The document discusses the US government's efforts to promote the adoption of electronic health records (EHRs) in the 2000s. It notes that in 2004, the president issued an order calling for most Americans to have EHRs within 10 years. It then outlines initiatives by various federal agencies like the VA, DOD, IHS to implement EHR systems. It also discusses public-private partnerships and grants provided by agencies like AHRQ and CMS to support EHR adoption and health information exchange, especially in small and rural settings.

2. 
APRIL 2004
president of the us issued an executive order that called for action to put
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electronic health record system (EHRS) in place for most Americans in 10 years.
this order give momentum to effort across the health care community to
use health information technology (HIT) to improve health care .
Institute of Medicine (IOM)
has been calling for the use of technology (IT) to
improve the efficiency safety and quality of the health care Americans receive in a
series of ground breaking reports.
modified this definition in its report, key capabilities of an (EHR-S) 2003.
Electronic Health Record System (EHR-S)
 reiterating the new definition in a report on patient safety.
used interchangeable with computerized pt. record, clinical information
system electronic medical record.
reflects the breeder focus on the health of the consumer or pt. and
indicates that the EHR-S may be used by all participants in the process of achieving
health, including all disciplines of clinicians family caregivers and the pt.
International Organization for Standardization (IOS)
 had drafted its standard for EHR definition scoop and context ISO 20514
the final version was expected in 2005 or 2006.
Federal Initiative
 within the federal government, different exerts different influences
toward the common goal of an EHR for American agencies providing direct health care
offer evidence.
other agencies provide leadership by offering military incentives
founding research development and demonstration project and shaping regulations and
policy.
Government as provider early adopter
 their are two examples of national institute of health (NIH) and
department of health and human services (HHS).

3. 
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Department of Defense (DOD) and the Indian Health Services (IHS) in the
Department of HHS
both acquired the VA’s original clinical information system years ago
customizing it to meet their clinical and business needs.
Department of Veterans Affair
in 2004 VA began implementing health the veteran as an internet tool for
personal health management.
voluntary interact w/ subsets of their vist a health record and ultimately
manage their own personal health record (PHR)
Veterans Health Information System and Technology Architecture (Vist A)
supports day to day clinical and administrative operations at local VA
facilities health care
1990
graphics use interface was added to bundle all existing function from Vist A
Computerize Patient Record System (CPRS)
provided a single place for healthcare providers to review and update the pt
health records and order medications special procedures, x-ray, nursing order, dicks and
laboratory result
supports 158 hospitals and 854 clinics in processing 865,000 orders over half
a million progress notes and 585,000 medication administered via VA’s bar code
medication administered per day.
Department of Defense (DOD)
providers have had a computerized physician order entry capability that
enables them to order laboratory test and radiology examination and issue prescription
electronically for over 10 years.
January 2004
DOD began a world wide rollout of the next generation system the composite
healthcare system II (CHCS II) a secure scalable, pt centric EHRs II.

4. 
May 2004
CHCS II had more than 1.3 million pt encounters recorded in and
available from its data base.
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Indian Health Service (IHS)
has long been a pioneer in using computer technology to capture clinical
and public health data.
Resource and Patient Management System (RPMS)
develop in the 1970’s,and many facilities have aces to decodes for
personal health information and epidemiological data on local populations.
Patient Care Component (PcE)place since the early 1980’s.
Government as leader
Federal agenciesdo not provide direct care are taking multiple approaches to promote use
of EHR-S.
decreasing the cost and risk of acquisition and providing incentives for
their use.
target the sharing of electronic data across and among system to provide a
pt centric view of data across organize boundaries.
Federal Activities
focused on the development and adoption of terminologies and standards,
grants for community demonstration of data exchange and other pilot project.
Government
 focusing in the development of a public-private national health information
network to facilitate EHR-S development.
Office of the National Coordinator for Information Technology
 position to bring together public and private entities for accelerating
solutions to known problem.

