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Nursing Information Systems Background: Evolution of technology “technology explosion” nursing informatics to include the application of: Computers Technology Nursing science to the management and processing of nursing data, information and knowledge
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Computers, Informatics, Clinical Information, and the
Professional Nurse Nursing Information Systems
Background: Evolution of technology technology explosion nursing
informatics to include the application of: Computers Technology
Nursing science to the management and processing of nursing data,
information and knowledge Purpose of Nursing Informatics
Micro-level: Study the process and structure of nursing information
to support clinical decision-making and the delivery of nursing
care. In Jordan, electronic patient files are not yet created for
nursing and medical care purposes they exist only for the purposes
of accounting and billing mostly in the private sector (will be a
paperless hospital) Macro-level: Helps in retrieving evidence-based
standards of practice, legislation acts, statistical analysis of
the profession of nursing and practitioners of nursing in Jordan at
any given time or interval of time. Issues Raised by the Emergence
of Nursing Informatics in Jordan
Preparation of nursing students in: Computer skills Electronic
information management systems Ethics and confidentiality of
patients records How do we maintain consistent quality standards of
caring across Jordan? May 2002 Royal Decree approving constitution
of the JNC
The Role of the Jordanian Nursing Council (JNC) in Monitoring
Nursing Information Systems and Informatics in Jordan May 2002
Royal Decree approving constitution of the JNC July 2002 HRH
Princess Mona El Hussein appointed President of the JNC Nine Task
forces are currently working for the purpose of developing the
nursing profession in Jordan by regulating its practice and
developing scientific knowledge and practical skills in nursing The
Role of the Jordanian Nursing Council (JNC) in Monitoring Nursing
Information Systems (Continued) A large data base isbeing mounted
to: Study the situation and the status of nursing to include all
education levels and service sectors Study current and future
requirements for nurses and midwives Nursing specialties, standards
of nursing practice and competence in each specialty Job
descriptions and nursing ethics with case studies and situation
analysis Well-articulated and coordinated nursing information
systems are needed to inform these taskforces based on national and
international databases Issues Raised at the Macro-level by the
Emergence of Nursing Informatics in Jordan
How will these databases be used to advocate effectively for
legislation reform and to gain the support of the government for
the nursing profession? How will the private sector be included in
the process to gain national consensus? How will these databases
and identified needs from them be used to implement change at the
education, practice and research levels in nursing in Jordan?
Knowledge Management and Nursing Informatics Frameworks
Types of knowledge initiatives Sharing knowledge & best
practices Instilling responsibilities for knowledge sharing Driving
generation for innovation Producing as a product Capturing &
reusing past experiences Building & mining Customer bases
Mapping networks of experts Understanding & measuring the value
of knowledge Leveraging intellectual assets Top 10 domains for
management Source: Xerox Company Application of Knowledge
Initiatives in Nursing
Nursing Informatics is now taught in certain university programs at
the graduate level in USA Program Outcomes are: Prepare leaders in
the specialty Develop technologies that support clinical
decision-making Facilitation and support of data collection, entry
and retrieval in collaboration with other health care disciplines
creation of an integrated clinical information system Integrating
standardized nursing languages into clinical information systems
Application of Knowledge Initiatives in Nursing (continued)
Best practices very trendy and completely a participatory process
of knowledge sharing and measurement to get evidence-base for
professional standards Global networks of nursing experts such as
the International Network for Doctoral Education (INDEN) are mapped
electronically as well as networks of research the Nursing
Informatics Workgroup ( a part of the International Medical
Informatics Association (IMIA-NI) Building knowledge customer base
is done by Client-centered Informatics a trend in health care and
Nursing Informatics in particular Transformation of Data to
Knowledge Four Main Concepts Identified in Nursing
Informatics
Data (objective information) Information (data + interpretation +
organisation + structure) Knowledge (information + synthesis) and
relationships identified and formalised Nursing Informatics
Map
RN BSN MSN PhD NI specialist Skills and experience hierarchy
Information science Nursing Computer science Nursing Informatics:
What?
