Nursing informatics

What is nursing informatics?

 In 1994 American nurses association(ANA) recognize the
nursing field of nursing informatics. In 2008 ANA defines
nursing informatics “ A specialty that integrates nursing
science, computer science and information science to manage
and communicate data, information, knowledge and wisdom
in nursing practice.
 ANA identified two distinct roles in nursing informatics.
 1. Informatics nurse
 2. informatics nurse specialist
Role of IN/INS
 The job responsibilities of in/ins consists of
 A) Product evaluation
 B) System implementation including preparing users,
training and providing support
 C) System development and quality initiative including
system evaluation/problem solving and quality
improvement/patient safety.
 D) others duty as assigned (HIMSS 2011)
Professional, practice trends and
issues.
 What are regulatory and accreditation requirement?
 HIPPA and TJC impact the daily work of clinicians and
organizations to provide safe nursing care.
 HIPPA
 1996 HIPPA was signed into law. The law defines standard
that were developed to ensure that health care organizations
collect the data in a common format so that data can e shared
as well as protect the privacy and security of patient data. The
major impact from these regulatory legislation in these areas
 Health information privacy law
 Data security standards
 Electronic transactions standards
 HIPPA and the use computing devices.
Knox and Smith 2007 think encourage everyone to think about
patients privacy and the HIPPA compliance in clinical areas
because of growing use of laptops, tablet p.cs, cell and smart
phones that take pictures and records.
The following are the list of some simple precautions to take to help
secure patient information that may be stored on a mobile device.
These recommendations should be followed as standard practice.
 keep careful physical control of the device at all time.
 Use a password or other user authentication and time out to
reactivate the authentication
 Install and enable encryption
 Install and activate remote wiping/or remote disabling
 Disable and do not install or use file sharing applications
 Disable the infrared ports & wifi except when they are actually
being used.
 Do not send infrared or wifi transmissions' in public location
 Keep your security software up to date
 Research mobile applications before down loadings .
 Use adequate securities to send and receive health information
using public wifi networks.
 Delete all stores health information before discarding or re-using
mobile device.
 Nomenclature classification and
taxonomy
 Standardized nursing languages sometimes called nomenclatures
offer a recognized systematic classification and consistent methods
of describing nursing practice.
 ANA committee for nursing practice information infrastructure
requires that classification or languages meet certain criteria
including:
 The language consists clear and unambiguous terms.
 The language provides clinical, useful terminology and rationale
for the development.
 The developer provides evidence of reliability, validity and utility.
 The language includes a unique identifier for each item.
Theories
 Although there are multiple theories that are applicable to
nursing informatics, three most common are:
 General systems theory: this theory organizes interdependent
parts working together to produce a product that none used
alone can produce. Key elements are input, process, output,
control and feedback.
 Rogers Diffusion of innovation theory: A 5 step process of an
individual’s decision to adopt an innovation includes
knowledge, persuasion, decision, implementation and
confirmation (Rogers,2003)
 Change theory: Kurt Lewins change theory
 The E-world is coming…wait its here
 The 10 E’s in “E-health”
1) Efficiency leading to decreasing cost by avoiding duplicate or
unnecessary diagnostic or therapeutic interventions, through
enhanced communication possibilities b/w health care
establishments, and through patient involvement .
2) Enhancing quality of care by allowing comparisons b/w
different providers, involving consumers as additional power of
quality assurance and directing patients dreams to the best
quality providers
3) Evidence based intervention effectiveness efficiency should not
be assumed but proved by rigorous scientific evaluation
4) Empowerment consumers and patients by making the
knowledge bases of medicine and personal electronic
record accessible to consumers over the internet; E health
opens new values for patient centered medicine and
enables evidence based patient choice
5) Encouragement of a new relationship b/w the patient and
health professionals, toward a true partnership are made in
shared manner
6)Education of physician and health care providers through
online sources (continuing education) and consumers (
health education tailor preventive information for
consumers)
 7) Enabling information exchange and communication in a
standardized way b/w health care establishments
 8)Extending the scope of health care beyond its conventional
boundaries
 9) ethics E-health evolves new forms of patients physician
interaction and poses new challenges and threats to ethical issues
such as online professional practice , informed consent , privacy,
and equity issues.
