GROUP 5 WRITTEN

OUTPUT
(Chapter 37-42)

Submitted by:
AMANSE, JOTESSA
PEREZ, LEA ANN
MAULION, FRANCIS
VARGAS, MERLAND
BLANCE, MARY GRACE
CEDO, APRIL
TURIANO, APRIL KRISTINE
LASTRELLA, RONALYNE
SAN JOSE, JEDAH
SAN JOSE, JILLIAN

Submitted to:
Jonathan Orea, R.N, M.A.N
INTERNATIONAL
PERSPECTIVES

2
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
expand knowledge and research on determinants of quality nursing
care… CNA believes that registered nurses should advocate and lead in
implementing the collection, storage and retrieval of nursing data at
the national level.” (Canadian Nurses Association, 2001)
Focus of NI in Canada is the role of nursing within healthcare
organization. In most HC organizations, nurses manage both patient
care and patient care units within organization. Usually nurse clinicians
manage patient care and nurse managers administer the patient care
units within the organization. Therefore, for some time, nursing’s role
in the management of information has been considered to include both
the information necessary to manage patient care using nursing
process and the information necessary for managing patient care units
within the organization.
Nurses must be able to manage and process nursing data,
information, and knowledge to support patient care delivery in diverse
care delivery settings (Graves & Corcoran, 1989). There is an essential
linkage among access to information, client outcomes and patient
safety. “As Lang has succinctly and aptly described the present
situation: If we cannot name it, we cannot control it, finance it, teach
it, research it or put it into public policy” (Clark & Lang N., 1992).

3
 Access to information about their practice arms nurses with evidence
to support the contribution of nursing to patient outcomes. Outcomes
research is an essential foundation for evidence based nursing
practice. Evidence based practice is a means of promoting and
enhancing patient safety.

CONTEXTUAL FACTORS INFLUENCING THE DEVELOPMENT OF

HEALTH INFORMATION IN CANADA
Pressure on health services delivery systems Demographic
changes
[New treatments, new programs, new

technologies] Managed care Risin

g
drug
1. Economic reason
2. Eroded tax base
costs
3. Reduced Shifting paradigm to
intergovernmental community-based
transfer of funds care

HEALTH SERVICES Maldistribution of

DELIVERY SYSTEM professional
Decreasing caregivers
government
expenditures on
health care Rising labor cost

Effectiveness
Efficiency (fiscal (Outcomes)
accountability) Quality of
ca
re
NATIONAL HEALTH INFORMATION ORGANIZATIONS

 Canadian Institute for Health Information

The establishment of the National Health Information Council in the
late 1980’s lead to the National Task Force on Health Information, also
known as the Wilk Task Force, which presented comprehensive goals

4
and a strong vision for a nationwide health information system
(National Task Force on Health Information, 1990, November).
Subsequently, the recommendations of the Wilk Task Force (National
Task Force on Health Information, 1991) resulted in the merger of four
existing entities to create the Canadian Institute for Health Information
(CIHI) in 1992 (Canadian Institute for Health Information, 2002;
Project Team for the Planning of the Canadian Institute for Health
Information, 1991, December). CIHI is an independent, national, not
for profit organization, established jointly by federal and
provincial/territorial ministers of health,

During the decade of its existence CIHI has become an

acknowledged and trusted source of quality, reliable 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.

 Canada Health Infoway Inc.

As CIHI, and its various aggregated databases, evolved and
matured, their focus was on health indicators and population health as
well as information to manage the health care system. The health care
community came to realize that there was still limited information
available to support decision making related to clinical care of
individuals and groups of patient/clients of the health systems. The
need for a pan-Canadian electronic health record gradually emerged
during the later half of the 1990’s beginning with the report of the
National Forum on Health (National Forum on Health, 1997, February).
The recommendations in this report resulted in the commitment in
October, 2000 by the federal government of $500 million to support

5
the development and coordination of pan-Canadian health information
systems necessary to achieve an Electronic Health Record. This
funding was recognition by federal, provincial and territorial
governments of the potential of information and communications
technologies to improve the efficiency, cost-effectiveness, access,
quality and safety of health services in Canada. The
Federal/Provincial/Territorial Advisory Committee on Health
Infostructure (Advisory Committee on Health Infostructure, 2001,
November) set its top priority on the development of electronic health
records (EHR) and telehealth. It identified the need to begin working
immediately on the building blocks for the next stages in development
of EHRs.
Canada Health Infoway Inc. (Infoway) was incorporated in January
2001 and began its first year of operation in April, 2001. The Infoway
Mission (Canada Health Infoway Inc., 2005) is “ Fostering and
accelerating the development and adoption of electronic health
information systems with compatible standards and communication
technologies on a pan-Canadian basis with tangible benefits to
Canadians. Infoway will build on existing initiatives and pursue
collaborative relationships in pursuit of its mission.”
The emerging pan-Canadian EHR will ultimately incorporate data
related to patient assessment and interventions contributing to patient
outcomes and providers’ patterns of practice. It is imperative that
nursing assessments, interventions and practice patterns are included
in the EHR because nursing is the single largest group of health care
providers.

 Standards Council of Canada

The Canadian Advisory Council (CAC) on Health Informatics (Z295)

6
advises the Canadian Stands Association (CSA). CSA is accredited by
the Standards Council of Canada (SCC) as the Standards Development
Organization that advises SCC on matters related to Health Informatics
Standards. SCC is the official Canadian member of International
Standards Organization (ISO). The CAC/Z295 provides representation
on behalf of Canada at the ISO’s Technical Committee 215 on Health
Informatics Standards where CAC/Z295 representatives speak on
behalf of Canada. The CAC/Z295 has a dual role: first, to provide
technical input to SCC on the Canadian perspective on Health
Informatics standards development internationally and secondly to
provide advise to SCC through CSA on appropriate health information
standards for use in Canada as National Standards of Canada. The goal
of the CAC/Z295 is to harmonize national health information standards
with international. The CAC/Z295 has two co-chairs one responsible
for Canada’s international participation in health informatics standards
development at ISO TC 215 and one responsible for coordinating
domestic health informatics standards activities. Members of
CAC/Z295 represent key stakeholder groups in the area of health
information and health informatics in Canada, and reflect a balance of
interest from industry, governments, users and general interest
groups. These members have an obligation to consult widely within
their respective constituencies with a view to having the greatest
possible input to both domestic standards work and Canadian input to
international standards development. (Hannah, 2004)

Another national organization, the Canadian Organization for the

Advancement of Computers in Health or COACH, founded in 1975,
has actively initiated professional protocols for using computer
systems in Canadian health care. One important document, Guidelines

