6120543 Nursing Informatics

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Informatics in the Health Care Professions Hardware,Software, and Roles of Support Personnel

Definitions:

Informatics(informatics comes from the French word informatique which meanscomputer science).Informatics is defined as computer science + informationscience. Used in conjunction with the name of a discipline, it denotes an applicationof computer science and information science to the management and processing ofdata, information, and knowledge in the named discipline. Thus we have, medicalinformatics, nursing informatics, pharmacy informatics and so on.

Hebda (1998 p. 3), defines nursing informatics as "the use of computers technology tosupport nursing, including clinical practice, administration, education, and research."

American Nurses Association (ANA) (1994) has defined nursing informatics as "the

development and evaluation of applications, tools, processes, and structures whichassist nurses with the management of data in taking care of patients or supporting the

practice of nursing."

Graves, J. R., & Corcoran, S. (1989). The Study of Nursing Informatics. Image:Journal of Nursing Scholarship, 27, 227-231. define nursing informatics as "acombination of computer science, information science and nursing science designedto assist in the management and processing of nursing data, information andknowledge to support the practice of nursing and the delivery of nursing care."

The framework for nursing informatics relies on the central concepts ofdata,information and knowledge:

datais defined as discrete entities that are described objectively withoutinterpretation

information as data that is interpreted, organized or structured

knowledge as information that has been synthesized so that interrelationshipsare identified and formalized.

Resulting in decisions that guide practice

The management and processing components may be considered the functionalcomponents of informatics.

Example:

Data: 140 systolic


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Information: 50 year-old male, day 3 of hospitalization, BP 140/70

Knowledge: Pt. demographics, record of BP readings, circulation system: anatomy &physiology, pharmacokinetics of ordered medication

Decisions: That guide practice

Application of Nursing Informatics:

Nursing Informatics can be applied to all areas of nursing practice, which include;clinical practice, administration, education, and research. Below are some examples ofhow nursing informatics, information technology and computers, are used to supportvarious areas of nursing practice.

Nursing Clinical Practice (Point-of-Care Systems and Clinical Information Systems)

Work lists to remind staff of planned nursing interventions

Computer generated client documentation

Electronic Medical Record (EMR) and Computer-Based Patient Record (CPR)

Monitoring devices that record vital signs and other measurements directly into

the client record (electronic medical record)

Computer - generated nursing care plans and critical pathways

Automatic billing for supplies or procedures with nursing documentation

Reminders and prompts that appear during documentation to ensure

comprehensive charting

Nursing Administration (Health Care Information Systems)

Automated staff scheduling

E-mail for improved communication

Cost analysis and finding trends for budget purposes

Quality assurance and outcomes analysis

Nursing Education

Computerized record-keeping

Computerized-assisted instruction

Interactive video technology

Distance Learning-Web based courses and degree programs

Internet resources-CEU's and formal nursing courses and degree programs

Presentation software for preparing slides and handouts-PowerPoint and MS

Word


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Nursing Research

Computerized literature searching-CINAHL, Medline and Web sources

The adoption of standardized language related to nursing terms-NANDA, etc.

The ability to find trends in aggregate data, that is data derived from largepopulation groups-Statistical Software, SPSS

Benefits of Computer Automation in Health Care:

Many of these benefits have came about with the development of the electronicmedical record, which is the electronic version of the client data found in thetraditional paper record.

EMR benefits include:

Improved access to the medical record. The EMR can be accessed from severaldifferent locations simultaneously, as well as by different levels of providers.

Decreased redundancy of data entry. For example, allergies and vital signs need onlybe entered once.

Decreased time spent in documentation. Automation allows direct entry frommonitoring equipment, as well as point-of-care data entry.

Increased time for client care. More time is available for client care because less timeis required for documentation and transcription of physician orders.

Facilitation of data collection for research. Electronically stored client recordsprovide quick access to clinical data for a large number of clients.

Improved communication and decreased potential for error. Improved legibility of

clinician documentation and orders is seen with computerized information systems.

Creation of a lifetime clinical record facilitated by information systems.

Other benefits of automation and computerization are related to the use ofdecision-support software, computer software programs that organize information to aid indecision making for client care or administrative issues; these include:

Decision-support tools as well as alerts and reminders notify the clinician ofpossible concerns or omissions. An example of this, is the documentation ofpatient allergies in the computer system. The health care providers would bealerted to any discrepancies in the patient medication orders.

Effective data management and trend-findinginclude the ability to providehistorical or current data reports.

Extensive financial information can be collected and analyzed for trends. Anextremely important benefit in this era of managed care and cost cutting.

Data related to treatmentsuch as inpatient length of stay and the lowest levelof care provider required can be used to decrease costs.


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The Role of the Nursing Informatics Specialist (NIS):

Because of the increased importance of computers and information technology in thepractice of professional nursing; a new role has emerged, the nursing informaticsspecialist (NIS). The NIS is a nurse who has formal education, certification and

practical experience in using computers in patient care settings. The American NursesAssociation (ANA, 1994), lists several functions of the NIS:

Theory development. The NIS contributes to the scientific knowledge base of nursinginformatics.

Analysis of information needs. The identification of information that nurses' need to inorder to accomplish their work; client care, education, administration, and research

Selection of computer systems. The NIS, guides the user in making informed decisionsrelated to the purchase of computer systems.

Design of computer systems and customizations. The NIS collaborates with users and

computer programmers to make decisions about how data will be displayed andaccessed.