How nurses manage and collect data Process data into information
and knowledge Make knowledge-based decisions and inferences for
patient care Using empirical and experiential knowledge to broaden
scope and enhance the quality of professional practice A
combination of computer science, information science and nursing
science Multidisciplinary, scientific endeavor of modeling: Nursing
Informatics: How?
Using discourse about motives for computerised systems Analysing,
formalising, and modeling nursing information processing in:
Clinical practice Management Education Research Investigating
Determinants Conditions Elements Models and processes to test
effectiveness and efficiency of computerised information,
telecommunications and network systems for nursing practice and
their effects on nursing practice Nursing Informatics: Values and
Beliefs
The nursing information system supports a professional practice
model (Data input for advancing science of nursing, best in
research (evidence- based best practices) . Data belong to the
patient (integrates with other applications as part of the
electronic patient record continuity of health care documentation
across the life span. The nursing information system uses
standardized language (pre-defined data elements: structured data
base ALL health care members improve communication improve quality
management and nursing research WITHIN and ACROSS health care
settings . The nursing information system provides decision
support: guide care planning and documentation Nursing Informatics:
Values and Beliefs (continued)
The nursing information system reflects standards of care Hospitals
Nursing professional associations Regulatory agencies Departmental
policy and procedure committee The nursing information system
supports professional nursing judgment: A rich database of patient
care order groups assures that the nurse can individualize the
patient's care. Each order group contains patient care orders that
can be modified to meet individual needs. Users are involved in
every aspect of the nursing information system: Design,
development, implementation, and evaluation. Nurses from all areas
of practice participate in our informatics committees and groups.
Applications Of Nursing Informatics USA and Jordan
Point of care computers placed on the nursing units provide access
to patient electronic records to nurses and other health care
providers resulting in: Error-free orders Capturing drug and food
allergies Documentation of medications Capturing nursing care
measures electronically Paperless diagnostic results from x-ray and
laboratory departments and physical and respiratory therapy
departments. Worldwide web is used by nurses for: Informing
themselves of current research Industry updates Experiences and
publications in health care and nursing Consumers are informed
about: Aspects of wellness and quality of life Elements of health
care Applications Of Nursing Informatics USA and Jordan
USA: first two graduate programs in Nursing Informatics at the
University of Maryland and the University of Utah in 1988 and 1990
respectively Jordan: None of the nine faculties of nursing provides
Nursing Informatics either at the graduate or undergraduate levels.
Private universities: Al Zaytoonah considering to offer a course at
the fourth year undergraduate levelas an elective stream parallel
to community health nursing Continuing professional education:
willbe considered with the JNC The issue of unavailability of
faculty tot each this subject and the alternative is to recruit
non-Jordanian faculty and send Jordanian faculty for preparation in
the USA Nursing Roles in Informatics: USA
Nurses to be included in the design and application of systems of
Software used in Nursing Informatics Nurses are processors of
information as they manage and communicate data in a variety of
settings Career opportunities, employment in: Acute ambulatory
settings Academia Computer applications companies Consulting firms
Nursing Roles in Informatics: USA
Evidence-based practice has led to the fact that all nurses need to
be computer and information management literate At the entry level
nursing role (post BSN) a nurse must be able to: Use a word
processor, communicate by, use bibliography from the Internet
Respect copyright laws and netiquette and respecting
confidentiality of patients files. Human-computer interaction
ergonomics become instrumental for nurses to know Tele-health
technologies used by the nurses in the USA for rural areas and
prisons Nursing Roles in Informatics: Jordan
In Jordan roles are less developed than USA however all faculties
have included basic and advanced computer skills courses as a
requirement from MOHE for accreditation Some of the faculties
(JUST, Hashemite University and Al Zaytoonah Private University of
Jordan) have started e-learning initiatives and on-line courses
Some of the teaching hospitals are planning to become paperless for
e.g. King Abdullah the Founder teaching hospital At the service
levels acute ambulatory settings and some of the private and
teaching hospitals have computer applications and point-of-care
computers to a varying degree: electronic files are used for
billing, pharmacy, disposable and medicalsupplies items as well as
dietary and hospitality services. A paper less hospital opening
very soon JNC is planning a computer-based JNCE for all
baccalaureate graduates effective next year Jordanian Nursing
Council for Nurses and Midwives currently retrieving a national
database of nursing and midwifery practitioners in Jordan.
