In April 2004, the United States president called for action to put EHRs in place for most
American in 10 years. Today, these systems can manage healthcare data and information in a
way that is patient- centered and information in a way that is improved information and for the
better patients care.
The term EHR-S is often used interchangeably with computerized patients record, clinical
information systems, electronic medical record, and etc. and this term was eventually used
internationally. EHR’s also can be made up of one or more applications. The 10M’s 1991
definition of computer based patient record systems is currently the basic for domestic and
international definitions of an EHR-S.
The sets of component that form the mechanism by which patients records are
created, used, stored and retrieved. A patient record system is usually located within a
healthcare provider setting. It Includes people, data, rules and procedures, processing and
storage devices and communication and support facilities (Dick, Steen and Derimer,1991).
EHR-S includes the following;
1. Longitudinal collection of electronic health information for and about persons, where health
information is defined as information pertaining to the health of an i9ndividual or health
provided to an individual.
2. Immediate electronic access to a person and population level information by authorized, and
only authorized users.
3. Provision of knowledge and decision support that enhance the quality safety, and efficiency
of patient care: and
4. Support of efficient process for healthcare delivery.
An agencies providing direct healthcare offer evidence that the use of HER-Ss across a multifacility
enterprise is a realistic goal with measurable, repeatable positive outcomes.
GOERNMENT AS PROVIDER AND EARLY ADOPTER
1. The veterans health administration in the Department of Veterance Affairs
2. The National Institute of Health (NIH) in the department of Health and Human Services (HHS) are
the two examples of the initiation of systems in the 1970’s that were actively used by clinicians.
The Department of Defense (DOD) and the Indian Health Services (HIS) in the department of HHS both
acquired the VA’s original clinical information systems years ago customizing it to meet their clinical
and business needs (Kolodner, 1997).
DEPATMENT OF VETERARS AFFAIRS
The Veterans Health Information Systems and Technology Architecture (VISTA) supports day-to-day
clinical and administrative operations at local VA health facilities.
DEPARTMENT OD DEFENSE
Within DOD, provides have a computerized physician order entry capability that enables them to
order lab test and radiology examinations and issue prescriptions electronically for over 10 yrs.
INDIAN HEALTH SERVICE
The HIS has long been a pioneer in using computer technology to capture clinical and public health
data. Many of its components are imported from the VA’s CPRS and adapted to fit the business needs
of the HIS clinical environments of care.
GOVERNMENT AS LEADER
Federal activities are focused on the development
and adoption of terminologies and standards,
grants for demonstrations of data exchange, and
other pilot projects. The government is also
pursuing the development of a public-private
national health information network to facilitate
OFFICE OF THE NATIONAL COORDINATOR FOR
HEALTH INFORMATION TECHNOLOGY
The national health information network is the
technical infrastructure enabling national
interoperability. Regional health information
organizations are now being proposed at the
community, regional or state level, as mentioned
in the discussion of the Agency for Healthcare
Research and Quality (AHRQ).
THE NATIONAL COMMITTEE ON VITAL AND
NCVHS (2002) presented the concept of an
infrastructure that emphasizes health-oriented
interaction and information sharing among
individuals and institutions, rather than simply the
physical technical, and data defined the NHII as
including the values, practices relationships, laws
standards, systems, applications and technologies
that support all facts of individual health,
healthcare, and population health.
Three dimensions of the National Health
Information Infrastructure and examples of
HEALTHCARE PROVIDER DIMENSION
-decision- support programs
PERSONAL HEALTH DIMENTION
-non-shared personal information
POPULATION HEALTH DIMENSION
-planning and policy document
-health disparities data
SOURCE; National Committee on Vital and
CENTERS FOR MEDICARE AND MEDICAL SERVICES
Within HHS, the CMS has initiates several pilot projects to
promote health IT. In May 2004, CMS awarded as $ 100,000
grant to the American Academy of Family Physicians (AAFP) for a
pilot project to improved comprehensive, standardized HER
software to small and medium sized ambulatory care practices.
Although the use of health IT is not mandatory, CMS views CCIF
as a significant opportunity to demonstrate
innovative, integrative information infrastructures and
Are those formed specifically to address issues of
connectivity, HIT, and standards of organizations.
CONNECTIVITY FOR HEALTH
A large private collaborative with federal participants supported
by the Marlke and Robet Wood Johnson Foundations, connecting
for Health is addressing the barriers to development of an
interconnected health information infrastructure.
CENTERS FOR MEDICARE AND MEDICAL
Within HHS, the CMS has initiates several pilot
projects to promote health IT. In May
2004, CMS awarded as $ 100,000 grant to the
American Academy of Family Physicians (AAFP)
for a pilot project to improved
comprehensive, standardized HER software to
small and medium sized ambulatory care
practices. Although the use of health IT is not
mandatory, CMS views CCIF as a significant
opportunity to demonstrate
innovative, integrative information
infrastructures and communication
Are those formed specifically to address issues
of connectivity, HIT, and standards of
CONNECTIVITY FOR HEALTH
A large private collaborative with federal
participants supported by the Marlke and
Robet Wood Johnson Foundations, connecting
for Health is addressing the barriers to
development of an interconnected health
Is an independent, nonprofit affiliated organizations
established to faster improvement in the quality,
safety and efficient of health care through
information and IT. Its membership brings together
hospitals and other providers, practicing clinicians,
community organizations, payers, employers,
community-based organizations, HIT suppliers
manufacturers, and academic organizations.
