Nursing Informatics

The importance of information

• The healthcare of our clients is largely dependant
on information.
• Every action taken depends on previous
information and knowledge.
• The delivery of health care requires information
about:
– Science of type of care (nursing)
– Patient or client
– Provider
– Outcomes
– Process and systems for delivery of care

The importance of information

The science of type of care (nursing)
• The “science of care” refers to the scientific
foundations of the profession that provides healthcare.
• Science helps determine the body of knowledge,
language, and focus of that profession.
• Scientific rationale or evidence provides a
foundation for decision-making within that profession.

The importance of information

Patient or client
• Information on the client is required for his/her
individual care.
• The assessment process consists of gathering
information.
• The use of technology can assist in collecting this
information.
• Information on the client can be found in the
patient record, the patient’s history, lab results.
• Information on the client changes and grows over
time.

The importance of information

Provider
 • Information about the provider of care helps
determine the type of assessment and the focus of care
given.
• The provider can be an individual professional
such as a nurse, a physician, a physiotherapist.
• The provider can also be the facility in which care
is provided such as a public health unit, a hospital.

The importance of information

Outcomes
• The outcome of treatment and care now requires
more attention than ever.
• There is a growing interest in ensuring that care
results in quality outcomes in a cost-efficient manner.
• Outcomes can be difficult to measure.
• Technology can assist in measuring because it can
enhance gathering, analysis and dissemination of
outcomes.

The importance of information

Process and systems for delivery of care
• Information about the process and systems for
delivery of care assists in deciding on the type and the
amount of care required.
• This is the tracking on interventions and the
process used for each intervention.

The importance of information

• Information about each of these areas have an
impact on the type and the amount of care given.
• Information must be:
 accurate
 timely
 accessible
 understandable

What is information?
The structure of information
 • Delivered in conversation, handwritten notes,
stored in a computer.
• Regardless of the form, the same basic principles
apply to the structure and the use of information.
• Words are often used interchangeably to describe
information.

The structure of information

• Data: discrete entities objectively described,
without interpretation or context.
– Example: 110
• Information: data processed into a structured
form. Data that are interpreted, organized, structured
and given meaning are referred to as information.
– Example: When combining 110 with other
data, it becomes information. Systolic blood
pressure of 110 mmHg and diastolic blood
pressure of 70 mm Hg. This information can be
captured in a form, on a graph on in a report.
• Knowledge: synthesized information derived from
the interpretation of data. It provides a logical basis for
making decisions.Essential to decision-making and to
new discoveries.
– Example: When the blood pressure reading is
combined with information about anatomy and
physiology, pharmacology, pathophysiology,
knowledge is used to decide about further care
and treatment.

The five rights of information

Information has five rights:
 Right information
 Right person
 Right time
 Right place
 Right amount

What is healthcare informatics?

 • With the knowledge of the importance of
information in healthcare, healthcare informatics has
become a specialty.
• Healthcare informatics is a combination of
computer science, healthcare science,
information science and cognitive science.

What is healthcare informatics?

• Computer science: development, configuration,
architecture of computer hardware and software.
• Healthcare science: body of knowledge on which
healthcare profession bases their practice. The sciences
of anatomy, physiology and knowledge specific to each
profession.
• Information science: also includes information
technology which involves the process of sending and
receiving information.
• Cognitive science: the process of human
thinking, understanding and remembering.

 “Nursing Informatics (NI) is the application of

computer science and information science to nursing. NI
promotes the generation, management and processing of
relevant data in order to use information and develop
knowledge that supports nursing in all practice domains”
(Hebert, 2000).

Nursing Informatics

 “Integrates nursing science, computer science,

and information science to manage and communicate
data, information, and knowledge in nursing practice”.