Conclusion: Ethical and Quality Concerns with Nursing
Informatics
Confidentiality Standards for confidentiality must be set in place
during automation and be monitored by a Quality Assurance or Ethics
Committee or even Risk Management Committee Data entry quality:
systems to monitor of complete and accurate data entry must be set
in place to maintain data integrity otherwise speeding up
communication and dissemination of errors in data. Fragmentation of
nursing tasks: How to match standards of care with advances in
technology? Answer lies in having nurses involved with system
designexplore workflow processes because automated information
system development is NOT a duplication of the paper system. It
involves an IMPROVEMENT in the processes in place by using
technology TECNOLOGY IN THE HOSPITAL INDUSTRY
The integration and assimilation of technology into the everyday
life of health managers and health professionals will inevitably
become an increasing reality. Table of Contents Introduction..
4
Systems for Admission, Discharge, Transfer. 5 Order Communication
Systems.. 7 Test Result Reporting. 9 External Access to Multisource
Data.11 Electronic Methods of Access and the Master Patient. 13
Central Scheduling Systems.. 16 Improvements in the Patient Care:
Telehealth.. 20 Telnursing. 22 Telemedicine 23 Telepresence ..23
Telepractice . 24 Robots in surgery 25-28 Conclusion Telehealth,
Telenursing, Telemedicine
Information technology refers to a system utilized to retrieve,
manage, process, and disseminate information by means of
telecommunication. Telecommunication is the transmission of
information from one site to another. Use of equipment to transmit
information in the form of signs, signals, words, or pictures by
cable, radio or other systems. SYSTEMS FOR ADMISSION, DISCHARGE,
TRANSFER
Improving Patient Care by Information Systems SYSTEMS FOR
ADMISSION, DISCHARGE, TRANSFER A patients entry into health care
always involves registration at the providing facility.
Registration information is needed by all care providers. It was
this need that supported the development of registration systems as
one of the first information systems (Iss) to be used in health
care. Systems for Admission, Discharge, Transfer
Information collected through registration should be electronically
transmitted to all user who need the data. Electronic transmittal
assures that uniform data exist at all locations. Also, electronic
transmittal decreases the risk of errors associated with duplicate
data. Registration system assigns a unique identifier to all
patients, which has been called the medical record number. To
access patient records at different sites of care, users must have
a way to link all medical record numbers within an enterprise to
obtain a longitudinal record of care received by the patient. Order
Communication Systems
Order communication systems automate the processing of clinical
orders to the providing departments. Traditionally, order entry
systems have been transcription based, which allow for clerical
entry of physician order from paper charts. Support of clinical
order entry through use of graphical user interface (GUI) orders.
GUI uses pull-down menus, dialog boxes, pictures or icons, file
folders, and other on-screen aids to allow user to navigate the
system operations. GUI orders allow users to easily enter new
orders or modify existing orders at any time, from any system
function, during patient record review. Orders Communication
Systems
When the order management system sends an order to an automated
ancillary system, the order is electronically placed directly into
the ancillary system, without intervention of department staff.
Orders transmitted to ancillary departments that are not automated
are usually sent via message to the department printer. The most
commonly automated ancillary systems are laboratory, radiology, and
pharmacy. Test Result Reporting After tests are reported by the
service department, the results should be made accessible to all
system users. To facilitate review, results should be presented in
results display and results storage. Results display: Test results
are accessible for on screen display. The list is usually presented
in reverse chronological order. Results storage: Results are stored
in the systems database. Two ways of access to results; by direct
access into the source system or by query into the source system.
Test Results Reporting
*Ancillary and clinical system results can also be stored in a
clinical data repository. *Use of a common data repository for all
clinical systems allows users to access information from one
location. *Also eliminates or decreases duplication of data entry,
and usually enhances performance. External Access to Multisourced
Data
External access is generally less efficient. Often, institutions
that have very effective internal IS s lack effective linkages to
patient data at other sites of care. Hospital based caregivers can
usually access results from any automated hospital based system.
