This document discusses nursing informatics topics including nursing records and reports, management information systems, electronic health records, telemedicine, and telenursing. It provides definitions and discusses the importance, types, and best practices for nursing records and reports. Records and reports are important for documenting care, communication between providers, and evaluating services. The document also defines management information systems and describes their objectives and importance for supporting strategic goals, planning, and evaluating health programs.

1. NURSING
INFORMATICS

2. INDEX
 Nursing records and reports
 Management information and Evaluation System (MIES)
 E-Nursing
 Telemedicine
 Telenursing
 Electronic medical records

3. 1. NURSING RECORDS
AND
REPORTS

4. INTRODUCTION
 All professional persons need to be accountable for the performance of their duties to the
public.
 Since nursing has been considered as profession, nurses need to record their work on
completion.
 Records are a practical and dispensable aid to the doctor, nurse and paramedical
personnel in giving the best possible service to the clients.
 Report summarizes the services of the person or personnel and of the agency.

5. DEFINITION
 A record is a permanent written communication that
documents information relevant to a client’s health
care management.
 A record is a clinical, scientific, administrative and
legal document relating to the nursing care given to
the individual family or community.
 Reports are oral or written exchanges of information
shared between caregivers or workers in a number of
ways.
 A report is the summary of the services of person or
personnel and of the agency.

6. NURSING RECORDS

7. INTRODUCTION
 Records are a practical and dispensable aid to
doctor, nurse and paramedical personnel in
giving the best possible service to their clients.
 Recorded facts have value and scientific
accuracy for more than mere impression of
memory and there are guidelines for better
administration of health services.

8. PURPOSES OF RECORDS
 Supply data that are essential for programme planning and evaluation.
 Provide the practitioner with data required for the application of professional services
for the improvement of family's health.
 Tools of communication between health workers, the family & other development
personnel
 Effective health records show the health problem in the family and other factors that
affect health.
 Indicates plans for future.
 Help in the research for improvement of nursing care.

9. PRINCIPLES OF RECORD WRITING
 Nurses should develop their own method of expression and form in record writing.
 Written clearly, appropriately and adequately.
 Contain facts based on observation, conversation and action.
 Select relevant facts and the recording should be neat, complete and uniform.
 Valuable legal documents and so it should be handled carefully, and accounted for.
 Records should be written immediately after an interview.
 Records are confidential documents.
 Accurately dated, timed and signed
 Not include abbreviations, jargon, meaningless phrases

10. VALUED AND USES OF RECORDS IN HOSPITALAND
HEALTH CENTERS
For the Individual and Family
 Records serve to document the history of the client.
 Records assist in the continuity of care.
 Records serve as evidence to support or to manage or
face the legal questions that arise.
 Records serve to recognize the health needs and can be
used as a research and teaching tool.

11. CONTINUE…..
For the Doctor
 Serves as guide for diagnosis, treatment, follow up and
evaluation of services.
 Indicate progress and continuity of care.
 Help self evaluation of medical practice.
 Protect the doctor in case of legal issues. Records may be
used for teaching and research.

12. CONTINUE….
For the Nurse
 Provide with documentation of services rendered, i.e. shows
health condition of the client.
 Provide data essential for planning and evaluation of services
for further improvement.
 Serve as a guide for professional growth.
 Enable to judge the quality and quantity of work done.
 Serve as communication tool between staff and other members
involved in care.
 Indicate plans for the future.

13. CONTINUE….
For Authorities
 Provide the management with statistical
information necessary for decision in regard to
utilization of resources, planning for
administrative control and future references.
 Help the supervisor evaluate the services
rendered, teaching done and a person’s action
and reactions.

14. TYPES OF RECORDS
1. Cumulative or continuing records
 This is found to be time saving, economical and also it is helpful to review the total
history of an individual and evaluate the progress of a long period.
2. Family records
 All records, which relate to members of family, should be placed in a single family
folder. Gives the picture of the total services and helps to give effective, economic
service to the family as a whole.
 Separate record forms may be needed for different types of service such as TB,
maternity etc. all such individual records which relate to members of one family
should be placed in a single family folder.

15. RECORDS MAINTAIN IN HOSPITAL
 The patient’s clinical record
 Records of nurses’ observations – Nurses’ Notes
 Records of orders carried out
 Records of treatment
 Records of admission and discharge
 Records of equipment loss and replacement ( inventory)
 Records of personnel performance.