Testing of computer systems. Systems must be checked for proper functioning beforethey are made available for use in patient care.

Training users of computer systems. Users need to be trained in how the systemworks, the importance of accurate data entry, and how the system will benefit them,and more importantly how it will improve patient outcomes

Evaluation of the effectiveness of computer systems. The unique role of the NIS makesthem the ideal person to evaluate the effectiveness of computer systems.

Ongoing maintenance and enhancements. The NIS makes sure the computerizedsystem functions properly and explores possible enhancements to the system that willbetter serve the users and the patients.

Identification of computer technologies that can benefit nursing. The NIS must keepabreast of the changes in the fields of computers and information technology,including new hardware and software that will benefit the nurse and patient.

Hardware, Software, and the Roles of Support Personnel:

Hardware is the physical part of the computer and its associated equipment. Computer

hardware can comprise many different parts, these include:

Input Devices: used to enter data; keyboard, mouse, trackball, touch screen,light pen, microphone, bar code reader, fax modem card, joystick, and scanner.

Output Devices: used to view and hear processed data; video monitor screens,printers, speakers, and fax.


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Central Processing Unit (CPU) "brain" of the computer, three components:

Arithmetic Logic Unit (ALU): number "crunching"

Memory: is the storage area in which program instruction (code)reside during execution.

Read-only memory (ROM) is permanent; it remains whenthe power is off. Start-up instructions for the computer is anexample of ROM.

Random access memory (RAM) is a temporary storage areafor program instructions and data that is being processed, itis only active while the computer is turned on. (located onthe motherboard not part of CPU)

Control Unit: manages instructions to other parts of the computer,

including input and output devices "traffic cop"

Secondary Storage: provides space to retain data in an area separate from thecomputer's memory after the computer is turned off, these include; hard diskdrives, floppy disks, tape, zip drives, optical drives and CD-ROM drives.

Computer Categories:

Super computers, are the largest and most expensive, can performbillions of instructions every second

Mainframes, large computers capable of processing severalmillions instructions per second. They support organizationalfunctions, therefore have been the traditional equipment inhospitals. Customized software results in high cost.

Minicomputer, is a scaled-down version of the mainframe, sincethey are now becoming more powerful they can now be found inhospitals and HMO's

Microcomputers (PCs), inexpensive processing power for anindividual user.

Laptop or Notebook, Handheld, and Personal Digital Assistants(PDAs)

Networks:

A network is "a combination of hardware and software that allowscommunication and electronic transfer of information between computers" (ascited in Hebda, 1998, p. 19).


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Hardware may be connected permanently by wire (Ethernet), or temporarily bywireless communication, and modems/telephone lines. This allows the sharingof computer and software resources, through the use of the network. Forexample, several computers may share one computer, or a word processing

program could also be accessed by many different users.

Networks, no matter how small or large, operate with the client/servertechnology.

A Serverstores files and programs that are accessed by the client on thenetwork. When you access the Internet from home, you the client (yourcomputer), requests files from a Server (another computer), you see theresults displayed on your screen through a browser. You may also accessa network in your clinical practice; you the client, accesses a patientrecord on the floor from a server, which stores the patient record.

Types of Networks: They range from small (home network) to very large(Internet)

Home Networks - within a home

Local Area Networks (LAN) - networks within a area, location orbusiness. The University connects all its computers on a LAN.

Wide Area Networks (WAN) - several LAN connected together

Internet - many WAN connected together around the globe to giveus the Internet that we use today

Intranets - private company networks that are protectedfrom outside access Kaiser HMO and its clinics andhospitals is an example.

Extranets - several Intranets connected together, Kaisermaintains Extranet a network connection with its suppliers

Selection Criteria for Computer Equipment:

When selecting a computer system or related hardware, you must take

into consideration the following:

The types of applications requiredSome people need word processing,while others may need database or spread sheet software.

The program execution time and computer capacity needed to processjobs Complex jobs require more processor speed and memory.


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Storage CapacityNeeds are determined by the amount of informationthat must be kept and the length of time that it must be retained.

Backup Options When information is critical to conduct daily business,another backup system may be need if the primary one fails.

Operating Systems: A collection of programs that manage all of the computer'sactivities, including the control of hardware, execution of software, and managementof information.

Operating Systems provides a user interfaceby which the individualinteracts with the computer. Types include; text based commands,graphical user interfaces (GUI), and object-oriented interfaces (OOI) agraphic interface in which visual metaphors are employed.

Roles of Support Personnel:

Support for computer systems and networks is extremely important in order tomaintain system functionality, support includes: 1) planning system upgrades,2) installation of upgrades for operating systems and various applications, 3)troubleshooting, and 4) user education and training.

Superuser: This person has additional experience over the averageemployee and serves as a local resource person. In the hospital settingthis is user who know the clinical area and the computer system.

Microcomputer Specialist: Provides PC information and training; hasspecial training and degree in computer science or a related area.

Analyst: They are frequently clinicians, who become involved in systemselection and training. Many have learned their role on the job andfurthered their education by taking computer or information scienceclasses.

Programmer: Writes code, computer instructions; they often lack theclinical experience. For this reason the analysts are responsible forcommunicating user needs to programmers

Network Administrator: They are responsible for the planning,management and expansion of networks.

Director, Information Services: These individuals should have a boardview of the needs of the institution and the design, implementation, andevaluation of information systems. Responsibilities include planning,

policy development, budgeting, information security, and overallmanagement of the information systems.


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6120543 Nursing Informatics

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