NCM110 LECTURE
NURSING INFORMATICS
FINALS NOTES FOR NURSING INFORMATICS
TOPIC OUTLINE:
I. Application of nursing informatics to
nursing practice
a. Electronic health record system
- EHR
- EMR
b. Healthcare information system
- Clinical information system (CIS)
- Administrative information system
- Smart technology
c. Consumer health informatics application
- EHealth Literacy
- Patient engagement
- Health games
- MHealth
- eHealth
- personal health records and patient
- health: tracking & disease management
d. public health informatics systems
- electronic lab reporting
- health statistics surveys
- health surveillance systems
e. connected healthcare (telenursing and
technology enabled healthcare)
II. Application of Nursing Informatics to Education
and Research
a. Education
- Educational Software Sources
- Technology Tools Supporting Education
- Simulation, Game Mechanics, and Virtual Worlds
in Nursing Education
b. Use of Informatics to Support Evidence-
based Practice and Research
- Data Collection, Processing, and Analysis
- Data Mining as a Research Tool
- Data Analytic
APPLICATION OF NURSING INFORMATICS TO
NURSING PRACTICE
ELECTRONIC HEALTH RECORD SYSTEM
ELECTRONIC HEALTH RECORD
 It is an electronic version of a patient’s medical
history, that is maintained by the provider over time,
and may include all of the key administrative clinical
data relevant to that persons care under a particular
provider, including demographics, progress notes,
problems, medications, vital signs, past medical
history, immunizations, laboratory data and
radiology reports.
ELECTRONIC MEDICAL RECORD
 The EMR, or electronic medical record, refers to
everything you’d find in a paper chart, such as
medical history, diagnoses, medications,
immunization dates, and allergies. While EMRs
work well within a practice, they’re limited because
they don’t easily travel outside the practice. In fact,
the patient’s medical record might even have to be
printed out and mailed for another provider to see it.
PERSONAL HEALTH RECORD
 A PHR is an electronic record of an individual’s
health information by which the individual controls
access to the information and may have the ability
to manage, track, and participate in his or her own
health care. PHRs universally focus on providing
individuals with the ability to manage their health
information and to control, to varying extents, who
can access that health information. A PHR has the
potential to provide individuals with a way to create
a longitudinal health history and may include
common information such as medical diagnoses,
medications, and test results
PRIMARY DIFFERENCES
 The primary differences between EHR, EMR, and
PHR are who has access to the healthcare
information. The HER are medical records access
by all medical providers, the EMR have limited
access and medical information for a patient’s
specific primary care physician. The PHR is
controlled by the patient who information must
remain confidential and cannot be released unless
the patient signs a HIPAA document that allows a
physician or medical facility to access the patients’
medical information.
RELATIONSHIP BETWEEN HER AND EMR?
 EHR is a digitized record system of all types of
health information, whereas EMR is a digitized
system of medical records maintained in the form of
a chart.
 EHR is easily accessible and can be shared with
healthcare providers and practitioners across health
organizations. EMR, on the other hand, are used for
individual practice and are not meant to be shared.
 EHR mainly consists of information like diagnoses,
immunization calendar, lab reports, imaging
records, allergy records, demographic data,
insurance records, etc. EMR is a minimized version
of EHR with relevant information related to an
individual patient.
 EHR gives the flexibility to the patient party to
schedule their own appointments and streamlines
the workflow of the staff as everyone is on the same
page. EMR mainly facilitates the workflow of an
individual practitioner.
SIMILARITIES
 Both supports cloud technology and provides
unlimited storage capacity of the records for an
extended period of time.
 Unlike the paper-record system, both ensure no
loss of data as the information is protected from any
type of natural or artificial disasters.
 Both EMR and EHR are a one-time charge solution
assuring overall cost reduction in maintaining
patient records.
 Both makes sure the data is safe and secure and a
good EHR and EMR system will provide authorized
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NURSING INFORMATICS
FINALS NOTES FOR NURSING INFORMATICS
hosting provider services that look after the
maximum security of data.
 Both guarantees ease of use and hassle-free
healthcare management
MEANINGFUL USES RELATED TO EHR
 EHRs are built to share information with other
health care providers and organizations – such as
laboratories, specialists, medical imaging facilities,
pharmacies, emergency facilities, and school and
workplace clinics – so they contain information from
all clinicians involved in a patient’s care
AN EHR IS NECESSARY TO MEET MEANINGFUL USE
REQUIREMENTS:
1. Meaningful Use is a Medicare and Medicaid
program that supports the use of an EHR to
improve patient care.
2. To achieve Meaningful Use and avoid penalties on
Medicare and Medicaid reimbursements, eligible
providers must follow a set of criteria that serve as a
roadmap for effectively using an EHR.
3. CMS has renamed the Medicare Meaningful Use
program into MIPS and the Medicaid program into
Promoting Interoperability.
4. Using Practice Fusion enables you to meet the
criteria for Meaningful Use so you can receive
reimbursement
BENEFITS OF EHR
The EHR is the future of healthcare because they provide
critical data that can help coordinate care between everyone
in the healthcare ecosystem.
 Comprehensive view of the patient
o Dynamic patient-centered records that
track the care continuum over the person’s
lifetime, in sickness and health. Having a
single, continuous record for a patient
provides a holistic view of overall health for
better diagnosis and lifetime treatment.