16. PATIENTS CLINICAL RECORDS
The Head Nurse’s Responsibility for the Clinical
Record
 Protection from loss
The head nurse is responsible for safeguarding the
patient’s record from loss or destruction. No individual
sheet is separated from the complete record unless, as
with the doctor’s order sheet, it is kept in a special
place where its safety is guarded.
 Safeguarding its content
The hospital administration usually has a procedure
with which the head nurse should be familiar for
handling legal matter of this kind. Patient has the right
to insist that his record be confidential.

17. CONTINUE…..
Completeness
 Compile records with complete identifying data on
each page in the form approved by the hospital. The
two parts of the record for which the nursing service is
universally wholly responsible are the vital sign,
graphic sheet and nurses’ observation or nurses’ notes.
Responsibility for nurses’ notes
 The form for nurses’ notes which has been established
by the hospital should be used by all nurses.

18. HOW TO IMPROVE RECORD-KEEPING
 Get into the habit of using factual, consistent,
accurate, objective and unambiguous patient
information
 Use your senses to record what you did.
 Ensure there is a reasoned rationale (evidence) for
any decision recorded.
 Ensure notes are accurately dated, timed, and signed,
with the name printed alongside the entry.
 Write the notes, where possible, with the
involvement and understanding of the patient or care
taker.
 Errors should be corrected by putting a single line
through the incorrect statement and signing and
dating it.

19. CONTINUE…..
 Follow the SMART model (Specific, Measurable, Achievable, Realistic and Time-based)
or similar when planning care
 Write up notes as soon as possible after an event and, by law, within 24 hours, making
clear any subsequent alterations or additions
 Do not include jargon, meaningless phrases (for example 'slept well'), offensive
subjective statements.
 It must be clear what was originally written and why it was changed, therefore correction
fluids should not be used.

20. NURSING REPORTS

21. INTRODUCTION
 Reports can be compiled daily, weekly, monthly,
quarterly and annually. Report summarizes the services
of the nurse and/ or the agency. Reports may be in the
form of an analysis of some aspect of a service. These
are based on records and registers and so it is relevant
for the nurses to maintain the records regarding their
daily case load, service load and activities.

22. IMPORTANCE OF REPORTS
 Good reports save duplication of effort and
eliminate the need for investigation to learn the
facts in a situation.
 Full reports often save embarrassment due to
ignorance of situation.
 Patients receive better care when reports are
thorough and give all pertinent data.
 Complete reports give a sense of security which
comes from knowing all factors in the situation.
 It helps in efficient management of the ward.

23. CRITERIA FOR A GOOD REPORTS
 Reports should be made promptly if they are to
serve their purpose well.
 A good report is clear, complete, concise.
 If it is written all pertinent, identifying data are
include – the date and time, the people concerned,
the situation, the signature of the person making the
report.
 It is clearly stated and well organized for easy
understanding.
 No extraneous material is included.
 Good oral reports are clearly expressed and
presented in an interesting manner. Important points
are emphasized.

24. TYPES OF REPORTS
 Oral reports : Oral reports are given when the
information is for immediate use and not for
permanency. E.g. it is made by the nurse who is
assigned to patient care, to another nurse who is
planning to relieve her.
 Written reports : Reports are to be written
when the information to be used by several
personnel, which is more or less of permanent
value, e.g. day and night reports, census,
interdepartmental reports, needed according to
situation, events and conditions.

25. REPORTS USED IN HOSPITAL SETTINGS
1. Change- of- shift reports or 24 hours report
 Provide only essential background information
about client (name, age sex, diagnosis and
medical history) but do not review all routine care
procedures or task.
 Identify clients’ nursing diagnosis or health care
problems and other related causes
 Describe objective measurements or observations
about clients’ condition and response to health
problems. Stress recent change, but do not use
critical comment about clients’ behavior

26. CONTINUE….
 Share significant information about family
members, as it relates to clients’ problems.
 Continuously review ongoing discharge plan. Do
not engage in gossip.
 Describe instructions given in teaching plan and
clients’ response.

27. CONTINUE….
2. Transfer reports
 A transfer reports involve communication of information
about clients from the nurse on sending unit to the nurse
on the receiving unit. Nurse should include the following
information.
 Client’s name, age, primary doctor, and medical
diagnosis.
 Summary of medical progress up to the time of transfer.
 Current health status- physical and psychosocial.
 Current nursing diagnosis or problems and care plan.
 Any critical assessment or interventions to be completed
shortly.
 Needs for any special equipment's etc.

