I.

Overview of Informatics and Nursing Informatics

Informatics
- Studies the representation, processing, and communication of information in natural and
engineered systems. It has computational, cognitive and social aspects. The central notion is the
transformation of information whether by computer or communication, whether by organisms or
artifacts.
- It is the science of how to use data, information and knowledge to improve human health and the
delivery of health care services.
- It change the face of healthcare. How?
- As technology advances, healthcare organizations and providers are able to collect, analyze and
leverage data more effectively, influencing the way care is delivered, resources are managed and
teams operate each day.
- Informatic – Science that combines:
 Domain Science
 Computer Science
 Information Science
 Cognitive Science
- Scopes of Informatics:
Informatics has many aspects, and encompasses a number of existing academic disciplines -
Artificial Intelligence, Cognitive Science and Computer Science. Each takes part of Informatics as
its natural domain: in broad terms, Cognitive Science concerns the study of natural systems;
Computer Science concerns the analysis of computation, and design of computing systems;
Artificial Intelligence plays a connecting role, designing systems which emulate those found in
nature. Informatics also informs and is informed by other disciplines, such as Mathematics,
Electronics, Biology, Linguistics and Psychology.

Health Informatics
- Applies principles of computer and information science to the advancement of life sciences
research, health professions education, public health, and patient care.
- This multidisciplinary and integrative field focuses on health information technologies (HIT), and
involves the computer, cognitive, and social sciences.

Nursing Informatics
- According to American Nurses Association NI is the specialty that integrates nursing science with
multiple information management and analytical sciences to identify, define, manage, and
communicate data, information, knowledge, and wisdom in nursing practice.
- NI supports nurses, consumers, patients, the interprofessional healthcare team, and other
stakeholders in their decision-making in all roles and settings to achieve desired outcomes.
- The core phenomena of nursing are: nurse, patient, health and environment. NI is interested in
these core phenomena aside from date, knowledge, information, information structure and
technologies.
- This support is accomplished through the use of information structures, information processes,
and information technology”.
- NI is a nursing specialty that combines nursing, information management and the science of
analytics. The combination of nursing science, health records and data, along with information
technology, is designed to make use of healthcare data through the entire healthcare system,
with the goal of improving patient care and outcomes.
- NI represents the transition of data and data information and knowledge into action.
- It represents the practice, administration, community health, nursing education, and nursing
research applications. Also, it includes other new applications such as international aspects or
peripheral to the field such as legal, consumer issues, or theoretical issues.
- The IT supports nurses to improve quality, ensure safety, measure outcomes, and determine
costs.
 - NI is basically a career field that places emphasis on devising solutions to improve information
communications and management in nursing for the purposes of reducing costs, enhancing
patient care quality, and improving efficiency.
II. Concepts, Principles and Theories in Nursing Informatics

History of Nursing Informatics:

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 expertise; in 1990
this number increased 500% to approximately 5,000 nurses; and by the year 2000 it increased
approximately another 500%. However, by the year 2010, it is anticipated that majority of nurses entering
the profession will be computer literate. It is also anticipated that every healthcare setting – acute care
hospital, academic school of nursing, large community health agency or healthcare setting where nurses
function – will employ at least one NI specialist and will implement some type of a CIS.

What is CIS? A CIS is designed to support clinical nursing practice.

 It requires not only an understanding of professional nursing practice process but also technology
that is the application for the science to function electronically

Six time periods: prior to the 1960s, the 1960s, the 1970s, the 1980s, the 1990s and post-2000
PRIOR to the 1960s.
 Starting in the 1950s, and as the computer industry grew, the use of computers in the health care
industry also grew.
 During this time, there were only a few experts who formed a cadre of pioneers that attempted to
adapt computers to health care and nursing.
 During this time, the nursing profession was also undergoing major changes.
 The image of nursing was improving, nursing practices and services were expanding in scope
and complexity, and the number of nurses was increasing.
The 1960s.
 During the 1960s the uses of computer technology in health care settings began to be
questioned. Questions such as “Why computers?” and “What should be computerized?” were
discussed.
 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.
 The nurses’ station in the hospital was viewed as the hub of information exchange, the most
appropriate center for the development of the computer applications.
 During this period, computer technology advanced, while the number of health care facilities
increased.
 The introduction of cathode ray tube (CRT) terminals, online data communication, and real-time
processing added important dimensions to the computer systems providing more accessible and
“user-friendly” machines.
The 1970s.
 In the 1970s, the inevitable continued integration of computers into nursing.
 Nurses began to recognize the value of the computer for their profession.
 During this decade, giant steps were taken in both dimensions: nursing and computer technology.
 Nurses recognized the computer’s potential for improving the documentation of nursing practice,
the quality of patient care, and the repetitive aspects of managing patient care.
 They assisted in the design and development of nursing applications for the HISs and other
environments where nurses functioned.
 During this period, several states and large community health agencies developed and/or
contracted for their own computer-based management information systems.
 Generally, public health MISs provided statistical information required by local, state, and federal
agencies for specific program funds, whereas home health agencies provided billing and other
 financial information required for reimbursement of patient services by Medicare, Medicaid, and
other third-party payers.
The 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; that is, as new computer technologies emerged and as computer architecture
advanced, the need for nursing software evolved.
 During this period, many mainframe HISs emerged with nursing subsystems. These systems
documented several aspects of the patient record; 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.
 PCs brought computing power to the workplace and, more importantly, to the point-of-care. PC s
served not only as terminals linked to the mainframe computers but also as stand-alone systems
(workstations).
The post-2000.
 The early years of the new millennium continued the torrid pace of hardware and software
development and growth. This growth is reflected in healthcare and nursing, with developments
such as wireless point-of-care, serious consideration for open-source solutions, regional
database projects, and increase IT solutions targeted at all healthcare environments.
 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
record (EHR).
 Information technologies continued to advance with mobile technology such as with wireless
tablet computers, personal digital assistants (PDAs), and smart cellular telephones.
 The development and subsequent refinement of voice over Internet protocol (VolP) promises to
provide cheap voice communication for health care organizations.

A. Informatics Theory

THEORIES, FRAMEWORKS, AND MODELS

 Models are representations of some aspect of the real world.
 It is important to remember that different models reflect different view - points
 Informatics theory builds not just on information theory, but uses concepts from change theories,
system theory, chaos theory, cognitive theory, and sociotechnical theory.

Nursing Informatics models is composed of 5 general models.

