ENHANCING CLINICAL

CARE THROUGH NURSING

INFORMATICS

DECEMBER 14, 2009

1
QUOTE OF THE DAY

"Computers are incredibly fast,

accurate and stupid. Human
beings are incredibly slow,
inaccurate and brilliant.
Together they are powerful
beyond imagination."
- Albert Einstein
2
DO YOU KNOW WHAT A TOILET
BOWL CAN DO?

• can redden faces

• can measure sugar levels in urine
• can measure blood pressure,
heartbeat, body fat and weight
• can do nearly everything
3
REDDEN FACE?

An American diplomat was at a

dinner party in a Japanese home
when he excused himself to go to
the bathroom. He did his
business, stood up and realized
he didn't have a clue about how to
flush the toilet.
4
REDDEN FACE?

The diplomat speaks Japanese, but

he was still baffled by the colorful
array of buttons on the complicated
keypad on the toilet. So he just
started pushing. He hit the
noisemaker button that makes a
flushing sound to mask any noise
you might be making. 5
REDDEN FACE?
He hit the button that starts the
blowdryer for your bottom. Then he
hit the bidet button and watched
helplessly as a little plastic arm, sort
of a squirt gun shaped like a
toothbrush, appeared from the back
of the bowl and began shooting a
stream of warm water across the
room and onto the mirror. 6
REDDEN FACE?
And that's how one of America's
promising young Foreign Service
officers ended up frantically wiping
down a Japanese bathroom with a
wad of toilet paper.
"It was one of my most embarrassing
experiences in Japan," said the
embassy employee who asked not to
be identified. 7
NEOREST 600

8
 NEOREST 600

The Neorest 600 from Japanese plumbing

manufacturer Toto is a tankless toilet and
personal cleansing unit. Its lid automatically
opens when a person approaches it. When
a person walks away from the Neorest 600,
it automatically flushes and closes the seat
and lid. There's a remote control for
operating features including water spray
temperature, pressure and direction; seat
heater; air dryer; and deodorizer. List prices
for the Neorest 600 start at US$5,200. 9
FRIENDLY RESTROOM

10
 FRIENDLY RESTROOM

Built-in assistance: The Friendly Rest Room

combines a slew of high-tech features including a
contactless smart card to store users' preferences,
voice activation interface, and sensor systems for
detecting falls and emergency situations. Users can
control settings including seat height and tilt with a
remote control or voice-activated commands.
Researchers affiliated with Vienna University of
Technology in Austria conceived the Friendly Rest
Room as a way to provide greater independence to
elderly and disabled people who might otherwise
rely on assistance from a caregiver to use a toilet.
11
INTELLIGENT TOILET

12
 INTELLIGENT TOILET

Japanese homebuilder Daiwa

House Industry collaborated
with Toto to design the
Intelligent Toilet, which doubles
as an in-home health monitor.
The design includes devices for
measuring sugar levels in urine,
blood pressure, body fat and
weight. 13
WHO AMONG US ARE
LIKE THIS FELLOW?

14
ARE YOU FRIENDLY OR
“TOXIC” TO COMPUTERS?

Let Computers Help

You, Not Break
You! 15
HOW?

BY IMPROVING
YOUR
COMPUTER
LITERACY…
16
COMPUTER LITERACY

Computer literacy is commonly

used today to denote some
kind of basic knowledge and
an understanding of
computers combined with the
ability to use them effectively.

17
COMPUTER LITERACY

On the least specialized level,

computer literacy involves knowing
how to turn on a computer, start and
stop simple application programs, and
save and print information. It also
refers to the attitude about computers
and the actual ability to do some
tasks or programs on the computer.
18
COMPUTER LITERACY

The relationship between computer

literacy, technological competence
and a nurse's ability to care is
congruent for quality care. Computer
literacy represents a proactive
response to technology which
enhances caring in nursing (Delaney,
1990).
19
COMPUTER LITERACY

AM I
COMPUTER
LITERATE?
20
HOW FAR DO YOU KNOW?