28. 3. Incident reports
 The nurse who witnessed the incident or who found the
client at the time of incident should file the report.
 The nurse describes in concise what happened specifically
objective terms, etc.
 The nurse does not interpret or attempt to explain the cause
of the incident.
 The nurse describes objectively the clients, conditions when
the incident was discovered.
 Any measures taken by the nurse, other nurses, or doctors at
the time of the incident are reported.
 No nurse is blamed in an incident report
 The report is submitted as soon as possible.
 The nurse should never make photocopy of the incident
report.

29. 4. Census report
 This is a report compiled daily for the number of patients. Very often it is done
at midnight and the norms are collected by the night supervisor. The report will
show the total number of patients, the number of admissions, discharges,
transfers, births and deaths. The nurses should remember that a single mistake
in the census figures made buy one of the nurses make the census report of the
entire institution incorrect.

30. 5.Birth and death report
 The nurses are responsible for sending the birth and
death reports to governmental authorities for
registration within the specified time.
6. Anecdotal report
 An anecdote is brief account of some incident.
Incident reports and reports on accidents, mistakes
and complaints are legal in nature. A written record
concerning some observation about a person or
about her work is called an anecdote note.

31. HOW TO WRITE A BETTER REPORTS
 1.Before anything can be written clearly, it must be clear
in one’s own mind.
 2.Reports, lacking facts, may be biased or worthless.
 3.Conciseness, accuracy and completeness are essential
to good reports.
 4.It is better to write several reports than one when there
is more than one main subject upon which to report.

32. CONTINUE….
 5.Use terminology in keeping with the nature of reports:
• Short, simple, commonly used words for nontechnical reports.
• Scientific terms when issuing reports to professional personnel.
• Specific rather than general words
• Use a single meaningful term rather than phrases.
 6.Observes mechanics of good writing.
• Use goods sentences and paragraphs
• Observe margins
• Spell properly; avoid abbrev

33. • Use correct pronoun
• Don’t forget punctuation
• Be neat
 7.Write report in a conversational manner.
 8.Date reports
 9.If report is typed by someone else, check it before signing it.

34. NURSE RESPONSBILITY FOR RECORD KEEPING AND
REPORTING
 The patient has a right to inspect and copy the record
after being discharged
 Failure to record significant patient information on the
medical record makes a nurse guilty of negligence.
 Medical record must be accurate to provide a sound
basis for care planning.
 Errors in nursing charting must be corrected promptly
in a manner that leaves no doubts about the facts.
 In reporting information about criminal acts obtained
during patient care, the nurse must reveal such
information only to the police, because it is considered a
privileged communication.

35. CONTINUE….
 FACT Information about clients and their care must be
functional. A record should contain descriptive,
objective information about what a nurse sees, hears,
feels and smells.
 ACCURACY A client record must be reliable.
Information must be accurate so that health team
members have confidence in it.
 COMPLETENESS The information within a recorded
entry or a report should be complete, containing concise
and thorough information about a client care or any
event or happening taking place in the jurisdiction of
manger.

36. CONTINUE….
 CURRENTNESS Delays in recording or reporting can
result in serious omissions and untimely delays for medical
care or action legally, a late entry in a chart may be
interpreted on negligence.
 ORGANIZATION The nurse or nurse manager
communicates information in a logical format or order.
Health team members understand information better when
it is given in the order in which it is occurred.
 CONFIDENTIALITY Nurses are legally and ethically
obligated to keen information about client’s illnesses and
treatments confidential.

37. 2. MANAGEMENT INFORMATION
AND
EVALUATION SYSTEM

38. DEFINITION
 Management information system: An array of components designed to transform a
collective set of data into knowledge that is directly useful and applicable in the
process of directing and controlling resources and their application to the achievement
of specific management objectives.
[Hanson 1982]
 Evaluation system: A periodic evaluation of system to assess its status in term of
original and current expectation and to chart its future direction

39. CONTINUE….
 Health information system: Health information is any quantifiable and non-
quantifiable information that can be used by health decision-makers and clinicians
to better understand disease processes and health care issues, and to prevent,
diagnose or treat health problems.
[WHO]

40. OBJECTIVES OF MIS
 To enhance communication among employees.
 To provide a system for recording and aggregating
information.
 Reduce expenses related to labor-intensive manual
activities.
 To support the organization’s strategic goals and
direction

41. IMPORTANCE OF MIS
 Planning systematically and coordinating activities.
 Establishing databases on budgets, personnel ,facilities and
equipment.
 Providing guidance in choosing entry points for program
interventions and establishing active partnerships with other
organizations
 Providing information on the status of the population served,
such as its health status (i.e. defines surveillance levels).

