NUR 215: NURSING INFORMATICS

UNIT 2: COMMUNITY HEALTH APPLICATIONS

LEVEL 2: DIVISION OF MATERNAL AND CHILD NURSING

● When the nurse uses knowledge to make

appropriate decisions and acts on those decisions
OUTLINE he or she exhibits wisdom.

I. Hospital/Critical Care Applications

II. Community Health Applications THREE STATES OF DATA
III. Ambulatory Care Systems
Data at rest data on a storage device
IV. Emergency Preparedness and Response
V. Administrative Assistive Devices and Workplace
data that a database program is
Technologies Data in use
reading or writing
VI. Telehealth
moving between applications, over
Data in motion
DATA AND DATA PROCESSING the network, or over the Internet

DATA
● are raw, uninterrupted facts without meaning DATABASE
INFORMATION ● An organized collection of related data.
● facts with meaning ● Placing notes in folders and folders in file cabinets
KNOWLEDGE is an example of creating a paper database.
● understanding the information ● Basic data can be aggregated and summarized to
WISDOM produce new data and information that a different
● knowledge used to make appropriate decisions set of users may use.
and acting on those decisions
The possibility of finding databases depends on the
NELSON DATA TO WISDOM CONTINUUM four important factors:
● The Nelson data to wisdom continuum moves 1. The data naming (indexing) and organizational
from data to information to knowledge to schemes
wisdom with constant interaction within and 2. The size and complexity of the database
across these concepts as well as the environment. 3. The type of data within the database
4. The database search methodology

TYPES OF DATA
CONCEPTUAL DATA TYPES
1. reflect how users view the data. The source of the
data may be the basis of conceptual data types.
Conceptual data classifications may include
financial data, patient data, or human resource
data

COMPUTER-BASED DATA TYPES

● Alphanumeric data include letters and numbers in
any combination; however, you cannot perform
numeric calculations on the numbers in an
alphanumeric field.
a. Alphanumeric Data
DATA AND DATA PROCESSING b. Numeric Data
● Context and pattern knowledge allow the nurse c. Date and Time
to understand the meaning and importance of d. Logic Data
those data and to make decisions about nursing
actions about the information. COMMON APPROACHES TO ORGANIZING DATA:
● While data by themselves are meaningless, A. Sorting
information and knowledge, by definition, are B. Classifying
meaningful. C. Summarizing
D. Calculating

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DATABASE MANAGEMENT SYSTEM (DBMS)
processes meanings, reorder data
● DBMSs are computer programs that are used to:
○ Input Data output Online and written reports, Processed
○ Store operations data as charts and graphs
○ Modify
○ Process
○ Access Data DATA WAREHOUSES
● A large collection of data imported from several
● Before you can use a DBMS, you must first create
different systems into one database
the structure for the database using the data
● The source of the data includes not only internal
elements necessary to manage the data specific to
data from the institution
the project.
● Can also include data from external sources
● This process of configuring the database software
is called database system design.
● Once you configure the database for the project, DATA MARTS
you use the database software to enter the project ● One might develop a data mart with the historical
data into the computer. data of a department or a small group of
departments
● One might also develop a data mart by exporting a
A FUNCTIONING DBMS CONSISTS OF THREE
INTERACTING PARTS: subset of the data from the data warehouse
(1) The data
(2) The designed database PURPOSES OF A DATA WAREHOUSE
(3) The query language that you use to access the 1. Spares users from the need to learn several
data different applications.
2. Makes it possible to separate the analytical and
ADVANTAGES OF AN AUTOMATED DBMS INCLUDE: operational processing
(1) Decreased data redundancy 3. Provides an architectural design for the data
(2) Increased data consistency warehouse that supports decisional information
(3) Improved access to all data needs.
4. The user can slice and dice the data from different
DBMS: STRUCTURE – FIELDS, RECORDS AND FILES angles and at different levels of detail.

● Fields describe the type of data expected in the

related field FUNCTIONS OF A DATA WAREHOUSE
1. Must be able to extract data from the various
● Each row represents a record of the data in each of
computer systems and import those data into the
the fields of the database
data warehouse
● Each record is assigned a primary identifier (also
2. Must function as a database able to store and
known as primary key or unique identifier)
process the data in the database
● All the records together in a table constitute a file, a
3. Must be able to deliver the data in the warehouse
set of related records that have the same data
back to the users in the form of information
fields.
● A database consists of several files that the DBMS
can then search across the tables or files to find DATA ANALYSIS AND PRESENTATION
data related to any one entity in the database as DATA ANALYTICS
long as they share a common identifier. ● The process one uses to make realistic, quality
decisions using the available data.
THE FUNCTIONS OF A DBMS ARE TO: ● Analysis involves a systematic examination and
1. Store the data evaluation of data to uncover interrelationships
2. Update the records within the data, thereby producing new insights
3. Provide easy retrieval of the data and information.
4. Permit report generation ● The process usually involves breaking the data into
Most DBMS permit you to create custom reports based on smaller parts to better understand the area of
selections of retrieved data. concern.
● Business Intelligence (BI) is when the data includes
administrative data that relates to the day to day
DBMS: COMMON DATABASE OPERATIONS operation of the institution, as well as strategic or
long range planning data.
Data input Input new data, Update data, Change
● Depending on the size of the database, one can
operations or modify data
use simple tools like spreadsheets or other tools
designed for larger data sets.
Data processing information extraction, discover new

