PRACTICE APPLICATION

Practice Application

Critical Care Application

Community Health

Application

Ambulatory Care System

Internet Tools

Informatics Solution

Vendor Applications

Practice Application

Historical Perspectives

•More than 150 years ago, Florence Nightingale spoke about the critical importance of nursing informatics in patient care. “Decision making must be based upon the use of accurate data”, she said (Ulrich, 1992, p.68)•The nursing pioneer also spoke of frustration from difficulties of exacting such critical patient- related data from hospital record.•It was more than a century after Florence Nightingale’s era that computer made their appearance on the hospital landscape. The first hospital information system arrived in the late 1950’s to the mid-1960, although these systems focused primarily on processing financial and administrative information

Nursing Informatics as Evolving Definition

A specialty that integrates nursing science, computer science, and information science in identifying collecting, processing and managing data and information to support nursing practice, administration, education and research; and to expand nursing knowledge. The purpose of nursing informatics is to analyze information, requirements design, implement and evaluate information systems and data structures that support nursing and identify and apply computer technologies to nursing. (ANA, 1992)

Informatics Competencies: Beginning to Experienced

Information literacy skills: these are the basic computer skills needed to use a word processor; access a database; create a spreadsheet; communicate with the e-mail; and

interact with clinical documentation systems.General informatics competencies: these basic skills are

required for all nurses but are not sufficient for specialists: identifying, collecting and recording data relevant to the nursing care of patient; analyzing and interpreting patient and nursing information; using applications of informatics as an integral part of the nursing process; and implementing institutional and public policies regarding privacy, confidentiality and

security of information. (ANA, 2011, p.26)

Problem Solving as an Organizing Framework

According to the ANA (2001), the informatics nurse specialist moves beyond the foundational competencies and into a practice specialty in which there are organized and recognized standards of practice and performance include six major areas that mirror the traditional nursing process. (ANA, 2011, pp. 32-39)

Information Technology and the Actual Work of Nurses

At the beginning of the new century, much was written about the reality that information technology had become important in the delivery of contemporary healthcare. A federal report (U.S Department of Health and Human Services, 2011) on proposed strategies to build a national health infrastructure emphasized the need for all health care providers to be skilled in using technology for decision-making.

Nursing Documentation

Nursing documentation in the patient record has become more complex as nursing practice has expanded to

encompass care to critically ill and specialty patients, and as

technologic advances have become standards of care in

practice.

In 1989, the steering

Committee was establish

In 1993, the ANA house of Delegate passed a resolution to “develop

nursing classifications specifically aimed at diagnosis, interventions, and

nursing sensitive patient outcomes, and support activities directed toward the inclusion of nursing data elements

in healthcare databases.

Care planning

•The computer-based patient record facilities the automation of the nursing care planning process. The benefits and the challenges of integrating computerized systems with the care planning have been extensively reported in the literature during the last decade.

Decision-Making with Expert Systems

Broadly defined the term clinical support system (CDSS) includes an array of computer-based applications that assist healthcare clinicians in the day-to-day work of patient care. These may include programs that involve artificial intelligence (AI); different types of knowledge such as uncertainty, heuristics and fuzzy logic; expert systems; and decision support systems.

Two types of AI

•Expert system

•Machine Learning

Outcomes Management

A chapter on the use of computers in nursing practice today would be incomplete without a description of how informatics is being used to organize and implement systems for outcomes

management.

A look at outcomes management provides a powerful illustration of how nurses use

informatics in daily practice to evaluate the relationship between patient goal attainment and

nursing interventions.

Discharge Planning

The documentation of patient care usually begins with the admission

assessment and ends with the discharge care plan.

Discharge care plan systems provide for continuity of care from the

home to the hospital and back to the community, another care

facility, an outpatient department, or the home

Summary of the admission assessment

Summary of learning needs that the patient had at discharge

Multidisciplinary plan including problems still unresolved and outcomes not met during hospitalization

Medication and procedures that the patient must continue

Summary of selected patient outcomes that a multidisciplinary team desired as minimal criteria for the patient to have achieved during

hospitalization. (Romano, McCormick, and McNeely,1982)

Five components or Types of discharges plan

Healthcare Collaboration

Collaboration with other members of the healthcare team has always been a critical component of nursing.

