1. nursing informatics lecture

Lets Take The Relationships
Deeper, Simpler & sweeter This
time Around…

True or false

1- if both statements are true
2 – if statements are contradicting
3 – if both statements are false

1. - the binary symbol of number 6 is 110
- the binary system was influenced from von
Leibniz mechanical device.

2. - the Boolean Algebra is used for searching
bibliography
- the Boolean Algebra is used in searching for
database

3. - Hollentin machine is a descendant of the
Jacquard loom concept .
- Charles Babbage is the father of modern
calculator.

4. – Hollerith machine is the origin of the Y2K
- ENIAC is the exact replica of MARK 1

5. - the intuitive way for calculation is the Abacus
- the Antikythera is the most intuitive machine

6. - the Pascaline was influenced by von Liebniz
- the Pascaline was accepted and widely used
7. - the primary language of modern computer is
the Binary system.
- the logarithm inscription is currently used by
modern computer.
8. - the major characteristics of the ENIAC are its
movable parts.
- the first generation computers used vacuum
tubes.

9. - the vacuum tubes was smaller than the
transistor.
- the ENIAC help the US census to more faster

10. - Mark 1 is the 1st to used cathode ray tubes
- Abacus on stores the computation result step
by step.

Match Everything!!!
• Communicating & Interacting A. Arithometer
with Patients B. Abacus
• Slide Rule C. Punch cards
• Requires Extensive Training D. Boolean Algebra
• 1,000: 10 3 = 10x 10x10 E. “Human should be in parallel
• Weaving machine with machine”
• 1st Calculator F. Logarithms
• Equation Stating True or False G. 1820
• Charles Babbage H. ENIAC
• Charles Xavier Thomas I. William Oughtred
Colmar J. Computer Networking
• First Generation Computer K. Binary System

History of Nursing Informatics
1950 – UNIVAC 1 aka giant brains
1956 – transistor was used; smaller, energy efficient
1958 – Integrated Circuit (IC) by Jack Kilby
- predecessor of all micro chips
1960 – mouse was invented by Douglas Engelbert
- video conferencing, multiple window screen
1964 – 23 Generation Computer using Operating System
RD

1977 – Basic Programming Language
1980- Micro Soft Sytem by Bill Gates (16 bit)
1981 – IBM release first PC with MS DOS
- Color graphics were extra
- intel were first used
1984- Apple introduces Macintosh with 32 bit
- graphics and wide screen
1992 – Apple introduced the Personal Digital Assistant
2007 – first time PDA was in clinical area

the two 19 century women
th

• Lady Ada Lovelace – 1st computer programer
- aka Ada Byron
- met Charles Babbage the developer of
first computer
• Florence Nightingale – the founder of modern
nursing
- Birth: May 12, 1820; Florence
- Start: Crimean war; she develop a pie graph,
uses statistical analysis, and develop a form for
the hospitals in order to generate data and statistics
- considered the early informatics nurse

* both are mathematicians

1950s & 1960
• Prior to 1960
- image of the nurses improved
- nurses practice grew in scope and complexity
- Increase in number of professional nurses
- Growth in computer industry
- Computers first use in the health facility
a. office functions c. paper tape
b. punch cards d. teletypewriters

1950s & 1960
• 1960
- increase in number of health care facility
- nurse are started to be considered the
centre of communication activities &
information exchange
- Desktop terminals were developed called CRT
- Email was used 1965
- HIS mainly for;
a. Accounting b. basic business c. finance

1970

• HIS - integrated more into the hospital system
• MIS ( Mngt. Information System)
– statistical information
– billing
– insurance reimbursement
- chip was develop
- Microprocessors introduced (1971)

1980
• 1982: First international medical informatics Association
Working Conference (London, England)
• 1985: Another conference in Calgary, Canada
• 1985: MS release windows 1; as well as intel 386
• 1986: Informatics field introduced

• PC/ Micro Computer
• HIS CPRS( computer based patient record
system)
• Incorporated – Documentation
– Doctors Order - Lab results
– Kardex - Nurses Notes
– V/S or TPR
– Discharge Planning

1990 and beyond
• NI was approved by ANA (1992)
• Computer become smaller, faster, and easier
to use
• Internet become a tool for clinical application
• Knowledge if the focal point in nursing; as
knowledge workers nurses are:
a. Data gatherer d. knowledge builders
b. Information users
c. Knowledge users

Nursing Informatics the Philippines
nursing informatics..
• word were mostly unfamiliar with in the nursing
community up until 2007-2008.
• Not yet found & recognized as a sub-discipline
• Founded by pioneers: Philippine Medical
Informatics Society (PMIS)
• PIMA official registered in 1996 mainly
composed of 11 physicians
• 1st head: Dr. Alvin Marcelo

• 1998: several faculty of UO began formal
education & training
• Dr. Herman Tolentino took postdoctoral
fellowship in medical informatics @
University of Washington.
• Dr. Alvin Marcelo later trained @ National
Library of Medicine.