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● R Project which is an environment for data ● Healthcare Information Systems refers to a set of
analysis and visualization. systems for the entire healthcare services
● DataWrangler for cleaning and rearranging data. encompassing patient care as well as services for
● CSVKit for working with .csv files the early detection of disease, prevention of health
problems and promotion of wellness, at any
location.
● An information system that facilitates the activities
of a hospital takes into consideration:
○ The functions of a health care facility
○ The capability of information technology
● In general, information systems of a healthcare
facility facilitate two main group of activities,
functions and services i.e.:
1. The core business of providing healthcare
to its clients.
2. Managing the hospital as a business
entity, a provider of hospitality services
and a physical facility
● The Hospital Information System (HIS) is focused
primarily on the Operations Management of the
hospital. However, data available from the system
may be collated, analyzed and used for strategic
management including research. The HIS is
envisaged as consisting of two broad systems i.e.

CAPABILITY OF INFORMATION TECHNOLOGY

DASHBOARDS
● Systems process data and then present it in a
visual layout so that one can easily visualize the
information and the interrelationships for the
purpose of decision making and benchmarking.
● A visual display of the most important information
INFORMATION SYSTEMS FOR PATIENT CARE
needed to achieve one or more objectives,
consolidated and arranged on a single screen so
the information can be monitored at-a-glance.

OBJECTIVES & FUNCTIONS OF PATIENT CARE

INFORMATION SYSTEM
1. Productivity
2. Effectiveness
3. Appropriateness
4. Efficiency
5. Quality
6. Safety
7. Privacy and confidentiality of information
HEALTH INFORMATION SYSTEM
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THE COMPUTERIZED INFORMATION SYSTEM IS

REQUIRED TO PROVIDE THE FOLLOWING FUNCTIONS
1. Guide and enable the performance of patient care
processes
2. Facilitate communication between care providers
through sharing of information
3. Enable automation of work processes through links
within it, integration with other components of the
hospital information system and interfacing with
other computers, machines, printers and scanners
4. Provide clinical decision support at point of care
CLINICAL INFORMATION SYSTEM
5. Gather, store and make available vital clinical
information (individual and aggregated) for primary
NEXT GROUP (to continue)
and secondary use
● The Clinical Information System (CIS) facilitates
6. Maintain a permanent record of events and all
direct patient care i.e. activities where care
activities of patient care (as the electronic medical
providers i.e. mainly doctors and nurses but also
record and other documents based on medico-
includes Dietitians, Therapists, Clinical
legal requirements)
psychologists, Clinical pharmacists, Clinical
Microbiologists, Interventional Radiologists,
THE PATIENT CARE INFORMATION SYSTEM CONSISTS OF:
Endoscopists, Optometrists, Audiologists and
1. Patient/Client Management (Administration)
many others. A good CIS provides assistance and
Information System
guidance for clinicians to perform their work
2. Clinical Information System (CIS)
besides capturing pertinent data that is generated.
a. CIS for various specialties
● The CIS contains application modules (however
b. Clinical Documentation
named) that enable the following:
c. Clinical Decision Support
1. Planning of care (use of Care Plans)
d. Centralized Continuous Monitoring
2. Provision of Clinical Decision Support
System
3. Clinical Data Documentation (Data entry)
e. Electronic Medical Record
4. Quality Control
3. Clinical Support Systems
5. Data Storage
a. Laboratory Information System
6. Data Retrieval and Display
b. Blood Banking Information System
c. Radiology Information System
d. Pharmacy Information System
e. Food and Beverage Supply System
f. Operation Theatre / Suite Information
System
g. Sterilization and Sterile Inventory &
Supplies System
h. Other support systems
4. Bridging or intermediary systems
a. Order Entry – Result Reporting System
(CPOE)
b. Patient Information Database
Management System
5. Applications that support Clinical Governance
a. Clinical Managerial Decision Support
Application
b. Quality and Productivity Management
Application
c. Infection Prevention and Control
Application
d. Clinical Data Extraction and Reporting
Application
6. Means of supplying data to external organizations