Older Methods of Access: clinicians have compensated for a lack of
access to patient information by phoning for the data and writing
it down External Access to Multisourced Data
*This method is less than desirable because it is time consuming
and holds considerable potential for errors. *With the
proliferation of fax, which provide clinicians with paper copies of
patient data from alternate sites of care, access to information
has improved. *However, faxes still present a problem, in that
access requires that the site be open when the information is
needed. *When caregivers cannot access data, they must determine if
test results can wait or if repeat testing is needed. Electronic
Methods of Access and the Master Patient Index
*The real value of collecting data electronically is assuring
access to all users at the time of need. *Access to records should
be available regardless of the location of the user or the record.
*Preferred solutions for access to multisourced data include the
use of: Data repositories: Which store data from multiple systems
and allow users, based on security clearance, to access the data.
Electronic Methods of Access and the Master Patient Index
Data repositories:Which store data form multiple systems and allow
users, based on security clearance, to access the data. Networks:
Which link computers with link computers within the same general
physical area, and wide area networks which create links over large
geographic areas. Community health information networks: Which are
clinical messaging networks that provide patient data form multiple
sites across defined geographic areas. Master patient indexes
(MPIs): Which is a cross-referencing mechanism for identification
and access of patient data from multiple sources. *It supports
health care organizations with multiple and changing sources of
patient identification and registration. Electronic Methods of
Access and the Master Patient Index
*Common objectives for MPI include: a) Providing a fast, reliable,
thorough, enterprise wide patient search capability. b) Assisting
in the prevention of duplicate patient entries in a network. c)
Detecting duplicate patient entries and providing facilities for
review and correction of these exceptions. d) Accepting
registration, case, and member input from multiple sources. e)
Cross-referencing entries form multiple data sources. f) Storing
patient demographics, insurance, and other data. g) Providing a
source for network wide unique patient identifiers. Central
Scheduling Systems
It was developed to facilitate patient scheduling through one or
more department within an institutions or an enterprise. Central
scheduling departments schedule both inpatients and outpatients for
exams, tests, and other procedures. Central scheduling systems give
institutions a distinct competitive edge in the marketplace. Also
place an increasingly important role in patient satisfaction
outcomes. Central schedulers have access to identified department
patient schedules and coordinate scheduling of patient test. At the
same time, schedulers assure that exams are appropriately
sequenced. In addition, that patients are expedited through
multiple departments and/or facilities in the shortest time
possible. Central Scheduling Systems
Patient have one stop scheduling and are assured that test are
appropriately sequenced. Central scheduling department staff
assures that patients receive appropriate instructions required for
test. Some unique issues of a central scheduling systems include:
Departmental ownership and control of schedules: Scheduling
departments frequently believe that only the servicing department
can appropriately schedule patients. Central Scheduling
Systems
Staffing concerns: When scheduling staff are centralized,
participating departments need to contribute to the full-time
equivalent component of the new centralized scheduling department.
The goal of computerized patient records is to use automation to
provide users concurrent data analysis, and appropriate warnings
and alerts. Fully functional automated systems improve patient
care, clinical outcomes, and caregiver productivity. Information is
one of the most valuable resources in health care
Information is one of the most valuable resources in health care.
Appropriate management of information as a resource will maximize
the usability, quality, and value of information. To the extent
that we are able to collect, store, and retrieve clinical
information within institutions, across organized sites of care,
and across nonaligned sites of care, we will be able to improve the
delivery of care, clinical outcomes, and operations within and
beyond the enterprise. Improvements in the Patient care
TELEHEALTH: Telehealth is the utilization telecommunications
technology to link two or more end-user sites by any interactive
electronic means, such as telephone, computers,, fax, and
interactive video transmissions for the purpose of transfer and/or
exchange of information and data in any health-related application.
It is remote, electronic, clinical consultation, assessment, and
monitoring of consumers of any form of health care. Telehealth has
now become an integral component in the delivery of health care,
regardless of geographic or socioeconomic status. Telehealth
continuation
A variety of related services and resources including the
following: *Retrieval and transmission of medical records and data.
*Consultation, assessment, and management of medical record and
data. *Identification and diagnosis of new illnesses.
