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 In April 2004, the president of the United States
issued an executive order that called for action
to put EHRs in place ...
 The involvement of nurses is critical to
such efforts responsible for care
coordination and promotion of wellness,
nurse...
 After a brief overview and discussion of
the definition of EHR-Ss, this chapter
covers two main areas :
 1. Federal ini...
 An early adopter of EHR-s the U.S
government is currently advancing
initiatives to accelerate the use of HIT in
both the...
 Improved information access and
availability can enable both the provider
and the patient to better manage the
patient’s...
 The term EHR-S is often used interchangeably
with computerized patient record, clinically
information system, electronic...
 EHR may be used by all participants in
the process of achieving
health, including all disciplines of
clinicians, family ...
 The set of components that form the
mechanism by which patient records are
created, used, stored and retrieved. A
patien...
1. Longitudinal collection of electronic health
information for and about persons, where
health information is defined as ...
 Within the federal government, different
departments exert different influences
toward the common goal of an EHR for
mos...
 Federal Agencies that provide direct
care have been early adopters of EHRS.
Those that don’t are providing multiple
appr...
 Government as Provider and early Adopter
-Federeal agencies that provide direct
care have been early adopters of EHR-s
...
 Department of Defense
-Have had a computerized physician
order
 Indian health service
-The EHR-S as long had been pione...
 Government as Leader
-Federal agencies that do not provide
direct care are taking multiple
approaches to promote use of ...
 Office of the national coordinator for health
information technology.
-The executive of April 2004, mentioned earlier
in...
 The national committee on vital and
health statistics
-In 2000 and 2001, the national
committee on vital and health stat...
 Agency for healthcare Research and
Quality
-In 2003-2004, AHRQ unveiled a major
HIT portfolio, with grants, contracts an...
 Computerized Patient Record System
 CPRS (Computerized Patient Record
System) provided a single place for
healthcare pr...
 A number of collaborative efforts are
focused on use of EHR-s and HIT to improve
care
 Among these private sector organ...
 Institute of Medicine
-As an independent advisor to the
nation with the goal of improving health,
the IOM has championed...
 Health Level Seven
- An intentional, not for profit, volunteer
standards, organization, health level seven
is known for ...
 Over the next 10 years, as the nation
moves toward the goal of EHRS, nurse
informaticists will have increased
opportunit...
 The healthcare industry is undergoing a
dramatic transformation from today’s
inefficient, costly, manually, intensive,
c...
 The electronic health record (EHR) will form the
foundation for pervasive, personalized, and science-
based care.
 The ...
 The International Council of Nurses (ICN) Code
of Ethics for Nurses affirms that the nurse “holds
in confidence personal...
 Thus ethical obligations drive
requirements for Dependability, which
comprises 6 attributes:
 1. System reliability
 2...
 1. System reliability: The system consistently
behaves in the same way.
 2. Service availability: Required services are...
All computer systems are vulnerable to
both human-created threats, such as
malicious code attacks software bugs, and
natur...
A more practical approach to
attaining dependability is to build
tolerant systems-systems that anticipate
problems; that d...

Guideline 1: Architect for Dependability
A fundamental principle of system
architecture is that an enterprise system
arc...

Guideline 1: Architect for Dependability
While these applications provide services that
are critical to assuring px’s pr...
Guideline 2: Anticipate Failure
As computers are getting faster, systems are getting
more complex and design flaws are bec...

Guideline 3: Anticipate Success
The systems planning process should anticipate
business success and the consequential ne...
 Guideline 4: Hire Meticulous Managers
Managing and keeping complex networks
and integrated systems available and
respons...
 Guideline 5: Don’t Be Adventurous
One should use only proven
methods, tools, technologies, and
products that have been i...

This assessment is by no means
“scientific,” nor is it intended to represent
“all” healthcare provider organizations.
Ra...
 For adherence to the first guideline
“architecture for dependability” the clinical
care provider community gets a barely...
 The Health Insurance Portability and
Accountability Act (HIPAA) security
regulation prescribes administrative,
physical,...
 The following represent important
operational practices that clearly will
contribute to system dependability:
 Eight Re...
1. Security management, including
security analysis and risk management
2. Assigned security responsibility
3. Information...
 5. Security incident procedures, including
response and reporting
6. Contingency planning, including data
backup plannin...
1. Access control, including unique user
identification and an emergency access
procedure
2. Audit controls
3. Data integr...
 In a healthcare environment, access must
be more liberally authorized than in many
other security environments because
a...
