1. Introduction to Computers and
Nursing Informatics
A. Historical perspective of Nursing and
the Computer

3. Nursing Informatics
(ANA, 2001)
• A specialty that integrates
nursing science, computer
science, and information science
to manage and communicate
data, information and knowledge
in nursing practice;

5. Nursing Informatics
(ANA 2001)
• It facilitates the integration of
data information, and knowledge
to support patients, nurses, and
other providers in their decision-
making in all roles and settings;

6. Nursing Informatics
(ANA, 2001)
• The support is accomplished
through the use of information
structures, information
processes, and information
technology;

7. NI History
• In 1992, the American Nurses Association
(ANA) recognized NI as a specialty.
• To be acknowledged as a specialty within
nursing, informatics had to demonstrate a
differentiated practice base, identify the
existence of educational programs in the field,
show support from nationally recognized
organizations, and develop a research agenda.
•

8. • The term NI first appeared in the literature in
the 1980s.
• In a classic article that describes its domain, NI
was defined as the combination of nursing,
information, and computer sciences to
manage and process nursing data into
information and knowledge for use in nursing
practice.

9. • Most recently, NI is described
more broadly as “…a specialty
that integrates nursing science,
computer science, and
information science to manage
and communicate data,
information, and knowledge in
nursing practice.

10. • NI facilitates the integration of data,
information, and knowledge to
support patients, nurses, and other
providers in their decision-making in
al roles and settings. This support is
accomplished through the use of
information structures, information
processes, and IT” (ANA, 2001, p.17)

11. NI History
Six time Period
Before the 60’s
• Computers in business functions;
–e.g. Punch cards, tele-type writers
–1960’s why computers? What
should be computerized? Health
Information System (HIS)?
Financial transactions;

12. NI History
Six time Period
• 1960’s why computers? What should be
computerized? Health Information System
(HIS)? Financial transactions;
• 1970’s recognized the value of computers in
nursing; large community health agencies
used computerized Management Information
System (MIS);

13. NI History
Six time Period
• 1980’s - fields of informatics emerged;
computer-based patient records; discharge
planning systems; PC were user-friendly and
allowed nurses to create their own
applications;
• 1990’s - computers became integral part of
health care systems; policies & legislation,
demand for expert NI increases;

14. NI History
Six time Period
• 2000’s - Computer-based Patient Record
Institute
• Post 2000 – hardware and software
development, wireless point-of-care, open
source solutions, internet boost...

15. Common Terminologies
• Nursing Standards – a measure used to for an
agreed upon level of care for a particular
purpose; it is usually derived in a democratic
way participated by all stakeholders;
• Tele-health – the delivery of health related
services and information via
telecommunication technologies;

16. Common Terminologies
• Clinical Information System - (Hospital
Information System); is a comprehensive,
integrated information system designed to
manage the administrative, financial and
clinical aspects of a hospital;
• Computer Information Officer (CIO) – the
head of the IT group usually reports to the
Chief Executive Officer (CEO);

17. Common Terminologies
• Computerized Prescriber Order Entry (CPOE)
– electronic entry of patients’ treatment in a
computer network it decreases delay and
minimizes errors related to the completion of
prescribed interventions;

18. • Clinical Care Classification – (CCC)
• The System (version 2.5) consists of two
interrelated terminologies - the CCC of
Nursing Diagnoses and Outcomes and the CCC
of Nursing Interventions and Actions -
classified by 21Care Components to form a
single system.

20. Nursing Informatics and Healthcare Policy
• Policy is defined as a course of
action that guides present and
future decisions. Both existing
conditions and emerging trends
in the healthcare industry
influence policy decisions.
•

21. • NI practice differentiates itself from other
areas of nursing practice but emphasizes its
interaction with informatics disciplines such as
mathematics, statistics, linguistics,
engineering, computer science, and health
informatics.
• NI has been described as one example of a
specific domain of informatics that falls under
a broader umbrella of health informatics.

22. Healthcare Policy and NI Issues
• Nurses shortage
• Patient’s Safety
• Health Insurance Portability and
Accountability Act (HIPAA)

23. The Role of Technology in the
Medication-Use Process
• Scenario:
– numerous steps required in the care of patients;
– healthcare industry is an inherently error-prone
process fraught with opportunities for mistakes to
occur ;
– Priority placed by the healthcare industry to
provide safety nets

24. Barriers to Ineffective Communication of
Medication Orders
• issues with illegible handwriting (the
most common; leads to delays of
administration);
• use of dangerous abbreviations and dose
designations;
• and verbal and faxed

25. Medication-use Process/Systems
• CPOE
• Bar-code enabled medication
• Automated dispensing cabinet

26. • CPOE
• can be defined as a system used for direct
entry of one or more types of medical orders
by a prescriber into a system that transmit
those orders electronically to the appropriate
department (AHA, 2000).