1st, Graves and Corcoran's model.
2nd, Schiwirian's model.
3rd, Turley's model.
4th, Data Information Knowledge (D-I-K) model.
5th, Benner's Novice to Expert model.
 The 2 specific informatics models are Philippine Health Ecosystem model and Shift Left model.
According to GRAVES AND CORCORAN’S MODEL (1989), that nursing informatics as the linear /
sequential progression, from data into information and knowledge. Management processing is
integrated within each element, depicting nursing informatics as the proper management of knowledge,
from data as it is converted into information and knowledge.

According to SCHIWIRIAN’S MODEL (1986), nursing informatics involves identification of information

needs, resolution of the needs, and attainment of nursing goals/objectives. Patricia Schwirian proposed a
model intended to stimulate and guide systematic research in nursing informatics, model/ framework that
enables identification of significant information needs, that can foster research

According to TURLEY’S MODEL (1996), nursing informatics is the intersection between the discipline-
specific science (nursing) and the area of informatics. And in this model, there are 3 core components of
informatics, namely Cognitive science, Information science, and Computer science.

In the DATA-INFORMATION-KNOWLEDGE MODEL, NI is a specialty that integrates nursing science,

computer science and information science to manage and communicate data, information,
knowledge and wisdom into nursing practice. Nursing informatics is an evolving, dynamic process
involving the conversion of data into information, and subsequently knowledge.

BENNER’S LEVEL OF EXPERTISE MODEL said that every nurse must be able to continuously exhibit
the capability to acquire skills (in this case, computer literacy skills parallel with nursing knowledge), and
then demonstrate specific skills beginning with the very first student experience.
According BERNER, there are 5 levels of expertise:
1. Novice – individuals with no experience of situations and related content in those situations where
they are expected to perform tasks.
2. Advanced Beginner – marginally demonstrate acceptable performance having built on lessons
learned in their expanding experience base; needs supervision.
3. Competent – enhanced mastery and the ability to cope with and manage many contingencies.
4. Proficient – evolution through continuous practice of skills, combined with professional experience
and knowledge; individual who appreciates standards of practice as they apply in nursing
informatics.
5. Expert – individual with mastery of the concept and capacity to intuitively understand the situation
and immediately target the problem with minimal effort or problem solving.

 According to PHILIPPINE HEALTH CARE ECOSYSTEM:

 Nursing informatics is a huge network that encompasses all the sectors of the health
care delivery system – government agencies, health care facilities, practitioners,
insurance companies, pharmaceutical companies, academic institutions, and suppliers.
And the government, different nursing associations and developmental agencies maintain
and balance the network.

INTEL’S SHIFT LEFT MODEL:

 Patient care shifts/progresses from a high-quality delivery of lift through technology with
increased costs (right side) into quality of life with minimal health costs.
 Inverse relationship between quality of life and cost of care/day.
PATIENT MEDICAL RECORD INFORMATION MODEL (PMRI): BASIS OF EHR
 The type and pattern of documentation in the patient record will be dependent on 3 interacting
dimensions of health care:
 1. Personal Health Dimension - personal health record maintained and controlled by the
individual or family; nonclinical information.
2. Health Care Provider Dimension - promotes quality patient care, access to complete
accurate patient data 24/7.
3. Population Health Dimension - information on the health of the population and the
influences to health; helps stakeholders identify and track health threats, assess
population health, create and monitor programs and services, and conduct research.
ABC CODES:
 Mechanism for coding integrative health interventions by clinician for administrative billing and
insurance claims.
 Includes complementary and alternative medicine interventions and codes that map all NIC,
CCC, and Omaha system interventions.

Perioperative Nursing Data Set (PNDS):

 Universal language for perioperative nursing practice and education; standardize documentation
of perioperative data in all perioperative settings.
 Diagnosis based on NANDA, interventions based on NIC, and outcomes based on NOC.

B. Computer System: Computer / Computer System in Nursing Informatics

The computer
 It is the most powerful technological tool to transform the nursing profession prior to the new
century.
 It transformed the nursing paper-based records to computer-based records.
 The computer and the internet have become essential to the modern day which functions a lot.
 “Computer” is an all-encompassing term referring to information technology (IT), computer
systems, and when they are used in nursing information systems (NISs), nursing applications,
and/or nursing informatics (NI).
 “NI” has emerged as new term encompassing these technologies enabling nurses to manage
health care and patient care more efficiently and effectively and, at the same time, make nurses
more accountable.
 Computers in nursing care are used to manage information in patient care, monitor the quality of
care, and evaluate the outcomes of care.
 Computers and networks are now used for communicating (sending/receiving) data and
messages via the Internet, accessing resources, and interacting with patients on the World Wide
Web.

COMPUTER SYSTEM
 It is a collection of entities (hardware, software and
liveware) that are designed to receive, process,
manage and present information in a meaningful
format.

COMPONENTS OF COMPUTER SYSTEM

 Computer hardware - Are physical parts/ intangible
parts of a computer. eg Input devices, output
devices, central processing unit and storage devices
 Computer software - also known as programs or
applications. They are classified into two classes
namely - system software and application software
 Liveware - is the computer user. Also known as the
human ware. The user commands the computer
system to execute on instructions.
Computer Hardware refers to the physical, tangible computer equipment and devices, which provide
support for major functions such as input, processing (internal storage, computation and control), output,
secondary storage (for data and programs), and communication

Hardware Categories

INPUT DEVICES - Are devices used for entering data or instructions to the central processing unit. Are
classified according to the method they use to enter data.
KEYING DEVICES - Are devices used to enter data into the computer using a set of Keys eg Keyboard,
key-to- storage and keypad.

The keyboard
 Keyboard (similar to a typewriter) is the main input device of a computer .
 It contains three types of keys-- alphanumeric keys, special keys and function keys.
 Alphanumeric keys are used to type all alphabets, numbers and special symbols like $, %, @, A
etc.
 Special keys such as <Shift>, <Ctrl>, <Alt>, <Home>, <Scroll Lock> etc. are used for special
functions.
 Function keys such as <Fl>, <F2>, <F3> etc. are used to give special commands depending
upon the software used e.g.F5 reloads a page of an internet browser.
 The function of each and every key can be well understood only after working on a PC. When any
key is pressed, an electronic signal is produced. This signal is detected by a keyboard encoder
that sends a binary code corresponding to the key pressed to the CPU.
 There are many types of keyboards but 101 keys keyboard is the most popular one.