Advances in technology, however, have changed the ways in which members of interdisciplinary healthcare teams

are and will be communicating in new millennium.

As Alpay and Russel suggested, “the use of IT is part of the development and delivery of health services”

The inevitable integration of computers into nursing

practice has been accompanied by speculation, controversy, and research on

the benefits, barriers, and real potential of NISs for

improving clinical practice and giving nurses a voice in

the development of healthcare policy.

Although related research on the practice application of computers in nursing will

certainly continue, there is general agreement that

organization and use of data with computers have exerted

a positive influence on the provision of the patient care.

Progress in practice

Critical Care Application

Critical Care NursingIs an area of

expertise within nursing that focus specifically with

human responses to life-threatening

problems.

Critical Care Nurse

Is responsible to ensure that

critically ill patients are seriously conditioned individuals.

Ensure that families of the medically ill

patients should receive optimal

care.

Critical Care ApplicationsAreas where patients

require complex assessment, high-

intensity medication, continuous therapy and interventions,

and unrelenting nursing attention and continuous watchfulness.

Critical Care Information System

Provide real-time resource utilization data and management of information and access critical care areas through the integration of the medical facilities in the critical to an intelligent computer system which is capable of processing all data.

Enables the electronic collection of hospital and patient-specific critical care data of the entire patient in the critical care areas which can be processed to create a patient profile which generate real time and historical report

Automated collection and management of medical information will become the important task of the critical care information system

Medical Information Bus (MIB)

Provides a generalized method of attaching patient monitoring devices to a common interface.

This interface converts the unique manufacturer data communications protocol into a standardized hardware and software system

It eliminates the need for custom connector and software presently needed to interface such device.

Has the ability to filter, store and select information sent for inclusion into the clinical medical record on the clinical computer system

Advantages of Critical Care Information System

Intelligently integrates and process physiologic and diagnostic information and store it to secured clinical repository.

Creates trends analysis with graphical representation of results.

Offline stimulation can be performed to test the condition of the patients.

Provide clinical decision support system

Provide access to vital patient information

Providing feedback and quick evaluation of the patient condition and provides alert.

Community Health Application

•Collective term for the methodical application of information science and technology to community and public health process.

•Focuses on the health information system of the community, it is centered on the majority part of the public.

•Emphasizes the prevention of the disease, medical intervention and public awareness.

•Fulfils a unique role in the community, promoting and protecting the health of the community at the same time maintaining sustainability and integrity of health data and information.

Goal of Community Health Informatics

Effective and timely assessment that involves

monitoring and tracking the health status of populations

including identifying and controlling disease outbreaks

and epidemics.

Community Health Nursing

Comprehensive directed towards the majority of

individuals, families, and the community at large.

Community Health Application System

Encourages optimal application of computer system, computer programs and communication system for the benefit of majority of individuals, families and community.

Primary Focus of Community Health Information System

•Preventing, identifying, investigating and eliminating communicable health problems.•Accessibility of data and information, through communication

•Educating and empowering individuals to adopt health life style•Facilitate the retrieval of data

•Effective transformation of data into information•Effective integration of information to other disciplined to concretized knowledge and creates better understanding.

Computer Based Survey System

Health Statistical Surveys

•Are used to collect quantitative information about items in a population to establish certain information from the obtained data.•Focused on opinions or factual information depending on it’s purpose and many surveys involves administering questions to individuals.

Advantagesof Community

Health Systems

Consistent exchange of

response

Disease tracking

Building strategies

Control of spread of disease

Building strong communication

National alertness and preparedness

Synchronization of the decisions

Ambulatory Care System

Ambulatory Care

These services are performed at outpatient clinics, urgent care centers, emergency rooms, ambulatory or same-day surgery centers, diagnostic and imaging centers, primary care centers, community health centers, occupational health centers, mental health clinics, and group practices.

