broad day health service best practices

1. NURSING INFORMATICS
HISTORICAL PERSPECTIVE

2. Anyone who has been in the nursing field for an extended period of
time will tell you that a lot has changed. In fact, the twentieth century
brought – literally – a technological “invasion” to nursing.
Medical advancements and information technologies of the twentieth
century have not only changed the face of the nursing – they have become
part of the intricate fabric of the field.

3. 19 technologies that changed nursing forever.
1.Electronic IV monitors

4. 2.The Sphygmomanometer

5. 3.Information management

6. 4.The portable defibrillator

7. 5. Sturdy, portable IT devices

8. 6. Readily accessible base of information

9. 7.The sonogram/ultrasound

10. 8.Local wireless telephone networks

11. 9. Hands-free communication devices

12. 10.Communications options

13. 11.Patient remote monitoring
12.RFID technologies
13.Compact, portable medical devices
14. Neo-natal nursing advancements
15.Drug management technologies
16.Configurable nursing environments
17.Learning technologies
18.Video conferencing
19.The blogosphere

14. What will the rest of the twenty-first century bring?

15. Computer
An electronic device that performs tasks, such as calculations or electronic
communication, under the control of a set of instructions called a program.
Programs usually reside within the computer and are retrieved and processed by
the computer’s electronics. The program results are stored or routed to output
devices, such as video display monitor or printers. Computers perform a wide
variety of activities reliably, accurately, and quickly.

16. Nursing and the Computer
Historical Perspectives
4 major historical perspectives of nursing and
computers
1. Six Time Periods
2. Four Major Nursing Areas
3. Standard Initiatives
4. Significant Landmark Events

17. Six Time Periods
I. Prior to 1960’s
II. 1960’s
III.1970’s
IV.1980’s
V. 1990’s
VI.Post 2000

18. Prior to 1960’s
1950’s
- Computer industry grew
- Nursing also made major changes
- Computers are used by healthcare facilities for basic business functions:
+ Punch cards (A punched card or punch card is a piece of stiff paper
that can be used to contain digital information represented by the
presence or absence of holes in predefined positions)

19. + Card readers (A card reader is a data input device that reads data
from a card-shaped storage medium)
+Sort and prepare data for processing (a series of operations on data,
especially by a computer, to retrieve, transform, or classify information.)

20. +Teletypewriters (A teleprinter (teletypewriter, Teletype or TTY) is
an electromechanical typewriter that can be used to send and receive
typed messages from point to point and point-to-multipoint over various
types of communications channels. )

21. 1960’s
- Use of computers is being questioned
- Nurses station is viewed as the “hub” of
information exchange
- Introduction of Cathode Ray Tube (CRT)
and online data communication and real
time processing (a high-vacuum tube in
which cathode rays produce a luminous
image on a fluorescent screen, used
chiefly in televisions and computer
terminals.)

23. - Hospital information systems were developed primarily for Billing and
Accounting systems.
- Vendors of computer systems and applications in hospitals started

24. 1970’s
- Nurses began to see the value of computers in the profession
+ documentation of nursing practice
+ quality of patient care
+ repetitive aspects of managing patient care

25. - Computers are perceived as cost-saving technologies
- HIS’s further advanced
- Computer-based MIS in public health developed

26. 1980’s
- Nursing Informatics emerged
- Need of data standards, vocabularies, and classification schemed for
computer based patient record system (CPRS which is an EHR)
identified
- Microcomputer / Personal Computer emerged
+ has brought computing power to workplace, especially the point of
care
+ served as stand alone system (workstation)
User-friendly and allowed nurses to create their own applications

27. - HIS emerged with nursing subsystems
+ Order Entry (like KARDEX)
+ Results reporting
+ Vital signs
+ Narrative nursing notes

28. 1990’s
- Computer technology became an integral part of health care settings,
nursing practice, and the profession.
- Nursing informatics was approved in 1992 by ANA as a new nursing
specialty
- Demand for NI expertise increased greatly

29. - Use of innovative technologies for all levels and types of nursing and
patient education demanded
- Laptops and notebooks were utilized at bedside and all point-of-care
settings

30. - LAN were developed in hospitals
- WAN were developed for linking care across health care facilities
- Internet is widely used and helped information and knowledge
databases to integrated into bedside systems
1995- internet was brought to social milieu
+ E-mail
+ file transfer protocol (upload and download)
- The internet was used to exchange data between CPRS, while the
web became the means to communicate online services and
resources to the nursing community.

31. Post-2000
- Development of wireless point-of-care system with focus on open
source solution
- Clinical Information System (CIS) became individualized in the
electronic Patient Record (EPR) and patient specific systems
considered for lifelong longitudinal record or the HER

32. - Mobile technology advances
+ wireless tablet computers
+ PDA
+ smartphones
+ VOIP (voice over internet protocol)
+ Health smartcards
- Telenursing became popular
+remote monitoring of ICU patient, community patients

33. Four Major Nursing Areas
Significance of Nursing Informatics
Nursing Informatics can be applied to all areas of nursing practice, which
include; clinical practice, administration, education, and research.
Below are some examples of how nursing informatics, information technology and computers,
are used to support various areas of nursing practice.

34. Nursing Clinical Practice (Point-of-Care Systems and Clinical
Information Systems)
 Work lists to remind staff of planned nursing interventions
 Computer generated client documentation
 Electronic Medical Record (EMR) and Computer-Based Patient
Record (CPR)

35. Nursing Administration (Health Care Information Systems)
 Automated staff scheduling
 E-mail for improved communication

36. Nursing Education
 Computerized record-keeping
 Computerized-assisted instruction
 Interactive video technology

37. Nursing Research
 Computerized literature searching and Web sources
 The adoption of standardized language related to nursing terms-
NANDA, etc.

