``Brief History of Nursing Informatics inCanada ``"Registered nurses need to be able to demonstrate their unique contribution to the health of Canadians within Canadas rapidly evolving health care system. Basic, essential nursing information is required by nurses, employers, researchers, educators, policy makers, and clients so that informed decisions can be made about nursings role in the changing health care system," - Canadian Nurses Association, 1993: Policy Statement on Health Information: Nursing Components,
The CNA wrote this policy statement to highlight the importance of developing the nursing data components that will be included in our emerging national health information system. The CNA has also spearheaded an initiative, the National Nursing Informatics Project, to begin to develop a national consensus on definition, competencies, and educational strategies and priorities.
The use of technology in nursing is not new, in fact nurses have become proficient in utilizing and adapting complex technology into caring nursing practice for decades, at least since the time of Florence Nightingale in the United Kingdom and even earlier, when Jeanne Mance (1606-1673) founded the first hospital in Montreal,Canada in 1642. Various forms of machinery such as ventilators and physiological monitors were first used in intensive and critical care settings, and are now currently used in adapted form in less acute areas, even in home care.
Nursing has evolved significantly over the past few decades, with many of the changes being driven by advances in information and communication technology (ICT). ICT has permeated all aspects of society, including health care and affects all members of the interdisciplinary health team. Since nurses are the largest group of health care providers, discipline-specific competencies in the use of ICT and other technologies are imperative.
“Nurses in Canada have made an enormous contribution to all aspects of Canadian society. Their involvements have influenced the wider social, economic and political history of Canada, as well as the history and politics of health care. Nursing history provides the public with valuable perspectives on emerging technologies, health care reform and gender issues in Canadian history”(Canadian Nurses Association, 2004, p. 2).
Nursing informatics began to evolve as nurses participated in the early initiatives in hospital information system adoption in various health agencies across the nation. As these systems improved, specialized nursing components and even free-standing nursing information systems began to sprout up. Early systems were primarily imported from other countries, especially the USA. By the late 1980s, most hospitals had at least a rudimentary information system that required nurses to enter common data such as admission profiles and basic care requirements like diet, medications, and treatments into a computer as part of their routine duties.
The National Nursing InformaticsProject In 1998, the Canadian Nurses Association spearheaded another initiative, the National Nursing Informatics Project, to begin to develop a national consensus on definition, competencies, and educational strategies and priorities in nursing informatics development. The first phase of the project was the development of a Discussion paper in 1999, and the collection of feedback on key issues related to nursing informatics competencies development from Canadian nurses.
Nursing Minimum Data Set The Nursing Minimum Data Set was the first major Canadian Nurses Association informatics initiative beginning in 1990. This was in response to the strong conviction that nursing data must be included in the centralized national health data system being planned by the Canadian Institute of Health Information (CIHI)
Raising Canadian NursingAwareness The Canadian Nurses Association released a number of other supportive documents in 2001. A key one was published in the September Nursing Now Bulletin, entitled: What is Nursing Informatics and why is it so important? This publication was a critical overview of the essential characteristics of the emerging field of nursing informatics in Canada. It also introduced a definition of nursing informatics, formulated by the National Nursing Informatics Project working group.
The CIHI helped introduce the Strategic Plan for Health Information Management in British Columbia in 1996 that provides guidelines for holistic assessment and processing of information. In 1999, a second edition of these guidelines was produced, which incorporated issues related to the advancement of health information and technology. In 2002, an updated version Privacy and Confidentiality of Health Information at CIHI: Principles and policies for the protection of health information
In March 2000, the CIHI published an updated version of the Roadmap Initiative a national vision and four-year action plan to modernize Canadas health information system. Led by CIHI, this Initiative is a collaborative effort with Statistics Canada, Health Canada and many other groups at the national, regional and local levels.
the Canadian Organization for the Advancement of Computers in Health or COACH, founded in 1975, has actively initiated professional protocols for using computer systems in Canadian health care. In 2001, COACH, as Canadas Health Informatics Association, launched the Patron Program. In February 1999 the Canadian Federal government published the timely document, Strengthening Health Care for Canadians, outlining new initiatives and funding to promote health care technology and informatics initiatives.