• ANIA • EHR
• BCMA • EMR
• CI • HIS
• CPOE • PC
• CPU • PDA
• CPRS • RAM 21
HOW FAR DO YOU KNOW?

• ANIA - American Nursing Informatics Association

• BCMA - Bar Code Medical Administration
• CI - Clinical Informatics/Informaticist
• CPOE - Computerized Physician Order Entry
• CPRS - Computerized Patient Record System
• EHR - Electronic Health Record
• EMR - Electronic Medical Record
• HIS - Hospital Information System
• PDA - Personal Digital Assistant
22
TOP BUSINESS ISSUES IMPACTING
HEALTHCARE

1. Increasing Patient
Safety/Reducing Medical
Errors
2. Patient (Customer)
Satisfaction
3. Nursing Shortage
23
CURRENT IT PRIORITIES

1. Reduce Medical
Errors/Promote Patient Safety
2. Implement an EMR
3. Connecting IT at Hospital and
Remote Locations
Source: Healthcare Information and Management Systems Society (HIMSS)

24
CHALLENGES FOR NURSING

• Fragmented, frequently interrupted, in chaotic

work environment
– Interrupted mid-activity 8 times per every 8 hours*
• Switch patients every 11 minutes*
• Average activity time – 3.1 min/care activity*
• Average of 8.1 operational failures per 8
hours*
– Missing med
– Missing supplies
– Missing order
– Missing/ broken equipment 25
CHALLENGES FOR NURSING
• 9% of time spent on resolving system failures
or errors*
– Most common was missing medications
• Direct patient care tasks done in 2:43 minutes
chunks
• Average 44 minutes overtime
• Only 30% of shift time is in direct patient care**
• Medication administration errors
– in 1999, ADE cost the U.S. $2 billion annually

Sources:
* Tucker and Spear. Operational Failures and Interruptions in Hospital Nursing. HSR 41:643-662, 2006
** Hendrich A., George V. Random work sampling of Medical Surgical nurses using PDAs. Reported at 26
Health Management Academy, May 20, 2004. Unpublished Data
CHALLENGES FOR CLINICIANS

• We practice with incomplete information

• We have alarming error rates
• We spend 30-50% of time on administrative
activities
• Errors are associated with surveillance,
change in venues, and patient handoffs
• Fragmented, incomplete records can cause
confusion, communication breakdown, and
the opportunity for error.
• We need to reduce burdens related to
documentation 27
LEARNING OBJECTIVES

• Define nursing informatics

• Demonstrate how NI supports nursing
process
• Explain the value of NI to nursing practice
and healthcare
• Identify roles for NI practice
• Identify practice areas and settings
• Identify education paths and certifications

28
THE IMPORTANCE OF INFORMATION
• The healthcare of your clients is largely dependant on
information.
• Every action taken depends on previous information
and knowledge.
• The delivery of health care requires information
about:
– Science of type of care (nursing)
– Patient or client
– Provider
– Outcomes
– Process and systems for delivery of care

29
THE IMPORTANCE OF INFORMATION

• Information about each of these areas

have an impact on the type and the
amount of care given.
• Information must be:
accurate
timely
accessible
understandable

30
WHAT IS INFORMATION?

The structure of information

• Delivered in conversation, handwritten notes,
stored in a computer.
• Regardless of the form, the same basic
principles apply to the structure and the use
of information.
• Words are often used interchangeably to
describe information.

31
WHAT IS INFORMATION?

The structure of information

• Data: discrete entities objectively described,
without interpretation or context.
– Example: 110
• Information: data processed into a structured form.
Data that are interpreted, organized, structured
and given meaning are referred to as information.
– Example: When combining 110 with other data, it
becomes information. Systolic blood pressure of 110
mmHg and diastolic blood pressure of 70 mm Hg. This
information can be captured in a form, on a graph in a
report. 32
WHAT IS INFORMATION?

