NURSING INFORMATICS 1

Eugene Flor L. Ulpindo, MSN, RN, ECE

Course Name: INFORMATICS

Course Credit: 2 units Lecture; 1 unit Laboratory
Contact Hours/Sem: 36 lecture hours; 54 laboratory hours
Course Objectives:
At the end of the course and given relevant actual or simulated situations/ conditions, the student will be able to:
1. Apply concepts, theories and principles of informatics in nursing and health care
2. Discuss issues and trends in informatics relevant to nursing and health.

Course Outline
A. Computers and nursing
1. Computers and nursing
2. Historical perspectives of nursing and the computer
3. Electronic health record from a historical perspective
B. Computer system
1. Computer hardware
2. Computer software and systems
3. Open source and free software
4. Data processing
5. The internet: a nursing resource
6. PDA and wireless devices
7. Incorporating evidence: use of computer-based clinical decision support system for health professionals
C. Issues in informatics
1. Nursing informatics and healthcare policy
2. The role of technology in the medication-use process
3. Healthcare data standards
4. Electronic health record systems: U.S. federal initiatives and public/private partnerships
5. Dependable systems for quality care
6. Nursing minimum data set systems
D. Informatics theory
1. Theories, models and frameworks
2. Advanced terminology systems
3. Implementing and upgrading clinical information systems
E. Practice application
1. Practice application
2. Critical care applications
3. Community health applications
4. Ambulatory care systems
5. Internet tools for advanced nursing practice
6. Informatics solutions for emergency preparedness and response
7. Vendor applications
F. Consumers use of informatics
1. Consumer and patient use of computers for health
2. Decision support for consumers
G. International perspectives
1. Nursing informatics in Canada
2. Nursing informatics in Europe
3. Pacific Rim
4. Nursing informatics in Asia
5. Nursing informatics in South America
H. The future of informatics
Future directions

COMPUTERS AND HEALTH

1. Computers and Nursing: Overview

Nurses serve as the largest group of professionals that provide clinical care to patients and remain the consumer advocate.
Recent survey data indicate that a growing number of nurses are qualified as information specialist.
They may serve as:
Administrators
Researchers
Educators
Community healthcare professionals
Work as Computer Information Officers (CIOs)
Corporate executives in vendor companies
Implementers of information technology
Developers of systems and
Consultants
 NURSING INFORMATICS 2
Eugene Flor L. Ulpindo, MSN, RN, ECE

Informatics in the Health Care Professions Hardware, Software, and Roles of Support Personnel

Definitions:

Informatics (informatics comes from the French word informatique which means computer science). Informatics is defined as
computer science + information science. Used in conjunction with the name of a discipline, it denotes an application of computer
science and information science to the management and processing of data, information, and knowledge in the named discipline.
Thus we have, medical informatics, nursing informatics, pharmacy informatics and so on.

Hebda (1998 p. 3), defines nursing informatics as "the use of computers technology to support nursing, including clinical practice,
administration, education, and research."

American Nurses Association (ANA) (1994) has defined nursing informatics as "the development and evaluation of applications,
tools, processes, and structures which assist nurses with the management of data in taking care of patients or supporting the
practice of nursing."

Graves, J. R., & Corcoran, S. (1989). The Study of Nursing Informatics. Image: Journal of Nursing Scholarship, 27, 227-231. define
nursing informatics as "a combination of computer science, information science and nursing science designed to assist in the
management and processing of nursing data, information and knowledge to support the practice of nursing and the delivery of
nursing care."

The framework for nursing informatics relies on the central concepts of data, information and knowledge:

data is defined as discrete entities that are described objectively without interpretation
information as data that is interpreted, organized or structured
knowledge as information that has been synthesized so that interrelationships are identified and formalized.
Resulting in decisions that guide practice

The management and processing components may be considered the functional components of informatics.

Example:
Data: 140 systolic
Information: 50 year-old male, day 3 of hospitalization, BP 140/70
Knowledge: Pt. demographics, record of BP readings, circulation system: anatomy & physiology, pharmacokinetics of ordered
medication
Decisions: That guide practice

Nursing Informatics is defined by the American Nurses Association (ANA, 2001) as:

A specialty that integrates nursing science, computer science, and information science to manage and communicate data,
information and knowledge in nursing practice. Nursing informatics facilitates the integration of data, information, and knowledge
to support patients, nurses, and other providers in their decision -making in all roles and settings. This support is accomplished
through the use of information structures, information processes, and information technology.

In the past 25 years, NI specialists emerged as a new specialty by the ANA.