5. 
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April 2004
mentioned earlier in the chapter, created the ONCHIT to coordinate HIT efforts in
the federal sector and to collaborate of the private sector in driving HIT adoption across the
healthcare system.
David Brailer , MD, PhD
was name to fill the subcabinet-level post.
HHS Secretary Tommy Thompson and Dr. Brailer
in July 2004,release a framework for strategic actions
Office of the national coordination
positioned to bring together public and private entities for accelerating solutions to
known problems.
National health information network
 the technical infrastructure enabling national interoperability.
Regional health information organizations
 now being propose at the community, regional, or state level, as mentioned in the
discussion of the agencies for healthcare research and quality (AHR-Q).
National committee on vital and health statistics.
2000 and 2001
 advises 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)
Information for health and NNHS
 in 2002 presented the concept of an infrastructure that emphasizes health oriented
interactions and information sharing among individuals and institutions, rather than simply the
physical technical and data system that make those interaction possible.
NCHII
 including the values, practices, relationship, laws, standards, system, applications.
also encompasses tools such as clinical practice guidelines, educational recourses for
the public and professionals, geographic information system permitting regional's analysis and
comparisons, health statistics at all levels of government

6. 
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NCHVS and PHR’s
core component of the NHII, enhancing the ability of each individual to
control his/her health data and the aces by the health care providers to those data.
EHR’s and PHR’s
both enable by the NHII in the senses that their optimal lye and
effectiveness requires the comprehensive infrastructure and enabler of the NHII.
Agency for healthcare research and qualityin 2003-2004, AHRQ unveiled a major HIT portfolio w/ grants, contracts,
and other activities to demonstrate the role of HIT improving pt safety and the quality
of care.
-$ 14 million was targeted for small and rural hospitals and communities.
Return on investment (ROI)
derive for the adoption, diffusion and use of HIT totaled approximately $
10 million.
Objective
of these project was to provide health care facilities and providers w/ the
information they need to make inform clinical and purchasing decisions about using
HIT.
AHRQ
awarded the IHS $ 2 million in fiscal year 2004 toward the enhancement of
the IHS, HER.
entities must be determine core health care entities for data exchange and
exchange 25 % of this core care data in the 1st years, 50% in the 2nd, and 100% in the
3rd.
funded demonstration grants to establish and implement interoperable
health information system and data sharing to improve quality safety, efficiency on
populations on a specific state or regional level.
contracted over $ 18 million for a health IT resource center to provide
technical assistance, serve as repository for best practices.
2004
also funded five contracts of about $ 1 million/year for five years each for
state and regional demonstrations of health IT.

8. 
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Five entities
1. Colorado
2. Indiana
3. Rhode island
4. Tennessee
5. Utah
State and regional grantees
must involve variety of health care setting, including major purchasers of
health care; significant payers, both public and private, and providers, including
hospital, ambulatory care facilities, home healthcare, and long term care providers
Center for Medicare and Medical Services
 initiated several pilot project to promote health IT.
May 2004
 awarded a $100,000 grant to the American academy of family physician
(AAFP) for a pilot project to provide comprehensive, standardized EHR software to small
and medium size ambulatory care practices
AAFP
 to learn more about what factors facilitate or hinder smooth adoption of
the technology.
Several large pilot program
 authorize in the 2003 Medicare modernization act (MMA).
Care Management Performance Demonstrations Program
 3 years, Is intended to promote continuity of care, help stabilize medical
condition, prevent or minimize acute exacerbation of chronic condition and reduce
adverse health outcomes, such as adverse drug interactions.
MMA
develop a national standard for electronic rx, 80 that provider can share
information on what medications a pt is taking and to be alerted for possible adverse
drug interactions.