• Dr. Cito Maramba went to Coventry for
Masters in Information Science @
University of Warwick
• 2003: Proposed course in NI @ UP
• 2005-2006: College of Arts & Science
(major in bioinformatics) and Master of
Science in Health Informatics was offered.

• 1999: National Institute of Health –UP Manila
form a study group to identify the international
standards for health promotion and its
adaptability in the Philippines,
• “Standards of Health Information in the
Philippines, v. 1999” or “SHIP99”.
• PNA was included in the group by Ms.
Evelyn Protacio.

• despite that representation & inclusion in the
curriculum nurses in the Philippines still lag
behind our foreign counterparts.
• 2008: Nursing Informatics in the undergraduates
was defined by CMO#5 s.2008.
• 2009: revised & included as Health informatics in
the CMO#14 first implemented in 2010 summer

problem encountered
adaptation of an international materials which does
not suit the local needs which should be community-
centered using information, communication &
technology.
Lack of certification & credentialing programs in
post-graduates level

nursing informatics.. future
• due to the integration in the curriculum made an
increase in awareness & interest of NI.
• Development of training, certification and credentialing
are on the process by PNIA.
• Partnership with local & international NI organization
• CORE X strategic platform (Competency, Organization,
Recognition, Experience & Expertise )
*thrust: - support use of health information standards
- have a nursing informatics specialist inevery hospital

• persistent issues :
- inequities in access, cost, inefficiency
- maldistribution of health care providers, and public health systems
managers,
• Information and communications technologies (ICT) offer
- accessible,
- affordable
- standard tools in the health arena.
• Since 1998, the National Telehealth Center has championed its use in health
and development in the field now known as eHealth.
• Theme: Putting health in the hands of the people,
• Learning in four strategic areas;
a. assisting remote health professionals in their clinical decision making
(telemedicine),
b. developing relevant electronic health record systems intended for government
primary care centers where the poor seek care,
c. building capacities of health care and eHealth practitioners (eLearning and
trainings)
d. actively advocating for policies that promote the relevant and meaningful use of
ICT in health.

• National Telehealth Center (NTHC) conducted a “webinar”
• eRecords – national database
• eMedicine - tele-referrals between Doctors-to-the-barrios
and PGH using mobile phones and internet technologies.
• eLearning - systematic deployment of scarce trainers where
there is a greater need while providing access to up-to-date
knowledge.
• eHealth Training for Educators of the Health
Profession was held the National Telehealth Center,
UP Manila.
• Philippine Undergraduate Research on eHealth
(PUReHealth) Awards Student Orientation


eRecords
• Data not managed is useless.
• Improve efficiency of health records collection through electronic
systems for organizing health data.
eReordssystem
• developed by NThC is
CHITS
• a free and open source (FOSS) software designed specifically for local
government health centers
• collects existing routine health data in the Field Health Services
Information System (FHSIS) of the Department of Health
• Integrates them into a unified computerized system.
Community Health Information Tracking System

Nursing Informatics
more future..world spectrum
a. Quantity of electronic resources will multiply, as mobile device increasing
power
b. Variety of devices will increase to meet the diverse needs of the practice
c. Clinical decision support software will become increasingly sophisticated
d. Smart cards that authenticate the user’s identity
e. Increasingly life like simulation & virtual reality for educating nursing
staff & students
f. Development in sophisticated distance patient visits (convenient home
visits follow up)
g. Bioinformatics will continue to unravel information related to genetics to
formulate gene therapy
h. Speech recognition will enable providers to dictate system for accurate
documentation.
i. More online health services

QUIZ COVERAGE

1-20. FROM SIR CANDOG
21- 60 . THESE WEEK’S DISCUSSIONS

4 Domain Applications
1. Nursing Practice Domain Application
- Electronic Health Record uses such as;
a. computer generated nursing care plan
b. clinical decision making alerts
c. electronic monitoring devices
d. patient specific discharge instructions
e. online evidenced based nursing
resources

2. Nursing Administration Domain Application
-reporting statistical data
- planning resources
- budgeting
- documentation such as;
a. workload measurement system
b. online policy, manual and procedure
c. staff scheduling systems
d. internal email
e. cost analysis
f. patient tracking system

3. Nursing Education Domain Application
- computer revolutionized education process
- online courses/distant education
- home study/university without walls
- services such as;
a. online registration, scheduling,
attendance, grade management
b. computer based tutorials
c. remote library access
d. webcasting
e. simulation labs