42. CONTINUE….
 Guiding prioritizing by identifying major problems.
 Providing indicators for monitoring and evaluation
of performance.
 Assessing the impact or effectiveness of services.
 Guiding the forecasting of Commodity or service
needs.
 Methods for improvement

43. IMPLEMENTATION METHOD OF MIS
1. Direct Approach: Direct installation of the new system
with immediate discontinuance of the old existing system is
referred as “cold turnkey” approach. This approach becomes
useful when these factors are considered.
 The new system does no replace the existing system.
 Old system is regarded absolutely of no value
 New system is compact and simple.
 The design of the new system is inexpensive with more
advantages and less risk involved.

44. CONTINUE…..
 Parallel Approach: The selected new system is
installed and operated with current system. This
method is expensive because of duplicating
facilities and personal to maintain both the
systems. In this approach a target date must be
fixed when the operations of old system cease
and new one will operate on its own.

45. CONTINUE….
 Modular Approach: This is generally recognized
as “Pilot approach”, means the implementation of
a system in the Organization on a piece-meal
basis.

46. ADVANTAGES OF MIS
 The risk of systems failure is localized
 The major problem can be easily identified and corrected
before further implementation.
 It supports and enhances the overall decision making
process.
 MIS enhances job performance throughout an institution
 It provides the means through which the institutions
activities are monitored and information is distributed to
management, employees and customers.
 It measures performance, manage resources
 It can also be used by management to provide feedback on
the effectiveness of risk controls.

47. LIMITATIONS
 Technology also increases the potential for
inaccurate reporting and flawed decision making.
Because data can be extracted from many financial
and transaction systems, appropriate control
procedures must be set up to ensure that
information is correct and relevant.

48. 3.E–NURSING

49. INTRODUCTION
 Nurses all around the world have risen to the challenge
of new technology. Today, the nurses work in a variety
of E-Health programs such as tele- triage. They access
online libraries and databases of clinical practice
guidelines from computers in their work places. Nurse in
specialized areas of practice now interact with their peers
in discussion groups over the internet. Nurses are also
involved in standards development for the
implementation of electronic health records and many
nursing educational programs are now offered online.

50. CONTINUE…..
 Patient safety is fundamental to nursing care. To provide safe, high 'quality care, nurses
must integrate new health care knowledge into their practice. Nurses must work to
maintain their area of practice, they must be able to access information on best practices
from expert nurses and other professionals nationally and internationally. Nurses need
resources to be available 24hours a day, seven days a week, whenever and wherever
they are working or living. Many nurses practice in remote and isolated regions where
accessing needed information and resources is difficult.

51. DEFINITION OF E-NURSING
 E-nursing involves the use of computers or electronic devices in some way to
provide training, education and learning material
-Derek Stockley
 E-nursing comprises of all forms of electronically supported learning and
teaching. The information and communication system whether networked
learning or not, serves a specific media to implement the nursing process.
-Adam

52. GOAL OF E-NURSING
 To enhance nurses to benefit from all
developments in information, communication
and technology, to improve nursing and client
outcomes.

53. PURPOSE OF E – NURSING
 To guide the development of ICT (Information
and communications technology). initiatives in
nursing so that nursing practice and client
outcomes are improved.

54. E – NURSING STRATEGY FOR PROFESSION
Nurses In Clinical Practice
 Participate in ICT initiatives, identify needs and evaluate possible solutions.
 Increase competence in use of ICT.
 Access multiple source of information for evidence-based practice.
Employers and Administrators
 Recognize ICT as a tool of professional nursing practice.
 Support involvement of nurses in ICT initiatives.
 Encourage adoption of ICT that supports nursing practice.

55. CONTINUE…..
Educators and Researchers
 Incorporate ICT competencies into curriculum.
 Develop research programs to optimize nurses’ use of ICT.
Nursing Organizations
 Provide leadership for nurses’ involvement in ICT.

56. BENEFICIARIES OF E – NURSING
 Individual nurses
 Their clients
 Employers
 Nursing professional
 Regulatory organization
 The profession as a whole both nationally and
internationally.