In 1981, there were approximately 15 nurses who identified this new specialty as their area of interest and experties
In 1990, the number increased 500% to approximately 5,000 nurses and by the year 2000 it approximately increased to
another 500%.
By the year 2010, it is anticipated that the majority of nurses entering the profession will be computer literate.
It is also anticipated that every healthcare settingacute care hospital, academic school of nursing, large community health
agency or healthcare setting where nurses functionwill employ at least one NI specialist and will implement some type of
a CIS.

Clinical Information Systems(CIS) is designed to support clinical nursing practice. It requires not only understanding of
professional nursing practice process but also technology that is the application for the science to function electronically.

Purpose:
o The purpose of the monograph is to revisit and reformulate the principles and guidelines for clinical information systems to
support professional nursing practice in light of events, learning, and other forces of the past 10 years.
 NURSING INFORMATICS 3
Eugene Flor L. Ulpindo, MSN, RN, ECE

o The new generation of information systems must extend beyond meeting basic information needs towards providing
support for professional nursing practice to improve patient outcome.

Organizing Framework of Clinical Information Systems

Key Concepts:
o Professional nursing practice process understanding
o Technology
o Policy, regulation, and standard
o Information systems
o Human factors
o Technology adoption
o System utilization
o Professional nursing practice

Professional nursing practice process understanding is the explicit identification of related nursing activities that when correctly
performed, satisfy the nursing practice goal. This concept provides the foundation for defining the functional requirements of an
information system useful for nurses.

Technology is the application of science to work, and includes physical devices, programs, and ways of organizing work. Information
technology enables implementation of the functional requirements that are necessary to support applications that meet the needs
of nurses and other clinicians.

Policy, regulation, and standard influences all concepts in the organizing framework and may shape their manifestation at any point
in time. Healthcare policy and emerging national and international standards, combined with economic forces, impact the adoption
of technology and require healthcare organizations to remain responsive to continually changing requirements for capturing, storing
and communicating data.

Information systems representing the technical implementation of functional requirements, including application features and
functions as well as the interfaces by which uses interact with an application. The design and implementation of information systems
may influence the degree to which users adopt and utilize the system in their work.

Human factors defined as the set of characteristics that underlie an individual or groups interaction with a system, can also
influence the extent of a systems adoption and use. Human factors also influence information systems design.

Technology adoption is the degree of acceptance and use of an information system within the performance of professional nursing
practice. The extent of technology adoption influences the scope and depth of system utilization by individuals and organizations.

System utilization determines sand impacts the data and information derived from the information system.

Data and information about professional nursing practice informs and enhances our understanding of the processes of
professional nursing practice. System utilization and the data and information derived from an information system also support
validation of current knowledge and facilitate the synthesis of new knowledge.

2. Major Historical Perspectives of Nursing and Computers

Computer technology emerged in nursing in response to the changing and developing technologies in the health care
industry and in nursing practice.

Six Time Periods:

Six historical perspectives of nursing and computers:

Prior to the 1960s

Starting in the 1950s, computer industry grew as well as the use of computers in the healthcare industry.
Few form a cadre of pioneers that attempted to adapt computers to health care and nursing.
Computers were initially used in health care facilities for basic business office functions: used punch cards to store
data and card readers to read computer programs, sort and prepare data for processing.

1960s
The uses of computer technology in health care settings began to be questioned. Nursing practice standards were
reviewed, and nursing resources were analyzed.
Studies were conducted to determine how computer technology could be utilized effectively in the health care
industry and what areas of nursing should be automated.
Hospital information systems (HISs) were developed primarily to process financial transactions and serve as billing
and accounting systems.
 NURSING INFORMATICS 4
Eugene Flor L. Ulpindo, MSN, RN, ECE

Vendors of computer systems were beginning to enter the healthcare field and market software applications to
various hospital functions; however, because of technology limitations, lack of standardization and diversity of
paper-based patient care records, progress was slow.

1970s
During this decade, giant steps were taken in the dimensions: nursing and computer technology
o Nurses recognized the computers potential for improving documentation of nursing practice, the quality
of patient care, and the repetitive aspects of managing patient care.
o They assisted in the design and development of nursing applications for the financial and management
functions of patient care system.
During this period, several states and large community health agencies developed and/or contracted for their own
computer-based management information systems (MISs).

