NURSING INFORMATICS

KENNETH EARL I. DIZON RN MAN

Course Description:
The focus is on the integration of nursing,
computer, and information science for the
support of professional nursing practice.
Students will be able to define nursing
informatics and information science. They
will learn to evaluate information literacy
standards and assess the role of the nurse
in the application of nursing informatics.
Course Objective:
At the end of the course, the students will
be able to:
1. Address and enhance computer skills.
2. Gain knowledge and skills in relation to
nursing informatics that are unique
innovative and can be integrated in the
nursing profession/practice.
Course Objective:
3. In future research, competencies need to
be leveled by nursing leadership roles and
responsibilities, that is needed to determine
the applicability across health care settings.
Learning Outcomes
At the end of this lecture, students will
be able to:
Identify the various roles that
computers play in nursing education,
practice, management, and research.
Grading system
•Major Examination40%
•Quizzes 30%
•Attendance 15%
•Attitude/Recitation 15%
Definition/s
 Nursing informatics is the integration of
nursing , their information, and information
management with information processing
and communication technology, to support
the health of people – it has implications for
health administration, nursing clinical,
research and education activities

7
Nursing Informatics Competencies
 NI competencies encompass many skills,
not only computer-related skills, but
knowledge and attitudes needed by
nurses in relation to information and
communication technologies.

8
HISTORY OF NURSING INFOMATICS

Florence Nightingale
Founder of Modern Nursing
Mathematician
Crimean war – develop the first “Pie
Chart/Graph”
Used statistical analysis and develop forms for
the hospital to generate data & statistics.
Considered as the first INFORMATICS
NURSE.
HISTORY OF NURSING INFOMATICS

1950-1960
Image of nursing improved
Practice of nursing grew in scope & complexity
Increase in the no of professional nurses
Growth in the computer industry
Computers in the health care facility
Office functions
Teletypewriters
Punch cards
HISTORY OF NURSING INFOMATICS

1950-1960
Increase in the no. of health care facility
Nurses are considered as the center of
communication activities and information
exchange.
Desktop terminals were developed
Email was developed and used in 1965
HIS (Hospital Information System) used mainly for
Accounting
Finance
Basic Business
HISTORY OF NURSING INFOMATICS

1970
Integration of the HIS
Chip was developed
Microprocessors were introduced (1971)
Development of the MIS (Management
Information System) used mainly for
Statistical Information
Billing
Insurance & Reimbursements
HISTORY OF NURSING INFOMATICS

1980
1982 - 1st National International Medical
Informatics Convention working conference
was held in London, England.
1985 – 2nd Conference was held in Calgary,
Canada also MS released windows 1 as well as
intel 386
1986-Informatics field is introduced
Statistical Information
Billing
Insurance & Reimbursements
HISTORY OF NURSING INFOMATICS

1980
1986-Informatics field is introduced
PC/Micro Computer
HIS
CPRS (Computer based Patient Record System)
Incorporated the following:
Doctor’s Order Lab Results
Kardex Nurses Notes
V/S & TPR Discharge Planning
HISTORY OF NURSING INFOMATICS

1990 to Present
1992 – NI was approved by the ANA
Computer becomes faster & easier to use
Internet became a tool for clinical applications
Knowledge is the focal point in NI
Data gatherer
Information users
Knowledge users
Knowledge builders
NURSING INFOMATICS IN THE
PHILIPPINES

MS word was unfamiliar in the nursing

community until 2007-2008.
Not yet acknowledged to be a sub-
discipline
Pioneers (Philippine Medical Informatics
Society)
PIMA officially registered in 1996 composed
of 11 physicians headed by Dr Alvin Marcelo
later trained in National Library of medicine
NURSING INFOMATICS IN THE
PHILIPPINES