The keys on your keyboard can be divided into several groups based on function:
 Typing (alphanumeric) keys. These keys include the same letter, number, punctuation, and
symbol keys found on a traditional typewriter.
 Special (Control) keys. These keys are used alone or in combination with other keys to perform
certain actions. The most frequently used control keys are CTRL, ALT, the Windows key, and
ESC.
 Function keys. The function keys are used to perform specific tasks. They are labelled as F1, F2,
F3, and so on, up to F12. The functionality of these keys differs from program to program.
 Cursor Movement (Navigation) keys. These keys are used for moving around in documents or
WebPages and editing text. They include the arrow keys, HOME, END, PAGE UP, PAGE
DOWN, DELETE, and INSERT and ARROW KEYS.
 Numeric keypad. The numeric keypad is handy for entering numbers quickly. The keys are
grouped together in a block like a conventional calculator or adding machine.
POINTING DEVICES - Are devices that enter data and instructions into the computer using a pointer that
appears on the screen. The items to be entered are selected by either pointing to or clicking on them. e.g
mouse, joystick, touch sensitive screen, trackballs

A mouse is a small device used to point to and select

items on your computer screen. It's small, oblong, and
connected to the system unit by a long wire that resembles
a tail and the connector which can either be PS/2 or USB.
A mouse usually has two buttons: a primary button
(usually the left button) and a secondary button.

SCANNING DEVICES - Are devices that capture an object or a

document directly from the source. They are classified
according to the technology used to capture data e.g.
Scanners and Document readers.

Scanners - Used to capture a source document and converts it

into an electronic form.
Example are - FlatBed and HandHeld scanners.

Document readers - Are documents that reads data directly from source document and convey them as
input in the form of electronic signal. e
Types of Document Readers
i) Optical Mar Reader (OMR)Image result for optical
mark reader
ii) Barcode reader
iii) Optical Character reader

THE CENTRAL PROCESSING UNIT (CPU) - Is the brain or the heart of a computer. Is also known as
processor and consist of three units namely:
i) Control Unit ( C U)
ii) Arithmetic logic Unit ( A L U)
iii) Main Memory unit ( M M U)

FUNCTIONS OF CENTRAL PROCESSING UNIT

- Process data
- Control sequence of operaions within the computers
- It gives command to all parts of a computer
- It control the use of the main memory in storing of data and instructions
- it provides temporary storage (RAM) and permanent storage(ROM) of data

C. Personal, Professional, and Educational Informatics

Personal Informatics
 Personal informatics (PI) system allow users to collect and review personally relevant information.
 The purpose commonly envisioned for these systems is that they provide users with actionable,
data – driven self – insight to help them change their behavioral patterns for the better.
 A class of tool that help people collect personally relevant information for the purpose of self –
reflection and self – monitoring.
  The basis of personal health informatics is the availability of online patient information’s, new
resources, desire for self – management and care.
 These tools help people gain self – knowledge about one’s behaviors, habits, and thoughts.
 It goes by other names such as living by numbers, personal analytics, quantified self, and self –
tracking.
 Information services, often accessible via a mobile device, that search, sort, mine, corelate or
otherwise filter information for a persona based on their preferences, transaction logs, location,
social networks and other personally relevant information.

Professional Informatics
 Health Informatics (HI) professionals are tasked with the important responsibilities of obtaining,
storing, organizing manage and utilize data for the purpose of improving the services provided
by the healthcare industry especially for patient care.
 HI specialists with expertise in both healthcare and information technology (IT) are increasingly
integral to the delivery and management of patient care in today’s complex healthcare industry.
 Health informatics professionals use their knowledge of healthcare, information systems,
databases and information technology security to gather, store, interpret and manage the
massive amount of data generated when care is provided to patients.
 They are typically well-versed in the language of medical coding
 Responsibilities of Health Informatics Professionals
- Analyzing data to help facilitate decisions and actions
- Developing data-driven solutions to improve patient health
- Collaborating with other departments in the healthcare system to reduce expenses
through strategic data analysis
- Designing and implementing tools to measure data, patient care effectiveness and
processes
- Facilitating the communication and translation of regulatory and IT requirements between
departments

Educational Informatics
 It represents the convergence of aspects of information science, computing, education,
instructional systems technology, and learning sciences, and building on, integrating, and
extending these areas of endeavors.
 The primary focus is on computer applications, systems and networks that support research in
and delivery of education.
 Education informatics is based upon information science, computer science and education but
particularly addresses the intersection of these broad areas.
 Education informatics is an emerging sub-discipline of education and informatics that "incorporate
new technologies and learning strategies to enhance the capture, organization, and utilization of
information within the field of education

I. Information Technology System Applicable in Nursing Practice

Information systems
 It is an umbrella term for the systems, people and processes designed
to create, store, manipulate, distribute and disseminate information.

Information Technology
 (IT) is the use of computers to store, retrieve, transmit, and manipulate
data or information.
 The most basic information technology definition is that it's the
application of technology to solve business or organizational problems
on a broad scale.
 Information technology is building communications networks for a
company, safeguarding data and information, creating and
 administering databases, helping employees troubleshoot problems with their computers or
mobile devices, or doing a range of other work to ensure the efficiency and security of patient and
company information.

Information Technology Systems

 Information technology falls under the IS umbrella but deals with the technology involved in the
systems themselves.
 It can be defined as the study, design, implementation, support or management of computer-
based information systems.
 IT typically includes hardware, software, databases and networks. Information technology often
governs the acquisition, processing, storage and dissemination of digitized information, or data,
generated through the disciplines of computing and telecommunications.
 Information technology focuses on managing technology and improving its utilization to advance
the overall business goals.

Nursing Informatics: An evolving definition

Since 1980, nursing informatics has been defined broadly either with a focus on the technologic aspects,
on the concept of nurses interacting with technology to produce greater knowledge, or on the role of
nurses who specialized in developing applications of technology to nursing practice – ANA, 2001
A combination of nursing science, information science, and computer science to manage and process
nursing data, information and knowledge to support the practice of nursing and delivery of nursing care –
Grave & Corcoran, 1989
Nursing informatics is 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

Goal of Nursing Informatics, said by the ANA is to:

 Improve the health of population, communities, families, and individuals by optimizing information
management and communication. This includes using technology in the direct provision of care;
establishing administrative system; managing and delivering educational experiences; supporting
life – long learning, and support nursing research.

Nursing Informatics: Scope and Standards of Practice

Nursing Informatics (NI) integrates nursing science, computer and information science, and cognitive
science to manage, communicate, and expand the data, information, knowledge, and wisdom of nursing
practice.
Nurses trained in NI support improved patient outcomes through their expertise in information processes,
structures, and technologies, thus helping nurses and other care providers to create and record the
evidence of their practices.