 Results management
o No Need to Duplicate Recent
o An EHR lets you receive lab results,
radiology reports, and even X-ray images
electronically while ensuring tests are not
duplicated. Without access to lab results
and other tests in a timely fashion, medical
providers sometimes are forced to make
their patients repeat tests. Instead of
scrambling for the fax machine or calling
up a lab to get the needed information, the
staff can access test results by connecting
with data via an EHR solution. It’s also
bothersome when the tests are expensive,
such as an MRI.
 Patient support
o Engage your patients by allowing to them
to receive educational material via the
EHR and enter data themselves through
online questionnaires and home
monitoring devices.
 Administrative processes
o The system lends a hand with practice
management and helps avoid delays in
treatments. Patients can schedule their
own appointments and staffers can check
on insurance eligibility.
 Coordinate Care Among Multiple Health Care
Providers
o Whether your patient needs to go to an
after-hours clinic, a hospital or emergency
room or a specialist, it’s important that the
staff at these facilities gain access to all
pertinent information. An EHR system
helps you coordinate care among multiple
health care providers, giving them access
to the most recent data in the patient’s
chart.
 Access Health Records
o Whenever You Want Another great benefit
of EHR systems for patients is their ability
to access their health records whenever
they want. waiting for the results of a lab
test, and getting access to this information
through a safe and secure system from the
privacy of home with a personal computer
can mean the difference between suffering
through an anxiety-filled weekend or
getting to relax because the results were
available sooner
CURRENT FUNCTIONALITY OF EHRS
 Contain a patient’s medical history, diagnoses,
medications, treatment plans, immunization dates,
allergies, radiology images, and laboratory and test
results.
 Allow access to evidence-based tools that providers
can use to make decisions about a patient’s care.
 Enables the sharing of data, increase their
engagement in their care and improving care
coordination between the healthcare provider and
other healthcare providers. It can help with patient
teachings and promote self-care management.
 Automate and streamline provider workflow
HEALTHCARE INFORMATION SYSTEM
CLINICAL INFORMATION SYSTEM
 CIS is a computerized system that compiles,
maintains, and verifies all of your medical data.
Your medical history, medications, doctor's notes,
dictation, and other data are all stored electronically
in one place. The old paper charts have been
replaced by this.
ADMINISTRATIVE INFORMATION SYSTEM
 Administrative Information Systems (AIS) refers to
the applications that generally comprise the
environment that supports Banner, the campus
administrative system, and also includes other
applications that may or may not support or require
integration with Banner.
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NURSING INFORMATICS
FINALS NOTES FOR NURSING INFORMATICS
DIFFERENCE OF CIS & AIS
 Physicians are required to record administrative
data, such as activity measurement, case mix for
their specialty, billing, for statistical, legal, or
reimbursement purposes. On the other hand, they
are also required to gather detailed patient data,
such as clinical evolution, for the patients' daily
care, or for clinical research. Both on the
administrative side, with registration officials and
administrators, and on the clinical side, with nurses
and other care providers, there are numerous
additional players involved in these processes.
Applications for gathering and distributing
information in accordance with these particular
actors and specialized purposes have been
developed within hospital information systems.
APPLICATION OF CLINICAL INFORMATION SYSTEM
 To continually monitor extremely sick patients.
 All such measurements can be captured, recorded
and collated electronically.
 This reduces the need for many different paper-
based forms
 Saves time and reduces the risk of error
EXAMPLES OF CLINICAL INFORMATION SYSTEM
 Electronic Medical Record (EMR) and Electronic
Health Record (EHR)
 Practice Management Software.
 Master Patient Index (MPI)
 Patient Portals.
 Remote Patient Monitoring (RPM)
 Clinical Decision Support (CDS)
APPLICATION OF ADMINISTRATIVE INFORMATION
SYSTEM
 Can reduce the chance of errors
 It’s also a great way to gather, store, and retrieve
patient information when needed.
 Easier Scheduling
 Reducing Cost
 Easy Transfer and Access to Data
 Fewer Errors
 Handling Emergencies and Adapting to Change
 Higher Patient Satisfaction
SMART TECHNOLOGY
 Smart technology in healthcare is a health service
system that uses technology such as wearable
devices, and mobile internet to dynamically access
information, connect people, materials and
institutions related to healthcare, and then actively
manages and responds to medical ecosystem
needs in an intelligent manner.
 Smart technology in healthcare is changing the way
patients are treated with telehealth, remote care,
and health monitoring technology connecting
patients and doctors like never before.
FIVE EXAMPLES OF SMART TECHNOLOGY IN
HEALTHCARE
REMOTE MONITORING AND AUTOMATED
HEALTHCARE SYSTEMS
 A growing trend that goes beyond traditional
healthcare and into mainstream culture. For
example, connected inhalers are a smart
technology in healthcare that saves lives by helping
patients to track usage and by reminding them
when to take a dosage to maintain a healthy
schedule.
TELEHEALTH AND REMOTE CARE
 Part of this virtual care was the use of medical
portal technology to build secure online healthcare
portals to help providers and patients track
treatment, store health records, and collect and
access data from wearable devices or clinic visits.
CONNECTED EMERGENCY RESPONSE SOLUTIONS
 Connectivity can greatly improve the efficiency and
response times of emergency care, something that
can be the difference between life and death.
 With modern healthcare smart technology, it’s
possible to share data between ambulances,
physicians, first responders, and accident and
emergency departments in a reasonable amount of
time that allowed for a real time response.