1980s
During the 1980s, the field of informatics emerged in the health care industry and nursing:
NI became an accepted specialty and many nursing experts entered the field. Technology challenged creative
professionals and the use of computers in nursing became revolutionary.
As computer systems were implemented, the needs of nursing took on a cause-and-effect modality.
During this period, many mainframe HISs emerged with nursing subsystems that documented several aspects of
the patient records; namely, order entry emulating the Kardex, results reporting, vital signs, and other systems that
documented narrative nursing notes via word-processing packages.
Discharge planning systems were developed and used as referrals to community health care facilities in the
continuum of care.
The microcomputer or personal computer (PC) emerged:
o Made computers more accessible, affordable, and usable by nurses and other health care providers.
o PCs served not only as terminals linked to mainframe computers but also a stand- alone systems
(workstations).
o User friendly and allowed nurses to create their own applications
1990s
Beginning with the early 1990s, computer technology became an integral part of health care settings, nursing
practice, and nursing profession.
o The professional organizations identified initiatives that addressed IT and informatics
o Policies and legislation were adopted promoting computer technology in health care including nursing.
The nursing profession became actively involved in promoting NI. In 1992, NI was approved by the American
Nurses Association (ANA) as a new nursing specialty (McCormick et al., 1994).
The 1990s brought smaller and faster computers to the bedside and all of the point-of-care settings.
Workstations and local area networks (LANs) were developed for hospital nursing units.
Wide area networks (WANs) were developed for linking care across the different systems.
The internet made it possible for information and knowledge databases to be integrated into bedside systems.
By 1995, the Internet had moved into the mainstream social milieu with electronic mail (e-mail), file transfer
protocol (FTP), Gopher, Telenet, and WWW protocols, which greatly enhanced its usability and user friendliness
(Saba, 1996; Sparks, 1996).
The INTERNET began to be used for:
o High performance computing and communication (HPCC) or the information highway
o Facilitated data exchange between computer-based patient record systems (CPRSs) across facilities and
settings and overtime.
o The Web became the means for communicating online services and resources to the nursing
community.
o Became an integral component of all IT systems, and the WWW used to browse the Internet and search
worldwide resources (Nicoll, 1998; Saba, 1995b; Saba, 1996; Sparks, 1996).
Post 2000
The early years of the new millennium continued the torrid pace of hardware and software development and
growth.
Further clinical information systems became individualized in the electronic patient record (EPR) and patient
specific systems considered for the lifelong longitudinal record or the electronic health care record (EHR).
Information technologies continued to advance with mobile technology such as:
o Wireless tablet computers
o Personal digital assistance (PDAs)
o Smart cellular telephones
The development and subsequent refinement of voice over internet protocol (VoIP) promises to provide cheap
voice communication for health care organizations.
The advancemnt of the Internet as well as the forces of labor shortage and cost containtment continue to provide
impetus for increased adoption and utilization of information technology in nursing and healthcare.
Post -2000 also witnessed the continued impact of legislation on the U.S, healthcare industry.
The Health Insurance Portability and Accountability Act of 1996 (HIPPA) was enacted to streamline healthcare
transactions and reduce costs.
 NURSING INFORMATICS 5
Eugene Flor L. Ulpindo, MSN, RN, ECE

Standardized transaction and code sets were selected to protect the security as well as ensure the privacy and
confidentiality and were implemented in 2004.
The legislation also recommended healthcare providers use a provider identification number (PIN) to maintain
privacy and security of patient information (Appavu, 1999; Coate and McDonald, 2002).

Four Major Nursing Areas

The historical perspectives of nursing that shaped the need for computers, information technologies, and informatics.

Application of Nursing Informatics:

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

Nursing Practice
Nursing practice has evolved and changed radically. It has become an integral part of the EHR:
for Computer systems with nursing and patient care data, nursing care plans are no longer separate
subsystems of the computerized HISs, but rather integrated into one interdisciplinary patient health record in
the EHR.
Further nursing practice data emerged with the introduction of several nursing terminologies that were
recognized by the ANA as coded terminologies usable for the EHR.
They are used to assess problems, document care, track the care process, and measure outcomes. Thus the
electronic version of nursing practice the computer- has revolutionized and transformed nursing practice.

Work lists to remind staff of planned nursing interventions

Computer generated client documentation
Electronic Medical Record (EMR) and Computer-Based Patient Record (CPR)
Monitoring devices that record vital signs and other measurements directly into the client record (electronic
medical record)
Computer - generated nursing care plans and critical pathways
Automatic billing for supplies or procedures with nursing documentation
Reminders and prompts that appear during documentation to ensure comprehensive charting

Nursing Administration
Nursing administration in hospitals has also changed with the introduction of the computer that links nursing department
together.
Most policy and procedure manuals are accessed and retrieved by computer.
Workload measures, acuity systems, and other nursing department systems are online and integrated with the
hospital or patients EHR system or in separate nursing department systems.
The Internet is being used by nurses to access digital libraries, online resources, and research protocols at the
bedside.