INSTIUTE OF MEDICINE
The 10M has championed the advantage of use of IT
to improved healthcare since its 1991 foundational
work. The 10M continues to illuminate the
importance for the use of IT in healthcare.
CERTIFICATION COMMISSION FOR THE HEALTH
The goal of this group is to support goal1, strategy2,
“Reduce risk of HER investments,” of the strategic
framework shown in representing the federal
HEALTH LEVEL SEVEN
An non-for-profit volunteer standards organizations,
Health Level Seven (HL7) is known for its large body
of work in the production of technical specification
for the transfer of healthcare data.
This time of great change brings grand opportunities
for nursing informatics and the entire nursing
DEPENDABLE SYSTEM FOR QUALITY CARE
Dexie B. Barker
The transformation of the healthcare industry is
undergoing manually intensive, crisis-driver model
of care delivery to a more efficient, consumercentric, science-based model that proactively
focuses on health management.
Are thus ethical obligations drive requirements for
system reliability, availability, confidentiality , data
integrity, responsiveness, and safety attributes
Dependability is also a measure of the extent to
which a system can justifiably be relied to delver
the services expected from it.
DEPENDABILITY SIX ATTRIBUTES
WHEM THINGS GO WRONG?
Even we would like to be able to assume that
computers, networks and software are as
dependable as our toaster and telephones,
unfortunately that is not the case, and stories that
have appeared in trade journals have documents
The bottom line is that systems, networks, and
software applications are highly complex and the
only safe assumption is that failures will occurs.
GUIDELINES FOR DEPENDABLE SYSTEMS
A more practical approach to attaining
dependability is to build tolerant systems- systems
that anticipate problems, that detect faults,
software glitches, and intrusions, and that take
action so that services can continue and data are
protected from corruption, destruction and
GUIDELINE 1: ARCHITECT FOR DEPENDABILITY
At the bottom of the architecture are the physical
and logical networks that support the enterprise
and provide the “pipes” that carry data from
systems to system. The simplest design and
integration strategy will be the easiest to
understand to maintain, and to recover in the case
o a failure or disaster.
GUIDELINE 2: ANTICIOATE FAILURES
In anticipation of failures at the infrastructure
level, features that are transparent to software
applications should be implemented to defects
faults, to fail over the redundant components
when faults are detected. And to recover from
failures before they become worst.
GUIDELINE 3: ANTICIPATE SUCCESS
The systems planning process should
anticipate business, success and the
consequential need for larger networks, more
systems, applications, and additional
GUIDELINE 4: HIRE METICULOUS MANAGERS
These managers use middle ware to manage
the work load access the network. They take
emergency and disaster planning seriously.
GUIDELINE 5: DON’T BE ADVENTUROUS
The products brochure urges the consumers
to be adventurous and states that the
company guarantees satisfaction or the
purchaser’s money will be cheerfully refunded.
ASSESSING THE HEALTHCARE INDUSTRY
For adherence to the first guideline
“architect for dependability” the clinical
care provider community gets a barely
passion grade of “D”. Healthcare
organizations build or perhaps ”compose”
– their systems from the top down rather
than from the bottom up.
THE HEALTH INSURANCE PORTABILITY AND
ACCOUNTABILITY ACT (HIPAA)
The following eight required administrative
safeguards represent important
operational practices that clearly will
contribute to system dependability.
Security management, including security
analysis and risk management.
Assigned security responsibility.
Information access management, including
the isolation of clearing house functions
from other clinical functions.
Security awareness and training.
procedures, including response
Contingency planning including
data backup planning, disaster
recovery planning, and planning
for emergencies mode
Business associate contracts that
lock in the obligations of
business partners in protecting
health information to which they
may have access.
Five specified physical
safeguards also contribute
to systems dependability by
facilities, workstations, devi
ces and media be
Access control, including
unique user identification
and on emergency access
Data integrity protection
Person or entity
For adherence to the second guideline
“expect failure” the clinical care provider
community gets another grade of “D”.
Medical technology and prescription drugs,
as well as clinical treatment protocols, are
required to undergo extensive validation
before they can be used in clinical practice.
Healthcare organizations definitely expect
their software applications computer
systems, and network to work.
Organizations have hired IT managers who
appreciate the important role of IT in a
healthcare environment and who
recognized the need for dependable
systems that can anticipate and recover
ADVENTUROUS TECHNOOGIES IN
On the one hand, healthcare givers
typically are not early adopters. But on the
other hand, they seem to cast fate to the
wind for technologies that catch their
NATIONAL NURSING MINIMUM DATA SETS
The early NMDS work in the United States
spurred development of NMDS on
numerous other countries.