• Knowledge: synthesized information

derived from the interpretation of data. It
provides a logical basis for making
decisions.Essential to decision-making and
to new discoveries.
– Example: When the blood pressure
reading is combined with information
about anatomy and physiology,
pharmacology, pathophysiology,
knowledge is used to decide about
further care and treatment. 33
THE FIVE RIGHTS OF INFORMATION

Information has five rights:

Right information
Right person
Right time
Right place
Right amount

34
USING INFORMATION

“Up-to-date,
accurate
information of
each step of the
Nursing
Process is the
Power behind
safe, high
quality patient-
centered care!”
35
USING INFORMATION

• Evidence-based practice leads to:

– Determining standards and guidelines
– Guide for decision-making process
– Determines best practice
• Nursing informatics can enable dissemination of
new knowledge.
– Practitioners update themselves of new developments
through journals, conferences, continuing education
sessions.
– The information is varied and copious.
– There is a need to find the relevant evidence in a timely
way.

36
WHAT IS HEALTHCARE INFORMATICS?

• With the knowledge of the importance of

information in healthcare, healthcare
informatics has become a specialty.
• Healthcare informatics is a combination of
computer science, healthcare science,
information science and cognitive
science.

37
WHAT IS HEALTHCARE INFORMATICS?

• Computer science: development, configuration,

architecture of computer hardware and software.
• Healthcare science: body of knowledge on
which healthcare profession bases their practice.
The sciences of anatomy, physiology and
knowledge specific to each profession.
• Information science: also includes information
technology which involves the process of sending
and receiving information.
• Cognitive science: the process of human
thinking, understanding and remembering.
38
HOW FAR HAVE WE COME?
• 1992 – First Scope of Practice for
Informatics Nurse
• 1992 – Informatics Nursing recognized as
a specialty by ANA
• 1994 – First Informatics Nursing
Certification exam offered by ANCC
• 2007 – 3rd Version of Informatics Nursing
Scope of Practice
• 2007: AONE identifies Information
Management and Technology as a core
competency for Nurse Executives 39
WHAT IS NURSING INFORMATICS (NI)?
“Nursing Informatics is a specialty that
integrates nursing science, computer science,
and information science to manage and
communicate data, information, and
knowledge in nursing practice.  Nursing
informatics facilitates the integration of data,
information, knowledge, and wisdom to
support patients, nurses and other providers
in their decision-making in all roles and
settings.  This support is accomplished
through the use of information structures,
information processes, and information
technology.” 
 (ANA Scope & Standards of Nursing Informatics Practice, 2008) 40
WHAT IS NURSING INFORMATICS (NI)?

• Like any knowledge-intensive field these

days, nursing is greatly impacted by the
explosive growth of computer technology.
Nursing informatics is a new and exciting
specialty that combines nursing skills with
computer expertise. Nurse informatics
specialists manage and communicate
nursing data and information to improve
decision making by consumers, patients,
nurses and other health care providers.
41
SCOPE & STANDARDS OF PRACTICE

• System Lifecycle
• Human Factors
• Information Technology
• Information Management
• Professional Practice
• Models and Theories

42
IN vs. INS

• IN – Informatics Nurse:
– RN who works in the area of informatics
– This RN is not formally prepared in
informatics but has an interest and/or
experience working in the area.
• INS – Informatics Nurse Specialist:
– RN with advanced, graduate education in
nursing informatics or information
management
43
NURSING INFORMATICS JOB TITLES

– 14% “clinical analysts”

– 14% “informatics nurse specialist” or
“nursing informatics specialist”
– 9% “consultant”
– 40% identified “other”
• Director of Clinical Informatics, Clinical
Informatics Coordinator, Clinical Systems
Analyst, Clinical Informatics Specialist

44
NI SPECIALIST SALARY

• In 2007, the Healthcare Information and

Management Systems Society (HIMSS)
conducted a major survey of nurse
informatics specialists. The average salary
earned by respondents to this survey was
$83,675, compared to $69,500 in the 2004
survey. This is strong evidence of the
increasing maturity and value of the
specialty.
45
NURSE INFORMATICS CAREER OUTLOOK

• The demand for all types of nurses is

expected to increase significantly over the
next ten years. In general, the more
training, certifications and experience a
nurse has, the more demand there will be
for his or her skill set.

