THE INTERNET

The internet carries an enormous collection of information resources and services that change the lifestyle of the humanity; links millions of public and private users that perform communications, business and commerce, information

dissemination, file and data transfer, gaming and amusement, etc; and provides the ability for the computer system connected to the network, thru the cables and hard wires to receive and send information from the other computer system, regardless of their locations. Internet is not a government association nor funded by the government. The definitive authority of the Internet is the Internet Society whose purpose is to promote global information exchange. Though, internet and World Wide Web (WWW) are often used interchangeably, one has to take note that these two systems are not the same. The Internet is a global data communications system. It is a hardware and software infrastructure that provides connectivity between computer systems, whereas the World Wide Web (WWW) is one of the services communicated via the Internet. It is a collection of interconnected documents, files, data and other resources, coupled by a hyperlink.

ORIGIN OF THE INTERNET 1969 Department of Defence (DOD) of USA

ARPANET (Advanced Research Projects Administration Network)

MILNET

ARPANET (smaller)

1980 - NSFNET (National Science Foundation Network) 1990 - NSFNET giving birth to Internet

ACCESSIBILITY OF THE INTERNET

Routers

Mobile Phones

INTERNET

Consoles

Handheld Devices

NURSING INFORMATICS Nursing informatics is a collective term for the study of how health care data is acquired, communicated, stored, and managed, and how it is processed and transformed into information and then translated into knowledge.

GOALS FOR IMPLEMENTING AUTOMATION

1 4 5 2

Promote Integrity, Efficiency, Effectiveness, Timeliness Accuracy, Reliability and Safety

Eliminate Errors

Minimize Cost and Contingency Effort

Improve the Quality of Nursing Processes

Improve and Enhance Decision-Making Process

etc

Efficacy and Reliability

Current Current System

Extent of Customization

Interfacing

Workflow Realignment

Streamlining Process

Patient Support and Acceptance Implementation Process

FUNCTIONS OF A COMPUTER SYSTEM

Data acquisition and translation into information

Data Warehousing and Remote Accessing

Communication and Integration of Information

Statistical Information System Effective Decision Support

Computer Systems

FUNCTIONS AND COMPONENTS OF A HEALTHCARE INFORMATION SYSTEM A carefully designed computer-based system can: Increase the effectiveness and productivity of health professionals Improve the quality and reduce the cost of health services Improve levels of service and of patient satisfaction Health Information Systems also shore up the decision-support systems capabilities. Clinical decision-support systems directly assist nurses and other healthcare provider in data preparation, interpretation and decision making, to make diagnostic suggestions, to provide limited therapeutic advice, and to provide information on medication costs. DECISION-MAKING PROCESS IN HOSPITAL AND CLINIC Every practitioner nurses and other healthcare provider must develop a strategic approach to test the selection and interpretation, understand ideas of sensitivity and specificity, and be able to assess the urgency of a situation. Therefore, he/she must be able to: a. Know when additional data become hindrance in decision making that will confuse rather than clarify certain issues and scenarios b. Improve good problem-solving skills c. Know how to set appropriate goals for a task d. Know how to reason out about each goal e. Know how to make explicit the risk between human life and suffering

AUTOMATED DECISION SUPPORT SYSTEMS Automated or computer based decision support system are customized computer programs developed primarily to support nurses and other healthcare provider in decision making and initial assessment of the condition. This automated system dynamically downloads and integrates data and translate it into information, thus, it can be regarded as a medical information expert systems.

PROBLEM WITH ASSESSMENT DATA Experienced nurses are challenged to keep current and appropriately perform data assessment beyond their duty. When assessment data are missing, regardless of the cause, the end result is either an oversight of nursing diagnoses, erroneous diagnoses, or incorrect qualifying statements about the diagnoses. Incomplete collection can occur when the nurse has not taken the time to appropriately address all subjective and objective data. Restricted data collection occurs when a client is unable or unwilling to provide the necessary data. Failure of data validation occurs when the nurse does not confirm previously collected data. Inappropriate data clustering may occur when the nurse lacks sufficient theoretical and clinical expertise and knowledge to appropriately cluster data cues.

MODELLING OF MEDICAL KNOWLEDGE Modelling of knowledge-based decision support system takes a collaborative effort of nurses, healthcare providers, clinicians, physicians, information technology expert, policy makers, hospital management, and government agencies to

conceptualize a state of the art decision-support system suitable to every hospitals and clinics. Creation of a computer-based decision support system thus requires substantial modelling activity: deciding what clinical distinctions and patient data are relevant, identifying the concepts and relationships among concepts that bear on the decisionmaking task, and ascertaining a problem solving strategy that can use the relevant clinical knowledge to reach appropriate solutions.

EVIDENCE-BASED DECISION-MAKING PROCESS Evidence-based decision making involves combining the knowledge arising from ones clinical expertise, patient preferences and the research evidence within the context of available resources. It is a perspective approach to making choices which is based on ideas of how theory can be used to improve real word decision-making. Nurses working on different environment, different processes, and different condition have a different set of decision challenges and the decision time needed.