7
to Promote Confidentiality and Security of Automated Health-related
Information (1979), has been incorporated into the national
accreditation guidelines approved by the Canadian Council of Health
Facilities Association in 1991. These guidelines were also supported by
the CNA in 1993.
In 2001, COACH, as Canada's Health Informatics Association,
launched the Patron Program. As an individual member based
organization, COACH promotes understanding and effective utilization
of information and information technologies within the Canadian
Healthcare industry through education, information, networking and
communication. With the development of the Patron program,
members are hoping to build stronger links between COACH and
private and public enterprise in pursuit of this mission. It is an
opportunity for corporations to join in partnership with COACH.
COACH's vision is to be THE catalyst in advancing the practice of
health information management in Canada.
Today, COACH is a leading organization with an evolving
membership. It is in the forefront of the Canadian Healthcare
information resource and technology field by working cooperatively
with health institutions, professions, associations, consultants, vendors
of information technology and applications, government and regulatory
organizations in the pursuit of its mandate.
The backgrounds of COACH members range from health executives,
physicians, nurses and allied health professionals, researchers and
educators to information systems managers, technical experts,
consultants, and information technology vendor representatives.
Organizations represented include the broad range of healthcare
institutions, community and public health, private practice,
government, consulting firms, commercial providers of information and

8
telecommunications technologies, educational institutions and
industry.
The Canadian Nursing Informatics Association
In 2001, a new group, the Canadian Nursing Informatics
Association (CNIA) received emerging group status from the CNA and
affiliate status in 2003. The CNIA now has full associate status with the
CNA.
The mission of the CNIA is to be the voice for Nursing Informatics in
Canada. Recognizing the importance of the work the CNIA is
undertaking, the Canadian Nurses Association has granted associate
group status to the CNIA. The CNIA is also affiliated with COACH,
Canada's National Health Informatics Association. Through this
strategic alliance CNIA is the Canadian nursing nominee to the
International Medical Informatics Association - Special Interest Group
in Nursing Informatics (IMIA-SIGNI).
The CNIA conducted a study in 2002 - 2003 on the Informatics
Educational Needs of Canadian Nurses, funded by the Office of Health
and the Information Highway, Health Canada or OHIH called Educating
Tomorrow's Nurses: Where's Nursing Informatics?
The intent of the study was to describe the current state of:
• informatics education opportunities currently available to
students of nursing across the country,
• the level of preparedness of nursing faculty to deliver these
offerings,
• information and communication technology infrastructure and
support for faculty in delivering these offerings, and
• opportunities to enhance nursing curricula, faculty preparedness,
and ICT infrastructure and support in schools of nursing across
Canada.

9
 The study was conducted across Canada and included a
representative sample of nursing schools from across the country. A
Kwantlen nursing faculty is a longtime member of the CNIA Executive
Board. June Kaminski (Kwantlen Polytechnic University, author of this
informatics curriculum) was Director of Communications (and designer
of the CNIA website) and is now the President of the Association. The
Canadian Journal of Nursing Informatics was launched by the CNIA in
2006, which invites papers, multimedia, and other electronic media
focused on the diverse arena of nursing informatics.
The Canadian Nurses Portal Project, NurseONE, E-Nursing
Strategy
Over the last two decades Canadian leaders in nursing informatics
have discussed and conceptualized a nation wide nursing informatics
strategy that would benefit all nurses and nursing students. In 2006,
the Canadian Nurses Association launched the Canadian Nurses
Portal Project, shortened to NurseONE to address this vision, in the
form of a e-nursing strategy. “The purpose of the e-nursing strategy is
to guide the development of ICT initiatives in nursing to improve
nursing practice and client outcomes” (Canadian Nurses Association,
2006, p. 7).
Initial goals of this e-nursing strategy include:
• advocating for nurses' access to ICT and the resources required
to integrate ICT into nursing practice;
• supporting the development and implementation of nursing
informatics competencies among the competencies required for
entry-to-practice and continuing competence; and
• advocating for the involvement of nurses in decision-making
about information technology and information systems.
(Canadian Nursing Association, 2006, p. 10).

10
 The e-nursing strategy will address these goals by adopting a three
pronged approach:
• Access – better connectivity in work environment, more access
to a variety of computer technologies, e.g. PDAs, hardware,
software, station computers.
• Competency- ongoing ICT skill development, integration into
nursing curriculum
• Participation - “as knowledge workers in this technological age, it
is essential that nurses play an increased role in the
development of ICT solutions” (Canadian Nursing Association,
2006, p. 15).

OBSTACLES TO EFFECTIVE NURSING MANAGEMENT OF

INFORMATION IN CANADA

1. In Canadian health care delivery organizations, like hospitals

and health care agencies in other countries, the major obstacles to
more effective nursing management of information are: the sheer
volume of information, the lack of access to modern information
handling techniques and equipment, and the inadequate information
management infrastructure. The volume of information that nurses
manage on a daily basis, either for patient care purposes or
organizational management purposes, is enormous and continuing to
grow. Nurses continue to respond to this growth with incredible mental
agility. However, human beings do have limits and a major source of
job dissatisfaction among Canadian nurses is information overload
resulting in information induced job stress.

2. Antiquated manual information systems and outdated

11
information transfer facilities are information redundant and labor
intensive processes, to say nothing of an inappropriate use of an
expensive human resource, that is to say nursing time and energy.
Modern information transfer and electronic communication systems
allow rapid and accurate transfer of information along electronic
communication networks. Yet, the nursing contribution to patient care
is not even on the radar screen for the pan-Canadian EHR or any
provincial EHR. Nursing documentation is being captured in some
regional or facility based patient records e.g. the Integrated Cancer
Care Network of the Alberta Cancer Board, St John Regional Hospital.

3. Software and hardware for modern electronic communication

networks are only two aspects of an information infrastructure. The
other major aspect is lacking in most hospitals and health services
organizations, that is, the absence of appropriate infrastructure to
facilitate information management. Infrastructure includes but is not
limited to: data management policies and procedures, methods for
data stewardship and custodianship, user training and information
management support staff. Support staffs are necessary to support
nurses in appropriately analyzing and interpreting aggregated
information.

ISSUES RELATED TO EFFECTIVE NURSING MANAGEMENT

OF INFORMATION

1. Lack of adequate educational programs in information

management techniques and strategies for nurse clinicians and nursing
managers. At the time of writing, there are only a few pre-service
nursing education programs in Canada offering a course in modern

12
information management techniques and strategies related to nursing.
At a minimum, such a program must include advanced study of
information management techniques and strategies such as
information flow analysis, the use of spreadsheets, databases and
word processing packages. Ideally such courses would also introduce
concepts and provide hands-on experience related to the use of
patient care information systems.
2. Nursing is frequently under represented in the decision
making related to health information systems and EHRs in Canada.
Regrettably, even when the opportunity is available, many senior
nurse managers fail to recognize the importance of this activity and
opt out of the process. They then complain when the systems do not
meet the needs of nursing. Canadian senior nursing executives must
recognize the importance of allocating staff and money to participate
in the strategic planning process and policy making for information
systems and EHRs in their organizations, provinces and national
organizations. Leaders in provincial and federal EHR and health
information systems initiatives must also recognize the importance of
nursing input into the strategic planning process and decision/policy
making related to such initiatives. In any Canadian health care
delivery organization, nurses are the single largest group of
professionals using a patient care information system or EHR and
nursing represents the largest part of the budget. Nursing, therefore,
represents the single largest stakeholder group in Canada related to
either patient care information systems or EHRs.

