NURSING INFORMATICS

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. A laboratory session shall be provided for practice
application

OBJECTIVES
At the end of the course and given relevant actual or simulated situations or conditions, the
student will be able to:

1. Apply concepts, theories and principles of informatics in nursing and health care
2. Discuss issues and trends in informatics relevant to nursing and Health

A. Computers and Nursing

1. Computers and Nursing
2. Historical Perspectives of Nursing and the Computer
B. Computer System
1. Computer Hardware
2. Computer Software and Systems
3. Open Source and Free Software
4. Data Processing
5. The Internet: A Nursing Resource
C. Issues in Informatics
1. The Role of Technology in the Medication- use Process
2. Healthcare Data Standards
3. Electronic Health Record Systems
4. Dependable Systems for Quality Care
5. Nursing Minimum Data Set Systems
D. Informatics Theory
1. Theories, Models and Frameworks
2. Advanced Terminology Systems
E. Practice Application
1. Critical Care Applications
2. Community Health Applications
3. Ambulatory Care Systems
4. Internet Tools for Advanced Nursing Practice
5. Informatics Solutions for Emergency Preparedness and Response
6. Vendor Applications
F. Consumer's Use of Informatics
1. Consumer and Patient Use of Computers for Health
 2. Decision Support for Consumers
G. International perspectives
1. Nursing Informatics in Canada
2. Nursing Informatics in Europe
3. Pacific Rim
4. Nursing Informatics in Asia
5. Nursing Informatics in South America

GRADING SYSTEM
If without Lab Activity # 7
- CS 40%
- Online Exam 30%
- Reporting 30%

If with Lab Activity # 7

- CS 30%
- Online Exam 30%
- Reporting 25%
- E Portfolio 15%

What is INFORMATICS?
-Informatics
● French word "informatique" computer science.
● The study of computers, including both hardware and software design.
● 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

● "The use of computers technology to support nursing, including clinical practice,

administration, education, and research." Hebda (1998 p. 3)

● "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” American Nurses Association (ANA)(1994)

● “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”
(Graves, J. R., & Corcoran, S., 1989)

ORIGIN of Nursing Informatics

● Increase in knowledge led to the development of many specialties and subspecialties.
 ● The number of cases increased with increase in population, discovery of more diseases
and extension of life expectancy.
● Due to increased workload, lack of time to channel into useful information or knowledge -
this led to the development of healthcare informatics

ORIGIN of Nursing Informatics

Top 4 Problems of nurses in the workplace:
1. DOCUMENTATION IS EXCESSIVE
○ writes narratives (patient's history, progress notes, care pans and special reports)
○ fills up forms, records VS in graphing paper and writes in tables input/output
2. TURNAROUND TIME IS TOO LONG
● Turnaround time starts from the time a request is made to the time it was fully
accomplished
○ (ex. laboratory tests or ancillary orders)
○ Automation helps accelerate the processes of request and facilitate presentation
of current status of result of the request
3. STEPS IN THE NURSING PROCESS ARE INACCURATE
● Rushing of nursing process may lead to commission of errors
ERRORS: Medication errors; wrong entries, dictation, translation and transcription of orders.
● Automation of these processes mostly done beside a natient leads to a areat reduction
of errors.

4. COMMUNICATION IS POOR
○ Communication between healthcare providers and between departments is
POOR when served with telephone systems because of its real time nature that
requires the presence of both,
○ Phone lines may be tapped or bugged breaching privacy and confidentiality
○ Computers provide different modes of communications like chat, telephony, or
video-conferencing or e-mail and simple text messaging whatever is most

Framework for Nursing Informatics

Relies on the central concepts of data, information and knowledge: DIKD
1. A DATA is defined as discrete entities that are described objectively without
interpretation
2. An INFORMATION as data that is interpreted, organized or structured
3. A KNOWLEDGE as information that has been synthesized so that interrelationships are
identified and formalized.
4. Resulting in DECISIONS that guide practice

● Teaching Nursing Informatics is a must in the Philippines.