 Medical technology and prescription
drugs are required to undergo extensive
validation before they can be used in
clinic...
 Healthcare organizations definitely expect
their computer systems to work.
However, healthcare organizations do not
fore...
 IT managers who recognize the strong
relationship between system
dependability and the quality of patient
care implement...
 Healthcare clinicians are typically very resistant
to change because they are taught to
circumspect in considering new a...
 Clinical Nursing Visibility from NATIONAL
to INTERNATIONAL context:
-There’s a recognition of growing
needs for Nursing ...
 The NMDS identifies
essential, common, and core data
elements to be collected for all
patients/clients receiving nursing...
 The NMDS was conceptualized through
a small group work at the nursing
information systems (NISs) conference
held in 1977...
 NMDS includes 3 broad categories of
elements:
 1. Nursing Care
 2. Patient Demographics
 3. Service Elements
 1. Access to comparable, minimum
nursing care, and resources data on local,
regional, national, and international levels...
 5. Improved data for quality assurance
evaluation
 6. Impetus to further development and
refinement of NISs
 7. Compar...
 Established NMDSs
- The early NMDS work in the United
States spurred the development of
NMDSs in numerous other countrie...
 Emergent NMDS’s:
- Several countries across most countries beyond
North America are exploring development of NMDS’s
syst...
 Call for Standardized Contextual Data:
- Ample studies have demonstrated the
significance of nurse staffing, patient/sta...
 Call for Standardized Contextual Data:
-The development within the United
States of the NMMDS addresses this void.
The 1...
 Call for Standardized Contextual Data:
-The NMMDS support numerous constructed
variables as well as aggregation of data,...
Evolution of Concept:
-The i-NMDS the core, internationally
relevant, essential, minimum data elements
to be collected in...
 Evolution of Concept:
-The i-NMDS project is intended to build on
and support data set work already underway in
individu...
 Cosponsorship:
- The i-NMDS Research Center is lead by
steering committee of international
representative of countries w...
 Purposes:
· Describing human phenomena, nursing
interventions, care outcomes, and resource consumption
related nursing s...
 Data Elements:
- The i-NMDS elements are organized into three
categories: setting, subjects of care, and nursing element...
 Data Elements:
- Last, nursing care elements include
nursing diagnosis/subject of are
problems, interventions, and outco...
 Future Directions:
- The power NMDSs to describe nursing
practice from an international perspective is
daunting. Knowing...
Nursing Informatics chapter14, 15, 16
Nursing Informatics chapter14, 15, 16
Nursing Informatics chapter14, 15, 16
Nursing Informatics chapter14, 15, 16
Nursing Informatics chapter14, 15, 16
Nursing Informatics chapter14, 15, 16
Nursing Informatics chapter14, 15, 16
Nursing Informatics chapter14, 15, 16
Nursing Informatics chapter14, 15, 16
Nursing Informatics chapter14, 15, 16
Nursing Informatics chapter14, 15, 16
Nursing Informatics chapter14, 15, 16
Nursing Informatics chapter14, 15, 16
Nursing Informatics chapter14, 15, 16
Nursing Informatics chapter14, 15, 16
Nursing Informatics chapter14, 15, 16
Nursing Informatics chapter14, 15, 16
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Nursing Informatics chapter14, 15, 16

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Nursing Informatics chapter14, 15, 16

  1. 1.  In April 2004, the president of the United States issued an executive order that called for action to put EHRs in place for most Americans in 10 years.  Today there is growing consensus that EHRs, can meet clinical and business needs in healthcare by capturing, storing, and displaying clinical information when and where it is needed to improve treatment and to provide aggregated cross-pattern data analysis.  These systems can manage healthcare data and information in a way that is patient-centered and information-rich.
  2. 2.  The involvement of nurses is critical to such efforts responsible for care coordination and promotion of wellness, nurses are often the patient’s primary contact and the final point in healthcare delivery where medical errors and other unintended actions can be caught and corrected.
  3. 3.  After a brief overview and discussion of the definition of EHR-Ss, this chapter covers two main areas :  1. Federal initiatives and ;  2. Public-private partnership.
  4. 4.  An early adopter of EHR-s the U.S government is currently advancing initiatives to accelerate the use of HIT in both the public and private sectors.  Both sectors have done considerable EHR-S innovation and some notable benchmark implementation over the past decade federal initiatives continue to actively identify and target solutions that lessen the barriers and accelerate use of EHR-S.
