Introduction to Computers and Nursing Informatics

A. Historical perspective of Nursing and the Computer

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;

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;

Nursing Informatics(ANA, 2001)

• The support is accomplished through the use of information structures, information processes, and information technology;

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.

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• 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.

• 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.

• 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)

NI HistorySix 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;

NI HistorySix 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);

NI HistorySix 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;

NI HistorySix time Period

• 2000’s - Computer-based Patient Record Institute

• Post 2000 – hardware and software development, wireless point-of-care, open source solutions, internet boost...

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;

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);

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;

• 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.

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.

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• 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.

Healthcare Policy and NI Issues

• Nurses shortage

• Patient’s Safety

• Health Insurance Portability and Accountability Act (HIPAA)

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

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

Medication-use Process/Systems

• CPOE

• Bar-code enabled medication

• Automated dispensing cabinet

• 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).

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.

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

Automated Dispensing Cabinet

• Improving pharmacy productivity • Improving nursing productivity• Reducing costs• Improving charge capture• Enhancing patient quality and safety

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).

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).

• 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.

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

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.

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;

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;

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

Basic Components

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

Cont. Of Basic Components

• Duplicate Record Merge: Patient Merge• Event Capture• Medications• Inpatient Medications• Intravenous Inpatient Medications -

Unit Dose• Integrated Billing

Cont. of Basic Components

• Laboratory• Laboratory Electronic Data

Interchange• Lexicon Utility• Master Patient Index• Master Patient Index/Patient

Demographics• National Drug File

Cont. Of Basic Components

• Outpatient Pharmacy• Patient Information Management

Systems (Admission, Discharge, Transfer, Registration)

• Pharmacy Benefits Management• Pharmacy Data Management• Radiology/Nuclear Medicine• Scheduling

Multiple Uses of EHR

• Patient care• Quality improvement• Outcome reporting• Resource management• Public health communicable disease

surveillance

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;

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

cont. Data Elements of NMDS

• Nursing care– Management demographic profile

– Staffing

– Staff demographic profile

– Staff satisfaction

cont. Data elements of NMDS

• Financial Resources– Payer type

– Reimbursement

– Budget

– Expense