Automated staff scheduling

E-mail for improved communication
Cost analysis and finding trends for budget purposes
Quality assurance and outcomes analysis

Nursing Education
The computer has radically changed nursing education:
Most universities and schools of nursing offer computer enhanced courses, online courses, and/or distant
education.
Campus wide computer systems are available for the students to communicate via e-mail, transfer data files,
access the digital libraries, and retrieve online resources of millions of Internet WWW sites (Saba, 1996).

New educational strategies require different methods of teaching:

The use of internet to teach courses via Web and communicate with their students via e-mail.
Requires new tools, techniques, and full array of multimedia strategies to stimulate students.
Interactive teleconferencing courses (via computer system, digital telephone lines, sattelite communication to
remote sites).

Computerized record-keeping
Computerized-assisted instruction
Interactive video technology
Distance Learning-Web based courses and degree programs
 NURSING INFORMATICS 6
Eugene Flor L. Ulpindo, MSN, RN, ECE

Internet resources-CEU's and formal nursing courses and degree programs

Presentation software for preparing slides and handouts-PowerPoint and MS Word

Nursing Research
Nursing data provides the impetus to use the computer for analyzing nursing data.
Software programs are available for processing both quantitative and qualitative research data.
Large databases are used for meta-analysis to develop evidenced-based practice guidelines (Saba et al., 1989).
The Internet also provides online access to the millions of Web resources around the world which have
increased the capabilities and expanded the field of nursing research.

Computerized literature searching-CINAHL, Medline and Web sources

The adoption of standardized language related to nursing terms-NANDA, etc.
The ability to find trends in aggregate data, that is data derived from large population groups-Statistical
Software, SPSS

Standards Initiatives

Standards initiatives focuses on nursing practice standards, nursing data standards, and healthcare data standards as well
as federal legislation that impact on the use of computer into nursing.

Nursing Practice Standards

The ANA published The Standards of Clinical Nursing Practice (ANA, 1998) which focused not only on the
organizing principles of clinical nursing practice but also the standards of professional performance.
They recommended that the nursing process serve as the conceptual framework for the documentation of nursing
practice.
Nursing practice standards have also been set by the Joint Commission on Accredetation of Hospital Organization
(JCAHO)which stressed the need for:
Adequate records on patients in the hospitals and practice standards for the documentation of care by nurses.
Acuity systems to determine resource use.
Required care plans for documenting nursing care.
Further, they have included in their recent manual the required contents of an EHR, such as what data should be
collected and how the data should be organized in the electronic database (Corum, 1993).

Nursing Data Standards

It has emerged as a new requirement for EHR. There are currently 13 nursing terminologies that have been
recognized by the ANA.
Each of the 13 terminologies was developed at different times, has different characteristics, and is used for
documenting different aspects of nursing practice.
The ANA is responsible for the recognition of the terminologies and for determining if they have met the criteria to
be included in the National Library of Medicine (NLM) United Medcal Language Systems (UMLS) (Humpreys and
Lindberg, 1992; Saba, 1998).

Health Care Data Standards Organizations

It is critical to review the standards of organizations that have emerged to either develop or recommend
healthcare data standards that should be recommended to the federal government as required health care data
standards.
The following are the lists of organizations :
American National Standards Institute (ANSI)- was combined with the Health Care Informatics Standard Board
(HISB) to form ANSI-HISB
American Society for Testing and Materials (ASTM)- is an accredited committee that develops standards for health
information systems designed to assist vendors, users and anyone interested in systematizing health information
(Cedrowska et al., 1999; Hammond, 1994).
Health Level Seven (HL7)- is an organization accredited by ANSI, which was created to develop standards for the
electronic interchange of clinical, financial, and administrative information among independent healthcare-
oriented information information systems.
SNOMED International- is another organization that serves as an umbrella of the structured nomenclatures.
SNOMED CT serves the coding strategy and has become a national standard for EHR aspects of which are
integrated into the UMLS and available to the public.
 NURSING INFORMATICS 7
Eugene Flor L. Ulpindo, MSN, RN, ECE

The National Committee on Vital and Health Statistics (NCVH) Workgroup on Computer-based Patient Records:
o Evaluated and recognized medical, nursing, and other health profession nomenclatures for Department
of Health and Human Service (DHHS).
o Proposed standards for the electronic transmission of federally mandated reimbursement for Medical
and Medicaid patient services.
o Recommended that the selected transaction and code sets primarily focus on privacy and security for the
EHR.
o They have been involved in several other federal and national initiatives such as the Patient Medical
Record Information (PMRI) which is the second phase of the Health Insurance Portability and
Accountability Act (HIPAA) legislation.

