NURSING INFORMATICS IN CANADA The Canadian Nurses Association (CNA) has taken the position that registered nurses

and other stakeholders in healthcare delivery require information on nursing practice and its relationship to client outcomes. A coordinated system to collect, store and retrieve nursing data in Canada is essential for health human resource planning and to e pand kno!ledge and research on determinants of quality nursing care" CNA #elieves that registered nurses should advocate and lead in implementing the collection, storage and retrieval of nursing data at the national level.$ (Canadian Nurses Association, %&&') (ocus of N) in Canada is the role of nursing !ithin healthcare organi*ation. )n most +C organi*ations, nurses manage #oth patient care and patient care units !ithin organi*ation. ,sually nurse clinicians manage patient care and nurse managers administer the patient care units !ithin the organi*ation. Therefore, for some time, nursing-s role in the management of information has #een considered to include #oth the information necessary to manage patient care using nursing process and the information necessary for managing patient care units !ithin the organi*ation. Nurses must #e a#le to manage and process nursing data, information, and kno!ledge to support patient care delivery in diverse care delivery settings (.raves / Corcoran, '010). There is an essential linkage among access to information, client outcomes and patient safety. As 2ang has succinctly and aptly descri#ed the present situation3 )f !e cannot name it, !e cannot control it, finance it, teach it, research it or put it into pu#lic policy$ (Clark / 2ang N., '00%). Canadian Institute for Health Information The esta#lishment of the National +ealth )nformation Council in the late '01&-s lead to the National Task (orce on +ealth )nformation, also kno!n as the 4ilk Task (orce, !hich presented comprehensive goals and a strong vision for a nation!ide health information system. C)+) is an independent, national, not for profit organi*ation, esta#lished 5ointly #y federal and provincial6territorial ministers of health. 7uring the decade of its e istence C)+) has #ecome an ackno!ledged and trusted source of quality, relia#le and timely aggregated health information for use in understanding and improving the management of the Canadian health systems and the health of the population of Canada.

8tandards Council of Canada The Canadian Advisory Council (CAC) on +ealth )nformatics (9%0:) advises the Canadian 8tands Association (C8A). Canadian Organization for the Ad an!ement of Com"uters in Health or COACH# founded in '0;:, has actively initiated professional protocols for using computer systems in Canadian health care. The Canadian Nursing Informati!s Asso!iation )n %&&', a ne! group, the Canadian Nursing Informati!s Asso!iation (CN)A) received emerging group status from the CNA and affiliate status in %&&<. The CN)A no! has full associate status !ith the CNA. The mission of the CN)A is to #e the voice for Nursing )nformatics in Canada. =ecogni*ing the importance of the !ork the CN)A is undertaking, the Canadian Nurses Association has granted associate group status to the CN)A. The Canadian Nurses $ortal $ro%e!t# NurseON&# &'Nursing Strateg( )n %&&>, the Canadian Nurses Association launched the Canadian Nurses $ortal $ro%e!t# shortened to Nurse?N@ to address this vision, in the form of a eAnursing strategy. The purpose of the eAnursing strategy is to guide the development of )CT initiatives in nursing to improve nursing practice and client outcomes$ (Canadian Nurses Association, %&&>, p. ;). O)STAC*&S TO &FF&CTI+& NURSING MANAG&M&NT OF INFORMATION IN CANADA '. )n Canadian health care delivery organi*ations, like hospitals and health care agencies in other countries, the ma5or o#stacles to more effective nursing management of information are3 the sheer volume of information, the lack of access to modern information handling techniques and equipment, and the inadequate information management infrastructure. %. Antiquated manual information systems and outdated information transfer facilities are information redundant and la#or intensive processes, to say nothing of an inappropriate use of an e pensive human resource, that is to say nursing time and energy. <. 8oft!are and hard!are for modern electronic communication net!orks are only t!o aspects of an information infrastructure. The other ma5or aspect is lacking in most hospitals and health services

