Introductionx The worlds of health care, communication, and information technologies are ever growing, separately and together.x As nurses in the community expand their practice definition to embrace new information technologies, opportunities for improved health care to populations seem endless.
Introduction……………..x This advancement is seen as a union of health care technology with information and communications technology, nurturing the design and implementation of health care management information systems in a variety of clinical practice settings. New technology Acute care in Community hospital based setting setting environment
What is Informatics?x Organizations such as hospitals and community-based agencies such as public health departments and home agencies use information and communications technologies to collect, restore, retrieve, analyze, and present client care data in the care delivery settings.x Decisions related to client care continue to increase in complexity, with the need for rapid, accurate information for clinical decisions making as a priority for effective care.
Health Informaticsx Application of information technology to the health sector has tremendous potentiality for efficacy of health care delivery institutions and provision of cost- effective health care.x Health care delivery institutions will need and use information technology to meet their client demands and stay competitive, since, the future for them lies in cost-effective health care.
Health Informaticsx That is why a host of solutions, standards and services are emerging to meet needs of the health sector.x Application of information technology to the domain of health care delivery is referred to as Health Informatics..
What is Nursing Informatics?x Nursing informatics is a field within the field of health informatics, where people who have a nursing degree are involved in the implementation of a computer application in a hospital, nursing home, doctor’s office, public health clinics, or other healthcare setting.
Definition………..Informaticsx Informatics generally can be defined as the art and science of turning data into information. The more recently informatics defined as the study of the application of computer technology and statistical techniques to the management of information.
Definition…Nursing Informatics ANAx Nursing informatics (NI) is a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, knowledge, and wisdom in nursing practice.x NI supports consumers, patients, nurses, and other providers in their decision- making in all roles and settings.x This support is accomplished through the use of information structures, information processes, and information technology.
Nursing Informatics… Definitionx Nursing Informatics uses nursing science, computer and communications technologies to produce effective and efficient client outcomes for individuals and communities.
Nursing Informatics… Definitionx 1989—Graves and Corcoran defined Nursing Informatics as x “Computer science, information science, and nursing science combined to assist in the management and processing of nursing data, information and knowledge to support the practice of nursing and the delivery of nursing care.”
Nursing Informatics - Definitionx “The use of technology and / or a computer system to collect, store, process, display, retrieve, and communicate timely data and information in and across health care facilities that: x Administer nursing services and resources; x Manage the delivery of patient and nursing care; x Link research resources and findings to nursing practice; x Apply educational resources to nursing education” (Saba, 1996).
How it all began….x Late 1960’s first computer systems were implemented in hospitalsx Computer nurses began to appear in hospitals x Excellentclinicians x Technically curious and willing to try new things
Nursing Informatics - Focusx Nursing informatics focuses on the use of “nursing information system” (NIS) to administer nursing resources: x To assist in effective information management; x Monitor the quality, effectiveness, and outcomes associated with the provision of care; x Protect the confidentiality and privacy of patient data.
Conceptual Framework Nursing Process Data Information Knowledge (raw facts) (interpreted facts) (synthesized information)minute level SynthesisInformation andCommunication Technology
Reasons for Classification System Developmentx To standardize classificationx To expand nursing knowledgex To develop information systemsx To teach decision makingx To determine nursing costsx To allocate nursing resourcesx To communicate nursing to non-nursesx To link nursing knowledge
Basic concepts Basic concepts for information systems:x Nursing data: refers to unstructured raw facts; Are discrete entities; Lack interpretation. Forms the basis for a nursing information system.x Nursing information: data that has been given shape and has been interpreted.x Nursing knowledge: synthesized information derived from the analysis of data that has been processed.
Nursing Data Standardsx Needed for the management, documentation and communication of nursing diagnosis, interventions, and outcomes (patient and nursing sensitive).x researchedand supported by the ANA Council on Computer Applications in Nursing and the NLN’s Council for Nursing Informatics.
Nursing informationx Nursing information systems exists within the background of the total continuum of the “integrated patient record system”.x Health care is, and will continue to be an information- intensive attempt.x Information is a critical resource in the health care delivery environment.x Nursing Practice is essentially an information- processing activity.
Nursing information……x Nursing information is essential to the accuracy of integrated systems (both health care delivery and information systems).x Patient-specific data are the central point of a totally integrated patient-record system.x Atomic-level data, captured within a Nursing Information System will be used for many purposes.
Nursing Knowledgex Data and data elements required for nursing information systems are developing.x To ensure high-quality practice, nurses need access to sources of data that are ”beyond institutional, patient-specific data”.x “There will always be a need for human interpretation of computer-processed data”.
Nursing ClassificationSystem’s IntegrationInto Nursing Practice
x Information systems development.x Need for standards-based, evidenced based practice. guidelines.x Need for standardized language across the continuum and across nursing practice settings.x Integrated from a trans-disciplinary, integrated healthcare delivery perspective.
