Nursing informatics professionals need to be aware of healthcare policy to effectively practice in today's changing healthcare environment. Healthcare policy is established at local, state, and national levels to guide solutions for population health needs. For nursing informatics to be recognized as a specialty, it had to demonstrate a differentiated practice, identify educational programs, develop a research agenda. Standards are critical for electronic health records and the effective exchange of health information. Adoption of technologies like computerized provider order entry and smart infusion pumps can help reduce errors and improve workflow.

1. NURSING INFORMATICS and
HEALTHCARE POLICY
To practice effectively in today’s continually changing
healthcare environment, informatics professionals need to be
aware of existing and proposed healthcare policy.
Policy a course of action that
guides present and future
decisions.

2. Healthcare policy is established on local,
state, and national levels to guide the
implementation of solutions for the
populations health needs.
To be acknowledged as a specialty within nursing, informatics had to:
Nurses have contributed to the
purchased, design, and implementation
of IS since the 1970s and in 1992, the
American Nurses Association (ANA)
recognized NI as a specialty.
Demonstrate a differentiated practice base
Identify the existence of educational programs in the field.
Develop a research agenda

3. The
defini
-tion
of NI
Before: NI was defined as the combination of nursing
information, and computer sciences to manage and
process nursing data into information and knowledge for
use in nursing practice.
Now: NI is described more broadly as a specialty that
integrates nursing science, computer science, and
information science to manage and communicate data,
information, and knowledge in nursing practice.

4. Differentiated and Interdisciplinary Practice
NI practice differentiates itself from other areas of nursing practice but
emphasizes its interaction with informatics disciplines such as mathematics,
statistics, linguistics, engineering, computer science, and health informatics.
NI brings an added dimension to nursing practice that focuses on knowledge
and skill in information management techniques.

5. Nursing Shortage and Nursing Informatics

6. Unless something is done the shortage will rise from 6% in
2000 to 29% in 2020 or more than 800,000 nurses short of the
number needed.
The Bureau of Labor Statistics As Phase 2 of the AAN
technology project began, staff nurses from three hospitals in
Virginia and California were asked to identify or verify the
most difficult aspects of their practice and how technology
would improve those tasks.
As the project continues, systems will be designed,
implemented, and tested to determine their effect on nurses’
work.
It is up to NI specialists to help design and implement IT
systems that will finally assists nurses in their practice and to
validate the results thru research.

7. National Health Information
Infrastructure
Another national initiative that will impact NI is the
National Health Information Infrastructure
(NHII). This voluntary initiative, involving a three
stage process over 10 years, is intended to improve
the effectiveness, efficiency, and overall quality of
health and healthcare in the United States.

8. Health Insurance Portability and
Accountability Act (HIPAA)
HIPAA was passed in 1996 and is intended to improve public and private
health programs by establishing standards to facilitate the efficient
transmission of electronic health information
HIPAA preempts state law and payer specific variations of data
standards; mandates input from private, standard setting organizations.
 HIPAA has a significant impact on informatics: IT must be designed to
comply with Title II of the act.

9. ROLE OF TECHNOLOGY IN MEDICATION
USE PROCESS
Introduction
Due to the numerous steps in required in
the care of the healthcare industry is an
inherently error-prone process that is
fraught with for mistakes to occur. This
concept was confirmed in the oft-quoted
1999 Institute of Medicine (IOM) report, To
Err is Human: Building a safer Health

10. Illegible handwriting on medication orders has
been shown to be a common cause of
prescribing errors and patient injury and death
have actually resulted from such errors.
The use of CPOE system has the potential to alleviate
many of these problems. CPOE can be defined as a
system used for direct entry of one or more types of
medical orders by a prescriber into a system that
transmits those orders by electronically to the
appropriate department.
Computerized Prescriber
Order Entry (CPOE)

11. Influences on the Adoption of
Technology
Consumers have become increasingly concerned that
hospitals are less than safe following the numerous mass
media reporting of medical mistakes, which have resulted in
patient harm and deaths.
According to a 1992 American Medical Association
report, medication errors related to the misinterpretation of
physician’s prescriptions were the second most prevalent
and expensive claim listed on malpractice cases filed over a
7-year period on 1992.