CANADIAN INITIATIVES DIRECTED AT THE DEVELOPMENT OF

NURSING COMPONENTS OF HEALTH INFORMATION (HI:NC)

13
 In Canada nurses are in the fortunate position of recognizing the
need for nursing data elements at the time when the national health
infostructure is under development. The challenge for nurses is to
capitalize on this timing and speak with one voice to promote the
inclusion in the CIHI DAD and the Infoway EHR of those data elements
required by nurses in Canada. To prevent nurses in Canada from
losing control of nursing data, nurses must take a proactive stance and
mobilize resources to ensure the development and implementation of a
national health data base and a pan- Canadian EHR that is congruent
with the needs of nurses in all practice settings in Canada. Some
initiatives intended to promote the vision, of nursing date integrated
into the pan-Canadian EHR and national health data base, are in
progress.
Building on work of our U.S. colleagues on the NMDS, and in
response to contextual factors influencing nursing in Canada, nurses in
Canada have recognized the importance of the collection and storage
of essential data elements (Canadian Nurses Association, 1990, June).
Under the leadership of the Canadian Nurses Association, nurses have
more than 15 year of experience in initiatives directed at building
awareness and consensus regarding the definition and coding of these
essential nursing components of health information (Canadian Nurses
Association, 1990, June). Nurses built consensus (Canadian Nurses
Association, 1993a, 1993b, 2001, April, 2001, November) on the five
essential nursing components of health information:
• Client status is broadly defined as a label for the set of
indicators that reflect the phenomena for which nurses
provide care, relative to the health status of clients
(McGee,
1993).

14
 The common label “client status” is inclusive of input from all
disciplines. The summative statements referring to the phenomena for
which nurses provide care (i.e. nursing diagnosis) are merely one
aspect of client status at a point in time, in the same way as medical
diagnosis.
• Nursing interventions refer to purposeful and deliberate
health affecting interventions (direct and indirect), based
on assessment of client status, which are designed to
bring about results which benefit clients (Alberta
Association of Registered Nurses (AARN), 1994).
Client outcome is defined as a “clients’ status at a defined point(s)
following health care [affecting] intervention”(Marek & Lang, 1993). It
is influenced to varying degrees by the interventions of all care
providers.
• Nursing intensity “refers to the amount and type of
nursing resource used to [provide] care” (O’Brien-Pallas &
Giovannetti, 1993)
• Primary Nurse identifier is a single unique lifetime
identification number for each individual nurse. This
identifier is independent of geographic location (province
or territory), practice sector (e.g. acute care, community
care, public health) or employer.
It is one component of fully integrated health information data,
e.g. the CIHI DAD[Discharge Abstract Database] (Canadian Institute
for Health Information, 2002) or an EHR such as that being developed
under the leadership of Infoway. Therefore, the five nursing data
elements were identified collectively as the Nursing Components of
Health Information (Health Information: Nursing Components, HI: NC)
(Canadian Nurses Association, 1993b).

15
Identifying those data elements that represent the most important
aspects of nursing care is only the first step. In Canada, nurses faced
an immediate challenge to determine the most effective and efficient
means to collect and code data elements that reflect nursing practice.
To collect the data reflecting nursing contributions within the larger
health information system, “there is a need for consistent data
collection using standardized languages to aggregate and compare
data” (Canadian Nurses Association, 1998).

IMPLICATIONS OF THE NURSING COMPONENTS OF HEALTH

INFORMATION

The definition of nursing components of health information is

essential to influence health policy decision-making. Historically health
policy has been created in the absence of nursing data. At a time when
we are in the midst of profound health care reform it is essential that
nurses demonstrate the central role of nursing services in the
restructuring of the health care delivery system.

CONCLUSION
It is clear that a priority for nursing in Canada is the inclusion in
electronic health records and national health data sets of the nursing
components of health information that have been identified, those
essential nursing data elements that must be collected, stored and
retrieved from a national health information data base. Nursing leaders
must respond to the challenge to identify those data essential for the
management of patient care and patient care units. The nursing
components of health information have the potential to provide nurses
with the data required to build information for use in reshaping

16
nursing, as a profession prepared to respond to the health needs of
Canadians in the twenty-first century. However, the window of
opportunity to have nursing data elements included in a national data
set is narrowing. We must ensure that the vision of nursing
components in our national health information system becomes a
reality for nursing in Canada.

17
 Nursing Informatics in Europe

• Europe is a continent with over 750 million inhabitants in about

50 countries with many different languages, cultures, social
systems and other living condition.
• Widespread of use of IT in healthcare services is very limited in
comparison to other areas of society.
• The main mission in Europe is to establish a stable infrastructure
that improves healthcare quality, facilitates the reduction of
errors and delivery of evidenced based and cost effective care.
• The Europe Union (EU) is a driving force of healthcare
informatics development by funding projects that are all cross-
cultural involving healthcare professional users, educators, and
administrators, always with three or more countries
participating.
• Telemedicine or telehealth, which is the practice of medicine and
nursing over a distance where data and documents are
transmitted through telecommunication system, is widely
disseminated in parts over Europe.

Electronic Patient Record

• All RN in Sweden are by law, since 1986, obliged to document

nursing care (SFS, 1985)
• Regulations emphasize that RN’s have an autonomous
responsibility for planning, implementing and evaluating nursing
care and that nursing diagnoses in the patient record is a part of
that responsibility (SOSFS, 1990).

18
 Nursing Practice in Europe

• Association for Common European Nursing Diagnoses.

Intervention and outcomes (ACENDIO), which was established in
1995. The aim of the association is to support the development
of standardized classifications, terminologies, and data sets for
sharing and comparing nursing data.

ACENDIO

• Supports the development of nursing informatics by biannual

conferences, publications and presentations to advance
understanding.
• Serves as a network for nurses in different European countries
so that they can share knowledge about developments.
• Provides resources such as reference lists and sample
methodologies for developing and evaluating nursing
vocabularies and by providing interpretation of international
standard for terminologies and classifications.