46
HEALTHCARE INFORMATION AND MANAGEMENT
SYSTEMS SOCIETY (HIMSS) LEVEL 7
STAGE CUMMULATIVE CAPABILITIES % OF
HOSPI
TALS
7 Medical record fully electronic; care delivery organization 0.0%
able to contribute to electronic health record as byproduct
of electronic medical record
6 Physician documentation, full clinical decision support 0.1%
system (variance and compliance), full PACS
5 Closed-loop medication administration 0.5%
4 CPOE, clinical decision support system (clinical protocols) 1.9%
3 Nursing documentation, eMAR , clinical decision support 8.1%
system (error checking), PACS
2 Clinical data repository, controlled medical vocabulary, 49.7%
clinical decision support interface engine, document
imaging
1 Ancillaries: laboratory, radiology, pharmacy 20.5%
47
0 All three ancillaries not installed 19.3%
WHY IT IS IMPORTANT?
• Nurses need to develop
competencies in
informatics.
• Informatics enables
nurses to use information Technology
and communications
technologies in the: Nursing
– collection of data,
– use of information
– generation of knowledge to
support nursing practice
48
WHY IT IS IMPORTANT?

 the trend in hospitals are computerizing

nursing documentations
 for effective and efficient data
management such as workload statistics,
performance monitoring, etc.
 promotes and improves evidence-based
nursing practice and patient outcomes.

49
WHY IT IS IMPORTANT?

 Nursing informatics enables nurses to

quickly move to the synthesis of nursing
knowledge and the development of
nursing wisdom. Gone were the days of
manual documentation that consumes
most of your time, now, more time are
used in applying nursing knowledge and
wisdom to everyday care because of
informatics.
50
WHY IT IS IMPORTANT?

NURSING INFORMATION SYSTEMS (NIS)

includes:
1. Patient Charting
2. Staff Schedules
3. Clinical Data Integration
4. Decision Support

51
WHY IT IS IMPORTANT?

• Patient Charting: A patient’s vital signs, admission

and nursing assessments, care plan and nursing
notes can be entered into the system either as
structured or free text. These are the stored in a
central repository and retrieved when needed.
• Staff Schedules: Nurse can self schedule their
shifts using scheduling rules provided in shift
modules. The shifts can later be confirmed or
changed by a scheduling coordinator or manager.
Shift modules are designed to handle absences,
overtime, staffing levels and cost-effective staffing.

52
WHY IT IS IMPORTANT?

• Clinical Data Integration: Here clinical information

from all the disciplines can be retrieved, viewed and
analyzed by nursing staff and then integrated into a
patient’s care plan.
• Decision Support: Decision support module can be
added to NIS , and they provide prompts and
reminders, along with guides to disease linkages
between signs/symptoms, etiologies/related factors
and patient populations. Online access to medical
resources can also be made available.

53
54
ROLE OF THE NURSE INFORMATICIST

– Nurse programmers who write or modify

computer programs for use by nurses
– Nurse communicators who work with other
nurses to identify computer system needs or to
assist in the training and implementation of
those systems
– Informatics nurse managers who manage or
administer information systems
– Nurse vendor representatives who
demonstrates systems to potential customers
55
WHAT CAN AN INFORMATICS NURSE DO?

1. Support nursing work processes using

technology
– Design systems to match clinical workflows
• Telehealth
• Homehealth
• Ambulatory care
• Long-term care
• Acute care – all specialties
• Outpatient settings
• Software development
56
WHAT CAN AN INFORMATICS NURSE DO?

