1. Nursing Informatics Instructor: Ian Jasper Mangampo Schedule: 13:00 – 16:00 MTW RM319(LAB) 13:00 – 16:00 ThF RM302(LEC)

2. Course Description This course deals with the use of information technology system and data standards based on nursing informatics principles/theories. It further deals with the utilization of clinical information systems in the management and decision-making of patient care.

3. Course Credit 2 units Lecture 1 unit Laboratory Contact Hours: 36 Lecture Hours 54 Laboratory Hours

4. Course Objectives At the end of the course and given relevant actual or simulated situations/conditions, the student will be able to: Apply concept, theories and principles of informatics in nursing and health care Discuss issues and dtrends in informatics relevant to nursing and health.

5. Course Outline Computers and Nursing Computers and Nursing Historical Perspectives of Nursing and the Computer Electronic Health Record from a Historical perspective Computer System Computer Hardware Computer Software and Systems Open Source and Free Software Proprietary Software System Software Application Software Data Processing Software The Internet, a Nursing Resource PDA and Wireless Devices Incorporating Evidence: Use of Computer-Based Clinical Decision Support System for Health Professionals

6. Issues in Informatics Nursing Informatics and Healthcare Policy The Role of Technology in the Medication-Use Process Healthcare Data Standards Electronic Health Record Systems Dependable Systems for Quality Care Nursing Minimum Data Set Systems Informatics Theory Theories, Models and Framework Advanced Terminology Systems Implementing and Upgrading Clinical Information Systems

7. Practice Application Practice Application Critical Care Application Community Health Applications Ambulatory Care Systems Internet Tools for Advanced Nursing Practice Informatics Solutions for Emergency Preparedness and Response. Vendor Applications

8. Administrative Application Administrative Applications of Information Technology for Nursing Managers Translation of Evidence, Clinical Practice Guidelines, and Automated Implementation Tools Data Mining and Knowledge Discovery Consumer’s Use of Informatics Consumer and Patient Use of Computers for Health Decision Support for Consumers Educational Applications The Nursing Curriculum in the Information Age Accessible, Effective Distance Education Anytime, Anyplace Innovations in Telehealth

9. Research Application Computer Use in Nursing Research Computerized Information Resources International Perspectives Nursing Informatics in Canada Nursing Informatics in Europe Pacific Rim Nursing Informatics in Asia Nursing Informatics in South America The Future of Informatics Future Directions

10. What is INFORMATICS?

11. Informatics Informatics comes from the French word informatique which means computer science. Informatics is defined as computer science + information science. Used in conjunction with the name of a discipline, it denotes an application of computer science and information science to the management and processing of data, information, and knowledge in the named discipline.

12. What is nursing informatics?

13. Hebda (1998 p. 3), defines nursing informatics as: “The use of computers technology to support nursing, including clinical practice, administration, education, and research.“

14. American Nurses Association (ANA) (1994) has defined nursing informatics as: “The development and evaluation of applications, tools, processes, and structures which assist nurses with the management of data in taking care of patients or supporting the practice of nursing.”

15. Graves, J. R., & Corcoran, S. (1989). The Study of Nursing Informatics. Image: Journal of Nursing Scholarship, 27, 227-231. define nursing informatics as: “A combination of computer science, information science and nursing science designed to assist in the management and processing of nursing data, information and knowledge to support the practice of nursing and the delivery of nursing care.”

16. Framework for Nursing Informatics The framework for nursing informatics relies on the central concepts of data, information and knowledge: A DATA is defined as discrete entities that are described objectively without interpretation An INFORMATION as data that is interpreted, organized or structured A KNOWLEDGE as information that has been synthesized so that interrelationships are identified and formalized. Resulting in DECISIONS that guide practice

17. Application of Nursing Informatics Nursing Informatics can be applied to all areas of nursing practice, which include; clinical practice, administration, education, and research.