Early Computer-Based Nursing Applications

Several computer-based nursing applications were developed in its own way focused on documentation of nursing
practice and management of patient care.
These applications were designed for:
o Hospitals
o ambulatory care settings and
o community health agencies
These major nursing applications, which influenced the industry were subsystems or components of early HISs
focused on:
o Early HISs
o Early ambulatory care information systems
o Early community health nursing information management systems
o Early computer focused nursing projects
o Early educational applications

3. Electronic Health Record (EHR) from a Historical Perspective

An electronic health record (EHR) (also electronic patient record or computerized patient record) is a collection of
electronic health information about individual patients or populations.

It is a record that is capable of being shared within across different health care settings, by being embedded in network-
connected enterprise-wide information system.

Such records may included a whole range of data in comprehensive or summary form, including

o Demographics Medication and allergies,

o Medical history Laboratory test results,
o Immunization status Radiology images,
o Nursing Documentation Billing information

An EHR is generated and maintained within an institution, such as a hospital, integrated delivery network, clinic, or
physician office.

Its purpose can be understood as a complete record patient encounters that allows to automate and streamline workflow
in health care settings and to increase safety through evidence-based decision support, quality management, and outcomes
reporting.

Benefits of Computer Automation in Health Care:

Many of these benefits have came about with the development of the electronic medical record, which is the electronic version of
the client data found in the traditional paper record.

EMR benefits include:

Improved access to the medical record. The EMR can be accessed from several different locations simultaneously, as well as by
different levels of providers.

Decreased redundancy of data entry. For example, allergies and vital signs need only be entered once.
 NURSING INFORMATICS 8
Eugene Flor L. Ulpindo, MSN, RN, ECE

Decreased time spent in documentation. Automation allows direct entry from monitoring equipment, as well as point-of-care data
entry.

Increased time for client care. More time is available for client care because less time is required for documentation and
transcription of physician orders.

Facilitation of data collection for research. Electronically stored client records provide quick access to clinical data for a large number
of clients.

Improved communication and decreased potential for error. Improved legibility of clinician documentation and orders is seen with
computerized information systems.

Creation of a lifetime clinical record facilitated by information systems.

Other benefits of automation and computerization are related to the use of decision-support software, computer software
programs that organize information to aid in decision making for client care or administrative issues; these include:

Decision-support tools as well as alerts and reminders notify the clinician of possible concerns or omissions. An example of
this, is the documentation of patient allergies in the computer system. The health care providers would be alerted to any
discrepancies in the patient medication orders.
Effective data management and trend-finding include the ability to provide historical or current data reports.
Extensive financial information can be collected and analyzed for trends. An extremely important benefit in this era of
managed care and cost cutting.
Data related to treatment such as inpatient length of stay and the lowest level of care provider required can be used to
decrease costs.

The Role of the Nursing Informatics Specialist (NIS):

Because of the increased importance of computers and information technology in the practice of professional nursing; a new role
has emerged, the nursing informatics specialist (NIS). The NIS is a nurse who has formal education, certification and practical
experience in using computers in patient care settings. The American Nurses Association (ANA, 1994), lists several functions of the
NIS:

a) Theory development. The NIS contributes to the scientific knowledge base of nursing informatics.
b) Analysis of information needs. The identification of information that nurses' need to in order to accomplish their work;
client care, education, administration, and research
c) Selection of computer systems. The NIS, guides the user in making informed decisions related to the purchase of computer
systems.
d) Design of computer systems and customizations. The NIS collaborates with users and computer programmers to make
decisions about how data will be displayed and accessed.
e) Testing of computer systems. Systems must be checked for proper functioning before they are made available for use in
patient care.
f) Training users of computer systems. Users need to be trained in how the system works, the importance of accurate data
entry, and how the system will benefit them, and more importantly how it will improve patient outcomes
g) Evaluation of the effectiveness of computer systems. The unique role of the NIS makes them the ideal person to evaluate
the effectiveness of computer systems.
h) Ongoing maintenance and enhancements. The NIS makes sure the computerized system functions properly and explores
possible enhancements to the system that will better serve the users and the patients.
i) Identification of computer technologies that can benefit nursing. The NIS must keep abreast of the changes in the fields of
computers and information technology, including new hardware and software that will benefit the nurse and patient.

