Practice Application- Nursing Informatics


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Essentials of Nursing Informatics
International edition 4th edition
written by Virginia K. Saba

Published in: Healthcare, Health & Medicine
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Practice Application- Nursing Informatics

  1. 1. Practice Applications
  2. 2. 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
  3. 3. 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
  4. 4. Nursing informatics is the specialty that integrates nursing science, computer science, and information science in identifying, collecting, proces sing, and managing data and information to support nursing practice, administration, educa tion, research and the expansion of nursing knowledge. - ANA, 1994
  5. 5. 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.
  6. 6. 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.
  7. 7. Critical Care Applications Chapter 21 Jade Mojica
  8. 8. 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.
  9. 9. 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.
  10. 10. 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
  11. 11. Focuses of Discussion • Physiologic monitors • Arrhythmia monitors • Hemodynamic monitors • CCISs
  12. 12. 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
  13. 13. 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)
  14. 14. 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)
  15. 15. 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
  16. 16. Arrhythmia Monitor • Computerized monitoring and analysis of cardiac rhythm • Basic Components – Sensor – Signal conditioner – Cardiograph – Pattern recognition – Rhythm analysis – Diagnosis – Written report
  17. 17. 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
  18. 18. • 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
  20. 20. President George Bush April 27, 2004 White 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 .
  21. 21. 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.
  22. 22. Four Major Goals GOAL 1 Inform Clinical Practice. Bringing information tools to the point of care, especially by investing EHR systems in physician offices and hospitals. GOAL 2 Interconnect 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.
  23. 23. 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
  24. 24. 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.
  25. 25. 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
  26. 26. Financial Benefits Cost Effective Timely bill submission processed resulting decreased days in accounts payable Reduction of rejected claims Accurate insurance information obtain
  27. 27. Administrative benefits Reduction 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
  29. 29. Regulatory Requirement Resource Based Relative Value Scale Department of Health and Human Services
  30. 30. 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 .
  31. 31. Implementations Issues and Challenges