Information Technology System Applicable in

a. Hospital / Critical Care Application
b. Ambulatory Care System
c. Community Health Application

a. Information Technology System in Critical Care Application

Critical Care Nursing – Is the nursing specialty that deals with human responses to life – threatening
problems. Is responsible to ensure that critically ill patients are seriously conditioned individuals.
Ensure that families of the medically ill patients should receive optimal care.
Rely upon a dedicated knowledge, skills and experience and of course automated system of support and
intelligent system to provide care to patient and families and create environments that are healing,
compassionate and caring.
Critical Care – Multidisciplinary healthcare specialty that cares for patients with acute life – threatening
illness or injury.

Information management is critical to modern health care. Nurses who specialize in informatics work with
computers to help hospitals and medical facilities introduce new clinical information systems, educate
staff on clinical computer applications and use programs to track clinical outcome

Critical Care Applications

Areas where patients require complex assessment, high-intensity medication, continuous therapy and
interventions, and unrelenting nursing attention and continuous watchfulness.
Critical Care Information System
1. Provide real-time resource utilization data and management of information and access critical
care areas through the integration of the medical facilities in the critical care or intensive care unit
to an intelligent computer system which is capable of processing all data.
2. Enables the electronic collection of hospital and patient-specific critical care data of the entire
patient in the critical care areas which can be processed to create a patient profile which generate
real time and historical report on indicators including bed occupancy, delayed discharges,
readmission rates, and outcomes.
3. Automated collection and management of medical information will become the important task of
the critical care information system.

In 1986 Saba and McCormick estimated that the volume of data collected by nurses in critical care sttings
on daily basis was as high as 1,500 data points

Data point is a discrete unit of information. In a general sense, any single facts is a data point. In a
statistical or analytical context, a data point is usually derived from a measurement or research and can
be represented numerically and / or graphically. The term data point is roughly equivalent to datum, the
singular form of data.

Focus of Discussion
 Physiologic monitors
 Arrythmia monitors
 Hemodynamic monitors
Developments
- Functions
 Rapidly analyzed small samples of gas or fluids
 Maintained near – normal physiologic ranges with life –
supporting equipments

 Stored large volumes of data that would otherwise be
disorganized, lost, inaccurate, or illegible
 Address alarms and clinical alerts

IT System in Critical Care Settings

 Process, store, and integrate physiologic and diagnostic information from various sources
 Present deviations from present ranges by an alarm or an alert
 Accept and store patients care documentation in a lifetime clinical repository
 Trend data in a graphical presentation
 Provide access to vital patient information form any locations, both inside and outside of the
critical care setting
 Comparatively evaluated patients for outcome analysis
 Preset clinical data based on concept – oriented views (organize
data by patient problem, or by system)

Bedside Physiologic Monitoring Equipment

  Basic components
 Sensors (e.g. pressuure transducer, ECG electrodes)
 Signals conditioners to amplify or filter the display device (eg, amplifier, oscilloscope,
paper recorder)
 File to rank and order information (eg storage file, alarm signal)
 Computer processor to analyze data and direct reports (eg paper reports, storage for
graphic files, summary reports)
 Evaluation or controlling components to regulate the equipments or alert the nurse (eg a
notice on the display screen, alarm signal)

 Hemodynamic Monitors
Can be used to:
 Measure hemodynamic parameters
 Closely examine cardiovascular functions
 Evaluates cardiac pump output and volume status
 Recognize patterns (arrhythmia analysis) and extract
features
 Assess vascular system integrity
 Evaluate the patinet’s physiologic response to stimuli
 Contniously evaluate blood gases and electrolytes
 Estimates cellular oxygenation
 Continuously evaluate glucose levels
 Store waveforms
 Automatically transmit selected data t a computerized
patient database

 Arrythmia monitor
 Computerized monitoring and analysis of cardiac rhythm
 Basic components:
- Sensors
- Signal Conditioner
- Cardiograph
- Pattern recognition
- Thythm analysis
- Diagnosis
- Written report

Critical care Information System (CCIS)

 Designed to collect, store, organize, retrieve, and manipulate all data related to care of critically ill
patient
 Primary purpose is to recognize patient’s current and historical data for use by all care providers
in patinets care
 Should include data and information from bedside devices and comprehensive plans of care to
guide patinet care

Components of the CCIS

 Patient management
 Vtal sign monitoring
 Diagnostic testing results
 Clinical documentation to support the process of physical assessment findings
 Decision suport
 Medication management
 Interdisciplinary plans of care
 Provider order entry
Advantages of Critical Care Information System
1. Intelligently integrates and process physiologic and diagnostic information and store it to secured
clinical repository.
2. Creates trends analysis with graphical representation of results.
3. Offline stimulation can be performed to test the condition of the patients.
4. Provide clinical decision support system
5. Provide access to vital patient information
6. Providing feedback and quick evaluation of the patient condition and provides alert.

b. Information Technology System in Ambulatory Care System

Goals
1. Inform clinical practice. Bringing information tools to the point of care, especially by investing HER
systems in physician offices and hospital
2. Interconnect clinicians. Building an interoperable health information infrastructure, so that records
follow the patient and clinicians have access and involvement in health decision.
3. Personalize Care. Using health information technology to give consumer more access and
involvement in health decisions.
4. Improve popular health. Expanding capacity for public health monitoring, qulity – of – care
measurement, and bringing research advances more quickly into medical practice.

Issues for Ambulatory Care

  Those who work in ambulatory care are similar across the healthcare enterprise including
increased accountability, the need for continuous and documented service improvements,
pressures to control utilization, and the protection of confidential information

Application Necessary in the Ambulatory Environment Ambulatory

Administrative Benefits
 Reduction in size of the record room
 Reduce time spent finding and delivering chart
 Increase privacy of data
 Formats that are legible
 Comply with legal regulations
 Promotions of quality assurance
 Improve patient satisfaction
 Ability for home access by the physician and nurse practitioners
 Alerts for incomplete data
 Integration of clinical data

c. Information Technology System in Community Health Application

CHN agencies have used computers since the late 1960’s, when computers were introduced into the
healthcare industry.
As healthcare services continued to evolve, community health services primarily due to consumer choice,
cost control initiatives, and the increase in numbers of healthcare recipients with chronic illness.
The changing healthcare trends have been the impetus for increasingly sophisticated Management
Information Systems (MISs),
- which transformed data into information to measure outcomes, track client progress, exchange
healthcare information among physicians, nurses, insurers, managed care companies, regulatory
agencies, and public reporting, and analyze financial data.
- These systems supported clinical care delivery, electronic billing, and had the potential for
multiple user access.
4 domains of Management Information Systems (MISs)
1. Public health that focused on population interventions and the outcomes related to epidemiologic
and / or mortality / morbidity trends
2. Home health that focused on skilled nursing care for individuals or aggregated populations
 3. Special population community practices (e.g mental health) that focused on specific diagnostic
care and / or treatment needs and the outcomes related to care delivery for individuals, diagnostic
groups, and / or aggregated populations
4. Outpatient care that focused on intermittent, episodic, or preventive care for individuals and the
outcomes related to interventions for individuals and / or aggregate groups, inclusive of national
health prevention standards.