2. Increase the accuracy and completeness

of nursing documentation
3. Improve the nurse’s workflow
– Eliminate redundant documentation
4. Automate the collection and reuse of
nursing data
5. Facilitate analysis of clinical data

57
WHAT CAN AN INFORMATICS NURSE DO?

• Admitting a patient
– Admission Assessment in computer
• Placing orders
• Requesting consults
• Sending data to NIS/HIS
• Resolving clinical reminders
– These things involve a computer as well
• Take V/S
• Give medications
• Consent for surgery
• Make the bed 58
WHAT CAN AN INFORMATICS NURSE DO?

Prepare/provide workload statistics

• How many new orders written on Ward X in
a day?
• How many medications given on Ward X in
a week?
• Nurses bypassing BCMA by using Manual
Medication Entry
• Show me all restraint orders for the past
month
59
WHAT CAN AN INFORMATICS NURSE DO?

6. Information system management

7. Documenting patient education
– Incorporated into daily charting
8. Training/educating
– New employees
– Student nurses

60
COMPETENCIES REQUIRED

• Most theorists also emphasize the

need for every nurse whether
employed in the practice or education
setting, to develop a minimum of a
"user" level in computer literacy and
informatics theory.

61
TECHNICAL COMPETENCIES

• Related to the actual psychomotor use of

computers and other technological
equipment. Specific nursing informatics
competencies include the ability to use
selected applications in a comfortable and
knowledgeable way. It is important that
nurses feel confident in their use of
computers and software in the practice
setting, especially at the bedside, in order
to be able to attend to the client at the
same time. 62
LEVEL OF COMPETENCIES

• beginner, entry or user level

• intermediate or modifier level and;
• advanced or innovator level of
competency.

63
COMPUTER APPLICATIONS

All three levels of competencies - users,

modifiers and innovators need to
develop a working knowledge of the
following computer programs and
processes:
• Word processing
• Keyboarding
• Spreadsheets
• Presentation Graphics 64
COMPUTER APPLICATIONS

• Databases (simple to complex)

• Desktop Publishing
• World Wide Web
• E-mail programs
• Expert data systems
• Multimedia
• Telecommunication devices
• Nursing information systems
• Hospital information systems
• Peripherals (Printers, CD/DVD) 65
USER LEVEL TECHNICAL COMPETENCIES
INCLUDE:
• uses word processing applications
• demonstrates keyboarding skills
• uses spreadsheet applications
• uses telecommunication devices to
communicate with other systems
• uses e-mail systems to communicate with
other health care professionals
• uses presentation applications to create
slides, displays, overheads
(PowerPoint, Corel Presentation, etc.)
• uses multimedia presentations 66
USER LEVEL TECHNICAL COMPETENCIES
INCLUDE:
• uses internet resources to locate client
support groups, online resources
• uses sources of data that relate to nursing
practice and care
• accesses, enters and retrieves data related
to client care via available hospital or
nursing information systems
• uses database management programs to
develop and access databases and tables
• uses database applications to enter and
retrieve data and information 67
USER LEVEL TECHNICAL COMPETENCIES
INCLUDE:
• conducts online and database literature
searches
• uses decision support systems, expert
systems and other aids for clinical decision
making and care planning
• uses computer applications to document
client care
• uses computer applications to plan client
care, including discharge planning
• uses computer applications to enter client
data (demographic, V/S, physiological data) 68
USER LEVEL TECHNICAL COMPETENCIES
INCLUDE:
• uses information management systems for
client education
• uses technology based client monitoring
systems
• operates peripheral devices (bedside and
hand held)
• uses operating systems
• uses computer peripheral devices (CD
ROMs, DVD, zip drives)
• uses computer technology safely
69
USER LEVEL TECHNICAL COMPETENCIES
INCLUDE:
• navigates in Windows environment
effectively
• demonstrates basic technology skills (load
paper, change toner, unjam printers, print)

70
MODIFIER LEVEL TECHNICAL
COMPETENCIES INCLUDE:
• applies technology support to provide
evidenced based practice
• synthesizes data from more than one
source and applies to practice
• demonstrates awareness of and ability to
access data and information from multiple
sources
• uses decision support systems in practice