18. Nursing Clinical Practice (Point-of-Care Systems and Clinical Information Systems) Work lists to remind staff of planned nursing interventions Computer generated client documentation Electronic Medical Record (EMR) and Computer-Based Patient Record (CPR) Monitoring devices that record vital signs and other measurements directly into the client record (electronic medical record) Computer - generated nursing care plans and critical pathways Automatic billing for supplies or procedures with nursing documentation Reminders and prompts that appear during documentation to ensure comprehensive charting

19. Nursing Administration (Health Care Information Systems) Automated staff scheduling E-mail for improved communication Cost analysis and finding trends for budget purposes Quality assurance and outcomes analysis

20. Nursing Education Computerized record-keeping Computerized-assisted instruction Interactive video technology Distance Learning-Web based courses and degree programs Internet resources-CEU's and formal nursing courses and degree programs Presentation software for preparing slides and handouts-PowerPoint and MS Word

21. Nursing Research Computerized literature searching-CINAHL, Medline and Web sources The adoption of standardized language related to nursing terms-NANDA, etc. The ability to find trends in aggregate data, that is data derived from large population groups-Statistical Software, SPSS

22. Benefits of Computer Automation in Health Care: Many of these benefits have came about with the development of the electronicmedical record (EMR), which is the electronic version of the client data found in the traditional paper record.

23. EMR benefits include: Improved access to the medical record. The EMR can be accessed from several different locations simultaneously, as well as by different levels of providers. Decreased redundancy of data entry. For example, allergies and vital signs need only be entered once. Decreased time spent in documentation. Automation allows direct entry from monitoring equipment, as well as point-of-care data entry. Increased time for client care. More time is available for client care because less time is required for documentation and transcription of physician orders.

24. Facilitation of data collection for research. Electronically stored client records provide quick access to clinical data for a large number of clients. Improved communication and decreased potential for error. Improved legibility of clinician documentation and orders is seen with computerized information systems. Creation of a lifetime clinical record facilitated by information systems.

25. Benefits of automation and computerization are related to the use of decision-support software, computer software programs that organize information to aid in decision making for client care or administrative issues; these include: Decision-support tools as well as alerts and reminders notify the clinician of possible concerns or omissions. Effective data management and trend-finding include the ability to provide historical or current data reports. Extensive financial information can be collected and analyzed for trends. An extremely important benefit in this era of managed care and cost cutting. Data related to treatment such as inpatient length of stay and the lowest level of care provider required can be used to decrease costs.

26. Nursing Informatics Specialist Because of the increased importance of computers and information technology in the practice of professional nursing; a new role has emerged, the Nursing Informatics Specialist (NIS). The NIS is a nurse who has formal education, certification and practical experience in using computers in patient care settings.

27. The Role of the Nursing Informatics Specialist (NIS)

28. The American Nurses Association (ANA, 1994), lists several functions of the NIS: Theory development. The NIS contributes to the scientific knowledge base of nursing informatics. Analysis of information needs. The identification of information that nurses' need to in order to accomplish their work; client care, education, administration, and research Selection of computer systems. The NIS, guides the user in making informed decisions related to the purchase of computer systems.

29. Design of computer systems and customizations. The NIS collaborates with users and computer programmers to make decisions about how data will be displayed and accessed. Testing of computer systems. Systems must be checked for proper functioning before they are made available for use in patient care. Training users of computer systems. Users need to be trained in how the system works, the importance of accurate data entry, and how the system will benefit them, and more importantly how it will improve patient outcomes

30. Evaluation of the effectiveness of computer systems. The unique role of the NIS makes them the ideal person to evaluate the effectiveness of computer systems. Ongoing maintenance and enhancements. The NIS makes sure the computerized system functions properly and explores possible enhancements to the system that will better serve the users and the patients. Identification of computer technologies that can benefit nursing. The NIS must keep abreast of the changes in the fields of computers and information technology, including new hardware and software that will benefit the nurse and patient.