  5. 5.  Improved information access and availability can enable both the provider and the patient to better manage the patient’s health by using capabilities provided by enhanced clinical decision support and customized education materials.  Nurses are drivers in organizational planning and process reengineering to improve the healthcare delivery system.
  6. 6.  The term EHR-S is often used interchangeably with computerized patient record, clinically information system, electronic medical record, and many others.  As a term EHR-S is recognized internationally by including the word system, the term forces a distinction between an EHR, which is physical or logical(virtual) repository of data, and EHR- S, which can be made up of one or more applications.  At the time of writing, international organization for the standardization (ISO) had drafted its standard for EHR definition, escape, and context, ISO 20514; the final version was expected in 2005 or 2006.
  7. 7.  EHR may be used by all participants in the process of achieving health, including all disciplines of clinicians, family caregivers, and the patient.  EHR-S provides the components that support clinical and healthcare functions including business rules, procedures and so forth by accessing the EHR to write and/or read patient data.
  8. 8.  The set of components that form the mechanism by which patient 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.
  9. 9. 1. Longitudinal collection of electronic health information for and about persons, where health information is defined as information pertaining to the health of an individual or healthcare provided to an individual. 2. Immediate electronic access to person and population level information by authorized, and only authorized, users. 3. Provision of knowledge and decision support that enhances the quality, safety, and efficiency of patient care. 4. Support of efficient processes for healthcare delivery.
  10. 10.  Within the federal government, different departments exert different influences toward the common goal of an EHR for most Americans. Agencies providing direct healthcare offer evidences that the use of EHRS across a multifacility enterprise is a realistic goal with measurable, repeatable positive outcomes. Other agencies provide leadership by offering monetary incentives and shaping regulations and policy.
  11. 11.  Federal Agencies that provide direct care have been early adopters of EHRS. Those that don’t are providing multiple approaches to promote use of EHRS. These include decreasing the cost and risk of acquisition and providing incentives for their use.
  12. 12.  Government as Provider and early Adopter -Federeal agencies that provide direct care have been early adopters of EHR-s  Department of Veterans Affairs(VA) -Veterans Information System and TechnologyArchitecture(VistA) supports day to day clinical and administrative operations at local VA healthcare facilities
  13. 13.  Department of Defense -Have had a computerized physician order  Indian health service -The EHR-S as long had been pioneer in using computer technology to capture clinical and public health data. Its primary clinical component, the patient care component (PCC) has been in place since the early 1980’s.
  14. 14.  Government as Leader -Federal agencies that do not provide direct care are taking multiple approaches to promote use of EHR-S. -Federal activities are focus on the development and adoption of terminologies and standards, Grants for community demonstrations of data exchange and other pilot projects.
  15. 15.  Office of the national coordinator for health information technology. -The executive of April 2004, mentioned earlier in the chapter, created the ONCHIT to coordinate HIT efforts in the federal sector and collaborate with the private sector in the driving HIT adoption across the health care system. - In July 2004, HHS secretary Tommy Thompson and Dr.Brailer release a framework for strategic action. The office of the national coordinator is positioned to bring together a public and private entity for accelerating solutions to known problems.
  16. 16.  The national committee on vital and health statistics -In 2000 and 2001, the national committee on vital and health statistics (NCVHS), which advices the secretary of HHS on health information policy, held a series of national hearings to develop a consensus vision of the national health information infrastructure (NHII).
  17. 17.  Agency for healthcare Research and Quality -In 2003-2004, AHRQ unveiled a major HIT portfolio, with grants, contracts and other activities to demonstrate the role of HIT in improving patient safety band the quality of care.
  18. 18.  Computerized Patient Record System  CPRS (Computerized Patient Record System) provided a single place for healthcare providers to review and update a patient’s health record.  All aspects of a patient’s record are integrated including active problems, allergies, and current medications. All electronic records are password protected to guarantee patient privacy.
  19. 19.  A number of collaborative efforts are focused on use of EHR-s and HIT to improve care  Among these private sector organizations are those formed specifically to address issues of connectivity, HIT, and standards development. Others are established standards development organization; some are based in professional association where they arose in efforts to serve their membership.
  20. 20.  Institute of Medicine -As an independent advisor to the nation with the goal of improving health, the IOM has championed the advantages of IT to improve health since its 1991 foundational work the computer base patient record, which was revised and republished in 1997.