1999 National Institute of Health UP Manila

formed a study group to identify the
international standard for health promotion
and its adaptability in the Philippines
2003 Proposed a course in NI in University
of the Philippines
2005-2006 College of Arts & Science Major
in Bioinformatics and Master of Science in
Health Informatics was offered.
 NURSING INFOMATICS IN THE
PHILIPPINES

Standards of Health Information in the

Philippines v. 1999 was introduced
commonly known as SHIP99.
Informatics was introduced in the PNA by
Evelyn Protacio
Despite representation & inclusion in the
curriculum nurses in the Philippines still lag
behind.
NURSING INFOMATICS IN THE
PHILIPPINES

2008 Nursing Informatics in the undergraduates is

defined as CMO#5 s. 2008
2009 revised & included in the Health Informatics
in the CMO#14 to be implemented summer 2010
Problems encountered
Adaptation of local materials which does
not suit local needs which should be
community centered
Lack of certification & credentialing
programs in post graduate levels
NURSING INFOMATICS IN THE
PHILIPPINES

Due to integration in the curriculum, made an

awareness & interest in NI.
Development of training, Certification & &
credentialing are on the process by PNIA.
Partnership with local & International NI
Organization
CORE X strategic platform (Competency,
Organization, Recognition & Expertise)
Have a Nursing Informatics specialist in every
Hospital
NURSING INFOMATICS IN THE
PHILIPPINES

ISSUES:
Inequities in cost, access & inefficiency
Mal distribution of health care providers and
public health system managers
NURSING INFOMATICS IN THE
PHILIPPINES

National Telehealth Center conducts Webinar

eRecords - database
eMedicine – tele referrals between Doctors to
the barrios & PGH using mobile phones &
internet technology
eLearning – systematic deployment of trainers
where there is greater need while providing
access to up to date knowledge
eHealth Training – for educators of heath
profession was held in national teleheath center,
UP Manila
 American Nurses Association's Scope and
Standards for Nursing Informatics Practice (2008)
:

“ Nursing Informatics is a specialty that integrates

nursing science, computer science, and
information science to manage and communicate
data, information, knowledge and wisdom in
nursing practice.”
Standard areas of nursing :
Nursing P ractice
Nursing E ducation
Nursing R esearch
Nursing A dministration.
COMPUTER Assisted Education

 PDA (Personal Digital Assistants)

 LCD Projectors
 Wireless Routers
 Desktops
 Laptops
 Smartphones
VIDEOS/ANIMATIONS
 Distance learning
 Testing (NCLEX)
 Student and course record management
 Functions :

 Records client information

 Provides access to other departments
 Used to manage client scheduling
 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.
 Records clients assessments, medication
administration, progress notes, care plan
updating, client acuity and accrued charges
EMRs/CPRs

 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
 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
 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
A. Human resources

◦ All employers must maintain a data a database

on each employee
◦ Administrators can use this database to
communicate with employees, examine
staffing patterns, and create budget programs
B. Medical records management

◦ Allow client records to be searched for

trends, number of cases, most expensive cases,
and client outcomes.
◦ Nurse informaticist can assist administrators
with the design and implementation of
systems that allow such searches to be
generated, analyzed, printed, and distributed.
C. Facilities management
 Heating,
 Air conditioning,
 Ventilation,
 Alarm systems are computer controlled.
D. Budget and finance

◦ Claims are transmitted much more quickly

◦ Can also effect cost-savings by reducing the
desired services time needed for accounts
payable and receivables.
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 analysis

◦ Helps create form 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
 Nursing practice will be revolutionized
and we will truly be a profession of
nurses with our own classification
systems, bibliographic systems, and
payment systems .
We need to think outside the box?
 We need to use the Internet to enhance
our practice and provide telenursing care .
We need to become wireless and
conduct our services using all the newer
IT tools.
 “ We have a long way to go, but if we
utilize information technology effectively,
informatics will become an integral part
of our profession and the health care
industry. I do believe we have the
knowledge and perseverance and I am
convinced it will come to pass.”-Dr.
Virginia Saba
COMPUTERS in NURSING
EDUCATION
Computers are used extensively in nursing
education; libraries are computerized, nursing
educationalists use computers in classroom
teaching and for academic record keeping.