SMART HOSPITAL MANAGEMENT
 Smart hospital management can help improve
efficiency and effectiveness, improve patient
experience, and help doctors by connecting digital
systems to make it easier to access information like
bed occupancy, device usage, equipment status,
materials and supply counts, and other operational
data.
AI IN HEALTHCARE
 Utilizing AI within healthcare can help providers
make more informed decisions and greatly improve
patient care with proactive care predictions, quicker
data analysis, and even more rapid diagnosis.
BENEFITS OF SMART TECHNOLOGY TO PATIENTS
 Promotes ethical and effective care delivery to
patients
 Allow patients an immediate access to their health
data
 Help patients to track and monitor their vital signs
 It saves money and time
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FINALS NOTES FOR NURSING INFORMATICS
BENEFITS OF SMART TECHNOLOGY TO HEALTHCARE
PRACTITIONERS
 Easy access to patient medical records.
 Reduction in medical errors
 Greater patient care
 Reduction in cos
CONSUMER HEALTH INFORMATICS
 Consumer health informatics functions as a
subdiscipline of general health informatics. It focuses
on understanding consumer needs, finding ways of
making health data and services more accessible,
and considering patient preferences when
developing health information systems.
IMPORTANCE OF PATIENT ENGAGEMENT IN NURSING
INFORMATICS
WHAT IS PATIENT ENGAGEMENT?
 Patient engagement has become a key strategy that
refers to the tools and actions taken by patients,
caregivers, and healthcare providers to promote
informed decision-making and behaviors to facilitate
improved health outcomes. The importance of
“patient engagement” has been widely researched
and discussed with evidence supporting its
significance on lowering cost and improving patient
outcomes. What is interesting is that amid all of the
industry buzz, “patient engagement” is not a
revolutionary new concept.
 In the business world, it is called “consumer
engagement.” Retailers, banks, and other service-
related industries have all been providing their
customers with information, tips and other forms of
communication attempting to engage their
consumers. For decades, marketers have been
seeking new strategies to engage the customer,
create better experiences, and strengthen brand
relationships all aimed at improving outcomes.
Those who don’t deliver are likely to be put out of
business by those that meet this demand. There is
nothing new or groundbreaking about this strategy.
In fact, it is in almost every marketing and business
textbook ever written.
TECHNOLOGY’S ROLE IN PATIENT ENGAGEMENT
 Medical providers have long understood the value of
having a patient engaged in their own health. While
the concept of “patient engagement” may not be
new, what is new is the significant role that
technology is having on patient engagement. A
recent survey performed by Deloitte suggests patient
engagement is seeing the most growth within the use
of technology.
 Consumers are becoming more trusting of
healthcare information online. Social media and
patient portal use for healthcare data have also seen
significant growth. We are living in a connected and
engaged society. The Internet allows us to get what
we want on demand at our fingertips. Patients and
consumers have started placing these same
expectations on healthcare.
 Below are a few statistics from Google and Pew
Research Center that further support the impact
technology is having on patient engagement:
o 4.7 billion: daily Google searches
o 1 in 20 Google searches is for health-related
information
o 80 percent of Internet users seek online health
information
o 77 percent of patients used a search prior to
booking an appointment
o 66 percent of Internet users look online for
information about a specific disease or medical
problem
o 44 percent of Internet users look online for
information about doctors or other health
professionals
TECHNOLOGY AND TOOLS FOR PATIENT
ENGAGEMENT
 Some of the latest technologies focused on
patient engagement involve managing patient
health data, managing communication with
physicians, self-care at home, education, and
financial management. From wearable tech and
medical devices to patient portals and personal
health records, all of these innovations are
aimed at improving the overall patient
experience.
 With the implementation of health information
exchanges, electronic health records, and
patient portals, patients are naturally becoming
more engaged in their health. Healthcare
institutions and practices should embrace and
integrate these changes while seeking to adapt
to this new and rapidly evolving landscape.
 Of course, all of these tools are useless if the
patient does not have interest in taking an active
role in their health. Patient engagement requires
action that must be initiated and sustained by
the individual. It is also through the
encouragement of the provider that patients
learn to utilize tools and technology that produce
improved health results. If neither the provider
nor the patient is interested in the utilization of
these technologies, then no one will benefit from
them. Engagement implies active involvement.
All parties must be willing to participate and
embrace the shift to technology, in order to
achieve better outcomes and reduce costs.
THE BENEFITS OF PATIENT ENGAGEMENT
 Reduced costs: Technology such as EMR/EHR can
help improve workflow through the use of shared
information. This can reduce or eliminate paperwork,
assure accurate information and provide patients
with a better experience. Technology can reduce
errors, improve scheduling, insurance, and
payments.
 Increased communication: Through the use of
technology, physicians and patients can
communicate with one another more often and
provide updates or changes on the patients’
condition.
 Increased patient satisfaction: Through increased
communication and more information regarding their
health, patients are more confident regarding their
condition and diagnoses.
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 Population health: Through the improvement of
health-related information systems, scientists can
analyze public health data that can help to identify
trends and improve outcomes.
CHALLENGES OF PATIENT ENGAGEMENT
 For healthcare institutions and medical practices,
successful patient engagement relies not just on new
technology but also on a cultural shift. As the industry
adapts to these changes, providers and healthcare
administration must be prepared to face obstacles
such as:
o difficulty shifting behaviors
o different communication preferences
o lack of health information exchanges
o technology ease of use
o operational and implementation challenges
o workforce reluctance
 The many benefits of new health care technology
and patient engagement have been proven to
outweigh the costs and challenges of
implementation. However, successful adaptation
and cultural shifts rarely occur without obstacles.
