Foundational Documents Guide Nursing Informatics Practice 2001- The American Nurses Association (ANA) published the Code

of Ethics for Nurses with Interpretative Statements, which is about the direct patient care, education, administration or research. 2003- A second foundational professional document, Nursing Social Policy Statement, Second Edition, provided 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 treatment of human response, and advocacy in the care of individuals, families, communities and populations. 2004- Nursing: Scope and Standards of Practice immediately followed an further reinforces the recognition of nursing as a cognitive profession. Definition Informatics and Healthcare Informatics Informatics is a science that combines a domain science computer science, information science, and cognitive science. Healthcare Informatics may be defined as the integration of healthcare sciences, computer science, information science, and cognitive science to assist in the management of healthcare information. Medical Informatics is now more clearly a subdomain of healthcare informatics may mean informatics used in educating healthcare clients and/or the general public. - Medical Informatics historically has been used in Europe as the preferred term for healthcare informatics.

Nursing Informatics Kathryn Hanna proposed a definition that nursing informatics is the use of information technologies in relation to any nursing functions and actions of nurses (Hannah, 1985). Graves and Corcoran presented a more complex definition of nursing informatics.

- Nursing Informatics is 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 (Graves and Corcoran, 1989). - ANA defined nursing informatics as the specialty that integrates nursing science, computer science, and information science in identifying, collecting, processing and managing data and information to support nursing practice, administration, education, research and the expansion of nursing knowledge (ANA, 1994). Scope and Standards of Nursing Informatics Practice in 2001 - Nursing Informatics is 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.(ANA, 2001b, p.viii) Nursing Informatics as a specialty  Unique among healthcare professions, this designation as a specialty provides official recognition that nursing informatics is indeed a part of nursing and that it has a distinct scope of practice.  The scope of nursing informatics practice includes activities such as developing and evaluating applications, tools, processes, and strategies that assist registered nurses in managing data to support decision-making. Areas of nursing practice: y Client care y Research y Education y Administration Information Handling- the processes involved in managing data, information, and knowledgeincludes naming, organizing, grouping, collecting, processing, analyzing, storing, retrieving, transforming and communicating data and information.

The core phenomena of nursing y Nurse y Patient y Health y Environment Nursing informatics is interested in these core phenomena, decision making, data, information, and knowledge, as well as information structures and technologies.

Models of Nursing Informatics -Models are representations of some aspect of the real world. - Models show particular perspectives of a selected aspect and may illustrate relationships. - Models evolve us knowledge about the selected aspect changes and are dependent on the world view of those developing the model. GRAVES AND CORCORANS SEMINAL WORK - Their model placed data, information, and knowledge in sequential boxes with one- way arrows pointing from data to information to knowledge. The management processing box is directly above, with arrows pointing in one direction from management processing to each of the three boxes. - The model is a direct depiction of their definition of nursing informatics. PATRICIA SCHWARIAN - In 1986 she proposed a model of nursing informatics intended to stimulate and guide systematic research in this discipline. - The model provides a framework for identifying significant information needs, which in turn can foster research. The four elements are the: y The Raw material y The technology y The users TURLEY - Writing in 1996, proposed another model in which the core components of informatics are depicted as intersecting circles.

DATA, INFORMATION, AND KNOWLEDGE

KNOWLEDG E COMPLEXITY iNFORMATION DATA

HUMAN INTELLECT

Registered Nurses as Knowledge Workers - Knowledge work is the exercise of specialist knowledge competencies. - Registered nurses are consummate twenty-first century knowledge workers. Their skill in assessment, planning, critical thinking, and evaluation are transferable to many different settings but are most exquisitely employed in nursing practice. - Atomic level data are the foundation for the transforming processes by which knowledge work is accomplished. - Analysis, and summarization are ways in which an information system can transform atomic level data to information and knowledge.