In nursing education, computers are used in

teaching and learning, testing, and student and
course record management.
Teaching and Learning

Computers enhance academic performance for

both students and faculty through facilitating
access to literature, computer-assisted
instruction, classroom technologies, and distance
learning.
Teaching and Learning

Literature access and retrieval: computers

have significantly improved our abilities in keeping
abreast of the information on any subject. In a
fraction of time, continuously updated cumulative
indexes of subjects can be searched electronically.
Teaching and Learning

Once a list of search matches is displayed

on screen, the user can select all or certain
citations and either print them or store them
on the hard disk.
Computer-Assisted Instruction (CAI)

Many software programs help students and

nurses learn and demonstrate learning. These
include drug dosage calculation and ethical
decision making.

Examples of tutorials include ECG

interpretation, drug interactions, and legal aspects
of nursing.
Computer-Assisted Instruction (CAI)

Completion of CAI programs may be an

acceptable means of demonstrating continuing
education activities. For example, nursing faculty
can obtain a certificate from the National
Institute of Health (NIH) regarding the
protection of human subjects in research.
Classroom Technology

New educational buildings are wired to

accommodate technology. This includes electric
outlets and wireless technology for network or
Internet access.

For nursing faculty, liquid crystal display

(LCD) panels allow computer screens to be
displayed to the entire classroom.
Testing

This is the second use of computer in nursing

education.

Surveys, including anonymous questionnaires,

can be completed online.
Testing

For testing, large banks of potential items can be

written and the computer can generate different
exams for each student depending on the
selection criteria. Students’ answers can also be
scored electronically and the exam results
analyzed quickly. For example, the National
Council Licensure Examination (NCLEX-RN)
moved from paper and pencil tests to computer
tests.
Student and Course Record Management

Computers are useful for maintaining results of students’

grades or attendance.

Students are frequently asked to evaluate faculty and

courses. These data are also scanned into the computer
so that cumulative results can be calculated and stored.

Many schools have now all student records on computer.

From application through graduation, the registrar’s office
keeps track of names, addresses, courses taken, grades,
and all other important data.
COMPUTERS IN NURSING PRACTICE

Computers help nurses collect, record, and

use client’s data.

Nurses maintain client’s data in computer

records, assess other departments’ information
about him/ her, and use computers to manage
client schedules
Documentation of Client Status and
Medical Record Keeping

Computer can help nurses in service in their daily

activities by reducing the amount of time needed to
record in the client’s file, to access data about the client
that may be somewhere in the file or elsewhere in the
health institution.

Computers can help nurses in accessing standardized

forms, policies, and procedures.

Within the context of the above title, we will discuss

next bedside data entry, computer-based client records,
data standardization and classification, and tracking client’s
status
CASE PROBLEM PRESENTATIONS
 Accessible to
Authorised
The Future Single Health Record On-line Care Providers Across
the Continuum of Care

The Present Multiple Health Records Across All Care Settings

Health Care Providers Across the Continuum of Care

Primary Health Specialist Care Hospital System Community
Care Health Services

•General Practitioner •Paediatrics •Specialist Services •Education

•Allied Health •Orthopaedics •24 hour Nursing Care •Drug and Alcohol
•Surgery •Therapists •Mental Health
•Medical Centre •General Medicine •Pharmacists •Sexual Assault
•Alternative Therapists •Gerontology •Dietitians •Home Help
•Ambulance/Paramedics •Dermatology •Social Workers •Meals on Wheels
•Respiratory •Psychologists •District Nursing
•Cardiology •Diagnostic Services •Health Promotion
•Gynaecology •Administrators •Child Protection
•Obstetrics etc. • etc. Transition Module 2006 Health
• Baby Hardy etc. 55
 Discharge
Medications