● January 2008 - CHED memorandum order CMO NO. 5 series of 2008 to all deans of the
colleges of nursing throughout the country.
CMO NO. 5 series of 2008 - It requires the replacement of basic computer with 3-unit Nursing
Informatics in the new curriculum.

COMMON COMPUTER-RELATED ACRONYMS IN NURSING INFORMATICS

● CAl - Computer Assisted Instruction
● CPOE - Computerized Provider (or Physician) Order Entry
● CPR - Computer-based Patient Record
● EDI - Electronic Data Interchange
● EHR - Electronic Health Record
● HIS - Hospital Information System
● MIS - Management Information System
● PDA - Personal Digital Assistant
● PHI - Protected Health Information
● PHR - Personal Health Record

COMPUTERS IN CLINICAL PRACTICE

Functions:
1. Records client information
2. Provides access to other departments
3. Used to manage client scheduling
4. Documentation of clients status & medical records keeping
● Provides access to standardized forms, policies and procedures
● Access data about client that may be somewhere in the medical record or
elsewhere in health care agency.
5. BEDSIDE DATA ENTRY
● records clients assessments, medication administration, progress notes, care
plan updating, client acuity and accrued charges
6. COMPUTER BASED CLIENT RECORD EMRs/CMRs
● Provides easy retrieval of specific data such as trends in vital signs, immunization
records, current problems
● It can be designed to work providers about conflicting medications or client
parameters that indicate dangerous conditions
7. ELECTRONIC ACCESS TO CLIENTS
● Used extensively in health care to assess and monitor clients conditions
● Data accumulated from various electronic devices are stored for research
purposes Can monitor client
● Computerized diagnosis
● Telemedicine
8. PRACTICE MANAGEMENT
● Used to order supplies, tests, meals, and services, from other departments
● Allows nursing service to determine the most costly items used by a particular
nursing unit.
 ● May provide information or decisions to modify budget, provide different staffing,
move supplies to different locations, or make other changes for more efficient
and higher quality care

COMPUTERS IN NURSING ADMINISTRATION

Human Resources
- employers maintain an employee database containing the ff: demographic and salary
data; records of unique fields and special certifications, health requirements,
immunization records and performance appraisals
- allows communication with employees, determines staffing patterns and creates budget
projections

Medical Records Management

- for research and client care
- human time and energy plus inefficiency in accessing contents > storage of paper
documentation
- allows access to information regarding most common diagnoses, case numbers,client
outcomes, most expensive cases, length of stay
- they increase the ability to demonstrate the value of nursing care

Facilities Management
- computer control of facilities like heating, airconditioning, ventilation and alarm systems
- Inventory management
- Other examples:
- security devices like readers scan identification cards, bar codes
- Magnetic strips permit only authorized personnel to enter client or private areas

Budget and Finance

- in computerized billing, claims are transmitted more quickly with greater likelihood of
being accurate and complete compared to handwritten documents
- clerical service time is reduced
- special spreadsheet programs allow tracking, forecasting and planning of budget
*Quality Assurance and Utilization Review
- used in internal and external audit
- once standards, pathways, key indicators and other vital data have been identified and
described, computers can facilitate the accumulation and analysis of data
- also used for examining trends and proposing advantageous uses of resources
"Quality is a process, not an endpoint."

Accreditation
- efficient online mechanisms used in monitoring quality indicators help reduce the
difficulty and time involved in the accreditation process
- health care agencies must maintain databases of policies and procedures, standards of
care, employee accomplishment, continuing education and in-service training
 - computer systems that assess outcomes rather than processes are required

Computer Assisted Education makes use of the ff

● PDAs (Personal Digital Assistants) like smartphones and tablets
● LCD Projectors
● Wireless Routers
● Desktops
● Laptops
● Online applications and programs (ex. Medscape)