*Implementation and management of a medical regimen of treatment
for those illnesses. *Patient and caregiver education and support.
TELENURSING: Telenursing is the subset of telehealth that utilizes
telecommunications and nursing informatics to support the practice
of nursing and the provision of professional nursing care to
patients on remote residential or clinical settings. It is a
amalgam nursing informatics, nursing science, and the art of
nursing. The focus of the most recent activity, however, has been
on telenursing applications that primarily employ advanced image
and audio capabilities. These technologies can range from
high-resolution still images (e.g., X-rays) to sophisticated
interactive teleconferencing systems and networked computers.
Telenursing is the synchronicity of nursing scienceand nursing
informatics. TELEMEDICINE: Telemedicine is the transfer of medical
information from one distant site to another utilizing electronic
communications for the purpose of illness prevention, health
maintenance, provision and monitoring of patient care, education of
patients and their health maintenance, provision and monitoring of
patient and their health care providers, and support of health care
practitioners from other disciplines. It is remote electronic
medical diagnosis, consultation, and treatment that can take place
either synchronously (in real time) or asynchronously.
TELEPRESENCE: This is the newest concept in telemedicine. It
encompasses the use of advanced technology such as virtual reality
for relatively The provider fo the service might be a nurse.
Sophisticated medical procedures such as surgery, in which robotics
and virtual reality are integrated to manipulate instruments and
perform selected surgical procedures on patients at remote, often
inaccessible sites. TELEPRACTICE: Telepractice may refer to any
professional providing interactive, long-distance consultant
services to his or her client.. The provider fo the service might
be a nurse. In its broadest applications, telepractice can utilize,
telephone, fax, or any form of Internet communication. Robots in
Surgery We always hear in the news almost every day of some kind of
technology or scientific advance. One of the topics more
interesting that are surrounding us right now is the robotics
technology. The machines might be permitted to make all of their
own decisions without human oversight, or else human control over
the machines might be retained. Some of the robots that we have
right now are the following: ROBOTS THAT OPERATE IN BRAINS: This
robot is called Pathfinder and it will provide surgeons with away
of guiding instruments very precisely to the chosen site of the
brainwith minimal damage to surrounding tissue. Potential uses
included the treatment of brain tumors The robot carries a camera
that automatically matches the scanner image to the position of the
patient's head on the operating table. ROBOTS TO PERFORM HEART
SURGERY: It performs heart bypass surgery using robotic devices in
the delicate procedures. The aim of this robot was to create a
safer less invasive means of performing heart surgeries. The robot
has the ability to hold the camera and tools perfectly that leads
to eliminates errors caused by even slighttremors of the surgeons
hands. ROBOTS IN LAPAROSCOPIC INGUINAL HERNIA REPAIR:
This robot know as AESOP a fiber optic camera smaller than a pencil
is threaded in to the abdomen that is held by the robot. This robot
responds to oral directions. The robot might not recognize the
voice, if thesurgeon's tone that day is different from the
recording. ROBOTS IN TELESURGEERY:Using surgical robots and
computers, experienced physicians can conduct surgery anywhere in
the world. Surgical robots augment a surgeon's ability by scaling
down range of motion, providing three-dimensional vision and
eliminating hand tremor. Since laparoscopic surgery is performed
with only a minimal incision, the patient e Robots are expected to
make surgery safer and cheaper, and recovery much faster. But
mostly the idea is to do surgery with the smallest incision
possible. CONCLUSION As we can see technology is and it is going to
be the world revolution of any time. Since scientists, engineers
and all kind of people will look for better ways of make life
easier and safer. And the only way to achieve this is with the help
of Technology. This science is growing rapidly and is offering us
great advantages to our life. Like is in the Hospital Industry. We
could see that technology is very important in here because, one of
the most important things for the humanity is our HEALTH, that is
why this industry has to be updated in order to offer new
discoveries to help people to survive and always be healthy. We can
see that we dont have the same utensils as before, now we are
updated and we have the newest and biggest technology in medicine.
This made us think about the big help that the world needs from us.
As a CIS student we can contribute with anything to the world
industry. THANK YOU!