Also, one of the biggest challenges that remain is the
implementation of effective evidence-based methods
of measurement for patient engagement.
 Current practices devoted to improving patient
engagement show a lack of defined guidelines and
confusion about what patient engagement is, how it
is achieved, and how to produce meaningful
outcomes. Researchers and policymakers recognize
the importance of having an evidence-based
measurement of patient engagement, as it is a
necessary tool for planning and implementing
initiatives. However, with very few studies and limited
data available, there is a lack of clearly defined
evidence-based guidelines available.
 While researchers and stakeholders continue to
debate the most effective methods of measuring
patient engagement techniques, more formalized
studies are underway. In the meantime, healthcare
providers will be performing their own analytics and
measurements regarding their patient engagement
activities.
FEATURES, ADVANTAGES, AND DISADVANTAGES OF
VARIOUS HEALTH INFORMATICS APPLICATIONS
FEATURES OF EHEALTH LITERACY
1. Efficiency
2. Enhancing the quality of care
3. Evidence-based
4. Empowerment of consumers and patients
5. Encouragement
6. Education
7. Enabling
8. Extension
9. Ethics
10. Equity
FEATURES OF PATIENT ENGAGEMENT
1. Engaging with patients through collaboration
2. Understanding patient goals
3. Listening to the patient
4. Understanding the purpose of treatment and
medication
5. Respect and empowerment through patient
engagement
FEATURES OF HEALTH GAMES
1. Effective in focusing a patient’s attention away
from the pain caused by their treatment
2. Education is the primary goal rather than
entertainment
3. Improve cognitive and motor skills of patients
during the rehabilitation process
FEATURES OF MHEALTH
1. Health tracking and care support
2. Usability
3. Health data privacy
4. Data transfer and communication with providers
5. Behavior change techniques
FEATURES OF PERSONAL HEALTH RECORDS AND
PATIENT PORTALS
1. Track and assess the client’s health
2. Make the most of doctor visits
3. Manage a client's health between visits
4. Organized
5. Securely message the doctor
6. Request prescription refills
7. Schedule non-urgent appointments
8. Check benefits and coverage
9. Update contact information
10. Make payments
11. Download and complete forms
12. View educational materials
FEATURES OF HEALTH TRACKING AND DISEASE
MANAGEMENT
1. Nutrition Tracking
2. Goal Setting
3. Progress Tracking
4. Heart Monitoring
5. Sleep, Food, and Water Tracker
6. Patient self-management Education
7. Online Consultation
8. Tracking Number of Steps Taken
9. Push Notification System & Reminders
10. Evidence-based practice guidelines
ADVANTAGES OF VARIOUS HEALTH INFORMATICS
APPLICATIONS
 Cost Reduction – Healthcare informatics has
contributed immensely in reducing cost in the
medical business as it has a way of minimizing
medical errors which costs a lot in the business.
Statistics had it that each year, about $136 billion
takes over error costs in the United States. However,
technologies like Computer Provider Order Entry
Systems (CPOE) or Clinical Decision Support
Systems (CDSS) are programmed to detect medical
errors specifically in duplication, mismatches, and
allergies of patients based on their data, leading to
huge cost-reduction for healthcare companies.
 Enhanced Coordination – With an increase in
specialization of healthcare, patients usually receive
care simultaneously from different medical
professionals in one hospital stay. This increase in
the number of medical professionals attending to a
patient may lead to a certain level of incoordination.
Health informatics makes the necessary
coordination possible by allowing health
professionals involved in a patient’s care to
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simultaneously record, disseminate, and share
updates, logs, and findings. It also ensures that
conversations regarding issues like blood levels,
therapy, nutrition, discharge instructions, etc. are
made in tandem with one another so as to avoid
problems.
 Better and More Efficient Storage of Patient
Records – For a long period of time, most medical
facilities used outdated methods to store patient
records. Even to this day, a large number of hospitals
around the world still use paper-based system of
patient data storage. However, with the informatics
industry booming and allowing for new electronic
technology and information systems e.g., Electronic
Health Record (EHR) systems, the management of
patients’ records is now made faster and easier.
Medical professionals now find patient’s data stored
in convenient coded computer systems. Also,
workload is drastically reduced as searching for data
using the manual processes puts extra stress on the
entire personnel of a medical facility thereby
hindering their ability to work efficiently throughout
their shift.
 Patient Empowerment – Patients having electronic
access to their own health history and
recommendations are most likely to be empowered
in taking care of their health. In addition to keeping
track of their symptoms and medications, having
access to information allows patients to be more
involved in their treatment plans and stay better
informed about their conditions. This systematic
process also allows patients to reach out to the right
healthcare professional or access expert advice in
real-time when needed. These innovations taking
over the healthcare industry creates a wide array of
possibilities in the medical field. This systematized
process encapsulates everything from electronic
access to patients’ data, less trial-and-error
operations, reduced cost in the business, and high-
quality care delivery.
 Improved Outcomes – With manual jobs and tasks
now being automated, time and money are being
saved both for patients, hospitals, insurance
companies, and even the government. Also, there
are now improved diagnoses and lesser errors,
which have led to an increase in healthcare
efficiency.