12. Bar Code-Enabled Point -of- Care
Technology

13. NEW TYPES OF MEDICATION ERRORS
Omissions
Wrong
dose
Wrong
dosage form
Charting
errors
Unauthorize
d drug
Wrong
drug
Extra dose

14. Automated Dispensing Cabinets
The ADC is a computerized point-of-
use medication-management system
that is designed to replace or support
the traditional unit-dose drug delivery
system. Many healthcare facilities have
replaced medication carts or open unit-
stock systems with ADCs.

15. The rationales behind the wide acceptance of
this technology are the ff.:
Improving pharmacy
productivity
Enhancing patient
quality and safety
Improving charge
capture
Reducing costs
Improving nursing
productivity

16. Infusion pumps with dose calculation
software, sometimes referred to as “smart
pumps”, could reduce medication errors,
improve workflow, and provide a new
source of data for continuous quality
improvement by identifying and correcting
pump-programming errors.
"Smart" Infusion Pump Delivery System

17. Standards are critical components in the
development and implementation of an
electronic health record (HER). The
effectiveness of healthcare delivery is
dependent on the ability of the clinicians
to access critical health information
when and where it is needed.

18. Data standards as applied to healthcare
include:
Methods
Protocols
Storage
Exchange
Terminologies
Specification for the
collection

19. International statistical classification of diseases and
related health problems: 9th revision and clinical
modifications
>is the latest version of a mortality and morbidity
classification that originated in 1893
>widely accepted, used in the healthcare industry and has
been adopted for a number of purposes
 Data collection
Quality of care analysis
Resource utilization
Statistical reporting

20. International statistical
classification of diseases
and related health
problems:10th revision
-is the most recent revision of the
ICD classification system for
mortality and morbidity which is
used worldwide
Is a listing of descriptive terms
and codes for reporting medical
services and procedures.
In addition to descriptive
terms and codes, it contains
modifiers, notes and guidelines
to facilitate correct usage.
Current procedural
terminology.
4th revision

21. Systematized Nomenclature of Human Veterinary Medicine
International, Clinical terms
> (SNOMED) comprehensive multiracial nomenclature and classification
system for indexing human and veterinary medical vocabulary, including signs
and symptoms, diagnoses and procedures.
LOINC or logical observation identifiers names and codes
provide a set of universal names and numeric identifier codes for
laboratory and clinical observations and measurements in a data
base structure
represents laboratory data in terms of names for tests and clinical
observations
it is clear that such consistency in terminology is important for
patient safety

22. RxNorm
 (FDA) food and drug administration
(VA) department of veterans affairs
RxNorms provides standard names for clinical drugs (active ingredient+
strength+dose form) and for those forms as administered.
 It provide links from clinical drugs to their active ingredients, drug
component (active ingredient+strength) and some related brand names.
Is a clinical drug nomenclature produced by
NLM in consultation with:

23. (UMLS) consist of metathesaurus of terms and concepts from
dozen of vocabularies: a semantic network of relationships among
the concepts recognize in the metathesaurus: and an information
sources map of the various biomedical database referenced.
National Uniform Claim Committee Recommended Data Set for a
Noninstitutional Claim
> promote and maintain a standard data set for use of
noninstitutional claims and encounter information
Unified Medical Language System

24. IHE or integrating the healthcare enterprise
Is an initiative that provide detailed framework
for implementing standards and their
implementation.
It is increasingly recognize that combining the
strength of these initiatives and their approaches
tends to minimize their weaknesses and can lead
to significant gains for the healthcare sector as a
whole.

25. International Organization of standardization
(ISO) Is an organization that develops and
publishes standard internationally.
Integration of reference Terminology Model
for Nursing
>this standard includes the development of
reference terminology models for nursing
diagnosis and nursing actions and relevant
terminology and definitions for its
implementation.