9. 
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Federal Government
authorized to give grants to doctors to help them buy computer software,
and training to get ready for electronic prescribing.
End of 2004
 CMS lunched the chronic care improvement program (CCIP)
AIM
 to help beneficiaries manage their health adhere to the plans of care given
by their physician, and assure that they seck or obtain medical care that they need to
reduce their health risks.
Public-private partnership a no. of collaborative efforts are focused on the use of HER-Ss and HIT to
improve care.
Private sector Program
 formed specifically to address issue of connectivity, HIT and standards
development.
Connecting for Health
 supported by the Markel and the Robert wood Johnson
 addressing the barriers to development of an interconnected health
information infrastructure.
1st phase
 drove consensus on the adoption of an initial set of data standards develop
case studies on privacy and security and helped define the electronic PHR
July 2004
 release an incremental “roadmap” that laid out near term action necessary
to achieving electronic connectivity.
eHealth initiative
 independent, nonprofit affiliated organization established to poster
improvement in the quality, safety and efficiency of healthcare through information and
IT
membership brings together hospital and other providers, practicing clinicians,
community organizations, payers, employers, community-based organizations.

10. 
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Major program connecting communities for better health
nearly $ 4 million program that provide seed funding and technical
support to multi stake holder collaborative w/in communities (both geographic and
non geographic) that are using electronic health information exchange and other
HIT tools.
Institute of Medicine (IOM)
 has championed the advantages of use of it to improve healthcare
since its 1991 foundational work.
Computer- Based Patient Record
 was devise and republished in 1997 (Dick, Steen, and Detmer, 1991,
1997).
IOM
 continues to eliminate the importance for the use of IT in healthcare.
Summer 2003
 at request of IHHS
Certification Commission for Health It
Goal
 this group is to support goal 1, strategy 2, “reduce risk of EHR
investment”.
Health Level Seven
 is known for its large body of work in the production of technical
specifications for the transfer of health care data.
 continues to have technical specifications for message as the primary
body of its work product but is changing to address.
 the trial period did not result in subsequent ballot’s, the draft status
would be expire at the end of 2 years period of 2004-2006.
3 categories
1. Direct Care Functions
 familiar to clinicians; these function are needed to support direct care
delivery.

11. 2. Supportive Functions
secondary use of the data captured via the direct care function; these
function support enhanced functions for direct care.
3. information Infrastructure
 “back end” of the system unfamiliar clinicians.
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Use Profile
 develop by clinicians to provide care to their pt population.
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Product Profile
 customized to describe a vendor product.

15. References
o
Committee on Data Standards for Patient Safety.(2003).
Key Capabilities of an Electronic Health Record
System: Letter Report. Washington D.C: National
Academies Pess
o
Health Information and Management Society
(HIMSS).(2004,September 1). Certification
Commission for Healthcare Information Technology
Names Inaugural State of Commissioners. Retrieved
October 8,2004,from http.//himss.org/asp/Content
Redirector.asp?contentid=547=97
o
Health Information and Management System Society
(HIMSS).(2003).Position Statement: National Health
Information Infrastructure. Retrieved June 21,2004,
from www.himss.org/content/files/NHII_Fact_Sheet .pdf
o
International Standard Organization, Technical Standard
(ISO/TS) 18308.(2004).Requirements for an
Electronic Health Record Reference Architecture.
Retrieved October 7,2004, from www.iso.org/iso/en/CatalogueDetailPage
o
National Committee on Vital and Health Statistics
(NCVHS).(2002).Information for Health: A Strategy
for building the National Health Information
Infrastructure. Report and Recommendations
Washington,DC:US. Department of Health and
Human Services www.ncvhs.hhs.gov/nhiilayo.pdf

16. Chapter
15
Dependable
Systems for
Quality Care

17. 
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Health Care Industry
is under going a dramatic transformation from today's inefficient, costly,
manually intensive, crisis driven model of care delivery to a more efficient, consumercentric, science based model that proactively focuses on health management.
Electronic Health Record (EHR)
form the function for pervasive, personalize, and science based care.
Clinical Information System (CIS)
integrated, outcomes- based decision support, clinical knowledge bases.
Computerized physician order entry (CPOE).
Enterprise Applications Integration (EAI)
wireless communication; handled tablet computer; continues speech
recognition.
Internet Council of Nurses (ICN)
code of ethics for nurses affirms that the nurse “holds” in confidence
personal information and “ensures that use of technology”..compatible with the safety
dignity and right of people.
Six attributes
1. System Reliability
the system consistently behaves in the same day.
2. Service Availability
required services are present usable.
3. Confidentiality
sensitive information is disclose only to those authorized to see it.
4. Data Integrity
data are not corrupted or destroyed.
5. Responsiveness
the system respond to user input within an expected and acceptable time
period.
6. Safety
the system does not cause harm.