 Patient Privacy – Data confidentiality and patient
privacy is a very vital aspect in healthcare, therefore,
using blockchain technology, medical professionals
are already experimenting with new methods of data
encryption. When data gets encrypted, patients and
doctors wouldn’t have to worry about data breaches
and compromised data, as records will now be
completely safe. This particularly fosters patients’
faith in doctors and makes them eager to provide
more crucial information. Out of all the benefits of
health informatics, blockchain-powered privacy
benefits are perhaps the closest to becoming a
standard.
DISADVANTAGES OF VARIOUS HEALTH INFORMATICS
APPLICATIONS
 Disadvantage #1 – Expensive
 An increasingly sophisticated health technology
does not come cheap. We have to understand that
all first world national healthcare systems face a
range of challenges; one of which is the ageing
population. People are living longer. So, what does
this imply? This means an increased health needs
but the working population generating income to pay
for healthcare system is reduced.
 Disadvantage #2 – Requires time to adapt fast
 As we know, technology is constantly evolving. Many
a time there will be new software, new upgrades,
new way of doing things. In order to keep up with the
competitive edge, hospital staff has to keep up with
such changes. This can be a struggle for some,
especially for the older staff.
 Disadvantage #3 – Over-dependency on
technology
 While once the staff has adapted to the new way of
work, there comes the next problem. It is not
uncommon for a computer system to face technical
errors. The health care informatics system is no
exception. This problem is especially crucial in the
Accident & Emergency (A&E) Department. Various
departments in the hospital are interconnected by a
common information system. When 1 department is
down, others are affected. For example, a patient
was rushed into the A&E Department. When there is
an error while retrieving blood analysis information,
the rest of the procedures following it will be delayed.
This will cause huge inconveniences, or worse; it
may even have adverse effects in the patient’s health
condition.
 Disadvantage #4 – Susceptibility to network
hackers
 Patients’ medical history and other health information
should be kept confidential for ethical and legal
reasons. While the health care system network is
equipped with security measures, it is not impossible
for network hacking to occur. Hence, this is certainly
a vulnerability of Health Informatics.
RECOMMENDATIONS FOR CONSUMER EVALUATION
OF ONLINE INFORMATION
 Check for the currency of the Information:
o When was the information published or
posted?
o Has the information been revised or
updated?
o Does your topic require current information,
or will older sources work as well?
o Are the links functional?
 Check for the Relevance of the Information:
o Does the Information relate to your topic or
answer your question?
o Who is the intended audience?
o Is the Information at an appropriate level?
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o Have you looked at variety of sources
before determining this "Information" is the
one you will use?
 Check for the Authority:
o Who is the Author, Publisher, or Source of
the Information?
o What are the author's credentials or
organization affiliation?
o Is there a contact information such as
email?
o Does the URL reveal anything about the
author or source? Example: .com, .edu,
.gov, .org, .net
 Check for the Accuracy of the Information:
o Where does the information come from?
o Is the information supported with evidence?
o Are there spelling, grammatical, or
typographical errors?
o Can you verify any of the information in
another source or from personal
knowledge?
PUBLIC HEALTH INFORMATICS SYTEM
 Public health information System is the systematic
application of information, computer science, and
technology to public health practice, research, and
learning. This system captures information on
disease incidence for diseases, which require
accurate and timely information for effective
prevention and control.
 Public Health Information Systems are used to store
and make available service data that reflect activities
performed by public health organizations and other
health-related entities. It store and make available
population-based data that are important for
surveillance, program evaluation, policy making, and
priority setting in public health.
ELECTRONIC LAB REPORTING
 the transmission of digital laboratory reports, often
from laboratories to state and local public health
departments, healthcare systems, and CDC
 Receiving timely, accurate, complete, and consistent
laboratory report data can improve the effectiveness
and efficiency of public health responses to
outbreaks.
 PROCESS OF ELR:
o Healthcare facilities and laboratories must
notify public health agencies, like the state
or local health department, of reportable
conditions. Historically, these reports are
received through mail, fax, or phone calls
and manually entered into electronic
systems used for disease surveillance and
case management. ELR automates a large
portion of the reporting process by
translating the information in a laboratory
system into an electronic message that can
be automatically sent to and processed by
the public health agency.
 1. result(s) are entered and stored securely in a
Laboratory Information Management System (LIMS).
LIMS is a software-based system that supports key
laboratory functions like workflow, specimen and
result tracking, and electronic data exchange
 2. The information in the LIMS is used to create
standardized electronic messages, like HL7 v2.5.1 or
other ELR formats, that can be processed and
understood by other electronic systems.
 3. After these electronic messages are created, they
are sent from the laboratory to public health partners,
like the state health department or CDC, through
secure transport mechanisms.
 4. The public health agency receives the ELR
messages and processes them into electronic
systems that store information on reportable
conditions. The ELR data may be added to existing
case reports or may be used to initiate a new report.
 5. Depending on the condition, the state or local
health department may reach out to the patient or
healthcare system to perform a case interview,
initiate contact tracing, release medical
countermeasures from the Strategic National
Stockpile, or take other public health action.
 IMPORTANCE OF ELR:
o ELR Improves Laboratory Report Data
Quality
o ELR Foundations Strengthen COVID-19
Laboratory Reporting
HEALTH STATISTICS SURVEY
 Increases in international funding for health have
been accompanied by accelerating demand for more
and better statistics, which are needed to track
performance and ensure accountability.
