Practice Applications

Nursing informatics: An evolving definition

• since 1980, nursing informatics has been defined broadly either with a focus on the technologic aspects, on the concept of nurses interacting with technology to produce greater knowledge, or on the role of nurses who specialized in developing applications of technology to nursing practice - ANA, 2001

• A combination of nursing science, information science, and computer science to manage and process nursing data, information and knowledge to support the practice of nursing and the delivery of nursing care - Grave & Corcoran 1989

A specialty that integrates nursing

science, computer science, and information

science in identifying, collecting, processing,

and managing data and information to support

nursing practice, administration, education, and

research; and to expand nursing knowledge. The

purpose of nursing informatics is to: analyze

information requirements; design, implement

and evaluate information systems and data

structures that support nursing; and identify and

apply computer technologies for nursing. – ANA,

1992

 Nursing informatics is the specialty that integrates

nursing science, computer science, and information

science in identifying, collecting, processing, and

managing data and information to support nursing

practice, administration, education, research and the

expansion of nursing knowledge. - ANA, 1994

Goal of Nursing Informatics, said the ANA, is to;

• Improve the health of populations, communities, families, and individuals by optimizing information management and communication. This includes using technology in the direct provision of care; establishing administrative systems; managing and delivering educational experiences; supporting life-long learning, and supporting nursing research.

Nursing Informatics: Scope and Standards of Practice

• Nursing informatics (NI) integrates nursing science, computer and information science, and cognitive science to manage, communicate, and expand the data, information, knowledge, and wisdom of nursing practice. Nurses trained in NI support improved patient outcomes through their expertise in information processes, structures, and technologies, thus helping nurses and other care providers to create and record the evidence of their practice.

Critical Care ApplicationsChapter 21

Jade Mojica

Critical Care Nursing:• Is the nursing specialty that deals with

human responses to life-threatening problems.

Critical Care:• Multidisciplinary healthcare specialty

that cares for patients with acute, life-threatening illness or injury.

In 1986…

• Saba and McCormick estimated that the volume of data collected by nurses in critical care settings on a daily basis was as high as 1,500 data points

– A data point is a discrete unit of information. In a general sense, any single fact is a data point. In a statistical or analytical context, a data point is usually derived from a measurement or research and can be represented numerically and/or graphically. The term data point is roughly equivalent to datum, the singular form of data.

As technology expands

Available information expands

Making it increasingly difficult to access and manage the volume of data.

The clinician integrates data from:• Hemodynamic devices• Mechanical ventilators• Bedside testing devices• Observation from direct patient assessments

Focuses of Discussion

• Physiologic monitors• Arrhythmia monitors• Hemodynamic monitors• CCISs

Developments

– Functions• Rapidly analyzed small samples of gas or fluids• Maintained near-normal physiologic ranges with life-

supporting equipment• Stored large volumes of data that would otherwise be

disorganized, lost, inaccurate, or illegible.• Address alarms and clinical alerts

Information Technology Capabilities and Applications in Critical Care Settings

– Process, store, and integrate physiologic and diagnostic information from various sources

– Present deviations from preset ranges by an alarm or an alert– Accept and store patients care documentation in a lifetime

clinical repository– Trend data in a graphical presentation– Provide access to vital patient information form any location,

both inside and outside of the critical care setting– Comparatively evaluate patients for outcomes analysis– Preset clinical data based on concept-oriented views

(organize data by patient problem, or by system)

Bedside physiologic Monitoring Equipment

• Basic components– Sensors (e.g., pressure transducer, ECG electrode)– Signal conditioners to amplify or filter the display device

(e.g., amplifier, oscilloscope, paper recorder)– File to rank and order information (e.g., storage file, alarm

signal)– Computer processor to analyze data and direct reports (e.g.,

paper reports, storage for graphic files, summary reports)– Evaluation or controlling component to regulate the

equipment or alert the nurse (e.g., a notice on the display screen, alarm signal)

Hemodynamic Monitors• Can be used to

– Measure hemodynamic parameters – Closely examine cardiovascular functions– Evaluate cardiac pump output and volume status – Recognize patterns (arrhythmia analysis) and extract features– Assess vascular system integrity– Evaluate the patient’s physiologic response to stimuli– Continuously evaluate blood gases and electrolytes– Estimate cellular oxygenation– Continuously evaluate glucose levels– Store waveforms– Automatically transmit selected data to a computerized patient

database

Arrhythmia Monitor

• Computerized monitoring and analysis of cardiac rhythm

• Basic Components– Sensor– Signal conditioner– Cardiograph– Pattern recognition– Rhythm analysis– Diagnosis– Written report

Critical Care Information System (CCIS)

• Designed to collect, store, organize, retrieve, and manipulate all data related to care of the critically ill patient.