Public Health Information Network

The center for disease control (CDC) recognized that there are multiple systems in place that support
communications for public health laboratories, the clinical community, and state and local health
department.
The creation of Public Health Information Network (PHIN) – enable the consistent exchange of
response, health, and disease tracking data between public health partners through defined data and
vocabulary standards.

5 key components of PHIN

1. Detection and monitoring
2. Analysis
3. Information resources and knowledge management
4. Alerting and communication
5. Response

National Electronic Disease Surveillance System – enable to promote the use data and information
system standards to advance the development of efficient and integrated surveillance systems at the
federal, state, and local levels.

It is designed to
1. Detect outbreaks rapidly and monitor the health of the nation
2. Facilitate the electronic transfer of appropriate information from clinical information systems in the
healthcare system to public health department
3. Reduce provider burden in the provision of information
4. Enhance the timeliness and quality of information.

d. Telehealth

Any technology that is used to store, share, or analyze health information can be referred to as “health
information technology” or healthIT”
This broad category includes things like practice management systems and online patient portals.

 Telehealth, or telemedicine, is a group of technologies within health IT that is used to provide

clinical care, health information, or health education at a distance.
 Telehealth is the use of digital information and communication technologies, such as computers
and mobile devices, to access health care services remotely and manage your health care.
These may be technologies you use from home or that your doctor uses to improve or support
health care services.
 Telehealth technology includes both software and hardware.

The goals of telehealth, also called e-health or m-health (mobile health), include the following:
1. Make health care accessible to people who live in rural or isolated communities.
2. Make services more readily available or convenient for people with limited mobility, time or
transportation options.
3. Provide access to medical specialists.
4. Improve communication and coordination of care among members of a health care team and a
patient.
5. Provide support for self-management of health care.
Types of Telehealth Technology
There are three main categories of telemedicine technology: remote patient monitoring, store-and-
forward, and real-time audio/video encounters.

I. Remote Patient Monitoring

 Remote patient monitoring, which is sometimes called self-monitoring or self-testing, is a
means of monitoring patient health and clinical information at a distance.
 It helps to simplify patient compliance with testing, and it lowers the cost of frequent
monitoring.
 It is frequently used in the treatment and management of chronic illnesses like asthma,
cardiovascular disease, and diabetes.

II. Store-and-forward
 Store-and-forward is the oldest form of telehealth technology.
 It refers to the transmission of images or information from one provider to another.
 For example, if your doctor sends digital images of an x-ray to a radiologist for analysis,
they are leveraging store-and-forward telehealth technology. This is one of the most
common uses, but images and information of any type can be transmitted in this matter.
One thing we should point out, however, is that store-and-forward telehealth is not always
covered by state telemedicine reimbursement laws, even in states that require parity for
real-time communication.

III. Real-Time Audio/Video Communication

 Real-time communication is probably what jumps to mind when you think of telehealth
technology.
 It happens with the patient is at one location and the provider is at another and they
connect using a video-enabled device and a telephone or computer audio.
 Sometimes the patient might be at a healthcare facility with a provider and they establish
communications with a specialist at a remote location, other times the patient might not
be at a medical office at all.
 She might join the encounter from work or the office, for example. Many state laws
require insurers to reimburse for these types of video visits. Most don’t have a similar
stipulation for telephone calls that don’t involve video.

Telehealth services that is beneficial for health care.

A. Patient portal
 These portals offer an alternative to email, which is a generally insecure means to
communicate about private medical information.
 A portal provides a more secure online tool to do the following:
 Communicate with your doctor or a nurse.
 Request prescription refills.
 Review test results and summaries of previous visits.
 Schedule appointments or request appointment reminders.
 If doctor is in a large health care system, the portal also may provide a single
point of communication for any specialists you may see.

B. Virtual appointments
 A virtual appointments enable the patient to see their doctor or a nurse via online
videoconferencing. These appointments enable the patient to receive ongoing care from
his/ her regular doctor when an in-person visit isn't required or possible.
 Other virtual appointments include web-based "visits" with a doctor or nurse practitioner.
These services are generally for minor illnesses, similar to the services available at a
drop-in clinic. Some large companies provide access to virtual doctors' offices as a part of
their health care offerings.
  Similarly, a nursing call center is staffed with nurses who use a question-and-answer
format to provide advice for care at home. A nursing call center doesn't diagnose an
illness or prescribe medications.

C. Remote monitoring
 A variety of technologies enable the health care team to monitor patient’s health
remotely.
 These technologies include:
 Web-based or mobile apps for uploading information, such as blood glucose
readings, to patient’s health care team
 Devices that measure and wirelessly transmit information, such as blood
pressure, blood glucose or lung function
 Wearable devices that automatically record and transmit information, such as
heart rate, blood glucose, gait, posture control, tremors, physical activity or sleep
patterns
 Home monitoring devices for older people or people with dementia that detect
changes in normal activities such as falls

D. Doctors talking to doctors

 Doctors can also take advantage of technology to provide better care for their patients.
One example is a virtual consultation that allows primary care doctors to get input from
specialists when they have questions about your diagnosis or treatment.
 The primary care doctor sends exam notes, history, test results, X-rays or other images
to the specialist to review. The specialist may respond electronically, conduct a virtual
appointment with you at your doctor's office, or request a face-to-face meeting.

E. Personal health records

 An electronic personal health record system — often called a PHR system — is a
collection of information about your health that you control and maintain.
 A PHR app is accessible to you anytime via a web-enabled device, such as your
computer, laptop, tablet or smartphone.
 In an emergency, a personal health record can quickly give emergency personnel vital
information, such as current diagnoses, medications, drug allergies and doctor's contact
information.