 10) equity to make health care more equitable is one the promises
of E-health but at the same time there is a considerable threat that
E-health may deepen the gape b/w the “haves” and “have nots”
deepening the digital divide
 Advantages of electronic health
records:
 Simultaneous, remote access to patient from many locations
 Legibility of record_ no hand writing.
 Safer data backup and disaster recovery system, so less prone to
data loss
 Patient data confidentiality authorized use can be restricted and
monitored automatically
 Flexile data layout can recall data in any order
 Integration with other information resources
 Incorporation of electronic data can automatically capture
physiological data from bedside monitors, laboratory analyzers
& imaging devices.
 Continuous data processing check and filter the data for errors,
summarize and interpret data and issues alerts/ reminders
 Assisted search can search free text or structured data to find
specific data value or to determine whether a particular item has
been recorded previously
 Greater range of data output modalities data can be presented to
users via computer generated voice, two way pagers, email and
smart phones
 Tailored paper output data cane printed using variety of fonts,
color and sizes to help focus the clinicians attention on the most
important data; images can be included to help see a more
complete picture of a patients condition
 Always up to date
 Eight core function of electronic health
record
 A committee of the institute of medicine of the national
academies has identified a set of 8 core care delivery function that
electronic health record (EHR) systems should be capable of
performing to promote greater safety, quality and efficiency in
health care delivery.
 These 8 core functions are;
 Health information data
 Result management
 Order management
 Decision support
 Electronic communication and connectivity
 Patient support
 Administrative process and reporting
 Reporting and population health
 Personal health record(PHR)
 “is an electronic record of an individual’s health information by
which individual control access to the information & may have
the ability to manage, track and participate in his or her own
health care”
CPOE and clinical decision support
computerized provider order entry(CPOE) completely changes
the workflow for writing orders.
 CPOE is a technology enabled process hat allows providers such
as physician, nurse practitioners, and pharmacists to enter
patient care orders directly into computer system that transmit
these directly to the receiving department pharmacy, radiology,
dietary).
 Research has begun to confirm BENEFITS such as “averting
problems with hand writing, similar drug names, drug interactions,
and specification errors; integration with electronic medical records,
decision support systems, and adverse drug event reporting systems;
faster transmission to the pharmacy; and potential economic savings”
(AHRQ 2012)
What id the meaningful use
 In 2009 American recovery and Reinvestment act and the
centers for CMS proposed a rule to give financials incentives
to the physician and hospitals for the meaningful users of
EHR.
 GOAL: of meaningful use is to promote the spread of HER
to improve health in the united state by complete and
accurate information better access to information and
empowerment of patients to participate more actively in
their health.
 Barriers still remain..
 Following are the barriers:
1) Lack of standardization across care areas that’s the need for
laboratory data and pharmacy system to e integrated with the
patient HER and emergency department system need to share
data with inpatient system
2) Funding_ information technology is costly and often the major
cost are borne y hospitals rather than sgred by other
providers, peer and employers.
3) Privacy loss_ a single set of privacy loss is needed to simplify
the communication across facilities agencies and local state and
fedral govt.
4) Lack of uniform approach to match patient’s record_ a single
authentication number is reduced safety and to provide uniform
access to patients.(AHA 2006)
 CARS checklist
 It is developed by Haris in 1997 and updated in 2007 is designed
to evaluate the website, although few sources will need majority
of criteria. The check list will helpful in separating the high
quality information and low quality information.
 C- credibility_ an authoritative source includes authors
credentials, evidence of quality control such as peer review
 A-accuracy_ a source that is correct today (not yesterday);
comprehensive.
 Reasonableness_ look at the information for fairness, objectivity,
moderateness, consistency, and world view.
 Support support that provides convincing evidence for the claims
made; a source that you can triangulate
 Basic computer competencies
The basic skills include:
 Concepts of information and communication technology
 Using the computer and managing files
 Word processing
 Spread sheets
 Using data bases
 Presentations
 Web browsing and communication
 Information literacy
 Association of college and research libraries defined information
literacy as “ the set of skills needed to find, retrieve, analyze, and
use information”
The TIGER recommendation is that all practicing nurses and
graduating nursing students will have the ability to:
• Determine the nature and extent of information needed
• Access needed information effectively and efficiently
• Evaluate information and sources critically and incorporate
selected information into his/her knowledge base and value
system
 Individually, or as a member of a group, use information
effectively to accomplish a specific purpose
 Evaluate outcomes of the use of information