Transition Module 2006 Hardy 56

 Clinical Systems Integrated Framework

Patient Administration and Unique Patient Identifier

Hospital Environment

Point-of-Care
Clinical System
Electronic
Discharge Referral
Prescribing
System
Decision Support Clinical Information
Access Program
(CIAP)

Clinical Allied
Emergency
Specialty Radiology Pathology Pharmacy Dietary Health
Department
Systems Systems

Community Health Information System (CHIME)

Electronic Health Record

Transition Module 2006 Hardy 57
 Clinical Systems Integrated Framework

Patient Administration and Unique Patient Identifier

Hospital Environment

Point-of-Care
Clinical System
Electronic
Discharge Referral
Prescribing
System
Decision Support Clinical Information
Access Program
(CIAP)

Clinical Allied
Emergency
Specialty Radiology Pathology Pharmacy Dietary Health
Department
Systems Systems

Community Health Information System (CHIME)

Electronic Health Record

Transition Module 2006 Hardy 58
 Medication Error

The National Coordinating Council for Medication Error Reporting and

Prevention defines medication error as follows:

“A medication error is any preventable event

that may cause or lead to inappropriate
medication use or patient harm while the
medication is in the control of the healthcare
professional, patient, or consumer.”

Transition Module 2006 Hardy 59

Where Medication Error Occurs
6%

34%

56%

4%
Prescribing Dispensing Administration Other
Transition Module 2006 Hardy 60
 Type of Administration Error

 Missed doses of medication

 Wrong time of administration of medication
 Wrong medication administered
 Wrong medications due to misidentifying the patient
 IV rate too fast, delivering too much medication
 Wrong concentration/dosage of medication delivered IV
 Wrong route of administration (eg, oral solution given IV)

Transition Module 2006 Hardy 61

 Prescribing Errors

 Prescribing wrong drug, wrong dose, wrong route

 Disregarding altered physiology e.g. liver impairment, pathology
results etc
 Disregarding allergies or previous drug reactions
 Illegible orders
 Unaware of best practice recommendations
 Poor communications with patient or health care team

Transition Module 2006 Hardy 62

The Solution to Adverse Events
 A Point-of-Care Clinical System
◦ Order Management
◦ Results Reporting
◦ Clinical Documentation
 Electronic Prescribing Decision Support System
 Clinical Information Access Program

Transition Module 2006 Hardy 63

Features of Clinical Systems
Assist with decision making tasks by:
◦ Generating alerts and reminders
◦ Providing diagnostic assistance
◦ Identifying errors and omissions
◦ Retrieving information from credible sources
◦ Automatically interpreting images (ECG, X-Rays
CT Scans etc.

Transition Module 2006 Hardy 64

The Care Process
 Patient history and examination
 Review past history Assess
 Record medical alerts/allergies
 Order tests and treatment
 Review results reports
 Initiate care pathway/plan
 Commence discharge planning
Evaluate Plan
 Record observations
 Record interventions
 Evaluate care & manage variances
 Educate the patient
 Generate reports
 Discharge patient Implement

Transition Module 2006 Hardy 65

Information to Support the Care Process
 Patient history and examination  Clinical Documentation
 Review past history  Clinical Documentation/EHR
 Record medical alerts/allergies  Rules - Alerts and Prompts
 Order tests and treatment  Order Management
 Review results reports  Results Reporting/EHR
 Initiate care pathway/plan  Clinical Pathways
 Commence discharge planning  Discharge Plan
 Record observations  Charting
 Record interventions  Progress Notes
 Evaluate care & manage variances  Clinical Reports
 Educate the patient  CMIs/ Protocols/Guidelines
 Generate reports  Clinical Reports
 Discharge patient  Discharge Referral/ EHR

Decision Support
(e.g.CIAP, E-PDS, Rules, Alerts, Prompts, Clinical Practice Guidelines)
Transition Module 2006 Hardy 66