18. 
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March 2013 Kaiser Permanente
learned how the lack of dependability can affect its business.
 force to contact 4,700 people to verify their orders.
one month after the Kaiser incident, a new laboratory computer system at
the los Angeles medical center overloaded, forcing the emergency room to turn away
the ambulances when the day appeared at the door.
August 2003
blaster and so beg worm attacks invaded hospital around the world.
Glascow and Scotland
10,000 computer use by city hospital and emergency services were
infected, and system at one hospital were down for 15 hours.
1/3 of the computer at Baylor college of medicine.
exceed $100 K and 25 days productivity were lost campus wide due to
system outages.
Guidelines for dependable system
all computer system are vulnerable to both human created threats, such as
malicious code attacks and software bugs, natural threats, such as hardware aging and
earthquakes.
Guidelines 1: architect for dependability
a fundamental principle of system architecture is that an enterprise system
architecture should be develop from the bottom up so that no critical component is
dependent on a component less trustworthy than itself.
one or more computer are connected to this network, and the software
foundation of each computer is an operating system, that is responsible for managing
all of the resources in the computer system.
Single point dependencies
should be avoided or eliminated.
No Single dependencies
should be capable of bringing the system town should that component fail.

19. 6
5
4
Series 1
3
Series 2
Series 3
2
1
0
Category 1
Category 2
Category 3
Category 4

20. Guidelines 2: anticipate failures
- anticipate failure they will happen.
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Guidelines 3: anticipate success
-anticipate business success- and the consequential need for larger networks more
system, new applications and additional integration.

Guidelines 4: hire meticulous managers
managing and keeping complex networks and integrated system available and responsive
requires meticulous overseers- individuals who knows that failures occur and accept that failures are
most likely to occur when they are less expected.
-they take emergency and disaster planning very seriously; they develop maintain; and judiciously
experience plans and procedures for managing emergencies and recovering from disaster.

Guidelines 5: don’t be adventurous
the products brochure urges the consumer to be adventurous and states that the company
guaranties satisfaction or the purchasers money will be carefully refunded.
dependability, one should use only at a scale similar to the intended environments.
proven methods, tools, technologies, and product that have been in production under
conditions and at a scale similar to the intended environments..
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Assessing the healthcare industry
healthcare clearly has a need for dependable system- both now and after the
transformation, as the industry becomes increasingly dependent on IT in the delivery of the pt care.
assessment is by no means “scientific” nor is it intended to represent “all” healthcare
provider organizations.

Healthcare architectures
the Healthcare professionals select the users interfaces they like, and the IT team
negotiates terms with the vendors who offer the system that generate those interfaces.
Healthcare insurance portability and accountability act (HIPAA)

security regulation prescribe administrative, physical and technical safeguard for
protecting the confidentiality and integrity of health information and the availability of critical system
services.


21. Guideline
Grade Comments
Architect for
Dependability
D
Builds system top down instead of
bottom up . Too complex
Expect Failures
D
Assumes systems will work
Expect success
C
Assumes systems and network are
infinitely expandable and
adaptable, but does not plan for
systems expansions and
consolidations
Hire Meticulous
Managers
C
Sometimes, but doesn’t give them
adequate support.
Don’t Be
Adventurous
C
Yes and no.