  21. 21.  Health Level Seven - An intentional, not for profit, volunteer standards, organization, health level seven is known for its large body of work in the production of technical specification for the transfer of health care data. - Supported by public and private groups the HL7’s EHR technical committee developed draft standard for trial use, known as a DSTU, for EHRS and made it available for public comment prior to being reballoted as a standard.
  22. 22.  Over the next 10 years, as the nation moves toward the goal of EHRS, nurse informaticists will have increased opportunities to participate in the activities of formative groups, using the growing body of tools available to them. This time of great change brings grand opportunities for nursing informaticists and the entire nursing profession.
  23. 23.  The healthcare industry is undergoing a dramatic transformation from today’s inefficient, costly, manually, intensive, crises-driven model of care delivery to a more efficient, consumer-centric, science-based model that proactively focuses on health management.
  24. 24.  The electronic health record (EHR) will form the foundation for pervasive, personalized, and science- based care.  The technologies that enable the transformation are largely state of the art and include enterprise application integration (EAI);wireless communications; handheld and tablet computers; continuous speech recognition; new models for knowledge representation, integration, and interpretation; electronic sensor; radio frequency identification (RFID) tagging; and robotics.
  25. 25.  The International Council of Nurses (ICN) Code of Ethics for Nurses affirms that the nurse “holds in confidence personal information” and “ensures that use of technology is compatible with the safety, dignity and rights of people.”  Fulfilling these ethical obligations is the individual responsibility of the nurse, who presumably has the ability and authority to ensure that personal information is protected and that technology is safe.  Thus, ethical obligations drive requirements for dependability.
  26. 26.  Thus ethical obligations drive requirements for Dependability, which comprises 6 attributes:  1. System reliability  2. Service availability  3. Confidebtiality  4. Data integrity  5. Responsiveness  6. Safety
  27. 27.  1. System reliability: The system consistently behaves in the same way.  2. Service availability: Required services are present and usable when they are needed.  3. Confidentiality: Sensitive information is disclosed only to those authorized to see it.  4. Data integrity: Data are not corrupted or destroyed.  5. Responsiveness: The system responds to user input within an expected and acceptable time period  6. Safety: The system does not cause harm.
  28. 28. All computer systems are vulnerable to both human-created threats, such as malicious code attacks software bugs, and natural threats, such as hardware aging and earthquakes. Removing all system vulnerabilities is not practical particularly given complex, heterogeneous environments where software and hardware changes are a part of routine operations.
  29. 29. 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 actions so that services can continue and data are protected from corruption, destruction, and unauthorized disclosure.
  30. 30.  Guideline 1: Architect for Dependability A fundamental principle of system architecture is that an enterprise system architecture should be developed from the bottom up so that no critical component is dependent on a component less trustworthy than itself. At the bottom of the architecture are the physical and logical networks that support the enterprise and provide the “pipes” that carry data from system to system.
  31. 31.  Guideline 1: Architect for Dependability While these applications provide services that are critical to assuring px’s privacy and safety, these services are only as dependable as the system services on which they depend. In particular, operating systems provide system-level security functions that are critical to assuring that individuals can access only those resources for which they are authorized.
  32. 32. Guideline 2: Anticipate Failure As computers are getting faster, systems are getting more complex and design flaws are becoming a problem. In anticipation of failures at the infrastructure level, features that are transparent to software applications should be implemented to detect faults, to fail over to redundant components when faults are detected, and to recover from failures before they become catastrophic. Another effect of increasing complexity is an increase in vulnerabilities which serve as “opportunities” for malicious attack. Safety-critical systems should be designed and built to fail in a safe state.
  33. 33.  Guideline 3: Anticipate Success The systems planning process should anticipate business success and the consequential need for larger networks, more systems, new applications, and additional integration. Modeling of use-case scenarios that anticipate hospital and clinic mergers, acquisitions, and a growing patient/customer base will enable the system designer to visualize the data flows, system loading, and network impact resulting from business growth and success. Such models and provide valuable input into planning for scalability and future integration.
  34. 34.  Guideline 4: Hire Meticulous Managers Managing and keeping complex networks and integrated systems available and responsive requires meticulous oversees individuals who know that failures will occur and accept that failures are most likely to occur when they are least expected. They take emergency and disaster planning very seriously; they develop, maintain, and judicious exercise plans and procedures for managing emergencies and recovering from disasters.
  35. 35.  Guideline 5: Don’t Be Adventurous One should use only proven methods, tools, technologies, and products that have been in production, under conditions, and at a scale similar to the intended environment. The enterprise with a requirement for dependable systems should not be the first (or second) to adopt a new technology.