Ambulatory Care

Information System

Provides automated processing of data and information such as allergies and medical alerts, patients accounting system such as charging, billing, discounts and concessions, diagnostics imaging treatments, and etc.

Advantages of Ambulatory Care Information System

•Real-time and easy access to patient’s medical records by healthcare providers.•Improved workflow, which allows more time for comprehensive patient counseling and review.•Reduced errors with the availability of various automation engines – drug interaction engine; medical alert engine; patient billing engine, etc.•Improved clinical outcome analysis •Improvement in hospital inventory management.

Issues in Ambulatory Care Information System

•Increased accountability•The need for continuous support•Privacy and confidentiality of information•Accessibility and security of data and information•Integration and support to the other system

The Role of Nurse Using Information System in the Ambulatory Care System

•The very basic objective of the automated ambulatory care information system is to easily integrate the data to the other data and easily translate these data into information.

•The effective transformation of data can be integrated to the other processes to transform it into knowledge.

•The ambulatory care nurse and other health care provider should be capable enough to implement the process effectively.

Three Strategies

Name precisely the information being sought. If the search terns used precisely chosen, the searcher goes directly to the desired information.

Use a search string (one or more search terms) rather than a single word to increase the preciseness of a search. Enter the precise terms in a string, rather than a single term.

Enhances search strings by Boolean or natural language methods. Use Boolean terms: and, or, not. The term “AND” is used when search terms or strings need to be added together. The term “OR” is used when equivalent terms or synonyms are used to capture the information.

Internet Tools for Advanced Nursing Practice

Regardless of the search engine used, certain search methodologies, if applied correctly, increase the efficiency of retrieval if needed information. The three strategies are: name precisely the information being sought, use search strings rather than single words, and enhance search strings by using Boolean or natural language methods.

Basic and Advance Internet Search Methods

Internet-Available Clinical Practice Tools

This section is divided into the most basic components of nursing process: assessment, diagnosis, treatment, and outcome evaluation. These component provide the outward structure for development of a clinical information database for advanced practice nursing.

Assessment

Assessment refers to the systemic collection of data needed to arrive at one or more diagnoses. The tools

included in this section include forms,

miscellaneous screening tools, risk assessment

instrument, and information, and

information of the manifestation of signs and

symptoms. These tools represent a sampling of

assessment content available on the internet.

Treatment is diagnostic specific. Hence, diagnosis

and treatment information categories are frequently not

discreet.

The etymology of the word “diagnosis” is based in its Greek roots. “Dia” means “through,” and “gnosis”

means knowledge base of the person diagnosing.

Diagnosis

New Threats

to Health

Mass Trauma Preparedness

Response

Bioterrorism Agents/Diseases

Clinical Agents

Recent Outbreaks

and Incidents

Type Department of Oncology

Human Response to Illness/ Health

Diagnoses

Methods of Contributing to

Terminology Revision and Development-

The International Classification

Functioning, Disability, and Health (ICF)

Treatment

The term “treatment” is used in lieu of interventions and nursing actions, because it expresses more precisely the broad clinical management focus of this section.

Nursing treatment

Calculators

•Several Internet sites are available for those who desire more information on Saba’s framework/structure examples, a NIC intervention example, Omaha System case studies, and PNS examples and outcomes. They are:

• Nursing Intervention Classifications (NIC)

• Omaha System• Peri-operative nursing

data set

•Internet tools are available to facilitate calculations used in planning treatment. Examples include:

• Martindale’s Calculators Online Part I: Nutrition

• Nursing calculators for drug administration purposes

• Medical calculators developed by Cornell University Medical College, Pediatric Critical Care Medicine.

Drug Management

Drug Enforcement

Agency

Food and Drug Administration

NLM Clinical Alerts Database

Center for Drug research and

evaluation

FDA Safety Information and Adverse Event

Reporting Program

Medwatch Adverse Event and Product Problem Forms

NLM Clinical Alerts Database

The National Institutes of

Health

Drug Management

National Institutes on Alcohol Abuse and Alcoholism

National Institutes on Drug Abuse

National Center for Complementary and Alternative Medicine

The Center for Disease and

Control

CDC Vaccines and Immunization Program

CDC National Immunization

Program

More information on

vaccines

Drug Management

University sites are excellent sources of

information

Commercial sites that provide readily

accessible manufacturer’s

information on drugs

Commercial sites that provide excellent

online clinical educational information

Medscape Rxlist

Evidence-Based Practice Guidelines

Government Sites Practice/ Treatment guidelines are available at several government

sites.

