3. Lets Take The RelationshipsDeeper, Simpler & sweeter This time Around… True or false1- if both statements are true2 – if statements are contradicting3 – if both statements are false
4. 1. - the binary symbol of number 6 is 110 - the binary system was influenced from von Leibniz mechanical device.2. - the Boolean Algebra is used for searchingbibliography - the Boolean Algebra is used in searching for database3. - Hollentin machine is a descendant of theJacquard loom concept . - Charles Babbage is the father of modern calculator.4. – Hollerith machine is the origin of the Y2K - ENIAC is the exact replica of MARK 15. - the intuitive way for calculation is the Abacus - the Antikythera is the most intuitive machine
5. 6. - the Pascaline was influenced by von Liebniz - the Pascaline was accepted and widely used7. - the primary language of modern computer is the Binary system. - the logarithm inscription is currently used by modern computer.8. - the major characteristics of the ENIAC are its movable parts. - the first generation computers used vacuum tubes.9. - the vacuum tubes was smaller than the transistor. - the ENIAC help the US census to more faster10. - Mark 1 is the 1st to used cathode ray tubes - Abacus on stores the computation result step by step.
6. Match Everything!!!• Communicating & Interacting A. Arithometer with Patients B. Abacus• Slide Rule C. Punch cards• Requires Extensive Training D. Boolean Algebra• 1,000: 10 3 = 10x 10x10 E. “Human should be in parallel• Weaving machine with machine”• 1st Calculator F. Logarithms• Equation Stating True or False G. 1820• Charles Babbage H. ENIAC• Charles Xavier Thomas I. William Oughtred Colmar J. Computer Networking• First Generation Computer K. Binary System
7. History of Nursing Informatics1950 – UNIVAC 1 aka giant brains1956 – transistor was used; smaller, energy efficient1958 – Integrated Circuit (IC) by Jack Kilby - predecessor of all micro chips1960 – mouse was invented by Douglas Engelbert - video conferencing, multiple window screen1964 – 23 Generation Computer using Operating System RD1977 – Basic Programming Language1980- Micro Soft Sytem by Bill Gates (16 bit)1981 – IBM release first PC with MS DOS - Color graphics were extra - intel were first used1984- Apple introduces Macintosh with 32 bit - graphics and wide screen1992 – Apple introduced the Personal Digital Assistant2007 – first time PDA was in clinical area
8. UNIVAC 1
9. the two 19 century women th• Lady Ada Lovelace – 1st computer programer - aka Ada Byron - met Charles Babbage the developer of first computer• Florence Nightingale – the founder of modern nursing - Birth: May 12, 1820; Florence - Start: Crimean war; she develop a pie graph, uses statistical analysis, and develop a form for the hospitals in order to generate data and statistics - considered the early informatics nurse* both are mathematicians
10. 1950s & 1960• Prior to 1960 - image of the nurses improved - nurses practice grew in scope and complexity - Increase in number of professional nurses - Growth in computer industry - Computers first use in the health facility a. office functions c. paper tape b. punch cards d. teletypewriters
11. 1950s & 1960• 1960 - increase in number of health care facility - nurse are started to be considered the centre of communication activities & information exchange - Desktop terminals were developed called CRT - Email was used 1965 - HIS mainly for; a. Accounting b. basic business c. finance
12. 1970• HIS - integrated more into the hospital system• MIS ( Mngt. Information System) – statistical information – billing – insurance reimbursement - chip was develop - Microprocessors introduced (1971)
13. 1980• 1982: First international medical informatics Association Working Conference (London, England)• 1985: Another conference in Calgary, Canada• 1985: MS release windows 1; as well as intel 386• 1986: Informatics field introduced• PC/ Micro Computer• HIS CPRS( computer based patient record system)• Incorporated – Documentation – Doctors Order - Lab results – Kardex - Nurses Notes – V/S or TPR – Discharge Planning
14. 1990 and beyond• NI was approved by ANA (1992)• Computer become smaller, faster, and easier to use• Internet become a tool for clinical application• Knowledge if the focal point in nursing; as knowledge workers nurses are: a. Data gatherer d. knowledge builders b. Information users c. Knowledge users
15. Nursing Informatics the Philippinesnursing informatics..• word were mostly unfamiliar with in the nursing community up until 2007-2008.• Not yet found & recognized as a sub-discipline• Founded by pioneers: Philippine Medical Informatics Society (PMIS)• PIMA official registered in 1996 mainly composed of 11 physicians• 1st head: Dr. Alvin Marcelo
16. Nursing Informatics the Philippinesnursing informatics..• 1998: several faculty of UO began formal education & training• Dr. Herman Tolentino took postdoctoral fellowship in medical informatics @ University of Washington.• Dr. Alvin Marcelo later trained @ National Library of Medicine.
17. Nursing Informatics the Philippinesnursing informatics..• Dr. Cito Maramba went to Coventry for Masters in Information Science @ University of Warwick• 2003: Proposed course in NI @ UP• 2005-2006: College of Arts & Science (major in bioinformatics) and Master of Science in Health Informatics was offered.