Nursing 1 -Busy Medical Admission Unit -40 to 50 patients per day - Critical Disease

Nursing 2 -Not so busy -10 patients per day -Health Visitor

Nursing 3 -Information -40 to 50 patients per day -Admission and Visitor

Nursing 4 -Pharmaceutical and Dispensing -200 drug order per day

COMPUTERIZED EVIDENCE-BASED DECISION-MAKING PROCESS Computerized evidence-based decision-making process can be integrated to health information system through the use of statistical information system. It involves combining the knowledge arising from ones clinical expertise, patient preferences, research evidence coupled with computer programming skills.

Statistical Health Information System

Nursing 1 -Busy Medical Admission Unit -40 to 50 patients per day - Critical Disease

Nursing 2 -Not so busy -10 patients per day -Health Visitor

Nursing 3 -Information -40 to 50 patients per day -Admission and Visitor

Nursing 4 -Pharmaceutical and Dispensing -200 drug order per day

Example of Evidence-Based Decision Making Process Based on the tabulated data shown below, Barangay 5 and Barangay 7, has the most number of dengue cases and incident. The field nurse can already decide and prepare necessary actions because of the alarming data gathered. Barangay 5 and Barangay 7 should be prioritized first in the medication process before the other barangay, however, corrective actions, minor relief actions, advance surveillance groups, and strategies.

1% 4% 15% 4% 30% 3% 4% 5%

32%

2%

Barangay 1 Barangay 6

Barangay 2 Barangay 7

Barangay 3 Barangay 8

Barangay 4 Barangay 9

Barangay 5 Baranagay 10

NURSING INFORMATION SYSTEM Nursing Information Systems (NIS) are computer systems that manage clinical data from a variety of healthcare environments, and made available in a timely and orderly fashion to aid nurses in improving patient care.

CONCEPTUAL DESIGN OF NIS PATIENT

NIS Data Base

Level of Education Level of Training

NURSE Availability

Salary Rate

Skills

Decision Capability

NURSING INFORMATICS

Nursing informatics is a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, and knowledge in nursing practice. Nursing informatics facilitates the integration of data, information, and knowledge to support patients, nurses, and other providers in their decision making in all roles and settings.

Nursing Science

Information Science

Computer Science

NURSING INFORMATICS SPECIALIST Is responsible for providing clinical information and data analysis for effective patient care and monitoring. Works with computer systems, data and information analysis systems such as statistical information system to ensure optimal health care is provided. Should have a good understanding of basic nursing techniques and standards coupled with statistical data collection, data analysis and interpretation, information allocation and dissemination capabilities. Evaluates patient care based on the data and information and determines more appropriate care and medical process.

SPECIFIC ROLE NURSE INFORMATION SPECIALIST To employ informatics theories, concepts, methods, and tools; To analyze information and information system requirements; Design, select, implement, and evaluate information systems, data structures, and decision-support mechanisms that support patients, nurses, and their human-computer interactions within healthcare contexts; and To facilitate the creation of new

THE ROLE AND LIMITATIONS OF NURSING INFORMATICS The development of nursing informatics in the Philippines will transform the ways hospital, clinics and healthcare systems acquire, store, process, and converse medical information from one institution to another.

Electronic Health Record

Healthcare Information System

Hospital Information System

Clinical Information System

General Public
Unrestricted Confidential

The full implementation of hospital information system, electronic health record system, clinical information system, etc. should be effectively studied, considering its boundary and limitations in conveying information; one good approach in maximizing the full capability while minimizing its potential hazards is through legal reforms and setting public standards for accessibility.

CONFIDENTIALITY OF MEDICAL DATA Sensible data are susceptible to new technologies of transferring data to an electronic device. Capturing transmitted data over a public wireless network may be technically simple. Public wireless networks should only be used if end-to-end confidentiality of data is ensured, however, sensitive data gathered overtime, patient profile, historical data, etc. should have a proper encrypted code so that no computer system and software could translate and transform the data into a simple format.

STRUCTURE OF DATA INTERCHANGE/FETCHING AND QUERY PROCESS Interchange of standard data between every department such as Pharmacology, Nursing, Critical Care, Laboratory, Accounting and Finance, etc. are processed via a dedicated specialized transmission technique.

SERVER

Finance and Accounting

Nursing Dept

Laboratory Dept

Patient

Policy Maker, Health Institution and Government

Special customized protection for the network

MANIPULATING DATA For auditing purposes, it is necessary that the healthcare information system should have an audit log. Intermediate processing steps must not alter the original data.

ETHICAL ISSUES IN HEALTH INFORMATICS Confidentiality and security of data Decision-support Quality of care Preservation of integrity of data Dependability to computer system Reliance to the information process, etc

NURSE TO PATIENT RELATIONSHIPS If Health Informatics System can improve the nurse to patient relationships, perhaps by improving communication, then we shall have achieved a contented result.