32. A general term referring to information technology ( IT) and computer systems.

34. Computers are used to manage information in patient care, monitor quality of nursing care and evaluate care outcomes

36. Historical Perspectives Nursing and the Computer

38. Four major Nursing areas

39. Standard Initiatives

41. 1960’s Use of computers in healthcare is questioned Studies on computers in nursing is started. Introduction of cathode ray tubes Development of Hospital Information System for financial transactions

42. 1970’s Nurses assisted in the design of HIS Computers used in financial and management functions Several communities developed Management Information sytem

43. 1970’s Nurses assisted in the design of HIS Computers used in financial and management functions Several communities developed Management Information sytem

44. 1980’s Nursing Informatics is formally accepted as new nursing specialty. Nursing Education identified need for update Emergence of microcomputers/PC

45. 1990’s Computer technology became an integral part of the healthcare setting. Policies and legislation on promoting computers in healthcare were adopted. Approval of NI by ANA as a new nursing specialty. Dr. Nicholas Davies excellence award is given for excellence in health information technology, this is managed by HIMSS.

46. Post 2000 Clinical Information System became individualized in the electronic patient record. Mobile computing device were introduced New technologies were utilized Internet provided new means of development Health Insurance Portability and Accountability Act of 1996 was enacted.

47. COMPUTERS Computers can perform a wide range of activities that save time and help Nurses provide quality nursing care. in NURSING

48. Nursing Practice Computer systems, patient care data and NCP’s are integrated to Electronic Health Record Need for EHR was perceived New Nursing Terminologies were recognized by ANA

49. Nursing Administration Computers linked department together. Hospital data are accessed through computers. Hospital process goes on line Internet was utilized.

50. Nursing Education Most nursing schools offered computer enhanced courses. Campus-wide computer systems became available. Computer technology integrated into teaching methodologies World wide web facilitates student-centered instructional settings.

51. Nursing Research Provides an avenue for analyzing data Softwares are available for processing qualitative and quantitative data Research databases emerged Online access

52. Standard Initiatives ANA – considered as the official nursing organization that contributes in the development and recommendation of standards of nursing practice worldwide. Joint commission on Accreditation of Hospital Organizations ( JCAHO) – focuses on the need for adequate records on patients in hospital and practice of standards in documentation of care

53. Significant Landmark of Event 1961 – Healthcare Information and Management systems Society was founded 1965 – Development of one of the first hospital Information system in California 1973 – First Conference on Management Information Sytem

54. 1981 – First National Conference on Computer Technology in Chicago 1984 – First Nursing Computer Journal is published. 1989 – graduate program in Nursing Informatics is introduced in Maryland university

55. 1993-establishment of electronic library 1995 – first International Nursing Informatics Teleconference held in Australia 2002-JCAHO identified clinical information system as a way to improve safety and recommends that hospitals adopt technology.

56. 2003 – Health Insurance Portability and Accountability Act was enacted 2004 – Establishment of the National Health Information Coordinator.

57. Historical Background of Electronic Health Records

58. An electronic record composed of health information regarding an individual patient that exists as part of a complete system designed to provide access to, and management of, such information. The EHR is developed and managed by the health facility or provider. The term Electronic Health Record has largely replaced the older “Electronic Medical Record.” Electronic Health Record (EHR)

59. It is much more than an electronic replacement of existing paper systems. The EHR can start to actively support clinical care by providing a wide variety of information services. However, it is hard to understand what information is really important to clinical care and what is simply occasionally desirable.

60. The EHR bring uncountable advantages in primary health care detaching such as faster access to information, and updated information. It allows having a clinical process with all the patient clinical information and an easier access to information (ex: allows the simultaneous access from different locations).

61. Recognizable efforts in the development of EHR are distinguished by the Nicholas E. Davis Awards of Excellence Program whose history describes the improvement of EHR in different settings.

63. It was among the first nationally based organizations to initiate and coordinate activities to facilitate and promote the routine use of Computer-Based Patient Records (CPRs) throughout healthcare.The Nicholas E. Davies Awards of Excellence Program

64. The CPRI group on CPR Systems Evaluation developed the CPR project evaluation criteria in 1993 which became the basis in assessing accomplishments of CPR projects and provided the Foundation of Nicholas E. Davies Awards Excellence Program

65. The Program was named after Dr. Nicholas E. Davis, an Atlanta-based physician, president elect of the American College of Physicians, and member of Institute of Medicine (IOM) committee in improving patient records. He was killed in a plane crash just as the IOM report on CPRs was being released

66. The HIMSS Nicholas E. Davies Awards of Excellence recognize excellence in the implementation and use of health information technology, specifically EHRs, for healthcare organizations, private practices and public health systems.