Hardware, Software, and the Roles of Support Personnel:

Hardware is the physical part of the computer and its associated equipment. Computer hardware can comprise many different parts,
these include:

Input Devices: used to enter data; keyboard, mouse, trackball, touch screen, light pen, microphone, bar code reader, fax
modem card, joystick, and scanner.

Output Devices: used to view and hear processed data; video monitor screens, printers, speakers, and fax.

Central Processing Unit (CPU) "brain" of the computer, three components:

 NURSING INFORMATICS 9
Eugene Flor L. Ulpindo, MSN, RN, ECE

Arithmetic Logic Unit (ALU): number "crunching"

Memory: is the storage area in which program instruction (code) reside during execution.

Read-only memory (ROM) is permanent; it remains when the power is off. Start-up instructions
for the computer is an example of ROM.

Random access memory (RAM) is a temporary storage area for program instructions and data
that is being processed, it is only active while the computer is turned on. (located on the
motherboard not part of CPU)

Control Unit: manages instructions to other parts of the computer, including input and output devices
"traffic cop"

Secondary Storage: provides space to retain data in an area separate from the computer's memory after the computer is
turned off, these include; hard disk drives, floppy disks, tape, zip drives, optical drives and CD-ROM drives.

Computer Categories:

Super computers, are the largest and most expensive, can perform billions of instructions every second
Mainframes, large computers capable of processing several millions instructions per second. They support
organizational functions, therefore have been the traditional equipment in hospitals. Customized
software results in high cost.
Minicomputer, is a scaled-down version of the mainframe, since they are now becoming more powerful
they can now be found in hospitals and HMO's
Microcomputers (PCs), inexpensive processing power for an individual user.
Laptop or Notebook, Handheld, and Personal Digital Assistants (PDAs)

Networks:

A network is "a combination of hardware and software that allows communication and electronic transfer of information
between computers" (as cited in Hebda, 1998, p. 19).

Hardware may be connected permanently by wire (Ethernet), or temporarily by wireless communication, and
modems/telephone lines. This allows the sharing of computer and software resources, through the use of the network. For
example, several computers may share one computer, or a word processing program could also be accessed by many
different users.

Networks, no matter how small or large, operate with the client/server technology.

A Server stores files and programs that are accessed by the client on the network. When you access the Internet
from home, you the client (your computer), requests files from a Server (another computer), you see the results
displayed on your screen through a browser. You may also access a network in your clinical practice; you the client,
accesses a patient record on the floor from a server, which stores the patient record.

Types of Networks: They range from small (home network) to very large (Internet)

Home Networks - within a home

Local Area Networks (LAN) - networks within a area, location or business. The University connects all its
computers on a LAN.

Wide Area Networks (WAN) - several LAN connected together

Internet - many WAN connected together around the globe to give us the Internet that we use today
Intranets - private company networks that are protected from outside access Kaiser HMO and its clinics
and hospitals is an example.
Extranets - several Intranets connected together, Kaiser maintains Extranet a network connection with its
suppliers

Selection Criteria for Computer Equipment:

 NURSING INFORMATICS 10
Eugene Flor L. Ulpindo, MSN, RN, ECE

When selecting a computer system or related hardware, you must take into consideration the following:

i. The types of applications required Some people need word processing, while others may need database or
spread sheet software.

ii. The program execution time and computer capacity needed to process jobs Complex jobs require more
processor speed and memory.

iii. Storage Capacity Needs are determined by the amount of information that must be kept and the length of
time that it must be retained.

iv. Backup Options When information is critical to conduct daily business, another backup system may be need if
the primary one fails.

Operating Systems: A collection of programs that manage all of the computer's activities, including the control of hardware,
execution of software, and management of information.

Operating Systems provides a user interface by which the individual interacts with the computer. Types include;
text based commands, graphical user interfaces (GUI), and object-oriented interfaces (OOI) a graphic interface in
which visual metaphors are employed.

Roles of Support Personnel:

Support for computer systems and networks are extremely important in order to maintain system functionality, support
includes: 1) planning system upgrades, 2) installation of upgrades for operating systems and various applications, 3)
troubleshooting, and 4) user education and training.

Superuser: This person has additional experience over the average employee and serves as a local resource person.
In the hospital setting this is user who knows the clinical area and the computer system.

Microcomputer Specialist: Provides PC information and training; has special training and degree in computer
science or a related area.