organi*ations, that is, the a#sence of appropriate infrastructure to facilitate information management. )nfrastructure includes #ut is not limited to3 data management policies and procedures, methods for data ste!ardship and custodianship, user training and information management support staff. 8upport staffs are necessary to support nurses in appropriately analy*ing and interpreting aggregated information. CANADIAN INITIATI+&S DIR&CT&D AT TH& D&+&*O$M&NT OF NURSING COM$ON&NTS OF H&A*TH INFORMATION ,HI-NC. )n Canada nurses are in the fortunate position of recogni*ing the need for nursing data elements at the time !hen the national health infostructure is under development. To prevent nurses in Canada from losing control of nursing data, nurses must take a proactive stance and mo#ili*e resources to ensure the development and implementation of a national health data #ase and a panA Canadian @+= that is congruent !ith the needs of nurses in all practice settings in Canada. Nursing Informati!s in &uro"e @urope is a continent !ith over ;:& million inha#itants in a#out :& countries !ith many different languages, cultures, social systems and other living condition. 4idespread of use of )T in healthcare services is very limited in comparison to other areas of society. The main mission in @urope is to esta#lish a sta#le infrastructure that improves healthcare quality, facilitates the reduction of errors and delivery of evidenced #ased and cost effective care. The @urope ,nion (@,) is a driving force of healthcare informatics development #y funding pro5ects that are all crosscultural involving healthcare professional users, educators, and administrators, al!ays !ith three or more countries participating. Telemedicine or telehealth, !hich is the practice of medicine and nursing over a distance !here data and documents are transmitted through telecommunication system, is !idely disseminated in parts over @urope. Nursing $ra!ti!e in &uro"e Association for Common @uropean Nursing 7iagnoses. )ntervention and outcomes (AC@N7)?), !hich !as esta#lished in '00:. The aim of the association is to support the development of standardi*ed classifications, terminologies, and data sets for sharing and comparing nursing data.

NURSING INFORMATICS IN TH& $ACIFIC RIM Trends in +ealthcare Ne! 9ealand has seen more colla#orative approach resulting in integrated care #eing seen as a priority. )ntegrated care is #eing supported #y technology. The 4e# environment and the use of po!erful integration engines, is no! providing conte tual vie!s of data that is #ro!ser#ased and single logon. Blaced over multiple hospital information systems this connection provides a single patient vie!$ of data across all medical applications. ?nline technologies provide products and services that enhance patient care and improve clinical outcomes through evidenceA#ased health information and decision support systems. Although Ne! 9ealand is a small country, it has a surprising num#er of health )T companies !ho are producing soft!are that is #eing used #oth locally and internationally, the iA+ealth. Ne! 9ealand has #een em#racing changes in technology. No longer is information restricted to individuals and organi*ations. +igher speed net!orks including !ireless and #road#and are ena#ling information in a variety of formats to #e shared. @ ploration into telehealth has occurred in a num#er of fields including teledermatology, teleradiology, telepsychiatry, and telepediatrics (?akley, %&&'). Bersonal 7igital Assistants (B7As) and ta#lets are #eing used in the clinical setting #y students and healthcare professionals. 8ome Australian nurses are using B7As for pointAofAcare information and clinical documentation for community and acute hospital nursing, hospitalA#ased infection control and !ound management. (unding for the use of the technologies is pro#a#ly one of the #iggest limitations imposed in em#racing ne! technologies to enhance care delivery. Nurses need to #e prepared to !ork alongside and use technology to #est care for clients. Current National )nitiatives The Ne! 9ealand Cinistry of +ealth, in %&&', prepared a :Ayear #road strategic directive for information and technology developments, referred to as The 4AD@ =eport$. The report !as produced #y means of colla#oration among industry, clinicians, government and healthcare managers. The report has also formed the foundations for longAterm issues such as @+=s.

NURSING INFORMATICS IN ASIA '0;&sA computers !ere first introduce in Asian Countries. The first applications of information technology in healthcare in Asian countries !ere in Administration# )illing# and Insuran!e.A No! these countries are moving to!ard implementing paperless electronic health records. SOUTH /OR&A ' Comprises of 1 provinces !ith ; metropolitan cities. Total population3 E; million in %&&% ' '0&, ;%&A licensed mid!ives and nurses (1',E;1 are practicing) ' +ealth informatics in Forea gro!n !ith the professional outreach activity of F?=@ANN 8?C)@TG ?( @7)CA2 )N(?=CAT)C8 (F?8C)) as !ell as !ith the help of3 ' .overnment ' Brivate #usinesses ' Academic institutions ' Cedical and Nursing organi*ations US& OF INFORMATION T&CHNO*OG0 IN C*INICA* $RACTIC& Gear %&&&Haccording to report pu#lished #y Forean +ealth )ndustry 7evelopment )nstitute that has hospital information system3 '&&IA Teaching hospitals 0>IA .eneral hospital ;:IA Brivate clinics All Teaching +ospital and E&I of .eneral +ospital ' Use Order Communication SystemAAA4hich ena#le physician to communicate !ith other departments for practice related requisitions and the retrieval of data. A8ome hospitals initially used computers mainly for administration and #illing, later a patientAcare component !as addedAAAThese system allo!ed physician to enter medical orders directly into computer and ma5or departments could receive requisitions and enter test results. AThe nurse !ork list could #e vie!ed on screens or printed so that nurses did not need to copy medication schedules or care activities onto Farde . +ome +ealthcare 8ystemACommunity #ased practice