  36. 36.  This assessment is by no means “scientific,” nor is it intended to represent “all” healthcare provider organizations. Rather it conveys observations of the healthcare industry as a whole and the opinions of a passionate advocate of dependable systems for healthcare.
  37. 37.  For adherence to the first guideline “architecture for dependability” the clinical care provider community gets a barely passing grade of “D”.  Healthcare organizations build or perhaps “compose” their systems from top down rather than from the bottom up.  These systems are familiarly known as "Departmental" systems because they generally are used only in one department, such as registration, laboratory or pharmacy.
  38. 38.  The Health Insurance Portability and Accountability Act (HIPAA) security regulation prescribes administrative, physical, and technical safeguards.  This safeguards contributes to system dependability and for protecting the confidentiality and integrity of health information and the availability of critical system services.
  39. 39.  The following represent important operational practices that clearly will contribute to system dependability:  Eight Required Administrative Safeguards  And Five Specified Physical Safeguards
  40. 40. 1. Security management, including security analysis and risk management 2. Assigned security responsibility 3. Information access management, including the isolation of clearinghouse functions from other clinical functions 4. Security awareness and training
  41. 41.  5. Security incident procedures, including response and reporting 6. Contingency planning, including data backup planning, disaster recovery planning, and planning for emergency mode operations 7. Evaluation 8. Business associate contracts that lock in the obligations of business partners in protecting health information to which they may have access.
  42. 42. 1. Access control, including unique user identification and an emergency access procedure 2. Audit controls 3. Data integrity protection 4. Person or entity authentication 5. Transmission security
  43. 43.  In a healthcare environment, access must be more liberally authorized than in many other security environments because access to information is a prerequisite to care. Unfortunately, healthcare enterprises view security as a “compliance” issue and not a core business need. Until the healthcare industry recognizes information security as a core business requirement, enterprise system dependability will not be achievable.
  44. 44.  Medical technology and prescription drugs are required to undergo extensive validation before they can be used in clinical practice.  Computers are increasingly being used in safety-critical clinical applications and without careful and appropriate attention to software safety, we can reasonably expect that failures will contribute to the loss of human life.
  45. 45.  Healthcare organizations definitely expect their computer systems to work. However, healthcare organizations do not foresee that their business success may increase their need for processing power and networking capability. Nor do they foresee mergers’ and acquisitions’ creating the need to consolidate their systems with those of another healthcare enterprise. 
  46. 46.  IT managers who recognize the strong relationship between system dependability and the quality of patient care implement fault-tolerant systems with strong security protection, middleware to manage workload and tools to continuously monitor the health and performance of their systems. 
  47. 47.  Healthcare clinicians are typically very resistant to change because they are taught to circumspect in considering new approaches, treatment, protocols, and drug regimens. Before adopting any new idea, they investigate it. For dependable IT, the healthcare practitioner’s skepticism is a good thing.  Newness and change are anathema to stability. While well planned executed changes over time are desired and expected, healthcare provider organizations should not be overly eager to adopt
  48. 48.  Clinical Nursing Visibility from NATIONAL to INTERNATIONAL context: -There’s a recognition of growing needs for Nursing Data but has been fuelled by International as well as national factors -The identification of NMDSvisionary work begun in the US by Werley and Lang and has spurred activity to develop similar data set around the world.
  49. 49.  The NMDS identifies essential, common, and core data elements to be collected for all patients/clients receiving nursing care.  The NMDS is a standardized approach that facilitates the abstraction of these minimum, common, essential core data elements to describe nursing practice (Werley and Lang, 1988) from both paper and electronic records.
  50. 50.  The NMDS was conceptualized through a small group work at the nursing information systems (NISs) conference held in 1977 at the University of Illionois College of Nursing (Newcomb, 1981).  Werley and colleagues took the NMDS forward at the NMDS conference in 1985 held at the University of Wisconsin – Milwaukee School of Nursing.
  51. 51.  NMDS includes 3 broad categories of elements:  1. Nursing Care  2. Patient Demographics  3. Service Elements
  52. 52.  1. Access to comparable, minimum nursing care, and resources data on local, regional, national, and international levels  2. Enhance documentation of nursing care provided  3. Identification of trends related to patient or client problems and nursing care provided  4. Impetus to improved costing of nursing services
  53. 53.  5. Improved data for quality assurance evaluation  6. Impetus to further development and refinement of NISs  7. Comparative research on nursing care, including research on nursing diagnoses, nursing interventions, nursing outcomes, intensity of nursing care, and referral for further nursing services  8. Contributions toward advancing nursing as a research-based discipline
  54. 54.  Established NMDSs - The early NMDS work in the United States spurred the development of NMDSs in numerous other countries. - To date seven countries have identified NMDS systems, including Australia, Canada, Belgium, Iceland, The Netherlands, Switzerland, and Thailand.
