
Remote Patient Monitoring) • Pill organizers with audible reminders
• Devices are used to capture and transmit
biometric data

Nonclinical Uses of Telehealth

Distance education; Grand rounds; Patient

education; Meeting; Research
III. CONSUMER INFORMATICS
AND HEALTH LITERACY 3. Personal Health Records
for patients and their families

Software or website

Reminders to be sent to the user’s web-

enabled phone.

Built-in alerts when to call the physician.

Record of personal disease-specific

information

1. Information Seeking 4. Decision Support

Fast, anonymous, available Multimedia presentations

Multiple sites for accuracy of information Alternative treatment

Common topics: disease, treatments, diet, or Advice for follow-up

nutritional information
Drug-drug interactions
2. Communication and Support
Risk assessment tools
E-mail / Web site / e-visits
5. Disease Management
Online support groups
Currently used mainly by insurers and health
Get health reminders and personalized plans
information.
Enrolled to a program to record data.
Ask questions.
Disease-focused questionnaire
Make appointments.
Devices that capture physical parameters such
Get laboratory results. as weight or blood sugar.

Reasons for Reluctance ISSUES IN CONSUMER COMPUTING FOR

(Manhattan Research, 2004)
Liability
Reimbursement
Confidentiality and security
Impact on office workflow
HEALTH
Variability of quality of information available
to consumers
Lack of security of Internet-based transactions
Uneven accessibility across age, ethnic and
socioeconomic status (Digital Divide)
 Educational and cultural barriers
Physical and cognitive disabilities
Impact on relationship with healthcare
providers
Health Literacy and Health Numeracy
HEALTH LITERACY
"The degree to which individuals have the
capacity to obtain, process, and understand
basic health information and services needed to
make appropriate health decisions."
HEALTH NUMERACY
“The degree to which individuals have the
capacity to access, process, interpret,
communicate, and act on numerical,
quantitative, graphical, biostatistical, and
probabilistic health information needed to
make effective health decisions.”
ELECTRONIC HEALTH RECORD
A client health record database supported by
computer, electronic and communication
technologies.
Previously known as CPR, EMR, EPR, CMR
2001: patient medical record information
(PMRI) as a model identified by the National
Committee on Vital and Health Statistics
(NCVHS)
PMRI:
Dimensions of PMRI
Personal health – personal health record,
nonclinical information, and other supports to
manage wellness & healthcare decision-making.
Health care provider – 24/7 access to
complete accurate patient data.
Population health – identify & track health
threats.
Reasons for Documentation
• COMPLIANCE
• COMMUNICATION
• CONDUCT OF RESEARCH & CLINICAL TRIALS
• COSTING OUT SERVICES
• CREATION OF CLAIMS FOR PAYMENT FOR
SERVICES

“WHEN YOU DON’T HAVE A PAPERLESS

SYSTEM:
• FIRST OF ALL, A LOT OF PAPER IS WASTED.
• SECONDLY, THERE'S A DELAY, AND NUMBER
• THREE, YOU'RE NOT INTERCONNECTED.”

“ASIDE FROM QUICKER TRANSACTIONS,

EMR PROMOTES PRECISION AS EACH
RECORD WOULD BE PATTERNED AFTER
CLINICAL PRACTICE GUIDELINES”

“EMR CAN REDUCE MEDICATION ERRORS…

IT'S CLEAR, NO ABBREVIATIONS, AND THE
SYSTEM CAN DETECT DRUG INTERACTIONS. IF
THE MEDICINES ARE NOT GIVEN, THE SYSTEM
WILL FLAG IT”