19
 NURSING INFORMATICS IN THE PACIFIC RIM

Trends in Healthcare
New Zealand has seen more collaborative approach resulting in
integrated care being seen as a priority. Integrated care is being
supported by technology.
The Web environment and the use of powerful integration
engines, is now providing contextual views of data that is browser-
based and single logon. Placed over multiple hospital information
systems this connection provides a “single patient view” of data across
all medical applications. Online technologies provide products and
services that enhance patient care and improve clinical outcomes
through evidence-based health information and decision support
systems.
Although New Zealand is a small country, it has a surprising
number of health IT companies who are producing software that is
being used both locally and internationally, the i-Health.

Technology Trends
New Zealand has been embracing changes in technology. No
longer is information restricted to individuals and organizations. Higher
speed networks including wireless and broadband are enabling
information in a variety of formats to be shared. Exploration into
telehealth has occurred in a number of fields including
teledermatology, teleradiology, telepsychiatry, and telepediatrics
(Oakley, 2001).
Improvements in portability are now allowing the use of
technology in a greater range of settings. Personal Digital Assistants
(PDAs) and tablets are being used in the clinical setting by students

20
and healthcare professionals. Some Australian nurses are using PDAs
for point-of-care information and clinical documentation for community
and acute hospital nursing, hospital-based infection control and wound
management.
Funding for the use of the technologies is probably one of the
biggest limitations imposed in embracing new technologies to enhance
care delivery. Nurses need to be prepared to work alongside and use
technology to best care for clients.

Current National Initiatives

The New Zealand Ministry of Health, in 2001, prepared a 5-year
broad strategic directive for information and technology developments,
referred to as “The WAVE Report”. The report was produced by means
of collaboration among industry, clinicians, government and healthcare
managers. The report has also formed the foundations for long-term
issues such as EHRs.
Following the WAVE report, the drive for collaboration from the
bottom-up has consolidated as the district health boards (DHBs)
replace their isolated departmental systems with more integrated and
dynamic Web-based technologies that support a more connected
delivery network. Such arrangements have reduced duplication and
contributed to more effective and efficient management of
infrastructure.
1993 – Establishment of the National Health Data Dictionary.
1999 – The first national strategic information action plan,
Health Online was initiated. This was followed by a number of projects
initiated by the Australian government: HealthConnect, MediConnect,
the provision of quality health information for consumers known as
HealthInsite, along with more than 360 projects.

21
 2005 – It was expected that a strengthened governance model
with greater central leadership will be implemented to enable better
use of information technologies. The overall aim is to improve health
outcomes while containing cost increases driven by advances in
medical technologies and an ageing population.

Standards Development and Adoption

The minister of health directed that a WAVE working group, the
Ministerial Committee on a Health Information Standards Organization
(HISO), be established to investigate the implications of establishing a
nonstatutory organization to manage health information standards.
The scope of development activities that HISO will be involved with
includes standards associated within the following categorization
scheme:
• Records structure and content – data formats.
• Vocabulary – codes for medical and other healthcare terms.
• Messaging – standards used for interchange of data.
• Security and privacy – how access to information is managed.
HISO, and supported by the Ministry of Health produced the New
Zealand Draft National Health Standards Information Plan (NZHSP) to
assist in its role of developing health information standards for the
health and disability sector. HISO enhances the New Zealand e-
Government Interoperability Framework (e-GIF) direction.
The HZHSP proposes a framework for describing the sector
priorities, standards development processes, governance and
leadership, and presents a clear statement of the proposed plan.
HISO’s role is aimed at the acceptance throughout the health and
health-related industries of such standards. The availability of detailed
and clinically relevant data is essential for clinical care decisions and

22
for oversight groups making decisions related to the quality of that
care.
Standardized terminology systems are essential to permit the
use and exchange of clinical data across applications and IT systems.
Give point-of-care documentation, technology is now available to build
electronic health information systems that will efficiently meet a
variety of needs. This includes providing immediate feedback to care
providers by, for example, exchanging critical patient information in a
timely manner across the healthcare continuum, and reducing provider
burden associated with current documentation requirements.
Archetypes are constraint-based models of domain entities and
were first defined by the Australian-based OpenEHR group, an
international not-for-profit foundation working toward interoperable
lifelong EHRs.
In July 2004, NHIG endorsed L7 as the standard for healthcare
messaging in Australia. This represents a small step toward the
implementation and an increase in the adoption of available standards.

Research
Health-related information has a number of uses. Apart from the
direct use of information in the care of clients, there is a growing
awareness of the need for timely and accurate data for research. Two
specific areas that are currently gaining more attention within NI are
clinical pathways and evidence-based practice. In the New Zealand,
this is demonstrated by The Centre for Evidence Based Nursing –
Aotearoa (CEBNA) and the New Zealand Guidelines Group (NZGG).
CEBNA is a partnership between the Auckland District Health
Board and the University of Auckland, School of Nursing. It
collaborates with the Joanna Briggs Institute for Evidence Based

23
Nursing and Midwifery, the lead, centre, in an Autralasian-wide
collaboration, that includes centers throughout Australia, Hong Kong,
and Singapore. These centers are committed to an evidence-based
approach to healthcare and to promoting an evidence-based culture in
nursing.
NZGG is an informal network of expertise and information on
guidelines development and implementation. It is funded by the
Ministry of Health and through contracts with other health agencies
such as ACC.
HISA organizes an annual conference where between 40 and 60
papers are presented each year. These are indexed in CINAHL and
provide a good overview of progress in health informatics in Australia.
Health informatics does not exist as a research category for the major
government research funding organizations which makes it difficult o
obtain research funds from these organizations. It is anticipated that
this will change in the near future as part of the Australian
government’s health workforce capacity building initiative.

Education
In New Zealand, NI has been recognized as significant by the
Ministries of Health and Education since the early 1990s. A national
“Guidelines for Teaching Nursing Informatics” curriculum was
introduced into the undergraduate preparation of nurses programs in
1991. Undergraduate nurse education reflects the need for computer
literacy. The new nursing student, most commonly from secondary
school, enters with increased computer skills than ever before.
Since the mid-1990s nurses registering for practice in New
Zealand also complete an undergraduate degree. Furthermore, the
changes in health service delivery in New Zealand and the

24
establishment of new roles and career opportunities for nurses are
drivers for an increased demand for postgraduate nursing education.
Yet there have been barriers to nurses accessing postgraduate
education, which is generally based in urban areas. Nurses are found
throughout the country and the nature of nursing necessitates shift
work.
While NI as a postgraduate specialist subject has not been
recognized in New Zealand, nurses are favouring the health
informatics options. In 1998, the University of Otago offered for the
first time a diploma in health informatics. The University of Auckland
commenced offering postgraduate programs that include courses in
health informatics in 2001. Both tertiary education providers have
given nurses the opportunity to study informatics in abroad context
alongside other health professionals.
The first Australian experiences of nurses using computers were
compiled into a edited text by Graham MacKay and Anita Griffin in
1989.
Informatics education for nurses in Australia varies considerably
from one university to another. Most have one person attempting the
impossible, often in environments where fellow nurse academics have
little or no knowledge of informatics. In some instances, there is active
resistance to its introduction.
Some schools of nursing integrate informatics into their
undergraduate nursing program to some extent. Most universities offer
one unit of study within their undergraduate nursing pre- and
postregistration programs as an elective. This enables all registered
nurses either to obtain a double degree or convert their hospital-based
certificate into a Bachelor’s degree.
CHAPTER 40

25
 NURSING INFORMATICS IN ASIA

1970s- computers were first introduce in Asian Countries.