• Primary purpose is to organize patient’s current and historical data for use by all care providers in patient care

• Should include data and information from bedside devices and comprehensive plans of care to guide patient care

• Components of the CCIS– Patient management– Vital sign monitoring– Diagnostic testing results– Clinical documentation to support the process

of physical assessment findings– Decision support– Medication management– Interdisciplinary plans of care– Provider order entry

AMBULATORY CARE SYSTEM

JOVELYN CABUNGCAL

President George Bush April 27, 2004White House E.O 2004

- announced a goal to establish electronic health records (EHRs) for all citizens within a 10-year time frame. Created the position of a national health information technology coordinator to develop a nationwide interoperable health technology infrastructure .

Tommy G. Thompson Health and Human Services

Secretary Announced the “Decade of Healthcare Information Technology” and announced the publication of a report which reveals how vital it is to have automation in the physician’s and ambulatory offices.

Four Major GoalsGOAL 1

Inform Clinical Practice. Bringing information tools to the point of care, especially by investing EHR systems in

physician offices and hospitals.

GOAL 2Interconnect clinicians. Building an interoperable health information infrastructure, so that records follow the patient and clinicians have access and

involvement in health decisions

Goal 3: Personalize Care. Using health information technology to give

consumers more access and involvement in health decisions.

Goal 4: Improve population health. Expanding capacity

for public health monitoring, quality-of-care measurement, and bringing research advances

more quickly into medical practice.

Where Ambulatory Clients are Being Treated:

Ambulatory Clinics

Surgery Centers

Single and Multispecialty Group

Diagnostics Laboratory

Health Maintenance organizations

Independent physician organizations

Birthing Centers

College and Universities health Services

Issues for Ambulatory Care

• Those who work in ambulatory care are similar across the healthcare enterprise including increased accountability , the need for continuous and documented service improvements, pressures to control utilization, and the protection of confidential information.

are design to store

manipulate

retrieve information for planning, organizing, directing, and controlling

administrative

clinical activities associated with the provision and use of ambulatory care

services and facilities

Applications Necessary in the Ambulatory Environment Ambulatory

Financial Benefits

Cost Effective

Timely bill submission

processed resulting decreased days in accounts payable

Reduction of rejected claims

Accurate insurance

information obtain

Administrative benefitsReduction in size of the record room

Reduce time spent finding and delivering chart

Increase privacy of data

Formats that are legible

Comply with legal regulations

Promotions of quality assurance

Improve patient satisfaction

Ability for home access by the physician and nurse practitioners

Alerts for incomplete data

Integration of clinical data

CLINICAL BENEFITS

Medication recordVital Signs

Progress notesResults from laboratoryRadiology departments

Flow sheetsGrowth Charts

Immunization recordsMedication allergies

Profiles Alerts

RemindersFollow-up system

E-prescribingEvidence- based medicine

Prob

lem

list

by A

CPOE

Regulatory Requirement

Resource Based

Relative Value Scale

Department of Health

and Human Services

Regulatory Requirement

Current Procedural Terminology• codes describe medical

procedure performed by physicians and other health providers.

Ninth Revision of the International Classification of

Diseases

Health Common Procedural Coding System,•Collection of codes that

represent procedures, supplies, products, and services which maybe provided to Medicare beneficiaries and to individuals enrolled in private health insurance programs .

National Drug Code• Identifies

pharmaceutical in detail including the packaging. Its use is required by the FDA for reporting and it is used in many healthcare information systems to aid reimbursement. NDC directory - Is limited to prescription drugs and few selected over-the-counter products .

Implementations Issues and Challenges