“GOING DIGITAL” WOULD REQUIRE BOTH

HARDWARE AND SOFTWARE, AND
CONNECTIVITY WITH OTHER HOSPITALS THAT
ARE ALREADY USING A DIGITAL SYSTEM,
STARTING FROM DIAGNOSIS TO TREATMENT
OF THEIR PATIENTS. AS SUCH, IT WOULD BE
EASIER TO MANAGE A PATIENT'S MEDICAL
HISTORY WITH THE SYSTEM.
IV. ADMINISTRATIVE
APPLICATIONS OF NURSING
INFORMATICS
SYSTEMS LIFE CYCLE
A systematic approach for the development,
implementation, deployment, maintenance and
eventually retirement of information systems
(ISs)
Allows optimization of system performance
and efficiency while conserving resources and
costs
WATERFALL MODEL
1. Feasibility: TELOS Strategy
Technological and systems feasibility –
expertise and infrastructure
Economic feasibility – cost-benefit analysis
Legal feasibility – legislations, contracts
Operational feasibility - effectiveness
Schedule feasibility – time frame viability
2. Analysis phase – examination of work flows
and business practices
3. Design phase – establishing which programs
are needed
4. Implementation – programming
5. Testing – alpha and beta
6. Maintenance – user software
Healthcare Computing Personnel &
Automated Data
Healthcare Computing Personnel
Chief Information Officer (CIO)
- or Director of Information Services (DIS)
- administratively responsible for the
operation of the information services
department
System analyst
- work with users to define their
information needs and design systems
to meet those needs.
 Programmers
- design, code and test new software
programs as well as maintain and
enhance current applications.
Microcomputer specialist
- support personal computer users
throughout the institution; install new
software, troubleshoot or repair
personal computers, answer user
questions, and train users on new
software.
Computer operators
- an individual who runs a mainframe or
minicomputer; have minimal
interactions with health care providers.
Information specialists
- health care professionals who have
completed additional education r/t the
field of informatics.
TYPES OF AUTOMATED DATA
Clinical or client data – all data r/t an
individual client
Financial data – all the fiscal data r/t the
operation of the health care institution
Human resources data – all data r/t
employees
Material resources data – all the tangible
resources used in the operation of the health
care institution.
Intellectual data – factual data stored in
various disciplines or subject-specific database.
Healthcare information Systems
Integrate or interface various applications
throughout the organization.
Manage admission, discharge, and transfer.
Interface with financial systems
Produce a number of administrative reports
to support daily operations and long-term
planning.
HIS: Core Business Systems
1. ADT system – provides and tracks patient
details; all patient interactions are tracked or
linked to basic information such as
demographics, insurance information, care
providers, next of kin
2. Financial Systems – track financial
interactions and provide the fiscal reporting
necessary to manage an institution
3. Acuity Systems – monitor the range of
patient types within a healthcare organization
using specific indicators; provide feedback
about how intensive the care requirement is for
an individual patient or group of patients
4. Scheduling Systems – coordinate staff,
services, equipment, and allocation of patient
beds
Informatics in Management and
Quality Improvement
Uses of Management Information Systems for
Nurse Administrators
Financial management
Process improvement – to meet requirements
for quality, customer satisfaction and financial
goals.
 Project management – to keep projects on General systems theory
time and within budget
Chaos theory
Human resource management
Cognitive science
Quality improvement
Usability theory
Benchmarking
Learning theories.
Business intelligence/Healthcare data
analytics – integrate financial data, patient data
and quality data to produce predictive and
prescriptive analytics for decision makers in
Contributions of Theories of Informatics
healthcare Sociotechnical theory and social informatics –
improve interaction between an information
Process Improvement
system and the organizational culture.

Change theory – increase the chance of

success in implementing a system by attending
to the reactions to the change.

General systems theory – contribute to the

understanding of the complexity of an IS.

Chaos theory – improve the design of an IS.

Project Management Cognitive science – improve the ability of user

1. Initiation – comparable to assessment and
diagnosis
2. Planning – identify process changes,
materials needed to complete the change, any
educational needs
3. Execution
4. Monitoring/evaluation – progress reports
5. Closing – sustainability of the new process
to gain knowledge from an IS.
Usability theory – improve ease of use and
satisfaction with an IS.
Learning theory – teach the use of a system
and design or select computer-aided
instruction.
NI theory – convert data into information and
information to knowledge; nurse adds wisdom

Tools Used in Management and QI

THEORIES RELATED TO NI Spreadsheets
Sociotechnical and social informatics Flowcharting software applications – nurse
administrators can map processes in patient
Change theories.
care.
Rogers’ diffusion of innovations theory
Cause-and-effect charts – also known as
Lewin’s field theory fishbone chart.
 Project management software – tracks the
project’s progress using tools such as a Gantt
chart.

Human Resource Management Software

(HRMS) – essential for planning and staffing
nursing services appropriately.

HRMS Components
Personnel profile

Daily work schedules and time-off requests

Payroll data

Education, skills qualifications, and licensing

information