The Need of Nurse Informaticistsx Analyze clinical and financial datax Promote and facilitate access to resources and referencesx Provide nursing content to standardized languagesx Enable cost savings and productivity goalsx Source
The Need of Nurse Informaticists ……….x Nurses do not want to be passive consumers of technologyx Nurses want devices that are integrated, voice activated, handheld, use biometrics, provide translation, are portable, are wireless, auto settle, and are “smart”x Greater nurse satisfaction leads to greater patient satisfaction
The Benefits of Nurse Informaticistsx Nurse Informaticists promote and facilitate access to resources and referencesx Support for their mission to deliver high quality, evidence-based carex Support for better service by facilitating true interdisciplinary carex Improvement in key relationships withx providers & care recipientsx Enable cost savings and productivity goalsx Facilitate change managementx Enhance continuity of care
IntroductionTechnologies emerging in the fields oftelecommunications, video and digital imaging, andmicroprocessing are shaping the future of nursingpractice. To measure up to the future needs ofnursing, nurses of today must have the vision anddesire to become computer aware andtechnologically literate.
Definitionx Nursing Informatics (NI) is the specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, and knowledge in nursing practice. Nursing informatics facilitates the integration of data and knowledge to support patients, nurses, and other providers in their decision-making in all roles and settings. This support is accomplished through the use of information structures, information processes and information technology. (Scope of Standards of Nursing Informatics Practice -American Nurses Association 2001)x Nursing informatics refers to electronic information combined with nursing and any aspect of clinical practice, administration, research, or education (Guenther, 2006).
Goalx The goal of Nursing Informatics is to improve the health of populations, communities, families, and individuals by optimizing information management and communication. This includes the use of technology in the direct provision of care, in establishing effective administrative systems, in managing and delivering education experiences, in supporting life-long learning, and in supporting nursing research.
Standards of practiceOrganized around a general problem-solving framework thatclosely resembles the familiar nursing process ofx Assessmentx Diagnosisx Planningx Identification of Outcomesx Implementationx EvaluationSupports all facets of Informatics Practice, including thosewithout technology
SolutionAn informatics solution may encompass technology and nontechnology products such as:xDeveloping a databasexPurchasing a new computer applicationxCreating nursing vocabularyxDesign informatics curriculaxCreating a spreadsheetxTailoring an application to a particular environmentx Designing a research study to describe required informaticscompetenciesxDescribing information flow in a process redesignxCreating a structure for information presentation
Historyx For three decades or more, nurses have held informatics roles and been key stakeholders in developing, implementing, an devaluating informatics solutions. Although implementingx informatics solutions continues to be very important, more recently informatics nurse specialists have worked to develop and refine nursing’s language, implement tele-health systems, establish NI educational programs and expand the focus.
Nursing Informatics (NI) – futurex Ubiquitous computing is becoming a reality and the continued innovation and miniaturization of technology is evident. Consequently partnering between nurses in all specialties and new technologies is becoming imperative.x Technological innovations are challenging many traditional processes, Telecommunications technologies are one set of tools used in nursing practice.x Core competencies across informatics specialties should be identified in the near future. The distinctions among informatics specialties will continue to blur.x The speed of information transfer and the increasing availability of communication technologies will impact nurses and informatics nurse specialists in the future, making nursing practice and NI, in particular, more international in practices with world-wide standards, competencies and curricula.
Trends In Nursing Informaticsx Mature and Ubiquitous Technology Solutionsx Mid-Stage Technology Solutionsx Emerging Technology Solutions
Mature and Ubiquitous Technology Solutionsx Order Management & Communicationx Clinical Repositoriesx Departmental Systems (LAB, RAD, etc.)x Picture Archiving Communication System(PACS)x Online Electronic Bed Management Systemsx Departmental Schedulingx Staff Schedulingx Intranet/Internet Based Reference Materials (Orders, Protocols, Drug Monographs) Phones, Pagers, In-house Communication Devicesx Wide Variety of Fixed & Mobile Devices
DEPARTMENTAL SYSTEMx Understan ding the organizatio n and functions of the hospitalx Quality of care -x Leadership
PACSx n. picture archiving and communication system: an electronic system enabling the storage of digital images on electronic media, for later retrieval and subsequent display on high-resolution monitors.