27. Advantages of CPOE
• Improve quality, patient outcomes, and
safety;
• Identifying patients needing updated
diagnostic/laboratory procedures ;
• Reduction in the variation in care;
• Improve disease management/follow-up
• Improve d reminder system
• Automating evidence-based protocol
• Adhering to clinical guidelines to help
diagnosis disorder.

28. Bar Code-Enabled Point-of-Care Technology
• Up-to-date drug reference information from
online medication libraries
• Customizable comments or alerts
• Monitoring the pharmacy and the nurses’
response to predetermined rules
• Reconciliation for pending or STAT orders
• Capturing data for the purpose of retrospective
analysis of aggregate data to monitor trends
• Verifying blood transfusion and laboratory
specimen collection identification

29. Automated Dispensing Cabinet
• Improving pharmacy productivity
• Improving nursing productivity
• Reducing costs
• Improving charge capture
• Enhancing patient quality and safety

30. What Are Data Standards?
• Data standards encompasses methods,
protocols, terminologies, and specifications
for the collection, exchange, storage, and
retrieval of information associated with health
care applications, including medical records,
medications, radiological images, payment
and reimbursement, medical devices and
monitoring systems, and administrative
processes
(Washington Publishing Company, 1998).

31. Standardizing health care data
involves the following:
• Definition of data elements—determination of
the data content to be collected and
exchanged.
• Data interchange formats—standard formats
for electronically encoding the data elements
(including sequencing and error handling)
(Hammond, 2002).

32. • Interchange standards can also include
document architectures for structuring data
elements as they are exchanged and
information models that define the
relationships among data elements in a
message.
• Terminologies—the medical terms and
concepts used to describe, classify, and code
the data elements and data expression
languages and syntax that describe the
relationships among the terms/concepts.

33. • Knowledge Representation—standard
methods for electronically representing
medical literature, clinical guidelines, and the
like for decision support.

34. Standardization of data elements
include:
• (1) defining what to collect;
• (2) deciding how to represent what is
collected (by designating data types or
terminologies); and
• (3) determining how to encode the data for
transmission.

35. Electronic Health Record (EHR)
• It is a record in digital format that
is capable of being shared across
different health care settings, by
being embedded in network-
connected enterprise-wide
information systems;

36. Electronic Health Record
• It may also include a whole range of
data in comprehensive or summary
form, including demographics,
medical history, medication and
allergies, immunization status,
laboratory test results, radiology
images and billing information;

37. Elements of EHR
• Patient demographics.
• History, examination and progress reports
• Allergy lists, and immunization status
• Laboratory and tests.
• Medical imaging studies
• Medication
• Clinical practice guidelines
• Appointment scheduling
• Claims and payment processing
• Reminders

38. Basic Components
• Accounts Receivable
• Consolidated Mail
• Outpatient Pharmacy
• Controlled Substances
• Current Procedural Terminology
• Diagnostic Related Group (DRG)
Grouper
• Drug Accountability/Inventory
• Interface

39. Cont. Of Basic Components
• Duplicate Record Merge: Patient Merge
• Event Capture
• Medications
• Inpatient Medications
• Intravenous Inpatient Medications -
Unit Dose
• Integrated Billing

40. Cont. of Basic Components
• Laboratory
• Laboratory Electronic Data
Interchange
• Lexicon Utility
• Master Patient Index
• Master Patient Index/Patient
Demographics
• National Drug File

41. Cont. Of Basic Components
• Outpatient Pharmacy
• Patient Information Management
Systems (Admission, Discharge, Transfer,
Registration)
• Pharmacy Benefits Management
• Pharmacy Data Management
• Radiology/Nuclear Medicine
• Scheduling

43. Multiple Uses of EHR
• Patient care
• Quality improvement
• Outcome reporting
• Resource management
• Public health communicable disease
surveillance

44. Nursing Minimum Data Set
NMDS
• Identifies essential, common, and core data
elements to be collected for all
patients/clients receiving nursing care;
• A standardized approach to facilitate the
abstraction of data elements to describe
nursing practice;

45. Data Elements of NMDS
• Environment
– Unit/cost
– Type
– Patient/client population
– Volume
– Accreditation
– Organizational decision making power
– Environmental complexity
– Patient/client accessability
– Method of care delivery
– Clinical decision making complexity

46. cont. Data Elements of NMDS
• Nursing care
– Management demographic profile
– Staffing
– Staff demographic profile
– Staff satisfaction

47. cont. Data elements of NMDS
• Financial Resources
– Payer type
– Reimbursement
– Budget
– Expense