26. American National Standard Institute
>ANSI serves as the coordinator for
voluntary standards activity in the U.S
American National Standard Institute
(OMG) is representative of different
approach to standard development.
is an international consortium of over 800
organizations, primarily for profit vendors
of information system technology, who are
interested in the development of standard
based on object oriented technologies.

28. Electronic Health Record Systems: U.S.
Federal Initiatives and Public/Private
Partnerships

30. Department of Veterans Affairs
 The Veterans Health Information Systems and Technology
Architecture support day to day clinical and administrative
operations at local VA healthcare facilities.
 This new interface named the Computerized Patient Record
System provided a single place for healthcare providers to
review and update a patient’s health record and order
medications, special procedures, x-rays, nursing orders, diets,
and laboratory tests.

31. Providers have had a computerized physician order entry
capability that enables them to order lab tests and radiology
examinations and issue prescriptions electronically for over 10
years.
 DoD Pharmacy Data Transaction Service links military
treatment facilities, mail order, and network pharmacies. This
service enables providers at all military and civilian pharmacies
to track daily medication transactions and to check for drug
allergies and drug interactions.

32. Indian Health Service
The IHS has long been a pioneer in using
computer technology to capture clinical and
public health data. Its Resource and Patient
Management Systems was developed in the
1970s, and many facilities have access to decades
of personal health information and epidemiologic
data on local populations.

33. The executive order of April 2004, mentioned
earlier, created the ONCHIT to coordinate HIT
efforts in the federal sector and to collaborate
with the private sector in driving HIT adoption
across the healthcare system.
Office of the National Coordinator for Health
Information Technology

34. The National Committee on Vital and Health
Statistics
Held a series of national hearings to develop a
consensus vision of National Health Information
Infrastructure (NHII). In the resulting report,
Information for Health, presented the concept of an
infrastructure that emphasizes heath-oriented
interactions and information-sharing among individuals
and institutions, rather than simply physical, technical,
and data systems that make those interaction possible.

35. Agency for Healthcare Research and Quality
AHRQ funded demonstration grants to establish and
implement interoperable health information systems
and data sharing to improve the quality, safety,
efficiency, and effectiveness of healthcare for patients
and populations on a specific state or regional level.

36. Centers for Medicare and Medicaid
Services
CMS has initiated several pilot projects
to promote health IT.
Public-Private Partnership
Focused on the use of EHR-Ss and HIT to
improve care. Among these private sector
organizations are those formed specifically
to address issues of connectivity, HIT, and
standards development.

37. Connecting for Health
A large private collaborative with federal
participants supported by the Markle and the
Robert Wood Johnson Foundations, Connecting for
Health is addressing the barriers to development of
an interconnected health information infrastructure.
It brings together several dozen of leading
healthcare provider and payer organizations, HIT
vendors, and representatives of federal and state
agencies.

38. Health Initiative
Is an independent, nonprofit affiliated organization
established to foster improvement in the quality,
safety, and efficiency of healthcare 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.

39. Institute of Medicine
Certification Commission for Health
Information Technology
As an independent advisor to the nation with the goal of
improving health, the IOM has championed the
advantages of use of IT to improve healthcare since 1991
foundational work. The IOM continues to illuminate the
importance for the use of IT in healthcare.
The Health Information and Management
Systems (HIMMS), American Health Information
Management Association (AHIMA), and National
Alliance for Health Information Technology
(NAHIT), have joined together to establish the
(CCHIT).
The goal of this group is to reduce risk of EHR
investment.

40. Health Level Seven
An international, non-for-profit, volunteer standards
organization known for its large body of work in the production
of technical specifications for the transfer of healthcare data.
 is considered essential by informaticists and technical staff.

41. DEPENDABLE SYSTEMS FOR QUALITY HEALTHCARE
INTRODUCTION
The healthcare is undergoing a dramatic
transformation from today’s inefficient, costly,
manually intensive, crisis driven model of care
delivery to a more efficient, consumer-centric,
science-based model that proactively focuses on
health management.