COMPETENCIES

- Benners (1982) work, built on the Dreyfus model of skill acquisition that describes the evolution of novice to expert, merits discussion for nursing informatics. This changed in skills involves the evolution from a novice level to advance beginner to competent to proficient to finally an expert level. The advanced beginner can marginally demonstrate acceptable performance having built on lessons learned in their expanding experience base. Individuals at these levels often need oversight by teachers or experienced colleagues to help structure the learning experience and support appropriate and successful workplace decision-making and action. - Continued practice, combined with additional professional experience and knowledge, allows the nurse to evolve to the proficient level of appreciating the rules and maxims of practice and the nuances that are reflected in the absence of the normal picture. - Staggers, Gassert, and Curran recently published information about their research identifying informatics competencies necessary for all nurses. - Their conceptual framework guiding the research included computer skills, informatics knowledge, and informatics skills as the informatics competencies. - Identified informatics competencies for four levels of nurses: beginning nurse, experienced nurse, informatics specialist, and informatics innovator. - The ANCC content expert panel has over-sight responsibility for the content of this examination and considers the current informatics environment and research when defining the test content outline. Currently, the topics addressed include human factors, system life cycle, information technology, information management and knowledge generation, professional practice, trends, and issues, and models and theories. - The Healthcare Information and Management System Society(HIMSS) has recently established a certification program that may be of interest to informatics nurses. - The content outlines for the examination and other administrative and application details are available at the HIMMS Website. Electronic Health Record - The focus in this chapter is on the client health record as database. Any client health record, whether paper-based or computer- based, is a database made up of the ,myriad data elements for which data are gathered and which are used in health and healthcare decision making by healthcare practitioners, providers, individuals, and families.

- EHR is a client health record database supported by computer, electronic, and communications technologies. - The concept of EHR emerged, initially, as a computer-based patient record or CPR and was given significant impetus by a 1991 report from the Institute of Medicine that advocated the adoption of the CPR as the primary source of client healthcare data and information. - The CPR was conceived as a longitudinal medical record receiving data from multiple worldwide sources, not simply an electronic copy of the traditional paper medical record. - Other terms for the CPR have been used, such as electronic medical record (EMR), electronic patient record (CMR). - American Society for Testing and Materials (ASTM) Standard E 1384-02a defines the HER as any information related to the past, present, or future physical/mental health, or condition of an individual. - The information resides in electronic system (s)used to capture, transmit, receive, store, retrieve link, and manipulate multimedia data for the primary purpose of providing healthcare and health related services. - An EHR encompasses the entire scope of health information in all media forms. - EHR is the primary source for information about a client; the place where client information is recorded or documented. - In 2001, the National Committee on Vital and Health Statistics (NCVHS) identified the patient medical record information (PMRI) as a model for the specific content necessary for the HER, - The personal health dimension includes the personal health record maintained and controlled by the individual or family, nonclinical information such as self-care trackers and directories of healthcare and public health service providers, and other supports to manage wellness and healthcare decision-making. - There are many reasons for healthcare data and information documentation. These include compliance with law and regulations, adherence to the standards of accrediting agencies, communication with others providing healthcare to the client, conduct of research and clinical trials, provision of a basis for costing out services, and creation of claims for payment for services. TERMINOLOGIES - Concept representation involves the set of terms and relationships that describe the phenomena, processes, and practices of a discipline, such as nursing. Data elements, classification, nomenclatures, vocabularies, and