22. 
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8 required administrative safeguard
1. security management,. Including security analysis and risk
management.
2. assigned security responsibility.
3. information access management, including the isolation of clearing
house functions from other clinical functions.
4. security awareness and training.
5. security incident procedures, including response and reporting.
6. contingency planning, including data back up planning, disaster
recovery planning for emergency mode operations.
7.evoluation
8. business associate contracts that lock in the obligations of business
partners in protecting health information to which they may have access.
Five specified physical safeguard
1. access control, including unique users identification and an emergency access
procedures.
2. audit control
3. data integrity protection
4. person or entity authentication
5. transmission security
HIPAA
 “information system activity review” important safeguard to
counterbalance the necessary of authorizing many people access to pt record.
Anticipating failures
2nd guidelines “expect failure” the clinical care provider community gets
another grade of “D”.

23. 
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Personal data assistants (PDAs)
have a higher likelihood of failure than application hosted on server
machines that are physically protected, manage by trained system administrator and
continuously monitored.
PCs
 connect to the enterprise network from outside, laptops with wireless
modems, smart phones and PDAs that synchronized with enterprise system.
Computers
increasingly being used in safety critical clinical application, and without
careful and appropriate attention to software safety, we can reasonably expect that
failures will contribute to the loss of human life.
Between June 1985 and January 1987
therac 25 massively overdose six people, resulting in deaths and serious
injuries.
Therac-25 incident
FDA has improve its reporting system and augmented its procedure and
guidelines to include software.
FDA
requires failure modes of effect analysis for product with software
components, which helps detect errors in software controlled, medical devices that
requires FDA approval.
CIS
product companies incorporate software safety design and assurance method
in their development environment.
Anticipating success
3rd guideline “expect success” the clinical care provider community has
earned a Medicare grade of “C”
Healthcare organization
definitely expect their software applications, computer system, and networks
to work.
 do not foresee that their business success may increase their need for
processing power and networking capability.

24. 
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Boston care group
instance discussed earlier offers a good e.g. of a hospital that did not
anticipate its own success and the resultant needs for its network to grow.
1996, Beth Israel hospital
implemented a state of the art network .
November 2002
 highly successful care group was running is critical clinical applications on a
vintage 1996.
Spanning tree protocol
A switched network uses something. To figure out the shortest route to send
network traffic to its destination.
Management
fourth guideline “expect success” the clinical care provider community has
been assigned a Medicare grade of “C”.
 who recognize the strong relationship between system dependability and the
quality and safety of pt. care implement fault-tolerant system with strong security
protection.
Health care organizations
view IT as a “support function” and costly business expanse, frequently select
IT manages who may understand the healthcare business.
IT environment
tend to be loose composites of proprietary.
Past decade
healthcare has invested only 2% 5 its revenues in IT. Compared to 10% for
other information-intensive intensive industries.

25. 
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$8000
$1000
per worker per year for technology.
per worker for healthcare.
Adventurous technologies in healthcare
Fifth and final guideline “don’t be
adventurous” is the most difficult to assess for
healthcare.
HIMSS 2004 technology leadership survey
found that 72% of the surveyed
healthcare organizations had wireless networks.
Wireless networking and hand
held comp. clearly- central to the
ability to provide pervasive care in the future.
Wireless technology
express and product vendors are
working diligently toward comprehensive security
solutions, but such solutions have not yet arrived.

26. References
o
Department of Health and Human Services(DHHS).
(2003).Health insurance reform; Security standards,
Final rule.45 CFR parts 160, 162. and 164 Federal
Register
o
o
o
o
.
Health Information Management System Society
(HIMSS).(2004).15th Annual HIMSS Leadership
Survey . sponsored by Superior Consultant Company,
Inc. Final report: Healthcare CIO
International Council of Nurses(ICN).(2000).The ICN
Code of ethics for nurses . Geneva, Switzerland.
Retrieved July 9, 2004, from http://www.icn.ch/icncode.pdf
PDA cortex.(2004).Mobile Computing in Nursing Study.
Retrieved July 9, 2004 , from
http://www.rnpalm.com/Mobile_Computing_Nursing_Study.htm
President Bush Touts Benefits of Health Care Information
Technology.(2005).Washington, DC: The White
House. Available at http.//www.whitehouse.gov/news/releases/2004/04/20040427-5.html