F. Personal health apps

 A multitude of apps have been created to help consumers better organize their medical
information in one secure place.
 These digital tools may help patient to:
 Store personal health information.
 Record vital signs.
 Calculate and track caloric intake.
 Schedule reminders for taking medicine.
 Record physical activity, such as your daily step count

Informatics Applications in Evidence – based Nursing Practice

 Informatics is becoming increasingly present in the nursing profession due to rapidly changing
technological advances. Healthcare systems are assimilating technology into daily practice at a
quick pace.
 Security and patient privacy must be upheld while achieving the goal of transforming data into
useful knowledge. Integrating informatics with evidence-based practice (EBP) can only help
improve the care we provide to our patients.
 Applying technology to knowledge may help identify potential problems earlier. For example, with
the use of electronic documentation, identifying changes in patient status can occur quickly
because the information is readily available. Trending of patient vital signs is always accessible
 and the data are interpreted, systematized, and arranged. The nurse is able to use this
knowledge to formalize an appropriate plan of action.
 Standardizing nursing language will facilitate acceptance of new methods of documentation in the
electronic health record. A template for nursing notes is one method of assisting with our daily
workload. The use of a template can remind you of important information required in the
documentation of patient care.
 Research studies, patient care data, and national and local standards are used to develop
informatics programs at healthcare organizations. Other measures include return on investment
analysis, patient preferences and/or needs, and infection control data

Integrating Evidence – Based Practice in the IT System

EBP (Evidence – based practice)
 It is a process that has developed from a need to improve the quality and manage the economics
of healthcare delivery.
 It is the process of collecting, processing, and implementing research findings to improve clinical
practice, the work environment, or patient outcomes.
 According to the American Nurses Association (ANA), nursing interventions should be practical,
methodical decisions based on EBP research studies.
 Utilizing the EBP approach to nursing practice helps us provide the highest quality and most cost-
efficient patient care possible. Here we'll discuss the key characteristics of EBP relating to nursing
research.

The components of EBP include:

 A systematic and critical evaluation of the current literature,
 The nurse’s clinical expertise and available resources, and
 Patients’ values and preferences

Computer – generated Nursing Care Plan

 Nursing information system (NIS) can increase efficiency and accuracy in all phase of the nursing
process – assessment, nursing diagnosis, planning, implementing and evaluating. It can help
nurses meet standards of nursing practice and documentation. In addition, a NIS can help nurses
spend more time meeting patients’ needs.
 Consider the following uses of computers in the nursing process
 Assessment
Use the computer terminal to record admission information. As the nurse collect data,
enter further information as prompted by the computer’s software program. Enter data
about the patient’s health status, history, chief complaint and other assessment.
 Nursing Diagnosis
Most current programs list standard diagnosis with associated signs and symptoms as
reference. After the nurse uses their clinical judgement to determine a nursing diagnosis
for each patient, they can rapidly get information related to that diagnosis.
Example: the computer can generate a list of possible diagnosis for a patient with certain
signs and symptoms or it may enable them to retrieve and review a patient’s records
according to the nursing diagnosis
 Planning
To help the nurses begin writing a plan of care, newer computer programs display
recommended interventions for the selected diagnosis and expected outcomes.
Computers also can track for large patient populations

 Implementation
Use the computer to record interventions and patient information such as transfer and
discharge instructions and to communicate this information to other department.
Computer – generated progress notes automatically sort and print out patient data – such
as medication administration, treatments and vital signs – making documentation more
efficient and accurate.
  Evaluation
Nurses can use computers to compare large amount of patient data, help identify
outcomes patients are likely to achieve based on individual problems and needs and
estimate the time frame for reaching outcome goals.
During evaluation, use the computer to record and store observation, patients’ responses
to nursing interventions and nurses own evaluation statements. Nurse also may use
information’s from other health care team members to determine future actions and
discharge planning. If the desire patient outcome hasn’t been achieved record new
interventions taken to ensure desired outcomes.

Application of informatics in Critical pathways

 This are care plans that detail the essential steps in patient care with a view to describing the
expected progress of the patient.
 It reduces the cost of care and the length of patient stay in hospital.
 It also has a positive impact on outcomes, such as increased quality of care and patient
satisfaction, improved continuity of information, and patient education.

Clinical Guideline
 Clinical practice guidelines are “systematically developed statements to assist practitioner
decisions about appropriate health care for specific clinical circumstances.
 Guidelines can be used to reduce inappropriate variations in practice and to promote the delivery
of high quality, evidence-based health care
 The role of informatics in the implementation of clinical guidelines and its integration into the
systems for decision support and clinical audits:
 Informatics can provide strategies that support the access, communication, and evaluation of
clinical guidelines through the three functions identified: knowledge browsing, messaging, and
counting. Knowledge browsing describes the use of informatics to access information from a
knowledge base. Messaging describes the way in which informatics is used to exchange
information—for example, through records, assessments, and referrals.
 Counting describes the use of informatics to generate and analyze data about the impact of
clinical guidelines on practice and quality of care.
 The clinical guideline process context model shows how these three functions can integrate
clinical guidelines into the processes of providing quality health care while promoting the
involvement of patients throughout.

Electronic Journal
 It is a periodical publication which is published in electronic format, usually on the Internet.
 Advantages of e-journal over traditional printed journals:
 It can be search the contents pages and/or the full text of journals to find articles on a certain
subject.
 It can be journal articles can be access using desktop
 Articles are downloadable for printing
 Hypertext links allow individuals to move to different sections within individual journals or articles
and can link to related resources on the Internet.
 Journals can include more images and audio-visual material.
 Journals can be interactive - readers can e-mail the author or editor with their comments.

V. Policies, Guidelines and Laws in Nursing Informatics

There are several laws designed to protect personal health information.

Patients have the right to privacy, and they have the right to have the information shared with healthcare
providers who will use it with discretion in the patient’s best interest.

Importance of federal and state laws that Protect Health Information (PHI) in storing and transmitting by
electronic health record systems.
Privacy Act of 1974
 The Privacy Act of 1974 regulates information collected by the federal government and its
agencies.
 The legislation allows citizens to know what information is collected about them, assure the
veracity of that data and obtain copies of the information.

Alcohol- and Drug-Abuse Patient Confidentiality

 The Confidentiality of Alcohol and Drug Abuse Patient Records rule allows for additional privacy
in any federally assisted drug or alcohol-abuse program.
 Identity, diagnosis and treatment are treated as confidential information.
 Patient impairment does not excuse release of confidential patient information.