Center for Disease

and Control

National Guidelines

Clearinghouse

National Institute of

Health

Outcomes

Patient safety

Nursing outcomes

Nursing Home and

Home Healthcare

Setting Outcomes

Office Tools Online Health Record Audit and Patient Satisfaction

Forms

Short Form (SF)

Health Survey

Outcomes Measurement:

Internet-Available Bio statistical and

Analytical Tools

CLINICALOGA Web-Based Clinical

Encounter

Database

Healthcare settings are integrating clinical information systems into all aspects of care planning, delivery, and evaluation. To prepare clinicians to recognize and capitalize on the potential of this information to affect health outcomes, informatics needs to be integrated into the clinical course work. The eClinicaLog is part of an educational strategy, initially designed to build data entry, analysis, and synthesis skills in nurse practitioner students. As its version have evolved, eClinicaLog has become relevant to undergraduate education as well.

Informatics Solution for Emergency Preparedness

and Response

•Events in the United States, such as the September 11, 2001 incident and the anthrax breakout lead the government of the United States to respond at an unprecedented pace to better prepare and manage terrorist events. Informatics could contribute to increasing the efficiency in disaster response as well as providing a telepresence for remote medical caregivers.•The purpose of this chapter is to explore current and future roles of informatics in emergency preparedness and response.

Changes in the Federal System Affecting Emergency Preparedness and

Response

A New Definition of Community Federal Responsibilities

for Healthcare Providers

Community health is the provision of healthcare

outside the hospital infrastructure. As such, the public health departments have been viewed as the major delivery system of

healthcare.

The U.S. Department of Health and Human Services (DHHS) is responsible

for the education of healthcare professionals in preparedness for emergencies, including potential

terrorism. Three of the units focus on emergency planning and response: the CDC the Agency for Healthcare Research and Quality (AHRQ), and

HRSA. Each of these agencies play a critical role in emergency planning and

response.

New Visibility of CDC Promotes Informatics

Solutions

Several of the CDC initiatives require informatics support. The National Electronic Disease Surveillance System (NEDSS) is an initiative that promotes the use of data and information system standards to advance the development of efficient, integrated, and interoperable surveillance systems at federal, state and local levels. It is a major component of the Public Health Information Network (PHIN).

Roles of AHRQ in Stimulating New

Informatics Solutions

AHRQ’S involvement in bioterrorism comes for the recognition that clinicians, hospitals, and healthcare systems have essential roles in public health infrastructure.

Decision Support System

AHRQ’s Integrated Delivery System Research Network (IDSRN) is to develop a computer simulation model for citywide response planning for mass prophylaxis and vaccination during bioterrorist attacks and other public health emergencies.

Syndromic Surveillance

It is a detection of a disease outbreak before the actual disease or mechanism of transmission is identified. Real-time outbreak and disease Surveillance (RODS) system is a system that provides early warning of possible infectious disease outbreaks caused by bioterrorism or other public health emergencies.

Helping Clinicians Respond

•Provider training and education are also critical elements of a comprehensive plan for bioterrorism and public health preparedness in general.

•Researcher at the University of Alabama at Birmingham have developed continuing medical education training modules to each healthcare professionals to identify various biologic agents, as many pathogens and conditions(such as smallpox) are rarely seen in the United States, which limits clinicians from being familiar with related infection.

Roles of Health Resource & Services Administration (HRSA) in Promoting Informatics Educational Solutions

•The Hospital Bioterrorism Preparedness Program and the Bioterrorism Training and Curriculum Development Program (BTCD) are 2 grant management programs that exist under the management of the HRSA. •The purpose of the National Bioterrorism Hospital Preparedness Program is to aid state, territory, and care system, including hospitals, emergency departments, outpatient facilities, emergency medical services systems, and poison control centers, to respond to incidents requiring mass immunization, isolation, decontamination, diagnosis, and treatment, in the aftermath of terrorism or other public health emergencies.