38. Standard Initiatives
1. Nursing Practice Standards
ANA – considered as the official nursing organization that contributes in the development and
recommendation of standards of nursing practice worldwide
Joint commission on Accreditation of Hospital Organizations ( JCAHO) – focuses on the need for
adequate records on patients in hospital and practice of standards in documentation of care

39. 2. Nursing Data Standards
Emerged as a new requirement for HER
13 nursing terminologies that have been recognized by the ANA for
this 4th edition.
The ANA is responsible for the recognition of the terminologies and
for determining if they have met the criteria to be included

40. 3. Healthcare Data Standard Organizations
American national standard institute
The national committee on vital and statistics work group on computer
based patient records

41. 4. Early computer-based nursing applications
Developed before the mid 1970’s
Different nursing applications focused on documentation of nursing
practice and management of patient care.

42. Landmark Events in Nursing and Computers
Significant Landmark of Event
1961 – Healthcare Information and Management systems Society
was founded
1965 – Development of one of the first hospital Information system
in California
1973 – First Conference on Management Information System
1981 – First National Conference on Computer Technology in
Chicago

43. 1984 – First Nursing Computer Journal is published.
1989 – graduate program in Nursing Informatics is introduced in
Maryland university
1993-establishment of electronic library
1995 – first International Nursing Informatics Teleconference held in
Australia
2002-JCAHO identified clinical information system as a way to improve
safety and recommends that hospitals adopt technology.
2003 – Health Insurance Portability and Accountability Act was enacted
2004 – Establishment of the National Health Information Coordinator.

44. History of Nursing Informatics in the Philippines
The Philippine nursing community have long sought to keep up with increasing use
of information and technology in the healthcare system. Nursing Informatics
follows the footsteps of biomedical informatics which has gained relative
popularity earlier than its other allied medical counterparts.

45. Some of the major milestones in nursing informatics history in the Philippines
which includes the participation of the Philippine Nurses Association (PNA) in
the development of Standards for Health Information in the Philippines(SHIP)
in 1999, the formation of the Master of Science in Health Informatics(MSHI)
which began in 2005 and the formation of the Philippine Nursing Informatics
Association(PNIA) in 2010 as a sub-specialty organization of PNA for nursing
informatics.

46. The words "nursing informatics "were unfamiliar among the nursing
community until the year 2008. There were only a handful of people with
knowledge and experience in nursing informatics but the discipline have
not yet found its recognition as a sub-specialty of nursing arts and science
in the country. The origin of this budding discipline indirectly came from
the pioneers of health informatics in the Philippines.

47. The Philippine Medical Informatics Society(PMIS) and its founders had
strong influence in the development of health informatics in the Philippines.
The PMIA was officially registered under the Securities and Exchange
Commission in 1996 by its board composed of eleven physician. The
organization was headed by Dr. Alvin Marcelo.

48. Since 1998, several faculty members of the University of the Philippines
began formal education and training. Dr. Herman Tolentino took a post-
doctoral fellowship in medical informatics at the University of Washington.
Dr. Alvin Marcelo followed a year later for his training at the National Library
of Medicine. Dr. Cito Maramba went to Coventry for his Masters in
Informatics on Sciences at the University of Warwick. They were later
followed by other physicians such as Dr. Micheal Muin and Dr. Ryan Bañez.

49. By the year 2003, a Master of Science in Health Informatics was proposed
to be offered by UP-Manila College of Medicine (major in medical
informatics) and the College of Arts and Science (major in bioinformatics)
and was later approved to be offered starting academic year 2005-2006.

50. In 1999, a study group was formed headed by the National Institute of Health
of the University of the Philippines Manila. This group identified international
standards for health information and their adaptability in the Philippines. The
document is referred to as the "Standards of Health Information in the
Philippines, 1999 version" or"SHIP99". Representatives from various sectors
collaborated on this project including the Philippine Nurses Association (PNA)
in the person of Ms. Evelyn Protacio.

51. CHED as a Catalyst
The nursing community was still yet to follow its international counterparts
in the adoption of information, communication and technology in nursing
practice in the Philippines. Despite the inclusion of Informatics course in the
undergraduate curriculum which focused on basic desktop applications, the
need for genuine nursing informatics course had not yet been realized.

52. Early in 2009, Mr. Kristian R. Sumabat and Ms.Mia Alcantara-Santiago, both
nurses and graduate students of Master of Science in Health Informatics at the
University of the Philippines, Manila began drafting plans to create a nursing
informatics organization.

53. They were joined by founding members Ms. Sheryl Ochea, a graduate of
MAster of Sciencein Nursing major in nursing informatics at Xavier University
(Ohio, USA), Ms. Alexrandra Bernal, a graduate student and telehealth nurse
of the National Telehealth Center, Ms.Pia Pelayo, a former telehealth nurse
and a project coordinator of the National Epidemiology Center, Department
of Health and Mr. Sid Cardenas, also a telehealth nurse. Other founding
members include Mr. Noel Bañez, Ms. Rona Abcede, and Mr. Harby Ongbay
Abellanosa.

54. Issues and Challenges
Like many other disciplines, nursing informatics face many challenges
while in its infancy stage. The inclusion of informatics as an integral part of
the undergraduate curriculum has been one of the most influential factors
for the increased awareness and interest in this field of nursing. However,
the contents of the curriculum was adapted from international materials
which does not match the local needs.

55. Future Direction
Development of training, certification and credentialing programs are in the
pipeline for the Philippine Nursing Informatics Association. Future
partnerships with local and international nursing and health informatics
organizations have started as well. Other programs are expected to be slowly
delivered with PNIAs CORE X strategic platform which stands for Competency,
Organization, Recognition, Experience and Expertise.

56. End of 2nd Day