Computer Assisted Education

● software programs that help student nurses learn and demonstrate learning
● topics include drug dosage calculations, ethical decision making, etc. in the form of
tutorials, drills, online practice sheets, simulations, mock tests with diagrams, graphics,
animations, videos and audio files
● may be available through CD-ROM or through the internet

Computer Assisted Education

● Distance learning
● educational opportunities delivered under situations in which the teacher and the learner
are not physically in the same place at the same time
- can be synchronous and/or asynchronous
- makes use of educational platforms/e-learning management systems, online storage
folders or programs, online libraries, YouTube and even podcasts
● allows users to create virtual communities
• Testing
- computers are ideal for conducting learning evaluations
- large banks of potential test items can be made to allow computers to randomly generate
different exam question for students
- students'
- students' scores can be scored electronically and stored for future reference
- best example: NCLEX

Student and Course Record Management

- accessible for students and faculty members
- used for keeping records of students' progress, including grades or attendance,
computing test scores and publishing results to be viewed by each student in private
- data can be stored in computers, allowing cumulative results to be calculated, which is
an example of data warehousin (accumulation of large amounts of data that are stored
over time and can be generated into different types of reports)
- best examples: Automate and Quipper

COMPUTERS IN NURSING RESEARCH

1. PROBLEM IDENTIFICATION
- Useful in locating current literature about the problem and related concepts. Helps in searching
for existing documents, and e-mail to colleagues.
2. LITERATURE REVIEW
- Software facilitate searches, contains thesauruses so that the most appropriate terms can be
selected.
3. RESEARCH DESIGN
- Search literature for instruments that have already been established or to design and test
instruments that need to be developed for past study.

4. DATA COLLECTION AND ANAI-YSIS

- Helps create forms for the collection of data such as informed consent, demographic
data, and recording forms. Commonly used software for quantitative data analysis:
SPSS( statistical package for social sciences), SAS (statistical analysis system), Sys
STAT. MYSTAT
5. RESEARCH DISSEMINATION
- computer word processing programs are used to author the final reports of research and
send research to various readerships. Help speeds completion or research projects

Automated System in the philippines

- 1970s
● computers were mainly used to automate billing.
● Hospital networks expanded to include information process in admission, discharge and
transfer (ADT) (mid 70s)
● Networks included pharmacy section, connecting 3 big departments: accounting, ADT
and pharmacy. (late 70s)
- 1980s
● Laboratory and imaging departments started using their special computers (early 80s)
● Integrated system expanded to the clinical area. (mid 80s)
● 90's hospital bought conversion software and hardware in order to deliver the laboratory
and imaging machines to link their main system creating interfaced systems.
- 2000s
● LABORATORY INFORMATION SYSTEM (LIS) & RADIOLOGY INFORMATION
SYSTEM (RIS) started to encroach into the main hospital information systems.
● Late 2000s - The Philippine Heart Center implemented the internet-based hospital
information system (HIS) to allow healthcare team to access access it anywhere

Looking Inside the Computer System

Parts of the Computer System Computer systems have four parts:

1. Hardware
2. Software
3. Data
4. User

•HARDWARE
● Mechanical devices in the computer; physical components of the machine
● Anything that can be touched
○ Electronic circuits, microchips, processors & motherboard - main circuit board
that all other internal components connect to (placed inside computer housing)
● PERIPHERAL DEVICES (input & output devices)

Essential Computer Hardware

● Computers use the same basic hardware
● Hardware categorized into four types

PROCESSING DEVICES
- Brains of the computer
- Carries out instructions from the program
- Manipulate the data
- Most computers have multiple processors
- Central Processing Unit (CPU)
- Secondary processors
- Processors made of silicon and copper

MEMORY DEVICES
- Stores data or programs
● Random Access Memory (RAM)
○ Volatile
○ Stores current data and programs (temporarily)
○ More RAM results in a faster system
○ changeable and used for primary storage
● Read Only Memory (ROM)
○ Permanent storage of programs; does not change; can't be erased or altered