CLINICAL SUPPORT SYSTEM

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● The Managerial Information System refer to the set
of sub-systems and applications that assist
managers in running the hospital as a:
a. business entity
b. provider of hospitality services
c. physical facility
COMPONENTS OF MANAGERIAL INFORMATION SYSTEM
Systems that support the business operations include:
1. General Administration Information System & Office
Automation
2. Charging, Billing and Receipt of Payment
● The main patient care applications software i.e. the
(Accounting) System
Clinical Information System and the various Clinical
3. Human Resources Management System
Support Systems are built around key bridging
4. Finance and Budgetary Systems
(intermediary) components:
5. Consumables Purchasing and Inventory System
1. Patient Administration/Management
System (Registration, Scheduling,
Resource allocation)
2. Order-Entry Result Reporting Application
(CPOE)
3. Database Management System (DBMS)
4. Electronic Medical Record
5. A common user-system interface (front
end screen, GUI)

LESSON 1
Hospital/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
MANAGERIAL INFORMATION SYSTEM information will become the important task of the
critical care information system.

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● Collective term for the methodical application of
information science and technology to community
and public health process.
● Focuses on the health information system of the
community, it is centered on the majority part of
the public.
● Emphasizes the prevention of the disease, medical
intervention and public awareness.
● Fulfils a unique role in the community, promoting
and protecting the health of the community at the
same time maintaining sustainability and integrity
of health data and information.

MEDICAL INFORMATION BUS (MIB) GOAL OF COMMUNITY HEALTH INFORMATICS

1. Provides a generalized method of attaching patient ● Effective and timely assessment that involves
monitoring devices to a common interface. monitoring and tracking the health status of
2. This interface converts the unique manufacturer populations including identifying and controlling
data communications protocol into a standardized disease outbreaks and epidemics.
hardware and software system. Medical ● Comprehensive directed towards the majority of
Information Bus (MIB) individuals, families, and the community at large.
3. It eliminates the need for custom connector and
software presently needed to interface such PRIMARY FOCUS OF COMMUNITY HEALTH INFORMATION
device. SYSTEM
4. Has the ability to filter, store and select information ● Preventing, identifying, investigating and
sent for inclusion into the clinical medical record on eliminating communicable health problems.
the clinical computer system. Infusion pumps, ● Accessibility of data and information, through
ventilators, pulse, and other patient equipment are communication
now transmitting clinical information for use in ● Educating and empowering individuals to adopt
clinical data reporting and decision making. health life style
● Facilitate the retrieval of data
● Effective transformation of data into information
● Effective integration of information to other
disciplined to concretized knowledge and creates
better understanding.
● Creation of computerized patient records, medical
information system
● Central repositions of all data such as data
warehouse
● Simple Graphical User Interface (GUI) for nurses
and other healthcare provider, patient and
consumer
ADVANTAGES OF CRITICAL CARE INFORMATION SYSTEM
1. Intelligently integrates and process physiologic and ADVANTAGES OF INTEGRATION OF COMMUNITY HEALTH
diagnostic information and store it to secured SYSTEMS
clinical repository. ● Consistent exchange of response
2. Creates trends analysis with graphical ● Disease tracking
representation of results. ● Data and information sharing
3. Offline stimulation can be performed to test the ● Building strategies
condition of the patients. ● Early detection and monitoring of disease and
4. Provide clinical decision support system sickness
5. Provide access to vital patient information ● Control of spread of disease
6. Providing feedback and quick evaluation of the ● National alertness and preparedness
patient condition and provides alert. ● Building strong communication
7. Offline stimulation can be performed to test the ● Maintaining strong relation between nurses and
condition of the patients. other healthcare provider
8. Provide clinical decision support system ● Continuous coordination of the healthcare
professionals
LESSON 2 ● Synchronization of the decisions
Community Health Information System ● Streamlining of the process

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● Effective management of data and information ● Reduced errors with the availability of various
● Optimal operation of hospital and clinics automation engines – drug interaction engine;
medical alert engine; patient billing engine, etc.
RxBox ● Automated and integrated back-end process such
ADVLTH SYSTESUBHEADING 1 as pharmacy, billing, purchasing, inventory
management, etc.
● Improved clinical outcome analysis – enhanced
research productivity through data mining and
facilitate institutional handling of managed care
challenges in a timely manner.
● Improvement in hospital inventory management. •
Better monitoring and management of costs –
prescription, consumables, doctor’s fees, etc.