27. Chapter
16
Nursing
Minimum Data
Set System

28. 
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Clinical Nursing Visibility from National to International Context
provide a synthesis of historical currents and future NMDS system which can
increase nursing data and information capacity to drive knowledge building for the
discipline and professions and contributes to the standards supportive of the HER
NMDS
identifies essential, common and core data elements to be collected for all
pt/clients receiving nursing care.
 conceptualize through a small group work at the nursing information system
(NIS) conference held in 1977 at the university of Illinois college of nursing.
64 conference.
Werley and Categories
took the NMDS for ward at the NMDS conference in 1985.
3 Board Categories of Elements
A. nursing care.
B. pt or client demographics
C. service elements
AIM
 not to be redundant of other data sets, but rather to identify what are the
minimal data needed to be collected from records of pt receiving nursing care.
8 benefits of the NMDS.
1. access to comparable, minimum nursing care, and resources data on local, regional,
national and internal levels.
2. enhance documentation of nursing care provider.
3. identification of trends related to pt/client problem and nursing care provided.
4. impetus to improved costing of nursing services.
5. improve data for quality assurance evaluation.
6. impetus to further development and refinement of NISs

29. 
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7. comparative research on nursing care, including research on nursing diagnosis,
nursing intervention, nursing outcomes, intensity of nursing care and referral for
further nursing services.
8. contribution toward advancing nursing as a research based discipline
NMDS
 influence the work of the professional nurses association.
1991
 American nurses association (ANA) recognize the NMDS as the minimum
data elements to be included in any data set or pt record.
ANA
 establish the American nurses association steering committee on data bases
to support clinical nursing practice.
 launched a recognition process for standardized nursing vocabularies needed
to capture the NMDS data elements for nursing diagnosis, interventions and outcomes
in a pt record.
 II languages have been recognize by ANA.
NMDS
 serves as a key component of the standards develop by the nursing
information and data set evaluation center (NIDSEC)
 has supported nurse’s participation in developing computerized health
information system (HISs), utilization of data and information to support evidence
based.
 work in the U.S.
American association of colleges of nursing (AACN)
 white paper in the clinical nurse leaders is one example of the recognition of
the essential core function of the informatics expertise w/in practice.
seven countries have identified

30. 
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NMDS system
1. Australia
2. Canada
3. Belgium
4. Iceland
5. Netherlands
6. Switzerland
7. Thailand
Emergent NMDS
North America
 exploring development of NMDS system.
Europe
 WHO has been concerned with variables including nursing
care, personal data, medical diagnosis and service data.
U.K
 work is ongoing.
Scotland
 identify NMDS to be congruent with the initiatives of the
national health service.
Nordic countries
 ongoing activity to identify NMDS.
France
 pursuing identification of a NMDS.
Brazil
 leading efforts in south America to identify a NTADS.
Korea and Japan
 focusing in the development effort as well.
New Zealand
 focus effort on a diabetes specific data set to date.

31. 
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Call for standardize contextual data
 Ample studies have demonstrated the significance of nurse staffing, pt/
stafrations, professional autonomy and control organizational characteristic, unit
internal environment, staff work satisfaction, education of staff, multidisciplinary
coordination collaboration and educational level on the quality of outcomes of pt care.
e.g. Belgium calls for data related to # of beds and # of nurses available.
18 NMMDS elements are organized into 3 categories.
1. environment
2. nursing care resources
3. financial resources
NMMDS
 minimum set of items of information with uniform definitions and categories
conserving the specific dimension of the context of pt/client care delivery.
 focuses on the nursing delivery unit/service/center of excellence level across
these setting.
NMDSs relationship to international nursing minimum data set (i-NMDS)
Evaluation of concept.
i-NMDS
 core, internationally relevant, essential minimum data element to be
collected in the course for providing nursing care.
Encouraged to establish triads composed of.
A. Representative (s) of the national nurses association (preferably
international council of nurses [CN]member.
B. International medical informatics association nursing informatics special
interest group (IMIA NI-SIG) representative.
C. Informatics expert