 Nursing informatics facilitates the integration of

data, information, and knowledge to support clients,
 nurses, and other providers in their decision-making in
all roles and settings."
(Staggers & Bagley-Thompson, 2002).
Why is it important?
• Nurses need to develop competencies in
informatics.
• Informatics enables nurses to use information
and communications technologies in the:
– collection of data,
– use of information
– generation of knowledge to support
nursing practice

Therefore, NI competencies need to include both

knowledge and skills required:
 To use information and communication
technologies to enter, retrieve and manipulate
data.
 To interpret and organize data into
information to affect nursing practice.
 To combine information to contribute to
knowledge development in nursing.

Using information
• Evidence-based practice leads to:
– Determining standards and guidelines
– Guide for decision-making process
– Determines best practice
• Nursing informatics can enable dissemination of
new knowledge.
– Practitioners update themselves of new
developments through journals, conferences, and
continuing education sessions.
– The information is varied and copious.
– There is a need to find the relevant evidence
in a timely way.
Literature databases
• Provide access to relevant literature and are an
important research source.
• Usually cover a specific list of periodicals or other
publications that give the database defined boundaries.
• Usually specific to one field such as healthcare,
social sciences, education.
• The database may be limited to research articles
or may include newspaper clippings, magazine articles.

Literature databases
• A database provides a controlled, specific and
systematic way of finding relevant information on a
specific topic.
• Each entry in a database usually contains an
article citation, subject heading and a text summary
known as the abstract.
• It may include the name of the author(s) and the
full text of the article.

Obstacles to using information

• There is a need to further emphasize on the
importance of evidence-based practice.
• There is a need for convenient access to literature
resources.
• Education to use technology to access and
retrieve information relevant to clinical practice.
• There is a need to instill a information-seeking
modeling behavior.

Transformation of Healthcare: The Evolution of

Nursing Informatics
Objectives…
• Relate the role of the Informatics Nurse as it was
defined by Scope and Standard of Practice in the early
1990’s, to the evolving work of clinical automation
within hospitals.
 • Define the industry term “Clinical Transformation”
as it related to the implementation of an Electronic
Medical Record; by using examples from hospital and
health care organizations
• Describe the most recent evolution of Nursing
Informatics which is as a Core Competency for all Nurse
Executives and Chief Nursing Officers.

Do you remember the change from….

• Light Pen  Mouse

• DOS  Windows 3.1

• Computer Nurse  Informatics Nurse

History
• 1965 – Invention of the Mouse
The Past 15 years
• 1992 – First Scope of Practice for Informatics Nurse
• 1992 – Informatics Nursing recognized as a specialty by
ANA
• 1994 – first Informatics Nursing Certification exam
offered by ANCC
• 2007 – 3rd Version of Informatics Nursing Scope of
Practice
• 2007: AONE identifies Information Management and
Technology as a core competency for Nurse Executives

1978
• Epson's first dot matrix printer, TX-80 (80 from the
number of columns it printed per line), was introduced in
1978.

• "640K ought to be enough for anybody.“

Bill Gates, 1981

1985
 • 1 Mb of RAM becomes a standard in 286
computers.
• The new 286 CPU is able to address 16 Mb of
memory and has a clock speed that varies between 8 to
20 MHz. The processor supports 1024 colors but only 16
to 32 colors (depending on the amount of video
memory) can be displayed at once.
• Tetris is written by Russian Alexey Pazhitnov.
1985: Windows 1.0 released
1985
• Microsoft unveils plans for a new spreadsheet
program designed for the Apple Macintosh. The new
product, called Excel, gives the Apple a badly needed
business application
1986
• Integrated software (Word processor,
Spreadsheet, Database, Graphics, Communication) are
now common amongst advanced users.
1988 – Internet WORM
• A malicious program called a worm affects some
six thousand computers, Computer Emergency
Response Team (CERT) is formed.
• At the event of the birth of the computer virus
there are several opinions:
• The virus is as ' Coocoo' and compared the
programmers who believe in the virus with "the people
who leave small milk bowls outside to feed the
gnomos."
Byron C. Howes, of the University of North Carolina

1988 – Internet WORM

"I believe that all this is a joke. Like the prediction of an
enormous earthquake for the 8th of May of 1988 by
Nostradamus. That did not happen, and this either."
– -- Barry B. Cooper
• "This is an urban myth. It is like the history of the
crocodiles in the sewers of New York. All world knows of
them, but nobody has seen them."
– -- Peter Norton
 • "The problem of the virus is fleeting and will only
last for a few years“
– -- John McAfee

1989
• Window 3.0 has become a GUI (Graphical User
Interface) which adapts automatically to the built-in
CPU and memory (RAM).