 This rapid escalation of demand has exposed major
gaps in the supply of health statistics for developing
countries but also provides major opportunities to
increase the supply and use of sound health
statistics.
 emphasis on monitoring and evaluation is leading to
proliferation of indicators and excessive reporting
requirements, and needs to be refocused on
systematic investments in data generation and
analysis
 the risk of inadequate or poorly targeted investments
can be kept to a minimum by understanding the
causes of poor availability of health statistics,
including lack of accurate measurement instruments,
application of suboptimum methods of data
collection, and inadequate use of methods and
analyses to produce comparable estimates.
 (the risk of inadequate or poorly targeted
investments can be kept to a minimum by
understanding the causes of poor availability of
health statistics, including lack of accurate
measurement instruments, application of
suboptimum methods of data collection, and
inadequate use of methods and analyses to produce
comparable estimates.)
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 (accelerate the production and use of accurate,
complete, and timely health statistics for decision-
making by investing in country health information
systems that should be based on an efficient and
effective mix of standardised methods of data
collection and analysis that meet country and
international needs.)
HEALTH SURVEILLANCE SYSTEMS
 The ongoing, systematic collection, analysis, and
interpretation of health-related data essential to
planning, implementation, and evaluation of public
health practice, closely integrated with the timely
dissemination of these data to those responsible for
prevention and control.
GOAL OF PUBLIC HEALTH SURVEILLANCE
 Provide information that can be used for health
action by public health personnel, government
leaders, and the public to guide public health policy
and programs.
CONNECTED HEALTHCARE (TELENURSING AND
TECHNOLOGY ENABLED HEALTHCARE)
 CONNECTED HEALTH is a vision, a new model for
managing people’s health. It transcends episodic
care and takes a more comprehensive and a more
long-term view.
 In a CONNECTED HEALTH WORLD, providers,
caregivers and patients have access to the right
information at the right time in the right form to
make better decisions. Connected Health not only
connects providers to patients (as in Telehealth),
but also consolidates health-relevant information
from multiple sources inside and outside the
system, to inform decision making. Ultimately,
better outcomes are about better decision making
including the decisions patients make.
 CONNECTED HEALTH is the vision of knowledge-
driven care: a fully-networked healthcare system
where patients and providers can easily connect
with one another regardless of their location,
doctors connecting with patients, generalists
connecting with specialists, caregivers connecting
with loved ones, etc. and where all pertinent
information (patient condition, health history,
treatment options) is readily available to facilitate
quality decision making
4 COMMON TERMS IN CONNECTED HEALTH
 Telehealth - is a broad, catch-all term, referring to
electronic and telecommunications technologies
used to provide remote care and services.
 Telemedicine - at the intersection of healthcare
and technology, is frequently used for primary and
urgent care, monitoring and evaluating conditions,
medication management, mental health services,
and an expanding array of specialty care types.
 Virtual Care - is a broad term, encompassing all
the different ways healthcare providers remotely
interact with their patients. Especially beneficial for
underserved patients, it can refer to any high-
quality, cost-effective clinical care delivered at a
distance via live video, audio, and instant
messaging.
 Hybrid Care - is the strategic application of all
available modalities of care delivery, including in-
person care, to suit the patient’s current needs. This
often involves a digital front door that efficiently
triages patients to the most appropriate care given
both their preferences and the provider’s capacity.
WHAT DOES CONNECTED HEALTH DO?
TELEHEALTH
 is the use of digital information and communication
technologies to access health care services
remotely and manage your health care.
Technologies can include computers and mobile
devices, such as tablets and smartphones. This
may be technology you use from home. Or a nurse
or other health care professional may provide
telehealth from a medical office or mobile van, such
as in rural areas. Telehealth can also be technology
that your health care provider uses to improve or
support health care services.
 The goals of telehealth, sometimes called e-
health or m-health (mobile health), includes:
o Make health care easier to get for people
who live in communities that are remote or
in the country.
o Keep you and others safe if you have an
infectious disease such as COVID-19.
o Offer primary care for many conditions.
o Make services more easily offered or
handy for people who have limited ability
to move, time or transportation.
o Offer access to medical specialists.
o Improve communication and coordination
of care among health care team members
and a person getting care.
o Offer advice for self-management of health
care.
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TELEHEALTH IN NURSING PRACTICE
 Telehealth can be used to support in-patient care,
giving nurses a way to monitor patient health after
they are discharged from the hospital or while
managing a chronic illness at home.
 Telehealth is the use of digital information and
communication technologies to access health care
services remotely and manage your health care.
Technologies can include computers and mobile
devices, such as tablets and smartphones. This
may be technology you use from home.
 The advantages of telehealth nursing include
convenient access any time of day or night, cost-
savings for both patients and providers, and
efficient care with shorter wait times.
 Telehealth allows for remote monitoring of patients.
This means nurses and other healthcare providers
can track important health information from patients,
such as vital signs, outside of clinical settings
RESOURCES AND ASSOCIATED TECHNOLOGY FOR
TELEHEALTH
1. PHYSICAL SPACE
 There are several considerations for establishing a
physical space that is appropriate for delivering
telehealth services. The ATA recommends that
healthcare programs design private telehealth
workspaces that maximize patient confidentiality.
This could include a room where private
conversations cannot be easily overheard and with
a lockable door. Appropriate lighting is also critical
to successful live-video telehealth encounters.