4. Nursing Research Domain Application
- analyze nurses data (stats and trends)
- this includes;
a. computerized literature
b. software that process quantitative &
qualitative
c. reference and other related studies

Standards Initiative
1. Nursing practice standard
2. Nursing Data standard
3. Health Care Data Standards Organization

type of HIS
a. early HIS
b. early ambulatory care information system
c. early computer
d. early educational application

Electronic Health Record
• Patient safety - Computerized Provider Order Entry (CPOE) allows
physician to enter orders or findings directly to the computer.
With most includes ;
-electronic medication administration record preventing errors in
medication administration.
-bar coding vs clients ID band
- associated with written orders
1. illegibility
2. inaccurate abbreviations
- Clinical decision support software provides;
1. dose calculations
2. warns the prescriber of any patients allergy, drug to drug
interaction
3. drug contra indication
4. considers relevant lab result

Electronic Health Record
1974 – Marc Lalonde indicated that;
“there is a lack of a uniform and integrated
system for maintaining health records of
individuals because essential data were
scattered in many location”
2002 – Roy Romanow “to take full advantage of the
potential of information, evidence and ideas in
the health care system, thus infrastructure must
be in place, in support it recommended the
HER”

…to the future
a. Quantity of electronic resources will multiply significantly due to
mobile devices
b. Devices will increase to meet the four domains of nursing
c. Support software will become increasingly sophisticated like;
- Recognizing when patient assessment falls outside the normal ranges,
prompting communication to the physician.
d. Smart card- authenticate users identity allowing access to
computers.
e. Use of virtual reality for educating students
f. Telecommunication – TELEHEALTH
g. Bioinformatics – gene functions or gene therapies
h. Speech recognition – saves time
i. Online health care services – information for self management

EHR & EMR

• primarily on storage of patients record electronically
• Downside: medico-legal issues exposure by practitioners
such as violation of right to privacy
• From paper based to electronic version of patient record
• Issues:
• 1. Who is responsible for Management of data
• 2. What are patients rights and expectations
• 3. How to obtain consent without physician
• 4. How to make it inaccessible to unauthorized people
• 5. Are the information reliable
• 6. What are the medical liability issue arising from this

EHR vs EMR

• HER is a secure and private lifetime record of an individual’s health and
care history, available electronically to authorized health care providers
• Distinctions:
- EMR refers to an electronic version of the paper record that doctors have long
maintained;
- EMR holds all medical information gained from individual physician’s care;
- EMR has depth
- EHR is a compilation of core data from multiple sources and it may be
comprised of many different e-records submitted by different providers in
different jurisdictions;
- EHR has breathed because it contains all record from EMR
- EHR does not necessarily contain all the information from EMR

• accountability, privacy, security, confidentiality, accountability, liability

Davies Award of Excellence
• Named after Dr. Nicholas E. Davies; advocated for the
development of patient record
• Its is as award program that bring to national attention
excellence in the implementation of computerized
medical records
• Philosophy: health care organization benefit when
collective experiences and lessons are shared.
• Criteria
1. Organizational/Acute Care
2. Ambulatory Care
3. Public Health care

iNfoRmATicS

• French word “informatique”; the computer
milieu
• 1970-1980 : nursing informatics broadly
defined as the use of computer technology to
support all aspects of nursing practice
• 1996: Turley introduced the Nursing
informatics model

150 & 100 BC – Antikythera mechanism
3000 – 500 BC – Abacus (Greeks,Romans, Chinese,
aztecs)
3 - Slide rule by William Oughtred
1642- Pascaline by Blais Pascal
1694- Binary System by Gottfried Wilhem von Leibniz
(computer language)
1804 – Weaving Machine by Joseph Marie Jacquard
using punch cards.
1820 – Arithometer by Charles Xavier Thomas de Colmar
(first real calculator)

1822-1871 – Difference engine; analytical engine;
connected relationship between mathematics &
machines
1854 – Boolean Algebra or Arithmetic; that any equation
can be stated as either true or false
1889- Punch Cards by Herman Hollerith; used first for US
census (from 7 years to 6 mos.)
-IBM was founded
1931- Bush Differential Calculator
1944- Mark I by Howard H. Aiken ( a 150 feet long with
500 miles of wiring)

1946 –First Generation Computers (1st electronic
computers)
ENIAC (Electronic Numerical Integrator & Computer)
-18,000 vacuum tubes, 70,000 computer resistor and 5
million soldered joints
- 1,000 more faster
-world first complete computer
1947 – Transistors by William Shockely, John Bardeen,
Walter Brattain
- smaller that vacuum tube
- started the 2nd generation computer

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