Analyst: They are frequently clinicians, who become involved in system selection and training. Many have learned
their role on the job and furthered their education by taking computer or information science classes.

Programmer: Writes code, computer instructions; they often lack the clinical experience. For this reason the
analysts are responsible for communicating user needs to programmers

Network Administrator: They are responsible for the planning, management and expansion of networks.

Director, Information Services: These individuals should have a board view of the needs of the institution and the
design, implementation, and evaluation of information systems. Responsibilities include planning, policy
development, budgeting, information security, and overall management of the information systems.

Summary Part 1: Informatics in the healthcare profession

Data are collection of numbers, characters or facts that are gathered accordion to some perceived need or analysis and
possibly action at a later point in time
Data have little meaning alone, but a collection of data can be examined for patterns and structure that can be interpreted.
AT this point, data becomes information
Knowledge is the synthesis of information derived from several sources to produce a single concept or idea
Healthcare delivery systems are knowledge-intensive settings with nurses as the largest group of knowledge workers within
those systems. Information technology offer several tools to support nurses and other healthcare workers in their
knowledge work
Good information management ensures access to the right information at the right time to the people who need it. This is
particularly important when the volume of information exceeds human processing capacity
Informatics is application of computer and statistical techniques to the management of information
Nursing informatics is the use of information and computer technology as a tool to process information to support all areas
of nursing, including practice, education, administration, and research. The definition of nursing informatics continues to
evolve
A formal definition of nursing informatics serves to shape job descriptions and educational preparation for informatics
practice
 NURSING INFORMATICS 11
Eugene Flor L. Ulpindo, MSN, RN, ECE

Nursing informatics is a necessity, not a luxury, in todays rapidly changing healthcare delivery system. All nurses need basic
informatics skills
Computer technology facilitates the collection of data for analysis, which can be used to justify the efficacy of particular
interventions and improve the quality of care
Other healthcare providers also benefit from nursing informatics
Nursing informatics allows nurses to have better control over data management
According to the American Nurses Association (ANA) the informatics nurse specialist (INS)has advance graduate education
in nursing informatics or a related field and may hold ANCC certification in informatics whereas the informatics nurse (IN) is
a nurse who works in informatics or has interest in the area but does not have formal informatics preparation
Current education programs fall short of providing the number of needed informatics nurse specialists
New technologies will impact the practice of nursing informatics in ways that cannot be forecast at present
Nursing informatics will continue to evolve with changes in the profession, the healthcare delivery system and informatics
in general
Consumer interactions will become an increasingly important part of nursing informatics practice

Source: Hebda, T. & Czar, P. (2009). Handbook of informatics for nurses & healthcare professional 4 th edition, Pearson, Philippines

Additional Notes Part 2: Nursing Information System

Information system is defined as the use of computer hardware and software to process data into information to solve a
problem
Clinical information system (CIS) are large, computerized database management system that supports several types of
activities that may include provider order entry, results retrieval, documentation, and decision support across distributed
locations
Administrative information system support client care by managing financial and demographic information and providing
reporting capabilities
Nursing information system supports the use and documentation of nursing processes and activities, and provide tools for
managing the delivery of nursing care
2 approaches to nursing care documentation using automated information system
o Traditional nursing process approach allows documentation of nursing care using well-established formats such
as admission assessments, problem lists, and care plans
Standardized nursing language (SNL) include nursing diagnoses defined by NANDA, Nursing
Interventions Classification (NIC), Nursing Outcomes Classification (NOC), and several other languages
Nursing process approach the nursing process approach to automated documentation is based on the
paper forms traditionally used by nurses
Documentation of nursing admission assessment and discharge instruction
Generation of nursing checklist that indicates routine scheduled activities related to the care of
each client
Documentation of discrete data or activities such as vital signs, weight, and I&O measurements
Standardized care plan
Documentation of nursing care in progress note format and of medication administration
o Critical pathway, or protocols approach - often used in multidisciplinary manner, with many types of care
providers accessing the system for information and to document care
Can select one or more appropriate critical pathways for the client
Interaction with physician order
Tracking of protocol variances
Monitoring system are devices that automatically monitor biometric measurements in critical care and specialty areas,
such as cardiology and obstetrics
Order entry system orders for medication and treatments are entered into the computer and directly transmitted to the
appropriate areas such as pharmacy, laboratory, radiology, social service or another area
o Computerized physician, provider, or prescriber entry (CPOE)`
Laboratory systems provide many benefits including shorter turnaround time for results, prevention of duplicate testing,
decreased likelihood of human error, and identification of abnormal results
Radiology information system provides scheduling of diagnostic tests, communication of clinical information, generation
of client instructions and preparation procedures, transcription of results and impressions, and the file room management
such as tracking of film location
Pharmacy application system tracking of medication use, costs, billing information, automatic alerts, access to formulary
information, critical steps to reduce medication errors
 NURSING INFORMATICS 12
Eugene Flor L. Ulpindo, MSN, RN, ECE