The first applications of information technology in healthcare in
Asian countries were in Administration, Billing, and Insurance.-
Now these countries are moving toward implementing paperless
electronic health records.
The adoption of Informatics in Asian countries occurred in
Nursing care practice, Education, and research organizations, as
well as within the information technology industry and via related
government departments and existing professional
organizations.
This chapter provides historical events of nursing informatics in
 South Korea
 Japan
 Taiwan
 China
 Thailand

The progress in Japan, China and South Korea has

been expedited by the hosting of the International Medical
Informatics Association (IMIA) triannual conference in 1980,
1989,and 1997.-----organizes conference , seminars and workshops,
creates a forum for sharing of experiences and knowledge among both
experts and users of these countries.
 SOUTH KOREA
- Comprises of 8 provinces with 7 metropolitan cities.
Total population: 47 million in 2002
- 190, 720- licensed midwives and nurses (81,478 are practicing)

26
 - Health informatics in Korea grown with the professional outreach
activity of KOREANN SOCIETY OF EDICAL INFORMATICS
(KOSMI) as well as with the help of:
- Government
- Private businesses
- Academic institutions
- Medical and Nursing organizations
HISTORY OF NURSING INFORMATICS IN KOREA
1970- Use of computers in South Korea healthcare began
- Used in hospital finance and administration system to expedite
insurance and reimbursement.
1987- KOSMI (Korean Society of medical Informatics) was
founded and introduced the term “Health Informatics” and “Nursing
Informatics” in Korea.
1993- The Nursing Informatics Special Interest Group was
organized as one of five special interest groups of the KOSMI.
-Since Nursing informatics Group was held its own session at
biannual conference of KOSMI.
1995- Korean nurses represented the country at IMIA-NI Group
( International Medical Informatics Association).
IMIA- International Medical Informatics Association.
- IMIA conference MEDINFO98 held in Seoul----provided an
excellent opportunity for Korean nurses to become acquainted
with NI.
USE OF INFORMATION TECHNOLOGY IN CLINICAL
PRACTICE
Year 2000—according to report published by Korean Health
Industry Development Institute that has hospital information system:
100%- Teaching hospitals

27
 96%- General hospital
75%- Private clinics
All Teaching Hospital and 40% of General Hospital
- Use Order Communication System---Which enable physician to
communicate with other departments for practice related
requisitions and the retrieval of data.

-Some hospitals initially used computers mainly for

administration and billing, later a patient-care component was
added---These system allowed physician to enter medical orders
directly into computer and major departments could receive
requisitions and enter test results.

-The nurse work list could be viewed on screens or printed so

that nurses did not need to copy medication schedules or care
activities onto Kardex.

Home Healthcare System-Community based practice

- They use laptop computers to note and check medication and
progress on electronic patients record, and to communicate
electronically with other non-healthcare team members.
HEALTH INFORMATICS EDUCATION
According to recent survey in health informatics as computer
education program in South Korea 21% of nursing schools and 25% of
medical schools—offer health informatics courses, while the remaining
offer introductory computer courses.
-Most nursing schools in Korea are adding informatics to
graduate curricula—so that graduate students can take informatics
courses as an elective.

28
 STANDARDIZATION ACTIVITIES
There are Korean representative actively involved in several
international initiatives toward the end such as INTERNATIONAL
ORGANIZATION for STANDARDIZATION/TECHNICAL COMMITTEE 215
and Health level seven.
The majority of existing nursing terminologies:
• NANDA- North American Nursing Diagnosis Association
• NIC- Nursing Intervention Classification
• HHCC- Home Healthcare Classification
• NOC- Nursing Outcome Classification
• ICNP- International Classification for Nursing Practice.

GOVERNMENT INITIATIVES
-The Government has contributed to the development of health
information by funding or other incentive and guidelines in
telemedicine, emergency medical systems, infectious disease reporting
system and standardization.
2 Information Highways
1. South Korea advanced Research Network---which is mainly
use for research activity.
2. Nationwide commercialized network built by
telecommunication companies.
TECHNOLOGY TRENDS
-The need for telemedicine continues to grow in Korea with an
increasing numbers of elderly, patients with chronic disease, and
patients who are discharged early.
Example of telemedicine:
1.Telecare at home--- Telepractitioners at these centers

29
maintain special schedules for their remote clients.
-They set aside 1-2 days per week to take care of their clients
using virtual reality technology via the Internet.
-currently, teleconsultation fee is reimbursed by Health
Insurance.

 JAPAN
Population: 127 million –twice that united kingdom---half that of
US
Number of hospitals: 10, 000 hospitals
Number of nurses: about 750, 000—including 220, 00 nurses
aides.—260,000 medial doctors—90, 000 dentist—230, 000
pharmacist.
--In Japan all citizens can choose healthcare institutions and
doctors freely, and their financial contribution to health insurance.
-The hospitals received reimbursement for the balance from the
national health insurance.
-The Japanese government contribute maximum of 70, 000 yen
to the medical treatment of a person over 1 month.
HEALTH INFORMATICS IN JAPAN
1970s- Japan began to pay attention to the use of computers in
healthcare.
1980- Japan hosted the IMIA (International Medical Informatics
Association) conference MEDINFO80.
JAMI- Japanese Association of Medical Informatics was also
founded during 1980s with the aim of supporting health informatics in
Japan.
-Standardization is one of the problems in the use of Healthcare

30
information technology that needs to be resolved.

HISTORY OF NURSING INFORMATICS IN JAPAN

1980- The Third International Congress on Medical Informatics,
MEDINFO80,was organized by IMIA was held in Tokyo.
1990s- Nursing education in Japan rapidly shifted to a more
academic orientation, and there are now 100 universities offering
baccalaureate programs and 40 universities offering graduate
p0rograms.---some baccalaureate programs and graduate schools
include NI courses in their curricula.
-The Japanese Nurses Association prepared course of nursing
information management as first step of continuing education
curriculum for ward managers.
NURSING INFORMATICS EDUCATION
April 2004- there were 486 professional schools, 31 junior
colleges, 120 universities and 45 graduate schools in Tokyo Japan.
-Universities provided elementary computer literacy education
during the first half of 1990s.
Barriers to the development of NI in Japan:
1. There are few researchers and educators in Japan
2. There is little development of educational tools
3. The cost of improving the network and computer environment
is high.