Conditions for Coverage of Specialized Services by Suppliers

 The Conditions for Coverage of Specialized Services by Suppliers is part of Medicare laws that
govern providers and requires that all PHI be kept confidential and protected against loss,
destruction or unauthorized use.
 This information requires the written approval of the patient before it is used or forwarded.
Hospitals must protect this information against unauthorized use and current Electronic Health
Records allow for monitoring and securing data.
 Patients always have a right to access their records; an institution is allowed to charge a usual
and customary fee for paper copy costs. These laws extend to home health agencies and long-
term care facilities.

Institutional Review Boards

 Institutional Review Boards are governed by state and federal laws and require informed written
consent and data security and privacy.
 State laws vary and may include special requirements with regard to drug and alcohol treatment,
special disease states and mental illness.

JCAHO
 The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) is a private
organization that has been used since 1965 to accredit hospitals and facilities, which allowed for
their participation in Medicare.

HITECH Act
 The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009
empowers the Federal Department of Health and Human Services (HHS) to oversee the
promotion of Health IT – including quality, safety and security as well as the secure information
exchange.

HIPAA
 The Health Insurance Portability and Accountability Act (HIPAA) of 1996 was enacted to allow for
continuance of health insurance coverage in situations involving job changes or loss.
 Major provisions of this law were enacted to formulate and regulate federal guidelines and
standards pertaining to electronic healthcare.
 Standards were developed to allow for identifications of providers, health insurance plans and
employers, including the National Provider Identifier Standard (NPIS), which provides every
physician with a unique number used in all aspects of healthcare.

Affordable Care Act

 The Affordable Care Act of 2010 was set up to fundamentally change the way people are insured;
goals include lowering healthcare costs and making coverage accessible to previously uninsured
people.

FDASIA
  The Food and Drug Administration Safety and Innovation Act (FDASIA) of 2012 resulted in the
collaboration of the HHS and FDA to recommend a regulatory framework for Health IT to improve
mobile applications and other means to promote patient safety and innovation in healthcare
delivery.

MACRA
 The Medicare Access & CHIP (Children’s Health Insurance Program) Reauthorization Act of 2015
is intended to ensure that physicians are paid fairly, that Medicare Part B costs are controlled and
that healthcare is improved.
 The passage of MACRA in August 2015 signaled a move away from the Sustainable Growth
Rate (SGR) Formula once used to determine physician reimbursement and toward a model
based on the quality, efficiency, value and effectiveness of the medical care provided. In addition,
MACRA also will combine existing quality reporting programs into one new system.

21st CENTURY CURES ACT

 The 21st Century Cures Act, passed by both houses of Congress and signed into law by
President Obama in December 2016, covers many facets of healthcare.
 The goals for all, though, are the same: to “help modernize and personalize health care,
encourage greater innovation, support research, and streamline the system,” according to the
act’s mission statement.

Intellectual Property Law

 Intellectual property (IP) is defined as property that can be protected under federal law, including
copyrightable works, ideas, discoveries, and inventions.
 Most research and publications on IP focus on technological development within companies and
industries and on academic and government laboratories.
 This focus is both the result of and reinforcement for the misconception that modern technological
innovation is the purview of industry and academia.

Copyright Law

Of the four pillars of Intellectual Property Law (copyright, trademark, patent, and trade secret), copyright
is considered the most relevant for nursing professional development specialists (NPDSs). Whether
teaching face to-face or online or developing instructional materials, policies/procedures, or research
proposals, NPDSs must be careful to respect copyright protection related to how and when to use others’
works.
 The Copyright Act of 1976 states that copyright protection is granted to ‘‘original works of
authorship fixed in any tangible medium of expression’’.
 The key concepts are ‘‘protection,’’ ‘‘original with a modicum of creativity,’’ ‘‘authorship,’’ and
‘‘fixed in a tangible form.’’
 Five fundamental rights are sometimes called the ‘‘bundle of rights’’ are given to protect owners
of works to decide who can reproduce, adapt (make a derivative work), publish (distribute),
perform, and publicly display their works, either with or without the owner’s permission
 Current copyright law grants five exclusive rights to the owner of a copyrighted work. These
include the right to: (1) distribute, (2) reproduce, (3) adapt, (4) perform, and (5) publicly display
the protected work.

Netiquette Rules and Guidelines

Netiquette
 It is a set of rules that was developed to instruct Internet users on how to act properly. It is applied
to e-mail conversations, forum postings, and instant messaging.
 According to Hebda, Czar, and Mascara (2005), the core rules of netiquette are:
 Do not assume
 Do not judge
 Do not use all uppercase letters
  Proofread
 Be facilitative
 Be honest
 Reply in a timely manner
 Posts should be brief

Examples of Netiquette:
1. Respect copyright laws for images you use.
2. Do not change the wording when re-posting a message you received.
3. Do not send chain letters via email.
4. Be sure that the recipient of the message knows who you are and is able to contact you. A
signature file can be created that includes your contact information.
5. Try to avoid this by using mixed case.

How can it be applied to health care?

Communication may be via e-mail or website forums.

 The nurse and patient should both use proper etiquette to decrease misunderstandings and
protect patient information.
 It would be appropriate for doctors to review netiquette too.
 The implementation of health care systems has switched phone communication between health
care professionals to e-mail or text messages.
 Doctors are also responsible for communicating health care information to patients. Both nurses
and doctors can use the Internet to further enhance care and suggest optional sources of
information. The patient must still employ netiquette when interacting with these sites and forums

Additional Notes:

Data processing

 Data processing is the conversion of data into usable and desired form.
 This conversion or “processing” is carried out using a predefined sequence of operations either
manually or automatically.
 Most of the data processing is done by using computers and thus done automatically.
 The output or “processed” data can be obtained in different forms like image, graph, table, vector
file, audio, charts or any other desired format depending on the software or method of data
processing used

Fundamentals of data processing

 Data processing is undertaken by any activity which require collection of data.

 This data collected needs to be stored, sorted, processed and analyzed.
 This complete process can be divided into 6 basic simple stages which are:
 Data collection
 Storage of data
 Sorting of data
 processing of data
 Data analysis
 Data presentation and conclusions

Types of data processing

 1. Manual data processing
In this method, data is processed manually without use of machine or electronic device; data is
processed manually without using any machine or tool to get required results; all the calculations
and logical operations are performed manually on the data

2. Mechanical data processing

Data processing is done by use of mechanical device or very simple electronic devices like
calculator, typewriter, and printers.