Lighting can affect a provider's abilities to accurately
assess the patient's state and gather diagnostic
clues
2. STAFFING
 Many rural programs designate a staff member to
serve as a telehealth coordinator who can manage
telehealth referrals, brief the patient on telehealth
services, coordinate with the telehealth provider,
facilitate the technological aspects of the visits, and
schedule follow-ups as necessary.
3. TECHNOLOGY
 Common types of telehealth technology that rural
programs might need include videoconferencing
software, telemedicine carts equipped with cameras
and screens, and remote patient monitoring
devices. The National Telehealth Technology
Assessment Resource Center can help rural
communities select the most appropriate telehealth
technology for their program. Rural communities
may need to apply for grant funding to support initial
costly investments in technology or the addition of
new technologies
4. PARTNERSHIPS
 Many rural programs rely on partnerships to
implement, expand, and sustain telehealth services.
Some communities build affiliations with partner
organizations in order to receive access to
telehealth technologies and resources.
LEGAL AND ETHICAL CONSIDERATIONS
1. SCOPE OF PRACTICE
 Telehealth is simply an alternative way to deliver
healthcare, so a health professional’s scope of
practice is usually the same as it would be when
treating a patient in person. Telehealth is not limited
by the location of the health professional or the
patient, so clinicians can, in theory, provide services
to individuals in other parts of their country or even
overseas. It is, therefore, important to note that the
scope of practice for physiotherapists can vary
within countries and between countries, so you will
need to check that you are correctly licensed to
treat a patient in a different region before
undertaking a telehealth consultation.
2. PATIENT CONSENT
 As with any patient interaction, informed consent
needs to be obtained prior to undertaking a
telehealth assessment or treatment. However, there
are additional issues to consider when adopting
digital technologies. As well as providing
information about assessment and treatment, health
professionals will need to provide information about
the specific features of telehealth, including its
strengths and weaknesses. Certain risks such as
miscommunication or incomplete examination must
be considered. When using telehealth to treat
vulnerable groups, such as older adults or children,
it is also important to consider whether or not a
parent/caregiver or advocate should be present.
3. PRIVACY
 Privacy concerns arise when adopting telehealth.
Because a patient’s medical information is suddenly
available on multiple devices, there is an increased
risk of security problems, which may decrease an
individual’s willingness to adopt telehealth. It is
therefore essential that you uphold the same level
of privacy and confidentiality for a telehealth
consultation as you would if you were treating the
client in person. Technology and security issues will
be discussed in greater detail on the next slide, but
they are important to consider in relation to privacy -
particularly as telehealth consultations involve a
greater number of parties than face-toface
healthcare interactions due to the use of video/call
applications.
4. TECHNOLOGY SECURITY ISSUES
 The use of telehealth creates many new issues in
relation to privacy and security. As health providers,
we need to consider whether or not the platform we
are using is secure with end-to-end encryption. For
instance, many people believe that common
applications are safe and secure, but this is not
always the case. Each technology options should
be evaluated against the local state or country laws.
Storage of electronic information also needs to be
considered. Patient information, like notes,
photographs and videos, must be stored in a secure
location so that only clinicians involved with the
patient's care can access them.
5. EQUITABLE ACCESS TO TECHNOLOGY
 The issue of access to technology is another
important consideration when adopting telehealth.
NCM110 LECTURE
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Some vulnerable client groups, including those who
live in remote areas or who are of low
6. PROFESSIONAL REGULATIONS AND
INDEMNITY
 Because telehealth is rapidly evolving and has not
been previously used in some regions, your
professional indemnity insurance may not include
specific clauses relating to the provision of digital
health. It is, therefore, essential that you find out
from your insurer if your policy covers telehealth to
ensure you remain protected.
STANDARDS FOR PRIVACY INFORMATION SECUIRTY
IN CONNECTED HEALTH
1. CREATE THROUGH POLICIES AND
CONFIDENTIALITY AGREEMENTS
 Drawing up all-encompassing and wide-ranging
confidentiality agreements or policies means that
everybody on your medical team knows exactly
what is expected of them in every eventuality. It
must be read from cover to cover by every staff
member and signed. It can also be regularly shared
with patients to demonstrate that your organization
upholds strict confidentiality procedures
2. PROVIDE REGULAR TRAINING
 People adhere best to policies and practices when
they fully understand why they are in place. Holding
regular training sessions for all your staff members,
from administrators to doctors and nurses, helps to
reinforce how essential confidentiality requirements
are, and provides a refresh of staff duties and
expectations. For best results, make these training
times fun and a good opportunity to learn while
getting to know colleagues. Taking a creative
approach to the topic and introducing games can
also help the information be more engaging whilst
also being a positive experience for your staff.
3. MAKE SURE ALL INFORMATION IS STORED ON
SECURE SYSTEMS
 As the standard of healthcare improves and
populations expand the amount of patient data
being stored has increased astronomically. As a
result, many practices and clinics may face
challenges in correctly storing this information, both
in terms of where huge data quantities can be
saved and making the information easily accessible.
Alongside these systematic difficulties, it is essential
that the highest level of security and digital
protection is used when storing patient data.
Purchasing platforms or using cloud providers that
ensure your data is safe is the best way to look after
this. Furthermore, it is important that only strictly
necessary personnel have access to this data.