Source: Hebda, T. & Czar, P. (2009). Handbook of informatics for nurses & healthcare professional 4 th edition, Pearson, Philippines

Summary Part 2: Healthcare Information System

A hospital or healthcare information system consists of clinical and administrative system

Well-designed clinical information system can improve the quality of client care
Clinical information system can extend the capabilities of healthcare providers
A nursing information system using the nursing process approach should support the use and documentation of nursing
processes and provide tools for managing the delivery of nursing care
The use of standardized nursing languages such as NANDA, NIC and NOC supports automation of nursing documentation
and expands the utility of collected information
The critical pathway/protocol approach to nursing information systems provides a multidisciplinary format for planning and
documenting client care
Other clinical systems, including order entry, radiology, laboratory, pharmacy systems, and physician management systems,
give the nurse and other healthcare providers the support and tools to more effectively care for clients
Administrative systems support the process of client care by managing nonclinical, client-related information, including
demographics, codes for procedures, and insurance
Information systems enable decision makers to examine trends and make informed choices during threes times of
healthcare reform
Federal initiatives for patient safety call for the implementation of computerized physician order entry and barcode
medication administration as a method to reduce error
Personal device assistants and wireless technology further enhance the capability of information systems to support the
work of clinicians
Source: Hebda, T. & Czar, P. (2009). Handbook of informatics for nurses & healthcare professional 4 th edition, Pearson, Philippines

Summary Part 3: Using computer to support healthcare and patient education

Computer technology can help revolutionize education in formal healthcare programs, continuing education, and consumer
education. It also provides informal opportunities for networking among professionals via e-mail, and social networking
systems, such as wikis, blogs, and podcasts
Successful use of computers for education requires careful planning, specific learning objectives, orientation to the
technology, convenient access, opportunities to question what is not understood, instructional design, and sound
evaluation of learning outcomes
Formal education is a logical place to introduce or expands basic computer skills, such as word processing, internet access,
e-mail, online literature searches, and use of Web 2.0 applications
Educational software should be subject to the same review criteria applied to other instructional materials before their
adoption and following student use
Computer instruction should clearly matched curriculum level and objectives
NCLEX-RN preparation programs and HESI exit exams are popular use of computerized test programs in basic nursing
programs
Connectivity to hospital information system from schools of nursing allows students more opportunity to analyze client
information before scheduled clinical experience and facilitates professional socialization
Computers provide invaluable assistance in the preparation of educational materials and presentations, the delivery of
instruction, examinations and evaluations, and the maintenance of educational records
Virtual learning environments (VLE) are examples of the use of computers to teach a subject other than computing. A VLE
offers the following advantages: convenience, decreased learning time, and increased attention
Teleconferencing is the use of computers, audio and video equipment, and high-grade dedicated telephone lines, cable or
satellite connections to provide interactive communication between two or more persons at two or more sites. It may
occur via desktop computers or via larger systems with multiple persons participating at one time
Distance education is the use of print, audio, video, computer, teleconference capability to connect faculty and students
located at a minimum of two different sites. Distance education may take place in real time or on a delayed basis. It
expands educational opportunities without the need for a long commute
Web-based instruction uses the attributes and resources of the internet to deliver and support education. It may be used as
a stand alone course or to supplement traditional classes
E-learning uses electronic media to present instruction. It is often suggested for corporate training because it is considered
to be efficient. It allows users to skip materials they already know
 NURSING INFORMATICS 13
Eugene Flor L. Ulpindo, MSN, RN, ECE

Multimedia refers to the ability to deliver presentations that combine text, voice or sounds, images and video. Multimedia
presentations tend to improve learning by actively engaging the senses
Educational opportunities in nursing informatics range from the informal to the formal. There are numerous introductory
courses on undergraduate and graduate levels. Some institutions offer areas of specialization within a degree on the
graduate level or certificate programs. Opportunities for doctoral work in nursing informatics are limited

Source: Hebda, T. & Czar, P. (2009). Handbook of informatics for nurses & healthcare professional 4 th edition, Pearson, Philippines