71
MODIFIER LEVEL TECHNICAL
COMPETENCIES INCLUDE:

• accesses pertinent literature resources and

incorporates into practice and professional
development
• creates and accesses research and other
documents electronically

72
INNOVATOR LEVEL TECHNICAL
COMPETENCIES INCLUDE:
• participates in the design and development
of information systems for nursing practice
• develops inventive ways to access data
and interact with information systems
• participates in the design and develop
design and development of new
applications for nursing practice
• participates in developing new methods for
data and information organization

73
INNOVATOR LEVEL TECHNICAL
COMPETENCIES INCLUDE:
• collaborates with information technology
consultants and other members of
information system development team
• collaborates, negotiates with and directs
information technology vendors
• proficiency in diverse computer application
programs
• manipulates and enhances nursing data
sets
• organizes and directs applications of
shared data sets 74
INNOVATOR LEVEL TECHNICAL
COMPETENCIES INCLUDE:
• develops data gathering tools and
processes for literature search access for
nurses
• develop charting and documentation
templates for use in nursing practice
• design and development of evidenced
based practice documentation and
processing within practice area

75
CERTFICATION AND EDUCATION
• AMERICAN NURSES CREDENTIALING CENTER
(ANCC)
– Informatics Nurse (23%)
is the official certifying organization for informatics nurses.
The prerequisites for certification include a baccalaureate or
higher degree in nursing or a baccalaureate degree in a
relevant field, an active registered nurse (RN) license in the
United States, and 2 years of RN practice plus 2,000 hours
of informatics nursing practice within the previous 5 years or
12 hours of academic credit in a graduate program in
nursing informatics and 1,000 hours of nursing informatics
practice within the previous 5 years.
76
CERTFICATION AND EDUCATION

• HEALTHCARE INFORMATION &

MANAGEMENT SYSTEMS SOCIETY
(HIMSS)
– Certified Professional in Healthcare Information
and Management Systems (CPHIMS – 3%)

• OTHER – 9%

• NONE – 55%
77
SUMMARY
• Informatics can make nursing practice visible
in local, national, and international health
care data sets, thus empowering nurses with
information to influence policy.
• Information is a critical component of
effective decision-making and high quality
nursing practice.  The information and
knowledge gained through nursing
informatics can bring increased awareness
and understanding of nursing and health
care issues. 78
SUMMARY
• Nursing Informatics is committed to
maintaining a clinical perspective and
promoting research that would bear directly
on improving patient care.
• Recognition of Nursing Informatics team
value in support of clinical excellence is
crucial to any healthcare organization’s
success.

79
FRIENDLY ADVICE…

• Work towards achieving the

INNOVATOR LEVEL of technical
competency
• Keep abreast of “latest greatest”
technology trends
• Assess newest technology for “fit”
and potential applicability in your
nursing profession
80
NURSING INFORMATICS ORGANIZATIONS
A short list of examples includes:

• American Nursing Informatics Association (ANIA)

• Australian Nursing Informatics Council (ANIC)
• Brazilian Nursing Association Nursing Informatics Group
• British Computer Society Nursing Specialist Group
• European Nursing Informatics (ENI)
• International Medical Informatics Association Nursing
Informatics Special Interest Group (IMIA-NI)
• NURSINFO: Hong Kong
• Spanish Society of Nursing Informatics and Internet (SEEI)
• Swiss Special Interest Group Nursing Informatics (SIG-NI)
81
CONCLUSION

• Computers cannot replace a

nurse, they cannot replace your
intuition, and they cannot replace
your intelligence and certainly not
your TLC. Nurses cannot become
robots, doing only what the
computer tells them to do.
82
QUOTE OF THE DAY

"Computers are incredibly fast,

accurate and stupid. Human
beings are incredibly slow,
inaccurate and brilliant.
Together they are powerful
beyond imagination."
- Albert Einstein
83
84
REFERENCES

• http://nursing-informatics.com
• http://ojni.org
• http://www.ania.org/
• http://www.himss.org
• http://www.cna-nurses.ca

85