INPUT AND OUTPUT DEVICES

- Allows the user to interact
- Input devices accept data
● Keyboard, mouse
- Output devices deliver data to external world (text, data files, sound, graphics or signals)
● Monitor, printer, speaker
- Some devices are input and output
● Touch screens

STORAGE DEVICES
● Hold data and programs permanently
 ● Different from RAM
HARD DRIVE
● very fast means of storing and retrieving data as well as having a large storage capacity
MAGNETIC STORAGE
● Floppy/DISKETTE and hard drive
● Uses a magnet to access data
OPTICAL STORAGE
● CD and DVD drives
● Uses a laser to access data

SOFTWARE
- Tell the computer what to do; describe the function or the contribution of the sets of
commands, procedures in the computer system
- Also called a program
- Thousands of programs exist
● Operating system
● Word processor
● database
● benefits the nursing from doing a manual preparation of reports and documents, due to
readily available information, the nurse will have more time synthesizing and analyzing
information

Software Runs The Machine

• Two types
- System software
- Application software

SYSTEM SOFTWARE
● " boots up" (starts up and initializes) the computer system; controls, input, output and
storage; and controls the operation of the application software.
● Most important software
● Operating system
○ Windows XP
● Network operating system (OS)
○ Windows Server 2003
● Utility
○ Symantec AntiVirus

APPLICATION SOFTWARE
● includes the various programs that users require to perform day-to-day tasks. They are
the programs that support the actual work of the user. Accomplishes a specific task
● Most common type of software
○ MS Word
● Covers most common uses of computers
THIRD TYPE OF SOFTWARE = utility
programs.
● used to help maintain the system,
● clean unwanted programs,
● protect the system against viruses and
● access the World Wide Web.

DATA
● Pieces of information
● Computer organize and present data
● Fact with no meaning on its own
● Stored using the binary number system
● Data can be organized into, files

USERS
● People operating the computer
● Most important part
● Tell the computer what to do

Computer users
Role depends on ability
● -Setup the system
● Install software
● Manage files
● Maintain the system
"Userless" computers
● Run with no user input
● Automated systems

INFORMATION PROCESSING CYCLE

• Input
• Processing
• Output
• Storage

TYPES OF COMPUTERS
SUPERCOMPUTERS
● largest type of computer; a world class "number cruncher"
● It is a computational-oriented computer specially designed for scientific applications
requiring gigantic amounts of calculations.
● designed primarily for analysis of scientific and engineering problems and for tasks
requiring millions or billions of computational operatións and calculations.
 ● It is found primarily in areas such as defense and weaponry, weather forecasting and
scientific research
MAINFRAMES
● It is the fastest, largest and most expensive type of computer used in corporate America
for processing, storing and retrieving data.
● It is a large multiuser central computer that meets the computing needs of a large
organization such as repetitive calculations of bills and payrolls.
● A mainframe has an extremely large memory capacity and fast operating and processing
time and it can process a large number of functions at one time.
MICROCOMPUTERS (Personal Computer)
● being used for an increasing number of independent applications as well as serving as a
desktop link to the programs of the mainframe.
● Desktops can serve as stand-alone workstations and can be linked to a network system
to increase their capabilities.
HANDHELD COMPUTERS
● These are small, special function computers. smaller size than the standard desktop
microcomputers, some have claimed to have almost the same functionality and
processing capabilities as the standard desktop microcomputer.
● More popular are the palm-sized computers such as
○ personal digital assistant (PDA) = provides calendar, contacts and note-taking
functions and may provide word processing and spread sheet.

VIDEO NOTES
● Source Code- The technical blueprint that tells a program how to function
● closed source software, also known as proprietary software - The public is not Given
access to the source code, so they can’t see, or modify it
● open source software - othe source code is publicly available and programmers can see
or, modify that code, if desired
● You don’t have to read or change code in order to use open source

OPEN SOURCE AND FREE SOFTWARE

Open Source Software

● " The open source concept is said to promote software reliability and quality by
supporting independent peer review and rapid evolution of source code, as well as
making it freely available.
● In addition to providing free access to the programmer's instructions to the computer in
the programming language in which they were written, many versions of open source
license allow anyone to modify and redistribute the software.