Most continents beyond North America are
developing of NMDS systems. In
summary, it is clear that there is major
work being accomplished across the globe
to ensure the nursing essential data will be
more comprehensively available in the
CALL FOR STANDARDIZED CONTEXTUAL
Ample studies have demonstrated the
significance of nurse staffing,
patient/staff ratios, professional
autonomy and control, organizational
characteristics, unit internal
environment, work delivery patterns,
work group characteristics, external
environment, staff work satisfaction
education of staff, multidisciplinary
educational level on the quality and
outcomes of patient care.
The development within the United Sates
of the NMMDS addresses this void.
The 18 NMMDS elements are organized into three categories:
Unit / cost center identification
Organizational decision making power
Patient/ client population
Patient/ Client accessibly
Method of care delivery
Clinical decision making complexity
Management demographic profile
Staff demographic profile
NURSING MINIMUM DATA SETS SYSTEMS
Connie White Delaney
The NMDS historical Summary
It is a standardized approach that facilitates the abstraction of these
minimum, common, essential core data elements to describe nursing
practice (Werly and Lang,1988) from both paper and electronic records.
Eight benefits of NMDS
Access to comparable, minimum nursing care and resources data on
local, regional, national and international levels.
Enhanced documentation of nursing care provided
Identification of trends a related to patient or client problems and
nursing care provided.
Impetus to improved costing of nursing services
Improved data for quality assurance evaluation
Impetus to further development and requirement of NISs
Comparative research on nursing outcomes, intensity of nursing
care3, and referral for further nursing services.
Contributions toward advancing nursing as a research-based discipline.
STANDARDS AND RESEARCH ERATWENTY-FIRST CENTURY
Although the full benefits of the NMDS are
still being, the NMDS work has influenced
a number of advances.
The NMDs serves as a key component of
the standards developed by the Nursing
Information & Data Set Evaluation Center
(NIDSEC). The tools and methods to
facilitate comparability of nursing data
continue to evolve, including the
international for nursing practice.
NMDSs relationships to International
Nursing Minimum Data (i-NMDS)
EVOLUTION OF CONCEPT
Te i-NMDS includes the core,
internationally relevant, essential minimum
for providing nursing care (Clark and
These data can provide information to
describe, compare, and examine nursing
practice around the globe.
I-NMDS research center is lead by a
steering committee of international
representatives of countries with existing
and emerging NMDS as well as
professional co sponsorship and areas of
Contribution of nursing care and nurses is
essential to healthcare globally
The i-NMDS as a key data sets will
-Describing the human
phenomena, nursing interventions, care
outcomes and resources consumption
related to nursing services
-Improving the performance of healthcare
systems and the nurses working within
these systems worldwide.
-Enhancing the capacity of nursing and
-Addressing the nursing
shortage, inadequate working conditions
poor distribution and inappropriate
utilization of nursing personnel and the
challenges as well as opportunities of
global technological innovations.
The elements of i-NMDS are organized
into three categories setting subjects of
care and nursing elements (Delaney et
Setting variable include country
characteristics as well as descriptors of the
location of the care, whether the setting is
acute ambulatory, home and so on.
Measures includes care personnel
characteristics including numbers, fulltime
equivalents, education, gender and so on.
Normalization of data collection time
periods is a difficult issue.
To describe the power of NMDS in nursing
practice from international perspective is
daunting, (Delaney, 1996, et al.)
The human phenomena serve by nursing
the interventions given and the outcomes
realized are essential to improving
outcomes assuring patient safety, and
providing wise stewardship of ll resources,
from human to financial.
The National Service in collaboration with
the world health organization wishes to
establish bench makers for case.
You are ask to file a report
addressing the following:
What is the relationship
between and among the
number, education, certifica
tion and experience of
healthcare workers and the
What is the relationship
between and among the
experience of health
workers and turnovers
What is the relationship
between and among the
experience of healthcare
workers and the following
Patient/ Family satisfaction
with care received
Length of stay appropriate
THEORIES, MODELS AND
Kathleen M. Hunter
Based on the recognition of
patterns and variances, builds
on previous experiences and
knowledge and involves the
use of analogies. Recognition
of such learning principles
proves in valuables for those
exploring or already engage in
nursing informatics practices
because the nurse in this
specially roles is always
learning and always teaching.
GUIDE NURSING INFORMATICS
Nursing working in the
informatics specialty are
professionally bound to follow
Terms such as decisionmaking comprehension
information, knowledge share
goals, disclosure , outcomes,
Confidentiality, protocols and
factual documentation abound
throughout the explanatory
language of the interpretative
IT IS A SCIENCE THAT COMBINES A DOMAIN
SCIENCE, COMPUTER SCIENCE, INFORMATION
SCIENCE AND COGNITIVE SCIENCE.
According to Kathryn Hanna who proposed a
definition that NI is the use of information
technologies in relation to any nursing
functions and actions of nurses