18. Nursing Informatics the Philippinesnursing informatics..• 1999: National Institute of Health –UP Manila form a study group to identify the international standards for health promotion and its adaptability in the Philippines,• “Standards of Health Information in the Philippines, v. 1999” or “SHIP99”.• PNA was included in the group by Ms. Evelyn Protacio.
19. Nursing Informatics the Philippinesnursing informatics..• despite that representation & inclusion in the curriculum nurses in the Philippines still lag behind our foreign counterparts.• 2008: Nursing Informatics in the undergraduates was defined by CMO#5 s.2008.• 2009: revised & included as Health informatics in the CMO#14 first implemented in 2010 summer
20. Nursing Informatics the Philippinesproblem encountered adaptation of an international materials which does not suit the local needs which should be community- centered using information, communication & technology. Lack of certification & credentialing programs in post-graduates level
21. Nursing Informatics the Philippinesnursing informatics.. future• due to the integration in the curriculum made an increase in awareness & interest of NI.• Development of training, certification and credentialing are on the process by PNIA.• Partnership with local & international NI organization• CORE X strategic platform (Competency, Organization, Recognition, Experience & Expertise ) *thrust: - support use of health information standards - have a nursing informatics specialist inevery hospital
22. Nursing Informatics the Philippines• persistent issues : - inequities in access, cost, inefficiency - maldistribution of health care providers, and public health systems managers,• Information and communications technologies (ICT) offer - accessible, - affordable - standard tools in the health arena.• Since 1998, the National Telehealth Center has championed its use in health and development in the field now known as eHealth.• Theme: Putting health in the hands of the people,• Learning in four strategic areas; a. assisting remote health professionals in their clinical decision making (telemedicine), b. developing relevant electronic health record systems intended for government primary care centers where the poor seek care, c. building capacities of health care and eHealth practitioners (eLearning and trainings) d. actively advocating for policies that promote the relevant and meaningful use of ICT in health.
23. Nursing Informatics the Philippines• persistent issues : - inequities in access, cost, inefficiency - maldistribution of health care providers, and public health systems managers,• Information and communications technologies (ICT) offer - accessible, - affordable - standard tools in the health arena.• Since 1998, the National Telehealth Center has championed its use in health and development in the field now known as eHealth.• Theme: Putting health in the hands of the people,• Learning in four strategic areas; a. assisting remote health professionals in their clinical decision making (telemedicine), b. developing relevant electronic health record systems intended for government primary care centers where the poor seek care, c. building capacities of health care and eHealth practitioners (eLearning and trainings) d. actively advocating for policies that promote the relevant and meaningful use of ICT in health.
24. Nursing Informatics the Philippines• National Telehealth Center (NTHC) conducted a “webinar”• eRecords – national database• eMedicine - tele-referrals between Doctors-to-the-barrios and PGH using mobile phones and internet technologies.• eLearning - systematic deployment of scarce trainers where there is a greater need while providing access to up-to-date knowledge.• eHealth Training for Educators of the Health Profession was held the National Telehealth Center, UP Manila.• Philippine Undergraduate Research on eHealth (PUReHealth) Awards Student Orientation
25. Nursing Informatics the Philippines eRecords• Data not managed is useless.• Improve efficiency of health records collection through electronic systems for organizing health data. eReordssystem• developed by NThC is CHITS• a free and open source (FOSS) software designed specifically for local government health centers• collects existing routine health data in the Field Health Services Information System (FHSIS) of the Department of Health• Integrates them into a unified computerized system. Community Health Information Tracking System
26. Nursing Informaticsmore future..world spectrum a. Quantity of electronic resources will multiply, as mobile device increasing power b. Variety of devices will increase to meet the diverse needs of the practice c. Clinical decision support software will become increasingly sophisticated d. Smart cards that authenticate the user’s identity e. Increasingly life like simulation & virtual reality for educating nursing staff & students f. Development in sophisticated distance patient visits (convenient home visits follow up) g. Bioinformatics will continue to unravel information related to genetics to formulate gene therapy h. Speech recognition will enable providers to dictate system for accurate documentation. i. More online health services
27. QUIZ COVERAGE1-20. FROM SIR CANDOG21- 60 . THESE WEEK’S DISCUSSIONS
28. 4 Domain Applications1. Nursing Practice Domain Application - Electronic Health Record uses such as; a. computer generated nursing care plan b. clinical decision making alerts c. electronic monitoring devices d. patient specific discharge instructions e. online evidenced based nursing resources
29. 4 Domain Applications2. Nursing Administration Domain Application -reporting statistical data - planning resources - budgeting - documentation such as; a. workload measurement system b. online policy, manual and procedure c. staff scheduling systems d. internal email e. cost analysis f. patient tracking system