- The Open Source Initiative (OSI) created a certification mark, "OSI certified"
- in order to be OSI certified, the software must be distributed under a license that
guarantees the right to read, redistribute, modify and use the software freely.
 - The actual category of software that is considered free is almost exactly the same as the
actual category of software that is considered open source.

"Free software"
● software that respects users' freedom and community. freedom to run, copy, distribute,
study, change and improve the software.
● Thus, "free software" is a matter of liberty, not price.

"FOUR ESSENTIAL FREEDOMS"

● "to run the program as you wish, for any purpose (freedom 0).
● To study how the program works, and change it so it does your computingas you wish
(freedom 1).
● Access to the source code is a precondition for this. to redistribute copies so you can
help your neighbor (freedom 2).
● to distribute copies of your modified versions to others (freedom 3).

● "Free software" does not mean "noncommercial"

● But regardless of how you got your copies, you always have the freedom to copy and
change the software, even to sell copies.
● Most free software licenses are based on copyright, and there are limits on what kinds of
requirements can be imposed through copyright
● - However, some free software licenses are based on contracts, and contracts can
impose a much larger range of possible restrictions. That means there are many
possible ways such a license could be unacceptably restrictive and nonfree.

VIDEO NOTES
● Source Code- The technical blueprint that tells a program how to function
● closed source software, also known as proprietary software - The public is not Given
access to the source code, so they can’t see, or modify it
● open source software - othe source code is publicly available and programmers can see
or, modify that code, if desired
● You don’t have to read or change code in order to use open source

COMPARE/CONTRAST
● free software and open source ideologies are distinct
● basically refer to the same software licenses, with a few minor exceptions
● The term "open source" software is used by some people to mean more or less the
same category as free software.
● accept some licenses that we consider too restrictive. and there are free software
licenses they have not accepted.
● •nearly all free software is open source, and nearly all open source software is free.
● OSS/FS has been described as the electronic equivalent of generic drugs.
 ● In the same way as the formulas for generic drugs are made public, so OSS/FS source
code is accessible to the user. Any person can see how the software works and can
make changes to the functionality.
● As the OSS/FS can be obtained royalty free, it is less expensive to acquire than
proprietary alternatives.
● This means OSS/FS can transform healthcare in developing countries just as the
availability of the generic drugs have.

VistA: (Veterans Health Information System and Technology Architecture)

● VistA is the "mother of all health care applications". It is not strictly OSS/FS but has been
promoted by it.
● patient records, prescriptions, laboratory results, and other medical information.
● It contains among other components, integrated hospital management, patient records
management, and medical imaging systems.

DATA PROCESSING

● "The collection and manipulation of items of data to produce meaningful information.”

● It is the process of putting information into a computer so that the computer can organize
it, change its form, and etc.
● It is also the conversion of raw data to machine-readable form and its subsequent
processing (as storing, updating, rearranging, or printing out) by a computer.
● Nurses continually collect data about their clients. The data are organized and
processed, producing information about client needs and potential interventions.
● Using an intensive nursing knowledge database, the information is interpreted.
● The goal of this plan is to provide caring cost-effective quality care.
● in modern healthcare, the process of moving from data collection to implementing and
evaluating and individualized plan of care is highly dependent on automated database
systems.

DATA PROCESSING FUNCTIONS

1. Validation - Ensuring that supplied data is "clean, correct and useful"
2. Sorting - "arranging items in some sequence and/or in different sets.
3. Summarization - reducing detail data to its main points.
4. Aggregation - combining multiple pieces of data.
5. Analysis - the "collection, organization, analysis, interpretation and presentation of
data.".
6. Reporting - list detail or summary data or computed information.
7. Classification - separates data into various categories.