NURSING INFORMATICS PRACTICE

-The Japan Nursing Association does not recognized the training
for electronic health record and information systems.
-Hospitals are looking for new healthcare staff with knowledge of
both healthcare and information technology who can control

31
information flow.
JAPANESE GOVERNMENT INITIATIVES AND STANDARDS
DEVELOPMENT IN JAPAN
-The standardization of medical information is one of the main
themes in healthcare sector.
The Ministry of Health, Labor and Welfare announced a
grand design for healthcare, and set the following achievement goals
for 2006:
1) Electronic Health Records will be introduced into 60% of
hospitals with more than 400 beds and of 60% of clinics .
2) The electronic health expenditure payment system will be
introduce into 70% of all hospitals.
-Nursing terminology are currently under development, nursing
actions and observation items in nursing terminology are available to
the public since 2004.
-Continuous 24-hour observation of nursing care can be shared,
indicating that the use of such system is very useful for the medical
profession.

China
According to the Fifth National Census reported by the National
Bureau of Statistics, the population of China was almost 1.3 billion in
2000. The population is aging fast, with those 65 years old and older
representing 6.96% of the population in 2000 compared to 5.57% in
the 1990 census. Only 5 and 20% of registered nurses in China have
baccalaureates and 3-year diplomas, respectively.
In China, the majority of the population is found in rural
areas, and thus the overall healthcare level, stability of society, and
economic development of the whole China is influenced by healthcare

32
services in rural areas. The primary healthcare systems in rural China
include providing medical services, the training of healthcare staff,
hygiene education, and the development of a patriotic health
campaign.
The SARS epidemic in China leads to reconsiderations of
the current healthcare systems in rural areas. Some Chinese consider
that more effort should be devoted to epidemic prevention, and that a
new system of cooperative medical care and new salvation system of
the poor should be set up to ensure health in rural areas and enhance
the stability of society and economic development of country. The
SARS epidemic also led to suggestions of an integrated system for
responding to public health emergencies and for disease control and
prevention.
The China Medical Informatics Association (CMIA) was
founded in 1981. This is an academic group and is a member of the
IMIA. There are two other professional societies related to medical
informatics in China: the Chinese Society of Medical Information and
the Chinese Hospital Information Management Association. The
Chinese Society of Medical Information was founded in 1993, and its
activities include holding academic conferences and seminars,
continuing education, and training. The Chinese Hospital Information
Management Association was founded in 1996, and its activities
include holding national and international academic collaborations and
exchanges, establishing rules and standards of national hospital
management, and training hospital information management staff.

Nursing Information System in China

The development of nursing information management

33
systems began in China in late 1970's and they were first used in
1987. The first software implementation was a computer-assisted
primary nursing care system. The development of information
management systems for nursing in Chinese traditional medicine
began in 1994. Some examples include a nursing information system
for the management of nursing staff, nursing operation work,
continuing education, scientific research, and finance and economics;
nursing information systems for nursing records and nursing
management based on an army satellite project called the No. 1
Project of PLA; and an Internet-based nursing information
management system.

History of Nursing Informatics in China

The Nursing Informatics Special Interest Group with 20 hospital

nurses was founded as a branch of the CMIA in 191. A year later an
expert group for nursing information technology was founded by the
Nursing Department of the Chinese Ministry of Health, its mission
being to establish criteria for nursing management and the training of
nursing administrators for nursing information management.
The first article referring to the term “nursing information
science” appeared in China in 1999, and this led to the application of
information technology in the field of nursing science for education and
research. The term NI was first used in the Chinese literature in 2002.

Nursing Informatics Education

Higher nursing education was introduced in 1983. By

2001, at least one computer course is required at the baccalaureate

34
level, and nursing students can select other computer courses as
elective courses.
According to a literature review, computer-assisted
instruction began at nursing institutes in China during the mid-1990's.
Distance learning is also being used for nursing continuing education in
China.

Nursing Informatics Research

NI is at its infancy in China, with only 30 research articles

published in domestic nursing journals from 1994 to 2004.

Nursing Informatics Practice

The use of NI in clinical practice in China includes nursing

quality management, staff management, nursing information
management, and training clinical skills for staff nurses. Several expert
systems for nursing diagnoses, nursing care plan, and nursing
assessment have been reported.
The major weakness of nursing information management
systems in China is the lack of national standards and the low level of
computer literacy and informatics skill exhibited by nurses.

Thailand

Thailand has a population of about 65 million living in 76

provinces. The life expectancy of males and females is 71.6 and 74.7
years, respectively. There were 92 regional/general hospitals, 707
community hospitals, and 9,559 health centers across Thailand in

35
2004 The government is currently launching a Universal Healthcare
Coverage policy in order to improve the access to and quality of
healthcare, as well as to contain healthcare expenditure. The nThai
government is restructuring its healthcare system by placing more
emphasis on primary care and health promotion.
The NI was introduced as small special interest groups and
later expanded to the national level through the support of the Nurse's
Association of Thailand, the WHO, and the Ministry of Public Health
(MOPH).

The Development of a Health Information System

In 1997, the Thai MOPH began to implement a

national health information system which included the development of
a nursing component. The former director of the MOPH Nursing
Division, Mrs. Areeya Suppalak, considered it important to provide
nurses with the means of using information technology. Funding was
received from the WHO in 1999 as a result of a collaborative effort
between the Center for Nursing Research at the Department of
Nursing, The Faculty of Medicine, Ramathibodi Hospital, Mahidol
University, and the MOPH Nursing Division to develop the ideal nursing
minimum data set (NMDS) and a preliminary nursing classification
system. The NMDS was identified as essential for developing an
efficient nursing database.

Development of an NMDS

There were 23 items of nursing data identified, including

patient name, hospital number, ID number, admission number,

36
patient's address and phone number, address and phone number of
significant person, gender, birth date, religion, education, health
insurance, patient and family medical history/allergy, admission date
medical diagnosis, laboratory test, nursing problem, nursing
intervention, nursing outcome, discharge/expired date, discharge plan,
condition before discharge, referral, and home visit.

ICNP Translation and Validation

A resolution o developing an international nursing

language was adopted during the 1989 ICN meeting in Seoul , Korea.
The ICN therefore committed itself to the development of an
international nursing taxonomy (i.e. the ICNP). The Nurse's
Association of Thailand, under the former president Dr. Tassana
Boontong, endorsed the development of the ICNP and agreed to
translate it into Thai and validate an alpha version thereof. Later, in
1999, the translation of the beta version of the ICNP was completed,
validated and disseminated. The content was further revised for
improvement as the Nurse's Association of Thailand continued to
further develop the nursing classification. The ICNP is currently used
as a basis for the data set describing the nursing care of patients and
their families.

