Nursing Informatics

Sanil Varghese
HEALTH CARE INFORMATICS-
HISTORY
 MEANING
Informatics comes from the French
word informatique which means
computer science.
Informatics is defined as computer
science+information science.
 DEFINITION
Hebda (1998), defines nursing informatics as
the use of computers technology to support
nursing, including clinical practice,
administration, education and research.
ANA (American Nurses Association) 1994, has
defined nursing informatics as the
development and evaluation of applications,
tools, processes and structures which assist
nurses with the management of data in taking
care of patients or supporting the practice of
nursing.
 APPLICATION OF NURSING
INFORMATICS / GENERAL PURPOSE
Nursing Clinical Practice:
Work lists to remind staff of planned nursing interventions.
Computer generated client documentation.
Electronic medical record (EMR) and Computer based
Patient Record (CPR).
Monitoring devices that record vital signs and other
measurements directly into the client record (EMR).
Computer generated nursing care plans and critical
pathways.
Automatic billing for supplies or procedures with nursing
documentation.
Reminders and prompts that appear during
documentation to ensure comprehensive charting.
Nursing Administration (Health care
information system)
Automated staff scheduling.
E-mail for improved communication.
Cost analysis and finding trends for
budget purposes.
Quality assurance and outcomes
analysis.
Nursing Education:
Computerized record keeping.
Computerized assisted instruction.
Interactive video technology.
Distance learning- web based courses and
degree programmes.
Internet resources- formal nursing courses
and degree programmes.
Presentation software for preparing slides and
handouts- power points and MS words.
Nursing Research:
Computerized literature searching-
CINHAL, Medline and web sources.
The adoption of standardized
language related to nursing terms-
NANDA etc.
The ability to find trends in
aggregate data, that is data derived
from large population groups- SPSS.
 Patient Education:
Nursing informatics can be used for symptom
management and patient education. The nurse can
access the information for the patient or teach the
patient where to find appropriate and helpful
information. For example, on an oncology unit,
nursing informatics can be used to teach patients
effective symptom management of the treatment
modalities which often cause pain, fatigue and
poor nutritional status. Nursing informatics can
also aid in other nursing interventions of the
oncology nurse, such as analgesic administration
and stress-reduction techniques.
 Clinical Alert System:
The computerized clinical alert
system can be used in conjunction
with the hospital pharmacy. A system
design is created to alert both
pharmacy and health staff when two
or more drug prescriptions are
incompatible.
 Patient Data:
Nursing informatics can also be useful in a
physicians clinic. In a managed care
environment, information systems make
administrative management more efficient. The
private practitioner, program or facility to manage
every aspect of patient care can use one data
management system. In each of these health care
settings data management systems can be
applied to treatments, diagnostics,
documentation, practice management, insurance
claims and referrals and protocols as well as
treatment and diagnostics results.
 Telehealth:
Telehealth includes the use of telephones and sophisticated
image transmission systems like ECG, faxes and remote
camera imaging. Telehealth places the ambulance
personnel in touch with the Emergency Department and it
also operates to put the generalist nurses and doctors at
the ED in touch with specialists. Telehealth is used to
evaluate the stroke victims while they are in transit so
appropriate therapy can be initiated quickly upon arrival at
the ED. In similar fashion, a nurse practitioner in a remote
ED might be guided via telephone in the proper procedure
for inserting chest tubes so a man with a collapsed lung
could be stabilized for subsequent transport to a major
hospital. Finally, nursing informatics can be useful for
interdepartmental communication such as ordering
supplies from central supply, lab work, etc.
 Clinical Information:
In order for the nurse to ensure the patient is receiving the
most up-to-date care for a variety of chronic conditions, the
National Institute of Health (NIH) have an agency designed
to offer such guidance. Clinical practice guidelines can be
found at http://www.nhlbi.nih.gov/guidelines/index.htm.
The practice guidelines found at this site provide
management information for asthma, cholesterol,
hypertension and obesity.
Clinical practice guidelines for the management of diabetes