32. 
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•
•
•
•
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Project teams
 provide coordination and communication of project work in each country.
i-NMDS project
 in intended to build on and support data set work already underway in
individual countries, as well as the work w/ another ICN initiative, the ICPN.
i-NMDS project focuses
 coordinating on going international data collection and analysis of the iNMDS to support the description, study, and improvement of nursing practice.
Cosponsor ship
i-NMDS research center
 lead by a sheering committee of international representatives of countries
w/ existing and emerging NMDS’s as well as professional Cosponsor ship.
Project
 Cosponsor ship by the ICN and the IMIANI-SIG.
Project work
 also coordinated w/ international standards organizations and other slake
holders to assure harmonization of these efforts.
purposes
i-NMDS as a key dataset will support
describing the human phenomena, nursing intervention, care outcomes, and resource
consumption related to nursing services.
Improving the performance of health care system and the nurses working within these
system world wide.
Addressing the nursing shortage, inadequate working conditions, poor distribution and
inappropriate utilization of nursing personnel, and the challenges as well as
opportunities of global technology, innovation.
Testing evidence based practice improvements.
Empowering the public internationally.

33. 
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Data elements
i-NMDS elements organized into 3 categories
1. Setting
 country characteristic as well as description of the
location of care, whether
 Acute, ambulatory, home and so on.
2.Subjects
 individuals, families, groups or communities.
Nursing Care Data
 collected using standardized languages.
3.Nursing Care Elements
 nursing diagnose/subject of care problem;
interventions, and outcomes.
Issues
 continuing attention needs to focused on consistency
w/ the i-NMDSs across all countries.
Future Directions
 the power of NMDSs to describe nursing from an
international perspective is daunting.
Information and Knowledge
 key to supporting an essential knowledge driven
professional service and improving healthcare through effective
policy changes.

34. References
Aiken , L.H., Clarke, S. P., Cheung, R. B., Sloane, D. M.,
And Silber, J.H. (2002). Hospital nurse staffing and
Patient mortality, nurse burnour and job dissatisfaction.
Journal of the American Medical Association
288(16):1987-1993.
o
Delaney, C., Goosen, W., Park, H., Junger, A., Oyri,, K.,
Saba , V., and Coenen , A . (2003)., Seeking international
consensus on elements of the international nursing
minimum data set (iNMDS)[abstract].In H.Marin,
E.Marquez., E.Hovenga, and W.Goosen (eds).,
Proceedings of the 8th International congress in
Nursing Informatics(pp.74-75)
o

35. •Chapter 17
Theories, Mod
els, and
Framework

36. 
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Foundational documents guide nursing informatics practice.
2001
 ANA published the code of ethics for nurses w/ interpretative statements, a
complete revision of previous ethics provisions and interpretive statements that guide
all nurses in practice, be it in the domains of direct pt care, educ, adm. Or research.
Terms
 decision making, disclosure, outcomes, privacy, confidentiality, disclosure,
policies, protocols, evaluation, judgment, standards, and factual documentation about
through out the explanatory language of the interpretative statements.
2003
 2nd foundational professionals document, nursing social policy statements
second edition, provide a new definition of nursing.
Nursing
 is the protection, promotion and optimization of health and abilities,
prevention of illness and injury, alleviation of suffering through the diagnosis and tx of
human response, advocacy in the care of individuals, families, communities, and
populations.
Early 2004
 further reinforces the recognition of nursing as a cognitive profession.
st Assessment
1
 data collection begins the nursing process.
nd step diagnosis/problem definition
2
 reflects the interpretation of the data and information gathered during
assessment.
3rd step
 out comes identification
th step
4
 planning
th step
5
 implementation

37. 
Nursing process
 literature, includes numerous feedback ropes and incorporates evaluation activities
throughout the sequencing.
Informatics and health care information.