Enterprise Systems Online Electronic Bed Management Systemsx Nurse assignments are no longer hand writtenx Determine the real-time census of unitsx Reports available to track lengths of stayx Monitor delays in patient movementx Determine bed availability quicklyx Spend less time negotiating on the telephone Departmental Scheduling Systemsx Deployed as standalone or in centralized models
Administrative & General Workflow Staff Schedulingx Allows healthcare facilities to create templates for the various skills and skill mixes that exist across their units and facilities Using this template a computerized system optimizes staffing based on identified and known constraints.x Facilitates identification of staff preferences in mindx Logic identifies when a skill mix is offx Logic identifies when a nurse is being asked to go to an area that she/he is not trained forx Time required for schedule creation has decreased significantlyx Staff satisfaction has improved
Intranet Based Reference Materials (Orders, Protocols, Drug Monographs) Phones, Pagers, In-house Communication Devicesx Wide Variety of Mobile Devicesx Designed to augment clinical workflow needs can be personalized to the care giver and specific documentation or data entry needsx Laptopsx PDAsx Notebooksx COWs (Computers on Wheels)x Many Others
Mid-Stage Technology SolutionsOnline and Integrated Electronic Patient Documentationx Integrated Hemodynamic Monitors (Vitals Signs) with EMRx Hand-held Devices for Data Collection & Inputx Online Fully Integrated Medication Administration Recordx Online and Integrated Rules and Alertsx CPOE – Computerized Provider Order Entryx Bar Code Technologyx Access and Security Technologyx Sophisticated Implementation Methodologiesx Organization of Nursing Practice through Technology- Time and Motion Templates, Nomenclature/Data Standardization Tools, Care Plan Standardization and Tool Sets
Clinician’s Access to patient record systemx Attending Physician, Nursing, Consulting Physician(s), Respiratory Care, Case Managementx Nutritional Services, Risk Management, IV Team, Patient Financial Services, Infection Controlx Wound Management, Pastoral Care, Clinical Process Improvement, Cardiology, PT/OT/Speech, Others.
Barriersx Record must be on unitx All clinicians and support, personnel must walk to location of chartx One person can access the chart at a timex Legibility of chart inputx Timely filing of data results into chartx Finding clipboard for most current informationx Redundant information
Clinician’s Access to online recordElectronic patient data barriers:• Systems Availability• User Acceptance
Integrated Hemodynamic Monitors (Vital Signs)with EMRxVital signs are automatically updated to the patientEMRxEliminates paper documentation and accuratelycaptures patient information at the point of carexDevices are fixed in the patient room or mobile onCOWs (Computers on Wheels)
Hand-held Devices for Data Collection & InputxAssist with obtaining, verifying, and communicatingdataxCardiology, Transplant, and other clinicallysignificant data can be entered directly onlinexEliminates the need for bulky data collection sheetsxEnhances the ability for version control of data entryDocuments
Online Fully Integrated Medication AdministrationRecordxSignificant time reduction associated to documentingmedicationsxSignificant time reduction associated withtranscription of medications to paper MARxDecreased transcription errorsxIncreased patient safety
Online and Integrated Rules and Alerts(Workflow)xDrug-allergy alerts based on order entry functionalityxDrug-drug interaction alertsxAlerts for abnormal lab values and vital signsxAlerts for new ordersxAlerts for order renewalsxAlerts for scheduled patient events
CPOE – Computerized Provider Order EntryxNurses no longer struggle to read physicianhandwritingxReduces verbal ordersxAll providers can enter orders directly online -Integrated rules and alerts, Integrated allergy checkxDecreases chances for transcription errorxReduces delays in patient care
x Bar Code Technologyx Barcodes on patient bands and medication packaging helps to double check that the right medication is being given to the right patient at the right timex System alerts the nurse immediately if any inconsistencies or potential problems existx Internal back-up systems are in place to back-up information regularly so a MAR can be printed in the event of system downtimex Integration with electronic MAR and documentation systems becoming more common place
Access and Security Technologyx Single Sign-Onx BiometricSophisticated Implementation Methodologiesx Sophisticated planning and implementation methodologies take the guess work out of project managementx Include workflow, communication, risk mitigation, system design and analysis, as well as overall task management activitiesx Tightly integrated financial management tools to ensure projects stay on track and in budget
x Organization of Nursing Practice through Technologyx Time and Motion Templatesx Nomenclature/Data Standardization Toolsx Care Plan Standardization and Tools Sets
Emerging Technology Solutionsx National Patient Databases for comprehensive patient record across disparate providersx Patient Health Cards – contain all medical records and informationx Advanced Biometric Access and Security functionalityx Voice recognition within electronic medical recordsx Hands free communication tools
Journals on Informatics Nursingx CIN: Computers Informatics Nursing (formerly, Computers in Nursing)x Journal of the American Medical Informatics Association (JAMIA)x International Journal of Medical Informatics (IJMI)x International Journal of Bio-Medical Computing (IJBC)x Online Journal of Nursing Informatics (OJNI)
x SUMMARYx MEANING AND DEFINITIONx NURSING INFORMATICSx HISTORYx NURSING CLASSIFICATION SYSTEMx BASIC CONCEPT
x NEED OF NURSING INFORMATICSx BENEFITx TRENDS AND DEFINITIONx TRENDS IN NURSING INFORMATICS.
Conclusionx Nursing informatics is a developing ﬁeld of study that is highly interdisciplinary. It is strongly connected to education, business, and computer science.