Changes Affecting Emergency Preparedness and Response

Competency – Based Learning and Informatics

Needs

The American College of Emergency Physicians (ACEP) formed a nuclear, biologic, and chemical task force to evaluate the status of bioterrorism training in the United States, identify barriers to this training, and offer recommendations for effective education

Informatics and the

Emergency Operations

Center

The Incident management system (IMS) was first used by firefighters to control disaster scenes in a multijurisdictional and interdepartmental manner.

Vendor Applications

This chapter presents the current trends, issues, obstacles, and opportunities facing the nursing profession with regard to utilization of HCIT. The focus was on leading HCIT vendors that provide organization wide, hospital-centric information systems, and address nursing applications in context of a patient-centric EMR. The response of these vendors to the demand by nursing for improved information systems was discussed. In addition, the demand for delivery of standard-based nursing or clinical data sets with the software application and how leading vendors are responding to this demand were presented.

Current Trends Toward Prime Vendors, EHRs, and Systems

Integration

•“NICHE” applications focus on a discrete set of nursing functions such as care planning.•“DEPARTMENTAL” systems address a more comprehensive set of functions. This is either of the three: for a single point of service such as labor and delivery; or department such as cardiology; or closely aligned group of departments such as the perioperative suite.

New Technologies

New and emerging hardware and software technologies such as handheld devices are increasingly being incorporated in nursing applications. Key goals are to improve quality of care, mobility of caregivers and collaboration among the care team. Currently, strong emphasis is being placed on delivering technology at the point of care via bedside terminals and wireless devices such as PDAs and Laptops.

Historical Perspective

Current Situation

Historically, nurse executives have not widely embraced it as a strategic business tool. The nursing profession has been largely underserved by HCIT vendors, even though Nursing is one large beneficiaries of IT. There are a variety of reasons why Nursing is not highly provided by these vendors. In most national and local healthcare debates, nursing has been essentially invisible, partly because this is the only profession that does not charge for services rendered.

Today, the majority of nursing-related patient care applications are acquired as part of EHR decisions . But some of the products released are poorly designed and user-unfriendly for nurses.

Factor Affecting Vendors Application

Nursing is an untapped and underserved resource in provider organizations

Automation is not highly priority for nursing in their organizations

Vendors are out of sync with nursing needs

Some new tools and technologies have complicated rather than simplified nursing practice, at times decreasing productivity and introducing an element of increased risk to patients.

Root causes of poorly designed nursing

applications

•Vendor product design processes driven by non-nurse professionals•Insufficient nursing representatives on vendor executive and development teams•Then HCIT industry’s overall woeful lack of adequate requirements definition, functional specifications, and process analysis•Early focus on automation of the paper chart without a full understanding of underlying nursing process, workflows, and ergonomic challenges•In response to patient safety concerns, vendors and provider organizations have focused on two primary HCIT initiatives; (1) Computerized Physician Order Entry [CPOE] and (2) Bar-Code Medication Administration [BCMA].

Vendor Response

In response to market demand, HCIT vendors are delivering more robust and tightly integrated clinical solutions that better address the needs of all health care providers for more coordinated, streamlined patient care delivery. While some vendors offer clearly superior nursing applications, no solutions; each has different strengths and limitations.

Standard Terminology Provided with Clinical Applications

Expectation of the marketplace

Current Status

Despite the lack of a national consensus

regarding one standard nursing terminology or data set, HCOs expect their EHR vendor to

deliver a Standards-based set of nursing content for

charting and planning care.

Responding to this market demand, most of the major HCIT vendors now

deliver at least basic starter set of terminology. An increase number of

these vendors are including standards-based terminology with their clinical documentation application as well as

evidence-based standards of care with their care planning and clinical

pathway applications, and some are using standard terminologies that map

to SNOMED[Systematized Nomenclature of Medicine].