NINFOR

• Nursing informatics (NI) was first identified

  1980s
• Nursing informatics (NI)


  The combination of nursing, information and computer sciences to manage and process nursing data into information and knowledge for use in nursing practice
• Domain of NI


  • Data and its structures
  • Information management
  • Technology
• Concepts from other disciplines included in NI

  • Linguistics
  • Organizational dynamics
  • Communication engineering
  • Library science
• Development of nursing informatics as a specialty

  • Nursing shortage has been seen as detrimental in the delivery of quality healthcare
  • Several factors have necessitated the use of IT in nursing: number of hours needed for quality care, development of health sciences, aging of baby boomers, average age of nurses is 45.2, presence of training programs for nursing
• The Institute of Medicine found that 2.9 to 3.7% of admissions had experienced adverse events
• Reason for nursing informatics

  To improve patient safety
• Outcomes of computerization of hospital documentation/processes

  • Reduction in paper expenditure
  • Streamlining of organizational processes
• Safety is always the top concern in healthcare
• Healthcare is a high error-prone industry
• Deaths in hospitals are usually attributed to practitioners interacting with bad systems
• Acquisition of computers were focused on stand-alone systems
• Less than 10% of healthcare organizations have put significant amount of resources in this area
• Computerized Prescriber Order Entry (CPOE)

  A system that is used for direct entry of one or more types of medical orders electronically into a system that transmits those orders electronically to the department concerned
• Paper-based system is still used as a form of communication among healthcare providers
• It was hard to locate pertinent information on the papers that hold the record
• Illegible handwriting and multiple volumes of patient records are also factors that were considered in the development of CPOE
• Advantages of CPOE


  • Medication errors are reduced by 55%
  • Non-missed dose errors fell to 26.6/1000
  • Handwriting misinterpretation errors would be eliminated
  • Errors of omission would be reduced
  • Fewer handoffs will occur, thus minimizing duplicated efforts
  • Transmission of information will be faster
• Barcode-Enabled Point-of-Care Technology (BPOC)

  • 38% of errors occur in the medication administration process
  • Barcodes have a major impact on productivity and identification
  • Includes a second identifier for a patient receiving a medication
  • The system helps to verify that the right drug is administered to the right patient at the right dose and at the right time
  • Negative effects: nurses find it difficult to deviate from the norm, nurses have their own strategies that circumvented the BPOC
• Healthcare data standards


  The methods, protocols, terminologies and specifications for the collection, exchange, storage and retrieval of information associated with healthcare applications, including medical records, medications, radiological images, payments and reimbursements, medical devices and monitoring systems, and administrative processes
• Data standards aim to reduce the level of ambiguity in the communication of data
• Address the format of messages that are exchanged between computer systems, document architecture, clinical templates, user interface and patient data linkage
• To achieve data compatibility between systems, it is necessary to have prior agreement on the syntax of the messages exchanged
• Four broad classes of message format standards

  • Medical device communications
  • Digital imaging communications
  • Administrative data exchange
  • Clinical data exchange
• Standards development process


  • The core of every system is the concept of a secure, patient-centered EHR that safeguards personal privacy, uses standardized medical terminology, eliminates the danger of illegible handwriting and missing patient info, and can be transferred as a patient's care requires over a secure communications infrastructure for electronic information exchange
• Unfortunately, not all computer systems are invincible to attacks
• One example was what happened to CareGroup in the US
• August 2003, Blaster and SoBig worm attacks invaded hospitals
• The complexity of computer systems are always prone to fail
• Guidelines for dependable systems

  • Removing all system vulnerabilities is not practical because of its complexities and the heterogeneous environments where software and hardware changes are part of routine operations
  • The more practical approach is to build a tolerant system that can anticipate problems, detect faults, software glitches and intrusions, and take action so that services can continue and data are protected from corruption
• Guidelines for dependable systems


  • Architect for dependability
  • Anticipate failures
  • Anticipate success
  • Hire meticulous managers
  • Don't be adventurous
• Nursing Minimum Data Set (NMDS)

  To enter into automated healthcare information systems with potentially wide-scale application, the nursing community should standardize data, and once standardized, these data become a valid element of knowledge
• To come up with standards, the nursing profession should convene
• Criteria for NMDS


  • Data must be useful to most potential users
  • The items in the set must be readily collectable with reasonable accuracy
  • Items should not duplicate other available data
  • Confidentiality must not be violated
• Recognized terminologies in US NMDS

  • NANDA (North American Nursing Diagnosis Association)
  • NIC (Nursing Intervention Classification)
  • NOC (Nursing Outcome Classification)
• 16 elements of NMDS

  • Demographic elements: personal identification, date of birth, gender, race, residence
  • Service elements: service agency number, unique number of principal registered nurse provider, health record number, episode admission or encounter, discharge or termination date, disposition of client, expected payee
  • Nursing care elements: nursing diagnosis, nursing intervention, patient outcome, intensity of nursing care