Informatics
 science that combines a domain science comp. science information
science,
and cognitive science.

Healthcare informatics
 defined as the integration of health care science, comp
science, information science, and cognitive science to assist in the management of the
healthcare information.
 sub discipline of informatics.
 relatively young addition to the informatics umbrella, you may see other
terms that seem to be synonyms for this same area, such as health informatics or
medical informatics.

Medical informatics
 used in Europe.
 more clearly a sub domain of healthcare informatics and health
informatics may mean informatics used in educating healthcare clients and/or the
general public.
 evolves so will the clarity in definition of terms and scoop[s of practice.
 addresses the study and management healthcare information.

Nursing informatics
 unique areas that address the special information needs for the discipline
of nursing.

1985 (Kathryn Hanna)
 proposed a definition that nursing informatics is the use of information
technologies in relation to any nursing function and action of nurses.

graves and Corcoran
 presented a more complex definitions of nursing informatics.
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38. 
ANA
 defined nursing informatics as the specially that integrates nursing science

comp. Science and information science in identifying, collecting, processing, and
managing data and information to support nursing practice, adm, education, research
and the expansion of nursing knowledge.
2000
 ANA convened 90 expert panel to review and revise the scope and standards of

nursing informatics practice.
Staggers and Thomson's 2002 JAMIA ARTICLE
“the evolution of definitions for nursing: a critical analysis and revised

definitions”
Nursing informatics as a specially
 Early 1992
 established nursing informatics as a distinct specially in nursing with a
distinct body of knowledge.
 American nurses credentialing center(ANCC)
 establish a certification examination and process in 1995 to recognize those
nurses with basic informatics specially competencies.
 Model for nursing informatics
 Models
 representations of some aspect of real world.
 Direct depiction of their definition of nursing informatics.
 provides a framework for identifying significant information needs which in
turn can foster research.

39.  Four elements

1.Raw mat.(nursing related information)
2.technology( a computing system)
3.users(nurses, students and context)
4. Goal or object toward which the preceding elements are directed.
 Bidirectional arrows
 connect the three base components system to form the pyramids
triangular base.
 1996
 proposed another model in which the core components of
informatics are depicted as intersecting circles.
 Nursing science
 larger circle that completely encompasses the intersection between
circles.
 Data information and knowledge
 Current met structures or overarching concepts for nursing
informatics with specific definitions in the” scope and standards of nursing
informatics practice”.
ANCC
 expert panel has oversight responsibility for the content of this
examination and considers the current informatics environment and research
when defining the test content outline.

40. 
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System life cycle
 system planning, analysis, design, implementation and testing,
evaluation, maintenance, and support.
Information Management and Knowledge generation
 Data, information, knowledge.
Professional practice, trends and issues
 roles, trends and issues, ethics.
Healthcare Information and Management System Society
 established a certification program that may be of interest to informatics
nurses.
EHR
Healthcare Environment
 characterized by significant emphasis on establishing the EHR in all
settings.
Data sets
 comprised of data elements brought together for a specific person.
Modern database
 used for storing data in a way that maintain the logical relationships
among data elements, and are stored in a computer.
Focus
 client health record as a database.
Simple Perspective
 that the EHR is a client health record database support by computer,
electronic, and communication technologies.
American Society for Testing and Material(ASTM)
 any information related to the past, present or future physical/mental health, or
condition of an individual.

41. Terminologies
 Nursing Minimum Data Sets(NMDS)
 developed Dr. Harriet Werleys considered the foundational work for
nursing languages and represents the 1st attempts to standards the collection of
essential nursing data.
 Four nursing care elements
1. Nursing diagnosis
2.nursing interventions
3.nursing outcome
4.intensity of nursing care
Pt/client demographic elements
Address personal identification
Date of birth
Gender
Race
Residence
Seven service elements
1.unique facility or service agency number
2.Unique health record number of patient
3.Unique number of principal RN provider
4.Episode admission or encounter data
5.Discharge or termination date
6.Disposition of patient
7expected payer.
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