57. ADVANTAGES OF E – NURSING
 Integration of information, communication and
technology.
 Improved information and knowledge in the nursing
practice.
 Human resource planning will be facilitated.
 New models of nursing practice and health services
delivery will be supported.
 Nursing group will be well connected.
 Improves the quality of nursing work environments.
 Contribution to the global community of nursing.

58. DISADVANTAGES OF E – NURSING
 High expense
 Decreases manual contribution
 Increases dependence on ICT
 Misuse of the technology provided

59. 4.TELEMEDICINE…

60. INTRODUCTION
 Telemedicine is an upcoming field in health science arising out of the effective fusion
of Information and Communication Technologies (ICT) with Medical Science having
enormous potential in meeting the challenges of healthcare delivery to rural and
remote areas besides several other applications in education, training and management
in health sector. It may be as simple as two health professionals discussing medical
problems of a patient and seeking advice over a simple telephone to as complex as
transmission of electronic medical records of clinical information, diagnostic tests
such as E.C.G., radiological images etc. and carrying out real time interactive medical
video conference with the help of IT based hardware and software, video-conference
using broadband telecommunication media provided by satellite and terrestrial
network.

61. DEFINITION
 There are several definitions of telemedicine.
According to World Health Organization,
telemedicine is defined as, “The delivery of
healthcare services, where distance is a critical
factor, by all healthcare professionals using
information and communication technologies for
the exchange of valid information for diagnosis,
treatment and prevention of disease and injuries,
research and evaluation, and for continuing
education of healthcare providers, all in the
interests of advancing the health of individuals
and their communities”.

62. TYPES OF TELEMEDICINE PROCESS
 Telemedicine process can be categorized in two ways
i.e. technology involved and application adopted.
 A. Technology involved:
 1. Real Time or Synchronous:
 Real time telemedicine could be as simple as a
telephone call or as complex as telemedical video
conference and tele-robotic surgery. It requires the
presence of both parties at the same time and a
telecommunication link between them that allows a
real-time interaction to take place. Video-conferencing
equipment is one of the most common forms of
technology used in synchronous telemedicine.

63. CONTINUE…..
2.Store-and-forward telemedicine or Asynchronous:
 It involves acquiring medical data (like medical history,
images, etc.) and then transmitting this data to a doctor
or medical specialist at a convenient time later for
assessment offline. It does not require the presence of
both parties at the same time. Store-and-forward
telemedicine is an efficient way for patients, primary
care providers, and specialists to collaborate because
they can all review the information when it is convenient
for them. Examples are tele-pathology, tele-radiology,
tele-dermatolgy.

64. 3. Remote patient monitoring (RPM)
 RPM is the collection of personal health and medical data from a patient or
resident in one location that is then transferred electronically to a nurse,
caregiver, or physician in a different location for monitoring purposes. RPM is
already being used to a great extent in senior living in order to prevent falls and
monitor the vital health statistics of residents.

65. CONTINUE…..
(b) Application adopted:
 Telepathology
 Tele-cardiology
 Teleradiology
 Telesurgery

66. APPLICATIONS OF TELEMEDICINE:
 1.Tele-health care: It is the use of information and
communication technology for prevention, promotion
and to provide health care facilities across distance. It
can be divided in the following activities
- Teleconsultation
- Tele follow-up
 2.Tele-education: Tele-Education should be understood
as the development of the process of distance education
(regulated or unregulated), based on the use of
information and telecommunication technologies, that
make interactive, flexible and accessible learning
possible for any potential recipient.

67. CONTINUE….
 3. Disaster Management: Telemedicine can play an
important role to provide healthcare facilities to the
victims of natural disasters such as earthquake,
tsunami, tornado, etc. and man-made disaster such as
war, riots, etc. During disaster, most of the terrestrial
communication links either do not work properly or
get damaged so a mobile and portable telemedicine
system with satellite connectivity and customized
telemedicine software is ideal for disaster relief.

68. CONTINUE…..
 4.Tele-home health care: Telemedicine technology can be applied to provide
home health care for elderly or underserved, homebound patients with
chronic illness. It allows home healthcare professionals to monitor patients
from a central station rather than traveling to remote areas chronically ill or
recuperating patients for routine check-ups. Remote patient monitoring is less
expensive, more time savings, and efficient methodology. Tele-home care
virtual visits might lead to improved home health care quality at reduced
costs, greater patient satisfaction with care, increased access to health care
providers and fewer patients needing transfer to higher, more costly levels of
care. A Computer Telephone Integrated (CTI) system can monitor vital
functions of patients twenty four hours a day and give immediate warnings.