  55. 55.  Emergent NMDS’s: - Several countries across most countries beyond North America are exploring development of NMDS’s systems: for example, in Europe. -The World Health Organization has been concerned with variable including nursing care, personal data, medical diagnosis, and services data. -Work is ongoing in the United Kingdome, e.g., Scotland, to identify NMDSs to be congruent with the initiatives of the National Health Service. The Nordic countries likewise have much ongoing activity to identify NMDSs, e.g.. Finland -France also is pursing identification of a NMDS
  56. 56.  Call for Standardized Contextual Data: - 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 coordination/collaboration, and educational level on the quality and outcomes of patient care.
  57. 57.  Call for Standardized Contextual Data: -The development within the United States of the NMMDS addresses this void. The 18 NMDS elements are organized into three categories: environment, nursing care resources, and financial resources. The NMDS most appropriately focuses on the nursing delivery unit/service/center of excellence level across these settings.
  58. 58.  Call for Standardized Contextual Data: -The NMMDS support numerous constructed variables as well as aggregation of data, e.g,, unit level, institutional, network, system. This minimum data set provides the structure for the collection of information that influences quality of patient care, directly and indirectly. These data, in combination with actual patient data identified in the NMDS support clinical decision making: management decisions regarding the quality, quantity, and satisfaction of personnel; cost of patient care; clinical outcomes; and internal and external benchmarking.
  59. 59. Evolution of Concept: -The i-NMDS the core, internationally relevant, essential, minimum data elements to be collected in the course for providing nursing care. Work toward the i-NMDS is intended to build on the efforts already underway in individual countries. -It is imperative that the national healthcare infrastructure supports the collection and reuse of nursing data.
  60. 60.  Evolution of Concept: -The i-NMDS project is intended to build on and support data set work already underway in individual countries, as well as the work with another ICN initiative, the ICNP. Data collection in the i-NMDS pilot project will be cross mapped and normalized to the ICNP. -This i-NMDS work will assist in testing the i- NMDS and also advancing the ICNP as a unifying framework .Overall, the i-NMDS project focuses on coordinating ongoing international data collection and analyses of the i-NMDS to support the description, study, and improvement of nursing practice.
  61. 61.  Cosponsorship: - The i-NMDS Research Center is lead by steering committee of international representative of countries with existing and emerging NMDS as well as professional cosponsorship and areas of informatics expertise (http:llwww.inmds.org). - The project is consponsored by the ICN and the IMIA NI-SIG. Project work is Also coordinated with international standards organizations and other stakeholders to assure harmonization of these efforts.
  62. 62.  Purposes: · Describing human phenomena, nursing interventions, care outcomes, and resource consumption related nursing services · Improving the performance of health care system and the nurses working within these systems worldwide · Enhancing the capacity of nursing and midwifery services · 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 · Testing evidence – base practice improvements · Empowering the public internationally
  63. 63.  Data Elements: - The i-NMDS elements are organized into three categories: setting, subjects of care, and nursing elements. Setting variables include country characteristics as well as descriptions of the location of care, whether the setting is acute, ambulatory, home, and so on. - Measures include care personnel characteristics, including numbers, full-time equivalents, education, gender, and so on. Subjects of care can include individuals, families, groups, or communities. Demographics of the subject (individuals, families, groups, and communities) are included, e.g., country of residence, disposition, age, gender, medical diagnosis are described. Last nursing care elements included.
  64. 64.  Data Elements: - Last, nursing care elements include nursing diagnosis/subject of are problems, interventions, and outcomes. A measure of intensity of recourses consumption will be developed. Nursing care data may be collected using standardized languages., Clinical Care Classification (CCC), Omaha, NANDA, NIC, NOC. All nursing care data will be normalize using
  65. 65.  Future Directions: - The power NMDSs to describe nursing practice from an international perspective is daunting. Knowing the human phenomena served by nursing, the interventions given and the outcomes realized are essential to improved outcomes, assuring patient/client safety, and providing wise stewardship of all resources, from human to financial. - Information and knowledge are key to supporting an essential knowledge-driven professional service and improving healthcare through effective policy changes.

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