Professional Outreach

The Thai Medical Informatics Society (TMI) introduced the

concept of medical informatics into Thailand. The founders were a
group of medical professors whose original idea was to apply computer
technology to medical care.

37
 The main objectives of TMI are as follows:
1. To be the center for coordinating and distributing medical
information
2. To develop means for the management of medical information in
administration and academic areas
3. To exchange information and experience in medical informatics
4. To support those who practice medical informatics
5. To provide suggestions and recommendations for medical
information sectors both within and outside the MOPH
6. To not be involved in any commercial or political activities

The main activities of TMI are as follows:

1. Holding an annual conference
2. Supporting the meeting, training, and information sharing for the
development of medical informatics in Thailand
3. Publishing and distributing four issues of documents per year as
approved by the board
4. Being the center for the coordination of the medical information
exchanges
5. Being the center for information and ideas focused on the
development of medical informatics

The TNI supports the development of NI, especially

nursing databases using the ICNP. The Nurse's Association of Thailand
currently aims to develop a standard nursing care pla for clinical
applications using the ICNP.
The activities of TNI are as follows:
1. Holding a joint annual meeting with the Nurse's Association of
Thailand and TMI

38
 2. Publishing and distributing its newsletter every 4 months
3. Supporting other academic and research activities in NI
4. Responding to the NI training needs of Thai nurses

Taiwan
There were 610 hospitals and 175,000 healthcare professionals
in Taiwan in 2002, serving a population of 22.5 million. The healthcare
professionals included 34.3% registered nurses and 17.7% licensed
practicing nurses.

History of Nursing Informatics in Taiwan

The term NI was first used in Taiwan in 1990. At that time the
focus was on hospital information systems providing nursing data such
as personnel information, care planning, and scheduling. Since the
1980's, computers had been used in nursing education. Although a
formal master's program focusing on NI was not available until 2001.
All baccalaureate programs included at least one or two computer
courses.

Nursing Informatics Education

Computer-assisted instruction programs have been developed by
the Ministry of Education for nursing vocational education programs
since 1986. The content includes diet education for diabetic patients,
biostatistics, maternal child health, stress management, and patient
nutrition. Online courses are available for baccalaureate programs in
counseling, teaching principles and strategies, and long-term care.

Nursing Informatics Research

NI research is still at its infancy in Taiwan, with only around 40

39
papers published in domestic nursing journals in the period 1994-
2003. Standardized terminology such as existing nursing diagnosis
classification systems and the ICNP has been translated for clinical
use, and tests of their reliability and validity have been proposed in
Taiwan. Qualitative approaches such as interviews have been used to
explore how well nurses will accept the change from manual charting
to computerized documentation. Quantitative approaches such as
surveys have been applied to investigate the attitude and satisfaction
towards the use of PDAs for charting and for storage of nursing
records.
Nursing Informatics Practice
Computerized care plans are now common in clinical use.
Moreover, decision support systems to test the integration of medical
diagnoses and nursing diagnoses, and expert systems implemented on
PDAs for the emergency triage system have been reported. PDAs have
been recently used by nurses in their daily practice.

Nursing Informatics in South America

What is the objective of this chapter?
• To present an overview of the development of Nursing
Informatics in South America.
• To identify some initiatives in the field, including discussion

40
 on the current user of terminologies.
• To identify imitative to disseminate nursing informatics
resources in the region.

Introduction:
• Nursing Informatics in 13 South America countries has been
based more on ACTIVITIES of INDIVIDUALS than on a policy
established by governments or national efforts.
• Each country has varied levels of development and deployment
of technological resources.
----Technology is visible tendency in
1. Health
2. Nursing Education
3. Nursing Practice
4. Nursing research
5. Administration
• The growth of information technology in Latin America and the
Caribbean was been consistently
• The world’s highest for 20 years.
• Most developed parts of the country have better access and
ability to implement services and applications in nursing.

Health institutes and universities are exploring ways to introduce

news resources on order to facilitate the process of the patient care
and promote quality and safety.

BACKGROUND:
• Historically nurses are used to facing challenges, adapting new
tools in to the practice to improve their performance.

41
 • Creating new models to enhance patient care.
• Technology can represent a unique instrument to help nurses
to face further challenges and discover how to use its resources
to involve and maybe to design their way taking care of the
people.
• Information is the key element for decision- making process in
the health care area.
---the more specific information in place to support
clinical decisions, the better care can be delivered to the
patient.

• Technology plays an important role in facilitating access to the

information because for the information to be useful and
meaningful, it has to be timely.
• In this, there is a clear trend in the direction of the
computerization of health records.
--peolple are able to connect to the internet that is a
telecommunication resource with no parallel to fast exchange data and
information.

--In result we can expect to see better- informed healthcare

providers and consumers.

• Considering trends and tendency in healthcare informatics and to

facilitate the process in South American countries, the Pan
American health organization (PAHO) has published guidelines
and protocols to orient the development and deployment of
information and communicating technology in Latin America and
Caribbean (Pan America Association) World Health Organization

42
 1991, 2001 and 2003.)
• Latin America and Caribbean region rank third in information
technology expenditure.
• A study performed by the PAN America health Organization/
World Health organization information, computer and social
infrastructure is evolving rapidly.

Nursing Informatics Initiatives

In South America countries…
• The initial motivation to develop computer systems
in yhe healthcare area was driven by financial and
administrative concerns.
• The hospital sector can be considered the area better
served by information systems.

1. Brazil
2. Mexico
3. Argentina
4. Colombia
5. Paraguay
These countries have clinical information systems in hospital or
health institutes.

In general…
Patient data that are also used for nursing administration
are integrated in the systems or nurses have to collect and analyze
nursing data separately.
• Hospitals have been working to design their own systems
in order to attend to specific needs and policies.

43
 • National and International software industry become more
represented in South America health care worker.
• They provide a broader range of solutions with systems
that address patient are documentation.
• Most of the computer systems implemented is intended to
control administration data.
• Congress, conferences, workshops, education and training
programs are being organized in the countries to share
experiences and information in nursing searching for
solutions that could enhance the delivery of patient care.
Distance Learning and the educational perspectives in
Nursing Informatics
• Technology is transferring not only nursing practice but
also nursing training and education models.
• Nurses became the PRIMARY USERS, responsible for data
input.
• They become “computer- Literate” in order to use
computer technology in a efficient manner.
• To meet education and training needs, nursing schools and
hospitals initiated programs to prepare nurses to use
computers.
• Computer applications in nursing education from a passive
teaching to an active changing nursing education from a
passive teaching to an active learning process.