69. ADVANTAGES OF TELEMEDICINE
FOR THE PATIENTS
 People at remote areas get top class medical
facility from reputed hospitals.
 Reduces travel cost and save time for the rural
patients.
 Reduces lot of inconvenience for the rural
patients.

70. CONTINUE…..
FOR THE HOSPITALS
 Hospitals can spread their reach in remote villages and
serve people without much investment on the infrastructure.
 The hospitals get revenue from the reference made from the
remote locations.
 After care or post operated care patients need not come to
the main hospital for minor consultation.
 Primary diagnosis can be done with the use of telemedicine
and patient can come to the main hospital for major surgery.
 Hospitals can have CME programmes with other hospitals
and medical colleges.

71. BARRIERS IN TELEMEDICINE PRACTICE
 The practice of telemedicine – through transmission of digitized
data, audio, video and images – is getting popular all over the
world as it provides hitherto unavailable access to tertiary level
specialist healthcare even in geographically remotest areas
without displacement of the patient, physician or the equipment.
It is not only cost-effective to the patient but cost-beneficial to
the society also. More and more doctors and patients are
resorting to the use of telemedicine due to its advantages of
convenience and cost-saving. The practice of telemedicine,
however, has brought with it several complicated issues. These
issues involve not only healthcare workers and consumers but the
society, technologists and the lawmakers also. Those interested in
the specialty of telemedicine need to address these issues.

72. 1. Physician/Patient Acceptance
 Physicians and patients have unique technological resources
available to improve the patient-physician relationship. It has
been found that patients have no difficulty in accepting
telemedicine program. In almost all the cases the patients are
more than happy and satisfied as they don’t have to travel
1500 km to show their diagnostic reports to their doctors.
However, some resistance is seen amongst doctors. Doctors in
government sector tend to look upon telemedicine as an
additional duty or workload. Therefore, there is need to
weave telemedicine into the routine duties of the doctors. The
private doctors sometime fear that telemedicine is likely to
reduce their practice. They need to realize that this technology
enhances their reach and exposure and is only likely to
increase their practice further.

73. 2. Availability of Technology at a Reasonable Cost
 It is myth that to establish a telemedicine platform is an
expensive. The basic system needs hardware, software
and telecommunication link. In all the areas there is a
significant reduction in the prices. Most of these costs
are well within the reach of most of the hospitals, and
can be recovered by nominal charge to the patients and
students in case of tele-education which would be much
less than the physically traveling.

74. 3. Accessibility
 Although information technology has
reached in all corner of the country but the
accessibility of people living in remote
and rural area to the nearest health center
(PHCs, CHCs or district hospital) may not
be easy due to poor infrastructure of road
and transport. It may be possible that the
available telemedicine system in thee
health centers may not function because
of the interruption in power supply.

75. 4. Reliability
 Some healthcare professionals has doubt about the
quality of images transmitted for tele-consultation and
tele-diagnosis. In tele-radiology, telepathology, tele-
dermatology the quality of image (color, resolution, field
of view, etc.) should be international standards to avoid
any wrong interpretation and mis-diagnosis. The delay
in transmission of data may be of critical importance in
tele-mentoring and robotic surgery and have to be
reduced to the minimum.

76. 5. Funding/ Reimbursement Issues:
 There should be a format to calculate the investment and recurring cost of the
telemedicine system. The insurance companies have to decide whether the cost of
tele-healthcare should be reimburse or not.
6. Lack of Trained Manpower:
 Telemedicine is a new emerging field, there is lack of training facilities with
regards to application of IT in the field of medicine. Most of the healthcare and IT
professionals are not familiar with the terms commonly used in telemedicine such
as HIS, EMR, PACS, etc. Telemedicine is also not the part of course curriculum of
medical schools.

77. 7. Legal & Ethical
 Telemedicine technology has been proved and
established and its advantages and benefits are well
known but still many healthcare professionals are
reluctant to engage in such practices due to
unresolved legal and ethical concerns. In case of a
cross-border tele-consultation which country’s
litigation laws will be applied in case– those of the
country in which the patient is living or those of the
remote physician?

78. Privacy and Security Concerns:
 There are many issue that should be considered regarding the
security, privacy and confidentiality of patient data, in telemedicine
consultations How are patients’ rights of confidentiality of their
personal data ensured and protected How to ensure security of the
data and restrict its availability to only those for whom it is intended
and who are authorized and entitled to view it? How to prevent
misuse and even abuse of electronic records in the form of
unauthorized interception and/ or disclosure?