languages are some of the ways in which nursing concepts may be represented. Data elements are terms for which data are collected and for which values are assigned. Nursing minimum data set (NMDS) developed through Dr. harrier Werleys research is considered the foundational work for nursing languages and represents the first attempt to standardize the collection of essential nursing data. This data contains 16 data elements divided into patient, service, and nursing care elements, and foster the comparison of nursing data across time, settings, and populations. The four nursing care elements include nursing diagnosis, nursing intervention, nursing outcome, and intensity of nursing care. Patient or client demographic elements address personal identification, date of birth, gender, race and residence. The seven service element include unique facility or service agency number, unique health record number of patient, unique number of principal registered nurse provider, episode admission or encounter data, discharge or termination date, disposition of patient, and expected payer. There are other data sets that contain nursing data elements, such as minimum data set (MDS) developed long term care facilities and outcome and assessment information set (OASIS), the home health data set is used by home health agencies. Nursing terminologies offer systematic , standardized ways of describing nursing practice and include data sets: y Taxonomy- is the study of classification and simultaneously refers to the end product of classification. y Nomenclatures- or vocabulary is a set of word labels for naming concepts. y classification systems- are the ordering of entities, including nomenclatures, into groups or classes on the basis of their similarities.

-Nursing terminologies focus on the patient and care process, not reimbursement or mortality, and are increasingly important as EHRs become an integral component of healthcare services delivery. -These terminologies are used to capture, store, and manipulate data in EHRs. - This diversity offers practitioners choices in how to best describe their patient population and practice.

Table1.1 ANA Recognized Terminologies Terminologies Contact Information NANDA-I E-mail: info@nanda.org Website: www.nanda.org Website: www.nursing.uiowa.edu/centers/cncce/

ANA Recognition 1992

Nursing Interventions Classification (NIC)

1992

Clinical Care Website: www.sabacare.com Classification (CCC)[Previously known as Home Health Care Classification(HHCC)] E-mail: martinks@tconl.com Website: www.omahamasystem.org Omaha System Website: www.nursing.uiowa.edu/centers/cncce/ Nursing Outcomes Classification(NOC) E-mail: connie-delaney@uiowa.edu E-mail: diane-huber@uiowa.edu Nursing Management Minimum data set E-mail: judy.ozbolt@vanderbilt.edu (NMMDS) Patient care data set (PCDS) Perioperative nursing data set (PNDs) E-mail: pnds@aorn.org Website: www.aorn.org E-mail: dkonice@cap.org Website: www.snomed.org

1992

1992

1997

1998

1998 1999

1999, 2003

SNOMED CT

E-mail: connie-delaney@uiowa.edu

1999

Nursing minimum data set (NMDS) International

E-mail: coenena@uwm.edu E-mail: aamherdt@uwm.edu Website: www.icn.ch/icnp.htm

2000

Classification for Nursing Practice( ICNP)

E-mail: Melinna.Giannini@alternativelink.com Website: www.alternativelink.org E-mail: susan.matney@ihc.com Website: www.loinc.org

2000

2002

ABC codes

Logical Observation Identifiers Names and Codes (LOINC)

NANDA NANDA-I has evolved from an alphabetical listing in the mid- 1980s to a conceptual system that guides the classification of nursing diagnoses in a taxonomy and includes definitions and defining characteristics. Nursing Interventions Classification (NIC) The fourth edition of NIC contains 514 nursing interventions that describe the treatments nurses perform, update linkages with NANDA diagnoses, and core interventions identified for 44 specialty practice areas. Nursing Outcomes Classification (NOC) The latest edition of NOC has 330 research- based outcomes to provide standardization of expected patient, caregiver, family and community outcomes for measuring the effect of nursing interventions. Clinical Care Classification (CCC) [Formerly Home Health Care Classification (HHCC)] is a research- based nomenclature designed to standardize the terminologies for documenting nursing care in all clinical care setting. - Two terminologies: CCC if Nursing Diagnoses and Outcomes and CCC of Nursing Interventions and Actions.