67. Nowadays the Nicholas E. Davies Awards Excellence Program is managed by the Healthcare Information Management Systems Society, and has the following program objectives:

68. The Healthcare Information and Management Systems Society (HIMSS) is the healthcare industry's membership organization exclusively focused on providing global leadership for the optimal use of healthcare information technology (IT) and management systems for the betterment of healthcare. The Healthcare Information Management Systems Society (HIMSS)

69. Vision - Advancing the best use of information and management systems for the betterment of health care Mission - To lead change in the healthcare information and management systems field through knowledge sharing, advocacy, collaboration, innovation, and community affiliations HIMMS

71. Understand and share documented value of EHR systems

72. Provide visibility and recognition for high impact EHR system

73. Share successful EHR implementation strategies

74. Encourages and recognizes excellence in the implementation of EMREHR systems: Implementation, Strategy, Planning, Project Management and Governance– StrategyHIMSS objectives:

75. Computer Systems

76. BEFORE AFTER

77. BEFORE AFTER

78. The Basic System Components The basic operational design of a computer system is called its architecture. John Von Neumann, a pioneer in computer design, is given credit for the architecture of most computers in use today. A typical Von Neumann system has three major components: the central processing unit (or CPU) memory, and input/output(or I/O).

79. Von Neumann’s Computer Architecture I/O Devices CPU I/O Devices

80. Major Components of Computers

81. Hardware Devices Hardware is the physical part of the computer and its associated equipment. Computer hardware can comprise many different parts, these include: Input Devices: used to enter data; Examples: keyboard, mouse, trackball, touch screen, light pen, microphone, bar code reader, fax modem card, joystick, and scanner. Output Devices: used to view and hear processed data; Examples: video monitor screens, printers, speakers, and fax.

82. Input Devices

83. Output Devices

84. Central Processing Unit (CPU) “Brain" of the computer Three components: Arithmetic Logic Unit (ALU): Number "crunching“ Registers Similar to memory but has special purposes Control Unit: manages instructions to other parts of the computer, including input and output devices "traffic cop“

85. Primary Memory: The storage area in which program instruction (code) reside during execution. Read-only memory (ROM) is permanent; it remains whenthe power is off. Start-up instructions for the computer is anexample of ROM. Random access memory (RAM)is a temporary storage area for program instructions and data that is being processed, it is only active while the computer is turned on. (located on the motherboard not part of CPU)

86. Secondary Storage: Provides space to retain data in an area separate from the computer's memory after the computer is turned off, these include; hard disk drives, floppy disks, tape, zip drives, optical drives, flash memory, and CD-ROM drives.

87. Networks A network is "a combination of hardware and software that allows communication and electronic transfer of information between computers" (as cited in Hebda, 1998, p. 19). Hardware may be connected permanently by wire (Ethernet), or temporarily by wireless communication, and modems/telephone lines. This allows the sharing of computer and software resources, through the use of the network. For example, several computers may share one computer, or a word processing program could also be accessed by many different users.

88. Computer Categories Super computers The largest and most expensive, can perform billions of instructions every second Mainframes Large computers capable of processing several millions instructions per second. They support organizational functions, therefore have been the traditional equipment in hospitals. Customized software results in high cost. Minicomputer A scaled-down version of the mainframe, since they are now becoming more powerful they can now be found in hospitals and HMO's Microcomputers (PCs), Inexpensive processing power for an individual user. Laptop or Notebook, Handheld, and Personal Digital Assistants (PDAs) Portable devices which can be used almost anywhere.

89. References: http://www.scribd.com/doc/6120543/Nursing-Informatics http://www.snomed.org/ http://himss.org http://www.amia.org/ni-wg http://www.healthitcertification.com/about.html http://www.caringonline.org/ http://www.imia.org/ni/index.html http://en.wikipedia.org/wiki/Nursing_Informatics