The Canadian NursingInformatics Association In 2001, a new group, the Canadian Nursing Informatics Association (CNIA) received emerging group status from the CNA and affiliate status in 2003. The CNIA now has full associate status with the CNA. The CNIA has a website and the executive board encourages new members, including student members.
Canadian Nursing Informatics Association(CNIA)• exists to help nurses across Canada to learn, share, research, and create informatics-related projects and experiences that can help to boost the competencies, theory, and practice of informatics on a national level.
Canadian Nursing Informatics AssociationMission~To be the voice for Nursing Informatics in Canada. The CNIA is the culmination of efforts to catalyze the emergence of a new national association of nurse informaticians.
Goals• To provide nursing leadership for the development of Nursing/Health informatics in Canada.• To establish national networking opportunities for nurse informaticians.• To facilitate informatics educational opportunities for all nurses in Canada.
• To engage in international nursing informatics initiatives.• To act as a nursing advisory group in matters of nursing and health informatics.• To expand awareness of Nursing Informatics to all nurses and the healthcare community.
Nursing Informatics In 2009, IMIA-NI redefined nursing informatics as " Nursing Informatics science and practice integrates nursing, its information and knowledge and their management with information and communication technologies to promote the health of people, families and communities world wide" at NI 2009 and encouraged all of its members, including CNIA to use this definition.
Health informatics Health Informatics projects in Canada are implemented provincially, with different provinces creating different systems.
A national, federally-funded, not-for-profit organization called Canada Health Infoway was created in 2001 to foster the development and adoption of electronic health records across Canada. As of December 31, 2008 there were 276 EHR projects under way in Canadian hospitals, other health-care facilities, pharmacies and laboratories, with an investment value of $1.5-billion from Canada Health Infoway.
Provincial and territorial programsinclude the following: eHealth Ontario was created as an Ontario provincial government agency in September 2008. It has been plagued by delays and its CEO was fired over a multimillion-dollar contracts scandal in 2009.
Alberta Netcare was created in 2003 by the Government of Alberta. Today the netCARE portal is used daily by thousands of clinicians. It provides access to demographic data, prescribed/dispensed drugs, known allergies/intolerances, immunizations, laboratory test results, diagnostic imaging reports, the diabetes registry and other medical reports.
netCARE interface capabilities are being included in electronic medical record products which are being funded by the provincial government.
Canadian Institute for Health Information (CIHI)• CIHI plans to establish an expert working group to review many of the issues relating to nursing workload measurement systems and to make recommendations regarding future developments and implementation efforts.
Classification Standard for Health Interventions• CIHI completed the development of a new Canadian Classification for Health Interventions (CCI) that is currently being implemented in a number of provinces.
• The classification contains a comprehensive list of diagnostic, therapeutic, support and surgical interventions, allowing for the standardized collection of health interventions, regardless of the service provider or service setting.
Classification Standard for Health ConditionsTo accompany the CCI, CIHI alsoenhanced the new version of theInternational Statistical Classification ofDiseases and Related Health Problems,Tenth Revision for Canadian use (ICD-10-CA).
Nurses provided input to the developmentof both the CCI and ICD-10-CA.CIHI plansto maintain both classifications on anongoing basis to ensure their continuedrelevancy and utility to the field.
Client Outcomes• Ontario Nursing and Health Outcomes Project has done significant work in identifying client outcomes that are sensitive to nursing.
• The client outcomes that have been identified to date include: functional status, self-care, symptom control (dyspnea, nausea, fatigue, pain), patient satisfaction with nursing care, adverse occurrences such as nosocomial infections, patient falls and decubitus ulcers.
• Future plans include developing pilot projects in acute, long-term and community care.
Privacy, confidentiality and security of health information• Nurses have identified the protection of personal health information as a critical issue in the context of rapidly evolving health information technologies.
• Individuals and organizations responsible for the development of systems designed to collect, process, store, and share health information have a responsibility to ensure that these systems are secure in order to maintain the integrity and confidentiality of personal information.
The Code of Ethics for Registered Nurses (CNA, 1997)• states that nurses safeguard the trust of clients that information learned in the context of a professional relationship is shared outside the health care team only with the client’s permission or as legally required. Finally, security refers to the procedures and technologies that are used to restrict access to, and maintain the integrity of health information.