30. 4 Domain Applications3. Nursing Education Domain Application - computer revolutionized education process - online courses/distant education - home study/university without walls - services such as; a. online registration, scheduling, attendance, grade management b. computer based tutorials c. remote library access d. webcasting e. simulation labs
31. 4 Domain Applications4. Nursing Research Domain Application - analyze nurses data (stats and trends) - this includes; a. computerized literature b. software that process quantitative & qualitative c. reference and other related studies
32. Standards Initiative1. Nursing practice standard2. Nursing Data standard3. Health Care Data Standards Organizationtype of HISa. early HISb. early ambulatory care information systemc. early computerd. early educational application
33. Standards Initiative1. Nursing practice standard2. Nursing Data standard3. Health Care Data Standards Organizationtype of HISa. early HISb. early ambulatory care information systemc. early computerd. early educational application
34. Electronic Health Record• Patient safety - Computerized Provider Order Entry (CPOE) allows physician to enter orders or findings directly to the computer. With most includes ; -electronic medication administration record preventing errors in medication administration. -bar coding vs clients ID band - associated with written orders 1. illegibility 2. inaccurate abbreviations - Clinical decision support software provides; 1. dose calculations 2. warns the prescriber of any patients allergy, drug to drug interaction 3. drug contra indication 4. considers relevant lab result
35. Electronic Health Record1974 – Marc Lalonde indicated that; “there is a lack of a uniform and integrated system for maintaining health records of individuals because essential data were scattered in many location”2002 – Roy Romanow “to take full advantage of the potential of information, evidence and ideas in the health care system, thus infrastructure must be in place, in support it recommended the HER”
36. …to the futurea. Quantity of electronic resources will multiply significantly due to mobile devicesb. Devices will increase to meet the four domains of nursingc. Support software will become increasingly sophisticated like; - Recognizing when patient assessment falls outside the normal ranges, prompting communication to the physician.d. Smart card- authenticate users identity allowing access to computers.e. Use of virtual reality for educating studentsf. Telecommunication – TELEHEALTHg. Bioinformatics – gene functions or gene therapiesh. Speech recognition – saves timei. Online health care services – information for self management
37. EHR & EMR• primarily on storage of patients record electronically• Downside: medico-legal issues exposure by practitioners such as violation of right to privacy• From paper based to electronic version of patient record• Issues:• 1. Who is responsible for Management of data• 2. What are patients rights and expectations• 3. How to obtain consent without physician• 4. How to make it inaccessible to unauthorized people• 5. Are the information reliable• 6. What are the medical liability issue arising from this
38. EHR vs EMR• HER is a secure and private lifetime record of an individual’s health and care history, available electronically to authorized health care providers• Distinctions: - EMR refers to an electronic version of the paper record that doctors have long maintained; - EMR holds all medical information gained from individual physician’s care; - EMR has depth - EHR is a compilation of core data from multiple sources and it may be comprised of many different e-records submitted by different providers in different jurisdictions; - EHR has breathed because it contains all record from EMR - EHR does not necessarily contain all the information from EMR • accountability, privacy, security, confidentiality, accountability, liability
39. Davies Award of Excellence• Named after Dr. Nicholas E. Davies; advocated for the development of patient record• Its is as award program that bring to national attention excellence in the implementation of computerized medical records• Philosophy: health care organization benefit when collective experiences and lessons are shared.• Criteria 1. Organizational/Acute Care 2. Ambulatory Care 3. Public Health care
40. iNfoRmATicS• French word “informatique”; the computer milieu• 1970-1980 : nursing informatics broadly defined as the use of computer technology to support all aspects of nursing practice• 1996: Turley introduced the Nursing informatics model
41. History of Nursing Informatics150 & 100 BC – Antikythera mechanism3000 – 500 BC – Abacus (Greeks,Romans, Chinese, aztecs)3 - Slide rule by William Oughtred1642- Pascaline by Blais Pascal1694- Binary System by Gottfried Wilhem von Leibniz (computer language)1804 – Weaving Machine by Joseph Marie Jacquard using punch cards.1820 – Arithometer by Charles Xavier Thomas de Colmar (first real calculator)
42. Antikythera mechanism
43. History of Nursing Informatics1822-1871 – Difference engine; analytical engine; connected relationship between mathematics & machines1854 – Boolean Algebra or Arithmetic; that any equation can be stated as either true or false1889- Punch Cards by Herman Hollerith; used first for US census (from 7 years to 6 mos.) -IBM was founded1931- Bush Differential Calculator1944- Mark I by Howard H. Aiken ( a 150 feet long with 500 miles of wiring)
44. History of Nursing Informatics1946 –First Generation Computers (1st electronic computers) ENIAC (Electronic Numerical Integrator & Computer) -18,000 vacuum tubes, 70,000 computer resistor and 5 million soldered joints - 1,000 more faster -world first complete computer1947 – Transistors by William Shockely, John Bardeen, Walter Brattain - smaller that vacuum tube - started the 2nd generation computer