3. Electronic data processing

This is the fastest and best available method with highest reliability and accuracy. Technology
used is latest as this method uses computers and employed in most of the agencies. The use of
software's forms the part of this type of data processing. Electronic Data Processing is the
modern technique to process data. The data is processed through computer; Data and set of
instructions are given to the computer as input and the computer automatically processes the
data according to the given set of instructions. The computer is also known as electronic data
processing machine

Importance of Data Processing

 Nowadays more and more data is collected for academic, scientific research, private & personal
use, institutional use, commercial use.
 This collected data needs to be stored, sorted, filtered, analysed and presented for it to be of any
use. This process can be simple or complex depending on the scale at which data collection is
done and the complexity of the results which are required to be obtained.
 The time consumed in obtaining the desired result depends on the operations which needs to be
performed on the collected data and on the nature of output file required to be obtained.

Steps/basis of Data Processing

 Batch processing
 Real time processing
 Online Processing
 Multiprocessing
 Time sharing

Dependable Systems for Quality Healthcare

 Is a measure of the extent to which a system can justifiably be relied on to deliver the services
expected from it. It can also be define as the measure of the effectiveness of healthcare delivery,
quality of service and quality of care through the use of health information system.
 The healthcare is undergoing a dramatic transformation from today’s inefficient, costly, manually
intensive, crisis driven model of care delivery to a more efficient, consumer-centric, science-
based model that proactively focuses on health management.

Dependability Comprises the following Six Attributes:

1. System reliability: The system consistently behaves in the same way.

2. Service availability: Required services are present and usable when they are needed.
3. Confidentiality: Sensitive information is disclosed only to those authorized to see it.
4. Data integrity: Data are not corrupted or destroyed.
 5. Responsiveness: The system responds to user input within an expected and acceptable time
period.
6. Safety: The system does not cause harm.

Guidelines for Dependable Systems

All computer systems are vulnerable to both human-created threats, such as malicious code attacks and
software bugs, and natural threats, such as hardware aging and Disasters like earthquakes.

 GUIDELINE 1: ARCHITECT FOR DEPENDABILITY

 GUIDELINE 2: ANTICIPATE FAILURES
 GUIDELINE 3: ANTICIPATE SUCCESS
 GUIDELINE 4: HIRE METICULOUS MANAGERS
 GUIDLINE 5: DON’T BE ADVENTUROUS

The five specified physical safeguards also contribute to system dependability by requiring that facilities,
workstations, devices, and media be protected.

 Access control, including unique user identification and an emergency access procedure
 Audit controls
 Data integrity protection
 Person or entity authentication
 Transmission security

The Role of Technology in the Medication-Use Process

 Due to the numerous steps in required in the care of the healthcare industry is an inherently error-
prone process that is fraught with for mistakes to occur.
 The technology are helpful in medications process since it can help the health care provider to
search the right medicine into a particular patient.
 Using the information technology it will reduce the rate of medication errors.
 Computers are the excellent means for storage of patient related data. Big hospitals employ
computer systems to maintain patient records. It is often necessary to maintain detailed records
of the medical history of patients. Doctors often require the information about a patient’s family
history, physical ailments, already diagnosed diseases and prescribed the right medicines.
 Computers can keep track of prescriptions and billing information.
 They can be used to store the information about the medicines prescribed to a patient as well as
those, which cannot be prescribed to him/her.
 Computers enable an efficient storage of huge amounts of medical data.
 Medicine comprises good knowledge. Computer storage can serve as the best means of housing
this information.
 Medical journals, research and diagnosis papers, important medical documents and reference
books can best be stored in an electronic format.
 In the field of medicine, computers allow for faster communication between a patient and a
doctor. Doctors can collaborate better over the Internet.
 Today, it is possible to obtain experts’ opinions within seconds by means of the Internet. Medical
professionals sitting on opposite sides of the globe can communicate within minutes by means of
the Internet.

Examples of Technology used in the Medication-Use Process

 *Computerized Prescriber Order Entry (CPOE)

  *Bar Code-enabled point-of-care technology
 *Automated Dispensing Cabinets
 *Smart Infusion Pump Delivery Systems

Advanced Terminology Systems and Implementing and Upgrading Clinical Information Systems

 Primary motivation - the need for valid, comparable data that can be used across information
system applications to support clinical decision-making and the evaluation of processes and
outcomes of care.
 Vocabulary problem - Failure to achieve a single, integrated terminology with broad coverage of
the healthcare domain

Reasons for Vocabulary Problem

 Multiple specialized terminologies has resulted to overlapping content, areas of which no content
exists, and large numbers of codes and terms.
 Existing terminologies are primarily intended for human interpretation, with computer
interpretation as only a secondary role

Evaluation Criteria related to Concept-oriented Approaches

 Atomic-based – concepts must be separable into constituent components.

 Compositionality – ability to combine simple concepts into composed concepts
 Concept permanence – once a concept is defined it should not be deleted from a terminology
 Language independence – support for multiple linguistic expressions.
 Multiple hierarchy – accessibility of concepts through all reasonable hierarchal paths with
consistency of views.
 No ambiguity – explicit definition for each term.
 No redundancy – one preferred way of representing a concept or idea
 Synonymy - support for synonyms and consistent mapping of synonyms within and among
terminologies

Components of Advanced Terminology Systems

1. Terminology Model

 A concept-based representation of a collection of domain-specific terms that is optimized for the

management of terminological definitions.
 It encompasses both schemata and type definitions.

2. Representation Language

 Represents classes and their properties

 Able to support the formal definition of concepts in terms of their relationships with other
concepts, and facilitate reasoning about those concepts

3. Computer-Based tools

 A representation language may be implemented using descriptin logic within a software system or
by a suite of software tools.
Clinical Information Systems (CIS)

 “CIS” is an array or collection of applications and functionality; amalgamation of systems, medical

equipment, and technologies working together that are committed or dedicated to collecting,
storing, and manipulating healthcare data and information and providing secure access to
interdisciplinary clinicians navigating the continuum of client care.
 Designed to collect patient data in real time to enhance care by providing data at the clinician’s
fingertips and enabling decision making where it needs to occur-at the bedside”.

Areas addressed by CIS

 Clinical decision support:

 Electronic medical records (EMR):
 Training and Research

Benefits of a CIS

 Ease of obtaining patient data at the point of care

 Ability to search patient data easily
 There is no concern with legibility of charting
 Ability to analyze data easily
 Enhanced patient safety

Key Players to a CIS

 Nurses
 Nurse managers
 Support staff
 Performance improvement analysts
 Physicians
 Administration After all, all of these people will have to use the system

Eight Phases of Clinical Information Systems Implementation

 Planning
 System Analysis
 System Design/ System Selection
 Development
 Testing
 Training
 Implementation
 Evaluation