Omahama System Released in November 2004. Originally developed for use in home health practice, the Omahama System is now used in all clinical settings. - Assessment component: Problem Classification Scheme, Intervention Scheme, Problem Rating Scale for Outcomes. Perioperative Nursing Data Set (PNDS) The PNDS provides a universal language for perioperative nursing practice and education and a framework to standardize documentation. The diagnostic component is based on NANDA, while the interventions are NIC terms and outcomes are from NOC. SNOMED CT The SNOMED CT is a core clinical terminology containing over 357,000 healthcare concepts with unique meanings and formal logic-based definitions organized into multiple hierarchies. As of January 2004, the fully populated table with unique meaning for each concept contains more than 957,000 descriptions. The July 2004 release contained HHCC version 2, NANDA Taxonomy II, NIC Version 4, NOC Version3, PNDS Version 2, and the Omaha System (1992). ABC Codes The ABC Codes provide a mechanism for coding integrative health interventions by clinician by state location for administrative billing and insurance claims. Patient Care Data Set (PCDS) The PCDS includes terms and codes for patient problems, therapeutic goals, and patient care orders. This data set was developed by Dr. Judith Ozbolt. Logical Observation Identifiers Names and Codes (LOINC) The LOINC originated as a database of standardized laboratory terms for result reporting for chemistry, hematology, serology, microbiology, and toxicology.

- LOINC now includes 32,000 terms, including a clinical portion with codes for observations at key stages of nursing process, including assessments, goals, and outcomes. International Classification for Nursing Practice (ICNP) The ICNP is a combinatorial terminology for nursing practice developed by the international nursing community under sponsorship of the International Council of Nurses (ICN). - The ICNP elements o Nursing Phenomena (Nursing diagnosis) o Nursing Actions (Nursing Interventions) o Nursing Outcomes Nursing Management Minimum Data Set (NMMDS) It includes terms to describe the context and environment of nursing practice, and includes terms for nursing delivery unit/service, patient/client population, care delivery method, personnel characteristics, and financial resources. Organizations as Resources Many organizations have emerged to provide information resources and value-added membership benefits that support those individuals interested in healthcare and nursing informatics. The ANA and its affiliates and several nursing specialty organizations have informatics committees and government affairs and lobby offices addressing information technology, EHRs, standards and other informatics issue. American Medical Informatics Association Is an individual membership organization dedicated to the development and application of medical informatics in the support of patient care, teaching, research, and healthcare administration. AMIA serves as an authoritative body in the field of medical informatics and frequently represents the United States in the informational arena of medical informatics in international forums and is the U.S member of the International Medical Informatics Association (IMIA)

Healthcare Information and Management System Society It represents a membership of over 14,000 individuals and 200 corporations interested in healthcare informatics, clinical systems, information systems, management engineering, and telecommunications. HIMSS members are responsible for developing many of todays key innovations in healthcare delivery and administration, including telehealth, CPRs or EHRs, community health information networks, and portable/wireless healthcare computing. National League for Nursing The mission of NLN is to advance quality nursing education that prepares the nursing workforce to meet the needs of diverse populations in an ever-changing healthcare environment. The Educational Technology and Information Management Advisory Council (ETIMAC) was established to promote the effective use of technology in nursing education, both as a teaching tool and as an outcome for student and faculty learning, and to advance the integration of information management into educational practices and program outcomes. Society for Health Systems Is a society of the Institute of Industrial Engineers. SHS itself is an individual membership organization that exists to enhance the career development and continuing education of professionals who use industrial and management engineering expertise for productivity and quality improvement in the healthcare industry. Association for Computing Machinery It was founded in 1947 and has become a major force in advancing the skills of information technology professionals and students worldwide. ACMs over 75,000 members have made possible the development of ACMs leading portal to computing literature and its authoritative publications, pioneering conferences, and twenty-first century leadership. ARMA International

Is a not-for-profit association serving more than 10,000 information management professionals in the United States, Canada, And over 30 other nations. The mission of ARMA international is to provide education, research, and networking opportunities to information professionals, to enable them to use their skills and experience to leverage the value of records, information, and knowledge as corporate assets and as contributors to organizational success. American Society for Information Science and Technology It was established in 1937, describes itself as the society for information professionals leading the search for new and better theories, techniques, and technologies to improve access to information.