Levels of password protection that controls access
is also worth considering and investing in
KEY CONSIDERATIONS FOR FUTURE APPLICATION IN
CONNECTED HEALTH
 Connected Health technologies can be employed
for adapting public health policies, addressing a
broader health-related impact, which also involves
transitions to new models of care. The availability of
Connected Health data combined with big data
analytics can be of added value toward supporting
the learning health system cycle
 Connected Health tools may be able to prolong the
period when patients and consumers would be
capable to successfully manage their health and
care according to their lifestyle, preferences, and
goals
 Connected Health is a new promising direction for
improved health and well-being services
APPLICATION OF NURSING INFORMATICS TO
RESEARCH
DATA MANAGEMENT
 Is the process of controlling the collection, storage,
retrieval and use of data to optimize accuracy and
utility while safeguarding integrity.
 Efficient and effective data management optimizes
the value of the data for informed decisionmaking
(Shanrakaranarayanan, Even & Berger, 2015)
 Good data management requires thorough planning
(Wills, 2014)
DATA COLLECTION, PROCESSING, AND ANALYSIS
 Is part of the research data management
 Data Collection or Acquiring data
 Acquisition involves collecting or adding to the data
holdings. There are several methods of acquiring
data:
o collecting new data
o using your own previously collected data
o reusing someone others data
o purchasing data
o acquired from Internet (texts, social media,
photos)
DATA PROCESSING
 A series of actions or steps performed on data to
verify, organize, transform, integrate, and extract
data in an appropriate output form for subsequent
use. Methods of processing must be rigorously
documented to ensure the utility and integrity of the
data.
DATA ANALYSIS
 involves actions and methods performed on data
that help describe facts, detect patterns, develop
explanations and test hypotheses. This includes
data quality assurance, statistical data analysis,
modeling, and interpretation of results.
TOOLS
 Microsoft Excel
 Statistical Analysis
 Statistical Package for the Social Sciences (SPSS)
is a software program used by researchers in
various disciplines for quantitative analysis of
complex data.
 Stata is statistical software for data science
NCM110 LECTURE
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FINALS NOTES FOR NURSING INFORMATICS
 Qualitative Data Analysis
o Content Analysis
o Narrative Analysis
o Thematic Analysis
o Qualitative Data Analysis Software
o 1. MAXQDA 6. Dedoose
o 2. Nvivo 7. Taguette
o 3. ATLAS.tu 8.
MonkeyLearn
o 4. QDA Miner 9. Orange
o 5. Quirkos
QUALITATIVE ANALYSIS SOFTWARE
 MAXQDA
o is a qualitative, quantitative, and mixed
method data analysis tool.
o It lets you input data from a range of
sources such as surveys, interviews, and
focus groups to name a few.
o You can then tag and categorize this data
for analysis.
 Nvivo
o is a software tool that allows its users to
organize and store their qualitative data
ready for analysis.
o You can also import word docs, PDFs,
audio, images, and video.
o Best for: Researchers or academics
looking for software with autocoding.
 ATLAS,ti
o s a powerful QDA software tool, it supports
large bodies of textual, graphical, audio
and video data
o Is a powerful QDA software tool, it
supports large bodies of textual, graphical,
audio and video data
 QDA Miner
o is a qualitative and mixed-method software
that helps you to organize, code and
analyze your data
o Best for: Those looking for advanced
visualizations and who are working alone.
 Quirkos
o a simple software tool that can help in the
analysis of qualitative data. It is affordable
and is popular within the education
sector.
o Best for: Students and academics
 Dedoose
o 100% web-based tool for qualitative
analysis. It was created by academics from
UCLA and was designed to analyze both
qualitative and quantitative data.
o It’s capable of importing data from a range
of different formats, including documents,
images, audio, video, and spreadsheets. .
o Best for: Those who want a fully web
based option where they can easily
collaborate with team members.
 Taguette
o Is a free open source qualitative data
analysis tool that allows you to tag your
data so you can then export it for analysis.
o Best for: Those looking for a basic, free
option to organize their data for analysis.
 MonkeyLearn
o is a powerful qualitative analysis software.
o It differs from most of the tools we have
listed here in that it harnesses the power of
AI and machine learning to make your data
analysis process as efficient as possible.
o It offers an intuitive no-code interface that
gets you to the stage of analyzing and
visualizing your data in much less time.
o It’s also useful if you are not a data expert
and you don’t have hours to spend coding
manually or if, due to the size of your
datasets, it’s simply impossible to do so.
 Orange
o Orange is a component-based visual
programming software package for data
visualization, machine learning, data
mining, and data analysis.
o Orange components are called widgets
and they range from simple data
visualization, subset selection, and
preprocessing, to empirical evaluation of
learning algorithms and predictive
modeling.
o Visual programming is implemented
through an interface in which workflows
are created by linking predefined or user-
designed widgets, while advanced users
can use Orange as a Python library for
data manipulation and widget alteration
DATA MINING AS A RESEARCH TOOL
 Data Mining – the process of examining big data
for patterns
 Big data – refers to a very large data sets that are
beyond human capability to analyze or manage
without the aid of technology.
DATA ANALYTICS (GUDIVADA, 2017)
 is the science of integrating heterogeneous data
from diverse sources, drawing inferences, and
making predictions to enable innovation, gain
competitive business advantage, and help strategic
decision-making.
 The data analytics domain has evolved under
various names including online analytical
processing (OLAP), data mining, visual analytics,
big data analytics, and cognitive analytics.
 analytics is used to refer to any data-driven
decision-making.
SECONDARY DATA ANALYSIS (O’CONNOR, 2020)
 is now firmly embedded in nursing science, helping
researchers to uncover new insights that can
improve nursing education, patient care, health
service delivery, public health, and health policy.