mellitus and menopause can be found at
http://www.aace.com/clinguideindex.htm. Further
information can be found through the Medscape Nurses
site and National Institute of Health- http://www.nih.gov.
 SIGNIFICANCE OF NURSING
INFORMATICS
I. Nursing informatics facilitates
communication.
II. Nursing informatics allows
articulation of organized
information.
III. Nursing informatics leads to
credibility.
BENEFITS OF COMPUTER AUTOMATION IN
HEALTH CARE
 EMR
Improved access to the medical ward: the
EMR can be accessed from several
different locations simultaneously, as well
as by different levels of providers.
Decreased redundancy of data entry: for
example, allergies and vital signs need
only be entered once.
Decreased time spent in documentation:
automation allows direct entry from
monitoring equipment, as well as point of
care data entry.
 Increased time for client care: more time is
available for client care because less time is
required for documentation and transcription of
physician orders.
Facilitation of data collection for research:
electronically stored client records provide quick
access to clinical data for a large number of
clients.
Improved communication and decreased
potential for error: improved legibility of clinician
documentation and orders is seen with
computerized information systems.
Creation of a lifetime clinical record facilitated by
information systems.
 Other Benefits:
Decision support tools as well as alerts
and reminders notify the clinician of
possible concerns or omissions. An
example of this, is the documentation
of patient allergies in the computer
system. The health care providers
would be alerted to any discrepancies
in the patient medication orders.
Effective data management and trend
finding include the ability to provide
historical or current data reports.
 Extensive financial information: can
be collected and analyzed for trends.
An extremely important benefit in
this era of managed care and cost
cutting.
Data related to treatment such as
inpatient length of stay and the
lowest level of care provider required
can be used to decrease costs.
TRENDS NURSING
INFORMATICS:
Past Nursing Informatics
Nursing informatics was first defined
as the use of computer technology to
support nursing, including clinical
practice, administration, education
and research.
 The first generation of nursing information systems
was designed to speed paperwork and
communication. In general, the systems
accomplished this by transferring information to the
computer, what nurses had done on paper and by
telephone. These systems replaced paper records,
filing cabinets and pneumatic tubes. Although this
was helpful and effective in reducing the time spent
on documentation and communication it did not
address many of the fundamental issues for nurses
use of data, information and knowledge to guide
effective care (Executive summary, 2004).
 Until 1948, primary care remained in the home. With
the development of Hill-Burton Act of 1948, money was
provided for the building of hospitals and promoted a
catalyst for change in healthcare. In the 1960s,
Medicare and Medicaid provided reimbursement for
services to many individual patients and the health
insurance industry grew. This provision of funding
allowed many new innovations: new drugs, advanced
surgical procedures, new technologies and equipment,
and sophisticated diagnostic procedures. All of which
led to the development of medical specialties, each
treating a different part of the patient and creating its
own records for what patient (Thede, 2003).
 It is not unusual to find a patient being
treated by several physicians at the
same time. These physicians share little
information; they may duplicate tests or
prescribe medications that are not
compatible with those prescribed by
another physician. The current healthcare
system relies primarily on paper records
that are oriented to episodes and
providers (Thede).
 During the past four decades the U.S. government
has played a major role in the development and
promotion of telehealth through various agencies.
Although interest waned as funds were depleted
in the 1980s, technological advancements made
it a more attractive prospect. Federal monies and
Agriculture Departments 1991 Rural
Development Act laid the groundwork for bringing
the information superhighway to rural areas for
education and telehealth purposes (Hebda, et al,
2001).
 The most aggressive development of
telehealth consults for Armenian
earthquake victims in 1989, while
more recently the military has been
working on several projects to feed
medical images from the battlefield
to physicians in hospitals for
improved treatment of casualties
(Hebda, et al, 2001).
Present Nursing Informatics