' They use laptop computers to note and check medication and progress on electronic patients record, and to communicate electronically !ith other nonA healthcare team mem#ers. 1A$AN Bopulation3 '%; million Jt!ice that united kingdomAAAhalf that of ,8 Num#er of hospitals3 '&, &&& hospitals Num#er of nurses3 a#out ;:&, &&&Hincluding %%&, && nurses aides.H %>&,&&& medial doctorsH0&, &&& dentistH%<&, &&& pharmacist. AA)n Kapan all citi*ens can choose healthcare institutions and doctors freely, and their financial contri#ution to health insurance. AThe hospitals received reim#ursement for the #alance from the national health insurance. AThe Kapanese government contri#ute ma imum of ;&, &&& yen to the medical treatment of a person over ' month. H&A*TH INFORMATICS IN 1A$AN '0;&sA Kapan #egan to pay attention to the use of computers in healthcare. '01&A Kapan hosted the )C)A ()nternational Cedical )nformatics Association) conference C@7)N(?1&. KAC)A Kapanese Association of Cedical )nformatics !as also founded during '01&s !ith the aim of supporting health informatics in Kapan. A8tandardi*ation is one of the pro#lems in the use of +ealthcare information technology that needs to #e resolved. China According to the (ifth National Census reported #y the National Lureau of 8tatistics, the population of China !as almost '.< #illion in %&&&. The population is aging fast, !ith those >: years old and older representing >.0>I of the population in %&&& compared to :.:;I in the '00& census. ?nly : and %&I of registered nurses in China have #accalaureates and <A year diplomas, respectively. Nursing )nformation 8ystem in China The development of nursing information management systems #egan in China in late '0;&Ms and they !ere first used in '01;. The first soft!are implementation !as a computerAassisted primary nursing care system. The development of information management systems for nursing in Chinese traditional medicine #egan in '00E.

8ome e amples include a nursing information system for the management of nursing staff, nursing operation !ork, continuing education, scientific research, and finance and economicsN nursing information systems for nursing records and nursing management #ased on an army satellite pro5ect called the No. ' Bro5ect of B2AN and an )nternetA#ased nursing information management system. Thailand Thailand has a population of a#out >: million living in ;> provinces There !ere 0% regional6general hospitals, ;&; community hospitals, and 0,::0 health centers across Thailand in %&&E The government is currently launching a ,niversal +ealthcare Coverage policy in order to improve the access to and quality of healthcare, as !ell as to contain healthcare e penditure. The nThai government is restructuring its healthcare system #y placing more emphasis on primary care and health promotion. The N) !as introduced as small special interest groups and later e panded to the national level through the support of the NurseMs Association of Thailand, the 4+?, and the Cinistry of Bu#lic +ealth (C?B+). Taiwan There !ere >'& hospitals and ';:,&&& healthcare professionals in Tai!an in %&&%, serving a population of %%.: million. The healthcare professionals included <E.<I registered nurses and ';.;I licensed practicing nurses. +istory of Nursing )nformatics in Tai!an The term N) !as first used in Tai!an in '00&. At that time the focus !as on hospital information systems providing nursing data such as personnel information, care planning, and scheduling. 8ince the '01&Ms, computers had #een used in nursing education. Although a formal masterMs program focusing on N) !as not availa#le until %&&'. All #accalaureate programs included at least one or t!o computer courses.

Nursing Informati!s in South Ameri!a Introdu!tion Nursing )nformatics in '< 8outh America countries has #een #ased more on ACT)D)T)@8 of )N7)D)7,A28 than on a policy esta#lished #y governments or national efforts. @ach country has varied levels of development and deployment of technological resources. AAAATechnology is visi#le tendency in '. +ealth %. Nursing @ducation <. Nursing Bractice E. Nursing research :. Administration The gro!th of information technology in 2atin America and the Cari##ean !as #een consistently the !orld-s highest for %& years. Cost developed parts of the country have #etter access and a#ility to implement services and applications in nursing. Nursing Informati!s Initiati es )n 8outh America countries" The initial motivation to develop computer systems in yhe healthcare area !as driven #y financial and administrative concerns. The hospital sector can #e considered the area #etter served #y information systems. '. %. <. E. :. Lra*il Ce ico Argentina Colom#ia Baraguay

These countries have clinical information systems in hospital or health institutes.