79. 5.TELENURSING

80. DEFINITION
 Tele nursing refers to the use of telecommunications
and information technology for providing nursing
services in health care whenever a large physical
distance exists between patient and nurse.

81. APPLICATIONS OF TELENURSING
 Home Care
Tele nursing applications is home care. For example, patients
who are immobilized, or live in remote or difficult to reach
places, citizens who have chronic ailments, such as chronic
obstructive pulmonary disease, diabetes, congestive heart
disease, or disabilitating diseases , such as neural degenerative
diseases (Parkinson’s disease, Alzheimer’s disease, ALS) etc.,
may stay at home and be “visited” and assisted regularly by a
nurse via videoconferencing, internet, videophone etc. other
applications of home care of patients in immediate post-surgical
situations, the care of wounds, ostomies, handicapped
individuals etc. In normal home health care, one nurse is able to
visit up to 5-7 patients per day.

82. CONTINUE…..
 Case management
A common application of telenursing used by call
centers operated by managed care organization
which are staffed by registered nurses who act as
case managers or perform patient triage
,information, and counseling as a means of
regulating patient access and flow and decrease the
use of emergency rooms..

83. LEGAL, ETHICALAND REGULATORY ISSUES
 Tele nursing is fraught with legal, ethical and
regulatory issues, as it happens with tele health as a
whole. In many countries, interstate and intercountry
practice of tele nursing is forbidden (the attending
nurse must have a license both in her state/ country of
residence and in the state/ country where the patient
receiving telecare is located). Legal issues such as
accountability and malpractice etc. are also still
largely unsolved and difficult to address. In addition,
there are many considerations related to patient
confidentiality and safety of clinical data.

84. GUIDELINES FOR TELE-NURSING
 Nurses and midwives practicing in tele nursing shall be
registered nurses or midwives. Enrolled nurses involved
in tele nursing need to be under the supervision of a
registered nurse or midwife.
 Nurses and midwives practicing tele nursing are
personally responsible for ensuring that their nursing
and/or midwifery skills and expertise remain current for
their practice.

85. CONTUNUE…..
 Nurses and midwives have a duty to inform consumers of
their name, qualification and registration status. Consumers
may wish to confirm registration status with the relevant
nursing and midwifery regulatory authority.
 Nurses and midwives should inform consumers of tele
health process including other person/professionals who
may be participating or present in the tele health
consultation and obtain consent before proceeding.
 Nurses and midwives in tele nursing have a duty to provide
privacy and confidentiality in all interactions.
 Nurses and midwives must comply with government and
institutional policies relating to privacy, confidentiality,
informed consent, information security and documentation
during the provision of tele nursing care.

86. CONTINUE…..
 Nurses and midwives are required to do
documentation during the provision of tele nursing
care. Nurses and midwives are required to document
all interactions during the tele nursing consultation.
 Nurses and midwives practicing in tele nursing should
be aware of both the evidence base for the practice and
the areas of practice in need of research.
 Nurses and midwives practicing tele nursing should
engage in evaluation of their practice in relation issues
of quality, safety and patient outcomes.

87. 6. ELECTRONIC MADICAL
RECORDS

88. INTRODUCTION
 An electronic medical record (EMR) is a digital
version of all the information you’d typically find in
a provider’s paper chart: medical history, diagnoses,
medications, immunization dates, allergies, lab
results and doctor’s notes. EMRs are online medical
records of the standard medical and clinical data
from one provider’s office, mostly used by providers
for diagnosis and treatment. Comprehensive and
accurate documentation of a patient’s medical
history, tests, diagnosis and treatment in EMRs
ensures appropriate care throughout the provider’s
clinic.

89. Benefits of EMR
1. Improved Patient Care
 Doctors using EMRs can see patient information in different ways than with the
traditional paper record. In the long run, patients can expect to have better health
outcomes. EMRs can turn health data, such as weight, cholesterol levels, and blood
pressure, into useful charts. Better information over time allows physicians to screen for
potential health issues or manage previous diagnoses.
 EMRs also improve patient care by forging stronger relationships between providers and
their patients. When a patient has clear information about their medical history and overall
health, they can become better advocates for themselves and have a more trusting
relationship with their doctor.

90. CONTINUE…..
2. Care Coordination
 EMRs allow providers to see a picture of a
patient’s history with their clinic or office. This
picture is fundamental to coordinate medication,
treatments, and lab tests.
 Patients will also be able to access all of their
medical records to coordinate care with other
clinics, if necessary.