Although the history of nursing

informatics extends only some
twenty years, the field is advancing
rapidly as a scientific discipline and
has significant implications for
patient care (Executive Summary,
2004).
 As research in nursing informatics evolves,
it has become apparent that the issues
are far more complex than reducing time
spent on paper work. The high-intensity
generation, management, processing of
data and knowledge are integral
components of nursing care. Informatics
gives nurses the means to carry out these
aspects of care efficiently and effectively
to improve outcomes for patients.
 Nursing informatics impacts nurses today.
Today, evolving standards of practice increase
the nurses accountability. The malpractice
crisis has strengthened accountability and
increased emphasis on complete and detailed
nursing documentation. Changes in
reimbursement methods are affecting nursing
care delivery. Cost containment and
consumerism place additional pressures on
not only the individual nurse but also the
entire nursing profession (Ball, et al. 2000).
 Future Nursing Informatics

Nursing informatics has arrived and

the baby has started to walk. In the
process, nursing informatics has
introduced new challenges and
opportunities along with new
computer applications.
 Nursing informatics is a growing field
for advancement and offers many
potential areas for cost containment.
 Nursing informatics and managed
care, make telehealth an attractive
tool to save healthcare dollars:
Telehealth may provide savings in
the following areas: improved access
to care, allowing clients to be treated
earlier and with fewer interventions.
 Clients may receive treatment in
their own community where services
cost less, improving quality of care
and improved continuity of care
through convenient follow-up.
 Telehealth applications vary greatly and
include client monitoring, diagnostic
evaluations, decision support systems,
storage and dissemination of records for
diagnostic purposes, image
compression for efficient storage and
retrieval, research, voice recognition for
dictation and education of healthcare
professionals and consumers.
 Many providers expect that
telehealth will revolutionize
healthcare. It promises to improve
speed and accuracy of
communicating with medical
providers to gather information and
address concerns.
 Nursing informatics and telehealth
will continue to grow and become
commonplace (Hebda, et al, 2001).
 Telehealth is an expansion of telemedicine and
unlike telemedicine (which more narrowly
focuses on the curative aspect) it
encompasses preventive, promotive and
curative aspects. Originally used to describe
administrative or educational functions related
to telemedicine, today telehealth stresses a
myriad of technology solutions. For example,
physicians use email to communicate with
patients, order drug prescriptions and provide
other health services.
 JOURNAL REFERENCES
Exploring the impact of health
information technology on
communication and collaboration in
acute care nursing.
Nurses experiences using a nursing
information system: early stage of
technology implementation.
The perfect role for nursing
informatics: Nursing staff
development.
 USE OF COMPUTERS IN
HOSPITAL AND COMMUNITY
CLINICAL IMPLICATION
Assessment:
Patient monitoring:
Documentation:
Nursing minimum data sheet:
Telemedicine:
Electronic Medical Records (EMR):
Increased efficiency:
Improved documentation:
Improved quality of care:
Improved security:
Reduced documentation expenses:
ADMINISTRATION:
Provision of data required by the nurse
administrators to:
Define the cost of nursing services.
Evaluate quality assurance programme.
Demonstrate the cost effectiveness of
nursing care
Justify new roles for nursing in the health
care system
NURSING PRACTICE:
Enhance documentation by the nurse.
Provision of data to enable research directed
at examining relationship between data
elements and nursing outcomes to identify
optimal nursing care for use in practice.
Facilitate nursing process through use of the
NMDS in practice.
Nursing workload measurement system: The
three most widely used nursing workload
measurements are:
Project research in nursing:
Medicus.
GRASP (Grace- Reynolds application)
RESEARCH:
The advent of computerized data bases of
literature helps to search rapidly and to retrieve
abstracts of literature immediately.
Conduct online searches of data base.
Provides online full text information on legal,
news, business and general information.
Eg: CINHAL, Medline, Science Direct.
Preparation of research document:
Data gathering:
There are three types of computer assisted
interviewing:
Computer self administered interviewing:
Computer assisted telephone interviewing:
Data analysis:
 EDUCATION:

The use of computer in nursing

education includes:
Computer assisted instruction:
Computer assisted interactive
video instruction:
Simulation:
Tutorials:
 COMMUNITY SETTING:
The main uses of computers in community
are:
Gathering of epidemiological and
administrative statistics.
Patient appointments- identification
system.
Patient assessment and data gathering.
Monitoring.
Documentation.
Special need application.
 PATIENT RECORD SYSTEM
DEFINITION
A medical record is a patient record,
consisting of sufficient data written in
sequence of events to justify the diagnosis
and warrant treatment and end results. It
must be adequately informative, highly
scientific and legally protective.
It may be defined as a clinical, scientific,
administrative and legal document relating
to the patients care.
 IMPORTANCE OF MEDICAL RECORDS
To the patient
It helps in the following ways:
It serves to document the history of the patients
illness.
It serves to avoid omission and unnecessary
repetition of diagnosis and treatment measures.
It assists in the continuity of care in the event that
future illness requires attention in or out of the
hospital.
It serves as evidence to support or to refute any
legal questions which may arise.
It assists the patient and authorities concerned in
fixing disability entitlements under the Workmans
Compensation Act.
 To the hospital
The medical records from the basis of many
phases of administrative efficiency:
It provides the management with statistical
information necessary for decision making with
regard to utilization of resources, planning for
administrative control and future references.
It also furnishes documentary evidence for purposes
of evaluation of hospital care in terms of quality,
quantity and adequacy (medical audit).
It protects the hospital in the event of legal
questions (Torts suits).
 To the doctors
It assures the doctor of the quality and
adequacy of the diagnostic and
therapeutic measures undertaken by him.
It assures the doctor of the continuity of
medical care.
It helps the doctor in self evaluation.
It protects the doctor in case of legal
suits.
 To the public health authorities
It provides a reliable mortality and
morbidity statistics and thus helps
the public health authorities to plan
preventive and social measures to
meet the needs of the community.
Early warning of the incidence of
communicable diseases is often
obtained from hospital records.
 To medical education and
research
Since recorded observations and
case studies are the basis of all
clinical research, medical records
become invaluable in all research
and teaching programmes.
CHARACTERISTICS OF GOOD PATIENT RECORDS

Complete: Sufficient data to identify

the patient, justify diagnosis and
warrant treatment and outcome.
Adequate: All necessary forms and
all relevant clinical information.
Accurate: Capable of quantitative
analysis.
 COMPUTERIZED PATIENT
RECORD
Advantages of CPR:
Have the patients entire history.
Can flag drug reaction problems.
Can eliminate redundancy in record
keeping.
Eliminate the need for taking
repeated histories.
Can, if utilized properly, reduce error.
Disadvantages of CPR:
Are very expensive to set up.
Are less secure.
Require standardized coding
systems, which force all users to use
entries that the computer can
understand.
 FUNCTIONAL COMPONENTS OF A COMPUTER-BASED
PATIENT-RECORD SYSTEM

The five functional components are:

Integrated view of patient data
Clinical decision support
Clinician order entry
Access to knowledge resources
Integrated communication support
THANK
YOU