42. DEPENDABILITY COMPRISES THE FOLLOWING SIX
ATTRIBUTES:
1. System reliability: The system consistently behaves in the same
way.
2. Service availability: Required services are present and usable
when they are needed
6. Safety: The system does not cause harm.
5. Responsiveness: The system responds to user input within an
expected and acceptable time period
4. Data integrity: Data are not corrupted or destroyed.
3. Confidentiality: Sensitive information is disclosed only to those
authorized to see it.

43. GUIDELINES FOR DEPENDABLE SYSTEMS
All computer systems are
vulnerable to both human-
created threats, such as malicious
code attacks and software bugs,
and natural threats, such as
hardware aging and earthquakes.

44. GUIDELINE 1: ARCHITECT FOR
DEPENDABILITY
GUIDELINE 2: ANTICIPATE FAILURES
GUIDELINE 3: ANTICIPATE SUCCESS
GUIDLINE 5: DON’T BE ADVENTUROUS
GUIDELINE 4: HIRE METICULOUS MANAGERS

45. Clinical nursing visibility from national to
international contexts. The identification of the
NMDS visionary work begun in the united states in
1980s by Werly and Lang ( 1988), has indeed spurred
activity extending to national efforts to develop
similar data sets around the world. Moreover, these
national efforts have supported an initiative to
develop an international i-NMDS.

46. NMDS historical summary:
NMDS- is a standardized approach that
facilitates the abstraction of these
minimum, common, essential core data
elements to describe nursing practice
from both paper and electronic records.

47. Three broad categories of
elements of NMDS:
A) nursing care
B) patients or client
demographics
C) service elements
NURSING CARE ELEMENTS:
•Nursing diagnosis
•Nursing intervention
•Nursing outcome
•Intensity of nursing care

48. PATIENT OR CLIENT
DEMOGRAPHIC ELEMENTS:
•Personal identification
• Date of birth
• Sex
• Race and ethnicity
• Residence

49. EIGHT BENEFITS OF THE 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 related to patient or client
problems and nursing care provided.
•Impetus to improved costing of nursing services.
•Improve data for quality assurance evaluation.
• Impetus to further development and refinement of NISs.
•Comparative research on nursing diagnoses, nursing
interventions, nursing outcomes, intensity of nursing care,
and referral for further nursing services
•Contribution toward advancing nursing as a research-
based discipline.

50. Languages:
• ABC codes
• Clinical care classification (ccc) (formerly home
• Health care classification)
• International classification for nursing practice (ICNP)
• Logical observation identifiers names and codes (LOINC)
•NANDA- nursing diagnoses, definitions, and classification
• Nursing outcomes classification (NOC)
•Nursing interventions classification (NIC) system
• Omaha System
•Patient care data set ( PCDS)
•Perioperative nursing data set (PNDS)

51. DATA SETS:
•Nursing minimum data set (NMDS)
• Nursing management minimum data set
(NMMDS)
• The NMDS – serves as a key component of the
standards developed by the nursing information &
data set evaluation center(NIDSEC).
• NIDSEC develops and disseminates standards
related to nomenclature, clinical associations,
clinical data repositories, and system
characteristics/ decision support/ contextual
variables pertaining to data sets in information
systems that support the documentation of nursing
practice.

52. Environment:
 Unit/cost center identifier
 Type
Patient/client population
Volume
Accreditation
Organizational decision making power
Environmental complexity
Patient/client accessibility
NMDS AND DATA ELEMENTS:

53. Method of care delivery
 Clinical decision making complexity
 Nursing care:
 Management demographic profile
 Staffing
 Staff demographic profile staff
satisfaction
 Financial resources:
Payer type reimbursement
Budget
 Expense

54. NMDS relationship to international
nursing minimum data set (i-NMDS)
Evolution of concepts:
The i-NMDS includes core internationally relevant, essential,
minimum data elements to be collected in the course for
providing nursing care.
These data can provide information to describe, compare, and
examine nursing practice around the globe.
i-NMDS- is intended to build on the efforts already underway
in individual countries. It is imperative that the national health
care infrastructure supports the collection and reuse of nursing
data.