91. 3. Efficiency
 EMRs enable hospitals and clinics to run more efficiently.
They eliminate mountains of paperwork that
administrative staff must file and store in a safe and
secure location. And there is always the risk of a paper
record being lost or accidentally destroyed.
 EMRs also prevent physicians from ordering duplicate
tests that are unnecessary for their patients. This
streamlining of information saves time and money for
patients and providers.
 Also, EMRs help medical providers of all sizes better
manage and share information in the long-term. Keeping
good records of medical advice and treatments is a
cornerstone of reputable medical practices. Patients can
expect their doctors to share information quicker, as well
as to alert them to potential issues or changes in their care.

92. 4. Reduced Medical Errors
 Electronic records assure doctors and patients that the information they have is the
most accurate and up-to-date. An EMR reduces medical errors by removing the risk of
inaccurate data. Paper records can be lost or illegible, which could result in a
misdiagnosis or an improper prescription. Electronic records also aid providers from
ordering a medication that could be potentially harmful. Medications with similar
chemical constructs that may not trigger an interaction in the provider's memory.

93. TYPES OF ELECTRONIC MEDICAL RECORDS
 EMR SOFTWARE
1. Cloud-Based EMR Software
 A cloud-based EMR software allows data to be
accessed online. Remote access to information is a
primary feature of a cloud-based EMR software.
Medical information about patients is stored securely
“in the cloud.” Because servers do not host data,
cloud-based software can be a more affordable EMR
option. These types of systems are also known as Web-
based or Software-as-a-Service (SaaS).

94. CONTINUE….
2. Mac EMR Software
 Mac EMR software, as can be assumed by the name,
includes software compatible with all Apple devices.
There are Mac-native options, which are designed
exclusively for the Mac operating system. There are
also cloud- or web-based software options that run
optimally on any Apple device with access to the
Internet.

95. 3. ONC-Certified EMR Software
ONC-certified EMR software refers to any software that meets requirements set by the
Office of the National Coordinator for Health Information Technology (ONC). These
requirements focus on the proper management and storage of sensitive patient data.
ONC-certified EMRs are software that is tested by bodies authorized by the ONC for
testing and certification. Testing ensures that software meets criteria set by the ONC
for the meaningful use of health information. These criteria include patient portal
access, a place to create care plans, quality reporting methods, and more.

96. 4. Behavioral/Mental Health EMR Software
 EMRs for behavioral and mental health
providers offer a different range of features.
These features are more specific to the needs of
mental health clinics, therapists, and group
clinics. For example, accessing old notes can be
a time-consuming task for a therapist or mental
health clinician. Advanced note management
features on behavioral/mental health EMR
software make accessing notes a more efficient
process.

97. 5. Medical Billing Software
 Processing patient statements and insurance claims can be
more manageable with medical billing software. There are
software systems that integrate with EMRs to form a
complete and robust administrative department.
 Medical billing software offers medical providers a way to
automate different billing tasks, including verifying
insurance, processing claims, and payments, and
following up on denied insurance claims. Frustrating
administrative tasks become automatic processes done
efficiently. The automation of information with EMRs
frees up administrative personnel for more patient-facing
responsibilities.

98. SUMMARIZATION
 Nursing informatics combines multiple disciplines into a functional and coordinated
healthcare mechanism. The informatics mechanism assists with communication of
healthcare professionals, like nurses and doctors, as well as with patient information
on a practical level. Informatics also optimizes nursing services, preventative
medicine and patient outcome.

99. CONCLUSION
 Nursing informatics is essential to the delivery of safe and effective healthcare. It
helps with the selection, implementation, and evaluation of health technology.
Aspects such as data recovery, patient care, ethics, human-computer interaction,
electronic health records, security, electronic learning, and telenursing are all aspects
that are a part of nursing informatics Further more, it supports high quality and safe
patient care– this is a field that promotes and improves quality care.

101. BIBLIOGRAPHTY
BOOK REFRENCES
 Basheer P. Shabeer, Khan S.Yaseen. Advanced Nursing Practice. 2nd ed.
Mahalakshmipuram, Bangalore:
 Comprehensive Textbook On Nursing Management.K Deepak C Sarath Chandran, Bp
Mithun Kumar, 420-421.
INTERNET REFRENCES
 https://www.slideshare.net
 https://www.nursingpath.in