ISSUES IN AMBULATORY CARE INFORMATION SYSTEM

● Increased accountability
● RxBox is a multi-component program (biomedical ● The need for continuous support
device, electronic medical record system and ● Privacy and confidentiality of information
telemedicine training) designed to provide better ● Accessibility and security of data and information
access to life-saving health care services in ● Integration and support to the other system
isolated and disadvantaged communities
nationwide. TYPES OF AMBULATORY CARE INFORMATION SYSTEM
● It is one among the Department of Science and 1. Ambulatory EHR/EMR - CureMD, eClinicalWorks,
Technology’s efforts for a “Smarter Philippines”. It iSalus, athenaHealth, Meditouch, Allscripts
is also an ICT (Information and Communications 2. Ambulatory Practice Management - Kareo,
Technology) innovation designed to support the athenaHealth, AdvancedMD, Care360
Department of Health’s call for Kalusugang 3. Ambulatory Patient Portal - Bridge Patient Portal,
Pangakalahatan or Universal Health Care. Solutionreach, Updox
● The RxBox is a telemedicine device capable of 4. Ambulatory Medical Billing - Iridium Suite, Mercury
capturing medical signals through built-in medical Medical, Medical Mastermind, NueMD
sensors, storing data in an electronic medical
record (Community Health Information Tracking
System –CHITS), and transmitting health
information via internet to a clinical specialist in the
Philippine General Hospital for expert advice.

LESSON 3
AMBULATORY CARE SYSTEMS
● Covers a wide range of health care services that
are provided for patients who are not admitted
overnight to a hospital.
● These services are performed at outpatient clinics,
urgent care centers, emergency rooms, ambulatory
or same-day surgery centers, diagnostic and
imaging centers, primary care centers, community
health centers, occupational health centers, mental
health clinics, and group practices.
● Provides automated processing of data and
information such as allergies and medical alerts,
patients accounting system such as charging,
billing, discounts and concessions, diagnostics
imaging treatments, and etc.

ADVANTAGES OF AMBULATORY CARE INFORMATION

SYSTEM
● Real-time and easy access to patient’s medical
records by healthcare providers.
● Improved workflow, which allows more time for
comprehensive patient counseling and review.

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LESSON 5
ADMINISTRATIVE ASSISTIVE DEVICES AND WORKPLACE
TECHNOLOGIES
● Patient care technology has become increasingly
LESSON 4 complex, transforming the way nursing care is
INFORMATICS SOLUTION FOR EMERGENCY conceptualized and delivered.
PREPAREDNESS AND RESPONSE ● Before extensive application of technology, nurses
● Informatics is not only used in hospital but also in relied heavily on their senses of sight, touch, smell,
disaster response. and hearing to monitor patient status and to detect
● It can be used in tacking victims, Electronic health changes.
records, supply inventory and surveillance of threat ● Over time, the nurses’ unaided senses were
detection. replaced with technology designed to detect
● Also, it helps in informing the volunteers about the physical changes in patient conditions.
plans and reports. ● While technology has the potential to improve care,
● Informatics is not only used in hospital but also in it is not without risks.
disaster response. ● The World Health Organization identified that: (1)
● It can be used in tacking victims, Electronic health Technological advances, (2) Economic
records, supply inventory and surveillance of threat investment, and (3) Social and cultural changes,
detection. are contributing to the realization that the health
● Also, it helps in informing the volunteers about the sector must now integrate technology into its way
plans and reports. of doing business
● eHealth is an emerging field of medical
informatics, Referring to the organization and
delivery of health services and information using
the Web and related Technologies.
WEARABLE AND PORTABLE MONITORING SYSTEMS
● Remote patient monitoring, considered
experimental a few years ago, is now maturing,
with a number of applications available.
VitalJacket

● VitalJacket is one example that utilizes

microelectronics in a wearable T-shirt that
continuously monitors electrocardiogram waves
and heart rate.

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Decision Support Tools

● Teletriage is a component of telenursing
● Decision support tools have been developed as a
BodyMed
guide for the teletriage nurse assessing a patient.
● A system available today from BodyMedia is a
● These tools provide the nurse with structure around
wearable monitoring system that focuses on weight
the teletriage processes.
loss, health, and fitness.
● Utilizing these decision support tools, along with
● The armband has sensors that collect heat flux,
nursing judgment and critical thinking skills, helps
galvanic skin response, skin temperature, as well
to minimize risk when providing telephone
as an accelerometer.
assistance.

Telenursing and Decision Support Tools

Health Buddy System

● a remote monitoring platform that provides a daily
interface between care coordinators and patients
with chronic illnesses.
● The appliance can also connect glucose meters,
weight scales, blood pressure cuffs, and other
medical devices so additional patient data are sent
to the healthcare professionals.
● Health Buddy has been used with a variety of
patients, including coronary artery bypass graft,
chronic heart failure, diabetes, and asthma. • Care
providers’ access data that can provide an early
alert of warning signs that the patient is
deteriorating.
● It addresses gaps in care before the patient
becomes critical.
Telenursing
● Telenursing is broadening the role of nurses and
advancing their value in the chain of healthcare
delivery to consumers in remote regions or to
homebound patients.
● Home health nursing via visual communication is a
technique that provides accessible care and
reduces both travel time and expense.