• The NUCLEO de Informatica em Enfermagen at Universidad

de Federal de Sao Paulo (NIEN/UNISEF) was the first center to
offer the specialization degree (certificate) in South America.
NIEN/UNISEF

44
 o Provides since 1989, the nursing informatics discipline in
its graduate and undergraduate nursing programs.
o The research “line” in nursing informatics is attended by
professionals from different regions of the country and has
been responsible for the preparation of several master and
doctoral students in nursing informatics.
o The student after graduation return to their own instates
to implement education and research programs and to
participate in the development of patient care systems.
The Latin America countries are investing a significant effort to
prepare professionals in health informatics.
Nursing Terminologies and Documentation
• Sharing and communicating information is essential to make
decisions and deliver care.
• Exchange of information requires the communicationg parties to
agree on a communicating channel, an exchange protocol and a
common language.
• The language includes an alphabetic words,phrases and symbols
that express and assign meaning, understood by all users ( PAN
America Health Association/world health Organization,1997)

CLARK (1995)
- Pointed out that “communicating among ourselves has always
been important but communicating with other people about
nursing has acquired a new urgency since we are forced to
recognize that the value of nursing is no longer apparent to
those who have the power to influence our practice”.

45
 Other issues to be considered:
- Reimbursement
- Policies
- Cost containment
- Technological development in recent years

• Nurses’ responsibility to decide not only what kind of data is

important to describe the continuous care but also to decide how
these data could be described.

SUMMARY
Nursing Informatics as an integrated part of health follows the
progress that has been made in the whole sector of health informatics.
Because of the variety among countries and even inside larger
countries, the development of nursing informatics is conducted on a
case-by-case basis, taking into consideration the specific requirements
of each region.

---The development and deployment of nursing informatics is

dependent on national priorities and human capabilities.

---The situation represents a great oppurnity for nursing.

The future is exciting because with technological advances
nurses have the change to drive their own professional destinies.
Adapting technological resources to their practice help nurses to
see emerging trends in healthcare field as challenges and unique
opportunities for career growth. There are new roles, new areas and
new jobs demanding experts. Opportunities are wide open for those

46
who have decided to incorporate information technology into their
daily practice in the process of taking care of patient.

47
THE FUTURE OF
INFORMATICS

48
 Chapter 42 – Future Directions (part 1 of 2; PP 671-674)

The New Twenty-First Century Scenario

The new science is revolutionizing the way we conduct science and
the way we will:
♥ Prevent disease and diagnose and treat patients

♥ Also allow the nurse to point to the particular patient’s reason for
a disease (eg: MI – whether the person can regulate CA, K, NA
compared to normal persons)

♥ Have the mechanism identified on the way that enzymes (such

as lipase) either work correctly or incorrectly in the metabolic
process.

The scenario begins and ends with the generic information (whether
the concerns of the nurse are prevention, diagnosis, sure or
rehabilitation). The types of IT needed to support these new
approaches to healthcare are grid technologies, high performance
computers, and robust integrated information systems based on
standards.

A President and a Secretary of Health Decree Acceleration

“By computerizing health records, we can avoid dangerous medical
mistakes, reduce costs, and improve care.”
- George W. Bush – State of the Union Address – January 20,
2004

“Modern technology has not caught up with a major aspect of

healthcare and we have got to change that”

49
 ♥ On April 27, 2004, the announcement of President’s Bush’s
groundbreaking Health Information Technology (HIT) Plan was
made during his speech at the American Association of
Community Colleges Annual Convention in Minneapolis, MN.

♥ The president set a 10-year goal for a majority of Americans to

have EHRs when and where they are needed.

♥ EHRs that are designed to share information privately and

securely among and between healthcare providers when
authorized by the patient.

David J. Brailer, MD, PhD – the first National Health Information

Technology Coordinator, a sub-Cabinet level post at the Department of
Health and Human Services (HHS) on May 6, 2004.
Michael Leavitt – Secretary of DHHS; in May 2005 he indicated that he
will unveil a plan to lead collaborative state efforts to create a digital
health care environment.
“We will need 6,000 more physicians and 6,000 more nurses prepared
in information sciences to move in this direction.”
- Dr. Charles Safran – the former President of American Medical
Information Association (AMIA)

A Nation’s Health Information Technology Plan:

♥ The federal government to accelerate the identification and
adoption of voluntary standards necessary for the safe and
secure sharing of health information among health providers.

♥ Increased money for demonstration projects involving modern

electronic records systems that test IT and establish best
practices for wider adoption, including a doubling of
demonstration project funding to $100 million in the President

50
 Bush’s budgets.

♥ Creating federal incentives and opportunities that encourage

healthcare providers to use electronic medical records.

National Standards Endorsement on July 1, 2003

Honorable Tommy Thompson – former secretary of HHS, announced
two new steps in building a national electronic healthcare system that
allowed patients and their doctors to access complete medical records
anytime and anywhere they are needed, leading to reduced medical
errors, improved patient care and reduce healthcare costs:
♥ First – the department had signed an agreement with the
College of American Pathologists (CAP) to license the College’s
standardized medical vocabulary system (SNOMED) and make it
available without charge to throughout the US. These actions
open the door to establishing a common medical language as a
key element in building a unified electronic medical records
system in the US.

♥ Second – HHS has commissioned the Institute of Medicine (IOM)

to design a standardized model of an HER. The HL7 – a
healthcare standards development organization evaluated the
model once it had been designed.

51
 In the past 25 years of implementing systems, people,
organizations and policies are dominant forces 90% of the time and IT
is only 10% of the implementation.

Several Drivers of More Information Technology Today

Healthcare and hospitals are increasingly investing in IT to deal with
several issues. American Hospital Association and Cap Gemini study
forecasts top issues:
♥ Patient safety

♥ Rising costs and limited access to capital.

♥ Scarce labor pool of nurses

♥ Complexities of healthcare conditions

♥ Complexities of medical reporting

♥ Competitions

HIMSS Leadership Healthcare CIO Surveys:

♥ A way to monitor the trends in the US healthcare IT is from the
Healthcare Information Management Systems Society (HIMSS)
annual survey of healthcare Chief Information Officer (CIO).

♥ Upgrading the security on IT systems to meet the Health

52
 Insurance Portability and Accountability Act (HIPAA)

♥ The top technologies that the CIOs predict for the future were:

» High speed networks

» The internet

» Client server systems

» Wireless information systems

Trends Toward 2030:

♥ Demographics – the graying of America

♥ Growth in Chronic Disease

♥ Emerging infectious disease threats

♥ Changes in health-seeking behavior toward the internet

♥ Focus on quality = focus on IT

♥ Security and biodefense

♥ Genetic revolution

Demographic Trends
» The US population will shift toward an aged population in the
next decade, thus shifting the focus form a youth-centric to an
aged-centric culture.

» Aged persons have more health conditions, take more

medications and require more procedures than the younger
persons.

53
» There will be an increased focus on preventing, diagnosing, and
delivering care to this population.

» New predictions by Olschansky warn us that this influx of aged

persons might cease and the mortality might actually decline in
the new century because of infectious diseases and obesity that
claim lives at any age.

54