1991
• W.H. Bill Inmon publishes: "Building the Data
Warehouse".
– Data warehousing takes data from
transaction systems (e.g. hotel databases) and
stores it in a new environment for strategic (and
some tactical) analysis.
– This alleviates the transaction systems of
major queries (if not: cause of a considerable
slowing down of operations eds.), allowing them
do what they were designed to do and the data
warehouse to do what it was designed to do.
– Organizations will want to analyze their data
to gain knowledge on how to provide value to their
internal and external customers.
1992 – March
• Microsoft ships Windows 3.1, and shortly after
3.11 (workgroups) which will become the most popular
version of Windows until the release of Windows 95.
• Windows 3.1 is viewed as a major improvement
over earlier versions of Windows, originally released in
1985.

1993: PDAs hit the Market

• A new trend in Personal Computing is to market
PDA appliances: the so-called Personal Digital
Assistant. Because of the size of these computers this
family is called: Palmtop, or handheld

1994
 • Microsoft releases Windows 95 in August.
• More than 20,000 retail stores offer copies for
sale. Microsoft prepares for support calls, with 1600
people staffing tech support lines.

1995
• MS-DOS 3.1 supports a network environment.

1996
• Corel (founded 1985) buys WordPerfect, Quattro
Pro, and the PerfectOffice application suite from Novell.
• Microsoft unveils Windows CE operating system for
hand-held PCs.

1997
• March, the Palm Pilot is available for consumers.

• Google, founded by Larry Page and Sergey Brin in

1998, enters the search engine arena and opens
business.
• “Googol" is the mathematical term for a 1 followed
by 100 zeros:

IN –vs- INS
• IN – Informatics Nurse:
– RN who works in the area of informatics
– This RN is not formally prepared in
informatics but has an interest and/or experience
working in the area.
• INS – Informatics Nurse Specialist/Nurse
Informaticists
– RN with advanced, graduate education in
nursing informatics or information management
• Language is consistent with that used to describe
clinical nurse specialists within the ANA.

Definition of 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.
• NI supports patients, nurses, and other providers
in their decision-making in all roles and settings.
• This support is accomplished through he use of the
information structures, information processes, and
information technology.

• D-I-K-W Continuum
D-I-K-W Continuum

Work of the Informatics Nurse Phase 1

• Began as the “computer nurse”
• Provided the clinical expertise for content to be
built into the system
• – more data and content driven.
• Basis skill set: could use computers and knew
clinical practice
• Knew how to use Email, WordPerfect, Work,
GroupWise, etc
• Could teach other nurses how to login to computer
and use a light pen/mouse.
Phase 2 Evolution: Data  Information
• As clinical automation penetrated health care,
realized that nurses needed to be part of the IT team.
• Nurses were hired into IT departments for constant
clinical input and oversight into system design
• Began to realize value of automated data
collection and how it could be used for reports –
INFORMATION

Phase 3: Information  Knowledge

• Continued value of discrete data capture in a
relational database
• Provided an easier method of extracting data for
information and reports
• Began to see the impact of Patient Care Process
and Clinical workflow as part of design
• Ultimate impact on efficiency and patient care

Phase 4: Knowledge  Wisdom

• Just beginning to embark on this phase within
HealthCare
• Some organizations have achieved this with
Decision Support Rules
• Data Mining (not just data query) of clinical
databases